Tag: Medicine

Complacency in the Medical-Industrial Complex

Long gone are the days of scientists only locked up in labs, secluded from everything but their microscopes and calculators. Now, more than ever, scientists find themselves writing reports and grant proposals, managing jobs, sitting on committees, and delivering lectures.

Scientists work in issues at the forefront of policy, ethics, law, and other areas of society. Though these duties may be as fluid as viscous liquid or as dynamic as biological evolution, scientists and non-scientists alike struggle everyday with understanding science’s role in society.

When Lisa M. Lee, Executive Director for the Study of Bioethical Issues, gave her talk “Handling Obstacles to Ethics in Public Health,” she spoke to an audience of professors, physicians, and other professionals about the current state of affairs in public health ethics and bioethics. She spoke from her background in bioethics, including her work in public health surveillance and privacy. But, as I sat in the front row of the lecture hall, I couldn’t help but wonder, if scientists have expanded their roles in other areas, why was there still such a huge gap between science and policy?

No matter whether you’re a physicist or a lawyer, we’ve taught ourselves to be complacent. With the slow death of the liberal arts education and the reduction of college down to a means to manufacture employees, students have anguished over how to get into medical school or make a successful living in the future, but forgotten about the important values of humanism necessary for personal growth. We need to encourage science as a way to seek the truth, of both the economy and virtues. No doubt, science should make money, but it should also teach us values such as wonder, curiosity, and humility in the world.

Dr. Lee suggested requiring ethics training programs for graduate students. I was dubious of this solution because, while it may help students understand ethics, a requirement can only do so much to foster curiosity and humanism before encouraging complacency and discouraging innovation.

Students who aspire to become physicians suffer from this complacency. As pre-medical undergraduates, we have long paths in front of us before becoming a practicing physician. We spend four years taking courses like organic chemistry, physics, and biology while completing the Medical College Admissions Test (MCAT). Our required courses are rigid, standardized, and structured upon what the officials dictate to be important. As we sit in crowded lecture halls, hoping for a good grade or a recommendation letter, our pre-medical overlords teach what’s going to be on the exam, nothing more and nothing less. Along the way, we volunteer, shadow, and engage in extracurriculars before entering a four-year medical school program. After that, we have residency and training before becoming a fully-practicing physician. With such a long, stringent path, it’s easy to forget about what’s really important and how to “live in the moment.” Instead, we succumb to utilitarian, consumeristic motives as we value information over wisdom, marketability over authenticity, and dogmatism over free thought. And, when we aren’t prepared for the future, the “Medical-Industrial Complex,” as Dr. Lee puts it, thrives.

Compare the path to becoming a doctor to that of future lawyers, who intern for attorneys as soon as they enter law school. While law students get to see the employable fruits of their efforts almost immediately after college, medical students have to spend much more time preparing before witnessing the value of what they’re being taught. It’s much more difficult for pre-medical students to truly ponder how their courses will give them benefits in the future, and, especially with stringent and demanding science course-loads, it’s easy to lose sight of more valuable goals of methodic inquiry and rationalization in the tense, competitive world of exam scores, GPAs, “informational texts,” and oft-repeated “problem-solving skills.” And, since most pre-medical students take a large number of science courses, the medical curricula is centered around STEM goals of economic prosperity and political motives.

Pictured: my organic chemistry class.

It might sound absurd to describe the current state of affairs in medicine as a “medical-industrial complex,” but it makes much sense in the context of the militarization of education. With the Independent Task Force’s “U.S. Education Reform and National Security” in 2012, our education has been structured in the following areas: “economic growth and competitiveness, physical safety, intellectual property, U.S. global awareness, and U.S. unity and cohesion.” The highly controversial report has been criticized and praised by professors nationwide, and some, most notably in those in the humanities, have expressed concerns for its methods of re-structuring education. In the report, “What is Education?”, Professor of Hebrew and Comparative Literature at Berkeley Robert Alter writes, “Should a teacher’s motives for introducing seventh-graders to science be that she is preparing cadres of future technicians who will be able to design bigger and better defenses against ICBMs?” A future in which students are put in and out of the school-military pipeline is frighteningly grim, and structuring an ethics curriculum would certainly be an effective counter to these woes. And with our war history in Vietnam, Iraq, Afghanistan, and other places, there is a pressing need for us to understand culture, history, language, and other aspects of the human condition in order to address the issues of the future. Sure, we could pump more students into “critical” departments of language and culture based on our political concerns (such as foreign languages of Spanish, Arabic, or Chinese). But, in order to truly address the ethical dilemmas of tomorrow (including political concerns), there must be a change in education that runs much deeper than simply forcing students to take a course in ethics, literature, or history. It must be a change in the way we think about those courses.

In “What is Education?” James Engell, Professor of English and Comparative Literature at Harvard University, writes:

Studies show that in our schools, public or private, student cheating, dishonesty, and plagiarism are on the rise. School administrators in many locations have themselves been caught cheating in order to make the performance of their students look better. Federal and other studies indicate that scientific misconduct and falsification of scientific data are increasing problems. A society without ethical education cannot expect either good government or real security, no matter what shape its laws take or how “reformed” its educational system. The damage done may come slowly but the rot is deeper. The Report says nothing about ethical or moral aspects of education.

