History > 2009 > USA > Health (II)
A Cadaver, for the Sake of Science
Swine Flu Pandemic
April 30, 2009
Filed at 2:43 a.m. ET
By THE ASSOCIATED PRESS
The New York Times
MEXICO CITY (AP) -- Global health authorities warned Wednesday that swine flu
was threatening to bloom into a pandemic, and the virus spread farther in Europe
even as the outbreak appeared to stabilize at its epicenter. A toddler who
succumbed in Texas became the first death outside Mexico.
New cases and deaths finally seemed to be leveling off in Mexico, where 160
people have been killed, after an aggressive public health campaign. But the
World Health Organization said the global threat is nevertheless serious enough
to ramp up efforts to produce a vaccine against the virus.
''It really is all of humanity that is under threat during a pandemic,'' WHO
Director General Margaret Chan said in Geneva. ''We do not have all the answers
right now, but we will get them.''
It was the first time the WHO had declared a Phase 5 outbreak, the
second-highest on its threat scale, indicating a pandemic could be imminent.
The first U.S. death from the outbreak was a Mexico City toddler who traveled to
Texas with family and died Monday night at a Houston hospital. U.S. Health and
Human Services Secretary Kathleen Sebelius predicted the child would not be the
last U.S. death from swine flu.
The virus, a mix of pig, bird and human genes to which people have limited
natural immunity, had spread to at least nine countries. In the United States,
nearly 100 have been sickened in 11 states.
Eight states closed schools Wednesday, affecting 53,000 students in Texas alone,
and President Barack Obama said wider school closings might be necessary to keep
crowds from spreading the flu. Mexico has already closed schools nationwide
until at least May 6.
''Every American should know that the federal government is prepared to do
whatever is necessary to control the impact of this virus,'' Obama said,
highlighting his request for $1.5 billion in emergency funding for vaccines.
Just north of the Mexican border, 39 Marines were being confined to their
California base after one contracted swine flu. Senators questioned Homeland
Security Secretary Janet Napolitano about her decision not to close the border,
action she said ''has not been merited by the facts.''
Ecuador joined Cuba and Argentina in banning travel either to or from Mexico,
and other nations considered similar bans. In France, President Nicolas Sarkozy
met with cabinet ministers to discuss swine flu, and the health minister said
France would ask the European Union to suspend flights to Mexico.
The U.S., the European Union and other countries have discouraged nonessential
travel to Mexico. Some countries have urged their citizens to avoid the United
States and Canada as well. Health officials said such bans would do little to
stop the virus.
Germany and Austria became the latest countries to report swine flu infections
Wednesday, with cases already confirmed in Canada, Britain, Israel, New Zealand
In addition to the 160 deaths, the virus is believed to have sickened 2,498
people across Mexico. But only 1,311 suspected swine flu patients remained
hospitalized, and a closer look at daily admissions and deaths at Mexico's
public hospitals suggests the outbreak may have peaked during three grim days
last week when thousands of people complained of flu symptoms.
Scientists believe that somewhere in the world, months or even a year ago, a pig
virus jumped to a human and mutated, and has been spreading between humans ever
since. Unlike with bird flu, doctors have no evidence suggesting a direct
pig-to-human infection from this strain, which is why they haven't recommended
Medical detectives have not zeroed in on where the outbreak began. One of the
seven deaths in Mexico directly attributed to swine flu was that of a
Bangladeshi immigrant, said Mexico's chief epidemiologist, who suggested that
someone could have brought the virus from Pakistan or Bangladesh.
Miguel Angel Lezana, the epidemiologist, said the unnamed Bangladeshi had lived
in Mexico for six months and was recently visited by a brother who arrived from
Bangladesh or Pakistan and was reportedly ill. The brother has left Mexico and
his whereabouts are unknown, Lezana said.
By March 9, the first symptoms were showing up in the Mexican state of Veracruz,
where pig farming is a key industry in mountain hamlets and where small clinics
provide the only health care.
The earliest confirmed case was there: a 5-year-old boy who was one of hundreds
of people in the town of La Gloria whose flu symptoms left them struggling to
Days later, a door-to-door tax inspector was hospitalized with acute respiratory
problems in the neighboring state of Oaxaca, infecting 16 hospital workers
before she became Mexico's first confirmed death.
Neighbors of the inspector, Maria Adela Gutierrez, said Wednesday that she fell
ill after pairing up with a temporary worker from Veracruz who seemed to have a
very bad cold. Other people from La Gloria kept going to jobs in Mexico City
despite their illnesses, and could have infected people in the capital.
The deaths were already leveling off by the time Mexico announced the epidemic
April 23. At hospitals Wednesday, lines of anxious citizens seeking care for flu
symptoms dwindled markedly.
The Mexican health secretary, Jose Angel Cordova, said getting proper treatment
within 48 hours of falling ill ''is fundamental for getting the best results''
and said the country's supply of medicine was sufficient.
Cordova has suggested the virus can be beaten if caught quickly and treated
properly. But it was neither caught quickly nor treated properly in the early
days in Mexico, which lacked the capacity to identify the virus, and whose
health care system has become the target of widespread anger and distrust.
In case after case, patients have complained of being misdiagnosed, turned away
by doctors and denied access to drugs. Monica Gonzalez said her husband,
Alejandro, already had a bad cough when he returned to Mexico City from Veracruz
two weeks ago and soon developed a fever and swollen tonsils.
As the 32-year-old truck driver's symptoms worsened, she took him to a series of
doctors and finally a large hospital. By then, he had a temperature of 102 and
could barely stand.
''They sent him away because they said it was just tonsillitis,'' she said.
''That hospital is garbage.''
That was April 22, a day before Mexico's health secretary announced the swine
flu outbreak. But the medical community was already aware of a disturbing trend
in respiratory infections, and Veracruz had been identified as a place of
Gonzalez finally took her husband to Mexico City's main respiratory hospital,
''dying in the taxi.'' Doctors diagnosed pneumonia, but it may have been too
late: He has suffered a collapsed lung and is unconscious. Doctors doubt he will
Swine flu has symptoms nearly identical to regular flu -- fever, cough and sore
throat -- and spreads like regular flu, through tiny particles in the air, when
people cough or sneeze. People with flu symptoms are advised to stay at home,
wash their hands and cover their sneezes.
While epidemiologists stress it is humans, not pigs, who are spreading the
disease, sales have plunged for pork producers around the world. Egypt began
slaughtering its roughly 300,000 pigs on Wednesday, even though no cases have
been reported there. WHO says eating pork is safe, but Mexicans have even cut
back on their beloved greasy pork tacos.
Pork producers are trying to get people to stop calling the disease swine flu,
and Obama notably referred to it Wednesday only by its scientific name, H1N1.
