THE SEMIANNUAL NEWSLETTER OF THE ROBERT PENN WARREN CENTER FOR THE HUMANITIES VOL. 12, NO. 1 • FALL 2003 • VANDERBILT UNIVERSITY Medicine, Health, and Society An Interview with Matthew Ramsey and Larry Churchill

he 2003/2004 Fellows Pro- Letters, Professors Ramsey and medical center—a group that in- bridging the traditional discipli- gram at the Warren Cen- Churchill discussed the program, cludes both clinicians and re- nary divides that have long been Tter, “Medicine, Health, its integral role in supporting the searchers. The larger project of the associated with this field. and Society” investigates one of initiatives of the new Center for group has been the construction LETTERS: Could you describe the most dynamic and rapidly Medicine, Health, and Society at of a major inter-school, interdisci- in greater detail the new curricular growing areas of interdisciplinary Vanderbilt, and new directions plinary center for Medicine, programs associated with the research and teaching. This field, for the expanding field of MHS Health, and Society at Vanderbilt. MHS initiative? which we may refer to as MHS studies. The new MHS Center, based in RAMSEY: In the Medical studies, has its roots in a tradition LETTERS: This Fellows pro- the College of Arts and Science, School, the old biomedical re- of programs and courses in the gram emerged from a faculty which I direct, is the first step to- search requirement for first- and medical humanities that have long workshop/planning group in ward this long-term objective. We second-year students has been re- served to enrich and broaden the Medicine, Health, and Society now need mechanisms to facilitate placed by a menu of options, curriculum of future medical prac- known as the Emphasis titioners by connecting medicine Program. One of the to such fields as literature, the arts, options is the medical history, philosophy, religion, law, humanities; we’ll be and social policy. But this new ap- working through the proach to the study of health and MHS center to arrange health care moves beyond the fo- for people from outside cus on clinician-centered subject the medical school, matter and patient-physician in- mostly from the College teractions, to look more broadly at of Arts and Science, to how various societies—including mentor these students. our own—have understood, expe- It’s a very exciting op- rienced, and responded to disease. portunity, but we need MHS studies recognizes that to give a lot of careful health-related beliefs and practices thought to how it’s go- are deeply embedded in particular ing to work—not just societies and cultures, and that the mechanics, but also disease can be studied as a social the themes, the em- and cultural phenomenon. This phases, and the sorts of year’s Fellows program reflects this Larry Churchill and Matthew Ramsey issues we want to ad- interdisciplinary approach in the dress. It’s certainly something that diverse academic interests of its studies that has been meeting for the interactions of our diverse we’ll talk about here in the Fellows participants, who include faculty the last two years at the Warren membership to develop more spe- group. In the College of Arts and from such disciplines as medical Center. Could you say more about cific goals. The Fellows program ethics, history, human and organi- this group, the background of the at the Warren Center is one key Inside zational development, theology, members, and the kinds of inter- part in that process. This year’s English, and sociology. In addi- sections you see developing be- program involves one of the most 2003/2004 Fellows ...... 6 tion, the program will include one tween this more private venue for diverse groups of Fellows that the 2004/2005 Fellowships ...... 6 clinician from the Division of Sur- discussion and the public interest? Warren Center has ever spon- Stephen J. Pyne to Deliver gical Oncology. The program’s co- RAMSEY: The group at this sored. The Fellows group will 2003 Howard Lecture ...... 7 directors are Matthew Ramsey, point has more than one hundred work in tandem with the larger 2004 Summer Graduate associate professor of history, and faculty members from all nine MHS center to develop an under- Student Fellows Program . . . . .8 Larry R. Churchill, Ann Geddes schools of the University, includ- graduate program in Medicine, 2002/2003 Fellows Conference . .8 Stahlman Professor of Medical ing the Blair School of Music. Health, and Society studies, and Race and Wealth Disparity . . . .8 Ethics. In a recent interview with About half of them are from the we’re going to build from there,

Letters • Fall 2003 • 1 Letters • Fall 2003 • 2

CHURCHILL: There is a rule of rescue in this country that says no one should die on the street, whether they have health care or not.

