Claude Moore Health Sciences Library

Emergency physician, historian of medicine, and bioethicist Robert Martensen has worked—combining clinical practice, history of medicine, and bioethics — at medical institutions across this country, including Harvard, the University of Kansas, and Tulane. He is author most recently of A Life Worth Living: A Doctor’s Reflections on Illness in a High-Tech Era, a book written for a general audience about the medical challenges facing patients and their families in our country today. As health care reform looms as a possibility for the U.S., what is the state of medical care in our nation, for each of us and for our families and communities? What are our most common serious chronic illnesses and conditions, our health-care system's present approaches to serious illness and to the end of life, the most pressing ethical questions facing the medical profession, the health-care industry, and our society? In this Medical Center Hour, drawing on historical background and on clinical cases from his practice, Dr. Martensen explores some of the more difficult dilemmas in contemporary American medicine for patients, families, health care professionals, and policymakers.

One of America’s leading spiritual teachers and authors, Sharon Salzberg is cofounder of the Insight Meditation Society (IMS) in Barre, Massachusetts. She has played a crucial role in bringing Asian meditation practices to the West. The ancient Buddhist practices of vipassana (mindfulness) and metta (lovingkindness) are the foundations of her work. Sharon Salzberg has been a student of Buddhism since 1971, and has led meditation classes and retreats worldwide since 1974. She teaches both intensive awareness practice (insight meditation) and the profound cultivation of lovingkindness and compassion in a non-sectarian, inclusive framework. Sharon has played a crucial role in bringing meditation practice to the West, and is committed to exploring the role of spiritual awareness in daily life and in issues of social justice. In this Medical Center Hour she will lead a conversation about “Empathy, Compassion, and Balance” in our lives and work. During these times of uncertainty and turmoil — whether regarding world economics, job losses and struggles in the US, war, famine, or natural disasters, the pain and suffering among the world’s inhabitants is great. Also in the setting of health care where attention to disease often predominates, there is great suffering among the ill as well as their care givers. How can this suffering be faced day after day? How can we remain interested, engaged and open-hearted? Can compassion for ourselves and others be enhanced? How is it possible to maintain balance in the face of such need? Sharon Salzberg will discuss this complex area bringing new awareness and opportunities.

In 1997, Jean-Dominique Bauby’s book, The Diving Bell and the Butterfly, acquainted readers around the world with the state of being “locked in.” Incapacitated by a devastating stroke, the 43-year-old Frenchman, editor of Elle magazine, was completely paralyzed, “imprisoned inside [my] own body, unable to speak or move,” trapped in a body he characterized as a hermetically sealed diving bell. But Bauby had a small window - he could blink his left eye - and this enabled him to communicate, painstakingly, by eye-blinks in response to recited letters of the alphabet. Thus he “wrote” his book, giving voice to both his severely limited physical existence and his illimitable memory and imagination. Persons who are locked in as a result of severely paralyzing neurological illness or injury face overwhelming challenges to communication. Few can manage as did Bauby. A lively mind in an immobilized body — how is one to register needs and wants, connect with others, express one’s thoughts, emotions, and creativity? This Medical Center Hour explores new research by UVa psychologists that uses a locked-in person’s brain signals to facilitate communication, in one case helping an artist with advanced amyotrophic lateral sclerosis (ALS) to paint digitally. What is the promise of this research and associated technology, for patients, families, and clinicians?

In the winter of 2005, the world watched as Terri Schiavo, a young woman in a persistent vegetative state (PVS) since 1990, became the focal point of debate and decisionmaking regarding the rights and care of persons in minimally conscious states. Emotions ran high within Schiavo's family circle but also in advocacy groups across the sociopolitical spectrum as state and federal courts and even the Florida governor and legislature grappled with questions of continuing or discontinuing life support—to feed or not to feed?—for this young woman. In the end, a local court's decision to remove Schiavo's feeding tube was carried out, and she died shortly thereafter. The actions taken and decisions made during Terri Schiavo’s last years assumed a life of their own, however, even as medicine has become more adept at sustaining life after devastating neurological injury and we understand better, though far from perfectly, the neuroscience of minimally conscious states. This Medical Center Hour explores the ways in which the Schiavo case continues to have repercussions for all of us—for persons nearing death, to be sure, and their families, but also for health care professionals, attorneys, lawmakers, clergy, researchers, disability advocates, bioethicists, the media, and anyone contemplating appointing a surrogate decision-maker or making their last wishes known in an advance directive.

