mercredi 14 janvier 2015

SUCCESSFUL SOCIAL AND CULTURAL RESEARCH IN HEALTH, ILLNESS AND DISEASE

SUCCESSFUL SOCIAL AND CULTURAL RESEARCH IN HEALTH, ILLNESS AND DISEASE
You have to tip your hats off to molecular scientists who concentrate on a minute aspect of metabolism. But it is that concentration that produces revelations, those results converted down the line into treatments for common and rare disorders.
As a Medical Anthropologist, is there an equivalent to that kind of concentration on small components of everyday life, in our field of observation and research?
Yes!
Observe, participate, assist and share the lives of the same groups of people over a long period of time
When you are thinking of the welfare of a group of people, rather than an individual in a group or working on an instrument or a pharmaceutical drug, the worldview has to be a selfless one. A purity of intentions usually fires the enthusiasm when working for the welfare of a group of people. A Community is not a collection of individuals living in proximity to each other, brought there because of external parameters, such as wealth or education.
I am lucky to be working with American Indians, henceforth referred to as Indians, who have not only a shared culture, history and many a times, a language and a religion but also a collective unconscious, which Carl Gustav Jung was able to codify while watching them.
By describing their lived in experiences and explanatory models of their illnesses, it was evident that the aetiology of their diseases did not and does not fit into the commonly accepted physiological and biochemical explanations.
One has to be a Medical Anthropologist if you wish to understand fully the suffering of a community, regardless of which country they live, Canada or USA or Australia or Aotearoa; only by understanding can you assist in some meaningful help to alleviate that suffering a little bit.
The Cartesian dichotomy of Mind and Body has had a strong influence in the Western Medical thinking, it often asks, What is happening?
And looks for an explanation by objecitivising the symptoms of suffering of the person into physiological dysfunction with a name, Disease: to be measured, treated and followed up, in a strict Quantitative fashion.
An anthropologist may ask a different approach, about the same phenomenon: Why is this happening? Why is this happening now? What alleviates this suffering? What can be done?
Two observations stand out in the context of my first contact with the Indians.
a.     The tribe which once used to be healthy and lean, are now overweight, obese. At the time of contact the white men wondered about the excellent health of the natives. In 300 years, their social, cultural and economic as well as physical situation had deteriorated.
b.     Fortunately enough during my travels among other indigenous peoples of the American Continent, it was curious to observe that these afflictions were rare among the other Indians, who are related to the North American Indians. The Kuna of the Panama had no Diabetes, were not overweight, had no change in Blood Pressure with age.  Many other tribes, in Mexico, Guatemala, Ecuador and Peru, were strangers to the afflictions and suffering of their brothers and sisters to the North.
Obviously then it was not a genetic phenomenon, perhaps an epigenetic phenomenon, even though the concept was not popularized until recent times.
For a social scientist, it was probable that the sufferings of Indians of North America, including Canadian First nation people as well as Australian Aboriginals and Maori of Aotearoa, were the results of social dysfunction caused by maladjustment to another society, culture and not to mention an inferior food product (which was to become clear in the analysis in the new century). It exhibited as Obesity, Diabetes and Hypertension in the body as well as other chronic metabolic problems.
It is interesting to look at the history of these diseases among the Indians. Hrdlicka in his book published in 1908 had mentioned that pathological obesity did not exist among any of the Indian tribes he had encountered. Doctors working with the Navajo exclaimed that they never saw a patient suffering from High Blood Pressure. Even the doyen of Diabetes in America, Dr Joslin, conducing a large number of measurements appropriate for the day, in 1920s, declared that American Indians are free of Diabetes. Records indicated that it was rare for an inpatient at an Indian Hospital to carry a Diagnosis of Diabetes.
Why this dramatic change? In less than fifty years, ninety per cent of the American Indians were overweight or Obese (paradoxically enough the percentage of Obese Indians is greater than Overweight Indians, rather than the other way around, once again challenging the physiological thinking).
It was clear, at least to me, that something was coming from outside: social, cultural and chemical that was the cause of this sudden change in a short period of time. When I mentioned these ideas to my colleagues in the USA, it was ridiculed. (except Dr Mark W who was not practicing Medicine for financial security but out of a desire to be of help to people)
The postgraduate education in Medical Anthropology in London which I definitely needed to acquire tools to understand what was happening to the Indians in the USA, helped me a great deal, allowing me to see the socio cultural aspects of their suffering.
The chemical aspect, something that is inflaming, was that a possibility?
In 2002, I was wandering around the streets of Johor Bahru in Malaysia, after a delicious south Indian meal while being on a stopover in Singapore.
A temple in the centre of town advertised a book fair was in progress. I entered the sacred grounds with no expectations. Instead of a cacophony of religious ministrations and philosophical outpourings it was surprising to find all sorts of books on sale. In one corner, a stall had lots of booklets, the kind that would fit into a shirt pocket but their titles were tantalizing.
American Indians would say: things happen for a reason, it is just we are not smart enough to figure out why.
Toxics in Plastics, exclaimed one booklet which I began reading. It was an eye opener, explaining the various ingredients used in various types of plastics that we use in everyday life and their ill effects.
Reading extensively on the already available medical literature, it became clear that,
a.     The knowledge that outside chemicals in the form of plastics causing damage to the body was not something new
b.     While it was not suppressed, it was not being publicized or released for mass consumption for the media. A generation of babies were being exposed to BPA in their feed bottles!
The conclusion, now more than ten years ago,
a.     Chemicals enter the body usually in the form of some additive in “food”
b.     Their chemical composition or metabolism was not discussed, but quantitative biological measures, such as Protein, Fat, Carbohydrate content were being used to hide the chemical nature.
The best example was High Fructose Corn Syrup. With an excess of corn to get rid of, with biological alteration of molecules, HFCS was created, touted as the healthy alternative to Table Sugar, while having very similar content of Fructose and Sucrose.
Here is a conversation with my erudite colleague, Dr Mark W

