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Voice of reason in nuclear-weapon talks
COMMENTARY 1
Storek J,Witherspoon RP. Immunologic reconstitution after hematopoietic stem cell transplantation. In: Atkinson K, ed. Clinical bone marrow and blood stem cell transplantation. 2nd edn. Cambridge: Cambridge University Press, 2000: 111–46. 2 Dejbakhsh-Jones S, Jerabek L,Weissman IL, Strober S. Extrathymic maturation of alpha beta T cells from hemopoietic stem cells. J Immunol 1995; 155: 3338–44. 3 Rocha B. Characterization of V beta-bearing cells in athymic (nu/nu) mice suggests an extrathymic pathway for T cell differentiation. Eur J Immunol 1990; 20: 919–25. 4 Jendro MC, Ganten T, Matterson EL,Weyand CM, Goronzy JJ. Emergence of oligoclonal T cell populations following therapeutic T cell depletion in rheumatoid arthritis. Arthritis Rheum 1995; 38: 1242–51. 5 Mackall CL, Fleisher TA, Brown MR, et al. Age, thymopoiesis, and CD4+ T-lymphocyte regeneration after intensive chemotherapy. N Engl J Med 1995; 332: 143–49. 6 Weinberg K, Annett G, Kashyap A, Lenarsky C, Forman SJ, Parkman R. The effect of thymic function on immunocompetence following bone marrow transplantation. Biol Blood Marrow Transplant 1995; 1: 18-23. 7. Storek J,Witherspoon RP, Storb R.T cell reconstitution after bone marrow transplantation into adult patients does not resemble T cell development in early life. Bone Marrow Transplant 1995; 16: 413–25. 8 Mackall CL, Punt JA, Morgan P, Farr AG, Gress RE.Thymic function in young/old chimeras: substantial thymic T cell regenerative capacity despite irreversible age-associated thymic involution. Eur J Immunol 1998; 28: 1886–93.
the Bulletin of Atomic Scientists (www.thebulletin.org), US negotiators are trying to assuage Moscow’s fears by telling the Russians that if they keep their nuclear weapons on “launch on warning” status, they will be able to answer an American first strike before the US missiles land—but to many keeping the decaying Russian early-warning system on hair-trigger-alert status seems a dangerous gamble. Given how much the world has changed since the Cold War ended, terms such as “first strike” and “launch on command” in diplomatic exchanges seems almost surreal. The hope is that, though limited, the agreement hammered out last week will help to recast the debate and move the nuclear powers away from old rivalries and old thinking to meet the new challenges of a very different world, where the greatest threats to peace and security are no longer clashes of ideology, but poverty and disease. Michael McCarthy The Lancet, Seattle, WA 98103, USA
A fresh look at HIV infection See page 1897
Voice of reason in nuclear-weapon talks After 4 weeks of difficult negotiations at the Nuclear Nonproliferation Treaty Review Conference, which ended in New York last week (May 20), the five leading nuclearweapon states—Britain, China, France, Russia, and the USA—pledged to destroy their nuclear arsenals. The document coming out of the conference promises an “unequivocal undertaking by the nuclear weapons states to accomplish a total elimination of their nuclear weapons”. But no timetables were set. Even so, the statement is considered the strongest yet committing these nations to full nuclear disarmament. The document also called for, among other things, continuing the moratorium on nuclear-weapon test explosions until all signatories ratify the Comprehensive Test Ban Treaty, and the negotiation of a treaty to ban the production of fissile materials for weapons. The outcome of the meeting was far better than many expected. The conference had opened amidst widespread concern that the 30-year-old treaty was starting to unravel. Since the last review conference in 1995, India and Pakistan have detonated nuclear weapons, raising the spectre of a nuclear-arms race between two nations that have waged a series of wars over border disputes. Also worrying were signs that several nations, including Iraq and North Korea, were intent on developing their own nuclear-weapon capabilities. Meanwhile, Russia has renounced its long-held pledge of no first use and indicated that it intended to increase its reliance on nuclear weapons. The biggest cloud over the conference was the USA’s plans to proceed with deployment of an antiballistic missile system to protect itself from limited missile attacks such as those that might be launched by small, “rogue” states. Critics of the system say that the system is ineffective because it can be easily overcome by simple, inexpensive measures, and dangerous in that its deployment could trigger a new arms race. Deployment of the system violates the 1973 Antiballistic Missile (ABM) Treaty, long considered one of the key arms-reduction agreements between the USA and Russia, and Moscow now warns that if the USA goes ahead, it would have no choice but to tear up the START II arms-control treaty the Duma ratified last month. The USA’s approach is to try to get the ABM agreement amended. According to documents obtained by 1844
