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Month: March 2022

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In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post highlights transgender healthcare equity.

Visibility. What does it mean to you? Does it mean being seen or acknowledged? If something or someone is visible are they not only ‘seen’, but also understood? When someone is seen, is it the individual that is seen or is it a label ascribed to them that is seen? A fuller understanding of what it means to be transgender and the issues transgender people face within the current healthcare climate is the first step in changing the system towards a more equitable healthcare system for transgender people.

On March 31, 2022, International Transgender Day of Visibility, the United States is set to to break its all-time record for the introduction of anti-transgender legislation. While anti-transgender legislation covers a vast array of human activities – from using the restroom to participating in sports – the impact this kind of legislation has or may have on healthcare is not something to be ignored. Around the United States, transgender people, their families, and their healthcare providers are at risk of severe punishment for trans-affirming care. 

In Texas, transgender rights came into the spotlight recently when Gov. Greg Abbott instructed health-related agencies in the State of Texas to treat gender-affirming care provided to transgender minors as “child abuse” and that anyone could and should report transgender individuals, their families, and their healthcare providers under that definition (Ghorayshi, 2022; Goodman, 2022). Despite having no legally binding authority and being temporarily blocked by Judge Amy Clark Meachum, this order has already forced many families to face investigations that threaten to separate them from their transgender children. (Klibanoff & Dey, 2022)

In Idaho, HB675 seeks to group a variety of medical procedures under the definition of “genital mutilation” and was introduced in late February. Should this bill pass, medical service providers who administer medications or procedures in order “to change or affirm the child's perception of the child's sex if that perception is inconsistent with the child's biological sex, shall be guilty of a felony” (H.B. 675, 2022). This excludes procedures such as circumcision and controversial and often medically unnecessary surgeries performed on intersex children (Ejiogu, 2020), but includes the use of puberty blockers (also known as GnRHas) to delay puberty until a child comes of age and has the ability to consent to hormone replacement therapy if they so choose. A healthcare provider convicted of a felony under this proposed legislation would “be imprisoned in the state prison for a term of not more than life” (H.B. 675, 2022). This bill passed the House, but the Idaho Senate Majority Caucus released a statement against HB675, so it is unlikely that it will become law (Russell, 2022).

In Louisiana, bill HB570 functions similarly to Idaho’s HB675, with a few slight changes. Rather than a felony charge, healthcare providers would “be subject to discipline by the licensing entity with jurisdiction over the physician, mental health provider, or other medical healthcare professional” (H.B. 570, 2022). Healthcare providers might also be liable for compensation should the patient file a claim, or should their parents do so in the patient’s stead. In addition, HB570 includes sections that would restrict usage of public funds that might be used for gender affirming care (H.B. 570, 2022). This bill is currently awaiting review by the Louisiana House Committee on Health and Welfare.

In Tennessee, bill HB2835 is similarly structured. This bill includes restrictions regarding public fund usage, but medical service providers would be “subject to revocation of licensure and other appropriate discipline by the medical professional's licensing authority. The medical professional will be subject to a civil penalty of up to $1,000 per occurrence” (H.B. 2835, 2022). HB2835 also includes provisions that would require any individuals employed by the state to “immediately notify, in writing, each of the minor's parents, guardians, or custodians” of a minor’s transgender identity upon learning of it (H.B. 2835, 2022). The bill does not include any exceptions regarding this requirement should there be reason to believe that the parents, guardians, or custodians would react to the news violently. TN HB2835 was moved to the Tennessee House Health Committee for review on March 22, but was taken off notice and is unlikely to continue through any future voting procedures. (H.B. 2835, 2022)

These are only a few of the many parallel legislations raised in the last few months that have framed transgender-related care as abuse and mutilation. New Hampshire, Arizona, and Wisconsin have seen similar legislative proposals. That said, regardless of whether or not this kind of proposed legislation is passed, they raise a startling concern: how can healthcare providers care for their transgender patients should state laws subject those involved to harsh punishments? 

The truth is that visibility alone does not protect transgender individuals who would be impacted by such legislation. Healthcare providers can update their knowledge regarding legislation that targets gender affirming care. Freedomforallamericans.org features up to date information on all current anti-transgender bills, many of which are healthcare related. The Transgender Law Center’s National Equality map tracks legislation that impacts LGBTQIA+ individuals and includes healthcare as one of the major legislative categories. 

Healthcare providers can access resources to update their knowledge and to support high-quality care for transgender individuals via multiple resources available in Himmelfarb Library’s collections including:

The Whitman Walker clinic has a Cultural Competency toolkit that focuses on practices you can provide to all LGBTQIA+ patients. Other helpful associations include:

  • The DC Center for the LGBTQ Community aims “to promote health equity in our local LGBTQ Community'' with programs such as free at-home STI & HIV testing kits, the binder donation project, trauma-informed mental health support groups, and more. 
  • The DC Trans Coalition “is a volunteer, grassroots, community-based organization dedicated to fighting for human rights, dignity, and liberation for transgender, transsexual, and gender-diverse (hereafter: trans) people in the District of Columbia.” (“About DCTC”) The DC Trans Coalition has a transgender healthcare resource list, as well as a guide to educate transgender DC residents on their rights.
  • The Fenway Institute has a sub-organization known as The National LGBTQIA+ Health Education Center, which focuses on producing seminars and guides to educate health service providers. These resources cover gender-affirming surgeries, HIV and PrEP, research and data collection, and more.

