Disease Risks OLD News
Extracts from EEIN 1991-1994. Latest news is at the bottom. Provided by Eubios Ethics Institute , at http://eubios.info/index.html.
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Abbreviations for journals
There has been recent progress in the development of alternative methods to the use of animals for toxicology studies (Ratner, M. (1990) "Toward using in vitro toxicology in the drug approval process", Biotechnology 8: 1248-1249). The considerations of animal rights may not be the major factor in the use of such tests however, rather the cost and efficiency of the alternatives. The inventor of the Ames test that has been used in toxicity studies and coresearchers report in a series of papers the deficiencies in such tests (Science 249: 1357; Science 250: 743-5; Proc. Natl. Acad. Sci. (USA) 87: 7772-86). The most dangerous carcinogens in food are naturally occuring, and they occur in levels thousands of times higher than many chemicals. The proportion of pesticides in food that are natural is about 99.99%, and the natural compounds also induce cancer in rodents, therefore they are the major health hazard - not synthetic chemicals. The current testing procedures are deficient because such a high proportion of natural and synthetic compounds will be judged positive, and better methods are required.

There has been much response to the series of articles by Ames et al (EEIN 1: 4) on the carcinogen testing using rodents (Science 250 (1990), 1498-9, 1644-6). Ames and Gold argued that synthetic chemicals pose little cancer risk to humans. The majority of DNA damage occurs as a consequence of oxidants produced during normal metabolism. Although the majority of pesticides are natural (99.99% that we take in our diet) and from plants, we should still eat those vegetables that have antioxidants, to reduce the damage caused to our DNA by normal metabolism. The toxicity of natural and synthetic chemicals is similar. They still say that occupational exposures to chemicals can be dangerous because they may be at a high level. There is some debate about the mechanism of cancer development, and the dose response of human carcinogenesis from different chemicals (i.e. whether it is linear or exponential). These new theories should be incorporated into risk assessment methods (Science 250 (1990), 1497).
Additional comments and letters are seen in Science 251 (1991), 10-13, 142-4, 257-8, 606-8. They include comments from the FDA and EPA in the USA onm their testing policies. The question of what role mitogenesis plays in cancer is still being discovered, but it appears to be only one factor in carcinogenesis (Science 251: 387-8). Mitogenesis may not be the rate-limiting step in carcinogenesis. This article argues for the continued use of rodent assays, saying that they do provide useful information about carcinogens.
For papers on the safety of dioxin see NEJM 324 (1991), 212-8, 260-2. They suggest that the lifetime cancer risk of workers exposed to dioxin may be an extra 0.2%. A paper on the molecular mechanism of dioxin action and the way the EPA performs tests is L.Roberts (1991) "Dioxin risks revisited", Science 251: 624-6.

A review on the possible protective action of estrogen in women is E.Barrett-Connor & T.Bush, "Estrogen and coronary heart disease in women", JAMA 265: 1861-7. The risk of a coronary event may be reduced by 50%, in women who are not smoking. A possible protective action of soya products in breast cancer in young women is discussed in Lancet 337: 1197-1200.
An Australian court has recently ruled that passive smoking causes lung cancer, asthma attacks, and respiratory disease; BMJ 302: 943-5. This may be important in the growing campaign to ban smoking in public places because of the proven health risk to passive smokers. There is also a clear ethical obligation on people not to smoke, from the principle of nonmaleficence. The tobacco industry continues to fight such bans because they reduce sales considerably, by reducing the time that people can smoke. Other comments appear in BMJ 302: 805, 985, 1227-8; NEJM 324: 913-20. The NEJM paper discusses the harmful influence of the tobacco industry on developing countries. The public attitudes to a restaurant ban on smoking in Australia are presented in MJA 154: 292-3. Arguing for safer systems for nicotine use after the year 2,000 see Lancet 337: 1191-2, 1278. It is still leaving the problem of drug addiction, and should governments promote clean nicotine delivery systems, for this drug addiction, instead of arguing against all types of nicotine use.
The new US EPA regulations on lead in drinking water require monitorring of lead in household taps, and efforts be taken to lower the level below 15 parts per billion, in samples that were taken 6 hours after the taps are turned off (meaning the effective concentration will be closer to 5ppb). The current standard is 50ppb. Many lead pipes will need to be replaced. On the EPA's analytical methods for water see Environmental Science & Technology 25: 998-1006. For comments on environmental illness see JAMA 265: 2335-7. Regarding the toxic effects of excess fluoride in fluorinated water in India see Lancet 337: 1213. On the safety of mercury fillings see Current Contents (22 April 1991), 3-5.
