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Epidemiology of non-communicable disease
BOOK REVIEWS
873
importance is being attached to the detection and removal of toxins present in plants used for food production. In 1966, the US National Research Council of the National Academy of Sciences published a wide-ranging survey of naturally-occurring toxins. In contrast the book under review provides a more detailed coverage of only the more important topics arising from the consideration of plants used for human food. Those selected include protease inhibitors, haemagglutinins, goitrogens, cyanogens, cycads, saponins, gossypol, lathyrogens, favism, allergens and a group of miscellaneous toxins which receive less attention (oestrogens, stimulants and depressants, hypoglycaemic agents, hepatotoxins, toxic amino acids, antivitamin factors, antienzymes, metal-binding constituents, flatus-producing factors and others including a carrot toxin). In dealing with the major groups of toxins, a series of specialists describes the distribution of the toxins in the plant kingdom, their distribution and physiological function within the plant itself, their physical, chemical and toxicological properties, their nutritional significance and finally methods for their detection and estimation and for their removal and detoxication. Bacterial toxins fell outside the scope of this book, but a rather surprising addition, in view of the stress on natural constituents throughout most of the text, is the account of the toxicological significance of various food additives, chemical contaminants and fungal toxins in processed foods. This book will serve as a useful work of reference despite its limited scope and is a worthy addition to the Food Science and Technology series.
Epidemiology of Non-Communicable Disease. Edited by E. D. Acheson. British Medical Bulletin. Vol. 27, no. 1. Medical Department: The British Council, London, 1971. pp. 94. £2. Epidemiological studies are playing an increasingly important role in the detection, control and prevention of disease and in the study of unwanted effects of drugs and other chemical agents. Of the 15 topics forming this issue of the British Medical Bulletin, four may be of particular interest to our readers. Paula J. Cook and D. P. Burkitt (the latter of Burkitt's lymphoma fame) present a fascinating survey of the geographical distribution patterns of ten different types of tumour in Africa. Plans are afoot to determine the aetiological significance of aflatoxin ingestion in primary liver cancer and of consumption of nitrosamine through the drinking of illicit spirits in oesophageal cancer. One success scored so far is the finding that the malaria vector plays an important role in the development of Burkitt's lymphoma. More successes would be well merited, and the need for studies of this kind is stressed elsewhere in this issue (p. 901). The article by M. D. Crawford and others on the association between cardiovascular mortality and the mineral content of drinking water in the U K poses some interesting questions, the most important of which is whether artificial softening of water supplies is detrimental to health, or alternatively whether artificial hardening would be beneficial. J. C. Wagner and his colleagues provide an up-to-date account of recent epidemiological studies of asbestos-related cancers in various countries and of measures taken to reduce the incidence of these lesions. Finally, R. Doll describes, with the aid of many examples, how population studies have been used to good effect in detecting toxic drug reactions and explains why the methods of investigation vary according to the prevailing circumstances. The value of these studies is shown particularly when the effects become manifest after an
874
BOOK REVIEWS
interval, as in the cases of the foetal malformations caused by thalidomide or of many toxic blood dyscrasias, but they are also valuable when the undesirable effect of the drug is non-specific or may be confused with a manifestation of the disease being treated, as in the recent upsurge of deaths among asthmatics.
