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Notes and News

OXYPHENBUTAZONE LICENCES REVOKED

THE Minister for Health announced on May 15 that the medicalproduct licences for tablets containing oxyphenbutazone were to berevoked on grounds of safety. This decision followsrecommendations from the Committee on Safety of Medicineswhich were the subject of further representations to the MedicinesCommission at the request of the company involved, GeigyPharmaceuticals, whose products ’Tandacote’, ’Tanderil’, and’Tanda1gesic’ (oxyphenbutazone and paracetamol) were concerned.The Commission has confirmed the advice of the CSM that thelicences should be revoked. The Minister said that the companywould be writing to chemists by May 18 asking them to returnunused stocks to wholesalers not later than June 8. Chemists wouldbe reimbursed in full for stocks returned by that date. The companywere also writing to doctors to advise them that the product wouldno longer be available.In a letter to doctors dated May 16, Geigy Pharmaceuticals

informed them of the revoking of the licences. The letter, signed byDr J. G. Domenet, medical director continued:"This advice from-the CSM has been upheld by the Medicines

Commission, despite our appeal that there is still a place foroxyphenbutazone in clinical practice where other therapies havebeen found unsuitable. We retain this view. Tanderil, Tandacoteand Tandalgesic are being withdrawn and should no longer beprescribed. We sincerely regret any inconvenience that this maycause, but should you require any further assistance please contactus."A report by Annabel Ferriman, health correspondent, in The

Observer of May 20,stated that a spokesman for the company hadsaid that the letter was designed to tell doctors that if they wanted tocontinue prescribing oxyphenbutazone for certain named patientsthe company would provide it. The spokesman added: "Taking intoaccount the existing situation regarding phenylbutazone (whichhospital doctors are allowed to prescribe for a certain condition), wewill adopt a policy of supplying Tanderil and Tandacote againstnamed patient prescriptions where such prescriptions have beenissued for supply through a hospital pharmacy. Clearly, in suchcircumstances supplies are made on the prescriber’sresponsibility".

TOWARDS ONE PROBE FOR RETINITISPIGMENTOSA

THE ways in which the group of retinal degenerative diseasesknown as retinitis pigmentosa can be inherited are too numerous fora single prenatal diagnostic test or test of the carrier state to beconceivable. The genes involved have not been identified and thebest that molecular biologists can offer is, as for Huntington’sdisease or Duchenne muscular dystrophy, a device that falls short ofbeing a gene probe but that has a target close enough to the gene toencourage clinicians. This much has now been achieved for a

common variety of retinitis pigmentosa, the X-linked form (XLRP),by a team based in Edinburgh. The DNA probe (L 1 - 28) comes intwo forms, both of which are common in the population at large, andone or other allele will almost certainly be inherited together withthe XLRP gene on the proximal part of the X chromosome. At thispoint clinicians should turn to Miranda Robertson’s clear accountof the limitations of this work.2 For example a pregnant obligatecarrier, a woman whose father has XLRP, may be offeredtermination if her fetus is male, knowing that her pregnancy has a50% chance of being normal. The new probe may improve on thisbut only if an affected male in the family is available so that thisallele (Ai or A2) can be determined and if the woman is

heterozygous: if she is homozygous, as is more likely than not, theknowledge that her male fetus is A1 or A2 will not help.

1. Bhattacharya SS, Wright AF, Clayton JF, et al Close linkage between X-linked retinitispigmentosa and a restriction fragment length polymorphism identified byrecombinant DNA probe L1 ·28. Nature 1984; 309: 253-55.