U.N. animal health expert Juan Lubroth noted some scientists say ''Mexican flu''
would be more accurate, a suggestion already inflaming passions in Mexico.
Authorities have sought to keep the crisis in context. In the U.S. alone, health
officials say about 36,000 people die every year from flu-related causes.
Mexico's government said it remains too early to ease restrictions that have
shut down public life in the overcrowded capital and much of the country.
Pyramids, museums and restaurants were closed to keep crowds from spreading
''None of these measures are popular. We're not looking for that -- we're
looking for effectiveness,'' Mexico City Mayor Marcelo Ebrard said. ''The most
important thing to protect is human life.''
Associated Press writers Olga Rodriguez in Oaxaca, Mexico, E. Eduardo Castillo
in Mexico City, Lauran Neergaard and Tom Raum in Washington, Juan A. Lozano in
Houston, Mike Stobbe in Atlanta, Patrick McGroarty in Berlin and Maamoun Youssef
in Cairo contributed to this report.
WHO Says Swine Flu
Pandemic Is Imminent, NYT, 30.4.2009,
First U.S. Death
From Swine Flu Is Reported
April 30, 2009
The New York Times
By SHARON OTTERMAN
and MARK McDONALD
President Obama confirmed the first death outside of Mexico from swine flu on
Wednesday, and recommended that schools with confirmed cases of swine flu
“strongly consider temporarily closing.”
“This is obviously a serious situation, serious enough to take the utmost
precautions,” Mr. Obama said.
The president’s remarks, his most extensive on the outbreak since it began, came
as fears the spread of the disease around the world deepened on Wednesday.
The number of confirmed cases of the disease continued to rise in Europe. In
France, the health minister took the extraordinary step of calling for a
suspension of all flights from the European Union to Mexico, the epicenter of
the outbreak, even as a Mexican health official said that the death toll
appeared to be stabilizing.
Dr. Richard Besser, acting director of the Centers for Disease Control and
Prevention, said Wednesday in an interview with CNN that the first American
death of the disease was a 23-month-old child in Texas. He gave no other details
about the child. President Obama said his “thoughts and prayers” were with the
Mr. Obama spoke a day after he had asked Congress to provide $1.5 billion in
emergency funds to fight the disease, and his comments appeared to reflect a
deepening sense of the risk the still ill-understood flu might pose.
This strain of the flu is suspected to have killed more than 150 people in
Mexico and has been confirmed in at least seven countries around the globe, from
Spain to Canada to New Zealand.
By urging parents to make contingency plans in the event of school closings —
simply placing children in crowded day-care centers was “not a good solution,”
he noted — Mr. Obama indicated that his administration was contemplating the
possibility, at least, of a serious increase in the flu’s prevalence.
France’s request to suspend all flights from the European Union to Mexico would
be made at a meeting of European Union health ministers, due to be held Thursday
in Luxembourg, French Health Minister Roselyne Bachelot said. The World Health
Organization has argued against such travel bans, arguing that they are an
ineffective way to stop to spread of the disease.
Cuba and Argentina have both banned flights to Mexico, while the C.D.C. has
advised Americans only to “avoid all nonessential travel to Mexico.”
Mexico’s health secretary, Jose Cordova said late Tuesday that emergency
measures to curb the disease’s spread there appeared to be having an impact. The
Mexican death toll, he said, was “more or less stable.” More than 2,000 people
are believed to have been sickened by swine flu there.
Mexico City, one of the world’s largest cities, has taken drastic preventative
steps, shutting down schools, gyms, swimming pools, restaurants, and movie
theaters. Many people on the streets have donned masks in hopes of protection.
Schools are closed throughout Mexico, affecting some 33 million students. Many
tourist sites — including museums and archaeological sites — have been put off
The number of confirmed swine flu cases in the United States rose Wednesday to
66 in six states, with 45 in New York, 11 in California, six in Texas, two in
Kansas and one each in Indiana and Ohio, but cities and states suspected more.
In New York, the city’s health commissioner said “many hundreds” of
schoolchildren were ill at a school where some students had confirmed cases.
Germany confirmed three cases of the disease, becoming the third European
country to report cases. The country’s disease control agency, the Robert
Koch-Institut, said the three include a 22-year-old woman hospitalized in
Hamburg; a man in his late 30s being treated at a hospital in Regensburg, north
of Munich, and a 37-year-old woman from another southern town.
Health and airport authorities in Munich said the first direct flight carrying
vacationers back to Germany since the outbreak of the disease in Mexico was
expected and might be quarantined if passengers showed symptoms of swine flu.
Spain said Wednesday that the number of confirmed cases of the flu had risen
from two to four, including one in the northern Basque region, all in people who
had recently returned from Mexico. The health ministry said authorities were now
observing 59 suspected cases.
In London, Prime Minister Gordon Brown told parliament that three more cases of
swine flu had been confirmed in Britain, one of them a 12-year-old girl, in
addition to a Scottish couple, bringing the total to five. All three had
recently travelled from Mexico, had mild symptoms and were responding to
treatment, he said. A school attended by the 12-year-old in southwest England
had been temporarily closed, he added.
Canada has 13 confirmed cases, all of which are mild, Canada’s chief public
health officer, Dr. David Butler-Jones, said Tuesday.In all, the United Nations
global health body, the World Health Organization, has confirmed 105 cases of
swine flu in seven countries. More than half of those — 66 — are in the United
New Zealand officials said on Wednesday that 14 cases had been confirmed there.
New Zealand has been screening all arriving air passengers, and Dr. Fran
McGrath, the deputy director of public health, said that five foreign travelers
were being treated under quarantine for mild cases of the flu. All five were
being “kept in isolation” at an undisclosed location in Auckland.
Also on Wednesday, at least 10 countries — from China to Russia to Ukraine to
Ecuador — have established bans on the importing all pork products, despite a
declaration from the W.H.O. that the virus cannot be transmitted by eating pork.
“There is no risk of infection from this virus from consumption of well-cooked
pork and pork products,” the W.H.O. said in a statement.
Egypt on Wednesday went further, ordering the culling of all pigs in the Arab
country as a precaution against swine flu, the country’s health minister said.
While most Egyptians are Muslim and do not eat pork, it is available, and is
mostly consumed by the Christian minority and foreigners.
"It is decided to slaughter all swine herds present in Egypt, starting from
today," Health Minister Hatem el-Gabali said in a statement published by state
news agency MENA.
Numerous countries in Europe, Asia and Latin America have been screening
arriving passengers, including thermal facial scans and on-board checks of air
travelers. Several countries have set up diagnostic and quarantine facilities
for travelers suspected of being ill.
Five cruise lines, including the world’s two largest, Carnival and Royal
Caribbean, said they were immediately stopping all port calls in Mexico.
