— begin part 1 of 2 cut here —
Volume 2, Number 24 June 12, 1989
+————————————————+
! !
! Health Info-Com Network !
! Newsletter !
+————————————————+
Editor: David Dodell, D.M.D.
St. Joseph’s Hospital and Medical Center
10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
Telephone (602) 860-1121
(c) 1989 – Distribution on Commercial/Pay Systems Prohibited without
Prior Authorization
International Distribution Coordinator: Robert Klotz
Nova Research Institute
217 South Flood Street, Norman, Oklahoma 73069-5462 USA
Telephone (405) 366-3898
The Health Info-Com Network Newsletter is distributed weekly. Articles on a
medical nature are welcomed. If you have an article, please contact the
editor for information on how to submit it. If you are intrested in joining
the distribution system please contact the distribution coordinator.
E-Mail Address:
Editor:
FidoNet = 1:114/15
Bitnet = ATW1H @ ASUACAD
Internet = ddod…@stjhmc.fidonet.org
LISTSERV = MEDNEWS @ ASUACAD
Distribution:
North America Australia/Far East Europe
FidoNet = 1:19/9 David More Henk Wevers
Usenet = kr…@mom.uucp FidoNet = 3:711/413 Fidonet
Internet = krobt%…@uokmax.ecn.uoknor.edu 2:500/1
Sponsors
========
Dr. Edward Delgrosso Black Bag BBS (FidoNet 1:150/101) Tel 1-302-731-1998
===============================================================================
T A B L E O F C O N T E N T S
1. Comments from the Editor
News from the Editor ………………………………………….. 1
2. Medical News
Medical News for week ending June 12, 1989 ………………………. 2
Medical News from the United Nations ……………………………. 9
3. Center for Disease Control Reports
MMWR for June 1, 1989 …………………………………………. 15
4. Columns
CDC Calendar of Events ……………………………………….. 24
Health InfoCom Network News Page i
Volume 2, Number 24 June 12, 1989
===============================================================================
Comments from the Editor
===============================================================================
News from the Editor
David Dodell
I am pleased to announce the resumption of news from the Centers for Disease
Control. This includes month AIDS statistics. You will notice a slight
format change this week, where the entire MMWR was placed in the newsletter as
one article.
In the old format, I received the MMWR in sections, so it was very easy for me
to break it up for this newsletter, however, this week I received it in one
complete piece. Being pressed for time, I didn’t break it up this week, BUT I
plan on doing so in the future.
It will just take a little time to adjust to the new feed for the information.
Thank you for your patience.
Health InfoCom Network News Page 1
Volume 2, Number 24 June 12, 1989
===============================================================================
Medical News
===============================================================================
Medical News for week ending June 12, 1989
(c) 1989, USA TODAY/Gannett National Information Network
INSULIN MIGHT SHOW HEART RISK:
Excess insulin in the blood might be the earliest predictor of coronary
risk in men, two studies out Sunday suggest. The findings point to extra
insulin as the initial problem that often leads to high blood fat levels.
Results of the study, which tested 1,263 men and women, were released at the
American Diabetic Association’s annual meeting in Detroit.
AIDS BATTLE HAS NEW WEAPONS:
Experts at the Fifth International Conference on AIDS on Montreal say there
now is much help available for people who carry the virus but don’t yet have
the life-threatening infections and cancers of full-blown AIDS. HIV co-
discoverer Dr. Luc Montagnier said he expected to be able to prevent AIDS in
some HIV infected people within five years.
RESIDENT DOCTORS GET BREAK:
The clock is ticking for New York hospitals who must cut back on resident
doctors hours. A recent court ruling aimed at ending 36-hour shifts and 100-
hour workweeks for resident doctors requires New York hospitals to cut shifts
80 hours per week or 24 consecutive hours at a time. The bill, challenged in
two suits by the Hospital Association of New York State, takes effect July 1.
DEATH PROMPTED RULE CHANGE:
Rules capping the hours of resident doctors in New York state were
introduced after an 18-year-old woman died at New York hospital. The parents
of Libby Zion said exhausted interns and residents failed to treat the teen-
ager properly when she was admitted to the hospital in 1984. The change would
cut resident workweeks to 80 hours, down from 100.
U.S., SOVIETS OK DRUG TESTS:
The U.S. Olympic Committee and Soviet authorities agreed on a plan to test
Olympic athletes in both countries for drugs. The agreements, made final at a
conference in Iowa Sunday, calls for random testing of athletes from both
countries for steroids and other drugs. Penalties: Two-year suspension from
the sport for first offense; life suspension for repeat offenders.
