- Email: [email protected]
Notes and News
78
jerks. After FG 7142, intermittent light stimulation for a few seconds induced in these baboons a generalised tonic-clonic seizure. These results indicate that the potent anxiogenic compound FG 7142 is also a proconvulsant. Its use in human investigations should be tempered with caution. JEAN ROSSIER Neurophysiology Laboratory and Institute of the Chemistry Natural Substances, National Centre for Scientific Research (C.N.R.S.) 91190 Gif sur Yvette, France
ROBERT DODD SOPHIE FELBLUM ANNE VALIN LIA PRADO DE CARVALHO PIERRE POTIER ROBERT NAQUET
Obituary FRANCIS ALAN ROLAND STAMMERS C.B.E., T.D., Ch.M. Birm., F.R.C.S.
Professor Stammers held the chair of surgery in the from 1946 to 1963. He died on
University of Birmingham Dec. 12 aged 84. He
educated
Dudley Grammar
School from where, in he went 1916, directly into the Garrison Artillery, serving as Royal a subaltern until the end of hostilities and being wounded in 1918. On his return to civil life he the entered University of Birmingham to read medicine. He graduated in 1923 and two years later became F.R.c.s. Thereafter he worked at the London Hospital and Children’s the Birmingham Hospital before becoming resident surgical officer at the Birmingham General Hospital for three years. In this mis PUM he imu had Hiiipic ample uppui post 111; opportunity LU11UY to perfect his surgical skills and it was apparent to everyone who met him that he was one of the great surgeons of the future. He spent 1929 as a Rockefeller fellow at the Mayo Clinic studying neurosurgery, then an emerging specialty. On his return to Birmingham he was immediately appointed to the consultant staff of the Birmingham Children’s and General Hospitals and he was in great demand all over the Midlands as a neurosurgeon and as a general surgeon too. In 1939 when his career was fulfilling the expectations and hopes of all who knew him, a second war came. He immediately joined the R.A.M.C., serving first as a surgical specialist for a brief period, then for over two years in command of a surgical division, and finally as a consultant in surgery with the rank of brigadier. He was appointed C.B.E. and mentioned in dispatches for his service in Italy; and later he was awarded the Territorial Decoration with clasp. Returning again to Birmingham, Stammers was appointed the first full-time professor of surgery. He addressed himself and his department to the treatment of duodenal ulcer, then one of the most common disabilities affecting those best equipped to serve the nation. Without exception all those who trained in his department have achieved success and distinction in abdominal surgery, and they owe this to Stammers’s fine example of service, his superb surgical judgment and technique, and his wonderful qualities. Few could have remained so constantly modest, courteous, and helpful to everyone they met, despite world acclaim and unceasing demand to lecture, to tour overseas, and to hold high office for many surgical organisations. To detail all his professional distinctions and his enormous contributions to the surgical literature would be impossible; suffice it to say that few surgeons have achieved so much throughout the world. In 1933 he married Lois Marris, also a medical graduate of Birmingham. She died in 1978. They had a son and two daughters. was
at
A. G. W. W.
Notes and News NEW YEAR HONOURS IN the honours list published on Dec. 31 knighthoods were awarded to the following members of the medical profession:
Christopher Charles Booth, director, Medical Research Council Clinical Research Centre; John David Nunes Nabarro, chairman, Joint Consultants Committee, lately consultant physician, Middlesex Hospital. Others awarded knighthoods include: Brian Harry Bailey, chairman, South West Regional Health Authority; Rt Hon. Kenneth Robinson, Minister of Health, 1964-68. RECRUITING FOR MULTICENTRE TRIALS MULTICENTRE trials are formidable logistic exercises and the U.S. Coronary Primary Prevention Trial (CPPT) has been no exception. The object was to see if men without symptoms who had cholesterol values of 265 mg/dl or more would benefit from a regimen (cholestyramine) designed to lower their serum cholesterol concentrations. This placebo controlled study was planned to have a follow-up of at least seven years and the number of men required was 3550. Where were they to come from? Physicians, advertisements in the media, clinical laboratories, blood banks, occupational screening-these and others were all potential sources, and all to some extent were used. The organisers had hoped that referrals from physicians and from clinical laboratories would provide the right number of recruits at the right rate, but they did not and the programme soon began to run behind schedule. When other sources were tapped the yield, in terms of eligible men, fell away. The key term in a very detailed account of the recruitment for the CPPT’ is "efficiency"—what percentage of initial contacts remained on the books at least as far as the first protocol visit? For medical referrals, where so much of the groundwork had already been done, the figure was 46’ 5% but for blood banks and occupational and community screenings, with their much larger numbers of potential participants, the figure hovered around 21/2%. The warning from this experience is that recruitment always falls short of the target rate. The numbers who fall by the wayside can be huge. In four big U.S. trials of this sort (CPPT, the National Diet Heart Study, part of the Hypertension and Detection Follow-up Study, and the Veterans Administration Mild Hypertension Study) almost a million contacts had to be scrutinised to yield 11 000 entrants. TROPICAL DISEASES RESEARCH AT THE NATIONAL INSTITUTE FOR MEDICAL RESEARCH NEW ways to attack African trypanosomiasis are urgently needed, because no new drugs have been developed commercially in the past thirty years and some of the few existing drugs have been withdrawn. Dr J. Williamson, of the National Institute for Medical Research,2in collaboration with Dr J. R. Brown, of Sunderland Polytechnic, has found that the antineoplastic antibiotic, daunorubicin, active against trypanosomes only in vitro, can also be made trypanocidal in vivo by means of protein conjugation. The conjugates are active against a trypanosome strain resistant to most known trypanocides and against Trypanosoma congolense, a major cause of infection in African cattle. The trypanocidal activity of coordination complexes of transition metals, especially platinum, is also being studied. Some platinum complexes of existing trypanocides have greater activity against the parasite than the original drug and are no more toxic to the host. Trypanosomiasis is accompanied by a general immunosuppression. The immunology division at NIMR is studying this profound and acute immunodeficiency with the aims of understanding the 1.
