Unpacking intoxication, racialising disability.

This article examines concepts whose strictly medical applications have only partly informed their widespread use and suggests that demonstrably shared logics motivate our thinking across domains in the interest of a politically just engagement. It considers exchanges between the culturally complex concepts of 'toxicity' and 'intoxication', assessing the racialised conditions of their animation in several geopolitically--and quite radically--distinct scenarios. First, the article sets the framework through considering the racial implications of impairment and disability language of 'non-toxic' finance capital in the contemporary US financial crisis. Shifting material foci from 'illiquid financial bodies' to opiates while insisting that neither is 'more' metaphorically toxic than the other, the article turns to address the role of opium and temporality in the interanimations of race and disability in two sites of 19th-century British empire: Langdon Down's clinic for idiocy, and China's retort on opium to Queen Victoria. The article concludes with a provocation that suggests yet another crossing of borders, that between researcher and researched: 'intoxicated method' is a hypothetical mode of approach that refuses idealised research positions by 'critically disabling' the idealised cognitive and conceptual lens of analysis.

Traditional ecologies of the opium poppy and oral history in rural Turkey.

Cultivated in the Eastern Mediterranean region for millennia, the opium poppy (Papaver somniferum) was profoundly significant in the economies, ecologies, cultures, and diets of the peoples of many towns and villages of rural Anatolia. When the United States compelled Turkey to eradicate cultivation of the plant in the early 1970s in order to diminish the flow of heroin into America, farmers were obliged to deal with not only changes in their incomes but also profound changes in their relationships with the land and the state. Although Turkish officials later allowed production to resume in a highly controlled manner for pharmaceutical purposes, significant socioeconomic and ecological dimensions of Turkey's poppy-growing communities were forever changed. Interviewing now-retired poppy farmers, I employ oral history as my primary source of historical evidence to reconstruct these past ecologies and associated social relationships and to give voice to the informants.

"Poppies are democracy!" A critical geopolitics of opium eradication and reintroduction in Turkey.

Historical scholarship in traditional geopolitics often relied on documents authored by states and by other influential actors. Although much work in the subfield of critical geopolitics thus far has addressed imbalances constructed in official, academic, and popular media due to a privileging of such narratives, priority might also be given to unearthing and bringing to light alternative geopolitical perspectives from otherwise marginalized populations. Utilizing the early-1970s case of the United States' first "war on drugs," this article examines the geopolitics of opium-poppy eradication and its consequences within Turkey. Employing not only archival and secondary sources but also oral histories from now-retired poppy farmers, this study examines the diffusion of U.S. antinarcotics policies into the Anatolian countryside and the enduring impressions that the United States and Turkish government created. In doing so, this research gives voice to those farmers targeted by eradication policies and speaks more broadly to matters of narcotics control, sentiments of anti-Americanism, and notions of democracy in Turkey and the region, past and present.

Poppies for medicine in Afghanistan: lessons from India and Turkey.

This study examines India and Turkey as case studies relevant to the Senlis Council's 'poppies for medicine' proposal. The proposal is that Afghan farmers are licensed to produce opium for medical and scientific purposes. Here it is posited that the Senlis proposal neglects at least three key lessons from the Turkish and Indian experiences. First, not enough weight has been given to diversion from licit markets, as experienced in India. Second, both India and Turkey had significantly more efficient state institutions with authority over the licensed growing areas. Third, the proposal appears to overlook the fact that Turkey's successful transition was largely due to the use of the poppy straw method of opium production. It is concluded that, while innovative and creative policy proposals such as that of the Senlis proposal are required if Afghanistan is to move beyond its present problems, 'poppies for medicine' does not withstand evidence-based scrutiny.

Cultural components of behavioural epidemiology: implications for primary health care.

In this article we discuss the association of culturally linked behaviour and epidemiology: that patterns of disease are significantly related to cultural sets of normative beliefs and behaviour. The literature on this is vast and includes much of what is written under the headings of Medical Anthropology as well as, for example, Cross-cultural Psychiatry and Medical Geography. A comprehensive review is obviously impossible, but as this is presented primarily as a background paper, basic issues are raised, and related to examples from the literature, to stimulate discussion. The article is divided into four subsections which give an indication of our focus: culture, disease and illness causation; utilization and provision of health resources; health, illness and normative socio-political and economic behaviour and primary health care, community participation and culture--implications for the future.

Harm reduction and alternative development in the Golden Triangle.

