The 1960s Medicine and Health: Topics in the News

MORE CARS EQUAL MORE SMOG

One of the downsides to the automobile boom of the 1950s and 1960s was deteriorating air quality, particularly in the nation's most heavily traveled communities. In the 1950s, the California Institute of Technology estimated that 70 percent of the brown haze, called smog, that permeated the air in the Los Angeles area was the byproduct of automobile usage. In 1960, the California state legislature enacted a law requiring all cars to be equipped with an apparatus that would limit noxious fuel emissions.

Air pollution eventually became a national issue. In 1965, Congress passed the Motor Vehicle Air Pollution Control Act, which established national emission standards for cars. The Air Quality Act of 1967 allowed the federal government complete responsibility for air quality.

ARTIFICIAL HEARTS AND HEART TRANSPLANTS

The great advances in the field of cardiovascular (heart) surgery ranked high among the health care-related marvels of the 1960s. During the decade, efforts were made to develop an artificial heart to be employed during surgery when a patient's heart was not completely functional. Early experiments focused on a plastic, banana-shaped apparatus whose valves assisted the blood in its movement between the machine and the patient. However, the machine's pump was found to cause blood clots. Then a similar-looking device was developed that would be implanted permanently in the chest cavity of patients suffering from acute heart failure. This machine was developed by Adrian Kantrowitz (1918–) of Maimonides Hospital in Brooklyn, New York. It first was implanted in February 1965, but the patient died within twenty-four hours. A second procedure was slightly more successful. The pump operated properly; however, the patient died of a stroke twelve days after the implant. In 1966, Michael DeBakey (1908–) successfully implanted a pump in the heart of a patient suffering from rheumatic fever (a communicable disease that causes an inflammation of the heart valves). This pump was different from the one developed by Kantrowitz in that it provided temporary aid to hearts with diseased valves and other irregularities. It supported the left ventricle, the area of the heart that pumps reoxygenated blood to the body.

In 1969, Denton Cooley (1920–) became the first surgeon to place a complete artificial heart in a patient. Cooley and his associates had been attempting to perfect an artificial heart for a decade; for the operation, he used a device designed by a colleague, Domingo Liotta (1924–). It was the approximate size of a real heart and was composed of Silastic, a silicone plastic. First Cooley attempted to remove the damaged part of the heart and mend it using a Dacron graft (transplant). However, the heart completely stopped beating. Cooley removed it in its entirety, temporarily placed the patient on a heart-lung machine, and then installed the artificial heart. The patient regained consciousness and even was able to speak, but died thirty hours later of pneumonia and kidney failure. At the time, Cooley and DeBakey both were affiliated with the Baylor University College of Medicine. DeBakey was angered by Cooley's decision to perform the operation without consulting him and even accused Cooley of stealing his research. This dispute resulted in Cooley's decision to resign from Baylor and move to the University of Texas at Houston.

In 1967, Christiaan Barnard (1922–2001) of South Africa performed the first successful heart transplant operation, relocating a heart from one human being to another. The following year, Cooley became the first American to complete the procedure. He transplanted the heart of a just-deceased fifteen-year-old girl, whose brain had been damaged during a suicide attempt, into the body of a forty-seven-year-old man. The patient initially recovered, but died 204 days later.

Operating Room Miracles

Heart transplants and artificial hearts may have earned the bulk of the headlines, but they were not the only ground-breaking operating room procedures developed during the decade. As the 1960s began, major transplant surgery only involved the kidneys. By decade's end, the first liver and lung transplants had been performed.

While the recipients died, the operations were important first steps in the development of these procedures. Moreover, during the decade, limbs that had been severed during accidents were reattached successfully.

Among the decade's other breakthroughs in the field of cardiovascular surgery: the development of the coronary artery bypass, using a method called revascularization (which guided the flow of blood from the heart's nonessential left internal mammary artery, avoiding diseased arteries); a more sophisticated bypass technique, employed when more than one of the heart's three main arteries needed repair; and endarterectomy, a technique employed to remove cholesterol and fatty materials that had built up over time in the inside walls of arteries. Researchers also developed the hand-pump (or closed-chest) massage, a technique used to revive victims of heart failure. The hands are employed to rhythmically apply and release pressure over the lower section of the victim's breastbone. The pressure pushes the chest cavity down, squeezing blood out of the heart and allowing it to flow. This method is commonly known as cardiopulmonary resuscitation (CPR).

THE DEMISE OF THE HOUSE CALL

For decades in the United States, a worried parent would contact the family doctor to set an appointment for the examination of a sick child. At the set hour, the parent did not have to bundle up the youngster for the trip to the doctor's office. Instead, the doctor traveled to the family's home to look at the afflicted child.

