Faculty Bibliography

Richard Suzman and Matilda White Riley of the National Institute on Aging noted that the rapid expansion of the oldest old in a population ''is so new a phenomenon that there is little in historical experience that can help in interpreting it.'' * Too often physicians are likely to ascribe a disability or an abnormal physical or laboratory finding to ''old age,'' when the actual cause is a specific disease process. For instance, when an older-aged patient has anemia, a physician may fail to pursue its source. Also, some hereditary disorders such as polycystic kidneys - a common cause of kidney failure -may not cause symptoms until the advanced years. Further, older people are peculiarly susceptible to certain conditions such as fractures of the hip from falls. ''Election exit polls have shown over and over again that the votes of older persons distribute among candidates in about the same proportions as the votes of midde-aged and younger persons,'' Dr. [Robert Binstock] said

Mr. [Nancy Reagan]'s White House is particularly sensitive because at 74 he is the oldest man to hold the office. In 1981, after he was shot in an assassination attempt, it took many days to confirm that the bullet had come to rest in a section of lung about an inch from his heart. There was also a serious discrepancy in the first public account of the number of blood transfusions Mr. Reagan received. Later, Mr. Reagan's doctors revised their account to about twice the original number after being challenged by data presented by this reporter. Dr. [T. Burton Smith], a urologist who is now the White House physician, customarily sees the President every day, as did Dr. Daniel Ruge, the neurosurgeon who was his predecessor. Additionally, Navy doctors examined Mr. Reagan in routine checkups. Moreover, Dr. Steven Rosenberg, the chief of surgery at the National Cancer Institute, was on the team that removed Mr. Reagan's cancerous colon polyp. Doctors often speak of the inadequate care that often goes with V.I.P. medicine. They point out that potentially life-saving steps, which should often be taken as routine, are omitted in deference to the patient's status. It is not known whether Mr. Reagan's doctors examined his skin carefully and yet missed the pimple for the skin cancer that it was, or whether his condition was one of those unusual cases in which it takes irritation or some other factor to highlight the appearance of a skin cancer

The skepticism of the doctors interviewed was passed along to the White House by this reporter. Mr. [Mark Weinberg] replied that they were ''all wrong.'' Later, however, Mr. Weinberg called back to say, ''We went back based on your skepticism, which was well-founded.'' Last week, Mr. [Larry Speakes] said a local dermatologist had performed the procedure in the White House medical office. On Tuesday, Mr. Speakes said ''it was done at Bethesda'' by military doctors. It is unclear whether he meant that the procedure or the examination of the tissue was done at Bethesda. ''The conventional approach is to scrape it deeply and to burn it with an electric needle three times,'' Dr. [Bernard S. Goffe] said. ''That is an extremely painful procedure.''

The White House yesterday revised its description of the procedure used last week to remove the skin cancer from President [Reagan]'s nose after several dermatologists expressed concern about whether all the cancer cells had been removed by the procedure as originally described. Shaving is usually done with a scalpel. Curettage is done with a curved blade that scoops deeper into the skin. Because the skin cancer is softer than the surrounding tissue of the nose, the doctor is generally able to follow the curve of the tumor. An electro-dessicator uses a charge of electricity to burn blood vessels to seal them. Without anesthesia electro-dessication is painful. [Larry Speakes] has said he had not asked doctors whether they were satisfied that all of the skin cancer had been removed from Reagan's nose

At a news conference Thursday, Larry Speakes, the White House spokesman, was questioned about the skin problem. But he said that he knew little about it beyond his description of it as a ''bump'' that had been present for ''months if not longer'' and that had been irritated by the tape that held a stomach tube that was inserted through the President's nose for a few days after his major surgery. Mr. Speakes said he ''would not characterize it as a growth'' but ''more as a gathering of the skin, a piling up of the skin.'' For example, asked ''Could you give us an answer to the biopsy?'' the White House spokesman replied, ''Well, we don't have it and when we have it we'll tell you about it.''

