Faculty Bibliography

The drug, clopidogrel, which Bristol-Myers Squibb and Sanofi-Synthelabo make as Plavix, is often prescribed for two to four weeks to prevent formation of clots in newly opened arteries. After the short-term course of clopidogrel, patients usually continue to take aspirin. The two drug companies paid for the study, which was led by Dr. Steven R. Steinhubl of the University of North Carolina. The study found that continuing clopidogrel in combination with aspirin for one year significantly reduced the number of heart attacks, strokes, repeated angioplasties and fatalities by 26.9 percent compared with a second group in the study that took clopidogrel for only four weeks. The combination of clopidogrel and aspirin ''will probably become a standard of care for at least the first year following'' angioplasty, Dr. [Valentin Fuster] said, and, after further testing, possibly for patients with coronary artery disease who are at high risk for strokes and heart attacks but who do not undergo the procedure

The aim of the tests conducted so far on humans is to determine safety, not effectiveness. Although researchers reported evidence that the transferred cells took root and flourished in scarred areas of the heart, they said they still had to prove that the new cells would make the heart pump more forcefully without significant risks. It will be years before any method becomes part of standard practice, if indeed it does. What the researchers envision is injecting muscle cells taken from the thigh or elsewhere to grow new cells in hearts scarred by heart attacks. Dr. Douglas B. Cowan, a cell biologist at Children's Hospital in Boston, reported that skeletal muscle cells put in the hearts of rats survived for more than a year and seem to have connected with heart cells beginning 10 weeks after implantation

The president took as many as eight medications a day, says the historian, Robert Dallek. A committee of three longtime Kennedy family associates, who for decades refused all requests to look at the records, granted Mr. Dallek's request, in part because of his 'tremendous reputation.' Mr. Dallek is writing a biography, An Unfinished Life: [John F. Kennedy], 1917-1963, to be published next year by Little, Brown. The information shows how far Kennedy went to conceal his ailments and shatters the image he projected as the most vigorous of men. Yet for all of Kennedy's suffering, the ailments did not incapacitate him, Mr. Dallek concluded. In fact, he said, while Kennedy sometimes complained of grogginess, detailed transcripts of tape-recorded conversations during the Cuban missile crisis in 1962 and other times show the president as lucid and in firm command

Heart disease is the leading cause of death in the United States, and the experimental therapies of seeding cells focus largely on heart failure, the disease's terminal stage. The damage from a heart attack is permanent because heart cells cannot regenerate the way liver cells can. Dr. Nabil Dib of the Arizona Heart Institute in Phoenix reported what are believed to be the first human tests in the United States of injections of skeletal muscle cells into severely damaged hearts. The procedure, tested on 16 patients, involved growing millions of a patient's own skeletal muscle cells in test tubes and then reinjecting various amounts of them. The patients involved were receiving coronary bypass surgery or mechanical pumps to keep them alive until they could get a heart transplant. Dr. Dib's team examined the transplanted cells after the damaged heart was removed in a transplant. The cells ''survived and thrived,'' Dr. Dib said, ''and areas damaged by heart attack and cardiovascular disease showed evidence of repair.''

The two companies that received rush VIG orders were the DynPort Vaccine Co. of Frederick, Md., which has a long-standing contract to supply vaccines for smallpox, botulism, plague, anthrax and tularemia to the military, and the Cangene Corp. of Winnipeg, Canada, which makes antibody products that protect babies with dangerous Rh mismatches, pregnant women exposed to chickenpox and people exposed to anthrax, hepatitis B and other diseases. Cangene, by contrast, has a bigger contract but a less urgent time frame. It is to produce up to 100,000 doses of VIG for the U.S. civilian population over five years. Lacking a pool of frozen plasma, it is seeking about 10,000 volunteers like [Michael Kuring] to be inoculated for smallpox and then bled twice a week for two months. Plasma is spun off their blood and their red cells are returned to them. So far, it has found 1,300 VIG donors through advertising and word of mouth. All donors must have been vaccinated against smallpox as children, and have the scars as proof. If they have no memory of bad reactions, that is taken as evidence that they had none. They are screened for all diseases, like AIDS, that disqualify blood donors, and asked if they have a history of skin problems