The question of dioxin safety, and the response of living organisms to it, is discussed in SA (April 1991), 15. Some of the recent work on the dioxin receptor is commented on in Science 252: 924-5. The US EPA is reassessing the toxicity of dioxin following recent scientific developments; Science 252: 911. Many German school grounds have been found to have used material from a copper smelting plant which was contaminated with dioxin. This material is being removed, but is a huge job; NS (4 May 1991), 11.
In EEIN 1: 40 mention of epidemiological studies using East German cancer records was made. However, such studies are currently held up while decisions about the privacy laws in Germany are made; Science 252: 915. The privacy laws mean that the actual cancer records are illegal, so they are locked up while moves to change the laws to allow such a valuable resource for cancer studies are made. They can determine whether the lung cancer rates in industrial cities are similar to nonpolluted areas, as an initial study suggested. A 169pp. supplement to the J. Cinical Epidemiology Vol. 44 focuses on Ethics in Epidemiology. There are many papers of interest to ethics, particularly regarding the privacy of subjects, and the disclosure of results. A code of ethics is outlined in the end, and the papers were presented at a meeting in 1989.
A report on the mortality of aerial pesticide applicators is in Arch. Env. Health 46: 110-6. Rather than finding any cancer risks, the survey documented the high incidence of aircraft accidents as a cause of death. On the harm done by exposure to organophosphate pesticides see NS (18 May 1991), 30-35. On the political forces in the USA regarding pesticides see Policy Sciences 24: 1-18. The mortality of workers exposed to the sterilising agent ethylene oxide is discussed in NEJM 324: 1402-7.
Comments on the Chernobyl accident and the recent studies of its effects on human health are in Nature 351: 1,4, 335; Lancet 337: 1086-7, 1339; NS (20 April 1991), 5, 20-22, 24-9; (27 April 1991), 7, 47; (1 June 1991), 17; CMAJ 144: 748-52; BMJ 302: 1295. A method to use a cesium binding dye (Prussian Blue) to extract the 137 cesium from contaminated sheep has been used in Norway; NS (27 April 1991), 20. It is being exported to the Soviet Union. The dye is to big to pass to the blood, so it is excreted with the bound cesium. The cancer risk from stress about the health risk may cause more cancer than the radioactivity itself; AJPH 81: 719-24; Nature 351: 429.
A study in Japan has linked radiation exposure with IQ; BMJ 302: 808. Relating to a more universal form of radiactive exposure see; B.A. Bridges, "Possible association between mutant frequency in peripheral lymphocytes and domestic radon concentrations", Lancet 337: 1187-9. Also comments on UV-induced carcinogenesis is in Lancet 337: 1258-9.
For a comment on safety legislation in general and children, and the compulsory use of cycle helmets in the state of Victoria is in MJA 154: 155-7. The successful use of helmets in reducing mortality from accidents, is an extension of traffic rules that other countries may consider. The development of such safety rules requires ethical considerations, along the theme of the individual freedom, versus society interests. When examing bioethics and thinking about future legal trends, the broader legal developments, and society's tolerance of such laws should be kept in mind.
There is a letter regarding the Eosinophilia-myalgia syndrome outbreak and tryptophan use in MJA 154: 295. The occurence of cyanide poisoning associated with medicine in Washington state in 1991 is discussed in JAMA 265: 1806-7; Lancet 337: 968.

A comment on the large funding devoted to cancer research and the methods used in clinical trials is in Biotechnology 9: 772. There needs to be careful consideration of the ways new treatments are tested. As mentioned above, WHO is expected to revise the international ethical research conduct guidelines; JAMA 266: 187. The problems of randomised clinical trials are discussed in NEJM 324: 1585-92, from the ethical point of view by S. Hellman & D.S. Hellman, and E. Passamani. See also G.M. Shenfield & J.E. Hirshorn, "Good clinical practice in the investigation of pharmaceutical products", MJA 154: 631-6; R. Doll, "Development of controlled trials in preventive and therapeutic medicine", J. Biosocial Science 23: 365-78; and a comment on controlled trials in single subjects in BMJ 303: 173.
The safety of using insecticide-treated bed insect nets in combating malaria is reported in P.L. Alonso et al., "The effect of insecticide-treated bed nets on mortality of Gambian children", Lancet 337: 1499-502. The bed nets are a cheap method which can be used while people wait for the hoped for vaccine. A letter defending Monsanto's dioxin research is in Science 252: 1231.
A commentary on methods for the detection of human carcinogens is in Nature 352: 185-6. A letter on carcinogenicity tests is in Lancet 337: 1408-9. The results of tests on the effects of psoralen and ultraviolet A radiation (PUVA) therapy are in B. Linelof et al., "PUVA and cancer: a large-scale epidemiological study", Lancet 338: 91-3. The tests in Sweden showed a positive risk for squamous cell cancer in treated patients. A comment on water fluoridation is in MJA 154: 435-6.
