Tobacco Documents Online

[ B .wn lun theo_ry some don't cotton to | A secret agent in cotton causes brown | lung disease -- the pulmonary illness of fia | textile workers. Some believe that the ed l agent is a toxin produced by bacteria ~n ~| presen| in cotton~.d~ast. Others believe,the ief | agent is arl inherent chemical component )1:- '| Of cotton.At the American. Chemical' Soci- al| ,~ty .[~,cs) meet, in.g ¢~ Atlanta ~:st apri~g. ~y | tl~eir case (SN: 4/11/81, p. 231). Now comes rs | a word from the other camp. this substance already has been isolated from branches and leaves o[ co'fton and has been shown to display some byssino- sis-related activity- such as histamine release ~ in anlmals. Researchers do not suspect that ~CM~ itself is the chemical culprit responsible for byssinosis, ~hough, because ~he levels of activity it. d~splays extremely water soluble, and researchers know that the b.yssin~sis agent can be | John E M:c~orm[ck arrd~ Teruo. Shin- ~v,~ash~d;[r0m~¢Otton,{on impracticalsoIu- -[ ---- ~[ ~-~m,p~ne~~ of cotton, but also Shinmyozu therefore set out to synthesize could be causative agents of brown lung disease, or byssinosis. The researchers -- whose work will be presented next month at ihe ~,cs Midwest Regional Meeting in Columbia- have synthesized chemical cousins of a compound called Lacinilene C Methyl Ether, o~ LCM.~:. ' .McCormick an~Sh~n.~nyozu ~tarted with '~c~ as the parent compound, because I~acin~lene C Methyl R-H Glycosides synthesiz~:l: R = glucosyl, galaclosyl compounds related to LCME that are more water soluble and that show higher levels of activity related to brown lung disease. Such compounds are glycoside deriva- tives of LCM~, or ~-¢M~ compounds with glucose or galactose grouI~s attached. The researchers have synthesized a variety of ti~ese derivatives, and some show up to five times more byssinosis-like activity in • animals than does ~CME. Moreover, be- cO~e glucose andI galact~se are ~a~or ~o;~stffuents of c~t~on-pl'ant carbohy-' drates, it is entirely possible that glycoside derivatives of LC~E hre components in- herent to the plant. McCormick and Sli|n- myozu now are picking through cotton components to determine whether their hypothesis is correct. But even if one of their tCM~.de~ivatives is discovered in cotton, the search, for thb elusive brown lung disease ageht will bc far from complete. Explains McCormick, "The chances are damn good that there is ,more. than one." [] Another novel tack against Chagas disease An effective, safe drug for Chagas dis- ease, a form of sleeping sickness that iri- feels 10 million South Americans, may at long last be in the works. Sciehtists at Albert Einstein College of Medicine recently re.ported success in using the ex- perimental anti-tumor drug taxol to in- hibit in the test-tube the parasite~ that cause the disease (SN: 8/29181, p. 134). And now chemicals that help counter sleeping sickness in rats have been identified and may eventually be used to treat'Chagas disease phtients~AHen B. Clarkson Jr. and O, eorge H. Mellow of New York University School of Medicine i~ New York City report in the OcL 9 ~cmuc~ The compounds appear to be rheumatoid factors, which are pro.duced in the blood of rheumatoid artbrhis patients; First, Clarkson and Mellow showed that lactating rats have an unusual resistance to..To'Pono~oma le.,isi, the parasite that causes sleeping sickness in rats; that blood from lact.ttiog rats tends to clump ~ h.u.i~i, and that nur,~ng enhances rat pups' survival from sleeping sickness. These findings suggested that bI0od from lactating rats contains some cbemi.cal .or chemicals that help counter sleei~ing ~ickness. The re~earch(~rs knew that rats infected with T. lewisi help fight off infection with a class o[ antibodies called IgG antibodies. Rheumatoid ~rthritis patients manufac- ture IgM antibodies that react speciflcafiy