Category Archives: History of Medicine

Academic medical centers: Education or profits?

ludmerer-let-me-heal

The quality of health care depends on many things, but certainly medical education is uniquely significant. Following four years of medical school, the additional years of internship, residency, and fellowship are not simply a time for acquiring the latest insights into the nature and treatment of disease. This is when fledgling doctors imbibe the values and priorities of the medical profession from the attending physicians who mentor them. If attendings have no time to mentor the doctors they are presumably training, the quality of doctors who emerge from such a system will suffer. And if the priority of an academic medical center is to increase profits rather than care for patients, patients will also suffer, first at the hospitals associated with these centers and later as patients of the doctors who trained there. The decline in the residency system for training doctors is the subject of Kenneth M. Ludmerer’s Let Me Heal: The Opportunity to Preserve Excellence in American Medicine.

From mentorship to profits

Sir William Osler established his ideal of medical training at Johns Hopkins Hospital in the 1890s. The guiding principle was that doctors should learn to care for patients under the close supervision of highly experienced attending physicians. Right up to WWII, the highest priority of teaching hospitals remained education. Faculty members formed intense mentorships with their students, often lasting a lifetime. Lara Goitein, in an essay/review of Let Me Heal, writes: Read more

Share

When health was something we could simply “forget about”

get-well-soon

I came across the following sentence in The Positive Thinkers, a book originally published in 1965. It strikes me as a good example of how the meaning of health has changed. (emphasis added)

Health is ordinarily regarded — when it is “regarded” at all, for ordinarily the point of being healthy is to be able to forget about it — as a means to other things; healthy men are those able to pursue their ends.

Health is hardly something we’re able to forget about today. We live in a culture where it’s commercially profitable to constantly remind us of widespread, proliferating risks. The conscious, highly intentional pursuit of health is a mark of social status for which we expect to be admired and envied. We “regard” it all the time. Read more

Share

Social history of medicine — August 2014

history-of veterinary-medicine

The August issue of Social History of Medicine contains eight original articles:

  • Late 19th/early 20th century food adulteration in an increasingly industrialized and globalized world and the search for safety standards
  • The shift in cancer education in the 1950s, no longer downplaying post-operative recovery
  • The 20th century shift in British veterinary medicine towards small animals (dogs, cats), as the need to attend to horses declined (open access)
  • How complaints about the quality of London drinking water in the 18th century reflected the new popularity of bathing for health and social attitudes towards bathers from the lower classes
  • A re-evaluation of the prevalence of venereal disease at the time of the World War I (open access)
  • How quacks preyed on people with hearing loss in mid-19th century Britain
  • How the 1975 TV play, ‘Through the Night,’ portraying what it was like to experience breast cancer treatment, registered with medical professionals and activists who complained of ‘the machinery of authoritarian care’ (open access)
  • Did Axel Holst and Theodor Frølich actually develop an animal model of experimental research?

There are also a large number of book reviews, including:

  • Writing History in the Age of Biomedicine by Roger Cooter with Claudia Stein
  • Emotions and Health, 1200–1700 by Elena Carrera (ed.)
  • The Age of Stress: Science and the Search for Stability by Mark Jackson
  • Before Bioethics: A History of American Medical Ethics from the Colonial Period to the Bioethics Revolution by Robert Baker

Read more

Share

Why women should not ride bicycles: The medical opinion in 1896

women-bicycles-19th-century

In the 1890s, bicycles became safer and more comfortable to ride (detailed in this Wikipedia entry on the history of the bicycle). This may have something to do with the increased number of women who were attracted to bicycle riding. (There’s a correlation, but the causation is undoubtedly much more complex.)

Some celebrated this development. Susan B. Anthony, for example:

Let me tell you what I think of bicycling. I think it has done more to emancipate women than anything else in the world. It gives women a feeling of freedom and self-reliance. I stand and rejoice every time I see a woman ride by on a wheel … the picture of free, untrammeled womanhood.

Read more

Share

Healthy lifestyles: Social class. A precarious optimism

Social determinants of health. Marmot, WilkinsonContinued from the previous post, where I noted that the Lalonde report — despite its good intentions — was followed by an emphasis on healthy lifestyles and personal responsibility for health, as well as increased health care costs.

