Learning from the RussiansBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7561.267 (Published 27 July 2006) Cite this as: BMJ 2006;333:267
All rapid responses
Many studies on the alcohol consumption in Russia [e.g., 1] and other countries have often been based on surveys. However, there are significant East-West differences. Evaluating the results of surveys and questionnaires, it should be taken into account that these valuable research tools have been largely discredited in Russia since the 1990s by means of widespread obtrusive solicitations to partake in different surveys, often asking for private information: in the streets, per telephone, and also by agents coming to private homes. Answers to the questionnaires can be biased. The statements e.g. that the ‘earlier research has suggested that, at least for drinking behaviour, reports [by adolescents] can be regarded as being generally valid’  are therefore not substantiated by references to studies from West Europe , where the attitude to the surveys must be significantly more responsible.
The study  was based on a survey carried out in Russia among adolescents 13-17 years old. ‘In terms of sexual behaviour, there was no difference in the odds ratios between binge drinking and non-binge drinking girls and boys for non-condom use during last sex’ . However, it can be reasonably assumed that the study subjects answered the question ‘The last time you had sex did you or your partner use a condom?’ with ‘yes’ without pondering that it is a research having potential significance for the public health. There are no reliable statistics, but the abortion rate in the former Soviet Union was reported to be the highest in the world , which was caused not only by insufficient availability of modern contraception but also by irresponsibility of some males . Alcohol misuse was generally perceived as a contributing factor. Admittedly, an improvement tendency could be noticed since approximately the last decade or more . The role of alcohol in safer sex decision making is broadly discussed in professional literature, the prevailing opinion being that binge drinking and alcohol consumption at sexual relations are risk factors for non-use of condoms [6-9]. Admittedly, the topic is not without controversy [10,11]. In conclusion, data obtained by means of a survey in Russia are of limited scientific value, which should be taken into account evaluating alcohol-related studies from Russia.
1. Stickley A, Koyanagi A, Koposov R, et al. Adolescent binge drinking and risky health behaviours: findings from northern Russia. Drug Alcohol Depend. 2013;133(3):838-44.
2. Lintonen T, Ahlström S, Metso L. The reliability of self-reported drinking in adolescence. Alcohol Alcohol. 2004;39(4):362-8.
3. Popov AA, Visser AP, Ketting E. Contraceptive knowledge, attitudes, and practice in Russia during the 1980s. Stud Fam Plann. 1993;24(4):227-35.
4. Jargin SV. About the treatment of gonorrhea in the former Soviet Union. Dermatol Pract Concept. 2012;2(3):12.
5. Jargin SV. Changing pattern of alcohol consumption in Russia. Adicciones. 2013;25(4):356-7.
6. Eaton LA, Cain DN, Pitpitan EV, et al. Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships. J Prim Prev. 2014;35(4):255-65.
7. Howells NL, Orcutt HK. Diary study of sexual risk taking, alcohol use, and strategies for reducing negative affect in female college students. J Stud Alcohol Drugs. 2014;75(3):399-403.
8. Leigh BC, Stall R. Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention. Am Psychol. 1993;48(10):1035-45.
9. Medić A, Dzelalija B, Koźul K, et al. Risk factors influencing non-use of condoms at sexual relations in populations under heightened risk. Coll Antropol. 2014;38(3):895-900.
10. Cooper ML. Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence. J Stud Alcohol Suppl. 2002;(14):101-17.
11. Davis KC, Masters NT, Eakins D, et al. Alcohol intoxication and condom use self-efficacy effects on women's condom use intentions. Addict Behav. 2014;39(1):153-8.
Competing interests: No competing interests
There are indications that the cause-effect relationship between alcohol consumption, cardio- and cerebrovascular mortality, and the incidence of these diseases in the former Soviet Union (SU), have been overestimated e.g. in (1-3). According to the author’s observations in pathology since 1982, the cardio- and cerebrovascular diseases have been often overdiagnosed post mortem in unclear cases (4). After 1990 the quality control has deteriorated; autopsies were often made perfunctorily. If a cause of death was not entirely clear, it was usual to write on a death certificate: “Ischemic heart disease with cardiac insufficiency on the background of atherosclerosis” or a similar formulation. A tendency to overdiagnose cardio- and cerebrovascular diseases exists also for people dying at home and not undergoing autopsy.
Stroke as a cause of death has sometimes been overdiagnosed in cases with neurological symptoms, which in reality could have been caused by intoxication with poor-quality alcoholic beverages i.e. substances other than ethanol. Quality decrease in anatomic pathology and in the health care in general during the 1990s coincided with the increase in the cardiovascular (5) and hypertension-related (2) mortality; at the same time, the stroke mortality “jumped dramatically” (1). In this connection, the following citation should be commented: “Increases and decreases in mortality (have been) related to cardiovascular diseases (CVD), particularly to ‘other forms of acute and chronic ischemia’ and ‘atherosclerotic heart disease’, but not to myocardial infarction, the proportion of which in Russian CVD-related mortality is extremely low” (3). The explanation is evident: the diagnosis of myocardial infarction is usually based on clear clinical and/or pathological criteria, whereas entities such as “atherosclerotic heart disease” have often been used without evidence. Note that, on the contrary to myocardial infarction, gross features of a brain infarction can be imitated artificially destroying brain tissue e.g. by a junior pathologist not inclined or incapable (because of the limited spectrum of available methods, toxicological tests etc.) to search for a true cause of death. The author recollects such cases of false-positive post mortem diagnosis of brain infarctions in an academic institution, which has probably happened more frequently in pathology departments of hospitals. Furthermore, the following should be commented about the article (1).
