Eubios News in Bioethics & Biotechnology - July 1999


Eubios Journal of Asian and International Bioethics 9 (1999), 120-127.

Comments are written in text form together with recent references. This list continues from the last issue of EJAIBand will continue. The full list of news (OLD = 1991-1993; NEW = 1994+) until May 1999 is available on-line topic-by-topic, at: http://eubios.info/NBB.html

Abbreviations


News in Bioethics & Biotechnology

Comments are written in text form together with recent references. This list continues from the last issue of EJAIB and will continue. This list is available on-line topic-by-topic, at:
http://eubios.info/NBB.html


Genetic Engineering of Plants

The use of nutrients can alter weed growth, as found in an observation that potassium-depleted soils do not support dandelions, Science 284 (1998), 1249-50. Spiders scare off some insects and help plants boost seed production in exchange for nectar, NS (15 May 1999), 17. A study of subspecies regulation of Bt protoxin genes is AEM 65 (1999), 1849-53.

The results of a symposia on plant mitochondrial genetics are in J. Heredity (May 1999), 333-392+. Papers on hybrid classification are in Ecology 80 (1999), 359-60, 361-70. It is difficult to determine how genes and environment interact to make hybrids resistant to herbivores, Ecology 80 (1999), 382-91. Cost studies of biodiesel production have found that it is still not cost-effective, and new techniques are needed, Bioresource Technology 70 (1999), 1-15, 81-7. Improved stearate phenotype in transgenic canola expressing a modified acyl-acyl carrier protein thioesterase is reported in NatBio 17 (1999), 593-7. A general review of a book is Lappe, M. & Bailey, B., Against the Grain: The Genetic Transformation of Global Agriculture (Earthscan, 1999, 160pp.) is Nature 399 (1999), 319-20.

Genetic Engineering of Animals

A report on the cloning of transgenic goats, one of which produces human antithombin III in its milk, is GEN 19 (15 May 1999), 6, 51; Science 284 (1999), 903. Cloning may cause health defects, Renard, JP. et al. "Lymphoid hypoplasia and somatic cloning", Lancet 353 (1999), 1489-91; BMJ 318 (1999), 1230; NS (8 May 1999), 5. A method for mammalian transgenesis by intracytoplasmic sperm injection is Science 284 (1999), 1180-2. A letter on the 1981 paper by Illmensee on mouse cloning that was rejected is Nature 398 (1999), 19-20; 399 (1999), 13. Norway may ban the cloning of invertebrates, Nature 399 (1999), 98. A method for gender preselection in cattle is described in Biology of Reproduction 60 (1999), 1194-7.

PPL Therapeutics is now looking for funding for its production facility for alpha-1 antitrypsin in US/UK/New Zealand, GEN 19 (1 June 1999), 1, 14, 48. In general on transgenic animals, GEN 19 (1 May 1999), 1, 14, 29.

On mice models: Necdin-deficient mice do not show lethality or obesity and infertility of Prader-Willi syndrome, NatGen 22 (1999), 15-6; mice lacking vascular endothelial growth factor isoforms VEGF164 and VEGF188 have impaired angiogenesis, NatMed 5 (1999), 495+; Alzheimer presenilin 1 mutations lead to increased neurodegeneration, NatMed 5 (1999), 560-4; Mice lacking IKKalpha have limb and skin abnormalities, Science 284 (1999), 313-6; mice lacking IKB Kinase 2 gene have severe liver degeneration, Science 284 (1999), 321+; mice lacking endoglin have defective angiogenesis, Science 284 (1999), 1534-7; A model for achondroplasia was produced by targeting of mast growth factor receptor 3, PNAS 96 (1999), 4455-60. Inhibition of caspase-1 slows disease progression in a mouse model of Huntington's disease, Nature 399 (1999), 263-7.

Designer Molecules

New strategies are being tested to accelerate drugs by extending molecular diversity, GEN 19 (1 June 1999), 1, 30, 43. On combinatorial protein engineering by incremental truncation, PNAS 96 (1999), 3562-7. Improving antibody affinity by mimicking somatic hypermutation in vitro is reported in NatBio 17 (1999), 538-9, 568-72. Conversion of Lactococcus lactis from homolactic to homoalanine fermentation through metabolic engineering is reported in NatBio 17 (1999), 539-40, 588-92.

Biotechnology & the Public

The European Commission has released a catalogue of contracts on the Ethical, legal and social aspects of the life sciences and technologies programmes of the fourth framework programme (European Commission, EUR 18309 EN, 329pp., ISBN 92-828-5379-9). The proceedings of a 1996 International Symposium have been published, Gunergun, F. & Kuriyama, S, ed., The Introduction of Modern Science and Technology to Turkey and Japan (International Research Center for Japanese Studies, No. 10, 1998, 257pp.). On science policy, Science 284 (1999), 259; Nature & Resources 34 (No.4, Oct. 1998), 48-53; Nature 399 (1999), 219; and education, Science 284 (1999), 1447, 1473-4. Germany is promoting efforts to increase public understanding of science, Nature 399 (1999), 514. A general call for science academies to encourage ethics debate is Nature 399 (1999), 516.

A new book is Walter P. von Wartburg & Julian Liew, Gene Technology and Social Acceptance (University Press of America, 1999, ISBN 0-7618-1325-X, 338pp.). It includes a chapter on patents, and several on the roles and acceptance of technology in society, and looks at how society can make decisions on controversial issues. A collection of summaries of public opinion surveys of biotechnology is Hamstra, IA. Public Opinion about Biotechnology: a Survey of Surveys (EFB Task group on Public perceptions of Biotechnology, 1999).

A new report is EFB Task Group on Public Perceptions of Biotechnology, Ethical Aspects of Agricultural Biotechnology. Bioethical Aspects of Biotechnology in the Agrofood Sector (BABAS) (Cambridge Biomedical Consultants 1999, 63pp.). It has chapters on food, environment, medicine, developing countries, and industry. The UK is opening biotech regulation to greater public involvement, Nature 399 (1999), 287-8; 188. The USDA is setting up a biotechnology advisory committee to help allay public fears of biotechnology, Nature 399 (1999), 508. The NRC Panel on genetically modified pesticide-producing plants has been attacked at being slanted to industry by opponents, Nature 399 (1999), 7. The EPA is softening its stance on such plants, Science 284 (1999), 249.

