書誌

Lock, Margaret, 2013, The Alzheimer Conundrum : Entanglements of Dementia and Aging. Princeton, New Jersey : Princeton University Press.

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【プリンストン大学の広告】

The Alzheimer Conundrum : Entanglements of Dementia and Aging

"Because of rapidly aging populations, the number of people worldwide experiencing dementia is increasing and the projections are grim. Despite hundreds of millions of dollars invested in medical research, no effective treatment has been discovered for Alzheimer's disease, the most common form of dementia. The Alzheimer Conundrum exposes the predicaments embedded in current efforts to slow down or halt Alzheimer's disease through early detection of presymptomatic biological changes in healthy individuals. Based on a careful study of the history of Alzheimer's disease and extensive in-depth interviews with clinicians, scientists, epidemiologists, geneticists, and others, Margaret Lock highlights the limitations and the dissent implicated in this approach. She stresses that one major difficulty is the well-documented absence of behavioral signs of Alzheimer's disease in a significant proportion of elderly individuals, even when Alzheimer neuropathology is present in their brains. This incongruity makes it difficult to distinguish between what counts as normal versus pathological and, further, makes it evident that social and biological processes contribute inseparably to aging. Lock argues that basic research must continue, but it should be complemented by a realistic public health approach available everywhere that will be more effective and more humane than one focused almost exclusively on an increasingly frenzied search for a cure."

「急速な高齢化により、世界中で認知症の 患者数が増加しており、その予測は厳しい。医学研究に何億ドルもの資金が投入されているにもかかわらず、認知症で最も一般的なアルツハイマー病に対する有 効な治療法は発見されていない。アルツハイマーの難問』は、健康な人の無症候性の生物学的変化を早期に発見することによって、アルツハイマー病を遅らせた り、食い止めたりしようとする現在の努力に潜む苦境を暴いている。アルツハイマー病の歴史を丹念に調べ、臨床医、科学者、疫学者、遺伝学者などとの綿密な インタビューに基づいて、マーガレット・ロックはこのアプローチの限界と反対意見を浮き彫りにしている。彼女は、アルツハイマー病の神経病理が脳内に存在 しても、かなりの割合の高齢者にアルツハイマー病の行動学的徴候がないことがよく証明されていることが、一つの大きな困難であると強調している。この不自 然さが、正常と病的の区別を難しくし、さらに、社会的・生物学的プロセスが老化に不可分に寄与していることを明らかにしている。ロックは、基礎研究は続け なければならないが、それを補完する現実的な公衆衛生的アプローチが必要であると主張する。

【イアン・ハッキングのジョーク】

The captain (James Cook - added) has previously been diagnosed by scholars with this or that flavor-of-the-day physical/mental disorder. Today he would be a candidate for early-onset Alzheimer's, except that he doesn't seem to have the pedigree. - Ian Hacking (1999: 217)

And his, Hacking's, notes that "Retroactive diagnosis, as I have repeated1.Y said elsewhere, is a mug's game, so this remark is only half-serious. We think of Alzheimer's in terms of memory loss. It is very striking to read in the psychiatric records from early in the century, when the neurologist Alois Alzheimer identified the plaque that is associated with the disorder, that memory loss is not the primary sign of dysfunction. This is especially true when the illness strikes early, that is, when the patients are in their forties. Instead we encounter meaningless irritability and aggression, combined with confusion. One of the reasons that loss of memory is so emphasized today is that we can easily define objective quantitative tests for memory loss, but have no agreed way to measure degree of aggression."(Hacking 1999: 237)

船長（ジェームズ・クック-追記）は以 前、学者たちによって、その日その日の身体的／精神的障害と診断されたことがある。今日、彼は早期発症型アルツハイマーの候補者であろうが、血統書を持っ ていないようであることを除けば。- イアン・ハッキング (1999: 217)

そして、彼の、ハッキングの、「遡及的診断は、私が他の場所で繰り返し1.Yと言ったように、マグカップゲームである。私たちはアルツハイマー病を 記憶喪失という観点から考えている。神経学者アロイス・アルツハイマーがアルツハイマー病に関連するプラークを同定した今世紀初頭の精神医学の記録を読む と、記憶喪失が機能障害の主要な徴候ではないことがわかる。このことは、病気が早期に発症した場合、つまり患者が40歳代の場合に特に当てはまる。その代 わりに、無意味な過敏性や攻撃性が混乱と結びついて現れる。記憶喪失が今日これほど強調されている理由のひとつは、記憶喪失の客観的な定量テストは簡単に 定義できるが、攻撃性の程度を測定する合意された方法がないからである」(Hacking 1999: 237)。

