Cultural Appropriation vs. Quackery

Christian Lander, a white American male, freely admits to his enjoyment of the very fads he identifies in his humorous and satirical blog “Stuff White People Like”. In posts #2 and #15, Lander highlights religions- mostly Eastern- to which Americans subscribe for the exoticism they offer, as well as the American appropriation of yoga, a meditative form of healing from India. These posts, albeit light-hearted, suggest that Americans collectively endorse certain activities or ideas and alter them so that they lose enough of their ethnicity to satisfy American tastes. His self-aware mockery of culturally sensitive themes contrasts to the articles this week that question the authenticity of both Ayurvedic and Tibetan medicine pitting them against the Western standard of biomedicine. 

Labels pervade American culture- especially when determining if an entity earns the title of legitimate (“legit” in colloquial American English) or fails to meet that esoteric standard, thus condemned to quackery. In Jean Langford’s article “Medical Mimesis”, she investigates the Ayurvedic medicine practice of Dr. Mistry, a self-proclaimed specialist in pulse reading, from her perspective as a medical anthropologist based here at University of Washington. Langford embarks on her mission to conduct ethnographic field work in India with a clear understanding of the criticism that Baudrillard and Taussig, well-published anthropologists, issue for those suspected of medical mimesis.

“…mimesis involved in any act of signification, suggest, on the contrary, that simulation is integral to medical practice, troubling the binary of truth and falsehood that is the foundation of scientific knowledge”, Langford reports of the analyses by Baudrillard and Taussig (Langford 24). While not entirely unbiased, she does attempt to thoroughly examine Dr. Mistry by exploring several perspectives of him and of his practice; in spite of his controversial approach, he still sees over 400 patients daily and employs a handful of assistants (Langford 28). She interviews a fellow practitioner, Dr. Upadhyay, who decries Dr. Mistry’s practice as“mimicry of both professional Ayurvedic doctors and bona fide folk practitioners” (Langford 35). In response, Dr. Mistry finds his critic’s practice too dependent on allopathic, or bio, medicine. This ironic string of judgements reflects the subjective standards that we are all guilty of applying to dissimilar practices or beliefs.

Ayurvedic pulse reading
Courtesy of Ayurveda Intro

An important aspect of the analysis on Dr. Mistry’s medical methods remains: his effectiveness in healing patients. He claims that psychological effects of illnesses produce more than half of the symptoms patients feel.  Langford allows, “Pulse reading sparks the faith that fires the healing process”, naming the faith that Dr. Mistry inspires as his treatment plan (Langford 40). The biomedicine on which Westerners rely even permeates the practices of Ayurvedic practitioners, as evidenced by Dr. Upadhyay’s strong objection to the lack of physiological knowledge Dr. Mistry displays (Langford 34).

Vincanne Adams’s “The Sacred in the Scientific” discusses the spiritual emphasis grounded in Tibetan medicine. In attempts to modernize, the Tibetan government insists that medicine turn to science instead of religion. Adams relates of Tibetan medicine, “Medical truth became visible as a set of relationships between mental perception, emotional responses, the five elements, and finally the physician’s own capacities for clear insight,” underscoring the mixture of old 12th century tradition and newly adopted concepts like the physician (Adams 560). However, the task of modernization proves difficult as spirituality and religion remain deeply ingrained and inseparable within Tibetan medicine.

Why do we need labels to decide which medical practice is legitimately Ayurvedic because it contains the perfect balance of Hindu and Western elements and which is “quackery”?  How can Tibetan medicine modernize to ease political tension but also retain its spiritual values so that it remains uniquely Tibetan instead of a Western progeny? Finally, why is it acceptable for Westerners to appropriate practices of other cultures until they resemble forms of quackery while we selectively judge dissimilar entities out of context and label them as fraudulent?

Martha Stewart and Trudie Styler (wife of Sting) on Martha Stewart Show
Courtesy of Chicago Now

Returning to the blog, post #15 reads, “Yoga is also an expensive activity. It gives white people the chance to showcase their $80 pants,” alluding to the yoga fashion industry that Americans inspired. Although this post makes several statements without supporting evidence like, “One can find more yoga studios in white neighbourhoods such as Kitsilano or Orange County than in Kolkata”, its purpose is to describe not only the extent of the fervor but also to highlight the entirely different interpretation of yoga in the states. In India yoga represents a meditative, spiritual practice that began in ancient civilization while in America, the stereotypes for yoga enthusiasts include affluent white women and celebrities. Can we deem American yoga as quackery?

