Two new medical schools are planned for England as part of a programme to boost student numbers by more than 1000 from October 2003 and to draw on applicants from a broader social background.

The new medical schools–one based jointly at the universities of Brighton and Sussex and the other jointly at the universities of Hull and York, aim to attract more students from middle and lower income families, according to the Department of Health.

But the BMA has warned that students will be able to afford to embark on a

degree in medicine only if more funding is made available to support their studies. Kate Duffield, chairwoman of the BMA’s Medical Students Committee, said that levels of debt among medical students was putting many people off a career in medicine.

“Ever since the government replaced grants with loans and introduced tuition fees, debt amongst medical students has risen to such a level that it has made it impossible for many talented potential doctors to consider a career in medicine,” she said. “Medicine is far more expensive than other courses due to the length of the course, the high cost of medical text books and equipment, shorter holidays with less time for temporary work, and the need to dress formally during the practical elements of training.”

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On its surface, the ripples of development activity generated by the Bayh-Dole Act seem to know no containment. The 1980 act has spurred technological development and led to massive reinvestments by the country’s universities. In the medical field, the policy preceded a wave of new pharmaceuticals development, with almost 400 new therapeutic agents in clinical trials in the field of ontology alone.

The field of healthcare, in fact, is of singular note with regard to the Bayh-Dole Act. Medicine may be the one field wherein the principles of Bayh-Dole hit the wall of controversy–a controversy which has become more pronounced as a number of voluntary standards have emerged which seem to cut against the grain of the federal Law.

It all has to do with conflicts of interest. Recent trends may indicate an inherent contradiction in the Bayh-Dole Act’s policies, at least vis-a-vis medical care. For since a number of tragic deaths in the late 1990s, professional medical organizations have been devising conflict-of-interest rules for healthcare-related research, and in March 2003, the federal government followed suit with the publication by the U.S. Department of Health and Human Services (www.dhhs.gov) of a voluntary guidance on the subject. Last fall, the trend came full circle as the Association of American Medical Colleges (www.aamc.org) published its standards for institutional conflicts of interest in biomedical research.

Problem is, there are a lot of dollars attached to the patent interests in that research. According to the most recent license survey by the Association of University Technology Managers (www.autm.net), in the past 10 years, federal government research expenditures at U.S. hospitals and medical research institutions have nearly tripled, rising from just over half a billion dollars in 1991, to $1.47 billion in 2001. Patents filed by these institutions rose from 416 in 1991, to 1,212 in 2001, according to the survey.

American medical schools, some say, seem to have an inherent financial conflict whenever they host clinical trials on technology in which they hold a patent interest.

The Evolution of a New Standard?

Let’s step back a bit, for a refresher course on the Bayh-Dole Act itself.

The 1980 Act gives research institutions the right to seek a patent interest in discoveries made with federal funds. Institutions generally proceed to license the technology at a fairly early stage, thereby garnering more investment dollars to conduct clinical trials (eventually, on human subjects), as a drug, device, or discovery gradually makes its way from the level of basic science all the way to the marketplace.

And the law places other requirements on those institutions which choose to patent a discovery funded with federal money, reminds William Tew, assistant provost and assistant dean at Johns Hopkins School of Medicine (MD). “It requires that we seek licensees, that we show preference for small companies; and that we share the income with the inventor, for the inventor’s personal use,” he says. “Like some other institutions, Johns Hopkins shares 35 percent of the net value with the inventor,” he adds.

Still, it is because of this patent interest that some analysts theorize research institutions and their employees have a financial conflict of interest, which gives rise to two concerns in research: 1) the objectivity of the research itself, and 2) especially in the healthcare field, the protection of the human research subjects. Medical advances usually must undergo clinical testing on significant populations of human subjects before the FDA allows them to be marketed, but these clinical trials may be conducted at the patent-owning institution, at another institution, or independently by a “contract research organization” (CRO).

Since the tragic death of Jesse Gelsinger, a healthy teenager who participated in a gene therapy trial and died in 1999, it is the issue of human participant protection which has gotten the most attention. The financial interest of the individual inventors, as pointed out by Tew, has received regulatory attention for some time. By federal law, those conducting a clinical trial on human participants must disclose financial interests above a certain threshold amount ($10,000 or 5 percent equity, according to the U.S. Public Health Service regulations).

