The take off on
the myth of death.
Really art.
Who do we want to start with again? We want to start with you. I'll start
, we'll start with Dr Kaplan again. Now you had no problem following the
chit chat back and forth because we want to encourage that. All right, go
for it. Shall we give me the countdown whenever you're ready? Stand by?
These are not exactly studio conditions but it, but it is what you should
be talking about poverty and health care.
OK. And 54321
capel. Let me start again with you. One of the issues here at the
conference has been in the area of neonatology. And I think the simplest
way is to begin with a little bit of history. What are some of the cases
that have prompted this discussion in neonatology? There have been three
major cases in the past two or three years that have really focused both
medical and public attention on practices in neonatology. The first is the
so called baby dough case in Indiana. The child was born suffering from
Down Syndrome, genetic condition that is associated with mental
retardation. It also had a blockage of its stomach. There was a kind of a
gap surgery could be performed to correct this stomach problem. The
parents said no. And the doctor, their family doctor went along with that
decision. Basically, there was a disagreement on the part of the hospital
staff. Some of the nurses thought that the procedure should be done,
however, they respected the parents' wishes. They did try to take the case
to court. But the baby died before the court rendered a decision as it
happened. The court eventually said that it supported the parent's right
to say no to that treatment. So the question there was is mental
retardation a sufficient reason that particular condition downs through
syndrome not to treat. Second case was the Siamese twin case in Danville,
Illinois. Siamese twins were born. The parents basically said they were
going to live a life of pain and suffering because they have this terrible
condition. We don't think you should treat. In this case, the hospital
overrode the parents' decision went to court got a order to treat the
Children and in fact, they were treated and are still alive to this day.
In this case, the state took authority into its own hands and overrode a
parental decision about treatment. The most recent case and probably the
most controversial of all is the baby Jane Doe case out on Long Island.
The child was born with spina bifida with malformation of the brain with
certain deficits of limbs, motion and ability to move. And the physician
of the family in this case predicted that the child would live a life of
pain and suffering and probably be very retarded as all of us know. By now
in this situation, a lawyer appeared right to life group lawyer and got a
court to appoint a guardian who urged that the hospital treat the child.
After some time of wrangling around in the courts, the federal government
got involved. It sent out a notice to the hospital ordering it to treat
basing its claim on the fact that it was discriminatory not to treat
someone because they were handicapped and it violated discrimination
statutes. So we have three cases that highlight some of the conflicts that
have come up between parents, the courts and the state and the medical
profession regarding treatment and failure to treat decisions. Well,
clearly, we've established some conflicts here. We've probably established
some conflicts of propriety. Now, the question that I would raise next
logically is how do we solve some of these problems of propriety who
should decide? And when? Well again, I think the historical background is
important here until fairly recently, it has usually been the parents in
consultation with the family physician who have made the decision whether
to treat or not treat the disabled newborn. We've seen that that kind of
private decision making has led to some outcomes which many people find
unsatisfactory and has provoked a good deal of fear in the courts and the
public discussion in the press. What are the alternatives? Well, one of
the alternatives that's been tried recently, I think in a way that's
produced perhaps more harm than good is administrative regulation. An
attempt by the Department of Health and Human Services to issue rulings
which would take control of the decision making out of the hands of those
nearest to the scene. Even more recently, Arizona has passed a baby do law
of its own which very closely mirrors the HHS regulations. It's now being
modified as the original HHS regulations have been modified. People have
been very concerned that this administrative law approach is too much of a
blunt instrument. It's too intrusive, it takes control too much control
out of the hands of the family and the physician. The most recent
alternative that's been proposed to this kind of obtrusive approach is the
use of institutional ethics committees to provide some safeguards for
decision making about treatment or non treatment for disabled newborns.
And the Arizona baby dough law has now been reformulated just recently in
the last few weeks to encourage reliance upon institutional ethics
committees for the most problematic cases. Well, this strikes me that it's
a case where it's very similar, for example to an institutional review
board that might pass judgment on whether a patient is ready to receive an
experimental heart put into his chest. Something similar to the case that
we saw in Utah,
what is the function of this institutional review board? Has it worked? Is
this a good idea? Well, it's a little early to have a clear track record.
