A Legacy of Scientific Racism: William Osler's "An Alabama Student".

William Osler's essay "An Alabama Student" made John Young Bassett (1804-1851) a widely admired avatar of idealism in medicine. However, Bassett fiercely attacked the idea that all humans are members of the same species (known as monogenesis) and asserted that Black inferiority was a justification for slavery. Antebellum physician-anthropologists bequeathed a legacy of scientific racism that in subtler forms still runs deep in American society, including in the field of medicine.

Antibody immunodeficiency diseases.

Among primary immunodeficiencies, antibody deficiencies are the most common. Patients often are examined first by multiple medical providers by whom the diagnosis may be missed or delayed, because signs and symptoms are usually sinopulmonary in origin, simulate common respiratory infections or respiratory allergies, and are usually responsive to symptomatic antimicrobial treatment. Because these diseases can be treated effectively, it is important to recognize them before complications occur. We have provided updated information on the more common antibody deficiency syndromes, their diagnostic assessment, and advances in treatment.

The Meeting.

A group of black physicians whose request to attend educational programs at the University of Mississippi Medical Center had been rebuffed by the school's second dean played a central role in helping UMMC survive a federal investigation for non-compliance with the Civil Rights Act of 1964. Unknown to Dean Robert Marston, these physicians had been active in civil rights activities at both state and national levels and were in dialogue with federal civil rights agencies and with the NAACP who filed the complaint against UMMC. Marston called on them as part of a marathon of preparation for the inspection, and they assisted him in achieving an improbable outcome, a finding of compliance. In the process, Marston developed a positive relationship and ongoing dialogue with these black physicians and realized their value to Mississippi. In turn, they elected him to membership in the Mississippi Medical and Surgical Society.

Dietary recommendations in ambulatory care: evaluation of the Southern Remedy Healthy Eating Plate.

There are few useful tools to provide dietary health education including calorie and portion control to patients, particularly in a busy ambulatory health care setting. In this report, we provide results of the evaluation of an adaptation of the recent US Department of Agriculture dietary recommendations modified for the southern diet and individuals with limited knowledge of healthy eating. Using standardized methods, we found that the "Southern Remedy Healthy Eating Plate" was well accepted by patients and can be used quickly and effectively in the outpatient setting. Moreover, the review of this placemat with easy to understand instructions for meals and snacks was associated with acceptable levels of data retention after a single visit averaging 5 minutes. Although the need for some modification of instruction techniques was identified, the Southern Remedy Healthy Eating Plate appears to be a practical and useful format for providing structured dietary counseling and education in this setting and others.

Fungal immunotherapy in patients with allergic fungal sinusitis.

BACKGROUND: Allergic fungal sinusitis is a disease for which optimal treatment is unclear. Previous studies using fungal immunotherapy reported less recurrence after surgery. There has been concern that traditional high-dose immunotherapy could induce systemic hypersensitivity in patients with this condition. OBJECTIVE: To determine the safety of high-dose subcutaneous fungal immunotherapy in patients with allergic fungal sinusitis. METHODS: Safety of high-dose subcutaneous fungal immunotherapy was assessed in 14 patients from our clinic who met diagnostic criteria for allergic fungal sinusitis. Results were compared to a control group of 14 patients with chronic rhinosinusitis without allergic fungal sinusitis who received subcutaneous fungal immunotherapy. We also performed a literature search to identify all previous reports of subcutaneous fungal immunotherapy. RESULTS: No differences between numbers of immediate local or large local reactions, delayed local reactions, or required dose adjustments were noted between patient and control groups. One patient from each group experienced a mild systemic urticarial reaction to immunotherapy. Similarly, there were no differences in complications in either group that also received immunotherapy with nonfungal allergens. No patient developed evidence of immune complex disease. Eight publications were identified for inclusion in our literature analysis, 7 of which used low-dose subcutaneous immunotherapy. None of these noted complications more serious than local reactions. CONCLUSION: Our data demonstrate that subcutaneous fungal immunotherapy in patients with allergic fungal sinusitis is unlikely to cause adverse reactions other than those occurring with pollen immunotherapy. Clinical trials of high-dose, traditional immunotherapy with fungal allergens for efficacy may proceed in patients with allergic fungal sinusitis without undue concern.

Ending Racial Bias in American Medicine: A Call for Help from the AMA, NMA, AAMC, and the Rest of Us.

