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PubMed2001

The Icelandic genome debate.

Three of the central issues in contemporary debates about the commodification of the human body are those of property, ownership, and access. This article uses the case of the central medical database on Icelanders to discuss contesting claims about the ownership of the human genome, with respect to the rapid development of biotechnology, human genome projects and DNA collections. We emphasize the contrast between commercial and communitarian perspectives and to illustrate our argument we explore debates about the Icelandic database. These debates have been intense, focusing on a range of issues, including ethics, academic freedom, public health and, last but not least, the control and ownership of medical records, genetic information and genealogical data. This article should be seen primarily as an anthropological commentary on ongoing developments.

Bioethics↗
PubMed1999

Purchasing a quick fix from private pharmacies in the Gaza Strip.

Increasingly, it is recognised by health planners and social scientists that self medication with drugs bought over the counter in private pharmacies is extremely widespread. Some anthropologists see this trend as an aspect of the 'commodification of health'. In this study, group interviews with health service users and providers in Gaza revealed many health service users reporting an inadequate supply of drugs resulting in the purchasing of drugs in private pharmacies. As a result, a survey of the pattern of utilization of three private pharmacies in three contrasting urban areas within the Gaza Strip was undertaken. Using a questionnaire, data were collected from all customers buying drugs. The results show that variations in the patterns of health seeking behaviour were associated with socioeconomic status. Adult males were the most frequent customers of all three pharmacies. They were buying medicines for members of their nuclear family more often than for themselves. Overall, pain and influenza were the most commonly reported conditions. The drugs purchased most frequently for women were for reproductive health problems, particularly infertility. Customers of the pharmacy in the relatively prosperous area more commonly purchased drugs which were prescribed by a private doctor.

Adult↗
PubMed1998

Quantitative health research in an emerging information economy.

This paper is concerned with the changing information environment in the U.K. National Health Service and its implications for the quantitative analysis of health and health care. The traditionally available data series are contrasted with those sources that are being created or enhanced as a result of the post-1991 market-orientation of the health care system. The likely research implications of the commodification of health data are assessed and illustrated with reference to the specific example of the geography of asthma. The paper warns against a future in which large-scale quantitative health research is only possible in relation to projects which may yield direct financial or market benefits to the data providers.

Asthma↗
PubMed2000

Regulating human body parts and products.

This special volume of Health Care Analysis is dedicated to a consideration of the status of body parts and products and the role of law in regulating them. We argue that such a discussion is timely given the conflation of technological and academic concerns posed by the complex legal framework within which these issues are currently addressed and in the light of debates such as those regarding the storage of children's organs addressed by inquiries at Alder Hay and Bristol, United Kingdom. The contributors address specific legal problems which have been brought before the courts in the UK and other jurisdictions, something which we suggest is likely to occur with increasing regularity once the Human Rights Act 1998 comes into force in October 2000. The issues are also considered on a more theoretical level with papers exploring the role of concepts such as property, donation, commodification and kinship in these debates. While the volume focuses principally upon the manner in which these issues have arisen in a UK context, though with reference to certain comparative examples, the concepts discussed here are of more general application across other jurisdictions.

Government Regulation↗
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↗
PubMed2003

Deconstructing risk assessment and management in mental health nursing.

RATIONALE: Risk assessment and management have a taken a central position in the delivery of contemporary mental health services. However, these concepts are generally taken-for-granted as necessary and unavoidable aspects of mental health nursing practice. This deconstructive analysis explores some of the assumptions and values that underpin these concepts. AIMS: The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. DESIGN: This paper takes a deconstructive approach to the exploration of the historical, clinical, cultural, political and economic context of the concept of risk and its assessment and management. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and management in clinical practice. FINDINGS: The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organization. CONCLUSION: The mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.

Delivery of Health Care↗
PubMed2003

"Just trying to relax": masculinity, masculinizing practices, and strip club regulars.

This article explores customers' understandings of their visits to heterosexual strip clubs and the ways in which those visits become meaningful to them in relation to cultural discourses around masculinity, sexuality, leisure, and consumption, as well as in relation to their everyday lives and relationships. Not every man finds strip clubs pleasurable, yet understanding why some men frequent these venues can inform us more generally about the links between sexuality, gender, and the marketplace. This article focuses on regular male customers' stated motives for visiting strip clubs and examines those visits as touristic and masculinizing practices. It also explores gender, sexuality, and power in the men s performances of desire in the clubs, taking up issues of visibility, virility, youthfulness, and commodification.

Adult↗
PubMed2005

Lives to save lives--the ethics of tissue typing.

Should we allow tissue typing of in vitro embryos in order to implant those which could provide potentially life-saving cells to an existing serious ill sibling with that tissue type? A case is made that such tissue matching does not involve unacceptable instrumentality towards or commodification of children. The key distinction is that the parents' request for tissue typing is reactive in the face of serious medical need rather than being proactive in the sense of seeking the means to specify a child with chosen desirable characteristics. Nevertheless, as preimplantation genetic diagnosis (PGD) is a relatively new technique, both long-term safety issues concerning effects on child development following embryo biopsy and the risks of misdiagnosis must be given due weight as must the avoidance of exploitation of couples desperate to save a sick child. The HFEA originally made a distinction, recently revoked, between allowing tissue typing after PGD to select against affected embryos and denying it when PGD is not required because the embryos are not at risk of inheriting the disease suffered by the existing sibling. If tissue typing is not inherently unethical and misdiagnosis poses a greater risk than biopsy damage, then this distinction is not ethically tenable.

Female↗
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↗
PubMed2005

A question of perception: Bourdieu, art and the postmodern.

Bourdieu and Darbel's classic study of European art museum audiences, The Love of Art (1991), remains one of the most influential academic studies of the social indices of art perception. Its findings were central to Bourdieu's on-going study of culture-mediated power relations, as found in the book Distinction (Bourdieu 1984), as well as social surveys of the behaviour of museum audiences across the world. Much in Bourdieu's account of art perception, however, has begun to appear dated and in need of supplementation. This paper will be a critical but sympathetic re-reading of Bourdieu's sociology of art perception in the light of recent criticisms of his approach. Whilst fine art and its institutions continue to function as sources of social identification and differentiation, this paper argues that the relationship between perception and stratification is somewhat looser than connoted in Bourdieu's work. Beyond the shift to a less rigid taxonomy of social formations, the immense expansion of the visual arts complex has opened up possibilities for the dissemination of art knowledge beyond the cultivated bourgeois. The erosion of boundaries between the aesthetic and the economic, between art and popular culture, are the result of processes of commodification that have placed museums alongside shopping malls within the realms of consumption and entertainment. New audiences have emerged from this mix with less dichotomized - that is, either cultivated or popular - ways of seeing culture that suggest a revision of Bourdieu's overly integrated account of class and cognition. An alternative, 'postmodern', approach to art perception is entertained, where an aesthetics of distinction is replaced by a culture of distraction, but this abstracts culture from any structural grounding. Capturing the shift to an accelerated cultural present, instead, requires a warping of Bourdieu's categories to account for broader patterns of culture and economy and the accentuation of modern visual culture.

Art↗
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↗