IPR+Neg+-+Western+Medicine+K

1. The discourse of Western Medicine is part of the civilizing mission of development. The aff establishes a hegemonic relationship between medical authority and indigenous peoples. Andrew Cunningham, senior research fellow, History of Medicine, department of History and Philosophy of Science, Cambridge University, and Bridie Andrews, Assistant Professor of the History of Medicine, Harvard University, 1997, Western medicine as contested knowledge, Manchester University Press, p. vii, [IK]

The symbiotic relationship between imperialism and the development of Western intellectual disciplines and their practical application in the nineteenth and twentieth centuries has recently been subjected to increasing scrutiny. This has been particularly true of medical history, since Western medicine was both profoundly influenced by, and established hegemonic relationships through, encounters with the rest of the world during the imperial era. European medical practitioners, their methodologies still in the process of formulation, embarked upon their own patterns of social and scientific dominance. Through medicine and its related disciplines, the West assured itself that it was capable of diagnosing the bodily ills of the indigenous peoples of empire as part of its wider cultural, political and economic project. Such a medical conquest far exceeded the formal boundaries of empire. Western doctors conceived a mission, scarcely less fervent than that of the Christian missionaries with whom they were often associated, to take their insights to the furthest corners of the world. Many missionaries – Livingstone was perhaps the most celebrated example - adopted medicine as a prime vehicle for imparting Christian values and ultimately beliefs. Within formal empire, medicine and its practitioners enjoyed high prestige, soon establishing powerful administrative networks and close connections with the armed forces, services associated with the environment, and educational institutions. It thus became both a significant cultural marker of imperial superiority and an acknowledged, if often exaggerated, facilitator of the white presence and dominance in the wider world. It is, then, not surprising that its pervasive authority should have had little difficulty in surviving into the post-imperial age. Despite its comparatively limited focus in the understanding of health, illness, diagnosis and treatment, despite the modern fascination with alternative medical traditions, it is still invariably privileged as a superior 'scientific' system. This has had a profound influence on health-related international organisations and the social and cultural analysis of 'epidemics', of which AIDS is perhaps the best example.

WESTERN MEDICINE K 2/4 2. Western medicines objectifies Africa based on its absolute scientific authority Andrew Cunningham, senior research fellow, History of Medicine, department of History and Philosophy of Science, Cambridge University, and Bridie Andrews, Assistant Professor of the History of Medicine, Harvard University, 1997, Western medicine as contested knowledge, Manchester University Press, p. 5-6, [IK]

Taken together, the workers in the hospital and the laboratory isolate instances of disease, seek to understand their causes, and endeavour to supply cures for them, with the success of scientific medicine being assessed by its ability to deliver cure. This is the practice of scientific medicine. The process requires the 'objectification' of the patient, transforming the patient mentally from a whole suffering person into an integrated set of physiological processes, one or more of which.is malfunctioning, which can be treated independently of the personality or the social position of the patient. In that sense scientific medicine treats the disease - more precisely, the cause of the disease - not the patient. Above all, scientific medicine is premissed upon authority, the authority of qualified medical personnel over the patient, and indeed over the population at large. That authority, in turn, is itself premised on the scientific basis of this medicine, on the rational, systematic, dispassionate, objective basis on which its knowledge has been built up and warranted true and effective. Thus the patient is not a participant in the diagnostic or curative processes, except in a trivial sense. The patient does not share the knowledge world of the doctor, for the patient has no scientific expertise. The patient has to take on the submissive 'patient's role' in order to receive treatment. There is no room for social negotiation of roles: doctor and patient do not come to a consensual conclusion about the nature of the illness or its treatment the friends and relatives of the patient are not admitted as participants to discussion of the disease, its origin or its prognosis. Indeed, when talking about disease and cure, doctor and patient literally speak different languages. Scientific medicine is not open to alternative views, or to input from anyone not medically or scientifically qualified. In scientific medicine, health is not just a matter of the care of individuals or small groups: health is a social matter, involving the whole community. Germ theory, the child of laboratory medicine, provides an understanding of disease causation which demands large-scale state involvement in medical care in times of epidemics, with military-style operations directed by doctors, in order to control the population and the spread of infection. It is again the scientific basis of the medicine which gives authority to such medical intervention on the large scale: public health and sanitary measures such as inoculation, health checks, sanitation, intrusive measures in epidemics, are all accepted without question in the modern Western state because they are premised on the scientific viewpoint. Its basis in the scientific approach also accounts for why scientific medicine is considered equally applicable to chronic conditions, even though it is relatively ineffective in this area by comparison with its successes in dealing with acute medical conditions. Based as it is on the true (that is, on the scientific) approach, scientific medicine is deemed applicable to all medical conditions, in all places, at all times, since scientific truth is one and indivisible and valid everywhere.

