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Vol. 8 Issue 34…Dedicated to the Dialogue on Race…August
26, 2005
Hippocrates
(c. 460 BC- 380 BC)
There are in fact two things, science and
opinion; the former begets knowledge, the latter ignorance...Prayer indeed is
good, but while calling on the gods a man should himself lend a hand.
Ancient Greek physician, Hippocrates was born
in 460 BC on the island of Cos, Greece. Well-educated, Hippocrates acquired
immense knowledge of natural sciences including chemistry, physics and biology.
Armed with this knowledge, he played a key role in efforts to rid ancient
Greece of the notion that illnesses were caused by evil spirits or demonic
possessions. Medicine based on religious beliefs of the time reduced physicians
to roles of sorcerers and exorcists.
Hippocrates believed illness had a physical
and rational explanation. Basing his medical practice on observations and study
of the human body, Hippocrates recommended that physicians record their
findings and methods for future doctors. Likely written by many, but attributed
to him, Corpus hippocraticum or "Hippocratic writings," some
60 or 70 books on all aspects of ancient medicine, laid the foundations of
medicine as a branch of science. Primum non nocere (first, do no harm) is one
of the famous rules ascribed to Hippocrates.
In following this rule, Hippocrates treated
the body as a whole, rather than as a series of parts. He accurately described
disease symptoms and noted individual differences in coping with disease and
illness. Believing in the natural healing process, Hippocrates recommended
rest, a good diet, fresh air and cleanliness. He was the first physician to
attribute thoughts, ideas, and feelings to the brain as opposed to the heart.
Hippocrates traveled throughout Greece
practicing his medicine. He founded a medical school on the island of Cos,
recruited and trained new entrants into the medical field. Probably sworn to by
these new entrants, the best known of the Hippocratic writings is the
Hippocratic Oath, which detailed responsibilities the physician had to the
patient. It is regarded as the most valuable statement of medical ethics and
good practice. He died in 377 BC. Today, Hippocrates is generally considered
"the Father of Medicine." (Sources: www.quotationspage.com, www.allsands.com/Science/hippocratesbiog_rtb_gn.htm,
http://en.wikipedia.org/wiki/Hippocrates
and http://www2.sjsu.edu/depts/Museum/hippoc.html)
Worldwide Medical Errors
According to the World Health Organization
(WHO), health care errors seriously harm one in every 10 patients. Nearly a
million patients in the US alone die or incur serious injury as a result of
medical errors each year.
WHO, the Joint Commission International and
the Joint Commission on Accreditation of Healthcare Organizations, which
accredits US Hospitals, are creating a collaborating center to focus worldwide
attention on best practices to reduce safety risks to patients. Dedicated
solely to patient safety, the WHO Collaborating Center will provide for better
information sharing and coordination, which will allow everyone to learn from the
mistakes and best practices of others.
Liam Donaldson, chairman of WHO's World Health
Alliance for Patient Safety, acknowledged, "Human error is inevitable. We
can never eliminate it. We can eliminate problems in the system that make it
more likely to happen."
The safety measures experts will focus on in
eliminating problems in the system include ways to avoid mixing up drugs,
procedures to safely place tubes threaded through the nose and stomach to feed
patients or remove poisons and procedures to prevent performing surgery on the
wrong body part or even the wrong patient.
Disparities in Medicare
Services
In 1998, the average life expectancy for
African American males was 7 years less than white males, and African American
females lived 5 years less than white females. Gornick et al. replicated other
studies that documented wide disparities between blacks and whites in Medicare
services. They studied the effects of race and income on mortality and use of
services. They linked 1990 census data with 1993 Medicare data for 26.3 million
beneficiaries age 65 or older (24.2 million whites and 2.1 million blacks).
For mortality, the black/white ratios were
1.19 and 1.16 for men women, respectively. For hospital discharges, the ratio was
1.14, and for visits to physicians for ambulatory care, it was 0.89. The
black/white rate ratio for bilateral orchiectomy was 2.45 and 3.64 for
amputations of all or part of the lower limb. For every 1000 beneficiaries,
there were 515 influenza immunizations among whites and 313 among blacks.
Comparing rates in the most affluent with the least affluent group, the rates
were 26 percent lower among whites and 39 percent lower among blacks.
Gornick et al. concluded race and income have
substantial effects on mortality and use of services among Medicare
beneficiaries. Consequently, just providing health insurance will not guarantee
that all beneficiaries effectively and equitably utilize the program. (Source: www.ncbi.nlm.nih.gov)
Emergency Room
Disparities
Despite changes in medical technology and
health care advances, minorities have continued to suffer higher mortality for
a number of common health conditions. Many disparities in medical care occur in
emergency care (EC). Functioning as the sole provider for the uninsured, the inadequately
insured, and those who have difficulty navigating the primary care system, EC
is their health care safety net. Excessive mortality/morbidity persisted even
after adjusting for socioeconomic status for both non-preventable as well as
preventable causes of death.
