The formation of drug policy is a complex phenomena influenced by a multi tude of sources. Among others, these influences include historical factors, contemporary public opinion regarding the nature and magnitude of drug use and abuse, the portrayal of illicit drugs and drug use in the media, and lobbying efforts by special interest groups (e. g. , The Drug Policy Foundation), including government agencies (e. g. , the Justice Department and law enforcement). An additional source of influence are the activities of specialists directly engaged in studying drug use and treating drug dependence. This includes individuals involved in drug treatment, anthropological and cultural studies, policy analy ses, basic psychological and pharmacological research, research on the epide miology of drug use and dependence, and research on prevention. This influ ence by specialists might be usefully distinguished from those influences first mentioned for two reasons: First, studies of drug use and dependence attempt to uncover empirical generalizations about drugs, and second, because these findings are empirical, there is a hope that they guide, at least to some extent, the actions of other forces that more directly determine drug policy. Psychology as an empirical discipline has long been interested in the use of psychoactive drugs. At the level of basic science in psychopharmacology, a most important contribution has been the demonstration that drugs of abuse function as reinforcers and thus enter into the same psychological processes as do other appetitive stimuli.

Recent Developments in Graves' Ophthalmopathy offers an overview of the pathogenesis, assessment and management of patients with thyroid-associated eye disease. Each chapter is written by an expert and truly represents the current state of the art on the particular topic. This book can therefore almost be considered a textbook on this enigmatic disorder. Recent Developments in Graves' Ophthalmopathy is designed for all those interested in this disease, including basic scientists, clinical endocrinologists, ophthalmologists, radiotherapists, and orbital surgeons. The book gives a comprehensive overview of all aspects of Graves' ophthalmopathy. Subjects covered include the pathology of Graves' eye disease and the controversial views on its autoimmune pathogenesis; assessment of the eye changes using reliable measurements; medical management of Graves' eye disease with an overview of the many treatment options available to the clinician, including orbital radiotherapy and other immunosuppressive treatments; management of the thyroid disease; and finally, the techniques for performing various surgical procedures, which are explained and illustrated.

Statistical methods are becoming more important in all biological fields of study. Biometry deals with the application of mathematical techniques to the quantitative study of varying characteristics of organisms, populations, species, etc. This book uses examples based on genuine data carefully chosen by the author for their special biological significance. The chapters cover a broad spectrum of topics and bridge the gap between introductory biological statistics and advanced approaches such as multivariate techniques and nonlinear models. A set of statistical tables most frequently used in biometry completes the book.

From the President of the Research Society on Alcoholism This annual book series is a valuable resource for the alcoholism field, because it provides critical and timely reviews of selected areas that have interest to both practitioners and researchers. It tries to achieve a balance between psy chosocial and biomedical topics and between research and patient-care activ ities. Such a mix is offered in Volume 6. The Research Society on Alcoholism whose membership embraces researchers from all disciplines that study the etiology, treatment, and prevention of alcoholism and alcohol-related disa bilities-regards the support and sponsorship of this book series as one of its major missions. Ting-Kai Li, M. D. President, Research Society on Alcoholism From the President of the American Medical Society on Alcoholism and Other Drug Dependencies The broadening scope of clinical and scientific interest in alcohol dependence is reflected in this sixth volume of Recent Developments in Alcoholism. It offers valuable reviews on important current issues in the field, namely, the inter twining of nature and nurture, a continuing search for predictors and indi cators of the disease, and the social impact of alcoholism on the job and in special populations. This material should pique the interest of clinicians from all disciplines. Medical, social, and political planners also need to turn to the expanding body of knowledge in the field of chemical dependence reflected here. The volume is therefore of value to a contemporary readership and to those who will turn to it in future years.

Significant progress has been made in recent years in understanding the origins of cutaneous maligant melanoma. Knowledge of the relationship between solar radiation and melanoma has changed and it now appears that both the character and timing of exposure may be more important than total cumulative dose in accounting for risk. The melanoma-sunlight model may prove an instructive heuristic exercise for environmental epidemiology, as we currently tend to restrict ourselves to a search for uniform total dose--response relationships between cancers and suspected environmental carcinogens. The study of the relationship between acquired melanocytic nevi and melanoma has led to useful new information about predictors of melanoma risk, and in addition has opened new perspectives on the development of nevi in children. Definition of the factors for nevus development in children may lead to the possibility of primary prevention programs for melanoma in younger generations of children. Recent new evidence suggests that certain occupational groups may be at elevated risk of melanoma. A great deal of work is going into the study of ways of screening high risk populations in order to detect melanoma at its earliest stages when current treatment protocols are most effective. The visibility of lesions on the skin challenges classical definitions of early detection and screening in epidemiology.

