差異を身につける : 糖尿病薬の使用にみる人間と科学技術の相関性 Embodying Difference : The Pharmaceutical Mediation of Human and Scientific Values in Diabetes Care

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差異と類似の評価は、現代医療の現場で極めて重要な役割を果たしている。医療技術の選択肢をめぐる、年々に増大している多様化と共に、身体を生きる患者の生活における異質性も注目の的になりつつある。こうした科学知識と文化における複数の差異を媒介するのは、M.ストラザーンによれば、身体を「公的表面」(public surface)として生み出す医療のさまざまな人工物である。本論文で取り上げる糖尿病薬は、このような科学と文化の多様性を動員する人工物のひとつである。従来の人類学者はいろいろな角度から医療の多元性を描いてきた。西洋医学と異なる医療体系を記述した数多くの民族誌から、患者と医療者の種々の解釈への関心や、医学知見としての疾病と文化現象としての病の対立まで、生物医療を囲む多様性の存在については、十分に分析されてきた。しかし差異は体系、信念、あるいは解釈だけではない。差異は実践は要素でもある。本稿では、鈴蘭病院(仮名)という糖尿病センターで行われる薬物療法の実践を人類学の眼鏡を通してみていくことにより、薬の、科学と文化と身体のそれぞれのレベルにおける差異化を結びつける役割について検討する。ここでは(1)日本における内分泌学のモデルと、(2)鈴蘭病院と呼ぶ糖尿病センターの組織と、(3)様々な薬の吸収に伴う病気の身体知の3つの事例をもとに、複雑化した社会における差異の技術的な媒介を示してみる。さらに、医療実践の「中」で、いかに文化と自然における違いが同時に構成しあいつつあるかを明らかにした上で、多元性の人類学における主導的な論考を批判しよう。

<p>Diabetes is a major health problem in Japan, affecting more than 5 million people directly. Its public health implications grow along with the potential market of newer and simpler medications, making it one of the most dynamic fields of collaboration between the state, scientific research and private pharmaceutical companies. In this article, my concern is to describe how hypoglycemic agents (i.e. diabetes drugs) perform those links, which, in turn, articulate biological and cultural differences by measuring, negotiating and imaging them in medical practice. The increasing presence of pharmaceutical innovations in Japan calls for a shift of focus to the local settings of learning and appropriating such medications in daily life - that is, how people come to understand pills and injections that are designed to treat their disease. After delivering the prescription, the physician has to align the drugs with offers of the salesmen, skills of the pharmacists and patients' complaints etc. Norms of blood sugar, clinical trials and that of social life all become interrelated, through the calculation of which medications constitute sameness to such norms, and those that constitute a difference. By pointing at the metabolism, the drug orients toward an embodied understanding of seemingly unimportant events in daily life: what and when to eat, how much to sleep, where to spend the weekend, etc. It opens new ways for formulating questions and interpretations that differentiate the patient from others, while at the same time displaying the metabolism as part and parcel of the patient's life. But how does one account for such overlapping biological and cultural variations simultaneously? Drawing on the plurality of perspectives surrounding health and disease is an established method of medical anthropologists. Differences play a crucial role in contemporary medicine, and anthropologists are, by profession, attentive to the plurality of illness and its social consequences. However, as recent dialogues between science studies and anthropology have shown, such plurality is present on both sides of the divide, and anthropologists should address them symmetrically if they want to overcome both cultural and technological reductionism. One way to do so follows the practicalities of medicine, where such differences are performed and embodied locally in the relations of scientific knowledge and personal suffering. As shown by anthropologists, putting skills to practice does not necessarily follow their acquisition. Rather, learning is often a part of the very routines it brings about. Similarly, the self-management of chronic conditions is more than simply the internalization of a scientifically given knowledge. The techniques of putting pharmaceuticals to use are embedded in an open-ended mediation of disease: an attunement of bodies and their affects. Through a fieldwork study of the practice of pharmacological therapy at a diabetes clinic in the northern part of Japan, the dominant pluralist model of medical anthropology will be criticized here. I will show, instead, how differences are mobilized in the embodied relationship of science and culture through the technological mediation and daily routine of pills, insulin pens and medication diaries. First, I explore the shifting endocrinological categories that frame the practice of the self-management of diabetes in Japan (ch. 3). Then, I focus in on the specific case study of Suzuran Diabetes Center (pseudonym), to illustrate the interaction between scientific facts and cultural values in the clinical organization of the use of medications (ch. 4). Those interactions take place through the embodied practices of dosing drugs and learning to live with the scientific knowledge they distribute. Such finding is, however, not merely a hypothetical concern of the anthropologist, as I will point out in the fifth section, but a long</p><p>(View PDF for the rest of the abstract.)</p>

収録刊行物

  • 文化人類学

    文化人類学 73(1), 70-92, 2008

    日本文化人類学会

各種コード

  • NII論文ID(NAID)
    110006793233
  • NII書誌ID(NCID)
    AA11958949
  • 本文言語コード
    JPN
  • ISSN
    1349-0648
  • NDL 記事登録ID
    9568263
  • NDL 雑誌分類
    ZG1(歴史・地理)
  • NDL 請求記号
    Z8-240
  • データ提供元
    NDL  NII-ELS  J-STAGE 
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