Archive for April, 2008

Albert Einstein College of Medicine Social Medicine Course

Add a comment

The Social Medicine Course at the Albert Einstein College of Medicine is celebrating its 10th birthday in 2008. It was founded by a group of 8 students in 1998 and remains entirely student-run.

Why a course in social medicine?

Traditionally, the preclinical science curriculum of medical school has left huge gaps in medically relevant, but “unscientific,” topics. Specifically, social factors such as economics, politics, race, and other issues related to healthcare disparities are often minimally addressed. The Social Medicine course aims to inform students about current issues in medical ethics, health economics, health policy and various other topics dealing with health and disease from a socio-economic perspective. The course is offered annually and has been very well attended in recent years. It runs in the spring semester for 12-14 weeks. Students design the curriculum each year, and the lectures are given by faculty and invited speakers. Topics covered in the course have included: the practice of social medicine, correctional health, community-based clinics, the ethics of stem cell research, medical waste, drug policy in the US, no free lunch, healthcare for people with disabilities, the politics of abortion, gun violence, elder abuse, race/ethnicity and unequal treatment, refugee health, liberation medicine, war as a public health problem, and more.

For more information on the 2008 course, please contact the organizers: Laureen Ojalvo and Carolyn Saylor. What follows is the 2008 schedule (which can also be downloaded here).

Wednesday, January 9, 2008
Matthew R. Anderson, MD, MSc, Irwin Redlener, MD,

Carol Harris, MD and Victor Sidel, MD:

“OPENING SESSION: Social Medicine Practice on the Community, National and Global Levels”
The kick-off session for the 2008 course is an introduction to and celebration of the practice of Social Medicine. This event will be chaired by Dr. Victor Sidel who has been the faculty mentor for the course since its inception. The night begins with Matt Anderson, MD from the Department of Social Medicine at Montefiore Medical Center. His title is ‘Introduction to Social Medicine.’ The evening continues with a presentation by the President of the Children’s Health Fund, and Associate Dean for Public Health Advocacy and Preparedness at the Mailman School of Public Health at Columbia University, Irwin Redlener, MD titled, ‘A Failed Recovery: Stranding Children and Families in the Aftermath of Hurricane Katrina.’ The last speaker for the evening is Carol Harris, MD who directs the Global HIV Medicine Institute at AECOM and will discuss ‘Through the Wardrobe Door from Bronx to Africa.’
We welcome all to join us at the conclusion of this session for a reception outside Robbins Auditorium.

Wednesday, January 16, 2008
Robert Fullilove, EdD:

“Race and Health”

Associate Dean for Community and Minority Affairs, Mailman School of Public Health, Columbia University


Dr. Robert Fullilove teaches courses including Race and Health in the Department of Sociomedical Sciences. Dr. Fullilove is a civil rights advocate, a community organizer of over 40+ years, and a researcher who has been involved with IOM studies on minority health, substance abuse and addiction, HIV/AIDS, TB. Dr. Fullilove brings his work to AECOM in this talk discussing the public health impact as it involves race and racism.

Wednesday, January 23, 2008
Gal Mayer, MD:

“The Medical Care of Transgender Patients”

Medical Director, Callen-Lorde Clinic
Gal Mayer, MD, is Medical Director of the Callen-Lorde clinic (www.callen-lorde.org) in Manhattan, serving New York’s LGBT community. He is an AECOM graduate. This session will focus on the concepts of what is transgender? what is gender? what do all the words mean? what pronoun do I use? How do I stay respectful?

W ednesday, January 30, 2008
Len Rodberg, PhD:

“Presidential Candidates’ Proposals for Universal Health Care”

Chair, Professor, Urban Studies Department, Queens College
Leonard Rodberg teaches the Department’s undergraduate and graduate courses on using the computer in urban analysis, as well as courses on the urban economy and health care policy. Rodberg is also Research Director for the NY Metro Chapter of PNHP. Rodberg, a theoretical physicist by training, is the Chair of the Department. He has a background in public policy and the social impact of technology. Rodberg has worked with the Office of Community Studies in developing Infoshare Community Information System, a computerized data base system that allows community groups, non-profit organizations, and others to access demographic, health, and economic information about New York City. The Infoshare system and databases are now on the web, at www.infoshare.org,and are in use by organizations and individuals throughout the City and State.
Talk: The Presidential candidates have each put forward their proposals for “affordable quality health coverage for all.” Many of these proposals share a common set of elements. What are those elements? What is missing from these plans? Are they politically “realistic?” Will they work?

Wednesday, February 6, 2008
Irene Soloway, RPA and Donald Davis, VHIP:

“Harm Reduction in the Bronx: Dealing with the Hepatitis Epidemic among IV Drug Users”

Viral Hepatitis Intervention Program, AECOM
VHIP is a government-funded harm reduction program geared towards education and prevention of viral hepatitis in the Bronx community. It is primarily run by NYHRE (New York Harm Reduction and Education) and AECOM faculty (Dr. Alain Littwin and Dr. Melissa Stein of the Department of Medicine.) Students are closely supervised by AECOM faculty, Irene Soloway and NYHRE supervisor Donald Davis, as they assist in giving vaccinations and phlebotomy, as well as providing health education and counseling to program clients.

Many of these clients participate in the syringe exchange program located next to the VHIP tent. New services are always being introduced, including rapid HIV testing and student-run group counseling sessions.

