Robustness Enhancement of Sensory Transduction by Hair Bundles

This paper reports the findings of a survey of medical students’ attitudes toward torture and discusses variables that may correlate with those attitudes. In late 2016, 483 enrolled medical and MD–PhD students at the Weill Cornell Medical College received an anonymous, institutional review boardapproved survey that included questions about torture and its effectiveness, demographic questions, inquiries about personal experiences of harassment or discrimination, and questions regarding engagement in human rights activities. Some questions were drawn from a 2008 University of Illinois survey of medical students’ attitudes toward torture, the only prior such survey at a US medical university. Of the 483 students who were contacted, 121 (25%) returned completed questionnaires, with responses indicating strong opposition to torture and skepticism about its usefulness. Respondents expressed greater opposition to torture in this survey than those who participated in the 2008 survey. Respondents’ involvement in Weill Cornell’s human rights program was associated with significantly stronger opposition to torture, while personal experiences of harassment were associated with a trend toward weaker opposition to torture. Respondents’ answers closely approximate the clearly stated ethics of the profession, suggesting that human rights education during medical school may contribute to the development of proper values in young physicians even before they proceed into practice. Krista Dubin, BA, is an MD–PhD candidate at the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program and a senior student advisor for the Weill Cornell Center for Human Rights, Weill Cornell Medical College, New York, NY, USA. Andrew R. Milewski, BA, is an MD–PhD candidate at the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program and co-executive director of the Weill Cornell Center for Human Rights, Weill Cornell Medical College, New York, NY, USA. Joseph Shin, MD, is an assistant professor in the Department of Medicine and co-medical director of the Weill Cornell Center for Human Rights, Weill Cornell Medical College, New York, NY, USA. Thomas P. Kalman, MS, MD, is a clinical professor in the Department of Psychiatry and co-medical director of the Weill Cornell Center for Human Rights, Weill Cornell Medical College, New York, NY, USA. Please address correspondence to Thomas Kalman. Email: tpkmd49@gmail.com. Competing interests: None declared. Copyright © 2017 Dubin, Milewski, Shin, and Kalman. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. Health and Human Rights Journal HHr HHR_final_logo_alone. indd 1 10/19/15 10:53 AM k. dubin, a. r. milewski, j. shin, and t. p. kalman / papers, 265-277 266 D E C E M B E R 2 0 1 7 V O L U M E 1 9 N U M B E R 2 Health and Human Rights Journal Introduction Physicians are subject to broadly accepted standards governing ethical and professional conduct. The condemnation of physicians’ direct or indirect participation in torture is one example. This is asserted by the World Medical Association, American Medical Association, American Psychological Association, World Psychiatric Association, American College of Physicians, American Psychiatric Association, and innumerable countries’ medical societies.1 However, as Steven Miles reminds us, many medical personnel continue to participate in and condone torture: “Many torture survivors report that clinicians monitored their mistreatment. The presence of a physician during torture compounds the victim’s suffering by emphasizing that even the humanity of medicine is turned against the prisoner. ”2 This paper explores the knowledge and attitudes of medical and MD–PhD students at one institution on matters relevant to the practice of torture and physician complicity with torture. Many physicians and medical personnel who participate in torture do so as they succumb to conflicts between professional ethics and the demands of their work, superiors, and peers. The authorization of torture during the Bush administration by government authorities (Departments of State, Defense, and Justice) enabled its legitimization through the military chain of command. In military settings, many may fear retaliation or disciplinary consequences should they fail to follow orders. From a psychosocial perspective, Myles Balfe identifies factors that may contribute to a physician’s participation in torture, such as the passionate assumption of the need to defend the United States from grave danger.3 Balfe further notes that the capacity for rationalization (such as euphemistically referring to torture as “enhanced interrogation procedures”) and cognitive distortions (such as the belief that without medical supervision, greater harm might ensue) are clear factors. Additionally, the splitting of roles such that responsibility can be diffused among many participants, each believing that their individual contribution to torture was minor or insignificant, creates an environment that enables medical personnel’s participation in torture. The present study explores future US physicians’ attitudes toward the permissibility and utility of torture, as well as their beliefs about physicians’ participation in torture. A previous survey of medical students’ attitudes toward torture, conducted in 2008 at the University of Illinois College of Medicine-Chicago (UIC), provided a precedent for our project.4 That six-question survey of 336 medical students across the four years of study revealed a level of support for torture that the authors reported as distressing, given medical associations’ widespread condemnation of physicians’ participation in torture. Specifically, the authors found that 35% of their sample would condone torture under certain circumstances; 24% agreed with the use of torture if a chance to elicit life-saving information existed; and 22% agreed that it was permissible for physicians to treat individuals so that torture could be initiated or continued. These and other findings led the authors to recommend the implementation of medical school curricular assessments to address ignorance or attitudes among students that are at odds with the universally and clearly stated ethics of the profession. International surveys of medical students’ attitudes toward torture or the mistreatment of prisoners have generally revealed a somewhat greater tolerance for such practices among medical students than in the UIC survey. For example, in a study conducted in Mauritius, 37.4% of surveyed medical students were in favor of beating individuals in police custody to obtain information, and in a study of New Delhi medical students, nearly 30% of respondents indicated approval of this practice.5 Taken together, these studies demonstrate the importance of assessing medical students’ attitudes toward such a major human rights issue. The UIC survey has not, to our knowledge, been repeated at any other medical university in the eight years since it was administered. In addition to replicating the prior study, our project attempts to delineate personal and demographic factors that may be associated with attitudes toward torture. Clearly a question of great political, ethical, and medical sensitivity, this topic invites medical training institutions to examine curricula and human k. dubin, a. r. milewski, j. shin, and t. p. kalman / papers, 265-277 D E C E M B E R 2 0 1 7 V O L U M E 1 9 N U M B E R 2 Health and Human Rights Journal 267 rights educational efforts. It is important that medical students have solid grounding on matters such as torture and the obligations of the profession before they begin to practice independently in society. Subjects and methods The Institutional Review Board of the Weill Cornell Medical College in New York City approved this study. All enrolled four-year medical and MD–PhD students (483 total) received an email in November 2016, shortly after the conclusion of the national elections, containing links to a 28-item questionnaire (see Appendix). Their participation in the survey was anonymous and completely voluntary. Appropriate encryption procedures were employed to ensure that the identification of participant/ non-participant status was impossible. Institutional review board-approved consent was obtained from all participants through encrypted procedures, and participants could access the survey only after first providing their consent. The survey instrument contained 10 items addressing specific torture activities, justifications for torture, and ways that physicians might participate in torture. Five of these items matched questions from the 2008 UIC study. To identify factors that might influence students’ attitudes, the survey also included demographic inquiries related to age, gender, ethnicity, religious affiliation, sexual orientation, and stage of medical school training; questions examining individual and family histories of exposure to trauma, harassment, or discrimination; and items surveying respondents’ participation in student human rights activities at Weill Cornell, their familiarity with certain human rights statistics, and their opinions about human rights curricula in medical school. Participation in the survey was initiated by 146 students, but 19 were excluded because they did not complete any sections. Responses from six more participants were discarded, either because those respondents failed to complete the 10 torture-specific items or because they neglected to indicate their gender or age. The final sample size was thus 121 respondents. We employed two methods to identify associations between participants’ attitudes toward torture and their responses to the no