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Can’t get enough? I don’t blame you! Here’s a reading list and movie selection to keep the fire burning.


Reading

Culturally Diverse Populations

  • Reading Doctors Writing – David Piers Thomas
  • Medical Apartheid – Harriet A. Wasington
  • The Immortal Life of Henrietta Lacks – Rebecca Skloot
  • Songlines – Bruce Chatwin
  • Dark Emu – Bruce Pascoe

Women’s Health

  • Sex and Suffering – Janet McCalman
  • The Birth Wars – Mary Rose Maccoll
  • Testosterone Rex – Cordelia Fine
  • Elizabeth Packard: A Noble Fight – Linda Carlisle
  • Invisible Women: Data Bias in a World Designed for Men – Caroline Criando Perez

LGBTIQ+ Health

  • I don’t understand how emotions work – Fury
  • Structural Violence: On sex, gender and the medical cis-tem – Asiel Adan Sanchez
  • Queerstories – Maeve Marsden
  • Tranny – Laura Grace Jane
  • Gender Medicine – Marek Glezerman
  • Middlesex – Jeffrey Eugenides
  • And the Band Played On: Politics, People and the AIDS Epidemic – Randy Shilts

Who are the doctors we’re afraid of?

  • House of God – Samuel Shem
  • This is Going to Hurt – Adam Kay
  • God’s Hotel – Victoria Sweet
  • Being Mortal: Medicine and What Matters in the End – Atul Gawande
  • The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics – Barron Lerner

Other

  • The Narrow Road to the Deep North – Richard Flanagan
  • When Breath Becomes Air – Paul Kalanithi
  • The Double Edged Helix: Social Implications of Genetics in a Diverse Society – Joseph Alper
  • Behind the Shock Machine – Gina Perry
  • Frankenstein – Mary Shelley

Film

  • Putuparri and the Rainmakers (2016)
  • After the Apology (2018)
  • The Immortal Life of Henrietta Lacks (2017)
  • One Flew Over the Cuckoos Nest (1975)
  • Silence of the Lambs (1991)
  • Hysteria (2011)
  • Three Identical Strangers (2018)
  • Get Out (2017)
  • Gattaca (1997)
  • The Stanford Prison Experiment (2015)
  • Shutter Island (2010)
  • On Guard (1984)
  • The Danish Girl (2015)
  • The Pill (1988)
  • No mas bebes (2015)
  • Yentl (1983)

Culturally Diverse Populations

“People fail to get along because they fear each other; they fear each other because they don’t know each other; they don’t know each other because they have not communicated with each other.” – Martin Luther King, Jr.

Members of cultural minorities around the world typically face poorer health outcomes. This is due to numerous complex and intersecting factors that span across the economic, political, social and geographical spheres. As such, the solution is not simple. Regarding health, it requires top-down re-evaluation of the systems in place, and advocacy for ground-up initiatives to support these vulnerable people.

As Australians, this is something that is all too familiar to us. Indigenous Australians comprise ~2.5% of the Australia’s population. Indigenous people in Australia experience much poorer health outcomes than non-indigenous people. The most common causes of death in this population are circulatory disease (26%), neoplasms (19%), and external causes (15%) – which includes suicide (30%), transport accidents (28%), accidental poisonings (10%), assault (9%) and drowning (4%). Four groups of chronic conditions account for the majority of the gap in mortality between Indigenous and non-indigenous Australians; these conditions are circulatory disease, endocrine/metabolic/nutritional disorders (including diabetes), cancer, and respiratory disease. Our track record of providing health to our migrant population is similarly poor.

This exhibition aims to give a few example of the inequities inherent in health systems, both here in Australia, and abroad. Unfortunately, despite the current state of affairs, there is little education and training available to medical students regarding cultural safety. Consider your own competence when it comes to delivering culturally appropriate healthcare. Do you know the right questions to ask? How comfortable would you feel asking them?


IN A NUTSHELL:

  • Australia has a poor history of providing care to the culturally diverse members in our population – particularly Indigenous Australians and people seeking asylum.
  • Examining the history of medicine globally, this story is no different, with the impact of institutionalised racism and discrimination evident in patient outcomes.
  • As future medical practitioners, we all play a role in fighting the racism that is entrenched in the medical system, to ensure the delivery of healthcare that is both culturally sensitive and accessible to all.

Image #1 (sourced here): Henrietta Lacks (1920 – 1951), a young mother of five, presented to the Johns Hopkins Hospital with vaginal bleeding in 1951. John Hopkins was, at the time, the only hospital to treat poor African American citizens. On examination, she was discovered to have a large malignant cervical cancer. Henrietta passed away, aged 31, later that year.

A sample of her cancer was sent to Dr Gey, a prominent cancer and virus researcher, who noticed that Mrs Lacks cells doubled in number every 20-24 hours, rather than dying like his other samples. These cells, named ‘HeLa cells‘, are still in use today to study the effects of toxins, drugs, hormones and viruses on the growth of human cancer cells. They played a crucial role in the development of the polio vaccine and have taught us about the human genome. HeLa cells are the oldest and most commonly used immortal cell line in scientific research. Read more about Henrietta’s legacy here, check out Rebecca Skloot’s novel, or watch the film.


Collection #2: The Tuskegee Syphilis Experiment

Patients involved in the Tuskegee syphilis experiment, the infamous and unethical clinical study conducted between 1932 and 1972 by the US public health service. The purpose of the study was to observe the natural history of untreated syphilis. Study participants were all African-American men, who were told that they were receiving free healthcare from the US government. Even when penicillin became available to treat syphilis in 1947, participants did not receive the drug. The study was conducted without informed consent. Read more here. (images sourced here & here).


