Cultural health beliefs in a rural family practice: a Malaysian perspective

BACKGROUND: Understanding the sociocultural dimension of a patient's health beliefs is critical to a successful clinical encounter. Malaysia with its multi-ethnic population of Malay, Chinese and Indian still uses many forms of traditional health care in spite of a remarkably modern rural health service. OBJECTIVE: The objective of this paper is discuss traditional health care in the context of some of the cultural aspects of health beliefs, perceptions and practices in the different ethnic groups of the author's rural family practices. This helps to promote communication and cooperation between doctors and patients, improves clinical diagnosis and management, avoids cultural blind spots and unnecessary medical testing and leads to better adherence to treatment by patients. DISCUSSION: Includes traditional practices of 'hot and cold', notions of Yin-Yang and Ayurveda, cultural healing, alternative medicine, cultural perception of body structures and cultural practices in the context of women's health. Modern and traditional medical systems are potentially complementary rather than antagonistic. Ethnic and cultural considerations can be integrated further into the modern health delivery system to improve care and health outcomes.     

Integrating homeopathy and biomedicine: medical practice and knowledge production among German homeopathic physicians

Abstract The purpose of this study is to assess the ways in which homeopathic physicians deal with the conceptual tensions between homeopathy and biomedicine. The data‐collection included twenty semi‐structured interviews which were conducted with homeopathic physicians in Berlin. Three distinct patterns of homeopathic practice emerged from the data: a) segregating the patients into categories of homeopathic and biomedical patients; b) complementing a predominantly homeopathic practice with a few biomedical strategies for diagnostics; c) focusing on homeopathy and condemning biomedicine with the exception of emergency medicine and surgery. On the level of medical knowledge the physicians’ perspectives on the efficacy of homeopathy and some of its controversial concepts (opposition to vaccinations, miasm, vital force) are examined. It also becomes evident that German homeopathic physicians do not sacrifice central aspects of homeopathic concepts in order to gain legitimacy. Finally, it is argued that complementary medicine and alternative medicine are both rather unfortunate terms for studying homeopathy in micro‐sociological settings. Heterodox medicine is favoured.     

Holistic sickening: breast cancer and the discursive worlds of complementary and alternative practitioners

This paper introduces the concept of holistic sickening to the sociological literature on illness narratives. Drawing on interviews with 46 Boston-area complementary and alternative medicine (CAM) practitioners who treat breast cancer patients, we found that the CAM practitioners redefine their patients' breast cancer diagnoses in ways that expand and transform their illness, sometimes into a lifetime journey. The practitioners, for the most part, espouse broad and complex etiological frameworks that help give meaning to the woman's cancer. They tend to speak about breast cancer as a symptom of problems that exceed the cancer itself, at times suggesting that women are responsible, to some extent, for their own breast cancer. The practitioners articulate holistic philosophies that describe healing as open-ended with correspondingly expansive definitions of what it means to be healed, rarely articulating clear ways of conceptualising or measuring the efficacy of their own treatments. Their use of expansive and detailed etiological frameworks alongside vague and unelaborated efficacy frameworks make up the holistic sickening phenomenon described in this paper.     

'The illness is part of the person': discourses of blame, individual responsibility and individuation at a centre for spiritual healing in the North of England

While the growth in usage and practice of varying forms of complementary and alternative medicine (CAM) continues apace, social science has increasingly turned to CAM's often individualistic approach to health and illness. CAM has been perceived as both partly a cause of and a response to the well-documented ideology in modern healthcare of 'individual responsibility for health'. This occasionally manifests in a 'victim-blaming' ideology amongst both orthodox and CAM practitioners alike. These issues emerged as key themes in an ethnographic study of a Centre for spiritual healing in the North of England. By drawing upon a range of qualitative data gained through the researcher's participation at this healing centre, I argue that the healers' focus on individual responsibility for health is not so much a part of the current socio-political health ideology of 'victim-blaming', rather, it is illustrative of an important contemporary social phenomenon: the movement towards the subjectification and personalisation of public life.     

Knowledge, attitude and practice of complementary and alternative medicines for diabetes

