DISCUSSION QUESTION

Anthropology & Medicine

Vol. 12, No. 2, August 2005, pp. 91–103

Rethinking Medical Anthropology: How Anthropology is Failing Medicine Colin P. Hemmings

There is a great need for medical anthropology within medicine. Anthropology’s

influence on medicine was examined by library and electronic searches of the medical and medical anthropological literature in the past two decades. This evidence suggests

that medical anthropology continues to make little impact. Medical anthropology has helped to articulate the problems of medicine but not provided realistic solutions. It is

argued here therefore that much of medical anthropology’s lack of success is of its own making. Some of medical anthropology’s own problems, and some of the ways that it needs to change, are explored.

Introduction

Medical anthropology has been recognised as an academic sub-discipline since the beginning of the 1960s (Landy 1977). Some still reject the validity of a specialised

medical anthropology (Morgan 1990) but even among those who do not, there has been no consensus for its definition or purpose. Clinical anthropologists have worked in health care settings although critical anthropologists claim this just

means subservience to doctors’ professional interests. They care little whether or not doctors (or patients) find anthropology useful (e.g. Taussig 1980) and some

may even be directly opposed to helping health professionals (e.g. Scheper-Hughes 1990). Others see medical anthropology as the best way to link biological and

social anthropology and to develop theory. Singer (1992, p. 2) even wondered if the ‘promise of medical anthropology is that it can offer medicine’ for the ‘struggling

discipline’ of anthropology. Many have assumed however that one of medical anthropology’s major aims

should be to influence medical care (Loudon 1976). Perhaps revealingly, there is no direct evidence to know whether this is being achieved. We have to consider indirect evidence, such as the dissemination of anthropological ideas in medical literature

Correspondence to: Dr Colin P. Hemmings, BSc, MB BS, MSc, MA, MRCPsych, Consultant Psychiatrist

in Learning Disabilities, Department of Mental Health in Learning Disabilities, York Clinic, Guy’s

Hospital, 47 Weston Street, London SE1 3RR, UK. Tel.: þ44 (0)207 188 3481; Fax: þ44 (0)207 188 3479;

Email: [email protected]

ISSN 1364-8470 (print)/ISSN 1469-2910 (online) � 2005 Taylor & Francis Group Ltd DOI: 10.1080/13648470500139841

as well as evidence of influence on medicine in anthropological literature. Phillips

(1985) noted that medical anthropology had made little impact after its first two decades. Critical examination of the medical and anthropological literature from the

last 20 years by library and electronic searches was therefore performed. Medical anthropology is still largely ignored in clinical settings and training, or considered

at best peripheral. Anthropology is thus still failing to influence medicine. If anthropology does have something useful to offer, then, to put it more starkly,

medical anthropology is failing medicine.

The Need for Anthropology in Medicine

Medicine needs anthropology because the delivery of its benefits remains inefficient.

It is often said that the greatest medical advances would occur if existing treatments were used more effectively. Doctors are mostly unaware of the evidence base of lay beliefs and that is why health education programmes often fail (Fitzpatrick

1984). They still assume that most patients will follow their advice (Littlewood 1991). Despite recent portrayals of patients as educated consumers, the gap between

patients’ beliefs and doctors’ knowledge may have actually increased, owing to advances in specialised scientific knowledge. Kleinman (1978) argued that poor

communication and contrasting expectations between doctors and patients leads to poor clinical care, producing less effective outcomes and more medico-legal and

patient management problems. Fitzpatrick (1984) argued similarly that lay concepts help determine how, why and when the patient presents their problem as well as

significantly affecting compliance.

