Faculty Bibliography

For 40 years, there has been a burgeoning in life-saving and life-extending medications, the likes of which have never been seen before. Even with the most advanced technologies, some of the greatest discoveries have occurred by accident. From the treatment of HIV disease to the treatment of diabetes to the treatment of acid reflux disease, new drugs have reduced suffering and improved the quality and length of life all over the world. Perhaps, in the interests of full disclosure, it should be mandatory for critics of the drug industry to include a listing of the medications they take whenever they make negative comments

Regional health information organizations and electronic health information exchange may have an important impact on the practice of emergency medicine in the United States. Regional health information organizations are local or regional information-sharing networks that enable electronic data interchange among stakeholders in a given geographic area. These stakeholders may include hospitals, skilled nursing facilities, clinics, private physicians' offices, pharmacies, laboratories, radiology facilities, health departments, payers, and possibly the patients themselves. Regional health information organizations are being formed across the country to improve the safety and efficiency of clinical care; improve public health efforts, biosurveillance, and disaster management response; and potentially create large databases of deidentified aggregate data for research. Because of the unique need for rapid access to information and the acuity of the clinical environment, few areas of the health care delivery system stand to change and benefit more from health information exchange than our nation's emergency departments. This article will explain the motivation for the development of regional health information organizations, identify some of the important issues in their formation, and discuss how their development might affect the practice of emergency medicine

Nobel wrote his will in Swedish a year before his death while he lived in Paris, and the portion dealing with the prizes was one long paragraph. It named the groups to make the awards: the Karolinska Institute (medicine), the Swedish Academy of Sciences (chemistry and physics), the Swedish Academy (literature) and the Norwegian Parliament (peace). Later, economics was added as a separate prize. Nobel was unhappy in love, never married and described himself as a loner. Mr. [Ragnar Sohlman] wrote that when one of Nobel's brothers asked for a biographical note, Nobel said about himself: ''Alfred Nobel -- a pitiful half-life which ought to have been extinguished by some compassionate doctor as the infant yelled its way into the world.'' The first Nobel Prizes were awarded in 1901. Wilhelm Konrad Roentgen, top, won in physics for his discovery of X-rays, and [Emil von Behring] won in medicine for developing a diphtheria immunization. Alfred Nobel's will, below, which he drew up himself, was challenged in court by disinherited relatives. (Photo by Bettmann/Corbis); (Photo by Corbis); (Photo by Nobel Foundation)(pg. F6); THE BENEFACTOR -- [Alfred Nobel], shown in 1853, the Swedish inventor of dynamite, bequeathed the bulk of his estate to establish the prizes that bear his name. (Photo by Nobel Foundation)(pg. F1)

Cattle farmers are not thinking of the harmful effects of manure; they are concerned about selling their product. Sellers of organic fertilizer made from manure are hoping their product will grow vegetables, not concerned that it will contaminate water or spinach. Salad makers screen and cleanse their food but can't always afford the expensive equipment to detect the most elusive bacteria. There is also not enough separation between animal and animal products before they become human food. Multiple studies in the agricultural literature have shown that dairy cows shed harmful bacteria at variable rates. This shedding is dependent on several factors that could be controlled, including the animal's feed. Studies have shown that changing feed from grain to hay decreases the acidity in the gut of cows that allows bacteria to thrive. Because very small amounts of 0157:H7 can cause human infection and because shedding of the bacteria by cows is so variable, proper surveillance of manure is also crucial in preventing outbreaks. But sophisticated laboratory techniques that are most effective at detection are very expensive and not commonly used. Current agricultural attempts to contain manure and organic fertilizers at the farm are not sufficient to prevent occasional seepage into water supplies, which sparks outbreaks. E. coli 0157:H7 is a strain that produces a toxin that breaks down the lining of blood vessels, causing bloody diarrhea in humans and sometimes kidney failure. Because cows lack the receptor on their cells to absorb the toxin, they don't show symptoms that they are carriers of the bacteria

Nip-Tuck [Television Program] -- As to whether [Sean McNamara] should operate on his own child, [James P. Bradley] bucks conventional wisdom. Most doctors say that the lack of emotional distance interferes with medical judgment and surgical precision. But Bradley disagrees, asserting that such a decision isn't unwise as long as the doctor is qualified. 'A good surgeon can learn to suspend the emotional component,' Bradley says. 'If you're the best-trained surgeon for the procedure, then you're the one to do it.' ECTRODACTYLY, often known as lobster claw syndrome or split hand/ foot malformation, is fairly common, with six cases per 10,000 human births. All forms are associated with at least one genetic mutation, one of the most frequent (Type 1) caused by a mutation on chromosome 7. Ectrodactyly often occurs in common with other congenital anomalies -- such as a cleft lip and palate, and ectodermal dysplasia (hair, skin and nail deformities). In 'Nip/Tuck,' McNamara views a photograph of a hand with ectrodactyly and contemplates [Connor]'s surgery

E. Coli is a common bacteria; trillions of strains that don't make us ill thrive and multiply in our intestines. But the 0157:H7 strain, which has been found in cow intestines, makes a toxin that damages human blood vessels and can cause blood clots and damage kidneys, especially in children. Cows don't have the receptors in their blood vessels to pick up the toxin, so they are asymptomatic carriers. What to do about the bacteria? Some studies suggest that feeding cattle hay rather than grain, or injecting them with 'pro-biotic' bacteria may help to reduce the prevalence of 0157:H7. At the national level, we need more integrated food-safety measures, a better way to coordinate the FDA and the USDA animal and food inspections. This could be accomplished by a new food-safety agency that acts as a bridge, or by expanded regulatory roles in both the FDA and the USDA

The 157:H7 strain of E Coli, which can populate the intestines of cows, makes a toxin that damages human blood-vessel lining, causing bloody diarrhea. It can also lead to blood clots and kidney failure, especially in children. Cows lack the toxin receptors in their blood vessels, and so are asymptomatic carriers. The manure from infected cows can contaminate ground water or organic fertilizer. Since very small amounts are necessary for human infection, it is fairly easy to cause a limited outbreak, especially in farms that rely on manure for fertilizer. There have been at least 11 outbreaks of this E Coli in salad foods since 1995. No one knows the exact mechanism in each case, but possibilities include contaminated water, equipment or fertilizer. In 1999, nearly 1,000 people were infected, and at least two died after consuming water (believed to be contaminated by manure after a heavy rain) at a county fair in upstate N.Y

The four other Lasker winners are Dr. Elizabeth H. Blackburn, 57, of the University of California at San Francisco; Dr. Carol W. Greider, 45, of Johns Hopkins University School of Medicine; Dr. Jack W. Szostak, 53, of Harvard Medical School; and Dr. Joseph Gall, 78, of the Department of Embryology at the Carnegie Institution in Baltimore