In 2006, the first baby boomers in the U.S. turned 60. Concern was voiced then about the affordability of retirement—including health care expenditures—for this unusually large segment of our population; indeed, there were gloomy predictions that, in retirement, the boomers would be such an albatross around society’s neck that, barring major reforms, Social Security and Medicare simply could not accommodate this generation's needs, much less those of succeeding generations. But conventional wisdom may not hold true for boomers, whose roadmap for the future seems not to call for retirement en masse or at the earliest opportunity. Indeed, there are ways to see the baby boom as a wave of seniors who will bring considerable resources, financial and otherwise, into their later years. Can the nation craft social policies that will foster a pro-work, pro-savings, pro-health improvement culture for boomers in retirement and for later generations? Social scientist and futurist Jeff Goldsmith takes an optimistic view of this situation, particularly in his latest book, The Long Baby Boom: An Optimistic Vision for a Graying Generation (2008). But what about now, when the U.S. faces its gravest economic crisis since the Great Depression? Is it all gloom and doom, or might there be ways to reconceive and manage the boomers’ retirement and health care in constructive, socially beneficial ways? Indeed, in these first days of the Obama administration, can we be hopeful on this front, too? This Medical Center Hour features Jeff Goldsmith and Carolyn Engelhard, health policy analyst and co-author of Health Care Half-Truths, and their views on what retirement for the baby boom can or will look like, especially with respect to health care. Co-presented with the History of the Health Sciences Lecture Series.

"The American healthcare system is a dysfunctional mess." So begins physician-bioethicist Ezekiel Emanuel's new book, Healthcare, Guaranteed. Despite the vast sums of money paid out for health care in the U.S.—one of every six dollars spent in this country—the health status of our citizens is, in a word, "sickly" when measured against the health status of populations in other industrialized nations. Across the U.S., even in affluent communities like Charlottesville-Albemarle, diabetes, obesity, infant mortality, substance abuse, cancer, and communicable infections take a toll, individually and socially. Beyond these specific health concerns, screening and prevention play too small a role in Americans' care, medicines are priced beyond many citizens' pocketbooks, and lack of sufficient (or any) insurance works against many people seeking timely, appropriate medical attention for serious physical or mental conditions. What's to be done? Calls for health care reform are ubiquitous these days, from persons of every political persuasion. But, while there's consensus that our "system" is broken, proffered solutions are many and varied, with bedeviling details. In this Medical Center Hour, Ezekiel Emanuel outlines the essential elements of an effective, sustainable health care system and makes the case for comprehensive change.

The City of Charlottesville and Albemarle County have recently completed a comprehensive study of our community's health. The study was done through the Thomas Jefferson Health District under the auspices of Mobilizing for Action through Planning and Partnerships (MAPP), a community-wide assessment and strategic planning tool for improving health, developed jointly by the National Association of County and City Health Officials and the Centers for Disease Control and Prevention. The data show that our city-county community is growing and evolving, and these processes are presenting new challenges to achieving and maintaining health. We are fortunate to have some resources that are not always available in other communities—two major hospitals, an ample supply of physicians, a free clinic, and a not-for-profit children's dental clinic. And in many instances, we have been able to make substantial improvements in community health through new programs, campaigns, laws, and other mechanisms. But, despite many successes, our community still struggles with issues that affect the quality of our citizens' health—and in turn, the quality not only of individuals' lives but of our collective life. What are the biggest health-related challenges facing Charlottesville-Albemarle? How will all sectors of our locality—government and social service agencies, health care organizations and professionals, educational institutions, businesses and employers, churches and volunteer organizations, individual citizens—come together to respond to the MAPP assessment's "diagnoses," and how do we then, all of us, care for our community?

