P&S Journal: Spring 1997, Vol.17, No.2
Thank you for the stimulating issue, Winter 1997. I would like to add a fundamental consideration to the "Ethics in Medicine: Managed (or Mangled?) Care" discussion that deserves heavy emphasis. Distributive justice has taken over our society, displacing autonomy as the driving principle. Historically, as long as we had plenty, either worldly goods or a frontier to develop without having to consider others, autonomy didn't generate any ethical conflicts. Squatters rights became law, and the only limitations were the avoidance of actively harming others in the pursuit of one's desires. Poor people could always walk to an unoccupied plot and fend for themselves. Now, as population density increases, the sharing of the fixed resources of the planet has underscored the harm we inflict on others when seeking our own benefits. As a society we need to address the issue of distributive justice as the foundation for managed care. Are we isolated individuals on the planet, or are we a society? As a society, do we offer the individual members any value at all? Wall Street certainly has invaded our profession. Are we just greedy business people now? Few of us have in-depth familiarity with the business world. But all of us have appreciated that wealth is accumulated by charging as much as the traffic will bear, and paying as little as possible overhead. Clearly obscene multi-million dollar salaries to administrators of plans that thrive on care denied has to stop. The media have certainly helped expose this problem. May Dr. Relman's prediction--the country's disenchantment with for-profit, investor-owned managed care--materialize soon!
Dr. Grant alluded to the relationship between cost and quality. Bravo! As oblivious as any of us have been re cost of care, there isn't a physician or nurse who hasn't been painfully aware of both the soul and dollar cost of complications of medical care. The very possibility of reducing the incidence of preventable complications should be inspiring to all our medical leaders. The savings are akin to compound interest. The moneys saved by the prevention of complications can serve other patients, whose care, if spared complications, compounds the savings.
Let us settle the issue of our civilization's priorities. Society or the Individual? If our society derives its basis from the nuclear family, we clearly must acknowledge the intrinsic value of caring for each other, with occasionally one of us making sacrifices for the other, always based on the limitation of resources. Even in a hierarchical family, all receive care, though the power figures more than the average member. Even wild animals care for one another--wolves, elephants, wildebeests, chimpanzees, and gorillas. For goodness sake, why can't we do at least as well?
Great information systems could empower managed care companies to define best practices, something all of us have been seeking since entering medical school. We could then not only discuss ethical medicine, but proudly practice it as well.
Claude S. Poliakoff'64
Colorado Springs, Colo.
Faculty Remembered (Still)
When I opened the Winter 1997 issue of P&S Journal it fell open to Page 3, and 52 years vanished in a flash as I saw the image of Dr. Philip Smith in his natural habitat--microscopes and a tray of slides.
Dr. [Nick] Christy's word portrait got it exactly right: "austere," "unquestioned authority," "parental figure," "flinty and severe"--these terms fit my memory of Dr. Smith.
However, I also felt (or may have imagined) what the article didn't mention: a carefully concealed kindness, a consideration and respect for bumbling freshmen as he leaned over my microscope and told me, in his liquid half-lisp, that the object I had indicated with the pointer was a mast cell.
The next year in neuroanatomy class Dr. Elwin showed us some of Dr. Smith's early work with brain transplants, racing tadpoles around a track in a petri dish to test ones missing a mid-brain, or with an extra fore-brain or hind-brain.
It's true that, as the memoir suggested, I never knew him as an eminent research scientist, but only as P&S's Father Histology. But that was enough for me, and that introduction into the wonderful world of microanatomy has been the foundation of my medical thought and practice to this day.
Of Mice and Disease
I write about the article in your Winter 1997 issue by Devera Pine titled "Coming soon to a lab near you: A mouse model for breast cancer."
While knockout mice are and will lead to wonderful models for a variety of diseases, I fear your article is misleading in that it does not consider other ways in which mouse models for diseases can be developed. As an example, my laboratory here at P&S developed a new mouse model for poliomyelitis (Ren, R., F. Costantini, E.J. Gorgacz, J.J. Lee, and V.R. Racaniello (1990). Transgenic mice expressing a human poliovirus receptor: A new model for poliomyelitis. Cell 63: 353-362) which may replace the costly and inconvenient monkey model for testing poliovirus vaccines. These are not knockout mice, but transgenic mice made with the human poliovirus receptor gene.
