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VATICAN VACCINES the &
TO TRANSFORM
THE FUTURE OF CARE DELIVERY
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Philadelphia County Medical Society
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EXECUTIVE COMMITTEE
Domenick Bucci, MD PRESIDENT
Walter Tsou, MD, MPH PRESIDENT ELECT
John M.Vasudevan, MD IMMEDIATE PAST PRESIDENT
David A. Sass, MD, FACP SECRETARY
Sharon Griswold, MD TREASURER
BOARD OF DIRECTORS
Victoria Cimino, MD, MPH
Brian Hannah, MD
Cadence A. Kim, MD, FACS
William King, MD
Pratistha Koirala, MD
Elana McDonald, MD
Max E. Mercado, MD, FACS
Ricardo Morgenstern, MD
Natalia Ortiz, MD, DFAPA, FACLP
Dhruvan Patel, MD
Graeme Williams, MD
Heta Patel
FIRST DISTRICT TRUSTEE
Michael A. DellaVecchia, MD, PhD
EXECUTIVE DIRECTOR
Mark C. Austerberry
Editor Kevin Bezler
4 Papal Patronage: A History of Vatican Leadership in Vaccine Science and Public Health 8 Welcome Dr. Walter Tsou, 164th President of the Philadelphia County Medical Society 10 Getting to Know Dr. Brian A. Hannah, Philadelphia County Medical Society Secretary 2025 14 Clearing the Air in the Commonwealth: The Facts About Smoke- and Vape-Free Spaces 15 Student Public Health Research on Display 16 Temple Health’s Dr. Theresa Pazionis is Revolutionizing Spinal Surgery, One 3D-Printed Implant at a Time
18 A Student’s Voice: PCOMA Medical Student’s Understanding of Anatomy Through Variation and Perseverance 20 The Collapse of Healthcare in Delco: Crozer’s Last Days
The Dr. Harvey Lefton Memorial GI Conference 26 From Distrust to Confidence: Can Science and Health Care Gain What’s Missing? 30 Philadelphia Medicine Doctors’ Lounge
PAPAL PATRONAGE:
A History of Vatican Leadership in Vaccine Science and Public Health
By René F. Najera, D rPH
The relationship between the Catholic Church and vaccines spans centuries, marked by consistent support and advocacy from numerous popes. Contrary to some misconceptions, the Vatican has historically championed vaccination efforts, recognizing them as crucial tools for public health. From the earliest days of smallpox inoculation to the development of modern COVID-19 vaccines, papal leadership has played a significant role in promoting vaccine acceptance and accessibility worldwide.
Historical Papal Champions of Early Vaccination
The Catholic Church’s support for vaccination dates back to well before the advent of modern medicine. As early as the 1720s, Jesuits were inoculating indigenous populations in the Amazon against smallpox (a procedure called variolation involving inoculation with a milder form of smallpox). A significant milestone occurred in 1757 when Pope Benedict
XIV personally received the smallpox inoculation, setting a powerful example for Catholics worldwide. This papal action demonstrated an early understanding of the importance of preventive medicine, particularly remarkable given the limited scientific knowledge of the era.
The early 19th century marked a turning point in the Vatican’s approach to public health. In 1822, under Pope Pius VII, the Papal States initiated a comprehensive vaccination campaign against smallpox. Cardinal Secretary of State Ercole Consalvi issued a detailed decree outlining the vaccination strategy, describing smallpox as a disease that “maliciously robs man of even a minimal life […] and rages against the human species to destroy it at its infancy.” This campaign was revolutionary, as it made the Vatican the first sovereign nation to implement a vaccine mandate. (Massachusetts passed the first law regarding vaccination in 1810.)
Pope Pius VII recognized vaccination as “a precious discovery which ought to
be a new motive for human gratitude to Omnipotence.” His successor, Pope Gregory, continued this tradition by making vaccines obligatory for prisoners in the Papal States and establishing the Special Congregation of Health in 1834. Throughout the 19th century, priests accompanied people to get the smallpox vaccine. They served as trusted intermediaries between medical authorities and local communities, much like Community Health Workers do today.
Vatican-Scientific Collaboration Through the Ages
The partnership between Catholic clergy and medical professionals played a crucial role in overcoming vaccine hesitancy. In Italy’s Apulia region in 1810, priests and physicians collaborated to promote vaccination, with many clergy personally administering vaccines. This collaboration reached its zenith in 1822 with the establishment of municipal vaccination councils that included representatives from the clergy.
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Papal Patronage: A History of Vatican Leadership in Vaccine Science and Public Health continued from page 5
Luigi Sacco, a pioneer of smallpox vaccination in Italy, recognized the essential role of the clergy in building public trust. In 1824, he was awarded membership in the Golden Spur, an honor conferred on those who dedicated themselves to spreading the message of the Church, specifically for his contributions to mass vaccination campaigns. This recognition exemplifies the Vatican’s value and reward for scientific contributions to public health.
Pope Francis and the Modern Vaccine Movement
In our contemporary era, Pope Francis has emerged as a powerful advocate for vaccines, particularly during the COVID-19 pandemic. When COVID-19 vaccines became available in early 2021, Pope Francis was among the first world leaders to receive the vaccine, along with Pope Emeritus Benedict XVI. This act of leadership sent a clear message about the Vatican’s position on vaccination.
Pope Francis has repeatedly framed vaccination as a moral obligation, calling it “an act of love” in a video message produced in conjunction with the Ad Council. He emphasized that getting vaccinated is “a simple yet profound way to care for one another, especially the most vulnerable.” When questioned about vaccine skepticism, including among some cardinals, Francis responded with historical perspective: “It’s a bit strange, because humanity has a history of friendship with vaccines.”
The pontiff has also emphasized the importance of accurate information, stating that being correctly informed about COVID-19 vaccines is a fundamental human right. He has cautioned against “fake news” while encouraging respect for individuals who may hold misconceptions “without full awareness or responsibility.”
In February 2024, Pope Francis appointed Nobel Prizewinning biochemist Katalin Karikó to the Pontifical Academy for Life. The appointment of Karikó, who helped develop the mRNA technology used in Pfizer and Moderna COVID-19 vaccines, was said to represent Pope’s commitment to engaging with cuttingedge scientific research and recognizing its value for humanity.
The Significance for Global Public Health
The consistent support for vaccines from the Vatican throughout history carries profound implications for global health initiatives. Religious authorities often hold substantial influence over their followers’ health decisions. When popes endorse vaccination, they help overcome hesitancy rooted in religious concerns, particularly among the world’s 1.3 billion Catholics.
The Catholic Church has carefully addressed ethical questions surrounding vaccines, including those developed or tested using cell lines with remote connections to aborted fetuses. The Vatican has clarified that receiving such vaccines is “morally acceptable” given the grave danger posed by infectious diseases. This nuanced position strikes a balance between respect for Catholic ethical teachings and pragmatic public health considerations.
At the same time, the Church maintains that vaccination should remain voluntary, while emphasizing the responsibility to act for the common good. As the Archdiocese of San Francisco noted, “Everyone has a responsibility to act in accord with the common good but this does not equate to a general obligation to be vaccinated.” This balanced approach respects individual conscience while encouraging collective responsibility.
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Continuing a Legacy of Faith and Science
The centuries-long support for vaccines by successive popes demonstrates the potential harmony between religious faith and scientific advancement. From Pope Benedict XIV’s smallpox inoculation in 1757 to Pope Francis’s COVID-19 vaccination in 2021, papal leaders have consistently recognized that science and faith can work together for the common good and human flourishing.
This history offers a compelling counternarrative to those who perceive tension between religious belief and scientific progress. The Vatican’s sustained commitment to vaccination illustrates how religious institutions can serve as powerful allies in advancing public health initiatives and overcoming misinformation.
