Faculty Bibliography

Health officials must also stop thinking about food-borne disease as an inconvenience that just causes vomiting and diarrhea. Some bacteria cause other serious illnesses, said Dr. Michael T. Osterholm, an official of the Minnesota Health Department and a leading expert on food-borne illness. But ''guesstimates outweigh our knowledge'' of a more precise number due to inconsistencies in available data because of inadequate surveillance of food-borne illness and laboratory facilities in state and local health departments, Dr. Osterholm said in a featured talk before 2,500 participants from every state and 70 countries at the first international meeting on new and emerging diseases. It was sponsored in part by the Centers for Disease Control and Prevention and the American Society of Microbiology. Examples of recently recognized food-borne parasites include E. coli 0157:H7, a strain that produces potentially fatal blood and kidney damage; Listeria monocytogenes, which can cause blood stream infection and meningitis; and Campylobacter, which can lead to paralysis that begins in the legs and spreads to the chest and neck. In England a small number of human cases of a new form of neurological illness have been linked to mad cow disease, which is believed to result from a newly recognized infectious agent known as a prion

It took nearly two centuries to achieve the goal of eradication set by the British doctor Edward Jenner after he learned from a milkmaid that the cowpox virus could be used as a vaccine to prevent smallpox. After a scientific journal rejected his paper on the technique, Dr. Jenner persevered and published on his own the vaccination technique, the first ever. In the late 1970's, the vaccine finally ended the scourge that killed one in four victims and left many survivors scarred and blinded. Once eradication is achieved, costly control programs can cease, with the savings channeled to other areas of health services. Eradication programs can create coalitions of interested partners, and even raise new money for public health. Further, eradication is egalitarian because it protects rich and poor alike. Sharp debate has developed among different factions in public health over the merits of using scarce funds to concentrate efforts on eradicating one disease in developing countries where people suffer from many other preventable ones. Wealthier countries may favor eradicating a disease to save money because they would no longer have to pay for vaccinations and other health services needed to keep their countries free of the disease. Discussions get even more acrimonious over the confusion created by imprecise use of words like eradication, elimination and control of disease, particularly when the meaning has been twisted to suggest that more progress has been made than is actually the case

The growing strength of managed care has diminished the financial and clinical autonomy of many orthopaedic surgeons. In part to offset these negative trends, new relationships are being developed to define doctors' methods of contracting with health-maintenance organizations. These include physician practice management companies (PPMs), independent practice associations, management service organizations, and physician-sponsored organizations. Each entity offers distinct advantages and disadvantages. While the PPM is the most popular new vehicle to offset adverse market trends, it carries with it some of the greatest potential pitfalls. In every case, before negotiating to join one of these new entities, it is important for a physician to have a solid understanding of the competing claims made by each entity, as well as insight into the fiscal health of the particular company in question. For some doctors, these arrangements offer a solution to current woes. For others, PPMs interpose another meddlesome intermediary in a market already bloated by layers of bureaucracy.

It is the first time that a drug has led to growth of new coronary blood vessels by mimicking the way collateral vessels naturally develop in some people with blocked arteries. The drug, a protein known as a growth factor, is called F.G.F.-1 (for fibroblast growth factor). The doctors made it with genetic engineering techniques in their laboratory in Fulda, Germany. F.G.F.-1 was injected into heart muscle near the grafts that surgeons made to create new channels around blocked coronary arteries during standard bypass operations at the Fulda Medical Center. For now, the drug could not replace bypass surgery, the German doctors said. Dr. Thomas-Joseph Stegmann, the head of the team, said the chief objective was to prove the concept that F.G.F.-1 could safely produce new blood vessels in the heart. Although other growth factors are now used safely in medical practice, some experts had warned of dangers with F.G.F.-1. One, Dr. Wolfgang Schaper of the Max Planck Institute in Bad Nauheim, Germany, wrote in 1993 that he doubted that the growth factor would have more than moderate benefit and said ''its pronounced toxicity would preclude its use in human patients.''

Women with scleroderma had fetal cells present in their blood decades after pregnancy more often and in larger numbers than mothers who did not have the condition. The disease is scleroderma, an autoimmune disorder in which the body mysteriously attacks its own healthy tissues. For equally mysterious reasons, scleroderma strikes women four times as often as men. The study neither proves that fetal cells cause scleroderma nor provides a full explanation of how such cells might cause the disease. But identification of such a link has astonished many experts in scleroderma and related diseases who said the finding, if confirmed, would have important implications for autoimmune disorders

