The cruellest month

This April in Chicago the weather was unseasonably cold; Waterstone's closed their bookstore off Michigan Avenue; the Commission on Tall Buildings ruled that the twin Petronas towers in Kuala Lumpur and not the Sears tower were the tallest skyscrapers in the world; and dust blown from work on pipes caused two schools to be temporarily closed because of high lead levels. This coincided with a report from Boston suggesting that lead was an independent risk factor for hypertension and renal insufficiency.

Elsewhere the law caught up again with a man, known for his engaging bedside manner, who first practised orthopaedics, then switched to internal medicine; was convicted of manslaughter after treating diabetic ketoacidosis with antihistamines; and eventually reappeared doing routine physical exams—all without ever going to medical school.

Dark beer this month joined aspirin and red wine in allegedly being able to prevent heart attacks; it contains beneficial flavonoids, as does black tea. Coffee, however, merely raises adrenaline levels, which has not prevented expresso bars in the city from proliferating or people from walking to work carrying their paper cups of cappuccino or cafe latte. Others prefer vitamin C but should note that the recommended “optimal amount” is now 200 mg, still more than the 10 mg required to prevent scurvy but less than the megadoses advocated by Linus Pauling. A study in Nebraska farmers has found that well done beef may increase the risk of stomach cancer—perhaps because of carcinogenic heterocyclic amines—and a biotechnology firm is working on developing gene therapy for baldness.

According to a new federal rule, health maintenance organisations must disclose if they pay their doctors more than 25% of their income as incentives or bonuses for saving money and increasing profits. President Clinton has at last signed a budget agreement for what is left of 1996; but vetoed a bill outlawing third trimester so called partial birth abortions. A bill to reform health insurance by making it transferable for employees changing jobs may be slowly wending its way through Congress; and so is a bill to reform the ever controversial Food and Drug Administration. New studies estimate the annual cost of defensive medicine in the United States at $50 billion and the cost of fraud in the food stamps programme for poor people at $3 billion. Efforts to reform Medicare remain stalled, even though the fund paying for the programme lost $4.2 billion last year.

Several courts of appeal have recognised a constitutional right to die by striking down state laws forbidding physicians to assist mentally competent persons to commit suicide, but the issue will probably be referred to the supreme court. The Food and Drug Administration has approved several antiproteinase AIDS drugs that for $6000 a year for each patient reduce viral loads and raise CD4 cell counts, a modern way of buttering the opsonins. Finally, on 15 April millions of Americans thronged into post offices to meet the deadline for filing their income tax returns, confirming that April is indeed the cruellest month.—GEORGE DUNEA, attending physician, Cook County Hospital, Chicago, USA