Fighting the Cancer Wars: Patient activism, politics, and medical

							Fighting the Cancer Wars:
Patient activism, politics,
   and medical ethics
           HI31L
          Week 19
Ending medicine’s ‘golden age’
   ‘Magic Bullet’-proof: Antibiotic resistance,
nosocomial infection & the return of the ‘sanitary’
  •‘Two conclusions regarding staphylococcal infections appear to be
  increasingly clear. One is that staphylococci are producing significant
  numbers of infections among hospitalized patients in all parts of the
  civilized world, and the other is that the control of this problem
  requires more than good medical care of the individually infected
  patient by his personal physician. … In some hospitals the incidence
  of infections has reached epidemic proportions, and in others there has
  been an insidious but definite increase in the number of infections ...
  Hospital personnel have contracted infections from patients and in
  turn spread infection to other patients and members of their
  families.’ Yow,Yow et al, Houston TX 1958

  •The municipal Jefferson Davis Hospital in Houston
  experienced a nosocomial epidemic in 1958 , with 279
  cases and 17 deaths – mostly mothers and infants
  infected in the hospital’s over crowded maternity wards.
              • 1956-61 Thalidomide licensed
                and sold in over 40 countries for
Thalidomide     morning sickness and
                sleeplessness in pregnancy, but
                not USA, where [female] FDA
                physician refused a license on
                grounds that more tests were
                needed.
              • 1956-62 ~10,000 children born
                with severe deformities as a
                result
              • Food, Drug, and Cosmetics Act
                Amendments of 1962 passed in
                direct response to Thalidomide
                tragedy, and mandated tests for
                safety in pregnancy before legal
                sale of drugs in US; similar laws
                passed elsewhere.
 Thalidomide Protests continue…




But so does thalidomide research;
thalidomide is now prescribed
under tight control for multiple
myeloma
• “Only one small study was
  performed on the Dalkon Shield,        Women’s risks,
  solely to determine the device's
  effectiveness in preventing             corporations’
  pregnancy. To make matters
  worse, the study's chief
  investigator never revealed his
                                             profits
  conflict of interest. As a developer
  of the Dalkon Shield, Hugh Davis,
  M.D., a faculty member of the
  Johns Hopkins Medical School,
  was entitled to a percentage of the
  profits on its sales. He claimed to
  have studied 600 women using the
  Shield for a full year and found a
  failure rate of only 1.1%”
• In 1976, the U. S. Food and Drug
  Administration began to require
  testing and approval of "medical
  devices", including IUDs, by
  enacting the Medical Device
  Amendments
Impact of feminist activism on medical research
• Mid-1980s: attention focused on exclusion of women from
  biomedical research into health and disease via all male samples
  like the Physician’s Health Study: women would ‘confuse results’
  by having hormones... Women excluded from studies even of drugs
  subsequently marketed to them
• Also, rise of interest in breast cancer, Breast cancer foundation
  founded. “Science will suffer” if forced to respond to politics?
• 1986 PHS agrees with women, but…
• 1990 nothing has changed.
• 1990 Congressional Caucus for Women introduces Women’s
  Health Equity Act, and NIH forced by political pressure to create
  Office for Research on Women’s Health. Even JAMA get in on the
  act!
• 1991 First female head of NIH, $600m for women’s health initiative
  to redress balance.
• 1991 National Breast Cancer Coalition 44,500 breast cancer deaths
  in America – more than soldiers in Vietnam – but look at the initial
  constituency: upper/middle class white women!
• 1994 NIH new guidelines mandating investigation of impact on
  minorities and women in all clinical trials.
     Historical responses to Breast Cancer


c.17th
century
  Historical responses to Breast Cancer




                                      National Institutes of Health poster c 197?
                                      (advert for film on breast self-examination
USPHS Public Health Poster c. 1950s
   Artistic responses to breast cancer




Richard Tennant Cooper, Allegory of   Mfon Essien, The Amazon’s New
breast cancer and science, c 1912     Clothes, c.2000-2001