- Email: [email protected]
Indoor air pollution in developing countries
358
LETTERS to the EDITOR
Clinical ultrasound in
developing countries
Indoor air
SiR,—Your Nov 17 editorial (p 1225) stresses the usefulness of ultrasound in developing countries. However, few data on the indications for ultrasound and contribution to problem solving in the third world are available. I report here the results of systematic ultrasound examinations in a group of elderly patients in central Africa. The examination was part of a prospective study on the medical problems of the elderly in Rwanda and was done in the department of internal medicine, University Hospital of Butare, from April, 1986, to March, 1987. (Details of the complete study are to be published elsewhere.) Of the 227 consecutively seen patients aged 60 or more, 207 (91’1%) were given an ultrasound examination of the abdomen and, when indicated, other regions. An ADR real-time sonograph with a 3-5 MHz transducer was used. The indications for and usefulness of these examinations are shown in the table. INDICATIONS FOR AND USEFULNESS OF ULTRASOUND EXAMINATIONS
pollution
in
developing countries
SIR,-Your editorial (Dec 22/29, p 1548) rightly draws attention the likelihood of indoor pollution as a cause of respiratory disease in developing countries. We studied the effects of indoor pollution on children of Zimbabwean families that cook over open wood fires in cooking huts.’ Blood sampling from 25 children shortly after exposure to the atmosphere in these huts revealed a mean carboxyhaemoglobin (HbCO) concentration of 6-45%, comparable with that recorded in adult smokers. In 130 children presenting to hospital with lower respiratory tract infection, mean HbCO was 2-98%, the mean delay from exposure to sampling being 112 h. In 40 children with upper respiratory tract infection mean HbCO was 3-98%, with mean delay from exposure to sampling of 5-6 h. These results confirm exposure in each group. The mean concentration of particles in the air of cooking huts while the main meal of the day was being prepared showed serious pollution in both groups, with a significant difference between them. In 18 homes of children presenting with lower respiratory tract infection the mean concentration was 1998 Jlg/m3 (range 36-7507 Jlg/m3) compared with a mean of 546 tg/ml (29-2315 pg/m3) in the homes of 15 children with upper respiratory tract infection. A questionnaire was completed for 244 children with lower respiratory tract infection and 500 children from a well-baby clinic. Significant differences existed between these groups for cooking over open wood fires and school-aged siblings. We conclude that exposure to indoor air pollution from wood smoke contributes to lower respiratory disease in children under 3 years. These observations confirm those of others.24
to
5 Fifth Street,
Marondera, Zimbabwe
K. S. MARTIN
Sithole SD, Martin KS. Indoor woodsmoke pollution causing lower respiratory disease in children. Trop Doct 1990; 20: 151-55. 2 Sofuluwe GO Smoke pollution m dwellings of infants with bronchopneumonia Arch Environ Health 1968; 16: 670-72. 3. Kossove D. Smoke-filled rooms and lower respiratory disease m infants S Afr Med J 1.
Collings DA,
1982, 63: 622-24 Akpom CA, Osbome JS. Infant respiratory illness and indoor pollution from a wood-burning stove. Paediatrics 1983; 71: 126-28.
4. Honicky RE,
*More than
one
per
patient possible.
Of the 207 examinations 126 (60-8%) were abnormal and for 149 (71-9%) patients the findings contributed to the resolution of the clinical problem. In 54 (26-0%) patients the ultrasound appearances were deemed specific enough to permit a diagnosis with a high degree of probability: 27 patients with liver cirrhosis (retracted, dense liver), 12 with malignancies of the liver, 6 with cardiac disease, 4 with a lower-urinary tract obstruction, 2 with liver abscess, 2 with atrophic kidneys, and 1 with a generalised malignancy. In 40 patients with a suspicion of cirrhosis or malignancy of the liver biopsy was done with a ’Tru-cut’ needle (Travenol) under ultrasonic guidance; no major complication occurred. Cirrhosis was found in 24 and primary hepatocellular carcinoma in 11. These data confirm that ultrasound can make a substantial contribution to problem solving and to clinical management in developing countries. Although many ultrasound images lack specificity,l in this series a larger number of diagnoses were made. This can only partly be explained by the advanced stage of disease in many
patients.
Geriatric Unit, Department of Internal Medicine, Academic Hospital, Free University of Brussels (VUB), B-1090 Brussels, Belgium
1. Maharaj
B, Bhoora IG, Patel A, Maharajh J. Ultrasonography and liver disease m developing countries. Lancet 1989; ii: 853-56.