Agras WS, Bradford RH, Marshall GD, eds. Recruitment for clinical trials: the Lipid Research Clinics Coronary Primary Prevention Trial experience: its implications for future trials. Circulation 1982; 66 (part II, no. 6): 1-78/Am Heart Assoc Monogr no. 93.
2 National Institute for Medical Research. Annual
Research
Council,
1982.
Report,
1981-82.
London, Medical
79 cellular basis of the defective immune function and identifying the parasite product(s) causing the defect. Macrophages seem to be at least one of the key target cells for parasite action and after uptake of parasites in the presence of antibody they can mediate in vivo the immunosuppression characteristic of active infection. The acquired immunity in schistosomiasis is being studied by the parasitology division. Protective immunity has been demonstrated in a variety of animals after an initial infection, and the immunity is directed at the young schistosomula of a reinfecting population. Present investigations aim to elucidate the means of induction and .the mechanism by which the immune response destroys the schistosomula and the mechanisms used by the invading parasite to evade the immune response. Results in mice of cell and serum transfers from immune donors to naive recipients indicate the presence of a cell-mediated component during the first two weeks of immunisation, and experiments are now under way in which donors are treated with cyclophosphamide before cell transfer to eliminate any cell suppressor activity and enhance cellmediated responses. WHO ARE THE BOAT PEOPLE? THE number of Vietnamese refugees who have arrived in the United Kingdom since April, 1975, was, at the end of 1981, 15 855. Roughly 80% of these people are of Chinese descent. The majority formerly lived in North Vietnam, where they were regarded with suspicion when conflict with China broke out in 1977, and they came to Britain via Hong Kong. Of the remainder nearly 5000 left South Vietnam by boat, because their mercantile status was interpreted as ideological opposition to the new Communist Government. The first language of the Chinese is Cantonese and many also speak Vietnamese. The Vietnamese speak Vietnamese in all its dialects. A guidel for health workers, produced by the Health Education Council, offers this kind of basic background information on the Vietnamese community living in the U.K. The book throws light on the oriental system of names (the family name comes first-unless the order has already been reversed), the general lifestyle and beliefs of the Vietnamese (including a sad account of one family’s attempts to follow traditional mourning and burial rituals in the intransigent face of British funeral customs), and the kind offood likely to be acceptable to the Vietnamese in Britain. The sections of the book dealing with communication illustrate how ambiguous medical instructions can be: "tablet to be taken 4 times a day", for example, could easily be interpreted as "divide one tablet into four quarters and take these at intervals through the day". A mass of information is attractively presented, with photographs and diagrams, in a large-format book-the first of a series for health workers on the racial minorities of Britain. THE SURVIVAL GAME
manual2 was written "for people society’s prevailing pessimistic mode". The author, who is information officer for the Nuclear Protection Advisory Group, reasons that, however vigorously world peace is pursued, the movement may well fail; and in the meantime anyway, nuclear weapons are here, and while they are here so is the possibility that they will be used. He argues forcefully against the attitude of the Campaign for Nuclear Disarmament-that disarmament is the only true civil defence-and he censures the Ivan
Tyrell’s
nuclear defence
not stuck in our
U.K. Government’s failure to protect its citizens. Vast amounts of public money are spent on nuclear shelters for Government personnel, thus indicating, he points out, that "they do not have the same blind faith in deterrence that they expect from the rest of us". Tyrell describes some of the thorough civil-defence programmes pursued by the U.S.S.R., China, Switzerland, Sweden, and other countries. The only remnant of Britain’s efficient wartime civil-protection skills is an effective early warning system. He writes of the taboo surrounding any discussion of methods of
war and offers his information (in lieu of official advice) for the guidance of the individual thrown back on his or her own resources. A further 150 pages of down-to-earth instructions and diagrams, ranging from how to improvise a ventilation system for a fall-out shelter to suggestions for impregnating clothes against toxic particles, make frightening yet at the same time curiously heartening reading. Total lack of preparation for a nuclear attack can perhaps only be described as suicidal. Existence after a nuclear war is hardly imaginable or inviting, but this book diminishes the usual sense of impotency and doom and inspires some sort of dim survival instinct and hope.
surviving nuclear
CHOOSING A RADIONUCLIDE "THERE are no ideal radiopharmaceutical drug products for use in 1 or therapy"-so begins the second chapter in a report from the National Council on Radiation Protection and Measurements. Decisions have to be compromises. A table of radiation absorbed doses lists over seventy radioactive agents "commonly used in patients". Elsewhere, we find a rehearsal of the bayesian approach to calculating whether a diagnostic nuclear medicine procedure has added much that is of value to the clinician and his patient. How often has Bayes’ theorem been used to yield convincing evidence for the diagnostic procedures listed? Besides the table of basic radiobiological information there are, as an appendix, guidelines for evaluating radiopharmaceuticals, prepared in 1977 by a Food and Drug Administration subcommittee. The text of this N.C.R.P. report covers all the factors that clinicians and others will need to take into account when formulating a policy on nuclear medicine both for the individual patient and for institutions. Most of it is internationally transferable, though the section on how to manage a "misadministration" (a 50% dose excess for a diagnostic test and a 10% excess for a therapeutic administration) is U.S. in orientation.
