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Medical Apartheid

In Books, medicine on June 20, 2011 at 8:30 am

I just finished reading “Medical Apartheid: the dark history of medical experimentation on Black Americans from colonial times to present” – Wow, what a read!  Major kudos to Harriet A. Washington for having the courage and gusto to pursue such an expansive project in the face of such resistance.  Our nation’s ability to bury, in an attempt to erase, undesirable history is something else.  I hope that one day (sooner rather than later), someone will turn this work into a documentary. I was searching a few months ago for a documentary our SNMA chapter could show on the historical basis for the mistrust of the medical community observed in the African American community – none exist that don’t focus solely on Tuskegee, shame. Spike Lee, where you at?

I would urge any medical student to read this book – not just African Americans and not just those interested in medical research.  Why?  Well, as can be easily observed, many of our nation’s medical schools are situated in predominantly minority communities.  As such, the population medical students will be honing their skills on are minorities, and since we are underrepresented in medicine, I question the knowledge the majority has about these communities. Personally, I have found my own formal education on minorities’ plight in our nation’s history lacking…  Furthermore, logic tells us that by having an appreciation for the history of the community we serve can better inform our communication with said community.  In other words, if the Black community is untrusting of the medical community (Washington uses the term iatrophobia = fear of medicine), there might be ways we adjust our delivery to make them more receptive to our message so that we can help eradicate those fears instilled from decades of abuse and exploitation from…well, us. Makes sense to me.  How can you possibly expect to slay a dragon if you don’t know what it looks like?  You have to have some idea of the beast you’re going to face to adequately prepare to beat it… And let it be known that this beast of distrust has a very sound basis and is contributing to the vast health disparities observed in our nation.

I think what surprised me most in this 400 odd-some pages of this book is a 3-way tie:

  1. How many other atrocious studies of similar duration were conducted while the notorious Tuskegee syphilis experiment was occurring.  From XYY experiments with young Black boys to government-engineered disease-ridden mosquitos bred and released, en masse, on certain Black communities in the South, leading to illness and death.
  2. How many of these breaches of trust occurred up North, where I was raised to believe that we were “more liberal and socially advanced than the antiquated South” – false. I do think, overall, the North tended to treat Black populations a bit better than the South (ex: “The Mississippi Appendectomy“).  Actually, I take that back – it seems that the North initially left Blacks alone (or were more prone to use them as a last resort vs the cheap lab rats physicians of the South described Blacks as), but something happened where post-1960/70 it seemed that Northern medical schools and researchers found it ok to conduct experiments that were largely non-therapeutic, without consent and/or informing of participants, and maybe even coerced when involving children and inmates.
  3. The modern-day exploitations of Black Americans by the medical community. So, I went into this book knowing that I’d be a little nauseous reading about experimentation on slaves, but didn’t expect to be so blown by the exploitations in the past few decades (by prominent medical institutions), both in the US and in Africa.  I mistakenly thought “we” had learned and grown from “our” past, and were better than that.  Granted, the US is doing a much better job than they were in the ’70s at shutting down such projects, but 1) unethical projects are still arising and 2) the culprits (White male doctors) are still making a name for themselves and getting off relatively scotch-free.

But, I think my biggest take-home was how much the medical community truly owes the Black community. And I do mean truly owes.  Oh so many institutions and “Fathers of Medicine” have built their name and fame by abusing the trust and vulnerable position of the Black community.  Prime example – many of the “Fathers of Medicine” that built their fortune on using slaves for experimental surgeries…without anesthesia, dehumanizing and over-sexualizing Blacks, and then addicting them to morphine post-surgery. Ex: Dr. J. Marion Sims, Father of American Gynaecology, who ironically has a statue erected in his honor in an area of Central Park in Harlem. (not going to lie, I was reading this book when I was back home in Jersey and it took every fiber of self-control to not march over to that statue with a sledgehammer or spray can and go.to.town.! or at the very least, spit on it)  Some argue that it’s ok because it was common practice, and thus ethically sound at the time to use slaves for medical research…regardless, it’s still disgusting and many physicians unnecessarily went beyond what was even accepted by their medical peers for treatment of slaves.  When were move past the slave era, the same abuses of power can be observed.  Honestly, I feel that had similar medical experiments been conducted on concentration camp victims, there would have been an enormous outrage…oh wait, that’s right – there was! (i.e. the Nuremberg Trials and Code). aside: I find it interesting that medical researchers in these trials used in their defense that they based their practices on American physicians’ treatment of Blacks in America…hmmm.  And yet, no outcry, just perpetuation of the same stripping of dignity and metamorphosis into other forms of exploitation.