There have been lots of different groups that have called themselves
institutional ethics committees, but they've done quite different things.
I think the important thing to do is to distinguish between a committee
that would try to make treatment decisions and one which would play other
roles. In fact, I think no one who is now in support of institutional
ethics committees views them as primary decision makers instead they are
thought of as having a couple of functions. First of all, they should
review prognosis or make sure that prognosis is reviewed, make sure that
the facts are accurately appreciated by the decision makers in the
Bloomington Indiana case. There's reason to believe that the family
physician presented the family with a very inaccurate picture of the
success rate for the operation and the severity of the child's condition.
Secondly, they can provide consultation and advice for difficult ethical
decisions. And third, they can scrutinize the question of guardianship. If
there's a case in which it looks as if the family is acting
inappropriately, there's a strong conflict of interest or the family
itself, the parents are incompetent to decide for the child. The committee
might seek appointment of a guardian, it might go to court. But all of
these functions are quite different from the function of having the
committee make the decisions itself.
Ultimately, I suppose with the exception of perhaps genetic disorders over
which we virtually have no control. There may be some steps that parents
can take before a child is either conceived or perhaps with genetic
counseling or after a child is conceived, some prevention steps that can
be taken. Now, it strikes me that there might be some conflicts built into
the system as we have developed it so far between prevention. And once a
problem presents itself, our ability to rush in and try to do something to
intervene in that problem. Yeah, I think this is the most troubling aspect.
For me. It's not really what happens in the neonatal unit. It's what
happens before one gets there and what happens afterwards. The
administration in Washington has been very strong on arguing that maximal
aggressive care should be given to every child no matter what their
quality of life, what their prognosis. It seems to me at the same time,
very ironic that the government has been pulling money away from prenatal
care for women. Remember, we know the cause of many of the problems that
appear in neonatal units, poor nutrition, drug abuse in the mother,
smoking, drinking herpes rubella. We know the factors that bring about
conditions that have to be treated in a neonatal unit. It seems very short
sighted to say on the one hand, we're going to spend billions spent $2
billion last year. On neonatal care. And at the same time, say we're not
going to spend anything on nutrition programs, education and other
preventative measures. Then the other side of the coin is once the child
comes out of the neonatal unit, where are the resources for institutional
care, for support for the parents? We've done a very bad job in the
society of taking care of our handicapped. Yet, the administration in
Washington and I must say at the state level, and even in the State of
Arizona has been very reluctant to commit serious resources to the care
and help of handicapped Children.
Dr Kaplan of the Hastings Center Hastings on Hudson, New York and Dr Alan
Buchanan with the University of Arizona. Thanks very much for joining us
here on
have given him an appreciation of Arizona's people, its places and music.
It would seem the next chapter would be played as a curator of those
things. Bill Music is one of the most neglected art forms of our state.
You go into any library, you will find poetry, you'll find history, you'll
find uh Indian dances, you'll find anything you want to find on Arizona in
the Southwest. You look for Arizona music and I defy you to find it. Katie
Lee has written a book that's the only one that I have found. We have folk
musicians, great folk personalities in this state that are not being
eulogized or if they have been eulogized in songs, they're not where
they're supposed to be. They should be in our libraries, they should be in
our museums. We have songwriters, folk musicians that most of the public
because they're not really famous people. They need to be preserved and
they need to be remembered. They're making a great contribution to this
state. So what is it you're planning to do? I am planning on building a
home and a museum complex out by the Sara Lake area. I've already
purchased the land and there we are going to salute Eulogize Preserve
Arizona music, Arizona folk musicians and those people that, that music
and places and things that, that music has been written about and it's
going to be there are other states that do have music museums. Arizona
doesn't have one, not only does Arizona not have one, it's not even in our
libraries. So we're going to put one together and hopefully it's going to
be a well visited place
to close her.
A
how would Dolan Ellis describe Dolan Ellis, the person,
I'm the person that's um
been over a lot of hills and down in a lot of valleys and it makes life
very interesting
and do.
Yeah.