2. Robertson M. Progress in sight. Nature 1984; 309: 210.

THE MAN’S ROLE IN CONTRACEPTION#

CONCENTRATION on women’s responsibility for contraceptionover the past couple of decades has, according to a reportl from theBirth Control Trust and the Family Planning Association, left menout in the cold. Between 50 000 and 100 000 vasectomies are

performed in Britain annually; and long waiting lists have built upin some parts of the country. Men are clearly willing to make thisstep in order to prevent unwanted children. Apart from vasectomyand withdrawal, however, sheaths are the only male method ofcontraception and one which usually has to be paid for over thecounter. It is believed that sheaths are second only to the pill as themost commonly used contraceptive measure (there are an estimated2 - 8 million users of the sheath and 3 - 5 million women on the pill),but general practitioners will not prescribe them and familyplanning clinics rarely welcome men on their premises nor hand outsheaths generously to women. Women have fought long to obtainfertility control, but in the process, men have received less and lesssupport for their involvement in contraception, which is, after all, ofmutual concern in a partnership. The report argues that some of the200 000 unwanted pregnancies a year might be avoided were clinicsto offer contraceptive advice to men and were GPs to providesheaths.

QUESTIONABLE USE OF VITAMINS

ARE vitamins useful therapeutic agents? And when should they beprescribed? These questions are answered in a recent Drug andTherapeutics Bulletin.2 The NHS dispensed 5 million worth ofvitamins in 1981-but over-the-counter sales accounted for a

staggering 45m. And most of the latter were taken for conditions,such as the common cold, in which their efficacy was doubtful. Evensome of the well-established uses of vitamins are questioned in theBulletin. For example, folic acid is not thought to be justifiedroutinely for all pregnant women unless there is a suspicion of poornutrition. Similarly the evidence for prophylactic multivitamins inwomen wishing to become pregnant again after the birth of a childwith neural tube defects is unclear.Likewise the Bulletin scorns the prescription of multivitamins to

healthy children and adults, although there are definite exceptionssuch as Asian children eating chapatis, who may need supplementsof vitamin D and calcium. Cyanocobalamin is frowned upon,although its potentially serious side-effect (optic nerve damage) isnot mentioned.The Bulletin advises doctors to prescribe vitamins only for a

definite therapeutic purpose, not as a tonic. Many doctors have beenguilty of prescribing vitamin C, or equivalent, as a placebo, but it isimportant that only the patient is beguiled, not the prescriber.

SAFETY MEASURES FOR WORK WITH ASBESTOS

LAST week the Health and Safety Executive published a new codeof practice for people working with asbestos.3 The 12-point code isto be followed by further measures to minimise the risk of exposureto asbestos. From Aug 1, new control limits for asbestos will comeinto force. That for blue asbestos (crocidolite) will remain at thepresent level of 0 - 2 fibres/ml, but the limit for brown asbestos(amosite) will be reduced from the present 0-5 5 fibres/ml to

0 - 2 fibres/ml, and that for white asbestos (chrysotile) will bereduced from 1 fibre/ml to 0-5 5 fibres/ml. Also from Aug 1, allcontractors working with asbestos will require a licence from theHealth and Safety Executive,4 and later in the year there is likely tobe a ban on the import, use, and marketing of all brown and blueasbestos as well as on all asbestos spraying and insulation.

1. Men, Sex and Contraception Available (£3) from the Birth Control Trust, 27-35Mortimer Street, London WIN 7RJ.

2. Rational use of vitamins Drug Ther Bull 1984; 22: 33-363. Asbestos and You. Leaflet, poster, and pocket card available from area offices of the

Health and Safety Executive -and from the Enquiry Point, Health and SafetyExecutive, St Hugh’s House, Stanley Precinct, Bootle, Merseyside L20 3QY

4. A Guide to Asbestos (Licensing) Regulations 1983. London: HM Stationery Office£2.75.

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HANDLING MILK SUGAR

MILK sugar (lactose) is a puzzle. It constitutes 2-7% of the breastmilk of all mammals except the sealion but the mother has to make it

from glucose and to glucose it eventually returns in her baby.Lactose has, with milk proteins, lipids, and even the appearance andflavour of the liquid, had its turn at being blamed for the fact thatmany people find milk disagreeable. The issue became important inthe 1970s when controversy arose over the possible hazards of wholemilk when used in the management of malnutrition. Inevitably, thefocus of a symposium held in Sophia-Antipolis, France, in

