P&S Journal: Spring 1996, Vol.16, No.2
Alumni Association Activities
The guest speaker at the Nov. 8 council dinner was Dr. Rogerio A. Lobo, chairman of obstetrics and gynecology. Dr. Lobo began his presentation with a brief history of obstetrics and gynecology at P&S, from the founding of the original Sloane Maternity Hospital in 1886 (thanks to a generous donation of funds by Mrs. Emily Sloane) to the hospital's expansion in 1910, its name change to the Sloane Hospital for Women, and subsequent incorporation into the Columbia-Presbyterian Medical Center.
| Dr. Lobo cited major advances pioneered by the department, such as Rhogam therapy for erythroblastosis fetalis, amniocentesis, in vitro fertilization, in utero surgery and Apgar scoring (initiated by the late Virginia Apgar'33). Referring to a current crisis in the teaching of OB/GYN-marked by few programs for teaching clinician scientists in the field, the lack of an NIH institute, the absence of role models for women in the field-he outlined his project to reinvigorate the department, despite downsizing and shrinking resources.|
Plans are under way, he said, to create a new center for the study of menopause, a neglected field. Under his direction, the Center for Reproductive Sciences will serve as a locus to bring together basic scientists and clinicians to promote excellence in women's health. With the aid of the Sloane Scholars program, created by the late Dr. Mortimer Rosen, he hopes to help mold top-notch physician-scientists in the field.
|Dr. Rogerio A. Lobo, chairman, Department of Obstetrics and Gynecology|
George L. Hawkins'41 Lecture on Ethics in Medical Practice
|Addressing the sensitive issue of "The Ethics of Human Experimentation," Dr. David Rothman, the Bernard Schoenberg Professor of Social Medicine and director of the Center for the Study of Society and Medicine, and Dr. Barron Lerner, the Arnold P. Gold Assistant Professor of Medicine, shared the podium for the first George L. Hawkins'41 Lecture on Ethics in Medical Practice.|
The event was held Oct. 20 in the Alumni Auditorium. The late Dr. Hawkins, a neurosurgeon from St. Louis, created a fund for the teaching of ethics to medical students at P&S. His family has continued to lend their support to this vital effort.
Dr. Rothman reviewed the modern history of human experimentation in clinical research from its "cottage industry" beginnings to the federally funded programs during and in the wake of World War II to the creation of the Institutional Review Board. "It is difficult to think of anything more important," he said, "than that move from laboratory to bedside in terms of research and investigation." When research moves from the animal model to the human, he explained, "you are at the crux of the question of human experimentation."
|George L. Hawkins'41|
Dr. Rothman quoted from a letter of Louis Pasteur in which the celebrated researcher revealed hesitation, despite his confidence in the efficacy of his vaccination, to extend his rabies experiments to the human. "However I should multiply my cases of protection in dogs," he wrote, "I think that my hand will shake when I have to go on to man."
|Dr. Rothman summed up scientists' dilemma: "You can never be certain that something untoward isn't going to happen when you shift from the animal model to the human being." The essence of the problem for the clinician scientist, interested above all in the accumulation of knowledge, he explained, is the fact that "you are running against the most profound, obvious, and self-evident principle in medical ethics: that the patient is always an end in him- or herself and never a means to an end."|
Dr. Lerner focused on issues of methodology and controlled trials. To prevent selection bias, he explained, investigators in the 1920s began to randomize subjects. The first placebo control trial occurred in 1938. The final major innovation in clinical trials was double blinding, first used in the testing of streptomycin for the treatment of tuberculosis in the late 40s and early 50s.
"While most commentators now agree that randomized controlled clinical trials are the gold standard for determining the efficacy of a given therapy," Dr. Lerner pointed out, "such trials nevertheless raise a number of ethical issues."
|Dr. David Rothman|
The debate continues to this day concerning the necessity of randomized trials for all therapies. In this regard, he cited the ethical issues surrounding the experimental use of AZT in 1986 in the treatment of AIDS or AIDS-related complex and the subsequent death of control patients given the placebo. Critics at the time pointed to the availability of enough uncontrolled data beforehand suggesting that everyone should have been treated with the drug. Other potential areas of ethical conflict he discussed were the use of placebo in lieu of alternative treatment, the ethical bind faced by investigators who receive drug company money to conduct a placebo trial when another effective therapy exists, and the dilemma faced by physicians on whether to refer their patients into clinical trials.