But it is not merely the share of the license interest that is relevant here, onlookers insist. Doctors running a clinical trial may also receive funding from the trial’s sponsor (the pharmaceutical company, which may have licensed the drug from the university). And in some circumstances, the doctor may receive speaking honoraria or other compensation from the trial sponsor. Yet, in all of this, the question of the independence of the research institution itself often went unaddressed. Even after the death of Jesse Gelsinger (as the American Society of Gene Therapists, the American Society of Clinical Oncology, and the Association of American Medical Colleges devised frameworks for regulating individual conflicts of interest in clinical research), nobody was really asking whether the institution itself could be objective.

But research institution administrators and academics maintain they are indeed sensitive to institutional culpability. Some of the voluntary frameworks of the professional organizations even surpass the federal rules, they insist. “We don’t allow clinical investigators to accept any money at all from sponsors,” says Lisa Bero, professor of Clinical Pharmacy and Health Policy at the University of California-San Francisco. UCSF holds the patents for the research that led to the hepatitis B vaccine, and (along with California’s Stanford University), the Boyer-Cohen cloning technique, making it something of an 800-pound gorilla in the field, according to UCSF Executive Vice Chancellor Regis Kelly.

Clearly, there have been other decisions made in favor of removing institutional conflicts of interest during clinical trials. “I have direct experience whereby in the presence of a financial conflict, an institution has said, ‘This is not the place to conduct a Phase III trial’” reports Susan Ehringhaus, vice chancellor and general counsel for the University of North Carolina at Chapel Hill. Ehringhaus is also incoming associate general counsel in Regulatory Affairs for the AAMC. “The AAMC taskforce on conflicts felt that it was extremely important for academic medical centers, teaching hospitals, and schools to take a leadership role in defining the standard for conflicts of interest,” she says. “They proceeded in an attitude of some skepticism regarding the ability of science to police itself. The standards which the AAMC urge are intended to supplement the government standard,” she asserts.

And indeed, in October 2002, the AAMC did supplement its policy on individual conflicts with one on institutional conflicts. It suggested, among other things, that institutions ought to examine their involvement when they hold an equity interest in a nonpublicly traded sponsor, or an interest worth $100,000 or more in a publicly traded one. In March 2003, HHS issued its own draft guidance, which offers an analysis regarding institutional conflicts. “The standard the AAMC offers is consistent with the government standard,” Ehringhaus says.

What the Rules Provide

High-level talk about reforming the clinical trial process is nothing new. For all its success, the American drug and technology discovery process has always been the center of a firestorm of controversy. When, for instance, it has not responded to the need for a streamlined process to make treatments for previously untreatable fatal conditions available to the public, the government has tried to come up with new approaches. This time, however, there is even more momentum behind government efforts–and that’s because there is concern both about the reliability of data and the well being of enrollees.

The series of policies, rules, and guide Lines issued since 2000 vary in their provisions, details, and, importantly, in their exceptions, but they all have one thing in common: ALL four of those issued as of this writing detail greater responsibility and heightened scrutiny in reviewing potential conflicts of interest for the research institution, the clinical investigators, and any other clinical investigators, including those from the healthcare and pharmaceutical industries.

visit for more @ medical & health

On its surface, the ripples of development activity generated by the Bayh-Dole Act seem to know no containment. The 1980 act has spurred technological development and led to massive reinvestments by the country’s universities. In the medical field, the policy preceded a wave of new pharmaceuticals development, with almost 400 new therapeutic agents in clinical trials in the field of ontology alone.

The field of healthcare, in fact, is of singular note with regard to the Bayh-Dole Act. Medicine may be the one field wherein the principles of Bayh-Dole hit the wall of controversy–a controversy which has become more pronounced as a number of voluntary standards have emerged which seem to cut against the grain of the federal Law.

It all has to do with conflicts of interest. Recent trends may indicate an inherent contradiction in the Bayh-Dole Act’s policies, at least vis-a-vis medical care. For since a number of tragic deaths in the late 1990s, professional medical organizations have been devising conflict-of-interest rules for healthcare-related research, and in March 2003, the federal government followed suit with the publication by the U.S. Department of Health and Human Services (www.dhhs.gov) of a voluntary guidance on the subject. Last fall, the trend came full circle as the Association of American Medical Colleges (www.aamc.org) published its standards for institutional conflicts of interest in biomedical research.

Problem is, there are a lot of dollars attached to the patent interests in that research. According to the most recent license survey by the Association of University Technology Managers (www.autm.net), in the past 10 years, federal government research expenditures at U.S. hospitals and medical research institutions have nearly tripled, rising from just over half a billion dollars in 1991, to $1.47 billion in 2001. Patents filed by these institutions rose from 416 in 1991, to 1,212 in 2001, according to the survey.

