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Profit-boosting manipulation and subterfuge is axiomatic to late-stage US capitalism, even in healthcare. I demonstrate how acknowledgements of this can overextend into ‘false beliefs’ using data f...

With an eye to health equity and community engagement in the context of the initial COVID-19 vaccine roll-out, the COVID-19-related concerns of the Latinx (Hispanic/Latino) community in southern San Diego (California, USA) were examined using 42 rapid, ethnographically-informed interviews and two focus groups conducted in early-mid 2021. An anthropologically oriented qualitative analysis delimited the cultural standpoint summarized as aguantarismo, which celebrates human durability in the face of socioeconomic hardship and the capacity to abide daily life's challenges without complaint. After characterizing aguantarismo, its role in both undermining and supporting vaccine uptake is explored. To avoid diverting attention from the structural factors underlying health inequities, the analysis deploys the theoretical framework of critical medical anthropology, highlighting inequities that gain expression in aguantarismo, and the indifference toward vaccination that it can support. In placing critical medical anthropology into conversation with the cultural values approach to public health, the analysis sheds new light on the diversity of human strategies for coping with infectious disease and uncovers new possibilities for effective vaccination promotion. Findings will be useful to public health experts seeking to convert non-vaccinators and optimize booster and pediatric COVID-19 vaccine communications. They will also contribute to the literature on cultural values in relation to Hispanic/Latino or border health more broadly, both by confirming the vital flexibility of cultural standpoints like aguantarismo and by documenting in situ what is to the social science and health literature, albeit not to cultural participants, a novel constellation.

Biomedicine controls seizures for many children with epilepsy - but not all. In such cases, parents struggle in the wake of various structural, cultural, and corporeal ruptures. Continued use of ineffective medications can lead, iatrogenically, to frightening and serious symptoms and debilitations whose effects, along with those of uncontrolled seizures, ripple outward in challenging ways. Using data from 25 Californian (US) parents who favored providing cannabis to their ill children to meet the iatrogenic burdens of biomedical epilepsy treatments in 2015, well before cannabis's present destigmatization, this paper explores parental refiguration of the effects of clinical iatrogenesis as inevitable - and as productive of evidence necessary to finding better options. In attending to the generative dimensions of iatrogenesis, this paper strives to help clarify the dilemma for parents who critique biomedicine's isolating, materialist, and sometimes apparently haphazard approach to their children, but depend on biomedical and associated systems for their family's well-being nonetheless. Along the way, this paper underscores raced and gendered dimensions of their experiences. Rather than rejecting biomedicine, most hung on tightly, blaming the uncontrolled seizures and their aftermath on a lag in 'the science' and pointing to the cultural idea that every child is unique in explaining their own children's non-responsiveness to treatment thus far. Likewise, they worked to determine effective cannabis regimens with scientised rigour. However, in the end - and in keeping with a culture of (male) Whiteness - stigmatisation, fatigue from chronic care provision, faith in science, and a need for a biomedically-mediated form of social belonging underwrote a majority desire for cannabis's incorporation into the official biomedical pharmacopeia.

In the aftermath of Mr. George Floyd’s senseless execution on 25 May 2020, in commemoration of and in opposition to countless similar instances of police brutality against unarmed Black Americans, waves of solidarity have pulsed through US streets and now are surging internationally in protests, demonstrations, and vigils. The affirmation that ‘Black Lives Matter’ has likewise been pouring outward in personal as well as official statements. Numerous higher education institutions, scholarly organizations, and academic journals have expressed solidarity and grief, as well as committing to amplify Black voices as one way to help overturn entrenched injustice.Anthropology & Medicine joins the collective outcry in mourning and resolve. We note that the Black Lives Matter (BLM) movement is not solely about George Floyd. We say their names: Trayvon Martin, Sandra Bland, Eric Garner, Freddie Gray, Tamir Rice, Ahmaud Arbery, Breonna Taylor – we invoke the names of all individuals whose lives have been taken by racism.

Contraception is an issue of considerable concern to a great many heterosexually active people. Yet the impact of contraceptive technologies in the world today, in particular their implications for kinship, gender relations, and other aspects of social life, receives relatively little scholarly attention.This book brings a new perspective to the study of contraception, by collecting together in one volume leading experts in the fields of contraception, family planning and reproductive health. Contributors look at the social, economic, political and cultural contexts in which contraceptive providers and recipients make decisions about whether and what forms of contraception to use. User perspectives (whether those of recipients or providers of contraceptive services) are taken seriously, as are the perspectives of policy-makers and development experts. With its in-depth, case-study approach, this challenging book will appeal to practitioners and planners in the fields of family planning and reproductive health, as well as to students and academics of applied and medical anthropology, health studies, gender and development studies, or anyone interested in the social, cultural and ethical issues raised by contraceptive technologies.

