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Acceptable EvidenceScience and Values in Risk Management$
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Deborah G. Mayo and Rachelle D. Hollander

Print publication date: 1994

Print ISBN-13: 9780195089295

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195089295.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 05 December 2021

Understanding Uncertainties in Medical Evidence: Professional and Public Responsibilities

Understanding Uncertainties in Medical Evidence: Professional and Public Responsibilities

6 (p.115) Understanding Uncertainties in Medical Evidence: Professional and Public Responsibilities
Acceptable Evidence

Valerie Mike

Oxford University Press

The case of Linda Loerch and her son Peter presented to the Minnesota Supreme Court raises the question of whether legal liability can extend beyond the second generation. During the pregnancy leading to Linda’s birth, her mother had taken the synthetic hormone diethylstilbestrol, commonly known as DES. Linda herself has a deformed uterus, and her son Peter, born twelve weeks prematurely, is a quadriplegic afflicted with cerebral palsy. The family is seeking damages for the child’s condition from Abbott Laboratories, the manufacturer of the drug taken forty years earlier by his grandmother (MacNeil/Lehrer 1988). The claims of this lawsuit hinge on the evidence available when the drug was prescribed. The case illustrates, with some new ramifications, the interrelated issues of ethics and evidence surrounding the practice of medicine, a major theme of this chapter. The DES story first became national news at a time that marked the rise of the new field of bioethics. The Food and Drug Administration (FDA) issued a drug alert in 1971 to all physicians concerning the use of DES by pregnant women, as an association had been found between the occurrence of a rare form of cancer of the vagina in young women and their mothers’ exposure to DES. The drug had been prescribed widely since the 1940s for a variety of medical conditions, including the prevention of miscarriages. It is estimated that during this period four to six million individuals, mothers and their offspring, were exposed to DES during the mothers’ pregnancy. The full dimensions of the medical disaster, the subject of continued controversy, have yet to be firmly established. DES daughters are at risk of developing clear cell adenocarcinoma of the vagina, the risk estimated to be one per one thousand by age twenty-four. Ninety percent have a benign vaginal condition called adenosis, and many have other genital abnormalities. They are at higher risk of pregnancy loss and infertility. DES mothers also may be at a higher risk for breast and gynecological cancers, and DES sons may be at an increased risk of genitourinary abnormalities, infertility, and testicular cancer. DES may, as well, have affected fetal brain development, leading to behavioral problems and learning disabilities.

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