The 1970s Medicine and Health: Topics in the News

KAREN ANN QUINLAN AND THE RIGHT TO DIE

On the night of April 15, 1975, while at a friend's birthday party, Karen Ann Quinlan drank several gin-and-tonics and swallowed at least one tranquilizer. The combination of alcohol and drugs had a disastrous effect on the twenty-one-year-old. When she collapsed and stopped breathing, her friends called the police. By the time she was rushed to nearby Newton Memorial Hospital in New Jersey, she had ceased to breathe for at least two separate fifteen-minute periods.

Quinlan's parents arrived at the hospital to find her in a coma. The attending physicians believed her brain had been damaged irreversibly, although they did not know exactly why she had stopped breathing. They described her condition as a persistent vegetative state, which meant she had some brain activity, but was permanently unconscious and was not aware of herself or her surroundings. Physicians performed a tracheotomy to help her breathe, cutting a hole in her throat and inserted a respirating tube into her trachea. They also inserted a tube through her nose that supplied water and artificial nutrition to her stomach.

Within days of her admission to the hospital, Quinlan began to assume a fetal position. As the damage to her brain progressed, her physicians held out no hope for her recovery. On April 24, she was transferred to St. Claire's Hospital in Danville, New Jersey, and was placed in the intensive care unit. After three months, with her condition steadily deteriorating, Quinlan's parents met with her attending physicians and the hospital chaplain. All agreed that her respirator should be removed. Her father then signed a release asking the hospital to do so.

Yet a few days later, with the support of the hospital, Quinlan's primary physician refused to disconnect her respirator, citing moral concerns. As a physician, he was obligated to save lives. By withdrawing Quinlan's treatment, he believed, he would cause her death.

In response, Quinlan's parents went to court seeking to have her father named her legal guardian, which would give him the right to authorize the decision to disconnect the respirator. New Jersey's attorney general, the county prosecutor, the attending physicians, and the hospital joined together to block such action.

The court was faced with a dilemma. There was no precedent (previous legal case) that addressed such an issue. Traditional legal definitions of death had been complicated by advances in medical technology, which preserved the lives of patients who previously would have died. This life-saving technology raised many questions: Has anyone the legal right to terminate care and condemn a patient to almost-certain death? If so, who has that right? And under what conditions can that right be given? Faced with these questions, the court sided against the Quinlans and appointed someone else to be her legal guardian.

The Quinlan family appealed the decision to the New Jersey Supreme Court. On March 31, 1976, almost a year after Quinlan had slipped into a coma, the state supreme court unanimously overturned the lower court's judgment. In its landmark ruling, the court appointed Quinlan's father her guardian with full legal authority to make decisions about her care. It allowed him to decide to disconnect the life-support system with the agreement of the hospital's ethics committee.

Ironically, sensing the court would rule in favor of the Quinlans, the hospital medical staff had already begun to wean Quinlan off the respirator so she might be able to breathe on her own. Even after the decision was handed down, the hospital refused to remove the respirator immediately. Finally, in May 1976, Quinlan was taken off the respirator permanently. A month later, her parents transferred her to a nursing home where she remained for the next nine years. She lingered in a coma in a rigid fetal position, breathing on her own and receiving nutrients through a tube in her nose. On June 11, 1985, at the age of thirty-one, Quinlan died of pneumonia.

THE FITNESS MOVEMENT

In 1968, Dallas physician Kenneth Cooper coined the word aerobics and published a slim book by the same name that promoted the health benefits of regular, moderate aerobic exercise. Although it ran counter to almost all the conventional medical wisdom at the time, the book spurred a fitness revolution in the 1970s. Aerobics, bicycling, dancing, jogging, isometrics, stretching, swimming, walking, yoga—Americans tried anything to improve their health, flatten their stomachs, cure their bad backs, or reduce their stress levels.

By 1977, a record 87.5 million Americans over the age of eighteen claimed to participate in athletic activities. That same year, James Fixx published The Complete Book of Running, a best-seller that motivated some nine million joggers to trot along urban park paths and suburban byways. Thousands of those joggers raised their fitness levels high enough to participate in marathons held around the country. By far, joggers were the most visible sign of the fitness boom.

New Technologies in Medicine

Advances in military technology, computer technology, and bioengineering (the combination of medicine and engineering) in the 1960s and early 1970s led to a technological revolution in medicine. Of great benefit to patients and medical personnel were newly created devices and techniques such as ultrasound, CAT scanners, MRI, and microsurgery.

