Media & Medicine Midterm

Death of Deference

1950s: From the vantage of 1950s, therapeutic triumphs of 1940s and 1950s would continue. Penicillin in the 1940s and polio vaccine were the start of a new era. Status of medicine had risen since the turn of the century and there was no reason to think that that would or might end 1960s: Medical profession became target of criticism, losing esteem in American society. Suffered from stunning loss of confidence. Economic and moral problems of medicine, rivaled in a new way scientific progress that had been at the center of public attention. Criticism of medical authority during the 1960s was part of wider skepticism of wider authority that became more announced during this decade. Establishment came under attack. Anti-psychiatry movement. Mental health professionals used medical authority to label as deviant people who had the right to be different. Roles of medical hospitals was dramatized (ex. One flew over the cuckoo's nest). In the movie, Maverick refuses to play by rules so he is sent from prison to mental institution for belligerence, talking when unauthorized. Chief psychiatrist realizes he's not mentally ill but doesn't want to bug the system. Nicholson's character remained institutionalized, feisty and is controlled by being lobotomized - medical power abused, psychiatry as social control. First heart transplants -- drew media attention as medical advance that could strain doctor patient relationship raising questions of potential conflicts of interest (well-being of sick person vs. person in the next room who needed a heart) 1970s: The Establishment was vague / open-ended but everyone knew what It was was even if they didn't have criteria for what defined it. Establishment was the bad guys abusing authority society gave them. It was time to take the authority back -- Civil Rights movement against Vietnam and later Watergate. Medical profession came under scrutiny and things like sterilization of women started to draw attention. Demonstrations outside AMA meetings, major hospitals, against new medical industrial complex (play off military industrial complex). People protested against medical school empires. Health New Left introduced "American Health Empire" in the 1970s. New skepticism about authority of science. Science remained and remains powerful indisputably in American society but in the 1960s, it began to lose some measure of its moral authority. Prevailing image of science in the 50s was not just powerful but good. The medical profession had been very successful in elevating its standing in American society by linking itself to the authority of science but as the image of science began to get tarnished, benefits of the medical profession from association grew murky. There was a growing distance between doctors and patients, some critiqued the deeper mechanistic roots of medicine as well as the human costs to hi-tech medicine. 1973: "Struggling to stay human in medicine": dehumanization of doctor and patient, concern was about how the relationship was breaking apart, critics saw tendency for modern doctors to become mere medical technicians while losing sight of the patient as person -- ethically wrong

Tony the Tiger

1951: Created in 1951 by Leo Burnett through a firmwide copetition. Early on, Tony was an orange cat with a blue nose, black stripes and walked on all fours. Overtime his physique evolved with cultural interests in physical health. Thurl Ravenscroft (Tony's voice) personified him with interests and disinterests. Research shows that children find that food tastes better when it's tied to a mascot.

Pocket Card of Media

"1. Message: intention of message, form of message 2. Content: what is the content (verbal, music, multiple types of information) 3. Source: government, public health department, company, hospital, pharmaceutical 4. Audience: you, health insurance company 5. Impact: what is the impact, how does it make you feel, how do you make health decisions on the basis of what you're exposed to, what is the impact in terms of dollars (target audience), is the goal to change your behavior, how the media shapes what you do professionally, how you make decisions as a patient, whether or not to trust the information given to you"

4 boys bitten by rabid dog

1880: 4 boys in Newark, NJ were bitten by a rabid dog. The next day a local physician wrote to a NY newspaper urging the children be sent to France immediately to be treated by the vaccine. Within hours, working men collected donations and brought them to the doctor's office. The story was covered by the NY Post, NY Herald (which raised a fund for the children) and Pasteur's reply was recorded in the newspapers. As long as they got to Pasteur in time, the disease could be halted. The new transatlantic cable allowed stories to be printed daily through eyewitness reports. The boys became the first celebrity patients. A wax museum advertised Pasteur and the boys as the newest sensation. Dime museums fought to cover the boys' story with 20+ shows a week. They would be put in shows that had then displayed alongside a stuffed dog.

1880s

1880: Mass retailers, department stores, mass produced brand name consumer goods, solicited ads to fill up newspapers and magazines

Louis Pasteur

1880: Microbes and bacteria were one of the main causitive agents of a whole host of diseases. Established the laboratory as the hallmark of this new scientific medicine. Inoculated against anthrax and developed rabies vaccine (?)

Germ Theory of Disease

1880: Replaced miasma theory, the idea that a noxious form of "bad air" from rotting organic matter caused disease. Germ theory argued that microbes can cause illness. Something that you can't see, taste, and smell is deadly. It was popularized by researchers like Louis Pasteur and Robert Koch and taken up by American doctors in the final decades of the 19th century. It led to a golden era of bacteriology during which the theory quickly led to the identification of the actual organizisms that caused many diseases. Viruses were discovered in the 1890s. The golden age of medical bacteriology was 1870s-1880s. Change in medical thinking presented a whole host of challenges of how to convince the public that something you couldn't see was dangerous and so the age of advertising took hold of the public health movement.

Robert Koch

1882: Used experimental methods to identify TB bacillus in 1882.

Rabies Vaccine

1885: Pasteur's announcement in 1885 of a rabies cure in humans marked the inception of the breakthrough model and initiated a different / new relationship among media, medical researchers, and the American public. Medical discoveries now warranted human interest. By 1860 / 1870, Pasteur investigated animal diseases and was successful in developing a series of vaccines. By 1884, he developed a vaccine that could be injected into an experimentally infected animal by drawing the spinal cord of animals infected with rabies. The incubation period was long enough that the vaccine could be administered even after the point of infection.

1890s

1890: Advertising agencies took over copy and design work for ads making jingles, trademarks and other promotional gimmicks. Rise of new general interest magazines such as the Ladies' home journal. Rise of yellow journalism (sensationalist, self-promoting, eye-catching headlines). Coincided with emergence of germ theory. Manufacturers employed techniques that made clear germ phobia or paranoia were beginning to hold -- germ proof water filters, burden of germ avoidance fell on women

Coca-Cola

1892: Founded by Robert Woodrow, Coca-Cola aligned their product with cultural identities of nostalgia, lifestyle, happiness, and patriotism at the onset of WWII (every soldier would get a coke for 5 cents a bottle at whatever cost to the company. Annual sales top $50 billion and in the late 1990s, American families were dirnking more soda than water and milk. Catch phrases: "It's the real thing, Coke", "Thirst asks nothing more".

Walter Reed

1900: American medical hero -- attributes (contribute to national pride, scientific knowledge, defense of the nation). Medical officer in the US army in the wake of the Spanish-American War, which led to a yellow fever commission to American-occupied Cuba. Discovered the mosquito as the carrier of Yellow Fever, announced in the NYT in 1900. Led to the anti-Yellow Fever campaigns in the panama canal and southern ports of US. Reed returned from Cuba to Washington where he taught in the Army's medical school until he died from appendicitis in 1902. Depicted as a martyr following his death scripting his biography to conform to the American myth of a self-made man, raised in a log cabin, etc. Depicted in 1937 radio as a self-experimenting devoted, committed, American health hero. Public stature recieved a cultural boost when Cuban mosquito experiments became a Broadway play and Hollywood film.

Medical Breakthrough

1900: At the turn of the 20th century, the expectation that breakthroughs would be news emerged in the context of germ theory. Medical breakthroughs became a naturalized idea and it was tightly tied to the simultaneous emergence of modern medicine and modern media. Journalists catalyzed the breakthrough model and uplifted the standing of the medical profession in society. Ex. Louis Pasteur and the vaccination of rabies (1885)

National TB Association

1904: In 1900, 1 in 10 American deaths were due to TB. Founded in 1904, started the first national modern health crusade. By the start of the 20th century, public health officials had borrowed the major tools of modern advertising. Christmas seals were sold as the first mass health education campagin in sync with modern consumer culture to blur the boundaries between education, advertising and entertainment. Drew on medieval imagery giving children ranks (squire, knight, seat at round table of Health Chivalry) which corresponded to sales of seals. By 1922, 7 million American children were enrolled. Trademark was the double-barred Lorraine cross (foreshadowing of ribbon culture of late 20th century). Publicity events included traveling TB exhibits, plays, posters, parades, billboards. Anti-TB peaked in the 19teens and the 1920s. In 1915, the modern health crusade was founded by a Yale grade and the KKK was also refounded. Commissioned Thomas Edison to make Anti-TB films beginning in 1910, which started a tradition of a yearly film that coincided with the Christmas seal campaign.

