- Email: [email protected]
European centre for infectious disease
CORRESPONDENCE
European centre for infectious disease Sir—Your Oct 17 editorial1 and the letter by Johan Giesecke and Julius Weinberg (Oct 17, p 1308)2 discuss the European Centre for Infectious Diseases (ECID) project of which I am the coordinator. You clarify the debate between two opposite concepts—(1) internet and e-mail-operated networks, and (2) a centralised institution with a triple mission: advanced research, surveillance and control, and teaching/training. Is a wall structure indispensable? The US Centers for Disease Control and Prevention is not “indispensable”. It is impossible to show mathematically that a centralised institution is preferable to networks—it is a matter of vision. Your editorial suggests a strong misunderstanding of the very idea of ECID. The existing structures are useful to monitor the current infectious problems in EU countries. However, the ECID project also aims at integrating non-EU countries, including those in eastern Europe and the former USSR, and at establishing privileged links with developing countries. Indeed, apart from any humanitarian consideration, if we want to contain the infectious problem in western Europe, we have to do it in eastern Europe and in developing countries. Hoping that internet networks will face such challenges is just a websurfer’s fantasy. Research and control of infectious diseases in Europe are played by brilliant soloists of a cacophonic orchestra: internet networks will be unable to conduct the orchestra in harmony. Therefore, although more costly than networks, the ECID is probably a much more effective financial investment. Opposing networks and wall structure is actually artificial. Networks are indispensable for a better use of what already exists. However, working together in a wall structure only allows effective interaction between researchers, epidemiologists, and public-health professionals. Now, existing networks and collaborative centres are indispensable to relay the action of a centralised structure. This initiative was launched by biomedical researchers. However, it is risky to think that clinicians and health workers would dislike the ECID—a scientific and medical challenge, a strong political symbol of peaceful European sovereignty, and much more attractive and exciting than electronic networks. Anyway, I take up the gauntlet: I invite your readers to tell me and the other members of the ECID
THE LANCET • Vol 353 • January 23, 1999
steering committee (Marc Struelens, Brussels, representative of the European Society of Clinical Microbiology and Infectious Diseases, Jean-Claude Piffaretti, Lugano, Chairman of the Swiss Society of Microbiology, Santiago Mas Coma, Valencia, Vice-President of the European Society of Parasitologists) what they think of this project. If many European researchers, clinicians, and health workers do it, the European parliament and the national governments will consider it seriously. The preference of The Lancet for a shy “virtual CDC” is against the present return of a welcome European political voluntarism. Hence, rather than declaring prematurely that the ECID is a politically dead project, we hope that The Lancet will go beyond purely emotional controversy and allow an open and fair scientific debate. Michel Tibayrenc Centre d’Etudes sur le Polymorphisme des Micro-organismes (CEPM), Orstom, BP5045, 34032 Montpellier, France (e-mail: [email protected]) 1
Giesecke J, Weinberg J. A European centre for infectious diseases? Lancet 1998; 352: 1308.
Sir—Johan Giesecke and Julius Weinberg1 argue that there is no need to set up a European Centre for Infectious Disease. I disagree with their views and support the idea advanced by Michael Tibayrenc2 that there is a need for such a centre. The establishment of such a centre is essential because of the emergence of new infections and reemergence of older ones, even in the more developed nations. The other factor which should not be forgotten is the ease of travel in this jet-age era which increases the risk of spread of an infection from a remote part of the world to areas where it is unknown. Migration from disturbed or other areas also exposes the population in the European Union at risk of acquiring tropical diseases. The setting up of small centres in various countries may have the benefit of reducing costs, but may not be feasible in countries in Eastern Europe with limited resources. In addition, there has to be one major centre responsible for the overall supervision of the networked centres and for the training of physicians and technical staff. In addition, a good centre can also act as nodal point where personnel from developing countries can come and imbibe the latest technological advances, which can be used cost effectively for diagnosis and treatment of various tropical diseases, It is not
essential that a brand new centre has been started from scratch, but existing centres, such as the London School of Tropical Medicine and Hygiene, can be upgraded to fit the role since they have an expertise of over a century in this area. Another important point is the absence of such centres in the tropics. For example, India, where major tropical and infectious diseases abound, has only one School of Tropical Medicine in Calcutta. There is no other institute in India. The Calcutta School itself is ignored in government grants since health seems to be low priority. India needs regional centres to tackle infectious diseases with experts in various fields available who can nip any emerging or re-emerging epidemics in the budding stages. This sort of intervention would need grants from national and international bodies; the latter being more or less uninterested since it is an issue for developed countries. Developed countries and developing nations should both have centres for tropical infectious diseases since these may be one of the major health-care issues in the next century. Rakesh Sehgal Department of Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India-160012 1
2
Giesecke J, Weinberg J. A European centre for infectious diseases? Lancet 1998; 352: 1308. Tibayrenc M. European centres for disease control. Nature 1997; 389: 433–34.