American medical schools, some say, seem to have an inherent financial conflict whenever they host clinical trials on technology in which they hold a patent interest.

The Evolution of a New Standard?

Let’s step back a bit, for a refresher course on the Bayh-Dole Act itself.

The 1980 Act gives research institutions the right to seek a patent interest in discoveries made with federal funds. Institutions generally proceed to license the technology at a fairly early stage, thereby garnering more investment dollars to conduct clinical trials (eventually, on human subjects), as a drug, device, or discovery gradually makes its way from the level of basic science all the way to the marketplace.

And the law places other requirements on those institutions which choose to patent a discovery funded with federal money, reminds William Tew, assistant provost and assistant dean at Johns Hopkins School of Medicine (MD). “It requires that we seek licensees, that we show preference for small companies; and that we share the income with the inventor, for the inventor’s personal use,” he says. “Like some other institutions, Johns Hopkins shares 35 percent of the net value with the inventor,” he adds.

Still, it is because of this patent interest that some analysts theorize research institutions and their employees have a financial conflict of interest, which gives rise to two concerns in research: 1) the objectivity of the research itself, and 2) especially in the healthcare field, the protection of the human research subjects. Medical advances usually must undergo clinical testing on significant populations of human subjects before the FDA allows them to be marketed, but these clinical trials may be conducted at the patent-owning institution, at another institution, or independently by a “contract research organization” (CRO).

Since the tragic death of Jesse Gelsinger, a healthy teenager who participated in a gene therapy trial and died in 1999, it is the issue of human participant protection which has gotten the most attention. The financial interest of the individual inventors, as pointed out by Tew, has received regulatory attention for some time. By federal law, those conducting a clinical trial on human participants must disclose financial interests above a certain threshold amount ($10,000 or 5 percent equity, according to the U.S. Public Health Service regulations).

But it is not merely the share of the license interest that is relevant here, onlookers insist. Doctors running a clinical trial may also receive funding from the trial’s sponsor (the pharmaceutical company, which may have licensed the drug from the university). And in some circumstances, the doctor may receive speaking honoraria or other compensation from the trial sponsor. Yet, in all of this, the question of the independence of the research institution itself often went unaddressed. Even after the death of Jesse Gelsinger (as the American Society of Gene Therapists, the American Society of Clinical Oncology, and the Association of American Medical Colleges devised frameworks for regulating individual conflicts of interest in clinical research), nobody was really asking whether the institution itself could be objective.

But research institution administrators and academics maintain they are indeed sensitive to institutional culpability. Some of the voluntary frameworks of the professional organizations even surpass the federal rules, they insist. “We don’t allow clinical investigators to accept any money at all from sponsors,” says Lisa Bero, professor of Clinical Pharmacy and Health Policy at the University of California-San Francisco. UCSF holds the patents for the research that led to the hepatitis B vaccine, and (along with California’s Stanford University), the Boyer-Cohen cloning technique, making it something of an 800-pound gorilla in the field, according to UCSF Executive Vice Chancellor Regis Kelly.

Clearly, there have been other decisions made in favor of removing institutional conflicts of interest during clinical trials. “I have direct experience whereby in the presence of a financial conflict, an institution has said, ‘This is not the place to conduct a Phase III trial’” reports Susan Ehringhaus, vice chancellor and general counsel for the University of North Carolina at Chapel Hill. Ehringhaus is also incoming associate general counsel in Regulatory Affairs for the AAMC. “The AAMC taskforce on conflicts felt that it was extremely important for academic medical centers, teaching hospitals, and schools to take a leadership role in defining the standard for conflicts of interest,” she says. “They proceeded in an attitude of some skepticism regarding the ability of science to police itself. The standards which the AAMC urge are intended to supplement the government standard,” she asserts.

And indeed, in October 2002, the AAMC did supplement its policy on individual conflicts with one on institutional conflicts. It suggested, among other things, that institutions ought to examine their involvement when they hold an equity interest in a nonpublicly traded sponsor, or an interest worth $100,000 or more in a publicly traded one. In March 2003, HHS issued its own draft guidance, which offers an analysis regarding institutional conflicts. “The standard the AAMC offers is consistent with the government standard,” Ehringhaus says.

What the Rules Provide

High-level talk about reforming the clinical trial process is nothing new. For all its success, the American drug and technology discovery process has always been the center of a firestorm of controversy. When, for instance, it has not responded to the need for a streamlined process to make treatments for previously untreatable fatal conditions available to the public, the government has tried to come up with new approaches. This time, however, there is even more momentum behind government efforts–and that’s because there is concern both about the reliability of data and the well being of enrollees.