Venereal Disease

1910: Vice commission investigated and combatted prostitution and through it, VD. During WWI (1914) VD became a national issue. Mass media health education about VD defined what it meant to be sick and what it meant to be healthy. Avoidance of disease was a matter of citizenship, patriotism, and national defense. Sexual double standard was taken for granted. If men were infected, wives were not told, but public health officials targeted prostitutes ("enemies at home") who came to represent the source of VD. War department detained at least 18,000 American women suspected of being sex workers.

Oreo

1912: The best selling cookie in the US since 1912. Oreos were expanded into India in March 2011. A blue bus from Mumbai to Dubai represented an educational theme for their marketing campaign "oreo togetherness", "twist, lick, dunk". The goal was to teach the country's population of 1.2bn now to eat an Oreo

Temple of Moloch

1914: Presented the case of a careless consumptive as high melodrama, sweeping, ventilation. Idealistic public health young doctor trying to help a working class family. The NYC health department would host outdoor screenings onto the side of tenement buildings and get audiences of 1000s. An example of an Edison film about TB commissioned by the National Tuberculosis Association.

Anti-VD Campaigns of WWI

1914: Through posters and films drew on patriotic spirit to combat VD among soldiers. Health was a matter of patriotism and national defense and disease was a failure in citizenship. Soldiers were examined on a bi-monthly basis and given prophylactic treatment and kits to prevent / treat VD

How Disease is Spread (1924)

1924: USPHS film where filmmakers confronted how to make something invisible (germ) seen as deadly and dangerous, black stars made germs visible and revealed that acceptable social interactions are germ spreading. Other messages were that in the 1920s a new woman (independent, mobile, potentially dangerous) was coming into being, sexualization of germ transmission

Paul de Kruif

1926: One of the first science journalist which popularized medical heroes in the 1920s and 30s. Published Microbe Hunters in 1926 which included dozens of dramatizations of bacterial discovery (Pasteur, Erlich, Koch, Reed. No other book in the 20th century did more to recruit people to medical research and microbiology. Designed to engage readers but also convey health lessons. Image of biomedical research as drama, romance, adventure. In collaboration with SInclair Lewis wrote Arrowsmith in 1925 which enhanced the image of scientist as hero by introducing Martin Arrowsmith, a biomedical researcher whom de Kruif colored with technical knowledge. First major American novel to depict a medical scientist. Later adopted into a full length feature film in 1931 (start of golden age of American medicine and rise in the prestige of the medical profession). Lewis won the Nobel prize in literature for his third novel in 1930.

The Hays Code

1930: First attempt at introducing film censorship in US through laying down a series of guidelines to film producers. First introduced voluntarily as a moral protection code by MGM. Included dos, don'ts and be careful ofs. You could not have a couple in the same bed, at least one leg had to remain on the floor, couldn't show drug abuse. Lasted through the 1960s. Public efforts to break the taboo against openly addressing VD in mass media: syphilis, gonorrhea as a medical rather than moral idea

Sinclair Lewis

1930: In collaboration with Paul de Kruif wrote Arrowsmith in 1925 which enhanced the image of scientist as hero by introducing Martin Arrowsmith, a biomedical researcher whom de Kruif colored with technical knowledge. First major American novel to depict a medical scientist. Later adopted into a full length feature film in 1931 (start of golden age of American medicine and rise in the prestige of the medical profession). Lewis won the Nobel prize in literature for his third novel in 1930.

Sydney Howard

1934: Screenplay who wrote Yellow Jack (=Yellow Fever). He also wrote the screenplay for Arrowsmith as well as Gone with the Wind. Yellow Jack opened on Broadway in 1934 and celebrated what these men did without portraying them as they were. In 1937, MGM bought film rights to Yellow Jack.

Thomas Parran

1936: 1926: Head of VD division of USPHS. 1930: NY State health commissioner under FDR. 1934: planned radio speech that would use word syphilis but network refused to air it, so a newspaper printed it instead. Broke taboo of talking about VD in the press like Koop did for HIV / AIDS. 1936: Appointed surgeon general and spoke of syphilis as a medical not moral problem. Effort to diagnose African-Americans in the rural South for syphilis "bad blood" gave rise to the Tuskegee Study. Plain Words About VD (1942)

The Story of Louis Pasteur

1936: Setting is June 1881. Robert Koch has identified the anthrax vacillus in 1876 and in 1881 Pasteur claims to have developed a vaccine against the disease. 2 pens of sheep are exposed to anthrax and only 1 pen is inoculated. Inoculated sheep jump to their feet at the bark of a rabid dog foreshadowing Pasteur's cure for rabies just 4 years later. The first film to be made on a medical professional. Allowed Warner Brothers to modify its image as a purveyor of movies of gangsters, sex to a new image.

Yellow Jack

1937: Produced by MGM with screenwriter Edward Chodoroy. Created a Walter Reed with a love story. Soldiers volunteered to be infected with Yellow Fever out of reverence for Reed. Reed honors the action of the men with gravity and gratitude for future generations. Apocryphal phrase - never happened - "Gentlemen, I salute you"

Health Heroes

1940: MetLife Insurance Company pamphlet which featured prominent medical heroes: Reed, Pasteur, Koch, Marie Curie, retelling obstacles, discoveries, contributions. The pamphet equated medical progress with breakthrough discoveries and attached an authority to physicians. Wider trends in popularization: science as an event / product rather than as a method, research as a heroic drama

Dr. Erlich's Magic Bullet (1940)

1940: Salvarsan (1909) was the cure for syphilis developed by Dr. Erlich. It was the first clear triumph of chemotherapy and referred to as a "magic bullet". Warner Bros produced a film in 1940 depicting Ehrlich working against the hypocricy of his time to advance medical progress. Film was a biopic of a medical scientist. Nazis came into power in 1933 so Ehrlich's success as a Jewish medical researcher served as a political statement.

Plain Words about Veneral Disease

1941: Directed at public to educate them that military wasn't taking sufficient precautions against VD by not aggressively suppressing prostitution near army camps. Paul de Kruif wrote an endorsement to instill a sense of urgency. Thousands of women were rounded up, posters and films were made, villified women ("loose charlottes, cacky wackeys"). Films included "USS VD Ship of Shame" (1945) for sailors susceptible to girl next door, "Easy to Get" (1943) directed at African-Americans, ways of keeping clean, responsibility to communities, families, ourselves. Getting VD was unpatriotic and men needed to be protected from the girl next door

In Defense of the Nation

1941: Made for civilians just before the war. Produced by the American Social Hygiene Association with themes of guilt (disease, broken morale, weakness leads to prostitution, gambling) and responsibility (health and high morale leads to healthy sport). Plans for education and repressing prostitution

Rose Kushner & Gadette Roseman

1945: Rose: Journalist diagnosed with breast cancer in 1945. Villified by medical community. If you had a biopsy and you were found to be cancerous, you woke up to a radical mastectomy. Gadette: early pioneer in convincing physicians about treatment options. Began to see that outcomes with radically mastectomies were no better than women who had not gone under this time, surgery, and climate

Willowbrook

1947-1987: The largest state-supported institution for children with intellectual disability created to care for but inevitably housed intellectually and physically disabled persons - over 6,200 residents. Described within pediatric medical literature and ethical literature as a version of a pediatric Tuskegee. First created as a VA hospital intended to serve 3,000. It meant tremendous labor, new jobs to Staten Island, relief for families and was viewed widely as a success in the 1940s. "Island's Largest Employer" "600 Willowbrook Kids enjoy Christmas in July". 1955 start to see advertisements requesting more staffing due to enrollment reaching 4,300. Begin to see the depersonalization of individuals with a 1:60 attendant to patient ratio. Justification of acts conducted by staff are due to difficult patients. Held the greatest number of the state's black and puerto rican mentally handicapped population In 1965, Senator Robert Kennedy paid a surprise visit to the institution and said individuals were living in filth and dirt. In 1972, Geraldo Rivera, an investigative reporter uncovered the deplorable conditions in Willowbrook through an expose called "Willowbrook: The Last Great Disgrace". Story aired and within 24 hours of broadcast, ABC had over 700 calls expressing outrage. NYT published op-ed saying the state dishonors itself. The visual story was beginning to catalyze change. Rivera was on Dick Cabot show along with the physicians. Rivera became very close with Bernard Carabello - a man with severe cerebral palsy who had never gotten formal education and became close with him over the years, he was able to communicate clearly, unlike what media coverage had said in past years giving patients a more human quality. Began to see an ongoing reportage of the story in more high profile news organizations. Rivera wrote 2 books. Expose led to a class-action lawsuit in 1972 "New York ARC v. Rockefeller" and the 1975 Willowbrook Consent Decree that commited NY state to improve community placement for the "Willowbrook Class" and led to the ultimate closure of Willowbrook in 1983. The last children left in 1987. The media's job was to afflict the comfortable and comfort the afflicted. Began disabilities rights movement - empowering disabled and questioning the humanitarian environment of institutions.

