- Email: [email protected]
Childhood deaths in England and Wales
1437
Pressor for action
Irresponsible, profligate experimentalists. Hidebound, catchpenny conservatives. War has broken out-and if blood-pressure pundits themselves cannot agree on the most appropriate approach to first-line therapy, small wonder that general practitioners are confused. But even where there is general agreement among the specialists, does the message get through to the people who treat most hypertensive patients? Dismal figures for cardiovascular mortality and morbidity in the UK indicate that attempts at prevention are far from successful. A recent telephone survey of 300 general practitioners who agreed to be interviewed showed that 29% would screen for hypertension only those people with other risk factors or with symptoms, 92% would recommend hypertensive patients to stop or to reduce smoking (so, presumably, 8% would not), and only just over half would suggest weight loss or reduced alcohol consumption. 48 of the 300 would consider only treatment if the diastolic blood pressure consistently exceeded 105 mm Hg, and 2 would hold out for 130 mm Hg. Perhaps disturbing findings such as these will persuade adherents of the rival camps that to publicise the points on which they do agree might be more beneficial for patients than to emphasise the seemingly irreconcilable differences that remain-albeit much less fun.
Pesticides in the third world In the industrialised world concern about the health effects of focuses on the risks of low-level contamination of food and the environment. In developing countries, however, the major threat from pesticides is not from long-term exposure but from acute poisoning. A recent estimate by the World Health Organisation (WHO) puts the annual number of severe acute poisonings at 3 million (with 220 000 deaths), but Jeyaratnam, extrapolating from a survey of self-reported minor poisoning in four Asian countries, calculates that each year 25 million agricultural workers in the third world have an episode of pesticide poisoning.1 The bulk of these episodes do not get recorded, some because they appear minor and tend to be self-limiting but many because agricultural areas tend to be remote from health care facilities. The scale of pesticide poisoning as a public-health problem is revealed by a study in-Sri Lanka, where, in 1982, in a population of 12 million, there were 1000 deaths from acute pesticide poisoning-more than twice as many as the total number of deaths from malaria, poliomyelitis, whooping cough, diphtheria, and
pesticides
tetanus.
Easy access to pesticides has allowed these highly toxic substances become a major cause of suicide in the third world-Jeyaratnam estimates that self-poisoning accounts for two-thirds of acute episodes, the herbicide paraquat being extensively used for this purpose. In Malaysia, 73% of paraquat poisonings are suicides, compared with 14% due to accidents and 1% to occupational
to
developing countries to reap the maximum benefit from pesticides without the devastating health costs. 1.
Jeyaratnam J. Acute pesticide poisoning: a major global health problem. Wld Hlth Statist Quart 1990; 43: 139-44.
The UK
pharmaceutical industry and Europe
Erosion of the effective patent life of new drugs by long periods spent on development and testing recently led the USA and Japan to extend their patent protection times for drugs by up to 5 years. In both countries new formulae now give pharmaceutical products an effective protection period of 14 years from approval for marketing. The European Commission has followed suit with a proposal that provides for 16 years’ effective protection. The British Government, however, took what Kenneth Clarke, former Secretary of State for Health, described as an "agnostic" view of the proposal. While recognising the needs of the pharmaceutical industry, the Government was concerned that extension of the protection period could, by hindering competition from generic drugs, undermine efforts to encourage general practitioners to
prescribe more economically. In a report prepared for the Association of the British Pharmaceutical Industry,l management consultants Touche Ross argue that the British Government’s approval for the EC proposal is essential if the UK is to maintain an internationally competitive, research-based industry. The British pharmaceutical industry, which discovered three of the world’s five best-selling medicines, earns almost 1 billion a year in exports. But Touche Ross conclude that the UK will lose its standing as a centre of pharmaceutical research and development if it fails to accept the EC proposal, especially since France and Italy are likely to improve their patent protection regardless of the Community’s decision. In a report from the King’s Fund Institute and York University’s Centre for Health Economics,2 Taylor and Maynard argue that, in the UK and in Europe as a whole, it is in the public interest to ensure that the "positive contributions" of a "dynamic, cost-effective and innovative" pharmaceutical sector are retained. However, to dispel suspicions that decisions about such matters as the proposed extension of patent
protection
may be
subject
to
"hidden
influences", they plead for open, honest, and informed public debate about the options facing the British and European pharmaceutical industries. This sector of industry the authors regard as too important to be left to "private interactions between commercial interests and political decision takers". Patent extension, they suggest, needs to be balanced by pan-European regulations covering drug promotion and measures to ensure full competition between non-patented products. Taylor and Maynard also warn that evidence of benefit to patients does not necessarily justify supranormal profit-taking by pharmaceutical companiesthe vigorous pursuit of cost-benefit analysis to justify medicine prices is a form of "quack" economics they deplore.