The risk of smallpox appearing in the United States is still theoretical. But ever since Ken Alibek, the former deputy director of Biopreparat, the Soviet biological weapons apparatus, freely admitted to extensive amounts of smallpox existing in the Soviet Union, there is every reason to believe that some of the stockpiled virus may have found its way into the hands of rogue dictators or terrorists. And smallpox may be aerosolized -- if it is sprayed, it could infect hundreds of victims right off the bat. The fear associated with smallpox is much more contagious than the disease. Smallpox is one of our ancient scourges, and it captures the dark side of our imaginations. Schoolchildren learn of smallpox as the first bioweapon, distributed in blankets to Native American tribes by British troops during the French and Indian wars of the 1750s. Vague memories of our earliest immunizations against smallpox haunt many of us. This antiquated vaccine is not safe when given to people who have certain skin conditions, are immuno-compromised or pregnant. Unfortunately, these conditions may be hidden. The one recent death from the smallpox vaccine occurred in a military recruit who unknowingly was HIV-positive

The records are largely from Dr. [Janet G. Travell], a specialist in internal medicine and pain management who treated Kennedy for years before ultimately being eased aside after bitter arguments with other doctors about his care. She gathered files from before and after he became president in 1961. Kennedy's widow and brothers, Robert and Edward, donated them in 1965 to the Kennedy Library, Deborah Leff, the library's director, said, and a half-dozen scholars who sought permission to see them over the years were rebuffed. Dr. [Jeffrey A. Kelman] and Mr. [Robert Dallek] said the records suggested at least two hypotheses about Kennedy's illnesses. One is that he developed a number of medical conditions independently early in life, including colitis and osteoporosis. If so, he had ''markedly washed-out bones at an early age,'' Dr. Kelman said. X-rays in the new files showed the spinal fractures and metal screws in the vertebrae. This is especially intriguing because Kennedy's autopsy report found ''no significant gross skeletal abnormalities,'' aside from the bullet wounds in the skull. Many experts have criticized the report, and Mr. Dallek's findings raise new questions. President [John F. Kennedy] had to be hoisted aboard Air Force One in 1961. He was known to have back pain, but his ills were more extensive. (Lynn Pelham/Timepix)(pg. 1); The biographer Robert Dallek, above, was granted rare access to the medical records of John F. Kennedy. What Mr. Dallek found portrays a man more ill and in more pain than he let the world know. The records came largely from the White House physician Janet G. Travell, right, who treated Kennedy for years. Kennedy, whose back pain was known but who led an active life despite it, used crutches en route to cruise on the Potomac. (Associated Press, 1961); (Doug Mills/The New York Times); (Associated Press, 1961)(pg. 26)

Yet for all of Kennedy's suffering, the ailments did not incapacitate him, [Robert Dallek] concluded. In fact, he said, while Kennedy sometimes complained of grogginess, detailed transcripts of tape- recorded conversations during the Cuban Missile Crisis in 1962 and other times show the president as lucid and in firm command

At times the president took as many as eight medications a day, says the historian, Robert Dallek. A committee of three longtime Kennedy family associates, who for decades refused all requests to look at the records, granted Dallek's request, in part because of his 'tremendous reputation,' said one of them, Theodore C. Sorensen, who was the president's special counsel. Yet for all of Kennedy's suffering, the ailments did not incapacitate him, Dallek concluded. In fact, he said, while Kennedy sometimes complained of grogginess, detailed transcripts of tape- recorded conversations during the Cuban missile crisis in 1962 and other times show the president as lucid and in firm command. For many years, Kennedy's back problems were largely attributed to injuries suffered when his Navy patrol boat, PT-109, was sunk in World War II. In fact, he had back pain before that. Dallek said his vertebrae may have begun degenerating as a result of the steroids he may have taken for intestinal problems in the late 1930s