activism in medicine: history, literature, and contemporary issues and movements martin donohoe

Activism in Medicine: History, Literature, and Contemporary

Issues and Movements

Martin Donohoe

Overview

• Background

• Issues

• History

• Literature

• Quotes and Photos

• Education, the media, and democracy

• What you can do

Portland, OregonMount 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

• Florence Nightingale

• Margaret Sanger

• Albert Schweitzer

• Charles Dickens

• George Orwell

Important Historical Figures in Medicine/Public Health and Social Justice

• Upton Sinclair

• Anton Chekhov

• William Carlos Williams

• Thomas Hodgkin

Important Contributions of Public Health

• 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 = $5-50

• 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

• 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, antibiotic-resistant 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-in-chief– 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-in-chief – 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

• 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

• 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”

1997 1976

• Astrology 37% 17%• UFOs 30% 24%• Reincarnation 25% 9%• Fortune-Telling 14% 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 disability-adjusted 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

• 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

• 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

martindonohoe@phsj.org