anthropology

Duke University Press in Uganda

Last fall, we were thrilled to publish the first book of our new Critical Global Health series, Second Chances: Surviving Aids in Uganda, edited by Susan Reynolds Whyte. The book was celebrated at a launch in Uganda in February, at Makerere University in Kampala. Four prominent Ugandans discussed the book. All have been and continue to be major players in shaping the response to AIDS in the country.

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In their remarks they touched on three themes:

As clinicians, they found that the book gave them understanding of their patients as people.

Peter Mugyenyi, Director, Joint Clinical Research Centre, a leading authority on the treatment of AIDS in Africa:

“As a person who was involved in access to ARV drugs in this country, I found this story very moving. Any health care provider who reads this book, and listens—it is like listening to people talking to you, that’s how well it is written—your practice will never be the same…I looked at this book and I started reflecting on what sort of services we provide to patients. When you read this book your vision of such issues will never quite be the same.

Through the stories that these patients told, I could see you the interviewers. I saw how you felt for the study participants you looked after and followed up. I saw how you got involved, and then in the end you told a moving story.”

Harriet Mayanja, Dean, School of Medicine, and former Head of the Department of Internal Medicine, treating AIDS patients at Mulago, the national referral hospital:

“This book is not only second chances for the people they write about. It is also second chances for us to look at disease and people who are unwell as individual human beings with families, with homes, with worries, with fears as opposed to cases and statistics.”

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Q&A with Sharon R. Kaufman

Photo by Susan Merrell

Photo by Susan Merrell

Sharon R. Kaufman is Professor Emerita and Chair, Department of Anthropology, History and Social Medicine at the University of California, San Francisco. Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line is an ethnography about the dilemmas 21st century American health care poses.  Centered on the intersection of medicine, our aging society and the concerns raised by today’s treatment options, the book is about the structure and culture of the entire biomedical health care enterprise, from research funding for treatments, to what is reimbursed by insurance companies, to what is considered standard and necessary and why, to what, ultimately, patients and doctors talk about and decide to do. It reveals how the organization of the system determines so much of what happens to everyone and why it is so difficult to see the line between ‘enough’ and ‘too much’ medical intervention.

What is the medical-industrial complex and is there a way to counteract its effects on how we experience illness and death?

In 1980 Arnold Relman, then editor of the New England Journal of Medicine, coined the phrase “medical-industrial Ordinary Medicinecomplex” to describe the ways science, medicine, profits and politics were becoming entangled and were beginning to have a growing impact on health care.  Inspired by President Eisenhower’s earlier coinage of the term military-industrial complex, Relman defined that new health care complex as “a large and growing network of private corporations engaged in the business of supplying health-care services to patients for a profit.”

I draw attention to that complex in Ordinary Medicine.  The worries Relman articulated in 1980 were about the corporatization of health care, the rise of the medical marketplace and the demise of medicine as a social good.  His worries were prescient of course.  The contemporary medical-industrial complex I describe in Ordinary Medicine shows the ways in which the commercial business of health care has grown enormously since the 1980s.  For example, biomedical research in the United States is a $100 billion enterprise today, largely funded by private industries.  The market-driven, market-expansion goals of the pharmaceutical, device and biotech companies have a greater influence on the development and use of treatments than ever before.  Private industry largely determines which therapies will be investigated in clinical trials and other studies and which patient-consumer markets will be exploited. As a consequence, its role in shaping what doctors recommend and what patients ask for has increased dramatically in the past several decades, and it continues to increase.

Because the medical-industrial complex shapes the clinical trials enterprise and what we have come to regard as evidence-based medicine, because that complex churns out new diagnostic procedures and therapies at an unprecedented rate, and because it guides physicians and patients in their thinking about treatment options, there is no way to counteract its effects, per se, on how we experience illness and advanced age.   We can, however, be mindful of those effects when we consider whether to employ every new treatment modality that comes along to fight the ills – and the inevitability– of old age and approaching death.

