 Good afternoon everybody. I'm delighted to welcome you to today's talk. Today's talk will be by Mindy Schwartz and Steven server will be working with Mindy. It will be as you know, the final talk in the series of 28 talks that have been held between October of 2021 and today on the topic that Mindy Schwartz help develop the topic was called the history of medicine and ethics. There has been a yearly lecture series that started in 1981 and currently is in its 41st annual year of running this annual lecture series. The series is jointly sponsored, both by the McLean Center for clinical medical ethics and by the Bucksbaum Institute for clinical excellence. Each year, really since the early 80s, we've been presenting somewhere between 20 and 30 lectures. In the past 10 years, some of the lecture series topics have been reproductive ethics organ transplantation, pediatric ethics, global health, health care disparities, end of life care. Neuro ethics, the doctor patient relationship, and a few years ago, the COVID-19 pandemic. But today I am so excited to introduce you to the speakers. Dr Mindy Schwartz is a professor of medicine in the general internal medicine department here at the University of Chicago. Dr Mindy Schwartz teaches nutrition courses to medical students and residents, and another area of her academic interest is the history of medicine. Dr Schwartz currently serves as one of the medical school advisors, serving along with Brian calendar as the head of the Kaga shawl society. She serves as the chapter advisor of the Gold Humanism Honor Society, and she was former associate program director and chair of the internship selection committee in the department of medicine here in 1994 to 2004. Dr Mindy Schwartz has been an award winning teacher and was elected in 2010 as a master of the University of Chicago's critical school of medicine Academy of distinguished medical educators. In the past 10 years, Mindy has studied and taught medical history to medical students and the internal medicine residents in May of 2014. Dr Schwartz was the local chair for the National Organization of medical historians that called the American Association for the history of medicine. Joining Dr Mindy Schwartz today is MD PhD candidate, Steven server. Steven is a member of the committee on the conceptual historical studies of science, the Department of History, and the Pritzker School of Medicine. Steven recently submitted his dissertation entitled a test of conscience, navigating Mexico's servicio medical social 1935 to 1940. The title of Dr Schwartz and Steve's talk today is studying the past and creating the future. I'm delighted to turn you over to Mindy Schwartz and Steven server. Well, thank you, Mark. Just make sure I'm not muted. And no, I'm not. Let me get my slide set out. And I want to just share the screen. Okay, can everybody see the slides? Thank you. Thank you, Elena. Okay, so I wanted to thank everybody for coming today and for participating in this terrific educational experience. You know, this is the last lecture of the year and I took a page as the organizers prerogative to give the summary and closure, because my friend and colleague Brian Callender did the same thing last year. And I thought it would be nice to have the last word rather than the first word. Now, when I first approached Mark about incorporating history into the interdisciplinary lecture series, I thought it would be a nice variation since it hadn't been addressed directly over the last 40 years. And I also thought that the historical approach would be very welcome, particularly in light of the shadow of COVID with a political situation, racial issues, climate change, congressional gridlock, and now an evolving war in the Ukraine. And if there was never, if there was ever a propitious time to study history, certainly now. And at the beginning, when we invited the speakers, I was actually hoping eventually that it would be hybrid, that we would go in person at some point. But just like everything else related to COVID, you know, you really, you can't bank on anything. So it turned out to be virtual and surprisingly, we've actually grown accustomed to it. You know, it will be nice to be in person, but I think a lot of us have anxiety about groups. So I want to go back to what I call first principles and make the case for the value of history and medical education, as well as clinical practice. And I hope doing this, instead of having given this talk on the first day, my hope is that I want to leave you with food for thought, and hope to continue your interest in this area. For the Ethics Fellows, I've put together a bunch of resources that I hope people will be able to look at and share, including books and articles and other references. But on the last slide, my goal is to give our both Steve and my email address so anybody who's interested, I want to make this widely available. So as many of you know, anybody who knows me in person knows for the last 20 years, I've been reading, studying, exploring, sharing and teaching medical history to anyone who will listen. Now this is primarily the greater University of Chicago community. And personally, I've been interested in what I call clinical historical connections or the clinical relevance of the past in the digital age. The other thing, the other piece of this talk we're going to give is called studying the past, creating the future, because at the best, I think history can give us a template of how to think about change when it comes along, and how we can be maybe proactive rather than reactive. Now Steve's going to talk about this as an activist versus a nostalgic view. But as we've learned, change is disruptive and that means it's not linear. So maybe when the time comes for us to improvise, if we have a perspective about what works and maybe equally what has not worked, it will give us some insight into how to plan a better future. So history can teach us not only how to be humble, but maybe how to be active. And as the more we know, maybe the better we can get in as pasture is quipped, chance favors the prepared mind. And maybe the issue is not so much as understanding the past as it is for advocating for the future. Now this slide shows one of my favorite cartoons. When I was younger, there was a cartoon called Rocky and Bowenkel, and this is Sherman and Mr. Peabody. Now Mr. Peabody's the dog, Sherman's the boy, and they used to go on these adventures in what they call the Wayback Machine. Now the thing about Rocky and Bowenkel was they got the adventures wrong, but on the other hand, the thing about these adventures were that history was like an exciting place to go. And I always held on to that from when I was very young. And you can't study history without winding up back in ancient Greece, you know, one way or another. And this is Clio, or Clio, the muse of history. And her name means to either make famous or to celebrate. And she's often shown with a stack of books, an open scroll, a set of tablets. And one of the several muses, origin of the museum, is Clio. And Clio is the daughter of Zeus and the titanist Nemosthenes, who is the goddess of memory. So why study history? Why study history? It goes all the way back. And there's much written about why study history. But I'm going to go over some of the basic foundational issues that I think apply to history in general. And then I'm going to bring them more specifically into clinical medicine. And this is taken from the University of Wisconsin History website, which I thought made a succinct argument. So obviously we know the past is the foundation for the present. It helps us understand why things work or don't work. History also creates empathy as we understand, you know, in a more personal way, that the people in the past were just like us, you know, imperfect, not omniscient, you know, making mistakes, fundamentally human. The other thing is history can be personal and very personal, you know. All you have to do is watch that show, finding our roots, and you can see how these very famous people who get exposed to learning about their history can be very either sometimes really encouraged or sometimes overwhelmed at their past. And then everything has a history. As I was looking at the website, you know, there's a history of, you