- Email: [email protected]
Scourge of Japanese encephalitis in south-western Nepal
CORRESPONDENCE
with standardised, carefully produced preparations. We often forget that cannabis has been an accepted medicament of western medicine, and that it was available in many countries until some decades ago. There is still much to learn about cannabis, but that is also true for single cannabinoids, especially for new synthetic cannabinoid analogues. Leaving aside the route of administration and the hazards (eg, contamination) caused by its legal status, I cannot see that the plant as a whole would cause any more health risks than THC alone would do. The argument for cannabinoids, versus cannabis, is based on the wish to restrict those who want cannabis use to be legalised. Maybe it is based on fear of not being taken seriously by the scientific community, but in fact this fear may undermine the credibility of the scientific argument. Franjo Grotenhermen Arbeitsgemeinschaft Cannabis als Medizin, Maybachstraße 14, D-50670 Köln, Germany 1
Morris K. The cannabis remedy—wonder worker or evil weed. Lancet 1997; 350: 1828.
Research funding in Canada Sir—Wayne Kondro’s report of the “self-congratulatory” tone of the report on Canadian federal government spending on science and technology in his Jan 10 news item (p 119)1 contrasts sharply with the sense of crisis permeating the research community in Canada. Many in this community view the current situation as little short of a disaster, and wonder for how much longer a broadly based, internationally competitive, national research effort can be sustained. Underlying this crisis is the chronic underfunding of the Medical Research Council (MRC) and Natural Sciences and Engineering Research Council (NSERC), compounded by annual decreases to the base budgets of these funding bodies in recent years. The situation in Canada, where government investment in research and development is declining,1 contrasts starkly with the trend in other developed countries, particularly the USA. In constant dollars, the Canadian MRC budget is now at the same level as it was in 1987, whereas the budget of the US National Institutes of Health (NIH) has doubled within this time.2 In fiscal year 1998–99, the MRC base budget will decrease by a further 3%,
THE LANCET • Vol 351 • March 7, 1998
whereas the US Congress is moving in the direction of a further doubling of the NIH budget within the next 5 years.2 Even in Japan and South Korea, countries hard hit by recent currency and stock market turmoil, research and development is protected, with spending increases actually being proposed in both countries.3 As a result of current federal government policies, the number of funded Canadian researchers is steadily declining, and those who are funded have seen operating and equipment budgets continue to shrink. In the latest MRC competition, the “success” rate for operating grant applications was only 19·5%, with many highly rated grants falling below the cutoff line, because of lack of funds. The 19·5% “success” rate could be achieved only by cutting the recommended budgets of funded applicants by 26% overall. The average size (in direct costs) of an MRC research grant is now Cdn$70 000, versus Cdn$213 000 for an NIH grant. Federal government spending per person for basic biomedical, clinical, and health research is at least six-fold higher in the USA than in Canada, and rising. In the face of this is it any wonder that Canadian researchers remain sceptical about selfcongratulatory reports on the health of the research and development enterprise in Canada? Carl Sagan4 highlighted two different views of the role of government in the advancement of knowledge. Current US legislators seem to be heeding the advice of George Washington, who in an address to Congress in 1790 asserted: “There is nothing which can better deserve our patronage than the promotion of science and literature. Knowledge is in every country the surest basis of public happiness”, Canadian legislators seem to be more in tune with the views of Ronald Reagan, who in a campaign speech in 1980, asked: “Why should we subsidise intellectual curiosity?” If Canadian funders do not know the answer to that question, they should not be surprised if the country becomes a net exporter of intellectual capital, as well as of natural resources. Michael W Gray Program in Evolutionary Biology, Canadian Institute for Advanced Research, Department of Biochemistry, Dalhouse University, Halifax, Nova Scotia B3H 4H7, Canada (e-mail: [email protected]) 1 2
3
Kondro W. Canada’s government talks up Canadian science. Lancet 1998; 351: 119. Pear R. Medical research to get more money from government. New York Times January 3, 1998. Saegusa A. Japan maintains research funding
4
boost . . . as science escapes cuts in South Korea. Nature 1998; 39: 111. Sagan C. The demon-haunted world. Science as a candle in the dark. New York: Ballantine Books, 1995.
