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Letters to the Editor Issue 287

by Letters(more info)

listed in letters to the editor, originally published in issue 287 - June 2023

Long-Term Use of Steroids could Impair Memory

Memory impairment associated with steroid use has been identified in a new study. The University of Bristol-led findings, published in PNAS[1], show great potential for the identification of drugs that could be adapted to treat certain memory disorders.

Glucocorticoids, commonly known as steroids, are the most commonly prescribed anti-inflammatory drug used to treat a range of conditions including allergies, asthma, arthritis and inflammatory bowel disease. However, they often have an adverse effect on mood, sleep and memory and many patients prescribed steroids report cognitive decline and memory impairment.

A multidisciplinary research team at the University of Bristol, led by Dr Becky Conway-Campbell, wanted to examine the impact of steroid treatment on memory processes to find out if the reported adverse effects were a result of the steroid or the underlying medical condition.

Using a rodent model, the team found that even a relatively short course of prescribed steroids - methylprednisolone for five days – led to impaired memory performance when carrying out a memory and learning-related task.

An analysis of the rodent model brains indicated that the brain region important for memory and learning – the hippocampus – was significantly altered by the treatment. The functional activity of the hippocampus, measured by electrophysiological recordings, was profoundly impaired in the rodent model treated with methylprednisolone, providing the first evidence of a root cause for the memory deficit.

Dr Matthew Birnie, Fellow at the University of California and first author, who carried out the gene expression aspect of the work during his PhD at the University of Bristol, said:

“People who are prescribed steroids often report memory deficits. However, it’s been difficult to disentangle if this is the result of the underlying medical cause, or if it’s an adverse effect of the treatment itself.

“Our findings provide breakthrough insights into the impact steroid treatment has on memory processes in the absence of underlying medical conditions. Importantly, these findings identify the critical importance of matching a prescribed course of medical treatment to endogenous steroid release.”

Stafford Lightman, Professor of Medicine at the Laboratories for Integrative Neuroscience and Endocrinology (LINE) at the University of Bristol, explained:

“We have shown how important it is to record the times in which you do any experiments. In our model of memory that looks at synaptic plasticity  - the way neurons talk to each other - we have shown that the phenomenon of synaptic potentiation in the hippocampus is only seen during the active time of day and not during sleep.

“Additionally we have shown that long-term treatment of steroids can block its effectiveness at all times of day and could contribute to the brain fog experienced by many people on steroids.”

Dr Conway-Campbell Research Fellow in Bristol Medical School’s Translational Health Sciences group, added:

“The strength of the study is due the excellent multidisciplinary team here at Bristol Medical School and Department of Physiology, Pharmacology and Neuroscience; notably including the rising star young scientist and co-first author of the paper, Dr Matthew Claydon, who performed the electrophysiological experiments in Dr Zuner Bortolotto’s lab, as well as the excellent work of Dr Gareth Barker and Dr Rebecca Demski-Allen who performed the behavioural studies in Professor Clea Warburton’s group.” 

She concluded “Our study’s findings may finally help to explain the molecular basis for memory deficits associated with steroid treatment and chronic stress conditions, as well as lead to the identification of drug treatments that could be adapted to treat these types of memory disorders.”

Reference

  1. Birnie MT, Claydon MDB, Troy O, Flynn BP, Yoshimura M, Kershaw YM, Zhao Z, Demski-Allen RCR, Barker GRI, Warburton EC, Bortolotto ZA, Lightman SL, Conway-Campbell BL. Circadian regulation of hippocampal function is disrupted with corticosteroid treatment. Proc Natl Acad Sci USA. ;120(15):e2211996120. doi: 10.1073/pnas.2211996120. Epub Apr 6 2023 . PMID: 37023133; PMCID: PMC10104554. Apr 11 2023

Further Information

This research was funded by the Wellcome Trust and Medical Research Council.

For further information please contact Joanne Fryer [Mon to Wed]  joanne.fryer@bristol.ac.uk  Mobile: +44 (0)7747 768805 or Caroline Clancy [Wed to Fri]  caroline.clancy@bristol.ac.uk, Mobile: +44 (0)7776 170238 in the University of Bristol Media Team.