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Table of Contents
Acknowledgments ix
Orientations 1
Chapter 1 Making and Remaking Alzheimer Disease 26
Chapter 2 Striving to Standardize Alzheimer Disease 51
Chapter 3 Paths to Alzheimer Prevention 76
Chapter 4 Embodied Risk Made Visible 100
Chapter 5 Alzheimer Genes: Biomarkers of Prediction and Prevention 132
Chapter 6 Genome-Wide Association Studies: Back to the Future 156
Chapter 7 Living with Embodied Omens 174
Chapter 8 Chance Untamed and the Return of Fate 207
Chapter 9 Transcending Entrenched Tensions 229
Afterword: Portraits from the Mind 243
Notes 247
Bibliography 277
Index 301
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■章以下の節の紹介

Table of Contents
Acknowledgments ix
Orientations 1
    Conceptualizing the Aging Brain: Fundamental Tensions 4
    Techno-phenomena and Reality 6
    From Cure to Prevention 8
    An Imperialism of Probabilities 11
    Politicizing Alzheimer's Risk 12
    Medicalization and Destigmatization 14
    Global Responses to Aging 15
    The Modern Rise of Longevity 17
    Styles of Thought 18
    Data Collection and Outline of Chapters 21
Chapter 1 Making and Remaking Alzheimer Disease 26
    Is Aging a Disease? 27
    Somatikers and Psychikers 28
    Senility in Old Age 30
    Seduced by Plaques and Tangles 32
    The Partial Eclipse of Alzheimer Disease 36
    Medicalization of Aging 37
    The Politicization of Alzheimer Disease 38
    A Brief History of Normal 42
    When Is Pathology Normal? 43
    A Diffuse Clinical Syndrome 47
    Aging as a Continuum 49
Chapter 2 Striving to Standardize Alzheimer Disease 51
    Standardizing a Diagnosis of Alzheimer Disease 52
    Neuropathology as the Gold Standard 60
    The Amyloid Mafia and the Prevailing Paradigm of Alzheimer Disease 65
    Anti-amyloid Therapeutics 70
    The Move to Prevention: Finding a New Lexicon 73
Chapter 3 Paths to Alzheimer Prevention 76
    Circumscribing Mild Cognitive Impairment 77 （※MCIをめぐる語りがある、比較的長い節）
    Animating Public Interest in New Directions in Alzheimer Research 93
    Revising the Definition of Alzheimer Disease 98
Chapter 4 Embodied Risk Made Visible 100
    Public Critique of the New Proposals 101
    Unhooking the Clinical-Pathological Entity of an Outdated AD 106
    Striving for Radical Change 108
    Future Prognostications 112
    Amyloid In Vivo 114
    The New Phrenology 118
    Rethinking Amyloid 120
    Toward Neuroimaging for All 124
    Brain Identity 127
    Pasting Over Incommensurabilities 128
Chapter 5 Alzheimer Genes: Biomarkers of Prediction and Prevention 132
    Dominantly Inherited Alzheimer's 133
    The Paisa Mutation 135
    Trial Preparation 138
    A Q!Iestion of Beneficial Distribution 140
    Genetic Testing for Early-Onset AD 142
    An Elusive Susceptibility Gene 143
    HumanAPOE-WhichAllele Came First? 148
    APOEe4 and Neurodegeneration 150
Chapter 6 Genome-Wide Association Studies: Back to the Future 156
    Questions Triggered byGWAS 162
    Raising the GWAS Stakes 166
Chapter 7 Living with Embodied Omens 174
    Exposing the Genetic Body 177
    Testing for the APOE Gene 180
    Conceptualizing REVEAL 183
    Recalling Genotypes 186
    Imparting Risk Estimates 192
    The Familiarization of Alzheimer's Risk 193
    Beliefs about the Causes of Alzheimer's 196
    Unknown Genotypes 201
    Sources of Information about Alzheimer Disease 204
Chapter 8 Chance Untamed and the Return of Fate 207
    A Worldwide "Call to Arms" 213
    A Nail in the Coffin of the Amyloid Hypothesis 215
    Beyond the Dogma of Genetic Determinism 218
    Epigenetics: An Expansion of Horizons 220
    Buzzing Confusion 221
    Intimations of the Future? 223
    Epigenomics and the Life Experiences of Individuals 225
Chapter 9 Transcending Entrenched Tensions 229
    Competing Ideas about Causality 229
    Contextualizing the Brain 230
    Is Alzheimer Disease on a Continuum with Normal Aging? 232
    Embedded Bodies 238
Afterword: Portraits from the Mind 243
Notes 247
Bibliography 277

