Showing 1 - 10 of 258 annotations tagged with the keyword "Medical Advances"

Summary:

In Medical Bondage: Race, Gender, and the Origins of American Gynecology, Owens argues that the emergence, practice, and professionalization of American gynecology in the 19th century were inextricably enmeshed with the institution of slavery and discourses of biological racism. “Modern American gynecology,” writes Owens, “could certainly exist without slavery, but slavery’s existence allowed for the rapid development of this branch of medicine, and especially of gynecological surgery” (6). As she shows, gynecology developed as quickly as it did only because white American physicians had access to women’s bodies marked as racially inferior. That gynecology’s maturation accelerated in the American South is no indication that its practitioners had a humane interest in enslaved women’s health (66). On the contrary. Owens argues that slave owners were invested in maintaining the reproductive health of enslaved women in the interest of increasing the size of their population: “Thus the repair of any medical condition that could render an otherwise healthy slave woman incapable of bearing children further strengthened the institution of slavery” (39). Additionally, there were broader implications, as medical research using enslaved women’s bodies produced knowledge about how to treat, in turn, white women: “Black lives mattered medically because they made white lives healthier and better” (107).

This leads Owens to argue why enslaved women should be esteemed as the maternal counterparts to the oft-celebrated white ‘fathers’ of American gynecology: “. . . black women, especially those who were enslaved, can arguably be called the ‘mothers’ of this branch of medicine because of the medical roles they played as patients, plantation nurses, and midwives. Their bodies enabled the research that yielded the data for white doctors to write medical articles about gynecological illnesses, pharmacology, treatments, and cures” (25). This is especially true, as she points out, when examining the medical research of the lauded gynecologist, James Marion Sims, who opened and operated a “sick house” for enslaved women suffering from gynecological ailments (36). Sims operated this clinic to devise a surgical solution to a serious and commonplace gynecological issue among enslaved women, vesico-vaginal fistulae. As an enterprising young physician, Sims took advantage of enslaved women’s bodies to conduct his surgical trials. Eventually, he triumphed and cured an enslaved woman, and published the results in a respected medical journal, thus enshrining his reputation (39). The point, Owen emphasizes, is that “[t]hanks in large part to his experimentation on enslaved black women, Sims had established himself as one of the country’s preeminent gynecological surgeons less than a decade after he began his gynecological career” (39). Medical Bondage thus strives, in part, to restore the lives and contributions of these enslaved women to the story of American gynecology’s genesis.

Owens’ study takes a surprising turn, arguing that “. . . the later development of modern American gynecology can no more be disentangled from Irish immigration than it can be separated from its roots in slavery” (90). This shift in racial and geographic focus parallels the similar roles of enslaved black women of the South and poor, immigrant Irish women of the urban North in the development of gynecology. Owens shows how racial alterity was “mapped onto” poor Irish immigrant women living in major urban centers, such as New York City (20). As many Irish immigrant women suffered poverty, inadequate (if any) medical care, sexual assault, and were drawn into prostitution (and the attendant onslaught of venereal diseases), they became ideal medical subjects for gynecologists. Physicians eventually published their Irish patient case studies, which “. . . helped to create the foundation for the racist laws that colored the Irish as not quite white and sometimes placed them alongside black people as biological models for racial inferiority” (90). Just as Southern gynecologists had access to enslaved women’s bodies, their Northern counterparts treated and experimented on racially othered immigrant women. In this way, Owens argues, “[t]he scientific and medical beliefs that doctors held about Irish women were nearly indistinguishable to [sic] those they held about African women” (115). Overall, Medical Bondage articulates a well-researched and sobering retelling of the dominant accounts of American gynecology.

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The Way of All Flesh

Parry, Ambrose

Last Updated: Oct-04-2022
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Will Raven is a medical student beginning his apprenticeship with Dr James Young Simpson. He has been involved with a prostitute Evie whom he finds murdered. Simpson’s housemaid, Sarah Fisher, takes a dislike to him, not least because of his educational and social privileges. She is barred from such opportunities because of her gender and class, despite her greater intelligence. Sarah studies medicine on her own. Coming from poverty, Raven is nevertheless, pompous, chauvinistic, quick to fight, and desperate to earn money and status. 

