Skip to main content
SpringerLink
Log in

The Clash of Medical Civilizations: Experiencing “Primary Care” in a Neoliberal Culture

  • Published:
Journal of Medical Humanities Aims and scope Submit manuscript

Abstract

An anthropologist describes how he found himself at the vortex of a “clash of medical civilizations:” neoliberalism and the international primary health care movement. His involvement in a $6 million social change initiative in medical education became a basis to unlock the hidden tensions, contradictions and movements within the “primary care” phenomenon. The essay is structured on five ethnographic stories, situated on a continuum from “natural” species-level primary care to “unnatural” neoliberal primary care. Food is an element of all tales. Taking the long view of history/prehistory permits us to better recognize ideological distortions in order to more capably transform medicine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Adorno, Theodor W. 1981 [1951]. Negative Dialectics. New York: Continuum,

    Google Scholar 

  • Angell, Marcia. 2009. “Drug Companies & Doctors: A Story of Corruption.” New York Times Review of Books 56(1), January 15.

  • Asthana, Shana. 1994. “Primary Health Care and Selective PHC: Community Participation in Health and Development.” In Health and Development, edited by David Phillips and Yola Verhasselt, 182-196. London: Routledge.

    Google Scholar 

  • Baer, Hans, and Merrill Singer, eds. 2008. Killer Commodities: Public Health and the Corporate Production of Harm. Lantham, MD: AltaMira.

    Google Scholar 

  • Baer, Hans, Merrill Singer, and Ida Susser. 2003. Medical Anthropology and the World System. Westport: Praeger.

    Google Scholar 

  • Bauman, Zygmunt. 2007. Liquid Times, Living in an Age of Uncertainty. Cambridge: Polity.

    Google Scholar 

  • Bauman, Zygmunt. 2005. Liquid Life. Cambridge: Polity.

    Google Scholar 

  • Berliner, Howard S. 1975. “A Larger Perspective on the Flexner Report.” International Journal of Health Services 5: 45-70.

    Article  Google Scholar 

  • Bledstein, B. J. 1976. The Culture of Professionalism: The Middle Class and the Development of Higher Education. New York: W. W. Norton.

    Google Scholar 

  • Boggs, G.L. 1996. “Cuba and Self-Reliance.” New York: Monthly Review, December.

    Google Scholar 

  • Boggs, G.L. 2008. A New Outlook on Health (abridged). The Boggs Center. See The Boggs Center: http://www.boggscenter.org/ see also reprint: http://www.yesmagazine.org/issues/columns/2536

  • Brouwer, Steve. 2011. Revolutionary Doctors, How Venezuela and Cuba are Changing the world’s conception of health care. New York: Monthly Review.

    Google Scholar 

  • Castro, Arachu and Merrill Singer, eds. 2004. Unhealthy Health Policy, A Critical Anthropological Examination. Lanham, MD: AltaMira.

    Google Scholar 

  • Chomsky, Noam and Michel Foucault. 2006. The Chomsky-Foucault Debate: On Human Nature. New York: New Press.

    Google Scholar 

  • Cluster Evaluators. 1992. Concept paper: Change in Community On Empowerment. Battle Creek, MI: Kellogg Foundation.

    Google Scholar 

  • Cockerham, William C. 2007. Social Causes of Health and Disease. Cambridge: Polity.

    Google Scholar 

  • Cohen, Larry, Chavez, Vivian and Chehimi, Sana. 2007. Prevention is Primary: Strategies for Community Well-Being. San Francisco, CA: Jossey Bass.

    Google Scholar 

  • Cohen, Robin A. et al. 2011. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey. National Center for Health Statistics, Atlanta, GA: Centers for Disease Control and Prevention.

    Google Scholar 

  • Coreil, Jeannine and Dennis J. Mull. 1990. Anthropology and Primary Health Care. Boulder: Westview.

    Google Scholar 

  • DasGupta, S. et al. 2006. “Medical Education for Social Justice: Paulo Freire Revisited.” Journal of Medical Humanities 27:4: 245-251.

    Article  Google Scholar 

  • De Waal, Frans. 2009. The Age of Empathy, Nature’s Lessons for a Kinder Society. New York: Harmony.

    Google Scholar 

  • Deyo, Richard A. and Patrick, Donald. 2005. Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises. New York: AMACOM.

    Google Scholar 

  • Dyrbye, LN, MR Thomas MR, and TD Shanafelt. 2006. “Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.” Academic Medicine 81:4: 354-73.

    Article  Google Scholar 

  • Eisenberg, David et al. 1993. “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use.” New England Journal of Medicine 328:4: 246-52.

    Article  Google Scholar 

  • Falk, Dean. 2009. Finding our Tongues, Mothers, Infants, and the Origins of Language. Boulder: Perseus.

