Medical Humanities Blog

On Updates to the National Library of Medicine's Images from the History of Medicine Database

I had a lovely time at the AAHM conference this past weekend, and while there, learned more about the fabulous work the NLM History of Medicine Division is doing.  Their latest effort is the launch of an entirely new platform for their premier database in the History of medicine.  Here are the details:

Using award winning software developed by Luna Imaging, Inc., NLM offers greatly enhanced searching and viewing capabilities to image researchers. Patrons can view search results in a multi-image display, download high resolution copies of their favorite images, zoom in on image details, move images into a patron-defined workspace for further manipulation, and create media groups for presenting images and sharing them via e-mail or posting on blogs.

With these new capabilities, NLM greatly enhances usability of its image collection, where inspection and comparison of images is often as important as access to bibliographic data. IHM is available online, free of charge, at http://ihm.nlm.nih.gov.

Comprising almost 70,000 images from the Prints and Photographs and other collections held in the History of Medicine Division, IHM is one of the largest image databases in the world dedicated to images of medicine, dentistry, public health, the health professions, and health institutions.

The collection includes portraits, photographs, caricatures, genre scenes, posters, and graphic art illustrating the social and historical aspects of medicine. Most types of printmaking are represented: woodcuts, engravings, etchings, mezzotints, aquatints, and lithographs. Also included in the collection are illustrations from the historical book collection. Newly acquired posters and other materials are continually being added to IHM.

The collection is administered by the NLM History of Medicine Division.

(text copied from H-SCI-MED-TECH listserv)

I simply cannot say enough good things about the NLM-History of Medicine division.  There are some fantastic scholars and historians there, the collections are nothing short of awe-inspiring -- and, even better, are open to the public -- and their use of technology to facilitate research, scholarship, and access is incredible.  Medical humanists of all stripes -- make use of these wonderful resources!

On Swine Flu

It is fascinating to observe the current American discourse on swine flu.  Keller reminds that scientific discourse is a praxis, which indicates that the phenomena of the reaction to swine flu plays out in a space between public, lay, media, and professional stakeholders.  Public reactions, impressions, and language shape scientific, epidemiological, and political responses and actions, and vice-versa, in a constant feedback loop.

One of the most prevalent themes in the social construction of disease in general, but especially as to infectious disease, is the tight connection between illness and culpability.  This is a topic I am currently working on, though it has consistently enjoyed ample attention in the medical humanities literature.  But no sooner does news break of a potential influenza pandemic then the finger-pointing and responsibility-assessing begin.  As countless historians of medicine & public health, and other medical humanities scholars have painstakingly demonstrated, these assessments frequently stratify along social fault lines, typically coming to rest at the feet of already marginalized and disadvantaged social groups.  Thus, it should be entirely unsurprising that the "patient zero" trope identifies impoverished, rural Mexican pig farmers, and, predictably, the nascent anti-immigrant predilections in the U.S. have also been activated.

Perhaps, then, this is a good time to revisit Wendy Parmet's recent article on the ethical inadvisability of the "dangerous patient perspective," which traces causal roots of infectious disease outbreaks to individual actors.  This makes absolutely no sense epidemiologically, of course, because epidemic disease are primarily the result of social, economic, and political conditions.  Mary Mallon did not cause any epidemics of typhoid fever (<50 people were infected as a result of contact with her -- this is not trivial, but is nevertheless a tiny fraction of the numbers of persons infected with typhoid fever at the time); as Leavitt demonstrates, and Parmet notes, thousands of persons became infected with typhoid fever in NYC at the fin-de-siecle, persons who had no contact with Mallon.  Once again, I suggest, thinking deeply about our attributions of disease causality is a powerful window into the social and cultural meanings of illness.

Thoughts?

UPDATE: Erin Koch, over at Somatosphere, has a fine post where she explains in a bit more detail some of the social and economic factors that are prime determinants of the spread of this particular influenza outbreak:

  . . . industrial livestock production is the main culprit here . . .

[I]ndustrial livestock production is a powerful driver of viral (and bacterial) evolution. Davis emphasizes that the transition "from old-fashioned pig pens to vast excremental hell, unprecedented in nature, containing tens, even hundreds of thousands of animals with weakened immune systems, suffocating in heat and manure, while exchanging pathogens at blinding velocity with their fellow inmates and pathetic progenies" creates a perfect storm for evolving pathogens likely to establish resistance to antivirals and antibiotics. This is not just the case in China (everyone's favorite target for allocating bird flu blame) or Mexico (everyone's new favorite target for allocating swine flu blame). 

