Another lesson from anthrax

Yale Medicine’s roundtable on bioterrorism was an encouraging take on a very discouraging subject (“Lessons from Anthrax,” Spring 2002). It was particularly heartening because so much care has gone into thinking about how to deal with the possibility of great tragedy.

The big issue that those interviewed skirted, however, was the politics of coercion in public health policy. This is an old issue within public health, certainly. But it becomes much more salient as discussions proceed about mass vaccination for diseases such as smallpox and anthrax, either before or during an epidemic.

Under what circumstances would it be permissible for the federal or state governments to require vaccination for such diseases? Right now, most public health authorities are advocating only “ring vaccination” in case of an outbreak of smallpox. And even Anthony Fauci has eloquently written in a recent issue of The New England Journal of Medicine that the formulation of smallpox vaccination policy must proceed through democratic dialogue.

But how will we balance the often-competing values of democracy and authority, coercion and informed consent, in the midst of a bioterror crisis?

One thing is certain: we need to begin to reflect on these matters now, not during such an episode. The time to begin is now, and our discussions must include ordinary citizens as well as public health elites.

Robert Johnston
Associate professor of history

A slight for sore eyes?

Apropos of the letter from John Mahoney, M.D. ’00, in the Winter 2002 issue, I’m gratified that he, as a young person, pointed out the difficulty of reading the small print in the magazine. The magazine itself is very attractive, but we needed a magnifying glass to read much of it. Also, in our age group many of us have painful arthritis in the hands, and the stiff cover as well as stiff binding and stiffer (than in old format) pages make it hard to turn the pages. Miserere nobis. …

Thanks.

Laura Neville, M.D. ’46
John Neville, M.D. ’46
Cotuit, Mass.


Amen, amen and amen to John Mahoney’s comments regarding the size of the print in Yale Medicine. On the other side, thank you for using adequate contrast between the print and the colored background.

Edna May Klutas, M.P.H. ’57
Newville, Penn.

Good news, bad news

We found ourselves on the receiving end of a brief flood of opinions this spring from readers who found our new typeface too small. “Your format is great—it will win awards, but not from your senior readers. One needs a magnifying glass to read it,” wrote George R. Barnes, M.D. ’47, HS ’50, of Tucson, Ariz., one of a half-dozen readers who weighed in on the topic.

Dr. Barnes was right on both counts. In April, Yale Medicine won the silver medal for best magazine and bronze medal for Visual Design in Print from the 23,500-member Council on Advancement in Support of Education. The category in which we were judged was special-interest magazines, which includes entries from graduate and professional schools nationally. These honors follow the Award of Excellence granted last November by the Association of American Medical Colleges, the group’s highest level of recognition. But regardless of these glories, it is also true that Yale Medicine is hard to read for many in our audience. To address this, we are tuning up the type for better legibility in time for the Summer issue.

From the Editor:

Feedback mechanism

Two years ago, the spring issue of Yale Medicine included a feature story on an initiative by Dean David A. Kessler, M.D., to review the curriculum and examine the larger questions surrounding medical education at the start of the 21st century. The magazine also featured an interview with the school’s new education dean, Herbert S. Chase Jr., M.D., and a collection of alumni essays titled “Eight Decades of the Yale System.” Several issues earlier we had invited alumni to reminisce about what the Yale System meant to them and to their generation. The response we received was overwhelming, as was the obvious affection nearly every alumnus and alumna appears to have for the Yale System.

This past February, a new generation of Yale scholars brought the topic into focus once again with a statement and petition, mailed to alumni, seeking to prevent proposed changes to the second-year testing format. The nine medical students who circulated the petition felt that requiring certain qualifying exams was incongruous with the Yale System, conceived in the 1920s by then-Dean Milton C. Winternitz, M.D. His vision was to give students freedom to pursue knowledge in a graduate-school-like environment by eschewing grades, class rankings and required exams in favor of close mentoring relationships between students and faculty and the completion of a thesis based on original research.

The proposed second-year qualifiers have since been dropped, but not before the issue elicited a huge response from alumni. From their mailing to more than 4,000 addresses, the students received well over 400 replies, many echoing Stanford oncologist William M. Rogoway, M.D. ’61, who wrote: “The freedom to chart one’s own course with support and encouragement along the way (and few inhibiting rules) is a model for a professional career.”

As a course director at Columbia P&S in the mid-1990s, Chase
lobbied for the abolishment of grades for the first- and second-year courses, and he came to New Haven excited about Yale’s emphasis on intellectual independence. He thinks there are other, more serious threats to the Yale System: the incursion of managed care into teaching time, class sizes that are too large, an overstuffed schedule and incapacitating student debt. In response, the faculty has increased the number of small-group discussions and reduced class hours and the total number of qualifying exams. Chase is working on ways to boost financial aid and the rewards for teaching.

Following our initial coverage in 2000, we planned to revisit this topic as it evolved and will do so in depth in an upcoming issue. The intense interest of both current students and alumni reinforces the view that the Yale System is not only central to the experience of Yale medical students but also that it is here to stay.

Michael Fitzsousa
michael.fitzsousa@yale.edu