A letter questioning any link between radiation release in Sellafield nuclear reprocessing plant in the UK and leukaemia, using the Japanese radiation studies, is in BMJ 302: 1404. On leukaemia risks and radon see Nature 352: 288. There has been a link established between radon and mutation in peripheral T lymphocytes. On mercury poisoning from exposure in private residences see JAMA 266: 196-7. Meanwhile, the (East) German cancer registry (EEIN 1: 40, 49) appears to be safe, and will be able to be used for epidemiological research after it is anonymised and a special law is passed; Lancet 337: 1468.
A general comment on public health is in Lancet 337: 1381-3. The use of seat belts in drivers in USA accidents is reported in JAMA 266: 194-5. On the costs of road traffic accidents to an orthopaedic department see BMJ 303: 27. Comments on general effects of diet upon health are in Lancet 337: 1596, 338: 109, 111, and also see W.S. Browner et al., "What if Americans ate less fat? A quantitative estimate of the effect on mortality", JAMA 265: 3285-91. A letter on the reported link between IQ and diet (EEIN 1: )is in Nature 352: 292. The use of one aspirin every six weeks appears to reduce the risk of cardiovascular disease in women; J.E. Manson et al., "A prospective study of aspirin use and primary prevention of cardiovascular disease in women", JAMA 266: 521-7, see also 565-8.

The FDA approval to the anti-AIDS drug dideoxyinosine (DDI) is welcomed as a case of accelerated review for urgently needed drug; JAMA 266: 757-8, 761-3. More on DDI in Science 253: 509, 1557-9; Nature 353: 589; Clinical Pharmacology & Therapy 50: 278-85. A possible AIDS drug is looking for a sponsor, and on AIDS drugs see Science 253: 262-3. On AIDS treatment also see JAMA 266: 1613.
Halcion, the world's most widely prescribed sleeping pill has been banned. The active ingredient, triazolam, causes more psychological side effects, such as amnesia and depression, than other drugs in that class; BMJ 303: 877; NS (12 Oct 1991), 11, 13. The results of clinical trials almost 20 years ago had been kept covered, and have now been released, supporting recent evidence on the side effects. There was a recent court case in the USA where a woman accused of murder was acquitted because this drug may have been the possible cause of strange behaviour.
A new method for risk assessment of substances in the USA may be introduced if laws that are being debated are approved; Nature 353: 289. The bills debate the use of low risk carcinogens in foods. On the individual cancer risk see Science 253; 612-6. See a longer review of the environmental and genetic aspects, P.G. Shields & C.C. Harris, "Molecular epidemiology and the genetics of environmental cancer", JAMA 266: 681-7. On the Ames test see BMJ 303: 428-9, also Lancet 338: 940. On the rate of spontaneous mutation in microbes appears to be constant between species see PNAS 88: 7160-4.
The US government is looking at dioxin's toxicity again; Nature 352: 753. See also Science 253: 949, Lancet 338: 948. On British monitoring of pesticides see BMJ 303: 662-3. On the pesticide residue Alar, see Science 254: 20-2. A report on the widespread occurrence of organohalogens in nature is in EST 25: 1346-50; and on fears of PCBs see Science 253: 361, 1334. On risk assessment in environmental releases of substances see EST 25: 1074-81. Chemotherapy does not appear to be linked with higher incidence of congenital abnormalities in future children; NEJM 325; 141-6. A new anti-cancer agent, taxol, has been identified, from extracts of Yew trees; Biotechnology 9 : 933-8.
On tobacco control see BMJ 303: 732-3; on the European advertising ban Lancet 338: 748-9; on Canadian advertising bans, BMJ 303: 537; on Australian studies, MJA 154: 788-9, 793-7, 797-801; on US high school campaigns, JAMA 266: 1611-2, 1755-6; on non-smoker's rights in Japan, Social Science & Medicine 33: 717-21; on China's law on tobacco, BMJ 303: 381. On an inverse relationship between alcohol consumption and risk of coronary disease in men; Lancet 338: 464-8. On alcohol abuse see MJA 154: 838-44, 155: 117-9. On fluoride benefits and risks; JAMA 266: 1061-7.
On other issues of atmospheric pollutants see J.M. Samet & M.J. Utell, "The environment and the lung", JAMA 266: 670-5. Also, JAMA 266: 627-8, 659-63, 664-9; Lancet 338: 500-1; BMJ 303: 329, 836-8; MJA 154: 716-7. On occupational diseases see JAMA 266: 676-80; Br. J. Industrial Medicine 48: 675-83. On formerly East German towns with high childhood disease associated with pollution see Lancet 338: 809, one such town is suitably named Bitterfeld.