 

 

How Medical Treatment could Soon be Tailored to our Own DNA Profile

A leading testing expert says healthcare is heading for a revolution. Personal genotyping, sequencing our DNA and understanding its complexity, will lead to precision medicine, tailored for every individual. This will soon be the basis of many treatments, from high cholesterol to cancer, empowering patients and doctors to make better health decisions.

Harnessing the combined powers of science, data and medicine, healthcare in the UK is set to change dramatically over the next few years, based on our genetic fabric.

A leading health testing expert says recent leaps in technology have brought us from studying a single strand of DNA in the 1950s to recognising the patterns, interactions and behaviours of almost 3 billion individual DNA units, in each of the trillions of cells in the human body.

Dr Avinash Hari Narayanan MBChB, Clinical Lead at London Medical Laboratory, says: ‘The idea of tailoring isn’t new – you get the best “fit” with things made bespoke for you, based on your physique, preferences and predispositions. This “tailoring” in medicine has long been envisioned as the holy grail in highly personalized and individualized treatments, resulting in the best potential outcomes. Now, thanks to dramatic new developments in DNA sequencing, the dream of precision medicine is becoming a reality.

“Twenty years after Watson, Crick and Franklin discovered the structure of DNA in 1953, Gilbert and Sanger introduced the methods of sequencing it. Now we are on the brink of precision medicines, based on our unique DNA profiles, becoming the basis of perhaps most medical treatments.

“Precision medicine, as a concept, is not new, but its emergence as a real holistic approach to treating patients will be a powerful tool to solve a variety of health problems, from those as common as high cholesterol to those as severe as cancer. Not only can it provide us treatment relevant information, it can also inform patients on a variety of health-related topics, from disease risk to medication response to sleep behaviours and even personality traits.

“Precision medicine is an evolving approach to healthcare that tailors medical decisions to the specific genetic composition of the individual. It relies heavily on our understanding of our genetic information, its patterns and unique factors that can influence our health. The key technology driving the development of precision medicine is personal genotyping, which provides large volumes of highly detailed genetic information that can be analysed, probed and understood.

“Genotyping, achieved by DNA sequencing, was once a laborious and highly expensive scientific process. The technique has come on by leaps and bounds since the 1970s, from requiring complex laboratory equipment and set-ups to a simple processing chip and sequencing machine.

“Personal genotyping is done by sequencing an individual's DNA from saliva, sputum or blood. This allows us to study individual genes or the genome itself, which is the sum of all genetic information obtained. The technique produces a large volume of data, which provides a detailed map of an individual's genetic makeup. All of us, though we may have many similar features, will generate a genetic map that is highly individualized and unique. Precision medicine relies on these maps to tailor healthcare decisions based on predispositions and susceptibilities.

“The idea of individual genes influencing our responses to treatments or risk factors isn’t new, but having an in-depth view into how exactly these can occur, considering the genetic variation in individuals, is breath-taking. A classic example of this is the acetylator status of an individual. In other words, how a specific enzyme in the body influences how we process different substances such as medication. Up to 50% of people in the UK may process specific medications differently because of their genetics.

“Using genetic information this way, pharmacogenomics (PGx) makes it possible to determine optimal patient treatment that is tailored to each unique genetic profile. However, at present, this information is investigational and should never form the sole basis of treatment. That’s because pharmacogenomics is only one of several factors, such as age, sex, ethnicity and medical history, that determines a patient's response to medication.

The Secret of our Health is in Our Genes

“Fascinatingly, PGx is just the tip of the iceberg. DNA testing can identify a huge number of other conditions. These include potential allergies and addictions, and a wide array of ailments and illnesses, from sleep disorder to cardiac problems, diabetes to bone health. It seems the secret of our health is in our genes.

“For example, if an individual has a genetic predisposition to a certain type of cancer, personal genotyping can enable healthcare providers to develop a more targeted screening programme that identifies the disease at an early stage, when it is more treatable. Similarly, personal genotyping can help identify individuals who may be at increased risk of heart disease, enabling healthcare providers to develop more effective prevention and treatment strategies.

“Personal genotyping can also enable researchers to identify new genetic targets for drug development. For example, if a particular genetic mutation is found to be associated with a certain type of cancer, researchers can develop drugs that specifically target that mutation, potentially leading to more effective treatments with fewer side effects. This aspect of precision medicine remains highly experimental at present but is likely to come into clinical practice in the future.

