Sunday, June 28, 2009

DES as a Model of Damage to our Children

In 1998 I published my first novel, Rx for Mass Murder, which contained the hypotheses that intrauterine exposure to DES administered by prescription to pregnant women in the fifties and early sixties was a cause of the AIDs epidemic and gender selection in the male offspring of those pregnancies. I remember quite clearly the 'Aha' moment when I decided to write this work. I was sitting at a restaurant in Chicago with a distinguished scientist from Sweden, John-Gunnar Forsberg in 1985 preparing him for his testimony in a DES daughter trial. In this particular case, the young woman had suffered vaginal cancer as a result of her mother taking DES. We had tried the case initially in 1978, but the case was reversed by the Seventh Circuit Court of Appeals for reasons not germane to the present discussion. We had come back to Chicago to retry the case in 1985. Dr. Forsberg had testified in the 1978 trial based on his experimental work with rodents during which he established the mouse as the model for what was being observed in human beings. He had been able to replicate everything that had been observed in humans in mice and this type of cross species correlation is considered in the scientific community to be a strong predictor and indicator of causality in the human. Between 1978 and 1985 Dr. Forsberg had performed additional research on this subject which he described to me in that Chicago restaurant. He described with particularity his findings that the mice offspring who developed cancer after being exposed in utero to DES did so as a result of damage to their immune systems; specifically, the T-cell lymphocytes in these animals were missing or significantly reduced. At that point in time, the American public was being made generally aware of the scope of the AIDs problem in homosexual men, including its relationship to T-cell lymphocyte levels. The big moment with Dr. Forsberg came when I said "This would suggest that the current
AIDs epidemic may be due to DES exposure in males in the fifties?" and Dr. Forsberg's response was "Quite right, quite right."

It took me nearly ten years to write the book, but the success or rather lack of success of that effort is also not important to this discussion. What is important is that I have followed the scientific literature avidly since that meeting with Dr. Forsberg, both before and since the publication of the novel. I have read nothing to dispute the veracity of my hypothesis and should note that scientists with far greater qualifications than mine have written extensively about the likelihood that AIDs is not being caused by HIV, but some type of intrauterine exposure. It should also be noted that Americans are inundated with exposures to hormonal agents which have been administered to beef cattle (and formerly chickens) since the 19th mid-century.

All of this information is prefatory to discuss briefly a paper published the past two weeks by the Endocrine Society. Endocrine is the general term for hormones. The Society presents the "evidence that endocrine disruptors have effects on male and female reproduction, breast development and cancer, prostate cancer, neuroendocrinology, thyroid, metabolism and obesity, and cardiovascular endocrinology." "Endocrine-Disrupting Chemicals" (EDC) as described in this paper "implicate EDCs as a significant concern to public health." To paraphrase a recently popular and overworked expression, "that's what I was talking about" in my novel. Below I have included the abstract of this detailed report.


Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement

Evanthia Diamanti-Kandarakis, Jean-Pierre Bourguignon, Linda C. Giudice, Russ Hauser, Gail S. Prins, Ana M. Soto, R. Thomas Zoeller and Andrea C. Gore
Endocrine Section of First Department of Medicine (E.D.-K.), Laiko Hospital, Medical School University of Athens, 11527 Athens, Greece; Department of Pediatrics (J.-P.B.), Centre Hospitalier Universitaire de Liege, 4000 Liege, Belgium; Department of Obstetrics, Gynecology, and Reproductive Sciences (L.C.G.), University of California San Francisco, San Francisco, California 94131; Department of Environmental Health (R.H.), Harvard School of Public Health, Boston, Massachusetts 02115; Department of Urology (G.S.P.), University of Illinois at Chicago, Chicago, Illinois 60612; Department of Anatomy and Cell Biology (A.M.S.), Tufts University School of Medicine, Boston, Massachusetts 02111; Biology Department (R.T.Z.), University of Massachusetts, Amherst, Massachusetts 01003; and Division of Pharmacology and Toxicology (A.C.G.), The University of Texas at Austin, Austin, Texas 78712

Correspondence: Address all correspondence and requests for reprints to: Andrea C. Gore, Ph.D., The University of Texas at Austin, College of Pharmacy, 1 University Station, A1915, Austin, Texas 78712. E-mail: andrea.gore@mail.utexas.edu.

