Stewart Wolf - Böcker

Medical sociologists have long recognized the importance of community and family structure in the health of individuals. However, the past quarter century in America has seen an increasing emphasis on individualism and materialism that has effectively diminished the cohesiveness and emotional support provided by these basic social units. The Power of Clan examines the health effects of social change in a largely Italian-American town over a twenty-five-year period and provides substantial evidence of the protective effect of family bonds and shared social values against coronary heart disease and sudden death.The unique feature of the Roseto, Pennsylvania community was its remarkably low death rate from heart attacks, this in spite of the fact that such risk factors as smoking, lack of exercise, high fat and cholesterol diet were found to be just as prevalent in Roseto as in four nearby control towns. Roseto's traditional, family-oriented social structure, however, differed vastly from that of neighboring towns where materialistic values were predominant and where the individual, rather than the family, was considered to be the unit of society.At the beginning of their study in the early 1960s, the authors noted indications of imminent social change toward a more Americanized system of values and behavior. Interviews with younger inhabitants revealed much respect for old-world traditions but not as much enthusiasm for living by them. The study's prediction that the abandonment of selfless, communal standards would undermine Rosetans relative immunity to heart disease was borne out as death rates from heart attack climbed to levels comparable to those of the control towns by 1975. The Power of Clan is the product of twenty-five years of continuous observation. The findings of its original study have been carefully examined and its predictions largely confirmed. It is a landmark volume in the longitudinal study of health in an advanced industrial society. It also constitutes a large step forward in the cooperation of medical and sociological researchers.

The French physiologist Claude Bernard was responisble for investigating the chemical phenomena of digestion. This text reproduces his research into experimental medicine. A new introduction looks at his impact on the world of medicine.

Roseto is a small Italian-American community in east-central Pennsylvania. This fifteen-year study drawing on medical histories, physical examinations, and laboratory tests, compared a large sample of Rosetans to inhabitants of two neighboring communities, Bangor and Nazareth, and followed up this research with a sociological study of the three communities.Despite a greater prevalence of obesity in Roseto, and despite similar dietary, smoking, and exercise habits and similar ethnic and genetic background, the inhabitants of Roseto were relatively immune to heart disease at the beginning of the research in 1963. They were also strikingly tenacious in adhering to Old World values and customs. When these traditional values and relationship were abandoned by the rising generation, the death rate from heart disease climbed toward the American norm. The study concluded that unconditional interpersonal support counteracts life stress and thus preserves life.

At a time when medical care for the people of the United States is undergoing wrenching change due mainly to vast and costly technological progress, doctors have had to cede much of their initiative and responsibility to third parties. Medicine has become a commercial enterprise. Patients must affiliate themselves with a managed health care organization in order to have access to their doctors. In the hurly-burly of today's techno-medicine, many physicians are too busy to spend time in dialogue with their patients. As a consequence, social and emotional circumstances that have been thoroughly documented to affect physiology and susceptibility to disease are overlooked.Stewart Wolf here critiques the medical establishment and the way those concerned with its various responsibilities discharge them. He puts medicine's responsibilities to society into historical perspective, relating it to social changes. He begins with the ways medical candidates are selected. He continues with commentary on currently designed teaching and learning, the qualities required in a physician and in a medical scientist, and the nature and challenges of disease and what can be done about them. Finally, Wolf provides a useful way of thinking about human biology, to better understand why people become sick or well and what people have to contend with to stay well. Throughout he emphasizes the role of the brain in controlling behavior of all sorts, general and visceral.Wolf emphasizes the regulatory power of the nervous system as it perceives and evaluates life experiences and influences learning, behavior, and susceptibility to disease. Wolf'sgoal is not to supply a recipe for the achievement of better health, but to encourage a better understanding of ourselves and the paths toward health. Educating Doctors reexamines the responsibilities, goals, and activities of the medical establishment. As such it is a must read for policymakers, sociologists, and professionals working in the medical field.

The French physiologist Claude Bernard was responisble for investigating the chemical phenomena of digestion. This text reproduces his research into experimental medicine. A new introduction looks at his impact on the world of medicine.

