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A new image for plastic surgery?
48
Noticeboard A
new
image for plastic surgery?
We recently received a strange request from a television company. Could we, it asked, publish an appeal for three plastic surgeons to appear on a quiz show. The idea, we were told, was to give the show a "facelift"--chocolate moulders, ballroom dancers, and funeral directors were apparently failing to attract the viewers. This misunderstanding of what plastic surgery is all about appears to be widespread. The British Association of Plastic Surgeons (BAPS) has cornmentedl that many people, including doctors, regard plastic surgery as "unnecessary, frivolous, or trivial", because they equate it with cosmetic surgery. Women’s magazines have perpetuated this misconception, and several have published guides to cosmetic surgery-telling readers where to find a surgeon to reduce their thighs, redesign their noses, or cure their earlobe fatigue. One magazine even suggested that plastic surgeons are forever searching for new operations in order to extract more cash from their well-heeled patients. Life for the average National Health Service plastic surgeon is very different, however-a typical one will spend 20% of his time correcting congenital abnormalities, 20% on managing the late effects of bums, 20% on reconstructions after ablation of neoplasia, and 40% on repairs following trauma. In a recent questionnaire the BAPS sought its members’ views on a proposal to change the name of the specialty to "plastic and reconstructive surgery" in an attempt to improve its image. The results have not been published, but the proposal is thought to have had strong support. British plastic surgeons have more to worry about than their image. Gross understaffmg in NHS plastic surgery is another concern, reflected in exceptionally long waiting lists. Research and teaching are also suffering, according to the BAPS, because plastic surgeons are having to devote too much of their time to service commitments. Despite a 44% increase in the number of plastic surgery consultant posts between 1976 and 1985, the UK still has only one plastic surgeon per 500 000 population-only half the level recommended by the BAPS in 1976 in its evidence to the Royal Commission on the NHS and well below the ratios achieved in many other countries (in Europe, North America, and Australasia it approaches 1 per 100 000 population), including some third world ones. The BAPS now estimates that the ratio in the UK should be 1 per 125 000 to account for the rising incidence of skin cancers, the introduction of new microsurgical techniques, increasing longevity of the population, and other factors that are adding to the plastic surgeon’s workload. Between 1975 and 1984 the average plastic surgeon’s waiting list increased by 18% (from 393 to 463 patients), despite the rise in the number of consultants. In 1990, 52% of NHS plastic-surgery patients had waited over a year for treatment, compared with 29% awaiting oral surgery, the specialty with the next longest waiting times. The Department of Health has promised 25-5 million to regional health authorities that achieve agreed reductions in some of the worst waiting lists, but plastic surgery does not figure among its targets. More evidence that plastic surgery is not taken seriously in the UK? 1. British Association of Plastic
Surgeons.
Plastic
Surgery
in Great Britain. London,
1986.
Rogers DJ, Randolph SE. Mortality rates and population density of correlated with satellite imagery. Nature 1991; 351: 739-41. 2. Brady J. Seeing flies from space. Nature 1991; 351: 695. 1.
tsetse
flies
Popular p53 The
suppressor gene, p53, mutations of which are in implicated many inherited and sporadic human malignancies, has won a coveted place in the Institute for Scientific Information’s "hot topic" list of most cited papers.! 102 papers on the p53 gene were published in 1990, compared with 50 in 1989, and 4 recent papers are among the 10 most cited reports in medicine in ISI’s current pop chart. Research on the p53 gene, which was discovered in 1979, focused at first on its ability to transform normal cells into malignant ones, but interest later switched to its tumoursuppressing role. The p53 paper most often cited in the early months of 1991 was one by Finlay et aP at Princeton demonstrating, for the first time, that overexpression of wild-type p53 suppresses the development of transformed cells in culture. tumour
1. Anon. Scientists focus on role of p53 gene m cancer initiation and suppression. Science Watch April, 1991. 2. Finlay CA, Hinds PW, Levine AJ The p53 proto-oncogene can act as a suppressor of transformation. Cell 1989; 57: 1083-93.
