Friday, May 15, 2009

A Doctor to the Stars

Message to Carl: Wow! Big, as in really big, cold, impersonal hospital! Then I got to the front door and my biases and ill-conceived notions began to be shattered one by one. First there was the beautiful Caroline, a stunningly gorgeous Indian woman who has been in the United States since 1978. Her parents arrived here four years earlier after putting her and her two sisters in an orphanage where they would stay until her parents were able to afford bringing them to America. Now she is a highly skilled and extremely personable registered nurse who does intake procedures at St. John’s hospital in Detroit for surgical same day procedures. Bottom line; one hundred per cent for efficiency and quality and two hundred per cent for making an old geezer like me feel comfortable about the morning’s spinal surgery for a ruptured disc that had persisted as a result of a fall on my bicycle in September 2007. I have to go back one step; I love to read and I constantly have a novel at my side lest I waste a spare minute without having the opportunity to occupy my time by its reading. I was instructed to arrive at eight o’clock in the morning for a thirty five minute surgery that was to begin at eleven o’clock. That gives me about two hours and fifty minutes for reading if the experience was going to be a typical contact with the medical providers. I’ll eliminate the mystery right up front. I did not have one moment in time to read my book. Following Caroline came the charming and effusive Dr. Haas, an eighty year old physician who has been retired from private practice since age sixty five. A big man, but cute in his bow tie and sparkly eyes as he told corny jokes non-stop. A regular standup comedian, but he did his job, completing my screening physical examination thoroughly and, competently. Did I mention that he was from Austria and fought against our side in World War Two? He came to the United States after the war and was immediately drafted into the American army where he served three years in Korea during that war. He went to Germany to obtain his medical training because the Veteran’s Bill did not cover former combatants against the U.S. He returned to this country shortly after completing his training and practiced at the Hollywood Clinic on Mack in Grosse Pointe until his retirement. Dr. Haas’ bottom line; one hundred per cent for efficiency and two hundred percent for the aforementioned ‘making it easy for an old guy.’ The pattern is beginning to become clear by now. I was a star. The reception that I was receiving made me feel like a star. I was somebody special and Caroline and Dr. Haas had that wonderful ability to make it so. Whatever adjectives that describe the opposite of cold and impersonal would apply to the two of them and to my continuing venture through the pre-surgical arena, surgery room, recovery room and my private room which was more like a fancy hotel room in New York than a hospital room in Detroit. The attentiveness of the hospital staff and my surgeon were beyond anything that I imagined and I have elected not to delve more deeply into the various persons that I came across. Suffice it to say that these contacts were Caroline/Dr. Haas-like.

Why did I start this writing with the mention of Carl? Carl is a friend of mine, a retired orthopedic surgeon, who has graciously kept track of me and my back conditions for more than ten years on a more or less informal basis. If forced to describe what Carl does, I would say that he is a healer who brings the quality of compassion to his dealings with people big time. He does so in a way that he makes someone like me feel like a star. Carl, sometime in the next week, you will receive a package that will reflect my appreciation for what you have done for me and, hopefully, the discussion above will explain the message conveyed on the contents of that package.

Sunday, May 3, 2009

Pick Me. Pick Me

Dear President Obama: I hereby submit my application so that you may consider appointing me to the Supreme Court of the United States. I know, I know, You may never had heard of me and your first question may be whether or not I have had any experience as a judge (none whatsoever, a big plus rather than a minus.) I will resist telling you that I, too, once had a dog named Bo who was as cute as yours. I don't believe its proper to do such a thing to simply try to ingratiate myself to influence your choosing me. Why you should pick me is, simply put, I have no political affiliation or credentials to weigh down the selection process, but I do have tons of experience in representing the small guy or gal in American life. On more than one occasion I have actively represented persons whose constitutional rights were being damaged by governmental entities and have done so pro bono without any attempt to blow my own horn about it. I know the difference between right and wrong and some of this knowledge was acquired by, what might be said, on the job training. Most of all, I respect the principles enunciated so clearly in the Constitution of the United States. As a lawyer of thirty five years, I have never lost sight of the commitment I made when I took the oath to practice law, i.e., to support and defend the Constitution. I have never donated money to a judge's campaign and on one occasion I have donated money to a Senator's campaign. (I later asked for it back.) If you appoint me, I promise to resign shortly before you end your second term as president so you can appoint someone else. By then I'll be 76 years old. Also, I will work for free. I guarantee that any paycheck that is given to me will be returned unsigned and unopened to the U.S. Treasury. I look forward to discussing my credentials with you privately and while I would not relish public exposure, my stories about my grandchildren will surely be well received throughout the country. Sincerely, Tom Bleakley