    Google Scholar 

  • Farquhar, L. J. 2007. Michigan’s Physician Shortfall and Resulting Advocacy Efforts. Institute for Health Care Studies, MSU: East Lansing.

    Google Scholar 

  • Foucault, Michel. 1973. The Birth of the Clinic. New York: Vintage.

    Google Scholar 

  • Freire, Paulo. 1970. Pedagogy of the Oppressed. New York: Seabury Press.

    Google Scholar 

  • Gaventa, John. 1980. Power and Powerlessness. Urbana: University of Illinois Press.

    Google Scholar 

  • Giroux, H. 2007. University in Chains. Boulder: Paradigm Publishers.

    Google Scholar 

  • Giroux, Henry. 2004. The Terror of Neoliberalism. Boulder: Paradigm Publishers.

  • Giroux, Henry. 2010. Zombie Politics and Culture in the Age of Casino Capitalism. New York: Peter Lang.

    Google Scholar 

  • Giroux, Henry. 2011. “War Colleges: The Politics of Militarization and Corporatization in Higher Education,’ CounterPunch, June 29.

  • Good, Byron J., and Mary-Jo DelVecchio Good. The Semantics of Medical Discourse. In Everett Mendelsohn and Yehuda Elkana (eds.), Sciences and Cultures. Sociology of the Sciences, Volume V, pp. 177-212. Dordrecht, Holland: D. Reidel Publishing Company.

  • Harvey, David. 2010. The Enigma of Capital. Oxford: Oxford University Press.

    Google Scholar 

  • Heggenhougen H. K. 1984. “Will Primary Health Care be Allowed to Succeed?” Social Science and Medicine 19:3: 217-224.

    Article  Google Scholar 

  • Hogan, Andrew. 2011. “Was the W.K. Kellogg Foundation’s Community Partnerships in Health Professions Education Initiative a Cost Effective Model for Influencing Health Professions Student Choice of Primary Care Specialties?: Evidence from a Cluster Evaluation, Two Scientific Misconduct Investigations and Two Freedom of Information Lawsuits.” Personal Manuscript.

  • Hogan, Andrew. 2003. “Letter to the Editor.” Lansing State Journal, February 2.

  • Hunt, Andrew D. 1990. Medical Education, Accreditation and the Nation’s Health, Reflections of an Atypical Dean. East Lansing, MI: Michigan State University Press.

    Google Scholar 

  • Illich, Ivan. 1976. Medical Nemesis: The Expropriation of Health. New York: Bantam.

    Google Scholar 

  • Kassirer, Jerome P. M.D. 2005. On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health. New York: Oxford.

    Google Scholar 

  • Linden, Robert A. 2010. The Rise & Fall of the American Medical Empire. Minnesota: Sunrise.

    Google Scholar 

  • Ludmerer, K. 1999. Time to Heal, American Medical Education from the Turn of the Century to the Era of Managed Care. New York: Oxford.

    Google Scholar 

  • McKenna, Brian. 2012. “Medical Education under Siege: Critical Pedagogy, Primary Care and the Making of ‘Slave Doctors.’” International Journal of Critical Pedagogy 4:1: 95-117.

    Google Scholar 

  • ----- 2011a. “Please Tell us about your last Doctor’s Visit, Exposing Medicine’s Complicity with the Cruelties of Capitalism,” Society for Applied Anthropology News 23:3: 5-8.

    Google Scholar 

  • ----- 2011b. “Doctor My Eyes (Are Watching You),” Society for Applied Anthropology News 22:2: 21-25.

    Google Scholar 

  • ----- 2010. "Take Back Medical Education, The Primary Care Shuffle." Invited Editorial for Medical Anthropology:Cross-Cultural Perspectives in Illness and Health 26:1: 6-14.

    Google Scholar 

  • ----- 1998. “Articulations and Contests between Biomedicine and Community in a University-Based Primary Health Care Education Project in a Midwestern U.S. State.” PhD diss., Michigan State University.

  • ----- 2008 “Melanoma Whitewash: Millions at Risk of injury or Death because of Sunscreen Deceptions.” In Merrill Singer and Hans Baer (Eds.), Killer Commodities: A Critical Anthropological Examination of the Corporate Production of Harm. 2008, Lanham, MD: AltaMira Press.

  • McKenna, Brian and Antonia Darder, eds. 2011. “The Art of Public Pedagogy, Should ‘the truth’ Dazzle Gradually or Thunder Mightily?’ Special Edition, Policy Futures in Education, 9:6: 670-685.

  • McKenna, B. and Notman, M. 1998. “Social Medicine and the Struggle for Primary Health Care: Comparative Perspectives: State, National and International,” The CASID Connection, Center for Advanced Study of International Development, Michigan State University: East Lansing. 13:1.

