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In 1990, University of Pittsburgh Public Health Professor John C. Cutler delivered to the university's archives thousands of pages of documents and photographs about an unpublished research project that he ran in Guatemala for the U.S. and Guatemalan governments between 1946 and 1948. Duly cataloged, the files then sat in the library until the mid 2000s, when historian Susan Reverby began to read them as part of her book project on the Tuskegee syphilis studies.
Who knew that the infamous U.S. Public Health Service Study of Untreated Syphilis in Tuskegee, Alabama, had an off shore successor? Unlike Tuskegee, the Guatemala studies led by Dr. Cutler involved actual inoculation of sexually transmitted diseases and the paying of sex workers to transmit disease. Unsuspecting and unconsenting prisoners, soldiers, mental patients, and sex workers participated; only some were treated if and when they became infected.
In 2009, Professor Reverby returned to the Pittsburgh archive, and in 2010 she wrote up her findings on the Guatemala project. She shared her unpublished article with the late David Sencer, former director of the Centers for Disease Conrol (CDC), who gave the article to the current CDC leadership. The CDC prepared its own report and sent it, along with the Reverby article, up the chain of command to the White House. On Oct. 1, 2010, Health and Human Services Secretary Kathleen Sebelius and Secretary of State Hilary Rodham Clinton apologized to the Guatemalan government and President Obama telephoned then President Colom in Guatemala to explain. In the spotlight of worldwide media attention, presidential commissions in both countries undertook investigations, and survivors of the study filed suit against the U.S. government. The Guatemala study and its aftermath have urgently renewed debate about the ethics of clinical research involving human participants, especially research carried out with vulnerable populations and in the global arena.
In this Medical Center Hour, Susan Reverby discusses how her discovery of the Guatemala study files set in motion international investigative and diplomatic processes and what we can learn from this ethically immoral use of medical science. Bioethicist John Arras, a member of the Presidential Commission for the Study of Bioethical Issues, will comment on the commission's investigation and its 2011 report, Ethically impossible: STD research in Guatemala from 1946 to 1948.
A diverse population of caregivers working in clients' homes constitutes a vital link in our health care “system,” their services filling a gap between institutional care and what families are able to manage on their own. Who are these caregivers, what is their work, and what does their work mean—to them, to the clients and families they serve, to our larger society? Prompted by the recent documentary film, CARE, by Deirdre Fishel, which profiles five caregivers and their elderly clients, this Medical Center Hour inquires into the nature and lived experience of home-based caregiving for elders. What role will such home care play as our society ages and people seek to stay at home with complex, care-intensive medical conditions? How can we better value and compensate care workers and better support families who need their services? What about the sustainability of the home health caregiving economy and its workforce?
A John F. Anderson Memorial Lecture
Co-presented with the Department of Chaplaincy Services, UVA Health System
At a time when lesbian, gay, bisexual, and transgender (LGBT) individuals enjoy ever greater social acceptance and legal protection, transgender teens and young adults still face challenges on many fronts. Simply negotiating adolescence isn't easy, and gender identity issues can complicate matters. Health care for transgender youth is in transition, as the population becomes better understood. In this Medical Center Hour, a panel of pediatricians makes the case for increased cultural competency in medicine and society alike to help give transgender teens a safe medical home and help them to lead satisfying, successful lives.
Tuberculosis continues to be one of the world's most deadly infectious diseases, killing almost two million people each year. In this Medical Center Hour, historian Christian McMillen explores TB's stubborn staying power by examining key aspects of the disease—including the rise of drug resistance and TB's resurgence with the HIV/AIDS epidemic—and detailing global efforts to control it since 1900.
Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
Neurologist Oliver Sacks (1933-2016) was a legend in his own time—as a physician but also as a writer whose work probed medicine, science, and the arts and as a tireless explorer of both the natural world and the human condition. His clinical tales, published in the medical literature and mass media alike, found a wide audience across medicine and society. Behind these tales, which stretched the case history to illuminate and celebrate the person who was marked, and often rendered remarkable, by neuropsychological illness, flared Sacks's own curiosity, an insatiable urge to question and a generous capacity for paying meticulous attention.
In this inaugural Hook Lecture in Medicine and the Arts, writer and photographer Bill Hayes, who was Sacks's late-life partner, offers insights into Oliver Sacks as a person and a physician whose creative nature and prodigious output enriched medicine and culture across a long and productive life. A writer and photographic artist in his own right, Hayes addresses the place of curiosity and creativity in Sacks's practice and his own, especially how, for both, interest in and radical openness to a fellow human being are paramount.
The Edward W. Hook Lecture in Medicine and the Arts / Medical Grand Rounds
Co-presented with the Department of Medicine, with which the Medical Center Hour shares a fund established by the late Edward W. Hook MD MACP whereby the arts can generously enrich medical education and training.
