Tag Archives: public health

Public Health on Drugs

Michael Agar

Michael Agar

Rachelle Annechino invited me to write something about the concept of “public health” as I experienced it in my decades-long and checkered past in the drug field. That past is described in unbearable detail in a book called Dope Double Agent: The Naked Emperor on Drugs. The bottom line of my memory (if memories can have a bottom line) is that the phrase “public health” was a severe case of metaphor abuse. I only got clear on this slowly over the decades. This is the first time that I’ve tried to box it up in a summary, courtesy of ten years of hindsight after leaving the field.

The history of policy and practice around psychoactive substances in the 20th century U.S. has been a long slow-dance between docs and cops. Consider opioids as an example – opium and morphine and laudanum, and later heroin, and later methadone, and later buprenorphine, and now oxycontin — all opioid drugs that range from the organic to the synthetic. The docs first celebrated them for their medical use, then got upset when users broke the compliance rules and used them on their own, at which point the cops stepped in. In their different historical contexts they went through the same cycle, from legit (more or less) medication to popular use to crime. To those of us working in what the bureaucrats called the “demand” side of the drug field, attention to public health made a lot more sense than what the better funded “supply” side lusted after, namely, toss the addicted into jail.

The question was, how could anthropologists, among others, use and subvert the public health discourse in useful ways?

Like most U.S. presidential elections, “public health” was only the better of two bad choices. “Public health” has its uses. Boas studied with Virchow, a founder of social epidemiology, after all. It isn’t the right framework to describe and understand people in their social worlds and how chemicals they ingest do and don’t fit into the flow. But, if you want to join policy conversations about “substance abuse” in most countries I’ve worked in, you have to translate your arguments into a doc/cop creole to make sense to the other participants. It’s the old problem of naïve realism, as the social cognition types say, or doxa, if you’re a Bourdieu fan. Do you push from the outside or talk on the inside? I chose the latter. So the question was, how could anthropologists, among others, use and subvert the public health discourse in useful ways?

Here’s a pretty easy example of one way we did that. Historically, public health arose out of successes at finding and then controlling the biological mechanisms that caused a disease. Public health found those mechanisms using epidemiology and then attempted to control them with biology. Epidemiologists built a database of “case records.” A good case record consists of clinical criteria for diagnosis, severity, time and place of onset, and demographics. (See, for example, this introduction to epidemiology [pdf].)

With time, as the DSM molted during its travels along its Roman numeral marked trail, diagnostic criteria have become more subtle and more reasonable, but that official definition of “abuse” remains on NIDA’s web page today. By this definition, it’s hard to imagine anyone who hasn’t been, at least at one point in their life, a drug abuser.

In the drug field, “ diagnosis” and “severity” were corrupted by war on drugs ideology. The insanity reached a peak in the 1980s with the official definition of “drug abuse” as “any illicit use of a substance” — any at all — including “illicit use” of a legal substance as well. This madness occurred at about the same time as the famous “library purge” of 1984, in which the National Institute on Drug Abuse (NIDA) expunged a set of its own titles from its archives and encouraged librarians to remove them from card catalogs. With time, as the DSM molted during its travels along its Roman numeral marked trail, diagnostic criteria have become more subtle and more reasonable, but that official definition of “abuse” remains on NIDA’s web page today. By this definition, it’s hard to imagine anyone who hasn’t been, at least at one point in their life, a drug abuser. The “diagnostic” part of a case record lost any useful meaning for research or intervention.Read More… Public Health on Drugs

Measurements: The Qualitative Work of Quantitative Work

Katie Pine

Katie Pine

Max Liboiron

Max Liboiron

Editor’s Note: and continue this week’s theme of makers, hackers, and engineers with a post about the politics and performativity of measurements, central to the practice of many engineers and scientists.

(@khpine) is a postdoc in Intel Labs Cultural Transformation Lab, and is currently in residence at UC Irvine.  Katie’s work bridges Computer Supported Cooperative Work, Organization Studies, and Science & Technology Studies.  At present her NSF-funded research examines micro-foundations of IT-enabled accountability policy and practice in the healthcare domain.

(@maxliboiron) is a postdoc at Northeastern University’s Social Science Environmental Health Research Institute (SSEHRI) and a co-founding member of the Superstorm Research Lab, a mutual aid research collective. Liboiron studies “techniques of definition,” the tools and practices used by scientists and activists to make emerging, contested, amorphous forms of environmental harm manifest.

From common core to quantified self, measurement is increasingly part and parcel of our daily lives.  We use number-driven measurements to make visible, manage, and regulate increasingly nuanced aspects of daily life, work, public institutions, and our environment.

However, measurements are never mere faithful representations of nature, but have social and political origins and ramifications.  We are exploring two aspects of measurement that often go unnoticed: first, the situated, complex work that goes into making measurements work in the first place (and the fact that this work is inherently social, cultural, and political), and second, the idea that measurements themselves can be seen as performative, creating and re-creating the very things they are intended to make visible.