Dr. Sydney Farber

1948: Pediatric pathologist and father of chemotherapy. He witnessed the polio epidemic and was fascinated with the polio advocacy group and how they used the media to advance / publicize the disease and fundraise. He envisioned a foundation for cancer that would spread a campaign like that: Variety Club of New England. The VCNE created the Jimmy Fund campaign, which raised $240,000 in support of cancer research. Jimmy on the radio was a tremendously successful campaign, people were lined up around teh hospital to donate to the cause before the broadcast ended. Portrayed cancer as a disease that could be disclosed, supported by the community. Farber needed more funding to build a national scientific edifice against cancer. He did reveal the paternalistic role of patient against cancer -- patients had no role in therapies, decision-making, weren't even allowed to know their diagnosis. Patients had no say in allocation of funds or research paradigm.

James Moser

1954: Originally picked up interest as a writer for crime series, grew up watching Dr. Kildare and thought it didn't capture real process of becoming a physician. Trained at LA hospital through immersive experience and wanted to portray medical realism. First program pitch was Medic, which NBC agreed to, was sponsored by DOW chemical. Struck deal with LA medical association to use their hospital facilities in return for signing off on scripts. Program was too realistic, attempted to show a live C-section, featured a black physician, which led to controversy and the end of the series

High Fructose Corn Syrup

1960: Created during the Nixon presidency of the 1960s, it was created to prevent starvation. It was a means to end hunger but received much backlash at one point 55% of Americans listed it as one of their highest public health concerns. The Corn Refiners Association tried to rehabilitate teh reputation spending $30 million over a 30 month campaign targeted at moms.

Mary Lasker

1960: Lost her husband in the mid-1950s to colon cancer amidst fundraising efforts through the American cancer society to create a national research agenda for cancer. Initiatived more effort to create a model that didn't exist in the US: pamphlets, she was a fundraising expert and Farber was the scientist. Lasker believed it was a matter of enough investment to cure cancer, which Farber also believed.

Dr. Kildare

1960: One of the first stars who graced American films beginning with a book series in the 1930s and 40s, radio series in 1950s, and a TV show in the 60s. Media celebration of doctors generated cultural capital for medicine. Portrayals of physicians in the media influenced who was valued within the hierarchy of medicine. Dr. Kildare portrayed a one-dimensional, all-sacrificing, all-perfect physician. The secret of Dr. Kildare (1939) Kildare comes to the rescue of mentor who nearly collapses from overwork looking for a cure of pneumonia. The difference between medical doctor and research scientist is glossed over to make it easier for doctors to glean stature by association with medical research. Largely uncritical portrayal of doctors and nurses. AMA became deluged with requests from film and TV companies for medical consultants.

Golden Age of American Medicine

1960: Starting in the 1960s and 70s, media began contributing to the rise and erosion of cultural authority as well as the reflection and shaping of public perception and expectation through the Tuskegee Syphilis Study, early women's health movement, and black panther efforts promoting African-American health care

Norman Felton

1961: Producer and director of Dr. Kildare (played by Richard Chamberlain). Spent lots of time in hospital due to illness, wrote public service programs for NBC Radio and network of Chicago for the AMA detailing achievements in modern medicine. Dr. Kildare mixed romance with medical realism by following progress of a young, attractive doctor through training. 190 episodes on NBC 1961-1966. On closing screen would thank AMA for advising. Suggested actors and roles they played were interchangeable. Chamberlain would recieve letters asking for medical advice, articles were riddled with medical jargon. Series idealised concept of beauty, valued sacrifice of personal life, blurred fiction and reality, created a hierarchy within the medical community.

Stigma

1963: (1) Attribute that is deeply discrediting and reduces the bearer from a whole and usual person to a tainted and discounted one -- Erving Goffman. (2) Complex phenomenon that occurs at a public level toward people and a level of self. (3) A relationship between an attribute and a stereotype that assigns undesirable labels and qualities and behaviors to a person. (4) Labeled individuals are devalued socially leading to disapproval, rejection, exclusion, isolation and discrimination.

Cancer films

1970: Begin to see cancer films still exhibiting a paternalistic experience. 90% of patients wanted to know their diagnosis while 2/3 of physicians thought cancer should not be disclosed.

Halsted

1970: Father of general surgery, "lesser surgery is done by lesser surgeons". Removing more was considered better so the patient experience was extreme, dramatic and painful.

Jerry Falwell

1980: An American Southern Baptist pastor, televangelist, and conservative activist used AIDS as an opportunity to moralize the diagnosis. It was seen as God's punishment for homosexuals and his punishment for a society that tolerated Homosexuality. It was proof of society's moral decay. It was associated with tremendous rejection -- people lost jobs, housing, social systems, in addition to having to battle a horrible diagnosis.

Reagan's Presidency

1981-1989: By 1982, AIDS appeared in major medical journals, networks, newspapers, and was universally considered to be lethal. It was percieved to impact a small subset of the population (GRID: Gay-Related Immunodeficiency). A transcript of Reagan's press secretary communicates that the disease was one of other. It was uncomfortable and foreshadowed government agencies being unprepared to deal with this epidemic though 250,000 were confirmed to be affected. It took 18 months since the first cases had been written about in medical journals for the white house to comment on the epidemic.

Hospital Advertising

1982: Hospitals began to use ads through reputation advertising: emotional, inspirational, exotic, miracles, institutional prestige, testimonials, technology, comfort. Ex. NY Presbyterian "amazing things are happening here" campaign. Hospital advertising is not regulated. When patients were surveyed, about half felt that there should be no change at all to hospital advertisement regulations.

Ryan White

1984: In Indiana, Ryan White, who was 14 at the time was diagnosed with AIDS as a result of him getting a contaminated blood treatment. He was forced to leave school and eventually his community after a bullet was fired through his home. He moved to Florida and became one of the biggest spokespeople for the disease. "I'm just like everyone with AIDS" but he had been a hemophiliac. His experience led to the Ryan White CARE Act (1990) the largest federally funded program in the US for people living with HIV / AIDS which sought to improve the availability of care for low-income uninsured and under-insured victims of AIDS and their families.

Chlorpromazine (1953)

Developed in 1953 allowed for the patient to calm down and think more clearly. Once tranquilizers came in, everyone began to use them and they spread like wildfire. Could be given in an outpatient setting - patients were no longer reliant on hospital for their treatment. Availability of oral pills that dealt with symptoms, behavior control, but also root of the illness was a really big deal. DTC ads weren't used until 1980s but advertising was used in medical journals promising to curb mental outbursts and help modify delusions, hallucinations, and confusion

Rock Hudson

1985: AIDS referred to as the Gay Plague until Rock Hudson's death in 1985. He was a the romantic leading man of Hollywood in the 1950s and 1960s and was beloeved by the American public. Some famous films included Pillow Talk. In the Summer of 1985, he attended a premier of Pillow Talk co-star, Doris Day, where his physical appearance was telling of his diagnosis. He then transferred to UCLA Medical center to recieve treatment and an announcement was made that he had AIDS. His impact was raising awareness about AIDS, no longer was it assumed to be a homosexual disease or a disease that could be ignored. The message morphed into the assumption that everyone was at risk -- bus drivers wore rubber gloves, people were fearful of toilet seats and drinking fountains

Pharma Popular Advertising

1985: Pharmaceutical advertising is only allowed in the US. It was first done with patient package inserts for inhalers then for birth control. Created by the FDA as a way to empower consumers and help people get a better understanding of drugs. Until the mid-1980s, most ads for medicine were in medical journals. Before 1997, FDA talked about fair balance: of information about the risks and benefits of using a drug. It must include a brief summary mentioning every risk described in the product's approach labeling. "Brief summary" prevented TV ads. The 1997 passing of the FDA Modernization Act called for the expansion of DTC advertising to broadcast and electronic media. Required a major statement: advertisements must disclose a product's major risk and most commonly occuring adverse effects in either the audio or visual parts of the presentation. You saw 20% annual growth and $6.1bn in investment in 2015, 8.5mm Americans recieved a prescription after naming a drug ad when they went to their doctor's office.

Cleve Jones

1985: The Names Project: Memorial Quilt. In 1985, Jones came up with an idea for an AIDS memorial quilt to memorialize and celebrate those who had died of HIV. When people with AIDS died, many could not have funerals and people lacked a sense of closure as families weren't able to handle the deceased. The 3x6 panels which made up the quilt was the size of an average grave. Stitched altogether it weighted 54 tons and was put on display in Washington DC. It was a healing, therapeutic, inclusive, familiar object to many and encouraged people to see the disease without judgment and encouraged communities to interact, talk, and share memories. Cleve Jones was nominated for the peace prize in 1989.

