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Kasabach-Merritt syndrome
DISSECTING ROOM
who succeed usually do so only after many attempts. Although approximately 70% of smokers in a given year want to quit, only 2·5% successfully do so. The consenting adults are often hooked early. The concluding chapter is headed by a 1922 quote from H L Mencken which begins: “Hygiene is the corruption of medicine by morality . . . The physician does not preach repentance; he offers absolution.” Sullum acknowledges that, “judging by the share of experimenters who become regular users . . . tobacco is more addictive than any other recreational drug . . . (and) judging by the share of users who die from its effects, tobacco is also far more hazardous than any other recreational drug.” But he disdains public health as “paternalistic tyranny” and fears that government intervention will lead to total prohibition of tobacco, with tens of millions of smokers turned into criminals overnight: “For someone who believes, as I do, that the government has no business telling adults what chemicals they may ingest, citing the inconsistency of US drug policy is risky. There are, after all, two ways to correct the inconsistency: by legalising the currently proscribed drugs or by proscribing the currently legal ones. If tobacco really is worse than heroin—and in some ways it clearly is—why not ban tobacco? Assuming that the government has a duty to protect people from dangerous addictive substances, it seems like a logical step.” Sullum reminds us of the failures of the Volstead Act, implementing alcohol prohibition in the USA and he could have spoken to the problems related to current US drug policies which overly focus on criminalisation of individual users and in which spending for punishment and interdiction greatly exceeds that for prevention and treatment. But the answer is not to do nothing and allow teenagers and the tobacco industry “freedom of choice” only to face their regrets later.This is neither the 1916 of the Volstead Act nor the 1922 in which Mencken wrote. Public health experts have been informed by the past but this past includes the 20th century litany of studies listing the harmful effects of smoking, the addictive potential of nicotine, and the duplicity and power of the tobacco industry. Rather than all-powerful paternalistic tyrants, we are simply “redefining the unacceptable” and working to protect the health of individuals and society. James Curran Dean Rollins School of Public Health, Emer y University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
THE LANCET • Vol 352 • August 29, 1998
Kasabach-Merritt syndrome The anticipated twofold name par t Prussian even, the stacked pages and graphs are beyond me, the blackish photographs, words like hemangioma, vascular, primitive angioblast, self-limiting, transient, cosmetic and benign and then to scare me: or morbid and cavernous. I turn back to the table, the harsh light where you lie without protest naked, new born, your skin is gray and ill like fine sand weightless or weighed down your life’s violence and possibility presenting only in this scattering of dark lesions, visible and terrible. Described as warm to the touch, taut, pulsatile, without audible bruit. A string of three across your brow blood-red and shiny, so my pencil leaps and cringes. More on your belly, your side, while down your gauzy arm and at your throat swarm the enlarged and involute: black, foamy, petrified. I draw a listless hand finger by finger, the forgiveable minutiae of nail, knuckle, and on the third, there— a berr y, a sudden ruby! Ruby. In a word I see you, the air goes clear as water, you’re bejewelled then, bedecked as with coral rising, its gems and encrustations islands of breathing silence, you are star studded, manifold, and my hand steadies, my vision writes indelibly, as with points of diamonds. Heather Spears Edmonton, Vancouver, Canada
Skim Jenny Pockley
747
who succeed usually do so only after many attempts. Although approximately 70% of smokers in a given year want to quit, only 2·5% successfully do so. The consenting adults are often hooked early. The concluding chapter is headed by a 1922 quote from H L Mencken which begins: “Hygiene is the corruption of medicine by morality . . . The physician does not preach repentance; he offers absolution.” Sullum acknowledges that, “judging by the share of experimenters who become regular users . . . tobacco is more addictive than any other recreational drug . . . (and) judging by the share of users who die from its effects, tobacco is also far more hazardous than any other recreational drug.” But he disdains public health as “paternalistic tyranny” and fears that government intervention will lead to total prohibition of tobacco, with tens of millions of smokers turned into criminals overnight: “For someone who believes, as I do, that the government has no business telling adults what chemicals they may ingest, citing the inconsistency of US drug policy is risky. There are, after all, two ways to correct the inconsistency: by legalising the currently proscribed drugs or by proscribing the currently legal ones. If tobacco really is worse than heroin—and in some ways it clearly is—why not ban tobacco? Assuming that the government has a duty to protect people from dangerous addictive substances, it seems like a logical step.” Sullum reminds us of the failures of the Volstead Act, implementing alcohol prohibition in the USA and he could have spoken to the problems related to current US drug policies which overly focus on criminalisation of individual users and in which spending for punishment and interdiction greatly exceeds that for prevention and treatment. But the answer is not to do nothing and allow teenagers and the tobacco industry “freedom of choice” only to face their regrets later.This is neither the 1916 of the Volstead Act nor the 1922 in which Mencken wrote. Public health experts have been informed by the past but this past includes the 20th century litany of studies listing the harmful effects of smoking, the addictive potential of nicotine, and the duplicity and power of the tobacco industry. Rather than all-powerful paternalistic tyrants, we are simply “redefining the unacceptable” and working to protect the health of individuals and society. James Curran Dean Rollins School of Public Health, Emer y University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
THE LANCET • Vol 352 • August 29, 1998
Kasabach-Merritt syndrome The anticipated twofold name par t Prussian even, the stacked pages and graphs are beyond me, the blackish photographs, words like hemangioma, vascular, primitive angioblast, self-limiting, transient, cosmetic and benign and then to scare me: or morbid and cavernous. I turn back to the table, the harsh light where you lie without protest naked, new born, your skin is gray and ill like fine sand weightless or weighed down your life’s violence and possibility presenting only in this scattering of dark lesions, visible and terrible. Described as warm to the touch, taut, pulsatile, without audible bruit. A string of three across your brow blood-red and shiny, so my pencil leaps and cringes. More on your belly, your side, while down your gauzy arm and at your throat swarm the enlarged and involute: black, foamy, petrified. I draw a listless hand finger by finger, the forgiveable minutiae of nail, knuckle, and on the third, there— a berr y, a sudden ruby! Ruby. In a word I see you, the air goes clear as water, you’re bejewelled then, bedecked as with coral rising, its gems and encrustations islands of breathing silence, you are star studded, manifold, and my hand steadies, my vision writes indelibly, as with points of diamonds. Heather Spears Edmonton, Vancouver, Canada
Skim Jenny Pockley
747