Medical Humanities Blog

Call for Papers: 2011 Annual Meeting, American Association for the History of Medicine

The AAHM Annual Conference is marvelous, so this Call for Papers is not to be missed:

Call for Papers
2011 Annual Meeting of the American Association for the History of Medicine

The American Association for the History of Medicine invites submissions in any area of medical history for its 84th annual meeting, to be held in Philadelphia, Pennsylvania April 28 through May 1, 2011. The Association welcomes submissions on the history of health and healing; history of medical ideas, practices, and institutions; and histories of illness, disease, and public health. Submissions from all eras and regions of the world are welcome. In addition to single-paper proposals, the Program Committee accepts abstracts for sessions and for luncheon workshops. Please alert the Program Committee Chair if you are planning a session proposal. Individual papers for these submissions will be judged on their own merits.

Presentations are limited to 20 minutes. Individuals wishing to present a paper must attend the meeting. All papers must represent original work not already published or in press. Because the Bulletin of the History of Medicine is the official journal of the AAHM, the Association encourages speakers to make their manuscripts available for consideration by the Bulletin.

The AAHM uses an online abstract submissions system. We encourage all applicants to use this convenient software. A link for submissions will be posted to the website at http://histmed.org.- (coming soon)

If you are unable to submit proposals online, send eight copies of a one-page abstract (350 words maximum) to the Program Committee Chair, Susan E. Lederer, [selederer@wisc.edu], Dept of Medical History and Bioethics, University of Wisconsin School of Medicine and Public Health, 1300 University Ave. Madison, WI 53706. (608.262.4195)

When proposing a historical argument, state the major claim, summarize the evidence supporting the claim, and state the major conclusion(s). When proposing a narrative, summarize the story, identify the major agents, and specify the conflict. Please provide the following information on the same sheet as the abstract: name, preferred mailing address, work and home telephone numbers, e-mail address, present institutional affiliation, and academic degrees. Abstracts must be received by 15 September 2010.

E-mail or faxed proposals cannot be accepted.

On Three Dogmas of Bioethics and A Treatment

Angus Dawson (Keele University), one of the co-editors of the excellent journal Public Health Ethics, has a provocative and fascinating article in a recent theme issue of Bioethics devoted to the "future of bioethics."  The article is entitled The Future of Bioethics: Three Dogmas and a Cup of Hemlock.  Here is the Abstract:

In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self-reflection that I characterize here as a commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction.

Highly recommended.  As readers of MH Blog are likely aware, I share many of Dawson's concerns regarding dominant discourse in Western bioethics.  I also share Dawson's interest and focus on public health ethics, although I have some reservations on the latter, particularly because the overlap between what seems to me to be the most pressing matters of population health (e.g., the social determinants of health, chronic, non-communicable disease, health inequities) and public health practice are not nearly as extensive as I would hope.

Thoughts? 

On "Collection" vs. "Collective Action"

The following is an excerpt from an article entitled Crocodile Tears for Health Inequality that appeared in a recent BMJ:

I begin to feel that I have witnessed one too many worthy presentations on the nature, extent, and dimensions of health inequality—locally, nationally, and globally. I have myself been guilty of such presentations in the past, but almost no one needs to be told about this any more or to be asked to look at more graphs or tables of figures. Instead, we need finally to find the collective will to do something about it. The documentation and discussion of health inequality has become an industry: a search of Google Scholar reveals 7860 academic references in 0.18 seconds. Like the National Lottery, the scholarly exploration of health inequality seems to result in the paradox of the poor directly subsidising the more affluent.

Similar articles have been published in the U.S. over the last few years, but the need to continue collecting data on the overwhelming health inequities is, IMO, nowhere near as pressing as the need to actually do something about them.  This may seem trivially true, save for the apparent fact that the policy initiatives we might need to implement to have a pronounced effect on the fundamental causes of health inequity do not seem to me particularly close to fruition in the U.S.  There are many reasons for this, but one may well be it generally requires no real collective act of political will to document health inequalities.

Thoughts?

(h/t SDOH listserv) 

On the Very Idea of a Tight Connection Between Genetics & Population Health

One of the underlying themes I return to frequently on Medical Humanities Blog is whether genetics at the present has a pronounced effect on population health.  This empirical question is important to a normative inquiry that I am most interested in, regarding the priority to which we should order goals as they relate to health.  If we posit, for example, that compressing certain health inequities is a normative goal, the empirical question of which policies and practices we are most justified in believing will satisfy the criterion turns out to be critically important.  This follows partly from Deborah Stone's observation that policy is inevitably contested space, and there are always opportunity and switching costs that must be expended on meeting any policy objective, even if there is no outright opposition to the putative objective.  One obvious example of an empirical proposition which has important consequences for a prioritarian assessment of how best to allocate scarce resources to population health objectives is Sir Geoffrey Rose's prevention paradox, which Peter Allebeck nicely explains here:

The key messages of Geoffrey Rose may be summarized as follows: the distribution of risk levels for major determinants of disease follows a continuum in which the high-risk persons are at the extreme end. A large number of persons with moderately increased risk levels contribute more cases than a small number with extreme risk levels. Thus, interventions targeting the general population, aiming at shifting the risk curve to the left, are more effective than interventions targeting high-risk groups. This latter is called the prevention paradox, since it is not the individuals with moderately elevated risk that have the greatest benefit from such interventions.

