Topics in the News
With a declining birthrate, longer life spans, and the inevitable aging of the baby boom generation, the American population grew older throughout the 1990s. This demographic change created demands for new therapies to combat the challenges of aging. In March 1997, for instance, the Food and Drug Administration (FDA) approved Viagra, the first pill for treatment of male impotence. By the third week in April, doctors were writing 120,000 prescriptions a week for the drug, and Pfizer stock jumped to new highs. Michael Podgurski, director of pharmacy at the four thousand-outlet Rite Aid drugstore chain, said, "It's the fastest takeoff of a new drug that I've ever seen, and I've been in the business for 27 years." In spite of its popularity and promise, Viagra was not a wonder drug and problems began to appear. Some men found it ineffective and, more seriously, by October 1998, at least sixty-nine men had died after taking the drug. New prescriptions fell from a high of 280,000 to around 100,000 per month. Health insurers and Health Maintenance Organizations (HMOs) debated whether they should cover the cost of what some described as a recreational drug. Men also tried to counter other signs of middle age, with greater and lesser degrees of success. Hair loss, weight gain, decreased libido, and urinary problems—all once assumed to be a natural part of the aging...
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A Continuing Epidemic.
Throughout the 1990s the worldwide Acquired Immunodeficiency Syndrome (AIDS) epidemic continued to take a devastating toll in human lives. In 1999 2.6 million people worldwide died from the disease, bringing the total number of deaths attributed to AIDS to 16.3 million. Although its effects were felt globally, by the end of the decade more than 70 percent of those infected with the Human Immunodeficiency Virus (HIV) lived in sub-Saharan Africa. In the United States forty thousand new cases of AIDS were reported each year. In spite of these numbers, mortality rates in the United States declined dramatically. With the advent of new, expensive multidrug "cocktails" of potent, antiviral drugs, often including reverse transcriptase and protease inhibitors, a positive blood test for HIV was no longer seen as an immediate death sentence. AIDS fell from being the eighth leading cause of death in 1996 to fourteenth a year later. Because the virus could be reduced to undetectable levels, and the onset of the symptoms of AIDS delayed for many years, HIV positive men and women continued to live productive lives for many years. AIDS remained incurable but was considered a chronic condition rather than immediately lethal. This treatment had significant implications for health insurance coverage and hospital costs. Many AIDS patients exhausted the coverage limits permitted by their...
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Research and Treatment.
In 1993 1.1 million new cases of cancer were reported in the United States. Cancer of the lung ranked first in number of occurrences, followed by cancer of the colon. Researchers found that a faulty MSH2 gene, detectable by a blood test, predisposed one in two hundred people to the development of colon cancer. Another blood test, the PSA (prostate specific antigen), showed an elevation in the presence of prostate cancer and became an effective screening technique for the early stages of the disease. Basic research on multiple fronts sought new ways to treat or prevent cancer. Dr. Judah Folkman, director of the Surgical Research Laboratories, Children's Hospital of Boston, discovered two drugs, endostatin and angiostatin, which could cure cancer in mice by altering new blood vessel growth. Although there was no evidence that this treatment would work in humans, the price of stock in his biotech firm increased from $12 to $85 a share. Folkman once quipped, "As long as there is an unconquered disease, we have an obligation to pursue research… [For now], if you have cancer and you are a mouse, we can take good care of you." On a less high-tech level, phytochemicals (plant-derived nutrients) and other naturally occurring compounds were promoted as cancer preventives and widely marketed as food supplements.
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Right To Die.
During the 1990s Dr. Jack Kevorkian forced a major ethical controversy into the public arena. Although some physicians had for years quietly provided painkillers in amounts they (and their terminally ill patients) knew would shorten life, Kevorkian, a retired Michigan pathologist, publicly and openly assisted in the suicide of his "patients." He even introduced a device called the "Suicide Machine." In June 1990 Kevorkian helped Janet Elaine Adkins of Portland, Oregon, end her own life. The fifty-four-year-old Adkins had been diagnosed with Alzheimer's disease and preferred to take her own life rather than slowly lose her mind. Kevorkian's actions put the debate about such controversial decisions into the open, and even though he was widely and harshly criticized, the public no longer wished to leave such matters in the hands of physicians. Many doctors, fearing the legal consequences of inaction, often ignored the patient's wish to be permitted to die.
