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Homeopathy, along with many other alternative therapies, has come under severe attack from apologists for orthodox medicine. Given the cultural authority of medicine, what then provides the impetus for people to take up homeopathy as a clinical practice? This article addresses this question in the context of homeopathic practice in New Zealand. Five focus groups were conducted with 22 homeopaths in five cities. The study found that it was common to be drawn to homeopathy through witnessing in themselves, their family, friends or animals, the positive effects of homeopathy, commonly after negligible success from conventional medicine. For many participants, all of whom were women, the opportunity to study homeopathy occurred when they were the primary carers of children, with homeopathy providing a possibility for a change in work trajectories. Many participants had previous occupations inside the conventional health system. Central to the appeal of homeopathy as a subaltern practice in New Zealand is the often dramatic impact of witnessing the effects of the therapeutic modality, which is conceptualised as analogous to an 'event' that tears at the fabric of the everyday. [ABSTRACT FROM AUTHOR]

In this article the concepts of statist medicine and subaltern therapeutics are used to provide insight into the debates over the therapeutic use of marijuana in cases of serious or terminal illness. In 2015 medical marijuana gained public attention in Aotearoa New Zealand as cases of people facing life-threatening conditions who wished to use marijuana for therapeutic purposes were given voice in the popular media. In Aotearoa New Zealand marijuana use is illegal for recreational purposes, but theoretically patients with particular conditions could gain access to medicinal forms of marijuana if health professionals, the Ministry of Health and the relevant government minister approved. This approval process is embedded within statist medicine's regulatory regimes, where access can be provided on condition that the medication meets standards of safety and efficacy. Patients faced with the difficulty of negotiating the processes of statist medicine to access medical marijuana often reverted to illegal means of accessing the plant. Access to illegal forms of marijuana for medical purposes could be through 'green fairies', people who provided the plant for therapeutic purposes in a way that was distant from the criminalised recreational use of the drug obtained through 'dealers'. The process of the state, patients and marijuana providers negotiating the regulation of therapeutic uses of marijuana provides insights into the role of statist medicine and subaltern therapeutics. The case of medical marijuana alerts us to the possibilities of other subaltern therapeutic practices that operate beyond the gaze of the state. [ABSTRACT FROM AUTHOR]

Indigenous peoples have poorer health outcomes than their non-indigenous counterparts and this applies to cancer outcomes for Māori in Aotearoa/New Zealand. Differential access to and quality of healthcare contributes to poorer survival rates for Māori. This research provides insight into some of the mechanisms that hinder and facilitate care access. Thirty four people who had undergone cancer treatment (19 Māori and 15 non-Māori) were interviewed by two Māori researchers. The analysis of the interview transcripts was informed by membership categorization analysis. This form of analysis attends to the categories that are used and the activities and characteristics associated with those categories. From this analysis it is argued that the classical patient role, or sick role, inadequately captures the kind of role that some Māori take in relation to their healthcare. Māori can also have culturally specific family (whānau) influences and a greater draw towards alternative approaches to healthcare. Dissonant roles contribute to a different experience for Māori. A better understanding of the categories and roles that are relevant to those who have cancer provides opportunities to attenuate the monocultural impacts of healthcare. [ABSTRACT FROM AUTHOR]