Personal responsibility and social class

In Why Are Some People Healthy and Others Not?, Marmor et al, writing in 1994, were disappointed that the Lalonde report had not effectively prompted governments to address the underlying causes of health and disease. One reason for this, they believed, was that health policy reflects public opinion. If the public holds traditional views on what makes us sick (pathogens), what prevents disease (medical care), and what we can do to be healthy (take personal responsibility), new policies that include social determinants are unlikely. Those who are on the forefront of professional, scientific opinion may very well understand the importance of social determinants, but public opinion changes slowly. Without an education program, such as the relatively successful anti-smoking campaign, the public is unlikely to endorse change.

This is certainly true, although I believe there’s also something more fundamental at work here, namely, how a society accounts for the different life outcomes of its citizens. In Unequal Childhoods: Class, Race, and Family Life, Annette Lareau describes the assumptions people make when they hold others personally responsible for their life circumstances. Read more

Share

Healthy lifestyles: The unfortunate consequences

Healthy lifestyles yoga poseContinued from the previous post, where I discussed the expansion of universal health care prior to the 1970s, how this created a growing demand for health care, and the problem health care costs posed for governments, especially when the economy suffered a downturn in the seventies. One response to the situation was to consider new ideas. Rather than limit strategies to what could be done by the health care industry, why not directly address the underlying causes of disease by considering social determinants of health.

Canada’s Lalonde report

In 1974, Canada produced the Lalonde report. It has been described as

[the] first modern government document in the Western world to acknowledge that our emphasis upon a biomedical health care system is wrong, and that we need to look beyond the traditional health care (sick care) system if we wish to improve the health of the public.

The US Congress emulated this thinking in 1976 by creating the Office of Prevention and Health Promotion. The US Department of Health, Education, and Welfare began publishing the document Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention in 1979. The response in European countries — caught in the same bind of greater demand, increasing costs, and the financial consequences of a deteriorating economic landscape – was similar.

The common thread in these new perspectives on health was the assertion that health could be improved — without increasing health care costs — if we concentrated on such things as the work environment (occupational health), the physical environment (air and water pollution, pesticides and other carcinogens in food), genetics, and healthy lifestyles. The approach was broad: the environment was considered at least as important as the promotion of healthy lifestyles. Read more

Share

Healthy lifestyles: The antecedents

Healthy lifestyles yoga poseIn the 1970s, public health policies began to promote the idea that individuals are responsible for their health and therefore have an obligation to adopt healthy lifestyles. Over the ensuing decades, health became both an extremely popular topic for media coverage and a lucrative market for vendors of health-related products and services. What followed was a substantial increase in health consciousness and greater anxiety about all things that concern the body.

Do healthy lifestyles actually produce better health? That they should may seem like common sense, which is one reason it’s been so easy to promote the idea that they do. The question is difficult to answer with absolute certainty, however. For one thing, the behavior that counts towards a healthy lifestyle does not readily lend itself to the objective measurements required for reliable scientific evidence. Defining health is also tricky. Lifespan is often used to compare the ‘health’ of different nations, but this fails to capture the subjective sense of health that is meaningful to individuals. Perhaps most important, while in theory a healthy lifestyle might improve health, that does little good if – as is now obvious – it’s extremely difficult to maintain behaviors that require things like changing what we eat and how often we exercise.

A related question would be: Did the promotion of healthy lifestyles reduce health care costs? This too seems like a sensible assumption, and the assertion is quite popular, especially among politicians. Health care costs have increased to hand-wringing levels. Promoting healthy lifestyles costs governments next to nothing, while the cost of health care is all too easily quantified. Read more

Share

What is healthism? (part one)

Apple and stethoscopeThroughout history there’s been an understandable desire to find connections between our behavior and our health. Human beings have practiced health regimens involving diet, exercise and hygiene since antiquity. When medicine was based on the humoral theory of disease, for example, individuals were advised to purge the body in the spring and, in the summer, avoid foods or activities that caused heat. Bathing in ice water was recommended in the 19th century. Mark Twain quoted the advice: “the only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d druther not.”

In the second half of the 20th century many Americans adopted the idea that a ‘healthy lifestyle’ (diet, exercise, not smoking, etc.) was a good way to prevent disease and live longer. This particular attitude was a product of popular perceptions about health (a surge of interest in holistic/alternative practices, self-care movements such as Our Bodies, Ourselves) and prevailing social attitudes (such as desirable body images). Perhaps more so than in previous centuries, the growth of media consumption and the effectiveness of modern advertising allowed commercial interests (books, magazines, fitness merchandise, vitamins and supplements, weight loss pills, diet and energy foods, …) to exert considerable influence on health behavior.