The uniting thread of this book is the abuse of a population of people who are least likely to benefit from the results of the experiments conducted on them, with little-to-no admission of guilt by and repercussions for those conducting such projects (mostly White men, and sometimes the government).  So much of what we know medically is based on this, and Blacks, throughout generations have passed down their “iatrophobia” (or witnessed these patterns of abuse first-hand in recent years and arrived at the same conclusions) and thus are reluctant now to enroll in research studies that are so desperately needed to be conducted to bring our health status to the levels of the majority.  It is a shame what has transgressed and persisted in this nation, and the consequences of such sins.

For me, the book lost it’s wind in the third section (on the complex relationship between racism and research), but all-in-all it is a stripped down chronology of a disgraceful history of American medical research that has been excluded from every history book I have ever looked at, and something that should be incorporated into medical training.  That being said, I attend a med school that was repeatedly mentioned throughout this book, so I have my doubts of this change coming to fruition :/

Remaining on My Summer Reading List:

Feel free to leave any book recommendations…I need some non-medically-related texts!!

***Note: Washington has a new book coming out that I’m looking to read…Deadly Monopolies: The Shocking Corporate Takeover of Life Itself – and the Consequences for Your Health and Our Medical Future. Look for it soon…***

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Our Food…smh

In health, Rants on June 14, 2011 at 3:15 pm

Confession: I’ve been bingeing on food-related documentaries.  In the past 24 hours, I’ve watched Food, Inc., Super Size Me, Food Matters, and Fed Up!, all thanks to the wonderful Netflix.  Seriously, if you haven’t invested in Netflix, it’s well worth it.  I believe I was on the later side of joining the revolution (joined in Jan of this year) and absolutely love it.  Plus, I’m a documentary junkie, so it satiates my video hunger rather well.  I know these documentaries have been out for a few years, but I kept putting them off.  Needless to say, I am happy I finally came around.

A little background from my life. Coming from a single mother home, I didn’t grow up with the healthiest foods stocked in our kitchen – we were always on the go, so “quick” was emphasized over “quality”.  Not to say we ate junk food…actually, in retrospect, I think we did pretty well considering our circumstances and the general level of nutrition knowledge in America during the 80s and 90s…I mean really, who was talking about organic back then?  We’d pick up fast food after games or practices, but we basically only drank water and milk, and had home-cooked meals whenever possible (never fried!).  Comparing my home’s food stock now to then is like night and day.  Now, we’re stocked with fresh fruits and veggies, organic everything (grass-fed if at all possible)…accompanied with much larger grocery store bills (thank you, Whole Foods).  But, my mom has made the choice that she’d rather sacrifice certain luxuries (say an extra vacation) than her health, and has thus chosen to spend more to eat better.  In sum, we did the best with what we had, and now we’re doing better.  Anywho, all this to say I’ve been blindly eating organic for a while, not really cognizant of the depths of why it is so important to do so.  Until I watched these docs…

I was truly at a loss for words after watching Food, Inc. and Super Size Me.  All I could say was “Wow!” and “Yikes!” and pull a smh.  I’m not even sure where to begin in this analysis.  I guess I’ll just word vomit points that stood out to me and highly recommend you checking these documentaries out if you haven’t already.  The entire experiment of Super Size Me was fascinating in and of itself.  I was simultaneously repulsed and spellbound by this healthy man’s 30 day transformation into a disgusting, bloated, lethargic, food-controlled mess with a dysfunctional liver!  He really made quite the sacrifice to make a point.  Granted, the man ate McDonald’s 3x/day for 30 days, but who would’ve thought it would 1) substantially increase his risk for developing Gout! (Whaat?) and 2) his liver would turn fatty that quickly from food and mirror that of an alcoholic’s.  Sad thing is the amount of people who rely substantially on fast food for most of their meals…yikes!

