- Email: [email protected]
Alas, Alois
1264
The
case
for animal research
"Much of the information about medical research is at best ill-informed and at worst maliciously misleading." Dr Bridget Ogilvie (director of the W elkome Trust) was speaking at the launch in London last Monday of the Research for Health Charities Group (RHCG). The group, which includes eight major charities (Action Research, Cancer Research Campaign, Cystic Fibrosis Research Trust, Multiple Sclerosis Society, Muscular Dystrophy Group, British Heart Foundation, Imperial Cancer Research Fund, and Wellcome Trust) aims to improve public understanding about the role of animals in medical research. If the use of animals ("the essential link between the test-tube and the patient") is prevented, they say, medical and veterinary progress will grind to a halt. At the launch, many of the usual arguments and counterarguments given at a conference earlier this year (see Lancet May 4, p 1089) were reiterated, but this group hopes to break new ground by involving not only scientists but also general practitioners and patients who benefit from such research. The RHCG sees the animal rights’ campaigns in schools as especially damaging because young people, the scientists and doctors of the future, are being told that medical progress can be made without the use of animals. The group accepts that alternative methods should and are being used whenever possible but recognises that all medical research entails the use of animals at some stage. The group will counter the claims of animal rights activists by, for example, providing schools with leaflets, asking scientists to visit schools, and encouraging general practitioners to tell patients how their treatments were discovered. For
more
information
contact
Mr
Myc Riggulsford, RHCG, PO Box
1417, Shepton Mallet, Somerset BA4 4YZ
Lessons in AIDS prevention
Agency for International Development the largest single funder of AIDS prevention programmes in developing countries, has committed more than $160 million to fighting AIDS in the past five years. The agency has recently completed a new contract for$167 million over five years with Family Health International (FHI) in North Carolina and, all told, plans to spend$385 million world wide in the next five years. On Nov 4 and 5 USAID brought together over 300 people in Rosslyn, Virginia, to review lessons learned in AIDS prevention, the main one being that the only effective response to the pandemic is to help people reduce high-risk behaviours by encouraging them to use condoms, limit the numbers of their sexual partners, and avoid contracting the disease through intravenous drug use and contaminated blood products. There was a strong consensus that, individually, education about reducing the number of sexual partners, condom distribution, and treatment of sexually transmissible diseases (STDs) had a weak effect in limiting the spread of HIV but that all three together could have a much stronger impact. Selling condoms through commercial outlets at subsidised prices adjusted to those whose need is greatest has proved to be a cost-effective way of encouraging "safe sex". Population Services International in Zaire, for example, distributed 20 million condoms this year, compared with 1 million in 1988. Less success has been achieved in improving the treatment of STDs. An audit of treatment in Jamaica demonstrated that half the government clinics did not counsel patients on the need to reduce the number of their sexual partners, a quarter used inappropriate therapies for gonorrhoea, and only one in five offered clients a supply of condoms. The problem is probably much worse in Africa and parts of Asia. There is an urgent need to improve STD treatment through government services, in the private sector, and by enlisting the help of traditional medical practitioners. Education to reduce the number of sexual partners has been uneven and difficult to document, although lifesaving changes in sexual behaviour can probably be achieved in the long term. Some groups of men in some cultures visit prostitutes frequently--eg, twice a month on average for some Thai men and once a month for many Guatemalan soldiers. The United States
(USAID),
Data are accumulating on the cost-effectiveness of some interventions. FHI estimated that the cost of averting one primary AIDS infection ranges from$200 to$1000 according to the location. When secondary infections were taken into account the bcncnt:cost ratio rose to 2 7:1 at a minimum and more likely to over 10:1. AIDS prevention is now in the top ten most cost-effective ways of saving human lives in the developing world. In her keynote speech Mrs Janet K. Museveni, the First Lady of Uganda, recognised that the Ugandan Government had failed to react quickly enough to the rapid spread of AIDS in the early 1980s. Several speakers emphasised the need for early intervention and drew attention to the important role of the private sector and non-governmental organisations in the critical early stages of the
panendemic. Sun in Oxfordshire Last