Engell continues that these “moral” and “ethical” shortcomings in education have been brought on by a certain “blindness” in accepting results has cost us much in “disease prevention, agricultural production, sustainable resources, and, most troubling, in respect for the procedures and results of science itself.” In order to address the ethical issues of tomorrow, we need a fundamental shift in the way we approach our classes to fight the complacency and individual shortcomings that give rise to our blindness. Though Engell isn’t a scientist, his concerns for the addressing scientific misconduct come from an appeal to morals and ethics. These moral and ethical considerations come from elements of an education that the humanities emphasize, including the human narrative, critical speculation, heedless skepticism, and empathy. From a more “ethical” look at the world, by emphasizing the education as a humanistic search for truth and justice, we can rise above the typical requirements and capital greed of the militarized education system, whether it’s in the sciences or the humanities, and fight the power.

We can only address the ethical issues in science, medicine, and public health through a thorough examination the values we instill in ourselves through education. Those of us who can break from the complacency of everyday life to higher ideals, including courage, justice, and compassion, will be ready to fight the problems of tomorrow.

November 28, 2015

Medicine
Protecting the Privacy of Mental Health Data

The paranoia of everyday life

Read this article in the Indiana Daily Student here….

When speaking about the rights of an individual to his/her personal information, it’s easy to overlook the “personal” nature of mental health data. And, within the rhetoric of mental health, we spend a lot of time expressing the behavior, feelings and thoughts of those who suffer from mental illness, but we forget about the a deeper issue: who should know about it?

How much can more data actually help us? With so much information about ourselves, it’s easy to be misguided. Some, like Jesse Singal of NYMag’s “Science of Us,” have decried the calls of certain mental health issues at universities tremendously serious, yet suffering from confirmation bias or similar statistical fallacies. [6] If anything, we might just well be overwhelmed by how much we know about ourselves scientifically that we forget the humanistic aspect of ourselves. Basic science research in psychiatry hasn’t reached the goals it has claimed to make over the past few decades. Will turning to the social sphere, like Insel suggests, do any better?

As science and medicine call for greater access to information for the purpose of research and clinical treatment, privacy becomes an issue. When we collect information from an individual, whether it’s a medical record from a hospital or a meeting with a school therapist, we have to protect his or her rights. How can we make sure data doesn’t fall into the wrong hands? What if a scientist’s data is used without permission or for unintended purposes?

“But we would want you and your family members…to take part because we want to have that information…And that’s obviously also going to be very sensitive but very important because it’s such a problem in this country.” – Francis Collins[7]

References:
[1] http://www.nytimes.com/2015/09/16/health/tom-insel-national-institute-of-mental-health-resign.html
[2] https://www.washingtonpost.com/news/answer-sheet/wp/2015/11/12/the-astonishing-amount-of-data-being-collected-about-your-children/
[3] http://www.nih.gov/news-events/news-releases/new-prize-competition-seeks-innovative-ideas-advance-open-science
[4] http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/mhguidance.html
[5] http://www.pbs.org/newshour/bb/push-use-human-genome-make-medicine-precise/
[6] http://nymag.com/scienceofus/2015/11/myth-of-the-fragile-college-student.html#
[7] http://thedianerehmshow.org/shows/2015-09-28/nih-head-francis-collins-on-new-efforts-to-use-medical-records-of-volunteers-to-treat-diseases
[8] http://www.thestar.com.my/story/?file=%2f2008%2f10%2f15%2fcentral%2f2246634&sec=central

November 21, 2015

Medicine, Philosophy
Mental Illness as a Language

Read this article in the Indiana Daily Student here….

Mental health is an increasingly important issue. The World Health Organization estimates mental disorders will have become the world’s largest cause of death and disability by 2020. [3] Alongside this, we’ve put forth tremendous effort to understand our mental health from a scientific point-of-view. Our post-Enlightenment positivist view of scientific happiness has exponentially grown in accuracy. Though we’ve been doing this since the eighteenth century, in recent years, we’ve become more and more observant and critical of how our minds truly function in the scary world. All of our actions, behaviors, and moods can be measured down to a very fundamental level. But these efforts ignore the socio-political and cultural tendencies that have driven mental health over the centuries. In spite of this, it’s no wonder mental illness is on the rise.

Still, some criticize the field of psychiatry for being scientifically backwards. But far more insidious is the cultural deafness. Many of us have forgotten the role culture plays in mental health because we have tried to only use science to explain mental health.[1] However, our knowledge of the brain is is still very far from explaining mental disorders. We should remember the symptoms of mental illnesses are, not only scientific issues, but also a language through which we express ourselves. And we need to understand our culture and history to figure out what our distressed unconscious tries to tell us.[1] Maybe mental illness is not a “harmful defect we shun” and more a way we understand who we are. Seen this way, the mental issues we face are less of “biological flaws” and more of ways we express ourselves in society.

Speaking of the 21st century, our anxieties and insecurities are probably more philosophically and existentially grounded than we like to think. Many of us struggle with the postmodern irony and individualism that simultaneously shuns tradition while embracing conformity. Some of us call ourselves “introverts” as a form of self-identification to internalize some of our behaviors as “natural” or “acceptable.” We look at all the other amazing introverts and find some sense of belonging. But labeling ourselves just covers up who we really are. Others among us chase ideas and culture in hopes that we can find something unique about ourselves, that separates us from other people, but we’re only sharing the same social assumptions about what defines us.

