Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care.

A. L. Cochrane's Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence-based medicine. Cochrane's concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane's approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane's original vision arising from the difficulties of separating cure from care; the overlap between prevention and cure; the complex actions of some multi-faceted therapies; and recent reconceptualisations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical "evidence pyramid", a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterised by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical tradition's approaches to prevention, cure, care, as well as efficiency, efficacy and equality.

From body-talk to body-stories: body work in complementary and alternative medicine.

This paper explores the 'body work' undertaken by practitioners of complementary and alternative medicine (CAM), in the light of ethnographic research on the education of osteopaths and homeopaths. The data presented focus on practitioners' experiences of learning to communicate, touch and facilitate the healing process for their patients. Two new concepts are introduced: listening to body-talk and constructing body-stories, which are discussed as aspects of body work. Body-talk expresses the idea that the embodied patient is not a passive recipient of healthcare, but that the 'body' is able to communicate its distress and its needs. The body-story concept highlights the interactional nature of the therapeutic encounter and the profound interrelation between the treatment and case-taking aspects of the practitioner's clinical tasks. By drawing on key sociological concepts of the body and embodiment, reflexivity and narrative, I argue that the dialogical construction of body-stories challenges Cartesian dualism. Finally, I discuss what the data might mean for the future development of the sociological concept of 'body work', drawing particular attention to the necessity to problematise the concept of the 'body' and to pay great attention to body work as embodied work.

The researcher as experimental subject: using self-experimentation to access experiences, understand social phenomena, and stimulate reflexivity.

The current article argues that researcher-as-subject self-experimentation can provide valuable insight and systematic knowledge to social psychologists. This approach, the modus operandi of experimental psychology when the field was in its infancy, has been largely eclipsed by an almost exclusive focus on participant-as-subject other-experimentation. Drawing from the non-experimental first-person traditions of autoethnography, participant observation, and phenomenology, we argue that participating as both observer and subject within one's own social psychological experiment affords researchers at least three potential benefits: (1) access to "social qualia," that is, the subjective experience of social phenomena; (2) improved mental models of social phenomena, potentially stimulating new research questions; and (3) an enhanced ability to be reflexive about the given experiment. To support our position, we provide first-person self-reflections from researchers who have self-experimented with transformed social interactions involving Milgram's cyranoid method. We close by offering guidelines on how one might approach self-experimentation, and discuss a variety of first-person perspective ethnographic technologies that can be incorporated into the practice.

Chasing the dragon: the cultural metamorphosis of opium in the United States, 1825-1935.

Many things to many people, opium has played a role in the emergence of several power bases in the United States. In turn, these bases of power have shaped what opium is for the rest of us. Allopathic medicine brought opium and its derivatives under its control around the turn of the century, promulgating "addiction theory" and addiction clinics as part of its rise to preeminence among rival forms of medicine. Opium also played a role in the U.S.'s international economic and imperialistic ascendance. When politicians began to deploy a new discourse on opium early in this century, they were able to appropriate medical rhetoric. As the politics of opium heated up, some doctors were able to exploit the emerging politically inspired discourse to generate a subtly different medical knowledge of opiates and addiction while establishing a new subdiscipline with the political support of lawmakers and state institutions.

Organoterápicos a partir de tecidos de carneiro: relato etnográfico e preparação / Organotherapy medicines from sheep: ethnographic report and preparation

Organoterápicos (OT) são medicamentos diluídos e agitados, produzidos a partir de órgãos de animais saudáveis e utilizados como complemento ao tratamento homeopático ou convencional. As matérias-primas (matrizes) disponíveis no país não ofereciam rastreabilidade ou informações como a origem do material preparado. Este artigo apresenta um relato etnográfico e descreve a produção de matrizes de OTs a partir de tecidos de carneiro nas proporções (escalas) decimal, centesimal e cinquenta milesimal. Foram obtidos 70 diferentes órgãos, partes de órgãos e algumas composições, com informações completas sobre a origem e rastreabilidade. (AU)

