- Email: [email protected]
Trials progress report
1341
political involvement in Africa). Citizens who go abroad are now screened, but the exemption of visitors to the country from screening represents potential for introduction of infection. Development of their own serological tests (validated with collaboration from Brazil and Sweden) and the provision of facilities for the tests cost approximately US$3 million, while the programme of screening all individuals aged 15 and above has cost [2m per year since 1986. The educational programme takes second place in HIV control. The quarantine policy is said to be under constant revision. Since there is no immediate prospect of an effective vaccine or other means of eradicating the infection, there are tentative plans to reintroduce selected infected individuals to the community. In the mean time, even when their views are specifically sought, members of the public do not express their disagreement with the policy. 1. Perez-Stable EJ. Cuba’s response to the HIV epidemic. Am
J Publ Health 1991; 81:
563-87.
Trials progress report Do patients with symptomless prostate cancer require immediate therapy? 700 patients have been recruited to a study of immediate vs deferred prostatectomy or hormone therapy, the only randomised trial in the 40 years of hormone treatment for prostate cancer to examine this question-but 2000 are needed for an unequivocal answer to be obtained. Similarly, 400 patients are required for the trial to confirm whether the superior survival rates obtained by Japanese surgeons for advanced gastric cancer is the result of their practice of radical resections involving extended lymphadenectomy. The trial required the recruitment of surgeons able and willing to do the operations in a standardised manner. The study was begun in October, 1985, but cases are not being accumulated as fast as the expected rate of 4 per surgeon per year. 311 patients were recruited in the first 3 years, but only 153 were suitable for randomisation to standard resection or to radical procedures. More participants are needed. Dutch surgeons are about to start a similar trial, and there are plans to pool the UK and the Dutch data. Attracting participants for their trials was one of the aims of the Medical Research Council’s Cancer Therapy Committee in producing the report of the activities of their working parties. Another was to show participants the achievements of the trials organisation to which they have contributed. Publications of this kind are bound to be of interest to many, whether or not past, present, or potential trial participants. The descriptions of the work of the various working groups are a good summary of the issues that need to be settled. Data from completed trials are presented in clear and simple tabular or diagrammatic form (these tables and illustrations are available as teaching slides). And there must have been many a time when one has wondered what stage a trial has reached; such information is usually hard to obtain elsewhere. 1. Medical Research Council Cancer Therapy Committee Report 1990. London. MRC.
1991. Pp 109.
In
England Now
I met Kieran again at a meeting recently, and we spent half an hour catching up on each other’s news. Kieran is the occupational physician for Lincaster Health Authority and is outspoken on most
topics. "Playing the devil’s advocate", he calls it, but he invariably ends up in court or on the television, which, of course, as a good
Irishman, he relishes. "Solvents", he said after a while. "Oh yes?" I replied, sensing a
Kieran specialty. "Yes, solvents. A solicitor rang yesterday for my
opinion." Kieran recognises himself as an expert in everything from blue-green algae to electromagnetic fields, so a new expertise came as no surprise. I plugged him further. expert
"The solicitor represents two octogenarian sisters who have run a small dry-cleaning business for sixty years. They claim the dry-cleaning fluid has caused mental deterioration and they want to sue the company that makes the solvent. The solicitor sought my services but that is the only sensible thing he has done so far. "First I asked him whether he had the datasheet on the solvent; he hadn’t. Had exposure levels been measured? No. Which neurologist examined the old girls? They hadn’t seen one. What were the results of the psychometric assessments, CT scans, EEGs, and relevant blood tests? Were they necessary, he asked? And no, he hadn’t approached the manufacturer. He did have a letter from the general practitioner, who was sure that the dementia was due to solvent, however. "When I told him that probably wasn’t much use and there was no good evidence that exposure to solvent caused dementia, he got quite annoyed and asked if I could recommend any other experts." "And did you?" "Of course. There are three other experts I know, but didn’t tell him that two work for the manufacturers and the third is an academic in Japan."" This all seemed a bit disappointing for Kieran. I’m still waiting for another incident on the scale of the body mass index at pre-employment screening episode. That ended with a confrontation between Kieran and fifty overweight and very angry domestics on live television. He obviously detected my despondency and so kindly reassured me that he felt there was bound to be more mileage in this one. Funnily enough, I bumped into Kieran shopping with his wife a few weeks later. "Any more on the solvents?", I asked eagerly. No. came the somewhat muted reply. Then I noticed that Kieran was beardless. His