Nationally, transgender individuals can find healthcare-related support through a variety of organizations. Healthcare providers can share the following resources with their transgender patients in order to improve patient education, particularly since generalized healthcare is often not suitable for transgender individuals:

  • The National Center for Transgender Equality (NCTE) aims “to change policies and society to increase understanding and acceptance of transgender people,” by way of legal support, news involving transgender rights, and guides for a variety of transgender-related topics”. (“About Us”, transequality.org) The topics of those transgender-specific guides include general healthcare, COVID-19, and health coverage. NCTE also has a page dedicated to mutual aid and emergency funds in the event that a transgender individual needs legal support when facing discrimination in a variety of spheres of life, including healthcare. 
  • In addition to legal support in defense of transgender individuals facing discrimination, Lambda Legal, which boasts “the oldest and largest national legal organization whose mission is to achieve full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and everyone living with HIV” (“About Us”, Lambda Legal) has a downloadable Transgender Rights Toolkit to support transgender individuals facing any number of discriminatory matters, including health care discrimination. Lambda Legal also has a LGBT rights by state tool to help find information about local legislation, including healthcare-related legislation.
  • The Transgender Law Center (TLC), a trans-led advocacy organization, hosts a page of health resources. This includes a guide for transgender patients on how to negotiate for more inclusive coverage, as well as a guide that explains nondiscrimination rights under the Affordable Care Act (ACA).
  • The Transgender Legal Defense and Education Fund, which offers legal services and public policy education, also manages the Trans Health Project. This program includes insurance tutorials, statements from major medical organizations in recognition of the medical necessity of treatments for gender dysphoria, literature reviews to support appeals that require proof of medical necessity, and more.
  • Anti-transgender discrimination can also be reported through the American Civil Liberties Union (ACLU), which has a page dedicated to transgender health. This page regularly updates with press releases and news analyses.

Visibility is important, and at Himmelfarb we believe that it is a human right to be acknowledged for who you are. While transgender healthcare has come a long way, there are still ways that we can improve our care and protect our patients, particularly those who live in states with anti-transgender legislation on the rise. We hope that the resources in this piece will help medical professionals, transgender patients, and allies to take action and defend transgender people so that they can be visible. 

References

“About DCTC.” DC Trans Coalition. https://dctranscoalition.wordpress.com/about-dctc/. Accessed March 30, 2022.

“About Us.” Lambda Legal. https://www.lambdalegal.org/about-us. Accessed March 30, 2022.

“About Us.” National Center for Transgender Equality. https://transequality.org/about. Accessed March 30, 2022.

Ejiogu, N. I. (2020). Conscientious Objection, Intersex Surgeries, and a Call for Perioperative Justice. Anesthesia and analgesia. Vol. 131 (5), 1626-1628. http://doi.org/10.1213/ANE.0000000000004946

Feinberg, L. (2013). Transgender liberation: A movement whose time has come (pp. 221-236). Routledge.

Ferrando, C. A. (2020). Comprehensive care of the transgender patient. Elsevier.

Forcier, M., Van Schalkwyk, G., & Turban, J. L. (2020). Pediatric gender identity : gender-affirming care for transgender & gender diverse youth. Springer.

Ghorayshi, A. (2022, February 23). Texas Governor Pushes to Investigate Medical Treatments for Trans Youth as ‘Child Abuse’. New York Times. https://www.nytimes.com/2022/02/23/science/texas-abbott-transgender-child-abuse.html

Goodman, J. D. (2022, March 11). How Medical Care for Transgender Youth Became ‘Child Abuse’ in Texas. New York Times. https://www.nytimes.com/2022/03/11/us/texas-transgender-youth-medical-care-abuse.html

Hardacker, C., Ducheny, K., & Houlberg, M. (2019). Transgender and Gender Nonconforming Health and Aging. Springer.

H.B. 570, House of Representatives, 2022 Reg. Sess. 397. (Louisiana 2022). https://www.legis.la.gov/legis/ViewDocument.aspx?d=1256678

H.B. 675, House of Representatives, 2022 2nd Reg. Sess. (Idaho 2022). https://legislature.idaho.gov/sessioninfo/billbookmark/?yr=2022&bn=H0675

H.B. 2835, House of Representatives, 2022 Health Subcommittee. (Tennessee 2022). https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB2835&ga=112

Keuroghlian, A. S., Potter, J., & Reisner, S. L. (2022). Transgender and gender diverse health care : the Fenway guide. McGraw Hill.

Klibanoff, E., & Dey, S. (2022, March 11). Judge temporarily blocks Texas investigations into families of trans kids. Texas Tribune. https://www.texastribune.org/2022/03/11/transgender-texas-court-hearing/

LGBTQ+ : support and care. Part 3, Caring for transgender children (2021). American Academy of Pediatrics.

Russell, B. (2022, March 15). Senate GOP releases statement on its opposition to HB 675 on trans youth care. Idaho Press. https://www.idahopress.com/eyeonboise/senate-gop-releases-statement-on-its-opposition-to-hb-675-on-trans-youth-care/article_5c5305d4-9854-568f-b27a-76865a04b75c.html

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The academic publishing landscape can be difficult to navigate and Himmelfarb Library’s Scholarly Communications Committee is dedicated to answering general and specific questions that arise during the submission and publication process. The Committee continues to expand its ‘Scholarly Communications Short Video Library’ and there are nearly 20 videos to watch that cover various topics such as how to properly change citation styles, how and why to archive your publications with an institutional repository and how to set up your Google Scholar profile. If you’d like to watch the videos, but are unsure of where to begin here are some suggestions:

Advanced Literature Searches and the PubMed MeSH Search Builder:

In this lecture, you’ll learn about PubMed’s MeSH builder and how you can use it to help you perform advanced literature searches. Paul Levett, a Reference and Instructional Librarian, provides a step by step guide on how MeSH terms can be used to locate specific research articles that can assist you during the advanced literature search process. If you’re in the beginning stages of brainstorming a research topic or question, this tutorial will provide insight into how to conduct your own literature search and discover publications that will help you narrow the scope of your own research. 

