Showing papers in "JAMA in 1971"
TL;DR: Professor Titmuss, an eminent English social theorist, believes that man is inherently altruistic and that the duty of government is to create that social and economic climate which best channels man's drive to work together for the common good.
Abstract: Professor Titmuss, an eminent English social theorist, believes that man is inherently altruistic and that the duty of government is to create that social and economic climate which best channels man's drive to work together for the common good. In support of this belief, he has written a book about the procurement, distribution, and transfusion of human blood, a medical topic which he employs as an illustrative social and economic microcosm. The conclusion he reaches is foregone: "The voluntary socialized system in Britain is economically, professionally, administratively and qualitatively more efficient than the mixed, commercialized, and individualistic American system" (Titmuss, R.M: "Why Give to Strangers?" Lancet 1 :123-125, 1971). As the book was written with a bias, so will it be read with bias. My own bias is that of an American and a blood-banker. I am only too conscious of many deficiencies in the American complex of arrangements—it isn't
924 citations
TL;DR: Postmortem coronary angiography and dissection of hearts from 105 United States soldiers killed in Vietnam demonstrate that 45% have some evidence of atherosclerosis.
Abstract: Postmortem coronary angiography and dissection of hearts from 105 United States soldiers killed in Vietnam demonstrate that (1) 45% have some evidence of atherosclerosis; (2) 5% have gross evidence of severe coronary atherosclerosis; and (3) no patient had angiographic evidence of severe coronary narrowing, and in only one patient was any degree of stenosis observed.
621 citations
TL;DR: The problem of methicillin resistance at Memorial Hospital for Cancer and Allied Diseases, New York, during a six-year period ( Feb 24, 1964 to Nov 25, 1969) is reviewed.
Abstract: To the Editor.— Recently, O'Toole et al called attention to an outbreak of methicillin-resistantStaphylococcus aureus(213:257,1970). We have reviewed the problem of methicillin resistance at Memorial Hospital for Cancer and Allied Diseases, New York, during a six-year period ( Feb 24, 1964 to Nov 25, 1969).. We were concerned whether methicillin resistance was occurring and could be reliably established by routine disk methods in a diagnostic microbiology laboratory. Antibiotic sensitivity was determined in the microbiology laboratory of the hospital by the disk sensitivity method; 5μg methicillin, 1μg oxacillin, and 30μg cephalothin disks were used. Of 6,209 cultures containing coagulase-positiveS aureus, 168 (2.7%) were resistant to methicillin during the study period. Of the 168 only 66 (1.1%) were resistant to both methicillin and oxacillin. Our hospital laboratory began testing the sensitivity ofS aureusto cephalothin on April 13, 1966. From that time until the conclusion of the study,
458 citations
TL;DR: The 3 1/2-year case fatality rates among women with histologically confirmed breast cancers reinforce the impression that screening leads to lowered mortality, and more time is needed to establish whether the effect of the screening program is short-term or long-term.
Abstract: First results in a long-term investigation to determine whether periodic breast cancer screening with mammography and clinical examination leads to lowered breast cancer mortality provide grounds for cautious optimism. The study compares the experience in a random sample of 31,000 women, aged 40 to 64 years, offered screening examinations with the experience in a similarly constituted "control" group. There were 52 deaths due to breast cancer in the control group, as compared with 31 breast cancer deaths in the study group, in the period available for follow-up. The 3 1/2-year case fatality rates among women with histologically confirmed breast cancers reinforce the impression that screening leads to lowered mortality. More time, possibly ten years of follow-up, is needed to establish whether the effect of the screening program is short-term or long-term.
422 citations
TL;DR: It is concluded that the only road to a substantial reduction in premature CHD mortality is prevention of CHD.
Abstract: Since 1948, a cohort of 5,209 residents of Framingham, Mass, have been examined biennially. In the first 14 years, 120 died of coronary heart disease (CHD) before reaching 65 years of age. Two thirds of these deaths occurred outside the hospital—the majority suddenly— within one hour of onset of the terminal event. Nearly one half of the deaths from the initial coronary attack were sudden and unexpected. One half of all persons with sudden deaths had no prior clinical heart disease. While nonsudden coronary deaths were ordinarily preceded by clinical CHD, the disease was frequently first manifest close to the final episode. Only a small percentage of persons were seriously disabled six months before their death. Even among persons with known CHD, nearly one half of the deaths occurred outside the hospital. It is concluded that the only road to a substantial reduction in premature CHD mortality is prevention of CHD.