  • McKenna, James. 2000. “Goodnight Nobody? 100 Years of Medical Misrepresentations of Healthy Infant Sleep Behavior and Arrangements: Why We Never Asked, Is It Safe For Infants To Sleep Alone.” Mother-Baby Behavioral Sleep Laboratory, U. of Notre Dame. See: http://www.nd.edu/~jmckenn1/lab/articles/Goodnight%20Nobody.rtf

  • McKnight, J. 1995. The Careless Society, Community and its Counterfeits. New York: Basic.

    Google Scholar 

  • Moerman, D. 2002. Meaning, Medicine and the ‘placebo effect’. Cambridge: Cambridge.

    Book  Google Scholar 

  • National Center for Children in Poverty, 2011. See: http://www.nccp.org/topics/childpoverty.html.

  • Navarro, Vicente. 1993. Dangerous to Your Health: Capitalism in Health Care. New York: Monthly Review Press.

  • Newman, D. H. 2008. Hippocrates’ Shadow, Secrets from the House of Medicine. New York: Scribner.

    Google Scholar 

  • Nutting, P. ed. 1990. Community-Oriented Primary Care. Albuquerque: University of New Mexico Press.

    Google Scholar 

  • Panitch, Leo and Colin Leys, eds. 2009. Morbid Symptoms, Health under Capitalism. Pontypool, Wales: Merlin.

    Google Scholar 

  • Rhodes, L. A. 1990. “Studying Biomedicine as a Cultural System. In Medical Anthropology, Contemporary Theory and Method, edited by Thomas M. Johnson and Carolyn F. Sargent, 159-173. New York: Praeger.

    Google Scholar 

  • Sanders, David. 1985. The Struggle for Health. London: MacMillan.

    Google Scholar 

  • Saputo, Len, MD. 2009. A Return to Healing: Radical Health Care Reform and the Future of Medicine. San Rafael,CA: Origin Press.

    Google Scholar 

  • Singer, M. and Hans Baer. 2012. Introducing Medical Anthropology, A Discipline in Action. 2nd ed. Lanham, MD: AltaMira.

    Google Scholar 

  • Singer, M. 2009. Introduction to Syndemics, A Critical Systems Approach to Public and Community Health. New Jersey: John Wiley & Sons.

    Google Scholar 

  • Smith-Nonini, S. 2010. Healing the Body Politic, El Salvador’s Popular Struggle for Health Rights from Civil War to Neoliberal Peace. Piscataway, NJ: Rutgers.

    Google Scholar 

  • Starfield, Barbara. 2010. “Reinventing Primary Care: Lessons from Canada For The United States.” Health Affairs 29:5: 1030-1036.

    Article  Google Scholar 

  • Starfield, Barbara. 1992. Primary Care, Concept, Evaluation, and Policy. New York: Oxford University Press.

    Google Scholar 

  • Thomas, Matthew R. M.D., Dyrbye, L. M.D. et al. 2007. “How Do Distress and Well-being Relate to Medical Student Empathy? A Multicenter Study” Journal of General Internal Medicine 22:2: 177-183.

    Article  Google Scholar 

  • Trevathan, Wenda, E. O. Smith and James McKenna, eds. 2007. Evolutionary Medicine and HealthNew Perspectives. New York: Oxford.

    Google Scholar 

  • Van Dinh, Tran. 1987. Independence, Liberation, Revolution, An Approach to the Understanding of the Third World. Norwood, NJ: Ablex Publishing Corporation.

    Google Scholar 

  • Waitzkin, Howard. 2001. At the Front Lines of Medicine: How the Health Care System Alienates Doctors and Mistreats Patients. . .and What We Can Do about it. Lanham, MD: Rowman & Littlefield.

    Google Scholar 

  • White, K. L., M.D. and J. E. Connelly. 1991. “The Medical School’s Mission and the Population’s Health.” Annals of Internal Medicine 155:12: 968-972.

    Google Scholar 

  • Wolin, Sheldon S. 2008. Democracy Inc., Managed Democracy and the Specter of Inverted Totalitarianism. Princeton: Princeton University Press.

    Google Scholar 

  • Wrangham, Richard. 2009. Catching Fire: How Cooking Made us Human. Boulder: Perseus.

    Google Scholar 

  • Wright, D. 2004. “MSU Official Quits Over Simon Appointment,” City Pulse, July 28, 3,7.

Download references

Author information

Authors and Affiliations

  1. Department of Behavioral Sciences, University of Michigan-Dearborn, 4901 Evergreen Rd, 4025 CASL Building, Dearborn, MI, 48128-1491, USA

    Brian McKenna

Authors
  1. Brian McKenna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian McKenna.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McKenna, B. The Clash of Medical Civilizations: Experiencing “Primary Care” in a Neoliberal Culture. J Med Humanit 33, 255–272 (2012). https://doi.org/10.1007/s10912-012-9184-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10912-012-9184-6

Keywords

Search

Navigation