There is growing interest in the possible health threat posed by endocrine-disrupting chemicals (EDCs), which are substances in our environment, food, and consumer products that interfere with hormone biosynthesis, metabolism, or action resulting in a deviation from normal homeostatic control or reproduction. In this first Scientific Statement of The Endocrine Society, we present the evidence that endocrine disruptors have effects on male and female reproduction, breast development and cancer, prostate cancer, neuroendocrinology, thyroid, metabolism and obesity, and cardiovascular endocrinology. Results from animal models, human clinical observations, and epidemiological studies converge to implicate EDCs as a significant concern to public health. The mechanisms of EDCs involve divergent pathways including (but not limited to) estrogenic, antiandrogenic, thyroid, peroxisome proliferator-activated receptor , retinoid, and actions through other nuclear receptors; steroidogenic enzymes; neurotransmitter receptors and systems; and many other pathways that are highly conserved in wildlife and humans, and which can be modeled in laboratory in vitro and in vivo models. Furthermore, EDCs represent a broad class of molecules such as organochlorinated pesticides and industrial chemicals, plastics and plasticizers, fuels, and many other chemicals that are present in the environment or are in widespread use. We make a number of recommendations to increase understanding of effects of EDCs, including enhancing increased basic and clinical research, invoking the precautionary principle, and advocating involvement of individual and scientific society stakeholders in communicating and implementing changes in public policy and awareness.

Saturday, June 27, 2009

Empathy and Judges

Thomas Jefferson wrote the Declaration of Independence in the 1770s declaring that "All men are created equal." That document serves as the foundation upon which the United States was created and that phrase still stands as the single proclamation and premise that binds our nation together, not to mention the hopes and dreams of those throughout the world who hear those words, but do not have the benefit of experiencing its impact in their own cultures, religions or forms of government. In our country we are moving toward a watershed moment as Congress takes up the qualifications of Judge Sottomayer to be the next U.S. Supreme Court justice.

We hear the word empathy bantered about as though the presence or absence of this characteristic somehow defines the ability or inability of Judge Sottomayer to perform the duties of a judge of the highest court of the land. At the time of the writing of the Declaration of Independence, Jefferson owned several hundred slaves. A ten year old child reading that document could only conclude that black men would be encompassed within its meaning. Not so, however. The interpretation at the time by Jefferson and others was that "all men" meant only white men; No blacks, no women. A civil war was fought almost one hundred years later to establish that black men had the right to participate in our democracy. Women, white and black, were finally included as participants in this American ideal in the early 1910s by being granted the right to vote. Sixty years later, the rights of blacks in our society were finally and firmly established in the Civil Rights Act, the validity of which has been upheld by the Supreme Court on numerous occasions. Let me ask whether or not the Justices voting on these issues of the constitutionality of black folks or women of all races enjoying the same rights and privileges as white men invoked the quality of empathy in arriving at their decisions? Or whether it required empathy, in obvious contradiction to Jefferson's proclamation about "all men," to include women in our participatory process of democracy? The answers to these questions are simple; Of course it did.

I submit that empathy is a quality in a person of judgment, including our judges, that is an essential requirement. To lock into the language of law and phrases without breathing life into them in considering modern circumstances implies that the village idiot could be the ultimate arbiter of issues in our complex society. Some of the recent decisions suggest that we may have several of these village idiots already on the Court. They want to go back in time to a different era using the language of our U.S. Constitution as a fixed in time piece of work that can go no further in advancing the causes or true meaning of liberty. The current nominee, Judge Sottomayer, will be a welcome addition to the Court because she does have the essential qualities, including empathy, to advance the course of our nation.

Thursday, June 25, 2009

Malpractice Revisited

My last blog entry was modified and submitted as a comment to an op-ed written by Nicholas Kristoff in the New York Times on June 25, 2009. In his article, Mr. Kristoff insisted that tort reform was an essential element of lowering medical costs and completely overlooked the value of exposing shoddy medical practices in elevating the standard of medical care. I submitted my comment as follows:

Tom Bleakley
Bradenton, Florida
June 25th, 2009
6:30 am
The unwarranted plea for tort reform by Mr. Kristoff needs to be addressed specifically because there is so much propaganda about so-called nuisance lawsuits that one of the purposes of tort litigation is often overlooked. In my view, malpractice suits serve not only to compensate victims, but to elevate stqndards of practice by calling attention in a meaningful way to lax behaviors which harm patients. I need to present a couple of examples of typical medical malpractice cases I handled over my thirty five years of law practice.