with IgG antibodies and are called ~rheumatoid fdctors." So they hypothe- sized that the chemicals in blood from lactating rats that help coimter sleeping sickness might be th~ rheumatoid fac- tors--and that by so inter'acting, the lgM antibodies would enhance IgG antibody protection against the disease. To tes! their hypothesis, they first used standard immunological techniques, to ideutib, the Z lewisf-ch,mping chemicals in the lactating rats" blood as IgM an- tibodies. Then they pat the IgM autibodies [rr~n lactating rats' blood, as ',e, L'I! aS blotn:l h'om uotda~ tating, uni.ff, c-ted rats, in the • OCTOBER 10, leVI presence of IgG-coated Z/ewisi and of nonlgG-coated T. lewisL The igM an- tibodies adhered to the IgG-eoated parasites; blood from the nonlactating. uninfected rats did not. Neither the an- tibodids nor the blood adhered to nonlgG-coated parasites. These findings suggested that the lgM antibodies were specific for the IgG-coated parasites and that,.by reacting with the lgG-coated para- sites, they enhanced the lgGs" protection agai~netl's:Meping s~ckness. ~Thls is the first evidence of a rheumatoid factor helping control an infection," Clarkson and Mellow conclude. s~¢C~iff~a[Iy w~ith lgG-coatefl; Trypan osomo cruzi, the parasite that causes Chagas dis- ease in humans. They are ~'lso irying to find some way of temporarily in.ducing rheumatoid factors in Chagas disease pa- tients, Clarkson told ScmNcE NEws, in. hopes that the factors might eventually be used to treat such patients. Fina~ test set for Ariane The fourth and final test flight of the European. Space Agency's Ariane rocket has been scheduled for Dec. 14, fi'om the ESA launch site in Kourou, Guiana. The first Ariane was launched on the day be. fore Chirstmas of 1979, and scored a re- souudlng success. The secoud, on May 23, 1980, ended in a mid-air explosion that slowed the programby eight mo.nths whim engineers sought to find and fix the prob- lem. The third flight took place on June 19 of this year, again a guccess. If the r.emain- ing test is similarly trouble-free,'Ariane will graduate to become Europe's princi- pal gateway to space, and significant com- petition to the U. S. space shuttle. From the second flight on, the Arianes have been carrying satellite payloads to orbit (those aboard number 2 were de- stroyed in the blast), and flight 4 is no exception. Aboard will be MARECS-A, the firsi of two MARitime Eui'opean Commu- nications Saiellites, as well as an in- strumented cai~sule designed to monitor the new booster's performance. (The cap- sule wilt also house an .ionospheric electron-density experiment designed by a group of young people from France ~ Ariane's principal participant country.) From there on, Ariane will be consid- ered an officially opei'ational vehicle, al- though its first six taunches follow.ing the test program have been dubbed the "pro- motional series.= A private organization called Arianesi~ace has bOen set up to market the rocket's earth-to-orbit serv- ices, but the launch business is already looking good:-Ariane's manifest shows firm c~mmitments for 13 launches, with reservations (some of them double- b,,¢,klngs that way end up ou the l) 5. shuttle) for II more, eate~mllng L]ltoitJh TI05280081

~ .~ :-..~...=~.i~-_.. ~.. ~2. . " -.~ TI~E NEW ENGLAND JOURNAL OF MEDICINE . " Oct. ~5, 1981 n~ - ",'.::' ": "" :'-..".:.--.:~.:.:; "-'-c'~- :':-?:-:..:-- ':';'- : .-" ". • " .~:-" ~ _ maximized. ~/he, such incentives exist, at least some people will re- suggests that at least a portion of "DRG ~t'~.ep" represents a cur- .: -'.'~spond to them. Indeed, the klnd~ of sgphisticated computer pro- ...?~ctwon of faulty Ln[ormatinn rather than systematic upcodi~g. " grams that Dr. Simborg envislu~'For'~ha{ has eo~e t~ be"~:~lled- ".'