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- Convenors:
-
William Sax
(South Asia Institute, Heidlberg)
Sandra Bärnreuther (University of Zurich)
- Chair:
-
Roger Jeffery
(University of Edinburgh)
- Location:
- 22F68
- Start time:
- 23 July, 2014 at
Time zone: Europe/Zurich
- Session slots:
- 2
Short Abstract:
The panel examines concepts and practices regarding evidence in South Asia. We are interested in accounts of how notions of evidence are employed, negotiated and contested, as well as in analyzing practices that facilitate and govern the production of evidence in medicine and healing.
Long Abstract:
The rise of evidence-based biomedicine has provoked new scholarly reflections on the notion of evidence (e.g. Ecks 2008, Lambert 2006, 2009), but along with related questions of truth, knowledge and efficacy, "evidence" has long been a topic of reflection by numerous healing traditions outside of biomedicine, such as Ayurveda, Yunani, and various vernacular healing traditions. Despite the immense current interest in the topic, detailed studies on evidence-making in actual healing encounters (e.g. consultations, rituals) and in formal medical settings (e.g. hospitals, laboratories, medical schools and journals) in South Asia are rare.
This panel will assemble scholars from Social and Medical Anthropology, Science and Technology Studies as well as Public Health to address the following questions: What does evidence mean in diverse locales or at different times? What kinds of data are considered to be evidence in various medical traditions and fields? And what has to be made 'evident' in the first place? Further, how is evidence produced in daily healing practices and how are evidence and experience connected in this regard? What forms of evidence are valued in certain circumstances and what social, political and economic factors are involved in the comparison and judgment of evidence? How do different kinds of evidence co-exist and relate to each other? And finally, how are claims of evidence used in therapeutic sessions, clinical encounters, institutional contexts, scientific debates or political decision-making processes?
Accepted papers:
Session 1Sylvia Sax (University of Heidelberg)
Paper short abstract:
Healthcare standards are increasingly used internationally to gather evidence of healthcare quality. We use recent research in the Pakistan health system to explore social, political and other factors influencing the use of standards in providing evidence of healthcare quality.
Paper long abstract:
Healthcare standards are increasingly used internationally to gather evidence of quality of healthcare services and the wider healthcare system. What makes healthcare standards internationally acceptable as a means for this proof? Are there social, political and other factors that influence the use of healthcare standards as a mechanism of proof within a country context, and, if so, is there anything distinctively 'South Asian' about these factors? Our recent research in Pakistan on the introduction of healthcare accreditation identified the codification of the healthcare standards approach through the International Society for Quality in Healthcare (www.isqua.com). Though codified, we found that the production and use of the standards still involves interpretation and negotiation at all levels in the local health system, from policy managers through practicing clinicians to the users of the healthcare services, including negotiation of whether they can be used as proof of a quality service. We use three examples to explore perceptions of proof and the factors influencing the proof. We explore whether: (1) The standards prove that the healthcare service is a quality service; (2) The standards provide evidence for management decisions about individual facilities or health providers; (3) The standards provide evidence for a regulatory mechanism to close unsafe providers. We close by discussing whether there is anything distinctively 'South Asian' about the factors influencing the use of standards as proof of healthcare quality.
Sheela Saravanan (Goettingen University)
Paper short abstract:
This paper examines how different actors (both medical and non-medical) involved in the process of commercial surrogacy in India, use 'evidence' vis-à-vis other actors and in rationalizing particular therapeutic practices and its implications on consent, preferences and decision making.
Paper long abstract:
The process of commercial surrogacy in India involves a complex association between the medical practitioners, surrogate mothers, intended parents and surrogate agents. Drawing on propositions for evidence-based medical anthropology, this paper examines how different actors (both medical and non-medical) involved in the process, use 'evidence' vis-à-vis other actors and to justify particular therapeutic practices. The differential capacity between actors leads to designation of powers through rules in the surrogacy process. Evidence of socio-economic capacity and existing social stigma is used by actors in different contexts and settings. Information is presented selectively in different settings and used strategically in different contexts meant for a particular audience. Versions of this use are drawn from; participant observation and in-depth interviews with actors, a book published by the clinic meant only for intended parents and media interviews. The paper also examines the implications of this on consent, preferences and decision making.
Sandra Bärnreuther (University of Zurich)
Paper short abstract:
The paper examines practices of proof in In-Vitro Fertilization clinics in India with regard to genital tuberculosis and analyzes the transformation of clinical experience into scientific evidence.