The same way culture fashions us to understand aesthetics, value, ethics, and other humanistic qualities, our struggles with the emotions of mental illness could be the way our bodies understand the world. Einstein himself found solace, not only in science and art, but in the philosophical work of Schopenhauer, as he wrote on Planck’s 60th birthday:[4]

To begin with, I believe with Schopenhauer that one of the strongest motives that leads men to art and science is escape from everyday life with its painful crudity and hopeless dreariness, from the fetters of one’s own ever shifting desires. A finely tempered nature longs to escape from personal life into the world of objective perception and thought; this desire may be compared with the townsman’s irresistible longing to escape from his noisy, cramped surroundings into the silence of high mountains, where the eye ranges freely through the still, pure air and fondly traces out the restful contours apparently built for eternity.

Maybe our searches for “objectivity” of understanding mental illness are caused by these similar desires that motivate scientist. In this sense, our mental health is the way we search for meaning and satisfaction in the world.

All the world’s a stage, And all the mentally ill merely players.

References
[1] http://www.psmag.com/books-and-culture/real-problem-with-dsm-study-mental-illness-58843
[2] http://mh.bmj.com/content/28/2/92.full
[3] https://newhumanist.org.uk/articles/4934/the-cost-of-happiness
[4] http://www.neurohackers.com/index.php/fr/menu-top-neurotheque/68-cat-nh-spirituality/99-principles-of-research-by-albert-einstein

October 26, 2015

Medicine, Philosophy
De-Stigmatizing Mental Illness: An Inquiry into Depression

‘Nature vs. Nurture’ vs. ‘Nature and Nature’

Here at IU, we have a lot of campaigns directed towards the de-stigmatization of mental illness. Last year, the Hutton Honors College hosted a discussion about issues with Autism in Pop Culture. Though the discussion mostly consisted of sharing personal stories of those with the disease and speaking of our desire to let them know that it is okay to have it, there wasn’t much critical thought put into the assumptions upon which our views toward mental health are built. We were too intimate with a desire to accept one another for who we are that we didn’t try to understand what autism, or any disease, really is.

As a science enthusiast, I believe it’s important for us to realize how our biological frameworks of disease affect the stigma of mental illness. One might adopt a view of mental illness in which everyone (not just those who suffer from mental illnesses) has different genetic mutations, and some of those mutations are caused by diseases. With this in mind, despite the way biology affects who we are, everyone still has responsibility, personhood, goodwill, etc. This will reduce stigma as we understand disease as something that does not detract from who we are, but, rather, something “natural” that comes about through the same biological processes that make up everyone. These mutations may have affects on proteins, cells, etc., and give rise to various phenomena., etc. At first glance, it seems as though this mentality would reduce stigma of mental disease. But how effective is it?

A recent article in the Hedgehog Review suggested that emphasizing biological roots of disease actually causes us to view mental illness more negatively:

Over the past two decades, both the general public and patients themselves—historically quite resistant to disease models of emotional and psychological problems—have become relatively more biologically minded. This change correlates with an increased endorsement of seeking professional help and using prescription medicine, as well as some reduction in attributions of blame: three of the central goals of the public anti-stigma campaigns (and pharmaceutical advertising). The change, however, also correlates with more intensely negative attitudes toward those with mental health problems, attitudes that are shared even by sufferers themselves.

Joseph E. Davis explains that a “trade-off” between responsibility and medical roots causes this negative attitude. I believe the issue is that there is a misconception that the existence of a disease/illness creates a trade-off between nature and nurture, when, in reality, the disease/illness do not detract an individual’s rational ability to make decisions for him/herself. It only means that a person’s ability to make decisions and his/her personhood are now in a different “context,” and that the person still has the same control over what he/she chooses to do. “Nature vs. Nurture” implies a tug-of-war between which the existence of forces on one side diminishes the other, so it might be better for us to adopt a more accurate phrase: “Nature and Nurture.”

A Different Kind of Disease?

Is mental illness really as “natural” as other types of diseases? Mental illness not only affects our physical body (most notably through neurological changes), but affects the very way we think. Through our inquiry into mental health, we must approach disease with a critical look at morals, values, and humanism in what we do. This separates mental diseases from others, and, for this reason, we might be inclined to view them as, frankly, different kinds of diseases.

Depression, a common disease of the mind, has been seen as both a mark of honor and as a stain of shame, with ethical challenges to both viewpoints. Freud noticed that the melancholic “has a keener eye for the truth than other people who are not melancholic. When in his heightened self-criticism…, it may be…that he has come pretty near to understanding himself.” The romantic genius burdened by age-old questions of existence and the unsocial artist obsessed in his craft may both be seen as filled with woe in light of their gifts. Isaac Newton, David Foster Wallace, and Montaigne have battled with feelings and perceptions inherent to depression, yet we still highly regard their mentalities as though they were heroes. Maybe depression is a different kind of disease in the sense that we may sometimes glorify it? Despite any intellectual value, our society still generally sees depression as something that should be abolished as we have put forth tremendous amounts of effort to help people overcome depression. But positing depression as something that should fight may conflict with our belief that it is “okay to have depression.” More generally, our motives of de-stigmatization vs. treatment are often at ends with one another. Simultaneously, we should also be skeptical of the way we glorify the melancholy as those who are truly in-tune with the harsh reality of the world. The way I see it, it’s very dangerous to view depression as “accept yourself the way you are because that’s what you are.” Though we want more people to realize the reality of depression, image and stigma of depression are still too harsh for us to use depression as our identities. And these challenges in our approach to the disease are similar to be found in any mental disease.

