OMAHA, Neb. (KMTV) Medical humanities is something taught to medical students so they learn to understand patients more holistically. One Creighton University professor is taking an artistic and personal approach to her lessons.

Rachel Mindrup has been painting her whole life. It was her calling. But after her son was diagnosed with a genetic disorder before he even turned one, her calling changed.

Hes got an optic tumor and hes got about four tumors on his brain now," Mindrup said.

Her son Henry Mindrup has NF, or Neurofibromatosis. It's a genetic disorder that causes tumors to grow all over the body. To help deal with all the complications that come with that, Mindrup did what she knows how to do best.

I didnt really set out to start painting portraits of people with the some genetic disorder, I just didnt know what I was supposed to do," she said.

One in 3,000 people are affected by NF, but Rachel says no one knows about it. So, she began her series of portraits called "The Many Faces of Neurofibromatosis" to raise awareness.

Now, the painting professor is taking on a new role at the medical school to bring together the arts and medicine with medical humanities.

So the med students are going to be drawing and observing and actually asking themselves do they trust their eyes or are they just always going to go with whats on the patient chart," Mindrup asked.

Rachel says NF is different in each person. She wants to teach the medical students at Creighton to look past the patient chart with not only this disorder but all types of cases.

Kind of caring for the whole person and also thinking more holistically. Where does this person come from? What are the background experiences? Are they scared right now? What do they need from me? And it might not always just be an in an out, six minutes, heres a prescription, see you later," she said.

This is the first role of its kind at Creighton's newly formed Department of Medical Humanities at the medical school.

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Creighton painting professor takes on new role at the medical school teaching medical humanities - KMTV - 3 News Now

Years of medical school, graduate school and clinical hours are meant to make doctors ready for anything. But no number of disaster-scenario trial runs or years of on-the-ground experience could have prepared health care professionals for the early weeks of the COVID-19 pandemic.

Nothing like whats happened with COVID-19 prepared us for what was coming, says Parveen Wasi, associate dean of postgraduate medical education at McMaster University.

Even in Toronto, with its handling of SARS1 in 2003 and H1N1 flu in 2009, the learning curve has been steep.

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The disease and the pattern [of the viruses] are different, but the principles were familiar, and we had some structures in place, explains Glen Bandiera, associate dean of postgraduate medical education at the University of Toronto. The magnitude of this response was bigger and the threat [the pandemic] posed to the system was greater because of the sheer numbers of [patients], the lack of personal protective equipment and the impact on the health work force.

Medical schools were doubly hit: Not only were they responsible for the continuance of studies and keeping student residents safe, they also had to change the way medical education was being delivered, and quickly. Medical students were pulled from all clinical settings in March across Canada and didnt start returning until August, which meant a large number of training hours had to be made up.

And while residents are still in training, theyre also hospital employees and, therefore, essential workers. We had to start from ground zero in terms of how we protected our residents and then how we planned education around the pandemic, Dr. Wasi says.

This meant identifying gaps in the system, such as issues around PPE. For example, health care professionals using N95 respirators are required to be fitted every two years. At some hospitals, many of the residents had never been fitted and there was no documentation to confirm who had. As PPE use is exacting, protocols must be followed to protect patients and health care workers; how its done changes, depending on the level of exposure to infectious agents.

I mask-fitted two years ago, but when I actually had to use one, I wasnt 100 per cent sure how to, Dr. Wasi says. Training for PPE how to don and doff appropriately, how to put on an N95 mask was hit and miss prior to this.

The pandemic has also highlighted the need for more training in infection control for postgraduate students. We just assumed it would also occur in the hospital setting, Dr. Wasi adds. So, lesson learned.

Over all, the response by medical schools to the new world has been overwhelmingly swift and often innovative. While U of Ts medical school includes pandemic planning in its curriculum, a specific COVID-19 curriculum was constructed for third-year students returning to clinical environments in the summer. The new program includes PPE instruction, a mask-fit for N95 and an in-depth study of the virus itself.

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Dr. Patricia Houston, vice-dean of medical education at the University of Toronto.

Thomas Bollmann/The Globe and Mail

Patricia Houston, vice-dean of medical education at U of T, says students learn about ethical concepts, palliative care and virtual delivery of health care. We give them tips about how the hospital [is] different in these pandemic times. We also help them to deal with it personally and talk about being resilient.

Within a week of COVID-19 being declared a pandemic, Dr. Houston says the school had moved lectures, small-group learning sessions and even clinical skills courses online. Our pivoting is all strategic, and [the changes] will form the new normal, which have to be robust enough and responsive enough to future needs.

Since mid-March Roger Wong, vice-dean of education at the faculty of medicine at the University of British Columbia, has been adapting the curriculum, beefing up sections on public health, social determinants of health and disease-specific treatment strategies, as well as developing COVID-19-specific sessions for final-year medical students.

UBC also moved to a blended mode of curriculum delivery, virtual and in-person when possible. It developed a free online learning module for medical and health professional students on how to use PPE appropriately. And over the summer, Dr. Wong and his team created a virtual anatomy lab, offering students three-dimensional scans of specimens to study at their leisure.

Its fair to say that everyone around the world is learning actively as the situation evolves, he says. [The pandemic] has catalyzed a large number of innovations in medical education that would have taken decades to happen otherwise. It would be almost unimaginable.

Alim Pardhan, assistant professor of emergency medicine at McMaster, says flexibility for medical schools, doctors and hospitals is key, for example, changing the focus of the health care system from a single discreet event with lots of patients to a longer-term event that might last a year or two where you have higher volumes, fewer beds available and extra precautions with certain patients.

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All agree that COVID-19 will have an enduring impact on health care. Dr. Houston hopes the experience of the past six months will increase the support for, and understanding and appreciation of, public health.

Were always looking for the next cutting-edge medicine, she says, but we need to understand how we can better take care of not just individuals, but populations and communities. And thats something public health teaches us to do.

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For 50 years, the Poussaint Prematriculation Summer Program (PPSP) at Dana-Farber Cancer Institute has given incoming Harvard Medical School students from underrepresented groups an opportunity to immerse themselves in the world of science and medicine before starting classes. The format of this years program may have changedbecoming all-virtual because of the coronavirus crisisbut the spirit of learning and professional apprenticeship was fully intact.

At a teleconference forum on July 24, the 12 participants spoke about their experience with the program and what they will take from it as they begin their medical education. The students had spent the previous two weeks learning about cancer care and research from Dana-Farber clinicians and scientists and began their HMS degree programs during the first week of August.

