MinervaBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6980.680 (Published 11 March 1995) Cite this as: BMJ 1995;310:680
Many of the top scientists concerned with the identification and investigation of the breast cancer gene BRCA1 have joined a group called the International BRCA Consortium and are freely sharing data and laboratory materials (Science 1995;267:1086). This move signals their disenchantment with efforts made by some teams to take out patents on their discoveries. Nevertheless, patents are being taken out and marketing agreements made: vast sums of money will eventually be earned. Fifty odd years ago the team that developed penicillin decided not to apply for any patents, believing that its discoveries should be made freely available to the world.
Manufacturers of modern drugs are quick to point to the vast costs of developing and testing new agents. A review in “Psychopharmacology: the Fourth Generation of Progress” (New York: Raven Press, 1995) quotes the costs of developing a new psychotropic drug in the United States in the early 1970s as $121m; by the early 1980s this had risen to $279m (both figures converted to 1992 dollars). There is no indication that the increase in development costs has come to an end.
Many university teachers believe (though few will openly say) that public health has no place in undergraduate medical education (Journal of Public Health Medicine 1994;16:389). Students are interested above all in the diagnosis and treatment of individual patients. Should public health teachers stop wasting their time and concentrate their efforts elsewhere? This question should at least be examined.
Participants in sports in all parts of the world have become concerned about the risks of acquiring HIV infection from bleeding injuries. A review of the risks in “Annals of Internal Medicine” (1995;122:283-5) confirms the standard advice that the chances of infection on the sportsfield are vanishingly small—the important risks for HIV and hepatitis infection come from activities off the field.
A prospective study of 100 Danish children referred for advice after a heart murmur was found (European Journal of Pediatrics 1995;154:15-17) showed that non-specialist paediatricians were as competent as paediatric cardiologists in sorting out those with a serious heart lesion from those without.
“Clinical Risk” is a new journal from Churchill Livingstone, which includes the “Action for Victims of Medical Accidents Medical and Legal Journal.” Its first issue has a review of risk management and minimal invasive surgery (1995;1:5-9), one quotation from which appealed to Minerva: “The law does not generally expect surgeons to reveal information about themselves to their patients…a surgeon is not required to disclose that she has previously been sued, or indeed that she has a hangover.” That being so, surgeons have no duty to say that the operation they are going to perform will be their first go at it.
Women who have to stand or walk about for more than five hours during a typical working day are more likely than controls to have a preterm delivery (British Journal of Obstetrics and Gynaecology 1995;102:198-206). Women who continue to work at jobs requiring standing and walking in the second trimester have 3.3 times the risk of preterm delivery when compared with women who have to stand for two hours or less a day.
Minerva has been sent an invitation to a conference in New York on “How to develop, make claims on, and market nutraceuticals.” These are foods that offer health benefits, including the prevention and treatment of disease. A news article in “JAMA” (1995;273:607-9) reports that the botanical industry is growing at 15% a year. Authorities in the United States are now calling for clinical trials to assess the efficacy of plant products promoted as having therapeutic actions. One example cited is a four year trial under way in Germany into the effect of garlic on the development of plaques in the carotid arteries.
In the Gambia at least 1000 children die of malaria each year. Research (Lancet 1995;345:479-83) has shown that treating mosquito nets with insecticides saves the lives of many children: mortality was cut by about a quarter in areas where such treatment was used. But the cost, which works out at $600 for each death prevented, is too much for a poor country to afford.
A man aged 59 who had had a sore throat for a week coughed up some tissue, which his general practitioner sent to the local hospital laboratory. It was identified as a metastasis from a renal carcinoma (Journal of Laryngology and Otology 1994;108:1108-10). The secondary tumour in the tongue and the primary in the kidney were removed surgically: 18 months later there was no evidence of recurrence.
Laparoscopy has become the first invasive stage of treatment in women diagnosed as having appendicitis. A series of 107 such women seen in Adelaide is described in the “Medical Journal of Australia” (1995;62:130-2). Acute appendicitis was confirmed in 63; no diagnosis was made in 7; and some other diagnosis, mostly gynaecological, was made in 37 women, 28 of whom did not need surgery. The median inpatient stay was two days—no wonder hospitals now manage to treat more patients with fewer beds.
Vaccine associated paralytic polio is much more common in Romania than in other countries. An investigation by a team from the United States (New England Journal of Medicine 1995;332:500-6) of 31 children who became paralysed by a vaccine strain of polio pinned the blame on intramuscular injections of antibiotics—commonly given in Romania to infants with febrile illness. Half the children affected had had more than 10 injections in the month preceding their paralysis.
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