Med Anthropol Q
· 2021 Jun · PMID 33866590
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The declaration of an overdose public health emergency in Vancouver has generated an "affective churn" of intervention across youth-focused drug treatment settings, including the expanded provision of opioid agonist ther...The declaration of an overdose public health emergency in Vancouver has generated an "affective churn" of intervention across youth-focused drug treatment settings, including the expanded provision of opioid agonist therapy. In this article, I track moments when young people became swept up in the momentum of this churn and the future possibilities that treatment seemed to promise. I also track moments when treatment and what happened next engendered a sense of stagnation, arguing that the churn of intervention ensnared many youth in rhythms of starts and stops that generated significant ambivalence toward treatment. The colonial past and present deepened this ambivalence among some Indigenous young people and informed moments of refusal. Youth's lives unfolded through but also around treatment programs, in zones of the city where drug use could generate a sense of momentum that was hooked not on futures, but on the sensorial possibilities of the now. [North America, overdose, drug treatment interventions, youth, affect].
Oocyte cryopreservation (i.e., egg freezing) is one of the newest forms of assisted reproduction and is increasingly being used primarily by two groups of women: (1) young cancer patients at risk of losing their fertilit...Oocyte cryopreservation (i.e., egg freezing) is one of the newest forms of assisted reproduction and is increasingly being used primarily by two groups of women: (1) young cancer patients at risk of losing their fertility through cytotoxic chemotherapy (i.e., medical egg freezing); and (2) single professionals in their late 30s who are facing age-related fertility decline in the absence of reproductive partners (i.e., elective egg freezing). Based on a binational ethnographic study, this article examines the significance of egg freezing among Jewish women in Israel and the United States. As they face the Jewish maternal imperative, these women are turning to egg freezing to relieve both medical and marital uncertainties. In both secular and religious Jewish contexts, egg freezing is now becoming naturalized as acceptable and desirable precisely because it cryopreserves Jewish motherhood, keeping reproductive options open for Jewish women, and serving as a protective self-preservation technology within their pronatalist social environments.
Med Anthropol Q
· 2021 Jun · PMID 33788964
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The following article discusses a collaborative, reenactment film made with the residents of a drug rehabilitation center in Iquitos, Peru. In so doing, it raises questions about narratives of recovery from addiction, an...The following article discusses a collaborative, reenactment film made with the residents of a drug rehabilitation center in Iquitos, Peru. In so doing, it raises questions about narratives of recovery from addiction, and the tensions that emerge between these narratives and the often-ambivalent feelings of the people who tell them. Practices of filmmaking and reenactment generate a collaborative theorization of lived experience-in this case, the multifaceted natures of both addiction and recovery. At the same time, these practices are also attentive to the embodied memories and complex feelings of the film's actors. Further engagement with the filmic materials demonstrates how the film became an active exploration of the ongoing nature of recovery, complicating the therapeutic trajectories of a group of actors struggling to reconcile ambivalent feelings as they attempt to craft new narratives of self.
Med Anthropol Q
· 2021 Jun · PMID 33715229
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Opioid abuse is an increasingly global phenomenon. Rather than assuming it to be a uniformly global or neoliberal pathology, how might we better understand comparative and locally specific dimensions of opioid addiction?...Opioid abuse is an increasingly global phenomenon. Rather than assuming it to be a uniformly global or neoliberal pathology, how might we better understand comparative and locally specific dimensions of opioid addiction? Working with neighborhoods as a unit of analysis, this article analyzes the striking differences between patterns of addiction and violence in two proximate and seemingly similar urban poor neighborhoods in Delhi, India. Rather than global or national etiologies, I suggest that an attention to sharp ecological variation within epidemics challenges social scientists to offer more fine-grained diagnostics. Using a combination of quantitative and ethnographic methods, I show how heroin addiction and collective violence might be understood as expressions of what Durkheim called "suicido-genetic currents." I suggest the idea of varying currents as an alternative to the sociology of neighborhood "effects" in understanding significant differences in patterns of self-harm and injury across demographically similar localities.
Med Anthropol Q
· 2021 Sep · PMID 33711178
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This article explores how inequities are reproduced by, and valued within, the increasingly ubiquitous world of medical crowdfunding. As patients use platforms like GoFundMe to solicit donations for health care, success...This article explores how inequities are reproduced by, and valued within, the increasingly ubiquitous world of medical crowdfunding. As patients use platforms like GoFundMe to solicit donations for health care, success stories inundate social media. But most crowdfunders experience steep odds and marginal benefits. Drawing on the problematic figure of the "black box" in health disparities research and technology studies, I offer ethnography as a tool for unpacking often inscrutable and complex pathways through which online platforms amplify inequities. By leveraging both online and traditional research strategies-a platform analysis and paired narratives of crowdfunders' disparate experiences, drawn from open-ended interviews-this article explores how inequities are created and experienced by users. The analysis highlights how inequities are simultaneously central to the functioning of this marketplace and occluded by its platform design. Consequently, crowdfunding is concealing health inequities while shifting public values about who is entitled to health care, and why.