Drugs: Development and Use. Edited by D. R. Laurence. British Medical Bulletin, Vol. 26, no. 3. Medical Department: The British Council, London, 1970. pp. 266. £2. Relatively recently, the British Medical Bulletin published an excellent collection of papers dealing with mechanisms of toxicity (Cited in F.C.T. 1970, 8, 415). This periodical's growing interest in toxicology is again in evidence, this time with the evaluation of drug safety as the main theme. Much of the information conveyed is also applicable to food additives and one of the 15 chapters is specifically devoted to food-additive problems. Most of the contributions fall into three main groups concerned respectively with the benefits of drugs, the safety testing of drugs prior to marketing and the monitoring of drugs for adverse effects after marketing. In order that the enormous benefits that drugs have brought should not be overlooked, the first three chapters illustrate how drugs have changed the patterns of infectious, non-infectious and mental disease. Five papers cover different aspects of experimental investigations of drug safety in animals and man. Two of them (by T. Hanley and his colleagues and by S. B. de C. Baker and D. G. Davey) overlap slightly in their discussion of the basic principles underlying drug toxicity studies, the types of effects to look for and the value of animal findings for predicting likely effects in man. A third, by C. T. Dollery and D. S. Davies, describes the conduct of initial drug studies in man. Another, by J. M. Robson, on testing for teratogenesis and effects on fertility, analyses differences in the official U K and US approaches, reviews two recent problems (LSD and 2,4,5-T) in this formidable field and explains why monitoring of drugs after use is necessary. Problems encountered in assessing the safety of food additives are appropriately left to R. F. Crampton, who draws attention to the different considerations required for drug and food-additive assessments and points out why judgements on the clearance of food additives are more problematical than those concerning drug clearances. The experimental issues leading to the recent banning of brominated vegetable oils and cyclamates serve to illustrate some of the toxicological problems on which difficult decisions must be taken and, in the case of cyclamates, some o f the non-toxicological factors that may influence such decisions. Although divorced from this group of papers on toxicological evaluation, a second chapter of direct interest to the food industry is one by G. C. Brander outlining the potential hazards to man of residues of various drugs and insecticides in animal tissues and of the emergence of resistant bacterial strains as a result of antibiotic usage in animals. Three papers are devoted to the monitoring of drugs for adverse reactions. One provides a general account of the issues involved and emphasizes the need for more sophisticated recording systems, especially for detecting carcinogenic effects of drugs administered for long periods. The other two deal specifically with the reported rise in mortality among young asthmatics and with thromboembolism in women taking oral contraceptives. To complete this well-balanced issue on drug development and use are three unrelated topics dealing with standards and specifications for drugs, the abuse of drugs by the public and by doctors and the role of the Committee on Safety of Drugs.
873
importance is being attached to the detection and removal of toxins present in plants used for food production. In 1966, the US National Research Council of the National Academy of Sciences published a wide-ranging survey of naturally-occurring toxins. In contrast the book under review provides a more detailed coverage of only the more important topics arising from the consideration of plants used for human food. Those selected include protease inhibitors, haemagglutinins, goitrogens, cyanogens, cycads, saponins, gossypol, lathyrogens, favism, allergens and a group of miscellaneous toxins which receive less attention (oestrogens, stimulants and depressants, hypoglycaemic agents, hepatotoxins, toxic amino acids, antivitamin factors, antienzymes, metal-binding constituents, flatus-producing factors and others including a carrot toxin). In dealing with the major groups of toxins, a series of specialists describes the distribution of the toxins in the plant kingdom, their distribution and physiological function within the plant itself, their physical, chemical and toxicological properties, their nutritional significance and finally methods for their detection and estimation and for their removal and detoxication. Bacterial toxins fell outside the scope of this book, but a rather surprising addition, in view of the stress on natural constituents throughout most of the text, is the account of the toxicological significance of various food additives, chemical contaminants and fungal toxins in processed foods. This book will serve as a useful work of reference despite its limited scope and is a worthy addition to the Food Science and Technology series.
