Medical Humanities Blog

2010 Conference of Society for the Social History of Medicine

The Society for the Social History of Medicine invites submissions for its 2010 Conference 'Knowledge, Ethics and Representations of Medicine and

Health: Historical Perspectives', to be held at Durham and Newcastle (UK),

8-11 July 2010, organised by the Northern Centre for the History of Medicine (NCHM).

Deadline for proposals: 1 November 2009

The organisers welcome proposals for 20-minute papers under the theme 'Knowledge, Ethics and Representations of Medicine and Health: Historical Perspectives'. We particularly encourage papers addressing questions such

as:

* What processes have generated knowledge about the body, illness and

health that has become authoritative in different societies?

* How have claims of medical expertise been justified vis à vis claims

from other domains of social and cultural authority such as religion and law?

* What did it mean for medical practitioners in different cultural and

social contexts to claim to be ethical as well as knowledgeable?

* How did they present themselves to the public?

* What kind of material, visual and textual representations of body, mind,

health and disease have gained 'defining power' exerting influence on medical practice and research until today?

Submissions covering all periods (from Antiquity to the 21st Century) and all regions of the world are welcome.

In addition to individual papers, we seek proposals for panel sessions (with 3 papers), as well as suggestions for suitable chairpersons.

Abstracts of up to 250 words should include the title of the paper, information concerning the research question examined, the sources used and preliminary results. Please also include on the abstract your contact details (name, affiliation, e-mail-address).

All papers are to represent original work not already published.

Please send your proposal by 1 November 2009 to the NCHM (Email:

conference@ nchm.ac.uk). Decisions on papers will be made by January 2010.

Organising Committee: Philip van der Eijk (Newcastle University), Holger Maehle (Durham University), Cathy McClive (Durham University), Diana Paton (Newcastle University), Thomas Rütten (Newcastle University), and Lutz Sauerteig (Durham University)

For more information on the SSHM please see www.sshm.org. For more information on the NCHM, a collaboration of historians of medicine from Durham and Newcastle universities, please see www.nchm.ac.uk.

_________________________

Katherine Smith

Administrator/Outreach Officer

Centre for the History of Medicine and Disease Wolfson Research Institute Durham University Queen's Campus University Boulevard Thornaby Stockton on Tees

TS17 6BH

Tel: + 44 (0)191 3340700

Email: Katherine.Smith@durham.ac.uk

(h/t H-SCI-MED-TECH)

On Political Epidemiology

Interesting new article in the latest Journal of Epidemiology & Community Health.  The article is entitled How Political Epidemiology Research can Address why the Millennium Development Goals have not been Achieved: Developing a Research Agenda.  The abstract is less interesting than the following excerpt:

Public policies, and their relation to health, are still not part of mainstream epidemiology, which continues to consider health as apolitical, and applies a definition of health that is centred on the individual illness rather than on society health problems.  As a result, health policies are equated to healthcare services policies, and inequalities in health distribution are considered to be the result of individual problems (chosen lifestyle) or of how healthcare is implemented. This perspective has the effect of directing political attention towards the most manageable variable, the healthcare services. However, health inequalities have a political basis.10 Information on health inequality is not sufficient in order to decide what is inevitable and what is unjust, and such a decision does not depend solely on logic and empirical research, but also on an assessment of politics and ideology.

(footnotes omitted) 

This paragraph should be required reading (& reflection) for any health policy scholar.   

My reaction to reading Deborah Stone's Policy Paradox (Stone is as fine a health policy scholar as there is, and is always required reading, IMO) was to express astonishment at the to-me ludicrous idea that policy -- health or otherwise -- can be conceptualized coherently outside of politics.  I could not understand why Stone had undertaken to write a book exploding the duality, and it was only as I began to do my active policy work that I began to see just how pressing was the need for her book.

