Читать книгу A Companion to Medical Anthropology онлайн

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Most applied medical anthropology exists in a complex multidisciplinary space where each of the scientific specializations has a strong and defensible history of both theory development, and the development of associated methods that support those theories and allow them to be used to frame seminal applied research questions. Disciplinary specialization has commonly led to intensive elaborations of highly specific methods to extract information in minute detail from closely defined phenomena. In some ways, anthropology is in competition with these trends and has to accommodate the assumptions and the biases behind those paradigms. Much of the research conducted in medical schools, research institutes, and corporate research and development laboratories focuses on well-defined (mostly quantitative or probabilistic) boundaries within established disciplines. In the context of both multidisciplinary (multiple disciplines individually focused on a problem at the same time) and transdisciplinary (approaches that synthesize across disciplines) traditional disciplines can form synergistic relationships that unify results from the laboratory to the everyday human condition. In this context, the anthropological approach is often described as inductive research which attempts to build (or find, or identify) theory during the data gathering process. Atheoretical or emergent theory studies conducted by sociologists (cf. Corbin & Strauss 1990), or anthropologists (cf. Agar 1980; Spradley 1980) start out with very few assumptions about how the phenomena to be studied fit together to produce explanatory schema. This lack of assumptions (an attempt at neutrality, if not objectivity) allows the investigator to collect information and examples of the studied phenomena wherever and in whatever condition they may be found, without making a priori assumptions about what should be, or must be, or ought to be found. For example, in a study of needle use among injecting drug users (IDUs), it became clear through participant observation that needle “sharing” was inadequate as a descriptive term for use of contaminated injection paraphernalia (Page 1990) because the term sharing suggested an exchange or mutual use of the injection equipment. By not accepting the “sharing” gloss which had general acceptance among health researchers before going into the field, it was possible for the investigator to identify more accurately the kinds of risky behavior that took place among IDUs. These behaviors included use of “pooled” syringes (Page et al. 1990), transfer of drugs from syringe to syringe (Inciardi and Page 1991), use of common water containers (Page et al. 1990) and cookers, and cottons. In fact, sharing in the sense of passing a used needle from one person to another did not occur in any of the observational settings reported in these articles. Subsequent investigations by Koester (1994) and Jose et al. (1993) have supported the development of a theoretical concept of “indirect contamination” by these and other means. On a practical level, when drug users were told to “not share needles,” they could reply that they were not sharing, yet they were still becoming infected. The successful prevention campaigns that resulted from this applied approach were modified to fit the reality of the risks, so eventually people were cautioned to not share directly or indirectly, with considerably more success than the old messages that were not effectively changing behavior.