Our current health care system is profoundly dysfunctional, inaccessible to some, and unaffordable to many. And while cost, financing of and access to health care are vitally important issues deserving attention, real reform lies in dramatically changing the health care delivery system. As noted in a Letter to the Editor in Health Affairs (Mar/Apr, 2008), Joanne Disch noted: Health care reform is destined to – and deserves to – fail if we do not diagnose and treat the right problem – the dysfunctional health delivery system… Finding better ways to finance, access or measure results within the current paradigm is not the good news – or the right answer. What is needed is to move from the physician-dependent, hospital-based, acuity-oriented system to one that is safe, convenient, effective, efficient and personalized. How do we achieve real, sustainable health care reform? By listening to and working with the American public. They show us on a daily basis what they want in a health care system, and what we need to do. Our challenge is to maneuver through the landmines of historical tradition, professional competition, and personal preference to deliver on this responsibility.

Cancer has been a prime target of intensive biomedical and pharmaceutical research for the last half-century, with promising results in the treatment of many malignancies and improved survival times for many patients. But looking beyond even our most sophisticated trial-and-error treatments, cancer researchers now see a new breakthrough on the horizon: patient-specific, individualized therapy, which allows for each cancer patient to receive treatment tailored to his or her physiology, disease type and stage, and overall health status. In this Medical Center Hour, UVA urologist and investigator Dan Theodorescu explores the new frontier of personalized medicine—where are we in the quest for such customized cancer treatment, and what will the benefits be, for medicine, for patients, for society? Dan Theodorescu, M.D., received his MD degree from Queen’s University in 1986, did his residency in Urology at the University of Toronto and then a fellowship in urologic oncology at Memorial Sloan-Kettering Cancer Center. At the University of Virginia his research interest concentrates on molecular biology of prostate and bladder cancer and his clinical practice and his clinical practice focuses on prostate, bladder, kidney and testicular cancers and their therapies. He is a Professor of Molecular Physiology and Biological Physics and the Director of the Paul Mellon Prostaste Cancer Institute. W. Jeffrey Elias, M.D. graduated Phi Beta Kappa from Wake Forest University and attended the University of Virginia for medical school and neurosurgical training. He completed intramural fellowships in neuropathology and spinal surgery before spending a year in Plymouth England as a senior registrar. Following his neurosurgical residency, he pursued additional training in stereotactic and functional neurosurgery at the Oregon Health Sciences University. Dr. Elias returned to the University of Virginia where he is currently the Director of Stereotactic and Functional Neurosurgery with a large multidisciplinary program in the surgical treatment of movement disorders and epilepsy. His clinical practice also includes minimally-invasive spine surgery, peripheral nerve surgery, spasticity, and neuropsychiatric procedures. His clinical research interests are in the fields of movement disorder and intracranial monitoring for epilepsy. His laboratory research is focused upon thalamic physiology in epilepsy.

For Americans coming of age in the late 1960s, "Plastics, my boy. Plastics," the advice given young Benjamin (Dustin Hoffman) in "The Graduate," was a code phrase betokening an exciting, transformational future in which inexpensive petrochemicals replaced many natural materials. A full generation later, we're seeing a darker aspect of plastics: are some of them making us sick? New research using tools of modern molecular genetics is revealing that some environmental contaminants, among them certain plastics and plasticizers, can alter gene expression even at levels far below what has been considered toxic by traditional standards. Research findings implicate some plastics in significant trends in human disease, including metabolic disorder, obesity, and type 2 diabetes, as well as cancers of the prostate and breast. Conventional regulatory toxicology and epidemiology used for decades may be blind to these mechanisms and their effects and may have yielded false negatives, with the result that current health safety standards inadequately protect public health. This Medical Center Hour, featuring experts in environmental health science and environmental law, inquires into how new scientific insights can yield both more appropriately precautionary health standards and important health benefits.

Each of us knows well that we are all creatures of our cultural context. And yet, are we fully aware of the extent to which culture shapes our attitudes, world-view, and ideas? And what if we are not? In this Medical Center Hour, the Ghana-born literary scholar Ato Quayson focuses on his own development as a disability studies scholar. He looks closely at his previously unexamined attitudes toward disability, attitudes particularly colored by his cultural upbringing in Africa where there are taboos on talking about disability. But this alone does not address some quite problematic cultural attitudes towards persons with disability that still persist unexamined. What happens when Professor Quayson places his own cultural blindness within the wider context of attitudes toward disability in Africa and elsewhere, paying particular attention to the unexamined belief systems and attitudes that underwrite particular therapeutic itineraries, both biomedical and otherwise? The point of this inquiry, and the brief commentary that follows from the perspective of bioethics, will be to open up discussion rather than to impose closure.

