- 1905, the German surgeon H. F. W. Braun developed
novocaine, which rapidly became the most widely
used painkiller in dentistry. Its ability to blot
out pain, if not the noise of the drill,
encouraged the idea of regular dental checkups.
- 1909, Sigmund Freud visited the USA.
- 1910, Marie Curie isolated radium.
- 1916, Margaret Higgins Sanger opened the first
birth control clinic in Brooklyn. By 1925, the
former nurse had become world famous.
- 1918, the flu epidemic killed >21 million
people worldwide, including 12.5 million in India
and >500,000 in the USA.
- 1920, the bubonic plague struck India, killing at
least 2 million people.
- 1935, Frederic Joliot and Irene Curie, who at
marriage took each other's names to become
Joliot-Curie, received the Nobel Prize in
chemistry for their work in the production of
radioactive substances through bombardment by
alpha particles.
- 1940, Dr. Richard Charles Drew founded the blood
bank in New York City. Dr. Drew himself was
forbidden to donate blood there because he was
black.
- 1941, Howard Florey and Ernst Chain produced
penicillin in large quantities. Penicillin was
discovered in 1928 by Alexander Fleming and was
mass produced about 10 years later.
- 1946, Dr. Benjamin Spock's Common Sense Book
of Baby and Child Care appeared and became
the bible of American child care for decades. By
the time Benjamin Spock died in 1998, >50
million copies of various editions of his baby
care book had been sold around the world.
- 1950, Dr. Richard H. Lawle performed the first
organ transplant (kidney) in Chicago, Illinois.
- 1953, Dewey Watson (USA) and Francis Crick (Great
Britain) uncovered the double helix structure of
DNA, the principal component of the chromosomes
that determine our heredity.
- 1953, a woman was successfully impregnated with
frozen sperm. This event was followed later by
the introduction of sperm banks.
- 1954, Jonas Edward Salk developed the polio
vaccine, a killed-virus vaccine administered by
injection. Five years later, a live-virus vaccine
was developed for oral administration.
- 1954, a report indicating that cigarettes caused
cancer was published.
- 1960, the first laser (Light Amplification by
Stimulated Emission of Radiation) appeared.
- 1967, Christiaan Barnard performed the first
heart transplant in South Africa. The recipient
lived 18 days.
- 1980, the US Supreme Court ruled that a microbe
created by genetic engineering could be patented.
The ruling opened the way to greatly increased
research in genetic engineering, since the
ability to patent the results of such work could
ensure eventual profits from it.
- 1981, Italian voters approved abortion. This
development was an enormous embarrassment to the
Vatican, which had found itself unable to defeat
the pro-choice forces even in its own backyard.
- 1981, AIDS was officially recognized and
discovered to be due to a virus called HIV.
- 1990, surgery on an unborn child was performed
within its mother's womb in London, United
Kingdom.
- 1997, an adult sheep was cloned in Edinburgh,
Scotland, producing a genetic copy named
“Dolly.”
SHINGLES
An estimated 1,000,000 Americans develop shingles
every year (2). Most are >50 years of age, and many
suffer months of incapacitating pain. Shingles is caused
by the same virus that causes chickenpox
(varicella-zoster virus). Until recently, just as the
fever and itchy blisters of chickenpox were an inevitable
part of childhood, shingles was considered an unavoidable
risk of old age, impossible to predict or prevent and
often accompanied by pain notoriously difficult to
control.
When children catch chickenpox, their rash scabs over
within a week or so and heals, but the virus does not
leave the body. It retreats from the skin back to large
clusters of nerve cells that lie on either side of the
spinal cord. There it lies dormant, kept in check by the
body's immune system. If something goes wrong with the
immune system years later, such as cancer or AIDS or
something as subtle as the normal changes in immunity
that occur with aging, the chickenpox virus can
reactivate in a cluster of nerve cells and begin to
reproduce again, heading back out along delicate
branching filaments of the nerves to the skin. Once back
in the skin, the virus causes exactly the same kind of
blisters as it did during chickenpox, but only in the
patch of skin where the nerves with the virus have
endings.