Quite.

UPDATE II (5.3.09): Friend of MH Blog Dan Bustillos points me to an article discussing the predictable linking of swine flu with concerns over immigration.  From the article:

The North Carolina-based Americans for Legal Immigration called for the border to be shut down and asked for the resignation of Homeland Security chief Janet Napolitano because she did not order agents on the border to wear masks . . .

Swine flu is a mix of pig, bird and human genes, and some radio hosts are calling it the Fajita flu – including Neal Boortz, an Atlanta-based radio talk show host.

In Texas, especially, the humorous ignorance of this appellation is perfectly clear.  (Pork is never, ever served with fajitas).

On Eugenics & North Carolina

Daniel Smith, the Special Collections Librarian at the University of North Carolina - Chapel Hill's Health Sciences Library, has a fascinating post on the history of eugenics in North Carolina.  Here is an excerpt:

In North Carolina over 7,600 people were sterilized between 1929 and 1974 under the state’s Eugenics Sterilization Program. Indiana was the first state to implement such a program, and eventually over 30 states followed suit, including North Carolina in 1929. The Eugenics Board of North Carolina reviewed petitions for sterilizations and authorized sterilizations in over 90% of cases. Of those sterilized, approximately 38% were black and 84% were female; moreover, 71% were classified as “feebleminded.” While most states’ sterilization programs diminished in scope after World War II, almost 80% of North Carolina’s cases occurred after 1945. By the late 1960’s over 60% of those sterilized in North Carolina were black and 99% were female.

Smith notes current legislative efforts intended to investigate and memorialize this history, and notes primary sources available in the Special Collections.

(h/t H-EUGENICS listserv)

Call for Papers: Healthcare Disparities, Medical Humanities

The Drew University Journal of Medical Humanities has announced a call for papers on healthcare disparities.  Aside from my graduate program at UTMB, Drew is the only school in the nation to have a doctoral-level program in the medical humanities (Drew awards a D.M.H, or Doctor in Medical Humanities rather than a Ph.D in medical humanities).

The call sounds fascinating, and I am ever eager to support any and all work targeted at the medical humanities, but I do think it is interesting to note that the call focuses on healthcare disparities, rather than health disparities or health inequities.  This is noteworthy to me because of my insistence on the differences between health and health care, and also because the term "disparities" is less of an normative term than "inequities."

Of course, there is a great need for research and analysis on healthcare disparities as well, so have at it.  Here is the Call:

Call for Papers:

The Drew University Journal of Medical Humanities (DMH) is looking for submissions for its second edition on the topic of healthcare disparities. 

Suggested threads include:

• Health/illness/access to care and social disparities (e.g.: urban versus rural communities)
• Health/illness/access to care and racial/ethnic disparities
• Heath/illness/access to care and socioeconomic disparities
• Health/illness/access to care and disparities with regard to other demographic information (e.g.: gender, age, etc.)
• Healthcare as a right
• Social justice v. market justice

Health care reform that might respond to or rectify the above disparities
We welcome discussions on these topics from the standpoints of bioethics, public health, medical anthropology, health policy, medical narrative, and history of medicine.  As medical humanities is highly interdisciplinary, we encourage submissions from whatever your field of expertise. We hope this edition of DMH will offer a greater understanding of the issues that we face as a national community in trying to determine what health care justice encompasses.
 
Mission Statement:

The Drew University Journal of Medical Humanities (DMH) publishes peer-reviewed, original research of an interdisciplinary nature, aimed at breaking down conventional boundaries, bridging the gaps between the humanities, social science, technology, medical education, and public policy, and inviting an honest discussion about the human experience of illness and the need for a more humane approach to health care.  DMH, like the field of Medical Humanities as a whole, is committed to infusing medical education and practice with ethical, historical, social, and cultural meaning.  DMH engages and informs scholars across all disciplines, health care professionals, health care consumers, medical educators, and policy-makers.  Giving a platform to a range of diverse voices, DMH publishes articles that advance the work of Medical Humanities in general as well as articles that focus on special issues or symposia topics.  Submitted manuscripts undergo a rigorous peer-review and editorial procedure to ensure the academic integrity of all published work. 
 
