Faculty Bibliography

The problem has become so nettlesome that the Brigham and Women's Hospital in Boston, which is a Harvard teaching hospital, felt it had to post signs in its elevators recently saying: ''Hospital staff are reminded that patient information should not be discussed in public areas.'' In modern times, total confidentiality probably never existed. Eric W. Springer, a lawyer in Pittsburgh, said at a law and medicine conference at the University of Alabama in 1981, ''We are the victims of our own myth- making. There never was absolute confidentiality in health information, although many acted and pontificated as if this were the case.'' Doctors are well aware of the problem because there have been articles in medical journals calling confidentiality in medicine ''dead,'' ''shot full of holes'' or ''a decrepit concept.'' Moreover, few doctors are required to take the Hippocratic Oath before they obtain their medical licenses and, even when they do, the oath has no power beyond its tradition

Many medical leaders, like Dr. George M. Lundberg, editor of The Journal of the American Medical Association, now regard the decline in autopsies as deplorable. They firmly suspect that it is behind recent studies indicating that the percentage of correct diagnoses is actually declining in many hospitals in the United States, despite the development of CAT scanners, ultrasound and other sophisticated diagnostic equipment. These medical leaders and those in other countries believe there is a general relationship between the number of autopsies performed and the accuracy of medical diagnoses - that the discipline of a pathologist checking the accuracy of a clinical diagnosis carries over to the clinician's care of the next patient. Beyond that, some doctors may be reluctant to press for an autopsy because of the fear that it might reveal a serious medical error, which could result in a lawsuit. Clearly, the autopsy could prevent unwitting repetition of the same mistakes. But, as Dr. Lundberg has said, the time has come for doctors to ''stop burying their mistakes.'' The American health care system is based on fees for service, and that incentive is often lacking in autopsies, since only rarely are doctors paid for them. Medical journals reports have said that autopsy costs are not reimbursable to hospitals. But Dr. Lundberg of The Journal of the American Medical Association disagrees. ''The allegation that there is no money to pay for autopsies is a cop-out,'' he said, noting that the Medicare program and many private health insurance plans will reimburse hospitals

In 1976, Dr. [David D. Rutstein], with another team of colleagues, tried to provide a measure of the quality of medical careby formulating a list of so-called ''sentinel health events.'' These are diseases, disabilities or deaths considered preventable with good medical care. Their occurrence can signal the need for improving the quality of preventive care or giving better treatment, or both. A major problem in diagnosing occupationally related diseases is the long period that often passes between exposure to a dangerous agent and development of symptoms. Physicians, Dr. Rutstein said, are ''not going to have that suspicion unless medical education drills it into them'' and even the leading medical schools devote very little time to occupational medicine in their curriculums. To Dr. J. Donald Millar, the head of Niosh, the sentinel health event list could be a framework for developing a national system for the surveillance of occupationally related diseases. ''In the 13 years that Niosh has existed, we haven't reached the point where we can say anything definitive about the health of large occupational groups compared to the health of the general population,'' Dr. Millar said. ''We have some studies about single agents, like lead, but not for the more general, cross-sectional approach of the working population.''

Another reason, one of those familiar with the Cardinal's health said, was that admission to a hospital for such care would cause ''a marked change in the dignity of his life.'' According to Dr. [Kevin M. Cahill], the Cardinal is ''comfortable, walks around and is very much at peace'' in his residence under the care of a nurse. ''We have almost been able to establish a hospital setting there,'' Dr. Cahill said. Dr. Cahill specializes in the treatment of tropical diseases, and he said he first cared for Cardinal [Cooke] about 10 years ago when he developed ''acute malaria'' on a trip to Africa

''We asked ourselves: Is our experience unique?'' he said. ''Is there something in our environment or in the way we practice medicine or the people we select that encourages or somehow specially recruits people who are drug- prone?'' ''In the past when it was called the Committee on Environmental Health, the primary issue was that of operating room pollution,'' the ill effects of anesthetic gases released into the room,'' Dr. [Lawrence J. Saidman] said. ''Now most people are changing their focus and feel that the primary environmental hazard to anesthesiologists is not O.R. pollution but alcohol and drug related problems.'' 'Underestimating' the Problem ''Over the past three years or so, medicine in general and anesthesia in particular have become much more concerned and aware of the magnitude of the issue,'' he said. ''I don't think we were as good at ferreting out the problem in 1970 as we are now. I am sure a lot of people graduated from programs with big time drug problems.''

