Transcript Slide 1

Activism in Medicine: History,
Literature, and Contemporary
Issues and Movements
Martin Donohoe
Overview
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Background
Issues
History
Literature
Quotes and Photos
Education, the media, and democracy
What you can do
Portland, Oregon
Mount Hood
Multnomah Falls, Oregon
Am I Stoned?
A 1999 Utah anti-drug pamphlet warns:
“Danger signs that your child may be
smoking marijuana include excessive
preoccupation with social causes,
race relations, and environmental
issues”
Harvey Cushing
“A physician is obligated to
consider more than a diseased
organ, more even than the
whole man. He must view the
man in his world.”
Medicine and Public Health
• Schism between the fields
• Witnessed victims vs. “statistical”
victims
• Precautionary Principle
Important Historical Figures in
Medicine/Public Health and Social Justice
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Florence Nightingale
Margaret Sanger
Albert Schweitzer
Charles Dickens
George Orwell
Important Historical Figures in
Medicine/Public Health and Social Justice
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Upton Sinclair
Anton Chekhov
William Carlos Williams
Thomas Hodgkin
Important Contributions of Public
Health
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Water and food safety
Sanitation
Vaccination
Fluoridation
Iodine supplementation of table salt
Seat belts, air bags
Bed nets for malaria prevention
Barriers to decrease bridge suicides
Rudolph Virchow
• Founder of modern pathology
–Thrombosis, pulmonary embolism,
leukocytosis, leukemia
• Member of state and local
government for over 30 years
• Founded journal Medical Reform
Rudolph Virchow
• Argued that many diseases result
from “the unequal distribution of
civilization’s advantages”
• Advocated public provision of medical
care for the indigent
• Promoted universal education
Rudolph Virchow
• Worked to outlaw child labor
• Improved water distribution and
sewage system
• Enhanced food inspection process
• Published study of skull volumes to
dispute myth of larger Aryan brains
Rudolph Virchow
• Passed hygiene standards for public
schools
• Set new standards of training for
nurses
• Improved local hospital system
Rudolph Virchow
“Doctors are natural attorneys
for the poor … If medicine is
to really accomplish its great
task, it must intervene in
political and social life…”
Issues
• Access to care
• Boutique medicine
• Racial, sexual and SES discrepancies
in outcomes
• Homelessness
• Effects of poverty on health
• Hunger
U.S. Health Care
• Per capita expenditure on health care:
– U.S. = $4,000
– Typical poor African/Asian country = $550
• Even so, U.S. has 47 million uninsured,
ranks 24th worldwide in overall population
health as judged by disability-adjusted life
expectancy
Headline from The Onion
Uninsured Man Hopes His
Symptoms Diagnosed This
Week On House
Racial Disparities in Health Care:
African-Americans
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Higher maternal and infant mortality
Higher death rates for most diseases
Shorter life expectancies
Less health insurance
Undergo fewer diagnostic tests /
therapeutic procedures
Issues
• Excessive pharmaceutical company
influence, dubious marketing practices
• Women’s rights issues:
– Violence against women
– Access to reproductive health care
– Female genital cutting
– Political, legal, and educational
marginalization
Status of Women
• Economic discrimination
–Women do 67% of the world’s work
–Receive 10% of global income
–Own 1% of all property
• A woman in a developing country
walks an average of 6 km/day to
obtain water
Issues
• Environmental degradation
–Overpopulation
–Air and water pollution
–Toxins
–Deforestation
–Global warming
Issues
• Environmental degradation
–Unsustainable agricultural and
fishing practices
–Famine
–Commodification of world’s food
and water supply by corporations
–Species loss
Poverty Worldwide
• 1.1 billion people lack access to safe,
clean drinking water
– 1.8 million child deaths/year
• 2 billion have no electricity
• 2.6 billion do not have adequate sanitation
services
• Hunger kills 18,000 people per day, most
under age 5
Consequences of Pollution
• Air pollution causes approximately
60,000 - 75,000 premature deaths/yr.