Please send a statement of intent to Managing Editors Elizabeth Fehsenfeld (efehsenf@drew.edu) and Katie Grogan (kgrogan@drew.edu).  Manuscripts should be submitted no later than June 12, 2009 and will be reviewed by members of the editorial advisory board.  Manuscripts should be formatted in Microsoft Word or WordPerfect, with one inch margins and twelve point font, and should be in the range of 2500 to 3500 words.  All copy, including quotations, footnotes, and references should conform to the guidelines of the Chicago Manual of Style, Fifteenth Edition. Please include a cover sheet with: name, title, address, phone number, email address, affiliation.

Submissions can be emailed to the managing editors or mailed to:
Editor—Drew University Journal of Medical Humanities
Caspersen School of Graduate Studies
Drew University
Madison, New Jersey 07940-4000
U.S.A.  

On "Dangerous Perspectives"

Full-text downloads of a new article from Wendy Parmet (Law- Northeastern) are available here.  Parmet's work is generally always worth reading.  The subject of this article -- the perils of atomizing public health -- is near and dear to my heart.  Here is the Abstract:

In the spring of 2007, the U.S. Centers for Disease Control and Prevention (CDC) announced that it had issued its first quarantine order on an individual in over 40 years. The subject of the order, Atlanta attorney Andrew Speaker, had traveled to Europe after being diagnosed with multi-drug resistant tuberculosis and had returned to the U.S. after CDC had asked him to remain in Italy based on the erroneous belief that he had extensively drug-resistant tuberculosis. During the ensuing uproar and media circus lawmakers compared Speaker to a terrorist and demanded that the government take tough actions to protect the public against such cases in the future. 

This paper uses the Speaker case to examine both the causes and consequences of what I term "the dangerous person perspective." This perspective identifies both the risk of and responsibility for disease with particular individuals (such as Speaker or Typhoid Mary) and presupposes that public health can be protected only if action is taken against those individuals. The paper uses several social science theories, especially social amplification theory and behavioral economics, to explain the tendency to identify diseases with particular individuals and treat them as if they were morally culpable for their illness, as well as the reasons why we tend to ignore broader social determinants of health. The paper then discusses the implications of this identification for both public health policy and public health law. For public health, the dangerous person perspective is problematic because it offers the false promise that health can be protected by acting against particular individuals while distracting policymakers from undertaking more effective interventions. In addition, the dangerous person perspective encourages policies that are highly coercive and very stigmatizing. Such policies are apt to be ineffective and even counterproductive, as they undermine the relationship between affected populations and public health officials. For public health law, the dangerous person perspective leads to an over-emphasis on emergency powers and an exaggeration of the conflict between individual rights and public health. Perhaps most disturbing, like fears of terrorism, the dangerous person perspective encourages undue deference to the extraordinary powers of executive officials. In short, the fear aroused by the dangerous person perspective can threaten the role of the rule of law in public health.

I'll have more after I've digested the piece.

Call for Papers: Drugs, Standards, and Chronic Illness

Call for Papers

New deadline: 8 May 2009

DRUGS, STANDARDS, AND CHRONIC ILLNESS

Workshop To be held at the

Centre for the History of Science, Technology and Medicine

University of Manchester

27-28 November 2009

Non-communicable illnesses such as cancer or heart disease have long been feared. Having previously been conceived of as ‘diseases of civilization’ or ‘degenerative diseases’, in the twentieth century, when the threats posed especially by tuberculosis declined in the industrialised world, these illnesses turned into major issues for policy makers and public health experts, pharmaceutical companies and an anxious public.  Cancer and cardiovascular disease and the role that the development and marketing of treatments for chronic illness have played in the broader history of standardization in medicine will be the central theme of this workshop.

The histories of cancer, cardiovascular disease and other non-communicable illnesses have much in common, but there are important differences between them that are worth exploring. Many of the blockbuster drugs of the last 50 years have been developed for the

treatment of cardiovascular disorders. In the course of this development, some illnesses have been transformed from acute to chronic (e.g. malignant hypertension) and it has become acceptable to treat physiological parameters that do not cause symptoms but are

statistically associated with illness later in life (e.g. mild hypertension or hypercholesterolaemia). In contrast, and with few exceptions, cancer drugs have often been used to treat what might otherwise be considered as orphan diseases and have rarely been as commercially profitable as cardiovascular drugs. Nevertheless, cancer

has been central to the development of many of the practices, such as testing, clinical research, and standardization, which are increasingly applied to other fields of medicine, above all the multi-centre randomised clinical trial.

