To Do No Harm

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DES and the Dilemmas of Modern Medicine

Roberta Apfel and Susan Fisher

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“Apfel and Fisher raise important questions about the explosion of modern medical technology. They vividly delineate the factors contributing to experimentation with new techniques and drugs and how the pressures experienced by physicians, coupled with their fantasies of heroism, meld with pressures from their patients to tempt them to take risks prematurely…. The volume is provocative and effective. It should be read by all who take part in the health care system, patients and their caretakers.” –Carol Nadelson, M.D., Journal of the American Medical Association

"A brilliantly presented historical essay, full of practical judgement. It is a book for everyone to read, especially those who have in mind the care of the intrauterine baby and its future as an adult." —E. James Anthony, M.D., Professor of Child Psychiatry; Director, Edison Child Development Research Center; President, World Association for Infant Psychiatry and Allied Disciplines

"Must reading. Patients, physicians, psychiatrists, medical students, social workers, and drug salesmen will all derive 'pearls' from reading this excellent book."—Louis Burke, M.D., Associate Chairman, Ob/Gyn Beth Israel Hospital; Associate Professor, Ob/Gyn Harvard Medical School

"An extraordinary and provocative book that raises important questions about the way we go about stimulating, interpreting, and disseminating research findings. The clinical examples add dramatic and effective counterpoint to this fascinating account." —Carol Nadelson, M.D., Professor of Psychiatry, Tufts Medical School, President-Elect American Psychiatric Association

"This is a very sensitive and careful analysis of the unfolding of one of the mysteries of modern medicine. In addition to presenting the scientific background of DES, this physician-psychoanalyst team describes the human dimensions of the problem. This story is a compelling argument for the establishment of safety and efficacy prior to the introduction of new remedies in medicine." —Julius B. Richmond, M.D., Director, Division of Health Policy Research and Education, Harvard University

"A sensitive case study of how efforts to apply increased, incomplete knowledge through the use of a new hormonal-pharmacological agent led from a do-no-harm-base for mothers to increased risk and harm for many of the offspring. What mothers used to promote life led after the passage of time to a constriction of and threat to life for their daughters. Clearly, thoughtfully written, the authors avoid the pretense of neutrality while reflecting on the painful, tragic lessons that can be learned when new pharmacological agents appear to have an immediate salutory impact followed by delayed injurious effects."—Albert J. Solnit, M.D., Sterling Professor of Pediatrics and Psychiatry, Yale University

"This reflective study of a modern-day public health disaster, which resembles a Greek tragedy in its scope and inevitability, will be of interest to DES users, their children, health professionals, and those interested in the sometimes deleterious impact of drugs on our health."—Booklist

"A brilliant and cogent analysis of a specific medical disaster which has wide implications for the practice of medicine today and in the near future. . . . Drs. Apfel and Fisher have done a great service in compiling this book. It deserves wide recognition by all involved in health services, by the public in general, and by government agencies."—Cecil Mushatt, M.D., Boston Psychoanalytic Newsletter

"To Do No Harm deserves a wide readership so that it might do good. Dealing with an emotionally charged issue, it is everything that a scholarly book should be—well researched, reasoned, objective, and readable. . . . As in other successful books of this type, one is presented with the facts; and the issues are directly and intelligently stated. Can one ask for more? Strongly recommended for public as well as for college and university libraries."—Choice

"Apfel and Fisher raise important questions about the explosion of modern medical technology. They vividly delineate the factors contributing to experimentation with new techniques and drugs and how the pressures experienced by physicians, coupled with their fantasies of heroism, meld with pressures from their patients to tempt them to take risks prematurely. . . . The authors carefully and painstakingly provide clear documentation, unraveling the complex process of gathering and disseminating information about the consequences of the use of DES. They present clinical material to elucidate their points. In the glossary, they define the terms used throughout the book so that it can be a bridge between professionals and lay readers. . . . The volume is provocative and effective. It should be read by all who take part in the health care system, patients and their caretakers."—Carol Nadelson, MD, Journal of the American Medical Association

"Illuminating. . . . What is uniquely valuable is the authors' psychoanalytic approach to the DES events; it is a perspective that leads to key insights regarding the complex suffering of the mothers and children affected and to understanding of the motives for the drug's prescription by an essentially benevolent profession. For the policy analyst concerned with the ramifications of scientific innovation this is highly recommended reading." —Andrea Levin, Journal of Policy Analysis and Management

"A well-researched and probing work."—Library Journal

"[Apfel and Fisher] tell the story of DES with compassion. They are most comfortable—and engrossing—when discussing case studies that illustrate the sensitivity required of doctors who deal with DES patients."—Alison Knopf, New York Times Book Review

"[Apfel and Fisher] raise disturbing questions about how we as consumers view the role of physicians, how medical students are led to an uncritical view of their goodness and skills, and how reluctant we are to examine or change our expectations and habits. It is a book that every medical student should read." —Elof Axel Carlson, Quarterly Review of Biology

"The authors are to be credited for furthering the discussion of the psychological and social dimensions of the DES problems. . . . There is useful information in this work and provocative insights into a problem that is far more than physical. The book is well written, has a glossary of medical terms, 20 pages of footnotes, a bibliography of 400 references, and an index, all of which enhance its usefulness. This work could be consulted by clinical therapists and counselors and health professionals and would be of interest to the educated lay person."—Adeline Levine, Science

"An illuminating account. . . . For the policy analyst concerned with the ramifications of scientific innovation this is highly recommended reading."—Andrea Levin, Journal of Policy Analysis and Management

"Compulsory reading for all medical students, physicians, and those who 'prescribe' herbal remedies, vitamins and suchlike."—Reuven Ben-Dov, Jerusalem Post

"This book is well written in clear language than can be understood by the nonmedical reader. The glossary defines technical terms. Clinical examples throughout the text give it life, vividness, immediacy. This is a small book with a broad scope. It will inform the lay reader and the health professional and will be thought provoking to all."—Malkah T. Notman, American Journal of Psychiatry

"The introduction to Drs. Apfel and Fisher's book and its first three chapters present a superb dispassionate account of the development of DES."—Boston Psychoanalytic Society and Institute Newsletter

"In the lucid introduction to this book the authors, describing the medical disaster which has touched the lives of 4 to 6 million Americans (mothers, daughters and sons) as a result of the use of diethylstilboestrol (DES) in pregnancy, say 'the whole episode could happen again at any time'. They suggest that understanding what happened, how it happened, and what the consequences have been, might prevent such a repetition."—C. Paul, International Journal of Epidemiology

ISBN: 9780300036190
Publication Date: September 10, 1986

204 pages, 5 1/2 x 8 1/4