University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

Page 15 text:

5i 'i 37' REBER T I gmrcrcftlf . iufrllrlrftflfll Hlllllllfifll mul!!! Hills :llI!ll!lIl1ll Hlllllll c mm., Ill lllll Population Problems Roger Grekin It appears that medical advances may be preventing modern- ization of under-developed nations. The New York physician treating malaria in Nairobi, and the Canadian Hghting cholera in Indonesia may be thwarting the progress and well being they are trying to bring to troubled and impoverished countries. The logic and simplicity of poverty and hunger in the under- developed world are starkly obvious. There are too many people or not enough food, and usually both. Most of the poorer coun- tries are trying desperately to accumulate some surplus from the land and convert it into economic improvement, but in general things are getting worse, not better. India's yearly increases in food production have not matched her population growth in this decade. An obvious first step is population planning, and many am- bitious programs are being attempted, but they do not seem to be working. Despite the efforts of a large group of talented men, the poor people of these countries are not being convinced of the need for fewer children. It is inhnitely easier to save an infant with tetracycline or IV fluids than it is to prevent his birth. Medical programs in Asia, Africa, and Latin America have been highly successful and infant mortality is lower and life expectancy is greatly increased. Without attempting to discuss the moral implications in- volved in saving or not saving life, it can be safely stated that chances of developing a poor country would be better with a high infant mortality rate and a short life expectancy. Fewer mouths to feed means more chance to build excess capital and savings. The path toward industrialization is fought with difficulty and the odds against development for many poor countries are long. If we are to make the odds even longer by saving lives that consume food, we must at least be aware of the implications of our actions, and weigh the future chances of development against the medical needs of today. ll

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Medical Care For All Walter Faggett We as new physicians are inheriting the privilege and prob- lems of providing the highest quality of care to all patients. lt is imperative that our role in this capacity be clearly defined and enhanced by an awareness of the medical and social needs of the present day society. We have received the finest technological and scientific medical preparation in the world and must, from this point on, determine how we can best apply our 'knowledge and training in meeting the challenge of the health crisis so im- minent at this time. As leaders of the health team as well as of the community. the physician is in a uniquely strategic position to mold and con- ceptualize improved methods and organization of health care delivery. He is free to determine his own level of commitment in seeking solutions to this growing problem, whether in his own practice, local medical organization or in community work. There is a need for professional guidance and commitment in assuring that the practice of medicine within the physicians sphere of activity is as efficient and competent as his training and ability can provide. The traditions of medicine are very well entrenched and are resistant to criticism and re-evaluation. The Hippocratic oath was written to provide guidelines for the practice of medicine as it was known during Hippocrates' time. Revised abortion laws and rapid advances in medicine such as organ transplanta- tion and artificial biochemical synthesis of life itself force us to re-consider our interpretation and application of this sacred document. Indeed the exclusion of the physician's social obliga- tion to the patient community in this basic document of medi- cal practice, emphasizes yet another inadequacy therein. It is very apparent what the critical nature of today's health problems demands. That imaginative new philosophies and programs must be undertaken to assure use of modern concepts in the practice of medicine. Dr. Marion Folsom, speaking at the White House Confer- ence of Health, stated that health is a basic human right and that comprehensive, continuous and personal care should be available to all. ln this abundant society, he noted, we have the resources, capacity and obligation to do this. The costs of health care today have skyrocketed to three hun- dred percent more than the rates of ten years ago. Now most Americans are a disadvantaged majority with Medicaid and Medicare offering better protection to the indigent than the coverage required by the general public. Some method of co-operation between private and public in- surance plans must be sought to provide better health protection for all people. Increased protection will result in increased demands for medical care with further straining of the already inadequate medical care system. A very real health crisis is developing. The 180,000 physicians in private practice handled 844 million visits in 1964, and the patient load is increasing. Better utilization of paramedical personnel and more efficient delivery of health care must be effected if we are to provide high quality health care for all people. This is our challenge and we accept it with serious concern. Besides clamoring for care for more people, the public is demanding improvements in the quality of medical care. Succesjul or not, heart transplantation and other advances have whetted the desires of people fir cures and better care, desires the medical prrjession must work bard to satijy. For example, South Africa's Christiaan Barnard whose feat is more notable for its courageousness and impetuosity than technical achieve- ment has fred this already awakening interest in and scrutiny of medicine, phenomena unknown a few decades ago. In a slightly dwerent vein the three pictures at the right show the progression of another problem, the parking problem, from a time thirty years ago when it was non-existent to what engineers deem-probably incorrectly-to be a solution to the confusion which 10 all medical students experience so painfully now. The connection between parking and the next essay is quite tenuous but like many well-worn memonics, it may prove benejicial due to the remoteness rj its reference, That connection lies in the following slogan: TROUBLE PARKING? SUPPORT PLANNED PARENTHOOD More to the point, one of man's greatest problems to- day is his inclination to multiphi. While not evident in !VIontana or the Upper Peninsula, the pressures of numbers are felt in urban areas and countries like India. Consider what Roger Grekin feels about the problem below and then turn to pages 15 6f1 59 for an insight into the opinions of several other Senior medical students.

