The Center for Medicine, Health and Society's fast-growing major helps students see 'the big picture in health care'

by Jim Patterson
photo by John Russell

The school is still to be determined, but David Amsalem plans to start training to be a medical doctor this fall.

Although he’s not exactly sure where he’s going, Amsalem is confident that where he’s been provided excellent preparation. That’s the Center for Medicine, Health and Society, home of one of the fastest-growing undergraduate programs at Vanderbilt and locus of a movement to produce a new, better kind of medicine.

“I couldn’t have asked for better training and background,” said Amsalem, who has already worked as a paramedic and helped develop a medical emergency response system in Nepal. “It was perfect for me, someone who was interested in certain areas of public health but really wasn’t thinking of medical school when I was starting my undergraduate work.”

The undergraduate arm of CMHS has grown at a rapid clip since it debuted in 2003 championed by Matt Ramsey, its first director and associate professor of history. As the program prepares to welcome new director Jonathan M. Metzl this fall, it has grown from five majors in 2006 to more than 250 today.

“I had not expected it to grow so rapidly,” Ramsey said. “It came about because I noticed there were a lot of colleagues across the university who shared related interests in health and health care in a social context, but they didn’t know about each other.”

The center has since added a graduate program and with the arrival of Metzl is poised to dramatically expand its research component.

“Have you ever heard of the Latino health paradox?” asks Katharine Donato, outgoing director of CMHS and chair of sociology.

Studies of the paradox – one of a number of race-based health questions being examined at the center – seek answers for questions such as why Latina women with poor education and low prenatal care levels have fewer problematic pregnancies than expected. They’re also looking into related questions, such as why many immigrants are healthier after they first arrive in the United States compared to five years after they’ve been here. There are other issues to be explored, including disparities in juvenile- and adult-onset diabetes, the explosion in autism cases and how race affects medical diagnoses.

“I think there are so many provocative questions like this that are broad and require people who are in the humanities and social sciences to investigate,” Donato said. “So to have the possibilities we have here to bring in M.D.s and Ph.D.s from the medical side of campus to join into these conversations is very promising.

“I think that’s ultimately how we will get answers to the big questions.”

One of those big questions is explored by incoming director Metzl in his book The Protest Psychosis: How Schizophrenia Became a Black Disease. His research shows that before the civil rights movement, the diagnosis of schizophrenia was overwhelmingly given to white patients. By the 1970s, that had changed to young black men. Furthermore, research into 80 years of records of a defunct psychiatric institution in Michigan found that upon its closing, white schizophrenics had a much easier time securing their release than their black counterparts.

This is the kind of issue CMHS was created to explore, Donato said.

“I think medical schools in the last 10 to 15 years have recognized that the training of M.D.s and what they do after they get their degrees needs to be much more informed by the changing larger social and cultural context in which medicine is practiced,” she said.

Donato believes that much of the rapid growth of the CMHS undergraduate program is traceable to a surge in interest from students without aspirations to become medical doctors.

“I think they see their parents and grandparents aging, and they also know that the whole country is aging,” Donato said. “They understand that the health care industry in the United States is a for-profit industry and there are important jobs to be done that would be helped by a better understanding of the big picture in health care.”

Amsalem, though now in the process of choosing a medical school, was one of those students.

“I really had no idea what I wanted to do with my life, but I was interested in certain areas of public health,” he said.

Entering the undergraduate CMHS program “encouraged and inspired” Amsalem to become a volunteer in Nepal, where the trained paramedic helped set up an emergency medical response system that has improved care for many in that country.

“Lots of professors in CMHS helped out with that project,” he said. “The program really gave me an all-encompassing education as far as health and how health care systems affect society.”

When Holly Tucker, associate professor of French, took an interest in botany, her involvement with two Vanderbilt centers helped steer her in still another direction.

“I was associate director at the Center for Medicine, Health and Society for two years and also a fellow at the Robert Penn Warren Center for the Humanities,” Tucker said.

Stumbling across an anecdote about early blood transfusions, Tucker saw the makings of an educational medical thriller – which became her second book, Blood Work: A Tale of Medicine and Murder in the Scientific Revolution.

“The advantage of being at Vanderbilt is that it’s a liberal arts college that is part of a heavy-hitting research institution,” she said. “My work at the centers gave me the opportunity to interact with colleagues in the medical school and more colleagues in history, sociology and anthropology, and also with students who are making extraordinary links across disciplines.

“How many French professors write books on the history of medicine?” she said. “At Vanderbilt, it’s entirely possible.”

Blood Work, to be published this month by Norton, is being touted by some critics as a true-life medical mystery in the tradition of Rebecca Skloot’s best seller The Immortal Life of Henrietta Lacks.

“It’s exciting that you get to make all these cool connections and follow your interests,” Tucker said. “The role of these centers in the creation of my book was huge.”

Posted 03/01/11