1984 - Medicine

Medicine

Virologist Luc Montagnier of the Paris Institute publishes the genetic code of the AIDS retrovirus January 21; National Cancer Institute researcher Robert C. Gallo at Bethesda, Md., publishes the code for a retrovirus that he has isolated January 24; Gallo announces June 13 that he and Montagnier have compared notes on the retrovirus that is spreading AIDS and agreed that Montagnier's LAV and what Gallo calls HTLV-3 (human T-cell leukemia virus type 3) are "close relatives" (see Montagnier, 1983). The genetic codes are in fact virtually identical and vary in some vital aspects from any HTLV viruses heretofore known. Who discovered the retrovirus remains in dispute, but the journal Science cites evidence July 6 that the virus has been found both in the plasma of a blood donor (who had shown no symptoms) and in a patient recipient who subsequently developed AIDS. Centers for Disease Control researchers report August 6 that they have succeeded in infecting chimpanzees with the virus, an essential step toward developing a possible vaccine (see 1985).

Bennington College freshman Libby Zion, 18, is brought to the emergency room of New York Hospital March 4 dehydrated and suffering from the chills and fever that physicians call "rigors." She is given 25 mgs. of Demerol but thrashes about so violently that nurses strap her to her bed to keep her from falling out; Zion dies 4 hours later, evidently from adverse drug reactions, and her father, New York Times writer Sidney Zion, 49, will sue the hospital and its staff members for malpractice and pain and suffering. Litigation will continue until February 1995, juries will find no evidence of malpractice, administering such a small amount of Demerol will be ruled out as having contributed to the girl's death, but the case will lead to legislation limiting the number of hours that hospital interns and residents can work without rest.

The Canada Health Act approved by Parliament at Ottawa April 1 reaffirms the government's commitment to its universally accessible, comprehensive, portable, publicly-administered health insurance system (see Hall Commission report, 1979). While the system works better in some provinces than in others, and there are sometimes lengthy waits for elective surgical procedures, the vast majority of Canadians are well pleased with their nation's healthcare system.

What to Expect When You're Expecting becomes mandatory reading for pregnancy women despite criticism that it reinforces negative worries and contains some misinformation. New Yorker Heidi Murkoff (née Eisenberg) got the idea for the book while carrying her first child and wrote the book with her sister Sandee (Hathaway) and their mother, Arlene Eisenberg, 48. Within 20 years more than 13 million copies will be in print.

More than 20,000 pregnant U.S. women choose amniocentesis to detect chromosomal abnormalities in unborn infants. First used in the late 1960s, the procedure can find recombinant DNA markers for disease—most commonly Down's syndrome (trisomy 21). Between the 16th and 20th weeks of pregnancy, a tiny amount (less than 1/8 cup) of amniotic fluid, containing cells sloughed off by the fetus, is taken from the uterus; the cells are grown in a culture and then examined for genetic defects, a procedure that takes 2 to 4 weeks of complex laboratory work that costs $400 to $1,000 (even states that fund abortion often do not fund amniocentesis, so accessibility is a problem). Many genetic defects—e.g. Tay-Sachs disease, Cooley's anemia, sickle-cell anemia, and spina bifida—can be detected by prenatal diagnosis, but amniocentesis is surer. Chances of giving birth to an infant with Down's syndrome are about one in 2,000 at age 22, one in 885 at age 30, one in 365 at age 35, and one in 109 at age 40. Named for British physician J. Langdon Down (1828-1896), Down's syndrome, or Mongolism, means mental retardation, and where once scarcely any Down's syndrome children survived beyond age 20, many can now live to age 50 or more. About 95 percent of Down's syndrome pregnancies are terminated (second trimester abortions are done with saline or urea injections into the uterus to kill the fetus, although drugs are sometimes used to induce early labor; dilation and evacuation procedures are also performed by vacuuming out the amniotic fluid and then removing the fetus).

Ultrasound diagnostic procedures determine the gender of a fetus in China, India, and other developing countries; used before the 16th week of pregnancy, they cost only a fraction of the price of amniocentesis or CVS. Female fetuses are aborted at an alarming rate in China and India, where male births consequently outnumber female by a wide margin (see population, 1981). Beijing will outlaw the use of sonograms to determine gender in rural areas, but many will defy the ban.

The Hatch-Waxman Act (Drug Price Competition and Patent Restoration Act) signed into law by President Reagan September 24 expands the availability of low-cost generic versions of prescription drugs. Pharmaceutical companies have claimed that up to 8 years of a product's 17-year patent term may be spent negotiating the federal approval process.