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Baby-harming medical research | |||||
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about baby-blinding retinopathy of prematurity by H. Peter Aleff, 2005 to 2009 |
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2.2: Smear propaganda against life-saving oxygen Oxygen was the ideal scapegoat. Incriminating it would exonerate the nursery doctors from all responsibility for the clearly iatrogenic blinding because if they had given the babies too much of it they had done so only with the laudable intention to save their lives. This argument would offer them the easy defense that the disease was an unfortunate but difficult-to-avoid side effect of premature birth. In addition, controlling the flow of oxygen would provide doctors at long last with a real role in the nurseries which were then dominated by skilled nurses. Some doctors described these experienced nurses as "opinionated" [1] because they talked back and did not blindly obey their orders. The power to prescribe or withhold oxygen, however, would establish doctors as the indispensable navigators between the Scylla of eye damage from too much oxygen and the Charybdis of death and brain damage from too little[2], based on the implied and still often unquestioned medical assumption that these risks are on the same level.To make the charges against oxygen stick, despite its long track record as saver of many lives, and despite the nurses’ daily experience how well it helped the tiniest preemies in their often desperate breathing struggles, the eugenics advocates needed a large clinical trial. The function of that trial was not to learn anything about ROP but only to condemn oxygen publicly with the inquisitorial might of infallible medical science. The ex cathedra results from a big show trial would allow them to hide under a candy-coating of fake data the distasteful substance of the intended euthanasia program. Dr. William A. Silverman, a now retired neonatologist much involved in the early debate about ROP, chronicled in his 1980 book Retrolental Fibroplasia: A Modern Parable, how the first such trial came to be held. According to him, Dr. Leroy Hoeck, director of the intensive care nursery at the Washington, D.C., Gallinger Municipal Hospital, mused to Dr. Arnall Patz, a young ophthalmologist resident from nearby Baltimore, Maryland, that high oxygen concentrations given to the babies might be involved in their blinding. That conversation must have taken place not long after the May, 1949, publication of Payne’s euthanasia recommendation because Silverman reports that Patz “dropped the matter for a while”, initially dismissing that idea as unlikely on theoretical grounds. Then, “in late 1949”, Patz changed his mind and began to design a clinical trial to test the influence of oxygen on ROP in the intensive care nursery. He proposed to assign premature infants in alternate order to incubators with either routinely high or low oxygen enrichment [3].That oxygen-restricting proposal flew in the face of everything then known about premature babies and oxygen. Oxygen had been routinely administered to them for many decades to help their immature lungs until they were ready for room air, and it was given as a matter of course since it was such a clearly beneficial life-saver. Already the 1893 “Transactions of the American Pediatric Society” show diagrams of preemie incubators with items labeled “connection for oxygen supply” and “oxygen pipe”, and a medical report from 1897 mentioned also continuous administration of pure oxygen as one of the routine resuscitation techniques for preemies [4].These proofs of earlier oxygen use date from 47 years before the first baby ever suffered from ROP, and 61 years before Reese and his like-minded colleagues would suddenly declare this then longstanding habit of giving the babies oxygen to be the culprit for the then recently started epidemic of preemie-blinding. Throughout these years, pictures of preemie incubators often showed an oxygen bottle next to them [5]. Also, Dr. Julius Hess, one of the pioneers of modern neonatology, described in 1934 how he had routinely kept preemies in atmospheres of 40% oxygen which was at times increased to 50 or 55%, and in some cases even in a mixture of 5% carbon dioxide with 95% oxygen. Some of the survivors weighed as little as 790, 865, 890, and 970 grams at birth[6]. None had or developed ROP.Similarly, a 1952 article about Current Trends in Premature Care that summarized the experience gained over the years with oxygen praised it as one of the most effective weapons against respiratory problems that should be applied without waiting for the baby to develop breathing difficulties:
