Faculty Bibliography

A panel of specialists advising the government on smallpox vaccinations recommended on Wednesday offering the immunization to an estimated 500,000 emergency room workers and other hospital employees because of the possibility of a bioterrorist attack. The government usually follows vaccine recommendations from the panel, which advises the Centers for Disease Control and Prevention, headquartered here where the panel met on Wednesday and will continue to meet today

The decision on how many people to vaccinate has been complicated and contentious because the vaccine is dangerous, smallpox was eradicated in 1980 and the threat of a bioterrorism attack that releases that smallpox virus is unknown. The panel also said workers should be asked whether they are pregnant or infected with the AIDS virus, H.I.V., before receiving the vaccine. Both conditions can increase the risk of adverse reactions to the smallpox vaccine, which experts consider the most dangerous of all immunizations. In June, the panel rejected a proposal to offer smallpox vaccine to every American at this time. But earlier this month top Health and Human Service officials said that they had not yet ruled out offering smallpox vaccine to all Americans; however, they said they would prefer to do so after a newer version of the vaccine is licensed, which cannot occur before 2003

The network will also be used to determine who will get the scarce and dangerous drugs needed to treat complications of the smallpox vaccine, and when, said Dr. Gina Mootrey, another official at the centers, in announcing the monitoring plan to a panel advising the government on smallpox vaccinations. The panel also recommended not giving smallpox vaccine to anyone who has a family or household member with either skin condition because the virus in the vaccine could be transmitted to them. The other is cidofovir, a drug that experts hope might be effective against vaccinia, the virus in the vaccine that protects against smallpox. Cidofovir must be injected, is dangerous and its only approved use is for a different virus

Federal health officials had recommended a 60-day course of an antibiotic for more than 9,300 workers who were exposed to anthrax spores in four states and the District of Columbia in 2001. In making their recommendation, officials had to weigh the benefit of preventing cases of anthrax and the risks of side effects from the drugs themselves. [Colin W. Shepard] said that his team was confident that antibiotic prophylaxis had prevented some cases of anthrax among those exposed to the letter sent to Sen. Tom Daschle, the majority leader, because of the heavy exposure of spores in the Senate and the Brentwood postal processing center in Washington. The antibiotics available to the exposed workers were Ciprofloxacin, Doxycycline and Amoxicillin, licensed drugs that the government distributed free of charge to workers. Ciprofloxacin was the drug used most often in the initial days of the anthrax attacks. It can cause convulsions as well as other adverse effects on the brain and central nervous system

Federal health officials had recommended a 60-day course of an antibiotic for more than 9,300 workers who were exposed to anthrax spores in four states and the District of Columbia in 2001. In making their recommendation, officials had to weigh the benefit of preventing cases of anthrax and the risks of side effects from the drugs themselves. Dr. [Colin W. Shepard] said that his team was confident that antibiotic prophylaxis had prevented some cases of anthrax among those exposed to the letter sent to Senator Tom Daschle, the majority leader, because of the heavy exposure of spores in the Senate and the Brentwood postal processing center in Washington. The antibiotics available to the exposed workers were Ciprofloxacin, Doxycycline and Amoxicillin, licensed drugs that the government distributed free of charge to workers. Ciprofloxacin was the drug used most often in the initial days of the anthrax attacks. It can cause convulsions as well as other adverse effects on the brain and central nervous system, and also lead to rupturing of the Achilles tendon and others

''We'd have no difficulty recognizing'' the chemical and providing the appropriate care, Dr. [Lewis R. Goldfrank] said. But the Moscow disaster and a theoretical attack on this country differ in crucial ways. If the agent is a narcotic like fentanyl or heroin, victims will probably be calm, their pupils pinpoint size, their breathing and heart rates slow and their blood pressures low. Other types of drugs could produce opposite symptoms. If it is scopolamine, an anti-motion sickness drug that robbers have used to incapacitate victims, people may be delirious. While treatment progresses, toxicologists will use laboratory tests to try to quickly identify the chemical used in the attack. All major cities have equipment to identify or rule out certain classes of chemicals. Many hazardous materials teams carry mass spectrometers and other analytical tools that can screen a large number of chemicals and provide specific identification of an agent, said Jerome M. Hauer, who directs the Office of Public Health Preparedness in the Department of Health and Human Services

Cangene, by contrast, has a bigger contract but a less urgent time frame. It is to produce up to 100,000 doses for the United States civilian population over five years. Lacking a pool of frozen plasma, it is seeking about 10,000 volunteers like Mr. [Michael Kuring] to be inoculated for smallpox and then bled twice a week for two months. Plasma is spun off their blood and their red cells are returned to them. Each is paid $100 a week, but four donors interviewed in Marietta said money was not a factor. Mr. Kuring, Ralph McKinstry, Albert Casanova, all veterans, and Kathy Eagye, who has a master's degree in public health, said they wanted to help protect others. Ms. Eagye, however, did confess that she so feared a smallpox attack that she volunteered partly to get revaccinated. Ralph McKinstry, recently immunized for smallpox, gives blood to help create a treatment for people who have serious reactions to the vaccine. (Photographs by Erik S. Lesser for The New York Times)(pg. F1); Jacke Grayson, left, gives a smallpox vaccine to Karl Fivecoat, who has provided blood to help create an antidote to the vaccine's side effects. (Erik S. Lesser for The New York Times)(pg. F2)

The first thorough examination of President John F. Kennedy's medical records, conducted by an independent presidential historian with a medical consultant, has found that Kennedy suffered from more ailments, was in far greater pain and was taking many more medications than the public knew at the time or biographers have since described. At times the president took as many as eight medications a day, says the historian, Robert Dallek. A committee of three longtime Kennedy family associates, who for decades refused all requests to look at the records, granted Dallek's request, in part because of his 'tremendous reputation,' said one of them, Theodore C. Sorensen, who was the president's special counsel

At times the president took as many as eight medications a day, says the historian, Robert Dallek. A committee of three longtime [John F. Kennedy] family associates, who for decades refused all requests to look at the records, granted Dallek's request, in part because of his 'tremendous reputation,' said one of them, Theodore C. Sorensen, who was the president's special counsel. In The Atlantic, Dallek writes that while Kennedy's secrecy can be taken as 'another stain on his oft-criticized character,' the records also reveal the 'quiet stoicism of a man struggling to endure extraordinary pain and distress.'

At times the president took as many as eight medications a day, says the historian, Robert Dallek. A committee of three longtime Kennedy family associates, who for decades refused all requests to look at the records, granted Dallek's request, in part because of his 'tremendous reputation,' said one of them, Theodore Sorensen, who was President Kennedy's special counsel