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Can you move one eye only?
coverage, but were successful with national immunisation days (NIDs), or pulse immunisation,2 which tactic is more important to prevent transmission? In my opinion, NIDs are more important (even essential) than routine immunisation, which had failed. Field evidence is provided by the investigators themselves, because four imported polio cases did not spread infection in De Hong during 1995–96. Whether or not routine immuniation coverage is high, the widest possible coverage with NID doses must be ensured to interrupt or prevent transmission of indigenous or imported wild poliovirus, and to maintain it. I must point out that the sample (5–9-month-old infants) selected by the investigators is biased towards low vaccine coverage. The interval between the two two-dose NIDs is 10 months. Babies born during this time constitute about 83% of all infants and about 17% of all children under 5 years. Their three-dose coverage does not reflect the overall coverage of children under 5 years. All of them become eligible in the 10th month for NID doses of OPV. 1 Much of the deficiency of routine doses would be made up in the NIDs. Whereas routine doses do not interrupt wild virus transmission, NID doses do and also increase the individual’s protection. A decision to discontinue pulse immunisation (national or regional) must be made only after careful assessment of the risk of importation. Second, as more countries eliminate wild viruses and as the whole world progresses towards eradication, the likelihood of importation steadily declines. As in China, high-quality surveillance for acute flaccid paralysis and virological investigations are the key to detect importation, so that intervention to intercept transmission can be applied without delay. This is a lesson for every country, whatever the stage of wild virus elimination in that country. Third, a decline in routine immunisation coverage of not only OPV, but also of other vaccines in the WHO Expanded Program of Immunisation (EPI) is one of the adverse effects of the high-profile and labour-intensive NIDs in some countries. This decline, in a way, is a price to be paid for prioritising polio for eradication and for choosing OPV to implement it, since in many settings NID campaigns are required to interrupt transmission because of low vaccine efficacy and poor herd effect of OPV. 3 Resurgence of diphtheria, whooping cough, or measles should be expected in such situations. For this
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reason, high routine-immunisation coverage with all EPI vaccines must be maintained, less for the sake of polio and more for the sake of these other diseases. T Jacob John Department of Clinical Virology, Christian Medical College Hospital, Vellore, Tamilnadu, 632 004, India (e-mail: [email protected]) 1
2
3
Kobayashi M, Masuba T, Chiba Y, Zhengrong D, Zhisong L. Can we stop national immunisation days before global eradication of poliomyelitis? Lancet 1999; 353: 2129–30. John TJ, Pandian R, Gadomski A, et al. Control of poliomyelitis by pulse immunisation in Vellore. BMJ 1983; 286: 31–32. John TJ. Poliomyelitis outbreak in Taiwan: lessons for developing countries. Lancet 1985; i: 872.
I were an alien. After that, I was able to hold their attention easily, and they listened very carefully to my short lecture on neurological reflexes and watched a demonstration of reflexes with fully opened eyes. A couple of jokes will make your lecture more vivid. A couple of questions will make it more stimulating. However, I do not know of any questions more provoking than the title of this letter in the teaching of neurology. If you would like to know how to move one eye, please study the figure below. One more suggestion: do not practice the method shown in the figure while driving! Tomohito Hamazaki Department of Clinical Application, Institute of Natural Medicine, Toyama Medical and Pharmaceutical University, Toyama-shi, Toyama 930-0194, Japan
Research grants and acknowledgment of funding of published studies Sir—In your July 24 editorial1 you discuss the method by which research funds are allocated and highlight the opportunity cost of not only the peer review system but also the research process itself. But why do studies declare only the source of funding and not its magnitude? There will always be difficulties in identifying the true cost of a study. However, a declaration of the value of funding in addition to its source would at least facilitate the first step towards a more transparent system to ascertain whether results were commensurate with the resources that had been allocated to their production. D P Kernick St Thomas Medical Group Research Unit, Exeter EX4 1HJ, UK 1
Editorial. Untold costs of keeping up appearances. Lancet 1999; 354: 265.
Can you move one eye only? Sir—When I had to teach a small group of medical students about neurological reflexes, I found the question in the title very intriguing. When I asked the question, they all said “no”. They knew from their experience that sight is dependent on conjugate movements of both eyes. Surprisingly, the correct answer is “yes”. So, in front of the students, I actually moved one eye only (this time my left eye, because the left one was easier for me). Of course they were astonished, and stared at me as if
How to move one eye only (1) Stretch your right hand forward with the index finger up, and look at the tip of the index finger. (2) Move the index finger straight toward the centre of your right eye. (3) Reverse procedure 2. In this way you can horizontally move your left eye (centre, to right, to centre), while fixing your right eye. Then practice without your right hand. Once you can quickly move your left eye only without the help of any device, practice moving your right eye only; this is important because otherwise people might think that you are neurologically abnormal.