The authors of this Digest are anthropologists from Macquarie University, Sydney Australia. At the invitation of the German aid agency GTZ, they have been monitoring opium use and the impact of drug rehabilitation in Muang Sing Laos over the past 3 years. Their role is to provide analyses of how development projects alter the social make-up of their target communities and contribute to ways in which substance use/abuse is understood, practiced and controlled or reconfigured. In their consideration of development projects they take the perspective that harm reduction can and should include pre-emptive concern with factors that promote damaging drug use in the first place and furthermore, that these factors are at times the products of the distinct drug reduction strategies themselves.

Infertility: a global perspective. The role of pelvic infection.

PIP: The results of an examination of 5800 couples in 33 World Health Organization centers in 25 countries have provided the most comprehensive information on infertility in both developed and developing countries. Prior infection and bilateral tubal blockages were frequently traced as the cause of infertility. In the African sample; up to 64% of female patients had prior infection as the cause of infertility. A gynecological history of sexually transmitted disease, pelvic inflammatory disease (PID) and infection-related pregnancy complications of normal childbirth and abortion were directly related to infertility. 49% of the African couples and 11-15% of other patients in other parts of the world had infectious tubal disease. Westrom's study found that after PID 6-60% of patients became infertile. The factors affecting the infertility were the number and severity of infections, and the age when initial infection occurred. Between 1960 and 1980, in Sweden and the US, infertility doubled. Cates in the US has estimated that after 3 PID infections more than 50% of patients will be infertile. Ectopic pregnancy is another outcome of pelvic infection and sexually transmitted disease. Common PID infections are caused by Chlamydia trachomatis and Neisseria gonorrhea. These infections can cause tubal obstruction or pelvic adhesions and destructive tubal damage. After an ectopic pregnancy, 50% of patients are infertile and 10% have subsequent ectopic pregnancies. Some infertility may be treated. Microsurgery can be performed for tubal disease. Hysteroscopy can be used to treat intrauterine adhesions (Asherman's syndrome). Success has been better with hysteroscopy. Tubal microsurgery had led to conceptions in only 30-30% of patients, and a very high percentage of tubal pregnancies. The most successful results have come from tubal reanastomosis for reversal of tubal sterilization. The most promising results have come from "in vitro" fertilization and other methods of assisted reproduction. However, there must be a more simplified technology, improved results, and reduced costs before large numbers worldwide can benefit. The best approach is prevention and early detection of infection, and risk assessment. Culturally sensitive education programs will generally alert the population to precursor conditions of infertility.^ieng

Vaginal contraceptive rings: option for the new millennium.

PIP: Vaginal contraceptive rings, currently in advanced clinical trials, offer a simple, long-acting, woman-controlled method of fertility control. A ring developed by the Population Council's Center for Biomedical Research, with continual release of 20 mcg of ethinyl estradiol and 1 mg of norethindrone acetate, has been accepted by a commercial partner for further studies leading to market introduction. Another Population Council-developed ring combines an even lower dose of estrogen (15 mcg) with its own patented progestin, NESTORONE. Organon is in phase III trials of a ring combining 15 mcg of ethinyl estradiol and the progestin etonogestrel and expects to complete its research by mid-1999. Of particular interest is the potential for vaginal irritation. The one-size ring is smaller than most diaphragms and does not require fitting. Once a woman has received instructions, she can insert and remove the ring herself. The ring's regimen of 3 weeks of use and 1 week of rest is similar to the schedule for oral contraceptives (OCs), but provides better cycle control than a combined OC that delivers one-third more of the same progestin and estrogen. Finally, a progestin-only vaginal ring for lactating women has been licensed for manufacture and distribution in Latin America.^ieng

[Oral contraceptives and blood platelets]. / Contraceptifs oraux et plaquettes sanguines.

