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WEIGHTS OF BRITISH AND FRENCH CHILDREN
862
BMI centiles (97,90,75,50,25, 10, and 3) at ages 7, ll, and 16 years for cohort of British children born in 1958 superimposed on INSERM growth charts for French children born in 1953. 1
-
Left = boys. Right = girls.
WEIGHTS OF BRITISH AND FRENCH CHILDREN
SIR,-The publication of body mass index (BMI) charts derived from a longitudinal study of children born in France in 19531,2 has allowed us to compare these centiles with those derived from the National Child Development Study of all children born in England, Scotland, and Wales in one week in March, 1958.3 The figure shows centiles of BMI (weight in kilograms divided by square of height in metres) for British children plotted on the French charts. The British centiles are higher especially in the top centiles (though this may partly reflect skewness in the distribution of BMI). A British 11-year-old boy of average height (1-43 cm) whose BMI is on the 50th, 90th, or 97th centile will be about 0 -7, 1’6, and 5 -1kg heavier, respectively, than his French counterpart. Could this observation, indicating that more British children are overweight, have health implications? Institute of Child Health,
University of London, London WC1N 1EH
O. STARK C. S. PECKHAM A. ADES
1. Rolland-Cachera
M-F, Sempé M. Institut de la Santé et de la Recherche Médicale courbes de la corpulence Paris: INSERM, 1985. 2 Rolland-Cachera M-F, Sempé M, Guilloud-Bataille M, Patois E, PéquignotGuggenbuhl F, Fautrad V. Adiposity indices in children. Am J Clin Nutr 1982; 36: 178-84. 3. Peckham CS, Stark O, Simonite V, Wolff OH Prevalence of obesity in British children born in 1946 and 1958. Br Med J 1983; 286: 1237-42.
after taking a homoeopathic treatment called ’Dumcap’. This preparation was sent to my patient, who took three capsules a day. Symptoms and PEFR improved (figure) and the patient was able to stop oral steroids for the first time in 7 years. The patient was asked to stop taking dumcap and to restart oral prednisolone whilst the capsules were analysed. The container describes the medication as homoeopathic and the ingredients are said to be "nux vomica, arsenic album, Blatta orientalis and stramoni folic" (ie, strychnine, arsenic trioxide, cockroach extract, and stramonium). Only the stramonium, an anticholinergic agent, could be expected to have an effect on asthma. Adulteration was therefore considered likely. Steroid tablets and the capsules were extracted in ethanol for silica gel thin-layer chromatography of 100 1 samples on Merck plates (60 F254) run in 97% ethyl acetate/3% ethanol with staining with phosphomolybdic acid. Two spots were obtained with dumcap, which ran with prednisolone and betamethasone (RF values 0 - 5 and 0-7). The prednisolone content of dumcap was estimated by ultraviolet absorbance at 242 nm1 and found to be about 4 mg per capsule. Capillary gas chromatography and mass spectrum analysis confirmed the presence of synthetic prednisolone. Adulteration of this "homoeopathic" medication with 4 mg prednisolone and an unknown quantity of betamethasone accounts for the clinical improvement seen in my patient. The manufacturers (Duzcap Pharmacy, Khoprapar, Karachi) tell me that dumcap has been used to treat millions of patients in Pakistan and the
ADULTERATED "HOMOEOPATHIC" CURE FOR ASTHMA
SIR,-Homoeopathic medicine has a reputation for safety -namely, freedom from the side-effects of conventional drug treatment. I report here a case of severe asthma which responded strikingly to a homoeopathic medication, obtained from abroad, that turned out to be far from inert in its constitution. A 53-year-old man with severe, chronic asthma was maintained on oral prednisolone 5-20 mg, inhaled salbutamol and beclomethasone and oral astemizole. His asthma was extrinsic, with positive skin reactions to grass pollen, house dust, house dust mite, cladosporium, and cat fur. Spirometry demonstrated severe airways obstruction while on 10 mg oral prednisolone daily, with forced expiratory volume in 1 s of 1-15 (predicted 3-53) 1, forced vital capacity 2-2(4-8) 1, and peak expiratory flow (PEFR) 190 (615) 1/min. The patient’s brother, a headmaster in Pakistan, had noted that several of his pupils with asthma had been able to return to school
Evening PEFR:
Effect of medication.
rest
of the
BMI centiles (97,90,75,50,25, 10, and 3) at ages 7, ll, and 16 years for cohort of British children born in 1958 superimposed on INSERM growth charts for French children born in 1953. 1
-
Left = boys. Right = girls.
