Young MD

[youngmed18]

How We Memorialize

This past week our class went on a tour of Mount Auburn Cemetery located in Cambridge, Massachusetts. When we first arrived at the cemetery I noticed the abundance of trees and the beautiful landscape which I had not seen when visiting my grandmother who passed in August 2016. Mt Auburn Cemetery had a true memorializing feel which was expressed through the various headstones/memorials and strategically placed pathways. This beautiful landscape creates a sense of serenity.Where my grandmother is buried, the pathways are relatively straight and trees seemed to be scattered throughout, leaving a lot of open area. The headstones are also placed in rows, almost in a way that seemed to get the most out of the space.This brought me to question, Why is there a difference in the appearance and memorial in these two cemeteries? Is it because of their location and when they were built or is there an underlying reason behind it all?

Through research I found my answer was simple. I had not known the exact name of the cemetery that my grandmother is located at. I found out she is actually located at Jefferson Barracks National Cemetery. Since Jefferson Barracks is a military cemetery, there is a set order to how things are run and where everything is placed. Originally, Jefferson Barracks served as a military post selected for its geographic location(pictured above). Around 1840, this post was the largest military establishment in the United States. Jefferson Barracks is home to soldiers of every war. This national military cemetery is open to members of the armed forces, veterans, their spouse,widow or widower, and even children dependent on eligibility. In 1866 Jefferson Barracks was officially established as a National Cemetery , however, the first burial is believed to have occurred in 1827.

In contrast, Mount Auburn Cemetery was built with the purpose to become a “rural cemetery” and experimental garden. The pathways are not straight because they represent the unknown. This cemetery is also non-denominational. The main difference other than landscape appearance is the type of headstones. Mount Auburn Cemetery has many intricate headstones that each hold a personal and universal meaning. Take the following image for example:

This headstone represents the death and mourning of a child or young person who passed too early.The way this is know is by the shortened column and cloth thrown over. The shortened column represents early death and the cloth represents mourning. 

No headstone or memorial was exactly the same. Each held their own meaning and story. The following image shows mourning and a women holding a urn which possibly represents that the person was memorialized through cremation.

The following image is Jefferson Barracks National Cemetery. It can be seen how everything is the similar in shape and distance apart. The only way to tell the difference between each memorial is by looking at the name and possibly a symbol on the headstone, there are no personally stories behind them.

Mount Auburn Cemetery is in form, a museum. By walking around this garden and looking at the various headstones, you’re able to glance into someone’s final moments through some of the detailed images left on the memorials and headstones.This is why Mount auburn is, in sense, a museum. On the Headstones of Jefferson Barracks Cemetery,  you could possibly find the following symbols, however not guaranteed, that represent a small aspect of the person’s life:

It is then a process to add to the memorial because of specific regulations on what can and can not be added to the grave and when(see below).

In conclusion, the reason why they are different is because of their purposes. Mt Auburn was built as a experimental garden and rural cemetery to get away from spreading disease and city cemeteries. Jefferson Barracks is a military national cemetery which requires a lot of order and requirements before you can be buried there.

Sources:

Tour guide information

https://www.cem.va.gov/cems/nchp/jeffersonbarracks.asp

http://mountauburn.org/consecration/

[youngmed18]

The Benefits of the Placebo

In a society where medicine dominates, the thought of being healed without it would seem impossible. However, people have been healing themselves without typical medications for centuries. Culturally, every treatment is a little different although they hold the same purpose, to heal.It would seem that many of these treatments should not work because they hold no medical value, but they do.This can be attributed to what is called a placebo effect. According to the Online Etymology Dictionary, in the early thirteenth century, a placebo is from Latin, “I shall please.” Placebo was first recorded medically in 1785 as “ a medicine given more to lease than to benefit the patient;” placebo effect came around 1900.

We were recently assigned to read the article “ The Power of Nothing” by Michael Sector. This article discussed the study of the placebo effect and how it could benefit medicine. This reading fascinated me since I have often thought about the ability to be able to heal oneself simply through thought. It seems that I have always had this thought of, “If you think you will get better, than you will.” The concept of the placebo effect is this exactly. You are given a treatment that is believed to heal you, whether that is a conscious belief or not, and in many cases, the placebo works.

This brought me to question, where does the placebo effect come from and how does it work so well?

“The relevance is not related to the drug itself but how it is presented to the patient. If a patient believe they are being protected from something, that belief system alone may a role in the drug’s effectiveness”.

