History

Ready to be moved? Take a few minutes to read this touching essay, which CommonHealth posted today, on being gay in the medical field. Written by Mark Schuster, MD, PhD, the William Berenberg Professor of Pediatrics at Harvard Medical School and chief of general pediatrics at Children’s Hospital Boston, the text is based on a speech the author gave in 2010 at the Children’s Hospital Boston GLBT & Friends Celebration.

Schuster records incidents of discrimination he faced or observed during his medical education in the 1980s and in his early career. He also remarks on how the field has progressed in its treatment of gays and lesbians and brings to light issues that still need addressing. From the piece:

It may seem odd that I didn’t complain to anyone, but there was no one at the medical school or the hospital to whom I or my gay classmates thought it was safe to complain. There were no policies to protect us; no grievance boards; no mechanisms in place. Times have changed, but I still have undergrads ask me if they can come out in their medical school applications and medical students ask if they can come out in their residency applications. Yes, times have changed, but they have not changed enough.

…

I could not believe that in a mere two decades we had gone from “I’ve decided not to write you a recommendation” to “Your job is to get this guy’s partner a fellowship.”

…

It’s easy for me to think that my experiences two decades ago are ancient history. For me, they are. I’ve been lucky enough to construct a life that does not involve a daily fear of being outed, of being beaten, of being fired, or of having my children taken away from me. But many people still live with such fears. My experiences wouldn’t sound so quaint to them.

This week, the Wellcome Collection opens a new exhibit titled ‘Brains: The mind as matter‘. This intriguing photo of a trephination set circa 1771-1830 comes from the ‘cutting-treating’ image gallery of the exhibit.

Trephination is an early surgery procedure that involves drilling a hole into the skull to treat certain medical conditions. As the image caption explains:

The basic practices and tools have remained largely unchanged for centuries. Among the trephines themselves, with their cylindrical blades, are a large brace to hold the trephines during drilling, two rugines to remove connective tissue from bones, two lenticulars to depress brain material during surgery and a brush to remove fine fragments of bone. The styling of the instruments and their box reflects a long tradition of producing surgical and scientific instruments as finely crafted, gentlemanly possessions.

Photo by Wellcome Trust

Since publishing the seminal text Who Shall Live? Health, Economics, and Social Choice in 1974, Stanford’s Victor Fuchs, PhD, often has been cited on the economics of health care policy. Now, in a perspective piece published today in The New England Journal of Medicine, Fuchs provides a historical view of health care trends in the United States.

In the piece, the author explains the almost continuous increase in expenditures in the last six decades and comments on the challenges undermining cost-control efforts. And he provides a staggering figure that situates the health care problem as a major, long-term economic one:

In 1950, health expenditures accounted for only 4.6% of the gross domestic product (GDP). In 2009, they accounted for more than 17%, a larger share than all manufacturing, or wholesale and retail trade, or finance and insurance, or the combination of agriculture, mining, and construction.

Fuchs doesn’t expect that number to come down anytime soon:

It is difficult to see how the health sector can continue to expand rapidly at the expense of the rest of the economy, but every past prediction of a sustained slowing of the growth of health expenditures has been proved wrong. Rapid growth may continue as a result of political gridlock regarding the form that curbs on expenditures should take. There is no public consensus about how much care should be provided for the poor and sick or how it should be done. Similarly, there’s no public consensus regarding efforts to increase the efficiency of care.

Previously: Views on costs and reform from the “dean of American health care economists”, Health economist Victor Fuchs looks at Who Shall Live, Why is cost-effective care so difficult to achieve? and Victor Fuchs talks health-care costs and reform in Q&A

I missed this last Friday, but Letters of Note has an historical letter from Marilyn Monroe to her physicians written shortly before she had an appendectomy. Apparently the note was a surprise to her physicians and was taped to her stomach. She begins:

cut as little as possible I know it seems vain but that doesn’t really enter in to it. The fact I’m a woman is important and means much to me.

The letter is short and the rest is worth reading. Head over to Letters of Note for more.

Today Letters of Note is featuring a fascinating letter from Lucy Thurston, a 60-year-old missionary living in 1855 Hawaii, in which she recounts undergoing a mastectomy without anesthesia. Writing to her daughter, she describes how the procedure began:

Thus instructed, and everything in readiness. Dr. Ford looked me full in the face, and with great firmness asked: “Have you made up your mind to have it cut out?” “Yes, sir.” “Are you ready now?” “Yes, sir; but let me know when you begin, that I may be able to bear it. Have you your knife in that hand now?” He opened his hand that I might see it, saying, “I am going to begin now.”

The rest of the letter isn’t for squeamish readers, but it does provide a fascinating look at 19th-century medicine. Reading it will make you very thankful for modern anesthesiology.

