Medicine is not practiced in a vacuum; cultural and geographical context matter, and the community shapes both innovation and practice. Cleveland’s history reveals the remarkable collaboration of medical institutions and the public—it does not rest only in the hands of physicians or with distant hospital systems. Now, as then, health is everyone’s concern. But how do we engage the public? And how can we make it plain that the public has rights–and power–to shape medicine? Historically, individuals had a greater share in shaping their care out of necessity. The Dittrick Museum’s collection of herbals and medical remedies is a testament to just how much people took health into their own hands. Dr. Culpepper’s Last Legacy (1655) contains prescriptions for do-it-yourself potions [from our instagram]: Obviously, we are not mixing witches’ brew these days, and certainly no doctor or pharmaceutical company is going to publish recipes for homemade medicine. Then again, a resurgence in homeopathy and plenty of websites that promote home-remedies suggest that there is an audience…And a quick scan reveals plenty of misinformation, too. How can an interested public find good information about their health and health choices? Whose responsibility is it to make access to care, and even information about care, easier and more intuitive? The patient often does not feel like an empowered part of the medical process. A few years ago, The Atlantic published a piece called “Power to the Patients” that took issue with the traditional doctor knows best mantra: “it is only by empowering patients – entrusting them with greater responsibility and putting opportunities for self-directed care into their hands – that health care can be made significantly more efficient and effective.”  But, the article goes on to admit, sorting out how you can be empowered in the midst of a health crisis is probably too late. Let’s take it a step further: do healthy people feel empowered about their health? Do they understand that they are stake-holders? Possibly not. The New York Academy of Medicine is taking a community approach to this problem. They have a renewed dedication to “urban health,” and seek to address the broader determinants of health, and “the importance of interdisciplinary approaches to care.” Their new logo sports the phrase: Healthy Cities. Better Lives. It’s not a new idea. It’s a return to an old idea–one that thrived in cities of the 19th and early 20th centuries. Cleveland, Ohio, is one brilliant example. Polio hit urban centers hard, leaving debilitated children in its wake. The iron lung could keep people alive, but the world needed a vaccine, and then a systematic way of implementing vaccination protocols. A combined effort of doctors, philanthropists, the media, and everyday people led to record-breaking changes. Salk’s vaccine dropped cases by 90% by 1962 in Cleveland, and led to the eradication of the disease in the rest of the US. Public awareness and empowerment did what laboratory medicine could never hope to achieve on its own. Community engagement, public empowerment, and (key in the polio crisis) access to care and information wins the day. And that returns us to the first question. How do we engage and educate the public? Whose job is it?
The short answer: it’s everyone’s job. But I want to take a moment and focus on the power of history. Museums and libraries–and institutions generally–have an important role to play. To address misunderstandings about medicine, and crucially about who controls or drives innovation, the Dittrick has developed an interactive, digital exhibit and attendant programming called How Medicine Became Modern. The exhibit will be a free-standing digital touch-screen wall, 10ft x 4ft, in the main gallery, providing the story of our shared medical past and cultivating means of seeing the relationships among culture, society, and health. But we have also begun two types of public outreach as well–“conversations” that begin with the history, then allow panels and round tables to discuss medicine today. The story of polio and others like it remind us: we are part of this story. History records more than the names of famous doctors. It demonstrates the innovation, the boldness, the concern, and the action of every day citizens. Medical humanities, or health and humanities, is all about the human story at the core. Let’s work together to bring that story out, and to be part of it.  Clayton M. Christensen and Jason Hwang. “Power to the Patients” The Atlantic 2009