Princess Cruises, Holland America and Norwegian Cruise Line also said they were
suspending Mexican stopovers. Cruises to Mexico accounted for about 7 percent of
cruise traffic worldwide in 2008, according to the Cruise Line Industry
In California, Gov. Arnold Schwarzenegger declared a state of emergency. But the
nation’s highest number of cases continued to be in New York City, where 45
people were confirmed to have swine flu.
In Washington, Congress held hearings Wednesday to address the seriousness of
“I really think we need to be prepared for the worsening of the situation,” Rear
Adm. Anne Schuchat, the C.D.C.’s interim science and public health deputy
director, told a Senate Appropriations health subcommittee. “It’s more of a
marathon than a sprint,” she said, echoing what Dr. Besser had said on Sunday,
when the country first declared swine flu a public health emergency.
Senator Tom Harkin, the Iowa Democrat who heads the subcommittee, noted that
“there’s a lot of anxiety right now across the country.”
Reporting was contributed by Liz Robbins, Donald G. McNeil Jr., Anahad O’Connor
and Anne Barnard from New York; Nicholas Confessore from Albany; David Stout and
Brian Knowlton from Washington; Marc Lacey from La Gloria, Mexico; Alan Cowell
from London; Ian Austen from Ottawa; and Keith Bradsher from Hong Kong; and
Victor Homola from Berlin.
First U.S. Death From
Swine Flu Is Reported, NYT, 30.4.2009,
Claims First American Victim,
April 29, 2009
Filed at 9:37 a.m. ET
By THE ASSOCIATED PRESS
The New York Times
ATLANTA (AP) -- The CDC on Wednesday confirmed the nation's first swine flu
death in the current outbreak, a 23-month-old child in Texas.
The first swine flu death outside of Mexico was confirmed by Centers for Disease
Control and Prevention spokesman Dave Daigle.
The acting head of the CDC called the confirmation tragic, but said it's too
soon to say just how fast the swine flu virus is spreading.
Dr. Richard Besser said in a nationally broadcast network interview that health
authorities had anticipated that the virus would cause deaths, and said that
''as a pediatrician and a parent, my heart goes out to the family.''
But Besser said on NBC's ''Today'' show that it's too soon to say if the death
in Texas suggests the virus is spreading to more states. Nor would he say
whether officials think it will become a nationwide problem.
He also said he does not believe the flu strain has become more dangerous.
Besser went on to note that even with seasonal flu, there are always some people
who can't resist it very well, and said authorities need to learn more about the
Children, especially those younger than age 5, are particularly vulnerable to
flu and its complications, and every year children die from seasonal flu.
According to the CDC, more than 20,000 children younger than age 5 are
hospitalized every year because of seasonal flu. In the 2007-08 flu season, the
CDC received reports that 86 children nationwide died from flu complications.
As of April 11, CDC had received reports of 53 seasonal flu-related deaths in
children during the current seasonal flu season.
Swine Flu Claims First
American Victim, C.D.C. Says, NYT, 29.4.2009,
Swine Flu Vaccine
May Be Months Away,
April 29, 2009
The New York Times
By ANDREW POLLACK
Federal officials said it would take until January, or late November at the
earliest, to make enough vaccine to protect all Americans from a possible
epidemic of swine flu.
And beyond the United States and a few other countries that also make vaccines,
some experts said it could take years to produce enough swine flu vaccine to
satisfy global demand.
Although production is much faster than would have been possible even a few
years ago, it still may not be in time to avert death and illness if the virus
starts spreading widely and becomes more virulent, some experts said.
In this country, the biggest problem is that despite years of effort, the
country is still relying on half-century-old technology to make the flu
Federal authorities have spent years and more than a billion dollars trying to
shift vaccine production to a faster, more reliable method — one that involves
growing the vaccine viruses in vats of cells rather than in hen’s eggs, the old
technology. And there are numerous small companies developing totally new
approaches that might allow for the production of huge volumes of vaccines in a
matter of weeks.
But the cell-based production is not quite ready, and some of the newer
techniques are not proven enough to satisfy many experts.
“Those are all great technologies, but it isn’t going to happen in time,” said
Dr. Greg Poland, head of the vaccine research program at the Mayo Clinic.
Federal officials have not yet made a decision on whether the swine flu is
enough of a threat to warrant vaccine production. But they are taking the
A potential problem is that producing swine flu vaccine might interfere with
production of the seasonal flu vaccine for next winter.
“We would have to most likely make a compromise,” Andrin Oswald, chief executive
of the vaccine division at the drug maker Novartis, said in an interview.
But Robin Robinson, who runs the emergency preparation research program for the
federal Department of Health and Human Services, said most manufacturers would
have finished producing the bulk of seasonal vaccine by June.
If production of the swine flu vaccine were to start right after that, the first
50 million to 80 million doses would be available by September, Dr. Robinson
A full 600 million doses, enough to provide the required two shots for each
American, could be finished by January. If immune stimulants called adjuvants
were added to the vaccine, that could reduce the dosage needed by each person,
allowing enough doses to be ready by late November, he said.
The vaccine industry is in a much stronger position to respond now than it was
five years ago, when the United States had only two flu vaccine suppliers and
was hit by a severe shortage.
Now there are five suppliers to the domestic market. And the vaccine industry,
once a backwater of the pharmaceutical industry, is attracting new investments,
lured by government subsidies and higher prices for vaccines.
Still, a study done with the World Health Organization and the International
Federation of Pharmaceutical Manufacturers and Associations estimated that it
would probably take four years of production to satisfy fully global demand for
a vaccine to protect against the bird flu strain that has concerned health
authorities for the last few years.
Similar projections might apply to the swine flu vaccine, some experts say.
“The bottom line is there won’t be enough vaccine quickly enough and the vaccine
will largely go to the countries that already produce the vaccine,” because
countries will restrict exports in a pandemic, said Dr. David Fedson, an
independent expert on pandemic preparedness.
The federal government is encouraging manufacturers to set up production in the
United States, since all companies but one, Sanofi-Aventis, now import their flu
The government also gave $1.3 billion, spread among several manufacturers, to
develop ways of producing the vaccine in vats of animal cells rather than in
eggs. Cell culture is less vulnerable to contamination and the process could
save at least a few weeks.
The results so far have been mixed. Solvay, which was awarded the biggest
federal grant, nearly $300 million, decided it was economically too risky to
build a flu vaccine plant in the United States. (Most of the grant money had not
yet left federal coffers and will not be lost, Dr. Robinson said.)
Sanofi-Aventis has also put cell culture production on the back burner, Dr.