Collection #3: Medevac

On Tuesday 12th February 2019, the Medevac Bill passed by one vote, guaranteeing medical transfer of sick asylum seekers from Nauru and Manus Island to Australia for treatment. A prime example of Australian doctors standing together to advocate for change. Read more about the Medevac Bill, the health crisis on Manus and Nauru, and the campaign led by Dr Neela Janakiramanan and Dr Sara Townsend (image 3.1). (images sourced here, here)


Collection #4: Close the Gap

The concepts of health and healing in Indigenous Australian culture are intimately connected to nature. Bush medicine is a practice where plants are utilised for their healing properties, for example boiling the leaves of ‘old man’s weed’ (Centipeda cunninghamii – pictured 4.1) to sooth the symptoms of arthritis. Each Australian region has its own plants. The practice of bush medicine thankfully endured colonisation despite the instigation of typically patriarchal western medical systems and the failure of said system to recognise the legitimacy of natural Indigenous healing. The great divide between these two divergent medical systems, at cultural, spiritual and philosophical levels, cannot be ignored as a significant and ongoing contributor to the gap in health outcomes between Indigenous and non-Indigenous Australians that still exists today.

A number of initiatives are in place to rectify the current state of affairs regarding Indigenous Health outcomes in Australia. These include the Close the Gap initiative, which started in 2008 and aimed to eliminate the gap between Indigenous and non-Indigenous Australians across a range of parameters (health, education, employment). This has been supported by a range of Australian organisations including Red Dust and NACCHO, and has seen the establishment of innovative and creative ways to deliver healthcare in remote communities, including the dialysis bus. That said, there is still a long way to go in closing the gap – and all of us have a part to play.

Read more about the Close the Gap targets and recent progress. Get more information about the reasons why things are the way they are in Indigenous Health by reading this in depth literature review. Also check out the UoM Medical History Museum’s awesome exhibition titled ‘The Art of Healing’, a celebration of 65000 years of Indigenous Australian healing practices through contemporary art. (images sourced here, here, here and here).


“Three generations of imbeciles are enough.” – Justice Oliver Wendell Holmes (USA)

Forced sterilization of women was commonplace throughout the 20th century. Women with undesirable traits such as ‘feeblemindedness’, ‘promiscuity’, mental illness, developmental disability were medically sterilized. Forced sterilization largely targeted the least powerful people, with minority women and immigrants making up a large proportion. The sterilization of American Carrie Buck (pictured) is one such example. Read more about the eugenics movement in the USA here.

Forced sterilization was a manifestation of the growing eugenics movement, that gained momentum under the Nazi Germany regime after the establishment of the ‘law for the prevention of genetically defective progeny’. Between 1970 and 1976, 25-50% of all African American women were sterilized. This was happening everywhere, however was most prevalent in Puerto Rico.

Collection 5: sterilization. (images sourced here, here, here and here)

Collection 6: eugenics. (images sourced here, here, here and here)


WANT MORE?

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LGBTIQ+ Health

Lesbian, gay, bisexual, transgender, intersex and queer/questioning (LGBTIQ) Australians experience significantly poorer health outcomes when compared to the broader population. The reasons for these inequalities are grounded in Australia’s long history of institutionalised discrimination. These include:

LGBTIQ+ individuals are more likely to suffer poor mental health and engage in high risk activities such as smoking, illicit drug use or alcohol abuse. Health disparities between sexual minority and heterosexual populations appear to be attributable to stress arising from heterosexist discrimination and victimisation. Lack of safety leads to sexual identity concealment in the face of anticipated stigma (so called ‘minority stress’). Heteronormativity, prejudice, rejection and internalised homophobia compound this minority stress. The health inequalities faced by LGBTIQ+ people are the most prevalent amongst the ageing LGBTIQ+ population, who are doubly invisible regarding the provision of healthcare.

What’s more, there is a disturbing lack of education about LGBTIQ+ during medical school, particularly regarding the health of transgender and lesbian individuals. This does not bode well for changing a system that is already inept at providing safe and inclusive healthcare to LGBTIQ+ individuals.


IN A NUTSHELL:

  • LGBTIQ+ individuals throughout history have suffered globally due to discrimination and persecution.
  • LGBTIQ+ Australians face poorer physical and psychological health outcomes, and are more likely to engage in risk taking behaviour including heavy drinking, smoking, and illicit drug use.
  • Despite recent progress, there is still a long way to go in ensuring equity of access to inclusive healthcare for all.

Collection #1: HIV

1981 saw the discovery of what was then known as ‘gay cancer’ (Kaposi’s sarcoma). This new disease was full of mystery and fear – nobody knew what it was, where it was coming from. All they knew is that it would eventually kill them.

The AIDS scare was an incredibly distorted and duplicitous public health panics of the last half century. The politics of AIDS have always been governed by fear; in the early days, health professionals were not exempt from this, with everyone jumping on the fear bandwagon.

In the 1980s, treating the much feared GRID (gay-related immune deficiency) was difficult. Senior consultants wanted nothing to do with it. Many were calling for a moratorium on the provision of care, with a view that they were likely to die regardless and that the potential for spread of the condition was too great. Try and imagine yourself in the situation. How would you feel, performing CPR on a crashing patient with ‘gay cancer’? Not to mention the emotional burden doctors suffered, dealing with the loss of so many patients and helping their families during this time.

Beyond the four walls of the hospital, fear was everywhere; spurred on by scaremongering political advertising campaigns (pictured). Even if you ‘looked gay’, you were at risk of sustaining physical abuse, facing stigma and discrimination around every corner.

Thankfully, by the 1990s, solid progress was being made in the establishment of supportive networks and access to appropriate treatment for HIV sufferers. Outside of Africa, HIV infection today continues only to affect vulnerable members of our society (injecting drug users, men who have sex with men). Even within these communities it remains quite rare, and is a treatable and preventable chronic disease.

For more information about the timeline of the AIDS epidemic, check this out. (Images sourced here, here, and here).


Collection #2: #TransDocFail

Dr Richard Curtis was the UK’s first transgender doctor. Dr Curtis specialises in the treatment of gender dysphoria. Dr Richard Curtis was born a woman but described himself as feeling like a “gay man trapped in a woman’s body”. As a GP in the UK, he was investigated by the General Medical Council for prescribing sex change hormones to several patients without the specialist knowledge or skills to do so. This negative media portrayal lead to the #TransDocFail, sparking discussion among the trans community of their experiences of how they are treated by medical practitioners in general. Several thousand tweets proved that the biggest problem facing the trans community was institutional transphobia rather than a rogue specialist. Read more here.

