For those of you that have not been to medical school, the clinical years can be a little stressful. Waking up at 4 am to see patients (and waking them up at 5 am with a cheerful “How are you doing this morning?” only to get a “What time is it???”), spending quality time in an operating room, and learning how to “see patients” through very different eyes all contribute to us becoming “doctors.” My 3rd year was spent predominately at Charity Hospital in New Orleans, where the patient base was mostly poor and African-American, in contrast to the Tulane medical students.
Part of this year was spent with one of the fathers of modern cardiology, Dr George Burch. Dr Burch, who was in his 80s, would appear twice a week and help the team work through problem patients. He would then take the student part of the team up to his lab, where his lab techs (themselves in their 60s) would serve us tea and cookies as he instructed us on the nuances of medicine. We students couldn’t help but notice the three-dimensional vector EKGs inhabiting the room. These were like minimalist sculptures of hearts, and there were many hundreds lining the walls. Finally one of us got up the courage to ask about them.
“Oh, those,” Dr Burch replied. “I’ve been collecting those for years. When the patient died that I’ve done a vector EKG on I collect the hearts as well. I have 1500 of them. Some day I am going to dissect the hearts and correlate the anatomy with the physiology.”
He died about 5 years later and I suspect never got around to completing this task. I am afraid that the frozen human hearts did not survive Katrina.
I read the Immortal Life of Henrietta Lacks this weekend. The extremely abridged version of the story is that Ms. Lacks, a poor woman who lived in Baltimore at the time, was going to Johns Hopkins for a complaint related to her “womb.” In the course of the diagnostic and therapeutic interventions, some of her tumor was collected and was the first human cell line to be able to grow independently. The HeLa cell was used to develop and test the polio vaccine, develop techniques used for IVF and creating other cell lines, used to create the building blocks for the human genome project, and is used to test drugs that affect cell growth to this day. Although Hopkins got no money for developing this directly, their reputation was certainly enhanced greatly (5 Nobel prizes can be directly linked to HeLa). Many companies have made a lot of money using this commercially available descendent of Ms Lacks. The Lacks family, on the other hand, struggled for years with lack of access to basic education and health care as well as being treated as research subjects rather than fellow human beings.
Most medical training in New Orleans in my time was (and likely still is) accomplished while caring for the poor of New Orleans. My choice of Tulane, in part, was because of a reputation for academic excellence and innovation by such folks as George Burch (founder of American Heart Association), Louis Ignarro (Nobel for work on nitric oxide), Michael deBakey (inventor of heart-lung machine key component), and Andrew Shalley (Nobel for discovery of pituitary hormones). I suspect ALL of these folks would have had much less success without their own Henrietta Lacks at Charity Hospital. I suspect Dr. Burch, for example, did not get solid permission for the donation of the hearts, though I could be wrong.
Modern medicine and modern society have moved beyond (I hope) the concept of poor people existing in the health care world so doctors can practice for their well-heeled private clientele. Much of the Henrietta Lacks story is one of objectification of tissue, families, and the entire African-American culture. The ethics of access to modern medical discoveries are difficult. It is when the very people upon whose backs the discoveries are made seem to be denied access systematically that we need to step in. Although not perfect, the Affordable Care Act is a start, and its promise of access beginning in 2014 is a down payment on correcting these disparities.