Luther B. Adair, II, M.D.
There they were, my dad and my new cocker spaniel, Jocko (seemed like a great name at the time). It was no different a night than several other nights in 1982 when my father came home and trained Jocko in the concrete floored basement of our split-level, ranch-style suburban home. At the time, the stairs that led to the basement were open to the view of the basement from an unenclosed stair rail. As a 5-year-old, however, this was not a stair rail at all; it was a gymnastics paradise to display my ninjutsu expertise—plus a bonus view of my personal dog trainer and my new puppy. It does not get much better for a 5-year-old except for the frequent chastising I would receive for using the rail for that very purpose. “You will fall and hurt yourself,” was the usual caveat. On this particular night, that warning would go unheeded and my grip would betray me. Gravity was there to teach me a lesson. I fell head-first and landed on the concrete. Now much of what happened later is recalled from a post-traumatic memory and what my parents later told me, but to make a long story short, I remember waiting a very long time in an unfamiliar emergency room.
I guess now would be a good time to tell you that my father was a neuroradiologist, the chairman of the Department of Radiology at the more familiar hospital, and a student of the great Juan Taveras (MGH Neuroradiology) during the dawn of the CT scan. Needless to say, my father would not allow me to be evaluated with radiography alone and insisted upon having the hospital perform a CT scan evaluation of my head (imagine a time when routine brain MRIs from the emergency department weren’t the norm). My father’s hospital did not have a CT scan. I eventually received a CT scan and a diagnosis of a concussion. Subsequently, my father was able to convince his hospital board to allow him to use his personal finances to help purchase a CT scan for the hospital where he was employed.
This story seems inane now because most hospitals in the U.S. have CT scans that are readily available. However, in many cases such ubiquity has become another spectrum of the same problem—the overuse of such technology and the radiation associated with the overuse. There has been extensive controversy regarding the overuse of CT scans ordered by the emergency departments over the last six years—just “google” CT scan, pediatrics and CNN. Some argue that the legal system is causing doctors to practice defensive medicine. Others argue that the training of emergency personnel promotes a flippant approach to the use of diagnostic imaging.
Recently, my 8-year-old nephew suffered a head injury while playing and I realized after talking with his parents that the responsibility should also lie with the parents to understand their available options in similar circumstances. Hence the reason my company, Viewbox Holdings, LLC, and I decided to create our second (and most unlikely) product, a children’s book.
The book, Learning about X-rays with Lula and Ethan, is loosely based on my nephew’s experience and it attempts to educate the pediatric population about possible concerns around radiation exposure, but also explains its necessity in certain situations. Most importantly, and aligning with the ACR’s Heart of Radiology campaign to educate the public about our role as radiologists, this book introduces readers, both parents and children, to one of their key health care providers—the radiologist. This book was written for ages 7+ and features two children eating lunch and discussing one child’s experience of getting an X-ray. Obviously, it is our desire that parents would never need such a resource, but given the trend of increased diagnostic imaging in the emergency setting, as well as the large numbers of allied providers joining the health care force over the next few years, we believe this resource will help families and providers.
It is our hope that any provider that treats the pediatric population has access to this resource for their patients (even radiologists in the outpatient or emergency waiting rooms). You can purchase either the paperback version for $9.59 or the e-book for $4.99 directly from the publisher by following this link http://www.blurb.com/b/6950764-learning-about-x-rays-with-lula-and-ethan. The book will also be available through Amazon, Barnes and Noble, and in the Apple iTunes Store where you can also find our iPad application for radiology trainees, Viewbox. Because the information and message in Learning about X-rays with Lula and Ethan also aligns with the Image Gently Campaign, this non-profit organization has also agreed to endorse the book by placing it on their website: http://www.imagegently.org. During the editing process, we received guidance and amazing support from the chair of the Image Gently Campaign, Dr. Donald Frush, as well as my sister, Dr. Candace Adair, who is a child and adolescent board-certified psychiatrist. If you have any questions or comments please feel free to email me directly at email@example.com.
A review of Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science
Peter Oluwaṣeyitan Bamikole, MSI
“Read Gawande.” That was the brief answer a doctor gave me when I asked him what medicine is like. So I started with this book, and thoroughly enjoyed it. To better commend it to you, I will briefly review it here. Dr. Atul Gawande, an American surgeon, opens Complications with two central assertions: “[Medicine is not] an orderly field of knowledge and procedure,” but instead “it is an imperfect science, an enterprise of constantly changing knowledge…” (Kindle p. 7). To support these claims, he compiles 14 essays loosely federated under three headings: Fallibility, Mystery and Uncertainty.