Dr. Colin J. Schwartz, the scientific editor of this volume, has stated in his preface that this series is based on the needs identified by two scientific conferences, one in Lindau in April of 1970, and the other held in Heidelberg in October of 1973. Since those conferences, numerous data about vascular disease have been accumulated. Even though atherosclerosis remains the major cause of death in industrial countries, evidence in affluent societies points toward a decline in arteriosclerotic death- strokes and myocardial infarction in particular - during recent years. The most prominent example comes from the U. S. , but other high-risk regions such as eastern Finland, have also reported a decline. Most likely, this development stems from a change in so­ called environmental risk factors. Volume II of this handbook deals further with the structure and function of the circulation and con­ sequently addresses the basic physiological and anatomical elements which are ultimately responsible for the pathological and anatomical changes in the arterial system. While not specifically devoted to the description of disease, this volume nevertheless touches on rele­ vant pathogenetic and etiologic mechanisms. More than a century ago the pathogenesis of atherosclerosis in its initial phases had been described by VIRCHOW. He made endothe­ lium the centerpiece of his observations. The morphology of the endothelium and its function playa key role in the manifestations of atherosclerosis. Our knowledge about the function of these cells have yielded important insights.

This volume contains the edited proceedings of a workshop conference, THE SMOOTH MUSCLE OF THE ARTERIAL WALL, held at Max Planck Haus, Heidelberg, West Germany, on the occasion of the dedication of the new Myocardial Infarct Institute of the Univer­ sity of Heidelberg. The conference was a sequel to one held three years earlier at Lindau, West Germany, on THE ARTERY AND THE PROCESS OF ARTERIO­ SCLEROSIS. The earlier conference examined available data and conflicting theories on the pathogenesis of arteriosclerosis. A major yield of this gathering was a consensus that smooth muscle cell proliferation in the sub-endothelial space is a fundamental feature of atherogenesis. It was, therefore, decided in a second conference to bring together existing knowledge of arterial smooth muscle and of the structure and function of smooth muscle in general. Accordingly an international and interdisciplinary group of experts were gathered together to assess current knowledge, to attempt reconciliation of disparate data and synthesis of widely scattered information and to identify critical areas of ignorance. As before, the conference was conducted in the form of a dialogue with only a minimal number of formal presentations. Grateful acknowledgement for financial support of the confer­ ence is extended to: The Government of Baden-Wurttemberg, West Germany The Marine Biomedical Institute of the University of Texas Medical Branch, Galveston, Texas The Office of Naval Research, Washington, D.C.

This is the third volume of the comprehensive series on Struc­ ture and Function of the Circulation, edited by Dr. Colin J. Schwartz with the collaboration of Nicholas T. Werthessen and Stewart Wolf. Dr. Schwartz, an authority on vascular structure and function and a respected investigator in this field for many years, selected as authors for the chapters an outstanding group of scientists from various parts of the world. As indicated in the Preface, the impetus for this broad treat­ ise evolved from the scientific sessions of three interdisciplinary international conferences held in Lindau in 1970, in Heidelberg in 1973, and Totts Gap, Pennsylvania, in 1976 as well as from numerous informal discussions. The subjects dealt with in these three volumes range from the roots of our knowledge in ancient history to the most recent inform­ ation on contractile proteins of smooth muscle cells. The structure, distribution, and dynamics of arteries, veins, and lymphatics are described in chapters on the systemic circulation as well as that of the heart, the vessels themselves, the brain, nerves, and viscera. Descriptions of ultrastructure, histochemistry, metabolism, and func­ tion of endothelium and of vascular smooth muscle and of vascular changes in aging are all included in the vast scope of this under­ taking.

Substantial progress toward reconciling disparate theories of the pathogenesis of arteriosclerosis was recorded in Volume I of this book. the proceedings of an interdisciplinary workshop conference held at Lindau. Germany, April 19-25, 1970. Strong evidence was ad­ duced that the early stages of arteriosclerosis consist of intimal proliferation similar to that associated with the increase in arteri­ al size and caliber that characterizes normal growth. The findings described recall a theory proposed by Richard Thoma (Thoma and Kaefer, 1889) of Heidelberg toward the end of the nineteenth century. He sug­ gested that the pathogenesis of arteriosclerosis began with intimal thickening that was initially adaptive. Past a certain point, how­ ever, the thickening compromised the nutrition of the artery wall, leading inevitably to degenerative changes. In 1944 Hueper (Hueper, 1944), reemphasized the threat to the nu­ tritional support of the artery and proposed that the many etiologic factors capable of inducing arterial atheroma did so through the final common pathway of interfering with oxidative mechanisms in the vessel wall. Thus, it is proposed that arteriosclerosis is basically an aspect of the "behavior" of the artery. The nature of the lesion, therefore, depends more on the biochemical and structural response capabilities of the tissue itself than on the characteristics of the various etiologic agents. The idea that arteriosclerosis begins as uncontrolled or disturbed adaptive behavior was shared by Duff and also by Winternitz (Duff, 1954; Winternitz, 1954).

