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Do Something: Activism 101 for Medical Students and Physicians

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Title: Am I Stoned? Author: Owner Last modified by: Owner Created Date: 11/18/2009 10:20:17 AM Document presentation format: On-screen Show (4:3) Company – PowerPoint PPT presentation

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Title: Do Something: Activism 101 for Medical Students and Physicians


1
Do Something Activism 101 for Medical Students
and Physicians
  • Martin Donohoe

2
Am I Stoned?
  • A 1999 Utah anti-drug pamphlet warns
  • Danger signs that your child may be smoking
    marijuana include excessive preoccupation with
    social causes, race relations, and environmental
    issues

3
Outline
  • Impediments to public health and social justice
  • What you can do
  • Individually
  • Group
  • Heroes of Medicine and Public Health

4
Impediments to Public Health and Social Justice
  • Medical education
  • Failures of health care system
  • Actions of academic medical centers
  • Scientific Ignorance and Pseudoscience

5
Impediments to Public Health and Social Justice
  • Exploitation
  • Maldistribution of wealth and resources
  • Corporations
  • Environmental Destruction
  • War
  • Lack of international cooperation

6
Schism between medical schools and schools of
public health
  • Dates back to the early twentieth century
  • Medical schools more focused on biochemical
    mechanisms of disease and drug therapies
  • Public health focused on populations and societal
    issues

7
Medical Ethics Today
  • Overemphasizes individual conflicts and
    fascinating dilemmas involving expensive
    technologies (e.g., gene therapy, cloning, face
    transplants)
  • Underemphasizes the psychological, cultural,
    socioeconomic, occupational, and environmental
    contributors to health

8
The State of U.S. Health Care
  • 49 million uninsured patients
  • Millions more underinsured
  • Remain in dead-end jobs
  • Go without needed prescriptions due to
    skyrocketing drug prices
  • Est. 48,000 deaths/year due to lack of health
    insurance

9
Headline from The Onion
  • Uninsured Man Hopes His Symptoms Diagnosed This
    Week On House

10
The State of U.S. Health Care
  • US ranks near the bottom among westernized
    nations in life expectancy and infant mortality
  • 22 of US children live in poverty
  • Gap between rich and poor widening
  • Racial inequalities in processes and outcomes of
    care persist

11
Racial Disparities in Health Care African-America
ns
  • Equalizing the mortality rates of whites and
    African-Americans would have averted 686,202
    deaths between 1991 and 2000
  • Whereas medical advances averted 176,633 deaths
  • AJPH 2004942078-2081

12
Meanwhile, Outside the US
  • 1 billion people lack access to clean drinking
    water
  • 3 billion lack adequate sanitation services
  • Hunger-related causes kill as many people in 8
    days as the atomic bomb killed at Hiroshima

13
James Nachtwey
14
The Decline of Medicine?
  • Patient and physician dissatisfaction with
    current fragmented health care system is growing
  • Cynicism and burnout common
  • Interest in primary care low/inadequate

15
Income Inequality
  • Lower life expectancy
  • Higher rates of infant and child mortality
  • Short height
  • Poor self-reported health
  • AIDS
  • Depression
  • Mental Illness
  • Obesity

16
Maldistribution of Wealth is Deadly
  • 880,000 deaths/yr in U.S. would be averted if the
    country had an income gap like many Western
    European nations, with their stronger social
    safety nets
  • BMJ 2009339b4471

17
Voltaire
  • The comfort of the rich rests upon an abundance
    of the poor

18
Hudson River, 2009
19
Colonial Exploitation
  • Christopher Columbus log entry upon meeting the
    Arawaks of the Bahamas
  • Theybrought usmanythingsThey willingly
    traded everything they ownedThey do not bear
    armsThey would make fine servantsWith fifty men
    we could subjugate them all and make them do
    whatever we want.

20
Colonial Exploitation
  • Cecil Rhodes (Rhodesia, Rhodes Scholarship,
    DeBeers Mining Company)
  • We must find new lands from which we can easily
    obtain raw materials and at the same time exploit
    the cheap slave labour that is available from the
    natives of the colonies. The colonies would also
    provide a dumping ground for the surplus goods
    produced in our factories.