Seer, forecaster, prophet, geomancer, or tout - all predict future events as physicians must. The medical activity is prognosis from the Greek pro (forward) and gnosis (special knowledgeL thus foreknowledge, and the practitioner is the prognosticator, a sobriquet which falls unhappily upon the ear. Like it or not, there is nothing more critical in the management of chronic rheumatic conditions than a reasonably clear picture of what time and disease will bring. The knowledge is so much a part of ordinary medical thinking that we rarely grace it with the label prognosis. But, like so much of "ordinary medical thinking" (an oxymoron, perhaps), quantitative data are very thin and the chestnuts of personal observation and authority figure assertion loom large. Unlike several books I have seen or written, this one on prognosis needs no justification. The entirety of a person's life contributes to and confounds what the future holds. The ingredients include education levet income, support structures such as family, housing, occupation, availability of medical services, diagnosis, treatment, rate of disease progression, age, gender, race, marital status, and others too numerous to mention or too arcane to be recognized. One would think the task of estimating prognosis impossible. And yet there is light on the horizon -we do know a few things such as the effect of high rheumatoid factor titers on the prognosis of RA or the likely outcome of certain kidney lesions in SLE.

This book contains the latest information on surveillance by the international public health community, including: the WHO's Stepwise Approach, the U.S.'s Behavioral Risk Factor Surveillance System, the Finbalt Health Monitor, the EURALIM Experience, and the Mega Country Health Promotion Network. It is for those involved in planning or conducting chronic disease risk factor surveillance and for those interested in developing a global network of persons involved in this arena.

The Monograph deals with the conception, planning, implementation, results and conclusions of the International Witches' Broom Project (IWBP), which was set up in 1985 with the aim of producing an economic management system for witches' broom disease of cocoa. The contributions of the various sponsors, and the roles played by the participating organizations and scientists are described in the introductory chapter. Chapter 2 provides a review of what was, and what was not known from published literature about the cocoa witches' broom pathosystem in 1989. The scope of the project and the approaches used are covered in Chapter 3, while Chapters 4 to 13 report on the field studies themselves in detail. The recent appearance of witches' broom in the important cocoa area of Bahia in Brazil is described in Chapter 14, before disease management recommendations are summarised and future prospects considered in the closing chapters. The many man-years of field research in the IWBP in a total of six countries generated much useful information which was analyzed both in the individual countries and collectively. Even with a document of this size, certain information and analyses with less direct relevance to disease management had to be omitted. It is expected that more detailed treatments of certain aspects will emerge in scientific papers, and further analyses will be undertaken."

This book is a logical companion volume to Women at High Risk to Breast Cancer (Kluwer, 1989) edited by me previously. It distinguishes two aspects of current ap proaches to clinical breast cancer prevention. The first is the need to advise individ ual women on how they might reduce their personal risk, while the second is the design of measures aimed at reducing the total incidence of breast cancer in the community. While the former is a problem faced daily by clinicians, the latter is a goal which will involve large scale, carefully planned interventional studies. Because knowledge of the risk factors for breast cancer is incomplete and clinical trial reports are scarce, there is as yet, no scientifically-based model for personal breast cancer prevention. Nevertheless, widespread publicity associated with breast screening programmes has created a large group of highly anxious women who have been informed that they are at higher than average risk to the disease. They are con cerned by the personal threat posed by a family history of the disease and by the al leged dangers of obesity, diet, alcohol, or the use of hormonal agents such as oral contraceptives or hormone replacement therapy."

Based on findings from a sample of nearly 1,100 Puerto Ricans living in the New York area, this book posits that adhering to traditional cultural values (for example, the family) has the socially desirable consequence of discouraging such deviant behaviors as substance abuse. The authors conclude that promoting specific values will not prevent certain individual and social ills; rather, promoting a 'sense of tradition' itself is needed.