 How do we reconcile the fact that developed countries like the US are “overmedicated” while countries in Africa and Asia can be in urgent need of better health care? Should we pursue progress in health care as a global goal?

It is indeed difficult to contemplate the disparity between overtreatment, the exorbitant cost of treatments and the intensive therapies given to those near the end of life in the U.S. while so many others – within our nation as well as throughout the developing world — cannot gain access to what are today considered preventive and curative interventions.  Yes, we should pursue progress in health care as a global goal.  But the American experience, especially our culture of complaint about too much technology near the end of life, should be viewed as a cautionary tale for other locales.  What do we mean by medical progress in the first place?  As the most advanced technologies in the industrialized world come to be taken up elsewhere (for example, ventilators in intensive care units; costly cancer drugs; cardiac implantable devices; expensive diagnostic and surgical tools) the question, “what kind of progress?” looms large.   This is a rich area of study for anthropologists, sociologists and public health scholars and will continue to be so in the future.

 What are “living donors”?

“Living donors” are individuals who decide to give a kidney or a portion of their liver to a sick person in need of an organ.  There are at least several reasons why transplantation with organs from living donors is occurring with increasing frequency today. Medical science has shown that most individuals can live healthy lives with just one kidney, and giving away a portion of one’s liver does not undermine health. Demand for organs far outpaces the deceased donor organ supply. Today over 100,000 people are on the U.S. national waiting list for a deceased donor kidney. Yet the number of available kidneys has remained static, at about 13,000, for more than a decade.  Older persons now contribute to the growing demand, and approximately 15% of the deceased donor supply goes to persons age 65 and over.  Studies reveal that recipients of kidneys from living donors live slightly longer on average than those who get kidneys from deceased donors. Taken together, these facts put enormous pressure on families, friends, acquaintances and sometimes strangers to offer to donate a kidney to someone in need.  Finally internet solicitation of living donors has emerged in recent years, contributing to the ordinariness of asking for, offering, and accepting a kidney from a living person.

Are quandaries about options, costs, obligations, and risks also present in medical arenas other than terminal illness, such as pediatrics or obstetrics? 

Yes. The value of patient autonomy in health care, together with the demise of physician paternalism, has placed the onus for decision-making on patients, and often on their families.  Quandaries arise for patients and sometimes for doctors in all branches of medicine when more than one treatment option for a particular problem is available. And there is always the potential choice of no treatment.  Which option to choose is particularly troublesome in the case of life-threatening illness, regardless of age. For example, are the risks of one treatment greater than another, or greater than no treatment? Will the costs of all treatments, especially experimental therapies, be covered by insurance?

 Are all life-prolonging procedures negative?

Certainly not!  Medicine’s ability to prolong wanted life through both low-tech and high-tech interventions is positive.  The problem of where to draw the line arises because of the perfect storm we find ourselves in today. The socio-medical imperative to employ those life-prolonging and death-defying techniques now exists in an ever-aging society in which private industry churns out greater numbers of interventions than ever before; in which no age or cost limits exist for Medicare reimbursement of those procedures; in which many older persons, their families and their health providers must consider whether additional treatment will bring with it pain and suffering; and in which saying ‘no’ to advanced, expensive or new procedures seems somehow suspect or ethically wrong. These features of American society and health care organization have spurred our currently lively national conversation about whether staving off death is always the best thing to do.

 Where should we draw the ethical line between putting a brake to excessive treatment and the patients’ and their family members’ wish to stay alive?   

There is no easy or precise answer to this question.  The reasons this question has become a pressing socio-cultural theme today are the subject of Ordinary Medicine.  Our insurance industry has not been able to create guidelines for such a line. When Medicare, our national health insurance system for citizens age 65 and above, was established in 1965-66, no cost or age limits were set on reimbursement for therapies. Though the subject of limits to reimbursement – one means for drawing such a line — has been broached in the years since then, there has not been the political will to change the status quo. Neither physicians nor consumers of health care have been able to effectively draw such a line either, and both groups show great variation in on-the-ground practice.  For more than two decades doctors have complained that some patients and their families demand treatments that are futile and may cause suffering at life’s end. On the other hand patients and families also complain that physicians pursue aggressive treatments way too long, sometimes against their wishes. In my experience both views are correct and both groups are culpable.