New Methods of Combating Disease

Outside the operating room, a host of new machinery greatly simplified the treatment of disease. One involved the process known as dialysis, in which the blood of patients suffering from kidney failure is removed, cleansed of its poisons, and returned to the body. Without dialysis, the patient will die of uremia (named for a toxic substance that builds up in the blood). Dialysis required the use of expensive equipment, and twice-a-week visits to the hospital. During the decade, the introduction of home dialysis machines significantly reduced the cost of, and time required for, the procedure.

Prior to World War II (1939–45), approximately 40 percent of doctor-patient contact consisted of physicians making what were known as "house calls." By the beginning of the 1960s, that number had declined to 10 percent. At the decade's close, house calls had become practically extinct. Many in the general population, particularly the elderly and parents of young children, lamented the demise of the house call. They might have been soothed by the presence of the doctor at their bedside, bothered

by the inconvenience of trekking to the doctor's office, or convinced that physicians who came to their homes somehow were more caring. However, doctors had come to view house calls as medically ineffective. The time spent traveling from house to house might be better spent treating patients. During house calls, doctors were hampered by the limited equipment they could carry in their medical bag. All the new machinery and drugs that had been developed, and that allowed doctors to more accurately diagnose illnesses, could not be transported from patient to patient.

To convince the population that the demise of the house call was beneficial to patients, the American Medical Association (AMA) issued a public service message in 1964. The point of the message was to illustrate how the house call had become as outdated as the horse-drawn carriage. The message read in part,

In granddad's time, ol' Doc Brown dashed into the dark of night in his horse and buggy to reach a sick patient on the old homestead. Those days are gone forever, and you can be glad of it! Doc Brown was a good doctor for his time, but often there was little he could do—either in the home or in his office—with the few pills and tonics in his little black bag. There were no diagnostic laboratories, no x rays, no vast array of wonder drugs, none of the innumerable testing and treatment devices that modern medicine now makes available to your family doctor. Today he can give you much better care in his well-equipped office.…

THE OBLIGATION TO SAVE THE PLANET

One of the offshoots of the 1960s anti-Vietnam war protest movement was an increased awareness of the manner in which industrial wastes were polluting the environment. Just a few years earlier, in the 1950s, it might have been fun for a child growing up in a mill town to guess the color of water in the stream flowing through town. Each day, the color would change, depending upon the excess dye that the local textile factory was dumping into the water. No one gave a thought to the effect those chemicals were having on the environment in general and, even more specifically, how it might be affecting the very water that child drank.

During the 1960s, environmental pollution awareness was directly linked to student activism. Interest in the environment grew quickly throughout the decade. The inaugural Earth Day, held on August 22, 1970, involved 1,500 colleges and 10,000 schools. Nevertheless, young people were not the only participants; Time magazine reported that 20,000,000 individuals of all ages participated in the event. In describing the first Earth Day, Audubon magazine noted, "Now, suddenly, everybody is a conservationist."

When manufacturers were first reproached for polluting the environment, their general response was defensive. They claimed that the protestors were communist-inspired, anticapitalist, and antibig business. However, environmental pollution was a problem that transcended profit-and-loss statements and political agendas. The work of environmentalists during the 1960s was rewarded on January 1, 1970, when President Richard Nixon (1913–1994) signed into law the National Environmental Policy Act of 1969. One of its provisions was the creation of the Environmental Protection Agency (EPA), which coordinates government activity relating to environmental issues and serves as the public's defender in pollution-related disputes.

MAKING HEALTH CARE AVAILABLE TO ALL

One consequence of advances in medical technology was a steep increase in the cost of medical care. New surgical procedures and diagnostic machinery were expensive. While the medical profession is a for-profit business, illness does not play favorites with regard to the size of a patient's wallet. How might the poor, the working class, and the elderly be able to afford top-quality medical care?

As part of his Great Society initiative, President Lyndon Johnson (1908–1973) called for the establishment of the Medicare and Medicaid health care programs. Medicare went into effect in 1966. At its inception, it assisted America's elderly with the cost of hospitalization, home nursing service, outpatient diagnostic testing, and nursing home care. In addition, senior citizens could voluntarily pay a nominal monthly fee of $3 to partially cover perscription drug costs and doctors' visits. Medicaid, meanwhile, was designed to address the health care needs of the poor.