On the EPA report discussing the possible link between electromagnetic field (EMF) radiation and adverse health see Lancet 338: 749. A new study in the American J. Epidemiology has found that workers exposed to EMF radiation indicates men exposed have a double chance of developing breast cancer; Science 253: 964, see also p.955. Comments on radiation exposure and cancer are in JAMA 266: 652-5, 698-701; Br. J. Industrial Medicine 48: 670-4. On worker safety see FDA Consumer (Oct 1991), 16-9; BMJ 303: 908-10. A recent study links leukaemia in the U.K. with higher socioeconomic status; Nature 353: 373; Lancet 338: 807.
Changes in the WHO essential drug list appear in Lancet 338: 743-5. In Japan, the Ministry of Public Welfare has recently decided to require the listing of possible drug side-effects for 500 prescription drugs. Currently, no such information is provided, 36 people have so far died in 1991 because of prescription drug side effects. On drugs that interact with RNA see Nature 353: 302-3. On drug delivery using prodrugs see Science 253: 1095-6. On protein drugs see Biotechnology 9 : 926-7.
On obesity and disease see BMJ 303: 704-6. On a USDA food survey see Science 253: 1349. On vitamins and intelligence see Nature 353: 103. On breast feeding see NEJM 325: 1036-7. On the effects of being on space on health see Science 253: 1491.

The drug Halcion has been taken off the U.K. market (EEIN 1: 76), but UpJohn is contesting this; BMJ 303: 1000. On the case of the restriction of another prescribed drug with health risks, benzodiazepine, see JAMA 266: 2392-7. In the case of New York state, they have found that restricting the sale of this drug has lead to prescription of worse drugs.
On a rather negative view of the effects of pesticides see Peter Hurst et al., The Pesticide Handbook , (Pluto, 358pp., 72-50), reviewed in NS (23 Nov 1991), 57-8. See also Chemistry & Industry (2 Dec 1991), 862; Lancet 338: 1200-1; R. Saracci et al., "Cancer mortality in workers exposed to chlorophenoxy herbicides and chlorophenols", Lancet 338: 1027-32. Their cancer could be due to dioxin contaminants. There is fresh research into dioxin, and the relationship between exposure and human risk; Science 254: 377; A. Manz et al., "Cancer mortality among workers in chemical plant contaminated with dioxin", Lancet 338: 959-64. On genes that dioxin alters the expression of see T.R. Sutter et al., "Targets for dioxin: genes for plasminogen activator inhibitor-2 and interleukin-1ß", Science 254: 415-8.
A series of papers on cancer are in the 22 November issue of Science , including B.E. Henderson et al., "Toward the primary prevention of cancer", Science 254: 1131-8. Many lifestyle changes are required to lower cancer risk. On the continuing debate over whether there is a link between dietary fat and breast cancer see NS (7 Dec 1991), 12. In the Netherlands, Britain, Denmark and New Zealand people obtain about 40% of their calories from fats, and their breast cancer mortality is about four times higher the rates in many Asian countries with much lower fat consumption. But there is conflicting data, although some people suggest linoleic acid may be specifically involved. A study in the NEJM (26 Dec 1991), has found a link between diagnostic X-rays and breast cancer in women who have one of the alleles for the recessive disease ataxiatelangiectasia. This has led to suspicion that this may explain the rising rate of breast cancer, because of increased use of diagnostic X-rays.
There are claims that the US food survey of 1988 was flawed; BMJ 303: 1016, because of methodology. On household nutrition, see papers in Social Science & Medicine 33, issue 10. The labels on food can be very misleading; Times (12 Nov 1991), 5, as can those on drugs; Lancet 338: 1384-5. On diet and coronary heart disease see a review in Lancet 338: 985-92.
The safety of cosmetics is discussed in FDA Consumer (Nov 1991), 18-23. Silicone breast implants are reported to be probably safe in several North American reports; BMJ 303: 1351-2. On the dangers of overwork for health see BMJ 303: 1419. On public health in general see JAMA 266: 2336-40.
The underlying chemistry of the UV-induced mutations that lead to melanoma is described in D.E. Brash et al., "A role for sunlight in skin cancer: UV-induced p53 mutations in squamous cell carcinoma", PNAS 88: 10124-8. The change CC to TT was detected in patients, and is only known to be caused by UV light. On the dangers to health of ozone depletion see BMJ 303: 1326-8. As the UV light over mid-latitudes reaching the earth's surface is rising (by up to 8-10% since 1980), and is expected to increase another 10% by the year 2000, due to ozone depletion, we must look at the health effects (and effects on crop production) of the increased UV light. On air pollution, and climate change, and health; BMJ 303: 1124-6, 1254-6, 1459-61.
