Mr. Thursday’s Book Shelf: PATHOLOGIES OF POWER

“First, to what level of quality can medical ethics aspire, if it ignores callous discrimination in medical practice against large populations of the innocent poor? Second, how effective can such theories be in addressing the critical issues of medical and clinical ethics if they are unable to contribute to the closing of the gap of socio-medical disparity?”
–Marcio Fabri dos Anjos “ Medical Ethics in the Developing World: A Liberation Theology Perspective”

I took a class in college on medical ethics. Professor Peluchon, a tiny blond professora from southern France, tried to explain to my class (mostly pre-med students and one philosophy major who was, uh, me) the intricacies of ethics concerning End-of-Life issues such as euthanasia or palliative care (treatment which alleviates symptoms without treating the underlying cause). She taught about the utilitarian approach of stem-cell researchers and abortion clinics. She focused on topics that will be important to medical practitioners who will work in the suburbs of America in the future.

Now, I don’t like to think of myself as small-minded, but I didn’t even begin to consider the questions of medical ethics that concern over one sixth of humanity. I thought of medical ethics as abortion, palliative care, drug abuse, and just nominally The Tuskegee Experiment. However, I never took my questions to the next step. I never considered the larger picture. I never looked outside of US healthcare needs, and even then, I barely considered America’s destitute. That’s where Paul Farmer comes in.

Paul Farmer is a Harvard and Duke educated doctor and medical anthropologist. He works in one of the best hospitals in the United States, Brigham and Women’s Hospital in Boston, MA. He co-founded an internationally recognized medical non-profit, Partners in Health. He has also dedicated his life to working with individuals in the Central Plateau of Haiti, and he has been doing it for over twenty-years. I first learned about Paul Farmer’s work in Kenya this summer. Another volunteer raved about him as being inspiring and tenacious. Reading his biography and some of his own books not only inspired her to work in a clinic in Western Kenya, but he also inspired her to return to school for a nursing degree.

Pathologies of Power is Paul Farmer’s unveiling of a new worldview. It is a worldview that has been violently apparent to the silent multitude for decades, but ignored by the minority who possess power. Those who die prematurely from disease, those who are sentenced to death by disease, and those who are used or ignored by Western medicine are the focus of this book. Farmer asserts, through individual stories and grandiose theory (liberation theology), that the international community has an inherently flawed view of aid especially concerning healthcare. Structural violence enacted against the world’s most desperate cannot be their fault. It is the fault of the Western market economy. And it is the duty of the West to correct this.

He decries the West for focusing on “the right to vote” as opposed to “the right to survival”. He exposes the hypocrisy of Western leaders who proclaim that sufficient care for those with Multi Drug Resistant Tuberculosis (MDRTB) is “not cost effective” although they would demand the best care for themselves. He challenges the reader to truly recognize that all human beings deserve to be treated with respect.

For example, recently there was a study conducted in Uganda that found that circumcision reduces risks for HIV transmission in heterosexual couples. That’s all good. What wasn’t widely reported was that participants (who participated under the promise that they would receive medical care) were not provided any antiretroviral drugs and their spouses or partners were not to be advised of the participants’ HIV status. These individuals were a control group. Those who ran the study believed that their actions were justified for the greater good.

Pathologies of Power forces one to consider the tragic irony of the international aid apparatus. The World Trade Organization is designed to provide guidance on improving healthcare for the world. However, it is restrained by donor states who don’t want to hear that a new TB program in Bolivia will save millions of lives except will be very costly. They’d rather have a program that will save thousands of lives and be “cost effective” or “sustainable”. Paul Farmer rejects this approach. To his (and the book’s) detriment, he is unable to provide an alternative approach to healthcare that improves state apparatus’ from the inside out. He only approves of programs that ensure large influxes of capital into failing health infrastructure. How can progress be maintained? If he has an answer to that question, he does not provide it here.

Pathologies of Power: Health, Human Rights, and the New War on the Poor
Paul Farmer
Paperback: 402 Pages
University of California Press

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