May 22, 2006
Spotlight
Photo by Leah Gourley
Allan Brandt |
Charting the Social Currents of Disease
Following is the fifth vignette in a series on the revised medical curriculum, to be launched in August.
Disease is not simply a matter of physical processes. “Social forces affect who gets sick, when they get sick, and whether they get appropriate care—from poverty and nutrition to environment to housing,” said Allan Brandt, the Amalie Moses Kass professor of the history of medicine in the Department of Social Medicine at HMS. Nor does treatment stop at diagnosis and care; some diseases stigmatize the sufferer while others make the patient a magnet for sympathy and research dollars. Social medicine, the study of the social forces determining the incidence of disease and its treatment, has been elevated in the new curriculum from elective to required topic for first-year students.
“The Medical School has made a major commitment that no medical student should leave Harvard without a really intensive introduction to a full range of social science disciplines,” said Brandt, who will coteach the course. “Even if you have a vaccine for AIDS today, the social and political questions of the appropriate development, testing, and allocation of that vaccine really require very significant attention to social science. To only understand the biological is to be missing a crucial component of both the forces that make disease and the forces that lead to successful treatment.” In addition to Brandt, the course faculty are Jim Kim, the incoming chair of the Department of Social Medicine, who is fresh from heading the World Health Organization’s AIDS treatment campaign in Africa, and Paul Farmer, the Maude and Lillian Presley professor of social medicine and a prominent advocate of health care for the needy.
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“To only understand the biological is to be missing a crucial component of both the forces that make disease and the forces that lead to successful treatment.” |
Besides the obvious topic of AIDS, the course will study tuberculosis, which declined in the industrialized nations well before there were antibiotics to treat it. “That’s a very powerful lesson in social medicine,” said Brandt. Another is smoking and lung cancer, Brandt’s area of expertise. Lung cancer has become stigmatized and attracts diminishing research because it is seen, insofar as it strikes smokers, as self-inflicted and avoidable, he said. “There’s a tendency for more victim blaming,” Brandt said. “We’ll be pursuing some of these questions about how we adjudicate responsibility for disease.”
The course will examine the health care system’s flow chart, setting up the fuller discussion to be undertaken in HMS’s required health policy course. For Brandt, weaving a seamless continuum between social science classes, and between the social sciences and basic sciences, has been a positive product of curriculum reform.
“Now, for the first time, instead of having courses competing in fields like social medicine, medical ethics, and health policy, we really have an articulated, longitudinal curriculum across those fields,” explains Brandt. “All of us sat down together and really explored what each one would do.” He also brainstormed with clinical directors of basic science courses that will be taught simultaneously with his. The bacteriology course, for example, which deals, in part, with tuberculosis, will be coordinated with the instruction Brandt gives on the social and political determinants of TB incidence and care.
Past Vignettes:
• Series
Introduction: New Curriculum Revs Up for Summer
• Introduction to the Profession: Entering Students Take the Plunge
• Fundamentals
of Medicine, Semester 1: A Bridge to Physician Training
• Medical Ethics and Professionalism: Critical Examination of Ethical Issues
• Fundamentals
of Medicine, Semester 2:
Integrating Competencies
Copyright 2006 by the President and Fellows of Harvard College