Representational theory defines measurement as “the correlation of numbers with entities that are not numbers,” a process of transformation, translation, and even interpretation at the level of sampling and gathering data. What is selected for measurement and what is not, how measurements are standardized, what counts as an important unit of measure, and how measurements are used all have stakes for the systems of which they are part.

Moser & Law (2006) argue that current metaphors for information as “flow” are inaccurate, as these metaphors presume that information is immutable, something that is created and exists in the world and thus can be taken up, passed around, and used for calculation.  Moser and Law instead argue that we can see information as something that is inherently mutable and relational, that changes its shape as it is circulated and used.  To put it more simply, information never fully has meaning on its own – it becomes meaningful and usable when a particular person or group make decisions about what the information is and how they can use it.


A good example comes from a recent study on counting rates of infection in hospitals (Dixon Woods et Al., 2012).  The authors found that an act as seemingly simple as counting infections was actually highly social and cultural – the answer to the question “what counts?” varied widely from one hospital to another, calling into question the current focus in healthcare (and investment of healthcare dollars) on quality measures as a tool for achieving reforms such as infection reduction in practice. Making meaning of numbers requires acts of both calculation and judgment, what Moser & Law call “qualculation.”

Read More… Measurements: The Qualitative Work of Quantitative Work

Innovation in Asthma Research: Using Ethnography to Study a Global Health Problem (3 of 3)

Editor’s note: This report is the final post in the Innovation in Asthma Research series. It shares with readers how anyone can contribute to The Asthma Files’s research. Catch up on the first post in this series that explained the project history and the second post that took us into the project’s knowledge platform. In our ongoing efforts at Ethnography Matters to highlight innovative ethnographic research, we believe The Asthma Files is a great example of how ethnographers are tying insights to action. In this case, The Asthma Files is collecting data to advance asthma research and environmental public health work.

In our previous posts, we’ve talked about why we chose to study asthma ethnographically, and how working with the platform helps us rethink the way we do ethnography. In this concluding post, we’ll talk more about how other researchers and citizens can become involved with The Asthma Files.

Participating in The Asthma Files can take on many forms. Whether a researcher, student, or member of the non-academic public, it is possible to take part in the research project. Since its onset, the project was designed to draw in many kinds of participants.

The first kind of participant consists of ethnographers and other cultural analysts who want to work with materials archived in The Asthma Files, contribute new materials or create new asthma files.

For example, one researcher recently uploaded a series of photographs and images from Compton, CA, to document the heavy historical presence of chemical and petroleum refineries around an area heavily populated historical disadvantaged groups.

A smog cloud over south Los Angeles, near the city of Compton. A historically African-American and Latino community, Compton is surrounded on all four sides by major highways, and one of its elementary schools sits between a cement plant and a major oil refinery.

A smog cloud over south Los Angeles, near the city of Compton. A historically African-American and Latino community, Compton is surrounded on all four sides by major highways, and one of its elementary schools sits between a cement plant and a major oil refinery.

Our repository is publicly accessible, and contains sections to archives such things as primary material, grey matter, and media files. We’ve provided step-by-step instructions on how to upload material to the site once you’ve created an account. This will allow your material to be easily available to anyone wishing to use it for research or informational purposes.

timelinessRead More… Innovation in Asthma Research: Using Ethnography to Study a Global Health Problem (3 of 3)

“The @Adderall_RX Girl”: Pharmaceutical self-branding and identity in social media

headshot of Tazin Karim

Tazin Karim

Editor’s Note:  Tazin Karim (@PharmaCulture) is a medical anthropologist who studies pharmaceutical culture in the US and contexts of prescription stimulant use.  She is also active in the Digital Humanities and Social Sciences. In this post for our Virtual Identity edition, Taz examines the ways in which people use Twitter to construct virtual identities centered on the brand name stimulant Adderall.


In today’s digital world, choosing the right Twitter username is an important decision. It’s the first thing people notice and immediately signals to a potential follower who you are and why they should be interested in what you have to say. Although many stick to their given names, others use the opportunity to highlight their best qualities and brand themselves as an expert academic, baseball fanatic, or mother of the year. So when I found out there were over a hundred people on Twitter with the word “Adderall” in their username, it definitely got my attention. Of all the things to advertise, why would someone want to brand themselves around a mental health drug?

Adderall is a prescription stimulant designed to treat the symptoms of Attention Deficit and Hyperactivity Disorder (ADHD) – a condition affecting 12% of children and 5% of adults in the U.S. It is also used non-medically by a number of people from middle aged mothers to professional football players looking to manage their high-stress lives. My research in particular looks at the popularity of Adderall use among college students and how it is influencing cultural conceptions of mental health and academic performance.

