The term "biotin" should now replace several old names, to wit: coenzyme R, protective factor X, the protective factor against egg white injury, the vitamin H and a part of the Bios II b or the adsorbable factor of the yeast growth promoting substance. It was isolated and from the Bios II b factor of yeast as a methyl ester of the empirical composition C 11 H 18 O 3 N 2 S and having a melting point of 166°-167° when highly purified. Saponification with cold alkali gives free biotin of the empirical composition C 10 H 16 O 3 N 2 S and melting at 230°-232°. Biotin is a simple monocarboxylic acid, a derivative of valeric acid. The nitrogen atoms form a urea structure which can be opened up with a loss of one carbon to form a diaminocarboxylic acid, from which in turn one can reform biotin by reaction with phosgene. The sulfur is functioning in a thioether structure, since a sulfone can be formed by oxidation. The most probable structure is that of 2′-keto-3,4-imidazolido-2-tetrahydrothiophene-n-valeric acid.
Looked upon as an active principle of yeast growth biotin is active even at a concentration of one part in 500,000,000,000. As the active substance stimulating several species of the root-nodule bacterium Rhizobium and obtained from concentrated cultures of Azotobacter, and previously known as coenzyme R (R=respiration) it shows effects in concentration of I part in 100 billion. As Vitamin H (H for "Haut" or skin) it counteracts the effects of avidin of both raw and dried egg white to the extent of 10,000 units per milligram by a rat assay method (i.e. 0.1 gamma of biotin per rat per day for 30 days protects against egg-white injury).
The biotin may be extracted from liver, dried eggs, potato starch, fresh eggs, dried yeast, autolyzed yeast.Inactivation of biotin has been accomplished both under acid and alkaline conditions. Aeration is not effective but stronger oxidizing agents destroy activity quickly and completely. Nitrous acid inactivates without a loss of nitrogen.Biological effects of biotin other than those used in assay of the foregoing effects concern the fatty infiltration of the livers of rats on a low fat diet with high biotin. The fermentation of yeast is increased as well as its respiration and growth both aerobically and anaerobically, in the presence of plentiful nitrogen in the form of ammonia. Butter-yellow tumor formation brought on by avidin-containing diets should be counteracted by biotin.
Thursday, September 27, 2007
Biophysics scope principles methods
The domain of discussion may be indicated by defining biophysics as the application to biological research of the methods and content of the physico-mathematical sciences. "Method" is advisedly placed first. It has become clear that the experimental and theoretical procedures usually associated with physics are not the exclusive property of that science, but represent rather adequately the developed and mature form of the scientific method itself. Biophysics is the adaptation of this methodology to the problems of biology.
It appears from this that the word "biophysics" is in part a misnomer. Biophysical research is biological research with a particular emphasis--concern for the logical ordering and quantification of biological theory, for the more intimate unification of theory and experiment, for the introduction into experimental biology of techniques and measuring devices which have been developed in the so-called physical sciences, and for the reduction-when it is possible and useful, and only then-of biological problems and concepts to already existent laws and concepts of the physical sciences.
That physics--the science of matter--has in fact preoccupied itself with those objects which used to be termed "non-living" is logically accidental, not intrinsic. Taken in this sense, the "physicalizing" of biology merely means the attempt to analyze certain complex phenomenal patterns in terms of somewhat simpler patterns which have already been the object of intensive study. In this sense it is neither novelty nor heresy, but an inevitable extension of the classical biological procedure of analyzing organisms into organs, organs into tissues, tissues into cells, and cells finally into their discernible parts.
It is only fair to add that "biophysics" is usually used in a sense which contrasts it with biochemistry--that is, as a study of the physical as distinct from the chemical aspects of biological systems. This viewpoint would see viscosity, osmotic pressure, surface tension, the electrical and mechanical properties of biological systems as physical, while the composition and metabolic activities of such systems are the concern of chemistry.
This criterion has been serviceable in the past, of course; but it is so narrow as to be both cramping to research and rather difficult rigidly to maintain. Thus, the study of bioluminescence must in this view separate sharply into two parts: the analysis of the luciferinluciferase system is biochemistry, while the emission of a photon by the reduced enzyme is biophysics. It is valid to say, "For the moment, let us consider only the physical aspects of this phenomenon, and ignore the chemical and purely biological." But the moment passes quickly, and the essential inseparability of the different aspects demands the broader interpretation.
It remains to consider the best way of subdividing biophysical activity into its branches according to some specified criterion of classification. From the preceding discussion it is clear that one apparently natural division-into theoretical and experimental--is not a desirable one. The nature of biophysics, as here defined, demands the same close interweaving, mutual support, and mutual stimulus of theorizing and experimenting as is now practised so successfully in physics.
To adopt the existing fundamentum divisionis of biology is no more desirable; for the fences around bacteriology, embryology, histology, physiology, botany, and the like, in view of their haphazard historical origin, exhibit small regard either for practical utility or for logical consistency. Some of these fields are organized around a particular function, some around a particular set of structures, some around a particular class of organisms, and some are mere catch-alls for topics which do not fit handily into the remaining cells.
If we accept the cell as fundamental concept in biology, a useful though by no means perfect mode of classification suggests itself--the hierarchy: cell-parts, cells, cell-aggregates. These further subdivide in a fairly natural way, principally according to functions and activities. Thus, under Cell-parts, we think of: Protoplasmic Structure; Enzyme Systems of the Cell; Nucleus and Chromosomes; Cell Membranes and Permeability; Golgi Bodies and Mitochondria.
Under Cells would come: Growth; Form; Motion; Division; Differentiation; Metabolism; Senescence; Stimulus-Response.
Under Cell-aggregates there are similar categories: Organic Form and Differentiation; Growth; Metabolism; Senescence; StimulusResponse. These would intersect with the triple classification: Tissues; Organs; Organisms. Thus, for example, we would find Secretion under Metabolism, Organs (perhaps also under Cells, Metabolism); special senses under Stimulus-response, Organs; and the nervous and endocrine systems under Stimulus-response, Organisms. Another category under Cell-aggregates would be Populations, which would cover the material of biometrics, ecology, and much of bacteriology.
Such a topic as The Virus is not an insuperable obstacle to this arrangement; there are many good reasons for placing it under CellParts. But it is obvious from the topics named that a better method than either equal-ranking classes or a hierarchy would be a multidimensional network, in which topics may be different distances apart, but in which each topic is linked to many others directly, and to all others indirectly. Protoplasmic Structure would be close to if not precisely at the centre of such network. With the further development of biophysics, the appropriate ordering will doubtless become more evident.
Applied biophysics is exceedingly scanty. There are a few scattered medical applications, such as the gold number or its modern equivalents in the analysis of cerebrospinal fluid, the use of X-rays and radium in the treatment of cancer. But biophysics is yet too young to show applications on any large scale.
There are many fields of biology in which the rather young biophysical method has not been active, so that a sufficient amount of representative material is not available for presentation. Some topics of biophysical interest, e.g., metabolism, are still referred to biochemistry for the same reason.
It appears from this that the word "biophysics" is in part a misnomer. Biophysical research is biological research with a particular emphasis--concern for the logical ordering and quantification of biological theory, for the more intimate unification of theory and experiment, for the introduction into experimental biology of techniques and measuring devices which have been developed in the so-called physical sciences, and for the reduction-when it is possible and useful, and only then-of biological problems and concepts to already existent laws and concepts of the physical sciences.
That physics--the science of matter--has in fact preoccupied itself with those objects which used to be termed "non-living" is logically accidental, not intrinsic. Taken in this sense, the "physicalizing" of biology merely means the attempt to analyze certain complex phenomenal patterns in terms of somewhat simpler patterns which have already been the object of intensive study. In this sense it is neither novelty nor heresy, but an inevitable extension of the classical biological procedure of analyzing organisms into organs, organs into tissues, tissues into cells, and cells finally into their discernible parts.
It is only fair to add that "biophysics" is usually used in a sense which contrasts it with biochemistry--that is, as a study of the physical as distinct from the chemical aspects of biological systems. This viewpoint would see viscosity, osmotic pressure, surface tension, the electrical and mechanical properties of biological systems as physical, while the composition and metabolic activities of such systems are the concern of chemistry.
This criterion has been serviceable in the past, of course; but it is so narrow as to be both cramping to research and rather difficult rigidly to maintain. Thus, the study of bioluminescence must in this view separate sharply into two parts: the analysis of the luciferinluciferase system is biochemistry, while the emission of a photon by the reduced enzyme is biophysics. It is valid to say, "For the moment, let us consider only the physical aspects of this phenomenon, and ignore the chemical and purely biological." But the moment passes quickly, and the essential inseparability of the different aspects demands the broader interpretation.
It remains to consider the best way of subdividing biophysical activity into its branches according to some specified criterion of classification. From the preceding discussion it is clear that one apparently natural division-into theoretical and experimental--is not a desirable one. The nature of biophysics, as here defined, demands the same close interweaving, mutual support, and mutual stimulus of theorizing and experimenting as is now practised so successfully in physics.
To adopt the existing fundamentum divisionis of biology is no more desirable; for the fences around bacteriology, embryology, histology, physiology, botany, and the like, in view of their haphazard historical origin, exhibit small regard either for practical utility or for logical consistency. Some of these fields are organized around a particular function, some around a particular set of structures, some around a particular class of organisms, and some are mere catch-alls for topics which do not fit handily into the remaining cells.
If we accept the cell as fundamental concept in biology, a useful though by no means perfect mode of classification suggests itself--the hierarchy: cell-parts, cells, cell-aggregates. These further subdivide in a fairly natural way, principally according to functions and activities. Thus, under Cell-parts, we think of: Protoplasmic Structure; Enzyme Systems of the Cell; Nucleus and Chromosomes; Cell Membranes and Permeability; Golgi Bodies and Mitochondria.
Under Cells would come: Growth; Form; Motion; Division; Differentiation; Metabolism; Senescence; Stimulus-Response.
Under Cell-aggregates there are similar categories: Organic Form and Differentiation; Growth; Metabolism; Senescence; StimulusResponse. These would intersect with the triple classification: Tissues; Organs; Organisms. Thus, for example, we would find Secretion under Metabolism, Organs (perhaps also under Cells, Metabolism); special senses under Stimulus-response, Organs; and the nervous and endocrine systems under Stimulus-response, Organisms. Another category under Cell-aggregates would be Populations, which would cover the material of biometrics, ecology, and much of bacteriology.
Such a topic as The Virus is not an insuperable obstacle to this arrangement; there are many good reasons for placing it under CellParts. But it is obvious from the topics named that a better method than either equal-ranking classes or a hierarchy would be a multidimensional network, in which topics may be different distances apart, but in which each topic is linked to many others directly, and to all others indirectly. Protoplasmic Structure would be close to if not precisely at the centre of such network. With the further development of biophysics, the appropriate ordering will doubtless become more evident.
Applied biophysics is exceedingly scanty. There are a few scattered medical applications, such as the gold number or its modern equivalents in the analysis of cerebrospinal fluid, the use of X-rays and radium in the treatment of cancer. But biophysics is yet too young to show applications on any large scale.
There are many fields of biology in which the rather young biophysical method has not been active, so that a sufficient amount of representative material is not available for presentation. Some topics of biophysical interest, e.g., metabolism, are still referred to biochemistry for the same reason.
Bioluminescence
Bioluminescence is a word applied to the light emitted by various living organisms. At least 40 different orders of animals contain luminous species and two groups of plants, the bacteria, responsible for the luminescence of flesh and dead fish, and the fungi, which live in phosphorescent wood. Luminous bacteria are so small that individuals cannot be seen by their own light but colonies are visible. They are easily cultured and are nonpathogenic to man but may infect living animals, giving rise to a luminescent disease of sand-fleas, shrimps and midges, which is eventually fatal. Luminous bacteria may also live symbiotically in special organs of certain fish, notably Photoblepharon and Anomalops, of the Banda islands.
Bacteria and fungi emit light continuously day and night, while all other forms luminescence only when stimulated. The phosphorescence of the sea appears when many different kinds of small organisms are disturbed by the breaking of waves or motion of a boat. Among the groups of animals containing luminous species are flagellates, radiolaria, sponges, jelly-fish hydroids, sea pens, ctenophores, nemerteans, earthworms and many marine worms, shrimp, ostracods and copepods, myriapods, several groups of insects, monuses, squid, brittle stars, balanoglossids, tunicates and fish.
Bioluminescence is never dependent on a previous illumination of the cells or a previous radiation of any kind, nor is it connected with crystallization, friction, or rubbing, but is the result of oxidation by molecular oxygen of a definite substance produced in the luminous cell. It is a chemiluminescence. The luminous material or photogen is almost universally manufactured by living cells as granules, which may normally undergo oxidation within the cell, as in the fire-fly, (intracellular luminescence) or be extruded as a luminous slime or secretion (extracellular luminescence) as in a small ostracod crustacean, Cypridina. Most is known concerning the chemistry of extracellular luminescence, especially that of Cypridina.
In Cypridina the granules in the secretion dissolve on contact with sea water and the homogeneous luminescence is emitted by the resultant colloidal solution. Two kinds of granules are distinguishable in the cells of Cypridina, one large and yellow, the other small and colorless. In fact, in five of twenty-five different groups of luminous animals tested, it can be demonstrated that luminescence is due to two chemical substances, luciferin (yellow) and luciferase (colorless), which can be easily separated because of a difference in resistance to heating and other properties.
Crude luciferin solution is prepared by making a hot water extract of a luminous organ. Heating destroys the luciferase but does not harm the luciferin. Crude luciferase solution is prepared by making a cold water extract of a luminous organ, when both luciferin and luciferase dissolve and luminescence occurs. The extract is then allowed to stand in the air until the light disappears, evidence that the luciferin has been completely oxidized, leaving the luciferase, an enzyme, in solution. A luciferase solution, by virtue of this mode of preparation, must contain the oxidation product of luciferin as well as luciferase.
Luciferin and luciferase are quite specific. Luciferin from one animal will not luminesce if mixed with the luciferase of another luminous form unless the animals are closely related, such as two species of the same genera or two genera within the same order. Even if the color of the luminescence is different in the two different species light will appear, provided the species are closely related. In this case it is interesting to note that the color of luminescence of the resultant "cross" is determined by the animal supplying the luciferase. Luciferase must be the source of the light. It is convenient to designate the luciferins and luciferases by prefixing the name of the animal from which the substances are obtained.
