CONTENTS Choose All that Apply pg 4
To Do No Harm pg 2
Saltman Quarterly
The Tipping Point pg 6
Volume 15 | Winter 2021
K C A BL S T S I T N E I SC
t, s a p g n i t a celebr ure t u f d n a t presen
c
igal
talie Madr
tion by Na over illustra
written by Daniel John
illustrated by Sara Kian
I
TO DO NO HARM
n a room lined with shelves upon shelves of medical textbooks and anatomy models, I sat across from Dr. Tyrone Hardy. Doctors aspire to work the frontiers of their fields; Dr. Hardy is a peak example with 50 years of physicianship and as one of the first African American surgeons specialized in stereotactic neurosurgery. Medical students commit to such a path upon taking the Hippocratic Oath, committing to “do no harm” to patients, prevent illness whenever possible, and treat patients as humans rather than infectious beings. However, if one were to follow the trajectory of Black individuals’ health care through the history of the United States, the opposite becomes apparent; medicine has often involved taking rather than giving. Many of the treatments we have today are a result of unethical experimentation on populations that were never compensated for their contributions. Unraveling and exposing this reality is important to understanding the foundations of Western medicine. Despite the barriers posed by racist institutions and the doctors that reinforced them, African Americans have time and again contributed to the advancement of medicine for all. An understanding of contemporary medical practice would be remiss without considering its convoluted origins.
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Dr. Saiba Varma is a professor of Anthropology at UC San Diego. Varma teaches courses on global health, inequality, and medical and psychological anthropology. She asserts, “We have to think about the ways in which public health as a discipline emerged as a part of the project of colonialism; it was designed to control Black and Brown bodies and produce maximum labor out of these bodies.” Colonial medicine was in-
formed by prejudiced beliefs rather than science. White doctors adjusted medical infrastructure according to their belief in their own superiority; they created separate hospitals and medical school curriculums, and their research studies treated Black bodies as fundamentally different from white bodies. According to the Washington Post, white slave-owning doctors put forth claims, for example that Black men had smaller brains and thinner blood vessels, despite a complete lack of evidence for their assertions. Specialized physicians relied on entirely different medical literature while treating Black slaves. Medical knowledge was generally inaccessible to the public, lending little means for accountability and allowing medicine to remain a tool for a small group of elites to justify racist beliefs. With tensions over slavery flaring up across the United States in the 1800s, African American leaders concentrated their efforts to challenge racial norms. They recognized that racism would also have to be challenged on the scientific front to dispel notions of biological or intellectual inferiority. In 1837, Dr. James McCune Smith became the first African American to graduate with a medical degree. He had been rejected from med-
ical schools in the United States, but he was welcomed by abolitionists at Scotland’s University of Glasgow. In a field that as a whole underestimated Black intelligence, Smith proved an undeniable contradiction. Despite the hatred and violence he faced, Smith opened a pharmacy—the first to be both African American-owned and operated. He believed in the importance of a robust education system within the African American community, which he argued was the only way the abolitionist movement could create a strong empirical foundation from which African Americans could dismantle racist hierarchies. Smith became a beacon of hope and a model for Black academics; he opened the door for Dr. Daniel Hale Williams’s pioneering work in surgery. Hospitals were still entirely segregated, but Williams used this as an opportunity. He believed that the only way to improve Black access to health care was to build a medical infrastructure from within, saying, “A people who don’t make provision for their own sick and suffering are not worthy of civilization.” With this goal in mind, Williams opened Provident Hospital—the first Black-owned hospital in the country— where he trained Black interns and nurses. Williams was also a crucial innovator in the operating room. With no invasive cardiac treatment available, the heart was considered untouchable for practicing doctors in the 1800s. This changed in the summer of 1893, when a man named James Cornish was rushed into Provident Hospital with a knife wound. After Williams repaired damage to the left mammary artery, he saw a small but fatal cut in the pericardium, the membrane enclosing the heart. In that moment, Williams sutured the tear while coordinating his movements with the rhythm of Cornish’s heart, jumpstarting the field of cardiovascular medicine. After 51 days of recovery, Cornish was successfully discharged with no complications. Williams thus performed