Screening: What do Editors Look For?

When you’re ready to submit your research for publication, this tutorial by Reference and Instructional Librarian Stacy Brody will talk in-depth about how journal editors select manuscripts for their respective journals. The submission process may seem mysterious and difficult to understand, but this video will discuss six features editors consider when evaluating manuscripts.  

Retractions, Corrections, & Expressions of Concern:

Are you unsure of the difference between retractions, corrections and expressions of concern? Would you like to ensure you’re using research that is considered a valuable source to cite? In this tutorial, Ruth Bueter,  Serials and Systems Librarian, breaks down the difference between these terms and discusses how and why an article may be retracted or corrected or why there may be concerns with a published article.

These are just a few of the many videos currently available in the Scholarly Communication’s video library. The Scholarly Communications Committee is currently working on a new round of videos to add to the video library and hopes to share their new lectures in late spring or early summer. if you’d like to suggest a topic please fill out this suggestion form!

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When you search Health Information @ Himmelfarb, the library’s search box, you will now be alerted to retracted content in the search results. This service is courtesy of Third Iron’s LibKey which provides the PDF and View Issue Contents buttons in article records. When an article is retracted, the PDF button is replaced with a Retracted Article button as illustrated below.

Screenshot of result with retracted article link on Health Information @ Himmelfarb

Clicking on the Retracted Article button opens a window that displays the retraction details (why the article was retracted) and PDF link if you still want to read or download the article. 

Screenshot of LibKey retraction notice window

Retraction data comes from Retraction Watch, a service of the Center for Scientific Integrity. 

Retraction notices are now available in other Third Iron products. For example, if you use the Browzine app to read e-journals from Himmelfarb, alerts to retracted articles will appear there.  LibKey Nomad can be installed as an extension to your Chrome, Edge, or Firefox browser to provide PDF buttons in databases like PubMed. Nomad will now display Retracted Article buttons in those databases.

Screenshot of Article Retracted button on PubMed

Need help searching for articles or other resources? Contact our reference team at himmelfarb@gwu.edu or through our chat service.

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Awareness. It is one thing to read about it and another to understand what it means. The beauty of awareness is that it often inspires change in our actions, thoughts and lives. March just so happens to be Developmental Disabilities Awareness month, and is a fantastic opportunity for the medical community to recognize the importance of educating ourselves and our patients when it comes to developmental disabilities. 

Children develop at their own pace, but there are important milestones that should be achieved by a certain point in a child’s development. These skills are not only fundamental to a child’s growth, but if not monitored closely, long term developmental disabilities can worsen such as ADHD, autism, cerebral palsy, learning disorders, or a loss of hearing or vision. Developmental disabilities may be physical or intellectual; Intellectual and Developmental Disabilities or IDDs is the term used to describe instances when an intellectual disability and other disabilities are present.. For further reading, see what the NIH has to say about IDDs. 

Ask yourself: “Is my patient developing at a rate they are supposed to?” Observation is key when it comes to treating children. Monitor your patients. If you notice an ongoing pattern, seek appropriate treatment for them.

For further information on Developmental Disabilities and what you can do to protect and prevent your patients’ symptoms from worsening, visit the CDC’s Developmental Disabilities homepage. 

Additional reading can be found at: 

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Images of Dr. Margaret Chung, Dr. Virginia Alexander, Henrieta Villaescusa, and Estelle Brodman.

In honor of Women’s History Month, Himmelfarb Library celebrates the lives of four influential women within the health sciences. Today, we honor: Dr. Margaret Chung, the first Chinese American woman to become a physician; Dr. Virginia Alexander, African American physician and public health expert who fought against racial discrimination in healthcare; Henrieta Villaescusa, the first Hispanic nurse appointed as Health Administrator of the Department of Health, Education and Welfare; and Estelle Brodman, a medical librarian who had a profound impact on the field of medical librarianship.

Dr. Margaret Chung: The First Chinese American Woman Physician

Image of Dr. Margaret Chung.
Public domain image retrieved from https://www.nps.gov/people/dr-margaret-mom-chung.htm

Margaret Jessie Chung, born in Santa Barbara, California in 1889 and the daughter of Chinese immigrants, dreamed of becoming a medical missionary to China from a young age. She graduated from the University of Southern California Medical School in 1916 as the first American-born Chinese female doctor (PBS, n.d.). As a medical student, Chung was the only woman in her class, and often wore masculine clothing and referred to herself as “Mike” (Wagner, 2021a). 

After graduating medical school, she was denied residencies and internships in local hospitals and was rejected from becoming a medical missionary based largely on her race (Stanford Libraries, n.d.). She moved to Chicago where she completed an internship and residency in surgery and psychiatry (Stanford Libraries, n.d.). She returned to California and accepted a staff physician position at the Santa Fe Railroad Hospital in Los Angeles where she specialized in emergency plastic surgery for victims of  railroad accidents (PBS, n.d.). She soon started a private practice that catered to the actors and musicians of Hollywood’s growing entertainment industry (Wagner, 2021a). In the early 1920s, she moved to San Francisco where she helped establish the first Western hospital in San Francisco’s Chinatown (PBS, n.d.). She led the OB/GYN and pediatrics units.

