The Michigan Daily - Thursday, February 17, 1994 -E
.Midwives
may be
safer than
4#octors
By DWIGHT DAVIS
FOR THE DAILY
High-tech procedures used to assist
in the birthing process lead directly to
increased instances of complications
during thatprocess, accordingto a study
conducted on 1,406 women at the
University's Medical Center, under the
co-direction of Prof. Deborah Oakley
*f the School of Nursing.
Speaking before a crowded room in
Rackham yesterday afternoon, as part
of a continuing series of seminars spon-
sored by the Michigan Initiative on
Women's Health, Oakley presented
preliminary results to her five-year
study. The study sought to compare the
procedures and effectiveness of certi-
fied nurse midwives and physicians.
"Safety is, of course, the No. 1 con-
cern and there is general agreement that
certified midwives provide safe care.
The question now becomes one of cost
and effectiveness," Oakley said.
Oakley stressed that physicians and
certified midwives start with a similar
set of goals: to provide a safe and satis-
fying birth experience.
They also share many of the same
methods and patients-of the 4 percent
* U.S. births performed by certified
midwives, most involve some collabo-
ration with a physician, who provides
backup support in case of complication.
These similarities notwithstanding,
Oakley said study after study has turned
up significant differences in procedure
and result, between women whose pri-
mary care providers were certified mid-
wives and those who saw physicians.
Comparisons within samples of the
5 to 80 percent of U.S. births that
certified midwives are qualified to per-
form, so called "low-risk" births, con-
sistently show certified midwives help-
ing more women have spontaneous
vaginal deliveries than physicians. Lev-
els of fetal distress are comparable for
the two goups. And in some studies the
certified midwife-deliveried babieshad
a higher average birth weight.
1 Certified midwives did all thiswhile
performing far fewer expensive, high-
tech procedures, which Oakley defined,
as anything that gets plugged into the
wall at some point such asintraveneous
fluids, anesthesia, electric fetal moni-
toring and Cesarean sections, which are
done by a collaborating physician.
Oakley added that all the studies
suffered to varying degrees from an
gability to control for such factors as a
patient's request for certain procedures,
that might not have been performed by
the physician. The actual degree of risk
of certain births, that may have incor-
rectly been classified as "low risk."
She added that the lumping in of
family practitioners and medical stu-
dents with fully trained obstetricians,
when evaluating physicians as a group,
lso blurs the value of the study.
Oakley sought to control these fac-
tors in the University study. Only fully
trained obstetricians were included. All
of the patients in the study included
were screened for risks, both in the pre-
natal and actual birthing process, that
mould exclude them from the "low-
risk" control group.
The analysis of this group of pa-
tients found that those cared for by
*hysicians were more than twice as
likely to have had anesthesia, nearly
twice as likely to have had forceps used
inthe delivery and more than 50 percent
more likely to have a Cesarean section
performed--18 percent of the total for
physician provided care, verses 11 per-
cent for certified midwive care.
Most startling was Oakley's con-
tention that complications were actu-
Sly caused by the high-tech aides used
childbirth. Although necessary in
some instances, the study showed an
increase in complications associated
with these procedures that could not be
accounted for in any other way.
IS WINTER OVER?
Violinist awarded
for excellence in
studio teaching
With warmer temperatures and melting snow, reflections are back on campus. Angell Hall is reflected in the water.
Study finds insurers 'arbitrary'
on breast cancer treatments
THE WASHINGTON POST
WASHINGTON - Insurance
companies cover an experimental
breast cancer treatment so inconsis-
tently that they often grant coverage
to some patients and deny it to others
with the same medical characteris-
tics, according to a study by Duke
University researchers.
Decisions involving coverage of
costly bone marrow transplants for
533 patients "appeared to bear little
relation to available medical or scien-
tific information, and often seemed
arbitrary and capricious," the re-
searchers say in today's edition of the
New England Journal of Medicine.
The report highlights one of more
emotionally charged issues in the de-
bate over national health care policy:
When should potentially lifesaving
experimental treatments be covered,
and who should decide?
When the decisions are left to in-
dividual private insurers, patients
"might just as well one day be ap-
proved as the next day denied,"said
study co-author William P. Peters,
director of Duke's Bone Marrow
Transplantation program.
Physiologist John Cova, a con-
sultant to the Health Insurance Indus-
try Association, agreed that policies
vary considerably, but he said insur-
ance companies are not typically re-
sponsible. Many employers determine
their own health benefits policies and
simply hire insurance companies to
administer them, he said.
"Our (employer) clients don't want
to pay for experimental (treatments)
or for therapies that aren't proven to
be safe and effective," said Charles
Cutler, vice president for medical ser-
vices at Prudential Insurance Co. of
America, which under certain circum-
stances covers transplantation treat-
ments for breast cancer.
