Terms

acupuncture
macrobiotic
placebo
quag dab peg
txiv neeb
MCMC
Hmong
dab

1. Our overall discussion involves alternatives to "western medicine", but to have that discussion we need to think about what is essential about the character of this thing, western medicine. We are not proposing alternative or eastern medicine as a replacement; we envision medical pluralism. At the same time, it is essential for this medical sociology course for us to understand what it is about western medicine that is limiting and a problem.
   1. We must go through the case of Lia Lee, Foua, her mother, and Nao Kao, a Hmong family living in Merced, Calif. where Lia experienced a series of epileptic seizures and encounters with the Merced County Medical Center (MCMC)
      1. Hmong are an ethnic group, moved to the U.S. from Thailand, with a history of resistance to dominant ethnic groups in China and elsewhere, and resistant to cultural assimilation.
      2. The Hmong have a system of medical beliefs that view wellness or illness as related to social relationships, specialized dietary practices, and the notion that there is a nonbodily realm of souls that dramatically affects everyday life
         1. One important character is called a dab which generally is an evil spirit that can affect many aspects of one's life
         2. Another aspect of the story is that one's soul is essential to healthy life, but one's soul must be attracted into your body from the spirit world (through a ceremony for babies)
         3. Especially with young children, souls rest in the body in a fragile way and may be scared out of the body (as happened with Lia when her sister slammed the door and startled her)
         4. In Hmong culture, epilepsy is called quag dab peg or "the spirit catches you and you fall down", referring to the perception that the condition occurs when your sould leaves and your body has no guidance (so you fall down)
         5. But when this happens, the understanding is that the soul is communing with other souls and providing means for the individual involved to act as a medium interacting between the spirit world and the world of flesh
         6. Thus, someone who experiences quag dab peg is a sort of priest who is much respected and has high status called a txiv neeb
         7. Thus in Hmong culture there is ambivalence about epilepsy since although it can be scary it also can be very positive in one's life
      3. We have a discussion question for Friday about whether epilepsy is a disease which implies that the issue is problematic.
         1. Is epilepsy a disease, a disability, or a personal attribute like hair color?
         2. What defines something as a disease...if it must be negative is it still a disease if it is not negative?
         3. Is it a matter of abnormality? If so, would the capacity to run a sub-4 minute mile be a disease?
   2. We talked about the preference in biomedical research and practice circles for interventions and research anchored in a biomedical, experimental design methodology.
      1. I talked about my research experience with emergency medicine,
         1. the social character of emergency medical practice
         2. the insistance of major journals on research that is biological and experimental in focus
         3. and the assumption that the only people who would do research (and therefore who are allowed to do research) on emergency medicine would have medical degrees.
      2. The preference in medicine is for a model of disease and treatment that is anchored in a disease model
         1. a specific description of a biochemical, biological, or physiological process that leads to a specific dysfunctional outcome
         2. The notion that research ought to test the accuracy of the model using experimental tests that can be reproduced in another lab
         3. The notion that we must identify a control group and then introduce a specific change or intervention in an experimental group to see if we can produce a change predicted by the disease model
         4. Concern that we use appropriate double blind testing procedures so that experimenter bias will not affect results.
         5. With a disease like AIDS, specific experimental tests established the nature of the pathological agent, a virus, and eventually specific biochemical interventions that could be therapeutic---drugs that intervene on the disease process destroying t-cell lymphocytes.
      3. If a specific disease model cannot be proposed and supported through experimental research, then we do not know either if we have identified the disease process or effectively explained how intervention and remediation can happen.
      4. This experimental model for identifying disease and proposing curative interventions is extremely rigorous and limiting.
   3. We will be talking about various understandings of the term "disease" in coming weeks, and one of the things we will recognize is that the disease model approach simply does not apply to many things we want to call "disease"
      1. One example we talked about briefly is alcoholism which has no identifiable physiological dysfunction nor any single route to improvement and cure.
      2. Saying that alcoholism does not fit the biomedical model definition of disease does not mean that it is not a disease in some meaningful way.
      3. However, we in sociology are uncomfortable when conditions like alcoholism are called diseases because it represents an attempt to extend the reach of medicine to other kinds of social problems than those that typically have been viewed as illnesses---we call this process "medicalization".
      4. Many of the problems that are medicalized exist within a complex life-world of the patient and we really need a whole life approach to understand and treat the problem.
      5. We bring in medical terminology in part, however, because we want to use and take advantage of the authority the medical system provides for dealing with "disease" and people who are affected by a problem.
   4. When we contrast western medicine to eastern medicine and other approaches, the tendency is to think that we are trying to offer acupuncture, macrobiotics, or yoga as a substitute for biomedical treatment.
      1. More accurately, the value of non-traditional approaches is to emphasize the importance of holistic conceptions of illness and medical treatment.
      2. If we look at the problems the Hmong and Lia confront in Fadiman's book, the situation represents a social and cultural breakdown at the same time that (presumably) high quality biomedicine is being offered.
      3. It is an inexplicable failure of the values of medicine to provide care and treatment that the MCMC would not take the lifeworld in which Lia exists as seriously in treating her as it does the biomedical aspects of her care.
      4. While this problem is highlighted in the Fadiman book, this tension is present in most medical care.
         1. One reason the problem arises is that medical researchers and practitioners use narrow methodologies for understanding the problems that they treat.
         2. One reason they do this is that the authority of the doctor is a central part of their approach to treatment and they are not equipped to share authority with parents or community leaders or other significant folks in a patient's life.
         3. On the other hand, the scientific research emphasis in medicine is overemphasized in the way that most physicians want to approach care since they want to say it is an art: based in experience, intuition, and the context the patient lives in.
      5. The advantage we gain from emphasizing eastern medicine is that we are pushed to think of medical problems using many approaches simultaneously---what we call a pluralistic approach to medicine.