- Email: [email protected]
FLUORIDE TOXICITY
1217 that beset our world, we can, at least, grant the oppressed the small comfort that is theirs if their plight is at least not
denied. Coney Island Hospital, 2601 Ocean Parkway, Brooklyn, New York 11235, U.S.A.
SEYMOUR M. GLICK.
"
*** The remark Not too much sign there of an oppressive and restrictive regime " has been taken too literally and used to place this journal in a position it has never occupied, as Dr Glick will see if he refers to two earlier editorials.·2
Our latest editorial was an attempt to the other side of the argument on Soviet psychiatry. 70,000 is at least better than nothing.-ED. L. extract
FLUORIDE TOXICITY
SIR,-Your editorial (Oct. 20, p. 889) suggests that the case for fluoridation has never been adequately documented. There must in fact be few subjects which are better documented in the world literature. The Kettering Abstracts on Inorganic Fluorides issued by the University of Cincinnati summarises every publication of substance and extends now to many thousands of abstracts. The impormaterial is assembled in works of reference such as Hodge and Smith’s Fluorine Chemistryand the W.H.O. Monograph on Fluorides and Human Health,4 and doubts such as those mentioned in your editorial have been examined and shown to be without substance in the reports of the various official committees and commissions of inquiry which have from time to time been held in various parts of the world. Thus the report of the Tasmanian Royal Commission on the Fluoridation of Public Water Supplies5 is a particularly useful document. For those who have not the time to study the subject in such depth, the information in the Reports on the Fluoridation Studies 6,7 issued by this Department and the document of Questions and Answers issued by the British Dental Association8 are useful. As is inevitable in all medical and scientific subjects, a few research-workers will be found who hold views differing from the general consensus of scientific opinion, and their evidence must always be carefully assessed. Most of the doubts on fluoridation expressed by members of the general public arise from ill-founded statements in the various publications of the anti-fluoridation organisations.
tant
Department of Health and Social Security, Alexander Fleming House,
G. E. GODBER,
London SE1.
Chief Medical Officer.
CHLORAMPHENICOL
SIR,-In their report on indications and warning about chloramphenicol, Mr Dunne and his colleagues (Oct. 6, p. 781) indicated that the International Organisation of Consumers Unions is interested in the indications and sideeffects of drugs. We wholeheartedly approve this attitude, since adverse reaction to drugs is a growing problem the world over, underrated by many doctors. As our country was not 1. Lancet, 1971, ii, 1361. 2. ibid. 1972, ii, 1237. 3. Hodge, H. C., Smith, F. A. Fluorine Chemistry (edited by J. H. Simmons); vol. 4. New York, 1965. 4. Monograph Ser. W.H.O. no. 59. 1972, Geneva. 5. Government of Tasmania. Report of the Royal Commission into the Fluoridation of Public Water Supplies, 1968. 6. Rep. publ. Hlth med. Subj., no. 105. 1962. 7. ibid. no. 122. 1969. 8. British Dental Association. Fluoridation of Water Supplies: Questions and Answers. London, 1969.
included in the international survey, one could assume that chloramphenicol is not indiscriminately recommended In Belgium, chloramphenicol or misused, which is not so. is still being prescribed in instances in which it offers no serious advantages over safer drugs. As hasmatologists we have had in recent years knowledge of four chloramphenicol" aplastic-anxmia patients who were treated in the University Hospital and who died. In each instance the drug was given for unjustified indications: (1) bronchitis in a 20-year-old athlete before a competition, (2) a 16-year-old girl wrongly suspected of " criminal" abortion, (3) an older patient needing the " cheapest " drug for an acute otitis media, (4) a 35-year-old woman treated for angina. We strongly feel that some more stringent action has to be taken to prevent such tragic events. In this context attention should be drawn to the widespread use of other than Parke Davis brands of chloramphenicol, using unconnected brand names. Besides the four brands mentioned by Dunne et al., a fifth brand is sold in some E.E.C. countries : ’Proterciclina’ (Laboratori Pro-ter, Milano, Italy, and Chemielux, Luxembourg). The main problems with proterciclina are: (1) the carton of the oral form does not mention the true nature of proterciclina (thus this drug tends to be confused with safe antibiotics); (2) the leaflet mentions that this drug is a chemical combination of chloramphenicol and tetracycline and wrongly claims that, due to the lower dosage, the danger of complication is decreased (the risk of chloramphenicol aplastic anxmia is not dose-related). We entirely agree with the recommendations suggested by the Research Institute for Consumer Affairs. One more recommendation is being proposed: any brand should clearly mention the true chemical nature of the drug under a name familiar to all practitioners. "
Department of Medical Research, University of Leuven, 3000 Leuven, Belgium.