As we face ongoing and future health challenges, the historical precedent set by numerous popes provides a foundation for continued collaboration between religious and scientific communities. By understanding this rich history, we gain insight into how influential religious leaders can play a crucial role in addressing global health crises through their moral authority and practical example. •
Sources and Additional Reading
Martini, M., Brigo, F., & Rasori, G. (2022). Vaccination in the 19th century in Italy and the role of the catholic church in public health: a historical overview. Journal of preventive medicine and hygiene, 63(1), E104-E108. https://doi.org/10.15167/2421-4248/ jpmh2022.63.1.2518.
MD, V. I. (2018, April 5). The catholic church and vaccines. VAXOPEDIA. https://vaxopedia.org/2018/04/04/the-catholic-churchand-vaccines/.
Sisti, L., Sisti, L., Buonsenso, D., Moscato, U., Costanzo, G., & Malorni, W. (2023). The Role of Religions in the COVID-19 Pandemic: A Narrative Review. International Journal of Environmental Research and Public Health, 20(3), 1691. Scarani, P., & Nebuloni, M. (1997). Luigi Sacco e la storia del vaiolo in Italia [Luigi Sacco and the history of smallpox in Italy]. Pathologica, 89(2), 211–214.
Vaccines for everyone, for the poor: Examples from Pius VII and Pius IX - Vatican News. (2021, May 8). https://www.vaticannews.va/en/ pope/news/2021-05/vaccines-for-all-history-pius-vii-xi-editorial.html.
Welcome Dr. Walter Tsou
164th President of the Philadelphia County Medical Society
By Karen L. Chandler
“I was always interested in how science could be used to help people. That’s why people should go to medical school,” said Walter H. Tsou, MD, MPH. “You don’t do it for the money and now anyone who thinks you should go to medical school for the money is totally mistaken. It’s really the calling.”
On June 21, 2025, Dr. Walter Tsou becomes the 164th president of PCMS. Although Walter considers himself a rather unconventional choice as he brings his public health background into his new office, he confirms that his years of practicing medicine has given him a great respect for everyone who practices today.
In his new position, Walter hopes to set groundwork for physicians to gain more autonomy and control in today’s changing medical profession but admits that marked progress in that effort will be difficult in his one-year term. He said, “The things you have to go through to practice medicine these days are so much more onerous. One of the things I hope to do is represent some of the anxiety and concerns that doctors have in practicing in this market-based medical society that we have today.”
Fostering an air of camaraderie among PCMS physicians through community-based activities and continuing Doctors’ Lounge programs with speakers on topics such as business and government are also key to Walter’s plans in the upcoming months.
Although he notes that young physicians from area medical schools remain interested in joining PCMS, Walter hopes to inspire even more interest in the organization with a program he calls the Soul of Medicine. He believes bringing students into group settings with speakers who draw from experiences practicing medicine in other cultures will provide a setting to discuss the humanity and art of medicine. “It’s very easy in this very technical world where we live to forget that why we went to medical school in the first place is to help people,” Walter said.
Walter grew up in Abington, Pennsylvania, where he lived with his parents, brother, and sister. Life was simple back then and Walter fondly remembers those days of collecting coins and playing softball in the backyard with neighborhood kids.
Walter’s father, an immigrant from Shanghai, China, undoubtedly inspired Walter’s interest in chemistry. After the devastation in China during World War II, there were limited opportunities for further education, leading Walter’s father to leave his country to attend the University of Nebraska to obtain his PhD in Chemistry. After working as a chemist in the adhesives industry, Walter’s father transitioned to biochemistry research at the University of Pennsylvania.
“He knew that if he got a position at Penn, he could get free tuition for us. He became an assistant professor and later an associate professor in the Department of Surgery, focusing on enzyme histochemistry,” Walter said. “I think it impacted my career choice to pursue public health. If I would have been mired with debt, I’d want to be a surgeon or a specialist of some fashion. But because I was offered this incredible opportunity not to be saddled with so much debt, the idea of going into public health was not a bad decision.”
After graduating from Abington High School in 1970, Walter continued his education as a chemistry major at Penn where he graduated in 1974. He was accepted to Penn Med and completed the program in 1978.
Walter matched in general internal medicine at Presbyterian Hospital in Philadelphia and finished there in 1981. Despite assuming he would enter private practice, there were no opportunities available when his job search began. Following up on a suggestion to practice at one of Philadelphia’s eight health centers became a light bulb moment.
“We had patients who were actually seeing me as their doctor. These were people who entrusted their care to you,” Walter said. “If it wasn’t for the health centers, they couldn’t pay for doctors or meds and would not have gotten any care. When I started realizing that by treating their hypertension or controlling their diabetes better, I could actually keep people out of the hospital. That is the crux of what public health is all about, prevention.”
From Walter’s experiences in Philadelphia, he would officially make public health his career. He entered the Master in Public Health program at Johns Hopkins and graduated in 1988. “Hopkins was an eye opener,” Walter said. “In many ways we do healthcare backwards in America. We teach the specifics like nursing, medicine, social work, and later on people realize they never understood the foundation of how health care systems work.”
Although he was offered a spot at Johns Hopkins, Walter returned to Philadelphia and accepted a position as the Clinical Director of Ambulatory Health Services in the Philadelphia Health Department, working to create health programs for the city’s poor and indigent patients.
Walter’s experiences in the health department were some of the most impactful of his career. He explained that at that time in the late 1980s, to receive a mammogram women would need a diagnosable symptom. Walter worked diligently to secure a small pilot grant from the American Cancer Society, a partnership with a mobile mammography van, close to pro bono services by radiologists, and donated film from Kodak to create a free mammogram screening program through the health centers. Two early-stage cancers were detected in the 400 women at the onset of the program and its success led to the purchase of mammogram machines for all the health centers and the continuance of the program to this day.
Another meaningful stage of Walter’s public health career came as he was offered the opportunity to join a team establishing the first public health department in nearby Montgomery County, Pennsylvania, an accomplishment affirming his decision to pursue his public health school degree. Offering free immunizations, well-baby checks, and STD screenings made meaningful changes in the community. Walter said, “We were one of the early pioneers of getting Hep B vaccines through the school systems. That’s the kind of power that public health has. You can change the expectations of healthcare in a county by getting kids immunized and protected against infectious diseases. I got really excited about public health and its potential.”
Walter was interviewed and chosen to become the Health Commissioner for Philadelphia under then-Mayor John F. Street. Although the move was an opportunity to promote public health, it was also rife with political challenges. Moving on, Walter became president of the American Public Health Association in 2005, a position which enabled him to continue promoting public health, both nationwide and internationally.
A subsequent retirement allowed Walter to devote time to his family. Today, his wife is a nephrologist at Temple Hospital and his daughter is studying bilingual education as a graduate student in Chicago. The family lives in Mt. Airy, Philadelphia.
Walter enjoys gardening and continues advocating for public health. He is the recipient of numerous awards, including the Public Health Recognition Award from the College of Physicians of Philadelphia, the Leadership Award from the Delaware Valley Healthcare Council, and the Broad Street Pump Award from Physicians for Social Responsibility. He was named Practitioner of the Year by the Philadelphia County Medical Society in 2001. •
Getting to Know Dr. Brian A. Hannah Philadelphia County Medical Society Secretary 2025
By Karen L. Chandler
The path Brian A. Hannah, MD, MS, followed was varied and he feels fulfilled and happy with his current destination.
Brian has been a member of the Pennsylvania Medical Society and Philadelphia County Medical Society (PCMS) since 2005. He is a delegate to the PAMED House of Delegates. As a newly elected Board member of PCMS, Brian hopes to increase the organization’s outreach to various Philadelphia physician communities and local communities in need.
Overall, Brian hopes the Medical Society can work to ensure its value to physician members moving forward. “One of my concerns is, why are not a lot of physicians a member or engaged or coming to meetings?” he said. “We need to find out if they see the organization as valuable. Doctors are busy and have a lot on their minds.”