Cannabis is an increasingly sought-after remedy for US children with intractable (biomedically uncontrollable) epilepsy. However, like other complementary-alternative medicine (CAM) modalities, and particularly as a federally illegal, stigmatized substance, it is unsanctioned by mainstream medicine. Parents are largely on their own when it comes to learning about, procuring, dispensing, and monitoring treatments. Exploring how they manage is crucial to better assist them. Moreover, it can illuminate how 'research' done on the ground by laypeople variously disrupts and reinforces lay-expert and science-non-science divides. To those ends, in 2016, 25 Southern California parents who used, had used, or sought to use cannabis pediatrically for epilepsy/seizures were interviewed regarding their evidentiary standards, research methods, and aims when trying the drug. Parents generally described their work as experimentation; they saw their efforts as adhering to authorized scientific practices and standards, and as contributing to the authorized medical cannabis knowledge base. Findings subverted assumptions, based on an outdated stereotype of CAM, that cannabis-using parents do not believe in biomedicine. Indeed, parents' desire for their children's biomedical demarginalization, combined with biomedical dependency and a high caregiver burden, fueled a collaborative stance. Implications for understanding the boundaries of science are explored, as are norms for parent agency as ill children's care managers, radicalization among people affected by contested illnesses, and the future of 'medical marijuana.'

Vaccination rates in some areas of the United States are decreasing. Decreases are slight but significant: the incidence of vaccine preventible disease outbreaks has risen. Vaccination is, once aga...

In light of current concern over pediatric immunization rates, 53 US parents with at least one child kindergarten age or younger were surveyed and interviewed regarding vaccine decision making. Data were collected in 2014 in San Diego, California. Herd immunity was not a salient issue: only six (11.3%) referenced the term or concept spontaneously; others had to be prompted. Parents familiar with herd immunity (70%) variously saw it as not just unnecessary but unproven, illogical, unrealistic, and unreliable. For instance, parents questioned its attainability because many adults do not immunize themselves. Some understood the concept negatively, as an instance of "herd mentality." Further, having knowledge of herd immunity that public health experts would deem 'correct' did not lead to full vaccination. Implications of findings for understanding how the public makes use of scientific information, the potential role of public health messaging regarding altruism and 'free-riding,' and assumptions that vaccine-cautious parents would willfully take advantage of herd immunity are explored in relation to parent role expectations and American individualism.

To learn about pediatric vaccine decision-making, we surveyed and interviewed US parents with at least one child kindergarten age or younger (N = 53). Through an anthropologically informed content analysis, we found that fully vaccinating parents (n = 33) mostly saw vaccination as routine. In contrast, selective and nonvaccinating parents (n = 20) exhibited the type of self-informed engagement that the health care system recommends. Selective vaccinators also expressed multiple, sometimes contradictory positions on vaccination that were keyed to individual children's biologies, child size, environmental hazards, specific diseases, and discrete vaccines. Rather than logical progressions, viewpoints were presented as assembled collections, reflecting contemporary information filtering and curation practices and the prevalence of collectively experienced and constructed digital "hive" narratives. Findings confirm the need for a noncategorical approach to intervention that accommodates the fluid, polyvalent nature of vaccine reasoning and the curatorial view selectively vaccinating parents take toward information while honoring their efforts at engaged healthcare consumption.

U.S. media reports suggest that vastly disproportionate numbers of un- and under-vaccinated children attend Waldorf (private alternative) schools. After confirming this statistically, I analyzed qualitative and quantitative vaccination-related data provided by parents from a well-established U.S. Waldorf school. In Europe, Waldorf-related non-vaccination is associated with anthroposophy (a worldview foundational to Waldorf education)—but that was not the case here. Nor was simple ignorance to blame: Parents were highly educated and dedicated to self-education regarding child health. They saw vaccination as variously unnecessary, toxic, developmentally inappropriate, and profit driven. Some vaccine caution likely predated matriculation, but notable post-enrollment refusal increases provided evidence of the socially cultivated nature of vaccine refusal in the Waldorf school setting. Vaccine caution was nourished and intensified by an institutionalized emphasis on alternative information and by school community norms lauding vaccine refusal and masking uptake. Implications for intervention are explored.

