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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
When the First Nations of Big River and Ahtahkakoop in Canada's Saskatchewan province realized they had an HIV epidemic within their rural communities, their leadership and health centers rallied community members to determine the social and structural issues behind the epidemic. One of the driving factors proved to be injection drug use. Big River and Ahtahkakoop then developed culturally competent, community-based care to address the intertwined issues of HIV, hepatitis C, and substance use. In this presentation, spokespersons from these two communities describe how they took on these epidemics and discuss the solutions that have worked for them. What can other communities struggling similarly with substance abuse and related infectious disease outbreaks learn from these First Nations' grassroots responses? Are there lessons here for communities in Virginia, where, on average, three people die each day from opioid overdose?
Co-presented with the Department of Medicine and the Center for Global Health, in conjunction with the conference, "Best Practices in Community Mobilization in Response to Substance Use and Related Epidemics"
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
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
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
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
The caregiver—whether a family member pressed into service or an underpaid home-care aide—is a representative figure of our time. This status is paradoxical because actual caregivers (so often female) do their work largely out of sight and almost in secret. It is an uncanny representative figure whom we do not see.
Writer and scholar David Morris spent over a decade as caregiver for his late wife, Ruth, a medical librarian who in her mid-fifties began to show signs of dementia, most likely earlier-onset Alzheimer’s disease. In this Medical Center, Morris describes his experience but also uses his personal caregiving as a fulcrum for opening up larger questions about what biomedicine often overlooks in its molecular vision of illness. Desire is the neglected force that Morris sees as basic to illness, and it is the role of desire in illness that he seeks to clarify. Desire, it turns out, also offers an unanticipated common ground where health-care professionals—caregivers too in their medical role—may meet with patients and families in mutual, richer understanding.
A John F. Anderson Memorial Lecture
Where you live in a particular U.S. city determines your predicted life expectancy. Neighborhood is destiny, in a way. For example, in New Orleans, there is a twenty-five-year difference in life expectancy from one parish to another only three miles away. This pattern of great gaps in health status, even over short distances, repeats itself in New York, Chicago, the Bay Area, and many other American cities, with harsh consequences.
In 2005, Tulsa, Oklahoma was one of the first cities to recognize such dramatic neighborhood variations in life expectancy, with a fourteen-year difference in life expectancy between north Tulsa and midtown—and to take action. In this presentation, Dr. Gerard Clancy describes specific initiatives and lessons learned on the ten-year journey, from 2005 to 2015, to reverse these health disparities and improve the health of the people in north Tulsa. The successes of the past decade have inspired a new ten-year initiative in Tulsa focused on mental health system improvements.
Co-presented with the Brodie Medical Education Award Committee, the Academy of Distinguished Educators, and the Department of Medicine
Does some aspect of our personality survive bodily death? Long a philosophical and theological question, in the 20th century this became the subject of scientific research. Fifty years ago, in 1967, Ian Stevenson, then chair of UVA's Department of Psychiatry, created a research unit—now named the Division of Perceptual Studies—to study what, if anything, of the human personality survives after death. Dr. Stevenson's own research investigated hundreds of accounts of young children who claimed to recall past lives.
In this Medical Center Hour, faculty from the Division of Perceptual Studies highlight the unit's work since its founding, including studies of purported past lives, near-death experiences, and mind-brain interactions in phenomena such as deep meditation, veridical out-of-body experiences, deathbed visions, apparent communication from deceased persons, altered states of consciousness, and terminal lucidity in persons with irreversible brain damage. As the division enters its second half-century, what are its research priorities and partnerships?
History of the Health Sciences Lecture
Co-presented with Historical Collections, Claude Moore Health Sciences Library and the Department of Psychiatry and Neurobehavioral Sciences, UVA
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