This is a guest post byCambria Chou-Freed, Ph.D. Candidate, UCSF Biomedical Sciences (BMS) Program
This week, I was very interested in our class discussions about how race is used as a variable in medicine/biomedical research and about the contexts in which this might exacerbate vs. combat health inequities. I especially appreciated the UCSF debates over the use of genetic ancestry vs. race in eGFR and polygenic risk score calculations. What stuck with me was the question: how can we, as scientists and physicians, feel comfortable using race as a variable in the same way we use quantitative, measurable variables (ex: blood cell or RNA transcript counts) to make research claims and clinical diagnoses? We know that race is an inaccurate proxy for genetic ancestry in many cases. Furthermore, when we want to use race as a proxy for social factors, I wonder whether in the future we will move toward incorporating other, more precise variables instead (such as to what degree a person experiences racism in their life, or what neighborhood they live in, an example given in class). As a mixed-race person, it has always made intuitive sense to me that race is not clearly defined or discrete, even when I didn’t have the words or data to back this up. Similarly to what Dr. Grubbs argued in the debate, I wonder how researchers would calculate my risk for polygenic diseases if I don’t fit accurately or precisely into their race-based model?
Another question that came up in class is how epigenetics might be used in medicine/biomedical research. Epigenetic marks are thought to encode experiences and environmental factors such as trauma and stress at the molecular level, and there is evidence that epigenetic changes to DNA can be passed on through multiple generations. Many people see epigenetics as an opportunity to study the effects of social factors such as racism on human health, and I certainly see the potential benefits of this. However, I also worry that some people will use epigenetics as the next generation of scientific evidence to back the claim of “biological differences due to race” and that a new form of discrimination could emerge as a result.
This is a guest post byLauraAnn Schmidberger, Ph.D. Candidate, UCSF Tetrad Graduate Program
Assuming that the color of someone’s skin explains their life history seems ridiculous when it’s phrased that way, but it is easy to see how doctors can fall into the trap of using racial categories in their practice, especially given the pressure to assess their patients quickly. This article made me think of racial profiling—it is understandable that authorities would want a quick way to identify potential suspects, but to conflate race with the likelihood of committing a crime is inappropriate. Race is a much less important factor in both community safety and medicine than socioeconomic, geographic, and familial backgrounds. The author makes it clear that while taking the time to understand a patient’s background may not be as rapid, it is ultimately more efficient, because it will lead to fewer misdiagnoses. False assumptions about a patient’s condition based on their outward appearance increases the time it takes for an accurate diagnosis, which in the worst cases can be deadly. A country largely segregated by not only race but also geography and socioeconomic status became a country in which the three were conflated and each race was assumed homogenous, when in reality our communities have never been more diverse. Each person has a unique background, and “if a physician simply diagnoses ‘race,’” that background, including “environmental exposures, family histories, the stress of dealing with racism, access to and quality of care [,] may be left unexamined.”
This is a guest post byMariko Foecke, Ph.D. Candidate, UCSF Biomedical Sciences (BMS) Program & Eliza Gaylord, Ph.D. Candidate, UCSF Developmental and Stem Cell Biology (DSCB) Program
Despite the profound advancements achieved by modern medicine, people with ovaries in the United States were at a 10% greater risk of dying from a pregnancy-related death (PRD) in 2017 than they were in 19871. Strikingly, this risk is even greater for the BIPOC community, as Black people with ovaries account for 41.7% of PRDs. This statistic is three times higher than PRD rates for White people with ovaries1. The Centers for Disease Control defines a PRD as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy”2.
Recent research highlights variables that may contribute to disparities in PRDs for people of color, such as quality of and access to care, implicit bias, and psychological stress induced by structural racism1. Examination of disparities in PRDs across socioeconomic and educational backgrounds identified that African Americans with ovaries with at least a college degree were 5.2 times more likely to suffer a PRD than White people with ovaries with the same level of education. Furthermore, the mortality rate of infants of college-educated African American people with ovaries was 3.1 times higher than infants of high school or less-educated White people with ovaries3. Thus, as disparities in PRD and infant mortality rates continue to rise, there is a critical need to understand the physiological impact of social determinants of health during pregnancy and their potentially multigenerational effects.