Science, we are close to having ap- in MHS studies, with support cine, which was grounded in sci- visions for primary care such as proval for an undergraduate minor from the Warren Center; this ence, and other kinds of medi- the ability to see a physician to get in MHS studies, and the possibil- could become the model for fu- cine, which sometimes claimed to your diabetes or hypertension un- ity of a contract major, in which ture conferences organized by the be grounded in science but clearly der control is the kind of thing students will design a program and MHS center. had a different cognitive basis. I that’s bought and sold on the mar- submit it for approval to the Com- LETTERS: In your proposal, you am currently completing a large ket. These are really interesting mittee on Individual Programs. If identify three areas of investigation book on the development of pro- questions to me because they illus- the minor is approved early in the that current scholarship tends to fessional monopoly in French trate an aligning of values in rela- fall semester, we will offer a foun- engage: medical pluralism, the medicine. I am interested in the tion to how the health care system dation course in MHS in the provision of health care, and the ways in which some of the people works. Obviously, such questions spring semester that will involve who practiced what we involve issues of financing and dis- guest lecturers from across the would now call non-offi- tribution, but they also involve the campus. One product of this year’s cial medicine were ex- cultural issue of what Americans Fellows program may be designs cluded from the medical think about health care, and what for courses that each of us might field, even though many dimensions of it they think are im- individually want to teach for patients continued to con- portant. These are critical ques- MHS studies. sult them. I am also cur- tions in terms of understanding Churchill: The Emphasis Pro- rently engaged in some the system that we now have. In gram that Matt just mentioned is other projects that connect asking ourselves why we have the an innovative program in the Med- less to medical practice and system we do, we must realize that ical School that will begin in 2004, more to therapeutics. I just our sense of ethics as well as our and it is truly innovative in the gave a series of lectures in cultural values tend to give the sys- sense that it is designed to add an France that I expect will tem the shape that it has. One of independent scholarly emphasis to become a small book on the things that is always on my the curriculum. It will make Van- the therapeutic uses of the mind when I am thinking about derbilt unique in allowing students human body. One lecture Medicine, Health, and Society is to devote a year and a half of work covered the use of excre- the ways in which the health care in a particular subject of their mental remedies; a second system reflects our social and cul- choosing related to medicine and one concerned the thera- tural values. We have the particu- health care. There are eight differ- peutic use of human body lar system we do because of the ent areas; one of these is medical parts, sometimes called way we have organized and dis- humanities. We would expect “medical cannibalism”; tributed a lot of other social goods, Larry Churchill about a dozen or so students a year and the third was on the and it’s important to put all of this to select this field, and we will be impact of new diseases and tech- history and pre-history of blood into context. We’re fortunate to engaging faculty not just from the nologies. What are your current transfusion and organ transplants. have the diverse group that we medical school, but also across the research interests, and how do Churchill: Most of my back- have for this year’s Fellows pro- campus and in particular from Arts they inform the larger body of ground and training is in ethics gram, because diverse perspectives and Science, to be mentors for scholarship in these areas? and so most of what I do in the are crucial to understanding the these students over that eighteen Ramsey: Much of my work medical school concerns ethical full picture. And, actually, one of month period. That’s something over the last decade has focused questions and issues, particularly the geniuses of the whole effort in that we’re very excited about, espe- on what we might call medical those that have an impact on the Medicine, Health, and Society at cially since Medical School Dean pluralism—differences in medical provision of health care. One of large is this understanding of disci- Stephen Gabbe has decided that practices and beliefs within and the things I have been preoccupied plinary diversity as organic to this the Medicine, Health, and Society across cultures. In particular, I with studying is the mechanism field of study. Center will be the chief contact have done quite of bit of work on for distributing health care re- Ramsey: I also have a broader point for the non-medical school the divergences in health practices sources in this country, and the interest in how cultural and social faculty who will serve as the men- of particular historical popula- ways in which mechanisms have differences affect responses to dis- tors for these medical students. tions, most specifically, those of changed over time. My predomi- ease in different societies, includ- That expresses a lot of confidence eighteenth- and nineteenth-cen- nant framework considers ques- ing our own. In the case of the in the initiative that Matt and his tury France. I’m interested, for ex- tions of justice and the allocation provision of health care, it is inter- colleagues have put forward and ample, in the process through of resources, and interrogates who esting to see how various also gives us a place to build on our which certain practices that were gets health care services, who industrialized societies confront interdisciplinary teaching. We’re widely shared over centuries (such doesn’t, and why this is the case. the problem of containing hoping that this will be an indica- as the inspection of urine to diag- For instance, emergency health costs. Even countries with very tion of the way in which the MHS nose disease) persisted in some care resources, like access to emer- generous national health insurance center can actually assist interdisci- populations and disappeared in gency rooms, are typically open to programs, such as France, are seek- plinary teaching and scholarship others over the course of one hun- everyone. There is a rule of rescue ing more effective ways of contain- on the campus. dred years or so, from the mid- in this country that says no one ing the cost of health care. They Ramsey: We also plan to orga- eighteenth to the mid-nineteenth should die on the street, whether have been wrestling with it for a nize a national conference for the century. A very clear distinction they have health insurance or not. generation, but the government is year after next on new directions emerged between official medi- On the other hand, very basic pro- now thinking about much more Letters • Fall 2003 • 3

RAMSEY: The question of alternative medicine is very complex, in part because the concept embraces a number of very different things...

