Medical Humanities Blog

Call for Papers: Joan Didion's "The Year of Magical Thinking"

The NEMLA (Northeast Modern Language Association) Convention (4.10.07 - 4.13.07 in Buffalo, NY) is sponsoring a panel devoted to Joan Didion's phenomenal book, The Year of Magical Thinking.  Here is the call for papers:

In her characteristically sparse yet rich prose, Didion’s book recounts the year in which she was simultaneously grieving the death of her husband of forty years, John Gregory Dunne, and coping with the hospitalization and illness of their only daughter. With the current Broadway staging of Didion’s The Year of Magical Thinking, featuring Vanessa Redgrave, the memoir has garnered renewed attention following its initial publication in late 2005. Halfway through the year, Didion asks: “Was it only by dreaming or writing that I could find out what I thought?” This panel seeks papers which address Didion’s text, Redgrave’s performance of it onstage, or which more broadly explore the concept of “magical thinking” as an escape from or construction of reality, at the intersection of “dreaming or writing”.

Approaches and connections could include, but are not limited to: death and dying; grief, mourning, and representation; the physiology of grief; staging and performing grief; public grieving; the stylistics of bereavement; trauma studies; crisis management; narrative theory; narrative medicine and medical humanities; memory and meaning (or the collapse of meaning); reconstruction and recovery; memoir and lifewriting. Email submissions preferred; please send 250-500 word abstracts as MSWord attachments to Dr. Clare Emily Clifford no later than September 15, 2007 . Accepted panelists must be or become members of NEMLA by November 2007 in order to present at the conference.

If you have yet to read the book, it is worth reading and then some.  Here is an NPR story on it, and a collection of reviews.

On "Biocultures"

Bradley Lewis at the Literature, Arts and Medicine Blog brings word of an exciting new approach to the kind of interdisciplinary work that characterizes the medical humanities: "biocultures."

One of the most challenging problems of contemporary scholarship involves the deep segregation of the academy: between the humanities and social sciences on the one hand and biology and the natural sciences on the other hand. This “two culture” divide has long been lamented for the biases and distortions it creates in knowledge and for the increasing risks associated with disconnecting bioscience capacities from the wisdom of history, culture, and philosophy.

Indeed.  As I shall argue in my dissertation, the divide animates some of our problems with pain management.

Yet even as many of us have lamented this situation, a grassroots movement of academic research has gradually emerged that effectively integrates the two cultures. Certainly traditional medical humanities and bioethics are part of this grassroots movement, but more recently they have been joined by scholars in areas like disability studies, cultural studies of the body, gay and lesbian studies, gender studies, Africana studies, Asian-American studies, Latino-Latina studies, science studies, literature and science, public health, medical anthropology, medical sociology, and medical education (particularly professors of medicine and society).

These scholars not only intermingle facts and values from the two cultures in their work, many of them break down the “fact/value” distinction all together—asking pressing questions about what are the values associated with various research agendas (the making of facts) in the first place.

Agreed.  I particularly like the last sentence -- breaking down the fact/value distinction, or at least problematizing it, is a core project for a medical humanist, IMO.

The main thing missing from this grassroots movement is a common identity. This why Lennard Davis and David Morris are proposing the term “biocultures” as an umbrella term for this group of scholarship. Davis and Morris define biocultures as a new and “counter-intuitive (but perhaps destined to be commonplace) proposal: that culture and history must be rethought with an understanding of their inextricable, if highly variable, relation to biology” (Davis and Morris, forthcoming).

Wow.  The work of Lennard Davis and David Morris is extremely important in and across a variety of disciplines.  Both are formally trained as literature scholars, but the former is one of the leaders of disability studies, and a member of the only department in the U.S. that currently grants a Ph.D in disability studies.  Morris writes on a variety of issues, and his work is particularly important to my studies as he has (very successfully, IMO) examined pain from a cultural vantage point.

To learn more about the emerging biocultures movement you can check out the upcoming special issue of New Literary History that is edited by Davis and Morris devoted to biocultures. Davis and Morris kick off the issue with their “Biocultures Manifesto” which will send chills down the spine of any of you in the medical humanities world who have felt that you are all alone (or almost all alone) in your university.

The rationale for Project Biocultures is fascinating.  I do wonder how those on the "other" side of this divide will receive this project.  The (non-existent, IMO) boundary between facts and values is, in my experience, often taken as a given by scientists, physicians, etc., even though there are a plethora of compelling arguments from Hume to Quine, Kuhn, and Feyerabend that cast the distinction into serious doubt.

If those disposed to hang onto the distinction have not been convinced yet, I wonder what rhetoric Project Biocultures will employ to disabuse dissenting interlocutors.

Thoughts?

On Epstein v. Relman (& Public Health Policy)

Howard Brody (the Director of the Institute for Medical Humanities, where I am a graduate student), has an interesting take on the kerfuffle between Richard Epstein and Arnold Relman regarding the former's new book, Overdose.

Brody notes:

Relman beats up on Epstein for two cardinal sins. First, Epstein is a frequent consultant for the drug industry and is also an economic disciple of Milton Friedman. Second, Epstein is a lawyer writing about health care matters. Both sins show that he is an idiot and that he cannot possibly therefore be correct about anything further.

