When health means wealth, can bioethicists respond?

Around the world the wealthy can get their lives extended while the poor get little basic medical help. Over the same years that the field of bioethics has prospered and expanded, this disparity has increased. Reasons for the failure of bioethics to successfully address this health/wealth issue include its identification with the cognitive and social authority of medicine; its gatekeeping behavior; its funding sources; its questionable use of "principlism" and its emphasis on crises and dilemmas to the neglect of "housekeeping" issues. The work of most women in bioethics rarely addresses the health/wealth issue; if it does, their work may be ignored, as were the recommendations of Canadian feminists working under government grants. To achieve equity in health care, the structure of both medicine and bioethics needs to be changed. Yet, since bioethicists generally have accepted the status quo, this seems unlikely to happen.

In vitro fertilization in the Netherlands: experiences and opinions of Dutch women.

We sent written questionnaires to 93 Dutch women [73 current and potential clients of the Rotterdam in vitro fertilization (IVF) program and 20 fertile nonusers] to determine the motivation for participation in IVF, patients' reactions to treatment, and views of concerned laypersons on current ethical/social issues. Seventy-eight (84%) completed the questionnaires. A large majority was strongly positive toward the having of children and toward IVF, but fewer fertile than infertile women (P less than 0.05) believed that "a child of one's own" was a right and that government insurance ought to cover IVF. Nearly all the patients (with or without successful pregnancies) were very satisfied with their clinical treatment and would recommend IVF. A large majority of all the women favored gamete donation and surrogate gestation, but fewer fertile than infertile women approved experiments with "spare" embryos or implanting donor embryos.

Pharyngoesophageal diverticula.

We reviewed 17 cases of pharyngoesophageal diverticula treated at the Medical University of South Carolina during the period 1955 to 1979. Of these 17 patients, 13 had primary excision of the diverticulum, with no deaths, one recurrence, and two significant complications. One patient with a perforated diverticulum died after simple drainage. The average age of the patients was 68, with a range of 40 to 83 years. The indicence of concurrent serious disease was quite high. We conclude that primary diverticulectomy is the current treatment of choice and is the standard against which other surgical technics must be measured. The place of cricopharyngotomy deserves further evaluation.

Hashimoto's thyroiditis and its relationship to other thyroid diseases.

The experience of the Medical University of South Carolina with Hashimoto's thyroiditis revealed an 8.3 per cent incidence of carcinoma. The most common type of carcinoma was an associated lymphoma. There was an additional 8.3 per cent incidence of a benign adenoma. Needle biopsy as a mechanism for diagnosing Hashimoto's disease, we believe, is inaccurate. A larger aliquot of tissue should be removed for the pathologist if there is a suspicion of an associated tumor. An open biopsy permits the pathologist to make an accurate diagnosis with a minimal amount of morbidity.