OBJECTIVES: To investigate the current status of knowledge, attitude and practice of patients with diabetes relating to complementary and alternative medicine (CAM) in an Indian community, and to determine perceptions about the use of CAM and factors influencing knowledge and usage. SETTING: Endocrine clinic of Swaroop Rani, Nehru Hospital, Allahabad, India. STUDY DESIGN: Hospital-based cross-sectional study. PARTICIPANTS: Patients with diabetes attending the clinic for the first time. SAMPLE SIZE: A sample of 493 study participants selected by systematic sampling from a population of 6094 patients with diabetes. STUDY VARIABLES: Age, socio-economic status, educational status, religion, family history of disease, knowledge and practice of CAM, reasons for using CAM, method of use and perceived relief. STATISTICAL ANALYSIS: Normal test of proportions, chi(2) test, Kolomogorov-Smirnov test. RESULTS: Awareness of CAM among patients was high (71%). High prevalence of CAM use was found (67.7%) among all participants, and 95% among participants aware of CAM, mostly using 'naturopathy' (97.3% among users). No significant gap (P>0.10) between knowledge and practice in different categories was observed. Desire for quick and additional relief was the most common perceived reason for using CAM (86.8%). Higher levels of education and socio-economic status were significant positive correlates of CAM use. Knowledge of CAM was gained mainly from friends and neighbours. About 30% of users adopted CAM without allopathic treatment earlier. Only 42.2% of users perceived some relief by using CAM. Lowering of blood sugar was the most common perceived relief. CAM, along with diet control and exercise, resulted in maximum degree of satisfaction (61.9%) experienced by users. No relief was experienced by 53.6% of users of 'naturopathy'. CONCLUSIONS AND SUGGESTIONS: Use of CAM in diabetes is highly prevalent despite high levels of disappointment after its use. In this study, we suggest the need for health education relating to CAM and self-care in diabetes. Use of CAM should be explored with patients before clinical decisions are made.     

The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Four ethnographic case studies

The apolitical legitimacy of “evidence-based medicine” offers a practical means for ethnography and critical social-science-and-humanities-of-health theory to transfer survival resources to structurally vulnerable populations and to engage policy and services audiences with urgent political problems imposed on the urban poor in the United States that harm health: most notably, homelessness, hyperincarceration, social service cut-backs and the War on Drugs. We present four examples of collaborations between ethnography and clinical research projects that demonstrate the potentials and limits of promoting institutional reform, political debate and action through distinct strategies of cross-methodological dialog with epidemiological and clinical services research. Ethnographic methods alone, however, are simply a technocratic add-on. They must be informed by critical theory to contribute effectively and transformatively to applied health initiatives. Ironically, technocratic, neoliberal logics of cost-effectiveness can sometimes render radical service and policy reform initiatives institutionally credible, fundable and capable of generating wider political support, even though the rhetoric of economic efficacy is a double-edged sword. To extend the impact of ethnography and interdisciplinary theories of political-economic, cultural and disciplinary power relations into applied clinical and public health research, anthropologists – and their fellow travelers – have to be able to strategically, but respectfully learn to see through the positivist logics of clinical services research as well as epidemiological epistemology in order to help clinicians achieve – and extend – their applied priorities. In retrospect, these four very differently-structured collaborations suggest the potential for "good-enough” humble scientific and political strategies to work for, and with, structurally vulnerable populations in a punitive neoliberal era of rising social inequality, cutbacks of survival services, and hyperincarceration of the poor.     

Medical modernization, scientific research fields and the epistemic politics of health social movements

As health social movements (HSMs) and complementary and alternative medicine (CAM) professions increasingly mount challenges to the authority of medical knowledge, the tendency for the medical research community and medical profession to dismiss such epistemic challenges (termed here 'paternalistic progressivism') and the corresponding response from challengers that medicine is corrupt (termed here 'medical devolution') has given way to a process of incorporation of challenges under the rubric of evidence-based research (termed here the epistemic dimension of 'medical modernization'). Under conditions of medical modernization the distinction between lay/alternative knowledge and scientific knowledge, upon which the epistemic authority of medicine rested, is submerged in a more complex field of competing scientific networks and research programmes. Furthermore, the older policy of transmitting science to an illiterate public and suppressing dissidents is replaced by an emerging system of the 'public shaping of science', in which there is both greater agency of social movement/lay advocacy organisations and greater recognition of the legitimacy of that agency. Indirect and direct forms of the public shaping of science are discussed, as are emergent problems of co-optation. Understanding the emergent epistemic politics that are characterised here as medical modernization requires an ongoing theoretical integration of medical sociology and the sociology of science.     

Ethnographic reflections on communicative inequities,global health relationships,and two decades of HIV in the Bolivian press

ABSTRACT

This article draws on two decades of media representations of HIV, ethnographic research among people living with HIV, and an analysis of global health programms in Bolivia. In doing so, we chart the evolution of media representations in relation to the global health context and the implications of these representations for people living with HIV. Our overarching argument is that media discourses on HIV in Bolivia have consistently been produced in a context of an unequal balance of power between global health bodies and local actors. This power imbalance has enabled global health bodies operating in Bolivia to maintain authority in producing local narratives about HIV, even when these narratives do not adequately capture the particularities of the Bolivian context. The mismatch between dominant global health narratives that have infiltrated the Bolivian media and ethnographic realities can have deleterious effects on people living with HIV. We draw on the concept communicative inequities to highlight how global health bodies shape dominant media narratives and the ways these dominant narratives at times misrepresent ethnographic realities. Thus, a media analysis informed by ethnographic experiences offers a unique lens for interrogating the implications of global health interventions.