Russian Physicians Research Articles

"Curing and Crippling": Biomedical and Alternative Healing in Post-Soviet Russia

From its inception after the 1917 Bolshevik Revolution, the centrally controlled Soviet medical system attempted to monopolize medical practice-stigmatizing and punishing alternative practitioners who worked outside the state system. Nonetheless, alternative medical practitioners survived the seven decades of Soviet power. Ordinary people never stopped seeking them out, and since the late 1980s, the number of alternative healers in the Russian Federation has increased astronomically. The aim of this article is to analyze the forms of alternative medicine that exist in contemporary Russia and to offer an explanation for their continuing popularity in terms of popular conceptions of health and healing, the functioning of the state medical care system, and the attitudes of Russian physicians toward alternative healing.

"Educational" advertisements--I haven't seen one yet!

Since perestroika, Russians have been exposed to freemarket advertising. Russian physicians are no exception, and pharmaceutical companies have rushed in with advertisements to fill the void in information on current drug therapies. The pharmaceutical industry has long argued that advertising and other promotional efforts can be educational. However, as Vlassov and colleagues show, pharmaceutical ads in Russian medical journals are characterized by a lack of information on indications, safety, drug interactions, and supporting resources. This is not surprising because pharmaceutical ads in the United States and other countries also have a poor record. Earlier studies have shown that drug ads contain misleading and incorrect information,1 and this information is associated with inappropriate prescribing.2 Herxheimer and colleagues examined drug ads from 18 countries and found that those from journals in developed and developing countries lacked essential information.3 Thus, advertisements in countries like Russia, where physicians are eager for educational information on new products, are no more informative than those in other countries. One way that pharmaceutical companies could carry through on their promise to educate physicians would be to link ads to resources with more detailed information. In practice, however, advertisers respond to requests for additional information slowly or not at all.4 In addition, when supplemental technical information is provided, it is often from non-peer-reviewed, drug industry-sponsored studies. Ads are only 1 aspect of drug promotion. Other promotional activities are even more likely to be disguised as education. The authors could do an interesting follow-up to their current study by assessing the types of promotional materials that are distributed to Russian physicians, such as journal reprints, pamphlets, and reminder items. Although not labeled as advertisements, these materials also tend to be promotional rather than educational and often fail to convey important information about drugs.5 Why do researchers spend their time documenting that drug ads are incomplete, unbalanced, and inaccurate? Isn't it naive to ever expect that an advertisement, which focuses on a single product, can be educational? Studies such as this show that drug ads do not meet the standard put forth by the International Federation of Pharmaceutical Manufacturers Association. Other studies have shown that drug ads also fail to meet the standards required by regulatory bodies such as the Food and Drug Administration or advisory organizations such as the World Health Organization.3,5 Thus, people who are exposed to drug ads must realize that voluntary and regulatory guidance has little influence on their content. As inaccuracies and unbalance in drug ads are exposed, physicians must learn to seek information elsewhere. By critically appraising drug ads, as well as other sources of information on drugs, physicians can use their time efficiently to keep up-to-date on drug therapies.

Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany

Objectives—The study was performed in order to investigate how end-of-life decisions are influenced by cultural and sociopolitical circumstances and to explore the compliance of doctors with patient wishes Participants and...

Russian Physicians Helped to Upgrade Medical Skills

Russian Physicians Helped to Upgrade Medical Skills

Russian Physicians Helped to Upgrade Medical Skills

Russian Physicians Helped to Upgrade Medical Skills

Can Western Quality Improvement Methods Transform the Russian Health Care System?

