[Medical applications of genome discovery]

The discovery of the complete base sequence of human genome unveils several perspectives to understand human diseases and develop new therapies. Human genome contains approximately 39,000 genes of which 26,000 code specific proteins that have been identified. There are approximately 1,500 diseases with identified molecular disturbances. Genes can modify signs and symptoms of common diseases. Thus, there are no pure monogenic diseases. Chronic diseases of adults are complex and dependent on multiple factors. Several genes that predispose to chronic degenerative diseases have been identified. This is revealing the complex nature and the interaction of these ailments with the environment. The discovery of bacterial and viral genomic sequences will allow the manufacturing of new vaccines and specific molecular antimicrobials. The new pharmacogenomics will devise treatments for each subject according to her specific genomic profile. The new applications of genomic technology is creating new paradigms in biomedical research such as functional genomics, proteonomics, epigenetic regulation. Gene diagnosis and therapy will considerably improve the future of medicine.

[History of the scientific work of Eduardo Cruz-Coke Lassabe]

BACKGROUND

Eduardo Cruz Coke M.D., (1899-1974) was one of the precursors and pioneers of biomedical research in Chile, as professor of Physiological and Pathological Chemistry at the University of Chile, from 1925 to 1962. He was a disciple of Dr. Juan Noe and studied in Europe with the Nobel Prize winners Otto Warburg, Jean Perrin, Louis de Broglie and Frederic G. Hopkins. In Chile, he founded a scientific academy with disciples that later obtained the National Sciences Award, such as Hector Croxatto, Jorge Mardones, Hermann Niemeyer, Luis Vargas and Jorge Allende. He carried out pioneering research in metabolism, nutrition, endocrinology, oncology and nephrogenic hypertension. He published more than 50 scientific papers in French, English and Spanish. He founded scientific societies, edited journals and created the National Commission of Nuclear Energy. His books were "The ionic acidity in the clinic", "Preventive and directed medicine", "The adrenal cortex". He was Ministry of Health between 1937 and 1938 and passed important socio-medical bills. He obtained the distinguished international awards in Europe, the U.S.A. and Latin America. The Biomedical Sciences Institute of the University of Chile carries his name.

[UNESCO's bioethical norms to avoid eugenic practices]

The author, member of the UNESCO Bioethics Committee, participated in the preparation of the Universal Declaration about Human Genome and Human Rights, in 1997. The aim of this work is to analyze the initial articles of such Declaration, defining the bioethical principles that defend human dignity, freedom and rights, against the madness of the present biotechnological revolution. The development of genetics for the benefit of mankind will be guaranteed if these principles are honored. Genetic discrimination, reductionism and determinism, are identified by the author as perversions that, if used by biotechnologists, can lead to the rebirth of eugenism and racism, that were condemned by the Code of Nuremberg, in 1947. Investigators must assume their responsibility, respecting the principles of human dignity, the real freedom of research and solidarity among people. This attitude will avoid the use of genetics for purposes other than the welfare of mankind.

[The history of genetics in Latin American countries during the twentieth century]

The aim of this historical review is to evaluate the evolution of genetics in the context of Latin American scientific culture, to value foreign influences and to highlight the discoveries and contributions of Latin American geneticists. During the first third of the twentieth century, local naturalists, botanists and physicians understood the chromosomal theory of heredity and Mendelian theory of evolution and begun research and teaching on these new theories and technologies. During the thirties and forties, North American geneticists visited South America and formed development poles on cytogenetics and population genetics in Brazil and Argentina. During the fifties and sixties, human genetics was formally established in Brazil, Argentina and Chile. Genetics teaching became generalized in universities and national Genetics Societies were formed. In 1969, the Latin American Genetics Society was created, unifying the efforts of zoologists, botanists, physicians and anthropologists in an unique Latin American cultural space, organizing 11 meetings between 1972 and 1994. Latin Americans have made a great contribution in genome discovery of animal, vegetable and human species in their territory. They explored the great genetic diversity of the continent, discovering new genes and diseases. The biomedical area had the greatest development. In 1997, there were 130 medical genetics centers, 120 hospitals specialized in congenital malformations, 56 molecular biology centers and 26 molecular genetics centers. At the end of the twentieth century, human genetics is completely integrated to medical sciences in Latin America.

