Faculty Bibliography

Mr. [Bush] fainted after a pretzel stuck in his throat and he gagged and coughed. Dr. Richard J. Tubb, the White House physician, said pressure from the pretzel on Mr. Bush's esophagus stimulated the vagal nerve, which connects the brain and the heart and other organs. The vagal action slowed Mr. Bush's heartbeat and lowered his blood pressure, making him faint, a reaction that is called vaso-vagal syncope. Dr. Tubb said in an interview that he based the diagnosis on his examination on findings from several standard tests. Dr. Tubb said a cardiologist and neurologist who had examined Mr. Bush during an extensive medical checkup on Aug. 4, Mr. Bush's first as president, concurred in the diagnosis. Ms. [Cindy Wright] checked Mr. Bush's blood pressure, which was 111/70 and pulse, which was 51, both normal levels for him. After Ms. Wright paged him and another White House doctor, Bill Lang, at 5:48 p.m., Dr. Tubb said, he drove to the White House and found Mr. Bush ''sitting on his couch.'' Mr. Bush was wearing his reading glasses, which were twisted, but the lenses were intact

[Robert Stevens] worked in a state where no anthrax had been reported in years. Inhalation anthrax was virtually unknown in the United States. [Larry M. Bush] interviewed Stevens' wife, who said her husband opened letters all day, and concluded that the anthrax had come through the postal system. Bush said he told local health officials, the federal Centers for Disease Control and Prevention and the FBI about his suspicions

[Robert Stevens] worked in an office, in a state where no anthrax had been reported in years. And inhalation anthrax was virtually unknown in the United States. [Larry Bush] interviewed Stevens' wife, who said her husband opened letters all day, and concluded that the anthrax had come through the postal system. Bush said he told local health officials, the federal Centers for Disease Control and Prevention and the FBI about his suspicions. Scientists knew that anthrax spores could lie dormant in soil for decades and then cause disease. They also knew that inhalation anthrax occurred when spores entered the lungs and were swept into lymph nodes in the mediastinum, in the middle of the chest, where they germinated and pumped out toxins. But scientists still had much to learn. Medical experts also misjudged the difficulty that doctors would have in diagnosing inhalation anthrax, assuming that a sophisticated surveillance system was needed to detect an attack. But Bush, the Florida infectious disease expert, said he knew immediately what was wrong with Stevens, the first patient with inhalation anthrax

Mr. [Robert Stevens] worked in an office, in a state where no anthrax had been reported in years. And inhalation anthrax was virtually unknown in the United States; almost all of the very few cases had occurred in workers exposed to airborne spores -- by working with hides of infected animals, for example. Dr. [Larry M. Bush] interviewed Mr. Stevens's wife, who said her husband opened letters all day, and concluded that the anthrax had come through the postal system. Dr. Bush said he told local health officials, the federal Centers for Disease Control and Prevention and the Federal Bureau of Investigation about his suspicions. Medical textbooks say that inhalation anthrax starts with mild, flulike symptoms that are hard to recognize, and that by the time it progresses to its severe phase, it is easy to diagnose but virtually impossible to cure. But the two postal workers who came to the emergency room at Inova Fairfax in October did not have textbook symptoms. The first patient did not even seem very ill, but a CT scan of his chest showed telltale signs of anthrax. The second patient complained of the worst headache of his life. But he did not have the classic signs of inhalation anthrax -- bacteria in his spinal fluid and abnormalities in a chest scan. Doctors learned he had anthrax only when they examined his blood and saw the characteristic boxcar-shaped anthrax bacteria. Dr. Larry M. Bush diagnosed anthrax in a Florida patient in October. (Alex Quesada/Matrix, for The New York Times)(pg. 1); Dr. [Julie L. Gerberding] -- Acting deputy director, Center for Infectious Diseases at the Centers for Disease Control and Prevention: ''In retrospect, we were certainly not prepared for layers and levels of collaboration that would be required.'' (Alan S. Weiner for The New York Times); Dr. [D. A. Henderson] -- Director, federal Office of Public Preparedness: ''Everything we knew about the disease just did not fit with what was going on. We were totally baffled.'' (Carol T. Powers for The New York Times); Dr. [John F. Eisold] -- The Capitol physician, on the anthrax mailed to Senator [Tom Daschle]'s office: ''People thought each spore was plutonium.'' (Stephen Crowley/The New York Times)(pg. 16)