Case #1: My client was an emotionally disturbed ex-nun who left her convent after fifteen years (at the age of thirty two). She spent two years trying to establish a social life all the while teaching at a public elementary school. Her inability to relate well to others led her to a prominent psychiatrist who she saw weekly for thirteen years. The last ten years of her treatment with Dr. X consisted of her performing fellatiio upon him for forty five minutes while he looked at the pornographic pictures in the magazine she purchased for him that particular week. It should be mentioned that sex under the guise of therapy is a felony in the State of Michigan punishable by ten years imprisonment. It should also be mentioned that patients under psychiatric care undergo what is termed transference. In short, they fall ‘in love’ with their therapists. Ethical therapists recognize that transference is a valuable part of the treatment process and consciously use a variety of acceptable methods and practices to benefit the patient. Ten years after this therapy my client remained an emotional recluse, hoarding objects and animals in her home and rarely ventured outside.

Case #2: My ciient was a young wife and mother pregnant with twins. She had the misfortune of going into labor on a Friday evening, during her obstetrician Dr. Y’s cocktail hour. Dr. Y showed up after having imbibed three martinis and delivered the children. The first child was delivered safely and is entirely normal. He dropped the second infant on her head in the delivery room and the retarded child will spend her life in a wheelchair resulting from the damage to her brain from the fall to the floor. Dr. Y was known by hospital personnel to have a drinking problem for at least five years before this incident. At least three nurses present at or prior to the delivery of these children recognized that Dr. Y should not be permitted into the delivery room. A resident in the third year of obstetrical training was present during the delivery and testified that Dr. Y insisted on performing the delivery without assistance.

I could go on and on, most particularly in the area of malpractice situations arising from ignorance about prescription drugs; the area where I spent the vast majority of my professional time. But these examples will suffice to make the point I need to make. In each of these cases, prominent colleagues of Drs. X and Y ventured forth and gave ‘expert” testimony as to why the acts of each of them were within the standard of care and were appropriate given the circumstances in each of the case. Never once in thirty five years of practice did I encounter a situation in which the doctor admitted fault and agreed that he had harmed my client without encountering a staunch defense and the defense of the doctor’s acts by his fellow physicians.

It should be stated that most states already have strict procedures in place to ensure that so called nuisance cases do not find their way into the system. In short, there is absolutely no need to further restrict the rights of our citizenry under the Seventh Amendment to the U.S. Constitution to pursue legitimate claims against physicians and hospitals, as well as other medical care providers. The elimination of all medical malpractice cases has long been the mantra of the American Medical Association and the Republican party. To cave in to these special interest groups under the guise of reducing medical costs will only reduce the quality of care for all of us. Sorry, Mr. Kristoff, but you are absolutely on the wrong side of this issue.

Monday, June 15, 2009

Not the Kind of Change I Envisioned

The honeymoon is over. Those of you who have followed my writings and rantings over the past three years know just how much I was enthralled with the prospect that Obama would bring an entirely new perspective into how our federal government operates. Before I get into my current status of disenchantment, I need to present a couple of examples of typical medical malpractice cases I handled over my thirty five years of practice.

Case #1: My client was an emotionally disturbed ex-nun who left her convent after fifteen years (at the age of thirty two). She spent two years trying to establish a social life all the while teaching at a public elementary school. Her inability to relate well to others led her to a prominent psychiatrist in downtown Detroit who she saw weekly for thirteen years. The last ten years of her treatment with Dr. X consisted of her performing fellatiio upon him for forty five minutes while he looked at the pornographic pictures in the magazine she purchased for him that particular week. It should be mentioned that sex under the guise of therapy is a felony in the State of Michigan punishable by ten years imprisonment. It should also be mentioned that patients under psychiatric care undergo what is termed transference. In short, they fall ‘in love’ with their therapists. Ethical therapists recognize that transference is a valuable part of the treatment process and consciously use a variety of acceptable methods and practices to benefit the patient. Ten years after this therapy my client remained an emotional recluse, hoarding objects and animals in her home and rarely ventured outside.

