Faculty Bibliography

In the fall of 2005, the purchase of hand sanitizers was up almost tenfold. I'm sure this is a response to the fear of getting bird flu -- a way to reassure yourself that you are doing something to protect yourself. I would never discourage hand cleansing, but keep in mind that any quick remedy for bird flu fears also reinforces the notion that bird flu is almost here, when there is no evidence to support this. The same is true for avoiding poultry. It may make some people feel safer for a brief moment, but it also reinforces the misconception that our poultry supply is at risk. The chances of an infected human bringing bird flu to the United States on a plane are practically nonexistent, simply because there are so few cases of human bird flu. But even if someone brought bird flu here, it would not spread because there is no human-to-human transmission with bird flu in its current state. It is very unlikely that a live bird will pass bird flu to North America, though bird smugglers do exist and Pacific flyway birds can occasionally make it across Siberia to Alaska. It is far more likely that some chilled or frozen poultry containing H5N1 will arrive here, mislabeled or smuggled from Asia. In that case, the virus would be destroyed as soon as the poultry was cooked, and the virus would not be transmitted to humans or other animals

Last year a study in the journal Cancer Epidemiology, Biomarkers & Prevention looked at 7,000 current and former smokers and found a marked reduction in cancer occurrence and mortality in those who exercised regularly and vigorously, even among current smokers. For example, there was a 25 percent reduction in cancer deaths in the 54- to 62-year-old smokers who followed a workout program compared to those who did not exercise. The study is among several that shows exercise has a positive effect even in heavy smokers. The study looked at 43,000 people from the 1970s through 2002 and found that those who smoked very little (one to four cigarettes daily) had poor health outcomes. These light smokers were three times more likely to die of heart disease than nonsmokers; heavy smokers were four times more likely. Light smokers also had significantly higher death rates over the 30 year period -- 1.5 times higher generally -- than those who had never smoked. Going from zero to four cigarettes per day showed by far the greatest correlation in the study between smoking and associated death rates. In fact, it wasn't until cigarette consumption increased to 25 cigarettes per day that the corresponding death rate from all causes reached three times normal. Certainly, a subset of patients has been so devastated by smoking that any exertion may present a strain too great for a severely damaged heart or lungs. Any smokers considering beginning an exercise program must consult with their physicians first. But for most smokers it seems clear that regular exercise initiates a healthy cycle that is likely to improve, and perhaps extend, their lives

All too often, however, the authors' statements seem more like polemic pronouncements than demonstrable, inarguable facts. They rely heavily on their interpretation of the 9/11 Commission report as well as circumstantial evidence. As an example, they state: 'The Bushes would not be eager for the press to learn that on Monday, September 10, the Dulles hijackers had been guests in the same hotel as Saleh Ibn Abdul Rahman al-Hussayen, the top liaison to the worldwide Islamic charities that funded Osama bin Laden.' The authors never provide us with the specifics about the funding of the terrorists, and they go on to speculate further: 'Because of pressure from Prince Bandar [of Saudi Arabia] on the Bush administration ... on September 19, al-Hussayen was allowed to fly to Saudi Arabia.' Walking through John F. Kennedy International Airport and observing these proud new TSA agents, better paid and with better benefits, it is difficult for me to believe they could be less effective than a group put together by private companies. Yet the Trentos state that 'the TSA screeners have a substantially higher failure rate than the private screeners did.' I speak with one of the new TSA supervisors, who has a background in law enforcement, and he acknowledges that many of his screeners are former teachers, clerks and students. He calls TSA 'a work in progress' but says he would never stay with the job if he didn't think there was real progress and adds that the current system is better than the former one. The contention that we are no safer in the skies today than before 9/11 may seem difficult to believe until the authors detail the poor shape of the current 'no-fly' lists, where dead terrorists and non-terrorists still abound. (For its part, the government claims that it cannot definitively confirm the identities of many of the 9/11 hijackers, which is why some names remain on the list.) The Trentos were also able to interview a sought-after hijacker from the 1980s not in some secret bunker but at an outdoor Beirut cafe. They write that the skies can be safe only 'if the U.S. government, airlines, and local airport authorities demand that our intelligence agencies finally provide a usable national database of people who should not be allowed near passenger planes.'