The complexity and sophistication of health care today can be daunting to any patient, but, even for the well-educated and well-informed among us, health literacy may also be an issue. Indeed, it is estimated that nearly 90 million Americans have trouble reading, understanding, and following through on health information and instructions. Research shows that poor health literacy contributes to health disparities: persons with low health literacy tend to have more health problems and less knowledge about available health care services. Yet, often, busy physicians and other health professionals don't have a good appreciation of which of their patients have low literacy levels, nor may they know how to address or remedy the problem. What are the literacy-related barriers to maintaining and improving health? What can health care institutions, communities, libraries, and individual health professionals do to promote and help improve health literacy among patients and our populace? Co-presented with the Claude Moore Health Sciences Library's Health Literacy Working Group

Study of anatomy has for centuries been an integral—and often highly charged—part of medical education. Anatomical instruction and dissection were inculcated in American medical education in 1765, with the founding of the Medical Department of the University of Pennsylvania. As other medical schools formed in the United States in the first half of the nineteenth century, they also incorporated anatomical dissection into their formal instructional program. Both the University of Virginia and the Medical Department of Hampden Sydney College, later the Medical College of Virginia, took pride in their anatomy classes. Of course, anatomical study required a ready supply of cadavers. In the period before the 1884 passage of the Virginia Anatomical Act, legislation which legalized procurement of dead bodies for anatomical study, the two schools both cooperated and competed in their quests to obtain appropriate human dissection material for instructional purposes. This Medical Center Hour explores the two schools’ stories of deception, dissection, and resurrection and affords insight into anatomical instruction in 19th-century Virginia. Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library

This Medical Center Hour celebrates the humanistic values at the heart of doctoring—including compassion, respect, integrity, altruism, self-reflection, and openness to being moved and changed by one's patients—with a presentation by one of this medical school's most esteemed senior clinicians, pediatrician Sharon Hostler. Dr. Hostler's long and luminous career, which in recent years has included intensive, high-level administrative service and leadership, began and remains grounded in developmental pediatrics. Lessons she has learned along the way from her young patients—babies, children, and adolescents—have been, for her, professionally and personally transformative. For example, in the late 1990s, the Children's Medical Center launched an innovative project that allowed adolescents facing serious illness to express themselves through the creative arts. One participant was Sabrina Justice, who, while a patient in the pediatric intensive care unit, wrote a story about cancer to reassure her five-year-old sister and a song, "Better at Seventeen" (lyrics below), for the clinical team. For Dr. Hostler, both story and song proved to be superb tutorials. As she explores in this presentation, her young patients and their families have made her the doctor and teacher she is, but, even more, they have inspired her nontraditional leadership style and helped her to foster a more nurturing, supportive environment for medical school (and, now, university) faculty at every stage of career development and professional life. Co-presented with the Gold Humanism Honor Society, UVa Chapter

Vaccination raises unique ethical, political, and legal questions. Like any medical intervention, vaccination carries with it the small risk of adverse reactions. Unlike other procedures, however, it is performed on healthy people, most commonly children, and, importantly, vaccination has been mandated by law because of its community-wide benefits. For much of the life of this country, and especially during the past 150 years, public health and medical professionals have sought to achieve high levels of vaccine use in the U.S. population against a growing catalogue of infectious diseases. Nevertheless, vaccination policy and practices have always been subject to challenges by individuals and groups and, even today, controversies swirl in association with efforts to vaccinate our population. While the science of vaccination has often seemed clear and straightforward, the politics of vaccination is quite another matter, and this Medical Center Hour inquires into that complex situation across our country's history and into the present moment. Co-presented with the Institute for Practical Ethics and Public Life and the History of the Health Sciences Lecture Series, Historical Collections of the Claude Moore Health Sciences Library.