PIP: This work describes a study of the effects of combined oral contraceptives (OCs) on lipid biosynthesis in platelets of female rats and women. A highly significant hypercoagulability due solely to increased activity of platelet factor 3 can be observed in women using combined OCs. The phospholipidic nature of factor 3 has been demonstrated. Phospholipids are implicated in the aggregation of platelets because they are the essential constituents of the platelet membranes and the precursors of prostaglandins. Platelets actively synthesize their own lipids, and combined OCs modify serum lipid metabolism. In each experiment, a control group of rats weighing 180-200 g received .5 ml/g body weight of olive oil once daily for 4 days. 3 groups of experimental rats received .5 ml of olive oil containing 10 mcg of ethinyl estradiol (EE) and 250 mcg of lynestrenol or 10 mcg of EE alone or 250 mcg of lynestrenol alone per 100 g of body weight. The doses were the equivalent of 1/2 that required to block ovulation in adult female rats. Platelets were studied on the 5th day. In another experiment a group of rats was given a triple dose of EE and lynestrenol on the 1st study day. Platelets were studied on days 1, 3, 5, and 8. Lipid biosynthesis was studied by incorporation of carbon 14 labelled acetate and mevalonate precursors. Radioactivity was measured for the lipids as a whole and for different lipid fractions separated by chromatography. Incorporation of carbon 14 labelled acetate was augmented by 44.6% in animals receiving EE and lynestrenol and by 43% in animals receiving EE alone, but was not modified in animals receiving lynestrenol alone. In animals receiving a triple dose of hormones, incorporation was maximal on the 3rd day, diminished on the 5th day, and normal after 8 days. The EE component thus appears to be responsible for modifications in platelet lipid metabolism during OC use. The response appears after a latency period and seems to be irreversible, since the duration of life of platelets is 4-5 days. The increased synthesis occurs mainly in cholesterol and its precursors lanosterol and dihydrolanosterol. Supplemental in vitro experiments suggested that lanosterol was responsible for the increased platelet activity. 17 nonsmoking women aged 32 years on average who took no medications were compared to 18 women aged 30 years on average who took OCs with estrogen doses of 30-40 mcg for at least 6 months. As in the rat studies, lipid biosynthesis was analyzed by incorporation of carbon 14 labelled acetate or mevalonate in the platelets. Compared to control women, the women on OCs showed an augmentation of 37% in incorporation of mevalonate and 28% of acetate. The labelled acetate showed a higher incorporation at the level of each of the lipid fractions. Mevalonate showed the highest augmentation in the lanosterol fraction. 43% of the women taking OCs showed an increased platelet sensitivity to thrombine. The increased sensitivity was correlated with increased lanosterol synthesis, but the relation was only observed in women taking OCs. The phenomenon is of interest because of its possible relationship to the increased risk of thromboembolic accidents in women taking OCs.^ieng

Airing method-specific advertisements.

PIP: The Turkish Family Health and Planning Foundation initiated the commercial marketing of contraceptives in 1989 as part of a Contraceptive Social Marketing (CSM) program to make available low-cost contraceptives. In 1988 modern methods were used by 31% and traditional methods by 32.3%, while 36.6% used no contraceptives. Only 6.2% were current pill users mainly because of health reasons since high-dose pills dominated the market. A 1990 survey among urban consumers indicated a 94% awareness of contraceptive methods, 76.1% of current use, and preference for the IUD. The side effects of the pill were cited for disliking it, and the condom was rated higher. The CSM project aims at popularizing low-dose pills by explaining the differences and benefits regarding high-dose pills. It collaborated with manufacturers: Schering, Wyeth, Organon, and Eczacibasi Ilac. In 1991 a TV and radio advertisement campaign started that involves the low-dose products Microgynon, Triquilar, Desolet, Lo-Ovral, and Tri-Nordial. The introduction of the Okey condom by Eczacibasi Ilac. In June 1991 also entailed extensive promotion with newspaper ads and TV spots after getting official permission. 1.3 million condoms were sold in the 1st 2 months in 13,000 retail outlets, and 4 million more were projected to be sold. A shift of the attitude of supermarket owners allowing stocking of condoms and the support of the Turkish Ministry of Health, USAID, and the Turkish Radio and Television Bureau has facilitated the CSM project implementation that will profoundly affect family planning in Turkey.^ieng

A post-Cairo profile. The Population Council.

PIP: The Population Council has been in the vanguard of the population field since its founding in 1952. The Council first focused on research in demography and reproductive physiology in order to increase the expertise of developing countries. Over the years, the Council's mission broadened as did its size and budget. It is staffed by several hundred people, with just over half located in the New York headquarters. The Council's work is guided by a mandate statement drafted in 1993, which proclaims that it seeks to improve reproductive health and strives to achieve a sustainable balance between people and resources. The previous emphasis on demography has been eased, but too rapid population growth is still a prime concern. Two issues papers codified the Council's contributions to the population field. John Bongaarts's paper on population demonstrated that family planning programs alone cannot slow population growth because of the population momentum and the desire for large families. Social investments in health care, education, and poverty reduction are needed for smaller families. The second paper, on reconsidering the rationale of family planning programs, argued for reducing unwanted fertility by helping people meet their own goals in a healthful way. The Council also develops and tests contraceptives, aids governments in designing effective population policies, and trains population specialists from the developing countries. Research is being carried out in male contraceptive development and physiology, since only an estimated 8% of the world's contraceptive development budget is spent on male contraceptive methods. Scientists and researchers are burgeoning in the developing world whose knowledge acquired in the developed countries is complemented by their own research projects. The Council's regional offices around the world are multidimensional. The offices are headed by professionals from the region striving for excellence in population study.^ieng

Contraceptive social marketing in the Philippines. A new initiative.