The Problems of Modern Medicine

Accounts summarising medicine’s problems (e.g. Engel 1977; Kleinman et al. 1978; Cassell 1985; Hahn 1995) have remained largely unknown outside of the social

sciences. Their main themes can be summarised here: medicine has become more technically successful yet paradoxically more criticised. In this era of scientific

progress, there is more litigation, dissatisfaction, and complaints. Medicine has lost focus on the person and their experience of illness. It responds inadequately to

patients’ need to find meaning. History taking is being continually downgraded as a skill. Too much reliance is increasingly placed on technical procedures and

tests. Scientific medicine emphasises technological fixes rather than psychosocial interventions. Curing is considered more important than caring. Patients can be

treated like machines; this also tends to dehumanise doctors. There is preoccupation with quantification, objectification and measurement. Biological data, considered

more real and clinically significant, are not considered linked to psychosocial data, which are largely ignored.

Anthropologists also attack science as medicine’s foundation. These attacks

are almost stereotyped and can be briefly summarised: science has now been dis- credited, for example, by Kuhn’s (1962) study of the history of scientific practice.

Deconstruction of so-called scientific language has exposed medicine’s false neutrality.

92 C. P. Hemmings

Examination of historical and social contexts has shown how so-called objective

medicine is influenced by the dominant values of time and place (e.g. Foucault 1975). There are multiple truths, not single, universal ones. A patient’s understand-

ing of clinical reality is thus just as true as that of the doctor’s. Doctors’ decision making is not always dictated by rationality or by medical criteria (Katz 1985). Much

of medicine is really therefore pseudoscience (Hahn & Kleinman 1983).

Myths in Medicine

One of the most important ways in which doctors defend themselves from such criticisms is by ignoring the evidence of their work. They hold false, but powerful and widespread beliefs, which can be named the ‘myths in medicine’. Here are some

examples. Social factors are not the major influence in a person’s decision to become a patient. The vast majority of ill patients seek medical help. Patients who are ill

have a clear biological abnormality. Patients always want to get better and not to be ill. Patients largely do as their doctors advise them. Doctors and patients have similar

ideas about what constitutes successful treatment. Doctors treat patients objectively and their values rarely affect their practice. Clinical tests and investigations give

the truth. Patients’ feelings towards their treatment and doctors might be important but do not affect treatment success. Most medical problems are acute. Successful

treatment is biologically based such as surgery or medication. Other psychological or social treatments are less important or effective. They might make the patient feel

better but cannot alter the patient’s biology. Medical and psychiatric patients are a very different and non-overlapping group of patients. Training in any psychological and social factors in illness is not important for the work of doctors in ‘general

medicine’ or surgery. Evidence from social science has shown that all of these ‘myths’ are false. Chronic

illness now dominates the illness profile of modern societies (Bury 1997). For the majority of chronic, non-trivial medical conditions there is no cure. Much of

health care in developed countries, even including that in hospital ‘Accident and Emergency’ departments, is dealing with the same disorders that traditional healers

treat in developing countries (Kleinman & Sung 1979). ‘General’ hospitals (that is, for ‘physical’ illnesses) have many patients who are there because of mental disorder

and/or psychosocial reasons. People with substance misuse, deliberate self-harm, non-compliance, ‘somatisation’, ‘secondary gain’ and so on are seen by ‘medical’ and

‘surgical’ doctors. Although these doctors frequently complain that they have to deal with ‘social problems’, this is the reality of their work. Stein (1986, p. 223) found

that doctors divided patients into the ‘deserving’ and ‘non-deserving’ categories of ‘sick people’ and ‘trolls’. Jeffrey (1979, p. 95) found similarly a categorisation of patients into ‘interesting’ (and ‘good’) cases and those that were ‘rubbish’ and ‘dross’.

Press (1990, p. 1005) also reported that hospital nurses and doctors felt ‘their true training to be wasted on, and betrayed by drunks, addicts, ‘‘freeloaders’’ and mothers

with dribbly-nosed kids’. Yet whether they like it or not this is ‘real’ medicine, in which biological factors are inextricably entwined with the psychological, social,

cultural and political.

