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PubMed1999

Status, sale and patenting of human genetic material: an international survey.

Following a decade of debate, the European Directive on the Legal Protection of Biotechnological Inventions was adopted by the European Parliament and the Council of the European Union on July 6, 1998. The Directive constitutes a legal and social policy landmark in biotechnology, taking an explicit position on the contentious issue of the patentability of higher life forms. It fails, however, to provide definitive statements on the legal status of human genetic material or the possibility of personal financial gain in relation to such material. An overview of the international, regional and national positions (as found in laws and official policy statements) on the status, commodification and patentability of human genetic material indicates that, although the Directive represents a consolidation of opinions, many issues remain unresolved.

Commerce↗
PubMed1996

Feminist critiques of new fertility technologies: implications for social policy.

This essay aims to show how feminist theoretical and practical perspective have enriched and deepened debate about moral and social issues generated by the proliferation and commodification of new reproductive techniques. It evaluates alternative feminist appraisals beginning with the first group to organize a collective response to the medicalization of infertility and explores several weaknesses working within their assessment: objectification of infertile women, naturalizing constructions of motherhood, hostility to technology, and an overly simplistic conception of power relations. Next, it shows how subsequent feminists have reframed the issues to overcome these weaknesses, drawing on themes prominent in recent theoretical debates: the need to reclaim women's agency, to revalue mothering, and to reappraise power relations. Lastly, it weighs the prospects for a collaborative politics that is sensitive to the social marginalization of vulnerable women and suggests practical strategies for responding to mounting pressures to procreate at any price.

Dehumanization↗
PubMed2001

Competition, race, and professionalization: African healers and white medical practitioners in Natal, South Africa in the early twentieth century.

The licensing of African healers in the province of Natal, South Africa combined with urbanization, medical commodification, and an overcrowded biomedical market led to ideological and commercial competition between White biomedical practitioners and African healers in the early twentieth century in southeastern Africa. This article examines the historical antecedents of this competition and focuses on the role that competition, race, and gender played in the construction of local biomedical and African ideas of medical authority. Adopting the idea that medicine is an important site of power, contestation, and cultural exchange, I aim not only to document these historical changes in African therapeutics, but to problematize current ideas of biomedicine's colonial hegemony.

Economic Competition↗
PubMed1999

Managed medical education?

The forces of rationality and commodification, hallmarks of the managed care revolution, may soon breach the walls of organized medical education. Whispers are beginning to circulate that the cost of educating future physicians is too high. Simultaneously, managed care companies are accusing medical education of turning out trainees unprepared to practice in a managed care environment. Changes evident in other occupational and service delivery sectors of U.S. society as diverse as pre-college education and prisons provide telling insights into what may be in store for medical educators. Returning to academic medicine, the author reflects that because corporate managed care is already established in teaching hospitals, and because managed research (e.g., corporate-sponsored and -run drug trials, for-profit drug-study centers, and contract research organizations) is increasing, managed medical education could become a reality as well. Medical education has made itself vulnerable to the intrusion of corporate rationalizers because it has failed to professionalism at core of its curricula-something only it is able to do--and instead has focused unduly on the transmission of esoteric knowledge and core clinical skills, a process that can be carried out more efficiently, more effectively, and less expensively by other players in the medical education marketplace such as Kaplan, Compass, or the Princeton Review. The author explains why reorganizing medical education around professional values is crucial, why the AAMC's Medical School Objectives Project offers guidance in this area, why making this change will be difficult, and why medical education must lead in establishing how to document the presence and absence of such qualities as altruism and dutifulness and the ways that appropriate medical education can foster these and similar core competencies. "Anything less and organized medicine will acknowledged... that it has abandoned its social contract and entered the temple of those who clamor, 'I can name that tune in four notes.'"

Cost Control↗
PubMed2001

Harvard v. Canada: the myc mouse that still squeaks in the maze of biopatent law.