Regulation & Field Trials of GMOs

The stability of transgenes is affected by the surrounding genes, Vain, P. et al. "Matrix attachment regions increase transgene expression levels and stability in transgenic rice plants and their progeny", The Plant Journal 18 (1999), 233-42. The question whether buffer zones will prevent genes from leaving GMO crop fields is discussed in NS (17 April 1999), 25. There is evidence for lateral gene transfer between Archaea and Bacteria from the 1.8Mb genome sequence of Thermotoga maritima, Nature 399 (1999), 323-7. A review of marine viruses is Nature 399 (1999), 541+. On the evolution of recombination and meiosis, Genetical Research 73 (1999), 119-31.

A study in Cornell University has found that Monarch butterflies are harmed by pollen from some Bt corn, and there are urgent calls for further verification of the results and studies on possible impacts of Bt toxin, Nature 399 (1999), 214. Resistance to Bt appears to be inherited as an incompletely dominant autosomal gene, Huang F. et al. "Inheritance of resistance to Bacillus thuringiensis toxin (Dipel ES) in the European Corn borer", Science 284 (1999), 965-7; see also NatBio 17 (1999), 531-2.

A new book is Ad van Dommelen, Hazard Identification of Agricultural Biotechnology. Finding Relevant Questions (Utrecht: International Books, 1999, ISBN 90-5727-034-X, 238pp.). It is a thorough analysis of some issues of identifying hazards of GMOs, and includes a chapter looking at hazards of herbicide resistant plants. It challenges scientific experts to have moral responsibility also, and examines how familiarity affects the setting of criteria for asking what is safe. Cynicism and politics dominate UN biotechnology deliberations, as discussed by Watanabe in this issue of EJAIB 9 (July 1999), also NatBio 17 (1999), 515-6.

The US decision not to destroy smallpox is discussed in Science 284 (1999), 718-9; NatMed 5 (1999), 474; Lancet 353 (1999), 1539. A book review of Alibek, K. Biohazard (Hutchinson, 1999) is in NS (29 May 1999), 46-7. Methods to prevent bioterrorism are discussed in GEN 19 (1 June 1999), 6, 31, 45. A review is Inglesby, TV. et al. "Anthrax as a biological weapon. Medical and public health management", JAMA 281 (1999), 1735-45. The plan to import Chinese leaf-eating beetles into the US as a biocontrol agent is being criticized, Science 284 (1999), 1255. Exotic species are affecting Baltic Sea ecology also, NS (24 April 1999), 18-9. A review on plant disease, also related to biowarfare is Rogers, P. et al. "Biological warfare against crops", SA (June 1999), 70-74.

Vaccines & Diseases

There is currently no evidence of vaccination leading to diabetes but further studies may be useful, BMJ 318 (1999), 1159-60. Discussion of the future of international vaccination efforts with the closure of the Children's Vaccine Initiative are in NatMed 5 (1999), 469-70; NEJM 340 (1999), 1373; Science 284 (1999), 587; also JAMA 281 (1999), 1366-7, 1482-3. A report on efforts to eradicate the last pools of wild polio in Cambodia and Vietnam are reported in JAMA 281 (1999), 1690-1. There are now efforts to block a gene DNA adenine methylase that is required for disease progression in a number of diseases as a vaccine target, Science 284 (1999), 883. The WHO is targeting malaria (again), Nature 399 (1999), 99. An editorial looking at when we can cure the common cold is JAMA 281 (1999), 1844-5. A study of BCG vaccines by whole genome DNA microarray is Science 284 (1999), 1520-3. To cure disease by vaccine will be best if it is needle free, JAMA 281 (1999), 1879-81.

Some further research on prion disease is reported in NatMed 5 (1999), 486-7; Lancet 353 (1999), 1502. Canadians who visit the UK may be disqualified from giving blood because of fears of CJD, NS (20 May 1999), 20; Lancet 353 (1999), 1775. A book review of Markel, H. Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892 (John Hopkins University Press 1997) is JAMA 281 (1999), 1758-9. On possible TB vaccines, Science 284 (1999), 1479-80. Reye's syndrome has largely been eradicated in the USA, NEJM 340 (1999), 1423-4; as has a lot of measles cases, Lancet 353 (1999), 1424.

Infections that may lead to cancer are discussed in Science 284 (1999), 1279. An outbreak of haemorrhagic fevers in the Democratic Republic of Congo has been suggested to be Marburg virus (related to Ebola), and suggests that it may be carried by bats, NS (15 May 1999), 12. A study suggests that sex twice a week improves immune function, by boosting IgA, NS (17 April 1999), 6.

A possible vaccine is reported in McKenney, D. et al. "Broadly protective vaccine for Staphylococcus aureus based on an in vivo-expressed antigen", Science 284 (1999), 1523-7. Bacteria resistant to drugs are discussed in GEN 19 (15 May 1999), 1, 19, 50; and a study has found 3% of clinical Streptococcus pneumoniae strains are resistant to vancomycin, Nature 399 (1999), 524-6; Science News 155 (1999), 175. A study found vancomycin-resistant enterococci in imported chickens in Japan, Lancet 353 (1999), 1854. Papers on microbe management are in Science 284 (1999), 1301-32. Less use of antibiotics in ambulatory practice can be safely done, JAMA 281 (1999), 1512-9.

AIDS & Sexually Transmitted Diseases

The Irish High Court doubled the amount of compensation given to a woman who contracted hepatitis C in 1977 through infected anti-D immune globulin, Lancet 353 (1999), 1507; saying that the 150,000 pound cap was no longer enough in such cases.

South Africa has made AIDS a notifiable disease, BMJ 318 (1999), 1308; Nature 399 (1999), 288; Lancet 353 (1999), 1599. A letter suggesting that mandatory name reporting may alter use of HIV testing is JAMA 281 (1999), 1377-80. On screening for syphilis, Lancet 353 (1999), 1441. Routine PCR screening of blood is discussed in Lancet 353 (1999), 1799-800. On risks of catching HIV for healthcare workers, Lancet 353 (1999), 1855-6.

Breast feeding from HIV infected mothers may reduce morbidity, BMJ 318 (1999), 1303-4; however an Oregon state judge banned a mother from breast-feeding her infant, Lancet 353 (1999), 1506. California has offered free milk for mothers with HIV to feed their babies. Numerous letters on the ethical issues are in Lancet 353 (1999), 1878-81. The French Bioethics Committee has issued an opinion about "serodifferent" couples, meaning when one person has HIV and the other does not, IDHL 50 (1999), 98-9.