I do believe American yoga appropriates from Indian culture but refrain from calling it quackery. As long as yoga enthusiasts here acknowledge they practice an interpretation and not mimicry, the highly negative connotation that quackery holds does not apply. This follows for Dr. Mistry and Dr. Upadhyay. They each practice different versions of Ayurvedic medicine and satisfy their respective patients. Neither practitioner deserves the title of quack.

Bibliography:
Adams, Vincanne. "The Sacred in the Scientific: Ambiguous Practices of Science in Tibetan Medicine." Cultural Anthropology 16.4 (2001): 542-75.

Lander, Christian. "Yoga." Web log post. Stuff White People Like. 22 Jan. 2008. Web.

Langford, Jean M. "Medical Mimesis: Healing Signs of a Cosmopolitan "Quack"" American Ethnologist 26.1 (1999): 24-46. Print.

Global Health and Human Experiments

Image from Doctors Without Borders

 Excerpt from "A Bitter Pill: Exporting Drug Trials to the Developing World"

By David Concar

"When a deadly epidemic of bacterial meningitis swept through northern Nigeria in 1996, Samaila Musa's parents did the obvious thing. They took their stricken 7-year-old to the infectious disease hospital in the nearby city of Kano.

Amidst an anguished dispute over what happened next, one thing is clear: The world's richest pharmaceutical company enrolled Samaila, and hundreds of infected children like him, as test subjects in a now-notorious drug trial.

A team from Pfizer Inc. had learned of the outbreak on the internet and flown to Kano armed with a promising new antibiotic called Trovan (trovafloxacin). With meningitis rare in the West, it was a golden opportunity to put the drug through its paces, compare it to a rival company's approved treatment, and gather the data needed for a license to market the potentially lucrative drug.

Trovan, alas, was no miracle cure. Several (the exact number is disputed) of the sick children given the experimental drug died. Many more suffered lasting injuries from their infections. Samaila, now a teenager, was struck deaf and dumb.

Pfizer says that Trovan worked better than any other treatment administered in Kano. But lawyers representing outraged Nigerian families dispute that view and claim that the trial violated international agreements, including the Nuremberg Code. These international guidelines were drawn up in 1949 to protect human subjects from the kind of appalling experiments Nazi doctors performed on concentration camp inmates.

"The Kano patients didn't know they were being enrolled into a for-profit study. It is absolutely abhorrent that you can use sick children as guinea pigs without informed consent," says Elaine Kusel, the legal partner handling the case at Milberg Weiss in New York.

Pfizer spokesperson Kate Robins disagrees. "The study was conducted in accordance with standard international legislation on clinical trials and the verbal consent of family members of all treated patients," she wrote in a statement sent to Amnesty International Magazine.

Whoever triumphs in the lawsuit, the Trovan affair is just one of several cases from the past decade that have begun to expose the secretive, ethically fraught nature of the pharmaceutical business and the globalization of human experimentation.

Shoe and clothing companies were among the first to seek out the cheap labor, tax breaks, and looser regulations of developing countries in the recent wave of globalization. Pharmaceutical companies discovered that they, too, could save money and time by moving the costliest part of their business — clinical trials — overseas.

It's easy to see why. While pharmaceutical companies face complex regulations and wary patients in the West, the developing world is filled with patients whose only hope of treatment is enrollment in a clinical trial. Add improving infrastructure to the mix and the attraction gets stronger. Chile, Argentina, and Thailand, while poor, have aspiring doctors, hospitals, and health ministers eager for the prestige, money, and access to medicines and equipment that accompany major drugs trials.

The pharmaceutical industry denies using the developing world as the medical equivalent of a sweatshop. "No matter where clinical trials are held, they're held to the same ethical standards," says Mark Grayson of Washington-based Pharmaceutical Research and Manufacturers of America.

Grayson points out that Western-sponsored clinical trials often spur access to better treatments and help countries develop medical expertise and understanding. "A medicine must at some point be tested where a disease exists, and this is why Pfizer sent its doctors to Nigeria," adds Pfizer's Kate Robins in her statement. It is "simply not the case" that the pharmaceutical industry is "conducting more and more trials in less developed countries to avoid regulations."

