Prerequisites for global child and adolescent mental health.

The epidemiology of the mental and physical health of children and adolescents the world over reflects: the genomes they inherit (and the modifications those genes undergo in utero); the pregnancies that led to their births, whether their mothers survive those pregnancies, and whether their births were welcome; the parents, the neighbors, and the neighborhoods they 'inherit' along with their genomes; when and where they live (by cohort, by country, and by province); the air they breathe; the water they drink; what and how much they eat; the schools they attend (and by whom they are taught what and for how long); the energy they expend; the family status in the social order; the friends they have; and last but not least, the amount and kind of medical and psychiatric care they receive.

Occupational deaths among healthcare workers.

Recent experiences with severe acute respiratory syndrome and the US smallpox vaccination program have demonstrated the vulnerability of healthcare workers to occupationally acquired infectious diseases. However, despite acknowledgment of risk, the occupational death rate for healthcare workers is unknown. In contrast, the death rate for other professions with occupational risk, such as police officer or firefighter, has been well defined. With available information from federal sources and calculating the additional number of deaths from infection by using data on prevalence and natural history, we estimate the annual death rate for healthcare workers from occupational events, including infection, is 17-57 per 1 million workers. However, a much more accurate estimate of risk is needed. Such information could inform future interventions, as was seen with the introduction of safer needle products. This information would also heighten public awareness of this often minimized but essential aspect of patient care.

Are genes destiny? Have adenine, cytosine, guanine and thymine replaced Lachesis, Clotho and Atropos as the weavers of our fate?

It is as futile to ask how much of the phenotype of an organism is due to nature and how much to its nurture as it is to determine how much of the area of a rectangle is due to its length and how much to its height. Phenotype and area are joint products. The spectacular success of genomics, unfortunately, threatens to re-awaken belief in genes as the principal determinants of human behavior. This paper develops the thesis that gene expression is modified by environmental inputs and that the impact of the environment on a given organism is modified by its genome. Genes set the boundaries of the possible; environments parse out the actual.

Complementary and alternative medicine: what is its role?

Complementary and alternative medicine (CAM) remedies vary greatly in safety and effectiveness. Then why is their use increasing at a time when evidence for the effectiveness of "orthodox" treatments is greater than ever before? Dazzled by technology, physicians dismiss "nonspecific" treatment effects as mere "placebo" and ignore the effects of caring. Over half of patients with anxiety or depression consult CAM practitioners in any given year. The popularity of CAM attests to its responsiveness to patients' search for more than procedurally oriented care. It reflects biomedicine's failure to give patients the time they need to tell their story and to explain the nature of problems they face, and its failure to provide sufficient information to allow patients their choice among therapeutic alternatives. Effective CAM practices should be incorporated into care, whether treatments are provided by biomedical or CAM practitioners.

Is biology destiny? Is it all in our genes?

The completion of the working draft of the human genome in 2001 is an important milestone in achieving greater understanding of the role of genetics in health and disease. This very important technological achievement holds both promise and peril for the theory and practice of medicine. The author discusses how the information in the genome, coupled with insights into the interactions of gene and environment, may revolutionize clinical practice and eventually make it possible to tailor diagnosis and treatment to the allelic and experiential nature of the individual patient. He also points out the dangers of leaping from gene discovery to premature diagnosis and unproven interventions that may endanger patients and gives several examples of such occurrences. What is known about the relationship between gene and phenotype is reviewed and examples of the different phenotypes that may arise with identical genomes are presented to illustrate how environment influences gene expression, both in humans and other species. Finally, the author considers the challenge in conveying newly gained knowledge of genetic risk in ways that will benefit rather than harm patients.