African Americans with ovaries experience high levels of physiological stress due to social discrimination and systemic racism4. Additionally, racial discrimination is directly correlated with higher levels of depression14, a known consequence of stress15. For decades, it has been appreciated anecdotally that both pre-pregnancy and maternal stress contribute to adverse health and infant birth outcomes5. Maternal stress during pregnancy may lead to high blood pressure and changes in dietary intake, increasing the risk for gestational diabetes, preterm labor, and preeclampsia16. Additionally, exposure to physiological stress after pregnancy may lead to postpartum depression or substance abuse17, accounting for an estimated 14% – 30% of reported maternal deaths18.
Concurrently, recent research has gleaned insights into the mechanisms underlying how the negative effects of maternal stress may persist for up to three generations6-8. In response to stress, fertility is known to decline as a consequence of a diminished ovarian reserve, which encompasses the quantity and quality of ovarian egg cells, or oocytes9,10. The incidence of oocyte aneuploidy, referring to an abnormal number of chromosomes, increases in response to maternal stress and is a known cause of infertility and disease11. Importantly, of the 10% of individuals with ovaries who struggle with fertility in the United States, 15% of them are affected by oocyte aneuploidy12. In fact, aneuploidy occurs in 5% of all clinically recognized pregnancies and is causal in 1 in 3 miscarriages13.
As the connection between physiological stress and poor health and infant outcomes, particularly for Black women, become increasingly clear, there is a dire need for immediate and effective action to close the persistent PRD and infant mortality gaps. In addition to implementing policy designed to protect vulnerable populations from stressful, discriminatory experiences in professional and higher education environments3, implicit bias training for healthcare professionals should be required to decrease disparities in prenatal and postpartum care19. Finally, legislation to provide federal support that increases access to mental health care and social services specifically to people of color with ovaries before, during, and after pregnancy19 is necessary to reduce this devastating maternal health crisis.
Bibliography:
Pregnancy Mortality Surveillance System. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2019).
Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. Centers for Disease Control and Prevention. (2019).
Fishman SH, Hummer RA, Sierra G, Hargrove T, Powers DA, Rogers RG. Race/ethnicity, maternal educational attainment, and infant mortality in the United States. Biodemography Soc Biol. (2020).
Howard JT, Sparks PJ. The role of education in explaining racial/ethnic allostatic load differentials in the United States. Biodemography Soc Biol. (2015).
Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P. Maternal stress and preterm birth. Am J Epidemiol. (2003).
Crews D, Gillette R, Scarpino SV, Manikkam M, Savenkova MI, Skinner MK. Epigenetic transgenerational inheritance of altered stress responses. Proc Natl Acad Sci U S A. (2012).
Ward ID, Zucchi FC, Robbins JC, et al. Transgenerational programming of maternal behaviour by prenatal stress. BMC Pregnancy Childbirth. (2013).
Kiss D, Ambeskovic M, Montina T. et al. Stress transgenerationally programs metabolic pathways linked to altered mental health. Cell. Mol. Life Sci. (2016).
De Felici M, Klinger FG, Farini D, Scaldaferri ML, Iona S, Lobascio M. Establishment of oocyte population in the fetal ovary: primordial germ cell proliferation and oocyte programmed cell death. Reprod Biomed Online. (2005).
Mikwar M, MacFarlane AJ, Marchetti F. Mechanisms of oocyte aneuploidy associated with advanced maternal age. Mutat Res. (2020).
Eisenberg E, Brumbaugh K, Brown-Bryant R, Warner L. Health topics: infertility. Office on Women’s Health in the U.S. Department of Health and Human Services. (2019).