The curves of alcohol consumption and stroke mortality, shown on the graphs, follow each other; but reliability of quantitative estimation of alcohol consumption appears to be questionable: “The harm indicator series used was alcohol psychoses incidence rate because this indicator depends almost entirely on alcohol consumption” (1). However, psychosis can be caused not only by excessive intake of ethanol but also by other substances in alcoholic beverages. In particular, we observed psychosis-like conditions after a consumption of fortified wine surrogates sold in shops. Misdiagnosis of neurological derangements after an ingestion of toxic alcohol-containing fluids as psychosis can happen as well. False-positive diagnostics of psychosis in the former SU was known to occur (6). According to (7), about a half of the cases of lethal intoxication by alcohol-containing fluids during the 1990s were caused in some areas by legally sold beverages, while in many lethal cases a relatively low blood alcohol level was found (7); more details are in (8). During the anti-alcohol campaign, massive consumption of alcohol-containing perfumery and technical fluids was observed. Considering the large scale of window cleaner sales in some areas, it was knowingly tolerated by authorities. In some papers dedicated to the consumption of alcohol surrogates in the former SU (9), the readers’ attention is diverted to industrial spirits, perfumery and samogon (moonshine). However, when legally sold alcohol is relatively cheap (the minimal vodka price / average salary rate was approximately 5 times higher early in 1985 than in 2010) (8), consumption of noncommercial alcohol would not be high. According to the author’s observations, consumption of alcohol-containing industrial fluids and perfumery decreased abruptly after the anti-alcohol campaign; the consumption of samogon has apparently decreased as well. Published statistics can be unreliable, while there are obvious motives to exaggerate consumption of the noncommercial surrogates to veil the issue of toxicity of legally sold alcoholic products. Admittedly, a tendency of quality improvement of alcoholic beverages has been noticed since approximately the last decade.
Costs of drugs for an outpatient treatment are not covered by the obligatory medical insurance in Russia; and there are no discounts for a majority of patients. Regular therapy of hypertension and diabetes mellitus, especially that using modern medication, is hardly affordable on a regular basis for many people with low incomes. Irregular treatment of hypertension continues to be a major problem in the countries of the former SU (10). There is also a gender-related aspect: middle-aged men are underrepresented among visitors of governmental policlinics; in particular, people recognizable as alcohol abusers are not always welcome. For these and other reasons, many middle-aged men including alcohol abusers often stay at home even if they have symptoms, thus receiving no adequate treatment for chronic diseases.
Finally, the following statement should be commented: “Epidemiological evidence suggests that binge drinking is an important determinant of high stroke mortality rate in Russia” (1). However, the heavy binge drinking is visibly in decline in Russia since approximately the year 2000, especially in large cities such as Moscow, which is in agreement with (11,12). During the Soviet period and shortly afterwards, many inebriated individuals could be seen in public places: drinking, sleeping, making noise, etc. In contrast with the past, there are less heavily drunk people in the streets today, and even marginalized persons are rarely seen drunk in public. Consumption of vodka has been partly replaced by that of beer (13) contributing to the decline in the heavy binge drinking pattern.
In conclusion, among the principal causes of the relatively high mortality especially among men in the former SU are insufficient quality and availability of health care, poor quality and toxicity of some alcoholic beverages, acknowledging that there has been an improvement tendency since approximately the last decade.
1. Razvodovsky YE. Fraction of stroke mortality attributable to alcohol consumption in Russia. Adicciones (2014) 26:126–33.
2. Razvodovsky YE. Contribution of alcohol to hypertension mortality in Russia. J Addict (2014) 2014:483910. doi: 10.1155/2014/483910
3. Davydov MI, Zaridze D G, Lazarev AF, Maksimovich DM, Igitov VI, Boroda AM, Khvastiuk MG. Analysis of mortality in Russian population. Vestn Ross Akad Med Nauk (2007) (7):17–27.
4. Jargin SV. Health care and life expectancy: a letter from Russia. Public Health (2013) 127:189–90. doi: 10.1016/j.puhe.2012.11.003
5. Zatonski WA, Bhala N. Changing trends of diseases in Eastern Europe: closing the gap. Public Health (2012) 126:248–52. doi: 10.1016/j.puhe.2011.11.017
6. Jargin SV. Psychiatry in Russia: economic upturn must bring improvements. Rev Bras Psiquiatr (2010) 32:460–1. http://dx.doi.org/10.1590/S1516-44462010000400024
7. Nuzhnyi VP, Kharchenko VI, Akopian AS. Alcohol abuse in Russia is an essential risk factor of cardiovascular diseases development and high population mortality (review). Ter Arkh (1998) 70(10):57–64.
8. Jargin SV. Letter from Russia: minimal price for vodka established in Russia from 1 January 2010. Alcohol Alcohol (2010) 45:586–8. doi: 10.1093/alcalc/agq061
9. Razvodovsky YE. Consumption of noncommercial alcohol among alcohol-dependent patients. Psychiatry J (2013) 2013:691050. doi: 10.1155/2013/691050
10. Roberts B, Stickley A, Balabanova D, Haerpfer C, McKee M. The persistence of irregular treatment of hypertension in the former Soviet Union. J Epidemiol Community Health (2012) 66:1079–82. doi: 10.1136/jech-2011-200645
11. Neufeld M, Rehm J. Alcohol consumption and mortality in Russia since 2000: are there any changes following the alcohol policy changes starting in 2006? Alcohol Alcohol (2013) 48:222–30. doi: 10.1093/alcalc/ags134
12. Perlman FJA. Drinking in transition: trends in alcohol consumption in Russia 1994-2004. BMC Public Health (2010) 10:691. doi: 10.1186/1471-2458-10-691
13. World Health Organization. Global Information System on Alcohol and Health (GISAH). Russian Federation. Geneva: WHO (2011).
Competing interests: No competing interests
Dr Jargin’s comments (1) remind us of the many and varied determinants of harmful alcohol consumption in the Russian Federation, with consumption patterns so highly publicized that, despite concerns about availability of data, alcohol use in Russia has its own Wikipedia page (2). Yet, recent reports of decreasing or stable trends in alcohol consumption in Russia provide positive news (3, 4). Given the well-documented negative health consequences of alcohol use (5) and the heavy demands they pose on health care systems in Russia (6) we wonder about other countries with limited availability of data and the potential for alcohol-related harms? One study using the same alcohol consumption screening instruments across countries has found China’s consumption patterns more risky than in Russia. The Study on global AGEing and adult health (SAGE) is a multinational, longitudinal, nationally representative survey of adults aged 50 and above in six countries, including Russia and China (7). Panel data from 2004 and 2009 show a slight increase from baseline to follow-up in the rate of heavy episodic drinking (5 or more drinks on one occasion) in the week prior to interview among drinkers in Russian women (10.2% to 12.4%) and men (23.6% to 26.4%). In contrast, rates of heavy episodic drinking amongst past week drinkers changed significantly among both Chinese women (2.7% to 15.0%) and men (20.4% to 32.2%). The rates of harmful drinking are now higher in China than Russia.