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When LSD is mentioned it is usually associated with such institutions as Hippies, Haight-Ashburjy, love- ins, marijuana, and even Mt2d dress, mini-skirts, and long hair. While these institutions may not ft well in one cubicle, they have this in common-in a-year or two they will have been replaced by other easy solu- tions to the world's problems and other undorms of individuality. David Drachler's essay deals with the reasons behind drug use todaryq it is exerpted from his Victor Vaughan paper. Drugs and Man Throughout history man has deliberately sought means to es- cape reality. ln his efforts to go out of his mind man has em- ployed isolation, deep breathing exercises, hypnotic induction, oscillating body movements, prayer, fasting, sleep deprivation, flickering lights, self-flagellation, sensory deprivation, chants, thirst, heat, plants, and chemicals. The current favorite is the chemical LSD, and the controversy surrounding its use is one of the most interesting issues confronting our society. What makes it so interesting is that its sponsors are the elite of society-the in- tellectuals, artists, and youth. To appreciate the acceptance of LSD today one need examine what motivated man to try to go out ofhis mind during earlier generations. For the primitive subcultures, fear and superstition were moti- vations. There was the fear of gods, enemies, famine, disease, failure, and the fear of extinction. I-Iallucinogens, provided the helpless native with a means of acquiring supernatural powers and hope for his future. They were a source ofstrength and power for their leaders, witch doctors, priests, and prophets. They pro- vided the tribe with a mystical ritual which meant that their anxieties, frustrations, and guilt would be eased. The hallucino- geiis were therefore a means of protection, a basis for unity, and a measure to reduce pain and suffering. Many of the trubes attributed the knowledge of the intoxicants to messages from their gods. lt was only natural that the herbs became a sacred substance. These 'ftheobotanicalsn created a trance-like state, increased suggestibility, gave mystical powers to their visionaries, were a means of identity, and served as a source David Drachler of cult unity. They cleared the mind for meditation and enhanced spiritual development. Peyote cactus was the favorite of New World Indians while opium and marijuana satished the European peasantry. For centuries the psychobotanicals were primarily associated with primitive cultures, the lower classes, and mystical cults. Perhaps the first wave to rock the upper classes was created by Thomas DeQuincey's Confessions of an Opium Eater in 1821. De- Quincey was an eccentric Oxford scholar who insisted that the search for euphoria, self-conhdence, and fulhllment could be completed via the poppy. In fact he implied that it was the edu- cated man who could best appreciate the apocalypse of the world within . . The present involvement of youth with psychedelic drugs is unique to the history of hallucinogens. One sociologist describes the situation as being a breakdown of communication between adults and youth. Another blames a crisis over sexual identity in late adolescence. A purely economic explanation is that food and shelter are readily available to modern youth and occupy so little of his attention compared to youth before World War Il. The specific reasons for taking the drugs are legion, but one thing is certain, the movement is a rebellion against the values of our society. lt is a revolution to establish freedom from restraint, freedom to explore, and freedom to escape. It is mystical as well as intellectual. And it is a romantically optimistic revolution be- cause it holds that within one's consciousness there lies greatness. The following five pages are presented more for the readers' edyication and etnohyment than instruction. Hrs! is an essay by Glenn Geelhoed dealing with an aspect ff the physician-patient relationship. Next is a piece by Dick Lewis on the Caduceusq in connection with the paper, it should be noted that the emblem on the 'yearbook cover is not the Caduceus, but the rod of Aesculapius. The poem by Dr. Robert Green is re- printed from the Sept.-Oct. issue of The University of Michigan Medical Center Bulletin where it was pref- aced by these words: Reflections on the management I2 ff a patient with status asthmaticus presented in a post- graduate course on chronic obstructive pulmonary diseasef' The poem echoes the recurring theme of Dr, Gosling's history course. The final two pages are devoted to the Hippocratic oath: The first version of the oath is a more literal translation rf the Greek than the second which is the version used at commencement exercises here. Sandwiched in between are Ralph Sawyer's comnzents on the specyicity, universality, and interpretation ff the oath.