The author outlines historical and current reasons that the National Institutes of Health (NIH) and academic medicine are inherently political and are now facing expanding political exposure. She emphasizes especially the power of modern discoveries in biology; this power stems from the many practical benefits that these discoveries can bring and their economic implications, and the growing public awareness of these benefits and implications. She then discusses the political realities of the biomedical enterprise, illustrating them by describing the nature of issues surrounding (1) the NIH budget and (2) technology transfer. Discussion of the latter topic includes a detailed description of controversies about patents (which revolve around the issue of who owns and controls the distribution and use of scientific information) and several important policy issues that are raised by these controversies (e.g., should there be uniform international policies regarding intellectual property rights associated with discoveries of novel biologically expressed genes of uncertain in-vivo function, and if so, how is that achieved?). The author concludes by stating that these examples of the politics of knowledge and of the NIH are among many vital biomedical issues of American life (which she lists) that require the academic medicine community to look beyond its own walls and participate in the complex world of politics and public policy.

Economics, Medical↗

PubMed1990

Atrial natriuretic factor in patients with right ventricular infarction.

To determine the possible role of atrial natriuretic factor in right ventricular infarction, serial measurements of this hormone were performed in 21 patients with acute inferior myocardial infarction. All patients underwent enzymatic, electrocardiographic, echocardiographic and coronary arteriographic studies. Ten patients also had right heart hemodynamic measurements. Eight patients had evidence of an associated right ventricular infarction (Group I) and 13 patients did not (Group II). Enzymatically estimated infarct size, presence of left heart failure and arrhythmias were similar in both groups. Mean arterial pressure in Group I (72.1 +/- 4.4 mm Hg) was significantly lower (p = 0.02) than in Group II (89.5 +/- 4.6 mm Hg). Seven (88%) of the eight patients in Group I had elevated right atrial pressures and a higher incidence than Group II of prolonged hypotension (75%) and right ventricular dysfunction (75%) clinically and by echocardiography. Plasma atrial natriuretic factor levels (mean values +/- SEM in pg/ml) for days 1, 2, 3 and 7 after infarction were, respectively: 152 +/- 30, 165 +/- 48, 199 +/- 27 and 189 +/- 31 for Group I versus 55 +/- 9, 55 +/- 11, 61 +/- 13 and 77 +/- 20 for Group II. The difference between groups was significant for days 1 (p less than 0.05), 3 and 7 (p less than 0.01) and not significant for day 2 (p = 0.07). These findings show that atrial natriuretic factor elevation is part of the neurohumoral response to right ventricular infarction and are consistent with the hypothesis that atrial natriuretic factor may play a pathophysiologic role in the right ventricular infarct syndrome.

Adult↗