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Spotlight on HIV care
1138
Noticeboard
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Tobacco subsidies and health In October, 1990, the Europe Against Cancer campaign held a conference that targeted smoking, a habit that kills over 400 000 Europeans each year. The European Commission is proud of the campaign, into which it puts 11 million ecus ($14 million, 73 million) every year. But this figure pales into insignificance beside the 1300 million ecus ($1600 million, C870 million) it spends on subsidies to Europe’s tobacco growers. As part of its Common Agricultural Policy the EC is pledged to support tobacco farming and encourage expansion of production, which was formerly limited mainly to France and Italy, into disadvantaged areas. In relation to the area under cultivation tobacco is now Europe’s most heavily subsidised crop. The European dimension adds a new twist to the familiar hypocrisy of industrialised nations that proclaim the dangers of smoking and pay out token sums for health education while ensuring that tobacco companies, if not their customers, flourish. The difference is, however, that the European strategy, which was intended to protect farmers’ incomes and adapt production to demand, has proved to be economically unsound. Demand for the dark tobacco that dominates European production has fallen while demand for light Virginia type tobacco has risen, and the system of subsidies and quotas designed to change the balance has not achieved its purpose. Joossens and Raw claim that expenditure on such manipulations has spiralled out of control, production of unmarketable varieties of tobacco has risen enormously, and the EC is now the world’s largest importer of tobacco.’ Tobacco subsidies do not make economic sense, and in view of the health risks of the product Joosens and Raw urge that intervention buying and subsidised export (dumping) should be stopped immediately and the total subsidy reduced by 10% per year. "From a health perspective", they say, "any financial support in the community for tobacco is inappropriate and should be stopped within ten years". Some of the money saved, they suggest, could be better spent on healthier alternatives, such as income support and early retirement for tobacco growers. 1.
Joossens L, Raw M. Tobacco and the European common agricultural policy. Br J Addiction 1991; 86: 1191-202.
Spotlight on
HIV
care
Recent World Health Organisation estimates put the total number of people infected with the human immunodeficiency virus (HIV) at between 9 and 11 million world wide. How good are services for those with HIV-related disease in the UK? A report from the National Audit Office1 suggests that pressures for more resources from other sectors of health care, notably building projects, have led to money being taken out of supposedly ring-fenced HIV budgets. For instance, North West Thames Region took 8-5 million (23%) of its [,36.9 million AIDS budget in 1989-90 to offset overcommitments to its capital spending programme. The Government has asked the region to repay this sum over the next two years. Although the Department of Health has responded quickly and effectively to the demands of the HIV pandemic-[,450 million was allocated by government between 1985 and 1991-a closer watch is needed on both the funding arrangements for and the quality of these services. Voluntary reporting of new cases of HIV infection to national surveillance centres has been poor in some health authorities, with the result that targeting of resources has been frequently based on misleading data. Few health authorities have identified the full cost of their services to HIV-positive patients, and most have failed to evaluate the quality of care provided. The report points to the need for education and prevention programmes to be directed at those who are at most risk-eg, by promoting needle-exchange schemes. 1. National Audit Office. HIV and AIDS related health Stationery Office. 1991 Pp 36. £680.
services.
London: HM
Recklinghausen pinpointed
A new mutation that causes the most common type of neurofibromatosis (NF) has now been identified.! The results of this study are likely to have wider implications for the understanding of the processes leading to DNA insertions that cause other disease states. Neurofibromatosis is a generic description for a spectrum of seven or eight different disorders.2 The two major catagories are NF-1and NF-2. Linkage studies have pointed to a genetic locus for NF-2 (bilateral acoustic NF) on chromosome 22q. The more common NF-1 (von Recklinghausen’s disease) is an autosomal dominant condition characterised by progressive neurological deterioration associated with speech and learning disabilities; it has a high spontaneous mutation rate with 30-50% of cases being due to new mutations. A repetitive genetic element-the 282-base-pair Alu sequence, which is present on average once every 5 kb of human genomic DNA-has been found to be inserted, as a de-novo mutation, into an intron on chromosome 17 in a man with NF-1.1 Inappropriate insertions of the ubiquitous Alu sequence may be more common than had been thought previously and will probably be found in other genetic diseases. 1. Wallace MR, Andersen LB, Savlino AM, Gregory PE, Glover TW, Collins FS. A de novo Alu insertion results m neurofibromatosis type I. Nature 1991; 353: 864-66. 2. Riccardi VM. Neurofibromatosis. In: Kennard C, ed Recent advances in clinical neurology. London Churchill Livingstone, 1990: 187-208.
