Archive for January, 2009

Record Marijuana arrests feed the prison industrial complex

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From Norml.org

In 2007 the Department of Justice reported that there were 1,841,182 drug arrests in the United States; the report noted that there were  more drug abuse arrests than any other category of offenses.  Marijuana arrests accounted for 47.4% of the drug abuse arrests. This allows us to estimate that about 872,720 persons were arrested for marijuana offenses. Eighty-nine percent of these arrests were for possession. The 2007 arrest data is even worse  than 2006 when 829,627 people were arrested for marijuana (a Project Censored’s top 25 story in 2008).  In 2005 there were 786,545 marijuana arrests, meaning that the number of arrests increased by 86K in just two years.   Clearly, marijuana is an intense focus of police interest and activity; far more, apparently, than the less important crimes occurring at the same time on Wall Street.

The focus on marijuana may reflect its important role in feeding the prison-industrial complex.  Last year the Pew Charitable Trusts reported the somber statistic that one out of every 100 Americans is behind bars. This rate is far and away the world’s highest making the US the world’s preeminent jailer. International comparisons (using a different estimate of incarcerations) highlight that the US incarceration rate of 750/100,000 population is 5.1 times that of England (148/100,000) and 8.8 times that of France (85/100,000). The website of the Marijuana Policy Project notes that: “Federal government figures indicate there are more than 41,000 Americans in state or federal prison on marijuana charges right now, not including those in county jails. That’s more than the number imprisoned on all charges combined in eight individual European Union countries.”

The phenomenon of concentrated arrests in specific, usually minority, neighborhoods has been called mass incarceration.  It is well illustrated by our own reality in the Bronx.  In New York City incarceration affects  poor and working class communities among them certain neighborhoods in the the Bronx, the poorest of New York City’s five boroughs.  In 2007, there were 86,446 adult arrests made in Bronx County, NY, a county of 1.4 million.  Seventy-two percent of these arrests were for misdemeanors; fewer than 8% were for violent felonies.  There is a marked racial differential in who gets incarcerated.  In New York State prisons, 51% of inmates are African American and 26% are Hispanic , although African Americans and Hispanics comprise 17 and 16% of the New York State population respectively.

It is hard to justify this war on marijuana from any public health point of view.  Readers who are interested in medical background on marijuana may want to read the 1999 Institute of Medicine book – Marijuana and Medicine – which is available for free at the National Academies Press.  Websites of various advocacy groups (see below) detail the devastation brought about by the drug war.  For young people marijuana arrests can have very serious consequences.  Drug convictions bar students from receiving any Federal Student Loans.  Again, this is a policy that preferentially impacts on working class and minority communities.

This is truly a case where the cure is worse than the disease.  For advocacy on this issue visit the websites of

Students for a Sensible Drug Policy

The Marijuana Policy Project

National Organization for the Reform of Marijuana Laws (Norml)

Posted by Matt Anderson, MD, MS

People's Health Movement USA: Role of the Private Sector in Universal Health Care

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The USA circle of the People’s Health Movement is participating in two events in Washington in early February.  In collaboration with Oxfam these two forums will address the role of the private sector in promoting access to universal health care.  Here are the flyers for the two events:

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The USA circle has recently set up a section on the PHM website which is worth a visit.  You can now sign up for a PHM/USA listserve.

Posted by Matt Anderson

Peckham Experiment (1926-1950): Turning the conventional Medical view inside out

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peckhamhealthcentreThe Peckham Experiment (1926-1950) was a remarkable English attempt to rethink the role of health and medicine, an attempt that greatly influenced subsequent thinking about community health.  We recently learned the the Pioneer Health Foundation, which was set up to finance the Experiment, is still in existence and has a very informative website. The wealth of pictures and documents on the site really brings this piece of history alive.

The story of the Experiment begins in 1926 when two English physicans  Scott Williamson, a pathologist, and his (future) wife Innis Pearse set up a small health center in Peckham, a working class neighborhood of southeast London.  Located within a small house, the first Pioneer Health Center was a social club which also provided physical examinations (“overhauls”), day-care, social services, and orthopedic consultation.

Williamson and Pearse were struck by the degree of disease they found among the attendees at the Center.  Quoting from Pearse (see link):

“Suffice it to say that of all those overhauled, only 10 per cent were found to be without any clinically discoverable disorders. There were some 25 – 30 per cent who knew they had some disease; less than one half of these were under medical treatment at the time of examination. The remaining examinees (some 65 to 70 per cent) all had some pathological disorder of which they were unaware, or which they ignored.” (J Roy.Coll. Gen. Pract., 1970, 20, 147)

Findings like these spurred a rethinking of the role of the center. In the words of Mary Langman, the Center’s Founder Secretary:

“Within a few years Scott Williamson shut this venture down; it had become apparent that whatever abnormalities they found were returning in some form even where they had been successfully treated, on return to the same environment as had caused them in the first place.