But Novartis is building a cell culture flu vaccine factory in Holly Springs,
N.C., which might be ready for use in 2010 or 2011. The federal government is
providing nearly $500 million in construction costs and guaranteed vaccine
Swine Flu Vaccine May Be Months Away, Experts
Say, NYT, 29.4.2009,
Dealing With the Swine Flu Outbreak
the Swine Flu Outbreak
April 29, 2009
The New York Times
To the Editor:
Declares Health Emergency as Cases of Swine Flu Emerge” (front page, April
As someone who has worked in a nursing home for many years, I’ve seen outbreaks
of infections. And I’ve seen our rapid responses to contain and prevent their
spreading by quarantining. So I’m frankly quite baffled by our government’s
response, or lack of it, to the swine flu outbreak.
We now know that the only confirmed outbreak in New York City is at St. Francis
Preparatory School, where you reported that students visited Mexico on spring
break. Once it became apparent last week that the source of the flu was Mexico,
why wasn’t our immediate response to prevent passage into Mexico or out to the
United States? And if we delayed in doing that, why aren’t we doing that now?
Isn’t the job of our government to protect us?
Bronx, April 28, 2009
To the Editor:
The rabid anti-immigration-ism that is stoked by mistruths and omissions of the
mainstream media, especially on television but in newspapers as well, is a
continuing public health menace when outbreaks of infectious disease like the
swine flu occurs — in that immigrants without green cards will not feel free to
seek medical care at health institutions.
The vigilante atmosphere is self-sabotaging and as mentioned is in and of itself
a public health hazard because, similar to the critical census-taking protocol,
it relies on people to identify themselves in an atmosphere of racism, hate,
xenophobia and scapegoating.
A many-pronged approach by local, state and federal institutions needs to
address this obstacle to isolating and treating outbreaks of contagious
illnesses. Cindy Shapiro
Beulah, Mich., April 27, 2009
To the Editor:
The Senate should not have delayed acting on the nomination of Gov. Kathleen
Sebelius of Kansas as health and human services secretary, so a permanent
director of the Centers for Disease Control and Prevention could be appointed.
The secretary of homeland security and the White House press secretary, Robert
Gibbs, are not the usual individuals to decide on the status of a public health
Bertrand M. Bell
New York, April 28, 2009
The writer is a professor of medicine at the Albert Einstein College of
To the Editor:
Re “The New Swine Flu” (editorial, April 28): Here are the nonmedical problems
associated with this potential pandemic disease:
The Republicans in Congress took $900 million out of the stimulus bill that was
to be used as an “insurance policy” against possible pandemics.
There are thousands of people coming across our border from Mexico, and if the
news reports are to be taken seriously, most are coming into the United States
with virtually no screening or questions asked.
The party of “no,” the same Republicans on Capitol Hill, have until recently
been blocking action on the nomination of Gov. Kathleen Sebelius to become
secretary of health and human services, leaving a huge void at the top of the
agency that has the responsibility to protect us from pandemics.
The alerts and warnings that have gone up worldwide are a very good thing
indeed. America might want to look at temperature-screening devices at all entry
points into this country starting today! The last thing we need right now is an
epidemic of swine flu that could become a global pandemic.
Henry A. Lowenstein
New York, April 28, 2009
To the Editor:
Re “Officials Point to Swine Flu in New York” (front page, April 26):
Dare we ask why this happening? While its exact origin is still unclear, this
pathogen, and many others (like avian influenza), originated from animals being
raised or eaten for food.
As the world moves toward raising the majority of animals in the unnatural
setting of factory farms, it is likely that more, and worse, such pathogens will
arise. What will it take for us, and our public health leaders, to question our
addiction to meat and tolerance of factory farming? The meat industry is
environmentally devastating, incredibly inhumane and now potentially the end to
us all. Edward Machtinger
San Francisco, April 26, 2009
The writer is an associate professor of medicine and director of the Women’s
H.I.V. Program, University of California, San Francisco.
To the Editor:
The Centers for Disease Control and Prevention lists staying home from school or
work as one of the several precautionary measures for dealing with the swine
flu. Common sense also tells people who are sick to limit contact with others.
Yet for millions of people, that step could result in loss of wages or
disciplinary action at work.
Ensuring that those who are ill can stay home, or keep their sick children home,
is exactly why we need to guarantee a minimum number of paid sick days to all
workers. Every one of us needs this critical protection carried out before the
country faces a pandemic.
We urge Congress to take action on the Healthy Families Act and employers to
assure workers that they will not be punished for following guidelines from the
nation’s health experts.
Milwaukee, April 27, 2009
The writer coordinates Family Values @ Work: A Multi-State Consortium, a network
of state groups working for policies like paid sick days.
To the Editor:
A recent Times article (“Texas Governor’s Secession Talk Stirs Furor,” April 18)
quoted Gov. Rick Perry of Texas expressing sympathy for secessionist sentiment
in his home state: “If Washington continues to thumb their nose at the American
people, who knows what may come of that?”
But on April 26, you report that “Gov. Rick Perry of Texas asked the C.D.C. to
send 37,430 doses of Tamiflu.”
It would appear that the governor has realized that membership has its
privileges. David D. Turner
New York, April 26, 2009
Dealing With the Swine
Flu Outbreak, NYT, 29.4.2009,
Public Health Emergency
Over Swine Flu
April 27, 2009
The New York Times
By DONALD G. McNEIL Jr.
Responding to what some health officials feared could be the leading edge of
a global pandemic emerging from Mexico, American health officials declared a
public health emergency on Sunday as 20 cases of swine flu were confirmed in
this country, including eight in New York City.
Other nations imposed travel bans or made plans to quarantine air travelers as
confirmed cases also appeared in Mexico and Canada and suspect cases emerged
Top global flu experts struggled to predict how dangerous the new A (H1N1) swine
flu strain would be as it became clear that they had too little information
about Mexico’s outbreak — in particular how many cases had occurred in what is
thought to be a month before the outbreak was detected, and whether the virus
was mutating to be more lethal, or less.
“We’re in a period in which the picture is evolving,” said Dr. Keiji Fukuda,
deputy director general of the World Health Organization. “We need to know the
extent to which it causes mild and serious infections.”
Without that knowledge — which is unlikely to emerge soon because only two
laboratories, in Atlanta and Winnipeg, Canada, can confirm a case — his agency’s
panel of experts was unwilling to raise the global pandemic alert level, even
though it officially saw the outbreak as a public health emergency and opened
its emergency response center.
As a news conference in Washington, Homeland Security Secretary Janet Napolitano
called the emergency declaration “standard operating procedure,” and said she
would rather call it a “declaration of emergency preparedness.”
“It’s like declaring one for a hurricane,” she said. “It means we can release
funds and take other measures. The hurricane may not actually hit.”
American investigators said they expected more cases here, but noted that
virtually all so far had been mild and urged Americans not to panic.