In general on HIV, BMJ 318 (1999), 1231; NatMed 5 (1999), 488-9, 512-7; Nature 399 (1999), 413-5; Genetica 104 (1998), 85-132; 133-42. On research for AIDS vaccines, NatMed 5 (1999), 526-34; NEJM 340 (1999), 1756-7; Lancet 353 (1999), 1723, 1735-42. A month long interruption in HAART therapy may not have a deleterious affect on therapy, Lancet 353 (1999), 1417; AIDS 13 (1999), 677-83; see also Lancet 353 (1999), 1857. The approaches used in Thailand are reviewed in Lancet 353 (1999), 1600.

Bristol-Myers Squibb has announced a US$100 million program of AIDS research, treatment and education in southern Africa, Nature 399 (1999), 89. On the community service costs for people with HIV in London, SSM 48 (1999), 1433-40. Papers on the spread of HIV include SA (May 1999), 24-6; BMJ 318 (1999), 1321-2; JAMA 281 (1999), 1479, 1485-8; Lancet 353 (1999), 1522-4, 1657-61.

Microbes & Pollution Remedies

A paper on bioremediation of perchlorate and nitrate in water is J. Environmental Quality 28 (1999), 1018-24. A giant sulfur-eating microbe has been found in Namibia that is close to a mm in diameter, Science 284 (1999), 415. Bacteria that eat rotten waste can break down DDT, NS (8 May 1999), 6. A review on the scientific lessons from the Exxon Valdez disaster is Science 284 (1999), 247-9. The capacity of wetlands to assimilate phosphorus is reviewed in EST 33 (1999), 1545+.

Environmental Issues

A study has found that carbon dioxide can be fixed into trees at increased concentrations, DeLucia, EH. et al. "Net primary production of a forest ecosystem with experimental CO2 enrichment", Science 284 (1999), 1177+. A review of models to predict the Earth's global warming is Nature 399 (1999), 523-4, 313-4, 342-5; Science 284 (1999), 464+, 926-7. On greenhouse gas emissions, Ambio 28 (1999), 148-51; 171-81. Mercury in peat bog may be an archive of climate change, Science 284 (1999), 939+. A 420,000 year study of Vostok ice core found that methane and CO2 are higher now than at any time in the past, Nature 399 (1999), 412-3, 429-36. In the past sea levels have altered by 20m when ice sheets melt, NS (17 April 1999), 5. Injecting carbon dioxide by deep ocean dumping may slow down global warming, NS (15 May 1999), 14.

A compilation of environmental protection laws is reviewed in IDHL 50 (1999), 146-7. On ethical issues, Ostrom, E. et al. "Revisiting the commons: Local lessons, global challenges", Science 284 (1999), 278-2. Environmental justice is discussed in EST 33 (1999), 200-4A. German environment policy is discussed in EST 33 (1999), 194-8A. Efforts to prevent pollution from airports are reviewed in EST 33 (1999), 210-2A; and tracing pesticides using anantiometers, EST 33 (1999), 206A+.

The reasons for mutations in frogs are discussed in Science 284 (1999), 800-4. Shellfish in the North Sea have recovered since small boats have been banned from using the antifouling paints containing tributyltin (TBT), but it is still used for larger boats, NS (8 May 1999), 23. The current US limit of 50 ppb arsenic in drinking water is considered too low by the NRC, EST 34 (1999), 188-9A. Health and the environment are discussed in JAMA 281 (1999), 1656, 1661; and the severe health impacts of coal use in China are reviewed in PNAS 96 (1999), 3427-31. On the effects of noise on hearing, JAMA 281 (1999), 1658-9.

Some of Sellafield's plutonium is missing, NS (24 April 1999), 17.

Biodiversity

On damage to fish populations, Ambio 28 (1999), 112-24; Science 284 (1999), 237, 574-5, 1537-8. The US dolphin-safe label on tuna will now also be permitted for tuna from boats that may have chased dolphins as long as dolphins were not killed, NS (15 May 1999), 22. On coral damage, Ambio 28 (1999), 188-90; NS (24 April 1999), 13. The consumer demand for turtles in China is the main cause of demise of their populations, and includes many endangered species, SA (June 1999), 32-3. A report on wildlife harvest in logged tropical forests is in Science 284 (1999), 595-6. Using market forces may be the way to control illegal wildlife trade, NS (8 May 1999), 51. On the resumed elephant ivory trade, Nature 399 (1999), 297.

In general on biodiversity, Science 284 (1999), 276-7. A series of papers on stress in ecological systems is in Ecological Applications 9 (1999), 429-503. There has been criticism from both sides over Canada's proposed conservation law, Nature 399 (1999), 10. A series of papers on Antarctica are in NS (17 April 1999), 28-58. Deer gender may be determined by deer density, Nature 399 (1999), 407-8.

Animal Rights

A new report is Straughan, R. Ethics, Morality and Animal Biotechnology (BBSRC (UK), Spring 1999, 26pp., ISBN 07084-06157). Papers include, Chapouthier, G., "Can the principles of human rights be extended to animals and the environment?", IJB 9 (No. 4, 1998), 53-60. A book review of Nichols, M. & Goodall, J., Brutal Kinship (Aperture 1999, 127pp., US$25) is Nature 399 (1999), 537; which highlights through photos the difference in life style imposed by humans on chimpanzees in captivity. A report on a grey whale kill by the Malak tribe in Washington state, USA is in NS (29 May 1999), 12.

Papers on animal welfare include, Fisher, M. "Animal welfare isn't just a science", Vetscript (June 1998), 2-3; Fisher, MW. "Agricultural ethics - a role in animal production", Proceedings of the NZ Society of Animal Production 57 (1997), 88-90. Results of opinion surveys on the issue in the UK find few people support animal experiments, NS (22 May 1999), 26-31. Animal activists have caused US$2 million damage in an attack at the University of Minnesota, Science 284 (1999), 410-1; NS (17 April 1999), 14. The US Senate is toughening federal penalties for such attacks, Nature 399 (1999), 397.

