- Email: [email protected]
Multiple sclerosis research centre
172
made for such a journey are given, as well as advice on eligibility for welfare benefits and housing rights whilst out of the UK. An understanding--however superficial-of the culture and background of a patient from an ethnic minority is invaluable for building a productive doctor-patient relationship. The Ethnic Health Factfile provides health professionals with a comprehensive guide to the cultural and religious practices of people from ethnic minorities.2 1. Gunaramam Y. Call for Care. London: HEA and
King’s Fund. 1992. Pp 71. £1.95 ISBN 1-854481533 (English). Available from: Distribution Dept, HEA, Hamilton House, Mabledon Place, London WC1H 9TX. 2. The Ethnic Health Factfile London: The Health and Ethnicity Programme. 1992. plus £0.60 p&p. £12.50.
Multiple sclerosis research centre The first research centre to focus exclusively on multiple sclerosis (MS) has been established in Cambridge with a /J2million grant awarded by the Multiple Sclerosis Society. The team of scientists, led by Prof D. A. S. Compston, will work in close collaboration with the new Medical Research Council Interdisciplinary Research Centre for Brain Repair, which will be built on a new site, also to be located in Cambridge. The research programme being funded by the MS Society aims to continue existing work on the nature of the inflammatory damage that underlies MS. But a larger part of this new initiative will concentrate on the repair mechanisms of the central nervous system (CNS) in response to damage. In particular, the group will study human glial cell lineages to identify whether oligodendrocyte cell precursors exist. If stem cells are found, manipulation of the growth factor microenvironment might enable oligodendrocytes to be directed at strategically placed CNS lesions to facilitate both repair and clinical recovery. Part of this investigation will require a greater understanding of how CNS tissue forms scars, and whether such scar formation can be prevented. If it is found that the brain’s capacity for repair is insufficient, then glial cell implantation might be the next step.
Concorde still in
flight
Concorde, the joint UK/French double-blind, placebocontrolled trial of zidovudine (AZT) in symptom-free individuals with human immunodeficiency virus infection (see Lancet Oct 19, 1991, p 1007) is to continue until the end of the year, when a definitive analysis will be conducted. This decision was made after the independent Data and Safety Monitoring Committee had reviewed the second detailed analysis of the trial. By the end of the year average follow-up time for the 1749 patients recruited will be 3 years,
In
as
planned.
England
Now
A 7-year-old was referred to me by her family doctor because he could find no physical cause for her loss of hair. She had behaviour problems and he wondered if her baldness could be psychological in origin. For six months she had been wearing a blonde wig with long curls. The mother gave me the history and went on to describe a typical "omnipotent child". Nobody was going to tell Darlene what to do. The mother had already warned me, "You’ll never get her to show you her scalp, if that’s what you have in mind". It was indeed one of the things I had in mind. However, since I occasionally lose on deals like this, I modestly replied, "We’ll see". When Darlene came in it took her only a minute or so to decide that I would be putty in her hands if she chose to open the throttle a little. I joshed about with her a while, talking of this and that, letting her take the lead. When I felt I had disarmed her suspicions, the cut-and-thrust went like this: "That sure a nice wig you got there, I wish I had one like it". She giggled. "No, I do. Mine is not half as nice as yours." "That’s your hair, not a wig", Darlene proclaimed insouciantly.
"It certainly is a wig", I replied, arranging some hairs across my spreading bald spot. "That’s not a wig. If you were going to buy a wig, you’d get a better one than that." It was a riposte worthy of Oscar Wilde. "You’re sure hard to fool, Darlene. OK. It’s my own hair-but think how wonderful I would look in a wig like yours." "You’d look silly", Darlene declared with majestic aplomb. "No way! Long curls down to my beard! I could wear it on TV." "You don’t go on TV," Darlene said rolling her eyes in mock despair. "You’re just a doctor." "I do go on TV", I replied with a little heat "and they powder my bald spot so it won’t shine into the camera". The circumstantial detail was getting to her so I pressed my advantage. "But if I had a wig like yours they wouldn’t have to." I smiled in a manner I imagined to be wistful. "I’d look like a judge." I made a gavel of my fist and bounced it off the table a time or two. "Order in the playroom." I declared. "Oh, you’re so dumb", Darlene said. "You’d look silly." With that she whipped off her wig and stuck it on me. "Wow! Do you " ever! I have no doubt she was right. I wish I had the thing on videotape. I had invented an entirely new interviewing technique and the world would never know. But at the time I was too busy to feel regret for I was checking out her scalp which was as barren as the Negev. Not a tuft from Beersheba to Eilat. Well that’s it, the Kojak manoeuvre. With variations it could revolutionise paediatric dermatology. Well, maybe not revolutionise, but it couldn’t hurt. And Darlene? We specialists pulled out all the stops but never found out why she lost her hair and never got it back for her. I did manage to do something about her adaptive immaturity, at least to the point that it is now tolerable for her family to live in the same house with her and she does have some friends.