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In her opening remarks, Andrea Reid, director of the HMS Office of Recruitment and Multicultural Affairs (ORMA) and associate dean for students and multicultural affairs at HMS, thanked Dana-Farber faculty and others who led and administered the program. You are the bedrock of the PPSP, she said. As lecturers, workshop leaders and lunchtime speakers, you put the same thoughtfulness and enthusiasm into the virtual experience that were the hallmarks of PPSP in its more traditional format.

The PPSP was created in 1970 by Alvin Poussaint, professor of psychiatry, emeritus, and founding director of ORMA at HMS, to give underrepresented students an opportunity to take science courses the summer before their first year in medical school and gain exposure to laboratory research. By 2016, it had evolved into an oncology-focused program with courses, seminars and virtual clinical experiences led by HMS and Dana-Farber faculty. Now co-sponsored by Dana-Farber and ORMA, the PPSP is supported by the Richard and Natalie Jacoff Breast Oncology Fund in honor of Lorraine Hunt Lieberson.

One of the reasons Dana-Farber became involved in this program is our desire to diversify the workforce in oncology in general and DFCI in particular, taking advantage of the excellence of students entering HMS who will be based in the Longwood area and who can easily become engaged in our research and clinical activities, said Robert Mayer, faculty associate dean for admissions at HMS, faculty vice president for academic affairs at Dana-Farber and an administrator of the PPSP.

In their reflections, students spoke about how the program had changed their perceptions of cancer and broadened their understanding of its impact on patients and families.

We had the privilege of learning about both the pathophysiology of cancer and the real-life experience of a cancer diagnosis and treatment from patients, said Angela Marie Mercurio, who graduated from the University of Nebraska. I found myself questioning what cancer means for people who feel like their entire lives are upended by a single word, a diagnosis. I also found myself thinking about the power that physicians hold in delivering this life-changing information. The responsibility that a physician has to hold a patients history, family, dreams, purpose and experience in balance with the finality of a diagnosis that can change it all.

Arinzechukwu Nwagbata, a native of Nigeria and a graduate of the University of Texas, also found himself thinking about the role of the physician, as well as the molecular intricacies of cancer. Illnesses may affect the patients family as much as the patient, and its left to a physician to be sensitive to the needs and worries of a patients family, he said. In oncology, families often find themselves worrying about the patient, the possibility of the cancers predisposition to other family members and the alarming costs of health care.

Nearly all the participants spoke of their admiration for the patients theyd met, their fortitude in the face of a difficult diagnosis.

Interacting with the patients, listening to their stories and observing how they respond to their diagnosis was priceless, said Trinity Russell, a graduate of Wesleyan University.

Even when their condition was seemingly unfavorable, the patients were filled with admirable levels of hope. Of all the moments I experienced during the past two weeks, perhaps the most memorable one occurred when the mother of a young patient shared an image of beads on a string. Every bead represented a procedure or cancer milestone the child endured. I was shocked by the length of the string, especially since the patient was only a few years old. The image of all the treatments strung in succession is one that I will hold close to my heart, Russell said.

Adapted from a DFCI Online article.

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Open Eyes and Hearts - Harvard Medical School

A Chicago doctor is suing his business partner, accusing her of looting more than $3.7 million from their business to finance an extravagant lifestyle and to lavish Ald. George Cardenas (12th) with luxurious trips, an expensive watch and a monthly stipend for consulting services.

Cardenas had been hired to drum up business for Omni Medical Student Training, which places students from Caribbean medical schools in residency programs with Chicago hospitals. The alderman wasnt very successful in getting hospitals to sign up, though, according to the suit.

Omnis owners Dr. Vivek Gupta and Theresa Siaw are fighting in court over her use of Omnis money the past five years, including payments to Cardenas, for Siaws mortgage and as much as $370,000 spent on her failed bid to defeat Ald. Robert Maldonado (26th) last year.

Three months after Siaw lost that election, Gupta filed suit in Cook County circuit court, accusing his partner of spending Omnis money without his approval.

Gupta says in the lawsuit that he discovered this after the Internal Revenue Service began auditing the company. He says the unauthorized expenses continued this summer, with Siaw withdrawing $251,442 from an Omni bank account, according to the suit.

Siaw, 33, says she didnt spend money without Guptas approval. In sworn pretrial testimony in a deposition she gave earlier this year, Siaw says Gupta gave her permission to use Omnis money to run for alderman and that he sued her because she ended their sexual relationship.

Gupta and his lawyer William Quinlan wont comment.

City Hall Inspector General Joseph Ferguson questioned Siaw earlier this year as part of an investigation into Cardenas campaign finances. Siaw fought his subpoena in court for nearly a year before agreeing to talk with his staff.

Cardenas, 55, wont talk about the $6,000 in campaign contributions he got from Siaw, their trips to Miami and Los Angeles seeking hospitals to accept the Caribbean medical students or the $5,000 watch he got as a bonus from Omni and then wouldnt return when a hospital decided against working with the company after all.

The alderman whose ward includes Little Village and Brighton Park says he provided consulting services to Theresa Siaw years ago. He referred question to his lawyer Ricardo Meza, a former federal prosecutor and state inspector general, who says, George Cardenas has done nothing wrong.

Siaw says she met Cardenas in 2012 when her boyfriend, Dr. Amer Rustom, ran the San Pablo Medical Center inside a building the alderman and his family owned at 2829 W. Cermak Rd. Siaw, who was pregnant with Rustoms son, signed a five-year lease with a minimum yearly rent of $32,400.

He didnt tell me he was an alderman, Siaw says of Cardenas. When my sons father drowned, thats when I started to get close to Cardenas. I was just mutual friends with Cardenas.

Rustom was boating on Lake Michigan with friends in September 2014 when he drowned, leaving behind four sons he had with three women.

Siaw met Gupta months later, and, in June 2015, they started Omni Medical Training, a program similar to Siaws previous business, International Medical Placement. Omni Medical Training operated out of Weiss Memorial Hospital until August, according to a Weiss spokeswoman who says the lease ended and that the North Side hospital no longer uses Omni to place students.

In her deposition, Siaw says the alderman recommended the company hire his brother Jose Cardenas as Omnis accountant and that Jose Cardenas prepared the 2016 federal tax returns that the IRS later audited.

Between 2016 and 2017, Siaw says she paid Cardenas Consulting $28,900, using Omnis money.