The news media regularly highlight incidents in which adolescents with serious, even life-threatening, illnesses challenge medical recommendations and refuse efficacious life-saving treatment. Such cases, aside from their celebrity, often represent wrenching, potentially divisive dilemmas for families and pose difficult ethical and legal challenges to health professionals and health care systems. In 2007, Virginia passed "Abraham’s Law," which allows teenagers fourteen years or older and their parents or guardians to refuse medical treatments for cancer and other life-threatening illnesses without such decisions being deemed neglectful or abusive and the parents or guardians being charged with neglect. The trend is clear: our courts and state legislatures are becoming more tolerant of permitting minors to refuse efficacious treatment for life-threatening illness, particularly when the minor and his or her parents (or legal guardians) are in agreement with one another. What liberties to refuse treatment are we as a society comfortable granting minors and families? How do case-specific clinical circumstances, including severity of illness and arduousness and efficacy of treatment, affect whether physicians honor or take issue with an adolescent's refusal of therapy? Are courts and state legislatures enlightened or mistaken in allowing teenaged minors and their families to say no to potentially life-saving medical care? Co-presented with the Institute for Practical Ethics and Public Life

Lou Gehrig, Steve McQueen, Margaret Bourke-White, Rita Hayworth, Barney Clark, Lorenzo Odone (of "Lorenzo's Oil")—these persons' fame rests as much (or more) on illness as on their life-accomplishments. Beginning with Gehrig, celebrity patients have increasingly divulged their diagnoses, and the media and public have increasingly claimed a right to know. Further, in a society where medical advances are headline news, we make stars out of patients on the leading edge of medical therapeutics. But while celebrity illnesses give us opportunities to learn about diseases and treatments, at the same time they can be sources of misleading information.

This Medical Center Hour is a conversation with distinguished historian and literary scholar of the Middle Ages Brian Stock. This expert on (among other subjects) the history of reading and its connections with meditation and self-knowledge actually began his studies as a student of medicine. How has his work evolved across his career, and what connections does he see now between his scholarship and a continuing interest in science, therapeutics, and the dynamics of healing?

The Institute of Medicine's landmark report on medical error in U.S. hospitals, To Err is Human (1999) continues to propel efforts to promote patient safety and prevent medical harm. This report's title hints at the proverbial relationship between error and forgiveness—To err is human, to forgive, divine—yet “systems” approaches to medical error may have difficulty incorporating forgiveness as a response to human error and as part of an effective program of patient safety. In her remarkable book, After Harm: Medical Error and the Ethics of Forgiveness, Nancy Berlinger draws on insights from scholarship in religion and culture to suggest how forgiveness, long recognized as having a restorative role between individuals and within communities, might inform our response to medical error. This Medical Center Hour explores how the idea and practice of forgiveness can potentially help clinicians, health care institutions, and medical educators address medical harm in productive ways, even while avoiding the dangers of prescribing forgiveness as the solution to harm. Insights about forgiveness can further help medical students come to terms with the sensitive matter of their own fallibility and its potential impact on patients and families and aid early-career physicians struggling with these issues at the most personal level.

Although qualitative research has been around for a long time, it has only recently begun to gain acceptance and respect in the health professions. Its inherent logic is not generally understood and how its methods can effectively be applied to medical education research is similarly misunderstood. Dr. Hafler aims to clarify some basic concepts of qualitative research and its potential in medical education research.

Conflicts of interest for physicians, especially those practicing in academic health centers, are at once less obvious and more substantive today than just pharmaceutical company sponsorship of lunches or CME opportunities. This Medical Center Hour explores how conflicts of interest are a common occurrence for many academic clinical investigators, teachers, and clinicians, how physician judgment is susceptible to external influence, and how institutions—including UVa—are not only drafting policies for addressing conflicts of interest but also developing ways to help physicians recognize and manage the conflicts they experience.

Independent writer and journalist on business and social policy, and author of Inside the FDA: The Business and Politics Behind the Drugs We Take and the Food We Eat.

James Stewart, Commonwealth Inspector General of Mental Health, and Richard Bonnie, Chair of the State Supreme Court's commission on mental health, discuss reforming Virginia's mental health system. What's being proposed, and why? How will changes in state law serve patients, their families, and the public?

