Jennifer Cohen 0:04
Welcome back to Voices in Bioethics. I’m Jennifer Cohen and it’s my great pleasure to welcome Hibah Ilyas to the podcast. Hibah Ilyas is a third year medical student at Lake Erie College of Medicine in Erie, Pennsylvania, and she’s currently doing a rotation at Rochester Regional Health in upstate New York. She holds a BS in Physiology and a BA in East Asian Studies from the University of Arizona. Thank you so much, Hibah, for speaking with me about your work.
Hibah Ilyas 0:33
Thank you, Jennifer, for having me.
Jennifer Cohen 0:34
Our pleasure. Let’s start with your medical course of study. So you are studying to become a DO – a Doctor of Osteopathy. The way I think of medicine, it sort of breaks down into two branches: the allopathic and the osteopathic. Is that correct? And if it is, can you define both those terms and describe how they differ from one another and how they are similar?
Hibah Ilyas 0:59
Yeah, so both courses of medicine, they are basically very similar. I would say in terms of curriculum, what the osteopathic curriculum really focuses on is the osteopathy, which really is the principle of seeing the body as a whole unit. So when we are talking about disease processes that, you know, an individual can get sick from, we don’t look at it as just, you know, what’s happening on a micro or cellular level. We look at, okay, this is how one part of the body is being affected and how it actually affects the rest of the body, including your mind and how that can eventually lead to other consequences and kind of related symptoms that may be more generalized than just associated with just one disease process.
Jennifer Cohen 1:56
Right. So Doctors of Osteopathy are fully licensed physicians. That’s correct.
Hibah Ilyas 2:02
Yes, that’s correct. So we can prescribe medications, we can see patients, we work in hospitals, we just have that kind of one additional training which involves the hands on osteopathic manipulation techniques, which our allopathic peers don’t have that extra training.
Jennifer Cohen 2:21
Okay, I want to unpack a lot of what you just brought up. So first, you mentioned that a feature of osteopathic medicine is that it endeavors to treat the whole person, the whole unit, as you said, versus just symptoms of disease. Can you flesh out how that plays out in clinical care?
Hibah Ilyas 2:42
Sure, so, often, I guess, like in a more is, you know, a patient comes in to an urgent care and, let’s say they have like a cold. So, you know, they have fever, chills and for a cold, you know, we do prescribe some kind of medication. Usually colds are, like, a viral infection so we don’t really give antibiotics for that. But we can help give, like, if you are, like, having a sore throat, we can give you something for that. But, and like, generally for your fatigue and for your fever we’ll often prescribe medications for that. But there are also things we can do in the office instead of just prescribing medications to kind of give some immediate relief. So if you have, like, body aches and trouble breathing because you’ve been coughing up so much, and just generally feeling ill, then we have some techniques that we can use on the body to kind of help. So most often what we are working with, with the techniques that we do is on different layers. So what we kind of treat our muscles and fascia, and we kind of move and try to relieve tension in those areas, in order for the body to kind of better perform. So in states of disease, kind of, like, your sympathetic system is kind of in overdrive. And so kind of placing our hands and putting pressure in certain areas that reaches the nerves and the fascia and the muscles that are kind of being triggered can help calm down that flare up. So it’s kind of the same, I guess, ideas like when you kind of ice, like a sore muscle or if you put like a hot pack in a very, like irritated area. It’s the same idea. But we kind of really , like, relieve the tension in those muscles.
Jennifer Cohen 4:43
So interesting. Can you talk a little more specifically about what these manipulative techniques entail?
Hibah Ilyas 4:50
Yeah, so for example, if I were to target, like, if you have chest pain, you’re not able to take a full breath. So we can kind of do some breathing exercises, while I also kind of like, if you inhale, I’ll, like, kind of put my hands on, like, the sides of your chest, you’ll inhale and then as you exhale, I may put some pressure on your ribs. And continue to do that with each inhale and exhalation and continue to put pressure while you exhale so that it kind of feels very tight while you breathe. And then when I suddenly release, that inhalation and exhalation actually kind of stimulates lymphatic flow. And also kind of allows your ribcage to kind of just like open up. So that is like one technique, especially when people are feeling ill, lymphatic flow techniques can really kind of help aid just like feeling better, because any of the bad cells that are in your body are kind of taken up by the lymphatic system. So kind of improving the flow will allow all of the bad cells to kind of clear out faster.
Jennifer Cohen 6:06
So interesting. So let me ask about consent, which is such a big issue in bioethics. How do osteopaths address the issue of consent when it comes to touching patients?
