Student Activists

"Medical students are ball bearings--smooth, round, all alike and never creating friction." So said an admissions official at a New York medical school a few years ago. There are still many aspiring physicians who are politically conservative and personally conformist and whose overriding concern is the second Cadillac. This summer, however, as many of the nation's 35,000 student doctors begin summer programs or internships, there is friction aplenty, and a new, rough-edged type of student activist is very much in evidence.

Carl Nathan, a Harvard Medical School sophomore, is a lean, personable redhead who recently testified against the drug industry before a Senate subcommittee. He is plainly representative of the new type. "Some people think they are serving humanity by withdrawing from the world and studying all the time," he says. "Studies are important, of course, but you have a duty not to withdraw from everything else." Ken Rosenberg, a second-year medical student at Tufts, is far more radical than Nathan. His Cambridge apartment is a hodgepodge of stray socks, underground newspapers and books by Herbert Marcuse. Rosenberg, uncertain whether to continue his studies, is taking next year off to think. "I want to work on understanding the medical system and see how I can break it."

Nathan and Rosenberg are far apart on many issues. But they share a deep concern for the state of medicine--and so do ever increasing numbers of their colleagues. "There are durned few students coming into medicine simply to collect country-club memberships," says Dr. Merrell Flair, assistant dean of Northwestern Medical School. At Tufts, Dr. H. Jack Geiger, a professor in the department of preventive medicine, estimates that 20% of medical students are activists willing to spend time on projects of liberal bent, while another 20% are sympathetic.

For the new medical activists, the chief issues include the need for more elective courses, earlier contact with the patient and increased admission of minority-group students. Most important, the activists call for a radical reorganization of existing medical and health services so that everyone will receive adequate care, regardless of ability to pay.

Thus far medical students have been reasonably civil in their confrontations with school authorities. But their demand for "relevance" is every bit as insistent as it is among undergraduates. "We spend eight weeks learning rat behavior and eight hours on child behavior," said a student at the University " of California's new San Diego School of Medicine. "There's an extreme imbalance there."

To express their discontent, activists at several medical schools recently returned the little black bags full of medical equipment, each worth $40, that the drug firm of Eli Lilly & Co. had given them. Others have concentrated on curriculum reform and participation in decision making. The 300 medical students at the University of Chicago achieved official recognition of their Council of Elected Representatives, then went on to win more elective courses.

At Northwestern and San Diego, students demanded and got seminars on social issues in medicine.

Work and Study. Off campus, medical activists are seeking to bring modern medicine to urban and rural slums. Sometimes the effort is made under university sponsorship, but often the initiative comes from the Student Health Organization, described by one educator as "the S.D.S. of the medical field," and the larger, more moderate Student American Medical Association.

S.A.M.A., an offshoot of the conservative A.M.A. with 27,000 members at 94 schools (v. a maximum of 3,000 at 30 schools for S.H.O.), has launched dozens of community projects. Under its auspices, 120 student doctors and nurses were fanning out last week through the poverty-stricken Appalachia region for two months of work and study with local doctors. Other S.A.M.A. summer projects include an eight-week work-study program in Washington, D.C., designed to give students firsthand knowledge of legislative and bureaucratic processes, and a medical-dental program at nine Job Corps centers from Los Angeles to New Jersey.

Some observers attribute the change in attitudes to the experience and example of the early civil rights workers, a number of whom are in medical school today. Harvard's Dr. Daniel H. Funkenstein, however, sees it as part of the emergence of "a new age of medicine," a "community era" in which adequate, humane health care will be available to everyone.

Like Dr. Funkenstein, many university officials welcome the activists. Others fear that activism may interfere with studies and contribute to a lowering of professional standards. "If students are to contribute to solving social problems, they will do it by being good physicians first," says Dr. Daniel Steinberg, professor of medicine at San Diego. Still others wonder whether students can maintain their social commitment all the way through medical school, internship and residency. Says Dr. Martin Cherkasky, chairman of the department of community health at Albert Einstein College of Medicine, "There will be a great change in American medicine if they do."

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