NOTES for Week 12

READER pp 242-247 Ethnomedical Beliefs and Patient Adherence

It is widely accepted in medical anthropology that the best compliance and the most success in treatment are achieved when the patient and healer share the same medical beliefs. You may object to calling medical science as system of beliefs, but consider this: fifty or one hundred years from now, many ideas about disease we accept now may then look quaint and peculiar.

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This article is about the treatment of high blood pressure, known medically as 'hypertension.' The editor points out that the methodology is clear, but the results are difficult to interpret.

Look over the dates of the references. This article is rather old. Keep that in mind.

Compliance is a problem with hypertension. The condition is managed, not cured. Furthermore, it is invisible. The authors cite the estimate that only one-fourth of hypertensive persons are under treatment and only half of those actually comply.

The authors don't mention side effects. They prescribe reserpine-a drug with many side effects and no longer a drug of choice. Diuretics, ACE-inhibitors, and beta blockers give better results with fewer side effects. A common side effect for men is impotence. You get the implication.

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Two terms from an earlier article reappear. This will refresh your memory (see pp 110-112):

• Personalistic medical systems believe that disease is the result of the active, purposeful intervention of a person (witch or sorcerer), ancestor, or deity. The sick person is a victim.
• Naturalistic medical systems explain illness in impersonal, systemic terms. Disease is the result of natural forces. Hot/cold, and other medical traditions that think of balance fit into this model. Diagnosis, a cornerstone of biomedicine, is of minor importance in this system

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The author treats biomedicine as a third category.

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Pay attention to the observation by the author (p 246) that the higher an individual's acceptance of personalistic beliefs, the lower their compliance.

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READER pp 248-250 Health Beliefs and Compliance-New Orleans 1985-1986

In a busy clinic staffed by physicians who would rather be somewhere else, consider how different the health beliefs are for the patients.

• High blood pressure is seen as blood that is too hot, rich, or thick.
• In high blood pressure, the blood rises higher in the body.
• Effective treatment in the patient perspective is not eating pork, hot or spicy foods, or 'grease.'
• 'High-pertension' is a 'nerve disease.'

Be sure to read the article. It is short and crisp. Some of the articles in the READER will be included in the study guide for the final exam.

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READER pp 279-286 . . . Lead Poisoning . . .

Remember empacho? We met the term earlier on p 418. In the folk medical model, empacho is a painful condition of the gut characterized by explosive evacuations and flatulence. It is believed caused by eating the wrong kind of foods.

Be sure to read about azarcon and greta and what toxic substances are contained in these folk remedies. Read the article.

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ORIGINAL ARTICLE

Patenting Life, an summary based on chapter 2 in Rifkin, J. The Biotech Century New York: Tarcher/Putnam, 1998. This article is intended as a companion to your unit on the rainforest this week.

I. GENE OWNERSHIP

Genes are the "green gold" of the biotech century. Biotech companies are seeking rare and unique genetic traits that might have market potential.

There is increasing conflict between the high-technology nations of the North and the developing nations of the South over the ownership of the Earth's genetic riches. Developing nations with rain forests insist that genetic resources they have in their country are their property, just like oil. They want to be compensated for them. Biotech companies counter by saying that it is their knowhow, skill, and investment that give genetic material its commercial value.

Governments have set up gene storage facilities. The U.S. has its National Seed Storage Laboratory at Fort Collins, Colorado. It contains more than 400,000 seeds. Many nations warehouse rare microorganisms and frozen animal embryos. Remember the American Type Culture Collection for microorganisms mentioned in article 7.1?

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II. HOW OWNERSHIP BEGAN

How is genetic ownership possible? It began when Ananda Chakrabarty, an employee of General Electric applied for a patent on genetically engineered microorganisms designed to eat oil spills on the oceans. The patent application was initially rejected, but was ultimately issued by court order on appeal. That decision was ultimately upheld by the U.S. Supreme Court in 1980.

The Court was cautious. It said that the far-reaching implications of genetic engineering should be determined by Congress not by the courts.

Nevertheless, the Court's action laid the all-important legal groundwork for the privatization and commercialization of genetic material. The distinction between living beings and inanimate objects had been breeched not by public consensus and congressional debate, but by the judicial branch of government.

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III. GENES BECOME BIG MONEY

The first privately held genetic engineering firm was Genentech. It was launched in 1980, just months after the Supreme Court decision. By the end of its first trading day, it was worth half a billion dollars. At that point in time, it hadn't made a thing! This is years before Bill Gates was a household name and present stock market boom. Genetics has emerged from arcane research into a new realm of big money-and controversy.

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In 1987, the Patent and Trade Office reversed itself and issued a ruling that all genetically engineered multicellular living organisms, including animals are potentially patently able. In a stroke, the 'Biotech Century' was launched. The Commissioner at that time excluded humans beings by saying that the Thirteenth Amendment to the Constitution forbids human slavery.

However . . . human embryos, fetuses, human genes, cell lines, tissues and organs ARE potentially patentable. An inventor must prove that an object is novel, non-obvious, and useful-and that no one has ever made the object before.

Some life patents are so broad that they give individual companies a virtual monopoly over a whole species. Many bioengineered crops such as Monsanto's genetically altered soybeans fall into this category. We have mentioned before that bioengineered crops are facing a marketplace backlash, particularly in Europe. The export of these crops is a serious economic concern this year, especially when such altered crops are commingled with non-altered crops.

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IV. THE GENES ARE OURS!

In centuries past, colonists and explorers searched for plant species. We have documented the export of latex rubber trees, cinchona, and coffee elsewhere. The host countries for these plants might prefer the term 'theft' over 'export.'

Today, the plant hunters have been replaced by gene prospectors. What we in this country call 'discovery,' the host countries call 'piracy.' Developing countries bitterly oppose corporate attempts to patent indigenous knowledge and native biological resources.

W.R. Grace has sought to patent certain processes using the neem tree in India. That tree is a symbol in India; ancient texts call it "the blessed tree" and the tree that "cures all ailments."

One use is dental: twigs from the neem tree are used as toothbrushes because of the tree's antibacterial properties. The tree has many other medicinal and insecticide products widely used in India. Centuries of indigenous research in India has produced knowledge about neemthat is shared openly and freely. People in India are furious on having their common knowledge patented by a company!

A growing number of non-governmental organizations, as well as some countries, are beginning to take the position that genes should not be sale for any price. They should be common property, say those organizations.

Gene patents have hurt one of the intellectual foundations of research: sharing of information. Publication and peer review have been replaced by 'proprietary information' held in secrecy. Gene patents have created a sort of gold rush wherein who ever is first, claims the property. Academic communication and morale have been hurt.

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V. HUMAN BEINGS AS INTELLECTUAL PROPERTY

A virus derived from the cell line of a twenty-six-year-old Guaymi Indian woman from Panama was studied by the NIH because that virus had the unique ability to stimulate antibodies against HIV. When the researcher applied for a patent on it, the Guaymi Indians raised a protest. They argued that the NIH had violated the privacy of their people, sought a patent without their consent, and intended to make a profit without getting a share. The NIH backed off on this one.

The issue of life patents has been the subject of growing scrutiny in Congress. As of this writing (11/16/99), no laws have been enacted. Probably the most articulate opposition has come from a coalition of Protestant, Catholic, Jewish, Islamic, Buddhist and Hindu leaders. Their question is this: how can life, a free gift of God, be defined as an invention?

....CJ '99