373 citations
TL;DR: The clinician's dilemma is presented but few clues to its resolution and the review of Toala et al on the lack of significance of 371 Candida isolates from specimens submitted for bacteriological examination leads only to more befuddlement.
Abstract: To the Editor.— The EDITORIAL "Candidiasis: Colonization vs Infection" ( 215 :285-286, 1971) presented the clinician's dilemma but few clues to its resolution. It quoted Ellis and Spivack's 12 cases of repeated candidemia and noted that six cases came to autopsy. Two cases were considered to be preterminal candidemia, in which no lesions were found at autopsy. Four cases showed widespread major organ candidiasis. Six patients got "well," two with the aid of antifungal therapy. The absence of a fatality in these six cases does not disprove the presence of candidal infection. Major organ disease in four out of 12 cases with persistent candidemia should give serious pause to any clinician. The review of Toala et al ( Arch Intern Med 126 :983, 1970) on the lack of significance of 371 Candida isolates from specimens submitted for bacteriological examination leads only to more befuddlement. Although Candida from any specimen should not be
359 citations
TL;DR: D dosage to plasma concentration of procainamide varied greatly among 186 patients; this variation resulted from individual differences in completeness of absorption, distribution space, and elimination rate.
Abstract: The relationship of dosage to plasma concentration of procainamide varied greatly among 186 patients This variation resulted from individual differences in completeness of absorption, distribution space, and elimination rate Plasma concentrations correlated well with therapeutic and toxic effects The usually effective antiarrhythmic concentration was 4 to 8 mg/liter; in occasional patients, 8 to 16 mg/liter was more effective Toxic manifestations were very rare with concentrations of less than 12 mg/liter, but common with concentrations of more than 16 mg/liter In most patients, procainamide hydrochloride in a daily dose of 50 mg/kg of body weight produces therapeutic plasma concentrations Three-hour dosage intervals are required to prevent fluctuations of plasma level exceeding 50% In urgent situations, a parenteral priming dose should be given In patients with cardiac or renal failure and when usual doses fail or toxic manifestations appear, determinations of plasma levels are useful guides to dosage
314 citations
TL;DR: The purpose of this letter is to present preliminary data concerning the most impressive change observed so far, namely, a substantial decrease in intraocular pressure observed in a large percentage of subjects.
Abstract: To the Editor.— It is accepted widely that the physiologic effects of smoking marihuana are not well known, despite an acknowledged high incidence of usage. Even the President of the United States has called for a major effort to study drug effects in a scientific manner. In an attempt to investigate the effects of marihuana smoking upon the human visual system, complete ocular examinations were performed in a group of youthful subjects, before and one hour after smoking. Selection of subjects, medical and other safeguards utilized, and details of the protocol will be presented in a later publication. The purpose of this letter is to present preliminary data concerning the most impressive change observed so far, namely, a substantial decrease in intraocular pressure observed in a large percentage of subjects. Applanation tonometry was performed by the same experienced examiner, using the same tonometer for each pair of observations. Marihuana was
271 citations
TL;DR: The problem of gene structure and coding was exciting while it lasted, but molecular genetics, pursued to ever lower levels of organization, inevitably does away with itself: the gap between genetics and biochemistry disappears.
Abstract: The problem of gene structure and coding was exciting while it lasted. The story of the past two eventful decades, including my own contributions, has been well told, 1-3 and need not be repeated here. But molecular genetics, pursued to ever lower levels of organization, inevitably does away with itself: the gap between genetics and biochemistry disappears. More recently, a number of molecular biologists have turned their sights in the opposite direction, ie, up to higher integrative levels, to explore the relatively distant horizons of development, the nervous system, and behavior. When the individual develops from an egg, the one-dimensional information contained in the linear sequence of genes on the chromosomes is somehow translated into a two-dimensional blastula, which later folds to produce a precise three-dimensional array of sense organs, central nervous system, and muscles. Finally, the ensemble interacts to produce behavior, a phenomenon which requires four dimensions, at the
267 citations
TL;DR: It is believed that it is more important to adjust dosage of a narcotic analgesic in relation to a patient's age than in connection to height, weight, or other patient characteristics.