beard has always been his pride and joy, which he strokes while passing some expert comment on television. "What on earth happened to your beard?", I exclaimed, incredulous that I hadn’t noticed its absence sooner. Kieran took a sudden interest in an adjacent tobacconists’, which is also strange for a man who has an asthma attack when exposed to cigarette smoke. I turned my questions to his wife. "Kieran managed to stick a carpet tile to his face at the weekend", she obliged. "The staff at Lincaster General had quite a job detaching him from it." I was still not much wiser but persisted. "He was laying carpet tiles in the hall", she explained. "All went quiet for a long time, so I went to investigate and found him unconscious with his face stuck to the floor. The hospital thought he must have been overcome by the solvent in the glue as he hadn’t opened the windows." I looked around to see Kieran through the shop window about to
buy a pipe. I’ve decided not to mention solvents for a while at least until Kieran’s beard grows back, but I am just wondering if that pipe is the first sign of dementia. *
*
*
It is true, or so it seems to me, that the older you get the quicker time passes. My psychologist colleagues have an explanation: something to do with the proportion of time one has been alive-ie, at age 10, one year is a tenth of one’s life, whereas at 60 it is but a sixtieth and thus appears to pass more quickly. Well, maybe. But I think that, as with so many things these days, market forces have a lot to do with it. Once the nation drags itself back to work in January, the shops shriek "Valentine’s Day" at us; on Feb 15, out come the Easter cards and chocolate eggs. On Easter Tuesday this year, our local newsagent brought out the 1992 calendars, and that has really upset my internal clock. Normally, at this time of year, one has a brief respite until, in August, the first Christmas cards appear, a prelude to the Season of III Will, with crowded shops, inflated prices, and inflamed tempers. So we have reached the end of another year, whilst somewhere are warehouses packed with Valentine cards, Easter bunnies, and witches’ masks-to say nothing of 1993 calendars-ready to begin the giddy cycle once again. Thus, thanks to market forces, we are constantly looking weeks or months ahead, never able to enjoy the fleeting seconds as they pass, merely regarding them as padding between one pseudo-festival and the next.
Or is it just that I
am
getting older?
political involvement in Africa). Citizens who go abroad are now screened, but the exemption of visitors to the country from screening represents potential for introduction of infection. Development of their own serological tests (validated with collaboration from Brazil and Sweden) and the provision of facilities for the tests cost approximately US$3 million, while the programme of screening all individuals aged 15 and above has cost [2m per year since 1986. The educational programme takes second place in HIV control. The quarantine policy is said to be under constant revision. Since there is no immediate prospect of an effective vaccine or other means of eradicating the infection, there are tentative plans to reintroduce selected infected individuals to the community. In the mean time, even when their views are specifically sought, members of the public do not express their disagreement with the policy. 1. Perez-Stable EJ. Cuba’s response to the HIV epidemic. Am
J Publ Health 1991; 81:
563-87.
Trials progress report Do patients with symptomless prostate cancer require immediate therapy? 700 patients have been recruited to a study of immediate vs deferred prostatectomy or hormone therapy, the only randomised trial in the 40 years of hormone treatment for prostate cancer to examine this question-but 2000 are needed for an unequivocal answer to be obtained. Similarly, 400 patients are required for the trial to confirm whether the superior survival rates obtained by Japanese surgeons for advanced gastric cancer is the result of their practice of radical resections involving extended lymphadenectomy. The trial required the recruitment of surgeons able and willing to do the operations in a standardised manner. The study was begun in October, 1985, but cases are not being accumulated as fast as the expected rate of 4 per surgeon per year. 311 patients were recruited in the first 3 years, but only 153 were suitable for randomisation to standard resection or to radical procedures. More participants are needed. Dutch surgeons are about to start a similar trial, and there are plans to pool the UK and the Dutch data. Attracting participants for their trials was one of the aims of the Medical Research Council’s Cancer Therapy Committee in producing the report of the activities of their working parties. Another was to show participants the achievements of the trials organisation to which they have contributed. Publications of this kind are bound to be of interest to many, whether or not past, present, or potential trial participants. The descriptions of the work of the various working groups are a good summary of the issues that need to be settled. Data from completed trials are presented in clear and simple tabular or diagrammatic form (these tables and illustrations are available as teaching slides). And there must have been many a time when one has wondered what stage a trial has reached; such information is usually hard to obtain elsewhere. 1. Medical Research Council Cancer Therapy Committee Report 1990. London. MRC.
