Papers by Michael Goldrich
Psychological Aspects of Gifts From Drug Companies
JAMA, Nov 12, 2003
To the Editor: In his Clinical Crossroads article about temporal lobe epilepsy, Dr Devinsky1 stat... more To the Editor: In his Clinical Crossroads article about temporal lobe epilepsy, Dr Devinsky1 stated that Vincent van Gogh had this disease. Arenberg et al, 2 however, have previously argued that van Gogh in fact had Meniere disease. In any event, the physician in this case assumed that the patient's complaints had either a psychiatric or neurological origin. I suggest they are primarily otologic. The main clue is the patient's ear noises. As I have previously argued, 3 there have been no documented cases of tinnitus in patients with ...
Psychological Aspects of Gifts From Drug CompaniesPsychological Aspects of Gifts From Drug Companies
JAMA, Nov 12, 2003
To the Editor: In his Clinical Crossroads article about temporal lobe epilepsy, Dr Devinsky1 stat... more To the Editor: In his Clinical Crossroads article about temporal lobe epilepsy, Dr Devinsky1 stated that Vincent van Gogh had this disease. Arenberg et al, 2 however, have previously argued that van Gogh in fact had Meniere disease. In any event, the physician in this case assumed that the patient's complaints had either a psychiatric or neurological origin. I suggest they are primarily otologic. The main clue is the patient's ear noises. As I have previously argued, 3 there have been no documented cases of tinnitus in patients with ...
Committee on Residents and Fellows in Training
Otolaryngology–Head and Neck Surgery, 1995
The future of otolaryngology and medicine in general will be shaped by modif icat ions in the cur... more The future of otolaryngology and medicine in general will be shaped by modif icat ions in the current physic ian workforce. Some of these changes, shaped by the marketplace, are already happening and are causing physicians to seek employment in fields different from the fields in which they were originally trained. Other workforce changes anticipated for the future will be mediated by multiple factors, including the following:
Psychological Aspects of Gifts From Drug CompaniesPsychological Aspects of Gifts From Drug Companies
JAMA, 2003
To the Editor: In his Clinical Crossroads article about temporal lobe epilepsy, Dr Devinsky1 stat... more To the Editor: In his Clinical Crossroads article about temporal lobe epilepsy, Dr Devinsky1 stated that Vincent van Gogh had this disease. Arenberg et al, 2 however, have previously argued that van Gogh in fact had Meniere disease. In any event, the physician in this case assumed that the patient's complaints had either a psychiatric or neurological origin. I suggest they are primarily otologic. The main clue is the patient's ear noises. As I have previously argued, 3 there have been no documented cases of tinnitus in patients with ...
Committee on Residents and Fellows in Training
Otolaryngology-Head and Neck Surgery, Aug 1, 1995
The future of otolaryngology and medicine in general will be shaped by modif icat ions in the cur... more The future of otolaryngology and medicine in general will be shaped by modif icat ions in the current physic ian workforce. Some of these changes, shaped by the marketplace, are already happening and are causing physicians to seek employment in fields different from the fields in which they were originally trained. Other workforce changes anticipated for the future will be mediated by multiple factors, including the following:
Development of cholecystokinin binding sites in rat upper gastrointestinal tract
American Journal of Physiology-gastrointestinal and Liver Physiology, Apr 1, 1987
Autoradiography using 125I-labeled Bolton Hunter-CCK-33 was used to study the distribution of cho... more Autoradiography using 125I-labeled Bolton Hunter-CCK-33 was used to study the distribution of cholecystokinin binding sites at different stages of development in the rat upper gastrointestinal tract. Cholecystokinin (CCK) binding was present in the distal stomach, esophagus, and gastroduodenal junction in the rat fetus of gestational age of 17 days. In the 20-day fetus, specific binding was found in the gastric mucosa, antral circular muscle, and pyloric sphincter. Mucosal binding declined during postnatal development and had disappeared by day 15. Antral binding declined sharply between day 10 and day 15 and disappeared by day 50. Pyloric muscle binding was present in fetal stomach and persisted in the adult. Pancreatic CCK binding was not observed before day 10. These results suggest that CCK may have a role in the control of gastric emptying and ingestive behavior in the neonatal rat.