But that's not the perception of some experts and human rights activists in poorer countries. "The companies don't want to apply the U.S. regulations because they are too tight," says Miguel Kottow Lang, an ethicist at the University of Chile in Santiago. "So they come here and say 'We will use your regulations, or the regulations we are going to teach you.' " 

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The clinicians, public health advocates, and a myriad of groups in the healthcare industry who entangle themselves in the complex web of global health encounter ethical dilemmas when they commit to health promotion in the developing world. That being said, the image above from a press release on Doctors Without Borders’ website represents an illegal drug trial that occurred in Nigeria. The Amnesty International article “A Bitter Pill” explains that Pfizer, the most affluent pharmaceutical company worldwide, entered Nigeria in 1996 with a drug recently developed to cure bacterial meningitis, a deadly infectious disease. However, the drug remained untested and its side effects on humans unknown. Anxious to beat competing pharmaceutical companies with a rival drug, Pfizer neglected to include this caveat. A human rights catastrophe ensued as the untested drug led to physical deformity, loss of physiological functions, neurological defects, and even death. 

The moneymaking intentions of Pfizer in this example seem irrefutable but statistics cited in “A Bitter Pill” point to an increasing number of situations in which companies take advantage of vulnerable populations. The article cites a 2000 report from U.S. Health and Human Services Department's Inspector General's Office about experimentation in the third world, “From 1990 to 1999, the number of foreign clinical scientists seeking FDA approval to market new drugs increased six fold…which raised concerns about "aggressive recruiting" of human subjects”.

Vincanne Adams in “Against Global Health?” acknowledges this shortfall in the global health system when she alludes to varying perspectives of each actor involved. Adams investigates “how the commitment to health- the singular goal of global health programs- often becomes the means by which such programs authorize subtle shifts between epistemological frames”, a phenomenon evidenced by the drug trial in Nigeria (Adams 41). Under the pretext of providing health services and resources to developing regions, actors in global health can reach their objective- whether that is developing a cheaper alternative drug like Pfizer or truly attempting to address health issues relevant to the community of interest; historically, the latter paved the way for ethnocentrism in regards to non-Western beliefs about medicine and perhaps, even set the precedent for the structural violence that meningitis-afflicted Nigerians experienced.

From the epistemological frame of science, the interconnectedness of polities under global health permits scientists and researchers to uncover the hidden secrets of pathogens and to develop treatment plans. Vulnerable populations receive this scientific probing in the hopes of health betterment and increased resources while Western providers get insight into their beliefs and cultures that sharply contrast the scientific method and medical knowledge. “…Traditional beliefs were not merely non-scientific in the colonial medical mind-set; they seemed to be “nonsense” as empirical explanations of medical facts”, Adams relates from her study of the scientific perspective on global health (Adams 43).  

Are health care providers and scientists, specifically physicians, to be blamed for the disconnect between viewing the patient as a fellow human being versus a patient whose body, or machinery, needs repair? The vicious cycle of ethnocentrism and structural violence perpetuates when global health actors fail to consider not only the significance of cultural beliefs but also the interest of the individuals in the community. Focusing again on the physicians’ role, how does a perspective of the human body as a machine develop?

“Learning Medicine” by Byron and Mary-Jo Good provides ethnographies of a class of Harvard medical students. The authors follow them as they internally transform and their perspectives of “the dual discourse” and the body change (Good 91). In the initial interviews, first-year medical students express this discourse as the importance of being a competent health provider while leaving intact the humanistic demeanor that allows for empathy. A common critique, that Western physicians omit the “caring” component of healthcare, points back to the statistics listed earlier about increased medical experimentation in the developing world. If physicians forget the “language of relationships, of attitudes and emotions, and of innate qualities of persons” and reduce patients to a body in which scientific reactions merely occur, human beings may become commodities to entities like pharmaceutical companies (Good 93).

However, physicians do not collectively deserve the position of global health scapegoat. Products of a system that Western academicians designed, physicians labor for several years to essentially learn a new medical vocabulary “as large as most foreign languages” and then dissect, dissect, dissect (Good 97). After year two of medical school, Harvard students recalled that anatomy lab marked the beginning of an alternate reality when their perception of the body reconstructed to become “machinelike” and “a thing of compartments” (Good 96). This reduction of a human being to organs and appendages reminds me of the Nigerians who served as study subjects for the experimental drug.

Nigerians enrolled in Pfizer’s 1996 study experienced commodification in that they represented an abstract variable with no agency in an experiment that put their lives in danger. Global health interventions service many deprived populations but also open up the same communities to possible exploitation. While physicians and members of the healthcare field claim to promote global health, perspectives among them form along the way that can lead to structural violence and in effect, do more harm than good.

