vendredi 21 novembre 2014
ANTHROPOLOGY IN MEDICINE
IS THERE AN ANTHROPOLOGIST IN THE HOUSE?
I was about to qualify as an Endocrinologist from the University of Miami when I decided to spend one month with an American Indian tribe. I went there with an open mind, and within a few days I realized that what I had learned in Medical School was geared towards the individuals but not toward people living as a community. That is when I decided to go back to University in London to do some postgraduate studies in Anthropology.
When I tell people I am an Anthropologist, they have visions of Indiana Jones or slick Armani clad Malpractice lawyers. Medical Anthropology teaches you to divert your gaze away from the laboratory tests to the patient and the social circumstances of the patient, looking at the tree and not just at the branch.
I thank my Meskwakia Indian teacher, Pat “Dr Brown” for making an Anthropologist out of me.
Before she would let me see a patient, she would give a genealogy of that patient, thus I learned about the interconnectedness of that community, what they value as a community more than the individual values and more importantly how the health of the individual would affect the health of the community as a whole. Once a jovial Indian was sitting in front of me, dressed in a torn t-shirt and jeans with a baseball hat. Dr B warned me, the man sitting in front of you is the spiritual leader of the Eagle Clan, and he has more knowledge and wisdom than you would ever have, so treat him with respect. It was she who taught me to RESPECT each and every patient of mine ever since.
I am happy to have studied Anthropology in London rather than the USA because the Medical Anthropology here highlights many of the conflicts in the American society. The Anthropologists in the USA are without power whereas the Doctors along with their Pharma cronies wield an enormous amount of power to change the habits of other doctors and patients. Thus the American Medical Anthropologists are far more theoretical and when you read some of their erudite articles, it elaborately describes nothing practical. The British Anthropologists who were my teachers, namely Adam Kuper, Ronnie Frankenberg and Cecil Helman were not only erudite but also very practical in their approaches. They admired the American capacity for analysis knowing fully well that American society has different priorities: Anthropologists can only do what they are allowed to do, by the powers to be.
In America, there is a need for more Medically Qualified Anthropologists. The best known medical anthropologist in the country, Paul Farmer, is a specialist in Infectious Diseases and his anthropological text books have already become widely read.
The new tool acquired in London at the halls of knowledge there, strengthened my curious mind to ask questions, WHY?
I was not satisfied with the biomedical explanations of a disease (as defined by the doctors) but wanted to know the social implications and aetiologies of that Illness (as defined by the patients)
Fortunate enough to work with the Native American Indians, I could observe many things that went against the teachings of the “experts” and also the machinations and manipulations of numbers and laboratory tests for those who stand to gain the most.
Some examples are given here and the reasons for my questioning
Blood Pressure 130/80 mm Hg is considered normal, but by whom? Where, when and how did they arrive at this conclusion?
Among the CUNA Indians who inhabit the San Blas Archipelago off the coast of Republic of Panama, no one has a blood pressure of 130/80, their median blood pressure is about 110/60
Also, their Blood Pressure does not rise as they get older, as we were taught in medical school to be a normal phenomenon in humans.
Despite the torrential increase in Diabetes Educators and Obesity researchers and Lifestyle coaches, the endemic of Obesity and Type 2 Diabetes has reached typhoon force!
I have to be thankful to my teacher, the late Dr Eric Reiss at the University of Miami about my critical thinking about Cholesterol.
He was conducting the usual Endocrinology teaching rounds and a proud student was presenting an older Black lady lying in her bed, with visible signs of Hyperlipidemia (collection of fats in the blood), with xanthelesmas (yellow collections of fat around the eyes). The student answered all the medical questions very cleverly and was beaming with self satisfaction when the ever observant Dr Riess asked him: why does this lady have a band aid on her breast? Is it covering some wound? The jaw dropped, the student looked in consternation, I don't know, I didn't ask her. Then Dr Riess when kindly asks the lady why the lady has the band aid on her breast. She said: I live in the poorer section of the town where the black people live and it is infested with rats and it is a rat bite.
She was being discharged that day from hospital and he continued: Is anyone picking you up? No, Sir. Do you have bus fare to get home? No, Sir. He gives her the 75 cents necessary for the bus fare
He turned around to all of us and said: Knowing all about the Cholesterol metabolism would not make you a better Doctor, but knowing about her living conditions and finding her transport to get home would.
Soon after there has been an explosion about Cholesterol but mainly about the treatment of elevated bad cholesterol and decreased good cholesterol.
Two thirds of Americans are either overweight or obese and coincidentally enough 200 million prescriptions were written for Statins (ant cholesterol medication) a few years ago. No one is certain how many people in America are taking Statin medications but it could well be 30 million adults.
How did this happen? Look at this Forbes article:
Taking Statins To The Next Level
AstraZeneca wants to get millions more people taking cholesterol-lowering drugs. Will it be enough to revive the drugmaker?