Abstract: Seven hundred and twelve patients who received 10 mg of morphine sulfate or 20 mg of pentazocine or both for acute postoperative pain were studied for possible correlations between pain relief and patient characteristics. Age proved to be highly correlated with pain relief reports, in that the older age group reported more pain relief. These data are consistent with the results of earlier studies of experimental pain, as well as with the results of studies of the response of patients to placebos. We believe that it is more important to adjust dosage of a narcotic analgesic in relation to a patient's age than in relation to height, weight, or other patient characteristics.
255 citations
TL;DR: There was no evidence that phenformin was more effective than any of the other treatments in preventing the occurrence of nonfatal vascular complications associated with diabetes, and the use of Phenformin has been terminated in the UGDP.
Abstract: The University Group Diabetes Program (UGDP), a long-term prospective clinical trial, was designed to evaluate the effects of various hypoglycemic agents on vascular complications in patients with asymptomatic, adult-onset diabetes. This study provided no evidence that phenformin was more efficacious than diet alone or than diet and insulin in prolonging life for the patients studied. In fact, the observed mortality from all causes and from cardiovascular causes for patients in the phenformin treatment group was higher than that observed in any of the other treatment groups. In addition, there was no evidence that phenformin was more effective than any of the other treatments in preventing the occurrence of nonfatal vascular complications associated with diabetes. For these reasons, the use of phenformin has been terminated in the UGDP. Data collection in this study is continuing for all surviving patients. The additional information obtained over a longer period of follow-up on patients in the two insulin groups compared with the patients in the placebo group will provide a more adequate basis for the assessment of the long-term effects of insulin.
TL;DR: The scintigraphic examination proved to be extremely sensitive in depicting small asymmetric differences in parotid gland activity and in monitoring the improvement in salivary gland function with immunosuppressive therapy.
Abstract: Sequential salivary scintigraphy, or the visual recording with a gamma scintillation camera of the uptake, concentration, and excretion of 99m Tc pertechnetate by the major salivary glands after the administration of sodium pertechnetate Tc 99m, was performed on 20 female patients with Sjogren's syndrome. The results were compared with those of other procedures currently used to evaluate xerostomia. The scintigraphic findings closely paralleled the results of the salivary flow-rate determinations and contrast sialography and the patients' clinical symptoms, but did not correlate with the finding of lymphocytic infiltration in lip biopsy specimens or the detection of the anti-salivaryduct antibody. The scintigraphic examination proved to be extremely sensitive in depicting small asymmetric differences in parotid gland activity and in monitoring the improvement in salivary gland function with immunosuppressive therapy. Sequential salivary scintigraphy appears to be an easy, safe, and objective means of evaluating xerostomia in patients with Sjogen's syndrome.
TL;DR: The hypothesis that control of the blood glucose level prevents or delays the vascular complications of diabetes has been supported so far only by evidence which is largely conjectural.
Abstract: "Field (clinical) trials are indispensable. They will continue to be an ordeal. They lack glamour, they strain our resources and our patience, and they protract the moment of truth to excruciating limits. Still, they are among the most challenging tests of our skills.... If, in major medical dilemmas the alternative is to pay the cost of perpetual uncertainty, have we really any choice?" 1 The clinical trial of the effect of hypoglycemic agents on the vascular complications of diabetes mellitus conducted by the University Group Program (UGDP) for the past ten years bears witness to the truthfulness of the above quotation. The hypothesis that control of the blood glucose level prevents or delays the vascular complications of diabetes has been supported so far only by evidence which is largely conjectural. 2 Such a relationship can be documented only with prospective study of patients randomly assigned to treatment regimens that differ
TL;DR: Thirty-five patients with decreased taste acuity and decreased olfactory acuity with or without perverted taste (dysgeusia, hyposmia, and dysosmia) and perverted smell had elevated median detection and recognition thresholds for the taste of salt, sweet, sour, and bitter, and abnormal forced scaling of taste qualities.
Abstract: Thirty-five patients with decreased taste acuity (hypogeusia) and decreased olfactory acuity (hyposmia) with or without perverted taste (dysgeusia) and perverted smell (dysosmia) had elevated median detection and recognition thresholds for the taste of salt, sweet, sour, and bitter, and abnormal forced scaling of taste qualities. Electron micrographs of taste receptors showed pathological changes in the taste buds of these patients. No apparent cause could be found for this disturbing and unpleasant symptom complex. These abnormalities appear to comprise a new syndrome which we have termed idiopathic hypogeusia with dysgeusia, hyposmia, and dysosmia.
