Social scientists and the new tuberculosis
Social scientists and the new tuberculosis
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DOI：
10.1016/s0277-9536(96)00143-8
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发表时间：
1997-02-01
影响因子：
5.4
通讯作者：
Farmer, P
中科院分区：
文献类型：
--
作者：
Farmer, P
在世界许多地方，结核病（TB）仍然是年轻人的主要杀手，尽管有效的化疗已经存在了50年。结核病的流行病学在贫穷国家持续存在，并在许多工业化国家的穷人中死灰复燃，这使那些负责保护公众健康的人感到恐慌。通常引用两个表面上是生物学性质的因素来解释这一挫折：艾滋病毒的出现和耐多药结核病（MDR TB）菌株的出现。但是，MDR TB的惊人模式发生-在美国，例如，在无家可归者收容所和市中心的人中，说明了在艾滋病毒出现之前开始的新流行病中起作用的一些大规模社会力量。这些力量（包括贫困，经济不平等，政治暴力和种族主义）通过一个年轻的海地男子与耐多药结核病，一种从未在海地描述的疾病的经验进行检查。从这个案例以及其他关于结核病和艾滋病的研究中得出的见解，是根据过去关于结核病的人类学著作来考虑的。有人认为，社会科学家经常对结核病的分布和病程做出“不谦虚的声明”，从而损害了对结核病的理解。提出了未来耐多药结核病社会医学研究的替代策略。版权所有（C）1997 Elsevier Science Ltd.
In much of the world, tuberculosis (TB) remains the leading killer of young adults, in spite of the fact that effective chemotherapy has existed for 50 years. The epidemiology of TB, with its persistence in poor countries and resurgence among the poor of many industrialized nations, causes consternation among those charged with protecting the public's health. Two factors, ostensibly biological in nature, are commonly cited to explain this setback: the advent of HIV and the emergence of TB strains resistant to multiple drugs (MDR TB). But the strikingly patterned occurrence of MDR TB-in the United States afflicting those in homeless shelters and in the inner city, for example-speaks to some of the large-scale social forces at work in the new epidemic, which began before the advent of HIV. These forces (which include poverty, economic inequality, political violence, and racism) are examined through the experience of a young Haitian man with MDR TB, a disease never before described in Haiti. Insights from this case, and from other research on TB and HIV disease, are considered in the light of past anthropological writings on TB. It is argued that, often, social scientists mar contributions to an understanding of TB by making ''immodest claims of causality'' regarding its distribution and course. Alternative strategies for future sociomedical research on MDR TB are proposed. Copyright (C) 1997 Elsevier Science Ltd.