In 2016, Siaw made two contributions, totaling $6,000, to the aldermans campaign. She says she made those political contributions using Omnis money.

Cardenas helped Gupta get a contract with Cook County Care, a Medicaid plan run by the Cook County Health and Hospitals System, according to Siaws deposition. She says the alderman also helped Gupta join the Chicago Housing Authoritys health partners program.

Siaw says Cardenas was paid between $2,200 and $2,500 a month to help Omni try to arrange to place medical students at Mount Sinai Hospital, Rush University Medical Center and St. Anthony Hospital but they struck out.

I always consulted with George Cardenas because he has brought contracts to Omni, Siaw says in the sworn testimony. Hes helped me, you know, get a connection with some hospitals.

Siaw testified that she had agreed to give Cardenas a $5,000 bonus if he could help Omni secure a contract with Rush and that Cardenas asked for a watch from Razny Jewelers on the Gold Coast.

I discussed it with Dr. Gupta, Siaw told attorneys in the civil case. I never had somebody ask me for something like that before.

Siaw testified she bought the watch for Cardenas but that the deal with Rush fell through, and the alderman wouldnt return the watch: He basically told me that hes not giving it back.

Meza denies that.

Cardenas was not paid for services rendered and was owed a substantial amount of money by one or more of the business partners, Meza says. The watch was payment for some but not all past-due services owed.

He says Cardenas was supposed to have been paid $2,000 a month but that, For many months, he was not paid at all.

He says the aldermans work for Omni ended in 2017.

Cardenas accompanied Siaw on two trips, trying to land deals for Omni to place Caribbean medical school students at hospitals in Miami and Los Angeles, records show. In December 2016, they stayed in a two-bedroom suite at the luxury Fontainebleau Miami Beach hotel, costing the company more than $19,000, according to records. Siaw testified that no other rooms were available. She also spent $17,199 at a Miami nightclub.

In June 2017, they stayed at the Four Seasons Hotel in Beverly Hills, according to the suit, which doesnt detail the cost.

Siaw also used Omnis checking account to buy two vehicles for $88,854, including a BMW that Cardenas was allowed to drive. Siaw says Cardenas drove the car for just 12 miles but refused to return it to her.

I thought he was avoiding me when I asked him for the car, Siaw told the Chicago Sun-Times. Our relationship ended over a car.

We were really good friends for a long time. It soured because he wasnt delivering what I was paying for.

On Aug. 25, Siaw was removed as Omnis manager by an arbitrator, former federal prosecutor James S. Montana Jr., who is presiding over the case under the terms of Omnis operating agreement.

The record in this matter is brimming with evidence of Ms. Siaws unauthorized, personal use of Omni Student funds, including extensive admissions by Ms. Siaw during hearing testimony, Montana wrote. Ms. Siaw has demonstrated she is essentially incapable of not using Omni Students funds for her personal use.

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Oakland University William Beaumont School of Medicines Anesthesiology Interest Group was recently named the American Society of Anesthesiologists Outstanding Anesthesia Interest Group for 2019-20.

It was the fourth consecutive year that OUWB students in the Anesthesiology Interest Group (AIG) were awarded a top honor from the American Society of Anesthesiologists (ASA). (The announcement came just a couple of weeks after OUWBs Pediatric Interest Group was named Pediatric Interest Group of the Year by the American Academy of Pediatrics.)

According to the society, awards are presented annually to those AIGs that show an exceptional level of participation, enthusiasm, program quality, professionalism, and involvement in their university, community, and at (ASAs) annual meeting.

The OUWB AIG currently at about 240 members edged out similar organizations from medical schools across the U.S., including last years winner from University of California San Francisco. (OUWB was named ASAs Most Innovative AIG in 2019.)

Through this award, the American Society of Anesthesiologists recognizes OUWB as an outstanding school for what we do in our group and the opportunities that we provide for students, said Alan Nguyen, the OUWB student who served as president for 2019-20. This lets program directors and other students know that (OUWB) is a contender.

The fact that weve won an award four years in a row is really saying something about our students and the dedication that they put into events, he added.

OUWBs AIG, launched in 2013, is designed to increase awareness of the spectrum of clinical practice in anesthesiology as well as encourage medical students to explore career opportunities within the field of anesthesiology.

The group aims to go beyond whats available through the OUWB curricular experience by providing opportunities for mentorship, education, and hands-on experience with anesthesiology faculty and residents.

Anesthesiology is one of those specialties where you might not get that much exposure in your first and second years (of medical school), said Paul Patel, current president of OUWBs AIG. The role we play in offering those anesthesiology-related connections and activities is crucial in providing early exposure to a field they otherwise might not get until their fourth year.

Patel said the group aims to hold an event once a month. Among other events held by OUWBs AIG in the last year were:

We put a lot of effort into making events that participating students, residents, and doctors will enjoy, said Nguyen. To get the Outstanding AIG Award offers proof positive that our hard work really does pay off.

Prior to last year, ASA annually awarded three schools an Outstanding AIG Award.

In 2018, OUWB shared the honor with the University of Miami Miller School of Medicine and the University of Oakland College of Medicine.

In 2017, OUWBs AIG was named outstanding alongside the University of Oklahoma College of Medicine and Vanderbilt University College of Medicine.

Nguyen said ASA changed the program starting in 2019. Changes included having only one school named Outstanding along with categories for Best New AIG and Most Innovative AIG.

Stacie Griebahn, president, ASA Medical Student Component, ASA, congratulated OUWBs AIG on being one of the top AIGs in an email announcement.

Your AIG deserves recognition as a model AIG that exemplifies the mission of the ASA Medical Student Component to encourage medical student participation in anesthesiology, provide resources for medical students pursuing careers in anesthesiology and providing leadership, research and education in the field of anesthesiology within your school, she said.

For more information, contact Andrew Dietderich, marketing writer, OUWB, atadietderich@oakland.edu.

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NOTICE: Except where otherwise noted, all articles are published under aCreative Commons Attribution 3.0 license. You are free to copy, distribute, adapt, transmit, or make commercial use of this work as long as you attribute Oakland University William Beaumont School of Medicine as the original creator and include a link to this article.

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The pandemic has been an all-hands-on-deck situation for health care. That has meant channeling the brainpower and energy of those who are just starting their careers in medicine: medical students.

Medical students have contributed in the clinical realm, through volunteer work and through embracing challenges in the digital health realm. That has been evident in the work done by Sling Health, an innovation incubator led by medical students and engineering students. The incubator aims to bridge the divide between clinicians and clinical problems.