[Hippocratic philosophy]

The art of medicine was formed in Greece in close relationship to culture and philosophy. During the Christian era, it was projected through the Corpus Hippocraticus, in several ethical and philosophical documents such as The Oath of Medical Science, Medical Law, Decency, Precepts, Antique Medicine, Airs and Aphorisms, Waters and places. The central idea of Hippocratic philosophy is the principle of wholeness, summarized by Plato in the sentence "The certain knowledge of nature is solely possible from medicine and only when it is correctly approached as a whole". Clinical actions, are imbued by Hippocratic ethics; their aim is the ill that is an anthropos, a human being. The physician must take care of the ill with devotion, selflessness, comprehension and compassion. The oath is the supreme deontological code that summarizes the essential concepts of Hippocratic philosophy. Recent studies suggest that there is a great distance between the thinking of Hippocrates and present scientific medicine. Hippocratic philosophy rejects the epistemological principles of modern science. The Hippocratic logic is probabilistic and temporal and rejects the principles of noncontradiction, of identity and therefore the abstract determinism of contemporary science. The present force of the oath is explained because its ethics and epistemology are matters of medicine that understands the real world of the ill, trying to avoid suffering and injustice. Only Hippocrates can defend each ill as a whole with the wisdom of its philosophy.

[Autonomy accreditation of private Chilean universities (1994-1998)]

BACKGROUND

In 1995, a score to measure the quality of private universities in Chile, using excellency indicators as predictors of autonomy certification, was devised by the author.

AIM

To compare this score with autonomy certification results of ensuing years, to assess the usefulness of excellency indicators.

MATERIAL AND METHODS

During 1995, the records of 21 private universities in Santiago were studied. These universities were qualified using eight indicators of academic excellency. These results were compared with the Superior Education Council qualification results, obtained between 1996 and 1998.

RESULTS

The scores obtained by universities ranged from 19 and 137 points. Universities with the better scores obtained autonomy and those with the worst scores were eliminated. There was a good concordance between the score obtained in 1995 and the fate of autonomy certification.

CONCLUSION

The best predictors and indicators of academic excellency to certificate autonomy of private universities were the magnitude of indirect budget contributed by the state, the size of academic list of staff and the percentage of admitted students with scores over 573 in the national academic aptitude tests.

[Posthumous nomination for Medicine Nobel Prizes II. The positivism era (1849-1899)]

The author proposes the nomination of great physicians of the second half of the XIX century for a posthumous Medicine Nobel Prize. The valorization given by medical historians Garrison, Lavastine, Castiglioni, Lain Entralgo and Guerra, is used to select the better candidates. One to three names are assigned by year from 1849 to 1899. Four categories of Nobel prizes are assigned: a) Basic biological disciplines, b) Clinical and surgical medicine, pathology and specialties, c) Discoverers of transcendental diseases that are eponyms and d) New medical technologies. A total of 84 nominees for the Nobel Prize are presented. These lists are presented as preliminary and tentative to allow an extensive debate about the history of medicine during the nineteenth century.

[Posthumous nomination for Medicine Nobel Prizes. I. The Romantic Era (1800-1848)]

In the centennial of Alfred Nobel's death, the author proposes the nomination of great physicians of XIX century for a posthumous Medicine Nobel Prize. The valorization given by medical historians such as Garrison, Lavastine, Castiglioni, Lain Entralgo and Guerra, was used to select the best candidates. One to three names were assigned per year, from 1800 to 1848. Four categories of "Romantic Nobel Prizes" are assigned: a) Founders of basic disciplines (anatomy, chemistry, physiology etc); b) Masters of clinical and surgical medicine, pathology and specialties; c) Discoverers of transcendental diseases that are eponyms and d) Other great inventors or discoverers. A total of 66 nominees for the Nobel Prize, equally distributed between French, German and English physician, are presented. The omissions and limitation of this proposals are discussed.

