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An oral history interview with Dr. Maurice Apprey, conducted on May 12, 2022. This interview is part of a joint effort of the Claude Moore Health Sciences Library and the UVA Medical Alumni Association and Medical School Foundation.
Maurice Apprey was born in Ghana, West Africa. He received a B.S. in Psychology, Philosophy, and Religion from the College of Emporia, Kansas, and graduated in 1974. Dr. Apprey was one of a small number of students who trained under Anna Freud at the Hampstead Clinic in London, from which he graduated in 1979. After studying phenomenological psychological research and hermeneutics with Amedeo Giorgi at the Saybrook Institute in San Franciso, CA, Dr. Apprey received a Ph.D. in Human Science Research. He later pursued a doctorate in Executive Management from the Weatherhead School of Management at Case Western Reserve University.
In 1980, Dr. Apprey joined the faculty of the UVA School of Medicine in the department of Psychiatry and Neurobehavioral Sciences. In 1982, he was appointed Assistant Dean of Student Affairs. His work with current and aspiring medical students continued for two and a half decades, and he was later appointed the Associate Dean of Diversity at the School of Medicine (in 1992) and the Associate Dean of Student Support (in 2003). During these years, Dr. Apprey was highly effective in increasing the number of students from under-represented backgrounds at medical school through initiatives like the Medical Academic Advancement Program (MAAP). He taught undergraduates, medical students, residents in psychiatry and psychology, and hospital chaplains, among others. In 2007, Dr. Apprey was invited to become Dean of the Office of African-American Affairs for the University of Virginia. He accepted and served in that role until his retirement in 2022.
Oral history interview with Michael Allen, class of 1985, via Zoom, on February 29, 2024. Allen discussed the formation and early activities of UVA Law’s Gay and Lesbian Law Students Association, which later became UVA Law’s chapter of Lambda Law Alliance.
Growing enthusiasm in medicine and in the population at large for early diagnosis has engaged many doctors in a systematic search for abnormalitites in persons who are well. While physicians, patients, and the press tend to focus on the potential benefits, Dr. H. Gilbert Welch in his work has exposed the often-ignored harm associated with this practice: overdiagnosis. Diagnoses of a great many conditions, including high blood pressure, osteoporosis, diabetes (and prediabetes), and even cancer, have skyrocketed in recent years, yet many individuals so labeled are destined never to develop symptoms, much less die, from their conditions. They are overdiagnosed. And overdiagnosed patients as Dr. Welch points out in the Medical Center Hour, cannot benefit from treatment since there is nothing to fix. But they can be harmed. Understanding the trade-offs involved is critical, Dr. Welch argues, so that health care systems don't further narrow the definition of "normal" and, ironically, turn more and more well persons into patients.
Co-presented with the Department of Public Health Sciences, School of Medicine; the Sadie Lewis Webb Program in Health Law, School of Law; and the Institute for Practical Ethics and Public Life, UVA
Over the last half-century, pain medicine has been defined by controversy: when is pain real? Does too-liberal, overly compassionate relief create addiction? Is chronic pain a legitimate basis for disability claims and long-term benefits? What should we do when end-of-life pain care resembles physician-assisted suicide or euthanasia? Professor Keith Wailoo explores the political and cultural history of these complex medical and social debates, examining how pain medicine emerged as a legitimate yet controversial field; how physicians, patients, politicians, and the courts have shaped ideas about pain and its relief; and how the question “who is in pain and how much relief do they deserve?” has become a microcosm of broader debates over disability, citizenship, liberalism, and conservatism in American society.
Co-presented with History of the Health Sciences Lecture Series and
the Institute for Practical Ethics and Public Life, UVA
History of the Health Sciences Lecture
Primum non nocere--"first, do no harm"--is a fundamental principle of medical practice, expressing both the hope and humility of physicians. It cautions doctors that even with the best intentions may come unwarranted consequences. One present-day application of this principle has to do with efforts to eliminate hospital-acquired infections. When we define such infections as inevitable if regrettable collateral damage wherever complex care is provided to very sick patients, we create a rationale for paying for them and institutionalize their harm. And we may lose sight of their tragic human and economic costs, and of clinicians' own involvement. The annual Richardson memorial lecture addresses the human toll of medical error and calls for improved patient safety. In this Richardson lecture, Dr. Richard Shannon challenges the academic medical center not only to create safer systems that prevent bloodstream infections but also to invest every frontline worker with the capability and responsibility to see and solve problems before they propagate into error. Importantly, this is about more than safety. It is about culture change, creating a culture of habitual excellence in everything we do. Safety is simply the unassailable starting point. Another foundational medical principle applies: Cura te ipsum--"physician, heal thyself."
Co-presented with the Patient Safety Committee, UVA Health System
Hospitals and clinics and safety-net organizations across the U.S. are increasingly challenged to provide medically appropriate care to undocumented and uninsured immigrants. These "patients without passports" do not qualify for public benefits that finance health care for low income persons and often lack other means to secure care for themselves and their families. In this Medical Center Hour, Nancy Berlinger, co-director of The Hastings Center’s Undocumented Patients project, explores the ethical and practical dimensions of health care access for this cohort of immigrants, drawing on data from Virginia and other states and on her work with New York City policymakers to improve health care access for vulnerable populations. UVA emergency medicine physician David Burt offers a local perspective.