Waldorf education, an independent alternative to public schooling, aims to produce holistically healthy graduates in a formulation that rejects the conventional distinction between education and health. Also striving to bridge that divide, this article characterizes the pedagogically salutogenic techniques Waldorf teachers use in pre-kindergarten (pre-K) and lower grade classes and explicates the ethnomedical understandings underlying them. Waldorf teachers position children as budding participants in a unified field of spiritual and other forces, prioritizing whole-child activities that keep these forces healthfully motile. Their work entails a critique not only of mainstream public schooling's ostensibly pathogenic "head-to-head" focus, but also of the biomedical approach to pediatric health. My analysis of this conjoined critique takes into account the cultural, structural, and existential realities within which Waldorf education's salutary pedagogy is daily framed and fabricated. Further, it explores the implications for anthropology of attending to movement as a key feature of healthful human experience.

In most US pre-k/kindergartens play is justified as serving academic goals. However, Waldorf education, an independent alternative to public schooling, leverages play to promote child health and well-being. This paper examines Waldorf education's approach to play with reference to the underlying cultural model of/for child development that Waldorf teachers subscribe to. It describes how teachers orchestrated play in four pre-k/kindergarten classrooms and examines, from the teacher perspective, how keeping children ‘in movement’ both physically and spiritually encourages healthful sensory-motor integration while nourishing children's ‘will forces’ and ensuring good health and flexible thinking in adulthood. In addition to providing insight into how we might foster more play in non-Waldorf settings and informing the theoretical construction of play-as-mood, the findings indicate that Waldorf education is not immune to the work-play opposition common to US educational discourse; accordingly, the pedagogic an...

Practicing anthropology within the Veterans Health Administration of the Department of Veterans Affairs (VA) has, until recently, received little serious consideration as a respectable career option for anthropology postgraduates. But times are changing. Anthropologists employed by the VA are responsible for some of the most important and actionable anthropologically informed health research today. Far from being a marginal pursuit, VA anthropology is in fact a generative force for medical anthropology and, indeed, the discipline as a whole.

Increasing HIV testing is a necessary step toward control of the disease. Many experts suggest routinely offering HIV testing to specific population segments. We explore provider discourse regarding an HIV test implementation project with the aim of illuminating a structurally emergent clinician strategy for promoting testing and the socio-cultural factors underlying it. Twenty US Veterans Affairs Healthcare System clinical care providers were interviewed. Using standard anthropological text analysis techniques, themes, their relationships, and the significance of these for increasing appropriately targeted HIV test offers were established. Presenting the HIV test offer to their patients as if routine ('routinisation') supported providers' desire to do no harm by lessening the test's potential stigma. Offering the test helped providers maintain professional integrity: it empowered veterans to realise access to care and fit with providers' sense of honour and duty. Routinising HIV testing also helped providers to manage scarce time effectively. Findings can be leveraged to support routine screening's successful roll-out. The carefully managed introduction of routine HIV test offering policies will formalise and legitimise productive strategies of destigmatisation already being enacted by some front-line providers. The fact that routinisation strategies are in use although HIV testing is not actually routine attests to the potential power routinisation has to reduce HIV's stigma, increase HIV test uptake, and thereby improve access to care. What I've learned about tough questions is: The more routine you make them, the easier it is to get the questions answered, the less destructive it is to the relationship and that's the sort of paradigm I've come to believe in and will use now into the future. (Marvin K, MD).

More US-based patients than ever are travelling abroad for medical or dental services. Beyond financial incentives, what cultural factors have supported this trend? Because of their interest in selling medical travel, medical travel agencies (MTAs) have vested interests in this question. To find out how they are answering it, an ethnographic content analysis of MTA websites was undertaken. Beyond themes promoting a 'worry-free experience' of 'legitimate services', themes linking healthcare consumerism to culturally specific identity ideals and self-creation/representation processes predominated. Themes relating to the demonstration of social position, savvy expression of good consumer judgment, and achievement of libertarian ideals figured highly. However, various inconsistencies (including an appeal to tourism in some but not other situations) suggested that medical travel involves, for the US-based consumer, a complex act of juggling context-specific self-identity desires and expectations in relation to healthcare. The potential impact of prevailing discourses on 'self-construction-in-practice' was explored. Findings enhance understanding of the care seeking process as experienced within the context of globalized, mass-mediated healthcare consumerism. They also point to the need for finer-grained distinctions than the global gloss 'medical travel' offers.