Buzz words You may suppose that cognitive scientists trying to explain the thought and the appearance of intelligence have their work cut out coping with the vagaries of human beings, lower primates, and rodents. Almost certainly you would not rate bumblebees as ideal subjects for studying the evolution of decision-making processes. But there you would be wrong, according to Real1 of the University of North Carolina, who points out that worker bumblebees, being sterile and so not both bothered about reproductive decisions, are almost exclusively engaged on one task of unquestionable evolutionary importance-collecting nectar and pollen to provide energy reserves for the colony. To determine what makes a bumblebee buzz,Real’s armamentarium included a netted enclosure, cardboard flowers of various colours, artificial nectar (diluted honey) to create a reward system according to floral type, and two sorts of bumblebees. In a series of ingenious experiments he showed that bees do not flit idly from bloom to bloom but frame their decisions according to their encounters with individual flowers or pairs of flowers. They use computational rules to form probabilities based on frequency of reward. So next time you hear that familiar sound emanating from the hollyhocks remember you are witnessing the activities of a short-term energy maximiser exploiting environmental resources (subject, of course, to neural or memory constraints). nature of
1. Real LA. Animal choice behavior and the evolution of cognitive architecture. Science
1991, 253 980-86.
Maharishi Ayur-Veda Last week, Dr R. A. Chalmers and Dr L. J. K. Davis were found guilty of serious professional misconduct after allegations had been made in connection with the treatment of HIV-positive patients with Maharishi herbal products and transcendental meditation.! The General Medical Council’s professional conduct committee has directed that the names of these two doctors be erased from the medical register on Nov 22 unless they exercise their right of appeal. The Journal of the American Medical Association recently reported on the wider implications of the international marketing activities of the Maharishi’s organisation.2 1 Anonymous. Ayur-Vedic medicine. Lancet 1990; 336: 1060-61. 2. Skolnick AA. Maharishi Ayur-Veda: guru’s marketing scheme eternal "perfect health" JAMA 1991; 266: 1741-50.
promises the world
Noticeboard
von
Tobacco subsidies and health In October, 1990, the Europe Against Cancer campaign held a conference that targeted smoking, a habit that kills over 400 000 Europeans each year. The European Commission is proud of the campaign, into which it puts 11 million ecus ($14 million, 73 million) every year. But this figure pales into insignificance beside the 1300 million ecus ($1600 million, C870 million) it spends on subsidies to Europe’s tobacco growers. As part of its Common Agricultural Policy the EC is pledged to support tobacco farming and encourage expansion of production, which was formerly limited mainly to France and Italy, into disadvantaged areas. In relation to the area under cultivation tobacco is now Europe’s most heavily subsidised crop. The European dimension adds a new twist to the familiar hypocrisy of industrialised nations that proclaim the dangers of smoking and pay out token sums for health education while ensuring that tobacco companies, if not their customers, flourish. The difference is, however, that the European strategy, which was intended to protect farmers’ incomes and adapt production to demand, has proved to be economically unsound. Demand for the dark tobacco that dominates European production has fallen while demand for light Virginia type tobacco has risen, and the system of subsidies and quotas designed to change the balance has not achieved its purpose. Joossens and Raw claim that expenditure on such manipulations has spiralled out of control, production of unmarketable varieties of tobacco has risen enormously, and the EC is now the world’s largest importer of tobacco.’ Tobacco subsidies do not make economic sense, and in view of the health risks of the product Joosens and Raw urge that intervention buying and subsidised export (dumping) should be stopped immediately and the total subsidy reduced by 10% per year. "From a health perspective", they say, "any financial support in the community for tobacco is inappropriate and should be stopped within ten years". Some of the money saved, they suggest, could be better spent on healthier alternatives, such as income support and early retirement for tobacco growers. 1.
Joossens L, Raw M. Tobacco and the European common agricultural policy. Br J Addiction 1991; 86: 1191-202.