This volume contains the edited transcript of the third Totts Gap Colloquium held at Totts Gap, Pennsylvania, June 14-16, 1976. The Colloquium was aimed at sensing and evaluating anticipated pat­ terns of medical responsibility and practice and preparing for im­ minent change - specifically as it will concern the role of the doctor. Recognizing that community values and social behavior are powerful forces affecting health, the participants explored ways in which the physician and the rest of the health care professionals may exert their salutary influence. What are the boundaries in which the doctor can function most usefully and effectively? The problem was examined from the view­ point of the philosopher, the public, the social scientist, the medical educator, the legislator, and the practicing physician. Currently available literature is unidimensional in the sense that it consists largely of essays written from an advocate point of view. In contrast, the participants of this Totts Gap Collo­ quium examined disparate data and opinion in the hope of achieving, insofar as possible, reconciliation and synthesis. The dialogue dealt with values and priorities attached to health and health care by our society and with the shifting perspectives occasioned by rapidly expanding scientific knowledge. Questions of economic choice and of public policy were dealt with, assessing anticipated costs of the various options to the community, as well as their implications for medical education.

This volume contains the edited transcript of the second Totts Gap Colloquium, held at Totts Gap, Pennsylvania, May 29-31, 1975. The objective of the Colloquium was to bring into focus what is known of pathogenic mechanisms of schizophrenic manifestations. One hope was to differentiate among syndromes that share the fea~ tures of schizophrenia, disorganization of thought and talk, inap­ propriateness of affect, circumstantiality, withdrawal from social interaction, paranoid ideation, hallucinations, delusions, catelepsy, catatonic excitement or mutism, etc. What is known of the neural and chemical processes capable of inducing such aberrations was discussed with an attempt to reconcile disparate findings and in­ terpretations, to synthesize current evidence and to point up cru­ cial areas of ignorance that need exploration. The program was designed to further the objectives of the Multidisciplinary Research Program in Mental Health, of the University of Texas Medical Branch and to supplement their efforts with a well focused look at the schizophrenic process. Accordingly, Dr. Allan Goldstein, Professor of Biochemistry and Acting Director of the Multidisciplinary Re­ search Program in Mental Health; Dr. Bernard Haber, Associate Pro­ fessor of Biochemistry and Member of the Marine Biomedical Institute; and Dr. Geraldine Cohen, Assistant Professor, Department of Human Biological Chemistry and Genetics, joined in discussion with the Colloquium participants who were as follows: Dr. Mark D. Altschule, Clinical Professor, Harvard Medical School. Dr. Llewellyn B. Bigelow, Director of ~ental Health Research, St. Elizabeth's Hospital. Dr. Eugene L. Bliss, Professor and Chairman of Psychiatry, University of Utah.

This volume contains the edited proceedings of the Totts Gap Colloquium on Diabetes Mellitus, DILEMMAS IN DIABETES. The Collo- quium, lasting two and a half days, was organized mainly as a dia- logue among experts in the field with different disciplinary back- grounds and, to some extent, differing points of view. The effort was to synthesize existing knowledge, reconciling disparate data and interpretation, and pointing up important areas of ignorance. Thus, the book should serve not only as a summary of recent information on diabetes, but as a reliable guide to the practicing physician as he wades through often conflicting etiologic dogmas and therapeutic practices. The Colloquium was made possible through the generous support of the Geigy Pharmaceutical Company and the conscientious and expert coordination of Mr. Oscar Swarth. The participants were: Dr. George F. Cahill, Boston, Massachusetts Dr. Harvey C. Knowles, Cincinnati, Ohio Dr. Rachmiel Levine, Duarte, California Dr. Lelio Orci, Geneva, Switzerland Dr. Norton Spritz, New York, New York Dr. Roger Unger, Dallas, Texas Dr. Robert Williams, Seattle, Washington Dr. Stewart Wolf, Galveston, Texas Dr. Arnold Lazarow and Dr. I.Arthur Mirsky were to have partici- pated, but unfortunately were ill at the time of the meeting. Others in attendance included five medical students, especially selected from medical schools in the Philadelphia/New York area.