know, history of refrigeration, history of condoms, everything that we know and are interested in has a history. But one of the important things about doing history is there's a skill set to history, and history can be like a puzzle, and historians are among the best detectives, and historians are great researchers, and that's part of the skill set of the historian. And I love this picture. This is a picture of Osler performing a history in physical. And one of the important points as a clinician is history is an essential part of what we do every day all the time. The ability to take a history. Every single patient we see, we have to take a history. And one of the critiques is that, you know, that we cut and paste from the medical record, or as they say in computers, garbage in, garbage out. But I want to just show you and have you take a look at this picture for a minute. On the top, it has a picture of Osler talking. Just to the top right, you have him auscultating. The bottom left, you have him palpating. And the thing that's just so powerful is he's sitting there with his foot on the chair, and he's actually thinking. And just as a moment of reflection in the modern time, that's the problem that we have with modern medicine. We're going so fast. You don't often get the time to think, history and physical, you know, every physician is a historian at some way. So there are two big, as well, let me say it differently. In my studies, I've been on a hunt to find materials that can introduce clinicians to history and speak to those who practice in a busy clinical world. And there are two really good references that help, there's many references, but I'm going to cite two that give us a framework. There's an article called Making the Case for History in Medical Education. And those of you who are attentive and paying attention will realize every single author on this, what we call, I call the white paper, have spoken in this lecture series. So you're really getting to hear from the best. And next is a list of how incorporating aspects, understanding different aspects of, you know, clinical practice can really make a difference in clinical education. So things like disease, what we count as efficacy, medical knowledge, technology, physicians, medical institutions in the medical marketplace, bodies, medicine and public health, and then health inequities and ethics. All of these things have a direct impact on medical practice and medical education are all areas that are explored extensively by historians. Now people often ask me, what's a good book to read about history? And I have many, many books, but if you want to read one single book, okay, this is a book by a guy named John Burnett. It's really written at the level of basically a college student, but the reason I like it is it helps organize a framework that we can build around. And at E, he describes the book with five dramas. The healer, the patient, the disease. Then we have discovery and transmission of knowledge, and that's a big part of the U of C ethos, right? And then medicine and health interacting with society. So I'm going to take that, you know, his framework and kind of exploded so we can learn a little more. And at the core is many people have talked about this. Jackie Duffin has spoken about this many times in her books talking about the Hippocratic Triad with the patient, the physician, and the disease. And it's easy to think about how these interactions are seminal to our practice and how many iterations we can find. And if you start with disease as a conceptual framework, you could teach history of medicine doing nothing, but just speaking about disease. What's normal versus abnormal? The clinical experience of signs versus symptoms. Symptoms, what patients feel, signs of what we observe. And then you have nozology, which is the branch of medical science dealing with the classification of disease. And this has clearly, you know, changed over time. We live in a world of medicalization, and I'm going to articulate that in a minute, the topic of demedicalization is equally important. What things were once the domain of doctors and now are actually considered normal. The whole ICD-11 codes, the international disease classification, which there's 55,000 different codes. And then there's classic diseases. You know, you think about diseases that we've seen over time, including things like gout, tuberculosis. And then you have modern diseases, you know. I mean, if you look at Mark's ethics lecture series, he started back in 1982 and 85 with AIDS, and now we're at COVID, you know, so we've seen this. And then one of the other most interesting things that I have about the issue of how are syndromes, and syndromes help us understand disease in a different way. And one of our colleagues, a historian named Howard Kushner, has written a very interesting article that I have on the reference list about using syndromes as a diagnostic tool. And as a general internist and a clinician, you can see even the etiologies and the treatments for disease have changed dramatically over time, right? One of the old adages was relating peptic ulcer disease to the high level of acid, no acid, no ulcer. And then in the recent years, helicobacter has, you know, been identified as a cause of ulcers. And treatments have varied from milk, the milk alkali treatment, vagotomy and pyloroplasty, and when I was a medical student and a resident, this was not an unusual thing, and we saw plenty of people with gastric emptying problems that had this. When I was a resident, H2 blockers were out, and then proton pump inhibitors came, so we have antibiotics against helicobacter. We drank the organism, made his colleagues scope him to document that he was so convinced that this was causative. And there's a whole interesting literature about self-experimentation. Even the same diseases over time are viewed in a different way. Chlorosis used to be a disease of, called the green disease, and used to be a disease of white women, and now it remains a major cause of micronutrient deficiencies. Iron deficiency anemia throughout the world is very common in, you know, in third world and low income populations, and most of the people now have iron deficiency anemia are actually not thought to be white, but thought to be of all different races. And then what counts as a disease and what doesn't? Here's a picture of Mary Mallon, who is typhoid Mary, and for those of you who know her story, Mary Mallon was actually a cook who was a typhoid carrier and was shut up in New York and quarantined for years because she was a transmitter of typhoid, but she was never sick. It's a fascinating story on many levels about how we understand disease, how, you know, immigration, the reach of public health. Much has been written about it. And you don't have to look any further than the history of sexuality to see how, you know, what we understand as normal and abnormal has changed. And there's a whole literature on onanism or masturbation in the 19th century. And one of the most interesting books written at the late 19th century was by a German physician named Richard von Kraft, Edwin called Psychopathia Sexualis. And it's really fascinating because it's kind of the modernization of sexual diversity. Focusing on immoral acts, and his concept was a temporary deviation of norm from the innate morbid condition. And it was part of forensic medicine, which focused on things like rape and sodomy and indecency. And man was thrust into this irregular behavior, not as sin or crime, but as symptoms of pathology. And it's kind of the medicalization of this. And then in the 20th century, we've seen as people call the discovery of homosexuality and certainly the rise of transgender as common in our world. And, you know, look no further than Caitlyn Jenner. And I think it's really important because there are generational issues. Obviously, for those of us who grew up in 19, I think it was 76 when he won the Decathlon. You know, Bruce Jenner was a symbol of, you know, masculinity, virility, accomplishment, athleticism. And he was on the Wheaties Box. So I think it has a different valence for people who live through that than younger people who really have a different view of what's normal and abnormal in sexuality. So when we use the