The procedure has been used pri-
marily for treatment of advanced can-
cer when the disease has spread.
It involves first removing a por-
tion of a patient's bone marrow, the
substance that constantly replenishes
a person's oxygen-carrying red blood
cells, infection-fighting white blood
cells and clot-forming platelets. This
is necessary because the chemo-
therapy treatment that follows is given
in such high doses that it kills marrow
cells along with - presumably -
breast cancer cells.
The bone marrow is then reinfused
in the patient, where it grows and
replenishes the blood-forming cells.
Inevitably, however, a transplant pa-
tient experiences a period of extreme
immune system suppression when
infections normally fought off easily
can be fatal.
The treatment is dangerous, un-
pleasant and expensive. At the same
time, it is increasingly viewed by many
women with breast cancer as the last
chance for a cure.
About 180,000 new cases of breast
cancer are diagnosed each year, and
about 50,000 women die from it. Some
researchers believe that as many as
15,000 women annually could be can-
didates for the procedure.
Peters said it costs an average of
$72,000, but insurance officials said
it can cost more than twice that much.
The National Cancer Institute is evalu-
ating the procedure in clinical trials
and has not yet concluded whether it
is superior to other treatments for
advanced cancer.
The results reported by some phy-
sicians come from treatment trials in
which the most promising patients
are chosen for the procedure. The
National Cancer Institute relies on
experiments in which patients are
assigned randomly to receive either
bone marrow transplant or conven-
tional therapy to determine the
procedure's worth.
The institute is sponsoring three
such "randomized controlled trials"
for women with various stages of
cancer. Results from them will not
be available for at least two years.
Based on Duke's experience,
Peters said, 15 to 20 percent of pa-
tients whose breast cancer had spread
to other parts of their bodies remain
alive and cancer-free five years after
undergoing the treatment, compared
with only 1 to 2 percent of patients
treated with chemotherapy.
The health insurance industry has
been reluctant to pay for the experi-
mental treatments for several rea-
sons. Their usefulness is unproven
and, perhaps more important, rou-
tine coverage of the procedure would
help it become the "standard of care."
In the case of bone marrow trans-
plants for breast cancer, this would
cost insurance companies to claims
of $1 billion a year as demand for the
procedure increases.
Lacking uniform national stan-
dards, denying coverage also entails
risks for insurers. A California jury
recently awarded the family of a
breast cancer patient $89 million af-
ter her health plan refused to pay for
the procedure and she died.
By MEGAN SCHIMPF
DAILY STAFF REPORTER
Paul Kantor wants his students to
be as independent as they can be.
"If we really allow people to think
independently, it's remarkable what
they come up with on their own," he
said. "I've learned an enormous
amount when students have latitude
in interpreting and finding technical
solutions to problems."
Kantor, a studio violin teacher in
the School of Music, recently won the
1994 Harold
Haugh Award ' .
honoring excel- The impac
lence in studio is enormou
teaching. He gave ater an
a master class yes-grae an
terday at the lasting thai
School of Music.
In place of the performing,
usual lecture, can impact
Kantor decided toa
give the master audience a
class - a lesson moment, bi
given before anlr
audience - be- onger.
cause he felt it was
in the spirit of the studio v
award.
Each of the 18
departments in the school nominates
one teacher by secret ballot. An ex-
ecutive committee then chooses the
person to be honored.
"It's a tremendous honor to be
recognized by your colleagues,"
Kantor said. "I was so gratified."
Gabriel Bolkosky, a School of
Music junior, said the independence
Kantor teaches distinguishes him from
other teachers he has had.
"He teaches you to be your own
musician, not just to be a Kantor stu-
dent," Bolkosky said.
He added that Kantor often says,
"This is just grist for the mill," when
making a comment, since his idea is
only one of many to consider. He
wants his students to be aware of that.
"It's important to be your own
musician," Bolkosky said. "I have to
be responsible for what I choose to
do."
Kantor said he thinks individual-
ity in an artist is critical.
"I think that's terribly important.
It affects so many things. We try to be
individuals as artists and strive for a
certain unique sound and a unique
way of expressing yourself," he said.
While Kantor still plays the vio-
lin, teaching gives him the greatest
satisfaction.
"The impact you have is enor-
mous. It's greater and more long-
lasting than performing, where you
c
i
t
can impact the audience at that mo-
ment, but not much longer," he said.
"I love it."
After helping a student, Kantor
said teachers experience a moment
that performers do not.
"There's a moment of recognition
when you can hear the results. It's a
wonderful moment. I've never expe-
rienced anything like that in playing.
It's very unique to teaching and very
special," he said.
Kantor has a unique ability to solve
students' problems, said Alfonso
Lopez, who has
t you have been a student of
s. lt's Kantor for four
years.
d more long- "From my very
n first lesson, he was
able to determine
, where you my weaknesses
the and how to solve
them. He could
t that pick them outright
ut not much away," Lopez
said. "He's always
going to find a
Paul Kantor musical aspect to
work on.
ioin teacher Don Sinta, a
saxophone profes-
sor in the School of Music, agreed.