Epidemiology of Non-Communicable Disease. Edited by E. D. Acheson. British Medical Bulletin. Vol. 27, no. 1. Medical Department: The British Council, London, 1971. pp. 94. £2. Epidemiological studies are playing an increasingly important role in the detection, control and prevention of disease and in the study of unwanted effects of drugs and other chemical agents. Of the 15 topics forming this issue of the British Medical Bulletin, four may be of particular interest to our readers. Paula J. Cook and D. P. Burkitt (the latter of Burkitt's lymphoma fame) present a fascinating survey of the geographical distribution patterns of ten different types of tumour in Africa. Plans are afoot to determine the aetiological significance of aflatoxin ingestion in primary liver cancer and of consumption of nitrosamine through the drinking of illicit spirits in oesophageal cancer. One success scored so far is the finding that the malaria vector plays an important role in the development of Burkitt's lymphoma. More successes would be well merited, and the need for studies of this kind is stressed elsewhere in this issue (p. 901). The article by M. D. Crawford and others on the association between cardiovascular mortality and the mineral content of drinking water in the U K poses some interesting questions, the most important of which is whether artificial softening of water supplies is detrimental to health, or alternatively whether artificial hardening would be beneficial. J. C. Wagner and his colleagues provide an up-to-date account of recent epidemiological studies of asbestos-related cancers in various countries and of measures taken to reduce the incidence of these lesions. Finally, R. Doll describes, with the aid of many examples, how population studies have been used to good effect in detecting toxic drug reactions and explains why the methods of investigation vary according to the prevailing circumstances. The value of these studies is shown particularly when the effects become manifest after an
874
BOOK REVIEWS
interval, as in the cases of the foetal malformations caused by thalidomide or of many toxic blood dyscrasias, but they are also valuable when the undesirable effect of the drug is non-specific or may be confused with a manifestation of the disease being treated, as in the recent upsurge of deaths among asthmatics.
Drugs: Development and Use. Edited by D. R. Laurence. British Medical Bulletin, Vol. 26, no. 3. Medical Department: The British Council, London, 1970. pp. 266. £2. Relatively recently, the British Medical Bulletin published an excellent collection of papers dealing with mechanisms of toxicity (Cited in F.C.T. 1970, 8, 415). This periodical's growing interest in toxicology is again in evidence, this time with the evaluation of drug safety as the main theme. Much of the information conveyed is also applicable to food additives and one of the 15 chapters is specifically devoted to food-additive problems. Most of the contributions fall into three main groups concerned respectively with the benefits of drugs, the safety testing of drugs prior to marketing and the monitoring of drugs for adverse effects after marketing. In order that the enormous benefits that drugs have brought should not be overlooked, the first three chapters illustrate how drugs have changed the patterns of infectious, non-infectious and mental disease. Five papers cover different aspects of experimental investigations of drug safety in animals and man. Two of them (by T. Hanley and his colleagues and by S. B. de C. Baker and D. G. Davey) overlap slightly in their discussion of the basic principles underlying drug toxicity studies, the types of effects to look for and the value of animal findings for predicting likely effects in man. A third, by C. T. Dollery and D. S. Davies, describes the conduct of initial drug studies in man. Another, by J. M. Robson, on testing for teratogenesis and effects on fertility, analyses differences in the official U K and US approaches, reviews two recent problems (LSD and 2,4,5-T) in this formidable field and explains why monitoring of drugs after use is necessary. Problems encountered in assessing the safety of food additives are appropriately left to R. F. Crampton, who draws attention to the different considerations required for drug and food-additive assessments and points out why judgements on the clearance of food additives are more problematical than those concerning drug clearances. The experimental issues leading to the recent banning of brominated vegetable oils and cyclamates serve to illustrate some of the toxicological problems on which difficult decisions must be taken and, in the case of cyclamates, some o f the non-toxicological factors that may influence such decisions. Although divorced from this group of papers on toxicological evaluation, a second chapter of direct interest to the food industry is one by G. C. Brander outlining the potential hazards to man of residues of various drugs and insecticides in animal tissues and of the emergence of resistant bacterial strains as a result of antibiotic usage in animals. Three papers are devoted to the monitoring of drugs for adverse reactions. One provides a general account of the issues involved and emphasizes the need for more sophisticated recording systems, especially for detecting carcinogenic effects of drugs administered for long periods. The other two deal specifically with the reported rise in mortality among young asthmatics and with thromboembolism in women taking oral contraceptives. To complete this well-balanced issue on drug development and use are three unrelated topics dealing with standards and specifications for drugs, the abuse of drugs by the public and by doctors and the role of the Committee on Safety of Drugs.