AIDS changed the terms of the debate. "In the 1980s," Dr. Lerner explained, "activists objected to what they saw as an unnecessarily slow and rigorous process of drug evaluation by the FDA." Their effective push to have the FDA relax certain rules to get medications on the market sooner, ostensibly without sacrificing much of the scientific validity, has subsequently been taken up by spokespersons for other patient groups.
Minority Affairs Reception
Alumni Association President John Schullinger'55 hosted a reception Nov. 9 at Bard Hall to greet new minority students. Lester Blair Jr.'74, chairman of the alumni committee for minority affairs, was on hand to help welcome the new recruits into the P&S family.
|Lester Blair Jr.'74, Karenza Alexis'98, Coral Omene'98, Barry Sandoval'99, John Schullinger'55, and Dr. Gerald E. Thomson|
Women in the Public Eye
Geraldine Ferraro, the first woman vice presidential candidate, and Dr. Alison Estabrook, the first woman chief of the breast service at CPMC, headlined the program at the conference on Women in the Public Eye Nov. 16 in the Alumni Auditorium.
Dr. Antonia Novello, the first woman and first Hispanic U.S. Surgeon General, was also scheduled to speak but fell ill and could not attend.
Alison Spencer'95, past director of the Women's Resource Center, called the meeting to order. Letty Moss-Salentijn, Ph.D., D.D.S., associate dean of the School of Dental and Oral Surgery and a member of the WRC Advisory Committee, delivered a greeting.
Dr. Mary Mundinger, dean of the School of Nursing, introduced Geraldine Ferraro as a woman who has worn many hats-teacher, mother, lawyer, congresswoman, writer, ambassador-and who "broke down barriers and opened doors that will never again be closed." Currently serving as U.S. ambassador to the U.N. Human Rights Commission, Ms. Ferraro recounted some of the highlights of her extraordinary career. "When I was a little girl," she said, "girls were supposed to dress up at Halloween as Miss America-I didn't want to be Miss America! I was Uncle Sam!" That same resolve carried her through college and law school, a stint in the DA's office, her campaigns for Congress, and her historic 1984 candidacy for the vice presidency on the Democratic ticket. Asked whether her run for the second highest office in the land was worth the effort, she flashed a feisty smile: "You better believe it!"
Dr. Estabrook, former Irving scholar, author of more than 30 peer reviewed papers, and a recipient of the Virginia Kneeland Frantz Award for outstanding woman physician of the year, recounted her adventures in surgery. "I wasn't totally oblivious to the fact that there were no women in my medical school class going into surgery," she recalls. "I really had no idea that I would be battling gender issues." It was pretty much smooth sailing through her residency training at Presbyterian, where she was one of six women residents in general surgery.
"The trouble really began when I was hired as an attending here," she said, at a salary far below that offered to males hired at the same time. And though she eventually came to love her specialty of breast surgery and has built up a big patient following, she resented the fact that the choice was imposed upon her by the then-chairman of the department. Despite her eminent qualifications, she was initially bypassed for promotion to chief of the breast service when that position came open.
Since her ascendency to that title in 1991, with Dean Pardes' support, she has helped build the biggest service in breast disease in the country.
A display of photographs by Elizabeth Wilcox gave a vivid pictorial history of the involvement of women in health care at P&S. Dr. and Mrs. Carl Feind'50 were awarded a citation for their early enthusiasm and continuing generous support for the WRC. The center is a group of women dedicated to excellence in the research and delivery of health care by and for women. Its new office is located on the second floor of the Energy Court of Presbyterian Hospital.
|Geraldine Ferraro, Dean Herbert Pardes, and Alison Estabrook, M.D.|