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Footnotes :

 

 

33 Silverman WA. Retrolental fibroplasia: a modern parable. Grune & Stratton, Inc., New York, 1980, Chapter 7: "Oxygen Treatment Practices in Premature Infant Care", 43-51, see page 45

 

 

 

34 Silverman WA. Retrolental fibroplasia: a modern parable. Grune & Stratton, Inc., New York, 1980, Chapter 4: "The Oxygen Hypothesis", see page 25.

 

 

  

35 Vignec AJ, Moser A, Ellis R. Angelos P. Current Trends in Premature Care. New York State Journal of Medicine, 1952, 52: Pt. 2: 1764-1769, see page 1766 left, bottom, and right, middle.

 

 

 

36 Reese AB. in discussion after Ashton N. Animal Experiments in Retrolental Fibroplasia, Trans Amer Acad of Ophthalmology and Otolaryngology, Jan/Feb 1954, page 54 left.

 

 

 

37 Silverman WA. Retrolental fibroplasia: a modern parable. Grune & Stratton, Inc., New York, 1980, Chapter 6: "The National Cooperative Study", 37-42, see page 38 top.

 

 

 

38 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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Oxygen was the ideal scapegoat. Incriminating it exonerated the preemies' physicians from fault for the clearly iatrogenic blinding and gave them the easy defense that the disease was an unfortunate but difficult-to-avoid side-effect of premature birth. They began to describe their role as trying to steer the babies between the Scylla of eye damage from too much oxygen and the Charybdis of death from too little, as if these risks were on the same level.

The more these doctors depicted themselves as the indispensable navigators, the more they enhanced their power in the intensive care nurseries which had previously been dominated by skilled nurses who knew from their daily experience that oxygen helped the preemies. They saw these nurses as "opinionated"33 but knew that they would yield to the ex cathedra authority of a big medical study.

The physicians in charge were so eager to condemn oxygen that they radically reversed its image. Not long before, oxygen had still been necessary for survival.

For instance, grant reviewers at the National Institutes of Health had in late 1949 criticized the grant application for a study of ROP outcomes with routine versus restricted oxygen by commenting

"... these guys are going to kill a lot of babies by anoxia to test a wild idea"34

and approved the grant only after the authors promised to maintain the babies in the low-oxygen group a healthy pink color.

Similarly, a 1952 article about Current Trends in Premature Care said about the indications for oxygen administration:

"Suction, gently applied, to keep the air passages clear, and the administration of oxygen are two of our most effective weapons in dealing with respiratory problems. (...) Except for the larger prematures who need no assistance, the burden of proof as to respiratory competence rests with the patient and unless within the first twenty-four to thirty-six hours we are convinced that he is able to maintain adequate respirations unaided, he remains in the incubator. The aim is to anticipate and not to wait for clinical signs to appear."35

Despite the regularly excellent results from such routine oxygen administration, the physicians who no longer liked the gas decided to put it on trial.  They were so convinced of its guilt that they did not even try to hide the pre-condemned status of the accused.

For instance, one of the leading ophthalmologists and trial instigators expressed at the October 1953 meeting of the American Academy of Ophthalmology and Otolaryngology what he and his colleagues wanted the trial to achieve: he expected that oxygen would be "successfully incriminated"36 -- eleven months before even the preliminary data from its alleged evaluation became available.

Once the verdict from this kangaroo-court trial was announced, the medical establishment here and abroad accepted at once the oxygen-condemning allegations and made them the basis of the damaging but still current practice of oxygen withholding.

In their rush to gore the red cloth, the judges of oxygen overlooked that the pre-arranged trial findings contradicted a large body of clinical experience that had consistently shown oxygen as beneficial. They further ignored that there were no parallels in animal research, that oxygen's innocence was proven by the complete absence of ROP during decades of its use, and that withholding life-saving oxygen in an attempt to prevent blindness makes about as much sense as not tossing a life preserver because a burr on its edge could scratch the drowning person.

To be fair, not all physicians joined the bandwagon. Dr. Silverman tells in his account of the 1953 meeting held to organize the trial that

"One splinter group felt that limiting oxygen would require infants to undertake an unjustified risk of death and brain damage."37

Unfortunately, those physicians who preferred expediency and herd-following over an ethical and scientific approach formed the great majority.

They knew that brain damage is less immediately noticeable than blindness, and the record shows that such initially hidden side effects did not interest the physicians who promoted the oxygen withholding study. They omitted any provision to check in the aftermath of their hit-and-run study for the morbidity which they knew would afflict the brains they had deprived of oxygen.

They were under pressure to end the blinding epidemic which the agencies providing services to blind people had begun to perceive as an urgent national problem. This political pressure made the study promoters skip the methodical or scientific approach and cluelessly jump into action for action's sake. Here is what happened, again in Dr. Silverman's words:

"... 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."38

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