Berson, Yalow, and the JCI: the agony and the ecstasy

The isolation of insulin in 1921 by Banting, Best, Collip, and Macleod stands as one of the most dramatic stories in modern medical investigation. Only two years passed between the initial experiments in dogs to widespread human application to the awarding of the Nobel Prize in 1923. Insulin-related research has also served as a focus, at least in part, for the work of three other Nobel Prize recipients: determination of the chemical structure of insulin by Frederick Sanger in 1958; determination of the three-dimensional structures of insulin and vitamin B12 by Dorothy Hodgkin in 1964; and finally, the development of immunoassay by Solomon Berson and Rosalyn Yalow in 1959-1960, which led to a Nobel Prize for Yalow in 1977 (five years after the untimely death of Berson). The history of Yalow and Berson's discovery and its impact on the field is an illustration of the adage that every story has two sides.     

Death, dying, and the brain

These cases have been cited and these issues presented to make the point that principles are often out of phase with perceptions. The argument is not that principles should cede to perceptions. This would imply resignation to the unlikelihood of moral development. Neither do we claim that perceptions should simply and generally capitulate to principles. This could mean an intolerable dictatorship of one philosophy over experience. Clinical ethics is the challenge to integrate principles and perceptions continuously and critically in resolving value conflicts about the best care of individual patients.     

Nurses, smoking, and the workplace

The purpose of this study was to examine attitudes and experiences of nurses regarding smoking and smoking cessation in the workplace. Eight focus groups were conducted with current or former smokers (n = 60). A questionnaire provided information about smoking history. Content analysis revealed six themes: taking breaks, stress and smoking, social support from colleagues, hiding smoking from patients and their families, impact of workplace smoking restrictions, and challenges to smoking cessation in the workplace. Nurses who smoke were perceived as taking more breaks and spending less time with patients than those who do not smoke. These findings document the impact of smoking among nurses in the workplace. Strategies are needed to support smoking cessation efforts of nurses as an important occupational health issue.     

Patients, physicians, and the Internet

Washington-based Group Health Cooperative has been providing personalized services to patients over the Internet for a year through the MyGroupHealth member portal. We continue to refine our communications to meet the needs of our patients online in the absence of experience comparable to that which we have gained in 54 years of in-person and telephone interactions.     

Anxiety,Arousal, and the Self-Concept

Too often, theories of emotions in humans are simple extensions of theories of emotions in subhuman animals. Though it is reasonable to extend our knowledge of emotions from lower to higher order animals, there is one major difference between man and other animals that imposes a serious limitation on this procedure. The difference is that man has a highly developed conceptual system that not only structures the content of what he fears, but itself must be defended against threat. Expressed otherwise, fears in animals are primarily a consequence of threats to life and limb, while in humans they are primarily a consequence of threats to ego. There are essentially two basic types of threat to ego, threats to the assimilative capacity of an individual's conceptual system, and threats to his self-esteem.     

Nutrition, aging, and the aged

Nutrition plays a significant modulating role in the aging process and is an important component in the health care of the elderly. While considerable study of the nutritional needs of the elderly has been accomplished in recent years, we are as yet very limited in our knowledge and understanding of the nutrient requirements of the elderly, the methodology for assessing nutritional status, and the impact of disease on the nutritional status of the elderly. Clearly, the dynamic interrelationships of nutrition, aging, and the aged emerge as pressing and important aspects of modern medicine. To probe into the intricacies of these relationships is a monumental challenge. This challenge will certainly accelerate in the future.     

Myeloma, paraproteinemias, and the skin

This review focuses on those systemic diseases or syndromes associated with monoclonal plasma cell disorders that may present with important cutaneous manifestations. Amyloidosis, POEMS syndrome, cutaneous plasmacytoma, xanthomas, benign hypergammaglobulinemic purpura of Waldenstr?m, and scleromyxedema are emphasized.