- Email: [email protected]
Garlic and cancer
888
liability only if they have been grossly negligent. Giesen submitted statutes are a "wholly anomalous and unacceptable exception to the general law of negligence". Furthermore he suggested that since there has been no case where a doctor has been sued for malpractice in treatment at an emergency in the USA or Canada, doctors’ fears about litigation are unfounded. In summary he recommended that "a clear, though sharply delimited and defined duty to rescue individuals in grave need of attention should be imposed on doctors and hospital authorities who are in a position that these
to
do so".
Sarah Ramsay
HTLV-II-related disease The US Food and
Drug Administration Blood Products
Advisory Committee met at Bethesda, Maryland, on March 25, to discuss emerging disease associations with human T-lymphotropic virus type II (HTLV-11), and to consider whether to screen United States blood donors should a test for the virus be licensed. Isolated from only a handful of patients in the early 1980s, HTLV-11 is now recognised as an endemic retrovirus of Amerindian tribes and as a highly prevalent infection among intravenous drug abusers. The meeting reached a consensus that the virus, previously considered innocuous, may play a pathogenetic role in neurological, haematological, and dermatological disease. At least 10 cases of HTLV-11 neurological disease similar to HTLV-I associated myelopathy (HAM), and characterised by slowly progressive leg weakness, spasticity, and bladder and bowel dysfunction have been identified.l-4 The syndrome seems to be less prevalent among HTLV-11 than among HTLV-1 carriers in the prospective Retrovirus Epidemiology Donor Study3 of HTLV health effects. Poiesz also reported two cases of large granular lymphocytic leukaemia in patients with antibodies to HTLV-11 . Several cases of cutaneous disease ranging from eczema to debilitating lymphocytic infiltration of the skin have also been described.6 Since the institution of HTLV-I screening of US volunteer blood donors in 1988, many cross-reactive HTLV-II carriers have been identified. However, between 10 and 40% of HTLV-II infected persons score negative on current HTLV-1 ELISA tests. New ELISA tests containing HTLV-I viral lysate plus recombinant HTLV-I p21 envelope protein show improved sensitivity for HTLV-II. Nevertheless, the committee balked at approving one manufacturer’s claim for HTLV-11 detection with such a test and has asked for additional data. After discussion of the low prevalence (estimated at 1 per 10 000) of HTLV-11 among blood donors, the risk of acquiring the infection through a positive blood transfusion (estimated at 30%), and the preliminary nature of the disease reports, the committee decided to postpone a vote on screening for HTLV-II among US blood donors. This decision was notable because screening for other viruses, such as HIV-2 or even HTLV-I, was implemented on the basis of equally small risk to the public health. Edward L.
Murphy
Hjelle B, Appenzeller O, Mills R, et al. Chronic neurodegenerative disease associated with HTLV-II infection. Lancet 1992; 339: 645-46. 2. Jacobson S, Lehky T, Nishimura M, Robinson S, McFarlin DE. Isolation of HTLV-II from a patient with chronic neurologic disease clinically indistinguishable from HAM/TSB. Neurology (in press). 3. Murphy EL, Engstrom JW, Miller K, et al. HTLV-II associated myelopathy in a 43 year old woman. Lancet 1993; 341: 757-58. 4. Harrington WJ Jr, Sheremata WA, Hjelle B, et al. Spastic ataxia associated with HTLV-II infection. Neurology (in press). 5. Loughran RP Jr, Coyle T, Sherman MP, et al. Detection of human T-cell leukemia/lymphoma virus, type II, in a patient with large granular lymphocytic leukemia. Blood 1992; 80: 1116-19. 6. Kaplan MH, Hall WW, Susin M, et al. Syndrome of severe skin disease, eosinophilia, and dermatopathic lymphadenopathy in patients with HTLV-II complicating human immunodeficiency virus infection. Am J Med 1991; 91: 300-09.
policies on primary health care. A community would be provided with essential drugs at low cost for sale at two or three times the cost price, the proceeds being used to set up a revolving fund for the purchase of more drugs and the development of primary care services. Doubts about the scheme ranged from the effect that charges would have on equity of access to care,l to whether the scheme would encourage dependence on UNICEF instead of promoting sustainability. An external assessment of the initiative, in the form of case-studies in five countries, had been conducted. Differences between countries in the context and form in which the initiative was introduced, and the early stages at which some of the activities were, precluded a blanket assessment of the initiative, but the evaluation team’s overall conclusion was the "much looks promising". Whether a country had already been charging for its services and its pre-Bamako level of resources and degree of decentralisation of management were important factors determining type of programme introduced and its effectiveness, which was assessed in terms of quality of services, affordability of care, pricing structures and cost recovery, health impact, community participation, and other implementation issues.
Vivien Choo 1. Editorial. The Bamako initiative. Lancet 1988; ii: 1177-78. 2. McPake B, Hanson K, Mills A. Implementing the Bamako initiative in Africa. London: London School of Hygiene and Tropical Medicine (Department of Public Health and Policy publication no 8, 1992). 1993. Pp 101.