Wednesday, February 13, 2008 – ***7:30pm – 8:30pm***
Lanny Smith, MD, MPH, TM:

“Liberation Medicine”

Clinical Faculty Residency Program in Social Internal Medicine and Primary Care at Montefiore
“In September of 2000 I joined the Residency Program in Social Medicine, clear that here is an environment within which it is possible to promote social justice through teaching and example. I continue in my volunteer position as Liberation Medicine Council and Member of the President’s Council of the International Humanitarian and Solidarity Volunteer Association Doctors for Global Health, DGH (www.dghonline.org), an organization I helped to found in 1995 which does concrete, positive work in social justice in El Salvador, Chiapas, Uganda and many other countries, including the USA. Among my responsibilities in the Residency Program in Social Medicine is teaching the core seminar in Liberation Medicine, “the conscious, conscientious use of health to promote social justice and human dignity,” a course which draws significantly on the Health and Human Rights Movement as well as the legacy of Community Oriented Primary Care, (COPC). I am also part of the group teaching Health Educators at Highbridge Community Life Center in the South Bronx. I serve as faculty mentor in International Health Electives for AECOM students and am on the Governing Council of the International Health Medical Education Consortium, IHMEC.” – quoted from faculty webpage at the Department of Family and Social Medicine.

Wednesday, February 20, 2008
David Bell, MD, MPH:

“Young Men’s Sexual Health and Reproductive Rights”

Assistant Clinical Professor of Pediatrics and Assistant Clinical Professor of Population and Family Health, Columbia University
“Dr. David Bell is an adolescent medicine physician and works primarily with ages 12-24. Dr. Bell is the medical director of the Young Men’s Clinic and the School-Based Clinic Program. The Young Men’s Clinic is a unique adjunct to the Center’s Family Planning Clinic. The school-based clinic program consists of 3 middle schools, and 2 high schools in upper Manhattan. Both are direct service components of the Center for Community Health and Education within the Mailman School of Public Health. He provides direct patient care for adolescent and young adult males and females within the Young Men’s Clinic and the Family Planning Clinic. He supervises mid-level practitioners at the school sites, as well as residents and students in the Young Men’s Clinic. Dr. Bell is currently on the board of directors for the Guttmacher Institute. He has consulted for the federal Office of Family Planning, and assisted with trainings on male health with Federal OFP Regions I, II, IV and VI, as well as with Engender Health (formerly AVSC). He has appeared on MTV, BET, and CBS, promoting male health issues. Dr. Bell completed a three-year adolescent medicine specialty fellowship at the University of California, San Francisco School of Medicine.”

Wednesday, February 27, 2008
Neil Aggarwal, MD, MA:

“Abusing Psychiatry: The Role of Psychiatrists in the War on Terror”

Yale Department of Psychiatry
After graduating from Case Western Reserve University with degrees in business and medicine, Neil enrolled at Harvard where he studied religion and anthropology of South Asia and the Middle East. He is interested in cross-cultural and international psychiatry of these regions, psychiatric anthropology, and the role of religion in healing.

About the Talk: I titled the talk “Abusing Psychiatry” for two reasons. The first is an attempt to be clever. The second is because it’s a play on words which actually reflects a professional tension that I’d like to explore regarding the role of psychiatrists in the War on Terror. I’d like to briefly review the literature within bioethics, medicine, and psychiatry to see how people have conceptualized the participation of psychiatrists in the War. Then I’d like to counter this literature with several key authors from anthropology and philosophy in order to help expose many of the assumptions medical professionals take for granted. I seek not to offer any final answers or to adjudicate between these divergent schools of thought, but rather to stimulate critical discussion on how we perceive our professional responsibilities. These questions require us to probe ourselves and for this reason, I don’t want to offer any solutions.

Wednesday, March 5, 2008
Allan Ross, MD:

“Public Health and Pediatrics in Kosovo”

Assistant Professor of Clinical Pediatrics, Columbia University
Dr. Alan Ross completed medical school in San Antonio when he was fifty. He had studied and taught Slavic studies for twenty years before that and, as part of his training, had spent a year in Tito’s Yugoslavia . He learned Serbo-Croat in Belgrade and made lasting friendships there. He and his wife met their first Albanians-not in the Balkans but at Albert Einstein and its affiliated hospitals. In order to learn some Albanian (she did, he didn’t!), they spent their honeymoon in Kosova in 1986. After the abrogation of the province’s autonomy by Milosevich, five years later, Dr. Ross began to devise public health programs for the area: these included a vaccination program in 1991, a TB campaign in 1994, the despatch of neonatal assistance teams to vulnerable children born in hospital, at home, and in an illegal private birthing center in 1996 and, when the rebellion began, the reorganization of a clinic for children driven out of their villages by the police. He gained -and lost- many friends during that time, most,but not all, Albanians, and it is in their honor that he reads these stories tonight.

Wednesday, March 12, 2008
Sheldon Tepperman, MD:

“Gun Violence”

Chief of Trauma and Critical Care Surgery at Jacobi Medical Center
Dr. Tepperman has firsthand experience with the devastation that gun violence can have in the Bronx. He is not only involved in the medical care of gun violence victims and their families, but he is a dedicated activist for legislative change and sits on the board of New Yorkers Against Gun Violence. He gives a riveting talk describing not only the impact that gun violence can have on our community, but several measures that can be taken to curb the illegal sale and use of guns.

