Monopolies, Maricopa, and marketing: a case study

The development of preferred provider organizations in recent years has caused significant concerns about the antitrust implications of these new organizational arrangements among healthcare providers. The potential of being accused of price-fixing, monopolistic, or anti-competitive activity has concerned many health professionals involved in establishing PPOs. This article presents the nature of some of the antitrust arguments and a few representative cases demonstrating various rulings about the anti-competitive elements present or absent from various PPO arrangements. In addition, selected state and federal legislation concerning PPOs is discussed. In addition to understanding the antitrust issues involved in PPOs, establishing a PPO also requires the active involvement of the various key players in determining structural and pricing arrangements. The case study presented here demonstrates the use of marketing principles which emphasize the importance of participation and communication in decision making with physicians in the formation of a PPO.

Smoking and myocardial infarction: secondary prevention

This prospective study examines the question 'Is it too late to stop smoking cigarettes once you have had a myocardial infarction?' One hundred and nineteen cigarette smokers (90 men, 29 women) who survived their first myocardial infarction for one month were followed for five years or until their death if earlier. The age corrected mortality rate of men who continued to smoke cigarettes was 2.2 times the age corrected mortality rate of those who stopped smoking after their infarct. The women who continued to smoke had 2.4 times the age corrected mortality of those who stopped smoking. The age and sex corrected mortality rates for the combined group of men and women show that those who stopped smoking after their infarction have 55% of the mortality of those who continued to smoke (P less than 0.05). These results suggest that smoking is not merely a 'risk factor' for myocardial infarction but is also a causal factor whose effects can be avoided by both men and women after an initial myocardial infarction.

Exocrine pancreatic function in diabetes mellitus

An investigation of serum immunoreactive trypsin concentration and pancreatic isoamylase activity in patients with diabetes mellitus has shown that exocrine pancreatic deficit is maximal in insulin dependent diabetics, intermediate in those controlled with sulphonylureas, and absent in patients controlled with biguanides or diet or both. A significant correlation between the serum concentrations of both these pancreatic enzymes and C peptide was found. Serum pancreatic enzyme concentrations were not related to glycosylated haemoglobin concentrations, the dosage of insulin, or the age of onset of diabetes. The concentration of immunoreactive trypsin was found to be low in most of the insulin dependent diabetics in whom this enzyme was measured at the time of the clinical onset of diabetes. Thus exocrine pancreatic deficit in diabetes closely parallels the endocrine beta cell deficit and occurs concurrently with, or antedates, the clinical presentation of type I diabetes. It is therefore possible that in type I diabetes similar mechanisms are entailed in the pathogenesis of impaired endocrine and exocrine pancreatic function.

Characteristics of a calcitonin-responsive cell line derived from a human osteosarcoma

Although the primary cell type in human osteosarcoma is usually a neoplastic osteoblast, numerous other mesenchymal cell types may coexist in the same tumor. Previously described cloned, long-term osteosarcoma cell lines have had an osteoblastic phenotype. In this report, we describe a nonosteoblastic, long-term cell line derived from an osteosarcoma in a patient with Paget's disease. The cell line (FM-2) is nontransformed in having a low saturation density and anchorage-dependent growth, and it is nontumorigenic in nude mice. Important features of its fine structure include numerous elongated mitochondria, abundant Golgi and lysosomes, and a poorly developed rough endoplasmic reticulum. The line has high levels of lysosomal enzymes (acid phosphatase and N-acetylglucosaminidase) and low levels of alkaline phosphatase. It lacks numerous macrophage markers (lysozyme, C3, Fc receptors, and M1 antigen). The FM-2 line had a dose-dependent cyclic AMP response (7-fold increase) following treatment with calcitonin but not with parathormone. In 125I-calcitonin-binding experiments, we calculated approximately 5.3 +/- 0.2 X 10(3) receptor sites/cell with a kd of 1.8 +/- 0.1 X 10(-9) M. Conditioned medium from the FM-2 line was a potent stimulator of calcium release as assayed in a 45Ca-labeled fetal rat bone organ culture. This activity was not prostaglandin, vitamin D, parathormone, or epidermal growth factor, which are known stimulators of bone resorption. The FM-2 line does not appear to be derived from an osteoblast, macrophage, or fibroblast and may represent a calcitonin-responsive bone stem cell.

Renal dysfunction in cadmium smelters: relation to in-vivo liver and kidney cadmium concentrations

Biochemical indicators of renal dysfunction have been compared with liver and kidney cadmium levels measured by neutron activation analysis in a group of 37 cadmium smelters. Higher than normal concentrations of cadmium in the liver reflect past exposure; they were associated with evidence of renal dysfunction in workers exposed to cadmium for more than 10 years. A small group of 6 workers exposed to cadmium for only a short time (mean = 4.6 years) had high hepatic cadmium concentrations but normal renal function. Longitudinal studies are required to establish the natural history of renal dysfunction following cadmium accumulation in industrial workers.

Physical examinations in inner-city preschools

This paper describes the physical examination program started in March 1974 and carried out by the Anacostia Headstart Program in Washington DC. Annual totals of 362, 274, and 458 preschool children were examined in 16 schools during the 1973-1974, 1974-1975, and 1975-1976 school years, respectively. For these years, 8, 9, and 12 percent, respectively, had heart murmurs. The rates for abdominal hernias were higher, 11, 17, and 16 percent, respectively. Eczema was also a common problem. Parents had easy access to counseling from health professionals who worked in the program.

Clinical and chromosome studies in Fanconi's aplastic anaemia

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