Born in 1957, Brian grew up in the rough Frankford area of Philadelphia. As a city kid, he played fast ball, stick ball, baseball, street hockey and soccer. He learned to play tennis in the free youth clinics at Wissinoming Park and played in high school and college. Brian was “Honorable Mention All-Catholic” in his senior year on the championship tennis team of Father Judge High School. Brian was also heavily involved in the Boy Scouts at Allegheny Baptist Church in Kensington and achieved the rank of Eagle Scout.
His Irish mother and Scottish father were no strangers to hard work and Brian was expected to pull his load. He began cutting lawns at age 11 to pay for Boy Scout summer camp in Maine. He eventually graduated from a push mower and hand-
clippers to a power mower, weedwhacker, and edger, and over 150 customers, and continued Spring-Summer-Fall till the week prior to medical school.
However, Brian’s curiosity and interest in biology overrode any thought of landscaping in his future.
“I remember one time in a high school class, we were discussing someone who was stabbed and killed. I asked the teacher why he died. I didn’t understand the process,” he said. “I remember distinctly the kid behind me hitting me in the back of the head and saying, ‘Dude, he got stabbed. He died. That’s it.” Terms such as “diabetes” and “hypertension” were perplexing, and he wanted to know more.
His 1975 graduation from Father Judge High School led to Brian’s attendance at St. Joseph’s University in Philadelphia with a major in Biology, a commitment funded by scholarships and by his lawn mowing earnings.
A 1979 graduate of St. Joe’s and the first college graduate in his family, Brian moved on to the University of Pennsylvania School of Medicine, graduating in 1984. He completed his internship and residency in Internal Medicine at George Washington University Medical Center in Washington, DC in 1987. Brian added on a Master of Science in Information Technology Leadership degree in 2008 from LaSalle University, Philadelphia. In 2014, he was boardcertified in Clinical Informatics by “The American Board of Preventative Medicine.”
With a severe hearing impairment since birth, Brian overcame challenges which he admits became even more serious during medical school and his next steps as an emergency room physician at the Southern Maryland Hospital Center in Clinton, Maryland; Frankford Hospital – Torresdale Campus (Level II Trauma Center) and The Methodist Hospital in Philadelphia; and the St. Mary Medical Center, a Level II Trauma Center in Langhorne, PA.
When people ask how Brian survived his work in the ER and trauma units, he explains that he is a thickheaded Scots Irishman, plus, at an early age he learned to read lips and learn people’s voices.
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“My family and I just didn’t accept my limitation. School was a challenge as most students know the tests are from the lecture notes. However, I had no notes. I could not read lips and take notes effectively at the same time. Lectures in amphitheaters were especially hard. Listening to attendings on rounds was tough. I had to read the entire texts to
compensate,” Brian said. “I think the blessing is that I had to talk directly to my patients. I always had to focus on my patient to lip read, so the patient always got my direct attention. Hopefully, I did some good and God recognizes that.”
In 1997, Brian left his ER career and became a founding member of the new
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Getting to Know Dr. Brian A. Hannah, Philadelphia County Medical Society Secretary 2025 continued from page 11
and teaching
Those years working back in the neighborhood where Brian grew up were the most impactful of his career.
“I enjoyed going back to my old (Frankford) neighborhood. I’m very comfortable there and those patients really are the salt of the earth, and they don’t get too much in their life,” he said. “They don’t get much respect in their daily lives. If you give them attention, care, and respect, they love you, and I felt that every day.”
It was at Frankford Hospital that Brian began the next phase of his career. In those days, physicians were supposed to enter their orders into the computer (Computer Physician Order Entry, CPOE). Nobody did. Without formal training, Brian learned from the nurses how to enter the orders into the computer system. Even though it was an old DOS system, he felt it was more efficient to directly discontinue/enter orders on the computer, which the nurses loved. When the IT Department set him up to access the system from home and he could monitor results and enter orders remotely without “calling the floor,” he was hooked. “I could view results, put the orders in, and adjust IVs from home. I thought, this is so cool,” Brian said, remembering the revelations from over twenty years ago.
When Frankford Health decided to implement a full Electronic Medical Record (EMR) system, Brian was asked to be “Physician Champion” and lead full CPOE. At the time, “they” said it would never happen. However, working single-handedly with the physicians over two years and enjoying their trust, Brian got the CPOE rate to over 65%. At that point, CPOE was mandated by administration and Brian led the IT analysts to implement full CPOE in three campuses of Frankford Health in six weeks.
Later, Brian advanced to the role of Medical Director of Information Systems and subsequently Chief Medical Information Officer until 2012. He worked closely with clinical department heads to develop and implement “Department Order Sets” such as “CHF,” “Acute Stroke” and “Community Acquired Pneumonia” based on “Evidence-Based Medicine” (EBM).
These later positions led Brian to realize the value using information systems can bring to the medical community. His focus became developing systems that would capture information, promote “ease-of-use” and remote access, and electronic information sharing to transform patient care by reducing costs and improving quality.
Moving onto the Universal Health Services, Inc. system in 2013 as the Assistant Chief Medical Information Officer meant Brian worked with various entities to design and implement physician order sets, documentation, clinical decision support, and voice recognition technologies in 24 acute care hospitals across the “Sunbelt” of the U.S.
In 2014, Brian became the Vice President, Chief Medical Information Officer for Trinity Health Mid-Atlantic PA division where he remained for over seven years. He managed a twelvemember team committing to champion Health Information Technology (HIT) in a continual process for improving patient care quality. In conjunction with the IT department, he was the business lead in the procurement and implementation of secure texting, single sign-on technology, voice recognition technology and universal electronic physician documentation, and universal electronic prescribing, including controlled substances at patient discharge for over 1,000 physicians.
Brian credits his success in various Health Information Technology initiatives over the years to gaining the trust and support of the various physician communities with which he worked. He recognized that change can be difficult. He appreciated the pressures they faced and sought to be a trusted ally.
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attending, a move which lasted until 2012. He also served as the Medical Director and teaching attending in the Internal Medicine Clinic.
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Brian is devoted to his lovely wife, Isabel, a native of Peru, and lives in Holland, PA. Brian enjoys maintaining his pool and landscape (still mowing grass), lifting weights, and trail biking with friends. He is active in his local fly fishing club.
An avid volunteer, Brian serves the community in a variety of ways. He recently brought his love of people and fly fishing to the Delaware Valley Fly Fishers, helping youth, veterans, and people with disabilities at the “Friends of the Borough Dam” event sponsored by Rotary International of Doylestown.
Brian is an active usher for St. Bede the Venerable Roman Catholic Church in Holland, PA. He is also involved in the Medical Reserve Corp of SERV-PA, on-call for disaster events. Recently, he was an “actor” in the Philadelphia Eagles, FIFA, and the Cybersecurity and Infrastructure Security Agency (CISA) full-scale disaster exercise at Lincoln Ficancial Field. In February, he served at Kensington Library, a “warming center” for the homeless during severe cold events. He is inspired to increase his support for the underserved communities in areas like Kensington with their various challenges.
“It’s become increasingly important to me over the years. I think it’s important to take care of the people that few care about,” he said. “My parents and relatives are from Kensington, and I want to increase my volunteer work there, right in the belly of the beast, so to speak.”
Brian’s ongoing passion for communication of all types is evident moving forward into his retirement, a love of people unaffected by his hearing loss.