Long after a woman has given birth, cells from her fetus may still circulate in her bloodstream, and a new study being reported Thursday has linked those cells to development of a disease in the mother years after pregnancy. The disease is scleroderma, a so-called autoimmune disorder in which the body mysteriously attacks its own healthy tissues. For equally mysterious reasons, scleroderma strikes women four times as often as men. The study neither proves that fetal cells cause scleroderma nor provides a full explanation of how such cells might cause the disease. But identification of such a link has astonished many experts in scleroderma and related diseases who said that the finding, if confirmed, would have important implications for autoimmune disorders

Long after a woman has given birth, cells from her fetus may still circulate in her blood stream, and a new study being reported today has linked those cells to development of a disease in the mother years after pregnancy. The disease is scleroderma, a so-called autoimmune disorder in which the body mysteriously attacks its own healthy tissues. For equally mysterious reasons, scleroderma strikes women four times as often as men. The study neither proves that fetal cells cause scleroderma nor provides a full explanation of how such cells might cause the disease. But identification of such a link has astonished many experts in scleroderma and related diseases who said that the finding, if confirmed, would have important implications for autoimmune disorders

But now that NASA is giving Glenn one last chance to show his 'right stuff' in space, he is enlisting the medical profession to his side: One rationale cited by the agency for Glenn's participation in the flight is the opportunity to carry out medical research on what will be the oldest-ever human body to orbit the Earth. Sen. Glenn, D-Ohio, will be 77 when he is launched on a 10-day space shuttle flight scheduled for October. He has volunteered for two experiments to assess muscle loss and sleep disturbances during the shuttle flight. In metabolism experiments for the shuttle flight, Glenn will swallow capsules containing one type of amino acid and receive intravenous injections of another. Then low-level X-ray studies will help detect any changes in lean body mass. Because amino acids are the building blocks of protein, the aim will be to relate any changes in hormonal levels with loss of protein and muscle atrophy in Glenn and, eventually, eight other crew members. For a sleep experiment, Glenn will swallow melatonin or placebo pills before retiring on four nights. He will also swallow a capsule containing a small thermometer to record core body temperature because that is a good indicator of biological rhythms. Devices attached to Glenn's scalp, chest and wrist during monitoring periods will record brain wave activity, breathing patterns and movements during sleep

STUDY DESIGN/METHODS:Cross-sectional data were analyzed from the Veterans Health Study, an observational study of patients receiving ambulatory care. OBJECTIVE:To develop a method of stratifying patients with low back pain by combining patient reports of radiating leg pain with the results of straight leg raising tests. SUMMARY AND BACKGROUND DATA/BACKGROUND:Four hundred thirty-four participants with low back pain were identified through patient reports of ever having had low back pain, of low back pain that began more than 3 months ago, and of a health-care visit for low back pain in the past year. Four hundred twenty-eight patients with low back pain were included in the current analysis. METHODS:Participants were mailed a health-related quality of life questionnaire and had an interview that included a low back pain questionnaire and a straight leg raising test. Patients' reports of radiating leg pain and results of the straight leg raising tests were combined into four hierarchical groups. This stratification was evaluated in relation to responses to the health-related quality of life questionnaire, localized low back pain, disability, and use of medical services. RESULTS:The intensity of localized low back pain and disability increased from Group 1 (low back pain alone) to Group 4 (pain below knee with positive straight leg raising test result), whereas health-related quality of life decreased. Group 4 patients were 5.1 times more likely than were Group 1 patients to use medications for low back pain (95% confidence interval 1.2, 22.9), 6.8 times more likely to have a spinal magnetic resonance study (95% confidence interval, 2.7, 17.2), and 3.9 times more likely to have surgery (95% confidence interval, 1.3, 11.4). CONCLUSIONS:The method of measuring correlation performs well in identifying patients with different levels of localized low back pain intensity, health-related quality of life, and use of services. It may be useful in studies of health outcomes, in clinical trials, and in predicting demands on health care resources.

Hillary Rodham Clinton's recent accusation that a 'vast right-wing conspiracy' exists to destroy her husband and his political agenda was bound to strike a nerve. There has been a lot of loose and malicious talk about the President, the right has spread much of it, and our culture feasts on conspiracy theories. But Mrs. Clinton's allegation is not exactly new. She asserts that an extremist minority, unable to defeat the President at the polls, is trying to thwart the will of the majority through a systematic campaign of slander. In the 1830's, Andrew Jackson attributed the same motives to his most strident critics. Later Abraham Lincoln, Theodore Roosevelt and Woodrow Wilson did the same. President Franklin D. Roosevelt, who was attacked more bitterly, perhaps, than any other modern chief executive, played the conspiratorial card shrewdly during his 1936 re-election campaign. He did so in reply to the American Liberty League, an organization of ultraconservative millionaires that spent a small fortune on advertising and promotions to portray him as 'the foul breath of Communist Russia.'