What’s Degna Stone? I guess you could say it’s medical information for the rest of us. No overly-scholarly, impossible to understand articles, yet no simplistic, trivialized information either. Just concise but thorough, useful, interesting medical information for, as we said, the rest of us.

Solving the Health Disparities Present In Underserved Populations

Health-care educators share the social responsibility to teach medical students about social determinants of health and health-care disparities and subsequently to encourage medical students to pursue residencies in primary care and medical practice in underserved communities. Free clinics provide care to underserved communities, yet collaborative partnerships with such organizations remain largely untapped by medical schools. Free clinics and medical schools in 10 US states demonstrate that such partnerships are geographically feasible and have the potential to mutually benefit both organizational types. As supported by prior research, students exposed to underserved populations may be more likely to pursue primary care fields and practice in underserved communities, improving health-care infrastructure.

The health-care system in the United States is burdened with disparities associated with a panoply of factors including complex interactions between race/ethnicity and socioeconomic status, geographic access to care, and health insurance status. For instance, insurance status is one of the strongest predictors of cancer screening utilization and advanced disease progression upon treatment, and the association between race/ethnicity and infant mortality rates is widely documented in the academic literature. Additionally, individuals living in health professional shortage areas are less likely to receive medications for cardiovascular disease prevention, including statins and warfarin, especially when uninsured.

Health Issues
Health Issues

Over 57 million individuals live in 5,864 designated primary care shortage areas in the United States. By definition, individuals in these urban and rural communities face a deficit of primary care providers in four primary care specialties: general or family practice, general internal medicine, pediatrics, and obstetrics and gynecology. Although primary care physicians compose only 37% of the physician workforce, they provide 56% of all physician office visits. Experts argue that the United States will face a serious shortage of primary care physicians in the near future, likely reducing further the access to primary care services for medically underserved individuals.

Health Concerns
Health Concerns

Health-care professional students who are exposed to underserved populations during education and training are more likely to care for this same population once in practice; this may strengthen the health-care infrastructure in underserved communities. In fact, primary care physicians who complete residency training in community health centers (safety-net providers for the uninsured and other vulnerable populations) are significantly more likely to practice in medically underserved areas. Finally, medical students who train with underserved populations are thought to learn and rediscover social responsibility and further understand the social determinants of health.

To encourage students to pursue primary care fields, medical schools and students across the country have embraced training opportunities in underserved areas. For instance, through the group Primary Care Progress, hundreds of students and faculty at the University of Colorado Anschutz Medical Campus have been working with the Aurora community to create an interdisciplinary student-run free clinic to meet the needs of the underserved. The DAWN clinic (Dedicated to Aurora’s Wellness and Needs) does provide integrated primary care and serve as a patient-centered medical home for the uninsured population of Aurora, while offering an opportunity for health students to learn and collaborate in an interprofessional setting.

Community Needs
Community Needs

The International/Inner City/Rural Preceptorship program at Virginia Commonwealth University School of Medicine partners with a local free clinic to provide enhanced teaching practice experience for program participants. This unique primary care learning experience partners medical students, pharmacy students, interpreters, and a variety of levels of learners to care for diverse patients within two free clinics, with a goal of accommodating the working uninsured. Students are precepted closely by health-care professional faculty, are supported by free clinic staff, and are challenged to work effectively on a team while addressing access, socioeconomic, language, and educational barriers.

Free clinics, however, remain an underutilized academic institution partnership. The United States is home to over 1,000 free clinic organizations that operate in 49 states (excluding Alaska) and the District of Columbia. Free clinics are nonprofit organizations that provide medical, dental, pharmacy, and mental health services or prescriptions to mostly uninsured patients and rely heavily on volunteers to provide clinical and administrative expertise. These free clinics in the United States annually provide health care to nearly 1.8 million people in the form of over 3.5 million medical and dental visits. Furthermore, these organizations have the potential to offer medical students an opportunity to serve underserved populations in a supervised environment, while simultaneously supporting the mission of the free clinic, because these organizations cannot exist without the support of health-care providers and the greater health-care community. See the Get A website for more on this topic.

The fate of free clinics following full implementation of the Patient Protection and Affordable Care Act (ACA) remains to be seen, although scholars have argued their necessity will remain unchanged. Despite the positive impact that the ACA will have on reducing the number of the uninsured, it is estimated that approximately 20 million people will remain without insurance. It is anticipated that the residual uninsured population will include a larger proportion of undocumented individuals and others who are noncompliant with the individual mandate. Experts agree that the remaining uninsured population is likely to continue to seek care in organizations that contribute to the health-care safety net. Partnerships between medical schools and free clinics may secure a role for free clinics in the health-care delivery environment as these clinics have served the underserved in the United States for decades. Therefore, the purpose of this paper is to examine the proximity of medical schools to free clinics and implications for changes in public health policy and medical education.