“In my various retirement activities, I am blessed that my circle of friends is really expanding and it’s all kinds of interesting people with opportunities to contribute to my communities outside of medicine,” he said. •
Clearing the Air in the Commonwealth: THE FACTS ABOUT SMOKEAND VAPE-FREE SPACES
TBy Ryan Coffman, MPH, Tobacco Policy and Control Program Manager, Philadelphia Department of Public Health
Elizabeth Hensil, Director, Advocacy for PA and WV, American Lung Association
he history of public health in the United States contains many examples of public health threats where scientific evidence was indisputable, and the public expressed support for proposed solutions. Unfortunately, society sometimes lacked the collective will to act on these threats. Not protecting people from secondhand smoke need not be another example that we regrettably cite in future historical documents. Asbestos and secondhand smoke are both recognized by the Environmental Protection Agency as Group A carcinogens. Both substances have no safe level of exposure and there is “sufficient evidence from human studies to show that it causes cancer in humans.” If a large-scale asbestos exposure to workers and the public were identified, we would swiftly and comprehensively take every measure to protect those exposed. No lengthy debates or discussions needed. It is past time to ensure that no one is forced to work in an environment suffused with a clear health hazard.
Yet, the Pennsylvania Clean Indoor Air Act currently exempts thousands of businesses throughout the state from a prohibition on indoor smoking. As a result, Pennsylvanians have been living and working under a public health “double standard” for decades. Attempts to provide all Pennsylvanians with smoke- and vapefree public spaces are often met with misinformation, pseudoscience, and excuses about why this just isn’t possible in the Commonwealth. In the nearly 20 years since the state Clean Indoor Air Act was passed into law in 2008, the body of independent, peer-reviewed science concerning the benefits of smoke- and vapefree laws has remained steadfast. Secondhand smoke continues to cause premature disease and death among workers and the public who are still exposed daily. Workers in the bar, food service, and casino industries endure higher rates of exposure at work, which often contribute to health disparities.
Public health research shows there is no safe level of exposure to secondhand smoke. In addition, there are harmful constituents
contained in the aerosols emitted from vaping products. Despite claims to the contrary from the tobacco industry and their allies, smoke- and vape-free policies reduce serious health issues resulting from secondhand smoke exposure, improve productivity, encourage quitting, reduce youth initiation, reduce absenteeism, and receive broad public support. Research confirms that no amount of ventilation or filtration systems can negate the harmful effects of secondhand smoke, and several studies show that revenue and employment for businesses improves after implementing smokeand vape-free policies.
“Ensuring smoke- and vape-free environments isn’t just about policy—it’s about protecting the health and well-being of every Pennsylvanian,” states Elizabeth Hensil, Director, Advocacy for PA and WV for the American Lung Association. “Years of research have proven that exposure to secondhand smoke and vaping aerosols can cause serious long-term health effects. No one should have to choose between their health, their job and the air they breathe. The American Lung Association continues to work alongside lawmakers, advocates, and communities to advance policies that prioritize clean indoor air and strengthen—not weaken—our commitment to a healthier Pennsylvania.”
Protecting all workers and the public from secondhand smoke and passive aerosol exposures is a public health imperative. It is time for the last, lingering venues in Pennsylvania to join the countless smoke- and vape-free workplaces, bars, restaurants, public transit and other spaces that a generation of Pennsylvanians have come to enjoy by removing all remaining Clean Indoor Air Act exemptions. We must protect every Pennsylvanian from this entirely preventable and deadly exposure by implementing the Centers for Disease Control and Prevention’s clear recommendations for “comprehensive smokefree laws and policies [to] fully protect people from secondhand smoke exposure.” •
Student Public Health Research on Display!
By Susan Robbins, MD, MPH, FAAP, FCPP
On May 1st, 2025, at The College of Physicians of Philadelphia, there was a convening of students of public health in the region, as well as their mentors and other healthcare professionals, in order for the students to present their research findings. This session was sponsored by the College’s Section on Public Health and Preventive Medicine, led by René Najera, MPH, DrPH, FCPP, along with Section officers, Robert Sharrar, MD, and Susan Salkowitz, MA.
Presenting at the session were students from many of the region’s institutions, including the University of Pennsylvania, Temple University, Philadelphia College of Osteopathic Medicine, Drexel University, and Thomas Jefferson University. The research displayed was on wideranging topics such as the following: emotional regulation interventions for adolescents; mental health awareness among Latino communities in Philadelphia; delays in assessment and treatment of obsessive-compulsive disorder; the early use of anti-obesity medications to treat severe adolescent obesity; student alcohol knowledge; antibiotic usage for infections in children in Bangladesh; an AI-powered clinical decision support system for patients with diabetes; and many more. Attendees were most welcome to interact with the students who seemed eager to discuss their projects and findings and answer occasional challenging questions. Part of the highlights of the event
came from the students themselves, as they interacted, discussed their interests and their considerations regarding their future plans.
Although during this event no judging of the research presentations occurred, there were honors given to two students who had been nominated by public health professionals and voted on by the members of the Section on Public Health and Preventive Medicine: Ebony Powell, a dual MPH and Master’s in City Planning student, and Eric Block, an MPH/Nutrition student at Temple University. Additionally, a public health professional (M. Pat West, MSSW) and an organization (Broad Street Love) were honored for their significant longstanding public health work as well.
The students appreciated the opportunity to present their research, and were wished well as their work will continue in various ways in the coming years. All of the attendees (minus the students who are relocating) look forward to next year’s event to continue exchanging ideas and knowledge, with the expectation that robust public health research will continue to address matters of much importance. •
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Utilizing adaptive intelligence and 3D-printed devices, Theresa Pazionis, MD, MA, FRCSC, uses a tech-forward approach to surgery to provide patients with more personalized spine care.
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By Grace Alvino, PhD
The latest advancements in spinal surgery—from adaptive spine intelligence to using AI for preoperative planning to 3D-printed implants—can sound like something out of science fiction. But Theresa Pazionis, MD, MA, FRCSC, ABOS, puts a very human face on these innovations and is using them to enhance the already-exceptional care she provides.
“When I began practicing in 2014, spine surgery relied heavily on freehand screw placement with minimal navigation,” Dr. Pazionis, an Assistant Professor of Orthopedic Surgery and Sports Medicine at the Lewis Katz School of Medicine at Temple University, explains. “We were templating spine surgeries on paper or early versions of Surgimap, a clinical imaging tool for spinal orthopedic surgeons. That gave us great outcomes, but it didn’t have the level of integration and consistency we see with robotic planning platforms today.
“Over time, we’ve integrated AI and robotics into preoperative planning, using systems that have integrated GPS, adaptive spine intelligence and patient-specific, personalized rods and interbody implants,” Dr. Pazionis continues.
“These technologies enable us to map surgical goals with high precision, optimize screw placement, and design patientspecific implants, resulting in more consistent outcomes, fewer complications, and improved correction accuracy compared to traditional methods. We’re also able to track patient- and surgeonspecific outcomes using radiomics, or data extraction from serial radiographs, to use predictive analytics to better plan and personalize surgical plans for our patients.”
More Personalized Spinal Surgery
In other words, these innovations help to make spinal surgery more consistent, more precise, and more personalized. The latter ties in with a broader trend in medicine, as Dr. Pazionis explains.
“The future is moving towards personalized surgical care,” she says. “Whether or not we’re using personalized or off-theshelf 3D-printed spinal implants, planning using predictive
analytics and robotics platforms allows us to give the patient the best surgery for their anatomy and physiology. Today, you can access patient-specific cages and 3D-printed implants tailored to individual anatomies. These allow for better load distribution across the endplate as opposed to point-loading, as well as more precise correction and reduced revision rates.
“With tools like patient-specific rods, we now leverage predictive analytics and digital twins to simulate outcomes, helping to ensure the best surgical strategy,” Dr. Pazionis continues. “This not only benefits the patient by improving their quality of life, but also reduces costs for healthcare systems by minimizing reoperations.”
Tech Meets Highest-Level Skill
Of course, as impressive as these technologies are, they’re best understood as enhancements to spinal surgeons’ highest-level skills.