WESTERN MEDICINE K 3/4 3. Implications – Western medicine is an medicine of domination. Its authoritarian structure places it in control over the lives of entire populations, which it renders disposable. Andrew Cunningham, senior research fellow, History of Medicine, department of History and Philosophy of Science, Cambridge University, and Bridie Andrews, Assistant Professor of the History of Medicine, Harvard University, 1997, Western medicine as contested knowledge, Manchester University Press, p. 10-11, [IK]

We asserted earlier that scientific medicine is inherently imperialist by nature, and we went so far as to say that, like imperialism itself, its subject is power, that it is a medicine of domination, and that it expresses a political ideology in its very structure and nature. The claim is built on the use, origin and structure of scientific medicine. First, with respect to its use, scientific medicine has been directly employed by imperialists to assist acts of imperialism and colonialism. Laboratory medicine in particular has been used to promote white settlement in areas hitherto shielded by 'tropical' diseases such as malaria, to protect colonial quarters from native diseases, to promote the efficiency of workers (against, for instance the 'germ of laziness' of hookworm disease) and the efficiency of animals and crops against insect-borne and microbial parasites. In the second place, scientific medicine is historically the product of the imperialistic societies of nineteenth-century Europe and America, with all that goes with that in terms of industry, types of government, class interest. Karl Marx, though currently so unfashionable as a historical analyst, pointed out that the belief system or ideology of any society is that of its ruling elite, and that, when the ruling elite of a society changes, so does its ideology. As the industrial and intellectual middle class came to dominate nineteenth-century Europe and North America, so its values too came to dominate, and to be taken as natural. The middle-class ideology was based on liberal philosophical systems which idealised freedom of thought and individualism against despotism and the Church, which espoused free trade and the freedom of the market at the same time as they also promoted the monopolistic claims of expertise - that quintessentially middle-class attribute - and the cult of the expert in all domains, including that of medicine. Simultaneously it was an ideology which promoted the development of the bureaucracies of centralising governments, where middleclass expertise, whether of civil servants or of sanitary police, was at a premium. These bureaucracies fostered the uniformity of institutions and values, and developed social and intellectual institutions to pursue the welfare of society as a whole, such as, in the case of medicine, hospitals and laboratories, and the superiority of reductionism in medical thinking over holism. This middle-class ideology promoted belief in progress as an unmitigated good, and in science as the embodiment of all good thinking and as the proper model for all other domains of, human thought. Such belief extended to the dividing of human knowledge into science versus the rest (science versus art, science versus religion, science versus superstition, science versus opinion). Empiricism and experiment were made the watchwords of all sound reasoning, and the scientific method (although remaining impossible to define with precision) was presented as the arbiter of logical thinking. And that leads on to the third dimension of scientific medicine which contributed and contributes to making it a medicine of domination: its very structure and nature, and the fact that modern Western society and its values are folded into it. Hence the authoritarian stance that the practitioners of Western medicine take as to its exclusive correctness: there is only one correct view, and it comes from the scientific basis of the medicine. This medicine is the domain of experts, whose writ runs everywhere. And, since the health of the people as a whole in any society is a society-wide issue, the concern of central governments, so health measures can and should be introduced forcibly if necessary. In such ways is scientific medicine a medicine of domination.

WESTERN MEDICINE K 3/4 4. Alternative – analyzing Western medicine from the view of marginalized groups is the most effective way to challenge the its discourse Andrew Cunningham, senior research fellow, History of Medicine, department of History and Philosophy of Science, Cambridge University, and Bridie Andrews, Assistant Professor of the History of Medicine, Harvard University, 1997, Western medicine as contested knowledge, Manchester University Press, p. 13-4, [IK]

There was much resistance to the imposition of scientific medicine. For the most part such resistance has looked simply like that to Western eyes: resistance, based on nothing better than ignorance, cussedness, conservatism, willful stubbornness. But looking from the point of view of those being colonised and imperialised, as our contributors do here, even 'passive resistance' (which Waller and Homewood discuss in Chapter Three below) can be a very positive act, sometimes the only avenue left to contest the claims of Western medicine and science in local contexts. Episodes of 'resistance' to Western medicine can be used as means of listening to the 'native voice', as it is called, and hearing it say something sensible and reasonable, in its own terms. The need to listen to the voice of 'the other', if one is to give accounts which do not simply replicate the power relations of the observers to the observed, has come to be appreciated by anthropologists, and recently also by historians. It is a theme which runs through virtually every contribution in the present volume. It requires a certain ingenuity for Western metropolitan intellectuals to hear such other voices. One way of doing so is to listen to disputes with a different ear - and hence with a different set of values - and that is what many of our contributors do. A valuable tool here is again the concept of 'contestation'. This concept has proved exceptionally useful in recent years, as one of the more accessible aspects of 'postmodernism' as applied to history, and it has been taken up in historical domains as varied as feminism, gay studies, ecology, new sociology, and even the functioning of the capitalist market; it has been of particular value in adding a new vigour to what used to be 'colonial' or 'imperial' history. For the postmodern approach in general rejects the customary historical stories of victorious modernisation, such as the triumph of the West (however ambiguous or ironic a triumph it is taken to have been), or the advancement of science, or (in the present case) the diffusion of scientific medicine, all of which have a strong moral subtext about the inherent superiority of whatever Western, male, industrial, scientific or political thing it is that is taken to have triumphed. And, in saying farewell to the grand narratives, postmodernists replace them with histories which explore cultural difference, are alert to political, sexual and cognitive pluralism, and focus on locally situated disputes. Taking a postmodern stance is itself an act of contesting the values inherent in the traditional accounts of how we got where we are. And 'contestation' is proving to be a valuable tool to use when exploring the activities of people who were or are challenging or resisting existing cultural authorities and hegemony in general, without having to abandon attempts to reach larger historical pictures as some postmodernist historians do.