Alpha Omega Alpha Honor Medical Society Autumn 2017 Illustration by Jim M’Guinness THE PHAROS of Alpha Omega Alpha honor medical society Autumn 2017 Alpha Omega Alpha Honor Medical Society “Be Worthy to Serve the Suffering” Founded by William W. Root in 1902 Editor Richard L. Byyny, MD Officers and Directors at Large Eve Higginbotham, SM, MD President Managing Editor Dee Martinez Philadelphia, Pennsylvania Alan G. Robinson, MD Art Director and Illustrator Jim M’Guinness President Elect Los Angeles, California Designer Erica Aitken Joseph W. Stubbs, MD, MACP Immediate Past President Albany, Georgia Wiley Souba, Jr., MD, DSc, MBA Editorial Board Secretary-Treasurer Hanover, New Hampshire Robert G. Atnip, MD, FACS, RPVI Jeremiah A. Barondess, MD James G. Gamble, MD, PhD C. Ronald Mackenzie, MD Hershey, Pennsylvania New York, New York Stanford, California New York, New York Holly J. Humphrey, MD David A. Bennahum, MD Michael Gerber, MD Philip A. Mackowiak, MD Chicago, Illinois Albuquerque, New Mexico Denver, Colorado Baltimore, Maryland Richard B. Gunderman, MD, PhD John A. Benson, Jr., MD Dean G. Gianakos, MD Ashley Mann, MD Portland, Oregon Lynchburg, Virginia Kansas City, Kansas Indianapolis, Indiana Richard Bronson, MD Jean D. Gray, MD J. Joseph Marr, MD Sheryl Pfeil, MD Stony Brook, New York Halifax, Nova Scotia Broomfield, Colorado Columbus, Ohio John C.M. Brust, MD Richard B. Gunderman, MD, PhD Aaron McGuffin, MD John Tooker, MD, MBA New York, New York Indianapolis, Indiana Huntington, West Virginia Philadelphia, Pennsylvania Charles S. Bryan, MD Lara Hazelton, MD Stephen J. McPhee, MD Steven A. Wartman, MD, PhD Columbia, South Carolina Halifax, Nova Scotia San Francisco, California Washington, DC Robert A. Chase, MD David B. Hellmann, MD Janice Townley Moore Peterborough, New Hampshire Baltimore, Maryland Young Harris, Georgia Lynn M. Cleary, MD Pascal J. Imperato, MD, MPH&TM Francis A. Neelon, MD Medical Organization Director Syacuse, New York Brooklyn, NY Durham, North Carolina Atul Grover, MD Fredric L. Coe, MD Therese Jones, PhD Douglas S. Paauw, MD, MACP Association of American Medical Colleges Chicago, Illinois Aurora, Colorado Seattle, Washington Washington, DC Jack Coulehan, MD John A. Kastor, MD John S. Sergent, MD Stony Brook, New York Baltimore, Maryland Nashville, Tennessee Councilor Directors Gregory Davis, MD Henry Langhorne, MD Jan van Eys, PhD, MD Regina Gandour-Edwards, MD Lexington, Kentucky Pensacola, Florida Nashville, Tennessee University of California Davis School of Medicine Lawrence L. Faltz, MD Jenna Le, MD Abraham Verghese, MD, DSc J. Mark Kinzie, MD Larchmont, New York New York, New York (Hon.) Oregon Health and Science University School Joseph J. Fins, MD Michael D. Lockshin, MD Stanford, California of Medicine New York, New York New York, New York Steven A. Wartman, MD, PhD Kathleen F. Ryan, MD Faith T. Fitzgerald, MD Jerome Lowenstein, MD Washington, DC Drexel University School of Medicine Sacramento, California New York, New York Gerald Weissmann, MD Coordinator, Residency Initiatives Lester D. Friedman, PhD Kenneth M. Ludmerer, MD New York, New York Geneva, New York St. Louis, Missouri Suzann Pershing, MD Stanford University Student Directors www.alphaomegaalpha.org Jeremy T. Bolin Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine Manuscripts being prepared for The Pharos should be typed double-spaced and conform to the format outlined Sean Christensen, MSIV in the manuscript submission guidelines appearing on our website: www.alphaomegaalpha.org/contributors.html. University of South Carolina School of Medicine Editorial material should be sent to Richard L. Byyny, MD, Editor, The Pharos, 12635 E. Montview Blvd, Suite 270, Aurora, CO 80045. E-mail: [email protected]. Samantha Dizon Requests for reprints of individual articles should be forwarded directly to the authors. University of Maryland School of Medicine The Pharos of Alpha Omega Alpha Honor Medical Society (ISSN 0031-7179) is published quarterly by Alpha Omega Alpha Honor Medical Society, 12635 E. Montview Blvd, Suite 270, Aurora, CO 80045, and printed by The Ovid Bell Press, Inc., Fulton, Missouri 65251. Periodicals postage paid at the post office at Aurora, Colorado, and at additional mailing offices. Copyright © 2017, by Alpha Omega Alpha Honor Medical Society. The contents of The Pharos can only be reproduced with the written permission of the editor or managing editor. (ISSN 0031- Administrative Office 7179). Richard L. Byyny, MD Circulation information: The Pharos is sent to all dues-paying members of Alpha Omega Alpha at no additional Executive Director cost. All correspondence relating to circulation should be directed to Ms. Dee Martinez, 12635 E. Montview Blvd, Aurora, Colorado Suite 270, Aurora, CO 80045. E-mail: [email protected]. 