The Russian health care system largely remains the same system that was in place during the existence of the Soviet Union. It is almost entirely state owned and operated, although ownership and management have developed from the central government to the oblast (province). The ZdravReform (Health Reform) Program (ZRP) in Russia, which began in 1993, included the goal of improving the quality and cost-effectiveness of the health care system. Work on introducing continuous quality improvement (CQI), evidence-based practice guidelines, and indicators of quality was conducted in 1995-1996. INTRODUCING EVIDENCE-BASED MEDICINE: As a result of the poor quality of Russian-language medical journals and the inability to gain access to the knowledge available in Western medical literature, Russian medical practices have not kept up with the rapid evolution of evidence-based medical practice that has begun transforming Western medicine. A number of evidence-based clinical practice guidelines were translated and disseminated to Russian-speaking physicians working in facilities participating in ZRP in Russia and Central Asia. Given the limitations of existing measures of the quality of care, indicators were developed for participating ambulatory polyclinics in several oblasts in Siberia. Russian physicians responsible for quality of care for their respective oblasts formed a working group to develop the indicators. A clinical information system that would provide automated collection and analysis of the indicator data-as well as additional patient record information-was also developed. CQI activities, entailing a multidisciplinary, participatory team approach, were conducted in four oblasts in western Siberia. Projects addressed the management of community-acquired pneumonia and reduction of length of stay after myocardial infarction (MI). One of the oblasts provided an example of a home-grown evidence-based protocol for post-MI care, which was adopted in the other three oblasts. Evidence-based medicine is critically needed to improve the quality of research and publications, medical education, and medical practice. Physicians everywhere are data driven; they change their practices when convinced by good data. The key to successful introduction of evidence-based medicine is understanding the fundamentals of good scientific method as applied to medicine. The Russian health care system's experience in reporting to higher authorities' process and outcomes data that resemble our modern indicators can provide the basis for accurate and valid measures of quality. In contrast with American expectations that a significant cultural change in an organization could take years, even with great effort, Russian physicians and other clinicians rapidly assimilated the new concepts of QI and put them to use. More on-site assistance by international medical consultants will still be needed for several years to hasten the process of change and ensure that it does not become stalled.

Use of the Internet for Long-Term Clinical Follow-Up*

Use of the Internet for patient-specific consultation across international boundaries has been demonstrated. This report describes the efforts of Baylor College of Medicine and NASA to conduct a telemedicine consultation with Moscow, Russia. Consultation between Russian and American physicians was performed over the Internet with a combination of real-time and store-and-forward techniques. The clinical focus involved a 65-year old Russian scientist who had undergone mitral valve replacement in the United States 5 years earlier. Development of new activity-related chest pain, dyspnea, and intermittent atrial fibrillation led to a consultation with his American cardiologist and cardiac surgeon. Real-time video was supplemented with telephone voice communication to overcome bandwidth limitations. Prior to the video link, the patient's recent history and clinical data were made available via the Internet using file transfer protocol (FTP). The patient's medications, new electrocardiographic findings, and activity status were reviewed. Specific clinical recommendations were made as a result of this telemedicine consultation. This case illustrates the technical factors, clinical implications, and confidentiality issues related to using the Internet for telemedicine consultations and demonstrates that the Internet may provide an alternative means for long-term clinical follow-up of patients.

A. A. Chuprov's Early Paper on Sampling of 1910 / A.A. Tschuprows frühes Referat über Stichproben im Jahre 1910

Summary This is a translation, complete with some comment, of A. A. Chuprov's early paper on sampling read in 1910 at the Congress of Russian Natural Scientists and Physicians, Moscow, first published in 1912 and available until now only in Russian. Chuprov's paper is popular-scientific. He vividly described the history of sampling and its penetration into natural science, explained the arguments of its partisans and opponents and argued that statistics was the link between natural science and sociology. His paper was indeed topical since even in 1921 E. Czuber, Vienna, did not mention sampling in his book on statistical methods.

The Frustration of Knowledge—Medicine in Russia

Russian physicians face financial restraints which hinder the supply of lifesaving medications. Drugs which are not available include surfactant—a treatment for respiratory distress syndrome in neonates. The author recently visited Tver, Russia, and comments on the maternal-newborn programme in this academic centre.

Letter from Yekaterinburg.

