Review

Four therapeutic diets: adherence and acceptability.

Many health conditions are treated, at least in part, by therapeutic diets. Although the success of any intervention depends on its acceptability to the patient, the acceptability of therapeutic diets and factors that influence it have been largely neglected in nutrition research. A working definition of acceptability is proposed and an examination and summary are provided of available data on the acceptability of common diet regimens used for medical conditions. The goal is to suggest ways to improve the success of therapeutic diets.

Changing the treatment paradigm for coronary artery disease.

This supplement to The American Journal of Cardiology presents the proceedings of the Summit on Cholesterol and Coronary Disease: Second National Conference on Lipids in the Elimination and Preven tion of Coronary Artery Disease presented by the Cleveland Clinic Foundation in cooperation with the Walt Disney Company in Lake Buena Vista, florida, September 4--5, 1997.

More than coronary artery disease.

[There is] an unreasonable gap between the medical enthusiasm devoted to acute interventions and the meager efforts currently devoted to secondary prevention. -- Rene C. Favaloro, MD Pioneer of Coronary Artery Bypass Grafting Interventional cardiology is symptomatic treatment. The late Dr. Lewis Thomas referred to this ap proach as "half-way technology," meaning that basic mechanisms of disease were not identified or treated. The bypass operation has significant mortality and morbidity, including further heart damage, stroke, and brain dysfunction.

Is the present therapy for coronary artery disease the radical mastectomy of the twenty-first century?

To fully grasp how so many smart, right-minded people could get it so wrong, it might help to start with a quick review of medical history. Take the radical mastectomy, conceived by William Halsted in the late 19th century. The procedure was intended to remove all cancer cells of the breast, the overlying skin, the underlying muscle, and regional lymph nodes (Figure 1). It was mutilating, permanently disfiguring, and no more effective than less radical, less disfiguring procedures.

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