Acquiring a new skill demands a learning curve. “As patients, we want both expertise and progress. What no one wants to face is the contradiction” (p. 27). Novices improve best with experience, under expert supervision. But the skills practiced in medicine involve real-life human beings, and this makes all the difference. What ailing person wants to be practiced on? When Dr. Gawande had a sick child, he himself—at the time a resident—refused to let a resident treat his daughter. He demanded an attending. This understandable fear means that doctors must be discreet about the training process, and trained physicians are necessary handmaidens to their trainees’ mistakes.
This bothers us so much because contemporary medicine prioritizes machine-like perfection in delivering care. Dr. Gawande visited Ontario to find his illustrative example. North York’s Shouldice Hospital is a ‘hernia factory’: they exclusively perform hernia repairs, cheaper and faster than anywhere else, yet with better outcomes. From the staff to the building’s very design, Shouldice “deliver[s] hernia repairs the way Intel makes chips” (p. 40). But could this “factory model” work on a grander scale? According to Gawande, the medical establishment is wary of this sort of automation especially as it pertains to the “art” of diagnosis.
Yet, regardless of their operative model, doctors must be healers. After all, “nothing splits a patient and doctor like a mistake” (p. 45). An instance of medical error is usually seen as a case of bad doctoring. It is often not so. Medical mistakes happen. He offers this advice to physicians: be diligent, expect perfection and own your errors.
Our view of pain is historically Cartesian (“pain is like pulling on a rope to ring a bell in the brain”), but was replaced by Gate-Control theory (the spinal cord modulates pain percepts before they reach the brain, so the “bell itself modulates the rope”). Now we think pain is “all in the head.” Under this dispensation, pain and other sensations are “neuromodules” in the brain, like computer programs. But these neuromodules are entire networks (mood, emotion, memory, anticipation etc.) that together decide the threshold at which they play. Pain, therefore, “is a symphony” (p. 124). This means that a mere toe stub is more complex than we thought, and it also explains why limbless people feel limb pain. Despite its physical basis, in the brain all pain is the same. Gawande weaved the story of a patient through this essay to strengthen his conclusion: the social coordinates of chronic pain merit our attention. By paying attention to the non-physical factors that may cause pain, this new model has, surprisingly, made pain political. What unites the essays in this section is the observation that mystery comes with the territory of doctoring. So make your peace with it, early and often.
In the opening essay, Gawande cites a 1971 paper about the nature of fallibility in science. Its authors argued that in applied sciences like medicine, perfect knowledge of a particular case is impossible. For example, who knows precisely where a hurricane makes landfall? They called this “necessary fallibility.” Yet some things (like ice cubes in a fire) are firmly predictable. Ignorance and ineptitude are surmountable sources of error, but necessary fallibility cannot be helped. So in medicine, “are people more like ice cubes or like hurricanes?” (p. 198).
Autopsies are on the decline, perhaps because of “medicine’s 21st century tall-in-the-saddle confidence” (p. 193). Folk wisdom states that autopsies rarely implicate misdiagnoses in the cause of death. But the four studies Gawande provides suggest that 33 to 40 percent of autopsies revealed misdiagnoses that would have saved lives had they been caught. And these rates haven’t improved since at least 1938. For his part, Gawande reckons that humans are equidistant between hurricanes and ice cubes: “permanently mysterious” in some sense, yet—given enough systematic investigation—“entirely scrutable” (p. 199). Gawande’s final essay recounts the case of a young girl with necrotizing fasciitis, and the book ends with the unsettled nature of his treatment decision. It helps the reader see what medical uncertainty looks and, perhaps, feels like.
These 14 essays are a humanizing account of medicine for doctor and patient alike. From Gawande’s description of cutting live skin for the first time (“thick and springy”) to his reflectiveness as an author, his writing gives one a sense of what it is like to newly enter this guild. Altogether, the essays are fertile ground for thinking about what it means to practice compassionate health care amid the necessary competencies of 21st century medicine. If systems simplify modern medicine, then remember older dimensions of care like talking to patients. To reduce medical errors, go after processes, not people. Don’t be so certain about the relationship of appetite and willpower in obese people. There are many more insights to glean, and some of the essays even function as a kind of cultural anthropology. Apparently, doctors—like all humans—are a superstitious lot. Also, who knew surgeons got lonely? And prior to a medical tragedy, does anyone care? Most of these essays are open-ended and consequently great for reflection. For us who strive to worship God by serving mankind, books like this are grist for the mill.
Carla Gibbs, MSI
Biomedical Research contributes to a large portion of the United States health care services in the form of medical products, pharmaceuticals and other innovations. The United States gross domestic profit largely favors the health care industry in the United States by 17.1% in 2013. In other words, the economic value placed on goods and services in the health care sector in the United States is of extreme importance and it doesn’t take long to figure out why.