The speed and the scope of the world’s response showed the value of preparations
made because of the avian flu and SARS scares, public health experts said.
The emergency declaration in the United States lets the government free more
money for antiviral drugs and give some previously unapproved tests and drugs to
children. One-quarter of the national stockpile of 50 million courses of antiflu
drugs will be released.
Border patrols and airport security officers are to begin asking travelers if
they have had the flu or a fever; those who appear ill will be stopped, taken
aside and given masks while they arrange for medical care.
“This is moving fast and we expect to see more cases,” Dr. Richard Besser,
acting director of the Centers for Disease Control and Prevention, said at the
news conference with Ms. Napolitano. “But we view this as a marathon.”
He advised Americans to wash their hands frequently, to cover coughs and sneezes
and to stay home if they felt ill; but he stopped short of advice now given in
Mexico to wear masks and not kiss or touch anyone. He praised decisions to close
individual schools in New York and Texas but did not call for more widespread
Besides the eight New York cases, officials said they had confirmed seven in
California, two in Kansas, two in Texas and one in Ohio. The virus looked
identical to the one in Mexico believed to have killed 103 people — including 22
people whose deaths were confirmed to be from swine flu — and sickened about
1,600. As of Sunday night, there were no swine flu deaths in the United States,
and one hospitalization.
Other governments tried to contain the infection amid reports of potential new
cases including in New Zealand and Spain.
Dr. Fukuda of the W.H.O. said his agency would decide Tuesday whether to raise
the pandemic alert level to 4. Such a move would prompt more travel bans, and
the agency has been reluctant historically to take actions that hurt member
Canada confirmed six cases, at opposite ends of the country: four in Nova Scotia
and two in British Columbia. Canadian health officials said the victims had only
mild symptoms and had either recently traveled to Mexico or been in contact with
someone who had.
Other governments issued advisories urging citizens not to visit Mexico. China,
Japan, Hong Kong and others set up quarantines for anyone possibly infected.
Russia and other countries banned pork imports from Mexico, though people cannot
get the flu from eating pork.
In the United States, the C.D.C. confirmed that eight students at St. Francis
Preparatory School in Fresh Meadows, Queens, had been infected with the new
swine flu. At a news conference on Sunday, Mayor Michael R. Bloomberg said that
all those cases had been mild and that city hospitals had not seen a surge in
severe lung infections.
On the streets of New York, people seemed relatively unconcerned, in sharp
contrast to Mexico City, where soldiers handed out masks.
Hong Kong, shaped by lasting scars as an epicenter of the SARS outbreak,
announced very tough measures. Officials there urged travelers to avoid Mexico
and ordered the immediate detention of anyone arriving with a fever higher than
100.4 degrees Fahrenheit after traveling through any city with a confirmed case,
which would include New York.
Everyone stopped will be sent to a hospital for a flu test and held until it is
negative. Since Hong Kong has Asia’s busiest airport hub, the policy could
severely disrupt international travel.
The central question is how many mild cases Mexico has had, Dr. Martin S.
Cetron, director of global migration and quarantine for the Centers for Disease
Control, said in an interview.
“We may just be looking at the tip of the iceberg, which would give you a skewed
initial estimate of the case fatality rate,” he said, meaning that there might
have been tens of thousands of mild infections around the 1,300 cases of serious
disease and 80 or more deaths. If that is true, as the flu spreads, it would not
be surprising if most cases were mild.
Even in 1918, according to the C.D.C., the virus infected at least 500 million
of the world’s 1.5 billion people to kill 50 million. Many would have been saved
if antiflu drugs, antibiotics and mechanical ventilators had existed.
Another hypothesis, Dr. Cetron said, is that some other factor in Mexico
increased lethality, like co-infection with another microbe or an unwittingly
Flu experts would also like to know whether current flu shots give any
protection because it will be months before a new vaccine can be made.
There is an H1N1 human strain in this year’s shot, and all H1N1 flus are
descendants of the 1918 pandemic strain. But flus pick up many mutations, and
there will be no proof of protection until the C.D.C. can test stored blood
serum containing flu shot antibodies against the new virus. Those tests are
under way, said an expert who sent the C.D.C. his blood samples.
Reporting was contributed by Sheryl Gay Stolberg from Washington, Jack Healy
from New York, Keith Bradsher from Hong Kong and Ian Austen from Ottawa.
U.S. Declares Public
Health Emergency Over Swine Flu, NYT, 27.4.2009,
April 24, 2009
The New York Times
In a further break from the Bush administration’s ideologically driven
policies on birth control, the Food and Drug Administration has agreed to let
17-year-olds get the morning-after emergency contraceptive pills without a
doctor’s prescription. It is a wise move that complies with a recent order by a
federal judge, based on voluminous evidence in F.D.A. files that girls that
young can use the pills safely.
For much of the Bush administration, the agency — ignoring the advice of its own
scientists — refused to let the pills be sold over the counter to anyone. It
insisted that women obtain a prescription, a time-consuming process that could
often render the pills useless. The morning-after medication, actually two pills
taken in sequence, blocks a pregnancy if taken within 72 hours of intercourse
and is most effective within the first 24 hours.
Facing intense Congressional and legal pressure, the F.D.A. finally relented in
2006 and made the pills available to women 18 and older without a prescription.
So far there has been no measurable effect on abortion or teenage pregnancy
rates. But individual women in distress have surely benefited from easier
Now the agency has announced that it will not appeal a federal judge’s ruling
that it must lower the age limit by another year. Still to be determined is how
the F.D.A. will respond to the judge’s additional order that it consider
removing any age restrictions, as recommended by health authorities. There is no
indication that the manufacturer plans to seek the agency’s permission to market
to girls 16 or younger.
in the Long Drive to Cure Cancer
April 24, 2009
The New York Times
By GINA KOLATA
In 1971, flush with the nation’s success in putting a man on the Moon,
President Richard M. Nixon announced a new goal. Cancer would be cured by 1976,
When 1976 came and went, the date for a cure, or at least substantial progress,
kept being put off. It was going to happen by 2000, then by 2015.
Now, President Barack Obama, discussing his plans for health care, has vowed to
find “a cure” for cancer in our time and said that, as part of the economic
stimulus package, he would increase federal money for cancer research by a third
for the next two years.
Cancer has always been an expensive priority. Since the war on cancer began, the
National Cancer Institute, the federal government’s main cancer research entity,
with 4,000 employees, has alone spent $105 billion. And other government
agencies, universities, drug companies and philanthropies have chipped in
uncounted billions more.
Yet the death rate for cancer, adjusted for the size and age of the population,
dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart
disease dropped 64 percent in that time, and for flu and pneumonia, it fell 58
Still, the perception, fed by the medical profession and its marketers, and by
popular sentiment, is that cancer can almost always be prevented. If that fails,
it can usually be treated, even beaten.