21
Sebastiao Salgado
22
Exploitation leads to
  • Maldistribution of wealth and resources
  • Environmental degradation
  • Wars
  • Over 250 wars in 20th Century
  • Most deaths among civilians
  • Militarism and war divert financial and
    intellectual resources away from social needs
  • Weapons of mass destruction

23
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24
Contemporary Research Imbalances and Exploitation
  • Unethical research on special populations
    (cultural minorities, prisoners, developing
    world, etc.)
  • Majority of phase 3 US drug company trial sites
    outside US, many in developing countries

25
Competitive Strategies of Financially-Strapped
Academic Medical Centers
  • Tuition hikes (?rising medical student debt)
  • Close public and charity hospitals
  • Single specialty hospitals

26
Competitive Strategies of Financially-Strapped
Academic Medical Centers
  • Recruit wealthy, non-U.S. citizens as patients
  • More aggressive billing practices / charging the
    uninsured higher prices

27
Competitive Strategies of Financially-Strapped
Academic Medical Centers
  • Increase cash services (botox treatments,
    cosmetic surgery) and reimburseable, covered
    services (e.g., cardiac catheterization, bone
    density testing)
  • Pay sports teams for privilege of being team
    doctors (in return for free publicity)
  • Develop luxury primary care clinics

28
The Medical Brain Drain
  • U.S. 280 physicians/100K people (vs.
    sub-Saharan Africa 18/100K people)
  • Five times as many migrating doctors flow from
    developing to developed nations than in the
    opposite direction
  • Example of inverse care law
  • Those countries that need the most health care
    resources are getting the least

29
Corporations Dominate the Global Economy
  • 53 of the worlds 100 largest economies are
    private corporations 47 are countries
  • GM is larger than Denmark and Turkey
  • Wal-Mart is larger than Israel and Greece

30
Corporations
  • 90 of transnational corporations headquartered
    in Northern Hemisphere
  • 500 companies control 70 of world trade
  • Corporations shouldered over 30 of the nations
    tax burden in 1950 vs. 8 today
  • Effective tax rate 2.8 per U.S. Treasury Dept.
    (2011)

31
Corporations
  • Purpose Make money for shareholders
  • Internalize profits
  • Externalize health and environmental costs

32
The Stock Market
  • The top 1 of Americans owns 51 of all stocks,
    bonds, and mutual fund assets
  • Consequences of Differential Stock Ownership
  • Corporations are answerable to their shareholders
  • Governments are answerable (at least in theory)
    to their citizens (either through elections or
    revolutions)

33
Corporations
  • Confidential legal settlements keep important
    public health and safety information secret
  • May delay governmental intervention, cause
    unnecessary morbidity and mortality

34
Corporate PR Tactics
  • Advertising
  • Greenwashing
  • Sponsored educational materials
  • Co-opting scientists and academic institutions

35
Corporate PR Tactics
  • Media control
  • Lobbying
  • Astroturfing - artificially-created grassroots
    coalitions
  • Corporate front groups

36
Corporate PR tactics
  • Invoke poor people as beneficiaries
  • Characterize opposition as technophobic,
    anti-science, and against progress
  • Portray their products as environmentally
    beneficial despite evidence to the contrary

37
Corporations and Health
  • The insurance industry
  • The alliance between GE Medical Systems and
    NY-Presbyterian Hospital
  • The American Council on Science and Health

38
Corporations and Health
  • Global Tobacco Treaty
  • Corporate Agribusiness
  • Prison-Industrial Complex

39
Pharmaceutical Industry
  • Influence over physicians through control of CME,
    gifts, research funding
  • Physician Payments Sunshine Act reporting
    requirements
  • Conduct seeding trials to alter prescribing
    patterns
  • Secrecy, statistical torturing of data sets,
    selective publication

40
Pharmaceutical Industry
  • Data mining of prescribing practices
  • OKd by SCOTUS in Sorrell v. IMS Health
  • Unethical trials in developing world
  • Poor compliance with Clinical Trials Registry
    rules