■On history of the studying on Alzheimer's Disease
・Virtual Disappearance of AD for over four decades 1920-1960s, (Lock 2013:22)
・Rediscovery of AD(Lock 2013:22)

■The Amyloid cascade hypothesis, Chap. 7, (Lock 2013:23)
・Localizing theory
・Alois Alzheimer（医師名） に帰属する病気としてのAD: [Orientation]
・Auguste Deter (May 16 1849 in Kassel, Germany - 8 June 1906 in Frankfurt) , p.31
・MCI diagnosis: 1980s, Chap.4
・Mild Cognitive Impairment, MCI
・the "Cerebral Reserve" hypothesis, (Lock 2013:44)

■Amyloid plaque
「アミロイド（Amyloids）はある特定の構造を持つ水に溶けない繊維状のタンパク質である。器官にアミロイドが異常に蓄積すると、アミロイド症など の神経変性疾患の原因になると言われている。」

■Neurofibrillary tangle, NFTs
・Neurofibrillary tangle＝Alzheimer's neurofibrillary tangle＝神経原繊維錯綜
「老人脳やアルツハイマー型痴呆脳にみられる重要な組織学的変化である．神経細胞胞体内に出現する嗜銀性封入体で，線維束状，糸巻き状，炎状，針金状など さまざまな形態像をとる．電顕上では，特有な線維構造物の集まりで，個々の線維は2本の紐をよりあわせたpaired helical filamentsで，径10nm, 80nm周期のくびれをもつ．不溶性のタンパクで，リン酸化されたニューロフィラメント，リン酸化されたタウタンパクを含んだ微小管付随タンパク（MAP 1, MAP 2），ユビキチンなどから構成される．この変化自体は神経細胞の老化現象とされ，非特異的所見とみなされている．正常老人脳では海馬や海馬傍回などに限局 してみられ，→アルツハイマー型痴呆＊では，全脳の大脳皮質や視床・脳幹などの一定の皮質下核群に多数出現してくる．他には，→ダウン症候群＊，→亜急性 硬化性全（汎）脳炎＊などの感染症，→頭部外傷＊などにも多数現れてくる」南山堂医学大辞典
"Neurofibrillary Tangles (NFTs) are aggregates of hyperphosphorylated tau protein that are most commonly known as a primary marker of Alzheimer's Disease. Their presence is also found in numerous other diseases known as tauopathies. Little is known about their exact relationship to the different pathologies." http://en.wikipedia.org/wiki/Neurofibrillary_tangle

■APOEε４
「アポリポタンパクEの特定の型（APOEε4）の対立遺伝子（アレル, allele）は、遅発性アルツハイマー病の危険因子の一つと考えられている。このAPOEε4アレルを持つ人と持たない人を追跡し、記憶の低下が始まる 年齢を比較した結果、アレル保有者はより若年齢で記憶機能の低下が始まることが示された。米Mayo Clinic ArizonaのRichard J. Caselli氏らの報告で､詳細はNEJM誌2009年7月16日号に掲載」（日経メディカルオンライン）
・APOEε４ gene, assisted with late-onset AD <--> early-onset AD
・APOEε４; the ε４ variations
・Familial AD early-onset AD
・
■genetic body, geneticization, biosociality

■(Lock 2013:25)
"The Alzheimer conundrum takes a very different tack...."

■Alzheimers' as Contact zone
"[O]f course, a localized approach to the AD conundrum and medicalization of AD will nevertheless continue" (Lock 2013:238).

■Shakespeare, As You Like It, Act2. Scene 7 - by Jacques
"The end this strange eventful history [of humankind] is second childishness and mere oblivion, sans teeth, sans eyes, sans taste, sans everything"(Lock 2013:28).

■Bichat, Parisian anatomist
"Open up a few cadavers, and you will disappear the obscurity that observation alone could not dissipate"(Lock 2013:42).