term medicalization, we are talking about the process by which human conditions and problems come to be defined and treated as medical conditions and become the subject of medical study, diagnosis, intervention, or treatment. And all you have to do is look at the ICD-11 to see some of the codes, things that used to be part of just being alive, erectile dysfunction, wrinkles, smoking, hot flashes are now diseases and therefore in the medical domain. Demedicalization is even more interesting. Obviously, we talked about the fact that homosexuality was taken out of the DSM. Jackie Duffin writes about love sickness and masturbation are clearly things that are now not thought to be pathologized. And I put the graham crackers here because in the 19th century, Sylvester Graham was part of a vegetarian movement that was very interested in how diet affects libido. But you don't have to look any further than the medicalized world in the fact that the same articles that are in Time magazine are also in nature and science. And we live in a world where people know medical terminology in a way that they didn't in our previous generation. And one of the things I love is, this picture from Steve Peitzman's book, it's from the 17th century showing on the left a person who has clearly what we now would think of some kind of anisarca, likely kidney problems or liver disc. You know, the poor woman has either nephrodic syndrome, cirrhosis, heart failure and it shows how she's got some areas where she probably had paracentesis and how different that is than our modern times. I found this thing on the web about patient experience. You know, we're in a world where patients are now consumers. And in the past to be a patient was a terrible thing. Now we're all part of a whole different world. So here the patient experience involves the wait time, meeting with the doctor, office and bathrooms, appointment. It's just a whole different world than the world our ancestors lived of patient experience. And then, you know, there's been a big push to look at medicine from what they call the bottom up from the patient's experience as opposed to the doctor. And, you know, we're all familiar with Frida Kahlo and her image, her self-images of her trauma from not only having polio but having, you know, been involved in that terrible bus accident and how it affected her life. And then you've got Edvard Munch who is a Norwegian expressionist and really captures the sickness yet a lot of TB in his family and this is the sick child. Here's another one, death in the sick room and these images are very evocative. Another book that talks about, you know, our approaches to, you know, the patient experience is Celebrity Illness when, you know, Baron Lerner wrote a really terrific book called Public Looking at Lou Gehrig, FDR. And the reason I have FDR here is because everybody knows about FDR polio but very few pictures of him in a wheelchair. It was really important not to have that showing. And Arthur Ash, Barty Clark, the recipient of the first artificial heart, Betty Ford. And we live in a world with direct-to-consumer advertising, you know. This is advertising Xarelto. And, you know, there was a time when you would be kicked out of the AMA for advertising and now we advertise dangerous drugs to patients. And then obviously physicians and other healers and if there's anything we've learned in this lecture series is that physicians are only one part of the healthcare team. We heard talks about nursing and osteopaths and anybody who does inpatient service knows that we are part of a bigger team which includes medics and midwives and bone sellers. Over time, physicians are just one of many. And then you can look no further than the iconography, right? On the left, the image of the doctor in the 17th century holding up the match of the urine that was his and typically it was his. That was this significant code whereas in the modern times, they're wearing the white coat with the stethoscope hung around their neck. And another interesting iconography is just Thomas Aikens showing the transition from the acceptance of antisepsis from 1875 to 1889 showing the gross in the Agnew Clinic two hospitals in Philadelphia where he was a painter and was invited to paint scenes of medical erosism. And this is a picture for our special collections. Just the only reason I show it as change in practitioners is because, A, these are medical students and, B, they're sitting with a skeleton which would not be, A, the demographics of medical school would be different but, B, having a skeleton would not be acceptable as part of our current practice. And then, obviously hospitals have changed over time for medieval hospitals which were typically right next to a church and places that were founded by religious organizations to Rush Medical College which is the precursor to the University of Chicago Medical School to our very own University of Chicago Medicine and just, you know, the hospital architecture and the changes are dramatic. And then how the same images can be weaponized and this is a critique of the famous Luke Fielders painting Voluntary health insurance, the American way keep politics out of this picture. Well, politics is certainly in the picture. And then the social contract. This is President Johnson signing, you know, the Medicare and Medicaid amendments to the Social Security Act in 1965 and it's important to remember that the mean life expectancy was 70 years back that nobody thought Medicare was going to be the behemoth that it's grown into. And then technology. We know that technology is part of broader systems and there is unanticipated costs and consequences of technology. Innovation isn't always progress and what happens in other fields bleeds into medicine. Just think about the role of something like photography, microscopy, the role of the automobile, the ambulance, computers, and I'm not even mentioning X-rays, ultrasound, CT, MRI and the whole diagnostics. This is a picture of Walter Freeman, one of the fathers of the early, you know, prefrontal lobotomy, which at one time was thought to be a big advance in medicine and now we obviously look at mental health and those treatments in a very different way. And then bodies. This is a milieu bloomer, a rebel in pants. You showed the 19th century how scandalous that was and it's not a long arc from the way we think about bodies now and obviously we're in another time period where we're reconsidering bodies of different ethnic groups and when they all matter and how we should think about them. And there's nothing more interesting from a historical point of view than going on a field trip and I encourage any of you if you haven't done this, go down and see Lincoln's home in Springfield, Illinois. It's only three hours from Chicago and you can see I did this 12 years ago. But the great thing about going and visiting these historic places are you get to be really surprised and one of the things that really struck me when I went, this is Lincoln's bedroom and apparently the wallpaper is a pretty good reproduction of what they had and I was just blown away by how vivid the purples were in the Lincoln bedroom. I know it seems mundane but I just was surprised that the colors were so rich back then. But the other thing that really struck my fancy was this was the back area, this was Lincoln's outhouse and what it reminded me of the fact that cultural norms and what we think and what's private and what's public is really different. Like in the 19th century when strangers slept in the same bed, clearly people's experience of sanitation was very different than ours. And here's a picture given to me by a friend of mine named Shauna Devine who's a historian of the Civil War. And what you see in this picture is that this is a picture from the Army Medical Officers dated in 1864 and only two of the people are actually looking at the camera. This is very common if you see photography from the late 19th and early 20th century. They're not necessarily looking forward. It's just a different convention but it shows how these subtle things really embody the kind of changes that we see. And obviously this is part of an ethics conference so this is a picture taken from the Tuskegee study which we've talked about things like eugenics, Nazi