Cancer
epidemiology studies
The latest Directory of On-Going Research in Cancer Epidemiologyl not only serves as a detailed list of current projects and investigators, intended to facilitate direct contacts between scientists and to avoid unnecessary duplication of work, but it can also be compared with its fourteen predecessors to assess research trends. Since the first directory in 1976, the proportion of studies into diet or nutrition has increased from 9% to 17% of projects, alcohol is now the main variable of interest in 10% (up from 4%), neck-and-neck with ionising radiation, but smoking still leads the field with 21 % (from 12 ).The types of study are also changing:
35%
are case-control studies, up from 27% in 1976, but these are matched by cohort studies (up from 16%). The directory, also available on computer disc, includes descriptions of 1147 research projects (slightly fewer than in recent years), 208 of which are newly registered. Despite all this research activity, international trends in cancer mortality seem to suggest increasing mortality from site-specific cancer, excluding those linked with smoking and hazardous occupational exposures, in elderly people from industrialised countries.2,3 now
Tracking the tsetse fly The tsetse fly, often blamed for preventing tropical Africa from joining in the agricultural revolution that began in the Middle East 6000 years ago, still blights the African landscape today. As a vector of cattle diseases it precludes mixed farming in an area of some 10
million km2; and it has
critical measurement is the normalised difference vegetation index (NDVI), a measure of intercepted photosynthetically active radiation that indicates the level of vegetation cover. The NDVI in turn reflects recent rainfall and saturation deficit, which quickly affect tsetse breeding and mortality. Rogers and Randolph’ found an inverse relation between mortality and the previous month’s NVDI for two species of tsetse, Glossina morsitans in Nigeria and G fuscipes in Uganda. A more detailed survey in the Ivory Coast showed that tsetse abundance, as well as mortality, was strikingly related to NDVI. Monthly NDVIs, which are available for the whole of Africa, can thus be used to fill some notable gaps in our knowledge of tsetse distribution. The small number of hard-pressed entomologists working in tsetse control (each has to cover an estimated 50 000 kmz on average2) will find this new index a valuable aid. Annually averaged NDVIs indicate where tsetse survival will be highest and risk of trypanosomiasis transmission greatest. The long-term aim is to produce maps of high risk of disease transmission by tsetse flies, and other insect vectors too.
an even more
direct effect
on
the human
population by exposing 25 million people to the risk of trypanosomiasis. Weather satellites may seem an unlikely weapon against this African scourge, but a report from two Oxford zoologists shows how data collected by meteorological satellites can be used to predict the fluctuating fortunes of tsetse populations across the continent and pinpoint areas of high infestation.1 The
1. Coleman
M, Wahrendorf J, eds. Directory of on-going research in cancer 1991. Lyon: IARC Sci Publ, 110. 1991 Pp 753. £36. ISBN
epidemiology
92-83221109. 2. Davis DL, Hoel D, eds. Trends m cancer mortality in industrial countries. Ann NY Acad Sci 1990; 609. Pp 347. $90. ISBN 0-897666437. 3. Davis DL, Hoel D, Fox J, Lopez A. International trends in cancer mortality in France, West Germany, Italy, Japan, England and Wales, and the USA. Lancet 1990; 336: 474-81.
Noticeboard A
new
image for plastic surgery?
We recently received a strange request from a television company. Could we, it asked, publish an appeal for three plastic surgeons to appear on a quiz show. The idea, we were told, was to give the show a "facelift"--chocolate moulders, ballroom dancers, and funeral directors were apparently failing to attract the viewers. This misunderstanding of what plastic surgery is all about appears to be widespread. The British Association of Plastic Surgeons (BAPS) has cornmentedl that many people, including doctors, regard plastic surgery as "unnecessary, frivolous, or trivial", because they equate it with cosmetic surgery. Women’s magazines have perpetuated this misconception, and several have published guides to cosmetic surgery-telling readers where to find a surgeon to reduce their thighs, redesign their noses, or cure their earlobe fatigue. One magazine even suggested that plastic surgeons are forever searching for new operations in order to extract more cash from their well-heeled patients. Life for the average National Health Service plastic surgeon is very different, however-a typical one will spend 20% of his time correcting congenital abnormalities, 20% on managing the late effects of bums, 20% on reconstructions after ablation of neoplasia, and 40% on repairs following trauma. In a recent questionnaire the BAPS sought its members’ views on a proposal to change the name of the specialty to "plastic and reconstructive surgery" in an attempt to improve its image. The results have not been published, but the proposal is thought to have had strong support. British plastic surgeons have more to worry about than their image. Gross understaffmg in NHS plastic surgery is another concern, reflected in exceptionally long waiting lists. Research and teaching are also suffering, according to the BAPS, because plastic surgeons are having to devote too much of their time to service commitments. Despite a 44% increase in the number of plastic surgery consultant posts between 1976 and 1985, the UK still has only one plastic surgeon per 500 000 population-only half the level recommended by the BAPS in 1976 in its evidence to the Royal Commission on the NHS and well below the ratios achieved in many other countries (in Europe, North America, and Australasia it approaches 1 per 100 000 population), including some third world ones. The BAPS now estimates that the ratio in the UK should be 1 per 125 000 to account for the rising incidence of skin cancers, the introduction of new microsurgical techniques, increasing longevity of the population, and other factors that are adding to the plastic surgeon’s workload. Between 1975 and 1984 the average plastic surgeon’s waiting list increased by 18% (from 393 to 463 patients), despite the rise in the number of consultants. In 1990, 52% of NHS plastic-surgery patients had waited over a year for treatment, compared with 29% awaiting oral surgery, the specialty with the next longest waiting times. The Department of Health has promised 25-5 million to regional health authorities that achieve agreed reductions in some of the worst waiting lists, but plastic surgery does not figure among its targets. More evidence that plastic surgery is not taken seriously in the UK? 1. British Association of Plastic
Surgeons.