We are what we eat. But what are we eating these days, and why, and with what health and social effects? This Medical Center Hour explores the new attentiveness to the foods we consume, with emphasis both on the complicated marketplace choices (natural? organic? genetically modified?) and on the power of local food to sustain not only our bodies but also community in its deepest and most enduring sense.

When organ and tissue transplantation is a possibility, how do physicians determine that a prospective donor has died so that organs may be procured? Determination of death by neurologic criteria ("brain death") is legal in the U.S. and many (though not all) other countries, and it's medically preferable, since optimal organ perfusion can be maintained until procurement. But by all appearances a brain-dead donor on life support doesn't seem "dead." Understanding the history as well as the science of determining death can help clinicians, families, and even prospective donors manage this challenging emotional and psychological aspect of transplantation medicine.

In marked contrast to medicine, nursing is a field in which philanthropic and altruistic ideals conflict sharply with professional self-determination. The conflict is most evident in the economics of being a nurse. While philanthropists and altruistic agents seldom seek economic gain or even parity for their efforts, professionals- who have devoted years to developing a particular expertise-expect to be paid well for their work and to be recognized in other ways as well. What is the historical basis for nursing's dilemma around dollars? Can the profession rethink its ambivalence toward money?

This keynote address for the UVa School of Medicine's annual Medical Student Research Symposium highlights medical research at the frontiers of science through examination of genomics researcher Stephen Rich's work on Type One diabetes. Dr. Rich's talk also offers glimpses of a life in science and the scientist's commitment to the health of the public.

Advances in genetics and reproductive technologies, as well as changing social mores around "enhancement medicine," make it increasingly possible for couples or individuals to design their offspring by selecting for (or against) certain genetically influenced traits or tendencies. What are the ethics of genetic enhancement for prospective parents, to be sure, but also for their larger communities and for the health professionals providing necessary services?

Pediatric surgeon and bioethicist Farhat Moazam is at home in two worlds-Pakistan, where she was born, studied medicine, and enjoyed much of her career; and the U.S., where she trained and practiced as a surgeon, then took degrees in bioethics. What qualities and skills do bioethicists and clinicians require to practice effectively at home-wherever home is-and to traverse cultural divides with patients, peers, and policymakers?

Lebanese-American scholar Evelyne Accad writes eloquently of her personal experience with breast cancer and also looks at breast cancer through anthropological, political and cultural lenses to offer a sense of how this disease affects women of and in the Middle East. How are health and health care around breast cancer bound up with politics, religion, the culture of science, artistic expression, and the social status of women in the Middle East-and even in the U.S.?

Urban renewal projects in the 1950s-1970s bulldozed entire districts and traumatically displaced hundreds of African American communities. The residents of these areas experienced "root shock" from the destruction of their physical and emotional ecosystems. With this perspective on urban renewal, including projects like Charlottesville's Vinegar Hill, what can we learn about the health status of urban African Americans and the health of our cities and neighborhoods?

For nearly 40 years, biomedical ethics and medical humanities have been part of medical education and medical practice in the U.S. and Europe. Often seen as upholding what's "good" or most virtuous in medicine, at UVa they have had influence since the late 1960s and had a formal place in curricula, training and practice since the late 1980s. How are these disciplines understood now, in light of current challenges to practice and professionalism-and in view of the recent Center for Biomedical Ethics and Humanities merger? How do they contribute to what we understand to be "good medicine"?

It's rare today in the developed world to encounter a cadaver, see human viscera, or confront bodies that bear significant disfigurement. Society has segregated these specimens of bodily presentation, allowing only medical, police and military personnel to transgress these secret places of human embodiment. Now, touring exhibits of plastinated, dissected human cadavers are drawing crowds. What's our fascination when we behold the body so exhibited? Who should have access to dead or irregular bodies? What are the ethics of human display?

For months following September 11, 2001, 20 NYU medical students volunteered in the office of the city's chief medical examiner to sort, catalog, and identify human remains. Interested in these students' experiences, scientist-artist Barry Goldstein photographed and interviewed them. His exhibit, Being There, explores the complex impulses that prompted students to volunteer and the challenges and consequences of their service.