For 40 years, there has been a burgeoning in life-saving and life-extending medications, the likes of which have never been seen before. Even with the most advanced technologies, some of the greatest discoveries have occurred by accident. From the treatment of HIV disease to the treatment of diabetes to the treatment of acid reflux disease, new drugs have reduced suffering and improved the quality and length of life all over the world. Perhaps, in the interests of full disclosure, it should be mandatory for critics of the drug industry to include a listing of the medications they take whenever they make negative comments

Eli Lilly was the winner for the best unbranded television ad award. Their television commercial on depression -- done in black and white -- clearly showed the conditions of a patient who is clinically depressed and badly in need of treatment. There was no mention of a product, but anyone watching this ad became instantly more aware of the symptoms and signs of an underdiagnosed, treatable disease. Lilly continues to have a stake in the proper recognition and treatment of depression

Ketek is an antibiotic with a deserved reputation as an effective treatment for bacterial respiratory infections. But erythromycin and all its derivatives, including Ketek, have some degree of liver toxicity. Ketek is now being deemed as unusually toxic -- at least according to a recent safety review by FDA officials. These officials have suggested that the FDA either force Sanofi-Aventis to withdraw Ketek from the market, severely restrict it, or at least add a stern warning to its label. Whatever the outcome for Ketek, the decision should be based on facts and statistical risks compared with the potential gain of lives saved

The 157:H7 strain of E Coli, which can populate the intestines of cows, makes a toxin that damages human blood-vessel lining, causing bloody diarrhea. It can also lead to blood clots and kidney failure, especially in children. Cows lack the toxin receptors in their blood vessels, and so are asymptomatic carriers. The manure from infected cows can contaminate ground water or organic fertilizer. Since very small amounts are necessary for human infection, it is fairly easy to cause a limited outbreak, especially in farms that rely on manure for fertilizer. There have been at least 11 outbreaks of this E Coli in salad foods since 1995. No one knows the exact mechanism in each case, but possibilities include contaminated water, equipment or fertilizer. In 1999, nearly 1,000 people were infected, and at least two died after consuming water (believed to be contaminated by manure after a heavy rain) at a county fair in upstate N.Y

Measles is preventable: 99% of those who receive the two-step vaccination develop immunity. The measles vaccine uses a live attenuated virus, which means a deactivated virus that can still provoke immunity but no longer get people sick. There is a growing irrational fear of vaccinations that is not connected to fact. This fear leads to disuse of a crucial preventative. While it is understandable that parents are concerned about vaccines their child receives, the measles vaccine requires 100% compliance to effectively prevent reoccurrence and control spread of a deadly disease

The science on the H5N1 bird flu virus may not support these conclusions. Two important studies published just last month in top science journals show that this bird flu virus is still multiple mutations away from being able to pass easily among humans. This bird flu appears to be better absorbed by the deep pockets of bird lungs, whereas human flu is absorbed by the cells of our upper airways. Dr. David Swayne, director of the Southeast Poultry Laboratory at the U.S. Department of Agriculture, has worked on avian influenza for many years. He takes all highly pathogenic bird flus seriously, including H5N1, but he feels they can most often be controlled. Swayne told me that H5N1 might still be eradicated in birds with the help of 'better diagnostic tools and improved strategies to protect birds from infection.'

The discovery of protease inhibitors was a revolutionary accomplishment in the world of virology that has changed the course of clinical disease for HIV patients. Here is how these drugs work: When the protease enzymes is blocked, HIV makes copies of itself that can no longer infect new cells. Studies have shown that these drugs reduce the amount of circulating virus in the blood and improve the body's immunological response to viruses. At a time when drug companies are routinely criticized for drug safety violations, it is good to recall the life-saving effects of the HIV drugs