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Doctors regard transplants performed between identical twins very differently from those between people who do not have identical genes. Transplanting an organ between identical twins can be likened to taking tissue from one area of a person's body and putting it in another area of the body. The transplant recipient does not need antirejection drugs. They include Ms. [Edith Helm] and another of Dr. [Joseph E. Murray]'s patients; a patient whose surgery was performed with Dr. Murray's assistance at the [Thomas E. Starzl] Oregon Health & Sciences University in Portland in 1959; and a patient of Dr. Starzl's who received a kidney at the Veterans Administration Hospital in Denver in 1962. Dr. Murray recalled that when Ms. Helm was having her first child, she was in the same hospital in Boston where Dr. Murray's wife, Bobby, was delivering her fifth child, Tom. Since then, Dr. Murray has often stopped to visit Ms. Helm on the way to see Tom in Denton, Tex

Immediate health threats include wounds from stepping on nails and broken glass; dehydration and heat stroke from exposure in hot muggy weather; the possibility of electrocution from downed wires; and diarrheal and respiratory diseases caused by various bacteria and viruses that can spread rapidly because of poor sanitation and a lack of clean water. Doctors Without Borders said it had to delay until Wednesday a shipment of 32 tons of relief materials to Sumatra from Ostende, Belgium, because of the lack of an available airplane. The cargo includes generators, water bladders and tanks, plastic sheeting, mosquito nets, chlorination kits, a hospital tent and various medical supplies. Dangers also loom from eating spoiled food. Infectious diseases like dysentery, cholera, hepatitis A and leptospirosis that are present in an area can spread through sewage, said Dr. Maria Connelly, a W.H.O. expert on emergencies. The threat depends in part on which diseases are prevalent in an area, and it can increase when sewage spills into streets

Both Vioxx and Celebrex are members of the class of drugs known as Cox-2 inhibitors, which act against an enzyme that causes inflammation but theoretically spare another that protects the stomach lining. The drugs had been promoted as stomach-safe, and heavy advertising had helped Celebrex become the top-selling arthritis drug in the country (although its stomach-protective benefits have never been proved). More than 20 million prescriptions were written for Celebrex last year alone, according to IMS Health, a pharmaceutical information company. It was true that the National Institutes of Health had just suspended an Alzheimer's prevention study after it was discovered that study participants taking naproxen (Aleve) for three years appeared to have a 50% increased risk of heart disease. This was still no reason that a patient couldn't take an occasional Aleve or its prescription counterpart. I tried to explain that daily use of nonsteroidal anti-inflammatory drugs -- be they the Cox-2 inhibitors or the more common ibuprofen or naproxen -- could put stress on the heart after several months or years by causing the organ to retain fluids and by raising blood pressure. But my patient no longer seemed to be listening. He'd been convinced by the drug representative to use Celebrex to replace Vioxx, and he'd even reported on how well it had worked. But now, disappointed by the sudden news, he no longer had faith in the earlier sales pitch. With Vioxx banned and Bextra, Celebrex and now Aleve seemingly down for the count, I instructed my office staff to beware of the Mobic representative. (Mobic is a nonsteroidal drug that has some of the properties of Celebrex but is not a full-fledged Cox-2 inhibitor.)

What isn't clear to the public is that drugs like Celebrex are largely safe when taken for shorter periods at lower doses, which is the way they're generally intended to be used for common joint inflammation. The increased risk to the heart is due to taking them at high doses over a prolonged period of time. Celebrex diminishes an enzyme that prevents clotting, which is associated with heart attacks. The prolonged use of Aleve, and perhaps all non-steroidal anti-inflammatory drugs, can lead to fluid retention and elevated blood pressure, itself a risk factor to the heart. Yet these drugs are being overprescribed by doctors and overused by patients who consider them safe and effective. Public expectation regarding Celebrex and Vioxx was ramped up by direct-to-consumer advertising, a process that is not adequately overseen by the Food and Drug Administration. The public was told that these so-called Cox 2 inhibitors protect the stomach in a way that other non- steroidal drugs, all of which can cause bleeding ulcers or gastritis, don't. Thinking of Celebrex as a wonder drug, the public naturally feels betrayed now that it understands that the stomach- sparing qualities, though they may exist, were not actually proven, and now that it knows about the elevated heart risk, which FDA scientists suspected from the outset. The FDA that engages in that analysis will have to be a much stronger and more effective agency than the one in place now. In an editorial in the Nov. 30 issue of the Journal of the American Medical Association, deputy executive editor Phil Fontanarosa discussed the creation of a new office of drug safety to ensure a more independent and extensive evaluation of drugs than the FDA can provide. It would seem that a better first step would be to try to strengthen the FDA itself, to make it a more effective regulatory agency less dependent on drug company money and political appointments