“Robotics and customized implants are not a substitute for excellent surgical technique,” Dr. Pazionis explains. “Medical optimization, including bone health and sarcopenia management, and excellent and efficient intraoperative carpentry are and always will be the gold standard of care. These implants are just the icing on the cake.”
Still, the results speak for themselves—and with Dr. Pazionis leading the way, the future of spinal surgery at Temple Health looks very bright indeed. The health system’s spinal surgeons provide multidisciplinary comprehensive care for all disorders of the spine, utilizing the most advanced and minimally invasive procedures in the management of low back pain, herniated discs, spinal stenosis, and degenerative disc disease. Thanks to their expertise and the latest innovations, patients are receiving lifechanging care—making Temple a leader in the high-tech spinal surgery revolution. Learn more about the Spine Care Program at Temple Health at https://bit.ly/3XlP4jJ. •
A Student’s Voice: PCOM A Medical Student’s Understanding of Anatomy Through Variation and Perseverance
By Lauren Raziano, OMS-I, Philadelphia College of Osteopathic Medicine
Written December 2024 for the February 2025 issue of the Journal of the POMA,“The Past, Present and Future of POMA.”
The experience of the anatomy lab is a rite of passage in medical school, a humbling, extraordinary journey into the intricacies of life itself.
The lab was overwhelming. The clinical smell of formaldehyde, the stark lighting, and the responsibility to care for a cadaver. As I looked around at other students who are also experiencing this environment for the first time, I realized that the lab is more than a classroom; it’s a space where the boundaries of science and humanity blur. I remember standing with my table mates, asking myself the question, How do you approach a person who has selflessly given their body for your education? But as I began, layer by layer, the fear gave way to focus, and with each lab, I uncovered both anatomical structures and parts of myself I had yet to understand.
There were moments of frustration when I couldn’t name a nerve or distinguish one muscle from another. I had to admit when I could not orient myself to the body before taking the next step, which gave me the confidence to ask for help from the anatomy assistants and professors. In these times, I learned the value of patience and persistence. While completing a pectoral dissection lab, I exposed the cephalic vein in the deltopectoral groove and proudly declared it my anatomy gold star. As I progressed through my musculoskeletal course, I grew more confident in what I knew. I learned that growth isn’t always linear—sometimes, it’s revisiting the same path until clarity emerges.
Anatomy lab also taught me the importance of teamwork. My friends and I often came into the lab after hours to identify structures like the internal pudendal artery or trace the sciatic
nerve pathway, celebrating when we correctly identified these items on our practical exams. These moments reminded me that medicine is a collaborative endeavor founded on shared knowledge and mutual respect.
Although we are taught that comparison in medical school can contribute to imposter syndrome, in the anatomy lab, comparison is critical for understanding that each person is physically unique. The anatomical variation that each person has tells a story about humility. Every structure, from the largest organ to the smallest vessel, told a story of resilience and adaptation. The human body is a testament to the incredible capacity for survival and healing. As I studied it, I found parallels in my own journey—adapting to the rigorous demands of medical school, balancing stress, and finding strength in vulnerability.
The cadaver before me was a bridge to the past—a reminder of the pioneers who first dared to study the human body. Their courage and curiosity laid the foundation for everything we now take for granted. Dissecting anatomy is not just about understanding the human body; it’s about embracing the complexity of life and the resilience it demands. As I continue this journey, I carry these lessons with me, grateful for the growth they have inspired and the privilege of learning from those who have given so much. •
Reviewed by Peter F. Bidey, DO, MSEd, FACOFP, Dean and Chief Academic Officer of Philadelphia College of Osteopathic Medicine
The Collapse of Healthcare in Delco: Crozer’s Last Days
By William King, MD, Editorial Board, PCMS Board Member
The closure of the Crozer Health System in Delaware County has unfolded as another example of another unfathomable collapse of healthcare providers in the Delaware Valley. This tragedy has not unfolded suddenly, but over a period of almost a decade, when the private equity-backed private health system Prospect Medical Holdings bought the Crozer Health System on July 1st, 2016. Prospect Medical Holdings declared Chapter 11 Bankruptcy on January 11th, 2025. In between these dates Prospect subsequently closed Springfield Hospital, Delaware County Memorial Hospital and this year has closed Taylor Hospital and Crozer Chester Hospital, the only trauma and burn center in Delaware County.
Pennsylvania State and Delaware County officials are left with the terrible gaps in service for a county with a population of 576,000 residents who lost EMS services for 26 municipalities; 4 of their most accessible and critical hospitals closed, including their Trauma and Burn units, and only 3 hospitals remain. The now-empty hospital buildings which had been owned by the prior nonprofit system are now mortgaged to a real estate investment trust (REIT) by a private equity owner that extracted more than 600 million dollars in equity from the now-abandoned health system. The Philadelphia region is now faced with the challenges placed on the Riddle Hospital to serve as the emergency room for Chester and other towns more than 30 minutes away, and emergency responders contemplating the fact that any collisions on I-95 south of the Schulkyll will need to navigate into West Philly to Penn Presby, downtown to Jefferson, or drive to Wilmington Christiana.
All of us who have worked in our disaster response teams are shaken by this new fact of life and death. MCP gone, Hahneman gone, Crozer Chester gone – heaven help us all. The lawsuits and recriminations begin, but Philadelphia Medicine magazine will take a moment to mourn this perfectly avoidable but inevitable tragedy of financial greed and medical and political naivety. Our civic leaders and healthcare administrators will be working to fix this disaster for years, but organized medicine must speak loudly against solving our public services with private equity, or none of us will have access to an emergency room in our time of need.
The medical professionals in the Delaware valley have been watching this story unfold under the watchful gaze of journalists of the Delaware County Daily Times (Delco Times – Delco PA News, Sports, Weather and Things to Do), particularly reporter Kathleen E. Carey. The following contextual stories are being reprinted courtesy of the Delco Times.
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The Collapse of Healthcare in Delco: Crozer’s Last Days continued from page 21
Last Days of Crozer Through Eyes of Staff, Patients
May 1st 2025
By Kathleen E. Carey | delcotimes.com
Patients were angry. They were upset. One had to stop driving because she had to vomit. Another said she was simply resigned to die now. “Distress isn’t even a word for how these patients feel and how lost and how angry they feel,” Melanie McKendry, the lead medical assistant in the gynecology oncology department at Crozer-Chester Medical Center, said of the news that these services were going to end this week. “They’re distraught. They’re distraught.” Headed by Dr. Justin Chura, the department is shutting down on Friday. “We see thousands of patients in a year,” McKendry said, adding that they would get their referrals from Women’s Health. All were in different stages of cancer.
This department was one of the casualties of the shutdown ordered by a Texas bankruptcy judge after Crozer Health parent company Prospect Medical Holdings said it no longer had enough money to operate Crozer-Chester Medical Center and Taylor Hospital. “On April 21, we were told hospital-wide by Prospect that they were shutting the hospital down,” the medical assistant said. “We were misled that we were going to be under Main Line and Penn … Prospect (then) decided that’s not what they were going to do. We were told we had 10 days to transfer patients,” she said. “We have had to cancel patient surgeries and tell them to go find another gyn/oncologist which are very hard to find.”
Patients react
The patients, who come from all over Delaware County and even as far away as Florida and Maryland, had a variety of reactions. Some were angry. Others cried. “One patient had to pull over on the side of the road and vomit because she’s losing her practice,” McKendry said. Another gave up. “I don’t drive,” one elderly patient said to the staff. “I’m old. I’ll just die.” McKendry said the majority of the patients received federal or state insurance.
“Money is already an issue,” she said. “We have patients who are demented. Now patients are lost and left to figure out things for themselves. After we close, patients don’t have anyone to advocate for them.” This stress added to the challenges of this particular cancer. “It’s a very personal experience,” McKendry said. “They are very intimate appointments. You’re exposing yourself, you are trusting this person to help save your life. It’s not just a hunky-dory decision. When you find comfort, you find comfort. Now, that comfort is being taken away.”