Read a summary of tweets using the #TransDocFail hashtag, put together by activist Zoe O’Connell here.


Collection #3: Homosexuality; A Disease to be Cured

Homosexuality was in the DSM as a formal psychiatric illness until 1973. Practices aimed at ‘curing’ homosexuality have existed for centuries; examples include:

  • Dr Carl Vaernet, a Nazi doctor who experimented with injecting hormones into testicles to cure homosexuality
  • A Nazi German doctor, Eugen Steinach (pictured), who believed that homosexuality was rooted in the testicles, and thus carried out testicle transplantation experiments

Gay conversion therapy (AKA cure therapy, reparative therapy, ex-gay therapy, or sexual orientation change efforts) comprises all ‘treatments’ aimed at changing a person’s sexual orientation to comply with the heteronormative standard.

These practices are diverse, spanning from intensive psychotherapy to chemical castration, electric shock therapy, aversion techniques, and ‘corrective rape’. Not limited to outdated practices, iTunes and Google Play offer a 60-day “gay cure” app. Rather than showing any demonstrable benefit, therapy has been shown to increase anxiety, depression, high-risk sexual behaviours and a nine-fold increase in suicidal thoughts. 

Gay conversion therapy remains legal worldwide, including in the UK, Germany, and the USA. (images sourced here, here, here, here and here)


Image 4: Reimer and Dr Money

In 1965, twins Bruce and Brian Reimer were born as perfectly normal healthy boys. However, due to issues with urination, they underwent circumcision at age 7 months. An accident during the procedure left Bruce without a penis. Dr John Money saw this as an opportunity to prove his hypothesis that gender is determined purely by how we are raised, so now 17 months old, Bruce became Brenda, undergoing full castration.

Dr Money told the Reimer parents to raise Brenda as a girl, stressing that if they wanted the sex change to work, the parents must never let Brenda or her twin brother know that she had been born a boy. Brenda was raised as a girl, but by the time she was 13, she was feeling suicidal.

At this stage, her parents decided to go against Dr Money, revealing the sex change. Within weeks Brenda chose to become David. However, the trauma of the experience plagued both David and his brother, who both committed suicide. Dr Money falsified his results, yet there are still decisions being made about whether to bring children up as male or female if they suffer from what is called Disorders of Sex Development based on his “research”.(images sourced here and here)

WANT MORE?

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Women’s Health

“To be ‘feminist’ in any authentic sense of the term is to want for all people, female and male, liberation from sexist role patterns, domination, and oppression… Feminism is for everybody.” Bell Hooks, 1981 (Ain’t I a Woman: Black Women and Feminism)
“I am angry, but I am also hopeful, because I believe deeply in the ability of human beings to remake themselves for the better.” Chimamanda Ngozi Adichie, We Should All Be Feminists

To this day, the world is still grappling with pervasive and inexcusable gender inequalities that are underpinned by bias and sexism. It is well established that women are under-represented in positions of power and leadership, and experience discrimination and gender-based violence. This has an undeniable and significant impact on healthcare delivery and has a deleterious effect on the health of women worldwide.

According the WHO, some of the sociocultural factors that prevent women and girls to benefit from quality health services and attaining the best possible level of health include:

  • unequal power relationships between men and women;
  • social norms that decrease education and paid employment opportunities;
  • an exclusive focus on women’s reproductive roles; and
  • potential or actual experience of physical, sexual and emotional violence.

You can read more sobering facts from WHO about the global state of Women’s Health here.

Considering the factors outlined above through the lens of intersectionality, and the picture becomes even more complex. Unfortunately, here in Australia we see the effects of gender discrimination play out all too often, despite decades of recognition. This RACGP report that compares the health of male and female Australians side by side paints an excellent picture of the current state of affairs in Australia.

Within the Australian medical system, it’s no different. You don’t have to search very hard to find proof of the gender pay gap, the gross under-representation of women in surgery, under-representation of females across the majority of specialist-in-training programs, and inequalities in paid parental leave, despite females making up more than half of Australia’s annual medical school graduates.

Equity is giving everyone what they need to be successful. Equality is treating everyone the same. We need to level the playing field. It is becoming increasingly recognised that actions must be directed at transforming the systems women work within, and pushing for institutional-level change.

Yes, we’ve come a long way. But we still have a long way to go. I’m not asking anyone to light their bra on fire and vociferously denounce the patriarchy here. All I ask of you, is this: consider your unconscious biases and how this might affect your medical practice. Consider your privilege, and what steps you might take to promote equity in healthcare. As medical practitioners, we have a role in changing the system.


IN A NUTSHELL:

  • Pervasive gender inequalities affect the health outcomes of women worldwide.
  • Gender inequalities affect women everywhere, including in the medical industry.
  • We all must strive for gender equity, and consider our unconscious biases, if we are to reduce the impact of gender discrimination both in Australian society and beyond.

Collection #1: The ‘Father of Modern Gynaecology’

Dr J Marion Sims (1813-1883), aka the ‘Father of Modern Gynaecology, was an American physician and ‘surgical pioneer’. His most significant work was the development of a surgical technique to repair vesicovaginal fistula (a severe complication of obstructed delivery). How did he go about developing his skills? By operating without anaesthesia on enslaved black women. According to Sims, the women had no better option and were willing to go under the knife. The ‘Sims Speculum’ (pictured) is still used today (allbeit rarely).

Read more about Dr Sims and his medical practice here. If you’d like to know more about the controversies surrounding Dr Sims, check this out. (Images sourced here, here, here and here).


Collection #2: Get Cliterate

Ever noticed that anatomy is typically taught exclusively using the male body? When Professor Helen O’Connell (pictured) (Australia’s first female urologist) was a medical student, she certainly did. Studying the 1985 edition of Last’s Anatomy, she found that there was no mention of the clitoris, despite there being two full pages on the penis. Additionally, female genitals were described, word for word, as a ‘failure’ of male genital formation. Prof O’Connell got to work on characterising the clitoris and its relation to the remainder of the female reproductive tract, work which culminated in the publication of her paper, Anatomy of the clitoris (2005). How is it, that the clitoris was only fully discovered in 1998? Read more about Prof O’Connell her story here.