Saturday evening rural Oxfordshire will have hosted many pyrotechnic displays. Hidden from public view-indeed unseen by all since the hottest ion plasmas are invisible-was a potentially far more exciting exhibition. For the first time, the 14-nation Joint European Torus (JET) operated with the fuel it was always intended to use, a mixture of the two heavy hydrogens deuterium and tritium. At a temperature variously reported as 10, 20, or 30 times that of the sun’s core JET’s success was fleeting but encouraging. Self-sufficiency was not achieved. The object of this international programme of fusion research is that the equation D + T -- He + neutrons + energy will sustain the magnetic fields and the hot plasma with enough left over to end up in a national electricity grid. That prospect looks like one for the mid-21st century. There are safety concerns about tritium (only 200 mg was used on Nov 9) and the torus needs rebuilding so that plasma near the walls can be cooler. This much publicised breakthrough comes at a time when the future of fusion research has as many political uncertainties as physical ones. A bigger machine costing almost 3 billion, though still only a pilot, is now required. But that plan is taking second place to an International Thermonuclear Reactor, in which Japan, the USSR, and USA might participate. Alas, Alois Few would wish immortality in association with dementia on one’s worst enemy. Pity, then, Alois Alzheimer.’ During 14 years in Frankfurt he used histological and histochemical techniques to investigate various inflammatory and vascular brain diseases but in 1903 was persuaded by Kraepelin to move to Munich. While at Frankfurt, in 1901, Alzheimer met a 51-year-old woman (appropriately known as AD) who had been admitted to the psychiatric hospital with impaired memory, aphasia, disorientation,
unpredictable behaviour, paranoid thoughts, auditory hallucinations, and general psychosocial incompetence. After her death in 1906 Alzheimer gave
an
address
to a
conference of
psychiatrists in Tiibingen entitled "On a peculiar disease process of the cerebral cortex". Alzheimer himself may not have been fully aware that he had noted a novel disease, but Kraepelin’s eighth edition of his influential textbook of psychiatry described this "presenile dementia", with diffuse brain atrophy, especially of the cortex, and various other histological changes, as "morbus Alzheimer". Kraepelin’s motives may not have been entirely pure, since he was in bitter rivalry with Arnold Pick in Prague, and Alzheimer was his deputy at the time (1906-09); one of Pick’s associates had published not dissimilar histopathological findings associated with senile dementia in 1907. But the name stuck. Alzheimer continued to explore the histopathology of dementia praecox and manic-depressive illness and got increasingly caught up in contemporary arguments about psychiatric nosology. Unfortunately, this most biological of psychiatrists died in 1915, at age 51, only 3 years after assuming the chair of psychiatry at Breslau. His disease, however, lives on. 1 Berrios GE, Freeman HL, eds. Alzheimer and the dementias. London: Royal Society of Medicine. 1991 Pp 149 Hardback £12 95; ISBN 1-853151573. Paperback £7.95; ISBN 1-853151564
The
case
for animal research
"Much of the information about medical research is at best ill-informed and at worst maliciously misleading." Dr Bridget Ogilvie (director of the W elkome Trust) was speaking at the launch in London last Monday of the Research for Health Charities Group (RHCG). The group, which includes eight major charities (Action Research, Cancer Research Campaign, Cystic Fibrosis Research Trust, Multiple Sclerosis Society, Muscular Dystrophy Group, British Heart Foundation, Imperial Cancer Research Fund, and Wellcome Trust) aims to improve public understanding about the role of animals in medical research. If the use of animals ("the essential link between the test-tube and the patient") is prevented, they say, medical and veterinary progress will grind to a halt. At the launch, many of the usual arguments and counterarguments given at a conference earlier this year (see Lancet May 4, p 1089) were reiterated, but this group hopes to break new ground by involving not only scientists but also general practitioners and patients who benefit from such research. The RHCG sees the animal rights’ campaigns in schools as especially damaging because young people, the scientists and doctors of the future, are being told that medical progress can be made without the use of animals. The group accepts that alternative methods should and are being used whenever possible but recognises that all medical research entails the use of animals at some stage. The group will counter the claims of animal rights activists by, for example, providing schools with leaflets, asking scientists to visit schools, and encouraging general practitioners to tell patients how their treatments were discovered. For
more
information
contact
Mr
Myc Riggulsford, RHCG, PO Box
1417, Shepton Mallet, Somerset BA4 4YZ
Lessons in AIDS prevention
Agency for International Development the largest single funder of AIDS prevention programmes in developing countries, has committed more than $160 million to fighting AIDS in the past five years. The agency has recently completed a new contract for$167 million over five years with Family Health International (FHI) in North Carolina and, all told, plans to spend$385 million world wide in the next five years. On Nov 4 and 5 USAID brought together over 300 people in Rosslyn, Virginia, to review lessons learned in AIDS prevention, the main one being that the only effective response to the pandemic is to help people reduce high-risk behaviours by encouraging them to use condoms, limit the numbers of their sexual partners, and avoid contracting the disease through intravenous drug use and contaminated blood products. There was a strong consensus that, individually, education about reducing the number of sexual