Spray J, Carter CR, Waters EA
… +1 more, Hunleth JM
Med Anthropol Q
· 2021 Jun · PMID 33502761
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Recent health policy in the United States encourages an outsourcing of labor from professional practice into domestic spaces, where in theory, medical professionals supply the training, technologies, and guidance needed...Recent health policy in the United States encourages an outsourcing of labor from professional practice into domestic spaces, where in theory, medical professionals supply the training, technologies, and guidance needed to discharge responsibility for care to patients or caregivers. Mattingly et al. (2011) term this labor "chronic homework," describing the relationship between the assigning and undertaking of medical care at the borders of professional and domestic domains. This is a system predicated on relationships between professional and caregiver. However, in our research with families and providers in two U.S. sites, we observed a "disarticulation" of asthma care from professional medicine. Caregivers may undertake routine asthma management with little physician oversight, transforming chronic homework into what we term "disarticulated homework." We argue that expanding the concept of chronic homework to theorize disarticulation processes can help elucidate how health disparities are reproduced in the gap between medical systems and domestic life. [asthma, self-management, caregiving pharmaceuticalization, health disparities].
Med Anthropol Q
· 2020 Dec · PMID 33274530
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To date, the strongest predictor for dying with COVID-19 is suffering from several chronic disorders prior to the viral infection. Pre-existing multimorbidity is highly correlated with socioeconomic inequality. In turn,...To date, the strongest predictor for dying with COVID-19 is suffering from several chronic disorders prior to the viral infection. Pre-existing multimorbidity is highly correlated with socioeconomic inequality. In turn, having several chronic conditions is closely linked to multiple medication intake, especially in richer countries with good access to biomedical care. Owing to its vertical structure, biomedicine often risks giving multiple treatments in an uncoordinated way. Such lack of integrated care can create complex forms of iatrogenic harm. Multimorbidity is often exacerbated by a pharmaceuticalization of social deprivation in place of integrated care. In this article, I explore the possibility that clusters of over-medication are a contributing factor to higher death rates from COVID-19, especially in poorer areas within richer countries. Anthropological perspectives on the social embeddedness of multimorbidity and multiple medication use can expand our understanding of who is most vulnerable to SARS-CoV-2.
Med Anthropol Q
· 2020 Dec · PMID 33274529
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Old age has been central to public health rationalities and contestations of the 2019-2020 coronavirus pandemic. This article thinks through what age is and does in pandemic times by juxtaposing four domains of ethical p...Old age has been central to public health rationalities and contestations of the 2019-2020 coronavirus pandemic. This article thinks through what age is and does in pandemic times by juxtaposing four domains of ethical publicity in which age comes to matter: (1) mass fatality of old persons under conditions of variable unpreparedness; (2) circulation of social-Darwinist argument for herd immunity through culling of the weak; (3) everyday challenges of late life care as these are amplified under quarantine; and (4) long-term conditions of economic and political impasse and environmental collapse, experienced as failure of older generations and abandonment of younger ones, a situation here termed generational affect. It asks to what extent the figure of the cullable old renders racialized disparities natural and makes sense through a generational affect in which the world feels as if the survival of the young is in question.
Med Anthropol Q
· 2020 Dec · PMID 33274452
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This article looks at the use of public health strategies to define political membership in the nation. I examine the use of the cordon sanitaire to mitigate the novel coronavirus in Qatar. I argue that it acts primarily...This article looks at the use of public health strategies to define political membership in the nation. I examine the use of the cordon sanitaire to mitigate the novel coronavirus in Qatar. I argue that it acts primarily as a boundary to map out zones of political exclusion, splitting those who are entitled to protection from disease from those who are not. Through an analysis of the logic, application, and history of the cordon sanitaire in Qatar and elsewhere, I argue that it is only a more explicit example of the ways that governments have applied public health measures such that they apportion exposure to COVID-19, protecting some while mandating exposure for others. Exposure, or protection from it, has become a means to spatialize power and territorialize the national imaginary, separating full members from those who are excluded and reduced to their economic function.
