A Hippocratic Oath for Public Health
The Hippocratic Oath has changed quite a bit over the years, as the original text forbade abortion and had some clauses about teaching only men but not women (this is perhaps an interesting historical footnote to the discussions on gender in our field). If Wikipedia can be relied upon (for I have not been to a med school graduation myself), it appears that medical schools now use various updated oaths, a popular one is the Declaration of Geneva. But regardless of how different institutions may ceremonially pass their students on to the real world of clinical practice, this tradition is important for its universality — all practicing doctors have taken this oath to protect their patients and treat them to the best of their abilities.
This idea, that of a universally applied oath and a code of conduct that creates a professional culture that values health and honesty, came up at the Progressive Student Public Health Summit back in April. In a discussion where Peter Montague (editor in chief and writer extraordinaire of Rachel’s Environmental and Health News) and several other public health Yodas were talking of their experiences of working as government employees in public health and of the intimidation and threats they faced when they dared to speak the truth about health threats in communities. Wouldn’t it be interesting, they said, if there were a Hippocratic Oath for public health. Or perhaps this idea is better phrased as a question: why do we not have an oath that an official who is responsible for looking after the health of you, your family and your community must swear to before he is charged with that dear responsibility? Would the institution of such an oath change the culture so that people who speak the truth don’t have to feel like intimidated whistle-blowers but rather as widely celebrated heros?
Perhaps most importantly, though, how could such an oath be implemented? It seems to me that a carefully targeted campaign at the deans of several prominent schools of public health could do a lot. Imagine if Hopkins or Harvard set the standard, so that each of their 250 or 500 graduates stood and recited some pledge before graduating? I’d wager other schools would follow suit. And of all values or ideas or institutions to which one could pledge allegiance, health promotion of your community seems like a damn important one.
August 17th, 2005 at 1:30 am
Well, I suppose here is as good as anyplace to make a comment, but it doesn’t pertain in particular to this article.
I know you guys are all students, and are all concerned with learning your way through the ins and outs of the highly political world of public health to which you will be entering, hence the focus here on broader issues of morality, on gender discrimination, and on other issues of the ‘business’ of public health, rather than the content or technology.
But I’m a little concerned that you only rarely seem to discuss the elephant in the room, and then not in great depth.
We sit on the verge of a pandemic which may well kill more human beings than anything since the genetic bottleneck we experienced 70,000 years ago. Granted that the worse case scenario will still leave us with more than 4 billion humans on the planet, but I don’t understand why you are not discussing this rather urgent issue more deeply or more frequently.
It seems a bit fatuous of you to be discussing the internal politics of your profession to the exclusion of how you, as students of public health, might serve in the event of a genuine and pervasive emergency that may greatly impact your generation. Are such things somehow not the purvey of this forum? Are you waiting for permission, or approval, or leadership, or what?
You seem to be missing what should be the Big Issue to your generation in this field at this time.
August 17th, 2005 at 3:18 am
Interesting point. Thanks for the feedback.
I, for one, take avian flu quite seriously. But there are other venues for that discussion (we are all regular Effect Measure readers), and I don’t feel the need to fill this space with that conversation. I do agree that what we might be able to add, here, is a student perspective on the potential crisis, and our roles in it, if any. Maybe we should make more of an effort to do so. It’s a good question: it’s hard for me to think of a role I am remotely qualified for, nor have I seen much thought given to school-wide preparation or training.
I have a very good friend from college who is now an MD MPH doing excellent tobacco-cessation work. When I started in public health, he politely asked what I was interested in working on, and then asked why I wasn’t doing tobacco. He sees it as the number one health problem, and so it may well be; but it doesn’t follow that everyone has to work on it until it is solved. Other problems still need to be addressed. Fatuous? I don’t think that’s fair.
Frankly, I think all the public health folks are missing the other elephant in the room, which, of course, is the upcoming collapse of cheap oil. The implications of that for the world economy and for public health are terrifying. But I’ll have to leave that for another time.
August 17th, 2005 at 4:11 am
How do you eat an elephant? One bite at a time.
Effect Measure shouldn’t be 100% bird flu 100% of the time either. I am not saying that everyone should work on Bird Flu, but that it should at least be discussed here.