WEIGHTS OF BRITISH AND FRENCH CHILDREN
SIR,-The publication of body mass index (BMI) charts derived from a longitudinal study of children born in France in 19531,2 has allowed us to compare these centiles with those derived from the National Child Development Study of all children born in England, Scotland, and Wales in one week in March, 1958.3 The figure shows centiles of BMI (weight in kilograms divided by square of height in metres) for British children plotted on the French charts. The British centiles are higher especially in the top centiles (though this may partly reflect skewness in the distribution of BMI). A British 11-year-old boy of average height (1-43 cm) whose BMI is on the 50th, 90th, or 97th centile will be about 0 -7, 1’6, and 5 -1kg heavier, respectively, than his French counterpart. Could this observation, indicating that more British children are overweight, have health implications? Institute of Child Health,
University of London, London WC1N 1EH
O. STARK C. S. PECKHAM A. ADES
1. Rolland-Cachera
M-F, Sempé M. Institut de la Santé et de la Recherche Médicale courbes de la corpulence Paris: INSERM, 1985. 2 Rolland-Cachera M-F, Sempé M, Guilloud-Bataille M, Patois E, PéquignotGuggenbuhl F, Fautrad V. Adiposity indices in children. Am J Clin Nutr 1982; 36: 178-84. 3. Peckham CS, Stark O, Simonite V, Wolff OH Prevalence of obesity in British children born in 1946 and 1958. Br Med J 1983; 286: 1237-42.
after taking a homoeopathic treatment called ’Dumcap’. This preparation was sent to my patient, who took three capsules a day. Symptoms and PEFR improved (figure) and the patient was able to stop oral steroids for the first time in 7 years. The patient was asked to stop taking dumcap and to restart oral prednisolone whilst the capsules were analysed. The container describes the medication as homoeopathic and the ingredients are said to be "nux vomica, arsenic album, Blatta orientalis and stramoni folic" (ie, strychnine, arsenic trioxide, cockroach extract, and stramonium). Only the stramonium, an anticholinergic agent, could be expected to have an effect on asthma. Adulteration was therefore considered likely. Steroid tablets and the capsules were extracted in ethanol for silica gel thin-layer chromatography of 100 1 samples on Merck plates (60 F254) run in 97% ethyl acetate/3% ethanol with staining with phosphomolybdic acid. Two spots were obtained with dumcap, which ran with prednisolone and betamethasone (RF values 0 - 5 and 0-7). The prednisolone content of dumcap was estimated by ultraviolet absorbance at 242 nm1 and found to be about 4 mg per capsule. Capillary gas chromatography and mass spectrum analysis confirmed the presence of synthetic prednisolone. Adulteration of this "homoeopathic" medication with 4 mg prednisolone and an unknown quantity of betamethasone accounts for the clinical improvement seen in my patient. The manufacturers (Duzcap Pharmacy, Khoprapar, Karachi) tell me that dumcap has been used to treat millions of patients in Pakistan and the
ADULTERATED "HOMOEOPATHIC" CURE FOR ASTHMA
SIR,-Homoeopathic medicine has a reputation for safety -namely, freedom from the side-effects of conventional drug treatment. I report here a case of severe asthma which responded strikingly to a homoeopathic medication, obtained from abroad, that turned out to be far from inert in its constitution. A 53-year-old man with severe, chronic asthma was maintained on oral prednisolone 5-20 mg, inhaled salbutamol and beclomethasone and oral astemizole. His asthma was extrinsic, with positive skin reactions to grass pollen, house dust, house dust mite, cladosporium, and cat fur. Spirometry demonstrated severe airways obstruction while on 10 mg oral prednisolone daily, with forced expiratory volume in 1 s of 1-15 (predicted 3-53) 1, forced vital capacity 2-2(4-8) 1, and peak expiratory flow (PEFR) 190 (615) 1/min. The patient’s brother, a headmaster in Pakistan, had noted that several of his pupils with asthma had been able to return to school
Evening PEFR:
Effect of medication.
rest
of the