Faculty Bibliography

Mr. Powell, who is 66 and by all appearances vigorous, has maintained a demanding schedule in recent weeks, traveling twice to Europe, at one point filling a hole in his schedule with a three-nation, two-day detour to North Africa. On such trips, Mr. Powell rarely lingers. He flies by night, then begins a full workday without ever seeing a bed. Mr. Powell kept up that pace over the weekend, as news emerged of the capture of Saddam Hussein, the deposed Iraqi leader. On Sunday, Mr. Powell spoke to 23 foreign ministers, Mr. Boucher said. Mr. Ereli said Mr. Baker, who was tapped by the president for the job, would limit his contacts to discussion of Iraq's debt. Any suggestion that Mr. Powell is being shunted aside ''is a bunch of hooey,'' said Mr. Ereli, who called the Baker-Powell relationship ''complementary, not competitive.''

'Harry' is one of my elderly patients who could have been helped by a comprehensive, Medicare prescription drug plan. But when he hears about the bill signed by President Bush last week -- with deductibles, co-payments and a large cash contribution coming out of his pocket -- he simply shakes his head and moves to my drug sample closet. Once the full benefit of the new plan takes effect in 2006, Harry will have to pay a $420 annual premium. After he pays a $250 deductible, Medicare would cover 75% of his annual drug costs up to $2,250 and 95% of expenses above $5,100, but nothing for drug costs between $2,250 and $5,100. Harry will continue to be charged top prices at the pharmacy, and the government, forbidden to negotiate or leverage for lower prices by buying in bulk, will also pay top dollar for what little coverage they do provide. In the meantime, I remain Robin Hood with my drug samples, brought by sexy salespeople who interrupt me in the hallway on my way to caring for Harry and others

Influenza is arguably the most unpredictable of viruses, and protecting the public is a tricky balancing act. It involves a number of factors: inadequate scientific knowledge of the virus; educated guesswork in choosing what strains of influenza to include in each year's vaccine; time-consuming, old-fashioned manufacturing techniques; and skills in communicating with a skeptical public. Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, says the majority of influenza cases are an annoyance, causing only a mild respiratory illness. But Gerberding also noted that influenza is lethal for 36,000 Americans on average each year. The time when the three strains are chosen is critical to vaccine production. One reason is that it takes tens of millions of chicken eggs to produce each season's vaccine, and they must be bought months in advance. Once production is complete, additional doses cannot be made without reducing the amount that could be produced for the next influenza season, Gerberding said

For all the public concern over the rapid spread of the new Fujian strain of influenza, health officials and doctors say there is still no way to know whether this year's flu season is particularly severe or just off to an early start. And for all the clamor for dwindling supplies of vaccine, no one knows how effective the current vaccine will be against the Fujian strain. No one knows why influenza has hit the western United States in particular, or why it happened so early this season. No evidence exists to suggest that the Fujian strain is more virulent than other strains that have caused past epidemics or that this season's influenza is worse than those of the past. Although the Fujian strain also struck early in Europe, the World Health Organization said it was not aware of unusually severe influenza this season outside the United States. The Fujian strain was detected too late to be included in this season's vaccine. Officials have said that the vaccine should still afford ''some protection'' against the Fujian strain but do not know how much

No treatment now exists for Ebola, and tests of a vaccine have just begun in humans. Though scientists have had earlier successes in treating Ebola in mice and guinea pigs with antivirals, these drugs did not work in nonhuman primates. In an interview this week in Dallas, Terry Fredeking, a co- author and an expeditionary biologist, said he supplied the raw material that was used to re-create a protein for the new drug. I won't say how long it took me to persuade Peter Jahrling that spit from hookworms might be able to treat monkeys with Ebola, said Fredeking, founder and president of Antibody Systems, a research company in Hurst, Texas. Fredeking said that the World Health Organization in Geneva had asked team members whether rNAPc2 might be used on an experimental basis to treat people in a current outbreak of Ebola in the Congo Republic north of that country's capital, Brazzaville. That outbreak, which is thought to be waning, has caused 28 deaths as of Dec. 2, according to the UN health agency