medicine, human experimentation. We didn't have a lot on torture but we certainly dealt with compromised leaders. And as Arthur Conan Doyle, the famous Scottish physician, wrote, when a doctor goes wrong, he is the first of criminals. He has nerve and all the knowledge. But as we're rounding out the year, I just wanted to remind people that this has been a really incredible lecture series and this is the final copy of it. But basically when I put this together I broke it down into thinking about history in four big categories. First, there was a general talk by Bob Richards on the past is not what you think. Then there's one I call history over time. Lydia is the lost art of dying. Jackie Duffins had a diagnosis of miracle. Walt Shalik talked about practice in medieval medicine. There was a lot on clinical historical connections including the history of nursing osteopathy and the yearly physical exam. And then clinical historical connections. And then the last is bioethical issues and bioethical lapses. And these are the talks about pain, fallen heroes, Tuskegee, the 25th amendment, radiation studies. Mark gave a great talk on the history of clinical medical ethics, wrestling with eugenics. Laney gave a talk on living organ donor transplant, the shadow of slavery. Sydney Halpern talked about the human experiments with hepatitis. And then last week we had Matt Winnie talk about how healers became not killers. And what I want to do now is transition this to my friend and colleague, Steve Server. And those of you who know me know I'm a clinician who's a historian enthusiast. But I wanted to have you hear from somebody who actually practices research and writes history. Steve is an MD PhD candidate who will receive his PhD in a few weeks and then return to the fourth year at the Pritzker School of Medicine. He's a close colleague and invaluable friend and a kindred spirit in this process. And I really wanted him to talk about the skills and approach that historians use and how historians can make meaning of things. So we're going to swap seats and I'm going to let Steve take it over. Thanks so much Dr. Schwartz and thank you all for being here. It's a wonderful opportunity to be able to talk to you all about the life I've lived for the last seven years, traversing back and forth across Ellis Avenue between the medical side of the university and the academic side of the university. To Dr. Schwartz's general point I hope to talk a little bit about the ways in which historians, academic historians make meaning of things in such a way as to potentially encourage clinicians to reflect upon the way that they make meaning of things. And perhaps there's some lessons that can be had from sort of looking over the fence at the way that others make knowledge. So a great way to start that as an MD-PhD historian I stand on the shoulders of giants one of whom is Jackie Duffen who's on the call. It's from this book, this article right here, Margaret Humphries is another MD-PhD historian. So Cleo in the clinic is essentially an attempt to sort of understand the role that history could play in medical practice. In this article called Beware the Poor Historian Margaret Humphries essentially sort of starts as a framing piece this idea about clinicians deeming sort of their patients poor historians. And the deeper question is okay well as an MD-PhD historian herself Margaret Humphries is eager to sort of problematize and think a little bit about what it really might mean to be a poor historian from the patient perspective but really focus more pointedly on what it means to be a poor historian from the MD's perspective. And so I think a way to sort of think about that is the ways in which there are different registers at which historians make meaning of things just as there are different registers at which clinicians make meaning of things. And sort of to blow that up and explore that in detail I think we can use an article that was in Tuskegee's Truths which was in the edited volume by Susan Reverby this is an article called Racism and Research by Alan Brandt who's a PhD historian. And I think it's a useful kind of framing device to really as I said probe the different ways in which or the different levels at which historians make meaning of things in a sort of historical episode that all of us sort of have a general understanding of. So the first level sort of a making meaning that historians engage with is sort of the question of what actually happened because sort of from a I think conceptual and philosophical perspective how can we really have any further conversations if we don't really agree on the basic contours of shared reality anecdotally maybe that's part of the sort of straits that we're in at the moment. And so you know Alan Brandt's chapter in that edited volume for example he went to the archives which you know the National Archives had sources that sort of dealt with the many years of the Tuskegee experiments and found something that the Health Education and Welfare Report of 1973 really didn't focus on which was the fact that MDs talking to sort of the patients that they interacted in Tuskegee argued that the spinal taps that they would be providing would be therapeutic as opposed to sort of diagnostic of neurosyphilis right so essentially in missing that key detail that the spinal taps were always articulated as therapeutic for patients essentially he discovered a matter of fact that totally alters the health education and welfare's report you know report casting of the Tuskegee sort of experience really emphasizes the level of the ethical violation in a way that the initial report that was undertaken by the federal government simply did not capture by sort of a neglect of the primary source base right and you know I think clinicians are quite comfortable at this register of making them right we live in a world of interpreting and analyzing various sorts of data both on their face but also sort of the meta level of you know what are the limitations of this form of data limitations of this test versus another test the use of complementarity in terms of testing right like what does this sort of source tell us that another source might not and reading together we get a better sort of overall understanding of the scenario on the ground and you know I think in general historians do a similar thing now historians use different sorts of primary sources than physicians do obviously they make recourse extensively to archives to publish sources these days more sort of big data sets and quantitative data but they've also you know used archaeological sources molecular data from ancient sources and our friends on the other side of university at the OI decided to make use of some of our medical technology to ascertain some interesting facts about historical figures namely these mummies and you can see if you're able to top right of this CT the patient is mummy and we can see this sort of finding in the lower left CT scan this sort of defect here would be the area where embalmers who are mummifying the body remove the brain and so essentially you know that's a creative use of sort of sources that are not commonly used by historians but there may be a potential for creative synergy if we think broadly and creatively about such things the next level that I think is useful to think about is sort of interpretive issues and it's sort of one thing to say oh yes these are the matters of fact but the context surrounding those matters of fact actually makes a great deal of difference in terms of our overall interpretation of the flow of events in time in other words in our search for multi-causal explanations for things within history and within medicine we need to take a very close eye on sort of the context within which our primary sources are elucidated now within history we think very pointedly about the theoretical commitments of the analyst of those primary sources so in addition to the fact that primary sources may tell different stories depending on where they come from the actual analyst his or herself is part of this process by which we have to parse what context they may be living in and so I put pictures up on the top here we have Carl Marx and Michelle Foucault who are sort of have been touchstones for generations of historians