When an accident involves many people and when its consequences are many and serious, we speak of a disaster. Disasters have the same causal fac tors as accidents: they differ from accidents by the gravity of consequences, not by causes. The action of a single individual may result in thousands of deaths and huge financial losses. The metal fatigue of a screw may, by a chain of events, cause an explosion killing hundreds or lead to a break in a dam and a devastating flood. The fact that minor and unpredictable acts can lead to disasters is im portant because it allows us to predict that the years to come will bring with them more disasters with ever more severe consequences. The density ofhu man populations is growing. By the year 2025 some four fifths of the world's population will be living in urban settings. An explosion or a gas leak in a densely populated area will cause incomparably more damage than a simi lar event in a rural area. Modern technology is immensely powerful (and its power is continuing to grow) and can be used in a disastrous manner. Ag gression is just as possible now as it was in the past, but the tools of aggression are vastly more dangerous than ever before. This book, edited by Johan M. Havenaar, Julie G. Cwikel, and Evelyn J. Bromet, is therefore very timely.

nd This book stems from the 2 Parkinson's Disease Symposium on "Neurotoxic Factors in Parkinsons disease and related disorders", held on August 6-7,1999 at the University ofUlm Medical School in Ulm at the Danube, Germany. The symposium wasalso asatellite ofthejointmeetingofthe InternationalSocietyfor Neurochemistry (ISN) and the European Society for Neurochemistry (ESN) that followed immediately afterwards in Berlin. The specific topic, neurotoxic factors in Parkinson's disease (PD), was chosen in light of accumulating neurobiological and epidemiological evidence indicating that the causes of this second most common neurodegenerative disorder, and possibly of related conditions such as multiple systems atrophy, in some manner involve environ- mental (xenobiotic) and even endogenous toxic agents. This volume brings together much of that neurobiological evidence; and in epidemiology, several recent major studies ofPD - for example, a study of20,000 twins published in the Journal of the American Medical Association in 1999 - conclude that environmental and life style than genetics, appear to be critical in the idiopathic disease. However, factors, rather the precise roles of neurotoxic factors in the pathogenesis of PD and related basal ganglia disorders remain uncertain, despite the cascade of research resulting from the discovery of the prototype MPTP in the early 1980's, and frankly, we have been surprised by the paucity of concentrated attention on specific environmental agents other than MPTP.

Pharmacokinetic variability of contraceptive steroids is a relatively under-explored area of contraceptive research, and hardly a common point of discussion among those who plan and deliver family planning services. Nevertheless, numerous independent studies over the last 15 years have indicated that women in different regions of the world vary in their pharmacokinetic response to contraceptive steroids. The causes of such variability are not known, but it has important consequences for contraceptive effectiveness. It may also offer insight to the basis of contraceptive side-effects. The impetus for this volume was to collect documentation of pharmacokinetic variability of contraceptive steroids, and to explore both the possible causes and implications of these data. Factors known to affect steroid pharmacokinetics, such as concurrent use of specific medications, are reviewed by Back and Orme. Other factors known to affect endogenous steroid dynamics are presented in chapters by Bradlow, Longcope, Goldin and Snow, because of their possible role in contraceptive steroid pharmacokinetics.

This volume is based on the program of the Second International Conference on Drugs of Abuse, Immunity and AIDS, held in Clearwater Beach, FL in June 1992. The Conference was supported in part by the University of South Florida College of MediCine with financial assistance from the National Institute on Drug Abuse. The focus of this conference was the effects of drugs of abuse on immunity. It is now widely recognized that psychoactive drugs of abuse, including marijuana, cocaine, and opiates, as well as alcohol, have marked effects in an individual, including effects on their nervous system and behavior. In the past two decades, the scope of studies concerning the effects of some drugs of abuse have also involved investigations of alterations of various physiologic parameters including effects on the immune system. and the influence of such immune alterations on normal physiological responses. In this regard, participants in this Second International Conference provided newer information concerning both basic and clinical aspects of drugs of abuse and immunity, especially immunodeficiencies. In this regard, advances have been made in recent years concerning the nature and mechanisms whereby the immune system is regulated and the possible mechanisms by which drugs of abuse influence such immune systems. In particular, the emergence of psychoneuroimmunology as a new discipline the last decade has heightened interest in the immune responses influenced by psychoactive drugs. This has resulted in interdisciplinary investigations involving both clinical and basic scientists, including microbiologists, immunologists, physiologists, psychiatrists, oncologists, psychologists, etc.

The papers contained in this volume were presented ati the Golden Jubilee Cancer Prevention Conference, "The Biology and Prevention of Aerodigestive Tract Cancers," sponsored by The University of Texas M. D. Anderson Cancer Center in Houston, Texas, February 21-23, 1991. The purpose of the conference was to further the understanding of the biology, epidemiology, and prevention of aerodigestive tract cancers. Advances in under standing the biology of aerodigestive tract cancers have led to successful early chemoprevention trials. Chemopreventive agents in current use are capable 9f reversing premalignant lesions, as well as reducing the number of second primary cancers of the head and neck. These trials hold the promise that effective prevention methods for these cancers will be forthcoming in the foreseeable future. Carcinogenic exposures appear to affect the entiry epithelial lining of the upper aerodigestive tract, a phenomena described as "field cancerization. " This process contributes to the development of both synchronous and metachronous aerodigestive tract cancers. It also provides a sound rationale for the chemoprevention of these cancers. Animal models are important for identifying the critical components of field cancerization and for testing potentially new chemopreventive agents and regimens. The hamster lung carcinogen esis model and the hamster cheek model are discussed. Aerodigestive tract cancers account for about 20% of newly diagnosed invasive cancers. Cigarette smoking and alcohol consumption are the most important risk factors for these cancers."