T. METS
scintigraphy
m
SiR,—Your editorial highlights an important yet little researched Most people in developing countries still depend on biomass fuels such as agricultural wastes, dried animal dung, wood, or charcoal, which are burnt in traditional cookstoves without a chimney. They also frequently have inadequate housing with overcrowding and poor ventilation. Women who spend a substantial amount of time cooking with biomass fuels are thus exposed to the effects of smoke. De Koningl has estimated that at least 300-400 million people, mostly women, are exposed to such smoke. Tobacco smoking leads to low birthweight. Recent evidence also links maternal smoking with perinatal mortality.’ Low birthweight is also associated with passive smoking.3 Unfortunately there is very little information on effects of exposure to smoke from biomass fuels on pregnancy outcome. Chen et al4 did not include effects on pregnancy in their review, perhaps because of lack of information. Our search of computerised databases, including MEDLINE, POPLINE, and TOXLINE, revealed no papers on this topic over the past ten years. After extensive search of publications between 1970 and 1984, Kramers found not one report on this topic. However, research from India suggests that exposure to biomass smoke from cooking raises carboxyhemoglobin levels to about 13%,6 which is higher than the level observed among mothers who smoke tobacco.’ In a case-control study of risk factors for poor pregnancy outcome in Ahmedabad, India,8 one factor explored was exposure to biomass area.
359
smoke. Stillbirth, early neonatal death, and preterm and term low birthweight showed significant associations with this factor: Outcome Stillbirth
Early neonatal birth Prcterm LBW Term LBW
No 465 160 644 673
Odds ratios (and 95% 162 (1 30-2 02)
Cl)
1-46 (1-04-2 05) 149 (1 23-1-81) 1 23 (1 02-1 50)
The odds ratio for stillbirth remained significant (OR 1 ’45, CI 1 00-2’H) after adjusting for other important factors; the odds
ratios for other outcomes were no longer significant after multivariate adjustment. These findings suggest the possibility of an adverse pregnancy outcome associated with exposure to biomass smoke. 30-40% of the cases and controls were exposed to such smoke in our study which makes this factor as prevalent as tobacco smoking is in developed countries. Given the high prevalence of such exposure and its potential for adversely affecting pregnancy outcome, we strongly feel that more research should be directed at the effects of biomass smoke and at strategies to reduce such exposure in developing countries. Division of Prevention Research, National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA
Departments of Otolaryngology, Pulmonary Medicine, and Medical Technology, Orebro Medical Centre Hospital, S-701 85 Orebro, Sweden
Koning HW. Smith KR, Last JM Biomass fuel combustion and health Bull WHO 1985, 63: 11-26. 2 Kleinman JC, Mitchell B, Pierre JR, Madans JH, Land GH, Schramm WF The effect of maternal smoking on fetal and infant mortality. Am J Epidemiol 1988; 127: 274-82 3. Rubm DH, Krasilnikoff PA, Leventhal JM, Weile B, Berget A. Effect of passive smoking on birth weight Lancet 1986; ii: 415-17. 4 Chen BH, Hong CJ, Panday MR, Smith KR. Indoor air pollution in developing counties Wld Health Stat Quart 1990, 43: 127-38 5 Kramer MS Determinants of low birth weight methodological assessment and meta-analysis Bull WHO 1987, 65: 773-37 6 Longo LD The biological effects of carbon monoxide on the pregnant woman, fetus, and newborn infant Am J Obstet Gynecol 1977, 129: 69-103 7 Behera D, Dash S, Malik SK Blood carboxyhaemoglobin levels following acute exposure to smoke of biomass fuel. Indian J Med Res 1988; 88: 522-24 8 Mavalankar DV, Trivedi CR, Gray RH Levels and risk factors for permatal mortality in Ahmedabad, India Bull WHO (in press
Transthoracic endoscopic photodynamic treatment of malignant mesothelioma SIR,-There is no cure for malignant mesothelioma of the pleura, palliation, including pleurectomy and cytotoxic drugs, is
and
ineffective’