David Vetter, who was known to the world as "David the 'Bubble Boy'' was born with a rare genetic disease called Severe Combined Immune Deficiency (SCID). He lived all but a few days of his short life (1971-1984) in an isolator, trapped behind sheets of plastic, confined within a tiny space, untouched by human hands and unable to touch others in return.The presentation will examine the decision to place David in the isolator literally seconds after he was born, and will pay careful attention to the ethical issues that are raised by David's case, which from beginning to end blurred the lines between treatment and research.

What if many --or even most --medical decisions are made by decision-making processes that differ substantially from standard notions of weighing risks and benefits of treatment options? Drawing on a remarkable archive of letters that people with diabetes wrote over the course of decades to their physicians, the talk will examine how patients and doctors made decisions as this disease was transformed from an acutely lethal condition before the discover of insulin to a chronic and still too-often debilitating malady.

The presentation will review the care of elderly people throughout history, from ancient times to the present, and will emphasize cross-cultural comparisons.

An abandoned troopship that took soldiers to three wars, including Vietnam, was found loaded with historic relics in Virginia's James River Reserve Fleet by military artifact historian Art Beltrone of Keswick. The relics, including graffiti- inscribed bunk canvases, provide a personal look at the mindset and emotions of young men going to war. Logs kept by the ship's master, or captain, described the myriad of accidents that plagued sailors and soldiers alike during the voyage aboard the ship, which was more than two football fields in length. Some of these wounds were treated in the ship's operating room.

Grand Opening of the Kerr White Health Care Collection Web Site (http://historical.hsl.virginia.edu/kerr/) and Reception in honor of DR. KERR L. WHITE Remarks by Dr. Kerr L. White, Dr. Robert E. Reynolds, Acting Chair of the Department of Public Health Sciences in the UVa School of Medicine, and members of the Library's Web site team.

Dr. Robert E. Reynolds, acting chair of the department of Public Health Sciences at the University of Virginia, interviews Dr. Kerr White about his career and legacy. Dr. White is an internationally recognized pioneer in the fields of Health Services Research and Primary Care Medicine. This interview is in conjunction with the Kerr White Health Care Collection, which White donated to the Claude Moore Health Sciences Library. The collection includes books, reports, journals and White's own papers dealing with a variety of health issues and problems experienced by diverse populations.

Medical students began to photograph the cadaver dissection process barely five years after the advent of the daguerreotype, as a way to preserve this central event of their medical education. James Edmonson, Ph.D., discusses the rise and fall of this phenomena and how we look at this period of history today.

A childhood doggerel claims that "sticks and stones may break my bones, but names will never hurt me." This talk suggests, rather, that names can hurt, and they also can change the course of a life, of history, of how historians tell history, and, most specifically, of how stigmatizing names can affect efforts to protect the public's health. A 2004 NOVA film, The Most Dangerous Woman in the World, based on Professor Leavitt's recent book, Typhoid Mary: Captive to the Public's Health, has been nominated for an Emmy in the historical documentary category.

Just over 100 years ago the Wright brothers ushered in the era of powered man flight. As more accidents and fatalities resulted from increased air travel and combat, attempts were made to develop criteria for screening and selection of pilots. Dr. Newman will trace the history of the development of the importance of vision in aviation and provide insight into how theories are formulated and how bureaucracies often have a difficult time in changing standards and requirements.

As the Civil War entered its third year the fate of black slaves occupied center stage among northern thinkers. Could the black man become a productive citizen? Would black people be able to care for themselves, and remain healthy? Would the black man make a good soldier? In 1863 and 1864 some 180,000 black men entered the Union army, and many hoped the experience would train them in citizenship skills. An alarming number died of disease, which led some to claim that the black body was inherently weak, unable to survive the rigors of the army and the modern world. This talk explores the disease experience of the black soldier and the factors which caused such high morbidity and mortality during the Civil War.

U.Va Professor Emeritus Dudley F. Rochester tells stories about working with the iron lung, once an important device for people with severe respiratory failure. He talks about the advances made in technology that made the iron lung obsolete.

Professor Fleming looks at the writings of Thomas Jefferson, Benjamin Rush, and Noah Webster that reflect their thoughts on the relationship of climate and health, and the lasting implications of these ideas for the Lewis and Clark Expedition and a subsequent generation of American climatologists and physicians.