How about the anatomical image of female breast tissue that went viral earlier this year? It seems as if, over the course of history, the female body and it’s anatomy has been ignored, and is still to this day a taboo topic. This tells us something about the society in which we live, and the status of women within that society. (images sourced here, here and here)


Collection #3: The Affliction of the Wandering Womb

It turns out that the practice of labelling women as ‘crazy’ has deep historical roots. Hysteria takes its etymological roots in the greek word ‘hystera’ meaning uterus, coined by Hippocrates in 5th Century BC. Subsequently, female hysteria was an official medical diagnosis used to explain symptoms including nervousness, hallucinations, emotional outbursts and various urges of the sexual variety (excessive vaginal lubrication, erotic fantasy, the list goes on). Interestingly, the cure for female hysteria involved ‘pelvic massage’ leading to ‘physician-assisted paroxysm’ (aka orgasm). Female hysteria actually led to the development of an ‘electromechanical medical instrument’ to provide therapy for these suffering women; enter the modern vibrator. Other therapies included, clitoridectomies, hydrotherapy (pictured), and wafting sweet meats and flowers between the legs of affected women. Hysteria as a term was not dropped until 1980.

Unfortunately, this is still happening today, the most recent example in the media hitting very close to home: earlier this year, a young surgical trainee was dismissed as being “an emotional female” after being exploited and overworked at Bankstown Hospital, Sydney. Read more here.

Image 1: a woman receiving hydrotherapy, sourced here. Image 2: an early vibrator used in the treatment of female hysteria, sourced here. Image 3: a hysterical woman, sourced here.


Collection #4: Out of the Kitchen, into the Asylum

Throughout the 19th century, prior to womens suffrage, it was generally expected that a woman’s place was in the home. Psychiatrists shared this view that women should be subordinate to their husbands and dedicated to their domestic responsibilities. Women who rebelled against their domesticity risked being declared insane and as a result being committed to an asylum. This was usually at the request of their husband or father. There was no right to contest or appeal the decision. The list of reasons detailing why these women were locked away is equal parts bizarre and chilling.

Elizabeth Packard (1816-97) (pictured) is one such woman who suffered in asylums throughout her life for ‘publicly expressing radical religious views’. Her so called ‘brain fever’ was deemed a risk to her husbands career and reputation. After convincing hospital staff of her sanity, her husband subsequently imprisoned her in her own home, by locking the doors and nailing the windows shut. After taking her husband to court for divorce, Packard was instrumental in instigating much needed reform – read about the Packard Laws here. Read more about lunacy in the 19th century here and here.

Image 1: Elizabeth Packard (see above, sourced here). Image 2: A list of reasons why women were admitted to in the 19th century, sourced here. Image 3-5: Women in the 19th Century asylums, sourced here, here and here.


Collection #5: What a mesh!

You’ve likely all heard about the pelvic mesh scandal that left thousands of women irreversibly harmed. The mesh was used for transvaginal or transabdominal repair of pelvic organ prolapse (including cystocele), and the associated symptoms (stress urinary incontinence). Women have experienced a range of outcomes after receiving mesh treatment, including:

  • chronic pelvic/back/hip pain;
  • PV bleeding;
  • haematuria secondary to erosion of mesh into the bladder, urethral obstruction leading to urinary retention, and recurrent UTI and/or vaginal infection;
  • fistula formation, wound breakdown, and mesh exposure.

Earlier this year in April, the FDA recalled all mesh products due to insufficient evidence assuring the benefits of these products outweigh the risks. An investigation uncovered a convoluted web of payoffs and dodgy dealings that allowed the use of transvaginal mesh without having solid evidence behind it. This issue sheds light on much bigger issues around the utilisation of implants and devices in our medical industry – particularly the overwhelming lack of regulatory systems allowing for product quality control, tracking, and recall.

Check out the Health Report Podcast on deadly devices and lacklustre regulation, and read about the latest updates here. (images sourced here, here and here).


Collection #6: Contraception

Somewhere along the way, a woman’s right to use birth control translated into a woman’s responsibility to use birth control.” – Lawrie James-Hawkins

The OCP became available for use in the 1960s (initially only for married women with a prescription). The feminist movement initially celebrated female contraceptives for giving women the power to control if and when they became pregnant. As the years passed, and the initial glow and joy brought by the pill and its reproductive freedom began to wane, as women realised that birth control was becoming both a right and a responsibility. Read more about this here.

Why is it, that birth control is still the sole responsibility of women? Yet another result of a patriarchal system and a pharmaceutical and medical industry where men hold all the power. Here’s a few facts for you:

  • although available to both men and women, sterilisation is cheaper, more effective, reversible and less invasive for males
  • clinical trials for male oral contraceptives were stopped because of adverse side effects including acne, mood disorders and raised libido

It’s likely the female OCP would have had the same fate if it were invented today! Read more about the contraception options available to men here, and about the process undertaken by the FDA in approving the pill for use here.

(images sourced here, here, and here).


Collection #7: No gloves? Big problem

Stewart Geoffrey Moroney (image 7.1), a 69yo general practitioner from Wangaratta, was accused of capturing sensitive female examinations on film and performing said examinations without gloves. He faced a string of charges including sexual assault and capturing intimate images. A total of 19 female victims have come forward during the investigation, aged between 17 and 60 years. He was found deceased prior to the formal conclusion of court proceedings. Read more here.

Dr George Tyndall (image 7.2), a former gynaecologist at the University of Southern California health centre, has been accused of sexually abusing hundreds of female students during is 30 year tenure at the clinic. Tyndall has been accused of performing unnecessary, often lengthy pelvic exams, without using gloves. Tyndall has been thoroughly investigated by the Los Angeles police and has subsequently had 650 law suits filed against him. There is considerable evidence that he preyed on foreign students who were vulnerable due to their age and poor english language skills. What’s even more despicable, is that USC was aware of his medical misconduct and looked the other way for years. Read more here.

