Optimum allocation of samples in strata-matching case-control studies when cost per sample differs from stratum to stratum

We investigate the allocation of samples over strata in case-control studies with consideration of sampling costs. We consider two situations, typical of strata-matched case-control studies. Subject to a fixed total cost we derived optimum allocations that maximize the asymptotic efficiency of Cochran's test, that is, minimize the variance of the maximum likelihood estimator of the common odds ratio when the common odds ratio is one. Our results show that the standard design with equal numbers of cases and controls in each stratum is inefficient when costs per control differ greatly from stratum to stratum. We show that the optimum design suggested in this paper is robust for values of the odds ratio common in epidemiologic studies.

Cancer research in New Jersey

The New Jersey State Commission on Cancer Research endeavors to support basic research in cancer by providing funds to New Jersey investigators. The Commission now is focusing attention on the important area of clinical research as well, including psychosocial and epidemiologic studies.

On studying the discourse of medical encounters. A critique of quantitative and qualitative methods and a proposal for reasonable compromise

Studies of doctor-patient communication, although leading to diverse findings, have not lent themselves to replication and also have not captured important features of medical discourse. Quantitative methods alone do not deal with the complexities of medical encounters, usually are not helpful in analyzing the social context of discourse, do not clarify underlying themes and structures, and are costly and tedious to use. With qualitative methods, the selection of discourse for analysis is not straightforward, quality of interpretation is difficult to evaluate, and textual presentation is not clear-cut. Several criteria of an appropriate method offer reasonable compromises in dealing with medical discourse: 1) discourse should be selected through a sampling procedure, preferably a randomized technique; 2) recordings of sampled discourse should be available for review by other observers; 3) standardized rules of transcription should be used; 4) the reliability of transcription should be assessed by multiple observers; 5) procedures of interpretation should be decided in advance, should be validated in relation to theory, and should address both content and structure of texts; 6) the reliability of applying interpretive procedures should be assessed by multiple observers; 7) a summary and excerpts from transcripts should accompany the interpretation, but full transcripts should also be available for review; and 8) texts and interpretations should convey the variability of content and structure across sampled texts. An ongoing study applies these criteria to research on ideology and social control in medical encounters.

Strategies for cancer prevention through diet modification

Diet and cancer research at the National Cancer Institute has grown from a budget of $2.5 million in 1974 to $55 million in 1988. The emphasis is partially on demonstrations of prevention strategies and chemoprevention trials. Studies to disseminate dietary goals in practical ways are undertaken with the aid of the food industry.

The Chief Scientist reports ... hearing research at the Medical Research Council Institute of Hearing Research (Scottish Section)

In addition to conducting research with the Section's own resources from the MRC and the Scottish Home and Health Department, the Section stimulates collaborative clinical research with the University and Health Service Departments. This work would be unlikely to take place without the existence of the Scottish Section of the MRC Institute of Hearing Research. Its presence has contributed to the continuing recognition of the Royal Infirmary Departments as an attractive centre for postgraduate training by both British and overseas graduates, leading in time to a substantial body of clinical research in ENT. This close interlinking between a research unit and an academic otolaryngology department is most unusual in the UK and encourages a programme which contains elements of readily applicable clinical research. Clinical and scientific environments are mutually stimulating, so the Section also incorporates in Glasgow some more fundamental laboratory-based studies also, which aim to investigate underlying issues in the diagnosis and management of otological conditions.

Cisplatin-based combination chemotherapy in the treatment of advanced-stage testicular cancer: cost-benefit analysis

A cost-benefit analysis of the impact of cisplatin-based combination chemotherapy for treatment of disseminated testicular cancer showed that the annual estimated economic value of this treatment innovation in the United States is approximately $150 million. The estimate was based on the human capital approach, which conservatively values a human life in terms of economic productivity. Because testicular cancer predominantly strikes young adult males, the savings reported were due to the future earning potential of the survivors. A comparison of relevant National Cancer Institute (NCI) costs for drug development and clinical trials versus annual savings realized indicated that the total costs over a 17-year period are recovered in less than 1 year. This report is an example of health care cost savings resulting from NCI support of biomedical research.