Happily, Thurston lived for many years after her mastectomy: “And here is again your mother, engaged in life’s duties, and life’s warfare.”

Photo of Lucy Thurston is in the public domain

A recent post on the Wellcome Collection blog examines how ancient artifacts, such as this Etruscan votive offering, can provide fascinating insights into cultures that existed thousands of years ago and how people at this time understood their bodies. Catherine Walker writes:

The knowledge of what was going on inside the body was limited, so what couldn’t be observed would have been assumed. If we take the votive uterus pictured above as an example, we can see that there was little knowledge of what the organ actually looked like. Autopsies would not have been carried out at this time; there are isolated cases in third-century BCE Alexandria, but these are not the norm. The form of this votive is based on assumptions and what observation could have been made. They would have been aware of the function of the organ and could have observed childbirth, so we see that this understanding has been incorporated into the votive as the wavy lines represent contractions…

This is why these votives are my favourite objects in the Medicine Man gallery. While we can gain insight into how much people knew about what was going on inside their bodies from classical texts, these votives show us how this knowledge impacted day-to-day life.

The full post is worth a read and will give you a greater appreciation of the dramatic advancements in both medicine and the technologies used to better understand our bodies.

Previously: A look at the history of X-rays
Photo by Wellcome Images

I have to admit, I’ve not yet seen Meryl Streep’s Margaret Thatcher in The Iron Lady. But the chameleon actress who inhibits the skin of all of her characters has brought the life of the former British Prime Minister to a whole new generation of moviegoers who may not have been aware of Thatcher’s reign over Great Britain from 1979 to 1990.

I recently came across a fascinating tidbit about Lady Thatcher when I sat with Stanford’s Robert Jackler, MD, to record a podcast about his latest study on the tobacco industry marketing cigarettes with the assistance of the medical community. After the interview, Jackler and I continued to gab about the genius marketing efforts of tobacco since the 1920s – reaching Hollywood stars, tapping athletes and sporting events and involving a huge lobbying machine that kept tobacco golden for decades. Jackler mentioned he had seen the Streep film over the weekend, and it reminded him about what he discovered about Thatcher while perusing secret documents uncovered as part of the 1999 Master Settlement Agreement between the tobacco industry, 46 state governments and five U.S. territories.

Shortly after she left 10 Downing Street, in a deal brokered by her son, Mark, Britain’s first woman prime minister became a shill for the tobacco industry, specifically Philip Morris. Jackler pointed me to a treasure trove of internal documents at the Legacy Foundation Documents Library detailing the Iron Lady’s partnership with the American tobacco conglomerate.

The deal was sealed on November 10, 1992 when Philip Morris’ General Counsel, Murray Bring, wrote Thatcher Foundation representative Robert Higdon pledging $750,000 to be split over three years beginning that year. Documents state that the contribution was just part of a larger financial arrangement that Philip Morris had with Thatcher:

Philip Morris Inter-Office Correspondence Date: September 30, 1991
To: Ms. Stephanie French (Vice President, Corporate Contributions)
From: Murray H. Bring

We are about to enter into a consulting arrangement with Mrs. Thatcher. It has been suggested by her representative, Mark Thatcher, that a portion of our fee should constitute an annual $250,000 grant to the Margaret Thatcher Foundation, which will be established in the U.S.

The memo continued:

Mark Thatcher advised me that the Foundation expects to be involved in a number of educational activities, and will also be heavily involved in environmental matters. He also indicated that we would be able to target our grant to specific Foundation projects which would be approved by us in advance.

Of course, Philip Morris’ desire to use Thatcher’s prominence to help gain access to world leaders and promote tobacco around the globe was never explicit, but the company’s intent was clear, as evidenced by an internal memo between two Philip Morris executives in January 7, 1992, shortly after the partnership commenced:

Inter-Office Correspondence
To: Murray H. Bring
From: Charles R. Wall
Subject: Margaret Thatcher

Two thoughts on Margaret Thatcher.
1) Can she help the proposed Ad Ban Directive under wraps? I can check with Hugh or someone to check with our Brussels people.
2) Can she help with any Eastern European countries where we are in negotiations, etc. with the governments? I do not know enough to be more specific.

It’s sad to think that peddling cigarettes around the world is one of the legacies of the woman who led Britain for more than a decade. Instead of Iron Lady, from now on I’ll have to think of Thatcher more as a blackened lung.

Previously: Throat doctors manipulated by Big Tobacco, Early anti-smoking advocate: King James I of England? and NPR’s Picture Show highlights Stanford collection of cigarette ads
Photo of Margaret Thatcher is U.S. Government Work

Yes, it might seem like sleep researcher William Dement, MD, PhD, and the late Jerry Garcia would make very strange bedfellows. But, that wasn’t the case at a Stanford event on Saturday. There, they blended together – albeit, in a circular way – like a sweet dream in a deep sleep.

