The contribution of ethnography to epigenomics research: toward a new bio-ethnography for addressing health disparities.

This article describes ethnography as a research method and outlines how it excels in capturing the salient experiences of individuals among diverse communities in their own words. We argue that the integration of ethnographic findings into epigenomics will significantly improve disparities-focused study designs within environmental epigenomics by identifying and contextualizing the most salient dimensions of the 'environment' that are affecting local communities. Reciprocally, epigenetic findings can enhance anthropological understanding of human biological variation and embodiment. We introduce the term bio-ethnography to refer to research designs that integrate both of these methodologies into a single research project. Emphasis is given in this article, through the use of case studies, to socially disadvantaged communities that are often under-represented in scientific literature. The paper concludes with preliminary recommendations for how ethnographic methods can be integrated into epigenomics research designs in order to elucidate the manner in which disadvantage translates into disparities in the burden of illness.

Accounting for variation in and overuse of antibiotics among humans.

Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over-the-counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.

Toxic Environments and the Embedded Psyche.

A discussion of the recent transition to a new geological epoch, the Anthropocene, opens this article. The need to declare a new era has been declared necessary by geologists, together with other scientists and critical commentators due to the inordinate amount of human-made destruction being imposed on the globe and its inhabitants. This destruction disproportionally effects those who are economically deprived and experience discrimination. An account of the recognition and routinization of epigenetics follows, in which an unexamined assumption of genetic determinism is debunked. A move to recognize human existence everywhere as contextualized in environments that impinge on body functioning throughout life opens up a discussion of the embodiment of trauma followed by six illustrative examples from the newly recognized field of environmental epigenetics.

The epigenome and nature/nurture reunification: a challenge for anthropology.

Recognition among molecular biologists of variables external to the body that can bring about hereditable changes in gene expression or cellular phenotypes has reignited nature/nurture discussion. These epigenetic findings may well set off a new round of somatic reductionism because research is confined largely to the molecular level. A brief review of the late nineteenth-century formulation of the nature/nurture concept is followed by a discussion of the positions taken by Boas and Kroeber on this matter. I then illustrate how current research into Alzheimer's disease uses a reductionistic approach, despite epigenetic findings in this field that make the shortcomings of reductionism clear. In order to transcend the somatic reductionism associated with epigenetics, drawing on concepts of local biologies and embedded bodies, anthropologists can carry out research in which epigenetic findings are contextualized in the specific historical, socio/political, and environmental realities of lived experience.

Postgenomics, uncertain futures, and the familiarization of susceptibility genes.

This paper draws on empirical findings from interview studies in the USA and Canada to interrogate the idea that expanding practices of genetic testing are likely to transform kin and family relations in fundamental ways. We argue that in connection with common adult onset disorders in which susceptibility genes with low predictive power are implicated it is unlikely that family relationships will be radically altered as a result of learning about either individual or family genotypes. Rather, pre-existing family dynamics and ideas about family susceptibilities for disease may be reinforced. The case of the ApoE gene and its relationship to Alzheimer's disease is used as an illustrative example. We found that "postgenomic" thinking, in which complexity of disease causation is emphasized, is readily apparent in informant narratives.

Situating the practice of organ donation in familial, cultural, and political context.

This article provides a discussion of the factors that have contributed in recent years to the assertion that there is a growing shortage of organs for transplant. Findings from ethnographic research carried out in 3 settings--the United States, Japan, and Mexico--are then presented to demonstrate that factors other than low education levels, irrationality, or a lack of generosity are at work when individuals make decisions about organ donation. In all 3 sites, it is clear that both the donation and receiving of organs are based on moral positions and felt obligations concerning appropriate behavior among close relatives and that the ideal of autonomous choice is not readily applicable. Culturally informed expectations are at work in all 3 sites, and in Japan and Mexico, social and political dimensions additionally come into play. We argue that a better accounting is called for of the familial, cultural, and political contexts within which organ transfer takes place.

Susceptibility genes and the question of embodied identity.

