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

1. Fighting the Cancer Wars: Patient activism, politics, and medical ethics HI31L Week 19

2. Ending medicine’s ‘golden age’

3. ‘Magic Bullet’-proof: Antibiotic resistance, nosocomial infection & the return of the ‘sanitary’ • ‘Two conclusions regarding staphylococcal infections appear tobe increasingly clear. One is that staphylococci are producingsignificant numbers of infections among hospitalized patientsin all parts of the civilized world, and the other is that thecontrol of this problem requires more than good medical careof the individually infected patient by his personal physician. … In some hospitals the incidence ofinfections has reached epidemic proportions, and in others therehas been an insidious but definite increase in the number ofinfections ... Hospitalpersonnel have contracted infections from patients and in turnspread 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.

4. Thalidomide • 1956-61 Thalidomide licensed and sold in over 40 countries for 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.

5. Thalidomide Protests continue… But so does thalidomide research; thalidomide is now prescribed under tight control for multiple myeloma

6. Women’s risks, corporations’ profits • “Only one small study was performed on the Dalkon Shield, solely to determine the device's effectiveness in preventing pregnancy. To make matters worse, the study's chief investigator never revealed his 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

7. 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.

8. Historical responses to Breast Cancer c.17th century

9. 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

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