Pathologies of Power: Health, Human Rights, and the New War on the Poor (California Series in Public Anthropology, 4)

Rating:
Summary: Great doctor, bad book
Review: Pathologies of Power describes a world in which the United States (except for Harvard) can do no right, and Cuba can do no wrong. Even the Cuban policy of rounding up its HIV (+) citizens into isolation camps (described as country clubs) is not criticized. No harsh words come forth regarding the lack of any public health rationale for such confinements. This vignette sets the tone for the whole book. The downtrodden of the world are called victims of structural violence, a rather nebulous term that refers to the effect of power and manipulation from outside forces which have served to perpetuate the misfortunes of the poor.
Dr. Farmer's outrage calls for perpetrators to be brought to justice. Augusto Pinochet should be held accountable for his crimes, he says, in spite of his age and illness. Now, pray tell, will Dr. Farmer praise the U.S. for bringing Saddam Hussein and Chemical Ali to justice? The importance of elections in Haiti is stressed. How about Iraq and all those who have died trying to establish elections there? The U.S. military is probably the only instrument able to bring aid to the tsunami victims in Indonesia - will that qualify as a good deed? Let's be objective here.
This brings us to the greatest fault of this book. It is ineffective, possibly even counterproductive. The shrill tone obscures the remarkable true lessons that it carries. Have you ever been mad at your child and yelled at them, to the extent that all of a sudden your yelling has become the issue, and the original point is lost? Such is this book. One may argue that this anger is justified, and it's about time,..... etc. Apparently Dr. Farmer's confidants in the rarified academic world advised him such a tact was appropriate. He needs some counterbalancing friends from Omaha. The purpose of such books, at least in my mind, should not be to preach to the choir in Boston, rather they should be able to play in Peoria as well.
Now, politics aside, Dr. Farmer is one of the greatest social reformers of our age, and PIH is a wonderful organization. Its just that their points come across much better in sound bites and pictures (the pre and post treatment pictures in the PIH literature for instance) than in this book. And many of it's lessons are simple, yet profound. Long established public health dogma has been shaken, and it makes sense. In these days of $12,000 shower curtains, $20 shots of single malt scotch, and $34 million dollar compensation for a Harvard endowment fund manager can't we rich folk afford to help those who are less well off? On a personal level consider this - why not buy the Toyota rather than the BMW, save the $15,000, give that to charity and get the tax deduction? You come out ahead and help the poor at the same time! All of us could do this in our lives every day and not suffer one bit.
Pathologies in Power exists as a small bump in the road that is the illustrious career of Paul Farmer. I'm sure he will continue his great work and I wish him and PIH all the best.

Rating:
Summary: 3.5 stars
Review: Dr. Farmer argues that, at the very least, access to health care should be a basic human right, especially if we are to uphold the belief that all human lives are equally valuable. Pathologies of Power is an indictment on the social structures that exist to keep the destitute poor of the world just as they are - destitute, impoverished, and without hope. While the powers-that-be make excuses, Dr. Farmer provides solutions that are, indeed, quite simple. His passion for his struggle to provide health care to the poorest of the poor is matched only by his disdain for the social inequities that perpetuate the structural violence inflicted upon the least fortunate of the world. It is heartening to know that there are a few compassionates, amongst the millions of complacent, that work so tirelessly to effect change that is so desperately needed. Hopefully this book will serve as a wake-up call for the rest of us.

Rating:
Summary: important topic with a unique approach
Review: Farmer is both an MD and anthropologist, and his writings of disease and the poor (topics unfortunately remote to most westerners) are very personal and interesting. He is a hands-on care giver in Haiti and also a powerful influence in the world politics of third world medical care. Please read this book.

Rating:
Summary: 3.5 stars
Review: I greatly respect Dr. Farmer's work and have followed Partners In Health's efforts in Haiti over the last several years. While this book has substantive significance in its attempts to discuss several public health and human rights crises in their social, economic, and political contexts; I think it fails to make a cohesive point or tell a cohesive story in the way that a book (rather than a collection of essays) demands. As a public health and human rights worker, I understand where Farmer was trying to go with his writing but I don't think he actually gets there in a coherent way. Perhaps he should have focused only on one health issue or country in order to more fully flesh out his thesis.

