KroeberAnthropological Society Papers, Nos. 71-72, 1990
Towards a More Critical Biomedical Anthropology
John S. Allen
Beginning with the basic observation that medical anthropology is primarily identified as a sociocultural
anthropological subdiscipline, Johnston and Low (1984) define a new topical area, "biomedical anthro-
pology," that combines "theoretical and methodological aspects of physical anthropology and medical
anthropology" in the study of disease and health in human populations. A definition of biomedical
anthropology vis-a-vis medical anthropology is easily derived given the divergent research concerns of
the two fields. However, an even more profound difference exists between them: medical anthropol-
ogists often question the primacy of positivist and other scientific ways of knowing, while biomedical
anthropologists, by definition, cannot. The real problem in establishing and defining an autonomous
biomedical anthropology lies not in separating itfrom medical anthropology butfrom traditional medical
science. Medicine and physical anthropology share a long history. The development of an avowedly
critical biomedical anthropology would serve to establish the autonomy of thefield within the medical
sciences, and by offering a positivist alternative interpretation of common medical practice, could help
improve the health and well-being of the general population.
INTRODUCTION: BIOMEDICAL
ANTHROPOLOGY AND MEDICAL
ANTHROPOLOGY
In 1984, Johnston and Low defmed a topical
area, "biomedical anthropology," as a typically
holistic, anthropological subdiscipline, combi-
ning "theoretical and methodological aspects of
physical anthrpology and medical anthropology"
in the study of disease and health in human
populations. They cited Greene's work on goiter
in high altitude populations in Ecuador (e.g.,
Greene 1973, 1974), Gajdusek and Blumberg's
Nobel Prize-winning investigation of the slow
virus-induced disease kuru (see Gajdusek 1977),
and Livingstone's pioneer analysis of sickle-cell
disease in West Africa (Livingstone 1958) as
prime examples of biomedical anthropological
studies. Other examples could include Katz's
studies of G6PD deficiency and fava bean con-
sumption in the Mediterranean region (Katz and
Schall 1979), McKenna's anthropological analy-
sis of sudden infant death syndrome (McKenna
1986), and our own work on the evolution and
cross-cultral distribution of schizophrenia (Allen
et al. 1990; Allen and Sarich 1988).
Johnston and Low stressed that their
biomedical anthropology is an integrative field
requiinng "significant and sophisticated contribu-
dons from both the biological and cultural"
(1984:225). In their view, the necessity of defin-
ing another sub-subdiscipline in anthropology
was dictated by the reality that medical anthro-
pology is, for the most part, primarily identified
with or as cultural anthropology. It should be
noted that this need is not perceived by all:
Browner et al. (1988) suggested a biocultural
methodology for medical anthropology without
drawing subdisciplinary boundaries. Nonethe-
less, Johnston and Low's point is well-taken,
and the term "biomedical anthropology" is useful
for defining an area or method of investigation
within general, medical and physical anthropol-
ogy.
In their review of medical anthropology (vis-
a-vis biomedical anthropology), Johnston and
Low (1984) emphasized that medical anthropolo-
gists are concerned with sociocultural aspects of
health and illness. They did not point out, how-
ever, that the very existence of a culture-oriented
medical anthropology forms a challenge to re-
searchers and clinicians in medical science, and
that in many cases, medical anthrbpologists main-
tain a critical and at times adversarial relationship
with the "Western medical establishment". This
conflict is ultimately rooted in a disagreement
concerning the "mode of production of medical
knowledge" (Young 1978), a disagreement
exemplified by the rejection by some medical
anthropologists of "positivist" (i.e., progres-
sively scientific) ways of knowing. Medical an-
thropology is different from medicine -- and from
biomedical anthropology -- because medical an-
dthopologists "reject the crude Cartesianism of the
biomedical model of sickness" (Young 1982:266)
and do not "fall prey to the biological fallacy and
related assumptions paradigmatic to biomedicine"
(Scheper-Hughes and Lock 1987:6). Indeed,
much of the power of medical anthropological
analyses derives not simply from a concern with
the sociocultural aspects of health and disease,
but from a willingness to question the primacy of
30
"Western science" as a means of understanding
and combatting human illness.
