As a medical student, faculty frequently remind me that I am in a unique position. Medical students are unhindered by the restraints associated with paid institutional roles but empowered by our growing body of clinical knowledge and structural failures making our voices apt for advocacy. Yet, utilizing this unique position in effective service to others can feel like a nebulous task to tackle this early in our career.
On Friday, December 1st, 2023, Dr. David Smith, founder of the Haight-Ashbury Clinic, and some of his current “co-conspirators” would relieve that pressure, as they emphasized a simple message of maintaining non-judgmental curiosity in our community until they steered towards the need.
Steve Heilig, of the San Francisco Marin Medical Society and legendary activist for individuals living with HIV, women’s reproductive health, the addicted, terminally ill patients, and more, would be our tour guide for the day.
After a morning of lectures on pulmonary physiology, his tour would transport us medical students through the Great Depression, the Beatnik Movement, and land us in the Summer of Love and the start of the Haight-Ashbury Free Clinic in 1967, when tens of thousands of “hippies” arrived in the unprepared neighborhood.
With Steve were six other experts, Drs. David Smith, Keith Loring, Sophia Vero, and three dogs. “We get together every Tuesday morning, walk our dogs, and discuss addiction medicine and psychedelics as medicine,” Keith quipped in an unassuming way that didn’t let on the powerhouse group with whom we’d be spending the day.
Dr. Smith started us off by showing his office tucked behind a nondescript door on Stanyan Street, just blocks from where he lived during his time as a UCSF medical student. Behind him were walls serving as a sort of photo book memorializing the different stages of the Haight-Ashbury Clinic, which we would later see has hardly changed in appearance since its opening.
Pictures featured the likes of the Grateful Dead’s Jerry Garcia, The Beatles’ George Harrison, and Janis Joplin, all of whom had either stopped by to visit the clinic for treatment or to raise money for it through a concert.
As hippies flooded San Francisco in 1967, Dr. Smith contemplated what to do with his career following his internship at San Francisco General Hospital. He opened the clinic at an abandoned dental office with money earned from a single lecture matched with a church donation.
Steve led us there through the upper Haight. He showed us former comedy clubs that have now been turned into breakfast bistros and called careful attention to clues of the neighborhood’s history hidden in plain sight, like a tile peace sign in a driveway or fragments of a rock and roll mural.
Acknowledging this history gave me a greater appreciation for how far we have come as a medical culture, in particular towards our treatment of addiction as a chronic disease. But it gave me a sense of direction as to where it can still go, including the use of psychoactives for the treatment of PTSD, wider acceptance for supervised substance use sites, and a greater investment in developing new therapies or interventions for substance use treatment.
When we arrived at the original site of Haight-Ashbury Free Clinic now run by Healthright 360, we bumped into organizers visiting from France, who were eager to take a photo with the legendary Dr. Smith. Jeffrey Schindler, Director of Philanthropy of Healthright360, took the opportunity to sit and talk with us about his personal experience being seen in Dr. Smith’s clinic.
Discussing the ways in which Dr. Smith could look beyond the scope of the world in which he grew up in, Jeffrey said “Here is David who was raised in the Eisenhower era where if you were drinking too much or using drugs, it was a moral failing, and then there was the hippies,” he said gesturing towards himself.
Schindler went on to say: “The reason my generation was not really thrilled with medical people was because it was mostly white men. They were very arrogant and very judgmental. The absolute opposite of what the Haight-Ashbury Free Clinic was.
There was David with his short hair. He could have gone anywhere with his degree.” Smith clarified that he did go on to grow out his hair. Schindler continued, “But he thought this was a healthcare emergency and knew how to solve it. He was determined, wise, inventive, flexible, funny… and always getting into hot water over something, including the needle exchange.”
At the start of the needle exchange movement during the AIDS epidemic, Dr. Smith came forward describing the practice as enabling individuals with substance use disorders. But when Steve Heilig challenged Dr. Smith on the topic and showed him how healing it could be in building trust with the community, Dr. Smith looked at the evidence before him and became one of the strongest advocates for needle exchange programs.
In reflecting on this history of needle exchange programs, Steve said, “We learned that Dave and I had something in common; we liked to break bad laws!” Dr. Smith’s humility in listening to the community, admitting error in his views, and joining other advocates in solidarity shows true leadership to me.
I looked around the room at my peers, eager to think that I may have identified a few of my own “co-conspirators.” More than ever, the medical community can use a reminder from Dr. Smith’s remarks about the clinic 55 years ago: “Health care is a right, not a privilege. No matter how you look, dress, or act.”
