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What does it mean to be a good doctor in America today? How do such challenges as new biotechnologies, the threat of malpractice suits, and proposed health-care reform affect physicians' ability to provide quality care? These and many other questions are examined in this book, which fully explores the meaning and politics of competence in modern American medicine. Based on ethnographic studies of three distinct medical communities—physicians in rural California, academics and students involved in Harvard Medical School's innovative “New Pathway” curriculum, and oncologists working on breast cancer treatment—it demonstrates the centrality of the issue of competence throughout the medical world. Competence, the book shows, provides the framework for discussing the power struggles between rural general practitioners and specialists, organizational changes in medical education, and the clinical narratives of high-technology oncologists. In their own words, practitioners, students, and academics describe what competence means to them and reveal their frustration with medical-legal institutions, malpractice, and the limitations of peer review and medical training.

What are the moral challenges and consequences of animal research in academic laboratory settings? Animal Ethos considers how the inescapable needs of lab research necessitate interspecies encounters that, in turn, engender unexpected moral responses among a range of associated personnel. Whereas much has been written about the codified, bioethical rules and regulations that inform proper lab behavior and decorum, Animal Ethos, as an in-depth, ethnographic project, probes the equally rich—yet poorly understood—realm of ordinary or everyday morality, where serendipitous, creative, and unorthodox thought and action evidence concerted efforts to transform animal laboratories into moral, scientific worlds. The work is grounded in efforts to integrate theory within medical anthropology (and, more particularly, on suffering and moral worth), animal studies, and science and technology studies (STS). Contrary to established scholarship that focuses exclusively on single professions (such as the researcher or technician), Animal Ethos tracks across the spectrum of the lab labor hierarchy by considering the experiences of researchers, animal technicians, and lab veterinarians. In turn, it offers comparative insights on animal activists. When taken together, this range of parties illuminates the moral complexities of experimental lab research. The affective qualities of interspecies intimacy, animal death, and species preference are of special analytical concern, as reflected in the themes of intimacy, sacrifice, and exceptionalism that anchor this work.

In April of 1979 the city of Sverdlovsk in Russia's Ural Mountains was struck by a frightening anthrax epidemic. Official Soviet documents reported sixty-four human deaths resulting from the ingestion of tainted meat sold on the black market, but U.S. intelligence sources implied a different story, and the lack of documentation left unresolved questions. In her investigation of the incident, the author of this book unravels the mystery of what really happened during that tragic event in Sverdlovsk. Anthrax is a virulent and deadly bacteria whose spores can remain in soil for as long as seventy years, killing grazing animals and putting humans in jeopardy of eating infected meat. Contemporary concern is more centered on anthrax as an airborne biological weapon whose inhaled spores can result in ninety percent mortality for those infected. As part of a team of doctors and researchers, the author traveled to Russia in 1992 to determine the cause and extent of the epidemic, and her narrative transforms a case of epidemiological investigation into a politically charged mystery. She creates a sense of immediacy and drama with her insider's account of the team's investigative work—the analysis of pathology photos and slides, meetings with political and public health officials, the retrieval of essential medical data—and reveals the subjective side of science as she conducts interviews with afflicted families, visits sites, and interacts with those suspected of clouding the truth.

As the great American work-benefit experiment erodes, companies are increasingly asking people to take responsibility for managing their own health. There is no question that work and health are intertwined. But what effect does an intensely productive, globally connected, high-tech work environment have on a population largely entrusted with overseeing their own health needs? In California's Silicon Valley, a distinctive and medically diverse health culture has emerged. This book explores this health culture, detailing the biomedical, countercultural, and immigrant-based beliefs and practices that shape ideas about working, care-giving, and what it means to be healthy. The book shows that the integration of workplace productivity with personal health has created national patterns of discrimination against those not in the productive mainstream, including the unemployed, retired, and chronically ill. But new ideas about work and health can clarify core American values, highlight emerging global trends, and provide a vital assessment of the evolution of our shared pursuit of well-being. While policymakers debate the possibilities for health insurance reform and government provisions, they overlook this lived experience. The shift of responsibility from organization to individual, a key feature of late capitalism, has significant implications. Individuals are supposed to be unfettered innovators at work, while managing the mundane details of their pensions and health plans. Workers are simultaneously responsible for work projects and for themselves as projects. Here, where work and health collide, in the front offices and on the warehouse floors, is one of the key ways in which people, in the guise of workers, feel capitalism.