She said there was a foundation that provided money so patients could use Uber to get back and forth to appointments. Their office wasn’t the only one these patients visited. They had primary physicians, gastroenterologists, gynecologists and others. “This is all they’ve known,” McKendry said. “This is their health care.” She said now they have to get on waiting lists in other places. In the meantime, the patients worried about the providers who have cared for them. “Our patients have been nothing but very concerned for us,” McKendry said.
Challenges for staff
The medical assistant said there have been other challenges as well. “We had very little direction from the current administration that is in the hospital,” she said. “We found out three days ago that the medical record company … has not committed to a contract as far as the patients getting their records.” So, she said, they have been giving the patients the information they can to continue their treatment elsewhere. She said there’s no communication from Crozer’s parent company. “Prospect won’t answer any phone calls,” McKendry said of employees who call. “If you call and you say you’re from Crozer, they hang up on you.” Plus, she said there’s no severance for these employees who stuck it out to the end. “Nobody’s getting a severance,” she said. “It’s under the bankruptcy blanket. We get nothing … We are losing our health insurance and we’re losing our providers as well.” McKendry added, “They have not paid into our 401(k) for three years.” On Thursday, the staff was met with junk-for-hire trucks outside the facility. “They’re literally taking things off the walls,” McKendry said. “They were taking it all down as we were walking in this morning.” It’s not what she anticipated when she joined Crozer Health five years ago, moving with Chura from the Cancer Treatment Center of America when it closed. Back then, care was provided and patients didn’t have to wait for things, McKendry said.
“Cancer does not discriminate against age,” she said earlier this week. “Right now, the main goal is trying to make sure the patients are transitioned as smoothly as possible. We give them the main things that they need to get to the next doctor. We’re open to Friday.” She said the five staff members — Chura, surgery scheduler Nicole Thomas, medical assistant Cassie Bradley, office manager Kathy Hija and herself — were a bonded unit. “We very much are a family here,” McKendry said. “We’re at our own wake, and the patients are coming in to say goodbye.” Her birthday is Saturday but they celebrated it earlier this week. “This is the last time we’re going to be together,” McKendry said. “I haven’t taken the time to think,” she added. ‘I”m more worried about, honestly, my patients. That is my big concern.” Asked what she’s going to do, McKendry said she didn’t quite know yet. “For me, I feel as
though I need to take some time and mentally and emotionally recover from this,” she said. “These patients need us most. When this is all said and done, I’m going to worry about the patients. They’re already in a battle for their life. This is the last thing they need to worry about – finding another provider.”
Delaware
County Council Hears How Fallout Continues From the Crozer Health Closure
May 11, 2025
By Kathleen E. Carey | delcotimes.com
Waiting time for ambulances has doubled; resources including a Tuesday stadium job fair are set up for Crozer employees and a health provider locator map has been established in the wake of Crozer Health hospital closures. Information on these and a
presentation on how Prospect owners took $658 million out of its system were shared at Delaware County Council’s recent meeting. “This is not a situation we should be in,” Delaware County Executive Director Barbara O’Malley said. “The mismanagement of this system and the resources that were taken from it for the profit of others have devastated a community.” Last year, she said the county convened a Hospital Contingency Planning Group after Prospect closed Delaware County Memorial Hospital and Springfield Hospital in 2022 and efforts to sell Crozer Health fell apart. The group’s focus, O’Malley said, was to respond if Crozer Health were to fail and to try to prevent that from occurring.
In February, the county established an internal Emergency Operations Center planning team after Prospect declared bankruptcy in January. Various work groups were established to address what the greatest needs would be upon a Crozer system closure. Delaware County declared a state of emergency on April 21 when Prospect announced and began its closure of Crozer Health facilities, as did 26 municipalities in the county. O’Malley said this gives the county flexibility in its EMS dispatching. “Taylor closed within a week,” she noted, adding that it was shuttered four days after the announcement was made. “Crozer-Chester Medical Center closed on Friday, May 2.” She said Prospect agreed to leave two ambulances at Crozer-Chester Medical Center through the end of May, although the county had asked for 16 weeks of coverage. “Prospect is gone from this community,” O’Malley said. “There will be no one at the hospital … Do not go to that emergency room.” When Crozer-Chester Medical Center and Taylor Hospital were open, 95% of Delaware County’s 576,000 residents were within five miles from a hospital. When they closed, 13% of county residents are not within 5 miles of a hospital, O’Malley said.
Jobless number spirals
Kate McGeever, executive director of the Delaware County Workforce Development Center, spoke of the impact and what’s being done. “Here in Delaware County, for the last several years, we have had anywhere between 10,000 and 12,000 people who were unemployed, giving us a quite low unemployment rate,” she said. “When Crozer announced their layoffs, we are anticipating a total of 3,200 individuals will be impacted, so this is quite a shock.” •
The Dr. Harvey Lefton Memorial GI Conference
14th Annual Clinical Update in Gastroenterology
Tled. Dr. David Sass, Rorer Professor of Medicine and Medical Director for the Liver Transplantation Program at Sidney Kimmel Medical College at Thomas Jefferson University and son-in-law to Dr. Lefton, has taken the reins. Dr. Sass currently serves PCMS as Secretary and has been a constant presence at the Annual Clinical Update in Gastroenterology.
inflammatory bowel disease, pancreatitis, MASLD, and irritable bowel syndrome.
About the Speakers
Dr. Priyal Sehgal delivered a presentation on updates in the medical management of Inflammatory Bowel Disease. Dr. Sehgal is Assistant Professor of Medicine at Sidney Kimmel Medical College, Thomas Jefferson University Hospital.
Saturday, April 26, 2025
his April, The Philadelphia County Medical Society proudly hosted our Dr. Harvey Lefton Memorial GI Conference at Thomas Jefferson University. Dr. Lefton, 151st President of PCMS, Cristol Award recipient, and Delegation Chair for the PCMS Caucus at the annual PAMED House of Delegates, passed away unexpectedly on November 5, 2024. He was the course director for our Annual Clinical Update in Gastroenterology program for 13 years. Dr. Lefton was a highly respected gastroenterologist who was former Chief of Gastroenterology at Jefferson Northeast Hospitals, former head of Gastrointestinal Specialists, Inc. (the largest GI practice in Northeast Philadelphia), and was a founding member and Past President of the Pennsylvania Society of Gastroenterology.
The program returned to an in-person format for the first time since the start of the COVID-19 pandemic and was a successful morning of collegiality and education amongst our participating members.
8:00 AM - 12:30 PM
Thomas Jefferson University, Bluemle Life Sciences Building, Rooms 105 and 107
The Dr. Harvey Lefton Memorial GI Conference is a free educational program featuring Philly’s top doctors discussing the latest in the field of Gastroenterology. This year’s presentations covered
233 S. 10th Street, Philadelphia, PA 19107
Dr. Sehgal received her medical degree from Icahn School of Medicine at Mount Sinai Hospital. She completed her residency at Mount Sinai Hospital and fellowships at Columbia University Irving Medical Center and the University of Pennsylvania.
Program Director : David A. Sass, MD FACP FACG AGAF FAASLD
Rorer Professor of Medicine, Division of Gastroenterology and Hepatology, Sidney Kimmel Medical College at Thomas Jefferson University, Medical Director, Liver Transplantation, Thomas Jefferson University Hospital
• Updates in the Medical Management of
• Approach to the Patient with Pancreatic Disorders
• What’s New in MASLD and PBC
• Optimal Treatment Strategies for Irritable Bowel Syndrome
The Dr. Harvey Lefton Memorial GI Conference continues the Annual Clinical Update in Gastroenterology series that he
Dr. Sehgal’s clinical specialties are Gastroenterology and Hepatology. In addition to Gastroenterology, she is also board certified in Internal Medicine.
