Faculty Bibliography

The vaccine did seem to significantly lower the infection rate among African-Americans and other non-Hispanic minorities participating in the trial, the company said. Its researchers called this finding totally unexpected and said they were at a loss to explain why there would be ethnic differences in response to the vaccine. They conceded that the findings, though statistically significant, might change if the vaccine were tested among more members of minorities, who were only a small fraction of the people in the trial. The vaccine, known as Aidsvax, is made from a protein called gp120, the same protein that protrudes from the surface of HIV and helps the virus dock with cells of the body's immune system. The protein in the vaccine is made in genetically engineered hamster ovary cells. Since the vaccine consists of only one protein and not the whole virus, it cannot give someone AIDS. But it is designed to provoke the immune system into making antibodies that will latch on to the gp120 protein in the real virus and the virus from infecting immune cells. Most mainstream AIDS researchers have said they do not believe the approach will succeed. For one thing, HIV mutates rapidly and there are a number of subtypes of the virus, which themselves may have many different strains. VaxGen's vaccine is designed to elicit antibodies to only two strains of subtype B, the type most prevalent in North America and Europe

The vaccine, known as Aidsvax, is made from a protein called gp120, the same protein that protrudes from the surface of HIV and helps the virus dock with cells of the body's immune system. The protein in the vaccine is made in genetically engineered hamster ovary cells. Since the vaccine consists of only one protein and not the whole virus, it cannot give someone AIDS. But it is designed to provoke the immune system into making antibodies that will latch on to the gp120 protein in the real virus and the virus from infecting immune cells

Once the organs arrived, [Jesica Santillan]'s heart and lungs were removed and the donor organs were implanted. Santillan was removed from the heart-lung bypass machine and the organs functioned well for 30 or 40 minutes. Then they began to fail and Santillan was returned to the machine. Moments later, the operating room heard the from the transplant immunology lab: 'The transplant was ABO incompatible with the recipient.'

Medical errors are thought to be responsible for as many as 98,000 deaths in the United States every year, and the nation's most august hospitals are far from immune. The errors have often resulted, as in Duke's case, not from a failure of cutting-edge medicine but from lapses in the most basic safety procedures. In 1999, the Institute of Medicine of the National Academy of Sciences reported that medical errors kill 44,000 to 98,000 people a year and that many of these deaths could be prevented by improving safety measures. Most medical errors do not result from individual recklessness, but from basic flaws in the way hospitals and clinics operate, the report said

After reviewing Ms. [Jesica Santillan], Duke officials began requiring three members of the transplant team to verbally communicate the results of the tests of the donor's and recipient's blood types, which are important in determining compatibility. Duke had not required it before. ''We believe that the changes we have put in place enhance the safety of the procurement process and should be considered as a national guideline,'' said Dr. William J. Fulkerson, vice president and chief executive of Duke University Hospital, and Dr. R. Duane Davis, surgical director of Duke's transplant program. Others believe that such changes should be determined by independent panels, not the hospitals that make the errors. Ms. Santillan's case ''is an unfortunate but pertinent illustration of the fact that these kinds of errors in complex situations are systematic errors,'' said Dr. Joseph J. Fins, an internist and the director of medical ethics at New York Hospital-Cornell Medical Center, ''and we need to devote as much money to the prevention of error and understanding of the systems that can engender error as we do to the understanding of the immunology of transplantation.''

Medical errors are thought to be responsible for as many as 98,000 deaths in the United States every year, and the nation's most august hospitals are far from immune. The errors have often resulted, as in Duke's case, not from a failure of cutting-edge medicine but from lapses in the most basic safety procedures. Of course, elite hospitals are not the only places where such errors occur. But serious mistakes at such institutions are particularly shocking because the hospitals are role models. They have earned their reputations because of their staffs' knowledge, technical skills and ability to develop and apply the newest and best therapies. In 1999, the Institute of Medicine of the National Academy of Sciences reported that medical errors kill 44,000 to 98,000 people a year and that many of these deaths could be prevented by improving safety measures. Most medical errors do not result from individual recklessness, but from basic flaws in the way hospitals and clinics operate, the report said

The doctors have discussed the findings with her family, the officials said, without adding further comment. Additional studies to assess brain function are under way and we continue to do everything we can to support her, the hospital said. On Feb. 7, after a three-year wait, [Jesica Santillan] received a heart and two lungs from a donor with an incompatible blood type. Duke officials have said they accept responsibility for the error, but they have not publicly disclosed precisely what went wrong. Jesica has blood group O; the first donor was type A. Right after her second transplant surgery, Dr. Duane Davis, surgical director of the lung transplant program at Duke, told reporters that she had not suffered any irreversible damage

It is a long shot for her to recover, said Dr. Robert Robbins, of the Heart-Lung and Lung Transplantation Program at Stanford University. Unlike [Jesica Santillan], most patients who receive second heart transplants do so because their immune systems reject the donor organs. Because the heart and lungs Jesica received came from a person with a mismatched blood type, her body mounted a furious attack on the mismatched organs. The blood type incompatibility is generally more serious in transplanting lungs because lung tissue has a propensity to react very strongly immunologically, the doctors said. Dr. Mehmet Oz, a heart surgeon at New York-Presbyterian Hospital, said that if Jesica survived, her chances for serious long- term medical problems like infection and immunological disorders would be about 80 percent. Still, Jesica's parents, who are from Mexico, celebrated that their daughter had been given a second chance when new organs from a donor with matching type O blood were found Wednesday. Outside the hospital here in Durham, Jesica's parents hugged in front of a growing crowd of reporters. The couple looked exhausted. We are blessed, her mother, Magdalena, said

Once the organs arrived, Ms. [Jesica Santillan]'s heart and lungs were removed and the donor organs were implanted. Ms. Santillan was removed from the heart-lung bypass machine and the organs functioned well for 30 or 40 minutes. They began to fail and Ms. Santillan was returned to the machine. Moments later, the operating room heard the worst possible news from the transplant immunology laboratory: ''the transplant was ABO incompatible with the recipient.'' Ms. Santillan's condition was stabilized and she was moved to the pediatric intensive care unit. Because the designated recipient's condition was not suitable for transplant surgery, Dr. [James Jaggers] asked about the availability of a heart and lungs for Ms. Santillan as well as the status of the donor's lungs. The coordinator offered the heart and lungs to Dr. [R. Duane Davis] for an adult patient. Dr. Davis declined because the organs were incompatible in size for an adult

In recent years, many expert panels have warned that budget cuts were causing the public health system in the United States to crumble. On top of traditional services for mothers and children, health departments have had to apply more sophisticated laboratory techniques and newer methods to counter the resurgence of tuberculosis and to keep other infectious diseases in check. The latest demands involve a vaccine that few practicing doctors have ever given because the United States abandoned it as a routine in 1972, eight years before smallpox was eradicated from the world. Now health departments must train workers in how to use two-pronged needles to administer the vaccine and recognize its many complications, some of which are rare but potentially lethal. The vaccine, which is made from a live virus that is a cousin to smallpox, is the most dangerous human immunization. Experts have predicted that some recipients will have sore arms and suffer flulike symptoms that will keep them home from work and that a few will have much more serious reactions. Some people are advised to forgo vaccination unless there is a terrorist attack. Among them are those with weakened immune systems or a history of eczema or atopic dermatitis, two common skin conditions. Dr. Elizabeth McNeill, the chief medical officer of the Pima County Health Department in Tucson, Arizona, said she had a hard time justifying putting so many resources into smallpox vaccinations. I don't see a tangible benefit, she said. In other words, there is no case of smallpox out there