Faculty Bibliography

'The Piano Tuner' by Daniel Mason is reviewed.

Accurate information and an informed perspective could bring the public's fear of smallpox more in line with its real risk. Exaggerating the side effects of a largely safe vaccine is not the best way to treat the fear of the virus

Meanwhile, the drug salespeople brought free lunches as well as flashy product samples to my office, trying to entice me and my patients with the latest and greatest. It was tempting to believe that the new pill would work -- we both wanted it to. It was easy to forget last year's pill, which was probably just as good and, having gone generic, a whole lot cheaper. But Mr. B was growing more and more cynical, not believing any pill could help his hip pain. On the rare day when his symptoms eased and he felt well, he would claim that medications had nothing to do with it. Mr. B would not consider hip surgery -- he was afraid of complications -- though he finally did agree to see an arthritis specialist. This doctor prescribed a yellow pill, the latest once-a- day medicine that was supposed to be easier on the stomach than other drugs. Taking it for a two-week trial, Mr. B reported that his stomach was fine, but he still limped noticeably. At his request, I sent him to a second arthritis expert, who switched him to a green pill, which didn't work even as well as the yellow one. The second arthritis expert recommended surgery, but Mr. B still refused it. In my office, the yellow pill competed with the green one for space in my sample closet. Both manufacturers clearly thought that I would end up prescribing the drug. All the drug salespeople seemed to know how much of their product I prescribed. They brought clumps of samples for various conditions all at once, probably believing if I gave out their green pill for arthritis, I would also start prescribing their red pill for sinus infections

Siegel discusses a recent experience having dinner at a restaurant sponsored by a drug company.

Since President Bush announced the smallpox vaccine would likely be made available to the American public in 2004, my patients have all been asking me the same question: Should they get the smallpox vaccine? Which is why President Bush's intention to make the old smallpox vaccine available to the entire population by 2004 might not be so wise. It could raise false hopes because there's no way to vaccinate everyone overnight. It could also limit the ability of doctors to counsel their patients on whether they should subject themselves to a somewhat risky vaccine. Smallpox is one of our oldest scourges. It should scare us. But we would do well to remember that even before there was a vaccine, smallpox never took over a whole region the way polio or influenza did. And smallpox isn't about to do that now

Which is why the president was right to make it clear in his speech yesterday that he was not recommending the old smallpox vaccine for the entire population. Doing so would have limited the ability of doctors to counsel their patients on whether they should subject themselves to a somewhat risky vaccine. In my experience, if people know that a vaccine or a treatment is out there, they are probably going to want it -- whether it will be helpful or not. With new, safer vaccines around the corner, doctors should be in as strong a position as possible to persuade people who are not at risk from using the live vaccine

The risk of smallpox appearing in the United States is still theoretical. But ever since Ken Alibek, the former deputy director of Biopreparat, the Soviet biological weapons apparatus, freely admitted to extensive amounts of smallpox existing in the Soviet Union, there is every reason to believe that some of the stockpiled virus may have found its way into the hands of rogue dictators or terrorists. And smallpox may be aerosolized -- if it is sprayed, it could infect hundreds of victims right off the bat. The fear associated with smallpox is much more contagious than the disease. Smallpox is one of our ancient scourges, and it captures the dark side of our imaginations. Schoolchildren learn of smallpox as the first bioweapon, distributed in blankets to Native American tribes by British troops during the French and Indian wars of the 1750s. Vague memories of our earliest immunizations against smallpox haunt many of us. This antiquated vaccine is not safe when given to people who have certain skin conditions, are immuno-compromised or pregnant. Unfortunately, these conditions may be hidden. The one recent death from the smallpox vaccine occurred in a military recruit who unknowingly was HIV-positive

The risk of smallpox appearing in the United States is still theoretical. But ever since Ken Alibek, the former deputy director of Biopreparat, the Soviet biological weapons apparatus, freely admitted to extensive amounts of smallpox existing in the Soviet Union, there is every reason to believe that some of the stockpiled virus may have found its way into the hands of rogue dictators or terrorists. And smallpox may be aerosolized -- if it is sprayed, it could infect hundreds of victims right off the bat. The fear associated with smallpox is much more contagious than the disease. Smallpox is one of our ancient scourges, and it captures the dark side of our imaginations. Schoolchildren learn of smallpox as the first bioweapon, distributed in blankets to Native American tribes by British troops during the French and Indian wars of the 1750s. Vague memories of our earliest immunizations against smallpox haunt many of us

A surgeon might favor surgery, while a nonsurgical neurologist might say that because some of the damage to the cord was irreversible, Why take the chance of scarring and inflammation from the surgery? On the other hand, doing nothing meant living with the unremitting pain, not to mention leaving the spinal cord vulnerable to further damage. The day before the surgery was scheduled, a routine blood test found a low sodium count. That meant an automatic delay because of the increased risk of seizure from low salt. Plus, the low sodium could be caused by dehydration, which would be compounded by blood loss during surgery. That sudden aberration before surgery seemed to be a warning that something else might go wrong. Weeks later, she arrived again at my office, not with tap-dancing shoes, as I had imagined, but unaided, without even a walker or a cane. She was calm and pleasant, and I could see her vitality starting to return. She was already walking better and feeling stronger than she did before the operation. As if to underline her full recovery, her blood tests were all normal, including the sodium, an indication that she had truly been dehydrated before surgery. Any other cause would not have gone away for good with just saline

Blood bank screening for hepatitis has brought several previously hidden cases to my office door. Some privacy has been forsaken for the more important goal of keeping our blood supply safe. A doctor must be able to communicate a patient's information to another doctor, provided the patient has authorized this referral. This method has always been used and it must continue. No additional written consent for expert consultation or chart notes passed among physicians is possible without gumming up the works. And a patient should want a consulting doctor to know his history and be able to pass a comprehensive evaluation back to the primary physician. This routine optimizes care