Quotes from Medical Anthropology: A Biocultural Approach, by Andrea Wiley and John Allen


- ‘Medical anthropologists work to understand the diverse factors influencing variability and universality in health and disease experiences across human populations and across time.’ (2)
- ‘Biocultural analysis considers the individual body as a starting point.’ (7)
- ‘Clinical biomedical understandings of disease tend to privilege the body as the only relevant ‘environment’ for the understanding of disease causation, and individuals are perceived as uniquely responsible for their health.’ (7)
- ‘In a famous pronouncement from the Alma Ata conference in 1978, the World Health Organization, the international organization based in Geneva, Switzerland that oversees health problems and interventions around the world, defined health as ‘a state of complete social, psychological, and physical well-being.’ ’ (10)
- ‘Illness complaints re what patients and their families ring to the practitioner. Indeed, locally shared illness idioms create a common ground for patient and practitioners to understand each other in their initial encounter…Disease, however, is what the practitioner creates in the recasting of illness in terms of theories of disorder.’ Kleinman (12)
- ‘When chest pain is reduced to chronic coronary artery disease for which calcium blockers and nitroglycerine are prescribed, while the patient’s fear, the family’s frustration, the job conflict, the sexual impotence, and the financial crisis go undiagnosed and unaddressed, [the treatment] is unsuccessful.’ Kleinman (13)
- ‘People with well-developed sources of social support often get sick less, recover faster, or live longer than those with less support. A study by Lisa Berkman, a public health researcher who pioneered the study of social support and health, and colleagues found that the risk of dying from any condition was inversely related to the extent of an individual’s social support.’ (15)
- ‘One of the hallmarks of anthropology is the concept of ‘cultural relativism’ – the idea that the elements of each culture must be understood on their own terms, without evaluations based on norms derived from other cultures. However, if a particular practice (such as female genital cutting…) is physically deleterious or painful, yet enhances a person’s social or psychological well-being, is this practice ‘healthy’?’ (16)
- ‘It should not be assumed that poor health in one population is just an intrinsic part of that culture, such that there is little to be done about it without ‘disrupting’ the integrity of that culture.’ (16)
- ‘What people with poor health tend to have in common around the world is poverty.’ (16)
- ‘A separation of the mind and body, the legacy of Rene Descartes’ attempt to separate the ‘intangible mind’ from the material body, has resulted in the latter being privileged over the mind in the search for the cause of a particular ailment.’ (17)
- ‘The extent to which people recognize social or even psychological phenomena to be aspects of health is highly variable across cultures. That is, health may be viewed as an exclusively somatic state rather than a characteristic of society.’ (17)
- ‘Sometimes called the political economy of health or critical medical anthropology, this perspective examines power differentials and their impact on health.’ (26)
- ‘Endemic – a disease that has a long history in the population, with little change in either prevalence or incidence over time. Epidemic – a disease that dramatically increases its incidence and prevalence in a short period of time…Pandemic – an epidemic that occurs on a global scale.’ (33)
- ‘Morbidity refers to disease: rates of morbidity describe the prevalence of a disease in a population. Mortality refers to death.’ (33)
- ‘Acupuncture involves the insertion of fine needles through prescribed points in the skin and then rotating them at specific rates…Classic acupuncture identifies about 365 points on the body distributed along 14 main channels (or meridians, through which qi flows); a typical acupuncturist uses only about 150 of these points. During a treatment, between 5 and 15 needles are inserted. Although the insertion of needles is classic acupuncture treatment, manual pressure may also be applied at these points.’ (51-52)
- ‘In terms of clinical treatment, the use of acupuncture for a variety of pain, including severe, chronic conditions, is reasonably well-established, and functional brain imaging shows that acupuncture stimulates patterns of brain activation in pain modulating areas that are not activated in control conditions mimicking acupuncture.’ (53)
- ‘Acupuncture has achieved somewhat mainstream status in American culture. More than 40 states license acupuncturists as independent health care professionals, and there are approximately 11 thousand nonphysician acupuncturists in practice. An acupuncturist’s education typically consists of two thousand to three thousand hours of training at an accredited school leading to the awarding of a master’s degree.’ (53)
- ‘Chiropractic treatment is quite literally hands-on, based on a procedure known as spinal manipulation or chiropractic adjustment. The focus of chiropractic treatment is impaired mobility of joints, which may result from a traumatic injury or repetitive strain. By manually manipulating these joints and surrounding structures, chiropractors seek to restore mobility and thereby reduce pain and discomfort. Chiropractic treatment is generally drug-free, which is undoubtedly part of its appeal to many patients who choose it over standard biomedical treatment…Given that it represents the largest nervous structure and center of the nervous system, the spine became the focus of chiropractic treatment.’ (54)
- ‘ Studies like the one conducted at UCLA, which show little difference between medical and chiropractic care, support the notion that medical consumers should be allowed to make a choice in the kind of care they receive, at least in treatment of lower back pain. After all, alternative forms of medicine need not exceed standard medical practice to justify their existence.’ (55)
- ‘Here, as in many other countries, a person’s organs are available for ‘harvesting’ once brain death has occurred, and if there is approval for the procedure indicated by the individual before becoming dead (e.g., via a donor card) or by the family. The neurological definition of brain death is based on several criteria. The individual must be in a coma (persistently unresponsive to stimuli) and unable to breathe on his or her own (i.e., on a ventilator). There is no response to stimuli in the head – pupils unresponsive, no sign of gagging, suckling, or swallowing, and so on. Spinal reflexes may be present in the limbs. Blood circulation may be intact and the body temperature should be normal (i.e., if someone’s condition involves being exceptionally cold, body temperature needs to return to normal before he or she can be declared brain dead). Acute drug intoxication must be ruled out (i.e., a negative drug screen should be obtained). There are various time requirements for the absence of vital signs depending on the age of the individual (ranging from 6-48 hours). There should be no electrical activity in the brain. Brain death should be differentiated from vegetative state, in which a person (usually following massive cerebral injury leaving the brain stem intact) maintains cardiorespiratory function, sleep-wake cycles, and some responses to external stimuli, but in the absence of consciousness or any sign of voluntary activity. In contrast to vegetative state, locked-in syndrome occurs with certain kinds of strokes in the brain stem, which results in paralysis of the entire body, while retaining cardiorespiratory function and some control of eye movement and blinking. Individuals with locked-in syndrome are fully conscious and can communicate by blinking or moving their eyes.’ (60-61)
- ‘Although the practice of recovering organs from brain-dead individuals for transplantation is widely accepted in most industrialized countries where biomedicine is dominant, there are some cultures that have not embraced this practice. Among Jews, especially orthodox Jews, it is thought to be essential that the body of the deceased is buried intact, hence the great efforts seen in Israel following terrorist attacks to recover all bodily remains no matter how miniscule.’ (61)
- ‘Japanese views of death are shaped by the state religion, Shinto, and also by Taoist, Confucian, and Buddhist principles and practices. Shintoism places a primacy on the preservation of life. However, the beating heart is taken to be the primary sign of life, hence to remove it or other vital organs would be precipitating death unnaturally.’ (62)