A recent episode of the AMA COVID-19 Update highlights the way in which student innovation has driven solutions during the pandemic.

For students interested in contributing to innovation during the pandemicand with most internship and development opportunities limitedSling Health offered a digital boot camp. Vithika Nag, a graduate student at Duke's Pratt School of Engineering, was among the attendees.

It was very fast paced, but I think the pressure kept us all on a really good timeline, kept us really productive, so it was just a very rewarding experience, she said. At the end of every week, we had some design reviews as well that kept us on a really nice milestone, and just checking all the things off our list.

Here's how medical student entrepreneurs can find out whether their idea has investor appeal.

Avik Som, MD, is co-founder of CareSignal Health. Both he and his company are Sling Health alumni. The pandemic forced CareSignala digital health company that focuses on deviceless remote patient monitoringto adapt on the fly.

When COVID really struck the United States, we rapidly saw that there was an immediate need among clinicians and hospital systems to get information out there for patients that are potentially experiencing some variation of symptoms, Dr. Som said. We generated, effectively, a text messaging support line, something we call the COVID Suite, and that we ended up giving for free to anyone.

Some medical students may be hesitant to get involved in innovation during their undergraduate medical training. Dr. Som advises students not to let their place in the pecking order work as a deterrent.

As a student, it can sometimes be very intimidating to go into clinic and make the claim, or think, that you can make it better, he said. The game is: Be proactive and don't ever be intimidated by titles. Don't be intimidated by all of the venture capital firms versus the chief medical officers. I found out as a student that just asking questions and bringing itpeople are so excited for the initiative and everybody wants to make it better for the patients.

The AMA has curateda selection of resourcesto assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.

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How medical students are innovating during COVID-19 - American Medical Association

You dont deserve abuse because youre a medical student.

You dont have to tough it out because youre a medical student.

You dont have to sit in silence and painfully nod along with an attendings racist, misogynistic lectures because youre their medical student. You dont need to pick the skin off your cuticles to stop yourself from replying. You dont need to learn how to hide your grimaces behind your mask because you know youll have to listen to them attack your identity for the next several weeks.

My first interaction with my new attending immediately set off alarm bells in my head: when I introduced myself, he commented on what a difficult name I had and asked twice if he could call me Abby. Throughout the day, he would go on to flippantly joke about mental illness, insist COVID-19 was a liberal political ploy, scoff openly at the message of the Black Lives Matter movement and call every female in the office (including patients as well as myself) inappropriate pet names like baby girl and little lady.

As he casually spouted countless racist or sexist views, I held my tongue and hid my discomfort. He was a white male attending in a suburban clinic and worked exclusively with other white male attendings; it didnt appear he had ever been challenged about his views or his behavior. As a woman of color and a student, I certainly wasnt going to speak up myself. This rotation was 1:1 with the attending and without other medical students, interns or residents to validate my concern, I convinced myself I would just have to make it through the next two months.

From just one day in the clinic, I had compiled a list of 13 bullet points that outlined the most flagrantly inappropriate comments and actions from my attending. But I still didnt trust my experience was I overreacting? Was I being too sensitive? Was I going to ruin this attendings life by voicing my concerns? As just a med student, did I even deserve the right to feel uncomfortable?

When I tentatively mentioned to colleagues and mentors the litany of offensive, problematic statements my attending physician had said during the first two days of my rotation, a common response was, welcome to medicine. That struck a nerve. I didnt want to accept that statement as fact, I didnt want to accept this environment as inevitable, and I didnt feel that we, as the next generation of physicians, should have to. More than my own discomfort, it was the frustrating complacency of that welcome to medicine statement that finally convinced me to reach out to my school about the attending.

I wasnt alone in my hesitancy to bring my concerns to my administration. The 2019 graduation questionnaire by the American Association of Medical Colleges (AAMC) noted that though 40.1% of graduating medical students experienced mistreatment during their time in medical school, only 23.2% of those students reported their experience. Students cited fear of retaliation, doubt that an event was important enough to report and the belief that nothing would be done about the situation as reasons for not reporting.

These were all thoughts that ran through my head; at the bottom of the hierarchy of medical education, we dont trust ourselves enough to believe that what feels wrong might actually be wrong. Most insidiously, a 2018 study found that one of the leading reasons medical students dont report mistreatment during their clinical years is the perception that mistreatment is a normal part of medical education, a rite of passage if you will Welcome to medicine.

When I came forward, I realized I was lucky because I had the most supportive medical school administration I could have hoped for. When I tentatively asked, Is this really that bad? they replied with a resounding YES! making it clear that they were on my side. They took me seriously and removed me from that rotation the minute they heard my concerns. I felt like my safety was their highest priority and Im grateful for that.

While my medical school acted swiftly in my defense, I later learned that other medical professionals were less supportive. After I left my rotation, I heard from students working in the same office that the other attending physicians were whispering about that poor medical student who did the right thing by leaving the clinic. Those physicians discussed amongst themselves how that attending had been becoming increasingly problematic, how his conspiracy theories were getting increasingly incredulous and he was becoming increasingly irreverent towards patients and students. They had known before my name had ever even shown up in the office inbox that this attending was a questionable teacher and provider, but never brought their concerns to the attending himself or the schools who subjected their students to him.

I struggled with pangs of betrayal and loneliness: these physicians had nodded to me in public and had gossiped about that poor medical student in private. While I was fielding microaggressions one-on-one across a desk, berating myself to get a grip, fighting against my own instincts, they had known all along that I was going to struggle and left me to flounder anyways. Those white male physicians, who held the most power in that clinic and would face few consequences by speaking up about a sexist and racist colleague, did nothing.

It genuinely baffled me that they could have these discussions about how inappropriate this attending was and still smile at me walking beside him every morning. I cant help but wonder- perhaps they were so complacent because they didnt see this as an anomaly in medicine. Perhaps they thought it was something students needed to get used to. Perhaps they too thought, Welcome to medicine.

I didnt learn much medicine the first week of my rotation, but I learned something else: I dont want to subscribe to the culture of medicine that makes students believe they have to tough it out. Medicine isnt an old boys club anymore. If we cant expect attendings to speak up on our behalf, then we will have to advocate for ourselves. I dont mean to say that there arent thoughtful, supportive attendings that continue to fight for us there are, and Ive had the privilege of working with many of them.