I do recommend this book as well as a visit to the Partners in Health web site at www.pih.org.

Rating:
Summary: Take Two Aspirin and Read This Book
Review: Paul Farmer's "Pathologies of Power" will probably give you a headache, undoubtedly cause sleep disturbance, and very likely turn your stomach. In short, it will make you sick. But if you are well enough to read this and rich enough to consider purchasing the book, you are better off than the "disposable millions" whose lives he illuminates and honors in this indictment of global public health as-we-know-it. In this passionate and well-researched treatise, a world-class physician takes his own disciplines of medicine and anthropology to task for failing to ask the right questions. Then, noting that the U.S. pharmaceutical industry is the most profitable industry in the most affluent country in the world, he blows through its defense of those extraordinary profits like a gust of fresh air. A similarly searing deconstruction of health policymakers' rationale for "cost-effectiveness" and their elite argot of oppression reveals a blame-the-victim mentality that plagues the world and explains why, in the midst of unprecedented wealth, over 40 million Americans are without health insurance of any kind. And that is just the beginning.

While Farmer's hospital in Haiti, Zanmi Lasante, is not the only hospital to successfully combat the forces of poverty and disease in that country (Hôpital Albert Schweitzer in the Artibonite Valley predates Farmer's project by nearly three decades), his twenty-year presence in Central Haiti has resulted in a deep understanding of how structural violence on a global scale is a leading cause of disease and death among the world's poor, wherever they may live. Drawing on case-study examples from Haiti, South America, Cuba, Siberia, and the United States, he deftly illustrates why tuberculosis deaths, which he describes as 95 percent curable with inexpensive medication developed many years ago, "occur almost exclusively among the poor, whether they reside in the inner cities of the United Stated or in the poor counties of the Southern Hemisphere." Addressing the growing trend of multi-drug resistant strains of TB, Farmer discusses "tuberculosis as punishment" in the world's prison populations and delivers a wake-up call to those who might consider themselves immune from this, and other, infectious diseases.

In his critique of the commodification of healthcare, Farmer speaks of "orphan drugs" drugs that are simply not developed because they are needed by people who cannot pay for them, the sale of organs by those without resources to those with money, and the equally revolting multi-million dollar compensation packages of pharmaceutical company CEOs and managed care executives. In the midst of the catalog of inequity, he wonders why medical ethics courses in American schools of medicine focus so narrowly on the "quandaries of the fortunate"¯like whether or not to refuse a particular technology or whether or not to leave a loved one in a prolonged coma¯when millions are condemned to death or disease before they learn to walk. Even the World Health Organization (WHO) does not escape his critical analysis: "... the language of social injustice is increasingly absent from public health parlance," he notes.

Farmer is one of those remarkable doctors working in remote places who, somehow, finds the energy to look up from his daily workload and ponder the underlying causes of the suffering he treats. Furthermore, he writes about it in the brisk and engaging prose of an investigative reporter and brings provocative interdisciplinary voices of others¯Gustavo Gutiérrez, Paolo Freire, Cornel West, Amartya Sen, Jon Sobrino, Nancy Scheper-Hughes, to name a few ¯to bear on his march toward social justice. His ideas are radical, in part, because they are simple and based on an equitable distribution of health, regardless of wealth. Bringing the observe, judge, act methodology of liberation theology to bear on global public health, Farmer advocates a "preferential option" for the poor, a redefinition of medicine as a healing profession (as opposed to medicine-as-commerce), and a new understanding of healthcare as a basic human right, for all.

Toward the end of a chapter entitled "Listening for Prophetic Voices," Farmer distills his argument into a call to action: "We thus find ourselves at a crossroads: healthcare can be considered a commodity to be sold, or it can be considered a basic social right. It cannot comfortably be considered both of these at the same time. This, I believe, is the great drama of medicine at the start of this century. And this is the choice before all people of faith and good will in theses dangerous times."