Cambridge Quarterly of Healthcare Ethics, Aug 9, 2006
The terrorist attacks of 2001 were a reminder that individual and collective safety cannot be tak... more The terrorist attacks of 2001 were a reminder that individual and collective safety cannot be taken for granted. Since then, physicians, alongside public health professionals and other healthcare professionals as well as nonhealthcare personnel, have been developing plans to enhance the protection of public health and the provision of medical care in response to various threats, including acts of terrorism or bioterrorism. Included in those plans are strategies to attend to large numbers of victims and help prevent greater harm to even larger populations. 1 It is important to recognize that unique responsibilities beyond planning rest on the shoulders of the medical profession. Indeed, irrespective of the cause of harm-whether it arises from natural disasters or otherwise-physicians are needed to care for victims. In some instances, this will require individual physicians to place their health or their lives at risk. Many physicians demonstrated their sense of duty and courage by participating in the rescue efforts that followed the events of September 11, 2001, and more recently the aftermath of Hurricane Katrina. These and other circumstances, such as the debate regarding smallpox vaccination of front-line responders and the SARS epidemic, require the medical profession and each of its members to reflect anew on ethical responsibilities that arise in the face of adversity. A Brief History of Ethical Obligations in the Face of Risks Prior to the events of 2001, the most recent profession-wide debate regarding a duty to treat despite personal risks arose when there was limited understanding of HIV transmission. Those who believed there was a duty to treat appeared to rely in part on historical evidence of the role physicians had played during epidemics. However, some historians remained cautious in making any claim that such a duty existed. 2 In fact, they pointed to many instances when physicians had fled in times of the plague, 3 and also showed that physicians who had provided care during epidemics had done so not out The Council on Ethical and Judicial Affairs of the American Medical Association formulates ethical policies for the medical profession through its interpretations of the AMA's Principles of Medical Ethics. The Council at the time this report was adopted consisted of Michael S. Goldrich, M.D. (Chair); Priscilla Ray, M.D.
Occupational Medicine, Mar 1, 2006
JAMA, Jan 2, 2002
NEW TRENDS IN CLINICAL RESEARCH The interaction between medical research and for-profit corporati... more NEW TRENDS IN CLINICAL RESEARCH The interaction between medical research and for-profit corporations is not new, but it has expanded considerably in recent years. Some of the recent trends may accelerate the research process, particularly when large clinical trials are required, but caution is essential. Investment in research and development by the top 20 pharmaceutical companies has more than doubled in the past 7 years. 1 In contrast, revenues are expected to grow only by 7% per annum for the coming years. Therefore, companies will need to generate more than $25 billion in sales to maintain current levels of profitability, which will require industry leaders to launch between 24 and 34 new drugs per year. 1 Furthermore, new drugs will have to cost less to develop or else be sold at higher prices to maintain current profit levels. To achieve this, the pharmaceutical industry will need to pursue more costefficient means of developing products. One way this can be achieved is by turning away from academic health centers , which often are slowed by lengthy review processes and have large overhead expenses. Instead, industry increasingly relies on for-profit intermediary companies to seek less costly venues for the conduct of trials. 2 These organizations-contract research organizations and site management organizations-enable physicians in the private sector to be involved in trials outside academic settings. 3,4 Parallel to the proliferation of these organizations, the overall number of physicians involved in clinical research has increased 600% in 10 years, reaching more than 30000 by 1998. 5 Investigators based in academic medical centers now represent only 46% of those conducting research, a decrease from 80% 10 years ago. 5 Also, only 40% of industry research funding is allocated to clinical trials performed in aca
Medical Students’ Involvement in Patient Care
The Journal of Clinical Ethics
In a recent issue of The Journal of Clinical Ethics, Peter A. Ubel and Ari Silver-Isenstadt repor... more In a recent issue of The Journal of Clinical Ethics, Peter A. Ubel and Ari Silver-Isenstadt reported on patients' willingness to participate in medical education. Their findings and other data they refer to suggest that patients are generally willing to interact with medical students, but that this willingness may vary depending upon the clinical setting. The authors concluded that patients hold a right to information regarding students' participation in their care and that openness in this regard is valuable. The Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association (AMA) recently developed a policy that addresses the issues that were investigated by Ubel and Silver-Isenstadt.
