Reading List Selected Artwork Medicine's Moving Pictures: Medicine, Health, and Bodies in American Film and Television by Leslie J. Reagan, Nancy Tomes, and Paula A. Treichler (2008) Cinema M.D.: A History of Medicine on Screen by Eelco F.M. Wijdicks MD PhD (2020) Sexual Visions: Images Of Gender In Science And Medicine Between The Eighteenth And Twentieth Centuries by Ludmilla Jordanova (1989) Reductionism in art and brain science : bridging the two cultures by Eric R. Kandel (2016) Shakespeare's Four Humors "Traveling" Graphic Medicine:"Mom's Cancer" Brian Pies "The Anatomy of Bones" William Cheselden "Breathing Vein" James Gillray Shakespeare's Four Humors "Exhibition" "Head Ache" George Cruikshank Graphic Medicine: "Marbles" Ellen Forney "The Anatomy of Humane Bodies" William Cowper Shakespeare's Four Humors "Education" "A Cure for a Cold" Anon Shakespeare's Four Humors "Credits" "Very Ill!" Anon Selected Films "The English Surgeon" (2007) "The House is Black" (1963) "Sound and Fury" (2000) "Unrest" (2017) "A Beautiful Mind" (2001) "A Theory of Everything" (2014) "Wit" (2001) "People Will Talk" (1951) "Charly" (1968) "One Flew Over the Cuckoo's Nest" (1975) "Awakenings" (1990) For a more comprehensive list of resources, please visit the full Visual Arts & Medicine Database: Access the Database Here!

Pitt Health Humanities Undergraduate Archive This is a resource for those seeking more information on the health humanities, particularly for undergraduate curriculum development or personal enrichment. The archive is structured by topic, including The Concept of the Self in Medicine, Gender and Women's Studies, Patient and Physician Narratives, Visual Arts and Medicine. You can also find below our general archive and resource list. The Concept of the Self in Medicine Gender and Women's Studies Literature & Medicine: Student Essays Patient and Physician Narratives The Visual Arts and Medicine Evolution of Doctor-Patient Relationship Intersectionality of Religion & Medicine Modern Disparities in the Gynecological Practice

Gender and Women's Studies Archive Part I: Ancient Medicine Part II: Development of Modern Medicine Part III: Modern Medicine Other Resources Part I: Ancient Medicine Anchor 1 Hippocratic Writings Hippocrates, G.E.R. Lloyd This collection of writings about hippocratic medicine is a great place to start when exploring the origins of modern medicine. One aspect of the text that may come as a surprise to readers is the fact that in Hippocrates' day, medicine was considered to be an art and not yet a science. "The Oath" and "The Canon" describe the character and ethics of Hippocrates' ideal physician. "Epidemics, Books I and III" gives the reader an insight into the medical notes of a Greek physician and allows them to draw conclusions and diagnoses based on the patients' symptoms. For those interested in obstetrics and gynecology, many of the female patients' conditions (notably identified by their relationship to a father or husband) are correlated with birth and pregnancy. "Airs, Waters, Places" describes various societies and nations that Hippocrates is familiar with. This chapter involves a discussion of fertility in relation to a population's health and environment. Some of the most interesting analyses of gender roles in a society come from Hippocrates' analysis of the Sauromatae and the Scythians. "Aphorisms" provides a list of medical facts and treatments from Ancient Greece, some of which are still scientifically accurate, and some that are plainly bizarre. The majority of aphorisms pertaining to bodies with uteruses are found in Section V, 28-62. "The Seed" and "The Nature of the Child" discuss conception, pregnancy, and childbirth. Hippocrates' proposed mechanism for conception is particularly fascinating, and differs slightly from Aristotle's. On the Generation of Animals Aristotle Aristotle's biological text on human and animal reproduction provides context not only into the scientific beliefs of his time but also the societal and cultural beliefs regarding gender and women's place in society. "Book I" describes human anatomy, including Aristotle's explanation of menstrual periods. He also introduces the two major schools of thought in regards to reproduction at that time. Book II establishes the female as "a mutilated male" and "that which comes into being is male, is better and more divine than the material whereby it is female." Book IV describes the determination between whether a fetus develops as a male or a female. It also describes "female character as being a sort of natural deficiency". This chapter also provides an explanation as to why many women do not menstruate while nursing after childbirth. Source: The Electronic Scholarly Publishing Project Politics Aristotle Aristotle's text on politics and society may not seem at first to have much to do with medicine, but it provides significant insight into Ancient Greek gender roles and Aristotle's perspective on women's role in society. Source: The Internet Classics Archive Agnodice The story of Agnodice is, at its heart, one of a physician who truly cares for her patients. While her existence is likely to be one of fiction rather than fact, she leaves behind a legacy for all physicians, regardless of gender, to follow in her footsteps. Sources: The Palgrave Macmillan Dictionary of Women's Biography The British Museum Encyclopedia of World Biography Women in World History: A Biographical Encyclopedia (Vol. 1) Source: The British Museum The Canon of Medicine Avicenna, translated by O. Cameron Grunner In this eleventh-century Islamic medical text, Avicenna (Ibn Sina) follows the four humors theory of medicine similar to Aristotle and Hippocrates over a thousand years before him. Book I, part 3 is notable in that it provides a comprehensive guide to breastfeeding and nursing. Though I was only able to access a translation of the first book of The Canon of Medicine , I have listed below a series of scholarly articles that analyze the text and its proposed treatments and etiology for a variety of topics. "Scientific evaluation of medicinal plants used for the treatment of abnormal uterine bleeding by Avicenna" "A medieval description of metastatic breast cancer; from Avicenna's view point" "Avicenna (AD 980 to 1037) and the care of the newborn infant and breastfeeding" "Avicenna aspect of premature ovarian failure" "The Air of History (Part V) Ibn Sina (Avicenna): The Great Physician and Philosopher" "The Relations of Ancient Medicine to Gynaecology" Edward W. Jenks, M.D. This article from 1876 serves as an analysis of ancient medical practices as well as a comparison of these ancient practices to the practice of obstetrics and gynecology in the nineteenth century. Jenks also makes a case for studying medical history in this text, stating that, "History repeats itself in medicine, as elsewhere" (20). Interestingly, he also acknowledges that future generations of physicians may one day come to judge his generation's own practices as they are judging the practices of ancient physicians. Source: U.S. National Library of Medicine The Trotula Monica H. Green (Translator) Supposedly written by a female physician in Salerno, Italy in the eleventh- or twelfth century, The Trotula serves as a comprehensive guide to obstetrics, gynecology, and medicine in the middle ages. The text provides information on everything from preventing pregnancy to removing wrinkles to faking virginity to treating ear worms. It characterized the uterus as a "a wild beast of the forest...wandering" (119-121). It proposes that one may tell whether they will have a male or female baby based on which breast is larger (105). It even suggests wearing the womb of a goat who has never given birth as a means of pregnancy-prevention (97). The text is a must-read for anyone interested in medieval medicine. Source: ProQuest Ebook Central For more on Monica H. Green's translation Below is a list of scholarly articles also pertaining to obstetrics and gynecology in the Middle Ages: "Women's Secrets: Gynecology in the Middle Ages" "Women's Medical Practice and Health Care in Medieval Europe" Medicine, Religion and Gender in Medieval Culture Naoë Kukita Yoshikawa (Editor) This collection of essays explores the ways in which religion affected gender roles and medical practice in Medieval Europe. A selection of these essays is listed below. Dianne Watt's "Mary the Physician: Women, Religion and Medicine in the Middle Ages" explores the relationship between religion and healing, specifically in relation to the Christian Virgin Mary and the comfort she often provided women who were ill or experiencing pregnancy or childbirth. In "'Maybe I'm Crazy?' Diagnosis and Contextualization of Medieval Female Mystics", Juliette Vuille discusses religious mysticism and how female mystics were received in comparison to male mystics. It also discusses the ethics of diagnosing historical figures without being able to fully understand the context within which they lived their lives. "Disabled Children: Birth Defects, Causality and Guilt" by Irina Metzler analyzes the Medieval view of disability and birth defects, which were often believed to have occurred due to a moral failing on behalf of the parents as a punishment from God. This blame was most often placed on the mother. "Marking the Face, Curing the Soul? Reading the Disfigurement of Women in the Later Middle Ages" by Patricia Skinner tells the stories of multiple Medieval women who either damaged their faces or threatened to do so when threatened with a marriage that they opposed due to religious beliefs. This essay speaks to the desperation that these women felt when faced with these proposed matches, and also the moral judgements placed on them when they followed through with their threats, even from religious communities. Source: JSTOR "Aquinas on Human Ensoulment, Abortion and the Value of Life" John Haldane and Patrick Lee In this article from Philosophy , the authors discuss the history of the Catholic Church's beliefs regarding ensoulment (when a fetus gains a human soul). This information is useful to provide context to the modern abortion debate, which is often dominated by religious rhetoric. Source: ResearchGate Anchor 2 Part II: Development of Modern Medicine The Female Body in Medicine and Literature Andrew Mangham and Greta Depledge (Editors) In a collection of essays ranging from the early seventeenth century to the mid-twentieth century, a variety of authors discuss several topics affecting women, gynecology, and obstetrics through the context of literature, pregnant machines, riddles, forgotten medical sub-specialties, and divorce cases. Source: ProQuest Ebook Central "The Life of John Snow, M.D." B.W. Richardson Pages xxx through xxxii of this document discuss how Anesthesiologist and Epidemiologist John Snow administered chloroform anaesthetic to Queen Victoria for the birth of her son, Prince Leopold, in 1853. Source: Michigan State University The John Snow Archive and Research Companion Medical Bondage: Race, Gender, and the Origins of American Gynecology Deidre Cooper Owens Dr. James Marion Sims is known as the "father of American gynecology" for his research on gynecological surgery, the repair of the vesico-vaginal fistulae in particular. However, the women whom he performed these dangerous operations on, often without consent and without anesthetic, are often ignored. Sims performed these surgeries on over a dozen enslaved women. In this book, Owens tell the stories of Anarcha, Betsy, Lucy, and other "mothers" of this field. Source: JSTOR "On Criminal Abortion: A Lecture Introductory to the Course on Obstetrics, and Diseases of Women and Children" Hugh L. Hodge MD This 1854 lecture to an all-male medical school class is a primary account of nineteenth-century medical opinions and protocols regarding pregnancy, childbirth, and abortion. Source: U.S. National Library of Medicine From Hysteria to Hormones: A Rhetorical History Amy Koerber Using a rhetorical perspective, Amy Koerber analyzes the sensationalized diagnosis of "hysteria", commonly diagnosed to women for behavior that was deemed to be peculiar or deviant. Beginning with uteruses that traveled throughout the body in the days of Hippocrates and progressing through modern understandings of hormones and even discussing victim-blaming politicians, this text provides context for the development of modern diagnoses from medical history. "Woman as a Physician" Eugene F. Cordell, M.D. In this 1883 lecture to female medical students, Cordell describes historical women physicians, such as Agnodice, and medical schools throughout history who have trained women, as well as giving his audience advice on their practice as women in medicine. Source: U.S. National Library of Medicine Fragment of an Analysis of a Case of Hysteria Sigmund Freud Freud's 1905 text on psychoanalysis and dream analysis is a case study of a young woman named Dora whom Freud proposes suffers from "hysteria". This text lends itself for several possible judgments by the reader, from the ethics of publishing such a case study to Freud's attitude towards Dora and the unwanted sexual advances that he postulated had caused her behavior. Source: University of Pennsylvania Below I have listed two other publications by Freud which I read over the course of this project: "Some Psychological Consequences of the Anatomical Distinction between the Sexes" (1925) "Female Sexuality" (1931) "The Freudian Coverup" Florence Rush In her 1996 paper, Rush analyzes Freud's observation that many of his patients who suffered from "hysteria" had also experienced sexual abuse in childhood, often by their fathers. She argues that Freud's refusal to blame the fathers, instead placing blame on the patients' mothers or the patients themselves, or even by insisting that the abuse was only a fantasy, has perpetuated a culture in which experts and healthcare providers may blame survivors of sexual abuse for their own assault. Source: Feminism & Psychology "Lesbians in Psychoanalytic Theory and Practice" Evelyn Torton Beck and Susan (Shanee) Stepakoff The authors of this paper analyzed five books discussing sexuality and psychoanalytic theory, specifically focusing on lesbianism. Through the context of these books, the Stepakoff and Beck describe Freud's view of homosexuality and how it affects psychoanalytic practice today. Source: JSTOR Anchor 3 Part III: Modern Medicine Sexual Behavior in the Human Female Alfred C. Kinsey, Wardell B. Pomeroy, Clyde E. Martin, Paul H. Gebhard, et al. Published in 1953, this second part of the Kinsey Reports describes the sexual behaviors and attitudes of thousands of American women. For the purposes of this project, I focused on chapters 1-5, 7-10. Kinsey and his colleagues provided statistical analyses of various types of sexual behavior compared with socioeconomic status, religious affiliation, education level, and several other factors. The authors also provided commentary on the cultural contexts within which these behaviors occur. Some of these 1950s stigmas and superstitions may be familiar to modern readers, while others, such as attitudes about the LGBTQ+ community, have greatly changed. Alternative Medicine and What the Body Told Rafael Campo These two collections of poetry describe life through the lens of Campo's family, culture, and career. The poems most relevant to this specific project tend to center on Campo's role as a physician, with many poems discussing his experience as a gay man and a physician during the AIDS epidemic. Recommended poems include "My Feminine Side", "Once There Was Great Love", "Canción de las Mujeres", "Song for Our Daughter, XIII. Population Explosion", "Ten Patients, and Another", "Song Before Dying, XII. The Patient-Doctor Relationship", "Hospital Song", "Phamacopedia for the New Millenium", "Recent Past Events", "Band of Gold", "Nude", and "Sestina in Red". Source: Alternative Medicine (ProQuest Ebook Central), What the Body Told (Duke University Press) The Pride Guide: A Guide to Sexual and Social Health for LGBTQ Youth Jo Langford This guide, written for LGBTQ+ youth, provides non-judgemental information on mental and physical health, pronouns, identities, STIs, online safety, parenting, coming out, and so much more. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty Dorothy Roberts Originally published in 1997 and still relevant over twenty years later, Dorothy Roberts discusses Black women's role in the contemporary reproductive justice movement. Roberts provides evidence that society's drive to control Black women's bodies and their reproduction did not end with the abolition of slavery, but it still maintained in government programs that discourage pregnancy and childbirth for Black women and in societal attitudes and prejudices against Black mothers. This text is indispensable for anybody who strives to practice intersectional feminism and anybody who is interested in reproductive medicine. Source: Penguin Random House Anchor 4 General Resources and Archives National Library of Medicine Islamic Medical Manuscripts at the National Library of Medicine Medieval Manuscripts in the National Library of Medicine The John Snow Archive and Research Companion University of Pittsburgh Library Catalogue Archives and Special Collections Library of Congress: Sigmund Freud Papers

Medical Narratives: Healing and Clarifying Purpose Medicine today is making a push to be more diverse, more humanistic, and more empathetic. Medical students and physicians are encouraged to write and work through their emotions to avoid burnout. Patients are sharing their stories to raise awareness for the reality of the medical field, find a community, and process the mental and emotional damage associated with physical illness. I set out to compile and examine patient and physician narratives from many types of people to better understand the field I am entering, prepare my classmates, and help us all be more aware of the empathy and humanity necessary in the medical field. Physician Narratives I'm a paragraph. Click here to add your own text and edit me. It's easy. Patient Narratives Separate for women and such Reading List The Immortal Life of Henrietta Lacks by Rebecca Skloot Learn the exploitation and history behind HeLa cells and explore the ethical dilemmas in medical research. Hippocratic Writings Explore one of the earliest summations of the medical field and consider how this differs from medicine today The Sound of a Wild Snail Eating by Elisabeth Tova Bailey Learn about the life and biology of a snail from the perspective of a chronically ill woman who is confined to her bed with an untreatable disease Two Kinds of Decay by Sarah Manguso At 21 years old, Sarah Manguso was diagnosed with a neural autoimmune disease that altered her life forever. This memoir recounts the grueling suffering she underwent and the mental strain of relapses and drug addiction Being Mortal: Medicine and What Matters in the End by Atul Gawande A potent physician narrative where Dr. Gawande recounts interactions with his patients and explores his own role as family member to his father assignments and enrichment If you are interested in healthcare, or generally just learning how to understand other people better, I highly recommend looking at some of the sources compiled here. I provided some discussion questions that can be the basis of an assignment or thoughtful discussion, and I will update this page accordingly as I work to include these ideas in the Biological Sciences Department at the University of Pittsburgh. Archive Discussion Questions: 1) What aspects of this narrative strike you as surprising, good, or unfair? 2) How are the actions in this narrative promoting benevolence or malevolence? 3) How could you do better, or encourage your peers to do better? Discussion Questions: 4) Are the changes you want to implement personal, or systematic? 5) How do we balance training medical personnel receive and stepping back to listen to patients without imposing their knowledge? 6) How did these narratives make you feel?

Ethical Challenges to Positioning Artificial Intelligence in Healthcare Abstract Artificial Intelligence (AI) was founded decades ago on the presumption that machines in the future could emulate human cognitive functions [1]. The early research decades ago on such advanced technologies is paving the way for computer scientists in developing AI systems that now have broader applicability, including applications in healthcare, where medical professionals are beginning to see them as powerful partners. The involvement of AI in medicine has evolved over the last five decades. More recently, the interest and advancement of medical AI applications have shown momentum due to tremendous improvements to predictive algorithms and the availability of powerful computing resources and digital data [2,3,4,5]. The healthcare-based AI tools can allow for more informed and personalized care experiences by synthesizing information about the patient and supporting physicians by providing more effective treatment options. While there are considerable benefits to using AI in healthcare, such technologies also create a unique set of ethical challenges that are vast and complex. Issues such as privacy and security, bias, trust, accountability, and responsibility have dominated to date when using AI tools in healthcare [6,7,8,9]. AI needs large datasets to learn and perform decisions, but data relating to ethnic, racial, gender, and socioeconomic groups of the human population, are not sufficiently and accurately represented in the modern healthcare datasets. The data disparities lead to unfair representation by algorithms making erroneous conclusions that could prove harmful and discriminatory against groups of people. The AI tools are amplifying bias, compounding existing healthcare inequalities. Then there are intellectual property concerns and data privacy issues resulting in a lack of transparency in the overall AI tool development and testing process. Many fear AI and see it as a black box as it is harder to explain the decisions it generates. There are also increasing security concerns as the normal functioning of the AI tools could be affected and the risk of patient personal data compromised by hackers. Finally, the providers and patients may not sufficiently understand and trust the new AI technologies showing considerable resistance when implementing or using such intelligent systems in healthcare environments [10]. Policymakers and businesses must address ethical concerns before truly embracing such automated solutions as part of the future of healthcare [11,12]. Data governance structures related to using AI technologies in healthcare should evolve, ensuring that ethical principles are applied to reduce risks for patients and providers [13]. Source: https://www.itnonline.com/article/ai-medicine-way-growthhttps://www.itnonline.com/article/ai-medicine-way-growth Ethical Challenges Healthcare systems are under tremendous strain with the shortage of resources and ever-increasing demand for quality care. There is a need for AI solutions within healthcare organizations to support the growing demand and augment decision-making capabilities. Ethical challenges pose a barrier to successfully implementing AI-driven solutions in healthcare. Such roadblocks must be addressed for AI innovations in healthcare to scale, and a sound framework developed to protect patients from harm resulting from unethical behavior. It is essential to understand the underlying issues causing ethical challenges and take an interdisciplinary approach and rely not only on natural sciences but also on humanities to provide critical viewpoints into how we can position these automated technologies in healthcare. More specifically, the ethical challenges relating to informed consent, safety and transparency, data privacy, and algorithmic fairness and biases. Informed Consent In the most basic sense, the process of informed consent in medical intervention is straightforward and varies in scope depending on the level of the patient's care. The patient is informed by the care provider of the proposed test or the surgical procedure, followed by the benefits and the risks and any other alternative options. Based on the information provided by the provider, the patient either provides or declines the consent to proceed with the treatment option. When cognitive technologies are added to healthcare decisions, the consent process becomes more complicated with emerging ethical questions [14]. Clinicians are increasingly turning to AI tools that do not have regulatory oversight to support them with patient care decisions. Often physicians do not get consent from patients or their families to use the AI tool as the physician does not have sufficient information on the tool's inner workings to disclose appropriate information to the patient who has the choice to pursue the medical treatment plan. The underlying issue is that the physician does not understand how the tool arrived at the decisions or if the tool is trained on unbiased medical data and capable of providing decisions for the particular patient group. The physician is also not knowledgeable in the specific AI tool's prior success or failure rates to inform patients and allow them to make informed decisions. In such instances, with a lack of disclosure, patients are unaware that their treatment plan involves a decision made by the AI tool. When the model makes a biased decision, it can even prevent patients from getting the necessary care or intervention that may not be necessary and can lead to other complications or even death for the patient. Physicians emphasize that their decision does not rely solely on the particular AI tool but is a small part of their overall decision-making process involving various other factors. Also, they emphasize that the AI tools are like any other medical tools and part of routine clinical care that doesn't require getting explicit consent from the patient [15]. AI's influence in healthcare is eclipsing more rapidly than expected. New laws, guidelines, best practices, and standards are evolving to resolve some of the ethical issues related to the informed consent process. Healthcare providers will have to do their part and be vigilant with legal and ethical responsibilities by disclosing AI usage in patient treatment decisions. Physicians using AI tools for medical intervention should be more self-aware of the technology, including its limitations. They should be able to alleviate patient fears and inaccurate perceptions about AI technologies with appropriate engagement when discussing treatment plans and include the risks and benefits of using such tools [16]. The social and cultural aspects could significantly influence the informed consent process, and providers should respect and make patients aware of their autonomous decision [17]. Source: https://www.natcom.org/communication-currents/patients-are-signing-consent-forms-they-don’t-understand-we-can-do-better Safety and Transparency Healthcare is a safety-critical domain, and when AI solutions as diagnostic tools are used for medical intervention, the safety and reliability of such tools become critical. Decision-based AI solutions rely heavily upon large training data sets to provide accurate patient diagnostic options for clinicians. Much of the success of integrating AI tools safely with the healthcare environment depends on the availability of accurately and sufficiently represented data. There exist numerous legal and cultural challenges associated with sharing and utilizing health data for AI applications. Privacy protection laws may limit information sharing mainly if such data includes sensitive personal information. In addition, embedded bias and less accurately recorded data in health systems may limit the accuracy of the AI tool analysis. Limited centralized health data sources also prevent AI tools from providing comprehensive diagnostic analysis. Patient records could be in siloed health systems that the AI tool may not have access to include in its decision-making [18]. The other factor that can affect patient safety when using these technologies is the algorithms embedded within the AI tools. The limited transparency and understanding of the algorithms, commonly referred to as the black box, makes it difficult for providers to assess the safety and effectiveness of the AI tools. Additionally, with these tools, it is hard to explain the decisions related to patient diagnosis, which can change over time as they continuously learn and adapt. Limited information shared on the AI tools by their developers also makes it difficult for healthcare providers to understand the testing methodology used and if the tools were validated across multiple health environments and using various patient groups. Over-reliance on the AI tool, known as automation bias, can occur when providers ignore erroneous decisions from the tool and jeopardize patient safety. Unintended biases caused by algorithms can further add to healthcare inequalities and patient safety issues [19,20]. The availability of high-quality representative bias-free healthcare data will allow developers to build AI applications that provide transparent and equitable decisions for clinicians. To that extent, policymakers and industry leaders should discourage inaccessible data silos in various healthcare settings and consider creating secure cloud-based centralized healthcare data warehouses to assist developers in building and training AI tools. Also, experts should enact appropriate policies, procedures, and