Also at work was extensive media coverage of a presumed link between preventive lifestyles and risk factors for disease (conflicting opinions about salt and which type of fats to eat are good examples). Unlike the vague aphorisms of previous generations, this more modern source of health advice had the scientific backing of epidemiology, if not the proof that comes from randomly controlled trials.

One of the terms used to describe the enormous increase in health consciousness is ‘healthism.’ Judging from how I’ve seen the word used, it means different things in different contexts to different people. I’m going to describe a few of those meanings.

This post grew rather long, so I’ve divided it into two parts. In part one I discuss an anti-authority sense of healthism as well as healthism’s most common meaning: a sense of personal responsibility for health accompanied by an excessive preoccupation with fitness, appearance, and the fear of disease. Part two discusses the moralistic and anxiety-inducing qualities of the term, plus an odd use where healthism becomes another word for health itself. Read more

Share

When the poor were contagious

Unsanitary living conditions 19th centuryThe Western world first industrialized in Great Britain, prompting vast numbers of inhabitants to move from the agricultural countryside to urban centers. Living and working conditions were deplorable. Andrew Mearn wrote in 1883 of the “pestilential human rookeries … where tens of thousands are crowded.” He continues:

To get to them you have to penetrate courts reeking with poisonous and malodorous gases arising from accumulations of sewage and refuse scattered in all directions and often flowing beneath your feet; courts, many of them which the sun never penetrates, which are never visited by a breath of fresh air, and which rarely know the virtues of a drop of cleansing water…. You have to grope your way along dark and filthy passages swarming with vermin. Then, if you are not driven back by the intolerable stench, you may gain admittance to the dens in which these thousands of beings who belong, as much as you, to the race for whom Christ died, herd together.

Pretty graphic. Roy Porter’s comment on this passage: “Historians still dispute whether industrialization raised or depressed wages and living standards – something, perhaps, impossible to measure.” Read more

Share

On sabbatical

Self-reflectionI’m taking a break from frequent blogging – want to take time to read, do some research, reflect, and think about what I most want to write about next. At the moment, my inclination is to concentrate on the history of medicine, starting with the Enlightenment, followed by the transformation of medicine into a science in the 19th century. I want to consider what the past might be able to tell us about the present.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

Medicine is not an abstract science, like quantum physics or mathematics. Scientific biomedicine may have its foundations in the research laboratory, but the practice of medicine takes place in the real, everyday world of doctors, patients, nurses, lab techs, clinics, hospitals, professional associations, patient advocacy groups, drug firms, insurance companies, politicians, the Internet, and the health advice columns of the Sunday papers. It takes place in a particular place at a particular time, and in a social, economic, political, and historical context.

To understand our dissatisfactions with and hopes for medicine – both as patients and practitioners – it helps to examine that context. And the context is easier to see if we step back from the immediacy of the current situation and consider the recent history of medicine. The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time.

“Not to know what happened before one was born is always to be a child.” (Cicero) Or, to expand on that a bit: “He who cannot draw on 3,000 years is living hand to mouth.” (Goethe)

Share

Is a liberal arts education good preparation for being a doctor?

Dr. Joel AngI’ve written before about doctors and the arts. In 1980 the cultural historian G. S. Rousseau, citing the techo-scientific nature of modern medicine, claimed that doctors no longer maintained the rich tradition of physicians as humanists. “Until recently, physicians in Western European countries received broad, liberal educations, read languages and literature, studied the arts, were good musicians and amateur painters; by virtue of their financial privilege and class prominence they interacted with statesmen and high-ranking professionals, and continued in these activities through their careers.”

Contemporary evidence contradicts Rousseau’s claim that physicians are no longer practitioners and connoisseurs of the arts. We may not personally encounter a doctor with her cello or recognize one painting en plein air in the little free time doctors have these days, but doctors write books that ascend the best-seller list, and many more write thoughtful, provocative blog posts. The poetry of doctors is published in medical journals and is available online in modest chapbooks. Nearly every major city throughout the world has an orchestra staffed by the medical profession. And the American Physicians Art Association encourages and assists physicians with art organizations and exhibits.