We are especially interested in contributions that are in themselves comparative or invite comparisons, between different illnesses (for example heart disease and cancer) or across different national contexts.

Papers may discuss issues surrounding notions of the chronic and the acute or the relationship between risk and disease. Or they may look at spaces of drug administration: from inpatient to outpatient departments.  Institutional developments will also have to be discussed. Another issue worth exploring is the concept of ‘chemotherapy’. What did it mean in different contexts? Regulatory institutions, policies and practices also lend themselves to international comparisons. Such practices were closely related to the clinical specialties dealing with the different diseases, inviting comparisons between them.

Further points for discussion will be issues related to the consumption of medicines, the

role of patients and patient organizations, and questions of gender. All these can be viewed as leading to the establishment of standards that were different between countries and diseases, in a process that can be studied historically and geographically.

We plan to organise the workshop around the following main analytical points:

- The management of risk and efficacy

- The structure of biomedical research: laboratories, clinics, protocols

- Market conceptualisation, market realities, sales and uses

- Regulatory frameworks and regulatory practices

Please send abstracts (no more than 500 words) to

Dr Carsten Timmermann: carsten.timmermann@manchester.ac.uk and

Dr Viviane Quirke: vquirke@brookes.ac.uk

New deadline for abstracts: 8 May 2009

The workshop forms part of the Research Networking Programme 'Standard Drugs and Drug Standards' of the European Science Foundation. For more information please visit http://drughistory.eu/

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

7th Annual Joint Atlantic Seminar for the History of Medicine

Announcing the 7th Annual Joint Atlantic Seminar for the History of Medicine, to be held the weekend of October 9-10, 2009, and hosted by the Department of the History and Sociology of Science at the University of Pennsylvania in Philadelphia, Pennsylvania. The seminar is organized and coordinated by graduate students across North America working in fields related to the history of medicine.  Our mission is to foster a sense of community and provide a forum for sharing and critiquing graduate research by peers from a variety of institutions and backgrounds.  For more information, including previous years’ programs, please visit www.jointatlantic.org.

THE CALL FOR PAPERS DEADLINE WILL BE MAY 15, 2009:

Graduate students are encouraged to submit abstracts for research presentations on topics related to the history of health and healing; of medical ideas, practices, and institutions; and of illness, disease, and public health, from all eras and regions of the world.

Abstracts should be no more than 350 words and should clearly state the purpose, thesis, methodology, and principal findings of the paper to be presented. Please note that abstracts more than 350 words in length will not be reviewed. Speakers must be enrolled as graduate students at the time of the conference. Successful proposals will engage with relevant historiographic issues and the potential contribution to scholarship on the history of medicine and health. A panel of graduate students and faculty members from several different institutions will review the abstracts.

All abstracts should be submitted electronically (either as a MS Word document or as text in the body of an e-mail) to Marissa Mika, Program Chair, at jasmedconf@gmail.com.

It is not clear at this time whether or not we will be able to provide financial support for travel to participants. However, we will make every effort to provide accommodation for presenters. We urge students whose papers are accepted to seek financial support from their home institutions to participate in the seminar. Registration for the conference is free.

The deadline for submissions will be May 15, 2008.

(h/t MEDANTHRO listserv)

On Narrative Medicine

I am particularly pleased to note the unveiling of a new Masters degree in narrative medicine at Columbia University.  Here are the details:

Dear Colleague,

It is our pleasure to announce Columbia University's Master of Science in Narrative Medicine (www.ce.columbia.edu/narrativemedicine), which welcomes its first class in the fall. This is the first degree program of its kind, and we are very excited to be able to pioneer this important educational advance.

Columbia University's Program in Narrative Medicine was founded in 2000 as a response to our growing recognition that doctors, nurses, social workers, therapists, and other caregivers need to be fortified with the knowledge of how to interpret and respond to their patients' stories. Since then, the program has become a national leader in this innovative and influential model of educating health professionals and caring for patients. 