The test, which was licensed last spring, ''seems to be extremely valuable in screening out'' blood contaminated with the virus that causes acquired immune deficiency syndrome, said Dr. Harry M. Meyer, an official of the Food and Drug Administration. The test ''picks up essentially every potentially infectious unit'' of contaminated blood, he said. The new testing process is ''just fantastic,'' said Dr. Walter R. Dowdle, director of the Center for Infectious Diseases at the Centers for Disease Control in Atlanta. He said his mood today was ''quite a high'' compared with last April, when the test was being introduced and when there was considerable controversy about its merits. Transfusion-associated AIDS accounts for about 2 percent of the 12,067 AIDS cases reported to the Atlanta diseases centers through Friday. ''Now that we have pretty much solved the transfusion-associated AIDS cases,'' Dr. [James W. Curran] said, ''we have to work to control the remaining 98 percent.''

Americans ''have a lot more than the French have in every respect -many more biologists, virologists and other scientists working on'' AIDS, said Dr. William Haseltine of Harvard Medical School and the Dana Farber Cancer Institute in Boston. He asserted that ''a lot of very good talent is not being coordinated and used to the best of our ability'' largely because the AIDS problem is not being recognized ''for the serious epidemic that it is.'' ''What we get from France now is the crummiest kind of anecdotal stories - they don't do the scientifically controlled trials'' that are necessary to provide the evidence about a drug's safety and efficacy. Dr. Haseltine said ''it is really a crime'' that the data from the ''spotty trials'' is not being collected and analyzed by a central repository. ''If somebody is going to die, he might resign himself to that'' bleak prospect, Dr. Haseltine said. ''But he might be very bitter if he realizes that his experience isn't going to help the next man down the line.''

Mrs. [Reagan] said in a television interview with John McLaughlin, who has a weekly syndicated program, that her husband's recuperation was ''probably ahead of schedule,'' despite the workload. But, speaking also as ''a doctor's daughter,'' Mrs. Reagan said in the interview, broadcast today, that she believed ''he should be allowed to have a recuperative period which is very necessary for any patient and he should be allowed to have that just as any patient would.'' ''There isn't any disagreement,'' Mr. [Larry Speakes] said, adding, ''She is comfortable with the pace set.'' He said Mrs. Reagan had told him that her ''toughest job is holding him back, getting him to throttle back just a little bit.'' Mr. Reagan said ''the most difficult time I had'' with the operation was when he was awakening from anesthesia ''trying to reorient as to where I was and had I been operated on yet or not - and they said, ''Oh, yes, it's all over.''

''The President has cancer.'' With these words, which he shared with the world only moments after telling President Reagan that his colon polyp was malignant, Dr. Steven Rosenberg turned a most intimate personal problem into one of the most extraordinary disclosures of a Presidential illness. Despite the refusal of the President's physicians to release the pathology report on the polyp surgeons at Bethesda Naval Hospital removed a week ago - and the reluctance of the White House to make the physicians available to reporters when questions over the timing and adequacy of Mr. Reagan's medical care arose - there is an abundance of information available about this President's illness, perhaps the most since Dwight D. Eisenhower, who probably set the modern standard by disclosing almost every detail about his heart attack and surgery for a bowel condition called regional ileitis. On Oct. 18, 1967, Mr. [Lyndon B. Johnson] had a secret operation to remove a skin cancer from his ankle. He declined to disclose it apparently because of deep concern that public reaction to the word cancer would far exceed the seriousness of the medical situation. Undoubtedly there was an element of privacy. But the type of skin cancer that affected Mr. Johnson - a basal cell epithelioma - has one of the most favorable prognoses of all cancers. It is rarely fatal. Yet it was only in 1977 that Navy officials confirmed Mr. Johnson's secret skin cancer operation as well as the diagnosis. And the confirmation came only after a report appeared in the Reader's Digest and then an investigation by The New York Times

Dr. [Donley McReynolds] said that earlier this week, after the President's operation, he spoke with the White House physician, Dr. Burton Smith, and Mr. [Neil Reagan]'s surgeon, Dr. Dale W. Oller. They called him, Dr. McReynolds said, ''because they were curious about the pathology'' in the two cases. Dr. Sidney J. Winawer, chief of gastroenterology at the Memorial-Sloan Kettering Cancer Center in New York, said that when a patient develops colon cancer, it increases the odds that a sibling might also develop colon cancer, but that the risk this will happen would still be relatively low. ''The best data we have is that the risk is three times above that of the average individual,'' Dr. Winawer said. ''The various studies are fairly consistent.'' ''It raises the risk, but not enormously,'' he said. ''The three-fold increase in risk still leaves a very low frequency of cancer in those patients.''