- Email: [email protected]
CARCINOGENICITY OF IRON-DEXTRAN COMPLEX
441
impressed with what I saw. I am certain that La Bourboule has got something ", though exactly what it has is hard to say. All the children who travel in these parties are recommended by, or at least have the approval of, their family doctor. Their doctors’ reports are kept by International Help for Children along with the reports of the children’s parents. Some months after the treatment a follow-up questionnaire is sent, which "
elicits almost 100% return. Many of the children suffer from intractable and disabling asthma, and often eczema too. Doctors treating them at home have often reached a therapeutic impasse and are waiting and " hoping for the children to grow out of it ". Meanwhile the children are missing many months of schooling every winter, often becoming increasingly deformed in both mind and bodyand more and more firmly tied to their mothers’ apron-strings. The following results are taken from the records for the past ten years: CONDITION OF ASTHMATIC CHILDREN AFTER VISIT
Most of the favourable reports are backed up by remarks such as " more confident ", " less nervous ", " only missed 4 days school last winter instead of the usual 4 months " or " (parent quoting child’s own request) Throw away the pills, Mummy; I’ve been to France and I’m cured now ". A visit to La Bourboule seems to break the vicious circle. The child is taken away from home, visits a new country, and receives concentrated treatment in an optimistic atmosphere. It is assumed that he will get better. He usually does. Such asthmatic attacks as did occur during the visit were sensibly managed and swiftly ended, usually without the use of drugs other than aminophylline (which is widely used by the French doctors). I was also fascinated to watch a dermatologist treating a stunted asthmatic child whose severe eczema covered most of his body. This doctor treated the child by means of the douche filiforme, a fine jet of hot spa water delivered at very high pressure with the aid of complicated manual movements, which he assured me acted as massage. After several days the eczema had virtually disappeared, at least
temporarily. It may be that the waters of La Bourboule exert a permanent beneficial influence in allergic disorders. It may be that the results are good partly because the apparatus is so impressive; I agree that the equipment for nebulisation (vapours), pulverisation (aerosols), nasal douching, garwing, and bathing is so impressive that no patient could doubt is efficiency.l A noted paediatrician has been heard to remark that the best way of treating asthma is to provide a therapeutic orphanage ": it may be that this plays an important part in the success of La Bourboule, though it should be pointed out that many French children come for treatment with their mothers (who are often treated too!). But certainly the English children, who were sent with long lists of written maternal regulations about food, sleep, tablets, warm clothes, and bowels, appeared to derive great benefit from the freedom resulting from everyone ignoring these instructions. It may be that the success of La Bourboule comes also from its delightful situation, its mountain walks, and the increase of appetite that comes from leading a healthy life. I suspect that the improvement is also due in no small part to the energy, interest, and devotion shown by the organisers of International Help for Children. I feel sure that the tremendous personal interest they take in each child has a big, and probably lasting, effect. "
Whatever the cause of the success, and whatever our " opinion of spa waters, there is certainly no therapeutic 1.
Lancet, 1949, ii, 1187.
establishment " in Britain where we can send asthmatic children away from their families and give them intensive and purposive treatment in beautiful surroundings with mountain walks and with a large number of admirable people determined to help them. a patient who might benefit from a visit Bourboule can write to International Help for Children, 43, Parliament Street, London, S.W.!.
Anyone who has
to La
London, S.E.21.
ANN MULLINS.
CARCINOGENICITY OF IRON-DEXTRAN COMPLEX
SIR,-Respect must be paid to the views and experience of Dr. Duthie and his co-signatories, expressed in their letter of July 16. Meantime I have had the advantage of It is obvious and some correspondence with them. that the administration of a great many drugs accepted in common use is a calculated risk, when the hope or certainty of immediate benefit has to be weighed against the possibility of later toxic effects. But I have been specially impressed by various considerations they have raised in the particular case of ’Imferon ’: for example, that many patients correctly so treated have disease of the alimentary tract reducing their life expectancy to below a latent period within which any carcinogenic hazard is improbable; or, secondly, that no advantage is to be achieved in withholding imferon from patients with unquestionably refractory iron-deficiency ansemia, if they are left without effective treatment, or given therapy carrying an immediate and known hazard, as from intravenous iron or transfusions. Having said this, I am, however, quite certain that no-one is justified in asserting at the present moment, as the authors do, that the use of imferon in the clinical dosage recommended carries a negligible risk. From the nature of the case we cannot have a useful answer to this question under something of the order of 15-20 years. The statistics of the hazard (if indeed it exists in man) are quite unknown. We cannot therefore say it is ’
negligible. The letter also raises another question. If the results of experimental work with imferon are in practice to be disregarded as an indication towards policy in man, what evidence from experimental work would be acceptable as justifying either the prudent withdrawal of a given preparation, or at least a warning statement ? Although the results of animal experimentation are immensely valuable in this kind of problem, they can never be regarded as more than an approximate guide. Agreed that we cannot extrapolate with any certainty to man, it will also be agreed that had the results of animal experimentation with imferon been negative, they would certainly (and not unreasonably) have been used as indicative of the preparation’s harmlessness. On balance, I believe all the work on imferon originating from H. G. Richmond’s most interesting observation, and extended in other papers and correspondence, has been profitable. It appears that the preparation had been used in very many cases without adequate indication, or indeed almost indiscriminately; and a useful result may be considerably to reduce its administration to younger age-groups, and to patients capable of responding perfectly satisfactorily to other means. Chester Beatty Research Institute, London, S.W.3.
