Faculty Bibliography

Only five percent of physicians in the US are African American and 2.2% are African American women. In 1860, Dr. Rebecca Lee Crumpler (1831-1895) earned entry into New England Female Medical College (NEFMC), the first medical school to train women as medical doctors. She subsequently graduated in 1864 with a "Doctress in Medicine," becoming the first African American female physician in the United States. Dr. Crumpler cared for approximately 10,000 freed African Americans, who were primarily poor, had no access to medical care, and were discriminated against by white doctors. She suffered from harsh conditions and severe discrimination by fellow physicians in Virginia. Hospitals would not admit her patients and pharmacies would not fill her prescriptions or medical supplies. With her 1883 publication, "A Book of Medical Discourses in Two Parts," she became the first Black physician to write a medical textbook, and the only female physician-author in the 19th century. As we reflect on the legacy of Dr. Crumpler, one cannot help but to think on the similar experiences that many Black female physicians experience in this country today, including both racism and sexism, and the challenges of caring for underserved patients with limited resources in hospitals that are under-resourced. The Black community is continuously plagued by a plethora of health disparities that Dr. Crumpler fought so hard to combat. These disparities include high maternal mortality rates among Black women, who suffer 3-4 times that of white women in the United States. During the period of 1725 to 1853, the death rate of "colored people" greatly exceeded that of whites. Today, Black women in particular experience higher rates of preterm labor, regardless of education or income. Disparities in breastfeeding impact the rates of infant mortality, among other causes in Black communities. The voices of Black women continue to be stifled similarly to that of Dr. Crumpler's. With less of a voice in academic medical centers, board rooms, and hospitals, Black women continue to have minimal influence on the health care system and its impact on underserved communities. They also face significant pay inequities as compared to their white male counterparts. Black women will lose approximately $941,000 to the wage gap over a 40-year career. In addition, Black women physicians tend to receive additional workloads within their employment site that do not lend them to promotion opportunities, such as full professorship, department chair or medical school dean. Just like Dr. Crumpler, Black women physicians advocate for respectable and accountable patient centered care and reproductive justice for their patients. They fight for social justice in education, housing, environment, immigration reform, criminal issues, maternity and childcare, all which impact health outcomes. We understand Dr. Crumpler's uphill battle to ensure proper care for the Black community. Black women physicians today continue the charge to further the work the Dr. Crumpler started. She laid the foundation for Black women as healers and we will continue to pursue this work to ensure equity for both our patients and fellow colleagues. Now we call for others to join us. Who else is with us? **Footnote: On July 19, 2020 on the 125th anniversary of her death, she and her husband received headstones in a public ceremony to commemorate her work and dedication to the practice of medicine In her honor, Dr. Crumpler has a permanent exhibit at the Boston University School of Medicine, efforts which were led by Dr. Melody McCloud, fellow alumni.
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OBJECTIVE: To review the patient profiles, laboratory data, and diagnostic approaches in factitious administration of glucocorticoids. METHODS: Four cases of surreptitious use of glucocorticoids are presented. Clinical and laboratory data as well as imaging studies are summarized. Pertinent case reports in the literature are reviewed. RESULTS: We report four cases of surreptitious use of glucocorticoids encountered within a 2-year period. All four patients were women without significant psychiatric histories. In three patients, the question of factitious Cushing's syndrome was suspected because of physical evidence or symptoms of Cushing's syndrome (or both) in the setting of suppressed cortisol levels. The fourth patient had undetectable cortisol levels in both serum and 24-hour urine samples but did not have signs or symptoms of adrenal insufficiency. In three cases, the diagnosis was confirmed by direct measurement of synthetic glucocorticoids in the patient's urine or serum. The fourth case was diagnosed by correlating increased cortisol levels with decreased precursor adrenal steroids. CONCLUSIONS: Exogenous corticosteroid use in the absence of a medical indication poses a serious risk to a patient. This possibility should be considered in patients with signs and symptoms consistent with Cushing's syndrome but with low serum and urinary cortisol levels. Similarly, this diagnosis should be suggested in patients without symptoms of adrenal insufficiency and with low cortisol levels. Laboratory measurement of synthetic steroids can be helpful in confirming the diagnosis