 How would you relate Ordinary Medicine to your previous book, And a Time to Die?

Ordinary Medicine is the companion volume, or prequel, if you will, to ...And a Time To Die.   I examined one feature of the quandary about enough or too much treatment and when to stop in …And a Time to Die. There I described hospital death and the social and structural forces that shape the ways many Americans die in the United States.  I explained how, unless and until someone says stop, the bureaucracy of the American hospital itself “moves things along” by channeling doctors and patients toward the most intensive, aggressive treatments, even when people claim they do not want those treatments, and even when death (which is rarely mentioned or expected) is imminent.  But what happens in the hospital when a patient is near death provides only one piece of the answer to why the default setting of medicine is more treatment.   Ordinary Medicine examines the upstream forces, beyond hospital walls, that are at the source of the standard more-is-better approach and that shape the organization of medical treatments.  The new book focuses on the multi-billion dollar research enterprise, especially the ascendance of the value of evidence-based medicine and the surge in clinical trials that shape so much about health care delivery since the turn of the millennium.

Those developments, in turn, determine insurance reimbursement, standards of care, and what physicians and patients agonize over and decide to do.

 How has the medical scene changed in the past ten years?

The good news is that despite the increased influence of the drug and device companies in promoting the use of aggressive treatments in later life, and even though the technological imperative in medicine remains a powerful driver, the medical scene has changed in the past decade for the better and continues to do so.  Palliative care has been accepted by greater numbers of doctors, patients, families and hospitals than in the past.  It is taught in medical schools.  A groundswell of books, medical articles, and reports in mainstream media outlets has appeared describing the problem of too much technological intervention for persons in later life and what needs to change.  The right-to-die consumer movement in health care has gained adherents and makes front-page news. Solutions to waste, overtreatment, futile intervention and patient and family suffering have been implemented in many medical centers and physician groups.  Hospitals, patient advocacy groups, and regional health care systems are working in various ways to change the default away from more so that age, comfort, meaning and mortality are acknowledged.  Yet there is still a long way to go because of the contradictory fact that we desire advanced, even experimental medical interventions without limit at the same time that we deplore the overuse of those tools and the suffering they sometimes cause.  In that way the quandary of the line continues to have profound effects.

You can order Ordinary Medicine from your favorite local or online bookstore, or call 888-651-0122 to order directly from Duke University Press. Use coupon code E15KAUFM to save 30%!

NATIONAL ANTHROPOLOGY DAY

Today is National Anthropology Day! The American Association of Anthropologists states that “anthropologists are innovators and creative thinkers who contribute to every sector of society,” and we couldn’t agree more. To celebrate, AAA has teamed up with universities and other institutions nationwide, to share and celebrate the many ways in which anthropology affects our lives, both big and small. Check here to see if an event will be hosted near you!

Anthropology can cover a wide variety of topics– from climate change and our disappearing beaches, to indigenous exploitation around the world; to the use and availability of pharmaceuticals and hospitals from Africa to Papua New Guinea. Anthropology can inform the theoretical, the concrete, and even poetry; it can be used to understand the past and be applied to our understanding of the future.

Is your interest piqued? We have lots of great anthropology titles to check out here. Some of our most recent titles include:

Ferguson cover image, 5886-2In Give a Man a Fish: Reflections on the New Politics of Distribution, James Ferguson examines the rise of social welfare programs in southern Africa in which states give cash payments to their low income citizens. These programs, Ferguson argues, offer new opportunities for political mobilization and inspire new ways to think about issues of production, distribution, markets, labor and unemployment.