These gentlemen are just two of many similar examples of doctors abusing their position of power in the doctor-patient relationship. Never forget the privilege afforded to us as medical professionals to be involved in the lives of our patients. Our interactions with are patients are often at times when they are at their most vulnerable. Tantamount to this, never forget the incredible ways in which we can influence the experience of our patients, both for the better and the worse. (images sourced here, here, here and here).


Image #8 (sourced here): A real ‘lady-killer’

Harold Shipman (1946 – 2004), also known as ‘Dr. Death’ and ‘The Angel of Death’ is one of the most prolific serial killers in history. He hid behind his status as a caring, family doctor, and was able to conceal his crimes for years. Eventually, he was found guilty of the murder of 15 patients under his care; however reports suggest that he killed up to 260 patients in total. 80% of his victims were elderly women. You can read more about his story here.

Image #9: Gynaecologist in Disgrace

Disgraced gynaecologist, Dr Emil Shawky Gayed, mutilated and performed unnecessary operations on dozens of women over the course of decades (dating back to 1997). What is similarly shocking, is that doctors and coworkers, to some degree, were aware of his disgraceful medical practices. Numerous investigations were conducted by the NSW medical board which ultimately found Gayed’s conduct ‘reasonable’. Read all about it here. Some of Gayed’s criminal conduct include:

  • removing three-quarters of a patients cervix without obtaining consent
  • completing a total hysterectomy on a patient without obtaining consent
  • perforating a patients bowel and uterus in multiple places, cuts ranging in size from 1cm to 5cm
  • breaching protocols for infection control
  • altered medical records

Read more about issues with dealing with medical malpractice suits in Australia here. (image sourced here).

Image #10: Dr Margaret

James Miranda Steuart Barry (1789 – 1865) was a successful British Army surgeon who served in India and Cape Town (SA). He started life as Margaret Ann Bulkley. Her uncle conspired to help her get into medical school, posing as as ‘James Barry’, during a time when women had limited career opportunities. Her secret was only discovered when she died of dysentery in 1856, at which time she had successfully spent 46 years masquerading as a man. This story illustrates the extreme lengths that some women were willing to go to to be able to enjoy the same privileges as their male counterparts.

Read more about Dr Barry’s life here. (image sourced here and here).


WANT MORE?

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Doctors are always appearing in popular culture, as characters in films, TV shows, books – you name it. For this reason, these representations play a significant role in shaping how doctors in reality are perceived by members of the general public. Additionally, these characters reflect public attitudes towards doctors, medicine and science more broadly within our community.

Television, films and the like aim to entertain. It cannot be denied that directors and producers often exaggerate in order to achieve this goal. That said, characters are inspired by lived experience and are grounded in reality. While some of the characters presented in this museum seem farfetched and at times, laughably detached from the reality of modern medicine, elements of these portrayals must hold true. Think about some of the doctors included in this museum – do you identify with any of them?

There are all kinds of different characters represented: extreme narcissists; beautiful arrogant heroes with excellent bedside manners; exceptionally smart with no beside manners at all; sex-obsessed, drug-addicted antiheroes; crazy harebrained scientists; all the way through to the downright clumsy and inept. Do any of these qualities align with your definition of ‘a good doctor’? What are the implications of presenting medical doctors in this way for the provision of healthcare?


IN A NUTSHELL

  • Doctors are often not presented accurately in popular culture, and this creates unrealistic expectations around who doctors are, what their lives are like, and what they are capable of.
  • Elements of these characters, as much as we are ashamed to admit it, are grounded in truth. Perhaps this means that as a profession we are not as reputable as we might like to think.
  • Keeping this in mind, it is important to consider what the qualities of a good doctor are, and how this might differ from those represented in popular culture.

Check out this article for more.


Television

Image #1: Characters Dr John Dorian, Dr Elliott Reid and Dr Christopher Turk from Scrubs (2001 – 2010) (sourced here).

Image #2: Characters from medical drama Greys Anatomy (2005 – present) (sourced here).

Image #3: Characters Dr Nick and Dr Hibbert from The Simpsons (1989 – present) (sourced here).

Image #4: Characters from M.A.S.H (1972 – 1983), a show that depicts the lives of doctors working in an army hospital in the Korean War (sourced here).

Image #5: The many different portrayals of ‘The Doctor’ in the Doctor Who series (2001 – current), who despite being an alien adventurer possesses skills in clinical medicine (sourced here).

Image #6: The Good Doctor (2017 – current) portrays the experience of a young surgeon with autism and Savant syndrome (sourced here).

Image #7: Excellent yet unorthodox diagnostician, the enigmatic Dr Gregory House from House M.D. (2004 – 2012) has an inflated ego, antisocial tendencies and a serious addiction to narcotics (sourced here).

Image #8: Keeping it close to home, All Saints (1998-2009) is an Australian medical drama set at the All Saints Western General Hospital, focusing on the experience of doctors and nurses working on the ‘garbage ward’ (sourced here).

Image #9: Perhaps a little less medicine and a little bit more romantic comedy, Offspring (2010-current) is another Aussie show depicting the life of Nina, a 30-something obstetrician and her ‘many romantic ventures’ (sourced here).


Film

Image #10: Psychiatrist Dr. Hannibal Lecter in Silence of the Lambs (1991) has been in maximum security for 10 years for being a serial killer who cannibalised his victims. Manipulative and cryptic, Lecter is a likely psychopath and homocidal maniac (sourced here).

  • Are you looking for sympathy? You’ll find it in the dictionary between shit and syphilis.” – Lecter

Image #11: Adapted from the acclaimed novel by the same name, Mary Shelley’s Frankenstein (1994) tells the harrowing life story of brilliant but unorthodox Dr. Victor Frankenstein who is on a quest to conquer death (sourced here).

Image #12: Dr Doolittle (1998) is a doctor who can speak to animals. Enough said (sourced here).

