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Footnotes :

 

24 Silverman WA. Retrolental fibroplasia: a modern parable. Grune & Stratton, Inc., New York, 1980, Chapter 4: "The Oxygen Hypothesis", pages 25-29.

 

25 Evans PJ. Retrolental Fibroplasia. Transactions of the Ophthalmological Society of the United Kingdom, 1952, 71: 613-16, quotes on pages 613 bottom, 614 top, and 615 middle.

 

26 Crosse VM, Evans PJ. Prevention of Retrolental Fibroplasia. A.M.A. Archives of Ophthalmology, July 1952, 48: 83-87, quotes on pages 86 bottom and 87 bottom.

 

27 Silverman WA. Retrolental fibroplasia: a modern parable. Grune & Stratton, Inc., New York, 1980, Chapter 4: "The Oxygen Hypothesis", see page 28.

 

28 Campbell K. Intensive Oxygen Therapy as a possible cause of retrolental fibroplasia: a clinical approach. The Medical Journal of Australia, July 14, 1951, pages 48-50.

 

29 Langs R. The Listening Process, Jason Aronson, London, 1978, as cited in Godwin R. Dimensions of the American Political Mindscape, The Journal of Psychohistory, Summer 1993, 21: 1: 79-96, see page 84.

 

30 Starr P. The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry. Basic Books, New York, 1982, see chapter on "Symbolic Politics, 1943-1950", 280-289, see pages 284, 285, and 287 bottom.

 

31 Post LT. The Art of Medical Practice. Address of the Guest of Honor at the Annual Session of the American Academy of Ophthalmology and Otolaryngology in October 1953, Transactions of the American Academy of Ophthalmology and Otolaryngology, November/December 1953, 841-47, see page 842 top left: "Socialized medicine, an actuality in some countries and a serious threat in this, is a terrible blow to the art of practice."

 

32 Silverman WA. Retrolental Fibroplasia: a modern parable. Grune & Stratton, New York, 1980, see Chapter 6: "The National Cooperative Study", pages 37-42, particularly pages 37 and 38; see also Silverman WA. in discussion at the Ross Conference on Family Centered Neonatal Care, Burlington, Vermont, June 27-29, 1992. Unpaginated transcript.


 


 

  

 

  

  Preemies gasping for breath

 

are denied the breathing help they need 

 
 

Davidpreem01.jpg (20108 bytes)

Medical oxygen-starving
practices and experiments

by H. Peter Aleff

 

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2.3. "Liberal" oxygen as political evil

The doctors responsible for that trial breached this duty, and many others described below, because they had become prejudiced against oxygen on a non-scientific, metaphorical, and political level.

Dr. William A. Silverman, a now retired neonatologist much involved in the debate about ROP, traced in his 1980 book Retrolental Fibroplasia: A Modern Parable24 how the American proponents of oxygen withholding acquired their sudden and fierce slant against that until then beneficial gas.  They got the idea from two British physicians who had not long before used it as an allegory for socialized medicine.

These two had branded the "liberal" use of oxygen a misguided subsidy symbolic of the wasteful and counterproductive profligacy to be expected from a National Health Insurance system, as introduced in England and greatly feared in the United States.

Here is how oxygen became identified with this political threat. A prominent British ophthalmologist had presented in March 1951 his views about the infant's need for "an oxygenated blood supply acquired by its own efforts".  Then he elaborated:

"Prior to 1930 [sic - please note that ROP began only in 1940] oxygen was not given so frequently as a routine or for such prolonged periods, or at so nicely uniform a level as today. Now [the infant] lives in a constant atmosphere of moderately high oxygen concentration (...) and certainly without the stimulus to private enterprise: hence an inertia results as we find in other human activities when over-subsidized. (...) They have oxygen 'on the State' (...) Perhaps this is only one further instance of the modern trend to save the individual from having to work his best to live, and perhaps our treatment is in fact the reason why this disease has now appeared."25

In July 1952, this author and a like-minded colleague continued, this time addressing an American audience:

"Prior to the modern technique of oxygen administration, the premature infant fought out its struggle for oxygenation. (...) It seems that, as in domestic and national policies, a prolonged subsidy paralyzes the ability to struggle which would otherwise have had the opportunity to develop, and that the disease has, in fact, been artificially induced by a well-intentioned, but misguided, change in the management of such cases. That a return to a less indulgent care of the premature infant prevents the disease should be appreciated as soon as possible, and cannot be too quickly undertaken."26

This metaphorical labeling of oxygen as a subsidy made it ideologically intolerable to subsidy opponents.

During those McCarthy-era witch hunting years, it was not necessary for charges of leftist connections to be proven to be believed, so the unfounded insinuations against the until then "life-saving" gas found a ready reception in medical circles from America to Australia27,28

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 represents29, the American medical community 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. (That amounts to over $16 million in today's money and was at that time the most expensive lobbying effort in American history.) Their advertisements had linked National Health Insurance with socialism and even fabricated Lenin quotes30, and the political fever inflamed by such slander continued to run high years later. According to the Guest of Honor at the 1953 Annual Session of the American Academy of Ophthalmology and Otolaryngology, socialized medicine was "a terrible blow to the art of practice" and a "serious threat"31

This emotional and political context made it easy for the pediatric leaders to project that threat into the symbol that their colleagues had connected with it. They were under pressure from the agencies providing services to blind people to end the epidemic of preemie blinding.  As Dr. Silverman tells it:

"... a small number of pediatricians and ophthalmologists met at the height of the retrolental fibroplasia epidemic in 1952. (...) The conferees began to argue vociferously about whether supplemental oxygen was or was not the cause of the RLF epidemic. At the height of the debates, Franklin Foote, Director of the National Society for the Prevention of Blindness, got up and reminded everyone that the blindness epidemic was an urgent national problem. 'We are not going to make any progress,' he said, 'if we continue to argue in this futile way. We need to think about what constructive action needs to be taken to hasten the end of this epidemic that has completely overwhelmed this country's facilities for the care of blind children.' From that point on, the meeting took off in a very different direction. After very little discussion, the participants agreed on the urgent need for a definitive test of the burning question about the role of supplemental oxygen."32

Blaming oxygen provided a convenient solution for a profession which had just demonstrated how little the public interest meant to its members.

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