TL;DR: A 29-year-old woman ingested 18 gm of acetaminophen with resultant hepatic necrosis and acute renal failure and should be considered as one of the causes of acute hepatorenal failure.
Abstract: A 29-year-old woman ingested 18 gm of acetaminophen with resultant hepatic necrosis and acute renal failure. Since 1966, eighty-six cases of hepatic necrosis secondary to acetaminophen overdose have been described. Acetaminophen overdosage should be considered as one of the causes of acute hepatorenal failure.
TL;DR: The results indicate that a significant five-year-cure rate of childhood ALL is an attainable goal with multiple-agent therapy.
Abstract: Between 1962 and 1965, combination therapy with multiple agents was administered to 37 children with acute lymphocytic leukemia (ALL). After five years, eight children continue to survive. Seven of the eight children are in complete remission, and have not been receiving any therapy for 1 1/2 to 3 1/2 years. The results indicate that a significant five-year-cure rate of childhood ALL is an attainable goal with multiple-agent therapy.
TL;DR: The results strongly support previous evidence that tobacco plays a major role in cancers of the oral cavity, pharynx, and larynx and cessation of smoking reduces the risk of second such cancers and may reduce premature deaths from some other common diseases.
Abstract: A total of 203 smokers "cured" of cancers of the oral cavity, pharynx, or larynx were divided into two groups: those who continued smoking and those who stopped. Within an average follow-up period of approximately seven years, 40% of patients who continued to smoke tobacco developed second cancers in tobacco-contact tissues, whereas 6% of patients who stopped smoking tobacco acquired second cancers. The death rate from second cancers was high; deaths from other causes occurred more often and earlier among the continuing smokers. These results strongly support previous evidence that (1) tobacco plays a major role in cancers of the oral cavity, pharynx, and larynx; and (2) cessation of smoking reduces the risk of second such cancers. Stopping smoking may reduce premature deaths from some other common diseases.
TL;DR: Surgical removal is followed by renal irrigation with a multivalent, buffered organic acid solution while a bacteriologically sterile urine is maintained, and in 14 consecutive cases followed for an average of 34 months, stones have not recurred.
Abstract: In patients with "infection stones," urea-splitting bacteria reside within the stones, protected from the action of antimicrobial agents. To achieve complete eradication of residual macroscopic particles, surgical removal is followed by renal irrigation with a multivalent, buffered organic acid solution while a bacteriologically sterile urine is maintained. In 14 consecutive cases followed for an average of 34 months, stones have not recurred. Antibacterial therapy was stopped in all patients within two to four weeks of discharge following surgery; only one patient, a paraplegic with an indwelling catheter, has had a urinary tract infection.
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TL;DR: Seventy patients with renal pelvic tumors were grouped during a clinicopathologic study according to a new proposed classification that is based on tumor stage and grade, and prognosis is excellent for patients with histologically benign papilloma or noninvasive or focally invasive papillary carcinoma.
Abstract: Seventy patients with renal pelvic tumors were grouped during a clinicopathologic study according to a new proposed classification that is based on tumor stage and grade. Prognosis is excellent for patients with histologically benign papilloma (group I) or noninvasive or focally invasive papillary carcinoma (group II). It appears good also for patients with fully invasive carcinoma that is still confined to the kidney itself (group III). Invasion outside the kidney or renal pelvis (group IV) is an ominous sign. In about one half of the patients there were associated tumors of bladder or ureter, and prognosis may be determined by these other tumors. Bladder tumors that developed after pelvic tumors almost all appeared within three years. Nephrectomy and total ureterectomy remain the treatment of choice under most circumstances. Local resection or partial excision is recommended for bilateral pelvic tumors.
TL;DR: Viral hepatitis, type B (MS-2) was prevented by active and passive immunization and one inoculation gave enough protection to prevent some cases and modify others.
Abstract: Viral hepatitis, type B (MS-2) was prevented by active and passive immunization. Active immunization was induced by inoculation of a boiled, inactivated preparation of a 1:10 dilution of MS-2 serum in distilled water; two inoculations at four-month intervals were more effective than one. However, one inoculation gave enough protection to prevent some cases and modify others.
