Message in a Bottle: The Making of Fetal Alcohol Syndrome
http://www.100md.com
《新英格兰医药杂志》
The author, a history professor, reviews the responses of medical, political, and legal institutions to the fetal alcohol syndrome. Leaving the biomedical discussion to standard medical textbooks, she focuses in this book on a social context beyond the consulting room.
Golden recounts the reluctance of physicians and society to accept alcohol as a teratogen, in spite of warnings dating back centuries. For example, Josef Warkany's monumental 1971 work on congenital malformations did not indict alcohol nor even include it in the index (the complete syndrome includes malformations of the face, viscera, and brain). The concept of a fetal alcohol syndrome emerged in the 1960s and 1970s, during a revolutionary expansion of knowledge about teratogenesis. It was the era of the realization that "the face predicts the brain," when physicians recognized many face–brain malformation syndromes and correlated them with abnormal karyotypes or exogenous teratogens. Golden points out that wide publicity about thalidomide-induced phocomelia had primed the profession to expect the identification of other teratogens in humans.
She reviews the polarized debates among religionists, feminists, and legislators as to whether to consider maternal alcoholism, with its potential for harming the fetus, as a moral failure or a disease that requires compassionate treatment. Should the law punish an alcoholic mother? Is the harmed child justified in suing her? Is brain impairment due to the fetal alcohol syndrome a justifiable defense for a criminal or, as attorney Alan Dershowitz contends, an "abuse excuse" that replaces personal responsibility with a diagnostic label? In the debate over "medicalizing" deviancies such as alcoholism and compulsive gambling as sicknesses, I would hope that physicians would prefer medicalization to punishment.
Because each new discovery opens a Pandora's box of reactions, physicians need to find effective means of public education that will elicit productive responses from society. In this area, Golden highlights the shortcomings of the news media, government agencies, and the courts and points to the resistance of manufacturers to publicizing warnings that raise liability concerns or that may result in controversial legislation.
Golden writes clearly, though occasionally repetitiously, and provides abundant references. She avoids personal polemics and evangelizing. Her modus operandi is to quote opposing viewpoints in their historical context and then underline contradictions. At times the reader may almost wish for recommendations, but Golden eschews easy answers. Most physicians and health workers will find the book interesting and provocative and will come away with a much fuller appreciation of the complex responses that medical discoveries trigger in society. These are excellent outcomes for a book.
William DeMyer, M.D.
Indiana University School of Medicine
Indianapolis, IN 46202
wdemyer@iupui.edu(Janet Golden. 232 pp. Cam)
Golden recounts the reluctance of physicians and society to accept alcohol as a teratogen, in spite of warnings dating back centuries. For example, Josef Warkany's monumental 1971 work on congenital malformations did not indict alcohol nor even include it in the index (the complete syndrome includes malformations of the face, viscera, and brain). The concept of a fetal alcohol syndrome emerged in the 1960s and 1970s, during a revolutionary expansion of knowledge about teratogenesis. It was the era of the realization that "the face predicts the brain," when physicians recognized many face–brain malformation syndromes and correlated them with abnormal karyotypes or exogenous teratogens. Golden points out that wide publicity about thalidomide-induced phocomelia had primed the profession to expect the identification of other teratogens in humans.
She reviews the polarized debates among religionists, feminists, and legislators as to whether to consider maternal alcoholism, with its potential for harming the fetus, as a moral failure or a disease that requires compassionate treatment. Should the law punish an alcoholic mother? Is the harmed child justified in suing her? Is brain impairment due to the fetal alcohol syndrome a justifiable defense for a criminal or, as attorney Alan Dershowitz contends, an "abuse excuse" that replaces personal responsibility with a diagnostic label? In the debate over "medicalizing" deviancies such as alcoholism and compulsive gambling as sicknesses, I would hope that physicians would prefer medicalization to punishment.
Because each new discovery opens a Pandora's box of reactions, physicians need to find effective means of public education that will elicit productive responses from society. In this area, Golden highlights the shortcomings of the news media, government agencies, and the courts and points to the resistance of manufacturers to publicizing warnings that raise liability concerns or that may result in controversial legislation.
Golden writes clearly, though occasionally repetitiously, and provides abundant references. She avoids personal polemics and evangelizing. Her modus operandi is to quote opposing viewpoints in their historical context and then underline contradictions. At times the reader may almost wish for recommendations, but Golden eschews easy answers. Most physicians and health workers will find the book interesting and provocative and will come away with a much fuller appreciation of the complex responses that medical discoveries trigger in society. These are excellent outcomes for a book.
William DeMyer, M.D.
Indiana University School of Medicine
Indianapolis, IN 46202
wdemyer@iupui.edu(Janet Golden. 232 pp. Cam)