R. L. VERWILGHEN M. VERSTRAETE.
SEVERE COMBINED IMMUNODEFICIENCY AND ADENOSINE-DEAMINASE DEFICIENCY
SIR,-A syndrome of severe combined immunodeficiency has been reported in association with an absence of the enzyme red-cell adenosine deaminase.1-3 Previous evidence indicated that accurate prenatal diagnosis might not be feasible in this disorder, since the red-cell isozymes of adenosine deaminase, thought to be controlled at a separate genetic locus from the tissue isozyme, were very often not expressed by normal fibroblasts in tissue cultures. However, we have lately determined that fibroblasts as well as tissues from one of these patients are deficient not only in the red-cell enzyme but also in the " tissue " isozymes of adenosine deaminase.5 We have performed enzyme assays by three separate methods,6-8 as well as zymograms on starch gel,7 on three fibroblastic amniotic-cell cultures derived from pregnancies not at risk for immunodeficiency diseases. As shown in the table, enzyme assays demonstrated activity similar to or higher than that of normal fibroblasts. The zymogram demon1. 2. 3.
4. 5. 6. 7. 8.
Giblett, E., Anderson, J., Cohen, F., Pollara, B., Meuwissen, H. J. Lancet, 1972, ii, 1067. Dissing, J., Knudsen, B. ibid. p. 1316. Ochs, H. H., Yount, J. E., Giblett, E. R., Chen, S. H., Scott, C. R., Wedgwood, R. J. ibid. 1973, i, 1393. Edwards, Y. H., Hopkinson, D. A., Harris, H. Ann. hum. Genet. 1971, 35, 207. Hirschhorn, R., Levytska, V., Pollara, B., Meuwissen, H. Unpublished. Goldberg, D. M. Br. med. J. 1965, i, 353. Spencer, N., Hopkinson, D. A., Harris, H. Ann. hum. Genet. 1968, 32, 9. Hirschhorn, R. Unpublished.
denied. Coney Island Hospital, 2601 Ocean Parkway, Brooklyn, New York 11235, U.S.A.
SEYMOUR M. GLICK.
"
*** The remark Not too much sign there of an oppressive and restrictive regime " has been taken too literally and used to place this journal in a position it has never occupied, as Dr Glick will see if he refers to two earlier editorials.·2
Our latest editorial was an attempt to the other side of the argument on Soviet psychiatry. 70,000 is at least better than nothing.-ED. L. extract
FLUORIDE TOXICITY
SIR,-Your editorial (Oct. 20, p. 889) suggests that the case for fluoridation has never been adequately documented. There must in fact be few subjects which are better documented in the world literature. The Kettering Abstracts on Inorganic Fluorides issued by the University of Cincinnati summarises every publication of substance and extends now to many thousands of abstracts. The impormaterial is assembled in works of reference such as Hodge and Smith’s Fluorine Chemistryand the W.H.O. Monograph on Fluorides and Human Health,4 and doubts such as those mentioned in your editorial have been examined and shown to be without substance in the reports of the various official committees and commissions of inquiry which have from time to time been held in various parts of the world. Thus the report of the Tasmanian Royal Commission on the Fluoridation of Public Water Supplies5 is a particularly useful document. For those who have not the time to study the subject in such depth, the information in the Reports on the Fluoridation Studies 6,7 issued by this Department and the document of Questions and Answers issued by the British Dental Association8 are useful. As is inevitable in all medical and scientific subjects, a few research-workers will be found who hold views differing from the general consensus of scientific opinion, and their evidence must always be carefully assessed. Most of the doubts on fluoridation expressed by members of the general public arise from ill-founded statements in the various publications of the anti-fluoridation organisations.
tant
Department of Health and Social Security, Alexander Fleming House,
G. E. GODBER,
London SE1.
Chief Medical Officer.
