Q&A/Cynthia Connolly

Cynthia Connolly, associate professor of nursingPhoto credit: Candace diCarlo

When President Bill Clinton tried in 1993 to reform health care, Cynthia Connolly remembers thinking something was missing from the debate.

“No one was talking about how it was that we got to where we were,” says Connolly, an associate professor in Penn’s School of Nursing. “Why did our health care system look the way it did in the early 1990s? I thought we needed to be thinking more about how we got to where we were, not to be hamstrung by history, but in order to be able to analyze why we made the choices we did.”

A clinician and nurse practitioner by trade, Connolly was inspired to explore the history of nursing and health care to better understand how to serve children and families today.

In her 2008 book, “Saving Sickly Children: The Tuberculosis Preventorium in American Life, 1909-1970,” Connolly examined facilities that housed children at risk for developing what was once known as the “White Plague.” These places, like the first one founded in 1909 by reformers in New York City, may have initially been a good idea, but they often made assumptions about at-risk children based on race, class and ethnicity, Connolly says.

“If you think back to New York in the early 20th century, it was teeming with new immigrants from Eastern Europe,” she says. “There were a lot of concerns about the changing national character of the United States and unhealthy cultural practices. By 1900, the better nutrition and plumbing that wealthier people could afford resulted in a dramatic decline in infectious diseases. TB became defined as a disease of dirt and bad hygiene.”

Her current project focuses on the history of children and pharmaceuticals, particularly after World War II. Presently, she is studying the history of pharmaceutical advertising to women and children—from the opium-laced “soothing syrups” popular in the late 19th and early 20th centuries, to today’s direct-to-consumer marketing of specific drugs.

Connolly sat down with the Current to discuss her research, her experience working on Capitol Hill for the late Sen. Paul Wellstone (D-MN) and the recent health care debate.

Q. Not too many faculty members have Capitol Hill experience on their resumés. How did you end up working for the late Sen. Wellstone?
A.
I’d love to tell you that they called me, but that would be a complete lie! I was doing my post-doc at Columbia, at the School of Public Health, and my original plan had been to continue my research and take some policy courses, and I got there and I thought, ‘You know what, I’ve taken so many courses in my life, what I really need to do is go take a policy clinical.’ Before I could lose my nerve, I wrote a letter to the senator I most admired, Paul Wellstone of Minnesota. Basically what I said is, I’d really like to come down and trade my labor working on whatever you think would be useful to your office.
Although I didn’t have Capitol Hill experience, I had lots of experience as a clinician and as a historian, so I could talk about health care today and in the 21st century as well as in the 19th and 20th.
It was just so much fun. I went everywhere it said ‘Staff Only’ because I knew this would be my only opportunity.

Q. What did you learn while working on Capitol Hill?
A.
It’s a place steeped in history. You walk around the Capitol, the Senate buildings, you feel as though you’re in a living museum, but it is also the most ahistorical place I have ever seen. When people thought historically, they really thought about the previous Congress.
As a nurse, I am a historian and researcher. I was able to bring a real world perspective to the debate that I was told was really valued.
That has made me passionate that we need more nurses on Capitol Hill. We need more health care providers of all kinds, and that’s something that I hope to do over the course of my career.

Q. What do you make of the current health care debate?
A.
I have been very discouraged over the course of the past month. When you look back, there was an attempt to do government-sponsored health insurance, at least at the local level, in New York State in 1917, and as part of the Social Security Act. FDR really wanted it, and in the late 1940s Harry Truman desperately tried to get it. There were proposals in the Nixon administration that would certainly today be considered left of where President Obama is. And when you look through a lot of the arguments against them, sometimes the language is different because it’s in a 1930s syntax, but the arguments so often are the same. That is, fear of government intrusion into our lives and fear of socialism that will result in lack of choice.
I do feel as though we are closer than we were in the Clinton administration to making something happen, and I do believe there will be some change.