thinking about analyzing primary sources in one way or another and so again to return to this Alan Brandt article the question is who is he writing in reference to or in relation to regarding to Ski and what are kind of the key thematic real issues that he chooses to engage with at his moment of writing and you know as I mentioned before it's this health education and welfare report of 1973 you know which I think is interesting in that in that report Brandt basically identifies this quote which is that the sort of authors of the report argued that sort of the experience of Tiske should not be construed to be a general repudiation of the scientific research with human subjects and so essentially he argued that because of the varying agenda of the health education and welfare department to ensure that sort of scientific research with human subjects could proceed apace they didn't do the diligence in the archives and really ascertain sort of the matters of fact to a satisfactory degree right so that that's at one level and at the other he basically argues that you know sort of circulating at the time was this idea and sort of it still persists is the idea that science is somehow free of values is a truly objective way of knowing the world and Brandt you know I think effectively uses primary sources to demonstrate that in point of fact the physicians who participated in the Tiske experiments were fundamentally immersed within a you know in medicalized racist sort of society and so the idea that they were doing science that was free of values is simply proven to be inaccurate and so you know again I think clinicians do this work all the time I think it's often implicit but they don't necessarily directly engage with some of the issues of positionality of agenda of commitment that I think historians sort of do in an automatic way and for historians this is done sort of automatically because we have a big commitment to understanding kind of historiography now I don't want to scare clinicians it's you know where some words have the potential to turn people off right away but I think if we do sort of a thought exercise together we might capture a little bit sort of what I mean by historiography and broadly it's sort of I think can be interpreted as our way of thinking about sources and the ways in which that can be informed by our environments as the analysts, our context our various agendas, theories commitments etc so you know this is a little bit of a speculative exercise but I think it's it can capture in a practical way what kind of a historiographical engagement might be so all of us I think are familiar with the 1918 pandemic and as perhaps you can appreciate at different periods in time we might have written about the 1918 flu pandemic in different ways so in 1967 for example we might have sort of taken a Marxist or materialist perspective you know which was common within histories at the time which might have meant that we focused on the perspective of workers, of farmers of those considered traditionally sort of proletarians given that in 1967 you know we were in the United States experiencing sort of a war in Vietnam and the pandemic in 1918 was sort of at the tail end of World War One maybe we would have seen echoes of sort of the dislocations caused by war and read them back into the 1918 pandemic in 1987 things obviously were different than they were in 1967 and so maybe historians you know might have looked to the AIDS epidemic as sort of an example to sort of frame their studies of the flu pandemic of 1918 within history it was more common in the 80s to focus on the role of the state per se in structuring our day-to-day realities and so maybe we would focus on the Wilson administration's approach to the flu pandemic in ways that they might not have done in the 60s. Now in 2019 which is should be more familiar to all of us in history it was I think it has been a trend to you know sort of problematize the idea of the state being the real author of sort of day-to-day life and focusing more on kind of the interstices between the state and local actors and how that ultimately gives rise to a form of living right like as I said before big data in 2019 has been more influential in history as a discipline and as you can appreciate in 2019 sort of right before the pandemic happened we tell a different story about the flu pandemic than we would in 2022 after we have just lived through a viral pandemic right. What would in 2022 would we write a history of the 1918 flu pandemic that calls it the Spanish flu I think perhaps not because of what we've observed about sort of the weaponization of sort of anti-Asian bias within our contemporary moment. Would we be so credulous about the role of the state to respond to sort of concerns? Would we be so credulous about sort of a shared public sort of conception of a fight against sort of a major challenge to health of an American society for example? Again I'm not so sure but I hope sort of by this kind of thought experiment you can appreciate the fact that the ways in which we understand history are kind of inextricable from the way that we as analysts live through history and sort of we can't divorce the fact that we are historical beings as we think about people in the past which I think is a lesson that is important for clinicians you know we all have theoretical commitments and the key is identifying what those might be. And so you know to that point I think the last level that I really want to talk about in terms of levels of making meaning is that you know history has the potential to have a practical purpose right? You know history's in a practical sense bring groups together. There's a sociological function to the telling of stories they allow us to articulate shared values, shared experiences and in so doing sort of coalesce a group of people around these kind of mythologizing tales. Now I think historically doctors have been very adept with this you know in an article by Brian and Longa which is on a bibliography they describe this as sort of a nostalgic professionalism that sort of the physicians have often deployed which fosters a sense of belonging solidarity and identity and you know arguably you could say some of the hegeographic histories written in the 19th century which is to say sort of histories that are celebrating the great heroes of the march of medical progress are of this genre if you will. They make meaning in this way which is that look to our great heroes and we can take heart that we're part of a noble profession right? And in that regard sort of the kind of nostalgic professionalist approach to history allows us to you know cultivate useful role models and in so doing we can sort of imagine a sort of virtue ethics developing out of these kind of nostalgic histories. But I think what's really important for clinicians as they move forward is that we pay it very close attention to the mythologies that we craft right? Certainly it's important to you know recognize our shared values as physicians over time and across the place but you know to bring up Baron Lerner's work earlier in this series sometimes our fallen heroes maybe you know should stay fallen and so I think we can be very purposeful about the kind of mythologies we craft because our current moment changes and medicine is a profession changes and we need to be very purposeful about the kind of set of shared values and experiences that we mean to create for our next generations. And I think the other sort of to that end I think sort of and in keeping with the theme of this talk explaining the past in a richer more comprehensive multi-causal way allows us not only to understand our present moment but also allows us to make plans to improve the future and you know I think sort of within social sciences work and among MD PhDs who do social sciences work this has sort of been operationalized as focusing on structural competency as opposed to some you know older paradigm of cultural competency among the training of physicians and really that's about identifying the deep structural causes be they racial, be they economic, be they political, be they social that undergird kind of the healthcare disparities that we unfortunately we experience and that persist and that really do a great deal to sort