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FAMILY PLANNING IN THE THIRD WORLD
344
few of the children seem disturbed. Drug-taking has dropped in troubled areas; anxiety symptoms are rare, and they tend to affect children whose parents have had the same symptoms either previously or concurrently. It would be naive, Lyons observes, to expect that teenagers and younger children, used by militant organisations during the troubles, will be content to satisfy their present and future needs amid play-centres, football pitches, and sports fields. The recurrent theme in this issue of The Northern Teacher is the problem of exploiting, in a productive and constructive fashion, the immense emotional forces which have been liberated among the young people of the province by the current disturbances. Thought is also given to how the divisions in the community might be healed. Fraser has argued that " total integration of children from primary-school-age upwards would be the most potent single factor in breaking down community barriers and in restoring long-term peace". 35 Reading the journal, with its almost unbearably moving accounts from pupils of the murder of fathers and the burning of homes, one is struck by the prediction that, when peace comes, the incidence of mental illness, delinquency, and minor crime will rise again, and that not merely parents and politicians but also educationists, probation officers, social workers, and psychiatrists will be required to help heal the wounds.
FAMILY PLANNING IN THE THIRD WORLD
THOSE who supervised the control of infectious disease in developing countries have been less energetic in tackling one of its consequences-a massive increase in population. The price of this delay is already being seen in a standstill or even relapse in per-caput economic growth and in massive underemployment and malnutrition; and indigenous support for the economies of the third world is falling on a working population which constitutes an increasingly small proportion of the total. The interdependence of health, economic growth, population, education, and resources was well illustrated in a lecture given by Dr F. T. Sai at the London School of Hygiene and Tropical Medicine on Feb. 21. Dr Sai argued that those setting national targets must take all these factors into account in their plans-a policy which, had it been adopted by the developed world a generation ago, might have prevented a lot of the hardship being suffered today. The developed countries put restraints on some family-planning methods, and Dr Sai believes that such policies have made the wide availability of certain contraceptive methods in developing countries a difficult objective. He claimed that Britain and the United States, in restricting the pill to prescription only, had given a wrong lead--or, as he put it, there had been a freak echo " taken up by leaders in the Whether he was really advocating world. developing
In Britain the introduction of family planning within the N.H.S. has had to be delayed by several months because of lack of agreement about payment; in the Republic of Ireland and France there are barriers just as strong as the cultural ones to be surmounted in Africa; in New York services are so difficult to run that they are being put into the hands of anyone who can pass the course. Perhaps the solution for the Governments of the third world is not to allow themselves to be led but to come to their own decisions in the full recognition that a few imperfections in the service they provide may be a price well worth paying. Speakers at a conference held in Sri Lanka in January (see p. 370) seemed willing to keep an open mind on the question of medical supervision of family planning. Medical knowledge should certainly be universal; but it need not be applied with unthinking uniformity.
ICRF 159
ALTHOUGH the neoplastic cells that comprise a tumour have been examined from almost every conceivable angle, the important fibrovascular stromal elements which provide the means for both nutrition and dissemination have received less attention. The morphologically abnormal blood-vessels that occur in or near malignant tumours are familiar enough 1; and much work has been done on more functional aspects of tumour vasculature. Attention has been drawn to the kinetics of endothelial cells,2,3 and to various abnormal responses to vasoactive Tumour agents of blood-vessels in tumours.4-6 vasculature may well comprise a weak link which can be exploited therapeutically-to control the growth of the primary lesion and perhaps also the initial phases of haematogenous dissemination. There is evidence that ICRF 159, the bis diketopiperazine
malignant
compound (±)1,2 bis (3,5 dioxopiperazinyl) propane, point. The initial discovery of ICRF 159 seems to have arisen from the misconceived generalisation that the activity of antitumour drugs depends on their chelating properties. Admittedly, the potent chelating agent edetic acid (E.D.T.A.) has no antitumour activity; but E.D.T.A. is a highly polar molecule, and a group of less polar chelating agents was accordingly studied.’ Some were active against a number of experimental
may act at this
tumours, but it became clear that one of the compounds, ICRF 159, exerted remarkable effects against metastases. With the murine Lewis tumour, various dose schedules of ICRF 159 (injected intraperitoneally) prevented or greatly reduced the development of pulmonary deposits even though growth of the " primary " transplant in the flank was little affected.8 Subsequent experiments showed that
"
the free availability of oral contraceptives in all countries is not clear, but the more we learn about hormonal contraceptives the less likely it looks that an over-the-counter policy should prevail. 35.
Fraser,
R. N. Wld Med.
June, 1972.