Is a liberal arts education valuable to physicians?

I have many unanswered questions about doctors as practitioners of the arts. I’d particularly like to know if the long-standing tradition of physicians as humanists has changed over the past half century. Higher education has definitely changed since the mid-20th century. In particular, there’s less emphasis on the value of a liberal arts education. (On this, see the excellent book, Not For Profit: Why Democracy Needs the Humanities, by Martha Nussbaum.) Has this affected physicians, either in their satisfaction with their careers or in their understanding of patients? Read more

Share

The tipping point for motor car casualties

From The Journal of the American Medical Association one hundred years ago:

An alarming increase in the number of street accidents from the recent development of motor traffic is shown by the report issued by the Highways Protection League. In 1905, thirty-five persons were killed and 1,557 injured by accidents due to motor traffic, while 118 were killed and 6,323 injured by horse traffic. In 1909, 163 persons were killed and 6,579 were injured by motor traffic, while 123 were killed and 5,589 were injured by horse traffic.

Horse carriage traffic Easter parade
Easter Parade on Fifth Avenue in 1900. There are at least two motor cars.
Read more

Share

History of patient modesty part 2: Convincing patients to disrobe

Pelvic exam patient modestyIn part one of this post I explained how a new anatomical understanding of disease in the 19th century changed the practice of medicine. Prior to this insight, there was no need to expose the naked body to observation or to touch parts of the body that were normally clothed. In order to apply the anatomical theory of disease, doctors needed to discover what was happening inside the body. This required a new type of physical exam, with much greater exposure and invasion of the body. The new exam was an abrupt and significant change in the tradition of patient privacy and modesty.

Making patients blush

Doctors welcomed both the new understanding of disease and new techniques, such as the stethoscope, that gave them useful information about the interior of the body. Understanding and technique alone did nothing to improve the ability to treat disease, by the way. That came much later. What doctors could do was provide a better prognosis, thus avoiding futile and painful treatment of the terminally ill.

How did patients react to this change in medical practice? Unfortunately, we have very little direct information. Most of the evidence we have comes from doctors, not patients. Doctors tend not to record the routine and taken-for-granted nature of a patient encounter. The private diaries of patients undoubtedly recorded reactions to the more invasive physical exam, but historians of medicine have typically been more interested in uncovering evidence of new medical discoveries than in noting patient experiences.

There is every reason to believe that women found the new physical exam deeply embarrassing. For example, a woman’s diary entry from 1803 reads: “Doctor Williams called and made me undergo a blushing examination.” In 1881, Conan Doyle recorded that a female patient would not let him examine her chest. “Young doctors take such liberties, you know my dear,” she told him.

The indirect evidence we have comes from efforts of the medical profession to convince patients that the new physical exam was necessary and proper. This took two forms: Emphasizing the professionalism of doctors and arguing for the scientific nature of medicine. These 19th century changes in the image of medicine contain the seeds of a new relationship between doctor and patient. They led to a style of medical practice today that increases rather than eases patient concerns about privacy and modesty. Read more

Share

History of patient modesty part 1: How bodily exposure went from unacceptable to required

Patient in open-back gownEven doctors can be embarrassed when it comes time to expose their private parts to medical personnel. In an essay that appeared in The Journal of the American Medical Association, a doctor describes her discomfort as she arrives for a colonoscopy appointment.

[A]s a person not exactly looking forward to the morning’s adventure, I found the receptionist’s demeanor and lack of eye contact wrapped me tight within a cold, impersonal cocoon. I was a subject. Though I hadn’t shared my sentiments with anyone, I felt both vulnerable and completely sheepish about having a very human reaction to such a common procedure. But this was my bottom and I was not happy to share it with others. Here to be exposed and invaded, in truth I was embarrassed and sought compassion. As anyone else would, I wanted to know that my discomfort, self-consciousness, and loss of control were understood. Instead, she exuded efficiency and delivered transparent quality assurance and poise.

The need to reveal private and intimate parts of our bodies is a routine occurrence in medical practice today. Though it may offend our modesty, we take it for granted that the embarrassing moments of a colonoscopy, a Pap test, or a prostate exam are necessary for our health.