An anthropologist would immediately see the connection.
It is not the health of the consumer.
It is not the recommendation of independent enquiry panel.
But it is the coveted aim of the drug manufacturer.
As I mentioned above, Cuna Indians had lower levels of Blood Pressure. But LOWER in that it is Lower than the accepted levels, for them, that was the normal level of BP.
Lower Level or acceptable levels can be manipulated. The upper levels of accepted CHOLESTEROL has been coming down in the past few years. Now they are even talking of treating the “normal” levels.
At no time are there discussions about WHY is the cholesterol level going up or remaining high.
Working among the American Indians was the way to work this out, I thought.
In a survey done between 1956-58, Total Serum Cholesterol was found to be lower among Five different Native Indian populations than the Cleveland Clinic population and other non Indian populations.
I was lucky to be able to gain permission from the Alabama Coushatta Tribal health Director to examine and obtain blood for Cholesterol studies and it showed that the tribal members had lower cholesterols: Total, LDL AND HDL . HDL is usually referred to as Good Cholesterol.
It became clearer and clearer as I thought about it over the years and saw hundreds more patients and visited them at home and saw what they ate as “food”, that the higher cholesterol was an indication of the INFLAMMATION of the body caused by the non food items in food. STATIN is an excellent medication against INFLAMMATION as well as CHOLESTEROL but that does not mean that its effects are due to lowering Cholesterol levels.
Indians love their meat and as their cholesterol went up, the pundits began associating cholesterol levels to their fat intake and advised that they should consume less meat, which does not sit well with them.
I remember a patient of mine, weighing over 300 lbs. who used to come regularly to the clinic. On one such visit it was noted that his Total Cholesterol was perched near the 300 mark (200 considered the upper level of the normal) and I expressed some consternation, he said calmly: Don't worry, doctor, I will bring it down.
I was curious and sure enough on his next visit the Total Cholesterol level had come down by over 100 points.
What have you been dong that is so different that the cholesterol levels came down?, I asked him.
Instead of buying eat from the supermarket, my friends and I now butcher our own meat.
End of the Story.
Indians have lower cholesterol but they still die of heart disease which was unknown to them until recent times.
The Cholesterol story continues… will discuss HDL cholesterol and its importance or lack of importanc in another blog…in numbers, we don't trust..
Posted by cochinjew at 15:05
mercredi 19 novembre 2014
There are some childhood memories, for me, the tropical torpor of the village of Kuala Belait, in Brunei, where wearing a newly acquired jacket which made me sweat heavily, I would run after butterflies. These memories do not arrive announced but their sudden arrival does portend a sense of disequilibrium. I have firm ideas about thinking about the past and the future. I hardly think of my school days or friends from those days.
Was that a protective mechanism?
Was it to forget incidents or geography or people that you no longer wish to be associated with? Things becomes clear from those times when I wish to extend my memory, and now I know that it has worked out to be a good defence mechanism for the kind of vagabond life I have lead, with chameleon like frequency all over the world.
There are people in your life, who came, left a strong imprint and walked away to find destinies of their own. I am lucky to have had many and they appear on my Gratitude List very often. One such was an Australian friend of mine, LS. She once drew a graph of a sinusoidal wave on a piece of paper. She then explained to me, most people lead a life of ups and downs and it is the normal way. You have chosen to just ski on top of the top of the waves, so that you can avoid the banality of everyday ordinariness and also not experience the beauty that comes with the mundane art of living. Did I make the waves of that sinusoidal wave come as closely as possible that I can surf over them? And not fall into an abyss?
Let us take travel for instance. Even before I became a Doctor, I read an obituary of a GP from England. I was not interested in his work or care of his patients but one sentence struck me, at that time, like a thunderbolt. Dr So and So took time to travel and had been an amazing 95 countries around the world! Wow! What a traveller, I thought to myself and secretly wanted to be a traveller, keeping 95 as my target. The first 10 came very quickly, and then it began to slow down, after 40 countries, unless you had moved to a new geographical region, visiting more countries becomes difficult. Fortunately, I moved from Australia to Europe to America back to Australia, thus covering a fair bit of the world. When Asia opened up, and the travel there became easier, more places were visited. I am not a stamp collector, to go somewhere and said I have been there, I want to know a country intimately and try to visit them repeatedly, for example, I have been to Argentina more than 15 times, but so have I to many others, including Myanmar.
Why do I mention this? Perhaps this was the peak of the sinusoidal wave for me for a considerable part of my life. Fortunately the interest in my profession never waned and was polished by further postgraduate studies in Medical Anthropology. Now, after many years of travel, I don't think I have had any two week stretch of time, that I have been idle and not been on a train, bus or plane, usually the latter.