Mhm
On Earth is over
in an encore science report tonight, we look at a promising new use of the
laser in neurosurgery. The technique is still experimental but preliminary
findings are very encouraging. Life is tough if you happen to be a
laboratory rat. This one for example is offering up a major nerve in his
hind leg, all in the name of medical science, his sacrifice and that of
many rats like him are paving the way for a new high tech approach to an
old surgical problem in cases of extremely severe injury. How does the
surgeon go about the difficult task of rejoining severed nerves and small
blood vessels in the past, conventional techniques for doing that have
involved using suture material often with the operating microscope. If the
vessels or the nerves are very small and physically joining the nerves
together with sutures, that certainly works but has had some drawbacks.
One being the time consuming nature of the suturing. And the second being
the possibility that the foreign body of the suture might produce scarring
or fibrosis that could interfere with the eventual result. Experiments are
now in progress to rejoin severed nerves, not with better sutures, but
with a laser beam, honing a Star Wars style light sword into a healing
instrument. A laser beam is a very precise modern instrument. It will
allow us to make lesions in the central nervous system precisely where it
need be. We can literally shave or evaporate cell layers of arteries and
nerves and in vital portions of the brain. In this regard, the laser can
also serve experimentally to enos or bring back together again, severed
nerves and arteries, intense beams of laser light do only one thing no
matter how they are applied in medicine and that is burn tissue. At this
point in time, I would like to turn on the carbon dioxide beam and
illustrate to you under low power situations, what it can do on this block
of wood. Now, I can control, as you see, and I'm going to turn on the beam
and I'm going to try carefully not to hold it in one spot too long.
Because if you do, we can get a little bit of a fire. But in this regard,
we can actually create charring due to the high energy nature of this
coherent light system. It occurred to Dr Fisher that the same intensely
hot but precisely controlled beam of light could be used to spot weld the
ends of a severed nerve back together. Working under a microscope, he
identifies and fully anesthetizes the sciatic nerve in the legs of rats
which are already under general anesthesia. In order to simulate a nerve
severed in an accident victim, the rat's sciatic nerve is cleanly
transected with a scalpel. The experiment in spot welding the nerve back
together by laser requires that the two free ends be lined up again and
temporarily held together or approximated as the surgeons like to say, for
that one single ultra thin stitch is used. The nerve itself is about one
millimeter in thickness
and the future is much less than that one nerve end at the top center has
had a single suture, needle pulled through it. This picture has been
magnified 25 times actual size by attaching the television camera to the
microscope, switching to a lower power, the severed nerve ends can be seen
coming together for that single temporary approximating stitch. Now the
laser can go into action. We'll start on the right side
and you can see a little bit of charring on the nerve itself. You have to
get very tangential to the nerve and just touch it with the edge of the
laser beam which creates a heat change in the nerve itself.
As a result, there are changes in the tissues or protein components of the
nerve wall.
And this acts as the anatomical basis of the spot welding forming scar
tissue all the way around the cut. With the laser beam produces an
extraordinarily strong instant natural bond. After lasering one nerve back
together and conventionally suturing one in the opposite leg of each rat,
the animals are allowed to fully recover from surgery and live an
additional month. Then each nerve is tested to compare the performance of
laser healing with suturing. We hope to prove that the
scar tissue formed by the laser will result in better physiologic
transmission of the nerve impulses across the area where they are joined
due to less scarring. As compared to this conventional suture technique.
At the present time, we are really not certain and no one else is either
whether this will prove to be a better technique, suture and assis. But
there's some reason to think that it might be and it does appear to be
more rapid or faster than suture and Amos for right now, sutures are the
norm for clinical work. I suspect that over the next several years,
research here and research that's going on in other centers will define
whether lasers are going to be a better way of doing this rejoining nerves
and small blood vessels using laser micro spot welding is still only in
the experimental stage. Even if these experiments prove that lasering is
superior to suturing for a number of reasons. The surgeon's needle and
thread is not likely to become obsolete in the foreseeable future. But
there is a good chance that the laser will find a new application among
the tools of the neurosurgeon.