Has it always been so? Have doctors always expected patients to disrobe? Have young male technicians always exposed the chests of female patients in need of a routine EKG? Have patients always been willing to allow doctors and their staff to view parts of the body normally seen by only the most intimate of partners? Read more

Share

The physical exam and society’s regard for physicians: A history

Laennec examines patient with stethoscopeThe physical exam – looking into the eyes and throat, taking the blood pressure, sounding the chest – is part of the process of medical diagnosis. It’s one way a physician attempts to determine the cause of a patient’s complaint.

In recent times, doctors have asked themselves whether the physical exam is becoming a lost art. It’s been replaced by an array of laboratory tests and high tech machines that presumably provide greater accuracy than the eyes, ears, and touch of a mere human being. (Smell, of course, also provides clues, and device makers are inventing medical gadgets that detect scents. Doctors no longer taste urine for sugar, as they did from antiquity into the 19th century, nor do they taste perspiration to see if it’s sweet, salty, or acrid.)

The reasons for the current decline of the physical exam are many. Hospital stays used to be much longer, so students had more time to learn from patients. The modern resident’s work week is officially limited, so there’s less time to spend at the bedside. Office visits are now much shorter, and a hands-on exam uses precious time. Read more

Share

Chilean miners benefit from older doctors

Trapped chilean miner rescuedWe live in a time when almost all doctors – even those who practice in rural areas of the US – rely on advanced technology for diagnosis and treatment. But there are times when knowing the old-fashioned way to practice medicine comes in handy.

Dr. Jorge Díaz, responsible for the team of 15 doctors who monitored the health of the trapped Chilean miners, has been a physician for a long time. As he put it, he “practised medicine before it became as sophisticated as it is today.”

One of the first medical emergencies his team encountered was a miner with a urinary tract obstruction. If the miner had been above ground, imaging technology could have located the obstruction and, if appropriate, a trained professional could have inserted a urethral catheter. Since that wasn’t an option, Dr. Diaz relied on his older, more basic skills. Read more

Share

I’m now a regular blogger on ConsultantLive

Marcus Welby and Steven Kiley at microscopeI‘m now a monthly guest blogger on ConsultantLive, and my first post appeared today. It’s the one where Marcus Welby gives a speech on the rewards of general practice as opposed to specialization.

I’d like to give the ConsultantLive site a plug here, since I’m grateful for the opportunity they’ve extended to me. (Disclosure: My relationship with ConsultantLive is totally non-financial.) The site is designed for primary care physicians, with a special emphasis on practical advice that helps doctors diagnose and treat common medical problems. There are lots of graphics – some of them undoubtedly not too appealing to the lay reader. Doctors can receive CME (Continuing Medical Education) credits by reading articles online and answering questions on what they’ve learned.

My column on the site is called “How Health Happened.” It’s mainly about the history of 20th century medicine and how that relates to changing attitudes towards health. I’ll probably be writing more posts here that emphasize the history of medicine, especially in relation to primary care. Read more

Share

The tyranny of health then and now

No socialism freedom vs tyrannyWhen we hear the words “tyranny of health” these days, it’s usually a reference to the tyranny of a government imposing unwanted health care on its citizens. It brings to mind images of protesters carrying signs that denounce the “socialism” of Obamacare.

As recently as 1994, however, the tyranny of health had a different meaning. That’s when Dr. Faith T. Fitzgerald published an article in The New England Journal of Medicine with that very title. What tyranny of health referred to – and what Dr. Fitzgerald’s readers readily understood at the time – was the idea that doctors should coerce their patients into being healthy. She objected to this increasingly prevalent attitude that expected the medical profession to be a combination of nanny and big brother.

Healthy lifestyles and the definition of health

The article begins with a reference to the recent emphasis on promoting healthy lifestyles: “Once upon a time people did not have lifestyles; they had lives.” (In 2010, it’s easy to forget that we did not always have “lifestyles.”) Dr. Fitzgerald then reminds readers of the 1946 definition of health from the World Health Organization (WHO): “A state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.” Read more

Share

“Tyranny of health” on KevinMD

One my recent posts — The Tyranny of Health — was a guest post today on KevinMD. Comments are available here.

The original “Tyranny of Health” article that I wrote about – published by Dr. Faith Fitzgerald in The New England Journal of Medicine in 1994 — is no longer available online in its entirety without a subscription. I plan to discuss it in more detail in the next post.