standards to prevent risks associated with data misuse and privacy. For AI tools to be deployed successfully in healthcare settings, best practices should be established for tool implementation, bias-free data collection, and handling interoperability concerns with other medical systems [21]. Patients and clinicians should be educated to believe that using AI tools in healthcare settings is safe and effective. Establishing trust among patients and clinicians for AI tools requires transparency and clinical credibility. Developers should combat the black box problem and foster transparency. They should ensure the AI tools are explainable and the results of the predictions from the tools are making sense for clinicians who are finally using them. A robust FDA approval process, including posting updates, could also ensure explainable AI and trust among the public. Detecting architecture bias within AI tools could be difficult, and understanding the data used by the tool, including frequent monitoring, could prevent such issues [20]. Finally, when AI tools are deployed in clinical settings, a framework needs to be developed to handle the accountability concerns about the possible safety consequences of using such tools [22]. Source: https://hbr.org/2018/11/building-a-culture-of-transparency-in-health-care Data Privacy The AI tools in healthcare using historical patient data consists of medical and contextual data to derive decisions for clinicians to improve diagnosis and disease understanding [23]. However, the adoption of AI in healthcare is not straightforward as the future of AI rests on how well the privacy and security of the patient data are assured and public trust in such tools is established. When building AI tools, developers should consider federal and state laws and regulations concerning the patient data they are collecting [24]. Medical data is highly personal, and handling data privacy and security issues are essential when designing and developing AI solutions for healthcare. When health data is leveraged for AI tools, the data should be de-identified to safeguard patient information. De-identifying health data includes removing patient identifying markers such as names, birth dates, gender, etc. Under HIPAA rules, the de-identified data is unprotected and available for AI solution developers to combine with other information as training data. But such data, even when de-identified, can be easily re-identified when combined with other datasets [25]. AI tools performing predictive analysis require large medical datasets to learn and provide decisions. Hackers consider such medical datasets treasure troves and are constantly under cyberattacks. Medical data for patients are accessed by individuals from various departments within the healthcare facility and outside by other healthcare providers, which are primarily web-based, making them vulnerable to attacks. Additionally, outdated applications and legacy software used within healthcare organizations are vulnerable to many attacks. Negligent and untrained personnel can also unknowingly cause data breach issues. When using AI in healthcare, there are many instances where clinical data is consolidated from multiple institutions for the algorithms to get understanding and insight. The data shared within public and private institutions can cause data breaches, including patient consent and privacy issues [26]. Integrating AI tools with legacy applications within healthcare organizations also can pose several challenges, including data security and privacy issues. AI is driving research and development in healthcare which depends on vast volumes of patient data. Such patient-centric data is expected to grow exponentially, increasing stress on the data centers and security concerns. The solution to managing data privacy and security issues requires a combination of novel approaches and techniques. To assist with the development and validation of AI tools in healthcare, synthetic datasets as an alternative could allow for capturing various patient characteristics of real datasets while avoiding issues of patient privacy and risks of personal identification [27]. De-identification of healthcare data plays a crucial role in ensuring patient privacy. However, the de-identification task requires collaboration at all levels of the healthcare ecosystem where health data is created, handled, stored, and transmitted. Institutions, where data is leaving their control should ensure the health data with personally identifiable characters are correctly de-identified [28]. Healthcare is not immune to cyberattacks and is on the rise. Healthcare organizations should prioritize the security of their systems and networks. Newer security technologies such as Cyber-AI could constantly analyze data flows and build an understanding of normal and abnormal instances to identify sophisticated cyberattacks. Ideal security for healthcare systems should support business as usual and automatically investigate incidents as soon as they are detected and perform appropriate targeted actions [29,30]. Healthcare organizations should train and educate staff on data privacy and security. Also, organizations should upgrade legacy systems and constantly update to the latest software to thwart security issues [31]. Source: https://www.imprivata.com/blog/5-ways-to-create-a-culture-of-patient-data-privacy-in-healthcare Algorithmic Fairness and Bias AI-enabled solutions have tremendous potential to transform healthcare, but there are troubling indications of bias in AI decisions that can have catastrophic consequences on patient care. In one study, the algorithm used by healthcare providers favored white patients over black patients for extra medical care because the algorithm relied on past patient healthcare spending. Black patients historically had less access to healthcare and therefore had less opportunity to pay for and receive care. While there have been many advances in algorithm development in recent years, the concerns relating to algorithmic bias still exist, leading to unintended or suboptimal outcomes [32]. Bias occurs when healthcare datasets used by AI do not reflect accurate population distribution resulting in decisions made by tools being different from actual estimates. Algorithmic bias is not exclusive to race but is also exacerbated by other factors such as gender inequalities. For example, cardiovascular disease has different patterns for men and women, but prediction models trained predominantly with data samples of men may not accurately diagnose women. AI needs large datasets to learn from data patterns and perform decisions, but data relating to ethnic, racial, gender, and socioeconomic groups of the human population, are not sufficiently and accurately represented in the modern health datasets. The data disparities lead to unfair representation by algorithms, exacerbating healthcare inequalities. When an AI tool is used as a diagnostic approach for patients who are minimally represented within the training datasets, the tool fails to diagnose entire patient groups. Sources for bias exist in most stages of the algorithmic development process. Data-driven bias occurs when AI training datasets are not representative of the human population. Algorithmic bias occurs when AI models using biased data reinforce patterns from the dominant model's trained data category. Human bias occurs when there is a lack of diversity within algorithm development teams. Developing inclusive technologies such as AI for healthcare relies on comprehensive datasets that do not exclude human population diversity. Design for fair implementation of AI in healthcare should include trust, openness, and diversity in medical datasets. In recent years, open data sharing is becoming more evident between public and private organizations in order to quantify and respond to health emergencies. Responsible data sharing frameworks such as federated learning systems with openness at their core could enable adequate training of AI algorithms. Robust anonymization processes could be conceived at data collection locations to protect patient privacy. AI tools require high-quality data from various sources, and data standardization encourages patient groups to capture their characteristics that facilitate interoperability and fair AI. When AI tools have limited access to unbiased datasets, artificially generated synthetic data could be used to augment underrepresented population groups. Similar to other healthcare interventions like clinical trials, AI algorithms should be rigorously field-tested to assess the performance and bias issues before being used for diagnosing or treating population groups. AI algorithm developers often employ the so-called black-box approach, where it is impossible to understand the model's decisions. Developers should be transparent and highlight the strengths and weaknesses of the model's decision-making process, including the training data used during the development lifecycle. Organizations developing AI solutions should also ensure diversity within their development teams. Participation from underrepresented groups could be encouraged to identify biases in the health datasets against their communities [33,34]. Understanding the patient's social determinants is another critical factor, and integrating such measures besides clinical data could also mitigate issues concerning algorithmic bias in healthcare [35]. Source: https://towardsdatascience.com/bias-and-algorithmic-fairness-10f0805edc2b Conclusion AI in healthcare is anticipated to grow and promises to provide exciting opportunities for the future. It will propel innovations in supporting healthcare providers and patients with every facet of the care. Ethical concerns pose a barrier to successfully implementing AI-driven solutions in healthcare. Such roadblocks must be addressed for AI innovations in healthcare to scale. Until regulations are enacted by the policymakers and safeguards are deployed for patient safety, healthcare providers who plan to deploy AI solutions must work with such technologies responsibly. Governments should enact friendly policies, and organizations developing healthcare solutions must address ethics during every stage of the AI development lifecycle to improve care delivery and quality, safety, and patient experience. References [1]: Technology assessment November 2020 Artificial Intelligence. (n.d.). Retrieved April 13, 2022, from https://www.gao.gov/assets/gao-21-7sp.pdf [2]: Cohen, S. (2020, June 5). The Basics of Machine Learning: Strategies and Techniques. Artificial Intelligence and Deep Learning in Pathology. Retrieved April 12, 2022, from https://www.sciencedirect.com/science/article/pii/B9780323675383000026 [3]: Artificial Intelligence (AI) – what it is and why it matters. SAS. (n.d.). Retrieved April 12, 2022, from https://www.sas.com/en_us/insights/analytics/what-is-artificial-intelligence.html [4]: Define_me. (n.d.). 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OF MAGIC, MEDICINE, AND THE HUMAN PSYCHE: FAIRY TALES AS A PSYCHOTHERAPEUTIC AND HEALING ART Fairy tales form a socially symbolic and culturally vast genre of fantasy that conveys paradigms of the human condition through a veil of wonder, magic, and enchantment. The themes, motifs, metaphors, and intimate relational patterns contained within the fairy tale are illustrative of the human creative fantasy and of the human psyche itself. This mythic link – between the literary fairy tale and modern psychotherapeutic medicine – is the nexus upon which my research is focused. Although far from comprehensive, my work will dive into the multifarious psychoanalytical theories of the fairy tale, provide an atlas for the many psychological and therapeutic uses of the fairy tale within medicine; provide a bibliography of research detailing its clinical applications, and ultimately make a case for the use of fairy tales and creative writing within health, social care, and the medical humanities. Research Aim A Brief History of the Literary Fairy Tale The fairy tale began as an oral tradition and their origins can be traced by thousands of years to the ice age. Originally, fairy tales were passed down generationally through verbal recitation or dramatic reenactment, and as the tales evolved through their transmission, they became mirrors of the speaker and of the society in which they were told. Primitive folk tales were told as endeavors to interpret and understand natural and social phenomena while providing a sense of community. As the West experienced socio-economic shifts, the characters, content, and functions of the tales gradually transformed to reflect new social needs, desires, and fears (Zipes 23). Folk tales were the traditions of wandering tribes, travelers, and traders until the 15th century, when the folk tale began to undergo “bourgeoisification” when Italian writers began to exploit and conventionalize the rhetorics, contents, and topoi of oral folk tales so that they may become suitable for bourgeois and aristocratic reading. This process continued until the 17th century, when the literary fairy tale came into vogue and was established as the mode appropriate for King Louis XIV’s court and the bourgeois literary salons (Zipes 23). This period became known as the Salon Era. These salons attracted intellectual, aristocratic women and fostered their creative and intellectual development during a time where women were formally barred from receiving higher education. The writing and sharing of fairy tales was a preeminent feature of these salons, and the tales monopolized upon the decorative and metaphorical language of fairy tales to conceal subversive messages that critiqued aristocratic society, court life, and the gender barriers that defined their lives (Feat 217-18). To learn more about the politically subversive nature of the literary fairy tales of the seventeenth-century salons, click on the link to the right to read “Playing the Game of Frivolity: Seventeenth-Century Conteuses and the Transformation of Female Identity” by Anne-Marie Feat. Feat's essay further describes how the autonomy women held within the literary salons nurtured an environment that bore a new form of mondain female creativity, one that engendered a potent authorial feminine persona that highlighted female solidarity and worked to reclaim the voices that traditional French society attempted to suppress. Read More During the Salon Era, Charles Perrault rose to notoriety with his Histoires ou Contes du temps passé (Stories of the Past, 1697), which is better known as Tales of Mother Goose today. Perrault marked the beginnings of a cultural mode of discourse that used literary fairy tales as a form of moral narrative for children. By the time Madame Leprince de Beaumont published