Faculty Bibliography

'It's very possible that West Nile virus was the cause of the baby's neurological deficit, but with only one case it's impossible to really determine cause and effect,' Lyle Petersen, a West Nile expert at the Centers for Disease Control and Prevention, said at a news conference

To reduce the risk of infection by the mosquito-borne virus, [Lyle Petersen] and other health officials urged pregnant women to wear protective clothing and to use insect repellents containing DEET during the mosquito season. The virus is still being transmitted in some Southern states

The study found that a diuretic, chlorthalidone, was more effective in preventing fatal and nonfatal heart attacks than were three other classes of drugs: amlodipine (sold as Norvasc), a calcium channel blocker; lisinopril (Zestril and Prinivil), an ACE inhibitor; and doxazonsin (Cardura), an alpha-adrenergic blocker. Diuretic use for hypertension costs about $25 a year, compared with about $250 for an ACE inhibitor and $500 for a calcium channel blocker, according to Dr. Paul Whelton, a leader of the study who is also professor of epidemiology at Tulane University. Compared with participants who took the diuretic, the ACE inhibitor group had, on average, about a 2 mm mercury higher systolic blood pressure, which is the top number in the blood pressure reading. Blacks in the group had a 4 mm mercury higher systolic blood pressure

The new study found that a diuretic, chlorthalidone, was more effective in preventing fatal and nonfatal heart attacks than were three other classes of drugs: amlodipine (sold as Norvasc), a calcium channel blocker; lisinopril (Zestril and Prinivil), an ACE inhibitor; and doxazonsin (Cardura), an alpha-adrenergic blocker. ''There were tremendous efforts to prevent doctors from using diuretics,'' Dr. Marvin Moser of Yale, an expert in hypertension, said in an interview. He said that the new findings vindicated experts who recommended the use of diuretics in the face of vast promotional efforts by some experts and manufacturers to sell more expensive patented drugs. Precisely how diuretics reduce high blood pressure is not known, despite their use for more than half a century. Although the new study showed the superiority of diuretics over other classes of drugs, it did not explain whether the findings were from positive effects of the diuretics or negative effects of the other classes, said Dr. Michael H. Alderman, a hypertension expert at Albert Einstein Medical School

The new study found that a diuretic, chlorthalidone, was more effective in preventing fatal and non-fatal heart attacks than were three other classes of drugs: amlodipine (sold as Norvasc), a calcium channel blocker; lisinopril (Zestril and Prinivil), an ACE inhibitor; and doxazonsin (Cardura), an alpha-adrenergic blocker. The market for blood pressure-lowering drugs is huge. High blood pressure affects 50 million Americans, and 24 million of them spend $15.5 billion a year for blood pressure-lowering drugs. The remainder do not know they have hypertension or do not take drugs for it. The prevalence of hypertension increases with age; more than half of people over age 60 have hypertension. Diuretic use for hypertension costs about $25 a year, compared with about $250 for an ACE inhibitor and $500 for a calcium channel blocker, according to Dr. Paul Whelton, a leader of the study who is also professor of epidemiology at Tulane University. 'There were tremendous efforts to prevent doctors from using diuretics,' Dr. Marvin Moser of Yale, an expert in hypertension, said in an interview. He said that the new findings vindicate experts who recommended use of diuretics in the face of vast promotional efforts by some experts and manufacturers to sell more expensive patented drugs

Since President Bush announced the smallpox vaccine would likely be made available to the American public in 2004, my patients have all been asking me the same question: Should they get the smallpox vaccine? Which is why President Bush's intention to make the old smallpox vaccine available to the entire population by 2004 might not be so wise. It could raise false hopes because there's no way to vaccinate everyone overnight. It could also limit the ability of doctors to counsel their patients on whether they should subject themselves to a somewhat risky vaccine. Smallpox is one of our oldest scourges. It should scare us. But we would do well to remember that even before there was a vaccine, smallpox never took over a whole region the way polio or influenza did. And smallpox isn't about to do that now

If a smallpox vaccine recipient inadvertently transmitted the virus in the vaccine to other people and they fell ill, who would pay for the sick people's medical care? The question arose over the weekend after President [Bush] announced a plan to vaccinate about 10 million health care and emergency workers with smallpox vaccine, which contains a live virus that is closely related to the one that causes smallpox. Smallpox vaccination differs from other immunizations because recipients can accidentally transmit vaccinia, the virus in the vaccine, to other people, in effect involuntarily vaccinating them and putting some at risk of life-threatening complications

The question arose over the weekend after President Bush announced a plan to vaccinate about 10 million health care and emergency workers with smallpox vaccine, which contains a live virus that is closely related to the one that causes smallpox. Smallpox vaccination differs from other immunizations because recipients can accidentally transmit vaccinia, the virus in the vaccine, to others, in effect involuntarily vaccinating them and putting some at risk of life-threatening complications. General recommendations are that people who have recently been vaccinated stay out of close contact with others or cover the vaccine site with a bandage, because the virus can be shed from the site for several weeks after inoculation. Some hospital officials say that newly vaccinated workers who take care of patients will be required to wear special semipermeable bandages at work, because they are better than gauze at containing the virus. If secretions from a smallpox vaccination soak into clothing or blankets, the vaccinia virus may survive in the fabric for a day or two and could theoretically infect someone else who comes into contact with the item, said Dr. Donald A. Henderson, the epidemiologist who led the global smallpox eradication program and who now is a senior science adviser to Mr. [Tommy G. Thompson]

A new smallpox vaccine will be provided free to Americans who want it if the vaccine, now being manufactured, passes licensing tests as expected in 2004, Tommy G. Thompson, the secretary of health and human services, said yesterday. As long as there are no smallpox cases, the vaccine is unlikely to be given to children, even if parents request it, because it has not been tested on them, said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. Researchers had hoped to conduct such studies in children, but ethics panels at medical centers refused to allow them, citing federal regulations banning human experiments in which risks outweigh benefits, he said. Plans are still being worked out to provide vaccine for Americans who want it now. Dr. Fauci said that one way was for people to enroll in clinical trials being conducted to study smallpox vaccine

Instead, Mr. [Bush] authorized a voluntary program to vaccinate about 450,000 doctors, nurses and emergency workers who would be the first to respond to any effort by terrorists or hostile nations to use smallpox as a weapon. The vaccinations are expected to be given from late January through March. In recent months, an advisory panel on immunization policy, many public health leaders and infectious disease experts have expressed deep concern that smallpox vaccination, the most dangerous human immunization, posed too great a risk for the public because no case of smallpox has occurred anywhere since 1980. Dr. E. Stephen Edwards, president of the American Academy of Pediatrics, urged the Bush administration to ''consider the devastating effects'' smallpox vaccinations could have on children. ''No trials have been conducted on children,'' who may have a higher incidence of injury from the vaccine than adults, Dr. Edwards said