マーガレット・ロック『アルツハイマーの謎』(プリンストン大学出版局、2013年)ノート
書誌
Lock, Margaret, 2013, The Alzheimer Conundrum : Entanglements of
Dementia and Aging. Princeton, New Jersey : Princeton University Press.
___________________
【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."
【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)
==============
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
===========
■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
=================================
【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.
========================================================
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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