Organotherapy (OT) employs serially diluted and agitated medicines prepared with organs of healthy animals as adjuvant to homeopathic or conventional treatment. The starting-substances for OT available in Brazil have no traceability and there is no information as to their origin. In the present article we present an ethnographic report of organ collection and preparation of 70 new OT medicines from sheep tissue in the decimal, centesimal and 50 milesimal scales which meet all traceability requirements. (AU)

Organoterápicos a partir de tecidos de carneiro: relato etnográfico e preparação / Organotherapy medicines from sheep: ethnographic report and preparation

Organoterápicos (OT) são medicamentos diluídos e agitados, produzidos a partir de órgãos de animais saudáveis e utilizados como complemento ao tratamento homeopático ou convencional. As matérias-primas (matrizes) disponíveis no país não ofereciam rastreabilidade ou informações como a origem do material preparado. Este artigo apresenta um relato etnográfico e descreve a produção de matrizes de OTs a partir de tecidos de carneiro nas proporções (escalas) decimal, centesimal e cinquenta milesimal. Foram obtidos 70 diferentes órgãos, partes de órgãos e algumas composições, com informações completas sobre a origem e rastreabilidade...

Organotherapy (OT) employs serially diluted and agitated medicines prepared with organs of healthy animals as adjuvant to homeopathic or conventional treatment. The starting-substances for OT available in Brazil have no traceability and there is no information as to their origin. In the present article we present an ethnographic report of organ collection and preparation of 70 new OT medicines from sheep tissue in the decimal, centesimal and 50 milesimal scales which meet all traceability requirements...

[To the study of conventual health in the beginning of 19th century: the pharmacies]. / Para o estudo da saúde conventual no início do século XIX: as boticas.

The institution "Junta do Exame do Estado Actual e Melhoramento Temporal das Ordens Regulares" (Examination Council for the Actual State and Temporal Improvement of the Religious Orders) was created in November of 1789. Among other things, each Religious House should inform that institution about its heritage either the movables and the landed estates. The inventorying included all the goods belonging to wards and drugstores. In this paper, we aim to study those places using records obtained from a variety of Religious Houses with no regional or Religious Order preferences. We will try to give answers to questions related to that spaces such as 'Which objects could be found inside the Houses?'; 'Were they properly equipped?'; and 'Were there big differences between them in what concerns Religious Orders and Houses locations?'.

Diversidad cultural de sanadores tradicionales afrocolombianos: preservación y conciliación de saberes / Cultural Diversity of Afro-Colombian Traditional Healers: Preservation and Conciliation of Knowledge / Diversidade cultural dos curandeiros tradicionais afro-colombianos: preservação e conciliação de saberes

La diversidad afrocolombiana entreteje prácticas culturales en salud específicas. Los sanadores tradicionales son poseedores de una costumbre milenaria en el cuidado de la salud. Gozan del reconocimiento, la confianza y el respeto de sus comunidades, pero son desconocidos o ignorados en las instituciones de salud y en el mundo profesional. Objetivo: describir las prácticas de cuidado realizadas por los sanadores tradicionales (remedieros y parteras) en una comunidad afrocolombiana en Guapi, Cauca, Colombia. Método: el estudio etnográfico utiliza observación participante y entrevistas en profundidad con tres remedieros y tres parteras. El análisis se realizó de forma inductiva e interpretativa. Resultados: los hallazgos evidencian diversos métodos de curación relacionados con el uso de hierbas, maniobras, fórmulas especiales y rezos, entre otros. Esta diversidad de métodos implica que las personas sean vistas de manera holística adoptándose diferentes maneras de sanar y cuidar la salud. Conclusiones: la importancia de conocer y preservar estos conocimientos es una forma de expresar el compromiso por proteger, rescatar y favorecer el diálogo entre los saberes profesional y popular. Es una invitación a conocer y reconocer el papel que pueden jugar los sanadores tradicionales en los sistemas de salud.