Something had to be done about that; but what? The doctors could have no control over the working environment, not over the facilities at home. They had little influence over conditions is schools. Their only point of leverage was small – the limited leisure time available to everyone at various time of their day.”

The logical conclusion was to build a new Pioneer Health Center, this in the form a recreation center. The beautiful new center (shown in the image) was opened in 1935 and included a gymnasium, theater,  swimming pool, and school. Nursery facilities were available and a cafeteria served organic food grown at the Center’s farm.  [The PHC website has beautiful pictures of these facilities.]  To join the center one had live nearby (“within easy pram pushing distance”), pay a small fee, and agree to a yearly, family physical examination.

The  Center was seen as a vast experiment to understand what promotes health.  Quoting from the website, it sought “to turn the conventional medical viewpoint inside out – to look at what is biologically right whereas pathology and therapeutics look at what is biologically wrong.”  Its results profoundly influenced thinking about community health.  Here is a brief summary prepared in 1986 of the major findings:

“Basic Concepts and Processes derived from the work of Dr George Scott Williamson and Dr Innes Pearse

1. Health is a positive process and not merely the absence of disease.
2. Health has action patterns and behaviour of its own, and its own laws.
3. The basic unity is the parents and their children.
4. Health is to be seen in the excellent of structure and function – in their individual actions and behaviour of this unity, and in their relationship to each other and the environment.
5. This excellence is established mainly during certain key phases of growth and development, from birth (or before) through infancy, childhood, puberty, adolescence, courtship, mating, parenthood.
6. Each phase has its own developments characteristic of that phase which are integrated into the whole person and the quality and direction of all future action.
7. The potential for this growth and development is inherent in the family and its individual members, and is entirely self-announcing and self-directing.
8. It announces itself in each phase through feelings, appetite, and interest in things pertinent to that particular development, and is characterised by the spontaneous nature of the behaviour.
9. It directs itself through the dedication of the individual or individuals in all the appetitive phases, e.g., in physical achievement or in courtship and marriage.
10. Its completion is accompanied by feelings of satisfaction and fulfilment.
11. The successful completion of such cycles is not only necessary for the acquisition of important skills/capabilities, but also provides a foundation of emotional health and contributes to such qualities as contentment, judgment and courage.
12. Throughout each phase there is a high degree of energy – vitality and drive manifested within the dedication.
13. The emerging skill can only grow and develop if the environment contains the appropriate opportunity/stimulus for exercise and practice.
14. The environment must contain sufficient families to cover the whole spectrum of interests, actions and growth and development, so that each family and its members may find opportunities for its own specific action and development.
15. This population must be one in action, through the full range of phases and interests, and visible and accessible to each member in continuity.
16. This population will develop and exhibit community integration, purpose and achievement in its major and minor actions. What is being manifested is the growth and development of the whole. It is a biological entity in its own right, as well as being the nurtural environment for each individual and family.
17. The growth and development of each family in mutuality with the social whole constitutes biological order.
18. Such a community is cultivable, and is self-sustaining. As was demonstrated by the Peckham Experiment, this is achieved by cultivation of the environment and not by direct cultivation of the individual and family.”
(Compiled by Douglas Trotter and Allan Pepper, November 1986)

The Center was closed during World War II and turned into a munitions factory.  It reopened in 1945 but then closed permanently in 1950 due to lack of funding. The Center apparently did not find favor in the new formed British National Health Service.  The building is now an apartment house.  The Pioneer Health Foundation has remained in business, publicizing the work of the Experiment.  For a fuller overview of the Experiment see the 1985 paper by Allan Pepper at this link.

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The Peckham Experiment is one of the most influential of many attempts to reconceptualize the role of clinical medicine by integrating it with the life of the community and focusing on health promotion by various means rather than simply the cure of disease using medicines.  One is struck by the bold vision represented by the project.  Also in this tradition is the work of Sidney and Emily Kark on Community Oriented Primary Care (originally, A Practice of Social Medicine).

posted by Matt Anderson

David Kindig: Health Care Reform is more than medical services

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Dr. David Kindig

Dr. David Kindig

On Tuesday January 20, 2009 Dr. David Kindig offered the second annual Harold Wise lecture as part of our Social Medicine Rounds series. The Wise lecture is organized the Residency Program in Social Medicine Alumni Committee.  His talk was entitled:  To: President Obama, From: Harold Wise, MD, RPSM Founder, Re: Beyond Health Care Reform. Dr. Kindig has kindly given us permission to post his presentation which can be downloaded here.  It should not be reproduced without his consent.