Hibah Ilyas 6:22
Always leave, like, even just, you know, meeting a patient for the first time, I believe all physicians, you know, kind of learn the etiquette of how to approach a patient, introduce themselves, kind of, like, sit eye level with the patient instead of standing over them to allow the patient and the physician to kind of interact on equal terms because being in the hospital and seeing a doctor or being sick, it’s all scary, and nobody likes it. So creating a comfortable setting is the first step for any physician when talking to a patient. But then, especially when evaluating and touching the patient, doing an exam or even doing a treatment, our best practices include kind of asking permission and also explaining what we’re doing because the patient doesn’t know. So, as we are doing our treatment, we and if usually we treat a patient on one of our, like, the beds, so we will help them lay down or support them, kind of instruct them which way we want them to turn, we kind of hold the side of the bed in case they feel like they may roll off. So all of that and just being close and be watchful and openly communicating to them that we’re here and like we’re gonna touch here, and we’re holding side of the table so you don’t fall, you can feel for you to grab my arm if you’re unstable, just that open communication really allows the patient to be comfortable in that setting. We’ll also let them know that you know we’re not going to do anything without letting them know and that just establishes a greater trust in the patient physician interaction.
Jennifer Cohen 8:03
Yeah, yeah, that seems to be a very different experience than many patients have in regular doctor’s offices. In terms of decision making by patients, so normally, when someone goes to the doctor’s office, it’s for something extremely specific. The medical intervention offered is usually very specific just for that problem. The side effects to the medication are explained and the patient consents or doesn’t consent, when you’ve got this whole body, whole system approach, how do you think that impacts a patient’s ability to consent?
Hibah Ilyas 8:39
So, I mean, like every treatment, it’s an option for a patient. So in addition to whatever medications we may offer, we can also offer “hey, like, we have this treatment that I think may benefit you,” and we would explain the process and how that will kind of help them get better. And they have that option of you know, like, “yes, I’d like to try that”or “no, I don’t think that would be helpful for me.” So, I mean, it really depends and I feel like even current osteopathic physicians, depending on what setting they’re in, they may or may not offer those services because first, it takes time. Second, patients are very familiar. They’re already not feeling well so sometimes people are not willing to, like, spend the extra time in that unfamiliar setting. But you know, some of the physicians who I have seen kind of practice in that way. Always explain thoroughly and try to make the patients understand that you know, doing this manipulative technique or treatment can give you some immediate relief. And also, we can prescribe kind of like home regimens. So we can perform it on the patient and then teach the patient how to do similar techniques on themselves or on their family members to provide relief.
Jennifer Cohen 10:11
Wow, does osteopathy encompass chiropracting?
Hibah Ilyas 10:16
No, I would say that chiropractors – I’m not too familiar – but they often use additional tools. They have, like, some, like, hammer guns and things that can kind of help assist – do help assist – with aligning the spine and stuff, but mostly, the osteopaths, we don’t use any extra tools. It’s all like just our hands and placing the patient in certain positions and straightening them or turning them ourselves and with the patient, it doesn’t require like any additional tools.
Jennifer Cohen 10:54
Are there misconceptions about osteopathic medicine that you’ve run into?
Hibah Ilyas 10:58
Definitely! A lot of people don’t understand just the term, I think, kind of throws people off, like, “oh, well, what is that? That must mean something different if you don’t have MD at the end of your name, that must mean that you’re not a real doctor.” So that’s just one thing – it’s just the unfamiliarity of what DO is. But in actual practice, when you’re seeing a doctor, nobody really asks them if they’re MD or DO or where they got their degree from. You go to the hospital and you see a physician and they take care of you and then you leave. So in terms of that, I do think that just in general, that when someone does kind of initiate and say like, oh, I’m a DO or I’m an osteopathic physician, questions come up, and like, “oh, what does that mean?” And when we explain manipulative techniques, they will say like, “oh, so you’re just giving me a massage” or you know, “yeah, you must be just like a chiropractor.” I mean, in essence, you know, what we may be doing may be very similar, but I think the training and the reason why we are offering that treatment are a little different, nuanced.
Jennifer Cohen 12:18
How many years of training does it take to become a Doctor of Osteopathy?
Hibah Ilyas 12:21
So after completing four years of an undergraduate education, you will have to complete four years of an osteopathic curriculum and then afterwards there – actually newly – there has been a DO-MD residency merger. So now MDs and DOs can all apply to all the same residencies and so depending on what you want to specialize, you will then do your additional residency training, which can range from three to five years. And if you want to do any fellowships, that can be an additional couple of years. So it’s, like, timeline wise, it’s the same as an allopathic physician’s timeline.