This article extends our understanding of the everyday practices of pharmaceuticalisation through an examination of moral concerns over medication practices in the household. Moral concerns of responsibility and discipline in relation to pharmaceutical consumption have been identified, such as passive or active medication practices, and adherence to orthodox or unorthodox accounts. This paper further delineates dimensions of the moral evaluations of pharmaceuticals. In 2010 and 2011 data were collected from 55 households across New Zealand and data collection techniques, such as photo- and diary-elicitation interviews, allowed the participants to develop and articulate reflective stories of the moral meaning of pharmaceuticals. Four repertoires were identified: a disordering society repertoire where pharmaceuticals evoke a society in an unnatural state; a disordering self repertoire where pharmaceuticals signify a moral failing of the individual; a disordering substances repertoire where pharmaceuticals signify a threat to one's physical or mental equilibrium; a re-ordering substances repertoire where pharmaceuticals signify the restoration of function. The research demonstrated that the dichotomies of orthodox/unorthodox and compliance/resistance do not adequately capture how medications are used and understood in everyday practice. Attitudes change according to why pharmaceuticals are taken and who is taking them, their impacts on social relationships, and different views on the social or natural production of disease, the power of the pharmaceutical industry, and the role of health experts. Pharmaceuticals are tied to our identity, what we want to show of ourselves, and what sort of world we see ourselves living in. The ordering and disordering understandings of pharmaceuticals intersect with forms of pharmaceuticalised governance, where conduct is governed through pharmaceutical routines, and where self-responsibility entails following the prescription of other agents. Pharmaceuticals symbolise forms of governance with different sets of roles and responsibilities. [ABSTRACT FROM AUTHOR]

Abstract: Using a material semiotics methodology, this paper explores the link between diagnostic practices, patient awareness of the body, and biopolitical governance. We collected video and audio recordings of a patient with chest pain involved in three medical interactions (a general practitioner [GP] consultation, an electrocardiogram stress test and a consultation with a cardiologist) in Wellington, New Zealand. Following the work of Annemarie Mol, we argue that each of these diagnostics interactions bring together a range of material and non-material entities that enact the body and disease. Consequently, we note how the diagnostic practices associated with cardiovascular medicine enable and prompt an awareness of the body based on uncertainty, and thus promotes the self-management of cardiac health and risk. This paper illustrates that a material semiotics methodology makes important contributions to the sociology of diagnosis. Firstly, it draws attention to the relationship between humans and material entities in rendering the body intelligible. Secondly, it illustrates that different diagnostic procedures can produce multiple, potentially conflicting, forms of self-awareness. Alongside these practices generating multiplicity, however, are those that presuppose and produce singularity and coherence. We illustrate how the cardiologist “patches” two potentially conflicting diagnoses together in order to provide a sense of coherence to the interactions. Thirdly, material semiotics illustrates how various diagnostic practices can reify risk, and produce bodies that lend themselves to particular forms of governance. [Copyright &y& Elsevier]

The article focuses on a study which compared the cancer treatment approaches applied to a nationally representative cohort of Maori (indigenous) and non-Maori New Zealanders with colon cancer. The study included 301 Maori patients and 329 randomly selected non-Maori patients who were diagnosed with colon cancer between 1996 and 2003. It examined the medical notes and surgical and oncology treatments received by the patients. It found that Maori New Zealenders with colon cancer were less likely to receive adjuvant chemotherapy.

Background Although teamwork is known to optimise good health care, organisational arrangements and funding models can foster, discourage, or preclude functional teamworking. Despite a new, enhanced population-based funding system for primary care in New Zealand, bringing new opportunities for more collaborative practice, fully implemented healthcare teamwork remains elusive. Aim To explore perceptions of interprofessional relationships, teamwork, and collaborative patient care in New Zealand primary care practice. Design of study Qualitative. Setting Eighteen nurses and doctors working in primary care, Wellington, New Zealand. Method Data were collected using in-depth interviews with individual nurses and doctors working in primary care settings. Perceptions of, and attitudes about, interprofessional relationships, teamwork, and collaborative patient care were explored, using an interactive process of content analysis and principles of naturalistic enquiry. Results Nurses and doctors working in New Zealand primary care perceive funding models that include fee-for-service, task-based components as strongly discouraging collaborative patient care. In contrast, teamwork was seen to be promoted when health services, not individual practitioners, were bulk-funded for capitated healthcare provision. In well-organised practices, where priority was placed on uninterrupted time for meetings, open communication, and interprofessional respect, good teamwork was more often observed. Salaried practices, where doctors and nurses alike were employees, were considered by some interviewees to be particularly supportive of good teamwork. Few interviewees had received, or knew of, any training to work in teams. Conclusion Health system, funding, and organisational factors still act as significant barriers to the successful implementation of, and training for, effective teamwork in New Zealand primary care settings, despite new opportunities for more collaborative ways of working. [ABSTRACT FROM AUTHOR]