A John F. Anderson Memorial Lecture
Co-presented with Institute for Practical Ethics and Public Life
Have you ever received an unsolicited email from a publisher you’ve never heard of inviting you to submit a paper to a journal with a generic-but-believable-sounding name or a conference abroad or at an airport hotel? These publishers may advertise their journals as “open access” and promise to make your work visible to well-known indices; they may claim “impact factors” and editorial board members who are leaders in their field. All that’s required of you is a modest fee—an "author’s processing charge"—and these publishers can deliver the lifeblood of any academic career: a peer-reviewed publication. There’s just one catch: the journals are fake.
These journals are labeled "predatory," and they are sometimes associated with the broader open-access movement. This Medical Center Hour tours the strange world of predatory publishing and describes some of its more outrageous excesses. But, as Brandon Butler will argue, the fake journals are just a distraction. The academy today faces more serious challenges as it wrestles with how best to share research and knowledge. How should academia confront the predatory moves of its most well-established publishing partners and take better advantage of open access?
A John F. Anderson Memorial Lecture
In a year that has seen gun violence in the U.S. escalate even more—consider the almost-daily gun deaths on the streets of Chicago or the recent Las Vegas massacre—this Medical Center Hour looks anew at this urgent public health problem. Distinguished bioethicist Steven Miles presents a comprehensive status report on gun deaths (homicides and suicides), including issues of gun supply, the relevance of mental illness, race, and poverty to firearm deaths, the effects of gun law reforms, and the prospects for better prevention of gun violence.
A John F. Anderson Memorial Lecture
Opiate abuse and addiction in the U.S. population have reached epidemic proportions, with one result being that primary care practices increasingly see patients for whom addiction is the presenting, or exacerbating, problem. But are primary care practitioners actively engaged in treating addiction? Unfortunately, no, says Dr. Hughes Melton, a primary care physician and Virginia's Chief Deputy Commissioner of Public Health and Preparedness. They lack the practical training and helpful mindset to approach addiction, but, also, addiction is more than a medical problem, with multiple stakeholders beyond patient and family, doctor, and clinic.
In this Medical Center Hour, Dr. Melton and two Generalist Scholars--students preparing for careers in primary care--consider what primary care practitioners need in order to care effectively for this urgent population health problem: practical skills and informed attitudes, to be sure, but also the will and nuanced capabilities to be robust social leaders in the community.
A John F. Anderson Memorial Lecture
Co-presented with the Generalist Scholars Program and the Department of Public Health Sciences in observance of Primary Care Week at UVA
Over the last decade, the number of reports urging American universities to expose their health professional students to interprofessional education (IPE), so that those who will practice together may learn together, has exceeded the number of actual IPE experiences in most nursing and medical students' entire curricula. In 2013, strong new calls for interprofessional education came from the Institute of Medicine and the Josiah Macy Jr. Foundation. What does this mean for the University of Virginia's Schools of Nursing and Medicine, our students, our health systems, and the patients and families we serve? If we were to push the envelope on IPE, where might we best focus our efforts? How might we lead in preparing the next generation of nurses and physicians for better collaboration and team-based care?
The Zula Mae Baber Bice Memorial Lecture, School of Nursing
Health care information can confuse doctors and patients alike. What are the risks and benefits of mammograms, of aggressive blood pressure control, of EKGs, of lung cancer screening, of heart stents? When patients can’t accurately answer these questions, they find it difficult to have sensible conversations about their health care with their doctors. And lack of comprehensible medical information not only interferes with shared decision-making between physician and patient but can also lead to over-screening and over-treatment, with deleterious consequences for patients as well as for the health care delivery system and medical reform.
In this Medical Center Hour, internist Andy Lazris and scientist Erik Rifkin assess this challenging situation and then present, as one solution, a novel decision aid called a Benefit Risk Characterization Theater (BRCT). When health care information is conveyed simply, factually, and in a non-numerical format, true shared decisions become possible. They offer BRCTs to explain the risks/benefits of some common medical interventions and demonstrate how this approach can improve health care delivery, lead to greater patient satisfaction, and result in less over-treatment, one of the main drivers of low-value health care cost.
Co-presented with the Department of Medicine
In September 1925, while the family of English composer, Herbert Howells, was on vacation in the English countryside, their son, nine-yer-old Michael Howells fell ill with polio and died in London three days later. Howells channeled his grief into the composition of the "Requiem," which drew heavily on an earlier, unpublished work. In this Medical Center Hour, fourth-year medical student and musician Rondy Michael Lazaro explores the historical context of polio in the 1930s and how the loss of Howells's young son played out in the composer's music. Mr. Lazaro conducts a chamber chorus in the performance of two movements from Howell's "Requiem."
Co-presented with the History of the Health Sciences Lecture Series
RN-MD collaboration in health care (or the lack thereof) is one of the more vexed issues facing our struggling health care system. Yet it rarely gets addressed in a substantive and purposeful way. The problem begins with the training of nurses and doctors. Nursing schools have seldom taught the nuts and bolts of working with physicians. Medical schools have taught future doctors almost nothing about working with nurses. Often the result in clinical practice is that each group finds the other difficult. Even so, nurse-physician collaboration is what makes health care possible, and good collaboration makes high quality care much more likely. In this Medical center hour, nurse and author Theresa Brown considers new, potentially revolutionary initiatives in health professional education, including at UVA, that bring nursing and medical students together as learners. Will interprofessional education lead to better RN-MD collaboration in practice and, as a result, to better patient care?
