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Chapter 1 creation (pages 1–2):
Chapter 2 Preventive drugs: The goals (pages 3–21): Richard Doll
Chapter three the worth of Prevention: financial points (pages 22–37): Bengt Jonsson
Chapter four The influence of latest equipment of Gene research on Screening for Genetic ailment (pages 38–54): D. J. Weatherall
Chapter five merits, hazards and prices of Immunization Programmes (pages 55–68): Jeffrey P. Koplan
Chapter 6 Screening in Adults (pages 69–87): T. W. Meade
Chapter 7 Screening for melanoma in Adults (pages 88–109): David M. Eddy
Chapter eight a number of probability issue Intervention in heart affliction (pages 110–125): Ingvar Hjermann
Chapter nine regulate of Tobacco?Related ailment (pages 126–142): Richard Peto
Chapter 10 Screening and Intervention for Alcohol?Related illness in Middle?Aged males: The Malmo Preventive Programme (pages 143–163): Bo Petersson, Hans Kristenson, Erik Trell and Bertil Hood
Chapter eleven the worth of actual health in Preventive drugs (pages 164–182): Roy J. Shephard
Chapter 12 function of managed Trials in comparing Preventive medication techniques (pages 183–202): Geoffrey Rose
Chapter thirteen matters within the layout of destiny Preventive medication reports (pages 203–217): Louise B. Russell
Chapter 14 Will ailment Prevention Spare the scientific Commons? (pages 218–245): Howard H. Hiatt and Milton C. Weinstein
Chapter 15 Chairman's final feedback (pages 245–247): A.G. Shaper

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Extra resources for Ciba Foundation Symposium 110 - The Value of Preventive Medicine

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Until recently the high mortality rates TABLE 3 Racial differences in frequency of genetic diseases Disease Race Frequency1 100000 births Porphyria variegata South African (white) Caucasians (general) Tasmania Japan Yupik Eskimos N. Americans N . Europeans Afro-Americans, Orientals Ashkenazi Jews Sephardi Jews, Gentiles Mediterraneans, Orientals N . Europeans Africans N. 3 100&2000 Rare 1000-2000 Rare Huntington’s chorea Adrenogenital syndrome Cystic fibrosis Tay-Sachs disease Thalassaemia Sickle cell anaemia in the neonatal period and early childhood from infection and malnutrition masked the existence of these genetic anaemias.

When we are making investments, for example in prevention, it is usually the marginal productivity that is of interest for the allocation of resources. Let me give an example. Mammography is a very useful technology for detecting breast tumours and thereby preventing later mortality due to carcinoma of the breast. When we are going to decide about a screening programme for breast cancer using mammography, we are not mainly interested in the average productivity of such a programme. The marginal productivity of extending the programme to certain age groups and of increasing the number of screenings per time period is of great interest for policy.

Hence, by gene mapping analysis and using a battery of restriction enzymes and radioactive probes, different-lengthed fragments of DNA will ‘light up’ according to the presence or absence of these polymorphic sites. Such restriction fragment length polymorphisms (RFLPs) provide many genetic markers that can be used to trace mutant genes to which they are linked through successive generations of families. They have been used successfully for the prenatal diagnosis of thalassaemia and sickle cell anaemia, using amniotic fluid cells (Kan & Dozy 1978, Kazazian et a1 1980) or chorion biopsy (Old et a1 1982).

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