Wednesday, March 19, 2008
Gary Kalkut, MD:

“Correctional Health at Rikers Island Health Services”

Vice President and Senior Medical Director, Montefiore Medical Center
Correctional healthcare is a challenging but rewarding area of medicine to which physicians receive little exposure. Dr. Kalkut, an attending physician from the Department of Medicine at Montefiore, will share his experiences and anecdotes as a physician at the maximum security Rikers Island Correctional Facility in NYC, which was a Montefiore facility until 1998. He will also talk about correctional healthcare as primary care for a needy population, with strong public health, social, and political implications.

Wednesday, March 26, 2008
Karen Hein, MD:

“Impact of Conflict, Tsunamis and HIV on Children”

Clinical Professor, Department of Pediatrics and Department of Epidemiology and Population Health, AECOM
“Karen Hein, M.D., became President of the William T. Grant Foundation on September 8, 1998. Dr. Hein was the Executive Officer of the Institute of Medicine (National Academy of Sciences) from December 30, 1994 to June 30, 1998. Dr. Hein is Clinical Professor of Pediatrics, Epidemiology and Social Medicine at Albert Einstein College of Medicine in New York. From l993-l994 she worked on health care reform as a member of the Senate Finance Committee staff in Washington, D.C., drafting legislation related to health benefits, workforce, and financing medical education and academic health centers.

Dr. Hein graduated from the University of Wisconsin (l966), attended Dartmouth Medical School (l966-l968) and received her medical degree from Columbia University, College of Physicians and Surgeons in l970. She was one of the founding members of the Dartmouth Medical School Board of Overseers (1973-1978).

During the past 25 years, Dr. Hein has assumed a variety of roles related to health policy through her activities in program development, teaching and clinical research. She directed a model program for health care of juvenile detainees. In l987, she founded the nation’s first adolescent HIV/AIDS program. She worked closely with the Board of Education to expand AIDS education to the million students in the New York City public school system. She has written over l50 articles, chapters and abstracts related to adolescent health, particularly focusing on high risk youth. Her book entitled, AIDS: Trading Fears for Facts, has sold over 100,000 volumes.

Dr. Hein has served as a consultant or advisor to many city, state and federal health organizations. She was President of the Society for Adolescent Medicine in l992. She has been a recipient of several awards including an Assistant Secretary for Health Award (DHHS) in l989, Health Care Financing Administrator’s Award (HCFA) in l993 and Stewart B. McKinney Foundation in l994 for leadership in the HIV epidemic. She is currently on the editorial advisory boards of 3 journals, a member of the Board of Directors of 7 national organizations (and Chair of the Center for Health Care Strategies).” – From David A. Winston Health Policy Fellowship

Wednesday, April 2, 2008 Sarah Woodward:

“Health Care in Nueva Vida, a Nicaraguan Hurricane Mitch Resettlement Community”

Center for Development in Central America, Ciudad Sandino, Nicaragua
Sarah Junkin Woodard comes to us from the Center for Development in Central America (CDCA), the Nicaraguan project of the non-profit, faith-based organization, the Jubilee House Community (JHC). Before moving to Nicaragua in 1994, the JHC operated shelters for the homeless and battered women in Statesville, NC, including facing issues of limited health care for the poor. Working in Nicaragua since then, the CDCA seeks to respond to human needs created by poverty in a nation where 45% of the population lives on less than $1.00/day, one of the poorest peoples in the western hemisphere, and where simply the lack of clean water impacts health on a daily basis. The CDCA is working to help communities become self-sufficient, sustainable, democratic entities, focusing its work in the areas of sustainable economic development, organic agriculture, appropriate technology, education, and health care. Donations of medicines and medical expertise help to defray the expense of running a full-time clinic. Sarah says, “The CDCA has been called to work with, and speak on behalf of, the poor in our area of Nicaragua, and to share their lives and stories with folks in the U.S., to bridge the gap between us and our neighbors.” Proceeds from craft sales go to the operating expenses of the project.

Wednesday, April 9, 2008
Julio Rivera:

“HIV Treatment Adherence at Lincoln Hospital”

Senior Associate Director, HIV Services Department, Lincoln Medical and Mental Health Center, Bronx, NY
Dr. Rivera currently leads the Treatment Adherence Pilot Program at Lincoln Hospital. The Treatment Adherence Pilot Program will enroll 40 HIV-infected individuals already enrolled in the Immunotherapy Clinic who are on or are in the process of being placed on single-dose, daily anti-retroviral (ARV) medication. The 40 patients who be those who have shown themselves to be non-adherent or poorly adherent to their ARV medication regimen. They initially will be assigned to one track, which requires them to receive a weekly visit from a member of the Treatment Adherence Pilot Program health education staff and to present themselves to their medical provider once a month for a medical evaluation.

The patients will be tracked throughout the duration of the Program; it is expected that 10 of the 40 patients will become seriously non-adherent enough to their medication regimen to justify they being transferred to a second track, the Directly Observed Therapy track. Patients in that track will receive daily visits from a member of the Treatment Adherence Pilot Program health education staff, who will observe the patients take their medication and provide them the education and encouragement needed to have them return to becoming adherence to their medication regimen. The patients will also present themselves to their medical provider one a month for a clinical evaluation.

The primary goal of the program is to reduce HIV-related morbidity and mortality, the secondary goals being to identify barriers to patients becoming and remaining adherence to their medication regimen; to reduce hospitalization rates of those patients participating in the Program; to reduce their number of opportunistic infections; to reduce their emergency room visits; to increase their ARV adherence rates; to improve HIV viral load suppression rates and CD4 counts; to educate patients about medication side effects; to build patient trust in the Treatment Adherence health educators and medical providers; to empower patients to become better informed about and involved in their medical treatment plans; and to increase weight gains among those with previous weight loss associated with their treatment regimen.