Kevorkian helped scores of terminally ill people to commit suicide and was charged repeatedly with murder, even though no jury could be found to convict him. The Michigan legislature specifically outlawed assisted suicide; Kevorkian ignored the laws and dared the state to do something about it. In November 1998, perhaps wanting to force the hand of the...
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Leaders in National Health Care Policy
Bush Appointees. Dr. Louis W. Sullivan, the first African American to be Secretary of the Department of Health and Human Services (HHS), was in office at the start of the decade, having been appointed by President George Bush and serving from 1989 to 1993. His term ended with the inauguration of President Bill Clinton, and he returned to the presidency of Morehouse School of Medicine in Atlanta. Dr. Antonia C. Novello, who was born and reared in Puerto Rico, was the first female and Hispanic to become Surgeon General of the United States. During her tenure in office, Novello focused attention on the health of women, children, and minorities, as well as on underage drinking, smoking, and AIDS. She worked to discourage illegal tobacco use by young people and criticized the tobacco industry for appealing to the youth market through the use of cartoon characters such as "Joe Camel." She left the post on 30 June 1993 to become the Special Representative for Health and Nutrition for the United Nations Children's Fund (UNICEF), a position she held until 1996.
Clinton Appointees. Novello was succeeded in the post of Surgeon General by the first African American
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Throughout much of the 1990s, health care was a political issue. Calls for reform came from across the political spectrum. Although most people agreed that something needed to be done to hold down spiraling costs and to provide better health care coverage for the uninsured, there was no agreement on how reform might be implemented. In 1990 the bipartisan Pepper Commission proposed creating two new programs to address the crisis. One program would have provided basic health insurance to those currently uninsured. Employer mandates would have required employers to either provide health insurance for their employees or to pay into a government fund to provide the insurance. Another program would have underwritten the costs of long-term care. The annual cost of the two programs was estimated at $66.2 billion. Neither program, however, was passed into law. A revised reconciliation budget was passed and signed into law in 1990 (HR 5835), which reduced spending on Medicare by $44.2 billion over five years. Most of the reduction, $34 billion, was achieved by lowering payments to providers. The rest came from out-of-pocket increases for beneficiaries. Senate supporters of rural hospitals were concerned that such institutions were absorbing a disproportionate share of the reduction. In 1991 more than three dozen health care reform bills were introduced in Congress. None of them were acted...
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Technological Advances and Challenges
Eyes That See Better.
Oculoplastic and refractive surgery, procedures that use a laser or scalpel to change the eyes and improve them, began being used. Although I. G. Pallikaris reported the procedure in the Archives of Ophthalmology in 1991, the operations did not become commonplace until late in the decade. Oculoplastic surgery is reconstructive surgery of the eye and eyelid to change the function and structure of the lids, tear ducts, and eye socket. The most common conditions that this surgery treats are loose, droopy, or baggy eyelids, tear duct block-ages, and eyelid damage from injuries. Refractive surgery changes the natural structure of the eye to alter its focusing power, which previously could only be changed by glasses or contacts; this surgery permanently eliminates the need for glasses or contacts. Although insurance companies declined to cover the cost of the operation ($1,500 to $2,000 per eye), many patients were eager to get rid of their eyeglasses and contact lenses. Radio and television advertising for the operation increased dramatically, with well-known athletes endorsing the procedure. A few surgeons opened offices in shopping malls and advertised the operation as quick and painless. Patients could walk in and, in less than an hour, leave without their glasses. The new procedure was a major financial boon to ophthalmology
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Anderson, W. French 1936-
Weird Little Boy.