Epstein replies in kind. Since Relman is a physician without any additional training, he clearly knows nothing about law, or economics, or corporations, so he's incompetent to pass judgment on any of these issues. And since Relman rejects Friedman, he must be an unreconstructed New Dealer (proof: he was born in 1923!) and is therefore completely unreliable on anything related to either economics or government.

Just how this pissing contest is supposed to enlighten the rest of us is never explained by either party.

A pox on both their houses?

Fortunately this is not about keeping score. It is about figuring out these thorny policy issues, and we cannot do so if we have a cardboard caricature of free-market worship on one side, and a cardboard caricature of anti-free-market attack on the other.

Instead, read two different books. First read Medicine and the Market by Callahan and Wasunna. You will find a careful analysis of both the ethics and the facts related to markets as a means of organizing medical care.

[ . . . ]

Next, read Leonard Weber's Profits Before People? Weber (an esteemed colleague of mine, who taught at University of Detroit-Mercy) has taught and written about business ethics in health care. His book on the pharmaceutical industry could be viewed as an ethics consultation, as if the industry had noted its poor PR lately and asked Weber for his ethical advice.

Recommended!

_________________________________

I recently read Medicine and the Market.  It's an excellent book, chock full of facts and valid arguments, but it does eventually advance the triumphalist claim that biologics must be a keystone in any health reform program, particularly in developing countries.  This is somewhat odd given that there is ample reason to doubt that pharmaceuticals -- as important as they might be -- have anywhere near the effect on population health, particularly in developing countries, as public health and preventive medicine measures.

Even more strange, Callahan and Wasunna cite the well-known evidence for this proposition, but then proceed to advance their claim on the primacy of pharmaceuticals. 

It may or may not be relevant that Wasunna, an accomplished scholar and an authority on health policy in developing countries, is an assistant director of International Programs for Pfizer, Inc.

In any case, this is not an argument against biologics per se, but a policy argument for priority-setting, and a suggestion that both OECD and developing countries might be better served by funnelling a larger percentage of health care resources to public health and preventive medicine than to biologics.  Such an argument does not deny the significance of pharmaceuticals, but simply contends that its importance to overall population health must be relativized to other health care policies. 

Health Wonk Review

Welcome to this week’s Health Wonk Review!

By way of introduction, for those who are unclear on the medical humanities, some of these posts may be helpful in explaining the context.

As I see it, the key role for a medical humanist – if they wish to be consistent with an ethos of medieval and Renaissance humanists – is to focus on the translation of theory into practice.  Humanists eschewed the logic and abstractions that Scholastics privileged, reasoning that they did little to move those outside the cloisters and universities to live virtuously.

This ideal is perhaps most easily exemplified by Erasmus, who, in the humanist tradition, prioritized the study of rhetoric because, as Petrarch put it in citing Cicero and Quintillian, rhetoric was what moved people’s hearts.

A contemporary of Martin Luther’s and a devoted Catholic, Erasmus saw the handwriting on the wall, and devoted much of his life to a kind of moral epistolary practice, exchanging letters with Luther in the hope of averting bloodshed.  Erasmus deemed the prospect of war obvious given Luther and the ‘schismatics’ belief system.

What could be more virtuous than using scholarship and language in the hopes of preventing violence and horror?

Not even his best efforts could prevent the coming storm, but his ideal remains one worth emulating, in my view.  Such is the need to translate scholarship into practice, and this is a quintessentially humanist precept.

As such, health policy remains a particular province of interest for me, and one in which I submit the medical humanist may have something to offer.  With this said, let us see what rhetoric our interlocutors have prepared for us, and what voices they speak in.

Call for Submissions: Disability History: Theory and Practice

Disability blogger extraordinaire Penny Richards brings word of a call for submissions for a conference entitled "Disability Theory: History and Practice."

San Francisco State University's Institute on Disability, the Disability History Association, and the Disability History Group of the United Kingdom invite submissions for papers to be given at a conference at San Francisco State University, 31 July-3 August 2008.

During the past two decades, research, teaching, and scholarly publication on the history of disability as a social, cultural, and political phenomenon has drawn increasing attention. The goal of this conference is to assess the state of the field. It will examine the theory and practice of disability history. And it will explore theoretical and substantive, methodological and practical strategies to promote the continued development and intellectual coherence of this field.

We invite proposals for papers on any aspect or stream of disability history. For example:

· Cultural representations.

· The histories of blind people; people with cognitive/developmental disabilities; deaf and hard-of-hearing people; people with physical or emotional disabilities.

· Any historical era.

· Any culture, society, or geographical locale.

· Ideologies and the history of ideas.

· Institutions, professions, and programs that historically have affected people with disabilities.

· Public laws and policies: civil/human rights, eugenic, rehabilitative, international.

· Social and political movements.

While this call is open-ended as to subject matter, we seek in particular historical case studies that can open up discussion of broader issues. We invite papers that use presenters' current research to consider how they approach the history of disability. What theoretical concepts inform their interpretations? What analytical and methodological tools have they found most useful?

