This is a very helpful book when it comes to thinking about health, and how each society views it. Often in the United States we say “health” and we really mean “healthcare.” Stephen Bezruchka has given several very good talks on this subject, and Lynn Payer’s Medicine and Culture makes a useful adjunct to his talks (or the other way around in my case, since I read this book before I found his work). It’s nearly impossible to understand a thing without understanding the context in which it exists, and Payer nicely highlights the sometimes absurd nature of medicine in cultural context. Ms. Payer points out why a French doctor might tell your problem is in the liver, a German doctor in the heart, an American doctor might prescribe pain and antibiotic medications, and a British doctor might tell you to come back in a week — all of these solutions for the same malady. If you’re interested in understanding health, or simply how healthcare differs from country to country, I recommend this book highly.
Early in the book she notes that,
“Many of the practices I had taken for granted now seemed to be not so much the result of scientific progress but rather outgrowths of American cultural biases that in some cases harmed more than helped our health and well-being.”
I suspect Dr. Stephen Bezruchka would approve of this phrasing.
There are just one hundred cardiologists in England, but an equivalent number of geriatric psychiatrists. Payer notes that they prioritize quality of life (in this case: during old age) over heart attack prevention. In France, “where great value is put on the woman’s ability to bear children, hysterectomy was not even suggested as an option,” for Payer’s fibroid tumor. Payer was told she must have a myomectomy, and that six such operations could be performed without even necessitating ceasarian section, should she become pregnant. When she returned to the US for treatment, she was “put under a great deal of pressure for hysterectomy and told that a second myomectomy would be impossible.”
Payer cites a French professor, on holiday in the US when he suffered angina, pressured into an immediate bypass operation, without knowing that incidence of coronary bypass operations in the US is 28 times that of some European countries, with studies showing that bypasses rarely have to be done immediately if at all. BCG, an obligatory immunization in France (also in Ghana and Nigeria, I can speak from experience) is “almost impossible” to obtain in the US.
A French patient has seven times the chance of getting drugs in suppository form as does an American. Treatable high blood pressure in the US might be considered normal in England. Low blood pressure can be treated in Germany with 85 different drugs, as well as hydrotherapy, but in the United States would qualify a person for lower life insurance rates. The French use half the number of bars of soap per person, per year, as the English. West Germans (this phrase, “West Germans”, betrays the age of the book) use six times the amount of heart drugs as the French and English.
In general this is a fascinating book, and gives a sense of the influence of culture and context on medicine and to a larger extent on health. At 150 pages it is a quick read, and well worth your time, even if it doesn’t directly speak to structural violence.