The rapid pace of discovery and realisation in the first two decades of the HIV pandemic made it possible to shift some agendas and to catalyse action with strong rhetoric and a sense of urgency. But now HIV and AIDS have ceased to have novelty value; perhaps the disease has lost its capacity to shock, or the enormity of the growing global challenge has substituted neglect for denial. So, how can decisionmakers be motivated and the agenda re-energised? How can policy be focused and embedded in appropriate, achievable, and locally adapted practical initiatives? The refreshing series of articles timed for the XIII International AIDS Conference in Durban, South Africa, offers substantial help in answering these questions. A deliberately diverse group of authors (some brought together specifically for the series) have combined expertise and experience, pragmatism with professionalism, to offer fresh, often hard-hitting, perspectives. Talking to each other across geographical and specialty barriers is a good example for all. As indicated by the theme of the Durban conference, it is time to “break the silence”. The full version of this foreword to the series appears on the Lancet website
Anthony Pinching Department of Immunology, St Bartholomew’s and the Royal London School of Medicine and Dentistry, London EC1A 7BE, UK
The Lancet Oncology and The Lancet This week, The Lancet launches a preview of its first offspring, a specialty-based monthly review and opinion journal in cancer medicine. The Lancet Oncology aims to preserve the twin informing and reforming instincts of is parent journal. But it also intends to step out in new directions—to commission systematic reviews across the science and practice of cancer; to promote debates about controversies in oncology; to explore the professional lives of prominent individuals in the field; and to provide a cancer news service. The editors, Sue Silver and Ezzie Hutchinson, have drawn together an international editorial board to assist them in these tasks. The first full issue will appear later this year, and the next few months gives ample time for your feedback to make a difference—something The Lancet too is committed to doing in oncology. Richard Horton The Lancet, London WC1X 8RR, UK
THE LANCET • Vol 355 • May 27, 2000
For personal use only. Not to be reproduced without permission of The Lancet.
Storek J,Witherspoon RP. Immunologic reconstitution after hematopoietic stem cell transplantation. In: Atkinson K, ed. Clinical bone marrow and blood stem cell transplantation. 2nd edn. Cambridge: Cambridge University Press, 2000: 111–46. 2 Dejbakhsh-Jones S, Jerabek L,Weissman IL, Strober S. Extrathymic maturation of alpha beta T cells from hemopoietic stem cells. J Immunol 1995; 155: 3338–44. 3 Rocha B. Characterization of V beta-bearing cells in athymic (nu/nu) mice suggests an extrathymic pathway for T cell differentiation. Eur J Immunol 1990; 20: 919–25. 4 Jendro MC, Ganten T, Matterson EL,Weyand CM, Goronzy JJ. Emergence of oligoclonal T cell populations following therapeutic T cell depletion in rheumatoid arthritis. Arthritis Rheum 1995; 38: 1242–51. 5 Mackall CL, Fleisher TA, Brown MR, et al. Age, thymopoiesis, and CD4+ T-lymphocyte regeneration after intensive chemotherapy. N Engl J Med 1995; 332: 143–49. 6 Weinberg K, Annett G, Kashyap A, Lenarsky C, Forman SJ, Parkman R. The effect of thymic function on immunocompetence following bone marrow transplantation. Biol Blood Marrow Transplant 1995; 1: 18-23. 7. Storek J,Witherspoon RP, Storb R.T cell reconstitution after bone marrow transplantation into adult patients does not resemble T cell development in early life. Bone Marrow Transplant 1995; 16: 413–25. 8 Mackall CL, Punt JA, Morgan P, Farr AG, Gress RE.Thymic function in young/old chimeras: substantial thymic T cell regenerative capacity despite irreversible age-associated thymic involution. Eur J Immunol 1998; 28: 1886–93.