Spotlight on
HIV
care
Recent World Health Organisation estimates put the total number of people infected with the human immunodeficiency virus (HIV) at between 9 and 11 million world wide. How good are services for those with HIV-related disease in the UK? A report from the National Audit Office1 suggests that pressures for more resources from other sectors of health care, notably building projects, have led to money being taken out of supposedly ring-fenced HIV budgets. For instance, North West Thames Region took 8-5 million (23%) of its [,36.9 million AIDS budget in 1989-90 to offset overcommitments to its capital spending programme. The Government has asked the region to repay this sum over the next two years. Although the Department of Health has responded quickly and effectively to the demands of the HIV pandemic-[,450 million was allocated by government between 1985 and 1991-a closer watch is needed on both the funding arrangements for and the quality of these services. Voluntary reporting of new cases of HIV infection to national surveillance centres has been poor in some health authorities, with the result that targeting of resources has been frequently based on misleading data. Few health authorities have identified the full cost of their services to HIV-positive patients, and most have failed to evaluate the quality of care provided. The report points to the need for education and prevention programmes to be directed at those who are at most risk-eg, by promoting needle-exchange schemes. 1. National Audit Office. HIV and AIDS related health Stationery Office. 1991 Pp 36. £680.
services.
London: HM
Recklinghausen pinpointed
A new mutation that causes the most common type of neurofibromatosis (NF) has now been identified.! The results of this study are likely to have wider implications for the understanding of the processes leading to DNA insertions that cause other disease states. Neurofibromatosis is a generic description for a spectrum of seven or eight different disorders.2 The two major catagories are NF-1and NF-2. Linkage studies have pointed to a genetic locus for NF-2 (bilateral acoustic NF) on chromosome 22q. The more common NF-1 (von Recklinghausen’s disease) is an autosomal dominant condition characterised by progressive neurological deterioration associated with speech and learning disabilities; it has a high spontaneous mutation rate with 30-50% of cases being due to new mutations. A repetitive genetic element-the 282-base-pair Alu sequence, which is present on average once every 5 kb of human genomic DNA-has been found to be inserted, as a de-novo mutation, into an intron on chromosome 17 in a man with NF-1.1 Inappropriate insertions of the ubiquitous Alu sequence may be more common than had been thought previously and will probably be found in other genetic diseases. 1. Wallace MR, Andersen LB, Savlino AM, Gregory PE, Glover TW, Collins FS. A de novo Alu insertion results m neurofibromatosis type I. Nature 1991; 353: 864-66. 2. Riccardi VM. Neurofibromatosis. In: Kennard C, ed Recent advances in clinical neurology. London Churchill Livingstone, 1990: 187-208.
Buzz words You may suppose that cognitive scientists trying to explain the thought and the appearance of intelligence have their work cut out coping with the vagaries of human beings, lower primates, and rodents. Almost certainly you would not rate bumblebees as ideal subjects for studying the evolution of decision-making processes. But there you would be wrong, according to Real1 of the University of North Carolina, who points out that worker bumblebees, being sterile and so not both bothered about reproductive decisions, are almost exclusively engaged on one task of unquestionable evolutionary importance-collecting nectar and pollen to provide energy reserves for the colony. To determine what makes a bumblebee buzz,Real’s armamentarium included a netted enclosure, cardboard flowers of various colours, artificial nectar (diluted honey) to create a reward system according to floral type, and two sorts of bumblebees. In a series of ingenious experiments he showed that bees do not flit idly from bloom to bloom but frame their decisions according to their encounters with individual flowers or pairs of flowers. They use computational rules to form probabilities based on frequency of reward. So next time you hear that familiar sound emanating from the hollyhocks remember you are witnessing the activities of a short-term energy maximiser exploiting environmental resources (subject, of course, to neural or memory constraints). nature of
1. Real LA. Animal choice behavior and the evolution of cognitive architecture. Science
1991, 253 980-86.
Maharishi Ayur-Veda Last week, Dr R. A. Chalmers and Dr L. J. K. Davis were found guilty of serious professional misconduct after allegations had been made in connection with the treatment of HIV-positive patients with Maharishi herbal products and transcendental meditation.! The General Medical Council’s professional conduct committee has directed that the names of these two doctors be erased from the medical register on Nov 22 unless they exercise their right of appeal. The Journal of the American Medical Association recently reported on the wider implications of the international marketing activities of the Maharishi’s organisation.2 1 Anonymous. Ayur-Vedic medicine. Lancet 1990; 336: 1060-61. 2. Skolnick AA. Maharishi Ayur-Veda: guru’s marketing scheme eternal "perfect health" JAMA 1991; 266: 1741-50.
promises the world