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Notebook Medicine


David Adams (second from right) with his 13-year-old son and the quadruplets. Joe McIlhaney and his wife Marion are on the left and right. (Handout)


Life trajectory

A pro-life ethic challenged and shaped OB-GYN and fertility doctor Joe McIlhaney’s long career

As a high-school senior, Joe McIlhaney wrote an English class essay on why he wanted to be a veterinarian. When he realized becoming a vet would require four more years of school after college, McIlhaney wondered: “Why do all that to take care of dogs? Why not take care of people?” So he decided to become a doctor.

Now 84, McIlhaney during his 58 years of practice has been an OB-GYN, an in vitro fertilization (IVF) pioneer, and an educator on sexual health. His path was twisting and not without difficulties, but McIlhaney learned the importance of an ethical framework and Biblical foundation.

McIlhaney graduated from Baylor College of Medicine in 1961. After completing a three-year residency in obstetrics and gynecology, McIlhaney moved with his wife and daughters to Austin, Texas.

Soon after Roe v. Wade legalized abortion, a woman visited McIlhaney’s office and said she would kill herself if she couldn’t have one. McIlhaney felt conflicted, but after getting pro-abortion advice from a Christian Medical Society representative and Dallas Theological Seminary’s Bruce Waltke, McIlhaney concluded, “I guess it’s the medical thing to do.” So he performed the abortion. 

Another woman came with a similar story, and McIlhaney performed his second abortion. As he finished the procedure, he saw little legs and feet and what looked like “little, tiny spaghetti”—the baby’s intestines. McIlhaney felt nauseous: “I don’t care what anybody says. These are human beings.” He never aborted another baby.

As an OB-GYN, McIlhaney met many couples struggling with infertility and started the first in vitro fertilization practice in Austin in 1985. As a Christian, he had a few ethical concerns with IVF. He knew the embryos he helped create in the lab were human beings, like the ones he had aborted. So McIlhaney only fertilized as many eggs as a husband and wife were willing to use. 

McIlhaney’s approach to IVF attracted the attention of Eve and David Adams, a Christian couple who had struggled with infertility for nine years. Eve’s appendix had ruptured three months after the couple had their first child, and the scar tissue led to infertility. The couple decided to try IVF when they learned Dr. McIlhaney believed in the sanctity of life.

Eve and David Adams flew from Georgia to Austin, where McIlhaney and his wife, Marion, hosted them. The Adamses decided to have McIlhaney transfer four embryos to raise the chances of pregnancy. They knew the odds of all four implanting and surviving were low.

When Eve went in for her first ultrasound, she told the nurse she had a feeling there were four babies. The nurse brushed her off, until she started counting, “One, two, three, how many did you say?” She told Eve to hold on a minute and ran to get the doctor: Four babies were growing in her womb.

When McIlhaney heard the news, he asked Eve, “Are you mad at me?” She responded, “Are you kidding? No, we’re thrilled!”

On Aug. 31, 1995, Eve gave birth to the first set of quadruplets to be born at Tallahassee Memorial Regional Medical Center. A little more than a year later, McIlhaney and his wife pulled up to the Adamses’ home in Thomasville, Ga., and spotted four little green lawn chairs in the yard. They spent a few days getting to know Olivia, Emily, Stephen, and Stephanie—four healthy children. McIlhaney is thankful he could use IVF to help families like the Adamses: “I’m glad for the babies that I got to be a part of bringing about. It’s God that does it, not me.”

The Adams quadruplets are in their 20s now. Since their birth, a lot has changed in the world of IVF, which troubles McIlhaney: “When you see what’s happened to it, you wonder, was I complicit in that?”

When McIlhaney brought IVF to Austin in 1985, his practice didn’t accept donor sperm or eggs. Now potential parents can shop at an online embryo bank and choose frozen embryos based on the donor’s physical appearance. McIlhaney’s original practice would only freeze as many embryos as a couple agreed to use later in life. In 2017 the Department of Health and Human Services estimated 620,000 embryos were currently cryo-preserved in the United States. McIlhaney compares IVF to a loaded gun: It can protect and it can kill. 

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Christopher Loren Ewers/PBS

Roger Frisch (Christopher Loren Ewers/PBS)


A steady hand

Innovative surgery stopped a violinist’s tremor, allowing him to continue in his calling

Roger Frisch had it all. A lengthy career as violinist and associate concert master of the acclaimed Minnesota Orchestra. A supportive, talented wife, Michele, principal flutist of the Minnesota Opera. Three adult children successfully launched. A fulfilling teaching post at a local Christian college.

But in 2007, at age 56, Frisch’s right arm started involuntarily quivering on a music ministry trip to China. He recalls, “It came on quickly. It progressed quickly. Real panic set in.”

Two years of deteriorating steadiness and more than a dozen doctors later culminated in a visit to neurologist Joseph Matsumoto at the Mayo Clinic in Rochester, Minn. Within 30 minutes, Matsumoto diagnosed him with essential tremor, a benign but progressive neurological disorder that could eventually render professional performing impossible. 