diagnosis
HEALTH FERVOUR THE health fiend is widely viewed as one of the harmless but great bores of today. The quest for perfect health involves rigorous discipline in the fundamental habits of life, and whether or not the consequent wellbeing springs from the new regimen or the conquest of the challenge it presents, one sure result is constant evangelism. A remarkable history2of American health reformers, from the earliest days of fervent vegetarianism to present faith in jogging, charts how this has always been the case. For one pioneer, J. H. Kellogg, constipation was the scourge of civilisation, so he asked the keepers of Boston and London zoos how often apes defaecated. When he heard that their average was some three to four times a day, Mr Kellogg promptly advocated fibre with every meal, paraffin to lubricate the canal, and a squatting posture to pass stool. For another, chewing every morsel forty times would prove the panacea to the ills of mankind. Prof. J. C. Whorton, associate professor of biomedical history in the University of Washington, catalogues the philosophical clashes between meat eaters and vegetarians and the enthusiasms of cyclists and bodybuilders to provide a background to current western preoccupation with health. The holistic connection with religion is paramount-from a moral superiority through striving for physiological hygiene at the turn of the century, to present-day yin and yang. Despite the sneers of the cynical, the health pundits have always attracted followers, and never more so than nowadays, when health is not only big business but is also respectably linked with preventive medicine and health education. In other words, if many of the quacks have been proved wrong, the original propounders of more exercise, less meat, and more fibre, have, for the time being at least, been vindicated. Professor Whorton’s account is liberally sprinkled with anecdotes and quotations to illustrate the reforming zeal of the era and makes
good reading. 1 National Council
1. The Vietnamese in Britain: a Handbook for Health Workers. By Penny Mares. Available (£3.95) from the Publications Department, National Extension College, 18 Brooklands Avenue, Cambridge CB2 2HN. 2. The Survival Option: a Guide to Living through Nuclear War. By Ivan Tyrell. London: Jonathan Cape. 1982. Pp. 237. $7.95.
on
Radiation Protection and Measurements. Nuclear Medicine:
influencing the choice and use of radionuclides in diagnosis and therapy (NCRP Rep no 70). Obtainable from N.C R.P. Publications, 7910 Woodmont Avenue, Suite 1016, Bethesda, Maryland, 20814, U.S A. $12 2. James C. Whorton. Crusaders for Fitness: the History of American Health Reformers. Princeton University Press, 1982. Pp. 359. £14. Factors
80 DRUGS BY OTHER NAMES
Correction
Dr E. E. J. Marler’s Pharmacological and Chemical Synonymsl is the latest beneficiary ofcomputerised information handling. Marler and his assistants confess to having found the complete revision (since 1978) of this valuable work of reference a laborious task. Small wonder, for there are 120 000 terms generated by perusal of more than four thousand pharmacological and related journals. From now on, perhaps, the job will be easier. The publisher’s Amsterdam printers ensure that the user’s eye will not be strained.
Neurological Surgery.—We regret that owing to a late printing error the name of the reviewer of this book (Dec. 25, p. 1435-36) was omitted. He was Prof. Edward Hitchcock.
Diary of the Week S JAN. 2 TO 15
Tuesday,
University of London Dr A. J. Barrett, senior lecturer in haematology at Westminster Medical School, has been appointed to the chair of haematology at
Charing Cross Hospital and Westminster Medical Schools.
University of Bristol Mr D. J. Fuller, consultant
orthopaedic surgeon at the Nuffield
Orthopaedic Centre and John Radcliffe Hospital, Oxford, has been appointed to the new Zimmer-Deloro chair in orthopaedic surgery. Faculty of Occupational Medicine Dr J. A. Smiley and Dr J. A. Eustace have been made honorary .
fellows; and Prof. A. M. Adelstein, Dr M. C. S. Kennedy, Dr D. A. Ferguson, and Prof. Margaret Turner-Warwick have been awarded fellowships by distinction. Medical Research Council Dr Malcolm Godfrey, dean of the Royal Postgraduate Medical School, University of London, has been appointed second secretary to
the Council. He succeeds Dr S. G. Owen.
The Wellcome Institute for the History of Medicine The Wellcome Trust seeks an established medical scientist or medical historian who will become director of the Institute for the History of Medicine, which is to be expanded and rehoused in a separate building opposite the Wellcome Building in Euston Road, London. The Institute, already distinguished for research and teaching in the history of medicine, is to be developed into a major international archive and research centre of modern biomedical science closely associated with the Royal Society of Medicine. Further information may be found on p. 6 of classified advertisements in this issue (London edition). Sir Douglas Black, P.R.C.P., has been elected president of the Medical Protection Society. He succeeds Mr Christopher Catterall. Dr George Radda, of the department of biochemistry, University of Oxford, has received the first of the biennial gold medal awards to be made by the British Heart Foundation.
