AMSA's 56th Annual Convention - Keynotes, Sessions, Awards...

KEYNOTE ADDRESSES

Cultural Lessons in Compassion
Surgeon Dr. Lori Arviso Alvord, perhaps best known for authoring The Scalpel and the Silver Bear, an account of her path as the first Navajo woman surgeon, reminded her audience that medicine has its own beliefs and values. "Sometimes those are the only ones we are allowed to practice."

Returning home to New Mexico after residency, she found that she was not immune to the religion of medicine. "I realized I had changed: I had become 'surgical.'" Afraid of becoming too bossy and arrogant, she decided to return to her cultural roots after a terrible day in the operating room. Her tribe views disharmony as the source of illness, and she began to incorporate that idea into her own work.

"If I've built trust with a patient, that can really carry us through some tough times," she said. "In Navajo culture, information is a gift. Wouldn't it be great to let [patients] give it to me?"-rather than having to extract it from them with pointed questions, Alvord posed.

"I just had these ideas about how to change medicine," Alvord said. "I didn't expect the world to pay attention to me."

Put Your Principles First
Former Food and Drug Administration (FDA) assistant commissioner Susan F. Wood spoke about her decision to leave the agency after 15 years of service when it became clear that politics had trumped science there. Wood resigned when then-commissioner Lester Crawford delayed the over-the-counter (OTC) approval for Plan B, an emergency contraceptive, indefinitely.

"This is why the whole FDA is at risk…. Any small group of people can override the science."

Wood explained the inner workings of the FDA, an agency with more than 10,000 employees and the responsibility to determine the safety and efficacy of prescription and OTC medications. She then showed how Plan B was singled out and removed from the normal approval pathway, despite the recommendation of an advisory committee that voted 23-4 for OTC approval. Normally, the commissioner is not even involved in the individual decision-making process, she explained.

Wood urged students to always provide correct information in discussions about Plan B: for example, that it works in the same manner as hormonal contraceptives, and it is not RU-486. In general, she stressed, students need to pay attention to policy issues, insisting that science drives health policy at the state and federal levels. "The pressure, the concern, the outrage needs to come from the real world, outside the Beltway," she said. "Take those shared values,…communicate them and take the next step."

PhRMA Has Its Say
Nervous anticipation rippled through the crowd just before Thursday's debate between Dr. Bob Goodman of No Free Lunch, an organization dedicated to reducing pharmaceutical marketing influence on physicians, and Dr. Paul Antony, chief medical officer for the trade group Pharmaceutical Research and Manufacturers of America (PhRMA).

Antony pointed out that pharmaceutical companies poured $40 billion into research and development last year, more than the National Institutes of Health. He told students to put their patients' interests first when thinking about how to respond to pharmaceutical marketing practices ranging from free coffee mugs to lunches. "If you think accepting coffee mugs is a problem for your patients, don't do what you think is wrong."

"Not everything the [pharmaceutical] industry does is right the first time around," Antony said, while downplaying the "subtle" influence of logos and small gifts. He also acknowledged trouble in the "critically important" relationship between the pharmaceutical industry and physicians, and between it and patients. He asked for constructive criticism and encouraged students to provide feedback to the industry.

The problem isn't just freebies, Goodman countered. The industry's relationship with researchers should also be examined. While pharmaceutical companies have a right to promote their products, a problem arises when physicians use drug representatives as a sole source of clinical information about treatment. "You don't go to the car dealer expecting them to look out for your best interest," he noted.

One Doc's Globetrotting Battle
In an address regarding differing global approaches and attitudes toward HIV/AIDS, Dr. Michael Alkan, head of the Institute of Infectious Diseases at Ben-Gurion University of the Negev Medical School, discussed his disparate experiences battling the disease in Botswana and China. In Botswana, he reported, the government declared they had "zero capacity" to deal with the threat and invited international assistance. In China, efforts were focused on small pilot programs.

"They have quotas for everything in China," he lamented. Even TB reporting there is driven by quotas.

Alkan showed how a pattern of HIV infection has swept north through China, following intravenous drug trade routes. Photos of some of his patients, fellow caregivers and a sampling of the incredible settings in which he has practiced illustrated his emotional speech.

Lifelines and Leadership
"My classmates were not particularly interested in social issues…," said Dr. Eric Whitaker, a former AMSA president who charted a course from the South Side of Chicago to director of the Illinois Department of Public Health. "They were already counting the money they were going to make…. They were not bad people; they just had different views of what life is." But through AMSA, Whitaker found a lifeline in like-minded students and opportunities for leadership.

Relating his more recent experiences working with those evacuated from the coast to Illinois after Hurricane Katrina, Whitaker said there is a lack of vision in the nation's leadership. But his current position offers him the opportunity to tackle huge health crises, like AIDS, and make a difference, he affirmed.

