2013 Spring Seminars

Seminar #1: The Undead: Bodies in Between

Faculty: Barry F. Saunders, MD, PhD

Associate Professor of Social Medicine

Adjunct Professor: Religious Studies & Anthropology & Communication Studies.

Time: Tuesdays 1:00-2:50 (SPRING)

Seminar Description:

The living dead: animated corpses, zombies, vampires… prematurely-buried, soon-to-be-resurrected. Not just ghosts: these amortal beings are more… fleshed-out. They are creatures of myth and fantasy. But liminal bodies like these also emerge within the beneficent, evidence-based practices of contemporary medicine. Brain-dead, comatose, anesthetized, resuscitated, cryogenically-preserved, prosthetically restored…

In this course we will reflect on medicalized bodies that seem both living and dead. We will consider some of the mythic, literary, and filmic forms of embodiment that they may resemble. This enterprise will be anthropological, historical, and philosophical. The course will be fun, but also, in places, disturbing. And it will be theoretically-demanding. It will challenge some fundamental assumptions about bodily norms, about definitions of death and life, and about work in settings that have an instrumental relation to modes of dying. Class sessions will address many of the problematic bodies mentioned above—as well as bodies of starved inmates of concentration camps, and the infra-human plasms of tissue culture labs and bioart installations. The course will also consider whether and how there is place for horror in regard to the more abject bodies that medicine produces.

Weekly readings will be about 25-30 pages—some of it difficult, and a lot of it in non-medical registers. A few sessions will also involve viewing of a film or film segment—which may entail additional time commitment. In the last three sessions, all students will make brief presentations of independent research. Writing assignments will include one short (3 page) paper responding to reading from the first half of the course, and a longer (8-10 page) research paper, developed in consultation with the instructor, on some bodily form or technical practice that relates to “living death.”

Seminar #2: Bioethics Methods, Concepts, and Cases

Faculty: Rebecca Walker, PhD

Associate Professor of Social Medicine

Adjunct Associate Professor of Philosophy

Time: 1:00-2:50 (SPRING)

Seminar Description:

“…a ‘Method of Ethics’ is explained to mean any rational procedure by which we determine what individual human beings ‘ought’- or what is ‘right’ for them- to do, or to seek to realise by voluntary action…”

Henry Sidgwick, The Methods of Ethics, Fifth Edition (London and New York: MacMillan and Co., 1983 [original 1893], p. 1)

This is a course on bioethics methods and concepts that engages with both clinical and research ethical issues and cases as well as broader bioethical topics. While science methods will be familiar to all medical students, the idea that there are methods of ethics may be new. Bioethics methods offer ways to frame and approach, and sometimes answer, difficult practical moral questions. Examples of bioethics methods include: a principles based approach (respect for autonomy, beneficence, non-malfeasance, justice), case-based (or casuistical) approaches, feminist, narrative, and applied moral theory (such as virtue ethical, utilitarian and deontological) approaches. Other general methods of ethics include philosophical argument and analysis. This course will introduce these different methods in a practical context of considering significant research, clinical and other bioethical questions such as: What do we owe non-human animals that are subjects of biomedical research? What does it mean to be “vulnerable” in the context of biomedical research? Who should decide about continuation of marginally beneficial life sustaining treatment when a patient cannot? How should health care providers address issues of “conscience” in the care of patients? How should we allocate scarce medical resources in a public health crisis? While the topics and questions for this course are wide ranging in scope, the unifying theme of methods for addressing these practical moral problems weaves a thread through these topics and offers a set of tools and perspectives useful regardless of the particular issue under consideration.

Readings for this course will be a mix of philosophical and bioethical articles. Other materials may include some regulations, government commission or interest group reports, articles reporting on the results of specific scientific studies, and some news media articles. Students should be prepared to focus closely on the theoretical and conceptual ethical issues in research, clinical, and broader bioethics and to read texts closely. Wider social, legal, historical, and political questions are salient and important to bring to the discussion, but will be a secondary focus.