As for Food, Inc., it’s atrocious how our nation’s farmers are treated like modern-day slaves.  It’s ridiculous that in a country that prizes freedom above all else, politics and greed are depriving us of the knowledge needed for consumers to make truly informed decisions on our purchases that are supposed to drive supply.  Supply and demand – we all know about it.  But what’s happening is that supply is perversely dictating demand through a huge coverup.  Someone, tell me how current US Supreme Court Justice Clarence Thomas (one of my least favorite Americans) used to be an attorney for Monsanto Company (a company that basically became a monopoly in genetically engineered soy beans…enslaving and bullying soy bean farmers around the US with its ridiculous patent) and then as a Supreme Court Judge wrote the majority opinion in a case brought against Monsanto that basically supported the legal rights and entrepreneurship of soy bean farmers? What type of logic is this? What kind of “justice” are we seeing?!?  We talk a lot about minority groups such as Blacks, Latinos, and homosexuals, and their fight for equality, but if ever there was a disenfranchised group in America it’s our modern-day farmers (ok, and Native Americans), and it truly breaks my heart.

After watching these films, especially Food, Inc., I am so uncertain as to what to put into my mouth.  I’m not a meat-heavy person by any means, but I do consider it a good source of protein, and as such have included it in my diet…until now.  I honestly am not quite sure what to eat now, in good faith and out of social justice.  This documentary highlighted how mega-corporations, especially McDonald’s, own such a ridiculously large portion of all meat produced in America that even if we’re not going to MickeyD’s to eat, the meat we buy in the supermarket is subject to the same processes as MickeyD’s – Shame! Unfair!  As a consumer, where is my control? Where is my say?  Answer: eat organic, buy local, remember that every scan at the grocery counter is a vote for what you want.  Still, I feel disempowered 😦 Same goes for fruits and veggies – buy in-season produce (or else you’re supporting imports from China, etc), buy local, yadda yadda yadda.  My city is currently having an “Eat Local Challenge”.  Granted, I’m away for half of the month, but I fully intend on joining in the effort upon my return.  It’s doable.  Sure, it requires a bit more time, a little more money, and quite a bit more thought and energy, but it’s worth it – to our bodies, to our farmers, to what this great nation was built upon.

Admittedly, this is a bit tangential to what I usually post, but I feel as (future) physicians, (and this is the public health in me coming out) it is imperative we inform our patients on the nutritional component of their health that we can affect change on a larger level.  Ideally, we inform them, they take it in and make better choices, and their new purchasing patterns change the food supply in this nation.  But how do we inform others if we aren’t ourselves informed? Among this epic food documentary viewing of mine, I watched Food Matters, which was an interesting looking at the medical aspect of nutrition and fall-outs from our nutrient deficient food system.  While I don’t fully buy into all their claims about high dose vitamins in curing many ails (and this could be the skepticism of a medical education rearing its ugly head), I think they made some strong points on the lack of adequate training in nutrition during med school.  It’s interesting that as fundamental as nutrition is to building a healthy, fully operating human body, it is given so little (if any) attention in medical training.  Granted, we have nutritionists (whom we should be incorporated more into our delivery of health care…especially primary care…but that’s for another day), but physicians shouldn’t rely on them to deliver the message.  The producers of this film made some good points as to the unfounded opposition to vitamin therapy (I say unfounded because there have been research studies on the effectiveness of such treatments that the government has deliberately chosen not to archive, which flies in the face of the pharmaceutical companies) and how such treatments, originally discovered by doctors, would decrease the need for certain types of doctors and for a plethora of drugs.  Hmmm, very very interesting.  I’m not going to lie, while they were presenting their case, the thought of well, what does this mean for me as an aspiring physician??  flashed through my mind…as I’m sure it has for decades in the minds of many doctors and others involved in our nations health care system.  In all these documentaries the common thread of deliberate cover-ups and keeping people in the closet on a multitude of issues was evident.  It seems to me that our government, which is supposed to be protecting its citizens, has been protecting a minority of citizens that have a lot of $$$ and spend it to harm the majority…

I could easily keep bringing up points I found particularly interesting or disturbing, but this is getting lengthy and turning into a rambling.  I’ll just leave you to consider checking out some of these documentaries when you get the chance – the dollar or two you’ll spend on these are well worth the payoff you’ll receive in increased knowledge.

Hello, Summer!