Hassold T, Hunt P. To err (meiotically) is human: the genesis of human aneuploidy. Nat Rev Genet. (2001).
Hudson DL, Puterman E, Bibbins-Domingo K, Matthews KA, Adler NE. Race, life course socioeconomic position, racial discrimination, depressive symptoms and self-rated health. Soc Sci Med. (2013).
van Praag HM. Can stress cause depression? World J Biol Psychiatry. (2005).
Stress and Pregnancy. March of Dimes. (2019).
Postpartum Depression. Office on Women’s Health in the U.S. Department of Health and Human Services. (2019).
Maternal Mortality May Be Even Higher Than We Thought. Columbia University Irving Medical Center. (2019).
Bailey SR. Our Black maternal health crisis is an American tragedy. American Medical Association. (2021).
This is a guest post byJackie Roger, Ph.D. Candidate, UCSF Program in Bioinformatics (BI)
Towards the end of this past week, several of the readings and videos discussed the intersection of racism and OB-GYN. We learned about the medical experimentation on black women’s bodies (Linda Villarosa’s article in NYT), the mutilation and subsequent museum display of Sara Baartman’s genitalia (Dr. Deirdre Cooper Owens’s talk on Youtube), and the black maternal health crisis (Dr. Susan R. Bailey article on the AMA site). These examples illustrate how the historical legacies of anti-black racism are embedded in present-day OB-GYN research and medicine. One component of this is disparities in the maternal mortality rate, which was the focus of Dr. Bailey’s piece.
She described two initiatives to reduce this disparity: the MOMMA Act to extend coverage for post-partum care and the Release the Pressure campaign to promote heart health and healthy blood pressure. The MOMMA Act seems like a good start, and could reduce both overall maternal mortalities and the racial disparities in maternal mortalities. The Release the Pressure campaign calls upon black people to take steps in their own lives to improve their heart health (since heart disease is one of the leading causes of pregnancy-related death). There are so many aspects of systemic anti-black racism within the medical system and beyond that directly contribute to increased risk of heart disease. A campaign that asks them to offset these things by “taking a few more steps a day” etc seems insulting. I think that truly addressing disparities in OB-GYN will require structural changes in the healthcare system.
This is a guest post by Aris Tay, PhD Candidate, Bruce Wang and Diana Laird Labs, Developmental and Stem Cell Biology (DSCB), UCSF
In session 3 of UCSF’s racism and race: the use of race in medicine and implications for health equity discussion, as well as many other works centered around race in medicine, it was mentioned that race, as we use it colloquially, is a social construct. Due to my own identity, I often think about how gender is a social construct and how scientists often use the two terms sex and gender to separate out what is and is not scientifically and empirically biological and hard-wired. However, until this course I had not made the connection that race and racial identity is a social construct just like how gender is.
In many large scale observational genetic studies, specific genetic signatures (typically single nucleotide polymorphisms) are often found to be associated and even predicative for certain diseases. These genetic signatures are often correlated with self-identified racial groups. Thus, the field has often incorrectly assumed that race causes these genetic signatures which leads to a predisposition for disease, and that this is why I often hear statements such as “Tay-Sachs is most common is Ashkenazi Jews” or “Sickle cell anemia is more common in black people”. However, it is difficult, in these large observational studies, to separate lifestyle, family history, etc from the check box self-identified categories that patients are asked to bin themselves into. Self-identified categories of gender and race are much easier to draw correlations from; however, it is now coming to light that detailed family history and lifestyle is much more accurate. Social constructs of gender and race often make up core aspects of someone’s identify. This will definitely affect one’s choices and lifestyle which could then affect which diseases one is predisposed to. However, jumping directly from A to C eliminates a large majority of people that did not follow the most common path, thus disenfranchising them from receiving accurate medical care. Eliminating social constructs from medical treatment and diagnosis is an endeavor that the entire field should embark on.
