Faculty Bibliography

Oshinsky reviews "The Last Campaign: How Harry Truman Won the 1948 Election" by Zachary Karabell

The reasons behind the new concern are as complex as medicine itself and as varied as recent changes in society, including medical advances, greater complexity of care, increasing challenge to medical authority and new techniques to pinpoint sources of errors in the maze of systems that doctors and hospital staffs use every day. As Dr. Mark R. Chassin, a former New York State health commissioner, put it: ''Talk about overuse and underuse of health care, issues that are as important as errors, and everybody goes to sleep. But mistakes can happen to anybody, and they provoke a visceral fear that is real.'' In adopting most of the institute's recommendations, President Clinton has called for a new patient safety center in the government to conduct research on reducing medical errors. Mr. Clinton has also called for mandatory reporting systems for deaths and serious injuries, and voluntary reporting for less serious injuries and close calls

'So I assume there is no reason to assume that the information is not good information,' Dr. [Marcia Angell] said. But, she added, 'If you ask me, was there any bias in these articles, I cannot answer that question. That's why we have a conflict-of-interest policy, because it is always possible for bias to fly under the radar screen. There is no way I can say whether it did or didn't.'

The New England Journal of Medicine, one of the world's top ranked scientific publications and a leading critic of doctors' financial ties to industry, apologized yesterday to its readers for violating its own financial conflict-of-interest policy 19 times over the last three years in choosing experts to review drug therapies. The journal said it had failed to disqualify the authors of the 19 reviews even though the authors had told them about their financial ties to drug companies that marketed therapies described in the articles. The journal's policy would have required it to select authors who had no ties to the companies making the drugs discussed in the articles. The policy is intended to avoid bias in reporting information about drugs that doctors prescribe for their patients

The journal said it erred 19 times over the past three years in choosing experts to review drug therapies. It failed to disqualify the authors of the reviews even though the authors had told the journal about their financial ties to drug companies that marketed therapies described in the articles

The inspector general of the Department of Health and Human Services was asked today to investigate whether a former government health official who recommended a multimillion-dollar federal research grant involving an experimental AIDS vaccine violated post-employment restriction policies by working for the vaccine's manufacturer, federal health officials said. Dr. William Heyward, the former chief of the AIDS vaccine unit at the Centers for Disease Control and Prevention, denied any wrongdoing in the allocation of $8 million for research involving volunteers who take the vaccine known as AIDSVAX. It is the world's first AIDS vaccine to undergo full-scale tests

Spanish news reports citing a confidential British doctors' examination of Gen. Augusto Pinochet said he suffers from a number of ailments that make him mentally unfit to stand trial. But the news accounts were based on excerpts from the doctors' full report and leave unanswered many medical questions about what ails General Pinochet. One question is what are the 16 ailments he is said to have. The news reports cited two medical problems: memory loss and difficulties in comprehension from recent and progressive cerebrovascular damage, and nerve damage to his legs as a complication of diabetes

Death rates for what had been an invariably fatal disease have dropped significantly since the introduction of combinations of protease inhibitors and other drugs. Many people with H.I.V., the AIDS virus, including some who were near death when they began taking the drug combinations in 1996, continue to lead more or less normal lives, though they must take a number of pills at specified times throughout the day, at costs that can exceed $10,000 a year. But the unflagging optimism that AIDS scientists displayed at an international meeting on AIDS in Vancouver in 1996 was absent at the Seventh Conference on Retroviruses and Opportunistic Infections here from Jan. 30 through Feb. 2. One reason is that the infection is spreading through many parts of the world. Another is that many of the participants at the conference were doctors who treat infected people for whom the drug combinations have not worked as well. No one knows for sure how many they are: reports range from 30 percent to 70 percent. A major cause of drug failure is H.I.V.'s uncanny knack of mutating to become resistant to drugs. Thus, the greatest challenges now are to develop novel classes of anti-H.I.V. drugs and new members of older classes that are active against resistant virus. At this year's conference, there were strong hints, from the very earliest stages of research, that such potent new drugs could eventually be developed, and experts greeted the reports with cautious optimism

Despite an intensive search for an immunologic explanation, none have been found. Now, an even more baffling finding has turned up in a study of 1,900 prostitutes in Nairobi, Kenya. Four of them became infected with HIV, the virus that causes AIDS, but only after they stopped working as prostitutes or took breaks of two months or more, leaders of the study reported last week at the Seventh Conference on Retroviruses and Opportunistic Infections