Faculty Bibliography

David M. Oshinsky reviews the book "The Children" by David Halberstam

Stricter control of antibiotic use and more stringent prevention measures are needed to stop the growing and related problems of drug-resistant and hospital-acquired infections, experts said today at a scientific meeting here. Among the measures proposed were mandatory auditing of antibiotic use, controlling the prescription of such drugs, officially rebuking doctors who overuse them, enforcing hand-washing practices among hospital employees, improving quality control in laboratories, and intensifying public education about the hazards of antibiotics. A major concern is that two million Americans pick up infections in hospitals each year, the cost of which runs to an estimated $4.5 billion. Of these infections, 70 percent are due to microbes that are resistant to one or more antibiotics, and in 30 percent to 40 percent of the infections, the causative microbe is resistant to the first-line treatment drug, a recent study has found

ATLANTA - In a major turnaround, the scientist who led the campaign that eradicated smallpox and eliminated the need for vaccination worldwide now says the United States should resume making the vaccine to deal with the threat of biological warfare. The scientist, Dr. Donald Henderson, a former deputy White House science adviser and dean emeritus of Johns Hopkins School of Public Health, spoke at an international meeting on new and emerging diseases Tuesday. U.S. 'ill-prepared' The United States is ill-prepared to confront a terrorist attack using biological weapons, and health officials need more money to prepare against such attacks, Henderson and other experts in infectious diseases said at the meeting, which was partly sponsored by the Centers for Disease Control and Prevention. The speakers said their new concern reflected the Iraqi buildup of biological weapons, terrorism attacks in Japan, and a breakdown in security at Russia's advanced bioweapons center in Koltsovo near Novosibirsk

The scientist, Dr. Donald A. Henderson, a former deputy White House science adviser and dean emeritus of Johns Hopkins School of Public Health, spoke at an international meeting on new and emerging diseases here today. The United States is ill-prepared to confront a terrorist attack using biological weapons, and health officials need more money to prepare against such attacks, Dr. Henderson and other experts in infectious diseases said at the meeting, which was partly sponsored by the Centers for Disease Control and Prevention. The speakers said their new concern reflected the Iraqi buildup of biological weapons, terrorism attacks in Japan, and a breakdown in security at Russia's advanced bioweapons center in Koltsovo near Novosibirsk. Dr. Henderson said in an interview that the United States stores should be increased by 20 million doses and speculated that the cost would be about $2 a dose. But Dr. Henderson stressed that the vaccine would be injected only if the bioterrorism threat materialized. Dr. Henderson also said that if more vaccine were ever needed, manufacturers should have capacity to produce it within several weeks, not the months it would now take

WHILE concern grows about the possible use of botulinum toxin for biological warfare, medical uses of this deadliest of poisons are expanding. Injections of tiny amounts of the same toxin that bacteria produce to cause botulism, a food-borne disease that paralyzes breathing muscles and kills by suffocation, can heal by producing a local paralysis. The toxin reduces excessive muscle contractions without causing significant functional weakness or diminishing sensation, safely turning several largely untreatable conditions into manageable ones. Under the orphan drug act that seeks to speed development of new drugs for rare diseases, the Food and Drug Administration in 1989 approved botulinum toxin -- Allergan Inc. of Irvine, Calif., makes and sells it as Botox -- for use in two conditions: crossed eyes, or strabismus, and involuntarily clenched eyelids, or blepharospasm. Last November, the F.D.A. gave Allergan permission to sell newly prepared lots of Botox. Allergan built a new plant in California just to produce Botox. The company said it has taken complete security precautions there, and all shipments meet Federal regulations for dangerous medicinal products. ''Botox is in no way capable of being a weapon'' because it can be used only as an injection and would not be potent if added to water supplies or other common sources, said Jeff D'Eliscu, a spokesman for Allergan. Nevertheless, Allergan declined to say where in California the plant is located

