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Pathologies of Power: Health, Human Rights, and the New War on the Poor 1st Edition

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ISBN-13: 978-0520235502
ISBN-10: 0520235509
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Editorial Reviews

From The New England Journal of Medicine

There are many kinds of gifted physicians: clinicians, researchers, and those who build institutions. Paul Farmer is the rarest of all: a prophet. Pathologies of Power is a jeremiad on how the "structural violence" of denied opportunities, economic deprivation, violent despots (and the powers supporting them), and international financial organizations harm the health of billions of people who are so distant that they are glibly and uncomprehendingly referred to as living in a "third world." This summary does not do justice to the richness of the book. Farmer deftly weaves personal stories from his work with the dispossessed, careful academic notes, and well-chosen quotations from intellectuals, poets, and proponents of liberation theology. These citations introduce marvelous writers who are not well known to readers from the United States. Farmer builds from the 19th century's Rudolph Virchow, who argued that physicians must advance public health through political and social reform as "attorneys for the poor." Farmer's anecdotes about mobilizing the poor on their own behalf echo the work of Norman Bethune. And Farmer extends Jonathan Mann's fusion of human rights and medical ethics to health and human rights. Farmer, a physician and an anthropologist, offers a blistering critique of anthropologists who describe colorful folkways or bits of social problems, such as sexual barter, without illuminating how such practices are sustained by class and political history. This critique and Farmer's advocacy for oppressed persons mark this book as a prophetic work. Therefore, it is also a towering work of medical ethics. Farmer's critique of anthropology applies equally well to medical ethics, with its scholastic focus on moral curiosities and its decorous silence on "political" issues such as the lack of insurance or the ways in which the policies of international financial organizations affect health and health care for the world's poor. The prophetic voice speaks for the marginalized and can strike listeners as shrill, odd, or discomforting. Farmer skirts that risk by careful scholarship and compelling writing. That being said, I think he overrates the competence of Haiti's reelected president Jean-Bertrand Aristide and the success of Cuba's program to suppress the human immunodeficiency virus. Though he correctly notes the entrenched and mistaken pessimism of the international health authorities about the ability of dispossessed people to complete tuberculosis treatment, he overestimates the capacity of the available infrastructure in many poor countries to manage daily antiretroviral therapy. Such quibbles do not diminish the importance of his larger thesis. Farmer calls on physicians to mount a sustained engagement against human-rights abuses as the roots of disease, disability, and lack of access to health care. Health itself, rather than technical compliance with laws or accords, must be the standard for evaluating governments, foreign policy, and the national restructuring plans of such organizations as the International Monetary Fund. Expanding health services and democratizing information must be central to the global agenda of all physicians. Academic research and education must use the privilege conferred by their power and independence to articulate specific relationships between human rights and abuses of human rights with health and disease. We live in a time when epidemics keep pace with globalization and when the map of deprivation and human-rights abuses precisely overlays the atlas of war, disease, and terrorism. Farmer's sane prescription is more likely to work than is rationalizing neglect, dribbling charity, averting our eyes, or attempting to build a garrison state bounded by a cordon sanitaire. Pathologies of Power is a profound work; it deserves the widest possible audience. Steven Miles, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

"This is an angry and a hopeful book, and like everything Dr. Farmer has written, it has both passion and authority. Pathologies of Power is an eloquent plea for a working definition of human rights that would not neglect the most basic rights...This plea has special potency because it comes from...a person who has proven that the dream of universal and comprehensive human rights is possible."--Foreign Affairs -- Review
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Product Details

  • Series: California Series in Public Anthropology (Book 4)
  • Hardcover: 419 pages
  • Publisher: University of California Press; 1 edition (April 25, 2003)
  • Language: English
  • ISBN-10: 0520235509
  • ISBN-13: 978-0520235502
  • Product Dimensions: 6 x 1.1 x 9 inches
  • Shipping Weight: 1.6 pounds (View shipping rates and policies)
  • Average Customer Review: 4.3 out of 5 stars  See all reviews (47 customer reviews)
  • Amazon Best Sellers Rank: #378,948 in Books (See Top 100 in Books)

More About the Author

Paul Farmer is UN's Deputy Special Envoy for Haiti and Chair of Global Health and Social Medicine at Harvard. He is also Professor of Anthropology at Harvard Medical School, chief of Social Medicine and Inequalities at Boston's Brigham and Women's Hospital, and founding director of Partners In Health. Among his numerous awards and honors is the John D. and Catherine T. MacArthur Foundation's "genius award."

Customer Reviews

Most Helpful Customer Reviews

110 of 111 people found the following review helpful By Patti M. Marxsen on April 10, 2004
Format: Hardcover Verified Purchase
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.
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58 of 60 people found the following review helpful By Friederike Knabe VINE VOICE on September 15, 2004
Format: Hardcover
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".
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21 of 22 people found the following review helpful By M. A. Krul on May 29, 2007
Format: Paperback
Paul Farmer, perhaps the most famous 'Third World doctor' living today, has written an eloquent and moving plea for a reconsideration of modern approaches toward healthcare in the developing nations in this book, "Pathologies of Power". Based on his personal experiences of care in Haiti, but also his professional visits to Russia, Africa, Central America, Mexico, Cuba and many other places besides, Paul Farmer demonstrates that the problematics of healthcare and those of poverty and inequality are insolubly linked in these nations. Whoever says "heal the sick" must also say "end poverty", for the one is not possible without the other; and whoever says "prevent disease" must also say "destroy socio-economic inequality", for the one is not possible without the other. That is the message of this book.

A large part of the work consists of reflections by Farmer on his experiences in Haiti and elsewhere and on the way in which the current worldwide economic structures engender a genuine and systematic violence against the rights of the poor. Strongly inspired by liberation theology (though not necessarily religious), Farmer eloquently and effectively contrasts the heavy importance attached to individual political and legal rights with the way in which the violations of rights done by structural inequalities and injustices is wholly ignored in the same circles that would complain about the former. Rights issues are the domain of jurists, development issues the domain of (liberal) economists; but the way in which the poor and weak are constantly crushed by the systematic repression that is poverty and inequality, at least as real and at least as much a violation as any torture, that seems to be the domain of nobody at all.
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