." . " ~: ..... '," "" ' " " PAUL L Grtt~Lot, l~n.D. " Princeton, ~J 08540 "'New Jersey Hospital. Assoclation The above l~aers were referred to the author of the Sounding B~ard" in question, who o~ers the following reply: T~ d~ Editor: The letters or Dr. Finley and Drs. Martin, Klelber~ .and Pa~caud cra~hasize ~hc public benefit that will come from reg- ~~i~e ~.~- 2" ~i~'~nat~y, f~e-~ffst~ncdv~ r~p~n~e~ ~of both provlde~'s and tlm~ courag~us e~p~iiment in Newjer~. However, any "" ~gulato~ may be to Focus on thc"te~nologic a~s race" that Sire .... . hu~ement ~he~e can and will elidt advise behavior from some bo~ de~ri~, to the exclusion or the real potential ~ncfit o~ DRG-" "phys~clam and hospital admini~ralo~. To the extent that tile a~i- "- • • - " based re~bu~ement: the formulatiofi of reimbursement rates and ' cle on DRG creep has helped to anticipate t~is behavior, ] hope ~at : "~"~: " .cost an~lysl~ on a cl~sificfftlon system that is elinlcally meaningful .:~ [he pap~ has e~anced the ability ~o ~myn~Z~ the sy~m against .:~ " ::" " - . -to pr~cin~ phys~c~am -"" ";.'.::'~ .:,~ :.:::: "-"~'. / :". " . ~: 2" " "?'~: : it. U~fortunately, I am not as sanguine as D~ FinleFand GH~I- "-~. '; ".:" "" , ..... ": ".." .... ,~Y~ ~.'?:":'=:::~ "'~.. 'Z ~'~z~-L".;';:- :." " ":~;2. ~di that '~me do~s not pay" for the DRG creepers. ~es~b~e- ' ".:C- , .- _ ... : Jo~ E. Fm~e, M.D., M.P.~. ~ s~onde~ts are cuff''that" hndcr pros~five reimbursement ~ ." : '~ " -. " ... Trento~-NJ 08625 ." ' . ... .... ?" "" ~." "Department of Health schemes, artificial alterations of diagnoses are selr-d~f~tlng in the .......l ~0'¢/~ 'F~aTt~ An~y .system of ret, ros~pectlve reimbursement is likely .. ~o, mo~dt~ a~ ~spit:al,'~s~ a.e6vit.y; d~.e~se ehang~ e~ be p~cly Formal . ;:~ ~.~.. ~.~ (~e~, ;~ ~t ~ the ~ffa~n~e off'chang dlagnos~ wtth a case-ram : . '. :: mo~el such as i.he ~e discussed by Simborg) o~ more Concrete, for - ~ e~mple, through an increase in the ~e~'ic~ rende~d (e.g., a bnger hospital s~a~, when the day otcare is the outpui dnit). Our point iS_ ~. that ha both cg~es (and probably in all practically imaginable long run. However, biased (but accurate) alteratlonsl are not soli- d,eating, but only self-llmltlng. Furthermore, under a case-mix • "ndexin~ scheme su~ch a~.that proposed by the Health. Care Financ- ing Adrninlstratio~ bmh artifidal and biased alterations a.re per- petuall~, r-eward~ng.. In addition, othe~{orms of DRG creep, suoh as change~ in physicians'diagnostic or admitting behavior, will be re- warding under both forms of reimbursement. These latter forms will be particularly refractory to auditing procedures. --:'::'..'.q " " - The impficalion of my article is not thai the~ act~of physiclafis " and hospital admlnlsti'ators will be dominated by a pro.fit motive. schemes}, misuse.of the output unit js possible. Clinical decision making,-as in the decision to perform a surgical In th~ struggle bet~,een the regulators and the regulated, one procedure or to order a diagnostic test, is a complex" process. In - might prefer to see the providers using computer programs as their ~ most situations, there is-no single "correct" answer, and different arms, as i/~-the exercise by the University of California at San Fran- -physlclans.will leghimalely come to different conclusions. I.n the __ . cisco, rather than the patient himself (e.g., through keeping him for complex milieu of factors that infiuenc~qhese-decislons, the relm- a longer period in the hospital or th~:ough o-~dering unnecessary bursement rfiechanlsm simply adds another vector. Although the x-ray films or labgratory tests), strength of this' vectorwill vary from situation to situation and frdrff J~^N M.xa'rlN, M.D. individual to ipd|vldual, its d:rcctlon is always the same: tins a rd the Cn^aL~S K~m~a more profitable alternative. FaEo P^cc^uv, M.D. Dox.