20th-Century American Medicine, HST 190A. 01 Spring 2012 Instructor: Peter C. English, MD, PhD penglish@acpub.duke.

edu Carr 328 office hours, by appointment

Teaching Assistant: Ms. Jeannine Cole djc29@duke.edu office hours, Wednesday, 3-4:30pm in Trinity Caf, East Union This course is about health, disease, and medicine in the twentieth-century United States. Topics include epidemic disease, public health, race, technology, gender, ethics, economics, and the relationship between doctor and patient. Texts: Greg Critser, Generation Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies Nancy King (ed), The Social Medicine Reader, Patients, Doctors, and Illness, vol 1 (SMR1) , The Social Medicine Reader, Social and Cultural Contributions to Health, Difference, and Inequality vol 2 (SMR2) David, Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making David Rothman, Beginnings Count: The Technological Imperative in American Health Care Abraham Verghese, My Own Country, A Doctors Story Sherwin Nuland, How We Die: Reflections of Lifes Final Chapter Kenneth Ludmerer, Learning to Heal: The Development of American Medical Education

Assignments/Grading: [I use Blackboard Grader] 1. Please check the course Blackboard site before each class. 2. discussion [10 points] a. you should come to class prepared to discuss the assigned reading. [5 points] b. twice during the semester, you should find and discuss a video news story, segment of a television show, a movie scene, etc which demonstrates how contemporary Americans view some aspect of medicine. You should email me the clip prior to class, briefly introduce the clip to the class, show the clip, then, with my help, place the clip within the context of the class. These video clips should be breaking news or from a recent TV show or movie. The clips should be no more than 3 minutes in length. [5 points]. 3. 3 in-class quizzes [45 points]: a. Quiz #1 Feb 14 [15 points]; b. Quiz #2 March 15 [15 points] c. Quiz #3 April 19 [15 points] 4. Group Research Project [25 points]Television Medicine Series. Each member of the group will receive the same grade 5. Individual Research Projects [20 points] a. Science, Technology, Disease [10 points]5-7 pages b. Ethics [10 points]5-7 pages

Group Research Project: After 1960, many of the most popular television series have focused on medicine. Your group will analyze 15-20 episodes of a television series: Dr. Kildare [1961-1962]; Marcus Welby, MD [season 2, 1971]; St. Elsewhere [1982-1983]; ER [season 2, 1996]; Greys Anatomy [season 2, 2006], or House [season 1]. You will sign up for your presentation in class on January 26. Individual Research Projects: From your television series, you will write two analytical essays: 1. Select an episode that depicts some aspect of medical science, technology, or disease and place into the historical context of when the episode was first shown. a. Select episode and topic-Feb 2 b. Sources-Feb 16 c. Final analysis due-Mar 1 2. Select another episode from your television series that depicts some ethical issue and place it within the ethical framework discussed in several readings from the course. a. Select episode and ethical issue-March 20 b. Sources-March 29 c. Final Analysis-April 12 Instructor Responsibilities for Grading 1. Dr. English will lecture in the course and will grade: Group Research Assignments, Individual Research Assignment #1, and Media Moments 2. Ms Cole will lead discussions and will grade: quizzes, Individual Research Project #2, and participation in class discussions of assigned readings.

Academic Integrity: This course strictly adheres to the Universitys policies regarding academic integrity. The librarys main webpage has links to a variety of sources concerning research papers, citing of sources, etc. If you have any questions about how these policies and sites relate to this course, please see me immediately.

Appeals: For all work, I will post your grades on Blackboard. In addition, Ms Cole will post an answer key which will give you an explanation of her grading. If you think that she has made a mistake or if you wish to appeal a grade, you must do so within the dates given in the answer key. Attendance: I expect you to attend each class. Please email me if you need to miss a class. In addition, if work was assigned for that day, please email it to me or submit a Short-Term Illness form. Remember, assigned readings count as missed work, if you are not in class. This requires a Short Term Illness Form. Inclement Weather: If the provost calls off class [or delays class during our early morning meeting time], we will NOT meet. Please check our Blackboard site to find out how we will cover the material scheduled for the missed session. Your Email Address: Please check to make certain that the email address in SISS still reaches you. Supreme Court Arguments on President Obamas health care plan. At some point during the semester, the Supreme Court will hear arguments on the constitutionality of President Obamas health plan. Depending on how this major event develops, we may interrupt the syllabus to focus on these arguments [and possibly the Supreme Court decision.]

Jan 12 Jan 17

The Transformation of Surgery at the Turn of the Century The Aging Population Reading: 1. How We Die, Chapter 3, 43-63 2. Levine, The Loneliness of the Long term care-giver, SMR2, 299-306 3. Callahan, What Do Children Owe Elderly Parents? SMR2 307-320.

Jan 19

Technology, X-rays, Hospitals [part 1] Reading: 1. Introduction and 2. Cassell, The Nature of Suffering and the Goals of Medicine, SMR1 1-20.

Jan 24

Influenza [1918, Bird, Swine] Reading: 1. Groopman, God at the Bedside, 2. Grouse, The Lie, SMR1, 154-158, 205-207.

