Faculty Bibliography

Three large new studies are challenging the safety and benefits of clot-busting drugs for older people suffering heart attacks, particularly those 75 and older. The American Heart Association and the American College of Cardiology recommend use of clot-busting drugs in heart attack patients. But the two leading heart organizations caution that evidence for the drugs' effectiveness and safety in older people has been equivocal. The two main clot-busting drugs, also known as thrombolytics, are T.P.A. (tissue plasminogen activator) and streptokinase. Now an urgent need exists to reassess the recommendations for treating heart attacks in older people, particularly because the number of heart attacks in people over 75 is growing rapidly as the population ages, said the researchers from Harvard, Johns Hopkins and Yale who led the studies. The same point was stressed in an editorial in the journal Circulation, which is publishing the Johns Hopkins study today

Dr.Jeffrey M. Drazen, a leading asthma researcher at Harvard with strong ties to the drug industry, was named the editor of The New England Journal of Medicine here today. Pledging to protect the integrity of The Journal's information, Dr. Drazen, a professor of medicine at Harvard, said he would recuse himself from the editorial process for any papers submitted that relate to asthma or to nine major companies from which he has received research grants or consultation fees. Last February, after an internal investigation prompted by articles in The Los Angeles Times, The Journal found that it had violated its own rules in publishing 19 articles by Dr. Drazen and other authors with industry ties. The Journal said the articles should have been written by scientists without such connections, but its editors blamed themselves and said Dr. Drazen had disclosed his industry support

The National Institutes of Health is set to begin its first full-scale tests of a vaccine for people already infected with the AIDS virus, the vaccine's manufacturer said yesterday. In the tests, injections of the vaccine, Remune, will be added to standard combination drug therapy for H.I.V., the AIDS virus. Such drugs can halt reproduction of H.I.V. in infected cells but do not eradicate the virus from those who are infected. Remune is intended to be a therapeutic vaccine, to stimulate the immune system to destroy H.I.V.-infected cells. Vaccines are routinely given to prevent polio and many other infections. If the tests are successful, Remune would be the first therapeutic vaccine for any disease to work in those already infected. But the vaccine is not expected to cure AIDS

In the tests, injections of the vaccine, called Remune, will be added to standard combination drug therapy for HIV, the AIDS virus. Such drugs can halt reproduction of HIV in infected cells, but do not eradicate the virus from those who are infected. Remune is intended to be a therapeutic vaccine, to stimulate the immune system to destroy HIV-infected cells. The study aims at determining whether Remune will keep the levels of HIV in the blood suppressed longer than anti-HIV drug therapy alone, and thwart progression of infection to AIDS. Vaccines are routinely given to prevent polio and many other infections. If the tests are successful, Remune would be the first therapeutic vaccine for any disease to work in those already infected. But the vaccine is not expected to cure AIDS

In the tests, injections of the vaccine, called Remune, will be added to standard combination drug therapy for HIV, the AIDS virus. Such drugs can halt reproduction of HIV in infected cells, but they do not eradicate the virus from those who are infected. Remune is intended to be a therapeutic vaccine, to stimulate the immune system to destroy HIV-infected cells. The study aims at determining whether Remune will keep the levels of HIV in the blood suppressed longer than anti-HIV drug therapy alone, and thwart progression of infection to AIDS. Other therapeutic HIV vaccines have been tested and found to be ineffective. Before combination anti-HIV therapy was introduced, the U.S. military conducted a large full-scale test of another therapeutic vaccine. Prolonged administration of the vaccine was safe, but it did not benefit infected volunteers

In the tests, injections of the vaccine, called Remune, will be added to standard combination drug therapy for HIV, the AIDS virus. Such drugs can halt reproduction of HIV in infected cells, but do not eradicate the virus from those who are infected. Remune is intended to be a therapeutic vaccine, to stimulate the immune system to destroy HIV-infected cells

The National Institutes of Health is poised to begin its first full-scale tests of a vaccine for people already infected with the HIV virus, the vaccine's manufacturer said Wednesday. In the tests, injections of the vaccine, called Remune, will be added to standard combination drug therapy for HIV, a virus that can develop into AIDS. Such drugs can halt reproduction of HIV in infected cells, but do not eradicate the virus from those who are infected. Remune is intended to be a therapeutic vaccine, to stimulate the immune system to destroy HIV-infected cells. The study aims at determining whether Remune will keep the levels of HIV in the blood suppressed longer than anti-HIV drug therapy alone, and thwart progression of infection to AIDS

Injections of the vaccine, called Remune, will be added to standard combination drug therapy for HIV, the AIDS virus. Such drugs can halt reproduction of HIV in infected cells, but do not eradicate the virus from those who are infected. The study aims at determining whether the vaccine will keep the levels of HIV in the blood suppressed longer than anti-HIV drug therapy alone, and thwart the onset of AIDS proper. The vaccine, developed in the late 1980s by Dr. Jonas Salk, the polio vaccine pioneer, is derived from HIV that is grown in test tubes and then killed by chemicals and irradiation. It is later mixed with mineral oil as an adjuvant aimed at boosting its power to stimulate the immune system

Like Mayor Rudolph W. Giuliani, 180,000 American men will suddenly learn this year that they have prostate cancer, and what makes their decisions about treatment so difficult is that doctors do not know which one is most effective. Alternatives include surgical removal of the prostate, radiation (delivered externally or implanted as ''seeds''), techniques to freeze and destroy the prostate, early hormonal therapy and watchful waiting. While there is no standard plan for such observation, it usually involves monitoring blood tests to determine if the prostate specific antigen level rises, rectal examinations to determine if prostate nodules develop and checking for developing symptoms. ''We don't know what the best treatment option is for men who are found to have prostate cancer and doctors do not always clearly say that to patients,'' said Dr. Timothy J. Wilt, who is directing a national study on outcomes of prostate cancer treatments

BACKGROUND: Black patients undergo coronary artery bypass grafting and percutaneous transluminal coronary angioplasty less often than white patients. It is unclear how racial differences in clinical factors contribute to this variation. METHODS: A retrospective cohort study was performed of 666 male patients (326 blacks and 340 whites), admitted to 1 of 6 Veterans Affairs hospitals from October 1, 1989, to September 30, 1995, with acute myocardial infarction or unstable angina who underwent cardiac catheterization. The primary comparison was whether racial differences in percutaneous transluminal coronary angioplasty and coronary artery bypass grafting rates persisted after stratifying by clinical appropriateness of the procedure, measured by the appropriateness scale developed by the RAND Corporation, Santa Monica, Calif. RESULTS: Whites more often than blacks underwent a revascularization procedure (47% vs 28%). There was substantial variation in black-white odds ratios within different appropriateness categories. Blacks were significantly less likely to undergo percutaneous transluminal coronary angioplasty (odds ratio, 0.30; 95% confidence interval, 0.14-0.63 [P<.01]) when the indication was rated "equivocal." Similarly, blacks were less likely to undergo coronary artery bypass grafting (odds ratio, 0.44; 95% confidence interval, 0.23-0.86 [P<.01]) when only coronary artery bypass grafting was indicated as "appropriate and necessary." Differences in comorbidity or use of cigarettes or alcohol did not explain these variations. Using administrative data from the Veterans Health Administration, we found no differences in 1-year (5.2% vs 7.4%) and 5-year (23.3% vs 26.2%) mortality for blacks vs whites. CONCLUSION: Among patients with acute myocardial infarction or unstable angina, variation in clinical factors using RAND appropriateness criteria for procedures explained some, but not all, racial differences in coronary revascularization use.