When medication didn’t work, Frisch knew any hope to extend his career entailed the radical next step: brain surgery. 

Renowned Mayo neurosurgeon, Dr. Kendall Lee, told me he’d been in Asia and saw a Japanese surgeon stop a patient’s tremors by lesioning, or damaging, part of the brain. Lee wanted to stop Frisch’s shaking by implanting electrodes to interrupt the tremor-causing impulses without harming tissue, a technique called deep brain stimulation.

Frisch recounts how in December 2009 he lay strapped to the operating table, his head propped up and immobilized by a bolted-on halo. He remained awake for the entire surgery, violin and bow in hand. 

The surgical team planned to measure precisely Frisch’s tremors while he played by using an oscilloscope attached to a first-ever “accelerometer” that Mayo engineers had innovatively created from inner workings of a Wii game accessory toggled to a $75 violin from eBay.

Lee drilled a small hole in Frisch’s skull and manipulated a lead with an electrode down into the correct region of the thalamus. He directed Frisch to draw his bow across the strings. Frisch complied, trembling noticeably less, but not enough to play smoothly.

After checking with Frisch, Lee in a surgical first inserted a second electrode on the same side of his brain. Frisch again drew his bow and pulled a long, steady, beautiful note, and then another. The tremor had disappeared.

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Jerry Holt/Minneapolis Star Tribune via ZUMA Wire/Alamy

Quinn Nystrom traveled from Minnesota to purchase insulin at Shoppers Drug Mart pharmacy in Fort Frances, Ontario. (Jerry Holt/Minneapolis Star Tribune via ZUMA Wire/Alamy)


A new drug war

U.S. turns to Canada for cheaper drugs, but does Canada have enough to share?

When pharmacist Heather Christ arrived for her afternoon shift at Shoppers Drug Mart in New Brunswick, Canada, she noticed a tower of empty pharmacy trays stacked nearly 2 feet high. The reason, Christ said: shortages. Patients with high blood pressure request a 90-day supply of medicine, but the pharmacist may only give them enough for 10 days. A mom comes to pick up an anti-convulsant for her epileptic child, only to find the drug isn’t available.

When drugstores run out of drugs, “people just get panicky,” says Christ. But that’s nothing new in Canada: Christ sighed heavily and said, “It’s been part of the scenery for so long.” Christ, a 30-year veteran of Canada’s pharmaceutical industry, says the country’s drug shortage has worsened in recent years. More than 1,800 drugs are on Canada’s needed list, according to the official Drug Shortages Canada website.

Last month U.S. President Donald Trump announced plans to allow the import of cheaper prescription drugs from Canada. But Canada doesn’t have enough drugs to share with the massive U.S. market, and the Canadian Health Minister’s office said, “While we’re aware of ongoing state-led initiatives to import Canadian drugs, we weren’t consulted on specifics.”

Given Canada’s preexisting drug shortages, Christ says expanding the market is “alarming from Canada’s point of view.” If the United States drills a hole in the already leaking Canadian drug pipeline, and then tries to fill a tank 10 times the size of Canada’s, the drug supply will run dry. A 2018 study published in the journal Health Economics & Outcome Research: Open Access found that if one-fifth of U.S. prescriptions are filled in Canada, Canada’s drug supply will be exhausted in six months.

Christ says Canadian pharmacists sometimes work around drug shortages by adapting prescriptions. They work from scratch to create alternative compounds. The process takes extra time and keeps patients waiting, but shortages leave them no choice.

Christ is allergic to bees, so she carries an EpiPen. When an EpiPen shortage struck Canada last summer, she didn’t feel right getting a new one. She and many other Canadians kept their expired EpiPens. A drug’s expiration date is the time after which the drug could have lost 10 percent of its potency, so an expired EpiPen might still work. But it might not work, and a severe allergic reaction would be the consequence. Thankfully, Christ didn’t have to find out because the shortage ended.

One year later, Canada is running out of EpiPens again. Pfizer, until recently the only company authorized to provide injectors to Canadians, continued to have manufacturing problems. Ginette Petitpas Taylor, the Canadian health minister, has signed an emergency interim order to allow U.S.-based provider Kaléo to send epinephrine auto-injectors to Canada.

That may sound like an easy solution, but it was complicated. The new injectors didn’t have instructions in French for distribution in Quebec. They operated differently than EpiPens, so pharmacists had to spend extra time teaching patients how to use them. The injectors came in packages of two, so pharmacists had to open the packages to redistribute them one per patient. And Kaléo had to rebuild trust, since it suffered a product recall in 2015.

Why the recurring shortages of other drugs? Opinions abound. Manufacturing and shipping problems. Disruptions in international supply. Discontinued generics in favor of newer, brand-name drugs with greater profits. Lack of suppliers. Government price caps imposed by Canada’s nationalized healthcare system. And the future of Canada’s drug supply? Christ said, “I’m discouraged.” She sees the recurring problems as the new normal: a normal that could be worsened if the United States comes looking for a share.

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