in U.S., 1.8 million worldwide
• NAS: Pesticides in food could cause
up to 1 million cancers in the current
generation of Americans
Air Pollution
Air Pollution
Toxic Exposures
• 13,000-15,000 deaths per day worldwide from
water-related diseases
• In developing countries, 90-95% of sewage and
70% of industrial wastes are dumped untreated
into the local water supply
• 1 in 4 U.S. citizens lives within 4 miles of a
Superfund site
• Lead and mercury exposure multi-billion dollar
problems
Water Pollution:
Bathtub=Toilet=Source of Drinking Water
Toxins:
Minimata Disease - W Eugene Smith
Deforestation
Greenland’s Ice Cap Melting: 1992
Greenland’s Ice Cap Melting: 2002
Greenland’s Ice Cap Melting: 2005
Climate Change: Drought
Famine
Factory Farms
• # 1 polluters of American waterways
• Agriculture accounts for 70% of U.S.
antibiotic use
– #1 contributor to food-borne, antibioticresistant infections (CDC)
– Source of MRSA, other resistant
bacteria
Factory Farming
Overfishing:
Factory Trawlers
Dynamite Reef Fishing
Species Loss = Lost
Pharmacopoeia
• Drugs from plants and native peoples’
health knowledge
– More than 1/2 of the top 150 prescription
drugs contain an active compound derived
from or patterned after natural products
-e.g. digoxin, vincristine, paralytic agents, etc.
• Of the more than 250,000 known flowering
species, <0.5% have been surveyed for
medicinal value
A Cure for Cancer?
Social Justice Issues
• Maldistribution of wealth
• Overconsumption (“affluenza”)
• Rise of the corporation
– 53 of the world’s 100 largest economies
are private corporations; 47 are
countries
• Minimum wage ≠ Living wage
• Third World debt crisis
• Human rights abuses
Maldistribution of Wealth
• U.S: Richest 1% of the
population owns 50% of the
country’s wealth; poorest 90%
own 30%
–Widest gap of any industrialized
nation
Maldistribution of Wealth
• Less than 4% of the combined wealth
of the 225 richest individuals in the
world would pay for ongoing access
to basic education, health care,
adequate food, safe water, and
adequate sanitation for all humans
(UNDP)
Overconsumption (“Affluenza”)
• U.S. = 6.3% of world’s population
– Owns 50% of the world’s wealth
• U.S. responsible for:
– 25% of world’s energy consumption
– 33% of paper use
– 72% of hazardous waste production
George Orwell
“Some people are more equal
than others”
Voltaire
“The comfort of the rich rests
upon an abundance of the
poor”
Primo Levi
“A country is considered the more
civilized the more the wisdom and
efficiency of its laws hinder a
weak man from becoming too
weak or a powerful one too
powerful.”
Issues
• War and Militarism:
– Diversion of economic resources and
intellectual capital
– Prejudice/hate crimes
– Erosion of civil liberties
– Weapons of mass destruction
The Military: Diversion of
Resources Away from Health Care
• 3 hours world arms spending = annual WHO
budget
• 1/2 day of world arms spending = full
childhood immunizations for all world’s
children
• 3 weeks of world arms spending/yr. = primary
health care for all in poor countries, incl. safe
water and full immunizations
• “War on Terror” creating enormous U.S. debt
War and Peace
• World military budget = $1,232 billion in
2006
– 228X what the UN spent on
peacekeeping
• US:
– Largest military budget, largest arms
supplier
– Greatest debtor to UN peacekeeping
fund
“Every gun that is made, every warship
launched, every rocket fired, signifies in
the final sense a theft from those who
hunger and are not fed, those who are
cold and not clothed.”
~ Dwight D. Eisenhower
“The problem in defense spending is to
figure out how far you should go without
destroying from within what you are
trying to defend from without.”