The good news is that many whose cancer has not spread do well, as they have in
the past. In some cases, like early breast cancer, drugs introduced in the past
decade have made an already good prognosis even better. And a few rare cancers,
like chronic myeloid leukemia, can be controlled for years with new drugs.
Cancer treatments today tend to be less harsh. Surgery is less disfiguring,
chemotherapy less disabling.
But difficulties arise when cancer spreads, and, often, it has by the time of
diagnosis. That is true for the most common cancers as well as rarer ones.
With breast cancer, for example, only 20 percent with metastatic disease —
cancer that has spread outside the breast, like to bones, brain, lungs or liver
— live five years or more, barely changed since the war on cancer began.
With colorectal cancer, only 10 percent with metastatic disease survive five
years. That number, too, has hardly changed over the past four decades. The
number has long been about 30 percent for metastatic prostate cancer, and in the
single digits for lung cancer.
As for prevention, progress has been agonizingly slow. Only a very few things —
stopping smoking, for example — make a difference. And despite marketing claims
to the contrary, rigorous studies of prevention methods like high-fiber or
low-fat diets, or vitamins or selenium, have failed to find an effect.
What has happened? Is cancer just an impossibly hard problem? Or is the United
States, the only country to invest so much in cancer research, making
fundamental mistakes in the way it fights the cancer war?
Researchers say the answer is yes on both counts. Cancer is hard — it is not one
disease or, if it is, no one has figured out the weak link in cancer cells that
would lead to a cure. Instead, cancer investigators say, the more they study
cancer, the more complex it seems. Many are buoyed by recent progress in cancer
molecular biology, but confess they have a long way to go.
There also are unnecessary roadblocks. Research lurches from fad to fad — cancer
viruses, immunology, genomics. Advocacy groups have lobbied and directed
research in ways that have not always advanced science.
And for all the money poured into cancer research, there has never been enough
for innovative studies, the kind that can fundamentally change the way
scientists understand cancer or doctors treat it. Such studies are risky, less
likely to work than ones that are more incremental. The result is that, with
limited money, innovative projects often lose out to more reliably successful
projects that aim to tweak treatments, perhaps extending life by only weeks.
“Actually, that is the biggest threat,” said Dr. Robert C. Young, chancellor of
the Fox Chase Cancer Center in Philadelphia. “Every organization says, ‘Oh, we
want to fund high-risk research.’ And I think they mean it. But as a matter of
fact, they don’t do it.”
A recent New York Times/CBS News poll found the public divided about progress.
Older people, more likely to have friends or relatives who had died of cancer,
were more dubious — just 26 percent said a lot of progress had been made. The
figure was 40 percent for middle-aged people, who may be more likely to know
people who, with increased screening, had received a cancer diagnosis and seemed
Yet the grim facts about cancer can be lost among the positive messages from the
news media, advocacy groups and medical centers, and even labels on foods and
supplements, hinting that they can fight or prevent cancer. The words tend to be
carefully couched, but their impression is unmistakable and welcomed: cancer is
preventable if you just eat right and exercise. If you are screened regularly,
cancers can be caught early and almost certainly will be cured. If by some awful
luck, your cancer is potentially deadly, miraculous new treatments and more in
the pipeline could cure you or turn your cancer into a manageable disease.
Unfortunately, as many with cancer have learned, the picture is not always so
Phyllis Kutt, 61, a retired teacher in Cambridge, Mass., believed the
advertisements and public service announcements. She thought she would never get
cancer — she is a vegetarian, she exercises, she is not overweight, she does not
smoke. And only two people in her extended family ever had cancer.
Then, in May 2006, Ms. Kutt’s mammogram showed a foggy spot. The radiologist
decided it was insignificant, but six months later, her internist found a
walnut-sized lump in her right breast close to her armpit. It was the area that
had been foggy on the mammogram.
“I was in real shock,” Ms. Kutt said. “How could this be happening to me?”
Still, it looked as if she would be fine. There was no sign of cancer in her
lymph nodes, and her surgeon removed the tumor.
Ms. Kutt, her husband and her oncologist were worried, though, and decided on
aggressive treatment — four months of chemotherapy followed by 33 rounds of
radiation. When it ended, she thought she was finished with cancer.
“My doctors never used the word ‘cure’ and I bless them for that,” Ms. Kutt
said. “But they do celebrate the end of chemo and they celebrate the end of
Last May the cancer came back, as a string of tiny lumps under her arm and a
lump on her bicep. CT scans revealed she also had tumors in her lungs.
But cancer is curable, she thought. There are amazing new treatments. She found
It turns out that, with few exceptions, mostly childhood cancers and testicular
cancer, there is no cure once a cancer has spread. The best that can be done is
to keep it at bay for a while.
Last June, Ms. Kutt started a new regimen — three weeks of chemotherapy,
followed by a week off. She is also taking a new drug, Avastin.
“I am still on that and will be forever until the cancer progresses and I change
to other drugs or some new drugs are developed, or I die,” she said.
The hardest part is explaining to friends and family.
“People will say to me, ‘So when is your treatment going to be over?’ ” Ms. Kutt
said. “That’s the perception. You get treated. You’re done. You’re cured.”
“I think some of my family members still believe that,” she added. “Even though
I told them, they forget. I get cards from my nieces, ‘How are you doing? You’ll
be done soon, right?’ ”
Dr. Leonard Saltz, a colon cancer specialist at Memorial Sloan-Kettering Cancer
Center, deals with misperceptions all the time. “People too often come to us
expecting that the newest drugs can cure widespread metastatic cancer,” Dr.
Saltz said. “They are often shocked to find that the latest technology is not a
One reason for the misunderstanding, he said, is the words that cancer
researchers and drug companies often use. “Sometimes by accident, sometimes
deliberately, sometimes with the best intentions, sometimes not, we may paint a
picture that is overly rosy,” he said.
For example, a study may state that a treatment offers a “significant survival
advantage” or a “highly significant survival advantage.” Too often, Dr. Saltz
says, the word “significant” is mistaken to mean “substantial,” and “improved
survival” is often interpreted as “cure.”
Yet in this context, “significant” means “statistically significant,” a
technical way of saying there is a difference between two groups of patients
that is unlikely to have occurred by chance. But the difference could mean
simply surviving for a few more weeks or days.
Then there is “progression-free survival,” which doctors, researchers and
companies use to mean the amount of time from the start of treatment until the
tumor starts growing again. It does not mean that a patient lives longer, only
that the cancer is controlled longer, perhaps for weeks or, at best, months. A
better term would be “progression-free interval,” Dr. Saltz said. “You don’t
need the word ‘survival’ in there.”