- ‘In Japan, stem cell research, including therapeutic cloning, can be pursued quite freely.’ (63)
- ‘Medical observers from other countries suggest that Americans believe that their bodies, like their cars, should always work. Hence the American invention of the annual checkup, sort of like a tune-up for the body, which is generally not part of medical practice in other countries.’ (66)
- ‘American physicians are much more likely to attempt heroic measures to keep patients with terminal illnesses alive; hospice care was developed relatively late in the United States compared to other countries and palliative medicine is relatively undeveloped in the United States.’ (66)
- ‘Clinicians have long noticed a specific kind of self-healing, which occurs following the administration of a placebo to a patient.’ (67)
- ‘The limited time course of placebo effectiveness is indicated by an old piece of medical advice to doctors, which states that they should not prescribe a placebo for too long a period to a patient. It may seem odd to think that a doctor would actually prescribe a placebo, but think of the millions of prescriptions of antibiotics that are handed out every year in the United States for the treatment of colds and sore throats that are known to be caused by a virus.’ (67)
- ‘Effects can be positive, which result in what we usually think of as the placebo effect. When they are negative, then there is a nocebo effect.’ (67)
- ‘Social psychologists have also shown that it is not hard to manipulate subjects to have negative responses to inert substances, if they are previously encouraged to have negative expectations about the substances.’ (68)
- ‘ ‘Big pharma,’ as it is sometimes called, currently spends about $3 billion on media advertising and $7 billion on its sales force every year; the nine largest pharmaceutical firms spend 2.5 times as much on marketing as on research and development.’ (69)
- ‘Formal training in nutrition is not generally part of medical school curricula, despite the clear importance of nutrition to health.’ (71)
- ‘Up to 20 percent of [caloric intake] goes to fuel our large brain [sic]!’ (72)
- ‘The vitamins are divided into those that are water-soluble (the B vitamins and Vitamin C), and those that are fat-soluble (A, D, E, K). Many of the B vitamins are involved in energy metabolism, a complex set of cycles requiring numerous enzymes and cofactors that include these vitamins. Vitamin B-1 is of particular interest, as it is found only in animal foods, and requires a special mechanism, the Intrinsic Factor, for absorption in the stomach.’ (73)
- ‘At high latitudes it may not be possible to synthesize sufficient Vitamin D during the winter months, as the sun’s rays are not sufficiently powerful to induce the conversion, but because Vitamin D is stored to a limited degree, this is not necessarily problematic.’ (73)
- ‘After two to three hours [in the stomach], the resulting material (chime) is sent into the small intestine. Most of the work of digestion is done within the small intestine. Here digestive enzymes (many coming from the pancreas) interact with food complexes to break down starches, complex sugars, fats, and proteins into their component parts, which can then be absorbed by the cells that line the small intestine. The remaining undigestible material continues on to the large intestine (colon), where water is absorbed along with the products of bacterial fermentation (such as volatile fatty acids), and other remaining biochemicals. The colon has large colonies of bacteria, most of which are quite helpful in that they can ferment some fibrous material that humans cannot break down with their own digestive enzymes. Treatment with broad-spectrum antibiotics often kills these bacteria, resulting in symptoms of diarrhea or gastrointestinal discomfort.’ (77)
- ‘Excess fats are stored, and excess sugar can be converted to adipose tissue (fat) as well. In contrast, the body has a limited capacity to store protein, minerals, or water-soluble vitamins, so surpluses of these are excreted in urine. This is one reason why there is little evidence to suggest that megadoses of most water-soluble vitamins (such as Vitamin C) or minerals are beneficial with respect to preventing the common cold or chronic disease.’ (78)
- ‘In response to low intake of nutrients, there are several adaptive physiological responses: more efficient absorption, conservation, mobilization of stores, or breakdown of active body tissues (e.g., muscle for protein) and prioritization of nutrient flow to more critical organs such as the brain.’ (78)
- ‘Cardiovascular disease can include any dysfunction in the heart or circulatory system, but the most common is atherosclerosis, or hardening of the arteries due to plaque buildup or inflammation.’ (86)
- ‘Because Homo sapiens evolved primarily under hunter-gatherer conditions, a diet characterized by a great diversity of wild plant and animal foods, and limited in sugars, fats, and salt, is that to which our bodies are well adapted.’ (88)
- ‘Reducing death from chronic disease is likely to have only a modest effect on life expectancy, with some estimates of four years or so if all of the major known risk factors for the leading chronic diseases were eliminated.’ (89)
- ‘The WHO currently estimates that one billion people in the world are overweight, and some three hundred million are obese.’ (89)
- ‘High levels of sugar and saturated fats, combined with reduced physical activity, have led to obesity rates that have risen threefold or more since 1980 in some areas of North America, the United Kingdom, eastern Europe, the Middle East, the Pacific Islands, Australia, and China…The obesity epidemic is not restricted to industrialized societies. Obesity prevalence is high in many developing countries, where is often coexists with undernutrition.’ (90)
- ‘In the United States, about 16 percent of all children and adolescents are considered overweight or obese, and this is two to three times higher than its prevalence in 1980.’ (90)
- ‘What else has contributed to this rise in obesity, especially in children? Increasing numbers of studies are pointing to the influence of advertising, especially that of high-calorie foods marketed to children in television programming; ‘pouring’ contracts in schools whereby soft drink companies have been allowed to put vending machines in schools in exchange for financial support or educational materials; reduction in physical activity programs in school or safe places for children to engage in such activities outside of school; the decline in home-prepared foods and ‘family dinners’ concurrent with the spread of fast-food restaurants in which calorie-dense foods predominate on the menu; large serving sizes of home meals and those served at restaurants; and the disproportionate amount of space in grocery stores devoted to foods that dietary guidelines suggest should be consumed ‘sparingly’…These are especially relevant for individuals living in working-class urban areas where caretakers work long hours and where there is limited access to fresh foods and large grocery stores, and a high density of fast-food restaurants.’ (94)
- ‘Obesity seems to ‘spread’ through social networks. The researchers found that if one person in a social network was obese there was an increased possibility that others in the network would also become obese (while controlling for numerous other environmental factors), even if members of the network were not geographically close.’ (94)
- ‘Obesity has social roots that need to be addressed as part of any sort of ‘treatment’ program.’ (95)
- ‘It is notable that obesity in the United States is more common among groups of lower socioeconomic status and minorities (the two categories often go together in the United States) such as African Americans, Native Americans, Hispanics, and Mexican Americans.’ (95)
- ‘Insulin, a hormone produced in the pancreas, is released as soon as glucose enters the bloodstream after a meal, and it stimulates the uptake of glucose by muscle, fat, and other cells, and the conversion of glucose into glycogen in the liver.’ (96)
- ‘There are two major types of diabetes. In diabetes mellitus Type I (also called insulin-dependent diabetes), the problem derives from reduced insulin production and release by the pancreas. Current research suggests that this can be triggered by an infection, which stimulates an immune response that destroys the insulin-producing beta cells and renders them incapable of producing insulin. This type of diabetes typically starts during childhood.’ (96)