Dr. Nitin Ahuja discussed optimal treatment strategies for irritable bowel syndrome. Dr. Ahuja is Associate Professor of Clinical Medicine in the Division of Gastroenterology and Hepatology, and Director of the Program in Neurogastroenterology and Motility at the University of Pennsylvania.
Dr. Ahuja received his undergraduate degree in Biology from Harvard and received his medical degree from the University of Michigan. He completed his residency in Internal Medicine at the
The Dr. Harvey Lefton Memorial GI Conference was held on Saturday, April 26 at the Bluemle Life Sciences Building at Thomas Jefferson University.
University of Virginia and a fellowship in Gastroenterology at the Johns Hopkins Hospital.
Dr. Rebecca Loh gave a lecture on updates in MASLD and PBC. Dr. Loh is Clinical Assistant Professor at Sidney Kimmel Medical College, Thomas Jefferson University Hospital.
Dr. Loh received her medical degree at Sidney Kimmel Medical College at Thomas Jefferson University and completed an internship as well as her residency and fellowship at Thomas Jefferson University Hospitals.
Her clinical specialties include viral hepatitis care, Gastroenterology and Hepatology, genetic and metabolic liver disease, liver transplants, liver tumors, and fatty liver care.
Dr. David Loren discussed approaches to the patient with pancreatic disorders.
Dr. Loren is System Director of Gastroenterology at Temple Health and Professor of Medicine at Lewis Katz School of Medicine, Temple University
Dr. Loren received his medical degree from Washington University in St. Louis. He pursued internship and residency in internal medicine at Beth Israel Hospital
in Boston and completed his senior residency at the University of Pennsylvania. His areas of expertise include GIST (Gastrointestinal Stromal Tumor), Esophageal Cancer, Liver, Gall Bladder & Bile Duct Cancer, Colorectal Cancer, Stomach (Gastric) Cancer, and Pancreatic Cancer. Dr. Loren has authored over 80 publications in areas such as pancreatitis and endoscopy.
Dr. Loren is a fellow of the American Society for Gastrointestinal Endoscopy, member of the American College of Gastroenterology, and President of the Foundation for Interventional and Therapeutic Endoscopy. Among his numerous awards are the Presidential Research Poster Award of the American College of Gastroenterology, earned three times, and the Dean’s Award for Excellence in Education from Jefferson Medical College. He has also been featured in Philadelphia Magazine’s Top Doctors list for several years. •
Can Science and Health Care Gain What’s Missing?
Although the COVID-19 pandemic highlighted a loss of trust in medical care, distrust in many communities is not new
By Monica Webb Hooper
Printed with permission by The Pew Charitable Trusts.
Terms and conditions at https://www.pewtrusts.org/en/about/terms-and-conditions
Since the COVID-19 pandemic shook the globe four years ago, headlines and public conversations have focused on the public’s trust—and the lack of it—in science and medicine.
But trust, mistrust, and distrust—we’ll get to the meaning behind those terms—have been changing shape in the U.S. for decades. Surveys show declines in trust in health care, especially among populations that historically have been harmed by medical research and scientific abuses whose legacies persist today.
As a licensed clinical psychologist, behavioral scientist, and health disparities researcher, I have witnessed these effects up close on a professional level:
A middle-aged Black American patient with late-stage head and neck cancer, whom I treated for anxiety and depression some years ago, delayed seeking medical care because of prior negative experiences with doctors (such as perceived disrespect and the hesitation of clinicians to touch him during physical exams); a preference for natural remedies (such as herbs and vitamins); costly medical bills; and a history of repeated clinic visits for other symptoms with no diagnoses but multiple prescriptions. By the time he sought help, the lump on his neck had grown to the size of a large apple, and the cancer had spread to other organs.
Still another example was a woman who is a member of my own family. A mother of six, she had such negative experiences in medical settings over the years and during previous pregnancies— feeling ignored and minimized, not given pain medication when needed, and discriminated against because of her race by White doctors—that she skipped all prenatal care and went to the ER only when she went into labor with her last three children, requesting cesarean sections based on her past deliveries.
And I’ve been affected by these concerns on a personal level through my own experiences in medical settings, and simply by the fact that I’m a Black American woman in a field that has
historically marginalized people like me. I was moved to partner with a community advisory board I worked with on research called the Forward Movement Project, which asked patients and residents from medically underserved populations to weigh in on health care concerns. The findings from this study and other research and surveys make clear that today many Americans deliberately avoid seeking out health care or participating in medical research until they have no other choice, reflecting personal and community experiences with these institutions that have led to widespread and deeply rooted medical distrust.
Trust, mistrust, and distrust: defining the terms
The psychological concepts of trust, mistrust, and distrust are interconnected, yet distinct and nuanced.
Trust refers to a belief in the reliability or ability of an individual or institution. In health care and science, it’s essential for cooperation and compliance with health interventions, treatment plans, and science-based clinical guidelines as well as clinical trial participation. Studies show that patients who trust their clinicians are more likely to follow medical advice, seek help when needed, and maintain ongoing care.
Mistrust involves a vague unease or a gut feeling of skepticism, often based on past experiences, but has not yet become full-stop rejection. The sources of the doubt may not always be clear. In health care, mistrust may lead to hesitating to accept information, expressing concern about the motives for a treatment plan, or seeking second opinions specifically for validation. The scientific literature often refers to mistrust for science and medicine especially among racial and/or minority populations, but distrust is the more accurate term.
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Distrust is more severe than mistrust, and reflects a firm belief that doctors, scientists, and/or health care institutions are untrustworthy, often rooted in personal or community experiences of harm or betrayal. It can result in underutilization of health care services, belief in conspiracy theories, or outright rejection of medical advice.
And, unfortunately, history is replete with cases that fuel distrust for many people.
Historical sources of medical distrust
The U.S. Public Health Service Untreated Syphilis Study at Tuskegee is one of the most infamous examples of institutional betrayal, fueling deep distrust in science and health care, particularly among Black Americans.
From 1932 to 1972, Black men with syphilis were misled into believing they were receiving free health care but were deliberately left untreated, even after penicillin was found to be a cure. This unethical study symbolizes racial exploitation in medicine. Although its ongoing impact on distrust is debated, Tuskegee has left a legacy of institutional distrust for many Black Americans.
And there are other egregious examples of human exploitation and intentional harm in science and health care that targeted specific communities.
The eugenics movement in the early 20th century in the U.S. aimed to eliminate what its proponents considered “undesirable” traits within the population. This movement sought to “improve” the human gene pool by promoting traits associated with White individuals and those without visible disabilities who were considered the most “fit.” Consequently, Black women and Latinas, including many Puerto Rican women, endured decades of coerced sterilization that persisted into the 1970s.
Even more recently, in 1989, members of the Havasupai Tribe, a small, economically disadvantaged Tribe of 650 people, asked an Arizona State University professor for help in understanding and addressing the increase in diabetes in their community. They supplied genetic samples, only to later learn that those samples were also used for purposes they had not consented to—including research on inbreeding and alcoholism. They brought a lawsuit against the university that was settled in 2010 with the samples returned, a monetary settlement, and help obtaining funding for a health clinic.
Recent sources of distrust: COVID-19 and beyond
who experienced disproportionately high rates of infection, hospitalization, and death—especially in 2020, 2021, and 2022.
Despite the rapid development of COVID-19 vaccines thanks to years of mRNA research, vaccine hesitancy and low uptake were widespread.
Although political discourse, misinformation, and disinformation played roles, vaccine hesitancy among populations experiencing health disparities stemmed from historical roots as well as ongoing experiences of discrimination and neglect within the health care system.