In the 1930s, during the Japanese invasion of China and the Sino-Japanese War, Dr. Chung became friends with a U.S. Navy Reserves officer, Steven G. Bancroft and his friends. The group saw her as a motherly figure and adopted her as “Mom” (Wagner, 2021a). Dr. Chung was instrumental in the creation of Women Accepted for Volunteer Emergency Service (WAVES), a reserve corps for women in the Navy (Wagner, 2021a). Although WAVES helped lay the groundwork for women’s integration into the U.S. armed forces, Chung was not permitted to serve, likely a result of her race and sexuality (PBS, n.d.) and she never received credit for her efforts in WAVES creation (Wagner, 2021a).  Judy Tzu-Chun Wu, the author of Chung’s biography, wrote that Chung “was not afraid to break barriers” (Stanford Libraries, n.d.). Chung’s fearlessness in breaking down barriers paved the way for other women and minority physicians to do the same!

Dr. Virginia Alexander: Pioneer of Public Health Equity 

Image of Dr. Virginia Alexander
Photo from https://files-profile.medicine.yale.edu/images/5e62b755-ac78-4a58-ba0b-b88675a5548d

 

Virginia Alexander was born in 1899 to formerly enslaved parents in Philadelphia, Pennsylvania. Her family faced financial hardships when she was a child. Her mother died when she was only four years old, and her father lost his livery stable when she was 13. The financial strain this placed on the family did not stop Alexander from pursuing her education, something her father was adamant that she continue. She was awarded a scholarship to the University of Pennsylvania and worked as a maid, a clerk and a waitress to pay her living expenses (NIH, 2015).

She went on to medical school at the Woman’s Medical College of Pennsylvania (Wagner 2021b). During medical school, Alexander experienced racism as one of the only Black students in her class (Wagner, 2021b). After finishing medical school, Alexander had trouble landing an internship because of her race and even her own medical school’s hospital did not accept Black doctors (Wagner, 2021b). She eventually landed a position at the Kansas City Colored Hospital. 

Dr. Alexander soon returned to Philadelphia and opened up her own community health clinic out of her home, Aspiranto Health Home (NIH, 2015). The clinic focused on treating Black patients who were refused treatment from white staff in Philadelphia hospitals free of charge (Wagner, 2021b). She cared for pregnant women and young mothers, and also provided contraceptives to women free of charge (Finlay, 2020). Over five years, Dr. Alexander saw 2,000 patients and delivered 43 babies (Finlay, 2020). 

In 1935, she conducted a study on race and public health in North Philadelphia that found “shocking disparities in health outcomes among Black and white residents'' (Wagner, 2021b). Her data showed that Black babies died at more than twice the rate than that of white babies, and that Black people were dying of tuberculosis at a rate six times higher than the white population in the city (Wagner, 2021b). Her work also exposed racial discrimination in segregated wards at hospitals and linked this issue to the inequality of social conditions including inadequate sanitation in Black neighborhoods (Wagner, 2021b). 

Dr. Alexander later earned a Master’s of Public Health degree at Yale University and accepted a position at Howard University as the physician-in-charge of women students (NIH, n.d.). She advocated for the 1939 National Health Bill, an early attempt at a national health insurance system (Wagner, 2021b). During the 1940s, she served with the U.S. Public Health Service. During WWII, Alexander volunteered for the government and treated coal and iron miners who were living in extreme poverty in Birmingham, Alabama (NIH, n.d.). While there, she contracted lupus. She died in Philadelphia at the age of 49. She once said that “we will have to send physicians into sections which have no bright lights and … take public health across the railroad tracks, to serve those most in need of comfort and care” (NIH, n.d.). Dr. Alexander truly lived out this belief throughout the course of her life and incredible career!

Henrieta Villaescusa: The First Hispanic Nurse Appointed as Health Administrator

Image of Henrieta Villaescusa
Image from https://nahnnet.org/about/bios/Henrieta-Villaescusa

Henrieta Villaescusa was born in Tucson, Arizona in 1920. She attended Mercy College of Nursing in San Diego, received a Bachelor's degree from Immaculate Heart College, and a Masters Degree from UCLA (NAHN, n.d.). Villaescusa held a variety of nursing positions, and eventually worked for the Los Angeles City Health Department, where she became the only Hispanic supervising public health nurse (Pasadena Star-News, 2005). She later worked as part of the Center for Disease Control’s Hispanic/Latino subcommittee for the National Diabetic Education Program where she worked to address the needs diabetic patients in the Hispanic and Latino population (Pasadena Star-News, 2005). 

Villaescusa’s career was one of many firsts for Latino women. She became the first Hispanic nurse appointed as Health Administrator in the Department of Health, Education and Welfare (NAHN, n.d.). She was also the first Mexican American Chief Nurse Consultant in the Office of Maternal and Child Health within the Bureau of Community Health Services (HAHN, n.d.). In this capacity, she identified the needs, trends, and priorities in nursing research and training (Pasadena Star-News, 2005). 

Villaescusa was also the first Hispanic to serve as the Bureau of Community Health Services’ Federal Women’s Program Manager (Pasadena Star-News, 2005). In the 1960s, she was appointed to the Alliance for Progress, making her the highest ranking Mexican American in the Bureau (Pasadena Star-News, 2005). In this capacity, her impact reached beyond the United States. She worked to improve the health of people in Latin America by partnering with the academic and community health nursing leaders to “develop nursing education programs, curricula, and collaborative partnerships with local health professionals in Peru, Ecuador, Bolivia and Panama” (Pasadena Star-News, 2005). 