of damage not only individual doctor-patient relationships but also the aggregate health of sort of our patient body. And so you know I think the goal of doing this kind of practical work which you know Brian Longo may be referred to as activist professionalism is not simply condemning historical actors right like surely you know there have been ethical violations in the past and certainly Alan Brandt identifies the ethical violations that were implicit in the Tuskegee experience right but it's not enough to simply say we condemn that. It's the key critical component of making meaning at this practical level is to explain why and how the Tuskegee experiments could have happened and could have persisted for you know whatever it is 40 years that will really allow us to identify the deeper structures implicit within medicine that we really need to pay a close eye to if we make plans if we are to make plans to improve things for our patients right you know to that end I think history and social sciences generally are useful in cultivating you know what we can think of as both kind of epistemic and clinical humility and so I think it's really useful for clinicians to ask themselves these questions so you know even the most celebrated historical figures had blind spots and committed you know acts that we would deem ethical violations of various sorts so you know I think what's useful about the social sciences is it demands that we as analysts examine our very own blind spots and force us to work to find mechanisms by which we can probe them and interrogate our own sort of blind spots and I think the other sort of benefit of doing social sciences work on a regular basis is the fact that some of the things that we do every single day we don't really pay a great deal of attention to and thinking as a social scientist thinking as you know in terms of structural consistency allows us to put those under the microscope and say perhaps there are things that I do every single day that might actually be contributing to some of these structural inequities and maybe I can change my daily practice so that I may not be let astray as it happened in the historical past right and you know I think there are several you know sort of great examples in recent very recent times of the ways in which history can be really used for good advocacy work to improve medicine I think this series is really a great example of demonstrating and identifying in a rich comprehensive way the various structures within medicine within which medicine has taken form you know it is expanded our understanding of sort of medicalized racism of medicalized misogyny of various inequities on political dimensions on social dimensions and so that kind of work I think really does advance the ball in terms of making medicine a more responsive you know sort of just endeavor a few weeks ago at Johns Hopkins they had this symposium in the history of medicine specifically focusing on closing this open wound and you can see their design there a really reckoning with the role that academic medicine has played not only actively sort of supporting scientific racism by its sort of scientific pretensions right but also by participating in processes of racial inequity and racial violence right and really doing structural violence and so you know putting a name to that and allowing for speakers to speak very openly about the participation of medicine in some of these sort of structurally violent projects of colonialism slavery etc again is a great way of doing historical work as advocacy and finally you know this is an article that was in JAMA several years ago really sort of addressed the rest of the AMA seeking to redress some of the racial injustices of its own sort of organizational past asked a group of scholars and physicians Matthew Winnie it was one of them to explore the role played by the AMA in essentially creating a segregated racialized medicine in the United States at the end you know from the 19th century into the 20th century and so all of these I think are great examples of what clinicians and historians can do sort of in lockstep to create a better structure for all of us to practice and a better more just structure for our patients to receive care in and you know certainly it's useful for already MDs to think about structural issues but I think you know perhaps more pointedly and more effectively we can think about what we can do for medical students to really become immersed and make a habit of thinking about things in structural manners right in a structural manner so you know within the medical education literature in recent times there's been this focus on physician burnout and to some degree we can sort of understand burnout as a syndrome if you will caused by kind of the moral distress and alienation caused by navigating kind of dehumanizing structural inequities inherent in modern medicine whether they be sort of the issues of having to deal with insurance companies or sort of the dehumanization of certain sorts of people that sometimes just happens in an implicit way in medicine structures that can certainly burn physicians out and within the medical education literature they basically argued that cultivating empathy sort of in quotes because it's not always clear exactly how we might do that or what it might mean but it's viewed that empathy is a primary prevention for the at-risk namely medical trainees and medical practitioners and so the question for all of us is well how we teach empathy and you know again let's look to history you know we know sort of the father of social medicine in the mid-19th century argued that well medicine is a social science and politics is nothing other than medicine at a larger scale and so I think you know perhaps what empathy might mean in an operational way in medical education is really focusing on the social sciences you know working to provide students with all of the intellectual tools certainly a rigorous training in the hard sciences but also sort of the important humanistic and social scientific tools that might allow them to better understand their patients and themselves as kind of richly contextual social beings as opposed to these kind of dehumanized operators in a structurally unequal system and then the question becomes well how do we teach that and you know I think unfortunately in recent years what has happened is we've kind of made recourse to all of those things that we think are important in the basic sciences right sort of reductionism, standardization centralization recourse to sort of multiple choice tests to an evidence-based curriculum and sort of a commitment to a scientific tidiness of the social sciences and you know I think you know using this Albert Einstein quote is maybe sort of illustrative of how I think about that which is that everything that can be counted doesn't necessarily count and that everything that counts can't necessarily be counted and so you know arguably there is it's sort of maybe the wrong tool for a job to assess the impact that certain sort of humanistic and social scientific interventions in medical school curricula might contribute to the benefit from an educational perspective of medical students you know I think Jeremy sorry Jeremy Green and David Jones both MD-PhD historians had an article on academic medicine in 2017 and obviously what Dr. Schwartz referred to as the white paper that Jones and Green and Jackie Duffin and John Harley alluded to is essentially this idea that you know it seems that the medical humanities are held maybe to a different standard, a different editor-in-chief standard to prove their ultimate benefit to medical students than anatomy has been you know Jones and Green basically argued that a lot of institutions you know within the last 10 years they just sort of dropped their anatomy curricula without sort of an evidence base showing that it was kosher for them to do that similar thing with adding genetics to curricula and you know essentially they argue that well you know maybe that says something about sort of our underlying biases about the appropriateness of including social sciences including history within our curricula and so instead maybe we can think in a different way about sort of the importance of history in the training of