DEPARTMENT OF ERROR Hormone replacement therapy—In this article by the Clinical Synthesis Panel on HRT (July 10, p 152), the penultimate sentence in the Dementia section should have read: “However, these studies are limited by changes in HRT use and the long preclinical phase of most dementias”. Ciprofloxacin in typhoid fever—In this Correspondence letter by A Kapil and colleagues (July 10, p 164), the last sentence of the letter should read: “One encouraging trend that we reported (April 10, p 1241)3 is the reemergence of strains of S typhi sensitive to chloramphenicol and amoxicillin in our region.”
THELANCET • Vol 354 • September 4, 1999
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reason, high routine-immunisation coverage with all EPI vaccines must be maintained, less for the sake of polio and more for the sake of these other diseases. T Jacob John Department of Clinical Virology, Christian Medical College Hospital, Vellore, Tamilnadu, 632 004, India (e-mail: [email protected]) 1
2
3
Kobayashi M, Masuba T, Chiba Y, Zhengrong D, Zhisong L. Can we stop national immunisation days before global eradication of poliomyelitis? Lancet 1999; 353: 2129–30. John TJ, Pandian R, Gadomski A, et al. Control of poliomyelitis by pulse immunisation in Vellore. BMJ 1983; 286: 31–32. John TJ. Poliomyelitis outbreak in Taiwan: lessons for developing countries. Lancet 1985; i: 872.
I were an alien. After that, I was able to hold their attention easily, and they listened very carefully to my short lecture on neurological reflexes and watched a demonstration of reflexes with fully opened eyes. A couple of jokes will make your lecture more vivid. A couple of questions will make it more stimulating. However, I do not know of any questions more provoking than the title of this letter in the teaching of neurology. If you would like to know how to move one eye, please study the figure below. One more suggestion: do not practice the method shown in the figure while driving! Tomohito Hamazaki Department of Clinical Application, Institute of Natural Medicine, Toyama Medical and Pharmaceutical University, Toyama-shi, Toyama 930-0194, Japan
Research grants and acknowledgment of funding of published studies Sir—In your July 24 editorial1 you discuss the method by which research funds are allocated and highlight the opportunity cost of not only the peer review system but also the research process itself. But why do studies declare only the source of funding and not its magnitude? There will always be difficulties in identifying the true cost of a study. However, a declaration of the value of funding in addition to its source would at least facilitate the first step towards a more transparent system to ascertain whether results were commensurate with the resources that had been allocated to their production. D P Kernick St Thomas Medical Group Research Unit, Exeter EX4 1HJ, UK 1
Editorial. Untold costs of keeping up appearances. Lancet 1999; 354: 265.
Can you move one eye only? Sir—When I had to teach a small group of medical students about neurological reflexes, I found the question in the title very intriguing. When I asked the question, they all said “no”. They knew from their experience that sight is dependent on conjugate movements of both eyes. Surprisingly, the correct answer is “yes”. So, in front of the students, I actually moved one eye only (this time my left eye, because the left one was easier for me). Of course they were astonished, and stared at me as if
How to move one eye only (1) Stretch your right hand forward with the index finger up, and look at the tip of the index finger. (2) Move the index finger straight toward the centre of your right eye. (3) Reverse procedure 2. In this way you can horizontally move your left eye (centre, to right, to centre), while fixing your right eye. Then practice without your right hand. Once you can quickly move your left eye only without the help of any device, practice moving your right eye only; this is important because otherwise people might think that you are neurologically abnormal.
DEPARTMENT OF ERROR Hormone replacement therapy—In this article by the Clinical Synthesis Panel on HRT (July 10, p 152), the penultimate sentence in the Dementia section should have read: “However, these studies are limited by changes in HRT use and the long preclinical phase of most dementias”. Ciprofloxacin in typhoid fever—In this Correspondence letter by A Kapil and colleagues (July 10, p 164), the last sentence of the letter should read: “One encouraging trend that we reported (April 10, p 1241)3 is the reemergence of strains of S typhi sensitive to chloramphenicol and amoxicillin in our region.”
THELANCET • Vol 354 • September 4, 1999