Vritions in Medicl Power Over Time nd Cross-Ntionlly - Essay Example

Vritions in medicl power over time nd cross-ntionlly Vritions in the re of medicine hve been lwys considered to be n dvncement in the front of mediclprogress. Cross-ntionl nd time chnges in medicl power cuse sense of hope nd sometimes even urgency s they question of wht sickness might soon be cured nd whose lives might be sved. Tht medicine will continue to progress in these struggles is something in which people hve tremendous fith. The rguments in fvor of developing ny emerging medicl technology re therefore especilly powerful nd seductive. They re rrely denied. In fct, it is lmost heresy to try. In this essy I would like to identify these irresistible themes of progress nd vritions tht occurred over times nd countries. In order to structure the discussion I will specify the trends in modern medicine nd emphsize chnges tht took plce recently. Verifictions in modern tretment Nowdys modern illlness occurs in confusing, trnsitionl lndscpe where doctors nd ptients incresingly see limittions in the biomedicl model. Ptients express this wreness very directly in huge out-of-pocket investment in so-clled nontrditionl or complementry therpies.( Eisenberg, 2003:247) Helth cre professionls express it through reserch into psychosocil vribles, qulity-of-life mesures, nd holistic therpies. Even insurnce providers express mixed fith in the biomedicl model through their new concern for outcomes tht focus on ptient stisfction. Modern pproches to tretment re concerns of psychologicl discipline. Not only from the view of biology is the illness regrded, but lso the importnce of personl pproch is tken into considertion. In the prctice of Germn medicine, the doctor, for exmple, must sk how fr norexi in young white middle-clss women depends on widespred culturl fers nd fntsies bout body weight. nother exmple is Frnce, where the tretment hs lso been the subject to verifictions. Here doctors re concerned how fr IDS depends not only on virus but lso on sexul prctices tht re lwys culturlly inflected. Modern pproch in medicl power suggests respectful pproch to the complictions rising t the crossrods of biology nd culture s deeply s it respects the complexities of cellulr processes. It enters the errtic lndscpe (resistnt to quntittive nlysis) where helth nd illness come in contct with culturl forces, from stress nd diet to environmentl toxins, s complex nd interdependent s the biophysicl forces tht converge in the growth of tumor. Double coding The double coding tht is chrcteristic of bioculturl model in tretment finds numerous exmples in the redirection of modern helth cre over the countries. Its preeminent expression lies in our new wreness of how humn interventions lter the course of environmentl illness.(Grrett, 2005: 18) It is reflected in the growing cross-culturl prctices described in ccounts such s The Sclpel nd the Silver Ber by Lori rviso lvord nd Elizbeth Cohen Vn Pelt, in which (s the dust jcket puts it) "the first Nvjo womn surgeon combines Western medicine nd trditionl heling."(lvord, Pelt, 2003). It shows up in the vst expenditures generted not only by new helth cre technologies but lso by prmedicl gends such s nti-tobcco cmpigns nd mlprctice suits. Double coding even ppers in the orgnized socil pressure tht surrounds specific illnesses, which often receive designted celebrity spokesperson, linking disese with the discourses of fund-rising nd of entertinment. Bioculturl double coding finlly tkes the innumerble shpes invented by medicl consumerism in which helth (or the ppernce of helth) is now prized commodity nd illness rises the suspicion of personl filure, s if people who fll ill hve shirked their responsibilities in the system designed to wrd off mldy with pproprite purchses of multivitmins, sun-block, nd cholesterol-lowering drugs. New understnding of chronic pin The trnsition to double-coded medicine finds powerful emblem in the new understnding of chronic pin. Reserch demonstrting psychologicl, socil, nd culturl components of the chronic pin process hs fundmentlly modified the biomedicl ccount of pin s mtter of nerves nd tissue dmge. The Interntionl ssocition for the Study of Pin (the min medico-scientific orgniztion worldwide) insists tht pin is not the trnsmission of noxious impulses: it is "lwys psychologicl" nd lwys "subjective stte." (Merskey, Bogduk, 2004:210) Your pin nd my pin, ssuming identicl forms nd degrees of tissue dmge, my differ significntly due to differences in our personl histories, feelings, memories, nd socil networks. Chronic pin, in short, is entngled in the dense field of interpersonl forces, from neighborhood phrmcies to medicl licensing bords, tht shpe how we ct, think, nd feel. One study mde in Cnd found tht the ptient's emotionl sttes nd the responses of significnt others ffected the chronic pin from condition so obviously orgnic s spinl cord injury, while nother study showed tht people who "hrdly ever" enjoyed their jobs were 2.5 times more likely to report bck pin in the workplce thn people who sid they "lmost lwys" enjoyed their jobs. (Summers, 2002:2) Cost-effectiveness Mny new medicl technologies re developed with the justifiction tht they will sve money in the long run. This my or my not be the cse, nd the economics of these mtters cn be extremely complicted. The generl irony of the cost-effectiveness rgument is tht becuse there will likely lwys be nother cuse of morbidity or mortlity following the one medicine hs prevented, there will lwys be new investment opportunity for medicine. In short, it will lwys be possible to spend more money to sve it. The rgument lso my hinge on the ssumption tht not to invest the money in the new life-sving technology will be to wste it somewhere else. Perhps the crudest expression of this cme from trnsplnt ustrlin surgeon: "Wht re innovtions if not cost-effective. . . . Innovtion is more cost-effective thn more bgs for colostomies or crutches." He lso dded tht if you do not wish to spend money on xenogrfts, consider your lest fvorite government progrm nd think of your money being spent there. On Empthy Empthy of lte hs blossomed into prominence in the discourse of tmodern medicine, lthough the chnge hs deep nd tngled roots. Medicl historin Ellen More writes tht "empthy" reentered medicine vi psychotherpy round the 1920s, fter feminized ssocitions of sentiment hd devlued its medicl predecessor, "sympthy." (More, 200:19) Empthy soon proved n importnt concept in the clinicl model known s "detched concern," where it indicted emotionl understnding of the ptient gered to more benevolent cre, but n understnding wholly comptible with the objective ttitudes held necessry for sound medicl judgment. Empthy hs no fixed mening or vlue in the history of medicine. It is contested term whose historicl complictions its opponents nd proponents silently sk us to forget. Communiction is vstly importnt in medicine, nd lmost ny step forwrd is positive. Still, tools re fmilir ffirmtion of medicl power. The trnsformtion of empthy into domesticted pltitude extends beyond medicine to the wider culture, in which emotion is simulted in thirty-minute pckets on TV. No doubt doctors, like mny of their ptients, find it hrd to recognize the truth of wht they feel when surrounded dily by polished simultions. On Heling Heling is not lwys the bnner of nostlgic or utopin vision of helth cre, but its invoction usully signls deep desire for vrition. In 1980 rthur Kleinmn drew ttention to wht he clled "the indequcy of our present understnding of the heling process." (Kleinmn, 1980:312) For Kleinmn, focus on heling s prctice employed in cultures round the world is wht "strips wy the illusion tht biomedicl reserch is the only scientific pproch to helth cre problems" (p. 312). Unfortuntely, the knowledge of the heling over the countries remins indequte, but one medicl specilty in which heling hs begun to trigger serious converstion is pllitive cre. In the end, modern er of medicine experiences number of vritions t therefore progresses in its development. It is n er of routine hip replcements, hert trnsplnts, nd hundred-yer birthdys, wht ctully constitutes the biologicl limits of being humn. Reserchers hve lernt to bnk sperm, implnt pcemkers, hrvest orgns, nd clone DN. few decdes hence will see the emergence of nnomedicine tht fills our bodies with invisible microchips progrmmed to seek nd destroy specific pthogens. Bibliogrphy: 1. D. M. Eisenberg et l., "Unconventionl Medicine in the United Sttes," NEJM 328 (2003): 246-52. 2. L. Grrett, The Coming Plgue: Newly Emerging Diseses in World out of Blnce (New York: Penguin Books, 2005), p. 18-25. 3. L.. lvord nd E.C. Vn Pelt, The Scpel nd the Silver Ber (New York: Bntn Books, 2003). 4. H. Merskey nd N. Bogduk, eds., Clssifiction of Chronic Pin: Descriptions of Chronic Pin Syndromes nd Definitions of Pin Terms, 2nd ed. (Settle: ISP Press, 2004), p. 210. 5. J. .D. Summers et l., "Psychosocil Fctors in Chronic Spinl Cord Injury Pin," Pin 47 (1991): 183-89; nd S.J. Bigos et l., " Prospective Study of Work Perceptions nd Psychosocil Fctors ffecting the Report of Bck Injury," Spine 16 (2002): 1-6. 6. E.S. More, "Empthy' Enters the Profession of Medicine," in The Empthetic Prctitioner: Empthy, Gender, nd Medicine, ed. E.S. More nd M.. Millign (New Brunswick, N.J.: Rutgers University Press, 2000), pp. 19-39. 7. Kleinmn, Ptients nd Helers in the Context of Culture: n Explortion of the Borderlnd between nthropology, Medicine, nd Psychitry (Berkeley: University of Cliforni Press, 1980), p. 312. 8. M. Lerner, "Heling," in B. Moyers, Heling nd the Mind (New York: Doubledy, 1993), pp. 324-27. Lerner, 1983 Mcrthur fellow, is described s ffilited with the Institute of Helth Policy Studies t the University of Cliforni Sn Frncisco School of Medicine. 9. J. Hillmn, "When You're Heled, Send Me Postcrd," in S. Gblik, Converstions before the End of Time (London: Thmes nd Hudson, 2002), pp. 176-201. 10. R.. Freits, Jr., Nnomedicine (ustin, Texs: Lndes Bioscience, 1999); nd B.C. Crndll, ed., Nnotechnology: Moleculr Specultions on Globl bundnce (Cmbridge, Mss.: MIT Press, 1996). Read More