Anthropology & Medicine 93

The Problems of Medical Anthropology

Despite these repeated criticisms medicine’s direction has still been towards further

biological reductionism, producing an increasingly fragmented health care. Critics

have not changed practice because they have not offered skills and knowledge to back

up their assertions (Cassell 1997). Medical anthropologists have repeatedly drawn

attention to medicine’s shortcomings but have not offered any realistic solutions.

Five ways in which they have contributed to their own lack of influence will be

considered.

Theoretical Approaches

Anthropology has been handicapped by its cultural relativism and so-called literary

turn (Rosenberg 1995). Adherence to relativism and postmodernism, despite

warnings (Kuznar 1997; Lett 1997), has reduced the credibility of anthropologists in

health care. Brown (1991) described the ideological resistance to universals from

anthropologists; generalisation seems to dehumanise and remove the ambiguity

that they often seem to want. When they have also been unwilling to make clear

statements of use or ‘sell’ their knowledge then they have differed from nearly all

the people that they have ever claimed to describe. They would be unique if their

activities were not assessed by ‘relevance, impact, outcome and other utilitarian

terms’ (Maretzki 1980, p. 19).

Anthropologists have celebrated their resistance to define as part of their romantic

self-image (Leslie 2001). But this can appear self-indulgent rather than intellectually

principled. There is not even a consensus about the meaning of culture, anthro-

pology’s raison d’être (Kluckhohn & Kroeber 1963). Debates in anthropology often

become ‘individuals talking past each other with no sharing of ideas’ and ‘pointless

exercises in miscommunication’ (Lett 1997, p. 2). Anthropologists are hardly unique

in recognising that exact definition is ultimately impossible, that medical knowledge

is incomplete and that medical ‘facts’ will always ‘underdetermine the theory’.

They also have had a crisis of representation and authority (Ahmed & Shore 1995)

and a fear of repeating colonial exploitation (Hymes 1974). This has led to timidity

in taking stances in a world which clinicians are only too aware is unclear and

contradictory. Anthropologists are not unified but they commonly like to think of

themselves as radical and ‘anti-discipline’. The result of this position (or lack of one)

is that they are sidelined and ignored.

Lack of Clinical Relevance

Medical anthropology has been frequently observed to not be clinically relevant

enough (Phillips 1985). Anthropologists have tended to claim a moral high ground

but can only do this if their work does not matter. Unlike doctors, they have tended

to remain in a ‘detached, information-providing role’, avoiding the need to ‘make

difficult choices and assume responsibility for outcomes’ (Johnson 1995, p. 109). Their

self-proclaimed ‘holistic’ perspective has often made them ‘unwilling to attempt the

94 C. P. Hemmings

kind of focussed, short-term research typically required by primary health care’

(Pelto & Pelto 1992, p. 1389). Anthropologists have had a tendency ‘to relish the role of critic and analyst without a willingness to put (their) ideas to the test’ (Ritenbaugh

1992, p. 148). Anthropologists also know very little of what doctors actually think, let alone do.

There are probably many doctors who can see links between anthropology and clinical practice but who have yet to find some knowledge, technique or method

that will help in their work. An anthropological ‘method’ such as that of ‘thick description’ (Geertz 1973) hardly seems to promise them anything useful. For most

doctors, anthropology should be seeking solutions to clinical problems in the way that they themselves do. Clinicians are ‘generally unreceptive to the theoretical

constructs of the social sciences; they want to know what to do and how changes in their behaviour will improve outcomes for their patients’ (Phillips 1985, p. 31). One

anthropologist reported that, in three years of working with doctors, her efforts to introduce an anthropological perspective were often rejected as ‘esoteric and besides the point’ (in Browner 1999, p. 136). By contrast, Katz (1985) found that surgeons

were receptive to her work, so long as she addressed an issue of concern to them. It would be ironic for most doctors to learn that medical anthropology has generally

been more concerned that it is atheoretical rather than how it can be applied. Doctors also often perceive anthropologists as hostile to them and as prioritising

a political agenda rather than patient care (e.g. Taussig 1980). But ‘the patient who seeks help from the doctor is today’s victim, not salvageable by tomorrow’s

hoped-for reform’ (Eisenberg & Kleinman 1981, p. 18). Statements such as ‘Praxis must not be left in the hands of those who would only represent the best interests of

biomedical hegemony’ (Scheper-Hughes 1990, p. 196) are off-putting. Stein (1995) argued against the use of hegemony as the type of jargonistic term that tends to

alienate clinicians.