1. Willis, R. A. Spread of Tumours in the Human Body. London, 1973 2. Tannock, I. F. Cancer Res. 1970, 30, 2470. 3. Tannock, I. F., Hayashi, S. ibid. 1972, 32, 77. 4. Cater, D. B., Adair, H. M., Grove, C. A. Br. J. Cancer, 1960. 20, 504. 5. Cater, D. B., Taylor, C. R. ibid. p. 517. 6. Underwood, J. C. E., Carr, I. J. Path. 1972, 107, 157. 7. Crieghton, A. M., Hellmann, K., Whitecross, S. Nature, 1960 222, 384. 8. Hellmann, K., Burrage, K. ibid. 1969, 224, 273. 1965
few of the children seem disturbed. Drug-taking has dropped in troubled areas; anxiety symptoms are rare, and they tend to affect children whose parents have had the same symptoms either previously or concurrently. It would be naive, Lyons observes, to expect that teenagers and younger children, used by militant organisations during the troubles, will be content to satisfy their present and future needs amid play-centres, football pitches, and sports fields. The recurrent theme in this issue of The Northern Teacher is the problem of exploiting, in a productive and constructive fashion, the immense emotional forces which have been liberated among the young people of the province by the current disturbances. Thought is also given to how the divisions in the community might be healed. Fraser has argued that " total integration of children from primary-school-age upwards would be the most potent single factor in breaking down community barriers and in restoring long-term peace". 35 Reading the journal, with its almost unbearably moving accounts from pupils of the murder of fathers and the burning of homes, one is struck by the prediction that, when peace comes, the incidence of mental illness, delinquency, and minor crime will rise again, and that not merely parents and politicians but also educationists, probation officers, social workers, and psychiatrists will be required to help heal the wounds.
FAMILY PLANNING IN THE THIRD WORLD
THOSE who supervised the control of infectious disease in developing countries have been less energetic in tackling one of its consequences-a massive increase in population. The price of this delay is already being seen in a standstill or even relapse in per-caput economic growth and in massive underemployment and malnutrition; and indigenous support for the economies of the third world is falling on a working population which constitutes an increasingly small proportion of the total. The interdependence of health, economic growth, population, education, and resources was well illustrated in a lecture given by Dr F. T. Sai at the London School of Hygiene and Tropical Medicine on Feb. 21. Dr Sai argued that those setting national targets must take all these factors into account in their plans-a policy which, had it been adopted by the developed world a generation ago, might have prevented a lot of the hardship being suffered today. The developed countries put restraints on some family-planning methods, and Dr Sai believes that such policies have made the wide availability of certain contraceptive methods in developing countries a difficult objective. He claimed that Britain and the United States, in restricting the pill to prescription only, had given a wrong lead--or, as he put it, there had been a freak echo " taken up by leaders in the Whether he was really advocating world. developing
In Britain the introduction of family planning within the N.H.S. has had to be delayed by several months because of lack of agreement about payment; in the Republic of Ireland and France there are barriers just as strong as the cultural ones to be surmounted in Africa; in New York services are so difficult to run that they are being put into the hands of anyone who can pass the course. Perhaps the solution for the Governments of the third world is not to allow themselves to be led but to come to their own decisions in the full recognition that a few imperfections in the service they provide may be a price well worth paying. Speakers at a conference held in Sri Lanka in January (see p. 370) seemed willing to keep an open mind on the question of medical supervision of family planning. Medical knowledge should certainly be universal; but it need not be applied with unthinking uniformity.
ICRF 159
ALTHOUGH the neoplastic cells that comprise a tumour have been examined from almost every conceivable angle, the important fibrovascular stromal elements which provide the means for both nutrition and dissemination have received less attention. The morphologically abnormal blood-vessels that occur in or near malignant tumours are familiar enough 1; and much work has been done on more functional aspects of tumour vasculature. Attention has been drawn to the kinetics of endothelial cells,2,3 and to various abnormal responses to vasoactive Tumour agents of blood-vessels in tumours.4-6 vasculature may well comprise a weak link which can be exploited therapeutically-to control the growth of the primary lesion and perhaps also the initial phases of haematogenous dissemination. There is evidence that ICRF 159, the bis diketopiperazine
malignant
compound (±)1,2 bis (3,5 dioxopiperazinyl) propane, point. The initial discovery of ICRF 159 seems to have arisen from the misconceived generalisation that the activity of antitumour drugs depends on their chelating properties. Admittedly, the potent chelating agent edetic acid (E.D.T.A.) has no antitumour activity; but E.D.T.A. is a highly polar molecule, and a group of less polar chelating agents was accordingly studied.’ Some were active against a number of experimental
may act at this
tumours, but it became clear that one of the compounds, ICRF 159, exerted remarkable effects against metastases. With the murine Lewis tumour, various dose schedules of ICRF 159 (injected intraperitoneally) prevented or greatly reduced the development of pulmonary deposits even though growth of the " primary " transplant in the flank was little affected.8 Subsequent experiments showed that
"
the free availability of oral contraceptives in all countries is not clear, but the more we learn about hormonal contraceptives the less likely it looks that an over-the-counter policy should prevail. 35.
Fraser,
R. N. Wld Med.
June, 1972.
1. Willis, R. A. Spread of Tumours in the Human Body. London, 1973 2. Tannock, I. F. Cancer Res. 1970, 30, 2470. 3. Tannock, I. F., Hayashi, S. ibid. 1972, 32, 77. 4. Cater, D. B., Adair, H. M., Grove, C. A. Br. J. Cancer, 1960. 20, 504. 5. Cater, D. B., Taylor, C. R. ibid. p. 517. 6. Underwood, J. C. E., Carr, I. J. Path. 1972, 107, 157. 7. Crieghton, A. M., Hellmann, K., Whitecross, S. Nature, 1960 222, 384. 8. Hellmann, K., Burrage, K. ibid. 1969, 224, 273. 1965