her Magasin des enfans (1756), which contained fairy tales such as “Prince Darling” and “Beauty and the Beast,” the literary fairy tale was a cultural institution used to convey Christian virtues, ideals, and etiquette to children of respectable upper-class families. Madame Leprince de Beaumont cemented social ideas within the children's fairy tales that are still considered standard today. These ideals were antithetical to the characteristics aimed for by the aristocratic Salon Era women within their tellings of fairy tales. Madame Leprince de Beaumont presented a framework that taught girls to believe that goodness and beauty aligned with their servitude towards a male-dominant code. She modified fairy-tale motifs to comply with the patriarchal conventionalized and institutionalized ways of Christian civilization and bourgeois industry (Zipes 24). Through its institutionalization, the literary fairy tale became socially acceptable as a conventional mode of writing for children. The classical writers of the literary fairy tale shaped the fairy tale discourse within their own societies and within the general western literary tradition at the same time. Literary Fairy Tales: Defining the Genre Fairy tales are differentiated from other literary genres by the magic contained within the story. Although this characteristic has allowed fairy tales to morph into their own distinct literary art form, it has made categorizing the genre a difficult endeavor for scholars and critics. However, to properly understand the literary fairy tale, it must be defined clearly. German scholar Jens Tismar was the first to define the literary fairy tale separately based on his four principles: (1) Literary fairy tales are written by a single identifiable author; (2) they tend to be simple, anonymous, artificial, and elaborate in comparison to the indigenous forms of the folk tale that emanates from culturally unique communities; (3) literary fairy tales and oral folk tales are intrinsically linked and neither is better than the other; (4) the literary fairy tale can not be independently understood and defined without understanding its relationship to the oral tales, legends, novellas, novels, and other literary fairy tales it uses, adapts, and remodels during the narrative conception of the author (Neophytou 5-6). Following these principles, the literary fairy tale can be further defined from other genres of folklore. Foremost, the literary fairy tale is neither myth nor legend. Myths generally refer to narratives about gods and supernatural beings while legends are stories of extraordinary events that happened to ordinary humans. Both myths and legends are typically believed to be true, but they insinuate that such events will never occur in the life of an ordinary mortal being. Fairy tales differ markedly as they portray a realistic event set in a fictional world with unrealistic and supernatural details (Neophytou 6-7). To further distinguish the fairy tale from the folktale, the distinguishing feature of the fairy tale is a complete detachment from reality. Typically, other types of folklore are set within a realistic setting with naturalistic details that allow for them to exist within reality. However, the fairy tale exists within a time and place that is beyond the veil of human existence (Neophytou 7). The Psychoanalytic Approach to Fairy Tales Debate exists over which approach to analyzing fairy tales is correct, and a plethora of them exist. Whereas each approach reveals a different aspect of the genre, my research will primarily focus on the psychoanalytic approach to fairy tales. To learn more about the various approaches used by scholars to explore fairy tales, use the link to the right to read Ana Neophytou's "Why are Grimms' Fairy Tales so Mysteriously Enchanting?" Neophytou provides a brief overview of the structuralist, literary, psychoanalytic, and socio-historical approaches used by Folklorists and scholars to analyze literary fairy tales. She then combines the approaches together to provide an in-depth analysis of how fairy tales, namely the Brothers Grimm fairy tales, have endured throughout the years. Read More Psychoanalysts argue that readers’ attraction to fairy tales is the result of the meanings that can be derived from the tales. Readers internalize the stories, connect with the characters on an emotional level, and vicariously embark on a journey with them. As the tale’s characters resolve their own issues, the readers also solve their personal problems. The study of fairy tales has yielded many different psychological methods that analyze fairy tales as symbolic expressions of the human psyche and emotional experiences. Most approaches focus on the semiosis of fairy tales and study the plots, motifs, and symbols of the stories to provide insight into human behavior. The two prominent psychoanalytical methods to studying fairy tales are the Freudian and Jungian approaches, although others exist. Whereas both the Freudian and Jungian approaches share similar methodologies to analyze and interpret the content of fairy tales, they differ in how they study the individual and the individual's reaction to fairy tales. To further understand the theories, methods, and applications of the dominant psychoanalytic approaches to the study of fairy tales, hover over each block to read more. The Freudian Approach Overview Sigmund Freud believes fairy tales were analogous to dreams and contained symbols that reflected conflicts, anxieties, and repressed desires. He believed that fairy tales carry important messages for the unconscious, preconscious, and conscious mind -- the id, superego, and ego. Bruno Bettelheim, a Freudian psychologist renowned for his work in child psychiatry, used this framework to guide his bookThe Uses of Enchantment: The Meaning and Importance of Fairy Tales (1975), to describe how fairy tales educate, support, and liberate the emotions of children. Read More Photo by The Jungian Approach Overview Read More Carl Jung believes in the existence of a collective unconscious that is shared by all until individuation - the process through which the unconscious being is brought to consciousness through their dreams and active imagination. Jungian psychologist, Marie-Louise von Franz, in her book, The Interpretation of Fairy Tales (1970), examines fairy tales as the purest and most distilled expression of the collective unconscious and of the archetypes of the collective psyche. Photo by To further explore the various analytic theories surrounding the appeal and longevity of fairy tales, view Moniek Hover's Ted Talk, "Fairy Tales are Full of Wonder." Contemporary Application of Fairy Tales in Psychotherapy AND mEDICINE Below is a collection of published articles and other written works describing the various uses of fairy tales within psychotherapy and medicine. The collected works are a mere sample of the vast body of folklore literature dealing with this research topic and its various subtopics. Therapeutic Use for Children The Witch Must Die: The Hidden Meaning of Fairy Tales Enchanted Hunters: The Power of Stories in Childhood Off with Their Heads! The Magic of Fairy Tales: Psychodynamic and Developmental Perspectives Children, Death, and Fairy Tales The Positive Impacts of Fairy Tales for Children Fairy Tales and Psychiatry: a Psychiatry Residency’s Experience Using Fairy Tales and Related Literary Forms to Highlight Theoretical and Clinical Concepts in Childhood Development Other Therapeutic and Medical Applications of Fairy Tales Through Emotions to Maturity: Psychological Readings of Fairy Tales Therapeutic Uses of Storytelling: An Interdisciplinary Approach to Narration as Therapy Fairy Tales and Wonderful Stories as Pedagogical Proposal for the Elaboration of Losses Teaching the art of empathetic interviewing to third-year medical students using a fairy tale -- "The prince who turned into a rooster" The Therapeutic Use of Fairy Tales with Adults in Group Therapy Fairy Tales: Visions for Problem Resolution in Eating Disorders Stories are Medicine: The Folklore of Healing The Brothers Grimm under the knife Fairy Tales and the Body Disability, Deformity, and Disease in the Grimms' Fairy Tales Disfigured: On Fairy Tales, Disability, and Making Space Fairies and the Folklore of Disability: Changelings, Hybrids, and the Solitary Fairy Types of Folktales on Illnesses and Cures Bodies: Sex, Violence, Disease, and Death in Contemporary Legend Medical conditions revealed in fairy tales, folklore, and literature Fairy Tales and Female Identity The wandering womb: a cultural history of outrageous beliefs about women Wise Women: Folk and Fairy Tales From Around the World Postmodern Fairy Tales: Gender and Narrative Strategies The Feminine in Fairy Tales Fairy Tales, Myth, and Psychoanalytic Theory: Feminism and Retelling the Tale Feminist Theory and the Study of Folklore Enchanted: A Qualitative Examination of Fairy Tales and Women's Intimate Relational Patterns Molding the Female Body in Victorian Fairy Tales and Sensation Novels Fairy Tales, Sexuality, and Gender in France, 1690-1715: Nostalgic Utopias See Archive

Health Inequities: Gender, Race, and Incarceration in the U.S. Archive Overview of the Prison-Industrial Complex Race, Reform, and Rebellion: The Second Reconstruction in Black America , Manning Marable The Politics of Injustice: Crime and Punishment in America , Katherine Beckett & Theodore Sasson The Strange Career of Jim Crow , Comer Vann Woodward “Clinton Crime Agenda Ignores Proven Methods for Reducing Crime”, Justice Policy Institute No Equal Justice: Race and Class in the American Criminal Justice System , David Cole Are Prisons Obsolete , Angela Y. Davis Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California , Ruth Wilson Gilmore “Punishment and Prejudice: Racial Disparities in the War on Drugs,” Human Rights Watch Gender & Sexuality in Prisons The Regulation of Desire: Homo and Hetero Sexualities , Gary William Kinsman Criminal Intimacy: Prison and the Uneven History of Modern American Sexuality , Regina Kunzel Global Lockdown: Race, Gender, and the Prison Industrial Complex , Julia Sudbury, Julia Chinyere Oparah Pedagogies of Crossing , M. Jacqui Alexander Criminal Injustice: Confronting the Prison Crisis , Elihu Rosenblatt Prison Masculinities , Donald F. Sabo, Terry Allen Kupers, Willie James London The Criminal Justice System and Women , Barbara R. Price, Natalie J. Sokoloff Against Equality: Prisons Will Not Protect You , Ryan Conrad Reproductive Health and Prisons No Magic Bullet? A Social History of Venereal Disease in the United States Since 1880 , Allan Brandt “Sterilization for Human Betterment,” E.S. Gosney and Paul Popenoe Reproductive Rights and Wrongs: The Global Politics of Population Control , Betsy Hartmann “Stop Prison Rape Now,” Human Rights Watch “No Escape: Male Rape in Prisons,” Human Rights Watch Our Bodies, Our Crimes , Jeanne Flavin (288 pages) Policing the National Body: Race, Gender, and Criminalization , Jael Silliman Race and Prisons “The Changing Racial Dynamics of the War on Drugs”, Marc Mauer Chicana Live and Criminal Justice , Juanita Diaz-Cotto Assata: An Autobiography , Assata Shakur Medicine, Ethics, and Prisons The Nazi Doctors and the Nuremberg Code : Human Rights in Human Experimentation , George J. Annas Bones in the Basement , R.L. Blakeley and Judith M. Harrington “On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life,” Charles Darwin Acres of Skin: Human Experiments at Holmesburg Prison , Allen Hornblum Bad Blood: The Tuskegee Syphilis Experiment , James Howard Jones In the Name of Eugenics , Daniel Kevles Kind and Usual Punishment: The Prison Business , Jessica Mitford “They Were Cheap and Available: Prisoners as Research Subjects in Twentieth Century America.” A.M. Hornblum “Prison Research: Does Locked Up Mean Locked Out?” Jeffery P. Khan, MD PhD “The prisoner as model organism: malaria research at Stateville Penitentiary,” Nathaniel Comfort “The Prison as Laboratory,” Silja J.A. Talvi Life After and Outside Prisons “Meeting the Challenge: Public Housing Authorities Respond to the ‘One Strike and You’re Out’ Initiative”, U.S. Department of Housing and Urban Development But They All Come Back: Facing the Challenges of Prisoner Reentry , Jeremy Travis Lesbian, Gay, Bisexual and Transgender Youth: An Epidemic of Homelessness , Nicholas Ray Stories of Transformative Justice , Ruth Morris

THE HISTORY OF TRANS MEDICINE: AN OVERVIEW Introduction As time progresses further into the 21st century, we progress medically and socially as well. Specifically, the perspective on being transgender has changed rapidly and dramatically over the last few decades. This report is an attempt at a brief but comprehensive summary of the basic steps that led our definition, outlook, and treatment of trans people in the medical community becoming what it is today. Historical Views on Gender Identity Early definitions of gender and transgenderism were much more fluid than modern ones. Ancient civilizations saw women as an imperfect form of men, and believed that “mannish behavior” would cause women's genitals to unfurl from their bodies, making them a man. Gender identity as a concept was never heavily explored. People were either biologically male or female. Any deviation from this was looked at as an oddity or curiosity, and there is little documentation on their conditions. The idea of gender being a defined binary only arose through the spread of religion, specifically Christianity, throughout the western world. Namely, scriptures like Deuteronomy 22:5 strictly prohibited cross-dressing and established rigid gender identities. The King James edition of the Bible states “The woman shall not wear that which pertaineth unto a man, neither shall a man put on a woman's garment: for all that do so are abomination unto the Lord thy God.” Because of this, deviations from traditional gendered outfits were labeled cross-dressing and were looked upon very negatively. Laws like the Masquerade Law established in New York in 1845 made dressing as the opposite sex in public outright illegal. Public Universal Friend Source: NPR However, there were certain exceptions to the quickly solidifying views on gender. Public Universal Friend was a preacher from the late 1700’s who rejected their birth names and personal pronouns, and established a religious group called the Society of Universal Friends that rejected gender roles. They would, in today’s terms, be considered non-binary, and were an early case of a public figure who opposed gender norms. There were also several historical records from the 19th century that documented people who were born women that transitioned into men as they grew, who would likely be labeled intersex in today’s terms. Multiple cases like these were documented throughout the