Paper long abstract:
This paper focuses on practices of proof in In-Vitro Fertilization clinics in India with regard to genital tuberculosis (TB). Genital TB constitutes a major cause of infertility in India and the suitability of different diagnostic measures is a highly debated issue among physicians. Diagnostic tests available differ starkly in their perceived adequateness in terms of sensitivity, specificity, rapidity and affordability. Further, many scientific publications are considered to be inadequate for a region with high numbers of latent TB infection. Some clinicians therefore contest the seeming universality of scientific data and undertake own efforts to produce locally meaningful evidence.
Based on ethnographic fieldwork in hospitals and a case study of a medical conference, the paper will discuss (1) practices revolving around the clinical detection of TB and (2) the production of scientific evidence from clinical data. How are TB infections made evident in fertility clinics in India? What kind of diagnostic measures count as appropriate evidence of genital TB? Further, how is the local production of evidence organized and debated in biomedical settings? How does clinical experience figure in these accounts? And how is clinical data translated into scientific evidence?
Nilisha Vashist (University College London)
Paper short abstract:
This paper studies the notions of evidence employed in understanding spirit possession and ritual healing in a North Indian temple by the afflicted and their care-groups and how these are negotiated and contested with and among different ritual healers and psychiatrists sought while seeking a cure.
Paper long abstract:
In the field of health, evidence is the essential prerequisite for accepting the sickness as well as the cure both socially and clinically. However, what constitutes as evidence varies widely depending upon the context of evaluation. Not only the notions of evidence differ as employed in psychiatric treatments and ritual healing but are also contested on popular and folk levels of understanding of possession and exorcism.
With the backdrop of ethnographic study of ritual healing of those possessed by spirits at Balaji temple in Rajasthan (India), this paper tries to study how evidence is understood, negotiated and contested in dealing with spirit-affliction and exorcism in different settings of temple healing and psychiatric consultations. The main aspects discussed are: 1) what constitutes as evidence in the episode of spirit affliction and subsequent exorcism in popular perception of sufferers and their care groups? 2) How is this evidence negotiated by the care-group with and contested among different ritual healers (priests and folk exorcists or bhagats) and psychiatrists/doctors? 3) How do these different notions of evidence co-exist and are managed by the care-groups while seeking treatment at different settings. The paper is built upon data from fieldwork based on in-depth interviews, illness narratives and focused discussions as well as case studies of process of evidence-making in actual healing encounters at the temple, a few of which have also been included here.
William Sax (South Asia Institute, Heidlberg)
Paper short abstract:
This paper compares evidence for mental illness with evidence for possession. To what degree do they overlap, and to what degree do they differ? Are the assumptions upon which they are based incommensurable, or are there points of agreement?
Paper long abstract:
The external signs of madness and of possession are rather similar. Unusual speech and behavior, regular attempts to harm oneself or others, seeing and hearing things that others do not see, unusual ways of positioning or moving (or not moving!) the body: such signs may lead mental health professionals to a diagnosis of mental pathology, while the same signs may lead religious specialists to a diagnosis of "possession." In addition to such external behavioral signs, what forms of evidence are sought by mental health professionals on the one hand, and religious specialists on the other, to confirm their respective diagnoses? To what degree do these forms of evidence overlap, and to what degree do they differ. Are the assumptions upon which they are based incommensurable, or are there points of agreement?
Helen Lambert (University of Bristol)
Paper short abstract:
This paper examines meanings and forms of evidence and the search for legitimation in both international health policy and a local Indian medical tradition. It discusses ways to bridge problems of incommensurability between medical traditions in evaluating therapeutic effectiveness.
Paper long abstract:
This paper situates dominant contemporary understandings of how 'evidence' is understood in health policy and biomedical science in socio-historical context. It argues for a re-focusing of attention on the original impetus for introducing 'evidence-based' approaches to clinical practices, as a means to bridge fundamental problems of incommensurability between different medical traditions in regard to the evaluation of effectiveness. Drawing on secondary analysis of evidence-based medicine in Euro-America and ethnographic exploration of an 'experience-based' local therapeutic tradition in north India, the paper discusses differing forms and meanings of evidence, the search for legitimation and the role of practitioner expertise in judging therapeutic effectiveness. I propose a shift in focus from issues of methodological incompatibility to patient accountability and fairness of evaluation in both social science and biomedical construals of evidence.