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Question 1

1. Biomedicine can be regarded as a cultural system BECAUSE
   A. It is only used by specific cultural groups in Western society
   B. Its scientific knowledge base is based on hypotheticodeductive reasoning, and is capable of being disproven
   C. It incorporates a set of transmissible knowledges that frame the worldview of believers
   D. It is used more frequently in Western society than ayurvedic medicine
   E. Many biomedical practitioners incorporate in their practices activities which are not evidence-based

Question 2

Ben Lee’s song Catch My Disease (2008 – those of you who don’t remember it can look it up on YouTube) is about his own feeling of overwhelming goodwill.

In one of his 29 books Paul Coelho writes “Love is a disease no one wants to get rid of. Those who catch it never try to get better, and those who suffer do not wish to be cured.” (The Zahir, 2005)
Using the definition of disease and illness that we use in this lecture, does either of these gentlemen really have a disease? Does either of them have an illness? Why or why not?

Question 3

3. What are the foundational disciplines of biomedicine and why?

Question 4

4. “The doctor said I must have had breast cancer for two years, but I just kept on with my career because I felt fine” [Kylie Minogue]. Assume that in the two years before diagnosis, Kylie had been in France for one month, and then travelled to the US which had a higher incidence of breast cancer for six months. She then lived in the UK for seventeen months. Assume also she has carried the gene which predisposed her to breast cancer since her birth in Australia. In what country did she become ill?

Question 5

1. Cogito ergo sum (“I think therefore I am”) means:
   A. When we use our powers of reason, we can understand others better
   B. Our ability to reason enables us to recognise that there are dual perspectives on
   everything
   C. Our ability for rational thought sets us apart from animals
   D. Our ability to think rationally limits our ability to see things as they truly are
   E. Our ability to reason is the basis of our selfhood.

Question 6

2. The implications of the Cartesian cogito for medicine are that
   A. The emotions are not integral elements determining who we are
   B. What people say they feel is as trustworthy and valid as what the doctor can
   deduce from examination and interrogation
   C. Brain-dead people are not fully human
   D. The mind and the brain are similar concepts
   E. Bodily experience (of the patient) is secondary to cognitive understanding (by the
   doctor or the patient)

Question 7

Psychosomatic medicine was an attempt to integrate the experience of the body into
the how illnesses and physical disabilities are caused and/or maintained by psychological
dynamics. It was intended to recognize the integration of the patient’s experience of
illness into the ways in which the illness or disease became expressed.
This category of illness failed in its quest to find equal space within medicine for the
lived experience and organic dysfunction because:
A. Patients saw themselves as not having a valid illness if they were told it had a
non-organic component
B. Doctors did not see that their role extended to managing illnesses that may not
have an organic component
C. Attempts to manage psychosomatic illness continue to use attempts to impose
rational thought upon the experience of the body, thus reasserting the primacy of
rationality over suffering.
D. Alternative therapists have taken over dealing with psychosomatic illnesses.
E. Psychosomatic explanations for illness behaviour are outdated with advances in
neurobiology

Question 8

Who said what?
I suppose the body to be just a statue or a machine made of earth.

[On humans] “Oh, there’s a brain all right. It’s just that the brain is made out of meat! …Yes,
thinking meat! Conscious meat! Loving meat. Dreaming meat. The meat is the whole deal!”

We exist as material beings in a material world, all of whose phenomena are the
consequences of material relations among material ENTITIES

Question 9

What is the relevance of materialism in medicine? When (if ever) might a dualist
perspective be usefuL?

Question 10

1. A nosology is a branch of medical science dealing with:
   A. The distribution of diseases
   B. The classification of diseases
   C. The nature and effects of diseases
   D. The phenomena that contradict physical laws
   E. The treatment of disease

Question 11

2. Which of the following is a nosology?
   A. SLUDGE – Salivation, Lacrimation, Urination, Defecation, Gastrointestinal Upset, Emesis
   B. The lymphatic system
   C. WHO Classification of Myeloid Neoplasms
   D. The Pharmaceutical Benefits Scheme Schedule
   E. Adult Disability Assessment Tool in the Social Security Act 1991

Question 12

(a) On what grounds would alcoholism be considered a disease? If so, how should it be classified?

