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critical medical anthropology

14 March, 2007

The latest contribution in the German anthropological journal  by Anke S. Weber deals with cultural difference in medicine. In recent years it has become common sense,that culture – in the words of Harvard medical anthropologist Arthur Kleinman  – “influences the experience of symptoms, the idioms used to report them, decisions about treatment, doctor-patient interactions, the likelihood of outcomes such as suicide, and the practices of professionals”. A large body of practitioner manuals, bestsellers (foremost Anne Fadiman’s The spirit catches you and you fall down (1997)) and trainings sets out to foster “cultural competence” in Public Health institutions. They point to conflicting medical worldviews which very often lead to misunderstandings and to minority patients being accused of “non-compliance”.  

Author Anke Weber gives just such an example when she points out that patients in many Latin-American societies distinguish between “hot” and “cold” illnesses, food and medicines. When a Puerto Rican with an illness, self-diagnosed as belonging of the “cold” variety, meets an American medical doctor who prescribes food or medicine which is also classified as “cold”, the patient is unlikely to accept it, as she expects a “hot” medicine to counterbalance her illness. Her refusal to follow the expert’s regime is likely to lead to frustration on both sides. 

Some illnesses obviously originate in specific cultural practices. Weber points to Kuru (also known as “laughing disease”), a deadly illness among the Fore in Papua New Guinea which came to the attention of doctors in the mid 20. century and which was caused by the ritual incorporation of deceased members (i.e. Fore ate certain parts of their dead). 

But quite often culturally sensitive approaches overemphasize the role culture plays in the shocking health gap between populations (for example, mortality due to tuberculosis among American Indians is 500 per cent higher than the United States average). As Anke S. Weber, following M.D. and anthropologist Paul Farmer (Pathologies of Power: Health, Human Rights and the New War on the Poor, 2005, Berkeley: University of California Press) points out, “cultural difference is often not the right diagnosis” for high infection rates and epidemics, but global economic and political imbalances. In his books Farmer describes a myriad of instances, where poor people were inadequately treated by the public health system, yet stigmatized as being “non-compliant” because of supposedly culturally divergent values and worldviews.

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