Friday, May 1, 2009

Let Me Go Back . . .

The trigger for this writing is the first sentence that appears in Paul Krugman's op-ed column in today New York Times. "The 2008 election ended the reign of junk science in our nation’s capital, and the chances of meaningful action on climate change, probably through a cap-and-trade system on emissions, have risen sharply."
I know about junk science. It has been more than twenty years and I am still licking my wounds. At the time, I represented more than 400 children who had been born with a variety of limb deformations. Approximately eighty of these children had both arms missing above the level of the elbow. The remainder had single amputations. All of these children had one thing in common; Their mothers took the drug Bendectin between days 28 and 56 of their respective pregnancies. When trying to prove that a drug can cause birth defects, it is necessary to look at a great deal of indirect evidence. Testing at the microscopic level revealed that Bendectin was capable of damaging the integrity of cells in a manner necessary to implicate the drug in causing birth defects. A substance that causes such cellular damage is labeled a mutagen. Bendectin was labeled a mutagen by the federal government in 1988 and the mutagenic effect was confirmed by a variety of subsequent research projects. In addition, a wide variety of animal research in which Bendectin, or its various components, were administered to pregnant animals and the offspring of these animals were examined in detail. Damage to the cells that ultimately become limbs was observed in multiple animal studies involving multiple animal species and was dose-related, a cardinal sign of a potential effect in the human. Then there were the human studies. One of the drug company's defense expert witnesses characterized the dilemma of human studies in his scientific writings. "Epidemiology is like a brief bikini bathing suit. What it reveals is interesting, but what it covers up is critical." Most of the epidemiology studies conducted on Bendectin defined exposure to the drug as women having taken the drug through 120 days of pregnancy. This group was then compared to a control group of women who had not taken the drug and the presence or absence of children born with various birth defects in both groups was compared. In these studies, it was a mistake to include women as being exposed to the drug when they started receiving the drug only after the critical period of limb development had been completed, i.e. after 56 days of pregnancy. For example, a woman who began Bendectin on the 85th day of pregnancy had done so at a time when the limbs of her baby were not in jeopardy of being damaged. Nevertheless, she would be included in the group of Bendectin exposures. The net result of this mistake was, of course, the conclusion that Bendectin was safe. I hired an eminent epidemiologist who reanalyzed all of the various epidemiology studies by eliminating this time discrepancy. Only cases in which the mothers actually took the drug during critical periods of limb development were considered as being exposed. The result of this reanalysis showed clearly that the likelihood of Bendectin causing limb defects was more than three times greater in a mother receiving Bendectin than those who did not. The reanalysis was labeled as junk science by the defendant drug corporation (because a plaintiffs' lawyer had paid to have it done) and that tag stuck with the federal judges who heard the same evidence in case after case and threw out successful verdicts in cases across America. Bendectin litigation became the poster child of junk science for the right wing's campaign against lawsuits to hold corporate America accountable for the harm its products caused.

The point of this diatribe is to illustrate how the machinations of the drug company and the federal judiciary in this particular very important piece of litigation served as the forerunner of the current status of science involved in larger questions today. Global warming? Junk science. Throw it out. Harmful effects of carbon dioxide? Same. Throw it out. What a breath of fresh air, literally and figuratively, to finally have politicians in place who seem to understand that the country needs to get back to a system of thought where a decision is made after information is presented. Only demagogues decide what an answer is first and then cherry pick evidence to support the ill-founded conclusion. Let me go back . . .