Jennifer Cohen 13:09
Okay. Let’s switch gears to some of your research interests. So you’ve done research studying the Ainu people of Japan. Who are they and how did you become involved with studying them?
Hibah Ilyas 13:23
Sure. So the Ainu people are the aboriginal people of Northern Japan, mostly located on the island of Hokkaido, which is very close to the Russian Peninsula up there. They are natives to Japan and I didn’t know anything about them until I actually had the opportunity to study abroad in Japan. And I was doing this for my East Asian Studies major, with an emphasis in Japanese culture. So I was taking a lot of courses on just general culture, food, I was taking language classes and it turns out that some of the cultural courses actually incorporated some topics on the Ainu people. I was very fascinated because as an American-born person going to Japan for the first time, I had never imagined that there was people that consider themselves other from the more traditional East Asian population. I mean, Japan is considered, for the most part, a homogenous kind of population. I never thought about it. I had never seen it in mass media. So I was very surprised. And there were actually opportunities for us at the Hokkaido University campus, where I studied abroad, to actually meet some Ainu people and kind of see some of their culture and read about them. And one of my professors was someone who was very involved in Ainu research as well. So kind of getting that exposure while I was there was what really interested me and kind of pursuing that further when I came back to the US.
Jennifer Cohen 15:20
Sounds like an incredible experience. So can you tell us about the type of research that was done into the Ainu people, why that type of research was problematic, and the reasons around discrimination against Ainu people?
Hibah Ilyas 15:37
Sure, so I like to say a lot of anthropological research. It was heavily for political reasons. So when, for any kind of, I guess, current nation, you know, land and acquiring land and acquiring riches, that was all part of, kind of, becoming a bigger and better society. So as Japan, in its colonial era, was trying to conquer more land and move further up north, the island, they kind of came into contact with the Ainu people. And visually, like when you just compare that population with the Japanese people who call themselves Wajin, they kind of saw a difference outright, that Ainu people were a little bit bigger, they had more facial hair, in addition to just like, the different clothing and the way they dressed and the different activities and cultural activities that they had. They said, well, these people are different from us. Like who are they? So a natural curiosity, I think, started that research. But in addition, because in their eyes, the Ainu people were lesser or had savage practices, it was easy for them to kind of say, “oh, well, you guys are lesser, we can take your land and take advantage of you.” So once they had access to the land and all the resources and they had established themselves there, they kind of had to justify why they were able to do that and why it was okay. And so then, while all of this, I mean, all around the globe, you know, people were conquering new lands and kind of going out and doing explorations and studying different peoples and cultures. In the same line of sight, they wanted to do the same thing to Japanese people. And so they kind of started recording the different practices of the Ainu people and putting down like, okay, they do these things that are different from us, they look different from us, and kind of making comments on how they could better them and kind of incorporate them into Japanese Wajin society. And so it was not only the Japanese researchers and conquerors who kind of wrote these things down, there are actually a lot of Western explorers and researchers who also came to visit Japan when the borders had opened up to kind of see the Ainu people and make their own conclusions on the state of the Ainu people and how backwards they may be, or how savage they may be and how, in comparison, the European and Japanese people were more advanced.
Jennifer Cohen 18:54
So was this sort of in the late 19th century, early 20th century, this is all happening?
Hibah Ilyas 18:58
Yeah.
Jennifer Cohen 18:59
Okay. Did the Ainu have their own language?
Hibah Ilyas 19:04
Yes. So they had an oral language. I don’t believe it was ever written down until afterwards in an attempt to kind of keep the language and teach people about it, but it was an orally transmitted language, yeah.
Jennifer Cohen 19:21
Okay. And this was, at that time, part of this whole thrust in anthropology around biological differences, as you mentioned. So in order to further this, there was a lot of digging up of graves and sacred land, is that right?
Hibah Ilyas 19:38
Mhm, correct.
Jennifer Cohen 19:38
And I guess that continued for quite a while because now there’s a big interest in remains in terms of DNA sequencing. So can you talk a little bit about what occurred and how that affected the Ainu people?
