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BMJ 1996; 312 doi: (Published 27 April 1996) Cite this as: BMJ 1996;312:0

Peanuts, Chernobyl, ethnicity, and the curse of answering machines

Pamela Ewan describes two patients who suffered respiratory arrests after inadvertently ingesting nuts to which they were allergic (p 1074). These two patients are presented in a series of 62 consecutive patients with allergies to nuts. Most (47) were allergic to peanuts, and allergic symptoms began before the age of 2 years in more than half. Dr Ewan believes that nut allergy is becoming more common, and Hugh Sampson supports this belief with data from the United States (p 1050). The condition may be becoming commoner because more children are being exposed to nuts early in life. Infants at high risk of allergy, particularly those from atopic families, should not be exposed to nuts in the first three years of life. But this can be difficult to achieve because many products contain nuts-and often in only tiny amounts. Better labelling would help.

It is exactly 10 years since the nuclear power station at Chernobyl exploded, rendering an area of 30 km radius uninhabitable (p 1078). Chernobyl has become a symbol as striking as that of thalidomide, signifying both the downside of science and the dangers of totalitarianism. Michael Ryan reviews an environmental and health atlas of Russia and points out how scientific data were used in the Soviet Union for propaganda rather than understanding (p 1108). Some 30 workers died in the cleanup, and around 600 children have developed thyroid cancer - a 100-fold increase on the normal incidence. Radioactive iodine did much of the damage, and relatively little radioactive caesium and strontium seems to have been transferred to the general population. New data we publish today show that even workers who took part in the cleanup after the accident did not receive substantial doses (p 1078). An underestimated cause of damage to health, suggests Denis Henshaw, may be the psychosocial effects of relocation. He has visited Chernobyl and seen that there is a greater need for basic medical facilities than for specific treatments for radiation induced problems. James Fraser and Richard Pullinger, two British registrars, also became involved in a humanitarian mission to Belarus (p 1107). They learnt that good intentions are not enough.

More and more research is appearing in medical journals on health indices and problems in particular racial, ethnic, and cultural groups, but much of this research is rendered almost useless by imprecise definitions of the groups being studied (p 1054). Kwame Mackenzie and Natasha Crowcroft illustrate the problem by showing how a black baptist born in the United Kingdom but whose parents were born in Jamaica might be called Afro-Caribbean, British black, of Caribbean origin UK born, West Indian, or Jamaican. The BMJ has produced guidelines on using ethnic, racial, and cultural descriptions (p 1094), and these boil down to trying to give as much precise information as possible. There is no simple fix of specified terms, but Mike Pringle and Ian Rothera show that it is feasible to record patient ethnicity in general practice (p 1080). Such recording may not, however, offer benefits that justify the costs.

A final lesson comes from retired general practitioner, Rex Last (p 1082). He describes being woken by a profoundly deaf man ringing to ask for emergency treatment for his wife. Dr Last wonders what would have happened if - as is now common - the man had spoken not to a doctor but to an answering machine.

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