exposure.
Clearly there is an urgent need to collect accurate data on acute pesticide poisoning in the third world,but even official figures show wide discrepancies. In Thailand, for instance, an epidemiological surveillance report records 2094 cases for 1985, with no deaths, whereas the National Environmental Board records 4046 cases, with 289 deaths. Misdiagnosis and incomplete compilation of data are two factors that contribute to such inaccuracies. There are some obvious ways to lessen the harm caused by pesticides, reduction of suicides by restricting access being one conspicuous example. But little progress has been made-Sri Lanka, for example, has no fewer pesticide deaths now than in 1982. So what is to be done? The agrochemical industry, Jeyaratnam argues, should not be singled out for blame, although it could contribute substantially to the control of poisoning by supporting research into developing protective clothing suitable for tropical climates and by providing safe pesticide containers. National governments (by providing health education and by enforcing pesticide legislation) and international agencies such as WHO and the International Labour Organisation (the latter by emphasising training in the safe use of pesticides) also have a vital role in enabling
Piecing together a healthy future: an examination of the implications for the UK of the proposal to extend the patent term for medicines in the European Community. By Touche Ross Management Consultants for the ABPI. London, 1990. 2. Taylor D, Maynard A. Medicines, the NHS and Europe. London and York: King’s Fund Institute and Centre for Health Economics. 1990. Available (£5.95 plus 60p postage) from Bailey Distribution Ltd, Dept D/KFP, Warner House, Folkestone, 1.
Kent CT19 6PH.
Childhood deaths in England and Wales Publication of the 1986 and 1987 childhood mortality data for England and Wales was delayed because the new stillbirth and neonatal death certificates introduced on Jan 1, 1986, meant that table specifications and computer programming had to be extensively revised. The new death certificates allow for entries for both maternal and fetal conditions that are thought to contribute to the death (but equal weighting is given to fetal and maternal factors). The 1986 and 1987 data have now been published in a combined volume.The commonest causes of neonatal deaths were congenital anomalies (34%), prematurity (26%), and respiratory disorders (26%). Almost half the postneonatal deaths were attributed to
1438
sudden infant death. In the postneonatal period, injury and poisoning was the major cause of death, especially for males (44-1 % male deaths and 28-6% female deaths), with motor vehicle traffic accidents being the commonest factor and drowning being another important one. The few deaths due to injury and poisoning in the postneonatal period were caused mainly by foreign bodies. 1.
Office of Population Censuses and Surveys. Mortality statistics: childhood 1986, 1987, England and Wales. London: HM Stationery Office. 1990. Pp 173. £12. ISBN 0-116913258.
Tea-tree oil and
acne
emission of "greenhouse" gases is clearly misguided-these are often the nations least able to deal with environmental change. A contribution to the debate from a more radical environmental standpoint (eg, Greenpeace) would have been valuable.