Like other prescription drugs, the consumption of Adderall has become an important part of identity construction for many Americans. For a person with ADHD, it acts to reify the sick role by offering a tangible solution to an illness that is difficult to biomedically conceptualize. Lay conceptions of ADHD extend beyond biomedicine and are intimately tied to academic culture (“my grades are poor because I have ADHD” or “his grades are poor, he must have ADHD”). As a result, Adderall consumption can also construct and facilitate non-medical identities like being a good student, son/daughter, athlete, or friend. As the prevalence of these pharmaceutical practices increases, Adderall use is becoming not only de-stigmatized in American culture, but a normalized, and even glamorized way to achieve these idealized identities – both off and online.Read More… “The @Adderall_RX Girl”: Pharmaceutical self-branding and identity in social media

The ethics of openness: How informed is “informed consent”?

SteepRavineEditor’s note: In this final post for February’s ‘Openness Edition, Rachelle Annechino takes us on a journey with her to the homes of her research participants and asks some really important questions about the wild “foreign languages” (legalese/medical-ese) that supposedly produce “informed consent” and the genesis of our understanding and practice of informed consent, and challenges us to think about how we might redesign informed consent in our own projects. 


One open window (Chris Downer) / CC BY-SA 2.0

One open window (Chris Downer) / CC BY-SA 2.0

Today I’m interviewing a couple of people who participate in a free program offered through a local hospital. The program mainly serves older adults who are dealing with a range of health issues, like diabetes, cancer, and arthritis. Many of the participants belong to groups that are affected by health disparities (or “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations” as defined by the US CDC [1]).

After hanging out at the hospital for a bit to check out the program, I go to the home of a woman in her 60s who couldn’t come to the hospital today. We talk about the study, its risks and benefits. It’s a small exploratory study, some semi-structured interviews; the hospital IRB gave it an expedited review.

The benefits, I explain, are that this might help improve the program or keep the program going. There aren’t really any direct benefits to you though. We wish we had something to give you to thank you for participating. Basically what we’ll do is just sit here and talk. A risk is that some of the questions could be uncomfortable, but we can skip anything you want. If it’s okay with you, I will record the interview. We won’t put your name on the recording or use your name in reports on the interviews.

We have this standard consent form that the hospital uses, I say. It’s kind of long. We can go over what’s in it together, and please feel free to take as much time as you want to look it over…

Et cetera. As I’m saying this stuff, I’m cautiously drawing out the consent form.

Which is eight pages long.

And crazy.

Read More… The ethics of openness: How informed is “informed consent”?

In between is the place where you have to understand people: Social science, stigma, and data big or small

Judd and Tamar

Editor’s Note: Judd Antin @juddantin is a social psychologist and user experience researcher who studies motivations for online participation. In 2011, he was named an MIT Technology Review Innovator Under 35. Prior to joining Facebook, he worked with Yahoo Research.  His educational background includes Applied Anthropology, Information Science, and training at the French Culinary Institute. One of my favorite papers of his is Readers are Not Free Riders: Reading as a form of participation on Wikpedia (pdf) [1].

Tamar Antin is a research scientist who uses mixed and especially qualitative methods to critically examine public health policies and narratives. She has several years of experience in public health research. One of her recent publications is Food Choice As a Multidimensional Experience [2].   Her dissertation [3] combining three papers on food choices and body image is excellent reading for any student of qualitative methods. 

I’ve known Tamar and Judd for several years now, and Tamar has been a mentor to me. Every time Tamar and I talk about research and ethnography, it never seems to last long enough; I just want to ask her more questions. And every time I see Judd, I want to ask him a million questions too. So a post for Ethnography Matters was a great excuse to get together with them for a chat on anthropology, Big Data and Small Data, and other interesting things.  –  Rachelle

P.S. This isn’t a straight transcript of our conversation but a sort of Frankenstein transcript made out of chopped up pieces sewn back together. 


1. Two Ethnographers
2. What they’re working on
3. Stigma and hacking
4. Qualitative research as art, science and handmaiden
5. Big Data and Small Data

1. Two Ethnographers

What’s your background in anthropology?.

Judd: I have an undergraduate degree in anthro from Johns Hopkins, where I was one of seven anthropology majors I think, like in the whole university. It was a small department. I got interested in anthro primarily because of my adviser, who became our friend, Felicity Northcott. Coincidentally she also married Tamar and I. She was internet ordained and she officiated our wedding. She’s awesome.  She was just a very down to earth, foul-mouthed, passionate anthropologist.

Tamar: And for me, I have an undergraduate degree in anthropology also, from the University of Texas. I was having this conversation with the undergraduate adviser there at the end of my senior year, like okay now I have this degree, but I didn’t really know what to do with it. I went to the career center, and they had a list of all the jobs that you could do with certain majors, and I think the only job that was listed for anthropology majors was travel agent.

Judd: What?

Tamar: Oh yeah. I was thinking, well I don’t want to do that.

Judd: Travel agent?!

Read More… In between is the place where you have to understand people: Social science, stigma, and data big or small