Case #2: My ciient was a young wife and mother pregnant with twins. She had the misfortune of going into labor on a Friday evening, during her obstetrician Dr. Y’s cocktail hour. Dr. Y showed up after having imbibed three martinis and delivered the children. The first child was delivered safely and is entirely normal. He dropped the second infant on her head in the delivery room and the retarded child will spend her life in a wheelchair, all resulting from the damage to her brain from the fall to the floor. Dr. Y was known by hospital personnel to have a drinking problem for at least five years before this incident. At least three nurses present at or prior to the delivery of these children recognized that Dr. Y should not be permitted into the delivery room. A resident in the third year of obstetrical training was present during the delivery and testified that Dr. Y insisted on performing the delivery by himself.

I could go on and on, most particularly in the area of malpractice situations arising from ignorance about prescription drugs; the area where I spent the vast majority of my professional time. But these examples will suffice to make the point I need to make. In each of these cases, prominent colleagues of Drs. X and Y ventured forth and gave ‘expert” testimony as to why the acts of each of them were within the standard of care and were appropriate given the circumstances in each of the case. Never once in thirty five years of practice did I encounter a situation in which the doctor admitted fault and agreed that he had harmed my client without encountering a staunch defense and the defense of the doctor’s acts by his fellow physicians.

Now, as to why the honeymoon is over; Obama has indicated his willingness to curtail medical malpractice cases as part of a medical care overhaul. It should be stated that most states, including Michigan, already have strict procedures in place to ensure that so called nuisance cases do not find their way into the system. In short, there is absolutely no need to further restrict the rights of our citizenry under the Seventh Amendment to the U.S. Constitution to pursue legitimate claims against physicians and hospitals, as well as other medical care providers. The elimination of all medical malpractice cases has long been the mantra of the American Medical Association and the Republican party. For Obama to cave in to these special interest groups under the guise of reducing medical costs will only reduce the quality of care for all of us. Sorry President Obama, but you are absolutely on the wrong side of this issue.

Friday, June 12, 2009

Part D, Short Memories and So Much Hate

A couple of crazy people murdered citizens in the past couple of weeks. The backgrounds of the crazies were such that they are generally associated with the lunatic fringe of far-right thinking. One of those murdered was a man that Bill O’Reilly has routinely referred to on his Fox TV talk show as “Tiller the baby killer,” a licensed physician who performed legal abortions authorized by both federal law and the laws of the State of Kansas where he practiced. In November, a black church under construction in Springfield, Mass. was burned to the ground by three men who bragged of doing so in protest of the election. In the same time frame, a cross was burned outside the home of a family of Obama supporters in Hardwick, N.J. A couple of guys at my local golf club in Michigan regularly refer to Nike golf balls as “nigger balls” (Tiger Woods, the best golfer in the history of the sport, is sponsored by Nike) and, almost to a person, everyone I talk to laments about the out-of-control spending of the Obama administration and that Obama is carrying us down the path of socialism. Part of this Obama administration stuff, Glenn Beck has asserted over the past few weeks on his Fox TV talk show, is the intimation that FEMA may be running “concentration camps” of American citizens. The other incident, the murder of a black guard working at the site of the Holocaust Museum in Washington was his shooting by a crazy man whose background and working papers decreed hatred of all things different to him including Jews, blacks, and Obama.

Let me switch briefly to Part D and short memories. Part D is the Republican created and supported part of Medicare which, by and large, gives Medicare recipients free drugs. Now, one might say to me, ‘Thomas, you are such a flaming liberal, why are you against this massive government handout?’ First of all, the Bush administration lied about the cost of this program, claiming that it would only cost taxpayers 250 billion dollars when it knew that the real cost was $550 biliion dollars. The best part of the deal which was sold as being good for Americans was that Medicare administrators were prevented by the law from negotiating the prices of drugs with the drug industry. In other words, the supposedly staunchly conservative Republicans who continuously harp about governmental spending opened the coffers of the American treasury to the drug companies and said, ‘come on in and help yourself.’ I think, as a minimum, that it is curious that not one Republican, including Rush, the person that Republicans currently identify in polls as being the number one spokesperson for the party, has mentioned this boondoggle once. Cheney and Palin haven’t referred to it either. Curioser and curioser! Obama didn’t cause the economic mess he inherited from his Republican predecessors; they caused it. Why are memories so short?