WHO Diarrhoeal and Acute Disease Control Division
Respiratory
Dr James Tulloch has been appointed director of the World Health Organisation’s newly created Division of Diarrhoeal and Acute Respiratory Disease Control (CDR). Dr Tulloch has been associated with WHO since 1976, first with its smallpox eradication programme and, since 1980, with the diarrhoeal disease control programme.
It is common practice to begin topical treatment for acne vulgaris with benzoyl peroxide: a peeling agent that has antibacterial (against Propionibacterium acnes) and anti-inflammatory properties. However, a group of Australian dermatologists have now shown that the essential oil extracted from Melaleuca alternifolia, more usually known as tea-tree oil and once given empirically for a wide variety of skin complaints, may have a beneficial effect in patients with acne.! Tea-tree oil consists largely of plant terpenes that have a proven antimicrobial action. 124 patients with mild to moderate acne entered a single-blind, randomised study to test the efficacy and safety of a 5% gel of tea-tree oil compared with 5% benzoyl peroxide lotion. Subject groups were similar for age, sex, and severity of acne. The tea-tree oil group had slightly more severe facial erythema. Both treatments produced a significant improvement in mean number of both non-inflamed and inflamed lesions after 3 months of daily application-only with non-inflamed lesions was benzoyl peroxide found to be more effective. Fewer patients reported unwanted effects (dryness, pruritus, stinging, burning, and redness of skin) with tea-tree oil (44% vs 79%). The clinical value of this traditional remedy may make it a valuable alternative for those who do not wish to subject themselves to the unpleasant side-effects of orthodox treatment. 1. Bassett
IB, Pannowitz DL, Barnetson R StC. A comparative study of tea-tree oil benzoyl peroxide m the treatment of acne. Med JAust 1990; 153: 455-58.
versus
In
England Now
The urchin who knocked on the door at eleven at night bore a stark message. "Come quick. Mum and dad have had a stroke." Putting on coat and gloves, I let him lead me to the house while attempting to access my knowledge of contagious cerebrovascular disease. The
dimly lit room held ten or so onlookers. Centre stage, at opposite ends of the kitchen table, sat wife and husband staring at each other. Apparently she had been struck speechless in the middle of a conjugal row, and the same had befallen the husband a few seconds later. That was the history. The wife was pointing to her mouth. Was I, I fleetingly wondered, going to see my first scold’s bridle? But I was keyed into the wrong memory bank: case-to-case spread in trauma and orthopaedics is much better known, and the diagnosis soon became plain. I reduced the wife’s dislocated jaw, then put my gloves on before doing the same for the husband. As I left, the argument, despite my advice, was resumed with heat, and the spectators stayed on to cheer.
International
Diary 1990
Health, the environment, and economic development With the intention of developing ideas that can be fed into the United Nations (UN) Conference on Environment and
Development in Brazil in June, 1992, a symposium was held by the International Science Policy Foundation (I SPF) in London on Nov 20. Although full of fine words and good intentions, the symposium was, with honourable exceptions, short on specifics and new ideas. Sir Crispin Tickell, one of a new breed of "green" diplomats and former British permanent representative at the UN, provided an excellent historical perspective on the environmental crisis we now all face. A key theme of his talk, and of others, was the effect that increasing human populations is having on health and the environment. Our ever-growing demand for energy and resources has led to global environmental changes, but the very fact that these changes are slow, in human terms, explains our tardiness in dealing with them. Tickell believed that population growth leads not only to overcrowding and famine but also to changes in ecosystems that may encourage the emergence of new pathogens and the migration of species, possibly including pathogens. Several speakers noted that better family planning, better education, and the creation of sustainable wealth were all crucial to reducing the rate of population increase. Dr Maurice Goldsmith, director of the ISPF, suggested that the true measures of development were a healthy life and access education and resources. The details of how these laudable aims are to be achieved were not discussed. The need for cooperation between nations was emphasised. Although the industrialised countries should take the lead in solving environmental problems, because they created most of the mess, it is in the interest of all nations to cooperate. The belief in certain developing countries that they cannot afford to limit, for example, to
An international symposium entitled Liposomes in Drug Delivery: 21 Years On will be held in London on Dec 12-15: Prof A. T. Florence, School of Pharmacy, University of London, 29/39 Brunswick Square, London WC1N lAX (tel 071-837 7651/8, fax 071-278 0622).