“A developing aspect of genotyping allows us to understand our personality and behavioural traits from intrinsic genetic patterns. This is a highly interesting area of evolving research but its use in-practice remains trivial. Data analysis has attempted to map genetic patterns to personality traits such as openness, extraversion, conscientiousness, agreeableness and even neuroticism, providing a curious view into our own psyches. However, it is important to note that personality and behaviour are not solely influenced by genetics. They are also strongly determined by life experiences, upbringing, intrinsic neurological and cognitive traits and environmental factors.

Profiling Concerns

“Despite the many benefits offered by personal genotyping, there are also some concerns about its use in healthcare. One of the main concerns is the risk that individuals could receive information about their genetic makeup that they may not fully understand or be able to act upon. For example, if a genetic predisposition to a certain disease is identified, early information, though immensely valuable, may not help in situations where there is no effective way to modify this risk, for example where there are no preventative measures or treatments.

“Some genetic patterns, such as harmful mutations in the BRCA1 or BRCA2 “BReast CAncer” genes, are well known to lead to breast and/or ovarian cancer. In these cases, individuals may be able to significantly alter their risk of contracting the disease based on appropriate medical review and decisions. That said, this may not be the case for other conditions. For example, Huntington’s Disease, a heritable mutation, is non-modifiable and life-limiting. It is vital for individuals to discuss the benefit and risk of genotyping with a doctor to have a balanced perspective before having the test.

“Despite these concerns, the increasing use of genotyping tests will likely continue over coming years. As technology becomes more affordable and accessible, it is extremely likely that genotyping will go hand in hand with conventional medicine and precision medicine. Though its exact and full implications are unclear to us at present, genotyping ultimately aims to improve the overall health and wellbeing of individuals and populations alike.

“Indeed, the first fruits of DNA-based investigations are already here. London Medical Laboratory’s new DNA Genotype Profile Test is a simple, at-home, saliva test kit. This once-in-a lifetime test gives over 300 reports: providing insights into nutrition, traits, fitness, and health from our genetic blueprint.  A single saliva sample allows each of us to know more about ourselves and facilitates the creation of personalised wellness products and plans, so we can make better decisions for a healthier future.

“The saliva test can be taken at home through the post, or at one of the many drop-in clinics that offer these tests across London and nationwide in over 95 selected pharmacies and health stores. For full details, see: https://www.londonmedicallaboratory.com/product/dna-genotype-test

Contact and Further Information

London Medical Laboratory’s Clinical Lead, Dr Avinash Hari Narayanan, is available to supply exclusive written comment or for interview. To contact Dr Hari Narayanan, or for more information, please email London Medical Laboratory’s Head of Public Relations, David Jinks M.I.L.T., at david.jinks@londonmedicallaboratory.co.uk .

 

 

How to Improve Medical Care: Include Treatment with Nutritional Supplements

by Michael Passwater MT(ASCP)SBB,DLM; CSSGB(ASQ) and Richard Cheng MD PhD

Originally published on orthomolecular.activehosted.com

https://orthomolecular.activehosted.com/p_v.php?l=1&c=280&m=279&s=c7ae1002d2f579a22c16a1b89c854212

A recent Gallup poll showed the majority of American adults feel the quality of healthcare in the US is unfavourable.[1] The US has the greatest healthcare expense per person in the world at $12,914 per person. That's more than $5,000 per person higher than the next most expensive country (Germany, $7,383 per person), and more than double the average expense per person among wealthy nations. The US spends $4.3 trillion per year on medical care (mostly on "rescue care" interventions). These expenses do not count the cost of medical buildings, medical equipment, and medical research.[2,3] The US also leads the world in per capita spending for retail prescription drugs, totalling $378 billion per year.[4] In spite of all of this spending, the 2022 Commonwealth Fund report reveals that among wealthy nations, the US has the highest infant mortality, maternal mortality related to childbirth, deaths from drug overdoses, obesity prevalence, and prevalence of people with multiple chronic conditions, and the lowest life expectancy at birth.[5] The public, and many medical providers, are seeking a better way to pursue health.