When considering poverty and access to care,
EC should be a mitigating factor for the poor. In that regard, access is a life
and death issue for poor uninsured patients; poverty rates among African
Americans, Hispanics and Native Americans are more than twice that of whites.
Lack of access may be a key to greater disease severity, thereby accounting for
higher rates of mortality and morbidity in minorities for diseases such as
asthma, congestive heart failure and diabetes. For example, Gornick and
colleagues found that despite lower rates of other preventive care measures and
interventional procedures such as angioplasty, African American Medicare
recipients have significantly higher rates of limb amputations. This is a
procedure directly linked to complications from diabetes. However, rates
reported in Gornick's study far exceeded the differentials in diabetes
prevalence between African Americans and whites.
Differences in primary care access, disease
severity and coverage may address some differences in poor health outcomes; it
does not completely explain disparities that persist once minority patients are
actually within the health care system. Differences in delivery of care that
persist even in the face of similar levels of disease severity have been found
in recent studies. Data showed that nonwhites with acute cardiac ischemia were
two times more likely to be sent home from the EC unit, and nonwhites with
myocardial infarctions were over four times more likely. In Todd et al.
significant disparities were found in administering something as simple as pain
medication in EC. Ethnicity affected the administration of pain medication to
patients with long-bone extremity fractures. They found that 55% of Hispanic
patients failed to receive appropriate analgesics compared to 26% of
non-Hispanic whites. African American patients also were significantly less likely
than white patients to receive EC analgesics. (Source: www.aemj.org)
Sex and Race Bias in
Science
Women and blacks are under-represented in the
sciences. Only twelve percent of all science doctoral degrees awarded in the
United States in 2003 went to minorities, according to the National Science
Foundation, which funds about 20 percent of all federally supported basic
research conducted by US colleges and universities.
According to research published in the journal
Science, women in science faced overt and covert bias. Researchers found
"no convincing evidence that women's representation in science is limited
by innate ability," a reference to statements to that effect made by
Harvard University President Lawrence Summers.
The lack of diversity in the science
professions is clearly not explained by biological differences.
Three-Fifths Compromise Healthcare
By
John Burl Smith
Last week (8-18-05) a report in the New
England Journal of Medicine re-ignited the debate about disparities between
blacks and whites in healthcare. At the heart of this controversy is the
history of slavery in the US. Racism, discrimination and other forms of
disparate treatment traditionally accorded blacks were codified in the 3/5
Compromise of Article I Section 2 of the US Constitution by the founding
fathers. Although, segregation was state law only in the South, all of
America's socioeconomic and political institutions discriminated against
blacks. The medical profession was no different. Doctors were educated in the
same segregated schools as lawyers, judges, businessmen and politicians. They
were trained to treat blacks differently to protect white privilege. National
efforts to reduce the discriminatory affects of the 3/5 Compromise became known
as "affirmative action" in the 1960s.
Patterns of disparate treatment for blacks
hold true throughout US society. Denying blacks opportunities reduce
competition for resources. All whites benefited from not having to compete with
blacks; this is the glue that holds the white lie of not discriminating against
blacks together. The majority of whites support this lie when it comes to
denying blacks access to medical school. Even though volumes of research
continue to show unabated disparities in every facet of American life, whites
continue to pretend that the gap is due to something other than race.
The collaborative study between Emory, Yale,
and other U.S. institutions that re-ignited this debate looked at the records
of 598,911 white and black patients treated for heart attacks between 1994 and
2002 in 658 hospitals. Their findings were consistent with other studies that
found significant disparities in treatment.
However, as Dr. Ashish Jha of the Harvard
School of Public Health, said "When we started our study two years ago, we
hoped we would find a few procedures where the gap was narrowing, or a few
regions around the country where the gap truly got eliminated. We couldn't find
any place in the country where the gap narrowed."
The relationship between improving minority
health and affirmative action may not be obvious to most whites. Inextricably
linked, discrimination is the root of both. Whites discriminate against blacks
because they want to continue controlling society's resources. Blacks suffer
far higher rates of heart disease, cancer, stroke and infant mortality than
whites for the same reason slaves wore rags and ate scraps, while whites
dressed in fine fashions and ate ham, and for the same reason blacks are denied
access to medical school-- whites control them. Healthcare for blacks has not
improved because the 3/5 Compromise and the discrimination it permits benefit
whites. It is the basis of white privilege and superiority.