A discussion of the large wastage of transgenic mice in the efforts to find the desired transgenic animal is NS (8 May 1999), 4. However, lab animals may also be spared with transgenic techniques using sperm, NS (22 May 1999), 21. On regulation of rodents for experiments in the USA, Science 284 (1999), 1463. . The US NAS is supporting the use of alternatives to animals for production of antibodies, Science 284 (1999), 230. The EPA has announced it will no longer require animals for some high production volume chemical tests, NS (15 May 1999), 15.

On the philosophy of pain in philosophy, IJB 9 (No. 4, 1998), 37-42. A series of papers on pain are in Lancet 353 (1999), 1607-9, 1610-5, 1784-8, 1865-9. When one person feels pain other person's neurons fire in sympathy, NS (8 May 1999), 17. A letter on the mystery of female beauty is Nature 399 (1999), 214-5. Evolution of behaviour is discussed in SA (June 1999), 98-9; Nature 399 (1999), 322; and on thinking, Science 284 (1999), 922-3, 970-4, 1531-3. Artificial intelligence is discussed in Science 284 (1999), 745; NS (8 May 1999), 26-31. A study of nerve cells has found that spindle-shaped cells that are associated with speech in humans are found only in closely related apes since the last 15 million years of evolution, but not in other mammal species of whales, NS (8 May 1999), 25. Of course there may be some other processes not yet found as well.

Safety of Recombinant DNA Products

A study in Cornell University has found that Monarch butterflies are harmed by pollen from some Bt corn, and there are urgent calls for further verification of the results and studies on possible impacts of Bt toxin, Nature 399 (1999), 214, 405. For some people to accept the idea that GM food may be safe may require a system for testing all foods, and to make comparisons, NS (17 April 1999), 18-9. At a recent meeting of the Codex Alimentarius Commission only the USA and Argentina support the position that GM foods do not need labels if they are substantially equivalent, Nature 399 (1999), 11; NatBio 17 (1999), 519. A comment is Miller, HI. "A rational approach to labeling biotech-derived foods", Science 284 (1999), 1471-2. The British medical Association report released on 18 May, 1999 suggests that GM crops should not be grown commercially in the UK until the food is proven safe, Lancet 353 (1999), 1769. Some comments over the consumption of GM food are in The Ram's Horn 169 (May 1999), 1-8; Splice 5 (May 1999), 3, 8-9; SA (May 1999), 34-5, EST 33 (1999), 186-7A; NS (22 May 1999), 3; Lancet 353 (1999), 1531, 1769, 1811; NatBio 17 (1999), 517. On the Pusztai affair, BMJ 318 (1999), 1284; Science 284 (1999), 21, 1442-4. The UK prime minister may have softened his support for GM food, Nature 399 (1999), 515. A report by the Nuffield Council on Bioethics advises to proceed cautiously with GM food, Nature 399 (1999), 287, 396.

Scientists advising the European Commission have supported a genetically modified radicchio lettuce that is resistant to herbicide and it may be the first product approved in Europe for raw eating, NS (May 1999), 52 (note that raw eating tomatoes were approved in the USA in the mid-1990s). The British charity Christian Aid has challenged companies to show how GM food will be an answer to global hunger, Nature 399 (1999), 99. A paper related to this issue is Gerngross, TU. "Can biotechnology move us toward a sustainable society?" NatBio 17 (1999), 541-4.

There are also new regulations developing to allow nutrient supplements to drinks, so-called "nutraceuticals", GEN 19 (15 May 1999), 9, 41. The 1998 European Parliament resolution on food law is in IDHL 50 (1999), 99-104. Organic farming is also associated with food scars, NS (29 May 1999), 4. A Japanese consumer group has protested the revelation that so-called cloned beef has been sold for 4 years in Nara prefecture, but it was produced by embryo-splitting which is different to nuclear transfer, and quite common in some other countries, Lancet 353 (1999), 1422.

A letter on detection of doping with human growth hormone is Lancet 353 (1999), 1532. TPA can provide nonproteolytic neuroprotection by dissolving clots, Science 284 (1999), 647-50; and on new antithrombotic agents, Lancet 353 (1999), 1431-6. Oral tolerance with copolymer 1 for treatment of multiple sclerosis is reported in PNAS 96 (1999), 3333-5. Erythropoietin can stimulate eryhthropoiesis in premature infants, Lancet 353 (1999), 1849. A review of use of recombinant human DNase in cystic fibrosis patients suggests it may work for some persons, Lancet 353 (1999), 1727. BST does not appear useful to promote mohair production in angora goats, J. Animal Science 77 (1999), 1029-36. The EC may propose a universal BST ban, NatBio 17 (1999), 519.

Disease Risks & Drugs

The European Commission's Scientific Committee on Veterinary Measures released a report on 3 may claiming that 17B-oestradiol is a carcinogen, thus justifying the EC ban on imports of hormone-treated beef from the USA, before the 13 May deadline of the World Trade Organization for the EC to lift its ban, Nature 399 (1999), 8; Lancet 353 (1999), 1864. The consequences for food safety from the use of fluoroquinolones in food animals is reviewed in NEJM 340 (1999), 1581-8. On food-borne illness, JAMA 281 (1999), 1845-7.

The FDA regulations on financial disclosure by clinical investigators are discussed in BME 147 (1999), 9-11. A review of the ten great achievements of public health in the USA this century is JAMA 281 (1999), 1481.

On the placebo effect, Nature 399 (1999), 427. Thalidomide is being reintroduced to medicine, NatMed 5 (1999), 489-90. On the use of alternative medicine, NEJM 340 (1999), 1758-9; JAMA 281 (1999), 1698-9; and safety of medicines, JAMA 281 (1999), 1753-4.

A paper on heroin trials in Australia is Pike, GK. "Heroin trials - no easy fix", Bioethics Research Notes 11 (1999), 1-4; JAMA 281 (1999), 1782-3. Also on drug policy, Science 284 (1999), 1277-8; Issues in Science & Technology 14 (1998), 45-52, 53-60; NS (29 May 1999), 7; Lancet 353 (1999), 1449-50; BMJ 318 (1999), 1300-1. Research to make tobacco less harmful is suggested in NS (May 1999), 18-9; and against smoking, Bulletin WHO 77 (1999), 367; NS (29 May 1999), 15, 18-9; AJPH 89 (1999), 691-8; JAMA 281 (1999), 1849+. On alcohol use, BMJ 318 (1999), 1311-6; AJPH 89 (1999), 678-84, 685-90; Lancet 353 (1999), 1448. Smoke-free ordinances in restaurants may increase patronage in a US study, JAMA 281 (1999), 1911-8.