This volume provides an overview of the important health promotion and disease prevention theories, methods, and policy issues. Applications of these theories and methods are reviewed to promote health through a variety of channels, for a variety of disease outcomes, and among a variety of populations. It can be used as a text for introductory causes to the field of health promotion and disease prevention, as well as a reference for researchers and practitioner's actively working in this area.

Death on Hemodialysis: Preventable or Inevitable? presents the transactions of the Brooklyn meeting, held in April 1993, including an analysis by Scribner and Schreiner and an introduction by Edmund Bourke. Authors include the heads of dialysis registries for Japan, Europe, and the United States, as well as protagonists of dialyser reuse and short dialysis times. Enthusiasts championed the determination of adequacy of dialysis by formulae or by clinical assessment. All chapters are direct and forceful. The reader will be able to judge the data on what are key controversies in planning dialysis protocols and schedules.

The effects of alcohol consumption on human health have fuelled a vigorous scientific debate in recent years. This volume, based on the scientific sessions of the International Meeting on MODERATE ALCOHOL CONSUMPTION AND CARDIOVASCULAR DISEASE, held in Venice October 30-31, 1999, is intended to offer an up-to-date view of the most recent information on this complex topic. While comprehension ofthe damages associated with alcohol abuse has improved, an increasing number of epidemiological studies performed in different countries of the world, have shown that individuals consuming moderate amounts of alcohol (l 0-30 g/day, approximately equivalent to not more than two drinks per day in men and one drink per day in women) are less affected by acute coronary events than total abstainers. The apparent protection is evident (the rate of coronary events in most studies is reduced by about 30%) and has been observed and documented among various population groups (men, women, several racial groups, middle-aged and older individuals). Protection is seen in patients with no known history of coronary heart disease, as well as in those with coronary heart disease, diabetes, etc. Recent data suggest that the protection induced by a moderate alcohol use extends to the risk of ischemic strokes and of ischemic damage to the lower limbs. Since adverse alcohol effects are less frequent at these low daily intakes, total mortality is also favourably affected in moderate alcohol consumers as compared to abstainers.

Incidence and mortality of atherosclerosis and coronary heart disease (CHD) vary considerably among races, populations and ethnic groups. Some individuals with low levels of risk factors succumb early to disease while many others with a high risk profile do not. CHD clusters in families and is manyfold increased in first degree relatives of persons with an early onset of the disease. Such studies provide compelling evidence of the high degree of heritability of CHD and its risk factors. This book consolidates the available evidence for the roles of genetics in atherosclerosis, its correlates and its sequelae. It presents and discusses the methodology currently used to elucidate the role of genetics. Separate parts focus on evidence of familial aggregation and ethnic variability of the disease and on monogenic and polygenic inheritance modes including all the recent findings and innovation. The book also contains chapters on the genetic aspects of vessel wall processes, such as early structural findings in histological studies and the variability of coronary anatomic patterns. Polymorphisms at the DNA level (RFLP) are detailed and reviewed. Directions for future research in the exciting and fast developing realm of genetic epidemiology are outlined and the major preventive and public health implications are discussed. Genetic Factors in Coronary Heart Disease provides a systematic review of findings, integrated to offer a comprehensive summary and stepping stone for future research. It will be of interest to investigators in atherosclerosis, genetics, epidemiology, biostatistics, cardiology and public health.

This volume is intended for the professional who is a newcomer to the area of environmental radon. It marks the first time that chapters on these subjects have been brought together in a single volume, and it is arranged so that anyone with some basic university-level chemistry and physics can develop a clear understanding of the different aspects involved. The volume is intended to serve as a supplementary textbook in public health, environmental, and health physics courses. It also can be used by the professional to get "up to speed" in this rapidly evolving field. The chapters are not necessarily a discussion of the latest research in this fast-moving field, but are intended to bring the reader to a level at which he can easily understand the current literature. At the back of this volume the reader will find the references for the individual chapters, a general list of reading materials, a glossary, an appendix describing the equations for radioactive decay for a series of progeny, a table of often used conversion factors, and the addresses and brief biographies of the authors and editors. Both historical and SI (International System) units are used throughout the book to provide information for the widest range of readers. Thanks go to Tom Hess for the idea for this volume and to Jessica Barron for help in editing.