For unknown reasons, the varicella virus prefers to
hibernate in the nerves that transmit pain and other
sensations from the skin to the spinal cord, where a
second relay of nerves then transfers the information to
the brain for processing. As the virus reactivates these
nerves, it can interfere with their normal functioning.
Unless shingles is on the face and affects the eye,
the rash usually goes away after several weeks without
complications. But about 50% of people >60 years of
age have persistent pain in the area that lasts long
after shingles has faded. The reactivation of the
varicella virus in nerves that control pain and sensation
often winds up destroying those nerves. Patients with
severe postshingles pain may have lost >=80% of
sensory nerve endings in the affected skin. The loss of
so many nerves may cause electrical chaos in the spinal
cord that is interpreted by the brain as overwhelming
pain. Other nerves in the skin that normally transmit
sensations of temperature or pressure, but not pain, can
become confused after an episode of shingles and start to
transmit pain too. As a result, patients with
postshingles pain find the light touch of bedclothes, and
even the touch of clothing, excruciating.
The pain of shingles is rarely responsive to aspirin
or nonsteroidal anti-inflammatory drugs. Lidocaine
patches may be helpful. Antidepressant drugs and
antiseizure drugs are sometimes useful. Codeine and
morphine may help, but they seldom abolish the pain
entirely.
New hope is on the horizon, and it is the chickenpox
vaccine, which was licensed for use in the USA in 1995.
It is already reducing cases of chickenpox in some
communities by as much as 90%. The vaccine contains a
weakened strain of the chickenpox virus that is strong
enough to boost older adults' waning immunity against the
chickenpox virus. When adults who receive the vaccine
develop shingles, they appear to have notably mild cases,
without protracted pain.
A study is now under way to test the chickenpox
vaccine in men and women >60 years who had chickenpox
as children. Of the 37,000 volunteers to be enrolled from
sites across the USA, half will be given the chickenpox
vaccine and half a placebo vaccine, and the rates of
shingles and pain will be monitored in both groups. A
toll-free phone number (1-877-841-6251) will direct those
interested in participating to the nearest enrollment
center.
EFFECT OF EACH CIGARETTE ON LIFE
EXPECTANCY
Dr. Mike Ramsay recently called my attention to a
piece by Shaw and colleagues (3) from Bristol, United
Kingdom. These investigators, using previously published
data of 34,000 male physicians >40 years of age, found
a difference in life expectancy between smokers and
nonsmokers of 6.5 years. They calculated that a man who
smoked the average number of cigarettes a year (5772)
from the median starting age of 17 until death at age 61
would consume 311,688 cigarettes in his lifetime. Each
cigarette would then cost him, on average, 11 minutes of
life: 6.5 years = 2374 days or 56,976 hours or 3,418,560
minutes; 5772 cigarettes per year for 44 years = 311,688
cigarettes; and 3,418,560 divided by 311,688 equals 11
minutes per cigarette.
Health and cigarettes are simply incompatible. The
nonsmokers are paying a good percentage of the smokers'
health bills, and that's unfair.
THINK OF LEXINGTON AND DAKOTA CITY, NEBRASKA, WHEN
EATING BOVINE MUSCLE
Lexington, Nebraska, is a town of approximately 10,000
persons and the location of the world's largest
meatpacker, IBP (formerly Iowa Beef Packers), which kills
1 head of cattle every 11 seconds (4). IBP employs 2300
workers, or one quarter of Lexington's population,
and exports prime beef worldwide. The stench of burning
blood, bristle, and bone lingers in the western Nebraska
air, and the invisible toxic cloud burns the residents'
throats and leaves a bitter taste on their lips. The
dead, heavy, nauseating smell is hydrogen sulfide, a
byproduct of organic decay in cattle feed lots, the
city's sewer system, and IBP's slaughterhouse. Hydrogen
sulfide corrodes the lungs and starves the brain of
oxygen. The toxicity of hydrogen sulfide was first
identified in the deaths of mid–19th century sewer
workers in Paris and London.