An egg a day may not harm health, JAMA 281 (1999), 1387-94; BMJ 318 (1999), 1094. Also on diet and health, BMJ 318 (1999), 1418-9; NEJM 340 (1999), 1770-2; Science News 155 (1999), 181; Lancet 353 (1999), 1458-9, 1540-1, 1547-57. NIH recommendations for vitamin C intake of 100-200 mg/day is suggested in JAMA 281 (1999), 1415-23, 1460. A series of papers on antioxidant action are in FASEB J. 13 (1999), 963-1106.

More reports from silicone breast implant safety trials are reviewed in Lancet 353 (1999), 1455, 1506. The question of whether cellphones cause cancer is discussed in NS (29 May 1999), 5. Limited vitamin D intake and sunscreens may lead to rickets in some cases, BMJ 318 (1999), 1417. On guns and death, BMJ 318 (1999), 1160-1.

Patenting & Business

A survey is Knoppers, BM. "Status, sale and patenting of human genetic materials: an international survey", NatGen 22 (1999), 23-5. On patent law, GEN 19 (15 May 1999), 11, 42. A comment on protection of databases is Science 284 (1999), 1129-30. A federal jury in San Francisco failed to reach a unanimous agreement on whether Genentech had infringed a patent held by the University of California for human growth hormone, although it upheld the validity of the original patent, in a case that suggests some scientific misconduct, Nature 399 (1999), 285, 289, 297, 512; Science 284 (1999), 883-5, 1465. In the US two former graduate students have sued universities over alleged misuse of ideas, Science 284 (1999), 562-3. The NIH rules on material exchange are on the Internet for comment <http://www.nih.gov/welcome/forum>, Science 284 (1999), 1445. The case for free access to fundamental data is made in Lancet 353 (1999), 1721; NatBio 17 (1999), 604-5..

Geron Corporation has bought Roslin Bio-Med to unite work on stem cells and cloning, Nature 399 (1999), 92; NatBio 17 (1999), 529-30. On biotech research in general, NatMed 5 (1999), 472; Science 284 (1999), 1124; Nature 399 (1999), 6; and on research in France, Science 284 (1999), 580-1; Nature 399 (1999), 4; and Israel, Science 284 (1999), 892-7. A UC Berkeley-Novartis deal is being debated, Nature 399 (1999), 5. On the use of foreign researchers in the USA, New Republic (29 March 19999), 17-22.

Birth Control

The Japanese Ministry of Health and Welfare has approved the female contraceptive pill, and 16 types of pill produced by 9 companies, will be available from September, Nature 399 (1999), 514. The health risks of the contraceptive pill are discussed in BMJ 318 (1999), 1095; Lancet 353 (1999), 1481-4. Viagra is being used by women as well as men, despite that the trials are not yet finished, SA (May 1999), 36-7.

A paper on reproduction in general is Figueroa, JG. & Esser, MY. "Reproduction and health services in Brazil and Mexico: Some ethical considerations", IJB 9 (No. 4, 1998), 61-76. A discussion of Catholic theology and reproductive control is The Thomist 63 (1999), 269-81. On women's health, Lancet 353 (1999), 1535; and reproduction in general, NEJM 340 (1999), 1519.

Embryo Status

Fetal cell implantation to treat Parkinsonian symptoms was tested by a trial involving 40 patients with placebo control, but had mixed results, and needs more time to be sure of any success, Lancet 353 (1999), 1501. Fear of black market means no RU-486 for Canada until US approves drug, CMAJ 160 (1999), 1753-4.

Assisted Reproductive Technology (ART)

Papers from a symposium on human primordial stem cells are included in Geron Ethics Advisory Board, "Research with human embryonic stem cells: Ethical considerations", with 5 commentaries, HCR 29 (No. 2, March 1999), 30-48. The NIH plans ethics review of research proposals including research on human stem cells, Science 284 (1999), 413-5. The US Presidential Commission on Bioethics controversially recommended that federal funds be used for extraction of embryo cells not only fund research on stem cells, Nature 399 (1999), 292, 402. The HUGO Ethics Committee Statement on Cloning is reproduced in EJAIB 9 (1999), 70-1; BME 147 (1999), 3-4.

The 1996 results of 300 ART programs in the USA are in Society for Assisted Reproductive Technology, The American Society for reproductive Medicine, "Assisted reproductive technology in the United States: 1996 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry", F&S 71 (1999), 798-807. Unfortunately not all outcomes from clinics are reported, Lancet 353 (1999), 1774. A report from a program using anonymous oocyte donation from embryos cryopreserved at the pronuclear stage is F&S 71 (1999), 830-5. A review of international developments and laws in ART is in F&S 71 (May 1999), Supplement 2, 32pp. Multiple embryo pregnancies present difficult ethical issues in selective fetal reduction, JAMA 281 (1999), 1480. On infertility in general, Lancet 353 (1999), 1724-5.

Fetal Environment & Neonates

On the use of folic acid in the USA, JAMA 281 (1999), 1883-4. The effect of folic acid fortification of food upon plasma folate in adults is positive, NEJM 340 (1999), 1449-54. Alcohol-related risks of breast cancer can be reduced by folate, JAMA 281 (1999), 1632-7. Fetal growth rate is discussed in Lancet 353 (1999), 1460. Prothrombotic mutations may be a risk factor for preterm birth, Lancet 353 (1999), 1411-2.

Pregnancy discrimination is discussed in Modern Law Review 62 (1999), 435-47; and safe motherhood in Bulletin WHO 77 (1999), 399-406. A program to allow pregnant mothers with phenylketonuria to seek advice from others with experience benefits the outcome of pregnancy, AJPH 89 (1999), 762-4. The semiconductor industry is associated with toxic chemicals, some of which are now blamed for birth defects, NS (15 May 1999), 18-9. A paper on the mother-to-child transmission of toxoplasmosis is Lancet 353 (1999), 1829-33.

On infant learning, Science 284 (1999), 434-7; Science News 155 (1999), 184-6. Preterm babies have increased chance of abnormal MRI brain scans, not only neurocognitive problems, Lancet 353 (1999), 1653-7. Low birthweight is also associated with diabetes, Lancet 353 (1999), 1789-92. Two paternal genes, Mest and Peg3 may alter a daughter's maternal instincts, NS (17 April 1999), 17. On rights in law for children, Modern Law Review 62 (1999), 350-70.