The series of policies, rules, and guide Lines issued since 2000 vary in their provisions, details, and, importantly, in their exceptions, but they all have one thing in common: ALL four of those issued as of this writing detail greater responsibility and heightened scrutiny in reviewing potential conflicts of interest for the research institution, the clinical investigators, and any other clinical investigators, including those from the healthcare and pharmaceutical industries.

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The Association of American Medical Colleges (AAMC) has reported that U.S. medical schools and teaching hospitals had a combined economic impact of over $326 billion and employed one out of every 54 wage earners in the U.S. labor force during 2002. The study, “The Economic Impact of Medical College and Teaching Hospital Members of the Association of American Medical Colleges,” measures the financial contributions of the association’s member institutions in the regions in which they are located and the nation as a whole. The report found that AAMC medical schools and teaching hospitals are major employers in their home states, accounting for 2.7 million jobs directly or indirectly in 2002. The report also corrects a major misconception that medical schools and teaching hospitals do not generate revenue for respective state governments. Although these institutions are generally not-for-profit, they still helped generate significant revenue in state income taxes producing a total ors 14.7 billion in state government revenues. Within their states, these institutions also generate additional government monies by paying sales taxes, corporate net income taxes and capital stock/franchise taxes that extend their contributed benefit beyond their traditional missions of education, research, and patient care. In addition, the study found that AAMC members generate $14 billion in out-of state medical visitor related revenue. This total includes $1 billion in direct spending, outside of medical schools and teaching hospitals by out-of-state patients, as well as another $1.5 billion spent by the friends and family who visit these patients. These institutions are also major sponsors of meetings, seminars and symposiums in their states. Tripp Umbach Healthcare Consulting, Inc. prepared the report for the AAMC.

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DIABETES is one of the most common chronic diseases of childhood, with 13,000 new cases diagnosed annually in children. In all, there are an estimated 125,000 youths under 19 years of age with diabetes in the U.S.

Most have type 1 diabetes, and must receive insulin through either injections or an insulin pump. Insulin taken in this manner does not cure diabetes and may cause the student’s blood glucose level to become dangerously low. But in recent years, there has been a huge increase in type 2 diabetes (the form of the disease that typically afflicts adults) victimizing youngsters. Health experts say this may be due to the increase in obesity and a decrease in physical activity in young people.

The surging numbers of youth with diabetes present particular challenges for parents and school systems. Federal laws protect children with diabetes. Under these laws, diabetes is considered a disability, and it is illegal for schools and/or day care centers to discriminate against children with disabilities. In addition, any school that receives federal funding, or any facility open to the public must reasonably accommodate the special needs of children with diabetes.

Federal law requires that accommodations be provided within the child’s usual school setting with as little disruption to the school’s–and the child’s–routine as possible. Allowing the child full participation in all school activities is the key to effective school care.

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News of a recent study by a Connecticut newspaper suggesting that graduates of Howard and Meharry medical schools were among the nation’s most reprimanded physicians left officials at both institutions and their alumni steaming with rage.

The study, conducted by The Hartford Courant and published the last week in June, called into question the academic quality of the two historically Black medical schools, the competence of their graduates and the future of the medical students who currently attend them.

“Classmates that I have spoken with are outraged,” says Dr. David Travillion, a 2002 graduate of Meharry Medical College in Nashville, and a resident at the University of Texas Health Science Center in San Antonio. Travillion heard about the newspaper’s findings while listening to an interview with one of the study’s authors on National Public Radio.

“The report made me feel self-conscious at first,” he says. “I expected to be confronted by colleagues…. I think it will bring unwarranted scrutiny on Meharry graduates.”

Both Howard, Meharry and a number of other organizations in the medical profession questioned the newspaper’s methodology and, therefore, its findings. Among them were Dr. Jordan Cohen of the Association of American Medical Colleges; Dr. L. Natalie Carroll, president of the National Medical Association; and Dr. Roxane Spitzer, CEO of Meharry’s teaching hospital, Nashville General.

“We are reviewing the methodology employed by The Hartford Courant,” a statement on Howard University’s Web site, posted July 7, said. “We also question the failure of The Hartford Courant to appropriately distinguish the type and manner of discipline involved in these cases and the reasons for the discipline. There is no way to determine, based upon the article, whether the discipline was in the form of an admonition, censure, suspension or revocation of license.”