Medical researchers borrowed sonar technology from the military and used it to create ultrasound, high-frequency electromagnetic waves that cannot be heard by humans. Like X rays, ultrasound allows physicians to see inside the human body, helping to diagnose problems without resorting to surgery. Ultrasound is an especially helpful tool for monitoring a fetus while it is still in the uterus, or womb.

An imaging device closely related to ultrasound is a computerized axial tomography (CAT) scanner. A CAT scanner is an X-ray machine that rotates around a person's body, recording data images of a specific body part from many different angles. That data is then sent to a computer, which collects it into a three-dimensional image. With little discomfort to a patient, a physician can then make a diagnosis based on the image.

MRI, or magnetic resonance imaging, is a sophisticated diagnostic procedure that allows a physician to view the inside of a patient's body without using X rays. Instead, the MRI scanner uses magnetic fields and radio waves to generate detailed, computerized, three-dimensional images of many different parts of the body, such as organs, bones, joints, and blood vessels. Sensitive to soft tissue, it can also provide detailed images of lesions and tumors.

Although people competed in marathons and other organized events, the new athletics sweeping the country minimized the importance of competition. For many, finishing a race was a victory, regardless of the final position relative to their fellow runners. For others, just participating brought them joy and a sense of accomplishment. And for a few, a solitary early-morning jog on a deserted city street or a bicycle ride on a quiet country road provided physical and mental benefits not available from any traditional sporting activity.

Recreation became fitness and fitness became big business in America in the 1970s. Aerobic dancing, home-conditioning equipment, and enrollment in health clubs fueled a $2-billion-a-year exercise industry. The cost of working out, and the time needed to do it, limited the fitness movement to the middle and upper classes in America. The movement, however, was not limited to men. Inspired by tennis star Billie Jean King's victory over Bobby Riggs in a 1973 tennis match billed as the "Battle of the Sexes," women began to work out in great numbers. With men and women both working out, often together, fitness activity was transformed from a solitary to a social event. In many large cities, the health club or jogging track replaced the singles bar as a place to meet someone of the opposite sex.

Variously labeled a "fad" or "craze" in the 1970s, the fitness movement began to slow down toward the end of the decade, but it did not fade away. In the years since, fitness has become part of the American lifestyle. Physicians and other medical professionals applaud this fact, knowing that regular exercise reduces heart rate and blood pressure, burns unwanted calories, and relieves stress.

THE RISE OF HMOS

The early years of the Great Depression (period of severe economic decline in the United States from 1929 to 1941) saw the emergence of managed health care systems, which are now called health maintenance organizations (HMOs). In these original prepaid medical care systems, people who enrolled paid a predetermined set fee on a regular basis to a physician, who then provided the necessary care under the terms of the system.

Top Causes of Death in America in 1975

In Elk City, Oklahoma, in 1929, physician Michael Shadid organized a cooperative health plan for several hundred farm families, who paid him an agreed-upon fee for his services. That same year, the Los Angeles Department of Water and Power contracted with two physicians to offer a prepaid health care system to its workers and their families.

In the following years, other companies across the country set up prepaid group practice plans to make health care available to their workers at costs they could afford. A pioneer in this area was businessman Henry Kaiser, who owned steel mills and shipyards on the West Coast. During World War II (1939–45), Kaiser organized comprehensive health services for the tens of thousands of people he employed. After the war, believing he could reorganize medical care to provide millions of Americans with affordable prepaid health coverage, Kaiser opened the Permanente Health Plan to the public. Within ten years, the health plan (renamed Kaiser Permanente) had a growing network of hospitals and clinics and five hundred thousand members.

Doctors' Average Salaries in 1975

In the 1960s and early 1970s, technological advances in medicine and governmental programs such as Medicare (health care for the elderly) and Medicaid (health care for the needy) caused health care costs to rise dramatically. Hoping to limit those rising costs and ensure health coverage for those people who lacked it, President Richard M. Nixon (1913–1994) sought to create new prepaid health plans as a way to improve the country's health system. The president asked the U.S. Congress to establish planning grants and loan guarantees for the development of health maintenance organizations or HMOs. In 1973, Congress responded by passing the Health Maintenance Organization Act, which authorized $375 million in federal funds to help develop HMOs and removed legal regulations that might hamper their development.