Through this course students will gain:

  1. A working understanding of core bioethics methods such as the four principles approach, casuistry, feminist, and normative moral theory applications. Included in this understanding will be appreciation for the strengths, weaknesses, similarities and differences between these perspectives.
  2. An appreciation for the underlying ethical concepts and problems that are shared across many different research and clinical endeavors and practices such as the notion of moral status and issues of vulnerability.
  3. Argument building skills in addressing specific practical moral problems in bioethics and analytic capacity in approaching bioethics texts.

Seminar Requirements:

  1. It is a background assumption that course participants will attend every seminar session fully prepared for active participation in each session.
  2. Formal requirements include class presentations, reading responses, and one longer or two shorter papers.

 

Seminar #3: The Ethics and Politics of Clinical Research

Faculty: Gail Henderson, PhD

Professor, Department of Social Medicine

Director, UNC Center for Genomics and Society

Time: 1:00-2:50 (SPRING)

Seminar Description:

“Clinical and Translational Science”—from bench to bedside to community—has  become the mantra of progress in biomedicine and a cornerstone of contemporary medical research. It is fueled by a convergence of advances in bioinformatics, genome research, and an NIH “roadmap” that promotes interdisciplinary, team science. This seminar will address how these forces are affecting the clinical research enterprise, and the ethical and political conflicts and tensions inherent in this transformation.

We begin with the rise of “biobanks” and controversies surrounding research with human specimens, and follow the translational pathway through early phase clinical trials to large scale projects barely imagined a decade ago.  We consider the role of clinical investigators, other key stakeholders in research, and the social, ethical, and legal issues that impact basic and human subjects research. Lastly, we explore the challenges of involving communities in the design and conduct of clinical research that ultimately must be relevant to their most pressing health concerns.  Our readings will draw from medicine, social science, bioethics, and law, and from the practical experiences and insights of those engaged in research, clinical medicine, and community engagement.

Seminar Requirements:

  1. Participants will attend every seminar session prepared for active discussion.
  2. Formal requirements include class presentation, reading responses, and one longer or two shorter papers focusing on a particular translational research project.

Topics addressed in this course may include:

  • Politics behind the science: What research topics get attention and why?
  • Research with human cells: What do we learn from the story of Henrietta Lacks ? What are the legal and ethical controversies surrounding research with biospecimens?
  • Research with specimens stored for unspecified purposes: Is consent the proper basis for future research?
  • Phase I clinical trials in humans:  Are they ethical? Should we all be willing to volunteer?
  • Clinical research in different settings:  Why does source of funding matter?
  • The clinician-investigator: What are the risks and benefits of this dual role? What prompts the rise of the clinical trialist?
  • The politics of science—The National Children’s Study: Why was it stopped?
  • The politics of science—HIV transmission research/HPTN052: Was it inevitable?
  • Can disease advocacy organizations change research? (From “ACT-UP” to the Genetic Alliance)
  • Advances in genome medicine: What should we do with all that “incidental information” produced by next generation sequencing? The NCGENES study
  • Advances in population science and genome medicine: Race/ethnic disparities between groups (the case of end stage renal disease)
  • Bringing communities into the translational pathway:  When, how, and why?
  • Translational research:  Myths and realities

Seminar #4: History of Medicine in the United States – Through the Prism of Medical Education

Faculty: George F. Sheldon, MD, FACS, FRCS Ed (Hon), FRCS Eng (Hon)

Zack D. Owens Distinguished Professor and Former Chair of Surgery

Time: Tuesdays 1:00-2:50 (SPRING)

Seminar Description:

This course is considered a survey course with emphasis on the development and evolution of (1) medical education; (2) the founding and growth of medical schools in the U.S.; (3) curricular concepts such as professionalism, scientific method, research, as well as generalism and specialism; (4) concepts of disease as science unravels secrets such as the germ theory, shock, genomics, etc.; (5) profile of the “typical “medical student.

