- Email: [email protected]
Funding of clinical research
CORRESPONDENCE
countries to a level that provides the most basic of human needs? Chris W Green Raya Housing Blok 0 No 1, Pondok Gede 17411, Indonesia (e-mail: [email protected]) 1
Slow drip of progress on safe water for all. Lancet 1999; 353: 2177.
Sociological models and health care Sir—We are glad that Patrick Corrigan and Daniel Luchins (June 19, p 2163)1 agree with our main argument that sociological research on health must be more widely understood by health-care professionals. As newcomers to much of the subject area, we accept that some of our interpretations could be improved upon. Their first point, that the works of Goffman and Rosenhan are only partially responsible for changes in mental health policy, is true. We did not mean to imply that these works were totally responsible for the changes witnessed, but to suggest that these works had no influence we cannot accept. These works, even if dated, have added to the body of knowledge on which we base our ideas. We selected them as fascinating and readable examples in a discipline where sociology has undoubtedly had an impact. We hope we achieved our main aim which was to encourage health professionals to take more interest in sociological research in health and heighten their awareness that medicine is practised within society. Jiri Chard MRC, Health Services Research Collaboration, University of Bristol, Canynge Hall, Bristol BS8 2PR, UK 1 Corrigan PW, Luchins DJ. Sociological models and health care. Lancet 1999; 353: 2163.
Funding of clinical res earch Sir—Paul Dieppe and colleagues (May 8, p 1626) 1 conclude that industrial funding has undue influence on the research agenda. Western societies are based on a market economy and sometimes on a social market economy. One fundamental and specific feature of this social order is that progress (including presumed progress) is stimulated and hence linked to the prospect of economic gain (potential gain). To make more money or to save money are the central triggers.
602
Developments in general in any branch of these societies—cars, computers, journals, drugs, etc—are submitted to the mechanisms of the market dictate. I shall not discuss whether this is positive or negative—it is one basic fact! Pharmaceutical industries merely behave within and according to this general pattern. Similarly, so-called independent research uses patents, exclusivity rights, and the sale of know-how to “sell” itself, its projects, and results. Unfortunately the key questions are centered on money (gain also as a measure of success). Unless we are able to identify and embrace convincingly values other than money this situation will not change. Via Polar 69a, CH-6932 Breganzona, Switzerland
epididymis and vas deferens of a 28 years old man who died 4 hours and 4 minutes prior to this operation . . . Subsequently, after removal of the upper skull, the pituitary (hyophysis) was removed and replaced with human pituitary of the above mentioned man . . . Indication for the operation: Prof Preobruzhensky’s expriment of combined testicular and pituitary transplantation in order to clarify the ability of the pituitary to survive a transplantation and to elucidate its influence on arrest of aging in man.”3 After the operation, the dog gradually turned into a human being. However his behaviour was so vulgar and unacceptable that Professor Preobruzhensky was forced to perform a reverse transplantation that turned the man-Sharik back to the dog-Sharik.
1
Samuel Lurie
Ralf Ruffmann
Dieppe P, Chard J, Tallon D, Egger M. Funding clinical research. Lancet 1999; 353: 1626.