(b) The Women’s Temperance Union (an organisation that advocated prohibition) was very active in promoting the view that alcoholism was a disease. Why do you think this group would take this view?

Question 13

When AIDS was first recognised in the 1980s a dispute broke out about whether this should be classified primarily as a haematological, immunological or infectious (or tropical) disease.

(a) Complete the following table by filling in the discipline under which you would   classify AIDS depending on what you used as your classificatory criteria

Question 14

b) Why did it matter to the medical profession how AIDS was classified?

(c) The first Chairperson of the AIDS Taskforce in Australia in the 1980s was    Professor David Penington.  He became the public face of Australia’s pragmatic and successful campaign to control the spread of HIV-related infection.  Apart from his intrinsic qualities, why was a specialist from this background chosen to be the public face of the AIDS response?

Question 15

Describe modes of therapeutic doctor patient communication

Answer 15

Paternalist
Consumerist
Partnership

Question 16

1. Embodiment refers to:
   A. The bodily aspects of human subjectivity
   B. The political control of bodies through exercising control over citizens’ liberty
   C. The arrangement of anatomical organs within the body
   D. The physiological function of organs within the body
   E. The ability to enter into others’ subjectivity

Question 17

Bodily expressions of illness draw on cultural repertoires of distress and the social and political contexts that shape them. The following are generally considered to be culture-bound illnesses (ie they only occur in some cultures). Match the illnesses to the social or cultural context.

Susto Political and entertainment culture that popularises violence
Koro Strongly networked society with social expectation of outbursts
Running amok Cultural equation of thinness with beauty
Going postal Female-subordinate culture in which religious healing is commonly practised
Bulimia Cultural preoccupation with male sexual performance

Is it correct to term these conditions culture-bound syndromes? Why or why not?

Question 18

Post-natal depression has been described as a Western culture-bound syndrome. If so, what cultural repertoires of distress does it draw on, and how does post-natal depression reflect its social and political and context?

Question 19

Pediatric plumbism is endemic in some indigenous communities, but is rare in non-indigenous communities. Although plumbism is not an idiom of distress (rather, an old-fashioned term for an overload condition), the behaviour that led to it has arisen in a particular social, cultural and political context. Identifying these contextual layers is important for a nuanced public health approach to this youth epidemic.

(a) What is plumbism?
(b) How do the subjective feelings of someone with plumbism reflect their social, political and/or cultural context?
(c) If you were a public health professional, where would you invest your intervention dollars to have maximal impact?

Question 20

The epidemiologic triad consists of host, agent and environment. Categorise the elements in the second column according to the component of the epidemiologic triad that they represent

Host
Hospital cooling towers
Legionella pneumonia
SARS
The Hulk
Mycelia family
Asthmatic children
Agent

Environment

Question 21

2. The Malthusian argument is
   A. that population increases arithmetically while the capacity to support it increases geometrically
   B. that infectious disease should die out with improvements in health technology
   C. that ageing humans exceed the capacity of health systems to look after them
   D. that reductions in fertility are associated with increases in lifespan
   E. that plagues and pestilences are nature’s way of rebalancing population growth

Question 22

3. McKeown’s hypothesis is
   A. that decreases in infant mortality are attributable to changes in the incidence of infectious disease
   B. that improvements in nutrition have led to reductions in the incidence of infections
   C. that population increases arithmetically with the increase in the carrying capacity of the land
   D. that decreases in fertility are associated with a population shift from high rates of high infection to one of high rates of chronic disease
   E. an underestimation of the impact of medical technology on reductions in the incidence of infections

Question 23

1. In 2005, Goulburn had been in a severe drought for three years and its dams were at 8% capacity. From the perspective of Amartya Sen, why did the citizens of Goulburn not suffer famine? List four reasons.

Question 24

In an evolving pandemic, there is often a process of locating the cause of infection elsewhere. Name the virus that caused the following illnesses, and who or what was being stigmatised as either originating the infection or being the major risk group.

