Medical Oxygen- Starving Practices and Experiments
Medical oxygen- starving practices and experiments
1. Unacceptable risks for uncertain benefits
Many premature babies die or suffer major permanent injuries because they do not receive enough oxygen in their first few days when they need it most(1,2,3.)
Until the often still immature lungs of these preemies can extract enough of this life- sustaining gas from the air they breathe, they need this essential nourishment in higher concentrations than babies more ready for the transition to life outside the womb.
Their need for more concentrated oxygen is similar to their need for the higher concentrations of essential food proteins which mothers of preemies provide in their milk as compared to that from mothers who carried their babies to term(4). The difference is that Nature tailors their food to their needs, but not their air.
Physicians have thus recommended since the turn of the century to help premature babies with higher- than- normal concentrations of oxygen, and many have fed them such enriched baby- fare of the lungs with consistent success and no harmful side effects(5, 6).
However, in 1954 the preemies' physicians began to curtail this choice remedy for respiratory diseases to the brink of babies turning blue from asphyxiation, and sometimes beyond. Even today, they still minimize the concentration of supplementary oxygen as well as the time they allow the preemies to enjoy any enriched breathing, despite their lack of knowledge what safety margin, if any, they have in so depriving the preemies, and despite the often confirmed experience that reducing the oxygen supply for preemies increases the mortality and morbidity among them.
The official reason for this systematic lung starvation is the nursery doctors' fear that too much oxygen could cause the babies to develop retinopathy of prematurity (ROP), formerly also called retrolental fibroplasia.
This retinal disease common in intensive care nurseries affects now to some degree up to two thirds of the smallest premature babies and up to one third of the larger ones. Most of the affected infants recover with minor or no immediately noticeable damage to their eyes, but many do not. Among the most susceptible babies, those with birth weights around three pounds or less, ROP was said to have in 1985 severely impaired the vision of about one in ten, and to have completely blinded up to about one in fifty(7).
Back in 1952, shortly before the oxygen starvation regimen was introduced, and a dozen years after the sudden appearance of the disease, the incidence of "gross visual defects" from ROP among the babies born in the same birth weight group in the state of New York was reported as about one in eighteen(8).
A few years after that report, the prescription to prevent this disease with oxygen restrictions was found to have cost the lives of an estimated extra one in twenty babies9 in a more than eight times larger10 group of mostly heavier-born preemies from the Baltimore region. That is, the rate of deaths from the cure around Baltimore was about eight times higher than the rate of gross visual defects from the disease had been in the state of New York.
The one-in-twenty extra deaths estimate is based on a review of autopsy reports in 1960 at Johns Hopkins Hospital in Baltimore. Two physicians there compared the rates of death from hyaline membrane disease, or breathing problems, among preemies with birth weights between 1000 and 2500 grams during five years before the oxygen rationing and five years after its beginning. They found that the hyaline membrane disease death rate had more than doubled, and that this sudden increase in that one cause had raised the overall mortality among those babies from 8% before the oxygen withholding doctrine to 13% after its introduction.
That comparison covered 1152 and then 1492 autopsy reports at one hospital; extrapolations from such small groups can be unreliable because the sample may not be representative. However, all the intensive care nurseries from Coast to Coast followed essentially similar oxygen policies based on the same suddenly introduced and much publicized official guidelines, with presumably very similar effects.
One can thus at least gain an impression about the order of magnitude for the respiratory distress epidemic by applying the 5% increase in mortality in and around Baltimore to the about 315,000 babies born nationwide in 1960 with birth weights below 2500 grams11. This calculation yields roughly 16,000 extra deaths per year in the United States from the oxygen withholding. Since the babies with birth weights below 1000 grams who were not included in the Baltimore review were even more likely to have died from lack of oxygen, the true toll was probably even higher.
The babies would certainly have been better off without this prevention effort: in the years before the oxygen throttling, ROP severely impaired the vision of at most up to 2,000 babies per year in the United States(12) and totally blinded less than 1,000 among these(13).
Two British researchers arrived in the early 1970s at surprisingly similar conclusions by an entirely different method. They compared the actual and expected mortality rates on the day of birth and during the first month of life for the periods before and during the oxygen restrictions, and they saw a striking picture emerge: after several decades of a steadily incremental decline, at the beginning of the oxygen withholding the graph of these rates began to diverge sharply from its projected path.
Instead of further diminishing, the annual toll in early deaths suddenly stagnated and even rose. The researchers took the differences between the projected and the reported death rates as related to the oxygen rationing and then divided the so calculated number of extra deaths by the difference in ROP cases before and during the oxygen rationing. By this method, they computed that the practice of oxygen withholding had cost in England and Wales about 16 deaths for each case of blindness prevented(14).