"You want to be around someone
who serves as a very distinct role
model and points out the things he
sees and hears," Sinta said. "His per-
ception as a teacher is very high."
Lopez said Kantor gives construc-
tive criticism.
"He always focuses on a problem
from a very positive point of view.
He's never negative and he never puts
a negative connotation on anything,
he said.
Kantor said he wants to keep the
love for music alive in his students.
"I try to convey and perpetuate the
natural enthusiasm students have for
music. That's why they go into music
in the first place," he said. "In the
quest for better, the joy and fun of
music making can get lost. I try to
keep that alive."
Bolkosky agreed.
"He's really concerned with stay-
ing fresh. Teachers can get burned
out," he said. "He's always monitor-
ing himself and making sure he's not
going stale."
Lopez, a School of Music senior,
said Kantor has given him values be-
yond music.
"He worked with my attitude and
showed me how to feel good about
myself and my playing. I'll take the
love for music and the desire to make
music for other people from him."
Clintons try to win senior citizen support for health care plan
THE WASHINGTON POST
EDISON, N.J. - President
Clinton and first lady Hillary Rodham
Clinton joined forces yesterday to in-
form senior citizens about the ben-
efits that the administration's health
care plan would bring to them and to
enlist their help in the legislative battle.
At the start of a renewed adminis-
tration push for the support of the
nation's 36 million senior citizens, a
critical constituency in the health de-
bate, the president also issued a blunt
appeal for the explicit backing of the
American Association of Retired Per-
sons (AARP).
The powerful lobby - which
sponsored the Clintons' appearance
at Middlesex County College -has
endorsed the principles of Clinton's
plan and said it is the best starting
point, but has so far refused adminis-
tration entreaties to go further.
"The time has come to be counted,
to stand up," Clinton told the group
yesterday, enumerating the benefits
you're going to have to fight for it."
The AARP, he said, "ought to be
for the only plan that helps you. Oth-
erwise the interest groups will con-
vince Congress that you don't really
care, and you will lose these parts of
our plan."
But an AARP spokesperson said
the group was not ready to go any
further, with its membership confused
about the plan and leery about what it
would mean for them. A recent AARP
poll indicated that more than half those
questioned either opposed the Clinton
plan or did not know whether to sup-
port it.
In addition, said Martin Cony,
AARP's director of federal affairs,
"When the president indicates flex-
ibility, as he should, that also sug-
gests there may be some elements of
the plan that may be subject to change
that might be important to us."
In his zeal to push the program,
Clinton went a bit overboard, describ-
ing his proposal as "the only one" that
Thirty-six million senior citizens are a critical
constituency in the ongoing health care debate.
provides long-term care and prescrip-
tion drug coverage. In fact, single-
payer plans under consideration would
include such benefits.
Both Clintons, appearing together
to sell the administration's health care
plan for the first time since October,
continued their assault on the insur-
ance industry's "Harry and Louise"
advertisements criticizing the Clinton
plan.
"I always want to say to Harry and
Louise," Clinton said. "You know
those health care ads where the actors
are telling you how scared you ought
to be of our program -they never put
any real people on there."
At the same time, the White House
said it was "looking into" Republican
complaints that a Democratic National
Committee ad distorted the views of
Republican Gov. Carroll A.
Campbell Jr. of South Carolina.
White House press secretary Dee
Dee Myers said the criticism was
"under review" and that the White
House wants to "determine what the
circumstances are."
As some of his aides acknowl-
edged, the president's speech was
somewhat disjointed, as he sought to
weave his opposition to the balanced-
budget amendment under consider-
ation in the Senate with the need for
health care overhaul:
1994 SUMMER EMPLOYMENT
OPPORTUNITY
DO YOU HAVE WHAT IT TAKES?
THE UNIVERSITY OF MICHIGAN
CONFERENCES AND SEMINARS
WILL BE HIRING SUMMER CONFERENCE:
--FRONT DESK STAFF--
" Gain valuable work experience.
I:Prnvide niiulity and nrofenniunal ervicet o our
Group Meetings
U Hindu Students Council, MLB,
Room 2002, 8 p.m.
U Orthodox Christian Fellow-
ship, Michigan Union Pond
Rooms. 7 p.m.
linity in a Tokyo Hostess Club,
Anne Allison, sponsored by the
Center for Japanese Studies,
Lane Hall Commons, noon.
U Religions Perspectives on Rec-
onciliation for Bosnia, spon-
Q Campus Information Center,
Michigan Union, 763-INFO;
events info., 76-EVENT; film
info., 763-FILM.
Q North Campus Information
Center, North Campus Com-
i