In medical school on June 6, 2011 at 9:12 pm

Once again, it’s been a while since I last blogged. While I’ve been done with first year for nearly 6 weeks now, and done with the school year ~1.5 weeks, I have yet to take a moment to reflect on the craziness that was first year! Literally, after finishing my last exam of the year and celebrating, I collapsed into a 4-day coma (which, in retrospect, was probably induced by the sudden withdrawal of caffeine that I had continually transfused into my bloodstream for the entire month of May). Anywho, I am back home after finishing the year strong (What a stark contrast to ugrad! Is that motivation I smell?) and am thoroughly enjoying my deserved summer break. Granted, I know that once I touchdown back South, I’m going to hit the ground running…

But, back to the topic on-hand: reflection. It’s mind-boggling to think that just 12 months ago, I packed up all of my belongings and made the long 24 hour drive down to my new “home”. Sooooo much has happened in those months, with too many memories to name without cues.  That being said, there were some big take-homes and tips I’d like to share… (mentioned in order they came to mind, not order of importance)

1) Work in study groups. Yeah, yeah, yeah – we’ve all heard this numerous times, but in med school, I found itparticularly difficult to find others I studied well with.  Many friends/peers can be distracting (i.e. socialize instead of memorize) or agitating (i.e. overcaffeinated, twitching, unstable studiers on the verge of collapse).  Personally, I “test studied” with people to see if we were compatible and went from there.  Keep the group simple 2-4 max., and make sure it’s with people 1) you trust to have the facts straight 2) don’t belittle others for not knowing something (surprisingly common, even if only done via inflection) 3) go at your pace and 4) that push you to excellence. [5) Bonus if they readily provide caffeine or treats!]

2) Keep it friendly.  Clearly, you’re not going to like everyone and some people won’t like you for whatever reason.  Clear up any miscommunications and keep it moving.  Be cordial, but don’t be fake.  Somehow, it always seems that those that annoy you most or that you dislike most will wind up in 90% of your “randomly assigned” small groups (not sure if I buy into this “random” biz).  Work well with all – even those you detest.

3) Leadership is good.  Imo, it doesn’t matter what area it’s in, but take on a little extra responsibility in something you feel passionate about.  While some mistakenly think it’ll be a great resume/CV booster for residency (FALSE: Step 1! Step 1! Step 1! then it’s like Dean’s Letter, LORs, Step 2, and research in some order), I think it’s 1) just nice to get involved with something tangentially related to what you’re memorizing in the books and 2) you get to meet some great people in that area that can give you tips and serve as mentors or liaisons.  That being said, don’t pull a me and find yourself in a position where you might just be overstretched come second year – oops.

4) Sleep is also good.  Took me a while to realize this one (ask about my patented Nap Schedule), but recall and focus is so much sharper with a solid night’s sleep under the belt.  Same goes for exercise and eating right, but you already knew that, right?  Oh, good tip for eating well during exams:  Cook 2x as much of everything the 1st week or so of a block and freeze half.  Pop that baby out of the freezer come exams week and you have quick, easy meals.  And yes, med students frequently “sleep” (re: pass-out) under desks…publicly…without shame.

5) Avoid drama and neuroticism like the plague – both are contagious and deadly! Simply put, med school is full of Type As (surprise, surprise).  Type As are notoriously neurotic.  Per Wiki – “ambitious, aggressive, business-like, controlling, highly competitive, impatient, preoccupied with his or her status, time-conscious, and tightly-wound.”  Um, Wiki…were you snooping on med students as your source of this definition??? But seriously, not everyone is like this all the time (well, some are – sprint the opposite direction), but even with half of a class in this state half of the time, the likelihood of interacting with one is pretty significant…especially when exams near.  Likewise, med school has often been described as High School, pt. II.  Well, I’d say Middle School, pt. II, but you get the deal.  Hang around the neurotics too long and next thing you know, you’ll be twitching and having heart palpitations.  And even being peripherally involved in the drama will lead to your name coming out of people’s mouths you don’t even know.  Solution? Smile and keep it moving!

