Reconstituting populations through evidence-based medicine: an ethnographic account of recommending procedures for diagnosing type 2 diabetes in clinical practice guidelines

Communicating "Evidence": Lifestyle, Cancer, and the Promise of a Disease-free Future

In the era of evidence-based health care, conferences aimed at disseminating scientific knowledge perform an essential role in shaping policy and research agendas and transforming physician practice. Drawing on observations at two U.S. cancer prevention conferences aimed at knowledge translation, we examine the ways that evidence regarding the relationship between cancer and lifestyle is articulated and enacted. We show that characterizations of the evidence base at the conferences far outstripped what is presently known about the relationship between cancer and lifestyle. The messages presented to conference participants were also personalized and overtly moralistic, with attendees engaged not merely as practitioners but as members of the public at risk for cancer. We conclude that conferences seeking to bring together knowledge "makers" and knowledge "users" play a potentially important role in the production of scientific facts and are worthy of further study as distinct sites of knowledge production.

Diabetes and Culture

Diabetes and its many manifestations articulate well with the four-field approach in anthropology, providing an almost seamless example of the relationship between human biology, behavior, society, and culture in both the past and the present tense. In general, publications on diabetes and culture echo Enlightenment philosophies on change and progress that posit the increasing prevalence of diabetes as a “crisis in human relations” ( Bendix 1967 , p. 302) for which culture plays a significant role. The undermining of racial approaches due to what now appears to be diabetes-without-borders has also directed anthropological research into the contingent temporal frameworks of history. The recent attention to society and the social production of the disease may portend the end of culture in research on diabetes and culture.

Hemoglobin A1c as a diagnostic tool: public health implications from an actor-network perspective

Public health arguments for collecting hemoglobin A1c (HbA1c) data, particularly in clinical settings, should be reframed to place more emphasis on nonmedical determinants of population health. We compare individual- with population-level interpretations of HbA1c titers. This comparison reveals that public health researchers need to pay close attention to diagnostic tests and their uses, including rhetorical uses. We also synthesize historical and current evidence to map out 2 possible scenarios for the future. In the first scenario, prevention efforts emphasize primary care and focus almost entirely downstream. The second scenario anticipates downstream interventions but also upstream interventions targeting environments. Our analysis adapts actor-network theory to strategic planning and forecasting in public health.