November, 1981, and now the basis of a book, was lactose and thenormal diminution of lactase activity that follows weaning. Not allof "milk intolerance" can be laid at the door of the lactose

hypothesis, but this has not prevented manufacturers from makingavailable lactose hydrolysed milk (or the enzyme in sachet form) ornutritionists from investigating its use in the developing world. Thetechnical problems of preparing lactose-free milk may have beenlargely solved, but the symposium’s editor, Prof J. Delmont (Nice)doubts if the case for using it has yet been proved. Using thecommercial enzyme preparation ’LactAid’ in a randomisedcontrolled trial in malnourished Guatemalan children B. Torun andcolleagues concluded that whole cow’s milk was an excellent foodfor the severely malnourished child. "When cow’s milk is availablefor the treatment of malnutrition, there is no need to alter the lactosecontent routinely." The other side of the coin is provided byJ. D. Mitchell and colleagues in their well-known studies inAustralian aborigine children. For background papers-forexample, on the evidence that the human caecum adapts to a rumen-like activity and so copes with lactose, on the genetics of lactase, andon the consequences of lactose intolerance in adults-this book willbe a useful source, and in an entertaining yet erudite way Delmont’sreview is splendid, whether read as a prelude or as.a coda.

BMA HOUSE-PARTY ON mSTAMINE

IT is nearly 80 years since Sir Henry Dale witnessed the firstdemonstration of the action of histamine on smooth muscle. In hiscelebrated Croonian lectures of 1929, Dale reported that a

substance which Sir Thomas Lewis had previously linked with the"triple response" was the HI receptor. These lectures stimulated anintense interest in the physiological properties of histamine and itremains a controversial subject. Histamine is widely distributed inplant and animal tissues, and its release in man produces a variety ofallergic reactions mediated through the so-called Ht and H2receptors.A film entitled Histamine-the Art of Scientific Discovery,2 had its

first public showing in London on May 18. Produced in one-hourand two-hour versions with the support of the BMA’s board ofscience and education and backed by Glaxo Pharmaceuticals, ittraces the steps in the discovery of histamine and its antagonists.The idea for the film came from pharmacologists at Glaxo and, asthe title suggests, its makers have been as much concerned with

shedding light on scientific methodology as they have withpresenting the facts about histamine.At a house-party given by Sir John Colvin (an imaginary and

wealthy character interested in allergy), seven eminent scientists areinvited to give presentations on their work; the film is remarkable inthat it gathers four of them in person, the other three being playedby actors. The viewer is introduced to the concept of biologicalspecificity by Paul Ehrlich (played by Roy Dotrice)-the "father ofchemotherapy", whose methodology formed the basis for much ofmodern drug research. The histamine pathway in allergic reactionswhich led to the discovery of the HI receptor is described by SirHenry Dale (Lloyd Lamble) and Sir Thomas Lewis (John Rolfe).Further contributions come in person from Dr Daniel Bouvet, whowas responsible for producing the first antihistamine drugs, andProf W. S. Feldberg, who identified the physiological role ofhistamine in anaphylaxis. Prof Charles Code postulated the role ofan H2 receptor in gastric secretion. Sir James Black provided the

1. Milk Intolerances and Rejection. Edited by J. Delmont Basle: Karger. 1983. Pp 169.SF140, $84.

2. Histamine: the Art of Scientific Discovery. Available as a 1 h or 2 h version from theBMA Film Library, BMA House, Tavistock Square, London WC1H 9JP.

proof for its existence, and his original thinking led to the conceptthat the H2 receptor could be antagonised by an H2 blocker.The film certainly conveys the enthusiasm of these seven men. No

doubt the scientific argument is presented more fully in the longerversion, which was not shown at the premiere. Perhaps this film willprovide the impetus for similar films in the future; the-discovery ofthe double helix would make interesting viewing.