[The genes of human hypertension]

In the last decade, two types of genes participating in the etiology of hypertension have been identified. The primary genes or blood pressure regulators are those that codify enzymes (renin, kallikrein, kininase, aminopeptidase), hormones (angiotensins, vasopressin, aldosterone, prostaglandins, and atrial natriuretic peptide) and substrates (angiotensinogen and kininogen). They cause arteriolar vasodilation or vasoconstriction or sodium retention in the extravascular space. Allelic polymorphisms associated to essential hypertension have been described. The secondary genes are those that produce hereditary diseases of low prevalence, associated to hypertension in 20 to 80% of patients (polycystic kidney disease, pheochromocytoma, adrenal hyperplasia, hereditary nephritis). Forty genes located in all chromosomes, that are dominantly, recessively or X-linked transmitted, have thus far been identified. Chromosomal maps with all genic loci are presented.

[Ethics code of the Chilean Biological Society]

The Chilean Biological Society has approved an ethics code for researchers, elaborated by its Ethic Committee. The text, with 16 articles, undertakes the main ethical problems that researchers must solve, such as institutional, professional or societal ethics, scientific fraud, breaches in collaborative work, relationships between researchers, participation in juries and committees, ethical breaches in scientific publications, scientific responsibility and punishments. This code declares its respect and valorization of all life forms and adheres to international biomedical ethical codes. It declares that all knowledge, created or obtained by researchers is mankind's heritage.

[50th anniversary of the great reform of Chilean medical education (1945)]

The author reminds the reform of medical education of 1945 in which he participated as a student. It was approved by the Decree #201 of april 2, introducing Chilean medicine into a new era of modernity. The reform was planned and conducted by professors Hernán Alessandri (1900-1980) and Alejandro Garretón (1900-1980) who proposed substantial modifications in the organization, methodology and contents of curricula. An active and formative medical teaching was imposed and scientific research was encouraged. The career lasted seven years and had 27 regular and five free courses. A Teaching Commission, with eleven professors and three students, was created to fulfill such reform during the deans-hips of Garretón and Alessandri. As a consequence of the reform, national medicine was modernized in the areas of public health and hospital assistance, since the number of professors, physicians and students increased in the new Faculties created in Valparaíso, Valdivia and Temuco. The teaching-assistance and basic-clinical relationships were consolidated, with the ensuing expansion of research and medical specialties. Bringing back this reform, we appraise its impact in the progress of Chilean medicine.

[Introduction to bioethics in contemporary medicine]

The author makes a historical revision of his 50 years experience in medical ethics as a student and physician. In 1944, medical ethics was traditional and resolved simple problems based on Hippocrates postulates and christian humanism. The present scientific and cultural revolution has impelled the rise of bioethics defined as "the systematic study of human behavior in life sciences, based on moral principles". The bioethical methods attempt to facilitate the application of universal ethical principles to the solution of complex cases, generated by the new medical technology. These ethical problems were posed in Chile in 1962 by the french professor Jean Cheymol, who reported the serious human rights abused derives from new scientific experiments. Later in 1973, Dr. Motulsky predicted the advent of "a brave new world" and the need to create a new biological ethic. These challenges were faced by the professors of the faculty of Medicine, who created ethics commissions in 1975 and edited medical ethics code texts. There are three players in the bioethic context. Physicians apply beneficence; patients defend their autonomy: the State and the society defends justice. A conflict of values lies in the bottom of bioethics. The author vindicates the coherence of traditional medical ethics. Philosophers, theologians and lawyers can only help physicians, but are not responsible. Bioethics must allow a frank dialogue between these professionals, respecting their roles and responsibilities.

