2020 Vision Health in the 21st Century (1996) / Chapter Skim
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New Knowledge for Heatlh
New Knowledge for Heatlh
Pages 81-92
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From page 81... ...
Those with increased inherited susceptibility, that is, who have inherited the defective detoxifying enzyme, are at greater risk of becoming ill after exposure to the exogenous agent than those who have inherited an 81
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From page 82... ...
The notion of preventive medicine at a personal level is in some respects antithetical to the traditional social contract between a physician trained in the Western tradition and his or her patient. The contract reads, in essence: "If you become sick, then I am available for help.
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From page 83... ...
Further, posttranslational events can affect fimction, tropism, and the quality of the protein produced by the gene. In most cases disease is a consequence of complex interactions of many genes and exogenous agents in the environment.
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From page 84... ...
As more anc! more complex systems are consiclerecl, multiple genes, multiple products, multiple external agents all interacting will be chaotic if not organized into an unclerstanciable moclel which can then be subjected to experimental anc!
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From page 85... ...
There are about 300 million carriers of HBV in the world. Many of these people carry infectious and replicating virus, and a portion of them are at high risk of developing life-shortening chronic liver disease and hepatocellular cancer (HCC)
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From page 86... ...
This may be related to the genetic control of the human immune system, to the control of other factors, or to as-yet uncliscovered genes that clirectly affect the probability of chronicity. Environmental factors include elevated total body iron stores, which increases the probability of cancer in those who are chronically infected with HBV.
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From page 87... ...
The detailed interaction of exogenous agents and genes can be illustrated by the impact of aflatoxin, a potent carcinogen elaborated by species of the fungus Aspergilus, which can infect improperly stored grains and other foodstuffs. In a study in China (Table 1)
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From page 88... ...
for Hepatocellular Carcinoma Associated with and without Chronic Infection with Hepatitis B Virus (HBsAg) and with Urinary Levels of Aflatoxin in a Population from Shanghai Aflatoxin HBsAg Negative Positive Negative 1.0 3.4~1.1, 10.0)
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From page 89... ...
We will attain new levels of understanding because we will be generating unprecedented amounts of knowledge and because we will have enormously expanded computational data capabilities. Any scientist contributing to the genome database will collect billions of bits and bytes of information about the molecular basis of the genome.
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From page 90... ...
To the extent that genetic interventions begin to occur at the somatic cell level with individuals, the basic physician-patient relationship should not be altered significantly. However, the ability to intervene at the molecular level in somatic cell disease processes likely will generate considerable controversy at the socioeconomic and ethical levels.
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From page 91... ...
What if a high public priority is to limit health care spending and one important part of that policy in this new age of molecular medicine is to hold individuals more accountable for certain behaviors that substantially increase health costs? What if public policy wants to preclude the lung replacement surgery that is available, although at substantial cost, and to limit total spending on the lung conditions of those with relevant risk factors who did smoke or who work in an environment identified as high risk?
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From page 92... ...
There are many strong forces acting in the medical profession at the moment that would happily see us become more like employees and line workers, technicians, or skilled crafts people. The nationwide skirmish going on right now about who makes the call in the application of health care knowledge may presage larger battles to come.
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