century, and could possibly be explained by several isolated incidences of 5a-Reductase 2 deficiency, in which testosterone is not broken down properly in the female body, eventually leading to full masculinization . Although there were individual cases of flouting gender norms, the rapidly increasing influence of the Catholic church and quickly spreading religious views across the western world meant that gender roles would remain steady through the 20th century, until the work of one German physician would put the long-held gender roles into question for the first time in the medical world. The Most Dangerous Man in Germany Die Transvestism created the term “transvestism,” coming from the Latin words for “across” and “dressed.” He claimed that the major marker of transvestism was not homosexuality, fetishism, or delusion but rather a complex phenomenon that must be researched and studied more carefully. He also established the theory of sexual intermediates and in doing so questioned the rigid gender binary, noting that there were people with different sexual organs and physical/emotional characteristics that were stereotyped of being from the other sex. He essentially argued that all people were bisexual to a certain extent, and hypothesized that gender is limitless. Most importantly, he argued that transvestism was a “harmless inclination,” and that transvestites should be accommodated and treated with psychotherapy rather than pushed away and jailed. His humanization of trans people would contribute greatly towards how they were and still are viewed by the medical community. They ceased to be anomalies in a social sense, and became patients that could be treated and studied. Hirschfeld’s work would act as a starting point for many other researchers in the future, and would be a marker in medicine for decades. Although Die Transvestism was infinitely important in bringing trans people to the attention of the medical community, research was still lacking in several areas. His desire to separate transvestites from homosexuals in an order to destigmatize them caused him to largely ignore those who were indeed homosexuals. He took a hegemonic approach to his subject’s interviews, choosing to interpret their words to fit his own interpretation. However, his work’s importance still cannot be denounced. Aside from his publications, Hirschfeld also created the Institute for Sexual Science in 1919. It was the first known major medical institute for researching sexual disorders, and worked in research, sexual counseling, and education. He would also begin researching testosterone and estrogen in hormone therapy with Austrian endocrinologist Eugen Steinach. This institute would run until 1933, when it would be burned down by the Nazi party. In 1910, German physician and sexologist Magnus Hirschfeld would publish Die Transvestism (The Transvestites), the first major publication suggesting that cross-dressers and other people who defied traditional gender roles were not perverse or morally wrong, but rather suffering from a form of gender identity crisis. To do so, he interviewed dozens of cross-dressers and trans people, listening to their experiences and documenting their stories. His work studying sexuality and gender identity would eventually cause Adolf Hitler to label him the “most dangerous man in all of Germany,” and make him a major pariah during the third Reich. Magnus Hirschfeld Source: Encyclopedia Britannica Surgery and War After the destruction of Hirschfeld’s institute, progress in trans medicine would take a short hiatus. As the world plunged into World War 2, researching sexuality and gender took a backseat to helping the war effort. Physicians hardly had time to focus on the “transvestite issue” while they were caring for injured soldiers. However, through war came an extremely important development: the first steps in gender reassignment surgery. Previous surgeries on sexual organs had existed beforehand (the first full orchiectomy, or removal of testicles, had occurred in Denmark in 1930 for a male to female transition, and the first full phalloplasty occurred on a cis male patient in 1936), but wounded soldiers with mangled genitals became the first test subjects for sexual surgeries. In 1940, British otolaryngologist Sir Harold Gillies (who would later become to be known as the father of modern plastic surgery) would develop the first female to male gender reconstruction surgery. He would later create the earliest gender-affirming vaginoplasty in the 1950s alongside Dr. Ralph Millard Jr, which would last until a more modern technique was refined in 1974. By the 1960s, there were many centers that had begun performing gender affirming surgeries, mostly large universities like Johns Hopkins and Stanford. By 1999, around 1000 Americans had undergone gender affirming surgery. While gender affirming surgeries became more common medically, they also grew more normalized socially. In 1953, former soldier and popular movie star Christine Jorgensen would undergo a highly publicized male to female transition. Her story was incredibly important in normalizing trans people to the general public, and her transition would inspire not just closeted trans people across the nation, but perhaps one of the most important figures in the history of trans medicine yet. Christine Jorgensen, Source: Wired.com Benjamin and Money: A Tale of Two Approaches In 1966, inspired by Christine Jorgenson and his studies at Hirschfeld’s institute, German-American sexologist Harry Benjamin would publish The Transsexual Phenomenon, a medical textbook in which he argued that the dictionary definition of sex being the same as gender is untrue. He proposed that sex should instead be divided into several categories: chromosomal, genetic, anatomical, legal, gonadal, germinal, endocrine, psychological, and social. Following in Hirschfeld’s footsteps and even expanding on his ideas, he stated that the phenomenon of wanting to transition or assuming the role of a different gender was not a novel concept. Harry Benjamin Source: The Kinsey Institute Although his work focused mainly on the idea of being able to pass as distinctly male or female and centered heavily on cis-normative stereotypes, Benjamin still was an incredibly important figure in trans history. His work allowed trans people to begin to be accepted by the medical community. The Transsexual Phenomenon would be cited in countless other works in the following years, and established being a “transsexual” as an official medical diagnosis. In fact, shortly after it was published, Johns Hopkins opened the Johns Hopkins Gender Identity Clinic, the first major health center for trans people. The clinic conducted major sex reassignment surgeries with the goal of aligning physical, social, and mental sex as much as possible, and conducted research on its patients. There was a very long and arduous process that candidates had to complete, and there was very little informed consent or psychological support for those who were admitted. Doctors mostly made decisions for the patients with little regard for what the patient really wanted. Similarly, the Stanford Gender Dysphoria Program was formed in 1968 with the same goal and methods. Problematic aside, these early programs were incredibly important in the research and implementation of trans medicine into modern medicine. While Benjamin was conducting his research, another medical professional was conducting his own. In 1955, psychologist John Money proposed the idea that all infants are completely gender neutral at birth, and only by raising them by societal standards are they assigned a gender. While his idea would not gain very much traction immediately, his unorthodox methods of experimentation would soon gather the attention of the public eye. The same year that Benjamin published The Transsexual Phenomenon, John Money encouraged the gender reassignment of David Reimer, a biologically male infant who had his penis irreversibly damaged during a botched circumcision. For years, Reimer was raised as a girl and unknowingly given hormone replacement therapy. As a child, he suffered from severe gender dysphoria and eventually developed major depressive disorder. When he was 15, he learned the truth about his sex and transitioned back to male. Reimer spoke out numerous times about his experience before ultimately committing suicide in 2004. David Reimer Source: Rachel Lawlor Backlash Once publicized, John Money’s experiment was initially viewed as a success. However, gradually, as David Reimer spoke out against his treatment, public as well as medical opinion began to turn on Money’s idea that gender was malleable. In addition, religious beliefs and anti-trans sentiment still seeped into the medical community, impacting how transgender patients were treated. Some physicians saw trans people as abominations against god and outright refused to treat them altogether . Opinions varied greatly, however, as one male-to-female transition account detailed the many different interactions they had with various doctors. The reactions to their transition from medical professionals ranged from flat out rejection, sympathy but misunderstanding, total acceptance, and everywhere in between. In addition to basic prejudice, new developments in the medical community led to certain regressions in the recognition of trans people. One major part of this was a study by Jon Meyer, the head of Johns Hopkins’s Sexual Behaviors Consultant Unit. In his 1979 study (now long overturned), he concluded that sex-change surgery was largely unhelpful with improving the lives of trans people, and argued that by providing it, Johns Hopkins was supporting a mental illness. A few months after publishing his study, Hopkins shut down their gender identity clinic, and many other academic hospitals followed suit, citing the study as their primary motive. Meyer’s viewpoints were far from uncommon in the medical community. In 1980, one year after his study, the American Psychiatric Association would publish the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II). It would contain “transsexualism,” defined as the desire to live as the other sex, solidifying being trans as being mentally ill. Shifting Tides Arguably the biggest event in the shaping of our modern medical perspective on transgender people was the HIV/AIDS crisis. In 1981, HIV/AIDS became incredibly prevalent among the LGBT+ community, and its highly publicized spread caught the eye of medical professionals and the general population alike. While the crisis brought HIV and AIDS to the public eye, it brought LGBT+ health to the medical one. It gave medical professionals a concrete metric to study, showed how queer people were disproportionately impacted by health crises, and increased medical focus on care for transgender people. More and more, medical textbooks and journals began to use the term “transgender” over “transsexual” to correct the idea that being trans was a sexual behavior rather than a internal gender one. New techniques and therapies involved in transitioning were invented as well, with puberty suppressants being used alongside hormone treatments starting from 1990 and the modern phalloplasty being developed in 1993. Act Up Demo protesting AIDS epidemic, New York, June 1994, Source: CNN The change from an older, more outdated medical view on trans people to the modern view for transgender people can be tracked directly through updates to the DSM. Released in 1994, the DSM IV replaced transsexualism with “gender identity disorder”, which was defined as a disturbance with which an individual strongly desires to be another sex. This definition took into account the disturbance caused within the individual due to the desire to be another gender, rather than solely focusing on the act of wanting to be another gender itself. Additionally, the World Professional Association for Transgender Health published the Standards of Care for the heath of transsexual, transgender, and gender-nonconforming people in 1980, with the most recent edition coming out in 2012. These were very important in creating baseline expectations for how trans people should be treated and increasing the access of trans people to healthcare. Modern Views Like all scientific research, the story of trans people in medicine is far from over. In the past decade, the way that medical professionals respond to transgender individuals has changed dramatically. In 2011, the National Institute of Health sponsored a survey to assess the impact of health science on LGBT+ populations and identify gaps in their research and opportunities to improve in those areas. In it, they stress that researchers should be very comforting and professional about the topic of LGBT health in order to make queer patients as comfortable with sharing their true stories as possible. This expectation has grown throughout the medical field. It has become a basic expectation for transgender people to be treated humanely and with respect, and while there are exceptions, medical professionals adhere to this to a reasonable degree. The most modern publication of the DSM, DSM V, was published in 2013. Gender identity disorder was changed to gender dysphoria, shifting its focus completely from transgender individuals to the gender crisis that some face, and emphasizing that gender nonconformity is not a mental illness, but the mental dysphoria that occurs is. Finally, in 2017, students and faculty alike at the Bloomberg School of Public Health denounced Jon Meyer’s study. Johns Hopkins responded by reopening their institute and renaming it the Center for Transgender Health. It now acts more as a place for patient care of trans people, and remains open to this day. Johns Hopkins Center for Transgender Health, Source: Johns Hopkins Resources Maintaining history is crucial to forging our future. Below is a collection of databases and published articles containing information about the history of trans and intersex medicine. They serve to outline just some of the resources we have on this topic. Trans Reads A collection of texts by, about, and for people that defy traditional western gender norms. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Research on the current state of trans medicine and what we can do to improve it. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery A comprehensive review on the history of genital reconstruction surgery. Advances in the Care of Transgender Children and Adolescents An overview of current modern standards for caring for trans children and teenagers. International Journal of Transgender Health A medical journal containing various articles about a wide range of topics involving trans medicine. Digital Transgender Archive An online archive dedicated to preserving trans history.