In Dakota City, Nebraska, where IBP also does
business, the Justice Department recently filed a lawsuit
accusing IBP of violating federal air, water, and
hazardous waste laws at the company's flagship plant and
former headquarters. IBP apparently emitted up to 1800
pounds of hydrogen sulfide a day in Dakota City without
notifying federal regulators. (Disclosure is required for
hydrogen sulfide emissions >100 pounds a day.)
IBP is the largest cow slaughterer in the world, with
40% of the US market. It also is the number 2 hog
slaughterer (after Smithfield Foods). It has 53 plants in
North America and 45,000 employees. Its major customers
are Burger King, Morton's of Chicago, Pizza Hut,
Godfather Pizza, Honey Baked Hams, and most grocery
chains. It produces about 3000 different products,
including deli meats, frozen appetizers and entrees, and
pizza toppings and crusts; raw materials for pet food and
animal feed; gelatin for food products and photographic
film; leather hides for clothing, car seats, purses, and
furniture; tallow for cosmetics, paint, glue, shortening,
and soap; and pharmaceutical products. Few people who eat
the steaks smell the stench, unfortunately.
THE WORST NATURAL DISASTER IN HISTORY
It happened in December 1999, on the Caribbean coast
of Venezuela (5). The death toll reached 20,000, twice
the number killed in 1998 when Hurricane Mitch hit
Central America. An estimated 35,000 homes were
destroyed, and more than 150,000 people were left
homeless when torrential rains soaked the area's
deforested terrain. Massive mudslides and flooding caused
the destruction of life and property.
EUROPEAN WINDS DEVASTATE FORESTS
Aside from killing >130 people, 87 of them in
France, 2 freak storms whipped across western Europe in
December 1999, destroying >270 million trees in
France, or about 50 million cubic yards of wood (6).
That's enough to build 1.3 million average-sized American
homes. It could take a century for forests to recover
fully. The winds reached peaks of 125 miles per hour.
Among the destroyed trees were 10,000 in the 330-year-old
Ch?teau of Versailles gardens and park, which draw
>10 million visitors a year. In Paris, hundreds of
trees along avenues snapped or were wrenched whole from
the sidewalks. Thousands of buildings were damaged,
including centuries-old monuments such as Notre Dame in
Paris and 935 public schools. About 300,000 households in
France were without electricity or heat for long periods.
It is amazing that more people were not killed.
NATURESPORT
The same people who brought the Marquis de Sade, the
guillotine, and the Peugeot also devised the most
sadistic athletic event on earth, the Raid Gauloises
(7). It has been an annual event since 1989. The first
Raid Gauloises included 26 teams, which raced 300 miles
across New Zealand's mountainous South Island, setting a
new standard for physical torture in the name of sport.
The winning team made it across in 5 days, 21 hours, and
15 minutes. The 1998 race was the scaling of the
19,347-foot Mount Cotopaxi in Ecuador, one of the highest
active volcanoes. The April 2000 race will be a 300-mile
trek beginning in Tibet across the Himalayas to northern
India. I'm not sure that “sport” has to be such
torture.
SEX ON TELEVISION
Dr. Dale Kunkel of the University of California
recently conducted a study for the Kaiser Family
Foundation, in which more than 1300 television shows from
the 1997 to 1998 season were randomly selected and
analyzed for sexual content (8). With the exception of
newscasts, sports, and children's programming, 56% of all
television shows either talked about sex or portrayed
sexual behavior, while 67% of all network prime-time
shows contained sexual content, averaging >5 sexual
scenes per hour, which adds up to essentially 1 sex scene
for every 12 minutes of viewing.
SEXUAL DESIRE AFTER HYSTERECTOMY
Contrary to popular belief, women's sex lives tend to
improve after hysterectomy. In the largest study of its
kind, 1300 Maryland women were interviewed before having
a hysterectomy and then 3, 6, 12, 18, and 24 months
afterwards (9). They had surgery for the treatment of
noncancerous conditions, such as uterine fibroids and
bleeding. After hysterectomy, the number of women having
sexual relations at least 5 times a month increased by
10%. Furthermore, orgasms were more frequent and
stronger, there was less pain during sex, and desire
increased. Ironically, some of the women had put off the
operation for years, fearing that removal of the uterus
would diminish their sex lives. This is all good news
because about 600,000 hysterectomies are performed
annually in the USA.
