Medical cultures

Social and cultural studies of contemporary biomedicine have flourished over recent decades, enriching our understanding as well as generating new questions about the vast domain of contemporary medicine. The social sciences have long and robust traditions analyzing the myriad ways that medical knowledge, training, and care are deeply embedded in social relations as well as imbued with profound and often soteriological cultural meanings (Good 1994). Our essay addresses culture and biomedicine, distinguishing between studies of “the culture of medicine” and studies of “culture in medicine.” Medical cultures are socially constructed worlds of illness and healing that vary

across local and national contexts. They stem from the dynamic relationship between the local and global worlds of knowledge production, technologies, markets, and clinical standards. Modern biomedicine, often popularly conceptualized as “Western medicine,” is frequently regarded as a universalized domain of science and technology largely devoid of cultural variations at its bioscience core. Contemporary biomedicine or “cosmopolitan medicine,” to follow terminology popularized in medical anthropology by Charles Leslie (1976) and Fred Dunn (1976), has become an integral part of scientific as well as popular cultures worldwide. And although biomedicine is fostered through an international political economy of biotechnology and by the investment in medical knowledge by an international community of medical educators, academic physicians, clinical investigators, and bioscientists, medicine is taught, practiced, organized, and consumed in local contexts (Good et al. 1999). Cultural approaches to the study of contemporary biomedicine are rooted in the work

of mid-twentieth-century anthropologists and sociologists who began to examine the social construction of health and illness and the institutional and cultural foundations of healing systems around the world. In the 1960s, involvement in public health projects led anthropologists to investigate how biomedical knowledge is received and understood. They argued that individuals are not “empty vessels” waiting to be filled and that medical “habits and beliefs” constitute elements in elaborate “cultural systems” (Paul 1955). In the 1970s, social scientists engaged Leslie’s (1976) comparative agenda, studying medical systems across a variety of cultural settings from small pre-literate villages to the great traditions of practice in Ayurvedic/Indian and Chinese classical and folk medicine

(see also Kleinman et al. 1976). The comparative agenda challenged assumptions that medical cultures are closed systems that develop autonomously; rather, it was shown that diverse medical traditions were pluralistic, evolving from dynamic, transnational flows of knowledge and practices integrated into local cultures, and that “cosmopolitan medicine” was a parallel system to the classical traditions.