The Canadian Supreme Court will soon make a decision about Harvard University's long-standing application for a Canadian patent on a mouse transgenic for the myc oncogene. That decision could reignite in North America the controversy that continues in Europe and elsewhere to surround the patenting of life forms. The tortuous steps in this 15-year patent maze are marked by the arguments about life patents that attended the U.S. Supreme Court's decision in Diamond v. Chakrabarty. This patent dispute about oil-digesting bacteria cracked open the door for animal patents in the United States and other countries, even though the legal arguments involved were based on patent applications for corn seeds and oysters, not mammals. The patent challenge to the Harvard mouse by the Canadian government now threatens to close this door in Canada. The arguments against life patents are commonly based on moral and religious grounds that regard the sanctity of life and oppose its commodification. The most compelling arguments for such patents are based on the benefits they deliver through commercial exploitation of inventions. The debate about patenting animals has been more heated outside North America and cacaphonic in the Third World. However, the Canadian debate could be amplified by the U.S. Supreme Court's recent entry on the biopatent stage through the side door of a new corn seed patent dispute. A narrow legal analysis by the Canadian Supreme Court would award the mouse patent to Harvard, while a policy analysis might support the government's challenge of the patent. Although the impact of the Harvard mouse patent process in Canada could be just a squeak, opponents of patenting life can mount the myc mouse to once again roar their opposition to animal patents. And the sound could resonate through the arguments about both biopatents and human cloning, with potentially important effects for academia, industry, and the public.

Animals↗
PubMed2000

Ethical issues in the ethnography of cyberspace.

The project of developing an anticipatory anthropology of the future reveals unique ethical opportunities. For example, the increased importance of performance means there is a substantial potential for a substantive "resocialing" of work in organizations, just as the decline of Modernism opens space for collective, situated ethics as opposed to individualized categorical imperatives. An anthropology of the future should address the question of the future of ethics in general. The very possibility of human agency, of informed individual moral action, is brought into question in new ways. The profound flexibility of the computer as a medium carries with it the dangers of hyper-abstraction, while the consolidation of capital reproduction on a global level increases the scope for apparently permanent mystification. Also important are the new ethical challenges raised for those engaged in knowledge "production" or science broadly conceived. These include the necessary effort to acknowledge fully the role of non-human agency, and the potentially profound possibilities in a transformation in the character of knowledge, a correlate, at least in part, of the commodification of knowledge associated with distance learning. These challenges accompany the more overt threats of transgenic entities and ecological degradation. How can one be an ethical intellectual or academic under these circumstances, let alone teach others to be? There are also some specific challenges facing anthropology in particular. Some derive from the increasing "privatization" of ethnography, both in its growing popularity in modes of social reproduction more directly implicated in the reproduction of capital and in the declining academic support for anthropology. In a very specific sense, anthropology has grounded its ethics on an appreciation of and support for the reproduction of "really existing" culture. This ethical compass is not available to the ethnographer who studies the future. How do we participate ethically in the construction of a future in whose character we are inevitably implicated?

Anthropology, Cultural↗
PubMed1991

Buying human kidneys: autonomy, commodity and power.

Buttle's reply to my objections to buying kidneys is helpful but unconvincing in two respects. Doing something freely leaves quite open the possibility that one is thereby making a commodity of a person; and the effects of institutionalising such a practice is itself a matter for concern. And while his emphasis on 'power' is important, the concept is hardly less problematic than 'commodification'.

Commerce↗
PubMed2001

The place for individual conscience.

From a liberationist, feminist, and Catholic point of view, this article attempts to understand the decision of abortion. People are constantly testing their principles and values against the question of abortion. Advances in technology, the rise of communitarianism and the rejection of individualism, and the commodification of children are factors in the way in which the abortion debate is being constructed in society. The paper offers solutions to end the ugliness of the abortion debate by suggesting that we would be able to progress further on the issue of abortion if we looked for the good in the opposing viewpoint. The article continues with a discussion of Catholics For a Free Choice's position on abortion, and notes firstly that there is no firm position within the Catholic Church on when the fetus becomes a person; secondly that the principle of probablism in Roman Catholicism holds that where the church cannot speak definitively on a matter of fact (in this case, on the personhood of the fetus), the consciences of individual Catholics must be primary and respected, and thirdly that the absolute prohibition on abortion by the church is not infallible. In conclusion, only the woman herself can make the abortion decision.

Abortion, Legal↗
PubMed2000

Population genetics and benefit sharing.