Is Mental Illness at odds with Reason?

We are in love with our ability to think rationally. We want to accept ourselves as creatures most closely defined by reason, and we closely associate our argumentation, rhetoric, and similar abilities with our identities. But how does mental health affect this identification? Kant would say depression is “the weakness of abandoning ourselves to morbid feelings,” and, since, according to Kant, this detracts us from our ability to reason, it means that Kant would have viewed depression as something connected to reason. This might explain why, despite our anti-stigma campaigns, it is difficult for us to swallow the idea that mental illnesses are just like other diseases. One might argue that, as a result of this account, we ironically have identified, not as masters of reason, but slaves to it.

Depression is not an emotion like other emotions, and, if one believes emotions are adversarial to reason, depression might just be the manifestation of undesirable thoughts that result from pushing reason to the extreme. But one might, in addition, declare that depression should still be avoided at all costs as, while it might not be a weakness in and of itself, its potential to create further weaknesses makes it too unreliable as a means of reasoning. This may compromise our view as depression as a beneficial, acceptable characteristic while avoiding the consequences of blindly praising it.

And, though there may be similarities between depression and other mental disorders, it would be an oversimplification to paint the entire category of mental illness with a broad brush. Rather, we should embrace a more nuanced approach to different types of mental health issues with science, philosophy, and humanism leading the way.

August 29, 2015

Medicine
The Eclectic Lunatic: At The Crossroads of Knowledge

The other day I had the wonderful opportunity to meet up with a high school friend. Through our conversation, we serendipitously wandered through topics of Nietzsche, statistical inaccuracies in peer-reviewed literature, ethnography, and much more that we had both studied. It was only speculation of both of our limited backgrounds, though. Neither of us intended to claim expertise on any of the subjects nor could reliably do justice to all of the topics we mentioned, but would enjoyed to muse about little things we had read here and there. Particularly, she was very interested in my academic background of physics and philosophy.

On a purely anecdotal level, I’ve already met plenty of students with studying disparate fields. Combinations like biology and art history, mathematics and philosophy, theatre and literature, and neuroscience and gender studies are just a few examples of degree programs of students only satisfied in intellectual diversity. These paths of disparate majors might have unexplored value, as well. We are already seeing more humanities majors entering medical school, and a students have perceived greater gains when studying seemingly unrelated fields.

“A man cannot serve two masters.”

Here at IU, many of my friends enter college with a lot of AP credits or exemption from certain classes. Some of us take advantage of this space to broaden our horizons or explore completely new fields of study. It’s also easy to find several course offerings that do not lie in a strict single “field,” and, instead, may invite knowledge from various areas (for example, the History and Philosophy of Science, Bioethics, Medieval Philosophy, etc). While I highly recommend pursuing academic excellence in disparate fields, I’m a bit more skeptical of the value of these interdisciplinary courses. They may compromise value from multiple fields for the sake of explaining a one-size-fits-all course that fails to do justice to any single field. It is better to understand how to approach problems from different points-of-view through specialized training of those different fields. Since we are at a university campus with monumental levels of diversity of course offerings, it makes sense that many of us choose to study subjects that may seem unrelated. But is our love of disparate disciplines only caused by having the luxury of being able to explore them? Or is it the result of something else?

Getting the best of both worlds meant everyday was something different for me. Sometimes I would be enamored by phase-space diagrams and other days it would be a classical dialogue. As the nights would linger on, I would spend each moment poring through the infinite of my laptop in a constant cycle between physics, philosophy, and probably something important. Sometimes my attention would become so I can hardly keep focus on a single thought for more than a few minutes at a time. I can’t help but wonder if our obsession with disparate fields is at least partly caused by an inundation of new, varied information everyday. But even before the advent of smartphones and personal computers, the unpredictable yet exciting problems of the 20th and 21st century have called for a certain intellectual flexibility that cannot be approached through simple, straightforward training programs anymore. The way we explore multiple fields might have value in the way we create a liberal arts education.

The type of undying curiosity and ambition hearkens back to the days of da Vinci and Michelangelo. Back to the days when engineers crafted sculptures, musicians wrote books, and philosophers had jobs. The University of Southern California created the program, “Renaissance Scholars” specifically for students who have studied disparate fields. One of my previous philosophy professors wasn’t too fond of the title “Renaissance Scholars.” “The Renaissance is over,” he declared. The Renaissance may be over, but let’s hope our re-birth of disparate knowledge never ends.

August 25, 2015

Education, Medicine, Science

The (Wrong) Reasons to Become a Doctor: A Medical Ethicist’s Perspective

This post is written from the point-of-view of pre-medical students, but I believe the issues and topics that I discuss can be applied to any undergraduate student who has a desire to learn.

As we search for meaning in our lives, we worry most about “Why do we want to become a doctor?” Indeed, as our fragile souls are knocked and swayed by existential crises and moments of doubt and insecurity by the overture of every Chemistry exam or weekend of volunteering, our searches for meaning and satisfaction ultimately leave us with only our constructed answers. Though it would be ridiculous to make decisions of the rest of our life in response to the temporary moodiness that mark any neophyte, whether we like it or not we, undergraduates, are forced to ask ourselves what we want to do with our lives and why. It’s important to put things into a bigger perspective that, while we are here to learn about ourselves and the rest of the world, we should not feel pressured to forget about our purpose.