Birthing: Amniocentesis and Hard Decisions

Background: This video, extracted from YouTube, originally aired on Showtime's "This American Life" on Season 2 Episode 1. Chicago Public Radio sponsors this highly acclaimed weekly radio broadcast that gained enough popularity to prompt its adaptation to television. Anthropological in many ways, “This American Life” identifies both obscure and ordinary phenomenon in American culture and compiles social ethnographies through interviews, images, and music that almost invariably challenge stereotypes. 

The episode “Escape” features Mike Phillips, a 27-year-old young man with a genetic disorder called spinal muscular atrophy. In effect, he cannot move his limbs. The only movements his muscles allow includes a weak tapping of his thumb that transmits letters, and eventually words, onto a screen as well as the blinking of his eyes in response to questions. Ira Glass, the host of TAL, describes Mike’s life as “tenuous”, hanging by a thread. Each meal represents a struggle with feeding tubes and every time he attempts mobilization- to the car or just to go outside- he risks death.

Mike’s steadfast mother, Karen, never mentions an experience with amniocentesis or a conscious decision to conceive a child prenatally diagnosed with such a rare and severe genetic disorder. However, in our readings this week, we explored amniocentesis as it related to women interested in determining prenatally whether or not their children had genetic abnormalities. Rayna Rapp in “Accounting for Amniocentesis” seeks to portray the multiple meanings of amniocentesis through the lenses of both women and other figures, each with their own association to the scientific process. 

The genetic technicians Rapp follows in the New York lab view amniocentesis as research, a means to uncover obscure genetic conditions, as well as a scientific process that for the time being pays their bills. Amniocentesis reduced to a perfunctory task, a lab tech likens a fetus to a wimp by stating, “It’s got a wimpy Y and the bikini on the X is pretty gross”, underscoring the detached emotions of the technician. Like many other things in life that vary in value depending on the beholder, the results of a “needle test” had huge implications to the pregnant clients but amounted to a toilsome task for the lab techs. 

Rapp remarks on the differing perspectives of mother vs. provider on a prenatally diagnosed, disabled baby. She asserts, “As the geneticists pathologized the mother ‘genealogized’”, a significant statement in that it summarizes the distinction between the two parties. The geneticists observed the child with the keenness of scientists gazing upon a study subject. While they hastily scribbled down notes on the baby’s condition, the mother fondly noted her child’s likenesses to family members. 

Two women from Rapp’s account closely align with Karen’s representation in Mike’s story: Veronique, who conceived a baby prenatally diagnosed with Trisomy 9, and Pat, who conceived a baby prenatally diagnosed with Downs syndrome. Their unwavering decisions to raise disabled children in spite of medical suggestions sparks questions. Why did the somber predictions made by the genetic technicians fail to deter Veronique and Pat from conceiving their children? And how is Karen able to so selflessly tend to her severely disabled son, both day and night without help? 

Veronique and Pat each created human beings who share their genes, even if that means unlucky ones that carried traits for abnormalities. Modern technology offered them a chance to throw back their creations, imperfect to the scientific eye, but they clung to them instead. Rapp uses metaphor for the uncharted amniocentesis process by dubbing it “the DNA research frontier”, “information for consumers without guideposts”, and “a play whose acts are as yet unwritten.” As an anthropologist, she halts judgment for the mothers’ choices and the geneticists’ attitudes, and continues to evaluate amniocentesis. 

Mike Phillips surely suffers from a condition unimaginable to most in its scope of pain and physical restrictions. However, he fights with vigor against his limitations and remains in solidarity with Karen, his mother who fights alongside him to increase his odds of surviving, each day at a time. Fortunately, Mike’s access to health care resources and Karen’s ability to serve as his full-time nurse allow him to exercise occasional autonomy, which helps his quality of life. 

In contrast to Mike’s relative privilege, at least socioeconomically, Rapp introduces amniocentesis as a public health measure in New York City used to curb seemingly extraneous funding for the disabled poor populations. Through the lenses of politicians, the costly “needle test” pales in financial comparison to the money necessary for social services to support disabled people in poverty. Similar to the geneticists’ emotionally removed interest in the findings from amniocentesis, the Health Department betrayed the population by blurring the lines between “eugenic and choice-enhancing aspects of prenatal diagnosis.” 

The complex array of perspective serves as essential tools in evaluating amniocentesis anthropologically. Rapp meets this task by introducing varying viewpoints and examining them critically but comprehensively. I highlighted Mike Phillips’ story because it provides duality to the conflict of determining the worth of allowing or refusing disabled lives before birth. On the extreme end of disabled, his obvious struggles require constant attention and interfere with his quality of life... In contrast, his attempts to actively study the human condition and to function in society mirror those of almost everyone I know.