Faculty Bibliography

''It is beginning to turn out that heterosexual AIDS is a poor people's disease,'' said Dr. Andrew Moss, an epidemiologist at the San Francisco General Hospital. ''Historically speaking, say 50 years from now, homosexuals and drug users will not be the central phenomenon in AIDS. AIDS will be a routine sexually transmitted disease, and we have to adapt to thinking in those terms.'' The AIDS virus has been slowly spreading among heterosexuals who do not use intravenous drugs, but again, the spread is mainly among the sex partners of drug abusers. The proportion of AIDS cases among people who are believed to have contracted the virus through heterosexual intercourse has risen steadily to 3.6 percent for new cases reported in 1988, as against 1 percent of a much smaller number in 1982. (These totals exclude people from Haiti and Africa, where heterosexual intercourse is the predominant means of spreading AIDS.) One remarkable thing about the epidemic is how consistent the evidence has been over the years on how the virus spreads and how it does not. Studies have shown that AIDS is spread by sexual intercourse, by virus-carrying blood entering the body, by sharing intravenous needles and syringes; AIDS is also spread from infected mothers to their babies. The studies clearly show that AIDS is not spread by casual contact or by insects. Dr. Peter Kerndt, who heads the AIDS epidemiology program for the Los Angeles County Health Department, said he was ''not convinced of a true decline or slowing'' in the number of AIDS cases among Los Angeles gay men, and that any perceived lull was due to ''underreporting.''

Today gay men still account for a majority of cases of AIDS and are believed to be the majority of those who carry the AIDS virus but are not ill. Evidence suggests that the virus is spreading fastest among those groups. Minority groups are disproportionately hit: Four of five AIDS cases attributed to sharing needles have occurred among the black and the Hispanic. 'Historically speaking, say 50 years from now, homosexuals and drug users will not be the central phenomenon in AIDS. AIDS will be a routine sexually transmitted disease, and we have to adapt to thinking in those terms.'

From the time of Hippocrates, who in 400 B.C. urged physicians to 'sometimes give your services for nothing,' doctors have cared for many patients for free or reduced fees. Then, in the 1960s, the government began the Medicare and Medicaid health insurance programs to pay for the care of those 65 and older and the poor, taking up much of the burden that had previously been handled by the medical profession, if it was handled at all. Donating care has also become more costly and burdensome to physicians than in the past. For instance, many retired physicians say they would be willing to provide care for free as part-time volunteers but cannot afford to pay for malpractice insurance or risk the financial consequences of working without it

Researchers noted that the great variations in attacks made it difficult to study the effect of drugs on narcolepsy. In some patients, the symptoms may be mild at the start and only gradually increase in severity. In others, the change occurs rapidly. Dr. [Jacques Mouret] said the new therapy grew out of research he began about 20 years ago. He said he began using l-tyrosine about three years ago and waited until now to report on its use in the first eight patients. Dr. Mouret said he achieved equally impressive results in 23 additional patients. Because l-tyrosine had not been linked to narcolepsy before Dr. Mouret's report, American experts said they were surprised by the finding and hoped to proceed with their own scientifically controlled trials

The medical association's president, Dr. James E. Davis of Durham, N.C., has been telling physicians that taxpayer subsidies of their education have added to ''a basic responsibility to see that they take care of the poor and needy of their community.'' Dr. [Daniel M. Musher] noted that most American physicians ran small but highly profitable private corporations. ''Yet the medical profession is not associated with corporate giving or sponsorship of communal activities that characterize other corporations and small businesses,'' he wrote in the New York State Journal of Medicine. ''We know that it does little good to offer a medication when our patient needs a home, a meal, a family, love, money and a thousand other things that we ourselves take for granted,'' Dr. [David Hilfiker] has written. ''We also confront the limitations of a society that refuses to accept responsibility for its broken ones, and so it is tempting to turn away, offering nothing, sparing ourselves the deep frustration.''

''No convincing evidence can be adduced to establish a causal link between [Guillaume Dupuytren]'s contracture and manual labor,'' Dr. John T. Hueston said in his text on the subject. ''It is as common in ministers as in miners.'' ''The punishment the hand takes in getting the diseased tissue out of a severely deformed hand can result in prolonged disability,'' said Dr. Richard Eaton, a hand surgeon at Roosevelt Hospital in New York. ''Removing the diseased tissue from a less deformed hand generally results in a fairly quick recovery.''

Dr. [Barry J. Marshall] said scientists are ''chipping away at determining the chain of events that produces infection and leads to gastritis and possibly ulcers in many people, while allowing others to walk around with C. pylori without being sick.'' These reports have convinced many doctors that C. pylori causes the most common form of gastritis. (Gastritis can also be caused by alcohol, aspirin and many other drugs.) In a recent editorial in the journal Gastroenterology, Dr. John G. Bartlett of Johns Hopkins University School of Medicine in Baltimore called the evidence for the role of C. pylori in gastritis ''irrefutable.'' Nevertheless, Dr. Martin J. Blaser of the Veterans Administration Hospital in Denver said in a recent issue of an another journal, the Archives of Internal Medicine, that the link between C. pylori and duodenal ulcer ''is at least as strong as that with gastritis.'' He added that vaccines and antimicrobial treatments for the disorders are no longer considered radical notions

The researchers said they had not definitely established that the substance identified in the blood test is such a marker. But they said that in about half of alcoholics it appears in the blood at about twice the level at which it is found in nonalcoholics, regardless of how much the alcoholics consume. Researchers generally acknowledge, however, that it is difficult to obtain accurate data on past alcohol consumption from alcoholics. Dr. Boris Tabakoff, scientific director of the National Institute on Alcohol Abuse and Alcoholism, said he had not seen the research report. But he said several other research groups had been exploring possible genetic factors in alcoholism. They have been trying to discover ways of identifying people at risk of becoming alcoholics. But none of these methods is ready for routine use, he said. Team's Accidental Discovery Sensing that the finding might be relevant to alcoholism, the Wisconsin scientists changed the direction of their research. They tested 25 alcoholic men from 18 to 52 years old who had an alcoholic father and 24 men from 20 to 48 years old who were neither alcoholics nor had immediate blood relatives who were alcoholics.. The alcoholics averaged 81 drinks per week and the non-alcoholics 4

''We were nervous because it took us years to become comfortable in using such drugs in the emergency room,'' Dr. [Mark V. Sherrid] said. ''We didn't want to give a drug in the field we hadn't used in the emergency room.'' ''Now the question is, how do we make the service more widely available,'' Dr. [Henry Greenberg] said, adding that he and others intend to discuss plans with city and other hospital officials. One problem, he said, is the reluctance of some hospital administrators to initiate such programs because of the malpractice risks involved in having a non-physician inject the drug. Another problem is financial. It would cost hundreds of thousands of dollars to equip every ambulance in New York with the new cardiogram machines. Dr. Greenberg said he ''would insist that the issue of cost-effectiveness of such a program be debated up front as part of policy before anything is decided.''