If, as they say, TSHTF with this pandemic, it will not matter so much what roles you are qualified for as what roles need to be filled. You may find yourself in a situation of having an unwanted ‘field promotion’–something that maybe you as students should discuss. You may well be the most trained person on a site, and people will be looking to you as the expert, even though among public health officials you are not. What might you need to know? How might you cope? What connections do you need to form now so that you can act as an authority by proxy if you need to?
Prior to any crisis, what needs to be done? You say you haven’t seen any school-wide preparation or training. Maybe that is something that you can follow up on. What has been done? If it hasn’t been done, then what can you do to either motivate someone to do it or acquire the skills to do it yourself? If no one else is taking the lead, then why are you not stepping up to fill that need? If someone challenges you and says you’re not qualified, you can always offer to step aside when someone qualified decides to get the job done–and meanwhile continue to get the job done.
Things you are qualified to do–
–letters to the editor in the local paper
–editorials in the local paper
–speaking to student organizations
–pressuring the school administration for a realistic campus pandemic plan
–speaking to your city government at city hall meetings
–inviting prominent experts to speak publicly at your university
–talking to local business managers about pandemic preparedness
–writing self-initiated articles for academic publication with your professors as co-authors.
–educating professors on the topic who may not be aware of it due to their research being in other areas.
–arranging vaccine drives for non-pandemic flu (to reduce risk of reassortment and to make H5N1 infections easier to detect out of the background)
–finding out what parts of your local health department’s plans might require a volunteer corps, and training in advance for those requirements
–creating educational videos for home health-care for flu victims, that could be aired in the event of an emergency (since most people will be at home even if they are sick enough to be hospitalized–expect insufficient staff and beds).
–creating bird-flu awareness public service messages to be run on donated local station air time (TV and Radio)
–writing to your political representatives to inform them of your bird flu concerns and the need to create/financially support appropriate defenses for the threat
–if necessary, demonstrating in an area near your local political center to draw attention to the issue.
You are students. You should be experimenting with new ways to do things. Why are you not activists? Why are you not out there pushing the envelope? Why are you waiting to be lead by someone else? Are you afraid someone is going to get mad at you? Are you afraid of stepping on someone’s toes? Are you just too focused on your studies or on schmoozing to get that job you envision?
There’s an overlap here with your concern, Pooghkipsie, about oil–supply chain disruption. So if that is your area of concern you can find a place for it that is bird-flu applicable.
It is just whenever I read this site I feel so claustrophobic and boxed in, like it is a blog-site for accountants or something. Think bigger. Eat an elephant.
Save the world.
August 17th, 2005 at 12:48 pm
so I won’t go eat an elephant- I’m a vegetarian. one personal way I resist our societal addiction to energy and oil (Yes, raising animals for food is MUCH more energy intensive than raising grains and veggies not to mention much more CRUEL).
Thanks for the feedback and ideas on how to promote change; most of which I agree with but I feel the need to comment on some of the things you said, particularly this paragraph below:
“You are students. You should be experimenting with new ways to do things. Why are you not activists? Why are you not out there pushing the envelope? Why are you waiting to be lead by someone else? Are you afraid someone is going to get mad at you? Are you afraid of stepping on someone’s toes? Are you just too focused on your studies or on schmoozing to get that job you envision?”
You are making a lot of assumptions about us in this paragraph based on limited knowledge you’ve extracted from a few blog readings. How do you know that none of us are activists or that we are not pushing the envelope? I won’t speak for others, but myself, I am part of a national coalition of environmental activists and academics currently trying to redefine the present day environmental movement and affect change and we are PUSHING THE ENVELOPE.
Your statement also suggests that students should always be the idealistic ones who are experimenting and “thinking out of the box”. Why is that? Shouldn’t everyone engage in such activities, why do we constantly support the notion that its okay to be an idealistic, rebel rouser while you’re studying but once you get out in the “real world” you need to take care of your family and stop contributing to society at large.
Many of the suggestions you gave us about things we can do concerning the avian bird flu are generic things that any member of society can do; anyone and everyone should more often:
-write letters to the editor
-write to their political representatives to inform them over their bird flu concerns
-participate in demonstrations near local political centers
-speaking to city government at city halls
etc. etc.
And lastly as for the purpose of this blog- my intent when deciding to participate in this blog was not to “save the world” but to engage in critical analysis of public health- both in terms of emerging issues but also the business of public health.
