Sunday, April 11, 1976 THE MICHIGAN DAILY Page Three inside: page four-boo!h sundy m tgctrnepage five- looing back Number 22 Page Three April FEATUR Gene tic co unseling: Unco vering birth defec is 4, 1976 ES Opinion is still divided on whether genetics will ultimately prove to be a boon to mankind or become the tool that enables despots to wreak their fantasies on the human race. In the meantime, however, counselors stick to the simpler task of screening L rth defects. . By STEPHEN SELBST IMAGINE A WORLD in which no children are born handicap- ped by birth defects. The gap be- tween reality and that goal is still wide, but genetic counselors, such as Dr. Robert Kelch at University Hospital, are working to narrow it. "A child has a right to come into the world born normally," the soft- spoken pediatrician declares. In a nutshell, that sentiment provides the humane rationale for screen- ing birth defects. Critics are more skeptical, taking a broader view of the long-term social implications of the process. At their darkest they prophesy Hitler-like schema in which couples would be allowed to reproduce only if they pass some test of genetic "fitness." -But selecting populations for desirable physical attributes is not what genetic counseling is about right now, and maybe it never will be. Presently tests to screen birth defects exist for ap- proximately 100 of the known to- tal of over 1,600 genetic disorders. Birth defects originate in muta- tions of genetic codes, the biologi- cal directions which govern the formation of protein chains. In- structions for each protein is con- trolled by a gene, and each cell in a human body contains over 100,- 000 genes, strung together in long chains called chromosomes. Nor- mal human cells contain 23 pairs of chromosomes, one set donated by the father and one by the mother. BIRTH DEFECTS result from breakdowns in the transmis- sion of g e n e t i c information. Down's Syndrome is among the most common of these. Also known as mongolism, Down's Syndrome occurs when a child ends up with three of the number 21 chromo- somes instead of the normal two. As is common with many genetic mutations, Down's Syndrome re- sults in mental retardation, which may range from moderate to se- vere. Victims also have short limbs, chronic heart conditions, and short lives. Death claims one third of all affected before one year, half by age five. Few survive past twenty. The overall incidence of Down's Syndrome in this country is ap- proximately 1 in 750 live births. Nationally, about 4,000 children are born with the condition each year. The risk of producing a child with Down's Syndrome increases dramatically with the age of the mother. While very young mothers bear 1 child with Down's Syn- drome out of every 1,200, by the time maternal age climbs past 40, the risk skyrockets to 1 out of ev- ery 50, or perhaps higher. Down's Snydrome, along with many other genetic disorders can be detected by amniocentesis, a re- cently developed test which in- volves drawing off some of the fluid surrounding a woman's fetus and analyzing it. Amniocentesis is performed by inserting a hollow needle into a woman's uterus and then simoly "tapping off" the fluid. Amniocen- tesis is a quick procedure, usually done under local anesthetic on an outpatient basis. Typically, the test is performed in the 16th or 17th week of pregnancy, which, even given the time needed to complete the test, allows the mother time to have an abortion if she decides she wants one. THE PHOTOGRAPH on the left shows a normal person's karotype, whch is a chart separating chromosomes according to size and shape. On the right, note the pre- sence of three of the number 21 chromosomes, a condition which produces Down's Syndrome, a form a mental retardation. Genetic counselors can now detect the presence of Down's Syndrome before an affected child is born. THE FLUID DRAWN off by the needle is grown for three or four weeks in a receptive environ- ment. When enough cells have multiplied, the sample can be test- ed. For some genetic disorders, these examinations take the form of chemical analyses. Finding Down's Syndrome however, re- quires another method. Using pho- tomicroscopy, chromosomes in a sample are magnified 6,000 times and then photographed. After the chromosomes have been identified, they* are then cut out and assem- bled into a karotype, a genetic chart which sorts the chromo- somes according to their size and distinguishing c h a r a c t e r- istics. Once arrayed in a karotype, the presence of a third number 21 chromosome, the cause of Down's Syndrome, is possible to detect. Still, amniocentesis, a new pro- cedure, is not entirely devoid of hazards. As with any surgical pro- cedure, no matter how simple, there is the possibility of compli- cations or laboratory error, al- though Kelch said that the "risks are under one per cent. The tests are really very reliable." The biggest danger posed by amniocentesis is that while the needle is penetrating the woman's uterus it will strike the fetus. To prevent that from occurring, be- fore the procedure is performed the doctor takes a picture of the fetus in the uterus using ultra- sonic sound waves. In any event, the normal re- sponse of the fetus, if touched, is to move away from the needle; the doctor, too, can feel if he has ac- cidentally grazed the fetus, and can withdraw the instrument. FROM PRELIMINARY DATA, the evidence suggests that the rate of spontaneous abortion suf- fered by women who have under- gone amniocentesis is no higher than normal. But the practice is still too new to determine what the long-range "effects are; observa- tion