Department of Obstetrics and Gynaecology, Wolfson Medical Center, Holon, Israel 1
Mikhail Bulgako v’s myth about medicine, literature, and fiction Sir—It was refreshing to read Ivan Oransky’s review of Mikhail Bulgakov (June 12, p 2059).1 Bulgakov graduated at the Medical Faculty of St Vladimir University in Kiev and became a physician at the Kiev Military Hospital. After being a provincial physician in the Smolensk province, he returned to Kiev in 1918, where he opened a private practice. In 1919, during the Russian Civil War, he was drafted by the White Army and then transferred to Northern Caucasus. There he became ill with typhus and was relieved to abandon medicine. Bulgakov recalls how he started writing: “Once in 1919 when I was travelling at night by train I wrote a short story. In the town where the train stopped, I took the story to the publisher of the newspaper who published the story.”2 Bulgakov’s inter-relationship with literature and medicine is incomplete without mentioning his brilliant The heart of a dog, which was written in 1925. It is an intelligent satire on the Russian regime in the early 1920s 3 and also elucidates the attitude of medicine in the 1920s towards the mysteries and function of the hypophysis and gonads. In the The heart of a dog, Professor Preobruzhensky performs a transplantation of human pituitary to a dog (Sharik): “Under chloroform anesthesia, Sharik’s testicles were removed and immediately replaced with testis,
2
3
Oransky I. Disarming life’s invisible enemies: Mikhail Bulgakov’s A country Doctor’s Notebook. Lancet 1999; 353: 2059–60. Konchakovska K, Yasinsky B, Mikhail Bulgakov in the western world. A bibliography. Washington, DC: Library of Congress, 1998. Bulgakov M. Coeur de chien. Ivrea: Paris, 1992.
Centenarian scientists Sir—In seeking centenarian scientists, Sachi Sri Kantha (June 26, p 2250)1 need look no further than the world of malaria. The distinguished malariologist, Sir Rickard Christophers died in 1977, aged 104; Colonel H E Shortt, co-elucidator of the liver cycle of Plasmodium falciparum, was 100 when he died in 1987, leaving a widow who was his senior. Two other eminent protozoologists, Percy Garnham and Cecil Hoare, lived well into their 90s. Does the female anopheles mosquito transmit a longevity factor? David Greenwood Division of Microbiology and Infectious Diseases, School of Clinical Laboratory Sciences, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK (e-mail: [email protected])
DEPARTMENT OF ERROR Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)—In this article (Sept 12, 1998, p 837), the lines for glibenclamide in figures 6 and 7 were underinked in the printing process: these can be viewed on The Lancet interactive at http://www.thelancet.com or on Sciencedirect http://www.sciencedirect.com/. The last line of the legend for figures 6 and 7 should read: Key as for figures 2 and 3.
THE LANCET • Vol 354 • August 14, 1999
countries to a level that provides the most basic of human needs? Chris W Green Raya Housing Blok 0 No 1, Pondok Gede 17411, Indonesia (e-mail: [email protected]) 1
Slow drip of progress on safe water for all. Lancet 1999; 353: 2177.
Sociological models and health care Sir—We are glad that Patrick Corrigan and Daniel Luchins (June 19, p 2163)1 agree with our main argument that sociological research on health must be more widely understood by health-care professionals. As newcomers to much of the subject area, we accept that some of our interpretations could be improved upon. Their first point, that the works of Goffman and Rosenhan are only partially responsible for changes in mental health policy, is true. We did not mean to imply that these works were totally responsible for the changes witnessed, but to suggest that these works had no influence we cannot accept. These works, even if dated, have added to the body of knowledge on which we base our ideas. We selected them as fascinating and readable examples in a discipline where sociology has undoubtedly had an impact. We hope we achieved our main aim which was to encourage health professionals to take more interest in sociological research in health and heighten their awareness that medicine is practised within society. Jiri Chard MRC, Health Services Research Collaboration, University of Bristol, Canynge Hall, Bristol BS8 2PR, UK 1 Corrigan PW, Luchins DJ. Sociological models and health care. Lancet 1999; 353: 2163.
Funding of clinical res earch Sir—Paul Dieppe and colleagues (May 8, p 1626) 1 conclude that industrial funding has undue influence on the research agenda. Western societies are based on a market economy and sometimes on a social market economy. One fundamental and specific feature of this social order is that progress (including presumed progress) is stimulated and hence linked to the prospect of economic gain (potential gain). To make more money or to save money are the central triggers.