Image #13: Dr Strange (2016), a brilliant neurosurgeon, must put his ego aside after a tragic car accident and learn the secrets of the metaphysical world (sourced here).

Image #14: Dr Spivey, a psychiatrist in One Flew Over the Cuckoos Nest (1975) is addicted to opiates and is notoriously submissive to the controlling Nurse Ratched. Spivey eventually gains spirit and courage from McMurphy (Nicholson), one of the patients on the ward (sourced here).

Image #15: Hitchcock’s classic Psycho (1960) is a horror film that tells the story of officeworker Marion who ends up checked in at the Bates Motel, run by introverted Norman. Dr Bill Raymond, appears in the lesser known Psycho II (1983) as Bates’ psychiatrist (sourced here).

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Doctors in Pop Culture

Dastardly Doctors


Historically, members of the medical profession have always been held in high regard. Along with this, comes idealistic (and often unrealistic) expectations about what doctors are able to deliver, how doctors should act, and the kind of people doctors should be. More information about the reasons why this is can be found here.

Despite spending years at university, passing numerous exams, and completing rigorous training, at the end of the day doctors are still human beings. And thank goodness, as our humanness is essential in connecting with patients and practicing empathic, patient-centred medicine. However, despite the lofty expectations placed upon doctors by society at large, doctors (in all their humanness) are fallible and are not immune to making mistakes.

There is a significant difference between a doctor making an honest, human mistake, and a doctor who abuses their position of power and privilege to intentionally cause harm. Between these two ends of the spectrum, there exists a vast grey area, where intention and fault is unclear. Consider the role of the individual within the context of the medical system – who is really at fault?

This part of The Vault exhibits a few examples of behaviours that, on reflection, may not be acceptable. This includes poor behaviour from single individuals, groups of individuals, and the medical system more broadly. Some examples show doctors making honest mistakes. Some are a little less innocent. A few show examples of downright dastardly doctors.


IN A NUTSHELL:

  • Doctors and medical professionals are held in high regard within society.
  • Despite the lofty and somewhat unrealistic expectations placed on medical professionals around what is and is not acceptable, doctors are still human beings, and as such are fallible.
  • Doctors will always make mistakes. How do we define what is and what isn’t acceptable behaviour for doctors, and to what degree is this governed by the medical system in which doctors operate?

Bizzarre Medical Endorsements

Got a headache? Feeling a bit under the weather? Here, have some heroin! Over the course of history, it has not been uncommon for advertising agencies to utilise the societal status possessed by doctors as a promotional tool.

Collection #1: Coca Cola

Collection #2: Cocaine, Heroin and Other Drugs

Images sourced here, here and here.

Collection #3: Cigarettes

Read more about doctors promoting cigarettes here. Images sourced here, here and here.


Bodysnatching

We’ve all been in the anatomy dissecting rooms at UoM. We also all know how much of a privilege it is to be able to learn in this way, and the sacrifices made by the patients and families who have donated their bodies. Unfortunately, this wasn’t always the way it was done.

Graverobbing or bodysnatching was a common practice throughout the 19th century as a means of obtaining corpses for anatomy dissection lectures. Often, it was the bodies of people belonging to socially and economically marginalised societal groups. Read more here.

Image #4: Medical students play poker with an anatomy cadaver (image sourced here and here)

Image #5: Doctors drink and cajole while graverobbing for bodies to dissect (image sourced here).


Unruly Individuals

Image #6 (sourced here): Make Medicine Great Again

Wearing a white lab coat and a gold plated stethoscope, there was a lot of chat on the internet about whether this guy was actually a real doctor. Turns out that he is a real physician. He certainly created a stir by positioning himself so stealthily behind Trumps podium. It’s hard not to question this guy’s M.O.

Image #7 (Sourced here): “False hope? There’s no such thing.”

You’ve all probably heard about Dr Charlie Teo, an Australian neurosurgeon who operates on brain tumours deemed, by cost-benefit risk analysis, to be inoperable by other surgeons. There has been significant controversy surrounding Teo recently, particularly around the exorbitant fees he charges for his risky procedures.

Is Dr Teo a cowboy surgeon skating on thin ice, or is he a well-intentioned doctor trying to advocate for his patients working within an oppressive system? Hero, or antihero?

If you’d like to know a bit more about Dr Teo, you can read more here, or listen to this informative 7am podcast. You can watch his Ted Talk below.

Image #8 (sourced here): Dr Death

Formerly a neurosurgeon working in Texas, Christopher Duntsch a.k.a ‘Dr Death’ had a promising future and medical career until drug abuse and mental health problems sent him into a downward spiral. Over the course of two years, he operated on 38 patients in the Dallas area, leaving 31 paralysed or seriously injured, and 2 dead as a result of surgical complications.

He concealed his adverse outcomes by moving from hospital to hospital. Duntsch was inadvertently aided in his endeavours by shifty medical organisations (including Baylor Plano) who swept his behaviour under the carpet with the aim of continuing to profit from his surgeries. Despite numerous poor patient outcomes and growing suspicion that Duntsch was a dangerous physician, he continued to operate, luring patients under the knife with his arrogance and false promises. In 2017, he was convicted of various crimes and sentenced to life in prison.

Read more here, or listen to the Dr Death Podcast.

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Who are the doctors we’re afraid of?

“Doctors enter medical school with the same mental health as their non-medical peers. We don’t start medicine with poorer mental health; poor mental health is an occupational risk of being a doctor.” – Dr Neela Janakiramanan. Read more.

Who are the doctors that you’re afraid of? Is it:

  • the overworked and burntout registrar that looks through you like you’re a part of the wall at morning ward rounds?
  • the consultant that always looks to your male colleagues for the answers?
  • your general practitioner who tells you to “slow down, you have to look after your mental health”?
  • the OSCE examiner with the punishing list of tickboxes in front of them?
  • yourself – soon to be intern, paralysed by fear that you will make a mistake, or not be able to cope?

The statistics around the mental health of Australian doctors and medical students are startling. Mental health difficulties are likely to have touched all of us in one way, shape or form throughout our lives both inside and outside of medicine.