Dr. Kindig began with some memories of Harold Wise, a Canadian physician born in Hamilton Ontario in 1937.  After receiving his MD degree at the University of Toronto in 1961, Dr. Wise completed an Internal Medicine internship at the Kaiser Permanente Foundation Hospital.  In 1964 he moved to Bronx and completed his Medicine residency at Montefiore.  He then served as Director of Ambulatory Services and Home Care at Morrisania City Hospital, a New York City hospital affiliated at the time with Montefiore.  In 1969 he became the director of the Dr. Martin Luther King Jr. Health Center, one of the first OEO (Office of Economic Opportunity) Community Health Centers in the US.  Faced with the problem of finding well-trained clinicians interested in working in underserved areas, Dr. Wise created the Residency Program in Social Medicine.  He passed away in 1998.

Dr. Kindig then discussed his own path to the Bronx.  As a pediatrics resident at the University of Chicago he had been told that spending a month working at a community health center was “not a legitimate PGY-2 activity.”  He was becoming increasingly politically active at the time and became interested in pursuing other paths in medicine.  He met up with Harold Wise who convinced him to come to the Bronx and develop a “Social Pediatrics” residency program.  Dr. Kindig moved from Chicago to the Bronx both creating the residency program and becoming its first graduate in 1971.   He went on to have a distinguished career in academics and government service.  He is currently Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin-Madison, School of Medicine. He also serves as Senior Advisor to the Wisconsin Public Health and Health Policy Institute.

His talk focused on the need to move beyond simply reforming health care in the United States.  Insuring all Americans and providing them with health care are two necessary and important steps for the new  Administration in Washington. But they are not enough.  True health reform would require addressing the multiple social determinants of health.  He discussed how the book Why Are Some People Healthy and Others Not? The Determinants of Health of Populations had been an epiphany for him.  He had come to see that curative medical services were of limited value in addressing social disparities and that spending more on such services might actually reduce the overall health of the population.  He briefly reviewed some of the recent evolution of thinking on population health and spoke about his own work in conceptualizing reimbursement systems that would pay for population health. His concepts are outlined in his book Purchasing Population Health (available on Google Books) and in a 2006 JAMA article A pay-for-population health performance system.

Currently, Dr. Kindig is active in the Robert Wood Johnson Health & Society Scholars Program and the Population Health Initiative at the University of Wisconsin.  At the Population Health Institute he leads an initiative to make  Wisconsin the healthiest state and he shared some of that work with us.  The project produces an annual report card on Wisconsin health. The 2007 report card noted that while health in Wisconsin was improving it was not improving as fast as other states.  The state was graded B- overall for health and D for addressing health disparities.  The program is moving beyond merely grading the state to better understanding the determinants of health and then to suggesting specific evidence-based  actions to address each one. The work of the program seemed embued with a very political sense of making health statistics understandable to the people who could actually influence public policy.

It is impossible to comment on the talk without mentioning the spirit of optimism generated by the inauguration earlier in the day of Barack Obama.   Rounds took place at the Cherkasky auditorium where some five hours earlier hospital employees had watched President Obama sworn in.  It in words of Montefiore President Steven Safyer it was a moment of Jungian synchronicity.

posted by Matt Anderson, MD

Family Centered Maternity Care

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images3Our colleague, Dr. Rebecca Williams, has set up a website exploring Family Centered Maternity Care (FCMC).  Family Centered Maternity Care, as she explains it, is a philosophical approach to prenatal care and delivery providing care to the pregnant woman in the context of her family. FCMC is prenatal care that considers, includes, and fosters the development of families. Historically, practitioners have also promoted natural childbirth.” While the site is primarily towards the teaching and clinical needs of our Family Practice residents, Dr. Williams updates it on a regular basis, making it a valuable resource.

The movement for Family Centered Maternity Care is several decades old.  Interested readers may want to consult Celeste R. Phillips‘ book  Family-Centered Maternity Care some of which can be read on Google Books. Phillips, a pioneer in the field, defines FCMC as “a way of providing care for women and their families that integrates pregnancy, childbirth, postpartum, and infant care into the continuum of the family life cycle as normal, healthy life events.”  She developed the following 10 principles for FCMC:

Principle No.1: Childbirth is seen as wellness, not illness. Care is directed to maintaining labor, birth, postpartum, and newborn care as a normal life event involving dynamic emotional, social and physical change.

