ABSTRACT
Which type of scientific study or trial can best determine whether a particular therapy/drug will cure?
Can the illness or death of one person change the course of medicine? Figure 8.1 is a haunting picture of just such a person. Libby Zion died at the age of 18 in 1984 and the cause of her death was never found. She was an 18-year-old college student who was admitted to the hospital with a high fever, dehydration, and mysterious jerking movements (Lerner 2009). She had a history of depression and was taking phenelzine, an antidepressant. At that time, the diagnosis was that she probably had a viral infection. e resident on duty with the verbal permission from her family physician and the attending doctor on record agreed to give her meperidine, an opiate, to stop her shaking. However, Libby became more agitated, so the rst-year resident on call, who did not visually examine her because she was so busy with other patients and understaed, with the second-year resident having gone across the street for a few hours of rest, ordered physical restraint as well as haloperidol, another sedating medication. Records show that Libby calmed down. When her vitals were rechecked in the morning, she had a temperature of 107°. e sta tried to cool her body, but she went into cardiac arrest and died. When her father found out that Libby had been tied down, neglected until morning, and the only doctors who had seen her were doctors in training (i.e., residents), he was furious. He sued the hospital and started a campaign to reform the medical system. Residents at that time routinely worked 36-hour shis, oen with little or no sleep. Libby’s story spread around the country. In the trial of 1994, the verdict placed equal blame on the hospital and Libby Zion, who had concealed her past use of cocaine. Ultimately, her death resulted in a change in resident work hours, workloads, and supervision. In 1987, Dr. Bertrand Bell, head of a New York State Commission, recommended that doctors-in-training (i.e., residents) work no more than 80 hours a week and no more than 24 hours in a row, and receive more on-site supervision from senior physicians. In 2003, the Accreditation Council for Graduate Medical Education made these recommendations mandatory for all residency training programs.