Callison cover image, 5787-2How Climate Change Comes to Matter: The Communal Life of Facts, by Candis Callison, is a rich ethnographic account describing the processes by which climate change comes to matter collectively and individually, and how vernacular explanations of climate change reflect diverse ways of knowing and caring about the world.

Starn cover image, 5873-2Using the influential and controversial Writing Culture as a point of departure, the thirteen essays in Writing Culture and the Life of Anthropology, edited by Orin Starn, consider anthropology’s past, document the current state of the field, and outline its future possibilities.

Kulick cover image, 5833-6In Loneliness and Its Opposite: Sex, Disability, and the Ethics of Engagement, Don Kulick and Jens Rydström argue that for people with disabilities, being able to explore their sexuality is an issue of fundamental social justice. The authors analyze how Sweden and Denmark engage with the sexuality of people with disabilities; whereas Sweden hinders sexuality, Denmark supports it through the work of third-party sexual helpers.

Mankekar cover image, 5836-7Purnima Mankekar offers a new understanding of the affective and temporal dimensions of how India and “Indianness,” as objects of knowledge production and mediation, circulate through transnational public cultures in Unsettling India: Affect, Temporality, Transnationality.

Freeman cover image, 5803-9Steeped in more than a decade of ethnography on the emergent middle class of Barbados, Entrepreneurial Selves: Neoliberal Respectability and the Making of a Caribbean Middle Class, by Carla Freeman, turns a spotlight on the entrepreneur, a figure saluted across the globe as the very embodiment of neoliberalism.

To learn more, check out our extensive list of anthropology titles, and read their introductions on Scribd.

Duke University Press at the 2014 American Anthropological Association Annual Meeting

boothWe had a great time attending the American Anthropological Association’s Annual Meeting in Washington, D.C. this past weekend! It is always a pleasure to participate in the hustle and bustle of a busy meeting, and to take the opportunity to mingle with our authors.

 

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At this meeting we were pleased to announce that Gilberto Rosas’ Barrio Libre (2012) won the 2014 ALLA Book Award from the Association for Latina and Latino Anthropologists Section of the AAA.

Anne Allison’s Precarious Japan (2013) also received an honorable mention for the 2014 AES Senior Book Prize from the American Ethnological Society.

 

Many authors stopped by our booth to say hello!

 Eben Kirksey and Brandon Costelloe-Kuehn

Here is Eben Kirksey, author of Freedom in Entangled Worlds and editor of The Multispecies Salon, with Brandon Costelloe-Kuehn, a contributor to The Multispecies Salon.

 

 

 

 

CallisonCandis Callison stopped by to see her brand-new book, How Climate Change Comes to Matter.

 

 

 

 

 

 

Newton

Esther Newton with the new paperback edition of her book, Cherry Grove, Fire Island.

 

 

 

 

 

 

Ochoa Gautier

Ana Maria Ochoa Gautier poses with her book, Aurality, and our editorial director, Ken Wissoker.

BeharWe snapped a picture with Ruth Behar and her book, Traveling Heavy.

 

 

 

 

BrennanHere is Denise Brennan, author of Life Interrupted.

 

 

 

 

 

 

Thanks for a great meeting this year! Check out our Facebook page for more great photos of authors with their books. And if you couldn’t make it to AAA, don’t worry, you can still buy all the great books we featured there at 30% off. Check out the program ad, and use coupon code AAA14 when you order by phone at 888-651-0122.