The majority of international or national guidelines, specific to human genetics concentrate on actual or potential clinical applications. In contrast, the Ethics Committee of the Human Genome Organisation (HUGO) attempts to provide guidance to the bench scientists engaged in fundamental research in genomics prior to any clinical applications. Often confused as constituting the Human Genome Project (HGP) itself, HUGO's (Human Genome Organization) ultimate goal is to assist in the worldwide collaboration underpinning the HGP. It is an international organisation with 1,229 members in approximately 60 countries. The Ethics Committee is one of HUGO's six international advisory committees. Composed of experts from a number of countries and disciplines, the HUGO Ethics Committee promotes discussion and understanding of social, legal, and ethical issues as they relate to the conduct of, and knowledge derived from, the Genome Initiative. Currently, it has 13 members from 11 difference countries. It has produced statements on the conduct of genetic research, on cloning, and, has most recently presented a 'Statement on Benefit-Sharing', April 11, 2000. The Intellectual Property Committee of HUGO has been active in the controversial area of patenting. The issue of benefit-sharing is one that has its source in the mandate of both committees. How to avoid both commodification of the person through payment for access to DNA and biopiracy with no return to benefits to the families or community? While patents are a legitimate form of recognition for innovation, there seems to be no therapeutic exception to some of its stringent rules and the 'morality' exclusion has lain dormant. The HUGO 'Statement on Benefit-Sharing' examines the issues of defining community, common heritage, distributive justice and solidarity before arriving at its conclusions in benefit-sharing. This communication reviews some of these issues.

Genetics, Population↗
PubMed1996

Effects of market reforms on doctors and their patients.

The outcome of the competitive revolution in health care will depend critically on how it affects physicians' behavior and their interaction with patients. From the standpoint of physicians, competition often seems mediated by three influences affecting their day-to-day practice environment: the organizational phenomenon, the customer phenomenon, and the commodification phenomenon. A careful examination of these three phenomena offers reasons to believe that both the supporters and detractors of competition may be partially correct. Competitive markets may work extraordinarily well for some consumers and very poorly for others. The competitive restructuring of our health care system will accentuate the divisions and inequalities that existed in our society before the transition to a market-based health care system.

Case Management↗
PubMed1999

Herbal remedies: issues in licensing and economic evaluation.

In recent years, the use of alternative therapies has become widespread. In particular, there has been a resurgence in the public's demand for herbal remedies, despite a lack of high-quality evidence to support the use of many of them. Given the increasing pressures to control healthcare spending in most countries, it is not surprising that attention is being focused on the cost effectiveness of herbal remedies. We address the question of whether there is sufficient information to enable the assessment of the cost effectiveness of herbal remedies. In so doing, we discuss the current state of play with several of the more high-profile alternative herbal remedies [Chinese medicinal herbs for atopic eczema, evening primrose oil, ginkgo biloba, hypericum (St John's wort)] and some which have made the transition from being alternative to being orthodox remedies. We use historical context to discuss, on the one hand, the increasing commodification of herbal remedies and on the other, the trend towards greater regulatory control and licensing of alternative herbal remedies. We argue that unless great care is exercised, these changes are not necessarily in the best interests of patients. In order to identify cost-effective care, we need reliable information about the costs as well as the efficacy and safety of the treatments being assessed. For most alternative therapies, such data are not available. We believe that studies to gather such data are long overdue. Whilst we argue strongly in favour of control of some herbal remedies, we urge caution with the trend towards licensing of all herbal remedies. We argue that the licensing of those herbal remedies with equivocal benefits and few risks, as evidenced by a long history of safe use, increases barriers to entry and increases societal healthcare costs.

Complementary Therapies↗
PubMed1984

Selected myths guiding the Reagan Administration's health policies.

This article analyzes four major assumptions that guide the Reagan Administration's health policies: 1) the Administration received an overwhelming popular mandate to reduce the federal role in the U.S. health sector; 2) the size and growth of federal social (including health) expenditures are contributing to the current economic recession; 3) the costs to business of federally imposed health and safety regulations have contributed to making the U.S. economy less competitive; and 4) market intervention is intrinsically more efficient than government intervention in regulating the costs and distribution of health resources. Based on these assumptions, the main characteristics of the Reagan Administration's health policies have been 1) a reduction of federal health expenditures and, very much in particular, expenditures to the poor, handicapped, and elderly; 2) a weakening of federal health and safety regulations to protect workers, consumers, and the environment; and 3) the further privatization and commodification of medical services. This article shows that there is no evidence to support the assumptions on which these policies are based. Quite to the contrary, all available evidence shows the opposite: 1) the majority of Americans want an expansion of federal health expenditures and a strengthening of federal health regulation; 2) U.S. government expenditures and regulations are much more limited than those of other countries whose economies are performing more satisfactorily; and 3) those countries with larger government interventions have more efficient health care systems than the American one, where the "free market" forces are primarily responsible for the allocation of resources. Thus, major Reagan Administration health policies are based on myth rather than reality.