Romanticisation of the ‘Exotic’

Medical anthropology has allowed itself to be stereotyped as concerning the

‘peripheral, the exotic and the bizarre’ (Browner 1999, p. 138) and being only relevant to ‘ethnic minorities’. Anthropologists have not emphasised that all human

activity is ‘cultural’ and that all patients and healers ‘inevitably conceive of the world, communicate and behave in ways that cannot be reasonably or safely assumed to

be similar or readily compatible’ (Hahn 1995, p. 265). Stein (1987, p. 3) described anthropologists’ ‘saccharine romanticisation of the non-Western’. For example,

Heinze (1991, p. 21) claimed, ‘Shamans treat the person, not the symptom’. Gellner (1992) argued that Western thought has led to advantages in development. Many

anthropologists would view this as colonialist, even racist. But that defies the reality that people in developing countries know of the benefits of scientific medicine and

‘they want more of it, not less’ (Bhardwaj 1975, p. 12). Some (e.g. Scheper-Hughes 1990) have also asserted that medicine is socio-

cultural and biological (less often also ‘psychological’), but then argued in effect that

medicine should not reflect this. Doctors themselves have often resisted demands to

Anthropology & Medicine 95

extend their roles in problems that may be best considered primarily ‘political’ rather

than ‘medical’; it is often patients who have demanded a medical term for their difficulties. Anthropologists have been contradictory when they have selectively

criticised the ‘medicalisation’ of life in developed societies (Kleinman 1978). A related criticism is that medicine (usually psychiatry) is a form of ‘social control’.

Yet traditional healers generally act to maintain and defend the social order. They are often enigmatic, uninformative, socially distanced, conservative, offer short

consultations and use obscure language (Kleinman & Sung 1979). Anthropologists seem to be reluctant to acknowledge that traditional healers too can be abusive,

negligent or harmful. Anthropologists have also tended to describe ‘alternative’ therapists in favourable terms, but they may be heavily influenced by certain

core cultural Western values that have otherwise been criticised as ethnocentric. ‘Alternative’ therapists may claim to be ‘holistic’ but are hardly so if they do not address ‘disease’ as well as ‘illness’. Moreover, they describe their practice in ‘mind–

body–spirit’ terms that are paradoxically similar to the most reductionist of doctors.

The Neglect of Biology

Medical anthropologists have been ‘remarkable for a general inattention to

physiology’ (Worthman 1992, p. 172) and have not acknowledged the expansion of knowledge in biology. Because of this they do not understand its strengths and

weaknesses. It is more likely then that they will tacitly accept the viewpoint of biologically focussed doctors. They seem unable to cope in practice with the

theoretical knowledge that there are no absolute distinctions between the social and the biological. But, as Littlewood (1992, p. 403) warned, ‘if medical anthropology

fails to take the biological perspective as legitimate . . . medical practice just continues, co-opting here where useful, dismissing where it pleases’. Adequate understanding of biology can often allow the conclusion that, for certain health

problems, it may not be the most important or fruitful level to find solutions.

Selective Critiques of Psychiatry

Anthropologists have often focused on psychiatry for it appears ‘socially constructed’

whilst the rest of medicine appears ‘natural’. This has meant that the biological elements of ‘mental’ disorders are downplayed (or even denied), whereas the

psychological and social elements of ‘physical’ disorders are treated similarly. This effectively condones a biologically obsessed medicine. By repeatedly examining

psychiatry, anthropology has been conservative, despite its radical pretensions. It would be astonishing to hear of a cardiologist or surgeon researching whether

they are giving equal quality care to their black patients. Anthropologists would deny that the rest of medicine is value-free but they have not set about finding the evidence.

