Jones Tackles Medical Ethics and History

Professor David S. Jones ’97 is the A. Bernard Ackerman Professor of the Culture of Medicine and this year he is teaching a new, wildly popular class entitled Ethical Reasoning 33: “Medical Ethics and History.”  In his most recent article in the New England Journal of Medicine, he explores the evolution of therapeutics from the days of blood-letting to what we see today.

The Harvard Crimson: In your article in the NEJM you state that therapeutic skepticism drove the therapeutic revolutions in the past. What do you think is the skepticism issue of our time?

David S. Jones:  The biggest problem facing physicians now isn’t lack of good treatments for particular diseases. The big challenge is getting the treatment we have in the hands of the patients who need them, and doing so in a way that is efficient and respectful of the costs involved. There are all sorts of different facts that people have for this problem, but on average across disease categories half of patients aren’t getting the treatments that they need that physicians have already discovered. There is certainly always room for people to discover new and better treatments going forward—what we really need right now is new and better ways to deliver.

THC: What got you interested in studying the history of science?

DSJ: I had been a history of science major as an undergraduate, many years ago, but I wasn’t at all interested in history of medicine. At that time, I had made a point of avoiding history of medicine altogether. I think one of the things that interests me, especially when I started medical school, was the very narrowed, focused scientific perspective that was emphasized. You had to learn anatomy, you had to learn biochemistry, you had to learn all this stuff—often it felt like it was a step removed from the experience of the patients and also wasn’t directly referable to the real challenges of providing good healthcare. It’s one thing to have great treatments, but if you don’t have good relations with your patients or you don’t have good healthcare delivery systems, or you don’t understand what barriers exist in people’s lives outside of the clinic, those are the things that deliver treatment. I really found that it was the social sciences—it was history, anthropology, or sociology—that can often produce perspectives that are generally neglected by physicians but can make a huge difference to what physicians actually deduce.

THC: You are teaching a very popular new class this semester Ethical Reasoning 33: Medical Ethics and History. What do you want your students to get out of this class?

DSJ: It’s a course that’s in the Gen. Ed. Program, so what I want students to get out of it is what the Gen. Ed. Program wants students to get out of these classes, which a recognition of how scholarly attention to some problem that we study in the classroom has relevance to the world outside the classroom. Presumably all of the students in the class have seen doctors in their lives and all of them will see doctors between now and until they die and all of them have parents, grandparents, relatives who interact with the healthcare system. Anyone who interacts with the healthcare system encounters the various ethical dilemmas that are inherent in healthcare, and so by helping these students think through these problems now,  by showing them how philosophers, historians, and social scientists approach these problems, the hope is that they will be able to better think about these problems in the future whether they encounter them as patients or whether they encounter them as physicians.

THC: What advice would you give to students interested in medical ethics and history of science?

DSJ: Major in history of science! Not as many people have gone into serious social studies of medicine since many people have gone into basic science. There are loads of interesting things about disease, about health care that have only begun to be studied. So there are loads of opportunities for people who develop the expertise in history or sociology or anthropology to make real contributions, not just to history or anthropology but to the questions of how we understand the causes of disease, how we design healthcare systems and what we can do to improve the experience of patients. So there are really wonderful opportunities for people who are interested in these questions.