TL;DR: This report surveys the techniques, safety and litigation experience of 170,000 exercise stress tests performed in 73 medical centers, finding that certain patterns emerged and mortality was not clearly related to type of test.
Abstract: This report surveys the techniques, safety and litigation experience of 170,000 exercise stress tests performed in 73 medical centers. Procedures and results varied but certain patterns emerged: (1) A medical history was required before testing in 89% of centers, a physical examination in 97%, and a resting electrocardiogram in 57%. (2) Active cardiac disease precluded testing. (3) Informed consent was sought in 75% and was required in written form in 30%. (4) Specific test-interruption criteria involved symptoms, signs, and ECG findings. (5) Progressive workloads were employed by 73%. (6) Full resuscitation facilities were available. (7) The mortality was about 1 per 10,000 tests (16 per 170,000). (8) Combined mortalitymorbidity was about 4 per 10,000 tests. (9) Mortality was not clearly related to type of test. (10) Successful litigation, with an out-of-court settlement was reported in one instance.
TL;DR: Three decades ago physicians commonly imposed a six-month convalescence upon patients recovering from myocardial infarction, but since that time recommendations have undergone a liberal transformation.
Abstract: Three decades ago physicians commonly imposed a six-month convalescence upon patients recovering from myocardial infarction (MI). Since that time recommendations have undergone a liberal transformation. Not only has “early mobilization” become the aim for patients with an uncomplicated hospital course,1 but those discharged are now expected to return to normal activities and employment much earlier than ever before. Indeed, for asymptomatic patients with uncomplicated coronary disease, Friedberg permits resumption of occupation after six weeks of convalescence.2 Despite these liberal trends, there is a growing body of evidence to show that at least half the patients permitted to return to work are reluctant to do so and remain inactive for a prolonged period.3–10 If capable of work, why should a patient procrastinate? A number of authors have indicated psychosocial factors such as fear of recurrent infarction, anxiety, and depression.5–8,11,12 In a more recent comprehensive review, Miller and Brewer11 classify factors which influence progress in rehabilitation and cite psychological problems as heavy contributors to delayed convalescence.
TL;DR: Interest was focused primarily in the return of function to the lower and upper extremities and to rectal and bladder control and on two major groups—the central spinal cord syndrome and the anterior spinal Cord syndrome which, combined, represent 90% of this series.
Abstract: Incomplete quadriplegia following closed injuries to the cervical spine is studied for future prognosis of this increasingly common lesion Sixty patients were included in this study and classified into one of four clinical syndromes to correlate the different types of quadriplegia to its final outcome Interest was focused primarily in the return of function to the lower and upper extremities and to rectal and bladder control This communication concentrates on two major groups—the central spinal cord syndrome and the anterior spinal cord syndrome which, combined, represent 90% of our series An ambulation follow-up comparison is made of central cord syndrome and anterior cord syndrome A more accurate prognosis of cervical cord lesions can be established on a statistical basis
TL;DR: To achieve maximum therapeutic benefit for Puerto Rican patients who adhere to the Hippocratic humoral theories of disease, the physician is advised to work within its framework in prescribing medicines and diet.
Abstract: Many Puerto Ricans classify illnesses, medicines, and foods according to an etiological and therapeutic system which derives historically from Hippocratic humoral theories of disease. Adherence to this system influences the way in which patients comply not only with therapeutic regimens for hypertension, arthritis, ulcers, and rheumatic fever but also with instructions on infant feeding, and antepartum and postpartum care. To achieve maximum therapeutic benefit for Puerto Rican patients who adhere to this system, the physician is advised to work within its framework in prescribing medicines and diet.
TL;DR: The documentation and quantification of mental effects of levodopa is particularly important because of the potential for increasing basic understanding of the relationship between brain amines (particularly dopamine) and psychological states both normal and abnormal.
Abstract: Levodopa is the amino acid precursor of the cathecholamines, dopamine and norepinephrine. Along with serotonin, these catecholamines serve as neurotransmitters in areas of the brain related to psychomotor, vegetative, and emotional functions; thus, it is not surprising that the administration of levodopa is associated with mental changes. The documentation and quantification of these mental effects is particularly important because of the potential for increasing our basic understanding of the relationship between brain amines (particularly dopamine) and psychological states both normal and abnormal. When administered to animals, levodopa has been shown to produce a variety of behavioral effects depending to some extent on the dose and species employed; in general, high doses of levodopa produce alerting, motor activation and increased aggressiveness. These studies have recently been the subject of extensive reviews.1,2 The rationale for the use of levodopa in Parkinsonism is based on evidence that a dopamine deficiency exists in
TL;DR: A total of 1,318 patients first treated for esophageal achalasia from 1935 to 1967 at the Mayo Clinic were observed, and the majority were squamous cell carcinomas.
