Medical Humanities Blog

On Nun Apothecaries in Renaissance Florence

A new article authored by Sharon T. Strocchia (Emory University) is available early view in Renaissance Studies entitled The nun apothecaries of Renaissance Florence: marketing medicines in the convent.  Here is the Abstract:

Using unpublished archival sources, this essay analyses the development of convent pharmacies in sixteenth-century Florence and situates them in a changing medical and political landscape. These female-run apothecary shops shed light on several important issues for historians of Renaissance medicine and society: the nature and extent of women's medical agency; the acquisition and transmission of specialized knowledge outside a university or guild setting; the regulation of unofficial practitioners by guild and state authorities. By producing and marketing drugs to the public, Renaissance religious women both augmented the medical resources available in Italian urban society and acquired roles of public significance beyond the spiritual realm. I analyse the roots of convent pharmacies in new social welfare initiatives circa 1500, then consider their products, clientele, business practices and methods of training new practitioners. Finally, I ask how convent pharmacies were regulated and why they were protected by early Medici dukes. I argue that Florentine convent pharmacies remained vigorous entities throughout the sixteenth century despite tighter enclosure provisions and professionalizing aspirations, partly because contestations over their status enabled Cosimo I de' Medici and his successors to advance their personal authority within a centralizing state.

The article is recommended.  (It should be plain to readers of MH Blog why Renaissance medicine is important not just in its own right, but for the ways in which it shapes contemporary understandings about medicine, science, and (late) modernity in general).

On the University of Chicago-Stateville Prison Malaria Experiments

Bernard Harcourt (University of Chicago Law) has a working paper up on SSRN (full-text open-access) entitled Making Willing Bodies: Manufacturing Consent Among Prisoners and Soldiers, Creating Human Subjects, Patriots, and Everyday Citizens - The University of Chicago Malaria Experiments on Prisoners at Stateville Penitentiary.  Here is the Abstract:

In March 1944, doctors at the University of Chicago began infecting volunteer convicts at Stateville Prison with a virulent strand of malaria to test the effectiveness and side-effects of potent anti-malarial drugs. According to Dr. Alf Alving, the principal investigator, malaria "was the number-one medical problem of the war in the Pacific" and "we were losing far more men to malaria than to enemy bullets." This refrain would rehearse one of the most productive ways of speaking about prisoner experimentation. The Stateville prisoners became human once again and regained their citizenship and political voice by sacrificing their bodies to the war effort. This paper explores how the consent of the prisoners was fabricated and compares this to the way in which the willingness of soldiers to sacrifice their lives is manufactured - and, far less dramatically, to the way in which we produce our own willingness in our everyday acceptance of the daily and ordinary routines of work, family life, and citizenship. Like the prisoners at Stateville, we are made to feel the need to sacrifice ourselves - to work, to vote, to serve, to abide, to agree - through very similar associations of bodily sacrifice with citizenship, loyalty, and patriotism.

The article is recommended.

For those interested in the general history linking malaria research, human subjects, and war, see the excellent monographs by Leo Slater and Margaret Humphreys.  For those interested in the theoretical point regarding bodily sacrifice, patriotism, and citizenship in context of coercive human subjects research, see Goodman, McElligott, and Marks's excellent anthology.

(h/t The Professor)

On Complexity Science, Population Health, & the SDOH

Readers of MH Blog are familiar with my interest in disease and epidemiologic causality, which has significant implications for matters of population health and inequities.  (Why this is so should be obvious: if we want to improve population health and compress health inequities, it is important to have some understanding of what are the prime causes of health and its distribution within and across populations).

For many years I have been attracted to models of complexity (formerly known as chaos theory) for conceptualizing health and illness, in large part because linear models map out very poorly onto the complex (nonlinear dynamic) adaptive systems that collectively and iteratively constitute population health and its distribution.  There has been some excellent work on this in recent years, but I wanted to highlight a new article written by Saroj Jayasinghe entitled Conceptualising population health: from mechanistic thinking to complexity science, in Emerging Themes in Epidemiology.  Like all articles published in BMC journals, the article is available full-text open-access.  Here is the Abstract:

The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS). The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections.

The article is highly recommended.

Call for Papers: The Language of Illness and Pain: Identity, Communication and the Clinical Encounter

Call for Papers: The Language of Illness and Pain: Identity, Communication and the Clinical Encounter

Saturday 2nd and Sunday 3rd July 2011 Venue: Birkbeck College, University of London, United Kingdom

Following the establishment of the British medical profession in the nineteenth century, which endorsed the concept of medicine as a science, the clinical encounter between doctor and patient came to occupy a contested territory with equally contested boundaries. The period saw a theoretical and practical shift away from the classical perception of medicine as an art, based on the patient’s story of his or her illness, to medicine as a science, based on the doctor’s clinical observations and supported by the rapid increase in technical training and new scientific procedures.

