300 CHAPTER 13 | Human Adaptation to a Changing WorldThroughout millions of years of human evolutionary his-
tory, biology and culture interacted to make humans the
species we are today. The archaeological record and con-
temporary human variation reveal that biology and culture
continue to shape all areas of human experience, includ-
ing health and disease. Indeed, an inside joke among an-
thropologists is that if you do not know the answer to an
exam question about biology and culture, the answer is
either “both” or “malaria.” Our current understanding of
malaria, as explained in previous chapters, illustrates how
answering “malaria” is just like answering “both.” Farm-
ing practices (culture) of the past created the perfect en-
vironment for the malarial parasite. The genetic response
(biology) to this environmental change was increased fre-
quencies of the sickle-cell allele.
To add a few more biocultural layers closer to the
present, think about how contemporary global inequali-
ties contribute to the continued devastating effects of ma-
laria in poorer countries today. For example, if malaria
were a problem plaguing North America or Europe to-
day, would most citizens of the countries with rampant
malaria still be without adequate treatment or cure?
Similarly, public health initiatives for genetic counseling
to reduce frequencies of sickle-cell anemia in the United
States have been met with distrust by African Americans
who have experienced racism rooted in a false message
of biological difference.^1 Would the average Euramericanfeel comfortable with genetic testing to eliminate a disease
gene if he or she had experienced some of the wrongs
underprivileged ethnic minorities have experienced in
the name of science?
Consider, for example, the Tuskegee Syphilis Study,
carried out by the U.S. Public Health Service in Macon
County, Alabama, from 1932 to 1972. This study involved
withholding syphilis medication from a group of poor
African American men without their knowledge, so
that the scientists could learn more about the biology of
syphilis in the “Negro.” These methods are now widely
recognized as a moral breach that caused unnecessary
pain and suffering to the men and their families. As a
result of these unethical practices, the U.S. government
changed its research policies involving the biological study
of human subjects. In short, when examining a seemingly
biological phenomenon such as disease, cultural factors
must be considered at every level—from how that phe-
nomenon is represented in each social group (reflected in
this case in the false notion that the biology of syphilis
would differ between people of different skin colors) to
how biological research is conducted.
An integrated biocultural approach is one of the hall-
marks of anthropology. In examples ranging from infant
feeding and sleeping practices to the relationship between
poverty and tuberculosis, biocultural connections have
been emphasized throughout this book. In this chapter,
we take a deeper look at this connection and examine
some of the theoretical approaches biological and medical
anthropologists use to examine the interaction of biology
and culture.The Tuskegee Syphilis Study denied
appropriate medical treatment to
African American men in order to
study the supposed differences in the
biology of the disease in the “Negro.”
This human experimentation was not
only false from a biological perspec-
tive but represents a moral breach
in research conduct. Public outcry
about this experiment led to regula-
tions that protect all human subjects
in biomedical research.© Corbis/Sygma(^1) Tapper, M. (1999). In the blood: Sickle-cell anemia and the politics of race.
Philadelphia: University of Pennsylvania Press.
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