The sense of morose that arises, like recently when I was marooned in Miami waiting for an Indian Visa, it almost makes you feel you are wasting your life.
I began reading a great little book, aptly titled, Casablanca: Movies and Memory by the well-known French Anthropologist, Marc Auge.
He escapes into the movies for memory, including the smell of theatres of the left bank of Paris growing up. I don't exactly escape into travel, since I don't remember the places or have a sense of déjà vu, but then again I am surfing the peaks of experiences and perhaps looking for more peaks than troughs.
It is so important to have corresponding friends. In the olden days of snail mail, one wrote long letters to friends and waited eagerly for enticing, stimulating replies of equal length to arrive by mail. I used to cherish those letters and walked around with an enhanced feeling for days that followed.
For the past ten years, instead of friends, I have acquired a country! Cuba where the stimulating exchange has no end, like a sweet bakery in the sky. It coincided also with the availability of Internet and email whereby the communications became superfast and one can spend hours each day as I do, dedicated to thinking or creating in my mind various lives that I can lead secretly.
In Miami, I am lucky to have many things and amongst which is an erudite friend, in fact a colleague from Medical school days. He quit medicine because the quotidian practice of it, directed by heartless administrators acting on behalf of the pillars of capitalism, was contrary to the ethics he was taught and believed in. We both have the luxury of time to read and discuss, not only matters of medical interest but also about very many other things we share an interest in.
His email to me this morning triggered this output from my brain.
I got this cartoon from our weight watchers leader. It's sort of describes the condition that I am in now in which I have in a de facto sense become on a maintenance program. I do very well during the week but on the weekends I indulge too much and then I like the stability of good quality home cooked food during the week.
It's an interesting question for the anthropologist. I think it describes the lives of many people. If you can figure out the answer please let me know…
What a great metaphor I thought.
Look at movies, Marc Auge would argue. There are no mundane moments, it does not show anyone sitting down to eat an ordinary meal and enquiring each other how their day went. It goes from excitement to excitement, anger and frustration. In cheaper versions, Soap Operas, one sees the faces to go with it, with its exaggeration of emotions. Sound and voices add to the exaggeration, especially if the soap operas are in Latin American Spanish or Brasilian!
The success of the magic of movies in depraved places like India or the success of soap operas in a country like Cuba, has to do with the fact that they know that they are not going to watch mundane things on the screen to which they are subjected to each and every day but magic awaits them on the silver screen (or HD TV that covers walls!)
I am not suggesting my friend lives a mundane life but his eating behaviour is such a good metaphor for the lives of people in Miami or elsewhere in the western world. In poorer or less educated societies the story is very different. There are no minutes left to ponder over the mundane moments of life, there is no memory but only oblivion.
Thinking about diets and weight loss, which is a multibillion-dollar industry in America, here are some sensible suggestions from a professor from Colorado who has been involved in this research. Since I see exclusively American Indian patients, our advice is culturally relevant and sensitive and also guised in symbols of their lives and spirituality. So I wont include it here but quote the professor that is relevant to most Americans and Europeans and Australians.
First, weight loss and weight maintenance are two separate things. “We’ve learned that losing weight and keeping it off are very different and, for each person, the best diet for weight loss is not the same as the best diet for keeping it off,” Wyatt said.
If you want to lose weight and not regain it, you must use different strategies during each phase. In both phases, but especially during the keep-it-off phase, Wyatt recommends eating foods that you like and that are compatible with your lifestyle.
“Physiology and metabolism may play a role” in how you respond to a diet, “but the way you grew up and cultural factors are just as important,” she said.
“The second biggest item we’ve learned is that exercise is the most important thing for keeping it off once you’ve lost weight. I tell my patients that in their initial weight-loss phase, diet is doing the driving and exercise is in the back seat. After that, physical exercise is in the front seat with diet in back,” Wyatt explained.
“We’ve also learned that while diet and exercise are important, just as important is your mind set — that is, why you want to lose weight, why you want this transformation. It’s a holistic approach.”
And finally, the most often neglected piece of the puzzle is tailoring your diet plan. “Matching the diet you choose to your activity level is important. If you are an athlete or have an active lifestyle, you can choose a diet with more carbohydrates and calories, a lot more sugar. But if you have a desk job or a sedentary lifestyle, you’re better off with a low-carb, low-sugar diet,” Wyatt said.
In addition to the three recommended diets already mentioned, the other diet plans that have been scientifically shown to be effective include Weight Watchers and Jenny Craig. Meal-replacement diets where you have a shake or a frozen entrée for one of your meals “have some good data, as do the low-fat, plant-based diets,” Wyatt said, noting that the latter also show good outcomes when it comes to heart disease.
“These are not exhaustive lists,” she added, but simply examples of the varied weight-loss paths.
