Fall 2009 Issue

Daniel Carlat, MD, is a practicing psychiatrist and an Associate Clinical Professor of Psychiatry at the Tufts School of Medicine. As founder and president of Clearview Publishing, he established and continues to be the Editor in Chief of The Carlat Psychiatry Report, an independent newsletter accredited by the Accreditation Council for Continuing Medical Education (ACCME) as a Continuing Medical Education (CME) Provider. He is a Massachusetts Representative of the American Psychiatric Association (APA) and is also a member of the Massachusetts Psychiatric Society (MPS). In addition to his role as editor of The Carlat Psychiatry Report, he maintains a presence as a widely-read commentator on the influence of the pharmaceutical industry on medical education, via the Carlat Psychiatry Blog and Twitter, and is an occasional contributor to the New York Times. His forthcoming book, Unhinged: The Trouble with Psychiatry, will be published in May 2010 by The Free Press. His two prior books are The Psychiatric Interview and Drug Metabolism in Psychiatry.

_Jeremy Nowak_ argues that taxing sugar will improve public health and reduce obesity, but _Lauren Elizabeth Palmer_ believes that such a tax will unduly burden lower income individuals and have detrimental effects.

The 1996 Peace Accords, which officially ended the 36-year conflict between the Guatemalan government and the guerilla forces, affirmed the right of all indigenous people to health care. As part of its reconstruction plan, the Accords provided for health sector reform and highlighted the government commitment to extend health care to previously neglected indigenous areas. Nevertheless, health care standards in Guatemala are lacking in several areas, from vaccinations to sexual health. Contraceptive use and family planning knowledge are two especially sensitive and significant topics in rural areas. To date, the necessary sexual health resources have not reached highly indigenous Mayan areas. Several non-governmental organizations, including APROFAM and USAID, have implemented various intervention strategies to access these Mayan areas. In doing so, they confront socio-cultural barriers that make this work uniquely difficult. This paper explores those barriers, which include religious restrictions, Mayan cultural practices, and general Guatemalan attitudes.

The internationally accepted standard for cesarean section rates per percentage of live births per country, as outlined by the World Health Organization and the Pan American Health Organization, is 10-15% of the country’s birth rate. Mexican national health care data from 2006 estimates the cesarean section rate to be at approximately 37.6% of all births. This makes Mexico one of the highest users of cesarean section globally. High rates of cesarean section increase the health risks for both mothers and children. This paper will explore the reasons why cesarean sections have become so prevalent in Mexico. In doing so, it will consider the clinical, financial, and psychosocial factors that contribute to Mexico’s overutilization of cesarean sections.

Angiogenesis is the process by which new blood vessels are formed in normal development, wound healing, and pathological tumor growth. Because of its role in the growth and metastasis of tumors, a great number of research efforts have sought ways to treat cancer by inhibiting angiogenesis. This was accomplished with great success through the inhibition of vascular endothelial growth factor (VEGF), a protein that mediates the endothelial cell proliferation and sprouting that culminates in the formation of new blood vessels in both embryonic and pathological angiogenesis. The inhibition of VEGF has been displayed to be widely effective in limiting tumor growth through hindering angiogenesis, and due to this it has been approved for use as chemotherapy. While VEGF inhibition has been largely successful in this role, there have been definite problems in its clinical application, the most troubling of these being the ability of cancers to acquire drug resistance. Resistance to VEGF inhibition has prompted increased research into angiogenesis, and currently many of these efforts concern Delta-like ligand 4 (Dll4). Dll4 is a protein that inhibits endothelial cell proliferation while promoting effective angiogenesis, its inhibition resulting in larger and more complex but dysfunctional vascular networks. The inactivation of Dll4 in murine cancers has been observed to result in increased, yet ‘nonproductive’ angiogenesis in that the resulting vasculature does not support significant tumor growth, and because of this Dll4 inhibition is considered to be a serious candidate for future use as cancer treatment in humans.