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CLASS SYMPOSIUM
Class of '79 Details Illness in the Body PoliticRichard Rockefeller was working with Doctors without Borders in Uganda when his weight began falling. Trained to scrutinize patients for telltale signs of disease, but like many physicians, blind to his own symptoms, he thought he was getting in shape. Stateside, Rockefeller, HMS '79, was diagnosed with chronic myelogenous leukemia.
"My proposal is that we think boldly about what is in front of us and that we think seriously about schools of health," said Deborah Prothrow-Stith. (Photo by Graham Ramsay) "I was like Mr. Magoo. I suddenly found myself in midair off a building," he told classmates at the HMS Class Symposium of the Harvard Medical Class of 1979 on June 10. Short-sightedness is not the only thing he would share with the cartoon character. Like Magoo, who had a habit of obliviously walking off buildings only to be rescued by a well-timed series of swinging girders, Rockefeller was incredibly lucky. Six months after his diagnosis, he started taking the new cancer drug Gleevec. He also joined an online patient community. Three and a half years after his diagnosis, he is free of disease--and of the illusion that he, or anyone, is invincible. "We are all Mr. Magoos," said Rockefeller, chair of the Health Commons Institute. "I recognize how close to the edge I was. But we are all close to the edge all the time. It is miraculous that we are alive on this hostile Earth." Which Way Is Up?In his talk and in others in the day-long symposium, there was a sense that the world, always a precarious place, has become even more hazardous in the past 25 years. "We all know we are moving in the wrong direction at a frightening pace," said Jill Stein, HMS instructor in medicine and former candidate for governor of Massachusetts. Though her remark was directed to the political situation in this country, it reflected other speakers' views of health care in America. Growing racial disparities, the rift between the fields of public health and medicine, and the rise of some questionable therapies in this country were among the troubling trajectories addressed.
Rockefeller, who followed Atwood, continued on the theme of Western medicine's failure to address patients' needs. Drawing on his experience in the online patient community, he described the knowledge, resourcefulness, and compassion of his fellow patients as more impressive than that of many physicians. "It was a long time before I reached or surpassed the knowledge of some of the people on the listserv," he said. He also learned that "an awful lot of medicine practiced out there is very bad. You get to see the full range as patients report back what their doctors say to them." Many doctors do not like patients coming in with knowledge. "They think all online information is quackery," he said. Rockefeller attributes his good health in part to the emotional support as well as the information he received from the online community--and friends and family. "The value of catharsis and expressing the way you are feeling is fantastic," he said. Bridging DividesThe power of words is so great that it can heal a whole community, said Kenneth S. Robinson, commissioner of the Tennessee department of health. Trained as a preacher as well as a doctor, he is launching a campaign to improve health care in Tennessee, currently ranked among the lowest in the country. "Tennessee is actually two states of health--the impact is much worse among minority populations," he said. Robinson explained that the success of his campaign will depend on some of the same rhetorical skills he uses in the pulpit. "You cannot make people do anything. My success as commissioner of health will rest on the power of persuasion.""I have been married to a preacher for 29 years, and I have learned never to follow a preacher," said the next speaker, Deborah Prothrow-Stith. As it turned out, her talk had plenty of thunder as she described her growing disenchantment with the practice of both medicine and public health. "I have looked at health from both sides now, and we are not getting it," said Prothrow-Stith, associate dean of the Harvard School of Public Health. "Medicine and public health are intertwined, yet they do not know each other very well." She traced the rift to historical tensions, differing world-views, separate educational institutions, and a single-minded focus on biological explanations. "We are realizing that the diseases put in front of us require more than the biomedical paradigm," she said. To overcome this, she proposed developing "schools of health" and offered the Family Van, started by classmate Nancy Oriol, HMS associate professor of anesthesia, as an example of how medicine and public health can work together. Medicine and politics might appear even stranger bedfellows and, indeed, Stein was not even a member of a political party when she was recruited by the Green-Rainbow party to run for governor in 2002. "I really entered into this process out of desperation," she said. "We face an incredibly pathological political system. It leaves us wondering what we can do about it." The richest one percent of Americans own 38 percent of the wealth, she said; less than one percent of voters contribute 80 percent of the money raised by politicians. "It has come to be a very money-dependent political process," she said. "The power of money is what it is about." A defining moment in her campaign was a debate--the only one she was allowed to enter--with the other candidates. Though she was often sidelined, many present at the debate, including a relative of one of the other candidates, told her she had won. "Values will win the day if we have full and informed discussion," Stein said. --Misia Landau |