Ray Brothers

1986: 3 hemophiliac brothers were diagnosed with HIV in 1986. Though they won a federal cour battle against DeSoto County School Board, their house was burned down in 1987 forcing the family to leave Arcadia. 2 brothers died at ages 15 and 22 but Randy Ray survived and is managing his HIV through medication. The Ray Brothers and Ryan White represented a new group of untouchables although of the 946,000 children attending NY city schools only one was known to suffer from AIDS. Public backlash was intense in 1985. Half of adults approved of quarantine and mandatory HIV cards for those who tested positive and 1/7 supported tattooing.

Larry Kramer

1987: Founded Act Up in March 1987. Used AIDS as a platform for protest. Had been with gay men's health crisis and felt the group was ineffective and wanted something more militant (broke into news network stations to chain themselves to news anchors' desks), confrontational, public to force institutions with power (pharma, government) to change their policies such as how clinical trials are run for diseases. They used catchy slogans (Silence = Death) and symbols (pink triangle of Nazi Germany) to protest corporate movements (Delta banning HIV patients from flying), and the high prices of drugs available in the 1980s, namely AZT. AZT came out in 1987 at $10,000 / year but in response to protests dropped the price by 40% in a week. Decided to take over the FDA and shut it down in a day of protest. Used media to force change within constituencies that provided services that could help their cohort of people. Act Up changed Phase 1 of clinical trials and allowed patients to participate in drug delivery.

Dr. C. Everett Koop

1988: American pediatric surgeon at the University of Pennsylvania Hospital who famously separated Siamese twins. He was an Evangenical Christian who had written a conservative book and was far right (pro-life). The Reagan administration nominated him to serve as Surgeon General from 1982-1989 for his right views. In 1986, Reagan asked Koop to write a report on HIV Aids in the First Surgeon General's Report -- his narrative of fighting a disease and not people and advocation to offer care to the sick with compassion caused him to come under fire from the far right. Phyllis Schafly, a conservative activist, called for Koop's resignation. However, Koop continued and would go on primetime television to talk about self-education, sex education, and condom use. In 1988, mass-mailed "Understanding AIDS" a pamphlet trying to destigmatize HIV -- it was the largest targeted mass mailing by the government and the Media had a heyday about it -- it included information about: risky behaviors, how you get AIDS, what AIDS patients look like.

Magic Johnson

1991: Lakers basket ball star who helped ignite campaigns and important constituencies that helped shape the trajectory of HIV. In 1991, Johnson held an 8-minute conference disclosing he had HIV. After his announcement, requests for testing increased significantly for African-American men, a population at greater risk for HIV. He started foundations and intiatives to speak in matter of fact terms and used his diagnosis to advocate and educate others.

ER

1994: Ran for 15 years with 35-50 million viewers, 122 emmys. Written by Michael Creighton (writer), Neil Bayer (intern at USC and writer for ER), scripted key characters which represented a new mosaic of new American physician and nurse with diversity of gender, nationality, sexuality, race. Pushed the definition of medical realism to show personal weakness and covered a wide array of topics and illnesses. Physicians were allowed to be competent and flawed at the same time.

Katie Couric

2000: "Katie Couric Effect" refers to how Katie Couric went live on television had an unsedated colonoscopy after her husband died of colon cancer, after which more people sought colonoscopies than ever before raising a question of her actions as entertainment or advocacy. It revealed that a celebrity spokesperson could have substantial impact on public participation in preventive care programs

Dr. Redl

Developed life-space interview technique through the study of 6 hyper-agressive boys, getting them to talk about their feelings during an outburst. He believed that these children returned to institutions because the transition between institutions and real life was not executed smoothly. So, he provided living quarters that resembled homes, encouraged affection in his counselors, did not put up fences because "the urge to run away" would not be curbed by fences in real life.

House

2004: American medical drama that debuted on Fox in 2004. Gregory House was the antithesis of House: unconventional, paternalistic, pill popping, disrespectful, genius, distrustful, saw patients as burdens. Most watched show in 2008. Medical "hero" was an internist where victory was not "cutting" but rather the thinking process of medicine. David Shore was the creator and director. Powerful episode was the surgical checklist. Created more change in the medical community than the academic paper on surgical checklist. Atul Guwande said more people have seen this clip than have read the WHO surgery checklist. Surgical scrub nurses were empowered as able to make a difference.

Biggest Loser

2004: Running for 17 seasons, most watched primetime reality program besides football with 10 million weekly viewers. Feature overweight individuals sent to weight loss boot camp to radically change caloric intake, physical outpit and compete for cash prizes in addition to losing weight. Take no prisoners trainers (Jullian Michaels) placing fault on individual, lack of will power and laziness, no thought given to other possible factors. Impact on audiences: In 2013, it was found by the American Journal of Public Health that people who watched the biggest loser were less motivated to want to exercise and increased biases against overweight people reinforcing the stereotype that overweight people are gluttonous and lacking initiative.

Let's Move

2010: Michelle Obama's campaign that sought to achieve the ambitious goal of trying to tackle childhood obesity through print ads, PSAs, what we know messaging approaches. Changing behavior through empowerment and health messages were conveyed by showing rather than telling: eat healthy, stay active. Empowered parents through engagement. Focus Group clip shows positive use of celebrities (Will Ferrell, Jimmy Fallon) and reframing of childhood obesity in a positive way.

Addiction Epidemic

2010: The next illness which needs to be destigmatized and leverage media as a means to improve public health. Leading cause of death for individuals under 50 in the US is drug overdose. Media can shape pulic understanding through private experiences of living with addiction. We need an Act Up for addiction and force FDA to bring more drugs to the pipeline, we need a Ryan White act to improve funding support, we need to use media to move levers of policy

Homeland

2011: A TV show which served to destigmatize mental illuess. Received award from National Association of Mentally Ill. Features prime character in a position of power rather than someone on the margin. Mental health affects 1 in 4 adults and fewer than 10% seek therapy or treatment because of fear of being labeled. It is a stigmatized condition but has become less so with examples of public disclosure. Jameson's An Unquiet Mind (psychologist at Johns Hopkins with bipolar disorder). Elon Sacks' The Center Cannot Hold (USC law professor with schizophrenia)

Xeralto

2011: FDA approved new oral anticoagulant in 2011. Easier to take than existing drugs. Bayer invested over $100mm in the first month of the campaign. Created an identification campaign with NASCAR celebrities and testimonials. Serial Position Effect (benefits interspersed in the first half and then towards the end with side effects near the middle) techniques used.

Bolthouse Farms Carrots

2011: Jeff Dunn, Chief Carrott Officer, previously worked for Coca-Cola and left because he was demoralized by the industry's relentless campaign to increase consumption. He helped shape Bolthouse Farms' carrot campaign. They sell 1bn carrots a year to produce $68mn in revenue. They pitched carrots as the antidote to junk food with the tag line "Baby Carrots: Eat 'Em Like Junk Food". Jeff Dunn famously said the selling of food matters as much as the food itself. If not more.

Strong4Life

2012: A campaign organized by the children's healthcare coalition of Atlanta ads made controversial claims such as "chubby kids may not outlive their parents" and "rewind the future" clips using attributional stigma (people are to blame for their own health problems, 50% of overweight patients reported recieving inappropriate comments from physicians and 2/3 of HC providers in UK viewed obesity as a lack of willpower'). However, there are many contributing factors to obesity including environment, diet, and stress. Through secondary anxiety and increased isolation the campaign did more harm than good. Nearly 2/3 of Americans are overweight or obese (17% of US children). WHO has called obesity a global epidemic that by 2030, 2.16bn people will be overweight and 1.12bn people will be obese.

Cereal Advertising

2017: Cereals advertise to children more than any other packaged food industry spending $1.8bn on food and beverages to youth. Children under 12 spend $35bn of their own money on cereal with annual sales of over $200bn.

