Anthropology in Action

On 18 December 2014, the results of the U.K.’s Research Excellence Framework (REF) evaluation exercise were released. This extensive and very costly exercise is intended to take the pulse of U.K. university-based research and now happens once every six years or so. It is also the principal tool used to determine the allocation of approximately £1.6 billion of quality-related (QR) research funding which maintains the fabric of research activity in U.K. HE institutions. Given the fiscal consequences of REF performance it is not surprising that that universities expended considerable time and effort preparing their submissions in the run-up to the exercise and that the results were pored over by academics and their managers across the country. This was a very complex set of runes to read.

In this article, I investigate the politicisation of the Caesarean-section (C-section) in Turkey as an anti-natalist procedure. In 2012, the Turkish state began to implement a series of interventions to lower the high rates of birth by C-section, which culminated in an attempted ban on elective C-section. In a previously unseen way, I argue that this intervention was based on the logic that because women are not medically recommended to undergo several C-sections, this surgical procedure limits the number of children a woman can give birth to, causing a concomitant decrease in population growth rates. This article traces the ways in which pronatalist discourses and interventions become meaningful in the medical setting by addressing the politicisation of C-sections. It examines how the C-section reflects a particular population discourse, which is marked by a moral language that stigmatises the fertility of Kurdish women.

In modern medicine, patient choice and involvement in treatment decision-making are increasingly recognised as an important issue in improving the quality of healthcare, and in recent years the concept of shared decision-making has attracted attention as a new approach in the medical encounter. This model is particularly appropriate in life-threatening situations in which no best treatment exists and there are trade-offs between benefits and risk of available treatments. In this article, I demonstrate how clinical uncertainty makes shared decision-making difficult in practice, using the case of elderly patients with end-stage renal failure based on data collected by interviewing renal healthcare professionals in the U.K. I then propose the possibility of 'patient choice' becoming a burden for some elderly patients and the institutionalisation of shared decision-making, and discuss the importance of building a good relationship between healthcare professionals and patients to facilitate shared decision-making.

This article explores a specific kind of student–patient interaction in Egypt. It demonstrates how the increasing need for patients in medical schools and the shift to a neoliberal economy have generated a population of 'bioavailable' professional patients who find meaning in their diseases and sell knowledge about them in medical schools. The encounter with these patients causes tensions and has its high financial costs for the students; yet, some perceive it as a solution to the shortcomings of the medical system. Furthermore, students view professional patients as a cooperative group who possess extensive medical knowledge and relate to their bodies differently compared to 'ordinary' patients. The encounter highlights the inadequacies pertinent to medical education in this system and shows that the rhetoric of patient-centred training, a common model around the world, can lead to inverted power relations and imbalances in the student–patient encounter.

This article first describes the unique place of emergency medicine (EM) within the American healthcare system. Second, it examines the uncertainty that underlies the practice of emergency medicine. It then describes how risk is perceived, negotiated and minimised by emergency physicians in their day-to-day practice. Finally, it explores how the management of medical risk is related to the establishment of trust within the physician–patient interaction and to the construction of the 'competent physician'. In caring for patients, the emergency physician must minimise risk and instil trust within a pressured, time-sensitive environment. Consequently, the management of risk and display of competence to patients are simultaneously accomplished by symbolic representations, the use of medical diagnostic tools in decision-making, and narrative construction within the clinical interaction.

In this article, I bring to the foreground the enactment of the logic of choice and focus on what happens when people are denied the interventions they choose. The specific interventions I focus on are home modifications. My aim is to show how people living with a chronic illness or disability interact with the logic of choice. Drawing from a narrative study on experiences of living with motor neurone disease, I present the narrative of one woman as she tries to enact a life that she can describe as good, or be er. Using empirical evidence, I explore some of the links between subjectivity and the logic of choice, focusing on the experiential knowledge that guides decision-making. In this article, I illustrate how people living with a chronic condition can enact subjectivity by choosing interventions that can a end to their social world.

Liquid Bread: Beer and Brewing in Cross-cultural Perspective. Wulf Schiefenhövel and Helen Macbeth. (eds), New York: Berghahn (The Anthropology of Food and Nutrition Volume 7) 2011, ISBN: 978-1-78238-033-7, 264pp., Hb £75.00, U.S.$120.00, Pb £16.50, U.S.$26.00.

Intimate Enemies: Violence and Reconciliation in Peru. Kimberly Theidon, Philadelphia: University of Pennsylvania Press, 2013, ISBN: 978-0-8122-4450-2, 461pp. Hb $75.00, £49.00.

Books for Review