If we look to our current and past milestones, the United States has made innumerate advances in the field of biomedical research in efforts to prolong lives and alleviate suffering from diseases. Including contributions from African Americans right here at Meharry Medical College, from Dr. James Hildreth and his research team developing potential creams to block HIV infection to an unsung hero of the North Nashville community, Dr. Matthew Walker Sr, one of the first African American surgeons to become a fellow of the American College of Surgeons.
However, in some cases, research has been used as a vehicle for poor decisions including the devastating yet economic boosting institution of slavery in our country.
According to the book, Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics, by Lundy Braun, we can learn about the questionable history of the device used to measure lung capacity and gain insight on how its results falsely concluded that African Americans had lower lung capacity. Subsequently, she reveals that researchers used that data as justification for the continuation of slavery on some southern plantations. Braun’s book states that” at the end of the Civil War, a large study of racial difference employing the spirometer appeared to confirm the finding, which was then applied to argue that slaves were unfit for freedom”. Sadly, this is only one example of many, which show the impact that research can have on society.
According to one National Academy of Science Report featuring Insuring America’s Health: Principles and Recommendations, “Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage”,. The report, which provides numerous supports from research, focused on the lack of health care coverage in the U.S. and also provided noteworthy resolutions, goes on to state “providing coverage to everyone would almost certainly be greater than the additional cost of providing health care”.
Naturally, these issues of “costs versus care” are at the forefront of the impending political elections of all candidates, with resolutions spanning from repealing the affordable care act, increasing funding to NIH, to the ever-popular lowering costs of insurance coverage’s.
While spending continues to increase, may we pause for a moment to consider, what role does the budding biomedical researcher have in influencing this labyrinth of what we know as the American health care sector?
Well according to the NIH, whose current slogan is, “Turning Discovery Into Health,” there are a myriad of research topics that researchers can apply to have grant funding. And regardless of which researcher one converses with, there is no doubt a consensus that competition exists when applying for and obtaining funding. However, how can one decide where to begin in the process of developing an ethical project to meet the needs of our society? Well I first suggest determining a moral imperative by answering: Is biomedical research a service or a commodity? By Merriam-Webster definition, a commodity is an economic good. By contrast, a service is a contribution to the welfare of others. With this in mind, I believe, we can bypass ever questioning if our work will benefit others.
In reality, we have more power to enact changes in society than we know, and it starts with that very first hypothesis we make.
I want to remind everyone that researchers are heavily governed and unable to make choices and decisions that may further their goals. As a result, if we are not utilizing the leaders in and around us by voicing our concerns, as the experts in scientific knowledge, then social norms of the past will continue to persist.
At Meharry Medical College our mission clearly states, we exist to improve the health and health care of minority and underserved communities. I urge our community to be reminded of this mission as we set out to accomplish our own personal goals within the realm of biomedical research.
 Nabel, Elizabeth G. 2009. “Linking biomedical research to health care.” Journal of Clinical Investigation. 119 (Oct) : 2858. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752107/.
 Health expenditure, total (% of GDP). The World Bank (World Health Organization Global Health Expenditure)
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS. Web. 1 Nov 2015.
 A Short History of the National Institutes of Health https://history.nih.gov/exhibits/history/index.html. Web. Nov 1 2015.
|Braun, Lundy. Breathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics. Minneapolis: University of Minnesota Press. 2014.|
 “Insuring America’s Health: Principles and Recommendations”. National Academy of Sciences. 13 Jan 2004.
Originally discussed at the Las Vegas Meharry Medical College Alumni Fall chapter meeting on 10/10/2015
Luther Adair, II, MD, ‘06
- The struggle to produce doctors of color remains
- Preservation of a legacy of leadership in service to underserved communities
- There are more choices than ever now
- Opportunity to reach within our pool of resources
Number 1. The struggle to produce more doctors of color remains at many crossroads: teaching institutions such as Meharry Medical College, Morehouse School of Medicine, and Howard University College of Medicine are in prime positions to nurture community-based partnerships in order to address the shortage of underrepresented minorities in the health professions. According to the Bayer corporation in 2010, the top three reasons for minority underrepresentation in the sciences are lack of quality science and math programs in poor school districts, persistent stereotypes that minority students can’t cut it, and financial issues related to the cost of education. Furthermore, as of 2006 when I graduated from medical school, underrepresented minorities made up just 6% of all physicians and 5% of dentists.
Number 2. The second reason centers around the preservation of a legacy of leadership in service to underserved communities. The legacy of African American leaders and principles continues to be questioned or marginalized. These things are especially hurtful to the future generations who will grow up without role models that resemble them. The problems faced by underserved populations remain constant while the definition of what constitutes a minority becomes nebulous. In every city that my wife and I have lived, this population is clear. And while it doesn’t always look the same or even speak the same language, the challenge is binding.