medical students by instead of you know searching for a scientific tidiness with which we can sort of describe the human experience and identify big social structures that cause inequities maybe we need to sort of dig deep into what is maybe in a pejorative way called to as human messiness but you know what historians live with every day which is an embrace of multi-causality, a diversity of sources of method of theory an appreciation of change over time a spirit of kind of self exploration and a commitment to sort of a rigorous subjectivity and sort of a habit of holding deeply held ideas up to close scrutiny both by oneself and by one's peers you know and I think if we're able to do that we will be sort of we can take shelter against some of the real challenges caused by living in a inherently turbulent challenging sometimes structurally violent world and particularly a challenging turbulent ever changing profession of medicine so just to return to Margaret Humphrey's piece that was in Cleo and the Clinic you know she basically argues that as an MD-PhD historian herself living through sort of residency during the height of the AIDS epidemic she had to sort of take heart that history would allow her to understand sort of the wild sort of changes around her and you can see at the bottom of this quote here you know her historical training allowed her to understand sort of what she was living through from the perspective of memory right understanding the history of medicine but also allowing her to understand the structures that would best permit her to evolve to be a better practitioner for her patient so again to return to this concept that I started with about sort of doctors frequently griping about patients as being historians you know I think it's useful to say that good historians make good patients but they really do make even better doctors and so I thank you for your attention and I really want to turn things back over to Dr. Schwartz my great friend and mentor so thank you okay friends we're in the home stretch we're just going to do one other quick thing that was terrific Steve so I just want to our um I just wanted to have our email addresses for anybody who is interested in continuing this conversation but what I wanted to do is also use this few minutes to thank people first I want to thank Mark Siegler who allowed me to kind of co-op this lecture series and kind of gave me carte blanche you can tell that I um picked like a group of colleagues friends and people I knew would be just terrific and very engaging for this group the other thing is Mark's got an incredibly talented staff starting with Elena Stankaitis Ronina Dine Kimberly Connor and Glynis Harris and the difference between having a lecture series that's good and a lecture series that's terrific is really a function of the attention to details and um Elena you can do anything you are um incredible I want to thank Steve who obviously you can see why he's my colleague in kindred spirit and he has tremendous potential that we're all going to support and then I want to thank the speaker the speakers including um all 28 speakers who gave talks and especially to Laney Ross and Sydney Halpern who pinched it at the last minute when we needed substitutions and did a superb job I want to thank Deb Warner for her contributions from the library and being in the chat and always referencing the U of C resources I also want to thank the community especially the McLean Ethics series Bucksbaum the university community and our friends from the American Association for the History of Medicine and just our many friends in kindred spirits worldwide Juliana Khalil was the intern who did marketing and but before we leave and before we start the question and answer period I want to just highlight one last thing about an upcoming exhibit that was put together by Brian Callender and Steve's going to talk about that and then we'll open it up for questions great so you know I talked a little bit about kind of the ways in which that kind of academic work and clinical work can be you know real allies in terms of advocacy work and I think you know Dr. Callender is exhibit here at the reg which is running now through 515 called reframing graphic medicine is a great example of that and I was very sort of very happy to be able to help him with it and you know I think really the exhibit focusing specifically on this question of history from below right challenging the traditional sources that we have used to understand some kind of the growth of medicine as a profession I think really allows us to see the ways in which again sort of these different structures have led to patient experiences that you know maybe doctors are not very familiar with so you know across comics, across zines, across graphic novels we are allowed insight into sort of patient experiences and dimensions of you know reproductive health mental health, infectious diseases, you know sort of issues of gender and sexuality in ways that I think just can't fully be captured by sort of a cold objective austere clinical report that many of us you know within history used to support our histories but also that many clinicians sort of understand our patients by means of so highly recommend a look and hopefully we'll have an opportunity all of us to get together there and chat and celebrate Dr. Callender's accomplishment with this great exhibit at the regs so with that I think we're ready to open up for questions yeah okay you guys you should take a look at the chat that's great so let's see what we got here there's actually a lot of really great references Debronette said Debronette said she was on call at the hospital when they did that CT at the mummy AJ you want to take over and should we stop the share yeah we can do that right yeah sure thanks yeah this is an excellent excellent talk as I always think I'm a philosopher not a physician or a historian and I have a couple of you know I'm not sure how to I'm always sort of puzzled by the sort of the philosophy of history in the following sort of sense that I mean on the one hand we think that you know part of the importance of history is getting us to you know we want to know sort of what happened we want to get to it is important to distinguish the facts of what actually occurred from misinformation from alternate histories that didn't actually occur and so that's effectively sort of like a realist picture of what history is supposed to do and you know in the sense of a model like that's what science is supposed to do it's supposed to get us to like we'll describe you know reality in itself on the other hand you know part of what's sort of interesting about you know history of science history of medicine is you know this sort of you know everyone has thought up to this point that we've gotten sort of that we're getting oh this is what this is what really happened this is what this is what's really going on in this in this patient and yet time and time again we have this sort of like we sort of show it's been you know it's been sort of demonstrate those sort of those claims have been sort of have been shown to be sort of inadequate maybe wrong handed maybe even pernicious and various and I think in the case of history that's really sort of interesting I loved your presentation of the 1918 pandemic where you know there's different sort of different sort of processes that we can take to this event based on you know our own current situation and I think you might but you might be you might be sort of inclined to think well you know okay there's the Marxist way of understanding this there's the you know there's a sort of more status approach there's sort of anti-status approach you might think who's you know who's what is the sort of right approach my understanding of like a lot of it's kind of like in a sense of kind of a like an ill-formed question because we don't have that sort of like view from nowhere but that sort of just leaves us in this you know this kind of like histories is kind of like Rashomon effect where and so I I'm curious if you have some thoughts on like how I mean obviously the humility aspect of this is going to play a big role here but I'm curious if you have any sort of thoughts on that sort of this sort of really troublesome issue at least