Scourge of Japanese encephalitis in southwestern Nepal Sir—In December, 1997, I visited the district hospital of Tikapur, a small rural town in south-western Nepal. Between July 16, and October 20, 1997, 339 patients with Japanese encephalitis were admitted to the hospital. 43 of the patients died, 262 survived, and 34 were transferred to a general hospital with 150 beds in Nepalganj, the largest city in the south-western region of Nepal or Lucknow, India. In Nepalganj hospital, 75 of 550 patients with Japanese encephalitis admitted are reported to have died by September, 1997. 1 In Tikapur, about 10% of patients who survived are reported to have modest to severe neurological sequelae and cognitive impairment. The principal of a local primary school told me that 115 children died of Japanese encephalitis or related disorders during that scourge. According to the Tikapur hospital record, the first epidemic of Japanese encephalitis occurred in 1982, the second in 1986, and the third in 1988. Since 1990, epidemics have scourged the area every year. The 1997 epidemic was one of the most severe in the past 25 years. No effective publichealth measures and medical interventions have been set up. Japanese encephalitis epidemics occur exclusively in China, India, and other Asian and Island regions. Although total deaths from this disease worldwide are only 29 000, cognitive impairment numbered 708 000 and neurological sequelae numbered 944 000, in 1990, respectively. 2 In poor countries like Nepal, such a burden of disease will further impede economic and social development, locally as well as nationally. WHO and other international agencies are urged to help collectively to tackle this health issue. Susumu Wakai Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi, 321-02 Japan 1 2
Jimba M. Khopasi report 41. JMA News 1997; 871: 5. Murray CJL, Lopez AD. Global health statistics. Global burden of disease and injury series, volume II. Cambridge: Harvard University Press, 1996: 379–87.
759
with standardised, carefully produced preparations. We often forget that cannabis has been an accepted medicament of western medicine, and that it was available in many countries until some decades ago. There is still much to learn about cannabis, but that is also true for single cannabinoids, especially for new synthetic cannabinoid analogues. Leaving aside the route of administration and the hazards (eg, contamination) caused by its legal status, I cannot see that the plant as a whole would cause any more health risks than THC alone would do. The argument for cannabinoids, versus cannabis, is based on the wish to restrict those who want cannabis use to be legalised. Maybe it is based on fear of not being taken seriously by the scientific community, but in fact this fear may undermine the credibility of the scientific argument. Franjo Grotenhermen Arbeitsgemeinschaft Cannabis als Medizin, Maybachstraße 14, D-50670 Köln, Germany 1
Morris K. The cannabis remedy—wonder worker or evil weed. Lancet 1997; 350: 1828.