Jan 26

American Health Economics [part 1] Reading: Sign-up: 1. Rothman, Beginnings Count [whole book] Group Research Project

Jan 31

Urban Health Reading: 1. Abraham, Where Crowded Humanity Suffers and Sickens: The Banes Family and their Neighborhood, SMR2 277-292.

Feb 2

Occupational Health Individual Research Analysis 1: select episode and topic

Feb 7

Reform in Medical Education Reading: 1. Ludmerer, Learning to Heal [whole book]; 2. Basson, Case Study: The Student Doctor and a Wary Patient, 3. Konner, Basic Clinical Skills: The First Encounters, 4. Gawande, The Learning Curve, SMR1 89-126

Feb 9

Diabetes and Insulin Reading: 1. Dickey, Diabetes; 2. Feudtner, The Want of Control: Ideas and Ideals in the Management of Diabetes, SMR1 22-25, 41-59.

Feb 14

Alcohol and Prohibition Quiz #1

Feb 16

Race and Medicine: E.E. Just; Tuskegee Syphilis Experiment Reading: 1. Estroff, Social and Cultural Contributions of Health, Difference, and Inequality, 2. Farmer, Introduction to Infections and Inequalities: The Modern Plagues, 3. Smedley, Unequal Treatment: What Health Care Providers Need to Know about Racial and Ethnic Disparities in Health Care; 4. Matthews, Coming to Terms with Advanced Breast Cancer: Black Womens Narratives from Eastern North Carolina, SMR2 4-28, 105-122, 123-132, 137-163.

Individual Research Analysis 1: Sources Feb 21 Hospitals [part 2], Child Birth, Mental Health Readings: 1. Mairs, On Being a Cripple, 2. Rapp, Extra Chromosomes and Blue Tulips: Medicofamilial Interpretations, 3. Zola, Tell Me, Tell Me, 4. Lee, The Meanings of Race in the New Genomics: Implications of Health Disparities Research, 5. Satel, I Am a Racially Profiling Doctor, SMR2 70-81, 50-69, 82-88, 218-251-268-273.

Feb 23

Television Series Presentations 1. Dr. Kildare 2. Marcus Welby, MD

Feb 28

Heart Disease and Death Reading: 1. Nuland, How We Die [whole book]; 2. Hilfiker, Facing Our Mistakes, SMR1 145-154.

Mar 1

Smoking and Lung Cancer Reading: 1. Carver, What the Doctor Said, SMR1 228 Individual Research Analysis 1-Due

Mar 6 Mar 8 Mar 13 Mar 15 Mar 20

No class, Spring Break No class, Spring Break no class Quiz #2 Infectious Disease: Antibiotics and Vaccines Reading: 1. Williams, The Use of Force SMR1 201-204.

Individual Research Analysis 2: Select Episode and Ethical Issue

Mar 22

Breast Cancer Reading: 1. Annas, Informed Consent, Cancer, and Truth in Prognosis, Freedman, Offering Truth: One Ethical Approach to the Uninformed Cancer Patient, SMR1 208-227.

Mar 27

Bioethics Movement Reading: 1. Rothman, Strangers at the Bedside [whole book].

Television Series Presentations St Elsewhere

Mar 29

Television Series Presentations ER Greys Anatomy Individual Research Analysis 2: Sources

April 3

Birth Control and Abortion Reading: 1. King, Glossary of Basic Ethical Concepts in Health Care and Research, 2. Churchill, Ethics in Medicine: An Introduction to Moral Tools and Traditions, 3. Historical and Contemporary Codes of Ethics: The Hippocratic Oath, Maimonides Prayer, the Declaration of Geneva, and AMA Principles of Medical Ethics, SMR1 161-190. 4. Fleck, Case Study: Please Dont Tell, SMR1 191-195.

April 5

The American Diet and the Obesity Epidemic Television Series Presentation e. House

April 10

AIDS Epidemic Reading, 1. Verghese, My Own Country [whole book]

April 12

Changing Nature of Drug Addiction [narcotics, cocaine, and crystal meth]; and Health Economics at the End of the Twentieth Century Individual Research Analysis 2-due

April 17

Prescription Drugs Reading: 1. Critser, Generation Rx [whole book] We will discuss some of these today; the rest after the quiz on April 21: 1. Amichai, A Man in His Life, 2.Churchill, End of Life Ethics, Some Common Definitions, 3. Miles, Informed Demand for Non-Beneficial Medical Treatment, 4. Angell, The Case of Helga Wanglie: A new Kind of Right to Die Case, 5. Edwards, Disconnecting a Ventilator at the Request of a Patient Who Know He will then Die: The Doctors Anguish, Olds, The Promise, 6. Quill, Death and Dignity: a Case of Individualized Decision Making, 7. Correspondence: Death and Dignity: The Case of Diane, 8. Quill, Doctor, I Want to Die. Will You Help Me? 9. Feldstein, The Chain of Safety, 10. Olds, The Promise 11. Amichai, Try to Remember Some Details, SMR 1 230-289.

April 19

Quiz #3 Discussion the rest of the Social Medicine Reader articles. Final Class Discussion, Teacher Evaluations

April 29