~t.D W. S~,~moR~, M.D. Serv~cd de la Sant~ Publlquc San Francisco, CA 94143 University of California CH-1001 Lausanne, Switzerland du Canton de Vaud • 7l"o th~ Editor: $imborg's comments about the theoretical posslbil- V" " CU'RBING CIGARE'FTE SMOKING icy of"DRG creep" and its potential to generate windfall profits areI/ • T~ ~/,, r',¢;~,,. I ,~,~,,t,4 ~;" To the E~itor: I would like to express my gratitude to Dr. Ebert for incomplete, if not misleading. First of all, when the principal dhg- his cdltor~al regarding ways to curb cigarette srfioklng (June 11 nosls is clearly identified (as in the majority of cases), it is illegal for issue). ¢ Physkians havea re.,ponsibility to promote health, and this hospitals to report otherwise. Judgment ran be exercised, however, " is one of the ways in which they can promote it. in cases in which the cause of admission is uncertain and in the de- There urc major teaching hospitals in the country that allow ~ig- termination of the secondary diagnosis. Secondly, scrutiny of DRG arette smoking in patients' rooms. The only restriction on this per- ' assignment by payers and the prospect of audits conducted by the mission is that one may not smoke ir oxygen is in use in the room. 1 state department of health are likely to identify and deter incorrect am sure that many physicians have patients who have stopped sequencing. Thirdly, the ethical implicaHons of dishonest sequent- smoking simply because they were confined to an iutensive-care ing will dissuade medical-records personncl h'gm improper efforts unit. I am sure that many patients have resumed smoking once they to maxhnize reimbursement. Fourthly, long-run financial conse- " have been transferred from the unit. However, prohibiting smoking quences of malicious coding may overpower short-run gai~" ir up- in hospital rooms would gh'e patients time without cigarettes ~nd coding today produces inadequate reimbursement tomorrow, would allow them to he dL~chargcd as nonsmokers ..... 'Dr. ~mho~ seems to criticize hospitals for asslduousl~ striving In addition~ the American Medical Association must ~be encour- to .dove,tent all. diag~ttostle |nrormatlon as metieu:lously as possible, aged to sell its stock in tobacco com@anlcs. Ahh6ugh one d~n argue Yet, how could anyo.ne expect hospitals to behave otherwise, given that such stock is not direct suppnrt of the tubacco industry, one that payraent depends on tiffs inFormatiou? It is also unrealistic to era :aluly can ~ondude that the AMA has imest~d in the bopc of fi- I~e responsibility for "'DRG creep" solely with l~ospitals. Does nancial re~ard. These're.wards will certainly tome about as the to- . out at least part of the eulpahilit~ lie with regulators svho ituple- ment a payment scheme cun~:~:ucted around a data basc knm~n to *Ehert RV. Coal smoke and dgarette smoke. N ih~gl ] Mud: 1981; "" be h~cotnplete and errot~cons? Furt!,crmore, its inadequate nature 304:IlRf-'L .~ Ti05280082

why the public may look on the medica! profession with suspicion. •, .: ~roU: On September 30 the Bo;lon Glab~ r~oned that the AMA bad com~g the talc atlas $1.4 million, ofst~k in KJ. R~olds NOTICES ++ - " ..... 25-27. The deadline Par receipt or abstracts is Janua~ 31'. ' • • PRoLoNGING LIFE IN'THE AGED . "" -. Contact Jennifer L. Piersma, University'nrCo~orado Health Sciences . .. : ,. ~ Cir.... 2". . . : .. ;...: .:.. : .: . . .~. -.. ".. - . . .." .'School of Nursing, 4200 E. Ninth Ave., C-298, Denver, CO 80262. . • .To the Editor: As a retired internist aged 88, I rc~'d'whh interest -" . . " " " " : .... • :... :: ,.. She"Open Letter to [his] Mother's Nephrologlst" by Dr. Mat- , ," ' . i ":- ...... ~ ... ~ "'. : ':'='" " " .zarella in the July 16 issue.* ! am one of a luncheon group ofhalfa ''- ". - ' " dozen octogenarians and nonagenarians ~;ho meet regularly with " the tramportatlon assistance of one of our former students -- a sep- tuagenarian, I cannot speak for anyone but myself, but ! should llke • to' se~on.d:,~r. M.aiz~Ila,',~ b~did,, in acc0~dan~ with. his, £~\bli~.a] quotation~ that to pos~one dearth in, an invalid of 89 is not ~-e~es~ saltily a ~0~dly thing, f~s~a~c you ~,~t'fl~e gl~a~Osl~herc at . " ' ".' .. ..