significant reductions in benefits, LETTERS: You mention briefly one thing that will come out of areas which involve the policing, and that is going to provoke a in your proposal that the work of the seminar, at the very least, is controlling, and regulating of so- strong social reaction. There are Bruno Latour has offered a theo- some exposure to different theo- ciety, the body, and human behav- also differences in how various so- retical framework that some schol- retical perspectives. ior. cieties deal with new technologies, ars in this field have found useful. One potential theoretical LETTERS: There seems to be a with organ transplantation, and But you also note that many framework for our discussions can trend among some patients in the use of knowledge about the scholars who work in this field do be found in the work of Michel seeking alternative treatments and human genome. For example, in not necessarily employ a specific Foucault, who greatly influenced healers, a practice that would France, it is illegal to sell blood theoretical lens. Could you say a an entire generation of scholars seem to undermine the status of products, unless they come from bit more about the role of theory working on the sociology and his- medicine as the exclusive domain umbilical cord blood, because the in this field and in what directions tory of politics and disease and of the elite professional. How umbilical cord is not considered a you think the field will be head- provided a way of talking about does your work take this trend part of the body belonging to an ing? In what ways is theory en- power relations, and also a way of into consideration? individual; of course, the situation abling and promoting new ways analyzing texts that has been Churchill: The relation be- in the U.S. is very different. An- of thinking about Medicine, widely influential. But his influ- tween traditional and non-tradi- other case in point is the difficulty Health, and Society? How might ence has been on the wane. Some- tional medicine is a subject of of working with embryonic stem it prove limiting? one whose star has been on the rigorous debate—one spawned by cells in the U.S. for political rea- Ramsey: On the whole, I think rise is Norbert Elias, the German David Eisenberg’s article in the sons. The U.K., not operating un- the social and cultural study of sociologist and philosopher, and New England Journal of Medicine der these same constraints, has medicine is about a generation be- author of The Civilizing Process. that discussed unconventional offered more opportunities for hind the social and cultural study Even though it seems that every- therapies in the United States such research, and is now a leader of science, or what is now some- one who borrows from his work (January 28, 1993). And in fact, in this area. This is a rather obvi- times called science studies, in the begins by saying that it’s too crude I’m currently involved in an Insti- ous illustration of social and polit- application of theory. It’s not a co- tute of Medicine study group ical constraints on scientific incidence that Latour, even that’s looking at this very research and innovation. though he writes about medical question—the question of Churchill: Matt’s cross-cul- topics, is primarily approaching why 50 percent of the Ameri- tural, historical work has been the subject from the point of view can population uses some very important to me in thinking of the philosophy and the anthro- kind of alternative therapy not only about how the U.S. pology of science. There is, how- or medication, or seeks alter- health care system sits in relation ever, a common foundation that native healers such as chiro- to the systems of other countries, we can build on. Most people practors, traditional Chinese but also how it has changed over who study medicine and health healers, acupuncturists, acu- time. It is interesting to note, for from the perspective of the hu- pressurists, and other non- example, that in the 1920s, the manities and social sciences are allopathic, or non-traditional American Medical Association aware of the ways in which society practitioners. was supporting universal access to and culture influence the experi- Ramsey: The French talk health care and was very much in ence of illness and the ways in about “parallel medicine.” In favor of a kind of policy in which which health care is provided. In English, we have talked the government played a substan- one sense or another, I think about “alternative medicine” tial role. That, of course, has been everyone in the seminar would ac- and, more recently, “alterna- anathema for the last sixty years. cept some form of the notion of tive and complementary It is important to see the way that the social framing or the social medicine.” The latter is the things change in relation to the construction of disease, and I title of a center at the Na- social and historical context, and think that even our one clinician tional Institutes of Health, to understand the forces that were from the medical school, Scott Matthew Ramsey and it implies that non-con- in play then, in comparison to Pearson, would subscribe to that ventional medicine is not what we’re doing now. It is of as well. He is interested in finding and lacks nuance, I think there is simply the opposite of official tremendous importance in cor- new ways of constructing patient a great deal of interest among medicine, but rather, constitutes recting one’s disciplinary provin- histories that take into account those who work on the body, and something that can connect to— cialism to establish a dialogue the ways in which individuals ex- on health and disease, in the no- and work with—biomedicine. with people who have been perience disease, as opposed to tion that there is an interconnec- Clearly, the question of vocabulary trained in different ways and who considering simply the biology of tion among societal attitudes is an important one. have had different experiences. disease. I don’t think that any of toward the body—views of clean- Churchill: Yes, and the most The potential to compare is one us has the expectation that we are liness, order, politeness, and even recent term I’ve heard is “integra- of the chief bases for making going to evolve a theoretical violence. There’s a sense in which tive.” There are a couple of centers judgments, and as long as one is model or approach that will be all of these things are intercon- for complementary and integrative inside of a particular set of experi- novel and will embrace all the nected. The implication for peo- medicines in this country that are ences and ignorant of the rest, things that we are doing. What we ple who study health and health working very hard to do tradi- thinking critically is a practical end up doing will probably be care from different perspectives is tional research in these fields—to impossibility. very eclectic. But I suspect that that there are parallels with other try to figure out, for example, Letters • Fall 2003 • 4