Genetic Disease Markers

The proceedings of a 1998 Conference organized by the Galton Institute, Human Pedigree Studies has been published (117pp.). On cystic fibrosis gene mutations in chronic pancreatitis, NEJM 340 (1999), 1592-3. On cancer genetics, NEJM 340 (1999), 1424-6; PNAS 96 (1999), 4221-3, 4240-5; Lancet 353 (1999), 1379-80, 1437+; JAMA 281 (1999), 1395-400. Risk factors for BRACE/2 mutations are discussed in JMG 36 (1999), 369-73; Science 284 (1999), 723-5; NatGen 22 (1999), 10.

The chromosome workshop summaries from the 1998 World Congress of Psychiatric Genetics are in AJMG 88 (1999), 215-286. A missense mutation in RPS6KA3 (RSK2) responsible for non-specific mental retardation is reported in NatGen 22 (1999), 13-4. There may not be a link between alpha-2 macroglobulin and Alzheimer disease, NatGen 22 (1999), 1-2, 16-21: also, Nature 399 (1999), 204-7. Methods using combined linkage and linkage-disequilibrium analysis to map complex traits are discussed in AJMG 84 (1999), 433-53. On male attractiveness for women, Lancet 353 (1999), 1500. Schizophrenia is reviewed in Lancet 353 (1999), 1425-30; JAMA 281 (1999), 1877-8.

A COL1A1 gene polymorphism test kit is being developed to assess risk of bone fracture, GEN 19 (15 May 1999), 1, 32. On amyloid and fibrillogenesis, PNAS 96 (1999), 3342-4. Turning off the gene for protein tyrosine phosphatase-1B protects mice against obesity and type II diabetes, SA (June 1999), 16. Also on diabetes, Science 284 (1999), 886; Lancet 353 (1999), 1649-52.

Genetic Screening Methodology

A paper on developing the new screening technology is Al-Mufti, R. et al. "Investigation of maternal blood enriched for fetal cells: Role in screening and diagnosis of fetal trisomies", AJMG 85 (1999), 66-75. With the current techniques, non-invasive testing at 10-14 weeks gestation could detect 60% of trisomy 21 fetuses with a false positive rate of 13% and 97% sensitivity. A study confirming that about 1 in 400 live births is a person with a sex chromosome aneuploidy, AJMG 85 (1999), 86-7. There are increased concentrations of follicle-stimulating hormone in mothers of children with Down's syndrome, Lancet 353 (1999), 1853-4.

The use of preimplantation diagnosis is reported in Xu, K. et al. "First unaffected pregnancy using preimplantation genetic diagnosis for Sickle Cell Anemia", JAMA 281 (1999), 1701-6.

A PCR detection of bacteria within 7 minutes is reported in Science 284 (1999), 449-50. New PCR techniques can save time and increase yield, GEN 19 (15 May 1999), 1, 14, 38. On microarray technologies, GEN 19 (1 May 1999), 1, 21, 31; Lancet 353 (1999), 1418. Double-stranded DNA arrays have been developed, NatBio 17 (1999), 536-7. Clinical epidemiological quality in molecular genetic research is discussed in JAMA 281 (1999), 1919-26.

A simple paper test that takes a few minutes has been developed to be a faster method for testing colour blindness in school children, NS (8 May 1999), 12. On prostrate cancer screening, JAMA 281 (1999), 1573-4; and on cervical cancer screening, JAMA 281 (1999), 1605-10. Advances in molecular genetics can aid the management of hypertrophic cardiomyopathy, JAMA 281 (1999), 1746+.

DNA Fingerprinting & Privacy

Papers on privacy in general include Etzioni, A. "Medical records: Enhancing privacy, preserving the common good", HCR 29 (March 1999), 14-23; BMJ 318 (1999), 1328-31. On Internet privacy, NS (8 May 1999), 3, 7.

Ethics & Genetic Screening

A study on the reporting of Down syndrome is Yamada, T. et al. "Recent trends in the prevalence of Down syndrome in Japan, 1980-1997", AJMG 85 (1999), 340-5. It noted no decline in birth because of increased maternal age. It also suggested that there is something unique in the bioethics because only 1% of advanced age pregnancies have amniocentesis. However, the editor disagrees, as results of surveys support, and the lack of services is the reason why so few pregnant mothers are offered the option of screening. On ethics, Goodey, C. et al. "The ethical implications of antenatal screening for Down's syndrome", BME 147 (1999), 13-17. A study of counseling found that even if male physicians gave longer consultation times female patients were generally more satisfied with female physicians, O&G 93 (1999), 635-41. A US study of genetics knowledge by obstetrician's found serious deficits, O&G 93 (1999), 642-7.

A study has found an absence of linkage of linkage of male homosexuality with microsatellite markers at Xq28, thus contradicting the idea of a so-called "gay gene", Science 284 (1999), 571, 665-7. A paper on genetic determinism is Holdrege, C., "Genes and life: The need for qualitative understanding", In Context. The Newsletter of the Nature Institute 1 (Spring 1999), 11-5. Also on ethics and genetics, BMJ 318 (1999), 1153.

The risk of suicide in Huntington disease is discussed in Bird, TD. "Outrageous fortune: The risk of suicide in genetic testing for Huntington disease", AJHG 64 (1999), 1289-92; Almqvist, EW. et al. "A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalization after predictive testing for Huntington disease", AJHG 64 (1999), 1293-304. Not many family members use cancer gene tests is Lerman, C. et al. "Genetic testing in families with hereditary nonpolyposis colon cancer", JAMA 281 (1999), 1618-22. The WHO "Proposed International Guidelines on Ethical Issues in Medical Genetics and Genetics Services" are on the Internet at <http://www.who.int/ncd/hgn/hgnethic.htm>, Nature 399 (1999), 297.

On intelligence and genes, Science 284 (1999), 589. A Nazi war crime trial has recently began in Austria, Lancet 353 (1999), 1421. New findings in the genetics of alcoholism are reported in JAMA 281 (1999), 1875-6. The WMA has opposed the Icelandic gene database, BMJ 318 (1999), 1096. Also on Icelandic genetics, NatBio 17 (1999), 517. A call to let deaf children chose whether to have cochlear implants is NS (24 April 1999), 52. The use of disability terminology in the media differs between Canada and Israel, SSM 48 (1999), 1395-405.