Most luminous animals, if dried rapidly will again luminesce on moistening. Dried Cypridinae have been kept for 26 years without deterioration and can be used for preparing luciferin and luciferase.
Cypridina luciferin is purified by extraction of the dry Cypridinae with methyl alcohol. Ten per cent of butyl alcohol is then added and the methyl alcohol removed in vacuo. The supernatant butyl alcohol extract is chilled and benzoylated with benzoyl chloride. After fifteen minutes this solution is diluted with ten volumes of water and the new inactive benzoyl luciferin derivatives extracted with pure ether. After removing the ether in vacuo the residual liquor is hydrolyzed with hydrochloric acid in absence of oxygen. The free active luciferin is left in the acid solution and can be extracted with butyl alcohol. By repeating the benzoylation and hydrolysis, a product purified 2,000-fold, as compared with dry Cypridinae, can be obtained.
To purify luciferase it is usually sufficient to dialyze a cold, wellstirred water extract of rapidly dried, powdered Cypridinae against cold running water for twenty hours. Dialysis removes pigment, and a precipitate forms which can be filtered off. A few drops of toluene added to this solution will preserve it for months with little loss in activity if kept in a refrigerator.
Cypridina luciferin is slowly dialyzable; not destroyed by trypsin; soluble in water, absolute methyl, ethyl, and propyl alcohol but insoluble in acetone, benzene and ether; readily adsorbed on fine particles. It does not act as an antigen.
Cypridina luciferase is non-dialyzable; destroyed by trypsin; soluble in water, but insoluble in alcohols and all fat solvents; readily adsorbed on surfaces. It is capable of forming an antiluciferase when injected into the blood of a rabbit. Other luciferins and luciferases have different properties.
The oxidation of luciferin with production of light in the presence of luciferase gives an oxidation product which cannot be reduced, whereas the oxidation without luminescence by oxidants like potassium ferricyanide is reversible.
This Product is called oxidized lucifenn. The change with ferricyanide occurs in two steps, one of which is the reversible oxidation previously referred to; the second is irreversible and probably also an oxidation, although this has not been definitely demonstrated. The spontaneous oxidation of luciferin without emission of light in crude solutions (without luciferase) is probably catalyzed by traces of heavy metals in the solution and proceeds much more slowly when the luciferin has been purified. Both the non-luminescent oxidation and the luminescent oxidation undoubtedly take place simultaneously when luciferin is mixed with luciferase.
Cyanide does not affect luciferase but forms an irreversible combination with purified Cypridina luciferin. Azide combines reversibly with luciferin whereas urethane, sulfanilamide, sulphathiazol, sulphapyridine and p-aminobenzoic acid probably act reversibly to inhibit luciferase activity.
Bacteria and fungi emit light continuously day and night, while all other forms luminescence only when stimulated. The phosphorescence of the sea appears when many different kinds of small organisms are disturbed by the breaking of waves or motion of a boat. Among the groups of animals containing luminous species are flagellates, radiolaria, sponges, jelly-fish hydroids, sea pens, ctenophores, nemerteans, earthworms and many marine worms, shrimp, ostracods and copepods, myriapods, several groups of insects, monuses, squid, brittle stars, balanoglossids, tunicates and fish.
Bioluminescence is never dependent on a previous illumination of the cells or a previous radiation of any kind, nor is it connected with crystallization, friction, or rubbing, but is the result of oxidation by molecular oxygen of a definite substance produced in the luminous cell. It is a chemiluminescence. The luminous material or photogen is almost universally manufactured by living cells as granules, which may normally undergo oxidation within the cell, as in the fire-fly, (intracellular luminescence) or be extruded as a luminous slime or secretion (extracellular luminescence) as in a small ostracod crustacean, Cypridina. Most is known concerning the chemistry of extracellular luminescence, especially that of Cypridina.
In Cypridina the granules in the secretion dissolve on contact with sea water and the homogeneous luminescence is emitted by the resultant colloidal solution. Two kinds of granules are distinguishable in the cells of Cypridina, one large and yellow, the other small and colorless. In fact, in five of twenty-five different groups of luminous animals tested, it can be demonstrated that luminescence is due to two chemical substances, luciferin (yellow) and luciferase (colorless), which can be easily separated because of a difference in resistance to heating and other properties.
Crude luciferin solution is prepared by making a hot water extract of a luminous organ. Heating destroys the luciferase but does not harm the luciferin. Crude luciferase solution is prepared by making a cold water extract of a luminous organ, when both luciferin and luciferase dissolve and luminescence occurs. The extract is then allowed to stand in the air until the light disappears, evidence that the luciferin has been completely oxidized, leaving the luciferase, an enzyme, in solution. A luciferase solution, by virtue of this mode of preparation, must contain the oxidation product of luciferin as well as luciferase.
Luciferin and luciferase are quite specific. Luciferin from one animal will not luminesce if mixed with the luciferase of another luminous form unless the animals are closely related, such as two species of the same genera or two genera within the same order. Even if the color of the luminescence is different in the two different species light will appear, provided the species are closely related. In this case it is interesting to note that the color of luminescence of the resultant "cross" is determined by the animal supplying the luciferase. Luciferase must be the source of the light. It is convenient to designate the luciferins and luciferases by prefixing the name of the animal from which the substances are obtained.
Most luminous animals, if dried rapidly will again luminesce on moistening. Dried Cypridinae have been kept for 26 years without deterioration and can be used for preparing luciferin and luciferase.
Cypridina luciferin is purified by extraction of the dry Cypridinae with methyl alcohol. Ten per cent of butyl alcohol is then added and the methyl alcohol removed in vacuo. The supernatant butyl alcohol extract is chilled and benzoylated with benzoyl chloride. After fifteen minutes this solution is diluted with ten volumes of water and the new inactive benzoyl luciferin derivatives extracted with pure ether. After removing the ether in vacuo the residual liquor is hydrolyzed with hydrochloric acid in absence of oxygen. The free active luciferin is left in the acid solution and can be extracted with butyl alcohol. By repeating the benzoylation and hydrolysis, a product purified 2,000-fold, as compared with dry Cypridinae, can be obtained.
To purify luciferase it is usually sufficient to dialyze a cold, wellstirred water extract of rapidly dried, powdered Cypridinae against cold running water for twenty hours. Dialysis removes pigment, and a precipitate forms which can be filtered off. A few drops of toluene added to this solution will preserve it for months with little loss in activity if kept in a refrigerator.
Cypridina luciferin is slowly dialyzable; not destroyed by trypsin; soluble in water, absolute methyl, ethyl, and propyl alcohol but insoluble in acetone, benzene and ether; readily adsorbed on fine particles. It does not act as an antigen.
Cypridina luciferase is non-dialyzable; destroyed by trypsin; soluble in water, but insoluble in alcohols and all fat solvents; readily adsorbed on surfaces. It is capable of forming an antiluciferase when injected into the blood of a rabbit. Other luciferins and luciferases have different properties.
The oxidation of luciferin with production of light in the presence of luciferase gives an oxidation product which cannot be reduced, whereas the oxidation without luminescence by oxidants like potassium ferricyanide is reversible.
This Product is called oxidized lucifenn. The change with ferricyanide occurs in two steps, one of which is the reversible oxidation previously referred to; the second is irreversible and probably also an oxidation, although this has not been definitely demonstrated. The spontaneous oxidation of luciferin without emission of light in crude solutions (without luciferase) is probably catalyzed by traces of heavy metals in the solution and proceeds much more slowly when the luciferin has been purified. Both the non-luminescent oxidation and the luminescent oxidation undoubtedly take place simultaneously when luciferin is mixed with luciferase.
Cyanide does not affect luciferase but forms an irreversible combination with purified Cypridina luciferin. Azide combines reversibly with luciferin whereas urethane, sulfanilamide, sulphathiazol, sulphapyridine and p-aminobenzoic acid probably act reversibly to inhibit luciferase activity.
Divisions of biochemistry
No rigid, conventional divisions of biochemistry exist, as in the case of chemistry and physics proper, where a distinction between organic' and "inorganic," for example, is rather sharp. Still dominant is the treatment where the class of substance involved is the name of the subject, as "Carbohydrates," "Fats," "Proteins. . . . . Inorganic Constituents," "Accessory Substances," and now '"Hormones." Almost all texts describe these groups of substances and then take up what is known of their ingestion or synthesis in the body, their role, their metabolism and the further course, final consumption and elimination of the products of their metabolism. That at least the principal classes of materials serve as equivalents of one another and are mutually convertible tends to upset any such classification. The latter part of many a text, therefore, resorts to a series of chapters where the physiological process, e.g. digestion, or the function of an important organ, e.g., the kidney or the liver, serves as the division of the subject.
Occasionally a text starts with a phsico-chemical introduction in place of the organic chemistry of the principal materials. In such cases a stress on colloid chemistry is imperative. The fields of biochemistry shape up as applications of sectors of the other sciences to living systems.
Occasionally a text starts with a phsico-chemical introduction in place of the organic chemistry of the principal materials. In such cases a stress on colloid chemistry is imperative. The fields of biochemistry shape up as applications of sectors of the other sciences to living systems.
Biochemistry Definitions and Classifications of Branches
Biochemistry is a hybrid science. It arose from the overlapping of more or less purely chemical issues and more or less biological issues. Consequently it is subject to a great variety of definitions reflecting the scope of the pure sciences and the manner in which they are combined. The manner of combination results either in an emphasis on biology or on chemistry.
"Biochemistry" is a term which stresses chemistry and to most biochemists, at least of two or three decades ago, it meant '"the chemistry of biologically important substances." The emphasis has been shifting to "the chemical aspects of living processes" and, we venture to predict, will lead to the employment of the expression "chemical biology." This is a trend in all scientific development and has led, for example, in the borderland between physics and chemistry, to the emergence of two subjects, "physical chemistry" and "chemical physics." Thus, we can expect another pair, "biological chemistry" (or biochemistry) and "chemical biology," to divide the field now customarily described by the former term. The term "physiological chemistry," designed possibly to call attention to the dynamics of the biological processes has been falling into disuse, because physiology is after all only one branch of biology. If it is retained it may become a branch of "biological chemistry."
It is possible also that "chemical biology" might receive a name like "cheobiology." The trend toward renaming in the direction in which "chemical" serves as the adjective is illustrated by the relatively rise of "chemical embryology". If we are right, this in itself may become a branch of "chemical evolution" which in turn would be a branch of "chemical biology."
Other definitions of biochemistry emphasize, consciously or unconsciously, the philosophy of the definer. The author of the definition, may be an outright materialist, in which case he would stress the physical basis of life, or an idealist of one kind or another who believes in entelechies, life principles and the like. One hates to think of what would become of the subject according to such a definition if there were no special distinctive "biotic energy."
The modern trend is toward what the author has called "dynamic biochemistry" before favoring wholeheartedly "chemical biology." A convenient, but theoretically poorly founded, distinction is that of a "pure" and an "applied" science. The varieties of "applied biochemistry" include what the medical student gets as "pathological chemistry" or what the botanist might take up as "phytochemistry," the zoologist as "zoochemistry."
There are even more complicated hybrids in such subjects as "biogeochemistry" and the loosely defined field of "comparative biochemistry"' which ranges over all living types in an evolutionary manner.
We suggest that order in this creation of sectors of research might be set up by listing the divisions of biology as (1) morphology (2) distribution (3) physiology and (4) aetiology and the customary divisions of chemistry as physical, inorganic, organic, analytical, etc., with subdivisions such as "colloidal" and the like, and then blending them into hybrid sciences. This will account for the appearance of such terms--used in England--as "aetiological chemistry" meaning the division of biochemistry dealing with "cause and effect in the determination of development" and thus naturally including as a part of itself "chemical embryology." In this connection we would prefer "chemical aetiology" or "chemical evolution." New subjects might be, for example, "colloidal chemical physiology" or "chemical genetics" or "chemical immunity." At present these subjects are suggested by expressions like "the biochemistry of genetics. . . . . the biochemistry of the earth," (i.e. of living forms in the earth's development), etc., etc.
"Biochemistry" is a term which stresses chemistry and to most biochemists, at least of two or three decades ago, it meant '"the chemistry of biologically important substances." The emphasis has been shifting to "the chemical aspects of living processes" and, we venture to predict, will lead to the employment of the expression "chemical biology." This is a trend in all scientific development and has led, for example, in the borderland between physics and chemistry, to the emergence of two subjects, "physical chemistry" and "chemical physics." Thus, we can expect another pair, "biological chemistry" (or biochemistry) and "chemical biology," to divide the field now customarily described by the former term. The term "physiological chemistry," designed possibly to call attention to the dynamics of the biological processes has been falling into disuse, because physiology is after all only one branch of biology. If it is retained it may become a branch of "biological chemistry."
It is possible also that "chemical biology" might receive a name like "cheobiology." The trend toward renaming in the direction in which "chemical" serves as the adjective is illustrated by the relatively rise of "chemical embryology". If we are right, this in itself may become a branch of "chemical evolution" which in turn would be a branch of "chemical biology."
Other definitions of biochemistry emphasize, consciously or unconsciously, the philosophy of the definer. The author of the definition, may be an outright materialist, in which case he would stress the physical basis of life, or an idealist of one kind or another who believes in entelechies, life principles and the like. One hates to think of what would become of the subject according to such a definition if there were no special distinctive "biotic energy."
The modern trend is toward what the author has called "dynamic biochemistry" before favoring wholeheartedly "chemical biology." A convenient, but theoretically poorly founded, distinction is that of a "pure" and an "applied" science. The varieties of "applied biochemistry" include what the medical student gets as "pathological chemistry" or what the botanist might take up as "phytochemistry," the zoologist as "zoochemistry."
There are even more complicated hybrids in such subjects as "biogeochemistry" and the loosely defined field of "comparative biochemistry"' which ranges over all living types in an evolutionary manner.