whether a non-allopathic treat- understand how Western biomedi- the patient narrative, and it’s a nar- certain fundamental continuities in ment such as acupuncture is going cine makes sense of this disease rative told by the person who is ill. the human condition; one of them to work just as well for certain and what it is that the doctors are But in trying to put this together, is the experience of having to deal kinds of problems or illnesses as trying to do. And of course, at we must also ask how we might with diseases that can’t be cured— traditional, allopathic therapies. I least in the beginning, the doctors combine Western science and the and ultimately with death. The think that the idea that this is such believe they are dealing with unal- kind of reductive biological orien- ways in which various healers have a force in terms of the experience loyed ignorance and superstition. tation that it has, with a meaning responded to these basic experi- of some people is an indication of No communication between the system that varies across time and ences at a human level have always the enormous pluralism of ap- groups is possible. culture—even within a commu- shaped the ways in which patients proaches with regard to health and Churchill: People don’t have nity. Part of what makes this inter- respond to them, in both Western the way in which it is conceptual- health insurance to cover alterna- esting is trying to imagine how one and non-Western societies. It’s not ized and understood. Even with- tive healers, so they’re paying out might do this and what kind of ad- a role that contemporary biomedi- out going abroad, you can find of pocket; this is an indication of vances one might achieve by study- cine plays very well. nuggets of complementarity as the significance of this phenome- ing and working on it. LETTERS: You note that our un- well as conflict with regard to peo- non. One of the things that the Ramsey: I think Larry’s com- derstanding of disease and our ple’s practices, and the philoso- studies that have been done indi- ments would apply to a wide range own bodies is undergoing a rapid phies and peripheral philosophies cate is that alternative healers do a of traditional healers who are transformation with the mapping that shape them. This is a terribly better job of getting in touch with members of the communities of the human genome, genetic interesting issue to me because it patients, of being empathetic and where they find their patients. testing, and cloning. In what ways approaches the pluralism question appreciating the world view and They would apply, for example, to is this new knowledge both em- in a different kind of way. It is a the values of the people who come curanderos in Hispanic communi- powering and disempowering? In worthwhile subject of study, be- to them. That is why they suc- ties in the American Southwest, what ways do you see it both in- cause for most people, health and ceed—at least in part—though, of and to traditional healers in many creasing and decreasing patients’ seeking health services is not just a course, they actually may have rural societies elsewhere. But there control over their own health? matter of seeing MDs in a clinic. some effective remedies. There’s a are also other patterns. Many peo- What evidence have you seen that The much broader and holistic no- powerful psychosocial component ple I’ve studied in the eighteenth might illustrate this? tions of what a symptom means, in shared assumptions about the and nineteenth century were itin- Churchill: If you think about and how patients understand what causes of one’s illness and what erant quacks, one of whose charac- this as a pendulum swing between is happening to them, affect the one might do to get better. Surveys teristic features was that they nature or nurture as the chief ele- kinds of providers that they subse- that have been done with people didn’t know their patients. They ments in determining our fate, our quently seek for treatment. who use alternative healers show appeared in the town square, dis- health, and our destiny, we’re now Ramsey: The question of alter- again and again that this is the tributed flyers, and provided enter- swinging back very heavily on the native medicine is very complex, case. And this isn’t surprising, es- tainment in order to draw a nature side, and this is what ge- in part because the concept em- pecially considering the con- crowd. They promised to cure cer- nomics is all about. In its crude braces a number of very different strained time for physician visits tain diseases and offered free ad- form, the popular image in the things. You have people who are and all of the things which have vice to the poor, and then they past was that there was a gene for members of what were referred come with managed care. An effi- sold their drugs and moved on. every particular trait, so that peo- to in the nineteenth century as ciency motif has descended on The healers were long gone before ple spoke seriously about finding a “sects”—groups that have a quasi- health care practices, and practi- the patient was able to judge the gene for homosexuality, or finding religious orientation or alternative tioners have much less time to talk outcome. Strange as it may seem, a gene for shyness, or for pyroma- cosmology and often have an alter- to people. People are expressing this is a model that is still with us nia. I think we’ve moved away native physiology and anatomy their dissatisfaction in the failure in various forms. We have alterna- from that more simplistic and false and a very different understanding of medical professionals to recog- tive medicines that are hawked on notion into more of a balanced of disease. For many of these nize them in terms of their whole the internet—there’s no physician- understanding. But I also think groups, the key principle is not to makeup, or to figure out what it is patient contact at all. that the mapping of the human accept official therapies, which are that they bring into this in terms The internet has transformed al- genome and the research that has considered dangerous. But that’s a of their individual model of illness. ternative medicine and medicine in been generated out of that in relatively small part of the phe- There’s a wonderful distinction general by creating virtual commu- terms of hoping to find cures for nomenon of alternative medicine. that I think is really crucial to un- nities of patients, a phenomenon genetic illness—and every illness is You also have large immigrant derstanding this phenomenon that is very new and yet also, in a genetic to some extent—has populations throughout the West- made by Harvard anthropologist sense, very old. Sometimes a com- spawned a renewed cultural sensi- ern world, who come from non- Arthur Kleinman. Kleinman notes mon disease defines these commu- tivity about genes. There’s a prece- Western societies that have very that physicians are trained to diag- nities; in such cases they are often dent for this, in the work of long established indigenous med- nose diseases in terms of an inter- essentially support groups. Some- Francis Galton, the early eugeni- ical traditions to which they re- national classificatory system—a times they are defined by a shared cist. His idea was that one could main deeply attached. There is a patient has diabetes, hypertension, belief in a healing system. These actually identify a genetically infe- marvelous study of Hmong immi- or whatever it is. But in reality, pa- kinds of communities can reinforce rior human stock and try to con- grants from Laos by Anne Fadi- tients also come in with an illness. a set of beliefs and the reputation trol for it. I think we’re a long way man called The Spirit Catches You An illness is their sense of why they of a healer people have never met, from that, but many people think and You Fall Down. She focuses on got sick, what it means to them, much in the same way that word that somehow we might be able to epilepsy—the book’s title is the lit- and what they might do to make it of mouth can reinforce the reputa- allow individuals to make better eral translation of the Hmong better or to find help. These two tion of a village healer. Part of what choices if they had genetic knowl- term for this condition—but also things have to come together interests me, as an historian, is how edge—knowledge about the vul- deals more broadly with the prob- somehow. To me, that’s a motif some of these patterns persist over nerability of their offspring to lem of cultural incommensurabil- throughout this whole discussion time, taking new forms as technol- certain kinds of illnesses. But our ity in medicine. In her account, in terms of trying to understand ogy changes and as political and infatuation with genetic control is the immigrant population cannot the variety of illness. This is part of social contexts change. There are fraught with enormous hazards, Letters • Fall 2003 • 5

