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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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A growing fear…

In medicine, Rants on November 8, 2010 at 4:47 pm

Hello, my internet readers!  Hope all is going well out there.  It’s been a while, but I’ve learned a lot of interesting stuff since we’ve last interacted.  All-in-all, now that everyone’s coming out of their shells, opening up, and putting false pretenses and facades aside, I ABSOLUTELY LOVE MY CLASS!!! I really do!  We had a few bumps in the road the first month or so of school, but I think people are starting to venture out of their comfort zones – all for the better.  I am all smiles.  Don’t get me wrong, at times I absolutely see how we can revert to high school (actually, middle school might be a more accurate analogy), but overall, life.is.great.! 🙂

Recently, we had to submit an introspective reflection on a major fear we have pertaining to our future careers.  Though rushed and not fully expounded, I thought I’d share one of mine…

As a tenderfoot on the path to full-fledged medical doctor status, I already find myself with drastically less free time.  And as leisure time diminishes, there is less time to devote to nonacademic activities, generating a growing fear that I will disconnect permanently from the nonmedical community – the very people I am training hard to one day serve.  Associated with this fear is the potential to transform into a physician that loses sight of her patients as unique individuals and who sees them for their condition, not for who they are, and consequently decreases the quality of care delivered to them.

My fear stems from various interactions with physicians – from personal interactions on the patient side of the medical relationship to listening to guest lecturers who had lost touch with their patients.  I have interacted with physicians that view their patients as little more than inanimate words on a page – age, gender, ethnicity, chief complaint – and have pondered as to how they came to this state-of-being.  Is coldness an inherent part of the training process?  Is it a probable fate that as I train and find myself insulated with medical professionals that my vision will narrow and I will lose sight of all that is outside of the hospital affecting my patients on a daily basis? These are the questions I ask myself, for this is the antithesis of the physician I aspire to become.

Inherent in our medical training is a certain degree of hardening.  In my opinion, we work with cadavers not only to learn the parts of the human body, but also because it is an exercise in dissociating the flesh from the being or the spirit of the individual.  Depending on what field of medicine is selected, the reality is that a certain amount of detachment is required to be able to perform specific procedures on patients.  At the moment, I am strongly considering a career as a surgeon, and therefore know that in order to take a scalpel to a living human being and perform complex procedures that are “unnatural”, I will need to master this dissociation.  That being said, I must not operate in a world where I neglect to re-associate the two – the presenting problem and the individual.

I can easily see how increased time demands can result in generating cognitive shortcuts that can become crutches on which care is executed.  How I master living in a profession that necessitates temporarily dissociation from my patients, whether to perform a procedure or to deliver bad news, as well as constricts my time to interact with the “real world” while simultaneously living in a world where deep human contact is integral to life is up to me.  It is my responsibility to ensure that over the years I remain the same core person I have always been – that I do not become the physician that transfers the distance required at work to “get the job done” to home life.

I do not believe it is necessary to surmount this fear, for this is a healthy fear to have – one that if kept in-check in the back of my mind, can serve as a positive directing force in my life.  There are two main ways I can avoid succumbing to this fear.  The first is the proactive choice of selecting training programs that emphasize patient-centered medicine.  The second way, which is more prolonged and repetitive, is remaining involved within the nonmedical community.  Not by merely financially contributing to charitable organizations, but by physically putting myself out in the community through service projects will I maintain the connections necessary to remain a physician in-touch with reality – this is what will make the difference in my life.

 

When the Boughs Break

In disparities, medicine, public health on September 15, 2010 at 4:04 pm
Judging by the date of my last blog, it’s evident that school is in full-swing. Actually, med school is a lot of fun! Consuming, but fun!