KOOP TO STAY VOCAL ON HEALTH:
Surgeon General C. Everett Koop will retire as the nation’s doctor on July
13, but plans to remain active in national health issues. Koop said recently
that he would write a book after leaving his post and plans to live in the
Washington, D.C., area and speak out often on national health issues.
Health InfoCom Network News Page 2
Volume 2, Number 24 June 12, 1989
PATIENTS COPE WELL WITH DISEASE:
Patients who discover the have incurable Huntington’s Disease cope well
with the illness, a study shows. Doctors at Johns Hopkins University followed
55 patients through tests for the illness, which is always fatal. Results, in
the current issue of The Journal of the American Medical Association: None of
those who found they had the disease experienced severe depression.
DOCTORS CLOSE TO FINDING GENE:
Doctors have identified genetic sequences very close to the gene that
causes Huntington’s Disease – a fatal genetic disorder of the central nervous
system. Researchers reported in the current issue of the Journal of the
American Medical Association that new tests had identified disease carriers
with 95 percent accuracy. The advances give hope of finding the gene that
triggers the disorder.
TESTS FIND CANCER EARLIER:
New tests that measure genetic changes in tumor cells might help doctors
make more accurate prognoses. Researchers at Johns Hopkins University are
using a test to determine the presence of chromosome parts that keep cells
from turning malignant. The tests, highlighted in the current issue of the
Journal of the American Medical Association, could help find and treat cancer
sooner.
NEW FERTILITY SURGERY ON WAY:
A new microsurgical technique - partial zona dissection – might benefit
couples with "extreme infertility" who have failed to achieve pregnancy with
standard in-vitro methods, said scientists at Reproductive Biology Associates
of Atlanta. It involves extracting a woman’s egg and making a tiny incision to
allow sperm to get inside. It should be widely available in two to three
years.
U.S. OVERESTIMATES AIDS CASES:
U.S. health officials say they’ve overestimated the number of people
infected with the AIDS virus for the past three years. Studies reported
Monday at the Conference on AIDS indicate 1 million to 1.5 million people in
the United States carry the virus now. Nearly identical estimates first made
in 1986 must have been too high, officials said.
ESTIMATES SHOW EXTENT OF AIDS:
Estimates released Monday at the Conference on AIDS in Montreal indicate
that in the United States between four and six of every 1,000 people carry the
disease. The statistics are from the United States Centers for Disease
Control. Those infected are disproportionately male, black and poor, officials
said.
AIDS WAR SHOW SIGNS OF STRAIN:
In the eighth year of the AIDS epidemic, the unparalleled network of fund-
raising and volunteers assembled in San Francisco is showing signs of strain.
Health InfoCom Network News Page 3
…
read more »
In article <24…@shemp.CS.UCLA.EDU> ATW1H%ASUACAD.BIT…@oac.ucla.edu (Dr David Dodell) writes:
> AIDS MUTATES TO RESIST MEDICINE:
> AIDS researchers say they’re racing against time to find drugs to
>supplement AZT, which starts losing effectiveness within two years, new
>studies show. Doctors at the Fifth International Conference on AIDS said
>benefits from AZT wane after 18 months. Reasons: The virus mutates to resist
>the drug and side effects make lower doses necessary.
Some time ago, Steve Dyer expressed dismay when I said that local AIDS
support groups were advising their members not to use AZT; he claimed
that it was an excellent and useful drug and that there was no evidence
against its effectiveness. This posting shows that they might have been
on the right track to avoid its use.
The fact that the virus is mutating to resist the drug makes me shudder.
It’s one thing when bacteria do it – we have a number of different
antibiotics, and have some ability to develop new ones. But with the
AIDS virus, we have so little ability to counter it. Is 18 months of
partial relief worth it, if it unleashes a more virulent mutation of the
AIDS virus in the world?
Andrea Frankel, Hewlett-Packard (San Diego Division) (619) 592-4664
"wake now! Discover that you are the song that the morning brings…"
______________________________________________________________________________
UUCP : {hplabs|nosc|hpfcla|ucsd}!hp-sdd!andrea
Internet : andrea%hp-…@hp-sde.sde.hp.com (or @nosc.mil, @ucsd.edu)
CSNET : andrea%hp-…@hplabs.csnet
USnail : 16399 W. Bernardo Drive, San Diego CA 92127-1899 USA
On 14 Jun 89 00:23:17 GMT, hp-sdd!hp-sdd.hp.com!and…@ucsd.edu
(Andrea K. Frankel) wrote
<Quotes reports that HIV-I appears to be able to become resistant to AZT.>
AF> The fact that the virus is mutating to resist the drug makes me shudder.