and often reduces the quality of life. Photodynamic therapy (PDT) has been used for treatment of malignant tumours with encouraging results,"* especially superficial bladder cancer. There are similarities between cancer of the bladder and mesothelioma of the pleura in that both, at least initially, grow superficially in the wall of a cavity. We treated a 64-year-old man with malignant mesothelioma of the pleura with PDT in January, 1990. The patient, who had previously been healthy, consulted a doctor for extreme tiredness and shortness of breath. Chest radiography revealed an effusion filling a third of the right pleural cavity. At thoracoscopy several polypoid tumours were found on the parietal pleura, and biopsy diagnosis was malignant mesothelioma of the epithelial type. The concentration of hyaluronic acid in the pleural exudate was significantly increased. A model of the right pleural cavity, made from a computerised tomographic (CT) scan, was used to determine the light distribution from fibre-tips in different positions. The patient was given 2-0 mg/kg ’Photofrin II’ and 48 h later thoracoscopy was repeated. The entire surface of the cavity was exposed to 20 J /cm2 of red light (628 nm) from a gold vapour laser. The procedure took 6 h and was done under epidural anaesthesia. The light dose was measured with a fibreoptic probe inserted through a separate puncture through the thoracic wall. The patient was very tired and in a poor general condition for the next 2 days. His serum creatinine rose temporarily and the sedimentation rate increased to 100 mm/h. The serum C-reactive protein became very high. He was given cloxacillin sodium as prophylaxis against infection. A CT scan 14 days after treatment
LENNART LOFGREN MATZ LARSSON LARS THANING STIG HALLGREN
A, Falkson G, Goedhals L, et al. Malignant pleural mesothelioma. a disease unaffected by current therapeutic maneuvers. J Clin Oncol 1988, 6: 527-35. 2. Marcus SL Photodynamic therapy of human cancer: clinical status, potential and needs. In: Gome CJ, ed Future directions and applications m photodynamic therapy (SPIE Inst Adv Optic Technol vol 156) Washington, DC: SPIE Optical Engineering Press, 1990. 3-56 1 Alberts
Trial of inhaled salbutamol for
DILEEP V. MAVALANKAR
1 De
usually
indicated a striking reduction in pleural tumours. To reduce the risk of metastasis in the two puncture channels through the thoracic wall, superficial electron radiation was given over the right thoracic flank 4 weeks after the PDT. No other radiotherapy has been given. The patient has been followed up with CT scans every third month. So far (10 months after the treatment) no sign of progression has been seen; all laboratory values are normal and the patient is symptom free and in good general condition.
proctalgia
fugax SIR,-A few years ago I reported in your correspondence columns that several patients, including a child, attained relief from the pain of proctalgia fugax by the inhalation of salbutamol.’ The efficacy of this treatment has been tested by a double-blind controlled trial. Thirty-one patients with the clinical diagnosis of proctalgia fugax, based on history and the exclusion of rectal pathology, were admitted to the trial. Active salbutamol and matching placebo metered dose inhalers were supplied in pairs by Glaxo, Australia. The patients were asked to use each inhaler, identified only by "A" or "B", for two attacks and to report the response.
Compliance was poor and only fifteen patients completed the protocol. Six found the active drug consistently effective and the placebo ineffective. Five, including two medical practitioners, reported the reverse. Of the others, two gave a mixed inconsistent response, one found both placebo and salbutamol effective, and one found both ineffective. This trial affords no statistical support for the efficacy of inhaled salbutamol in the treatment of proctalgia fugax, but it identifies a small cohort of patients who claim symptomatic relief. 116 Everton Street, Hamilton 2303, New South Wales, Australia
1
Wright JE
J. E. WRIGHT
Inhaled salbutamol for proctalgia
fugax. Lancet 1985, ii:
659-60.
