- Email: [email protected]
DUPLICATE PUBLICATION
CORRESPONDENCE
Distribution of head and neck cancer In UK Sir—In radio an interview on Jan 2, 2001, Gordon McVie highlighted the shortage of research funding for socalled low profile cancers in the UK. The government announced in September, 2000, the availability of extra funds for the treatment of stomach, pancreas, and oesophageal cancer, as well as improvement of research funding. However, the gap in research funding between the higher profile cancers and equally devastating cancers with a lower profile remains worryingly large. Head and neck cancer has a huge impact on patients’ quality of life. Advances in surgical techniques have improved functional outcomes, but mortality has not improved for decades. Research into possible new and more effective therapies is, therefore, urgently required. Rawls refined the main idea of justice as fairness by proposing two fundamental principles. The first safeguards everybody’s basic liberty, and the second ensures that the society is organised in a way that offers maximum help to the disadvantaged. According to the second principle, society has an obligation to the most deprived sectors, such as people typically affected by head and neck cancer.1,2 We postulated that the major cancer funding bodies in the UK provide a disproportionately low amount of funding for head and neck cancer research compared with that for breast and colorectal cancer—two of the most commonly arising tumours in the country. We wrote to the Medical Research Council, Cancer Research Campaign, and Imperial Cancer Research Foundation to request data on the amounts of money contributed by each towards the funding of new basic science and clinical or translational projects started in 1995–97. We compare the numbers with the relative incidence rates of these three index cancers.3 The Imperial Cancer Research Foundation funded no head and neck projects in the index years. Data received from the Medical Research Council were very clear, but those from the Cancer Research Campaign were taken from the scientific yearbooks and was not so specific. Much funding was given to basic science; we have included only funds given specifically to our index cancers. We calculated the percentage of projects for each cancer at specific centres to obtain the total
1982
funding for each as a proportion of the total funds donated to that centre. The relative incidence for the index years for breast, colorectal, and head and neck cancers was 4·5, 4·6, and 1·0, respectively. By contrast, the corresponding amount of funding provided was 61%, 29%, and 1% for the Medical Research Council, and 12%, 4%, and 1% for the Cancer Research Campaign. Two possible explanations for this difference in funding could be the low medical and cultural status head and neck cancer holds in society, and the distinct lack of high-quality grant applications for head and neck oncology received by the major funding bodies. For colorectal cancer, funding is disproportionately low compared with that for breast cancer, despite a notably higher incidence than that for head and neck cancer and absence of stigma, such as that related to cigarette smoking. Colorectal cancer has also not, received the high publicity that breast cancer has until the past few months. It will be interesting to see the outcome of that publicity. We thank David King at the Medical Research Council and Joanne Reynolds at the Cancer Research Campaign for their assistance in compiling the data.
the funds to the commercial promoters and the prejudiced critics could be to risk the waste of money. For example, Ernst, who is a well known critic of CAM, has published a report on acupuncture.3 Healthy doctor volunteers undertook a randomised controlled trial of auricular acupuncture to find out whether stimulation of two areas on the ear (the vagus and the control area) lowers the heart rate. He and his colleague concluded that no evidence could support the concept that the body is represented on the ear. Acupuncture textbooks document clearly that acupuncture can treat tachycardia, but does not affect normal heart rates under normal circumstances, just as aspirin does not affect the normal body temperature. We find it ludicrous that 41 medical doctors were misled into such an ill-designed study. This example is typical of the wasting of CAM research funds and efforts. *Han Y Chen, Bo-Ying Ma, Alicia Grant Association of Traditional Chinese Medicine, PO Box 1136, Headington, Oxford OX3 8XP, UK 1 2
*Jullan Savage, Martin Birchall Department of Otorhinolaryngology, University of Bristol, Southmead Hospital, Bristol BS10 5NB, UK (e-mail: [email protected]) 1
2
3
Greenberg RS, Haber MJ, Clark WS, et al. The relation of socioeconomic status to oral and pharyngeal cancer. Epidemiology 1991; 2: 194–200. Campbell AN. Medicine, Health and justice: the problem of priorities. London: Churchill Livingstone, 1978: 76–88. Cancer Research Campaign. Incidence statistics. London: CRC, 1995.