Otologic Trauma
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2020
Guidelines on gifts to physicians from industry: an update
Food and drug law journal, 1992
On December 3, 1990, the Council on Ethical and Judicial Affairs issued its six guidelines on gif... more On December 3, 1990, the Council on Ethical and Judicial Affairs issued its six guidelines on gifts to physicians from industry.' Since then, the Council has received numerous requests for interpretations of the guidelines. Many questions about the application of the guidelines can be answered by referring to the full report of the Council that was presented with the guidelines to the American Medical Association's (AMA's) House of Delegates. The report provides the reasoning behind the guidelines. In addition, the Council has prepared a number of interpretations in response to representative questions about the guidelines. These interpretations were issued on October 9, 1991. The remainder of this article includes the text of the full report of the Council, the six guidelines, and the representative questions and interpretations. Each of the questions and interpretations is listed under the applicable guideline.
Regulatory Peptides, 1985
An investigation of neurotensin (NT)-binding sites in rat brain has been carried out with 15pm co... more An investigation of neurotensin (NT)-binding sites in rat brain has been carried out with 15pm coronal sections incubated with lOnM 5H-NT (Amersham). After autoradiography (LKBUltrofilm), resulting autoradiographs were analysed by an image analysis system (IBM-PC/Digithurst). Displacement studies with various NT-related peptides indicated the binding affinity of each peptide e.g. ICso for NT 3.6riM; avian NT 12.6nM; [8-13]NT 183nM; [D-Trpll]NT llpM; [D-Tyrll]NT 285pM. The potency of the two latter NT analogues does not app~@r to be attributable to increased affinity for the NT receptor :-NT(Kd) 7.63nM; [D-Trp±±]NT(Ki) 123.5 pM; [D-Tyrll]NT(Ki) 4.77pM. By image analysis of autoradiography, NT binding was found to be highest in olfactory bulb, frontal cortex, central amygdaloid nucleus, hypothalamic dorsomedial nucleus, and ventral tegmental area (total binding at striataum 55.5 ± 4.75 fmol/mg protein; Kd 7.65 ± 0.88 riM; n=5 ± S.E.M.). Unilateral lesioning of dopaminergic system using 6-OHDA reduced binding in striatum on the lesioned side and in parts of the nucleus accumbens, suggesting a presynaptic component of NT receptors in this region:-those receptors unaffected by lesioning were more abundant in n.accumbens than striatum.
Occupational Medicine, 2005
Journal of Clinical Laboratory Analysis, 1996
Recently, sinusitis has been recognized as a frequent clinical problem in human immunodeficiency ... more Recently, sinusitis has been recognized as a frequent clinical problem in human immunodeficiency virus (HIV-1)-infected individuals. We hypothesized that quantitative defects in immune cells in the nasal mucosa of HIV-positive subjects might mirror those in the peripheral blood and explain a predisposition to sinus disease in this population. Nasal mucosa biopsies were obtained from three different groups of patients-HIV-1 seropositive with sinusitis, HIV-1 seronegative with sinusitis, and HIV-1 seronegative without sinusitis (normal volunteer)-and phenotyped for cluster of differentiation antigen (CD) markers. In this study, we found patients with HIV-1 and sinus disease to have significantly lower numbers of both CD3 and CD4 nasal mucosa lymphocytes than seronegative controls in the nasal mucosa (Pc0.05, Pc0.01, respectively).Acorrelation between nasal mucosal CD4 cells and peripheral-blood CD4 cells was noted (R = 0.67, P 5 0.01). No deficiency in the number of nasal mucosa T or TC type mast cells was noted for the HIV-1-positive sinusitis group. Further study is warranted to define more completely the pathophysiology and microbiology of, and therapy for, this important clinical problem.
