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Clinical Effectiveness Student Strives to Serve the Underserved
Camilla Graham, physician at Beth Israel Deaconess Hospital, has come to HSPH this summer to play her third role at the school. She was first here in the late 1980s, working as a laboratory assistant in a toxicology lab. She later visited as part of ACT UP, an AIDS activist group, to demonstrate on the Longwood Campus. Now, with a medical diploma hanging on her wall, she attends the Summer Program in Clinical Effectiveness, working towards her MPH. While her purposes for visiting the school have changed over the years, one thing has remained constant: her belief in the importance of patient advocacy.
"When many people think of patient advocates," she says, "they think of someone who visits a sick person at home to help with the tasks of day-to-day living. Or they think of someone who stands on the sidelines, screaming for patients' rights." Both of these descriptions do fall within the realm of patient advocacy, but so do many others--including the role of physicians who are determined to provide the best care for their patients.
Camilla Graham, MPH student, believes that health care must meet the needs of communities.
The function of patient advocacy, Graham says, is "to find out what care people need and find a way to best provide that care."
It was the unfolding AIDS crisis in the late 1980s that initiated her to patient advocacy. "I knew a lot of people who had AIDS," she says. "And this was before we had many treatment options. AZT was the only medically approved therapy, and patients could only receive other, experimental therapies if they were accepted into one of the clinical trials. Unfortunately, the exclusion criteria for these studies were strict, and many sick people were not able to receive all of the medical care that was available.
"I understood the importance of constructing a sound study, one that would yield meaningful results, and I know that this was the intent of those researchers. But I also think that researchers need to remember that the ultimate goal of the study is to benefit people. They need to be alert to the possibility that the study design may be preventing people from receiving therapy. You can be restrictive with your treatment population when you're working with tissue cultures or rats, but when you're dealing with a human population, and with the only known effective treatments, then you have to think harder about whom you're excluding and what that means to their health."
To add to Graham's frustration with early AIDS clinical trial exclusion criteria, she knew of the pioneering work of HSPH biostatisticians: "The researchers who constructed the AIDS clinical trial groups felt they needed to exclude people who took other medications. Yet Victor De Gruttola [professor of biostatistics] was talking about how they had developed statistical operations that would allow the researchers to control for confounding variables like taking other drugs."
Graham credits activist groups like ACT UP for applying the social pressure that sped the application of new biostatistical methods to the AIDS clinical trials. She also believes that patient advocacy groups like ACT UP provide an essential weight to balance the actions of the medical community.
As productive as her activism on behalf of AIDS patients had been, however, Graham wanted to do more. "I began to see that my non-physician status was a barrier to communicating with those in the medical community whom I most wanted to talk with," she says. "I also wanted to better understand the HIV virus. I realized that, in order to help people the way I wanted to help them, I needed to go to medical school."
Graham left Boston in the fall of 1990 to earn her medical degree at the Medical College of Pennsylvania, returning in 1994. As a medical student, she saw that there were diseases other than AIDS whose sufferers faced social barriers to receiving health care.
"I got involved with users of injectable drugs," she says. "These people had a host of medical problems--the same kinds of problems that all people have--but because they'd felt marginalized by society and the medical system, they weren't receiving care.
"I began to see that, as a physician, I still could play a role as a patient advocate," she says. This form of patient advocacy includes teaming up with other physicians to identify the populations who aren't receiving adequate care and formulating methods to draw them into the system. "It's an activist's way of thinking about medicine," she explains.
Graham has returned to HSPH for the Summer Program in Clinical Effectiveness with an interest in helping people who are infected with both HIV and hepatitis C. She is investigating the body's response to these illnesses and finds herself spending time again in research laboratories.
"The clinical effectiveness training," she says, "helps me take the research done in the lab and apply it to populations of real people."
She praises the faculty of the program: "They're aware that their students are clinicians. They know that we want information to apply to our patients and our research tomorrow, not in four years. The curriculum provides examples that are immediately clinically relevant."
As Graham has moved from laboratory assistant to AIDS activist to physician, she has always believed in one concept: "Medicine must be for the community. If we want to improve the health of the communities around us, we need to make sure that we're providing the care they need. This is best done by going into the community and talking with people, by asking them what care they want, and by looking to see what barriers might be preventing access to care."