the very first open-heart surgery and demystified the taboo surrounding the heart. Even with these stories emerging into the limelight, recognition for African Americans’ contribution to medicine is lacking. As Varma says, “We are still a long way aways from medicine taking accountability for its role in producing racial harm. Medicine still sees itself as neutral.” Within medical school curriculum, inclusive material needs to be taught that celebrates African American innovators. In fields where
Unraveling and exposing this reality is important to understanding the foundations of Western medicine. Despite the barriers posed by racist institutions and the doctors that reinforced them, African Americans have time and again contributed to the advancement of medicine for all. race is a key aspect of treatment, the curriculum must be adapted to effectively train physicians in these nuances. For example, dermatology textbooks need pictures of medical conditions on all skin colors, as the same skin ailments often present differently depending on skin type and color. Even after medical training, Black doctors face selective pressures outside the hospital. In my interview with Dr. Tyrone Hardy, he explained that one of the biggest challenges he and other Black doctors
Editors-in-Chief: Salma Sheriff, Andra Thomas Editor-at-Large: Arya Natarajan Head Production Editor: Julia Cheng UTS Production Editor: Nicole Adamson Production Team: Ashley Chu, Tania Gallardo, Zarina Gallardo, Amber Hauw Media Director: Sanjana Sharma
faced was gaining approval and coverage from health insurance companies, despite having evidence of comparable or superior quality of treatment. A vital part of Hardy’s story is the heroes around him that inspired him to challenge the social norms of what a doctor should be. At Howard Medical School in Washington DC, Hardy was able to study under Dr. Latunde Odeku, the first African American trained neurosurgeon, and Dr. LeSalle Leffall, the first Black president of both the American Cancer Society and the American College of Surgeons. In his experience, “there are always things holding back African Americans, but people like Dr. Daniel Hale Williams who broke the color barrier inspired me and other doctors to do the same.” Hardy also helps patients break their own barriers—between their volition and the neurons that should fire in response. At the age of 60, my grandfather’s Parkinson’s had taken away many important aspects of his life, especially his independence in movement and talking. A few years into his diagnosis, he was able to take advantage of a deep brain stimulation, a new technology that gave him new bouts of energy and the opportunity to interact with me again in a way that wasn’t imaginable before. This would be impossible without the software Hardy invented, which regulates the function in my grandfather’s deep brain stimulation probes to alleviate the symptoms of his late-stage Parkinson’s. Not all heroes wear capes. Mine was wearing a suit and tie as he sat across the table, explaining how he designed the technology responsible for giving me and my grandfather time we didn’t expect to have. Sometimes, they wear scrubs and have to overcome unfair challenges solely due to others’ perceptions of the color of their skin. With every Black doctor throughout the past hundreds of years, from Dr. Smith to Dr. Williams to Dr. Hardy, we get another step closer to healthcare that is genuinely equitable and medicine that truly does no harm.
Research Editors: Noorhan Amani, Nikhil Jampana Online Editor: Anjali Iyangar SQ Features Editor: Ingrid Heumann UTS Features Editor: Shreya Shriram Staff Writers: Daniel John, Lina Lew, Neha Sahota
Head Illustrator: Sara Kian Staff Illustrators: Shae Galli, Natalie Madrigal, Diana Presas Head Tech Editor: Juliana Fox Tech Editors: Anushka Bajaj, Max Gruber, Kaz Nuckowski, Ishrak Ramzan, Megha Srivatsa, Smriti Variyar
Vol. 15 | Winter 2021 | 3
illustrated by Shae Galli
written by Lina Lew
Choose All that Apply: American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White
F
rom standardized tests to job applications to doctor’s appointments, we’re confronted with this seemingly straightforward question over and over again, to the point where identifying one’s race seems like second nature. The persistent use of race as a distinctive category—along the same lines as gender and age—has naturally shaped the way we evaluate the world and the people in it. Race as a form of categorization has even gained substantial footing in the medical field, as physicians often turn to race as a biological indicator of an individual’s health. However, taking a closer look at the origins, applications, and implications of race reveal that the boundaries between races might not be as clear as they appear to be. In fact, they might not exist at all. At least, not biologically.
