- Email: [email protected]
Silicones and connective tissue disease
1019
journal publish the two analyses simultaneously, the journal replied on March 5,1993, that to its knowledge it had not received a paper from Monsanto on BST somatic-cell counts. The Brunner analysis shows, for geometric mean somatic-cell counts, an overall relative of 1-2, the 95% confidence interval not Last week Monsanto (St Louis, Missouri) told us that a multiauthor paper on mastitis incidence in sometribovetreated cows, thought to have been submitted, was still in preparation, and that a second paper, on somatic-cell counts in milk and coordinated by Monsanto Europe (Brussels), was being rewritten. effect
(treated/control)
spanning unity.
Syed Rizwanuddin Ahmad
exclusively for NHS use; changing poor working practices would be difficult than designing for efficient ones from the start. Many of the efficiency gains, he says, would come from escaping traditional NHS labour practices. The best way forward, Willetts suggests, would be to give private providers the opportunity of tendering for new NHS developments. "The political sensitivity surrounding private provision is much reduced if it is manifestly supplying an extra new facility." more
Vivien Choo 1. Willetts D. The Opportunity for Private Funding
Foundation (20 1-874097-08-9.
Vivien Choo
of the NHS. London: Social Market Queen Anne’s Gate, London SW1H 9AA). 1993. Pp 15. ISBN
Yews, fungi, and
Out comes Outcomes Briefing What is health outcomes measurement? According to the introductory issue of Outcomes Briefing,’- the subject is something over which there is considerable confusion. That question and three others-What health services are suitable for outcome measurement? What aspects of health can be measured? Which measures should be used?—are often put to the inquiry service run by the UK Clearing House on Health Outcomes. The confusion is also apparent from the surveys that the clearing house has conducted on health outcomes activities. Such activities have intensified with the creation of the internal market by the National Health Service reforms and the setting of the Health of the Nation targets. When a "call for information" was put out by the clearing house in August, 1992, details of over 400 projects were sent in. A discouraging finding was that half the studies were using locally developed measures. An Outcomes Projects Database has been created, and a thesaurus by which to classify and search outcomes material is being developed. The database will also contain material from commercially available sources. Other planned activities for the clearing house include a review of commonly used generic health status profiles, the development of a guide to the routine use of outcome measures, the provision of workshops, and a review of outcome measures within specific conditions. Vivien Choo
cancer
Taxol-a diterpinoid from the inner bark (phloem) of a yew-is the most promising anticancer agent since the vinca alkaloids in the 1960s. More than 1 kg of phloem is required for a single treatment course of taxol, and because the yew (Taxus brevO7ora) is scarce and slow growing, an alternative source is required. Synthetic taxins may have similar anticancer effects,! but a more interesting (and probably cheaper) method of production is that discovered by Stierle et al.2 Since a fungus causing a disease of rice was found to produce giberellins—diterpinoid plant growth hormones-in culture more than 50 years ago, many other pathogenic or symbiotic microbes have been discovered to share the production of chemicals with their plant hosts. Stierle et al sought a microbe associated with Taxus breviflora which produced taxol, and of 200 tested found one, a fungus. Although the amount produced is small-50 ng per litre of culture-the yield is expected to increase with improved cultural technique and genetic engineering. This discovery raises again speculation as to how the genes responsible for chemical synthesis come to be shared between microbe and plant and holds promise for similar useful discoveries in the future. It is salutary to be reminded that a fungus living in a yew tree can provide a treatment for cancer: an excellent reason for supporting any efforts to slow the rate at which civilisation is squeezing plant species (and their microbes) into extinction. John
Briefing, Spring 1993. Pp 25. Quarterly publication on Clearing House activities, and news, views, and reviews on outcomes-related topics. Produced by UK Clearing House on Health Outcomes, Nuffield Institute for Health, 71-75
1. Outcomes
Clarendon Road, Leeds LS2 9PL.
1.
Bignall
Georg GI, Cheruvallath ZS, Himes RH, Mejillano MR, Burke CT. Synthesis of biologically active taxol analogues with modified phenylisoserine side chains. J Med Chem 1992; 35: 4230-37. S, Stierle D. Taxol and taxane production by Taxomyces andreanae, an endophytic fungus of pacific yew. Science 1993; 260: 214-16.