This IMA Volume in Mathematics and its Applications STATISTICAL MODELS IN EPIDEMIOLOGY, THE ENVIRONMENT, AND CLINICAL TRIALS is a combined proceedings on "Design and Analysis of Clinical Trials" and "Statistics and Epidemiology: Environment and Health. " This volume is the third series based on the proceedings of a very successful 1997 IMA Summer Program on "Statistics in the Health Sciences. " I would like to thank the organizers: M. Elizabeth Halloran of Emory University (Biostatistics) and Donald A. Berry of Duke University (Insti tute of Statistics and Decision Sciences and Cancer Center Biostatistics) for their excellent work as organizers of the meeting and for editing the proceedings. I am grateful to Seymour Geisser of University of Minnesota (Statistics), Patricia Grambsch, University of Minnesota (Biostatistics); Joel Greenhouse, Carnegie Mellon University (Statistics); Nicholas Lange, Harvard Medical School (Brain Imaging Center, McLean Hospital); Barry Margolin, University of North Carolina-Chapel Hill (Biostatistics); Sandy Weisberg, University of Minnesota (Statistics); Scott Zeger, Johns Hop kins University (Biostatistics); and Marvin Zelen, Harvard School of Public Health (Biostatistics) for organizing the six weeks summer program. I also take this opportunity to thank the National Science Foundation (NSF) and the Army Research Office (ARO), whose financial support made the workshop possible. Willard Miller, Jr."

Susan M. De Vos uses comparative and life course perspectives to provide an in-depth demographic study of the household. Based on data gathered by the World Fertility Survey, this illuminating reference explores household composition in six Latin American countries and compares the situation with that in the United States and western Europe as well as with each other. The study examines the complex household; non-family household living; and the living arrangements of children, young adults, middle-aged people, and elderly people.

From the President of the Research Society on Alcoholism In recent years the alcohol research field has matured and is attracting a substantial number of eager and technically sophisticated researchers. There is a feeling of excitement and premonitions of breakthroughs as more and more of alcohol's actions are being detailed. I, however, have at times been sobered by the perception that the lure of parsimonious explanations and the appeal of studying easily demonstrable effects obscure the critical issues re garding alcohol abuse and alcoholism. Central questions regarding (1) the reinforcing properties of ethanol and other factors responsible for inappro priate consumption of alcohol, (2) the heterogenous characteristics (both bi ologic and sociologic) of the alcoholic population, and (3) the differential predisposition of individuals to alcohol-induced medical problems needed to be vigorously pursued. Researchers who used animals as models for the human condition needed to become more intimately aware of the variety of factors that are of importance in the development of alcoholism in an indi vidual. On the other hand, researchers studying humans needed to attempt to more clearly define and categorize diagnostic criteria and characteristics of various alcoholic populations. Such categorization and continued character ization of alcoholism allows not only for a framework of concepts within which proper animal models for studies of biologic mechanisms can be de veloped but also allows for consideration of the most apt treatment approaches.

Bradford Hill has defined a clinical trial as "A carefully and ethically designed experiment with the aim of answering some precisely framed question" 1]. This definition specifies a careful design and requires the provision of adequate controls. Random allocation of treatments to subjects is important to ensure is entitled that the treated and control groups are similar. Therefore this book Randomised Controlled Clinical Trials. We can define a randomised controlled trial by rewriting Bradford Hill's definition as follows, "A carefully and ethi cally designed experiment which includes the provision of adequate and ap propriate controls by a process of randomisation, so that precisely framed questions can be answered. " I am a firm advocate ofRandomised Controlled Clinical Trials but intend to give a balanced view of the advantages and disadvantages of these ethical experiments. This book is directed primarily at the medical research worker, although certain chapters may find a wider application. When discussing a randomised controlled trial, it is neither practicable nor desirable to divorce theory from practice, however the first ten chapters con centrate mainly on theory, and the remainder focus on practice. The segment on trial design is followed by sections on writing the protocol, designing the forms, conducting the trial, and analysing the results. This book is meant to serve both as a reference manual and a practical guide to the design and performance of a trial."

In this groundbreaking work, distinguished contributors explore the myriad relationships between networks of social support and the development, treatment, and rehabilitation of individuals with cardiovascular disease. Chapters span the range from conceptual to methodological issues, and take into account gender, environmental, and cultural differences. The book will provide a wealth of information for clinicians and students in the fields of behavioral medicine, psychophysiology, and cardiovascular disease.