Most research on why health care quality improvement implementation succeeds or fails focuses on front-line or provider-based factors. However, background factors related to the structures and processes of projects themselves also pose challenges. Using a focused ethnographic assessment approach, we undertook a case study to characterize particularly challenging background factors in an ongoing implementation effort. We found that the organizational structure of the project under study sustained several key "cultural" differences in stakeholder agendas. Moreover, it fostered the emergence of strategic communication processes that, despite their immediate utility, sometimes undermined progress and threatened long-term relations by distorting information flow in particularly patterned ways. These included a "focus on the local" and "information reconfigurations" or "partiality" that sometimes led to miscommunication or interpretive disjunctions between various stakeholders. Successful cross-organizational c...

Purpose:To explore the effectiveness of canine visitation therapy (CVT) in pediatric pain management in a tertiary care children's hospital, a descriptive pilot study was conducted. Method:A convenience sample of 25 English-speaking children ages 5 to 18 years who underwent surgery and experienced acute postoperative pain participated in a standard, one-time CVT intervention. Each child completed a pre-post survey and a postintervention interview. Findings: Quantitative pre-post findings indicate that CVT significantly reduced perceived pain. Qualitative findings suggest that one mechanism that makes CVT effective may be cognitive. That is, CVTdistracts children from pain-related cognition and possibly activates comforting thoughts regarding companionship or home. Conclusion:The study findings suggest that CVT may be a useful adjunct to traditional pain management for children. Implications:Nurses may better serve their patients when CVT is an option.

Children's health care services access, utilization, and outcomes in the U.S. are characterized by disparities across vulnerability factors such as socioeconomic status (SES), race/ethnicity, and language (Newacheck, Hughes, and Stoddard 1996; Smedley et al. 2003). While much research has documented the associations between variables such as insurance status, race/ethnicity, education, and English language ability on health care access and quality, less is known about the processes by which these associations arise. Qualitative, patient-centered research methods hold great promise for expanding our knowledge in this area. Building on Andersen and Aday's behavioral model of health care access (Aday and Andersen 1974; Andersen and Aday 1978), Aday's model of vulnerability (Aday 1993, 1994), and the noncategorical approach (Stein et al. 1993) to pediatric quality-of-care measurement, Seid et al. (2003) have proposed a conceptual model to organize examinations of how health care structures and processes affect health-related quality of life for vulnerable children. Earlier versions of this model have been used to generate a parent-report primary care measure (Seid et al. 2001), examine the effects of language, race/ethnicity, and access to care on parents' reports of primary care experience (Seid, Stevens, and Varni 2003), and compare child health services access and primary care experiences on both sides of the U.S.–Mexico border (Seid et al. 2003). However useful for describing relationships between vulnerability factors and access to and quality of care, these quantitative studies fell short in elucidating the processes by which these relationships might arise. For example, Seid, Stevens, and Varni (2003) documented, in a sample drawn from 18 elementary schools in an urban school district, that insurance status, language, and presence of a regular provider of care were significantly related to scores on a parent-report measure of pediatric primary care experiences called the Parent's Perceptions of Primary Care survey or P3C (Seid et al. 2001). A closer look at these data reveals that more than half (56 percent) of those with the lowest P3C scores (Z-scores less than −1.96) were insured, 43.5 percent completed the survey in English, and 39 percent reported having a regular doctor. In other words, despite the significant associations between vulnerability factors (insurance status, language, having a regular source of care) and the quality of primary care reported via the P3C score, a substantial number of children without these vulnerability markers experienced poor primary care. Conversely, a substantial number of children with vulnerability markers experienced better primary care.

A decline in people's trust of the US health care system has been documented. But do parents of pediatric patients have specific safety worries? If so, what are they? And what cultural factors inform them? To help answer these questions, in San Diego 35 English- and Spanish-speaking parents' (or guardians') self-reports of perceptions of their child's risk for experiencing a medical error during day surgery were collected using open-ended rapid assessment interviews, and analyzed using qualitative content analysis methods. (The innovative data collection and analysis protocol is described so as to be easily replicable in other settings for other types of highly focused quality improvement initiatives that rely on the inclusion of parent or patient perspectives and entail limited time and resources). Twelve key themes were identified. Anthropological discourse analysis techniques (modified for rapid use with rapidly collected interview data) were then applied to the transcripts in order to generate ideas regarding cultural factors underlying the themes. Discursive patterns of risk rationalization or refutation related to cultural expectations for parenting, children's bodies, and health care consumerism were found. Neither the (careful, loving, good) parent nor the (wisely chosen or well-reputed) care team was to blame for medical errors. Errors were cast as the inevitable results of latent, unanticipatable vulnerabilities inherent in the (defenseless) children undergoing surgery. The anxiety-generating potential of the surgical consent process also was noted. The implications of the findings for action as well as for theories of risk and vulnerability and of childhood and parenthood are discussed.