In my research for an answer, it was difficult to narrow down an exact time period for the use of the placebo effect. However, I was able to see the usage of the phrase “placebo effect” in books over a period of time by using Google Ngram. Through this program I was able to see that the placebo effect was at it’s highest in 2000 and had a increase from around 1950 to 1985 (see below).

These results are only useful in context to the use of “placebo effect” in books. There was not a real record for the verbal use of the “placebo effect.” However, the reason for the steady increase in the use in books was because of an increased interested in understanding the placebo effect. From a little before the 1950s people began studying the usefulness of the placebo effect, including Harvard. In one case I read about, the given placebo was even better than the actual drug in the trial. 

 In a recent study in open-label placebos, Ted Kaptchuk of Harvard Medical School gave 80 patients either no treatment or a placebo. He was able to find that those given the placebo had greater improvements in symptoms. These improvements can be from researchers expressing the effectiveness of the given placebo or from personal belief surrounding the placebo.

 Kaptchuk believes that recent theory called embodied cognition suggests that,” the possibility of improvement can trigger subconscious signals to pass between different parts of the body, resulting in chemical releases that alleviate symptoms.” Embodied Cognition is the theory that,”the mind is not only connected to the body but that the body influences the mind.” In all the studies I have read, while the placebo may not cure every ailment it helps the patient to feel improvement which allows for atual improvement to occur.

It was difficult finding a lot of information on the placebo effect because it is still ongoing research. From what I have seen so far, a placebo is only effective for certain illnesses and treatments such as headaches, upset stomach and depression. Although placebos are only effective to a certain degree, will there ever be a time when placebos could replace actual drugs? I can really see the usefulness in developing nations and areas where access to medical care is scarce.

Sources:

http://www.webmd.com/pain-management/what-is-the-placebo-effect#1

http://in5d.com/placebo-effect/

https://www.theguardian.com/lifeandstyle/2017/may/22/knew-they-were-sugar-pills-felt-fantastic-rise-open-label-placebos

http://www.health.harvard.edu/mind-and-mood/putting-the-placebo-effect-to-work

http://blogs.sciencemag.org/pipeline/archives/2015/10/15/the-rising-placebo-effect

Google Ngram

Online Etymology Dictionary

[youngmed18]

Taking from the Poor and Giving to the Rich

When “Protecting the Global Health” has Gone Too Far

This past week, we have discussed various topics surrounding Epidemics and Artifacts. Beginning  with the Measles outbreak of 2014 due to lack of vaccination through the mystery surrounding Phineas Gage. During our lecture on Epidemics, the concept of Bio-prospecting and Bio-piracy arose, specifically in relation to the Indonesian Government. The Indonesian Government withheld samples of an H5N1 sample for vaccine usage, fearing they would be neglected when one was created. They were correct. This particular discussion greatly impacted me. Living in the West, I have never stopped to think about the history of the vaccines that I am required to have. In the case of Indonesia, a major Pharmaceutical company came into possession of a sample, created a commercial vaccine, and essentially sold the limited supply to the highest bidder, not considering those who really need them. Those the really need a vaccination are used to make them but almost rarely receive them.

The Narrative of Epidemics is held by the major pharmaceutical companies and their possession of commercial vaccines. These companies turn around and make profits off of practices and contagions of poor and or indigenous communities. I question how companies give(or should give) financial credit to these nations/communities. The simple answer to this is to attribute parts of the vaccines to these indigenous/ poor communities or simply provide vaccines to them at little to no cost. However, pharmaceutical companies choose to inflate costs for personal gain. 

~Bio-Prospecting & Bio-Piracy~

Bio-prospecting and bio-piracy have a long standing history, even before they wer formally known as “bio-prospecting” or “bio-piracy.” From Cori Hayden’s article on Bio-prospecting, bio-prospecting is the use of plants & “traditional knowledge” as leads for developing new drugs. Bio-piracy is when “large pharmaceutical corporations make use of local medical knowledge without acknowledging that it is indigenous intellectual property” or from other nations. In the late 1980s when bio-prospecting was first given it’s definition, the line between it and bio-piracy seemed clear. Today, this line is extremely thin. The overlying issue with bio-prospecting is this, How should/do companies & Communities settle on the overlying issue of intellectual property rights towards various indigenous practices and what they ensue?