An HMO is a prepaid group practice in which a person or that person's employer (or both) pays a single, prearranged monthly fee for a set of basic and supplemental medical services. Physicians work in HMOs for a salary rather than for specific fees. Members of HMOs receive physicians' services, laboratory tests, X rays, and possibly prescription drugs and some other health care services at little or no extra cost. Limited hospital coverage is also provided, but HMOs try to avoid hospitalization and higher medical costs by emphasizing preventive health care. One of the disadvantages of HMOs is that members have to see physicians that are available within the network or organization rather than physicians of their own choice.

In 1970, thirty HMOs operated within the United States. By the end of the decade, more than two hundred HMOs had been established with over nine million people enrolled. Although that number was far below the goal that governmental administrators had originally set, managed care organizations continued to grow throughout the next several decades.

Shortage of Health Care Providers

At the beginning of the 1970s, only about 275,000 doctors were treating patients in the United States, an average of one doctor for every 740 people. Most of those doctors, and almost all who specialized in a particular field of medicine, practiced in urban areas. The lack of doctors in rural areas was a growing concern. By the end of the decade, however, an increase in the number of medical schools and the number of students enrolled in those schools helped ease that shortage. In 1979, approximately 399,000 physicians practiced medicine across the country, an average of one doctor for every 570 people. The rising number of specialists in relation to the number of general or family practitioners still remained an issue, though. Over the same time period, the number of nurses also increased, from 700,000 to 1,075,000.

LEGIONNAIRES' DISEASE: A MYSTERIOUS KILLER REVEALED

At the Bellevue-Stratford Hotel in Philadelphia, Pennsylvania, the Pennsylvania chapter of the American Legion held its fifty-eighth annual convention from July 21 to 24, 1976. (The American Legion, chartered by the U.S. Congress in 1919, is a national organization of American war veterans.) Within forty-eight hours of the start of the convention, legionnaires (members of the American Legion) began to exhibit pneumonia-like symptoms: high fever, chest pains, and lung congestion. By the beginning of August, 221 people were infected with the mysterious illness. Seventy-two of those people were not legionnaires but had been at or near the hotel during the convention. Of those infected, thirty-four eventually died.

Physicians and medical researchers were at a loss to explain the illness. Tracking down the culprit quickly became one of the biggest and most intensive medical investigations ever. Newspapers and other media put forth wild speculation regarding the source of the infection, such as conspiracies against American war veterans by communists and pharmaceutical companies, fueling public fears of an epidemic. The press labeled the unknown illness "Legionnaires' disease."

Researchers from the Centers for Disease Control (CDC), the federal government agency responsible for preventing and controlling disease, were called in to investigate the puzzling outbreak. As in other investigations, these "disease detectives" began by asking questions to try to gather as much evidence about the disease as possible: Who are the victims? What sets them apart from those who are not sick? Where were they when they became ill? What were they doing? What did they eat and drink?

CDC researchers questioned the over four thousand legionnaires who had attended the convention and their family members. They also performed autopsies on the bodies of the victims, looking for any biological clues. Finding that all who became ill were probably exposed at the same time and in the same place, researchers turned their attention to the hotel. They collected samples of air, soil, water, and other materials from the hotel and its grounds.

In January 1977, a breakthrough occurred. In the hotel's cooling tower, researchers discovered a previously unidentified bacterium. Tests confirmed that this bacterium, which researchers named Legionella pneumophilia, causes an acute respiratory infection similar to serious pneumonia. The cooling tower supplied water to the hotel's air conditioning system, and so the bacterium had been actively pumped into the hotel.

Since this first known outbreak, governments around the world have instituted strict guidelines for cleaning large-scale air conditioning systems. Despite this, cases of Legionnaires' disease are documented annually. The CDC estimates that 10,000 to 15,000 people are infected with the disease each year in the United States alone. Although Legionella pneumophilia favors warm, still water, it can be found in cooling towers and wells. It can also be found in trace amounts in lakes and rivers. Antibiotics are effective in treating the disease, which is not contagious.

American Nobel Prize Winners in Physiology or Medicine

THE SWINE FLU SCARE

While Legionnaires' disease was making headlines across the country in 1976, another possible epidemic had been panicking Americans for months. In February of that year, an outbreak of respiratory disease occurred among army recruits at Fort Dix, New Jersey, resulting in the death of one recruit. The Centers for Disease Control (CDC), the federal government agency responsible for developing and applying disease prevention and control, examined the recruit's body, finding an influenza virus similar to the swine flu virus. An investigation of the other recruits found thirteen similar cases. Concern began to spread.