Like Evie, other young girls are being brutally murdered in the Old Town of Edinburgh, and Raven and Sarah are separately motivated to find the killer. Their master, Simpson, is conducting experiments with anesthesia and suspicions are cast upon him. Although Raven and Sarah are part of his household, they find his behavior mysterious. Eventually they collaborate to solve both mysteries.

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Summary:

Andrew Mangham’s The Science of Starving in Victorian Literature, Medicine, and Political Economy examines how Victorian writers drew upon the era’s medicine and physiology to represent the physical realities of starvation. Wondering readers, at first glance, might ask if starvation can be described in any terms other than a physical experience; however, Mangham argues that prevailing nineteenth-century political economy theorized population growth and food scarcity in ways that radically obscured the corporeal suffering wrought by starvation. Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty. Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation.

For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31). While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works, Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it. Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but humanized renderings of the poor.

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Editing Humanity

Davies, Kevin

Last Updated: Jun-28-2022
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: History of Medicine

Summary:

Editing Humanity explores the history, biology, sociology, and ethical import of CRISPR (“clustered regularly interspaced short palindromic repeats”), the major new DNA technology indicated in the book’s subtitle, “The CRISPR Revolution and the New Era of Genome Editing.”  Using CRISPR, researchers can manipulate the DNA of animals, plants and microorganisms with extremely high precision. In particular, scientists now have the potential to customize the human genome.  

What is CRISPR? To quote Davies, “CRISPR is a small subsection of the bacterial genome that stores snippets of captured viral code for future reference, each viral fragment (or spacer) neatly separated by an identical repetitive DNA sequence.” (p. 23) When the cell is reattacked by a virus, an RNA copy of that virus’ stored “signature” forms a DNA-splitting complex that destroys the incoming virus. In 2012, Jennifer Doudna, of the University of California, Berkeley, and Emmanuelle Charpentier, of the Max Planck Institute, Berlin, demonstrated that CRISPR could be engineered to edit any gene. One could, for example, replace a disease-causing mutation in any DNA segment with the healthy variant, thus preventing genetic disease.  

The author, Kevin Davies is a geneticist and science writer whose previous books include Cracking the Genome and DNA: The Story of the Genetic Revolution.  In Editing Humanity, he discusses an array of actual and potential applications of CRISPR technology, including human disease prevention by altering susceptibility of animal vectors, improving farm productivity, and even resurrecting extinct species. However, the most powerful and controversial topic is genetic manipulation of the human embryo. Davies devotes several chapters to the cautionary tale of the young Chinese scientist He Jiankui who engineered the world’s first gene-edited babies, and the scandal and disgrace that followed. (He was convicted in China of “illegal medical practice” and sentenced to prison.)

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Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5).  He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease. 

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease. 

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections. 

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Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

A murder mystery set in Harlem of the 1930s. The Conjure-Man, Frimbo, is a reclusive, highly educated soothsayer and fortune teller born in Africa. His Harlem dwelling is a popular destination for local people seeking direction for the decisions that they confront. He takes pains to conceal much about his identity.

One evening, Frimbo is found dead by a client, while a handful of people occupy his waiting room. Doctor Archer, who lives across the street, is summoned to pronounce the death, and the police come soon, led by detective Dart. Then the corpse disappears, and the Conjure-Man reappears alive to the amazement of all.

The investigators use recent technology, including blood typing, to establish that the corpse was not that of the Conjure-Man. Over just a few days, the doctor and the detective work their way through all the possible scenarios to establish the identity and motive of the killer. The ending is surprising.

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Born to Be

Cypriano, Tania

Last Updated: Feb-26-2021
Annotated by:
Glass, Guy

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Born to Be is a documentary about the trailblazing work being done at the Mount Sinai Center for Transgender Medicine and Surgery.   