Pathologies of Power is a lucid and alarming statement from a fearless physician. It speaks truth to power and it speaks for the destitute sick. Take two aspirin, lie down, and read the book. In spite of its consciousness-raising side effects, this may be the beginning of a cure for what ails the world.

Rating:
Summary: Sobering
Review: Paul Farmer's "Pathologies of Power" will probably give you a headache, undoubtedly cause sleep disturbance, and very likely turn your stomach. In short, it will make you sick. But if you are well enough to read this and rich enough to consider purchasing the book, you are better off than the "disposable millions" whose lives he illuminates and honors in this indictment of global public health as-we-know-it. In this passionate and well-researched treatise, a world-class physician takes his own disciplines of medicine and anthropology to task for failing to ask the right questions. Then, noting that the U.S. pharmaceutical industry is the most profitable industry in the most affluent country in the world, he blows through its defense of those extraordinary profits like a gust of fresh air. A similarly searing deconstruction of health policymakers' rationale for "cost-effectiveness" and their elite argot of oppression reveals a blame-the-victim mentality that plagues the world and explains why, in the midst of unprecedented wealth, over 40 million Americans are without health insurance of any kind. And that is just the beginning.

While Farmer's hospital in Haiti, Zanmi Lasante, is not the only hospital to successfully combat the forces of poverty and disease in that country (Hôpital Albert Schweitzer in the Artibonite Valley predates Farmer's project by nearly three decades), his twenty-year presence in Central Haiti has resulted in a deep understanding of how structural violence on a global scale is a leading cause of disease and death among the world's poor, wherever they may live. Drawing on case-study examples from Haiti, South America, Cuba, Siberia, and the United States, he deftly illustrates why tuberculosis deaths, which he describes as 95 percent curable with inexpensive medication developed many years ago, "occur almost exclusively among the poor, whether they reside in the inner cities of the United Stated or in the poor counties of the Southern Hemisphere." Addressing the growing trend of multi-drug resistant strains of TB, Farmer discusses "tuberculosis as punishment" in the world's prison populations and delivers a wake-up call to those who might consider themselves immune from this, and other, infectious diseases.

In his critique of the commodification of healthcare, Farmer speaks of "orphan drugs" drugs that are simply not developed because they are needed by people who cannot pay for them, the sale of organs by those without resources to those with money, and the equally revolting multi-million dollar compensation packages of pharmaceutical company CEOs and managed care executives. In the midst of the catalog of inequity, he wonders why medical ethics courses in American schools of medicine focus so narrowly on the "quandaries of the fortunate"¯like whether or not to refuse a particular technology or whether or not to leave a loved one in a prolonged coma¯when millions are condemned to death or disease before they learn to walk. Even the World Health Organization (WHO) does not escape his critical analysis: "... the language of social injustice is increasingly absent from public health parlance," he notes.

Farmer is one of those remarkable doctors working in remote places who, somehow, finds the energy to look up from his daily workload and ponder the underlying causes of the suffering he treats. Furthermore, he writes about it in the brisk and engaging prose of an investigative reporter and brings provocative interdisciplinary voices of others¯Gustavo Gutiérrez, Paolo Freire, Cornel West, Amartya Sen, Jon Sobrino, Nancy Scheper-Hughes, to name a few ¯to bear on his march toward social justice. His ideas are radical, in part, because they are simple and based on an equitable distribution of health, regardless of wealth. Bringing the observe, judge, act methodology of liberation theology to bear on global public health, Farmer advocates a "preferential option" for the poor, a redefinition of medicine as a healing profession (as opposed to medicine-as-commerce), and a new understanding of healthcare as a basic human right, for all.

Toward the end of a chapter entitled "Listening for Prophetic Voices," Farmer distills his argument into a call to action: "We thus find ourselves at a crossroads: healthcare can be considered a commodity to be sold, or it can be considered a basic social right. It cannot comfortably be considered both of these at the same time. This, I believe, is the great drama of medicine at the start of this century. And this is the choice before all people of faith and good will in theses dangerous times."