Consumer groups, unions, and senior citizens' organizations lauded Medicaid and Medicare. However, organized medicine like the American Medical Association (AMA), insurance companies, and the majority of doctors vehemently opposed them. They categorized Medicare and Medic-aid as "socialized medicine" and contrary to the tenets of free enterprise. Before the decade ended, Medicaid succeeded in significantly raising health care costs because health services were being extended to individuals who previously had not sought medical care. The system was beleaguered by cost overruns and well-publicized bureaucratic bungling. Scandals resulted when health care professionals cheated the system by overbilling for services rendered. In an effort to halt the swift rise in physician fees, the U.S. government froze fee schedules paid under the program. This led to many doctors simply refusing to accept Medicaid patients.

MEASLES: NO ORDINARY ILLNESS

Back in the 1960s, measles, along with such maladies as chicken pox, mumps, and tonsillitis, was viewed as a routine childhood affliction. Measles was a communicable disease, caused by a virus, which resulted in fever, skin rash, and inflammation of the mucus membrane in the nose. Most youngsters contracted the disease; an adult's infection was considered far more critical. Nevertheless, measles was a serious disease for children. Each year, approximately four hundred Americans, mostly youngsters, died of measles. One out of every four thousand children who contracted the disease recovered physically but ended up mentally challenged. During the late 1950s, John Enders (1897–1985), a virologist (specialist in viruses) connected with Harvard University, isolated the measles virus. In 1961, he and his colleagues perfected a live-virus measles vaccine that offered nearly 100 percent immunity and saved tens of thousands of lives throughout the world.

The destructive nature of measles was never more apparent than between 1963 and 1965, when an epidemic of rubella (German measles)

swept across America. German measles also was contagious, and the afflicted individual suffered from sore throat, pain in the limbs, small skin rashes, and slight fever. While considered less severe than measles, rubella still caused long-lasting suffering among the thousands who were afflicted. A reported 30,000 pregnant women who contracted the disease suffered miscarriages (the premature delivery of the fetus, which does not live). An additional 20,000 gave birth to babies who suffered severe abnormalities, including blindness, deafness, limb and heart defects, and mental illness. Three different groups of researchers succeeded in isolating the rubella virus, which was the first step toward developing a vaccine. A test was also devised that would determine one's immunity to the disease. The actual development of a vaccine proved more complicated. One vaccine, made with a killed virus, proved unsuccessful. Another, which included a live virus, succeeded only in giving people rubella. A third consisted of an attenuated (weakened) virus, which was grown in the kidney cells of monkeys. This version was tested on sixteen youngsters at the Arkansas Children's Colony for mentally challenged children. It was given with their parents' permission. Half were administered the vaccine, and half served as controls. The test proved successful. The Food and Drug Administration (FDA) approved this vaccine in 1969.

SEX: MEDICAL (AND MORAL) ISSUES

With regard to religion and morality, feminism, and contemporary lifestyles, the sexual revolution that swept across the country during the 1960s was liberating to many women's rights advocates and upsetting to religious conservatives. However, it brought to light a host of health-related issues.

At the forefront of the sexual revolution was the availability of newly marketed birth control devices, which allowed women to take charge of their bodies, and their sexual behavior. One was the intrauterine device (IUD), which was made of plastic, nylon, or stainless steel. A doctor placed an IUD within the uterus of the patient, where it could be left for years. By 1963, more than 20,000 American women relied on IUDs. However, on occasion, they were known to cause heavy bleeding, and even severe, life-threatening infections.

Birth control pills also became wildly popular during the decade and, similarly, aside from the moral debate surrounding their use, their long-term side effects were unknown. Critics claimed that users of "The Pill" risked contracting breast and uterine cancer, allegations that were unsubstantiated. Before the decade ended, however, one potential threat was verified. Women over thirty-five who smoked and used birth control pills had a higher risk of suffering heart attacks, strokes, and blood clots in vessels that travel to the lungs.

The general increase in sexual activity that occurred during the decade also resulted in a rise in unwanted pregnancy. Throughout the decade, abortion was illegal in the United States. (In forty-five states, the procedure was allowed only if the pregnant woman's life was judged to be in danger; during the decade, Colorado passed a law allowing abortion in the case of incest or rape.) If a woman were desperate to abort a fetus, she often had no alternative but to have the procedure carried out illegally. A woman of means and with connections might be able to find a surgeon to perform the operation for a hefty fee. However, most abortions were performed by amateurs employing dangerous methods in less-than-sterile conditions.

On the other hand, many women wished to become pregnant but were unable to do so. During earlier eras, their only choice for parenthood involved adoption. However, during the 1960s, two effective drugs were developed in Europe—one in Sweden and the other in Italy—that combated infertility in women by stimulating the ovaries to prepare and release eggs. The Italian drug, called pergonal, was tested by researchers at New York's Columbia-Presbyterian Medical Center. Fifteen of twenty-one infertile women who were administered the drug became pregnant. Of the first seven who delivered, three had twins and one had quadruplets!