Of the estimated 250,000 known plant species in the world today, perhaps 5,000 have been screened for their medicinal potential. Yet, any one species could be the cure for a disease that is considered incurable. Consumers in the United States spend more than $6 billion annually on medicines derived from tropical plants. That lucrative market is the incentive pharmaceutical companies need to scour the rich rain forests of the tropics for the virtually limitless supply of active compounds, some of which could contain compounds for the next miracle drug.

- Conservation International

In my research for an answer, I found a prime example of the infringement on intellectual property rights. This is through a plant or weed know as Rosy Periwinkle(pictured above). Today, this plant is used in many modern medical procedures such as treatment for tumors and leukemia.However, Rosy Periwinkle is not a native species to North America. Rosy Periwinkle originates from Madagascar, growing along roads and infields near farms, not in threatened forests as some would believe and scientists claimed. Rosy Periwinkle represents the promises and dangers of harvesting rare plants for corporate gain.

The late 1980s gave rise to the “green rush” where plant species began to be screened at high rates due to new technological advancements( Bitter Roots: The search for Healing Plants in Africa, Ch.1). When Rosy Periwinkle was used in two valuable patents created by chemist Gordon Svoboda in 1965. This patent award gave Svoboda and the company he worked for “exclusive rights to unique processes to extract chemicals” from the rosy periwinkle plant. These chemicals would be used in drugs that treat leukemia and Hodgkin’s lymphoma. Annual profits from these medications were once reported to be up to $400 million. Svoboda and the pharmaceutical company were able to embrace the profits they earned but the indigenous people they took the plant from did not. 

It has been over two decades and the debates surrounding rewards from the plant-based medications. In the first chapter of “Bitter Roots: The Search for Healing Plants in Africa”,Osseo-Asare discusses the backgrounds of these debates and the various usages, and practices surrounding Rosy Periwinkle.Scientists behind many of the debates argued that Madagascar’s role in the discovering of the potential use of periwinkle for pharmacological action was minimal. The evidence they provided was how,“…it was certainly not easy and required millions of dollars of investment.” They then argued that compensation for periwinkle would provide incentive for the preservation of forests.However Periwinkle naturally does not grow in forests. Since Periwinkle grows along fields and near farms, these scientists had to infringe upon people’s personal property to gain samples. They then went forward and continued to display periwinkle as their own without acknowledging traditional practices.

This scientists “discover” of the usage of periwinkle reiterates my point about the thin line between bioprospecting and biopiracy. They believe they are doing things for the better of the community and gaining valuable knowledge, however, they attribute nothing to the teacher’s of this knowledge.

In a bioprospecting blog post I read, they stated my feelings on this topic perfectly. They stated, 

“No matter how convincing the rhetoric, conservation and equity are secondary issues. Under the vast majority of current bioprospecting agreements, when indigenous peoples share information or genetic materials they effectively lose control over such resources, regardless of whether or not they are compensated.”

This is evident in the case of rosy periwinkle;for decades this medication has been used numerous times, but without knowledge of where it came from. Although Rosy Periwinkle had been used for possibly centuries, the scientists ignored the rights of the indigenous people because they did not have any written record. The first written accounts of Rosy periwinkle were in the 1600s by French explores, documenting their medical usages and connection to Madagascar. 

The natives of Madagascar have been using periwinkle for various treatments as simple as headaches for centuries and passing them down through oral traditions or practices. This leads me to question: Will there ever truly be a way to claim certain practices without infringing on indigenous or prior intellectual property rights?

Sources:

https://bmcimglobal.wordpress.com/category/bioprospecting/

http://www.etcgroup.org/content/bioprospectingbiopiracy-and-indigenous-peoples

http://chicago.universitypressscholarship.com.ezp-prod1.hul.harvard.edu/view/10.7208/chicago/9780226086163.001.0001/upso-9780226085524-chapter-2   (Requires HUID)

http://www.iiirm.org/publications/Articles%20Reports%20Papers/Genetics%20and%20Biotechnology/Jim%20Zion%20Paper-Native%20Peoples%20Genetic%20Material%20Rights.pdf

Article: From Market to Market: Bioprospecting’s Idioms of Inclusion

[youngmed18]

Dissection

One of the other many things that is common in this society is dissections. Dissections can be performed as early as in middle school. When medical students first began to dissect bodies, they would steal them from graves, especially those of African Americans because during that periods they had little say in society. Many of the bodies were also those which went unclaimed. In New York, it was actually legal to take unclaimed bodies for dissection. However after 1865 states started to protect unclaimed bodies because they could be ones of fallen soldiers.

