Faculty Bibliography

[Peter Davies] said he believed the test could be modified for wider use within a year, but further work to make it useful in everyday medicine will take many more years. Davies' team has completed the first stage. It involved doing the test on samples of brain and cerebrospinal fluid kept frozen until the diagnosis of Alzheimer's was documented after death. Davies said the test showed the A-68 protein in all cerebrospinal fluids from Alzheimer patients, and none from the fluid of patients who died of other diseases. Davies said that from experience with a brain bank at Einstein he knew that the label of Alzheimer's in up to 20 per cent of patients is in error because of the imprecision of the diagnosis. Thus if Davies tests cerebrospinal fluid samples from 20 patients whose doctors believe them to have Alzheimer's and he identifies A-68 in 18 and not in two, what does that mean? That the test is not sensitive enough? Or that the doctors misdiagnosed the two patients? Verification of the diagnosis from autopsies might be delayed for years. If further research sows that A-68 appears in brain cells before people develop the symptoms of Alzheimer's, scientists could use this knowledge to find a drug to relieve the symptoms, or even to stop the progression of the disease. A diagnostic test would help eliminate patients with other forms of dementia from the studies, presumably providing more accurate evaluations of a drug's effectiveness on Alzheimer's. Researchers have speculated that imprecision in the diagnosis might be one reason for conflicting results in research studies with experimental drugs

The resulting blood shortages have led at times to the postponement of scheduled surgery, which is one reason more doctors have been asking more patients to donate their own blood. Although proponents of autologous blood transfusions contend that greater use of autologous donors could prevent further shortages in the nation's blood supply, Dr. Peter Page, who heads blood services in the Northeast region of the American Red Cross, stressed: ''We're not doing autologous programs because of a shortage and people wouldn't get blood otherwise. We're doing it because we think it is optimal therapy for each individual.'' Mrs. [Loretta Norrell] said she ''wouldn't have thought about giving my own blood'' had her surgeon, Dr. Christopher B. Michelsen, not suggested it. Given the nature of her surgery, he recommended that she store four units. ''The more I thought about it, the more it made sense,'' Mrs. Norrell said

The new blood test might also be used to monitor the effectiveness of cancer therapies, the researchers said in an article in the issue of The New England Journal of Medicine being published today. An editorial in the same issue calls the findings ''provocative.'' But it adds that the researchers, at the Beth Israel Hospital and Harvard Medical School in Boston, still have ''much work'' to do with much larger numbers of patients'' to determine what value the test has in routine physical examinations and in screening for early cancers among apparently healthy people. Dr. Philip S. Schein, a cancer specialist at the University of Pennsylvania who wrote the editorial, said it was ''essential'' for researchers to conduct more rigorous studies correlating the test results with the nutritional status of patients and with specific patterns of lipids in patients in the studies. Dr. Frank Rauscher of the American Cancer Society said that ''the jury is still out.'' Though his reaction to the report was ''conservative,'' Dr. Rauscher said, ''the fact is they have come up with something we haven't seen before. If this is as good as it sounds, then it's very good indeed.''

Meanwhile, although the NIH's budget has grown to $6.2 billion this year from $577 million in 1961, many political leaders and NIH officials have been concerned that too few Americans know about it. Though most scientists profess otherwise, politics has always been a major factor in the running of NIH, and the nature of NIH politics has changed significantly. [James B. Wyngaarden] cited two other areas of 'potential harm' he said had tarnished the image of the NIH and the rest of the biomedical community: a growing number of instances of scientific fraud and lapses in concern about animal welfare. Although such abuses have been few, Wyngaarden said, 'they are more widespread than we would like to admit.' Congressional questioning has been more probing, he said, adding, 'The reflex support of NIH is not as strong as it once was.'

Dr. [David Axelrod] said that Mr. [Cuomo] was not taking any medications and that none had been prescribed. ''The Governor is a therapeutic nihilist and getting him to take even an aspirin is a major concession,'' Dr. Axel-rod said. He said he and the orthopedic surgeon expected Mr. Cuomo's symptoms to subside with the traction treatment over the next few weeks. Dr. Axelrod also said he had ''no reason'' to believe surgery would be needed, but he added there was ''no way to rule out the prospects of surgery.'' The pinched nerve is Mr. Cuomo's second problem with his back. In the past, he has suffered from low back pain and no specific cause has been identified, Dr. Axelrod said. ''He has minor arthritic changes in the lower back,'' he said. He said the Governor had ''discomfort rather than pain.'' The results of the CAT scan were ''equivocal,'' Dr. Axelrod said, but the magnetic resonance image showed the pinched nerve as ''a relatively small area in clear outline.''