Gene Therapy

A paper against germ-line gene therapy is Billings, PR. et al. "Human germ-line gene modification: a dissent", Lancet 353 (1999), 1873-5.

Sustained correction of bleeding in hemophilia B mice has been reported, PNAS 96 (1999), 3906-10. Gene therapy vectors can take beta-endorphins into the spinal cord to relieve pain in animals, Lancet 353 (1999), 1595. New methods for gene therapy are reviewed in GEN 19 (1 June 1999), 8, 16, 42. Use of an aerosol gene therapy trial for cystic fibrosis in Stanford is commencing, BMJ 318 (1999), 1096. High pressure can insert antisense DNA into cells of blood vessels before they are implanted into patients, NS (6 May 1999), 6; and electrical pulse has been used for skeletal muscle, PNAS 96 (1999), 4262-7. New lipid vectors are reported in NS (22 May 1999), 25. An explanation for a block in retroviral-mediated gene transfer has been found, due to the need for a conformational change, PNAS 96 (1999), 4005-10. Hepatocyte gene therapy is reported in PNAS 96 (1999), 3981-6.

Human Genome Project (HGP)

A draft complete human DNA sequence will be ready by spring 2000, Science 284 (1999), 1439-40. The Wellcome Trust and several companies are funding a SNP Consortium which will create a database on genetic markers, BMJ 318 (1999), 1093; Science 284 (1999), 406-7; NS (17 April 1999), 12. Population genetics is discussed in Science 284 (1999), 267-8; AJHG 64 (1999), 1473-4; NatGen 22 (1999), 78-81. On the sequencing of viral genomes, NatMed 5 (1999), 484-5. A radiation hybrid map of the rat genome with 5255 markers is published in NatGen 22 (1999), 3-4, 27-36. Japan is attempting to catch up with the rapid advances in the genome project, Nature 399 (1999), 96; and on the falling stock value of the French genome company Genset, Nature 399 (1999), 185-6.

The distribution of haplotypes from a chromosome 21 region have been used to trace multiple prehistoric human migrations, PNAS 96 (1999), 3796-800. The proceedings of a 1996 International Symposium have been published, Omoto, K., ed., Interdisciplinary Perspectives on the Origins of the Japanese (International Research Center for Japanese Studies, No. 11-B, 1999, 349pp.). It includes various methods including DNA studies. An Inca mummy that is 500 years old is being used for research, Science 284 (1999), 427. The interaction between environment and behaviour of 2.5 million year old Bouri hominids is discussed in Science 284 (1999), 625+. A paper on the comparison that will be made between genes of humans and other great apes is NS (15 May 1999), 26-30. On the origin of life, Nature 399 (1999), 217-8.

General Medical Ethics

A special issue of the Japanese journal Clinical Evaluation 26 (No. 3, 1999), pp. 341-543, includes 13 papers on ethical issues related to human subject research. Several papers on bioethics in Latin America and Spain are in IJB 9 (No. 4, 1998), 61-106. International aspects are discussed in Beauchamp, TL. "The mettle of moral fundamentalism: A reply to Robert Baker", KIEJ 8 (1998),389-402; Macklin, R. "A defense of fundamental principles and human rights: A reply to Robert Baker", KIEJ 8 (1998), 403-22; Baker, R. "Negotiating international bioethics: A response to Tom Beauchamp and Ruth Macklin", KIEJ 8 (1998), 423-54. A paper on early Indian medical ethics is Blambal, V. "Health ethics of early Tamils", AIBA Newslink 2 (No. 3, June 1999), 2-3. A book review of Jonsen, AR., The Birth of Bioethics (Oxford University press, 1998, US$45) is NEJM 340 (1999), 1446.

Ethical issues in the design and conduct of cluster randomized controlled trials are debated in BMJ 318 (1999), 1407-9: Lancet 353 (1999), 1714. Ethics of placebos are discussed in Science 284 (1999), 238-40l, 913-4. In general on research ethics with mental disease, NEJM 340 (1999), 1427-34. The question of competence to make decisions is discussed in KIEJ 8 (1998), 359-388. Bioethics is expanding at the NIH in the UA, KIEJ 8 (1998), 455-66. In general on medical ethics, NEJM 340 (1999), 1446; Science 284 (1999), 919-21. Consent is discussed in Lancet 353 (1999), 1530-1, 1713; JAMA 281 (1999), 1657.

A paper on education is Brugman, et al. "Student's perception of moral atmosphere in secondary schools: their moral reasoning competence, and their practical judgment in school", MOSAIC Monograph Number 8 (University of Bath Press, 1999, ISBN 1-8579-057-X, 48pp). Medical education is discussed in BMJ 318 (1999), 1223-4, 1265-75, 1361; and Coughlin, SS. et al. "Ethics instruction at schools of public health in the United States", AJPH 89 (1999), 768-70.

Discussion of dealing with racist patients is BMJ 318 (1999), 1129-31; also on racism, Lancet 353 (1999), 1625, 1889. Gender is discussed in Nature 399 (1999), 117-8; NS (22 May 1999), 54-5. On mental health of patients, SSM 48 (1999), 1353-62; BMJ 318 (1999), 1225-6; JAMA 281 (1999), 1779-81; Lancet 353 (1999), 1397-400. The BMA has recommended that doctors must obtain informed consent for intimate body searches ordered by police and customs, BMJ 318 (1999), 1310. Letters on the care of prison inmates by impaired disciplined physicians is discussed in JAMA 281 (1999), 1889-91. The question of public disclosure of physician performance data is raised in Lancet 353 (1999), 1639-40. religion is discussed in Lancet 353 (1999), 1803-4.

Law & Medical Ethics

Several papers on the role of the Universal Declaration of Human Rights in national medical policies are in Health & Human Rights 3 (1999), 126-42, 144-58, 160-175; Lancet 353 (1999), 1626. An editorial on the trend to write guidelines for medicine is BME 147 (1999), 1; and on clinical practice guidelines, JAMA 281 (1999), 1900-5, 1950-1. The WMA has proposed some revisions to the Declaration of Helsinki, see BME 147 (1999), 18-22; Lancet 353 (1999), 1888.

The US government has settled out of court over radiation experiments on cancer patients, NS (22 May 1999), 12. There are some recriminations of the unethical malaria trials that were conducted in Australia in World War II in Lancet 353 (1999), 1597; BMJ 318 (1999), 1233.