Principle No. 2: Prenatal care is personalized according to the individual psychosocial, educational, physical, spiritual and cultural needs of each woman and her family.

Principle No. 3: A comprehensive program of perinatal education prepares families for active participation throughoutthe evolving process of preconception, pregnancy, childbirth and parenting.

Principle No. 4: The hospital team helps the family make informed choices for their care during pregnancy, labor, birth, postpartum and newborn care, and strives to provide them with the experience they desire.

Principle No. 5: The father and/or other supportive persons of the mother’s choice are actively involved in the educational process, labor, birth, postpartum and newborn care.

Principle No. 6: Whenever the mother wishes, family and friends are encouraged to be present during the entire hospital stay including labor and birth.

Principle No. 7: Each woman’s labor and birth care are provided in the same location unless a Cesarean birth is necessary. When possible, postpartum and newborn care are also given in the same location and by the same caregivers.

Principle No. 8: Mothers are encouraged to keep their babies in their rooms at all times. Nursing care focuses on teaching and role modeling while providing safe, quality care for the mother and baby together.

Principle No. 9: When Mother-Baby care is implemented, the same person cares for the mother and baby couplet as a single-family unit, integrating the whole family into the care.

Principle No. 10: Parents have access to their high-risk newborns at all times and are included in the care of their infants to the extent possible given the newborn’s condition.

Dr. Phillips currently runs a healthcare consulting company, Phillips + Fenwick, which assists hospitals in implemented FCMC programs.  The company website – www.panf.com – has some resources on FCMC, such as a short reading list.  Of particular interest, is her 1999 article Family-Centered Maternity Care: Past, Present, Future which discusses the history and current of FCMC. Readers may also wish to consult the WHO’s document on Care in normal birth, although this document is now 12 years old.

posted by: Matt Anderson, MD


No More Drug Company Pens: A Trojan Horse?

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I fear the Greeks...

I fear the Greeks...

As of January 1, 2009 drug company sales representatives are no longer supposed to be distributing branded trinkets such as pens and pads to doctors.  Hearing of this, I could not help thinking of the Trojan priest Laocoon. During the Trojan War Laocoon was rightfully suspicious of a certain wooden horse left by the Greeks on the beach.  “I fear the Greeks even when they bring gifts,” he is quoted by Vergil as saying.  Unfortunately, for his audacity (and for throwing a spear into the side of the Trojan Horse) he was punished by Minerva, protectress of the Greeks.  She sent two sea serpents who, after eating Laocon’s two children, proceeded to devour him.  I guess this illustrates the dangers of speaking truth to power.

The new rules are reflected in a revised Code on Interactions with Healthcare Professionals adopted by the Pharmaceutical Research and Manufacturers of America (PhRMA).  These regulations had been adopted in 2008, but did not go into effect until January 1.  They cover a variety of ways in which pharmaceutical representatives can interact with physicians.  For example while pharmaceutical representatives can provide meals if they are making a presentation, they can no longer: “provide any entertainment or recreational items, such as tickets to the theater or sporting events, sporting equipment, or leisure or vacation trips, to any healthcare professional who is not a salaried employee of the company.”

With respect to branded trinkets the rules state:

Providing items for healthcare professionals’ use that do not advance disease or treatment education — even if they are practice-related items of  minimal value (such as pens, note pads, mugs and similar “reminder” items with company or product logos) — may foster misperceptions that company interactions with healthcare professionals are not based on informing them about medical and scientific issues. Such non-educational items should not be offered to healthcare professionals or members of their staff, even if they are accompanied by patient or physician educational materials.

Items intended for the personal benefit of healthcare professionals (such as floral arrangements, artwork, music CDs or tickets to a sporting event) likewise should not be offered.

Payments in cash or cash equivalents (such as gift certificates) should not be offered to healthcare professionals either directly or indirectly, except as compensation for bona fide services (as described in Sections 6 and 7). Cash or equivalent payments of any kind create a potential appearance of impropriety or conflict of interest.

It seems a big disingenous to think that providing branded mugs fosters just the “misperception” that interactions are not based strictly on the science.  In fact, the very description of what is prohibited is a laundry of the unsavory types of interactions that have long characterized the work of drug reps.  (See our previous posting Former Pharmaceutical Reps Tell All).  The PharmedOut website has some interesting new videos in which drug reps discuss how they ply their trade.

So, is this really a “gift” from Big Pharma? Or a Trojan Horse?  Or a bit of both?  Here are some comments we have received as we have asked our colleagues what they think of these new rules.