Prof. G. T. Stevenson, director of the Tenovus Research Laboratory, has shared the first Arnand Hammer Award of$100 000 with Dr Ronald Levy, of Stanford University Medical Center, Palo Alto, California. The award recognises their research into the treatment of human lymphoid malignancies with monoclonal and polyclonal antibodies.
Southampton,
A conference organised by the London Medical Group and the Society for the Study of Medical Ethics on Human Rights in Medicine will take place at the Royal College of Surgeons of England, London, on Feb. 11-12. Further information may be obtained from the Conference Secretary, London Medical Group, Tavistock House North, Tavistock Square, London WCIH 9LG. A leaflet on Occupational Therapy with Children describes physical and psychiatric conditions which can affect children and how occupational therapy can help them. Written by occupational therapists for colleagues working in rehabilitation, it may be obtained from the College of Occupational Therapists, 20 Rede Place, London W2 4TU. 1. Pharmacological and Chemical
Synonyms: a collection of names of drugs, pesticides compounds drawn from the medical literature of the world, 7th ed. Compiled by E. E. J. Marler. Amsterdam. Excerpta Medical. New York: Elsevier, 1983 Pp. 514. D.fl. 180; $76.50. and other
4th
LONDON MEDICAL GROUP 5 45 P.M. (St Mary’s Hospital, Praed Street, London W2) Dr Jack Dommian: Early and Marry Often-the Causes of Mantal Breakdown.
Marry
Wednesday, 5th ROYAL MASONIC HOSPITAL, Ravenscourt Park, London W6 OTN 7 P.M. Mr P. H. Pattisson. Vascular Disease in the Lower Extremities. ROYAL FREE HOSPITAL SCHOOL OF MEDICINE, Rowland Hill Street, London NW3 2PF 5 P M. Prof. D. M. Denison: Assessment of Lung Function.
6th
Thursday,
LONDON MEDICAL GROUP 5 45 P.M. (St Thomas’s Hospital, Lambeth Palace Road, London SEI) to Pot: the Consequences of Legalising Marijuana.
Symposrum.-Going
Friday,
7th
NUFFIELD ORTHOPAEDIC CENTRE, Headington, Oxford OX3 7LD 6.30 P.M. Dr J. M. Connor’ Ectopic Ossification.
Saturday,
8th
NUFFIELD ORTHOPAEDIC CENTRE 8.30 A.M. Dr Connor: Myositis Ossificans Progressiva. 9.30 A.M. Mr M. Owen: Ossification Patterns.
Monday, 10th INSTITUTE OF OBSTETRICS AND GYNAECOLOGY, Conference Room, Queen Charlotte’s Maternity Hospital, Goldhawk Road, London W6 OXG 12.30 P.M. Mr David Horwell: Aspiration of Chorionic Villi for Antenatal Diagnosis.
Tuesday, llth LONDON MEDICAL GROUP 5.45 P.M. (University College Hospital, Gower Street, London WCI) Symposium -What tf Bisexuahty is the Norm? MANCHESTER MEDICAL SOCIETY, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PP 8 P M. Dr G. Read and Dr P. M. Wilkmson: Malignant Testicular Tumours. BIRMINGHAM MEDICAL INSTITUTE, 36 Harborne Road, Edgbaston, Birmingham B153AF 8 P.M. Dr Raymond Banner. The View from Within-a Broad Look at the Problem of
Body-mind-bram Relationships.
Wednesday, 12th INSTITUTE OF DERMATOLOGY, St John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London WC2H 7BJ 4.45 P.M. Dr F. T. Wojnarwoska Uses oflmmunofluorescence. INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, London WC1N 3BG 6 P.M Dr Peter Fenwick: Basic Electrophysiological Mechanisms of Epilepsy. 7 P M. Prof. R. W. Gilhatt: Recording Clinical Seizures. INSTITUTE OF OBSTETRICS AND GYNAECOLOGY 1 P.M (board room, Chelsea Hospital for Women, Dovehouse Street, London SW3) Sir John Dewhurst: An Historical Look at Menstruation. ROYAL MASONIC HOSPITAL 7 P.M. Dr Drew Thomson: The Pathology of Conditions Covered in the Previous Lectures ROYAL FREE HOSPITAL SCHOOL OF MEDICINE 5 P.M. Prof. R H. T. Edwards: Physiological and Metabolic
Study
of Human
Myopathy. NORTHWICK PARK HOSPITAL AND CLINICAL RESEARCH CENTRE, Watford Road, Harrow, Middlesex HA1 3UJ I P.M. Dr H. T. Davenport: Day Care Surgery. MANCHESTER MEDICAL SOCIETY 5 P.M. Dr H. Gunson: Trends in Blood Component Therapy. MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH 8 P.M. (Royal College of Surgeons, New Symposium Hall, Hill Square, Edinburgh) Prof. A. P M. Forrest, Dr Henry Gebbie, Mr David Hamilton, and Dr R. A. Parry The University, the N.H.S. and Private Practice.
Thursday,
13th
LONDON MEDICAL GROUP 6 15 PM. (Westminster Hospital, Horseferry Road, London SWI) Symposium.Depo-Provera and Women at Risk: a Case of Government Intervention.