- ‘Much more common is Type II diabetes mellitus, or non-insulin-dependent diabetes mellitus. NIDDM appears to derive from altered cellular responses to insulin. Cells that are the target of insulin (such as fat or muscle cells) become resistant to it, and more and more insulin is required to stimulate those cells to take up glucose. This can happen as a consequence of repeated insulin stimulation, as in a high glucose diet, or as a consequence of reduced cellular need, as in a lack of activity. This type of diabetes is generally manageable or reversible. Reduced intake of sugars, or other foods that increase blood sugar or insulin levels, combined with increases in physical activity, can reverse insulin resistance.’ (96)
- ‘It is estimated that 10 percent of all Americans over the age of 20 years have NIDDM. Rate among blacks and Hispanics are about 18 percent, and over 20 percent in Native Americans and Asian Americans and Pacific Islanders.’ (96)
- ‘No gene associated with vulnerability to Type II diabetes has been located.’ (98)
- ‘[In the US,] high fructose corn syrup intake has increased more than one-thousand fold since 1970, and now makes up over 40 percent of added sweeteners in foods. Fructose does not generate an insulin spike like glucose does, but it is preferentially stored as fat. It also does not stimulate the production of the hormone leptin, which, like insulin, promotes the sensation of satiety. Furthermore, there is evidence that calories from drinks do not promote the same sense of satiety as do those from solid foods. Thus Bray et al. suggest that HFCS is responsible, in part, for the epidemic of obesity, which began at about the same time that HFCS entered the diet, a claim that soft drink makers, in particular, object to vigorously.’ (99)
- ‘The ‘shutting off’ of lactase [enzyme that breaks down lactose] production occurs independently of the presence of milk in the diet; that is, it can not be kept on simply by continuing to consume milk.’ (100)
- ‘A small number of human populations are exceptions to the basic mammalian pattern in that they continue to produce lactase in adulthood (i.e., they are lactase persistent) and hence relatively few individuals in these populations suffer from lactose intolerance. Why do populations vary in this way? One attribute of all populations with high rates of lactase persistence is a history of keeping domestic animals such as cows, goats, or sheep for their dairy products.’ (100)
- ‘The assumption that European physiology is the healthy norm for the species remains widespread.’ (102)
- ‘This assumption also plays out in the donations of milk to populations experiencing food scarcity. Anthropologist Marvin Harris described his experience in Brazil in the early 1960s when the United States sent some 88 million pounds of powdered milk to Brazil as part of a Food for peace program. Many Brazilians complained that the milk gave them upset stomachs and diarrhea, much to the disbelief of American officials, who suggested that they must have been preparing it improperly.’ (102)
- ‘Hypertension is generally defined as having a blood pressure greater than 140/90 mm Hg.’ (102)
- ‘Although rising blood pressure is often seen as an ‘inevitable’ part of aging, this pattern is not universally found among the world’s populations, but is instead common to wealthy societies.’ (102)
- ‘One last example of human biological variation that is related to diet and often manifests clinically is celiac disease, also called celiac sprue, or gluten-sensitive enteropathy. Celiac disease is an immunologically mediated sensitivity to gluten, a protein found in wheat, rye, oats, barley and buckwheat. When individuals with celiac disease consume these foods, their immune system responds by damaging or destroying the villi, the cells that line the small intestine and that are responsible for the absorption of nutrients. Celiac disease is considered an autoimmune disorder, meaning that gluten stimulates the body’s immune system to attack its own, often in this case the villi of the small intestine. The resulting symptoms include those associated with malnutrition, as the villi become inefficient at absorbing nutrients, but also gastrointestinal pain and discomfort, dermatitis, and irritability.’ (103-104)
- ‘It is estimated that 10 percent of recognized pregnancies end in spontaneous abortion during the first trimester. Around 50 percent of all fertilizations end very early, before a woman even recognizes that she is pregnant, and these are most often due to genetic abnormalities of the zygote.’ (109)
- ‘The frequency of genetic mutations increases with maternal age.’ (109)
- ‘Folate, which is found in white grains, legumes, and dark green leafy vegetables, is essential to embryological development, especially the enclosure of the spinal cord. Folate deficiency is responsible for most cases of the congenital disease spinal bifida, a condition in which the spinal cord remains exposed.’ (109)
- ‘By the start of the second trimester, tissue differentiation is largely complete, and the embryo is now considered a fetus.’ (109)
- ‘Specific outcomes for individuals with fetal alcohol syndrome can include the following: Small size for gestational age or small status in relation to peers, facial abnormalities such as small eye openings, poor coordination, hyperactive behavior, learning disabilities, developmental disabilities (e.g., speech and language delays), mental retardation or low IQ, problems with daily living, poor reasoning and judgment skills, sleep and sucking disturbances in infancy.’ (110)
- ‘Worldwide rates of FAS range from a low of 0.5-2 per 1,000 birth in the United States, to a high of 39-46 per 1,000 births in South Africa…Although the rate in the United States is quite low, it is much higher than that of European countries, despite lower overall levels of alcohol consumption.’ (110)
- ‘About 80 percent of the newborn’s weight is accumulated during the third trimester. Restriction of calorie intake during this time will likely reduce the weight of the newborn.’ (111)
- ‘Birthweight is a commonly used measure of a newborn’s health status. It is a measure of the resources that an infant is born with and a predictor of its survival chances, with both very small and very large babies having higher rates of death than babies weighing around the average.’ (111)
- ‘The WHO is most concerned with the prevalence of babies of low birthweight, which is defined as a weight less than 2,500 grams (~5½  pounds). WHO estimates that more than 20 million infants worldwide, representing 16 percent of all births, are of low birthweight, 96 percent of them in developing countries. The level of low birthweight in developing countries (17 percent) is more than double the level in developed regions (7 percent).’ (113)
- ‘Newborns of recent migrants to high-altitude locales appear to suffer a greater decrease in birthweight than do those born to women native to high altitude.’ (114)
- ‘Newborns with low birthweight are more likely to die from coronary heart disease and develop Type II diabetes.’ (116)
- ‘The brain in particular grows very rapidly, and reaches more or less adult size by about five years of age. It requires between 40 and 85 percent of a young child’s metabolic needs, and therefore the diet of infants and young children needs to be energy dense.’ (117)
- ‘About 70 percent of women in the United States initiated breastfeeding, but only 33 percent were still nursing by four to six months of age. This rate of initiation is low compared to other industrialized and nonindustrializd countries, although the rate of continuation is higher than what is found in many other contexts. The reasons for early weaning or noninitiation of breastfeeding include maternal return to the workforce, lack of information on how to breastfeed successfully, lack of social support for breastfeeding, and easy availability and widespread promotion of infant formula.’ (117-118)
- ‘As an infant ages, his or her nutrient needs begin to outstrip that provided by breastmilk alone. This happens by around six months of age. Because infants of this age have very few or no teeth, they need foods that are soft and easily digestible and also free of contaminants. The introduction of ‘solid’ foods and a decreased reliance on nursing begins the process of weaning. Although technically weaning refers to the complete cessation of nursing, it is better to view it as a process that begins with the first supplementation. The duration of this process can be very short to several years.’ (119)
- ‘Once a child has successfully weathered the transition to adult foods, he or she enters childhood, a period of relatively slow growth that ends with the initiation of puberty. From a health perspective, this is a rather quiescent time. Generally speaking no new health challenges emerge, dietary and immunological capabilities have matured to an extent that most routine infections are not life threatening, and diet is sufficient to meet their needs.’ (120)