1. This is big.

Activist groups, such as No Free Lunch, the National Physicians Alliance and Healthy Skepticism, have long wanted to see branded trinkets out of doctors’ offices.   This has been reflected in efforts such as No Free Lunch’s Pen Amnesty and NPA’s Unbranded Doctor campaign.  It really is quite meaningful that doctors are no longer allow their bodies and their workspaces to serve as barkers for the drug companies.  This is big in that sense.

2. This is a small drop in a big bucket leaving the drug companies with many other ways to influence phyiscians and patients.

To put this change in context,  it is useful to reflect on the overall size of drug promotion to physicians.   According to a 2008 article by  Marc-André Gagnon and Joel Lexchin in PLOS: Pharmaceutical promotion in the United States in 2004 is as high as $57.5 billion compared to the figure of $27.7 billion given by IMS. Excluding direct-to-consumers advertising and promotion towards pharmacists, the industry spent around $61,000 in promotion per practicing physician.”

Well, $61K per doctor clearly is not buying trinkets.  What kinds of things are not covered by this exclusion?

1. The industry is still a major player in continuing medical education for physicians.  The role of big Pharma in CME was the subject of the August 30, 2008 British Medical Journal which reports that half of all CME is sponsored by pharmaceutical and medical device companies (see Roy Moynihan’s article:  Is the relationship between pharma and medical education on the rocks?

2. The industry will still be allowed to give free samples for patients. [It would, of course, be so  much nicer if they just took the $57.5 billion spent on advertising and lowered their prices.]

3. The industry can still produce patient education materials and pursue direct-to-consumer advertising.  It is not clear if infomercials, like the dreadful CNN Accent Health (hosted by our future Surgeon-General Dr. Sanjay Gupta) will continue to be allowed.

4. Drug representatives will continue to be allowed to give “informational presentations” to physicians along with free lunches.

5. The drug company can still hire physician “experts” to serve as paid consultants and speakers.  Members of committees which set drug formularies can be speakers and consultants as long as they disclose this to the drug company.

6. And drug companies can continue to gain access to the prescription history of individual physicians.  This may be the Trojan Horse in this gift.

4. These voluntary limits may be intended to forestall legislation with a far wider impact.

Current practice allows the pharmaceutical companies to purchase information on drugs prescribed by individual doctors. This is done without the consent of the physician or the physician’s patients.  The American Medical Association colludes with this policy by selling its Masterfile of physicians to the drug companies.  Sales of the Masterfile amounted to $44.5 million in income for the AMA in 2005.  (This information is drawn from an NPA issue brief).  This arrangement has been described as making the drug company “a silent third party in the examining room.”  Actually it’s more like the fourth party, because the insurance company also seems to be watching over every encounter.  Further background can be found at the NPA site.

New Hampshire, Vermont and Maine have all banned the sale of such data to the pharmaceutical companies, see a posting by the Electronic Privacy Information Center.  And a similar campaign is underway currently here in New York State.

In addition there are a number of laws on the books or proposed that would require physicians to make public any gifts or payments by drug companies.  Impetus for these laws came from 2007 and 2008 hearings held by Iowa Senator Charles Grassey of the Special Committee on Aging.

Given all these threats, Big Pharma may have decided it was better to get rid of the trinkets.

5. Why didn’t this come from the doctors?

The drug companies are facing an increasingly hostile and critical international movement.  Many of the most active members of this movement are physicians.  But they seem a minority within medicine.  The bulk of physicians seemed content to take trinkets.  There was no mass movement of physicians to “unbrand.”  And the AMA has been resistant to discontinuing its role in data-mining.

Whose side are we on anyway?

posted by Matt Anderson, MD

Cuba's Revolution at 50: The Importance of Health Care Workers

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mr090101cvr_140January 1, 2009 marked the 50th anniversary of the Cuban Revolution. Monthly Review, the US’s independent socialist magazine, devoted its January 2009 issue to the topic of Why Cuba Still Matters.  Among the articles in this issue, one particularly caught our attention: Steve Brouwer’s The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity.  Brouwer’s article provides a readable synopsis of the development of the Cuban medical system, first within Cuba and then increasingly overseas.

It is important to begin this story with 1958 Cuba where there was only 1 doctor for each 1,051 Cubans.  This statistic actually hid very large geographical disparities.  Most of Cuba’s doctors were concentrated in the towns and particularly Havana.  There were very few doctors in rural areas.  In the years immediately following the Revolution this situation only grew worse.  Many doctors emigrated, including much of Havana Medical School’s faculty.  By 1967 there was only 1 doctor for every 2,000 Cubans.  The health care system had, quite literally, to be rebuilt from scratch.