EFFECT OF LATE-NIGHT SHIFTS ON
MARRIAGE
If Mom or Dad works the midnight-to-8 am shift, the
risk of divorce increases significantly compared with
couples in which both parents work daytime hours (10).
The risk of divorce is 6 times greater for couples
married <5 years and 3 times greater for couples
married >5 years. For one spouse to work nights
clearly adds extra stress to a marriage. Factors at play
might include sleep deprivation, the impact on the
family's social life, and lack of time alone as a couple.
This 5-year study by Harriet Presser involved 3475
married couples and was the first to examine what working
late-night hours does to the stability of marriages. The
findings don't hold up for couples without children who
work similar hours. It turns out that only 55% of
employed men and women regularly work a standard 35- to
40-hour workweek Monday through Friday on a fixed
daytime schedule. The rest work nonstandard schedules.
Two fifths of all employed Americans work mostly evenings
or nights on rotating shifts and/or weekends.
ALZHEIMER'S DISEASE AND MARRIAGE
Researchers in France followed up on 2881 people over
5 years and found that those who had never married were 3
times more likely to develop Alzheimer's disease than
those who were married (11). The protection continued
even after the death of a spouse.
EFFECT OF COHABITATION ON SUCCESS OF
MARRIAGE
The Marriage Project at Rutgers University recently
reported that more than half of all marriages in the USA
are now preceded by cohabitation with the significant
other. This premarital “trial arrangement,”
however, is proving to be a lousy test for the success of
the marriage (12). Couples who live together before
marriage, the Rutgers project reported, are far more
likely to divorce than couples who do not. That is partly
because cohabitation does not test the most important
thing one needs to know about a prospective spouse:
whether this person can be trusted to be there when times
are really tough. Instead, by its very nature,
cohabitation raises doubts about dependability, for
cohabitation is a make-no-lasting-promises sort of
relationship. It asks for the privilege of married
life—a shared bed, a shared residence, a shared
life—without commitment to do the hard work that
makes for genuine love. Another unfortunate part about
this, especially for those young people whose lives
already have been ripped apart by their parents' divorce,
is that just because the law distinguishes between the
breakup of a marriage and the breakup of a cohabiting
relationship doesn't mean the heart respects such
distinctions. Indeed, many cohabitants have found that
“dumping the significant other” (or being
dumped) can be as emotionally wrenching as going through
a divorce.
So how can a person in our romantically chaotic times
safely test whether a person of the opposite sex is
trustworthy enough to marry? William Mattox, Jr.,
suggests reading the book Wing to Wing, Oar to Oar
by University of Chicago professors Amy and Leon Kass.
The Kasses teach a popular course that exposes students
to a rich treasure trove of great writings on love and
marriage, including stories by Homer, Shakespeare, Moses,
and Jane Austen, and philosophical reflections by Plato,
Erasmus, C. S. Lewis, and Thomas Aquinas. Their anthology
is intended to help young people of marriageable age and
their parents think about the meaning, purpose, and
virtues of marriage, and, especially, about finding the
right person with whom to make a life.
DIVORCED POPULATION RISES
In 1900, the US population was approximately
130,000,000, and about 200,000 were divorced (13). In
2000, the US population is 273,000,000 and nearly
20,000,000 are divorced, a 100-fold increase in 100
years.
FATAL LOVE
In a 48-hour period, Kathleen, aged 19, Marie, aged
39, and Joy, aged 18, were targets of homicidal attacks
by men with whom they had had romantic relationships
(14). Two died immediately, and the third lived only
because her former boyfriend's pistol jammed. In all 3
cases, the men believed responsible for the attacks
committed suicide shortly afterwards.
This type of crime is commonplace. According to
homicide statistics collected by the Federal Bureau of
Investigation, 32% of the 3419 women killed in the USA in
1998, the latest year for which data are available, died
at the hands of a husband, a former husband, a boyfriend,
or a former boyfriend. Many experts, however, believe
that the true figure is much higher, perhaps as much as
50% to 70%. In comparison, 4% of 10,606 male homicide
victims in 1998 were killed by current or former intimate
partners.