This experience has shown me, however disappointing the thought may be, that I cant necessarily count on that. But the old guard is not the future of medicine we are. Even as medical students, when we see things that we believe are wrong whether that is sexist and racist comments from attendings, overly harsh treatment of trainees or impolite comments about patients we have both the opportunity and the responsibility to act on them by bringing them up to the administration that oversees medical education. And when we eventually find ourselves in those positions of power as senior residents, attendings or medical school faculty, we must remember what it felt like to be at the bottom of the hierarchy and speak up for those below us. We can work towards a better system than, Welcome to medicine.

Image Credit: Best Shoes for Nurses(CC BY 2.0)bygm.esthermax

Contributing Writer

Saint Louis University School of Medicine

Apshara Ravichandran is a third-year medical student at Saint Louis University School of Medicine in St. Louis, MO. In 2018, she graduated from Williams College with a Bachelor of Arts in anthropology and chemistry. She enjoys reading, running, and going to the local dog park in her free time. After graduating medical school, Apshara would like to pursue a career in a pediatric specialty or child psychiatry.

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"Welcome to Medicine" in-Training, the online peer-reviewed publication for medical students - Pager Publications, Inc.

As flu season approaches some people are asking if it is possible to contract COVID-19 and the flu at the same time.

Unfortunately, yes, you can have both viruses, says Dr. Carl S. Goldstein, Clinical Professor of Medicine at Rutgers-Robert Wood Johnson Medical School.

These are different viruses and because they are structurally different, there is no cross-immunity, Goldstein says.

And if you have both? The risk of respiratory failure requiring a ventilator or cardiopulmonary death is much greater, he says.

The concern is that both of these diseases converge on respiratory failure, Goldstein explains. So COVID independently can lead to ventilator-dependent respiratory failure, as can influenza, and influenza notoriously can set the stage for a bacterial pneumonia occurring on top of influenza. So the risk is that if you are infected with both COVID and influenza, they will both exact harm independently and, likely, synergistically.

Goldstein says those who are already at risk for poor outcomes from COVID are exactly the same people who are at risk for poor outcomes when it comes to the flu.

"That population over 65, underlying cardiac or pulmonary disease, chronic kidney disease, diabetes, HIV, AIDS, cancer or cancer chemotherapy, organ transplant recipient that whole list of people who are at-risk people,' now become at really high risk people, he says, but adds that the the strategies which protect against COVID (masks, hand hygiene and physical distance) are "exactly the same strategies that protect against influenza, making these protective behaviors even more important.

How to tell whether you have COVID-19, the flu or both is a call best made by your physician, Goldstein says, adding that early intervention is critical for high-risk patients.

Clinically they both may present with fever, cough, muscle aches and pains. You cannot rely on symptoms to discriminate between these two diseases or between more common viral infections, he says. And if youre a person at risk and you develop respiratory symptoms any of them: fever, chills, cough, congestion shortness of breath, any of them if those symptoms are anything other than really ordinary, that probably deserves medical assessment because both influenza and COVID can get really ugly, fairly quickly.

And if its just the flu, an early diagnosis can often lead to effective therapy with Tamiflu or other antiviral agents, which, in some cases, could be lifesaving, Goldstein says.

Tell us your coronavirus stories, whether its a news tip, a topic you want us to cover, or a personal story you want to share.

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Jessica Remo may be reached at jremo@njadvancemedia.com.

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Can you have both COVID-19 and the flu at the same time? - NJ.com

The TCU and UNTHSC School of Medicine received a $25 million donation, contributing to the Lead On campaign.

Chancellor Victor Boschini announced the donation from Anne Marion, who died in February, and the Burnett Foundation on Tuesday in an email to students and faculty.

Instituted as The Anne W. Marion Endowment, the donation will be used to help the school become a top provider of medical education, equipping its students with the skills they need to handle complex health care issues, including those involved with serving patients during the COVID-19 pandemic.

The endowment will enhance the School of Medicines communication-based curriculum designed to cultivate empathetic scholars.

Marions Fort Worth family has been a contributor to TCU for over a century, and individually, she was known as a philanthropic leader and a supporter of the universitys advancement.

I am inspired by the vision of the School of Medicine to transform medical education, Marion said before she died. This school is bringing considerable advances and innovations that are reshaping curriculum and preparing its graduates to better serve the community. I am pleased to make this gift.

The Burnett Foundation has been a longtime benefactor to the Fort Worth community, enriching the citys arts, humanities, education, and health and human services.

This contribution bring the Lead On campaigns total funds raised to $671 million, putting it closer to the goal of $1 billion announced last October.

Read more: Lead On campaign to raise $1 billion

The campaign was initiated to strengthen the universitys endowment and its support of scholarships and academic programs, as well as to increase the diversity and inclusiveness of the student population.

With a goal of $1 billion, Lead On is the most ambitious campaign in the schools history.

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$25 million donated to the TCU and UNTHSC School of Medicine - TCU 360

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Head of Medical Public Affairs recognized by Association of American Medical Colleges Group on Institutional Advancement

Westerhouse

Joni Westerhouse, associate vice chancellor and associate dean in the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis, has received the 2020 Distinguished Service Award from the Group on Institutional Advancement (GIA) of the Association of American Medical Colleges (AAMC).

The honor presented to Westerhouse on Sept. 17 recognizes her for significant and longstanding contributions to the group, the AAMC and her profession.The GIA is a national professional-development group devoted to the role of institutional advancement in academic medicine.

Westerhouse has overseen the School of Medicines public relations, communications and marketing efforts as associate vice chancellor and associate dean since 2014. She joined the office in 1987 as medical editor of the Record and as a media relations specialist. Over the years, she has taken on myriad roles as a spokesperson, writer, editor, and director and executive director of medical communications before being named an assistant vice chancellor in 2011. She also has had leadership roles in events on the Danforth Campus, including as a member of several presidential and vice presidential debate planning committees.

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Westerhouse honored with AAMC Distinguished Service Award - Washington University School of Medicine in St. Louis

publication date: Sep. 18, 2020

Alan Blum, MD

Professor and Endowed Chair in Family Medicine,

Director, The Center for the Study of Tobacco and Society,

University of Alabama School of Medicine, Tuscaloosa

Eric Solberg, MS

Vice president, academic & research affairs,

University of Texas Health Science Center at Houston;

Faculty associate, McGovern Center for Humanities and Ethics,

McGovern School of Medicine, Houston

This story is part of The Cancer Letters ongoing coverage of COVID-19s impact on oncology. A full list of our coverage is availablehere.

The unprecedented COVID-19 pandemic makes it possible to compare and contrast the public health and political responses to previous health crises.

