BMJ No 7120 Volume 315 Saturday 29 November 1997 This Week in BMJ | Editor's Choice | Press releases Editorials 1389 Humanitarian action: the duty of all doctors Vivienne Nathanson 1390 Human rights and medical education Jennifer Leaning 1392 Blinding laser weapons John Marshall 1393 South Africa: does a truth commission promote social reconciliation? Derek Summerfield 1393 Embargoes that endanger health Tony Delamothe 1394 Prison health services Michael Levy 1395 Strengthening "DOTS" through community care for tuberculosis S Bertel Squire, David Wilkinson News 1397 UK adheres to Formula One exemption Paternity test on Yves Montand UK court lets terminally ill baby die US proposes patients' bill of right More money wanted for NHS JAMA calls for clinical alerts campaign Canada re-examines AIDS programme Deaths from HIV rise in Bombay Safeguards needed in UK children's homes Compensation for CJD deaths in UK SmithKline Beecham fined in Hungary EU takes action over food safety Doris Schopper, head of Médecins Sans Frontier Papers 1403 Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment Jimmy Volmink, Paul Garner 1407 Comparison of cost effectiveness of directly observed treatment (DOT) and conventionally delivered treatment for tuberculosis: experience from rural South Africa Katherine Floyd, David Wilkinson, Charles Gilks 1412 Mefloquine to prevent malaria: a systematic review of trials Ashley Croft, Paul Garner 1417 Weapons injuries during and after periods of conflict: retrospective analysis David R Meddings 1420 The quality of health care in prison: results of a year's programme of semistructured inspections John Reed, Maggi Lyne 1424 Household survey of locomotor disability caused by poliomyelitis and landmines in Afghanistan Marie-Laurence Lambert, Isabelle François, Cécile Salort, Vincent Slypen, Françoise Bertrand, René Tonglet General practice 1426 The validity of general practitioners' self assessment of knowledge: cross sectional study Jocelyn M Tracey, Bruce Arroll, David E Richmond, Philip M Barham Clinical review 1429 Recent advances: General management of end stage renal disease Robert Walker 1433 ABC of palliative care: HIV infection and AIDS Chris G A Wood, Sally Whittet, Caroline S Bradbeer Education and debate 1437 They were cheap and available: prisoners as research subjects in 20th century America Allen M Hornblum 1441 To the point of farce: a Martian view of the Hardinian taboo - the silence that surrounds population control Maurice King, Charles Elliott 1444 Personal paper: Africa in the 21st century: can despair be turned to hope? Dorothy E Logie, Solomon R Benatar 1447 Pitfalls of tuberculosis programmes in prisons Hernán Reyes, Rudi Coninx 1450 Abhorrent weapons and "superfluous injury or unnecessary suffering": from field surgery to law Robin M Coupland 1453 Antipersonnel landmines: facts, fictions, and priorities Chris Giannou 1455 Universal Declaration of Human Rights 1456 Walk in peace: banish landmines from our globe Eoin O'Brien 1458 Sudan: eating dust and returning to dust Hans Veeken 1460 Tajikistan: no pay, no care Hans Veeken Letters 1462 Progress in reducing inpatient mortality from acute myocardial infarction is slow C D Naylor and J V Tu 1462 Risk of testicular cancer in boys with cryptorchidism M Davenport; A J Swerdlow and others 1463 Trial of thyroxine treatment for biochemically euthyroid patients has been approved E H McLaren and others 1463 Doctors have moral imperative to call for end to embargo on Cuba D Parnham-Cope 1463 Reduction in use of temazepam is factor in deaths related to overdose T C Gilhooly 1464 Local research ethics committees D Talbot and D J M Reynolds; P G Stone and C E Blogg; R Rawlins; A Barton 1465 Total ban on landmines is unnecessary E Chaloner and S Mannion 1465 Treating alcohol dependence D M Keeling; C C H Cook and A D Thomson; A Herrán and J L Vázquez-Barquero; P Haddad and C Daly; M Ashworth and C Gerada 1466 Lactic acidosis induced by phenformin is still a public health problem in Italy G Enia and others 1467 Death of Diana, Princess of Wales E R L Williams and others; M Shevlin and others 1468 Review of interventions to prevent heart disease D Batty; S Ebrahim and G D Smith 1468 Academia: the view from below S Saxena; E Webb 1469 Public health information on world wide web is hard to find D A Agbamu and E Sim Obituaries 1470 A M Dawson, C H Gray, D N Kreibich, W M Thurlbeck, J B Young Medicopolitical digest 1471 BUPA partnership NHS charter advisers Access to GPs' records Underperforming GPs WMA support for refusal to take part in torture Views & reviews Soundings 1472 Downsizing at Rhinoceros General George Dunea Personal view 1472 Taking treatment to the people in Ethiopia James Rogers 1473 Ketamine and kalashnikovs Richard Garfield, Sarah Zaidi, Jean Lennock 1474 Medical care in Iraq after six years of sanctions Peter J Watkins, Val Watkins Medicine and books 1476 The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security Jacob S Hacker Donald Light The Hidden Epidemic: Confronting Sexually Transmitted Diseases Institute of Medicine Michael Adler Correction: Abortion: Between Freedom and Necessity Janet Hadley Minerva 1478 S2 Career Focus Classified supplement Thinking of taking a staff grade post? Graham Buckley Editor's choice Human rights begin at home This special issue of the BMJ contains an appalling catalogue of man's inhumanity to man. Much of the suffering results from war and its aftermath and from extreme poverty. Many readers of the BMJ have experienced neither and may be inclined to shudder and pass on. But the challenge to readers is to understand how the material is relevant to doctors practising in Britain, the United States, Western Europe, Australasia, and other privileged places. One way that it matters is that chilling abuses of human rights are conducted by doctors in privileged countries in the name of medical research. Allen Hornblum from Philadelphia details how prisoners in the United States have been used by doctors in highly dubious experiments throughout most of the century (p 1437). Dr Joseph Goldberger, a public health official, induced pellagra in adult male prisoners who "volunteered" after the offer of a pardon. After the second world war research in prisoners became a large industry in the United States, and prisoners were used in experiments into hepatitis, syphilis, dysentery, malaria, and flash burns "which might result from atomic bomb attacks." Researchers from the Sloan Kettering Institute for Cancer Research injected over 100 prisoners in Ohio with live cancer cells. This research on prisoners finally faded away in the 1970s. But prisoners are still a litmus test for human rights. John Reed and Maggi Lyne, official inspectors of England's prisons, describe low standards and unethical acts (p 1420). One NHS general practitioner working in a prison said of mentally disturbed prisoners: "One or two nights in the special [unfurnished] rooms tends to bring them to their senses." A nurse said: "What they [young prisoners] need is a good shouting at." One doctor sanctioned the "nursing" of a suicidal patient naked in an unfurnished room in early spring. "No one," says article 5 of the Universal Declaration of Human Rights, "shall be subjected to torture or to cruel, inhuman, or degrading treatment or punishment." We reproduce the declaration on p 1455, and it must rank as one of the great achievements of the 20th century, a century that has seen unprecedented abuses of human rights. The declaration was, remarkably, drafted by a committee. It was chaired by Eleanor Roosevelt, who when she spoke to the United Nations on the 10th anniversary of the declaration said: "Where, after all, do universal human rights begin? In small places, close to home - so close, so small that they cannot be seen on any map of the world. ... Unless these rights have meaning here, they have little meaning anywhere." Jennifer Leaning argues in an editorial that the declaration should be used in medical education and given to all students (p 1390). We agree. 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