CHLORAMPHENICOL
SIR,-In their report on indications and warning about chloramphenicol, Mr Dunne and his colleagues (Oct. 6, p. 781) indicated that the International Organisation of Consumers Unions is interested in the indications and sideeffects of drugs. We wholeheartedly approve this attitude, since adverse reaction to drugs is a growing problem the world over, underrated by many doctors. As our country was not 1. Lancet, 1971, ii, 1361. 2. ibid. 1972, ii, 1237. 3. Hodge, H. C., Smith, F. A. Fluorine Chemistry (edited by J. H. Simmons); vol. 4. New York, 1965. 4. Monograph Ser. W.H.O. no. 59. 1972, Geneva. 5. Government of Tasmania. Report of the Royal Commission into the Fluoridation of Public Water Supplies, 1968. 6. Rep. publ. Hlth med. Subj., no. 105. 1962. 7. ibid. no. 122. 1969. 8. British Dental Association. Fluoridation of Water Supplies: Questions and Answers. London, 1969.
included in the international survey, one could assume that chloramphenicol is not indiscriminately recommended In Belgium, chloramphenicol or misused, which is not so. is still being prescribed in instances in which it offers no serious advantages over safer drugs. As hasmatologists we have had in recent years knowledge of four chloramphenicol" aplastic-anxmia patients who were treated in the University Hospital and who died. In each instance the drug was given for unjustified indications: (1) bronchitis in a 20-year-old athlete before a competition, (2) a 16-year-old girl wrongly suspected of " criminal" abortion, (3) an older patient needing the " cheapest " drug for an acute otitis media, (4) a 35-year-old woman treated for angina. We strongly feel that some more stringent action has to be taken to prevent such tragic events. In this context attention should be drawn to the widespread use of other than Parke Davis brands of chloramphenicol, using unconnected brand names. Besides the four brands mentioned by Dunne et al., a fifth brand is sold in some E.E.C. countries : ’Proterciclina’ (Laboratori Pro-ter, Milano, Italy, and Chemielux, Luxembourg). The main problems with proterciclina are: (1) the carton of the oral form does not mention the true nature of proterciclina (thus this drug tends to be confused with safe antibiotics); (2) the leaflet mentions that this drug is a chemical combination of chloramphenicol and tetracycline and wrongly claims that, due to the lower dosage, the danger of complication is decreased (the risk of chloramphenicol aplastic anxmia is not dose-related). We entirely agree with the recommendations suggested by the Research Institute for Consumer Affairs. One more recommendation is being proposed: any brand should clearly mention the true chemical nature of the drug under a name familiar to all practitioners. "
Department of Medical Research, University of Leuven, 3000 Leuven, Belgium.
R. L. VERWILGHEN M. VERSTRAETE.
SEVERE COMBINED IMMUNODEFICIENCY AND ADENOSINE-DEAMINASE DEFICIENCY
SIR,-A syndrome of severe combined immunodeficiency has been reported in association with an absence of the enzyme red-cell adenosine deaminase.1-3 Previous evidence indicated that accurate prenatal diagnosis might not be feasible in this disorder, since the red-cell isozymes of adenosine deaminase, thought to be controlled at a separate genetic locus from the tissue isozyme, were very often not expressed by normal fibroblasts in tissue cultures. However, we have lately determined that fibroblasts as well as tissues from one of these patients are deficient not only in the red-cell enzyme but also in the " tissue " isozymes of adenosine deaminase.5 We have performed enzyme assays by three separate methods,6-8 as well as zymograms on starch gel,7 on three fibroblastic amniotic-cell cultures derived from pregnancies not at risk for immunodeficiency diseases. As shown in the table, enzyme assays demonstrated activity similar to or higher than that of normal fibroblasts. The zymogram demon1. 2. 3.
4. 5. 6. 7. 8.
Giblett, E., Anderson, J., Cohen, F., Pollara, B., Meuwissen, H. J. Lancet, 1972, ii, 1067. Dissing, J., Knudsen, B. ibid. p. 1316. Ochs, H. H., Yount, J. E., Giblett, E. R., Chen, S. H., Scott, C. R., Wedgwood, R. J. ibid. 1973, i, 1393. Edwards, Y. H., Hopkinson, D. A., Harris, H. Ann. hum. Genet. 1971, 35, 207. Hirschhorn, R., Levytska, V., Pollara, B., Meuwissen, H. Unpublished. Goldberg, D. M. Br. med. J. 1965, i, 353. Spencer, N., Hopkinson, D. A., Harris, H. Ann. hum. Genet. 1968, 32, 9. Hirschhorn, R. Unpublished.