Economic Competition↗
PubMed1996

Health as an irreversible part of the welfare state: Canadian government policy under the Tories.

This article provides an assessment of the health policy of the Canadian Conservative government under Brian Mulroney, 1984-1993. Underlying this assessment is the need to test the theory of the irreversibility of the welfare state in the light of its health component. The author argues that despite a political rhetoric that might have presaged a sharp rollback of Canada's Medicare, either through residualization or progressive commodification, Canada emerged from this period of New Right federal government with its state-funded health care system still in place. This argument is substantiated through a consideration of the social policy model inherited by the Mulroney government and how it was affected by the government's fiscal policies between 1984 and 1993.

Canada↗
PubMed2000

Ethnography and the Meta-Narratives of Modernity.

Current attempts to increase the relevance of sociocultural anthropology encourage anthropologists to engage in the study of modernity. In this discourse dominated by sociologists, the contribution of anthropology is often to reveal cultural diversity in globalization, leading to the notion of multiple modernities. Yet such ethnographic accounts draw upon familiar sociological abstractions such as time-space compression, commodification, individualization, disenchantment, and reenchantment. This article shows how an underlying meta-narrative preempts social scientific argument by making shifts in analytical scales look natural, as in the alleged need to "situate" the particular in "wider" contexts. This analytical procedure undermines what is unique in the ethnographic method-its reflexivity, which gives subjects authority in determining the contexts of their beliefs and practices. Two ethnographic case studies are presented to support this argument, one from Melanesia on current interests in white people, money, and consumption and the other from Africa on born-again Christianity and individuality. The article ends by reflecting not only on the limits of metropolitan meta-narratives in returning relevance to anthropology but also on the contemporary conditions of academic work that undermine the knowledge practices of ethnography and render such meta-narratives plausible.

Journal Article↗
PubMed2001

Indigenous property rights and river management.

The presence of indigenous property rights and interests arising from the survival of native title in Australia presents unique issues in the management of rivers and riverine lands. Existing common law and statutory tidal and non-tidal rights are a complex overlay of public and private property rights which are themselves undergoing significant change through the commodification of many natural resources by Commonwealth and State governments, such as marine species stock and non-tidal water. The melding of indigenous values and management practices with existing management regimes for rivers and riverine lands offers considerable potential for both sustainability of resource utilisation, and respect and recognition of native title with resultant predicted benefits in the vexed area of compensation.

Animals↗
PubMed1990

Is women's labor a commodity?

...A commercial surrogate mother is anyone who is paid money to bear a child for other people and terminate her parental rights, so that the others may raise the child as exclusively their own. The growth of commercial surrogacy has raised with new urgency a class of concerns regarding the proper scope of the market. Some critics have objected to commercial surrogacy on the ground that it improperly treats children and women's reproductive capacities as commodities. The prospect of reducing children to consumer durables and women to baby factories surely inspires revulsion. But are there good reasons behind the revulsion? And is this an accurate description of what commercial surrogacy implies? This article offers a theory about what things are properly regarded as commodities which supports the claim that commercial surrogacy constitutes an unconscionable commodification of children and of women's reproductive capacities.

Adoption↗
PubMed2001

Legal regulation of surrogate motherhood in Israel.

The Israeli Law on surrogate motherhood demands a preconception agreement to include payments to be made to the surrogate mother. Surrogacy arrangements with family members are forbidden. Commercial surrogacy is allowed and encouraged. The Law causes many problems. Validity of consent given by surrogate mothers is doubtful. Possible future psychological harm are ignored. There is a danger of "commodification" of children. Abusing women of low socio-economic status as breeding machines may be another outcome. No clear responsibility is imposed on the "intended parents" for an impaired child. The law ignores possibility of divorce or death of the "intended parents" before the child's birth. Splitting motherhood is another social problem that has to be dealt with. So far the sperm of the husband from the "intended parents" has to be used, but further steps may follow. It is not certain that a policy of "positive eugenics" will not develop.

Child Custody↗