On 6 January 2015 , "So we speculate that the different sugars could favor different microbes in the guts of mice. Other research has shown differences in bacterial communities in the gut to be associated with metabolic diseases in rodents and humans. It's possible one form of sugar causes more bacteria to get across your gut than another."
The difference between high-fructose corn syrup and sucrose
While high-fructose corn syrup and sucrose contain around the same amounts of fructose and glucose, there is a difference in how they are arranged molecularly.
In corn syrup, fructose and glucose are separate molecules, known as monosaccharides, whereas in sucrose the two sugars bond chemically to form a disaccharide compound
Dr Mark W
Interesting. I wonder if the absorption of the monosaccharides in corn syrup is faster and more likely to produce an insulin spike then the absorption of the sugars from sucrose once the molecule has been cleaved?
Do you have any facts or opinions on this?
Dr Sudah Yehuda KS:
my gut feeling is, pardon the pun, corn syrup acts in a different way than the physiological way that  table sugars are metabolized. I am sure you are able to find some information on that since you can understand it better. (biochemically)
25 % of obese people have no metabolic abnormality. And when they are fed a McDonalds diet, nothing bad happens to them, but in those obese people with metabolic abnormalities the same diet makes everything worse
a susceptibility as well, then.
For example, American Indians as a whole are susceptible to obesity with the kind of diet , so far different than their genetic diet.
When i hear now about a new combination medication for diabetes it does not interest me since the physiology of the diabetes and many inflammatory diseases is what we are after and not the age old physiology which may have been correct as an end product but not as an aetiology.. like they taught us that in  type 2 diabetes the insulin is not effective..in the medical school.
c.     Inflammatory molecules produced directly or indirectly (directly: reaction in the cells on contact or metabolism; Indirectly: secondarily by increasing fat cells or other cells which then produce inflammatory molecules), can give rise to :
Abdominal fat deposition
Fat storage elsewhere  such as the Liver
Act as Endocrine Disrupting chemicals, interfere with the action of the various hormones, such as Insulin, Cortisol, Testosterone and Oestrogen, among others.
The latest addition to this knowledge is the research published just two days ago from Dr Moynagh and colleagues from Maynooth University. My hats off to them.
They have discovered a protein called PELLINO 3 that may block obesity driven inflammation
inflammation and thus prevent insulin resistance and diabetes. According to the researchers, there is a direct correlation between low levels of Pellino 3 in obese individuals. This low level of Pellino 3  is associated with the production of a critically important pro-inflammatory protein called IL-1 that drives inflammation and ultimately Diabetes.

So, as you can see, consistent social observation of the same group of people over a period of time can lead to a good understanding of their suffering and arrive at conclusions later on validated by science.
This can be used to tailor the education, couched in cultural terms and historical information. Indians have a great respect for their ancestors, and of course the ancestral diet is not the one that made them sick.
I am convinced that Medical Anthropology or an Anthropological education is necessary to people who are suffering from maladies of maladaptation in everyday life.
I wish to thank my Indian teachers  Pat B of Meskwakia, Pierre M of the UmonHon and my colleagues, especially the PHNs I have worked with over the years at the various Indian Clinics in the USA.
And to  Dr Mark W