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Pathologies of Power uses harrowing stories of life—and death—in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.
Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer’s disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer’s urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world’s poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.
- Sales Rank: #42737 in Books
- Published on: 2004-11-22
- Original language: English
- Number of items: 1
- Dimensions: 9.00" h x 1.10" w x 6.00" l, 1.30 pounds
- Binding: Paperback
- 438 pages
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 detailed analysis of public health draws on perspectives from anthropology, history, liberation theology, sociology, law, and medicine. From this broad platform, Farmer takes us back through the causative underpinnings of disease-ridden lives and paints a unifying picture of ruling power structures aligned against impoverished constituents. His conclusions are well articulated, thoughtful, and damning. . . . Through his engaging and passionate style, Farmer gives voice to the unheard poor around the world and challenges medical professionals to broaden the vision of medicine to include human rights. In reinvigorating the role of human rights in the health and well being of the poor, Farmer's book is a valuable addition to the growing literature on health and human rights."--"The Lancet
From the Inside Flap
"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 of all: food, shelter and health. This plea has special potency because it comes from Dr. Farmer, a person who has proven that the dream of universal and comprehensive human rights is possible, and who has brought food, shelter, health, and hope to some of the poorest people on this earth."—Tracy Kidder, author of The Soul of a New Machine and Home Town
"Farmer's brilliance and charisma leap from the pages of his book. He challenges us to face the urgent theoretical and political challenges of the twenty-first century by linking structural violence to embodied social suffering and in the process calls for a new definition of human rights. Once this book is out, we will no longer be able to remain complacently--or rather, complicitly--on the sidelines."—Philippe Bourgois, author of In Search of Respect: Selling Crack in El Barrio
"A passionate critique of conventional biomedical ethics by one of the world's leading physician-anthropologists and public intellectuals. Farmer's on-the-ground analysis of the relentless march of the AIDS epidemic and multi-drug resistant tuberculosis among the imprisoned and the sick-poor of the world illuminates the pathologies of a world economy that has lost its soul."—Nancy Scheper-Hughes, author of Death without Weeping: the Violence of Everyday Life in Brazil
"In his compelling book, Farmer captures the central dilemma of our times—the increasing disparities of health and well-being within and among societies. While all member countries of the United Nations denounce the gross violations of human rights perpetrated by those who torture, murder, or imprison without due process, the insidious violations of human rights due to structural violence involving the denial of economic opportunity, decent housing, or access to health care and education are commonly ignored. Pathologies of Power makes a powerful case that our very humanity is threatened by our collective failure to end these abuses."—Robert S. Lawrence, President of Physicians for Human Rights and Edyth Schoenrich Professor of Preventive Medicine at the Bloomberg School of Public Health, Johns Hopkins University
"Farmer has given us that most rare of books: one that opens both our minds and hearts. It stands as a model of engaged scholarship and an urgent call for social scientists to forsake their cushy disregard for human rights at home and abroad."—Loïc Wacquant, author of Prisons of Poverty
"Paul Farmer is an original: a powerful writer, an insightful theorist, and a human rights activist on behalf of the health needs of some of the poorest and most excluded people on the planet. Pathologies of Power brings together all his strengths, as a thinker and an activist. Every health worker, human rights teacher, and government official who seeks to improve the health status and life chances of their fellow human beings simply must read this book."—Michael Ignatieff, author of Human Rights as Politics and Idolatry
"Paul Farmer is a great doctor with massive experience working against the hardest of diseases in the most adverse circumstances, and at the same time he is a proficient and insightful anthropologist. Farmer’s knowledge of maladies such as AIDS and drug-resistant tuberculosis, which he fights on behalf of his indigent patients, is hard to match. But what is particularly relevant in appreciating the contribution of this powerful book is that Farmer is a visionary analyst who looks beyond the details of fragmentary explanations to seek an integrated understanding of a complex reality."—Amartya Sen, Nobel Laureate, Economics
Most helpful customer reviews
115 of 116 people found the following review helpful.
Take Two Aspirin and Read This Book
By Patti M. Marxsen
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. Drawing on case-study examples from Haiti, South America, Cuba, Siberia, and the United States, he deftly illustrates why tuberculosis deaths, which he describes as 95 percent curable with inexpensive medication developed many years ago, "occur almost exclusively among the poor, whether they reside in the inner cities of the United Stated or in the poor counties of the Southern Hemisphere." Addressing the growing trend of multi-drug resistant strains of TB, Farmer discusses "tuberculosis as punishment" in the world's prison populations and delivers a wake-up call to those who might consider themselves immune from this, and other, infectious diseases.
In his critique of the commodification of healthcare, Farmer speaks of "orphan drugs" drugs that are simply not developed because they are needed by people who cannot pay for them, the sale of organs by those without resources to those with money, and the equally revolting multi-million dollar compensation packages of pharmaceutical company CEOs and managed care executives. In the midst of this catalog of inequity, he wonders why medical ethics courses in American schools of medicine focus so narrowly on the "quandaries of the fortunate" like whether or not to refuse a particular technology or whether or not to leave a loved one in a prolonged coma when millions are condemned to death or disease before they learn to walk. Even the World Health Organization (WHO) does not escape his critical analysis: "... the language of social injustice is increasingly absent from public health parlance," he notes.
Farmer is one of those remarkable doctors working in remote places who, somehow, finds the energy to look up from his daily workload and ponder the underlying causes of the suffering he treats. Furthermore, he writes about it in the brisk and engaging prose of an investigative reporter and brings provocative interdisciplinary voices of others---Gustavo Gutiérrez, Paolo Freire, Cornel West, Amartya Sen, Jon Sobrino, Nancy Scheper-Hughes, to name a few---to bear on his march toward social justice. His ideas are radical, in part, because they are simple and based on an equitable distribution of health, regardless of wealth. Bringing the observe, judge, act methodology of liberation theology to bear on global public health, Farmer advocates a "preferential option" for the poor, a redefinition of medicine as a healing profession (as opposed to medicine-as-commerce), and a new understanding of healthcare as a basic human right, for all.
Toward the end of a chapter entitled "Listening for Prophetic Voices," Farmer distills his argument into a call to action: "We thus find ourselves at a crossroads: healthcare can be considered a commodity to be sold, or it can be considered a basic social right. It cannot comfortably be considered both of these at the same time. This, I believe, is the great drama of medicine at the start of this century. And this is the choice before all people of faith and good will in theses dangerous times."
Pathologies of Power is a lucid and alarming statement from a fearless physician. It speaks truth to power and it speaks for the destitute sick. Take two aspirin, lie down, and read the book. In spite of its consciousness-raising side effects, this may be the beginning of a cure for what ails the world.
0 of 0 people found the following review helpful.
Interesting book for this who enjoy global health topics
By Samantha Revenaugh
Interesting book for this who enjoy global health topics. Some very sad moments and points but overall a great read.
0 of 0 people found the following review helpful.
Four Stars
By Lexie
A little difficult to read but it creates a great sympathy and call to arms for quality healthcare
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