Faculty Bibliography

The Gates foundation has made development of an effective vaccine against HIV, the AIDS virus, a major goal. The new grants bring to $528 million the foundation's investment for this purpose. By contrast, the National Institutes of Health has spent $3.4 billion since the 1980s to develop a vaccine. Until now, most HIV vaccine research has been conducted by small independent teams. But the new grants are being structured to encourage the 165 scientists receiving them to join forces. The goal is to overcome major immunologic and other scientific hurdles that hinder development of such a vaccine. The body invokes two types of immune reactions to defend against dangerous infectious agents

The Gates Foundation has made development of an effective vaccine against HIV, which causes AIDS, a major goal, and the new grants bring to $528 million the foundation's investment for this purpose. By contrast, the National Institutes of Health has spent $3.4 billion since the 1980s to develop a vaccine. Until now, most HIV vaccine research has been conducted by small independent teams. But the new grants are being structured to encourage the 165 scientists receiving them to join forces. The goal is to overcome major immunologic and other scientific hurdles that hinder development of such a vaccine

The Gates Foundation has made development of an effective vaccine against H.I.V., the virus that causes AIDS, a major goal, and the new grants bring to $528 million the foundation's investment for this purpose. By contrast, the National Institutes of Health has spent $3.4 billion since the 1980's to develop a vaccine. Most licensed vaccines work by stimulating the body to make neutralizing antibodies. But experimental H.I.V. vaccines have failed to produce such antibodies. The virus's propensity to mutate and produce different genetic subtypes will require an effective vaccine to produce antibodies that can neutralize a wide range of strains. Another team led by Dr. David Ho of the Aaron Diamond AIDS Research Center in Manhattan will receive $24.7 million to design experimental H.I.V. vaccines that bind to dendritic cells. These immune cells help strengthen production of antibodies and cellular immunity

The Gates Foundation has made development of an effective vaccine against HIV, the virus that causes AIDS, a major goal, and the new grants bring to $528 million the foundation's investment for this purpose. By contrast, the National Institutes of Health has spent $3.4 billion since the 1980s to develop a vaccine. Most licensed vaccines work by stimulating the body to make neutralizing antibodies. But experimental HIV vaccines have failed to produce such antibodies. The virus' propensity to mutate and produce different genetic subtypes will require an effective vaccine to produce antibodies that can neutralize a wide range of strains. Six grants will focus on ways to develop cellular immunity. Five grants will go to identifying new techniques to develop novel vaccines that produce neutralizing antibodies. The remaining five grants are for creating central laboratories and information analysis facilities, so that all the grant recipients can openly share data and develop standardized ways to compare their findings. Lack of such standardized tools hampers HIV vaccine research, the foundation said

Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart attack and stroke. Careful and responsible implementation of these tests as part of a comprehensive risk assessment and reduction approach is warranted and outlined by this report. Other tests for the detection of atherosclerosis and abnormal arterial structure and function, such as magnetic resonance imaging of the great arteries, studies of small and large artery stiffness, and assessment of systemic endothelial dysfunction, are emerging and must be further validated. The screening results (severity of subclinical arterial disease) combined with risk factor assessment are used for risk stratification to identify the vulnerable patient and initiate appropriate therapy. The higher the risk, the more vulnerable an individual is to a near-term adverse event. Because <10% of the population who test positive for atherosclerosis will experience a near-term event, additional risk stratification based on reliable markers of disease activity is needed and is expected to further focus the search for the vulnerable patient in the future. All individuals with asymptomatic atherosclerosis should be counseled and treated to prevent progression to overt clinical disease. The aggressiveness of the treatment should be proportional to the level of risk. Individuals with no evidence of subclinical disease may be reassured of the low risk of a future near-term event, yet encouraged to adhere to a healthy lifestyle and maintain appropriate risk factor levels. Early heart attack care education is urged for all individuals with a positive test for atherosclerosis. The SHAPE Task Force reinforces existing guidelines for the screening and treatment of risk factors in younger populations. Cardiovascular healthcare professionals and policymakers are urged to adopt the SHAPE proposal and its attendant cost-effectiveness as a new strategy to contain the epidemic of atherosclerotic cardiovascular disease and the rising cost of therapies associated with this epidemic.

Superman Returns [Motion Picture] -- AFTER returning to Earth from an extended sojourn, Superman (Brandon Routh) saves a space shuttle and its carrier jumbo jet from disaster, is assaulted by and prevails over criminals (in an incredibly vivid scene, his invulnerability to bullets is depicted as one is actually flattened by his eyeball), and is attacked by the evil Lex Luthor (Kevin Spacey). Luthor has discovered tiny remnants of Superman's home planet of Krypton that glow an unearthly green and make Superman ultra-vulnerable, and uses them with crystals from Krypton to build an expanding island that threatens to supplant North America. In trying to rid Earth of this island, Superman comes close to death and is brought to Metropolis General Hospital for treatment

For the ideal combination, mix an informed patient with an inquiring physician. Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania, likes to cite a quote attributed to the ancient Greek physician Galen: 'The best physician is something of a philosopher.' Such a physician does more than 'pose questions,' says Caplan. He 'isn't afraid to have them asked. The process of questioning can lead to understanding and patient satisfaction.' I treated [Brian Morton] for high blood pressure with a diuretic and a pill, Diovan, that dilates arteries. But when I began raising his Diovan dose in response to high readings -- ranging from 160 to 180 systolic pressure over 100 to 110 diastolic pressure (normal is generally considered less than 130 over 85) -- he was uneasy. Concerned about the potential side effects of higher doses, including fatigue and dizziness, he began to measure the pressure himself and record the values at home. The readings he got were consistently lower, 120 to 140 over 80 to 90. In the meantime, my patient's cholesterol readings remain high. After reading a news report about two patients suing Pfizer over pain, weakness and memory loss they claim was caused by Lipitor, she shot me an e-mail, saying such complaints are 'exactly what concerns me about the drug du jour.' Still, she is also more concerned about her cholesterol than before. On my end, there is a growing appreciation of her right to choose as well as her intuitive wisdom regarding her health

David Oshinsky reviews the books "The Great Deluge: Hurricane Katrina, New Orleans, and the Mississippi Gulf Coast" by Douglas Brinkley and "Breach of Faith: Hurricane Katrina and the Near Death of a Great American City" by Jed Horne