Throughout her career, Villaescusa worked closely with the National Coalition of Hispanic Health and Human Services Organization, and the Mexican American National Women's Association (NAHN, n.d.). She also served as the president of the National Association of Hispanic Nurses from 1984 to 1988 (NAHN, n.d.). Among her many other accomplishments, Villaescusa served as an advisor to director of health programs with the Office of Economic Opportunity, was the the only Hispanic member of the Board of Nurse Examiners in California, and was chief nurse with the Division of Maternal and Child Health where “she was responsible for all nursing aspects of the maternal and child health programs in the country” (Pasadena Star-News, 2005). Villaescusa was truly a trailblazer and her career left a lasting impact on the field of nursing, nursing education, and healthcare!

Estelle Brodman: “A Towering Figure” within Medical Librarianship!

Image of Estelle Brodman
NLM Digital Collections (1951?). Estelle Brodman [Digital image]. National Library of Medicine Digital Collections. http://resource.nlm.nih.gov/101410948

Estelle Brodman was born in New York City in 1914, and grew up in a Jewish household that placed a high value on education and learning. This love of learning served her well in her chosen field of medical librarianship. “I find learning a great joy and a great pleasure, …[others] think of learning as something they are required to do, and I think of learning as something I want to do” she stated in her oral history (Messerle, 2010). 

Brodman’s father was a physician and she and her brother both intended to follow in his footsteps. While her brother became a psychiatrist, she was not accepted to medical school despite having a bachelor’s degree from Cornell University in histology and embryology (Messerle, 2010). Determined to have a career in the medical field, she ultimately decided to become a medical librarian and received a master's degree in library science from Columbia University (Messerle, 2010). 

Over the course of twelve years, she held a number of librarian positions at the Columbia University College of Physicians and Surgeons Library. While serving as “Acting Librarian,” she was told that they would never make a women [head] librarian,” so she decided to get a Ph.D (MLA, 2016). She would go on to serve as the Chief of the Reference Division of the Army Medical Library, which would later become the National Library of Medicine (Messerle, 2010). 

In 1960, she was instrumental in developing and writing much of the Medical Library Assistance Act, which created regional resource libraries that were supported by the National Library of Medicine to improve medical library collections, upgrade facilities, and train medical librarians (Fee, 2015). Although the Medical Library Assistance Act was not passed until after Brodman had moved on, it had a “far-reaching impact” and contributed to the growth of medical librarianship and medical libraries (Messerle, 2010). 

Brodman later moved to Washington University in St. Louis. The position allowed her to teach, and she “was able to persuade them that just as any other department [the library] should do research and training” (MLA, 2016). Brodman developed the PHILSOM automation project, an automated serials control system, in the early 1960s (MLA, 2016). She was an early adopter of technology and later developed a training program in computer librarianship (Messerle, 2010). 

Brodman was active in professional associations including the a term as president of the Medical Library Association in 1964-65, the Special Library Association where she served as Director from 1949-1952, the NIH Biomedical Communication Study Section, History of Medicine Review Panel, the Council of the American Association for the History of Medicine, and the Presidential Commission on Libraries (MLA, 2016). She served as editor of the Bulletin of the Medical Library Association for ten years. In her work with the joint Medical Library Association/American Association of Medical Colleges Committee, she helped create guidelines for medical school libraries (MLA, 2016). When Brodman died in 2007, an article in The Journal of the Medical Library Association stated that we had lost “a towering figure of the profession” (Messerle, 2010). While she is no longer with us, her impact within the field of medical librarianship will not soon be forgotten!

 

References:

Fee, E. (October 22, 2015). The Medical Library Assistance Act of 1965. Circulating Now, National Library of Medicine website. https://circulatingnow.nlm.nih.gov/2015/10/22/the-medical-library-assistance-act-of-1965/

Finlay, M. (June 2020). “Guardian of the Health of Negro Women”: The Work and Legacy of Dr. Virgina Alexander. Drexel University College of Medicine Legacy Center Archives & Special Collections Blog. https://drexel.edu/legacy-center/blog/overview/2020/june/guardian-of-the-health-of-negro-women-the-work-and-legacy-of-dr-virginia-alexander/

Medical Library Association (MLA). (March 18, 2016). MLA Oral Histories: Brodman, Estelle (PhD, AHIP, FMLA)*. MLA website. https://www.mlanet.org/blog/brodman-estelle

Messerle J. (2010). Estelle Brodman, AHIP, FMLA, 1914–2007. Journal of the Medical Library Association : JMLA, 98(1), 6–8. https://doi.org/10.3163/1536-5050.98.1.004 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801987/pdf/mlab-98-01-6.pdf

National Association of Hispanic Nurses (NAHN). (n.d.). Henrieta Villaescusa, MPH, PN. NAHN website. https://nahnnet.org/about/bios/Henrieta-Villaescusa

National Institutes of Health. (June 3, 2015). Dr. Virginia M. Alexander Biography. https://cfmedicine.nlm.nih.gov/physicians/biography_5.html

Pasadena Star-News. (2005, March 9). Henrietta Villaescusa Obituary. Pasadena Star-News. https://www.legacy.com/us/obituaries/pasadenastarnews/name/henrietta-villaescusa-obituary?id=26841230

PBS (May 27, 2020). The First American-Born Chinese Woman Doctor. PBS American Masters website. https://www.pbs.org/wnet/americanmasters/first-american-born-chinese-woman-doctor-ysk233/14464/

Stanford Libraries (n.d.). Dr. Margaret Chung. Rise Up for Asian Americans and Pacific Islanders. https://exhibits.stanford.edu/riseup/feature/dr-margaret-chung

Wagner, E. (December 9, 2021b). Dr. Virginia Alexander. National Park Service website. https://home.nps.gov/people/dr-virginia-alexander.htm

Wagner, E. (October 8, 2021a). Dr. Margaret “Mom” Chung. National Park Service website. https://www.nps.gov/people/dr-margaret-mom-chung.htm

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Photo of MD class of 2022 students at Himmelfarb Library orientation in 2018.

