How: Health Policy Creation

Health policy creation is an important way that physicians can guide the future of medicine and the care of our patients. Any member of the AMA, a specialty society, or a local medical society can author health policy. An example of this is how I have become increasingly concerned about the use of anatomical specimens in medical education. After doing research and speaking with stakeholders, I wrote a policy that is now State Society and AMA policy. AMA and state medical society policy is used to advocate for and change local laws and policies. AMA policy sets the expectation of how medical institutions perform. 

Why: Reparative Work Addressing the Historical Injustices of Anatomical Specimen Use

America has a long and well-documented history of exploitation against Indigenous Americans, Alaska Natives, people of color, immigrants, those with disabilities, incarcerated people, non-Christian, and poor citizens, who historically have not been afforded the same rights as white, able-bodied Americans (1-4).  In the wake of the recent Harvard Anatomical Donation scandal,  there is a clear need to reform rules and regulations of anatomical specimens in medical education, anthropological study, and related disciplines (5-7). Preserved and skeletal anatomical specimens from as far back as the 1700s are still held by medical schools and used for educational purposes today (8-12).

The final manifestation of medical racism is the use of patients' bodies without their consent and the repatriation of these specimens is an important step toward healing minorities' distrust in medicine.

The need for anatomical specimens has long since outpaced supply now and even more in the distant past. 13 In the 1800s the theft of the bodies of minority populations like that of Indigenous, enslaved, free black, and impoverished citizens was a common practice increasing supply of anatomical specimens without attracting scrutiny from legal entities.14-16 Some institutions have begun decommissioning, cremating, or returning the remains of some slaves or minority populations (17-19).

Other institutions have fought to hold on to remains like those of mother Bessie Wilborn, who had Paget's disease, whose skeleton still hangs at the University of Georgia against the wishes of her family (20-21). Harvard holds human remains of 19 likely enslaved individuals and thousands of Native Americans according to a recent report (22-23). The Peabody Museum holds a collection of human remains taken from Indigenous people including clippings of hair from approximately 700 samples from inmates of federal Indian Boarding Schools (24).  

Today many states have presumed consent laws that still allow for bodies that haven’t been claimed in as short as a few days to be donated for dissection (25, 26). The majority of unclaimed bodies are non-white persons, persons with mental health issues, or are the bodies of low-income individuals (26-28). The medical ethics community in America has expressed concern about presumed consent in the case of organ donation due to the potential for damage to the relationship of trust between clinicians caring for patients at the end of life and their families, as well as loss of autonomy especially amongst those least capable of registering objections (27, 28).

Impact: The AMA Health Policy Now

https://policysearch.ama-assn.org/policyfinder/detail/specimen?uri=%2FAMADoc%2FHOD.xml-H-140.820.xml

Author: Leif Knight, MD, is a second year emergency medicine resident at Brown University/Rhode Island Hospital.

Faculty Reviewer: Michelle Myles, MD, is an assistant professor and clinician educator at Brown Emergency Medicine.

 References:

1. Hawkins, D. S. (2023, August 8). Medical exploitation of Black people in America goes far beyond the cells stolen from Henrietta Lacks that produced modern day miracles. The Conversation. https://theconversation.com/medical-exploitation-of-black-people-in-america-goes-far-beyond-the-cells-stolen-from-henrietta-lacks-that-produced-modern-day-miracles-200220

2. Christopher PP, Stein MD, Johnson JE, Rich JD, Friedmann PD, Clarke J, Lidz CW. Exploitation of Prisoners in Clinical Research: Perceptions of Study Participants. IRB. 2016 Jan-Feb;38(1):7-12. PMID: 26964404; PMCID: PMC4793400.

3. Sacks, T. K., Savin, K., & Walton, Q. L. (2021, February). How ancestral trauma informs patients’ health decision making. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/how-ancestral-trauma-informs-patients-health-decision-making/2021-02

4. Ouellette, A. R. (2019). People with disabilities in human subjects research: A history of exploitation, a problem of exclusion. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3492078

5. McColgan, F. (2023, August 6). New lawsuit against Harvard in wake of body part trafficking allegations puts victims first in complaint. Spokesman.com. https://www.spokesman.com/stories/2023/aug/06/new-lawsuit-against-harvard-in-wake-of-body-part-t/

6. Li, D. K. (2023, June 14). Harvard morgue theft ring stole body parts, sold brains and turned human flesh into leather. NBC News. https://www.nbcnews.com/news/us-news/4-charged-stealing-selling-human-body-parts-harvard-medical-school-mor-rcna89357

7. Stelloh, T. (2023, June 22). Harvard human remains case highlights need for body donation regulations, experts say. NBC News. https://www.nbcnews.com/news/us-news/harvard-human-remains-case-highlights-need-body-donation-regulations-e-rcna90524