The Zula Mae Baber Bice Memorial Lecture
Co-presented with the School of Nursing
Since its creation in 1999, the same year the Institute of Medicine issued its landmark report, To err is human, the Richardson Memorial Lecture has sparked and sustained conversation at the University of Virginia on the sensitive subject of medical error. The annual lectures ever since have brought to UVA noted experts on medical mistakes, communication about error, and the importance of clinicians' attending carefully to patients as persons. Collectively, the Richardson Lectures have provided opportunities for students, clinicians, educators, and administrators to learn better how to prevent medical errors, communicate about them when they do happen, improve quality of care in complex clinical systems, and assure patients and families of the best possible care and outcomes. The 2013 Richardson Lecturer is internationally known patient-safety expert Dr. Peter J. Pronovost, whose scientifically validated checklist protocol, developed at the Johns Hopkins University, is improving patient safety in health care institutions across the US and the world.
Co-presented with the Patient Safety Committee, UVA Health System
Part one. Law professor Jack Greenberg's class discusses executive governmental determination of states of emergencies, such as in South Africa during Apartheid and in the United States during Japanese-American internment in World War II. In 1987 states of emergency are called regularly in South Africa to detain people without reason in the name of public safety, to maintain the status quo, and to suppress the majority. Part two. What happens to democracy when the government alone has the power to declare a state of emergency? The class discusses the use of states of emergency as a way to suppress people and deny rights, preventative detention as an abuse of human rights, and using the courts in South Africa to fight the injustices of the states of emergency. Part three. How much does a democratically elected government insure adherence to human rights? The class also talks about the rights of the white minority in a future democratic South Africa. Part four. Examples of transitions to democracy.
Social and cultural factors, as well as biomedical ones, shape the way we understand and react to diseases. In the case of a disease associated with sex, social and cultural factors figure especially prominently in its history. Since moral and religious views influence almost everything connected with sex, including sexually transmitted infections (STI), syphilis can be an excellent case study to help us appreciate disease in a broader human context. This Medical Center Hour delves into the story of syphilis in America, from colonial times to the present; it looks back too at the origins and spread of the disease in Europe. How did medical science come to understand syphilis and develop treatments for it? What about public health protections against this socially stigmatized STI from prevention campaigns and quarantine of infected persons (usually, women only) to mandated reporting of infections? To what extent does syphilis's identity as an infection popularly associated with sex and sin complicate our response to it and to persons who contract and suffer with it? Finally, how might American social and cultural stigmas around syphilis have contributed to the intentions behind and conduct of the U.S. Public Health Service's unethical research studies at Tuskegee (1932-1972) and in Guatemala (1946-1948)?
Co-presented with the History of the Health Sciences Lecture Series
In 1759, London’s British Museum opened its doors for the first time, the first free national public museum in the world. In this Phi Beta Kappa Lecture at Medical Center Hour, historian James Delbourgo explores the role of slavery and imperialism in making this now venerable institution possible by exploring the career of its founder, Anglo-Irish physician Sir Hans Sloane. Sloane worked in Jamaica as a plantation doctor, used money from sugar plantations in the caribbean and from the Atlantic slave trade to support his collecting, and created his own personal imperial network to assemble one of the greatest cabinets of curiosities in the world—and one of the key institutional legacies of the Enlightenment.
Co-presented with Phi Beta Kappa (Beta of Virginia), President's Commission on Slavery and the University, Department of History, and History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
Part one. Footage of Clinton College and Friendship College in South Carolina. Part two. Footage of road in South Carolina. At 15:04 footage of South Carolina State Capitol in Columbia. Part three. Footage of South Carolina State Capitol in Columbia.
Our society is aging, and, thanks partly to the science and success of advanced health care, the journey into one’s last years is often long and richly rewarding. But our medicalization of aging also means that older adults are longtime patients entangled in complex, costly, fragmented, and sometimes ad-libbed “systems” of individualized care that are challenging for them and their caregivers to navigate. When elders’ health and functional status changes, ways of managing their care may come undone, just when robust attention is most needed to effect transitions in their care—and the goals of care.
In this Medical Center Hour, distinguished gerontologist Mary Naylor offers her pioneering approach to the design, evaluation, and dissemination of health care innovations that has at once improved outcomes for chronically ill older adults and their caregivers and lowered health care costs. Her collaborative work with an interprofessional team has yielded the Transitional Care Model, a cost-effective model led by an advanced-practice nurse that improves the transitions of frail elders as they move through both their final years and our fractured health care system.
The Zula Mae Baber Bice Memorial Lecture, School of Nursing
The Koppaka Family Foundation Lecture in Medical Humanities, School of Medicine
Co-presented with the School of Nursing and the Center for Biomedical Ethics and Humanities, School of Medicine
Our bodies are malleable, changing with age and the demands we place on them. And throughout our life, how we stand—our posture—defines us as healthy or ill, able or disabled, beautiful or ugly, even human or not human. The history of posture is also the history of our reading of human anatomy. From the ancients to the moderns, how the body’s anatomy is understood has shaped understandings of what is human (did Neanderthal Man “stand up straight” or slouch?), what is beautiful (“Posture Queen” competitions in 20th century America), what is patriotic (no slouching in ranks!). What we ascribe to upright posture is very much being the perfect human, today and projected into the past. In this Medical Center Hour, distinguished scholar Sander Gilman reflects on how our understanding of posture figures in the history of anatomy and how the history of anatomy has helped craft our understanding of posture. What do shifting cultural perspectives on bodily uprightness tell us about the claims society makes with respect to who we are and what we are able to do?
Co-presented with the History of the Health Sciences Lecture Series, Claude Moore Health Sciences Library; and the Institute for Practical Ethics and Public Life.
This program is also offered in conjunction with UVA's second biennial disability studies symposium, "Disability Across the Disciplines," 19 February 2016.