Garlic and
cancer
Nowadays garlic preparations are promoted for disorders ranging acne to impotence. For only a fraction of these is there any suggestion of its efficacy. Is it of any use in the treatment or prevention of cancer? Studies in Italy and China suggest that garlic consumption may protect against gastric cancer, and organosulphur compounds derived from garlic inhibit experimental mutagenesis (although to achieve effective tissue levels would require the ingestion of around 1000 cloves of garlic). The good news for those who wish to give garlic the benefit of the doubt is that fresh garlic contains more organosulphides weight for weight than even the most expensive "medicinal" extracts. from
John
Bignall
1. Dorant E, Van der Barndt PA, Goldbohn RA, et al. Garlic and its significance for the prevention of cancer in humans: a critical view. Br J Cancer 1993; 67: 424-29.
Birds and
Lyme disease
Borrelia burgdorferi have been found in Ixodes uriae ticks infesting razorbills on Bonden, a Baltic island 12 km from the Swedish mainland. In addition B burgdorferi-specific DNA has been found in biopsy specimens of the footwebs of razorbills. Since Bonden is not inhabited by mammals, the birds would seem to be a reservoir for the spirochaete (Nature 1993; 362: 340-42).
1.
HIV vaccine trial in children A study of the safety of three recombinant subunit vaccines against human immunodeficiency virus in children has been opened by the US National Institutes of Health. 90 symptom-free HIV-infected children aged 1 month to 12 years will be recruited (lymphadenopathy and mild enlargement of the liver and spleen are not exclusion criteria) for the ACTG 218 trial (vaccine for 6 months, then 24 months of follow-up) of a gp 160 vaccine (MicroGene Sys) and two gp 120 vaccines (Genentech and Biocine).
Action
Assessing Bamako There was unease about the Bamako initiative in its early years. Announced at a meeting of African ministers of health sponsored by WHO and UNICEF in 1987 and accepted by the UNICEF executive board in March, 1988, the scheme was intended to promote universal accessibility to and community participation in
on
unlicensed nicotine patches
The UK Medicines Control Agency has announced that product licences under the Medicines Act 1968 have been granted for only three nicotine patches: Nicabate, Nicotinell, and Nicorette Patch. Companies selling unlicensed nicotine or tobacco extract patches who do not withdraw their products from sale before assessment may face legal action.
liability only if they have been grossly negligent. Giesen submitted statutes are a "wholly anomalous and unacceptable exception to the general law of negligence". Furthermore he suggested that since there has been no case where a doctor has been sued for malpractice in treatment at an emergency in the USA or Canada, doctors’ fears about litigation are unfounded. In summary he recommended that "a clear, though sharply delimited and defined duty to rescue individuals in grave need of attention should be imposed on doctors and hospital authorities who are in a position that these
to
do so".
Sarah Ramsay
HTLV-II-related disease The US Food and
Drug Administration Blood Products
Advisory Committee met at Bethesda, Maryland, on March 25, to discuss emerging disease associations with human T-lymphotropic virus type II (HTLV-11), and to consider whether to screen United States blood donors should a test for the virus be licensed. Isolated from only a handful of patients in the early 1980s, HTLV-11 is now recognised as an endemic retrovirus of Amerindian tribes and as a highly prevalent infection among intravenous drug abusers. The meeting reached a consensus that the virus, previously considered innocuous, may play a pathogenetic role in neurological, haematological, and dermatological disease. At least 10 cases of HTLV-11 neurological disease similar to HTLV-I associated myelopathy (HAM), and characterised by slowly progressive leg weakness, spasticity, and bladder and bowel dysfunction have been identified.l-4 The syndrome seems to be less prevalent among HTLV-11 than among HTLV-1 carriers in the prospective Retrovirus Epidemiology Donor Study3 of HTLV health effects. Poiesz also reported two cases of large granular lymphocytic leukaemia in patients with antibodies to HTLV-11 . Several cases of cutaneous disease ranging from eczema to debilitating lymphocytic infiltration of the skin have also been described.6 Since the institution of HTLV-I screening of US volunteer blood donors in 1988, many cross-reactive HTLV-II carriers have been identified. However, between 10 and 40% of HTLV-II infected persons score negative on current HTLV-1 ELISA tests. New ELISA tests containing HTLV-I viral lysate plus recombinant HTLV-I p21 envelope protein show improved sensitivity for HTLV-II. Nevertheless, the committee balked at approving one manufacturer’s claim for HTLV-11 detection with such a test and has asked for additional data. After discussion of the low prevalence (estimated at 1 per 10 000) of HTLV-11 among blood donors, the risk of acquiring the infection through a positive blood transfusion (estimated at 30%), and the preliminary nature of the disease reports, the committee decided to postpone a vote on screening for HTLV-II among US blood donors. This decision was notable because screening for other viruses, such as HIV-2 or even HTLV-I, was implemented on the basis of equally small risk to the public health. Edward L.