Jonas Salk

Appointed to lead research for a polio vaccine in 1949. Mass nationwide trial of 1954 led to the first successful polio vaccine in 1955 despite persistent opposition to vaccine trial from within the scientific community on the grounds of efficacy and safety. Banished the word, experiment replacing it with trial. 1954 trial rallied participation as the only way to solve the mystery. By 1954, 2/3 of nation had contributed funds to March of Dimes. People were now asked to make financial contributions but also have their children volunteer for the vaccine trials - language of war and discovery to encourage polio pioneers (children who would participate in the trial). Celebrities (Lucille Ball) urged Americans in theatres, posters, pamphlets, brochures in schools and movie theatres. Nearly 2 million children volunteered as polio pioneers in the largest clinical trial of using human subjects in medical history. No medical trial in history had ever garnered as much public attention (98% knew about the trial, more than those who could recall the full name of the president). Jonas Salk was seen as a scientist hero unhampered by government interference and support because his success was driven by volunteer contributions. Moment of high optimism and public confidence - media helped create an aura around medicine that marked a high point about the golden age. With the standing of medical profession at its peak, the potential of medicine seemed to be boundless and expectations and confidence in biomedical research reached new heights. Media was a key engine in remarkable rise of medical profession and inflated expectations, which was a source of disillusionment, criticism, and declining cultural authority of medical authority that followed

Men in White (1934)

Depicts moral dilemma faced by Dr. George Ferguson (Clark Gable) - ambitious but idealistic physician spending way too much time in hospital and missing too many dinner parties. George turns for sympathy from a student nurse (Barbara) - leads to pregnancy and life-threatening complications from an illegal / botched abortion. Barbara rushed into operating room while George is on call. George's fiancé has chosen that same evening to finally see him at work. Heroes are very human but medicine remained very untarnished. Stark white of operating room, gleaming equipment and technology. Hospital was emblem of golden age and between 1904 and 1944: hospitals tripled. Drew on and promoted image of modern hospital as a temple of science - using and enhancing public esteem for the profession

Jean Heller

Associated Press reporter. July 1972 the story went out on the AP wire "Syphilis Victims in US Study Went Untreated for 40 Years". It's only in the final 2 words that there's any notice that the subjects all happen to be black. Within a day of this report appearing in the NY Times is a 15 second nightly news report on CBS with no mention of race. Tuskegee quickly became a shorthand for racism in American medicine. Much of the public was outraged - era of the late Civil Rights movement, protests against war in Vietnam. On July 25, 1972 word of the Tuskegee Study was reported by Jean Heller of the Associated Press; the next day the New York Times carried it on its front page, and the story captured national attention.

Ken Kesey

Author of 1962 book, One flew over the cuckoo's nest, which inspired 1975 film with Jack Nicholson. Protagonist is checked into a mental hospital and undergoes electroconvulsive therapy and lobotomy. Depicts mental hospitals and psychiatry practice as a punitive solution for people who didn't fit in in a convincing cultural critique.

William Bronston (1971)

Bronston was a pediatrician, physician-trained at UCLA, mentored by someone interested in creating better care for children of developmental delay. He was a civil rights activist, a real radical. First residency was in Kansas City but was expelled for calling AMA a criminal organization but blackballed as a result. He was an activist and very much came from the 60s era of confrontation, protest but had been fired from his residency and needed a job. He looked for work where they didn't require references. Willowbrook was perfect for that - had a reputation for being understaffed and in need "I just stood there and tears welled up in me. I'd never seen such squalor and excrement smell...It was absolutely like something out of Dante's Inferno. It takes you day after day to fathom this hell". Talks about Willowbrook as a form of trauma for him. Writes about being in charge of a building for 200 of the most enormously disabled people in his life. Having no orientation, no one helped him manage children with lacerations, fractures, seizures. Describes the place as a public health disaster -- Overabundance of tranquilizing medications, lack of food, unspoken rule was never touch them and never get close to them. He went to administrative leadership and protested inhumane conditions They went to Staten Island Advanced and Jane Kurtin wrote about this piece "1971: Willowbrook: Inside the cages" which encouraged parents to become involved with their children receiving inappropriate, inhumane care. Gave rise to protests of local Staten Island community and as a result, Wilkins and Bronston are fired for encouraging parents to organize and demand better conditions for their children. They had been friends with an activist lawyer who had turned to television (ABC) Geraldo Rivera and still had key to one of the buildings. Took the camera crew, went and filmed the inside of one of the Willowbrook units. Crew was there for less than 10 minutes but that's all they needed to create an uproar

History of PTSD

Civil War: "irritable heart" or "nostalgia" was the diagnosis that one finds most often in 19th century insane asylum records. Over 3 million veterans WWI: Shell shock was a new diagnosis thought to be caused by atmospheric pressure changes due to exploding artillery shells. Psychotherapy techniques were used to treat these mental disorders and return soldiers to battle. In 1915: 50% of allied casualties were from shell shock suggesting that illness was psychogenic. WWI soldiers were exposed to trench watfare, witnessing to impersonal deaths, and no choice of desertion. WWII: Mentally defective candidates (low grade morons, psychopaths, eccentric, emotionally unstable, sexually perverse, resentful of disciple) were thought to be "screened" out at induction so those who passed were seen as resistant or immune to psychological breakdown. In reality, interviews were 15 minutes long and elementary. 1.5 million of examined men were rejected for psychiatric reasons. Despite these efforts psychiatrically discharged men outnumbered new enlistments and so the Army reinstituted a plan for preventive psychiatry treating men on the front lines similar to WWI. Soldiers were given rest, warm food, a place to stay. Soldiers were diagnosed with combat exhaustion rather than a psychiatric diagnosis. The idea was to restore the soldier quickly in the vicinity of his unit where he would still feel loyalty and obligation to his buddies and return men as quickly as possible to the front lines. Men were salvaged close to the front and rate of return to combat exceeded 50%. Takeaways: every man has his breaking point and screening wasn't enough, environmental stress of warfare put every man at risk. Front-line psychiatrists emphasized that they were treating normal soldiers who had undergone extraordinary stresses. The post-war era saw efforts to re-masculanize American society with women re-entering domestic roles and men returning to the workforce. According to post-war psychiatrists, American mothers ("smothers") had raised a geenration of weaklings and predisposition for breakdown was the widely accepted argument -- soldiers regressed to a child-like state. By displacing trauma and uncovering a fundamental problem at the root of the American family, psychiatrists assured themselves of the broadcast field of application for their therapeutic interventions. Vietnam War: (1960s) Some vets were nervous, irritable, jumpy, felt guilty surviving the war. Post-Vietnam syndrome: War had left veterans psychologically damaged was dramatized in mid 70s. "Taxi driver", "The Deer Hunter" - Hollywood's image of PTSD

Charlie Lorde

Conscientious objector who was horrified by conditions at Philadelphia mental institution, Byberry, he tried to document what he saw using a camera. He told NPR in 2009: I tried to fill the frame, I'd try to get up as close as I could, the main thing was to show the truth. Published photographs in life magazine, presented them to Eleanor Roosevelt who then pledged to aid mental health reform

Miltown (1955)

Discovered in 1950 in NJ, called a minor tranquilizer as opposed to Thorazine (major tranquilizer). New because it was a lifestyle drug to be taken to tame life's difficult moments. Emerged amidst the polio panic and the Cold War. Celebrities used: Milton Berle renamed himself Miltown Berle, Aldous Huxley used while writing Brave New World (could be the gateway to world peace). Initially considered a men's drug - JFK, businessmen. Market grew and we got multiple other drugs (Ex. Valium). Psychiatrists worried that pills would be an easy way out, shortcut to happiness, avoiding psychotherapy. New concerns about addiction and silencing when it came to women. In the 1960s, doctors were doping women to keep them quiet and cure their boredom as chronicled in the 1963 book: The Feminine Mystique and 1966: Aftermath, Rolling Stones album and "Mother's Little Helper". Reflected how women were using to help them get through their day. Americans learning that benzos were not so benign - regulated in 1975 when Teddy Kennedy described tranquilizer epidemic as a nightmare.

Dr. Saul Krugman

Dr. Saul Krugman was brought in the early 1950s as a consultant to Willowbrook. He quickly realized that this was a tremendous research opportunity because the environment provided a chance to conduct a natural experiment - unsanitary conditions and propensity for children to languish uncleaned meant they were going to develop parasitic diseases and hepatitis. Hepatitis wasn't well-understood (transmission, therapeutic options) so Krugman was funded to research this. Krugman would eventually perform experiments at Willowbrook for over a decade. Viewed as a tremendous contribution to science but his studies are still seen as one of the most controversial human experiments of our time. By the late 1950s, there was tremendous overcrowding at Willowbrook. The only way you could get your child into Willowbrook or in a favorable ward, you had to allow your child to be a part of the Krugman studies. As a parent, this was viewed as advocacy. But the problem was that Krugman either infected children with Hepatitis or fed them fecal laced milkshakes and followed them. He did not treat the children with hepatitis and the therapies were mostly used for treating the military. Families were coerced into enrolling their child into this research project because of tremendous housing shortages. Krugman published widely "Parasitic Infections in a Closed Community". Other physician researchers on campus contributed as well. Krugman thought he was serving mankind for doing this. Disagreed with Beecher and published about it through the mid-1970s. Eventually the study was stopped through legislature. 1965 headlines of overcrowding, isolated deaths, events of harm, "Another dies in violence at Willowbrook". Kennedy visits unannounced, charges neglect of state care, coined the term snake pit. "Situation borders on a snake pit, children live in filth, many of our fellow citizens are suffering from lack of imagination, man power".