Research funds for complementary medicine Sir—We disagree with E Ernst (March 10, p803)1 about his suggestion that funds for complementary and alternative medicine (CAM) should be distributed to the people who want to test and critically analyse complementary medicines rather than to those who want to prove and promote it. This message followed Prince Charles’ call for a UK£10 million research investment for research into CAM. The research funding awarded to CAM is insufficient.2 Therefore, we would prefer that the funding be given to neutral and independent research teams with an enthusiastic and creative attitude, involving qualified conventional-medicine clinical investigators and well trained CAM experts. To give
3
Ernst E. Complementary and alternative medicine. Lancet 2001; 357: 803. House of Lords, Select Committee on Science and Technology 6th report: complementary and alternative medicine. London: Stationery Office, 2000. White A, Ernst E. The effect of auricular acupuncture on the pulse rate: an exploratory randomised controlled trial. Acupunct Med 1999; 17: 86–88.
DUPLICATE PUBLICATION CD36 deficiency associated with insulin resistance—In this Research letter by K Miyaoka and colleagues (March 3, p 686), the patterns of oral glucose-tolerance tests in five patients with CD36 deficiency presented in the figure have been published before in Mol Med 2000; 37: 30–38 (ISSN 0918-6557, in Japanese).
DEPARTMENT OF ERROR Application of an immunodiagnostic method for improving preoperative diagnosis of nodular thyroid lesions—In this Article by Armando Bartolazzi and colleagues (May 26, p 1644), the first sentence of the Methods section of the Summary should begin: “Expression of galectin-3 and CD44v6 was tested on 1009 thyroid lesions comprising 783 tissue specimens and cytological cellblocks (retrospective analysis) and 226 fresh cytological samples. . .”. In the footnote to table 2, the first sentence should be: “This analysis excludes ‘follicular neoplasms of indeterminate malignant behaviour’ and medullary carcinomas”. The first coauthor in the Thyroid Cancer Study Group should be: “Rino Bellocco”. Practical implications for the interpretation of minimum plasma concentration/inhibitory concentration ratios—In this Viewpoint by J Montaner and colleagues (May 5, p 1438), the last row of the Saquinavir (IDV) column in the table should be “1200 mg thrice daily: 1339 SQV:RTV 1600:100 mg once daily: 7139”.
THE LANCET • Vol 357 • June 16, 2001
Distribution of head and neck cancer In UK Sir—In radio an interview on Jan 2, 2001, Gordon McVie highlighted the shortage of research funding for socalled low profile cancers in the UK. The government announced in September, 2000, the availability of extra funds for the treatment of stomach, pancreas, and oesophageal cancer, as well as improvement of research funding. However, the gap in research funding between the higher profile cancers and equally devastating cancers with a lower profile remains worryingly large. Head and neck cancer has a huge impact on patients’ quality of life. Advances in surgical techniques have improved functional outcomes, but mortality has not improved for decades. Research into possible new and more effective therapies is, therefore, urgently required. Rawls refined the main idea of justice as fairness by proposing two fundamental principles. The first safeguards everybody’s basic liberty, and the second ensures that the society is organised in a way that offers maximum help to the disadvantaged. According to the second principle, society has an obligation to the most deprived sectors, such as people typically affected by head and neck cancer.1,2 We postulated that the major cancer funding bodies in the UK provide a disproportionately low amount of funding for head and neck cancer research compared with that for breast and colorectal cancer—two of the most commonly arising tumours in the country. We wrote to the Medical Research Council, Cancer Research Campaign, and Imperial Cancer Research Foundation to request data on the amounts of money contributed by each towards the funding of new basic science and clinical or translational projects started in 1995–97. We compare the numbers with the relative incidence rates of these three index cancers.3 The Imperial Cancer Research Foundation funded no head and neck projects in the index years. Data received from the Medical Research Council were very clear, but those from the Cancer Research Campaign were taken from the scientific yearbooks and was not so specific. Much funding was given to basic science; we have included only funds given specifically to our index cancers. We calculated the percentage of projects for each cancer at specific centres to obtain the total
1982
funding for each as a proportion of the total funds donated to that centre. The relative incidence for the index years for breast, colorectal, and head and neck cancers was 4·5, 4·6, and 1·0, respectively. By contrast, the corresponding amount of funding provided was 61%, 29%, and 1% for the Medical Research Council, and 12%, 4%, and 1% for the Cancer Research Campaign. Two possible explanations for this difference in funding could be the low medical and cultural status head and neck cancer holds in society, and the distinct lack of high-quality grant applications for head and neck oncology received by the major funding bodies. For colorectal cancer, funding is disproportionately low compared with that for breast cancer, despite a notably higher incidence than that for head and neck cancer and absence of stigma, such as that related to cigarette smoking. Colorectal cancer has also not, received the high publicity that breast cancer has until the past few months. It will be interesting to see the outcome of that publicity. We thank David King at the Medical Research Council and Joanne Reynolds at the Cancer Research Campaign for their assistance in compiling the data.