We suggest that order in this creation of sectors of research might be set up by listing the divisions of biology as (1) morphology (2) distribution (3) physiology and (4) aetiology and the customary divisions of chemistry as physical, inorganic, organic, analytical, etc., with subdivisions such as "colloidal" and the like, and then blending them into hybrid sciences. This will account for the appearance of such terms--used in England--as "aetiological chemistry" meaning the division of biochemistry dealing with "cause and effect in the determination of development" and thus naturally including as a part of itself "chemical embryology." In this connection we would prefer "chemical aetiology" or "chemical evolution." New subjects might be, for example, "colloidal chemical physiology" or "chemical genetics" or "chemical immunity." At present these subjects are suggested by expressions like "the biochemistry of genetics. . . . . the biochemistry of the earth," (i.e. of living forms in the earth's development), etc., etc.
Wednesday, September 26, 2007
Bile Tract Disease
Cholecystitis; cholangitis; cholelithiasis; dyskinesia of the bile passages; a group of disorders of the bile passages which may be characterized by the inflammation of the gall bladder (cholecystitis) or of the bile passages (cholangitis) or the formation of "stones" or calculi in the gall bladder or bile ducts (cholelithiasis) in both acute and chronic forms. The origin of these diseases may be due to infection by various bacilli, e.g. streptococcus, typhoid, bile stasis, dietary upsets leading to separation of cholesterol, especially in "gallstones" (cholelithiasis). An entire science of cholecystography has been developed to visualize the stones by means of dyes opaque to Xrays, which usually contain high percentages of iodine.
Jaundice is frequently an accompaniment of biliary disease because of liver involvement. The symptoms include "biliousness" which is characterized by nausea, headaches, drowsiness, belching. Gall stones are largely cholesterol with protein inclusions. In treatment the flow of bile can be increased only cautiously. The agents used to promote the flow of bile, cholagogues or cholekinetics, are usually magnesium salts. Substances which tend to increase the amount of bile secreted, or choleretics, may be salicylates or cinchophen combined with the bicarbonates and sulfates.
Numerous tests have been developed in connection with bile tract and liver diseases besides cholecystography. Bile pigments are determined in the blood and in the urine. Various types of jaundice (hemolytic, obstructive, parenchymatous) are thus distinguished. Liver function is also tested by ability of the liver to store glycogen from galactose, blood sedimentation tests, amino acid tests to determine breakdown of tissue, and special tests on serum proteins, e.g. Takata-ara reaction.
Jaundice is frequently an accompaniment of biliary disease because of liver involvement. The symptoms include "biliousness" which is characterized by nausea, headaches, drowsiness, belching. Gall stones are largely cholesterol with protein inclusions. In treatment the flow of bile can be increased only cautiously. The agents used to promote the flow of bile, cholagogues or cholekinetics, are usually magnesium salts. Substances which tend to increase the amount of bile secreted, or choleretics, may be salicylates or cinchophen combined with the bicarbonates and sulfates.
Numerous tests have been developed in connection with bile tract and liver diseases besides cholecystography. Bile pigments are determined in the blood and in the urine. Various types of jaundice (hemolytic, obstructive, parenchymatous) are thus distinguished. Liver function is also tested by ability of the liver to store glycogen from galactose, blood sedimentation tests, amino acid tests to determine breakdown of tissue, and special tests on serum proteins, e.g. Takata-ara reaction.
Bile
A bitter yellow fluid, secreted by liver cells of practically all vertebrates and stored in most species in the gall bladder, where it is considerably concentrated by absorption of water, with a change of its reaction from slightly alkaline to weakly acidic, it is eventually excreted into the duodenum, whence its essential constituents, the bile acids, return to the liver. The most important components of this aqueous solution, besides the alkali salts of the bile acids, are alkali carbonate, bile pigments, lipids, including cholesterol, and mucin. Bile is an emuslifying agent for lipids, thus essential for their digestion.
Bacteriophage
By definition "bacteriophage" (or phage) connotes a large group of sub-microscopic agents which induce transmissible lysis of bacteria and are capable of passing bacteriaretaining filters. They are widely distributed in nature, abound particularly in the intestinal tracts of man and animals and possess particulate diameters within the limits of 8 μμ to 100 μμ. Like the mosaic viruses, purified phage preparations have been found to be nucleoproteins. Molecular weight determinations by means of centrifugation analysis and diffusion have given figures of 400,000 to 300,000,000.
The first observations on bacteriophage were made in 1915 by Twort. He noted in colonies of Staphylococci isolated from calf-lymph curious, glassy-looking areas within which there were masses of granular debris. He found that it was possible to form vitreous zones in normal cultures by the simple expedient of placing on the surface of a young agar culture a drop of filtrate from a suspension of bacterial growth in which this degenerative change already had taken place.
In 1917 d'Herelle called attention to the same phenomenon observed while he was studying cultures of dysentery bacilli recently isolated from the stools of patients suffering from bacillary dysentery. For no apparent reason ordinary turbid broth cultures of dysentery bacilli would suddenly become crystal clear and this spectacular lysis could be induced in a fresh culture of dysentery bacilli by adding a drop of the filtered, cleared culture. d'Herelle coined the term "bacteriophagy" to denote all phases of the reaction between bacteriophage and the susceptible bacterial host and for several years he studied the phenomenon intensively. He developed the view that phage is a single living organism, "Protobios bacteriophagum" which may adapt itself to live upon a wide variety of bacterial substrates. Others, notably Bordet, believed that phage is a bacterial enzyme of unspecified origin but possessing such properties that its introduction into the bacterial cell disturbs the normal metabolic processes with the result that the cell initiates production of the same agent. The essential difference between the two hypotheses is simply that in d'Herelle's view phages are small living units stemming from a single parent "race" and acquiring special characteristics by adaptation while Bordet and his followers believe they are modified bacterial proteins. The consensus of opinion among modern workers is that phages are bacterial viruses, protein in nature and altogether analagous to the animal and plant viruses.
Protein Synthesis
Substrate hydrolysis has been the usual criterion of autolytic activity. On theoretical grounds we assume the reaction to be reversible and under proper conditions to lead to the synthesis of protein molecules from cleavage products. The experimental evidence for such reversals is obviously extraordinarily difficult to obtain in a tissue brei. Without the organization of the cell to protect and insure stability of a peptide chain once formed in order that it may go on to the next step in synthetic growth, the possibility of building up a native protein molecule seems remote.
Where the environment of the tissue extract, glutathione and cleavage products was changed from anaerobic to aerobic conditions. There have been a few other reports of similar successful syntheses. There have also been failures reported. Perhaps the most convincing demonstration of synthesis that liver or spleen cathepsin can catalyze the synthesis of a single specific peptide bond by the use of a well defined simple substrate. This experiment we believe finally completes the evidence which establishes the validity of the major concepts of the autolytic mechanism as functional in both atrophic and hypertrophic tissue changes.
The Autolytic Enzymes
The tissue proteinases were classified as consisting of cathepsin, carboxypolypeptidase, aminopolypeptidase and dipeptidase. Cathepsin was believed to be a single proteinase, acting best at pH 4, activated by -SH and similar reducing agents and initiating cleavage of the native proteins of the tissue. The remaining peptidases were believed to act specifically on the polypeptide fragments of primary cleavage, and on dipeptides, with the production of amino acids. The reaction curves of the members of this group overlap sufficiently so that they could conceivably function together in the complete conversion of tissue proteins to their final cleavage units.
Based upon separations and studies of specific behavior with synthetic substrates, there are many more enzymes in tissues than those, and that they will eventually be susceptible to an entirely different classification based upon more fundamental characteristics.
Anemias
Deficiencies in the number of red blood cells and in the hemoglobin content of the blood, which constitute a complex of symptoms, such as pallor, cardiovascular disturbances characteristic of oxygen deprivation, exertion dyspnea and palpitation, tachycardia, arrhythmia, low blood pressure, nervous symptoms, digestive symptoms, menstrual disturbances, loss of libido and albuminuria. The principal types are (1) normocytic (orthochromic) anemias (2) microcytic (hypochronic) anemias and (3) macrocytic (hyperchromic) anemias.
In the normocytic type the number of erythrocytes and the hemoglobin concentration are reduced in strict proportion. It is characteristic of hemorrhage, hemolyses due to poisoning and most infections or it may be "aplastic anemia" due to exhaustion of bone marrow. Blood transfusion is used as emergency treatment. Microcytic anemias are characterized by a reduction of corpuscular hemoglobin below 30% and a decrease of the mean volume of erythrocytes with a color index below one. This is usually caused by iron deficiency, inadequate digestion, exhaustion. The treatment is dietary.
Macrocytic anemias, including "pernicious anemia," have a high color index, with a mean corpuscular hemoglobin content above 30% and a high volume. They are caused by a lack of antianemic principle of the liver or the "intrinsic factor" secreted by the stomach. There is often failure of the stomach to secrete free hydrochloric acid. The missing factors have to be supplied as well as hydrochloric acid.
In the normocytic type the number of erythrocytes and the hemoglobin concentration are reduced in strict proportion. It is characteristic of hemorrhage, hemolyses due to poisoning and most infections or it may be "aplastic anemia" due to exhaustion of bone marrow. Blood transfusion is used as emergency treatment. Microcytic anemias are characterized by a reduction of corpuscular hemoglobin below 30% and a decrease of the mean volume of erythrocytes with a color index below one. This is usually caused by iron deficiency, inadequate digestion, exhaustion. The treatment is dietary.
Macrocytic anemias, including "pernicious anemia," have a high color index, with a mean corpuscular hemoglobin content above 30% and a high volume. They are caused by a lack of antianemic principle of the liver or the "intrinsic factor" secreted by the stomach. There is often failure of the stomach to secrete free hydrochloric acid. The missing factors have to be supplied as well as hydrochloric acid.
Interchange of Amino Acids between Blood and Tissues
During digestion the amino acid content of the blood rose about 20 per cent, as the blood perfused the intestines, and that the greater part of the absorbed amino acids was removed by the liver. In return, the liver poured into the blood of the hepatic vein an amount of urea nitrogen that had been taken up. One could watch the work of the liver in taking up the amino acids and destroying them, turning their nitrogenous parts into urea for excretion by the kidneys. Unreasonable and wasteful though it seems, a large part of the amino acids absorbed from the intestine appears to be captured and destroyed by the liver, and never to have a chance to reach and nourish the other tissues. Other experiments, showed that the liver did not get all the absorbed amino acids, but that some escaped, and could be absorbed by other tissues. It was found that even in the fasting animal the amino acid concentration in the tissues was about 10 times as great as in the blood plasma, viz., about 40 to 60 mg. of amino acid nitrogen per 100 grams of tissue, compared with 5 mg. per 100 grams of plasma. When amino acids were injected into the circulation they were quickly taken from the blood by the tissues, where the amino acid contents might be increased to 2 or 3-fold their former values.
In one experiment the amino nitrogen of the liver rose to 150 mg. per 100 grams; in the muscles the increase was never so great. During the next three hours the amino acids in the muscles and kidneys remained practically unchanged, but the amino acids in the liver fell almost back to their original level, and an equivalent of urea nitrogen appeared in the circulation. Fate of Amino Acids in the Liver. The evidence in these experiments, that the liver is the organ where urea formation takes place, supported an old but much contested hypothesis that the liver is the only organ that forms urea. The removal of the livers led to an accumulation of amino acids in the blood, and entirely stopped the formation of urea. Another vicissitude of the amino acids which the work of Mann and his colleagues located in the liver is transformation into glucose. When protein was catabolized by dogs made totally diabetic by phloridizin poisoning, about 60 grams of glucose were formed and excreted from each 100 grams of protein catabolized. When certain amino acids were fed their carbon was partly or entirely turned into glucose when their nitrogen was turned into urea. No glucose formation from proteins or amino acids occurred when the liver was excluded. Furthermore, the acceleration of the body's heat production that occurs during assimilation of protein digestion products was shown not to occur when the liver was excluded. This accelerated heat production, called the "specific dynamic action," apparently either represents energy produced by the reactions which the amino acids undergo in the liver, or is caused by other reactions in the cells which are stimulated by the presence of products formed in the liver. Such substances must be other than the urea and glucose, for neither of these causes the observed amount of heat acceleration. Not all the treatment met by the amino acids in the liver is destructive.
During periods of heavy protein feeding the body stores considerable amounts of protein in the liver and, in less amounts per gram of tissue, in the other tissues. The reserve protein seems to be different from the structural proteins of the tissues. In the liver it can in fact be differentiated with the microscope by its droplet structure in the cells. Functionally it is characterized by the readiness with which it is metabolized at the onset of starvation, and with which it is used to replace blood proteins depleted by hemorrhage. The liver also appears to be the place where plasma fibrin and albumin are formed. It was demonstrated hundred years ago that injury of the liver retarded or prevented formation of fibrin. The liver is essential also for the formation of the albumin of the plasma. These proteins are presumably formed from free or combined amino acids taken out of the blood by the liver.
In one experiment the amino nitrogen of the liver rose to 150 mg. per 100 grams; in the muscles the increase was never so great. During the next three hours the amino acids in the muscles and kidneys remained practically unchanged, but the amino acids in the liver fell almost back to their original level, and an equivalent of urea nitrogen appeared in the circulation. Fate of Amino Acids in the Liver. The evidence in these experiments, that the liver is the organ where urea formation takes place, supported an old but much contested hypothesis that the liver is the only organ that forms urea. The removal of the livers led to an accumulation of amino acids in the blood, and entirely stopped the formation of urea. Another vicissitude of the amino acids which the work of Mann and his colleagues located in the liver is transformation into glucose. When protein was catabolized by dogs made totally diabetic by phloridizin poisoning, about 60 grams of glucose were formed and excreted from each 100 grams of protein catabolized. When certain amino acids were fed their carbon was partly or entirely turned into glucose when their nitrogen was turned into urea. No glucose formation from proteins or amino acids occurred when the liver was excluded. Furthermore, the acceleration of the body's heat production that occurs during assimilation of protein digestion products was shown not to occur when the liver was excluded. This accelerated heat production, called the "specific dynamic action," apparently either represents energy produced by the reactions which the amino acids undergo in the liver, or is caused by other reactions in the cells which are stimulated by the presence of products formed in the liver. Such substances must be other than the urea and glucose, for neither of these causes the observed amount of heat acceleration. Not all the treatment met by the amino acids in the liver is destructive.