Genetic epidemiology of single gene defects in Chile

We have studied the correlation between the ethnic structure and the prevalence of single gene defects in Chile. At present the Chilean population is approximately 64% white and 35% Amerindian with traces of other admixture. Fewer than 4% of the Chilean population are foreign born. Investigations indicate that all severe diseases and many others without impaired reproduction have mutation rates within the range of the white population. Classical ethnic diseases are very rare. Autosomal recessive disorders have a wide range of variability: cystic fibrosis has a low incidence and PKU has a similar incidence to English rates. Only 30% of the inborn errors of metabolism have been described in Chilean medical publications. In addition, no Chilean haemoglobin or haptoglobin variants have been described. Some rare inherited diseases in Chilean human isolates have been described, including achromatopsia, chondrocalcinosis, and Creutzfeldt-Jakob disease. The prevalence of intrahepatic cholestasis of pregnancy and supernumerary nipples is the highest in the world and they are associated with aboriginal origin. Single gene defects in Chile are probably shaped by factors related to its ethnic population structure. These local rare single gene defects may be good markers of population admixture for genetic epidemiological studies.

[Ethical principles in human scientific research]

Hippocrates was the first physician to use the scientific method to find rational and not religious or mythic causes, for the etiology of diseases. Hippocrates and Aristoteles did not dare to dissect the human body. Afterwards however, many scientists such as Herophilus, Erasitastrus, Vesalus and Fallopio, performed experiments in human beings using vivisection. According to that age's ideas, there was no cruelty in performing vivisection in criminals, since useful knowledge for the progress of medicine and relief of diseases was obtained. Only during the nineteenth century and with Claude Bernard (1865), the ethical principles of systematic scientific research in humans were defined. These principles were violated by nazi physicians during Hitler's dictatorship in Germany (1933-1945). As a response to these horrors, the Ethical Codes of Nuremberg (1947) and Geneva (1948), that reestablished all the strength of Hippocratic principles, were dictated. The Nuremberg rules enact that a research subject must give a voluntary consent, that the experiment must by necessary and exempt of death risk, that the research must be qualified and that the experiment must be discontinued if there is a risk for the subject. The Geneva statement is a modernized hippocratic oath that protects patient's life above all. These classical rules, in force at the present time, are the essential guides that must be applied by physicians and researchers.

[The evolution theory in the medical sciences in Chile]

The evolutionist ideas of Lamarck, Darwin and Haeckel entered the country through the arrival of their books. "On the origin of Species" arrived in Chile in 1869. The most outstanding immigrant european physicians that discussed these ideas were Rodulfo A Phillippi (1808-1904) and Juan José Brunner (1825-1899). Both discussed Darwin's ideas in their books and conferences as academics of the Faculty of Medicine of the University of Chile. The first Chilean physicians that read and discussed the validity of evolution theory were Adolfo Valderrama (1834-1902) and Pedro Candia Salgado. Both wrote articles about this matter in Revista Médica de Chile in 1872 and 1874. The professor of general biology, Juan Noé Crevani, italian physician and zoologist that arrived in Chile in 1912, was the first to teach directly the concepts of the evolution theory until his death in 1947. Professor Noé founded the great biological school of the twentieth century in Chile and his disciples introduced the concepts of Mendelian theory and neodarwinism in the decade of fifties. The theory of evolution was taught as a chapter of general biology in the Faculty of Medicine between 1913 and 1947, but its practical applications to medicine were introduced with the birth of medical genetics in the decade of fifties and the foundation of Chilean Genetics society in 1964, under the direction of professors Danko Brncic and Gustavo Hoecker, both awarded with the National Sciences Prize.