Physician-writer Samuel Shem's iconic black humor-laced novel, The House of God (1978), written while he was a resident, was an exposé of medicine's often-heartless training culture at the time. The book became unofficial required reading for generations of persons going into medicine. His most recent novel, Man's 4th Best Hospital (2020), appeared when clinician morale was low, burnout rampant, and physician suicide on the rise; if anything, the COVID pandemic has exacerbated these conditions. In this Hook Lecture, Shem discusses how his books arose out of perceived injustice to take the measure of medicine's culture, and how he has used fiction both to resist injustice and to call upon doctors, nurses, and others to reclaim their once-humane calling.
Edward W. Hook Memorial Lecture in Medicine and the Arts
Medicine Grand Rounds
Co-presented with the Department of Medicine and with generous support from the School of Medicine's Anderson Lectures
Why do modern Americans eat so much sugar, and to what effect? This Medical Center Hour offers dual perspectives on the sweet stuff, what it does to/in us, and its many meanings in history and for health. UVA historian David Singerman and UVA physician Jennifer Kirby examine sugar’s impact on the body—past and present, historically, socially, physiologically, and nutritionally.
What if there were a vaccine that could prevent cancer? The human papillomavirus (HPV) vaccine, available since 2006, does this, guarding against cancers caused by this ubiquitous virus. This Medical Center Hour explores the sociopolitical context of HPV vaccination in Virginia and beyond. Using clips from a powerful documentary film, Someone You Love: The HPV Epidemic (2014), an expert panel of UVA researchers, clinicians, and oncologists discusses the crucial importance of HPV vaccination--for boys as well as girls--and the concerns that still limit its use.
A John F. Anderson Memorial Lecture
Co-presented with the Cancer Center, UVA
At a time when lesbian, gay, bisexual, and transgender (LGBT) individuals enjoy unprecedented social acceptance and legal protection, many LGBT elders face the daily challenges of aging isolated from family, detached from the larger LGBT community, and ignored by mainstream aging initiatives. These elders are more likely to be single, childless, financially insecure, fearful of encountering bias in health care settings, and socially isolated. And the continuing silence surrounding LGBT elders has left many of them underserved and at risk. This Medical Center Hour makes the case that increased cultural competency measures are necessary within medicine and society to help older LGBT persons overcome barriers to successful aging and to ensure that we are all taking good care of our LGBT elders. A John F. Anderson Memorial Lecture co-presented with qMD
A John F. Anderson Memorial Lecture co-presented with qMD
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.
Acclaimed physician-writer Christine Montross (Body of work, 2007; and Falling into the fire, 2013) discusses how diving deeply into her most challenging patient encounters has led her to the ancient concept of "abiding" as a lost tenet of patient care. A psychiatrist and medical educator, Dr. Montross speaks in defense of repugnance, and encourages physicians and doctors-in-training to acknowlege, rather than suppress the discomforts which naturally arise in the practice of medicine.
A John F. Anderson Memorial Lecture
The Affordable Care Act (ACA) has brought transformational changes to the healthcare system, including, in some ACA programs, movement away from a pay-for-volume system to pay-for-performance or outcome. Three programs exemplify this approach: readmission penalties, no payment for selected hospital-acquired conditions (HACs), and value-based purchasing. To date, the HAC nonpayment program has targeted prevention of central-line-associated bloodstream infections, catheter-associated urinary tract infections, selected surgical site infections, and methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile infections. With better understanding, improved procedural practices, and closer monitoring, more of these infections are proving preventable; infection rates, including for MRSA, have dramatically decreased. In this Medical Center Hour, distinguished medical epidemiologist Dr. William Jarvis discusses these successes, including their financial implications, and how further collaboration between clinicians and infection control programs can prevent even more hospital-acquired conditions.
The Hayden-Farr Lecture in Epidemiology and Virology/Medical Grand Rounds
Co-presented with the Department of Medicine, UVA
Over the past decade, several leading U.S. medical schools have developed courses combining art appreciation and clinical observation skills. Medical students venture from the clinical setting to the art gallery, where they are challenged by gallery educators and medical professors to observe and to articulate what they see in the art before them. Such courses aim to cultivate and deepen students' visual literacy, verbal facility, and tolerance for ambiguity with the expectation that more finely tuned visual observation and communication skills will help them to be better doctors.
Working with a task force in the UVA School of Medicine, Fralin Museum of Art academic curator Jordan Love has created and piloted The Clinician's Eye, an interactive workshop that aims to refine apprentice clinicians' skills through training in visual analysis. This Medical Center Hour invites audience members to participate—hands-on—in a version of this workshop.
A John F. Anderson Memorial Lecture
The history of eugenics is often characterized as a cautionary tale of life in the bad old days, when pseudoscientific assumptions about genetic determinism provided a respectable veneer that enabled barely submerged racism, xenophobia, and blatant discrimination against persons with disabilities to take root in American law. Some argue that, today, our science is sound, our attitudes enlightened; we need not be hobbled by fear of long-expired bad eugenic habits.
In this Medical Center Hour, Paul Lombardo, who has written extensively on eugenics and the law in America, challenges such assumptions, asserting that the same tendencies that led to a century of eugenic law and policy continue to inform our public debate over democratic values and the proper role of science as a tool for solving social problems.
The Joan Echtenkamp Klein Memorial Lecture in the History of the Health Sciences
Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
We hear much these days about the widening gap in America between the rich and the poor, the haves and the have-nots. Inequality is all around us, and it exacts a serious toll on health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. Indeed, there is a 35-year difference in life expectancy between America's wealthiest (and healthiest) and poorest (and sickest) neighborhoods.