< ._~Ro~ga¢ W. Bu~, M.D. ~Vab~n, MA 02168 .... :~ " 1438 B~acon St. *Ma~ardla V. An op¢n ]~11cr to my mother's ncph~oIogist. ~ Eng[ 3 Med. 1981~ 305:175. " " . To t~t ~itor: It is generally accepted that the keystone to control of nos~omial infection and high-quality patient care is hand wash- ing. As rat as I know, there arc no standards for the number, tion, or type of sin~ in hospitaIs~ with the exception ofoperatlng ~crc are personnel to wash their hands? In a walk through the average hospital, one notices a scarcity of ~adily available sinks. Pe~onnel shoutd not use patients' facilities; the b~y nu~ing sta- tion usually has a small sink; rest rooms arc at odd locations; treat- ment r~ms are often ~¢uplcd. A si~ controlled by foot or knee a rarity. If we arc to siress hand washing,* then we must set stand- .'" ards and make hand-washlng facilities rea~ly available, so t~t personnel can perform ~ulrcd duti~ with a minimal loss of "' . A.L. Roszszwz~, ~H.D. Richmond, VA 23227 " Richmond MemoNal Hospital *AIb,~ RK, Condlc F. Hand-washing patterns in m~ical fntcnsivc-car~ units. N Engl I Med. 19gl; To t~ ~'tor: We had begun mortaring hand-washing perform-" ancc by hoIpit~l pcrs.o~fl M 1979 as an el'omens o~our Quality su~nce Program. Foeus~g excluslv~y on isolation roo~, wc found ~at .onl~ 25 per cem ~f both phyd~zas and nurs~ actually attempted to ~sh as indicted ~ wh¢~ 60 per cent of fam~y mcmbc~ did ,o. An administ~fivcly dir~t~ cdncaffonal pro- ~am increased ~mplia~ce all ~c ~ay to 33 per cent. Sub~qucntly, one ~nvmcd head nurse led her nursing staffs' ~mshlng to increase to 92 p~ ~nt o~thc btdicatcd timc*. ~¢ polnt is simple: Periodic mcasur~en~ of compliancz and noncompli- Hotel in Chicago on November S at 8:00 p.m. The topic will bc "Monoclon- Contact Dr. Stanley P. Balccmak, Division or Hematology and Ontolo- gy, Ohio State Univcrsity Hospital, 410 W. Tenth Ave,, Columbus, OH 43210~ . "" ' AUDITORY BRA[NSTEM RESPONSE . ' :, A sympodum entitled "Auditory Brainstem Responsein Clinical Peat- - (iCe" will be held at Te,.as Medical center ~n Houston, "November 6-8'.- Contact Lila Lerncr, Offi~ of Continuing Education, Baylor ColI¢gv of Medicine, Texas Medical Car., Houston, TX 7"/030; or ca!l (.713} EVOKED POTENTIALS - - A seminar entitled "Evoked Potcntials" ~,ill be held in San Diego on November 6 and 7. Contact Chris Keller, The W~tcrn Society of EEG T~chnolog~sts, EEG Dept.-127, Veterans Administration Meal ca Ctr,,,3350 LaJolla ~)llage Dr., San Diego, CA 92161. CIIILD NEUROLOGY The fifth Latin American Congt'c~s of Child Neurology will he held in Quito. Ecuador, No~ ember 7-12. The topics will be development, cpilcpay. and neuroepidemiology. Contact Dr. Antonio Culebras, Dot:attache of NeurologY, SONY Upstate Medical Car.. 750 E, Adams St., Syracuse, NY 13210; or call (.315) 473.4627. .... MoNoCLoNAL ANTIBODIES" "~ - .x ." ~ ~L .... . " '" The annual meeting of the Midwest Blood Club will be held at the Drake ...... TOXIC AND POISONING ENIERGENCIE$ A course entitled "Toxic and Poisoning Emergencies: Clinical Briefing" will be held at St. Paul-Ramsey Medical Center in St. Paul, Minn., on No- • • ,.'ember 6. Tha fcc is S80. Contact the Office of Continuing Medical Education, St. Paul-Ramscy Medical Car., 640 Jackson St., St. Paul, MN 5SlOt; or call (612) 221-3992. HEPATIC AND GASTROINTESTINAL PAl HOLOGY A symposium entitled "Curr©nt TopiCS in Hepatic and Gastro;nt~t~nal Pathology' will be hdd at the Unls~sity of Mina~ota in Min,:~polis oa Nox~mb¢r & Contact th~ afire of Coathmin$ Med;cal Ed~lba, Uai~cr~y of Min- ncmta, Box 293 Md}~ 4~ Ddagare SL $.E., Minr.~lis, MN 55455; or tall {612} ]7~.101L - TI05280083