W. French Anderson admits that he was "a rather weird little boy." Born on 31 December 1936 in Tulsa, Oklahoma, Anderson could read, write, and do arithmetic by the time he entered kindergarten, skills, he said, that "did not endear him to the other schoolchildren." When he was eight years old Anderson was working his way through college medical textbooks in order to satisfy the love of science and medicine that he had developed at age three—a passion he has carried with him for the rest of his life. While an undergraduate at Harvard University, from which he graduated at seventeen in 1958, Anderson discovered his life's work. Attending a lecture about sickle-cell anemia, an inherited and usually fatal disease characterized by crescent-shaped blood cells, Anderson exclaimed: "You could actually change the genes and correct sickle-cell anemia." "What a stupid thing to say," the lecturer retorted, "This is a serious scientific session." Anderson was humiliated. One of his chemistry professors, however, told him that his idea was "interesting." That was all the encouragement Anderson needed. From that day Anderson remained steadfast in his determination to cure hereditary disorders and diseases by repairing or replacing faulty genes. He earned an M.A. in Natural Sciences from Trinity College, Cambridge University (England)...
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Atkins, Robert C. 1930-
CARDIOLOGIST AND DIET DOCTOR
Eggs and Sausage.
Dr. Robert C. Atkins graduated from Cornell University Medical School (1955) and is the founder and executive director of the Atkins Center for Complementary Medicine in New York City. Every morning for breakfast he enjoyed a plate full of scrambled eggs and sausage. Contrary to prevailing medical opinion, Atkins insisted that it was just what the doctor ordered. Controversial though Atkins's ideas were about diet and nutrition, they were also wildly popular. Atkins first came to prominence during the 1970s when he published Dr. Atkins' Diet Revolution: The High Calorie Way to Stay Thin Forever (1972), which, nearly twenty-five years later, remained one of the fifty best-selling books of all time. (It has sold in excess of 10 million copies.) In the 1990s, after a decade of low-fat, high-carbohydrate diet plans left 55 percent of Americans, and 25 percent of children, overweight, Atkins returned with a vengeance, advancing his theories in Dr. Atkins' New Diet Revolution (1996), which has stayed on the New York Times Best Seller list since 1997. Atkins promoted eating meats, cheeses, eggs,...
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Elders, Joycelyn 1933-
Sharecropper's Daughter, Joycelyn Elders (Minnie Joycelyn Jones) was the first African American and woman to serve as U.S. Surgeon General, She was born 13 August 1933 in Schaal, Arkansas, into a sharecropping family. Her mother believed that the only way her children could succeed was through a good education, Even with the heavy chores that Elders and her siblings did, they were not permitted to neglect their schoolwork. Elders graduated as the valedictorian of her high-school class and received a full-tuition Methodist scholarship to Philander Smith College. She then served a stint in the U.S. Army Women's Medical Specialist Corps (1953-1956). In 1956 she entered the University of Arkansas Medical School with funding from the GI Bill She graduated in 1960 with a specialty in pediatrics and then became a professor at the University of Arkansas Medical School.
Public Service in Arkansas.
In 1987 Bill Clinton, governor of Arkansas, appointed Elders as director of the Arkansas Department of Health. During her service in that post Elders worked for increased medical care for school children and the elderly. She also...
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Ho, David Da-I 1952-
VIROLOGIST, AIDS RESEARCHER
Image Pop-UpDavid Da-I Ho
An Immigrant Success Story.
Born on 3 November 1952, Da-I Ho was the first child of Paul Ho, an engineer, and Sonia Ho. In 1955, when Ho was three, his father left Taichung, Taiwan, and immigrated to the United States. Da-I did not see his father for nine years. In 1965 Ho left Taiwan with his mother and brother to join his father in Los Angeles. Ho's father renamed him David and his brother Phillip. A third child, born in the United States after the reunion, was named Sydney. In 1996 Ho told Judy Woodruff of the Cable News Network (CNN) that his parents early impressed upon him the importance of getting a good education. Their sacrifices in the effort to make a better life for their family furthered his determination to excel academically. Surmounting his early difficulties with English, which he did not know at all when he arrived in the United States, Ho achieved academic success in high school. After graduation he attended the Massachusetts Institute of Technology (MIT) in Cambridge for a year before transferring to the California Institute of Technology (Cal Tech) in Pasadena. During his undergraduate career, Ho frequented...