During periods of heavy protein feeding the body stores considerable amounts of protein in the liver and, in less amounts per gram of tissue, in the other tissues. The reserve protein seems to be different from the structural proteins of the tissues. In the liver it can in fact be differentiated with the microscope by its droplet structure in the cells. Functionally it is characterized by the readiness with which it is metabolized at the onset of starvation, and with which it is used to replace blood proteins depleted by hemorrhage. The liver also appears to be the place where plasma fibrin and albumin are formed. It was demonstrated hundred years ago that injury of the liver retarded or prevented formation of fibrin. The liver is essential also for the formation of the albumin of the plasma. These proteins are presumably formed from free or combined amino acids taken out of the blood by the liver.
Amino Acids Digestion and Absorption
In the human stomach the chief visible change, is that food proteins which enter as insoluble matter, such as meat or coagulated egg white, are dissolved. Chemical studies show that the long protein chains are unrolled and broken into relatively short peptide chains, which still, however, are fairly long. No absorption of the products occurs in the stomach; absorption begins only after the chyme enters the intestine. In the intestine the chyme meets the enzymes secreted by the pancreas and the intestinal wall. These enzymes hydrolyze the long peptides of the chyme to short peptides containing only 2 or 3 amino acids in the molecule, and to free amino acids. Also, any unchanged protein particles that have escaped the gastric juice are digested. The ability of the intestine to digest, not only gastric peptides, but also intact proteins, makes possible the nutrition of people with achylia gastrica and even of persons who have had the stomach completely removed.
Methods for Determination of Amino Acids
In studies of protein digestion and of the nature and fate of the digestion products, methods for measuring the amounts of amino acids present in blood and other parts of the body are indispensable tools.
The first was the "nitrous acid method" which depends on the reaction: RCH(NH 2 )COOH+HNO 2 = RCH(OH)COOH+H 2 O+N 2 The N 2 gas is a measure of the amount of amino acid present. The reaction is not entirely specific for amino acids, because other amines with NH2 groups also react; but such amines are usually not present in important amounts or can be removed.
A later and more specific method depends on reaction with a mild oxidizing agent called ninhydrin. Its effect is indicated by the equation: RCH(NH 2 )COOH+O= RCHO+NH 3 +CO 2 The analysis consists merely of heating the mixture for a few minutes and measuring the CO 2 evolved. This reaction is so specific for free amino acids that it serves to pick out and measure them in the most diverse mixtures of other amines, organic acids, peptides and other biological products.
The first was the "nitrous acid method" which depends on the reaction: RCH(NH 2 )COOH+HNO 2 = RCH(OH)COOH+H 2 O+N 2 The N 2 gas is a measure of the amount of amino acid present. The reaction is not entirely specific for amino acids, because other amines with NH2 groups also react; but such amines are usually not present in important amounts or can be removed.
A later and more specific method depends on reaction with a mild oxidizing agent called ninhydrin. Its effect is indicated by the equation: RCH(NH 2 )COOH+O= RCHO+NH 3 +CO 2 The analysis consists merely of heating the mixture for a few minutes and measuring the CO 2 evolved. This reaction is so specific for free amino acids that it serves to pick out and measure them in the most diverse mixtures of other amines, organic acids, peptides and other biological products.
Amino Acid Structure of the Proteins
The tissues of our bodies, skin, muscle, tendon, are chiefly protein substances. The number of proteins in the animal and vegetable world appears to be infinite. Yet they are all constructed of about twenty-one units, called the amino acids. These have an extraordinary ability to link together in chains in numbers up to thousands. One definition of infinity might be the possible number of different protein molecules that could be built by permutations and combinations of the amino acids. The extraordinary thing, in fact, is that nature ever succeeds in duplicating a protein molecule. Perhaps she never does exactly. But she comes so close to it that so far as we can tell the casein of cow's milk is always the same, the proteins of muscle seem to be constant in their properties, and so on through the list of proteins that make up the familiar animal and vegetable structures of which we are constructed and on which we live.
The common structure which all the amino acids posses, and which permits this chain-making, may be formulated as:
All the amino acids except proline and hydroxyproline have Structure I, while these two amino acids have II. Each amino acid has an amino group, NH 2 or NH·CH 2, which has an alkalinity about equal to that of ammonia; and each has a carboxyl group, COOH, which has the acidity of an unusually strong organic acid. The R represents a chemical group which is different in each amino acid, and gives it its character as an individual.
In proteins Emil Fischer demonstrated that the amino acids are joined, by what he termed peptide linkings, each NH 2 group condensing with the COOH of another amino acid, with elimination of the elements of water. Simple chains of a few amino acids, Fischer termed peptides.
The proteins are peptides of tremendously long chains. These protein chains seem usually to be rolled or folded into balls or otherwise made to take a globular or ellipsoid or sausage shape. Their rates of diffusion were found by Northrop and Anson to approximate the rates that would be calculated for spheres, and the asymmetries calculated from ultra centrifugation are not great. Exceptions are the fibrous proteins, such as silk and wool, in which the molecules appear to be extended into straight wavy chains, long bundles of which make the visible fibres.
Path of Amino Acids through the Body. Except for the transient supply of proteins with which we are born, all those in our bodies are obtained from the proteins of other animals and vegetables, which we eat and digest into their constituent amino acids or simple peptides, and then build into our own tissues. However, only a fraction of the amino acids that we invite into our bodies really find acceptance there as naturalized citizens, integral units of our own structures. Many other fates beset the immigrant amino acid; it may be disintegrated to make some entirely different product; or it may simply be burned for fuel.
The common structure which all the amino acids posses, and which permits this chain-making, may be formulated as:
All the amino acids except proline and hydroxyproline have Structure I, while these two amino acids have II. Each amino acid has an amino group, NH 2 or NH·CH 2, which has an alkalinity about equal to that of ammonia; and each has a carboxyl group, COOH, which has the acidity of an unusually strong organic acid. The R represents a chemical group which is different in each amino acid, and gives it its character as an individual.
In proteins Emil Fischer demonstrated that the amino acids are joined, by what he termed peptide linkings, each NH 2 group condensing with the COOH of another amino acid, with elimination of the elements of water. Simple chains of a few amino acids, Fischer termed peptides.
The proteins are peptides of tremendously long chains. These protein chains seem usually to be rolled or folded into balls or otherwise made to take a globular or ellipsoid or sausage shape. Their rates of diffusion were found by Northrop and Anson to approximate the rates that would be calculated for spheres, and the asymmetries calculated from ultra centrifugation are not great. Exceptions are the fibrous proteins, such as silk and wool, in which the molecules appear to be extended into straight wavy chains, long bundles of which make the visible fibres.
Path of Amino Acids through the Body. Except for the transient supply of proteins with which we are born, all those in our bodies are obtained from the proteins of other animals and vegetables, which we eat and digest into their constituent amino acids or simple peptides, and then build into our own tissues. However, only a fraction of the amino acids that we invite into our bodies really find acceptance there as naturalized citizens, integral units of our own structures. Many other fates beset the immigrant amino acid; it may be disintegrated to make some entirely different product; or it may simply be burned for fuel.
Amenorrhea
Abnormal absence or cessation of menstruation. Primary amenorrhea refers to nonappearance of menstruation at puberty, secondary amenorrhea to the same phenomenon after normal puberty. Anatomical causes sometimes occur as in surgical or X-ray removal or destruction. Otherwise the principal causes are anemia and tuberculosis. Occurrences have been reported in avitaminosis, insanity, shock, exposure, phantom pregnancy, and many other conditions of an endocrine character, as thyroid hyperfunction or subovarianism. The endocrinological type has been treated with some success by the use of the anterior pituitary sex hormone extracts.
Agricultural Biochemistry
Agricultural biochemistry is a branch of applied biochemistry which concerns itself with any and all possible situations involving life processes in the pursuit of agriculture. These may include numerous issues such as the cycles of soil organisms, the nurture of plants and their entire metabolic history, animal husbandry from birth to death, pathological conditions to both plants and animals, the biochemical aspects of genetics in the service of breeding, the preparation of animal and plant foods, the control of insects, the processing of farm products, quick ripening, storage, etc., from the pecullar viewpoint ot agriculture which may be described as the economic utilization of the farm for the production of food. There is also a growing tendency to include the biochemical aspects of chemurgy, which is the utilization of farm products for industrial purposes, such as the production of power alcohol, solvents, drugs, etc.
Where soils and crop improvement are concerned biochemistry is involved in the so-called "classification of soils," their preparation, the working over of fertilizers and their production by the aid of living organisms, and even genetic studies, in which chemicals, e.g. colchicine, are used to produce large or new plants. The effects of heat and cold, chemical reagents like ethylene, on storage and ripening have also biochemical aspects. The ethylene is supposed to react with starch in the ripening process. This field also should include aquaculture, or the growth of plants on synthetic nutrients in solution.
A large division of this subject deals with animal nutrition with the practical objective of obtaining more and better eggs, butter, milk and the like. An agricultural biochemist's interests might lead him to administer female sex hormones in order to induce virgin animals to secrete large amounts of milk. Fertility is an important consideration, and involves the usual attention to vitamin E and the like. Where animals are produced for food the conditions for rapid growth are a subject of serious study. Diets are investigated for special effects, e.g. the kind of fat to develop on a hog.
The pathological aspects of the lives of animals and plants occupy a great deal of the attention of the biochemist in this field. Plant diseases are of a very great variety and attack selectively seeds, roots, stems or leaves. The toxic agents have been extracted in many cases. The first viruses to be studied were plant disease viruses. An entire subject, "forest pathology," has grown up recently, which can be listed here as a close relative of agricultural biochemistry.
Where soils and crop improvement are concerned biochemistry is involved in the so-called "classification of soils," their preparation, the working over of fertilizers and their production by the aid of living organisms, and even genetic studies, in which chemicals, e.g. colchicine, are used to produce large or new plants. The effects of heat and cold, chemical reagents like ethylene, on storage and ripening have also biochemical aspects. The ethylene is supposed to react with starch in the ripening process. This field also should include aquaculture, or the growth of plants on synthetic nutrients in solution.
A large division of this subject deals with animal nutrition with the practical objective of obtaining more and better eggs, butter, milk and the like. An agricultural biochemist's interests might lead him to administer female sex hormones in order to induce virgin animals to secrete large amounts of milk. Fertility is an important consideration, and involves the usual attention to vitamin E and the like. Where animals are produced for food the conditions for rapid growth are a subject of serious study. Diets are investigated for special effects, e.g. the kind of fat to develop on a hog.
The pathological aspects of the lives of animals and plants occupy a great deal of the attention of the biochemist in this field. Plant diseases are of a very great variety and attack selectively seeds, roots, stems or leaves. The toxic agents have been extracted in many cases. The first viruses to be studied were plant disease viruses. An entire subject, "forest pathology," has grown up recently, which can be listed here as a close relative of agricultural biochemistry.
Intake of Food
It is rather difficult to discuss the intake of food in any broad fashion and, indeed, the subject is not one of particular interest to the general physiologist. At any rate, the ingestion of food by animals is of more concern to the naturalist who is interested in describing the habits and behavior of various forms than it is to the physiologist. One may distinguish between the entrance of food into the body of an animal and the entrance of food materials into the cells which compose the living part of the animal. Obviously in protozoa there is no distinction between these two processes, for the cell is the animal. In metazoa the food materials typically find their way into an alimentary canal or intestine, and pass from there to the surrounding cells or to the blood. The mechanism of such passage will be considered in a later section under the head of Absorption.
In plants, food enters the cells by diffusion. There are a few higher plants which trap and digest insects, but even in these forms as well as in all other plants, the food materials that are taken into the cells are either gaseous, liquid or in solution. In higher plants, carbon dioxide enters through the leaves, water and dissolved salts through the roots. The rate of entrance through the root hairs and the cells of the root is a function of the permeability of the plasma membrane. The accumulation of substances taken up by plant cells from their environment is dependent not only on permeability, but also on various other factors. One such factor is the chemical combination which may occur between the entering food substance and the protoplasm of the cell. Thus, some seaweeds contain very appreciable percentages of iodine, although the sea water in which they live contains only traces of this element. In this instance it is possible that iodine combines with the cell protoplasm, and is thus trapped within the cell. The factors underlying the accumulation of salts in plant cells are many and complicated.
In plants, food enters the cells by diffusion. There are a few higher plants which trap and digest insects, but even in these forms as well as in all other plants, the food materials that are taken into the cells are either gaseous, liquid or in solution. In higher plants, carbon dioxide enters through the leaves, water and dissolved salts through the roots. The rate of entrance through the root hairs and the cells of the root is a function of the permeability of the plasma membrane. The accumulation of substances taken up by plant cells from their environment is dependent not only on permeability, but also on various other factors. One such factor is the chemical combination which may occur between the entering food substance and the protoplasm of the cell. Thus, some seaweeds contain very appreciable percentages of iodine, although the sea water in which they live contains only traces of this element. In this instance it is possible that iodine combines with the cell protoplasm, and is thus trapped within the cell. The factors underlying the accumulation of salts in plant cells are many and complicated.
Food Requirements Vitamins
There is no clear-cut definition of vitamins, no sure way of deciding whether a substance important in nutrition is to be regarded as a vitamin or not. Vitamins are organic substances capable in small concentration of affecting the health or influencing the rate of growth of organisms. There are numerous substances that act in this way. Some of them are regarded as vitamins, others not, or there may be differences of opinion. Thus it was noted in the last chapter that certain unsaturated fats were necessary for the growth and well-being of rats. These fats can be regarded as a fat requirement or they can be called vitamin F. Similarly, various insects require cholesterol. This may be regarded simply as a sterol requirement, or the cholesterol may be considered a vitamin in the same sense that calciferol (vitamin D) is a vitamin. The fact that vitamins are capable of exerting a powerful influence when present in extremely low concentrations is an indication that they act in some way as catalysts. Certainly this is true of some vitamins.