Saturday,
15th
NUFFIELD ORTHOPAEDIC CENTRE 8.30 A.M Miss R. Wynne-Davis: Anarchic Bone Growth-Genetic and Other Varieties. 9.30 A.M Dr R. Smith: Treatment of Disorders of Ectopic Ossification.
jerks. After FG 7142, intermittent light stimulation for a few seconds induced in these baboons a generalised tonic-clonic seizure. These results indicate that the potent anxiogenic compound FG 7142 is also a proconvulsant. Its use in human investigations should be tempered with caution. JEAN ROSSIER Neurophysiology Laboratory and Institute of the Chemistry Natural Substances, National Centre for Scientific Research (C.N.R.S.) 91190 Gif sur Yvette, France
ROBERT DODD SOPHIE FELBLUM ANNE VALIN LIA PRADO DE CARVALHO PIERRE POTIER ROBERT NAQUET
Obituary FRANCIS ALAN ROLAND STAMMERS C.B.E., T.D., Ch.M. Birm., F.R.C.S.
Professor Stammers held the chair of surgery in the from 1946 to 1963. He died on
University of Birmingham Dec. 12 aged 84. He
educated
Dudley Grammar
School from where, in he went 1916, directly into the Garrison Artillery, serving as Royal a subaltern until the end of hostilities and being wounded in 1918. On his return to civil life he the entered University of Birmingham to read medicine. He graduated in 1923 and two years later became F.R.c.s. Thereafter he worked at the London Hospital and Children’s the Birmingham Hospital before becoming resident surgical officer at the Birmingham General Hospital for three years. In this mis PUM he imu had Hiiipic ample uppui post 111; opportunity LU11UY to perfect his surgical skills and it was apparent to everyone who met him that he was one of the great surgeons of the future. He spent 1929 as a Rockefeller fellow at the Mayo Clinic studying neurosurgery, then an emerging specialty. On his return to Birmingham he was immediately appointed to the consultant staff of the Birmingham Children’s and General Hospitals and he was in great demand all over the Midlands as a neurosurgeon and as a general surgeon too. In 1939 when his career was fulfilling the expectations and hopes of all who knew him, a second war came. He immediately joined the R.A.M.C., serving first as a surgical specialist for a brief period, then for over two years in command of a surgical division, and finally as a consultant in surgery with the rank of brigadier. He was appointed C.B.E. and mentioned in dispatches for his service in Italy; and later he was awarded the Territorial Decoration with clasp. Returning again to Birmingham, Stammers was appointed the first full-time professor of surgery. He addressed himself and his department to the treatment of duodenal ulcer, then one of the most common disabilities affecting those best equipped to serve the nation. Without exception all those who trained in his department have achieved success and distinction in abdominal surgery, and they owe this to Stammers’s fine example of service, his superb surgical judgment and technique, and his wonderful qualities. Few could have remained so constantly modest, courteous, and helpful to everyone they met, despite world acclaim and unceasing demand to lecture, to tour overseas, and to hold high office for many surgical organisations. To detail all his professional distinctions and his enormous contributions to the surgical literature would be impossible; suffice it to say that few surgeons have achieved so much throughout the world. In 1933 he married Lois Marris, also a medical graduate of Birmingham. She died in 1978. They had a son and two daughters. was
at
A. G. W. W.
Notes and News NEW YEAR HONOURS IN the honours list published on Dec. 31 knighthoods were awarded to the following members of the medical profession:
Christopher Charles Booth, director, Medical Research Council Clinical Research Centre; John David Nunes Nabarro, chairman, Joint Consultants Committee, lately consultant physician, Middlesex Hospital. Others awarded knighthoods include: Brian Harry Bailey, chairman, South West Regional Health Authority; Rt Hon. Kenneth Robinson, Minister of Health, 1964-68. RECRUITING FOR MULTICENTRE TRIALS MULTICENTRE trials are formidable logistic exercises and the U.S. Coronary Primary Prevention Trial (CPPT) has been no exception. The object was to see if men without symptoms who had cholesterol values of 265 mg/dl or more would benefit from a regimen (cholestyramine) designed to lower their serum cholesterol concentrations. This placebo controlled study was planned to have a follow-up of at least seven years and the number of men required was 3550. Where were they to come from? Physicians, advertisements in the media, clinical laboratories, blood banks, occupational screening-these and others were all potential sources, and all to some extent were used. The organisers had hoped that referrals from physicians and from clinical laboratories would provide the right number of recruits at the right rate, but they did not and the programme soon began to run behind schedule. When other sources were tapped the yield, in terms of eligible men, fell away. The key term in a very detailed account of the recruitment for the CPPT’ is "efficiency"—what percentage of initial contacts remained on the books at least as far as the first protocol visit? For medical referrals, where so much of the groundwork had already been done, the figure was 46’ 5% but for blood banks and occupational and community screenings, with their much larger numbers of potential participants, the figure hovered around 21/2%. The warning from this experience is that recruitment always falls short of the target rate. The numbers who fall by the wayside can be huge. In four big U.S. trials of this sort (CPPT, the National Diet Heart Study, part of the Hypertension and Detection Follow-up Study, and the Veterans Administration Mild Hypertension Study) almost a million contacts had to be scrutinised to yield 11 000 entrants. TROPICAL DISEASES RESEARCH AT THE NATIONAL INSTITUTE FOR MEDICAL RESEARCH NEW ways to attack African trypanosomiasis are urgently needed, because no new drugs have been developed commercially in the past thirty years and some of the few existing drugs have been withdrawn. Dr J. Williamson, of the National Institute for Medical Research,2in collaboration with Dr J. R. Brown, of Sunderland Polytechnic, has found that the antineoplastic antibiotic, daunorubicin, active against trypanosomes only in vitro, can also be made trypanocidal in vivo by means of protein conjugation. The conjugates are active against a trypanosome strain resistant to most known trypanocides and against Trypanosoma congolense, a major cause of infection in African cattle. The trypanocidal activity of coordination complexes of transition metals, especially platinum, is also being studied. Some platinum complexes of existing trypanocides have greater activity against the parasite than the original drug and are no more toxic to the host. Trypanosomiasis is accompanied by a general immunosuppression. The immunology division at NIMR is studying this profound and acute immunodeficiency with the aims of understanding the 1.