Recent longitudinal studies in Russia have observed an increased likelihood of alcohol-related mortality including both acute incidents (accidents, suicide) and chronic conditions (hypertension, liver disorders), even with fluctuations in alcohol use over time (8,9). Among older adults in particular, studies also show an association between heavy alcohol use in older age and cognitive declines (10). The relatively stable rates of heavy episodic drinking we observed in Russia in conjunction with this strong and recent evidence showing higher alcohol-related mortality and negative health consequences among heavy alcohol users suggest the health care needs of heavy alcohol users will continue to be a significant challenge for the Russian health care system, even given stable rates of heavy alcohol use. China, as a contrast to the stable rates of heavy episodic drinking in Russia, has experienced a marked increase over just a five-year period. Of particular concern is that this increase occurred among middle-aged women, a group with traditionally low levels of alcohol use generally, and heavy drinking in particular. Moreover, women may be less likely than men to seek treatment for alcohol-related problems (11) and may suffer more severe negative health and social consequences than men (12), especially in a setting with little resources to address these problems and disparities. While the trajectories of heavy alcohol use may differ between Russia and China, the need for continued monitoring of trends in alcohol use and their distribution across populations, and efforts to prevent and treat the negative repercussions of heavy alcohol use in Russia, China and other emerging economies are warranted.
1. Jargin SV. Alcohol problem in Russia is exaggerated to veil shortages of the health care system. BMJ. 2014;www.bmj.com/content/333/7561/267.1/rr/700222
3. Neuman M, Rehm, J. Alcohol Consumption and Mortality in Russia since 2000: Are there any Changes Following the Alcohol Policy Changes Starting in 2006? Alcohol and Alcoholism. 2013; 48(2): 222–230. doi: 10.1093/alcalc/ags134.
4. Perlman, FJA. Drinking in transition: trends in alcohol consumption in Russia 1994-2004. BMC Public Health 2010, 10:691. http://www.biomedcentral.com/1471-2458/10/691
5. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009; 373: 2223–33.
6. Sørgaard KW, Rezvy G, Bugdanov A, Sørlie T, Bratlid T. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway. Int J Ment Health Syst. 2013 Jan 14;7(1):4. doi: 10.1186/1752-4458-7-4.
7. Kowal P, Chatterji S, Naidoo N, Biritwum R, Wu Fan, Lopez Ridaura R, Maximova T, Arokiasamy P, Phaswana-Mafuya N, Williams S, Snodgrass JJ, Minicuci N, D'Este C, Peltzer K, Boerma JT, and the SAGE Collaborators. Data Resource Profile: The World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol.2012;41(6):1639-49.
8. Zaridze D, Lewington S, Boroda A, Scelo G, Karpox R, Lazarev A, Konobeevskaya I, Igitov V, Terechova T, Boffetta P, Sherliker P, Kong X, Whitlock G, Boreham J, Brennan P, Peto R. Alcohol and mortality in Russia: prospective observational study of 151 000 adults. Lancet. Apr 26, 2014; 383(9927): 1465–1473.
9. Razvodovsky YE. Contribution of Alcohol to Hypertension Mortality in Russia. Journal of Addiction. 2014. http://dx.doi.org/10.1155/2014/483910
10. Sabia S, Elbaz A, Britton A, Bell S, Dugravot A, Shipley M, Kivimaki M, Singh-Manoux A. Alcohol consumption and cognitive decline in early old age. Neurology. 2014 Jan 28;82(4):332-9.
11. Greenfield SF, Brooks AJ, Gordon SM, Green CA, Kropp F, McHugh RK, Lincoln M, Hien D, Miele GM. Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend. 2007. 5;86(1):1-21.
12. Kerr-Corrêa F1, Igami TZ, Hiroce V, Tucci AM. Patterns of alcohol use between genders: a cross-cultural evaluation. J Affect Disord. 2007 Sep;102(1-3):265-75.
Competing interests: No competing interests
Alcohol consumption in the former Soviet Union (SU) has been a theme of extensive research despite the difficulties of obtaining valid statistics. The fact that the state, at various times, encouraged alcohol sales is known to the international community (1). Veiled propaganda of alcohol consumption was recognizable during the 1960-1980s (before the start of the anti-alcohol campaign in 1985) and took place also earlier (3); more details are in (2). Alcohol consumption at workplaces was not only tolerated but also visibly encouraged among workers, students and intelligentsia. Parties at workplaces were often initiated or indirectly inspired by the management, which was common also in medical, educational and scientific institutions. In such institutions, technical or medicinal alcohol was consumed, which was knowingly tolerated by the management. It was known and seen that the management purloined alcohol themselves. The ringleaders could be observed, who manipulated others towards drinking in excess while non-drinkers were stigmatized.
Treatment and prevention of alcoholism was inefficient, placebos and persuasion being usual methods (4). Aversion (emetic) therapy and repeatedly induced teturam-alcohol reactions were applied (5). Correctional centres, so-called work-and-treatment prophylactoriums, were in fact a form of detainment for 1-2 years for chronic alcoholics evading treatment, violating community order or working discipline (according to the official definition); while loopholes were left for the patients to obtain alcohol e.g. over the fence. There was business with teturam preparations for the implantation, having a placebo effect at best (6,7): the patients were persuaded about efficiency and paid for the implantation. Finally, the so-called ultra-rapid psychotherapy or stress-therapy of alcoholism, known in the former SU as the ‘coding’, should be mentioned. The method was started during the anti-alcohol campaign; it was criticized as unethical (8) because of mystification, intimidating verbal suggestion, and painful or unpleasant manipulations: spraying the throat with ethyl chloride, massage of the trigeminal nerve branches, sudden backwards movements of the patient’s head by the therapist (8-10). We have found no reports on complications, but injuries of the cervical spine could have happened. Modifications of the method included general anaesthesia (11). The method is used in the former SU for the treatment of alcohol and drug addiction now as before (12).
The anti-alcohol campaign (1985-88) was initially successful but ended with a failure. It was accompanied, along with a temporary decrease in the alcohol-related mortality (1), by numerous fatal cases because of the increased consumption of alcohol-containing surrogates and technical fluids. The quality of alcoholic beverages deteriorated during that period (13). After the campaign, the alcohol consumption increased again, with vodka forming a larger share in the total (14), having partly replaced wine (15). Retrospectively, it becomes clear that the anti-alcohol campaign (1985-88) was used for the same purpose: its failure and the recoil-effect was predictable and occurred when it was required. Massive alcohol consumption after the campaign facilitated the economical reforms of early 1990s. It is known that alcohol abusers can experience emotions of shame, guilt and have a low self-esteem (16), therefore being probably easier to manipulate and to command. Workers did not oppose privatizations of state-owned enterprises by former administrators and party functionaries partly due to their drunkenness, involvement in workplace theft and other illegal activities, e.g. use of equipment for private purposes, which was often tolerated by the management at that time.