Carroll of the National Medical Association, the leading organization of African American physicians, said in a July 1 letter to the newspaper’s editor:

“We at the National Medical Association are extremely disturbed by the article’s unsubstantiated findings and the sweepingly negative implications upon the medical community at large, and specifically upon two premier medical colleges that have educated a large number of the nation’s physicians of color.”

Prior to the newspaper’s publication of the articles, Meharry President John Maupin said he asked one of the reporters of the study if the school could have access to the data in order to properly review them. The reporter said he would share some of it but not all, according to Maupin.

“Without being provided with the data in full, in the same format as it was obtained by the newspaper, we felt denied the opportunity to make an informed response,” Maupin said in a July 18 interview.

Regarding the methodology, Maupin said:

“First, we still don’t know what methodology the paper used…. The paper did not provide the complete analysis of the data, explaining their precise methodology. In fact, the most basic question concerning this group of physicians, ‘When did they graduate from medical school’? was never addressed in the article.

“Second, the paper looked at all disciplinary actions taken as a result of any infraction. … Without knowing the specifics of the infractions, it is impossible to judge how a physician’s medical school experience may have ultimately contributed to it…. Finally … there are any number of factors one must thoroughly review if trying to determine the causal relationship associated with disciplinary action against a physician. It is erroneous and just simply faulty to make a direct relationship between disciplinary actions and the quality of medical school education alone.”

The implications of the study’s findings were not lost on The Hartford Courant’s editorial staff. The newspaper ran the lead article with the stark title, “Med Schools: Four That Flunk.” After analyzing three separate databases, the study author’s concluded that Meharry and Howard, along with the Autonomous University of Guadalajara in Mexico and Manila Central University in the Philippines, were the only “elite” medical schools in the United States that were in the bottom 5 percent of all three databases. The Courant defined “elite” as “larger, well-established schools.” Graduates of these well-established schools made up 90 percent of the doctors in the three databases that the newspaper analyzed, according to the Courant. The databases, which included the consumer advocacy organization Public Citizen’s “Questionable Doctors” and two “physician profiles” maintained by California and Ohio, listed doctors who had been disciplined by federal and state regulators.

Jack Dolan, one of the two reporters of the Courant study said the newspaper struck a balance in its coverage by writing “the stories with an eye toward the remarkable challenges Howard and Meharry have faced over the decades.” As part of the two-day series, the newspaper reported a separate story on the historically Black medical schools entitled, “Black Medical Schools Struggle to Compete,” which ran June 30. The article discussed some of the factors, besides academics, that could have landed the schools at the bottom of the study. Among the other factors discussed were racism, inadequate funding, increased competition for good African American students, serving underserved students, and graduates serving underserved communities.

In a statement released to Black Issues, Howard officials pointed out that a significant number of their graduates serve disadvantaged communities:

“We expect our graduates to provide an exceptional level of service to the nation. And they do. In the most recent review, nearly 40 percent of Howard-trained physicians had returned to practice in America’s inner cities, where many patients are economically disadvantaged and medically underserved. In treating this segment of the population, physicians often provide medical services to patients suffering from more advanced stages of disease before help is sought and, consequently, requiring more complex treatment,” said the statement.

As well, Maupin is proud of the fact that Meharry admits some students from “disadvantaged backgrounds,” and that many of its graduates tend to practice in traditionally underserved medical professions and underserved areas. Instead of suggesting that those were culprits in the newspaper’s finding, Maupin instead wonders whether cultural or racial factors cause Black physicians to be disciplined more than others.

“We know that pockets of racism still exist in this country and do thread their way throughout society,” he says. “Therefore, we do believe that racism and ignorance of cultural differences probably do play a role in some, if not many, of the disciplinary actions taken.”

Along those lines, some have accused the newspaper of being racist.

“I know why they think that, and I don’t blame them,” Dolan says. “All I can say is that when I did the initial computer query, I wasn’t expecting to see Howard and Meharry. The results were a genuine surprise.”

The results also presented a dilemma for the newspaper, according to Dolan.

“Challenging governments and powerful industry organizations is our job, and we don’t shrink from it. But this time we found ourselves with evidence that basically noble, traditionally under-resourced institutions, were producing doctors who go on to endanger their patients at higher rates than other schools. That presented a dilemma. Ignoring our findings would have meant withholding important information from the public…. The flip side is that writing these stories was bound to bring some grief on people–graduates who have never been disciplined, for example–who don’t deserve it.”