Please Note: Image from the article “Lincoln Hospital: The Decline of Health Care” published in the Social Medicine Journal (http://www.socialmedicine.info) Volume 2; Number 2; 2007.

Wednesday, April 16, 2008
Oliver Fein, MD:

“Time for National Health Insurance for the US?”

Associate Dean and Professor of Clinical Medicine and Clinical Public Health, Weill-Cornell Medical College
Oliver Fein, MD Dr. Fein is a practicing general internist with experience in health policy and an interest in access to care, health system reform and global health education. He is currently Professor of Clinical Medicine and Clinical Public Health and Associate Dean for Affiliations at the Weill Cornell Medical College of Cornell University. As Associate Dean for Affiliations, he is responsible for Weill Cornell’s domestic affiliations and the Office of Global Health Education. He also coordinates the David Rogers Health Policy Colloquium, a weekly interdisciplinary health policy forum at Weill Cornell.
In 2004, Dr. Fein was elected to the Executive Board of the American Public Health Association (APHA). He is Chair of the New York Metro Chapter of Physicians for a National Health Program (PNHP) and was elected President-elect for 2008. He is also on the national board of the Global Health Education Consortium. He is a fellow of the American College of Physicians and serves as Chair of the Health System Reform Committee of the Society of General Internal Medicine (SGIM). He is on the Editorial Board of the journal Medical Care. In 1993-94, he was a Robert Wood Johnson Health Policy Fellow in the office of U.S. Senate Majority Leader, George Mitchell.

Talk: The US spends more on healthcare than any other country, yet there are now over 47 million Americans without health insurance. Furthermore, the US has the shortest life expectancy and highest infant mortality rate among developed countries, and over 18,000 people die each year due to lack of insurance. Countries with single-payer systems have longer life spans, less infant deaths, and spend far less on healthcare that covers all of their citizens. Is single-payer National Health Insurance the solution for this country? What are we waiting for?

Wednesday, April 30, 2008 [POSTPONED UNTIL WEDNESDAY, MAY 14]
Victor Sidel, MD:

“War and Public Health”

Distinguished University Professor of Social Medicine at Montefiore
“Dr. Sidel was one of the founders of Physicians for Social Responsibility (PSR) in 1961 and was its president in 1987-88. In 1980 he was one of the founders of the International Physicians for the Prevention of Nuclear War (IPPNW), the recipient of the 1985 Nobel Prize for Peace, and was its co-president from 1993 to 1998. He has spoken and published widely on the economic, social, environmental and health consequences of the arms race, on the risks posed by the proliferation of nuclear, chemical and biological weapons and on the diversion of resources and the curtailment of human rights entailed in responses to the threat of bioterrorism. Dr. Sidel is co-editor with Dr. Barry Levy of War and Public Health (Oxford University Press, 1997; updated paperbound edition, American Public Health Association, 2000) and of Terrorism and Public Health (Oxford University Press, 2003).”

Wednesday, May 7, 2008
Dahlia Wasfi, MD:

“The Human Toll of the Iraq War”

Global Exchange Activist
Please join us May 7th for the closing lecture for this year’s Social Medicine Course! This year 2008 is significant in many ways. Not only does it mark the 10th anniversary of Einstein’s Social Medicine Course, but it also marks the 5th anniversary of the Iraq War. Our closing speaker, Dr. Dahlia Wasfi, will discuss the health consequences and the human toll of the Iraq War, speaking from personal experience during her extended stay in the country.

As future health professionals who may encounter war veterans and their families, as well as immigrants and refugees fleeing from war-torn countries, how can we provide optimal care to our patients? As public citizens making informed decisions this election year, what critical issues should we be aware of as we choose government officials who will guide the future policies of this country? What is our role as physicians and citizens in addressing both health and social issues? Join us May 7th to discuss these and many other issues, and have the rare opportunity to hear from Dr. Wasfi as she provides first-hand accounts and attempts to put a human face to the atrocities of war.

About the speaker: Dr. Dahlia Wasfi was born in 1971 to a Jewish mother and Iraqi father. She spent her early childhood in Saddam Hussein’s Iraq until she returned with her family to the United States in 1977. Dr. Wasfi graduated from Swarthmore College in 1993 with a B.A. in Biology, and from the University of Pennsylvania School of Medicine in 1997. Her latest trip to Iraq was a 3-month stay during the spring of 2006, when she traveled to see her family in Basrah. Based on her experiences, she is speaking out against the negative impact of the U.S. invasion on the Iraqi people and the need to end the occupation.

There is also more information on the following websites:
http://liberatethis.com
http://www.globalexchange.org/getInvolved/speakers/124.html
http://www.youtube.com/watch?v=colcD8UVr90&feature=PlayList&p=F2CE027D408BB226&index=0

No Free Lunch: Saying No to Drug Reps

1 Comment

Under the banner “Just Say No to Drug Reps” the No Free Lunch campaign challenges doctors to give up their dependency on drug companies.

The site uses a alcoholism motif, beginning with a modified CAGE screening test:

  • Have you ever prescribed Celebrex?
  • Annoyed by people who complain about lunches & free gifts?
  • Is there a medication loGo on the pen you are using right now?
  • Do you drink your morning Eye-opener out of a Lipitor coffee mug?

