“Improvising Medicine”

I will share some impressions about this book once I have finished reading it, but already wanted to share two quotes (emphasis in bold mine):

From “Improvising Medicine” by Julie Livingston (2012)

“Ethnographers recognize that the hospital is an intensive space where critical moral, political, and social questions arise regularly and with great urgency, and where broader political, social, and moral forces in society can be witnessed in a condensed fashion. In other words, this ethnography describes oncology as a set of grounded practices occurring within a particular infrastructural, social, and epidemiological setting, rather than as a therapeutic ideal or model emerging out of cutting-edge medicine. I do not question evidence-based medicine or standards of care that emerge from careful metropolitan research; instead I witness how staff at PMH [Princess Marina Hospital, Zimbabwe] need to adapt this knowledge to their institutional setting like a round peg to a square hole.” (p25)

She quotes a 2003 report by the World Health Organization and the International Agency for Research on Cancer:

“Despite many new agents becoming available, often at great cost, the gains in terms of cure rates have been small. Fashion for high dose chemotherapy with bone marrow transplantation, the use of marrow support factors, biological therapies such as monoclonal antibodies or cytokines, have resulted in little overall gain but considerable expense. The driving force for medical oncology comes from the USA, which spends 60% of the world’s cancer drug budget but has only 4% of its population [the ulk of the remaining cancer drug budget is accounted for by Japan and Europe]. Huge cultural differences exist in the use of chemotherapy, with US-trained physicians following aggressive regiments for patients who in other countries would simply be offered palliative care. This has created a tremendous dilemma for those responsible for health care budgets. For example, the use of paclitaxel in patients with metastatic breast cancer will prolong survival by 6 months at a cost of US$12,000. In many countries this would far exceed the total health care consumption throughout a cancer patient’s life. Yet the pressure to use expensive patented drugs is enormous. Conferences, travel and educational events sponsored by the drug industry rarely give a real perspective on the effective prioritization of cancer for poorer countries” (p32)

The interaction between the development of evidence, policy and ‘best practices’ in higher income countries and how lower-income countries use these is something I would like to explore further. Also on my reading list are some sources that take the opposite perspective – what can higher-income countries learn from lower-income country practices? In the end, I would say that it’s not about higher to lower, or lower to higher income – the interaction is dynamic, and involves multiple factors. To be continued with some more concrete stories…

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