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..
