Faculty Bibliography

A nurse I spoke with later, Diane Graham, who has been treating patients in New Orleans since 1978, said there are thousands of people like Mr. [Joe Gendusa]. Many of them have sunk into clinical depression or worse, and yet the city lacks the services to handle their psychiatric needs. 'The ER is always full,' she said, 'and we never have the staff to take care of them.'

Fortunately, thanks in part to flu vaccines and other public health measures, the last three pandemics have been progressively milder from over 50 million dead worldwide in the worst flu pandemic in 1918,102 million dead in 1957, to 1 million fatalities in 1968 (see 'The World's 'Most Unwanted' List,' p. 14). You've probably heard your parents or teachers talk about the possibility of a bird flu pandemic. Or perhaps you even saw the frightening TV docudrama shown on a major network that followed the events of a fictitious bird flu outbreak among, humans, and the widespread panic that followed. However, our public discussions of a possible flu pandemic from the H5N1 bird flu have been informed largely by the ghost of the 1918 Spanish Flu, which was caused by a new flu virus, known as H1N1.

No one questions the fact that CT scans of the lung aid in early detection. Chest X-rays often miss primary lung cancers before they are at least one centimeter in size and have often spread beyond the lung; CT scans routinely discover malignant lesions that are just a few millimeters in size. This strategy should be in place before the test is ordered. Having the best team available to order and interpret results is not a factor that can be weighed or studied in clinical research. But a CT report that tells me to repeat it in six months, or a needle biopsy for an irregular uncalcified nodule performed by a discerning expert, is far better for a clinician like me to have in hand then no CT scan or biopsy at all. When my patient Mr. 'Azziz,' a two-pack-per-day smoker for more than 25 years reached the age of 45, I decided to order a screening CT scan. The results showed a nodule at the top of his left lung, a common place for lung cancer. The biopsy showed squamous cell, a common type of cancer that is often fatal

Over the next few years, the author is certain that statins will emerge from the false and unsubstantiated rumors of associated memory loss and receive the full recognition they deserve for battling heart disease before it ever becomes clinically apparent. Of course, the first such study has slipped below the media radar. The METEOR trial and future studies with larger cohorts may prove beyond a doubt that the author is right, but he is already sure of it, based on his clinical reasoning combined with the clinical trials conducted on sick patients

As the pioneer drug in a class known as CETP (cholesterol ester transfer protein) inhibitors, torcetrapib had been shown previously by Pfizer to raise HDL, or good cholesterol, by more than 60%. Now Pfizer has taken a public relations hit because of its study discovery that the torcetrapib group had a higher death rate than the control group. But the criticism is hardly fair when you consider the pioneer spirit and resources of the company and how this spirit has so often led to great drugs

Bristol-Myers Squibb (BMS) is the pioneer in the area of creating a social program necessary to combat AIDS in the poverty-stricken countries of Africa. Its 'Secure the Future' program focused on developing an infrastructure that would support medicine use, rather than just throwing pills at poor people who did not have food or clean water. The current program does not utilize or market BMS's own drug, but rather provides funding to the communities which allows drugs to be purchased through the countries' own programs. The program has grown to $150 million, supported by over 200 grants

Last fall, the Centers for Disease Control vaccine advisory panel voted to make the shingles vaccination routine for the 50 million Americans over the age of 60. As a practitioner, the author is traditionally slow to change, and he tends to be a cautious observer in the first year of a new drug or vaccine's existence, but now that Merck's safe Zostavax has been available for more than a year, he has begun to eagerly order his supply. The vaccine not only prevents shingles, it also reduces the excruciating post herpetic neuralgia by more than 65%

As soon as the Journal of the American Medical Association's study from Britain which showed an almost 50% increase in hip fractures in elderly patients taking stomach drugs Nexium, Prevacid and Prisolec was published, many patients were frightened to continue taking drugs which only a day before had helped them live pain-free, reflux-free lives. Over interpretation of a perfectly good study and fear leads to good drugs becoming instant bad guys. Many doctors are sure to continue using proton-pump inhibitors because people do not have good alternatives to these drugs

The Society for Research in Child Development found that 40 percent of children who have returned to school suffer such psychological problems as sadness, clinginess, difficulty concentrating, irritability and risk-taking behavior.

Forced substitution is a growing practice that occurs when an insurance carrier tells its patients that it will only cover certain drugs in a class, but not others. This practice may or may not be good business, but it is definitely not good medicine. Drugs are not identical. Rather than saving healthcare dollars, ironically, forced substitution may end up costing more in the long run -- one must factor in the cost of unnecessary side effects or of a preventable illness like heart disease