PTSD

Encouraged by lobbying, American psychiatric association came to embrace PTSD as a psychological disorder. Became centerpiece in social, emotional problems of Vietnam veterans (1960s). In 1980, PTSD officially became recognized as a psychiatric syndrome (DSM III). Stigma is a leading obstacle for PTSD and the media is playing a key role in whatever happens next in public understandings of PTSD, processes of (de) stigmatization, experiences and challenges of those with PTSD as well as their family and caregivers

Julius Rosenwald

Established the Rosenwald Fund, which donated millions in matching funds to support the education of African American children in the rural South, as well as other philanthropic causes in the first half of the 20th century. The Rosenwald fund set up 6 trial VD Syphilis treatment projects in the South. The demonstration programs would show state health officials that rural black populations were within the reach of effective public health change. It is widely said that the 1940s was when penicillin came to be, and when Tuskegee became an ethical problem due to withholding treatment.

Let there be light (1945)

Film commissioned by the US Army. In late 1944, FDR made a commitment to return men from war to being useful citizens including getting them treatment for psychological casualties. In 1945 there was a demobilization of military troops, and the US Army commissioned John Houston for film "Let there be light". The film followed 75 men (real doctors and patients) through 8 weeks in Macon General Hospital (main treatment center for the East coast) depicting successful therapy giving optimism and hope to viewers. This film would be shown to patients' families, healthcare providers, perspective employers, general public - part of wider effort to shape attitudes towards the psychiatric effects of war - you could embrace them back into society / your family. The Army hoped the film they commissioned would decrease stigma and public's reluctance to employ veterans would subside. This clip would be shown in a theatre before the main feature. It became the Army's official film shown for combat fatigue. "Others show no outward signs, but they too are wounded", "casualties of the spirit, men who are damaged emotionally". It captured what had come out of wartime experience with combat fatigue - every man has his breaking point Even though the military produced the film, they suppressed the film for 30 years because military officials denounced the film as unsuitable for public viewing and withdrew it from circulation. It was education but conveyed the wrong lesson, violated patient confidentiality by revealing names and identities of real patients and depicted favorable outcomes of treatment potentially placing the government at risk of lawsuits from families whose veterans weren't as responsive to psychiatric therapy. Military thought Houston had pulled a fast one and produced a film that was anti-war and the film was banned for decades. The film was not anti-war but the documentary did accurately capture wartime understandings of combat fatigue including the fact that war pushed men beyond their breaking point, it didn't sit well with seat change in military paradigm - neuropsychiatric disorders were not the fault of war as it were preexisting conditions pre-war: failures of American manhood and failures of American mothers. American psychiatrists didn't have sympathy for war as a cause and the psychotherapeutic methods of their front line colleagues. To ease the blaming of war for mental illnesses, letters sent home by soldiers were censored and pictures in newspapers and magazines were softened. After the war, psychiatrists grew concerned with factors that predisposed American men to mental breakdown. They blamed the underlying problem as early childhood experiences of soldiers who later just couldn't take it. (Ex. "Their mothers' sons" - Edward Strecker) They attributed high rate of breakdown during the war in the US Army to the permissive child rearing practices of American mothers and the resulting lack of character of young American men.

National Foundation for Infantile Paralysis / March of Dimes Foundation (1938)

Founded by FDR and later re-named in 1938, the NFIP was a non-partisan association of health scientists and volunteers that helped fund research for a polio vaccine and assisted victims on the long path through physical rehabilitation. Funded originally through the generosity of wealthy celebrities at yearly President's Birthday Balls (dance so others may walk). Raised over $1 million in its inaugural year. It also encouraged philanthropy in the general population with latest techniques in advertising and public relations. The foundation could not raise money fast enough to keep pace with polio's continued toll on America's children and, during the Depression, the polio epidemic worsened and the Birthday Ball proceeds were politicized, so the NFIP was developed. . In 1938, Roosevelt decided to appeal to the general public for help. At one fundraiser, celebrity singer Eddie Cantor jokingly urged the public to send dimes to the president, coining the term March of Dimes. The public took his appeal seriously, flooding the White House with 2,680,000 dimes and thousands of dollars in donations. In subsequent years, the March of Dimes continued to lead lucrative fundraising campaigns that set the model for other health-related foundations. In 1941, the foundation provided funding for the development of an improved iron lung, which helped polio patients to breathe when muscle control of the lungs was lost. Collection of small contributions from a large number of Americans would continue - ushers in theatres, door to door - mother's march (1951). Mother's March film was an instructional film and pep rally with a male voiceover that gave instruction - remind people what's coming, go after local advertisers, strike and strike hard, mother is the storm, 1946: March of dimes introduced Donald Anderson (first poster child). He had been saved by contributions of ordinary Americans. Poster child syndrome was exploitive, manipulative, and attention-grabbing with a new poster child every year. In 1945: Elaine Whitelaw, journalist turned fundraiser led the Women's Division of the Foundation hosting fashion shows and traveling jewelry exhibits to raise money for the March of Dimes and the Mother's March on Polio (1951-1955) and door-to-door canvasing effort where porch lights would indicate a family's willingness to give. But this campaign collected mostly from wealthy families as poor neighborhoods were avoided or did not have porch lights, etc. The March of Dimes appointed Dr. Jonas Salk to lead research for a polio vaccine in 1949. Roosevelt, who died in 1945, did not live to see Salk develop and test the first successful polio vaccine in 1955.

Guatemalan Syphilis Study

From 1946-1948 over 700 Guatemalan prisoners, mentally ill, and soldiers were infected with Syphilis. Led by Dr. Cutler, who was later implicated in the Tuskegee study, men were given syphilis through cuts on their bodies, spinal puncture, or through sleeping with prostitutes paid by the US government. This was occuring as the Nuremberg trials were taking place 1945-1946. Hillary Clinton apologized for these acts in 2010.

Golden Age of the American Medical Profession (1930s-1960s)

Golden Age of American Medical Profession (1930s-1960s): Rise in prestige of the medical profession; Elevated confidence in the efficacy of medical science; Governmental and philanthropic investment in medical institutions (schools, laboratories, hospitals). The Media didn't just reflect elevated standing of medical profession, it propelled it, it was constitutive. It elevated the standing of medicine was a continuation and culmination of the public expectation of medical progress - notion fostered by media that change would come through breakthroughs and that breakthroughs would be news; celebration of medical researchers as cultural heroes; Mass crusades against disease - combine education, awareness, participation, and fundraising. After the 1880s when the American press turned Pasteur's announcement of rabies inoculation into a new kind of story about scientific and medical discovery there were few medical / therapeutic advancements (other than Salvarsan and insulin). So, the extent to which the optimism of new scientific medicine to deliver the goods was sustained by faith rather than products in hand

Henry Beecher (1966)

Harvard-trained anesthesiologist, consulted for the army with regards to a truth serum. Interested in human experimentation and consent - began writing in the 1950s and 1960s, didn't attract much attention. NE Journal of Medicine appeared in the 1960s in which he describes 22 cases in which researchers failed to obtain consent or had harmed research subjects. Cases were anonymous, didn't whistle blow by naming names, used taxonomy to describe how research was conducted. Fires a warning shot, talks about experimentation, describes Willowbrook -- Artificial induction of hepatitis and says mild form of hepatitis was endemic, nothing told to parents of appreciable hazards involved, no right to risk an injury to 1 person for the benefit of others. Created more negative publicity for Krugman. Local papers published headlines "Hundreds of mentally retarded children have served scientists as guinea pigs, receiving infected serum to produce hepatitis". Willowbrook, like Tuskegee, begins to see small bits of publicity stuttering until you have a catalyst. Catalyst for Tuskegee was the Heller piece in the NYT and in Willowbrook it was Rivera Beecher's and other exposes started to reveal a conflict of interest between human subject investigators and their human subjects, researchers' ambitions and patients' well-being. Quickly became linked to rights movements of the 1960s because subjects were drawn from poor, mentally disabled, incarcerated. Linkage ensured rights of research subjects and the perceived need to restrict prerogatives of researchers would not only capture but hold public attention. Tuskegee broke in 1972 in this climate - gave new weight ot the idea of consent (Kennedy clip). Exposes grew from and propelled an erosion in trust - decline in deference (from public and media) given to doctors and their professional judgments. It was not only research at issue, the crisis was also in bedside practices.

Bill Jenkins

In 1968 William Carter Jenkins, an African-American statistician in the PHS, part of the Department of Health, Education, and Welfare (HEW), founded and edited The Drum, a newsletter devoted to ending racial discrimination in HEW. The cabinet-level department included the CDC. In The Drum, Jenkins called for an end to the Tuskegee Study. He did not succeed; it is not clear who read his work. (1969) Epidemiologist and one of the first African-Americans to work at the CDC. Bill Jenkins left the PHS in the mid-1970s for doctoral studies. In 1980, he joined the CDC Division of Sexually Transmitted Diseases, where he managed the Participants Health Benefits Program that ensured health services for survivors of the Tuskegee Study.