Health officials must also stop thinking about food-borne disease as an inconvenience that just causes vomiting and diarrhea. Some bacteria cause other serious illnesses, said Dr. Michael T. Osterholm, an official of the Minnesota Health Department and a leading expert on food-borne illness. But ''guesstimates outweigh our knowledge'' of a more precise number due to inconsistencies in available data because of inadequate surveillance of food-borne illness and laboratory facilities in state and local health departments, Dr. Osterholm said in a featured talk before 2,500 participants from every state and 70 countries at the first international meeting on new and emerging diseases. It was sponsored in part by the Centers for Disease Control and Prevention and the American Society of Microbiology. Examples of recently recognized food-borne parasites include E. coli 0157:H7, a strain that produces potentially fatal blood and kidney damage; Listeria monocytogenes, which can cause blood stream infection and meningitis; and Campylobacter, which can lead to paralysis that begins in the legs and spreads to the chest and neck. In England a small number of human cases of a new form of neurological illness have been linked to mad cow disease, which is believed to result from a newly recognized infectious agent known as a prion

It took nearly two centuries to achieve the goal of eradication set by the British doctor Edward Jenner after he learned from a milkmaid that the cowpox virus could be used as a vaccine to prevent smallpox. After a scientific journal rejected his paper on the technique, Dr. Jenner persevered and published on his own the vaccination technique, the first ever. In the late 1970's, the vaccine finally ended the scourge that killed one in four victims and left many survivors scarred and blinded. Once eradication is achieved, costly control programs can cease, with the savings channeled to other areas of health services. Eradication programs can create coalitions of interested partners, and even raise new money for public health. Further, eradication is egalitarian because it protects rich and poor alike. Sharp debate has developed among different factions in public health over the merits of using scarce funds to concentrate efforts on eradicating one disease in developing countries where people suffer from many other preventable ones. Wealthier countries may favor eradicating a disease to save money because they would no longer have to pay for vaccinations and other health services needed to keep their countries free of the disease. Discussions get even more acrimonious over the confusion created by imprecise use of words like eradication, elimination and control of disease, particularly when the meaning has been twisted to suggest that more progress has been made than is actually the case

The growing strength of managed care has diminished the financial and clinical autonomy of many orthopaedic surgeons. In part to offset these negative trends, new relationships are being developed to define doctors' methods of contracting with health-maintenance organizations. These include physician practice management companies (PPMs), independent practice associations, management service organizations, and physician-sponsored organizations. Each entity offers distinct advantages and disadvantages. While the PPM is the most popular new vehicle to offset adverse market trends, it carries with it some of the greatest potential pitfalls. In every case, before negotiating to join one of these new entities, it is important for a physician to have a solid understanding of the competing claims made by each entity, as well as insight into the fiscal health of the particular company in question. For some doctors, these arrangements offer a solution to current woes. For others, PPMs interpose another meddlesome intermediary in a market already bloated by layers of bureaucracy.

It is the first time that a drug has led to growth of new coronary blood vessels by mimicking the way collateral vessels naturally develop in some people with blocked arteries. The drug, a protein known as a growth factor, is called F.G.F.-1 (for fibroblast growth factor). The doctors made it with genetic engineering techniques in their laboratory in Fulda, Germany. F.G.F.-1 was injected into heart muscle near the grafts that surgeons made to create new channels around blocked coronary arteries during standard bypass operations at the Fulda Medical Center. For now, the drug could not replace bypass surgery, the German doctors said. Dr. Thomas-Joseph Stegmann, the head of the team, said the chief objective was to prove the concept that F.G.F.-1 could safely produce new blood vessels in the heart. Although other growth factors are now used safely in medical practice, some experts had warned of dangers with F.G.F.-1. One, Dr. Wolfgang Schaper of the Max Planck Institute in Bad Nauheim, Germany, wrote in 1993 that he doubted that the growth factor would have more than moderate benefit and said ''its pronounced toxicity would preclude its use in human patients.''

Women with scleroderma had fetal cells present in their blood decades after pregnancy more often and in larger numbers than mothers who did not have the condition. The disease is scleroderma, an autoimmune disorder in which the body mysteriously attacks its own healthy tissues. For equally mysterious reasons, scleroderma strikes women four times as often as men. The study neither proves that fetal cells cause scleroderma nor provides a full explanation of how such cells might cause the disease. But identification of such a link has astonished many experts in scleroderma and related diseases who said the finding, if confirmed, would have important implications for autoimmune disorders