On the other hand, when it comes to recruiting participants for large scale observational studies, clinical trials, etc. whether or not social constructs such as gender and racial identity should be accounted for is an outstanding question. Using clinical trials as an example, ensuring that the proposed experimental treatment works well on all races and genders is of utmost importance and has often been overlooked in historical trials. However, would using lifestyle in order to recruit not serve the same purpose? And be more accurate? Would taking detailed history and lifestyle cause too much strain during recruitment and completely offset its advantages? Would statistics be too difficult to run on family history and lifestyle when we know it’s possible and established using gender and racial identity. I leave you with some food for thought.
UCSF Archives and Special Collections is pleased to announce that three collections have been processed and added to the Tobacco Control Archives. The newly processed collections are the Seth L. Haber Materials, American Heart Association Records, and the Tobacco Control Ephemera Collection.
UCSF has been collecting materials on tobacco control efforts since the 1990s. We have collected papers and organizational records of government agencies and activist groups, as well as papers of individuals active in tobacco control.
Seth L. Haber, MD, FCAP, was the founding chief of pathology at the Kaiser Permanente Medical Center in Santa Clara, California, for 35 years, until his retirement in 1998. He was an elected member of the Permanente Medical Group Board of Directors for nine years, registrar, sommelier, and president of the South Bay Pathology Society. This collection includes publications by Seth Haber, anti-tobacco pamphlets, and correspondence.
Anti-Tobacco Pamphlets. Seth L. Haber material, MSS 97-19, box 1, folder 1.
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research. The American Heart Association records documents the activism that took place in San Francisco and the Bay Area in restricting smoking in restaurants and lounges. The collection includes flyers, tobacco advertisements, videos (VHS), surveys, and correspondence. Some documents from this collection are from the CLASH organization addressing how big tobacco companies targeted the gay and lesbian community through their ads.
Coalitions of Lavender-American on Smoking & Health (Clash). American Heart Association records, MSS 96-02, carton 1, folder 20
This collection is assembled from a number of different donations of ephemeral materials. Materials include pamphlets, posters, cigarette ads, and reports. Some of the cigarette ads in this collection are Kent and Chesterfield ads showcasing their milder cigarettes for women.
You can view the collection finding aids and other Tobacco Control Archive finding aids on the Online Archive of California. If you are interested in viewing digital collections from the Tobacco Control Archives or any of our other digital collections please visit the UC San Francisco page on Calisphere.
This is a guest post by Antoine S. Johnson, Ph.D. Candidate, UCSF History of Health Sciences.
The 2020 police killings of Breonna Taylor and George Floyd facilitated important dialogue about racism being a public health issue. It also led to myriad student demands at college campuses throughout the nation, including at UCSF. Students demanded course curriculum addressing racism in science and medicine, with the hopes that such information and classes would be integrated in their field. One of the results were Grad 202: Racism in Science, which was taught in the Fall 2020 quarter by Dr. Aimee Medeiros and me. Almost 200 students enrolled in the course, causing us to create two sections. As a Ph.D. candidate in UCSF’s History of Health Sciences program, this was an invaluable experience that allowed me to build community with several students in the class who are now working on an article on the importance of such classes in science programs.
Demand remained high after the class, culminating in mini courses, including this one, that would continue such conversations and answer student requests. Grad 219: The Black Experience in American Medicine, examines ways Black people have not only been the victims of medical racism, but also how they contributed to the creation and expansion of medicine and science; how they have operated in their respected fields; and the harm caused by biological deterministic arguments of so-called racial differences. Although only three weeks long, students will leave this class with an understanding of the medical community’s relationship with African Americans from the antebellum period to the present. From an analytical perspective, this class will foster honest and open conversations about the assigned material. Additionally, students will have the opportunity to share their thoughts on any conversation, reading, video, or observation through weekly blog posts that will be published here, on the UCSF Archives & Special Collection, Brought to Light blog. These are not polished submissions but are rather their takeaways on things that stood out to them. In doing so, they will be able to offer one another constructive feedback by commenting on each other’s posts to continue pertinent conversations.