Abstract: A total of 1,318 patients first treated for esophageal achalasia from 1935 to 1967 at the Mayo Clinic were observed an average of 13 years per patient. Carcinoma developed in seven of these patients, an incidence of 41 cases per year per 100,000. An additional six patients with achalasia and carcinoma of the esophagus had their initial treatment for achalasia either before 1935 or elsewhere than the Mayo Clinic. Achalasia had been present an average of 28 years prior to the diagnosis of carcinoma. The appearance of symptoms suggesting the possibility of esophageal malignancy occurred from two weeks to four years prior to diagnosis. Malignant tumors arose at all levels of the esophagus, and the majority were squamous cell carcinomas. Although surgical exploration was carried out in seven instances, there was only one survivor without evidence of tumor.
TL;DR: The results of this study indicate that the majority of patients referred to the Cleveland Clinic desired this information, and the value of informed consent is convinced.
Abstract: This study was made to determine the reactions of patients to a general disclosure of complications which might result from angiographic procedures To minimize bias and insure uniformity a form letter and questionnaire were chosen to impart this information The results of this study indicate that the majority of patients referred to the Cleveland Clinic desired this information I am convinced of the value of informed consent, for the benefit of both the patient and his physician
TL;DR: Acute rhabdomyolysis was observed as a new complication of intravenous heroin-adulterant injections in four men, and in one case an unusual picture consistent with tubular aggregates was demonstrated.
Abstract: Acute rhabdomyolysis was observed as a new complication of intravenous heroin-adulterant injections in four men. Clinical features included generalized muscle tenderness, edema, and profound weakness. Myoglobinuria was detected by a specific immunological method which measured levels up to 3.25 mg/ml. Serum myoglobin levels as high as 0.310 mg/ml were found, with serum creatine phosphokinase levels up to 14,000 units. Needle electromyography showed myopathic motor unit potentials in all muscles tested, most marked proximally. Histologic examination demonstrated acute myolysis, and in one case an unusual picture consistent with tubular aggregates. Renal failure occurred in two patients, one of whom survived. Resolution of weakness varied from two to six weeks. The process recurred in one patient following a subsequent heroin injection.
TL;DR: The first study dealt with physician response to apparently unexpected abnormalities in three routine screening tests in which it was found that physicians made no apparent response of any kind to approximately two thirds of the test abnormalities.
Abstract: One of the most important questions to be asked of any health care system is the following:Whoneeds to learnwhatto most improve health status of the population receiving care? Previous studies have demonstrated (1) that there is an important relationship between patient care assessment and education that might provide a framework for answering this question1and (2) that systematic application of this approach requires a priority list of health problems to be studied.2 The first study dealt with physician response to apparently unexpected abnormalities in three routine screening tests in which it was found that physicians made no apparent response of any kind to approximately two thirds of the test abnormalities. In solving this problem, it was learned that systematic investigation is needed to identify education objectives that specify the individual who needs to learn, as well as the goals to be achieved in the
TL;DR: The UGDP was undertaken to evaluate prospectively the influence of treatment upon the development of complications in adult-onset diabetics and the basic question, so vital to the day-to-day care of diabetic patients, has not been answered to date.
Abstract: To the Editor.— As a minor participant in the University Group Diabetes Program (UGDP), I think that the compelling reason for the study apparently has been lost (1) in the controversy over the validity of the reported finding of increased cardiovascular deaths in patients receiving tolbutamide, and (2) in the criticism of the Food and Drug Administration's bulletin to physicians with respect to its recommendations concerning the use of orally administered hypoglycemic agents. The Program was undertaken to evaluate prospectively the influence of treatment upon the development of complications in adult-onset diabetics. This basic question, so vital to the day-to-day care of diabetic patients, has not been answered to date by the Program. Both patients and their attending physicians are entitled to an answer; hence, this letter. Currently the Executive Committee of the UGDP is in process of preparation of a request to the National Institutes of Health to continue