Background:
I just finished attending an extra credit lecture for my Foundations in Medicine course in which we had a discussion based on the viewing of Unnatural Causes…is Inequality Making us Sick? – Episode 2:When the Boughs Break.  The documentary explores the phenomenon of African-American women at every socioeconomic level having higher rates of pre-term birth and infant mortality than white women who haven’t even finished high school or Black immigrants. The basic findings were that it’s not genetic and not socioeconomic (in fact, being a higher educated Black woman increased your risk instead of lowering it).  The general idea discussed is that birth outcomes are affected by the negative impact of racism over a lifespan and that racism in America is an addedsource of stress for people of color, leading to poorer health outcomes.  That’s the basic synopsis.  I’d highly recommend watching the documentary if you can get your hands on it. It was an eye-opener for many of my classmates.
Reflection:
I learned about the study discussed during the video this summer in one of my public health courses (Social & Behavior Aspects of Global Health).  At the time, the study was briefly touched upon, highlighting the possibility that operating under a lifelong level of elevated stress hormones is detrimental to overall health.  However, the course did not nearly go into as much detail as this film.  I was literally holding back tears at certain points during the film, telling myself, “this can’t be life.”  Nothing stated here struck me as new – I’ve always been one of few (if not the only) Blacks in a given environment (exception being college). As such, I have been aware of my race every day of my life since I can remember, and have had many struggles and obstacles because of it.  However, something about this film really struck a nerve in me.
Perhaps it is that I am older and have more life experience and feel that I have fought to carve out a good future for myself.  Now I finally feel that I have full ownership of my life.  It is frustrating to think that no matter what I do to shift things in my favor, certain things that I think I should have a significant handle on are out of my control.  Furthermore, according to this film, by working to put myself in a high socioeconomic level will actually have adverse affects on my life.  Coupled together, frustration, anger, and sadness abound within me.
I fully believe the Life Course Perspective, that the accumulation of this chronic life stressor of race is a determinant of health.  Unless we were able to do away with racism and prejudices, I don’t really see that stressor going away.  Therefore, I suppose it would be in my best interest to implement some coping mechanisms to deal with it, rather than to just sit back and accept it.  Easier said than done.  How do I take time and energy to calm myself down or cheer myself up sometimes multiple times a day when time is becoming an increasingly more precious commodity?  As one of three Black students in my class, I am all too aware of my race every day.  I play well with my peers and like most of them.  But even the ones I am closest with from time to time slip up and say something offensive about other Black people, or interact with me based on assumptions about the few other Black people they’ve had close interactions with over their life spans, or just interact with me differently than they do others.  I won’t even talk about the bad classmates…  To be honest, at times being here has been lonely – and one I don’t see improving over the course of my career. How does one stop ignorant comments and prejudiced actions of others? I have no problem fighting off verbal attacks, but how am I supposed to fight back against the subconscious physiological effects of these offenses?
As I sit and reflect on all the issues brought up in this film, and other underlying concerns triggered by this viewing, I am left with a series of unanswerable questions.  So, what am I to do? Right now, I feel it best to stay on my course to become a physician who will work to help study and, hopefully eliminate, some ethnic health disparities.  But, once again, I am left with a question that can’t be answered: what good will my future research be if it all boils down to the influence of a lifelong battle with racism yielding subconscious physiological consequences?
Aside: I am very happy I am pursuing the MPH degree – the MD is incomplete to developing a forward-thinking physician capable of making lasting societal change.  These questions might not yet be answerable, but at least they’re being asked, right?

Thoughts as a Future Career Woman

In medicine, Uncategorized on April 8, 2010 at 11:15 pm

As many random questions as I regularly am asked pertaining to my interest in and foresight into a career in medicine, the one that seems to throw me the most is, “How do you think you will handle being a female in a male-dominated profession?”

I guess it throws me the most because it’s an issue I’ve never really had to deal with in life.  Growing up, while I couldn’t stand getting dirty, I definitely wasn’t a girly girl. In fact, until I started undergrad, throughout the years, my best friends had always been guys.  I was usually the only girl in my group of friends, and it was something I was fine with or even preferred. Furthermore, whether it was in the classroom or on the playground or in rehearsals, I always gave the boys a run for the money. I’ve always liked the challenge of competing with guys – let’s face it, they tend to be more competitive (at least overtly), while refraining from cattiness. That’s definitely a good push for bettering yourself.

When I look at my time in college, I don’t recall ever feeling intimidated by the guys in my classes, so it’s not something I foresee changing in the near future – not for medical school, not for residency, never. However, I have always been in a position where the guy:girl ration was nearly even. And while I know medical school admissions programs have progressed a long way since the 70s, let’s face it, on some level medicine is still considered a “male profession”…especially in certain specialties (Think, all those male-dominated med school classes graduated in the 60s, 70s, and 80s are still in practice, so it’s still skewed).