- ‘From the 19th century through the 1930s, American men (of European descent) were the tallest in the world, at ~174 centimeters (5’8”) while Dutch men were 165 centimeters (5’5”) at that time, among the shortest in Europe. Currently Dutch men are the tallest in the world at 184 centimeters (just over 6’), and European-American men are about 179 centimeters (5’10”).’ (120)
- ‘There are noticeable differences in height between the rich and the poor in the United States, with the richer members of the country averaging about one inch more in height than the poor.’ (121)
- ‘Evidence accumulated on the milk-height relationship has not provided unequivocally strong support for a positive effect of milk on growth. It appears that milk may have its most significant effects among children with existing undernutrition, but few studies have compared milk consumption to supplements of other nutrient-rich foods to ascertain whether milk has ‘special’ growth-enhancing properties.’ (126)
- ‘The average age [of first period] in the United States currently is about 12.5 years, with a substantial amount of variation around this mean. About 10 percent of girls have reached menarche by age 11, and over 90 percent before age 14.’ (128)
- ‘The long-term health consequences of early menarche include both cardiovasacular disease and cancer. The former stems not specifically from early menarche per se, but from its frequent antecedents: overweight or obesity, high fat content of childhood diet, and high intake of animal protein (often associated with saturated fats). However, the association of early menarche with cancer is more closely related to the hormone estrogen.’ (129)
- ‘By about age 14, boys’ growth exceeds that of girls.’ (131)
- ‘The aspect of air quality that was most significantly associated with reduced birthweight was the amount of particulate matter that a pregnant woman was exposed to over the entire course of the pregnancy.’ (134)
- ‘There is ample evidence of an association between urban air pollution and compromised lung function in children, manifesting most often as asthma.’ (134)
- ‘When linear growth stops and organ systems are fully functional (mature), the life stage of adulthood has been reached. From a health perspective, the risk of most health problems is low at this point.’ (135)
- ‘Menarche signals the onset of ovulation, but regular patterns of ovulation take some time to get established, and so fecundability (the ability to conceive) tends to be low for some time after menarche. Furthermore, the pelvis continues to grow, and full reproductive maturity tends to occur when the pelvis reaches its adult size and regular ovulatory cycles are established.’ (140)
- ‘Across cultures menstruation is subject to varying valuation. In some it is considered a time when women are polluted, and menstrual blood itself is considered the source of that pollution. This is particularly true in India, where women cannot prepare food for others or engage in other domestic activities during their periods.’ (143)
- ‘Side effects such as breakthrough bleeding, nausea, headaches, mood changes, libido changes, and breast tenderness often lead women to discontinue oral contraceptive usage, although family planning policy analysts often trivialize these concerns. Virginia Vitzthum and Karen Ringheim argued that these may be much more common among women in less developed countries in part because their hormone profiles are lower than those in Western populations, yet the dosage of oral contraceptives that they are given is the same. In Bolivia, where Vitzhum has conducted long-term fieldwork on reproductive ecology, there is a 59 percent discontinuation rate for oral contraceptives, of which over 60 percent was attributed to side effects. Doctors often discount the severity of these side effects, yet they likely stem from the relative ‘overdose’ of hormones in oral contraceptives given to women with lower circulating levels of these hormones.’ (145)
- ‘For some women menstruation is painless, but for others it is accompanied by severe cramping from uterine contractions and substantial discomfort. In addition, some women experience a wide range of negative emotional symptoms just prior to the onset of menses, which now has a recognized medical term – premenstrual syndrome (PMS). It is not known with any certainly why women vary so much in this experience of their menstrual cycles. Dysmenorrhea, or having painful periods, is characterized by cramping, backache, bloating, or any combination of these, and is fairly universally recognized, if not experienced with every period.’ (146)
- ‘Menopause generally occurs around 50 years of age.’ (148)
- ‘Across populations, especially those that do not make extensive use of contraceptives, the most important factor that influences a women’s likelihood of getting pregnant again is the duration of lactational infecundability. Women are all infertile for a few weeks after birth until ovulation can be reestablished, but this period of time can be greatly lengthened by nursing.’ (149)
- ’85 percent of infertility in developing countries and 40 percent in industrialized countries can be attributed to STDs.’ (151)
- ‘Although males are certainly responsible for, or contribute to over half of the cases of infertility, interventions to improve a couple’s fertility inevitably target women. When it is not possible to ascertain the source, because it is females who do or do not get pregnant, women are most often blamed for a couple’s inability to produce a child.’ (151)
- ‘The WHO definition of infertility is the absence of conception after 24 months of regular, unprotected intercourse.’ (152)
- ‘Infertility affects 8 to 12 percent of all couples worldwide, with a wide variation across populations. It is estimated that about 5 percent of all couples have some unpreventable condition that inhibits their ability to conceive.’ (152)
- ‘Childless couples are subject to various forms of social stigma, marital instability, uncertain personal and social identity, and personal anguish as their desires to become parents are unfulfilled. They are often unable to afford assisted reproduction, which is made use of disproportionately by which, older, affluent urban couples.’ (155)
- ‘The prevalence of erectile dysfunction range from 7 percent in men aged 18 to 29 years to 85 percent in men aged 76 to 85 years.’ (157)
- ‘The prevalence of any form of genital cutting among females ranges from about 20 percent in Tanzania, Senegal, Cameroon, and Niger, up to over 90 percent in Egypt, Mali, Sierra Leone, Somalia, and the Sudan, with substantial variation by ethnic group. FGC is also found in areas of the Middle East, Malaysia, and Indonesia.’ (159)
- ‘The WHO classifies the potential effects into short-term consequences, such as pain, infection, or hemorrhage, and long-term complications such as difficulty in urination, urinary tract infections, menstrual difficulties, scarring, cysts, painful sex or sexual dysfunction, problems with pregnancy and birth, and emotional and sexual suffering. Existing data do suggest that these complications sometimes occur, but on the order of 2 to 20 percent of the time. It would seem that reduced sexual pleasure would result from any form of genital cutting, yet surveys routinely find that although some women report diminished sexual pleasure, others report either no difference or heightened sensation after such a procedure.’ (159)
- ‘Rates of nausea and vomiting in pregnancy appear to vary widely across populations, with 35 to 85 percent of women reporting that they experience it.’ (161)
- ‘NVP (sometimes also called ‘morning sickness’ although it is not confined to the morning hours), which is characterized by food aversions, nausea, and vomiting, is related to the high sensitivity of the embryo to toxins…it may be a sign of healthy embryological development, and attempts to stop it through medical interventions (e.g., antinausea drugs) may undermine its adaptive attributes.’ (161)
- ‘The focus of most food aversions of early pregnancy tends to be animal products, which would be more likely sources of infectious pathogens rather than plants.’ (162)
- ‘Cravings for and consumption of specific kinds of clay during the first trimester of pregnancy may also be beneficial. Clay consumption is surprisingly widespread, occurring in cultures throughout the world. Most of the work done on clay consumption in pregnancy has focused on the practice in sub-Saharan African societies and among African Americans in the United States. Because clays have a large surface area, they have the ability to bind foodborne toxins, thereby preventing them from being absorbed into maternal circulation…Because  they have these properties, kaolinic clays are important components of many over-the-counter antidiarrheal and antinausea medications. Clay consumption may play another role in pregnancy as a dietary supplement – many clays that women report craving have relatively high calcium concentrations.’ (162)