Following Through on Advocacy
Rounding out the convention theme of fresh physician advocacy, Dr. Fitzhugh Mullan walked students through his own training in medicine-and activism.

His path through public health and policy-making has wound through New York, New Mexico and Washington, D.C., where he has served as assistant surgeon general and is now professor of medicine and health policy at George Washington University.

While a medical student at the University of Chicago in the mid-1960s, Mullan was the founder of the Student Health Organization (SHO), which concerned itself with social justice in a turbulent time-something he did not find reflected in the then-Student American Medical Association. SHO used communication as its primary tool, with each chapter publishing its own provocative journal.

"People's priorities change," Mullan said. While student organizations have an easier time discussing the issues, that discussion must be carried into their future careers.

"We need to develop parity-and get away from paying absurd amounts of money for devices and not paying people for using their heads."

AWARDS National Primary Care Week: Kansas City University of Medicine and Biosciences won for best overall National Primary Care Week project. Golden Apple Award for Teaching Excellence: Dr. Andrew Flint of the University of Michigan Medical School received the Golden Apple, an honor he attributed to baking cookies for his students. Lesbian, Gay, Bisexual & Transgender Health Achievement Award: AMSA, together with the Gay and Lesbian Medical Association, presented students at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School with its coveted prize. Paul R. Wright Award for Excellence in Medical Education: The University of California, San Francisco, School of Medicine, won the 2006 award for incorporating professional development throughout its curriculum, including some electives.

SESSIONS

Daily programming at the 56th Annual Convention included sessions on everything from palliative care to fighting crystal meth's scourge on Chicago communities.

Medicine in the State House
Medicine does its good by helping individuals-but political action can potentially affect millions, said Wisconsin assemblyman Dr. Sheldon Wasserman. He wrote Wisconsin's automated external defibrillator law, and on the very day the law went into effect, the life of a security guard at the Miller Brewery was saved by one.

A practicing OB-Gyn, Wasserman described his complex schedule as he balances legislative sessions, campaigning, family and medical practice. He tells patients that he cannot guarantee that he'll be able to deliver their babies, and some are turned off by his high public profile.

Wasserman acknowledged the world of lawmaking is not as nice as medicine. "When you are in the ivory tower, people are going to take shots at you," especially in the dog-eat-dog world of politics. Still, Wasserman isn't done. He plans on a future run for national office.

Full-time Physician Activism
Dr. Peter Lurie's patient and consumer advocacy work on behalf of Public Citizen's Health Research Group is well known, and not just among physicians. Discussing health activism as a career choice, Lurie explained how to get-and stay-motivated.

"Any day, there should be something that makes you really angry," he told students gathered for his session.

Public Citizen stays focused on problems that affect many people, and ones in which the group has a chance at success. An activist's biggest problems, he said, are time and money. Not much can be done about the former, but the latter can be skirted by using "free" tools such as Freedom of Information laws; the Federal Advisory Committee Act, which requires committee testimony documents be made public prior to testimony; and the ubiquitous petition, which doesn't have to be a thousand-strong list of signatures, Lurie pointed out. It is simply a formal request for government action.

There are plenty of opportunities for medical students to involve themselves in their communities, Lurie said, but full-time activism can be a big leap. "Eventually, you have to make choices in life."

Patients and Spirituality
"To know a person, we must know that person's sense of meaning," said Rabbi Samuel Karff, a patient counselor with years of experience inside the health-care system.

In a session on patients' spirituality, he gave students concrete examples of how to deal with individuals who want to relate to their physicians spiritually-such as how to respond if a patient asks you to pray with him.

Patients want to be dealt with as human beings, not charts, he explained, and related a cautionary story of the physician who introduces himself by immediately commenting on his new patient's medical records. Karff offered a counter-example for opening up discussion of a patient's history: "What has your life been like since you last saw a doctor?"

Karff has seen improvement in the relationship between physicians and spiritual counselors. In the past, "the doctor's visit trumps mine." But now, students are increasingly taught to respect the patient's time and beliefs.

"Whatever your personal views of religion, you have an obligation to validate your patient's view," he concluded.

Summing It Up
Students attending AMSA's 56th Annual Convention found the diversity of keynotes and sessions interesting and the synergy of their peers exciting.

"Sometimes students who are willing to think outside the establishment feel isolated in medical school," said Javeria Qureshi (at right), a third-year at Rush Medical College. She spent the week reconnecting with friends, meeting new people and working with them on issues important to her.

She praised AMSA for its willingness to take on the "taboos," like the lack of minorities in medicine. "AMSA has the strength to bring in speakers who have an alternative view of medicine."

University of Chicago fourth-year Yousef Turshani, who recently matched in pediatrics at the University of California, Los Angeles, and its special track in advocacy and community health, said he appreciated the spectrum of topics covered at the convention. "They have sessions that don't deal with medicine," some instead focusing on the policy level, he commented. "The rally recharges people...the ideals of supporting every patient stays with you every year until the next."