Saturday, March 8, 2008

On Patriarchal Medicine: The Intersection of Feminist Critique and Anti-Vaccine Crackpottery

While browsing through the archives at Women's Space (a wonderful radical feminist blog, you should definitely check it out) I came across this post, which seems to give credence to the idea that vaccines cause autism. The first comment, from Ballastexistenz, does a great job of showing the inadequacy of that hypothesis (and the long history of bogus explanations being concocted to account for autistic regression), so I won't spend much time on that here.

No, what I'd like to comment on is the idea of "patriarchal medicine," and what is or is not opposed to it. In the comments at Women's Space, patriarchal medicine is equated with all of modern medicine as we know it. I don't think this is quite right. While there are aspects of modern, Western medicine that are patriarchal (the hierarchical, impersonal nature of the doctor-patient relationship; the historical exclusion of women from the medical profession; the overreliance of modern medicine on expensive, high-tech medications produced by pharmaceutical corporations; unneccessary surgical and pharmacological intervention in normal childbirth --- those are right off the top of my head, I'm sure the list can be extended), the central principle by which modern medicine operates (empiricism) is the same principle that guided the wise-women healers who preceded it. Indeed, in For Her Own Good: Two Centuries of the Experts' Advice to Women, Barbara Ehrenreich and Deirdre English make the case that the university-educated doctors who started (forcibly) horning in on the wise women's territory in the Middle Ages did a much poorer job of treating patients because their educations were based on ancient Greek and Roman texts, while the wise women had generations of empirical data on which remedies worked and which didn't to draw from.

An argument can be made that the empiricism the wise women practiced was of a different type than the kind valued by modern medicine: the wise women would have ministered to a small local community of a few families, and would have known each person intimately, while modern medicine relies on large-scale epidemiological studies and clinical trials. With the former method, you come to know a lot about the people within your small sample; their tolerances, their reactions, their baseline. You might not know as much about the range of possible effects a given remedy might have, since you have only your small group of people on whom to test it. But with your intimate knowledge of these people and their history (going back generations), you probably won't have as much need to test things on them. Though, with the changing nature of society (mobile populations, world travel etc.), more and more local populations are getting exposed to new kinds of sicknesses, which makes the larger scale of modern medicine more practical within our large-scale society. The fact remains, though, that these two approaches are more related than you might think. They're both based on evidence and experimentation; they differ mainly in the scale on which they are practiced and the attitude of the doctor toward the patient. To my mind, what makes medicine patriarchal is not the reliance on fancy equipment or expensive medications so much as it is the gulf between doctor and patient. If you believe your eight-year university education makes you infallible, and you think there's little of value your patients can tell you about their own experiences or histories, then even if you prescribe only herbal teas and massage you're still practicing Patriarchal Medicine.

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