One participant was Dr. Ary Bordes, the health minister of Haiti, who was perplexed by the reputation his country has acquired since the Centers for Disease Control in Atlanta named Haitians among the groups that had high ''risk factors'' for contracting AIDS. The other groups so far identified are male homosexuals, intravenous drug users, hemophiliacs and some recipients of blood transfusions. Of the 2,008 cases of AIDS reported in the United States, 105 victims, or about 5 percent, were Haitian-born people who said they did not belong to any of the other risk factor groups. What will Dr. Bordes do when he receives the formal request? ''Scientifically I have no reluctance'' to provide the information, Dr. Bordes said. ''But if those data will destroy my country, I will not do it because my main duty is to my country.'' ''Probably we have some cases, but we haven't found them - yet,'' Dr. [Humberto Bogaert Diaz], who heads the Dermatology Institute in Santo Domingo, said in an interview. AIDS can lead to an unusual type of cancer called Kaposi's sarcoma that shows up on the skin as well as elsewhere in the body. AIDS also causes a wide spectrum of unusual infections, and Dr. Bogaert Diaz said that after returning home he would discuss the issue with other physicians in the Dominican Republic who would be more likely to see such manifestations. ''We will look harder'' for AIDS, Dr. Bogaert Diaz said

''That's the beauty of these N.I.H. grants,'' Dr. [Fred T. Valentine] said. ''You are free to pursue the new directions that turn up during the course of your research because if we didn't have this flexibility, we might not discover anything. If you could always predict what was going to happen, by definition it wouldn't be research.'' Dr. Anthony S. Fauci, an immunologist at the National Institutes of Health who began working on AIDS early in the epidemic, said earlier this summer he disagreed with colleagues who argued that they would be well ahead in AIDS research if only more money had been available earlier - an argument that is arising in current Congressional hearings. But, he said, when he has asked such critics what they would have done with more money a year or two ago, he usually ''finds the ideas weren't there.'' Dr. Fauci's position is bound to ''create resentment,'' he said. Still, he maintained: ''If someone had given me a lot of money a year ago, I wouldn't have known what to do with it. Right now, I need money and I am getting it. I probably will need more money next year. I hope I will get it.''

The Muscular Dystrophy Association of New York, in announcing earlier this summer that it would provide funds for the doses under ''a crash program to evaluate the drug,'' called it ''the first treatment that has ever resulted in significant improvement'' in patients with amyotrophic lateral sclerosis. Previous work on the drug was paid for by the National Institutes of Health. According to the Lancet report, very large doses had to be given by vein before the weakened muscles of the patients began to strengthen. ''Moderate to marked improvement'' was reported among the 12 patients who received very large doses, up to 500 milligrams of thyrotropin-releasing hormone over two to five hours of continuous intravenous administration. Dr. [Engel]'s team reported that muscles so weak before the hormone therapy that they were unable to resist the force of a single finger ''became completely resistant to the full force of the examiner's hand (i.e., became normal or virtually normal).''

''We feel that we have not been given a chance at all,'' Dr. [Laine] of the Medical Association said in a telephone interview. Haitians have become ''victims of C.D.C.'s power and media propaganda,'' he said, adding: ''There is no scientific basis to classify a country or a people as a risk group. Even the C.D.C. recognizes that. If AIDS was a Haitian disease, I think the Haitian population would already have been wiped out.'' Now, he said, the disease center has ''taken steps to speed up the investigations'' because ''we are likely to get more clues by putting more investigators on Haitian cases than on intravenous drug users in the United States.'' He added, ''We have to ask, 'Is there a tropical element to this disease that is different?' '' Despite their disagreements, the United States and Haiti are cooperating in plans for intensified research. Dr. Warren D. Johnson Jr. of Cornell University Medical College is working with a group called ''Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections'' under a three-year grant from the National Institutes of Health. Dr. Johnson said the group's ''main goals will be to take well-documented cases and look for risk factors and to study the spectrum of infectious agents and to do immunological tests on Haitians with and without AIDS.''

- Dr. David W. Fraser, an epidemiologist, last year became Swarthmore College's 12th president and the first with a scientific background. Dr. Fraser, at the age of 38, is the youngest physicianpresident in the country. While at the Centers for Disease Control in Atlanta, he led the epidemiologic investigation of Legionnaire's disease in Pennsylvania in 1976. He also spent a year working for the Office of Management and Budget. ''Society tends to think that physicians are capable of doing anything,'' Dr. Fraser said, an attitude that has ''let me get into several situations, such as budget examiner, that have given me a range of experience useful in this job.'' There were many reasons beyond Dr. [Chase N. Peterson]'s public-relations talents for selecting him as president. In 1967, he was plucked from the practice of medicine in Salt Lake City to become dean of admissions at Harvard, in part because of the outstanding records of two of the first students he had recommended for admission. One became the top ranking Phi Beta Kappa student in his class. The other was captain of the crew that rowed in the Olympics. Dr. Peterson spent five years as dean of admissions and another six as a vicepresident, planning Harvard's major fund-raising campaigns