Map of life expectancy at birth from Global Education Project.

Thursday, July 14, 2005

A Forgotten Breakthrough

Speechless's comment on the previous posting reminds me of research done back in the '50s by my late mentor Irving Kenneth Zola. Irv interviewed patients at a clinic in Boston, back when immigrants to our town meant Irish, Italian, and Eastern European Jewish. He told me that quite a few of the patients told him "Dr. Zola, you've helped me more than any of the other doctors." That was just because he listened to them, of course -- he was a Doctor of Philosophy, who didn't give them any medical advice at all.

Anyway, although it wasn't the original intent of his research, Irv noticed something quite interesting: the physicians were much more likely to apply a diagnostic label indicating a psychogenic origin for symptoms to patients were Italian or Jewish, than to patients who were Irish or Anglo. (E.g., psychosomatic, hypochondriacal, anxiety, hysteria, etc.) After interviewing the doctors and making some observations of his own, he thought he knew why. The Italian and Jewish patients were far more emotionally demonstrative, more likely to express pain and to complain openly about their symptoms. The Irish and Anglo patients were more stoical and reticent about their suffering.

The physicians, who were Anglo and upper class Jewish (as opposed to the working class Jewish immigrant patients) perceived the Irish and Anglo patients as behaving appropriately, whereas the Italian and Jewish patients were hysterical and overwrought. So here we have the first (as far as I know) recorded discovery of cultural incompetency in medicine. Of course, it's been long forgotten.

P.S. Back in those days, social scientists didn't have computers. Irv had to set up his crosstabulations and do his chi squares by hand. A little while later he went back and did a three dimensional crosstabulation and he discovered something else: the difference was mostly accounted for by female patients. It was the Jewish and Italian women who were being called hysterical. So that was the right word choice.

Last year, a physician friend of mine told me about an amazing article he had read in a pediatric journal, about the "Ay ay ay" syndrome. It seems that Latina mothers in the pediatric emergency room would shout "Ay ay ay" as their children lay bleeding on the gurney. This was labeled by the authors as a form of pathology.

You can go to Harvard, do a pre med course and graduate summa cum laude; spend $250,000 on a medical degree; do three years of residency and two years of fellowship; and still be nearly as ignorant as a President.

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