The answer to better health care can include adequate nutritional supplements. Although supplements of essential nutrients are effective and widely used, they represent a tiny fraction of health care expenditures. Surveys indicate that 77 - 86% of Americans take at least one of the over 29,000 dietary supplements on the market. Vitamin D, magnesium, omega-3, Coenzyme Q10, and multivitamin supplements are the most commonly purchased dietary supplements. Approximately one third of Americans take vitamin C supplements. People with increased age, wealth, and education are more likely to use dietary supplements. Americans spend $30 billion per year on dietary supplements. Yet this expenditure is actually less than 1% (0.7%) of the money spent annually on "healthcare," and less than 10% (7.9%) of the money spent on retail prescription drugs).[6] Approximately 40,000 of the 209,000 family practice physicians in the US have invested in continuing education related to integrative medicine.[7]

Orthomolecular Medicine in Action

Here are a few snapshots from around the world showing glimpses of other approaches to care for some disease conditions. This list is not at all exhaustive, and is not meant to imply that perfect solutions have been found for these ailments. Hopefully they will stimulate discussion and provide encouragement that nutritional therapy supporting the body's natural defences and metabolism can help produce safe, effective, and less expensive outcomes. Together, we can keep finding better ways to care for one another.

A mother and her infant son sought treatment at a hospital for an upper respiratory infection while traveling in Astana, Kazakhstan. Covid-19 tests were negative. The mother was given IV vitamin C and ultraviolet light (UVB) treatment to stimulate vitamin D production. Both mother and child were prescribed vitamin C, vitamin D, and a decongestant. [Personal communication]

A 60-year diabetic man with severe Covid-19 and rapidly deteriorating disease recovered quickly after receiving antioxidant therapies including high dose vitamin C, vitamin D3 and glutathione. http://orthomolecular.org/resources/omns/v18n03.shtml

An elderly woman in China was in the ICU diagnosed with acute liver failure when her American daughter received notice from the hospital of her life-threatening condition. The patient received high dose IV vitamin C and liposomal vitamin C and recovered within days. [Practice, RZ Cheng]

In December 2022, when China suddenly relaxed its lockdown policy, a 5-year old boy with a high temperature (39.5C/103F) was diagnosed with Covid-19, but was unable to be admitted to a hospital due to a shortage of hospital beds. The boy received high dose antioxidant therapy including vitamin C, and recovered the next morning. [Practice, RZ Cheng]

An 86-year man with metastatic prostate cancer lived 6 more years on a ketogenic diet and nutritional supplementation including high dose IV Vit C. When he eventually passed away, there was no sign of his cancer. [Practice, RZ Cheng]

A young Norwegian man who had chest lymphoma found that the lymphoma disappeared after adopting a restrictive-ketogenic diet and nutritional supplementation including high dose vitamin C. http://www.drwlc.com/blog/2022/11/01/2351

A 62 year man with symptomatic CTA-confirmed atherosclerotic coronary artery stenosis saw his stenosis completely resolve after 20 months on a low carbohydrate diet and nutritional therapy including high dose vitamin C. [Practice, RZ Cheng]

A 63 year man with carotid artery stenosis, Hashimoto's thyroiditis (with elevated autoantibodies) , cholecystitis changes on ultrasound, as well as multiple other health problems received an integrative protocol including low carbohydrate/ketogenic diet, detox and nutritional therapy including high dose vitamin C, saw carotid artery stenosis disappear (CT confirmed) in 8 months. His thyroid autoantibodies became normal and inflammatory changes in his gallbladder went away as well. [Practice, RZ Cheng]

Many patients with autoimmune diseases have seen their disease improve or reverse, including Hashimoto cases, psoriasis,[8] vitiligo, eczema, idiopathic thrombocytopenic purpura (ITP), and inflammatory bowel diseases. http://www.drwlc.com/blog/2022/05/20/reversing-hashimotos-thyroiditis-with-orthomolecular-medicine

The Baylor College of Medicine reported a 44 year old woman with a life-threatening case of Thrombotic Thrombocytopenic Purpura (TTP), with ADAMTS-13 function < 10% of normal and ADAMTS-13 inhibitors present, was refractory to standard treatments and remained in a coma after 12 days of intensive care treatment. She became fully awake and responsive 18 hours after receiving 150 mg/Kg IV N-Acetyl Cysteine (NAC), a precursor to glutathione, on day 13 of her hospitalization. IV NAC was continued for 10 days along with UNUSED_going standard treatment, and she was discharged in good condition 31 days after admission. The ADAMTS-13 levels improved to 65% on day 28, and her platelet count and haemoglobin level normalized 7 days after discharge from the hospital (day 38 of treatment).[9]

