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History and Health: Understanding the Forces Behind Today's Medicine

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Antique Sterilizer
Photo: Mark Wooding (from the collection of Neal Cohen, MD)

by Chris Cai, MS1

“When treating patients with diabetes, physicians often tell their patients, ‘Eat less bread, less rice, fewer tortillas,” says Emily Wong, a second-year medical student.

“Yet while diet modifications are an important part of managing diabetes, physicians also have a duty to address the social and economic contributors to health.”

Wong is considering pursuing a PhD in History of Medicine and believes a historical lens can offer the tools to accomplish this.

“Many of my patients live in an area without a grocery store. I often ask myself, ‘Where do such food deserts come from? What are the historical forces that brought this patient to this clinic?’ History helps students appreciate how patients have interacted with medicine in the past, and how we can better care for marginalized populations in the future.”

Recognizing this importance of the historical trajectory of health and medicine,

UCSF is fortunate to house to the country’s second oldest History of Health Sciences department. The department provides training and research on the social and historical contexts that affect health.

Founded in 1929, the department merged with the program in medical anthropology in 1999 to become the Department of Anthropology, History and Social Medicine (DAHSM). The department's doctoral programs are internationally renowned.

“How we think of doctors today, and how our health care system operates, is the result of an array of particular historical conditions,” says Professor Brian Dolan, PhD, Vice Chair of DAHSM and Director of the Division of Social Medicine. “Nothing was, or is, inevitable about our beliefs and practices. So the more we understand these historical forces, the more informed and efficient we can be when setting goals for the future.”

Dr. Dolan wrote about the challenges of integrating the humanities with medical education in his book Humanitas, a volume that includes reprints of pioneering articles that were published on this topic over the past 100 years.

One way the DAHSM has attempted to overcome these challenges is by hosting the Culpepper Seminar Series. Held at Laurel Heights, the series offers a forum for prominent anthropologists and historians to speak to the public. Topics have included discussions on ‘Patient Autonomy since the National Research Act’, ‘The Black Box of Police Torture’, and ‘Managing the “Hot Spots”: Health Care, Policing, and the Governance of Policy’.

Wong says the Culpepper Seminars reinforced her appreciation for the history of health sciences, and its relevance to clinical practice. “We take for granted many things as scientific, when they are historically produced.”

Physicians, for example, are beginning to understand race less as a biological fact and more as a historically produced, sociocultural construct.

“At a time when the disparities in life expectancy between African Americans and Caucasians continue to grow, this is an invaluable perspective,” says Omar Mesina, a second-year medical student.

Mesina, along with Wong, has advocated for increased structural competency training, both within UCSF and as student members of the American Medical Association.

Mesina was motivated to change the way physicians address social determinants of health.

“Social determinants of health have been classically taught in a very superficial way in medical schools in the US that can actually inadvertently perpetuate stereotypes and health inequities. As a transplant to the Bay Area, the health disparities and social ills of the patients I’m interacting with are a consequence of political and economic histories that traditionally are not discussed in class and are left for us to discover on our own as we continue training. As part of the Bridges Curriculum, during our Health and Society block we had a small group to examine health disparities in San Francisco’s low-income communities and what stakeholders are involved, giving a space to begin this dialogue early on in our training.”

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Notable Faculty in the Division of History of Health Sciences

Brian Dolan, PhD, is a Professor, Vice Chair of DAHSM and Director of the University of California Medical Humanities Consortium. As founder and managing editor of the University of California Medical Humanities Press, Dr. Dolan has overseen the publication of 19 books on topics analyzing customs and beliefs that impact health and healing, including Heart Murmurs: What Patients Teach Their Doctors and Follow the Money: Funding Research in a Large Academic Medical Center. As author, his most recent books include A History of Neurological Surgery at UCSF, 1912-2015, A History of Urology at UCSF, and Humanitas: Readings in the Development of Medical Humanities.

Aimee Medeiros, PhD, is an Assistant Professor in DAHSM. Dr. Medeiros collaborated with other DAHSM faculty including Associate Professor Kelly Knight, PhD, and Joint Medical Program student Josh Neff, MS, to incorporate ’structural competency training‘ into the Bridges curriculum, as a means to teach healthcare professionals to respond to the health and wellness implications of social, economic, and political forces.

Dorothy Porter, PhD, is a Professor and former chair of DAHSM. Her research focuses on the history of public health and the history of disease. She is currently studying the history of Parkinson’s disease in her forthcoming book Creative Disability and the Shaking Palsy: Approaching a History of Parkinson’s Disease Discourses and Narratives.

Elizabeth Watkins, PhD, is a Professor in DAHSM, Dean of the Graduate Division and Vice-Chancellor of Student Academic Affairs. Dr. Watkins advises history of health sciences graduate students, oversees all PhD, masters and post-doctoral students and manages student services. She also conducts research on how communication flows between the scientific community and the public, and has published work on topics such as birth control, gender, and pharmaceuticals.

 

This article focuses on History of Health Sciences and Medical Humanities at UCSF and is part 2 of a 2-part series on the Department of Anthropology, History and Social Medicine.
Read Part 1