Flatliners (1990)

In contrast to Arrowsmith (1931) which depicted the American medical student in a presgitious, heroic light as was customary in the golden age of medicine, the 1960s and 70s saw a growing decline in the status of American medical students. This 1990 depiction of medical students shows Kiefer Sutherland, Kevin Baker, Julia Roberts, Olivia Platt as elite, ambitious, ivy league medical students. Heavy, dramatic music builds tension depicting the first flatliners. Cinematic representation of doctors like flatliners only began to appear in the 1990s.

Arrowsmith (1931)

Inspired a whole series of biopics that followed. Silhouetted microscope becomes emblematic in this era. Conflicts: moral dilemmas between personal lives and profession - doctors' idealistic allegiance to healing usually won out. Romances were doomed to allegiance to medical science. In collaboration with Sinclair Lewis wrote Arrowsmith in 1925 which enhanced the image of scientist as hero by introducing Martin Arrowsmith, a biomedical researcher whom de Kruif colored with technical knowledge. First major American novel to depict a medical scientist. Later adopted into a full length feature film in 1931 (start of golden age of American medicine and rise in the prestige of the medical profession).

The Winged Scourge (1943)

Joint venture between US army, Walt Disney, and the Office of Inter-American Affairs (OIAA) made in the 1940s as a part of health and literacy campaigns in South America. Served to promote a long-term US vision for the hemisphere where Latin and South Americans would demand improvements in health and education and the US would be able to help. Period of vigorous anti-mosquito/malaria campaigns in American South and in tropical regions of the world where US troops were deployed during war. During this time, anti-STI films were also being widely made and disseminated. Responsibility is being placed on individuals for disease prevention. Pervasive cultural identification in American society of whiteness with health and blackness with disease and disorder. Criminology is used as a metaphor for disease prevention - persistent gothic imagery, vampiric imagery to make public reconceptualize mosquitos as a profoundly dangerous creature. Strategies to be used to prevent mosquitos: (1) Screens over rain barrels, doors and windows; (2) Draining waterways; (3) Pouring oil into water; (4) Smoking houses; (5) Filling bodies of water with dirt; (6) Nets over beds; (7) Filling cracks in floorboards; (8) Use of celebrities/cartoons as vehicles for conveying medical messages

Personal Hygiene (1950)

May be the only musical the army has ever produced combining education with entertainment. Combination of narratives and folksongs to convey messages. Made by filmmaker Frank Payne who had spent his entire career making training films for US army. He persuaded the military that be that he could make a musical. Film was made in an era when the military was actively seeking to re-mold soldiers' understandings of their own physical, sexual, mental hygiene. Protagonist, Homer, grows frustrated his bunkmates because he has been thrown into the water because of his smell. The film features folk songs about hygiene. Homer's hygiene is transformed and he gets the girl, his accent changes, all is rosy. Records show that sales of toothpaste on army bases increased after the film was shown

Tuskegee (1932-1972)

Named after African-American institution of higher education. Historical context: the 1920s was an era where the health of African-Americans became a subject of interest for health informers and officials. There was an altruism and conviction that "germs know no color line". The Tuskegee study began in 1930s when syphilis could be cured with Dr. Erlich's Magic Bullet - arsenic containing drug that had been developed in 1909: Salvarsan. Publicity for this treatment was widespread (ex. USPHS Movie "Three Counties Against Syphilis" -- documentary film made as publicity film for STI treatment programs of the South, especially coastal Georgia, at the time, with the goal of educating the public through house to house canvasing and church communities) With the Stock Market Crash and Great Depression came a significant cut back in philanthropic funding. PHS decided to continue program in one demonstration site in Macon County, Alabama where about 1/3 of African-American men were infected with Syphilis. The Tuskegee institute was already there and saw the study as a government interest in the health of black populations. Officials at PHS conceived black residence of Macon County as natural, untouched scientific subjects - farmers who rarely saw a regular doctor. Thomas Parran the head of the PHS's new VD division was leading a discussion and debate at the time about what difference race made to the natural history of disease. Doctors in PHS - especially Raymond Vonderlehr saw a golden opportunity to contribute to scientific debate by studying untreated Syphilis in black men in Macon County. Project turned into a nontherapeutic experiment. Subjects were told they had bad blood, not syphilis, which could encompass a whole range of ills. Elsewhere in the country, PH workers went out of their way to say if you had bad blood, you had Syphilis, but not in Macon County. These men were not told they had a contagious disease or how the disease spread (to their family). The men didn't receive treatment, but government doctors who visited annually went to great lengths that they couldn't and wouldn't receive treatment for Syphilis (would've undercut the results). Controversially, the study continued even after Penicillin became standard treatment for the disease. They were not drafted into the army during WWII to limitt heir exposure to anti-VD campaigns. List of men was circulated to doctors in Macon County medical society - do not treat these men for Syphilis. PHS doctors visited for "annual roundup". Changed from summer to winter to give northern PHS physicians a nice break from cold northern winters. Orchestrating things on the ground at local level was Eunice Rivers. Clearly the most perplexing figure to know how to script her into this study as she was an African-American woman. She ensured the men's participation in annual roundups where their blood was taken. Men were deceived by PHS doctors and promised treatment and told the roundups were in the interest of their health. They were given placebos. Some of the tests performed on them were therapeutic procedures - even spinal tap. The goal was to bring the men to autopsy to study the symptoms while the patient is alive and correlate them to lesions after death. Researchers promised $50 in burial money - agree to be autopsied after death which ensured those living in poverty would receive a proper burial and funeral (culturally significant). Due to this promise, there was no quiet way to end the study because terminating it now would be ending the burial money which would be sure to lead to an outcry. Tuskegee study was never secret at least not to those in medicine. PH officials published in PH reports and medical reports - In Jamma (AMA journal), presented works in conferences. Visiting Macon County for 1-2 weeks became part of training for PHS doctors. Not a secret to local black physicians at Tuskegee hospital and Macon County medical society. The study survived Nuremberg code (moral imperative of informed consent) following WWII. 1943 director of PHS division of VD quote "I like almost everybody else was horrified at the things that were practiced on those Jewish people...all of those things were horrendous to me" but there was no association between Tuskegee and Nuremberg because "there was no similarity between them". Sharp distinction between evil Nazis and well-meaning American researchers pursuing greater good of medical truth

Antibiotics (1940s)

Prontosil was announced in Germany in 1935 - revolutionized treatment of bacterial infections. In December 1936: FDR Jr. was cured by strep by Prontosil the "miracle drug". The cornerstone of therapeutic golden age came in 1940s with antibiotics. Salvarsan, the "magic bullet" was developed in 1909 to treat syphilis. Penicillin: large scale use in 1942: America's worst fire at coconut grove night club in Boston - 492 people had died but burn victims who would have died were saved by penicillin. 1943: mass production of penicillin. 1944: experimental treatment to icon (soldiers --> civilians). Image of soldiers being treated on beaches and front lines were disseminated and widely viewed testimonies to this wonder drug and adopted by manufacturers of the drug. August 1945, the drug became widely available through US pharmacies.

The Snake Pit (1948)

Protagonist (Virginia) becomes psychotic - upper middle class white lady (showing that anybody could become psychotic). Treated for many months at a large state institution. When she misbehaves, she's thrown into a straight jacket and what she experiences as a snake pit - huge room of insane women muttering, rolling, without anyone to help them. Most people remembered the image of the jail that the hopelessly mad were punished in the name of psychiatry.