After four years of medical school, the MD Class of 2022 has made it to Match Day! Congratulations from all of us at Himmelfarb Library! We are so proud of what you've accomplished during your time here. Tune in to watch Match Day live! Remarks from leaders begin at 11:10am, and students will open their envelopes at Noon.

Here’s a look back at when you were just starting your med school journey.

Images from SMHS's Class of 2022 Himmelfarb Library orientation (August 2018).

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Color photograph of castle ruins
Photo Credit: Iain on Pexels

It is nearly impossible to pinpoint the exact start of Irish medical history as many sources, both primary and secondary, have been lost to time. Thankfully with the aid of historical town annals and medical manuscripts stored in either a private collection or at an institution, historians can peer into ancient times and learn more about professional medical practices in Ireland. Like many cultures, the medical traditions in Ireland were uniquely tailored to the lives and societal norms of the time period, often adapting to changes in the social hierarchy. There are books, articles and other scholarly sources that provide analysis and detailed overviews on Irish medical practices and we hope this article will encourage you to learn more. 

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Medicine & Religion: Pre-Christian Irish medical history is believed to be closely tied to the Druids and druidic practices. Due to a lack of firsthand knowledge about the Druids, their beliefs and practices, historians must separate facts from myths often ending up with inconclusive results. In Irish mythology, the Druid  “Diancecht' was known as the God of Healing and is said to have practiced hypnotism. He is said to have recognized fourteen disorders of the stomach.” (Woods, 1982 p. 35) Physicians and medical figures are woven into early Irish myths and legends, hinting at the importance of their profession during the ancient times when warfare was a common occurrence. “King Cormac who reigned in AD 227 made an order that all future monarchs of Ireland should at all times be accompanied by ten persons, a chief, a judge, a druid, a physician, a poet, a historian, a musician and three servants. This order apparently lasted until the death of Brian Boru in 1014 AD.” (Woods, 1982, p. 36) With the arrival of Christianity and the decline of the Druids, medical responsibilities shifted towards monasteries and Christian priests. 

Newly built Christian churches and monasteries contained separate wards and small hospitals that were dedicated to the care of sick or injured individuals. In these sick wards, the priests and nuns attended to their patients, often relying on prayer or herbal concoctions as remedies. Plagues were a common occurrence. There are documented cases of widespread sickness in 250 AD, 664-665 AD and the end of the sixth century when the bubonic plague reached Ireland. During these times, the Christian church grew in power as many in Ireland found comfort in Christian teachings. “The miracles of Christ, the miraculous power entrusted to his followers and the belief in the resurrection after death, gave hope to the sick and those living amidst a plague, while the Christian ethos of caring gave practical comfort.” (Woods, 1982, p. 37)  While secular physicians existed during these early times, for many years medical authority resided primarily with individuals and organizations tied to a religious background, starting with the ancient Druids before transitioning to the Christian priests once their faith reached Ireland. This union of medicine and religion lasted until the mid-twelfth century when medical authority once again shifted towards a new group of leaders and practitioners.

Hereditary Physician Families: The release of the ‘Papal Edict of 1163’ contributed to the downfall of the Christian church as a main source of medical authority. The edict prevented monks from performing surgery making it difficult for injured or sick people to rely on the church for care. As a result of this papal edict, hereditary physician lines grew in influence. Medical knowledge was usually passed from father to son even during the years when the Christian church was the primary healthcare provider. But from the mid-twelfth century to around the early seventeenth century, these hereditary lines established long-lasting connections with the Irish elites. These physicians were usually treated well and received fair compensation for their work. “The stipend usually consisted of a tract of land and a residence in the neighborhood, held free of all rent and tribute, together with certain allowances and perquisites: and the physician might practice for a fee outside his patron’s household” (Joyce, 1908, p. 267). Physicians were able to travel freely throughout the lands, even when they needed to travel into an unfriendly neighbor’s territory. These physicians typically possessed their own family medical book which contained medical treatises translated from other languages such as Greek or Latin as well as their own personal cures and recipes for common medicines. 

Despite the tremendous influence and respect these physicians earned, the Brehon Laws, Ireland’s main legal system for centuries, offered basic protections for patients if their physician intentionally or unintentionally harmed them during a procedure. Under the Brehon Laws a patient or their family could pursue litigation against a physician for any wrongdoing and in most cases the physician was forced to pay a fine in retribution. While physicians were well-respected members of the communities, these early patient protection legal codes point to the underlying danger of ancient and medieval medical practices. Even without the presence of a national medical board to issue medical licenses, early Irish physicians were held to a high standard and medical malpractice could lead to financial and legal consequences. 

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Collection & Preservation of Medical Manuscripts: Early Irish medical professionals relied on books to expand their understanding of medicine and how to treat the injured or infirmed. There was an active attempt at translating medical texts from other countries into Irish. Some of these medical manuscripts are stored in the Royal Irish Academy and they provide insight into the budding international medical community that existed during early and medieval times. For example, ‘The Book of O’Lees’ “contains a translation from Latin into Irish of a highly organised medical treatise, with 44 tables outlining details of diseases, each divided into 99 compartments, across, aslant, and vertical. These are coloured red and black, and comprise descriptions of different diseases, showing name, prognosis, stage, symptoms, cures, etc., of the disease in question. There are rough decorative drawings at the top left margin of many pages.” (The Book of O’Lees [“Book of Hy-Brasil”]: Medical treatise, 2015, para. 1) 

The Edward Worth Library is another prominent collection that contains many early Irish medical manuscripts and texts. Located in the Dr. Steeven’s Hospital in Dublin, this collection was donated to the hospital at Worth’s request after his death in 1733. “Edward Worth was a physician whose taste in books radiated outwards from his professional concern with medicine…Beside medical books, ancient and modern (ie. 18th century), one finds important contributions to the study of related sciences, then philosophy, the classics, history etc. Worth was particularly interested in the book as object: the collection not only holds fine examples of sixteenth-century typography but is also considered to be the best collection of early modern book bindings in Ireland.” (Edward Worth Library, n.d., para. 2)

The Edward Worth Library and the medical manuscripts in the Royal Irish Academy reveal an ancient medical community dedicated to learning not just from their fellow peers in Ireland, but from physicians and scientists abroad. The medical community did not work in isolation, but actively sought out other sources to improve their own craft and medical knowledge.

