On the eve of Mikhail Gorbachev's scheduled arrival in Washington tomorrow for a summit with President Bush, relations between and American and Soviet physicians have never been better.

From AIDS and arthritis to heart dieease and alcoholism, both countries have mounted joint medical proects that transcend politics.In addition to official exhcanges between the two governments, a variety of private health programs are expanding that involve American and Soviet medical institutions.

In recent weeks, for example, scores of Soviet researchers have traveled to the United States. A sampling from the month of May:

Former Soviet health minister Eugene Chazov, chief of the U.S.S.R. Cardiology Research Centre, and Vladimir N. Smirnov, director of the Centre's Institute of Experimental Cardiology, lectured in New York and reviewed cooperative heart research projects with the Rogosin Institute, an independent research and treatment center at New York Hospital-Cornell Medical Center. The pair also went to Kalamazoo, Mich., where Chazov was honored by the Upjohn Co., and to Washington to visit the National Institutes of Health.

A Soviet film crew interviewed National Heart, Lung and Blood Institute director Claude Lenfant as part of a film about U.S. efforts to prevent heart disease that is to be shown to the Soviet people.

On May 9 in New York, Herbert Pardes, dean of Columbia University's College of Physicians and Surgeons, and Mikhail A. Paltsev, dean of the I.M. Sechenov First Moscow Medical Institute, signed the first agreement between a Soviet and an American medical school for educational exchanges. Five Russian medical students are expected to arrive in September for a five-month program.

At the same time that the Boston Ballet was performing a Russian-staged version of "Swan Lake" with Soviet guest dancers from the Kirov and Bolshoi companies, Soviet and American experts held two symposia in Washington and Boston on "ballet medicine" focusing on dancers' injuries.

Soviet scientists spent two weeks in the U.S. studying Lyme disease. They visited the Rocky Mountain Laboratories in Colorado, where the organism that causes the disease was discovered, and New England Medical Center in Boston to see Allen Steere, who first recognized the disease in 1976.

Soviet and American scientists presented new findings from cooperative lung research at a meeting in Boston.

In June, a 21-member delegation of Soviet scientists plans to attend the international AIDS meeting in San Francisco with the help of the Public Health Service. Last year, only two Soviet delegates attended the international AIDS meeting in Montreal. One of this year's delegates, epidemiologist Vadim V. Pokrovsky, will also spend time at the federal Centers for Disease Control and the New York City Health Department.

Also in June, a government delegation of top Soviet health officials is scheduled to arrive in Washington to meet with top American government health officials in the 10th session of the U.S.-U.S.S.R. Joint Committee for Health Cooperation.

Glasnost goes the other way, too. In July, Alaskan physician Ted Mala will lead a second annual expedition of 40 Alaskans to study health and environment in the Magadan region of the Soviet Far East; the Soviets will return to Alaska in August.

And Columbia's Pardes is invited to Moscow for the 225th anniversary of the Sechenov medical school this December. Russian-speaking medical students at Columbia will spend part of their senior year at the school in 1991.

Loosening Up Under Glasnost

In the past, U.S. scientists participating in health exchanges with the Soviet Union often privately grumbled that the effort was a one-way street, benefiting the Soviet participants far more than the Americans.

Today, with the continuing shortcomings of the Soviet medical system and the limited funding of sophisticated medical equipment for research, East-West exchanges are still not a completely equitable arrangement.

Yet in the glasnost era of health exchanges, U.S. participants observe that the Soviets have loosened up considerably. The government is sending more scientists as well as younger scientists who are chosen for their expertise rather than political connections. They are allowed to come for longer periods of time and conduct true research. They are encouraged to hold more open discussions of health care problems as well as to share Soviet data and findings.

"The climate is definitely an improvement over what it was before," said Alexandra Stepanian, Soviet program officer at NIH's Fogarty International Center. "It's part of the liberalization trend and loosening of travel restrictions."

In the past, Soviet scientists often came for short stints as part of formal delegations that hopped from institution to institution -- a kind of scientific tourism. "We now find some of them coming for six, seven, eight months at a time," Stepanian said.

There is still far more interest among Soviets in visiting the U.S. than among American doctors in visiting the U.S.S.R. When the U.S. lifted a quota imposed in the early 1980s on the number of health exchanges, participation rose more rapidly on the Soviet side.

At NIH in Bethesda, 12 Soviet researchers are now working at different institutes as part of a visiting scientist program. In the past, only about two Soviets at a time would participate in the program.

Soviet scientists tend to stay in the U.S. for longer periods than their American counterparts do in the U.S.S.R. Over all, an estimated 65 Soviet health scientists came to the U.S. in 1988 as part of the formal governmental health exchanges for a total of nearly 99 months. This compares to 91 Americans who went to the Soviet Union for a total of fewer than 40 months. This still was double the time spent in 1987.

"We find in general that in many of our programs, it's more difficult to attract American scientists to go to foreign countries for long periods of time," said NIH's Stepanian. "Sometimes it's language, distance, their own career situation at home. It's also true in many areas that American science is more developed and more technologically sophisticated."