I think this blog is still in its infancy. Your advice is insightful and I do think we are still trying to define “our rhythm” of sorts, but I also think the quality and success of the blog is contingent on the quality of the comment and feedback of the readers. So if we’re going to think big and push the envelope, we need you as a reader to jump on board and help give a push.
August 17th, 2005 at 3:10 pm
As tempted as I am to ignore “Lisa the GP” I have to respond with two questions and a comment for Lisa. 1) What makes you entitled to judge our blog and arrive at the conclusion that our writing and discussion is “fatuous”? And 2) Could you not think of a nicer more compelling way to encourage us to write about a very serious public health problem?
My comment: If you feel so “claustrophobic and boxed in” when you read our site, then don’t. It could be bad for your health (which as an MD, you should know.). Instead, take your own advice and do something aside of critiquing the content of the blogosphere. If you feel like it, share your experience with us afterwards. But please, don’t make assumptions about what healthmongers do with our lives when we are not blogging.
August 17th, 2005 at 5:42 pm
Lisa the GP- I do really appreciate your comments and what I interpret as a challenge to us and other students of public health to focus our efforts on more action-oriented discussion. This is (as you can tell from the numerous bristly responses) a touchy subject, as we all feel strongly about the work that we are doing both in and out of school. For many of us, this blog has been a departure from our normal more direct grassroots MO and we have had many a discussion about just what productive action can come out of a blog. Of course, blogs have many strengths (easily updated and disseminated information, low/no production costs, ability to reach a widespread but specific audience, etc…) but I remain unconvinced (or at least have not seen many examples) of the blogosphere’s capacity to really generate the kind of large-scale actions that generate social change. Perhaps some of the fancy new integrations with cell phones where you can receive “action memos” as text messages with a phone-number hyperlink to your senator’s direct line where you can beef about the latest legislation is the closest thing I’ve seen yet to the integration of action with online organizing. For us, the healthmongers blog is more a networking and information tool for like-minded students than it is our primary organizing tool as I think we would be fools to rely on it as the latter. Check out the who we are post for a clear statement of our mission which includes nothing about using this as an online action-organizing tool.
All that said, I think it is important to be reminded by our peers and Yodas to not wander off into philosophical la-la-land and to keep our eyes on important issues.
All that said, I would still be interested in your response to this original post (now buried under all these comments). Can you enlighten us about the current practice of the Hippocratic Oath? Does it mean anything to doctors anymore, or is it a vestige of an old and outdated system?
everett
August 17th, 2005 at 5:52 pm
Hippocratic Oath.
Honestly, I have seen only one doctor who did not at least try to follow the oath. Many try and fail despite their best efforts, but I have only really seen one, who I regard as a sadist, who did not. This was a guy who, for a patient with acute exacerbation of chronic pancreatitis due to alcohol consumption, would not give the patient any pain medications because he wanted to ‘teach him a lesson.’ He had many other such violations of the spirit of medicine, most of them involving his own personal judgement of the social value of the patient.
Undoubtedly there are other ‘bad docs’ out there. And there are many docs I’ve met who I disagree with, or dislike or whatever. But save this one, they all seemed to me to be genuinely trying to help–at least when it came to patients. With regard to each other–well, there’s some nasty politics in medicine, no denying it.
I may return to this issue later, with your permission; I’m pressed for time at the moment after my last long post.
August 17th, 2005 at 9:48 pm
Everett–on closer reading of your post, let me clarify that I did not mean to imply that this be an organizing too for action, but a place to share what you have done, what you plan next, and whether what you do turns out to be effective.
It is your blog, not mine, but it doesn’t always seem to focus on the most pressing issues from my point of view.
August 17th, 2005 at 11:03 pm
[…] tle=”healthmongers.org”> Who are we? « A Hippocratic Oath for Public Health the next big th […]
August 22nd, 2005 at 8:46 am
Sistah–
I applaud that you are an activist toward improving the environment and reducing our oil addiction. Should your efforts not appear on this blog though, showing how these areas are vital to public health? Nobody can know what you are doing, what actions you are taking, what actions are succeeding or failing, unless you reveal them–and I think revealing them is a good idea. Share those activities, and others will learn from them, and you can learn from their comments as well.