Internist David Ansell MD has worked for four decades in hospitals serving Chicago's poorest communities. While he's witnessed first-hand the structural violence—racism, economic exploitation, and discrimination—responsible for the "death gap," he argues that geography need not be destiny. In this Medical Center Hour, Dr. Ansell outlines how we can address this national health crisis and act to remedy the circumstances that rob many Americans of their dignity and their lives.
Co-presented with Alpha Omega Alpha National Medical Honor Society, UVA chapter
Nimura, Janice P., University of Virginia. School of Medicine
Summary:
The world recoiled at the idea of a woman doctor, yet Elizabeth Blackwell persisted, and in 1849 became the first woman in the U.S. to receive an MD. Her achievement made her an icon. Her younger sister Emily followed her, eternally eclipsed despite being the more brilliant physician of the pair. Together, they founded the first hospital staffed entirely by women, in New York City. While the Doctors Blackwell were visionary and tenacious—they prevailed against a resistant male medical establishment—they weren't always aligned with women's movements, or even with each other. In this Medical Center Hour, biographer Janice Nimura celebrates the Blackwells as pioneers, change agents, and, for women in medicine today, compelling yet somewhat equivocal role models.
Co-presented with Historical Collections, Claude Moore Health Sciences Library
A documentary film series and website about Virginia's history since the Civil War.
Episode 1– New Deal Virginia explores two significant changes in Virginia history: the creation of Shenandoah National Park and the electrification of rural Virginia. Both stories trace the effects of the federal government on the lives of everyday rural Virginians in the 1930s. Letters, maps, newspaper stories and teaching resources accompany this exploration and film (30 minutes).
Episode 3 – Massive Resistance became Virginia's policy to prevent school desegregation in the wake of the Brown v. Board of Education Supreme Court decision in 1954. Many of Virginia's white leaders resisted integration with all of their considerable political and legal means. The story of massive resistance and of black Virginians' protests against segregation began in the early 1950s and continues today. This two-part film (one hour) traces the history of massive resistance in Virginia and considers some of its legacies. "Massive Resistance" was an Emmy Nominee in 2000 of the Washington, D.C. Chapter of the National Academy of Television Arts and Sciences and will be shown nationally on PBS in February 2002 for Black History Month.
Episode 4 – Virginia Fights World War II explores the transformative changes that Virginia experienced in World War II. Virginia mobilized hundreds of thousands of citizens during World War II and became the home base for a host of navy, army munitions, and defense industries. Virginia's soldiers fought in the Pacific and landed at Omaha Beach on D-Day. This two-part film (one hour) follows the stories of everyday Virginians, those who fought at D-Day and those who patrolled Virginia beaches, worked in the munition plants, flew missions in Europe, and fell in love during the war. This site contains the image archive for the film--over 1,600 images of Virginia or Virginians in World War II.
As our companion animals grow old and infirm, veterinarians and human caregivers alike face a complex and confusing array of choices and decisions. This Medical Center Hour explores some of the central moral challenges in end-of-life care for animals, from pain management and quality-of-life assessments to palliative treatment, hospice care, and making that final decision to hasten an animal's death. Considering this "last walk" with our pets, bioethicist Jessica Pierce and compassionate care advocate Susan Bauer-Wu borrow some ethical guideposts from the field of human bioethics (and offer a few in return).
A John F. Anderson Memorial Lecture
Co-presented with the Institute for Practical Ethics and Public Life, UVA
With malaria a real threat to American troops' fighting fitness, the U.S. government during World War II mounted an all-out hunt for a malaria cure. Tropical-disease researchers with the Rockefeller Foundation took the lead on a secret project that adopted German research models and methods, including use of institutionalized Americans—inmates in six mental hospitals and several large prisons—both for culturing the parasites that cause malaria (there was no animal model) and for testing experimental drugs against the disease. After thousands of failed starts (and much human harm), the researchers had their "magic bullet": a German antimalarial compound captured in battle. This drug, reformulated in the U.S., is chloroquine, one of the most important pharmaceuticals ever made to fight malaria.
In this Medical Center Hour, public health journalist Karen Masterson and infectious diseases specialist Dr. Richard Pearson delve into this tale of secret science in the service of war efforts and into research that was conducted before promulgation of federal rules and regulations governing human participation in biomedical research.
Co-presented with the History of the Health Sciences Lecture Series of Historical Collections, Claude Moore Health Sciences Library
In its emphasis on instrumentality, on the patient as something to be acted upon, and on the doctor as an abstracted agent of diagnosis and treatment, medicine often neglects the practitioner's involvement in the clinical scene. Recent attempts to direct attention to this aspect of practice have been stymied by medicine's nearly exclusive reliance on a quantitative, positivist disposition, with which humanist scholarship has had difficulty gaining traction. The narrative medicine movement, as articulated by Dr. Rita Charon of Columbia University College of Physicians and Surgeons, has gained widespread attention within the medical academy. But physician and literature scholar Dr. Terrence Holt argues that, for all its positive features (and despite Dr. Charon's efforts to define it otherwise), narrative medicine as applied remains committed to an interventional model that is at odds with the strengths of the humanities. Drawing on readings of texts such as Shakespeare's King Lear, Coleridge's Rime of the Ancient Mariner, Shelley's Frankenstein, and the poetry of John Keats, Dr. Holt contends that the value of the humanities in medical education and practice is not as an intervention but as a diagnostic modality—and that the proper first object of diagnosis may not be the patient, but the physician.
