Capsules

SUPPORT FOR SECOND OPINIONS

Should people seek out second opinions before elective surgery? Last December a Blue Cross study of a small group of volunteers suggested that second opinions might even increase the number of operations. These findings were contradicted last week by the most thoroughly documented report so far. Its conclusion: second opinions can save money and spare people surgery they probably do not need.

The study was conducted by a team led by Dr. Eugene McCarthy of New York Hospital-Cornell Medical Center, who pioneered the use of second opinions in 1972. Since then, 6,799 members of nine labor unions in the New York City area had to see a second doctor if they wanted their health insurance plans to pay for operations. In 19% of the cases, would-be patients got negative second opinions, and nearly two-thirds of them did not have surgery. Among the procedures frequently deemed unnecessary: bunion removal, hysterectomies, prostate surgery and knee operations. Judging by the experience of one union's health fund, every $1 spent for fees and administrative expenses in the program should save $2.63 in sick pay and hospital costs. Says McCarthy: "Every time a person was referred for a second opinion, the sponsoring fund saved $145."

A POX ON CHICKEN POX

Chicken pox is not a severe threat to most children, but it can be fatal to newborns and to thousands of youngsters whose natural immunity has been weakened by chemotherapy for diseases such as leukemia. Until recently, the only protection against chicken pox was an antiserum derived from the blood of patients recovering from the virus, since antibody levels are unusually high during convalescence. Locating such people is costly and difficult, so supplies were always scarce.

Now researchers at Massachusetts Public Health Biological Laboratories have found a way to screen out and concentrate chicken pox antibodies from the blood of healthy people. The procedure is similar to that used to extract gamma globulin for treatment of those exposed to rabies and hepatitis. Called VZIG, for Varicella-Zoster Immune Globulin, after the virus that causes chicken pox and shingles, the antiserum became available through the American Red Cross blood centers last week. The first supplies will go to vulnerable newborns and children with leukemia or weakened immune systems; a dosage provides immunity for about six weeks. But VZIG is not being recommended for all children. Pediatricians still believe the best way to develop a lifelong immunity to chicken pox is to get it, itching, scratching and all. qed

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