Eben Kirksey on Collaboration at the Intersection of Anthropology and Biology

upw-logo-2014Welcome to the third annual University Press Week blog tour! The theme of this year’s week is Collaboration and we offer a post by anthropologist Eben Kirksey about collaboration in his field. After reading this post, you’ll want to check out today’s other university press posts. At the University Press of Colorado, they write about  their collaboration with the Veterinary Information Network on a recent textbook, Basic Veterinary Immunology. On their blog, the University of Georgia Press features the New Georgia Encyclopedia, an award-winning, on-line only, multi-media reference work on the people, places, events, and institutions of Georgia. The University of California Press blog presents authors Dr. Paul Farmer and Dr. Jim Yong Kim writing on the collaborative work they are doing to fight the Ebola epidemic in West Africa. The University Press of Virginia highlights their collaboration with the Presidential Recordings Project at the Miller Center to create ‘Chasing Shadows,’ a book on the origins of Watergate, with a special ebook and web site allowing readers to listen to the actual Oval Office conversations. At the Project Muse blog, they write about university presses collaborating on the Project Muse platform. The Yale University Press blog features a post by Mark Polizzotti, director of the publications program at The Metropolitan Museum of Art on collaboration between the Press and museums and galleries. And finally, at the University of Chicago Press blog, they discuss the Turabian Teacher Collective. What a wealth of collaboration!

Collaboration was a dirty word in Nazi occupied France. Carl Schmitt, a Nazi theorist of collaboration, wrote of the friend/enemy distinction which “cannot be determined by moral or even utilitarian criteria.” Schmitt was interested in “the potentially groundless, high-stakes decision as to whether a particular group of men are to be considered friends or enemies.” Collaboration, for Schmitt, was a basic part of social and political life among friends, in contrast to enemies “with whom there is the real possibility of a violent struggle to the death.”

Rhizosphere

The rhizosphere, symbiotic fungi that interpenetrate plant roots—giving and taking important nutrients.

Risking an alliance with “the enemy” has the prospect of moving beyond eternal standoffs between opposing interest groups.  Clever engagements can bring specific goals within reach, even when collaborators do not share the same interests. Anna Tsing, a cultural anthropologist who studies out-of-the-way places in Indonesia, suggests that “collaborations create new interests and identities” but not always to everyone’s benefit. “Collaborations are the hopeful edge of a political project,” she insists.

Anthropologists have lately begun to reconfigure political relationships within the Ivory Tower by calling for new forms of collaboration. Biologists, who were regarded as “the enemy” of many cultural anthropologists during the Science Wars of the 1990s, have become allies. Moving beyond standoffs, anthropologists, biologists, and artists are using complimentary methods, tactics, and techniques to study contact zones where nature and culture meet.

Biological scientists, who are trained early in an ethos of collaborative research, have much to teach cultural anthropologists who are starting to co-author articles. The lexicon of theoretical ecology also offers rich resources to scholars in the fields of philosophy, anthropology, and cultural studies who seek to rethink collaboration. Symbiosis, in the eloquent prose of Lynn Margulis and Dorion Sagan, involves “the co-opting of strangers, the involvement and infolding of others.” These collaborative associations, in the mind of the philosopher Isabelle Stengers, involve beings with a mutual interest in the continued existence of one another. Beings co-invent one another when they reach symbiotic agreements by integrating “a reference to the other for their own benefit.”

Collaborations can produce transformative encounters, seductive moments that generate new entangled modes of coexistence. We live in multispecies worlds which involve “spaces of necessary sharing” to paraphrase Beth Carruthers. Critical friendships with biological scientists are important for anthropologists who seek to venture into these worlds. Reaching across conventional disciplinary divides, multispecies ethnographers are seeking out allies who share some of their interests, while actively creating new interests and identities.

Multispecies SalonAlliances with biologists and artists generated The Multispecies Salon, an art exhibit that traveled from San Francisco, to New Orleans, to New York City, and then became a collaboratively authored book. By dabbling in new fields as amateurs (de-skilling), and acquiring new specialized training (re-skilling), ethnographers who contributed to this collection responsibly entered new domains with help from collaborators. Artists also became authors, by experimenting with modes of making and writing culture. Hal Foster’s critical essay “The Artist as Ethnographer?” suggests that artists and ethnographers once envied each other. From the artist’s point of view, Foster claims, this envy stemmed from ethnographers’ ability to conduct contextual analysis, to forge interdisciplinary connections, and to engage in self-critique. On the flip side, Foster alleges that with the artist-envy of ethnographers, “The artist becomes a paragon of formal reflexivity, sensitive to difference and open to chance, a self-aware reader of culture understood as text.”