The Russian city of Yekaterinburg, known as Sverdlovsk before the influence of perestroika, lies at the eastern foot of the Ural Mountains on the border between Europe and Asia. It was the site of large armaments factories, most of which are now closed, but the area continues to feel the aftermath of their heavy pollution. The annual Congress of the Russian Society of Internal Medicine was held here in 1995 and was attended by physicians from all corners of this vast country. Leaders in the field of internal medicine from Russia presented state-of-the-art papers on many aspects of the theme of the conference, Emergencies in Internal Medicine. The problem of the acquired immunodeficiency syndrome was also discussed, but this subject is still taboo as far as the official health authorities are concerned. The Russian physicians talked about how they deplored the great shortage of disposable medical equipment. One of the most serious health problems in Russia is alcoholism; surprisingly, this problem was hardly mentioned at the congress. An open international exchange of information is again possible in Russia, but financial considerations restrict attendance at meetings abroad and the availability of professional journals domestically.

Russia to start anti-poliomyelitis vaccination campaign

The Russian Health Minister and the President of the Russian Academy of Medical Sciences sent an open letter to the people about the nationwide anti-poliomyelitis vaccination campaign scheduled for February 1996. The campaign aims to achieve 95% coverage of under-3 year olds. Currently 33% of the 3 million children aged less than 3 have not been immunized against poliomyelitis. The number of poliomyelitis cases increased from 3-17 cases over the course of many years to 145 cases in 1995. The vaccines and promotion for the campaign will cost 10 billion rubles. Campaign workers will focus on disadvantaged areas. Russia has faced much public hostility to any immunization for many years mainly due to fears of acquiring AIDS or hepatitis from reused and incorrectly sterilized needles. Various Russian physicians have also criticized mass immunization campaigns in professional publications as well as in the public press. Main criticisms are low quality vaccines in Russia and the poor health status of Russian infants. Vaccines are intended for healthy infants according to a member of the Medical Ethics Committee of the Russian Academy of Sciences. Mass immunization campaigns also tend to intimate Soviet propaganda for Russias new democrats. The campaign is expressed in quasi-military terms with slogans and exhortations targets completion dates and bonuses for meeting ones goal ahead of schedule. Yet such campaigns are possible in the post-Soviet era. In 1995 an anti-polio campaign in Uzbekistan reached 99% of infants and young children.

Telemedicine and International Disaster Response: Medical Consultation to Armenia and Russia Via a Telemedicine Spacebridge

The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

The Total Artificial Heart

In the early 1800s, an awareness of potential ventricular failure stimulated interest in artificial heart replacement. In 1937 the first total artificial heart (TAH) was implanted into the chest of a dog by Russian physicians. The primary driving force for mechanical cardiac assistance developed from the necessity for circulatory assistance in order to perform corrective cardiac surgery. In 1953 the first successful closure of an atrial septal defect using extracorporeal circulation was performed. During the following decade the concept of using mechanical devices to assist the failing heart was aggressively pursued. This culminated in the first implant of a TAH in a human in 1969 as a bridge to transplant. Clinical implant of the TAH as a permanent device was performed in 1982 by researchers at the University of Utah. This patient lived for 112 days. Three successive permanent implants were performed in Louisville, Kentucky, with one patient surviving for 620 days. All of these permanent TAH patients suffered from device-related complications including bleeding, infection, and thromboembolic events. It became apparent that the present configuration of the TAH with its external drive lines and large air console was not ideal for long-term support. In 1985 the first implant of the Symbion J-7-100 TAH (Jarvik-7) as a bridge to transplant was performed. This patient was supported by the device for 9 days and was successfully transplanted and discharged home. Since 1985 more than 170 patients have been bridged using the Symbion J-7 TAH with more than 70% of these patients being successfully transplanted. The incidence of thromboembolic events has dramatically reduced with better understanding of anticoagulation requirements. Infection continues to be the greatest potential complication with these patients. In spite of this, the pneumatic TAH has proved to be an adequate bridge to transplant device.

The search for Samojloff: a Russian physiologist in times of change.

