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STFM 36th Annual Conference 2003
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Sunday, September 21
8:30–10 am
“First Environment: The Ecology of Prenatal Life,
Infancy, and Early Childhood”
Sandra Steingraber, PhD, Cornell University, Center for the Environment
In between human brain cells and the capillaries that feed them stands the
blood-brain barrier, a cerebral suit of armor that works to prevent harmful
substances from damaging our central nervous system. However, we do not acquire
a blood-brain barrier until we are 6 months old. This is just one of many reasons
why human embryos, fetuses, and newborns are exquisitely sensitive to the brain-damaging
effects of environmental contaminants—even at vanishingly small concentrations.
Drawing on the emerging field of pediatric environmental health, this presentation
examines the intimate ecology of pregnancy, breast-feeding, and early childhood.
Of particular interest will be the effects of early exposure to endocrine-disrupting
chemicals, teratogens, and neurological toxins in creating risks for birth
defects, childhood cancers, behavioral disorders, learning disabilities, and
preterm labor.
Sandra Steingraber, PhD, is an accomplished scientist, ecologist, writer, speaker,
and a published poet. She is also a cancer survivor, a wife, and a mother of
two young children, Faith and Elijah. She brings all these perspectives and
passions to her work and her writing. She is an internationally recognized
expert on the environmental links to cancer, reproductive health, and fetal
development. She has held numerous visiting fellowships, served on President
Clinton's National Action Plan on Breast Cancer, received the 1998 first annual
Altman Award for "the inspiring and poetic use of science to elucidate
the causes of cancer,” and has keynoted conferences on human health and
the environment throughout the United States and Canada. She has a remarkable
ability to make the most complicated scientific processes and concepts read
like poetry and become immediately accessible to the reader.
In her highly acclaimed book Living Downstream: An
Ecologist Looks at Cancer and the Environment,
Steingraber presents cancer as a human rights issue and was the first to bring
together data on toxic releases with newly released data from US cancer registries.
In her most recent work, Having Faith: An Ecologist's Journey to Motherhood,
she explores the intimate ecology of motherhood as she describes her own pregnancy
and her scientific investigation of each child's first ecosystem—her
mother's womb. In 1999, the Sierra Club heralded Steingraber as "the new
Rachel Carson," and in 2001, Carson's own alma mater, Chatham College,
selected her to receive its biennial Rachel Carson leadership award.
Monday, September 22
8:30–10 am
Blanchard Memorial Lecture –
“Family Medicine and the Surgeon General Who Listened”
David Satcher, MD, PhD, Director, National Center for Primary Care, Morehouse School of Medicine
Dr Satcher’s background in family medicine was a major influence
in his approach to the office of US Surgeon General. When he was sworn in on February 13, 1998,
he stated that he wanted to be remembered as the Surgeon General who listened to the American
people and who responded with effective programs. His surgeon general’s reports which he released
as well as his leadership role in developing Healthy People 2010, all reflect this listening approach,
which is so basic to family medicine. Using examples from this and other work, Dr Satcher will discuss
family medicine influence on his tenure as US Surgeon General and Assistant Secretary for Health.
David Satcher, MD, PhD, is currently director designee of the
new National Center for Primary Care at the Morehouse School of Medicine. Although Dr Satcher is
most well known as a past US Surgeon General , he also served as the Assistant Secretary for
Health from February 1998 to January 2001, making him only the second person in history to have
held both positions of Surgeon General and Assistant Secretary for Health simultaneously.
As Surgeon General and Assistant Secretary for Health,
Dr Satcher led the department’s effort to eliminate racial and ethnic disparities in health,
an initiative that was incorporated as one of the two major goals of Healthy People 2010, the
nation’s health agenda for the next 10 years. He also released Surgeon General’s reports on
tobacco and health; mental health, which was followed by supplements on children’s mental health,
health disparities and mental retardation, and culture, race, and ethnicity; suicide prevention,
which was followed by a national strategy to prevent suicide; oral health; sexual health and responsible
sexual behavior; youth violence prevention; and overweight and obesity.