Why do so many American women allow themselves to become enmeshed in the standardized routines of technocratic childbirth—routines that can be insensitive, unnecessary, and even unhealthy? This book is a second edition of the text. The new preface in this edition makes it clear that the issues surrounding childbirth remain as controversial as ever. The book analyzes the technocratic method of birth, its cultural variations and alternatives, and obstetric training and women's experiences in Western culture. It covers ritual and how it is used in obstetrics, and compares the technocratic and holistic paradigms of childbirth. The book demonstrates the linkages between American core values concerning technology and expertise, and prevailing obstetrical practices.

This book takes us around the world in search of birth models that work in order to improve the standard of care for mothers and families everywhere. The contributors describe examples of maternity services from both developing countries and wealthy industrialized societies that apply the latest scientific evidence to support and facilitate normal physiological birth; deal appropriately with complications; and generate excellent birth outcomes—including psychological satisfaction for the mother. The book concludes with a description of the ideology that underlies all these working models, known internationally as the midwifery model of care.

This ethnography probes the intimate experience of gestational surrogate motherhood. The book shows how surrogates and intended mothers carefully negotiate their cooperative endeavor. Drawing on anthropological fieldwork among Jewish Israeli women, interspersed with cross-cultural perspectives of surrogacy in the global context, the book traces the processes by which surrogates relinquish any maternal claim to the baby even as intended mothers accomplish a complicated transition to motherhood. The book's analysis reveals that as surrogates psychologically and emotionally disengage from the fetus they carry, they develop a profound and lasting bond with the intended mother.

This book is the first systematic description of how American doctors think about racial differences and how this kind of thinking affects the treatment of their black patients. The standard studies of medical racism examine past medical abuses of black people and do not address the racially motivated thinking and behaviors of physicians practicing medicine today. This book penetrates the physician's private sphere where racial fantasies and misinformation distort diagnoses and treatments. Doctors have always absorbed the racial stereotypes and folkloric beliefs about racial differences that permeate the general population. Within the world of medicine this racial folklore has infiltrated all of the medical sub-disciplines, from cardiology to gynecology to psychiatry. Doctors have thus imposed white or black racial identities upon every organ system of the human body, along with racial interpretations of black children, the black elderly, the black athlete, black musicality, black pain thresholds, and other aspects of black minds and bodies. The American medical establishment does not readily absorb either historical or current information about medical racism. For this reason, racial enlightenment will not reach medical schools until the current race-aversive curricula include new historical and sociological perspectives.

This book chronicles the story of disability's emergence as an area of significant sociopolitical activity in contemporary China. Attentive to how bodies are embedded in discourse, history, and personal exigency, it details ways that disability became a fount for the production of institutions and identities across the Chinese landscape during the final decades of the twentieth century. The author looks closely at the creation of the China Disabled Persons' Federation and the lives of numerous individuals, among them Deng Pufang, son of China's Communist leader Deng Xiaoping.

This book explores the unintended consequences of compassion in the world of immigration politics. It focuses on France and its humanitarian immigration practices to argue that a politics based on care and protection can lead the state to view issues of immigration and asylum through a medical lens. Examining two “regimes of care”—humanitarianism and the movement to stop violence against women—it asks what it means to permit the sick and sexually violated to cross borders while the impoverished cannot? The book demonstrates how in an inhospitable immigration climate, unusual pathologies can become the means to residency papers, turning conditions such as HIV, cancer, and select experiences of sexual violence into distinct advantages for would-be migrants. It also indicts the inequalities forged by global capitalism that drive people to migrate, and the state practices which criminalize the majority of undocumented migrants at the expense of care for the exceptional few.