The hesitancy, particularly in communities hardest hit by COVID-19, didn’t surprise me. Many patients I encountered expressed concerns like, “We don’t want the vaccines at all” or “We don’t want the vaccines first.” People feared they would receive a “bad batch,” questioning why underserved communities were suddenly prioritized for the first time in modern U.S. history.
Ironically, the prioritization was due to public health leaders’ aim to promote racial and ethnic equity in vaccine access. But the long-standing and justified distrust left many skeptical—showing just how challenging building trust in many communities will be. This distrust extends beyond vaccines, affecting areas such as cancer treatment, maternal health, and mental health services, where access and outcome disparities persist.
The conversation around distrust in science and medicine tends to focus on racial and ethnic minority populations, though a Gallup Poll indicated that only 36% of U.S. adults overall say they have a great deal of confidence in the medical system, compared with 80% in 1975.
My own research on distrust in science and health care, the Forward Movement Project, offered an approach for examining these significant issues. We created a community-academic partnership to understand some aspects of the multilayered factors related to trust or distrust. Our community advisory board members were involved in every step of the research process—from identifying priorities to developing an intervention—giving them a sense of ownership and agency that are critical to rebuilding trust. We first went on a “listening tour,” hosting town hall-style meetings with members of underserved communities. FEATURE continued
The COVID-19 pandemic brought distrust in science and health care to the forefront, particularly among Black or African American, Latino or Hispanic, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander populations,
Moreover, other populations experiencing health disparities— including sexual and gender minority groups, people with low socioeconomic status, people living in underserved rural areas, and people with disabilities—also report trust-related concerns for clinicians or the health care system because of the way they are treated.
These concerns are ripe for repair. But building trust will require hard work and showing trustworthiness and genuine engagement with the people who have the least confidence.
The Forward Movement Project
The research participants spoke candidly about their personal experiences, as well as those of their family and friends, within medical settings, and many were related to their current medical distrust. “We don’t trust the system, because it can’t be trusted. Health care should come first, but it’s become a business,” one person told us. Another said, “Trust was broken long ago in the African American community when it comes to medical research. People should be informed before they agree to participate, but the health care system hasn’t done enough to ease our concerns.” We shared the findings with hospital leadership, clinicians, other researchers, and the very people we listened to.
Based on comments like these, the challenges for repairing confidence in the medical system loomed large. A key finding from the Forward Movement Project was the importance of reciprocal trust-building between communities and institutions. Participants stressed that trust must be earned through transparency, accountability, and collaboration, with institutions showing a willingness to listen, learn, and adapt their practices based on community input.
So, about a year later, we returned to the same neighborhoods for the second phase of the research, bringing clinicians with us so that they could talk directly with community members and answer questions raised about the health care system. This was what we called a “user-generated” intervention, which consisted of participantdriven dialogues with oncology clinicians and support professionals. This was a rare opportunity for conversations between community members and health care professionals and researchers, allowing participants to discuss their questions about care, and to initiate important discussions. Findings from this second phase of the project were positive and indicated that this activity helped people learn new things about science and medicine and would help them during future medical encounters, and over half reported more willingness to join a clinical trial than before the intervention. This kind of open communication is a crucial first step toward building trust.
The Forward Movement Project also highlighted the importance of representation in reducing distrust. Community participants noted that racial or ethnic matching with clinicians improves culturally competent communication and empathetic care. Other research supports increasing the number of scientists and health care professionals from underrepresented backgrounds to create a workforce that better reflects the communities it serves.
The road toward trust
Trust is a fragile, underappreciated psychological construct that must be earned and is difficult to repair once broken. In that way, institutional distrust is not unlike repeated betrayals in personal relationships, but on a much larger and intergenerational scale.
It’s up to those with power and authority to take concrete actions for improvement so biomedical institutions and health care systems hold the primary responsibility for addressing distrust. Here are some ways they could start:
Publicly acknowledge the historical wrongdoings that have contributed to distrust, such as the Tuskegee syphilis study and forced sterilizations. This includes issuing apologies, acknowledging ongoing harm, and outlining the tangible steps to ensure that these violations never happen again.
Recruit and retain well-qualified individuals from underrepresented backgrounds at all levels—from students to leadership positions. Reflecting the diversity of the populations served is important, as is ensuring that these persons are committed to the intentional and long-term efforts needed to make progress on building trust.
Implement continual and comprehensive training on factors known to influence trust and distrust, such as cultural competency, bias, and practices and policies that foster and maintain inequities.
Invest in long-term partnerships with communities, not just when there is a need for research participants or representatives to serve on patient advocacy boards without decision-making authority. The exchange of knowledge is critical, and community members can offer informed views on health care policy, research agendas, and institutional priorities.
Move beyond traditional metrics of success such as patient satisfaction surveys, and instead work with communities to define what successful relationships and outcomes look like, which might include measures of trust, community empowerment, and perceived respect. This also involves engaging in health education, supporting local health initiatives, and contributing to overall community wellbeing.
Demonstrate a genuine desire to build and maintain trusting relationships. This will require efforts to strengthen oversight and accountability, such as independent panels consisting of scientists, clinicians, and community voices; community-identified and wellresourced public health initiatives; regular equity-focused audits of policies, treatment, and health outcomes, research enrollment and patient demographics; and corrective actions when disparities are identified.
Reducing distrust that has built up over a long time is far from simple. However, science and health care institutions can choose to take proactive, transparent, and sustained steps toward rebuilding trust. Equally important, they should raise awareness at local, state, and national levels about their efforts to prioritize the best interests of all communities for a more equitable future. •
About the Author: Monica Webb Hooper is a clinical psychologist and deputy director of the National Institute on Minority Health and Health Disparities at the National Institutes of Health.
Doctors’ Lounge Philadelphia Medicine
By William King, Jr., MD, PCMS Board
Since the end of the pandemic, the Philadelphia County Medical Society has been collaborating with the College of Physicians to restore a predictable series of collegial conversation – the Doctors’ Lounge. The challenges facing physicians are myriad, as professionals, scientists, citizens and family members. The recent Doctors’ Lounge brought practitioners of one of the realms most baffling to the medical profession, the realm of politics. On May 1st our members joined the College of Physicians to attend How to Improve Your Political Success Without Running for Office, with State of Pennsylvania Representatives Arvind Venkat and Jared Solomon. Rep. Venkat is an emergency physician who is also the first Indian-American to be elected to the State House and the first physician to serve in the General Assembly in nearly 60 years. Rep. Solomon is an attorney and former Army Reserve JAG officer and serves as Chair of the Veterans Affairs & Emergency Preparedness Committee. The event was well attended with several dozen members joining the conversation over food and drink.
Our PCMS board member Cadence Kim, MD, FACS, Urologist, brought home lessons learned. “The most important takeaway message I learned was to focus on one or two legislative items and to pleasantly but persistently follow up locally, on a regular basis, preferably in person, with your legislator.”
John Vasudevan, MD, our PCMS past President, has been
instrumental in restarting the Doctors’ Lounge programs, and found this program particularly instructive. “This event provided an opportunity for physicians and trainees throughout the Philadelphia community to get to know two of our state Representatives not as politicians, but as the passionate people they are. It was refreshing to have a natural conversation and hear honest and genuine perspectives about the experience of public service. Furthermore, the ability to meet one of the very few physicians to ever serve in the Pennsylvania House was an opportunity to witness yet another way that physicians can advocate for the health of their patients.” Dr. Kim summed up the consensus: “Representatives Arvind Vekat and Jared Solomon were great and generous with their time and advice,” and reminded that as physicians, we need to overcome our reticence to engage with our political representatives since “the connections you make with them matter. In summary, the key is engagement; constant and steady.”
Our Doctors’ Lounge series is designed to bring physician and trainee members of the Philadelphia County Medical Society and The College of Physicians of Philadelphia together over food and drink to socialize and learn from expert panelists on how to use one’s medical degree to advance their goals in business, public health, leadership/administration, and politics. •
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