The paradox consists of the fact that the least advantaged here -- the groups who tend to be at highest levels of risk -- seems to command normative priority, and yet Rose's analysis suggests that doing so will have a lesser impact on population health than interventions targeted at the general population (and hence the population of less than highest-risk).  So there is an argument from a population health perspective for directing more resources to the general population than the most high-risk, who tend to be those populations suffering from the most deprivation. 

This is not to be mistaken for the naturalistic fallacy.  What we ought to do certainly does not follow from descriptive claims, even powerful ones like those developed by the likes of Geoffrey Rose and, e.g., Michael Marmot.  The metaethical point here is simply that the "is" informs (but never determines) the "ought," which ought to be entirely uncontroversial, in my mind.  (Humanists like Montaigne certainly thought so!). 

My argument, based in part on arguments made by Richard Lewontin, and Claudia Chaufan (and also influenced strongly by Evelyn Fox Keller's framework for thinking about genes and metaphors), is that the best evidence suggests that the scientific practice of genetics in its current state has only a weak connection with population health.  The argument is even sounder when applied to populations in the developed world, who have even less chance to benefit in the reasonably foreseeable future from developments in the genetic sciences.

None of this supports an argument that we ought not study genetics.  But if there is reason to believe that the praxis of genetic science has only an attenuated connection to population health, one which is in the reasonably foreseeable future not likely to compress health inequities or affect the structural foundations of health, the pressing normative question becomes why is such significant social and economic capital being devoted to the praxis of genetic science? (I assume without argument that my empirical claim here, that we spend comparatively significant amounts of money on genetics in comparison to, say, capital expended on ameliorating the social determinants of health.  If able readers dispute this assumption, they are welcome to respond in the comments).

All of this is a buildup to an interesting article authored by Nicholas Wade in the New York Times entitled A Decade Later, Genetic Map Yields Few New Cures.  Wade writes 

Ten years after President Bill Clinton announced that the first draft of the human genome was complete, medicine has yet to see any large part of the promised benefits.

A nice, direct lede.  The entire article is worth reading in full, and I won't excerpt it much here save to note that it is reasonably well-written, and is quite relevant to the arguments discussed above.  I was perhaps most struck by the quote from Harold Varmus, who is both a Nobel laureate and a former director of the NIH:

"Genomics is a way to do science, not medicine."

This is an intriguing distinction, and seems salient to the empirical question identified above as most interesting to me: the connection, in the reasonably foreseeable future between genetic research and population health (the irreducibly speculative nature of the claims of a powerful connection at some time t in the future is epistemically shaky, and the shakiness is itself an important criterion for evaluating the weight of the claim).

Thoughts?

Call for Papers: Valuing Lives: A Conference on Ethics & Health in the Environment

VALUING LIVES: A CONFERENCE ON ETHICS IN HEALTH & THE ENVIRONMENT

NEW YORK UNIVERSITY CENTER FOR BIOETHICS HOSTS
'VALUING LIVES: A CONFERENCE ON ETHICS IN HEALTH & THE ENVIRONMENT'
SATURDAY, MARCH 5, 2011

The NYU Center for Bioethics in conjunction with the NYU Environmental Studies Program will be hosting 'Valuing Lives: A Conference on Ethics in Health and the Environment' on Saturday, March 5, 2011. The event will be held on New York University's beautiful Washington Square campus, in the heart of Greenwich Village and will feature talks in a single day followed by an end-of-conference dinner at a local restaurant that night. Check again later for more details.

OFFICIAL CALL FOR PAPERS:
Please see this PDF for complete details and guidelines.

SUBMISSION GUIDELINES:
Submissions should not exceed 4000 words and must be prepared for blind review. Send the paper, a 150 word abstract and a separate document with your identifying information to Amanda Anjum at asa4@nyu.edu. Submission deadline is November 1, 2010. Notification of acceptance will be sent by December 15.

REGISTRATION:
Registration will open soon, and will be free of charge.

ACCOMMODATIONS:
We are attempting to secure a discounted conference rate at a nearby hotel. Check again later for more details.

CONTACT:
For further information, please contact Professor Benjamin Sachs at sachs@nyu.edu or at 212-992-8686.  Thanks to the NYU Humanities Initiative for its generous support of this conference.

_____________________________________

(h/t The Professor)