- ‘Most hospital births have women laying down during labor and delivery, whereas a more upright or squatting position would allow for an easier passage down the birth canal with the assistance of gravity.’ (168)
- ‘As occurred in Europe and the United States, traditional midwives are being replaced by medical birth ‘authorities’ with professional degrees, specialized knowledge, intensive and expensive interventionist technologies, and a set of expectations about what constitutes a ‘normal’ or ‘appropriate’ birth. The more informal knowledge and experience of midwives is discounted as ‘old fashioned’ and, more damningly, ‘dangerous.’ With the ascendancy and professionalization of obstetrics in the late 19th and early 20th centuries, midwifery was outlawed in many states in the United States, and home deliveries by midwives continue to be illegal in some areas.’ (171)
- ‘In their 2005 World Health Report, WHO reported that training programs for traditional birth attendants, which they had advocated in the 1970s, had largely failed to have any positive impact on improved birth outcomes.’ (171)
- ‘Infant-parent (usually mother) cosleeping is the norm in most societies, and those where cosleeping is not common are those that also have the highest rates of SIDS (the United States, European countries, Australia, New Zealand).’ (173-174)
- ‘In contrast to evolutionary-based hypotheses that view menopause as adaptive or as an evolutionary by-product, biomedical views of menopause tend to pathologize the cessation of ovulation. Menopause has become an ‘estrogen deficiency disease’ due to ‘ovarian failure’ and ‘treated’ with hormone replacement therapy. Initially only estrogen was used, but it was associated with an increased risk of endometrial cancer, and in the 1980s a new form of HRT was developed in which estrogen was combined with progestin, and this appeared to be protective against endometrial cancer.’ (177)
- ‘Recent findings have altered the medical recommendations for HRT, such that only women for whom menopausal symptoms are bothersome or debilitating are recommended HRT, and then only at the lowest effective dose for the shortest period of time.’ (178)
- ‘The link between the number of ovulations and breast cancer is through the hormone estrogen. Most breast cancers are estrogen-dependent; that is, they are more likely to occur and grow more rapidly in the context of high levels of estrogen.’ (178)
- ‘One result of having early menarche, few births relatively late in life with little or no breastfeeding, and prolonged estrogen exposure due to HRT or late menopause is that contemporary women in industrialized societies have relatively high rates of breast cancer.’ (178)
 - ‘Male pattern baldness, in which hair loss begins at the crown of the head and ultimately leaves only a fringe of hair on the sides and back of the head, is an age-dependent condition seen in about 20 percent of men in their twenties, two-thirds of men in their sixties, and 90 percent of those in their nineties.’ (187)
- ‘As people get older, they get shorter as well. This is due in part to the long-term effects of gravity, which leads to compression of the vertebral column. Height loss is typically about 0.4 centimeter per decade beginning at age 40, with the rate acceleration after the age of 70. Women tend to lose a greater relative amount of stature than men. This is due in part to a greater loss of bone mass in women resulting from a decrease in mineralization (calcium and phosphate) of bone.’ (188)
- ‘Within the US population, European American women have much higher rates of osteoporosis than African American women (20 percent versus 5 percent among women over the age of 50).’ (189)
- ‘Fracture rates (an index of osteoporosis) are highest in countries with the highest calcium and dairy product intakes and lowest in countries with low intakes. Further, the effects of calcium supplementation on osteoporosis are small at best. Instead, other lifestyle factors such as weight-bearing exercise, animal protein consumption, and smoking, among others, are likely to play more important roles in mediating the risk of osteoporosis and fractures among aging individuals.’ (189)
- ‘The rate of falls and fractures in individuals over the age of 65 years is at least double that of the rest of the population, with about one-third of adults over 65 suffering a fall each year.’ (190)
- ‘In sum, the body’s physiological systems show a functional decline beginning in the decade of the forties and accelerating in the sixties and seventies.’ (190)
- ‘An almost universal example of age-related functional decline is presbyopia, the eye condition that makes focusing on near objects (e.g, reading) more difficult. This is caused by a thickening of the lens of the eye, and also probably by a gradual loss of strength in the muscles that bend the lens for focusing. It strikes most people beginning around the age of 40 years.’ (193)
- ‘Peak performance in certain endurance- and strength-based sports is not reached until the age of 30.’ (193-194)
- ‘Throughout much of adulthood, the ability to form new or more complex connections among neurons outpaces the steady loss of the neurons themselves. However, after the age of 50 or 60, this ability is compromised; after the age of 70, we start to see the combined effects on white matter of the loss of neurons and of the reduction in the ability to maintain or grown new connections among neurons.’ (196-197)
- ‘What happens to cognitive function as the brain shrinks with age? In people who do not develop neurological disease, not much. Certainly, there is a slowing of reaction time, and there are declines in other specific abilities (e.g., memory), but there are abundant examples of older people who clearly maintain their cognitive abilities while working in highly complex environments.’ (197)
- ‘Alzheimer disease is characterized anatomically by the accumulation of localized areas of neuronal cell death of damage (called plaques), which can only be seen macroscopically. In the earliest stages of the disease, these plaques are most commonly found in brain areas involved in memory but they spread outward from there.’ (198)
- ‘The prevalence of Alzheimer disease is about 2 to 4 percent in the general population over the age of 65 years; the rate increases dramatically over the age of 75 years, and at least 20 percent of all people over the age of 85 years have the condition.’ It is important to note that Alzheimer disease is not the only form of dementia that afflicts older people, but it does account for about 80 percent of all cases.’ (198)
- ‘Decades of laboratory experimentation on rodents and nonhuman primates have identified one reliable way to extend the lives of these animals: caloric restriction, or undernutrition without malnutrition. By reducing caloric intake 40 to 60 percent through a greatly reduced daily diet or alternatve day feeding, the two-year survival rate of laboratory rats is doubled, and similar gains have been seen in a wide range of mammal species. One way caloric restriction appears to work is by both reducing celluar free radical sources and increasing the endogenous production of antioxidants.’ (202-203)
- ‘Although genetics may account for why some Okinawans live an exceptionally long time, it is clear that the overall rates of longevity are due to large part to an environmental factor: diet. Compared to the rest of Japan, where stomach cancer rates are among the highest in the world, Okinawans have a much lower rate, which some attribute to a much lower sodium intake.’ (204)
- ‘Infectious diseases are caused by several different types of microorganisms (microbes), some of which are truly microscopic and visible only with extremely powerful electron microscopes, and some of which actually are not really microscopic in that they are visible to the naked eye. These are also called pathogens or germs. Microorganisms that act in this way are part of a large category of organisms called parasites, defined as a group that makes use of the resources of other individuals, usually of a different, larger bodied species. Not all parasites cause disease. Some live unobtrusively in individuals without disrupting their health in any way. Others actually benefit the individual they inhabit, as in bacteria in the human colon that manufacture Vitamin K or digest fiber.’ (216)
