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Footnotes :
 

 

85 Weiter JJ. Phototoxic Changes in the Retina, in Miller D. (ed.): Clinical Light Damage to the Eye, Springer Verlag, New York, 1987, pages 79-125, see pages 86 and 122.
 

 

86 Kinsey VE, Arnold HJ, Kalina RE, Stern L, Stahlman M, Odell G, Driscoll JM, Elliott JH, Payne J, Patz A. PaO2 Levels and Retrolental Fibroplasia: A Report of the Cooperative Study. Pediatrics, November 1977, 60: 5: 655-68.
 

 

87 Silverman WA. Retrolental fibroplasia: a modern parable. Grune & Stratton, Inc., New York, 1980, page 143 middle
 

 

88 Kalina RE, Karr DJ. Retrolental fibroplasia - Experience over two decades in one institution. Ophthalmology, February 1982 89: 2: 91-5, see page 95 top left.
 

 

89 Letter dated March 17, 1993, from Linda L. Wright, MD, Special Assistant to the Director, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, to U.S. Senator Russ Feingold. See page 3.
 

 

90 Fax dated 6-18-93 from George W. Gaines, Legislative Liaison Officer, Office of Science Policy and Analysis, National Institute of Child Health and Human Development, National Institutes of Health, Phone (301) 496-1877, Fax (301) 496-4757, to William Feitlinger, Office of U.S. Senator Russ Feingold.
 

91 Phelps DL. National Eye Institute Grant Application No. 1 U10 EY09962-01, Draft Manual of Procedures, Multicenter Trial of Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP). Draft 1/27/92, page 1-1 top.
 

92 Szewczyk TS. Retrolental Fibroplasia: Etiology and Prophylaxis. A preliminary report. Am J Ophthalmol, 1951, 34: 1649-1650, as cited by Silverman WA. Retrolental fibroplasia: a modern parable. Grune & Stratton, Inc., New York, 1980, pages 26, 27, and 227.
 

93 Phelps DL. National Eye Institute Grant Application No. 1 U10 EY09962-01, Draft Manual of Procedures, Multicenter Trial of Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP). Draft 1/27/92, page 2-5 and reference 16, citing Szewczyk TS. Retrolental Fibroplasia and Related Ocular Diseases: Classification, Etiology, and Prophylaxis, Am J Ophthalmol 1953; 36: 1333-1361.
 

94 Phelps DL. National Eye Institute Grant Application No. 1 U10 EY09962-01, Draft Manual of Procedures, Multicenter Trial of Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP). Draft 1/27/92, page 7-2.
 

95 Phelps DL. National Eye Institute Grant Application No. 1 U10 EY09962-01, Draft Manual of Procedures, Multicenter Trial of Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP). Draft 1/27/92, page 2-8.
 

96 Zierler S. Causes of Retinopathy of Prematurity: An Epidemiologic Perspective. Birth Defects: Original Article Series, 24: 1: 23-33 see page 26 top and bottom, 27 top, 28 bottom, and 33 top.
 

97 Lucey JF. Perinatal Intracranial Hemorrhage and Retinopathy of Prematurity: Currently non-preventable complications of Premature Birth? Birth Defects: Original Article Series, 24: 1: 37-40, see page 39 top and middle.
 

98 Pomerance JJ, Ukrainski CT, Ukra T, Henderson DH, Nash AH, Meredith JL. Cost of living for infants weighing 1,000 grams or less at birth. Pediatrics 1978: 61: 908-10, see page 909 middle right.
 

99 Winslow R. Infant health problems cost business billions. The Wall Street Journal, May 5, 1992, as quoted by Silverman WA in "Overtreatment of Neonates? A Personal Retrospective", Pediatrics, December 1992, 90: 6, 971-76, see page 974 top left.


 


 

  

 

  

  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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2.8. The futile oxygen monitoring continues

The oxygen starvation routine continues despite these deadly outcomes, despite its lack of an effect on the blinding, and despite the fact that many other studies have also shown there is no scientifically defensible reason for it.

The 1953/54 Cooperative Study had only recorded the percentage of oxygen in the breathing mix but not how this translated into blood oxygenation for the baby. When actual measurements of arterial oxygen tensions became possible, these were incorrectly assumed to be an indicator of the retinal oxygenation. 

However, it had been known since 1924 that the retina has the highest rate of oxygen consumption among all the body tissues and can autoregulate the blood flow in response to changes in oxygen concentrations85. This autoregulation makes the amounts of oxygen that reach the retina independent of the arterial oxygen tension, and trying to extract the former out of the latter is thus as useless as trying to drag the reflection of the moon out of the water.