12635 E. Montview Blvd, Suite 270, Aurora, CO 80045 POSTMASTER: Change service requested: Alpha Omega Alpha Honor Medical Society, 12635 E. Telephone: (720) 859-4149 Montview Blvd, Suite 270, Aurora, CO 80045. E-mail: [email protected] 2 Editorial I Social determinants of health: Reforming education and public health to improve health in the United States Richard L. Byyny, MD, FACP 8 Astonished harvest: The joy of medicine Jack Coulehan, MD 14 Harold L. May, MD: Surgeon, community health pioneer, and family advocate Richard F. Gillum, MD 22 Do students lose empathy in medical school? Robert S. Brown, MD 27 Per Os (by mouth) David True, MD, PhD 28 science intersecting the arts: Puccini, Debussy, and radium therapy Gregory W. Rutecki, MD 34 Color blindness and its illuminations Rebecca M. Shulman 40 The “medicalisation of the sexually peculiar” Brit Trogen 49 The parking space (Sister) Autumn 2017 Autumn Wynn Morrison, MD • 50 A phantom disease Rachel Stern, MD 53 Doctor Dog Richard Bronson, MD 54 Reviews and reflections Volume 80 Number 4 Number 80 Volume 58 Medicine on the big and small screen • 61 National and Chapter news 64 Letters to the Editor Inside The Pharos Back64 An Open Letter from the Executive Director IN THIS ISSUE Cover Social determinants of health: Reforming education and public health to improve health in the United States By Richard L. Byyny, MD, FACP he determinants of health that are most focused per 1,000 live births, which is also behind most European on by physicians, and the general public, include and Asian countries.2 diseases, genes, biology, and pathogens. While Most of the improvements in lifespan, quality of life, Tthese are important, health and associated outcomes are infant mortality, and other indicators of public health oc- determined by social factors that are often unrecognized curred prior to the discovery of the causative factors of and unappreciated. diseases, and preceded the widespread use of vaccines, an- Social determinants of health (SDH) include early tibiotics, modern medical treatments, and other scientific life experiences; socioeconomic conditions (income and discoveries. It has been estimated that only about five years poverty); quality and level of education; access to employ- of the almost 30 years of increase in life expectancy in the ment, work/life balance, and work environment; social U.S. has been due to preventive and therapeutic medicine. and physical infrastructure and living conditions; com- Eighty percent of improvement in life expectancy and munity and environmental factors; behaviors, social net- health outcomes has been attributed to improvements in works, and public safety. The World Health Organization’s SDH, including income, sanitation, nutrition, clean water, Commission on the Social Determinants of Health uses education, living conditions, and public health measures to the definition “…the conditions in which people are born, prevent disease. As dramatic and consequential as medical grow, live, work and age,” with complex interactions care is for some patients, it is not the major determinant of among lifestyle, socioeconomic, biological, environmental, overall levels of the population’s health. and social factors that affect people’s health and well-be- ing. Physicians often learn about SDH through experiences Influences on health caring for patients and families, and in clinical and com- One of the most important contributors to poor health munity settings with diverse patient populations. is poverty. Adult life expectancy increases with increasing income, and men and women in the highest income group The cost of health care can expect to live at least 6.5 years longer than poor men The United States spends more than $3.4 trillion a year and women. Poverty leads to unhealthy behaviors, chronic on health care. This is more than $10,000 per person, and stress, and few resources for improved health and access more per person than any other country. The average life to preventive and primary health care.3 expectancy in the U.S. is 79.3 years, or 31st among devel- Education is also a significant determinant of health. oped countries. Most European and Asian countries, along Adult health status improves as educational attainment with Greece, Slovenia, Cyprus, and Chile are all ahead of increases. Babies born to mothers who did not finish the U.S.1 Infant mortality in the U.S. is 29th at 6.5 deaths high school are nearly twice as likely to die before their 2 The Pharos/Autumn 2017 first birthday as babies born to college graduates. Adult inflammatory responses; metabolic systems; cardiovas- life expectancy also increases with education. On aver- cular