~Dwight D. Eisenhower
US Anti-Terrorism Spending,
2006
Kuwaiti Oil Fires – Gulf War I
The Value of the History of
Medicine
• Provides context for contemporary
practices
• Promotes pride in our field and sense of
mission to carry on work of our
predecessors
• Fosters humility regarding utility of novel
technologies
Brigham and Women’s Hospital
• Established 1966 through merger of Peter
Bent Brigham Hospital, Robert Breck
Brigham Hospital, and Boston Hospital for
Women
• 1847: First administration of anesthesia in
childbirth
Brigham and Women’s Hospital:
History
• 1913: Harvey Cushing named surgeon-inchief
– Father of modern neurosurgery
– Used X-rays to diagnose brain tumors,
electrical stimuli to study sensory cortex
– Helped develop Bovie electrocautery
– Discovered Cushing’s Disease
Brigham and Women’s Hospital:
History
• 1923: Elliott Cutler performs world’s first
successful heart valve surgery
• 1926: William Murphy, George Whipple,
and George Minot discover that liver
extracts cure pernicious anemia
– Awarded Nobel Prize
• 1939: Soma Weiss named physician-inchief – co-discoverer of Mallory-Weiss
tears
Brigham and Women’s Hospital:
History
• 1949: first use of cortisone for rheumatoid
arthritis
• 1949: Carl Walter develops world’s first
blood bank
• 1954: Joseph Murray performs first
successful human organ (kidney)
transplant
– Awarded Nobel Prize
Brigham and Women’s Hospital:
History
• 1962: D/C cardioversion used for first time
to restore normal heart rhythm in A-fib
• Home of first CCU
• Today: one of the largest non-university
recipients of research funding from NIH
• Contemporary leaders in medicine
The Role of Literature
• Vicarious experience
• Explore diverse philosophies
• Promotes empathy, critical thinking,
flexibility, non-dogmatism, self-knowledge
• Encourages creative thinking
• Allows for group discussion/debate
Why Use Literature
• Encourage appreciation of non-medical
literature
• Develop reading, analytical, speaking and
writing skills
• Promote ethical thinking (narrative ethics)
• Identification with doctor authors (e.g.,
Keats, Chekhov, Maugham, Williams)
• Can be used in a variety of settings
Homelessness
Doris Lessing
“An Old Woman and Her Cat”
From the Doris Lessing Reader (New York: Knopf,
1988)
Race and Access to Care
Ernest J Gaines
“The Sky is Gray”
in Gray, Marion Secundy, ed. Trials,Tribulations,
and Celebrations: African American
Perspectives on Health, Illness, Aging and Loss.
Yarmouth, Maine: Intercultural Press, 1992
Poverty
• Orwell, George. How the Poor Die. In Sonia
Orwell and Ian Angus, eds. The Collected
Essays, Journalism and Letter of George Orwell,
IV; In Front of Your Nose, 1945-1950. New York:
Harcourt, Brace and World, Inc: pp.223-233.
• Checkhov, Anton. Letter to AF Koni,
January 26, 1891, Letter to AS Survivor,
March 9, 1890. In Norman Cousins, ed. The
Physician in Literature Philadelphia: WB
Saunders, 1982.
Impediments to Public Health and
Social Justice
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Political climate
Scientific Ignorance
Pseudoscience
Damaged educational system
The corporate media
• All lead to the decline of democracy
Bush Administration
• Key administrators/committee
members/regulators former industry
representatives and/or lobbyists
• Privatization of public services
– Corporate profit before public good
• Unsound/distorted/suppressed science
Bush Administration
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Rollbacks of key environmental laws
Lax enforcement of existing laws
Huge tax cuts primarily benefit wealthy
Federal and state government deficits
astronomical
– Program and funding cuts
• Trade deficit increasing
Would You Sign a Petition to
Ban Dihydrogen Monoxide?
1. It can cause excessive sweating and vomiting
2. It is a major component in acid rain
3. It can cause severe burns in its gaseous state
4. It can kill you if accidentally inhaled
5. It contributes to erosion
6. It decreases effectiveness of automobile brakes
7. It has been found in tumors of terminal cancer
patients
Environmental and Geographic
Ignorance
• A majority of Americans believe that electricity in
the U.S. is produced in nonpolluting ways
– 25% knew that majority (70%) comes from
oil, coal and wood
• Percent of US teens unable to locate the
following on a map:
– United States – 11%
– Pacific Ocean – 29%
– Japan – 58%
Pseudoscientific Beliefs
Percentage of Americans who believe
“at least to some degree” in these
“phenomena”
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Astrology
UFOs
Reincarnation
Fortune-Telling
1997
37%
30%
25%
14%
1976
17%
24%
9%
4%
Obfuscating Influence of Religion
• Onion Headline:
Greenwash
• Public relations / ad campaigns
–Chevron’s “People Do” Campaign,
butterflies/refinery
–Grants to a few scientists who
challenge environmental warnings
–Tobacco ads in 1950’s
Astroturf
• Artificially-created grassroots
coalitions
• Corporate front groups:
– The American Council on Science and Health
– National Wilderness Institute
– The Foundation for Clean Air Progress
Corporate-sponsored environmental
education materials (examples)
• Exxon’s “Energy Cube”
-“Gasoline is simply solar power hidden in
decayed matter”
-“Offshore drilling creates reefs for fish”
• Pacific Lumber Company
-“The Great American Forest is. . .
