Minerva

Minerva

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6950.350 (Published 30 July 1994) Cite this as: BMJ 1994;309:350

Minerva doesn't believe that healthy people benefit from taking vitamins, so she was pleased to read the results of a four year trial of ß carotene, vitamins C and E, both, and placebo in the prevention of colorectal adenomas (New England Journal of Medicine 1994;331:141- 7). No differences were found among the groups - a result in line with a report earlier this year showing that vitamins didn't prevent lung cancer either.

Health enthusiasts in the United States are complaining that these reports conflict with earlier studies; they are asking, says the “New England Journal of Medicine” in an accompanying editorial (1994;331:189-90), “Why can't researchers get it straight the first time?” The answer given by the journal is that it publishes working papers, not received wisdom. It might have added that often (but not invariably) the media rather than the scientists claim the dramatic breakthroughs.

As a treatment for breast cancer, lumpectomy plus radiotherapy is known to give as good results as mastectomy, yet more than half the surgeons recently questioned in the United States continued to recommend mastectomy to their patients (Mayo Clinic Proceedings 1994;69:601-2). Review of records at the Mayo Clinic came up with only 165 women treated by lumpectomy over a period of 10 years. Women continue to agree to the surgery offered to them, and surgeons continue to be conservative.

The first issue of the “Journal of Cardiovascular Risk” (1994;1:9-15) has tackled a question to which Minerva has long wanted an answer - why do Greek men live longer than their contemporaries in the rest of Europe? Part of the answer is their diet, rich in olive oil and fresh vegetables and fruit; but other factors suggested in this report are the relaxing psychological environment in Greek society, afternoon siestas, and even the mild climate.

A child who speaks at home but not at school is said to be electively mute. Eight of 18 children with this behaviour in schools in Leeds were found to have suffered definite or probable sexual abuse (Archives of Disease in Childhood 1994;70:540-1). Many types of trauma may precipitate mutism, the report concludes, but sexual abuse should be high on the list of possibilities.

The “Journal of Medical Genetics” includes in its current issue (1994;31:507-17) data on 139 loci (including 65 specifically identified genes) implicated in congenital malformations. This knowledge should lead to more precise diagnosis and prognosis and better prenatal prediction and carrier testing.

The tumour suppressor gene p53 is thought to be implicated in around half of all human cancers. Some research in the United States (Science 1994;265:320) has now suggested that it may also play a part in restenosis after coronary artery angioplasty. Inactivation of the gene by cytomegalovirus infection seems to lead to proliferation of smooth muscle cells in the artery wall. If these findings are confirmed antiviral treatment may become part of the postoperative care of patients treated by angioplasty.

Heautoscopy is the multimodal reduplicative hallucination of one's own person, the experience of a doppelganger. Poe and Wilde were only two of many authors who wrote of the experience leading to suicide. The “Journal of Neurology, Neurosurgery, and Psychiatry” (1994;57:838-9) reviews the connection between heautoscopy and epilepsy and describes a patient who attempted suicide after having the experience of a violent argument with his doppelganger.

Maternal mortality in Uganda remains high - 500 per 100 000 live births (Tropical Doctor 1994;24:103-7). Efforts are being made to train the traditional birth attendants, virtually all of whom are illiterate, and to provide them with basic materials such as razor blades and cord ligatures.

Figure1

A boy aged 5 presented with a clinical diagnosis of Henoch-Schonlein purpura. Venepuncture was difficult and required the use of a tourniquet and sustained pressure to control bleeding. He developed a massive haematoma and after two days required decompression of both the flexor and extensor compartments of the forearm, leaving an extensive area of scarring. The histological appearances in Henoch-Schonlein purpura are indistinguishable from those of necrotising vasculitis and the rash is more common on pressure sites. Blistering, ulceration, and gangrene have all been reported and particular care should be taken during phlebotomy.

A survey by the Institution of Environmental Health Officers has found that 80% of local authorities have received complaints about light pollution (European Environmental Extra 1994 June: 12). Many of the complaints concerned neighbours' security lights and decorative garden lighting. The Campaign for the Protection of Rural England is campaigning to “keep the starry night” - but sales of domestic security lights are increasing. Is there any medical evidence that the body needs darkness?

Reading through Steve Wing's article on the limits of epidemiology in “Medicine and Global Survival” (1994;1:74-86) Minerva was surprised and pleased to learn that the great nineteenth century pathologist Rudolf Virchow had said that “Medicine is a social science and politics nothing but medicine on a grand scale.”

Smoking is rife in countries such as the former Soviet Union despite there having been little or no tobacco advertising during the communist era. Western manufacturers are now competing for the huge market (Tobacco Control 1994;3:145-7). Attempts by the health authorities to introduce bans on tobacco advertising seem likely to be too little too late. The Western cigarettes sold in Russia carry no health warnings. A worsening epidemic of tobacco related diseases seems inevitable.

Around one quarter of the drugs in current use are based on compounds found originally in plants, and this explains why the pharmaceutical companies continue to screen plants in environments such as rain forests. A commentary in “Nature” (1994;369:702) suggests another possible source of new drugs - the texts of Aristotelian/Galenic medicine. Greek and Latin herbaria may contain descriptions of pharmacologically active plants whose properties have been forgotten.

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