Bird flu is highly lethal, having killed 32 of the 44 people previously confirmed to have caught it this year, all in Thailand and Vietnam. But the tests from Japan confirm reports that the virus can also cause infection that produces mild symptoms or none. Such findings have come from tests of farmers and health workers exposed to the A(H5N1) virus in an outbreak in Hong Kong in 1997, and a different type of avian influenza in the Netherlands in 2003. Scientists at the National Institute of Infectious Diseases in Tokyo had to adapt laboratory tests developed elsewhere to detect antibodies to A(H5N1) virus in humans. The more sophisticated tests were needed because the level of antibodies of the virus that humans form is much lower than the level formed in response to the regular human influenza, [Klaus Stohr] said. Because the tests involve live viruses, they must be conducted in a laboratory with tight biological security, he said. Scientists also must confirm the findings by using tests validated by other laboratories

The first successful organ transplant recipient was a 23-year- old man from Northboro, Massachusetts named Richard Herrick, who had just been discharged from the Coast Guard. On Dec. 23, 1954, he received a kidney from his healthy identical twin brother, Ronald, in an operation performed at what is now Brigham and Women's Hospital in Boston. Richard survived for eight years until the original kidney disease destroyed his new organ. Over the years, the biggest obstacle facing patients and surgeons has been the rejection of transplanted organs. Several years after Herrick's surgery, doctors began using anti-rejection drugs like azathioprine and, later, cyclosporine. In the early 1990s, [Thomas Starzl] and other transplant surgeons noticed that some patients who did not take their drugs regularly or at all were able to keep their donated organs. Perhaps the most disputed frontier in transplantation science is the face transplant, a procedure that surgeons say is now within their capabilities and that raises complex ethical questions extending even beyond identity and appearance. Ethics committees in England and France have rejected proposals to perform face transplants because of the unknown risks of long-term use of large doses of immunosuppressive drugs for a procedure that does not save lives. But in October, an institutional review board that oversees the safety of human experiments at the Cleveland Clinic became the first such group to approve a face transplant

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The tests from Japan confirm reports that the virus can also cause infection that produces mild symptoms or none. Such findings have come from tests of farmers and health workers exposed to the A(H5N1) virus in an outbreak in Hong Kong in 1997, and a different type of avian influenza in the Netherlands in 2003. Scientists at the National Institute of Infectious Diseases in Tokyo had to adapt laboratory tests developed elsewhere to detect antibodies to A(H5N1) virus in humans. The more sophisticated tests are needed because the level of antibodies of the virus that humans form is much lower than the level formed in response to the regular human influenza, Dr. [Klaus Stohr] said. because the 58 people whose blood was tested were a tiny fraction of workers exposed to the A(H5N1) virus, they did not represent a scientifically valid random sample, Dr. Stohr said, and firm conclusions about the frequency of symptomless infections cannot be drawn. More information may come from tests to be done on 1,200 blood samples obtained in Korea and hundreds more in China, Thailand and Vietnam

Thursday, Dec. 23, will be the 50th anniversary of the first successful organ transplant, a kidney transplant from a living donor performed in Boston in 1954. Mr. [Robert Phillips] and a small number of other long-term survivors attest to how well organ transplants can work in the best cases. A face transplant could also raise unrealistic hopes, experts say. No guarantee exists that the transplant recipient will look normal. The new face could worsen the appearance and reduce facial expression. A face transplant could be technically successful but leave the recipient and the family dissatisfied. At the same time, a successful transplant may send a message that disfigured people who do not choose to have transplants cannot have a high quality of life. Robert Phillips has lived almost 42 years since a kidney transplant. (Photo by Steve Ruark for The New York Times); [Richard Herrick], front left, recipient, and Ronald Herrick, donor, with the surgical team after the 1954 kidney transplant. (Photo by Courtesy of Brigham and Women's Hospital); The first successful organ transplant took place on Dec. 23, 1954, when Richard Herrick received a kidney from his healthy identical twin brother, Ronald. Richard survived for eight years until the original kidney disease struck again. (Photo by Courtesy of Brigham and Women's Hospital)(pg. F7); (Illustrations by Al Granberg, Alain Delaqueriere/The New York Times)(pg. F1)

In October, the nation's expected supply of influenza vaccine was suddenly cut in half when the British government suspended the manufacturing license of the Chiron Corporation, an American biotechnology company, because of contamination at its factory in Liverpool, England. Chiron, one of two major manufacturers of the vaccine for Americans, had been expected to supply nearly 50 million doses. The C.D.C. responded by limiting use of the vaccine to the vulnerable groups. Health officials still consider those groups a priority for influenza vaccine. But midseason estimates of vaccination rates are below those of last season for adults in the priority groups, said Dr. Julie L. Gerberding, the director of the centers