partners, condom distribution, and treatment of sexually transmissible diseases (STDs) had a weak effect in limiting the spread of HIV but that all three together could have a much stronger impact. Selling condoms through commercial outlets at subsidised prices adjusted to those whose need is greatest has proved to be a cost-effective way of encouraging "safe sex". Population Services International in Zaire, for example, distributed 20 million condoms this year, compared with 1 million in 1988. Less success has been achieved in improving the treatment of STDs. An audit of treatment in Jamaica demonstrated that half the government clinics did not counsel patients on the need to reduce the number of their sexual partners, a quarter used inappropriate therapies for gonorrhoea, and only one in five offered clients a supply of condoms. The problem is probably much worse in Africa and parts of Asia. There is an urgent need to improve STD treatment through government services, in the private sector, and by enlisting the help of traditional medical practitioners. Education to reduce the number of sexual partners has been uneven and difficult to document, although lifesaving changes in sexual behaviour can probably be achieved in the long term. Some groups of men in some cultures visit prostitutes frequently--eg, twice a month on average for some Thai men and once a month for many Guatemalan soldiers. The United States
(USAID),
Data are accumulating on the cost-effectiveness of some interventions. FHI estimated that the cost of averting one primary AIDS infection ranges from$200 to$1000 according to the location. When secondary infections were taken into account the bcncnt:cost ratio rose to 2 7:1 at a minimum and more likely to over 10:1. AIDS prevention is now in the top ten most cost-effective ways of saving human lives in the developing world. In her keynote speech Mrs Janet K. Museveni, the First Lady of Uganda, recognised that the Ugandan Government had failed to react quickly enough to the rapid spread of AIDS in the early 1980s. Several speakers emphasised the need for early intervention and drew attention to the important role of the private sector and non-governmental organisations in the critical early stages of the
panendemic. Sun in Oxfordshire Last
Saturday evening rural Oxfordshire will have hosted many pyrotechnic displays. Hidden from public view-indeed unseen by all since the hottest ion plasmas are invisible-was a potentially far more exciting exhibition. For the first time, the 14-nation Joint European Torus (JET) operated with the fuel it was always intended to use, a mixture of the two heavy hydrogens deuterium and tritium. At a temperature variously reported as 10, 20, or 30 times that of the sun’s core JET’s success was fleeting but encouraging. Self-sufficiency was not achieved. The object of this international programme of fusion research is that the equation D + T -- He + neutrons + energy will sustain the magnetic fields and the hot plasma with enough left over to end up in a national electricity grid. That prospect looks like one for the mid-21st century. There are safety concerns about tritium (only 200 mg was used on Nov 9) and the torus needs rebuilding so that plasma near the walls can be cooler. This much publicised breakthrough comes at a time when the future of fusion research has as many political uncertainties as physical ones. A bigger machine costing almost 3 billion, though still only a pilot, is now required. But that plan is taking second place to an International Thermonuclear Reactor, in which Japan, the USSR, and USA might participate. Alas, Alois Few would wish immortality in association with dementia on one’s worst enemy. Pity, then, Alois Alzheimer.’ During 14 years in Frankfurt he used histological and histochemical techniques to investigate various inflammatory and vascular brain diseases but in 1903 was persuaded by Kraepelin to move to Munich. While at Frankfurt, in 1901, Alzheimer met a 51-year-old woman (appropriately known as AD) who had been admitted to the psychiatric hospital with impaired memory, aphasia, disorientation,
unpredictable behaviour, paranoid thoughts, auditory hallucinations, and general psychosocial incompetence. After her death in 1906 Alzheimer gave
an
address
to a
conference of
psychiatrists in Tiibingen entitled "On a peculiar disease process of the cerebral cortex". Alzheimer himself may not have been fully aware that he had noted a novel disease, but Kraepelin’s eighth edition of his influential textbook of psychiatry described this "presenile dementia", with diffuse brain atrophy, especially of the cortex, and various other histological changes, as "morbus Alzheimer". Kraepelin’s motives may not have been entirely pure, since he was in bitter rivalry with Arnold Pick in Prague, and Alzheimer was his deputy at the time (1906-09); one of Pick’s associates had published not dissimilar histopathological findings associated with senile dementia in 1907. But the name stuck. Alzheimer continued to explore the histopathology of dementia praecox and manic-depressive illness and got increasingly caught up in contemporary arguments about psychiatric nosology. Unfortunately, this most biological of psychiatrists died in 1915, at age 51, only 3 years after assuming the chair of psychiatry at Breslau. His disease, however, lives on. 1 Berrios GE, Freeman HL, eds. Alzheimer and the dementias. London: Royal Society of Medicine. 1991 Pp 149 Hardback £12 95; ISBN 1-853151573. Paperback £7.95; ISBN 1-853151564