There is a report that aspirin use may reduce the risk of fatal colon cancer; M.J. Thun et al., "Aspirin use and reduced risk of fatal colon cancer", NEJM 325: 1593-6, 1644-5. On aspirins and strokes see NEJM 325: 1261-6.
There is growing debate to improve the US EPA regulations to better protect against reproductive toxins; Science 254: 507. On toxic waste sites see Science 254: 797; Occupational Health & Safety (Sept 1991), 18-22. On pollution in Czechoslovakia see Nature 354: 180. On benzene and cancer see TIPS : 214-7. On the debate over asbestos and health risks; Science 254: 928-31. Lead poisoning is discussed in MJA 155: 407-9.
Meanwhile, many US companies have voluntarily agreed to cut their production of noxious wastes by half by 1995, in what may be a sign of the times when the public is becoming more aware of pollution; Biotechnology 9: 1316-7. It may also have a lot to do with the federal government's document Toxic Release Inventory which details the toxic emissions of 20,000 factories in the US, so that if they do not clean up their emissions local public relations will become hostile. Also see Lancet 338: 1444.
On nuclear waste in the USA see NS (7 Dec 1991), 16-7, and on missing enriched Uranium in the U.K. see Nature 354: 422. The report on Japan's recent nuclear power plant accident is reviewed in Nature 354: 259. The psychological problems may be greatest in the initial period after radiation exposure in Chernobyl; BMJ 303: 1347-8, and Chernobyl reactors are now being closed; Nature 354: 8. On the link between cancer and electromagnetic fields see Occupational Health & Safety (Sept 1991), 28-30, 47; MJA 155: 289-92, 347; Nature 254: 260.
The cholera epidemic in Latin America and particularly in Peru has been aided by the decision not to chlorinate water supplies, a case of risk miscalculation; Nature 354: 255; Lancet 338: 1451.
Firearms control in Canada is discussed in CMAJ 145: 1211, 1217-26, 1332-40; and in the USA firearms are suicide and homicide risk factors; JAMA 266: 2342, 2989-95; NEJM 325: 1615-20, 1647-50. There is still low use of bicycle helmets in the USA, JAMA 266: 3032-3, but increasing use of car safety belts; NEJM 325: 1586-7.
On drug abuse see BMJ 303: 1043-6; JAMA 266: 2233-7, 2272-3, and on doctor's willingness in Australia to intervene with patient's drug problems see Social Science & Medicine 33: 1053-61. On tobacco see Lancet 338: 1383-4, NEJM 325: 1586; JAMA 266: 2061, 2110-7, 2131. US hospitals have begun to restrict smoking to specific areas, since January 1st, and should ban all smoking within 2 years according to new regulations. However, some psychiatric wards may refuse this.

The row over silicone breast implants continues, following the FDA voluntary ban on sales of such implants; Washington Post (15 Feb 1991), A3; see also Biotechnology 10: 121; BMJ 304: 138. On the 20 February a panel of experts unanimously recommended to the FDA that the government allow silicone breast implants only for experiments and for women needing breast reconstruction. Currently cosmetic surgery is the reason in 80% of the implants, so this decision will have a major impact. The FDA is expected to take their advice, within the next 60 days. Hopefully the ban might lead people to ask the question why people think it is good to have such implants, and to look at the social pressures which may push people to use cosmetic surgery. Society should work out these issues soon, before we have too many gene products to abuse.
A recent survey by the Pharmaceutical Manufacturers association in The USA has identified 263 drugs that are being developed in the USA for women; Nature 355: 287. There are additional ethical, legal and safety issues to test drugs in women of child-bearing age. On the orphan drug standards and the large profits that some companies are obtaining; see Nature 355: 381.
On public information about pharmaceuticals see Lancet 338 (1991), 1516. A computer database for prescription drug information is being developed; Lancet 338 (1991), 1513-4. The forces that change the pattern of drug prescriptions and how often doctors prescribe drugs is discussed in BMJ 304: 239-42. On the legal barriers to the provision of pain-killers that are used to treat chronic pain see MJA 155 (1991), 640-3.
On diet and cancer in humans and rodents see Science 255: 141. The food diets of people over world can vary greatly. It appears that the diet of South American Indian tribes can easily identify which tribe they belong to; Science 255: 163. On the prospects for improving the diet in Europe, and some summary information on current European diets, see BMJ 304: 178-80.
Also of interest; on chemical sensitization, Lancet 339: 297; Germany's new drug safety foundation founded by Bayer and Hoechst, Lancet 338 (1991), 1584; on asbestos removal hazards see JAMA 267: 52-3. 20 African countries have joined forces to attempt to stop the trade in counterfeit drugs; Nature 355: 192.