Whether it’s “Aloha!” on the West side of Honolulu, “Hola!” in East Las Vegas, or “What’s up!” in North Las Vegas, our connection with someone in these communities or communities with similar patterns is almost certain. To know that the color of one’s skin predisposes them to certain disease processes and healthcare risks is both a threat to good science and to the United States as a world leader.
Number 3. There are more choices than ever as the world is flat. Demographics are changing in cities quicker than ever, which also provides unique opportunities for some of our students. While the world remains flat, it is not time to dilute our product but to invigorate it with more cultured and achieved participants. Meharry Medical College committed to this very principle by placing Dr. James Hildreth at the helm as president of the College this past spring. Hildreth, who is attributed with groundbreaking research in HIV prevention, is not enough. We need 130 more James Hildreth’s each year between the graduating classes of dental and medical schools.
Number 4 . Reaching within our pool of resources becomes an opportunity for us to restore faith in ourselves. The funny thing is that with the three reasons I just mentioned, minority communities, particularly the African American community, aren’t always in agreement about the strength of its resources. However, having a consolidated group of resources that you can count on is a huge help in the real world. This is the talented tenth restoring faith in itself.
Now is not the time to become inert, as if you are not in the game, you or someone you love will become a casualty of it. Let’s support our beloved alma mater as institutional level commitments are needed in this fight and this is where it all starts.
U.S. Women and Minority Scientists Discouraged from Pursuing STEM Careers, National Survey Shows, Bayer Corporation Press Release, March 24, 2010, CSR Wire, http://www.csrwire.com .
Zayas, LE & McGuigan, D (2006) Experiences promoting healthcare career interest among highschool students from underserved communities. Journal of the National Medical Association; 98:15231531. Organized Noise: Partnering with the Community to Address the Shortage of
Underrepresented Minorities in the Health Professions, Issue Brief July 2011, Kweli R. Henry. Brooklyn Health Disparities Center, http://www.downstate.edu/healthdisparities .
A Report of the Sullivan Commission on Diversity in the Healthcare Workforce, Missing Persons: Minorities in the Health Professions (2004), www.sullivancommission.org.
Baltimore , Maryland, United States, 04/02/2015 /SubmitPressRelease123/
Luther Bert Adair, Sr, M.D. was born to Ella Mae Adair in Brooklyn, New York on February 25, 1944. Raised in a foster home, he spent his childhood and youth in Nyack, New York where he accepted Christ at an early age and became active and youth activities at Berea Seventh-day Adventist Church.
After receiving his high school diploma, he enrolled at State University of New York at Fredonia and, later, transferred to Howard University where he earned a Bachelor of Science degree in Zoology. He was accepted into Howard University School of Medicine in 1967, where he served as class president his junior and senior years. Dr. Adair also distinguished himself in the field of public health. He received the annual student award in community health practice from Howard University and a public health fellowship from the American Medical Association to study in Zagreb, Yugoslavia.
Dr. Adair would go on to serve as Chief Resident in radiology at Howard University under the mentorship of Dr. Harry Press, Chair of Radiology. He was an active member of the American Medical Association, the Southern Medical Association, the American College of Radiology, the Section on Radiology of the National Medical Association, and the Radiological Society of North America. He became a Diplomat of the National Board of Examiners, earned board certification in radiology from the American Board of Radiology, and was licensed to practice in the District of Columbia, Maryland, Massachusetts, and Tennessee. In 1976, Dr. Adair entered a fellowship in neuroradiology at The Massachussetts General Hospital, a training hospital of Harvard Medical School, where he published several articles.
In 1979, at the age of 35, Dr. Adair accepted the position of Chairman of the Department of Radiology at Meharry Medical College. In addition to his administrative duties, he reorganized the Meharry Medical Practice Group, invested in the first CT Scanner at Meharry Hubbard Hospital, and founded Nashville Radiology Partners. He remained a mentor to students and Professor and Chair of the Department of Radiology until his health failed in 1988.
Interested in church and community, Dr. Adair was a member of Hillcrest Seventh-day Adventist Church. He served dutifully as an elder and a member of several committees. In 1988, under Dr. Adair’s leadership as Chair of the F.H. Jenkins Elementary School board, a new school was constructed and the curriculum expanded. Before Dr. Adair became ill, he was active in other civic groups, such as the NAACP and Omega Psi Phi Fraternity. He was a lifetime member of both organizations.
On Monday, April 4, 2005, Dr. Adair departed this life. On Friday, April 3, 2015, the Adair and Moore families gathered to celebrate his life’s achievements and also announced a scholarship to Meharry Medical College in his name.
If you don’t know what happened in Pakistan recently, here’s some background reading:
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Come support your fellow Meharry medical students displaying their independent artwork at 429 Event Space this April 5th.