*
*
*
Sometimes you have to wait a long time to satisfy a secret craving. Sixty years in this case. One summer Sunday I was on a train with my father and when we got to our destination the door was jammed. Those were the days of small compartments and there was no other way out. When the train began to move off, my father-without the slightest hesitation-reached up and firmly pulled down the chain labelled "for emergency use only, penalty for improper use 5", a lot of money in those days. The guard was upset-"you didn’t need to do that, Sir"-but I was very impressed. Sixty years later, I find myself on a train travelling from central London into the wilds of Kent, and when we arrive at the little country station where I want to get off, I open the door and there’s no platform. The train is too long and I’m in the wrong place. Squeezing and staggering down the aisle, my suitcase and I try to get to the next coach before the train moves off. Too late: the train begins to move. Suddenly I realise that my once-in-a-life-time chance has arrived. It’s now or never. I pull hard on the chain and the train comes to a thrilling, grinding, juddering halt. "That’s going to cost you a lot of money", comments a fellow passenger, his face a remarkable blend of amazement, disapproval, and admiration. The driver of the train is not pleased with me; nor is the guard. Worse still, the train is still standing there ten minutes later as I finish giving my statement. I feel bad about this. Can’t the train now be on its way? Apparently not. So what’s my defence? Simple. Earlier in the journey I had been assured by the ticket collector that I didn’t need to move; I was in the right part of the train for the station I wanted. I have a good case and I resolve there and then that if British Rail dare to prosecute, I’ll fight them every inch of the way, to the House of Lords if necessary. But when I tell this to my brother-in-law, who is a judge, he’s not impressed. Not a hope, is his verdict: "I think that this court can safely assume that the accused, being a medical practitioner, understands the meaning of the word emergency. It may have been inconvenient. It may have been frustrating. It was not an emergency. Next case please". Well, it’s over a year ago now and I’ve heard nothing more. It seems that British Rail has decided to forgive and forget. So I’ll never know if my brother-in-law was right.
made for such a journey are given, as well as advice on eligibility for welfare benefits and housing rights whilst out of the UK. An understanding--however superficial-of the culture and background of a patient from an ethnic minority is invaluable for building a productive doctor-patient relationship. The Ethnic Health Factfile provides health professionals with a comprehensive guide to the cultural and religious practices of people from ethnic minorities.2 1. Gunaramam Y. Call for Care. London: HEA and
King’s Fund. 1992. Pp 71. £1.95 ISBN 1-854481533 (English). Available from: Distribution Dept, HEA, Hamilton House, Mabledon Place, London WC1H 9TX. 2. The Ethnic Health Factfile London: The Health and Ethnicity Programme. 1992. plus £0.60 p&p. £12.50.
Multiple sclerosis research centre The first research centre to focus exclusively on multiple sclerosis (MS) has been established in Cambridge with a /J2million grant awarded by the Multiple Sclerosis Society. The team of scientists, led by Prof D. A. S. Compston, will work in close collaboration with the new Medical Research Council Interdisciplinary Research Centre for Brain Repair, which will be built on a new site, also to be located in Cambridge. The research programme being funded by the MS Society aims to continue existing work on the nature of the inflammatory damage that underlies MS. But a larger part of this new initiative will concentrate on the repair mechanisms of the central nervous system (CNS) in response to damage. In particular, the group will study human glial cell lineages to identify whether oligodendrocyte cell precursors exist. If stem cells are found, manipulation of the growth factor microenvironment might enable oligodendrocytes to be directed at strategically placed CNS lesions to facilitate both repair and clinical recovery. Part of this investigation will require a greater understanding of how CNS tissue forms scars, and whether such scar formation can be prevented. If it is found that the brain’s capacity for repair is insufficient, then glial cell implantation might be the next step.
Concorde still in
flight
Concorde, the joint UK/French double-blind, placebocontrolled trial of zidovudine (AZT) in symptom-free individuals with human immunodeficiency virus infection (see Lancet Oct 19, 1991, p 1007) is to continue until the end of the year, when a definitive analysis will be conducted. This decision was made after the independent Data and Safety Monitoring Committee had reviewed the second detailed analysis of the trial. By the end of the year average follow-up time for the 1749 patients recruited will be 3 years,
In
as
planned.