During the Ebola epidemic in Liberia in 2014, Dr Jerry Brown and his team of "Ebola Fighters" at the ELWA Hospital were recognized as Time Magazine's "Person of the Year". Dr Brown was the last physician remaining in the area, and used an approach centred around isolation, hydration, multivitamins, and selenium supplements to keep his team healthy and to care for as many people as possible. More recently, as medical director for the 14th Military Hospital in Liberia, he again emphasized multivitamins and selenium supplements to help with Covid-19 outbreaks in the area.[10]

Dr Marik, founder of the HAT (hydrocortisone, ascorbic acid, and thiamine) treatment protocol for sepsis, and MATH+ (methylprednisolone, ascorbic acid, thiamine, heparin) treatment protocol for acute COVID-19, and 2022 recipient of a unanimous commendation from the Virginia House of Commons in 2022 for "his courageous treatment of critically ill COVID-19 patients and his philanthropic efforts to share his effective treatment protocols with physicians around the world." discusses his vision for healthcare in an interview with Dr Mercola: [11] https://covid19criticalcare.com/a-new-vision-for-health-care
https://www.bitchute.com/video/Ygqz05H6otqj

Conclusion

In the cases reported above, serious illness was successfully treated and/or reversed using high doses of nutritional supplements. The rationale for this life-saving treatment is that serious illness depletes the body's essential nutrients (such as vitamins and minerals). When essential nutrients are depleted, the body organs that rely on those nutrients cannot function and will often proceed to dysfunction and death. But with adequate levels of vitamins and minerals, the body shows its amazing power for recuperation. In cases where symptoms are mild and not life-threatening, higher levels of vitamins and minerals than the minimum (e.g. MDR) are helpful for optimum health.

Healthcare in the USA could be greatly improved with the inclusion of nutritional supplements in adequate individualized doses and duration into the "standard care" given by medical professionals.

"Truth is great and will prevail if left to herself, that she is the proper and sufficient antagonist to error, and has nothing to fear from the conflict, unless by human interposition disarmed of her natural weapons, free argument and debate; errors ceasing to be dangerous when it is permitted freely to contradict them." ― Thomas Jefferson

Education and free speech, not censorship, are the antidotes to misinformation.

Real learning and progress, including medical progress, depends on keeping an open mind, following the evidence, and sharing positive outcomes. The practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body - Orthomolecular Medicine - continues to provide a solid foundation for wellness and healing around the globe.[12]

References

  1. McPhillips D (2023) New poll shows jump in adults who rate the quality of US health care as 'poor'. CNN https://www.cnn.com/2023/01/19/health/us-health-care-poll-gallup/index.html
  2. Centers for Medicare and Medicaid, National Health Expenditure data fact sheet. (2021) https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet
  3. McGouth M, Telesford I, Rakshit S, et al. (2023) "How does health spending in the U.S. compare to other countries? " Health System Tracker. Peterson Center on Healthcare and KFF. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries
  4. Prescription drug expenditure in the United States from 1960 to 2021. Statista, accessed 4/10/2023. https://www.statista.com/statistics/184914/prescription-drug-expenditures-in-the-us-since-1960
  5. U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022
  6. Zippia. (2023) 25 Fascinating Supplements Industry Statistics (2023) Data + Trends. Zippia.com. https://www.zippia.com/advice/supplements-industry-statistics
  7. Ventola CL (2010) Current Issues Regarding Complementary and Alternative Medicine (CAM) in the United States Part 1: The Widespread Use of CAM and the Need for Better-Informed Health Care Professionals to Provide Patient Counseling. P T. 35:461-468. https://pubmed.ncbi.nlm.nih.gov/20844696
  8. McCullough PJ, McCullough WP, Lehrer D, et al. (2021) Oral and Topical Vitamin D, Sunshine, and UVB Phototherapy Safely Control Psoriasis in Patients with Normal Pretreatment Serum 25-Hydroxyvitamin D Concentrations: A Literature Review and Discussion of Health Implications. Nutrients 13:1511. https://pubmed.ncbi.nlm.nih.gov/33947070
  9. Tokpah WN (2020) Liberia: COVID-19 Cases Decline, Dr. Jerry Brown Discloses As Insurance Company of Africa Donates Supplement to Battle the Virus. Front Page Africa. https://frontpageafricaonline.com/news/liberia-covid-19-cases-decline-dr-jerry-brown-discloses-as-insurance-company-of-africa-donates-supplement-to-battle-the-virus
  10. Li GW, Rombally S, Kamboj J, et al. (2014) Treatment of refractory thrombotic thrombocytopenic purpura with N-acetylcysteine: a case report. Transfusion 54:1221-1224. https://pubmed.ncbi.nlm.nih.gov/24117464
  11. Front Line COVID-19 Critical Care Alliance (FLCCC) https://covid19criticalcare.com/experts/paul-e-marik
  12. Orthomolecular.org Therapeutic Nutrition Based Upon Biochemical Individuality. Accessed 4/10/2023. http://orthomolecular.org/library/definition/index.shtml