The history of medicine in the United States has unique scientific, cultural, and philosophical dimensions.  Knowledge of the evolution of health care in the United States is important for providing a background to understand the future, which will build on the trends of the past.  An appreciation and understanding of the background of medical evolution in the United States, the obligations of the medical professional, and the expectations of professional fulfillment are important issues to be developed in the seminar.

Rather than provide a total chronological approach to the history of medicine in the United States, the background will evolve from the European Founding and Curriculum, as exemplified by the University of Edinburgh.  The role of the university, dominant in the early years of medical education in the United States became diluted by growth of proprietary schools in the 19th Century. Many of the proprietary schools were based on cult concepts such as mesmerism, electro therapy, etc. Some cults, survive today, i.e., eclectism, homeopathy, osteopathy, chiropracty, and others, and a blended culture of medicine has resulted. Moreover, the culture of the doctor of the 19th and 20th centuries has evolved. i.e., more women physicians were practicing in Boston in 1900 than men and more than in 1950. The black medical schools, founded mostly after the civil war—as well as the exclusive women’s’ medical schools—largely closed after the Flexner Report in 1910.

The founding of the unique American educational format of a university teaching hospital to educate its health workforce, is a unique American phenomena.  Similarly, the development of research medical universities, which have evolved into academic health centers, is another unique American phenomena not copied or modeled anywhere else in the world.

Finally, the University of North Carolina at Chapel Hill has provided an excellent example of public responsibility in both education and health care.  Founded as the first state university under the Federal Constitution of 1789, the University of North Carolina was the dawn of public higher education in the United States.  At the time that the university was founded through the

state constitution all universities in the United States were denominational.  A public, non-denominational university as part of a state constitutional commitment was unique.  It is a model that has been followed by more than 40 of the 50 states.

Similarly, with the end of World War II when the state of North Carolina led the country in rejection for selective service for both literacy and health care, our public officials addressed the solution.  The Good Health Movement was launched in order to use education as a method of improving the health of the public.  From that particular post-World War II activity was founded North Carolina Memorial Hospital, a reinstitution of the M.D. degree granting medical school, and the founding of specialty education.  All students at the University of North Carolina should know that unique history.

Seminar Topics:

  1. The founding of medical education in the United States.  This topic will focus on the European models for medical schools, and the periods of influence, Edinburgh, (1749-1830). Paris (1813-1865) and Germany (1865-1914) in the United States.  It will focus heavily on the Edinburgh and London axis as the initial model when the first medical schools were founded.
  2. The post-Revolutionary War period and the chaotic 19th Century, contributions of Frank Billings, the evolution of scientific discovery of asepsis and antisepsis, the unique American discovery and specialty of anesthesiology, and others. The establishment of the teaching hospital model through Johns Hopkins and Peter Bent Brigham.
  3. The post-Flexnerian period evolving through World War I, the Great Depression, World War II, and the founding of federal support through the National Institutes of Health, the GI Bill, and the Medicare Law of 1965.
  4. Generalism and Specialism as dominant topics in the health workforce.
  5. Evolution of the concepts of professionalism.
  6. Medical Organizations and their role
  7. The Future

Seminar Requirements:

  1. Attend all sessions and prepare to discuss assigned readings.
  2. Team-teach one session with the instructor.
  3. Help design the evolution of the particular topics.
  4. Critique each session
  5. Bullitt History of Medicine Presentations. Students will be encouraged to attend these presentations.
  6. SITE VISIT –site visits will be arranged to view Rare Books in the History of Medicine as they apply to the seminar. These will include visits to the Collection at the UNC School of Medicine Library and possibly other collections in the area.
  7. WEB—there will be one brief demonstration of how to do historical research on the web.
  8. Optional topics within the construct will be considered based on student wishes.