[Fiftieth anniversary of classical genetics of professor Noe (1943-1993)]

Fifty years ago, the author was a student of Dr Juan Noé's general biology course. Dr Noé, an italian physician and biologist, was the most outstanding european teacher in Chile during the first half of twentieth century (1912-1947) and was the founder of the "Instituto de Biología de la Universidad de Chile". In 1943 Dr Noé taught to the author the classical genetics of that age that included basic concepts of mendelian theory, evolution, comparative anatomy, cytogenetics, eugenics and normal and pathological inheritance. He also undertook controversial problems of those times such as eugenics, racism, humanism and the ambiguity about "inherited defects" associated to syphilis, alcoholism and tuberculosis. The author received a firm education on the history of biological sciences, mendelism, evolution and genetic etiology of classical hereditary diseases such as hemophilia, daltonism, Huntington chorea and muscular dystrophy. Furthermore, Noé made mention of the hereditary etiology of cancer in animals and human leukemias and of the concept of polygenic diseases as a consequence inheritance-environment interactions. The author concludes emphasizing the importance of basic and clinical education in the teaching of medical genetics.

[Ethical principles to investigate the human genome]

The scientific community is becoming aware that mankind has started to directly manipulate the mechanisms that transmit life and guide our species evolution. These facts are overflowing the traditional concepts about humanism and medical ethics, with an unpredictable scope. Presently we are conscious that there is an universal and biological order that rules life in our planet. At the molecular level there is an hereditary order and scientists have established the "central dogmas" of molecular biology and "genetic creed" of Mendelian theory in population genetics. The biotechnological revolution of the last decades is dismantling the normal processes of biological balance through the early detection and healing of defects, the manipulation of reproduction and the rupture of species boundaries with interspecies hybridization. All these issues open debates about the ethical limits of scientific research freedom. As a consequence, the dictation of genetic ethical codes has been proposed and statements that restrain genic therapy methods, genetic heritage manipulation and the patent right for DNA sequences, have been approved. The Valencia Statement (1990) on ethics about human genome tries to conciliate and establish a minimal consensus among scientists. However it seems that we are tearing down the frontiers that keep the sanctuary of biological order closed and damaging the twentieth century science dogmas.

[The Expulsion of the Jesuits (1767) and its impact on Chilean medicine in colonial times]

In the mid XVIII century medical education was started in Chile with the foundation of the University of San Felipe. However, King Charles the Third expelled the Jesuits from the Spanish Empire in 1767 resulting in clear deterioration of medical development. Jesuits concentrated the cultural elite of the country and had the best professionals and libraries. A restrictive intervention from the Spanish government led to the establishment of a "Protomedicato" whose first director was Dr Jose Antonio Rios who remained in office for 40 years. At the end of the Colonial period, only 4 latin physicians and 3 bachelors in Medicine had graduated from the Universidad San Felipe, from an initial enrollment of 38 students in half a century. Only 5 among 25 doctors practicing in Chile in the first half on the XIXth century had been born in this country. This shortage was a severe handicap in the fight against smallpox and other plagues. Only the foundation of 2 hospitals (San Borja and Valparaíso) can be mentioned as positive actions coming from the Spanish government, and this was possible by using funds confiscated from the Jesuits. It was only after the establishment of the Republic and the foundation of the University of Chile, that medical development could again flourish in this country.

[150 Years of the University of Chile School of Medicine (1842-1992)]

The development of medical education during colonial times was slow due to problems analyzed elsewhere. In 1833, the first Medical School of the Republic was founded at the National Institute. The first four physicians graduated in 1842. The University of Chile was founded on november 19; 1842, Andres Bello being its first Rector. Medicine was among the first 5 Faculties. Two Chileans, Luis Ballester and Francisco Javier Tocornal and 6 foreigners, the Britishmen Thomas Armstrong, Nathaniel Cox, Juan Blest and Guillermo Blest and the Frenchmen Lorenzo Sazie and Julio Lafargue were the first Faculty members. Sazie was named Dean in 1943 with Tocornal as Secretary. A new curriculum was developed in 1845. The University of Chile and its Faculty of Medicine, as state supported non confessional and national institutions have played a fundamental role in the cultural and medical development of the country. Graduates from these institutions were instrumental in the development of social medicine during the XXth century.