Research funding in Canada Sir—Wayne Kondro’s report of the “self-congratulatory” tone of the report on Canadian federal government spending on science and technology in his Jan 10 news item (p 119)1 contrasts sharply with the sense of crisis permeating the research community in Canada. Many in this community view the current situation as little short of a disaster, and wonder for how much longer a broadly based, internationally competitive, national research effort can be sustained. Underlying this crisis is the chronic underfunding of the Medical Research Council (MRC) and Natural Sciences and Engineering Research Council (NSERC), compounded by annual decreases to the base budgets of these funding bodies in recent years. The situation in Canada, where government investment in research and development is declining,1 contrasts starkly with the trend in other developed countries, particularly the USA. In constant dollars, the Canadian MRC budget is now at the same level as it was in 1987, whereas the budget of the US National Institutes of Health (NIH) has doubled within this time.2 In fiscal year 1998–99, the MRC base budget will decrease by a further 3%,
THE LANCET • Vol 351 • March 7, 1998
whereas the US Congress is moving in the direction of a further doubling of the NIH budget within the next 5 years.2 Even in Japan and South Korea, countries hard hit by recent currency and stock market turmoil, research and development is protected, with spending increases actually being proposed in both countries.3 As a result of current federal government policies, the number of funded Canadian researchers is steadily declining, and those who are funded have seen operating and equipment budgets continue to shrink. In the latest MRC competition, the “success” rate for operating grant applications was only 19·5%, with many highly rated grants falling below the cutoff line, because of lack of funds. The 19·5% “success” rate could be achieved only by cutting the recommended budgets of funded applicants by 26% overall. The average size (in direct costs) of an MRC research grant is now Cdn$70 000, versus Cdn$213 000 for an NIH grant. Federal government spending per person for basic biomedical, clinical, and health research is at least six-fold higher in the USA than in Canada, and rising. In the face of this is it any wonder that Canadian researchers remain sceptical about selfcongratulatory reports on the health of the research and development enterprise in Canada? Carl Sagan4 highlighted two different views of the role of government in the advancement of knowledge. Current US legislators seem to be heeding the advice of George Washington, who in an address to Congress in 1790 asserted: “There is nothing which can better deserve our patronage than the promotion of science and literature. Knowledge is in every country the surest basis of public happiness”, Canadian legislators seem to be more in tune with the views of Ronald Reagan, who in a campaign speech in 1980, asked: “Why should we subsidise intellectual curiosity?” If Canadian funders do not know the answer to that question, they should not be surprised if the country becomes a net exporter of intellectual capital, as well as of natural resources. Michael W Gray Program in Evolutionary Biology, Canadian Institute for Advanced Research, Department of Biochemistry, Dalhouse University, Halifax, Nova Scotia B3H 4H7, Canada (e-mail: [email protected]) 1 2
3
Kondro W. Canada’s government talks up Canadian science. Lancet 1998; 351: 119. Pear R. Medical research to get more money from government. New York Times January 3, 1998. Saegusa A. Japan maintains research funding
4
boost . . . as science escapes cuts in South Korea. Nature 1998; 39: 111. Sagan C. The demon-haunted world. Science as a candle in the dark. New York: Ballantine Books, 1995.
Scourge of Japanese encephalitis in southwestern Nepal Sir—In December, 1997, I visited the district hospital of Tikapur, a small rural town in south-western Nepal. Between July 16, and October 20, 1997, 339 patients with Japanese encephalitis were admitted to the hospital. 43 of the patients died, 262 survived, and 34 were transferred to a general hospital with 150 beds in Nepalganj, the largest city in the south-western region of Nepal or Lucknow, India. In Nepalganj hospital, 75 of 550 patients with Japanese encephalitis admitted are reported to have died by September, 1997. 1 In Tikapur, about 10% of patients who survived are reported to have modest to severe neurological sequelae and cognitive impairment. The principal of a local primary school told me that 115 children died of Japanese encephalitis or related disorders during that scourge. According to the Tikapur hospital record, the first epidemic of Japanese encephalitis occurred in 1982, the second in 1986, and the third in 1988. Since 1990, epidemics have scourged the area every year. The 1997 epidemic was one of the most severe in the past 25 years. No effective publichealth measures and medical interventions have been set up. Japanese encephalitis epidemics occur exclusively in China, India, and other Asian and Island regions. Although total deaths from this disease worldwide are only 29 000, cognitive impairment numbered 708 000 and neurological sequelae numbered 944 000, in 1990, respectively. 2 In poor countries like Nepal, such a burden of disease will further impede economic and social development, locally as well as nationally. WHO and other international agencies are urged to help collectively to tackle this health issue. Susumu Wakai Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi, 321-02 Japan 1 2
Jimba M. Khopasi report 41. JMA News 1997; 871: 5. Murray CJL, Lopez AD. Global health statistics. Global burden of disease and injury series, volume II. Cambridge: Harvard University Press, 1996: 379–87.
759