In 1918, the swine flu virus had been the cause of a pandemic that killed twenty million people worldwide, including six hundred thousand in the United States. Since the late 1920s, the virus could be found only in pigs. This meant that in the 1970s, no human being under the age of fifty could have built up antibodies against the virus. (Antibodies are substances produced by the body to provide immunity or protection against a specific foreign substance.)

Lyme Disease

In the summer of 1975, residents around Lyme, Connecticut, started to develop a strange combination of shared symptoms: rashes, headaches, and pain and stiffness in their joints similar to arthritis. At first, doctors were baffled not only by the symptoms but also by the fact that many of those affected were children. Arthritis in children (called juvenile arthritis) is rare and is not contagious. Medical researchers investigating the mysterious outbreak were soon convinced they were looking at a new disease.

Piecing together the facts of the case, researchers discovered that all the victims lived near wooded areas and first noticed their symptoms in summer or fall. Many victims reported an unusual bull's-eye-shaped rash that appeared weeks before their symptoms arose. Researchers connected this rash to a similar one thought to be caused by a tick bite that had been reported in parts of Europe since the beginning of the twentieth century. Warm wooded areas are a perfect breeding ground for ticks, so researchers began collecting and examining ticks from the wooded areas around Lyme.

In 1977, researchers named the disease after the town around which the initial victims lived. A few years later, they discovered that the disease is caused by a spiral-shaped bacterium called Borrelia burgdorferi. It is carried and spread by ticks that infect deer, mice, and domestic animals, as well as humans. Antibiotics are the only weapons against the disease, which spread throughout the country. Annually, about sixteen thousand infections occur in the United States.

Believing that a new highly contagious strain of swine flu virus posed a threat to humans, the CDC recommended a major effort to produce a vaccine against it. In response, President Gerald R. Ford (1913–) announced in March 1976 an unprecedented nationwide campaign to vaccinate all 210 million Americans against swine flu. The U.S. Congress budgeted $135 million to finance the effort. After a variety of delays and concerns about proper dosages, the vaccination program finally began on October 1. More than one million Americans were vaccinated during the first ten days of the program.

Tuskegee Syphilis Study

In 1972, a breaking news story shocked the nation. For forty years, from 1932 to 1972, 399 African American men from Macon County, Alabama, were denied treatment for syphilis, a highly contagious sexually transmitted disease. The men, almost all of them poor and undereducated, were part of an experiment conducted at the medical facilities of Tuskegee Institute by physicians of the U.S. Public Health Service. The aim of the experiment was to document the long-term effects of the disease on the human body.

Told they were being treated for "bad blood," the men were given only aspirin, free medical exams, free meals, and burial insurance. Even though penicillin, a cure for syphilis, had become available in 1943, the men were deliberately denied such proper treatment.

By the time the experiment was exposed and halted, twenty-eight of the men had died directly of syphilis. One hundred more had died of related complications from the disease. Many of the men's wives had contracted syphilis from their husbands. In turn, many of these women had given birth to children with congenital syphilis (the disease was present in their bodies when they were born). The National Association for the Advancement of Colored People (NAACP) filed suit against the U.S. government on behalf of the participants in the experiment. In addition to a $9 million settlement, the government agreed to provide free medical and burial services to all living participants. It also extended treatment to the wives, widows, and children who had been infected because of the experiment. Shortly afterward, the U.S. Congress passed legislation aimed at preventing a recurrence of such callous governmental research practices. On May 16, 1997, President Bill Clinton apologized on behalf of the nation to the men and their families.

Then things went wrong. Reports of deaths following vaccinations surfaced first in Pittsburgh, Pennsylvania, then elsewhere around the country. Three weeks after the program started, forty-one people had died of side effects from the vaccine. A few weeks later, some people reported symptoms of nervous system disorders following vaccinations. Finally, on December 16, the federal government suspended the mass-vaccination program. By that time, forty-five million people had received the vaccine. Fifty-two had died of side effects and over five hundred had been hospitalized for disorders and impairments. At that time, not one new case of swine flu had been reported in the United States since the Fort Dix incident.

In early 1977, the federal government commissioned a review of what had become known as the "swine flu fiasco." Although it was clear that a mass epidemic is always cause for concern, the government realized it should have waited for evidence of a significant spread of the virus before proceeding with a nationwide vaccination program. Instead, it had acted too quickly to prevent an epidemic that never occurred.