Murphy
Hjelle B, Appenzeller O, Mills R, et al. Chronic neurodegenerative disease associated with HTLV-II infection. Lancet 1992; 339: 645-46. 2. Jacobson S, Lehky T, Nishimura M, Robinson S, McFarlin DE. Isolation of HTLV-II from a patient with chronic neurologic disease clinically indistinguishable from HAM/TSB. Neurology (in press). 3. Murphy EL, Engstrom JW, Miller K, et al. HTLV-II associated myelopathy in a 43 year old woman. Lancet 1993; 341: 757-58. 4. Harrington WJ Jr, Sheremata WA, Hjelle B, et al. Spastic ataxia associated with HTLV-II infection. Neurology (in press). 5. Loughran RP Jr, Coyle T, Sherman MP, et al. Detection of human T-cell leukemia/lymphoma virus, type II, in a patient with large granular lymphocytic leukemia. Blood 1992; 80: 1116-19. 6. Kaplan MH, Hall WW, Susin M, et al. Syndrome of severe skin disease, eosinophilia, and dermatopathic lymphadenopathy in patients with HTLV-II complicating human immunodeficiency virus infection. Am J Med 1991; 91: 300-09.
policies on primary health care. A community would be provided with essential drugs at low cost for sale at two or three times the cost price, the proceeds being used to set up a revolving fund for the purchase of more drugs and the development of primary care services. Doubts about the scheme ranged from the effect that charges would have on equity of access to care,l to whether the scheme would encourage dependence on UNICEF instead of promoting sustainability. An external assessment of the initiative, in the form of case-studies in five countries, had been conducted. Differences between countries in the context and form in which the initiative was introduced, and the early stages at which some of the activities were, precluded a blanket assessment of the initiative, but the evaluation team’s overall conclusion was the "much looks promising". Whether a country had already been charging for its services and its pre-Bamako level of resources and degree of decentralisation of management were important factors determining type of programme introduced and its effectiveness, which was assessed in terms of quality of services, affordability of care, pricing structures and cost recovery, health impact, community participation, and other implementation issues.
Vivien Choo 1. Editorial. The Bamako initiative. Lancet 1988; ii: 1177-78. 2. McPake B, Hanson K, Mills A. Implementing the Bamako initiative in Africa. London: London School of Hygiene and Tropical Medicine (Department of Public Health and Policy publication no 8, 1992). 1993. Pp 101.
Garlic and
cancer
Nowadays garlic preparations are promoted for disorders ranging acne to impotence. For only a fraction of these is there any suggestion of its efficacy. Is it of any use in the treatment or prevention of cancer? Studies in Italy and China suggest that garlic consumption may protect against gastric cancer, and organosulphur compounds derived from garlic inhibit experimental mutagenesis (although to achieve effective tissue levels would require the ingestion of around 1000 cloves of garlic). The good news for those who wish to give garlic the benefit of the doubt is that fresh garlic contains more organosulphides weight for weight than even the most expensive "medicinal" extracts. from
John
Bignall
1. Dorant E, Van der Barndt PA, Goldbohn RA, et al. Garlic and its significance for the prevention of cancer in humans: a critical view. Br J Cancer 1993; 67: 424-29.
Birds and
Lyme disease
Borrelia burgdorferi have been found in Ixodes uriae ticks infesting razorbills on Bonden, a Baltic island 12 km from the Swedish mainland. In addition B burgdorferi-specific DNA has been found in biopsy specimens of the footwebs of razorbills. Since Bonden is not inhabited by mammals, the birds would seem to be a reservoir for the spirochaete (Nature 1993; 362: 340-42).
1.
HIV vaccine trial in children A study of the safety of three recombinant subunit vaccines against human immunodeficiency virus in children has been opened by the US National Institutes of Health. 90 symptom-free HIV-infected children aged 1 month to 12 years will be recruited (lymphadenopathy and mild enlargement of the liver and spleen are not exclusion criteria) for the ACTG 218 trial (vaccine for 6 months, then 24 months of follow-up) of a gp 160 vaccine (MicroGene Sys) and two gp 120 vaccines (Genentech and Biocine).
Action
Assessing Bamako There was unease about the Bamako initiative in its early years. Announced at a meeting of African ministers of health sponsored by WHO and UNICEF in 1987 and accepted by the UNICEF executive board in March, 1988, the scheme was intended to promote universal accessibility to and community participation in
on
unlicensed nicotine patches
The UK Medicines Control Agency has announced that product licences under the Medicines Act 1968 have been granted for only three nicotine patches: Nicabate, Nicotinell, and Nicorette Patch. Companies selling unlicensed nicotine or tobacco extract patches who do not withdraw their products from sale before assessment may face legal action.