Med Anthropol Q
· 2020 Dec · PMID 33210338
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The claim that anti-malaria drugs, chloroquine and hydroxychloroquine, can cure COVID-19 became a focus of fierce political battles that pitted promoters of these pharmaceuticals, Presidents Bolsonaro and Trump among the...The claim that anti-malaria drugs, chloroquine and hydroxychloroquine, can cure COVID-19 became a focus of fierce political battles that pitted promoters of these pharmaceuticals, Presidents Bolsonaro and Trump among them, against "medical elites." At the center of these battles are different meanings of effectiveness in medicine, the complex role of randomized clinical trials (RCTs) in proving such effectiveness, the task of medical experts and the state in regulating pharmaceuticals, patients' activism, and the collective production of medical knowledge. This article follows the trajectory of chloroquine and hydroxychloroquine as anti-COVID-19 drugs, focusing on the reception of views of their main scientific promoter, the French infectious disease specialist, Didier Raoult. The surprising career of these drugs, our text proposes, is fundamentally a political event, not in the narrow sense of engaging specific political fractions, but in the much broader sense of the politics of public participation in science.
Med Anthropol Q
· 2021 Jun · PMID 33174644
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Beginning in 2015, Brazil witnessed the births of thousands of children with neurological abnormalities linked to the Zika virus. Drawing on ethnographic fieldwork conducted between 2016 and 2018 with parents of children...Beginning in 2015, Brazil witnessed the births of thousands of children with neurological abnormalities linked to the Zika virus. Drawing on ethnographic fieldwork conducted between 2016 and 2018 with parents of children with congenital Zika syndrome in Salvador da Bahia, this article attends to how one of Brazil's most overused obstetric technologies-cesarean section-was mobilized to mitigate the uncertainties of Zika's reproductive consequences. I argue that during the epidemic, C-section constituted a form of what I call interventive care, in which others interceded on behalf of pregnant women to secure surgical delivery. In dialogue with scholarship problematizing autonomy in reproductive decision making, I show how my Bahian interlocutors understood such intercessions, and the C-sections themselves, as forms of appropriate, concerned care. I suggest, furthermore, that interventive care highlights the ways in which reproductive decisions are distributed among people rather than autonomous, particularly in contexts of heightened uncertainty.
This article examines incarceration as a chronic condition with social, biological, and psychological elements. We do so through the lens of "institutionalization," a concept that emerged during interviews conducted with...This article examines incarceration as a chronic condition with social, biological, and psychological elements. We do so through the lens of "institutionalization," a concept that emerged during interviews conducted with 26 people incarcerated in Washington state prisons as a chronic and often disabling state resulting from prolonged incarceration. We argue that institutionalization helps conceptualize how the social inequities of mass incarceration become embodied as health inequities, and how social harms become physical harms. [prison, incarceration, institutionalization, chronic, inequality].
Med Anthropol Q
· 2020 Dec · PMID 33161617
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"Plantation politics" pervade multiple institutions in the United States, including public health. Drawing from my experience working as a volunteer at drive-thru COVID testing sites in the United States, I critically ex..."Plantation politics" pervade multiple institutions in the United States, including public health. Drawing from my experience working as a volunteer at drive-thru COVID testing sites in the United States, I critically examine the relationship between public health, the military, and capitalism when racial slavery serves as the sociopolitical backdrop of everyday life. I ponder what it means for Black people to toil for a country, in the midst of an emergent communicable disease outbreak, that would weeks later launch into protests for and debates about their entitlements to freedom, safety, and security. Starting from experiences of Black women on the frontlines, I reveal complexities that underlie and undermine notions of care as altruistic, natural, or ethical "in the wake" of chattel slavery and in the midst of racial capitalism.
Carroll JJ, Lira MC, Lunze K
… +3 more, Colasanti JA, Del Rio C, Samet JH
Med Anthropol Q
· 2021 Jun · PMID 33152133
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Public narratives often attribute the opioid overdose epidemic in the United States to liberal prescribing practices by health care providers. Consequently, new monitoring guidelines for the management of opioid prescrip...Public narratives often attribute the opioid overdose epidemic in the United States to liberal prescribing practices by health care providers. Consequently, new monitoring guidelines for the management of opioid prescriptions in patients with chronic pain have become recognized as key strategies for slowing this tide of overdose deaths. This article examines the social and ontological terrain of opioid-based pain management in an HIV clinic in the context of today's opioid overdose epidemic. We engage with anthropological analyses of contemporary drug policy and the nonverbal/performative ways patients and clinicians communicate to theorize the social context of the opioid overdose epidemic as a "situation," arguing that the establishment of new monitoring strategies (essentially biomedical audit strategies) trouble patient subjectivity in the HIV clinic-a place where that subjectivity has historically been protected and prioritized in the establishment of care.