One of the most basic classical insights (Plato, Aristotle) is that humans are political animals.  There is no such thing as a human enterprise in which socialization and political practice is absent.  This is in part why I find the discourse bemoaning the "politicization of science" tiresome and even bizarre.  What does this even mean? Scientific practice is irreducibly political.  Leigh Turner, whose work is also always required reading for me, addresses this issue in detail in a recent article, and argues that if we want to complain about a poor policymaking process, in which conclusions are predetermined, discourse is silenced, and stakeholders ignored, that is perfectly justifiable.  But those specific complaints have little to do with a nonsensical complaint that scientific practice and policy ought not be politicized.  News flash: scientific practice, like medical practice, like any human endeavor, is inherently political.  

This observation is important for a variety of reasons, not least of which is the implication that if we want to improve public health policy, political considerations are inextricably linked with the process itself.  It cannot be avoided.  It cannot be ignored.

Second, the authors note that mainstream epidemiology still focuses on individual illnesses rather than population health problems.  This is absolutely correct, IMO, though the tendency is certainly not limited to "mainstream epidemiology."  I am going to quote again and highlight the following two sentences, because they seem so important to me:

As a result, health policies are equated to healthcare services policies, and inequalities in health distribution are considered to be the result of individual problems (chosen lifestyle) or of how healthcare is implemented. This perspective has the effect of directing political attention towards the most manageable variable, the healthcare services.

Health services research and discourse is extremely important.  It is vital to understand how we are and are not utilizing health services.  But I am more convinced than ever that to reduce health policy, and the normative problems contained therein, to analysis of our utilization of services, is to make a grievous mistake.  Health and illness are not exclusively functions of health care utilization.  Health is not exclusively a function of health care.  The two are related, but the evidence that the former flows from the latter is, as I have noted before on this blog, not particularly strong.  The health policies we do and do not support are discursive products; they are results of a series of nonlinear dynamical systems, of social and cultural processes that combine to shape what policies do and do not get implemented.

Changing culture, of course, is just about the hardest thing to do in the world.  So we focus on the variables we can do more about in the short-term: utilization of health care services.  This, as far as it goes, is fine.  But the widely assumed inference, that if we do the latter, improved population health and decreased health inequities will ensue, is quite implausible, to me.

As such, the authors note:

However, health inequalities have a political basis.  Information on health inequality is not sufficient in order to decide what is inevitable and what is unjust, and such a decision does not depend solely on logic and empirical research, but also on an assessment of politics and ideology.

This too cannot be overemphasized.  It is entirely fallacious to infer what we ought to do -- what distributions of health are and are not unjust -- from a descriptive analysis of how we utilize health care services.  We desperately need information on health inequality.  But that information is not self-executing, from either a moral or a policy perspective.  The decision on how to act virtuously -- what kind of a society do we want to be -- in context of health does not follow from an analysis of how we consume health care services.  Political, social, moral, and yes, historical analyses are crucial.

Hence, I continue to believe that an interdisciplinary approach, medical humanities or otherwise, is a promising avenue for addressing health and health inequities.

Thoughts?  

On Poetry & Schizophrenia

Via the MEDSOC listserv, I learned of an opportunity for medical humanities programs to host Pam Spiro Wagner, who is about to publish a new book of poems:

Pam is an award-winning poet, and is one of the best writers I know. Pam's poetry addresses the usual range of topics, as well as addressing her decades-long battle with schizophrenia. She also co-authored an acclaimed memoir a couple of years ago.

Pam is about to publish a book of poems, and is eager to arrange speaking engagements (regarding either or both books). Because she lives on Social Security Disability, she can't earn more than $700 per month, so while an honorarium would be nice, it's not essential.  She would, however, need airfare and lodging. Also, her doctor requires that she travel with a companion, who needs about $250/day
to cover loss of income.

Here's a link to her poetry book:
http://www.amazon.com/Climb-Shaky-Ladders-Laurel-Books/dp/1933880104/ref=pd_rhf_p_t_1 

Pam can send sample poems to anyone who is interested. Her email
address appears below.

