Trust and informed consent: insights from community members on the Kenyan coast

May 9, 2010 By biotech-source.com Leave a Comment

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This digital document is a journal article from Social Science & Medicine, published by Elsevier in . The article is delivered in HTML format and is available in your Amazon.com Media Library immediately after purchase. You can view it with any web browser.

Description:
Trust is an important theme running through the literature on the ethics of biomedical research, but it is rarely given centre stage. In this paper, we present data gathered from a study aimed at exploring community views regarding the informed consent processes carried out by a large research centre on the Kenyan Coast. The findings point to the centrality of trust and elements of mistrust in general community views, in parents’ (mis)understanding of studies they consent their children to be involved in, in refusals and concerns, and in community members’ views about whether informed consent is a relevant and practical model to follow. Tentative ideas on how trust and a healthy mistrust might be balanced highlight the importance of strengthening communication surrounding basic health care as well as research, and of fostering ‘an inner generated ethic of service’. The latter is particularly fundamental, but cannot be built and regulated through the laws, policies and guidelines that currently govern biomedical research practice.

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The adapting healer: pioneering through shifting epidemiological and sociocultural landscapes

May 9, 2010 By biotech-source.com Leave a Comment

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This digital document is a journal article from Social Science & Medicine, published by Elsevier in 2004. The article is delivered in HTML format and is available in your Amazon.com Media Library immediately after purchase. You can view it with any web browser.

Description:
While it is true that healers selectively adopt and/or refashion aspects of biomedicine, the influence is not unidirectional with information flowing exclusively from hospitals into the workplaces of healers. This article examines healers in Tanga, Tanzania to explore the reciprocal relations between practitioners of indigenous medicine and biomedicine. An abbreviated ethnography of one healer in coastal Tanzania is used to illustrate some of the relevant influences and possible adaptations of contemporary healers. His experiences illuminate how multiple factors, especially sociocultural changes, biomedicine, AIDS, and related research(ers) can influence healers’ adaptations. In his case, biomedical health workers from a non-profit HIV organization call upon him not only to act as a liaison between their services and the community, but more importantly, to provide treatment for opportunistic infections and counseling for patients and to participate in biomedical and scientific projects. Reflecting on his experiences as a healer who has negotiated a position that straddles the world of biomedicine and the world of healers facilitates examination of important issues affecting healers today, including their relationship to biomedical health workers, bioprospectors, governments, non-profit organizations, and professional organizations of healers. Although the healer featured in this article is a pioneer in his own town, there are other examples in Africa where healers and biomedical practitioners are interacting. Therefore, he may represent a trend in healer adaptation.

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Hormones for life? Behind the rise and fall of a hormone remedy against sterility in the Swedish welfare state

May 9, 2010 By biotech-source.com Leave a Comment

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This digital document is a journal article from Studies in History and Philosophy of Biol & Biomed Sci, published by Elsevier in 2007. The article is delivered in HTML format and is available in your Amazon.com Media Library immediately after purchase. You can view it with any web browser.

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In 1948 the pharmaceutical company Leo launched a placental hormonal preparation, called Gonadex, in Sweden. During a press conference, and in commercials and newspapers, it was said that Gonadex could cure sterility as well as many other problems related to the endocrine system. The remedy was described as effective and pure, with no side effects whatsoever. For several reasons, Gonadex was looked upon as a ‘Swedish triumph’. Inspired by research on ‘mediation’, conducted within the field of social studies of pharmaceutical drugs, the present essay explores the political and scientific visions and values behind Gonadex; the propaganda for and marketing of Gonadex; the mediated image of Gonadex in the press; the reception by the medical profession, and finally the hopes and fears of the women who tried (or wanted to try) Gonadex. The essay argues that the public image of Gonadex was ‘oversell’ of hormone therapy, and that it was shaped by the way endocrinologists at Karolinska Hospital, notably Professor Axel Westman, mediated between Leo, the mass media, and the consumers when, and even before, Gonadex was introduced to the market.

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Between formal and enacted policy: changing the contours of boundaries

May 9, 2010 By biotech-source.com Leave a Comment

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This digital document is a journal article from Social Science & Medicine, published by Elsevier in 2005. The article is delivered in HTML format and is available in your Amazon.com Media Library immediately after purchase. You can view it with any web browser.

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This study examines the strategies of the biomedical discourse vis-a-vis the growing public demand for alternative medicine by comparing formal and informal claims for jurisdiction. The analysis is based on two main sources of data from Israel: (a) two formal position statements, and (b) a series of participant observations and interviews with practitioners in clinical settings where biomedical and alternative practitioners collaborate. At the formal level, the biomedical discourse seeks to secure its dominant position by drawing strict cognitive and moral lines differentiating ”proper biomedicine” from ”improper alternative medicine.” At this level alternative medicine appears morally ”contaminated” and its knowledge-base delegitimized by extreme forms of boundary-work. At the informal level, the contour of boundaries change. In the hospital field where alternative and biomedical practitioners are collaborating, mutual respect was expressed even as social and symbolic boundaries were being demarcated. Modifying the forms of boundary-work appears to be biomedicine’s reactive strategy in the field to changing environmental and market demands. It is a strategy that allows biomedical discourse to absorb its competitor within its professional jurisdiction with no battle, while retaining absolute epistemological hegemony and Institutional Control.

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The problem of evidence-based medicine: directions for social science

May 9, 2010 By biotech-source.com Leave a Comment

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This digital document is a journal article from Social Science & Medicine, published by Elsevier in 2004. The article is delivered in HTML format and is available in your Amazon.com Media Library immediately after purchase. You can view it with any web browser.

Description:
Evidence-based medicine (EBM) is arguably the most important contemporary initiative committed to reshaping biomedical reason and practice. The move to establish scientific research as a fundamental ground of medical decision making has met with an enthusiastic reception within academic medicine, but has also generated considerable controversy. EBM and the broader forms of evidence-based decision making it has occasioned raise provocative questions about the relation of scientific knowledge to social action across a variety of domains. Social science inquiry about EBM has not yet reached the scale one might expect, given the breadth and significance of the phenomenon. This paper contributes reflections, critique and analysis aimed at helping to build a more robust social science investigation of EBM. The paper begins with a ”diagnostics” of the existing social science literature on EBM, emphasizing the possibilities and limitations of its two central organizing analytic perspectives: political economy and humanism. We further explore emerging trends in the literature including a turn to original empirical investigation and the embrace of ”newer” theoretical resources such as postmodern critique. We argue for the need to move the social inquiry of EBM beyond concerns about rationalization and the potential erasure of the patient and, to this end, suggest new avenues of exploration. The latter include analysis of clinical epidemiology and clinical reason as the discursive preconditions of EBM, the role of the patient as a site for the production of evidence, and the textually mediated character of EBM.

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