Pathologies of Power is a lucid and alarming statement from a fearless physician. It speaks truth to power and it speaks for the destitute sick. Take two aspirin, lie down, and read the book. In spite of its consciousness-raising side effects, this may be the beginning of a cure for what ails the world.

Rating:
Summary: Sobering
Review: Reasoned yet impassioned dialogue on a variety of issues. Americans needn't feel left out of this either, as we are still the only industrialized country in the world without a universal health care system. geocities.com/singlepayerweb

Rating:
Summary: Giving a voice to nobodies...
Review: There are some books whose message is so pertinent to your daily life that they stay with you for a long time. Farmer's PATHOLOGIES OF POWER will have a profound impression on you. Its substance is highly relevant for current topical debates, whether on Medicare and the forty million uninsured in the US, the Canadian government's ambition to "fix" healthcare or on strategies to fight health pandemics like HIV/AIDS. Farmer submits an emphatic challenge to the medical profession, to political and business leaders, mainstream media and all of us.

Farmer stands emphatically on the side of the destitute, marginalized and usually overlooked. His vivid case studies exemplify the fate of millions of "nobodies" - the silent majority of the world's population who have none or inadequate heath care. Why, he asks, are health care services not made available to all human beings irrespective of race, gender, locale, or the ability to pay? Is it not a fundamental human right? Why do millions in developing countries, in the slums of US cities or prisons in Russia, die prematurely of infectious diseases to which medical research has found successful treatments? Can we morally accept that medical research prioritizes cures for baldness or impotence over medicines that protect from drug-resistant tuberculosis or malaria? And, where has medical ethics come to that condones, or even supports, the "commodification" of medicine? How can cost-effectiveness and the ability to pay apply to essential medical treatment? he queries.

Rooted in his deep belief in human dignity and the fundamental nature of human rights, Farmer also draws strength from liberation theology as he "walks the talk". For more than 20 years, Farmer, anthropologist as well as medical doctor, has dedicated his life to the struggle of the "nobodies" for survival, health and dignity. Working among the poorest and the outcasts, he has lived with the evidence that illness is intimately linked with poverty. From his base in central Haiti, one of the world's poorest regions, he has embarked on an international crusade for social and economic rights and the right to health for all - and "that means every body!" Whether in Haiti, the slums of New York and Boston, in Peru or the prisons in Russia, "structural violence" has been the underlying cause for the desperate spiral of illness and destitution. Farmer uses the concept of "structural violence" broadly to describe social inequalities, lack of economic opportunities, activities of oppressive states: the "misery of extreme poverty". Nobel Prize winning economist Amartya Sen, one of Farmer's mentors, describes it as the destructive forces of "unfreedoms".

Farmer's book is a passionate testament to his many patients and their struggle for rights and dignity. Consequently, it is a damning critique of current health delivery services by governments, international health experts and aid agencies. He analyses the flaws of the charity and development models to healthcare and concludes that "...In a world riven by inequity, medicine could be viewed as social justice work."
While his recounting of individual cases makes at times gloomy reading, his empathy and fervour speak directly to us, his readers. We are drawn emotionally and intellectually into this complex and multifaceted challenge. Drawing on numerous scholars and practitioners, he exemplifies why we should question the underlying fabric of our current approach to human rights, development policy and globalized economy. Human rights work, he argues, has primarily been viewed from a legal perspective with an emphasis on civil and political rights. Instead, he insists, the focus needs to shift so that public health and access to medical care are treated as social and economic rights. These, in turn, have to be understood as critical as civil and political rights, he concludes.

PATHOLOGIES OF POWER is central to the current debates on health, social justice and human rights. It is also an essential tool for anybody involved in any aspect of public health care, medical ethics and sustainable development. Furthermore, it is an extraordinary study resource for everybody interested in the future of human well being. Farmer's own testimony, "bearing witness", and his in-depth analyses are enriched by detailed quotes and ample footnotes from a wide spectrum of analysts and visionaries. [Friederike Knabe, Ottawa Canada]