PIP: By offering contraceptives at subsidized prices through pharmacies, drugstores, grocery shops, and other conveniently-located retail outlets, and promoting them with modern marketing techniques, social marketing programs can do much to reduce the unmet need for family planning. Users obviously benefit, while the family planning program benefits from advertising and marketing skills and some cost recovery. The Philippine Contraceptive Social Marketing Project (PCSMP) was formally launched in the Philippines in 1993 in response to the large unmet need in the country, and initial results are promising. The project was started with funding from the US Agency for International Development to provide affordable, quality contraceptives through the private sector to Filipino couples who choose to practice family planning. A 1988 survey found that only 22.4% of women aged 15-44 years were using modern methods of contraception and 13.8% were using traditional methods; approximately three million women therefore had unmet need for family planning. The PCSMP established an AIDS prevention component and a birth spacing component, enlisting the participation of oral contraceptive manufacturers Wyeth, Organon, and Schering, along with one condom distributor, Philusa. These companies lowered their product prices by 20% for the program. Despite objections from the Catholic church, sales of both oral pills and condoms increased in the first year. In its second year, the program will advertise Sensation condoms and the Couple's Choice Pills via television, through intensive distribution drives, consumer and trade promotions, and the continuous training of health professionals. The contraceptive injectable DMPA will be added to the Couple's Choice product line in April 1994. This method, too, will be heavily promoted.^ieng

Commitment to action. Population Action International.

PIP: The national chair of Population Action International (formerly the Population Crisis Committee), Robin Chandler Duke, is a crusader for women's reproductive rights. She was in Bangladesh in 1971 during its civil war. Soldiers would rape young Muslim women, and their families would reject them when they became pregnant. The head of the exiled government agreed to let physicians from IPPF perform abortions on these women, which allowed families to take them back. Opposition to the abortions arose, however. This experience in Bangladesh sparked Ms. Duke's interest in population control. Her years as the wife of a US diplomat granted her access to powerful people worldwide. Her predecessor, retired US Army General Bill Draper, called Ms. Duke from his death bed in 1974 to ask her to be national chair of PAI. She served as a delegate in various international meetings, e.g., the 1980 UNESCO meetings in Belgrade. Spain and Luxembourg honored her for her work of campaigning for women's reproductive rights. She believes that rapid population growth is the most significant problem in the world today. It exacerbates poverty, environmental destruction, and political instability. She believes that universal availability of high quality, voluntary family planning services, including safe abortion, is needed to save humanity from the vicious cycle. Since family planning, sex education, and abortion are the most personal and sensitive parts of people's lives, Population Action frames family planning in the context of basic health care. AIDS complicates the issue, because contraception is no longer limited to birth control. Even though the organization realizes that sexual abstinence is the best way to avoid AIDS, it tries to educate female teenagers not to let boys coerce them to have sex. If they do, have sex Population Action advocates condom use. Ms. Duke cites the family planning successes of Indonesia, Zimbabwe, and Thailand.^ieng

One woman's crusade. An interview with Dr. Mawaheb T. El Mouelhy.

PIP: The views and background of the 1992 recipient of the Organon Family Planning Scholarship, the Egyptian El Mouelhy, were summarized; a report was also provided on the population views of Egyptian Dr. Maher Mahran, a professor of gynecology and obstetrics at Ain Shams University and director of the Egyptian National Population Council (NPC). El Mouelhy stated that the population problem in Egypt is a reflection of 98% of the population being settled on only 4% of the land area. The average number of children per family is 4, and the growth rate is 2.4%. Population growth is expected to reach 93 million, a doubling by 2025. Illiterates have the highest fertility; illiteracy in rural areas can be as high as 6.4%. Her solution is to rely on the cooperative efforts of government and nongovernmental groups to improve the status of women. Dr. Mahran reports that one goal of the NPC is to encourage redistribution of the population along the northern coast and Red Sea areas and to develop satellite communities outside Cairo. There are currently 14,000 societies in Egypt devoted to the goals of family planning and better health care for women and children. Local health motivators have also been successful at outreach. The location of the Third UN World Population Conference in Cairo this year is a positive impetus to the family planning effort. Egypt is the first Muslim country to reach 50% contraceptive use. NPC will be directing efforts to underserved rural areas. El Mouelhy on her return will be preparing a national population plan of action.^ieng

Creating new reproductive strategies.