The new M.S. in Narrative Medicine is ideal for health care professionals and trainees, but is also valuable for those in the humanities and social sciences. The program can be completed in one year of full-time study or over two or more years of part-time study, and can be combined with degree programs in medicine or other fields.

We are confident that it will add an important dimension to the field, and we would like to ask for your support in spreading the word about it. Our upcoming information session in New York City is a great opportunity to learn more, so we hope you can attend.

Date: Monday, April 20, 6:30 p.m.
Location: Satow Room, Alfred Lerner Hall, Columbia Campus

RSVP (www.ce.columbia.edu/narrativemedicine

Sincerely,
Rita Charon
Director of the Program in Narrative Medicine

Marsha Hurst
Program Director of the M.S. in Narrative Medicine

Master of Science in Narrative Medicine
School of Continuing Education
Columbia University
www.ce.columbia.edu/narrativemedicine

Rita Charon, of course, is one of the leading scholars in literature & medicine, and I am overjoyed to see such a rich and exciting educational opportunity arise for health care professionals and budding medical humanists alike.  Although narrative studies are not my area of focus within the MH, such work is hugely important to the field, and it gladdens my heart to see the creation of such an exciting program in such a terrific setting.

(h/t AAHM-student-section listserv)

Metablogging

I know that Medical Humanities Blog has not been very exciting of late.  Yes, even less than is typical.

The principal reason for that is that I am hurtling towards my dissertation defense and potential graduation.  The former is scheduled for early May, and, barring unforeseen disasters, the latter should occur in August.

On top of my myriad other professional and personal responsibilities, I have had trouble making time to add substantive posts as regularly as I would like.

Thus, two points.  First, posting is likely to continue to be slow at least until I defend in early May.  Second, there are likely to be some changes in format and style at Medical Humanities Blog in the coming months.  Nothing earth-shattering; I have no intentions of closing up shop or anything like that, but this blog has been active since September 2006, and it is nigh time to change it up a bit.

Posting of events, conferences, and other substantive matters, to the extent I have time, will continue unabated, and, as ever, I want to thank all who spend a little bit of time in their day at Medical Humanities Blog.

(I'm going to pin this post, for obvious reasons). 

On Improving America's Health

The RWJF Commission to Build a Healthier America, which we've mentioned numerous times here on MH Blog, has released its Recommendations, contained in a report entitled, appropriately, Beyond Health Care: New Directions to a Healthier America.

From the Executive Summary:

Making America healthier will require action at all levels of society. Individuals, communities, health care, businesses and unions, philanthropies, and local, state and the federal government must work together to improve our nation’s health. Although medical care is important, our reviews of research and the hearings we’ve held have led us to conclude that building a healthier America will hinge largely on what we do beyond the health care system. It means changing policies that influence economic opportunity, early childhood development, schools, housing, the workplace, community design and nutrition, so that all Americans can live, work, play and learn in environments that protect and actively promote health. 

Indeed.  I enthusiastically agree.  The distinction between health and health care is a horse I will continue to flog, especially when one examines the recent issue of Health Affairs.  HA, of course, is a primary if not paramount health policy journal, and to their credit, published an excellent theme issue on the SDOH exactly one year ago (March/April 2008).  But if one looks at the current HA, it features a set of Web Exclusives, all discussing health care reform.  Amidst these commentaries, there is a short article by Gail Wilensky and David Satcher (both Commissioners in the WHO Commission on the SDOH) entitled, sadly, Don’t Forget About The Social Determinants Of Health.

The article begins by noting the intensity of the attention and focus on health care delivery and financing since President Obama took office, and then states that

Although there is a clear need to improve the performance of the delivery system, the two of us are hopeful that the country will begin to recognize the importance of an even more fundamental set of issues: the so-called social determinants of health.

It is somewhat sad to me that an "even more fundamental set of issues" that promotes or impedes population health -- the SDOH -- is relegated to something that must be almost pleaded lest it be forgotten.  Why are we in a state in which the most important determinants of health and illness are at risk of being forgotten???

I have some ready answers to this question, but none that satisfy me from a normative perspective.

In any case, the RWJF Commission's Report certainly seems like a step in the direction I think we ought to be moving in, and may even be responsive to Wilensky and Satcher's plea here.  I may come back with more commentary once I have had a chance to digest the full report.  You can download the Executive Summary and the full Report here, free of charge.