Two or more “yes” answers may indicate a problem. But fortunately the campaign can help you with your dependence problem.  Visitors can take a pledge to abstain from accepting gifts from drug companies and be listed on a “drug free doctor” database. There is even a “pen amnesty”!

No Free Lunch is the brainchild of Dr. Bob Goodman, a New York internist.  Among the other resources on the site are:

So, it’s really not all that complicated to deal with drug representatives. Just say no.

Global Health Watch: The Alternative Health Report

Add a comment

Global Health Watch is one of several civil society initiatives set up after the international community failed to reach the goal of “Health for All” in the year 2000. It is a “broad collaboration of public health experts, non-governmental organisations, civil society activists, community groups, health workers and academics” which attempts to produce an alternative health report. GHW was started by the People’s Health Movement, Global Equity Gauge Alliance and Medact.

GHW published its first report in 2005-2006 and it is available for free at this link. The report covers a broad variety of topics within contemporary global health. The 360 page report provides essential reading on globalization, health care systems, medications, the crisis in global health care workers, sexual and reproductive health, gene technology, indigenous health, disabled people, climate, water, food, education, war, the WHO, UNICEF, World Bank/IMF, big business, international AID, debt relief, and essential health research.

Work is currently ongoing on the production of GHW 2007-2008. One can also subscribe to the GHW monthly newsletter.

Here is the introduction to GHW 2005-2006:

“Today’s global health crisis reflects widening inequalities within and between countries. As the rich get richer and the poor get poorer, advances in science and technology are securing better health and longer lives for a small fraction of the world’s population. Meanwhile children die of diarrhoea for want of clean water, people with AIDS die for want of affordable medicines, and poor people in all regions are increasingly cut off from the political, social and economic tools they can use to create their own health and well-being.

“The real scandal is that the world lacks neither funds nor expertise to solve most of these problems. Yet the predominance of conservative thinking and neoliberal economics has led the institutions that were established to promote social justice into imposing policies and practices that achieve just the opposite. They police an unjust global trade regime with a doctrinaire insistence on privatization of public services, and preside over the failure to curb disease by tackling the poverty that enables it to flourish. Global Health Watch 2005–2006 is a collaboration of leading popular movements and non-governmental organizations comprising civil society activists, community groups, health workers and academics. It has compiled this alternative world health report – a hard-hitting, evidence-based analysis of the political economy of health and health care – as a challenge to the major global bodies that influence health. Its monitoring of institutions including the World Bank, the World Health Organization and UNICEF reveals that while some important initiatives are being taken, much more needs to be done to have any hope of meeting the UN’s health-related Millennium Development Goals.

“The report also offers a comprehensive survey of current knowledge and thinking in the key areas that influence health, focusing throughout on the health and welfare of poor and vulnerable groups in all countries. These issues range from climate change, water and nutrition to national health services and the brain drain of health professionals from South to North.

“Global Health Watch 2005–2006 is above all a call for action, written in a clear, accessible style to appeal to grass-roots health workers and activists worldwide, as well as to international policy-makers and national decisionmakers. Its resource sections advocate actions everyone can take, while its recommendations show how better global health governance and practice could work for Health for All rather than health for the privileged few.”

Reproductive and Sexual Health

Add a comment

The Department of Family and Social Medicine hosts a Reproductive Health Fellowship. For information on this fellowship please contact Dr. Marji Gold. This posting, originally published in March of 2005, was prepared by Dr. Louisa Hahn, one the (now former) fellows:

Sexual and reproductive health have been defined in different ways depending on the political and social climate of the times. In the last few decades, most social and international organizations have recognized the merging of health and human rights. This means in part that the state cannot violate people’s rights to sexual health. Governments must also assure that no other organization or person violates those rights and create the conditions in which people are able to fulfill the right to sexual health.

The right to sexual and reproductive health used to be viewed mainly in negative terms (freedom from disease and disfigurement) but is now also viewed in positive terms (freedom to enjoy pleasure and fulfillment). The US Surgeon General, Dr. Satcher, in 2001, sought to establish that “sexual health is not limited to the absence of disease or dysfunction, nor is its importance confined to the reproductive years.” The World Health Organization defines reproductive health as a state of physical, mental, and social well-being in all matters relating to the reproductive system at all stages of life. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this are the right of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.

The choice for women of whether or not to go through pregnancy and childbirth is an important reproductive right. Looking through the lens of social justice (PDF), we know that the women most harmed by lack of safe reproductive choices are those without financial means or social connections. Moreover, when women can make their own reproductive choices, it opens up opportunities to them for education and employment. To make these life choices, women must have full access to family planning methods and abortion for unplanned and unwanted pregnancies.

Abortion is a simple, safe medical procedure that saves lives when it is available. The risk of death associated with abortion performed by trained professionals is approximately 0.6 per 100,000 abortions, and the risk of major complications is less than 1 percent. Almost 90 percent of abortions are performed in the first trimester of pregnancy (within the first 12 weeks after the first day of the last menstrual period), and fewer than 2 percent of abortions are performed after 20 weeks. Currently in the United States, there are two safe and effective methods of first trimester abortion: medical abortion and suction abortion. Medical abortion uses pills called mifepristone or RU-486 and misoprostol that essentially induce a miscarriage. Suction abortion is performed with a plastic cannula and hand-held syringe or vacuum. For a description of these procedures and their differences, go to: The Access Project or Brandeis Medical Center.