This book raises issues for public policy in the medical field. It is based on data accumulated during long-term research on Navajo Indian epidemiology. Through examination of this medical microcosm, it can be seen that the role of Western medicine presently needs review, clarification, and perhaps redefinition in today's complex social milieu. This book sees a future challenge to medicine in dealing with the degenerative and man-made diseases, as contrasted with its past successes in controlling infectious diseases. The wealth of information and its in-depth analysis make this book a valuable contribution to the growing literature on cross-cultural healthcare.

This book is a candid account of a trauma surgical team based, for a tour of duty, at a field hospital in Helmand, Afghanistan. It tells of the highs and lows of surgical life in hard-hitting detail, bringing to life a morally ambiguous world in which good people face impossible choices and in which routines designed to normalize experience have the unintended effect of highlighting war's absurdity. With stories that are at once comical and tragic, the book captures the surreal experience of being a doctor at war. It lifts the cover on a world rarely ever seen, let alone written about, and provides a poignant counterpoint to the archetypical, adrenaline-packed, macho tale of what it is like to go to war. Here the crude and visceral coexist with the tender and affectionate. The book tells of well-meaning soldiers at hospital reception, there to deliver a pair of legs in the belief that these can be reattached to their comrade, now in mid-surgery; of midsummer Christmas parties and pancake breakfasts and late-night sauna sessions; of interpersonal rivalries and banter; of caring too little or too much; of tenderness and compassion fatigue; of hell and redemption; of heroism and of playing God. This is one of the first books ever to bring to life the experience of the doctors and surgical teams tasked with mending what war destroys.

The production of pharmaceuticals is among the most profitable industries on the planet. Drug companies produce chemical substances that can save, extend, or substantially improve the quality of human life. However, even as the companies present themselves publicly as health and environmental stewards, their factories are a significant source of air and water pollution—toxic to people and the environment. In Puerto Rico, the pharmaceutical industry is the backbone of the island's economy: in one small town alone, there are over a dozen drug factories representing five multinationals, the highest concentration per capita of such factories in the world. It is a place where the enforcement of environmental regulations and the public trust they ensure are often violated in the name of economic development. This book unites the concerns of critical medical anthropology with those of political ecology, investigating the multi-faceted role of pharmaceutical corporations as polluters, economic providers, and social actors. Rather than simply demonizing the drug companies, the book explores the dynamics involved in their interactions with the local community and discusses the strategies used by both individuals and community groups to deal with the consequences of pollution. It puts a human face on a growing set of problems for communities around the world, and encourages readers to think critically about the role of corporations in everyday life, health, and culture.

A Hindu monk in Calcutta refuses to take his psychotropic medications. His psychiatrist explains that just as his body needs food, the drugs are nutrition for his starved mind. Does it matter how—or whether—patients understand their prescribed drugs. Millions of people in India are routinely prescribed mood medications. Pharmaceutical companies give doctors strong incentives to write as many prescriptions as possible, with as little awkward questioning from patients as possible. Without a sustained public debate on psychopharmaceuticals in India, patients remain puzzled by the notion that drugs can cure disturbances of the mind. While biomedical psychopharmaceuticals are perceived with great suspicion, many non-biomedical treatments are embraced. This book illuminates how biomedical, Ayurvedic, and homeopathic treatments are used in India, and argues that pharmaceutical pluralism changes popular ideas of what drugs do. Based on several years of research on pharmaceutical markets, the book shows how doctors employ a wide range of strategies to make patients take the remedies prescribed. Yet while metaphors such as “mind food” may succeed in getting patients to accept the prescriptions, they also obscure a critical awareness of drug effects.

This book brings together the work of writers from a range of disciplines and cultural traditions to explore the social and political dimensions of sexuality and sexual experience. The chapters reconfigure existing notions of gender and sexuality, linking them to deeper understandings of power, resistance, and emancipation around the globe. They map areas that are currently at the cutting edge of social science writing on sexuality, as well as the complex interface between theory and practice. The book highlights the extent to which populations and communities that once were the object of scientific scrutiny have increasingly demanded the right to speak on their own behalf, as subjects of their own sexualities and agents of their own sexual histories.