PUBLIC HEALTH LABORATORY SERVICE AND THEROMAN TEMPLE

ARCHAEOLOGISTS working on the Roman temple in Bath havereason to be grateful to the Public Health Laboratory Service for thevigour and persistence with which the Service followed up a fatalcase of primary amoebic meningitis, a condition which appearsworldwide, sometimes in clusters arising from a common source.Naegleria fowleri had been isolated from a child who died in 1978.The most likely source was a public swimming pool supplied bywater from a hot spring. The PHLS annual reportf describes howthe mediaeval King’s bath had to be drained to see to the spring andthis search revealed serious erosion of the foundations of the l8th-

century pump room. Repair work meant removal of the floor of theKing’s bath, which facilitated exposure of the Roman temple longknown to be buried under the pump room. Regular sampling of thespring water eventually started in June, 1981, and by DecemberNfowleri began to be recovered. The amoebae had come from a bedof river gravel where the Roman springs arise and they had enteredthe supply through a fault under the pump room. A new bore holehas been drilled to give a supply of unpolluted spa water.Another project that the PHLS has worked on is the development

of a diagnostic kit for use in suspected or known paracetamolpoisoning-in response to a need for a reliable assay for emergencyuse. An enzymatic reaction detectable colorimetrically was thoughtto be the most suitable test, so the PHLS screened soil samples forbacteria that could degrade paracetamol and the enzyme arylacylamidase was extracted from Pseudomonasfluorescens. The kitwas launched on the UK market in November, 1982, and it has beenwell received; its appearance on the European and Americanmarkets is imminent.

THE NATIONAL BIRTHDAY TRUST

IN 1946, 1958, and 1970 the National Birthday Trust conductedsurveys of the maternity services which influenced the pattern ofmaternity care in the UK. The surveys were based on the

experiences of individual women giving birth. The Trust hasdecided that the next survey will be mounted in 1984 and willconcentrate on the places of delivery. Information will be sought onthe availability of staff and equipment at the place of birth. TheTrust asks that questionnaires be completed for 24 hours on the firstof August, September, October, and November, which will providesamples of different days of the week and different times of the year.Complete confidentiality will be maintained. Funds have beenreceived under Section 64 from the DHSS. The midwives have

agreed through their College to fill in the forms. The organisationwill take place from the National Birthday Trust Headquarters. Thecoordinator of the survey will be Miss Philippa Gunn and thesurvey will be supervised by Prof Geoffrey Chamberlain, St

George’s Hospital, London.

GOOD PRACTICES IN MENTAL HEALTH

ANOTHER report3 in the series Good Practices in Mental Healthforms a guide to effective local services in the North WestHertfordshire Health District. The booklet was published by aproject core group established in response to the InternationalHospital Federation’s plan. It includes details of those services

1. PHLS Annual Report 1982/3 London. PHLS Board, 61 Colindale Avenue, LondonNW9 SEQ.

2. The National Birthday Trust Fund, 57 Lower Belgrave Street, London SW1W 0LR(01·730 5076).

3. Good Practices in Mental Health North West Herts Health District Available (onreceipt of 39p SAE) from North West Herts Community Council, 1 Canberra

House, 17 London Road, St. Albans, Herts AL1 1LE

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considered to be special. The guide provides practical informationon 36 services in the district, including small groups such as theParents Anonymous Listening Service, to support parents who fearthey might harm their children, and specialist regional services suchas the Hill End adolescent unit. The implementation of the 1983Mental Health Act with its emphasis on the rights of mentally illpatients not to be admitted to hospital, nor to be detained thereunless absolutely necessary, will reinforce the demand for a wideand flexible range of health and social services. A fuller list of mentalhealth services and projects in North West Hertfordshire is

appended.