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Kevorkian, Jack 1928-
ADVOCATE FOR DOCTOR-ASSISTED
Jack Kevorkian was born on 26 May 1928 in Pontiac, Michigan, the only son of immigrant Armenian refugees. Kevorkian graduated from the University of Michigan School of Medicine in 1952 and was licensed to practice medicine the following year, earning a residency in pathology at the University of Michigan Hospital. He completed his internship at Pontiac General Hospital and was associated with Pacific Hospital, Long Beach, California, until 1982. Kevorkian first earned the nickname "Doctor Death" when he performed research on the eyes of dying patients. He photographed the retinas at the moment of death and discovered that corneas become invisible at death. He published this discovery in the hopes that it would help doctors distinguish between death and comas. In 1958 Kevorkian presented a paper to a scientific society proposing that death-row inmates be anesthetized instead of executed and their living bodies be used by medical science. In that way, he reasoned, condemned prisoners could benefit from a painless death, and society could benefit by obtaining medical data and body parts for procedures like...
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Novello, Antonia 1944-
SURGEON GENERAL OF THE UNITED STATES
Antonia Coello was born 23 August 1944 in Fajardo, Puerto Rico, to Antonio Coello and Ana Delia Coello. She suffered from congenital megacolon, and her difficult childhood experiences with this disease, resulting in her being hospitalized every year. She was supposed to have surgery to repair her colon when she was eight; however, she lived thirty-two miles from the hospital, and her mother, a school principal, could only take her on a Saturday. Her father died when she was eight and her mother remarried. She was finally able to have the surgery when she was eighteen, but she had to miss a semester of school and then wore diapers for the next six months. Through her health difficulties she developed a positive attitude that she could do anything, as well as an extraordinary sensitivity for patients. In 1970 she married a U.S. Navy surgeon, Dr. Joseph R. Novello.
Public Health Career.
Antonia Novello graduated from the University of Puerto Rico with a Bachelor of Science degree in 1965 and M.D. degree in 1970. She served her pediatric internship and...
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People in the News
On 16 April 1990 Marissa Eve Ayala was born, having been conceived by her parents to serve as a bone marrow donor for their daughter, Anissa, eighteen, who was suffering from myelogenous leukemia.
On 16 December 1991 David Baltimore, Nobel Prize-winning biochemist (1975), resigned from the presidency of the Rockefeller University after being charged with falsifying research data. The charges were upheld by a National Institutes of Health (NIH) investigation. In 1996 a federal appeals panel over-turned the charge and a year later he was appointed president of the California Institute of Technology.
On 13 July 1998 the remains of First Lieutenant Michael Joseph Blassie, shot down in Vietnam (11 May 1972), were positively identified through DNA testing. His remains had been interned at the Tomb of the Unknown Soldier in Washington, D.C., for fourteen years.
On 19 August 1996 Grady Carter, a former smoker and survivor of lung cancer, was awarded $750,000 in a liability suit against the Brown & Williamson Tobacco Company.
On 30 September 1991 Dr. Frances Conley rescinded her resignation as professor of neurosurgery at Stanford University School of Medicine. She had announced her resignation in May to protest alleged sexual harassment and the promotion of a male colleague but decided to...
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NOBEL PRIZE WINNERS IN MEDICINE OR PHYSIOLOGY
Joseph E. Murray and E. Donnall Thomas for their studies concerning organ and cell transplantation in the treatment of human disease.
No American Winner
Edmond H. Fischer and Edwin G. Krebs for their discoveries concerning reversible protein phosphorylation as a biological regulatory mechanism.