As a doctor who tries to be honest with patients, Dr. Saltz says he sees the
allure of illusions.
“It would be very hard and insensitive to say, ‘All I’ve got is a drug that will
cost $10,000 a month and give you an average survival benefit of a month or
two,’ ” he said. “The details are very, very tough to deal with.”
That does not help Ms. Kutt, who chafes at the way breast cancer is presented —
the pink ribbons, the celebration of survivors, the emphasis on early detection,
as though that will insure you will never get an incurable cancer.
She knows she frightens people with her bald head, so obviously a cancer
patient. When someone is on crutches with a broken ankle, strangers offer
condolences and ask about the injury. But people avert their eyes when they see
Ms. Kutt. Only once, she said, did a stranger approach, and that was a woman who
also had breast cancer.
And in her online discussion group of women with metastatic disease, some said
they had been asked to leave breast cancer support groups. Members whose cancer
had not spread considered themselves survivors, and those whose cancer had
spread were too grim a reminder of what could happen.
“It’s fear,” Ms. Kutt said. “You’re part of the death group.”
Advances Elusive in the
Long Drive to Cure Cancer, NYT, 24.4.2009,
With Son in Remission,
Family Looks for Coverage
April 21, 2009
The New York Times
By KEVIN SACK
HUMBLE, Tex. — When Danna Walker left the second-floor conference room and
returned tearily to her desk — where someone had already deposited a packing box
for her belongings — her first thought was not of the 14 years she had worked
for DHL or the loss of her $37,000-a-year salary.
It was of Jake. In three months, once her benefits ran out, how in the world
would she provide health insurance for Jake, her mountainous, red-headed
21-year-old son, who had learned three years earlier that he had metastatic
Since the day she was laid off in October, Ms. Walker and her husband, Russ,
co-owner of a struggling feed store here on the outskirts of Houston, have
mounted a largely fruitless quest to find affordable coverage for Jake’s
pre-existing condition. Their odyssey has become all too familiar to millions of
newly uninsured Americans who suddenly find themselves one diagnosis away from
medical and financial devastation.
The Walkers, both 46, are among nine million people who have lost
employer-sponsored insurance since December 2007, according to projections by
the Kaiser Family Foundation. Some have qualified for government insurance, and
others have bought individual policies. But an estimated four million have
joined the ranks of the uninsured, heightening the urgency in Washington to
close the coverage gaps in American health care.
Like many others, the Walkers live on a knife’s edge of risk. Without insurance
to cover her high blood pressure or his diabetes, they defer doctors’ visits
when possible and obtain their prescriptions — nine between the two of them —
for $4 apiece at Wal-Mart.
But their primary concern has been finding insurance for Jake, who, after four
operations, two stem cell transplants and round after grueling round of
chemotherapy, has been cancer-free for a year.
He continues to face a significant threat of recurrence and requires regular
monitoring for at least two years. His twice-a-year CT scans cost $3,000 each,
and quarterly blood tests and X-rays run more than $1,000.
Late last month, in a race against the clock, the Walkers obtained a short-term
policy for Jake through Oklahoma State University, where he is a junior studying
animal science on a scholarship. Doing so could be crucial to his future
insurability because federal law allows insurers to deny coverage for
pre-existing conditions when there has been a gap in coverage of at least 63
With a week to spare, they scraped together $335 to pay the quarterly premium by
delaying a house payment and pleading with the power company for a 10-day
extension. But the policy will expire on May 16, and its coverage limits will
afford minimal protection against bankruptcy if the cancer returns before then.
Now the Walkers face the possibility that Jake will no longer be seen at
Houston’s renowned M.D. Anderson Cancer Center, which they credit for his
“You realize how vulnerable you really are,” said Ms. Walker, who exhibits the
maternal ferocity of a black bear. “You just — not give up — but you just feel
that you’re at a loss, that you’re at your wits’ end. I ask myself, ‘Do I really
have to lose my home to save my son’s life?’ ”
Neither of the Walkers has been able to land a job with the kind of large group
coverage that would disregard Jake’s health status. His cancer history
effectively makes him uninsurable on the individual market. He is too old to
qualify for Medicaid as a child, and it is virtually impossible in Texas to
qualify as an able-bodied adult.
Because the Walkers own their modest house, they have been told they do not
merit other government assistance. With little predictable income beyond Ms.
Walker’s $688 unemployment check every two weeks, the family cannot afford the
state’s high-risk insurance pool or continuation coverage through the federal
To date, Jake’s treatment has cost nearly $2 million. Almost all of it has been
paid by Cigna under a preferred-provider family policy that Ms. Walker paid
$426.28 a month for through DHL, the troubled shipping company where she worked
as a billing agent.
Until last fall, Mr. Walker was the co-owner of a business that supplied DHL
with trucks and drivers, but it too fell victim to downsizing. The feed store,
the last in an area where suburbs are swallowing ranchland, has been losing
What has made the Walkers feel most helpless, though, is that their son has been
left so exposed, after all he has endured.
“Your job as a parent is to protect your children at any cost,” Ms. Walker said.
“I really felt like I had let him down.”
At 6-foot-2 and 285 pounds, Jacob Walker often dwarfs the prize livestock he
parades in the show ring. He first noticed that his left testicle had become
larger than the other as a senior in high school. He waited a few weeks to tell
his parents so he would not miss the county fair, where his favorite heifer and
goat both won grand-champion ribbons. By then, the cancer had spread to his
abdomen, and he received a Stage 3 diagnosis.
Over the next two years, surgeons would remove the testicle and slice off
diseased sections of his abdomen and liver. The chemotherapy preceding the stem
cell transplants was so toxic that it peeled his skin.
Through it all, Jake maintained an optimistic determination. “Life’s tough,” he
would say. “Sometimes you have to get a helmet and run with it.”
His mother left the hospital once in 26 days during the stem cell transplants.
When he started college online from his hospital bed, she read to him from his
world-literature text. His father, not often given to emotion, started telling
his son every day that he loved him, before going home to cry. During Jake’s
chemotherapy, his buddies in Future Farmers of America shaved their heads in
Late in 2007, Jake’s doctors at Texas Children’s Hospital told him that they had
done all they could and gave him a 20 percent chance of surviving the next year.
The Walkers were not ready to quit, and sought out Dr. Lance C. Pagliaro, a
specialist at M. D. Anderson.
Dr. Pagliaro recommended an experimental chemotherapy regimen, and Jake has
shown no sign of cancer since the treatments ended in March 2008. “Needless to
say, we’re very pleased with how he’s doing,” Dr. Pagliaro said.