Anastario M, Arias Rodas MG, Escobar Arteaga MA
… +3 more, Villanueva C, Chacón Serrano F, Ferdowsian H
Med Anthropol Q
· 2021 Jun · PMID 33035383
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Diseases of the genitourinary system are the leading cause of hospital deaths in El Salvador, and chronic kidney disease of unknown origin has been gaining attention as a public health problem among farmers in particular...Diseases of the genitourinary system are the leading cause of hospital deaths in El Salvador, and chronic kidney disease of unknown origin has been gaining attention as a public health problem among farmers in particular. Epidemiological studies point, in part, to environmental risk factors, which have shifted over time with the deployment of modern agricultural science and ongoing climate change. We examined how diseases of the genitourinary system were situated at several margins of an epidemic in one rural Salvadoran municipality where these environmental and epidemiological changes are occurring, albeit relatively slow. By using this approach to study diseases of the genitourinary system, we illustrate one way in which shifting human/environment entanglements can be experimentally "known" in the context of human diseases associated with them. Our approach offers a unique perspective in thinking with ethnographic data to compliment ongoing epidemiological investigations of kidney disease in El Salvador.
Med Anthropol Q
· 2021 Jun · PMID 33029848
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"End of AIDS" requires ambitious testing, treatment, and adherence benchmarks, like UNAIDS' "90-90-90 by 2020." Mozambique's efforts to improve essential maternal/infant antiretroviral treatment (ART) exposes how austeri..."End of AIDS" requires ambitious testing, treatment, and adherence benchmarks, like UNAIDS' "90-90-90 by 2020." Mozambique's efforts to improve essential maternal/infant antiretroviral treatment (ART) exposes how austerity-related health system short-falls impede public HIV/AIDS service-delivery and hinder effective maternal ART and adherence. In therapeutic borderlands-where household impoverishment intersects with health-system impoverishment-HIV+ women and over-worked care-providers circumnavigate scarcity and stigma. Worrisome patterns of precarious use emerge-perinatal ART under-utilization, delayed initiation, intermittent adherence, and low retention. Ending HIV/AIDS requires ending austerity and reinvesting in a public sector health workforce to ensure universal health coverage as household and community safety nets.
There is a growing anthropological literature analyzing the place that epidemiological surveillance occupies in contemporary global health. In this article, I build on this literature and take it into new directions by e...There is a growing anthropological literature analyzing the place that epidemiological surveillance occupies in contemporary global health. In this article, I build on this literature and take it into new directions by exploring what I call the epidemiological imaginaries of the social. Drawing on science and technology studies, I suggest that epidemiologists help make up the world, articulating complex and normatively loaded visions of social life that both enable and constrain action. More specifically, I argue that epidemiologists tell stories about the type of societies and people that compose the world and that these stories often shape global health policies and programs in powerful ways. To substantiate this argument, I examine epidemiologists' efforts to map smoking in postcolonial Africa, documenting how they have imagined smokers and smoking through the lense of modernization theory and showing how these imaginaries have shaped tobacco control policies in the region up to this day.
Med Anthropol Q
· 2021 Mar · PMID 32812269
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Based on ethnographic research in a public hospital trauma intensive care unit in Mumbai, India, this article formulates the concept of "social breathing" to analyze how breath is central to values of life at the edges o...Based on ethnographic research in a public hospital trauma intensive care unit in Mumbai, India, this article formulates the concept of "social breathing" to analyze how breath is central to values of life at the edges of death. Case studies of emergency resuscitation, intubation, and ventilation each illustrate breathing's sociality, as people and machines move air both materially and immaterially. Amid the hospital's rationing of life support technologies, forms of life that seem to be self-regulated are better understood as relational movements of breath. Social breathing stands to reshape our understanding of the biopolitics of intensive care by drawing attention to uncertain techniques of the body. These techniques move at the hinge between person and environment, self and other, public and private health care systems, and medicine and machine. Life's valuation at this hinge takes shape through breath moving against its limits. Ultimately, the article argues that it is crucial to understand how ventilators mediate the edges of life and death by tracing the circulations of life support as the movements of life itself. As patients, families, and hospital workers struggle to make and manage breath, we might better grapple with the social relations that emerge as life support shapes life.
Med Anthropol Q
· 2021 Mar · PMID 32812236
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As a therapeutic practice of care, "watchfulness" (Garcia 2010) implies a vigilant responsibility and constant mindfulness of others; in Hawaii, this is captured in the concept of aloha. This article explains how watchfu...As a therapeutic practice of care, "watchfulness" (Garcia 2010) implies a vigilant responsibility and constant mindfulness of others; in Hawaii, this is captured in the concept of aloha. This article explains how watchful care with aloha is discussed and mobilized in community suicide prevention in Hawaii. Rates of suicidality and suicide attempts in the state are high, among young people in particular. My ethnographic research follows a network of workers and volunteers as they incorporate local understandings of aloha into suicide prevention outreach. Following a history of aloha's meanings and (mis)uses in and beyond Hawaii, I draw on ethnographic examples to reveal how care with aloha prioritizes personal connection and individuality, rather than being rhetorically detached or "anonymous" (Stevenson 2014). But as my central vignettes reveal, there are difficulties in the implementation of this kind of watchful care, which ultimately question its utility in suicide prevention.