England
Now
A 7-year-old was referred to me by her family doctor because he could find no physical cause for her loss of hair. She had behaviour problems and he wondered if her baldness could be psychological in origin. For six months she had been wearing a blonde wig with long curls. The mother gave me the history and went on to describe a typical "omnipotent child". Nobody was going to tell Darlene what to do. The mother had already warned me, "You’ll never get her to show you her scalp, if that’s what you have in mind". It was indeed one of the things I had in mind. However, since I occasionally lose on deals like this, I modestly replied, "We’ll see". When Darlene came in it took her only a minute or so to decide that I would be putty in her hands if she chose to open the throttle a little. I joshed about with her a while, talking of this and that, letting her take the lead. When I felt I had disarmed her suspicions, the cut-and-thrust went like this: "That sure a nice wig you got there, I wish I had one like it". She giggled. "No, I do. Mine is not half as nice as yours." "That’s your hair, not a wig", Darlene proclaimed insouciantly.
"It certainly is a wig", I replied, arranging some hairs across my spreading bald spot. "That’s not a wig. If you were going to buy a wig, you’d get a better one than that." It was a riposte worthy of Oscar Wilde. "You’re sure hard to fool, Darlene. OK. It’s my own hair-but think how wonderful I would look in a wig like yours." "You’d look silly", Darlene declared with majestic aplomb. "No way! Long curls down to my beard! I could wear it on TV." "You don’t go on TV," Darlene said rolling her eyes in mock despair. "You’re just a doctor." "I do go on TV", I replied with a little heat "and they powder my bald spot so it won’t shine into the camera". The circumstantial detail was getting to her so I pressed my advantage. "But if I had a wig like yours they wouldn’t have to." I smiled in a manner I imagined to be wistful. "I’d look like a judge." I made a gavel of my fist and bounced it off the table a time or two. "Order in the playroom." I declared. "Oh, you’re so dumb", Darlene said. "You’d look silly." With that she whipped off her wig and stuck it on me. "Wow! Do you " ever! I have no doubt she was right. I wish I had the thing on videotape. I had invented an entirely new interviewing technique and the world would never know. But at the time I was too busy to feel regret for I was checking out her scalp which was as barren as the Negev. Not a tuft from Beersheba to Eilat. Well that’s it, the Kojak manoeuvre. With variations it could revolutionise paediatric dermatology. Well, maybe not revolutionise, but it couldn’t hurt. And Darlene? We specialists pulled out all the stops but never found out why she lost her hair and never got it back for her. I did manage to do something about her adaptive immaturity, at least to the point that it is now tolerable for her family to live in the same house with her and she does have some friends.
*
*
*
Sometimes you have to wait a long time to satisfy a secret craving. Sixty years in this case. One summer Sunday I was on a train with my father and when we got to our destination the door was jammed. Those were the days of small compartments and there was no other way out. When the train began to move off, my father-without the slightest hesitation-reached up and firmly pulled down the chain labelled "for emergency use only, penalty for improper use 5", a lot of money in those days. The guard was upset-"you didn’t need to do that, Sir"-but I was very impressed. Sixty years later, I find myself on a train travelling from central London into the wilds of Kent, and when we arrive at the little country station where I want to get off, I open the door and there’s no platform. The train is too long and I’m in the wrong place. Squeezing and staggering down the aisle, my suitcase and I try to get to the next coach before the train moves off. Too late: the train begins to move. Suddenly I realise that my once-in-a-life-time chance has arrived. It’s now or never. I pull hard on the chain and the train comes to a thrilling, grinding, juddering halt. "That’s going to cost you a lot of money", comments a fellow passenger, his face a remarkable blend of amazement, disapproval, and admiration. The driver of the train is not pleased with me; nor is the guard. Worse still, the train is still standing there ten minutes later as I finish giving my statement. I feel bad about this. Can’t the train now be on its way? Apparently not. So what’s my defence? Simple. Earlier in the journey I had been assured by the ticket collector that I didn’t need to move; I was in the right part of the train for the station I wanted. I have a good case and I resolve there and then that if British Rail dare to prosecute, I’ll fight them every inch of the way, to the House of Lords if necessary. But when I tell this to my brother-in-law, who is a judge, he’s not impressed. Not a hope, is his verdict: "I think that this court can safely assume that the accused, being a medical practitioner, understands the meaning of the word emergency. It may have been inconvenient. It may have been frustrating. It was not an emergency. Next case please". Well, it’s over a year ago now and I’ve heard nothing more. It seems that British Rail has decided to forgive and forget. So I’ll never know if my brother-in-law was right.