Raising the consciousness for identifying and controlling viral STDs: fears and frustrations--Thomas Parran Award Lecture.
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Extensive evaluation of a small series of potential renal donors has revealed an alarming rate of previously unsuspected disease precluding acceptability for renal donation. Of 19 patients considered for donation at the Medical University of South Carolina, 15 were unsuitable for medical reasons (diabetes mellitus, multiple sclerosis, sickle cell trait, hypertension, polycystic kidneys, duodenal ulcer, pulmonary disease), psychologic reasons, or changes on renal arteriography consistent with nephrosclerosis. The importance of a thorough donor evaluation including total patient awareness of the risks involved for both himself and the recipient and extensive psychologic testing is stressed. Even with strict criteria for renal donation, this high rejection rate is surprising.
Obesity is a major contributor to chronic and costly diseases and disabilities. More than 30% of American adults are obese, and the percentage has been rising for 20 years. A recent estimate placed the direct economic costs of obesity at more than $39.3 billion, or 5.5% of all medical expenditures in the mid-1980s. These numbers underestimate prevalence and cost because the studies designed to monitor our nation's health problems have ignored the most obese segment of the population-individuals weighing more than 350 pounds. The methods used to treat obesity are controversial, some of them lacking appropriate evaluation. Physicians have been reluctant to treat obese people because of the intensity and duration of an effective treatment program. Finally, many treatments fail in the long term and therefore are not considered cost effective. Multiple treatment options are currently available, and this review presents data to aid physicians in selection of the best therapy to help their patients. As cost advantages of comprehensive care of obese patients become more obvious under capitated financing systems, further investigation should focus on mechanisms of choosing more individualized care plans to defined subsegments of the obese population to make care more cost effective.
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The 70th Cold Spring Harbor Symposium, entitled "Molecular Approaches to Controlling Cancer," represented a critical and exciting transition in the fields of cancer research and cancer control. After years of successful research into the molecular genetic and cellular defects that underlie the disease, anticancer agents developed on the basis of these insights are now being used regularly in the treatment of cancer patients. Based on the availability of many more experimental drugs, powerful new methods of analysis, accurate models of the disease, and novel insights into cancer-relevant pathways that affect disease initiation and progression, there is considerable reason for optimism in the ability to one day control cancer.
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