Q. As a pediatric nurse practitioner, how do you see kids’ needs factoring in the health care debate?
A.
There are many children who have no health insurance or are underinsured. A question that is at the heart of my research is: How do we decide as an American society what’s in the best interest of children? That’s an important question to ask because most policy is driven by, or at least acknowledges, historical precedent. Aid to families with dependent children, or welfare, wasn’t invented in 1935. It was built on local and statewide programs that evolved in the 1910s and 1920s called Mothers Pensions for Deserving Women. The formulas and the set of principles that underpinned those programs were really lifted into the Social Security Act. We tend to incrementally modify programs, looking back at what we’ve done in the past for ideas for what we should do in the future.

Q. Talk a bit about your 2008 book, “Saving Sickly Children,” which illuminated the history of the tuberculosis preventorium.
A.
A test [to determine if children had TB] really set in motion the idea that poor children were more at risk, particularly children who lived in crowded quarters who didn’t get enough to eat, and that it would be important to get children out to the country, away from the source of infection.
There was a conflation with the early 20th century Americanization movement. What those reformers thought was, in addition to having [the children] outside, we’ll have them eat roast beef and potatoes and not Polish sausage and pasta. We’ll teach them how to set a nice table. We’ll certainly teach them how to say the Pledge of Allegiance, and the importance of being a good American and it was hoped that kids would stay and get healthy and go back to their homes and be these little missionaries and reform their families.

Q. Did preventoriums work?
A.
There’s no way to really know that because some of the children never went on to have TB, but would they have gotten TB anyway? We don’t know. In my book, I say that in the early decades of the 20th century, although the institutions were flawed, they made a lot of sense. There was no cure for TB. There were a lot of infected people.
The advent of antibiotics happened during the 1940s, but many of these institutions struggled to stay open in the 40s, 50s and 60s and at that point, they were, I argue, acting in their own best interests.
The whole story captivated me because parents were really pressured to give their kids over to these institutions. When you tell someone they’re being selfish, and not doing right by their child, people will pretty much do anything.

Q. You’re involved in a project exploring how pharmaceuticals have shaped pediatric medicine and practice over the years. Can you talk about advertising pharmaceuticals to mothers?
A.
The advertising piece intrigued me because the FDA in 2007 and 2008 had a series of hearings about over-the-counter use of cough and cold syrups and ended up recommending them, saying they should be used very cautiously in children under the age of 6 and not at all in children under the age of 2. These were drugs that had been marketed for years, and people were panicked and angry. When the media discussed the issue, it was all about the greedy drug companies, and incompetent, bungling federal regulators, helicopter parents, and physicians and nurses who were just interested in medicalizing childhood.
I thought it would be interesting to look at it taking a long view. In 1951, all drugs were cleaved into prescription and non-prescription. From the 1950s to the 1990s, most drug company advertisements were to the physicians, but before that and since then, most advertising was to the consumer.
Soothing syrups were opiate-laced syrups first imported from England. Parents were urged to give them for everything from teething or getting the kid to sleep at night so the mother could work outside the home, or in a crowded tenement and the baby was screaming and driving your neighbors crazy.
By the late 19th century, physicians and nurses were taking the lead against these substances. The legislation that led to the FDA surrounded these opium-laced syrups, because until 1906, you didn’t have to say what was in your product.

Q. How were these drugs marketed to parents, and specifically, mothers?
A.
From my limited research thus far, you find very little marketed to fathers. Most of the marketing is to mothers and it’s freighted in language like, ‘Why would you not want your child to not scream while teething?’ We as a society haven’t traditionally talked about what makes a good father versus a bad father, whereas being a good mother has a moral aspect, and engaging in certain practices and not engaging in other practices.

Q. Have children always been medicated? It seems as though there’s growing concern about how children today are given too many medications.
A.
There have been some studies lately talking about the growing use of pharmaceuticals in children and is that a bad thing or a good thing, and the issue is presented as a new problem. Historically, kids have always been medicated. Back in classical antiquity, there are substances being given to children, and certainly reading childrearing texts and medical texts from the 18th century you will see widespread use of medications in kids.
It has been the case for years. But there is an escalating use of psychotropic drugs in children and I do plan on exploring that further.

Originally published on September 17, 2009