Medical History and History of Racism

Question 1

therapeutic system

Answer 1

complex set of processes by which a society accounts for and responds to perceived disease

Question 2

Most illness episodes in the US today (75%) are managed by. . .

Answer 2

. . . individuals, with treatment decisions based on their own experience

Question 3

__% of patients sought care from an ‘unconventional healer’ within the past year.

Answer 3

34% of patients sought care from an ‘unconventional healer’ within the past year.

Question 4

Annual out-of-pocket spending on alternative medicine is ___ relative to annual out-of-pocket spending on conventional medicine.

Answer 4

Annual out-of-pocket spending on alternative medicine is roughly equal relative to annual out-of-pocket spending on conventional medicine.

Question 5

What is a profession?

Answer 5

A field granted a legal monopoly through policed liscensure and granted a substantial deal of autonomy, with the ability to self-regulate and train future professionals. Often involves mastery of a set of knowledge and the provision of some sort of public good.

Question 6

William Buchan’s Domestic Medicine

Answer 6

Published in 1769. The second highest selling book in the American colonies only to the Bible. Highlights that self-treatment was common and often valorized as part of the ideal of American self-sufficiency

Question 7

First professional medical society in America

Answer 7

The Massachussetts Medical Society, founded in 1781 by Dr John Warren in hopes “that a just discrimination should be made between such as are duly educated, and properly qualified for the duties of their profession, and those who may ignorantly and wickedly administer medicine.”

Almost immediately, the MMS ran into conflict with HMS as to whether or not an HMS degree was sufficient liscensure to practice medicine

Question 8

In the first few hospitals in the colonies. . .

Answer 8

• Admissions were controlled by trustees rather than doctors
• No nurses, families were expected to provide all food and nursing care
• Wards were unregulated and full of prostitution and gambling
• Hygiene was so bad that diseases were often contracted at hospitals
• Hospitals had no role in medical education - in fact students were discouraged from going as to examine an ill patient as a student was seen as offensive and a waste of the patient’s time and energy

Question 9

Boston University School of Medicine was founded as. . .

Answer 9

. . . a homeopathic medical school

Question 10

Mary Baker Eddy established Christian Science in. . .

Answer 10

. . . Boston in 1866

Question 11

A survey in Tennessee in 1851, to which 201 “doctors” responded, revealed that . . .

Answer 11

. . . 35 had obtained an MD, 42 had attended some lectures, 27 were botanics, and 97 were self-taught.

Question 12

The American Medical Association was founded in . . .

Answer 12

. . . 1847

Question 13

The first demonstration of anesthesia used for surgery by Morton and Warren was at the Ether Dome at MGH in . . .

Answer 13

. . . October 1846

Question 14

Carney Hospital and Boston City Hospital

Answer 14

Opened in 1863 and 1864 in Boston amid racial tensions in order to care for the segregated Irish immigrants.

Question 15

Beth Israel

Answer 15

opened in 1916 for Jewish patients

Question 16

Rise of germ theory

Answer 16

First gained popularity in the 1870’s and 1880’s. This was when allopathic medicine really began to stand out from competing “medical” fields. This is also when hospitals and medical schools began to associate with laboratory-based science research.

Question 17

The first Nobel Prize in Physiology or Medicine

Answer 17

1901, to Emil von Behring for producing the first antitoxin to diphtheria, another huge win for Germ Theory

Question 18

The first Nobel Prize in Physics

Answer 18

1901, Rontgen for X-rays

Question 19

The graduate-level, 2 year/2 year medical school model

Answer 19

Started by Johns Hopkins University School of Medicine in 1893

it required a bachelors degree for admission, and its four-year curriculum included two years of pre-clinical coursework and two years of intensive inpatient clinical training.

Question 20

The Flexner Report

Answer 20

Delivered in 1910. Flexner, a member of the AMA, visited all 155 medical schools in the US and found that most medical schools were stand-alone institutions, not affiliated with a university. They had no laboratories. The cadavers were not preserved, resulting in terrible conditions in the anatomy labs. He also found that there were too many physicians.

Flexner recommended that most of these schools close (from 155 to 31), and that the surviving schools adopt the Hopkins model, with, among other things, the hospital at the center of medical education

Question 21

By 1920, . . .

Answer 21

. . . The allopathic medical model, which had become synonymous with scientific medicine, was recognized as the only viable medicine by government and granted the only medical liscensure power. All medical schools switched to a hospital-centered John Hopkins model.