The Concept of the Self in Medicine Gender and Women's Studies Patient and Physician Narratives The Visual Arts and Medicine The Evolution of the Doctor-Patient Relationship The Intersectionality of Religion & Medicine Valuing the Patient-Physician Lexicon Modern Healthcare Disparities within the Gynecological Practice

The Evolution of the Physician-Patient Relationship Background: In the influential novel Middlemarch , author George Eliot writes, “the medical profession as it might be was the finest in the world; presenting the most perfect interchange between science and art; offering the most direct alliance between intellectual conquest and the social good” (136). While medicine is often considered to be a discipline deeply rooted in science, many contributing factors to patient care lie in the artistic realm of the field, particularly the humanities. Therefore, researching the humanistic aspect of medicine is as important as investigating the science. My project serves to epitomize medical humanities exploratory research for other students by viewing medicine under a humanities-based lens and analyzing a critical part of patient care: the physician-patient relationship. Source: blogs.bmj.com/medical-humanities/ By: Devesh Malik Purpose: What does it mean to have a strong physician-patient relationship? Why is this dynamic important, and how does it develop? In this research project, I compiled archival and contemporary literary sources, written in the perspective of either the patient or the physician, to synthesize an evolutionary model of the physician-patient interaction; I aim to juxtapose past medical practice with that of the present to provide insight into how the patient experience has developed over time and why these changes have improved patient care. Source: ortholive.com Early 20th Century Medicine: Literary Text Directly Used in Research: A Young Doctor’s Notebook by Dr. Mikhail Bulgakov Other Useful Texts: The Immortal Life of Henrietta Lacks by Rebecca Skloot Hippocratic Writings (Chapter: “Epidemics”) by Hippocrates, edited by G.E.R Lloyd Notes on Hospitals by Florence Nightingale (founder of modern Nursing) Johns Hopkins University Medical Archives (Chesney Archives) New England Journal of Medicine, 1900’s editions ---------------------------------------------------------------------------------------------------------------------------------------------- In the last century, western medicine has evolved drastically; with new medical discoveries, inventions, and technologies, patient outcomes have improved tremendously. However, one characteristic of clinical medicine that is often overlooked is the interaction between patients and their doctors. When these relationships are presented in the occasional research paper, physicians are often praised for their humanistic mannerisms. Yet, archival records of the physician-patient relationship suggest that these interactions were not as commonly respectful as they are now. Mikhail Bulgakov was a physician and writer in the early 20th century. One of his books, A Young Doctor’s Notebook , is a written record of a few of his cases as a doctor in a rural town of Russia. These records not only contain information about the medical cases, but also an autobiographical recollection of his actions and thoughts before, during, and after helping the patients. This style of record-taking allows us to enter the mind of a early 1900’s rural doctor, and analyze how they interacted with and thought about their patients. Bedside manner is a term commonly used in modern clinical practice that refers to a doctor’s attitude and mannerisms towards their patient. In Dr. Bulgakov’s records, it was strongly suggested that this was not a concept practiced in the past, at least not in rural Russia. When a little girl was brought in by her mother and an old woman, Dr. Bulgakov was astonished to see the state the girl was in: “With every breath, hollows were being sucked in on her throat, her veins were swelling up and the colour of her face was changing from pinkish to a slightly violet hue.” (Bulgakov 33) Dr. Bulgakov was even more taken aback when he found out that the little girl was left untreated for five days, and rudely said to the mother, “‘What on earth were you thinking of?...The girl’s suffocating, her throat’s already blocked. You’ve been killing the girl for five days.’” (33-34) While it was clear from the descriptions in the record that the mother was frightened, Dr. Bulgakov seemed to only worry about informing her of her wrongdoings. Furthermore, after the old woman attempted to talk to Dr. Bulgakov, he said to her, “‘You shut up, woman, you’re being a nuisance.’” (33) In saying this, Dr. Bulgakov essentially dismissed the old woman’s input and worries. Modern medical practices show us that it is part of a physician’s responsibility to care for their patient first, yet still consider the emotions of the patient’s loved ones, especially with the family of pediatric patients. Furthermore, it is a doctor’s duty as a medical educator to properly and respectfully inform those who may not be medically literate; instead, Dr. Bulgakov looked at the uneducated old woman and thought, “‘It’d be a good thing if there were none of these old women in the world at all.’” (33) It is uncommon for laypeople to completely understand medical issues, thus it is unreasonable for Dr. Bulgakov, as a physician, to assume that anyone who is medically uneducated is not worth his energy, time, or respect. Source: amazon.com In medical ethics, there are four fundamental principles: autonomy, beneficence, nonmaleficence, and justice. In the case of this little girl and Dr. Bulgakov, there are no indications of anything against the latter three. Dr. Bulgakov’s efforts were clearly in favor of saving the girl, which supports the principle of beneficence. While the surgery required having “‘to cut her throat open lower down and insert a silver tube to give the girl a chance to breathe,’” (35) it is clear that this intervention was necessary for the sake of the patient’s recovery, and therefore aligns with the principle of nonmaleficence, or doing no unnecessary harm to the patient. Lastly, while the principle of justice may not be directly relevant to this individual case, it can be noted that Dr. Bulgakov chose to help the little girl and practice effective clinical care despite his resentful emotions towards the patient’s loved ones, which aligns with this bioethical concept. However, despite following these three principles, Dr. Bulgakov fundamentally neglected the first bioethical principle of autonomy, or the right to make one’s own personal medical decisions. As a pediatric patient, the little girl’s medical autonomy lies in the hands of her guardians. In the book, the mother blatantly refused intervention, saying, “‘I don’t consent!’” (35); nevertheless, Dr. Bulgakov ignored her judgement. Later, the mother is unethically coerced into providing consent by the feldsher (nurse), when he says, “‘What, are you mad? What do you mean, you don’t consent? You’re condemning the girl to die. Consent. Have you no pity?...Come on, hurry, hurry up and consent! Consent!’” (36) After berating the mother, she finally agreed to the surgery. Source: ollieburton.com In regards to establishing a strong physician-patient relationship, the principle of autonomy is arguably the most crucial. The other three are then important for following through with care and maintaining the depth, trust, and compassion that underlies all effective physician-patient relationships. In developing a strong relationship, it is the physician’s responsibility to acknowledge the patient’s perspective and consider it when reaching a mutually agreed upon solution, modernly known as shared decision-making. If this is not established early on in the interaction, the patient can quickly become detached from the physician, which can lead to their unwillingness to fully cooperate or share, thereby hindering the physician’s ability to care for them. Despite the relationship being shattered with the patient’s guardian and not the patient herself, this is still the essential piece missing in Dr. Bulgakov’s mannerism. His record of the surgery brought into sharp focus the immediate effect of a negative interaction when he wrote, “I felt acute regret about having entered the medical faculty and about having ended up in these backwoods. In angry despair I thrust the forceps somewhere towards the wound at random.” (38) If Dr. Bulgakov was to have a similar conflict with his patient directly, the emotional states of both the patient and Dr. Bulgakov could be affected, leading to immediate and possibly multiplicative repercussions in the patient’s treatment. It is important to consider the entire narrative when evaluating the situation. In the case of the young girl, diagnosed with diphtheritic croup, Dr. Bulgakov properly managed the crisis and saved the patient through a difficult surgery. It is remarkable that a patient so far along in their emergent illness was successfully treated in a rural setting lacking proper medical tools and operating rooms. Yet, it is still important to highlight the ethical mistakes made in the patient’s care, how they affected the physician-patient relationship, and how they could have had detrimental effects on current and future treatment. Modern Medicine: Literary Text Directly Used in Research: How Doctors Think by Jerome E. Groopman, MD Other Useful Texts: Deep Medicine by Eric Topol Being Mortal: Medicine and What Matters in the End by Atul Gawande The Two Kinds of Decay by Sarah Manguso Published Research (PubMed database) ---------------------------------------------------------------------------------------------------------------------------------------------- Since the early 20th century, the physician-patient experience has evolved via positive changes in medical practice, namely the increased attention to bedside manner. According to a paper published in 2008 regarding doctor-patient communication, “Nowadays complete, correct and comprehensible communication is a primary exigency for the physician, for the patient/person and for all the organizational levels of the sanitary system.” (Conti) It has become more common for physicians to emphasize effective communication with their patients and respect their autonomy by including them in their own personal care. This shows the positive improvements that have been made in the physician-patient dynamic, which have bettered modern patient care. Jerome E. Groopman is a practicing physician and author of the book How Doctors Think , which provides insight into the mind of contemporary doctors with an emphasis on the physician-patient relationship. Dr. Groopman focuses on the benefits of strong patient relationships through the stories of other physicians, but also highlights issues that still exist, such as personal biases and framing patients via quick, assumed diagnoses. In the book, Dr. Groopman introduces a powerful anecdote of a patient, Anne Dodge, who was told by many doctors that she had bulimia and anorexia nervosa. Despite claiming to follow her doctors’ recommendations for an increased diet, the physicians refused to believe her because her test results showed otherwise. Dr. Groopman discusses that, after being diagnosed with these two conditions, it was unfortunately commonplace for her doctors to view her under those diagnoses alone. However, Dr. Groopman emphasizes that “a self-aware physician knows that accepting the frame as given can be a serious error.” (22); it is critical for physicians to consider other possibilities, especially with patients like Anne. Fortunately, Anne decided to see a gastroenterologist, Dr. Myron Falchuk, who “began to question, and listen, and observe, and then to think differently about Anne’s case.” (Groopman 3) Dr. Falchuk made the conscious decision to believe his patient and consider other possible reasons for Anne’s presentation; in using a holistic approach, Dr. Falchuk developed a foundational, compassionate relationship with the patient built on trust in her narrative, which led to her correct diagnosis and saved her life. Source: amazon.com Source: priviahealth.com Dr. Groopman sheds light on two critical physician characteristics that help tremendously in creating a strong relationship with a patient: humility and collaboration. Humility, or the ability to recognize one’s own faults and mistakes, allows a physician to maintain an open mind and consider all possibilities, minimizing the chances of making hasty conclusions. This leads to stronger clinical intuition and an open, inclusive relationship with the patient. (20) Furthermore, Dr. Groopman writes that, “doctors desperately need patients and their families and friends to help them think. Without their help, physicians are denied key clues to what is really wrong.” (20) Collaborating with a patient and maintaining an equal relationship with them bolsters the physician’s capacity to treat them properly. After describing how to develop a strong relationship, Dr. Groopman discusses the traits necessary for maintaining it. For example, he clarifies that in order for a patient to effectively collaborate with their doctor, they have “to trust not only [their doctor’s] skill but also [their] sincerity and motivations’… without trust and a sense of mutual liking, Anne Dodge probably would have deflected Falchuk’s suggestions of more blood tests and an endoscopy.” (23) Without mutual trust, the relationship crumbles and the patient’s care is jeopardized. As a physician taking care of vulnerable individuals, it is their responsibility to provide the foundation of trust for the relationships to build on. Moreover, Dr. Groopman considers the communicative aspect of the interaction. He quotes Judy Hall, a social psychologist focused on researching the dialogue between doctors and patients, who said, “‘the communication piece is not separable from doing quality medicine. You need information to get at the diagnosis, and the best way to get that information is by establishing rapport with the patient.’” (Groopman 20). Hall highlights the importance of communication in maintaining the dynamic between the physician and the patient. Conclusion and Future Directions: “Medicine is, at its core, an uncertain science.” (Groopman 7) Therefore, it is crucial to investigate not just the academic foundation of the discipline but also the subjective aspects, such as the physician-patient relationship. From the paternalistic medical practices of the 1900’s to the respectful shared decision-making model of the 21st century, medicine as a humanistic practice has come a long way; the juxtaposition of these two systems underscores the positive changes that have been made in the field of clinical medicine and the impact that a strong physician-patient relationship can have on patient care. Nevertheless, the patient experience is not perfect. Contemporary issues in healthcare, such as shortened patient appointments due to systemic insurance restrictions, can make it difficult to cultivate these important physician-patient relationships. Furthermore, heavy amounts of paperwork can steal physicians’ time away from patients (Sanders), and computer-based healthcare systems can distract physicians during patient interactions. It was also shown that physicians tend to interrupt their patients and not engage in eye contact or have meaningful interactions because of computer use. (Rhoades) Time restraints during appointments could also be a confounding factor for this. Eric Topol, author of the book Deep Medicine , discusses the possibility of using artificial intelligence during patient appointments to eliminate the physicians’ computer-based responsibilities during interactions. This would greatly improve the patient experience and allow for stronger physician-patient relationships. Despite the great strides taken in bettering the physician-patient relationship, Dr. Groopman and Eric Topol show us that there is still more room to grow; future research and analyses of these often disregarded parts of medicine are required to provide more insight into improving the holistic treatment of patients. Citations: Bulgakov, Mikhail. A Young Doctor's Notebook . Alma Classics, 2012. Conti, A A, and G F Gensini. “Doctor-patient communication: a historical overview.” Minerva medica vol. 99,4 (2008): 411-5. Eliot, George. Middlemarch . IndyPublish.com, 2006. Groopman, Jerome E. How Doctors Think . Houghton Mifflin, 2007. Rhoades, D R et al. “Speaking and interruptions during primary care office visits.” Family medicine vol. 33,7 (2001): 528-32. Sanders, James H. “How Much Paperwork Is Too Much?” American Academy of Family Physicians (AAFP), Jan. 2005. About the Author Project Archives

