Medicine and the social contract.
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Biomedical subjects
Publications and source records attributed to D E Rogers.
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Among the cereal flours, only wheat flour will form a viscoelastic dough when mixed with water. The viscoelasticity appears to be because the gluten proteins are water compatible and thus will swell and interact. The gluten protein's large molecular size and low charge density appear to allow them to interact by both hydrogen and hydrophobic bonds. Wheat flour doughs are also unique in their ability to retain gas. This property appears to result from a slow rate of gas diffusion in the dough. The third major unique property of wheat flour doughs is their ability to set in the oven during baking, and thereby to produce a rigid loaf of bread. Although not clearly understood, this appears to be a heat-induced crosslinking of the gluten proteins.
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Considerable evidence indicates that intravenous drug users are emerging as the group at greatest risk for both acquiring and spreading human immunodeficiency virus (HIV) infection. Thus, all possible methods to control the spread of HIV infection in intravenous drug users should be explored. Key recommendations are that HIV antibody testing of intravenous drug users should be voluntary, because mandatory testing is counterproductive; free distribution of needles and syringes to intravenous drug users should occur only in carefully controlled circumstances to determine its effectiveness in decreasing infection rates; and drug-free and methadone maintenance treatment programs should be available on demand to all intravenous drug users as a means of reducing the spread of HIV infection. At present, the primary strategy for prevention must be education resulting in behavioral change. Education is currently the only definitive means for controlling the spread of HIV infection among intravenous drug users, their sex contacts, and to fetuses.
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The key to the future of the HIV epidemic is the intravenous drug user. In New York City the future has arrived--intravenous drug use is now the predominant risk factor among new cases of AIDS. Our limited knowledge of most facets of drug abuse prevention and treatment and the emotional polarity and politicalization of the issues surrounding AIDS have made control of its spread among intravenous drug users very difficult. Clearly new research efforts are needed better to decide how to reduce the further spread of HIV infection among this group. But efforts to stop the spread cannot await these results. Intense and immediate efforts should focus on five areas for potential control of the spread of HIV infection among drug users: education, treatment on demand, expanding support services, providing sterile equipment, and readjustment of some of society's moral judgments that currently block action. Let us hope that in 10 years we do not look back and realize that we did too little too late while it was still possible to make a difference.
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