Arguably the effect of this development was to suppress the patient’s identity and voice. It also sidelined psychologically-driven theories, which were thought to lack evidence-based scientific rigour and were regarded as inferior to biomedical practice. As a result, conditions and identities associated with the troubled mind and with anti-social behaviours, for example, were pathologised to bring them into the province of orthodox treatments. The cure rate for the new taxonomies of stigmatised identities and psychosomatic conditions was disappointing.
Moreover there was considerable confusion at the interface between the disciplines of law, medicine, psychology, and social science in relation to distinctions between normal behaviour and deviancy, between the criminal and the patient, and between the mad and the bad.

This multidisciplinary and trans-historical conference seeks to examine the legacy of these trends through the analysis of communication and language in the clinical encounter, as it is represented in medicine and in the humanities. The objective is to break down the artificial boundaries between the arts and biomedical science to identify mutually beneficial fields of enquiry. In particular the conference aims to establish a forum in which academics, practitioners and students in the medical profession and in humanities can interrogate and evaluate the clinical encounter, the relationship between doctor and patient, and the language of illness and pain. The intention is to publish a collection of the best conference papers in a collection that will be of interest to the general reader but which can also be used by students and academics in teaching and research.

The conference is the result of the collaboration between Medical Humanities at Birkbeck College, University of London and the Kent, Surrey and Sussex Medical Deanery. It takes part over two days – Saturday and Sunday 2nd-3rd July 2011. Refreshments and lunches are provided and there will be a wine reception on Saturday, followed by a screening of Wit, the American TV drama based on the Pulitzer Prize-winning play by Margaret Edson, directed by Nike Nichols and starring Emma Thompson. Formal presentations end at lunchtime on Sunday and will be followed in the afternoon by a talk at the British Museum in the Wellcome Trust-sponsored Living and Dying Room.

The conference will be supported by an exhibition, which will include books, music, and visual art, which explore representations of, and the creative interaction between medicine and the humanities throughout the ages.

We invite proposals (300 words max) for 20-minute papers from academics and practitioners in the fields of the humanities and medicine, which explore any aspect of communication, language, narrative, and representation in relation to illness and pain. Proposals for panels of three speakers are welcome.

The following list of ideas is intended as a guideline only:

* Altered mental states
* Collective illness, collective healing
* Cultural perceptions of illness: gender, class, and ethnicity
* Cure or healing?
* Difference, otherness and pathologised identity
* Identity and the 12-step programme
* Illness, language and writing
* Illness as metaphor
* Illness and creativity / genius and madness
* It’s all in the mind
* Medicine and anthropology
* Medicine and music
* Medicine and place: exteriors and interiors
* Medicine and ritual
* Medicine and visual culture
* Narrative medicine and the clinical encounter
* Narrative, identity and psychoanalysis
* Narrative and the case history
* The art of dying
* The fictional doctor and patient
* The medical autobiography / memoir
* The Illness memoir
* The language of pain
* The language and lure of ‘Bad Science’
* The poetry of pain
* Symbolic medicine: the staff of Asklepios and the caduceus of Hermes
* Trauma and language
* Western biomedicine and trans-cultural practices
* Who owns the illness?

Format: Given the interdisciplinary nature of the conference, we would like papers to be accessible to all participants. If your proposal is accepted we will ask you to provide a short handout in advance of the conference, which includes an abstract that sets out your key arguments followed by brief definitions of terminology.

CPD points for clinicians: Given the contribution the conference will make to clinical practice, CPD credits may be claimed under your individual College guidelines.

The deadline for proposals is 25th February. Please contact Debbie Harrison (d.harrison@bbk.ac.uk) and Jo Winning (j.winning@bbk.ac.uk). We would be delighted to discuss your ideas informally in advance.

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I am biased given that pain is probably the central topic of my scholarship, but this sounds like a fabulous conference.  Too bad it is on the other side of the pond, and the travel budget for yours truly is stretched.

(h/t H-SCI-MED-TECH)

On the Social Function of the "Autonomy Zombie" in Western Bioethics

Stuart Rennie has a characteristically excellent post on the zombie-like existence of autonomy-centric bioethics.  But there's more here than the "cottage industry" of debunking obeisance to autonomy in Western bioethics.

Here's his conclusion:

. . . the horse has been flogged for ages, it is still not dead, and the current zombie-like state of the concept requires an explanation. Why is it, say, that people still find it attractive to say that organ trade between the rich and the poor could be reasonably conceived as a fair and unproblematic trade if conducted between consenting adults? Or that exploitation in international health research is morally acceptable if the 'exploited' party in the transaction adequately consented and might be worse off if he or she did not join a certain study? When a notion seems to be debunked but somehow survives, it is tempting to look past its content and look at the social function it may continue to serve. What does the use of the concept of autonomy 'do' for (some) people when deployed in bioethics arguments? Who gains and who loses when these issues are viewed and defended within frameworks that see individual choice as paramount?

Important questions these, that move well beyond the well-flogged critique to the wider question of why the discourse continues to enjoy such apparent currency in the face of such withering criticisms? Rennie is unquestionably right that a broader functional analysis of the role and utility of the rhetoric might help shed some light on the subject.

Thoughts?