such as the potential for discrimi- deal not only with the advance- Williams’ poetry and short stories who suffer from them. In the case nation against people on the basis ment of learning and the improve- are good examples of this, as is the of AIDS in particular, the role of of genetics for health insurance or ment of society, but also with the work of Lewis Thomas, a popular the arts has been extremely impor- job qualifications. There is incred- biological perfectibility of the hu- writer who was the head of the tant in conveying suffering that ible promise in the possibility of man species, moving towards im- Sloane Kettering Cancer Institute goes beyond what could be ex- finding ways of repairing genes, mortality. In William Godwin’s in the 70s. Thomas wrote a series pressed in a simple prose state- but we’re a long, long way from version, sex withers away because of essays that were originally pub- ment. To some extent the arts have that. It opens up a lot of old de- reproduction is no longer neces- lished first in the New England helped to normalize patient groups bates, rather than creating debates: sary. Journal of Medicine and were later that have been marginalized for debates about discrimination, de- The more we learn about the put into books. The Lives of a Cell various reasons. AIDS patients are bates about what makes us equal, processes—both biological and so- is probably the most important. a particularly good example of a and what makes us different, and cial—that produce unique human More recently, Margaret Edson’s much larger group of disease suf- the role genetics plays in that. individuals, the more we realize play Wit was turned into an HBO ferers who have been rejected be- There are also debates about what what we don’t know, and I think movie. It is a powerful embodi- cause of prejudice and fear. goals it is useful to achieve in it’s becoming very clear that de- ment of some of the difficulties of I don’t know if SARS has been terms of health, because if we can coding the human genome is only being a terminally ill person deal- around long enough for us to have manipulate genes, there is the po- the first step, not the culmination, ing with the health care system, a clear sense of the social response tential not only for making people in a very long process of discovery and being at the same time a pa- to its victims, but there was a very well, but also, in some cases, bet- that may lead to the sorts of prac- tient and a research subject. In interesting article recently in the ter than normal. Carl Elliott, a tical interventions that Larry is fact, we are going to be using this New York Times entitled “Behind philosopher at the University of talking about. What we’ll see film with second-year students this the Mask: The Fear of SARS,” Minnesota Bioethics Center, has a sooner are the products of what is year. I have also been revisiting which focused on a group of vol- book out called Better Than Well: called pharmacogenomics—the James Agee’s book A Death in the unteers from America who had American Medicine Meets the tailoring of medications to indi- Family, which is one of the most been recruited to go to Canada to American Dream, and it’s about viduals. This doesn’t necessarily moving and powerful psychologi- relieve medical personnel in the in- the ethics of enhancement. Sup- involve sequencing their genome; cal studies about the impact of fectious disease wards who had pose we could alter the human it may simply mean recognizing death. In recent years in particular, been working countless hours un- genome to enable all humans to how genetic differences expressed we’ve seen a lot of attention fo- der very difficult conditions. The get by on three hours of sleep a in the biochemistry of the body cused on specific disease entities; conversations that were reported night. Would we be better off? Or affect a patient’s response to med- Lucy Grealy’s Autobiography of a were timeless in a sense because suppose we could double memory ications. Face, the account of Grealy’s child- they recalled the responses to other capacity. Would we want that? LETTERS: This year’s Visiting hood battle with Ewing’s sarcoma threatening contagious illnesses in What are the implications of such Fellow, Stephen Rachman, is that left her face permanently dis- the past—leprosy in the Middle alterations? Not to mention things studying the medical/aesthetic re- figured, comes immediately to Ages, the plague in the early mod- like having a longer average life lationship between nineteenth– mind. In the last ten to fifteen ern period. Families asked them- span. If genetic manipulation of a century Chinese artist, Lam Qua, years there have been a large num- selves whether a parent should therapeutic sort is available only and American physician and mis- ber of works in which particular leave the children behind for a pe- to people who can afford it, then sionary, Peter Parker, whose pa- illness episodes, or courses of ill- riod to go to Canada and risk con- we will have done something dra- tients were depicted in Lam Qua’s nesses, have been dramatized in tracting a lethal disease. There matic not only to the already work. Clearly the relationship be- some way. I don’t know if this phe- were discussions about obliga- growing disparities between peo- tween society’s response to disease nomenon was prevalent in the tion—the human obligation to the ple in terms of health, but also to and its presentation in the fine arts past, but it seems to me that it patients and the professional oblig- their economic opportunities, and media is as important and rel- wasn’t, and this has done a lot for ation to colleagues who had given their social well-being, and their evant today as it was then. What the broad cultural understanding their all and had no more to give. power. So unlike the period in role do you see cultural produc- about what people experience. There were descriptions of the ter- which Francis Galton was advo- tions playing in changing the ways And sometimes these productions ror that spread through hospitals cating a societally-controlled eu- in which we think about disease? become catalyzing agents for advo- in Toronto and a few other places genics program, what seems more Churchill: I was thinking cacy groups. AIDS is easily the in Canada—accounts of doctors, likely today is discrimination about a course that I direct for most recognizable, but there are for example, who at a meeting based on genetic information. Of- first-year medical students. We use others as well. The cystic fibrosis would always stay on the other ten, such information is not even a lot of literature in the course and group, for example, is a powerful side of the room from colleagues good information—it’s misinfor- my teaching has always used a lot organization of people who have a who had cared for SARS patients. mation. Here, I’m thinking about of literature in conveying both the shared body of experience. It’s not This article succeeded in convey- the genetic testing that insurance social and cultural components of high art, but there are paradig- ing the human reality of a disease companies have occasionally tried illness and disease, as well as the matic stories that get passed experience that for most people to require for health policies. ethics. There is a tremendous body through these communities that has been a set of statistics and a list Ramsey: The British govern- of literature that deals with the become catalytic for political and of cities to avoid. If SARS returns ment has proposed collecting ge- fundamental human components social action, and they influence this winter, as it may, and spreads, netic information for all babies of illness, death, disability, rela- the ways in which research dollars I think we’ll start to see a response born in the U.K. It’s worrisome, tionships between healers, pa- are allocated. It’s very interesting that goes beyond these immediate and there is an interesting debate tients, and families, and dealing and it’s fabulous teaching material. news reports, and may ultimately that’s beginning to emerge. But with chronic illness. That has al- Ramsey: The representation of find a place in the arts. Artistic ex- the utopian vision has been there ways been a very important part of illness in the arts—whether in the pression may help to mediate the for a very long time. Some of the this broader understanding and high arts or in popular culture—is experience of the disease to a larger utopias of progress from the late- communication of what is actually extremely important in shaping public in ways that simple re- eighteenth-century Enlightenment happening. William Carlos perceptions of disease and of those portage cannot. Letters • Fall 2003 • 6