In a way this provided the Cubans with the opportunity to create an entirely different type of medical system, one established on principles of primary care and equal access to all.  By the mid-80’s the country had adopted a system of Comprehensive General Medicine (Family Medicine in US terms) based on doctor/nurse teams who served (and lived in) a neighborhood, typically of 800 people.  By 2007 there were 3 Cuban generalists per 1000 population as compared to 0.7 in the United States.  Many people attribute Cuba’s excellent health statistics to this commitment to primary care and equality of access.

However, developments on the island of Cuba are only half of this story.  Cuba had sent physicians on missions of medical solidarity since the early 1960’s.  This solidarity has accelerated notably in the past 10 years.  The 1998 Programa de Salud Integral (Comprehensive Health Program) sent brigades of Cuban doctors to Haiti, Guatemala and Honduras in the wake of Hurricanes George and Mitch.  These brigades led to semi-permanent Cuban health presences in these countries, particularly in the countryside.  Brouwer also examines the crucial role of Cuba in the Barrio Adentro program in Venezuela.

Sadly, the response of the Bush Administration has been the Cuban Medical Professional Parole Program,  an attempt to lure Cuban medical personnel to the US.  The existence of such a program is a backhanded compliment to the quality of Cuban medical personnel.  And a statement of the threat they posed to the Bush Administration.

The article closes with a discussion of Cuban medical training.  Brouwer highlights the Latin American Medical School (ELAM) as well as Cuban training in Venezuela and Yemen.   Brouwer notes that:

Cubans, with the help of Venezuela, are currently educating more doctors, about 70,000 in all, than all the medical schools in the United States, which typically have somewhere between 64,000 to 68,000 students enrolled in their programs. The U.S. students emerge from their four years of study burdened with an average of $140,000 of debt. So it’s not surprising that they have a desire to earn high salaries, either to pay that debt or simply enjoy the upper-middle-class lifestyle to which most first world physicians are accustomed. Consequently, very few U.S. medical school graduates go into residencies in family practice, the lowest paying specialty.

Interested readers are encouraged to consult the full text of the article which is available free online.

Further reading

One of the best English sources for current news about health and  medicine in Cuba is the MEDICC Review, publication of Medical Education Cooperation with Cuba.  Those who read Spanish may also want to visit the official Cuban Health Portal.

Our online journal, Social Medicine, has published articles on Barrio Adentro, the Latin American Medical School and the experience of a US student working in a Barrio Adentro clinic in rural Venezuela.

This Portal contains numerous postings about Cuba and the ELAM school.  Readers should note that Cuba still has several hundred  full scholarships for US students to attend the 6 year medical school in Havana.

posted by Matt Anderson, MD

Albert Einstein's (student-run) Social Medicine Course 2009

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doveThe schedule for the 11th year of the Social Medicine Course organized by students at Albert Einstein College of Medicine has just been announced.   The course, supported by the AECOM Division of Education, is designed to teach “Essentials of medical practice not taught in medical school.”

January 14: Integrating Prenatal Care with the Diagnosis and Clinical Management of HIV and Syphilis: A Latin American and Caribbean Initiative, Dr. Arachu Castro, PhD, MPH.  (Presented as part of the student-organized “Sex Week”)

Arachu Castro, PhD, MPH is a medical anthropologist trained in public health, working primarily in Latin America and the Caribbean on infectious disease (HIV/AIDS, TB, dengue) and sexual and reproductive health. She is Assistant Professor in the Dept. of Global Health & Social Medicine at Harvard Medical School, Project Manager for Mexico and Guatemala at the well-renowned NGO, Partners In Health, and Medical Anthropologist at the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital in Boston, MA.

Her talk will present an update on the Latin America and Caribbean Prenatal Testing Initiative for HIV and Syphilis, which she directs in collaboration with UNICEF, UNAIDS, the Pan American Health Organization (PAHO) ? an Initiative currently including Brazil, Colombia, Cuba, Dominican Republic, Nicaragua, Paraguay, Peru, and Uruguay, to identify barriers to testing for HIV and syphilis and scale up screening of HIV, syphilis, and other STDs during pregnancy in Latin America and the Caribbean.

January 21: Liberation Medicine, Lanny Smith, MPH, DTM&H, FACP (will start at 7PM) This talk has been rescheduled to May 12.

January 28: Social Medicine 101, Matt Anderson, MD, MSc

Dr. Anderson is a family physician working in the Department of Family & Social Medicine at Montefiore Hospital/AECOM.  He runs the Social Medicine Portal (www.socialmedicine.org) and co-edits an bilingual, online academic journal Social Medicine (www.socialmedicine.info).  In this talk he will discuss the core concepts of social medicine and how they have been developed and put into practice over the past 300 years.