- ‘Every virus has a protein on its surface that matches receptors on the target cells, and the specificity of these proteins allows viruses to infect a restricted array of cell types (e.g., red blood cells rather than kidney cells).’ (219)
- ‘Worms (also called helminthes) are another diverse taxon of multicellular organisms, with three groups causing disease in humans: the roundworms (nematodes), the tapeworms (cestodes), and the flukes (trematodes). As multicellular forms, they have internal organs and tough outer coating, making them difficult for the immune system to destroy and treatment problematic. It is likely that well over half of the world’s population is infected with one or more species of helminth, especially the intestinal roundworms.’ (224)
- ‘Among the flukes, Schistosoma is responsible for most human disease.’ (225)
- ‘Pathogens can exploit these existing systems to enter and exit the host’s body during eating, sex, skin-to-skin contact, nursing, sneezing, coughing, and other activities. These are all means of direct transmission from host to host. In addition, some pathogens use a vector to spread. A vector is any intermediate species or material that can take a pathogen from one host to the next. It can be a mosquito that takes a blood meal with parasites in it from one person, then bites another and injects these. Or, it can be water.’ (225)
- ‘As the epidemic progresses, more and more of the population is either: 1. infected already; 2. immune due to successful resolution of the infection; or 3. dead. Hence the number and density of susceptible hosts declines, and incidence rates likewise fall. This is called the epidemic curve.’ (225)
- ‘Pathogens entering through the respiratory system are usually entrapped in mucus that is then pushed upward through the lungs by the means of tiny hairs (cilia) to be coughed out. Thus coughing, sneezing, and blowing the nose are all mechanisms to get rid of respiratory pathogens.’ (227)
- ‘A key defense against food- or waterborne pathogens is the very low pH of the stomach, caused by strong acids that effectively kill many pathogens, especially bacteria. An interesting feature of this defense is that antacids taken against heartburn (which is due to acid from the stomach getting up into the esophagus) often contain sodium bicarbonate, which neutralizes the acid and raises the pH or the stomach. However, the reduces the effectiveness of this acid defense against pathogens, resulting in increased risk of infection.’ (227)
- ‘The human immune system is made up of two functionally interactive systems: the innate immune system and the adaptive immune system. The adaptive immune system is found not only among vertebrates, whereas the innate system evolved much earlier and is found among most multicellular organisms. The adaptive system is especially useful for long-lived organisms that encounter a broad array of ever-changing pathogens over the course of their lifetime…In general, the innate system involves recognition of some common patterns rather than specific characteristics of pathogens, and is a much faster response. The innate system is also more involved in the destruction of pathogens, whereas the adaptive system is highly sophisticated at recognition of pathogens.’ (229-230)
- ‘Adaptive immunity involves recognition of specific epitopes found on pathogens or on cells infected with a pathogen. Epitopes are bits of a pathogen’s proteins that are identifiable as nonself. Any large molecule or cell that contains epitopes on its surface is called an antigen; some may display hundreds of epitopes! In practice, the terms antigen and epitope are sometimes used interchangeably. A functioning human immune system can detect somewhere on the order of 100 million epitopes. The adaptive immune system can also remember which markers it has encountered previously.’ (230)
- ‘The key cells of the adaptive system involved in pathogen recognition are the lymphocytes, which exist in two major groups: the B-cells and the T-cells. B-cells are made in the bone marrow, whereas T-cells are made in the thymus…The B-cells monitor extracelluar spaces (such as blood and other fluids), whereas T-cells monitor intracelluarl infection.’ (230)
- ‘When a given lymphocyte encounters a pathogen that displays ‘its’ epitope, it begins to proliferate, a process that can take days. Many identical copies of that particular lymphocyte are made, each of which has an identical epitope recognition molecule. This process is experienced by an individual as the swelling of the lymph nodes while new lymphocytes are being made. After the infection has resolved, some lymphocytes remain as memory cells.’ (230-231)
- ‘Pathogens use three basic strategies to avoid detection or destruction by the immune system: They can conceal their presence, continually produce variable surface antigens (antigenic drift and shirt), or interfere with the immune cells’ ability to function.’ (236)
- ‘Many vaccines use the pathogens themselves, although in the development of the vaccine the pathogen is attenuated (meaning it cannot cause disease) or inactivated (killed). Attenuation can be produced by a process of ratification selection, in which mutant forms that cannot grow under normal host conditions are generated. Vaccines against tuberculosis, measles, mumps, and chickenpox, among others, are made in this way.’ (238-239)
- ‘Undernutrition and infection are synergistic in their effects, and combined, these can lead to severe disease and death.’ (240)
- ‘It was once thought that protein deficiency would most severely compromise immune function, but it is not understood that protein deficiency rarely occurs on its own and that energy malnutrition is sufficient.’ (240)
- ‘Infection itself can precipitate undernutrition. There are a number of reasons why this occurs. Infection with pathogens is often associated with a lack of appetite, and pathogens use significant amounts of nutrients for their own growth and reproduction, so that they compete with hosts’ needs, or facilitate destruction of hos materials. The body may also catabolize its own tissues to use for an immune response. If the infection is in the gastrointestinal tract, digestion and absorption of nutrients may be impaired, especially if the pathogen generates diarrhea or if the pathogen is sufficiently large.’ (241)
- ‘Some individuals exhibit symptoms of immune responses in the absence of an infectious disease, but in the presence of seemingly benign substances. These are allergies (also called atopy, or atopic disease) and asthma.’ (241)
- ‘Rates of allergies and asthma have skyrocketed over the past few decades. Currently about one-fifth of the US population suffers from some type of allergy symptoms or asthma, a rate that reflects a doubling of the rate 20 years prior. At the same time, allergies and asthma are virtually unknown among other populations, especially those of the Amazon and Africa. However, when migrants from countries with low rates of allergy and asthma come to industrialized countries, their children develop asthma and allergies at the same rate as native children. All of these data point to the role of environmental conditions as key to the rise in atopy.’ (241)
- ‘The immune response that typifies allergies is characterized by a high level of production of the antibody IgE, the antibody that is the least common, but the most potent, among the five antibody classes.’ (241)
- ‘At present there is no cure for allergies, only treatments for the symptoms. The best strategy is avoidance of known allergens, which often proves difficult for individuals with multiple allergies. Gradual immunological exposure to allergens seems to confer some benefits, although it requires ongoing injections of antigens over the course of months or years.’ (245)
- ‘Hospitals are often sites where virulent infections can spread easily. These are referred to as nosocomial infections.’ (248)
- ‘Surveys of hand-washing behavior in hospitals indicate that it is done less than half the time, with doctors being much less likely to wash their hands than nurses, even in known high-risk contexts.’ (248)
- ‘M. tuberculosis is destroyed by ultraviolet light, so it really flourishes as a domestic or hospital-based infection.’ (248)
- ‘Major social changes in human populations are the primary cause of changes in exposure to infectious disease.’ (254-255)
- ‘Although accurate statistics are hard to come by and there is a vigorous scholarly debate about the exact numbers, it is estimated that in 1500 there were between 50 and 100 million people in the Americas. One hundred and fifty years later, indigenous populations in North and South America numbered less than 10 million, and perhaps as low as five million.’ (265)