Pam's bio:

A writer who lives with schizophrenia and bipolar disorder, Pamela Spiro Wagner graduated magna cum laude from Brown University and attended medical school for one year. Despite having spent at least eight years of her life in psychiatric units, she has won many awards, including a First Place in the 2001/2 International Poetry Competition sponsored by the BBC World Service. In 2005, she co-authored, with her twin sister, a psychiatrist, Divided Minds: Twin Sisters and their Journey through Schizophrenia (St Martin's

Press, 2005), which won the national NAMI Outstanding Literature Award and was a finalist for the Connecticut Book Award. Her work has appeared in the New York Times Sunday Magazine, LA Weekly and Tikkun among other places. Born in Washington, Wagner has lived most of her life in Connecticut.

Her email address is pamwagg@cox.net

On Translation

Over at the blog for the journal Medical Humanities, Deborah Kirklin (EIC) asks an important question:

So here’s the thing. No matter how interesting (or otherwise) medical school deans and research grant making bodies  find the work done by medical humanities scholars and educators, the bottom line is (almost) always, what’s in it for patients? How will teaching students using art and literature make them better doctors; how will the insights offered by historians, anthropologists, philosophers etc help ensure that patients get better, more affordable, more appropriate care? Why, in other words, given all the other calls on my time and resources, should I support you and your work rather than focussing on biomedical research?

Rebecca Garden posted this query on the Lit&Med-ASBH Affinity Group Listserv, and I offered this comment, which I reprint here:

"One of the ideas I am working on is that, to understand the value of the medical humanities for illness sufferers, it helps to historicize the humanities themselves.  Our notion of the humanities derives of course from antiquity, but was mediated in crucial ways by the medieval and Renaissance humanists.  The studia humanitatis was the name of an educational program, with the overall ethos being a focus on practical engagement.

The humanists found lacking the disputations of the Scholastics precisely because their dialectic was not meaningful outside of the cloister (literally) and the rarefied air of the medieval universities.  They sought a way of learning and of acting that would encourage everyday persons to cultivate virtue in their daily lives, and they (correctly, in my mind), perceived the centrality of rhetoric to this task.

In other words, there is a serious case to be made that the humanists themselves were early translational researchers.  They sought to apply erudition in the service of virtue, and not simply virtue writ small, for scholars, but virtue in practice, in the shaping of moral communities and societies.

I think Deborah's question is absolutely the right one to be asking, but I also maintain that the medical humanities themselves, properly historicized, contain crucial keys to unlocking some promising answers to this question."

(edited slightly for grammar and content)

Thoughts?

Call for Submissions: Atrium

Atrium, one of the finest bioethics/medical humanities publications out there, has put out a call for papers:

Proposals are invited for the Fall '09 issue of Atrium, due April 16, responding to the theme "Killer Apps." In computer jargon, a "killer app" is a must-have application, an innovation so necessary or compelling that it sweeps the field, or provides the core draw for some larger technology. In the medical context, the concept of a "killer application" might have more sinister implications. What applications of the medical humanities and bioethics have changed, or potentially will change, the practice of medicine? Atrium encourages potential authors to think creatively about broad interpretations of theme.

For details on how to submit proposals, see:

http://bioethics.northwestern.edu/atrium/submissions.html

Be sure to go ahead and download the latest version of Atrium, available free on the web(PDF), with the theme of "Haunting."  Atrium is a wonderful resource, and well worth both reading and submitting.

Call for Applications: Chair of Department of Medical Humanities & Social Sciences, Florida State University

CHAIR -  MEDICAL HUMANITIES AND SOCIAL SCIENCES

The Florida State University College of Medicine invites applications

for the position of Chair of the Department of Medical Humanities and

Social Sciences.  The Chair reports directly to John P. Fogarty, Dean

of the College of Medicine and is responsible for all academic and

administrative activities.

The Department of Medical Humanities and Social Sciences is a unique

academic unit that encompasses several disciplines in the humanities

and behavioral/social sciences.  The fields of interest of the current

10- member Department are diverse and wide ranging.  The Chair will

provide leadership to the department and its educational programs,

including the integration of humanities and behavioral/social science

content into the medical curriculum.  The Chair is expected to promote

faculty development, research and scholarship.  They will serve as a

role model and be actively involved in multidisciplinary teaching of

medical students, residents, fellows and faculty.