Question 22

School for Health Officers

Answer 22

Established jointly by HMS and MIT in 1913. Would eventually become the Harvard School of Public Health, starting officially in 1922.

Question 23

Women at HMS

Answer 23

Women first requested admission to HMS in 1847. The President and Fellows of Harvard College considered the issue twice that year, but did not “deem it advisable” to change the male-only policy. In 1848 the Boston Female Medical College opened. When the HMS faculty voted to admit a woman in 1850, HMS students protested her admission and the faculty rescinded their offer.

In 1878 Marian Hovey offered HMS $10,000 if it would admit women. The faculty voted to change the policy only if a proper sum (e.g., $200,000) were raised. By the 1880s, when it looked like that sum might be raised, most of the faculty vowed to resign if women were admitted; the Overseers voted to refuse the gift.

This pattern of sexist behavior continued for decades, until the domestic needs of World War II finally forced HMS to admit women.

Question 24

E.H. Clarke’s notorious 1873 Sex in Education lecture

Answer 24

warned about the dangers of educating women: if women, especially adolescents, devoted too much energy to education, then their brains would develop at the expense of their reproductive organs, leaving them infertile, possibly even dead.

Question 25

1850 African-American admission to HMS

Answer 25

In 1850, the same year a woman first attempted to gain admittance to HMS, three African-Americans attempted under the premice of going to work as physicians in newly-established Liberia. This was met with great opposition by the students, and was abandoned until after the Civil War.

Question 26

By the 1930s, doctors were second only to ___ in terms of prestige and respect.

Answer 26

By the 1930s, doctors were second only to Supreme Court justices in terms of prestige and respect.

Question 27

National Institutes of Health

Answer 27

Created by Congress in 1948 following the incredible medical progress made during WWII by investing money into biomedical research

Question 28

Food and Drug Administration

Answer 28

Created initially in 1906 under President Theodore Roosevelt as part of the late 1800’s / early 1900’s progressive era in US legislation, when the backbone of American consumer protection and anti-trust legislation was passed. Initially just intended to insure the accuracy of drug labels.

In 1938 the FDA was given the power and responsibility to evaluate the safety of drugs and regulate the medical claims they make.

By the 1950’s, following the WWII research drive, new, unevaluated drugs and conflicts of interest abounded. This lasted until the FDA was restructured under the Kefauver-Harris amendments in 1962, following political outrage from tholidamide. This is where our phase I/II/III/IV trials come from.

Question 29

The first kidney transplant

Answer 29

Undertaken at the Brigham in 1954

Question 30

Late 20th Century Changes to Medicine

Answer 30

• The introduction of healthcare insurance and restructuring of the healthcare economy

Question 31

Theodore Roosevelt and national health insurance

Answer 31

Theodore Roosevelt had wanted to create a national healthcare system modeled on the German system, and ran on this when he went up against Woodrow Wilson. Of course, Wilson won, delaying this, and then WWI began, and focus shifted completely. This would not be revisited for the public until LBJ’s presidency.

In the meantime, the private sector began to address this problem itself with private healthcare insurance.

Question 32

Blue Cross and Blue Shield

Answer 32

In 1929 the Dallas teachers union made a deal with Baylor Hospital: every teacher contributed $0.50 each month to a fund that would cover up to 21 days of hospitalization if required (this became Blue Cross). A similar arrangement covered physician services (this became Blue Shield).

At first, the two competed and repeatedly had to come to compromise. Eventually, the two decided to merge and work for their muitual benefit, creating Blue Cross Blue Shield.

Question 33

Healthcare coverage from 1900 to 1970

Answer 33

1900: 0% coverage
1950: 50% coverage
1970: 70% coverage

Question 34

AMA’s response to Kennedy’s intent to inact socialized healthcare

Answer 34

Violent opposition. Famously in 1961 they hired Ronald Reagan to speak out against it, telling Americans to call their representatives and state their vehement opposition.

Of course, following Kennedy’s death, LBJ would ultimately pass Medicare and Medicaid.

Question 35

21st Century Cures Act

Answer 35

Passed under President Obama with bipartisan support. Increases funding for NIH (especially for cancer research) and makes it easier for companies to bring new drugs to the market.

Question 36

The FDA dilemma

Answer 36

When it is too stringent, the FDA is accused of harming patients by restricting access to potentially beneficial drugs. When it is too lax, the FDA is criticized for letting dangerous medications onto the market.