Howard and Meharry are two of the four historically Black medical schools in the United States. The two schools graduated the most African American physicians in 2002, according to Black Issues’ Top 100 graduate report (see Black Issues, July 3).

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According to the Association of American Medical Colleges, the number of African-American applicants and women of all races has increased in the nation’s 126 accredited medical schools this school year, the San Francisco Chronicle reports.

The number of African-American applicants rose nationwide by almost 5 percent to 2,483, but the number who actually enter medical school in 2003 declined by almost 4 percent to 1,089, the report states.

Overall the number of individuals, men and women, applying to medical school increased nationally by 3.4 percent, from 33,625 for last year’s class to 34,785 for the class of 2003.

The Association of American Medical Colleges states that the rise in applications reverses the negative trend that began after 1996 when the number of applicants to medical school peaked at 47,000.

Dr. Jordan Cohen, president of the Association of American Medical Colleges, attributes the boost to people who are looking for new career paths and says that “opportunities in other areas are not as great,” according to the Chronicle.

Dr. Cohen added that racial and gender diversity are important in medical schools because of the increasingly diverse U.S. population and because it gives other students a multiracial and multicultural perspective and sensitivity.

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According to the Association of American Medical Colleges, the number of applicants to U.S. medical schools is on the rise after a six-year decline. Almost 35,000 persons applied to attend medical school in the 2003-2004 school year, which is a 3.4 percent increase over the previous year’s number of applicants (33,625). Women made up the majority of applicants for the first time, with an increase of almost 7 percent over the previous year. Almost 10 percent more black women applied, but the overall number of blacks who entered medical school declined by about 4 percent. The sharp decline in men applying to medical schools, a trend that started in 1997, leveled off for the 2003-2004 school year.

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In 1980, when Bill McDade entered medical school at the University of Chicago, he was the only African American student in his class. “I felt very isolated,” said McDade, who graduated in 1990 and then did his residency at Harvard University’s Massachusetts General Hospital. “I came to all the classes. I took all my own notes. I never really collaborated with anybody in terms of studying in medical school.”

In the 24 years since, the U.S. Supreme Court has declared that university admissions boards can include race among the factors they use to weigh applicants, and several Chicago medical schools have developed recruitment programs to attract “underrepresented minorities”–blacks, Latinos and Native Americans.

But none of this has made Odey Ukpo’s class at Loyola University Chicago any different from McDade’s. Ukpo is also the only African American in his medical school class this year. “It is an environment that I’ve gotten used to,” he said. He recalls being the only black student in honors and advanced placement courses in high school and one of only a handful of biochemistry majors as an undergraduate at Loyola Marymount University in California. “There are obviously relating issues and things that are different between me and the other students,” he said. “But, when it comes down to school, this is just how it’s always been for me.”

Despite several efforts to actively boost their enrollment, African American and Latino students still are not attending any of the Chicago-area medical schools in large numbers, especially in comparison with the area’s general population.

Cook County is 26 percent African American and 20 percent Latino, and blacks and Latinos together make up about 23 percent of all the students at the city’s 10 largest universities. But, in 2002, blacks were 6 percent of the students in Chicago-area medical schools, and Latinos were 4 percent. Whites were 52 percent of all students at the medicals schools, and Asians were 30 percent.

Officials at six medical schools-the University of Chicago, Loyola University, the University of Illinois at Chicago, Northwestern University, Rush Medical College and The Chicago Medical School-say that increasing those numbers is vital in order to address the striking health care gap that separates white from black and Latino communities, since African American and Hispanic health professionals are more likely to practice medicine in those underserved areas. But the future of focused recruitment efforts is unclear, as minority programs and admissions policies at universities across the country have been halted under pressure from two anti-affirmative action groups.

Nationwide, the number of blacks enrolled in medical schools has dropped by 6 percent in the last decade. Last year, blacks and Latinos made up about 13 percent of all entering medical school students nationwide-about half of their percentage in the general population.

But those numbers don’t trouble the Center for Equal Opportunity or the American Civil Rights Institute. The groups are leading a nationwide battle against admissions policies and programs that “racially discriminate” against whites and Asians. They say that deliberately boosting the numbers of blacks and Latinos will force schools to admit less-qualified students.

“I don’t think that we should expect the medical profession or any other profession to mirror precisely the racial and ethnic makeup of the rest of the country,” said Roger Clegg, vice president and general counsel for the Center for Equal Opportunity, a nonprofit public policy research organization in suburban Washington, D.C.