Despite its selective interest, anthropologists have still not exerted any significant influence on psychiatry (Lipsedge 2000). They have shown little understanding of its

evidence base yet to make a credible critique they must be aware of psychiatry’s

96 C. P. Hemmings

advances (Kleinman 1987; Good 1992). Improved understanding of the neurobiology

involved in mental disorders has made several of the arguments of ‘anti-psychiatry’

writers (e.g. Szasz 1974) increasingly irrelevant, yet they remain repetitively quoted

by anthropologists. Psychiatric classification systems have been much criticised yet

they have brought advances in research, knowledge and patient care. The criteria for

certain medical conditions can equally seem on face value to be incredibly arbitrary

but there has been little, if any, anthropological attention to the inherent imprecision

of all diagnostic criteria (Ludwig & Othmer 1977). Another selective focus is in regard

to the ‘placebo response’, which is not valued or respected in medicine. Placebo

seems intuitively to be more important in psychiatry but it has been shown to be

important in surgery (Beecher 1961) as well as when machines are used (Moerman

2000). There are fewer examples of research of the placebo effect in general medicine

compared to psychiatry and so, not surprisingly, there is less evidence of it.

When anthropologists accuse psychiatry of having fewer biological ‘facts’, they

are tacitly accepting that there is more ‘fact’ in other medical specialties than is often

actually the case. Anthropologists who have not studied biology adequately, or are

not statistically competent, lack the confidence to assert that the rest of medicine is

full of uncertainty. By over-emphasising differences between medicine and psychiatry

anthropologists have implicitly colluded with the perpetuation of mind–body

dualism. Their selective focus on psychiatry has reduced anthropology’s influence on

medicine in general.

Medical Anthropology Needs to Change

The Need to be More Relevant and Pragmatic

Anthropologists need to produce evidence that their ideas can improve outcomes.

They need to conduct the types of research that will be most useful to medicine,

such as compliance studies, patient education, and clinician–patient interaction

studies (Phillips 1985). To continue to dismantle the remarkably endurable mind–

body distinction (Scheper-Hughes & Lock 1987) there needs to be further evidence

of how psychological and social processes impact on the individual’s biology and vice

versa by feedback processes (Kleinman 1978). Anthropologists must also research

more often the social and cultural influences on outcomes in so-called ‘physical’

illnesses. Research methods beyond participant-observation studies are required,

with anthropologists able when necessary to demonstrate statistical competence.

They should welcome technological progress but argue that we must not neglect the

fundamentals of patient care in the process. These fundamentals, sometimes

described as healing, need instead to be systematically researched to explore how best

they can be taught to professionals in training.

Kleinman’s (1978) concept of ‘explanatory models’ has been almost the only

example of the conversion of anthropological understanding into a practical and

useful tool for use by clinicians. Helman’s (1978) work was also unusual in that it

showed how lay beliefs heavily influence the consultation outcome within a ‘non-

exotic’ setting. The results could not then be easily ignored as being due to the

Anthropology & Medicine 97

irrational ‘other’ of, for example, an ethnic minority or the working class. Similar

studies would help to prevent anthropology being stereotyped and marginalised. It often seems that if anthropologists have a clinical background they have a greater

tendency to realise the importance of usefulness regarding their ideas. However, previous suggestions of a clinical anthropologist as a new type of health practitioner

(Shiloh 1977) fortunately led nowhere. More and more health professionals are only likely to confuse patients and add to communication problems. The idea of

anthropologists as patient advocates implies that clinicians either are unable to communicate inherently or that they should not bother with developing negotiation

skills. In any case, experience in participant-observation is not an automatic qualification to mediate relations among clinicians and patients (Anderson 1997).

