Jan Henderson is a medical historian who blogs at The Health Culture. This the last of a three part interview with her.
Do you support the Obama healthcare program?
Itâ€™s a first step. I think itâ€™s important and historic that Congress was able to pass any legislation at all.
Shortly before it passed, I saw an episode of the Charlie Rose show where the guests were Marcia Angell, the former NEJM editor, and Wendell Potter, a former insurance agency executive whoâ€™s now very active with the Center for Media and Democracy.
Angell took the position that Congress should not pass the bill because it didnâ€™t sufficiently curb the power of the insurance industry.
She was not going to settle for anything less — very idealistic, in the best sense of the word. I didnâ€™t agree with her at the time. I thought it was important to pass a bill, even an imperfect one. But ultimately sheâ€™s right.
My personal philosophy is that everyone has a right not only to health care, but to health and to a decent quality of life. I sometimes despair at how difficult it will be to achieve this.
Do you support single payer?
For reasons of equitable access to health care, yes. Practically, Iâ€™m not so sure.
I think the insurance companies have disgraced themselves and should not be allowed to continue what theyâ€™ve been doing.
I have concerns, however, about the governmentâ€™s ability to run such a massive operation efficiently, which is critical when lives are at stake. I take some heart from those who argue that Medicare has been a very successful program.
I wouldnâ€™t place any bets on whatâ€™s going to happen. When times are difficult economically, a conservative point of view tends to win the day.
What is your area of particular expertise in history of medicine and science?
As a graduate student, my area of expertise was mathematical astronomy â€“ Babylonian, Ptolemaic, and Renaissance – Copernicus.
Once I started teaching two survey courses every semester on science and medicine – one from antiquity to the Renaissance, the other from the scientific revolution to the present – I featured the history of medicine because of its interest both to me and my students.
All sciences are subject to events and ideas in the culture of their time, but that influence is often easier to see in medicine.
My graduate school training favored an â€˜internalistâ€™ approach to science and medicine: studying the original texts in their original languages.
The more I taught, the more I was attracted to an â€˜externalistâ€™ approach – understanding science as a product of its time and culture.
I approach the history of medicine as intellectual history and find that the most interesting ideas often come from sociologists, anthropologists, economic historians, and even media critics.
What are the three most important medical advances in the last 100 years, 50 years, and 20 years?
If I could be a bit fluid with those milestones, the most important advances â€“ the ones that initiated modern medicine – were anesthesia in the 1840s, the germ theory of disease in the 1850s, and antisepsis in the 1860s.
The next big advance was the development of antibiotics during World War II.
In more recent times, the most important developments will probably come from genetics.
I know many observers are a bit surprised and disappointed that sequencing the genome hasnâ€™t revealed a direct correlation between genetic information and disease. Itâ€™s a field that hasnâ€™t yet delivered on its promise. I suspect it will, however. The implications for reproductive technologies are enormous.
There have been a great many important technical advances in surgery and diagnostics over the last 100 years, but technical advances are more or less predictable.
The discoveries of the past that I most admire are those that were unexpected and required someone to relinquish a previously held belief.
Why has the patient safety push of the last 15 years failed to improve overall patient safety even the tiniest bit?
Because there isnâ€™t a simple technical fix. The problem is often one of inadequate communication. That requires changing human behavior, which is very resistant to change and takes time.
Many safety issues involve team work. Gawandeâ€™s work on checklists describes the improved communication among team members once theyâ€™ve gone through a list together.
The medical profession keeps talking about what to do. Meanwhile the statistics remain ghastly. There was just a story out of the UK on how nearly one in five dosages of pain killers are in error, resulting in death and injury.
I hope it doesnâ€™t take a catastrophe â€“ like the death of a favorite celebrity from medical error â€“ to ramp up the pressure.
Did you ever think about becoming a physician?
Yes, I spent some time during graduate school thinking I should switch to medical school. I had never taken courses like organic chemistry, however, and it would have been a big undertaking. I admire anyone who makes it through medical school, internship, and residency.
Recent studies show that medical school students who have a humanities background are as successful as students who have fulfilled all the traditional pre-med requirements. Things are different today.
What is one little known fact about the history of medicine that you think people should know?
Iâ€™m interested in how attitudes towards death and dying have changed over time. Thereâ€™s a little known incident from the late 19th century that made a difference in the care of the dying.
Easing the pain of death was a common medical practice in the 19th century. The doctorâ€™s black bag contained laudanum as early as the 17th century.
The 19th century added morphine in 1806, codeine in 1836, and aspirin in 1892, along with the anesthetics chloroform and ether.
At a time when physicians had very little to offer patients by way of cures â€“ other than the ineffective â€œheroicâ€ measures of bloodletting and purges – it was palliative care that made physicians welcome at the deathbed.
In those days, easing pain at the time of death was not called palliative care, but euthanasia. The term referred to the outward death of the body, in contrast to the death of the spirit. Euthanasia literally means a good death.
In 1870 a school teacher named Samuel Williams published an essay that used the term euthanasia to mean something else: mercy killing. The essay generated considerable interest and discussion. To make a long story short, the original meaning of the term euthanasia was completely lost.
Between those late 19th century discussions of euthanasia as mercy killing and 1975, when Balfour Mount introduced the term palliative care, there was no name for supportive care of the dying.
Without a name, there could be no specialists in the subject, no professors to teach it, no training for physicians. There was little discussion of the subject in medical schools.
Without a name, the subject could not be indexed and researched in medical literature. There could be no advances in knowledge or improvement in techniques.
What we now call palliative care had greatly enhanced the reputation of the medical profession in the late 19th century. How could the original meaning of â€œeuthanasiaâ€ be so easily displaced?
In an essay on the subject, Ezekiel Emanuel – Rahmâ€™s brother – suggests that it happened at a particular moment in the development of capitalism – a time of economic panics and stock market crashes, raw individualism, economic competition, and appeals to the Darwinian concept of survival of the fittest.
Euthanasia of the elderly, who were no longer productive members of society, was simply part of the universal struggle of the strong over the weak.
This incident illustrates the power of language. If you control the vocabulary â€“ so important today in discussions of morally tinged political issues – death panels, right to life – you can prevail.