Richard J. Roberts and Phillip A. Sharp for their discoveries of split genes.
Alfred G. Gilman and Martin Rodbell for their discovery of G-proteins and the role of these proteins in signal transduction in cells.
Edward B. Lewis, Christiane Niisslein-Volhard (Germany), and Eric F. Wieschaus for their discoveries concerning the genetic control of early embryonic development.
No American Winner
Stanley B. Prusiner for his discovery of prions—a new biological principle of infection.
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Janet Elaine Adkins, 54, Alzheimer's patient, suicide aided by Dr. Jack Kevorkian, 12 June 1990.
Lyle Martin Alzado, 43, professional football player for the Denver Broncos, Cleveland Browns, and Oakland Raiders, who developed brain cancer thought to be caused by steroids taken to build up his body and increase his strength, 14 May 1992.
Arthur Ashe, 49, African American tennis star who acquired AIDS through a blood transfusion in 1983 during a heart surgery, 6 February 1993.
Oscar Auerbach, 92, American pathologist who examined thousands of slides of human lung tissue to document the anatomical link between smoking and lung cancer, 15 January 1997.
Charles P. Bailey, 82, pioneering heart surgeon; first person to repair a hole between the two sides of the heart; preformed first closed mitral valve operation in the United States, 18 August 1992.
Theodore H. Benzinger, 94, inventor of the ear thermometer, 26 October 1999.
Kimberly Ann Bergalis, 23, first patient known to be infected with AIDS by a medical caregiver, in this case by bisexual dentist Dr. David Acer, in Florida, 8 December 1991.
Leroy Edgar Burney, 91, Surgeon General (1956-1961) and first in the office to implicate smoking as a...
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Robert C. Atkins, Dr. Atkins' New Diet Revolution (New York: M. Evans, 1996).
John Duffy, From Humors to Medical Science: A History of American Medicine (Urbana: University of Illinois Press, 1993).
Michael Fumento, The Myth of Heterosexual AIDS (New York: BasicBooks, 1990).
Edward S. Golub, The Limits of Medicine: How Science Shapes our Hope for the Cure (New York: Times Books, 1994).
Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery (Baltimore: Johns Hopkins University Press, 1997).
Caroline Hannaway, Victoria A. Harden, and John Parascandola, eds. AIDS and the Public Debate: Historical and Contemporary Perspectives (Amsterdam & Washington, D.C.: IOS Press, 1995).
Joel D. Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1995);
Alan M. Kraut, Silent Travelers: Germs, Genes, and the "Immigrant Menace" (New York: BasicBooks, 1994).
Katherine Ott, Fevered Lives: Tuberculosis in American Culture since 1870 (Cambridge, Mass.: Harvard University Press, 1996).
George Rosen, A History of Public Health (Baltimore: Johns Hopkins University Press,...
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Important Events in Medicine and Health, 1990–1999
- On January 1, the National Practitioner Data Bank (NPDB), established by the Health Care Quality Improvement Act of 1986 to record malpractice data on physicians, dentists, and other health care providers, goes into operation.
- On January 3, First Lady Barbara Bush receives radiation to relieve double vision caused by Graves' disease (hyperthyroidism).
- On January 15, the Food and Drug Administration (FDA) rescinds its approval of the Jarvik-7 artificial heart.
- On January 22, Dr. Charles S. Lieber of the Mt. Sinai School of Medicine reports greater susceptibility of women than men to alcohol intoxication.
- On February 5, a report estimates that the Shanghai flu infected fifty to sixty million Americans in forty states.
- On February 25, smoking is banned on all U.S. domestic flights fewer than six hours.
- On March 4, Hank Gathers collapses and dies of heart failure while playing in a basketball game for Loyola Marymount University, raising questions of why his medication for heart arrhythmia had been reduced and why he was allowed to continue competing.
- On March 9, Dr. Antonia Novello becomes the first female and first Hispanic U.S. Surgeon General.
- On March 16, Dr. Jonathan Mann, director of the United Nations...
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