New Advice on Cervical ScreeningThe Minister for Health stated last week that the Committee on

Gynaecological Cytology had in the light of recent research,reviewed and updated its recommendations on the age and

frequency of cervical screening. The committee strongly reaffirmedthe emphasis previously given to the screening of women over 35and those who had had three or more pregnancies, at five-yearlyintervals, particularly for women who had not been screened. Itsought to simplify its recommendations for symptomless youngerwomen. Its advice now is that screening should first take place forany woman who is or has been sexually active on her first

presentation for contraceptive advice or whenever she first requestsscreening. Screening should be repeated after that first occasion atthe ages of 20, 25, 30, and 35, and not on any other occasion, exceptthat every woman should be screened early in the course of care foreach pregnancy.

NSPCC Centenary AppealThe National Society for the Prevention of Cruelty to Children.has raised £ 4 27 million during the first five months of the appeal inits centenary year. The aim is to raise a total of D2 million. Between1977 and 1982, in areas covered by NSPCC special units, the rate ofinjury to children reported by parents increased from 0 - 43 per 1000children under the age of 15 to 0-63 per 1000. The NSPCCbelieves, however, that fewer children are suffering fatal or seriousinjury, and fewer are subjected to further injury in the year afterdiscovery in areas covered by the Society’s special units. On itsevidence, the NSPCC estimates that about 6000 children in

England and Wales were injured at home in 1982, 600 seriously. Afull analysis of these figures will be published in July.

British Society of Nutritional Medicine

This newly formed society is to hold its inaugural conference onSept 7 and 8. Details of the society and the conference can be hadfrom Dr Alan Stewart, PO Box 268, Brighton BN3 1RW.

The sixth prize of Fr F 15 000 will be awarded for medical research into

haemophilia by the French Association of Haemophiliacs in July, 1985:Secretariat of the Selection Committee (Association Francalse des

Hemophiles), CNTS, 6 rue Alexandre Cabanel, 75015 Paris.

The Parkinson’s Disease Society has produced a video programme incollaboration with Roche entitled Living Ones Life as One Can. Theprogramme features Dr Cecil Todes, a psychiatrist with Parkinson’sDisease. The video and a folder of relevant information are available from Mr

Nigel Goodman, Head Office, Roche Products Limited, PO Box 8, WelwynGarden City, Hertfordshire AL7 3AY.

The National Association of Family Planning Doctors will hold a

symposium on Problem Points in Family Planning at the Royal Society ofMedicine, London, on Thursday, June 7: NAFPD, 27 Sussex Place, Regent’sPark, London NW1 4RG (01-724 2441).

Dr Hans Moolenburg (Netherlands) will speak to members of the medicalprofession on The Holistic Medical Treatment of Cancer at the CancerHelp Centre, Bristol, on Friday, June 15, at 8 pm: Mrs Cynthia Slade, CancerHelp Centre, Grove House, Cornwalhs Grove, Clifton, Bristol BS8 4PG(0272743216).

The fourth Ida Mann lecture will be given by ProfB. R. Jones in the WittsLecture Theatre, Radcliffe Infirmary, Oxford, on Thursday, June 28, at 6 pm.Professor Jones will speak on Preventive Ophthalmology and

Community Eye Health-Humbug or Priority?

A Royal Society of Health conference on Parkinson’s Disease will takeplace at the University of Birmingham, on July 12: Royal Societyof Health, 13Grosvenor Place, London SWIX 7EN (01-235 9961).

A workshop on Medical Microcomputing Applications in climcalpractice and research will be held at the University of Liverpool on Sept 3-4.Mr W. A. Corbett, Department of Surgery, University of Liverpool, PO Box147, Liverpool L69 3BX.

A course on Advances in Medicine in Old Age will be held at theUniversity, Hospital of South Manchester on Sept 3-7: Prof J. CBrocklehurst, Department of Geriatric Medicine, University Hospital ofSouth Manchester, Nell Lane, Manchester M20 8LR (061-445 8111).