[ . . . ]

Moreover, the call expressly welcomes efforts from graduate students:

We welcome proposals from scholars of every rank and status from academically based senior faculty to graduate students, as well as public historians, archivists, and other scholars.

Proposals for papers should include a title and be no longer than 300 words. Depending on the number of papers accepted, presenters will have 15-20 minutes. A curriculum vitae of no more than three US letter-sized pages must accompany the proposal.

The deadline for proposals is November 1, 2007.  San Francisco State University is the home institution of Paul Longmore, a giant in disability studies in general and disability history in particular.  This sounds like a great opportunity and an even greater conference.

On Increasing Opioid Prescriptions

A question:

If it is the case that "[t]he amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005," why is it that pain remains so undertreated?

Given that pain and pain management is my dissertation topic, I am quite familiar with this literature, and I can say with some degree of confidence that, for example, an elderly chronic pain patient's odds of receiving appropriate pain management are not high.  Yet this is not because we currently lack appropriate and at least somewhat effective treatments for most (but not all) kinds of pain.

Consider this nugget buried at the bottom of the article:

"Spooked by high-profile arrests and prosecutions by state and federal authorities, many pain-management specialists now say they offer guidance and support to patients but will not write prescriptions, even for the sickest people."

This can be hard to believe, but it is absolutely true that many pain management experts refuse to prescribe opioids, even while opioids are considered frontline therapy for many different pain conditions. 

And I will here register my own view that some of the primary reasons pain remains undertreated -- and prescribers refuse to prescribe opioids -- are not because of the regulatory climate.  With rare exceptions, the ethics and policy of pain management are almost exclusively reduced to a discussion about enforcement and regulation.  This is a mistake, IMO.  Enforcement and regulation are very important, but legal culture is itself dialectic, which means cultural and social factors contribute to the particular form such enforcement and regulation takes.

Without giving too much away, analysis of these cultural and social factors is the core of my dissertation.

BLOGVERSATION: Healthcare Economist, Managed Care Matters, Health Law Prof.

2007 American Pain Foundation Pain and Creativity Exhibit: Call for Submissions

The American Pain Foundation has issued a call for submissions regarding its 2007 Pain and Creativity Exhibit:

Has your experience with pain (either personally or through a loved one) ever prompted you to express yourself in a creative way? Some of the most authentic and soulful works have had their origins in the deeply personal experience of pain.

Recognizing that we are all creative and have the power to turn adversity into opportunity, we would like to expand our Pain and Creativity network to connect artists and their expressions of pain through an online exhibit of creative work.

A select group of artists and their work will be honored and prominently featured with the American Pain Foundation and our project partner, the HealthCentral Network, through online and print publications. The pain and creativity community will be ongoing, but to be considered for this opportunity to be honored and have your work featured, we need your submissions by September 20th.

Further details available on the website.

Housing as a Risk Factor for Diabetes

In an elegant example of the social determinants of health, a new study in the American Journal of Epidemiology reports that housing conditions rated as fair or poor more than doubled diabetes risk.  This correlation remained significant even after confounding variables were controlled for.

The authors were unable to explain the rationale for the connection, and suggested that perhaps lead levels in the substandard housing had something to do with it.  While further investigation of why the correlation exists is certainly merited, it simply adds to the extensive (and, in my opinion, persuasive) case for the idea that distal social factors and conditions largely determine health.

(h/t Kaiser Health Disparities Report)

More on Hormone Therapy

The debate over the link between breast cancer on hormone replacement therapy continues with the latest study, published in the Journal of the National Cancer Institute.

The investigators set out to assess whether the marked decline in U.S. breast cancer incidence since 2003 is a result of a decline in certain screening mammography rates.  They answered this question in the negative, and noted that the decline in HRT utilization is a much likelier explanation for the decline in breast cancer incidence.

They conclude: "Our results suggest that a decline in postmenopausal hormone therapy use has contributed to the decline in breast cancer incidence in the United States and that the small decline in screening mammography observed in the United States is unlikely to explain the national declines in breast cancer incidence."

I have commented on this issue previously, and I will simply note here that this issue, like much that has to do with breast cancer, is likely to remain controversial.

(h/t Feminist Law Professors)

Workshop on Ethics of Neuroimaging

The philosophy department of Delft University in the Netherlands in conjunction with the 3TU.Centre for Ethics and Technology are hosting a workshop on the Ethics of Neuroimaging on October 4-5, 2007.

This workshop will be a two-day event, targeted at a wide audience consisting of both (a) ethicists and philosophers and (b) engineers and researchers working in the area of neuroimaging technology.

The planned workshop is unique in several respects: (a) in the Netherlands, relatively little attention has thus far been paid to neuroethics; (b) to the best of our knowledge, this is the first workshop exclusively devoted to ethical issues in connection with neuroimaging; (c) the workshop should bring together a wide range of professionals, varying from clinicians and engineers to brain researchers, policy makers and philosophers.

We intend to publish the proceedings either as a booklet or in the form of a special issue of a suitable journal.

Further details are available on the website, including a survey of some of the most pressing ethical issues in neuroimaging.

(h/t Neuroethics Society)