The Ellis Moore Lecture of the School of Medicine
With health care reform on the near horizon and other social realities (aging, immigration, chronic conditions, quests for prevention and wellness) dramatically changing health care in the U.S., what kinds of doctors will our health care system (and its patients) require? Clearly, not just medical school curricula but also the selection process for medical students will be key determinants of whether we have physicians fully prepared to practice as the 21st century progresses. This Medical center hour addresses transformational changes underway in the pre-professional preparation and selection of the nation's medical students, including a new version of the MCAT exam, which goes "live" in 2015. What does this new MCAT signal for premedical students as they prepare for medical school? How might colleges and universities offer their premedical students academic experiences that will better equip them for medical school and medical practice in the 21st century?
Co-presented with the Institute for the Humanities and Global Cultures, UVa
A John F. Anderson Memorial Lecture
The opioid epidemic raging in the U.S., including in Virginia and neighboring states, took nearly two decades to develop and will take years to quell. So says the recent National Academy of Medicine (NAM) report, Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use (July 2017). Drug overdose due to opioid medications is now this country's leading cause of unintentional injury death. The current crisis is particularly challenging because the epidemic's broad reach "has blurred the formerly distinct social boundary between prescribed opioids and illegally manufactured ones, such as heroin," asserts the NAM committee's chair, UVA law professor Richard J. Bonnie.
In this Medical Center Hour, Professor Bonnie and palliative care specialist Dr. Leslie Blackhall address the impact of this epidemic on public health and patient care and discuss what actions regulatory bodies, health care organizations, and health care professionals could take.
A John F. Anderson Memorial Lecture
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
The Diagnostic and statistical manual of mental disorders (DSM) is perhaps the most contested document in American medicine, vital for the organization and funding of psychiatric research and mental health care, yet perennially criticized both from within and behond the mental health community. Heated debate accompanied the 2013 publication of the manual's fifth edition, DSM-5. Critics charged that the new edition masks political interests (e.g. interests of psychiatrists and pharmaceutical companies) under the guise of science at patients' expense. DSM-5 defenders championed the inclusiveness and transparency of the review process and evidence-base behind the manual's diagnostic decisions. In this Medical center hour, psychiatrist and theologian Warren Kinghorn argues for a mediating alternative: that the DSM may be best understood as neither an apolitical "encyclopedia" of psychopathology nor a political cloak for psychatric power, but rather as a working document of a living moral tradition. In this case the tradition-constituted discourse allows for appreciation of the DSM as a useful scientific document that reflects the moral assumptions and convictions of the communities that created and continue to sustain it.
Co-presented with the History of the Health Sciences Lecture Series
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
Marijuana has had a rocky and peculiar history in the United States. The early history of marijuana prohibition is fairly well known, thanks in part to a classic work on the subject, The Marijuana Conviction, co-authored by Richard J. Bonnie while he was associate director of a commission apppointed by Richard Nixon. In 1972, to the surprise of many, the commission recommended decriminalizing marijuana use, but it also rejected the idea of legalization, expressing major concerns about the public health consequences of doing so. While loosening marijuana laws became a mainstream policy idea through the Ford and Carter admisistrations, in the Reagan White House, a policy of "zero tolerance" took hold and evolved into a new and costly war on all illegal drugs. Millions of marijuana arrests ensued. As the drug war's costs accumulated in the early 21st century, support for decriminalizing marijuana returned. Some states defied the federal government by legalizing medical use. Then, suddenly, in 2012, voter initiatives in Colorado and Washington legalized marijuana for recreational use and, in 2014, voters in Washington DC did the same, with legalization in the District due to take effect 26 February 2015. The worries raised by the commission in 1972 are back, complicated by the challenges of implementing the law. This Medical center hour's principal speaker, who has both chronicled this story and been a player in it for more than four decades, will reflect on why marijuana prohibition suddenly collapsed and on what should happen next.
Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
When it comes to matters of health, environment, and urban history, lessons of the past are often forgotten by Americans. However, in many ways, fears from American epidemics in the last 150 years have all become acute again with the COVID-19 pandemic. Working at the intersection of public health and urban/environmental history, architect Sara Jensen Carr investigates how shifts in the American urban landscape were driven by health concerns, and how these have led to this inflection point between living in the pandemic and a post-pandemic future. She's joined by urban and environmental planner Tim Beatley in this Medical Center Hour that addresses the "topography of wellness" in our urban public spaces even as we anticipate COVID-driven design changes.
History of the Health Sciences Lecture
Co-presented with Historical Collections, Claude Moore Health Sciences Library; Center for Design + Health, School of Architecture; and University of Virginia Press
We hear almost daily about the rapidly increasing rate of type 2 diabetes in the U.S. population. Many pronouncements are dire, proclaiming an "epidemic," and most make it sound as though this problem is relatively new-just three or four decades old. Yet almost 100 years ago a small group of U.S. health care professionals was already warning that diabetes was "a public health problem," fated to become worse if nothing was done soon. But what did they mean by this? Why had they grown concerned? And what measures did they recommend to try and reverse the upward trend in diabetes rates? In this Medical Center Hour, historian Arleen Tuchman asks what we can learn from history that might help us understand better how we are framing the diabetes "crisis" today, and why. How do cultural assumptions about diabetes, and about the particular populations believed to be most at risk, influence not only our understanding of this disease but also our efforts to gain control over it?
Co-presented with the History of the Health Sciences Lecture Series
The first global wave of reform in modern medical education occurred early in the 20th century, following the Flexner report. The second wave came in the latter half of that same century, led by innovations in problem-based learning and community orientation. Recently, the Lancet Commission called for a third wave of reform to create transformative system-based medical education that is socially accountable. This may be a fine aspiration, but is it possible? How can we translate new understandings from neuroscience, sociology, and the sciences of learning to meet this aspiration? In doing so, may we also transform research on medical education from eminence-based to evidence-based medical education? How accountable are we prepared to be for the results of our efforts? And to whom?