A 1 ’/2 -day symposium on Chorion Biopsy for Early Prenatal Diagnosiswill take place at the University of Nottingham Medical School on Sept 6-7:Symposium Organiser, Department of Obstetrics and Gynaecology, CityHospital, Hucknall Road, Nottingham NG5 IPB (0602 282257).

A Royal Institute of Public Administration residential conference on TheShifting State: Rules, Roles, and Boundaries in the 1980s will take placeat the University of Aston, Birmingham, on Sept 14-15: Conference Office,RIPA, 3 Birdcage Walk, London SW1H 9JH.

A Biochemical Society refresher course on Hormone Receptors will beheld at Middlesex Hospital, London, on Sept 17-19: Doris E. Hernott,Meetings Officer, The Biochemical Society, 7 Warwick Court, High Holborn,London WC1R 5DP (01-242 1076).

The 4th Oil Industry Nurses symposium organised in conjunction withthe Institute of Petroleum will take place at Magdalen College, Oxford, onSept 18-20: Miss Caroline Little, Conference Officer, Institute of Petroleum,61 New Cavendish Street, London W1M 8AR.

A one-day symposium on Monoclonal Antibodies in Derma-

topathology will be held at Keele University on Wednesday, Sept 19, prior tothe winter meeting of the British Society of Investigative Dermatology: DrRobin Russell Jones, Secretary, British Society for Dermatopathology, StJohn’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square,London WC2H 7BJ.The annual conference of the British Society of Gerontology on Ageing: A

Creative Response will take place at the University of Leeds on Sept 21-24:Tim Bilham, Director of Continuing Education, University of Leeds, LeedsLS2 9JT (0532 435036).The annual medical sociology conference of the British Sociological

Association will be held at the University of Sheffield on Sept 21-23. Thetheme of the conference will be Racism in the Health Service: Malcolm

Colledge, BSA Medical Sociology Conference, School of Behavioural Science,Newcastle upon Tyne Polytechnic, Northumberland Building,Northumberland Road, Newcastle upon Tyne NE1 8ST (0632 326002 ext3426). ).

Diary of the Week

MAY 27 TO JUNE 2

Tuesday, 29thNORTHWICK PARK HOSPITAL AND CLINICAL RESEARCH CENTRE,

Watford Road, Harrow, Middlesex HA I 3UJ1 pm Mr S. Neeley, Dr A. Cross, and Dr G. Taylor: Neurochemical Seiectivity ofHerpes

Virus In Vivo and In Vitro.

Wednesday, 30thROYAL COLLEGE OF SURGEONS OF ENGLAND, 35/43 Lincoln’s Inn Fields,

London WC2A 3PN

2.30 pm Prof E. R. Howard: Extra-hepatic Biliary Atresia (Huntenan lecture).3.30 pm Mr H. Reece-Smith: Pancreatic Islet Allotransplantation (Arris and Gale

lecture).5 pm Prof B. S. Ashby: Operative Choledochoscopy in Common Bile Duct Surgery

(Huntenan lecture).CHARING CROSS AND WESTMINSTER HOSPITAL MEDICAL SCHOOL,

Fulham Palace Road, London W65 pm (Brian Drew Hall) Mr B. P. Heather: What Can Vascular Surgeons Offer?

NORTHWICK PARK HOSPITAL AND CLINICAL RESEARCH CENTRE1 pm Dr A. M. Denman: Interpretation of Clinical Tests in Immunology1 pm Prof S S. Shapiro (Philadelphia)’ Platelet GPIIIa Related Protein Present in

Endothehal Cells

Thursday, 31stQUEEN CHARLOTTE’S MATERNITY HOSPITAL, Goldhawk Road, London

W6 OXG12 15 pm Dr A. Whttelaw: Intraventncular Haemorrhage-Prevention and

Management.