Thank you, and welcome to Grad 219 Course: The Black Experience in American Medicine.
By Shannon Foley, Archives & Special Collections Intern
Brought to Light wants to bring attention to remarkable former UCSF faculty member Freeman Bradley. His significant contributions to the medical community and the Black community at UCSF deserve to be recognized. Bradley grew up in Alabama, and after high school, he continued his education at Howard University in Washington D.C., where he received his bachelor’s degree in Biology. After his graduation, Bradley moved to Maryland and started working at the National Institute of Health, where he remained for four years before starting his career at UCSF. His position was with the Cardiovascular Research Institute, where he conducted research about respiratory changes associated with various anesthesias.
During his time at UCSF, Freeman Bradley worked as a technician to Dr. John Severinghaus and and Bradley’s contributions were fundamental to Severinghaus’s groundbreaking work. From 1957 to 1958, Dr. Severinghaus and Mr. Bradley combined technology created by Richard Stow and Leland Clark to create the first blood gas analysis system. Shortly after the first system was created, they were commercialized and proved revolutionary in health care. In Dr. Severinghaus’s written account of his research and the evolution of the invention of the blood gas analysis system, he emphasizes how his and Mr. Bradley’s invention changed medicine. By the 1960s they blood gas analysis systems were widely available, and and these tests provided essential information about a patient’s illness.. These systems are still used today, and in 1985 Dr. Severinghaus donated the first apparatus he and Mr. Bradley worked on at the Smithsonian Museum. In 1977 after his research with Dr. Severinghaus, Mr. Bradley was appointed Director of Development and Research. In this position, he helped progress the technology and development of medical tools. One of the other advancements he made at his time at UCSF was in the transportation technology of newborn babies or neonates. His contributions to medical advancements do not go unnoticed.
Freeman Bradley was not only an incredible asset to advancing medical research, but he also was an active member in UCSF’s Black Caucus. The Black Caucus is a club at UCSF whose mission statement is “The Black Caucus is a forum open to all Black-identified individuals and allies on this campus. Here they may openly express themselves regarding matters of race as they affect life on the campus and in the community. The Black Caucus serves as an instrument for the formation of a Black consensus on those racial matters that affect every person on this campus. This consensus will then be presented to the Administration for appropriate action.” One of the founding members and President of the Black Caucus, David Johnson, worked to create this community where Black members of UCSF could have their needs and concerns met. During Freeman Bradley’s time at UCSF and as an active member of the Black Caucus and used his calm temperament to make sure issues could be addressed and changes made. Mr. Bradley is quoted saying that even though he was criticized for staying diplomatic, he knew that it was the way to be more successful in the long run. In a 1983 interview of Mr. Bradley printed by Synapse, he shared his concerns with the lack of Black role models for youths in the sciences. He believes that minorities would be more likely to become a part of the medical field with more role models. Freeman Bradley is the perfect example of a role model to the youth and can be seen as an inspiration to all.
Severinghaus, John W. “The Invention and Development of Blood Gas Analysis Apparatus.” Anesthesiology, vol. 97, no. 1, 2002, pp. 253–256., doi:10.1097/00000542-200207000-00031, accessed April 21, 2021.
Archives is excited to provide access to the sketchbook of Phyllis Wrightson, which has been newly-digitized from within the Bernard Zakheim papers. Wrightson was Zakheim’s assistant during the painting of the frescoes inside UCSF’s Toland Hall, and the two later married.