- ‘Whereas the Spanish were interested in assimilation in their efforts at colonization, to bring indigenous people into the Catholic fold, northern European colonists were more concerned with their elimination. In the Northeast, British and French colonists commented on their food fortune at the demise of native populations. John Winthrop, the first governor of the Massachusetts Bay Colony, noted in 1634, ‘for the natives, they are neere all dead of small Poxe, so as the Lord hathe cleared our title to what we possess.’ ’ (271)
- ‘Microorganisms were not the only Old World species to move to these new areas – European domesticated plants and animals also established themselves, and similarly eradicated native flora and fauna with their pathogens. As a result, Europeans were able to establish ‘neo-Europes’ where their plants, animals, and descendants flourished without much competition from indigenous populations. They were not, however, able to have equal success in other parts of Asia or in Africa, despite their efforts to do so. From a disease perspective, there are two reasons for this. First, Europeans shared a common disease pool  with Asians for the most part, so they had no immunological advantage there. Second, in the southern parts of Asia and sub-Saharan Africa, Europeans ran into a ‘disease barrier.’ In the more tropical areas there existed a greater diversity of life forms in general and pathogens in particular, including many with which Europeans had no experience, and these were devastating to them as well as their plants and animals.’ (272)
- ‘Even when interventions served the locals they were seen as enhancing the productivity of the labor force needed to produce or extract the resources so valued by the colonists.’ (273)
- ‘The 19th century was one of scientific advances in Europe, and one of the public justifications for colonialism was that benefits of scientific medicine could be made available to people across the globe.’ (273)
- ‘New centers for the study of what came to be defined as ‘tropical medicine were established, although these were constructed in European capitals (e.g., the London School of Hygiene and Tropical Medicine), not in the colonies where their impact would have been more direct.’ (273)
- ‘The priorities of these centers were aligned with those of European colonists and scientists, and money was channeled toward high-profile research despite critics suggesting that the health problems of the colonies would be better addressed by more rudimentary interventions: safe drinking water, sanitation, and better nutrition.’ (273)
- ‘It wasn’t until World War II, when Java cam under Japanese control, that an adequate synthetic quinine – chloroquine – was developed to prevent American troops from succumbing to malaria.’ (274)
- ‘Yellow fever is caused by a virus carried by mosquitoes of the genus Aedes, of which Aedes aegypti is the most ubiquitous. Symptoms of the infection include fever and headache, progressing to chills, muscle aches, and vomiting. After about five days, internal bleeding occurs, and liver function is compromised, leading to the characteristic yellow tinge of jaundice that gives yellow fever it name. Internal hemorrhaging is responsible for the vomiting of ‘black bile’ and the very high mortality rate associated with yellow fever – about 50 percent of individuals with no previous experience with the disease die.’ (275)
- ‘Emerging diseases may thus be ‘new’ or ‘old,’ but in both cases they are defined by an increase in incidence. ‘Old’ diseases that show an increase in incidence are often called resurgent infectious diseases.’ (287)
- ‘What most surveys of emergent and resurgent diseases conclude is that it is social processes, sometimes acting through ecological changes, that are largely responsible for these ‘new’ threats to health.’ (288)
- ‘Diseases derived from animals make up the majority of emerging diseases, as humans have increasing contact with their wild animal reservoirs.’ (290)
- ‘Many of the diseases classified as emergent or resurgent have long been ‘hidden’ among the poor, and only when they capture media attention do they come into the larger public consciousness. Furthermore, it is also clear that attention is focused on them only insofar as they are perceived as a threat to those in power.’ (290)
- ‘Malaria is caused by four species of protozoa, all members of the genus Plasmodium.’ (291)
- ‘In the 1930s when malaria was endemic to the southeastern areas of the United States there were massive public works programs that drained swamps, screened buildings, and used larvicides to reduce the population of malaria-causing mosquitoes. These measures were quite successful, and malaria is no longer endemic to the United States.’ (299)
- ‘The total global budget for malaria research is less than $125 million, yet malaria kills almost three million people per year (mostly children) and there are some 500 million cases each year.’ (300)
- ‘Global warming may have the effect of increasing the range of malarial mosquitoes, or their reproductive rate, which is temperature sensitive.’ (300)
- ‘At present cholera can be treated by rapid rehydration (preferably through intravenous fluids) and antibiotics, and there is a vaccine that offers some protection against the bacterium.’ (303)
- ‘Because Vibrio cholerae [cholera] is attached to plankton, the use of material from local women’s saris as a filter is sufficient to remove up to 99 percent of the bacteria from water.’ (303)
- ‘Dam building in Africa has also been associated with an increase in two other parasitic diseases: schistosomiasis and onchocerciasis.’ (304)
- ‘Schistosomiasis is a difficult disease to treat. Means to prevent it have focused on ridding lakes of the snails. China launched the ‘Peoples [sic] war against the Snail’ in 1950, employing thousands of Chinese to dredge ponds and swamps, remove snails one by one if necessary, apply moluscides, and enforce strict sanitation laws, forbidding defecation in water sources. Simple sealed latrines were built to prevent transmission, which had the effect of reducing many gastrointestinal parasites besides schistosomiasis. As a result, schistosomiasis rates in China have decreased dramatically, although it remains an endemic chronic disease.’ (308-309)
- ‘HIV is an RNA retrovirus. Its RNA can be ‘reverse transcribed’ into viral DNA. This DNA is integrated into host DNA and can then be transcribed into host RNA.’ (310)
- ‘In African monkeys there is a similar virus called simian immunodeficiency virus and it may have ‘jumped hosts’ when humans were exposed to infected monkey blood while butchering hunted animals. Cases of HIV in Africa probably date back to the 1950s or early 1060s. At some point it appears to have mutated into the more lethal form that spread to cities via rural-urban migrants, and from there it was transported across the globe.’ (312)
- ‘According to the CDC, although African Americans account for 13 percent of the US population, 49 percent of all new HIV infections occur to African Americans. Sixty-five percent of the infants with HIV are African American. The rate of AIDS diagnoses for black women is nearly 23 times the rate for white women, and black men have rates that are 8 times the rate for white men.’ (312-313)
- ‘It is estimated that at least 20 percent of contemporary humans carry the [TB] bacteria; of them 10 to 15 percent develop active infection.’ (316)
- ‘Parents were more likely to question a treatment regime if the clinician specifically recommended against antibiotics. Mangione Smith et al. noted: ‘Parental questioning of the treatment plan was strongly associated with the physician communication practice of ruling out the need for antibiotics. Qualitative analyses of these exchanges suggested that these rule-out statements may motivate such questioning because they seem to delegitimize the parent’s decision to seek medical help for the child’s condition. These effects may be aggravated when attempts are made to reassure a parent by minimizing the significance of symptoms, or when recommendations for nonprescription medicines are vaguely described.’ In another study many physicians expressed concern that failing to meet patient expectations could lead to dissatisfaction with care and loss of business. They reported acquiescing to patients’ request for prescriptions because they did not have the time to explain why the problem did not require antibiotics.’ (320)
- ‘Research has shown that variation in life expectancy among wealthy countries is closely related to how wealth is distributed within those countries.’ (339)
