Faculty Bibliography

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.''

The physician who said the medical team had called for prompt action last March is Dr. Walter W. Karney, a Navy captain and the internist at Bethesda Naval Medical Center who coordinated the President's annual physical examinations in 1984 and 1985. He said Dr. Edward Cattau, a gastroenterologist who was a member of the examining team, had ''strongly urged'' last March that Mr. [Reagan] be given a colonoscopy ''as soon as possible.'' Mr. [Larry Speakes] said members of Mr. Reagan's medical team had been ''totally forthcoming'' in giving public accounts ''in greater detail, I would say, than any previous Presidential illness.'' Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute, who also participated in the operation, said the medical steps that Mr. Reagan's doctors had taken and that led to the operation had been ''flawless.'' He has said it is ''almost impossible'' to know what biological changes may have occurred since March, when the decision was made not to do an immediate colonoscopy

He said said Dr. Edward Cattau, a gastroenterologist who was a member of the examining team, had ``strongly urged'' after the examination last March that [Reagan] be given a colonoscopy ``as soon as possible.'' [Larry Speakes] said he had been told by all three White House doctors yesterday that although Cattau had recommended a colonoscopic examination, the recommendation ``did not stress a sense of urgency.'' In fact, he said, the White House was more aggressive in pursuing a colonoscopy than the recommendation from the Bethesda examining team suggested. [Walter W. Karney] said in the interview that the Bethesda hospital had been getting ``a bum rap'' from civilian experts who contend, with the benefit of hindsight, that a colonoscopy should have been performed 14 months ago, when the May 1984 physical found a small, benign inflammatory piece of tissue in Reagan's colon

[Larry Speakes] said the White House had a letter from [Edward Cattau] recommending that, if the polyp detected in March was confirmed not to be an adenoma, or potentially cancerous polyp, then six more blood-stool tests should be performed. Only if one or more of those tests were positive, Speakes said, did Cattau recommend that a colonoscopy be performed

Dr. [Steven Rosenberg], when asked directly, did acknowledge that he could not be sure that Mr. [Reagan]'s cancer had not already begun to spread. ''There is a possibility that the cancer can return,'' Dr. Rosenberg said. But a pathologist not connected with Mr. Reagan's case said he was confused about why the President's doctors were so conservative in their prognosis, of a greater than 50 percent chance of survival. Dr. Michael Kyriakos, a surgical pathologist at Washington University in St. Louis, said the description provided at the news conferences Monday by Mr. Reagan's doctors suggested a Dukes A colon cancer, with a more favorable prognosis, and not the less favorable Dukes B classification that Dr. Rosenberg gave. One yardstick is how the malignant cells appear to pathologists when they look at them through a microscope. Pathologists use the term well-differentiated when speaking of cancer cells whose architecture is well-constructed and which often grow more slowly. Pathologists use the term anaplastic to describe malignant cells with a more chaotic structure, which are likely to grow more quickly. Mr. Reagan's ''moderately well-differentiated'' cancer, as Dr. Rosenberg described it, is on the favorable side. ''A competent colonoscopist should be able to pass the instrument to the cecum in approximately 90 percent of examinations in 15 to 45 minutes,'' according to ''Internal Medicine,'' a medical textbook edited by Dr. Jay H. Stein