The Los Angeles Times from Los Angeles, California • 77

I CURSE OF THE DES BABIES Terror That Shouldn't Have Happened CoAnoeUiClmca sun, Oct ti. w7-f art IV 19 ayi drug companies are expected to be the final authorities on all medical research concerning their products. "It's just impractical to expect a single physician would keep current with active literature affecting all the drugs he prescribes," he says. Six months after the operation, as the Bichler family sat around the dinner table one night, they began to talk about a lawsuit. There were two possible obstacles that have continued to hamper other DES suits over the years.

First, statutes of limitation: In Illinois, for example, a DES daughter must sue within two years after she learns the drug made her ill. And in some states, such as New York, the countdown begins not with discovery of the injury but with the injury it-self-so that if a woman learns she has cancer after the statute of limitations has expired, she may be without legal recourse. Because of New York state law, Bichler was safe there. But like thousands of other DES daughters, she was never able to find the precise record of the drug her mother took. Please Turn to Page 20, Col.

2 There was nothing particularly unusual about the doctor's advice. Thirteen years earlier, a husband-and-wife doctor team at Harvard University had begun a series of tests on pregnant women that led them to conclude that DES helped prevent miscarriages and generally improve pregnancy. By the 1960s, some researchers had come to believe DES did not prevent miscarriages after ail-but in 1954, when Bichler was born, the conclusions of the Harvard team were still accepted by many doctors. But there was also a body of medical opinion-some of the studies go back as early as the 1930s-which linked estrogens to cancer in laboratory animals. Why hold the drug companies responsible for not heeding these studies, while exempting the doctors? David Fine, the Cambridge attorney working on the Massachusetts class action suit, University of New York at Stonybrook.

When she first noticed that her menstrual periods seemed longer and more frequent, she blamed the change in habitat-she had never lived away from home before. But by early 1972, when the blood was coming between periods and she sometimes thought she would faint, Bichler went to a doctor. "The first thing he asked my mother was, did you take anything during pregnancy with me?" Bichler says. "And my mother said yes, she remembered specifically taking something, but she couldn't remember what it was." Bichler mother, in her two previous (and successful) pregnancies, had bled during the first three months of each. The new doctor monitoring the pregnancy with Joyce urged Mrs.

Bichler to take DES. Today's decision will be tomorrow's quotation. BY CYNTHIA GORNEY ThtWMMltftMPtrt This is what Joyce Bichler remembers: "By January of 72, 1 couldn't deny it anymore, because the bleeding had really been quite heavy. There was one time when I would stand up, and it felt literally like I was hemorrhaging, and I couldn't get to the bathroom in time I remember sitting in the doctor's office with my mother and sister 1 remember asking him, 'What are the chances of its being cancer? And I remember how defensive he got. He said, 'Don't even use that word "And when they said, I just, you know, I really felt everything spin.

"Because I had never heard of such a thing before. I didn't know how they could do it." Vaginectomy: the surgical removal of the vagina. The surgeons also removed Bichler's uterus, Fallopian tubes, appendix and left ovary. She was 18 years old. This is what Anne Needham remembers: "When (the doctor) did do the internal exam, he just freaked.

He jumped up and said, 'Oh my God, I've never seen anything like this I went into shock. He ran across the room he called the nurse in. He said to her, 'Look at He said, 'You've got to go to the hospital. You've got to go to the hospital right One of Needham 's vaginal tumors was the size of a dime; the second was the size of a nickel. Her vagina, along with the rest of her reproductive system, was surgically removed.

She was given an artificial vagina, made from the grafted tissue of her buttocks. She was 20 years old. On April 22, 1971, in a startling article in the New England Journal of Medicine, a Boston physician named Arthur Herbst reported that during the previous five years he had examined eight young women with an extremely rare form of vaginal cancer. The disease was called clear-cell adenocarcinoma. It was deadly if not rapidly treated, and its sudden appearance in girls as young as 15 was so extraordinary that Herbst and his colleagues at Massachusetts General Hospital had pored through the patients' records, trying to find some medical link.

