Student Group Focuses on History
In medicine, when is race a useful category for distinction and analysis? If there is a race-signal in health data, what is the cause? When should physicians make decisions based on a patient’s race, ethnicity or other markers of difference? What can medical students do?
These were some of the questions posed by David Jones, the A. Bernard Ackerman Professor of the Culture of Medicine in the Blavatnik Institute at HMS, at a Feb. 11 lecture that explored issues where race and medicine intersect entitled “BiDil: Race, Pharmaceuticals and Social Justice?”
The lecture, positioned between courses in the students’ first-year curriculum, was designed to bridge issues of social science and basic science to give Harvard Medical School students insights into the discourse over what and how to teach and know about race in medicine.
Jones presented a historical case discussing the story of BiDil, a drug for heart failure marketed specifically for African Americans that was approved in 2004.
He described a long history of assumptions about scientific differences between black and white patients, saying that early studies of heart disease were inherently race-based because of beliefs that the slave trade caused evolutionary issues with sodium retention leading to hypertension, an idea that Jones said was ultimately completely wrong.
A difference between how various populations respond to medication exists, Jones said, but not necessarily enough of a difference to be a justification for prescribing different drugs based on race or ethnicity. Still, assumptions persist, he said, and while no other race-specific products have been put on the market, he added, some doctors still may prescribe different dosages based on race.
As for what students can do when faced with race-based issues, he advised them to “Research, publish, advocate.”
The lecture was sponsored by the History of Medicine student interest group, which was founded in 2015 by HMS faculty members Helen Shields, HMS professor of medicine at Brigham and Women’s Hospital, along with Jones and Scott Podolsky, professor of global health and social medicine in the Blavatnik Institute at HMS and director of the Center for the History of Medicine, and Stafford Cohen, HMS corresponding member of the faculty of medicine at Beth Israel Deaconess Medical Center.
The student interest group aims to teach HMS students about the history of medicine so that they can think critically about how history has shaped medicine and consider the implications for contemporary practice.
Cathy Wu and Evan Beiter, the student co-presidents of the group, emphasized the importance of analyzing the history of medicine, and of HMS, in order to understand the foundations of modern medicine.
Beiter said he believes clinical medicine is about “using our knowledge of the past to guide the future away from suffering, whether we’re studying the advancements of the field or the patients’ own history.”
Wu echoed this sentiment, adding that “ignorance of history amounts to an ignorance of the injustices happening today.” She said looking back provides students with insights into how to make future improvements.
Wu said Jones’ discussion of the use of race as a medical indicator shows that medicine “doesn’t exist in a vacuum” and is affected by human preconceptions.
Wu said she hoped the lecture would “jump start a conversation” about race in medicine and help illustrate “how societal opinion and financial incentives can color such discussions.”
The group hosts a number of events each year, typically lectures or field trips to places that have been important to scientific research.
In addition to off-campus trips, such as a visit to the Ether Dome at Massachusetts General Hospital and the Ether Monument in the Boston Public Garden, students have also been given behind-the-scenes tours of the various collections at the Francis A. Countway Library of Medicine, including a chance to see an iron lung in action following a talk on its history.
Planned future events include visits to the Beetham Eye Institute at Joslin Diabetes Center and Mount Auburn Cemetery.