The names of Russian physicians do not often spring to mind when recalling the advances of the past century, though a quick glance discloses many contributions, including those of Anitschkow in the pathogenesis of arteriosclerosis, Korotkoff in the measurement of blood pressure, and Elie Metchnikoff, the bacteriologist. Few, however, realise that James Herrick's diagnosis of coronary occlusion in the living patient1 had been anticipated by two years by two physicians from Kiev, Obrastzow and Straschesko. Their original description in Russki Vrach was republished almost simultaneously in German and was cited by Herrick.2 Even before this, however, a Russian physiologist, Alexander Filipovich Samojloff, had written the first book on electro cardiography, which should have been easily accessible to Western physicians because it was written in German and had been issued by a leading German publisher.3 The book is not, however, listed in two important EngUsh bibliographies,45 though it and several other publications by Samojloff were cited by Western contemporaries, and his contributions are proudly acknowledged in the Soviet Union. Who was Samojloff and what was his role in Russian and indeed international physiology?

The deprofessionalization of Soviet physicians: a reconsideration.

Traditional explanations for the relatively low status of the Soviet medical profession credit the Bolshevik government in the 1920s with deprofessionalizing or "leveling" a once autonomous and powerful occupational group. This article presents new data which challenge that interpretation. The Russian medical profession was never autonomous and powerful. Many physicians cooperated with the Bolsheviks because of shared beliefs regarding the organization of medical care. By the late imperial period, many physicians advocated the inclusion of all medical workers in policy-making administrative organs. Focusing upon Russian psychiatrists, the author analyzes the events that prompted the profession to adopt this position. The finding of greater continuity between prerevolutionary Russian and Soviet physicians suggests that this presumably anomalous case has greater significance for theoretical models of professionalization and occupational prestige than previously supposed.

Syphilis, historical and actual: cultural geography of a disease.

Nineteenth-century Russian physicians identified two forms of syphilis, venereal and endemic, which they associated with the difference between city and country life. Modern medical authorities have generally rejected Victorian ideas of nonvenereal contagion, but students of preindustrial societies have found evidence that endemic syphilis does in fact occur. Because it was hard to distinguish one form from the other, however, prerevolutionary Russian doctors allowed their cultural preconceptions to guide them where evidence was weak. Their view of syphilis thus provides the historian with a remarkable guide to attitudes toward class, gender, and social change. Modern neglect of the nonvenereal variant demonstrates not merely the progress of scientific knowledge but also the cultural restriction on our own view of the world.

Russian physicians and medical politics in the Revolution of 1917.

Alone among the major upheavals of modern European history, the Russian Revolution of 1917 has yet to be tackled by historians of medicine outside the Soviet Union. The interplay between medicine and revolution in London in the 1640’s, Philadelphia in the l780’s, Paris in the 1790’s, Berlin in 1848 and again in 1919 has received, and continues to receive, a good deal of attention; why not Petrograd and Moscow in 1917? True, many scholars are aware of the politicization which marked the Russian medical profession in tsarist times—reflected especially in the resolutions of the Pirogov Society's famous “Cholera Congress” in 1905—but few can say anything of substance about the aspirations, tactics, and involvement of physicians in the revolutionary events of 1917. Indeed, for those who do not know Russian, there is so little to read that the present situation verges on a historiographic scandal.

Russian Physicians in an Era of Reform and Revolution, 1856-1905. Nancy Mandelker Frieden

<i>Russian Physicians in an Era of Reform and Revolution, 1856-1905</i>. Nancy Mandelker Frieden

Russian Physicians in the Era of Reform and Revolution, 1856-1905. Nancy Mandelker Frieden

Previous articleNext article No AccessBook ReviewsRussian Physicians in the Era of Reform and Revolution, 1856-1905. Nancy Mandelker Frieden Alexander VucinichAlexander Vucinich Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Isis Volume 74, Number 4Dec., 1983 Publication of the History of Science Society Article DOIhttps://doi.org/10.1086/353389 Views: 2Total views on this site Copyright 1983 History of Science Society, Inc.PDF download Crossref reports no articles citing this article.

Nancy M. Frieden, Russian physicians in an era of reform and revolution: 1856–1905, Princeton, N.J., and Guildford, Surrey, Princeton University Press, 1981, 8vo, pp. xvii, 378, illus., £22.80.

Nancy M. Frieden, Russian physicians in an era of reform and revolution: 1856–1905, Princeton, N.J., and Guildford, Surrey, Princeton University Press, 1981, 8vo, pp. xvii, 378, illus., £22.80.