Heart Studies Lead the Way

The most successful area of cooperative government studies is in heart disease. This is a result of both the prominence of the disease -- it is the No. 1 killer in both countries -- and the prominence and personal camaraderie of the top researchers involved.

Theodore Cooper, who was director of what is now the National Heart, Lung and Blood Institute when the exchanges began in the early 1970s, developed a close relationship with his counterpart Chazov at the Soviet cardiology center. Cooper went on to become assistant secretary for health and is now chairman, president and chief executive officer of the pharmaceutical company Upjohn; Chazov, meanwhile, has played a powerful role in Soviet medicine as well, just recently stepping down as health minister.

Claude Lenfant, director of the U.S. heart institute for about a decade, has also had a longtime personal interest in promoting exchange with his Soviet counterparts.

"It's very productive, particularly in basic research," said Lenfant. "Make no mistake. They are very good." He noted that "there are areas where they are better than we are," particularly in laboratory techniques involving cell and tissue culture and the development of special probes called monoclonal antibodies. The Soviets also did early work on the treatment of heart attacks with drug therapy, he said.

But the Soviet Union lags in preventive efforts; diet, cholesterol, smoking and alcohol are major problems. In fact, while U.S. heart disease deaths have declined dramatically over the past two decades, the Soviet cardiac death rate has not improved, said Lenfant.

In recent years, the U.S.S.R. Cardiology Research Centre has expanded its dealings with the federal government to a variety of privately arranged exchanges. They include programs with Baylor College of Medicine, Ohio State University, Massachusetts Institute of Technology and Upjohn.

One of the Soviet Centre's earliest private heart research agreements was with New York's Rogosin Institute. Relations have thawed since the early 1980s. Under Gorbachev, "it's a lot easier to deal with the Soviets now," said Institute director Albert Rubin. "They have the same motivations and desire for basic and clinical research. They just don't have the financial means."

Soviet Lyme Disease, AIDS

Heart disease research, however, is far from the only area of active scientific exchange. Cooperative government-funded arthritis research has also proven particularly fruitful, said John Klippel, clinical director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Joint clinical trials to test drugs for the treatment of juvenile arthritis have involved children in both countries and been published in prestigious journals like the New England Journal of Medicine.

Some intriguing efforts are under way to compare Lyme disease in the U.S. with a tick-borne erythema or rash found in the U.S.S.R. When Lyme disease researcher Steere lectured in the Soviet Union five years ago, he was surprised to learn that the Soviets were studying a similar disease. Now in a joint project, researchers are seeking to discover if the two diseases are really the same and how the organism that causes both health problems -- known as a spirochete -- compares, Klippel said.

Another new study will compare the high prevalence of arthritis in Alaskan native Indians with arthritis in Soviet Indians across the Bering Strait.

There have also been exchanges in sports medicine. American experts visited the Soviet Central Institute of Traumatology and Orthopedics in Moscow in 1988 to discuss management of athletic injuries, and Soviet scientists came here this month for the ballet medicine seminars. "It's clear they have a high level of expertise," said Klippel. "The people in Washington were rather impressed by the presentations of the Soviets."

In cancer research, exchanges in the 1970s and early 1980s were generally less successful, but "two years ago, things really started to happen," said Federico Welsch, who directs the National Cancer Institute's international health office.

Exchanges now under way include American interest in a Russian technique using radiotherapy for deep-seated brain tumors, joint investigations of cancer rates in Alaskan natives, particularly the higher nose-and-throat cancer rate, to see how this compares in genetically related Soviet natives, and patient treatment trials in colon and breast cancer.

"Our science is substantially better, particularly in many cancer fields, but there are areas where they can contribute," said Welsch, adding "I wouldn't want to be a cancer patient {there}. They don't have many of the treatment compounds we have, and you should see their hospitals and compare. It's depressing."

The U.S. is setting up a program to provide Soviet cancer researchers, who often cannot afford expensive Western medical journals, with regular computer discs containing state-of-the-art cancer treatment information and abstracts of some 70,000 cancer research articles in the medical literature, said Welsch.

In other government health exchanges, notes a recent progress report, joint studies of viral diseases, including exchange of virus samples, are helping prepare new influenza vaccines. Work on alcohol and drug abuse is focusing on genetic markers that may aid in identifying high-risk individuals at an early stage. Environmental health workshops have shared studies on microwave radiation and electromagnetic fields. And the worldwide shortage of primate animals for research puts added importance on collaborative work with the Institute of Experimental Pathology and Therapy in Sukhumi, U.S.S.R., in studies of AIDS and other diseases in baboons and monkeys.

A new AIDS effort began last summer when two Soviet scientists visited the U.S. for several weeks to initiate some cooperative programs. In January, a U.S. delegation went to the U.S.S.R. to discuss the projects, according to Linda Reck, program analyst for the NIH Office of AIDS Research.

