vendredi 21 novembre 2014

ANTHROPOLOGY IN MEDICINE: IS THERE AN ANTHROPOLOGIST IN THE HOUSE?



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
Why?
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.
Why?
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!
Why?
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.
Why ?
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..