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The concept of race that we understand today can be traced back to the 17th century Scientific Revolution and European colonialism, during which the concept of race rose in prominence as a method of scientific categorization. For the first time, European scientists were confronted with human beings from “newly discovered” continents who looked different from the standard “blonde hair and blue eyes” phenotype with which they were accustomed. Scientists resorted to taxonomy as a scientific method of observing, naming, and ordering the new human phenotypes they were discovering. Carl Linnaeus, a renowned 18th century Swedish scientist revered as the “father of taxonomy,” described four varieties of humans in his findings published in Systema Naturae: H. sapiens europaeus, H. sapiens americanus, H. sapiens asiaticus, and H. sapiens afer. However, these scientific findings were far from objective. Linnaeus described H. sapiens europaeus as “vigorous, muscular. Flowing blond hair. Blue eyes. Very smart, inventive. Ruled by law.” On the other hand, H. sapiens afer was described as “sluggish. Lazy. black kinky hair, flat nose, thick lips. Craft, slow, careless. Ruled by caprice.” Linnaeus’s major influence on taxonomy and classification introduced subjectivity to an objective science, as his publications served as a catalyst to use categorization as a means to justify underlying prejudiced beliefs. The striking misconception about the biological basis of race, however, has been proven untrue through modern genetic science. After years of sequencing every gene in the human body, the Human Genome Project (HGP) concluded that humans are 99.9% alike and race indeed did not have any basis in science. The HGP showed that the human genome could not be distinguished between Hispanic, Asian, Caucasian, and African American participants—meaning, there is only one human race. Other bodies of research have found that genetic variability within a certain racial group accounted for 95% of all variation, while genetic variability between racial groups only accounted for about 5%. In other words, there were far more genetic differences among members of the same race than there were between members of different races. So the race that we talk about—and the racial differences that we
see today in almost every realm of society— doesn’t come from our genetic biology. It makes sense then, that although race is used in 80% of health-related biomedical science publications, race is never explicitly defined in these studies. Oftentimes, scientists rely on unverified self-reports to inform their racial classifications. The inclusion and pervasiveness of race in modern medicine also leads to the prospect of pharmacogenetics, or the study of how individuals personally respond to medication based upon their genetic makeup. Current pharmacogenetics focuses on the wide and unique individual variation in the effect of drugs, hoping to shift away from
To support the existence of biological races also implicitly affirms the belief that there is an inherent difference between races, a slippery slope that can directly translate into justifying superiority, inferiority, and the racist social systems currently in place. a “one size fits all” approach. However, the obstacle remains; the relationship between common illnesses like cancer, heart disease, and diabetes and specific genetic drug targets remains murky. In fact, these common diseases are linked to several genetic variants that either cannot be detected through genome-wide association studies or have unclear mechanisms of interaction with other genes. Ultimately, understanding the genetic cause of disease does not necessarily illuminate any insight on the role that these genetic variants play in disease risk and treatment. Mutational differences that are known to further the pathogenicity of diseases play a common role in all races. However, despite the lack of relational genetic data, pharmacogenetics continues to use race as a standing proxy for the eventual use of individual genetic difference in
tailored treatment and personalized medicine. Until pharmacogenetics can accurately explain and utilize individuals’ unique genomic data to prescribe treatment, scientists continue to pursue racial genetic differences. Yet, the conclusive jump from racial differences to an individual’s response to disease can only go so far; allelic frequency of a disease may provide a rough estimation of likelihood, but this likelihood diminishes when applied to individuals. From its clear historical roots in upholding structural inequalities, race is most accurately portrayed as a politically created system. However, race has also become a system that is unavoidable and integral to our nature of evaluating and categorizing, impacting our own interactions and perceptions of the world. Today, racial stereotypes are dangerously used as a way to justify biased conclusions at the individual level, resulting in health disparities and discriminatory treatments against racial minorities. Medicine itself is just one of many ways that biological race manifests itself in unjust ways. Other displays of racial biology, however, are no different in their systematic approach to disenfranchising the Black population. Moving forward can be a different story altogether. Though scientists throughout history have painted biology and race in black and white colors—objective, straightforward, non-negotiable—our biology is anything but. As biology continues to evolve into the far-reaching and omnipresent part of our human nature and embeds itself into societal implications, our social definition and understanding of biology must continue to adapt as well. Shifting our focus away from the biological roots of race to the social roots can help shape our understanding of how our social system creates the disparities we see in our health demographics. Although race is not biology, race becomes biology through the embodiment of our social world. Perhaps renewed attention on the cultural construct of race is exactly what we need to dismantle the biological roots of medical racism that have persisted for far too long. Read the entire article on: sqonline.ucsd.edu Vol. 15 | Winter 2021 | 5
SQ INSIDER
THE TIPPING POINT: why saving the planet means saving each other first