A symposium entitled Meningitis-Future Challenges will take place in London on Friday, Dec 14: Honorary Secretary, Royal Society of Tropical Medicine and Hygiene, Manson House, 26 Portland Place, London WIN
4EY, UK (071-580 2127). 1991 A conference on Advances in the Treatment of Myocardial Infarction is to be held in London on Jan 24-25: Catherine Barrett, IBC Technical Services, Bath House, 56 Holborn Viaduct, London EC1A 2EX, UK
(071-236 4080). A course entitled Clinical Aspects and Modern Management of Lung Disease will be held in London on Feb 12-13: Georgina Mason, IBC Technical Services, Bath House, 56 Holborn Viaduct, London EC1A 2EX, UK (071-236 4080).
An international symposium on Obstetrics and Gynaecology will be held in Istanbul, on June 3-6: Prof Necati Tolun, Department of Obstetrics and Gynaecology, Istanbul University, Cerrahpasa Medical Faculty, PO Box 12, Cerrahpasa, Istanbul 34301, Turkey (1-586 1514).
5th international conference entitled Laboratory Information-Your Business will take place in Surrey, UK, on June 4-6: Conference Registrar, Fifth International LIMS Conference, PO Box 341, High Wycombe, Buckinghamshire HP12QG. 5th world conference of Biological Psychiatry will be held in Florence, Italy, on June 9-14: Prof Giorgio Racagni, Scientific Sercretariat, Biological Psychiatry ’91, Center of Neuropharmacology, Institute of Pharmacological Sciences, Via Balzaretti 9, 20133 Milano, Italy (39-2-29404672).
Pressor for action
Irresponsible, profligate experimentalists. Hidebound, catchpenny conservatives. War has broken out-and if blood-pressure pundits themselves cannot agree on the most appropriate approach to first-line therapy, small wonder that general practitioners are confused. But even where there is general agreement among the specialists, does the message get through to the people who treat most hypertensive patients? Dismal figures for cardiovascular mortality and morbidity in the UK indicate that attempts at prevention are far from successful. A recent telephone survey of 300 general practitioners who agreed to be interviewed showed that 29% would screen for hypertension only those people with other risk factors or with symptoms, 92% would recommend hypertensive patients to stop or to reduce smoking (so, presumably, 8% would not), and only just over half would suggest weight loss or reduced alcohol consumption. 48 of the 300 would consider only treatment if the diastolic blood pressure consistently exceeded 105 mm Hg, and 2 would hold out for 130 mm Hg. Perhaps disturbing findings such as these will persuade adherents of the rival camps that to publicise the points on which they do agree might be more beneficial for patients than to emphasise the seemingly irreconcilable differences that remain-albeit much less fun.
Pesticides in the third world In the industrialised world concern about the health effects of focuses on the risks of low-level contamination of food and the environment. In developing countries, however, the major threat from pesticides is not from long-term exposure but from acute poisoning. A recent estimate by the World Health Organisation (WHO) puts the annual number of severe acute poisonings at 3 million (with 220 000 deaths), but Jeyaratnam, extrapolating from a survey of self-reported minor poisoning in four Asian countries, calculates that each year 25 million agricultural workers in the third world have an episode of pesticide poisoning.1 The bulk of these episodes do not get recorded, some because they appear minor and tend to be self-limiting but many because agricultural areas tend to be remote from health care facilities. The scale of pesticide poisoning as a public-health problem is revealed by a study in-Sri Lanka, where, in 1982, in a population of 12 million, there were 1000 deaths from acute pesticide poisoning-more than twice as many as the total number of deaths from malaria, poliomyelitis, whooping cough, diphtheria, and
pesticides
tetanus.
