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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
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
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
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
In this Medical center hour, prize-winning writer Leslie Jamison inquires into the phenomenon of empathy. It may be something more fraught then we often imagine it to be. Empathy isn't just an instinctive reaction but a more complicated blend of intuition and decision. And it's not neccessarily an unequivocal good. It can mislead. It can exhaust. Ms. Jamison draws on her experiences as a standardized patient, working with and observing student doctors getting "trained" in the practice of empathy, as well as her experiences as a journalist, inhabiting a vexed state of empathy for her subjects, to consider a variety of perspectives on what makes for good empathy and what good it can do.
A John F. Anderson Memorial Lecture
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.
What still resonates with you when you're spent? What can a caregiver—or a teacher, a leader, a colleague—offer and do when all else fails, when all that's left is our humanity? In this Medical Center Hour, Tim Cunningham weaves together three stories from disparate sites and desperate situations—the Ebola crisis in West Africa, rural Haiti, and an elite pediatric emergency unit on the Upper East Side of New York City—to inquire into what might matter the most at trying times. A clown, then a nurse, and now the director of the Compassionate Care Initiative and an assistant professor in UVA's School of Nursing, Cunningham shares what he believes matters most when all else is lost—and shows how we all have the capacity to access it.
Co-presented with the Compassionate Care Initiative, School of Nursing
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
In 1858, young English surgeons Henry Gray and Henry VanDyke Carter published an illustrated anatomy textbook for medical students. Gray's Anatomy has never since been out of print, but little was known about its author and illustrator until acclaimed science writer Bill Hayes—inspired by a photograph of Henry Gray—pieced together their story in The Anatomist. This Medical Center Hour explores the medical, historical, and artistic significance of Gray's Anatomy and also Hayes's unforgettable year alongside medical students in the anatomy lab.
Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
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