After the anti-alcohol campaign (1985-88), the quality of alcoholic beverages deteriorated, but they have become easily available. However, recent governmental measures in Russia, limiting availability of alcohol, in particular, a prohibition of small (0.33l) beer cans, can contribute even today to alcohol consumption in higher doses. Another recent anti-alcohol measure – prohibition from the 1 January 2013 of beer selling between 23 p.m. and 8 a.m. sometimes results in purchasing larger amounts in advance with subsequent consumption. Prohibition of beer sales at small kiosks will probably have a similar effect in the places with no shops near at hand. There is an opinion that the latter measure would have no impact on the volume of beer sales (17). Superficial anti-alcohol measures of this kind and accompanying rhetoric are in fact distracting public attention from the problems, which the government does not tackle, among them corruption, the insufficient public health and social security systems.
According to the author’s observations, the pattern of alcohol consumption in Russia has been changing since approximately 2000, with the average amounts of consumed alcohol tending to decrease. During the Soviet time and the 1990s, many inebriated people could be seen in public places: drinking, sleeping, making noise, etc. In contrast with the past, there are almost no heavily drunk people in the streets today; even the marginalized are rarely seen drunk in public. Concomitantly, the pattern of alcohol consumption has been changing: less heavy binge drinking of vodka, partly replaced by the moderate consumption of beer (15). A similar tendency is also noticed in smaller towns and rural areas, favoured by the ongoing immigration from the regions with less widespread alcohol consumption, such as Middle Asia and the Caucasus, or explained by the fact that local alcoholics have “died out” with fewer successors. Other reasons for these changes have been discussed previously: the more responsible way of life under the conditions of the market economy, intimidation and crime against alcoholics and people with alcohol-related dementia, including appropriation of their residences and other property (18).
After the anti-alcohol campaign (1985-88), average life expectancy at birth decreased sharply, especially in men: by 1993 it had slumped to about 59 years (14), today being estimated to be 64 years (19). According to a widespread opinion, many Russian alcohol abusers do not live long enough to die of liver cirrhosis or its complications. Among the most frequent causes of death of alcoholics are bronchopulmonary diseases including chronic bronchitis, bronchopneumonia, pleural empyema, and tuberculosis (20-22). This is probably partly caused by the cold climate coupled with the limited availability of warm public houses for the people with low incomes, so that they often drink and loiter outdoors and can fall asleep in a cold place. Smoking is also likely to be a contributing factor.
Another cause of the relatively high mortality has been the poor quality of alcoholic beverages, in particular, consumption of counterfeit products and surrogates sold also in legally operating shops (13,23). During the anti-alcohol campaign, many poisonings were caused by alcohol-containing technical fluids. The quality of legally sold alcoholic beverages deteriorated during that period; after the campaign, poor-quality beverages were produced and sold en masse (23). Numerous cases of death after the ingestion of moderate amounts (24), with a relatively low blood alcohol level (23) were reported, obviously caused by the substances other than ethanol contained in the consumed products.
Furthermore, a relatively high mortality rate from cardiovascular diseases in Russia has been reported (25,26). A cause of the high registered cardiovascular mortality in the former SU is evident for anatomic pathologists. Since the Soviet time, autopsy has remained obligatory for all patients dying in hospitals; but the attitude towards post-mortem examinations has become less rigorous. Autopsies were often performed incompletely. If a cause of death is not entirely clear, it is usual to write on a death certificate: ‘Ischemic heart disease with cardiac insufficiency’ or a similar formulation. A tendency to overdiagnose cardiovascular diseases also exists for people dying at home and not undergoing autopsy. This is likely to be one of the causes of the increase in cardiovascular mortality, especially among men (27). It can be indirectly confirmed by the following statement: ‘Increases and decreases in mortality [have been] related to cardiovascular diseases (CVD), particularly to ‘other forms of acute and chronic ischemia’ and ‘atherosclerotic heart disease’, but not to myocardial infarction, the proportion of which in Russian CVD-related mortality is extremely low.’ (28) The explanation is evident: the diagnosis of myocardial infarction is usually based on clear clinical and/or pathological criteria, while entities such as ‘acute and chronic ischemia’ or ‘atherosclerotic heart disease’ can be used post mortem without strong evidence. The ‘extremely low’ (28) mortality of myocardial infarction in Russia indicates that many cases remain undiagnosed and untreated.
The role of alcohol as a cause of premature death cannot be denied, but this role was obviously more significant during the 1990s, when alcohol consumption increased as a recoil effect after the anti-alcohol campaign. The causative role of alcohol in Russian mortality rates was obviously exaggerated in some publications, e.g. (29), where “the enormous scale of alcohol-related mortality” was reiterated without mentioning the insufficient availability and quality of health care as another cause of premature death. There is a tendency in the Russian literature to exaggerate the topic alcohol abuse and its cause-effect relationship with mortality, especially from cardiovascular diseases, e.g. (20,21,23,29,30). In this way, responsibility for higher mortality rates, partly caused by the shortages of the health care system, is in a sense shifted onto the patients themselves: they allegedly suffered from self-inflicted diseases due to their excessive alcohol consumption.
For example, it was stated on the basis of a large autopsy study that all 654 deceased individuals classified as hard drinkers were diagnosed post mortem with cardiomyopathy; while in the majority of the patients diagnosed with chronic alcoholism (172 cases) the cardiomyopathy was graded as pronounced (21). According to the monograph (20), clinically significant cardiomyopathy was diagnosed in approximately 50% of habitual alcohol consumers. Accordingly, cardiomyopathy is used to explain for sudden death among alcohol consumers (21), while the factual cause could have been undiagnosed disease or poisoning (28). The tendency to exaggerate the cause-effect relationship between alcohol and the cardiovascular morbidity is relatively new in the Russian literature. An earlier epidemiological study reported that rates of cardiovascular diseases including hypertension were not significantly higher among excessively drinking men compared to the general male population (22).
Exaggeration of alcohol-related mortality tends to veil shortcomings of the health care system, with responsibility for the low life expectancy especially among men shifted onto the patients, that is, self-inflicted diseases caused by excessive alcohol consumption. The purpose of this Rapid Response is to draw attention to this and other problems related to the alcohol consumption, such as the instable quality of legally sold alcoholic beverages Russia, which have sometimes caused poisonings even after consumption in moderate doses, and crime against alcoholics and people with alcohol-related dementia aimed at appropriation of their immobile or other properly (31).