Easy access to pesticides has allowed these highly toxic substances become a major cause of suicide in the third world-Jeyaratnam estimates that self-poisoning accounts for two-thirds of acute episodes, the herbicide paraquat being extensively used for this purpose. In Malaysia, 73% of paraquat poisonings are suicides, compared with 14% due to accidents and 1% to occupational
to
developing countries to reap the maximum benefit from pesticides without the devastating health costs. 1.
Jeyaratnam J. Acute pesticide poisoning: a major global health problem. Wld Hlth Statist Quart 1990; 43: 139-44.
The UK
pharmaceutical industry and Europe
Erosion of the effective patent life of new drugs by long periods spent on development and testing recently led the USA and Japan to extend their patent protection times for drugs by up to 5 years. In both countries new formulae now give pharmaceutical products an effective protection period of 14 years from approval for marketing. The European Commission has followed suit with a proposal that provides for 16 years’ effective protection. The British Government, however, took what Kenneth Clarke, former Secretary of State for Health, described as an "agnostic" view of the proposal. While recognising the needs of the pharmaceutical industry, the Government was concerned that extension of the protection period could, by hindering competition from generic drugs, undermine efforts to encourage general practitioners to
prescribe more economically. In a report prepared for the Association of the British Pharmaceutical Industry,l management consultants Touche Ross argue that the British Government’s approval for the EC proposal is essential if the UK is to maintain an internationally competitive, research-based industry. The British pharmaceutical industry, which discovered three of the world’s five best-selling medicines, earns almost 1 billion a year in exports. But Touche Ross conclude that the UK will lose its standing as a centre of pharmaceutical research and development if it fails to accept the EC proposal, especially since France and Italy are likely to improve their patent protection regardless of the Community’s decision. In a report from the King’s Fund Institute and York University’s Centre for Health Economics,2 Taylor and Maynard argue that, in the UK and in Europe as a whole, it is in the public interest to ensure that the "positive contributions" of a "dynamic, cost-effective and innovative" pharmaceutical sector are retained. However, to dispel suspicions that decisions about such matters as the proposed extension of patent
protection
may be
subject
to
"hidden
influences", they plead for open, honest, and informed public debate about the options facing the British and European pharmaceutical industries. This sector of industry the authors regard as too important to be left to "private interactions between commercial interests and political decision takers". Patent extension, they suggest, needs to be balanced by pan-European regulations covering drug promotion and measures to ensure full competition between non-patented products. Taylor and Maynard also warn that evidence of benefit to patients does not necessarily justify supranormal profit-taking by pharmaceutical companiesthe vigorous pursuit of cost-benefit analysis to justify medicine prices is a form of "quack" economics they deplore.
exposure.
Clearly there is an urgent need to collect accurate data on acute pesticide poisoning in the third world,but even official figures show wide discrepancies. In Thailand, for instance, an epidemiological surveillance report records 2094 cases for 1985, with no deaths, whereas the National Environmental Board records 4046 cases, with 289 deaths. Misdiagnosis and incomplete compilation of data are two factors that contribute to such inaccuracies. There are some obvious ways to lessen the harm caused by pesticides, reduction of suicides by restricting access being one conspicuous example. But little progress has been made-Sri Lanka, for example, has no fewer pesticide deaths now than in 1982. So what is to be done? The agrochemical industry, Jeyaratnam argues, should not be singled out for blame, although it could contribute substantially to the control of poisoning by supporting research into developing protective clothing suitable for tropical climates and by providing safe pesticide containers. National governments (by providing health education and by enforcing pesticide legislation) and international agencies such as WHO and the International Labour Organisation (the latter by emphasising training in the safe use of pesticides) also have a vital role in enabling
Piecing together a healthy future: an examination of the implications for the UK of the proposal to extend the patent term for medicines in the European Community. By Touche Ross Management Consultants for the ABPI. London, 1990. 2. Taylor D, Maynard A. Medicines, the NHS and Europe. London and York: King’s Fund Institute and Centre for Health Economics. 1990. Available (£5.95 plus 60p postage) from Bailey Distribution Ltd, Dept D/KFP, Warner House, Folkestone, 1.