Managing Public Perception of Vaccines

This past year, the onset of North America’s flu season coincided with reporting on a novel turn in the ongoing effort to fend off contagion: the use of social media to coordinate “pox parties” and to market mail-order lollipops “infected” with chicken pox to parents planning to expose their children to the live virus.1 The reasoning behind these practices, that helping children develop “natural immunity” would be less harmful than exposing them to the varicella (chicken pox) vaccine, positioned this emerging issue as a development in the anti-vaccination movement, a movement motivated by the discredited link between autism and the measles, mumps, and rubella (MMR) vaccine first proposed by Dr. Andrew Wakefield in the early nineties.

In challenging the effectiveness and safety of childhood vaccination, vaccine opponents weaken public confidence in immunization programs such as MMR. Vaccine proponents therefore often counter that, by framing immunization as if it is, first and foremost, a matter of personal opinion, vaccine debate itself risks intensifying the anti-vaccination movement and undermining one of our most effective defenses against contagion.2 Indeed, whether news reports accurately reflect growing health trends, attention paid by the media to unconventional alternatives to vaccination would seem to encourage the persistence of the vaccine debate.


Vaccines Work Video

In raising questions about the relationship between scientific knowledge, health beliefs, and public-health policy and practice, the vaccine debate presents an opportunity to consider what part persuasion plays in the management of public health. In this article, I argue that contemporary public health campaigns characterize rhetoric itself as corrective, a method of managing the health of the group through the isolation of harmful attitudes and beliefs, as described in this post.. My aim is not simply to displace this view but to understand it in relation to contemporary social and epistemological shifts, such as the use of the web to circulate information about public-health emergencies.

From there, I critique the ability of public health campaigns based on a sense of rhetoric as corrective to adequately counter anti-vaccination. In particular, I take up one of the most pervasive rhetorical strategies for constituting, and countering, the two sides to the vaccine issue, the commonplace that holds there to be “facts and fictions” or “myths” of science. I consider this strategy in light of a cornerstone of contemporary public health, scientia potentia est, or “knowledge is power,” a premise that often underlies and structures public health policy and practice, sometimes in implicitly disempowering ways.

At the end of this past summer, Ottawa Citizen science reporter Tom Spears bemoaned the “age of credulity” in which we live, “a constant state of disbelief where, despite having more education than any society in human history, people would rather take the word of an anonymous Internet post over that of a recognized authority, especially where there’s a conspiracy theory”. The hallmark of this age, as Spears elaborates, is the public misunderstanding of science, the worst symptom of which is the anti-vaccination movement because it can be linked to recent outbreaks of measles and, more problematically, the spread of “claims that H1N1 vaccine will kill you”. Spears is one voice in a bigger debate over how the scientific community can adapt the burden of proof in the face of communication technologies that remediate, reframe, and recirculate their research faster and farther than ever before, as well as in response to social movements, such as anti-vaccination, that threaten to undo the triumphs over infectious disease that marked the mid-twentieth century.

Recently, for example, a group of psychologists from Cardiff University argued in a Guardian op-ed that scientists should “be allowed to check stories on their work before publication” on the grounds that “public trust in science, and in science reporting, is harmed far more by inaccuracy than by non-independence”. This was a response to Ananyo Bhattacharya, the online editor of Nature, who two weeks earlier had argued that copy checking should be prohibited because “scientists have a vested interest in the way their work is portrayed in the media” — not least of which is funding. During that same month, however, while being interviewed for the podcast, “This Week in Virology,” medical writer Trine Tsouderos argued in support of copy checking by describing science journalism as akin to a non-native speaker presenting Chinese to a fluent audience, and characterizing science as a “grammar” that needed to be corrected by an expert whenever it was moved from the scientific community into the media. You can click here to read more.

While much of this discussion has centered on the possibility of allowing scientists more control over how their research is conveyed, the suggestion that scientific knowledge, when abstracted from its original context, may be harmful to the public has been made much more persuasive by the attribution of the return of preventable childhood infections such as measles to a rise in unfounded beliefs about vaccine science, rather than to other issues that have gained greater attention in the past year, such as the growing wage gap in North America and inadequate access to health care. In other words, while it’s critical that correlation does not equal causation in the context of vaccine science, the same principle is often moot in assessments of vaccine rhetoric.

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