Agras WS, Bradford RH, Marshall GD, eds. Recruitment for clinical trials: the Lipid Research Clinics Coronary Primary Prevention Trial experience: its implications for future trials. Circulation 1982; 66 (part II, no. 6): 1-78/Am Heart Assoc Monogr no. 93.
2 National Institute for Medical Research. Annual
Research
Council,
1982.
Report,
1981-82.
London, Medical
79 cellular basis of the defective immune function and identifying the parasite product(s) causing the defect. Macrophages seem to be at least one of the key target cells for parasite action and after uptake of parasites in the presence of antibody they can mediate in vivo the immunosuppression characteristic of active infection. The acquired immunity in schistosomiasis is being studied by the parasitology division. Protective immunity has been demonstrated in a variety of animals after an initial infection, and the immunity is directed at the young schistosomula of a reinfecting population. Present investigations aim to elucidate the means of induction and .the mechanism by which the immune response destroys the schistosomula and the mechanisms used by the invading parasite to evade the immune response. Results in mice of cell and serum transfers from immune donors to naive recipients indicate the presence of a cell-mediated component during the first two weeks of immunisation, and experiments are now under way in which donors are treated with cyclophosphamide before cell transfer to eliminate any cell suppressor activity and enhance cellmediated responses. WHO ARE THE BOAT PEOPLE? THE number of Vietnamese refugees who have arrived in the United Kingdom since April, 1975, was, at the end of 1981, 15 855. Roughly 80% of these people are of Chinese descent. The majority formerly lived in North Vietnam, where they were regarded with suspicion when conflict with China broke out in 1977, and they came to Britain via Hong Kong. Of the remainder nearly 5000 left South Vietnam by boat, because their mercantile status was interpreted as ideological opposition to the new Communist Government. The first language of the Chinese is Cantonese and many also speak Vietnamese. The Vietnamese speak Vietnamese in all its dialects. A guidel for health workers, produced by the Health Education Council, offers this kind of basic background information on the Vietnamese community living in the U.K. The book throws light on the oriental system of names (the family name comes first-unless the order has already been reversed), the general lifestyle and beliefs of the Vietnamese (including a sad account of one family’s attempts to follow traditional mourning and burial rituals in the intransigent face of British funeral customs), and the kind offood likely to be acceptable to the Vietnamese in Britain. The sections of the book dealing with communication illustrate how ambiguous medical instructions can be: "tablet to be taken 4 times a day", for example, could easily be interpreted as "divide one tablet into four quarters and take these at intervals through the day". A mass of information is attractively presented, with photographs and diagrams, in a large-format book-the first of a series for health workers on the racial minorities of Britain. THE SURVIVAL GAME
manual2 was written "for people society’s prevailing pessimistic mode". The author, who is information officer for the Nuclear Protection Advisory Group, reasons that, however vigorously world peace is pursued, the movement may well fail; and in the meantime anyway, nuclear weapons are here, and while they are here so is the possibility that they will be used. He argues forcefully against the attitude of the Campaign for Nuclear Disarmament-that disarmament is the only true civil defence-and he censures the Ivan
Tyrell’s
nuclear defence
not stuck in our
U.K. Government’s failure to protect its citizens. Vast amounts of public money are spent on nuclear shelters for Government personnel, thus indicating, he points out, that "they do not have the same blind faith in deterrence that they expect from the rest of us". Tyrell describes some of the thorough civil-defence programmes pursued by the U.S.S.R., China, Switzerland, Sweden, and other countries. The only remnant of Britain’s efficient wartime civil-protection skills is an effective early warning system. He writes of the taboo surrounding any discussion of methods of
war and offers his information (in lieu of official advice) for the guidance of the individual thrown back on his or her own resources. A further 150 pages of down-to-earth instructions and diagrams, ranging from how to improvise a ventilation system for a fall-out shelter to suggestions for impregnating clothes against toxic particles, make frightening yet at the same time curiously heartening reading. Total lack of preparation for a nuclear attack can perhaps only be described as suicidal. Existence after a nuclear war is hardly imaginable or inviting, but this book diminishes the usual sense of impotency and doom and inspires some sort of dim survival instinct and hope.
surviving nuclear
CHOOSING A RADIONUCLIDE "THERE are no ideal radiopharmaceutical drug products for use in 1 or therapy"-so begins the second chapter in a report from the National Council on Radiation Protection and Measurements. Decisions have to be compromises. A table of radiation absorbed doses lists over seventy radioactive agents "commonly used in patients". Elsewhere, we find a rehearsal of the bayesian approach to calculating whether a diagnostic nuclear medicine procedure has added much that is of value to the clinician and his patient. How often has Bayes’ theorem been used to yield convincing evidence for the diagnostic procedures listed? Besides the table of basic radiobiological information there are, as an appendix, guidelines for evaluating radiopharmaceuticals, prepared in 1977 by a Food and Drug Administration subcommittee. The text of this N.C.R.P. report covers all the factors that clinicians and others will need to take into account when formulating a policy on nuclear medicine both for the individual patient and for institutions. Most of it is internationally transferable, though the section on how to manage a "misadministration" (a 50% dose excess for a diagnostic test and a 10% excess for a therapeutic administration) is U.S. in orientation.
