Fighting both bugs and tobacco companies

BMJ 2001; 322 doi: (Published 05 May 2001) Cite this as: BMJ 2001;322:a

Read the BMJ of 60 years ago and you'll see little mention of tobacco. In the BMJ of 20 years ago there was nothing about AIDS. Now tobacco and AIDS are between them killing hundreds of millions—and both feature constantly. This week is no exception. (What, you might wonder, is missing from the journal now that will be dominating it in 20 years' time?)

One problem facing doctors treating patients with AIDS is increasing drug resistance of HIV (p 1074). It had to happen. Modern scientists may be clever, but they are battling evolution, which is even cleverer. Today's study from Birmingham adds new evidence showing that drug resistance is increasing (p 1087).

An even bigger problem than drug resistance is finding money to respond to the disease among those in developing countries. The recent withdrawal of pharmaceutical companies from a law suit in South Africa should mean that antiretroviral drugs will become much cheaper in the developing world (28 April, p 1011. Last week United Nations' secretary general Kofi Annan called for the creation of a war chest of $7bn-10bn (£5bn-7bn) to be spent annually on a global campaign against AIDS (p 1082). Readers might want to write to their political representatives in support of the call.

The battle against tobacco is a battle not with fast reproducing bugs but with devious tobacco companies. Clifford Douglas reviews a book by David Kessler, the former commissioner of the Food and Drug Administration (FDA), that describes the attempts of the administration to regulate tobacco products (p 1129). Douglas criticises Kessler for ignoring the contribution of Deep Cough, a “pioneering yet terrified informant” from the tobacco industry.

Ultimately the Supreme Court ruled that the FDA could not regulate tobacco products, but John Britton and Ann McNeill argue that Britain needs a nicotine regulation authority (p 1077). At the moment “the most dangerous product on general sale in the UK is subject to the least regulatory control” because it falls between various laws. The editorialists argue that the authority should regulate not only tobacco but also alternative nicotine products. A second editorial describes how all forms of nicotine replacement therapy are now available on prescription in Britain and discusses guidelines on smoking cessation that are being circulated to all general practitioners with this week's BMJ (p 1076).

Finally, please vote on on whether Nottingham University should give back £3.8m it's received from British American Tobacco, and on whether I (a professor in the university as well as editor of the BMJ) should resign if it doesn't (p 1118).


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