“There is no question that some students have more advantages than other students do,” said Clegg, who is white. “If the justification for the [minority] programs is to identify students who come from disadvantaged backgrounds, then the criteria should be economics and not race.”

But some school officials said that increasing the number of black and Latino medical students does not require them to come up with different standards, just different strategies.

“We don’t have any different set of criteria, don’t relax standards for [minorities],” said Dr. Raymond Curry, executive associate dean for Northwestern’s medical school, who is white. “It’s simply a matter of how actively you recruit minorities. We have that responsibility as a major urban medical center.”

Finding blacks and Latinos for medical school involves “casting a wide net” across the entire board of applicants, said Dr. Jorge Girotti, associate dean of admissions at the UIC medical school. He said UIC looks at college grades and Medical College Admissions Test scores, but also tries to account for challenges the applicants have overcome–such as working a part-time job while attending school.

Admissions policies considering these circumstances provide more opportunities to blacks and Latinos, but Girotti argues this does not mean the school is admitting underqualified students. “College grades and MCAT scores only tell you part of the story,” said Girotti, a Latino who is also the director of the medical school’s Hispanic Center. “By considering conflicts students have faced, we find people who can survive medical school.”

Each summer, the UIC medical school offers a six-week introductory term for as many as 60 newly admitted students-mostly blacks and Latinos–who lack undergraduate science degrees. The school also identifies 12 to 14 applicants each year for its post-baccalaureate program, a federally funded, yearlong curriculum for students without strong science backgrounds. Students receiving a “B” grade or higher and achieving required MCAT scores are guaranteed acceptance into the medical school.

Of all Chicago-area medical schools, UIC has traditionally had the highest representation of blacks and Latinos. In 2002, 9 percent of its students were African American, and 10 percent were Hispanic, according to data from the Illinois Board of Higher Education.

While Girotti thinks the programs help attract blacks and Latinos, he believes word-of-mouth is a stronger recruitment tool. “The diverse environment at UIC supports itself because minority students encourage other minorities to apply,” he said.

By contrast, McDade said the University of Chicago has traditionally had an “unfriendly reputation” among blacks and Latinos. “If you are the only one of anybody in your class, it’s very hard to find a group of people with whom you mesh, who understand where you come from and are interested in trying to work with you to become part of a larger group,” said McDade, who returned to the University of Chicago in 1994. Now, as the medical school’s associate dean of multicultural affairs, he works to recruit more underrepresented students.

Historically, the University of Chicago and other private medical schools in the area have not succeeded in recruiting as many African American and Latino students as UIC. Some officials pointed to higher tuition and fewer scholarships as explanations. Tuition at each of the private medical schools can be three times as high as the tuition at UIC, the only public medical school in the Chicago area.

Girotti said the lack of black and Latino medical school students reflects the dearth of black and Latino applicants–the result of poor academic preparation and advice those students have received. Hispanic students at UIC have told him that they were discouraged by their high school teachers and counselors to pursue math and science careers, he said.

Students from many black and Latino neighborhoods might lack motivation to aim for medical school, said Ukpo, president of Loyola’s Student National Medical Association, a group of minority students that encourages underrepresented minorities to enter medical school. “[They have] this feeling that they can’t do it,” he said. Loyola’s medical school enrollment in 2002 was one of the least diverse in the Chicago area, with African Americans and Hispanics each making up less than 3 percent of the student body.

“I don’t see the number of minorities in medical schools increasing the next few years,” said Ukpo. “We need to change access to education, even before college, so that the minorities will be prepared to be competitive medical applicants. I think that change will take a radical reform. It’s going to be a long process.”

But admissions officials at several medical schools said that increasing the number of black and Latino medical students will be more difficult because of the growing anti-affirmative action sentiment they’ve witnessed in the past five years.

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Long the dream of the Manhattan Beach Unified School District nursing team, a district Medical Advisory Board was launched two years ago. An expert team of medical personnel was invited to join with our district staff to guide personnel who deal with student health issues. As this pioneering group left its first meeting in June 2002, members knew they would be making a powerful contribution to the well being of our students.

How it started

Due to the many advances made in the field of medicine in recent years and the increasing populations of students with complex medical issues, school personnel felt a need to tap into additional professional resources. As general medical concerns and treatments changed, district leaders were faced with challenging decisions that affected individual students and the larger student population.

Over the years, district nurses had kept an ongoing list of medical professionals they could contact for specific student health issues. As needs of students grew, this “medical Rolodex” expanded, with the names of pediatricians, adolescent medicine experts and other specialists who were supportive in caring for our students.