■アミロイド・マフィアについて　（→140569mafiaOFAbeta.html）

■Ian Hacking
"It is true that some psychological approaches to cancer encourage the patient to visualize, become closely in touch with, the tumor, and sense how it reacts to being thought about. Who knows, that might be biofeedback, strictly understood, if it worked. Present studies show no more than that a positive mood and lifestyle arc correlated with a better chance of healing or remission. This is not the conscious biofeedback of the yoga master, but it can be called biolooping." - Ian Hacking, 1999, The Social Construction of What? Cambridge, Mass: Harvard University Press, p.110.

■Vicki's story, Lock 2013, pp.199-200.

■According Ludwik Fleck.... (Lock 2013:19)
 Fleck, Ludwik 1979, Genesis and Development of Scientific Fact. University of Chicago Press.

■Margaret Lock's The Alzheimer Conundrum, 2013 の構成
（１）科学史的なAD概念の来歴の奇妙さ、
（２）実体化以降の科学社会学的な聞き取りと、
（３）ADを見守る人々のインタビュー、
の３部構成でできているような感じがする。その点では、それほどエキサイティングな著作とは思えないが、各国の医療人類学者が、この著作を自国のものと比 較して民族誌的事実を収集し、相互に検討したら興味深い成果が出るのではなかろうか。

■本書の最後の段落は

"In closing, one further reality must be kept in mind: no amount of preventive measures and no drug will defeat aging (even though certain maverick scientists are attempting just this), nor can dementia be ''wiped out" as though it is an infectious disease -- aging and dementia cannot be disentangled; all we can strive for is to find ways to stave off or halt the progression of AD at whatever age it strikes." (p.242)

■アルツハイマーの病名（通称）は、Alzheimer's と所有形の形容詞の名詞的用法で表現する

■「アルツハイマーにならないための防止策だ」
・昨日（2013年12月23日）は、そのような話をして、記憶を辿ることが、自分（＝ドン・W）が「アルツハイマーにならないための防止策だ」と言った ことに、興味を覚えた。チャントラの町で、アルツハイマーになった人がいるかと聞いてみると、小学校の元教師の女性で、回りの人について失認して忘れてし まった人についての話してくれた。他にも（多数ではないが）何人かの人が、外出したけど、戻ることができなくなったとか、そんな人たちの話をしてくれた （Guatemalan memory Dic 22-23, 2013）。

■Eさん（クエルナバカ）のメキシコの日系人が「ボケ」ない理由
「頭がオクパードである」(2013年9月にインタビュー)

■リンク集

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【私の発表予稿】

Anyway I wonder how we had understood medical anthropology without studying abroad?: A personal commentary of Margaret-Lock-Sensei and MAOists of Osaka University (chiefly in 1980s)

Mitzub'ixi - Mitsuho Ikeda, Osaka University

As we have plenty of Japanese medical anthropologists today, it is laborious to summarize general overview of the present future of “our” academic paradigm in Japan. Nevertheless if we back to 1980s, we are easy to account a few “big names” of Japan, United States and Canada (also England) for explaining the configuration of “birth” of Japanese Medical Anthropology. In short I do not intend to talk a nostalgic buzz, but I contextualize my political and academic positionality in that time. I was a member of, the Medical Anthropologists in Osaka, acronym MAO, the parodist self-appointed MAOists of Osaka University, whose mentor or guru was Prof. Yonezō NAKAGAWA, medical historian, educator, and one of pioneers of bioethics in Japan. Under his liberal and anarchistic atmosphere, we could discuss on our concerned broad social medicine arena of the HIHANTEKI-IRYŌ, “critical medicine” in our lab. This was a part of the laboratory history of social hygiene (Gesellschaft für Hygiene) until pre-war Osaka Imperial University era. In this time we have confront with the Lock-Sensei’s critical essay on cultural resistance by Japanese good mothers and wise wives (RYŌSAI-KENBO NO TEIKŌ), 1983. The paper inspired us to need to rebuild MAOist’s thinking on critical medicine, also inspired by George L. Engel, Ivan Illich, Michael Foucault, Thomas McKeown, and so on (needless to say a series of foreign MA big names). I revisit our old theme and your new one: what premises that critical medicine can be potential to innovate “our” life beyond the Japanese cultural context. I also imagine building the anthropological medicine that was appeared in Arthur Kleinman’s paper once upon, instead of building medical anthropology in Japan.

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読書ノート：

Table of Contents
Acknowledgments ix
Orientations 1

Afterword: Portraits from the Mind 243
Notes 247
Bibliography 277
Index 301

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