- ‘If resources were distributed more evenly across society, as they are in many Scandinavian countries, how would health be impacted? Would it not diminish the health of the wealthy, as they would no longer be at the top of the hierarchy, or able to afford the best preventive and curative health care? Wilkinson reports that the effects are greatest among the lower classes. Importantly, the health of high-status individuals is not diminished. It is also enhanced, although not quite dramatically as is that of the poor.’ (343)
- ‘Japan has the highest life expectancy of any country in the world, at 82. It has also been characterized as a society with a strong group ethos, where individuals are secondary to the group, and the group’s well-being is privileged such that selfish or otherwise thoughtless individual behavior is not tolerated. The income distribution in Japan is also much narrower than that of the United States…, and the Japanese government remains committed to high employment levels, even during downturns in the economy. The workplace is characterized by loyalty and solidarity, with lifetime employment in one company being the norm. In addition, even factory work is made less mind-numbing by rotation among tasks and opportunities for workers to make suggestions for improvements (i.e., they have some control over their work).’ (344)
- ‘Within cultural anthropology, race is generally considered a social category, and hence socially constructed.’ (347)
- ‘Taking a broader view of life expectancy differences across races shows that the highest is among Asian females (86.7) and the lowest is among black males (68.7), an astonished 18-year difference.’ (348)
- ‘African American individuals with darker skin color perceive and receive more discriminatory treatment than those with lighter skin.’ (351)
- ‘There is also racial discrimination in medical care. One experimental study had physicians make recommendations for treatment of patients describing identical symptoms of chest pain. The patients were actually actors who were videotaped, and they ranged in age, sex, and race. Schulman and his colleagues found that the black patients were much less likely to be referred for treatment than were white patients, and black women were the least likely to be referred for treatment than were white patients, and black women were the least likely of all to be referred, despite the fact that all patients were describing the same set of symptoms. This provides strong support for the existence of racial discrimination in treatment for cardiac disease, and a proximate mechanism by which racism contributes to poor health outcomes and higher mortality from CVD.’ (351)
- ‘Human health and illness result from the interaction between our biological heritage and the cultural environment in which we live…Biological anthropologists try to avoid nature-nurture-type debates – there is very little sense in expecting that any complex human health phenomenon can be understood only in terms of genetics or the environment.’ (357)
- ‘Contemporary psychiatry does not deny the importance of family or larger sociocultural environment in developing or treating mental illness, and sees both biological and environmental factors as critical for understanding mental illness.’ (358)
- ‘[Clinically defined mental illness] must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual.’ (359)
- ‘Anorexia is characterized by the refusal to maintain a minimally normal body weight; people with bulimia engage in repeated episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives and diuretics, fasting, or excessive exercise.’ (369)
- ‘The DSM-IV diagnosis of the condition is given if a person is not maintaining t least 85 percent of his of her expected body weight, is intensely afraid of gaining weight, and exhibits significant disturbances in the perception and size of his or her body. Women with anorexia are typically amenorrheic (do not have menstrual periods).’ (369)
- ‘About 90 percent of all anorexia and bulimia sufferers are female, with onset typically in adolescence or early adulthood.’ (369)
- ‘In other countries, anorexia tends to be found more commonly in more Westernized segments of the population, suggesting the role of cultural change or transition on the development of anorexia.’ (372)
- ‘Depression is the most common form of mood disorder, which is a form of illness in which a disruption in mood is the primary feature. The DSM-IV has nine criteria for ‘major depressive episode,’ of which a minimum of five are required for diagnosis. The criteria are: 1. Depressed mood most of the day, nearly every day, as indicated by subjective report or observation made by others. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month) or decrease or increase in appetite every day. 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day. 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for committing suicide.’ (376-377)
- ‘A typical untreated depressive episode lasts about six months. In the majority of cases, there is ultimately a remission of symptoms and a return to previous levels of functioning. However, in a significant proportion of cases, depression is ongoing or there are recurrent episodes. The risk of suicide in depression is about 30 to 80 times greater than for the general population.’ (377)
- ‘The first-degree relatives of people with depressive disorder are 1.5 to 3.0 times more likely to develop the condition.’ (377)
- ‘In the United States, about 10 percent of pregnant women meet the criteria for major depression.’ (378)
- ‘It is estimated that about 10 to 15 percent of new mothers experience depression in the first two weeks after birth.’ (379)
- ‘Bipolar illness, or manic-depressive disorder, is widely known but a relatively rare condition, with a prevalence rate of about 0.5 to 1.5 percent. It differs from depression (unipolar illness) in that the affected person experiences both depressive and manic episodes. A manic episode is defined as a ‘period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week’ (American Psychiatric Association). According to the DSM-IV, it must include at least three of the following symptoms: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing 5. Distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli [sic] 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying, sexual indiscretions, or foolish business investments).’ (380)
- ‘Geneaological [sic], twin, adoption, and molecular genetics studies all suggest a strong genetic influence in developing bipolar illness.’ (380)
- ‘About 35 percent of patients attempt suicide, and completed suicide occurs in about 10 to 15 percent of cases.’ (380-381)
- ‘The relatives of people with mood disorders are also more likely to be found in creative professions (writers, people with postgraduate degrees).’ (382)
- ‘Schizophrenia is often thought – erroneously – to mean that a person has a split personality. Multiple-personality disorder is something quite different, and substantially less common.’ (385)
- ‘Estimates put the number of people with schizophrenia at about 1 percent of the population.’ (385)
- ‘The DSM-IB diagnostic criteria include the following symptoms, each of which must be present for a significant period of time over a one-month period, for the diagnosis of schizophrenia: 1. Delusions 2. Hallucinations 3. Disorganized speech (e.g., frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior 5. Negative symptoms: affective (emotional) flattening, alogia (poverty of speech), and avolition (lack of motivation or persistence to complete a task).’ (385)
- ‘The age of onset for schizophrenia is usually in the late teens or early twenties (women a little later than men typically). This is, of course, a particularly critical time during most people’s lives, as they attempt to define an independent role for themselves in society.’ (385)
- ‘A significant proportion (25-60 percent) of psychiatric patients is noncompliant for taking medications.’ (389)
- ‘Estroff found that about one-third of the clients she surveyed were positive about [newly prescribed] medications, seeing their benefit, and in some cases, deriving some satisfaction that their illness could be ascribed to a ‘chemical imbalance’ that could be ameliorated by medication. Another third of the patients were more neutral about medication – they recognized their need for it, and that it would be an ongoing part of their lives, side effects and all. The other one-third of the clients were strongly negative about medications. They expressed fears about the drugs they took, distrusted the psychiatrist’s motivations for prescribing them, and in many cases refused to acknowledged that they had psychiatric problems that needed to be addressed.’ (389)

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