You’ve probably heard the far too-oft repeated buzz-purpose “to work with people” or “help people.” I mean, it seems like an easy option, right? Despite its banal general feeling, wouldn’t want to work with other people or help others? It seems to be the prime quality of an empathetic, righteous human being. Throughout volunteering, extracurriculars, research, and whatever else we do, we find ourselves doing things out of a love of helping others and working with people. Digging deeper, we ask ourselves what it really means to “work with people.”

Yesterday, I had the wonderful opportunity to speak with Dr. Daniel Sulmasy, Medical Ethics Professor at the University of Chicago Pritzker School of Medicine, and ask him if he had made any observations about the motives and purposes of medical students in their work. I explained to him how I have already spoken with several different professors about how our motivations for why we learn and behave may have significant implications. Specifically, I asked Dr. Sulmasy about our pressure to act and do things for “utilitarian” purposes, rather than finding a “truer” meaning behind the things we do. He responded that there was indeed a difference between students pursuing actions for “Intrinsic”, rather than “Instrumental” purposes. One can imagine that studying for an exam because learning organic chemistry reactions has an intrinsic value that chemists and scientists truly appreciate may be more helpful and successful than students studying for the sake of obtaining a decent grade on an exam. Perhaps we, pre-medical students, should use these intrinsic values of our academics to find deeper meanings beyond “a desire to work with people.” As another example, we find students who want to study poetry for the sake of satiating a desire to understand the human condition and the beauty of art at odds with students who study how to program software that can detect viruses in human DNA. Sulmasy continued that the battle at the hands of our motives and purposes is a test of sincerity that is very often showed in graduate & medical school applications. And one does not need to throw away the motive of “utilitarianism” altogether. We could argue that, if students approach their studies for more “intrinsic” purposes, then society will have more motivated and mindful scientists & doctors that would provide a greater practical benefit for everyone. And, of course, these issues are exhibited among all students, not just pre-medical students. Aside from the amusing alliteration, his comparison drew from examples of doing things for the purpose obtaining a reward out of their pre-medical/medical experience exhibited by his students.

Back to the troubling idea of the proper reasons for becoming a doctor, we could choose to say that “we want to solve the problems of the world.” No matter whether you’re studying theoretical mathematics or creating irrigation systems in Sudan, the world has a lot of problems. And the “problem-solving” rhetoric has pervaded through all of society, especially in STEM fields. But what is “problem-solving”? This seems clear enough on the surface. The college education allow students to approach different types of problems. Who wouldn’t want someone to be able to think through problems for them? We hear about this a lot, especially in mathematics. We talk about how the U.S. needs more problem-solvers, how STEM is going to gift us with these important skills, and even how our medical schools place a huge emphasis on it. But what does “problem-solving” really mean?

While it is true that the pre-medical career and STEM courses give us amazing problem-solving abilities, the rhetoric for pursuing these opportunities is written with a solid practical underline. But let’s not write this off so quickly as a meaningless materialism. After all, we do want students to become scientists, engineers, and doctors so that they will help solve the problems of society. And this desire to help society may stem from humane virtues of empathy and love of what humans do. But, in reality, I do not believe it is even possible for students to learn how to solve the problems of society during our four years of sitting through lectures and laboratory discussions. Even for the most professional jobs, the administration of academia can’t reasonably give us the specific skills to solve problems that the world will face tomorrow. And I do worry, though, that our overemphasis in the rhetoric of these values of a STEM education causes us to lose sight of the similar values that can be obtained from studying the Arts & Humanities (similar to my previous comparison of a student studying poetry vs. a study studying software engineering). After all, while a Computer Science major may know how to write lines of code that can develop the next Uber, the English major will understand the complicated “expectations vs. reality” of Silicon Valley that will tell us what the good ideas are. It is still unclear how we should look at our education as a way of developing problem-solving skills because we don’t have a good idea of where those problems will lie now or in the future. With any doubt, we know that the liberal arts education must be protected to ensure students can obtain the full value of the disciplines and material that we choose to study.

Is our notion of “problem-solving” too broadly defined? If we look at our college education as a way to learn how to solve problems, then this certainly seems to satisfy both a utilitarian purpose that will help us in future careers and a more “scholastic” purpose that will do justice to the reasons why we should learn. Is this why we struggle to find meaning in our college education? All we know is that we must go beyond the superficial feelings of desires to “work with people” and “help others” of the American education system to know what we really want to know.

The Unspoken Harm in the (Pre)-Medical Experience: On History and Education

When the United States established its medical school system, we could have easily chosen to mimic Europe and create an alternative to the undergraduate degree for students who specifically wanted to become doctors. Instead, we created an idea of a “pre-medical student” who would finish a four-year bachelor’s degree in addition to pre-medical requirements before entering medical school. This would allow a unique, liberating approach in which we embrace the fruits of a liberal arts education while simultaneously preparing for professional school.