The health effects of exposure to dioxin a by product of the manufacture
of various herbicides and antibacterial agents has been the subject of
growing public concern and debate among government regulatory agencies,
environmental interests and chemical manufacturers in an effort to stem
the tide of what they perceive to be an avalanche of bad publicity and
misinformation. The Dow Chemical company has launched a public relations
campaign as one means of disseminating information among other things. It
is the Dow Chemical Company's position that scientific evidence does not
support a link between dioxin exposure and cancer in humans. And Doo
insists there is no substantive evidence evidence linking dioxin exposure
in humans with a higher than normal rate of birth defects with us this
evening to discuss the dioxin controversy are Horizons Eric Temple and
Sheila Britton, supervisor of the Aquatic Toxicology Testing Laboratory
from Dow Chemical Eric. Thanks Sheila. Welcome to Horizon. Thank you,
yourself and others are touring the country right now on behalf of Dow
Chemical in what some would call public relations campaign for dioxin.
Isn't this a little unusual for a company like Dow? Well, Eric, in light
of the bad publicity that has surrounded this issue, we have decided to
launch our own campaign to bring out what we feel is strong evidence
supporting the fact that Dioxin is not what they have perceived it to be
in the media in this recent campaign. Is this the reason why you are
launching this to sway public opinion to yes, we want to present our side
of this issue and show what we have found as evidence to support. It has
had admittedly a rocky public relations road to travel lately. Why such an
emphasis on public relations now? Well, like you said, we've had a bad
time in the past two decades and it's not so much just the bad publicity
we have received, but public relations has become important for all
corporations we have found in the past 10 years that most corporations
have launched public relations campaigns because of the public awareness
that people are now involved in. It's Dow's contention that scientific
evidence does not support a link between dioxin and cancer in humans. Upon
what basis does doo make that? Well, we have conducted extensive research
through our own laboratories and in research laboratories throughout the
country. And we have found that there is no substantive substantive
evidence that this is true and this is why we're out on the road now
trying to let the people know that we have found this to be true. But the
public perceives that risk or that connection between cancer and Dioxin.
How do you account for the public perception? Well, I think that has a lot
to do with the media and the fact that it is brought up, this is a great
concern. I understand the public being frightened by this, but this is why
we have conducted the research shifting gears a little bit. There's also
been a connection mentioned between birth defects and Dioxin. Why the
perception of that? Well, again, we have found that it's mainly what has
been leaked to the media in most cases, very untrue information. And we
have found in our research that there is no link between birth defects and
Dioxin. How does the public get misinformed? I mean, the rumors have to
start somewhere. Where do you think they come from? Well, I think possibly
it's not so much misinformation that is getting out. I think it's
information that is perceived incorrectly. And once people think that
there is this terrible link then they blow it out of proportion. And
that's when the scare begins. What would you say to a Vietnam veteran then
who had had contact with agent Orange and has had health problems related
to Dioxin? Well, I would say that with the evidence, we have found it
can't be supported. There's a lot of people out there. Yes, there is. But
this is the evidence that we have looked for and very strongly want people
to know that we have not been able to find any evidence. Linking this one
final question, the Environmental Protection Agency has expressed concern
about Dioxin. What are you doing to change their concern? The
Environmental protection Agency is there just for this reason to answer
these questions, they're looking as we have and I'm sure they'll come up
with the same information that we've found. Sheila Britton. Thank you for
joining us on Horizon. Thank you, Eric. Thank you tomorrow night on the
Thursday edition of Horizon. Business editor Phyllis Palaio reports that
as the valley's high tech industry grows. So does the threat of industrial
espionage? I say oil in extremely vulnerable because uh as you mentioned
before the open society and because I don't think many people take to
heart the threat and the loss of intelligence information tonight at 10
o'clock on crossfire, Pat Buchanan and Tom Braden. Look back at Watergate
with former President Richard Nixon. The mission is clear enough to assist
in the establishment of peace to serve as a peacekeeping force and to help
the government of Lebanon establish order so that it may be able to
control its own forces and to ensure that in due course, the country is
united that coming up later tonight on crossfire. Thanks very much for
joining us here on the Thursday edition. Please join Michael Grant
tomorrow night with journalists from around the state on the Friday
edition. I'm Rick Daley. Good night.