Towards a Critical Medical Practice: Reflections on the Dilemmas of Medical Culture Today ed. by Anand Zachariah, R. Srivatsan and Susie Tharu (review)

The study of the postcolonial Indian healthcare system with its manifold sociocultural complexities and incongruities offers rich cross-cultural perspectives; the interplay between the legacies of colonialism and the shifting priorities of a vibrant but bureaucratically entrenched state apparatus reveals that it has over the decades succumbed to pressures from neo-liberalism and the free market, and that its initial commitments to providing care to the economically disadvantaged or marginalized poor have at best been ambiguous. As with other facets of national development, India since 1947 has been straddling two wide-ranging policy alternatives: creating a world-class medical infrastructure staffed by superspecialists and equipped with the latest cutting-edge technologies that cater to the needs of the wealthy and the powerful, while at the same time delivering basic curative services to the masses.

Conceived originally as an academic seminar in December 2004 to probe certain issues on Indian medical education and practice, a cadre of physicians from the Christian Medical College (hereafter CMC) in Vellore (Tamil Nadu) and social scientists from Anveshi Research Center for Women’s Studies in Hyderabad (Andhra Pradesh) convened on several occasions to develop a syllabus on “Health, Illness and Disease in India.” They soon encountered a number of “impasses and dilemmas” that further impelled them to revise their preliminary investigations that ultimately brought about this volume under review. The editors’ goal is not so much as to suggest solutions or develop “policies for government to implement” but to invite others “to think critically and afresh about health care in India and the contradictions faced by doctors, patients and administrators in their every day work” (28). It is not clear that their goal has been realized.

A lengthy but nuanced introduction entitled “The Dilemmas of Medical Culture Today” precedes eighteen essays divided into five broad categories and crafted by fourteen individual authors (three with multiple contributions) or jointly by three others; one piece is a reproduction of a talk. Given the constraints of space, summarizing each of these categories however superficially is no small task as the essays lack uniformity of content, theme, and mechanics. Whereas some of the papers might be informative to an average reader, the volume as a whole presents neither a coherent description of the “dilemmas” that reinforce the prevailing “medical culture” nor allude to the existence of competing medical pluralism within the subcontinent, where people have recourse to other forms of cure, including religion. A few essays discuss a variety of diseases and their treatments that have implications far beyond the Indian borders. For example, the essays on hunger and malnutrition (despite India’s alleged self-sufficiency in food), on the cardiovascular epidemic that affects the affluent and the poor, on the public health campaign for AIDS, and on PTSD seem to appeal to a wider international audience, while those on the consumption of organophosphate in taking one’s life and the nonclinical modes of treating mental health patients offer extraordinary glimpses into Indian culture.

The editors posit that the current era of globalization and free-market enterprise with its indefensible drive toward profits constitutes the “golden age of medical sciences,” marked by its advanced technologies, new drugs with curative capabilities that defy simple description, and government focus on disease prevention. Yet, modern medicine remains an esoteric and complex system that does not address the needs of ordinary individuals nor can it cure certain sicknesses despite subjecting a patient to a battery of complex and expensive diagnostic tests; it is ill-equipped to comprehend the psychosomatic symptoms of the poor who subsist among squalor and disease. The poignant examples of two archetypical individuals—namely, “Mr B.” who ultimately succumbed to death from cancer at the CMC (far away from home), and “Hina Begum,” who amidst numbing poverty and family burdens has been suffering from a...