Medical Efficacy

Common sense inclines people to suppose that because internalizing systems are able to read embodied symptoms, they are more empirical and realistic than externalizing systems are. Ethnographic research, however, indicates that all medical systems, externalizing as well as internalizing, are generally empirical and realistic. That is, they are capable of routinely producing self-vindicating outcomes, evidence that demonstrates their efficacy.

Medical efficacy can be demonstrated by two different kinds of results. First, efficacy is sometimes a capacity for producing hoped-for results, such as the amelioration of pain or the remission of symptoms. In practice it is not difficult for externalizing and internalizing systems to produce hoped-for results in light of the fact that the majority of medical problems consist of either (1) transient or recurrent symptoms that are perceived as being discrete disorders or (2) self-limiting diseases, episodes that end in either spontaneous remissions or death. In these circumstances medical practices acquire a reputation for hoped-for efficacy when three conditions are met: An intervention routine occurs between onset and outcome, remissions predominate over deaths and other unwanted outcomes, and superior alternative interventions are absent or inaccessible.

Second, efficacy can take the form of producing expected results. This occurs when practices and procedures are able to produce evidence that affirms the line of reasoning and the underlying assumptions that persuade patients and practitioners to select particular interventions. Expected results can be produced without also producing hoped-for results. Thus there is the grim joke that the operation succeeded but the patient died: The patient's body, once opened up, reveals a pathology that affirms the correctness of the assumptions and choices that have led from diagnosis to surgery, but the intervention is unsuccessful because of circumstances beyond the clinician's control. All medical systems, whether internalizing or externalizing, appear capable of distinguishing between hoped-for results and expected results.

In addition, serious sickness is a source of distressing feelings that are only incidentally connected to the pain and suffering of a sick person. Medical practices may have the effect of reducing such distress by connecting sickness events to local systems of moral and cosmological meaning. This power to give meaning to and impose moral order on chaotic and threatening events may be sufficient to perpetuate certain medical practices even when those practices have no great reputation for producing cures. Those practices sometimes are called healing rituals by anthropologists.

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