The pre-medical requirements include required coursework, volunteering, extracurriculars, shadowing experience, a good GPA & MCAT score, recommendation letters, and maybe a hobby or two. As the information of these requirements disseminates through the advisors, organizations, faculty, and students of college campuses, we perceive strict, superficial standards on what pre-medical students should do that are, actually, quite arbitrary and variable. By “arbitrary,” I mean, we aim for illusory goals and set standards to ensure we complete X, Y, and Z before we apply for medical school. We follow the footsteps of students above us, never stopping to question the effects this dogmatic approach to our education has on us. I will explore what effect pre-medical requirements have on our education, but, since there is very little literature and research done on the issues pre-medical students face, it would be more helpful for us to first understand the problems of education in medical school to see if they reflect among our behavior. Through a study of the history of medical education, we can understand how we, pre-medical students, can forward in the uncertain 21st century.

Before medical schools were firmly established in the States, soon-to-be doctors would serve menial duties under experienced physicians for a required term that would culminate in clinical activities. By the late 1800’s, the first medical schools, constructed to be intertwined with hospitals, gave a breath of education of the classics alongside clinical training. After completing a bachelor’s degree (including knowledge of philosophy, mathematics, and Latin), students completed a year of training before an apprenticeship and lectures. The overall structure of this seems similar to the way a pre-medical student must complete required coursework before entering medical school, residency, and securing a career.

The ominous, exciting turn of the 20th century into the darkness that was “Hand mit Ringen” (Hand with Rings), the first medical X-ray.

But how has the medical education changed over time? With advances in technology, science, and epistemology, medical education has always struggled to keep up with preparing students to approach the biggest problems of the future while retaining the human values that we cherish. Through progress and breakthrough in science, medical schools emphasized new technology and research-driven approaches in their education. This has forced medical schools to embrace confusing tendencies that attempt to balance the art and science of medicine with one another. realized we needed a professional ethos to guide us, and students and physicians would reflect on the changes that flew before their eyes. Maybe the course of history in the education of medicine guided through nostalgia. Even as far back as 1953, we find those who “lament the fact that the personal tie between teacher and pupil no longer plays so vital a part in medical education, and they would urge a return to the earlier mode of teaching.” But why stop there? In 1910, years after the establishment of a science-driven Medical School at Johns Hopkins, educator Abraham Flexner reminisced the thoughts of one student,

“Our teachers were men of fine character, devoted to the duties of their chairs; they inspired us to enthusiasm, interest in our studies, and hard work, and they imparted to us sound traditions of our profession; nor did they send us forth so utterly ignorant and unfitted for professional work as those born of the present greatly improved methods of training and opportunities for practical studies are sometimes wont to suppose.”

Despite the progressively aggregating amounts of knowledge and its effects on human health, Flexner recognizes that the educators of the past were never as useless as the present students might think. Although Flexner does not suggest that medical students of his time were succumbing to an ominous, self-obsessed era of scientism and it would be ridiculous to assume that amazing advances in the sciences are driving students of medicine amok, there is still a balance of the sciences and humanities to be ascertained in order to completely realize Flexner’s vision of the American Medical Educaiton. For example, as the United States embraced the advancements of a science-driven era, some had hoped that the study of history of medicine would create a “counterbalance” to the “reductionist hubris” that plagued a physician’s knowledge in the science-dominated era.

I would occasionally browse Reddit on my phone as I sat in the crowded lecture hall during my Organic Chemistry II course this past semester. I would only look up to the notes on the projector when the professor had finished writing something new for me to copy into my notebook. Despite my distraction, I would try to review my notes over and over again until the professor would un-pause the streaming on his feature length film “Organic Chemistry II Notes.” We glazed at the information, soaking in anything and everything in the comfort that the professor would “only teach the things that would be on the test”, “this is how you solve the problem,” complete with practice exams and sample problems identical to those on the exam. I paid attention, though, as I believe understanding the puzzles and forces that governed chemical reactions was incredibly interesting. But, I lamented that the joy of learning science was reduced to a requirement that we were forced to suck-up.

I dropped that course later on in the semester.

Luciano Nezzo, 1856, A tooth-drawer concealing the dental key from the patient

Studies as recent as 2004 have examined the role that our modern economy has played on the medical education. “Habits of thoroughness, attentiveness to detail, questioning, and listening are difficult to instill when learning occurs in a clinical environment more strongly committed to patient throughput than to patient satisfaction. In addition, it is difficult to imagine how caring attitudes can be developed when medical education is done in a highly commercial atmosphere.” Necessities such as “questioning” and “thoroughness” are similar to the skills that I believe undergraduates need. I believe these issues of a “commercial atmosphere” among medical students parallel those that undergraduates face. Our business-like emphasis on fulfilling pre-medical’s requirements to please admissions officers causes issues of inhumane utilitarianism and dogmatic groupthink.

Viewing the the undergraduate education as a means of gaining something (whether that fools’ gold is skill, experience, recommendation letters, grades, or even the ambiguous buzzword “professional experience”) moves us towards utilitarianism, a motive with harmful consequences. We would have a materialistic view that loses the humanistic value given by an education. This materialism is both marked by a lack of interest in wonder and awe of scientific phenomena (similar to Flexner’s emphasis on the combined role of humanism with science) and greedy reward-driven pre-medical requirements (similar to mindset of medical education in a modern economy). While it is ridiculous to say all pre-medical students engage in extracurriculars solely for the purpose of becoming a better medical school applicant, there is no doubt that many pre-medical students are motivated by the idea there is a practical benefit in what they do. This practicality-driven view of our education also gives rise to anxiety and envy. These characteristics of a utilitarian approach to our pre-medical career may cause issues if we are ever to fulfill Flexner’s dream of finding a human value in medicine.