As an old guy I am alarmed by these various events because the right seems to be surrendering its principles, with which I generally agree, to an emotion I can only characterize as irrational hatred. As a grandparent, I sat (proudly) through two graduation exercises yesterday and both of the classes from middle class, relatively affluent, areas of southeast Michigan, were striking in their diversity; caucasions, blacks, Arab and Asian children in abundance. It is my fervent hope that these children, working and playing side-by-side, will begin to eliminate this ugly hatred that percolates through our society at the present time. We live in a great society that is changing. I issue this as a challenge to all Republicans. Step up to the plate. Examine your belief system and ask whether what you are doing and advocating is based on hate and, if it is, change it. Damn it, change it!

Tuesday, June 9, 2009

Something Really Refreshing

At the end of the NBA divisional championship series between Cleveland and Orlando, the 'super star" Lebron James walked off the court sulking in defeat without having the class to congratulate the team that had beaten his own. These are the kinds of acts which young kids see and mimic as they look up to these megastars while they are developing into young adults and entering the real world. Recently, one of the top MBA schools in the country attained some publicity by announcing that it was going to add an ethics class to its required courses. Oh really? The people we have been trusting with our business and financial decisions all these years are finding out for the first time that there may be some ethical considerations involved? My own profession, law, has gone way overboard in the course of the thirty five years that I practiced with the trend being to do whatever was necessary to win at all costs. In light of these prefatory remarks, I want to pass on some information that brings tears to eyes and swells my chest with pride. What follows are two recent communiques, unedited, from the tennis coach of Hope College to his team and a press release from the Intercollegiate Tennis Association (ITA). I should mention that the Jeff referred to is my grandson.


Boys,

Wow! It's not often you get to see Hope College next to UCLA in a sports release but here it is in black and white. And if you go to the website at www.itatennis.com you can see our team picture come up in full color (albeit very PINK). :) This is really cool! Congratulations to all of you for this award! We could have been nominated a hundred times over the course of this season for things we did on the court that exemplified great sportsmanship and character but someone selected this moment during our match with Luther as worthy of national recognition. Jeff and Alex were in a tight match at #3 doubles when they hit a cross-court volley that Luther returned into the net. I could tell that Jeff and Alex both saw the ball out so I asked them whether their shot was in. Jeff immediately replied, "No, it was out. Your point," and he and Alex walked back and got ready for the next point. That moment and that decision is exactly what separates Hope College from everyone else - we have the courage to make fair line calls, including against ourselves, and we have faith that it will all work out in the end. That is the strength of character that is at the heart of our team and our program.

I am so proud to be the coach of Hope College Men's Tennis and so blessed to have you all on our team. Thank you for who you are and for who you choose to be day in and day out. It is making a difference and providing a shining and inspirational example for others to follow. You guys are AWESOME!

Go Hope!

Coach

---------- Forwarded message ----------
From: Jason Berney
Date: Mon, May 4, 2009 at 11:59 AM
Subject: Hope College, UCLA receive ITA National Team Sportsmanship Awards
To: jberney@itatennis.com


For Immediate Release
Contact: Jason Berney, ITA (609-497-6921)
May 4, 2009

Hope College, UCLA receive ITA National Team Sportsmanship Awards

SKILLMAN, N.J. - The Hope College men's and UCLA women's tennis teams have been honored as April’s recipients of the Intercollegiate Tennis Association (ITA) National Team Sportsmanship Award, the ITA announced today.

The ITA National Team Sportsmanship Award is a monthly award that goes to one men's and one women's team that has exemplified outstanding sportsmanship, character and ethical conduct in the true spirit of competition and collegiate tennis. The winners are selected by the ITA Ethics and Infractions Committee from nominations received from all ITA member institutions (NCAA Divisions I, II and III, NAIA and Junior/Community Colleges). This monthly award began in 2003. In addition to the obvious reasons, sportsmanship and fair play are considered important in college tennis due to the fact that players make their own line calls during a match.