6) Take as much personal time as you need, without apology.  And I emphasize the “without apology.”  I’m not recommending disappearing for extended amounts of time without so much as a peep, but if #5 starts to get to you and/or you feel that you need an extended break from the insular medical school community – take it!  It’s your time and your life.  It’s much better to take that step back, regroup, refocus, and come back clear-headed than to get bogged down, unfocused, and irritated.  And if people give you slack about it, brush it off and do what you need to do to get where you need to be. Period.  Also, hold onto at least one thing non-medical that makes you smile and cherish the time you spend with it, without apology.

7) Keep it moving!  Successes, failures – I don’t care.  Either way, keep going!  Learn from both, but don’t stop for too long.  As I said, these next 4 years are pretty insular, and in that type of environment, it’s easy to turn minor events into major ones.  But in reality, all these happenings are just small snippets in a series of events that will compromise this “Med School Experience.”  Get caught up too long on one and you’re likely to miss the next.

8 ) Nepotism is real and isn’t going anywhere, so get used to it.  Personally, I thought I had left nepotism behind in ugrad.  Truth of the matter is, we live in America, so nepotism is here to stay.  What’s important is how you let it affect you.  You can get all worked up because so-and-so doesn’t have to work as hard because daddy will make sure they’re fine OR you can use it to fuel your drive to perform even better.  I chose the latter.

9) Be happy where you are, but never content. Be happy that you are blessed to be in this position at this point in time, regardless of where you are.  For me this means to be happy I’m fortunate enough to be at ___SOM, as a member of the great class of 2014 (yes, my class is GREAT – I love them because of and in spite of their foolishness!), in the great city of ___.  Am I content?  I personally believe that no matter where I am, I’ll never be content.  Does this mean I’m disgruntled?  No, I just believe that there is always room for improvement and ways to better and expand any institution, and that the best way for any of us to do that is to use our previous experiences to inform future growth – and that’s why we’re here. Keep pushing!

10) Never ever calculate the minimum you need to pass a class!  I swear, this leads to the death of all ambition.

11) Find yourself a mentor.  They really do provide priceless information and tips, and if nothing else, they’re a tangible role model that can increase your desire to study.  I know I’d often hit the wall studying and then go shadow my mentor, only to return to my desk ready-to-go!

12) It doesn’t matter at all that you can’t spell and only minimally matters that you can’t pronounce anything.  I’ll file this under my list of “Things that are True.”  Coming in, my spelling was poor (thank you, SpellCheck!) and now, I can legit only spell medical terms – all else has fallen to the wayside.  I’m impressed I am even able to type this blog.  When talking to many of my friends about various essays we had to turn in during the school year, most felt that their writing level had fallen to the level of a 4th grader.  Pronunciation comes with time…or never.  Luckily, exams are written multiple choice, ftw!

13) If for any reason you are debating whether or not to get a smart phone for med school, go ahead and invest.  So many things are a first come-first serve basis, and smart phone users have a leg-up.  I got a Droid X for Christmas and life hasn’t been the same since! (so, apparently my phone’s been “eclipsed” by the Droid X2 already -whomp whomp)

14) Don’t apologize for or explain the fact that you’re studying – you’re in med school! (I’m going to throw this on the list of “Things I Thought Died in Ugrad”)  Being in med school, it seems ridiculous that you’d ever feel compelled to apologize for studying, especially to classmates, however, I often found myself hesistant to say “No, I can’t go PlaceX because I need to study.” Doing so usually brought on heaps of verbal harassment by peers (nonsensical!) who emphatically stated that since they’re not studying, I don’t need to study.  Do not fall into this trap.   Why don’t they need to study?  Were they a Bio major who’s taken a bajillion bio courses (and you’re a non-science major)?  Is this nepotism or sheer laziness (re: “I just have to pass”)?  Are these people quiet gunners who’ve already secretly been studying? Do they have less extracurricular commitments than you? Are they just lonely and want company?  The world may never know the answer as to why some people continually try to stop others from studying.  All I’m saying is if you feel you need to study, do it and kiss those sorry haters good-bye!  Plus, true friends want your success and understand the sacrifice that sometimes needs to be made to achieve it.

Staying true to my Keep it Moving! theme, I’m going to enjoy the rest of my time here at home, but when I get back down South, I have some things to layout and some plans to execute.  Yes, summer is a time of R&R, but it’s also a time to prep for a busy upcoming year.

Hope life’s treating everyone well!  I will actually blog rather consistently this summer – I promise!

Summer Freedom