Biomedical anthropologists cannot reject the
"biological fallacy". In fact, the autonomy of
biomedical anthropology within medical anthro-
pology depends upon its embrace of positivism
and "biological logic". However, while it may be
clear that biomedical anthropology is different
from medical anthropology, it is not so clear that
it is different from medicine. For almost 100
years, concerned investigators have looked at
ways of introducing some of the results and
methods of physical anthropology into the medi-
cal community. This effort, from the perspective
of establishing an autonomous health science dis-
cipline, has been a total failure. Medical science
generally rejects evolutionary findings as being
too remote from the doctor-patient relationship to
be of any great use, and absorbs, with little im-
pact on the typological disease model of illness,
the existence and implications of human varia-
tion. Biomedical anthropologists have produced
valuable results; however, these results have not
necessarily contributed to the establishment of an
independent and recognized field of study. I be-
lieve that if biomedical anthropology is to become
an autonomous field, it must expand its research
concerns and methodological outlook to en-
compass an avowedly critical and adversarial
perspective: it should become more like medical
anthropology. By offering a positivist alternative
viewpoint to that provided by medical science,
biomedical anthropology will not only increase
the likelihood that it will be recognized as an in-
dependent research field, but it will also make
important contributions to the health and well-
being of the general population.
HISTORY: PHYSICAL ANTHROPOLOGY
AND MEDICINE
This paper is too short to review the entire
history of physical anthropology, but I will men-
tion that its history is one filled with medical men
and institutions. However, it is not correct to say
that physical anthropology evolved out of medi-
cine; rather, both modern medicine and physical
anthropology emerged from the more naturalistic
and scientific study of anatomy that appeared
during the Renaissance. By the end of the 19th
century, physical anthropology was beginning to
be recognized as an academic discipline, and
scientific (allopathic) medicine was asserting its
dominance over other medical sects.
Havelock Ellis, who later achieved fame as a
pioneer in British sex research, was one of the
earliest to look at the use of anthropological
knowledge in medicine (Ellis 1892). He began
by noting that the vast majority of prominent 19th
century anthropologists were trained in medicine,
and that such an involvement was not reflected in
the English medical curriculum. He believed that
anthropological insights were most valuable in
two areas: "practice abroad and asylum practice".
Race was obviously an issue in the British
Empire; anthropology was important in modern
psychiatry as a result of pioneering work in
neurology done by anthropologists (especially in
France). Ellis bemoaned the lack of an active
field of criminal anthropology in England, where
English psychiatrists "were content to leave the
first tentative efforts to a prison chaplain" (1892:
366). He acknowledged that the medical student
was perhaps already overburdened with course-
work, but suggested that anthropology be
inserted into the medical curriculum in place of
botany, a science of decreasing medical relevance
given that the physician was no longer respon-
sible for producing his own pharmacopoeia.
Ellis's views are interesting, but there is no indi-
cation that they had any influence.
Earnest Hooton, the pioneer American
physical anthropologist, also examined "the rela-
tionship of physical anthropology to medical
science" (Hooton 1916). His approach was sim-
lar to Ellis's: he began by noting the historical
contrbutions of physicians to physical anthropol-
ogy, and he decried the fact that modern
American physicians no longer made such con-
tributions. In terms of applying "theoretical
physical anthropology" to medicine, Hooton sta-
ted that a scientific knowledge of the human body
is incomplete without some knowledge of its evo-
lutionary history. In particular, he said that
physicians should be cognizant of the morpholo-
gical and physiological changes imposed upon
the body by the assumption of erect posture: "The
erect posture is responsible for man's liability to
hernia" (1916:261). He also discussed the possi-
ble importance of vestigial organs and atavisms,
both of which are most explicable in evolutionary
terms.
Hooton went on to review the potential con-
tributions to medical science of the "practical ends
of physical anthropology". He pointed out that
physicians in general, and orthopedic surgeons in
particular, should pay more attention to the sci-
ence of osteology and to the range of normal
variation, both qualitative and quantitative, found
in the human skeleton. He stressed the impor-
tance of "Racial Anatomy" in the study of disease
susceptibility; the United States, he said, was a
natural laboratory for the study of race. He called
for more studies of the American Negro, with
particular attention given to adaptations that may
31
have arisen in response to the change from a
tropical to a temperate environment. Although he
criticized the quality of the work of the criminal
anthropologist Lombroso, Hooton said that there
was still much to be gained from a wide applica-
tion of anthropometric techniques. Finally, he
warned physicians to temper their enthusiasm for
the "so-called eugenic movements", pointing out
how little was really known about human here-
dity.
Ales Hrdlicka, "America's first full-time
professional physical anthropologist" (at the U.S.
National Museum, Spencer 1979), also looked at
the relationship between anthropology and medi-
cine (Hrdlicka 1927). He believed that:
The bearing of anthropological know-
ledge on different branches of Medicine
is so intimate and important that a first-
class medical education today without
the anthropological aspect of things
must necessarily be incomplete and
constitute a serious handicap to the
graduate, which he may never be able to
overcome (1927:1).
Hrdlicka was originally trained as a physi-
cian at a sectarian (eclectic) medical school in
New York City. Like Ellis and Hooton, he was
well aware that in the past, training in physical
anthropology usually meant training in medicine.