General practitioners provide treatment for the majority of people diagnosed as having a mental disorder in New Zealand, but much research suggests that they fail to diagnose many common mental disorders. This paper explores the issue of GP recognition of mental health problems through four discussion groups with GPs from the lower half of the North Island of New Zealand. GPs were asked to consider what they thought their role was in relation to mental health, what facilitated discussion of mental health issues in consultations and what could influence patients to disclose mental health problems. The analysis of the data collected drew on thematic and discourse analysis. Four key domains that had an impact on the consultation were identified, which were categorised as practice pressures, socio-cultural factors, the medico-legal framework and the consultation process. GPs employ a number of strategies to respond to the systemic and social issues influencing the consultation. This research suggests that GPs do recognise mental health problems in patients, but that a number of important factors result in the consultations not being labeled as mental health ones. The paper concludes by offering a framework for the mental health consultation that illustrates the systemic issues that GPs consider when making decisions about mental health consultations. [ABSTRACT FROM AUTHOR]

Presenteeism is a concept used to describe the phenomenon of working through illness and injury. This paper is based on interviews and focus groups undertaken at three different work sites in New Zealand: a small private hospital, a large public hospital and a small factory. The research suggests that presenteeism is a prominent phenomenon in the lives of workers at these different sites, but the way in which it is rationalised and the factors that foster presenteeism are quite distinct. Exploring the way in which presenteeism links to economic and social constraints and workplace cultures provides insights into these rationalisations. The powerful forces promoting presenteeism tempers the research community's concern with absenteeism. A presenteeism discourse needs to be more prominently articulated to oppose both the absenteeism discourse, and to moderate the views taken by some postmodernist theorists on choice in relation to health practices in workplace settings. [ABSTRACT FROM AUTHOR]

Background Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori (Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplan—Meier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori (hazard ratio (HR)=1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients (HR=1.07, 95% CI 0.77 to 1.47). Conclusion Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer. [ABSTRACT FROM AUTHOR]

Abstract: In December 2008 the newly elected Prime Minister of New Zealand bypassed the agency that negotiates with manufacturers about the cost of medicines and agreed to fund Herceptin for women with early stage breast cancer for a twelve months course of treatment. This paper describes the unfolding of this decision and seeks to explain it in terms of the theory of countervailing powers, which has recently been applied to understand the rapid growth of medicines and the governance of the pharmaceutical industry. We explore the role of various actors in this debate about Herceptin funding, drawing on documentary analysis based on a systematic search of journals, websites and media databases. The case of Herceptin both confirms and questions the propositions of countervailing powers theory. On the one hand the manufacturers of the drug proved to be highly influential in their attempts to get Herceptin funded and were generally supported by consumer groups. On the other hand some scientists and regulators attempted to challenge the power of the manufacturers, with the regulators not showing signs of corporate bias as one might expect. Groups did not, as has been proposed, exert power monolithically, with several groups exhibiting opposing factions. The media, ignored in this literature, are considered as a potential countervailing force in the debate. In the end the government bypassed the recommendation of its regulators, thereby undermining the latter''s efforts to act as a countervailing power. [Copyright &y& Elsevier]

Abstract: Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods. Results suggest that increasing neighbourhood-level social fragmentation is associated with poorer mental health, when simultaneously accounting for individual-level confounding factors and neighbourhood-level deprivation. The association was modified by sex (stronger association seen for women) and labour force status (unemployed women more sensitive to NeighFrag than those employed or not in labour force). There was limited evidence of any association of fragmentation with non-mental health outcomes, suggesting specificity for mental health. Social fragmentation as a property of neighbourhoods appears to have a specific association with mental health among women, and particularly unemployed women, in our study. [Copyright &y& Elsevier]