Category: Medical anthropology

Inequality and Drug Use

By Mary Kate McNamara, Emily Schirack, Dana Sherry & Amy Vereecke

Close your eyes. Imagine a crack addict. What do you picture? A wealthy man in an Armani suit and tie? Or a poor man clothed in baggy jeans; violent, dark and dangerous? Is she seated behind a mahogany desk on the 22nd floor of an office building in Manhattan or is she standing on a graffiti-covered street corner in East Harlem?

We know that a person’s drug of choice is influenced by his or her social status, from the high-powered lawyer with a penchant for powder cocaine to the pill-popping rock star to the alcoholic factory worker to the unemployed crack head. Here we will show something more important about a person’s relationship with drugs: an individual’s decision to use drugs is embedded in an unequal social structure, a social structure that produces unequal outcomes for drug users contingent on their social status.

By being poor, under-educated and of a low-status ethnic group, a person is at a greater risk for not only social marginalization, but becoming a victim of addiction (Baer, Singer & Susser 2003: 131). As David Courtwright argues in Forces of Habit, social inequality is promoted by the elite to maintain control over a minority group of laborers. By suppressing the lower classes in a cycle of substance abuse and addiction, the wealthy are able to increase their own power and profits. At the expense of people they deem inferior—simply because these people lack the material means to rise from their position—the elite sustain their authority. “Next to profits and taxes, the utility of drugs in acquiring, pacifying and fleecing workers proved to be their greatest advantage to the elites…” (Courtwright 2001:135)

In analyzing society’s abuse of drugs, Courtwright comments that “a pattern of drug use can become so entrenched in a culture that it is impossible to permanently suppress and delegitimate it” (Courtwright 2001: 199). This entrenchment is facilitated by a cycle of poverty, inequality and addiction.

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‘Psychological kevlar’ and the burden of remembering war

I just read a fascinating piece by Clayton Dach, America’s Chemically Modified 21st Century Soldiers, on Alternet. Although there’s a sense in which Mr. Dach jumps to some of the worst possible outcomes when he looks at technology in the pipeline, on the whole, it’s a pretty well thought and concerned-but-not-hysterical account of some of the technology being brought to bear on soldiers, including the possibility of removing humans further from the ‘loop’ in combat decisions. I’m less interested with the latter — the robot warriors angle — not only because I think it’s been done better in science fiction movies, but also because I think it’s simply a more remote technology than some of the pharmaceutical work he discusses.

In particular, I found the discussion of ‘psychological kevlar’ to be interesting for neuroanthropology:

In the U.S., where roughly two-fifths of troops returning from combat deployments are presenting serious mental health problems, PTSD has gone political in form of the Psychological Kevlar Act, which would direct the Secretary of Defense to implement “preventive and early-intervention measures” to protect troops against “stress-related psychopathologies.”

Proponents of the “Psychological Kevlar” approach to PTSD may have found a silver bullet in the form of propranolol, a 50-year-old beta-blocker used on-label to treat high blood pressure, and off-label as a stress-buster for performers and exam-takers. Ongoing psychiatric research has intriguingly suggested that a dose of propranolol, taken soon after a harrowing event, can suppress the victim’s stress response and effectively block the physiological process that makes certain memories intense and intrusive. That the drug is cheap and well tolerated is icing on the cake.

With PTSD so prevalent among soldiers, can it be better treated, even if that means blocking the formation of traumatic memories? Daniel did a piece on PTSD rates in soldiers in April, Invisible Wounds of War, and he discussed a RAND Corporation estimate that treatment of soldiers with PTSD would cost ‘6.2 billion dollars in the first two years after returning from deployment.’ (Daniel also provided links to a number of articles on Iraq and its psychological effects in Wednesday Round Up #7.) The potential to use drugs to stop the development of PTSD, even if it also blocks normal memory formation, raises a number of ethical and moral questions as well as some interesting neuroanthropological ones.

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Dying Sooner: The New US Pattern

What the hell is wrong with this country? That is what came to my mind when I read a recent PLoS article “The Reversal of Fortunes: Trends in Country Mortality and Cross-County Mortality Disparities in the United States.” The basic conclusion: life expectancy is going DOWN in parts of the United States. How can that be?!

Here is what the PLoS article tells us: From 1983 to 1999, life expectancy declined significantly in 11 US counties for men and in 180 (!) counties for women. Why? “Life expectancy decline in both sexes was caused by increased mortality from lung cancer, chronic obstructive pulmonary disease, diabetes, and a range of other noncommunicable diseases, which were no longer compensated for by the decline in cardiovascular mortality [driven largely by better drugs and interventions]. Higher HIV/AIDS and homicide deaths also contributed substantially to life expectancy decline for men, but not for women.”

In their conclusions, the authors Majid Ezzati, Ari Friedman, Sandeep Kulkarni, and Christopher Murray single out some specific health problems: “The epidemiological (disease-specific) patterns of female mortality rise are consistent with the geographical patterns of, and trends in, smoking, high blood pressure, and obesity. In particular, the sex and cohort patterns of the increase in lung cancer and chronic respiratory disease mortality point to an important potential role for smoking.” So cigarettes kill.

But before we blame it all on individual behaviors, recall that these data are also geographic, by county. Where did life expectancy go down for 4% of the male population and 19% of the female population? “The majority of these counties were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas.” In the worst performing counties, life expectancy dropped SIX years for women and two and a half years for men. In contrast, in the best US counties, life expectancy rose by as much as five years.