Why are men so much more likely than women to kill
their partners? Feminist scholars and domestic violence
experts have long contended that such crimes reflect a
society in which men feel entitled to exercise power and
control over women and to use physical violence, when
necessary, to assert their dominance. Some evolutionary
psychologists also argue that men, as a whole, rather
than individual men, are the problem. They base this
assertion not on culture but on biology. Violence, they
believe, may have developed as a strategy for men to
exert proprietary control over women, and in particular
over their reproductive capacities. Other psychologists
focus on the personality characteristics and life
histories that lead men to batter and kill. At any rate,
social scientists in recent years have begun to
investigate homicides by intimate partners in a much more
systematic way, hoping to find ways to spot the potential
for lethal violence before it occurs and to develop
better tactics for intervention.
Many studies confirm that women are at particular risk
when they are in the process of leaving a relationship.
In a study of 293 women killed by intimates in North
Carolina from 1991 to 1993, 42% had been killed after
they threatened separation, tried to separate, or
recently separated from their partners. In another study
of 551 intimate partner homicides in Ontario, 32% were
committed in the context of a separation, and in another
11% the killer believed that the female partner was
sexually unfaithful. In a review of homicides in Chicago,
50% of the killings of wives by their husbands took place
within 2 months of a separation, and 85% occurred within
a year.
In a study of 50 men in prison for killing their wives
in British Columbia, the investigating psychologists
found that typically the murder was overkill—more
was done to the woman than was necessary to kill her. Of
379 women known to have been killed by male intimates in
New York from 1990 to 1997, 47% were killed with guns,
27% were stabbed, 8% were bludgeoned, 8% were strangled,
and 11% were killed by other means including suffocation
and being pushed from a window or the top of a building.
That women killed by male partners are more likely to be
stabbed or strangled than those killed by someone less
close to them reflects the emotional nature of the crime.
Stabbing or strangling someone to death is a lot more
intimate than shooting them.
The biggest risk factor found so far from the study of
completed and attempted murders of women by intimate
partners in 11 large and midsized cities was previous
assault by their partner: of the 250 women killed by
current or former partners, 65% had been assaulted by
their partners in the past; of the 200 victims of
attempted homicide, 72% had experienced a previous
assault. Past stalking of the woman by her male partner
also posed a significant risk, occurring in 69% of
homicides and 84% of attempted homicides. When the woman
had separated from her partner, the frequency of stalking
rose to 88%. In many cases stalking occurred even when
the couple lived together. A man, for example, might show
up unexpectedly at his partner's workplace, beep her
repeatedly on a pager and demand to know where she is, or
call her dozens of times a day. Other predictors of
lethal violence included an escalation in the frequency
or severity of physical abuse, attempts by the man to
choke the woman or to force her to have sex, the presence
of a gun in the house, the use of street drugs or the
abuse of alcohol by the man, verbal threats, and the
woman's belief that her partner was capable of killing
her.
A history of domestic violence is found less often in
men who kill themselves after killing their partners:
only about 25% of men who kill their partners commit
suicide afterward. Curiously, in the multicenter study,
men who tortured or killed animals—long thought to
be a sign of potential danger—were not more likely
to kill their partners. This all makes me think of the O.
J. Simpson case.
ROBERT SWANSON AND GENENTECH
In December 1999, Robert Swanson, a cofounder of
Genentech, died at age 52 from brain cancer (15). In
January 1976, Swanson, then a 28-year-old venture
capitalist, drove from Silicon Valley to the University
of California at San Francisco to meet with Herbert
Boyer, a biochemist and one of the inventors of
recombinant DNA. The discussion, planned for only 10
minutes, adjourned to a local pub for several hours, and
Genentech was born. This meeting produced a new structure
for science-driven business and fundamentally changed the
relation between business and research universities in
the USA. Before Swanson made that trip, the best
university research scientists would not consider joining
industry, believing that their academic careers would be
ruined if they did. Universities, with their basic
research laboratories, and corporations, with their focus
on product-driven development, passed like ships in the
night. While universities published research papers,
secrecy was the rule in industrial research.