the Bulletin of Atomic Scientists (www.thebulletin.org), US negotiators are trying to assuage Moscow’s fears by telling the Russians that if they keep their nuclear weapons on “launch on warning” status, they will be able to answer an American first strike before the US missiles land—but to many keeping the decaying Russian early-warning system on hair-trigger-alert status seems a dangerous gamble. Given how much the world has changed since the Cold War ended, terms such as “first strike” and “launch on command” in diplomatic exchanges seems almost surreal. The hope is that, though limited, the agreement hammered out last week will help to recast the debate and move the nuclear powers away from old rivalries and old thinking to meet the new challenges of a very different world, where the greatest threats to peace and security are no longer clashes of ideology, but poverty and disease. Michael McCarthy The Lancet, Seattle, WA 98103, USA
A fresh look at HIV infection See page 1897
Voice of reason in nuclear-weapon talks After 4 weeks of difficult negotiations at the Nuclear Nonproliferation Treaty Review Conference, which ended in New York last week (May 20), the five leading nuclearweapon states—Britain, China, France, Russia, and the USA—pledged to destroy their nuclear arsenals. The document coming out of the conference promises an “unequivocal undertaking by the nuclear weapons states to accomplish a total elimination of their nuclear weapons”. But no timetables were set. Even so, the statement is considered the strongest yet committing these nations to full nuclear disarmament. The document also called for, among other things, continuing the moratorium on nuclear-weapon test explosions until all signatories ratify the Comprehensive Test Ban Treaty, and the negotiation of a treaty to ban the production of fissile materials for weapons. The outcome of the meeting was far better than many expected. The conference had opened amidst widespread concern that the 30-year-old treaty was starting to unravel. Since the last review conference in 1995, India and Pakistan have detonated nuclear weapons, raising the spectre of a nuclear-arms race between two nations that have waged a series of wars over border disputes. Also worrying were signs that several nations, including Iraq and North Korea, were intent on developing their own nuclear-weapon capabilities. Meanwhile, Russia has renounced its long-held pledge of no first use and indicated that it intended to increase its reliance on nuclear weapons. The biggest cloud over the conference was the USA’s plans to proceed with deployment of an antiballistic missile system to protect itself from limited missile attacks such as those that might be launched by small, “rogue” states. Critics of the system say that the system is ineffective because it can be easily overcome by simple, inexpensive measures, and dangerous in that its deployment could trigger a new arms race. Deployment of the system violates the 1973 Antiballistic Missile (ABM) Treaty, long considered one of the key arms-reduction agreements between the USA and Russia, and Moscow now warns that if the USA goes ahead, it would have no choice but to tear up the START II arms-control treaty the Duma ratified last month. The USA’s approach is to try to get the ABM agreement amended. According to documents obtained by 1844
The rapid pace of discovery and realisation in the first two decades of the HIV pandemic made it possible to shift some agendas and to catalyse action with strong rhetoric and a sense of urgency. But now HIV and AIDS have ceased to have novelty value; perhaps the disease has lost its capacity to shock, or the enormity of the growing global challenge has substituted neglect for denial. So, how can decisionmakers be motivated and the agenda re-energised? How can policy be focused and embedded in appropriate, achievable, and locally adapted practical initiatives? The refreshing series of articles timed for the XIII International AIDS Conference in Durban, South Africa, offers substantial help in answering these questions. A deliberately diverse group of authors (some brought together specifically for the series) have combined expertise and experience, pragmatism with professionalism, to offer fresh, often hard-hitting, perspectives. Talking to each other across geographical and specialty barriers is a good example for all. As indicated by the theme of the Durban conference, it is time to “break the silence”. The full version of this foreword to the series appears on the Lancet website
Anthony Pinching Department of Immunology, St Bartholomew’s and the Royal London School of Medicine and Dentistry, London EC1A 7BE, UK
The Lancet Oncology and The Lancet This week, The Lancet launches a preview of its first offspring, a specialty-based monthly review and opinion journal in cancer medicine. The Lancet Oncology aims to preserve the twin informing and reforming instincts of is parent journal. But it also intends to step out in new directions—to commission systematic reviews across the science and practice of cancer; to promote debates about controversies in oncology; to explore the professional lives of prominent individuals in the field; and to provide a cancer news service. The editors, Sue Silver and Ezzie Hutchinson, have drawn together an international editorial board to assist them in these tasks. The first full issue will appear later this year, and the next few months gives ample time for your feedback to make a difference—something The Lancet too is committed to doing in oncology. Richard Horton The Lancet, London WC1X 8RR, UK
THE LANCET • Vol 355 • May 27, 2000
For personal use only. Not to be reproduced without permission of The Lancet.