1. McKee M. Alcohol in Russia. Alcohol Alcohol 1999;34(6):824-9.
2. Jargin SV. On the causes of alcoholism in the former Soviet Union. Alcohol Alcohol 2010;45(1):104-5.
3. Pelipas VE, Miroshnichenko LD. Problems of the alcohol policy. In: Ivanets NN, Vinnikova MA. (Editors) Alcoholism. Moscow: MIA, 2011:817-51. (Russian)
4. Fleming PM, Meyroyan A, Klimova I. Alcohol treatment services in Russia: a worsening crisis. Alcohol Alcohol 1994;29(4):357-62.
5. Altshuler VB. Alcoholism. Moscow: GEOTAR-Media, 2010. (Russian)
6. Johnsen J, Mørland J. Depot preparations of disulfiram: experimental and clinical results. Acta Psychiatr Scand Suppl 1992;369:27-30.
7. Wilson A, Blanchard R, Davidson W, et al. Disulfiram implantation: a dose response trial. J Clin Psychiatry 1984;45(6):242-7.
8. Voskresenskii VA. Critical evaluation of ultra-rapid psychotherapy of alcoholism (concerning the article by A.R. Dovzhenko et al. "Ambulatory stress psychotherapy of alcoholics"). Zh Nevropatol Psikhiatr Im S S Korsakova 1990;90(9):130-2.
9. Dovzhenko AR, Artemchuk AF, Bolotova ZN, et al. Outpatient stress psychotherapy of patients with alcoholism. Zh Nevropatol Psikhiatr Im S S Korsakova 1988;88(2):94-7.
10. Lipgart NK, Goloburda AV, Ivanov VV. Once more about A.R. Dobzhenko's method of stress psychotherapy in alcoholism. Zh Nevropatol Psikhiatr Im S S Korsakova 1991;91(6):133-4.
11. Belokrylov IV, Agibalova TV, Rovenskikh IN. Psychotherapy of alcoholism technology. In: Ivanets NN, Vinnikova MA. (Editors) Alcoholism. Moscow: MIA, 2011:396-438 (Russian)
12. Torban M, Heimer R, Ilyuk RD, Krupitsky EM. Practices and attitudes of addiction treatment providers in the Russian Federation. Journal of Addiction Research & Therapy 2011; 2:104.
13. Jargin SV. Letter from Russia: minimal price for vodka established in Russia from 1 January 2010. Alcohol Alcohol 2010;45(6):586-8.
14. Ryan M. Alcoholism and rising mortality in the Russian Federation. BMJ 1995;310(6980):646-8.
15. WHO. Russian Federation. Global Information System on Alcohol and Health (GISAH), Geneva: World Health Organization, 2011.
16. Scherer M, Worthington EL, Hook JN, Campana KL. Forgiveness and the bottle: promoting self-forgiveness in individuals who abuse alcohol. J Addict Dis 2011;30(4):382-95.
17. MacFarlane S. Regulation of brewing in RF – one of the most strict. Beer and Beverages (Moscow) 2013;(1):48-9.
18. Jargin SV. Changing pattern of alcohol consumption in Russia. Adicciones 2013;25(4):356-7.
19. Rehm J. Russia: lessons for alcohol epidemiology and alcohol policy. Lancet 2014;383(9927):1440-2.
20. Vertkin AL, Zairat'iants OV, Vovk EI. Final diagnosis. Moscow: Geotar-Media, 2009. (Russian)
21. Paukov VS, Erokhin IuA. Pathologic anatomy of hard drinking and alcoholism. Arkh Patol 2004;66(4):3-9.
22. Kopyt NIa, Gudzhabidze VV. Effect of alcohol abuse on the health indices of the population. Zdravookhr Ross Fed 1977;(6):25-8.
23. Nuzhnyi VP, Kharchenko VI, Akopian AS. Alcohol abuse in Russia is an essential risk factor of cardiovascular diseases development and high population mortality (review). Ter Arkh 1998;70(10):57-64.
24. Govorin NV, Sakharov AV. Alkohol-related mortality. Tomsk: Ivan Fedorov, 2012. (Russian)
25. Zatonski WA, Bhala N. Changing trends of diseases in Eastern Europe: closing the gap. Public Health 2012;126(3):248-52.
26. Razvodovsky YE. Beverage-specific alcohol sale and cardiovascular mortality in Russia. J Environ Public Health 2010;2010:253853.
27. Zatonski W. The East-West Health Gap in Europe - what are the causes? Eur J Public Health 2007;17(2):121.
28. Davydov MI, Zaridze D G, Lazarev AF, et al. Analysis of mortality in Russian population. Vestn Ross Akad Med Nauk 2007;(7):17-27.
29. Nemtsov AV. Alcohol-related human losses in Russia in the 1980s and 1990s. Addiction 2002;97(11):1413-25.
30. Razvodovsky YE. Estimation of alcohol attributable fraction of mortality in Russia. Adicciones 2012;24(3):247-52.
31. Jargin SV. Alcohol consumption in Russia 1970-2014. LAP LAMBERT Academic Publishing, Saarbrücken, 2014. ISBN: 978-3-659-22952-7
Competing interests: No competing interests
In 2008, the difference in life expectancy between men in some West-European countries and Russia was 20 years. Estimates from 2008 on the probability of death before 65 years of age for men are approximately 16% in Western Europe, compared with 31% in Eastern Europe and 54% in Russia . According to a widespread opinion, prevalent also in the ruling spheres of today’s Russia, the life of a male pensioner is of little value for the society because he does not sit with grandchildren. A grandmother sitting with children, cooking and making housework, is generally accepted in families; but the grandfather, not inclined to do it, is often not. The idea of his redundancy is in the air in some families; is can be spoken out more or less overtly, inducing suicidal thoughts in the old man  and also provoking him to neglect his own health, to overeat, to smoke and to drink alcohol. This is especially the case for middle-aged working-class men, whose mortality is greater than that of any other segment of society . Elder abuse and neglect are rarely mentioned in the Russian professional literature and mass media, but are certainly widespread. These phenomena can be encountered in any country; and there are civilized and humane solutions. One of them is as follows: to let old men, having otherwise not much to do, to sit in warm public houses, to drink beer, wine or whatever they want, to talk, play domino etc., to go for a walk, and then to sleep at home or… in his separate room in a retirement home. Poor conditions and habitually rude attitude of personnel of these homes to the inmates is a separate topic, tackled in . Furthermore, high mortality of middle-aged men in Russia has largely been caused by insufficient quality and availability of health care; but some authors sweepingly ascribe it to the alcohol misuse, e.g. [5,6]; commented in . In this way responsibility for high morbidity and mortality is shifted on the patients themselves, interpreting their diseases as self-inflicted.