They found it. During pregnancy, the mothers of seven of the young women had taken a widely prescribed synthetic estrogen called diethylstilbestrol, or DES. From 1941 on, despite published reports linking estrogens with cancer in laboratory animals, the drug had been given to hundreds of thousands of women (the figures vary, but estimates range up to 2 million) as a way to prevent miscarriages or bleeding during pregnancy. The Herbst study, and those that followed it, established that daughters born to these mothers were likely to have a condition called adenosis the presence of mucous-producing nonmalig-nant tissue in the vagina which required frequent and costly medical exams. And in some cases .14 to 1.4 per thousand, according to a Herbst followup DES daughters developed clear-cell adenocarcinoma.

Vaginectomy was the most widely accepted treatment, for those who lived. Joyce Bichler's mother had experienced bleeding. Anne Needham's mother had suffered two miscarriages. Ruling on Responsibility Recently, in the New York State Supreme Court in the Bronx, a six-person jury ruled that Eli Lilly one of the largest early producers of drugs containing DES, must pay $500,000 in damages to Joyce Bichler. Even though Bichler could not prove that Eli Lilly made the specific DES product her mother took, the jury accepted the argument of Bichler's attorney: that Lilly was one of the largest early manufacturers of DES, that DES was inadequately tested before marketing, that DES caused Bichler's cancer and that Lilly must therefore assume the responsibility.

Several weeks ago, in a second suit in Chicago, a jury awarded $800,000 damages to Anne Needham. Needham's mother, unlike Bichler's, had found clear records of the precise drugs she had taken her husband was the pharmacist who filled the prescription. White Laboratories, the New Jersey-based company that manufactured the drug, was found to have been negligent in its testing and marketing of DES. As Needham's attorney's argued in closing, the drug "scarred her, physically as well as emotionally, for life." The Michigan attorneys who argued Needham's case have lawsuits pending on behalf of about 315 DES daughters in 18 states. In Boston, a U.S.

District judge has agreed to hear what may develop into a multimillion-dollar class action against six drug companies on behalf of Massachusetts DES daughters. 'You've Changed the System' One New York law firm has lawsuits demanding $20 million in punitive damages on behalf of each of three DES daughters one of whom has since died of cancer. There are suits pending in almost every state in the nation, and the sums of money involved are potentially large enough to dwarf the estimated $141 million paid out to young victims of the West German-made sedative called thalidomide. White Laboratories is withholding comment on the Needham case while the company decides whether to appeal. Eli Lilly has already filed an appeal.

"If we're responsible for whatever a drug company does, whether it was our drug or not, you've changed the whole tort system in the United States," says Edwin Heafey, an Oakland attorney who has represented Lilly for 22 years. He says the predistribution testing was extensive and was conducted by the leading researchers of the day. And it cannot be conclusively proven that DES causes vaginal or cervical cancer, Heafey says. "We're talking, in the cancer situation worldwide, about a very small, minute incidence of the disease." he says. "Twenty-five percent of the people that die in America this year will die from cancer.

Then you take the 346 (the number of young women listed since 1971 in an international tabulation of clear-cell adenocarcinoma cases) and how many were exposed to estrogen? Two hundred and thirty. So twenty-five percent of them had the same thing and were not exposed to DES There's something else going on in the girls that have it, and I really believe that." "I was the underdog," Joyce Bichler says," and they were the big guys, and going into that trial they were laughing at us. They didn't think we had a chance, and we just stuck in there and fought back. And we won." Bichler is 25 now, a San Francisco social worker with wiry dark hair and blue-gray eyes that do not flinch as she talks about the raw details of her medical history. She is married to a speech pathologist, whom she loved seven years ago when she became ill in New York, and who would not go away after her operation, despite Bichler's insistence that no man could ever find her attractive again.

"It's something that is brought up to mind every single night of your life," Bichler says slowly. She is sitting on her living-room couch, hands in her lap, absently twisting her gold wedding ring. "It's not like I guess there are some surgeries where you just have a hysterectomy, you can forget about it and kind of go on living. But with this type of surgery you have the outward appearance of being OK but in your private life, you can never really forget what happened. "It's something you have to face constantly." In 1971 she was a freshman, hesitantly premed, at State jM! WMKKKHKKKKKm Mmm lllllillllBliill 1 We are discussing spheres of Influence, such as the Bonwlt Teller Lanvln Collection.

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