Kent CT19 6PH.
Childhood deaths in England and Wales Publication of the 1986 and 1987 childhood mortality data for England and Wales was delayed because the new stillbirth and neonatal death certificates introduced on Jan 1, 1986, meant that table specifications and computer programming had to be extensively revised. The new death certificates allow for entries for both maternal and fetal conditions that are thought to contribute to the death (but equal weighting is given to fetal and maternal factors). The 1986 and 1987 data have now been published in a combined volume.The commonest causes of neonatal deaths were congenital anomalies (34%), prematurity (26%), and respiratory disorders (26%). Almost half the postneonatal deaths were attributed to
1438
sudden infant death. In the postneonatal period, injury and poisoning was the major cause of death, especially for males (44-1 % male deaths and 28-6% female deaths), with motor vehicle traffic accidents being the commonest factor and drowning being another important one. The few deaths due to injury and poisoning in the postneonatal period were caused mainly by foreign bodies. 1.
Office of Population Censuses and Surveys. Mortality statistics: childhood 1986, 1987, England and Wales. London: HM Stationery Office. 1990. Pp 173. £12. ISBN 0-116913258.
Tea-tree oil and
acne
emission of "greenhouse" gases is clearly misguided-these are often the nations least able to deal with environmental change. A contribution to the debate from a more radical environmental standpoint (eg, Greenpeace) would have been valuable.
WHO Diarrhoeal and Acute Disease Control Division
Respiratory
Dr James Tulloch has been appointed director of the World Health Organisation’s newly created Division of Diarrhoeal and Acute Respiratory Disease Control (CDR). Dr Tulloch has been associated with WHO since 1976, first with its smallpox eradication programme and, since 1980, with the diarrhoeal disease control programme.
It is common practice to begin topical treatment for acne vulgaris with benzoyl peroxide: a peeling agent that has antibacterial (against Propionibacterium acnes) and anti-inflammatory properties. However, a group of Australian dermatologists have now shown that the essential oil extracted from Melaleuca alternifolia, more usually known as tea-tree oil and once given empirically for a wide variety of skin complaints, may have a beneficial effect in patients with acne.! Tea-tree oil consists largely of plant terpenes that have a proven antimicrobial action. 124 patients with mild to moderate acne entered a single-blind, randomised study to test the efficacy and safety of a 5% gel of tea-tree oil compared with 5% benzoyl peroxide lotion. Subject groups were similar for age, sex, and severity of acne. The tea-tree oil group had slightly more severe facial erythema. Both treatments produced a significant improvement in mean number of both non-inflamed and inflamed lesions after 3 months of daily application-only with non-inflamed lesions was benzoyl peroxide found to be more effective. Fewer patients reported unwanted effects (dryness, pruritus, stinging, burning, and redness of skin) with tea-tree oil (44% vs 79%). The clinical value of this traditional remedy may make it a valuable alternative for those who do not wish to subject themselves to the unpleasant side-effects of orthodox treatment. 1. Bassett
IB, Pannowitz DL, Barnetson R StC. A comparative study of tea-tree oil benzoyl peroxide m the treatment of acne. Med JAust 1990; 153: 455-58.