Update 10/18/10:

Here’s a rather lengthy response I wrote in reply to someone at KevinMD who asked: “In what way did the state turn over its responsibility of individual health to the individuals?” I’ve said these things before, both on this blog and elsewhere. It seems to be one of my pet topics. Read more

Share

Medicalization then and now

Traveling quackHere’s an editorial from an issue of The Journal of the American Medical Association published 100 years ago (emphasis added):

One of the cruellest and most despicable phases of the “patent medicine” business is the studied effort made by nostrum exploiters to frighten their victims into the belief that they are suffering from some more or less serious disease. Not content with the sale of their preparations to those who have—or who believe they have—one of the many diseases for which the products are recommended, the “patent medicine” vendors strive to create an artificial demand for their stuff by working on the imagination of the healthy and persuading them that they are sick. The scheme is an old one but none the less disreputable. One of the more recent modifications of this trick is the “gall-stone remedy” fake …

Compare this with a discussion of medicalization by Carl Elliott in his new book, White Coat, Black Hat . After describing how the condition formerly known as “urge incontinence” was repositioned as “overactive bladder” (to remove the stigma), he continues (emphasis added): Read more

Share

The art and science of medicine

Ars longa, vita brevisOne of my posts was featured today on KevinMD, Are physicians today active in the arts?.

While browsing the KevinMD site, I came across a post by “A Country Doctor,” Evidence based medicine at the expense of the art of medicine. My post was on the tradition of doctors as ”humanists” – educated professionals who contribute to the “fine” arts as writers, visual artists, and musicians. There’s a connection, however, between that tradition and the “art” of medicine.

What happens to doctors when the latest scientific methods of clinical decision making — as well as a reimbursement system that determines how medicine is practiced — encourage doctors to be little more than scientific technicians? Will their insight into the humanity and individuality of patients suffer? What happens to the physician’s art of addressing the uniqueness of each patient’s illness?

Read more

Share

Palliative care: Lost and recovered

Victorian deathbedHere’s an excerpt from the third and last part of the interview with me by Dr. Lisa Marcucci at Inside Surgery. The question asked for a little known fact from the history of medicine.

Easing the pain of death was a common medical practice in the 19th century. The doctor’s black bag contained laudanum as early as the 1600s. The 19th century added morphine (1806), codeine (1836), and aspirin (1892), along with the anesthetics chloroform and ether. At a time when physicians had very little to offer patients by way of cures – other than the ineffective “heroic” measures of bloodletting and purges — it was palliative care that made physicians welcome at the deathbed.

In those days, easing pain at the time of death was not called palliative care, but euthanasia. The term referred to the outward death of the body, in contrast to the death of the spirit. Euthanasia literally means a good death.

In 1870 a school teacher named Samuel Williams published an essay that used the term euthanasia to mean something else: mercy killing. The essay generated considerable interest and discussion. To make a long story short, the original meaning of the term euthanasia was completely lost.

Read more

Share

The tyranny of health

Chocolate cakeSomething happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”

This was not without consequences.

• Americans became increasingly preoccupied with diet, exercise, and health habits.

• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.

• The increase in news and advice columns on health and wellness made people more anxious about their health.

• The public sought medical care much more frequently for symptoms that would have been considered insignificant in the past.

Was “healthy lifestyles” a medical idea?

Health awareness and anxiety are nothing new. Throughout history people have been concerned about threats to their health. Bubonic plague killed 200 million people. The death rate for women who gave birth in the 19th century was 400 per 100,000 births, compared to 10 per 100,000 today.

Read more

Share

The physician as humanist

Still life with porcelain bowl and plums Ladislaus Rath BergerI have eaten
the plums
that were in
the icebox

and which
you were probably
saving
for breakfast

Forgive me
they were delicious
so sweet
and so cold

— William Carlos Williams

William Carlos Williams is part of an honorable tradition in the history of medicine — the physician/poet. He followed the example set by previous physician/poets, such as John Keats, Friedrich Schiller, and Oliver Wendell Holmes (of “Chambered Nautilus” fame). Physicians have also been writers, painters, musicians, philosophers, and – since the 19th century – photographers.