ALEXANDER HADDOW.
impressed with what I saw. I am certain that La Bourboule has got something ", though exactly what it has is hard to say. All the children who travel in these parties are recommended by, or at least have the approval of, their family doctor. Their doctors’ reports are kept by International Help for Children along with the reports of the children’s parents. Some months after the treatment a follow-up questionnaire is sent, which "
elicits almost 100% return. Many of the children suffer from intractable and disabling asthma, and often eczema too. Doctors treating them at home have often reached a therapeutic impasse and are waiting and " hoping for the children to grow out of it ". Meanwhile the children are missing many months of schooling every winter, often becoming increasingly deformed in both mind and bodyand more and more firmly tied to their mothers’ apron-strings. The following results are taken from the records for the past ten years: CONDITION OF ASTHMATIC CHILDREN AFTER VISIT
Most of the favourable reports are backed up by remarks such as " more confident ", " less nervous ", " only missed 4 days school last winter instead of the usual 4 months " or " (parent quoting child’s own request) Throw away the pills, Mummy; I’ve been to France and I’m cured now ". A visit to La Bourboule seems to break the vicious circle. The child is taken away from home, visits a new country, and receives concentrated treatment in an optimistic atmosphere. It is assumed that he will get better. He usually does. Such asthmatic attacks as did occur during the visit were sensibly managed and swiftly ended, usually without the use of drugs other than aminophylline (which is widely used by the French doctors). I was also fascinated to watch a dermatologist treating a stunted asthmatic child whose severe eczema covered most of his body. This doctor treated the child by means of the douche filiforme, a fine jet of hot spa water delivered at very high pressure with the aid of complicated manual movements, which he assured me acted as massage. After several days the eczema had virtually disappeared, at least
temporarily. It may be that the waters of La Bourboule exert a permanent beneficial influence in allergic disorders. It may be that the results are good partly because the apparatus is so impressive; I agree that the equipment for nebulisation (vapours), pulverisation (aerosols), nasal douching, garwing, and bathing is so impressive that no patient could doubt is efficiency.l A noted paediatrician has been heard to remark that the best way of treating asthma is to provide a therapeutic orphanage ": it may be that this plays an important part in the success of La Bourboule, though it should be pointed out that many French children come for treatment with their mothers (who are often treated too!). But certainly the English children, who were sent with long lists of written maternal regulations about food, sleep, tablets, warm clothes, and bowels, appeared to derive great benefit from the freedom resulting from everyone ignoring these instructions. It may be that the success of La Bourboule comes also from its delightful situation, its mountain walks, and the increase of appetite that comes from leading a healthy life. I suspect that the improvement is also due in no small part to the energy, interest, and devotion shown by the organisers of International Help for Children. I feel sure that the tremendous personal interest they take in each child has a big, and probably lasting, effect. "
Whatever the cause of the success, and whatever our " opinion of spa waters, there is certainly no therapeutic 1.
Lancet, 1949, ii, 1187.
establishment " in Britain where we can send asthmatic children away from their families and give them intensive and purposive treatment in beautiful surroundings with mountain walks and with a large number of admirable people determined to help them. a patient who might benefit from a visit Bourboule can write to International Help for Children, 43, Parliament Street, London, S.W.!.
Anyone who has
to La
London, S.E.21.
ANN MULLINS.
CARCINOGENICITY OF IRON-DEXTRAN COMPLEX
SIR,-Respect must be paid to the views and experience of Dr. Duthie and his co-signatories, expressed in their letter of July 16. Meantime I have had the advantage of It is obvious and some correspondence with them. that the administration of a great many drugs accepted in common use is a calculated risk, when the hope or certainty of immediate benefit has to be weighed against the possibility of later toxic effects. But I have been specially impressed by various considerations they have raised in the particular case of ’Imferon ’: for example, that many patients correctly so treated have disease of the alimentary tract reducing their life expectancy to below a latent period within which any carcinogenic hazard is improbable; or, secondly, that no advantage is to be achieved in withholding imferon from patients with unquestionably refractory iron-deficiency ansemia, if they are left without effective treatment, or given therapy carrying an immediate and known hazard, as from intravenous iron or transfusions. Having said this, I am, however, quite certain that no-one is justified in asserting at the present moment, as the authors do, that the use of imferon in the clinical dosage recommended carries a negligible risk. From the nature of the case we cannot have a useful answer to this question under something of the order of 15-20 years. The statistics of the hazard (if indeed it exists in man) are quite unknown. We cannot therefore say it is ’
negligible. The letter also raises another question. If the results of experimental work with imferon are in practice to be disregarded as an indication towards policy in man, what evidence from experimental work would be acceptable as justifying either the prudent withdrawal of a given preparation, or at least a warning statement ? Although the results of animal experimentation are immensely valuable in this kind of problem, they can never be regarded as more than an approximate guide. Agreed that we cannot extrapolate with any certainty to man, it will also be agreed that had the results of animal experimentation with imferon been negative, they would certainly (and not unreasonably) have been used as indicative of the preparation’s harmlessness. On balance, I believe all the work on imferon originating from H. G. Richmond’s most interesting observation, and extended in other papers and correspondence, has been profitable. It appears that the preparation had been used in very many cases without adequate indication, or indeed almost indiscriminately; and a useful result may be considerably to reduce its administration to younger age-groups, and to patients capable of responding perfectly satisfactorily to other means. Chester Beatty Research Institute, London, S.W.3.
ALEXANDER HADDOW.