Most importantly, if students are given a list of requirements that they must complete and achieve, then we will begin to see the fulfillment of those requirements as the purpose of our education. This, as I’ve explained with evidence from Harvard Medical School, should not be the case. Similar to the reductionist attitudes that Flexner criticized over a century ago, we cannot simply view our activities as means of gaining a practical benefit. And it forces us to aim towards the “end goal” of gaining experience in these requirements before we have given enough thought to the meaning and challenges of those “goals. Learning how to ace an interview and approach ethical issues in medicine become means of preparing students for the future rather than methods of discovering the true purposes in those activities. By this, I mean that pre-medical students are often encouraged to approach the requirements directly without adequate and appropriate training or discussion of those subjects.

All in all, we need more discourse among students. The lack of discussion, debate, and criticism about these issues demonstrate the groupthink that cause us to lose sight of what the value of an education should truly be. We mustn’t reject all the things pre-medical students have done nor devalue any benefit that we have already obtained from those activities. Rather, we should build upon what we’ve done and ask what the true meaning of a medical education should be.

As the old saying goes: Those who fail to learn from history will probably become doctors.

Myths in Medicine: The Epistemology behind so-called “Conflicts-of-Interest”

As tempting as it may be for one to believe that the medical products industry is free of corruption and that there are no people acting for heinous purposes, it’s difficult for anyone to take a position on issues in the health care industry without extensive knowledge. With the negativity of the discourse and multitude of issues surrounding making sure that we can provide for the health of everyone, it would be very refreshing and relieving for one to believe that all of those are simply results of misinformation and bad statistics.

In “Pharmaphobia” Dr. Thomas Stossel delineates his decades of research and work on studying the so-called “conflict-of-interest” issues in the medical industry. Stossel begins with general statements about how the health care that we receive today is, for better or for worse, much better than it has ever been in the history of forever. The modern medicine Dr. Stossel packs his book full of scientific studies, anecdotes, and policy analysis in his journey through the history of medicine up to the problems we face today. He makes the contrarian claim that there has been a “conflict-of-interest” movement founded on unjustified claims about responsibility of results, exploitation of research, flawed policies, and a number of other lofty subjects. As a result, we end up with unnecessary taxes on products, price controls, misconstrued research data and other causes that thwart medical innovation and progress.

Before we continue to explore these giants problems facing the medical industry, I’d like to take an aside and discuss certain epistemological approaches We tell ourselves to believe what is right and avoid what is wrong. What exactly does this mean though? As the moral value of knowledge lies on the foundation of what is true and what is false, it would be reasonable for us to ask ourselves what right we have to believe things that are true. Taking this a step further, we may posit that, by believing the truth, we are attempting to avoid believing things that are false and to have the most comprehensive set of beliefs as possible.

“The ‘flat earth’ vs. ’round earth’ is not a difference in opinion. It’s a matter of right & wrong.”

Consider two different approaches to solving a murder case. In the first approach, we choose to only use information given to us by evidence. In the second approach, we regard information by evidence as well as that information which we theorize. Which approach should we use? The former gives us a lesser chance of being wrong, as we take fewer risks with what could be true or false. The latter gives a greater chance of knowing more information. One might argue that you should believe something it true to a certain degree of probability. Maybe there is a certain risk that we can take with the possibility of believing something that is false. But before we can confront knowledge as a microeconomics problem, things get more confusing when we confront paradoxes such as the preface and the lottery. Hopefully it should be more apparent why our right to have knowledge brings about issues upon close inspection. The epistemology in our approach must align with the appropriate rights to knowledge in research, industry, practice, or any other part.

These challenges to our knowledge seem devastating (and they’re only the tip of the iceberg of epistemology), but there are ways for us to try to make sense of things. One may suggest that beliefs about which we confidently believe to be true are different from those beliefs that we believe true during inquiry. This way, there is a certain context to the truth of beliefs that we determine to be true. In other words, when we take for granted that a certain thing is true, then it doesn’t matter whether or not we regard it as true in the context of inquiry. Does it truly make sense to regard a certain belief as true in one context yet false in another? Well, throughout the history of science and medicine we see theories that change time and time again through the self-amending scientific method. Our current models always match existing data and information, and our theories make sense to us at the moment of what is available of scientific research. But, since most theories and models eventually are replaced by bigger, better ones, then it is reasonable to assert that our beliefs are false in the context of inquiry (since there is a very high chance that, someday, they will be disproved), but, as we are confident with the knowledge of those beliefs, we can believe they are true for now.

Evidence-based approaches to medicine have been criticism by scientists and philosophers, or both, such as Mario Bunge. Bunge would remark that evidence-based medicine “has only strengthened the empiricist tendency to accumulate undigested data and mistrust all theory.” Why should we throw away theory and hypothesis to only limit ourselves to the what may appear more “truthful” as empirical science? It may be appropriate to use the word “skepticism” here not in the sense that we are trying to believe as little information as possible to avoid the risk of believing something that is false, but applying skepticism to our theories of research and regulation in medicine to get a better understanding of the underlying assumptions that govern our lives. Any attempt to circumvent possible motives and purposes by mankind by putting our entire faith into the numbers and graphs given by scientific experiments does not allow the theoretical lead that should guide medical research. And, the more faith we put into developing models that we can use for developing medical products, the greater room we have for skepticism. We need to ask ourselves what are the true causes of the issues we face in medicine. If we don’t correctly identify the proper causes and effects of the issues, then, as Stossel explains, the conflict-of-interest myth will continue like a foggy, intimidating machine that envelopes various sectors of the American public.