Drawing on an assumption of the co-construction of the material and the social, late-onset Alzheimer's disease (AD) is used as an illustrative example to assess claims for an emergent figure of the "individual genetically at risk." Current medical understanding of the genetics of AD is discussed, followed by a summary of media and AD society materials that reveal an absence of gene hype in connection with this disease. Excerpts from interviews with first-degree relatives of patients diagnosed with AD follow. Interviewees hold complex theories of causation. After genetic testing they exhibit few if any subjective changes in embodied identity or lifestyle. Family history is regarded by interviewees as a better indicator of future disease than is genetic testing. We argue that, even when molecular genetics are better understood, predictions about complex disease based on genotyping will be fraught with uncertainty, making problematic the concept of individuals as genetically at risk when applied to late-onset complex disease.

Social, political, and epistemological aspects of genetics and genomics.

The papers in this special issue were first given at a conference in Toronto, Canada, in April 2004 entitled 'Genomics, Genetics, and Society: Bridging the Disciplinary Divides'. The papers fall into four intersecting themes. (1) The introduction of genetic and genomic technologies into communities. (2) Governance, the morals of scientific discourse and policy making. (3) What is a gene? (4) Public knowledge, public trust and improved dialogue between the public and scientists.

Culture and symptom reporting at menopause.

The purpose of the present paper is to review recent research on the relationship of culture and menopausal symptoms and propose a biocultural framework that makes use of both biological and cultural parameters in future research. Medline was searched for English-language articles published from 2000 to 2004 using the keyword 'menopause' in the journals--Menopause, Maturitas, Climacteric, Social Science and Medicine, Medical Anthropology Quarterly, Journal of Women's Health, Journal of the American Medical Association, American Journal of Epidemiology, Lancet and British Medical Journal, excluding articles concerning small clinical samples, surgical menopause or HRT. Additionally, references of retrieved articles and reviews were hand-searched. Although a large number of studies and publications exist, methodological differences limit attempts at comparison or systematic review. We outline a theoretical framework in which relevant biological and cultural variables can be operationalized and measured, making it possible for rigorous comparisons in the future. Several studies carried out in Japan, North America and Australia, using similar methodology but different culture/ethnic groups, indicate that differences in symptom reporting are real and highlight the importance of biocultural research. We suggest that both biological variation and cultural differences contribute to the menopausal transition, and that more rigorous data collection is required to elucidate how biology and culture interact in female ageing.

Genetic susceptibility for Alzheimer's disease: why did adult offspring seek testing?

This study explored why adult offspring of individuals with Alzheimer's disease (AD) sought genetic susceptibility testing for AD. Participants (N = 60) were a subset of subjects from the first randomized controlled clinical trial to offer such testing. Qualitative analysis revealed two central constructs: altruism and learning. Planning for the future, hoping to prevent AD, and need to know were concepts that explained the value of learning. These results add important contextual information into why people might seek information on their genetic risk for a severe neurodegenerative disease for which there are, as yet, no preventative treatments. As genetic susceptibility testing for numerous other diseases enters clinical medicine, these findings can enhance the knowledge and sensitivity of researchers and clinicians when they are asked by participants or patients whether they should be tested.

Inventing a new death and making it believable.

This article shows how the concept of 'brain death' was created in order that the routinization of solid organ transplantation could take place. The concept permitted individuals diagnosed as brain-dead but whose respiration and heartbeat continued through technological assistance to be counted as no longer alive, and therefore organs could be retrieved from them without legal reprisals. It is shown how, because the condition of brain-dead bodies is ambiguous--they are at once dead and alive--discursive practices must be put to work in both medicine and law to justify their status as dead. Despite an apparent consensus within the medical world about the concept of brain death, disagreement remains among various countries about how best to make the diagnosis. Moreover, professionals working with brain-dead patients draw on a Cartesian split between mind and body in order to allow themselves to count such patients as dead; this maneuver is justified because the minds of brain-dead patients no longer function, although their bodies clearly remain very much alive. Without the legal fiction of brain death the transplant world would be severely hampered.

Symptom reporting at menopause: a review of cross-cultural findings.

Extensive cross-cultural and comparative research reveals that the majority of women do not find the menopausal transition a difficult time. This research also shows considerable variation in symptom reporting at the end of menstruation. It is argued that socio/cultural variables, including language usage and expectations about the menopausal experience, do not fully account for these differences, and that biological variation must also be taken into account. In those societies where subjective reporting of symptoms, including vasomotor symptoms, is low, such findings should not be dismissed as the result of learned cultural expectations that mask reality.