PIP: Since the advent of oral contraceptives (OCs) some 30 years ago, Japanese women have been receiving mixed messages about their safety. Dr. Shoichi Sakamoto, president of the Japanese Association of Obstetricians and Gynecologists, believes the time has come for Japanese women to decide on contraception. In Japan, the overall birth rate was 1.48 in 1992. As more women pursue higher education, the average age at first marriage has become 26 years. Almost 70% of Japanese women work, which definitely contributes to women having fewer children. The Equal Employment Opportunity Law has allowed for women to pursue a career, but it is still very difficult to raise children owing to the unavailability of maternity leave and lack of day-care centers. Some 60% of married women use some kind of contraceptive, of whom 3/4 use the condom. Half of the Japanese women who have had an abortion used the condom as a contraceptive. The number of abortions stood at 440,000 in 1991 and has been falling steadily every year, although an increasing number of teenagers and women in their forties have had abortions. The ratio of aborted pregnancies to total pregnancies is 18% among women in their twenties and 29% among women in their thirties, whereas it is 81.3% among women in their forties. In 1992, some 30% of married women had abortions and over 12% of these aborted more than twice. One reason is that Japanese women have become more sexually active. In the 1960s OCs were not authorized because of the potential long-term side effects. Research on the safety and efficacy of the OC was completed in the summer of 1992, but the government shelved the matter when in 1991 the number of HIV infections had increased by 250% over 1990 through heterosexual intercourse. Women must have a reliable means of contraception, and the authorities will be required to approve OCs.^ieng

Implanon status report: not on U.S. market yet.

PIP: This article reports on a new single-rod progestin contraceptive implant (Implanon) produced by Netherlands-based Organon NV for market introduction in the US. While Organon considers the timing of Implanon's entrance in the federal Food and Drug Administration (FDA) approval process, Wyeth Ayerst Laboratories of Philadelphia has already FDA clearance in hand to market its two-rod levonorgestrel implant system. However, Wyeth Ayerst continues to conduct additional research. The company's research includes an assessment of potential design, with changes in the trocar insertion device for the two-rod implant being under consideration. Insertion and removal of the single-rod implant system is easier and quicker than with the original six-implant Norplant system. US clinicians and their patients are looking forward to the availability of Implanon.^ieng

USAID negotiating Depo purchase, but shelf life proves problematic.

PIP: The discussion focused on the variations in purchasing agreements for the injectable Depo-Provera. Negotiations are in process between the manufacturer in the US (the UpJohn Company) and USAID regarding size of purchase, prices, and time schedules. A glitch is that the US production plant provides a two-year shelf life for the product, while the Belgian plants provide a three-year shelf life. The one year difference could be significant in the distribution to hard-to-reach places, but the balancing point is that USAIDs effort are a positive development for expanding distribution. The UN Population Fund (UNFPA) and the International Planner Parenthood Federation (IPPF) already distribute Depo-Provera and were charged 72 and 75 cents, respectively; UpJohn recently increased the prices to 80 and 85 cents. The UNFPA prices were slightly lower due to larger purchases, and both concerns will be awaiting the outcome of USAID's price negotiations. Other manufacturers are a company in Indonesia, which sells only within the country, and Organon in Holland, which produces the drug under the name Megstron. UpJohn has the major share of the market. The cost of supplying Depo-Provera also includes the purchase of needles and syringes. Other international agencies are not limited by anything other than finding the lowest cost. UNFPA buys its supplies in Belgium at low cost and its contraceptives in Holland. USAID, however, must purchase needles and syringes from American facilities. IPPF will be watching to assure international organizations that no duplication of effort will occur with the USAID distribution and expects the shelf life problem to be resolved. The issue may be cleared up when UpJohn has sufficient time to resubmit its application with enough research to support the 3-year shelf life; the FDA had rejected Depo-Provera repeatedly since 1961, and the approval was granted on a rushed application that only included some of the Belgian research and could empirically only support a 2-year shelf life.^ieng