Juvenile Delinquency (1950s)

Psychiatrists and mental reformers were interested in mental hygiene especially among kids to prevent mental illness development in the future. In the 1950s, teenagers participating in A New Peer Culture. Certain clothing and hairstyles defined who was cool or popular, class, background -- Jeans: working class boys; Well off girls: poodle skirts. Teens listened to the blatantly sexual music of Elvis, different from anything parents listened to. Made teens cohesive, powerful consumers, threatening to adults around them. Movies: Rebel without a cause, A wild one (movies) represented culture and threat to society. Popularized the idea that teens in 1950s were oppositional for no reason. A Juvenile Delinquent was seen as someone who committed petty crimes - stealing, skipping school, sleeping around, dating older men. Reporter for LA Times: 1955 "It could be said a delinquent is any child who presents serious conduct problem, whose deportment does not comply with generally accepted behavior of our society". Blame was placed on the child's upbringing - euphemism for mother (smothering or neglectful). Senate sub-committee held hearings on delinquency in 1950s and 1960s - psychologists, psychiatrists, lawmakers. Series of hearings in 1954: blaming comic books (Mario) and creators, new media. Delinquents were arrested but instead of serving time or being given other punishment, they were given other treatment - treated for psychological distress and sent to child guidance centers with psychiatrists, psychologist, social workers or sent to punitive reform schools, training schools. Mental health experts tried to understand delinquency as a manifestation of underlying mental illness. West Side Story outlines all the ways of understanding JD and mental illuess (bad home, poverty) Public Health positions and schools tried to stop difficult situations from arising in the first place - mental health movies (hold off until marriage for sex, self-grooming and self-care). There was widespread belief that children could be vaccinated against delinquency with mental hygiene efforts

Sister Kenny (1946)

Replaced Philip Drinker's modern iron lung technique of treating polio. A pioneer whose common sense treatment methods revolutionized the field of polio aftercare. She came to the US in 1940 to convince American physicians to use her method of hot packs and muscle retraining rather than using braces and splits. Published 1943 autobiography "And They Shall Walk" as well as a textbook "The Kenny Concept of Infantile Paralysis and Its Treatment". In 1942, Sister Kenny set up her own institute, Elizabeth Kenny Institute in Minneapolis. This went against the NFIP reputation for helping crippled children receive the best care jeopardizing their fundraising efforts. So, the NFIP did not fund her research. In 1946, she applied for a $840,000 grant to the O'Connor Foundation but was denied. It was one among a series of serious disagreements she had with the National Foundation. Leaving for Australia in 1951 she died a year later. The film drew on biopic conventions but dramatized a critical view of medical professionals and the workings of scientific change. Intended to be a depiction of struggle and sacrifice, scientist against all odds but in typical Hollywood fashion the story was weaved around a love story choosing between professional success and personal happiness. Raised questions on whether the NFIP had a harmful, unjust monopoly over polio treatment. NFIP then released "The Kenny Question" a pamphlet which suggested that the film was propaganda to convince patients and doctors to try a technique that only quacks would consider. Still, many parents saw Kenny as their last hope. She was a "woman in white" who offered alternative, anti-orthodox to solutions that the American medical establishment could not solve.

Congressional hearings of Edward Kennedy

Senator Edward Kennedy called Congressional hearings investigating human subjects research in medicine and abuses in medical care, at which Buxtun and HEW officials testified. As a result of public outcry, the CDC and PHS appointed an ad hoc advisory panel to review the study. The panel found that the men agreed to certain terms of the experiment, such as examination and treatment. However, they were not informed of the study's actual purpose. The panel then determined the study was medically unjustified and ordered its termination. Fred Grey, lawyer who represented Rosa Parks, took on case and sued federal government on behalf of surviving men. As part of the settlement of a class action lawsuit subsequently filed by the NAACP on behalf of study participants and their descendants, the U.S. government paid $9 million (unadjusted for inflation) and agreed to provide free medical treatment to surviving participants and to surviving family members infected as a consequence of the study. Kennedy proposed a national commission for the protection of human subjects in behavioral and medical research. 1974: National Research Act -- IRBs had to rule on protocols of all federally funded medical research projects, IRBs charged with overseeing ethical conduct of research

Psychiatric Patient Population beginning of the 20th century

Since the late 19th century: hospitalization (state or locally run) existed many miles from city center. However WWII was instrumental to the idea that anybody could develop mental illness and after WWII, the public talk about mental health was centered around public ownership. Life in America during the Cold War was very different from what Americans experienced before and concerns about mental health became paramount to psychiatrists, politicians, schools, and families - new urgency, public health responses Demand rose early and quickly. 1903-1930: psychiatric patient population in US went from 143,000 to 336,000. Many hospitals had become more custodial than therapeutic by necessity - difficult to treat patients due to lack of therapies and because there were just too many patients (ex. Philadelphia state hospital with as many as 80 patients in a single room, unclothed patients wandering unsupervised). New drugs ushered in dramatic change and results. Psychiatric treatment moved from hospital and into community. Mental hospitals were exposed for their terrible conditions and attacks on psychiatry itself ensued. Pharmaceuticals used to be used for doctors to manage their patients (barbiturates: for patients who were out of control), but in the 1950s a new drug was introduced that promised to change a patient for good: Chlorpromazine ("major tranquilizer" from 1953)

National Mental Health Act (1946)

The National Mental Health Act (1946) provided money to states to train psychiatrists and open new treatment facilities in the community. Meanwhile, Filmmakers, photographers, writers, activists were trying to transform mental health policy by exposing awful conditions in large state mental hospitals. Led to the establishment of the national institute of mental health (1949) and brought unprecedented funding for psychiatric research. Equated the battles of war with battles of everyday life

Arguments against institutionalization of mentally ill (1960s)

Thomas Szasz: main critic who believed there was no such thing as mental illness so it was wrong to imprison people for something they didn't have. Erving Goffman said mental hospitals brainwashed people who lived in them and who worked in them. Patients lost their authentic selves and accepted the institution as their new reality - dehumanizing. However, deinstitutionalization (movement from mental hospitals to psychiatric treatment in the community) resulted in a large homeless population

The Age of Anxiety

Triumphant from WWII, several fears existed (Russian communism and atomic bomb - duck and cover drills, bomb shelters). Duck and cover films attempted to manage fear, come up with a plan, educate and falsely reassure people. Pressure to be patriotic - be a good consumer; Conformist culture - pressure to be similar; Pressure for men and women to adhere to idealized gender roles and middle class behavior. Can't measure anxiety level of any era, but Americans in Cold War believed they were more anxious than ever before, but wore that as a badge of honor. Barbiturates: used in mental hospitals, known to be addicting, rose in popularity

Peter Buxtun

VD investigator in San Francisco working for PHS. In a coffee room of clinic where he was working overheard older PHS officer talking about a physician who was punished for giving a subject penicillin. Protested to CDC which in 1967 responded by putting together a panel by looking at the scientific issues in the study. Panel included 0 African American members and no ethicist, nothing happened. 1972 at dinner party with friends with a young associated press reporter (Jean Heller). She had heard about the study before but this time there was something different, she realized this could be news. She asked Buxton if there were any documents and she took the story to her editor. He recognized there was a big story here but turned it over to Jean Heller in AP's DC office. Peter Buxtun, a whistleblower who was a former PHS interviewer for venereal disease, had leaked information after failing to get a response to his protests about the study within the department. He gave information to the Washington Star and the New York Times. Buxtun finally went to the press in the early 1970s. The story broke first in the Washington Star on July 25, 1972. It became front-page news in the New York Times the following day. Senator Edward Kennedy called Congressional hearings, at which Buxtun and HEW officials testified.

Shades of Grey (1947)

With veterans after the end of war, the focus shifted from general neurosis to general adjustment problems. There was a real demand for guidance from psychiatrists - special training courses, manuals and films. War contributed to new confidence in American psychiatry and a new social role for psychiatrists so much that the number of psychiatrists between 1940 and 1950 doubled. (1946) National Mental Health Act was passed brinigng unprecedented funding for psychiatric research. The film argued that psychoneuroses experienced in war is an exaggerated form of a type of illness whose seeds are latent in all of us, but the army insisted it was not a replacement for Houston film Filmmakers try to portray that war is not to blame, the seeds of psychoneuroses are latent in all of us. The film shows men with psychiatric disturbances and equates sinus problems, appendicitis, tuberculosis with psychiatric disturbances. Slight disturbances are present in everybody - some people worry too much, some lack confidence, quick tempered, oversensitive, indecisive, resentful. Tendencies if magnified can impair men's ability. Nobody has perfect, pure white mental health most are some shade of light grey Dominant idea of the film was how the seeds of vulnerability got planted in the first place. After WWII, women were driven from wartime jobs back to domestic roles of homemakers. Mother blaming was hardly new to American psychiatry but became a central theme into the 1950s and into the Cold War. Overprotective mothers had produced a generation of psychiatrically rejected. War had exposed preexisting weakness, failures of proper upbringing. The film contrasted 2 boys and their mothers. Showed that babies have little resistance of immunity to disease, resistance is developed and strengthened - same with mental health. Can't tell in adulthood who does or does not have healthy mental health. Joe Smith is a deep shade of grey, prime candidate for personality disorder and combat fatigue. Real soldiers like Bill Brown are hardy, strong, and heterosexual. This film was widely showed and promoted to the public and the overall message is that war is not the cause of mental illness, only serves as a stimulus that brings to the surface seeds of mental illness already there

Albert Deutsch

Writer who made observations on the history of psychiatry. (1948) The Shame of the States found that not a single American mental hospital were following standards of American psychiatric association (1:150 patients, in reality 1:800). The book was popular and raised awareness among politicians and lay public about conditions of mental hospitals. Photographic essay (1946)