There have been witnesses disputes at the Bristol Inquiry, Lancet 353 (1999), 1373, 1776. England and Wales have introduced a new system for medical negligence claims, BMJ 318 (1999), 1165. New rules for expert witnesses in the UK are discussed in BMJ 318 (1999), 1365-6; Lancet 353 (1999), 1380. In general on law, IDHL 50 (1999), 144-6. Direct to consumer advertising of prescription drugs is common in the USA but not in the UK, BMJ 318 (1999), 1301-2.

Scientific Ethics

A special issue of Science and Engineering Ethics 5 (No. 2, 1999), 131-302, includes 22 papers and commentaries on scientific misconduct. In US research fraud review the main problem is falsifying data, BMJ 318 (1 May 1999); see Office of Public Health and Science, Office of Research Integrity, Scientific Misconduct Investigations, 1993-1997.

The responsibility of editors to defeat fraud is discussed by the editorial of Nutrition in Nature 399 (1999), 13. On the firing of the JAMA editor, JAMA 281 (1999), 1789-94. The former JAMA editor has started an electronic journal, BMJ 318 (1999), 1094; SA (May 1999), 32-3. The NIH is proposing circulation of papers on-line as a more efficient system, Science 284 (1999), 718. On the style of scientific papers, BMJ 318 (1999), 1224-5. A call for papers to spell out the author' roles is Nature 399 (1999), 406. On financial disclosure, JAMA 281 (1999), 1424-30. A book review on Kevles, DJ. The Baltimore Case is JAMA 281 (1999), 1439-40.

In general on science and ethics and the UNESCO/ICSU World Conference on Science see Nature 399 (1999), 12.

Euthanasia & Terminal Care

A book review of Griffiths, J. et al. Euthanasia and law in the Netherlands (University of Michigan Press, 1998) is in IDHL 50 (1999), 142-4. A series of 7 papers on physician-assisted suicide are in Ethics 109 (April 1999), 497-642. In general on euthanasia, BMJ 318 (1999), 1415-6; NEJM 340 (1999), 1517-8; JAMA 281 (1999), 1488.

Issues 16 and 17 of the Japanese journal Hospice and Home Care continue to publish papers from research in Japan on the subject, and the 7th Annual Meeting of the Japanese Hospice and Home Care Association was held on 26-27 June in Okayama University. On the problems of the long-term care giver, NEJM 340 (1999), 1587-90; and information need sin terminal illness, SSM 48 (1999), 1341-52. Also on home care, Lancet 353 (1999), 1423: JAMA 281 (1999), 1683-5.

A Canadian study of 57 cases is presented in Mitchell, S. & Lawson, FME "Decision-making for long-term tube-feeding in cognitively impaired elderly people", CMAJ 160 (1999), 1705-9, 1721-2. They concluded that the substitute decision-making process for tube-feeding in cognitively impaired elderly people is limited by a need for advance directives, lack of confidence in substituted judgment and poor communication of information to the substitute decision-maker by the health care team.

Organ Transplants & Brain Death

A report on Chinese use of executed prisoner's organs is Probe VII (No. 7, 1999), 2-3. A study of the charts of 209 patients who died at a Hospital in Calgary found a significant number of viable kidneys could be retrieved and transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors, CMAJ 160 (1999), 1573-6. Pennsylvania plans to directly reward organ donation, BMJ 318 (1999), 1371. On resource allocation in liver donation, JAMA 281 (1999), 1381-6.

DNA delivery from polymer matrices can be used in tissue engineering NatBio 17 (1999), 534-5, 551-4. The cloning of human organs may allow substitute organs, and a research review on how organs may reach correct shapes in vitro is Science 284 (1999), 422-4; NS (29 May 1999), 40-4.. Functional arteries have been found to be able to grow in vitro, Science 284 (1999), 489-93. On hemoglobin-based blood substitutes, NatBio 17 (1999), 545-9. Artificial kidney research using living cells may be better than dialysis, NS (8 May 1999), 20.

The FDA has put in place a defacto ban on xenotransplants from primates, NatMed 5 (1999), 465; see also Lancet 353 (1999), 1443-4. One of the fears of cross-species xenotransplants is new viruses, and an outbreak of a new virus related to Hendra virus, called Nipah virus, has come from pigs to kill at least 95 people in Malaysia, Science 284 (1999), 407; BMJ 318 (1999), 1232; NS (24 April 1999), 12; JAMA 281 (1999), 1787-8. The anti-rejection drug, cyclosporine may directly trigger growth of cancer cells, Science News 155 (1999), 187. On transplant tolerance, NatMed 5 (1999), 470-1.

The legal status of blood is discussed in Annas, GJ. "Waste and longing - The legal status of placental blood banking", NEJM 340 (1999), 1521-4. A review on the use of new nerve cells in adult brains is SA (May 1999), 48-53. Japan is starting to regulate use of human cells and tissues for research, NatMed 5 (1999), 473.

Body images are discussed in Ventura, M. "Corpus luris and body images. Juridical and artistic creation in bioethics", IJB 9 (No. 4, 1998), 11-22. On stem cell transplants, Lancet 353 (1999), 1544-5. The physiological processes of keeping the body symmetrical are discussed in SA (June 1999), 46-51.

Health Costs

Managed care can affect professionalism, HCR 29 (March 1999), 7-13; also NEJM 340 (1999), 1445. On primary health care, Health Care Analysis 6 (1998), 330-40. In the UK it has been advised that GPs must explain to patients if they are removed from waiting lists, BMJ 318 (1999), 1309. On the UK NHS, BMJ 318 (1999), 1092, 1302-3, 1155-6. Wealth is related to cancer survival, BMJ 318 (1999), 1163. Continuity of care may be lost, NEJM 340 (1999), 1362-4. On justice and ethics, Philosophy & Public Affairs 27 (1999), 251-91.

The WHO agenda is discussed in SA (June 1999), 28-9; Lancet 353 (1999), 1863; BMJ 318 (1999), 1305; Science 284 (1999), 911. Medical services are still declining in Iraq, Lancet 353 (1999), 1861; and on health in India and Pakistan, BMJ 318 (1999), 1132-5; New Zealand, BMJ 318 (1999), 1346-9; Sweden, BMJ 318 (1999), 1156-7; and USA, NEJM 340 (1999), 1503-6.


Prepared by Darryl Macer
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