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

Find a Doctor

To locate an orthomolecular physician near you: http://orthomolecular.org/resources/omns/v06n09.shtml

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:

Albert G. B. Amoa, MB.Ch.B, Ph.D. (Ghana)
Seth Ayettey, M.B., Ch.B., Ph.D. (Ghana)
Ilyès Baghli, M.D. (Algeria)
Barry Breger, M.D. (Canada)
Ian Brighthope, MBBS, FACNEM (Australia)
Gilbert Henri Crussol, D.M.D. (Spain)
Carolyn Dean, M.D., N.D. (USA)
Ian Dettman, Ph.D. (Australia)
Susan R. Downs, M.D., M.P.H. (USA)
Ron Ehrlich, B.D.S. (Australia)
Hugo Galindo, M.D. (Colombia)
Gary S. Goldman, Ph.D. (USA)
Michael J. Gonzalez, N.M.D., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Claus Hancke, MD, FACAM (Denmark)
Patrick Holford, BSc (United Kingdom)
Ron Hunninghake, M.D. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Dwight Kalita, Ph.D. (USA)
Felix I. D. Konotey-Ahulu, M.D., FRCP (Ghana)
Peter H. Lauda, M.D. (Austria)
Alan Lien, Ph.D. (Taiwan)
Homer Lim, M.D. (Philippines)
Stuart Lindsey, Pharm.D. (USA)
Pedro Gonzalez Lombana, M.D., Ph.D. (Colombia)
Victor A. Marcial-Vega, M.D. (Puerto Rico)
Juan Manuel Martinez, M.D. (Colombia)
Mignonne Mary, M.D. (USA)
Joseph Mercola, D.O. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Sarah Myhill, MB, BS (United Kingdom)
Tahar Naili, M.D. (Algeria)
Zhiyong Peng, M.D. (China)
Isabella Akyinbah Quakyi, Ph.D. (Ghana)
Selvam Rengasamy, MBBS, FRCOG (Malaysia)
Jeffrey A. Ruterbusch, D.O. (USA)
Gert E. Schuitemaker, Ph.D. (Netherlands)
Thomas N. Seyfried, Ph.D. (USA)
Han Ping Shi, M.D., Ph.D. (China)
T.E. Gabriel Stewart, M.B.B.CH. (Ireland)
Jagan Nathan Vamanan, M.D. (India)

Andrew W. Saul, Ph.D. (USA), Editor-In-Chief

Associate Editor: Robert G. Smith, Ph.D. (USA)
Editor, Japanese Edition: Atsuo Yanagisawa, M.D., Ph.D. (Japan)
Editor, Chinese Edition: Richard Cheng, M.D., Ph.D. (USA)
Editor, Norwegian Edition: Dag Viljen Poleszynski, Ph.D. (Norway)
Editor, Arabic Edition: Moustafa Kamel, R.Ph, P.G.C.M (Egypt)
Editor, Korean Edition: Hyoungjoo Shin, M.D. (South Korea)
Editor, Spanish Edition: Sonia Rita Rial, PhD (Argentina)
Editor, German Edition: Bernhard Welker, M.D. (Germany)

Associate Editor, German Edition: Gerhard Dachtler, M.Eng. (Germany)
Assistant Editor: Michael Passwater (USA)
Contributing Editor: Thomas E. Levy, M.D., J.D. (USA)
Contributing Editor: Damien Downing, M.B.B.S., M.R.S.B. (United Kingdom)
Contributing Editor: W. Todd Penberthy, Ph.D. (USA)
Contributing Editor: Ken Walker, M.D. (Canada)
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