Concerns about BST SIR,-Mr Sibbison’s (Dec 15,
p
1498)
comment on
bovine
somatotropin (BST) is a farrago of misinformation and selective reporting. Having followed the rBST saga for several years with respect to the nutritional safety of milk I would add to some of Sibbison’s statements. To suggest that the risk to man is far from clear is nonsense. Not only does Juskevich and Guyer’sl report, to which Sibbison alludes, provide the background to the US Food and Drug Administration’s statement that the use of rbGH [rBST] in dairy cattle presents no increased health risk to consumers, but Sibbison also cites only the negative comments of campaigners against genetic engineering. Earlier,yAL4 published a special communication2confirming the safety of rBST, and, in an accompanying editorialGrossman concluded "it is both inappropriate and wrong for special interest groups to play on the health and safety fears of the public to further their own ends. If the issue is economic, let it be clearly stated as such and leave genetic engineering out of the controversy". Sibbison also cites negative comment by David Kronfeld at a National Instiiu.ss of Health meeting without mentioning that at
LETTERS to the EDITOR
Clinical ultrasound in
developing countries
Indoor air
SiR,—Your Nov 17 editorial (p 1225) stresses the usefulness of ultrasound in developing countries. However, few data on the indications for ultrasound and contribution to problem solving in the third world are available. I report here the results of systematic ultrasound examinations in a group of elderly patients in central Africa. The examination was part of a prospective study on the medical problems of the elderly in Rwanda and was done in the department of internal medicine, University Hospital of Butare, from April, 1986, to March, 1987. (Details of the complete study are to be published elsewhere.) Of the 227 consecutively seen patients aged 60 or more, 207 (91’1%) were given an ultrasound examination of the abdomen and, when indicated, other regions. An ADR real-time sonograph with a 3-5 MHz transducer was used. The indications for and usefulness of these examinations are shown in the table. INDICATIONS FOR AND USEFULNESS OF ULTRASOUND EXAMINATIONS
pollution
in
developing countries
SIR,-Your editorial (Dec 22/29, p 1548) rightly draws attention the likelihood of indoor pollution as a cause of respiratory disease in developing countries. We studied the effects of indoor pollution on children of Zimbabwean families that cook over open wood fires in cooking huts.’ Blood sampling from 25 children shortly after exposure to the atmosphere in these huts revealed a mean carboxyhaemoglobin (HbCO) concentration of 6-45%, comparable with that recorded in adult smokers. In 130 children presenting to hospital with lower respiratory tract infection, mean HbCO was 2-98%, the mean delay from exposure to sampling being 112 h. In 40 children with upper respiratory tract infection mean HbCO was 3-98%, with mean delay from exposure to sampling of 5-6 h. These results confirm exposure in each group. The mean concentration of particles in the air of cooking huts while the main meal of the day was being prepared showed serious pollution in both groups, with a significant difference between them. In 18 homes of children presenting with lower respiratory tract infection the mean concentration was 1998 Jlg/m3 (range 36-7507 Jlg/m3) compared with a mean of 546 tg/ml (29-2315 pg/m3) in the homes of 15 children with upper respiratory tract infection. A questionnaire was completed for 244 children with lower respiratory tract infection and 500 children from a well-baby clinic. Significant differences existed between these groups for cooking over open wood fires and school-aged siblings. We conclude that exposure to indoor air pollution from wood smoke contributes to lower respiratory disease in children under 3 years. These observations confirm those of others.24
to
5 Fifth Street,
Marondera, Zimbabwe
K. S. MARTIN
Sithole SD, Martin KS. Indoor woodsmoke pollution causing lower respiratory disease in children. Trop Doct 1990; 20: 151-55. 2 Sofuluwe GO Smoke pollution m dwellings of infants with bronchopneumonia Arch Environ Health 1968; 16: 670-72. 3. Kossove D. Smoke-filled rooms and lower respiratory disease m infants S Afr Med J 1.
Collings DA,
1982, 63: 622-24 Akpom CA, Osbome JS. Infant respiratory illness and indoor pollution from a wood-burning stove. Paediatrics 1983; 71: 126-28.
4. Honicky RE,
*More than
one
per
patient possible.
Of the 207 examinations 126 (60-8%) were abnormal and for 149 (71-9%) patients the findings contributed to the resolution of the clinical problem. In 54 (26-0%) patients the ultrasound appearances were deemed specific enough to permit a diagnosis with a high degree of probability: 27 patients with liver cirrhosis (retracted, dense liver), 12 with malignancies of the liver, 6 with cardiac disease, 4 with a lower-urinary tract obstruction, 2 with liver abscess, 2 with atrophic kidneys, and 1 with a generalised malignancy. In 40 patients with a suspicion of cirrhosis or malignancy of the liver biopsy was done with a ’Tru-cut’ needle (Travenol) under ultrasonic guidance; no major complication occurred. Cirrhosis was found in 24 and primary hepatocellular carcinoma in 11. These data confirm that ultrasound can make a substantial contribution to problem solving and to clinical management in developing countries. Although many ultrasound images lack specificity,l in this series a larger number of diagnoses were made. This can only partly be explained by the advanced stage of disease in many
patients.
Geriatric Unit, Department of Internal Medicine, Academic Hospital, Free University of Brussels (VUB), B-1090 Brussels, Belgium
1. Maharaj
B, Bhoora IG, Patel A, Maharajh J. Ultrasonography and liver disease m developing countries. Lancet 1989; ii: 853-56.