Hibah Ilyas 19:53
So the whole interaction in general of outsiders coming to Ainu land and displacing them, I mean, that was kind of, like, the first assault. And then in the name of research, kind of going in, and without actually consulting the Ainu people, taking any remains and doing whatever testing they were doing and publishing research on that was the second assault. And this kind of continued without, really, the Ainu people really knowing or kind of understanding what was happening, they just knew that there was this bad relationship with them, and the people who are doing this research and coming and kind of disturbing their peace, quote unquote. So it wasn’t until later, I would say in like, the 1800s, when there was an actual protest on the Hokkaido University campus grounds, because a lot of the remains and a lot of the research was happening there, where people kind of started to realize that, “oh, we have a voice and you know, we can use it to reclaim what was taken from us.” It’s hard to take away what has already been done, you know, the research was already put out there, the propaganda was already put out there. And the Ainu people, they were kind of lost. So they became integrated into Japanese society. And there’s actually, in Japan, they kind of trace your lineage. It’s been recorded for many, many generations of like, this person, their mother and father and their parents are these people, and they came from this tribe, and their parents are from here. So it goes all the way back. So you could technically trace a current, you know, citizen’s lineage all the way back to who their first ancestors were in modern day Japan. And so even today, as I’ve heard, in more traditional families, if you kind of follow that lineage, and you know, if a guy and a girl want to get married, and it turns out that one of them may have Ainu heritage, that the family may be opposed to them getting married. So it’s very difficult and it has placed the Ainu people in a fear of, if they identify as Ainu people they will be discriminated against. And Japan as a society itself, they don’t really appreciate differences. They have a certain way of doing things. And you know, everyone tries to blend in with each other. Nobody tries to make too much of a ruckus. And being different is not celebrated.
Jennifer Cohen 23:08
You’ve written that the Ainu were recognised as an indigenous people just in 2008. Very recently, wow.
Hibah Ilyas 23:16
Correct, yes.
Jennifer Cohen 23:17
Do you know if this specific issue of the digging up of remains that those were being housed at Hokkaido University? And then were some of them returned? Or are Ainu people trying to get these remains returned to them?
Hibah Ilyas 23:32
Yeah, so based off of the last legislation, actually, pretty recently, in 2012, I think this is the most recent lawsuit, where there were two Ainu elders, who were basically trying to meet with the Hokkaido University president. And they wanted to request further returns of the remains that had not been returned in previous communications. That conflict between the university and, kind of, the idea of the university having rights over the research versus the Ainu people having rights over the actual remains that were used in that research, you know, was brought to light and this was just recently in 2012.
Jennifer Cohen 24:31
So it’s ongoing, regrettable.
Hibah Ilyas 24:33
Right.
Jennifer Cohen 24:34
In your paper, you make some recommendations to try to ensure something like this doesn’t happen again. You make a fascinating suggestion of having almost a type of IRB that would consist of Ainu people – would consist of representatives from the group that’s being studied on the IRB.
Hibah Ilyas 24:56
Mhm.
Jennifer Cohen 24:57
You talk a little bit about that and other efforts that might be made to try and lessen some of the mistrust that goes on for generations after something like this?
Hibah Ilyas 25:07
Right, so
So the purpose of an IRB committee itself, right, is to challenge researchers, and the reason for why they are doing their research – if it’s necessary, and if it will be beneficial, and kind of the harm-benefit ratio. So similarly, for the Ainu people, you know, having research published on you about your people, the conclusions, I feel like for all research, you do the research, you get maybe some numbers, you get some kind of data, but the way you can interpret data, two different researchers can take the same data and interpret it differently. So really, when you’re interpreting data, what you say, from what you gather, can largely affect and kind of influence a greater population. So if you’re talking about and making comments about a very specific group, you know, what the impression of those conclusions may be could be very detrimental. So having the Ainu people on this board and kind of having an extra perspective and saying, “well, is this research beneficial to us as a people? And whatever the research conclusions may be, are we prepared to deal with whatever may be said about us?” And it can be a very hard line, because for researchers, they try to have the best intentions, right? In the name of research, we want to give everyone more knowledge and kind of expand on what we don’t know. But sometimes, information that is disseminated can be more harmful than beneficial. So you also kind of have to think about on the other side, you don’t want to censor information that may come out of research, that kind of can give the opposite effect as well. But I think that looking back at the history of people that have been so traumatized and taken advantage of, to not give them the opportunity to kind of reclaim and have a say in what is published about them, I think, is a little unfair. So kind of giving them a space to do that, I think is one of the ways where we can continue to study any differences within that culture and within that people, but also kind of give them an opportunity to use it as a way for them to kind of reconnect with their roots, since, you know many of them had been lost in the homogenous society that we see now, in Japan.
Jennifer Cohen 28:11
Along those lines, you talk in your paper about this divide, this historic divide between qualitative social science, humanities research and quantitative scientific medical research.
Hibah Ilyas 28:26
Right.