[Halfdan Mahler] said the AIDS program would include these points: Providing model policies and strategies for combating AIDS, chiefly through educational campaigns, for every country that requests help; Expanding a global information-gathering system to screen and disseminate information to health workers. An effort will be made to help countries benefit from educational programs proved effective elsewhere; Creating an international network among scientists to share information, and a far more aggressive program of research into drugs, vaccines and other therapeutic and preventive health measures; Tapping the skills of sociologists, behavorial scientists, communications experts and others outside the traditional boundaries of public health professions; Educating health workers about how AIDS spreads and the dangers of repeated use of needles without sterilization between injections, a common practice in Third World countries. Black & White Photo; Black & White Photo; Black & White Photo; Graphic, Diagram; Photos Star files; MEDICAL TECHNOLOGISTS, top photo, in a sterile room test for AIDS antibody. Below, a closeup of lymphocytes shows budding AIDS virus, as seen by an electron microscope, with closeup of AIDS virus, inset

''We're running scared,'' said Dr. [Halfdan Mahler]. He said he could ''not imagine a worse health problem in this century.'' ''We stand nakedly in front of a very serious pandemic as mortal as any pandemic there ever has been,'' he said. ''I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming.'' He Admits 'Gross Underestimate' Dr. Mahler chided many countries for lacking ''political guts'' to face the reality of AIDS and for ''everyone wishfully believing AIDS won't penetrate'' their borders because ''things are different here.'' Distinctions From Other Diseases

He said that the organization, a Geneva-based agency of the United Nations, also is giving the AIDS effort the kind of backing it gave to the eradication of smallpox. He said that the organization hopes to be raising $1.5 billion a year by the 1990s for the fight against AIDS. [Halfdan Mahler] said at the news conference that 100,000 people have come down with AIDS worldwide, according to reports by governments and extrapolations by WHO. One million people have AIDS-related disorders, he said, and up to 10 million are infected with the AIDS virus and presumably are capable of spreading it. In the United States, the Public Health Service has predicted a total of 270,000 AIDS cases by the end of 1991, including 179,000 deaths. Scientists now estimate that for those who do come down with AIDS itself, the average lag time between infection with the virus and diagnosis of the disease may be five years or more

The viruses are believed to cover an enormous spectrum; some appear to be strongly infective, others seem to be weak. Some strains of the same type of AIDS virus barely infect cells under laboratory conditions, Dr. [Robert C. Gallo] said, while other strains ''run to'' the cells. ''What makes one cause disease, another not, I don't know,'' Dr. Gallo said. But, he added, ''The answer will come in 1987.'' He said he hoped scientists would find a particular gene that accounted for the difference. Dr. [Luc Montagnier] said in an interview that he and his collaborators had detected the LAV-2 virus in at least six West African countries: Cape Verde Islands, Guinea-Bissau, Mali, Senegal, Guinea and Ghana, as well as in France, Belgium and West Germany. Dr. Montagnier said researchers were searching for the LAV-2 virus in Central Africa where AIDS is epidemic

The researchers reported last spring that A-68 apparently exists in large amounts only in brains destroyed by Alzheimer's disease. (Very small amounts have been found in two rare neurological disorders, Pick's disease as well as a form of Parkinson's disease found on Guam.) The studies, which were supported by the Commonwealth Fund, illustrate the complexity of turning a hot research lead into a development useful in standard practice. Much work needs to be done to document the test's accuracy and to learn when the protein first becomes detectable in the cerebrospinal fluid during the course of the disease. Dr. [Peter Davies]'s team has now advanced to the second stage: testing 50 spinal fluid samples, including those from 12 Alzheimer patients, in a so-called blind fashion without knowing which sample is which. Dr. Davies said that he ''did not believe any test until it is done blind.'' Among the other mysteries of Alzheimer's is why the brains of many older people with Down's syndrome develop the changes associated with Alzheimer's disease. Down's syndrome, a genetic disorder linked to an abnormality in the 21st chromosome, produces mental retardation. Thus, the development of strains of animals susceptible to Down's syndrome could offer important biological clues to the cause of Alzheimer's and its natural course. Such a development was reported last week by two teams of researchers at Johns Hopkins Medical School and at the University of California at San Francisco