the funds to the commercial promoters and the prejudiced critics could be to risk the waste of money. For example, Ernst, who is a well known critic of CAM, has published a report on acupuncture.3 Healthy doctor volunteers undertook a randomised controlled trial of auricular acupuncture to find out whether stimulation of two areas on the ear (the vagus and the control area) lowers the heart rate. He and his colleague concluded that no evidence could support the concept that the body is represented on the ear. Acupuncture textbooks document clearly that acupuncture can treat tachycardia, but does not affect normal heart rates under normal circumstances, just as aspirin does not affect the normal body temperature. We find it ludicrous that 41 medical doctors were misled into such an ill-designed study. This example is typical of the wasting of CAM research funds and efforts. *Han Y Chen, Bo-Ying Ma, Alicia Grant Association of Traditional Chinese Medicine, PO Box 1136, Headington, Oxford OX3 8XP, UK 1 2
*Jullan Savage, Martin Birchall Department of Otorhinolaryngology, University of Bristol, Southmead Hospital, Bristol BS10 5NB, UK (e-mail: [email protected]) 1
2
3
Greenberg RS, Haber MJ, Clark WS, et al. The relation of socioeconomic status to oral and pharyngeal cancer. Epidemiology 1991; 2: 194–200. Campbell AN. Medicine, Health and justice: the problem of priorities. London: Churchill Livingstone, 1978: 76–88. Cancer Research Campaign. Incidence statistics. London: CRC, 1995.
Research funds for complementary medicine Sir—We disagree with E Ernst (March 10, p803)1 about his suggestion that funds for complementary and alternative medicine (CAM) should be distributed to the people who want to test and critically analyse complementary medicines rather than to those who want to prove and promote it. This message followed Prince Charles’ call for a UK£10 million research investment for research into CAM. The research funding awarded to CAM is insufficient.2 Therefore, we would prefer that the funding be given to neutral and independent research teams with an enthusiastic and creative attitude, involving qualified conventional-medicine clinical investigators and well trained CAM experts. To give
3
Ernst E. Complementary and alternative medicine. Lancet 2001; 357: 803. House of Lords, Select Committee on Science and Technology 6th report: complementary and alternative medicine. London: Stationery Office, 2000. White A, Ernst E. The effect of auricular acupuncture on the pulse rate: an exploratory randomised controlled trial. Acupunct Med 1999; 17: 86–88.
DUPLICATE PUBLICATION CD36 deficiency associated with insulin resistance—In this Research letter by K Miyaoka and colleagues (March 3, p 686), the patterns of oral glucose-tolerance tests in five patients with CD36 deficiency presented in the figure have been published before in Mol Med 2000; 37: 30–38 (ISSN 0918-6557, in Japanese).
DEPARTMENT OF ERROR Application of an immunodiagnostic method for improving preoperative diagnosis of nodular thyroid lesions—In this Article by Armando Bartolazzi and colleagues (May 26, p 1644), the first sentence of the Methods section of the Summary should begin: “Expression of galectin-3 and CD44v6 was tested on 1009 thyroid lesions comprising 783 tissue specimens and cytological cellblocks (retrospective analysis) and 226 fresh cytological samples. . .”. In the footnote to table 2, the first sentence should be: “This analysis excludes ‘follicular neoplasms of indeterminate malignant behaviour’ and medullary carcinomas”. The first coauthor in the Thyroid Cancer Study Group should be: “Rino Bellocco”. Practical implications for the interpretation of minimum plasma concentration/inhibitory concentration ratios—In this Viewpoint by J Montaner and colleagues (May 5, p 1438), the last row of the Saquinavir (IDV) column in the table should be “1200 mg thrice daily: 1339 SQV:RTV 1600:100 mg once daily: 7139”.
THE LANCET • Vol 357 • June 16, 2001