8. Ouellette, A. R. (2019). People with disabilities in human subjects research: A history of exploitation, a problem of exclusion. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3492078

9. Human dissection in the early years of medical education at UNC. (2016, April 27). UNC Libraries Blogs. https://blogs.lib.unc.edu/uarms/2016/04/27/human-dissection-in-the-early-years-of-medical-education-at-unc/

10. Research guides: Searching the Warren anatomical Museum collection: Home. (2023). Research Guides at Harvard Library. https://guides.library.harvard.edu/c.php?g=311035

11. History. (2023). University of Pennsylvania | Pathology and Laboratory Medicine. https://pathology.med.upenn.edu/department/about-the-department/history

12. Strydhorst, N. (2017, June 21). “New lives for old specimens” illuminates research with historical samples. Yale School of Medicine. https://medicine.yale.edu/news-article/new-lives-for-old-specimens-illuminates-research-with-historical-samples/

13. About. (2023). Mütter Museum Mütter Museum. https://muttermuseum.org/about/overview

14. Tward AD, Patterson HA. From Grave Robbing to Gifting: Cadaver Supply in the United States. JAMA. 2002;287(9):1183. doi:10.1001/jama.287.9.1183-JMS0306-6-1

15. Hawkins, D. S. (2023, August 8). Medical exploitation of Black people in America goes far beyond the cells stolen from Henrietta Lacks that produced modern day miracles. Stamford Advocate. https://www.stamfordadvocate.com/news/article/medical-exploitation-of-black-people-in-america-18284630.php

16. Hammond, K. (2023, February 8). VCU’s medical college history found to be ‘intimately connected’ with slavery, report finds. WRIC ABC 8News. https://www.wric.com/news/local-news/richmond/vcus-medical-college-history-found-to-be-intimately-connected-with-slavery-report-finds/

17. Meier, A. (2019, February 18). Grave robbing, Black cemeteries, and the American medical school. JSTOR Daily. https://daily.jstor.org/grave-robbing-black-cemeteries-and-the-american-medical-school/

18. Reed, B. (2022, August 7). Ivy League university set to rebury skulls of Black people kept for centuries. The Guardian. https://www.theguardian.com/us-news/2022/aug/07/us-university-plans-repatriation-black-american-remains

19. Crimmins, P. (2021, April 27). Penn Museum apologizes for 'Unethical possession of human remains'. NPR. https://www.npr.org/2021/04/27/988972736/penn-museum-apologizes-for-unethical-possession-of-human-remains

20. Cheng, C. (2022, June 1). Harvard holds human remains of 19 likely enslaved individuals, thousands of Native Americans, draft report says. The Harvard Crimson. https://www.thecrimson.com/article/2022/6/1/draft-human-remains-report/

21.  BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA. v. OGLESBY. No. A03A1375. (Court of Appeals of Georgia, November 21, 2003) https://caselaw.findlaw.com/court/ga-court-of-appeals/1228176.html

22. Jaffe, L., Hudetz, M., Ngu, A., & Brewer, G. L. (2023, January 11). America’s biggest museums fail to return Native American human remains. ProPublica. https://www.propublica.org/article/repatriation-nagpra-museums-human-remains

23. Collins, B. (2018, September 18). Mayo issues an apology 156 years in the making. NewsCut. https://newscut.mprnews.org/2018/09/mayo-issues-an-apology-156-years-in-the-making/index.html

24. Quinet, K., Nunn, S. and Ballew, A. (2016), Who are the Unclaimed Dead?. J Forensic Sci, 61: S131-S139. https://doi.org/10.1111/1556-4029.12973

25. Woodbury collection. (2023). Peabody Museum. https://peabody.harvard.edu/woodbury-collection

26. Jordan, M., & Sullivan, K. (2021, September 17). Alone in death-Tens of thousands die each year in the United States and no one claims their bodies. The Washington Post. https://www.washingtonpost.com/nation/2021/09/17/alone-death/

27. Sohn H, Timmermans S, Prickett PJ. Loneliness in life and in death? Social and demographic patterns of unclaimed deaths. PLoS One. 2020 Sep 16;15(9):e0238348. doi: 10.1371/journal.pone.0238348. PMID: 32936820; PMCID: PMC7494098.

28. This is what happens to unclaimed bodies in America. (2022, December 19). TalkDeath. https://www.talkdeath.com/this-is-what-happens-to-unclaimed-bodies-in-america/

29. Peeler, M. (2020). An unexpected education — Unclaimed bodies in the anatomy lab. New England Journal of Medicine, 383(21), 2002-2004. https://doi.org/10.1056/nejmp2015975