The author describes recent trends in mortality and morbidity in the successor states to the former Soviet Union. Separate consideration is given to mortality under late perestroika (1987-1991) and subsequent mortality trends. The author concludes that "the collapse of the USSR and the problems of the successor states have had severe adverse affects not only on macroeconomic indices but also on the mortality and morbidity of the population.... Since the collapse of the USSR, the mortality situation in the successor states has rapidly and significantly worsened. Between 1991 and 1993 the crude death rate in Russia rose by 26%. As a result, by 1993 the life expectancy at birth of Russian men had fallen to about 59, which is about 6 years below the level of 1987.... By 1993, male life expectancy at birth in Russia had fallen below the level of the medium income countries and had probably fallen to a level about that of Indonesia in the second half of the 1980s. Ukraine has also experienced an increase in mortality since the collapse of the USSR. In other successor states, experiencing serious military conflicts, such as Tadjikstan and Armenia, the proportionate increase in mortality was even larger than in Russia."

Objective To evaluate the efficacy and tolerability of an oral preparation of iloprost, a prostacyclin analog, in patients with Raynaud's phenomenon (RP) secondary to systemic sclerosis (scleroderma). Methods A multicenter, randomized, parallel‐group, placebo‐controlled double‐blind study was performed at university and community‐based medical centers. Patients were randomly assigned to receive either 50 µg of iloprost orally twice daily or an identical gelatin‐coated capsule containing placebo for 6 weeks. Outcome measures included average total daily duration of RP attacks, average number of RP attacks, and RP condition scored via a standardized daily diary. Results Three hundred eight patients with scleroderma (272 women, 36 men, mean age 49 years [range 18‐80]) were enrolled. One hundred fifty seven were assigned to receive iloprost and 151 to receive placebo. One hundred forty‐three patients in the iloprost group (91.1%) and 144 in the placebo group (95.4%) completed the 6‐week treatment phase. Fifteen of these treated patients (8 iloprost, 7 placebo) failed to complete all of the followup visits. The mean reduction in the average duration of attacks from baseline to week 5‐6 was 24.32 minutes in the iloprost group and 34.34 minutes in the placebo group (P = 0.569). Likewise, the mean reduction from baseline to week 5‐6 in the daily frequency of attacks was 1.02 in the iloprost group and 0.83 in the placebo group (P = 0.459). The Raynaud's condition score, a patient‐completed assessment of the severity of RP attacks, was reduced by 1.32 in the iloprost group and 1.00 in the placebo group (P = 0.323). The lack of significant difference between treatment groups did not change when a variety of factors, including use of other vasodilators, duration of disease, classification of scleroderma (limited versus diffuse), or number of baseline digital ulcers were taken into account. Premature withdrawal from the study due to adverse events occurred in 10 patients (6.4%) in the iloprost group and 3 (2.0%) in the placebo group (P = 0.058). Conclusion Oral iloprost at a dosage of 50 µg twice daily is not better than placebo for management of RP secondary to scleroderma, either during 6 weeks of treatment or during 6 weeks of posttreatment followup.

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This paper presents an analysis of the economics of the 1947 Soviet famine, using data from recently declassified archives. It is argued that the best estimate that can currently be given of the number of excess deaths is the range 1•0-1•5 million. The demographic loss was greater. During the famine, surplus stocks in the hands of the state seem to have been sufficient to have fed all those who died of starvation. The famine was a FAD 2 (preventable food availability decline) famine, which occurred because a drought caused a bad harvest and hence reduced food availability, but, had the priorities of the government been different, there might have been no famine (or a much smaller one) despite the drought. The selection of victims can be understood in terms of the entitlement approach.

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