Medicine, Health, and Society: 2003/2004 Fellows Program

LARRY R. CHURCHILL, Ann Geddes transformation among persons with cancer, and book chapters on the history of medi- author of many articles on these subjects. Stahlman Professor of Medical Ethics, is as well as in the inter-related dimensions of cine. He is currently at work on a book She is currently engaged in studying stress Spence and Rebecca Webb Wilson Fellow culture, history, politics, and economics in project entitled “The Development of Pro- from a social psychological perspective and and co-director of the Fellows Program. He the phenomenon of cancer. fessional Monopoly in French Medicine,” plans to use her fellowship to bring two as- is known for his work on the social and as well as a book on the therapeutic uses of pects of her research (on coping with iden- cultural dimensions of health care and SCOTT PEARSON is assistant professor the human body in eighteenth- and nine- tity-threatening events and effective forms health policy, and has published on many of surgery at the Division of Surgical On- teenth-century France, which is based on a of social support) into one pilot project. topics in medical ethics, medicine and liter- cology at the Medical Center. Pearson’s re- series of lectures that he delivered in France She recently co-edited (with Peter J. Burke, ature, and medicine and philosophy. He is search is primarily focused on racial in the summer of 2003. Timothy J. Owens, and Richard Serpe) the co-author (with H. L. Smith) of Profes- disparity in the outcome of breast cancer. Advances in Identity Theory and Research, sional Ethics and Primary Care Medicine: He is the author of numerous journal arti- RUTH ROGASKI recently joined Vander- (Kluewer Academic/Plenum, 2003). Thoits Beyond Dilemmas and Decorum (Duke Uni- cles, book chapters, and abstracts on surgi- bilt as associate professor of history. Her re- is currently collaborating with a colleague versity Press, 1986); Rationing Health Care cal oncology. He is currently developing an search focuses on the intersection between at Tokyo Metropolitan University on a in America: Perceptions and Principles of Jus- interdisciplinary training program in narra- corporeal experience and Chinese construc- cross-cultural comparison of depression in tice (University of Notre Dame Press, tive medicine that teaches medical students tions of modernity. Her first book, Hygienic Japan and the U.S. 1987); co-editor (with N. M. P. King and to view their patients in a broader cultural Modernity: Meanings of Heath and Disease A. W. Cross) of The Physician as Captain of context. The goal of this program is to in Treaty-Port China (forthcoming, Univer- ARLEEN M. TUCHMAN, associate pro- the Ship: A Critical Reappraisal (D. Reidel teach physicians to include and address sity of California Press, 2003), explores fessor of history, is the author of Science, Publishing Company, 1988); Self-Interest early in patient interaction the impact of is- China’s engagements with imperialism and Medicine and the State in Germany: The and Universal Health Care: Why Well-In- sues of race, gender, socioeconomic status, modernity through the lens of medical his- Case of Baden, 1815–1871 (Oxford Univer- sured Americans Should Support Coverage for culture, and spirituality on the patient’s tory, examining in particular how hygiene sity Press, 1993). She is completing a biog- Everyone (Harvard University Press, 1994); care. became both a major marker of Chinese raphy of Marie Elizabeth Zakrzewska co-editor (with G. Henderon, N. Strauss, deficiency and a cornerstone of imagined (1829–1902), one of the most prominent and R. Estroff) of The Social Medicine STEPHEN D. RACHMAN, associate pro- modernity. She is currently working on a female doctors in post-Civil War America Reader (Duke University Press, 1997); Eth- fessor of English at Michigan State Univer- second book on the role of the biological and founder of the New England Hospital ical Dimensions of Health Policy (Oxford sity, was awarded the William S. Vaughn sciences in the construction of Asian em- for Women and Children, an institution University Press, 2002) co-edited with Visiting Fellowship for the 2003/2004 War- pires. that catered both to the care of the poor Marion Danis and Carolyn Clancy; and ren Center Fellows Program. He is the co- and the education of female physicians. most recently, series editor (with Allan M. editor (with Shawn Rosenheim) of The PEGGY A. THOITS, professor of sociol- Upon completion of the biography, Tuch- Brandt) of Ethical Dimensions of Studies in American Face of Edgar Allan Poe (The ogy, specializes in the sociology of mental man will begin research for a book-length Social Medicine (forthcoming from Univer- Johns Hopkins University Press, 1995); health; social psychology; the sociology of study on the history of diabetes in the sity of North Carolina Press). His current Cultural Pathology: Disease and Literature in emotion; self and identity; and stress, United States, focusing on the history of research interests include access to health Nineteenth Century America (forthcoming coping, and support processes, and is the the disease as well the history of health and care and the ethical dimensions of health from the Johns Hopkins University Press in health care disparities. policy. 2004); and co-author (with Peter Vinten- Johansen, Howard Brody, Nigel Paneth, CRAIG ANNE HEFLINGER, associate and Michael Rip) of Cholera, Chloroform professor in the Department of Human and the Science of Medicine: A Life of John and Organizational Development, has re- Snow (Oxford University Press, 2003); as ceived numerous honors and awards for her well as numerous articles on nineteenth- 2004/2005 Fellowships research in child and family health services. century American literature and literature She is co-editor of Families and the Mental and medicine. While at the Warren Center, The 2004/2005 Fellows Program at the Warren Center, Health System for Children and Adolescents: Rachman will continue work on a book “Strategic Actions: Women, Power, and Gender Norms,” Policy, Services, and Research (Sage, 1996) project titled “Memento Morbi: Lam Qua’s and co-author (with L. Bickman, Paintings, Peter Parker’s Patients,” which is will be co-directed by Vanderbilt University faculty mem- P. R. Guthrie, E. M. Foster, E. W. Lambert, about the medical/aesthetic relationship be- bers Holly McCammon (sociology) and Cecelia Tichi (Eng- W. T. Summerfelt, and C. Breda) of Man- tween a leading American medical mission- lish). The year-long seminar will bring together scholars aged Care in Mental Health: The Fort Bragg ary in China, the Reverend Dr. Peter Parker, Experiment (Plenum Press, 1995). and the 19th-century Cantonese artist, Lam from a variety of disciplines to explore the ways in which Heflinger’s recent work involves using large Qua, whose oil paintings depict Parker’s pa- women have acted strategically to further women’s interests data sets to examine health care access and tients. and to reconstruct gender norms. service use patterns. She is currently focus- ing on personal and cultural perceptions of MATTHEW RAMSEY, associate professor Women have been strategic in activism, literature, law, health, and factors influencing decisions to of history, is Jacque Voegeli Fellow and co- politics, religious institutions, families, the arts, the work- seek formal health care. director of the Fellows Program. He is also place, and the public dialogue. Their strategies are some- the director of the Medicine, Health, and LEONARD M. HUMMEL, assistant pro- Society Center at Vanderbilt. His research times globally focused but at other times are focused at the fessor of pastoral theology and counseling, interests concern the social and cultural his- national, community, or even personal level. Often the goals is director of research for religion and spiri- tory of late eighteenth- and nineteenth-cen- tuality at the Pain and Symptom Manage- tury France. He is the author of Professional of these actions are combined with racial, ethnic, class, or re- ment Program of the Vanderbilt-Ingram and Popular Medicine in France, gional agendas. Cancer Center. He is the author of God on 1770–1830: The Social World of Medical the Gallows: Consolation for Suffering in Practice (Cambridge University Press, His- Luther’s Theology and Lutheran Practice tory of Medicine series, 1988); a short The Warren Center will sponsor a Visiting Fellow with exper- (Fortress Press, 2002). He is currently col- monograph, The Politics of Professional Mo- tise in the area of study, in addition to selected Vanderbilt fac- laborating with medical researchers on a nopoly in Nineteenth-Century Medicine: The ulty members. Information regarding the internal and external proposal titled “Facing Death: Cancer and French Model and Its Rivals in Professions Spiritual Transformation.” He is particu- and the French State, 1700–1900 (ed. Ger- applications processes can be obtained from the Warren Center. larly interested in analyzing the religious ald L. Geison, University of Pennsylvania and theological dimensions of spiritual Press, 1984) as well as numerous articles Letters • Fall 2003 • 7