Getting past any feelings of envy that might have been present when Foster penned his critical intervention in the 1990s, artists and ethnographers at The Multispecies Salon initiated and sustained long-term collaborations based on shared aesthetic and critical sensibilities. Together these collaborators are repositioning biocultural elements in the field of anthropology—giving the discipline a push beyond anthropocentric concerns to interrogate posthuman modes of being.

Eben Kirksey is a permanent faculty member in Environmental Humanities at the University of New South Wales in Sydney, Australia. He is the author of Freedom in Entangled Worlds: West Papua and the Global Architecture of Power.

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Two Great Interviews

Dunham_cvr 978-0-8223-4599-2_Ho Listen to two great interviews with our authors. Maya Soetoro-Ng, daughter of S. Ann Dunham and sister of President Barack Obama, was interviewed this weekend by NPR's Guy Raz. She talks about her mother's book, Surviving against the Odds, about growing up in Indonesia and accompanying her mother on research trips, and about what their mother might have thought about her son becoming President. And on the BBC show Thinking Allowed, you can hear Karen Ho talk about her anthropological research in a very different locale: Wall Street. Ho took a job at Banker's Trust for a year and interviewed dozens of investment bankers for her book Liquidated: An Ethnography of Wall Street.

Dunham Launch Today

Dunham_cvr Everyone at the Press is excited for the big launch of S. Ann Dunham's Surviving against the Odds: Village Industry in Indonesia today. Dunham, the mother of President Obama, submitted her dissertation on metal workers in Java in 1992 and died before she she could get it published. Now, fourteen years after her death, we are proud to be bringing her important work to the public. The book is being launched today at the annual meeting of the American Anthropological Association. At noon there will be a press conference about the book and Dunham's work. Editors Alice Dewey and Nancy Cooper, Duke Press Editorial Director Ken Wissoker, University of Hawaii's Geoffery White, and Dunham's daughter Maya Soetoro-Ng will attend. The press conference is followed by a special Presidential Session on Dunham and her work. And later in the evening, Duke Press and the AAA host a reception and book signing. Of course the book will be on sale at Duke's booth in the exhibit hall throughout the conference. To read more about the book, check out this great Chronicle of Higher Education piece which includes interviews with Soetoro-Ng and Wissoker (subscription required) or this Publishers Weekly article.

Maya Soetoro-Ng on Diane Rehm Today

978-0-8223-4687-6 Today in the second hour of her program, Diane Rehm interviews Maya Soetoro-Ng, daughter of S. Ann Dunham and sister of President Barack Obama. Dunham died in 1995, before she was able to revise her dissertation, so Soetoro-Ng worked with editors Nancy Cooper and Alice Dewey to bring the work to publication. Surviving against the Odds: Village Industry in Indonesia is based on Dunham’s research over a period of fourteen years among the
rural metalworkers of Java, the island home to nearly half Indonesia’s
population. Soetoro-Ng will reflect on her mother's life and legacy and her own upbringing in Indonesia as the daughter of an anthropologist.

Sunday Times Returns to Java to Profile S. Ann Dunham

Javanese with Dunham book  The Sunday Times (London) sent reporter Christine Finn to Kajar, Java in Indonesia to revisit the site of S. Ann Dunham's research there. As you have read before on this blog, Dunham, who died in 1995, was President Barack Obama's mother. An anthropologist, she did her fieldwork on Javanese metal workers in the village of Kajar. Finn writes, "Dunham is still remembered in the central Javan hamlet of Kajar as a generous
benefactor whose gifts of money, food and schoolbooks helped numerous
villagers. Yet none of them had realised that the woman who paid several
visits to research rural crafts in the 1980s had a son who was to become
America’s 44th president." Duke will publish Dunham's dissertation, Surviving against the Odds: Village Industry in Indonesia next month.