In his Brodie Medical Education Award Lecture, Dr. Paul Worley draws on evidence from medical schools around the world to explore these critical questions and consider the challenge that social accountability brings to academic medicine's combined research, education, and service mission.
The Brodie Medical Education Award Lecture
Co-presented with the Department of Medicine and the Brodie Medical Education Award Committee, in association with the School of Medicine’s Medical Education Week, 29 February-4 March 2016.
The opioid epidemic is currently exacting a terrible toll on the health, lives, safety, and livelihood of persons and communities across Virginia, the Appalachian region, and, indeed, much of North America. What is being done to address this crisis at the levels of policy and practice in the Commonwealth of Virginia and in Charlottesville-Albemarle and environs? In this Medical Center Hour, the Honorable William A. Hazel Jr MD, Secretary of Health and Human Resources for the Commonwealth, discusses Virginia’s five-pronged approach to the epidemic and the impact of that approach to date. He is joined in this conversation by a primary care physician and community mental health professionals.
The Jessie Stewart Richardson Memorial Lecture of the School of Medicine
Co-presented with the Office of Quality and Performance Improvement, UVA Health System
The 1918 influenza pandemic was a global calamity that brought death on an unprecedented scale and intensified the devastating impact of World War I even as the armistice was signed in November 1918. Statistics tell the tale of this flu in one way, science tells it in another, but this Medical Center Hour—the third in a mini-series marking the pandemic's centenary—lets poetry speak to the human toll exacted by the 1918 H1N1 virus. In 1995, Virginia native and distinguished poet Ellen Bryant Voigt published Kyrie, a book-length sequence of poems in which small town speakers live through the harrowing epidemic and remember, defy, and mourn. Kyrie's fierce, moving poetry brings the global calamity home. In this Medical Center Hour, Voigt (on video) reads selections from Kyrie and discusses with poet Marianne Boruch the making and meaning of this American masterpiece.
Co-presented with the Bjoring Center for Nursing Historical Inquiry, Historical Collections in the Claude Moore Health Sciences Library, and Influenza! 1918-2018
Some physicians are born to write, while others have writing thrust upon them. As one of the latter, 2013 Moore Lecturer Margaret Mohrmann discusses what she has learned from writing about doctoring. The act of articulating her experiences as a pediatrician and teacher has shown her, over time, much more about her encounters with patients, and about herself, than she could see at the time those events occurred - or even at the time she wrote about them. Rereading one's own stories and having others read (and co-construct) them can expose the "ghost" in the story - "the story's silent twin," as British novelist Jeanette Winterson puts it. What couldn't be said, or wasn't noticed, or was forgotten often gets written in anyway, quietly, between the lines and within word choices and narrative structures. The process of discovering what went unseen before cultivates in both writer and reader the practice of paying close, compassionate attention to what's happening now, an essential ingredient of good doctoring.
The Moore Lecture
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
Since passage of the Patient Protection and Affordable Care Act (ACA) in 2010, this particular road to health care reform in the U.S. has been riddled with political potholes and subject to slowdowns as a result of legislative and judicial challenges. But with the Supreme Court's landmark stamp of constitutional approval this past June and with President Obama's reelection on 6 November, it is now clear that some form of "Obamacare" is here to stay, at least for four more years. Indeed, repeal of the ACA may no longer be a top Republican priority, as House Speaker John Boehner noted on 8 November: "The election changes that-Obamacare is the law of the land." So what's ahead as we implement the ACA? In this Medical Center Hour, Washington and Lee law professor and ACA expert Timothy Jost and University of Virginia health policy analyst Carolyn Engelhard outline what must be accomplished in order to realize this ambitious overhaul of our health care system. And what will be the responsibilities of and implications for academic health centers like UVA as the ACA takes effect?
Co-presented with the Sadie Lewis Webb Program in Law and Health, the Institute for Practical Ethics and Public Life, the Department of Public Health Sciences, and the Bioethics and Health Policy Medical Student Interest Group
A John F. Anderson Memorial Lecture
Amid the current opioid epidemic in the U.S., discourse around addicts and addiction can be overwhelmingly negative, pessimistic, and hopeless, reinforcing negative stereotypes. Even in health care, negativity about addiction prevails, making it more challenging for clinicians and organizations to respond with appropriate care, services, and resources. The toll of addiction is staggering. But while statistical and fiscal analyses of the national epidemic can also overwhelm and add to the negativity, might we gain a different view of addiction by accessing the particular experience of it, as it affects individuals and also their families? To know better what is at stake and how to foster recovery, this Medical Center Hour turns to poets Kate Daniels and Owen Lewis for their response to addiction when it strikes close to heart and home. How can writing serve to access the lived experience of addiction—in this case, addiction inside the family circle—and how might writing aid in recovery, for everyone involved?
Questions about transplant candidate suitability and priority made headlines earlier this year, when 10-year-old Sarah Murnaghan's parents went to court (and to the media) to request that their daughter, dying of cystic fibrosis, be placed on the eligibility list for a lung transplant. The court's decision, UNOS's followup (Sarah got a new, fictitious birthdate to qualify to receive adult lungs), and Sarah's two double-lung procedures galvanized the transplant community, bioethicists, policymakers, and the public alike.
Even as efforts continue to increase the organ supply, what should we do about our allocation systems? In this Medical Center Hour, three experts engage the medical, legal, and ethical questions raised by the Sarah Murnaghan case.