A combination of long work hours, significant risk of fatigue and burnout, high pressure and emotionally taxing situations, and a medical system that fails to provide support, make the medical profession a perfect storm for poor mental health. Bullying and harassment is “as old as the profession itself” and is commonplace, with juniors suffering at the hands of their seniors all too often. To add to an already complicated situation, doctors and students feat stigmatisation as a result of speaking up and seeking help.

Why are doctors afraid of speaking up?

  • doctors and students fear being barred from practice
  • doctors and students fear that their peers will perceive them as being less competent, or weak
  • there is a tendency for victim-blaming; particularly around lacking resilience and the ability to cope

It is clear that the toxic culture of bullying in medicine needs to change. Thankfully, there is increasing awareness of the issues faced for students and doctors as they progress through their careers. There is also increasing awareness of the risks to patients in the current system.


IN A NUTSHELL:

  • Australians in the medical profession are more likely to suffer poor mental health than the remainder of the population.
  • There are multiple factors
  • Practice self care, look out for your colleagues, and endeavour to be part of the change that needs to happen within the culture of medicine to safeguard the health of both medical professionals and patients alike.

Collection #1: Socks for Docs

Dr Geoff Toogood (pictured), a cardiologist at Peninsula Health and BeyondBlue ambassador, accidentally wore odd socks to work last year. One of his colleagues noticed, and knowing about Toogood’s previous battles with mental health, asked whether he was OK – and so began the crazy socks campaign. The campaign aims to raise awareness, create safe spaces to seek help, advocate for doctors and their mental health, and take action on changing the system. (images sourced here, here and here).

Other images sourced here, here, here and here.


If you or anyone you know needs help:

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Timeline

Let’s take a look now at the history of medicine and science over the course of the last 200 years. Please note that this timeline is not exhaustive, and only represents a selection of events relevant to the theme of ‘Atonement’.


Collection #1: 1840, Vaccination Act Passed in Great Britain

Anti-vaccination sentiment is far from new. Vaccination began in the early 1800s when Edward Jenner introduced his smallpox vaccine. As soon as the Vaccination Act was passed in 1840, which made it compulsory for infants to be vaccinated against smallpox during their first three months, anti-vaccination protests began. Wild claims were being made about vaccines causing cancer, vaccines only existing as a result of conspiracy by the medical establishment, and more. These protests intensified in the 1870s when the law was changed to punish officials who did not enforce the 1840 act. A large number of anti-vaccination books and journals appeared during the 1870s-80s, including: the National Anti-Compulsory Vaccination Reporter (1874), and the Anti-Vaccinator (1869).

More information can be found in this BMJ article.

Images 1, 2 & 3: Early anti-vaccination propaganda. (sourced here, here and here)

Image #4: The ‘Vaccination Monster’ (sourced here)

From the BMJ: “A mighty and horrible monster, with the horns of a bull, the hind of a horse, the jaws of a krakin, the teeth and claws of a tyger, the tail of a cow, all the evils of Pandora’s box in his belly, plague, pestilence, leprosy, purple blotches, foetid ulcers, and filthy running sores covering his body, and an atmosphere of accumulated disease, pain and death around him, has made his appearance in the world, and devores mankind —especially poor helpless infants—not by sores only, or hundreds, or thousands, but by hundreds of thousands (vide Vaccinae Vindicia: 413, 423).”

Image #5: A young female patient receives a vaccination. (sourced here)


Collection #2: 1940s, Wartime Experimentation

1. Japan, 1939-1945

Unit 731, a covert biological and chemical warfare research and development unit of the Imperial Japanese Army, undertook lethal human experimentation during WWII. It was one of two biological warfare research centres at the time, led by Lieutenant-General Ishii Shiro. As it was a clandestine operation, there is no complete list of experiments undertaken by the unit. The unit was infamous for its vivisections, particularly the infection of humans with the plague and anthrax, then subsequently eviscerating them without anaesthesia to determine the impact of the disease on human organs. Other experiments included:

  • locking prisoners inside pressure chambers to see how much the body could tolerate
  • exposure to cold until their limbs froze off in an effort to determine how best to treat frostbite
  • tying prisoners to stakes outside and testing biological weapons such as plague cultures or bombs filled with plague-infested fleas
  • testing of poison gases
  • administration of supratherapeutic doses of tetanus vaccine

At least 3000 prisoners died from the experiments performed by unit 731 between 1939 and 1945. No prisoner that entered the gates of the unit emerged alive. The weapons developed by the unit killed or injured an estimated 300,000 people. (Images sourced here, here, here and here)

2. Nazi Germany, 1933-1945

Under the Nazi regime in Germany, practices of killing and human experimentation became classed as ‘medical procedures’ as they were performed by licensed doctors. 7% of German doctors became members of the Nazi Party; a list of Nazi doctors can be found here. The experiments were conducted on prisoners in concentration camps, largely Jewish people from across Europe, and other minority groups including Soviet PoWs, homosexuals, and german people with physical disability.

The experiments conducted can only be described as medical torture. The aim of the experiments were multifaceted; to help military personnel in combat situations, to develop new weapons, and to advance the racial ideologies promoted by Hitler and the Third Reich. Experiments included:

  • sewing twins together in attempts to make ‘conjoined twins’
  • removal of sections of bone, muscle and nerve without anaesthesia
  • injection of bacteria directly into the bone marrow
  • multiple repetitive headstrikes using a mechanized hammer
  • exposure to extremes of temperature
  • intentional infection with various organisms including the malaria parasite, the hepatitis viruses, tuberculosis, typhus, yellow fever
  • deliberate exposure to mustard gas
  • deprivation of all food and drink other than seawater
  • sterilization using x-rays, intravenous solutions containing silver nitrate
  • blood clotting experiments, where prisoners were given a medication then intentionally shot through the chest, or limbs amputated without anaesthesia

The atrocities performed by doctors under Nazi rule culminated in the formation of the Nuremberg Code, a set of research ethics principles for human experimentation at the Nuremberg Trials. (Images sourced here, here, here and here)


Collection #3: 1960, The Thalidomide Disaster

Hailed as one of the darkest episodes of pharmaceutical research history, the thalidomide scandal has had a lasting impact on the way in which drugs are developed, tested and distributed.