Leonardo Da Vinci

When dissections first started to appear, they were considered disgusting and sinful. However dissection had been around for awhile. Leonard Da Vinci was interested in drawing bodies. his dissection of the body was in more of an artistic way and not in the way we know it today. His work was never meant to be published however through his pictures he captured, in a way, the purest form of the body.

 Dissections today

“If you cant cut into the dead body, how will you be able to cut into a live one?”

Dissections are a part of medical school that every student expects to experience at one point in their life. However, where are these bodies come from? The bodies used in medical school dissections today are donated by the person before they are living. Harvard currently has a program where you can essentially donate your body to the institution for various reason after you pass away. When it comes to programs like these or even donating your body to science, the topic becomes blurry. Although the person gave consent, who knows what will happen to their body. Why did the theory come that in order to learn about yourself, you must look inside a dead body. 

If a body is donated to either an institution or science, who is to say that they will follow your requests and even then, do they have an obligation to legally do so?

[youngmed18]

The Ether Mummy

Mummies have become a common aspect of modern society. It is likely that, in every child’s young life, they have studied mummies and been to an exhibit at least once. While mummies are available to be viewed and studied any time, this has not always been the case. It was not until 1823 when the first mummy appeared on the continent of North America. This mummy goes by the name of Padihershef. Padihershef has a long and often overlooked impact on the history of mummies in North America. 

Padihershef, nicknamed “Padi” by students, currently resides in the Ether Dome of Massachusetts General Hospital. The Ether Dome holds a great amount of medical history. It is the location of many surgeries and also the first public demonstration of the use of Ether. The dome is built at the top of the old hospital, presumably to prevent echoing of screams due surgeries. There are panels located on the right side of the dome which provide light directly onto the working area when opened. Walking into the dome, the mummy laying next to its outer coffin especially stands out. Where did this mummy come from and what is it’s purpose here in the Ether Dome?

 Padi was donated to MGH by the Dutch Merchant Jacon Van Lennep as a medical curiosity. When he first arrived at MGH, his sole purpose was to bring funds into the young hospital which had been opened only two years prior. The hospital would sent Padi to Springfield to be cleaned and examined.  Emil Schnorr, the Chief Curator at the museum. Everyday Schnorr spent 6 months working on Padi, using 900 moistened cotton swabs to dab off the built up millennia of dirt until he could no longer handle the smell of the body. He restrung the beads and glued the head on straight.

Who was Padihershef?

 In 1931, Dr. John Collins cut away the wrappings wanting to perform and anatomical examination, but  discovered the body was too fragile. However, information regarding Padihershef was discovered in the decades to come. He would be x-rayed twice and studied many times. Through reading the hieroglyphics, it was found that he was an Egyptian stone  cutter from the necropolis of Thebes during approximately Egypt's 26th Dynasty.

“[ Padihershef is a] common man who already has survived longer than many a phaaroah.”

In 1879 Padihershef was lent to the Boston Museum of Fine Arts but returned to MGH in 1896 because of the rise of mummies in museums and the lack of need for “another saite mummy.” However his outer coffin remained until 1932 and then later placed in Springfield’s Smith Art Museum. Currently Padihershef and his  outer coffin reside in the Ether Dome as a reminder of all the advancements he has helped to bring. Through him and the various examinations, scientists were able to discover his cause of death and understand more about the body.They even used imaging scans to create a depiction of what he may have been perceived when he was alive. 

“Padihershef was present at the first public demonstration of ether, casting the eye of immortality on an instant of eternity that had Been snatched from passing time.”

http://harvardmagazine.com/2014/01/from-egypt-to-the-ether-dome

http://www.massgeneral.org/museum/news/newsarticle.aspx?id=4353

[youngmed18]

Diagnosis and Hospitals

The history of diagnosis can be traced back to ancient Greece where the term “diagnosis” emerged. Diagnosis is the process by which an expert can recognize and distinguish symptoms and create a narrative reasoning behind them. The practice of diagnosing patients is a difficult subject. In the beginning, doctors relied upon their own knowledge and the patients descriptions to establish a diagnosis. They tried to connect what they were seeing and being told, but not all difficulties are visible; there may always be an underlying symptom or condition that goes unnoticed. 

With the development of diagnosis also came the development of various diagnostic methods. These methods included dissections, figuring what comes out of the body and what makes up the body, x-rays, chest percussion, for ways to “see” inside the body without dissection, and various other tools that would eventually lead doctors away from subjective patient views. These new methods lead to the building of laboratories and hospitals to further diagnosis and patient care.