Despite their reliance on technical knowledge that requires mastery, medicine, law, and business are all deeply human professions. Medicine is more than body repair, law more than legal systems, business more than the physics of money. While professional education necessarily must be at the cutting edge of technical expertise, it must remember too the human nature—including the values, emotions, and richly complicated lives—of professionals and professional organizations. In this Medical Center Hour, Professor Ed Freeman from UVA's Darden School of Business demonstrates how the creative arts and humanities can be embedded in professional education to address and actively teach ethical conduct in professional life and leadership of complex professional organizations. What lessons in course design, student engagement, and classroom outcomes might medical educators draw from Professor Freeman's courses, "Business Ethics through Literature" and "Leadership, Ethics, and Theater"?
A John F. Anderson Memorial Lecture
Co-presented with the Institute for Practical Ethics and Public Life, UVA
With the aging of our nation's practicing physicians and the recent, steep decline in medical graduates choosing careers in primary care for adults, U.S. patients today are hard pressed to find a primary care doctor. And the already impressive gap between supply and demand of primary care physicians will likely widen once more than 30 million people gain access to health insurance under the Affordable Care Act. The urgent shortage of primary care physicians compounds this country's already significant health care challenges regarding access, delivery, and cost of care. In an era when all of health care is undergoing potentially transformative change, what will be the role of primary care doctors? For patients, what will be the "value added" of having a primary care M.D.? What roles will other primary providers (physician assistants, nurse practitioners) play? Is the primary care physician an endangered species, or a key participant in a newly configured primary care team? How can we devise, model, deploy, and teach new ways of delivering primary care that are team based, interprofessionally collaborative, effective, and satisfying to patients and practitioners alike? In this Medical Center Hour, family doctor and medical journalist Susan Okie draws on her recent Perspective article in the New England Journal of Medicine to explore the prospects ahead for the primary care physician. Two of UVA's primary care physicians: one a mid career family medicine physician and teacher, the other a medical student planning a primary care career offer their perspectives as well.
Co-presented with the Generalist Scholars Program in observance at UVA of Primary Care Week
On 13 September 2017, the University of Virginia proudly dedicates as Pinn Hall the medical education and research building formerly known as Jordan Hall. The building’s new name recognizes UVA medical graduate Vivian W. Pinn MD, Class of 1967, founding director of the Office of Research on Women’s Health at the National Institutes of Health. Dr. Pinn was the second African American woman to graduate from the School of Medicine and went on to a distinguished career in pathology and in medical leadership. One of the medical school’s four colleges bears Dr. Pinn’s name, and she is an active presence in Pinn College student life.
This Medical Center Hour celebrates Dr. Pinn and her accomplishments and calls attention to critical current issues of fair and full access for underrepresented minorities, especially African American women, as students, practitioners, and leaders in medicine but also as beneficiaries of health care. Individually and institutionally, what can we learn from Dr. Pinn to ensure that her legacy matters?
Co-presented with the Department of Medicine and the Generalist Scholars Program, in conjunction with UVA's dedication of Pinn Hall and the UVA medical students' celebration of Primary Care Week
Early in her own training in psychology a decade ago, Casey Schwartz discovered that contemporary neuroscience and psychoanalysis are entangled in a conflict almost as old as the disciplines themselves. Many neuroscientists, if they think about psychoanalysis at all, view it as outdated, arbitrary, and subjective, while many psychoanalysts decry neuroscience as lacking the true texture of human experience. Yet some are now fighting passionately to bring the two fields together, including Mark Solms, a South African psychoanalyst, neuropsychologist, dream researcher, and towering presence in the effort to grow the hybrid discipline that he himself calls neuropsychoanalysis. Ms. Schwartz has written this story in her new book, In the Mind Fields: Exploring the New Science of Neuropsychoanalysis. In this Medical Center Hour, she tracks and interprets the ongoing struggle to define what we mean by the mind, the brain, and everything in between.
History of the Health Sciences Lecture
Co-presented with History of the Health Sciences Lecture Series and the Department of Psychiatry and Neurobehavioral Sciences
Whether we are students, educators, or clinicians (learners all!), our stated assumptions and principles are sometimes at odds with our actual practices. In this Brodie Medical Education Award Lecture, learners of all stripes will practice foundational skills such as cultivating beginner’s eyes and more accurate data collection in order to uncover and examine habits and thought patterns that may no longer serve us. Understanding our own assumptions and the values they reflect will allow us to be more intentional in designing educational programs and clinical learning/practice environments that are principle-driven and meet the needs of patients, learners, and caregivers.
The Brodie Medical Education Award Lecture/Medicine Grand Rounds