 

Seminar #5: The Stories We Live: The Parallel Chart Project

Faculty: Terry Holt, MD, MFA, PhD

Research Assistant Professor, Department of Social Medicine

Clinical Assistant Professor, Division of Geriatric Medicine, Department of Internal Medicine
Time: Tuesdays 1:00-2:50 (SPRING)

Seminar Description:

Over the past decade, medical students at the Columbia College of Physicians and Surgeons, the University of Rochester, and other schools around the nation have been meeting regularly in small groups to share their stories of life on the wards and in the clinics.  Studies of such “parallel chart” groups suggest that medical students who learn to cast their experiences as narratives make better doctors: more valued by their co-workers, seen as more caring by their patients, and judged more effective in their clerkships.  Writing and reading our stories offers a way of untangling the practical, ethical and emotional crises we encounter, a way of understanding what we experience, and of appreciating just how medical practice changes us.

This course is conducted as a writing workshop.  Every week three or four participants volunteer to post stories on the Sakai discussion forum for this section.  These are autobiographical stories drawn from clinical experiences during community weeks, experiences with medical education, or other encounters within the medical establishment.  Unlike the illness narratives from the first year, these stories focus on the perspective not of the patient but of the practitioner: i.e., your perspective in your new role as the one in the white coat.  The goal in writing these stories isn't to teach any lesson or to draw any conclusion, but simply to tell, as fully and honestly as you can, about things that have happened to you that seem important, puzzling, contradictory, comical or troubling—about the patients and doctors and relatives and nurses, the incidents that stick with you long after the fact. This selective offers the chance to tell that story, and with the help of your peers to understand just what it means, not only for you but for all of us.

Classes are devoted to discussion of these stories, as participants respond to the written work as fully and as articulately as possible, attempting to express just what effect the work produced, and how that effect came about.  The goal isn’t so much to evaluate as to understand the function of the story: how it made you feel, what it made you think, and why.  The task of the group is to point to places where the story affected us most powerfully, and if possible to explain that effect.  We will try as well as to point out places where the account doesn’t make sense, doesn’t add up, seems at odds with itself or muddled or dull—signs of places where the writer has failed to grasp the full meaning of events, shied off from their implications, or otherwise missed the point.  Such moments are inevitable in the act of creation; they are also invaluable, because in grappling with them we are given glimpses of a deeper understanding of ourselves and our situations.

Writing assignments are flexible, the only requirement being that we provide each other with material for discussion.   There are no assigned topics beyond the description in paragraph 2 above.  You can expect to write at least two complete narratives over the course of the term.  Because different participants volunteer to present their work each week, there is no fixed deadline, but because no participant can present a second story until everyone has presented a first story, the workload is spread out over the course; you may choose the weeks when you present your work (largely) at your discretion.

Evaluation is necessarily subjective.  There are no tests, quizzes or one-page answer sheets.  There is no lab.  You will not be asked to diagram the brachial plexus, unless you think it is important to the story.  Speaking generally, evaluations of your written work, which make up 50% of your grade, will depend on the accuracy of the telling and the depth of insight it reflects.  Some stories are too shallow to allow for much in the way of deep thinking, but if you have stories to tell, if they matter to you, and you are prepared to use the act of writing to help you think about what they mean, you will more than adequately satisfy the standards for the written requirement.  The other 50% of your grade will depend on your participation in discussion.  You have heard this before, but in this course the discussion is the subject matter.  Your participation will be evaluated for your ability to articulate your responses to the story, your honesty (and tact) in communicating those responses, and the depth of your insights into the issues the story raises, both formal (i.e., how well it’s presented, what problems the writer may be having with the material) and thematic (i.e., what the story has to say about medical practice and training).  If you are reluctant to articulate your responses before a group of your peers, this course will present a challenge (in the case of students with learning differences that might make such oral participation difficult, I will be happy to make accommodations that preserve the fundamental importance of critique to the skills this course emphasizes).