Stephen J. Pyne to Deliver 2003 Howard Lecture

tephen J. Pyne, professor of perback edition, University of “living author whose residence or more than 200 exhibitions in lo- Sbiology and society at Arizona Washington Press, 1997). Other focus has been in the West and cations including the National State University, will present the recent books by Professor Pyne whose career contributions merit Academy of Design, The Draw- 2003 Harry C. Howard Jr. Lec- include Smokechasing (University body-of-work recog- ing Center in ture on Thursday, October 23rd of Arizona Press, 2003); Year of nition.” New York, at 4:10 p.m. in 126 Wilson Hall. the Fires: The Story of the Great In conjunction and the Perc Professor Pyne’s lecture is entitled Fires of 1910 (Viking, 2001; pa- with this year’s Tucker Re- “American History, with Fire in perback, Penguin, 2002); and Howard Lecture, the gional Gallery its Eye.” Pyne, acclaimed by The Fire on the Rim: A Firefighter’s Warren Center will in Australia. A New York Times Book Review for Season at the Grand Canyon (New host a show of Van- recipient of his “major contribution to the lit- York: Weidenfeld & Nicolson, derbilt University numerous erature of environmental studies,” 1989; Ballantine Books, awards, she is the world’s foremost historian paperback edition, 1990; has curated of fire. He has published a series University of Washington more than of environmental histories, Cycle Press, paperback edition thirty exhibi- of Fire, now being republished with new preface, 1995). tions and her and expanded by the University Professor Pyne has re- work is in- of Washington Press. Books in ceived numerous fellow- cluded in the series, which have been trans- ships, including the many public lated into multiple languages, MacArthur “Genius” Fel- and private include Fire: A Brief History (Uni- lowship (1988), a Ful- Professor collections. versity of Washington Press and bright Fellowship, two of Art The Harry C. Howard Jr. Lec- British Museum, 2001); Vestal NEH fellowships, and has Marilyn ture Series was established in Fire: An Environmental History, twice held fellowships at Murphy’s 1994 through the endowment of Told through Fire, of Europe and the National Humanities series of Mr. and Mrs. Thomas E. Nash, Europe’s Encounter With the World Center. He is a Fellow of fire paint- Jr., and Mr. and Mrs. George D. (University of Washington Press, the American Association ings. Pro- Renfro, all of Asheville, North 1997; paperback edition, Univer- for the Advancement of fessor Carolina. The lectureship honors sity of Washington Press, 1997) Science, as well as the American Murphy is an artist whose oil Harry C. Howard, Jr. (B.A. and Fire in America: A Cultural Academy of Arts and Sciences. paintings, drawings, and prints 1951) and allows the Warren History of Wildland and Rural His works have garnered numer- create curious situations from Center to bring an outstanding Fire (Princeton: Princeton Uni- ous literary awards. In 1995, he what appears to be everyday life, scholar to Vanderbilt annually to versity Press, 1982; new preface received the Robert Kirsch Award giving the impression of film noir. deliver a lecture on a significant for paperback edition, 1988; pa- from the Los Angeles Times for a Her work has been shown in topic in the humanities.