February 4: Health Literacy, Jennifer Adams, MD & Fatima Ashraf, Mayor’s Office

February 11. Harm Reduction in the Bronx: Hepatitis & IV Drug Users, Donald Davis, VHIP

VHIP is the Viral Hepatitis Intervention Program, 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. http://www.aecommunity.com/vhip/Welcome.html

Donald Davis is the VHIP Coordinator at New York Harm Reduction Educators. He has been in the field of HIV and Harm Reduction for over ten years, having presented at numerous Hepatitis C conferences at the local, state and national level. He works with Irene Soloway, a Physician Assistant at Albert Einstein College of Medicine’s Division of Substance Abuse, in overseeing and supervising students in provide testing, vaccination and referral services to active drug users and supervise AECOM medical students at one of the NYRE syringe exchange outreach sites in Hunts Point.

The talk will introduce the concept of harms reduction with a focus on hepatitis C and how community-based screenings have affected the current situation. New York City has a higher prevalence of hepatitis C than the entire United States overall. Hepatitis C is also the most commonly reported type of viral hepatitis in NYC. Donald will address some of the issues that might be related to such a high prevalence, including incarceration, socioeconomic factors, HIV/AIDS, immigration and migration, drug and alcohol use, and hepatitis B. This talk will also cover how interventions, such as testing, vaccinations, referral services, and needle exchange programs have made an impact on hepatitis C rates as well as future interventions that can be implemented at the local community level.

February 18: Gun Violence, Jackie Hilly, NYAGV

What should the medical community know about gun violence prevention? This presentation will explore the legislative initiatives on gun violence, the public health approach to gun violence, and youth development models.

February 25: Physicians and the Pharmaceutical Industry, Joseph Ross, MD, MSH

Dr Ross will discuss the many ways physicians and the pharmaceutical industry interact and work together. He will describe how common these interactions are, and what their implications.

March 4: National Health Insurance for the US: Has Its Time Come? Oliver Fein, MD

This presentation includes a history of health insurance in the United States; a review of health care macroeconomics – where we spend our health care dollars and how we raise the revenue to pay for those expenses; an outline of the five fundamental problems facing the U.S. health care system; and, a description of single payer national health insurance and how it addresses those fundamental problems.

March 11: Environmental Justice and Climate Change Health Effects, Perry Sheffield, MD

March 17 (Tuesday): Women’s Health is a Family Value: A History of Reproductive Health Policies in the US, Carol Roye, EdD, RN, CPNP

Carol Roye is a Professor of Nursing at Hunter College in New York City and a practicing pediatric nurse practitioner in the Washington Heights neighborhood of New York. Dr. Roye’s research focuses on reproductive health issues pertinent to adolescents, including teen pregnancy prevention and working with mothers of pregnant and parenting teens to improve outcomes for their daughters. She is currently at work on a book which examines the genesis of current, unfavorable reproductive health policies and the adverse impact they have on child health in the U.S. and overseas.

March 18: Interactive Session: Novel Health Care & Sustainable Living, Frank and Bonnie Gifford, MD [This session has been postponed]

Bonnie and Frank Gifford run EntropyPawsed, a nature linked low energy living demonstration site located in the mountains of West Virginia. Their vision is to endeavor to develop a strong positive vision of the future and the personal qualities of strength, courage, wisdom, and perseverance necessary to make a positive vision reality. The Entropy Pawsed mission is to offer educational opportunities demonstrating simplicity in living with a deep ecology perspective so that we may leave a reasonable world for all children of future generations. An Einstein student, Michelle, who has studied with them, has organized a unique experience for students of the Social Medicine Course: and interactive distance-learning session, where we will practice the low-energy ideals and communicate “live via satellite” style and discuss how to incorporate sustainable practices into our future careers. http://entropypawsed.org/default.aspx

March 25: The Asian American Diabetes Epidemic, Perry Pong, MD

Despite having a lower body weight, Asian Americans are more likely than Caucasians to have diabetes. Diabetes is a rapidly growing health challenge among Asians and Pacific Islanders who have immigrated to the United States, affecting about 10 percent of Asian Americans; about 90 to 95 percent of Asians with diabetes have type 2 diabetes. Come learn about how this devastating disease has hit a seldom-discussed ethnic group – Asian Americans – and the active research that is underway to stop this epidemic.