The most obvious comparison is to the influenza epidemic of 1918-19, which took the lives of 675,000 Americans in less than two years.

Yet a comparison with cigarette smoking, which has killed untold millions of Americans in the 20th century and continues to take the lives of 500,000 a year, is arguably more illuminating. At first glance, comparing COVID-19 to cigarettes seems illogical. Yes, people who take up smoking do so willingly, although most do so before they reach adulthood. And yes, those who contract COVID-19 do not willingly seek out the virus.

Disease and death from smoking take years, even decades to occur. Deaths from COVID-19 can occur within days or weeks, albeit in less than 2.9% of victims, most of whom have comorbid conditions such as hypertension, obesity, and emphysema.

As we assess the 50-year War on Cancer that was declared when President Richard M. Nixon signed the National Cancer Act of 1971, some parallels and lessons from the past that can be gleaned from anti-smoking campaigns and applied to the efforts against COVID-19.

As defiant and skeptical as President Trump may be of the preventive behavioral measures that all health agencies agree are the first step to contain the spread of the virus, his magical-thinking approach mirrors the playbook of previous presidents to ending the cigarette pandemic, even decades after it was recognized as the nations leading avoidable cause of death and disease.

Should anyone really be surprised that when it comes to public health and health care, money and politics take precedence over science?

In early April, no sooner had Anthony Fauci, of the White House COVID-19 Task Force, come to the conclusion that all Americans, not just front-line health workers and patients, needed to wear face masks, practice social distancing, and wash their hands to prevent the spread of COVID-19, President Trump began subverting this message by retweeting Faucis original assertion in March that mask-wearing by the general public was not yet necessary.

By mid-summer, Trump had rejected the recommendations by the Centers for Disease Control and Prevention on protecting meat processing plant workers, teachers, other school personnel, and children from COVID-19. Trump not only muted, muzzled, and marginalized the CDC, he had also become its de facto spokesperson.

Even as he has publicly played down the ease of spread and the adverse health consequences of COVID-19, last week we listened to the recording of his February interview by reporter Bob Woodward, in which Trump acknowledged the ferocity of the new virus.

This called to mind the response by another president to the efforts by the top health official in his administration to launch the federal governments first anti-smoking campaign. In January 1978, U.S. Secretary of Health Education and Welfare Joseph A. Califano, Jr., announced that HEW would place the weight of its scientific authority behind programs to inform the publicespecially the youngabout why they should not smoke and how they can quit if they wish. As the chief health officer of government, I have the duty to see that we do just that.

Within weeks, Califanos efforts were being undermined by President Jimmy Carter, who traveled to North Carolina to assure tobacco famers that the government would make cigarette smoking even safer than it is today. As Califanos campaign continued to gain momentum, and after HEW published the most comprehensive indictment yet of cigarette smoking in its 1979 Surgeon Generals Report, Carter fired Califano. There was little doubt that the main reason was his fervent anti-smoking stance.

The present-day Republican-led opposition to state and local ordinances mandating the wearing of face masks in public places is akin to the vocal opposition in 1964 to federal legislation to require an understated warning on the side of cigarette packs (Caution: Cigarette Smoking May Be Hazardous to Your Health).

The staunchest opponents of the warning were not just the cigarette manufacturers and tobacco state congressmen, but also the American Medical Association, which claimed that the public was already well informed about the dangers of smoking.

In those days, Republican Sen. Jesse Helms were beating back anti-smoking bills introduced by Democratic Sens. Ted Kennedy and Dick Durbin and Reps. Henry Waxman and Ron Wyden. Today, we can take in the spectacle of Republican Sen. Rand Paul (a physician) and Republican House Members Matt Goetz, Luis Gohmert, and Mark Meadows deriding the recommendation to wear face masks.

All four contracted COVID-19, with Gohmert blaming his infection on having to wear a mask.

At his nationally televised town meeting on Sept. 15, in which he claimed that herd mentality could make the virus disappear, Trump also claimed that the repeated putting on and taking off a mask could increase the chances of becoming infected with COVID-19.

The other two physicians in the Senate, Republicans John Barrasso and Bill Cassidy, have stood behind Trump every step of the pandemic. In May, Barrasso, an orthopedic surgeon until he was appointed to the Senate in 2007, cited his medical background to support Trumps call to end COVID-19 containment shutdowns and echoed Trumps comment that we cannot allow the cure to be worse than the disease.

Granted, oversimplifying the comparison between the response to COVID-19 and the fight against smoking risks reducing it to a body count competition. Yet, that is just what Stanford historian Robert Proctor did in a book review in the July 7 issue of JAMA:

It all seems so February. Cigarettes remain the leading preventable cause of death, but that morbid fact is easily lost in more pressing pandemics. It is worth keeping in mind that even if the novel coronavirus 2019 (COVID-19) ends up killing 200,000 people in the U.S., that number will not be even half the annual toll from cigarettes, which still kill half a million Americans every year.

Such a comment is as simplistic and cold-hearted as any of Trumps unempathetic pronouncements downplaying the catastrophic impact of COVID-19. One hears echoes of the claim that the virus will just disappear, but smoking will remain.

Sadly, this is the same narrative that all too many individuals who work in the field of tobacco control have used for other emerging health crises such as the rapid rise in obesity, namely that smoking is always the bigger killer.

They seem to see other health issues as a threat to their turf. Proctor calls the assertion that his smoking dog is bigger than your COVID dog an enduring constancy and insists that scholars need to pay more attention to cigarettes, even in these distressing days of plague.

Any focus on disease that ignores the cigarette or the cigarette industry is like pretending to have an interest in malaria while paying no attention to mosquitoes or swamps. Nicotine addiction is likely to outlive coronavirus, shackling millions in chains that lead to suffering and death. The havoc wreaked on human health is worse than any virus.

Nathan Schachtman, an attorney and lecturer at Columbia Law School who has written on tobacco litigation, is appalled by Proctors claim. This type of comparison between COVID-19 and smoking is inapposite, he says. COVID puts me at risk from even a brief encounter with an infected person. I have no control as an individual over the risk of this infectious disease; it absolutely requires coordinated action by government. We can all agree that both smoking and COVID are public health problems, while refraining from making inane comparisons. The thing about COVID-19 is that a pandemic ensures that there will be innocent victimspeople who did not assume the risk, but had the risk of death and disability foisted upon them by fellow citizens.