It is by no means an easy task to present an up-to-date summary of our information concerning vitamins. The earlier studies of vitamins were essentially practical. Men suffered from diseases due to vitamin deficiency. It was important to discover which foods contained the necessary vitamins, and in what amount. Lacking a chemical knowledge of the vitamins it was essential to develop biological methods of assay. Thus, it was found that a certain amount of vitamin was necessary to cure pigeons of polyneuritis or to permit normal growth in rats. On the basis of such studies on rats, pigeons, and guinea-pigs, various types of vitamin units were established, and the vitamin content of all sorts of foods was determined. To raise colonies of rats and guinea pigs is rather an expensive and time-consuming business. Fortunately, the presence of vitamins and the amount of a certain vitamin contained in a given sample of food can be tested with organisms much easier and less expensive to raise than mammals and birds. Insects require many of the known vitamins and they might be used as test animals. But much more suitable are various bacteria and fungi. They can be raised in test tubes in a minimum of space. Obviously one must first determine the exact vitamin requirements of a given type of bacterium or fungus. The assay of vitamins by the use of bacteria is now well established practice and there is a large literature in the field.
The chemical composition of most vitamins is now known. This makes possible direct chemical analysis. Often such analysis is aided by spectroscopic study. Thus the A vitamins give a blue color with antimony trichloride and this color is the basis for spectroscopic tests. Some vitamins give characteristic absorption bands in the ultraviolet. Likewise, some vitamins are fluorescent, and the fluorescent color can be tested spectroscopically. Thus in addition to ordinary chemical assay methods, spectroscopic tests are of great value.
In many cases a vitamin may be replaced by other chemical substances related to it chemically. Thus various substances related to ascorbic acid (vitamin C) behave like ascorbic acid in preventing scurvy. There are many substances with vitamin D or vitamin K activity.
The fact that a substance has a chemical structure similar to that of a vitamin does not necessarily indicate that the substance will act like the vitamin. Often, indeed, a substance which resembles a particular vitamin in its chemical composition is an antagonist to it and tends to prevent its action. So, for example, Dicumarol is chemically close to vitamin K; and yet whereas feeding of vitamin K favors blood clotting in higher animals, Dicumarol prevents clotting. Similarly, various analogues of pyridoxine (a B 6 vitamin) act to prevent its action. Other cases of anti-vitamins could be cited. Studies of antivitamin action may give clues as to the mechanism of the action of the vitamin they antagonize. The subject is also of considerable interest to the theoretical pharmacologist. More and more cases are being discovered in which the harmful action of a particular drug is due to its chemical affinity to some substance important for the vital process.
In some cases, the need for a vitamin is lessened by feeding a substance which can be converted into it. In some organisms, tryptophan can be converted into nicotinic acid. Thus, chicks do not require nicotinic acid if fed enough tryptophan. Moreover, isotope studies show that tryptophan can be converted into nicotinic acid. Another instance in which a necessary vitamin can be replaced by an amino acid has been described for the lactic acid bacteria, Streptococcus faecalis and Lactobacillus casei. Certain strains of these species require vitamin B 6, but they can grow without this vitamin in the presence of dalanine (the dextro-rotatory, naturally occurring form of the amino acid). In this instance, however, the amino acid is not the precursor of the vitamin, but apparently the vitamin is necessary in order to produce the essential amino acid. These cases, interesting in themselves, indicate also that the need of a particular organism for a given vitamin may to some extent depend on the diet.
As a result of our knowledge concerning the chemical nature of the vitamins, many of them can be synthesized and are actually being manufactured on a large scale. We also have much knowledge concerning the specific vitamin requirements of many higher animals, of the isolated roots of green plants, of bacteria, fungi and protozoa. More and more information is becoming available concerning the vitamin needs of various insects. Vitamin studies are relatively simple for terrestrial forms-mammals, birds, insects. Aquatic forms are difficult material. Perhaps if fish could be grown in sterilized water and kept sterile, correct data on their vitamin requirements could be obtained. With ordinary methods of attack, one can never be certain of the contribution that bacteria and other microorganisms are making to the vitamin content of the food taken in by the fish. Even in terrestrial animals, microorganisms may play a part in providing vitamins. The bacteria in the intestinal tract can and do manufacture vitamins. In experiments with rats, it is sometimes necessary to prevent the animals from eating their feces, for such fecal material may be a source of vitamins. In many instances a mammal may not need a particular vitamin as food because it is manufactured by the bacteria of its intestine. By giving the animal antibiotics such as sulfa drugs and thus eliminating or reducing its intestinal bacterial flora, it is possible to investigate the need for a vitamin such as folic acid. The nutritional requirements of various types of animals may depend largely on the parasites or symbionts they harbor. Many species of insects, especially among the Hemiptera, have a constant association with symbiotic fungi. Even protozoa may contain symbionts or parasites within their single-celled bodies.
It is by no means an easy task to present an up-to-date summary of our information concerning vitamins. The earlier studies of vitamins were essentially practical. Men suffered from diseases due to vitamin deficiency. It was important to discover which foods contained the necessary vitamins, and in what amount. Lacking a chemical knowledge of the vitamins it was essential to develop biological methods of assay. Thus, it was found that a certain amount of vitamin was necessary to cure pigeons of polyneuritis or to permit normal growth in rats. On the basis of such studies on rats, pigeons, and guinea-pigs, various types of vitamin units were established, and the vitamin content of all sorts of foods was determined. To raise colonies of rats and guinea pigs is rather an expensive and time-consuming business. Fortunately, the presence of vitamins and the amount of a certain vitamin contained in a given sample of food can be tested with organisms much easier and less expensive to raise than mammals and birds. Insects require many of the known vitamins and they might be used as test animals. But much more suitable are various bacteria and fungi. They can be raised in test tubes in a minimum of space. Obviously one must first determine the exact vitamin requirements of a given type of bacterium or fungus. The assay of vitamins by the use of bacteria is now well established practice and there is a large literature in the field.
The chemical composition of most vitamins is now known. This makes possible direct chemical analysis. Often such analysis is aided by spectroscopic study. Thus the A vitamins give a blue color with antimony trichloride and this color is the basis for spectroscopic tests. Some vitamins give characteristic absorption bands in the ultraviolet. Likewise, some vitamins are fluorescent, and the fluorescent color can be tested spectroscopically. Thus in addition to ordinary chemical assay methods, spectroscopic tests are of great value.
In many cases a vitamin may be replaced by other chemical substances related to it chemically. Thus various substances related to ascorbic acid (vitamin C) behave like ascorbic acid in preventing scurvy. There are many substances with vitamin D or vitamin K activity.
The fact that a substance has a chemical structure similar to that of a vitamin does not necessarily indicate that the substance will act like the vitamin. Often, indeed, a substance which resembles a particular vitamin in its chemical composition is an antagonist to it and tends to prevent its action. So, for example, Dicumarol is chemically close to vitamin K; and yet whereas feeding of vitamin K favors blood clotting in higher animals, Dicumarol prevents clotting. Similarly, various analogues of pyridoxine (a B 6 vitamin) act to prevent its action. Other cases of anti-vitamins could be cited. Studies of antivitamin action may give clues as to the mechanism of the action of the vitamin they antagonize. The subject is also of considerable interest to the theoretical pharmacologist. More and more cases are being discovered in which the harmful action of a particular drug is due to its chemical affinity to some substance important for the vital process.
In some cases, the need for a vitamin is lessened by feeding a substance which can be converted into it. In some organisms, tryptophan can be converted into nicotinic acid. Thus, chicks do not require nicotinic acid if fed enough tryptophan. Moreover, isotope studies show that tryptophan can be converted into nicotinic acid. Another instance in which a necessary vitamin can be replaced by an amino acid has been described for the lactic acid bacteria, Streptococcus faecalis and Lactobacillus casei. Certain strains of these species require vitamin B 6, but they can grow without this vitamin in the presence of dalanine (the dextro-rotatory, naturally occurring form of the amino acid). In this instance, however, the amino acid is not the precursor of the vitamin, but apparently the vitamin is necessary in order to produce the essential amino acid. These cases, interesting in themselves, indicate also that the need of a particular organism for a given vitamin may to some extent depend on the diet.
As a result of our knowledge concerning the chemical nature of the vitamins, many of them can be synthesized and are actually being manufactured on a large scale. We also have much knowledge concerning the specific vitamin requirements of many higher animals, of the isolated roots of green plants, of bacteria, fungi and protozoa. More and more information is becoming available concerning the vitamin needs of various insects. Vitamin studies are relatively simple for terrestrial forms-mammals, birds, insects. Aquatic forms are difficult material. Perhaps if fish could be grown in sterilized water and kept sterile, correct data on their vitamin requirements could be obtained. With ordinary methods of attack, one can never be certain of the contribution that bacteria and other microorganisms are making to the vitamin content of the food taken in by the fish. Even in terrestrial animals, microorganisms may play a part in providing vitamins. The bacteria in the intestinal tract can and do manufacture vitamins. In experiments with rats, it is sometimes necessary to prevent the animals from eating their feces, for such fecal material may be a source of vitamins. In many instances a mammal may not need a particular vitamin as food because it is manufactured by the bacteria of its intestine. By giving the animal antibiotics such as sulfa drugs and thus eliminating or reducing its intestinal bacterial flora, it is possible to investigate the need for a vitamin such as folic acid. The nutritional requirements of various types of animals may depend largely on the parasites or symbionts they harbor. Many species of insects, especially among the Hemiptera, have a constant association with symbiotic fungi. Even protozoa may contain symbionts or parasites within their single-celled bodies.
Tuesday, September 18, 2007
Information and the Market for Health Insurance
Currently, in the market for most private health insurance, information is transmitted by the employer to the employee. That is, the employer, by offering one or more health benefit plans to retain employees, has substantial incentives to offer a plan or plans that coincide with the majority of the employees' desires. The employer generally has professional benefit managers on his staff to review potential legal loopholes and benefit inconsistencies in the plans offered. The most cost-effective insurer can be selected by the individual who has ample time to gather information before his or her decision. If the employer is to offer a greater array of benefit packages or a different structure of benefit packages under procompetition legislation, one would expect the employer to become an even more important source of information to the employee.
Information and the Market for Health Services. In general, an individual either does not know or is not concerned about the prices of physician and hospital services, the "appropriate" number of ambulatory procedures and lengths-of-stay in hospitals, or the "appropriate" number of hospital beds or types of sophisticated equipment in an area. Thirdparty insurers ( Blue Cross and the commercial insurers) and alternative delivery systems, however, know the prices of physician and hospital services and may well know the appropriate number of ambulatory procedures and lengths-of-stay in hospitals as well as the appropriate number of hospital beds or types of sophisticated equipment in an area. "Appropriate" is defined here as the point beyond which marginal benefits of health services are zero.
In addition, third-party insurers and HMOs clearly already have incentives to contain costs. Among third-party insurers, for example, generally vigorous competition in dental insurance has resulted in extensive pre-treatment review of dental procedures. Firms that are more successful in reducing the escalation of costs in dental care will be able to secure more business from the employer. The incentives that HMOs already have to contain costs have been described elsewhere. Furthermore, the fact that hospital prices are not still higher suggests that there are some limits to what third parties will pay or to the level at which providers will set their prices.
Cost containment involves certain costs, however, especially from the viewpoint of the traditional third-party insurer. These include the transaction costs of designing and carrying out the program, of ascertaining what appropriate medical procedures are, and of negotiating with the providers and potentially alienating the patients.
How might a third-party insurer with increased incentives use information to contain costs to a greater extent than at present? With a large number of enrollees and with physicians as consultants on its staff, the third-party insurer can examine more closely procedures or tests that exceed the point beyond which marginal benefits are zero. It can also question fees for procedures that exceed the mean for a group of enrollees in a particular location. A recent study of a small "administrative services only" firm that attempts to collect this information and subsequently use it to deter unnecessary utilization and higher than average fees found that the firm enjoyed some success in curbing higher fees as well as prohibiting procedures beyond which marginal benefits are zero. In instances where the marginal benefits were positive, the firm was less successful.
This seems to be consistent with Kenneth Arrow's notion that "an insurance company can improve the allocation of resources to all concerned by a policy which rations the amount of medical services it will support under the insurance policy." Arrow then suggests that
there might be a detailed examination by the insurance company of individual cost items allowing those that are regarded "normal" and disallowing others, where normality means roughly what would have been bought in the absence of insurance.
Third-party insurers might also generate and utilize information based on an entire health care market. An analysis might be made of the appropriate number of hospitals and beds within a hospital, as well as the appropriate number of sophisticated technologies. Insurers would then refuse to pay for that capital configuration beyond which the marginal benefits are zero.
A third party will not, however, attempt to contain costs for the entire health care market unless the firm has a substantial market share. A firm incurs certain expenses in setting up a cost containment program, including the design and administration of such a program. At the same time, these cost containment efforts are subject to the free-rider effect. Other insurer-competitors in the same market would also benefit if cost containment efforts were successful. In order to provide an incentive for an insurer's efforts at cost containment, which may potentially affect the entire health care market (a public good), a tax credit might be provided to internalize some of the benefits.
Not only do HMOs have the same types of information available to them as health insurers, but, because of their incentive structure, they can use this information to contain costs. Physicians who are paid on a salary basis have no incentives to provide services beyond which the marginal benefits are zero. The salaries of physicians and paraprofessional personnel need not be higher than their opportunity costs. The HMO, however, generally does not engage in the types of global cost containment that limit the number of hospital beds or sophisticated technical equipment.
Information and the Market for Health Services. In general, an individual either does not know or is not concerned about the prices of physician and hospital services, the "appropriate" number of ambulatory procedures and lengths-of-stay in hospitals, or the "appropriate" number of hospital beds or types of sophisticated equipment in an area. Thirdparty insurers ( Blue Cross and the commercial insurers) and alternative delivery systems, however, know the prices of physician and hospital services and may well know the appropriate number of ambulatory procedures and lengths-of-stay in hospitals as well as the appropriate number of hospital beds or types of sophisticated equipment in an area. "Appropriate" is defined here as the point beyond which marginal benefits of health services are zero.
In addition, third-party insurers and HMOs clearly already have incentives to contain costs. Among third-party insurers, for example, generally vigorous competition in dental insurance has resulted in extensive pre-treatment review of dental procedures. Firms that are more successful in reducing the escalation of costs in dental care will be able to secure more business from the employer. The incentives that HMOs already have to contain costs have been described elsewhere. Furthermore, the fact that hospital prices are not still higher suggests that there are some limits to what third parties will pay or to the level at which providers will set their prices.
Cost containment involves certain costs, however, especially from the viewpoint of the traditional third-party insurer. These include the transaction costs of designing and carrying out the program, of ascertaining what appropriate medical procedures are, and of negotiating with the providers and potentially alienating the patients.