Thalidomide (trade names Distaval, Softenon, Contergan), a sedative and hypnotic drug, was marketed as an anti-emetic to treat morning sickness. When it was approved, physicians assumed the placenta was impervious to drugs ingested by the mother. Additionally, drugs were not tested in animal models prior to approval for human use.

Over the few years Thalidomide was in widespread use in Australia, Europe and Japan, about 10,000 children were born with phocomelia (malformed limbs). Australian gynaecologist and obstetrician from Sydney, Dr William McBride, was one of the first doctors to report the connection between thalidomide and these birth defects.

Thalidomide was developed and marketed by german pharmaceutical company Chemie-Grunenthal that is still operational today (despite the huge damage inflicted, the judicial nightmare that ensued after the drug was withdrawn ended with the offenders walking free). Grunenthal finally apologised for the Thalidomide disaster over a century later, in 2012.

Read more about the Thalidomide disaster here. Read more about other drug recalls in history here. (Images sourced here, here, here and here)


Collection #4: Disturbing Experiments

  • The Milligram Experiments, a series of psychological experiments conducted by Yale University psychologist Stanley Milgram, that utilised electric shocks at near fatal levels (sourced here)
  • Willowbrook hepatitis experiments; mentally disabled children housed at the Willowborook state school in Staten Island, were intentionally given hepatitis in an attempt to track the development of the viral infection (sourced here)
  • MKultra experiments, also known as the CIA mind control program, had the purpose of identifying and developing mind control procedures to use during interrogation. (sourced here)
  • 1945, Plutonium trials; injection of plutonium into human subjects here
  • Dr Bender, a child psychiatrist began her electroshock treatments at Bellevue Hospital on children whom she diagnosed with ‘autistic schizophrenia’ (sourced here)
  • Prison experiments; Dr Leo Stanley, a stern eugenicist, at San Quentin prison conducted a series of unethical medical experiments on prisoners (sourced here)
  • Stanford prison experiment; a social psychology experiment that intended to investigate the psychological effects of perceived power, focusing on the struggle between prisoners and prison officers. (sourced here)
  • The Three Identical Strangers study was a twin study where identical triplets were separated at birth and raised in different families to investigate the nature vs nurture paradigm. (sourced here)

Collection #5: 1980s, Modern Anti-Vaccination Campaign

1980s: Global anti-vaccination activism is reborn!

  • 1998: British medical journal, The Lancet, published a paper by gastroenterologist Andrew Wakefield , that speculated that there was a connection between receipt of the MMR vaccine and the development of autism. Despite having a small sample size (n = 12) and a terrible design, the paper gained huge publicity and MMR vaccination rates began to drop. The paper was based on fraudulent data and was subsequently retracted in 2010. Dr Andrew Wakefield has been stripped of his medical licence.

Read more about the history of the anti-vaccination movement, and the controversy about Wakefield’s paper.

Image 1: A child gets involved with modern anti-vaccination protesting. (sourced here)

Image 2 (February 2019): People gather in Washington in protest of a proposed bill that would remove parents’ ability to claim philosophical exemption to opt out their school-age children receiving the MMR (sourced here)

Image 3: A photo of disgraced and fraudulent gastroenterologist Andrew Wakefield, who published a paper in the Lancet based on falsified data that claimed links between the MMR and autism. (sourced here).


Comprehensive Timeline

  • 1818: James Blundell performs first successful human blood transfusion
  • 1846: Nitrous oxide first used as an anaesthetic
  • 1853: First successful abdominal hysterectomy completed
  • 1856: Binaural stethoscope invented
  • 1861: Louis Pasteur discovers anaerobic bacteria
  • 1865: Joseph Lister introduces phenol (carbolic acid) as disinfectant in surgery
  • 1870: Koch and Pasteur develop the germ theory of disease (sourced here and here)
  • 1874: Pasteur suggests sterilising instruments by placing them in boiling water
  • 1876: Koch identifies anthrax bacillus
  • 1882: Cholecystectomies first introduced
  • 1890: First DTP vaccine developed
  • 1895: Wilhelm Conrad Roentgen discovers X-rays
  • 1896: First device for measuring blood pressure invented
  • 1903: William Einthoven describes the first ECG
  • 1928: Sir Alexander Fleming discovers penicillin
  • 1930: First successful sex reassignment (male-to-female) surgery performed in Dresden
  • 1935: First lobotomy performed in Lisbon hospital by portugese neurologist, Egas Moniz
  • 1945: First vaccine developed for influenza
  • 1946-1949: Nuremberg Trials and the signing of the Nuremberg Code, a set of research ethics principles for human experimentation created at the end of WWII.
  • 1959: In vitro fertilisation (IVF) invented
  • 1960: First combined oral contraceptive pill (COCP)
  • 1961: Thalidomide scandal
  • 1964: Declaration of Helsinki signed in Finland; a set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association
  • 1967: Dr Christian Bernard performs the first human heart transplant
  • 1967: Last trans-orbital lobotomy performed
  • 1975: First CT scanner invented by Robert S Ledley
  • 1980: Smallpox eradicated
  • 1983: HIV first identified
  • 1985: Kidney dialysis machine invented
  • 1988: The Alder Hey organs scandal; the unauthorized removal, retention and disposal of human tissue from 850 infants, culminating in the establishment of the Human Tissue Act (2004)
  • 1991-1995: Bristol heart scandal; in 5 years, 34 children under one year of age died after cardiac surgery due to a lack of leadership and accountability, staff shortages, an ‘old boys culture’, a lax approach to safety, and a lack of monitoring of performance. An additional 30 children were left with permanent neurological damage.
  • 1996: Dolly the sheep becomes the first clone
  • 2000: Draft of the Human Genome Project complete
  • 2006: First HPV vaccine is approved

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