Two hundred thousand deathsin addition to hundreds of thousands of potential long-haulers suffering from crushing fatigue, lung and heart damage, and other problemscaused by a single pathogen in just six months extrapolates to 300,000 deaths this year, plus a lingering morbidity comparable to that caused by cigarette smoking. And there is no cure in sight, but rather false promises by the president of a breakthrough vaccine just around the corner before Election Day.

Instead of trying to make the case that smoking is worse than COVID-19, we should instead be applying the lessons weve learned from anti-smoking efforts to reduce the toll of COVID-19, argues Michael Siegel, professor of community health sciences at Boston University School of Public Health. Most obviously, the chronic conditions of emphysema and cardiovascular disease that help COVID take hold are frequently due to smoking. The successes and failures of the past five decades of anti-smoking actions are playing out now in the daily COVID-19 death tallies.

Writing in Financial Times on Aug. 4, Sir Richard Feachem, who served as under-secretary-general of the United Nations and founding executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, warns that counting on a COVID-19 vaccine to come to our rescue soon is not only unlikely but is a dangerous assumption on which to plan the overall response to the pandemic.

Politicians and vaccine developers have incentives to reinforce this assumption, he notes, in spite of the long odds against a vaccine with high efficacy, a protracted duration of protection, a convenient dosing schedule, and the ability to administer billions of doses.

Is this not reminiscent of the never-ending quest for the Holy Grail of the safe cigarette? Can anyone doubt that the biggest failure in the history of the National Cancer Institute is not to have dispelled the myth that filtered cigarettes can prevent lung cancer?

The tobacco industrys view, as reflected in the Tobacco Observer, a publication of the Tobacco Institute, April 1982.

Following the release of the 1964 Surgeon Generals Report, there was a dramatic increase in advertising claims by the tobacco companies implying that filtered cigarettes were safer than non-filtered ones.

This campaign extended to Hollywood, where TV and movie heroes and heroines smoked filtered brands while the crooks and tramps smoked non-filters. Alas, the history of the filter is at the heart of why the reduction in smoking has been so slow.

Beginning in the early-1950s, when the devastating reports of the impact of smoking on health were making front-page news and beginning to drive down cigarette sales, the tobacco industry took the upper hand by proclaiming in full-page newspaper advertisements across the U.S. that it would fund research to identify and remove any harmful ingredients from cigarette smoke.

By the late 1960s and throughout the 1970s, the National Cancer Institutes research efforts on smoking were almost entirely directed toward finding a safer cigarette. This dead-end research didnt get the ax until 1980, when Vincent DeVita became director of NCI and began shifting the focus of smoking research to getting heavy smokers to quit.

Even then, a far more heavily funded NCI research project in the 1980s was chemoprevention, which aimed to reduce lung cancer in smokers with large doses of vitamin A. The highly promoted study was halted when it was found that this caused an increase in lung cancer.

The unequivocal conclusion of the landmark 1964 U.S. Surgeon Generals report on smoking and health that cigarettes cause lung cancer and other diseases was to have ended a debate that had raged for decades.

Instead, the tobacco industry made a preemptive strike by funneling a total of $18 million over 14 years to the American Medical Associationthe only major health organization to withhold its endorsement of the reportin a research program to identify and remove any possible harmful components of cigarette smoke.

Why did the AMA choose not to campaign against smoking, but rather to conduct the same kind of research that the report had already found sufficient for its indictment of smoking?

It did so in order to remain in the good graces of tobacco state senators, whom it counted on to help prevent the creation of Medicare by Congress. This, in turn, leads to another villain that has gone unnoticed: the insurance industry, which never lifted a finger to fight smoking, even long after a small Massachusetts insurer, State Mutual Life Assurance Company, offered the first non-smoker discount after the SG report came out in 1964.

Because the anti-smoking narrative has been revised as a great victory instead of an abject failure, the rogues gallery is endless. One of the genuine leaders was the fearless Sen. Maureen Neuberger, who castigated not just the tobacco companies but also the see-no-evil, hear-no-evil, speak-no-evil AMA in her 1964 book Smoke Screen: Tobacco and the Public Welfare.

The AMA/tobacco industry collaboration distributed research funds to dozens of universities to keep scientists in their laboratories and not out testifying to the need to end smoking now. Columbia University, although not a participant as an institution with the AMA program, went so far as to market a patented super-filter that it claimed would remove the cancer-causing tar and prevent lung cancer. It didnt.

The filter con endures to the present day. Ninety-nine percent of cigarettes sold are filtered brands, in spite of the fact that filters likely increase the risk of death and disease from smoking by virtue of the smoker needing to inhale more deeplyand by fostering complacency about the dangers of smoking.

Essentially the same kind of players that fought efforts to pass clean indoor air legislation or bills to ban or restrict cigarette advertising and promotion are at it again with COVID-19. The cigarette companies filter and low-tar hucksterism is not unlike the touting by Trump of oleander, hydroxychloroquine, zinc, bleach, Lysol, and UV light for the prevention of COVID infections.

Meanwhile, Trumps COVID-19 advisers include individuals untrained in infectious disease, notably retired Stanford radiologist Scott Atlas. In a scathing op-ed in the Los Angeles Times on Sept. 10 by Stanford epidemiologists Steven Goodman and Melissa Bondy, co-signed by all of their epidemiology colleagues at the university, the authors castigate Atlas for recommending less COVID-19 testing and less mask-wearing in indoor public spaces, as well as for downplaying the nonfatal health risks of the virus and its transmissibility by children.

The Washington Post and The New York Times were criticized by an editorialist at The Wall Street Journal for questioning Atlas fitness and credentials, even though Atlas got the job after espousing his unconventional views on Fox News. Both the Journal and Fox News are controlled by the pro-Trump Murdoch family, whose patriarch Rupert Murdoch served on the board of Philip Morris from 1989 to 1998; Philip Morris executives in turn have served on the board of Murdochs News Corp.

To think that in 1854, fully 40 years before Robert Koch discovered the bacterium that causes cholera, a lone London obstetrician named John Snow identified the source of a cholera outbreak with pencil, paper, and shoe leather.

By interviewing surviving family members of many of the more than 500 victims, he realized that the fatalities were clustered around a single water pump in Broad Street, from which most of the victims had obtained their household supply.

Countless lives were saved when the pump was ordered shut, over the objections of the water companies, which blamed the cholera epidemic on bad air, or miasma. Religious zealots blamed divine intervention.