[Antitubercular agents: pharmacogenetic factors in the development of adverse effects]

We studied the distribution of the acetylator phenotype in 47 patients aged 15 to 77 years receiving isonyazid as antituberculous therapy. 62% were fast and 32% slow acetylators. Ethnical, socio-economic and biologic factors were not related to acetylator type. The incidence of liver alterations, mainly elevated transaminase levels, was higher than reported in the literature and was not shown to be influenced by acetylator type. Adverse reactions to isonyacid were not related to drug serum levels.

A general diagram of the human genome

A general diagram of the whole structure of the human genome is drafted on a logarithmic metric scale located in the radius of a circle showing a full haploid set of chromosomes. A base pair scale of DNA is displayed in circumferences at different orders of magnitude from one metre down to one picometre (10(-12) m).

[Chilean medicine during the government of President Balmaceda]

This is a conference dictated on the occasion of the centennial of the First Chilean Medical Congress, the foundation of the first Public Health Council and the School of Medicine of the University of Chile (1889). During the government of president Balmaceda, prominent Chilean physicians and University professors were closely linked to the presidency, often in public office or Congress. The conditions were then created for an accelerated development of many aspects of Chilean Medicine, including the construction of 20 general hospitals nationwide, and major sanitary advances. Medical education was greatly improved by changes in curriculum following the European tradition. At the first Chilean Medical Congress, plans for a national policy for public health protection were elaborated. After 100 years, the action of such founders of Chilean Medicine can only be nostalgically admired.

[The National Museum of Medicine. III. The parliamentary period (1891-1925)]

During the european "belle epoque" and the period of positivism, Chilean medicine under a parliamentary regime, experienced great progress. Biomedical research began at the laboratories of the School of Medicine, University of Chile; the Sanitary Code, dictated in 1918, and the creation of the Ministry of Health (1924) may be considered the origin of social medicine in Chile; a new school of Medicine in Concepcion and Schools of Dentistry and Pharmacy in Santiago were created. Main public hospitals in Santiago and the "Asistencia Pública" were inaugurated at that time. Paintings of prominent physicians related to these activities are in display in the Museum. Most of the deans and distinguished professors of Medicine at that time had considerable political influence, many of them being simultaneously involved in governmental positions. This may explain why resources became available for a process which may be described as the development of Chilean medicine to serve the people.

[The National Museum of Medicine (II). The Republican period (1831-1891)]

This paper deals with the historic aspects of the XIXth century section of the Museum. Pictures, documents, objects and instruments of physicians at that time are displayed. This is the time of birth and development of Medical Education in Chile, with the creation of the School of Medicine (1833) and the Faculty of Medicine at the University of Chile (1843). New hospitals (Salvador, San Vicente and San José) were founded around 1872. The first Faculty members came from Spain, England, France and Germany, and were joined by some Chilean professionals. The new School of Medicine Building was inaugurated in 1889 and the Bureau of Public Health created at that time. The first Chilean physicians to obtain fellowships around 1874 brought the specific and technological advances found in Europe.

[The National Museum of Chilean Medicine: I. The Colonial period]

The first museum of Chilean Medicines was founded by Dr Enrique Laval in 1955. The new museum is a fusion of this one and patrimony of the School of Medicine and the ancient San Vicente Hospital. It was created in 1987 by the present Dean, Aleksandar Goic. The present article describes one of the halls, the Colony. Pictures of Governors and Conquerors who founded the first hospitals are in display. The period of Religious Medicine (1616-1823) is represented by pictures and religious objects, as well as hospital utensils. The times of the University of San Felipe and the "Protomedicato" (1756-1839) includes pictures and documentation from the first colonial physicians. Chilean medicine at that time stayed at a medieval level, lacking the influence of the Renaissance, the Barroque and other movements enlighting european medicine.

[Genetic factors as determinants of drug response]

Pharmacogenetics deals with the influence of genetic factors upon the response to drugs. Therapeutic and side effects are affected by pharmacokinetic and pharmacodynamic changes. Classic examples are presented, in particular those concerning mechanisms of oxidation, acetylation and hydrolysis. The impact of this discipline on therapeutics is discussed.

