Item 3 This is from the AAPHP Affiliate Listserver.- The American Legacy Foundation announces the availability of up to $35 million in grant funds to establish and support statewide youth movements against tobacco use.  Only the 46 states and 6 territories identified in the Master Settlement Agreement with tobacco product manufacturers may apply http://www.naag.org/tob2.htm .

This 3-year matching grant program, a companion to the national youth-led Truth campaign, is designed to foster statewide movements in which youth will take the responsibility in the fight against tobacco use. The American Legacy Foundation will offer two types of awards: One-time planning grants of $50,000 to $75,000 for states that have not completed the Youth Tobacco Survey. Legacy will offer a second application round in 2001 for those states that undertake the Youth Tobacco Survey after the first round deadline. Program grants of $500,000 to $1,000,000 per year for states that have completed the Youth Tobacco Survey. Program grants may be renewed annually for up to 3 years with a total award size of $1,500,000 to $3,000,000.  Through this grant initiative, the American Legacy Foundation aims to: Engage youth in community action against tobacco by developing a statewide coalition that reflects the state's ethnic and social diversity. The coalition may consist of youth organizations, health departments and agencies, education departments, volunteer organizations, and the business sector (e.g., the chamber of commerce), among others. Build or extend statewide youth movements against tobacco use. Foster meaningful youth-led tobacco prevention activities and programs.

The application guidelines are available through the American Legacy Foundation's website http://www.americanlegacy.org/grants/grant.html . If you have trouble accessing these materials, please send a request to grantsinfo@americanlegacy.org . Templates of the application forms will be available on-line by February 11, 2000. Applications are due May 15,

Item 4 Website additions - Thank you to Kim Buttery.
I will place this site  Translating Behavioral Science Into Action: Report of the National Advisory Mental Health Council Behavioral Science Workgroup'
http://www.nimh.nih.gov/council/bswsummary.cfm in our useful web links,

Item 6 Dear Mr. Goldberg, Thank you for the opportunity to review the draft report of AMA Council on Scientific Affairs entitled, "Xenotransplantation: Scientific Implications," on behalf of the American Association of Public Health Physicians. I have several specific suggestions that I hope you will be able to incorporate into a revised report.  While I would agree that there are many ethical issues with xenotransplantation, and I appreciate that they will be addressed separately by the Council on Ethical and Judicial Affairs, this paper inadequately describes the extent and scope of such ethical issues. Just a brief statement to that effect would more clearly circumscribe the focus of this paper.  The scope of this paper, scientific implications of xenotransplantation, clearly includes the realm of public health concerns raised by xenotransplantation, which deserve a clear explanation.
p. 1, line 11: Xenotransplantation, as defined by FDA, also includes " implantation, or infusion into a human recipient of either ... human body fluids, cells, tissues or organs that have had ex vivo contact with live nonhuman animal cells, tissues or organs." FDA Xenotransplantation Action Plan http://www.fda.gov/cber/xap/xap.htm . This should be explained in the paper.
p. 2, Background: In addition to the supply-demand imbalance for human-derived organs of transplantation, another factor is driving the need for animal-derived tissues/organs: Quoting FDA again, "...recent evidence has suggested that transplantation of cells and tissues may be therapeutic for certain diseases such as neurodegenerative disorders and diabetes, where, again human materials are not usually available."
p. 3, Public Health Concerns: By far, the biggest public health concern is for transmission of novel infections (line 36) and this deserves substantially greater discussion and higher profile in the paper. The issue of emerging infectious diseases has become a great concern of late, and xenotransplant must not become a source. This concern is driving the need for lifetime infectious disease surveillance of post-xenotransplant patients, which deserves mention.  The statement that "the risks, while real, are not well quantified," misses the point that no one can predict the course of an outbreak of a previously unknown disease in humans. This is not reassuring. Given this concern, public disclosure of risks of xenotransplant should be mandatory. As we have seen with the recent publicity about investigational gene therapy trials, public disclosure of adverse effects of xenotransplant investigations should be considered. The AMA can participate in this public debate.
There are other concerns, which must be articulated more clearly. First, amplification of zoonotic infections in the source animals for xenotransplant.  This requires surveillance and vigilance among the source animals. Second, post-transplant patients on immunosuppressive drugs are at higher risk of disease from organisms that they may come into contact with. This is not the same as disease transmission, and some confusion is evident on p. 3, lines 15-22.
p. 5, Ethics, line 31-35. I would state that the extent of evidence necessary to allow human application of a given xenotransplant procedure/technique is a public health issue, not an ethical one. Perhaps this is debatable, as suggested on line 32. However, given the safety concerns above, the public has an interest in preventing emerging infectious disease outbreaks that could spread to the general population to any extent. I would suggest that the term "from research status into clinical trials" be clearly changed to "allow human treatment," for the sake of clarity.
p. 6, Recommendations. These recommendations, which would become AMA policy on adoption of this report by the House of Delegates, are passive and toothless.The AMA should take an active role in the public debate on xenotransplantation, at the Secretary of HHS Advisory Committee on Xenotransplantation and the FDA's policy development process. There are clearly gaps at this point that need to be addressed, for example public release of adverse event reports in real time. Secondly, I do not understand how the AMA would "follow" the guidelines, since the organization is clearly not in the business of developing new treatments. Perhaps the language could refer to communicating with AMA members. If you have any questions, please do not hesitate to contact me at 301-279-5733.
Marcel E. Salive, MD, MPH, FACPM  Trustee