The Practice of Biomedicine and the Discourse on Hope

Abstract

Since 1971 and the passage of the National Cancer Act, we have witnessed in the United States an extraordinary burgeoning of specialization in medical, surgical and radiation oncology and of the complementary fields of research oncology, including clinical trials and clinical epidemiology. The creation of these new specialties, the concomitant commitment of government funds to the National Cancer Institute for biomedical research in oncology, the expansion of clinical trials to international cancer ‘centers’ and collaboration on research protocols, and the newly developing fee-for-service cancer research and treatment programs raise numerous questions for anthropological exploration[2].

I would like to acknowledge the contributions of my colleagues in the conceptualization of this research endeavor: Byron Good, Ph.D., Harvard Medical School, Deborah Gordon, Ph.D., Florence, Italy, and Stuart Lind, M.D., Massachusetts General Hospital and Harvard Medical School, Department of Medicine, Hematology/ Oncology. Cynthia Schaffer, HMS 1990, participated as a student researcher on the project, assisted in conceptualization, and conducted the majority of the interviews with clinicians under my guidance. This project constitutes the first phase of a longitudinal study of the culture of American oncology and its relationship to international biomedicine. The study of radiation therapy patients was conceptualized and implemented by Stuart Lind (MGH), Byron Good, Tom Csordas, Steve Seidel (HMS 1989) and myself. I would also like to thank the physicians who participated in this research and gave generously of their time; the conveners, Arthur Kleinman, Thomas Maretzki and Beatrix Pfleiderer, of “Anthropologies of Medicine: A colloquium on West European and North American Perspectives” Hamburg 4–8, 1988, and the participants in this colloquium. This research was funded in part by small grants from the Department of Social Medicine, HMS, the Milton Fund, HMS, and by BRSG S07 RR 05381-27, Biomedical Research Support Grant Program, Divison of Research Resources, National Institutes of Health. Portions of this paper were published in Culture,Medicine and Psychiatry 14: 59–79, 1990, In Good et al. “American Oncology and the Discourse on Hope”