Faculty Bibliography

Concerned that an estimated 250,000 Americans do not know they are infected with the AIDS virus, Federal health officials yesterday urged wider use of blood tests, particularly of a little-used test that can provide results in an hour or less. The single rapid test that is available in the United States has not come into wide use, in part because of doctors' reservations about its interpretation and because of Federal guidelines that said test results should not be given until preliminary findings are confirmed. The only rapid test approved by the Food and Drug Administration and marketed in the United States is made by Murex Diagnostics Inc. of Norcross, Ga. Once the sample is prepared, the test can provide results in 10 minutes

State health officials began an investigation and eventually determined that the most probable cause of Harry's death was an adverse reaction to use of a nonprescription drug phenylephrine, the same medication that is sold over the counter as Neo-Synephrine, which is used to relieve nasal congestion related to allergies and ear infections. Doctors used phenylephrine to control bleeding during the removal of the boy's adenoids. The reaction may have been due to its use with a beta blocker drug, which is commonly used to lower high blood pressure. The surgeon instructed a nurse to instill phenylephrine drops in the nose to help stop bleeding. Three minutes later the surgeon began to operate on the left ear. But Harry's blood pressure shot up. Surgery stopped while an anesthesiologist injected a drug to reduce the pressure. In another seven minutes, the ear surgery resumed

State health officials began an investigation and eventually determined that the most probable cause of Harry's death was an adverse reaction to use of a nonprescription drug, phenylephrine, the same medication that is sold over the counter as Neo-Synephrine, which is used to relieve nasal congestion related to allergies and ear infections. Doctors used phenylephrine to control bleeding during the removal of the boy's adenoids. The reaction may have been due to its use with a beta blocker drug, which is commonly used to lower high blood pressure. Harry underwent the operation because repeated ear infections had left him with a hearing loss and a speech problem. After Harry underwent anesthesia and a breathing tube was inserted in his windpipe, a surgeon removed the adenoids without complication. The surgeon instructed a nurse to instill phenylephrine drops in the nose to help stop bleeding. Three minutes later the surgeon began to operate on the left ear. But Harry's blood pressure shot up. Surgery stopped while an anesthesiologist injected a drug to reduce the pressure. In another seven minutes, the ear surgery resumed. But because the event had a deadly consequence and use of phenylephrine is common, Dr. DeBuono went a step further. The commissioner appointed a panel of 10 specialists headed by Dr. Jacqueline E. Jones, who directs pediatric otolaryngology at New York Hospital, to determine the rarity of the reaction. The panel was also charged with clarifying a body of conflicting information about use in operating rooms of phenylephrine and other drugs, like cocaine, that constrict blood vessels

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