Understanding pre-Christian Irish medicine is difficult due to the lack of information about the Druids and their customs. We see that even during ancient times, the Irish had a growing community of physicians who were important figures in the community. These medical communities grew and flourished, often establishing hereditary physician lines that worked for the lords and kings with excellent compensation for their services. Thankfully there are ancient medical treatises and texts that show how Irish physicians actively pursued international sources that were translated into Irish. If you’re interested in learning more about Irish medical history then read some of the sources listed in the ‘References’ section below! 

References:

Cunningham, Cantor, D., & Waddington, K. (2019). Early Modern Ireland and the World of Medicine: Practitioners, Collectors and Contexts. Manchester University Press. https://doi.org/10.2307/j.ctv18b5h6b

 Joyce, P.W. (1908). A Smaller Social History of Ancient Ireland, Treating of the Government, Military System, and Law; Religion, Learning, and Art; Trades, Industries, and Commerce; Manners, Customs, and Domestic Life, of the Ancient Irish People. Longmans, Green, & Co., 1908.

Woods, J.O. (1982). The history of medicine in Ireland. Ulster Medical Journal, 51(1), 35–45.

The Book of O’Lees [“Book of Hy-Brasil”]: Medical treatise. (2015, August 31). Royal Irish Academy. https://www.ria.ie/library/catalogues/special-collections/medieval-and-early-modern-manuscripts/book-olees-book-hy

The Edward Worth Library. (n.d.). Edward Worth Library. Retrieved March 15, 2022, from https://edwardworthlibrary.ie/

Subtracting insult from injury: The medical judgements of the Brehon Law. (2013, March 7). History Ireland. https://www.historyireland.com/subtracting-insult-from-injury-he-medical-judgements-of-the-brehon-law/#:~:text=The%20Brehon%20Law%20was%20the

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It’s a familiar scenario. You’ve completed your research, written up your findings, and selected a target journal  - which has sent your article out for review and accepted your work for publication!  You decide that you want to publish your research in an Open Access format to ensure that your findings are widely and equitably accessible. You convey your intentions to your publisher only to discover that they want you to pay a hefty Article Processing Charge (APC) in order to publish in an Open Access format. Shocked by the price, you go to your department chair with fingers crossed and request the funds to cover the fee. If you’re lucky, there are funds to cover the APC, but if not, you may find yourself having to reconsider publishing in an OA format. 

How can you be better prepared for the next time you try to publish in an Open Access format? Article processing charges frequently range from $2,000-$5,000 or more. Therefore, knowing how to identify these fees early in your research process may help you to better explore publishing options and account for costs. But finding exact costs on publisher websites can be challenging - many are located on supplemental spreadsheets that can be difficult to find. The following list can help you locate APCs for many prominent science journal publishers:

Looking for an APC not included on the lists above? Reach out to Sara Hoover, Metadata and Scholarly Publishing Librarian at shoover@gwu.edu for assistance. 

For more information on this topic, see Himmelfarb’s video tutorials:

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With the deadline for abstract submissions for SMHS Medical Student Research Day quickly approaching (Monday, March 14, 2022), there isn’t much time left to get your abstract ready. Himmelfarb Library can help! Our GW Research Day Resources: Writing Abstracts guide is a great place to get started!

Knowing what needs to be included in your abstract before you get started is key. Your abstract should include four specific aspects:

Abstract Do’s: 4 Things to Include

  1. Problem Statement/Introduction: Explain why your research is important, and be sure to make this engaging enough to grab the reader’s attention! 
  1. Methods: Explain how you did your research and obtained the results. Research design, setting, population and sample size, study duration, research instrument, and treatment or procedure should all be included here.
  1. Results: Explain your findings, but don’t analyze the results here - save your analysis for the conclusion!
  1. Conclusion: Analyze the results and implications of your findings here.

Knowing what not to include in your abstract is just as important as knowing what to include. Avoid including the following four pitfalls:

Abstract Don’ts: 4 Things to Avoid

  1. Too Much Information: An abstract should be succinct: keep it short and to the point. Don’t overload your abstract with information. A good abstract should be between 250-400 words, so keep it simple.
  1. Incomplete Sentences: Don’t use bullet points or incomplete sentences. An abstract is a short narrative of your project, so writing in complete sentences is a must.
  1. Jargon: Avoid using abbreviations, acronyms and jargon in your abstract. 
  1. Images, Tables, Graphs, and References: Images of any kind, or references to them, should be avoided. Save the graphics for your poster.

For a more in-depth explanation of best practices for writing research day abstracts, watch Himmelfarb’s How to Create and Write Your Abstract video.

Looking at examples of well written abstracts can also be helpful. Stay tuned to Himmelfarb’s blog in early April for more information on creating an effective poster! 

Good luck and happy writing!