In the mid-1970s, a structure to help new companies
commercialize technology was evolving in Silicon Valley.
But, the small community of venture-capital firms was
focused entirely on electronics. At about the same time,
Boyer at the University of California at San Francisco
and Stanley Cohen at Stanford had succeeded in making a
gene from one organism function successfully in a
different kind of organism. Recombinant DNA was the
province of a small group of academic scientists and the
subject of a lively ethical debate, with no commercial
interest whatsoever. A lone university administrator
persuaded the scientists to file a patent application.
Swanson, with degrees in chemistry and management from
the Massachusetts Institute of Technology, wondered
whether new organisms could be created to help discover
and produce pharmaceutical proteins. Swanson would have
to start a company, hire the best research talent, and
win over skeptical investors. This was the 1970s, and
gene splicing was not electronics. The most creative
researchers had little interest in working for business,
and there was no model for a start-up company based on
biology. Research and product approvals would take years.
Swanson would have to invent an entirely new kind of
company.
Swanson became chief executive officer of Genentech
and set out to create an organization that the best
scientists would want to join. The quality of their
science was paramount; they could publish as much, and as
often, as they wished. Genentech developed its own
products and retained the commercial rights. Unlike the
pharmaceutical industry, Genentech protected those rights
through patents, not secrecy. Swanson pioneered the use
of research and development partnerships to help fund the
research. Through stock options the scientists would
share in the success of their work.
Swanson had an unpretentious style that fit perfectly
with freewheeling scientists. He did not have an
executive parking spot. Genentech's Friday afternoon
parties would have made pharmaceutical executives blanch,
but these activities delighted the employees.
Within a few years, Genentech had succeeded
dramatically. A flood of new companies followed its path.
Swanson's eye for talent produced a remarkable alumni
group whose members now lead many of the next generation
biotech companies. Investors and the public were
transfixed. Fifteen years before the Internet frenzy
began, Genentech's initial public offering in October
1980 was the most successful in history. The stock opened
at $35 a share and reached as high as $88 on the first
day of trading.
Because pharmaceutical product development takes
enormous resources, in 1990 Genentech announced that
Roche Pharmaceuticals would buy a controlling interest
for $2.1 billion. But Swanson stayed on as chairman until
he resigned from the Genentech board in 1996.
In the quadrangle of the new research complex at
Genentech, there is a life-sized metal sculpture of 2 men
sitting at a table, each with a beer. One is Bob Swanson
dressed in a suit. He is leaning forward enthusiastically
making his point. The other is Herb Boyer, the
counterculture university scientist in denim vest and
bell-bottom jeans. He is leaning back, skeptical but
intrigued. He is on the verge of deciding to cast his
fate with the young venture capitalist. It is a fitting
memorial to the moment of the founding of Genentech, the
biotech industry, and a new approach to the business of
science.
TOM LANDRY
He died at Baylor University Medical Center at age 75
on February 12, 2000. The country remembers him most
vividly standing on the sidelines, coatless even in
subfreezing weather, immaculately dressed in suit and tie
and wearing his trademark porkpie hat (16, 17). Over the
years the stone face became a trademark as his winning
Dallas Cowboys (2 Superbowl championships) became
“America's Team” through Landry's no-nonsense,
workaholic methods enhanced by his strong beliefs in
self-sacrifice and Jesus Christ. A former bomber pilot,
Landry well knew that if one of the pilots flew just a
little bit out of formation, the rest of the squadron
could face disaster. He coached using the same
philosophy. Landry considered every eventuality and
prepared his players accordingly. He demanded that pass
routes be run with exactness. With Landry, there was no
room for flamboyance, individuality, or straying from the
established plan. He called every play during his
coaching career in Dallas. He coached the Cowboys from
1960 until 1989 when he was let go by the new owner with
never so much as a thank you, in the same cold manner he
had discharged a generation of players who had outlived
their usefulness. Old Stone Face, who was born and raised
in Mission, Texas, fulfilled his mission.