My point is that there are other ways to make mouse models for various diseases other than the knockout. Your article does a disservice by failing to point out that transgenic strategies have been available for some time and can also be used to produce useful mouse models.
Vincent Racaniello, Ph.D.
P&S Higgins Professor of Microbiology
Glancing at my copy of the latest issue of the local rag, I could not help but notice the cover "featuring" 10 researchers--all male--working on a "knockout" mouse for BRCA1. It seemed implausible to me that this is something that only men do, so I read on. Sure enough, there are women in the field. Why were none mentioned on the cover? I hope it was inadvertence, since the other possible explanation is worse. Could it be that you only featured Columbia researchers, and we have no women? (Your story mentions two female researchers from Columbia who have gone elsewhere; a third woman mentioned, Dr. Virginia Papaioannou, who is a member of our faculty, is quoted extensively, but the nature of her research is not fully explained so it is not clear why she is not "featured" on the cover.)
If the cover reflects a reality--no women--perhaps your story should have been about the peculiar and inexplicable dearth of women researchers at Columbia in an area of research that is so promising for women's health. If the cover does not reflect a reality, this is a problem you can and should attend to in the future.
Joan E. Bertin, J.D.
Clinical Professor of Public Health
School of Public Health Program on Gender, Science and Law
Bard Hall Players
It was nice to read Bruce Scotton's letter in the latest P&S Journal [Winter 1997] concerning the Bard Hall Players. We did present "The Boys from Syracuse" in the autumn of 1968, but "Brigadoon" must have been done in 1970, because the production in the autumn of 1969 was "A Funny Thing Happened on the Way to the Forum." I think we used the same togas from the year before. Rick Spiegel was a terrific Pseudolus, a veritable role model for Nathan Lane. I was the musical director. Candace Cooper, soon to be my wife, had some saucy role, as I recall.
It should be noted that there was another major component of extracurricular activity at P&S. Each spring the "Bard Hall Philharmonic" came to life and put on a concert. Students, faculty, Presbyterian employees, and ringers from the main Columbia campus gathered to put on early Beethoven symphonies, Brandenburg concerti, and Dvorak serenades. As I recall, Allan Steere'69 did the Brahms Violin Concerto.
May these "Bard Hall" traditions continue into the next millennium. They comprise a significant part of what makes P&S and its student body great.
Edward (Ted) Walworth'70
P.S. Jerry Leibowitz'69, also mentioned in Bruce's letter, is nowhere to be found in the new P&S Alumni Directory.
Since we seem to be reminiscing about the early days of the Bard Hall Players, let me go back to the real early days!
Some time during the spring of our senior year, our esteemed faculty, in an innovative mood and without much warning, held an oral, comprehensive examination of all seniors. This did not endear us to our faculty; few of us welcomed the innovation. So we decided to return the compliment with our own innovation. For the first time, I think, a P&S Senior Show was performed. It was held in the basement of Bard Hall. Attendance of senior faculty was mandated. The show featured a first time ever oral examination by students of selected members of the faculty!
Following a musical fanfare and an unflattering song about one of our instructors, the instructor was identified and escorted to the stage. He was confronted by "examiners" seated in a semicircle. Grossly uncomplimentary questions were asked. This sequence was repeated with at least five faculty members. Dana Winsley Atchley (where did you learn how to take a history?), Franklin Hanger (is cephalin flocculation the only test in your repertoire?) and Robert F. Loeb (is your chronically bruised finger the result of your superb technique of percussion?) were among those grilled. We even took personal pokes at Byron Stookey, neurosurgeon, the best dressed and most distinguished looking member of the faculty (where the hell do you get those tab collars?) and Hugh Auchincloss, another surgeon (is it true that you've dated Fanny Brice?). The gentlemen subjected to this first-time switch in interrogation seemed to take the punishment in good spirit. In any event, for better or worse, we graduated.
Obviously, Bard Hall Players have come a long way.
Ephraim P. Engleman'37
P.S. All of the above has been confirmed by classmate Mike Gompertz'37.
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