JAMA : the journal of the American Medical Association
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Cesarean section rates in the United States have increased from 5.5% in 1970 to 24.4% in 1987. This dramatic increase has generated considerable concern, leading to a variety of proposals to control rising use of cesarean section. Six strategies have been adopted or proposed to reduce cesarean section use: (1) education and peer evaluation, (2) external review, (3) public dissemination of cesarean section rates, (4) changes in physician payment, (5) changes in hospital payment, and (6) medical malpractice reform. ⋯ Educational efforts have been the most widely promoted. Of these, formal programs aimed at modifying practices within individual hospitals appear to be the most successful. However, insufficient research has been conducted to compare conclusively the impact and feasibility of these six strategies, pointing to the need for further study.
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Fetal tissue transplantation has been attempted for a limited number of clinical disorders, including Parkinson's disease, diabetes, immunodeficiency disorders, and several metabolic disorders. Fetal tissue has intrinsic properties--ability to differentiate into multiple cell types, growth and proliferative ability, growth factor production, and reduced antigenicity--that make it attractive for transplantation research. At this time the results from fetal tissue grafts for Parkinson's disease and diabetes have not demonstrated significant long-term clinical benefit to patients with these disorders. ⋯ For these clinical investigations to proceed, specific ethical guidelines are needed to ensure that fetal tissue derived from elective abortions is used in a morally acceptable manner. These guidelines should separate, to the greatest extent possible, the decision by a woman to have an abortion from her consent to donate the postmortem tissue for transplantation purposes. Such ethical guidelines are offered in this report.