As for popular or trendy diets, you “can argue about each one, but for a dieter to lose weight they must eat less,” and most such diets do reduce calories consumed and will work for some people, Wyatt said. That’s true for the Paleolithic diet, she pointed out, where “its general principles are fairly solid.”
But she cautioned that one difficulty with the Paleo, gluten-free and other diets of the day is that “people can’t adhere to them” — and that’s the key for any long-term plan.
Thinking about Casablanca, one of the earliest movie memories that have stuck along with Orfeo Negro (Brasil, Marcel Camus, France), I will be arriving in Casablanca in six days time. Alors, not to go to Rick’s Café but to await a Qatar Airways flight to New York arriving there on the day the Traditional Kickapoo like to call the Occupation Day! Americans call it Thanksgiving. Yes, they did get a Great Continent.
i remember watching Orfeo Negro on a saturday afternoon at a movie theatre in Brighton, Melbourne, inciting in me a lifelong passion for Brasil and its music and its people and its culture.
Posted by cochinjew at 02:32
lundi 17 novembre 2014
MUSLIMS IN CUBA, WELCOME TO FIDEL MOHAMMED FROM PROF HONORARY TURKISH PRESIDENT
If Barack Obama ever said that it was not Columbus who “discovered” America but Africans who were here three centuries before, because of coprolites of Indians living in Virginia reveal African agricultural samples, he would be even less popular than he is now! Worse still, if he said, at the site where they found the coprolites, they would build an African Monument to celebrate this great “discovery” First of all, USA is a participatory democracy with checks and balances and a President cannot build a palace for himself costing billions (Like the Turkish President is doing at the moment) or propose to build a monument on his own accord, as it has to be approved by the people or those representing them! (The Turkish president offered to build a mosque where Columbus described a “mosque”! but Cuban leaders being far better educated and worldly rejected the offer).
(these re constructed TAINO indian huts, were they the "Mosques" in question?)
The fact that America was named after a Florentine merchant, make the Catholics proud that they “found” America?
Why don't the Muslims themselves recognize the ridiculousness of this claim? Instead now, after the not so brilliant announcement by the Turkish President, you would hear President of Palestinian Authority or Hamas or Hezbollah demanding money from America because it was they who discovered the land and now occupied by Americans! You don't think it plausible? In Australia, a few years back, an Imam claimed that Australian was truly a Muslim land and that they had to drive out all the infidels who occupied it! Fortunately the Australian Government drove out that Imam back to his native Egypt!
Americans criticize other Americans when they make mistakes or do outrageous things, Jews do the same but not the Muslims. When are they going to stand up en masse to condemn the atrocities being done in the name of Islam? Just saying that only 10 per cent of the Muslims are radicals hold no water, only 10 per cent of the Germans were Nazis but look at the destruction they wrought!
Having lost their golden era and empire as far back as 1492, the Muslims dreamt of that glory, with a brief peak of the Ottoman Empire that dissolved in 1919, they long for that glory. That glory can be had only by mastering the sciences and trade and economy and not by beheadings.
But who was Amerigo Vespucci? Millions of people from Alaska to Tierra del Fuego call themselves Americans, in remembrance of Amerigo but who was he?
Vespucci, a Florentine merchant, employed by Medicis to look after outfitting Colon’s voyages, finally outfitted his own voyage in quest of the passage to the Indian subcontinent that had eluded Columbus. He sailed in 1499 -- seven years after Columbus first landed in the West Indies. Vespucci made two voyages between 1499 and 1502 and possibly a third one in 1503.
During his first voyage he explored the northern coast of South America to well beyond the mouth of the Amazon. He gave names like "Gulf of the Ganges," and other Asian place-names he knew about, to the things he saw. He also made significant improvements in navigational techniques. During this trip he predicted the earth's circumference to within 50 miles.
But the big breakthrough came on Vespucci's second trip. And that was the realization that what he was looking at was not India at all, but an entirely new continent. He verified the fact by following the coast of South America down to within 400 miles of Tierra del Fuego. Columbus found the new world, but Vespucci was the man who recognized that it was a new world.
And who wrote Vespucci's Christian name on the maps? The King of Spain? Our founding fathers? Vespucci himself? No -- it was none of these. An obscure German clergyman and amateur geographer named Waldseemuller gave us our name. Waldseemuller was a member of a little literary club that published an introduction to cosmology in 1507. In it he wrote of the new land mass that Vespucci had explored:
I see no reason why anyone should justly object to calling this part ... America, after Amerigo [Vespucci], its discoverer, and a man of great ability. ( from UH, Texas)
So Germans, Florentines all can take credit, if they wish, for the existence of America and American Continent.
Beautiful Baracoa, on the eastern most part of Cuba, where Christopher Columbus said to have landed (even though another spot in Cuba also claim that distinction). Colon does mention this hilltop. Is this the mosque, the Honorable President of Turkey referring to?
Posted by cochinjew at 03:45