Detention of potentially dangerous people Sir—I would like to draw attention to some practical issues in response to your 21 Nov editorial1 on the detention of potentially dangerous people. The usual mode of admission of people with an aggressive personality disorder is through the accident and emergency department where they present, usually in the middle of the night, complaining of depression with suicidal or homicidal feelings. The invariable use of alcohol and drugs further complicates the picture. The only place available to admit such patients for assessment is an ordinary psychiatric ward where, by morning they may have cheered up, but have a mass of complex social problems that they feel unable to return to without again feeling suicidal or homicidal. We try to sift reality from fiction, but soon they make their own rules, refusing to engage in the ward programme or actively disrupting it. Such people bring in drugs and alcohol for themselves or other patients. Some
329
European centre for infectious disease Sir—Your Oct 17 editorial1 and the letter by Johan Giesecke and Julius Weinberg (Oct 17, p 1308)2 discuss the European Centre for Infectious Diseases (ECID) project of which I am the coordinator. You clarify the debate between two opposite concepts—(1) internet and e-mail-operated networks, and (2) a centralised institution with a triple mission: advanced research, surveillance and control, and teaching/training. Is a wall structure indispensable? The US Centers for Disease Control and Prevention is not “indispensable”. It is impossible to show mathematically that a centralised institution is preferable to networks—it is a matter of vision. Your editorial suggests a strong misunderstanding of the very idea of ECID. The existing structures are useful to monitor the current infectious problems in EU countries. However, the ECID project also aims at integrating non-EU countries, including those in eastern Europe and the former USSR, and at establishing privileged links with developing countries. Indeed, apart from any humanitarian consideration, if we want to contain the infectious problem in western Europe, we have to do it in eastern Europe and in developing countries. Hoping that internet networks will face such challenges is just a websurfer’s fantasy. Research and control of infectious diseases in Europe are played by brilliant soloists of a cacophonic orchestra: internet networks will be unable to conduct the orchestra in harmony. Therefore, although more costly than networks, the ECID is probably a much more effective financial investment. Opposing networks and wall structure is actually artificial. Networks are indispensable for a better use of what already exists. However, working together in a wall structure only allows effective interaction between researchers, epidemiologists, and public-health professionals. Now, existing networks and collaborative centres are indispensable to relay the action of a centralised structure. This initiative was launched by biomedical researchers. However, it is risky to think that clinicians and health workers would dislike the ECID—a scientific and medical challenge, a strong political symbol of peaceful European sovereignty, and much more attractive and exciting than electronic networks. Anyway, I take up the gauntlet: I invite your readers to tell me and the other members of the ECID
THE LANCET • Vol 353 • January 23, 1999
steering committee (Marc Struelens, Brussels, representative of the European Society of Clinical Microbiology and Infectious Diseases, Jean-Claude Piffaretti, Lugano, Chairman of the Swiss Society of Microbiology, Santiago Mas Coma, Valencia, Vice-President of the European Society of Parasitologists) what they think of this project. If many European researchers, clinicians, and health workers do it, the European parliament and the national governments will consider it seriously. The preference of The Lancet for a shy “virtual CDC” is against the present return of a welcome European political voluntarism. Hence, rather than declaring prematurely that the ECID is a politically dead project, we hope that The Lancet will go beyond purely emotional controversy and allow an open and fair scientific debate. Michel Tibayrenc Centre d’Etudes sur le Polymorphisme des Micro-organismes (CEPM), Orstom, BP5045, 34032 Montpellier, France (e-mail: [email protected]) 1
Giesecke J, Weinberg J. A European centre for infectious diseases? Lancet 1998; 352: 1308.
Sir—Johan Giesecke and Julius Weinberg1 argue that there is no need to set up a European Centre for Infectious Disease. I disagree with their views and support the idea advanced by Michael Tibayrenc2 that there is a need for such a centre. The establishment of such a centre is essential because of the emergence of new infections and reemergence of older ones, even in the more developed nations. The other factor which should not be forgotten is the ease of travel in this jet-age era which increases the risk of spread of an infection from a remote part of the world to areas where it is unknown. Migration from disturbed or other areas also exposes the population in the European Union at risk of acquiring tropical diseases. The setting up of small centres in various countries may have the benefit of reducing costs, but may not be feasible in countries in Eastern Europe with limited resources. In addition, there has to be one major centre responsible for the overall supervision of the networked centres and for the training of physicians and technical staff. In addition, a good centre can also act as nodal point where personnel from developing countries can come and imbibe the latest technological advances, which can be used cost effectively for diagnosis and treatment of various tropical diseases, It is not
essential that a brand new centre has been started from scratch, but existing centres, such as the London School of Tropical Medicine and Hygiene, can be upgraded to fit the role since they have an expertise of over a century in this area. Another important point is the absence of such centres in the tropics. For example, India, where major tropical and infectious diseases abound, has only one School of Tropical Medicine in Calcutta. There is no other institute in India. The Calcutta School itself is ignored in government grants since health seems to be low priority. India needs regional centres to tackle infectious diseases with experts in various fields available who can nip any emerging or re-emerging epidemics in the budding stages. This sort of intervention would need grants from national and international bodies; the latter being more or less uninterested since it is an issue for developed countries. Developed countries and developing nations should both have centres for tropical infectious diseases since these may be one of the major health-care issues in the next century. Rakesh Sehgal Department of Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India-160012 1
2
Giesecke J, Weinberg J. A European centre for infectious diseases? Lancet 1998; 352: 1308. Tibayrenc M. European centres for disease control. Nature 1997; 389: 433–34.
Detention of potentially dangerous people Sir—I would like to draw attention to some practical issues in response to your 21 Nov editorial1 on the detention of potentially dangerous people. The usual mode of admission of people with an aggressive personality disorder is through the accident and emergency department where they present, usually in the middle of the night, complaining of depression with suicidal or homicidal feelings. The invariable use of alcohol and drugs further complicates the picture. The only place available to admit such patients for assessment is an ordinary psychiatric ward where, by morning they may have cheered up, but have a mass of complex social problems that they feel unable to return to without again feeling suicidal or homicidal. We try to sift reality from fiction, but soon they make their own rules, refusing to engage in the ward programme or actively disrupting it. Such people bring in drugs and alcohol for themselves or other patients. Some
329