2. Stierle E, Strobel
Towards
a
privately run NHS?
The Chancellor’s autumn statement indicated a keenness to encourage private finance projects. Who better qualified to give advice on how to take advantage of this eagerness and to attract private finance to the National Health Service than someone who has been a Treasury official, member of the Prime Minister’s Policy Unit, director of studies at the Centre for Policy Studies, and a member of a health authority and family practitioner committee? David Willetts, MP for Havant and consultant to a private company that operates an out-of-hours centre for patients seeking medical attention, was also closely involved in the government’s reform of the health service and is a board member of Social Market Foundation, for which he has prepared a paper1 for a Foundation seminar on the subject on April 21. He focuses on six different types of project, ranging from leasing arrangements to the building and running of a hospital. Willetts attributes the failure of most proposed schemes to a combination of Treasury rules, political caution, and exaggerated expectations on both sides, but says he has observed a change in Treasury thinking. He points out that the Treasury would have to accept that fairly long-term contracts (of at least five years) might be essential to obtain competent private management. He believes that the greatest efficiency gains would come from letting the private sector
design, build, equip,
own, and manage
a
hospital largely or
Silicones and connective tissue disease A special advisory group to the UK Department of Healthl has concluded that there is no increased risk of autoimmune disease in women who have had silicone implants for breast augmentation or replacement. Although this report-together with others that there is no increased risk of cancer-should put many minds at rest, both patients and surgeons should remain aware that the perceived benefits of any cosmetic procedures must be carefully weighed against risks-known and unknown. -
-
John
--
--
Bignall
1. Evidence for an association between the implantation of silicones and connective tissue disease. UK Department of Health MDD report 92/42. London: HM Stationery
Office. 1993. Pp 65.
£20.
ISBN 1-83-839-097-4.
Royal College of Anaesthetists The designation FRC Anaes for candidates who pass the College’s fellowship examinations has been replaced by FRCA. Those who qualified for fellowship before 1988 or between 1988 to March, 1992, may, if they wish, continue to use the designation FFARCS and FC Anaes, respectively.
journal publish the two analyses simultaneously, the journal replied on March 5,1993, that to its knowledge it had not received a paper from Monsanto on BST somatic-cell counts. The Brunner analysis shows, for geometric mean somatic-cell counts, an overall relative of 1-2, the 95% confidence interval not Last week Monsanto (St Louis, Missouri) told us that a multiauthor paper on mastitis incidence in sometribovetreated cows, thought to have been submitted, was still in preparation, and that a second paper, on somatic-cell counts in milk and coordinated by Monsanto Europe (Brussels), was being rewritten. effect
(treated/control)
spanning unity.
Syed Rizwanuddin Ahmad
exclusively for NHS use; changing poor working practices would be difficult than designing for efficient ones from the start. Many of the efficiency gains, he says, would come from escaping traditional NHS labour practices. The best way forward, Willetts suggests, would be to give private providers the opportunity of tendering for new NHS developments. "The political sensitivity surrounding private provision is much reduced if it is manifestly supplying an extra new facility." more
Vivien Choo 1. Willetts D. The Opportunity for Private Funding
Foundation (20 1-874097-08-9.