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Guns and Public Health

The New England Journal of Medicine has an informative podcast of an interview with David Hemenway on “gun violence in the United States and the likely effects of the Supreme Court case D.C. v. Heller.”

Hemenway covers the effect of gun control laws from the public health point of view. He provides a good international perspective, based both on variation in policy and research. One thing I did not know was how the US has become a major supplier of guns to Mexico, Japan and elsewhere–sold here, then imported illegally there. He also describes the impact of major gun control in Australia, where there was a significant reduction in violence post legislation.

The New England Journal of Medicine also provides a full-length editorial, Handgun Violence, Public Health, and the Law, by Gregory Curfman, Stephen Morrissey, and Jeffrey Drazen. Here is the opening: “Firearms were used to kill 30,143 people in the United States in 2005, the most recent year with complete data from the Centers for Disease Control and Prevention. A total of 17,002 of these were suicides, 12,352 homicides, and 789 accidental firearm deaths. Nearly half of these deaths occurred in people under the age of 35. When we consider that there were also nearly 70,000 nonfatal injuries from firearms, we are left with the staggering fact that 100,000 men, women, and children were killed or wounded by firearms in the span of just one year. This translates into one death from firearms every 17 minutes and one death or nonfatal injury every 5 minutes. By any standard, this constitutes a serious public health issue that demands a response not only from law enforcement and the courts, but also from the medical community.”

The same issue of NEJM also has a free-access article on this topic, Guns, Fear, the Constitution, and the Public’s Health, by Garen Wintemute. Focusing specifically on the Washington DC statute being challenged in the Supreme Court, Wintemute writes, “In 1976, Washington, D.C., took action that was consistent with such evidence. Having previously required that guns be registered, the District prohibited further registration of handguns, outlawed the carrying of concealed guns, and required that guns kept at home be unloaded and either disassembled or locked. These laws worked. Careful analysis linked them to reductions of 25% in gun homicide and 23% in gun suicide, with no parallel decrease (or compensatory increase) in homicide and suicide by other methods and no similar changes in nearby Maryland or Virginia.”

A Times Trifecta

Well, actually a double trifecta. The Science and the Health sections online (Tuesday publication) are all neuroanthropolicious.

John Schwartz’s article The Body in Depth covers the work of David Bassett, professor of anatomy and dissection. Even better, we get an online sampling of his dissections on human cadavers, Body Works but without the hype. eHuman will have the entire Bassett collection online (pay to download), with a sample and some accompanying audio here.

Christine Kenneally writes When Language Can Hold the Answer, describing a new way to the old Sapir-Whorf debate: “In stark form, the debate was: Does language shape what we perceive, a position associated with the late Benjamin Lee Whorf, or are our perceptions pure sensory impressions, immune to the arbitrary ways that language carves up the world?” Kenneally points to the role of objects, to brain function and color perception, and spatial processing as new ways to attack the old debate. One nice quote: “By giving us a framework for marshaling our thoughts, language does a lot for us,” Professor Gentner said. “Because spatial language gives us symbols for spatial patterns, it helps us carve up the world in specific ways.”

John Tierney’s piece This Time He’ll Be Breathless covers the magician David Blaine’s physical and mental training in his soon-to-be-successful attempt to break the world record for holding one’s breath. Even without moving and having breathed pure oxygen, 16 minutes sounds like a lot to me! Tierney describes well the mental approach and the embodied expertise, familiar themes for this blog, in accomplishing such a feat.

At 60, He Learned to Sing So He Could Talk is a great story by Karen Barrow on Harvey Atler’s recovery from a stroke. Using “melodic intonation therapy,” Atler learned to draw on the language/musical parts of his right brain after damage to the Broca area in his left hemisphere. In other words, singing helps the brain adapt after a stroke, recapturing language skills.

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Invisible Wounds of War

The RAND Corporation has just published a new study on the psychological and physical traumas of serving in Iraq and of veterans returning home. It’s entitled Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Here’s the link to the press release, the summary statement, and the research highlights. You can also check out a round up on Iraq and trauma in my latest Wednesday collection.

The news release carries the title “One In Five Iraq and Afghanistan Veterans Suffer from PTSD or Major Depression.” RAND estimates that these returning veterans will have direct and indirect costs of 6.2 billion dollars in the first two years after returning from deployment, to speak nothing of the distress and disruption felt by the servicemen and women and their families and friends. “If PTSD and depression go untreated or are under treated, there is a cascading set of consequences,” [study leader] Lisa Jaycox said. “Drug use, suicide, marital problems and unemployment are some of the consequences. There will be a bigger societal impact if these service members go untreated. The consequences are not good for the individuals or society in general.”

“We need to remove the institutional cultural barriers that discourage soldiers from seeking care,” Terri Tanielian said. “Just because someone is getting mental health care does not mean that they are not able to do their job. Seeking mental health treatment should be seen as a sign of strength and interest in getting better, not a weakness. People need to get help as early as possible, not only once their symptoms become severe and disabling.”

One of their major conclusions: “Improving access to high-quality care can be cost-effective and improve recovery rates.” The emphasis is on high-quality, something that reaches out to veterans and their families, and that is supported by evidence and not simply a feel-good budget moment.