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the particular screening strategy diat he wished to test. Within a few seconds he could obtain an estimate ofthe benefits to die persons screened and to the public health. Forinstance, die screening interval (e.g., rescreening annually, in 2 years, etc.) or the age at start ofscreening (e.g., 35, 40, 45, 50, etc.) are "design parameters " that a policymaker could control. It is then easy to search for an optimum strategy [10]. The benefits predicted by the model agreed weU with die benefits calculated direcdy from later American Cancer Society reports on the actual screening [H]. By September 1975 the benefits from optimum screening strategies could be compared with the health costs to the patient. The benefits would be cures expected from the earlier detection by mammography. The costs would be the additional cases of breast cancer produced by the dosage of x-ray used in die examination. It had become clear that in women under 50, the benefit-to-cost ratio was around 1:4 so that screening was doing more harm than good. The optimum policy in these asymptomatic women was not to screen diem. Subsequently this policy conclusion was independently reached by a series of National Cancer Institute committees. However, it was almost 2 years before an enforceable ban against screening women under 50 went into effect in May 1977. WhUe the model played a role in changing screening poUcy in the younger women, it did not manage to avoid the long delay involved in conventional medical decision making. REFERENCES 1.I. D. J. Bross. Design for decision. New York: Macmillan, 1953. 2.I. D. J. Bross. Scientific strategies in human affairs. Jericho, N.Y.: Exposition, 1975. 3.T. DAO, T. Nemoto, and I. D.J. Bross./n: A. P. M. Forrest and P. B. Kunkler (eds.). Proc. 1st Tenovous Symp., Cardiff, April 12-14, 1967. Edinburgh: Livingstone, 1968. 4.L E. Blumenson and I. D. J. Bross. Biometrics, 25(1):95, 1969. 5.I. D. J. Bross and L. E. Blumenson. J. Chronic Dis., 21:493, 1968. 6.I. D.J. Bross and L. E. Blumenson. Cancer 28(6): 1637, 1971. 7.I. D.J. Bross. Trans. N.Y. Acad. Sci., ser. 11, 34:187, 1972. 8.L. E. Blumenson. Math. Biosci., 30:273, 1976. 9.L. E. Blumenson. Math. Biosci., 33:73, 1977. 10.I. D. J. Bross and L. E. Blumenson. J. Surg. OncoL, 8:437, 1976. 11.I. D. J. Bross. Capital Proc. Vol., Univ. Akron's National Energy Forum, in press. Irwin Bross Roswell Park Memorial Institute 666 EIm Street Buffalo, New York 14263 Chemistry and Biology ofThrombin. By Roger L. Lundblad, John W. Fenton II, and Kenneth G. Mann. Ann Arbor: Ann Arbor Science Publishers, 1977. Pp. xii+564. $22.50. This book contains the proceedings of a conference on the chemistry and biology of thrombin which was held at the Mayo Clinic in April 1977. There are 632 J Book Reviews 42 papers dealing with various aspects of thrombin ranging from die basic chemistry of the molecule to various clinical aspects. Isolation and structural aspects of die prothrombin and the thrombin molecule are discussed in several papers. Of particular interest is the paper on the development of competitive reversible inhibitors of thrombin. Several papers deal with the activation of thrombin, including die mechanism of action ofantithrombin III and its potentiation by heparin, interaction with the alpha I antitrypsin-antiplasmin molecule. A series of papers deals with die interactions between thrombin and platelets. A most exciting group of papers discusses recent data on the role of thrombin in die initiation of cell division and related phenomena. AU the authors are active research workers and recognized experts in dieir fields. The book can be highly recommended to all hematologists and especially those active in the field of blood coagulation and related areas. Julian L. Ambrus and Clara M. Ambrus Roswell Park Memorial Institute 666 Elm Street Buffalo, New York 14263 Retrospectroscope: Insights into Medical Discovery. By Julius H. Comroe, Jr. Menlo Park, CaUf.: Von Gehr Press, 1977. Pp. 182. $5.00. During the past 2 years I have been eagerly looking forward to each issue of the American Review of Respiratory...


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