On 'Good Morning America,' Charles Gibson began a conversation with his co-anchor, Diane Sawyer, by saying: 'There's a study from the World Health Organization, this is for real, that blonds are an endangered species. Women and men with blond hair, eyebrows and blue eyes, natural blonds, they say will vanish from the face of the earth within 200 years, because it is not as strong a gene as brunets.' The British accounts were replete with the views of bleached blonds who said hairdressers would never allow blondness to become extinct, and doctors who said that rare genes would pop up to keep natural blonds from becoming an endangered species

In atrial fibrillation, the heart beats irregularly because the atria fire electrical signals in an uncontrolled and very fast way. When the signals arrive in the ventricles in an erratic pattern, the ventricles pump blood less efficiently to the body. The slower flow of blood promotes formation of clots in the atria. The danger from the blood clots promoted by atrial fibrillation is that pieces of clots will break off to lodge in arteries in the brain, causing strokes, or elsewhere in the body, damaging organs. In the studies, strokes tended to occur among those taking inadequate doses of anticoagulant drugs like warfarin (sold under the brand name Coumadin) or not taking them at all. Anticoagulants showed benefit even if the heart rhythm returned to normal. Among the drugs that have been most commonly used for atrial fibrillation, those to restore a normal rhythm, are amiodarone (sold as Cordarone), sotalol (Betapace), propafenone (Rythmol), procainamide, quinidine, flecainide (Tambocor), disopyramide, moricizine and dofetilide (Tikosyn)

The new study found that a diuretic, chlorthalidone, was more effective in preventing fatal and non-fatal heart attacks than were three other classes of drugs: amlodipine (sold as Norvasc), a calcium channel blocker; lisinopril (Zestril and Prinivil), an ACE inhibitor; and doxazonsin (Cardura), an alpha-adrenergic blocker. The market for blood pressure-lowering drugs is huge. High blood pressure affects 50 million Americans, and 24 million of them spend $15.5 billion a year for blood pressure-lowering drugs. The remainder do not know they have hypertension or do not take drugs for it. The prevalence of hypertension increases with age; more than half of people over age 60 have hypertension. Diuretic use for hypertension costs about $25 a year, compared with about $250 for an ACE inhibitor and $500 for a calcium channel blocker, according to Dr. Paul Whelton, a leader of the study who is also professor of epidemiology at Tulane University. 'There were tremendous efforts to prevent doctors from using diuretics,' Dr. Marvin Moser of Yale, an expert in hypertension, said in an interview. He said that the new findings vindicate experts who recommended use of diuretics in the face of vast promotional efforts by some experts and manufacturers to sell more expensive patented drugs

The plans must wait until President Bush announces whether he will limit vaccinations to about 500,000 health care workers or offer them to all Americans. No vaccination can occur until Bush's decision because the government owns all stocks of smallpox vaccine. Many health officials, administrators and doctors said that if vaccinations resumed, it would be after New Year's Day, to avoid problems at a busy time for hospital emergency rooms. Many hospitals are short of nurses and would find it difficult to find replacements for workers out sick because of sore arms, fevers and other reactions to vaccination

The largest study ever of high blood pressure has found that older diuretic drugs, or water pills, are as effective, if not more, than newer, costlier drugs..

Yet for all of Kennedy's suffering, the ailments did not incapacitate him, [Robert Dallek] concluded. In fact, he said, while Kennedy sometimes complained of grogginess, detailed transcripts of tape- recorded conversations during the Cuban missile crisis in 1962 and other times show the president as lucid and in firm command. For many years, Kennedy's back problems were largely attributed to injuries suffered when his Navy patrol boat, PT-109, was sunk in World War II. In fact, he had back pain before that. Dallek said his vertebrae may have begun degenerating as a result of the steroids he may have taken for intestinal problems in the late 1930s. The records show that Kennedy had 'a tremendous proclivity for infections,' [Jeffrey A. Kelman] said, contradicting [Janet G. Travell]'s assertion in 1960 that Kennedy had 'a better than average resistance to infection' and 'astounding vitality.'