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There's much mythology surrounding eating disorders. Myth: these are time-imited illnesses that resolve when a woman leaves adolescence. Myth: only women experience eating disorders. In a society that reveres bodily thinness and now also celebrates the extremely "fit" body, at once lean and overtly muscular, an estimated 25 to 30 million Americans currently suffer from an eating disorder. Most eating disorders look nothing like the stereotypes suggested by sensational media coverage. The afflicted include men and women of all ages and all ethnicities. And so alongside this country's well-publicized obesity epidemic rages another, quite invisible epidemic of eating disorders. This Medical Center Hour addresses eating disorders and related questions from three perspectives. Speakers include a UVA student in recovery, a parent and national advocate, and the coordinator of the prevention program at UVA's Women's Center. What role does family play in eating disorders? How as health professionals do we ensure that patients get the best treatment? What treatments are most effective? How can we, health professionals and laypersons alike, best support someone who is suffering? What resources are available at UVA and how do we get involved?
A John F. Anderson Memorial Lecture
Co-presented with the Women's Center, UVA
"Germs have always traveled. the problem now is they can travel with the speed of a jet plane." So said physician and medical historian Howard Markel in recent days, commenting on the spread of Ebola outside West Africa. This Medical center hour takes stock of the rapidly evolving Ebola epidemic and the concomitant rise in global health security concerns. What is known of this unusual virus and the life-threatening hemorrhagic fever it triggers? How are sociopolitical and cultural conditions and healthcare infrastructural inadequacies in West Africia and elsewhere hindering medical and public health response? How are governmental and health care institutions in the U.S. responding as cases erupt outside West Africia? And, looking ahead, what are the prospects for vaccine development and fast-track clinical trials?
A John F. Anderson Memorial Lecture
Co-presented with the Department of Public Health Sciences and the Center for Global Health
Patients sometimes complain that they are neither heard by nor really known to their doctors especially, perhaps, subspecialists to whom they've been referred for particular procedures and fear that, as a result, they may receive substandard care. Similarly, in fast paced practice, some physicians, including said subspecialists, may find it difficult to know their patients as persons. Cardiologist Joseph Gascho M.D. met these challenges for himself and his patients by devising ways he could hear and know the persons in his care through the media of photography and poetry. This Medical Center Hour examines doctors' use of the arts to improve the care that patients receive. Dr. Gascho describes three projects that have helped him to bridge the patienthood personhood gulf, enabling him to better understand his patients as individuals and to give them whole person care. He is joined by physician Julia Connelly M.D. for whom photography has become a way to bring care and connection with nature to elderly persons, including nursing home residents.
Anthropologist, activist, and priest Roshi Joan Halifax is the founder and head teacher of the Buddhist monastery, Upaya Zen Center. Seventeen years ago at Upaya, she pioneered a new form of bedside contemplative care known as "Being with Dying," which has since helped to illuminate and change the psychosocial, ethical, and spiritual care of the dying. Halifax's newest work probes what she calls five "edge states" of how we become involved with our fellow beings: altruism, empathy, integrity, respect, and engagement. In this Bice Memorial Lecture, she explores the risks and the opportunities for courage and compassion that persons in the helping professions encounter "at the edge."
Bice Lecture, Co-presented with the School of Nursing, UVA
In this Medical Center Hour, Ellen Ficklen, the former editor of "Narrative Matters," takes us behind the scenes at Health Affairs to probe the close working relationship between authors and editors as manuscripts are sculpted and polished into essays that surgeon/author Atul Gawande describes as "some of health care's most stunning writing."
A John F. Anderson Memorial Lecture
Among the COVID-19 pandemic's lessons is an increased awareness of the hazards of old age. But only a fraction of that risk is biological. At a moment in history when most of us will live into old age, we've created a world that's almost entirely focused on childhood and adulthood. It's time now to define, design, and empower this new, nearly universal elderhood. In this Medical Center Hour, geriatrician and writer Louise Aronson draws on her clinical experience and creative abilities to reimagine and advocate for old age not as a disease but as a vital phase of being human, with implications for social and community life, technology, geroscience, and healthcare. How shall we now approach elderhood?
Koppaka Family Foundation Lecture in Health Humanities
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
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
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.
Physician-author Lisa Sanders, who writes the popular "Diagnosis" column in The New York Times Magazine and "Think Like a Doctor" blog for the New York Times, probes the crucial exchanges between doctor and patient that are at the heart of every medical mystery and its solution.
The Koppaka Family Foundation Lecture in Medical Humanities