...the U.S. health care system is riddled with inequality in access and outcomes, demonstrated most glaringly by the high proportion of people who have no health care coverage. ...within the larger ...multimethod study (combining ethnography and surveys) of which that research was a part, ethnographic data revealed issues and problems related to the introduction of Medicaid managed care for both providers and patients that the population-based survey did not capture (Waitzkin et al. 2002). ...what is largely missing from analyses of managed care and other forms of market-based medicine and neoliberal health policy is the patient's perspective and experience. Many such patients have great difficulties managing their illnesses because they are faced with barriers to care in addition to other concerns such as securing adequate food, shelter, and caring for family members. Because most of these patients do not have a regular source of care, such as a doctor or clinic, they have problems getting appropriate medicines in sufficient supply and often seek care only when persistent symptoms interfere with their daily lives; the end result is that their illnesses are poorly controlled.
...the new medicines have mostly gathered dust on warehouse shelves. Since they were approved for use, a paltry 5% of patients in need have benefited from them. With support from Unitaid – which ...channels funding from a painless airline tax toward addressing neglected health problems afflicting the poor – we launched the endTB initiative to accelerate use of the new drugs in 17 countries facing TB epidemics. UN member states should use the occasion to pledge a radical increase in funding for TB programs around the world, and to overhaul an R&D model that has proved unfit for purpose.
Foreword Paul Farmer
Blind Spot,
09/2014
Book Chapter
It is rare that a scholarly work can be called soul-searching as well as wrenching, butBlind Spot, by physician-anthropologist Salmaan Keshavjee, is just such a book. Based on ethnographic research ...conducted after the collapse of the Soviet Union, in a remote and mountainous part of Central Asia at the margin of armed conflict, this is a haunting account of a goodwill effort to replace an inadequate public health system with a “sustainable” (and privatized) one. This new system is to be based, Keshavjee learns, on a post-Communist ideological framework even more impervious to course correction than the one preceding
La década de los noventa ha sido la más azarosa en la larga historia de las enfermedades infecciosas, entre las cuales, las enfermedades infecciosas emergentes (EIE) han aparecido y se han propagado ...a un ritmo explosivo. Algunas de ellas, como el sida y la fiebre púrpura brasileña, se consideran del todo nuevas, y otras tienen agentes etiológicos recién identificados o que se han incrementado de manera dramática, como los síndromes causados por el virus Hantaan. Los factores responsables de esto incluyen cambios ecológicos, anomalías climáticas, cambios demográficos y del comportamiento humano, el desarrollo humano y la adaptación y cambio de los microbios. En este artículo se examinan cómo emergen, de dónde emergen y hacia dónde van los EIE, así como las desigualdades sociales que provocan su propagación en ciertos grupos.
Any thorough understanding of the modern epidemics of AIDS and tuberculosis in Haiti or elsewhere in the postcolonial world requires a thorough knowledge of history and political economy. This essay, ...based on over a decade of research in rural Haiti, draws on the work of Sidney Mintz and others who have linked the interpretive project of modern anthropology to a historical understanding of the large-scale social and economic structures in which affliction is embedded. The emergence and persistence of these epidemics in Haiti, where they are the leading causes of young-adult death, is rooted in the enduring effects of European expansion in the New World and in the slavery and racism with which it was associated. A syncretic and properly biosocial anthropology of these and other plagues moves us beyond noting, for example, their strong association with poverty and social inequalities to an understanding of how such inequalities are embodied as differential risk for infection and, among those already infected, for adverse outcomes including death. Since these two diseases have different modes of transmission, different pathophysiologies, and different treatments, part of the interpretive task is to link such an anthropology to epidemiology and to an understanding of differential access to new diagnostic and therapeutic tools now available to the fortunate few. PUBLICATION ABSTRACT
Although the liver is the major source of circulating insulin-like growth factor-I (IGF-I), relatively little is known about the regulation of IGF-I gene transcription in this tissue. Since ...transcripts are initiated largely in exon 1, we established an in vitro transcription system to evaluate activation of transcription via the major exon 1 initiation site. Transcription of a G-free cassette reporter was directed by rat IGF-I genomic fragments, and the adenovirus major late promoter was used as an internal control. Tissue specificity was demonstrated by a 60-90% decrease in transcripts with spleen extracts as compared with liver. 54 base pairs (bp) of upstream sequence were sufficient to direct IGF-I gene transcription, and activity increased 5-fold with 300 bp of upstream sequence. DNase I footprinting revealed four protected regions between −300 and −60 bp; binding was confirmed by gel shift analysis, and tissue specificity was demonstrated by reduced shifts with spleen extracts. The necessity of transcription factor binding to such sites was established by competition analysis, which revealed a specific decrease in IGF-I transcription in the presence of a competing fragment. Use of this in vitro transcription system should permit analysis of the function of individual transcription factors involved in regulation of IGF-I gene expression.
Conversations with my father over many years reveal how genocides unfold invisibly in front of ethical witnesses. In August 1943, he was deported as a forced laborer by the French Vichy regime to ...work in the construction of the IG Farben petrochemical factory at Auschwitz, where he was recruited into a resistance group. His precise recollection of exactly what he knew or did not know, and what resistance acts he and his companions undertook demonstrates how terror can make uncertainty a strategy for survival as well as resistance. My father dissects multiple contradictory interpretations of ethical motivations for everyday acts of kindness and betrayal. He refuses to identify clear heroes or villains, ultimately condemning only those in power, especially Allied leaders who had the knowledge and logistical capacity to intervene, but instead allowed the trains to run on time. Primo Levi's concept of the Grey Zone alerts us to how institutionalized brutality overwhelms the possibility of human solidarity. What genocides and Grey Zones are we missing today?
Résumé
Plus de cinquante ans après l’introduction de la chimiothérapie comme traitement de la tuberculose, deux millions de personnes meurent de cette maladie tous les ans et 8,4 millions de nouveaux ...cas sont rapportés ; la tuberculose, en incluant ses formes multirésistantes, demeure parmi les maladies infectieuses guérissables celle qui fait le plus de victimes. Pourquoi les médi-caments qui permettraient d’arrêter ou de ralentir ces épidémies ne sont-ils pas disponibles là où on a le plus besoin? Pour répondre à cette question, nous explorons l’expérience de vie d’une famille haïtienne ainsi que les contextes sociaux dans lesquels les malades s’infectent, tombent malades et rencontrent toute une série d’aventures thérapeutiques qui mènent à plus de compli-cations, à une transmission croissante à d’autres personnes et, trop souvent, à la mort. Nous analysons aussi comment ces trajectoires sont le résultat de la violence structurelle et des inégalités sociales renforcées par la mondialisation.
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