Prior to his service as attorney general, Dr Satcher served as
director of the Centers for Disease Control and Prevention and administrator of the Agency for Toxic
Substances and Disease Registry.
Dr Satcher is a former Robert Wood Johnson Clinical Scholar
and Macy Faculty Fellow. He is the recipient of more than 30 honorary degrees and numerous distinguished
honors, including top awards from the National Medical Association, the American Medical Association,
the American College of Physicians, the American Academy of Family Physicians, the American Academy
for the Advancement of Science, and Ebony magazine. In 2000, he received the Didi Hirsch “Erasing
the Stigma” Mental Health Leadership Award, and the National Association of Mental Illness Distinguished
Service Award. In 1999, he received the Bennie Mays Trailblazer Award and the Jimmy and Rosalynn Carter
Award for Humanitarian Contributions to the Health of Humankind from the National Foundation for
Infectious Diseases.
Dr Satcher graduated from Morehouse College and received his
MD and PhD from Case Western Reserve University. He is a fellow of the American Academy of Family
Physicians, the American College of Preventive Medicine, and the American College of Physicians.
He is currently serving as a Senior Visiting Fellow with the Kaiser Family Foundation.
Tuesday, September 23
8:30–10 am
“Research and Development of Patient-centered Medicine”
Moira Stewart, PhD, Judith Belle Brown, PhD, Thomas Freeman, MD, MClSc, W. Wayne Weston, MD;
Ian McWhinney, MBB, MD, University of Western Ontario
Family medicine is guided by a clinical method that attends to
both disease processes and the whole person of the patient. This integrating clinical method rests
on the firm foundation of the ongoing patient-physician relationship. Leaders in the description of
the patient-centered clinical method will present their program of research, conceptual development,
and education which takes place within a vibrant academic department of family medicine. Ian McWhinney,
MBB, MD, will ask and answer the question: Why does medicine need a new clinical method?
Judith Belle Brown, PhD, will use new case examples to describe the patient-centered clinical method.
Wayne Weston, MD, CCFP, FCFP, will share recent teaching and learning approaches at the undergraduate
and post graduate levels. Moira Stewart, PhD, demonstrating an active research program, will answer
key questions: Does patient-centered medicine work, and can we teach it effectively? In conclusion,
Tom Freeman, MD, MCISc, will comment on the creative weaving of the education and research programs
into a busy department of family medicine.
Dr Stewart is a professor in the Department
of Family Medicine and the director of the Centre for Studies in Family Medicine
at the University of Western Ontario (UWO). She is an epidemiologist who, for
the past 25 years, has conducted primary care health services research, particularly
focusing on communication between patients and doctors. She has published numerous
papers in Social Science and Medicine, Medical Care, Family Practice: An International
Journal, Canadian Medical Association Journal, Journal of the Royal College
of General Practitioners, Journal of Family Practice, and the British Medical
Journal. She has coedited a series of five books on the foundations of primary
care research. She leads the patient-doctor communication group at UWO that
wrote Patient-centered Medicine: Transforming the Clinical Method which was
just published in its second edition. She is an honorary member of the College
of Family Physicians of Canada (1991), a Woman of Distinction for London, Ontario
(1993), and President-elect of NAPCRG.
Dr Brown is a professor in the Centre
for Studies in Family Medicine, the Department of Family Medicine at the University
of Western Ontario and the School of Social Work at King’s College, London,
Ontario. She conducts research in the areas of patient-doctor communication,
physician well-being, physician practice behavior (obstetrics, palliative care,
clinical practice guidelines, cancer care), empowerment of the chronically
ill elderly, the influence of culture on health, and women abuse. She was the
chair of the patient-centered learning task team at UWO. Dr Brown is a coauthor
of the book Patient-centered Medicine: Transforming the Clinical Method and
a coeditor of Challenges and Solutions in Patient-Centered Care: A Case Book,
which is a compilation of vignettes illustrating the patient-centered clinical
method. She has also published papers in Social Science and Medicine, Family
Practice: An International Journal, Canadian Medical Association Journal, Journal
of Family Practice, Family Practice Research Journal, Canadian Family Physician,
and Health Promotion International. She was made an honorary member of the
College of Family Physicians of Canada in 1996 and is a co-recipient of the
American Academy on Physician and Patient Award for Outstanding Research (1996).