renewable forever”
Sponsored Environmental
Education Materials (Examples)
• International Paper
-“Clearcutting promotes growth of trees
that require full sunlight and allows
efficient site preparation for the next
crop”
• American Nuclear Society’s “Activities
with the Atoms Family”
• Dow’s “Chemipalooza”
Advertising
“Doubt is our product”
Brown and Williamson Tobacco Company
Memo, 1960s
Advertising
• Record $570 billion spent on
advertising in 2005
–11X greater than in 1950
–Half in US
• The average American can recognize
over 1,000 corporate logos, but fewer
than 10 plants and animals native to
his/her locality
Television
• The average American youth spends
900 hrs/yr in school, 1,500 hrs/yr
watching TV
• By age 65, the average American will
have spent 9 yrs watching TV
• Contributor to obesity epidemic
Public Education in Disarray
• U.S. Schools ranked lowest
among western nations
• ↓ funding, infrastructure decaying
• 1/4 of U.S. Schools have no
library
Education in Disarray
• National HS graduation rate 65-70%
• College tuition costs rising
–Increasingly marginalizes poor,
minorities
Ignorance vs. Democracy
“Information is the currency of
democracy”
–Thomas Jefferson
The Media
• Most media organizations owned by
multinational, multi-billion dollar
corporations that are involved in a
number of businesses apart from the
media, such as forestry, pulp and paper
mills, defense, real estate, oil wells,
agriculture, steel production, railways,
and water and power utilities
Global Warming: Controversial?
• Of 928 articles in peer-reviewed scientific
journals, 0% were in doubt as to the
existence or cause of global warming
• Of 636 articles in the popular press (NY
Times, Washington Post, LA Times, WSJ),
53% expressed doubt as to the existence
(and primary cause) of global warming
Science 2004;306:1686-7
(Study covers 1993-2003)
Global Warming
• Causes estimated 160,000
deaths and 5.5 million disabilityadjusted life years lost per year
–WHO, UN Environment
Program
Lobbying
• 38,000 full-time lobbyists in Washington,
DC
• Lobbying groups spent just under 2.5
billion in 2006 (record)
• All single issue ideological groups
combined (e.g., pro-choice, anti-abortion,
feminist and consumer organizations,
senior citizens, etc.) = $76.2 million
The “Benefits” of Sterility-Causing
Chemicals in the Workplace?
12 September 1977
Dr. Eula Bingham, Assistant Secretary for Occupational Safety and Health
[Regarding] worker exposure to DBCP.
While involuntary sterility caused by a manufactured chemical may be
bad, it is not necessarily so. After all, there are many people who are now
paying to have themselves sterilized to assure they will no longer be able to
become parents...
If possible sterility is the main problem, couldn’t workers who were old
enough that they no longer wanted to have children accept such positions
voluntarily? Or…some [workers] might volunteer for such workposts as an
alternative to planned surgery for a vasectomy or tubal ligation, or as a
means of getting around religious bans on birth control when they want no
more children?
Sincerely,
Robert K. Phillips, National Peach Council
The Decline of Democracy
• True democracy demands an
informed citizenry (education),
freedom of the press (media), and
involvement (will, time, money)
What you can do
• Explore the history of medicine
– Respect
– Question dogma: “The least questioned assumptions
are often the most questionable” – Paul Broca
• Read great literature
– Patients illnesses are stories
– Take patient’s perspective
• Develop a public health-oriented perspective in
care of patients
• Find your passion
What you can do
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Become active in an organization
Educate yourself
Educate your students and your patients
Use the media
Volunteer, do pro bono work
– Satisfies your debt to society
– Feeds your soul
Contemporary Activist
Organizations
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Amnesty International, Oxfam
Partners in Health
PNHP
HCWH, NRDC, ED, Greenpeace, Sierra Club,
No Dirty Gold, PANNA
Union of Concerned Scientists, Public Citizen’s
Health Research Group
NARAL, Planned Parenthood
Physicians for Social Responsibility, Physicians
for Human Rights
Others
Anita Roddick
"If you think you are too
small to have an impact, try
going to bed with a
mosquito in your tent"
“First they came for the Jews”
by Pastor Niemoller
“First they came for the Jews, and I did not speak
up, for I was not a Jew.
Then they came for the communists, and I did not
speak up for I was not a communist.
Then they came for the trade unionists, and I did
not speak up, for I was not a trade unionist.
Then they came for me, and there was no one left
to speak up for me.”
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
[email protected]