I remember on one of my interview days, sitting in a room full or current M4s interviewing for Ortho residency positions. You guessed it, there was not one female in the group. In fact, aside from one Black male, the whole group was comprised of one demographic – white male. Certainly, this is not 100% representative of this specialty, however I think it is roughly representative in that Ortho (and I’m sure a few other specialties) are generally considered “male-only areas.” And not that women cannot wiggle into these unchartered territories and make a name for themselves, but it is certainly a difficult course to navigate.  I recall working in the Emergency Department at a certain hospital and sitting in the nurses station people watching as I do. So often, the male doctors and techs and nurses would babble away about sports or cars (cars = something I cannot for the life of me “get into”) or some other typically male topic of conversation.  I was so irritated sitting there day after day listening to them talking about the same mundane gibberish like it was sound profound discovery (I guess it’s their version of gossip?) – not so sure I would want to deal with that daily for my entire career.  But have no fear, I will be called doctor one day, and it will be said with respect, regardless of the composition of my peers, seniors, and subordinates.

And, think about it – when using the gender ambiguous term “doctor,” why is it that most people reply with “he” and not “she”? This can most likely be attributed to the residual, underlying sentiments that it is a “male profession.”  From a social standpoint, it’s true that at first glimpse who in their right mind would say that such a demanding profession that nearly consumes your life is a workplace suited for a woman desiring to make a family.

However, this view ascribes to the pre-women’s revolutionary view that women belonged in the home, raising the kids and keeping house. [Thank God along came feminism!] Clearly, many still chose to do this, but in the new millennium, we like to
think we’ve progressed from those caveman ideologies, where this is now a chose, not a contractual obligation.  However, even good ol’ progressive me still has a few hidden reservations.  Well, I’ll call them second-guesses – something I do not like to acknowledge I possess. But in all honesty, looking forward, it does seem daunting – the idea of juggling one of the most demanding careers out there with a possible family that includes children who need their mother. And I know me, as much as I want to be a career woman, I know that if I were to have kids, initially it would break my heart to be away from them and miss many of the key moments in their development.

Lucky for me, at the moment I’m at the point where I interact with enough bad kids on the regular to know I don’t want any…or at least not any time soon (thank you, substitute teaching at a Charter School! smh).  I have faith my kids will be well-behaved, however there is a sea of children out their with no value on life, and that makes a scary world to raise kids in. But, I digress…

The point is I’m the type of person who doesn’t try to plan things too far into the future.  Shoot, who’s to even say I’m going to get married? And even still, how do I know if my future spouse or I are able to conceive? Even still, who knows if I’ll ever come around to wanting kids of my own? No, too many unanswerable questions for me to waste my energy entertaining. I’d rather live life in the present and enjoy it now, and see what the future unfolds as I go out and live. If I don’t get married, I’d be fine with that. If I do get married, I’ll be fine with that and will work through those issues when they get here. Furthermore, if we do have kids, I will make a way for raising them to co-exist peacefully with the career I’ve worked for. Can I be greedy? Can I have my cake and eat it too? Why can’t I be both mother and doctor? I am fortunate enough to have a loving mother and support network who I know would be more than happy to lend a helping hand and be a daily part of my and my future children’s lives. Having Grandma & Co around to help with the kiddies would sure lighten the stress of the situation. I guess there is an added benefit to being both an only child and an only grandchild – help is literally only a phone call away 🙂  I admit, Iprobably cannot do it on my own, and I have no desire to.  My hard work plus God’s leading and protection plus support from family and friends will enable me to achieve anything I desire. Me, I want what’s coming to me…the world, chico, and everything in it. And if all else fails, I can always be a cougar! lol, I kid, I kid! Shoot – If Michelle Obama can do it, I can do it too – she’s my motivation 🙂

Death has a Face…and comes with Responsibility

In health insurance, medicine, Rants on January 9, 2010 at 10:49 pm

I naturally wake up every morning at 7:06 am on the dot – random time, I know, but that’s my Circadian rhythm for ya!  However, this past Monday was a morning seemingly straight from hell.  I unexpectedly awoke to the screeching screams and weeping of my mom coming from behind her closed doors.  From the intensity of the volume, I would’ve sworn that both of our doors were open.  Panicked and in a daze (I hope you never need to wake me while I’m sleeping…I am nonfunctional for a good 15 minutes, usually unable to talk) I stumbled over to her room and paused in her doorway to see her slumped over her desk, on the phone, with her entire body heaving up and down, nearly convulsing.  Usually relaxed and soft-spoken, I had only seen her in this state a few times before, and that was when close family members had unexpectedly passed away.  I waited for the right moment to interject, but unable to find one, I opted to hop in the shower and hope that she had gained some sort of composure by the time I got dressed for work.