Disgruntled feels:
Unimpressed! In response to his all-time low poll numbers,
George W. Bush's advisers decided he should take time from his busy vacation to
travel to some safe "red states" to publicly reiterate his
determination to stay the course in Iraq. Based on his public relations image,
Bush is a man of conviction. Without exception, according to his carefully
crafted public persona, once he decides on a course of action, Bush never
waivers. Flip-flops are for lesser men. Given such intransigence, which in any
other mortal would be labeled ignorance, Bush must always be right, even though
he is not known for due diligence. After all, he was a mediocre student and
remains a reluctant reader. On more than one occasion, members of his
administration have assured us that poll numbers do not drive Bush policies and
actions. Yet, here he is campaigning to convince Americans that he was right to
invade Iraq, although all the reasons cited for that act have since been proven
to be lies. Even he takes a different tact; instead of weapons of mass
destruction, he uses words like democracy to justify staying the course. Since
neither of his offspring is on his front-line in the war on terror, staying the
course is easy. However, falling poll numbers show a majority of parents are
too unimpressed with his act to serve their kids up as cannon fodder.
Disgruntled
says: A real right-wing Christian, Reverend Pat Robertson suggested
the US should just kill Venezuelan president Hugo Chavez. According to his
rather public tirade, Chavez should be wasted because, among other things, his
huge oil holding could "hurt us very badly." The assumption is, the
US could send commandos down there, decapitate the nation's leader and install
a puppet regime. Obviously, Robertson remembers when the US engaged in covert
assassinations all over South America. Now, only Israel openly engages in
targeted assassinations. After a firestorm of criticism and no public support
from fellow fundamentalists, Robertson retracted his terrorist suggestion.
Disgruntled
wants to know: The day of reckoning is fast approaching. Prices of all the
necessities of life from food to fuel are steadily rising. Question is, will
the bust come before or after Alan Greenspan, father of the dot.com and housing
bubbles, retire?
Hippocratic Oath --
Modern Version
By Louis Lasagna
I swear to fulfill, to the best of my ability
and judgment, this covenant: I will respect the hard-won scientific gains of those
physicians in whose steps I walk, and gladly share such knowledge as is mine
with those who are to follow. I will apply, for the benefit of the sick, all
measures which are required, avoiding those twin traps of over-treatment and
therapeutic nihilism.
I will remember that there is art to medicine
as well as science, and that warmth, sympathy, and understanding may outweigh
the surgeon's knife or the chemist's drug. I will not be ashamed to say "I
know not," nor will I fail to call in my colleagues when the skills of
another are needed for a patient's recovery.
I will respect the privacy of my patients, for
their problems are not disclosed to me that the world may know. Most especially
must I tread with care in matters of life and death. If it is given me to save
a life, all thanks. But it may also be within my power to take a life; this
awesome responsibility must be faced with great humbleness and awareness of my
own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever
chart, a cancerous growth, but a sick human being, whose illness may affect the
person's family and economic stability. My responsibility includes these
related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for
prevention is preferable to cure. I will remember that I remain a member of
society, with special obligations to all my fellow human beings, those sound of
mind and body as well as the infirm.
If I do not violate this oath, may I enjoy
life and art, respected while I live and remembered with affection thereafter.
May I always act so as to preserve the finest traditions of my calling and may
I long experience the joy of healing those who seek my help.
About
Me: This modern version of the Hippocratic Oath was written in 1964
by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University.
Very similar to the original oath ascribed to Hippocrates, it is used in many
medical schools today. For a translation of the original by Francis Adams, log
on to http://classics.mit.edu/Hippocrates/hippooath.html.
)
Healthy People 2010
The 1979 Surgeon General's Report, Healthy
People, and Healthy People 2000: National Health Promotion and Disease
Prevention Objectives established national health objectives. These
reports served as the basis for the development of state and community public
health plans. Healthy People 2010, which builds on these earlier
initiatives, is the national set of health objectives for the first decade of
the 21st century. Healthy People 2010 serves as a model for national
and international disease prevention and health promotion plans.
The two overarching goals of Healthy
People 2010 are: (1) to help individuals of all ages increase life
expectancy and improve their quality of life and (2) to eliminate health
disparities among different segments of the population. Reflecting the major
health concerns in the United States at the start of the new century, Healthy
People 2010 employs ten (10) leading health indicators, i.e., Physical
Activity, Overweight and Obesity, Tobacco Use, Substance Abuse, Responsible
Sexual Behavior, Mental Health, Injury and Violence, Environmental Quality,
Immunization and Access to Health Care, to measure national health. Each
indicator has one or more objectives. Under these ten indicators, there are 28
focus areas with more than four hundred specific objectives.
Built on the best scientific knowledge
available and designed to measure programs over time, Healthy People 2010,
like its predecessors, was developed through a consultation process. To ensure
it remains current, accurate and relevant, the U.S. Department of Health and
Human Services, Federal agencies and other experts assess data trends during
the first half of the decade, consider new science and available data, and make
changes that reflect this new information.
As part of this mid-course review, the public
is invited to comment on proposed changes. The public comment period extends
from 9:00 A.M. August 15 through 5:00 P.M., Eastern Daylight Time, September
15, 2005. The public can read more about Healthy People 2010, view
proposed changes to its objectives and register to submit comments at www.healthypeople.gov.
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