There has been some significant evidence produced in the UK to suggest a link between low level radiation exposure and leukemia; G.M. Kendall et al., "Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers", BMJ 304: 220-5; NS (1 Feb 1991), 17; Nature 355: 381. The total number of excess deaths is low, but the risk of contracting leukemia found in a long term study of the records of the UK National Radiological Protection Board on 95,000 former and current workers, was about double that found in previous studies. There are calls for tightening of radiation safety standards by others, but not by the authors of this paper. On environmental radiation see BMJ 304: 299-304. It concludes that control of the use of radiation exposure in medicine offers much scope for control. Doctors in Britain are called to limit the radiation exposure of patient's to X-rays; BMJ 303 (1991), 1497. The idea is to make doctors (and dentists?) think about when they really need an X-ray and not to use them unnecessarily.
On air pollution and heath see Nature 355: 290; and on traffic pollution see BMJ (1991), 1539-43. A broader look at traffic alternatives and pollution production is in BMJ 304: 48-50. A discussion of ozone and health is M. Lippmann, "Health effects of tropospheric ozone", EST 25 (1991), 1954-61.
On the continuing calls by the BMA to ban boxing because of its causative link to brain damage; BMJ 303 (1991), 1495. On stress, genetics and Graves disease see Lancet 338 (1991), 1475-9. On Alzheimer's disease and environmental risk see JRSM 85: 69-70.
The drug Halcion has been taken off the U.K. market (EEIN 1: 76), and UpJohn has failed to get the ban lifted; BMJ 304: 11. UpJohn has sued the author of an article in the NY Times (20 Jan 1991) who claimed that they had misled regulatory authorities; BMJ 304: 273.
Smoking bans in Britain appear to be gaining ground, especially in hospitals; BMJ 304: 274. A public opinion survey says that two thirds of the public in the UK want a ban on tobacco advertising, making more pressure on the British government to support a proposed European ban on tobacco advertising. The affects of such a ban on cigarette sales may be seen in the results of the ban in New Zealand, which has led to dropping cigarette sales. On the voting on a European ban see Lancet 339: 235. A special issue of JAMA (11 Dec 1991) focuses on tobacco control, and there is a series of articles, including methods for giving up the addiction, and approaches to ban smoking and advertising. The state of North Carolina, a tobacco producer, appears to be ignoring the adverse effects of smoking on maternal health; JAMA 266 (1991), 3399-3400. See also JAMA 267: 87-90; several papers in Social Science and Medicine 33 (1991), 1317-47; T.C. Schelling, "Addictive drugs: the cigarette experience", Science : 430-3.

In Christchurch, New Zealand , it was found that materials that had been labelled "not fit for human use" had been used by Canterbury Area Health Board hospitals. In a review of pharmacy prescriptions of 1989, 29 deficiencies had been found. However, the hospital replied saying that such drugs had only been used when the patient would die, when there was no other source available worldwide, and only when patient consent had been obtained, and local ethical committee's had approved of the cases. Such cases do emphasise the need for all pharmaceuticals to be labelled.
In Japan , doctors generally do not inform their patients what drugs they are given, and they are not labelled, so that popular books are sold listing the code numbers on pills with the relevant drug names and information. It should also be noted that many doctor's provide their own pharmaceuticals, or via family members, which is a lucrative business and one suggested reason why numerous pills are given following any visit to the doctor. In order to reduce the overprescribing of drugs, the Ministry of Health & Welfare has changed the minimum sizes for selling drugs to hospitals and doctors, reducing the sizes from 600 pills to 100 pill packages; Asahi newspaper (4 April 1992), 37. They have also changed the rules to allow more plants to be grown and imported for Chinese medicines because of high demand.
On the use of illegally manufactured drugs in the USA see JAMA 267: 1442. This problem is much greater among poorer countries, see BMJ 304: 334-5. The issue of charlatans (tricksters) in poor countries is still serious; Lancet 339: 795-6.
A major study conducted by a group of experts for WHO on Health and the Environment has been released, and was applauded in a review in Lancet 339: 605. A discussion of the recent South American outbreak of cholera and the lack of chlorination is Biotechnology 10: 223.
A paper looking at liability claims for diethylstilbestrol (DES) effects in grandchildren of users is in AJLM XVII (1991), 435-55. The guidelines on the use of silicon breast implants, which were recently banned for general cosmetic uses in the USA (EEIN 2: 20), are discussed in BMJ 304: 525-6; Lancet 339: 546; Nature 355: 755. On the lack of a relationship between ß-blockers and depression see JAMA 267: 1783-7, 1826-7. It is estimated that 3-4% of UK hospital patients are in hospital because of adverse drug reactions; Lancet 339: 486.
The safety of the contraceptive pill, and the need to consider its effects because the majority of women in industrialised countries have used it, is discussed in ; J. Public Health Medicine 14: 9-16; and the current lack of relationship between progestins and breast cancer, Fertility & Sterility 57: 473-91, 492-3.
