A genome-wide autosomal screen for schizophrenia susceptibility loci in 71 families with affected siblings: support for loci on chromosome 10p and 6.

Evidence from epidemiological studies and segregation analysis suggests oligo- or polygenic inheritance in schizophrenia. Since model independent methods are thought to be most appropriate for linkage analysis in complex disorders, we performed a genome-wide autosomal screen in 71 families from Germany and Israel containing 86 independent affected sib-pairs with parental genotype information for statistical analysis strictly identity by descent. We genotyped 305 individuals with 463 markers at an average distance of approximately 10 cM genome-wide, and 1-2 cM in candidate regions (5q, 6p, q, 8p, 10p, 18p, 22q). The highest multipoint LOD scores (ASPEX) were obtained on 6p (D6S260, LOD = 2.0; D6S274, LOD = 2.2, MHC region, LOD = 2.15) and on 10p (D10S1714, LOD = 2.1), followed by 5q (D5S2066, LOD = 1.36), 6q (D6S271, LOD = 1.12; D6S1613, LOD = 1.11), 1q (D1S2675, LOD = 1.04), and 18p (broad disease model: D18S1116, LOD = 1.0). One hundred and thirty-three additional family members were available for some of the families (extended families) and were genotyped for these regions. GENEHUNTER produced a maximum NPL of 3.3 (P = 0.001) for the MHC region and NPL of 3.13 (P = 0.0015) for the region on 10p. There is support for these regions by independent groups. In genome-wide TDT analysis (sTDT, implemented in ASPEX), no marker passed the significance level of 0.0001 given by multiple testing, but nominal significance values for D10S211 (P = 0.03) and for GOLF (P = 0.0032) support further the linkage results on 10p and 18p. Our survey of 22 chromosomes identified candidate regions which should be useful to screen for schizophrenia susceptibility genes.

Cooperation between health professionals from the United States and the Union of Soviet Socialist Republics. Conclusions from a trip to the Soviet Union.

The United States has long made its academic medical resources available to foreign medical graduates. Conspicuously absent from the number of foreign nationals, however, have been physicians, scientists, and educators from the Soviet Union. Under the new conditions of perestroika, Soviet medical professionals are seeking ways in which to open up broad collaboration with their American counterparts. Agreements are being sought between national organizations, between academic medical institutions, and for the exchange of individual scholars. Cooperation in the area of medical education is one of the distinctive bridges on the path to mutual understanding that will represent a strong link in the public diplomacy of the two superpowers. We recently had the opportunity to discuss in Moscow some of the issues with the U.S.S.R. Minister of Health and with the Pro-rector for International Programs of the Central Institute for Advanced Medical Studies, as well as with faculty members, young medical scientists, and medical students of the Moscow Medical Institutes. We describe briefly many of the similarities and some of the dissonances between our two health systems and set forth ideas for an exchange program in medical education.

The odyssey and outlook of graduate medical education.

The healthcare needs of our society are changing from hospital-based, disease-oriented services to community-based, prevention-oriented primary care. Medical educators must prepare the next generation of physicians for this transformation. Allopathic academic medical centers tend to be infatuated with technology, while osteopathic medicine always has been more oriented toward primary care. Osteopathic medicine is therefore in a better position to adjust its graduate medical education to meet society's need for primary physicians. Osteopathic medicine has a golden opportunity to create a new type of residency that will produce a genuine primary physician and give allopathic medicine a model to emulate.

How they've changed and how they're changing medicine.

Most Americans have, until recently favored a health care system preoccupied with treatment of disease, oriented around hospitals, and dominated by specialists. But this concept is being changed by economic, demographic, and technologic stresses. The public's new perception of how health care should be delivered is reflected by community-based medical services that emphasize health maintenance and that are dominated by primary physicians. It is not surprising that doctors are confused by this turn of events. Those who have built their careers around a particular set of concepts rarely find it easy to understand what is happening when the paradigm shifts. Nevertheless, understanding is essential if today's physicians--and tomorrow's--are to practice within the new health care system and continue to preserve medicine's professional values and traditions.

Medicine's great schism: prevention vs. cure: an historical interpretation.

All societies, primitive and advanced, demand therapeutic services, but a society must develop sophisticated prerequisites before it can support preventive services. This discordance in the origins of curative medicine and public health does not explain why a schism between them still persists. This gap should be closed since medicine has cured most curable diseases and the residue of chronic conditions is best handled by preventing them or detecting them before they become medical crises. Reasons for persistence of the schism include; early concentration of public health on environmental sanitation to the exclusion of medicine; identification of public health was governmental bureaucracy; linking care of the poor with tight-fisted welfarism; existence of two separate educational systems, the view of doctors, who are activists by nature, toward the excitement of cure; the custom of paying only for active therapy; and the orientation of the Hippocratic ethic toward individuals.