Certainly, all necessary measures should be taken to prevent violations of the public order by drunkards; but elderly alcohol consumers are usually peaceful and not prone to rampages, if not unnecessarily provoked. In our time of high labor productivity a few people can provide livelihood for many; at the same time, unemployment tends to increase. Under these circumstances, habitual alcohol users can be seen as voluntary outsiders, abstaining from different kinds of social competition and offering their place in the society to the non-drinking fellow-citizens. Therefore it would be correct not to mob them but to give them an opportunity to live the rest of their lives with dignity and some pleasure. The successfully developing Russian economy certainly can afford it.
1. Jargin SV. Health care and life expectancy. Public Health 2013;127(2):189-90
2. Jargin SV. Social vulnerability of alcoholics and patients with alcohol-related dementia. Alcohol Alcohol 2010;45(3):293-4.
3. Cockerham WC. Health lifestyles in Russia. Soc Sci Med 2000;51:1313-1324
4. Jargin SV. Radiotherapy in Russia: a redundant method. Lancet Oncol. 2009;10(1):8-9.
5. Zaridze D, Brennan P, Boreham J, Boroda A, Karpov R, Lazarev A, et al. Alcohol and cause-specific mortality in Russia: a retrospective case-control study of 48,557 adult
deaths. Lancet 2009;373:2201e14.
6. Nemtsov AV. Alcohol-related human losses in Russia in the 1980s and 1990s. Addiction 2002;97:1413-1425.
Competing interests: No competing interests
Many ex-Soviet prominences, when they become seriously ill, travel to Germany or other countries for medical treatment and consultation. Achievements of German medicine and the health care system are well known. Probably, in consequence of the World Wars, German medicine got rid of the dominance of political and military leaders. Medical science, practice and education require meticulous work and permanent study of literature, leaving almost no free time. Children of former functionaries are not accustomed to it. Moreover, medical ethics is not the same as the military one. Insufficient availability of health care for elderly Russians (especially for men, who are remarkably unwelcome at the free governmental polyclinics) results in a relatively short life expectancy (at birth in Russia: men - 61.83, women - 72.6 years, http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy ), which is obviously in accordance with the strategic interests: fewer pensions have to be paid. Insufficient professional knowledge and wrong decisions of health care authorities have caused loss of life or health for many people (1-3). Conclusion: Medical practice, science and education in the former SU should be liberated from the dominance of the Nomenklatura i.e. former Party and military functionaries and their children. An example of such dominance is the I.M. Sechenov First Moscow State Medical University, formerly named Academy (4). Another step that needs to be taken is the implementation of programs for Russian physicians to go abroad for temporary clinical attachments and for foreign specialists to come to Russia.
1. Jargin SV. Limited access to foreign literature in Russia and its consequences for medical practice. BMJ Rapid Response of 2011-01-12 http://www.bmj.com/rapid-response/2011/11/03/limited-access-foreign-lite...
2. Jargin SV. The state of medical libraries in the former Soviet Union. Health Information and Libraries Journal 2010;27(3):244-8
3. Jargin SV. On the RET rearrangements in Chernobyl-related thyroid cancer. Journal of Thyroid Research 2012, Article ID 373879. http://www.hindawi.com/journals/jtr/2012/373879/
4. Jargin SV. Pathology in the former Soviet Union: scientific misconduct and related phenomena. Dermatology Practical & Conceptual 2011;1(1):16. http://www.derm101.com/loadPdf.aspx?filename=dpc0101a16.pdf
Competing interests: No competing interests
On 26-30 May 2009 in Samara was held the 3rd Congress of Russian
pathologists and, at the same time, a meeting of the Russian Division of
the International Academy of Pathology (IAP), where its membership policy,
remaining largely unchanged since the 1990s, was confirmed again: only
those pathologists can become members of the Russian Division, who have
been awarded the academic degree "Doctor of Medical Sciences".
two academic degrees in Russia, in medicine as well as in other sciences:
Candidate of Sciences (regarded to be equivalent to the PhD in the U.S.A.)
and Doctor of Sciences (equivalent to the Higher doctorate in the
countries, where this term is used, and to the Habilitation in Austria and
Germany). Both are scientific degrees which can be acquired by
researchers, who have never been engaged in medical practice. Majority of
medical practitioners in the former Soviet Union have neither the
Candidate nor Doctor Degree. The number of the Candidates is again many
times higher than that of the Doctors.
Who are the Doctors of Medical
Sciences, having the privilege to become IAP members? Prominent
researchers? So it must be according to the official ordinances. In
reality, many administrators, former functionaries and persons connected
with them, obtained these degrees having made no substantial contribution
to medical sciences and, at the same time, having not much practical
experience. Official requirements to a doctoral dissertation are difficult
to comply with: it must be a "new large-scale scientific achievement or
solution of a large-scale scientific problem" (according to the
Governmental Ordinance on the awarding of scientific degrees, issued in
2002). In the former (1995) version of this Ordinance, there was a
formulation: "Considerable contribution to acceleration of the scientific-technical progress". Such requirements can move researchers towards
strained interpretations at least. Other requirements are global newness
and, in medicine, practical significance. The average level of our medical
science, pathology not excluded, often doesn't allow performing research
on the level of global newness. Another ingrained habit is the so-called
"raisin": modern sophisticated methods expected to be used in medical
dissertations. As a result, modern methods are sometimes applied without
practical or scientific relevance, just to enable claiming a "modern
A concluding point is that, so long as the Russian
Division of the IAP offers membership only to the Doctors of Medical
Sciences, it should be regarded, in part, as a representation of
administration. Therefore, the policy of the Russian Division is not in
agreement with the traditions of the IAP. About certifying of medical
specialists we reported previously (1).
1. Jargin SV. Legal regulations of pathology in Russia. Int J Legal
Competing interests: No competing interests
In 1980/81, during the fourth year of medical education, I worked
part-time as a nurse in an intensive care unit. Before that, I had no
training in nursing. After the third year of medical education, students
in the Soviet Union had a nursing rotation about one month long, but it
could be legitimately evaded e.g. by joining a construction brigade (so-
called stroyotriad); besides, some Komsomol activists evaded it using
their privileges. The nursing rotation was a mere formality for many
students, who came not every day and left before noon; it was difficult to
master even intravenous injections, let alone more complicated procedures.