Jennifer Cohen 28:26
And you make an argument that these two disciplines should really have more overlap. Do I have that right?
Hibah Ilyas 28:32
Right. So like I said, I can use, like, a general example – if you, you know, have a study looking at different disease rates in a very strict population. Now, it may be that, you know, in that population, there may be a higher disease prevalence compared to the rest of the population. But is that because it’s really because it’s only in that certain population? Or is it because there are other confounding factors like social economic factors, like environmental factors? So I think that kind of taking, you know, the more medical, like I said, really, the conclusions, what we’re taking from them, they may not be the whole picture. So if a research is saying that the disease is highly prevalent in one population without considering what other factors may be contributing to this difference that they may be seeing, it requires a more holistic and also more humanities based research and input because oftentimes, it’s not just because of one reason or for the reason that it’s only in this population, because the population is like this as well. Why is the population like this, you know?
Jennifer Cohen 30:05
So interesting. Okay, let’s turn to some of the volunteer work you’ve done and you’re doing. So you were involved in a group called Stressbusters. What was that?
Hibah Ilyas 30:16
Yeah, so Stressbusters was this amazing organization that I found on the campus of the University of Arizona and basically, they allow students to get training in backrubs, as we call, and they’re just very handy techniques that anyone can learn in a day’s training of how to, kind of, relax and relieve tension in the upper back and neck areas. So a group of us students received training in these kind of techniques and also training in how to approach a person and how to ask permission to touch the other person and how to adjust pressure when doing these techniques. Once we learned and practiced on each other, we would go to the main library on Monday nights and kind of offer these five minute backrubs to the students who were studying there. And it was really amazing to see students come up. First, people would be shy, but you know, one or two students would come and you know, get their five minute backrub and they would just feel so rejuvenated that they would come and bring their friends or we would see them every week, and it was just kind of like the highlight of their night because Mondays themselves are so stressful and then, you know, you’re a college student, you’re studying, you have so many things going on and having that brief period of relaxation was something that the students really enjoyed.
Jennifer Cohen 32:01
That sounds so fabulous. Physical and mental health benefits, wow, terrific.
Hibah Ilyas 32:08
Right.
Jennifer Cohen 32:09
And now you’re also involved in a group called Student National Medical Association. What is that and what is your role in it?
Hibah Ilyas 32:17
Yeah, so Student National Medical Association is a group of medical students who support and advocate for people in underrepresented minorities to enter medicine. So it starts from the very beginning, we have a lot of pipeline groups, we have MAPS chapters, which are SNMA organizations but at the undergraduate level. So every SNMA chapter has an associated MAPS chapter, so we kind of help those students who may be pre-med or pre-health to find mentors and also give them information and kind of help guide them into getting into medicine and into healthcare. And it doesn’t have to be necessarily medical school – it can be any kind of health profession but we allow these students to get exposure and meet people who look like them and come from their backgrounds to really get a hold in medicine and find opportunities that can benefit them and kind of reaching their goals.
Jennifer Cohen 33:36
Wonderful.
Hibah Ilyas 33:38
So yeah, so my role on the regional level is I’m the webmaster, so I do a lot of the marketing for our events. As a team, the regional team, we have many different players but we try to come up with fundraiser events, we have events for the MAPS students, we have research events and information, and information on how to get involved in SNMA itself, and any conferences, any events that we try to put on. I guess I’m the person who markets it and I mostly manage our social media on Instagram and provide updates and share any of the events that we have to the rest of the region and I collaborate with our local chapters in each of the states, and also our national body that supports all of us. So, you know, there’s a lot of different tiers of this organization but there’s a lot of collaboration from all parts, so it’s really amazing to be able to work with them and kind of display all the efforts that are going on, and getting people interested in medicine and in health.
Jennifer Cohen 35:06
Wonderful. And finally, Hibah, my last question, you graduate in, I think, 2024. Do you know what your future holds? What your next position will be?
Hibah Ilyas 35:17
Well, I would like to think that, you know, I graduate in 2024 as well and I’m actually working towards possibly pursuing psychiatry. I have an interest in geriatrics as well, but I’m kind of on the fence on whether, which route I want to go on. So I think for now, because I’ve actually done my clinical rotations in both psychiatry and geriatrics – they were both rotations I really enjoyed and also populations that I really enjoy working with. So I think I’m kind of between those two and figuring out which one is the best for me at this time.
Jennifer Cohen 36:09
Hibah Ilyas, thank you so much for speaking to us about your work and best of luck in your future.
Hibah Ilyas 36:16
Thank you so much. Thanks for having me.