troublesome for me okay yeah no I'm happy to talk about that and you know I don't want to get too deep into sort of hard philosophy of history stuff but you know I think it is I think you bring up a great point that's been sort of an epistemic anxiety within history you know really for a lot of the 20th century you know a lot of the work of kind of logical positivists logical empiricists in the mid 20th century you know which was this group of philosophers aiming to create sort of a philosophy of science that generated true knowledge based on laws of logic sort of it's a you know in some respects a kind of utopian project but in any event you know the idea was well what we should do with the social sciences is reform them in such a way such that the such that sort of historical knowledge is able to have as stable kind of ground as what we perceive the natural sciences to be and that means that historians need to start adopting sort of the principle of using natural laws that can explain human human behavior and causality and as perhaps you can appreciate historians were rather allergic to that idea Bob Richards who gave a talk earlier this quarter or I think it was winter maybe you know has a great sort of riposte to Carl Hempel's talk on sort of this what's called the kind of non-logical or scientific based history which is essentially the idea that well in point of fact you know even by the natural law approach and he uses this interesting example of a car radiator that cracks in the middle of the night in a Chicago winter and basically the sort of scientific historian would say oh well simply because the water froze at 32 degrees meant that the radiator cracked right and we can appreciate that that is an explanation but it might not be an adequate explanation when we learned that you know the guy wanted his son that night and put a so the son acting out put a cherry bomb in his radiator and blew up the radiator right and so you know by that logic essentially we're missing something by only making recourse to natural laws and instead what we need to do is sort of issue that and say let's really embrace narrativity as a fundamental way of making knowledge and so you know I think as you pointed out there are some tensions that are still sort of potentially exploitable by those who are eager to kind of critique inherent subjectivity in the history but I think day to day practice most of the time historians are somewhat pragmatic about this idea that like yeah there's kind of a there's something that really happened but sort of it's sort of like you know the anecdote of three people blindfolded people touching an elephant that sort of there is some underlying phenomenon and you know even though one person is touching the tusk one person is touching the skin and one person is touching the tail and are all sort of describing different facets of that underlying reality that you know different perspectives sort of have different meanings and so maybe I don't want to again talk too much about philosophy but maybe that's my kind of back of the envelope way of thinking about it I hope that was kind of helpful Anybody else interested in either making a comment or adding to the mix? Dr. Heckmacht you want to say something? Unmute yourself there you go I have an observation that I wonder if you agree with it the digital technology has improved a great deal diagnosis but you referred earlier that history taking and examination duration has diminished and it seems to me that taking history of the patient is not only clarifying some of the hidden part of the patient's illness but it develops doctor-patient relationship in a hidden way while you are talking to the patient take the history your children have you been in the past what is your history all these things develop amicable relation with the patient so not infrequently in surgery a patient comes with an MRI scan so it maybe shows a brain tumor and the patient come and say you know you have a brain tumor how come you come for additional consultation he said well the doctor look at my MRI and he just wanted to schedule me and I really didn't know the doctor and so because patient comes for consultation because they really don't want to have an operation and all of a sudden somebody say you need an operation without developing or another patient comes say you know you had this back pain and you look like you need an operation what made you not have it he said this doctor even touched my back now touching the back may not really make the diagnosis but develop that relationship down to a relationship that is needed I couldn't agree more and I think that somewhere down the road I hope we live to the point that we can see it is the fact that the doctor patient the doctor nurse relationship is really sacrosanct to trust and really effective health care and I think it is the critique people have of modern medicine you know outcomes may be objectively good, better and different but the patient's experience has been problematic and just like you see these images since we have had the electronic medical record of you know children have drawn like the doctor patient experience and they have a picture of a doctor sitting by a computer typing to the patient it is I think you know if anything history teaches us that things change and it is my great hope that over time we are going to slow down this assembly line view of medicine because it doesn't serve doctors it doesn't serve patients and I think at the end of the day it is more expensive because we go too fast we make mistakes and we don't do exactly what you have like a perfect example doctor Hecmod is you know years ago somebody had a surgery by a doctor and they would go you know they would go see that doctor afterwards in our hyper efficient you know organization you know that doctor may come in while they are getting pre-opped they are followed by an APN resident or something like that and it really dissolves the trust and the health care team if they are not even portrayed as a inner unit you know it is like a rotating circus like who are you and what are you doing here and you are supposed to help me and how do I know that you are not the cleaning lady versus you know the advanced practice nurse so I think that my hope is over time that that becomes one of the things that we can observe change and we have experienced it as Steve would say on a very human and interpersonal level both on both patients and as care providers thank you anyway so listen but thank you everybody for participating in this anybody who is interested I am just going to make a blatant shout out if anybody is really interested the American association for the history of medicine has all kinds of wonderful resources and terrific scholars and my hope is that we continue to incorporate history into medical education on every level doctors, nurses patients the whole health care team including all of our colleagues from occupational therapists physical therapists boy we have never been more of a team than before and I think that there is a role for us both interprofessional learning and just in terms of human contact and creating a palpable sense of community because if anything that the good part of COVID is that we felt like we were part of something bigger and when we've shown up in the best way you know it's been nice for people to go beyond themselves and help when they're needed so what I'm going to do is let everybody take a little deep breath I'm going to meet with the ethics fellow later I want to thank Steve I want to thank everybody for coming and thanks to the McLean center for allowing us to have a year which I thought was terrific and thanks everybody both the community and the speakers and we'll see you down next in a half hour to those and if not later on we've got all the resources that people want so thanks hold on just for one second first of all I want to congratulate you and Steven about your talk today but also congratulate you for the extraordinary program that you organized for the year I mean this series of 28 lectures many of them drawn from the American Association of the History of Medicine from your friends and colleagues I think this year's seminars with clinicians historians and other scholars who are simply incredible and outstanding