Name for illness Virus/Bacteria Who is being stigmatised and why?
The English disease
Spanish flu
Yellow fever
Gay related immune deficiency syndrome
The French disease

Question 25

3. The HIV pandemic is the central pandemic of the modern era. Australia is often held up as an example of a country which responded rapidly and effectively to the pandemic. In broad terms, outline the elements of this successful strategy.

Question 26

4. In 1996 there was a syphilis outbreak among among the schoolchildren of Rockdale County in Georgia in the USA. This generated a great deal of concern and publicity in the US, as they were in their early teens, and had wealthy parents. There was a well known documentary on this presenting the outbreak as essentially due to parental neglect, and boredom in a particularly boring part of Georgia. Other explanations may have been:

A.Particularly virulent syphilis infection spread through non-sexual means
B. Reduced capacity among girls to advocate for themselves in sexual situations
C. Rockdale county had a strong Christian community that advocated abstinence
D. Rockdale county public health services failed to perform adequate contact tracing in the early days of the outbreak.
E. Rockdale county had few youth-friendly health services
F. Penicillin injections (standard treatment for syphilis) are very painful.
G. Some of the children had a genetic predisposition to being super-spreaders of syphilis

For each of the above, label the reason as host/agent/environment. If you’re unsure, have a guess and give a rationale. Where would you, as a public health physician, throw your energies to reduce the syphilis epidemic? Or would you decide just to wait it out, and if so why?

Question 27

1. You have timetravelled to Medieval England. Timetravelling always gives you a headache, but fortunately you are taken to the village healer, Mad Meg, who treats you with a concoction of tree bark and bugs. You have never had this treatment and Mad Meg strikes you as very odd. An hour later you do notice that your headache has improved quite a bit. List possible explanations for the improvement.

Question 28

2. Improvements in motor performance in patients with Parkinson’s after sham implanation of dopaminergic neurones into the brain represent
   A. A placebo effect, in that the patient expected to get better and did
   B. A placebo effect, in that the patient had been conditioned by their own dopaminergic neurons
   C. A nocebo effect, in that the patient was likely to be disappointed that he had not had the correct surgery
   D. A nocebo effect, in that patients who did have real implantation of dopaminergic neurones were more likely to be contaminated with prions
   E. An opportunity to sue the hospital for failing to provide real medical treatment.

Question 29

“Prayer works in mysterious ways”. From a medical perspective, what are these mysterious ways?

Question 30

A 36 year old woman discovers she has breast cancer. She has a biopsy and oestrogen receptors and has a poorly-differentiated tumour, which has a poor outcome. She begins treatment with radiotherapy and oestrogen-blockers. She is offered genetic testing for herself, her sisters and her daughters to see if they carry the BRCA-1 gene, making them more susceptible to breast cancer. List the occasions in this clinical history where a nocebo effect may occur, explaining your answer.

Question 31

1. With regard to the location of death in modern medicine, which of the following is true?
   A. We define death as the cessation of the heartbeat
   B. Accounts of out-of-body experiences before death support the argument that the soul may lie in the brain.
   C. Bodies that do not putrefy are technically not considered dead.
   D. The Cartesian cogito supports the notion of death being defined through cessation of brain function.
   E. Life support technologies reinforce the notion that death is located in the brain.

Question 32

2. At the end of the Edgar Allen Poe’s The Fall of the House of Usher, the last surviving member of the family, Roderick, reminisces Gothically about his dead sister Madeleine: “We have put her living in the tomb! Said I not that my senses were acute? I now tell you that I heard her first feeble movements in the hollow coffin.”

Had Roderick been more prudent, what could he have done to ensure that Madeleine wasn’t buried alive?

Question 33

3. Japan, in contrast to most nations with developed medical systems, took many decades to embrace transplant surgery. List four reasons for this.

Question 34

Define the elements of a good death for you. Do they reflect your own personal experience, or do they draw on cultural notions of the good death? How does biomedicine define the good death, and are there differences within biomedicine about what constitutes a good death?