41
Corporatization and Inequalities Threaten
Democracy
  • True democracy demands an informed citizenry
    (education), freedom of the press (media), and
    involvement (will, time, money)
  • Democracy is critical to public health

42
Mahatma Gandhi
  • You must be the change you want to see in the
    world

43
Listen to Your Patients
  • Eye contact
  • Dont interrupt
  • Patients life and illness as story
  • Pay attention to social, cultural, and economic
    contributors to illness
  • Doctor as patient

44
Anatole Broyard
  • To most physicians, my illness is a routine
    incident in their rounds, while for me its the
    crisis of my life. I would feel better if I had a
    doctor who at least perceived this incongruity.

45
Know Your Patients
  • A physician is obligated to consider more than
    a diseased organ, more even than the whole man.
    He must view the man in his world.
  • - Harvey Cushing

46
Practice Humility / Know Your Limits
  • The only solid piece of scientific truth about
    which I feel totally confident is that we are
    profoundly ignorant about nature. Indeed, I
    regard this as the major discovery of the past
    hundred years.
  • Lewis Thomas

47
Contemplate Life and Death, Comfort the Grieving
  • Honor dead
  • Grieve
  • Awareness of own mortality
  • Follow-up

48
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49
Self Care/Education
  • Medical students and physicians have above
    average rates of burnout, mental illness, and
    suicide
  • Self Care
  • Relationships, sleep, recreation
  • Support colleagues
  • Seek help early when necessary
  • No stigma
  • Log off, experience nature
  • Continue your lifelong education

50
Care for the Poor
  • Doctors are natural attorneys for the poor If
    medicine is to really accomplish its great task,
    it must intervene in political and social life
  • - Rudolph Virchow

51
Jacob Riis
52
Dorothea Lange
53
Care for All Equally
  • A society should be judged not by how it treats
    its outstanding citizens but by how it treats its
    criminals
  • -Fyodor Dostoyevsky

54
Get Politically Active
  • Physicians have an obligation, borne of their
    privileged status, the publics investment in
    their training, and their roles as stewards of
    the publics health, to be politically active and
    ensure that our leaders provide for the sickest
    among us.

55
Political Solutions
  • Vote (physician voter turnout low)
  • Run for office (physician-legislators rare)
  • Lobby legislators (visits gt calls gt letters gt
    emails)
  • Shift focus from reimbursement rates to social
    justice issues

56
Power to the People, Not the Corporations
  • Support living wage laws
  • Restructure tax system
  • Combat corporate crime
  • Just say no to pharmaceutical company gifts and
    trinkets

57
Campaign for Fair and Representative Elections
  • Publicly financed campaigns and campaign finance
    reform
  • Proportional representation
  • Instant runoff voting/cumulative voting/range
    (rating) voting

58
Save the Planet Together
  • Combat environmental degradation and global
    warming
  • E.g., reduce/reuse/recycle
  • Support local economies and fair trade policies
  • Base solutions to environmental threats on the
    precautionary principle
  • Encourage international cooperation

59
U.S. International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • Kyoto Protocol on Climate Change
  • Convention on the Prohibition of Anti-Personnel
    Land Mines
  • Comprehensive Nuclear Test Ban Treaty

60
U.S. International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • Convention on the Rights of the Child
  • Convention on the Elimination of Discrimination
    Against Women
  • Convention for the Suppression of Traffic in
    Persons
  • UN Declaration of the Rights of Indigenous Peoples

61
U.S. International Non-Cooperation/Isolationism
  • Failure to sign or approve
  • UN Convention on the Rights of Disabled Persons
  • The Stockholm Convention on Persistent Organic
    Pollutants
  • WHO International Code of Marketing of Breast
    Milk Substitutes

62
Promote Fairness and Prevention
  • Fight for more equitable distribution of medical
    research funds and health care dollars
  • Focus on prevention
  • 40 of US mortality due to tobacco, poor diet,
    physical inactivity, and misuse of alcohol
  • Every 1 invested in community-based programs to
    increase physical activity, improve nutrition,
    and prevent tobacco use saves 5.60 in health
    care costs