The Need to Understand Doctors Better

Anthropologists have typically assumed the patient’s perspective rather than that of

the doctor (Maretzki 1985). Stein (1987, p. 7) suggested that often the anthropologist ‘identifies with the patient and subsequently becomes more clinician adversary’ but

that this makes ‘one participant in the encounter more than human and another less than human’. The stereotyping attitude of anthropologists to doctors has often

produced poor communication between them (Pelto & Pelto 1992). Stein (1985) argued that he had been most successful with doctors when he did not try to change

them, but instead helped them to see their own meanings and constructs that they brought to and imposed on their clinical practice. In this ideal the ‘clinical’

anthropologist becomes like a psychotherapist facilitator for doctors. Konner (1991, p. 81) also noted about medical anthropology a ‘carping, negative tone that is

counterproductive’. He added, ‘The anthropologists have tended to see the doctor as only the powerful one, not the human being struggling with uncertainty’ and even

predicted that the future influence of anthropology on medicine ‘will be propor- tional to its sympathy for the doctors’.

Medical anthropologists need to understand better their own cultural biases against doctors. Doctors sometimes do jealously protect their professional and

economic interests. They would be a unique group of people if they did not. But many are humanitarian, open to change and hard working for their patients. Some

others may be entirely self-serving but many perhaps only become that way because of the way of life they have been expected to lead, to survive as doctors in sometimes

harsh, even brutal environments. Just as doctors seem to care little for their patients’ experiences, medicine as a system cares little for them (Sinclair 1997). Doctors are

more likely to change when they see that some of their ways are inefficient as well as costing themselves too much personally (Cassell 1985).

The Need to Support Progressive Elements within Medicine

Medical anthropologists have not joined with potential allies from within medicine to call for improved health care. Some even suggested the ‘biopsychosocial’ model

(Engel 1977) was merely a cover for extending the power of doctors (e.g. Taussig

98 C. P. Hemmings

1980). Anthropologists need to support calls for more relevant professional medical

training. Medical students must learn to improve skills that they will use every day, no matter what their specialty. Every so often there are calls for them to have

exposure to the ‘arts’ during their training, as if this will make them somehow more humane and sensitive. But understanding such crucial clinical matters as placebo

effects, basic psychotherapy of reassurance, empathy and instillation of realistic hope and other communication skills must be very much part of the science of medicine

(Engel 1980). Those unable to grasp or learn social science concepts that are proven to be crucial to patient care should not be allowed to qualify.

There are frequent fears that better communication, though laudable, needs time that doctors have not got. Anthropologists need to help counter these fears, by

carrying out the outcome research that demonstrates that improved communication is more efficient and cost effective (Phillips 1985). For example, short conversations can have substantial effects on the healing course of surgical procedures (Moerman

2000). The sarcasm from many doctors about the importance of improving their communication skills fails not because they celebrate their own ignorance. It fails on

criteria which they do believe are important, such as the need to be scientific and to be efficient (Sinclair 1997). A typical ‘joke’ is, ‘would you want the surgeon or the

hospital chaplain to do your operation?’ This assumes a false forced choice between the doctor as technically competent and the doctor who has developed his

interpersonal skills (Cassell 1991). There is no inherent contradiction between, or even easy separation of, the treatment of disease and care for the patient (Engel

1980). Anthropologists need to be much bolder, to assert that thinking by anti- progressive elements within medicine is often poor science and contradictory, just

what many doctors profess to disdain. Just because they have passed science examinations ‘does not necessarily mean that that more than a tiny minority of them

learn scientific ways of thinking’ (Loudon 1976, p. 3). Anthropologists can only challenge unscientific thinking within medicine if their knowledge too is rigorously obtained and evidence-based.