diagnosis
HEALTH FERVOUR THE health fiend is widely viewed as one of the harmless but great bores of today. The quest for perfect health involves rigorous discipline in the fundamental habits of life, and whether or not the consequent wellbeing springs from the new regimen or the conquest of the challenge it presents, one sure result is constant evangelism. A remarkable history2of American health reformers, from the earliest days of fervent vegetarianism to present faith in jogging, charts how this has always been the case. For one pioneer, J. H. Kellogg, constipation was the scourge of civilisation, so he asked the keepers of Boston and London zoos how often apes defaecated. When he heard that their average was some three to four times a day, Mr Kellogg promptly advocated fibre with every meal, paraffin to lubricate the canal, and a squatting posture to pass stool. For another, chewing every morsel forty times would prove the panacea to the ills of mankind. Prof. J. C. Whorton, associate professor of biomedical history in the University of Washington, catalogues the philosophical clashes between meat eaters and vegetarians and the enthusiasms of cyclists and bodybuilders to provide a background to current western preoccupation with health. The holistic connection with religion is paramount-from a moral superiority through striving for physiological hygiene at the turn of the century, to present-day yin and yang. Despite the sneers of the cynical, the health pundits have always attracted followers, and never more so than nowadays, when health is not only big business but is also respectably linked with preventive medicine and health education. In other words, if many of the quacks have been proved wrong, the original propounders of more exercise, less meat, and more fibre, have, for the time being at least, been vindicated. Professor Whorton’s account is liberally sprinkled with anecdotes and quotations to illustrate the reforming zeal of the era and makes
good reading. 1 National Council
1. The Vietnamese in Britain: a Handbook for Health Workers. By Penny Mares. Available (£3.95) from the Publications Department, National Extension College, 18 Brooklands Avenue, Cambridge CB2 2HN. 2. The Survival Option: a Guide to Living through Nuclear War. By Ivan Tyrell. London: Jonathan Cape. 1982. Pp. 237. $7.95.
on
Radiation Protection and Measurements. Nuclear Medicine:
influencing the choice and use of radionuclides in diagnosis and therapy (NCRP Rep no 70). Obtainable from N.C R.P. Publications, 7910 Woodmont Avenue, Suite 1016, Bethesda, Maryland, 20814, U.S A. $12 2. James C. Whorton. Crusaders for Fitness: the History of American Health Reformers. Princeton University Press, 1982. Pp. 359. £14. Factors
80 DRUGS BY OTHER NAMES
Correction
Dr E. E. J. Marler’s Pharmacological and Chemical Synonymsl is the latest beneficiary ofcomputerised information handling. Marler and his assistants confess to having found the complete revision (since 1978) of this valuable work of reference a laborious task. Small wonder, for there are 120 000 terms generated by perusal of more than four thousand pharmacological and related journals. From now on, perhaps, the job will be easier. The publisher’s Amsterdam printers ensure that the user’s eye will not be strained.
Neurological Surgery.—We regret that owing to a late printing error the name of the reviewer of this book (Dec. 25, p. 1435-36) was omitted. He was Prof. Edward Hitchcock.
Diary of the Week S JAN. 2 TO 15
Tuesday,
University of London Dr A. J. Barrett, senior lecturer in haematology at Westminster Medical School, has been appointed to the chair of haematology at
Charing Cross Hospital and Westminster Medical Schools.
University of Bristol Mr D. J. Fuller, consultant
orthopaedic surgeon at the Nuffield
Orthopaedic Centre and John Radcliffe Hospital, Oxford, has been appointed to the new Zimmer-Deloro chair in orthopaedic surgery. Faculty of Occupational Medicine Dr J. A. Smiley and Dr J. A. Eustace have been made honorary .
fellows; and Prof. A. M. Adelstein, Dr M. C. S. Kennedy, Dr D. A. Ferguson, and Prof. Margaret Turner-Warwick have been awarded fellowships by distinction. Medical Research Council Dr Malcolm Godfrey, dean of the Royal Postgraduate Medical School, University of London, has been appointed second secretary to
the Council. He succeeds Dr S. G. Owen.
The Wellcome Institute for the History of Medicine The Wellcome Trust seeks an established medical scientist or medical historian who will become director of the Institute for the History of Medicine, which is to be expanded and rehoused in a separate building opposite the Wellcome Building in Euston Road, London. The Institute, already distinguished for research and teaching in the history of medicine, is to be developed into a major international archive and research centre of modern biomedical science closely associated with the Royal Society of Medicine. Further information may be found on p. 6 of classified advertisements in this issue (London edition). Sir Douglas Black, P.R.C.P., has been elected president of the Medical Protection Society. He succeeds Mr Christopher Catterall. Dr George Radda, of the department of biochemistry, University of Oxford, has received the first of the biennial gold medal awards to be made by the British Heart Foundation.