I do not think that only students should ‘think outside the box’. People at all stages of their careers need to do more of this. But I do think that if you don’t take up the activity while a student, you are unlikely to do so later in life.
My suggestions of things that you can do lists things that anyone can do, for several reasons. For one thing, since they require no ‘qualifications’, you don’t need qualifications to do them. For another, I don’t know your individual circumstances or have your individual creativities to come up with all the possibilities. Only you can do that. But there is a long road between ‘can’, and ‘do’. How many of you are using these methods, that anyone can do, plus others to promote an issue that you are working on or are passionate about? What is working? What is not? What tools can you add to this semi-generic list of actions that people can take on a public health cause? Don’t take these questions as criticisms, these are things I want to learn from you.
I propose to you, sistah, that discussing the business of public health and analysing it are among the teaspoons of tofu-elephant that you are eating, but that the reason you are eating them is, in fact, to improve on the current system. Hence, in teaspoon quantities, to save the world.
Please, please post about your environmental activism!
Chelsea–you know there are many people in your generation who have been raised on the ‘preserve the ego’ theory of education, and as a result have a difficult time assimilating any kind of criticism, whether helpful or not. I hope that now a few hours have passed you are able to see beyond your emotional response to my post and look at what I perhaps ham-fistedly am saying; many of the blogs here have focused on political minutia when there are larger and more important issues–and accomplishments (ref: sistah) that you could focus on.
You have asked specific questions–
1) what makes me entitled to judge?
The fact that I am a reader of your blog. The fact that you are writing for people to read and to understand your issues. Why put them forth into the public light other than to have them read, discussed, and judged by the public? I live on this planet too, I am affected by public health issues, as a doc I can be an instrument of public health policy–why should I not take an interest in what the next generation of public health professionals is doing and thinking?
2) could I not think of a nicer way…?
Can you only take input that is phrased nicely and politely? Can you not separate form from content? This reminds me somewhat of a scene in the movie ‘dangerous minds’, when a teen targeted for death by a gangster is unable to get help from the school principal because he failed to knock before entering the principals office. He is turned away and then killed by the gangster. So, Chelsea, must I now use the word ‘petty’?
You can only be judged here by what you print here, and what has been printed to me appears fatuous. I’m sorry if you don’t like the impression I get, but that is the only impression I can get given the posts that are here. If you want to change that impression, address additional issues in your posts, don’t blame me for making a judgement based on the limited available data.
As far as doing things beyond the blogosphere–on bird flu I’ve addressed my city council and inspired a champion on that council to work with the city administration on a pandemic preparedness plan to deal with infrastructure disruptions. I have spoken with the emergency management people of my local hospital about not only their acute patient management issues in a pandemic, but also the supply chain shortages and drug manufacturing shortages which may occur due to outbreaks that are not local to us. I have spoken with at least 8 (I lose count) managers of businesses in town, equipping them with Osterholm’s Foreign Affairs article and convincing them to begin planning for worker absences and economic fallout if the pandemic occurs. I have a letter to the editor coming out in one local paper, and a series of articles in the works for another. I’ve been corresponding with my local infectious disease department at the county health department, acting as a news screen and sending roughly one or two ‘highlight’ articles per day, with the returned email gratitude of those folk that they don’t have to look for them. I spent three hours on the phone briefing a Cox-news-service journalist in the science of bird flu, after calling to ask about a detail in his article and finding that he had a lot of knowledge-holes he wanted to fill in the medical aspects. And I’ve run around curevents trying to make sure that when something medically dangerous is proposed (home-made IV fluids, Tamiflu overdose), the reasons not to do it are presented.
All while looking for another pharma job.
So yes, I’m doing something other than criticising the blogosphere. And I’d like to hear what you are doing with your lives when you are not blogging.
Your balance here has been too far on the academic pondering level and not enough on the real world projects and actions that you have taken. Don’t abandon the pondering, but please add the action.
August 22nd, 2005 at 11:34 am
the above comment was actually submitted a week ago, before the oil post was made. Why has it taken so long to appear?
August 22nd, 2005 at 11:41 am
Lisa — your comment ended up in limbo awaiting approval, and we didn’t notice it (other comments haven’t needed approval). We’re trying to sort out why that particular one was embargoed. Sorry for the delay.