However, more persistent students could acquire some skills.
In the intensive care unit, there were 1 or 2 nurses on duty at
night; while a physician was not always present in the unit. Being alone
on duty, it was technically difficult to carry out all orders, especially
for an untrained nurse. There was no training at the work place, apart
from the possibility to ask for advice or to observe another nurse's work
(if there was one). So, I did not carry out all orders, even when there
was time for it, trying to omit what I considered less important, such as
vitamins; but occasionally left out also other medications. Sometimes I
injected "self-prescribed" drugs e.g. tranquillizer to agitated patients.
Often I invented blood pressure figures without actual measuring. Today,
it would be easy to say that it was caused by lack of training, overload
by work, and that other nurses did more or less the same; but it is
possible that my poor performance was occasionally favored by alcohol
consumption a day before. There were cases of alcohol consumption by other
nurses on duty, but I didn't participate. Alcohol consumption has been
common in some histopathological laboratories, often inspired by autopsy
helpers, having higher incomes from the funeral business; while it was
noticed to be accompanied by confusion of specimens .
Untrained students were taken for such jobs because of the shortage
of nurses, which has been caused by relatively low salaries and prestige
of the nursing profession. Such terms as care quality, audit, standards,
and risk management  have hardly ever been heard. Until now, there is
shortage of nurses and medical technicians, e.g. in histopathological
laboratories. Similar phenomena, in particular, unreliability and
insufficient qualification of some nurses, especially of male nurses
engaged at night, were encountered e.g. in Iraq [3,4]. Obviously, it was
caused by similar social factors (before the year 2003): low salary and
prestige of the nursing profession . Nurses in Iraq have been
"historically undervalued as a profession" , which was partly the case
also in the former Soviet Union. Another common problem was the absence of
a serious commitment to higher quality standards of patients' care 
that could be noticed at the management level. Furthermore, the external
social environment influences safety and quality of care by shaping the
context in which the care is provided ; but this theme is too broad to
be discussed in a Rapid Response. Note that apart from some beggars, there
are almost no people in wheel-chairs in Moscow streets, remarkably neither
children nor elderly. Many things have changed in the Russian health care
system during last decades, but some of the shortages are still remaining.
Today, in view of the growing Russian economy, there is a possibility to
improve the nurses' training, to enhance their living standards and social
status. Special attention should be given to invasive procedural training.
Importantly, achieving competence in invasive procedures is unique to each
trainee . Therefore nursing education must include identification of
students incapable of mastering required skills in order to help them
finding an adequate decision for their professional future. In conclusion,
I regret my misconduct in the past and ask all those, who could have come
to harm because of my action or inaction, to accept my sincerely
1. Jargin SV. The practice of pathology in Russia: on the eve of
modernization. Basic Appl Pathol 2010;3:70-73.
2. Adam SK, Osborne S. Critical care nursing. Oxford University
Press, New York, 2005.
3. Jargin SV. Nursing and security in Iraqi hospitals: some problems
can be solved without foreign help. Int J Nurs Pract 2009;15:129-130.
4. Jargin SV. Histopathology in Iraq: reliable diagnostics in spite
of shortages. Turkish J Pathol 2011;27:177-179.
5. Sansom C. The ghost of Saddam and UN sanctions. Lancet Oncol 2004;
6. Henriksen K, Dayton E, Keyes MA, Carayon P, Hughes R. Chapter 5.
Advances in patient safety. In: Hughes RG (Editor). Patient safety and
quality: an evidence-based handbook for nurses. Agency for Healthcare
Research and Quality (US), Rockville (MD), 2008; pp. 1-67-1-85.
7. Lenchus JD, Birnbach DJ. Rethinking invasive procedural training.
Acad Med 2010;85:570.
Competing interests: No competing interests
The articles1,2 were based on a candidate dissertation,3 were it is
stated that incisional renal biopsies (usually 6-10 mm in size), taken
during kidney-preserving operations on the urinary tract or kidneys (e.g.
lithotomy) from 105 patients with acute or chronic pyelonephritis and
urolithiasis, were used in the study. Note that pyelonephritis morphology
can be studied on material from total or partial nephrectomy or autopsy;
there are detailed descriptions in textbooks. This kind of research was
performed at the same and other institutions of the former Soviet Union,
also on more extensive material, including intra-operative core biopsies
of renal medulla taken simultaneously with excisional biopsies from the
cortex.4,5 In this case,1-3 it appears doubtful whether practical and
theoretical results of the study justified intraoperative excisions as a
method of material acquisition. We have found in the literature no studies
on excisional intra-operative biopsies in pyelonephritis, neither chronic
nor acute. Theoretically, intra-operative wedge excisions, especially in
acute or chronic pyelonephritis, might be associated with a risk of
complications (fistula, bleeding, abscess etc.) A question should be
posed, why this kind of research was planned and performed. Official
requirements to doctoral and candidate theses (dissertations) in the
former Soviet Union included global newness. The studies on pyelonephritis
discussed above, having hardly provided any substantial new information,
were in a sense globally new in regard to the used material. Furthermore,
the authoritative management style has contributed to this kind of
research. For example, it has not always been clearly understood that a
physician should be guided in his or her decisions by scientific knowledge
rather than by directives of superiors. Resulting attitude to patients can
be illustrated e.g. by the "football" phenomenon. Football is a well-known
medical term in the former Soviet Union, which means sending an elderly
patient from one physician to another to drag out time and to avoid an
operation. Furthermore, limited access to foreign professional literature
had consequences for research and practice, discussed in a preceding Rapid
1. Kirillov IuA. Morphogenesis of acute pyelonephritis: electron
microscopic study (in Russian with English summary). Arkh Patol.
2. Kirillov IuA. Morphogenesis of chronic pyelonephritis: electron
microscopic study (in Russian with English summary). Arkh Patol.
3. Kirillov IuA. Morphogenesis of chronic pyelonephritis (in
Russian). Candidate Dissertation, 1st Moscow I.M. Sechenov Medical
4. Ganzen TN. Morphological diagnosis of pyelonephritis by the data
from incisional and puncture biopsies of the kidney (in Russian with
English summary). Arkh Patol. 1974;36(1):30-7.
5. Ganzen TN. Clinico-morphological diagnosis of pyelonephritis and
significance of incisional renal biopsies in its diagnostics (in Russian).
Candidate Dissertation, 1st Moscow I.M. Sechenov Medical Institute, 1974.
