Data‐in‐terror: ad hoc local epistemologies and social life in crisis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156485/2/soca12817.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156485/1/soca12817_am.pd

“Making Moves” in a Cardiac ICU: An Epistemology of Rhythm, Data Richness, and Process Certainty

Ethnographers of clinical rationality often assume that the goal of biomedical practice is to eliminate uncertainty to produce definitive diagnoses. In this ethnography of an academic cardiac intensive care unit (CCU) in the United States, bodies are conceived instead as ever‐changing constellations of problems that make diagnostic certainty irrelevant and require clinicians to construct and reconstruct temporary models to facilitate action. They suspend their uncertainty to “convince themselves” enough to “make moves” on patients, driven by the relentless tempo of critical illness. This necessitates a practice‐oriented model of professional rationality that can account for the flow of time, with implications beyond the biomedical.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162749/2/maq12557.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162749/1/maq12557_am.pd

Is There a Global Bioethics? End-of-Life in Thailand and the Case for Local Difference

Western bioethics is insufficient, say the authors, to solve the problems created by the adoption of allopathic medicine in non-Western contexts

Misdiagnosis, Mistreatment, and Harm - When Medical Care Ignores Social Forces.

The Case Studies in Social Medicine demonstrate that when physicians use only biologic or individual behavioral interventions to treat diseases that stem from or are exacerbated by social factors, we risk harming the patients we seek to serve

The first nationwide survey of MD-PhDs in the social sciences and humanities: training patterns and career choices

Abstract Background While several articles on MD-PhD trainees in the basic sciences have been published in the past several years, very little research exists on physician-investigators in the social sciences and humanities. However, the numbers of MD-PhDs training in these fields and the number of programs offering training in these fields are increasing, particularly within the US. In addition, accountability for the public funding for MD-PhD programs requires knowledge about this growing population of trainees and their career trajectories. The aim of this paper is to describe the first cohorts of MD-PhDs in the social sciences and humanities, to characterize their training and career paths, and to better understand their experiences of training and subsequent research and practice. Methods This paper utilizes a multi-pronged recruitment method and novel survey instrument to examine an understudied population of MD-PhD trainees in the social sciences and humanities, many of whom completed both degrees without formal programmatic support. The survey instrument was designed to collect demographic, training and career trajectory data, as well as experiences of and perspectives on training and career. It describes their routes to professional development, characterizes obstacles to and predictors of success, and explores career trends. Results The average length of time to complete both degrees was 9 years. The vast majority (90%) completed a clinical residency, almost all (98%) were engaged in research, the vast majority (88%) were employed in academic institutions, and several others (9%) held leadership positions in national and international health organizations. Very few (4%) went into private practice. The survey responses supply recommendations for supporting current trainees as well as areas for future research. Conclusions In general, MD-PhDs in the social sciences and humanities have careers that fit the goals of agencies providing public funding for training physician-investigators: they are involved in mutually-informative medical research, clinical practice, and teaching – working to improve our responses to the social, cultural, and political determinants of health and health care. These findings provide strong evidence for continued and improved funding and programmatic support for MD-PhD trainees in the social sciences and humanities.https://deepblue.lib.umich.edu/bitstream/2027.42/136187/1/12909_2017_Article_896.pd

Health Is Still Social: Contemporary Examples in the Age of the Genome

Holtz and colleagues argue that social medicine, including an understanding of the social roots of disease, is as important now as it has ever been

Locating global health in social medicine

Global health's goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. To respond to these complex biosocial problems, we propose the recent expansion of interest in the field of global health should look to the older field of social medicine, a shared domain of social and medical sciences that offers critical analytic and methodological tools to elucidate who gets sick, why and what we can do about it. Social medicine is a rich and relatively untapped resource for understanding the hybrid biological and social basis of global health problems. Global health can learn much from social medicine to help practitioners understand the social behaviour, social structure, social networks, cultural difference and social context of ethical action central to the success or failure of global health's important agendas. This understanding - of global health as global social medicine - can coalesce global health's unclear identity into a coherent framework effective for addressing the world's most pressing health issues

The Uses of Dying: Ethics, Politics and the End of Life in Buddhist Thailand

In Thailand, a series of global and local political events has destabilized the concept of dying and begun to replace it with a competing concept known as "the end of life." As a result, the ethical frameworks governing the Thai deathbed have become disjointed. This dissertation is about the origin of these frameworks and how individuals, families and care providers navigate them. In Northern Thailand, dying has traditionally been conceived in two phases. First, from diagnosis until the hours before death, family members are driven by an imperative to pay back a "debt of life" to their relative by giving them "heart power" - support based on a unique model of the relationship between heart/mind, body and social world. The imperative to give "heart power" sets up an ambiguous relationship to truth-telling, which can drain heart power and hasten death. Second, the last hours of life are governed by an imperative to optimize the separation of body and spirit at the moment of death, best achieved in the familiarity of home rather than the metaphysically polluted hospital. It is into this ethical environment of these two phases that the new object "end of life" has arrived. In the 1990s, a military massacre of pro-democracy protesters and a scandal in the Buddhist clergy caused an opening in the traditional structures of Thai power. During this opening, the famous activist monk Buddhadasa died in the intensive care unit, against his wish for a natural death. Political and religious reform groups rallied around the Saint's death as the focus of their interventions for Thai society. They proposed a set of new ethical figures: the figure of the dying patient as a rights-wielding citizen, and the figure of the dying patient as seeker of wisdom. These ethical figures require a knowing subject and stretch the moment of death into a prolonged "end of life" that can be used for subject formation. These figures clash with the existing frameworks at the deathbed, which require an ignorant subject and conceive death as a moment. Individuals must navigate among these politicized ethical frameworks to make decisions about dying