Fortunately she had calmed down a bit by the time I went to check on her again (I hate interrupting people, especially when I feel that time to themselves is what’s most beneficial, but there was no way I could spend the next 9 hours of my life focus on what I needed my attention on if I knew she was home in this state with the reason unknown to me).  She told me that her dear friend had been found dead in bed early this morning.  Apparently, her leg had been bothering her for a while, and was acting up the night before.  Her husband, being the loving, caring man that he is, decided to give her a nice message before she went to bed, hoping that would help relieve the tension and stress she was feeling.  He woke up to her unresponsive in bed with him the following morning.  Yes, most likely his loving message had dislodged a blood clot that wound up being her untimely demise.  She leaves behind a husband and two young children.  According to my mom, she was one of the kindest souls on this planet.

So, why do I mention this story on this blog that usually pertains to medicine? A: Because this was a woman who had had a double mastectomy when the doctors had found a lump in one breast, out of fear and as a precaution as a middle-aged woman with a history of breast cancer in her family. She was the first one to run to the doctor when something was wrong – just to err on the side of caution.  Yet, she had to endure months upon months of pain and discomfort because…you guessed it – she had gotten cut from her job, couldn’t find a new FT position, and was without health insurance.

I know so many are against health care reform, and are specifically against a public option.  Many physicians, pre-meds, and medical students, if they are honest with themselves, are mainly against it because they think it will be a drain to the economy, and more specifically, a drain to their own pockets.  I, like many others have mixed feelings on this whole debate (I’m not really going to delve into it now, just give a quick run-through on where I stand). I do believe that this health care reform might lower the income for some physicians. And, I wouldn’t think that would be such a bad thing until you factor in costs of obtaining an MD and things such as malpractice insurance.  The only way I could justifiably see lowering the wages for physicians would be to likewise lower the cost of education in the US.  With undergraduate degrees costing $45K+ per year and medical school education costing $70K+ per year (assuming private schools here), are we expected to mount debt that we might not be able to climb out of for 20+ years? That’s ridiculous. Especially when you consider how highly respected this profession is.  People are quick to point overseas to health care systems that are “better” than ours, yet hesitate to look at other aspects that factor into those societies that enable those systems to work (i.e. their doctors aren’t coming out hundreds of thousands of dollars in debt!).

That argument aside, if everyone were required to buy-in, it really would not be a drain on our economy.  Shoot, other countries spend 6% of their GDP on health care and are doing just fine. Meanwhile, we’re spending 16%, as is, and we are clearly struggling.  Our economy is failing, over and over again, morbidity and mortality rates are increasing …something’s got to give! (ok, that last comment I have no empirical evidence to support, but I’m just taking a guess…increase unemployment, increase uninsurance rate, and increase untreated diseases).  And yes, I said everyone must buy-in. Pardon me this one time, but I am going to say screw freedom of choice!  The first ones screaming “Freedom of Choice!” will be the first ones up in the ER when something unexpected happens to their health and they don’t have the means to cover it.  Then what? We’ll wind up spending far more in late, emergency treatment than if they had been treated when symptoms first arose.

All this to say, I believe in the public option. It is long overdue. Shoot, I haven’t had health care since September. I’ve been missing my medications and have been in knee-pain for 5+ months now. I’m already tired of my current quality of life.  I can’timagine living indefinitely like this.  Fortunately for me, as soon as I’m officially a student again, I can have insurance factored into my bills (i.e. student loans). But what about those that don’t have that option?  It is my honest opinion that those against a public option have yet to lose anyone close to them due to something as simple and silly as lack of health care insurance.  Because, once you start putting faces and individual stories to the statistics, you start to interpret the data a bit differently – with more of a heart.