Showing papers by "Christopher J L Murray published in 1998"

The global burden of disease, 1990-2020.

Abstract: The authors discuss the Global Burden of Disease Study and its role in setting priorities for improving international public health into the next century * .

Modeling the impact of global tuberculosis control strategies

Abstract: An epidemiological model of tuberculosis has been developed and applied to five regions of the world. Globally, 6.7 million new cases of tuberculosis and 2.4 million deaths from tuberculosis are estimated for 1998. Based on current trends in uptake of the World Health Organization’s strategy of directly observed treatment, short-course, we expect a total of 225 million new cases and 79 million deaths from tuberculosis between 1998 and 2030. Active case-finding by using mass miniature radiography could save 23 million lives over this period. A single contact treatment for tuberculosis could avert 24 million cases and 11 million deaths; combined with active screening, it could reduce mortality by nearly 40%. A new vaccine with 50% efficacy could lower incidence by 36 million cases and mortality by 9 million deaths. Support for major extensions to global tuberculosis control strategies will occur only if the size of the problem and the potential for action are recognized more widely.

CD6 + T cell-depleted allogeneic bone marrow transplantation for non-Hodgkin's lymphoma

Abstract: For patients with non-Hodgkin's lymphoma (NHL) undergoing blood or bone marrow transplantation (BMT), the use of autologous grafts has often been preferred to that of allogeneic stem cells because of a significantly lower incidence of non-relapse mortality. If complications associated with allo-BMT could be minimized without compromising efficacy, then it might become a preferred strategy for certain subsets of patients. In this report, we describe the toxicity and long-term efficacy of T cell-depleted allogeneic BMT using anti-CD6 monoclonal antibody and complement alone to reduce the risk of GVHD and its sequelae. Twenty-two patients, aged 18-60 years, with high (n = 10), intermediate (n = 9), or low (n = 3) grade NHL underwent HLA-identical allogeneic BMT from siblings. Patients had either relapsed after at least one remission or never achieved a full remission with chemotherapy. Twenty patients had a history of marrow involvement. Bone marrow was depleted of CD6+ T cells with T12 monoclonal antibody and complement as the sole form of GVHD prophylaxis. Stable hematopoietic engraftment occurred in all 22 patients. Four patients developed grade 2 and 1 patient grade 3 GVHD (23% grades 2-4 GVHD). Chronic GVHD has occurred in three patients. Treatment-related mortality was very low. Only one patient died while in remission. Thirteen patients are alive and free of disease with a median follow-up of 30 months. Estimated event-free and overall survivals are 54 and 59%, respectively. CD6 allogeneic marrow transplantation is associated with a low risk of transplant-related complications and may offer advantages for certain patients with recurrent NHL felt to be at high risk for relapse after autologous transplantation.

Human Biology and Social Inequality

Abstract: Max Perutz is renowned for discovering the structure of hemoglobin. He and his colleagues disclosed the tetrameric structure of methemoglobin in 1970, 33 years after he had set himself that task while still a graduate student at Cambridge. There’s devotion for you! This book is a collection of his essays, and in one of the best, “The Second Secret of Life,” he describes how the dynamics of the three-dimensional structure of hemoglobin, atomic positional changes of a mere half-angstrom unit, make respiratory physiology, and life as we know it, possible—molecular biology at its most dramatic. In a sense, Perutz has written a kind of autobiography with this book. All of the essays tell us about the extraordinary range of ideas that excite him, and in reading it, I had the feeling that there was a connecting thread—a curiosity about the process of scientific discovery. In “I Wish I’d Made You Angrier Earlier,” he recounts a defining moment in his early struggles to interpret protein crystallography. The title quotes the reaction of his mentor, W.L. Bragg, to Perutz kicking himself for “having missed building that beautiful structure himself.” He was referring to the alpha helix as we now know it. In “Enemy Alien,” Perutz describes his wartime experiences as a prisoner of war in both the UK and Canada, and subsequent war-time work with the government. There are some fascinating biographical notes in this essay. Hermann Bondi and Klaus Fuchs are vividly recalled as fellow internees. After his release, Perutz collaborated with Geoffrey Pyke, who wanted to turn icebergs into aircraft carriers. Pyke was a dreamer who drove the admirals mad. Needless to say, the iceberg idea eventually sank. It is easy to pick out Perutz’s favorite essays. In “Splitting the Atom,” he reveals his admiration for Lise Meitner’s “selfless passion for science, her warmth and her sense of humor.” In “Liberating France,” he shows his sympathy for Francois Jacob’s attitude to scientific research: “a life animated as much by passion as by logic.” Peter Medawar’s brilliance and stylishness are affectionately recalled in “High on Science.” And in “What Holds Molecules Together?” Perutz sums up the incredible achievements of Linus Pauling and forgives his showmanship and geriatric aberrations. In “A Passion for Crystals,” he makes no attempt to hide his love for fellow crystallographer Dorothy Hodgkin. Of this remarkable woman he writes, “there was magic about her person. She had no enemies, not even among those whose scientific theories she demolished or whose political views she opposed. Just as her X-ray cameras bared the intrinsic beauty beneath the rough surface of things, so the warmth and gentleness of her approach to people uncovered in everyone, even the most hardened scientific crook, some hidden kernel of goodness.” Perutz gives his own assessment of the contents of this book in the preface. “This book,” he writes, “includes detective stories, tales of conflict and battle, a woman’s love affair with crystals, a man’s gruesome fascination with poison gas, cancer cures as Noble Laureates’ geriatric illusions, an onslaught on social relativists, a war hero’s anticlimactic homecoming that led to a Nobel Prize, phantom perils threatening to poison us, and real perils conquered by silent heroes.” This is a brilliant trailer for the book because they are all in it. At the end of his preface, he invites readers to skip to the next essay “if they don’t want to know all that.” My advice to readers is that if they have to skip something, do not skip the preface—it is full of goodies. The essays are beautifully written, with flashes of wit and humor. Many of the essays were written for the New York Review of Books; anyone addicted to that journal, as I am, will at once get a feel for the style of these essays. I read this as a bedtime book, so I dipped into it at random. When I finally found that there was no more to read, I felt quite disappointed—no more chocolates in the box!