of a group of children whose mothers underwent amniocentesis is still underway. The present capacity for per- forming amniocentesis tests is lim- ited, and the cost is relatively high, averaging around $300. More important than the cost, however, is the issue of who shall have ac- cess to the test. Some uses are easy to rule out. One of the by-products of amnio- centesis is that doctors can deter- mine the sex of the unborn fetus. If a healthy young woman asked for amniocentesis on that basis, however, Kelch would tell her, "no, that simply isn't indicated. I don't know any place in the country that would do that." For some women the test is not frivolous, however. "I think any woman over 35 who wants the test should have it," he says, but his voice trails off as he acknowledges that "if every woman over 35 who is pregnant demands it, we won't have the facilities." Because the procedure is still not widely known, and because it is relatively expen- sive, most of the beneficiaries of amniocentesis to date have been well educated women from families with above average incomes. But Kelch says that the demand for birth defect screening is rising rapidly as the practice receives more publicity. He believes that eventually political decisions for increased services will bring about an expansion of facilities. Such pressure brought about a Michi- gan law which now requires hos- pitals to screen newborn infants for phenylketonutria (PKU), a dis- order in which the absence of an enzyme leads to severe mental re- tardation. Prompt detection of the condition, which can be readily tested for a few days after birth, can prevent much of the brain damage if the affected chiles is put on a special diet. T'HE VAST MAJORITY of the states do some preliminary screening of infants for birth de- fects. Massachusetts has the most comprehensive program;, children fortunate enough to be born in that state are automatically in- spected for the presence of 16 pos- sible abnormalities. In the case of Down's syndrome, amniocentesis offers the prospec- tive mother solid evidence on whe- ther the child will be affected at birth. The certainty of deformity may be a painful one; a study done for a medical journal indicated that many couples who decided to abort a fetus suffered from depres- sion. A significant number were divorced not long afterwards. See SCREENING, Page S Stephen Selbst is the former City Editor of The Daily. 8 TV and alcoholism: Does the tube cause people to abuse the bottle? By BARBARA CORNELL THE - IMPACT OP TELEVISION on Americans cannot be un- derestimated. It is the incessant and sometimes insidious companion for millions of people. Used to its fullest capacity, television can sell just about anything - from cra- zy breakfast cereals that have al- most no vitamins to half-baked politicians who capitalize on smooth manners instead of sound policies - to just about anyone. And occasionally television can pull inadvertent con jobs, too. Television programming rarely focuses on the consumption of al- coholic beverages as a major theme. Yet, liquor - both the hard stuff and beer and wine - is often evi- dent, providing a soft, mellow back- ground with which the viewer can identify. Some media critics, however, worry that television tends to glam- orize booze or to treat it as a rela- tively harmless pleasure associated couple of "the boys." The thugs wanted to collect on an old co- caine debt Buddy owed. And they weren't particularly concerned whether they were paid in cash or flesh. With a little quick talking, Bud- dy escaped a pair of broken legs. He called his girlfriend out of the concern that Buddy and his friends didn't use any foul language or do anything of a sexually offensive nature, they had no qualms about the choice of liquid refreshments. But to some degree, the indus- try itself has tried to downplay the role of alcohol both in pro- gramming and advertising. Unlike ,if alcohol is the most heavily abused drug in America, then television is our number one pusher.' -Sen. William Hathaway consistent with plot and character development." Also the code de- clares that "the use of illegal drugs or the abuse of legal drugs (of which alcohol is one by strict medi- cal definition) shall not be encour- aged or shown as socially accept- able." Beyond these program re- strictions, the broadcasters have voluntarily banned all advertise- ments for hard liquor. And pitch- es for beer and wine must be "pre- sented in the best of good taste and discretion" - which means the products cannot be consumed on- camera. This "gentlemen's agreement" with the liquor industry grew out of a similar arrangement begun by radio producers in 1939. Similar guidelines were also placed on the movie industry by its executives during the post-prohibition era. In many instances, however, the Television Code seems to exist only on paper rather than in practice. After all, was Buddy's tippling an bedroom and looked generally pleased with himself. While ex- plaining the situation to his blonde companion, Buddy absent-minded- ly reached for a decanter, poured himself a drink, and took a cou- ple of quick belts. "Know something?" he giggled to his girlfriend, as he tipped his glass once again. "I think I can breathe again." the print media, television does fall. under federal government con- trol in that stations must be li- censed by the Federal Communica- tions Commission and have to dem- onstrate that they operate in the public interest. To help fulfill that requirement, the television execu- tives have drawn up a set of guide- lines that define what is consider- ed acceptable material for presen- Mw