Faculty Bibliography

The findings challenge a widely held belief that it is low blood sugar, or hypoglycemia, that causes marathon runners to develop a sensation of fatigue and muscle pain after running about 20 miles, a phenomenom called ''hitting the wall.'' Some marathon runners believe that drinking solutions of glucose will enable them to pass through this celebrated ''wall'' to complete a race. ''Our data document the ability of normal subjects to continue intensive exercise despite blood glucose levels of 25 to 48 milligrams per deciliter,'' the authors said. They were Dr. Philip Felig of Yale, and Dr. Ali Cherif, Dr. Akira Minagawa and Dr. John Wahren of the Huddinge Hospital in Stockholm

It is normal for the beta-blocker drugs to slow the heart rate. However, people with the enzyme deficiency can develop an exaggerated response to standard doses of a beta-blocker drug - their hearts can beat too slowly. As a result, they may experience fatigue, fainting and dizziness. Researchers from England, Sweden and Switzerland have reported the enzyme deficiency in recent issues of The Lancet, a British medical journal. According to one group of researchers headed by Dr. R.@R.Shah at St. Mary's Hospital in London, the discovery of the enzyme deficiency and its effects is a ''very important'' finding for the everyday practice of medicine. Dr. [Arno G. Motulsky] said in a recent interview that he agreed with Dr. Shah's assessment of the importance of the enzyme deficiency. The new finding is especially important, he said, because the P-450 system seems to affect not only beta blockers but also many other drugs and chemicals in the environment

Consider Wilson's disease, a rare disorder in which an enzyme defect leads to a toxic accumulation of copper and damages the liver, brain and other organs. It can be successfuly treated with Dpenicillamine. Because such drug therapy can benefit affected individuals before the damage is evident, doctors seek undetected cases among blood relatives who have abnormally large amounts of copper but have not yet manifested symptoms of the disorder. Inherited disorders can lead to abnormal responses to drugs. One example is malignant hyperthermia. Affected people have no symptoms unless they receive an anesthetic gas. Then the body temperature can rapidly shoot to as high as 107 degrees. In some forms, each child born to an affected parent has a 50-50 chance of having the same condition. When such a reaction occurs, warnings are issued to other blood relatives. Several years ago, when I investigated an unusual hereditary disorder that damages the eyes, skin and blood vessels, I traveled around the country to examine relatives of my patients for the disorder called P.X.E. (pseudoxanthoma elasticum). I detected several previously unsuspected cases among people who knew the condition ran in their families. Some had not told their doctors. Others had, but their doctors failed to recognize it

To the public, Dr. Deutsch was perhaps best known for her twovolume work, ''The Psychology of Women,'' which was published in 1944 in the United States. The first volume is on girlhood and the second on motherhood. For many years it was regarded as the most comprehensive psychoanalytical account of the subject. To psychoanalysts, Dr. Deutsch was probably best known for describing what she called the ''as-if'' personality, a concept focusing on people whose lives seem to them to be lacking in genuineness. Thus, her work can be seen as foreshadowing much of the current study of borderline and narcissistic personalities. ''She was a mean woman, and I did not want to be like her,'' Dr. Deutsch said in an article published in The New York Times Magazine on July 30, 1978

It took only three weeks for Dr. [Robert Koch]'s lecture to be published in a medical journal, an amazingly short period by today's standards. Newspapers quickly reported Dr. Koch's remarks: ''If the number of victims which a disease claims is the measure of its significance, then all diseases, particularly the most dreaded infectious diseases, such as bubonic plague, Asiatic cholera, etc., must rank far behind tuberculosis. Statistics teach that one-seventh of all human beings die of tuberculosis, and that, if one considers only the productive middle-age groups, tuberculosis carries away one-third and often more of these.'' Until Dr. Koch's discovery, medical leaders hotly debated the cause of tuberculosis, which was also called consumption, ''white plague'' and phthisis (from the Greek word meaning to melt and dissolve). Dr. Koch began his paper by noting the controversy, reviewing the discovery in 1868 by a French veterinarian, Jean-Antoine Villemin, that tuberculosis could be transmitted to animals by injections. A few years later, other experiments had shown that tuberculosis could be transmitted by inhalation. Discovery of what has been called ''Koch's bacillus,'' the microbe that causes tuberculosis, resulted from systematic research into the methodology of culturing and identifying microorganisms. In 1881, a year before his tuberculosis findings, he described a new method of obtaining pure bacterial cultures on solid media to the first International Congress of Medicine in London. Louis Pasteur, who was in the audience, proclaimed it ''a great step forward!'' It led to an array of further discoveries, chiefly by German scientists