versus
In
England Now
The urchin who knocked on the door at eleven at night bore a stark message. "Come quick. Mum and dad have had a stroke." Putting on coat and gloves, I let him lead me to the house while attempting to access my knowledge of contagious cerebrovascular disease. The
dimly lit room held ten or so onlookers. Centre stage, at opposite ends of the kitchen table, sat wife and husband staring at each other. Apparently she had been struck speechless in the middle of a conjugal row, and the same had befallen the husband a few seconds later. That was the history. The wife was pointing to her mouth. Was I, I fleetingly wondered, going to see my first scold’s bridle? But I was keyed into the wrong memory bank: case-to-case spread in trauma and orthopaedics is much better known, and the diagnosis soon became plain. I reduced the wife’s dislocated jaw, then put my gloves on before doing the same for the husband. As I left, the argument, despite my advice, was resumed with heat, and the spectators stayed on to cheer.
International
Diary 1990
Health, the environment, and economic development With the intention of developing ideas that can be fed into the United Nations (UN) Conference on Environment and
Development in Brazil in June, 1992, a symposium was held by the International Science Policy Foundation (I SPF) in London on Nov 20. Although full of fine words and good intentions, the symposium was, with honourable exceptions, short on specifics and new ideas. Sir Crispin Tickell, one of a new breed of "green" diplomats and former British permanent representative at the UN, provided an excellent historical perspective on the environmental crisis we now all face. A key theme of his talk, and of others, was the effect that increasing human populations is having on health and the environment. Our ever-growing demand for energy and resources has led to global environmental changes, but the very fact that these changes are slow, in human terms, explains our tardiness in dealing with them. Tickell believed that population growth leads not only to overcrowding and famine but also to changes in ecosystems that may encourage the emergence of new pathogens and the migration of species, possibly including pathogens. Several speakers noted that better family planning, better education, and the creation of sustainable wealth were all crucial to reducing the rate of population increase. Dr Maurice Goldsmith, director of the ISPF, suggested that the true measures of development were a healthy life and access education and resources. The details of how these laudable aims are to be achieved were not discussed. The need for cooperation between nations was emphasised. Although the industrialised countries should take the lead in solving environmental problems, because they created most of the mess, it is in the interest of all nations to cooperate. The belief in certain developing countries that they cannot afford to limit, for example, to
An international symposium entitled Liposomes in Drug Delivery: 21 Years On will be held in London on Dec 12-15: Prof A. T. Florence, School of Pharmacy, University of London, 29/39 Brunswick Square, London WC1N lAX (tel 071-837 7651/8, fax 071-278 0622).
A symposium entitled Meningitis-Future Challenges will take place in London on Friday, Dec 14: Honorary Secretary, Royal Society of Tropical Medicine and Hygiene, Manson House, 26 Portland Place, London WIN
4EY, UK (071-580 2127). 1991 A conference on Advances in the Treatment of Myocardial Infarction is to be held in London on Jan 24-25: Catherine Barrett, IBC Technical Services, Bath House, 56 Holborn Viaduct, London EC1A 2EX, UK
(071-236 4080). A course entitled Clinical Aspects and Modern Management of Lung Disease will be held in London on Feb 12-13: Georgina Mason, IBC Technical Services, Bath House, 56 Holborn Viaduct, London EC1A 2EX, UK (071-236 4080).
An international symposium on Obstetrics and Gynaecology will be held in Istanbul, on June 3-6: Prof Necati Tolun, Department of Obstetrics and Gynaecology, Istanbul University, Cerrahpasa Medical Faculty, PO Box 12, Cerrahpasa, Istanbul 34301, Turkey (1-586 1514).
5th international conference entitled Laboratory Information-Your Business will take place in Surrey, UK, on June 4-6: Conference Registrar, Fifth International LIMS Conference, PO Box 341, High Wycombe, Buckinghamshire HP12QG. 5th world conference of Biological Psychiatry will be held in Florence, Italy, on June 9-14: Prof Giorgio Racagni, Scientific Sercretariat, Biological Psychiatry ’91, Center of Neuropharmacology, Institute of Pharmacological Sciences, Via Balzaretti 9, 20133 Milano, Italy (39-2-29404672).