How might a third-party insurer with increased incentives use information to contain costs to a greater extent than at present? With a large number of enrollees and with physicians as consultants on its staff, the third-party insurer can examine more closely procedures or tests that exceed the point beyond which marginal benefits are zero. It can also question fees for procedures that exceed the mean for a group of enrollees in a particular location. A recent study of a small "administrative services only" firm that attempts to collect this information and subsequently use it to deter unnecessary utilization and higher than average fees found that the firm enjoyed some success in curbing higher fees as well as prohibiting procedures beyond which marginal benefits are zero. In instances where the marginal benefits were positive, the firm was less successful.
This seems to be consistent with Kenneth Arrow's notion that "an insurance company can improve the allocation of resources to all concerned by a policy which rations the amount of medical services it will support under the insurance policy." Arrow then suggests that
there might be a detailed examination by the insurance company of individual cost items allowing those that are regarded "normal" and disallowing others, where normality means roughly what would have been bought in the absence of insurance.
Third-party insurers might also generate and utilize information based on an entire health care market. An analysis might be made of the appropriate number of hospitals and beds within a hospital, as well as the appropriate number of sophisticated technologies. Insurers would then refuse to pay for that capital configuration beyond which the marginal benefits are zero.
A third party will not, however, attempt to contain costs for the entire health care market unless the firm has a substantial market share. A firm incurs certain expenses in setting up a cost containment program, including the design and administration of such a program. At the same time, these cost containment efforts are subject to the free-rider effect. Other insurer-competitors in the same market would also benefit if cost containment efforts were successful. In order to provide an incentive for an insurer's efforts at cost containment, which may potentially affect the entire health care market (a public good), a tax credit might be provided to internalize some of the benefits.
Not only do HMOs have the same types of information available to them as health insurers, but, because of their incentive structure, they can use this information to contain costs. Physicians who are paid on a salary basis have no incentives to provide services beyond which the marginal benefits are zero. The salaries of physicians and paraprofessional personnel need not be higher than their opportunity costs. The HMO, however, generally does not engage in the types of global cost containment that limit the number of hospital beds or sophisticated technical equipment.
How Will Increased Competition Affect the Costs of Health Care?
In an effort to slow escalating health care costs, several legislative proposals that rely on competition among insurers and alternative delivery systems have been introduced into the Congress. One type of "competition" bill would offer vouchers to individuals enrolled in Medicare and Medicaid that they could use to purchase qualified private health plans.
Thrust of Major Competition Bills
The common denominator of the major competition bills, including those that provide for vouchers for individuals enrolled in Medicare and Medicaid, is that insurer-based competition--that is, among third-party insurers, alternative delivery systems, limited-provider groups, and health maintenance organizations (HMOs) --is the most viable, if not the only, form of competition in health care. Currently, the advocates of insured-based competition argue, the market for health services is flawed because of excessive insurance, which allows the patient to demand services when the real societal costs are greater than the benefits. In addition, the market for health services is imperfect even without the presence of insurance, since an asymmetry of information exists between the patient and physician, which may lead to overutilization.
A choice of health care plans is expected to result in a greater growth of the more cost-effective plans, presumably the HMOs. It has been suggested that costs might decline between 10 percent and 40 percent for those enrolled in HMOs. The competition bills have not contained any estimates of how the escalation in costs might be affected by increased HMO enrollment.
Quality, access, and availability of care are apparently not affected adversely in this competitive environment. It has not been suggested that costs will be curtailed under the competition bills; it is presumed, however, that utilization will be curtailed when expected benefits are zero.
Incentives for the formation of cost-conscious health insurance plans would stem, first, from a change in the tax laws requiring that employer contributions above a certain amount be taxable to the employee just as ordinary income is taxable. Second, the employer would be required to offer a multiple choice of plans and to contribute the same amount to each of the plans; if the chosen plan's premium was less than the employer contribution, the employee would receive a tax-free rebate for the difference.
The bills directed toward Medicare and Medicaid recipients differ, in general, from those directed toward employer groups insofar as the employer plays no role in the offering of plans; rather, competing health plans are offered directly to the individual. One variation of the bills directed toward Medicare beneficiaries would "prospectively reimburse HMOs enrolling Medicare beneficiaries at a rate equal to 95 percent of the amount spent by Medicare for the average beneficiary in the area (the average area per capita cost or AAPCC)."
Toward Economic Efficiency
My assumption is that the insurer-based competition bills are intended to create a more efficient market for health insurance as well as for health services, and thereby to reduce the escalation in health care costs. In this section, first, I briefly comment on the efficiency of the market for private health insurance by stressing the importance of information in choosing among plans. Second, in the health services market, I suggest that the most important advantage of increased competition among insurers, alternative delivery systems, and HMOs is the increased incentive to utilize information that can be gathered from the health services industry to contain costs. Third, I suggest that, as a result of information in the health services market, the increased incentives to exert leverage over providers would also be a product of the insurer-based competition bills.
Monday, September 17, 2007
Self-Consciousness and Shyness
The students themselves, and especially the freshmen, who consulted the psychiatrist about lack of social success, usually attributed their failure to "shyness" or "self-consciousness." Their diagnosis, of course, describes two emotional sensations without identifying the factors contributing to them. Both words cover a multitude of things. Shyness describes the emotional condition of a person unwillingly isolated in a group. Self-consciousness may be experienced by the shy and the aggressive; in either case the individual is keenly aware of himself in a group, of his relations with people, of their attitude toward him, and their opinions of him. Both shyness and self-consciousness are in a sense generic words and one can distinguish a range of personality problems among the group to which they are applied. At one end are the problems of ordinary freshmen who are not quite able to size up their new environment and adjust themselves in it. At the beginning of the term, for example, a freshman may become homesick or depressed and shy.
Sympathy and stimulus from his counselor or from another student may help him to overcome his loneliness and find a place in a group. Such a maladjustment is mild, temporary, and easily remedied. But some people need more help. For them the shyness they feel on first coming to Yale is not a new sensation, but a condition persisting for many years. External factors, the home environment, the social attitudes of parents may have strengthened a natural tendency in the student so that he cannot easily overcome it. Such individuals had to be given special help in bolstering their desire to overcome feelings of shyness and self-consciousness and in the organization of their social lives. Most of them had had little social experience and needed direction in making overtures to the group and in building up a solid, continuous relation with it. For other students, shyness and self-consciousness were the outward signs of distress arising from emotional difficulties requiring investigation and treatment. Some were involved in a struggle to free themselves from family pressure and in fluence which absorbed their attention and energy and directed it away from the college; others were conscious of social barriers because of race, class, or economic status, and experienced feelings of inferiority which kept them from mingling with the group. Still others were preoccupied, as has been shown, with the scholastic adjustment, and there could be no social ease for most of the students whose security was constantly threatened by their inability to comply with the preliminary requirements of the environment.
A student who is habitually shy and self-conscious usually needs to be educated socially. For these feelings, especially shyness, are most often associated with a history of unsuccessful social experience. A lonely childhood without benefit of group contacts and subsequent lack of experience in mingling easily with contemporaries may strengthen a student's shyness and render it difficult for him to find friends. In order to overcome this feeling the individual needs to be able to evaluate his environment and decide how to organize his efforts to adjust himself in it. In most cases of this kind the student needs concrete help in attacking his problem. For social inexperience frequently results in an inability to direct his own activity toward fruitful ends. Moreover, the habit of solitude is not easy to break and the student usually needs encouragement to sustain his desire for a place in a group.
The preliminary issue of social technique, namely, the adequacy of an individual's social experience to prevent complete isolation, presents itself in the cases of sophomores and juniors in much the form which appeared in the freshman cases.
Sympathy and stimulus from his counselor or from another student may help him to overcome his loneliness and find a place in a group. Such a maladjustment is mild, temporary, and easily remedied. But some people need more help. For them the shyness they feel on first coming to Yale is not a new sensation, but a condition persisting for many years. External factors, the home environment, the social attitudes of parents may have strengthened a natural tendency in the student so that he cannot easily overcome it. Such individuals had to be given special help in bolstering their desire to overcome feelings of shyness and self-consciousness and in the organization of their social lives. Most of them had had little social experience and needed direction in making overtures to the group and in building up a solid, continuous relation with it. For other students, shyness and self-consciousness were the outward signs of distress arising from emotional difficulties requiring investigation and treatment. Some were involved in a struggle to free themselves from family pressure and in fluence which absorbed their attention and energy and directed it away from the college; others were conscious of social barriers because of race, class, or economic status, and experienced feelings of inferiority which kept them from mingling with the group. Still others were preoccupied, as has been shown, with the scholastic adjustment, and there could be no social ease for most of the students whose security was constantly threatened by their inability to comply with the preliminary requirements of the environment.
A student who is habitually shy and self-conscious usually needs to be educated socially. For these feelings, especially shyness, are most often associated with a history of unsuccessful social experience. A lonely childhood without benefit of group contacts and subsequent lack of experience in mingling easily with contemporaries may strengthen a student's shyness and render it difficult for him to find friends. In order to overcome this feeling the individual needs to be able to evaluate his environment and decide how to organize his efforts to adjust himself in it. In most cases of this kind the student needs concrete help in attacking his problem. For social inexperience frequently results in an inability to direct his own activity toward fruitful ends. Moreover, the habit of solitude is not easy to break and the student usually needs encouragement to sustain his desire for a place in a group.
The preliminary issue of social technique, namely, the adequacy of an individual's social experience to prevent complete isolation, presents itself in the cases of sophomores and juniors in much the form which appeared in the freshman cases.
The Importance of Social Acceptance
Social success cannot be underestimated in any consideration of the college community. The individual's first concern seems to be the opinion others have of him. This opinion is demonstrated by acceptance or rejection by the group. The following examples illustrate clearly the importance of social approval in the personal development of individuals and their relations with other people.
B99, an attractive, well-mannered sophomore, consulted the psychiatrist after fraternity elections in the fall of his second year at Yale. He complained of hand tremors and moodiness, and he considered leaving college. It soon became obvious that the boy's disappointment in Yale derived from the fact that he had not received a fraternity bid, and he was somewhat bewildered by his exclusion. True, he had not distinguished himself in any activity, but he had money, he came from a good family, and he was proud to be at Yale. Did not this automatically entitle him to recognition by the social arbiters? If this student had had entree to a clique through preparatory school connections, or if he had had some special ability--athletic or executive--he would undoubtedly have been elected to a fraternity. He was not in any way different from many who had been elected. As it was, he came from the west and had not had enough time at his eastern preparatory school to establish himself with a group.
In addition to his social problem the patient was troubled by masturbation which he had practiced for some time. His unhappiness and insecurity increased the frequency of the habit and made it difficult for him to interrupt it though he wanted very much to do so. He was in love with a girl whom he hoped to marry.
The psychiatrist decided to take active measures to help this boy socially in addition to treating the sexual problem. Aid was offered by one of the leaders among the undergraduates who undertook to get the boy into a prominent fraternity. It was made clear that though the patient could not bring the club prestige through his achievement, he could bring an attractive personality and loyalty and devotion to the group and to the college.
Once this patient was accepted by a fraternity he literally blossomed. He fitted into the group and became active in it and he went out for several athletic activities. In a short time his masturbation ceased altogether.
The relief and the feeling of security that social acceptance brings are tremendous, and for many students it is of decisive importance in their college development. The fear of being rejected is so potent that students often band together to protect themselves from the change which would inevitably occur if some and not all members of a clique joined fraternities.
B100 was seen by the psychiatrist at the request of the health department early in his sophomore year. The patient was troubled by dizzy spells and seemed upset. The cause of his distress was quickly determined. He had made a pact with a friend regarding fraternity elections. If both got bids to a good fraternity, they would accept, but if only one was lucky, he would refuse. The patient's friend received a bid and accepted it. The patient was left out and resented the fact that his friend broke their "pact," leaving him alone to face the conclusion that he had not made good and must find other friends.
The students who consulted the division of student mental hygiene because they were disturbed about aspects of their social adjustment were, of course, students who had failed on the whole to secure the kind of approval and acceptance they wanted at Yale. The disappointment of their ambitions occurred for many reasons. Often the ambition was not appropriate for the boy, given his personality, experience, and capacity for social adaptation. Often, too, the disappointment came from a failure to understand the society or from a tendency to accept its standards uncritically. In many cases the disturbance in the social side of a student's life was associated with other disturbances, perhaps more fundamental, in the growth of his personality and in his evaluation of himself as an individual. In most of the cases, the process of learning how to achieve a harmonious membership in the group or to reconcile oneself to not achieving it required the study and utilization of all a student's emotional resources.
There were differences among the cases which corresponded to differences in experience. The problems of freshmen, that is, differed somewhat from those of members of the middle classes and from seniors. A large number of the freshmen treated were concerned with inability to get started toward a satisfactory social adjustment in the college and a large number of the seniors were disturbed by the prospect of transition away from the security of the college environment into an unknown world outside. Generally speaking, it may be said that students who were unable to achieve a place within the college were more seriously disturbed if they faced the issue after freshman year for then such failure often carried with it a connotation of hopelessness that led the student to contemplate withdrawal from college. Thus, the most significant difference between social maladjustment among freshmen and among middleclassmen seemed to be the individual's attitude toward his position at Yale. Freshmen have usually an undifferentiated feeling of shyness, loneliness, or unhappiness. Many of them do not quite understand the organization or standards of the college society. Usually they are either oppressed by the size and strangeness of the university or accept what they do see enthusiastically and uncritically. On the whole, however, the freshmen were looking forward hopefully to adjustment, but the middleclassmen often regarded themselves as social failures and seemed eager to get away from the scene of failure.
B99, an attractive, well-mannered sophomore, consulted the psychiatrist after fraternity elections in the fall of his second year at Yale. He complained of hand tremors and moodiness, and he considered leaving college. It soon became obvious that the boy's disappointment in Yale derived from the fact that he had not received a fraternity bid, and he was somewhat bewildered by his exclusion. True, he had not distinguished himself in any activity, but he had money, he came from a good family, and he was proud to be at Yale. Did not this automatically entitle him to recognition by the social arbiters? If this student had had entree to a clique through preparatory school connections, or if he had had some special ability--athletic or executive--he would undoubtedly have been elected to a fraternity. He was not in any way different from many who had been elected. As it was, he came from the west and had not had enough time at his eastern preparatory school to establish himself with a group.