1991. Pp 109.
In
England Now
I met Kieran again at a meeting recently, and we spent half an hour catching up on each other’s news. Kieran is the occupational physician for Lincaster Health Authority and is outspoken on most
topics. "Playing the devil’s advocate", he calls it, but he invariably ends up in court or on the television, which, of course, as a good
Irishman, he relishes. "Solvents", he said after a while. "Oh yes?" I replied, sensing a
Kieran specialty. "Yes, solvents. A solicitor rang yesterday for my
opinion." Kieran recognises himself as an expert in everything from blue-green algae to electromagnetic fields, so a new expertise came as no surprise. I plugged him further. expert
"The solicitor represents two octogenarian sisters who have run a small dry-cleaning business for sixty years. They claim the dry-cleaning fluid has caused mental deterioration and they want to sue the company that makes the solvent. The solicitor sought my services but that is the only sensible thing he has done so far. "First I asked him whether he had the datasheet on the solvent; he hadn’t. Had exposure levels been measured? No. Which neurologist examined the old girls? They hadn’t seen one. What were the results of the psychometric assessments, CT scans, EEGs, and relevant blood tests? Were they necessary, he asked? And no, he hadn’t approached the manufacturer. He did have a letter from the general practitioner, who was sure that the dementia was due to solvent, however. "When I told him that probably wasn’t much use and there was no good evidence that exposure to solvent caused dementia, he got quite annoyed and asked if I could recommend any other experts." "And did you?" "Of course. There are three other experts I know, but didn’t tell him that two work for the manufacturers and the third is an academic in Japan."" This all seemed a bit disappointing for Kieran. I’m still waiting for another incident on the scale of the body mass index at pre-employment screening episode. That ended with a confrontation between Kieran and fifty overweight and very angry domestics on live television. He obviously detected my despondency and so kindly reassured me that he felt there was bound to be more mileage in this one. Funnily enough, I bumped into Kieran shopping with his wife a few weeks later. "Any more on the solvents?", I asked eagerly. No. came the somewhat muted reply. Then I noticed that Kieran was beardless. His beard has always been his pride and joy, which he strokes while passing some expert comment on television. "What on earth happened to your beard?", I exclaimed, incredulous that I hadn’t noticed its absence sooner. Kieran took a sudden interest in an adjacent tobacconists’, which is also strange for a man who has an asthma attack when exposed to cigarette smoke. I turned my questions to his wife. "Kieran managed to stick a carpet tile to his face at the weekend", she obliged. "The staff at Lincaster General had quite a job detaching him from it." I was still not much wiser but persisted. "He was laying carpet tiles in the hall", she explained. "All went quiet for a long time, so I went to investigate and found him unconscious with his face stuck to the floor. The hospital thought he must have been overcome by the solvent in the glue as he hadn’t opened the windows." I looked around to see Kieran through the shop window about to
buy a pipe. I’ve decided not to mention solvents for a while at least until Kieran’s beard grows back, but I am just wondering if that pipe is the first sign of dementia. *
*
*
It is true, or so it seems to me, that the older you get the quicker time passes. My psychologist colleagues have an explanation: something to do with the proportion of time one has been alive-ie, at age 10, one year is a tenth of one’s life, whereas at 60 it is but a sixtieth and thus appears to pass more quickly. Well, maybe. But I think that, as with so many things these days, market forces have a lot to do with it. Once the nation drags itself back to work in January, the shops shriek "Valentine’s Day" at us; on Feb 15, out come the Easter cards and chocolate eggs. On Easter Tuesday this year, our local newsagent brought out the 1992 calendars, and that has really upset my internal clock. Normally, at this time of year, one has a brief respite until, in August, the first Christmas cards appear, a prelude to the Season of III Will, with crowded shops, inflated prices, and inflamed tempers. So we have reached the end of another year, whilst somewhere are warehouses packed with Valentine cards, Easter bunnies, and witches’ masks-to say nothing of 1993 calendars-ready to begin the giddy cycle once again. Thus, thanks to market forces, we are constantly looking weeks or months ahead, never able to enjoy the fleeting seconds as they pass, merely regarding them as padding between one pseudo-festival and the next.
Or is it just that I
am
getting older?