Historical Analysis (Wailoo, 2018) The women Sims treated–Anarcha, Betsey, Lucy, and others–developed painful fistulas; Sims sough them out to explore a new surgical solution. (par. 4) Then I made this proposition to the owners of the negroes: ‘If you will give me Anarcha and Betsey, I agree to perform no experiment or operation on either of them to endanger their lives, and will not charge acent for keeping them, but you must pay their taxes and clothe them. (par. 4) quote by Sims discussing the arrangements on which he “acquired” the women he experimented on Under Sims, each woman underwent up to 30 operations over 4 years, allowing him to refine his technique. They were provided no anesthetics. (par. 5) For some physicians of that time, the black body was seen as “more insensible to pain” and more tolerant of hard labor, as Sims’ contemporary, Dr Samuel Cartwright, insisted. (par 8) (Khabele et al., 2020) —Quotes From 1845 to 1849, Sims performed experimental surgeries, without their consent and without the benefit of anesthesia, on at least 14 enslaved black women. (sec. 1) After 29 unsuccessful surgeries on Anarcha Westcott, Sims reported his first successful vesicovaginal repai r (sec. 2) Although the use of ether as a general anesthetic was novel at the time of Sims's surgical experimentation, it was publicly demonstrated in 1846 (3 years before his first successful repair), and Sims was aware of its use (sec. 1) Eventually, Sims moved to New York City and then traveled throughout Europe, where he offered vesicovaginal repair under anesthesia to mostly wealthy white women (sec. 1) (Armstrong, 2005) —Quotes A detailed poem written by one of the slave women described the horrific experiments they had to endure to further Dr. Sim’s discoveries Dr. Sims was working to perfect the operation to repair vesicovaginal fistulas, and he attempted his techniques on slave women sent by their masters The poem from a slave woman’s perspective says Dr. Sims “gets four strong field hands to hold me down, kneeling, he doesn’t say nothing to me” (lines 33-35) and details how Sims says “shut up gal and a hand over the mouth” (line 38) She goes on to describe her pain, saying “he cuts me inside—I feel the blood runnin’ down my legs to the floor—then he picks up the curved needles—and it goes on and on till I pass out” (line 42-45) Focus was placed on Anarcha, whom Sims “operated on 34 times, each time without anesthesia (paragraph 3) Quotation describes the atrocities of Sims' work by stating “But what sets Dr. Sims apart from other surgeons of his times was the repetitiveness with which he experimented Anarcha and slave women who were sent to him by their masters” (paragraph 6). Bock (2021) Quotes This article describes the connection between the deeply racist past of the practice of gynecology and how its effects are seen in modern-day life. Dr. Deirdre Cooper Owens stated “Physicians in the South developed the field of obstetrics and gynecology as quickly as they did because of their access to enslaved bodies” (paragraph 2), this shows how the use of slave women did progress the field, however it was in a horrific and nonconsensual way Dr. Sims “conducted most of his research on enslaved women without their consent or anesthesia” (paragraph 5)-- details the atrocities of his actions Additional examples of physicians who performed experiments on slave women without their consent or anesthesia are Drs. Ephraim McDowell, John Peter Mettauer, and Francios Marie Provost (paragraph 8) “McDowell was the first person to successfully remove an ovarian tumor. Mettauer performed the first successful repair of the vesico-vaginal fistula. Prevost was the second American to perform a successful Caesarean section” (paragraph 9) Cooper Owens described how horrific the treatment of these women was saying “There was brutality and cruelty to go around, especially from the perspective of enslaved women who had to undergo experimental surgeries that lasted for years after being taken away from their homes, families, friends and communities” (paragraph 10) “His patients remain mostly unknown except for three first names: Lucy, Anarcha and Betsey.” (paragraph 10) Not only would Sims make his patients suffer through his invasive procedures, but he would then tell “his enslaved patients they must now work as his assistants” (paragraph 11) Thanks to his team of enslaved women, who were described as “smart and dignified” Sims was able to perfect his technique for repairing vesicovaginal fistulas, however in subsequent articles, “Sims staff and patients were depicted as white”. Cooper Owens describes this as an erasure that occurred “visually and historically”. (paragraphs 12 and 13) Important quote to highlight: “Interest in the reproductive health of black women ended once slaves were granted freedom” !!!!! (paragraph 14) “Black women have higher rates of death and complications from pregnancy and childbirth. The rates of mortality and morbidity are very high”- Cooper Owens (paragraph 15) Ojanuga (1993) I think it is important to highlight that the condition Dr. Sims was working to find a cure for resulted in black women as a result of “poor nutrition, lack of prenatal care, and births at an early age” “The enslaved women were not asked if they would agree to such an operation as they were totally without any claims to decision making about their bodies or any aspect of their life”--highlights the lack of consent! Lucy’s story: “Lucy was operated on without anaesthetics as Sims was unaware of the advances which had been made in this area of medicine. The surgery lasted for an hour and Lucy endured excruciating pain while positioned on her hands and knees. She must have felt extreme humiliation as twelve doctors observed the operation” (+ includes info for rebuttal) THIS IS SO IMPORTANT: “Many white women came to SIms for treatment of vesico-vaginal fistulas after the successful operation on Anarcha. However, none of them, due to the pain, were able to endure a single operation” combats claims below made BY SIMS that the procedures “were not painful” Rebuttal: Ephraim McDowell asked a white woman for consent to conduct an abdominal operation and used sulfuric ether as anesthesia AND THIS OCCURRED AT THE SAME TIME AS SIMS “Sims’ use of slave-women as experimental subjects as by no means the order of the day” (Chan, 2023) Quotes: Sims’s work relied heavily upon his experimentation on and the labour of enslaved women. Presently the erected statues, namesake conferences, and contemporary scholarship that memorialize his legacy reproduce the implicit and explicit erasure of the violence of slavery within his personal publications (par. 1) Sims’s representations are distinct in that he depicts the labour and alleged consent of enslaved women to maintain a sentimental self-representation and thus, his innocence, despite his participation and role as an enslaver within the medical plantation (par.2). Sim’s self-representation is dependent on a rhetoric of sentimentality that at once secures his authority as a medical practitioner and propagates a narrative of innocence that contributes to the legacy of erasure within the institution of Western medicine, wherein the female patient’s subjective experience and affective movements are dismissed or removed from medical history and public memory (par. 2) argued by Chan an explanation of how the manipulative writings of Sims allowed his legacy to stand for so long In Sims’s autobiography, the conflation of the “self-made man” with the “sentimental” narrator functions to reaffirm his professionalization and social mobility through an affective call to readers to legitimize his presence in textual space (par. 5). Defenders of Sims (Wall, 2020) “The second assumption is that because Sims’s first patients were slaves, they must have been unwilling participants who could not consent to treatment. As a legal matter, consent to operate on a slave had to be obtained from the owner, but as a practical matter, slaves could assent to treatment by cooperating with a physician or surgeon in their shared quest for healing” (1302) “In the New York Medical Gazette of January 1854, Sims wrote: “I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not” (1302) Claims that the procedures were consensual, although the women were ENSLAVED only evident that the slave owners consented not the women themselves “Eventually, they became Sims’s surgical assistants, helping him to operate on one another until they were all finally cured” (1302) assuming that these women were not forced to be the assistants of Sims or that they did not only do that to help their friends ‘[Sims] stated “I never resort to them [anesthetics] in these operations, because they are not painful enough to justify the trouble, and risk attending their administration”’ false assumptions that the invasive procedures were “not painful” point proven wrong by the testimonial poem of one of his victims Wall (2006) The source uses Sims’ narration as evidence, but it was apparent that Sims’ lied based on other sources…? Reasoning states that Sims was permitted to perform experiments on slave women because he asked the owners for consent, (not the patient so it does not matter) States the women wanted to have their conditions fixed and were glad to participate–sources prove this is false consent/anesthesia was not prevalent during this time–can be rebutted with sources above, false claim Modern Statistics (Wailoo, 2018) —Quotes 2 years ago [2016] a provocative report was published that noted that medical students and residents at a leading institution held unfounded and deeply mistaken beliefs about blood of black and white patients coagulating at different rates, skin of black patients being thicker than skin of white patients, and African Americans having lower sensitivity to pain (par. 15). (Badreldin et al., 2019) Study to evaluate racial/ethnic differences in women’s pain scores postpartum and the administration of inpatient and discharge opioids (abstract) Study conducted was on women who were hospitalized for delivery from December 1, 2015 to November 30, 2016 (par.4) Women who reported a pain score of less than 5 were compared to those who who reported a pain score of 5 or higher (on a scale of 1-10). (par. 8). Quotes: Conclusion: Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain (abstract). Minority individuals have been shown to receive less opioid treatment than non-Hispanic white individuals for similar levels of pain and similar conditions (par. 2). Non-Hispanic white women were significantly less likely to report a pain score at discharge of 5 or higher than both Hispanic and non-Hispanic black women. Yet non-Hispanic white women received significantly greater MMEs/d [oral morphine milligram equivalents] as inpatients than Hispanic and non-Hispanic black women (par. 11). Non-Hispanic white women were also more likely to receive an opioid prescription at discharge than Hispanic and non-Hispanic black women (par. 11). Non-Hispanic black women were significantly more likely than non-Hispanic white women to report pain scores of 5 or higher and were significantly less likely to receive an opioid prescription at discharge (par. 13). (Bryant et al., 2010) Table 1: Black women found to have higher rates of Fetal demise preterm birth FGR (fetal growth restriction) Maternal Mortality Maternal Morbidity Hypertensive disorders maternal obesity and diabetes Found to be more likely to enter into prenatal care AFTER the first trimester have cesarean delivery Analysis: In 2006 the total US rates of preterm birth was 12.8%. 18.4% of this was black women. (337) More likely to present late to care (339) More likely to have to rely on public insurance sources (339) Maternal Mortality 2005 (338) N-H White: 11.7/100,000 live births Hispanic: 9.6/ 100,000 live births N-H Black: 39.2/100,000 live births How is the maternal mortality rates explained? Is it because black women are more predisposed to higher risk conditions? “[Studies] found that black women in the national sample did not have higher prevalence of preeclampsia/eclampsia, postpartum hemorrhage, placenta previa, or placental abruption, but for all 5 conditions, black women had case-fatality rate 2.4-3.3 times higher than that of white women” (338). This tells us it is an issue in the quality of care, not in the predisposition to conditions. Bougie (2021) “Race is not a factor for illness and death, but racism, bias, and discrimination definitely are.” “There is no known genetic connection between skin color or melanin concentration and !!! biological causes of maternal illness or death”, Crear-Perry “We tend to conflate race with class and assume all the problems are due to poor women of color lacking access to care, but Black women at all income and educational levels experience bad maternal outcomes,” Redmond Racism, classism, and gender oppression are at the forefront of reasons why there are unequal health outcomes in the maternity field. This resource’s objective was “to identify the presence of racial commentary in relation to endometriosis and other gynecological conditions in several prominent textbooks within the field of obstetrics and gynecology” (paragraph 1) The researchers performed a historical analysis of 8 OB/GYN textbooks from 1960 to 2020. The research noted the commentary that was used to describe conditions such as endometriosis, endometriosis and race, and the race factor in other gynecological conditions. The results of the research were as follows: “The analysis demonstrates that racial commentary has been consistently present in gynecology textbooks in the selected time period, though the frequency and nature has shifted” (paragraph 3) and that while there was a “decrease in endometriosis racial commentary while noting an upshift in other sections such as osteoporosis, pelvic infection (pelvic inflammatory disease, HIV/AIDS, HSV, etc.)” (paragraph 3) The conclusion of the research was that “racist ideas about the prevalence of endometriosis are still pervasive in textbooks today, despite being widely discredited and rooted in methodically flawed studies” (paragraph 4)- shows how racist history plays a role in education of medicine and increases implicit bias Clare (2022) This resource was written in response to a previous article that had cited race as a risk factor for postpartum preeclampsia, which is a condition in which one develops high blood pressure after childbirth, Dr. Clare stated, as the title says, “Race as a social construct should not be cited as a risk factor for postpartum preeclampsia” Dr. Clare noted that “Inequities in health outcomes on the basis of race and ethnicity are not because of biological differences but because of structural racism” (paragraph 1) This resource also notes that the false beliefs about physical differences between Black and White individuals continue to be prevalent among medical students and residents as “A 2016 study of 222 medical students noted that students believed there were differences in the nerve endings of Black and white patients, and hence, Black