But during Jake’s check-up in December, Ms. Walker told the hospital that her
son would be uninsured at the end of January. She said a hospital official then
told her that if she was not able to pay up front, she should take her son
Dr. Pagliaro pledged that he would do what he could to make sure that Jake would
be seen. “To deny him the relatively inexpensive follow-up that is so crucial,”
he said in an interview, “just makes absolutely no sense.”
But the doctor has yet to intercede with the business office about waiving fees,
saying it would be premature. Last month, when the Walkers showed up for an
appointment with Jake’s oncologist, only a last-minute dispensation enabled him
to be seen without payment in advance. The Walkers left with the impression they
would be billed $700; the hospital says it will be $1,507. In either event, they
have no way to pay it.
The hospital has suggested that Jake have his next tests elsewhere and send the
results to Dr. Pagliaro to review, with payment to be negotiated in advance.
The Walkers are now completing the voluminous paperwork to apply for M. D.
Anderson’s charity care program for Texas residents. The hospital, which had
$2.2 billion in net patient revenue last year, spent $209 million on such
But Dr. Ron Walters, the hospital’s vice president for medical operations, said
economic pressures had made it more difficult to assist patients who were not
under active treatment. Dr. Walters said it had been “good financial counseling”
to advise the Walkers to explore other options, and questioned whether they
would qualify for charity care because they had assets. Among the criteria, he
said, is whether a patient can receive comparable treatment elsewhere.
Dr. Walters said requests for deferred payment by uninsured patients had risen
tenfold in four years. But Ms. Walker said she could not help taking the
hospital’s stance personally.
“You feel like you’ve been kicked to the curb,” she said. “It’s like, ‘As long
as you have insurance, we’re willing to go over the moon to see you and make
sure that everything is taken care of.’ And the minute you don’t, they don’t
The Walkers had not heard about the Texas Health Insurance Risk Pool, which
provides coverage to 26,550 otherwise uninsurable people. Once they learned
about it, they concluded they could not afford the most useful policy for Jake,
a plan with a $1,000 deductible that would cost $414 a month.
Now they are revisiting whether they might extend their P.P.O. coverage under
Cobra, which allows laid-off workers to continue their insurance at full price
for up to 18 months. When Ms. Walker first investigated, she learned it would
cost $1,359 a month to replicate her coverage.
The recently enacted federal stimulus package includes a 65 percent subsidy for
nine months of Cobra coverage for the newly unemployed. That would reduce the
Walkers’ price to $476 a month, which they said they still could not afford.
They are now inquiring about whether they can cover only Jake. If they can find
a policy for him for less than $200 a month, Ms. Walker said, she would find a
“It will happen,” she said, “if I have to walk up and down the street and
collect tin cans.”
Brent McDonald contributed reporting.
With Son in Remission,
Family Looks for Coverage, NYT, 21.4.2009,
A Cadaver, for
the Sake of Science
April 2, 2009
The New York Times
To the Editor:
Body of Knowledge,” by Christine Montross (Op-Ed, March 27), was a welcome
reminder of the value of human dissection.
An anatomical image is just an image. But the cadaver is the medical student’s
first patient and the first encounter with the emotional burden of becoming a
physician. The impact is nowhere more apparent than in the student’s initial
reaction to dissection.
The sight and smell of the body, the sounds of cutting and sawing, and the feel
of human flesh have effects both empathic and repulsive. These sensations
provide the earliest opportunity to examine how doctors manage (or mismanage)
the inevitable emotions associated with patient care.
Taught properly, dissection of the cadaver allows students to examine
themselves. Gary J. Kennedy
Bronx, March 30, 2009
The writer, a professor of psychiatry at the Albert Einstein College of
Medicine, is the co-author of “Cadaver Conference: A Psychiatrist in the Gross
To the Editor:
In my human anatomy class, I came to appreciate the uniqueness of the individual
human body. I found that structures like arteries, veins, ducts and even organs
vary greatly from what is shown in textbooks or on computer scans.
Dissecting the human cadaver proved to be a truly visceral experience. Seeing,
touching, smelling, moving muscles and bones helped me as an anatomy student
(and later as an anatomy instructor) to use a very important organ, my brain, to
decipher the complexity and beauty of the human body, both on an intellectual
and an emotional level.
I agree with Christine Montross. Cadaver dissection is indeed a vital part of
the anatomy curriculum.
Long Valley, N.J., March 28, 2009
To the Editor:
No research demonstrates that learning anatomy using medical imaging is inferior
to the information gained through the brief dissection of the one cadaver
allotted to each medical student.
The role of technology and medical imaging will inevitably increase in anatomy
courses. New digital tools like the ones we are developing at Stanford have been
shown to greatly enhance the learning experience. We now have the ability to
visualize and interact with anatomical information that was previously
Teaching anatomy cannot be couched in an either-or framework; instead,
technology and cadavers should enhance each other. Only well-designed, validated
studies will provide answers to the issues introduced by Christine Montross.
W. Paul Brown
Stanford, Calif., March 30, 2009
The writer, a dentist, is a consulting associate professor in the Division of
Anatomy at Stanford University.
To the Editor:
I am disappointed to read in Christine Montross’s article that medical schools
are contemplating the transfer of anatomy from actual cadavers to virtual
reality because of cost.
As a first-year medical student, I find that most of our time is spent
relentlessly memorizing the exhaustive body of knowledge that has accumulated
through the years of research and science. It would be a great disservice to the
future of medicine to remove the single most important tool first- and
second-year medical students can physically access.
The cadavers present information that is simply inaccessible through the
computer. Could we simulate the systemic spread, consistency and color of the
many cancers discovered in the bodies? Would we empathize in the same way
looking through a monitor? Would a three-dimensional view be fully reproduced on
a two-dimensional screen?
It is my view that the answer to these, and countless more, is no.
Kansas City, Kan., March 27, 2009
To the Editor:
Most important, cadaver dissection enables students to appreciate the enormous
amount of anatomical variation among human beings. A computer program cannot
convey the fact that physical phenomena like aberrant arteries, accessory
glandular tissue or atrophied muscles belong to a particular formerly living
Dissection allows students to recognize people as truly unique individuals in
body and in spirit, each with their own “irregularities.”
Without going into the lab, students may fail to consider a fundamental tenet of
medicine: no two patients are identical, and therefore all medical care must be
individualized. Geoff Rubin
New York, March 27, 2009
The writer is a first-year medical student at the Columbia College of Physicians
To the Editor:
Christine Montross has perfectly described the value and beauty of the human
body when compared with electronic imaging. In pathology we often say “a picture
is worth a thousand words, but a specimen is worth a thousand pictures.”
Dennis G. O’Neill
Manchester, Conn., March 27, 2009
The writer, a medical doctor, is director of the department of pathology and
laboratory services at Manchester Memorial Hospital.
A Cadaver, for the Sake
of Science, NYT, 2.4.2009,