63
Address Social Factors Responsible for Illness
and Death
  • Deaths in 2000 attributable to
  • Low education 245,000
  • Racial segregation 176,000
  • Low social support 162,000
  • Individual-level poverty 133,000
  • Income inequality 119,000 (population-attributabl
    e mortality 5.1)
  • Area-level poverty 39,000 (population-attributabl
    e mortality 1.7)
  • AJPH 20111011456-1465

64
Deaths per year
  • Tobacco 400,000 ( 50,000 ETS)
  • Obesity 300,000
  • Alcohol 100,000
  • Microbial agents 90,000
  • Toxic agents 60,000 (likely higher)
  • Firearms 35,000
  • Sexual behaviors 30,000
  • Motor vehicles 25,000
  • Illicit drug use 20,000

65
Address Social Factors Responsible for Illness
and Death
  • Deaths in 2000 attributable to
  • AMI 193,000
  • CVD 168,000
  • Lung CA 156,000
  • AJPH 20111011456-1465

66
Become Active
  • Grow community partnerships
  • Obtain a global health education/work with the
    underserved
  • Advocate for womens rights
  • Find your passion

67
The role of the doctor in society
  • World Health Organization
  • The role of physicians and other health
    professionals in the preservation and promotion
    of peace is the most significant factor for the
    attainment of health for all.

68
Work Together
  • Never doubt that a small group of thoughtful,
    committed people can change the world. Indeed, it
    is the only thing that ever has.
  • - Margaret Mead

69
Contemporary Activist Organizations
  • Physicians for Social Responsibility, Physicians
    for Human Rights, Amnesty International
  • Union of Concerned Scientists, Public Citizens
    Health Research Group
  • PNHP, Doctors without Borders, Doctors for Global
    Health
  • Greenpeace, Sierra Club, HCWH, NRDC, ED, No Dirty
    Gold, PANNA
  • Planned Parenthood, NARAL
  • Others

70
Speak Up for the Disenfranchised
  • The first job of a citizen is to keep your mouth
    open.
  • - Günter Grass

71
Have Faith in Your Ability to Affect Change
  • "If you think you are too small to have an
    impact, try going to bed with a mosquito in your
    tent
  • - African Proverb

72
  • Public Health and Social Justice Website
  • http//www.publichealthandsocialjustice.org
  • http//www.phsj.org
  • martindonohoe_at_phsj.org

73
Heroes Rudolph Virchow
  • Founder of modern pathology
  • Thrombosis, pulmonary embolism, leukocytosis,
    leukemia
  • Member of state and local government for over 30
    years
  • Founded journal Medical Reform

74
Heroes Rudolph Virchow
  • Argued that many diseases result from the
    unequal distribution of civilizations
    advantages
  • Advocated public provision of medical care for
    the indigent
  • Promoted universal education

75
Heroes Rudolph Virchow
  • Worked to outlaw child labor
  • Improved water distribution and sewage system
  • Enhanced food inspection process
  • Published study of skull volumes to dispute myth
    of larger Aryan brains

76
Heroes Rudolph Virchow
  • Passed hygiene standards for public schools
  • Set new standards of training for nurses
  • Improved local hospital system

77
Heroes Rudolph Virchow
  • Doctors are natural attorneys for the poor If
    medicine is to really accomplish its great task,
    it must intervene in political and social life

78
Heroes
  • Dr. Thomas Hodgkin (abolitionist and opponent of
    British oppression of native populations in South
    Africa and New Zealand)
  • Nurse Margaret Sanger (founder of the family
    planning movement in the US)
  • Dr. Albert Schweitzer (won Nobel Peace Prize in
    part for developing a missionary hospital for the
    poor in Gabon, Africa)

79
Heroes
  • Florence Nightingale (feminist, founder of the
    modern nursing profession, and advocate for
    hygienic hospitals)
  • Dr. Salvador Allende (assassinated president of
    Chile and promoter of better living conditions
    for the poor and working classes).
  • The quiet and unknown

80
Heroes
  • YOU!
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