Capsules

HOPE FOR DES DAUGHTERS

During the 1940s and 1950s as many as 4 million women took the synthetic hormone DES (diethylstilbestrol) to prevent miscarriages. But by 1971 doctors had unequivocal evidence that the drug produced worrisome cervical abnormalities in the women's female children. Now, after a five-year study of DES daughters, a team at Boston's Beth Israel Hospital has encouraging news: two types of DES-linked cervical lesions in these offspring apparently disappear in time and do not seem to be precancerous.

Beth Israel researchers observed 178 DES daughters, some of them from puberty. Initially, 121 had cervical ectopy, a condition in which misplaced glandular tissue grows on the cervix. But subsequent examinations revealed that this tissue was being replaced gradually; in many of the young women the ectopy disappeared. At the start of the study, 123 women had fibrous ridges growing around their cervical walls; this "hood" later receded in 52% and vanished in 28%. But the good news has a bad side. If DES daughters lose their abnormal cervical "markers" and neglect checkups, doctors may not monitor them for another problem linked to the hormone: a high risk of pregnancies ending in premature birth.

WEALTH FOR THE HEALTHY

Confronted by repeated rises in the cost of his California district's health insurance plan and by lower revenues stemming from the state's tax-cutting Proposition 13, Assistant School Superintendent Ed Nickerman of Mendocino County knew he had to cut these bills. But how? After six months of campaigning, he persuaded the county school board to adopt his idea: the district's 165 school employees would be rewarded to stay well.

Nickerman's health incentive scheme works by annually crediting each participant with $500 in a credit union account. The employee can use the money to pay medical bills; any expenses above $500 are covered by Blue Shield. Thus the plan resembles a typical deductible program, with a difference: any money left over at the end of a year belongs to the employee, to be collected upon retirement or as severance pay. Interest on principal goes to the school district's insurance fund. Since the stay-well program began in 1979, employees have become extremely cautious about running to the doctor. With reason: if a teacher remains in the district's employ for just three years, say, and draws only $50 a year for medical bills, he will receive a bonus of $1,350 when he quits. The school board profits too. By investing the deductible money in short-term Government notes, it has already earned $400.

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