Bias based on skin color, religion, immigrant status, gender, and ethnicity are deeply rooted in American culture and have existed within the infrastructure of American medicine from the beginning. Now, medical educators are struggling to find curriculum and experiences that effectively address explicit and implicit bias among our increasingly diverse group of students, house staff, and practitioners. The leadership, experience, and lessons learned needed to scrub present medical school curricula of racial bias, to develop an antiracist curriculum, and to test its effectiveness already lies with the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), and the National Medical Association (NMA). We call on these organizations to jointly convene a consortium of medical educators, social scientists, curricular specialists, and others to chart a way forward to assist medical schools and professional organizations in developing evaluable curricular materials and experiences to eliminate bias in health care.

Syndromes of invasive fungal sinusitis.

Invasive fungal sinusitis should be suspected in immunocompromised or diabetic patients who present with acute sinusitis, inflammation of nasal septal mucosa, unexplained fever or cough, or the orbital apex syndrome. Histopathological studies are required to differentiate among these syndromes. Acute (fulminant) invasive fungal sinusitis has been called mucormycosis, zygomycosis and fulminant invasive sinusitis. Fever, cough, crusting of nasal mucosa, epistaxis, and headache are the most common presenting symptoms. Histopathological studies show hyphal invasion of blood vessels, vasculitis with thrombosis, and tissue infarction. Reports of granulomatous invasive fungal sinusitis come primarily from Sudan, but also from India, Pakistan, and the United States. Patients usually present with proptosis, appear to be immunocompetent and are infected almost exclusively with A. flavus. Chronic invasive fungal sinusitis can be distinguished from the two other forms of invasive fungal sinusitis by its chronic course, dense accumulation of hyphae resembling a mycetoma, and association with the orbital apex syndrome, diabetes mellitus, and corticosteroid treatment. Biopsy and orbital exploration show vascular invasion by fungal elements and only a sparse chronic inflammatory infiltrate.

My journey to the ants.

In this paper, I review the strange, unplanned and unexpected journey I have had with Solenopsis invicta, the imported fire ant. Through serendipity, good fortune and repeated invenomation, I have come to count as collaborators a number of entomologists, toxicologists, allergists and immunologists who have guided me on this journey to the ants. We now understand the mechanisms for the cutaneous reactions experienced by 50% of the exposed population stung per year, as well as the immunologic and toxicologic properties of the ants unique venom. Allergen immunotherapy to fire ant extracts has been demonstrated to protect patients from repeat anaphylaxis. Methods have been developed to prevent and treat massive sting attacks on frail elders, including those in residential and medical facilities. The potential beneficial effects of venom components are under investigation. And yes, the journey and the stings continue.

Marijuana's Effects on Brain Structure and Function: What Do We Know and What Should We Do? A Brief Review and Commentary.

The recent US Food and Drug Administration approval of the marijuana constituent cannabidiol as safe and effective for treatment of 2 rare forms of epilepsy has raised hopes that others of the 500 chemicals in marijuana will be found to be therapeutic. However, the long-term consequences of street marijuana use are unclear, and recent studies raise red flags about its effects. Changes in brain maturation and intellectual function, including decreases in intelligence quotient, have been noted in chronic users and appear permanent in early users in most but not all studies. These studies suggest that at a minimum, regular marijuana use should be discouraged in individuals under the age of 21.

Providing healthcare to evacuees in the wake of a natural disaster: opportunities to improve disaster planning.

BACKGROUND: The impending landfall of Hurricane Katrina on the Mississippi Gulf Coast resulted in large numbers of evacuees into the Jackson, Mississippi area. Many evacuees with chronic medical problems had been directed to the Mississippi Coliseum in the downtown area near the University of Mississippi Medical Center. As the storm passed through Jackson, serious damage occurred to the municipal infrastructure. In this article, we asked how that experience has affected health planning for the care of sheltered populations. METHODS: We reviewed the information accumulated in the course of operating a large medical clinic for evacuees at the Mississippi Coliseum. We also contacted representatives of disaster planning agencies and of healthcare planning organizations to determine changes that have occurred in strategic plans subsequent to Katrina. RESULTS: Using the resources of our academic health center, we were able to effectively deliver healthcare to sheltered evacuees. A model has been developed for future use from this experience. Much progress has been made toward preparation for care of the chronically-ill who may be displaced by future disasters. CONCLUSION: Hospitals and clinics on major evacuation routes for natural disasters can expect the sudden necessity to provide care to evacuees. Unless plans to care for chronically-ill individuals are incorporated into hospital disaster plans, local healthcare facilities may be unprepared to provide care. Many evacuees will have limited resources to pay for services. Academic medical centers have unique resources and capabilities to lead in the care plans for these populations.