Whether or not we call them “conflicts of interest” it is true that there have been dreadful instances in which the truth of science has been shrouded for other motives. When internist Barry Marshall and pathologist Robin Warren were working on a treatment for stomach ulcers, the cure, antibiotics, were cheap and easy to find. But the gastroenterologists had other ideas of the 1980’s had other ideas.

During that year Robin and I wrote the full paper. But everything was rejected. Whenever we presented our stuff to gastroenterologists, we got the same campaign of negativism. I had this discovery that could undermine a $3 billion industry, not just the drugs but the entire field of endoscopy. Every gastroenterologist was doing 20 or 30 patients a week who might have ulcers, and 25 percent of them would. Because it was a recurring disease that you could never cure, the patients kept coming back. And here I was handing it on a platter to the infectious-disease guys. (source)

Ultimately, the two ended up experimenting on themselves to prove to the world that H. pylori, not stress, spicy foods, or anything else, caused stomach ulcers. More importantly, we see that, even as recent as the 1980’s, there were still causes for disease that we are unable to completely “rule out.” There are also issues between medical journals and doctors themselves in asserting what is actually true and false about diseases and treatments.

What are the best ways for us to dispel the Conflict-of-Interest myth? Maybe it is more appropriate for us to search for evidence of collusion or similar ethical issues in the actions among researchers and practitioners before taking for granted what we may imagine to be the case. But, before we can do that, we must ask ourselves, do we really know anything?

Myths in Medicine: The Epistemology behind so-called "Conflicts-of-Interest"

“The ‘flat earth’ vs. ’round earth’ is not a difference in opinion. It’s a matter of right & wrong.”

“principle, that instances, of which we have had no experience, must resemble those, of which we have had experience, and that the course of nature continues always uniformly the same. (Hume “A Treatise of Human Nature” I.III.VI)

During that year Robin and I wrote the full paper. But everything was rejected. Whenever we presented our stuff to gastroenterologists, we got the same campaign of negativism. I had this discovery that could undermine a $3 billion industry, not just the drugs but the entire field of endoscopy. Every gastroenterologist was doing 20 or 30 patients a week who might have ulcers, and 25 percent of them would. Because it was a recurring disease that you could never cure, the patients kept coming back. And here I was handing it on a platter to the infectious-disease guys. (source)

What pre-medical students can learn from the humanities

As I finish writing my final lab report for my Intermediate Physics Lab, the fall semester of my sophomore year comes to a slow, much-needed end. I’ve taken some time to reflect on the impact my classes have had since the beginning of the year. This semester, unlike those of my freshman year, has been markedly different in several ways. For one thing, all my classes were either directed towards my physics or my philosophy degree; none of them were pre-medical requirements. This was a huge breather for me, not because it was less work or I had the chance to be lazy, but because I had more time to develop as a person.

When I took an Introductory Logic course last spring, I leveled up in “Hipster skills” by declaring my second major in Philosophy. Bear in mind that I didn’t know a thing about philosophy. I didn’t know a thing about fancy buzzwords like “existentialism”, “objectivity”, and “postmodernism” that the layman will throw around, and I had never read any philosophy text in my life.

Some park I visited while I was in Waterloo last summer or something.

Fast-forward to the present moment: the end of the fall semester after I had finished my Ethics course. Since the beginning of this class, I have created skills for myself in communication, resourcefulness, and an ever-increasing insight in human behavior and thought. I have started a Medical Ethics Committee and a Bioethics Society to promote the curiosity of ethics. These groups feature (or will feature) student-led discussions, lectures from faculty, opportunities to attend ethics conferences across the country, high school outreach, and a debate-style team to compete in bioethics competitions. I’ve developed a purpose for myself and helped others do the same for themselves through understanding the values of research, ethics, and curiosity in the world. All of this was only possible through my work in philosophy. It’s amazing how much you can learn when you step out of your comfort zone and, in my case, I did so by diving off the deep-end into philosophy.

Unlike the hypothesis-driven, progressive world of science, the humanities help us see each other as human beings capable of morals, emotions, judgements, and values. By understanding how society works from a non-scientific point of view, we are reminded that human beings are not guided by psychological or social phenomena. We are not physical or biochemical problems that are waiting to be solved. We are rational creatures who desire justice and purpose. Some might say that, unlike the sciences, the humanities make you feel more “humane.” I can agree with that.

(Physics equations on the wall from my visit to the Perimeter Institute.)

Though I would advise that humanities courses (like philosophy, history, art, or literature) are very helpful, their effectiveness ultimately depends on whether or not a student can find courses with a meaningful and welcoming atmosphere. I have no desire to sit through a humanities course that is a giant-lecture hall of watching lectures as though you were sitting through a movie with zero interaction.

When I was a freshman, I was incredibly unsure of myself for double-majoring in Physics and Philosophy with a pre-medical track. Though I loved those subjects, I thought it was too unfocused and doubted how they would ever be helpful for a career in medicine. Now, I think my choices have given me more than any other degree program would have, and I’m certainly glad I chose to make those decisions.

Tag: Medicine

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“A man cannot serve two masters.”