Faculty Bibliography

Quinolones are great drugs, but like all great drugs, they should be used judiciously. All drugs have side effects, and this family of antibiotics is no exception, causing occasional diarrhea, insomnia, tremors and restlessness. Quinolones have traditionally established themselves as gram-negative drugs for the urinary tract. But further quinolones were developed, including Levaquin and Avelox, that not only treated atypical lung infections but also showed better activity against garden-variety pneumococcus. Criticism against quinolones has obscured a safe, versatile and extremely useful category of drugs

My wife was on the verge of delivering. With the nurses trying to stop me, I quickly wheeled her past the desk to a delivery room. My wife positioned herself on the table while I rushed to find an obstetrician -- any obstetrician. Fortunately, a nurse was helping my wife into a gown and getting her ready. Just then an older obstetrician whom I'd never seen before ran into the room, donned gloves and gown and, less than five minutes later, delivered a healthy child. For the first time -- this was our third child -- I wasn't asked to cut the newborn's umbilical cord. Our own obstetrician came 10 minutes later and delivered the afterbirth. I wondered if our difficulties were some kind of divine punishment for my own professional insensitivities. As a physician in a busy practice, had I really listened to my patients who complained that they weren't treated in a timely manner? That there were too many forms to fill out? That I had scared them unnecessarily about a possible illness? Patients had good reason to be frightened, and I was getting a glimpse of this now. But regular patients and their families can have it much worse than I did. Even though the chief resident had treated me disdainfully, she had been influenced enough by my rank to participate in our son's birth. And perhaps it had been professional courtesy that motivated this unknown doctor to rush in to save the day, before our regular obstetrician arrived

With all the concern surrounding vaccines, and the public's assumed right to their availability, what is not appreciated are the difficulties drug manufacturers go through to produce them. Vaccines are usually generic products, which means a slim profit margin. Plus, they are regulated for sterility by the FDA, a very expensive process to ensure. Manufacturers are already strained to the limit, and the current technology using chicken-egg culture medium is inefficient. But the necessary genetic technology needed to upgrade vaccine-making capacity is very expensive

Polls show that our overall fear has remained fairly constant since 2001. An Associated Press/Ipsos poll the week after the July 7 bombings in London found 57% of us believe an attack on mass transit is inevitable, and 37% are concerned they or their loved ones will be the victims. These percentages have remained steady over the past year. But polls also indicate that recent attacks -- including the failed bombings July 21 in London and the successful ones two days later in Sharm el-Sheik, Egypt -- increase the public expectation elsewhere that the next strike might come soon. A USA TODAY/CNN/ Gallup Poll just after the London bombings found that 55% said an act of terrorism on U.S. soil was likely in the next few weeks. Elizabeth Phelps, professor of psychology and neural science at New York University, has been researching the effects of perceived danger on the human brain. She has added her findings to the pioneering work of Joe LeDoux, another neuroscientist at NYU. It turns out that the brain has a fear center, known as the amygdala. It's a tiny almond-shaped structure deep inside the brain that emits fear signals and initiates an outpouring of stress hormones. Though Ledoux's work on the amygdala is well established in animals, Phelps' applications to humans are still somewhat preliminary. Using the latest techniques in magnetic resonance imaging exam, Phelps has studied the brain's response to videos of dangerous situations rather than real dangers. She has shown that the effects on the brain's physiology are the same with a simulated attack as with a real one. Internet, television, movies -- these are all vehicles for the type of response that Phelps has studied. Visualized threats get our juices going, and we are ready to respond

Remarkably, I found that she was also much less confused. A lung doctor who had treated Pearl for many years for occasional bronchitis came to visit her in the hospital, and she cheerfully complimented the doctor on her new hairstyle. The lung doctor remarked to me that she thought Pearl was very observant -- and grumbled that her own husband hadn't noticed her hairstyle change. At first, the neurologist didn't agree. Ultimately, when Pearl resumed doing crossword puzzles and knowing the details of others' lives, even the neurologist -- though still not convinced -- admitted that the sodium aberration had been the more likely culprit. Because 4 million Americans suffer from Alzheimer's disease, including almost half of people older than 85 (Pearl was close at 83), it was understandable that the neurologist had considered this disease. Alzheimer's has a devastating outcome attached, and because there are many other conditions that can cause similar memory loss and confusion (depression, infection, metabolic disturbances of all kinds), rushing to give a stigmatizing diagnosis such as Alzheimer's is unwise unless a doctor is almost certain. Without absolute tests at this point, and because Alzheimer's disease evolves, diagnosing it properly means observing a trend, not making a pronouncement on one day's observations

With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains in the bird population. There is great value in improving our emergency health response system and upgrading our vaccine-making capacity. Government subsidies in these areas could make the public safer. With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains in the bird population. There is great value in improving our emergency health response system and upgrading our vaccine-making capacity. Government subsidies in these areas could make the public safer

The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation, but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected. With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains

A few months ago, one of my patients had an unexpected reaction to a statin drug, which is used to lower cholesterol levels. A routine liver test uncovered a large elevation in her enzymes. She had to be hospitalized immediately, narrowly avoided a liver transplant and has since recovered. Had she been able to obtain the drug over the counter, however, her liver problem probably wouldn't have been found in time. She might have died. Why the rush to unlimited access? Patents are running out, giving companies a financial motivation. If a drug is sold over the counter, the company can tap a market with millions of potential customers. Mevacor sales have dwindled since 2001, when it lost patent protection and was largely replaced by Lipitor and Zocor. Merck is doing what is good for business by pushing for over-the- counter Mevacor, but not necessarily what is good for the patient. Just last month, a study revealed that prolonged daily use of the arthritis drug Aleve can lead to heart disease. The FDA approved over-the-counter sales of Aleve a decade ago, despite the fact that it is prescription-only in several other countries, including Canada