The film’s central figure is Jess Ting, a plastic surgeon who studied music at Juilliard before making a career switch to medicine.   Scenes of him with patients are interspersed with domestic clips where he is at home with his children and playing the double bass.  Just a few years ago Ting had never even performed a single gender-affirming surgery.  He is the first to admit that he did not expect his career to take this turn: “Essentially, they just asked everyone else, and everyone said no except for me.  Everyone thought I was nuts.”  Be that as it may, Ting appears to have found his calling.  In a short time, he has performed well over a thousand gender-affirming surgeries, pioneered new procedures, and helped to start a fellowship training program.  

The stories of several of the Center’s patients are interwoven with that of Dr. Ting.  One client, Cashmere, is a retired sex worker.  Years of botched silicone injections have left her face chronically swollen.   Now in her 50’s, she hopes to have the effects reversed, and to finally undergo the vaginoplasty she has been dreaming of her entire life.  Another patient, Devin, 22, goes through a transition during the course of the film, renaming herself Garnet.  Not withstanding strong family support, years of bullying in school have taken their toll as she struggles with depression. 

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Annotated by:
Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

House on Fire:  The Fight to Eradicate Smallpox is a memoir written by William H. Foege, the physician best known for developing the strategy of ring-vaccination in the eradication of smallpox.  Concisely put by New Scientist, his book is “a mixture of memoir, dry public health guide, and riveting tale of an all-consuming mission.”   

Though a brief read, House on Fire is comprehensive on each of these fronts.  Foege walks us through his life, starting first with his upbringing in Washington state and ending with his role in India as part of the smallpox eradication team there.  Notably, the book’s narrative ends before Foege’s tenure as CDC Director in the late 1970s and early 1980s, focusing explicitly on his involvement in combating smallpox.  Using his career in public health as a framework, he details how he became involved in global health and how each deployment around the world, whether for the CDC, WHO, or Peace Corps, added to his understanding of contagious disease and of how to better approach smallpox containment.  Ever the epidemiologist, Foege does not shy away from including graphs and charts to emphasize his points, especially as they relate to public health data collection.  He takes the reader behind the scenes of conferences, regular meetings, and everyday discussions to show the collaboration necessary for global health work, the planning needed, and the good-natured humor and guile it often requires.  At times, his interactions seem like a who’s who of American public health:  throughout his career, he works with D.A. Henderson, Alexander Langmuir, David Sencer (who also writes the book’s foreword), and Don Francis.  

Outside of his own history, Foege acknowledges that in order to understand smallpox and to understand the mission of eradication it is necessary to understand the disease’s complex history.  He begins the book with the history of smallpox and details the development of the vaccine from its crude precursor, variolation, to Edward Jenner’s early version derived from cowpox.  As he progresses through his story, he notes important historical moments in the battle against smallpox:  the development of the jet injector and bifurcated needle as ways to better administer the vaccine, the elimination of the virus first from countries and then whole continents, and, most poignantly, the final cases of smallpox ever recorded.  

Though the book necessitates some level of public health knowledge, or at least a comfort with viral disease and baseline public health interventions, it consolidates its role as a basic public health guide at the appendix.  In the last pages, Foege reflects on what to do if there were ever a bioterror attack with smallpox, complete with a diagram on how to administer the smallpox vaccine.  

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Summary:

This is a quick and personal history of the Longwood Symphony Orchestra (LSO), a group of Boston area musicians who, in their working lives, are medical personnel. The first of its kind, there are now several such orchestras across the US and scattered throughout the world, notably in Europe. Lisa Wong, a pediatrician and violinist, tells her own history of medicine and music, including her involvement with the Longwood Symphony Orchestra over some 28 years. Other stories of individual doctor/musicians are threaded throughout the book, giving us a personal look at their interdisciplinary enterprise. While their medical specialties, ages, and backgrounds vary widely, while playing in the orchestra and, various professional ranks aside, they accept the direction of the conductor. While Wong mentions antecedents of medicine and music in ancient times, she chooses Dr. Albert Schweitzer as a patron saint for the LSO.