Hope College is a NCAA Division III school, coached by Steve Gorno and located in Holland, MI. In a critical juncture of a doubles match versus Luther College, a Luther player pursued an out ball and hit it into the net. Coach Gorno saw from a distance that the ball was out. He asked his players if their shot was in, they replied “no”, and gave Luther the point. Even though Luther ended up winning the match 5-4, the move displayed by the Hope College squad was definitive of a first class program.

UCLA is a NCAA Division I school, coached by Stella Sampras-Webster and located in Los Angeles, CA. The UCLA women’s squad travelled to Waco, Texas to take on Baylor. Upon arrival to the match, the courts had gotten wet due to an overnight shower. Stella and her squad helped dry the courts in the morning and were willing to help in anyway possible. The match was very intense but their players were fair and represented their university in a first class manner.

As the governing body of collegiate tennis the ITA promotes both the athletic and academic achievements of the collegiate tennis community. The ITA, which was founded in 1956 and is based in Skillman, N.J., administers numerous regional and national championships, the ITA Collegiate Summer Circuit presented by the USTA, and the Campbell/ITA College Tennis Rankings for men's and women's tennis at the NCAA Divisions I, II and III, NAIA and Junior College levels. The ITA also has a comprehensive awards program for players and coaches to honor excellence in academics, leadership and sportsmanship. The official ITA website is www.itatennis.com.

###

Sunday, June 7, 2009

Blogging or Slogging

Richard Jalichandra, chief executive of Technorati, reports in the New York Times that at any given time there are 7 million to 10 million active blogs on the Internet, but “it’s probably between 50,000 and 100,000 blogs that are generating most of the page views.” He added, “There’s a joke within the blogging community that most blogs have an audience of one.”

After nearly three years of active blogging, my best estimate is that my audience is such as to cause even my closest friends to wonder why I bother to pursue this activity. I do have at least one faithful reader, Stan of Palo Alto, an old friend and golfing buddy. I can always count on Stan to disagree with me on every single issue and position I take; sort of a point and counterpoint kind of thing. Other than Stan, there are several others who read out of kindness or shared beliefs and philosophies about some of the problems in the world or our lives, such as the problems caused by the various insensitivities of the George Bush regime.

But the real question is why I bother to continue slogging (Hey, I just invented a new, more realistic term for bloggers who suffer from the malady of small audiences). To be utterly candid, I ask that same question myself from time to time. I must mention that my original motivations were and are both different and several compared with the vast majority of bloggers who envisions attracting millions of avid readers and making the big bucks from this exciting new means of communicating with others. There has been a serious letdown from the hype that greeted blogs when they first became popular. Initially the thinking and hope was that no longer would writers toil in anonymity or suffer the indignities of the publishing industry, we were told. Finally the world of ideas would be democratized! This was the motivation that drove us. Some, of not most, early bloggers thought blogging was a fast path to financial independence, but have found themselves discouraged by the bitter reality that most others could care less about reading the writings of less than famous writers.

Others simply tire of telling their stories. So far, I haven't reached that point because, as I stated above, my motives for making this continued efforts are twofold; first, I view this activity as a means of communicating directly, either presently or at some point in the future, with my grandchildren. I want them to know about me, because, simply put, I know next to nothing about my grandparents. I have done things in my lifetime that I want them to know about so that they can learn from my experiences, so that they can understand that to really live life, perfection is not required and that one can benefit from the bad things that happen as well as the good. Life is one step at a time and sometimes these steps are taken backward, but there are always avenues to move forward. The other reason for continuing this blog is that I am writing my second novel. For eight years I have been working on the damn thing, and I find that my motivation wanders from time to time. This writer's block thing is real and the blogging effort has been helpful in getting me on a path of regular writing activity. I have turned the corner and am now actively engaged in the process off finishing the work.

When I write something I consider particularly clever or noteworthy, I notify or send a copy to a group of friends via e-mail. When I write something like this present blog, I do not do this, nor will I with this particular one. It will just be quietly placed
on the blog site (I might send it to Stan so he knows how much I appreciate having him as a friend).