Additionally, a technique called artificial insemination became more widely available during the 1960s, although it was considered controversial by some. There were legislators and religious leaders who wanted to outlaw the procedure, calling it a form of adultery. In cases where a husband was infertile (unable to produce children), the wife would receive a donor's sperm that had been frozen and stored for such a use. In 1960, between 1,000 and 1,200 babies were artificially conceived. These numbers increased as the years passed and legal challenges to the procedure declined.

Finally, the process by which women gave birth began to change significantly. Before World War II (1939–45), the majority of women gave birth at home. After the war, hospital births became more common. New drugs made the process less painful, and allowed doctors more control over the procedure. Although childbirth became safer in some ways, these changes caused women to become passive participants in one of the most significant events of their lives. While in labor, women were administered pain-reducing anesthesia agents. Near the conclusion, they were rendered unconscious by general anesthesia. Since they were unable to push the baby out, a physician employed forceps (large steel tongs) to complete the birth. However, studies in the 1950s and 1960s revealed that babies appeared to be affected negatively by the drugs their mothers took during pregnancy, and by the anesthetics administered during delivery. The use of forceps also occasionally caused injury to the baby.

As women began to expect to have greater control over their bodies by the end of the 1960s, interest grew in the natural childbirth techniques that had been pioneered in the 1950s by Fernand Lamaze (1890–1957), a French obstetrician. Pregnant women learned special breathing techniques to control pain during birth. They were prepared psychologically to undergo the process, and were given matter-of-fact information regarding pregnancy and childbirth. Among the tenets of Lamaze birth: "Women's inner wisdom guides them through birth"; "Birth is normal, natural, and healthy"; and "Childbirth education empowers women to make informed choices in healthcare.… "

Lamaze education and "natural childbirth" preparation were not widely accepted or available in the United States until the next decade. However, many young women in the later years of the 1960s pursued the opportunity to become educated about the details of childbirth, actively assist in childbirth, and ultimately, contribute to the well-being of their children through these methods and techniques.

SUGAR SUBSTITUTES: THE BITTER WITH THE SWEET

In the mid-1960s, individuals who wished to cut down on their sugar intake could choose from two chemical substitutes: saccharin and cyclamates. Both were extremely sweet. Saccharin often left a bitter aftertaste, while cyclamates did not. But during the latter years of the decade, it became known that continuous use of cyclamates could be deadly!

Cyclamates were introduced on the market during the 1950s. By the following decade, they were added to soft drinks, canned fruit, salad dressings, and candy. Between 1963 and 1970, national consumption of cyclamates rose from 5 million to 21 million pounds annually. In 1966, Food and Drug Administration (FDA) research determined that cyclamates caused birth defects in 15 percent of the chicks born to chickens exposed to the drug. It also caused chromosome breaks in rats that were fed high doses and cancer in other animals. Still, both the FDA and Abbott Labs, which produced cyclamates, decreed that the product was safe. A fiery public debate ensued. Eventually, all products containing cyclamates were ordered off supermarket shelves by February 1, 1970.

THALIDOMIDE: A GLOBAL TRAGEDY

Thalidomide first was developed in the United States as a possible anti-seizure drug. Eventually, Chemie Gruenenthal, a West German drug company, took over testing and found it to be effective as a sedative. Additionally, it relieved nausea (or morning sickness) in many women during the early stages of pregnancy. By 1957, Chemie Gruenenthal was marketing thalidomide over the counter in West Germany. Three years later, it was available throughout Europe, as well as in Canada and South America.

However, as thalidomide use increased, physicians began noting the appearance of a rare type of birth defect among the offspring of its users: phocomelia (literally "seal limbs"), in which the limbs of the fetus improperly form. For example, the baby might be born without an arm, or with a hand protruding from its shoulder. Babies also were entering the world with kidney problems, heart defects, and deafness. All these problems eventually were traced to the use of thalidomide. In fact, more than ten thousand children in forty-six countries were estimated to have been born with thalidomide-related deformities. In 1961, the drug was banned in West Germany.

Drugs and Their Side Effects

Just as the tragic side effects of thalidomide were determined, it was discovered that other drugs also caused unwanted, unexpected problems. For example, triparanol, marketed in 1959 as a blood cholesterol controller, was found to cause baldness and blindness. Richardson-Merrill, the company that marketed the drug, discovered the blindness side effect while testing the drug on laboratory rats and dogs. However, the company failed to note these findings to the FDA when requesting approval to market the drug. The FDA eventually brought charges against Richardson-Merrill and three former executives.

