Alleviating health disparities in the United States is a goal with broad support. Medical research undertaken to achieve this goal typically adopts the well-established perspective that racial discrimination and poverty are the major contributors to unequal health status. However, the suggestion is increasingly made that genetic research also has a significant role to play in alleviating this problem, which likely overstates the importance of genetics as a factor in health disparities. Overemphasis on genetics as a major explanatory factor in health disparities could lead researchers to miss factors that contribute to disparities more substantially and may also reinforce racial stereotyping, which may contribute to disparities in the first place. Arguments that promote genetics research as a way to help alleviate health disparities are augmented by several factors, including research funding initiatives and the distinct demographic patterns of health disparities in the United States.

OBJECTIVES: This study seeks to further characterize the role of exercise testing in the elderly for prognosis and diagnosis of coronary artery disease. BACKGROUND: Recent exercise testing guidelines have recognized that statements regarding the elderly do not have an adequate evidence-based quality because the studies they are based on have limitations in sample size and design. The Duke Treadmill Score has been recommended for risk stratification, but recent evidence has suggested that it does not function in the elderly.

METHODS: The study population consisted of male veterans (1872 patients >or=65 years; 3798 patients <65 years) who underwent routine clinical exercise testing with a mean follow-up of six years. A subset who underwent coronary angiography as clinically indicated (elderly, n = 405; younger, n= 809) were included. The primary outcome for all subjects was cardiovascular mortality with coronary angiographic findings as the outcome in those selected for angiography.

RESULTS: In survival analysis, exercise-induced ST depression was prognostic in both age groups only when cardiovascular death was considered as the end point. Peak metabolic equivalents were the most significant predictor for both age groups only when all-cause death was considered as the end point. New age-specific prognostic scores were developed and found to be predictive for cardiovascular mortality in the elderly. Moreover, in the angiographic subset of the elderly, a specific diagnostic score provided significantly better discrimination than exercise ST measurements alone. For any new score, there is a need for validation in another elderly population.

CONCLUSIONS: The mortality end point affected the choice of prognostic variables. This study demonstrates that exercise test scores can be helpful for the diagnosis and prognosis of coronary disease in the elderly.

Using data from a survey of deaths of children less than 5 years old conducted in 1997 in a county in Shaanxi Province, China, this paper examines gender differences in child survival in contemporary rural China. First, excess female child mortality in the county in 1994-96 is described, followed by an analysis of the mechanisms whereby the excess mortality takes place, and the underlying social, economic and cultural factors behind it. Excess female child mortality in this county is probably caused primarily by discrimination against girls in curative health care rather than in preventive health care or food and nutrition. Although discrimination occurs in all kinds of families and communities, discrimination itself is highly selective, and is primarily against girls with some specific characteristics. It is argued that the excess mortality of girls is caused fundamentally by the strong son preference in traditional Chinese culture, but exacerbated by the government-guided family planning programme and regulations. This suggests that it is crucial to raise the status of girls within the family and community so as to mitigate the pressures to discriminate against girls in China's low fertility regime. Finally, the possible policy options to improve female child survival in contemporary rural China are discussed.

Western democracies face increasing constraints on the use of their overwhelming military power. The classical logic, legitimacy and effectiveness of employing force to safeguard national interests apply less and less. State and non-state adversaries threaten important and even vital Western values and interests but are seemingly underterred by - or even inspired by - Western military superiority. At the same time, phenomena such as globalisation, the growing transparency of the battlefield and changing Western value systems subject civilian and military leaders to mounting pressure to wield military power selectively and to use increasing discrimination in choosing means as well as ends.

President George W. Bush has demonstrated impressive flexibility in reshaping his approach to foreign policy to deal with the new international challenges brought to the fore by the terrorist attacks.

Before Sept. 11, President Bush embraced a humble mission for the United States in the world. This country, he believed, had to "preserve the peace" by seeking to maintain the basic balance of power between nations. Now, Bush has abandoned the preservation of the old system. Instead, he seeks to change it by promoting liberty, freedom and eventual democracy in countries ruled by autocrats.

In doing so, Bush lines up next to "idealists" or "liberals" such as Ronald Reagan, Woodrow Wilson and Immanuel Kant, and implicitly distances himself from realists focused solely on the balance of power such as Richard Nixon, Thucydides and his own father, the 41st president.

In a second remarkable change, Bush has become a supporter, at least rhetorically, of nation building. Before Sept. 11, the Bush administration derided nation building as a Clinton-era distraction from the more important issues in international politics. Now, Bush has clearly identified the connection between rebuilding the failed state of Afghanistan and American national security interests. If Congress approves his proposals, Bush will be the author of the greatest increase in the American foreign aid budget since John F. Kennedy's presidency.

Third, the Bush administration before Sept. 11 expressed disdain for multilateral institutions. But in his speech this month before the United Nations, Bush outlined an ambitious proposal for revitalizing the United Nations and American cooperation with this most important multilateral institution.

To be credible, President Bush needs to do more to demonstrate his commitment to the promotion of democracy, nation building and multilateralism. Bush must show that he wants to see political reform in Saudi Arabia as well as in Iraq. Words about promoting liberty ring hollow if they apply only to some people.

To show seriousness on nation building, Bush should press for increases in the peacekeeping forces in Afghanistan. Those working to rebuild Afghanistan unanimously complain that the lack of security throughout the country is the No. 1 impediment to their work.

To make credible his pledge to reinvigorate the United Nations and other multilateral institutions, the president should complement his pledge to enforce U.N. resolutions on Iraq with a rededication of American participation in other international regimes. Bush could start with the ratification of the United Nations Convention on the Elimination of All Forms of Discrimination Against Women, an agreement that American officials helped craft.

Because many are suspicious of the president's recent embrace of democracy promotion, nation building and multilateralism, he must demonstrate a sustained commitment to his new foreign policy strategy.

If Bush has shown a willingness to consider new ideas about foreign policy, his critics -- both at home and abroad -- have demonstrated amazing conservatism. In a reversal of positions, those most opposed to Bush's new approach to foreign policy now seek to "preserve the peace" by defending the status quo. The core flaw in this is the assumption that the old international system was working. It was not.

Before Sept. 11, the United Nations had failed to enforce its own resolutions on Iraq. If the "international community" cannot act to execute its will when dealing with such grave issues as the proliferation of weapons of mass destruction, then it has no credibility on anything.

The international community is ineffective in dealing with despotism, poverty and human rights violations because it seeks to preserve state sovereignty above all else. Fifty years ago, this was a progressive idea, which brought about the end of colonialism. Today, it is a regressive idea, which preserves the sovereignty of dictators who defy international law, denying the sovereignty of their people.

It is odd to hear the international community invoked so often as the defender of high ideals and then see representatives from Iraq in the U.N. General Assembly. Should the United States really be a member of the same organization that includes Saddam Hussein? Eventually, autocracy should go the way of slavery and colonialism as simply unacceptable.

To be effective, the international community and the United States need each other. U.N. Security Council resolutions can only be enforced if the United States helps to enforce them. The United Nations can only assist in the building of new states or prevent the destruction of vulnerable regimes if the United States participates, and vice-versa. The international community has no army and no economy, but even the mighty and rich United States can't afford to remake the world alone. For an effective partnership, change has to come from both sides.

Michael McFaul is an associate professor of political science and Hoover Fellow at Stanford University and a senior associate at the Carnegie Endowment for International Peace.