In one fortuitous meeting, district nurse Judi Zimmerman had a conversation with prominent endocrinologist Dr. Kevin Kaiserman about the idea of a Medical Advisory Board that could meet regularly to guide our staff. His enthusiastic response and willingness to step in to lead the group was all the impetus that was needed for the board to be formed.

When another district nurse, Tami Simmons, had a similar conversation with her daughter’s pediatric ophthalmologist, Dr. Anne Simon, she responded with the same spirited energy.

Now that a core team of professionals was willing to come forward, some logistical planning was required. An outline stating the purpose, participating groups, time lines, focus areas and meeting dates was developed. This proposal provided a protocol for the new board to follow.

In order to facilitate record-keeping, some secretarial time was needed. A grant request developed by our business partnership coordinator was subsequently supported by the nearby Torrance Hospital Medical Center. Since Medical Advisory Board members meet in the evenings after their busy work days, part of the grant included a much-appreciated dinner for the triennial meetings. This dinner perk has prompted greater camaraderie and a “conversation period” that has bonded the group in support of our mission.

The medical personnel on the initial invitation list included an endocrinologist, pediatric gastroenterologist, pediatric cardiologist, infectious disease specialist, dermatologist, dentist, adolescent medicine specialist, clinical psychologist, pediatric ophthalmologist, emergency room physician, allergist, orthopedist and podiatrist. The director of a local urgent care facility and a director of the free clinic were also included. Fifteen letters were mailed to this select group, and all 15 professionals enthusiastically agreed to join the board.

Learning from each other

It is now more than two years later, and the Medical Advisory Board has emerged as one of the most valuable teams guiding our district. Participating physician Dr. Charles Song, an asthma and allergy expert, reflected on the significance of the group: “I thought the idea of the medical board was wonderful, because the physicians could offer expert opinions in their specialties to the school community and they could learn from each other.

“I personally was interested because I have been involved with a summer camp for children with asthma and with an asthma education outreach program. Allergy problems affect more than a fifth of our school children and the incidence rate is on the rise. It was a natural thing for me to be interested in the board and to share whatever expertise I have to assist our children.”

No shortage of issues

From the first meeting, it was clear that the health of the students was everyone’s primary concern, and the discussions were lively. Issues emerged that would fill dozens of agendas, including childhood obesity, soft drinks on campus, the rise in Type2 diabetes and guidelines for medicine distribution at school sites.

For example, board policies were changed to reflect new information on inhalers/nebulizers at school as well as rules regarding students with rashes. Dr. Joanna Wong obtained donations of nebulizers from a drug company for the schools, so that parents need only bear a portion of the treatment costs.

A subcommittee of the board worked with the Mira Costa High School vice principal to develop a new “Pre-Participation Physical Education” form implemented in 2004-2005 that is proving to be more comprehensive and succinct than the old form.

Physician review of forms

Physicians continue to generously offer their expertise in reviewing standard forms, such as our “Requests for medication during school hours,” among others. Templates have been developed related to “Guidance on Ozone Pollution and Physical Activities,” and a position paper from a Medical Advisory Team provided detailed recommendations regarding the role of schools in promoting a healthy lifestyle. Our dentist member provided all schools with a valuable protocol for dental emergencies.

Each year, the Medical Advisory Board has expanded to include new members, including more pediatricians and two psychiatrists. We hope in the near future to add a pediatric neurologist. Most telling for our efforts is the exceptional attendance rate and the enthusiastic involvement of all participants during the meetings.

Greater security for students

As medical expertise expands and the needs of our children grow, the support of this Medical Advisory Board team will continue to be an indispensable component of our district’s services. Hundreds of hours of contributions, years of expertise, and an exponential commitment from this dedicated and committed team have reaped peace of mind for our staff and students’ families and–ultimately–greater security for our children.

The end of ‘us vs. them’

Board member Dr. Linda Schack said, “I think many physicians have an ‘us vs. them’ view of the schools. Doctors have to fill out cumbersome forms, our patients have medical problems that have implications for school and we don’t know who to call, or the school is not allowing our patient to attend class because of illness and we don’t agree with the decision. We have talked about all of these issues and more while working on the board.”

Dr. Schack said, “I have been on several volunteer boards in the past, and sometimes the experience is that there are many meetings and discussions and very little gets accomplished. This board is very different. The district nurses should be commended for such an innovative concept.”

Gwen Gross is superintendent of Manhattan Beach Unified School District. Judi Zimmerman (RN, MSN) and Tami Simmons (RN, BSN) are nurses for the district.

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