Dr Freeman is a medical graduate of
the University of Western Ontario and completed his residency training in
family medicine at Dalhousie University, Halifax, Nova Scotia. After practicing
in a small town in southwestern Ontario for 11 years, during which time he
was involved with undergraduate education on a part-time basis, he moved
to a full-time academic practice at the University of Western Ontario in
1989. He is currently professor and chair of the Department of Family Medicine
at UWO. Areas of research interest include vaccine adverse effects, risk
perception and risk communication, and patients’ use of metaphor. He
has published in Journal of Family Practice, Family Practice: An International
Journal, and the Canadian Medical Association Journal.
Dr McWhinney obtained an MD from Cambridge
University in 1949. After internship, military service, and residency in general
medicine, he entered general practice. In 1964 he received a 6-month Nuffield
Travelling Fellowship, during which time he was a fellow in family medicine
at Harvard University. In 1968 he was appointed to the new chair of family medicine
at the University of Western Ontario. After stepping down from the chair in
1987, he continued to pursue his research interests as a member of the Centre
for Studies in Family Medicine. In 1987 he was appointed medical director of
the palliative care service at Parkwood Hospital and served in this capacity
for 5 years. Dr McWhinney has received an honorary MD from the University of
Oslo and an honorary DSc from the University of Western Ontario. He is an officer
of the Order of Canada and a foreign associate member of the Institute of Medicine
in the United States. He has received the Hippocrates Medal from WONCA-Europe
and Outstanding Educator Award from the Association of Canadian Medical Colleges.
Wednesday, September 24
8:30–9:45 am
“Family Medicine, Zen, and the Art of Motorcycle Maintenance”
Marc Rivo, MD, MPH, AvMed Health Plan, Miami, FL
The quest for quality and affordable health care for patients and the public
remains relevant, if not more urgent, in every community and country. Family
medicine and the family doctor should remain integral components of effective
health systems. The organization, delivery, and financing of primary care are
essential determinants of optimal family practice.
While continuing to advocate for the most-favorable health system conditions,
family medicine in the United States is appropriately turning inward at this
stage to redesign the optimal office practice and the role of the family doctor
in this practice. The family doctor and office practice must effectively meet
patient needs and expectations and ideally integrate individual and community
care. The practice must be able to function effectively within a dysfunctional
health system. From the perspective of the patient and the health system, Dr
Rivo will present a model of a relevant, effective, and independent family
practice and what it may take to build it and make it work.
Marc Rivo, MD, MPH, was the 2002 recipient of the AAFP Robert Graham Family
Physician Executive Award for his service in public health, government and
medical systems, and his deep, personal commitment for improving health care
access and quality.
From 1986 to 1991, as deputy administrator for preventive services in the Washington,
DC, Public Health Department, Dr Rivo developed innovative programs to bring
primary care and preventive services to the underserved. From 1991 to 1995,
as director of the Division of Medicine for the US Department of Health and
Human Services, he administered the Title VII programs that support family
medicine education and served as staff director for the Council on Graduate
Medical Education. Since 1996, Dr Rivo has been regional medical director and
medical advisor for disease management with AvMed Health Plan, Florida’s
oldest and largest non-profit health system. With Dr Rivo’s leadership,
AvMed has helped its physicians identify and deliver state-of-the-art chronic
disease care to its highest-risk members.
Dr Rivo serves as medical editor of Family Practice Management and a voluntary
clinical professor of family medicine at the University of Miami. He is editor
of WONCA News, a bimonthly global publication of the World Organization of
Family Doctors (WONCA). He is coauthor of the 2001 WONCA—WHO publication,
Improving Health Systems: The Contribution of Family Medicine.