If you would like to learn more about the Parallel Charts project, and narrative medicine in general, a good place to start is at http://www.narrativemedicine.org

Seminar Requirements:

1.  The Stories 50%

2.  Discussion 50%

 

Seminar #6: Global Health and Medical Ethics

Faculty: Stuart Rennie, PhD, MA

Research Assistant Professor, Department of Social Medicine

Adjunct Assistant Professor, Health Policy and Management

Co-Chair, UNC Socio-Behavioral Institutional Review Board

Co-Principal Investigator, UNC-Fogarty Bioethics Project in Central Francophone Africa

Time: Tuesdays 1:00-2:50 (SPRING)

Seminar Description:

Our contemporary world is marked by strong interconnections between countries as well as deep inequalities between them and within them. International networks of business, trade, and travel can enable diseases (such as SARS and H1N1 influenza) to easily penetrate international borders and impact significantly on health, security and the economy. Media images of the recent earthquake in Haiti or the ongoing HIV/AIDS crisis in Africa bring the suffering of distant others closer to home and raise awareness of global health (and other) inequalities. American society has also become increasingly diverse, exposing health care professionals to other cultural backgrounds and values within their own communities, and further underlining the importance of understanding health in a global context. Students are also increasingly interested in gaining global health experiences at home or abroad.

This seminar will explore ethical challenges raised by medical practice and biomedical research in a global context. The seminar will start with an introduction to global health ethics, including values important for those engaged in global health, such as humility, solidarity, introspection and social justice. In the following sessions, we will take a look at some classic ethical issues (such as informed consent and confidentiality) in relation to vulnerable populations in resource-poor settings. Ethical dilemmas that emerge for health care practitioners when working abroad, for example in humanitarian crises, will be discussed. We will explore one of the main ethical challenges faced international health research, i.e. how to avoid or minimize exploitation of local populations. We will take a look at ethical problems encountered by those seeking to implement effective medical interventions in circumstances of social, political and institutional adversity. Ethical issues at the interface of medicine and health policy, such as those raised by the prevention and control of infectious diseases, will be examined. The growing presence of global pharmaceutical companies, who increasingly outsource their research and marketing activities in developing countries, will also come under discussion.

Seminar requirements:

After the first introductory session, students will choose which of the remaining sessions they would like to lead. Students will be required to write a substantive essay of a topic within the general framework of the seminar.

 

Seminar #7: Racial and Ethnic Disparities in Health: Progress and Community Impart

Faculty: Giselle Corbie-Smith, MD, MSc

Professor of Social Medicine and Medicine

Time: Fall 2011-Spring 2012, Tuesdays, 1:00-2:50 p.m.

IMPORTANT NOTE: This seminar will meet every other week during both the Fall and Spring semesters.  Since it meets only every other week, it has the same number of class sessions as other seminars that meet weekly during one semester.

Seminar Description:

Why do some groups have better health than others? How do individual, environmental, structural and contextual factors contribute to racial differences in health outcomes? Besides the luck of the draw (our genetic inheritance), people are exposed to different educational, economic, and familial circumstances that lead them in varying directions. They pursue life's pleasures, endure stress or danger from difficult work situations, and seek support from friends and family…all in different ways, with different impacts on their health.

Environmental influences on health include social and economic factors such as income, education, employment status and working conditions, social networks and community cohesion. Income and education are among the most potent determinants of health. At a community level, disease and death rates are higher in residential areas that have the greatest gap in income between the rich and poor.

This two semester seminar will examine these relationships with the incidence and prevalence of chronic illness ranging from diabetes, cancer, and heart disease and examine the role that environmental influences, current and future, might play in reducing or reinforcing current health disparities. The seminar will take the form of a “lab” setting where students will work as part of a multidisciplinary research workgroup examining the role of environmental context in chronic disease. Each seminar meeting will start with a student led journal club that draws on seminal articles as well as contemporary literature on environmental influences on chronic illness.

Students will also develop mentored research projects within the context of ongoing research led by UNC faculty.

Seminar Requirements:

1.         Seminar members will take responsibility for the journal club, which involves meeting with Dr. Corbie-Smith, completing additional readings for that session, and preparing a handout for the class.

2.         Throughout the year students will be expected to attend meetings of the research team with which they are paired and to meet individually with workgroup faculty to ensure progress on the research project.

3.         The written assignments will include a series of journal entries based upon a synthesis of the class materials as well as the submission of an abstract, essay and/or manuscript based on the mentored research that is completed during the year.