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The development of university-based community-medicine programs represents one of the most fundamental reforms in medical education in recent times. These programs have attempted to train and motivate students to undertake research and innovations in health service and health-care systems, and to provide service to those in need. Since community medicine is based upon the collective needs of population groups, its relevance, value and effectiveness as a teaching, research and service device in the United States must be seriously questioned unless the prevailing system of individualized care is fundamentally changed to one of collective and regionalized organization. Moreover, working with small population groups, university programs do not provide a large enough epidemiologic base to serve as models for this reform. In developing countries community medicine has proved to be ineffective when isolated from broader socioeconomic development, and should, as now constituted, be abandoned as an independent undertaking.

The urinary excretion of uric acid in individuals with primary gout has been shown to be approximately the same as, or in a minority of instances greater than, that of normal subjects on comparable diets (2, 3). These observations, plus the failure to demonstrate significant differences in the renal clearance of uric acid in gouty and nongouty control subjects, have led to the conclusion that patients with gout excrete uric acid in a normal manner (2-5).This view has, however, recently been challenged (6) on the ground that in the studies on which it was based, differences in the plasma urate concentrations of gouty and nongouty subjects were not taken into account. In order to eliminate such differences Nugent and Tyler (6) induced hyperuricemia in nongouty individuals by the oral administration of uric acid precursors and compared uric acid excretion in these subjects and patients with gout. Under these conditions an impairment in urate excretion was clearly evident in patients with gout; both the excretion and clearance of urate were significantly less than in nongouty subjects with equivalent plasma urate levels.These observations of impaired uric acid excretion were fully supported by the present study, in which urate was administered intravenously to gouty and nongouty subjects in order to a) study urate excretion at equivalent and various plasma levels and b) examine the dynamics of the renal tubular transfer mechanisms for urate.