The present volume contains the edited transcript of a Totts Gap Colloquium held May 19-21, 1980 sponsored by the Muscular Dystrophy Association. The aim of the colloquium was to bring into focus data relating to cell membranes that might contribute to understanding the pathogenic mechanism of Duchenne muscular dystrophy. A major impediment to progress in understanding the patho­ genesis of muscular dystrophy has been the failure, so far, to identify the basic genetic defect. Pending the identification of the genetic lesion in Duchenne dystrophy and, in view of scattered but persistent indications of a basic membrane disturbance, it seemed worthwhile to explore in open dialogue the current state of knowledge of membrane morphology and chemistry with an eye to possible leads for further investigation. The participants, drawn from a variety of interested disciplines, attempted to synthesize and reconcile their findings and to identify crucial areas of ignorance in need of exploration. For the most part they avoided specialized jargon and spoke in a language that could be understood by the rest of the group. Apart from providing a review of widely varying approaches to the study of the composition and behavior of cell membranes, the discussions brought together current think~g on strategies and approaches to the study of the pathogenesis of muscular dystrophy. Already the personal contacts made at the colloquium have led to new inter-institutional collabora­ tive investigations.

This volume contains the edited proceedings of a Totts Gap Colloquium held June 15 to 17, 1980 at Totts Gap Medical Research Laboratories in Bangor, Pennsylvania under the sponsorship of three neighboring community hospitals in the Lehigh Valley; St. Luke's Hospital of Bethlehem, Easton Hospital of Easton and Muhlenberg Medical Center of Bethlehem. The objective of the meeting was to examine from several points of view the impact of rapidly proliferating technology on medical education, practice and research, on hospitals and on the community at large. The participants were selected not only for their diversity of experience and point of view, but also for ability to listen as well as to speak. They were asked to examine, in an informal analytical dialogue, the effects on the quality and cost of health care and health education brought about by increasing reliance on medical technology. A further aim was to explore various strategies through which might be devised an affordable way to benefit fully from technological advances without compromising human initiative or diminishing emphasis on clinical judgment and effective communication between doctor and patient. The participants included a medical student, seasoned practitioners and medical educators, young specialists, researchers, administrators and members of boards of trustees of community hospitals and laymen as follows: Dr. Robert Ackerman, Associate Professor of Radiology, Harvard Medical School and Director of the Carotid Evaluation and Cerebral Blood Flow Laboratories at Massachusetts General Hospital. Dr. Paul B.

This volume contains the edited transcript of the Second Topical Colloquium based on leads developed at the original conference on the artery and the process of arteriosclerosis (the Lindau Conference of 1970). The first follow-up colloquium on "The Smooth Muscle of the Artery" was held in Heidelberg in 1973. Planning for the present one was undertaken by the editors with Dr. C. Forbes Dewey, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts. The meeting itself was held June, 1976 at the Delaware Water Gap, Pennsy1vani~, under the joint sponsorship of Totts Gap Institute and the Massachusetts Institute of Technology with financial support from the American Heart Association, the Office of Naval Research, and the Smith, Kline and French Company. The objective of the series of meetings, beginning at Lindau has been to examine from an interdisciplinary and international point of view the fundamental physiologic and pathophysiologic processes pertinent to the development of arteriosclerosis. This colloquium sought to examine critically the evidence relating hemodynamic forces to atherogenesis, to reconcile disparate findings and interpretations in so far as possible; and to make a synthesis of the present state of knowledge of the dynamics of arterial flow. Grateful acknowledgement is made for the valuable assistance of Joan Martin and Helen Goodell in the entire editorial process. The editors acknowledge with thanks the secretarial assistance of Moira Martin, Colleen Nagle, Cindy Carter and Pat Ide. Special thanks are due Joy Lowe who executed the entire final manuscript.

The present volume contains the first half of the edited tran­ script of a six-day Conference, "Fundamental Data on Reactions of Vascular Tissue in Man," held April 19-25, 1970, in Lindau, West Germany. The remainder of the proceedings, dealing with the epide­ miologic, clinical and preventive aspects of arteriosclerosis, will be published in a second volume. The Conference was held under the auspices of the International Society of Cardiology, the International Cardiology Foundation and the European Atherosclerosis Group. The aim of the Conference was to achieve a synthesis of present knowledge concerning arterioscle­ rosis. Therefore, workers were brought together from several coun­ tries and from various disciplines that do not ordinarily intercom­ municate for free exchange of data and ideas. Six broad subject areas were introduced by single papers; three of them are included in this volume. In the discussion which followed each formal pres­ entation, the participants attempted to reconcile disparate data and interpretations and to reach .a clear identification of important areas of ignorance and of crucial questions for future research. The format of the proceedings does not follow precisely that of the Conference itself. The formal papers are included, somewhat ab­ breviated, and excerpts of the discussion have been gathered under a series of topics arranged in logical sequence. Therefore, the quoted statements do not necessarily appear in order or in the place in the program where they were made. Principal issues, syntheses and unanswered questions are interspersed among the topics as edi­ torial comments.