Medical histories ‘convey nothing of the person’ (Sacks 1986, p. x). Psychiatric practice already involves the taking of an extensive history (Littlewood 1990) and

encourages the use of perspectivism (Bursten 1979). The skill of self-reflexivity is also central to psychotherapy although anthropology has recently ‘discovered’ it as if it

were almost something new. Anthropologists’ longstanding resistance to psycho- analysis and psychology is hardly ‘holistic’. Instead of then repeatedly alleging that

psychiatry is not enough like the rest of medicine, anthropologists should be arguing the very opposite.

Conclusion

Lambert and McKevitt (2002) outlined how medical anthropology can help medicine to view the familiar afresh, reconfigure a problem’s boundaries and thus

yield productive insights. Anthropology emphasises the value of data gathered informally, the distinction between what people say and what they do, and knowing

not just ‘lay’ but professionals’ beliefs too. The authors argued that funding sources,

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institutional support and publications should reflect what anthropology could offer.

This may be true but they remain unlikely to do so. Arguments like these, thoughtful as they are, will never persuade the vast majority of health professionals that medical

anthropology and its ‘theoretical underpinnings’ should be prioritised amongst all the other issues competing for their attention.

Medical anthropology does not always have to be applied to have value. It would be false to argue that anthropologists have been unable to see beyond any ‘ivory

towers’. In any case, the ‘university is as much a part of the real world as is the factory or the hospital’ (Baer 1986, p. 100). There is not an easy or even desirable

divide between the academic and the clinical or the theoretical and the practical. Indeed, as Lewin wrote, ‘There is nothing as practical as a good theory’ (in Singer

1992, p. 8). But a major role of ‘medical’ anthropology, perhaps its most important one, must be to influence medicine to be more humanistic, efficient and successful.

If it does not have this aim then it should question whether it should call itself ‘medical’ anthropology.

Medical anthropology has helped to articulate the problems of medicine but not provided any realistic solutions. That is why it is failing to influence clinical practice.

Anthropologists are not merely resisting pressures to become doctors’ handmaidens but ultimately letting down those whose suffering is not currently well addressed

by standard medical care. Progressive elements in medicine need all available evidence to prevent relentless further biological reductionism, but anthropology has

lacked focus and usefulness. Anthropology and medicine have not been natural allies, particularly since anthropology is dominated by ideas not easily compatible, or

even sometimes hostile, to those of medicine. It is doubtful whether anthropology will make much progress at all within clinical settings, let alone quickly enough,

if it continues in the same ways. Medical anthropologists are used to criticising other people’s practice, sometimes constructively, often not. But medicine needs

anthropology so that it can progress to a better standard of care faster than any conceivable new technological advance would bring.

To increase the uptake of its messages, to change medicine, medical anthropology itself needs to change. To work successfully within medicine, anthropologists

need to be more pragmatic about ‘absolute’ truth, knowledge and certainty and to stop being more ‘holistic than thou’ when comparing themselves to others. Some reductionism is necessary in attempts to understand our infinitely complex

worlds. In particular, no medical anthropologist should ever make the farcical claim that all knowledge is of equal value, as in health care this is blatantly untrue and

dangerous. In fairness, there has been a minority of medical anthropologists who have been

well aware of the reasons for their lack of success. There is nothing it seems anthropologists like doing so much as to call for a ‘rethink’. ‘We need to make

ourselves useful in order to be heard’, wrote Kleinman (1985, p. 70). Leslie (quoted in Kleinman 1995, p. 256) warned, ‘The measure of the success of medical

anthropology must also include evidence that it matters for people in the world outside the academy’. And Maretzki (1992, p. 318) observed, ‘As long as we write for

colleagues in anthropology, we cannot really hope for a broader audience’. Many of

100 C. P. Hemmings

the major concerns about medical anthropology were raised over 20 years ago but

the warnings then seem to have gone unheeded. Medicine needs help in order to change. Anthropology is still not getting its messages across to medicine. Patients

rarely benefit from medical anthropology. Therefore anthropology is failing medicine. And unless it changes, it will continue to fail.

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