Capsules

-- Faced with enormous expenses, even publicly financed hospitals occasionally are reluctant to care for patients who cannot pay. But they will have to provide such care whether they want to or not. Elliot Richardson, Secretary of Health, Education and Welfare, last week ordered all hospitals receiving federal funds under the 1946 Hill-Burton Act to provide a minimum level of free services for the poor. The directive affects 6,308 health-care facilities, including half of the nation's hospitals, and is quite specific. Not less than 5% of an institution's operating costs and not less than 25% of its net income must be devoted to free medical care. The regulation, which takes effect in 30 days unless successfully challenged in court, contains sharp teeth. Hospitals that fail to comply will face the loss of federal or state aid--and perhaps their licenses as well.

-- Science has long searched for a means of controlling tumors, which can grow from pinhead to marble size in little more than a week. Dr. M. Judah Folkman of Harvard Medical School has found a clue as to how this may be accomplished. The growth of solid cancers appears to require the presence of a recently identified protein substance called tumor angiogenesis factor (T.A.F.). Though Folkman has been working with a variety of solid tumors, he told a neurosurgeons' meeting last week that his chief target has been certain malignancies of the brain, where the need for blood supply is greatest. The experiments show that tumors must develop their own circulation systems in order to obtain nutrients and carry off waste products. T.A.F., which is found in fetal cells but not in normal adult cells, induces capillaries (tiny blood vessels) to grow into the cancerous mass. This growth appears essential; when tumors were experimentally isolated from blood supplies, T.A.F.'s effects were canceled out and no capillaries formed. As a result, tiny tumors literally choked on their own wastes and failed to grow beyond a state considered harmless. Folkman's discovery suggests that interfering with T.A.F. production could halt, or even prevent tumor growth. He and his colleagues are now searching for a substance to run this interference.

>Varicose veins, those bulging, discolored blood vessels that cause cosmetic consternation in women and discomfort for both sexes, probably have a variety of causes. Habitual standing in place for long periods is one. Can sitting in chairs be another? So theorizes Dr. Colin Alexander of New Zealand's Auckland Medical School. Alexander's argument in the Lancet owes as much to geography as it does to anatomy. Varicose veins, he points out, are rare among the Japanese and other Eastern peoples who generally sit on the floor or the ground. But the condition is common among Westerners, who spend hours each day sitting in chairs. The reason, he speculates, is that chair posture increases the pressure in the saphenous vein of the leg, causing it to dilate and ultimately lose its elasticity. Floor sitting, in which the legs are horizontal rather than vertical, prevents this pressure from building up. Alexander's hypothesis implies that varicose veins can be avoided, but only at the cost of discomfort for the rump--not to mention the furniture industry.

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