Women can find themselves with an unwanted pregnancy for many reasons. For many, effective family planning is out of reach. At least 350 million couples worldwide do not have access to information about family planning and the full range of contraceptives options. The contraceptive methods that we have to offer are often not easy to use and sometimes fail even when used perfectly. Between 8 and 30 million pregnancies each year occur because of contraceptive failure. And unfortunately, sexual coercion or rape is common around the world. Between 20% and 50% of all women and girls report sexual abuse, rape or sexual coercion. Women also choose to have abortions due to a variety of social and economic reasons that include: being unmarried, abandoned by their partners, being too young, unstable partnerships, having too many children to support already, and living in poverty.

Of the estimated 45 million pregnancies worldwide that are terminated by abortion every year, about 19 million involve unsafe procedures performed by women themselves, by unskilled providers, or in settings with inadequate medical standards. Approximately 68,000 women die from complications resulting from unsafe abortion and even more suffer from infections, infertility, and long-term damage to their reproductive tract. Unsafe abortion deaths account for 13% of all maternal deaths globally and over 25% in some countries. Evidence from countries where women have full access to safe services shows that these abortion-related deaths and disability can be virtually eliminated with appropriate policies and programs.

But even where it is legal, safe abortion is not always available. In many developing countries, health workers, doctors and nurses do not have adequate training or equipment. Some refuse to refer or perform abortions because they do not understand the laws or because they personally do not support abortion. And when women have complications from an unsafe abortion, adequate medical support is often unavailable, and family planning is not discussed. As one of his first acts as president, George W. Bush re-imposed the global gag rule (or the “Mexico City Policy”) on January 22, 2001. This policy restricts foreign non-governmental organizations from using their own, non-U.S. funds to provide legal abortion services in order to receive U.S. family planning funds. It also prevents them from lobbying their own governments for abortion law reform, and prevents them from providing accurate medical counseling or referrals regarding abortion services.

In the United States, abortion has been a legal right of women since the court case of Roe vs. Wade in 1973. The conclusion held that a woman’s right to an abortion falls within the right to privacy protected by the Fourteenth Amendment. The decision gave women the right to abortion during her entire pregnancy and defined different levels of state interest for regulating abortion in the second and third trimesters. Since then, the number of deaths in the US per 100,000 abortion procedures declined five-fold between 1973 and 1991.

Significant barriers still face a large number of US women seeking this service, including the determination of viability, cost and insurance coverage, waiting periods and parental consent laws, restrictions on medical abortion, provider unavailability, harassment, refusal clauses, anti-choice laws, and the fetal legal rights movement. Federally subsidized abstinence-only sex education, which has not been shown to decrease the rate of unintended pregnancy (and may increase it), has expanded and access to a full range of contraceptive options has been limited. Eighty-six percent of US counties have no abortion provider. There has been a steady decline in abortion providers over the past two decades. Only 12 percent of all Obstetrics-Gynecology residency programs require training in first trimester abortion and 91 percent of residents report having no experience with abortion procedures. Currently, almost half the pregnancies in the United States are unintended, and teen pregnancy rates are much higher than other developed countries, and even many developing countries. Women of reproductive age currently spend 68 percent more in out-of-pocket health care costs than men, primarily because of reproductive health-related costs.

The policies of the current administration have strengthened barriers to abortion both at home and abroad. Preserving women’s right to choose in the United States will require improved public and professional education, legislative and legal efforts, and advocacy by physicians and other health care professionals. To eliminate these negative outcomes for women, health care workers and activists need to work to ensure universal access to family planning services, especially for young people and women at risk of sexual abuse, rape and violence. Our communities need to be educated about unsafe abortion, social disparities in reproductive health, and their consequences, and work to reform restrictive laws and policies that deny access to family planning, health and abortion-related services.

For more information about organizations that advocate for reproductive rights and choice, visit these websites:

United States:

International:

See also Martin Donohue’s article Increase in Obstacles to Abortion: The American Perspective in 2004, published in the Journal of the American Medical Women’s Association.

— By Louisa Hann, MD, Family Planning Fellow in Family Medicine

A visit with Dr. Walter Lear

1 Comment

Walter Lear at the Archive[Originally Posted in January of 2007.  For information on Dr. Lear's 85th birthday party -  May 4th 2008 - click here. ]

In late November 2006 the editors of the Social Medicine Portal visited the US Health Left History Center and its Health Activism History Collection in West Philadelphia. Here is a report on what we learned:

The Health Left History Center and its Collection were created by Dr. Walter J. Lear who in 1970 switched his professional work from public health to medical history, with the mission of “bringing out of the closet the history of the US health left and related activism.” Dr. Lear has also been a tireless and distinguished activist, recently receiving the American Public Health Associations Helen Rodriguez-Trias Award for Social Justice. Although “uncomfortable in the world of academia” by self-report, he is one of the founders and an officer of the Sigerist Society, an organization of critical and radical medical history scholars. Most of the materials in the unique and extensive Health Activism History Collection might have been lost but for the efforts of Dr. Lear. For example when describing his discovery of the complete organizational records of the American Soviet Medical Society (formed by Henry E. Sigerist), Dr. Lear explained how they had been stored in cartons in a Brooklyn basement, forgotten and untouched since the Society’s demise fifty years earlier. He subsequently used these records to write a chapter about the Society which was published in Elizabeth Fee and Theodore Brown’s Making Medical History: The Life and Times of Henry E. Sigerist. The Health Activism History Collection has seven divisions:

1. Archives of Organizations, Campaigns and Movements: These include the Medical Committee for Human Rights, the Physicians’ Forum, the Philadelphia women’s health movement of the 1970′s and 1980′s, American medical support for Spanish democracy, the American Soviet Medical Society and the various campaigns for national health insurance and a national health service.