European MPs have voted to ban tobacco advertisements; BMJ 304: 464. A review of the current smoking habits in Europe is in BMJ 304: 370-2. The development of smoke-free employment areas in the USA is discussed in Occupational Health & Safety (March 1991), 22-3. Methods to market smoking cessation programmes in Australia are discussed in BMJ 304: 691-4. Last year, was another record year for Japanese tobacco producers with sales of 328 billion cigarettes. Even some pro-tobacco media articles and TV programmes have appeared, saying smoking is beneficial to health. The effects of non-employment on smoking, drinking and body weight from a study in British men is in BMJ 304: 536-41. They only found a link between non-employment and increased body weight. A review of addictive drugs is T.C. Schelling, "Addictive drugs: The cigarette experience", Science 255: 430-3. The review of the book, Free to be Foolish. Politics and health Promotion in the USA and Great Britain, H.M. Leichter (Princeton University Press 1991, 281pp., US$35) is in Science 255: 480-1. An even more widely used drug is coffee , which can also lead to higher blood cholesterol levels; R.E. Fried, "The effect of filtered-coffee consumption on plasma lipid levels", JAMA 267: 811-5. If taking cocaine and alcohol , a third more lethal drug is made in the body; JAMA 267: 1043-4.
Public health education is needed about many risk behaviours; J. Public Health Medicine 14: 3-8. The methods used to measure public opinion on public health questions is examined in AJPH 81; 103-5. Public health policy in Europe is discussed in BMJ 304: 855-6. An editorial urging doctors to get on their bikes to aid healthier life changes is in BMJ 304: 588-9. Noise induced hearing loss could be easily prevented, yet exposure to damaging noise levels (>75dB) is still common; BMJ 304: 522.
An editorial on boxing and health is in MJA 156: 76-7. The relationship between firearms legislation, or the lack of it, and suicide is discussed in MJA 156: 75, 79-83; JAMA 267: 1171-2. The incidence of head injuries in the USA and its correlation with laws on motorcycle helmet use are in JAMA 267: 1649-51.
The method by which low dose radiation may cause cell damage is discussed in Nature 355: 738;BMJ 304: 523-4; JAMA 267: 929-30; NS (22 Feb 1992), 7. A review of the data on radiation effects relevant for human space travel is in FASEB J 6: 2338-43. The effects of Chernobyl are still being debated; Lancet 339: 484-5, and will be continued to be felt by many former residents of that area. The International radiation exposure limits set by the ICRP in 1977 were 50mS per year, but in 1990 they reduced these levels to an average of 20mS over 5 years with a maximum of 50mS in a year. In Japan there are generally very strict safeguards on radiation, for example, all radioisotope experiments at the University of Tsukuba must be performed in a special building. However, in a survey conducted by a company that analysed 150,000 radiation film badges last year, they found 400 people had more than 20mS and 37 people had more than 50mS exposure. There has also been much public concern over the trend to use repeated medical and dental X-rays.
The extraction of gold in many countries has been associated with mercury pollution. Such pollution is still very serious in Brazil as shown the levels of mercury in rivers; Nature 356: 389. High lead levels may permanently lower IQ, according to an Australian study; NS (29 Feb 1992), 7. The number of people killed from insecticides in India is increasing, in only the province of Maharashtra (9% of the population), about 3,050 people were killed or committed suicide using insecticides (especially aluminium phosphide) in 1990; Nature 356: 374. In Japan, the Ministry of Agriculture and Fisheries has relaxed the maximum pesticide residue limits on imported fruits and vegetables, increasing the permitted levels by about three times; Asahi newspaper (29 April 1992), 29.
On the use of cancer-fighting food additives see Science News 141: 104-6. It appears that vegetables do contain anti-cancer substances, but it is a complex story; Nature 356: 377. One component of broccoli, is sulforaphane, which is an anticancer agent; PNAS 89: 2394-403.
Vitamin C may protect sperm against genetic disease; NS (14 March 1991), 20. The level of vitamin C is 8 times more concentrated in seminal fluid than in blood plasma, suggesting it plays a role in protecting sperm from oxidative damage. Studies consistent with this role are ongoing.
A recent court case in Japan involved the case of an 11 year old boy who died due to allergic reaction to buckwheat noodles (Soba) while eating a school lunch. School lunches are provided at Japanese schools, and the teachers had been told that he had an allergy and should not eat soba. His parents sued the city (representing the school) and they were awarded about US$120,000 in damages by the court, who said that the school had responsibility because of a lack of care, even though the boy was 11 years old.

Recommendation of Dietary Fatty Acids by Giovanni Monte, Ph.D.
