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American Indian Medicine: Paternalism and Pluralism

Jean E. Smith, MD
JAMA. 1986;255(15):2027. doi:10.1001/jama.1986.03370150069025.
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To the Editor.—  I wonder if anyone else gets tired of hearing about the noble Native American culture and how beautiful, pure, and in harmony with the world it was until the rude, crude, modern "American" culture destroyed it. Your recent article on American Indian medicine1 approaches the subject in the usual "noble Indian/wicked white man" way.Having worked on an Indian reservation associated with public health for two years, I am by no means an expert on the subject; but neither am I ignorant of the many facets of the problem. It is of primary importance to understand that there is no one Native American culture. To group, therefore, a bunch of doctors who have at least one-eighth Indian blood together and make them represent all the Indian tribes is naive and dooms their efforts to improve the lot of Indians. The tremendous diversity in cultural backgrounds of different


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