Spring 2002
ARTICLES The case of Chester M. Southam: Research ethics and the limits of professional responsibility With the dawning of the era of gene therapy, questions about the integrity of the research process abound, and the struggle to regulate current research activities presents an increasingly complex task. The annals of history may hold the key to the formulation of proper research standards. The story of Dr. Chester Southam, a prominent American physician, provides a particularly fascinating and relevant case study. In the 1960s, Dr. Southam initiated a project to understand the body's immune response to cancer, involving the injection of live cancer cells into humans, including prisoners and the chronically ill. As part of this project, he initiated collaborative research with physicians at the Jewish Chronic Disease Hospital. These experiments generated much controversy, as informed consent was not obtained. I will explore the various factors which motivated Dr. Southam as well as those who objected to his work. The perspectives of those involved may provide insight into the development of future guidelines.
Exploring the rise in American pharmaceutical prices The exploding prices for pharmaceuticals has been making news for quite some time, and Congress appears ready to provide Medicare coverage for prescription drugs. However, without addressing the economics behind the increase in drug prices, any solution is bound to failure. This paper attempts to explain some of the factors driving the supply and demand of prescription pharmaceuticals. Supply is basically determined by the revenue-maximizing price. Demand has many more factors, such as the aging of the American population, the policies of HMO's, and direct to consumer (DTC) advertising. Of these, DTC advertising is realistically the easiest to affect. A rule change by the FDA, or a mandate by Congress to limit DTC advertising would have an immediate and significant impact on demand. This would ultimately ease the pressure on pharmaceutical prices. Though not perfect, it is a feasible interim measure until a more comprehensive solution can be found.
Cause of death: The mystery surrounding the death of Napoleon The cause of Napoleon's death has been debated for over a century. Over the past 40 years, several authors have suggested that Napoleon did not die from stomach cancer, but instead of arsenic poisoning. The memoirs of Napoleon's valet, Louis Marchand, describe many symptoms consistent with arsenic poisoning, and analysis of locks of Napoleon's hair revealed elevated levels of arsenic. Nor only do they believe Napoleon was poisoned, but they also proposed that Count Charles-Tristan de Montholon, whom they view as an agent of the restored Bourbon monarchy, poisoned him. Others have questioned this supposition, noting that Napoleon's symptoms did not exhibit many of the classic symptoms of arsenic poisoning. Various external contaminants for the arsenic in Napoleon's hair have also been proposed. It is the purpose of this paper to summarize the strengths and weaknesses of the arsenic theory and to offer some alternative ideas.
Lost in translation Interpreters are the most logical solution when a doctor and a patient do not speak the same language. Because I speak fluent Spanish, I have often served as a non-professional translator in the hospitals and clinics I have worked in. From my experiences, I have seen that interpreters are an imperfect solution. Professional translators are in high demand and frequently unavailable. They also do not have any established relationship with the patient. Using family members as interpreters introduces confidentiality and bias problems. Most importantly, the use of an interpreter makes the doctor-patient relationship an indirect one. Meaning is lost and body language is ignored. The level of trust established is not as high. Such obstacles could lead to a compromise in the quality of care. Interpreters will always be necessary, but they can never adequately replace direct doctor-patient communication. For that reason, medical students and physicians should be strongly encouraged to learn new languages.
PERSPECTIVES The context of your characters
POETRY Tree Surgery Neoplasia Mortal Combat Golden Gate Poppy Therapy
BOOK REVIEW Across the cultural barriers: The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures The AAMC recently reported that health care professionals of the future would be expected to be more effective in communicating with patients and their families, and with other members of the health care team. Anne Fadiman's book provides an excellent centerpiece for discussion of ways in which children and their families can often get caught in a web of communication challenges when cultural clashing prevents full understanding of cultural barriers. Although this book should not be expected to change the scientific nature of modern medical education, it can introduce health care professionals to information that will help them respect cultural differences among patients. Such an experience can encourage them to acknowledge and respond to particular cultural variables in future medical relationships. If this can be accomplished, medical students can develop successful relationships with patients from many diverse cultural backgrounds. |