602
Developments in general in any branch of these societies—cars, computers, journals, drugs, etc—are submitted to the mechanisms of the market dictate. I shall not discuss whether this is positive or negative—it is one basic fact! Pharmaceutical industries merely behave within and according to this general pattern. Similarly, so-called independent research uses patents, exclusivity rights, and the sale of know-how to “sell” itself, its projects, and results. Unfortunately the key questions are centered on money (gain also as a measure of success). Unless we are able to identify and embrace convincingly values other than money this situation will not change. Via Polar 69a, CH-6932 Breganzona, Switzerland
epididymis and vas deferens of a 28 years old man who died 4 hours and 4 minutes prior to this operation . . . Subsequently, after removal of the upper skull, the pituitary (hyophysis) was removed and replaced with human pituitary of the above mentioned man . . . Indication for the operation: Prof Preobruzhensky’s expriment of combined testicular and pituitary transplantation in order to clarify the ability of the pituitary to survive a transplantation and to elucidate its influence on arrest of aging in man.”3 After the operation, the dog gradually turned into a human being. However his behaviour was so vulgar and unacceptable that Professor Preobruzhensky was forced to perform a reverse transplantation that turned the man-Sharik back to the dog-Sharik.
1
Samuel Lurie
Ralf Ruffmann
Dieppe P, Chard J, Tallon D, Egger M. Funding clinical research. Lancet 1999; 353: 1626.
Department of Obstetrics and Gynaecology, Wolfson Medical Center, Holon, Israel 1
Mikhail Bulgako v’s myth about medicine, literature, and fiction Sir—It was refreshing to read Ivan Oransky’s review of Mikhail Bulgakov (June 12, p 2059).1 Bulgakov graduated at the Medical Faculty of St Vladimir University in Kiev and became a physician at the Kiev Military Hospital. After being a provincial physician in the Smolensk province, he returned to Kiev in 1918, where he opened a private practice. In 1919, during the Russian Civil War, he was drafted by the White Army and then transferred to Northern Caucasus. There he became ill with typhus and was relieved to abandon medicine. Bulgakov recalls how he started writing: “Once in 1919 when I was travelling at night by train I wrote a short story. In the town where the train stopped, I took the story to the publisher of the newspaper who published the story.”2 Bulgakov’s inter-relationship with literature and medicine is incomplete without mentioning his brilliant The heart of a dog, which was written in 1925. It is an intelligent satire on the Russian regime in the early 1920s 3 and also elucidates the attitude of medicine in the 1920s towards the mysteries and function of the hypophysis and gonads. In the The heart of a dog, Professor Preobruzhensky performs a transplantation of human pituitary to a dog (Sharik): “Under chloroform anesthesia, Sharik’s testicles were removed and immediately replaced with testis,
2
3
Oransky I. Disarming life’s invisible enemies: Mikhail Bulgakov’s A country Doctor’s Notebook. Lancet 1999; 353: 2059–60. Konchakovska K, Yasinsky B, Mikhail Bulgakov in the western world. A bibliography. Washington, DC: Library of Congress, 1998. Bulgakov M. Coeur de chien. Ivrea: Paris, 1992.
Centenarian scientists Sir—In seeking centenarian scientists, Sachi Sri Kantha (June 26, p 2250)1 need look no further than the world of malaria. The distinguished malariologist, Sir Rickard Christophers died in 1977, aged 104; Colonel H E Shortt, co-elucidator of the liver cycle of Plasmodium falciparum, was 100 when he died in 1987, leaving a widow who was his senior. Two other eminent protozoologists, Percy Garnham and Cecil Hoare, lived well into their 90s. Does the female anopheles mosquito transmit a longevity factor? David Greenwood Division of Microbiology and Infectious Diseases, School of Clinical Laboratory Sciences, University Hospital, Queen’s Medical Centre, Nottingham NG7 2UH, UK (e-mail: [email protected])
DEPARTMENT OF ERROR Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)—In this article (Sept 12, 1998, p 837), the lines for glibenclamide in figures 6 and 7 were underinked in the printing process: these can be viewed on The Lancet interactive at http://www.thelancet.com or on Sciencedirect http://www.sciencedirect.com/. The last line of the legend for figures 6 and 7 should read: Key as for figures 2 and 3.
THE LANCET • Vol 354 • August 14, 1999