Medicine's Deadly Dust: A Surgeon's Wake-Up Call to Society.

Richard F. Edlich Vandamere Press P.O. Box 5243 Arlington, VA 22205 236 pp., $24.95

Reviewed by Robert K. Jenner and Sarah Weyland

For years, cornstarch has been used to lubricate latex surgical gloves. Recent studies have shown that this use of a seemingly innocuous substance can be deadly. In May 1997, the Oregon Nurses Association presented a bill to the state legislature that would ban the use of cornstarch on gloves used in any health care facility.

And cornstarch is not the only problem. Over the last decade, the U.S. Food and Drug Administration (FDA) received more than 1,700 reports of severe allergic reactions, including 16 deaths, related to medical devices containing latex. In September 1997, the agency mandated that any medical device containing latex will have to carry a warning about allergic reactions.

Medicine's Deadly Dust: A Surgeon's Wake-up Call to Society, written by Richard F. Edlich, a professor of plastic surgery and biomedical engineering at the University of Virginia School of Medicine, addresses the dangers of using cornstarch powder to lubricate latex gloves and the latex allergy "epidemic."

Edlich's scientific interests are in surgical wound healing and infection. A proficient author, he establishes himself early in the book as a consumer advocate. It is clear he wants to get the message out about the dangers of latex and cornstarch in medical devices. Edlich has also created a Web site devoted to the subject. (http://www.deadlydust.com)

The book s opening chapters include five stories about exposure to airborne particles and post-operative reactions to cornstarch powder. With these examples, Edlich illustrates how a "conspiracy of silence" has kept the dangers of using cornstarch powder as a latex glove lubricant from reaching the public. He says that patients as well as doctors do not do enough to alert the public about the threats posed by cornstarch use.

Edlich argues that powdered gloves should be banned from medical use and supports this argument with conscientious research and case studies. He examines the biological processes by which cornstarch is rejected from the body and how allergic reactions to cornstarch and latex develop.

Edlich also discusses the correlation between cornstarch powder and latex allergy, noting that latex proteins adhere to the cornstarch, helping to spread latex allergens through the air. This discussion is especially timely in light of the ongoing multidistrict litigation against latex glove manufacturers for latex-allergy-related injuries. (in re Latex Glove Litigation, No. MDL 1148 (transfer order filed Feb. 26, 1997 E.D. Pa.).)

Addressing the public's role in ending the conspiracy of silence, Edlich lists several actions patients can take to influence the medical care they receive. He says that it is the responsibility of every patient to demand that doctors use powder-free gloves with low levels of latex allergens. He urges patients to take an active role in their medical care--a role that challenges the sanctity of doctor-patient relationships and requires patients to recognize the legal and ethical repercussions of physician fallibility.

Edlich also explores the roles of insurance companies and latex glove manufacturers in determining physician protocol and hospital management. These entities have, through economic influences, encouraged health care providers' use of powdered latex gloves and other medical devices containing latex, Edlich says.

The book doesn't merely identify problems and assign blame. Edlich also includes recommendations to the FDA, including developing minimum performance standards for surgical and examination gloves and banning the use of powdered gloves and gloves with a high latex allergen content

Interestingly, Edlich, a doctor, notes that litigation plays an important role in educating the medical industry and the public about latex-related injuries. Medicine, law, and business are tied together in an interdependent knot of ethical obligation, Edlich says. Each has a role in ensuring that the public receives quality medical care.

It is not often that physicians take on the health care industry. Indeed, it is refreshing to see an insider's critical evaluation. While Edlich makes few friends along his consumer activist path, it is exactly this type of insider advocacy that will be required to eliminate medicine's unnecessary deadly dust from our hospitals and our bodies and to alert the public to the dangers of latex allergy.

Robert K. Jenner is a partner with Freeman & Jenner in Rockville, Maryland. Sarah Weyland is a first-year law student at Boston College School of Law.