Ebola usually starts with a fever and flulike symptoms of malaise, muscle aches, headache, followed by vomiting, diarrhea and a rash. The virus disrupts the blood clotting system in monkeys and humans, leading to abnormal blood clotting and then to severe bleeding and death. Mr. [Terry M. Fredeking] said the World Health Organization in Geneva had asked team members whether rNAPC2 might be used on an experimental basis to treat people in a current outbreak of Ebola in Congo. That outbreak, which is thought to be waning, has caused 28 deaths as of Dec. 2, according to the W.H.O. Dr. C. J. Peters, an infectious-disease expert at the University of Texas Medical Branch at Galveston who has worked on Ebola, called the new results ''very impressive.'' Dr. Peters said a treatment for the Ebola virus would be even more important than a vaccine

She also mentioned a new type of vaccine -- given by nasal spray -- that is still readily available. As of Tuesday, nearly four million doses of the vaccine, FluMist, made from live but weakened influenza viruses, were available, Dr. [Julie L. Gerberding] said. Made by Wyeth Pharmaceuticals in Collegeville, Pa., the vaccine was licensed for the first time earlier this year, and is recommended only for healthy individuals ages 5 to 49. FluMist should not be taken by pregnant women and individuals with heart, lung, diabetes, kidney failure and other chronic conditions, health officials say. Individuals with weakened immune systems, like those infected with the AIDS virus, or who take anti-cancer and other medications that can weaken the immune system are also advised not to take FluMist. FluMist is not recommended for health workers who care for individuals with suppressed immune systems. Influenza can be treated with four licensed influenza drugs: amantadine, rimantadine, oseltamivir and zanamivir. Studies have shown that they can reduce the duration of influenza illness by about a day among healthy adults if taken within 48 hours on onset of symptoms

[Julie L. Gerberding] added that government rationing of the remaining stocks was not an option, because most vaccine is in the hands of practicing physicians, who dispense it according to patient need and demand. 'For the last five years, we have thrown a lot of flu vaccine away,' Gerberding said. Even if the government can import vaccine from Europe, the amount is likely to be relatively small. Gerberding said the government was exploring the possibility of securing a half-million doses of vaccine from the British unit of Chiron. That vaccine is licensed but not approved for use in the United States, Gerberding said, and her agency is working with the Food and Drug Administration to determine whether it can be used in time

Even if the government can import vaccine from Europe, the amount is likely to be relatively small. Dr. [Julie L. Gerberding] said the government was exploring the possibility of securing a half-million doses of vaccine from the British unit of Chiron. That vaccine is licensed but not approved for use in the United States, Dr. Gerberding said, and her agency is working with the Food and Drug Administration to determine whether it can be used in time. Health officials here and in Europe had earlier reported that a new Fujian strain of flu virus was causing a vast majority of cases of the respiratory illness. Also, Dr. Gerberding has said early laboratory tests show that the current vaccine offers some protection against Fujian flu. Dr. Gerberding said it would take several weeks before officials learned from studies how well this season's vaccine was protecting against the Fujian strain

When [John Elias] hears about the Medicare measure, with its high deductibles, co-pays and the possibility of $3,600 coming out of his pocket, he simply shakes his head. 'Got any samples?' he asks me. Elias uses a wheelchair. He has diabetes and hypertension, and because he has no drug coverage, he relies on free samples. When I run out of his medicine for blood pressure, it soars out of control. His blood sweetens and unsweetens depending on whether I can offer him his diabetes pills. Many of my elderly patients overcome the cash-for-pills hurdle by turning to New York's Elderly Pharmaceutical Insurance Coverage (EPIC) plan. The feds should have looked more closely at this plan. With EPIC, if a Medicare patient is able to show need and an insufficient income, there is only a small out-of-pocket annual fee for medications and a small co-pay. The rest is covered by the state. New York, in turn, is responsible for negotiating lower prices with the drug companies for its EPIC members