One prominent figure who discussed the development of hospitals and diagnosis methods was Michel Foucault. Foucault discussed how people used and disciplined their bodies, he wrote about the origin of medical clinics and the “medical gaze” that began to emerge. With the rise of hospitals, doctors needed training. This training leads to the development of the “medical gaze.” This gaze sets the doctor at a higher level than the patient, essentially creating a dehumanizing relationship between the two. Where the patient was once able to be their own advocate, the doctor solely focuses on the numbers. They are no longer asking, “where does it hurt” but “let me show you where it hurts.”

Michel Foucault’s observations could be seen in hospitals throughout history. Not only did doctors begin to move away from the close patient relationships, but the rise of hospitals also brought social stigmas. Hospitals were seen as places of Miasma or a stain; literally speaking, noxious vapors. Therefore, the prominent areas we can see around hospitals today were not previously present. Hospitals were actually built in the poor neighborhoods. Some were meant to quarantine while others wanted to help keep people healthy. Many hospitals were originally private, able to decide how many and how long patients would be accepted into the hospitals. These hospitals also came with high prices as technological advances began to emerge. This is where the formation of Bureaucratic hospitals begins to form. 

Hospitals would, and still do, often change the type of treatment given to a patient depending on if they could afford the treatment. In today’s modern hospitals and clinics, doctors have still reported how they change the treatment and diagnosis of a patient based on their insurance. Many hospitals only treat uninsured patients because it is required by law if it is in a emergency situation.

Everyday patients are denied service in a clinic or hospital and referred to go somewhere else simple because of their lack of insurance. Modern Hospitals have become so wrapped around profit that they have lost sight of the value of the patient. Is the patient’s life really less important than the profit earned? Should a patient be turned away because they are unable to afford insurance?

[youngmed18]

What is Modern Medicine and Where Did it Come From?

Making Modern Medicine: A History from 1800-Present

Walking into my class on Monday, I did not know what to expect. I was a little excited and nervous. Did I pick the right class? I have stuck with the class, and I think it was the right choice. The first class was like any other first class. We had our introductions and review of the syllabus. We had an in-class assignment where we analyzed various images and tried to determine what they represented. This was our image:

From the appearance of this image, it would seem that the patient is dead and there is a procedure being performed on them. This image is actually a depiction of what is believed to have occurred during the First Operation under Ether

It is amazing to see what you can find simply through analysis. This lead us into our readings. These readings discussed how we know what we know and how we understand it. Medicine essentially relies on the social interactions of our society. Disease does not become real until it is expressed. The social stigma surrounding disease and the name of the disease can make the disease appear worse than it really is. As it was stated in class, “ Naming the disease is the tip of the iceberg and holds a lot of power.”

What do We Classify as a Disease and How do We Treat Them?

Wednesday’s lecture was about disease. The classifications, treatments and understandings of disease. Before the 1950′s, the treatment of asthma was cigarettes. It then wasn’t until 1987 where Homosexuality was no longer considered a disease or mental disorder. At one point, the classification of a disease solely relied on the votes of a few select people. Today we are faced with illnesses that we did not have a few decades ago. One of these includes Alzheimer’s Disease, but is this truly a disease? It was only until recently that people began to live longer into their seventies. We do not know much about what occurs and when it begins to set in. This disease could be a factor in everyone’s life that simply occurs and different points. There is ongoing research in the treatment of this disease.

A century ago they had misconceptions of diseases and the ways they should treat them. We would not expect there to be many into today’s modern society, but there are probably many. The stigma surrounding diseases and the name they hold affects the way we view them. We search for cures and treatments, but what we find could be wrong or make things worse. We vaccinate ourselves, but even then it is not guaranteed to be protected from it. A thought proposed in class was the repeated vaccinations of diseases. If we constantly have to be vaccinated to “protect” ourselves from a certain disease, is what we may catch truly the same disease?

[youngmed18]

Trying Not to Get Lost in Widener Library

The highlight of class this week was the scavenger hunt at Widener Library. We met at the library and, after discussing a little about disease, we began our  scavenger hunt. I was not expecting the library to be as big as it is. From the outside the library looks smaller than what it hols inside. This scavenger hunt helped to familiarize ourselves with the library, because many student’s may never step foot in it once. Luckily for our team, we had someone who was already a little familiarized and were able to come out in second. If this was not the case, we would have been extremely lost.