In treating the pathological gambler, MDs must overcome the attitude, 'why bother?' (includes related article) (column)

Article Abstract:

Compulsive gambling was first recognized in the Diagnostic and Statistical Manual of Mental Disorders as an impulse control disorder in 1980. It is described as a "chronic and progressive failure to resist impulses to gambling, and gambling behavior that compromises, disrupts, or damages personal, family, or vocational pursuits." The condition was first described as a disorder in the 1960s by Dr. Robert Custer who initiated the first treatments for compulsive gamblers and described the progressive stages which include winning, loosing and desperation phases. Although the condition has been accepted by the mental health community, few professionals are familiar with methods of diagnosis or treatment. This article presents an interview with Dr. Sheila Blume, a psychiatrist who specializes in counseling compulsive gamblers and their families. Dr. Blume is currently the medical director of a 334-bed private psychiatric hospital that specializes in alcoholism, chemical dependency, and compulsive gambling. Four primary behavior characteristics of the compulsive gambler were described by Dr. Blume: anticipation and involvement in the ritual of gambling; more gambling becomes necessary as a tolerance is built for what Dr. Blume terms the "action" of gambling which is similar to the effect of a drug; a loss of control is experienced over the frequency of gambling episodes; and the compulsion takes precedent over the gambler's job and family. It is estimated that one to three percent of the US population, about three million people, suffer from this disorder. Dr. Blume and other experts believe that further education of mental health professionals concerning this disorder is advisable. Many professionals do not understand the problem and, therefore, can not effectively treat those who suffer from this condition. Also included in this article is a case history of a compulsive gambler that illustrates the damage that can result from this disorder to both the individual and his or her family members.

Psychological aspects, Care and treatment, Interview, Gambling, Impulsive personality, Impulse control disorders, Compulsive gambling, Blume, Sheila

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Tough talk from the President's physician

Article Abstract:

Dr. Burton J. Lee III, a long-time friend of President Bush, holds a full-time position as 'the President's physician.' Dr. Lee supervises a staff of 16, including three other physicians, physicians' assistants, intensive care nurse and medical corpsmen. Prior to assuming his post, Dr. Lee was an oncologist at the Sloan-Kettering Cancer Center in New York City for 30 years. Dr. Lee intends to use his new position to speak out on important health policy issues. A high priority of his is to devise a means to control medical costs while making the medical system more accessible to the millions of people who are uninsured. In his view, one of the principal reasons for high costs and limited access to health care is the tendency of physicians to take a 'piece-work' approach to medicine, prescribing and charging for procedures and tests which are costly and unnecessary. The inherent conflict of interest, which makes it in the physician's financial interest to over-test and over-operate, has contributed significantly to the rise in medical costs. In Dr. Lee's view, if the profession does not deal adequately with cost control, solutions may be imposed on it in the form of government regulation.

Health aspects, Evaluation, Laws, regulations and rules, Practice, Political aspects, Health planning, Medical care, Cost of, Health care costs, Bush, George H.W., Lee, Burton J., III

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The double helix - Watson & Crick's 'freak find' of how like begets like

Article Abstract:

James Watson and Francis Crick discovered the structure of DNA in 1953. This discovery started the genetic revolution that occurred in biology and medicine during the second half of the 20th century. DNA is the nucleic acid that contains the genetic code for all living things. It is made up of two strands of nucleotide base pairs wound together to form a double helix, which can continually split apart and reproduce itself. The sequence of nucleotide base pairs encodes for proteins that the body synthesizes. Watson and Crick continued to analyze the genetic code and to investigate protein synthesis after their revolutionary discovery in 1953. In 1968, Watson published a personal account of their search for the structure of DNA. Some individuals criticized Watson for being cold and calculating after his book was published. Both men continue their biological research at different institutions: Watson at Cold Spring Harbor Laboratory and Crick at the Salk Institute for Biological Studies.

DNA, Discovery and exploration, Watson, James D., Crick, Francis

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