IT was only 70 years ago that a heart attack was diagnosed in a living patient for the first time. The patient was a 55-year-old Chicago banker who survived for only 52 hours, and the diagnosis, confirmed by an autopsy, was made by Dr. James B. Herrick without the benefit of electrocardiograms, blood tests and other sophisticated medical tools now routinely used in cardiology. However, doctors were slow to accept the new condition, and the case report, Dr. Herrick later recalled, ''fell like a dud.'' Now the diagnosis is made a million times a year in this country alone, and about four million Americans have survived heart attacks. Over the years, doctors have revolutionized the way they diagnose and treat heart attacks, a revolution that continues to this day. But new clinical research findings are being translated into everyday practice much more quickly than they were in Dr. Herrick's day. In those years, doctors were learning to recognize that chest and arm pains could be symptoms of heart attacks and that some symptoms of many other conditions, such as ''acute indigestion,'' could mimic those of a heart attack. Now, physicians urge patients to report to emergency rooms when experiencing unfamiliar chest pains

The two cyclotrons achieve their biological effects by focusing charged particles on the tumor. However, the mechanisms differ. The Harvard cyclotron delivers proton-beam radiation. The larger Berkeley cyclotron accelerates helium ions instead of protons. Unlike the Xrays commonly used in radiation therapy, the beams do not penetrate the whole body and do not scatter, so their energy is more easily confined to the tumors. Ten patients were treated with the Harvard cyclotron in Cambridge. Of these, nine are still alive, with no sign of recurrence after follow-up periods of two months to eight years, Dr. Suit and his chief collaborator, Dr. Michael Goitein, a biophysicist, said the cyclotron therapy did not damage sensitive nerve tissues. Their findings were reported in the March issue of the Journal of Neurosurgery

''Physicians who have been conscientious about fully discussing all diagnostic and therapeutic things that a patient can expect will be less disturbed than the ones who have not done so habitually,'' said Dr. Leonard D. Fenninger, a vice president of the American Medical Association. ''The doctor who has a relatively overloaded practice, which is true of a lot of communities in the U.S., may find this quite hard to deal with,'' he said. Not only would it be time-consuming, he said, but the doctor's conscience would also produce anxiety about spending that time learning about drugs that he will never prescribe. Several people have told me that they would pay little attention to such advertisements because they paid their doctors to make such judgments for them. As one patient put it: ''I don't want the impetus for my taking a drug to come from someone profiting from the prescription. I want it from my doctor, who wants to prescribe it for a specific medical reason.''

In a letter to The New England Journal of Medicine, Dr. William M. O'@Brien of Charlottesville, Va., has criticized one proposed promotional plan on grounds that it could ''undermine physician control over prescribing,'' that ''most lay people are ill equipped to evaluate the efficacy and toxicity of drugs'' and that such campaigns to get patients to switch drugs ''might simply be medically unwise.'' According to Dr. [Arthur Hull Hayes Jr.], a new group of prescription items may soon be advertised to the public. ''Marketers of intra-uterine contraceptive devices have shown an interest in direct-to-theconsumer ads,'' he said in a speech to a meeting of the Pharmaceutical Advertising Council Inc. in New York. The speech was read in Dr. Hayes's absence by Dr. J. Richard Crout, head of the F.D.A's Bureau of Drugs. It was, Dr. Hayes said, one of ''numerous opportunities'' for drug advertisers in the 1980's. Among the others are these: tougher looks at claims that brand A is better than brand X; speedier licensing of new drugs; and stronger action against quackery

It is so small that it has no recognizable shape when examined under an electron microscope, according to Dr. Prusiner. The team has proposed that it be named a ''prion,'' for ''protein'' -because it appears to be a protein - and ''infectious.'' Reproductiveness a Question There is some doubt about the structure of the agent. ''We haven't purified it yet,'' Dr. [Stanley B. Prusiner] said. He said tests had excluded it from other known categories, such as bacteria and viruses, and had shown that it was not a viroid, one of the smallest infectious agents known. Perhaps the biggest puzzle is how the organism reproduces. ''We're really baffled,'' Dr. Prusiner said, because ''we cannot find a nucleic acid.''