Afro-Colombian diversity is interwoven with specific cultural health-care practices. Traditional healers possess a thousand-year-old tradition regarding health care. They enjoy the recognition, trust and respect of their communities, but are unknown to health institutions and the professional world, or ignored by them. Objective: The study describes health-care practices performed by traditional healers; specifically, remedieros (non-professional apothecaries) and parteras (midwives) in an Afro-Colombian community in Guapi, a town located in the Cauca region of Colombia. Methodology: This ethnographic study relied on participant observation and in-depth interviews with three remedieros and three parteras. The analysis was conducted in an inductive and interpretative way. Results: The results demonstrate different healing methods associated with the use of herbs, maneuvers, special formulas and prayers, among other elements. This diversity of methods implies the person is viewed in a holistic manner that is conducive to the adoption of diverse ways to heal and protect health. Conclusions: The importance of being aware of this knowledge and preserving it is a way to express a commitment to protecting, rescuing and favoring dialogue between professional and traditional healers. It also is an invitation to understand and acknowledge the role traditional healers can play in health care systems.

A diversidade afro-colombiana entretece práticas culturais específicas em saúde. Os curandeiros tradicionais são possuidores de um costume milenar no cuidado da saúde. Desfrutam do reconhecimento, da confiança e do respeito de suas comunidades, mas são desconhecidos ou ignorados nas instituições de saúde e no mundo profissional. Objetivo: o estudo descreve as práticas de cuidado realizadas pelos curandeiros tradicionais ("ervateiro" e parteiras) em uma comunidade afro-colombiana em Guapi, Cauca, Colômbia. Método: o estudo etnográfico utiliza observação participante e entrevistas em profundidade com três "ervateiros" e três parteiras. A análise se realizou de forma indutiva e interpretativa. Resultados: os resultados encontrados evidenciam diversos métodos de cura relacionados com o uso de ervas, manipulações, fórmulas especiais e rezas, entre outros. Essa diversidade de métodos implica que as pessoas sejam vistas de maneira holística, adotando diferentes maneiras de curar e cuidar a saúde. Conclusões: a importância de conhecer e preservar esses conhecimentos é uma forma de expressar o compromisso por proteger, resgatar e favorecer o diálogo entre os saberes profissional e popular. É um convite a conhecer e reconhecer o papel que os curandeiros tradicionais podem ter nos sistemas de saúde.

Is the cultural context of MMR rejection a key to an effective public health discourse?

OBJECTIVES: (1) To explore the social and cultural influences, and health beliefs associated with low uptake of MMR (measles, mumps and rubella vaccine). (2) To describe and explore the prevalence of health beliefs associated with non-compliance with MMR, with a view to improving the personal relevance and impact of information for parents, in the context of persisting low uptake following public controversy. METHODS: We undertook a survey of mothers' experiences of and attitudes to the MMR, developed through ethnographic study, which was linked to maternal and child information on the Child Health Database in Brighton, England. RESULTS: Mothers interpret MMR risk through concepts of child health embedded in family health history, with a majority both of compliers and non-compliers holding that each child's immune system is unique. Cultural 'risk factors' for non-compliance relate strongly to the use of complementary healthcare, such as homeopathy, with evidence that rejection of vitamin K is associated with MMR non-compliance. Forty per cent, both of compliers and non-compliers, did not consider the possible benefits to other children of MMR. CONCLUSIONS: These findings have paradoxical and challenging consequences for the promotion of immunization in the policy context of increasing emphasis on healthy choices. They demonstrate the need for immunization information that acknowledges and addresses lay concepts of immunity.

Communicating for a clinical purpose: strategy in interaction in healthcare consultations.

Many studies of communication employ interviewing techniques and conversation analysis, particularly in situations where one participant brings specialist resources. Interviews and recorded interactions are usually handled separately: ethnographic data are introduced once conversation analysis is complete, to validate findings or illustrate their wider significance. However, integrating interview data in conversation analysis has the potential to illuminate analysts' interpretations, and to enhance professionals' contributions from analysis through to dissemination. In this study, interviews highlighted a parameter between professionals who actively used communication to manipulate the consultation's course, engaging patients at particular points and in particular ways, and professionals whose consultation management was more 'clinical' and less dependent on interaction. The different ways professionals talked in interview were paralleled by differences identified from conversation analysis of consultations. For some, 'clinical' orientation was more prevalent in the organization of their consultations than 'active' manipulation of communication, and their management of the consultation more 'unilateral'. For others, communication played a more strategic and integral part in clinical practice, and their management of the consultation was more 'bilateral'. These contrasts in professionals' descriptions of their consultation management suggest that at least some features of a 'bilateral' approach are consciously employed and may be teachable.

