University of Vermont

Q(U)VM

The Making of a Modern-Day Doctor

Joseph Friedman’s senior thesis examines cutting edge genetic technology – and how it impacts patients as people

Student Joseph Friedman
“I spend most of my time in the medical library,” says anthropology major Joseph Friedman, who is working on his senior thesis, immersed in the literature that captivates him: how medical technologies reflect social norms and power dynamics. (Photo: Sally McCay)

Among the benefits of UVM’s pre-med program, according to senior Joseph Friedman, is the flexibility to design an undergraduate education that lets students engage in disciplines that will broaden their skill set as emerging physicians. For Friedman that meant a major in anthropology with a focus on medicine and a minor in biochemistry as well as Spanish, which he hopes will help him serve a broad section of the U.S. population that often has limited access to healthcare. The freedom allows him to follow his interest in both hard and soft science, pursuits now recognized by the Medical College Admission Test Program as integral to becoming a doctor – the 2015 MCAT will include content in both psychology and sociology).

“I can nerd out on the science,” Friedman says, “but I also appreciate what a dynamic art it is to be a clinician, to work with people and interact with them socially as well as medically. Disease isn’t happening in a vacuum or just within cells – it’s happening in a human life and it has a wider social context.”

He’s gotten the opportunity to witness that interplay first hand through the Pre-med Enhancement Program, which has allowed him to shadow one doctor-mentor each year, an experience that has taken him into low-income community health clinics, cardiothoracic operating rooms, gastroenterology clinics as well as genetic counseling sessions. It’s the latter, along with classroom exposure to the power of increasingly sophisticated genetic and genomic technology, that inspired Friedman’s senior thesis, an investigation into how these technologies impact Vermonters’ reproductive decision-making and their socially constructed perceptions of body image and merit.

His research is part conceptual, affording him the chance to dig into a rich body of literature about the medicalization of society, and part practical – Friedman is gathering data from diverse groups affected by genetic testing including patients, molecular pathologists, genetic counselors and members of the disability rights community.

Determining destiny

With a protocol that’s been scrutinized by UVM’s Institutional Review Board for human research in the medical sciences, Friedman doesn’t share many details of his interview process, but he explains the complex interplay of technology and social perceptions. As a scientist Friedman is awed by the potential genetics has to improve, even revolutionize, medical outcomes. Stepping back as an anthropologist, he holds the ambiguities of a science that has been controversial from its inception, including the eugenics movement.

“It’s emotionally charged,” Friedman says. “Some people get upset about it; for others, it’s the future of humanity.”

Either way, he notes, genetics is part of our social fabric, influencing everything from legal decisions to the way we view who we are, most people now having at least a lay person’s understanding of themselves as an amalgam of their ancestry. In terms of how deeply genetic technology can influence our identity, Friedman notes the impact for some women who test positive as carriers of the BRCA I mutation, indicating they may be more susceptible to breast cancer.

“They don’t have any symptoms,” he says, “but they now have a medical diagnosis, and their identity has changed to the point that they might have a preventative double mastectomy, radically altering their bodies.” In some Jewish populations, he adds, some partners may decide not to marry based on incompatible genetic profiles that could put their children at risk for dire conditions.

Friedman says his thesis, a complex work put in the barest terms, is tracing the history of genetics both technologically and socially. Ultimately he hopes to put all of his training together into work as a clinician-researcher who will bring these kinds of medical advancements to low-income patients for prevention and treatment.

His experiences, among a long resume, already include an NSF-funded paid summer research internship in Costa Rica for a Spanish-speaking undergraduate medical anthropologist with a team from the University of South Florida; serving as an officer for UVM’s MEDlife chapter, working to finance medical aid trips to impoverished villages in Latin America, traveling to Ecuador and Peru to shadow physicians and help run medical education programs; and an internship run through the Honors College research office with the Vermont medical examiner’s office where he says he learned a lot about forensic pathology and anatomy, “the tail end of medicine.”

“Joe has a clear hunger and enthusiasm for intellectual challenge that spans the social and natural sciences,” says his thesis adviser Jeanne Shea, associate professor of anthropology. “He is the kind of student who brings to his coursework, research and volunteer activities an infectious curiosity and energy, paired with a depth of intellect, social maturity, compassion and persistent hard work.”

Friedman plans to defer medical school for two years – once he defends his thesis he’ll be waiting to hear about applications for a Fulbright, which would allow him to do graduate studies in epidemiology in Mexico, and the Peace Corps, where, in his ideal world, he would put his medical training to work in West Africa. Just in case – or just because he loves languages and using them to cross cultural barriers – he’s teaching himself to speak French.

Friedman isn’t eager to talk about his desire to serve, simply acknowledging the disparities around him. “To have the privilege at even having a shot at being a doctor is an incredible opportunity.”