Journal of Allergy and Clinical Immunology, 1995
Background: The role of inflammatory cells at the local site of allergic inflammation in the nose... more Background: The role of inflammatory cells at the local site of allergic inflammation in the nose is unclear. Methods: Nasal biopsy specimens were obtained from l O patients with symptomatic seasonal allergic rhinitis and 10 normal subjects. Freeze-dried paraffin-embedded sections were stained for mononuclear cells and eosinophils. Tissues in Carnoy's fixative were stained for mast cells. Results: T cells were much more plentiful than B cells or macrophages, and no significant differences were found between the two groups in the number of T cells, T-cell subsets, B cells, and macrophages. However, the number of CD25+ cells (lymphocyte activation markers) and the number of eosinophils were significantly higher in the allergic group than in the control group. There were no significant differences between the two groups in the total mast cell number. However, mucosal type mast cells were slightly increased, and a higher ratio of mast cells were costained for IgE in the allergic group. IgE + cells mostly costained for mast cell tryptase and did not costain for J chain. Conclusions: These data suggest that unlike granulocytes, in some mononuclear cells qualitative, not quantitative, changes may be important in allergic rhinitis and that IgE may not be locally produced in the nasal mucosa.
Substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide increase in nasal secretions after allergen challenge in atopic patients
Journal of Allergy and Clinical Immunology, 1993
ABSTRACT
Cambridge Quarterly of Healthcare Ethics, 2006
The terrorist attacks of 2001 were a reminder that individual and collective safety cannot be tak... more The terrorist attacks of 2001 were a reminder that individual and collective safety cannot be taken for granted. Since then, physicians, alongside public health professionals and other healthcare professionals as well as nonhealthcare personnel, have been developing plans to enhance the protection of public health and the provision of medical care in response to various threats, including acts of terrorism or bioterrorism. Included in those plans are strategies to attend to large numbers of victims and help prevent greater harm to even larger populations. 1 It is important to recognize that unique responsibilities beyond planning rest on the shoulders of the medical profession. Indeed, irrespective of the cause of harm-whether it arises from natural disasters or otherwise-physicians are needed to care for victims. In some instances, this will require individual physicians to place their health or their lives at risk. Many physicians demonstrated their sense of duty and courage by participating in the rescue efforts that followed the events of September 11, 2001, and more recently the aftermath of Hurricane Katrina. These and other circumstances, such as the debate regarding smallpox vaccination of front-line responders and the SARS epidemic, require the medical profession and each of its members to reflect anew on ethical responsibilities that arise in the face of adversity. A Brief History of Ethical Obligations in the Face of Risks Prior to the events of 2001, the most recent profession-wide debate regarding a duty to treat despite personal risks arose when there was limited understanding of HIV transmission. Those who believed there was a duty to treat appeared to rely in part on historical evidence of the role physicians had played during epidemics. However, some historians remained cautious in making any claim that such a duty existed. 2 In fact, they pointed to many instances when physicians had fled in times of the plague, 3 and also showed that physicians who had provided care during epidemics had done so not out The Council on Ethical and Judicial Affairs of the American Medical Association formulates ethical policies for the medical profession through its interpretations of the AMA's Principles of Medical Ethics. The Council at the time this report was adopted consisted of Michael S. Goldrich, M.D. (Chair); Priscilla Ray, M.D.
Brain Research, 1986
The distribution and relative specificity of cholecystokinin (CCK) receptors in the rat brain was... more The distribution and relative specificity of cholecystokinin (CCK) receptors in the rat brain was mapped by in vitro autoradiography with [125I]CCK-33. We identified two distinct binding patterns, suggesting two CCK receptor types. The first is widespread and relatively non-specific. The second, localized to a few subcortical nuclei, has the specificity demonstrated for pancreatic CCK receptors. Localization of this receptor type to the area postrema provides a possible entry site into brain for circulating CCK that (1) would distinguish between CCK and gastrin and (2) could mediate some of CCK's behavioral effects.
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Papers by Michael Goldrich