Robert Penn Warren Center Executive Director Mona Frederick (left) and Associate Professor of English Kate Daniels met with Senator Lamar Alexander (Vanderbilt ‘62) in Washington, D.C. to discuss issues related to the humanities in higher education. Robert Penn Warren Center for the Humanities Non-Profit Org. VU Station B #351534 U.S. Postage Vanderbilt University Paid Nashville, Tennessee 37235-1534 Nashville, TN Permit No. 1460

2004 Warren Center 2002/2003 Warren Center Fellows Conference Summer Graduate Student The 2002/2003 Warren Center Fellows are planning a conference focusing on Fellows Program gender, sexuality, and activism. The conference will be held October 31 and November 1. Participants will include Alejandra Sarda, coordinator of the Pro- he Warren Center will offer graduate stu- gram for Latin America and the Caribbean at the International Gay and Les- dents in the College of Arts and Science the bian Human Rights Commission. Several local activists will participate in the opportunity to participate in a summer T conference as well, including Abby Rubenfeld (Human Rights Campaign and Graduate Student Fellows Program. Warren Center Graduate Student Fellows will receive a $4,500 ACLU-TN), Becca Stevens (founder, Magdalene House), Dwayne Jenkins and stipend and will meet weekly or twice-weekly for Victor Anderson (Brothers United), and Pamela Degroff (Tennessee Vals). More two hours, from mid-May through early June at the detailed information about the program will be distributed shortly. Warren Center to give presentations based on their research. Each Fellow will be expected to give one seminar presentation and will be required to attend all seminar meetings. Occasional social events will be a part of the program as well. After the four-week se- Race and Wealth Disparity in 21st-Century America ries of seminar meetings, the remaining portion of The Warren Center and the Vanderbilt Law School are cosponsoring a research circle the summer fellowship will be service-free. The War- entitled “Race and Wealth Disparity in 21st-Century America.” The project is funded ren Center grants are intended for graduate students in the humanities or qualitative social sciences who by the Ford Foundation and directed by Beverly Moran, professor of law and sociology are at the advanced stages of writing their disserta- at Vanderbilt University. Members of the research circle are working to bridge the gap tions. Detailed application and fellowship informa- between their separate disciplines by sharing each field’s unique insights and methods tion will be distributed during the fall semester. with one another and with the general public, through a series of private workshops The Warren Center hosted its inaugural Graduate and public lectures, as well as the development of teaching materials for use in the Student Summer Fellows Program in the summer of classroom. Participants in the program include faculty members from five colleges 2003. Participants in the program were: Ivan Fernan- within Vanderbilt University (College of Arts and Science, Law School, School of dez Pelaez, Department of Spanish and Portuguese; Medicine, Owen School of Management, and Peabody College), Fisk University, Elizabeth Festa, Department of English; Aisha X. L. Meharry Medical Center, and Tennessee State University. Also participating in the Francis, Department of English; Jennifer Holt, De- program is the executive director of the Tennessee Network for Community Economic partment of Philosophy; Karissa McCoy, Depart- Development, a not-for-profit organization committed to increasing asset acquisition ment of English; Matt O’Mansky, Department of among the working poor. The lecture series, which began in the fall of 2002, will con- Anthropology; and Carrie Lee Smith, Department of tinue during the 2003/2004 year. Lecture dates and topics will soon be announced. Sociology.

THE ROBERT PENN WARREN CENTER FOR THE HUMANITIES Warren Center Staff Letters is the semiannual newsletter of Statement of Purpose variety of specializations take part in the the Robert Penn Warren Center for the Established under the sponsorship of Warren Center’s programs, which are designed to intensify and increase inter- Mona C. Frederick, Humanities at Vanderbilt University, the College of Arts and Science in 1987 VU Station B #351534, Nashville, disciplinary discussion of academic, so- Executive Director and renamed the Robert Penn Warren Tennessee 37235-1534. (615) 343- cial, and cultural issues. Galyn Glick Martin, Activities Center for the Humanities in 1989, the 6060, Fax (615) 343-2248. For a list- Center promotes interdisciplinary re- Vanderbilt University is committed to principles Coordinator ing of Warren Center programs and search and study in the humanities, so- of equal opportunity and affirmative action. Elizabeth A. Festa, Editor activities, please contact the above cial sciences, and when appropriate, Published by University Design and Publishing address or visit our Web site at natural sciences. Members of the Van- Photographs by Neil Brake, except photo on www.vanderbilt.edu/rpw_center. derbilt community representing a wide page 7, courtesy of the U.S. Senate

Letters • Fall 2003 • 8