We seek accomplished scholars whose academic achievements meet the

criteria for the rank of full professor and who have a wide- ranging

appreciation for the medical humanities and social sciences with a PhD

or MD/PhD in one of the humanities or behavior/social sciences.  A

strong record of research and scholarship, and a commitment to

multi- disciplinary research and teaching, the biopsychosocial model,

and the college's mission are essential.  The ability to foster

consensus and collaborative process not only within the College of

Medicine, but throughout the institution and community will be

required.

Please send letter of interest and curriculum vitae to:

Eileen P. Blake

Alexander, Wollman & Stark

1835 Market Street, Suite 2626

Philadelphia, PA 19103

610- 399- 5284

610- 399- 5285 fax

epblake2001@yahoo.com

Electronic submission is strongly recommended.

New Journal: The International Journal of Healthcare & Humanities

The Department of Humanities at Penn State University (Hershey Medical College) has unveiled a new peer-reviewed journal entitled The International Journal of Healthcare & Humanities.  Here is some of the discussion regarding the Journal:

The International Journal of Healthcare & Humanities is a scholarly journal that stimulates creativity, scholarship, and compassion. The notion of combining the rigor of peer review, the constraints of APA formatting, and the beauty of words and art may seem paradoxical, but what better captures the essence of our lives as providers and guardians of health care?

In this era of high tech health care, it's no secret that the art and science of the caring professions is changed and changing. As we face a more complex practice environment, we need to be ready to flex every bit of our mental muscle in new ways in order to provide the best care possible. That's where the opportunity for a different perspective, such as this one, comes in. At the place where the humanities interface with health care is a space where we reside 24 hours a day, 7 days a week, 365 days a year. In that same place is the discovery of innovation, and new energy.

This journal has been selected to be archived online by the Penn State Universities Libraries.

Seeking Submissions
Published twice a year by the Penn State College of Medicine Department of Humanities. We are seeking submissions for both the fall and spring issues. The International Journal of Healthcare & Humanities accepts original articles, papers presented at scholarly conferences, essays. poetry, creative writing, letters to the editor, photography and original artwork. Work which examines the interface of healthcare and the humanities from a global perspective is welcomed.

All submissions will be peer reviewed as per standard practice, i.e. anonymously and with pre-established criteria for fit with the journal. A decision to accept, reject, or request revisions will be determined by reviewers. If you are interested in reviewing for the journal, please submit your c.v. to the Editor (cdellasega@psu.edu).

Manuscripts must be prepared in accordance with the style guidelines set forth by the publication manual of the American Psychological Association, 5th edition. The Journal reserves the right to edit manuscripts, delete extraneous or excess material, and change titles and headings. Please include a cover letter with your submission that acknowledges your role as creator of the work, along with signatures of any co--authors or co-contributors, and affirm that it is original work with rights owned by the creator(s).

Penn State - Hershey, it should be noted, was one of the earliest adopters of the medical humanities, back in the early-to-mid 1970s, when it undertook an experiment to conduct a radically different form of medical education.  The experiment in that form ended, but the tradition of the medical humanities is alive and well there, so the journal looks to be well-positioned, in my mind.  (As a side note, I do wonder why submissions to a medical humanities journal should take on APA style, as opposed to humanities, literature, or even biomedical style).

You can download the inaugural issue here(PDF). 

On Conflicts of Interest & Atypical Antipsychotics

In few areas of modern medicine are the forces at work relating to COIs more stark than in psychiatry.  There are some particularly good sources for discourse on these matters in the blogosphere, and among the very best is the anonymous blogger at Clin Psyc Blog.  Not content, like most of us, with simply noting and commenting, CP makes a habit of what em terms "research blogging."  The Professor himself, as well as Kalman Applbaum, are other good examples for those of us hoping to do more in the blogosphere than note and comment, but CP's latest research blogging addresses a recent article discussing the use of aripiprazole (branded as Abilify) for unipolar depression.

Here is a taste:

One of psychiatry's big-name academics, Michael Thase, signed on as lead author. I'm hoping that he didn't actually write the paper. Actually, there are eleven authors of the paper, which seems a little ridiculous given that the paper is an analysis of data which had already been collected for two previously published clinical trials. Seven of the authors are employees of Bristol-Myers Squibb (BMS) or Otsuka, which both market Abilify. Wait... If you look closely, you can see my favorite disclosure... In the fine print on the first page...