2. Personal Papers of Health Activists: These include Dr. Lear’s papers as well as those of Ruth Blier, Carl Dahlgren, JoAnne Fischer, Frank Furstenberg Sr, and Paul Lowinger.

3. Images: The collection contains over a 1000 photographs, cartoons and other images in 22 subject categories.

4. Audio-visual materials: The collection contains some 70 audio-interviews of health activists and a smaller number of videos.

5. Rare and Special Books, Pamphlets and Serials: 200 books, about 1000 pamphlets and twelve serials are located in this division. We had a chance to peruse Iago Galdston’s two books on Social Medicine.

6. Reference Division: This division contains information on over a 1000 individuals associated with the US health left. Dr. Lear is preparing a talk on pediatrician activists and showed us his four inch thick file on Allan Butler, a Chief of Pediatrics at Harvard and the Massachusetts General Hospital who had been persecuted by the House Un-American Affairs Commiteee despite being an anti-communist. This division also has files on over 700 organizations.

7. Epherema: Items such as buttons, banners and T-shirts.

Last year the US Health Activism History Collection was legally donated to the University of Pennsylvania’s Rare Book and Manuscript Library by the Institute of Social Medicine and Community Health. (the History Center’s parent organization). The transfer of the Collection from Dr. Lear’s beautiful pre-Victorian home to the University is being done in stages and will be completed in about a year.

Why is this history important to us today? At a time when the political class in the US has taken the goal of a proper national health care system off the agenda, it is important to remember that the struggle for this has a century long tradition. In addition much still needs to be done to eliminate elitism, racism and sexism in the health field. We can learn many lessons from past health activism and be inspired by those who have gone before us.

Dr. Lear shared with us a favorite quote from Antoinette Konikow, a Boston physician and birth control champion who – in 1943 at age 74 – told her communist party comrades at a rally: “I have always been a rebel and have led a life of struggle. But it has been a thrilling life. I will not see the time when you win. When you do, please lay the red flag on my grave.”

Dr. Lear has developed a list of 50 topics in the history of US health activism which he considers worthy of scholarly attention by students. This list, publications of the History Center and information about the US Health Left are available on request. He can be reached at: wjlear@critpath.org or 215-386-5327.

Matt Anderson and Carolyn Chu

Gesundheit Institute: The Power of a Positive Model

1 Comment

The Gesundheit Institute was founded in the 1970′s with the idea of creating a free silly hospital in Hillsboro, West Virginia. This vision was the dream of Patch Adams, a story dramatized in the 1998 Hollywood movie, Patch Adams. But this is more than a Hollywood tale.

While the hospital has yet to be built, Gesundheit serves as a model for a different, positive vision of health care; see, for example, Re-Designing the US Health Care System: Think Universally, Design Locally by Dr. Susan Parenti. Today this vision is embodied in a variety of programs hosted at the Institute:

The Institute sponsors a variety of workshops, such as Thinking Outside the Box 2008: Re-Design Our Health Care System which will take place from August 6-11 2008, at the Gesundheit. The aim is to seed a variety of designs of projects at the local level, that will fundamentally change the health care system for the better.

There are also clown trips. The 2008 trip will travel to Italy and will “spread joy” through clowning in hospitals, nursing homes, disabled centers, prisons for young people, and on the street. The Institute also offers speakers and individual workshops.

What follows is the report to the Portal from Portal Editor Michelle Yu who went to the Gesundheit Health Justice Gathering in 2005: “Wild wigs and clown noses, talks by Patch Adams and his team of doctor-dreamers, imaginations that span the sky, sunrise hikes in West Virginia hills, nonstop music and dance, organic nourishment, and most of all, inspiration to change the world of medicine! If any of the above pique your interests, read on, dear friends! We are looking for 30 heath justice activists nationwide to join together for an inspiring and unforgettable gathering at Patch Adams’ Gesundheit! Institute in Hillsboro, West Virginia. The first gathering in January 2005 featured workshops on Building Novel Model Health Clinics, Coalitions, Liberation Medicine, Greetings, Medical School Curriculum, and much more. Patch Adams, Susan Parenti, Lanny Smith, Andrew Ziwasimon, and other fantastic doctors and spirits participated and presented, and we’re looking to have a similarly brilliant line-up this year. Students and past participants organize the gathering each year, and the experience is unrivaled in your medical education. For questions or information, write to Michelle Yu.”

Physicians for a National Health Program

1 Comment

Per capita U.S. spending on health care is nearly twice that of any other country. Yet our health statistics are comparatively poor-life expectancy in the U.S. is 27th in the world and 45 million of our citizens go without health insurance (see US Health Care Spending In An International Context). The discrepancy between what we spend and what our health care system provides is clearly related to the fact that, alone among the advanced countries, we lack a national health care program. Our dependence on private, employer-based insurance is unique, and our system is failing-its costs rising by 10% or more each year, and its coverage declining, with less than 45% of private sector workers covered.


Physicians for a National Health Program, an organization of physicians, health care professionals, and concerned individuals, was founded in 1987 to work for a universal comprehensive national health insurance program. Current membership is over 10,000, with chapters throughout the country. The group has worked with Congressman John Conyers to develop H.R. 676, The United States National Health Insurance Act.