Co-presented with the Institute for Practical Ethics and Public Life
A John F. Anderson Memorial Lecture
Many doctors have also been celebrated writers, from Anton Chekhov, Arthur Conan Doyle, and William Carlos Williams to Perri Klass, Atul Gawande, and Maxim Osipov. The reading public (including other doctors) eagerly devours what doctors write, not least in hopes of glimpsing what makes physicians tick, as persons, as healers. But why do doctors write? In this Medical Center Hour, three of UVA's own accomplished physician writers respond, in their own inimitable words.
An Ellis C. Moore Memorial Lecture
Theresa Brown became a nurse-who-writes quite accidentally: she had a bad experience at work, wrote it down, and sent what she'd written to the New York Times. To her surprise, the newspaper published it, to great acclaim. From that column came the contract for Ms. Brown's first book, Critical Care, and she also began writing regularly for the Times, proud to have this chance to give voice to the often under-recognized nursing profession.
Only lately, though, while writing her second book, The Shift, did Ms. Brown realize not just how much her nursing gives shape to her writing, but also how her writing influences her nursing. There's much to mull over in health care and usually not much time to do that. Writing forces Ms. Brown to reflect. She learns both positives and negatives about her nursing work in the process of putting that work into words. In this Medical Center Hour, Ms. Brown talks about how writing, which she loves, makes her a better nurse.
The Catherine Strader McGehee Memorial Lecture of the School of Nursing
Co-presented with the School of Nursing, the Virginia Festival of the Book, and Hospital Drive
Whistle Words is a multimedia project helping women reclaim their sense of self after a life-changing cancer diagnosis--with the simple aid of a pen. Charlottesville-based Whistle Words offers writing workshops for women in and after cancer treatment. Being part of this project as an adjunct or follow-up to treatment can make a real difference in participants' outlook and healing, as demonstrated by women's writings in the recently published anthology, Truth: Voices of Women Changed by Cancer. In this Medical Center Hour, Whistle Words' co-founder Charlotte Matthews and UVA nurse/breast cancer survivor/workshop participant Susan Goins-Eplee introduce Whistle Words and explore the healing power of writing.
A John F. Anderson Memorial Lecture
Viewing women through an androcentric lens, Western medicine from Hippocrates and Galen forward explained women's behavior from headache to "troublemaking" as unhealthful signs of "hysteria," a suffocating madness believed due to a wandering womb. Centuries, even millennia before Freud asked, "What do women really want?" medical men assumed they knew what women with hysteria needed, and that remedy was pelvic massage to "paroxysm." By the late nineteenth century, with manufacture of electrified massage instruments, doctors could deliver said therapy more quickly and efficiently. This medical treatment, the Victorian social milieu in which it was prevalent (and popular), and (mis)understandings of female sexuality, intimacy, and inequality are the subjects of young American playwright Sarah Ruhl's comedy, In the Next Room or The Vibrator Play (2010). This Medical Center Hour's panelists explore a rich mix of ideas having to do with women, medicine, and The Vibrator Play.
Offered in conjunction with LiveArts' production of "In the Next Room or The Vibrator Play", 1-23 March
The influenza pandemic of 1918 was the most powerful pandemic disease in human history, emerging out of the worst-case scenario of an airborne virus mutating to an extremely lethal form amid crowded conditions of military training camps and battlefields. This deadly influenza exploded from the Western Front of World War I to circle the globe and kill at least 50 million people worldwide within 18 months. To open UVA’s centennial commemoration of the 1918 pandemic, historian Carol Byerly highlights the U.S. Army’s experience with influenza at home and abroad in the context of the historic relation between disease and war. What can we learn from 1918 even as we anticipate and fear future pandemics?
A History of the Health Sciences Lecture
Co-presented with the Bjoring Center for Nursing Historical Inquiry, School of Nursing; Historical Collections in the Claude Moore Health Sciences Library; and Influenza! 1918-2018
Martina Scholtens worked as a physician at Bridge Refugee Clinic in Vancouver for ten years, caring for patients from around the world. Her book about this work, Your Heart is the Size of Your Fist, is a creative nonfiction account of one Iraqi family’s first year in Canada from her perspective as their doctor. In this Medical Center Hour, Dr. Scholtens explores the physician writer’s obligation to patient, profession, and society and inquires into the legitimization of patient suffering, the concept of medical maternalism, and the challenges of advocacy.
The Moore Lecture of the School of Medicine/Medical Grand Rounds
Co-presented with the Generalist Scholars Program and the Department of Medicine, and offered in conjunction with Primary Care Week at UVA
First identified in 1947 and first known to cause human illness in 1953, Zika virus was seldom seen during the next 60 years. Starting in 2013, however, sizable outbreaks of human infection occurred, and in 2015 Zika appeared in the Americas, first in Brazil, then much more widely. The mosquito-borne virus also began making dramatic headlines. Zika was discovered to be transmissible during pregnancy, with serious, even devastating neurological injury to the baby, and transmissible between sexual partners, with risks to a fetus in the event of pregnancy. Earlier this year, the World Health Organization declared Zika a global public health emergency.
The 2016 Hayden-Farr Lecture by Dr. Lyle Petersen, Incident Manager for Zika Response at the Centers for Disease Control and Prevention, is an update on Zika--the science and the medical, public, health, environmental, social, and ethical implications that make this disease an urgent global challenge.
The Hayden-Farr Lecture in Epidemiology and Virology/Medical Grand Rounds
Co-presented with the Department of Medicine and the Office of the Hospital Epidemiologist, UVA Health System