Yet in 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine had overwhelmingly become a science and not an art, he claimed, the interests and accomplishments of physicians had narrowed. (emphasis added)

In our century nothing has influenced the physician’s profile more profoundly than the loss of his or her identity as the last of the humanists. Until recently, physicians in Western European countries received broad, liberal educations, read languages and literature, studied the arts, were good musicians and amateur painters; by virtue of their financial privilege and class prominence they interacted with statesmen and high-ranking professionals, and continued in these activities through their careers. It was not uncommon, for Victorian and Edwardian doctors, for example, to write prolifically throughout their careers: medical memoirs and auto-biographies, biographies of other doctors, social analyses of their own times, imaginative literature of all types.

In twentieth-century America, the pattern has changed; only the most imaginative physicians can hope for this artistic lifestyle as a consequence of the economic constraints and housekeeping demands placed upon the doctor …. [T]he diminution of ‘humanist’ content in the training of physicians has lent an impression – perhaps falsely so but nevertheless pervasively – that medics are technicians, anything but humanists. As a by-product, it has nurtured a myth (already old by the eighteenth-century Enlightenment) that medicine is predominantly a science rather than an art. Both notions require adjustment if physicians hope to return to their earlier enriched, and probably healthier, role.

Rousseau’s comment on constraints (for “housekeeping demands” substitute “dealing with insurance”) is even more true today, especially for primary care physicians. A liberal education that values the humanist tradition is also in danger. See, for example, Martha Nussbaum’s Not For Profit, where she writes that contemporary education favors profitable, market-driven, career-oriented skills and devalues imagination, creativity, and critical thinking – qualities essential to the art and science of medicine.

But Rousseau’s assessment that physicians lack artistic interests is simply not true. Physicians continue to be prolific in their contributions to the ‘humanist’ tradition, most visibly as writers.

A plethora of physician/writers

Read more

Share

A brief history of antibiotics

bad-bugs

* 2000 B.C. – Here, eat this root
* 1000 A.D. – That root is heathen. Here, say this prayer.
* 1850 A.D. – That prayer is superstition. Here, drink this potion.
* 1920 A.D. – That potion is snake oil. Here, swallow this pill.
* 1945 A.D. – That pill is ineffective. Here, take this penicillin.
* 1955 A.D. – Oops….bugs mutated. Here, take this tetracycline.
* 1960-1999 – 39 more “oops”…Here, take this more powerful antibiotic.
* 2000 A.D. – The bugs have won! Here, eat this root.
— Anonymous

From the World Health Organization, “How Resistance Develops and Spreads” (emphasis added):

Twenty years ago physicians in industrialized nations believed that infectious disease were a scourge of the past. With industrialization came improved sanitation, housing and nutrition, as well as the revolutionary development of disease-fighting antimicrobials. Populations living in those nations were not only enjoying an unprecedented decrease in mortality and morbidity, but a corresponding increase in life expectancy. …

Read more

Share

Déjà vu: Historical resistance to the inequities of health

If statistical analysis shows conclusively that morbidity and mortality are directly related to income, what should a (presumably) enlightened government do with this information? One approach, consistently popular throughout history, is to blame the victims. In the Reagan/Thatcher years we saw an enthusiastic promotion of taking personal responsibility for one’s health. Personal responsibility follows naturally… Read more

Share

Health inequities: An inhumane history

Whenever there are disparities in income, inequities in health are inevitable. Today in the US, the gap between the rich and the poor is much greater than in most other highly developed democratic countries, and so are the health inequities. The roots of this inequality lie deep in the histories of developed nations. When children… Read more

Share

Health Culture Daily Dose #17

Additional stories related to health. Categories include: More articles on Health Care Reform, History of Medicine, Medical Journalism, Medical Technology, Medical News, Pharmaceuticals, Pop Culture, Social Media and the Internet, and The So-Called Obesity “Epidemic.” HEALTH CARE REFORM A ‘Common Sense’ American Health Reform Plan (The New York Times – Uwe Reinhardt) After studying this… Read more

Share

Collateral circulation and the cat concerto

Like the appendix , collateral circulation is another part of our anatomy that was more useful to our ancestors. Collateral circulation refers to systems of veins and arteries that allow blood to continue flowing when the main pathway is blocked or damaged. These extra vessels sometimes develop in response to a circulation blockage. But certain… Read more

Share

Still useful after all these years: The gall bladder

The gall bladder is another useful but expendable organ (see recent posts on the appendix and the spleen). Unlike losing your spleen, living without a gall bladder is not detrimental to your health, though it may be inconvenient at times. The gall bladder is located under the liver, on the right side of the body.… Read more

Share