However, with all this routine use of oxygen in nurseries across the country and around much of the world, not one baby anywhere had ever developed ROP before 1940 and the arrival of the new bright lamps in American nurseries. And no baby born overseas got ROP before 1946 when these lamps began to become available there. Even retrospective studies among older blind people had turned up no previously missed cases of ROP from before that time, so there was no logically defensible way how this entirely new condition could suddenly have been caused by the long familiar and regularly administered oxygen. Despite this long history of oxygen as a non-blinding life saver and its perfect alibi in the case of ROP, Patz and Hoeck received the requested grant for their oxygen-restricting study with relatively little discussion. Silverman described how the reviewers at the National Institutes of Health initially criticized that grant application as:
Although the grant givers were easily won over, the objections of reviewers and nurses against oxygen withholding demonstrated that the until then unblemished reputation of oxygen as a safe and effective life saver had to be changed first before the idea of blaming it could become acceptable. Accordingly, some proponents of oxygen withholding began an international smear campaign against that until then so beneficial gas. There is no need for conspiracy theorists to imagine here some elaborately planned plot orchestrated by a sinister cabal with silly code names in dark underground garages. Instead, we can openly observe in the medical literature of the time how that campaign unfolded. The discrediting of oxygen appears to have been driven by spontaneous expressions from a few individual doctors who shared the same ideology and “doctor knows best” attitude. They also read and heard the same views and interpretations in their journals and meetings. It seems that this small group of medical opinion leaders had the willing ears of their receptive colleagues, and the internal ricochets of that group’s echoing their buzz about oxygen appear to have reinforced their mutual convictions. One of the most profuse among those early oxygen-accusers was Dr. Philip Jameson Evans, a prominent ophthalmologist in Birmingham, England. He expressed in March 1951 his views about the infant's need for "an oxygenated blood supply acquired by its own efforts", and he continued, in words that sound as if he had borrowed them from the earlier eugenics advocates:
In July of that same year, Dr. Kate Campbell, a neonatologist from Melbourne, published an article in The Medical Journal of Australia in which she said “colleagues returning from overseas” had suggested that oxygen might be responsible for the eye damage. She then described that her own general comparison of three nurseries with different means for paying the costs of oxygen seemed to confirm this suspicion. She concluded that preemies should not receive any oxygen supplements unless they turned blue from its lack, and if that happened because of a congenital cardiac defect, then “vain efforts should not be made to improve the infant’s colour with oxygen” [10].Silverman notes in his account of this earliest published clinical indictment against oxygen that Campbell’s informants had visited Birmingham, England [11], so her findings appear to have been inspired by Evans’ anti-subsidy rantings.A year later, Evans and Dr. Mary Crosse, his like-minded colleague in Birmingham, continued the slander against oxygen, this time in the respected American journal Archives of Ophthalmology, as edited by Reese:
This labeling of oxygen as a subsidy made it ideologically intolerable to the many doctors who still shared the eugenics movement’s aversion against any help for the struggling. Add to this that during those McCarthy-era communist-hunting years in America, it was not necessary for charges of leftist connections to be proven to be widely believed. In any case, Evans’ rhetorical insinuations against the until then "life-saving" gas found a ready reception in American medical circles, as the actions of their members would show. In a textbook example of what psychologists call projective identification and action discharge of disturbing internal stimuli, a condition common in political debate where people who feel threatened mistake the symbol for the real thing it represents[13], the American community of nursery doctors reacted to this red-painting of oxygen like a bull to red cloth. The American Medical Association had just spent $1.5 million in 1949 and $2.25 million in 1950 to defeat President Truman's National Health Insurance proposal, in what was back then the most expensive lobbying effort in American history. Their advertisements had linked British-style National Health Insurance with socialism and even with fabricated Lenin quotes[14], and the political fever inflamed by this type of slander continued to run high for years later. For instance, the Guest of Honor at the 1953 Annual Session of the American Academy of Ophthalmology and Otolaryngology declared that socialized medicine was "a terrible blow to the art of practice" and a "serious threat"[15]. This emotional and political context made it easy for the American pediatric leaders to continue linking that socialist threat with the oxygen that Evans and some of his colleagues had already connected to the socialist evil of “subsidies” dispensed by a loathed system. |
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