Ironically, it was a minister, Rev. Henry Whitehead, who at first contended that the outbreak was not caused by tainted water but by Gods will, who surprised himself to discover that the cause was a soiled diaper emptied into a leaky cesspool near the pump.

More than half a century after the causes of the epidemic of lung cancer and emphysema became known through epidemiologic studies, the tobacco industry, like the water companies of Snows London, insisted that their product was not to blame. They were backed up by administration after administration as the cigaretteand its tax revenuesbecame a mainstay of the economy.

Arguably the best single summary of government policy on smoking came from the United Kingdoms Royal College of Physicians in the 1971 sequel Smoking and Health Now to its pioneering report on smoking and health in 1962: Castigating the government for spending little to educate the public about the dangers of smokinga tenth of the amount spent on traffic safety.

The report dryly observes, It seems that Ministers, while accepting the evidence that cigarette smoking is dangerous to health, are guided in their actions by the view that the risks are regrettable but inevitable consequences of a habit which they believe to be an essential source of revenue.

The economy-over-lives approach to COVID-19 by the current president is reminiscent of other administrations approach to curbing smoking.

College football, get out there and play football, Trump said on Aug. 11, when the only major universities left whose officials had given the season a green lightin the Atlantic Coast and Southeastern conferencesare located in the very region with the least adherence to personal COVID-19 health precautions and a steady rise in the number of cases.

By his masks-be-damned rallies and his tweets to Liberate Michigan! and other battleground states with Democratic governors from the inconvenience of wearing a mask and washing hands, Trump has become a 21st century Typhoid Mary, a super-spreader of COVID-19 through his crowded campaign rallies.

By stoking the embers of anti-scientific thinking for years in regard to the safest and most effective vaccines, by mocking the wearing of masks and social distancing, and by claiming that there is a COVID-19 vaccine just around the corner, Trump has undermined confidence in the safety and efficacy of any such rushed-out vaccine by those who would normally support vaccination.

In addition, HHS and FDA have been corrupted by political pressure to approve hydroxychloroquine and convalescent plasma as treatments for COVID-19 in spite of the absence of safety data. Fauci has been told to refrain from stating that children can transmit COVID-19. And CDC has been forced to walk back recommendations on school reopening and contact tracing, and its venerable publication, MMWR has been censored by the administration.

On June 23, Financial Times published the marvelously understated headline, Resistance is low at U.S. disease-control body. This week we finally learned that the source of this chaos and the sharp decline in the publics and health professionals confidence in the CDC has been a troubled Trump appointee, Michael Caputo, a far-right conspiracy-monger and protg of convicted felon Roger Stone.

It is dj vu all over again. In 1987, one of us (AB) would be told upon assuming a faculty position at Baylor College of Medicine that he could not use his academic affiliation when speaking publicly on smoking and that he should consider getting into something more socially acceptable, like cocaine.

This meant, of course, that studying illicit drugsnot cigaretteswas where the grant funding wasand dont you keep messing with the folks at the tobacco companies who have influence over Capitol Hill and the NIH!

One year later, he would be offered the editorship of the journal of the American Academy of Family Physicians, American Family Physiciancontingent on his not speaking publicly on the subject of smoking.

The AAFP was a recipient of advertising revenue from food subsidiaries of RJ Reynolds and Philip Morris. AB turned down the job.

What is the fairest way to compare strategies to contain the virus with the efforts to reduce cigarette smoking? Why not begin with those who are made ill by a known agent through no fault of their own, as well as through willfully misleading directives by elected officials?

The turning point in the effort to reduce cigarette smoking came in the early 1980s, when studies in Japan and Greece found that long-term exposure to cigarette smoke could cause lung cancer in a person who did not smoke.

Certainly, those individuals who were involuntarily exposed to cigarette smoke over many years at the workplace and who developed terminal lung cancer or emphysema would be unequivocal innocent victims of smoking.

What about those who contract COVID-19?

The only ones in this population who arent unequivocally innocent victims are those who refuse to wear masks, practice physical distancing, wash hands frequently, and refrain from participating in social gatherings, political rallies, or protest demonstrations.

Another way to look at smoking-related deaths is through the number of those who had chosen to continue to smoke in spite of knowing that it could kill them.

One could argue that nicotine addiction is too powerful to overcome, and that, therefore, all of the blame must be laid at the feet of tobacco industry executives and the leaders of allied businesses that have engaged in the promotion of cigarettes in spite of the dangers.

But what about the accountability of public health agencies, which are tasked both with curbing infectious outbreaks and improving the health of the entire population? If a commissioner of health were found to have failed to allocate funds to mosquito control after an outbreak of West Nile, dengue, St. Louis encephalitis, or zika, then that individual would be held partially responsible for the cases that resultedand criminally negligent if the funds were deliberately withheld because the commissioner didnt believe that mosquitoes were the vector, or if he or she pocketed the money.

Analogously, why shouldnt a health commissioner or health agency that chooses not to allocate funding to discourage smoking be held accountable for a failure to reduce tobacco-related deaths and diseases and/or cigarette consumption? Fanciful? But if the number one avoidable cause of death and disease in the health district doesnt receive sufficient funding, then why shouldnt there be accountability?

Although Surgeon General Luther Terry called for appropriate remedial action on smoking in 1964, it would be fully 25 years before every state had even a single individual assigned to reduce smoking.

Nor were health department commissioners permitted to endorse efforts to pass clean indoor air regulations to protect nonsmokers.

And what about academia, organized medicine, and the voluntary health organizations, such as the American Cancer Society? What did they do as the battles over restrictions on cigarette advertising heated up in the 1980s? Most were nowhere to be found.

Individual tobacco product liability lawsuits brought against the tobacco industry beginning in 1983 by New Jersey attorney Mark Edell (Cipollone v Liggett Tobacco Group Inc.), followed by class action suits brought by several state attorneys general in the mid-1990s, began to expose the myth of organized medicine as an enemy of Big Tobacco.

In a TV interview in 1996, the president of the American Medical Association, Lonnie Bristow, famously claimed, We were duped.

This is in spite of the AMA having accepted cigarette ads in its journal from the early-1930s to the mid-1950s, the same time period when the epidemiological and pathological research showing the association between smoking and disease was being published.

This was also in spite of the publication of the Surgeon Generals Report in 1964, following which the AMA, as noted here, spent 14 years conducting research funded by the tobacco industry in lieu of taking action or even calling for action against smoking, apart from advising the public not to smoke in bed.

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Seeing COVID-19 through a cloud of cigarette smoke The Cancer Letter - The Cancer Letter