Despite this known impossibility, another major cooperative trial was launched in 1969 to explore the alleged relationship between blood oxygen levels and ROP risk86. Dr. Silverman described the results in his above-mentioned book:

"At the end of eight years of effort (3 years of observations and 5 years of analysis of the results!), there were no interpretable findings. To this day, when oxygen is administered to premature infants, they are exposed to the intertwined risks of brain damage, death and RLF with nothing more than authoritative guessing as protection."87

Others concurred that this trial had failed to show any correlation between arterial oxygen concentrations and the development of ROP88. And as mentioned above, the oxygen monitoring study in Miami had yielded the same result.

Yet, the National Eye Institute awarded in June 1993 the initial funding89, 90 for another study how arterial oxygen tensions relate to ROP.  This $1.2 million, three-year multi-hospital trial is called Supplemental Oxygen for Prethreshold Retinopathy of Prematurity, or STOP-ROP.

In an apparent retreat from the current pediatric teaching about oxygen, this study is based on the suggestion that medical management of oxygen further aggravates the development of ROP91. This suggestion was first proposed in 195192, shortly before oxygen fell in disgrace: that ROP might get worse from low oxygen levels and should be treated by slightly raising the arterial concentrations of oxygen as compared with the standard rationing93.

Although this could be considered a step in the right direction, the increase in arterial oxygen will be so small (from the typical 45-85 mm Hg to a partially overlapping 64-109 mm Hg94, versus the about 200-275 mm Hg95 customary before 1954), and it will be administered so late (only once ROP begins to develop, several weeks after birth), that the damage from early oxygen withholding will not be lessened. This new study will thus be just as wasted as its predecessors and achieve no benefit for the babies.

The uselessness of trying to control the preemies' arterial oxygen is well known among physicians. At a 1988 symposium about ROP, Dr. Sally Zierler, an epidemiologist at Brown University, had dissected the lingering unscientific belief in oxygen as the initiator of the disease:

"Room air may deliver excessive oxygen to the very premature neonate. Given the inevitability of postnatal exposure to oxygen levels that cannot be reduced without increasing risk of neurologic damage or death, there is limited usefulness in considering oxygen as a cause for ROP ( ...) The oxygen hypothesis becomes void of any scientific meaning because it is untestable. Oxygen is a necessary and ubiquitous exposure. In concept and in fact, there is no living population that is not exposed to oxygen. (...) Although the occurrence of retinopathy might be observed to increase with increasing duration of oxygen, one could not separate the effects of the underlying reason prompting higher or longer exposure from the exposure itself. (...) Many variables considered as risk factors for ROP have no association with the disease after controlling for the effects of prematurity and hyperoxia. (...) The distinction was made between an agent that initiates or promotes disease mechanism and a cause. Failure to appreciate this distinction has contributed to the confusion about the role of oxygen in the pathogenesis of retinopathy. "96

Dr. Lucey, the editor of Pediatrics, admitted at the same Symposium essentially the same thing:

"We now realize the absolute futility of trying to describe 'an arterial O2'. The sick infant exists with a constantly changing arterial oxygen tension. Along with these fluctuations, which we cannot control or avoid, occur changes in arterial blood pressure, cerebral blood flow, and probably retinal blood flow and intracranial pressure. (...) It is this deranged system of oxygen delivery to the brain and eye that makes it impossible to judge whether an elevated or a depressed oxygen concentration in a peripheral [emphasis in original] artery is the 'cause of retinopathy'. "97

To put this "absolute futility" of trying to describe a useful blood oxygen level in perspective, please keep in mind that oxygen control is one of the major functions of an intensive care nursery, and that about one third of the expenses in an intensive care nursery goes typically for oxygen management and measuring98.

In 1992, the Wall Street Journal gave the annual cost of intensive care nurseries in America as about 5.6 billion dollars99; almost two of those billions may thus pay for this absolute futility.

If this seems in line with other modern medical wastes of money, then consider the costs to the victims and their families. Many thousands of babies still die or suffer brain damage each year from the oxygen rationing based on this futility. In addition to suffering the permanent damage so casually inflicted on their body and/or brain, many of the survivors will need help for all their lives. So, in each of the years that this long acknowledged but still uncorrected error in the medical doctrine continues to harm preemies, its victims accrue many more billions in dollars in future costs for the life-long care they will require because of this absolute futility.

Continue to an update and sequel about the frauds in preemie studies.

 

 
 

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