In case you can't read the fine print: In defense of Thase and the other academic authors, they may have not actually written any of the paper. Much or all of the writing appears to be creditable to Ogilvy Healthworld Medical Education.

Ghost-writing, of course, is an enormous problem in the biomedical literature, and is intimately related to COIs.  It also seems a basic violation of publication ethics, though admittedly such violations are, both in my view and according to the best evidence, rampant.

My favorite portion of CP's post is when he discusses the article's "analysis" of safety:

The authors note that "adjunctive aripiprazole is relatively well-tolerated in patients with MDD." Relatively? Relative to what -- being hit with a baseball bat repeatedly? They note that akathisia occurred in 25% of patients on Abilify compared to 4% of patients on placebo. Restlessness: 12% vs. 2%; insomnia: 8% vs. 3%; fatigue: 8% vs. 4%; blurred vision: 6% vs 1%. The authors report that akathisia resolved in 52% of patients by the end of the study, which would also mean that for 48% of patients with akathisia, they were stuck with it at the end of the study. But don't worry, it's "relatively well-tolerated."

Mmm, yes.  Quite.

Go read the whole thing.

On Policy and the Social Determinants of Health

Lisa Berkman (Harvard School of Public Health), who is one of the leading social epidemiologists in the world, has a new article forthcoming in Annual Reviews of Public Health entitled Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?

Here is the Abstract: 

The United States ranks in the lower tiers of OECD countries in life expectancy, and recent studies indicate that socioeconomic inequalities in health have been widening in the past decades. Over this period, many rigorous longitudinal studies have identified important social, behavioral, and environmental conditions that might reduce health disparities if we could design effective interventions and make specific policy changes to modify them. Often, however, neither our policy changes nor our interventions are as effective as we hoped they would be on the basis of findings from observational studies. Reviewed here are issues related to causal inference and potential explanations for the discrepancy between observational and experimental studies. We conclude that more attention needs to be devoted to (a) identifying the correct etiologic period within a life-course perspective and (b) understanding the dynamic interplay between interventions and the social, economic, and environmental contexts in which interventions are delivered.

Highly recommended.

(h/t SDOH listserv)

Online History of Medicine Resources

In the past few weeks, I have learned of several digital resources that may be of interest to readers of Medical Humanities Blog.

First, sponsored by the Wellcome Trust, the website of the Science Museum, London, is featuring a section entitled Brought to Life: Exploring the History of Medicine.  This is really a wonderful resource, with really too much to even begin to get into here.  For example, the main page features links for teachers, for a section entitled "what it means to be well," and for a digital exploration of John Snow's iron lung.  Highly recommended!

(h/t Medieval Medicine listserv)

Second, the website of the Public Health Museum, Tewksbury, MA, has expanded and revamped its website.  Check out the photo gallery.

(h/t H-SCI-MED-TECH listserv)

Third, Steven Palmer, of the department of history at the University of Windsor, has unveiled a really amazing web site entitled Cultures of Health: A Historical Anthology.  Here is the description of the website, which presents opportunities for students as well as more established researchers:

A new on-line research magazine in history of medicine

Cultures of Health: A Historical Anthology is a website featuring archival material, research notes, interviews, bibliographic summaries, and practical, intriguing links in an accessible and usable format. Cultures of Health seeks to cross boundaries of method and presentation in the field, and is expanding to present multi-media explorations including audio and video.

Published by scholars with experience in the history of medicine and related fields, Cultures of Health approaches medicine and health from a social, cultural and political perspective using a wide lens and broad brush.  The editors welcome submissions of short pieces or annotated sources by interested scholars, and offer streamlined, rapid publication.  Copyright is retained by the contributor.

(h/t H-SCI-MED-TECH)

Highly recommended! It is amazing to see how much is opening up on the internet for those interested in the medical humanities and the history of medicine.  Between this and the incredible albeit controversial Google Books project, it is an exciting time to be working on projects related to MH/history of medicine.

Thoughts?