Faculty Bibliography

The advent of triple-drug therapy for HIV disease has raised the concern that disadvantaged patients with multiple social problems may be nonadherent to treatment. Fearing that partial adherence will lead to drug resistance, some clinicians are withholding these powerful new drugs from such patients. The historical record demonstrates that labeling patients as nonadherent may be both stigmatizing and inaccurate. Since 1900, such adjectives as ignorant, vicious, and recalcitrant have been used to describe patients who do not follow medical advice. Less judgmental terms, such as nonadherent and noncompliant, are now used, but these terms still imply that patients should obey physician-imposed regimens. Studies of nonadherence have consistently shown that the problem is widespread among all persons and cannot reliably be predicted on the basis of patient characteristics. This paper argues that physicians should deemphasize the standard approach of predicting and correcting nonadherent behavior in certain patients. Rather, clinicians should encourage all HIV-positive patients to devise individualized treatment plans that can facilitate reliable ingestion of medication. Although the potential development of resistance to triple-drug therapy remains an important public health issue, concern about this possibility must be balanced with respect for patients' rights. Encouraging the active participation of HIV-positive persons in their own treatment will help avoid judgmental and inaccurate assessments of patient behavior and may help patients take medications more successfully.

At Babe Ruth Day at Yankee Stadium in 1947, the baseball hero of the generation stood before an admiring crowd, deep in pain and emaciated from advancing cancer, not yet aware of what ailed him. In the dugout moments before, clad in a topcoat and golf hat, he suffered a coughing spell, then, pulling himself together, walked to home plate, mentally recalling the day Lou Gehrig had made the same trip. In fact, he was among the first patients anywhere to receive experimental chemotherapy, and some researchers say he was the first ever to receive a combination treatment of chemotherapy and radiation for his type of cancer. For Ruth, the chemotherapy worked dramatically - but only temporarily. Nevertheless, knowledge gained from his case helped shape the combination therapy that is now standard for his disease. But the images of a hoarse Ruth, perpetuated in audio and videotapes on the Internet, in movies and in sports broadcasts, in addition to his well-known smoking and drinking proclivities, have contributed to the myth that Ruth had throat cancer, which is generally taken to mean cancer of the larynx, or voice box

For one, Lymerix, which will be available in January, does not protect everyone who takes it against Lyme disease, a bacterial infection transmitted through tick bites. For maximum protection, three injections of the vaccine must be taken over a year. Studies have shown that taking three injections provides 78 percent protection against Lyme disease, while taking two injections provides only 50 percent protection

BEIJING - For the first time, scientists have calculated the devastating toll of cigarette smoking in China and declared the country to be on the verge of a calamitous epidemic of smoking- related deaths that may kill one in three Chinese men. 'There is an unprecedented epidemic of smoking deaths,' Dr. Chen Zhengming, a Chinese researcher now based at Oxford University, told a news conference Thursday in Beijing. 'And China is still in the early stages of the epidemic.' In two papers being published on Saturday in the British Medical Journal, researchers from China, Britain and the United States draw the outlines of China' emerging epidemic with countless statistics

An Australian man who received a transplanted hand and forearm in France seven weeks ago has begun moving each finger of the donor hand and is gaining function with surprising swiftness, his doctors said last week. They said that so far the man, Clint Hallam, had not shown any signs of rejection and had escaped adverse effects of potent immune-suppressing drugs. Mr. Hallam, 48, is ''far ahead of schedule, doing superbly and better than any of us ever would have hoped,'' said Dr. Earl Owen, an Australian microsurgeon who headed the international team that performed the transplant. Much of Mr. Hallam's early success is because of the prescribed intense exercise program he performed on the muscles of his handless right arm in the year preceding the operation. The muscles of both forearms were equally strong when the transplant was performed at Edouard Herriot Hospital in Lyons on Sept. 23, and they remain strong with twice-a-day physical therapy, Dr. Owen said

OBJECTIVES: To update the WHO global and regional estimates of the prevalence and incidence of syphilis, gonorrhoea, chlamydia, and trichomoniasis. METHODS: Prevalence estimates for syphilis, gonorrhoea, chlamydia, and trichomoniasis were generated for each of the nine UN regions for males and females between the ages of 15 and 49 in 1995 based on an extensive review of the published and unpublished medical literature since 1985. Incidence estimates were based on the prevalence figures and adjusted to take into account the estimated average duration of infection for each disease in a particular region. The latter was assumed to depend upon a number of factors including the duration of infection in the absence of treatment, the proportion of individuals who develop symptoms, the proportion of individuals treated, and the appropriateness of treatment. RESULTS: In 1995 there were over 333 million cases of the four major curable STDs in adults between the ages of 15 and 49--12 million cases of syphilis, 62 million cases of gonorrhoea, 89 million cases of chlamydia, and 170 million cases of trichomoniasis. Geographically, the vast majority of these cases were in the developing world reflecting the global population distribution. CONCLUSIONS: STDs are among the most common causes of illness in the world. Estimates of the global prevalence and incidence of these infections are limited by quantity and quality of data available from the different regions of the world. Improving global STD estimates will require more well designed epidemiological studies on the prevalence and duration of infection.