This book explicitly compares Japanese and North American medical and political accounts of female middle age to challenge Western assumptions about menopause. It uses ethnography, interviews, statistics, historical and popular culture materials, and medical publications to produce a detailed account of Japanese women's lives. The result offers irrefutable evidence that the experience and meanings—even the endocrinological changes—associated with female midlife are far from universal. Rather, the book argues, they are the product of an ongoing dialectic between culture and local biologies. Japanese focus on middle-aged women as family members, and particularly as caretakers of elderly relatives. They attach relatively little importance to the end of menstruation, seeing it as a natural part of the aging process and not a disease-like state heralding physical decline and emotional instability. Even the symptoms of midlife are different: Japanese women report few hot flashes, for example, but complain frequently of stiff shoulders. The study systematically undoes the many preconceptions about aging women in two distinct cultural settings. Because it is rooted in the everyday lives of Japanese women, it also provides an entrée to Japanese society as a whole. Aging and menopause are subjects that have been closeted behind our myths, fears, and misconceptions. This cross-cultural perspective gives us a new lens through which to examine our assumptions.

Millions of North Americans are priced out of North America’s expensive reproductive medicine industry. Ultimately, women learn about the possibility of doing IVF abroad, and this book reveals the layers of desire that motivate them to travel halfway across the world in their quest for parenthood. A global marketing chain has brilliantly packaged “fertility holidays”: a European vacation alongside a healthcare system where doctors really care and want you to have your beautiful white baby. Brokers promise couples that they will experience a more relaxing IVF cycle while also assuring them Czech doctors offer better care along with the highest standards of technology. Ultimately, my book reveals the alienation of poor patients in the U.S., their active response as they assume the role of global consumers of health care. Fertility clinics around the globe have begun to develop marketing schemes that cater to this North American desire for care, since it is an obvious deficiency in our healthcare system.

This book brings together the work of writers from a range of disciplines and cultural traditions to explore the social and political dimensions of sexuality and sexual experience. The chapters reconfigure existing notions of gender and sexuality, linking them to deeper understandings of power, resistance, and emancipation around the globe. They map areas that are currently at the cutting edge of social science writing on sexuality, as well as the complex interface between theory and practice. The book highlights the extent to which populations and communities that once were the object of scientific scrutiny have increasingly demanded the right to speak on their own behalf, as subjects of their own sexualities and agents of their own sexual histories.

Tibetan medicine has come to represent multiple and sometimes conflicting agendas. On the one hand, it must retain a sense of cultural authenticity and a connection to Tibetan Buddhism; on the other hand, it must be proven efficacious and safe according to biomedical standards, often through clinical research. Recently, Tibetan medicine has found a place within the multi-billion-dollar market for complementary, traditional, and herbal medicines as people around the world seek alternative paths to wellness. Healing Elements explores Tibetan medicine within diverse settings, from rural schools and clinics in the Nepal Himalaya to high-tech factories and state-supported colleges in the People’s Republic of China. This multi-sited ethnography explores how Tibetan medicines circulate as commercial goods and gifts, as target therapies, and as panacea for biosocial ills. Through an exploration of efficacy—What does it mean to say that Tibetan medicine “works”?—this book illustrates a biopolitics of traditional medicine in the twenty-first century. Healing Elements examines the ways in which traditional medicine interacts with biomedicine: from patient-healer relationships and the cultural meanings ascribed to affliction to the wider circumstances in which practitioners are trained, healing occurs, and medicines are made, evaluated, and used. As such, it examines the meaningful, if contested, translations of science and healing that occur within and across distinct social ecologies.

This study examines the role of today's Russian Orthodox Church in the treatment of HIV/AIDS. Russia has one of the fastest-growing rates of HIV infection in the world—80 percent from intravenous drug use—and the Church remains its only resource for fighting these diseases. The book takes the reader into a Church-run treatment center where, along with self-transformational and religious approaches, it explores broader anthropological questions—of morality, ethics, what constitutes a “normal” life, and who defines it as such. The book argues that this rare Russian partnership between sacred and political power carries unintended consequences: even as the Church condemns the influence of globalization as the root of the problem it seeks to combat, its programs are cultivating citizen-subjects ready for self-governance and responsibility, and better attuned to a world the Church ultimately opposes.