patients had more tolerance of pain: (paragraph 1) The resource describes how the teaching that racial groups are thought of as “inherently diseased” t is what leads to “healthcare bias and stereotyping in clinical settings, racially tailored clinical practice, and therefore, racial health inequalities”. (paragraph 2) It then goes on to describe how this is the origin of race-based medicine and how it results in racial inequities. Hoffman (2016) This resource “reveals that a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. It also provides the first evidence that racial bias in pain perception is associated with racial bias in pain treatment recommendations” (paragraph 1) The resource details that “extent research shows that relative to white patients, black patients are less likely to be given pain medications and, if given pain medications, they receive lower quantities” (paragraph 4) “Physicians were more likely to underestimate the pain of black patients (47%) relative to nonblack patients (33.5%)” (paragraph 6) -important for noting the modern-day disparities Stems from the racist beliefs that originated from slave owners and scientists/physicians at that time Dr. Samuel Cartright, who was a physician in the 19th century also did not believe in using anesthesia on his Black people stating ““Negro disease [making them] insensible to pain when subjected to punishment” The resource then details that “Other physicians believed that blacks could tolerate surgical operations with little, if any, pain at all” (paragraph 7)-- additional historical analysis “Study 2 also reveals that white medical students and residents who endorsed false beliefs showed racial bias in the accuracy of their pain treatment recommendations. Specifically, participants who endorsed more of these beliefs reported that a black (vs. white) target patient would feel less pain and they were less accurate in their treatment recommendations for the black (vs. white) patient” (paragraph 7) of the study 2 section; so so important shows the correlation between racial bias and misinformation on the role race plays in health and misdiagnosis and inaccurate results as well as racial bias. The results of the studies displayed that “beliefs about biological differences between blacks and whites—beliefs dating back to slavery—are associated with the perception that black people feel less pain than do white people and with inadequate treatment recommendations for black patients’ pain” (paragraph 1 of conclusion remarks)(--important as it displays the connection we are discussing, between racist history and the connection to the treatment of black people within healthcare (Jospeph 2021) Detailing about the importance of representation in healthcare and how it can impact the treatment of minorities in healthcare, this quote “A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals” (paragraph 1) Several influential systematic reviews have shown that healthcare providers’ implicit racial bias is associated with lower quality patient-provider communication which can affect patient satisfaction and contribute to health disparities” (paragraph 7)--. This shows the connection between the effect of implicit bias and the patient experience with a provider when they are of a different race and the provider has a preconceived notion of them because of their race “An important finding is that clinical educators themselves do not feel proficient enough to deliver training about race and discrimination. Gonzalez et al. [51] conducted 21 in-depth interviews with faculty who had the experience of teaching implicit bias or had an interest in facilitating discussions and found that they felt they lacked the skills and knowledge to appropriately discuss bias especially when students were resistant to learning about bias or expressed strong emotive reactions which present challenges within the learning environment”--SO IMPORTANT highlights the importance of medical schools having educators who understand racial disparities and know how to accurately teach their students. “It found that when non-African American students were exposed to disparaging racial remarks and jokes about black patients, they were significantly more likely to express racial bias [60]. These results suggest that the impact of the hidden curriculum may have a significant impact on healthcare professionals’ racial bias, but further studies in other countries and disciplinary groups are needed to explore this further.” - this highlights how important the medical school curriculum is and how vital it is to not have implicit bias play a role in the education of medical students Solutions: “Some studies suggest that in addition to being encouraged to become more aware of their personal biases, healthcare students should be taught bias reduction strategies and that these should be framed appropriately to reduce self-blame and shame” “By incorporating implicit racial bias training across the curriculum, evidence shows increased acceptance and reduced resistance to race discourse and shows promise for the long-term reduction of implicit racial bias in healthcare [63]” “the development of an inclusion strategy to show commitment to reducing bias, from hiring and retaining diverse faculty to admissions and assessment committees. In addition, they suggest that leadership may benefit from an organizational mandate to combine the use of diversity training and the IAT to identify and address bias throughout the workforce.” NIH Study (2021) This resource focuses on the “urgent need to address racial and ethnic disparities in maternal deaths” and details how many of the conditions are preventable, such as preeclampsia and eclampsia, which are blood pressure disorders that negatively impact black women more than white women, and are a major cause of the high number of maternal deaths seen in black women “Late maternal deaths — those occurring between six weeks and one year postpartum — were 3.5 times more likely among Black women than white women”-important statistic NIH study (2021) (Prater, 2022) “Specifically, Black women had 3.9 times higher odds of perceived discrimination, and had 10 times lower odds of perceiving they had substantial control over their healthcare choices” (1307). “Compared to other women of color, Black women reported higher rates of perceived discrimination (31% vs 11%, aOR 3.9 [1.2–12.1], p < 0.05) and lower perceived control over health choices (84% vs 98%, aOR 0.1 [0.0–0.8], p < 0.05)” (1306-1307). “Black participants were more likely to report their providers were not listening to them and were treated with less respect than others. This reflects either overt acts of racism or more likely implicit biases that affect healthcare providers’ interpersonal interaction with patients” (1308). (Grobman, 2015) Quotes- Ethnic disparities in health care have been defined as differences in the quality of care received by particular groups who have similar health insurance and the same access to a doctor when there are no differences between these groups in their preferences and needs for treatment (par. 1) Many studies have demonstrated the marked black–white difference that exists in both infant and maternal mortality (par. 2) …black women are more likely to have pregnancy-associated mortality even after accounting for severity of who reached complete dilation (par.2) Non-Hispanic black, Hispanic, and Asian women all had significantly greater odds of experiencing a severe postpartum hemorrhage or peripartum infection than non-Hispanic white women (sec. 3, par.1) Testimonies “Disconcerting results from Ubel et al. show that while many medical students are concerned with the moral aspects of performing nonconsensual pelvic examinations at the start of their training, ‘students who have completed obstetrics–gynecology clerkships place significantly less importance on seeking permission from women who are to be anesthetized before performing pelvic examinations’. This implies that medical students who are asked to participate in this training practice are learning not only the skills of obstetrics–gynecology but a moral lesson regarding when informed consent is and is not required.” (sec. 2) essentially this tells us that students that are taught to disregard consent for these practices are more likely to implement this into their own practices as physicians we are still being taught to disregard consent for the sake of “medical education” just as Sims did “400 medical students from five medical schools in Philadelphia, 90% of whom admitted to having performed a pelvic exam on an anesthetized woman” (sec. 1). Insight into how acceptance of non-consentual procedures from history can lead to the overlooking of consent for modern day education. Defenders of Sims say that what he did is justified as he did it "for the sake of scientific discovery" and this modern day "educational practice" is defended by the same excuse. (Khabele et al., 2020) Testimony of Dineo Khabele, MD “My husband and I, a black couple with a Harlem address, were admitted to the hospital with indifference” “I tried to ask for an epidural, but my labor pains were openly mocked. It is hard to describe how humiliating it is to be dismissed when vulnerable” “All I remember is wanting to be heard” Testimony of Linda D. Bradley, MD of biased treatment of black woman who was a victim of sexual assault “The chief resident looked at her with the most impatient attitude and shouted at her to move to the bottom of the gurney” ‘“Open your legs now,” he yelled as he tried to pry open her legs.’ “Her tears meant nothing to him. He did not acknowledge her pain and fear. He did not say that he felt sorry for what had happened to her” Trader (2022) Tons and tons of testimony stories Stress and fear black women face about reproductive outcomes: ““It just frightens me a little bit to, one, think about actually going through labor, but then, also, do I have to write my will within that timeframe of being nine months pregnant, or within that year postpartum? I don’t think people understand the type of stress that comes with knowing so much about what’s going on in the Black community.” (Participant 20) “We saw the news that black women are more likely to die, and now I’m scared to get pregnant” Pain: “Why are the stories that I hear from my Black girlfriends about these horrible experiences with the IUD? Is it because they think differently about Black women’s pain when they’re putting these things in? Or are people not being given enough choices?” Lack of listening from providers: “But I don’t necessarily like birth control. The fact that I’m always asked about it and my answer is always the same, it kind of rubs me the wrong way.” “They don’t think you know as much as they do, so they try to input their opinions and as far as what they think is the best route for you. So you’re forced to go by their opinions, rather than your research.” “provoked similar fear and anxiety, particularly when participants felt like the approach of the health care professional was “dismissive” or “passive.” When participants reflected on these negative outcomes, they wondered whether racism was at play and it contributed to their mistrust in reproductive health care.” Importance of representation: “When I’m with a physician that’s a Black person or another person of color, I more so just feel like I’m just in the room as myself and not having to explain or [be] stigmatized for certain things I’m experiencing.” (Participant 3) Mistrust: “I just didn’t feel vulnerable enough or safe enough to ask them those questions” Look into the story of Shalon Irving (Friesen, 2018) (Saraiva, 2023) “When addressing the situation of Black women, one cannot disregard the historical violence and sexual abuse, work exploitation and denial of the right to life, evidenced in the denied or non-assistance in accessing public services, especially health services, in primary, secondary, or tertiary care” (sec. 1). “thoughts that naturalize that Black people are more resistant to pain or that they hardly get sick and, therefore, tend to minimize complaints from Black people and reduce the use of medication and anesthesia, especially in women in prenatal and childbirth procedures” (sec. 2) Alyne da Silva Pimentel Teixeira went to the hospital November 13, 2002 “Alyne was black, 28, married, and the mother of a five-year-old daughter. With nausea and severe abdominal pain, shesought medical care, was given painkillers, and was discharged to return home” (sec. 1). Alyne returned to the hospital when she didn’t get better there it was confirmed that her unborn child had died “In the second hospital, the young woman waited several hours in thecorridor due to the lack of beds in the emergency room. She ended up dying on November 16,2002, due to a digestive hemorrhage caused by the delivery of a dead fetus” (sec. 1). Milene de Oliveira 19 year old black woman “the young woman reported unsuccess fully attempting to push for 13 hours in delivery after being admitted to the medical unit. She was harassed and embarrassed all the time, hearing that it was her fault” (sec. 1). “The young woman even begged for the cesarean procedure, as she could no longer bear the pain and depleted her strength to expel the baby, but her request was denied”(sec. 1). while she was in delivery the doctors told her : “Push, or else your baby will die” and “I am doing my best down here so your husband will want to have another child with you” (sec. 1)

Here, you will find all of the additional readings needed for the course Section One: Week One Psychology Today https://www.psychologytoday.com/us/blog/hot-thought/201406/what-is-the-self Week Three NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056146/ My Heart Sisters https://myheartsisters.org/2015/08/02/loss-of-self-chronic-illness/ The Mighty https://themighty.com/2017/12/losing-myself-to-my-illness/ Section Three: Week Nine The Atlantic https://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/ NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926580 Week Ten AP News https://apnews.com/9de024443e5745b6bafe714fd998b086/when-give-treatment-or-comfort-late-stage-cancer Section Two: Week Four AAPS https://www.aapsonline.org/ethics/oaths.htm Journal of the Royal Society of Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1457760/ Week Five Smithsonian Magazine https://www.smithsonianmag.com/history/in-need-cadavers-19th-century-medical-students-raided-baltimores-graves-180970629/ History https://www.history.com/news/the-infamous-40-year-tuskegee-study Week Six The Yale Journal of Biology and Medicine https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2595508&blobtype=pdf Week Seven The New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/nejmp2005492 NPR https://www.npr.org/2020/03/21/819645036/u-s-hospitals-prepare-guidelines-for-who-gets-care-amid-coronavirus-surge BMC Critical Care https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-02891-w Minnesota Department of Health https://www.health.state.mn.us/diseases/coronavirus/hcp/remdesivir.pdf Sections Four: Week Eleven frontiers in Behavioral Neuroscience https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4294163/ Patient Engagement HIT https://patientengagementhit.com/news/understanding-physician-empathy-how-it-impacts-patient-care NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494899/ Week Twelve Journal of Clinical Nursing http://pdfs.semanticscholar.org/efcb/a01f68c49d2dd5a3b8c704e722a0f3013b23.pdf DUKE Center for Personalized Healthcare https://dukepersonalizedhealth.org/2019/03/the-importance-of-physician-patient-relationships-communication-and-trust-in-health-care/ AMA Journal of Ethics https://journalofethics.ama-assn.org/article/they-are-people-first-then-patients/2017-05 NCBI https://www.ncbi.nlm.nih.gov/books/NBK115223/ Cambridge University Press https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1478951513000503