T. METS
scintigraphy
m
SiR,—Your editorial highlights an important yet little researched Most people in developing countries still depend on biomass fuels such as agricultural wastes, dried animal dung, wood, or charcoal, which are burnt in traditional cookstoves without a chimney. They also frequently have inadequate housing with overcrowding and poor ventilation. Women who spend a substantial amount of time cooking with biomass fuels are thus exposed to the effects of smoke. De Koningl has estimated that at least 300-400 million people, mostly women, are exposed to such smoke. Tobacco smoking leads to low birthweight. Recent evidence also links maternal smoking with perinatal mortality.’ Low birthweight is also associated with passive smoking.3 Unfortunately there is very little information on effects of exposure to smoke from biomass fuels on pregnancy outcome. Chen et al4 did not include effects on pregnancy in their review, perhaps because of lack of information. Our search of computerised databases, including MEDLINE, POPLINE, and TOXLINE, revealed no papers on this topic over the past ten years. After extensive search of publications between 1970 and 1984, Kramers found not one report on this topic. However, research from India suggests that exposure to biomass smoke from cooking raises carboxyhemoglobin levels to about 13%,6 which is higher than the level observed among mothers who smoke tobacco.’ In a case-control study of risk factors for poor pregnancy outcome in Ahmedabad, India,8 one factor explored was exposure to biomass area.
359
smoke. Stillbirth, early neonatal death, and preterm and term low birthweight showed significant associations with this factor: Outcome Stillbirth
Early neonatal birth Prcterm LBW Term LBW
No 465 160 644 673
Odds ratios (and 95% 162 (1 30-2 02)
Cl)
1-46 (1-04-2 05) 149 (1 23-1-81) 1 23 (1 02-1 50)
The odds ratio for stillbirth remained significant (OR 1 ’45, CI 1 00-2’H) after adjusting for other important factors; the odds
ratios for other outcomes were no longer significant after multivariate adjustment. These findings suggest the possibility of an adverse pregnancy outcome associated with exposure to biomass smoke. 30-40% of the cases and controls were exposed to such smoke in our study which makes this factor as prevalent as tobacco smoking is in developed countries. Given the high prevalence of such exposure and its potential for adversely affecting pregnancy outcome, we strongly feel that more research should be directed at the effects of biomass smoke and at strategies to reduce such exposure in developing countries. Division of Prevention Research, National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA
Departments of Otolaryngology, Pulmonary Medicine, and Medical Technology, Orebro Medical Centre Hospital, S-701 85 Orebro, Sweden
Koning HW. Smith KR, Last JM Biomass fuel combustion and health Bull WHO 1985, 63: 11-26. 2 Kleinman JC, Mitchell B, Pierre JR, Madans JH, Land GH, Schramm WF The effect of maternal smoking on fetal and infant mortality. Am J Epidemiol 1988; 127: 274-82 3. Rubm DH, Krasilnikoff PA, Leventhal JM, Weile B, Berget A. Effect of passive smoking on birth weight Lancet 1986; ii: 415-17. 4 Chen BH, Hong CJ, Panday MR, Smith KR. Indoor air pollution in developing counties Wld Health Stat Quart 1990, 43: 127-38 5 Kramer MS Determinants of low birth weight methodological assessment and meta-analysis Bull WHO 1987, 65: 773-37 6 Longo LD The biological effects of carbon monoxide on the pregnant woman, fetus, and newborn infant Am J Obstet Gynecol 1977, 129: 69-103 7 Behera D, Dash S, Malik SK Blood carboxyhaemoglobin levels following acute exposure to smoke of biomass fuel. Indian J Med Res 1988; 88: 522-24 8 Mavalankar DV, Trivedi CR, Gray RH Levels and risk factors for permatal mortality in Ahmedabad, India Bull WHO (in press
Transthoracic endoscopic photodynamic treatment of malignant mesothelioma SIR,-There is no cure for malignant mesothelioma of the pleura, palliation, including pleurectomy and cytotoxic drugs, is
and
ineffective’