"There's been an exchange of virus samples back and forth on both sides," she said, with an emphasis on development of new test systems for HIV infection. "We are very pleased with the level of interest. We're really cooperating on basic scientific endeavors."


The new openness under Gorbachev has unlocked some areas that were taboo. Alcoholism, once off limits, was added as a formal topic for exchanges, and Soviet psychiatry has come under greater scrutiny than before. Even the aftereffects of the nuclear accident at Chernobyl are finally being opened for study by outside researchers.

Because of alleged abuses of psychiatry for political purposes, since 1979 "we wouldn't have anything to do with them in the mental health area," said HHS's Harold Thompson, director of the Office of International Health of the U.S. Public Health Service. "But it's greatly loosened up under growing international pressure."

So much so that last year the Soviets allowed a State Department-sponsored delegation of U.S. psychiatrists and other experts to tour facilities and talk with patients. The delegation concluded that some Soviet psychiatric hospitals are still unduly harsh and restrictive and that some patients are denied basic rights.

But the delegation did find reforms under way, including the release of hospitalized dissidents and changes in law regarding involuntary hospitalization and treatment. In response, the Soviet government later acknowledged past abuses and last fall was given a conditional reinstatement in the World Psychiatric Association.

However, politics can still intervene. Recently, the United States made a last-minute postponement of a return visit by a Soviet delegation of psychiatrists after a human rights group, Helsinki Watch, complained that some Soviet delegation members were responsible for the past abuse of political dissidents and other patients in Soviet mental institutions. "We hope to salvage it" by rescheduling the meeting soon, one U.S. official said.

The 1986 Chernobyl nuclear power accident has also exemplified the tug-of-war between secrecy and openness in fostering cooperative efforts. Initially, the Soviet Union downplayed the accident. While California bone marrow specialist Robert Gale provided immediate private medical help, Soviet officials declined requests by American government researchers to study the effects of radiation from the accident.

"It was pretty much systematically rejected until recently," said Peter H. Henry, director of the Office for Europe and China in the international health program of the Public Health Service. "It was one of the areas they stonewalled us on." In 1988, however, the U.S. and U.S.S.R. signed a cooperative agreement on civilian nuclear reactor safety that included health effects of the Chernobyl accident. National Cancer Institute scientists have been involved in the study since last fall.


In the past, the Soviet Union stuck to formal health exchanges under strictly government auspices. But in recent years, the Reagan and Bush administrations have promoted direct exchanges between private institutions and individuals as the way to go.

"Governmental resources for collaborating with any country are drastically reduced. Funds are hard to come by. The fastest way of collaborating is directly with their American counterparts and bypassing the government. We've frankly encouraged them to do so," said Henry. "There has been a steady increase in the number of direct exchanges."

The advice is obviously being heeded. At almost any major medical school, chances are there is a Soviet connection. Health-related companies are getting involved, as well. Among the first direct exchanges to benefit from Gorbachev's increased openness was a cooperative effort involving the department of neurosurgery of Columbia's New York Neurological Institute and the N.N. Burdenko Institute of Neurosurgery in Moscow.

New York neurosurgeon Robert Holtzman recalled that he was initially unsuccessful in even getting Soviet neurosurgeons to attend an annual medical conference held in the United States. But since an agreement was signed in 1986, the sister Soviet institute has sent five neurosurgeons to study in New York and the U.S. institute has sent two resident doctors to Moscow. The effort is privately funded by the Harry Winston Research Foundation, set up by Ronald Winston, the son of the well-known jeweler, said Holtzman. "There is no political involvement. We don't want it. We've shunned it," he said.


Ted Mala used to fly halfway around the world to go next door. It took six stops during a three-day period via Copenhagen and Moscow to get to his destinations in Siberia and the Soviet Far East. Now it's a 40-minute flight on a seven-seat prop plane from Nome, Alaska, to Provideniya, across the Bering Sea.

Serving as an unofficial ambassador of health, Mala has helped thaw relationships between the two regions. An Alaskan physician born to an Eskimo father and a Russian mother, he has made the mutual problems of peoples in the frozen North -- from "cabin fever" to rural health care delivery -- a basis for launching joint efforts in research and medical care.

Earlier this month, Mala flew to Washington for a goodbye ceremony for Yuri Dubinin, the Soviet ambassador who had helped translate Mala's dreams into a program that bypasses federal red tape.

He was interviewed at Brown University's International Health Institute, where he gave a talk on "Glasnost and Public Health."

"Geopolitical boundaries divide us, yet our health problems are the same," said Mala, 44, who directs a new Institute for Circumpolar Health Studies at the University of Alaska in Anchorage. "Our exchanges deal with everyday health at the village level as well as research."

Last week, he met in Canada with a delegation of about 30 Soviet colleagues who had taken the newly opened short route through Alaska to get to an international polar health meeting. "Our little reunion here is certainly an indication of the friendship and the good relations our countries now have," said Alexei Lebedev, minister of health for the remote Soviet Far East region of Magadan, in a telephone interview from the Yukon capital of Whitehorse.