Faculty Bibliography

Because colchicine is a licensed drug, American doctors can prescribe it for cirrhosis without specific approval from the Food and Drug Administration. Surveys have found that about 11 million Americans are alcoholics, and cirrhosis can develop unpredictably among them

Dr. [Marcos Rojkind]'s team and the authors of an editorial published in the same issue of the journal called the findings ''striking,'' particularly because the course of cirrhosis is normally so dismal. ''How significant it is only time will tell, but at least it will change physicians' attitude toward treating cirrhosis,'' Dr. Rojkind said. A Common Symptom The Yale doctors cited several reasons in urging caution about the use of colchicine as a standard treatment for cirrhosis. One was that the results could have been due to chance. A second was ''unintentional bias'' due to the fact that Dr. Rojkind's team lost contact with 20 percent of the initial group of patients and hence could not determine whether they were alive or dead at the end of the study

The need for an international approach to fighting and treating AIDS was expressed most succinctly in Stockholm by Dr. Halfdan Mahler, a Dane who is retiring as head of the World Health Organization. ''AIDS cannot be stopped in any country unless it is stopped in all countries,'' Dr. Mahler said, adding that it would be discrimination to deny ''the fruits of international science to all of the world's peoples'' and to limit the benefits ''only to the rich.'' Mr. [Ingvar Carlsson], speaking of past experience and looking optimistically toward the development of therapies and preventions for AIDS, said that ''scientific knowledge has to be applied'' and drugs and vaccines ''have to be distributed to everywhere'' regardless of ability to pay. ''The assumption in the United States is that those on AZT will remain on it until they die or until something else comes along that is shown to be more effective,'' Dr. [Jonathan Mann] said. ''You have to be in a system that can assure lifetime commitments.'' Political instability, poverty and the frailty of medical institutions make that unrealistic in many countries.

Many scientists, sobered by the lack of reports of major advances of the type that characterized AIDS research a few years ago when they discovered the virus and developed a blood test, said the meeting reflected ''the maturity'' of AIDS research. ''This Stockholm conference stands as a symbol of the global will to solve the HIV/AIDS problems,'' she said, adding that personal discussions between scientists from many fields ''often yield as important knowledge and understanding as scientific studies.'' HIV is the name of the AIDS virus. Dr. James Rayhal, an infectious disease specialist at Booth Memorial Hospital in Flushing, Queens, said he had regarded each of the four international AIDS meetings as courses for learning the thousands of little points that relate to caring for patients and doing AIDS research. ''You won't understand the advances that will be described in 1993 if you do not understand what is learned each step of the way,'' Dr. Rayhall said. Scientists' Strange Language

Although a majority of drug users in some cities, such as New York, already carry the AIDS virus, the accumulating data ''indicate that we should be able to limit the spread of HIV to levels well below the 80 to 95 percent'' figures for hepatitis B infection seen among drug users in New York and San Francisco, he said. In another report, Dr. Jonas Salk of San Diego reported that no dangerous reactions occurred among the first 18 volunteers who received injections of a killed AIDS virus that his team at the University of Southern California is testing as a potential way to prevent those who are already carrying the AIDS virus from becoming seriously ill. The dead virus is one from which the outer coat has been removed. Dr. Salk hopes to determine whether injection with the material will stimulate the patients' body to produce defensive substances that suppress the activity of the live AIDS virus they carry. Encouraged by the safety study, he said the team recently began expanding it to include 54 carriers of the AIDS virus who had no symptoms of disease. He said that because of his fame as the developer of a polio vaccine, many people refer to his new experimental substance as a ''vaccine,'' but that he preferred to call it an immunomodulator, something designed to assist the body's own immune defences

''Unfortunately we cannot give you the headlines everyone wants about an AIDS vaccine coming tomorrow,'' said Dr. Friedrich Deinhardt of Munich, West Germany. New Data, New Questions In an earlier study from the New England center, the vaccine did not protect monkeys when they were injected with very large amounts of virus. The preliminary result of the newer study has led the researchers to begin a third experiment in the belief that an AIDS vaccine is ''theoretically possible.'' Commenting on the latest data, Dr. Harold Jaffe, chief AIDS epidemiologist at the Centers for Disease Control in Atlanta, said that ''the majority'' of virus carriers will develop AIDS. ''Whether that will be 70, 90 or 100 percent, we still don't know,'' he added.

The chairman of a scientific panel convened by the company to evaluate the trial, Dr. Edwin D. Kilbourne, a microbiologist at Mt. Sinai Medical Center in New York City, called the results ''encouraging'' but added that ''further work must be done'' because the trial was ''highly preliminary.'' ''Any time you're dealing with only 19 end points,'' he said, ''you're subject to the tyranny of small numbers'' and ''can't protect yourself'' against the possibility that the results were a statistical fluke. ''As nice as the study results look,'' he said, ''I'd be a lot happier to see two other studies report the same thing. It's important with something as encouraging as this to be absolutely sure.''

The procedure is supposed to be applied to to anesthetized patients or patients who are unconscious or nearly so. But ''the calamity of cardioversion of conscious patients'' is occurring ''with alarming frequency,'' said Dr. Peter R. Kowey of the Medical College of Pennsylvania in Philadelphia in the editorial in the May 1 issue of the cardiology journal. While he gave no numbers, and some other cardiologists said they believed the number of such cases was very small, Dr. Kowey said any such experience is ''alarming.'' ''Ventricular tachycardia makes doctors very nervous because it is a scary rhythm, especially if they do not see it often,'' Dr. Kowey said. ''The impulse is: 'This is ventricular tachycardia, I have got to get rid of this,' rather than 'This is V.T., the patient's blood pressure is stable, he is talking to me, and maybe I have a few minutes to consider alternatives.' '' ''But,'' the cardiologist went on, ''that is not the way it has to be. Our resolve is never to cardiovert an awake patient.''

Nevertheless, Dr. [Lars Olof Kallings] said, the ''overall impression is a feeling of optimism due to the strength'' of people to cope with the epidemic and the fact that ''knowledge is spreading faster'' than the disease. The AIDS virus ''is very clever, very shrewd,'' Dr. Kallings said, but is vulnerable to drugs because it ''depends on an intricate mechanism for its survival.'' But Dr. Kallings said there will be few reports about new compounds. ''While it has become somewhat fashionable to reassure and state that HIV will never threaten certain populations, we believe that virology, immunology, social science and epidemiology require us to take the long view, and a more somber view,'' he said. ''Let us remember that we are still in the early phases of a global epidemic whose first decade gives us every reason for concern about the future.''

Mrs. [Marilyn K. Goldhaber] said that when she heard accounts of the VDT problems, she was ''surprised to find that there was very little published in medical journals and no organized epidemiological study.'' Dr. [Michele Marcus] and Dr. Philip J. Landrigan, a professor of environmental medicine at Mt. Sinai, termed the Kaiser study good and credible. ''This is an important area that needs to be pursued in detail,'' Dr. Landrigan said. A Question 'We Cannot Answer' It is possible, the researchers said, that ''recall bias'' might have led women who had miscarriages to overestimate the time they spent at terminals. But Mrs. Goldhaber said the researchers discounted this possibility because there had been no such bias in reporting insecticide exposure