and often reduces the quality of life. Photodynamic therapy (PDT) has been used for treatment of malignant tumours with encouraging results,"* especially superficial bladder cancer. There are similarities between cancer of the bladder and mesothelioma of the pleura in that both, at least initially, grow superficially in the wall of a cavity. We treated a 64-year-old man with malignant mesothelioma of the pleura with PDT in January, 1990. The patient, who had previously been healthy, consulted a doctor for extreme tiredness and shortness of breath. Chest radiography revealed an effusion filling a third of the right pleural cavity. At thoracoscopy several polypoid tumours were found on the parietal pleura, and biopsy diagnosis was malignant mesothelioma of the epithelial type. The concentration of hyaluronic acid in the pleural exudate was significantly increased. A model of the right pleural cavity, made from a computerised tomographic (CT) scan, was used to determine the light distribution from fibre-tips in different positions. The patient was given 2-0 mg/kg ’Photofrin II’ and 48 h later thoracoscopy was repeated. The entire surface of the cavity was exposed to 20 J /cm2 of red light (628 nm) from a gold vapour laser. The procedure took 6 h and was done under epidural anaesthesia. The light dose was measured with a fibreoptic probe inserted through a separate puncture through the thoracic wall. The patient was very tired and in a poor general condition for the next 2 days. His serum creatinine rose temporarily and the sedimentation rate increased to 100 mm/h. The serum C-reactive protein became very high. He was given cloxacillin sodium as prophylaxis against infection. A CT scan 14 days after treatment
LENNART LOFGREN MATZ LARSSON LARS THANING STIG HALLGREN
A, Falkson G, Goedhals L, et al. Malignant pleural mesothelioma. a disease unaffected by current therapeutic maneuvers. J Clin Oncol 1988, 6: 527-35. 2. Marcus SL Photodynamic therapy of human cancer: clinical status, potential and needs. In: Gome CJ, ed Future directions and applications m photodynamic therapy (SPIE Inst Adv Optic Technol vol 156) Washington, DC: SPIE Optical Engineering Press, 1990. 3-56 1 Alberts
Trial of inhaled salbutamol for
DILEEP V. MAVALANKAR
1 De
usually
indicated a striking reduction in pleural tumours. To reduce the risk of metastasis in the two puncture channels through the thoracic wall, superficial electron radiation was given over the right thoracic flank 4 weeks after the PDT. No other radiotherapy has been given. The patient has been followed up with CT scans every third month. So far (10 months after the treatment) no sign of progression has been seen; all laboratory values are normal and the patient is symptom free and in good general condition.
proctalgia
fugax SIR,-A few years ago I reported in your correspondence columns that several patients, including a child, attained relief from the pain of proctalgia fugax by the inhalation of salbutamol.’ The efficacy of this treatment has been tested by a double-blind controlled trial. Thirty-one patients with the clinical diagnosis of proctalgia fugax, based on history and the exclusion of rectal pathology, were admitted to the trial. Active salbutamol and matching placebo metered dose inhalers were supplied in pairs by Glaxo, Australia. The patients were asked to use each inhaler, identified only by "A" or "B", for two attacks and to report the response.
Compliance was poor and only fifteen patients completed the protocol. Six found the active drug consistently effective and the placebo ineffective. Five, including two medical practitioners, reported the reverse. Of the others, two gave a mixed inconsistent response, one found both placebo and salbutamol effective, and one found both ineffective. This trial affords no statistical support for the efficacy of inhaled salbutamol in the treatment of proctalgia fugax, but it identifies a small cohort of patients who claim symptomatic relief. 116 Everton Street, Hamilton 2303, New South Wales, Australia
1
Wright JE
J. E. WRIGHT
Inhaled salbutamol for proctalgia
fugax. Lancet 1985, ii:
659-60.
Concerns about BST SIR,-Mr Sibbison’s (Dec 15,
p
1498)
comment on
bovine
somatotropin (BST) is a farrago of misinformation and selective reporting. Having followed the rBST saga for several years with respect to the nutritional safety of milk I would add to some of Sibbison’s statements. To suggest that the risk to man is far from clear is nonsense. Not only does Juskevich and Guyer’sl report, to which Sibbison alludes, provide the background to the US Food and Drug Administration’s statement that the use of rbGH [rBST] in dairy cattle presents no increased health risk to consumers, but Sibbison also cites only the negative comments of campaigners against genetic engineering. Earlier,yAL4 published a special communication2confirming the safety of rBST, and, in an accompanying editorialGrossman concluded "it is both inappropriate and wrong for special interest groups to play on the health and safety fears of the public to further their own ends. If the issue is economic, let it be clearly stated as such and leave genetic engineering out of the controversy". Sibbison also cites negative comment by David Kronfeld at a National Instiiu.ss of Health meeting without mentioning that at