Etnopsicanálise: embasamento crítico sobre teoria e prática terapêutica / Ethnopsychoanalysis: critical foundations on theory and psychotherapeutic practice / Etnopsicoanálisis: fundamentación crítica sobre la teoría y la práctica psicoterapéutica

Este trabalho busca apresentar a etnopsicanálise, disciplina científica que conjuga antropologia e psicanálise. O artigo contextualiza o desenvolvimento da etnopsicanálise ao longo do século XX, com teóricos como Géza Róheim e Georges Devereux, que transitavam entre ambas as disciplinas e propuseram-se a aprofundar o debate na teoria e na prática terapêutica. Em seguida, apresenta-se o atual contexto da etnopsicanálise, abordando os principais teóricos que trabalham na área e contribuem para elucidar e possibilitar o diálogo multidisciplinar. Ressalta-se a importância de se discutir sobre o alicerce teórico no qual surgiu a etnopsicanálise e a sua prática atual para refletirmos e contextualizarmos a aplicabilidade da mesma no Brasil.

This research aims to present ethnopsychoanalysis, a scientific area that joins anthropology and psychoanalysis. The paper provides the context for the development of ethnopsychoanalysis throughout the twentieth century, with theoreticians like Géza Róheim and Georges Devereux, who moved between both areas and intended to deepen the debate in theory and therapeutic practice. After that, the current context of ethnopsychoanalysis is presented, addressing the main theoreticians working in this area who contribute to clarify and permit a multidisciplinary dialogue. Furthermore, the importance of discussing the theoretical framework in which ethnopsychoanalysis emerged is highlighted and its current practice, in order to reflect on and provide a context for its applicability in Brazil.

La finalidad de este trabajo es presentar la etnopsicoanálisis, disciplina científica que conjuga antropología y psicoanálisis. El artículo contextualiza el desarrollo de la etnopsicoanálisis a lo largo del siglo XX, con teóricos como Géza Róheim y Georges Devereux, que transitaban entre ambas disciplinas e intentaron ahondar el debate en la teoría y en la práctica terapéutica. A seguir, se presenta el contexto actual de la etnopsicoanálisis, tratando los principales teóricos que trabajan en el área y contribuyen para elucidar y posibilitar el diálogo multidisciplinario. También se destaca la importancia de discutir sobre las bases teóricas que surgió la etnopsicoanálisis y su práctica actual para reflejar y contextualizar su aplicabilidad en Brasil.

Personalidad sobreadaptada y homeopatía / Personality sobreadaptada and homeopathy

El presente trabajo está destinado a describir una estructura de personalidad que se observa cada vez con mayor frecuencia, muy favorecida por la actual “cultura del éxito”. Quienes la presentan son personas que sostienen un excesivo ajustea la realidad exterior y a sus exigencias, disociando necesidades y posibilidades emocionales y corporales. Se establece la relación del cuadro psicopatológico con algunos remedios homeopáticos. (AU)

This paper is intended to describe a personality structure that is observed with increasing frequency, favored by the current "culture of success". Those who have are people who argue overshootingto external reality and demands decoupling emotional and physical needs and possibilities. The relationship of psychopathology with some homeopathic remedies set. (AU)

Personalidad sobreadaptada y homeopatía / Personality sobreadaptada and homeopathy

El presente trabajo está destinado a describir una estructura de personalidad que se observa cada vez con mayor frecuencia, muy favorecida por la actual “cultura del éxito”. Quienes la presentan son personas que sostienen un excesivo ajustea la realidad exterior y a sus exigencias, disociando necesidades y posibilidades emocionales y corporales. Se establece la relación del cuadro psicopatológico con algunos remedios homeopáticos.

This paper is intended to describe a personality structure that is observed with increasing frequency, favored by the current "culture of success". Those who have are people who argue overshootingto external reality and demands decoupling emotional and physical needs and possibilities. The relationship of psychopathology with some homeopathic remedies set.