Plastic
Surgery
in Great Britain. London,
1986.
Rogers DJ, Randolph SE. Mortality rates and population density of correlated with satellite imagery. Nature 1991; 351: 739-41. 2. Brady J. Seeing flies from space. Nature 1991; 351: 695. 1.
tsetse
flies
Popular p53 The
suppressor gene, p53, mutations of which are in implicated many inherited and sporadic human malignancies, has won a coveted place in the Institute for Scientific Information’s "hot topic" list of most cited papers.! 102 papers on the p53 gene were published in 1990, compared with 50 in 1989, and 4 recent papers are among the 10 most cited reports in medicine in ISI’s current pop chart. Research on the p53 gene, which was discovered in 1979, focused at first on its ability to transform normal cells into malignant ones, but interest later switched to its tumoursuppressing role. The p53 paper most often cited in the early months of 1991 was one by Finlay et aP at Princeton demonstrating, for the first time, that overexpression of wild-type p53 suppresses the development of transformed cells in culture. tumour
1. Anon. Scientists focus on role of p53 gene m cancer initiation and suppression. Science Watch April, 1991. 2. Finlay CA, Hinds PW, Levine AJ The p53 proto-oncogene can act as a suppressor of transformation. Cell 1989; 57: 1083-93.
Cancer
epidemiology studies
The latest Directory of On-Going Research in Cancer Epidemiologyl not only serves as a detailed list of current projects and investigators, intended to facilitate direct contacts between scientists and to avoid unnecessary duplication of work, but it can also be compared with its fourteen predecessors to assess research trends. Since the first directory in 1976, the proportion of studies into diet or nutrition has increased from 9% to 17% of projects, alcohol is now the main variable of interest in 10% (up from 4%), neck-and-neck with ionising radiation, but smoking still leads the field with 21 % (from 12 ).The types of study are also changing:
35%
are case-control studies, up from 27% in 1976, but these are matched by cohort studies (up from 16%). The directory, also available on computer disc, includes descriptions of 1147 research projects (slightly fewer than in recent years), 208 of which are newly registered. Despite all this research activity, international trends in cancer mortality seem to suggest increasing mortality from site-specific cancer, excluding those linked with smoking and hazardous occupational exposures, in elderly people from industrialised countries.2,3 now
Tracking the tsetse fly The tsetse fly, often blamed for preventing tropical Africa from joining in the agricultural revolution that began in the Middle East 6000 years ago, still blights the African landscape today. As a vector of cattle diseases it precludes mixed farming in an area of some 10
million km2; and it has
critical measurement is the normalised difference vegetation index (NDVI), a measure of intercepted photosynthetically active radiation that indicates the level of vegetation cover. The NDVI in turn reflects recent rainfall and saturation deficit, which quickly affect tsetse breeding and mortality. Rogers and Randolph’ found an inverse relation between mortality and the previous month’s NVDI for two species of tsetse, Glossina morsitans in Nigeria and G fuscipes in Uganda. A more detailed survey in the Ivory Coast showed that tsetse abundance, as well as mortality, was strikingly related to NDVI. Monthly NDVIs, which are available for the whole of Africa, can thus be used to fill some notable gaps in our knowledge of tsetse distribution. The small number of hard-pressed entomologists working in tsetse control (each has to cover an estimated 50 000 kmz on average2) will find this new index a valuable aid. Annually averaged NDVIs indicate where tsetse survival will be highest and risk of trypanosomiasis transmission greatest. The long-term aim is to produce maps of high risk of disease transmission by tsetse flies, and other insect vectors too.
an even more
direct effect
on
the human
population by exposing 25 million people to the risk of trypanosomiasis. Weather satellites may seem an unlikely weapon against this African scourge, but a report from two Oxford zoologists shows how data collected by meteorological satellites can be used to predict the fluctuating fortunes of tsetse populations across the continent and pinpoint areas of high infestation.1 The
1. Coleman
M, Wahrendorf J, eds. Directory of on-going research in cancer 1991. Lyon: IARC Sci Publ, 110. 1991 Pp 753. £36. ISBN
epidemiology
92-83221109. 2. Davis DL, Hoel D, eds. Trends m cancer mortality in industrial countries. Ann NY Acad Sci 1990; 609. Pp 347. $90. ISBN 0-897666437. 3. Davis DL, Hoel D, Fox J, Lopez A. International trends in cancer mortality in France, West Germany, Italy, Japan, England and Wales, and the USA. Lancet 1990; 336: 474-81.