Box 1. Reproductive Hazards and VDT Exposure
A 31-year-old woman, gravida 1, para 0, presents to her obstetrician at six weeks’ gestation with concerns about her home computer. She is a graduate student at the local university and is working on her thesis. This work requires that she use the computer for up to six hours per day. She has heard that there may be an association between electromagnetic fields from video display tubes (VDTs) and adverse pregnancy outcomes. She does not want to take any risks, but she hopes to finish her thesis before the child is born. She asks her physician’s opinion of the literature on VDT exposure and birth defects.
There have been many reported clusters of women working with VDTs in office settings who gave birth to children with birth defects. Reported defects were widely heterogeneous, including clubfoot, congenital heart defects, neural tube defects, and cleft palate. In addition, clusters of prematurity and spontaneous abortion have been reported. VDTs emit nonionizing radiation: light, radiowaves, and microwave radiation. While there is some concern about the association of nonionizing radiation in the form of electromagnetic fields and the risk of hematologic tumors, brain tumors, and adverse reproductive outcomes, the evidence is still very mixed. The evidence of an association between electromagnetic fields and specific cancers (e.g., leukemia, brain tumors) is much stronger at this time than the evidence of an association between these fields and reproductive risk. Most physicians do not feel that VDTs pose a significant risk of adverse pregnancy outcomes.
Patients’ concerns about potential occupational or environmental exposures during pregnancy must always be taken seriously. If the clinician does not know the medical literature on the exposure in question, it is imperative that he or she research the issue before simply reassuring the patient. Maternal exposures to many things clearly increase the risk of adverse pregnancy outcomes. Lead, solvents, ethylene oxide, glycol ethers, carbon monoxide, radiation, prolonged standing, and drugs such as thalidomide and alcohol are all clear examples of reproductive hazards. Caution and awareness of the possibility of new reproductive hazards is important to prevent unnecessary reproductive tragedies.
Adapted from Bentur and Koren (1991), Paul and Himmelstein (1988).
See also case study number 53 in Appendix C for more information on reproductive and developmental hazards.
four-year undergraduate medical curriculum that has been described by some as unresponsive to societal changes and needs (Abrahamson, 1978; Marston and Jones, 1992; Pew Health Professions Commission, 1991) and reinforcing and expanding this knowledge and these skills during postgraduate residency training is a formidable challenge.
Although efforts at curriculum reform have failed in the past, medical education may be embarking upon a new era. There are renewed calls for change; those calls and the