In addition to his social problem the patient was troubled by masturbation which he had practiced for some time. His unhappiness and insecurity increased the frequency of the habit and made it difficult for him to interrupt it though he wanted very much to do so. He was in love with a girl whom he hoped to marry.
The psychiatrist decided to take active measures to help this boy socially in addition to treating the sexual problem. Aid was offered by one of the leaders among the undergraduates who undertook to get the boy into a prominent fraternity. It was made clear that though the patient could not bring the club prestige through his achievement, he could bring an attractive personality and loyalty and devotion to the group and to the college.
Once this patient was accepted by a fraternity he literally blossomed. He fitted into the group and became active in it and he went out for several athletic activities. In a short time his masturbation ceased altogether.
The relief and the feeling of security that social acceptance brings are tremendous, and for many students it is of decisive importance in their college development. The fear of being rejected is so potent that students often band together to protect themselves from the change which would inevitably occur if some and not all members of a clique joined fraternities.
B100 was seen by the psychiatrist at the request of the health department early in his sophomore year. The patient was troubled by dizzy spells and seemed upset. The cause of his distress was quickly determined. He had made a pact with a friend regarding fraternity elections. If both got bids to a good fraternity, they would accept, but if only one was lucky, he would refuse. The patient's friend received a bid and accepted it. The patient was left out and resented the fact that his friend broke their "pact," leaving him alone to face the conclusion that he had not made good and must find other friends.
The students who consulted the division of student mental hygiene because they were disturbed about aspects of their social adjustment were, of course, students who had failed on the whole to secure the kind of approval and acceptance they wanted at Yale. The disappointment of their ambitions occurred for many reasons. Often the ambition was not appropriate for the boy, given his personality, experience, and capacity for social adaptation. Often, too, the disappointment came from a failure to understand the society or from a tendency to accept its standards uncritically. In many cases the disturbance in the social side of a student's life was associated with other disturbances, perhaps more fundamental, in the growth of his personality and in his evaluation of himself as an individual. In most of the cases, the process of learning how to achieve a harmonious membership in the group or to reconcile oneself to not achieving it required the study and utilization of all a student's emotional resources.
There were differences among the cases which corresponded to differences in experience. The problems of freshmen, that is, differed somewhat from those of members of the middle classes and from seniors. A large number of the freshmen treated were concerned with inability to get started toward a satisfactory social adjustment in the college and a large number of the seniors were disturbed by the prospect of transition away from the security of the college environment into an unknown world outside. Generally speaking, it may be said that students who were unable to achieve a place within the college were more seriously disturbed if they faced the issue after freshman year for then such failure often carried with it a connotation of hopelessness that led the student to contemplate withdrawal from college. Thus, the most significant difference between social maladjustment among freshmen and among middleclassmen seemed to be the individual's attitude toward his position at Yale. Freshmen have usually an undifferentiated feeling of shyness, loneliness, or unhappiness. Many of them do not quite understand the organization or standards of the college society. Usually they are either oppressed by the size and strangeness of the university or accept what they do see enthusiastically and uncritically. On the whole, however, the freshmen were looking forward hopefully to adjustment, but the middleclassmen often regarded themselves as social failures and seemed eager to get away from the scene of failure.
Social Adjustment College Life
Establishing oneself as a member of the college society is a complicated process and, at best, a gradual one. Adapting to a new world is a difficult task for most people and especially for those of college age, whose lives are burdened with physiological and psychological, social, educational, and emotional adjustments which tend to absorb much of their energies. Furthermore, a college community is a rather formidable new world to face, with its special standards and mores and its considerable authority. College life in the United States is highly organized and competitive, and the scheme of things at Yale, a relatively large university devoting much attention to undergraduate affairs, is not an exception to this rule. With its residential colleges, fraternities, and senior societies, its numerous student activities and high scholastic standards, Yale is a community which makes insistent demands upon its members.
Recognition, acceptance, and approval by the group are, of course, the social objectives of all students, for such acceptance represents a long step, in any society, toward security for most individuals. What constitutes suitable recognition varies from individual to individual, depending upon his own goals and upon his sensitivity to the conventions of the group. Some are content with the company of a few friends or the approval of their teachers. Others seek the companionship of fellow students, endowed in their opinion with particular prestige--the athletic, the literary, the fashionable, or the politically powerful. As in other societies, there are at Yale certain commonly accepted badges of social recognition. Conspicuous among them is membership in fraternities and in senior societies, based on election--thus giving potent evidence of group approval. There have always been rebels against these symbols of success; and perhaps the development of residential colleges has subtracted from the universality with which they are accepted as symbols. None the less, they remain important factors in the lives of many students and they are typical, in their impact on individuals, of the way in which all comparable forms of social recognition operate.
Recognition at Yale comes in many ways--through accident, influence, and friendship, as well as through achievement. But "achievement" is a characteristic standard for success at Yale, and participation in an important extra-curricular activity is a vital touchstone for acceptance into most student groups. While at Yale, as elsewhere, the cards are stacked somewhat in favor of the boy from a good private school, whose college life is made easier by his acquaintance with others from his school or family circle, the group at Yale is persistently willing to grant full approval to the boy from a small school or high school, whose energy and capacity for leadership carry him to the top in athletics, or school journalism, or one of the business enterprises operated by self-supporting students. The development of residential colleges at Yale promises to enlarge the importance of this element in Yale life. For under the college system student activities have multiplied, with the creation of college teams, magazines, print shops, music clubs, and so on. These activities offer an independent source of pleasure and companionship, making fraternity elections and the like less important, especially to non-fraternity students.
The formation and growth of prestige-carrying groups begin as soon as students enter college and continue steadily until they leave. At each stage of the college cycle the organization of such groups differs. In the freshman year, when fraternities are not open to students, the groundwork is laid for future recognition. The symbols of success vary, but in order to obtain later approval and security the entering student must reach out toward the group. Some follow the conventional pattern of behavior instinctively; others evaluate, rather self-consciously, the mores and the demands of the society and decide how they will act. Those who wish to be popular, to gain positions of influence and the social rewards connected with them, choose their activities with care and direct their efforts in an organized way toward their goals. Help in this process often comes from school friends, a year or two advanced, who indicate which dormitories are socially desirable and which activities most valued.
Whether they act through instinct or calculation, these students begin early in freshman year to make themselves a working part of the society. They "heel" the News or team managerships, go out for class teams and clubs, participate in some recognized athletic or recreational or civic activity. Through activity or association with a recognized clique, a student feels himself "belonging" to the college community. The cliques themselves are formed in various ways. Boys from the same school constitute the nucleus of such groups, the strong helping the weak, and all drawing prestige from the successes of a few members. Cliques form in order to exploit common interests. Those with pretensions to fashionableness find refuge from the common activities of the group at large in their association; habits of association and friendship develop among acquaintances made in class or on the playing field. New members are added to each group and old ones fall away as interests and activities change. As the process of reaching out toward the community and of attempting to gain security through membership in an approved group goes on, reputations are made. And at the end of freshman year the informal and often fluid classifications of the early period crystallize into more permanent form. In the beginning of sophomore year, fraternities elect and reject; teams and clubs are formed; the athletes, the intellectuals, the week-enders, and others become more or less distinct circles. At the end of junior year, an event occurs in the college which is for many students the climax of their competition for social recognition--the election of members by the senior societies, ninety out of a class of about five hundred being chosen, and perhaps three or four hundred appearing at the ceremony of election. By this time many have found in the community a place which satisfies their ambition and their need for approval. Others, having failed to do so, may have reconciled themselves to lesser satisfactions or found other interests, or they may feel rejected, dissatisfied, and emotionally disturbed. Many students who are not readily accepted into college groups through friends, special talent, or social position, find the job of achieving a place a drain on their emotional resources. Others, insecure in their novel surroundings, discover that a disturbance in any part of their lives is soon reflected in a disturbance of their social relationship to the group.
Taken together, the institutions, attitudes, and people who make up the undergraduate society constitute a complete order of values which it is almost impossible to escape. At some time in their college careers all but the most exceptionally independent Yale students measure the success of their careers in terms of these characteristic standards of success. Those who have been unable to win tangible approval often find recognition of the fact a shock, involving discouragement with themselves or disillusion with Yale standards.
Recognition, acceptance, and approval by the group are, of course, the social objectives of all students, for such acceptance represents a long step, in any society, toward security for most individuals. What constitutes suitable recognition varies from individual to individual, depending upon his own goals and upon his sensitivity to the conventions of the group. Some are content with the company of a few friends or the approval of their teachers. Others seek the companionship of fellow students, endowed in their opinion with particular prestige--the athletic, the literary, the fashionable, or the politically powerful. As in other societies, there are at Yale certain commonly accepted badges of social recognition. Conspicuous among them is membership in fraternities and in senior societies, based on election--thus giving potent evidence of group approval. There have always been rebels against these symbols of success; and perhaps the development of residential colleges has subtracted from the universality with which they are accepted as symbols. None the less, they remain important factors in the lives of many students and they are typical, in their impact on individuals, of the way in which all comparable forms of social recognition operate.
Recognition at Yale comes in many ways--through accident, influence, and friendship, as well as through achievement. But "achievement" is a characteristic standard for success at Yale, and participation in an important extra-curricular activity is a vital touchstone for acceptance into most student groups. While at Yale, as elsewhere, the cards are stacked somewhat in favor of the boy from a good private school, whose college life is made easier by his acquaintance with others from his school or family circle, the group at Yale is persistently willing to grant full approval to the boy from a small school or high school, whose energy and capacity for leadership carry him to the top in athletics, or school journalism, or one of the business enterprises operated by self-supporting students. The development of residential colleges at Yale promises to enlarge the importance of this element in Yale life. For under the college system student activities have multiplied, with the creation of college teams, magazines, print shops, music clubs, and so on. These activities offer an independent source of pleasure and companionship, making fraternity elections and the like less important, especially to non-fraternity students.
The formation and growth of prestige-carrying groups begin as soon as students enter college and continue steadily until they leave. At each stage of the college cycle the organization of such groups differs. In the freshman year, when fraternities are not open to students, the groundwork is laid for future recognition. The symbols of success vary, but in order to obtain later approval and security the entering student must reach out toward the group. Some follow the conventional pattern of behavior instinctively; others evaluate, rather self-consciously, the mores and the demands of the society and decide how they will act. Those who wish to be popular, to gain positions of influence and the social rewards connected with them, choose their activities with care and direct their efforts in an organized way toward their goals. Help in this process often comes from school friends, a year or two advanced, who indicate which dormitories are socially desirable and which activities most valued.
Whether they act through instinct or calculation, these students begin early in freshman year to make themselves a working part of the society. They "heel" the News or team managerships, go out for class teams and clubs, participate in some recognized athletic or recreational or civic activity. Through activity or association with a recognized clique, a student feels himself "belonging" to the college community. The cliques themselves are formed in various ways. Boys from the same school constitute the nucleus of such groups, the strong helping the weak, and all drawing prestige from the successes of a few members. Cliques form in order to exploit common interests. Those with pretensions to fashionableness find refuge from the common activities of the group at large in their association; habits of association and friendship develop among acquaintances made in class or on the playing field. New members are added to each group and old ones fall away as interests and activities change. As the process of reaching out toward the community and of attempting to gain security through membership in an approved group goes on, reputations are made. And at the end of freshman year the informal and often fluid classifications of the early period crystallize into more permanent form. In the beginning of sophomore year, fraternities elect and reject; teams and clubs are formed; the athletes, the intellectuals, the week-enders, and others become more or less distinct circles. At the end of junior year, an event occurs in the college which is for many students the climax of their competition for social recognition--the election of members by the senior societies, ninety out of a class of about five hundred being chosen, and perhaps three or four hundred appearing at the ceremony of election. By this time many have found in the community a place which satisfies their ambition and their need for approval. Others, having failed to do so, may have reconciled themselves to lesser satisfactions or found other interests, or they may feel rejected, dissatisfied, and emotionally disturbed. Many students who are not readily accepted into college groups through friends, special talent, or social position, find the job of achieving a place a drain on their emotional resources. Others, insecure in their novel surroundings, discover that a disturbance in any part of their lives is soon reflected in a disturbance of their social relationship to the group.
Taken together, the institutions, attitudes, and people who make up the undergraduate society constitute a complete order of values which it is almost impossible to escape. At some time in their college careers all but the most exceptionally independent Yale students measure the success of their careers in terms of these characteristic standards of success. Those who have been unable to win tangible approval often find recognition of the fact a shock, involving discouragement with themselves or disillusion with Yale standards.
Family and School Life Mental Health
Persons concerned with education need to remind themselves constantly that the family has had the child under its influence long before the school and continues to have him throughout school experience. It is in the home, very largely, that the stage is first set for learning patterns of human behavior. Practically unanimous agreement exists among psychiatrists and mental hygienists as to the significance of early family life for mental health.
Possibilities for the school, therefore, are definitely limited at the start. The "education" of the child has been under way for a number of years before he comes to school. What education can do for mental health will depend to a considerable extent on what the family and home have already done; also on what the family continues to do while the youngster is in school. Where the public educational provision includes the nursery school, as it should, the school is able to exert its influence at an earlier stage, of course, but the part of the home remains highly significant even then.
In the present discussion no attempt at a thoroughgoing survey of the broad field of parent education will be made. The purpose is rather to suggest, as a fundamentally important factor in mental hygiene education, the limitations placed upon the school by the preschool education of the home; to indicate something of the influence students of personality and mental health assign to the family situation; and to give some notion of the extent to which parent education of today has been directly affected by what is frequently called "the mental hygiene point of view."
Most authorities believe that the influence of the home and family in making or breaking wholesome personality begins very early and persists very late. Studies of babies in the first year, who showed all the marked differences that characterize later personalities--some slow in their reactions, phlegmatic, dull; others quick, amiable, responding with distinct pleasure to the different stimuli, or with clear evidence of discomfort. At the other end of the scale, there have been some noteworthy cases of adjustment of very difficult boys and girls in foster home surroundings long after older adolescence and beyond.