Vivien Choo
of the NHS. London: Social Market Queen Anne’s Gate, London SW1H 9AA). 1993. Pp 15. ISBN
Yews, fungi, and
Out comes Outcomes Briefing What is health outcomes measurement? According to the introductory issue of Outcomes Briefing,’- the subject is something over which there is considerable confusion. That question and three others-What health services are suitable for outcome measurement? What aspects of health can be measured? Which measures should be used?—are often put to the inquiry service run by the UK Clearing House on Health Outcomes. The confusion is also apparent from the surveys that the clearing house has conducted on health outcomes activities. Such activities have intensified with the creation of the internal market by the National Health Service reforms and the setting of the Health of the Nation targets. When a "call for information" was put out by the clearing house in August, 1992, details of over 400 projects were sent in. A discouraging finding was that half the studies were using locally developed measures. An Outcomes Projects Database has been created, and a thesaurus by which to classify and search outcomes material is being developed. The database will also contain material from commercially available sources. Other planned activities for the clearing house include a review of commonly used generic health status profiles, the development of a guide to the routine use of outcome measures, the provision of workshops, and a review of outcome measures within specific conditions. Vivien Choo
cancer
Taxol-a diterpinoid from the inner bark (phloem) of a yew-is the most promising anticancer agent since the vinca alkaloids in the 1960s. More than 1 kg of phloem is required for a single treatment course of taxol, and because the yew (Taxus brevO7ora) is scarce and slow growing, an alternative source is required. Synthetic taxins may have similar anticancer effects,! but a more interesting (and probably cheaper) method of production is that discovered by Stierle et al.2 Since a fungus causing a disease of rice was found to produce giberellins—diterpinoid plant growth hormones-in culture more than 50 years ago, many other pathogenic or symbiotic microbes have been discovered to share the production of chemicals with their plant hosts. Stierle et al sought a microbe associated with Taxus breviflora which produced taxol, and of 200 tested found one, a fungus. Although the amount produced is small-50 ng per litre of culture-the yield is expected to increase with improved cultural technique and genetic engineering. This discovery raises again speculation as to how the genes responsible for chemical synthesis come to be shared between microbe and plant and holds promise for similar useful discoveries in the future. It is salutary to be reminded that a fungus living in a yew tree can provide a treatment for cancer: an excellent reason for supporting any efforts to slow the rate at which civilisation is squeezing plant species (and their microbes) into extinction. John
Briefing, Spring 1993. Pp 25. Quarterly publication on Clearing House activities, and news, views, and reviews on outcomes-related topics. Produced by UK Clearing House on Health Outcomes, Nuffield Institute for Health, 71-75
1. Outcomes
Clarendon Road, Leeds LS2 9PL.
1.
Bignall
Georg GI, Cheruvallath ZS, Himes RH, Mejillano MR, Burke CT. Synthesis of biologically active taxol analogues with modified phenylisoserine side chains. J Med Chem 1992; 35: 4230-37. S, Stierle D. Taxol and taxane production by Taxomyces andreanae, an endophytic fungus of pacific yew. Science 1993; 260: 214-16.
2. Stierle E, Strobel
Towards
a
privately run NHS?
The Chancellor’s autumn statement indicated a keenness to encourage private finance projects. Who better qualified to give advice on how to take advantage of this eagerness and to attract private finance to the National Health Service than someone who has been a Treasury official, member of the Prime Minister’s Policy Unit, director of studies at the Centre for Policy Studies, and a member of a health authority and family practitioner committee? David Willetts, MP for Havant and consultant to a private company that operates an out-of-hours centre for patients seeking medical attention, was also closely involved in the government’s reform of the health service and is a board member of Social Market Foundation, for which he has prepared a paper1 for a Foundation seminar on the subject on April 21. He focuses on six different types of project, ranging from leasing arrangements to the building and running of a hospital. Willetts attributes the failure of most proposed schemes to a combination of Treasury rules, political caution, and exaggerated expectations on both sides, but says he has observed a change in Treasury thinking. He points out that the Treasury would have to accept that fairly long-term contracts (of at least five years) might be essential to obtain competent private management. He believes that the greatest efficiency gains would come from letting the private sector
design, build, equip,
own, and manage
a
hospital largely or
Silicones and connective tissue disease A special advisory group to the UK Department of Healthl has concluded that there is no increased risk of autoimmune disease in women who have had silicone implants for breast augmentation or replacement. Although this report-together with others that there is no increased risk of cancer-should put many minds at rest, both patients and surgeons should remain aware that the perceived benefits of any cosmetic procedures must be carefully weighed against risks-known and unknown. -
-
John
--
--
Bignall
1. Evidence for an association between the implantation of silicones and connective tissue disease. UK Department of Health MDD report 92/42. London: HM Stationery
Office. 1993. Pp 65.
£20.
ISBN 1-83-839-097-4.
Royal College of Anaesthetists The designation FRC Anaes for candidates who pass the College’s fellowship examinations has been replaced by FRCA. Those who qualified for fellowship before 1988 or between 1988 to March, 1992, may, if they wish, continue to use the designation FFARCS and FC Anaes, respectively.