[The genes of the Pascuense population]

An analysis of the interaction of evolutionary factors such as migration, mutation, selection random drift, and consanguinity upon the genome of Easter islanders is attempted. As many primitive populations, the Easter islanders genome has at least 2/3 of genetic loci in an isogenic state. The HLA system is reduced; other polymorphisms present high genic frequencies differentiating Easter islanders from other Andean and european populations. They are more similar to polynesians, with whom they share language and culture. Migration has been the main factor affecting the Easter islanders genome, leading to a ten fold increase in population and a 60% caucasian admixture. A linkage disequilibrium of the HLA9, w10 haplotype exists. In XIX century generations consanguinity was very low (alpha coefficient 7 x 10(-5) which may be explained by the exogamic tradition of the population; this acted as a factor opposed to random drift. A recent decrease in infant mortality rate leads to a relaxation of natural selection and contributes to hybridization of the population.

[The human genome in clinical medicine]

A revolution is taking place in Medicine as a consequence of advances in biotechnology and informatics. The unraveling of the human genome with a description of chromosomal maps for all structural genes affords a new framework for the understanding of etiology, diagnosis and prevention of every disease. More than three thousand million nucleotides codifying over 100 thousand genes may be manipulated by RNA recombinant techniques in order to identify location and help understand pathogeny as well as diagnosis and treatment of disease. Relevant techniques for genome desciphering include familial linkage, somatic cell hybridization, RFLPs, enzymatic quantification and analysis of chromosomal aberrations. Pathology of the genome may originate from germinal or somatic mutations. Resulting diseases may be classified as classic disease, physiologic disorders, congenital malformations and chromosomal aberrations. All diseases arise from alterations in the genome. Substitution of defective genes offers new forms of therapy. Advancing knowledge in this may lead to better control and prevention of genetic diseases.

Correlation between prevalence of hypertension and degree of acculturation

Epidemiological evidence indicates that the development of hypertension in human populations depends on the interaction of a genetic heterogeneity and multiple environmental factors. The purpose of this research is to demonstrate the hypothesis that the rise of prevalence of hypertension in developing countries is real and associated with the influence of environmental factors created by the process of 'acculturation'. I have studied all reported prevalence rates of hypertension in Chile between 1936 and 1984. Data from 31 studies in urban and rural populations were correlated to demographic markers of acculturation, life expectancy at birth and urbanization trend (%). Results showed that during this period life expectancy rose from 40 to 67 years and urbanization trend from 51 to 80%. These correlated with the secular increase in the prevalence of hypertension, from a 5% level to almost a 20% level. The study of the cultural breakdown of six rural isolated populations showed after a mean of 15 years a highly significant increase in hypertension prevalence from 1.5 to 7.5%. These positive findings support the hypothesis that the change in prevalence of hypertension in the Chilean population during half a century may be associated with the process of cultural transition to an industrial state.

Translocation chromosome map of oncogenes

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Cardiovascular diseases in Chile

In 1938, Chile became the first developing country to establish a state health system for the prevention of cardiovascular diseases (CVD). Although prevalence of CVD risk factors (smoking, high cholesterol and triglycerides, hypertension, and atherosclerosis) is lower than in industrialized countries, over the last 50 years CVD incidence in Chile has increased considerably. Cardiovascular disease is diagnosed in 25% of outpatients in departments of the National Health Service. Hypertension is the first cause of morbidity among the adult population (10%). Between 1960 and 1980, CVD mortality increased from 14 to comprise 27% of all deaths. Age-specific mortality for ischemic heart disease increased during the same period from 407 to 699 per 100,000 population. Surveys of the general adult population showed a prevalence of hypertension of almost 20%. Community hypertension follow-up programs obtained only 50% compliance, and blood pressure was normalized in only one-third of hypertensive patients. It is probable that the low standard of living may have influenced the poor results of prevention programs.