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In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post explores the ethics of using the results of Nazi experiments during WWII. This post is a follow-up to our International Holocaust Remembrance Day post from January 26, 2022.

It is no secret that during the Holocaust, Nazi’s performed brutal and inhumane experiments on prisoners in concentration camps. These experiments were not only painful, they were often deadly. It was not uncommon for prisoners who had survived these experiments to be put to death afterwards “in order to facilitate postmortem examination” (USHMM, n.d.). However, questions surrounding the ethics of using the data and results of these experiments remain unsettled.

In 1984, Kristine Moe attempted to tackle some of these questions in her seminal article titled Should the Nazi Research Data be Cited? In this article, Moe poses some interesting questions that are still worth considering today: 

“If the experiments were conducted in an unethical manner, can the results be considered reliable? If the results are useful, can we afford to ignore them? Does the use of the data imply an endorsement of the methods by which they were gathered, and provide a justification for further unethical research?”

(Moe, 1984)

At the time this article was written, many scientists viewed Nazi data as both useful and “necessary to their work” (Moe, 1984). Take for example Eduard Pernkopf’s Atlas of Topographical and Applied Human Anatomy, sometimes referred to as the “atlas of the Shoah” (Mackinnon, 2020). Nerve surgeon Susan Mackinnon writes about the ethical dilemma she faced upon realizing that the “old but precise textbook” she’d relied on for so long was the product of “a Viennese anatomist who had dissected Hitler’s victims to produce his detailed illustrations'' (Mackinnon, 2020). The accuracy and detail of the images in this textbook were a direct result of the “cadaveric nature of the emaciated bodies, a product of torture and great suffering” (Mackinnon, 2020).

In the late 1980s, Robert Pozos, a physiologist and expert on hypothermia, and Arthur Caplan, a professor of medical ethics, held a conference at the University of Minnesota to discuss if and how to “use hypothermia information gathered at Dachau” (Caplan, 2021). During this conference, some attendees expressed their view that “using immorally acquired information” is justifiable if it is the only way to save a life (Caplan, 2021). Caplan argues that the use of “tainted information” adds legitimacy to this information, thus requiring the need for “good teaching about the horrific history of this information’s creation and careful deliberation about how it is referenced and cited in journals, books, exhibitions, clinical practice guidelines, award presentations, talks, and other sources” (Caplan, 2021).

Some researchers find the Nazi data to be weak, but still use the data to affirm more reliable experimental results. Still others are wholly opposed to the use of this data. Arnold Relman, a former editor of the New England Journal of Medicine, stated that the Nazi experiments were “such a gross violation of human standards that they are not to be trusted at all” (Moe, 1984). Allen Buchanan, a former philosopher at the University of Arizona who reviewed work on human subjects observed that “experiments that are ethically unsound are also scientifically unsound. Very rarely have I seen an experiment that is very good and valuable that had serious ethical problems” (Moe, 1984). This statement makes a strong case against the scientific soundness of Nazi experiments.

A 1990 article entitled Nazi Science: The Dachau Hypothermia Experiments exposed the lack of credibility and scientific vigor of the Nazi experiments. These experiments were found to have been “conducted without an orderly experimental protocol, with inadequate methods and an erratic execution,” and reports were “riddled with inconsistencies” (Berger, 1990). Additionally, there was evidence of data falsification and fabrication (Berger, 1990). Berger makes a strong case for abandoning future citations of Nazi data based on “scientific grounds” (Berger, 1990).

Others find the issue to be more nuanced. Caplan argued that “tainted” information could be used “if, at the same time, non-maleficence can be achieved and the physician acknowledges and discloses the immoral origins of the work, in a manner that honors the victims but not its perpetrators” (Mackinnon, 2020). Mackinnon presented a four-step framework to consider when use of the Pernkopf Atlas is deemed to be potentially helpful. This framework includes taking a timeout to reassess planning, consult a colleague for help, and consult other educational resources or textbooks. As a last resort, the atlas can be consulted, but only if it is done with “disclosure, respect, gratitude, and solemnity” (Mackinnon, 2020). 

The dialog around this issue is an important one. The topic has experienced a resurgence in recent years and discussion of the topic has been renewed. Mackinnon eloquently states that “as physicians and educators, we have an enduring moral duty to recount history, share knowledge with generations that follow, and protect against new versions of the atrocities of the past” (Mackinnon, 2020). 

References:

Berger, R. L. (1990). Nazi science: The Dachau hypothermia experiments. New England Journal of Medicine, 322(20), 1435-1440. Retrieved from https://proxygw.wrlc.org/login?url=https://www.nejm.org/doi/full/10.1056/NEJM199005173222006

Caplan. (2021). How Should We Regard Information Gathered in Nazi Experiments? AMA Journal of Ethics, 23(1), E55–E58. https://doi.org/10.1001/amajethics.2021.55 Retrieved from https://proxygw.wrlc.org/login?url=https://journalofethics.ama-assn.org/article/how-should-we-regard-information-gathered-nazi-experiments/2021-01

Mackinnon S. (2020). When medical information comes from Nazi atrocities. BMJ (Clinical research ed.), 368, l7075. https://doi.org/10.1136/bmj.l7075 Retrieved from https://proxygw.wrlc.org/login?url=https://www.bmj.com/content/368/bmj.l7075

Moe, K. (1984). Should the Nazi Research Data Be Cited? The Hastings Center Report, 14(6), 5–7. https://doi.org/10.2307/3561733 Retrieved from https://proxygw.wrlc.org/login?url=https://www.jstor.org/stable/3561733

United States Holocaust Memorial Museum. (n.d.) United States Holocaust Memorial Museum Website. https://www.ushmm.org/

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