Prof. G. T. Stevenson, director of the Tenovus Research Laboratory, has shared the first Arnand Hammer Award of$100 000 with Dr Ronald Levy, of Stanford University Medical Center, Palo Alto, California. The award recognises their research into the treatment of human lymphoid malignancies with monoclonal and polyclonal antibodies.
Southampton,
A conference organised by the London Medical Group and the Society for the Study of Medical Ethics on Human Rights in Medicine will take place at the Royal College of Surgeons of England, London, on Feb. 11-12. Further information may be obtained from the Conference Secretary, London Medical Group, Tavistock House North, Tavistock Square, London WCIH 9LG. A leaflet on Occupational Therapy with Children describes physical and psychiatric conditions which can affect children and how occupational therapy can help them. Written by occupational therapists for colleagues working in rehabilitation, it may be obtained from the College of Occupational Therapists, 20 Rede Place, London W2 4TU. 1. Pharmacological and Chemical
Synonyms: a collection of names of drugs, pesticides compounds drawn from the medical literature of the world, 7th ed. Compiled by E. E. J. Marler. Amsterdam. Excerpta Medical. New York: Elsevier, 1983 Pp. 514. D.fl. 180; $76.50. and other
4th
LONDON MEDICAL GROUP 5 45 P.M. (St Mary’s Hospital, Praed Street, London W2) Dr Jack Dommian: Early and Marry Often-the Causes of Mantal Breakdown.
Marry
Wednesday, 5th ROYAL MASONIC HOSPITAL, Ravenscourt Park, London W6 OTN 7 P.M. Mr P. H. Pattisson. Vascular Disease in the Lower Extremities. ROYAL FREE HOSPITAL SCHOOL OF MEDICINE, Rowland Hill Street, London NW3 2PF 5 P M. Prof. D. M. Denison: Assessment of Lung Function.
6th
Thursday,
LONDON MEDICAL GROUP 5 45 P.M. (St Thomas’s Hospital, Lambeth Palace Road, London SEI) to Pot: the Consequences of Legalising Marijuana.
Symposrum.-Going
Friday,
7th
NUFFIELD ORTHOPAEDIC CENTRE, Headington, Oxford OX3 7LD 6.30 P.M. Dr J. M. Connor’ Ectopic Ossification.
Saturday,
8th
NUFFIELD ORTHOPAEDIC CENTRE 8.30 A.M. Dr Connor: Myositis Ossificans Progressiva. 9.30 A.M. Mr M. Owen: Ossification Patterns.
Monday, 10th INSTITUTE OF OBSTETRICS AND GYNAECOLOGY, Conference Room, Queen Charlotte’s Maternity Hospital, Goldhawk Road, London W6 OXG 12.30 P.M. Mr David Horwell: Aspiration of Chorionic Villi for Antenatal Diagnosis.
Tuesday, llth LONDON MEDICAL GROUP 5.45 P.M. (University College Hospital, Gower Street, London WCI) Symposium -What tf Bisexuahty is the Norm? MANCHESTER MEDICAL SOCIETY, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PP 8 P M. Dr G. Read and Dr P. M. Wilkmson: Malignant Testicular Tumours. BIRMINGHAM MEDICAL INSTITUTE, 36 Harborne Road, Edgbaston, Birmingham B153AF 8 P.M. Dr Raymond Banner. The View from Within-a Broad Look at the Problem of
Body-mind-bram Relationships.
Wednesday, 12th INSTITUTE OF DERMATOLOGY, St John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London WC2H 7BJ 4.45 P.M. Dr F. T. Wojnarwoska Uses oflmmunofluorescence. INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, London WC1N 3BG 6 P.M Dr Peter Fenwick: Basic Electrophysiological Mechanisms of Epilepsy. 7 P M. Prof. R. W. Gilhatt: Recording Clinical Seizures. INSTITUTE OF OBSTETRICS AND GYNAECOLOGY 1 P.M (board room, Chelsea Hospital for Women, Dovehouse Street, London SW3) Sir John Dewhurst: An Historical Look at Menstruation. ROYAL MASONIC HOSPITAL 7 P.M. Dr Drew Thomson: The Pathology of Conditions Covered in the Previous Lectures ROYAL FREE HOSPITAL SCHOOL OF MEDICINE 5 P.M. Prof. R H. T. Edwards: Physiological and Metabolic
Study
of Human
Myopathy. NORTHWICK PARK HOSPITAL AND CLINICAL RESEARCH CENTRE, Watford Road, Harrow, Middlesex HA1 3UJ I P.M. Dr H. T. Davenport: Day Care Surgery. MANCHESTER MEDICAL SOCIETY 5 P.M. Dr H. Gunson: Trends in Blood Component Therapy. MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH 8 P.M. (Royal College of Surgeons, New Symposium Hall, Hill Square, Edinburgh) Prof. A. P M. Forrest, Dr Henry Gebbie, Mr David Hamilton, and Dr R. A. Parry The University, the N.H.S. and Private Practice.
Thursday,
13th
LONDON MEDICAL GROUP 6 15 PM. (Westminster Hospital, Horseferry Road, London SWI) Symposium.Depo-Provera and Women at Risk: a Case of Government Intervention.
Saturday,
15th
NUFFIELD ORTHOPAEDIC CENTRE 8.30 A.M Miss R. Wynne-Davis: Anarchic Bone Growth-Genetic and Other Varieties. 9.30 A.M Dr R. Smith: Treatment of Disorders of Ectopic Ossification.