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icture this: the year is 2049. Humanity is struggling to survive. In India, constant flooding has eradicated the economy, and farmers are frequently unable to produce a reliable crop yield. In Guatemala, higher temperatures have resulted in a rapid spread of contamination and pathogens. In the United States, unpredictable weather patterns have decimated already poor infrastructure, destabilizing living conditions for millions of people. While this situation may sound dystopian, much of it resembles an unfortunate reality reflected in the world today. The Indian government has clashed with farmers over laws that ignore recently fickle weather crises and favor cheap, high-yield crop strains that impoverish soil health. Latin America is experiencing heightened transmission of temperature-influenced diseases like dengue. And the power outage and water shortage in Texas this past February has exposed how vulnerable our facilities are to new weather patterns. Not only are all of these issues rooted in climate change, their repercussions disproportionately burden individuals who most lack the resources to protect themselves. The critical cultural context that underlies the impacts of climate change can often go ignored, posing challenges to the pursuit of environmental protection for all. The lack of diversity in academia hinders our exposure to the important perspectives we need to understand these issues that exist at every local and global level. I had the opportunity to interview Bashir Ali, a PhD student at the Eliason lab in UC Santa Barbara. Ali studies integrative physiology, a field that concentrates on the structure and function of biological systems at different
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written by Neha Sahota illustrated by Diana Presas levels of organization. Ali’s work centers around how changes in climate and environment can affect the physiology of marine organisms. Ali didn’t always know that he wanted to pursue research—Ali entered college on a road he thought was headed towards medical school. His time in a non-medical lab proved to be an eye-opening experience that propelled him towards pursuing research instead. He joined the Doris Duke Conservation Scholars Program and was exposed to conservation studies at a level he had never seen before. In fact, he credits this program as a major driving force be-
The critical cultural context that underlies the impacts of climate change can often go ignored, posing challenges to the pursuit of environmental protection for all. hind his decision to pursue a PhD. This highlights the value of scholarship programs that directly exposes students to new career paths. After all, many students enter college with no real experience or understanding of the career paths open to them yet are expected to commit to a field of interest. This issue is exacerbated for students of color and first-generation college students, who may start out with a more limited view of the options they have. These
programs can help diversify academia and science by supporting students like Ali. Ali’s journey into science wasn’t linear, and his formative life experiences and the challenges he faced motivated him to persevere. As an immigrant from Somalia, Ali moved from continent to continent. This experience “put things into perspective” and built him to be patient and resilient, traits he finds immensely helpful while navigating the obstacles novel research presents. It also helped him through undergrad; Ali says, “I did poorly in chemistry in undergrad, and a lot of the work I do right now is all biochemistry, so don’t ever get scared by bad grades or not doing as well as you thought. You could end up doing your PhD in that same topic.” Ali was challenged by a rough transition into college academics, but after coming out on the other side, he has realized that it is all about “learning the system.” His most valuable advice for first generation students is that “if you are struggling with something, don’t tell yourself you aren’t capable. You are totally capable of learning it.” He emphasizes the value of students reaching out for help figuring out how to learn: “school is more learning how to learn than how smart or good you are.” He points out that even the smartest person in the room will fail if they don’t know how to prepare or what to expect. We can extrapolate this to a large-scope issues as well; how about climate change research? Even the most widely-published scientists would be unable to propose effective solutions if they don’t accommodate for the human environment. Context always matters. Ali describes his field of integrative physiology as a “reverse engineering” of sorts. Just as structural engineers may construct solutions based on their environment, Ali emphasizes that we can deconstruct the
biological relationships in our surroundings to better adapt to the challenges we face. Each of the levels of order in an organism, from molecular to visceral, have their unique responses to a stressor which are integrated to produce an organism-level response. How does increased temperature affect the enzymes within a seahorse’s kidney cells? How is this relate to the overall response of the seahorse kidney? By exam-
ining these relationships, scientists like Ali can elucidate, and someday predict, how climate change stressors impact organisms. When it comes to humans, Ali understands that the devastation of climate change “will have more impact on underrepresented groups of people...people who most don’t think about.” Ali points out how the lack of diversity among climate science researchers has resulted in conservation ef-
forts that, while well-intentioned, are limited in cultural perspective and end up fruitless. Cultures around the world have their own views on the role of nature: some cultures revere nature’s complexity and beauty, others see fear its raw power, and still others see it as a force to be subjugated. These perspectives count; as Ali states, “Biodiversity without human diversity is a complete contradiction”. If a conservationist tries to work with native land without first understanding its inhabitants, their culture, and what they know about the land, they are not pursuing conservation. Ali remarks, “When you think about the environment, most people tend to think about forests or isolated areas without humans—but that’s not true. There are humans that inhabit those environments, and you have to conserve everything, including human culture.” Ali points to the ongoing Flint Water Crisis as an infamous example of the consequences of our disregard for human life and sustainability in favor of cheap and ineffective “quick fixes.” According to the Washington Post, between 6,000 to 12,000 Flint children were exposed to lead-contaminated water, which means this disaster will continue to irreversibly damage public health for decades onward. Reflecting on how these severe outcomes were completely preventable, Ali explains that, “For underrepresented students who are coming into science, this is just as important as becoming a doctor. When you think about being a doctor, you think about saving lives ... climate research is the same thing. 50 years from now, we’re going to be facing a lot of problems, and we are going to have to step up and do the work. We have to figure out a way to help ourselves and be part of the solution.” We need to start now. The patient is our planet. By implementing infrastructure to support diversity in higher education and bring perimeter populations to the center of conversations, we can plant seeds to ensure the future health of all lands and communities.
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