April 1: Separate and Unequal:  Medical Apartheid in NYC, Neil Calman MD & Nisha Agarwal, JD

Bronx Health REACH, established in 1999, includes 40 community and faith-based organizations dedicated to eliminating racial and ethnic health disparities in health outcomes. In addition to its advocacy efforts, the group sponsors community health promotion and disease prevention programs, with support from the Centers for Disease Control and the NYS Department of Health. REACH is a project of the Institute for Family Health, a nonprofit organization that operates health centers and trains health professionals to work in urban, medically underserved communities in New York State. New York Lawyers for the Public Interest (NYLPI) is a nonprofit civil rights law firm that strives for social justice. NYLPI has worked with the Coalition on this issue for several years.

April 22: Health Consequences of Immigration Detention, Homer Venters, MD

Over 300,000 people are detained each year in the United States by Immigration & Customs Enforcement (ICE). These detainees are held in a wide variety of public and private jails, prisons and contract facilities but face the common problem of inadequate medical care. ICE is under no legal mandate to provide an acceptable standard of medical care, or to track and report adverse medical events for detainees. In addition, the health plan that governs much of the medical care received by detainees is inadequate and unethical. Analysis of this health plan, as well as the circumstances around a number of detainee deaths, reveals a system lacking medical sufficiency

April 29: War and Public Health, Victor Sidel, MD

May 6: Integrative and Botanical Medicine, Roberta Lee, MD

TUESDAY, May 12th: “Liberation Medicine,” Lanny Smith, MD, MPH, DTM&H, FACP

Talks (unless noted otherwise above) will take place on Wednesday evenings from 5:30 to 6:30 PM in the Forchheimer 5th floor lecture room. Dinner is provided.

Commentary:

The social medicine course, now in its 11th year, is one of the highlights of the activism by the students at AECOM.  There are over a dozen student groups at Einstein involved in questions of social justice.  They work together as part of the Einstein Umbrella.  One of the members of the umbrella is the ECHO clinic, a free clinic established by AECOM students in 1999.  This model has been followed at a number of other NYC medical schools (see our posting on Free and Low Cost Health Care in NYC).

This posting will be periodically updated as we get information from the course organizers about the details of each of the talks.

For information on similar courses in US medical schools, consult Public Citizen’s listing of health activism courses.

This posting was updated on 2/5/2009 to incorporate information about the talks.

Posted by Matt Anderson, MD

Low-cost dental care & Health Insurance, Free condoms: Only in NYC

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nyc-condomAfter our earlier posts on free and low-cost health care in New York, we were approached by someone seeking care for a broken tooth.

Our earlier post had suggested the NYU College of Dentistry Clinic and similar clinics at other dental schools. We also mentioned New York City Department of Health dental clinics for people up to age 21. (Our patient was 23).

The nagging memory of a 2006 social medicine rounds (12/19/2006) led us to the Mayor’s Office of Citywide Health Insurance Access, a part of the city government which tries to make health insurance available to as many New Yorkers as possible.   Their website has an extensive listing of Health Resources for the Uninsured.  This page provides links to low cost dental services, mainly in hospitals.  The site also has links to  community health centers, as well as information on medications, mental health resources, and vision services.

If you have no insurance, this is a useful site to visit.  It provides a screening tool (it shows up as a sidebar on each page) to help you determine if you might be eligible for any public or private insurance plans.

Finally, – in terms of free non-dental services – this week we learned the NYC DOH offers free condoms and lubricants to organizations that will distribute them for free. Click on this link.

Brush your teeth and floss after each meal, stay away from sweetened drinks and have fun (safely).

Posted by Matt Anderson, MD

Support a Vision and Help Build the Southeast Asian Community in the Bronx

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As a follow-up to our October 15, 2008 posting on the South-East Asian Community in the Bronx: Justice is Healing, we wanted to share this invitation from the Youth Leadership Project.  They will be holding a fund-raising benefit on 1/31/09 at St. Nicholas Tolentine 2345 University Avenue at Fordham Road, Bronx, N.Y. 10468 from 6PM to 1AM.  They are hoping to raise money to support a community center.

ylp-invite-2009

Support a Vision and Help Build the Southeast  Asian Community in the Bronx.

We believe in the healing and building of the Southeast Asian Community in the Bronxthat we will heal and build through the understanding and compassion we show to each other. Build a community center that will link the generations together; it will be a home away from home, a place of knowledge, strength and power.

We believe in the legacy of struggle, strength and resiliency of people– that the community’s history is important in building toward our future. We can share and learn from our history; pass it down through dance, art and activism. And that the young and the old will rebuild and build a sustainable Southeast Asian community.

We believe in changing the conditions and lives of our community with other communities in the Bronx-
With 10,000 Southeast Asian in the Bronx and a borough with so many different cultures and ethnicity we see our vision for change as part of the struggle to all who want to live free of violence. We are committed to building alliance and coalitions.

posted by Matt Anderson




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