CHARLES SCHULZ AND “PEANUTS”
Charles Schulz, aged 77, died from cancer in his sleep
on February 18, 2000, just as the last
“Peanuts” cartoon was loaded onto the
last trucks for the last home delivery (18, 19). His life
and his work were completed on the same day. For 50
years, Mr. Schulz was the scriptwriter, producer, and
director for a repertory company of small imaginary
characters who never changed. He penned more than 18,250
strips. He drew them when his hands were strong and his
line was sure, and he drew them when a tremor made it
hard to hold the pen. Long after his income had topped
$30 million a year, he got up every morning, drove to
breakfast and then to his studio at One Snoopy Place,
worked, went out for lunch, and came back to work. Only
once, under orders, did he take off for >10 days.
Charles Schulz was much more than a cartoonist; he was
a philosopher. He knew life is not always fair, but it
still can be fun. He and his “Peanuts” gang
took life very seriously but never took themselves too
seriously. “Peanuts” wasn't about failure, it
was about perseverance. Charlie Brown always missed the
football and always got his kites stuck in trees. Linus
always sucked his thumb and carried his comfort blanket.
Snoopy was a sleepy-eyed beagle who dozed at the
typewriter. Lucy's curbside psychiatric clinic didn't
offer a nickel's worth of good advice. That's life. He
made kids of all ages laugh. I hope the cartoon
characters made Charles Schulz smile as much as he made
the rest of us smile.
DR. JOSE GUERREROSANTOS AND AN INSTITUTE FOR
RECONSTRUCTIVE SURGERY
On January 29, 2000, I spoke at a meeting of the
Western Chapter of the Mexican Academy of Surgery in
Guadalajara, Mexico. I had been invited by Dr. Jose
Guerrerosantos, president of the Western Chapter, whom I
had met in Hermosillo, Mexico, several months earlier.
The meeting was held at the Institute for Reconstructive
Surgery of Jalisco, the state where Guadalajara is
located. I learned that this is probably the only
hospital in the world devoted exclusively to plastic
surgery. Approximately 30 years earlier, Dr.
Guerrerosantos had been the force behind its creation and
development. It is a state-owned institution, and
therefore the state pays for operations conducted there.
During the existence of the hospital, Dr.
Guerrerosantos has trained nearly 200 plastic surgeons.
Each year, he accepts into the 3-year program 10 trainees
who have completed their general surgery training.
Therefore, there are 30 young surgeons in training: 20 of
them operate at the institution, and 10 of them operate
on a rotating basis at 5 other hospitals in Guadalajara.
Approximately 20 plastic surgery procedures are done
daily at the institute, and nearly all of these
procedures are done by the trainees. Dr. Guerrerosantos
generally does 1 very complex operation at the institute
on Mondays, Wednesdays, and Fridays and assists the
trainees at other times. On Tuesdays and Thursdays, he
operates in his privately owned clinic and there does
approximately 4 procedures each day. For his work at the
institute, he is paid approximately $600 a month. In
contrast, patients pay cash for operations conducted in
his private clinic, where he also has beds for the
overnight stay of his patients.
Dr. Guerrerosantos, I believe, is the most respected
plastic surgeon in Mexico. One of his trainees, Dr. Oscar
Suarez, transported me around Guadalajara and told me a
lot about the training program. Dr. Suarez is from Costa
Rica. Six of the 10 third-year trainees in plastic
surgery under Dr. Guerrerosantos are from outside of
Mexico, mainly from Central and South America. Some of
the patients having plastic surgery procedures in Mexico
as well as in Costa Rica are citizens of the USA who
travel south of the border because of the excellent
reputation of plastic surgery there and the lower cost
compared with that in the USA. After completing the
present year, Dr. Suarez will return to the capital of
Costa Rica and join a large group of plastic surgeons
there. He told me that there are 27 active plastic
surgeons in Costa Rica, a country of approximately 3.5
million people. The hospitality provided by Dr.
Guerrerosantos and his lovely wife, Martha, and also by
Dr. Oscar Suarez was enormously appreciated.
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