Another drug, chloramphenicol, was useful in battling meningitis and certain rare, tropical diseases. It also was prescribed for minor bacterial infections. As early as 1952, chloramphenicol was found to cause anemia (low counts of red blood cells); eventually, the side effect was upgraded to aplastic anemia, a life-threatening ailment in which blood cells cease being produced within the body. Parke, Davis and Company had marketed the drug under the name Chloromycetin. Still, in 1968, between $70 million and $80 million worth of the drug still was being prescribed, mostly to combat colds and acne.

The previous year, Richardson-Merrill, a pharmaceutical company, submitted an application to the Food and Drug Administration (FDA) to market thalidomide in the United States. At the time, FDA regulations allowed doctors to distribute free samples of drugs being considered for approval. Before its side effects were noted, Richardson-Merrill distributed an undetermined number of thalidomide tablets, some estimates were that it was as high as 2,500,000, to more than 1,000 doctors to dispense as samples. Reportedly, nearly 20,000 patients, including pregnant women, received them. FDA employees contacted the doctors and urged them to inform those who had received the samples. Unfortunately, not all doctors maintained records pertaining to the drug's distribution. An undetermined number of deformed infants were born in the United States to mothers who had taken thalidomide.

As knowledge of the effects of the drug became known, the tragedy brought forth questions about the fairness of antiabortion laws that forced some women to give birth to children they knew would be seriously handicapped.

SMOKING AND HEALTH

By the early 1960s, scientists had become convinced that the use of tobacco products could be linked directly to the spread of cancer. However, two groups were dead-set against admitting this connection. The nation's tobacco growers wished to continue to thrive monetarily; at the time, tobacco was an $8 million a year industry. Plus, the economic survival of the nation's southern states depended upon a steady tobacco crop and a market of buyers. Together, both groups constituted a powerful political lobby. Politicians from these states, influenced in no small part by the tobacco industry, united to crush the dissemination of information relating cigarettes to ill health.

In 1962, President John F. Kennedy (1917–1963) asked U.S. Surgeon General Luther Terry (1911–1985) to examine the relationship between the use of tobacco products and the nation's health. Instead of commissioning a survey, Terry appointed a ten-person Advisory Committee on Smoking and Health to examine preexisting research. On the committee were three cigarette smokers, along with one pipe smoker and one cigar smoker. The committee spent two years poring over thousands of articles and reports on file at the National Medical Library in Bethesda, Maryland. Its members examined animal laboratory studies, human autopsy reports, clinical evaluations of patients, and statistical analyses. Their findings—issued in January 1964, in a 150,000-word, 387-page report—were presented on a Saturday morning, in order to prevent the result from immediately impacting on tobacco industry stock market prices.

Terry's committee found that cigarette smoking in general increased the death rate and caused a range of potentially fatal illnesses, starting with lung cancer, heart disease, and emphysema. The more one smoked, the more susceptible one was to these maladies. When one gave up smoking, the health risks decreased. While cigar and pipe smoking seemed less perilous than cigarette smoking, their usage seemed to slightly raise the risk of developing lip cancer. The sole positive note in the report was that smokers benefited psychologically from the pleasure they received from puffing cigarettes. The committee advised that "appropriate remedial action is warranted" in relation to the clear link between cigarette use and maintaining one's health. In response, tobacco growers and politicians from tobacco-growing states banded together to defame the report. Their power and influence were far-reaching. For example, at the time, tobacco products were marketed in commercials that regularly aired on television. After the release of the report, the National Interagency Council on Smoking and Health recommended a complete ban on cigarette advertising. Oddly, the American Medical Association (AMA) opposed the ban. Then it was revealed that the AMA had accepted a large monetary grant from the tobacco industry to conduct a five-year study of smoking and health.

In wake of the publicity surrounding the report, cigarette sales decreased by approximately 10 percent and cigarette company stock prices fell. However, both declines were temporary. Total cigarette sales in 1964 were just 3 percent less than the previous year, and stock prices climbed to previous levels. Meanwhile, in 1963, the American Heart Association announced the commencement of an antismoking campaign. The following year, the Federal Trade Commission ordered that, beginning in 1965, health warnings must be featured on cigarette packaging. Legislators from tobacco-growing states vehemently opposed the various bills that were being debated in Congress regarding the nature of these warnings. Eventually, a compromise was reached. Beginning in January 1966, cigarette manufacturers were required to include the following advisory on all cigarette packaging: "Caution: Cigarette smoking may be hazardous to your health."