PNHP’s proposal for a national health care program was first outlined in a 1989 article in the New England Journal of Medicine. PNHP proposes what is called a “single payer” plan, a system of healthcare that is publicly funded but delivered largely by private entities. The latest version of their plan is the Proposal of the Physicians Working Group for Single Payer National Health Insurance, published in JAMA and endorsed by more than 12,000 physicians. PNHP argues that savings in administrative costs through adopting this efficient financing mechanism-very similar to what the U.S. has today in the Medicare program-would allow everyone to be covered, at no additional cost (see, for instance, “Paying for a Single Payer National Health Insurance Program: Where Will the Money Come From?”, a Forum Report from the NY Metro Chapter.

By international standards, single payer is not a very radical plan; many countries have similar plans, and poll after poll show that two-thirds of the American people would support it. But the continual refrain from the media that it isn’t “politically feasible” keeps it from gaining wider attention. For a lively description of single payer, see this animated presentation.

PNHP has been critical of the idea that marketplace solutions are the answer to the current healthcare problems in the U.S. In part, this criticism has been based on the failures of “actually existing” profit-driven medicine. “Mayhem in the Medical Marketplace” an article in Monthly Review by PNHP’s David U. Himmelstein and Steffie Woolhandler, gives a succinct overview of the current problems with market medicine in the U.S. We know that for-profit medicine is associated with poor quality care, vast amounts of fraud, radically higher administrative costs for paperwork, marketing, profits, and obscenely high CEO compensation, as well as a variety of practices meant to increase profits at the expense of clinical care. (Many of these issues have been discussed in a multiple articles by Drs. Himmelstein and Woolhander in the New England Journal of Medicine).

Other organizations are working for universal health care in the U.S. A principal one is UHCAN, the Universal Health Care Action Network, which brings together state and local health care activists around a range of health care reform issues.

PNHP members are active in writing, speaking and advocacy. Their national website (www.pnhp.org) offers a wealth of information and opportunities for taking action in support of a single-payer plan. In addition you can join their “quote of the day” listserv which provides critical analysis of health-related issues.

The New York Metro Chapter of PNHP is runs lively monthly forums, publishes Forum Reports and Issue Papers, and provides speaker training, grand rounds speakers, and other activities. Medical students and residents are active in the Chapter, with Chapter sub-groups on each of the medical school campuses in the New York area. See the Chapter’s web site, for ongoing programs, publications, and contact information.

- Leonard Rodberg and Matthew Anderson

Encouraging and Supporting Breastfeeding: From the NYC DOH

3 Comments

The New York City Department of Health and Mental Hygiene publishes a monthly newsletter for clinicians entitled City Health Information. The March 2008 issue is devoted to Encouraging and Supporting Breastfeeding and is an excellent resource.

That is the good news…

The bad news is that so few women in New York breastfeed. The Health People 2010 goal for the US is that 60% of mothers exclusively breastfeed for at least the first three months of life. In New York City 85% of mothers start breastfeeding, but by 2 months only 26% of them are still exclusively breastfeeding.

This is an odd situation because breastfeeding has numerous health benefits for both babies and mothers. In addition, it saves $1000 a year in formula costs. And there are only a handful of absolute contraindications: infants with galactosemia; mothers who use illegal drugs; mothers with HIV, HTLV-I or II, or active herpetic lesion; and mothers on certain medicines (thyrotoxins, some chemotherapies and radioactive isotopes).

Why then do so few women breastfeed? This is clearly not simply an individual failing, a bad “lifestyle choice.” In 1991 UNICEF and WHO set out 10 breastfeeding policies that would identify a “baby friendly” hospital. These included the facilitation of rooming in, exclusive breast milk (unless formula was medically indicated), not providing pacifiers and artificial nipples, and the training of staff in breastfeeding promotion. It is disturbing that not one New York Hospital has been designated “baby friendly.” Why not?

City Health Information provides information on how to promote breastfeeding, how to address common questions and misconceptions about breastfeeding, the practicality of breast milk storage and use as well as New York City-specific resources such as newborn home visits.

Highly recommended for all clinicians, not just those from New York City. [Free CME is also available]

Social Medicine ePrint archive: Italian Social Medicine Institute

Add a comment

The Italian Social Medicine Institute has created an on-line archive of open access Social Medicine articles, called e-ms.  The list of articles goes back to 1922. Almost all of these articles are in Italian, but English abstacts are available (as are links to the actual articles).  The list can be searched or browsed using author, journal, date or subject criteria.

They describe the project in these terms:

“E-ms is an open access archive for scientific or technical documents, published or unpublished, on Social Medicine and related disciplines. The archive’s goal is to promote the rapid dissemination of papers.

E-ms has been established in 2005 as a community service by IIMS (Istituto Italiano di Medicina Sociale), to promote open access to papers as augured with Berlin Declaration and Messina Declaration of CRUI.”

Doctors of the World Human Rights Clinic Training

2 Comments

Doctors of the World offers Human Rights Clinic training sessions for licensed physicians and mental health professionals interested in evaluating torture survivors. The sessions provide volunteers with an understanding of the asylum process in the United States, prepare them to evaluate the effects of torture on survivors, and address the importance of writing effective affidavits. The next session is on Saturday, April 19, 2008 from 8:30 to 1PM. For further information or to register, please contact Lisa Jimenez at lisa.jimenez@dowusa.org or 212-584-4866. The training will take place at Doctors of the World-USA, 80 Maiden Lane, 6th Fl, NY, NY 10038.

These sessions are offered periodically and Interested professionals should consult the Doctors of the World website for the most current events.




Open