More than 60 people with a variety of ties to the Stanford Sleep Disorders Clinic and Research Center came together at the Jerry House (yes, that Jerry) for the unveiling of a long-awaited plaque discussed earlier today. I was one of the people there to honor the Stanford “sleep camps” held there in the 1970s and ’80s.

A wide variety of those involved with the camps showed up at the event to revisit their pasts and talk about their presents. It was a fun, wacky reunion, bringing together 10 years worth of researchers and researchees. Some flew in from distant ports, and their entrances generated hugs and squeals and hearty handshakes. There was a coterie of “campers,” some the progeny of professors and staff, who happily dispensed memories and swapped tales. There were full-fledged doctors who, as undergrads, acted as “sleep counselors.” And there were sleep-research luminaries who were, back then, just getting the sleep-research field powered up.

The plaque, which was concealed under a very ’60s tie-died cloth, was unveiled, and the researchers who led the work at the camps spoke, acknowledging the importance of the research and expressing gratitude to all involved. The remarks of Mary Carskadon, PhD, expanded into a very detailed string of stories – a decade of escapades involving rambunctious kids, stealthy undergrads, and 24-hour-a-day volleyball tournaments.

There was an abundance of delicious food, a terrific Sancerre, a quantity of beer and an enormous, mega-cake with a stunning replica of the plaque laid out in the frosting. It was the perfect fuel for dancing on a sunny, spring-like afternoon, so when the Grateful Dead-inspired band let loose, people were ready. The air was charged, and the past quickly became the present. Gauging by the expressions on many faces, I don’t think I was the only one transported back to college days!

Previously: Thanks, Jerry: Honoring pioneering Stanford sleep research
Photo of Dement by Robert Tognoli

As the writer who has long covered the sleep “beat” for our office, I’m quite familiar with Stanford’s rich history of sleep research. For those in need of some background: The Stanford Sleep Disorders Clinic and Research Center, the first center of its kind, was established in 1970 - by William Dement, MD, PhD, who came here after working in the lab where rapid eye movement was discovered – and numerous advances, like the discovery of the cause of narolepsy, have been made since then. Until recently, though, I wasn’t familiar with the role of a Stanford dormitory in that history.

As it turns out, for a ten-year period starting in the mid-70s, the residence now known as Jerry House served as the site of a series of pioneering sleep studies: Undergraduates and members of the community lent themselves for study during “summer sleep camps” at the house. Until that time, the field of sleep research - still in its infancy – had centered on nighttime events, but researcher Mary Carskadon, PhD, now a professor of psychiatry & human behavior at Brown University, focused these camp studies on the role of sleep in daytime function. The participants’ sleeping and waking were manipulated, recorded and examined; and the end result was important data on sleep restriction and sleep deprivation, and the establishment of clinical protocols still used today.

“Much of the essential, pioneering sleep work at Stanford was done in these camps,” sleep expert Rafael Pelayo, MD, recently told me. “The work had great consequences on the development of the field of sleep research here and around the world.”

This weekend, Pelayo joined Carskadon, Dement and others in honoring this early, important research and unveiling a wood-and-glass commemorative plaque to be housed there. (Writer Patrick May was there and reported on the event for yesterday’s San Jose Mercury News.) The plaque outlines the significance of the studies and highlights the successful careers of Carskadon and Dement, but I like its line of summary the best:

Jerry House at Stanford University was the unique site for seminal research findings that apply to every man, woman and child on the planet.

Photo courtesy of Stanford Residential Education

For half a century beginning in the 1920s, tobacco companies continued a campaign to manipulate throat doctors – primarily with money – into helping calm the public’s growing fears that smoking might not be good for you.

Most shocking about this was that many of the most well-respected leaders in the field of otolaryngology got on board with this campaign – testifying before Congress, recommending certain brands of cigarettees to their patients – into the 1970s when the scientific evidence pointing to the hazards of smoking had become overwhelming.

In a story I wrote for Inside Stanford Medicine today, Robert Jackler, MD, professor and chair of otolaryngology at Stanford, discussed his latest study on the manipulation of doctors by Big Tobacco. The paper appears in this month’s issue of Laryngoscope. An otolaryngologist himself, Jackler found the results of his research particularly disheartening:

Tobacco companies dreamed up slogans such as, ‘Not one single case of throat irritation with Camels;’ then, to justify their advertising claims, marketing departments sought out pliant doctors to conduct well-compensated, pseudoscientific’research,’ which invariably found the sponsoring company’s cigarettes to be safe.

Previously:  A conversation about the FDA’s new graphic health warnings for cigarettes, Early anti-smoking advocate: King James I of England? and NPR’s  Picture Show highlights Stanford collection of cigarette ads