AF> It’s one thing when bacteria do it – we have a number of different
AF> antibiotics, and have some ability to develop new ones. But with the
AF> AIDS virus, we have so little ability to counter it. Is 18 months of
AF> partial relief worth it, if it unleashes a more virulent mutation of the
AF> AIDS virus in the world?
This argument is specious in several, not terribly subtle, ways.
First, it assumes that the "new" strain is more virulent than the
older strain. In fact, AZT acts by inhibiting the action of viral
reverse transcriptase, which the virus causes to be synthesized in
order to infect its eventual host cells. The virus mutates by not
using this pathway, but rather by using a less efficient method of
infection—that is, by becoming *less* virulent.
Second, it assumes that the "new" strain is, in fact, "new".
In fact, the "new" strain of HIV is almost certainly co-existent with
the "wild-type strain". It can’t compete with its stronger cousin,
however, except in those circumstances where its stronger cousin is
selected against—that is, within the body of an immunocompromized
human who is taking AZT.
Finally, the argument ignores the fact that other anti-HIV drugs can
be constructed which interrupt the slower pathway. AZT is not a
wonder drug, except insofar as it’s all there is. As the metabolic
pathway by which HIV infects cells is elucidated, combinations of
drugs will be found that interrupt multiple infection pathways. Since
multiply-resistant strains are geometrically less common than
singly-resistant strains, such synergistic treatments will surely be
less prone to the selective effects of a single agent.
This does mean that an asymoptomatic HIV-positive who begins a course
of prophylactic AZT therapy is balancing the preservation of his or
her immune system, and the resulting wide-spectrum defense of his or
her health, against the eventual emergence of AZT-resistant strains of
the virus within his or her body. It is possible that the weakened
AZT-resistant strain might be successfully resisted by the stronger
immune system of the patient who is taking prophylactic therapy, but
in the absence of data, no scientific conclusions can be drawn.
But the possible emergence of AZT-resistant strains of the virus is
not a good reason for a person with full-blown AIDS to avoid AZT.
Anyone who argues that it is is causing unnecessary suffering to an
already terrible fate.
—
John Merrill | ARPA: merr…@bucasb.bu.edu
Center for Adaptive Systems |
111 Cummington Street |
Boston, Mass. 02215 | Phone: (617) 353-5765
In article <24…@shemp.CS.UCLA.EDU> andrea%hp-sdd.U…@ucsd.edu (Andrea K. Frankel) writes:
>> AIDS MUTATES TO RESIST MEDICINE:
>>benefits from AZT wane after 18 months. Reasons: The virus mutates to resist
>>the drug and side effects make lower doses necessary.
>Some time ago, Steve Dyer expressed dismay when I said that local AIDS
>support groups were advising their members not to use AZT; he claimed
>that it was an excellent and useful drug and that there was no evidence
>against its effectiveness. This posting shows that they might have been
>on the right track to avoid its use.
Andrea, maybe you’re reading in between the lines and spaces, but what
I read doesn’t say any such thing.
If someone is diagnosed with AIDS (not simple HIV+ status), then there is
overwhelming evidence that AZT will prolong life compared to people who
do not take AZT (or presumably some other anti-viral–but AZT is the only
approved drug right now, and the only one with long-term studies of its
efficacy.) There are some medical reasons that a selected subset of people
might be advised to not take AZT, but these reasons do not include "AIDS
is caused by a suppressed immune system, AZT suppresses the immune system,
therefore don’t take AZT", which was the original sentiment to which I
responded a few weeks ago.
Viral resistance is not an uncommon phenomenon, and it’s not surprising that
we’re beginning to see reports of this in people taking AZT. The challenge
is to find regimens, possibly in combination with other drugs, which increase
its effectiveness, decrease its toxicity and hopefully delay the development
of resistance. However, this is not an argument to *not* use AZT right now
in people who can benefit from it. Avoiding it all together when it could
be used safely is almost a guarantee of a shorter life.
The first reports of resistance are probably more important to those
researchers who are looking into AZT as an early intervention in asymptomatic
HIV+ individuals. Its efficacy versus toxicity versus the development of
resistance versus cost are all parameters which have yet to be determined.
–
Steve Dyer
d…@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer
d…@arktouros.mit.edu