For Wong and her fellow doctors, there are links between music and healing. Music helps keep doctors (and patients) healthy by calming the heartbeat, relaxing muscles, and lifting the mind (p. 86). Music therapy (the psychotherapeutic use of music) and music medicine (the more general uses of music, often in medical settings) can assist in patient care. For example, a dementia patient named Ruth reawakened upon hearing music. Some patients choose to listen to music in the final days of their lives (p. 184).      

For many doctors, music was an early pursuit. Neurological studies suggest that musical training helps develop “structural brain plasticity” that may show benefits in education and training. By contrast, however, sometimes musicians (doctors or not) develop overuse injuries and need specific physical therapy.           

Music has applications in mental health, hospitals in general, and community partners. The LSO has partnered with some 40 nonprofits in the Boston area. In one example, they helped grow the Asian bone marrow registry from 3,000 to 11,000 people (p. 225). An LSO concert raised $30,000 for the Mattapan Community Health Center in South Boston.  

Lisa Wong was president of the organization for 20 years. She writes, “Music goes a long way to heal entire communities. Social justice and social welfare are important determinants of health. Programs that look beyond the music are truly ‘Healing the Community through Music’” (p. 249). 

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Summary:

Elizabeth Siegel Watkins reports on the use of estrogen alone and in combination with progestin for women during menopause and after menopause from the 1890s until the book was published in 2007. She concentrates on the sixty years between 1942 and 2002. The event Watkins uses to mark 1942 as an important moment is the U.S. Food and Drug Administration (FDA) approval for the estrogen product Premarin as hormone replacement therapy (HRT) in women with menopause symptoms. The event she uses to mark 2002 is the release Women’s Health Initiative (WHI) findings that showed estrogen is not the “elixir of life” that many thought it was then.  

Watkins builds her story off the trajectory of estrogen use during this sixty-year period, which spanned two peaks followed by two crashes. The estrogens for HRT first crested in the early 1970s before its use dropped dramatically in 1975 on uterine cancer fears. Estrogen use began to rise in the early 1980s on regained confidence from combined use with progestin to reduce uterine cancer risk and from hopes that bone loss could be prevented and even reversed. This resurrection continued through the 1990s as estrogen use during and after menopause became “associated with reduced risk of colon cancer, prevention of tooth loss, lower incidence of osteoarthritis, increase in bone mass, reduced risk of Alzheimer’s disease, and lower rates of death from all causes” (p. 241). 
 

Based on surveys of prescribers and prescription data during this time, Watkins concludes that “physicians who saw menopausal women as patients were…enthusiastic prescribers of HRT” (p. 244). They remained enthusiastic, making Premarin the most prescribed pharmaceutical product through much of the 1990s and until 2002 when the WHI trial was stopped three years early because it showed that HRT failed to produce the expected benefits, and even worse.
Women who took the estrogen–progestin pills, as compared with those in the control group who took placebo pills, increased their risk of breast cancer by 26 percent (relative risk of 1.26), coronary heart disease by 29 percent (1.29), stroke by 41 percent (1.41), and pulmonary embolism (blood clot) by 213 percent (2.13). (p. 271)
The investigators advised clinicians based on these results, that HRT “should not be initiated or continued for the primary prevention of coronary heart disease” (p. 271). Watkins quotes an editorial from the Journal of the American Medical Association that went further in saying that the trial “provides an important health answer for generations of health postmenopausal women to come—do not use estrogen / progestin to prevent chronic disease” (p. 273). HRT prescriptions plummeted.  

These clinical inputs into the trajectory of estrogen are just the bare bones of estrogen history. Watkins fills in the story: 
The story of estrogen is woven from several strands: blind faith in the ability of science and technology to solve a broad range of health and social problems, social and cultural stigmatization of aging, shifting meanings and interpretations of femininity and female identity, and the pitfalls of medical hubris in the twentieth century. (p. 1)
Watkins weaves these strands into the story of estrogen, which she tells in a chronological fashion, often as the subjects of individual chapters. Some include: the implications of rising feminism; pharmaceutical company promotional activities; the roles of patient advocacy organizations; FDA requirements for patient information about prescription drugs; generational differences in views of menopause; evolving research methods and evidence standards; and cultural shifts and mainstream media influences. 

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