6. Jargin SV. Limited access to foreign literature in Russia and its
consequences for medical practice. BMJ Rapid response of 12 January 2011.
Competing interests: No competing interests
Limited access to foreign professional literature in the former
Soviet Union had consequences for public health; it has been additionally
complicated by fragmentary awareness of medical ethics and the ingrained
authoritative management style. For example, hardly understood has been
the principle that physician should be guided in decisions, relating to
the patients, by his or her conscience and professional opinion based on
scientific knowledge, rather than by directives of managers. Limited
access to foreign literature and disdainful attitude to academic knowledge
resulted in backlog in some practical fields. According to my estimates
after more than seven years practicing pathology abroad, an average tumour
size in routine surgical specimens (stomach, large intestine, breast,
uterus, prostate, skin and others) was at least 2-3 times larger in Moscow
clinics as compared to provincial hospitals in some West-European
countries, which means that early detection of malignancies is less
efficient in Russia. Abroad, almost all mastectomy specimens were without
muscle. In Moscow hospitals, modified radical mastectomy (Patey) with a
removal of the pectoralis minor muscle has been a predominant method
during the last 10-15 years; but the Halsted operation with removal of
both major and minor pectoralis muscles was applied as well. The Halsted
mastectomy prevailed before; it was recommended by Russian-language
textbooks of surgery and oncology for all types of breast cancer until the
late 1990s; it was presented as a single  or a second-choice 
treatment even in some handbooks issued after the year 2000. In an article
from the 1990s, authored by oncologists from a leading institution in
Moscow , it was stated that the Halsted mastectomy was used for
treatment of ductal carcinoma in situ. The negative appendectomy rate is
higher in Russia because of persistence of outdated concepts of the
"catarrhal", "chronic" and "non-destructive" appendicitis, not requiring
histopathological evidence of acute inflammation for the diagnosis .
Furthermore, partial gastrectomy for treatment of duodenal and gastric
ulcers was applied abroad much more seldom than in Russia, while its
volume was less extensive. An approach to surgical treatment of gastric
and duodenal ulcers has been different from international practice since
approximately the 1930s [5,6]. The use of partial gastrectomy for ulcer
treatment remains disproportionately high in many institutions until today
, which is explained by technical problems, conservatism among surgeons
, and limited availability of medical therapy, in particular,
eradication of Campylobacter pylori . Vagotomy, extensively used in
other countries, was not introduced into practice until the 1970s. Even
today, vagotomy is not applied by some institutions, continuing to perform
gastrectomy . In the 1960s, when gastrectomy (removal 2/3 - 3/4 of the
stomach) was almost a single surgical treatment method for ulcer (referred
to as the "classical method"), about 60,000 of such operations were
performed yearly in ulcer patients; and significant complications became
evident . In a textbook of surgery issued in 1995, the Billroth's
operations I and II are listed in the first place among the surgical
treatment modalities of gastroduodenal ulcers . Noticeably, a paper
from the 1940s, recommending gastrectomy for the treatment of duodenal and
gastric ulcers, was reprinted by the main journal of Russian surgeons
"Khirurgiia" in 1991 with approving words in the introduction . The so
-called "administrative factor" played its role , i.e. endorsement of
certain methods by the health care authorities, who sometimes favoured
less individualized approaches applicable en masse to large contingents of
patients. This factor obviously contributed also to the high negative
appendectomy rate and persistence of some outdated methods in other fields
of medicine, such as routinely performed diathermocoagulation or
cryotherapy of cervical pseudo-erosions (cervical ectopy), known to be
sometimes quite unpleasant because of insufficient anaesthesia. This
practice is at variance with scientific evidence not supporting the
hypothesis that coagulation of the ectopy provides protection against
cervical cancer . At the same time, smears for screening of cervical
cancer and precancerous lesions (Pap-test) were taken rarely, so that
cervical cancer has on average been diagnosed at an advanced stage . A
concluding point is that limited availability of foreign professional
literature has contributed to persistence of outdated methods in everyday
practice . At the same time, it has been compensated by production of
domestic editions, sometimes containing outdated or imprecise information,
plagiarism and mistranslations of the borrowed text. An example: a
Manual on immunohistochemistry  cannot serve as a substitute for
internationally used editions.
1. Kovanov VV, Perelman MI. Operatsii na grudnoi kletke i organakh
grudnoi polosti [Operations on the chest and thoracic organs]. In:
Kovanov, V.V. (ed.) Operativnaia khirurgiia I topofraficheskaia anatomia
[Operative surgery and topographic anatomy]. Moscow: Meditsina, 2001:
2. Semiglazov VV, Topuzov EE. Rak molochnoi zhelezy [Breast cancer].
Moscow: Medpress-inform, 2009: pp93-104
3. Frank GA, Volchenko NN. Morphological diagnosis and prognosis in
early ductal breast cancer (in Russian with English summary) Vopr Onkol
4. Jargin SV. Unnecessary operations: a letter from Russian
pathologist. Int J Surg 2010;8(5):409-10
5. Balalykin DA. Introduction of pathogenic principles of surgical
treatment of ulcer disease in Russian surgery (in Russian). Khirurgiia
6. Balalykin DA. History of surgical treatment of gastric and
duodenal ulcers in Russia (in Russian). Khirurgiia (Mosk) 2001;(3):64-6
7. Lobankov VM. Surgery of ulcer disease on the boundary of XXI
century (in Russian). Khirurgiia (Mosk) 2005;(1):58-64
8. Makarenko TP. Is it necessary to improve the classical method of
gastric resection in peptic ulcer? (in Russian) Sov Med 1973;36(6):46-50
9. Kuzin, M.I. & Chistova, M.A. The stomach and duodenum. In:
Kuzin, M.A. (Editor) Surgical diseases (in Russian). Moscow: Meditsina,
10. Iudin SS. Essays on gastric surgery (in Russian). Khirurgiia
(Mosk) 1991;(7):159-66 continued in (9):152-61
11. Machado Junior LC, Dalmaso AS, Carvalho HB. Evidence for benefits
from treating cervical ectopy: literature review. Sao Paulo Med J
12. Jargin SV. Perspectives of cervical cytology in Russia. Am J
Obstet Gynecol. 2008;199(2):e10
13.Jargin SV. The state of medical libraries in the former Soviet
Union. Health Info Libr J 2010; 27(3):244-8
14. Petrov SV, Raikhlin NT. (eds.) Manual on immunohistochemical
diagnosis of human tumors. 3rd edition (in Russian). Kazan: Titul, 2004
Competing interests: No competing interests