Phyllis Wrightson, second from left. (from L to R: Joseph Allen, Phyllis Wrightson, Bernard Zakheim, and F. Stanley Durie). Source: https://calisphere.org/item/ark:/81983/s9mw27/
The sketchbook contains fascinating detail of the historical research which went into the mural, and includes notes, clippings, and remarkable sketches made by Wrightson in preparation for the painting of the murals. Wrightson’s sketchbook is notable for the way it illuminates the immense amount of collaborative effort that went into creating a mural such as the Toland Hall frescoes, and documents the both the creative process and aesthetic decisions which were a part of the project.
The digitization of Wrightson’s notebook has been another fruitful collaboration between Archives and our colleagues in other Library departments, spurred by the COVID-19 pandemic. We would especially like to thank Andy Panado — Collections Analyst — for his work to create the digital files for this valuable resource.
By Erin Hurley, User Services & Accessioning Archivist
One of UCSF Archives & Special Collections’ most famous and beloved collections is the Japanese Woodblock Print collection – a collection of over 400 colorful and informative woodblock prints on health-related themes, such as women’s health and contagious diseases like cholera, measles, and smallpox. According to the Library website dedicated to the prints, they “offer a visual account of Japanese medical knowledge in the late Edo and Meiji periods. The majority of the prints date to the mid-late nineteenth century, when Japan was opening to the West after almost two hundred and fifty years of self-imposed isolation.”[1] The collection has been used, most recently, in a documentary about woodblock prints to be aired on NHK, Japan’s public broadcasting network, and has been a subject of enduring interest to researchers. I’ve heard colleagues wonder aloud about how UCSF came to own this unique collection, so I did some research. Naturally, an enterprising curator and librarian – Atsumi Minami, MLS – is to thank for the collection’s arrival at UCSF.
Walters, Tom F., “Atsumi Minami with items from UCSF Library East Asian Collection,” 1968. UCSF History Collection.
While I was not able to find the exact dates of her employment at UCSF Library, I do know that Minami began working at UCSF Library in 1959, and soon took charge of a small collection of 70 titles of materials related to East Asian medicine started in 1963 by John B. de C.M. Saunders (a shortening of his full name, John Bertrand de Cusance Morant Saunders), then Provost and University Librarian.[1] Minami could read Japanese script, so she became responsible for the collection and was soon given free rein to begin collecting additional materials. In order to do this, Minami “traveled to Japan and China and purchased items from various smaller, private collections, acquiring the woodblock prints as well as hundreds of rare Chinese and Japanese medical texts, manuscripts, and painted scrolls.”[2] Her collecting efforts spanned over 30 years, and produced a collection with over 10,000 titles. It would appear that Minami was still working at UCSF when this informative article was written for a 1986 issue of UCSF Magazine.[3] At the time that article was published, the East Asian medicine collection was also the only active collection of its kind in the U.S., making it even more notable.
Another woman who was influential in shaping the East Asian collection was Ilza Veith, a German medical historian and former UCSF professor in both the Department of the History and Philosophy of Health Sciences and the Department of Psychiatry. Veith, who in 1947 was awarded the first ever U.S. Ph.D.in the History of Medicine from Johns Hopkins University, was also awarded later, in 1975, the most advanced medical degree conferred in Japan, the Igaku hakase, from Juntendo University Medical School in Tokyo. Veith was extremely knowledgeable about both Chinese and Japanese medicine, and, in her time at Hopkins, translated Huang Ti Nei Ching Su Wen, or The Yellow Emperor’s Classic of Internal Medicine – the oldest known document in Chinese medicine. Though the text has somewhat mythical origins that make its author and date a little difficult to determine, it probably dates from around 300 BC. Veith also helped shaped UCSF’s East Asian medicine collection by donating a number of her Japanese medical books.
“Ilza Veith,” 1968. UCSF History Collection.
I would encourage anyone interested in the collection to browse the prints on our website, and to read more about their history via a finding aid on the Online Archive of California. Archives & Special Collections also houses the Ilza Veith papers. While we don’t yet have an Atsumi Minami collection, we welcome donations and would appreciate any information that the present-day UCSF community has about this amazing woman.