In his 1927 article, which was based on lectures
given to medical students, Hrdlicka emphasized
that anthropologists were interested in learning
about "physical man" in the hopes of "furthering
future human development", while medicine was
interested in curing ills that proved to be obstacles
to this development: "Anthropology is helping
light, Medicine to clear, the road of eugenic,
further human evolution" (Hrdlicka 1927:3).
Eugenics was not one of Hrdlicka's primary con-
cems (see the bibliography in Spencer 1979;
Kevles 1985), but perhaps it was a concem of his
audience. He stressed the importance of indivi-
dual and group (racial) variation in understanding
how disease may differently affect different
people. He noted that recent evolutionary chan-
ges in diet, brain size and especially locomotion
have implications in the current maintenance of
health. Hrdlicka also reviewed paleopathology
andpointed out that some diseases then common
(c.g., syphilis, tuberculosis) were not present in
populadons in the past. He concluded:
Man is by no means the same man
physically or chemically in the different
races and different parts of the world,
and the slowly increasing anthropolo-
gical understanding of these differences
cannot but be of direct concern and use-
fulness to Medicine (1927:9).
W. Montague Cobb (1956), writing just be-
fore the great expansion in academic physical
anthropology in the late 1950's and 1960's, no-
ted that physical anthropologists were becoming
increasingly removed from their medical roots
and from medical training. Cobb was a physical
anthropologist who taught at a medical school
(Howard); he was aware firsthand that there were
"certain difficulties" in convincing the "doubting
Thomases" among the medical faculty of the im-
portance of anthropology in medical education or
practice. These difficulties included the increas-
ing competition from new medical advances, for
which a place had to be made in the medical curi-
culum, and the fact that anthropological insights
were not perceived to be of much use in clinical
settings. Cobb noted that physical anthropol-
ogists who had served as anatomists in medical
schools were often, upon their retirements,
replaced by individuals with very different inter-
ests. He was unhappy that medical schools were
only rarely the raining grounds for physical an-
thropologists.
This historical discussion is not intended to
be comprehensive but is provided simply to illus-
trate that physical anthropologists have, for some
time, attempted to make physicians pay attention
to anthropological findings when they are dealing
with their patients or forming clinical policy. It is
apparent that some of the medical potential as-
cribed to physical anthropology by the authors of
these older articles (the most recent was 1956)
has been fulfilled (although not necessarily in
ways they would have predicted); so much so in
fact that Johnston and Low, in 1984, chose to
describe a new anthropological subdiscipline,
biomedical anthropology.
CONCLUSION: A CRITICAL BIOMEDICAL
ANTHROPOLOGY
As mentioned above, the autonomy of
biomedical anthropology within medical anthro-
pology is much more easily demonstrated than
the autonomy of the field within medical science
in general. If biomedical anthropologists receive
funding from medical granting agencies, examine
patients and subjects in hospitals controlled by
physicians, work in medical schools, receive
training primarily as physicians or medical re-
search scientists, and perhaps most importantly,
subscribe to similar scientific world views and
ways of knowing, then the difference between
32
biomedical anthropology and traditional medical
science becomes a semantic one. Obviously,
there are issues of medical importance that have
been profitably studied from a legitimate bio-
anthropological perspective; however, many of
these issues must be perceived as somewhat eso-
teric and academic by the medical mainstream.
Although the quest for relevance can be over-
emphasized, biomedical anthropologists should
remember that medical science is the most applied
of the applied sciences.
One way for biomedical anthropology to
establish its independence from medicine is to
become more like medical anthropology and
maintain an explicitly critical relationship with the
medical mainstream. A critical attitude has exis-
ted previously, but it was often implicit and
informed by the essentially extra-medical con-
cerns of ethnicity, variation and evolution.
Biomedical anthropologists, trained in a nonmed-
ical, positivist tradition, can expand their research
base by undertaking projects that review and
evaluate current medical practices. Opporunities
exist in several areas, including elective and plas-
tic surgery, psychopharmacology, orthodontics
and oral surgery, and obstetrics. The public can
only benefit (and should be made aware of the
potential benefits) from a more pluralistic, biolog-
ical view of the maintenance of their health.
In a very different context, Scheper-Hughes
and Lock (1987) call upon medical anthro-
pologists to "problematize the body". This is a
message that biomedical andtropologists should
heed as well. Workers in public health have for
decades provided a biologically-based altemative
to medical knowledge and opinion in the treat-
ment and prevention of illness at the social and
populational levels. Such a biological alternative
is lacking at the level of the body. Biomedical
anthropologists are in a position to provide such a
critical perspective. Combined with their tradi-
tional concerns for biocultural and evolutionary
issues, they can make that perspective both useful
in maintaining the health and welfare of the gen-
eral public and true to the historically important
issues of physical anthropology.
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