It seems as if the shocks which the individual receives from society are endurable only when he finds a haven, which in our society the family normally offers. Given such a haven, the expressions of his instincts are held within bounds acceptable to society. When this is lacking, the equilibrium of these unstable individuals is all the more readily thrown out of balance.
One of the most important points about parent education today is the extent to which mental hygiene principles have worked their way into its materials and procedures. An incredible amount of exceedingly valuable information about children's behavior has been brought within the reach of present-day parents, especially mothers, and a glance into the more recent study courses and publications used by parent and child study groups is distinctly reassuring.
There is a tendency in some quarters to view with suspicion the efforts of groups of parents to learn something about mental hygiene as applied to themselves and to their children. Probably not a large number of parents are as yet actually helped; possibly, too, a certain number are harmed--the psychiatrists report a few parents getting just enough of the jargon and the general point of view to find "problem" children where these do not exist. On the whole, however, it is doubtful whether in any other educational field mental health principles have penetrated as far and as well as in the modern plans and practices in parent education and education for family life.
Possibilities for the school, therefore, are definitely limited at the start. The "education" of the child has been under way for a number of years before he comes to school. What education can do for mental health will depend to a considerable extent on what the family and home have already done; also on what the family continues to do while the youngster is in school. Where the public educational provision includes the nursery school, as it should, the school is able to exert its influence at an earlier stage, of course, but the part of the home remains highly significant even then.
In the present discussion no attempt at a thoroughgoing survey of the broad field of parent education will be made. The purpose is rather to suggest, as a fundamentally important factor in mental hygiene education, the limitations placed upon the school by the preschool education of the home; to indicate something of the influence students of personality and mental health assign to the family situation; and to give some notion of the extent to which parent education of today has been directly affected by what is frequently called "the mental hygiene point of view."
Most authorities believe that the influence of the home and family in making or breaking wholesome personality begins very early and persists very late. Studies of babies in the first year, who showed all the marked differences that characterize later personalities--some slow in their reactions, phlegmatic, dull; others quick, amiable, responding with distinct pleasure to the different stimuli, or with clear evidence of discomfort. At the other end of the scale, there have been some noteworthy cases of adjustment of very difficult boys and girls in foster home surroundings long after older adolescence and beyond.
It seems as if the shocks which the individual receives from society are endurable only when he finds a haven, which in our society the family normally offers. Given such a haven, the expressions of his instincts are held within bounds acceptable to society. When this is lacking, the equilibrium of these unstable individuals is all the more readily thrown out of balance.
One of the most important points about parent education today is the extent to which mental hygiene principles have worked their way into its materials and procedures. An incredible amount of exceedingly valuable information about children's behavior has been brought within the reach of present-day parents, especially mothers, and a glance into the more recent study courses and publications used by parent and child study groups is distinctly reassuring.
There is a tendency in some quarters to view with suspicion the efforts of groups of parents to learn something about mental hygiene as applied to themselves and to their children. Probably not a large number of parents are as yet actually helped; possibly, too, a certain number are harmed--the psychiatrists report a few parents getting just enough of the jargon and the general point of view to find "problem" children where these do not exist. On the whole, however, it is doubtful whether in any other educational field mental health principles have penetrated as far and as well as in the modern plans and practices in parent education and education for family life.
Eating Disorders
Dieting is almost a precondition for female gender in American society. It goes along with the sense of femininity as being rather than acting. Physical attractiveness determines social standing to a much larger extent for women than men; it shapes how women and men interact and even how women relate to themselves. The message is clear: A woman's body is not acceptable unless it fits a certain ideal; it must be deodorized, shaved, cantilevered, and, above all, slim. A recent survey of female students at a high school revealed that half judged themselves to be somewhat or very overweight, although they acknowledged that their parents and peers would see them as average or below normal weight. Further, 69% of these females had engaged in dieting behavior; over half had undertaken their first diet before age 15, and 14% identified themselves as chronic dieters. It is more than the fact that our cultural ideal is for women to be slim. There is an unexamined assumption that it is perfectly normal and appropriate to dictate the body size, shape, and proportions of women in a way that would never be applied to men. The presumed right to impose basically frivolous and trivial expectations on women is indicative of the low status of women in general. The fact that some females get into serious health problems in the process of adhering to these demands is a manifestation of the larger issue.
Cultural explanations of anorexia and bulimia have both strengths and weaknesses. The major weakness is that many members of the culture are exposed to the same messages, rewards, and pressures without developing an eating disorder. However, a socially idealized body image, economic gains through the propagation of slimness, and the social context of gender-appropriate behaviors all suggest cultural influences. Family influences, early life trauma, and peer influences all operate within a sociocultural context.
Clothing fashion probably plays a significant role in establishing idealized body image for women. Styles are often hyped for their purported ability to make women appear closer to the cultural ideal. For example, padded shoulders ostensibly lend height and, by contrast, make the waist appear small. In fact, one could argue that American society has yet to give up the body image captured by the corset. Idealized standards for body shape indicate that waists should be at least 10 inches smaller than hip measurements. Dimensions of mass produced clothes reflect the expectation that waists will be diminuitive. Underweight fashion models emphasize this cultural ideal. The marketing of clothes for large women is limited to "plus size" departments or specialty stores for "stout" women, which emphasize their deviance from the ideal.
Each year, several thousand individuals receive treatment for eating disorders. The associated behavior patterns have serious personal, social, and medical health consequences. Those who follow starvation eating patterns indicative of anorexia nervosa commonly lose 20% of their ideal weight and are often hospitalized due to the physical effects and risks of starvation. Those who follow a binge/purge cycle typically maintain a normal weight but engage in secret consumption of vast calories in short periods of time, hence the term bulimia, which literally means ox hunger. Anorexia and bulimia are somewhat overlapped, with some anorexics occasionally resorting to purging as a means of maintaining an emaciated body weight. Definitions now include beliefs, behaviors, and physical signs. Distorted attitudes about food and body image characterize belief systems of anorexics. Many anorexics perceive themselves as being pudgy or fat even though they appear emaciated to others.
Cultural explanations of anorexia and bulimia have both strengths and weaknesses. The major weakness is that many members of the culture are exposed to the same messages, rewards, and pressures without developing an eating disorder. However, a socially idealized body image, economic gains through the propagation of slimness, and the social context of gender-appropriate behaviors all suggest cultural influences. Family influences, early life trauma, and peer influences all operate within a sociocultural context.
Clothing fashion probably plays a significant role in establishing idealized body image for women. Styles are often hyped for their purported ability to make women appear closer to the cultural ideal. For example, padded shoulders ostensibly lend height and, by contrast, make the waist appear small. In fact, one could argue that American society has yet to give up the body image captured by the corset. Idealized standards for body shape indicate that waists should be at least 10 inches smaller than hip measurements. Dimensions of mass produced clothes reflect the expectation that waists will be diminuitive. Underweight fashion models emphasize this cultural ideal. The marketing of clothes for large women is limited to "plus size" departments or specialty stores for "stout" women, which emphasize their deviance from the ideal.
Each year, several thousand individuals receive treatment for eating disorders. The associated behavior patterns have serious personal, social, and medical health consequences. Those who follow starvation eating patterns indicative of anorexia nervosa commonly lose 20% of their ideal weight and are often hospitalized due to the physical effects and risks of starvation. Those who follow a binge/purge cycle typically maintain a normal weight but engage in secret consumption of vast calories in short periods of time, hence the term bulimia, which literally means ox hunger. Anorexia and bulimia are somewhat overlapped, with some anorexics occasionally resorting to purging as a means of maintaining an emaciated body weight. Definitions now include beliefs, behaviors, and physical signs. Distorted attitudes about food and body image characterize belief systems of anorexics. Many anorexics perceive themselves as being pudgy or fat even though they appear emaciated to others.
Stress Management in the Workplace
Stress-related disorders, including certain headaches, stomach disorders, chronic muscular pain, cardiac and respiratory conditions, and psychosomatic complaints have been linked to a large percentage of doctor's office visits and hospital tests and admissions. One goal of stress management programs is to provide alternate ways to respond to stress, to prevent potential disorders, and ultimately to reduce health costs.
Stress level has been found to be linked to worker productivity. Stress in moderate amounts, such as from reasonable deadlines, a focus on quality, rational performance rating systems, a system of accountability, often motivates performance. When stress rises to higher levels and a number of stressors are affecting the individual, performance deteriorates. At times of high stress, an individual is not as effective in solving problems, and on-the-job performance is negatively affected. The goal of stress management programs in this case is to provide ways in which employees can cope better with increasing stress and continue to perform well on the job.
Stress management programs are usually popular with employees. Attendance at talks and workshops shows that the topic is a popular one. Many companies decide to implement these programs as morale boosters because they "can't hurt anything."
Stress management has become an integral part of most preventive medicine programs. These programs attempt to include education and training in a variety of ways so that the employees can safeguard their health.
Programs are offered in a variety of formats, depending on the amount of time made available for the program and the number of employees able to participate in the programs. The 3 standard formats include lunch-time talks, half-day programs, and full-day programs.
The lunch-time talks usually occur in no more than an hour's time. They are presented to any size group and are designed to fit into an easily accessible hour of the employees' time. The goal of these programs is to educate employees on a single topic. There is typically not enough time for interaction between the presenter and audience, so the programs take the form of lectures and demonstrations. Topics often include: "what is the stress response?"; "how do we contribute to our own stress?"; "coping with deadlines"; "coping with too much work"; and other similar topics.
The workshops in half-day programs usually occur in three to four hours' time. They are designed to present basic ideas in stress management and allow time for the group to practice and interact around these ideas. Topics usually include relaxation exercises, time management techniques, identifying stressors, identifying the body's stress response, identifying thinking patterns that contribute to stress reaction, and better problem-solving and crisis-handling techniques.
These programs are most effective when they are provided over several months' time with the same group of employees participating in each of the workshops. The intervening time between the workshops provides employees time to practice some of the techniques that were learned. They can receive additional feedback on them when they reconvene. The half-day format appears to be one of the most effective ways in which to deliver stress management programs inside the company.
In the full-day format, the program is put into a single full day or several consecutive days for an intensified experience. The advantage of this program is that the employees who meet together are better able to interact freely and overcome their inhibitions about discussing their stress-related issues in the group. Another advantage to this format is that the ideas can be presented and practiced immediately, with each level of stress training building on previous levels. The disadvantage is that so many ideas are presented over the course of the day(s) that the employee may not be able to retain much of the information given. There is also no opportunity for follow-up after the program unless the employee seeks it out individually.
The "media" program is typically not included in descriptions of stress management workshops, but it has many of the benefits of the lunch-time talk series. A media program includes articles in the company's local newsletter, posters describing certain facts or information, announcements of stress management programs that may be appearing on TV or radio in the viewing and listening area of the employees and their families, and literature on local agencies that provide stress management programs in the area. One of the most useful tools in the media program is the local newsletter. Articles that focus on a single topic and provide some sort of self-checklist or "do you believe..." type of assessment that is currently being used in stress management programs provide the employees with information about themselves that might motivate further interest and exploration.
The program must provide information on the physical consequences of stress and allow participants to assess their own physical response to stress. The content should, help participants understand the physical stress reaction and decide if they need to seek medical advice and treatment.
Stress level has been found to be linked to worker productivity. Stress in moderate amounts, such as from reasonable deadlines, a focus on quality, rational performance rating systems, a system of accountability, often motivates performance. When stress rises to higher levels and a number of stressors are affecting the individual, performance deteriorates. At times of high stress, an individual is not as effective in solving problems, and on-the-job performance is negatively affected. The goal of stress management programs in this case is to provide ways in which employees can cope better with increasing stress and continue to perform well on the job.
Stress management programs are usually popular with employees. Attendance at talks and workshops shows that the topic is a popular one. Many companies decide to implement these programs as morale boosters because they "can't hurt anything."
Stress management has become an integral part of most preventive medicine programs. These programs attempt to include education and training in a variety of ways so that the employees can safeguard their health.
Programs are offered in a variety of formats, depending on the amount of time made available for the program and the number of employees able to participate in the programs. The 3 standard formats include lunch-time talks, half-day programs, and full-day programs.
The lunch-time talks usually occur in no more than an hour's time. They are presented to any size group and are designed to fit into an easily accessible hour of the employees' time. The goal of these programs is to educate employees on a single topic. There is typically not enough time for interaction between the presenter and audience, so the programs take the form of lectures and demonstrations. Topics often include: "what is the stress response?"; "how do we contribute to our own stress?"; "coping with deadlines"; "coping with too much work"; and other similar topics.
The workshops in half-day programs usually occur in three to four hours' time. They are designed to present basic ideas in stress management and allow time for the group to practice and interact around these ideas. Topics usually include relaxation exercises, time management techniques, identifying stressors, identifying the body's stress response, identifying thinking patterns that contribute to stress reaction, and better problem-solving and crisis-handling techniques.
These programs are most effective when they are provided over several months' time with the same group of employees participating in each of the workshops. The intervening time between the workshops provides employees time to practice some of the techniques that were learned. They can receive additional feedback on them when they reconvene. The half-day format appears to be one of the most effective ways in which to deliver stress management programs inside the company.
In the full-day format, the program is put into a single full day or several consecutive days for an intensified experience. The advantage of this program is that the employees who meet together are better able to interact freely and overcome their inhibitions about discussing their stress-related issues in the group. Another advantage to this format is that the ideas can be presented and practiced immediately, with each level of stress training building on previous levels. The disadvantage is that so many ideas are presented over the course of the day(s) that the employee may not be able to retain much of the information given. There is also no opportunity for follow-up after the program unless the employee seeks it out individually.
The "media" program is typically not included in descriptions of stress management workshops, but it has many of the benefits of the lunch-time talk series. A media program includes articles in the company's local newsletter, posters describing certain facts or information, announcements of stress management programs that may be appearing on TV or radio in the viewing and listening area of the employees and their families, and literature on local agencies that provide stress management programs in the area. One of the most useful tools in the media program is the local newsletter. Articles that focus on a single topic and provide some sort of self-checklist or "do you believe..." type of assessment that is currently being used in stress management programs provide the employees with information about themselves that might motivate further interest and exploration.
The program must provide information on the physical consequences of stress and allow participants to assess their own physical response to stress. The content should, help participants understand the physical stress reaction and decide if they need to seek medical advice and treatment.
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