National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565, Japan
The specific dietary patterns of a population have a major influence on the prevalence and incidence of atherosclerosis vascular disease and coronary heart disease. Dietary fat consists of triglycerides which contain fatty acids of three types--saturated, monounsaturated and polyunsaturated, and each type appears to have different effects on cholesterol levels and on low density lipoprotein. Fatty acids are fat droplets in the cytosol of cells, and triglycerides and phosphoglycerides of the plasma membrane. These fatty acids are released by the action of intracellular lipases and phospholipases. The fatty acids that are oxidized in mammalian tissue are either taken up from the blood or hydrolyzed from intracellular lipids. Plasma lipoproteins contain triglycerides that may be digested by lipoprotein lipase before entering cells. Free fatty acids in the plasma are bound to albumin and are easily taken up by the cells of most tissues.
It is well known that high consumption of saturated fatty acids is one cause of obesity. Recent reports have demonstrated that the strong genetic component in the transmittance of obesity is associated with an increased prevalence of cardiovascular risk factors such as hypertension, lipid disturbances and diabetes mellitus. Demonstration of the genetic determinants of human obesity not only allows developments of better-informed programs of prevention, but it also provides a basis for the understanding and eventual control of this disorder. Increased physical activity is useful in the control of human obesity, but additional research is needed to understand the variables that influence food consumption, exercise behaviour, and the failure to maintain long-term change and weight loss. Our mission is to identify the full set of genetic instructions contained inside our cells and to read the complete DNA sequence.
Epidemiological comparison of the diets of Mediterranean and Japanese populations having a low coronary heart disease (CHD) rate with European and American populations having a relatively high CHD rate were made. The comparison suggests that low rates of CHD correspond with low consumption of fatty acids. Individuals with hyperlipidaemia are usually advised to reduce saturated fatty acids to 10% or less of total calories, and total fat to 30% or less of dietary energy (Table).
One of the goals of the Human Genome Project is to provide scientists with powerful new tools to help them clear the research hurdles that currently keep us from understanding the molecular cause of obesity. Also, I believe it is important to consider the possible implications of discovering the gene(s) connected to obesity for clinical practice and counseling, and to discuss the responsibilities of physicians and scientists in educating the broader public about the human genome project.
Recommendations of some dietary components for prevention of human atherosclerotic disease Component Recommendation
CARBOHYDRATES 50-60% of total calories
PROTEINS 10-20% of total calories
saturated fatty acids
polyunsaturated fatty acids
monounsaturated fatty acid
Dietary cholesterol
<30% of total calories
6-8% of total calories
10-15% of total calories
<300mg/day (<200mg/day for high risk groups)

A report on the reasons why the UK has withdrawn the drug Halcion that was given to the European Parliament gave as reasons for the withdrawel disclosure of many more cases of side reactions in clinical trials than hasd been reported; SCRIP (27 May 1992), 25. In one trial of prisoners that was used, only 27% of the psychiatric reactions to the drug were reported. However, there is since further safety doubts, and a new clinical trial may begin in the USA. We must be suspicious of companies which apparently hide results of clinical trials, and especially when considering the above reported news that foodstuffs produced by genetic engineering may not need special review procedures, can we leave it to industry to decide? Accusations that drug companies endanger people in developing countries is in BMJ 304: 1398.
The drug dideoxycytidine (DDC) has been approved in the USA for use in treatment against HIV infection, following approval by an FDA panel; Lancet 339: 1047. On the use of low dose interferon for HIV infection see Lancet 339: 1106. Revised pharmaceutical drug approval procedures in the USA and Australia are reported in Lancet 339: 982-3.
In Australia a recent court award has been made awarding damages to a worker exposed to smoke in the workplace; Lancet 339: 1406. This is a welcome case, and may help make smokers aware of the harm they cause others. In Japan, an employee of Japan Railways has sued the company for health damage due to the employers refusal to ban smoking from the workplace, but this is not a case of cancer but alleged respiratory and psychological problems. Generally there is little respect for nonsmokers rights in Japan, but from July all stations on the inner circle line, Yamanote line, in Tokyo, will ban smoking (currently smoking is banned on commuter trains but only at stations for several hours in rush hour (though it is not enforced). In the USA second hand smoking is being recognised as the killer it is; Newsweek (29 June 1992), 51. The results of a recent trial of how easy it is for minors to buy tobacco in Japan is in Lancet 339: 1163. Although the law says the minimum age is 20 years, it is easy to buy tobacco from shopowners, though it is even easier to buy from the numerous vending machines. Moves need to be made to decrease the smoking rate.
Australia has joined New Zealand and Canada with total bans on tobacco advertising; Lancet 339: 925; BMJ 304: 938. We can hope other countries follow. On the worldwide toll of tobacco sales see Lancet 339: 1267. France is restricting people from smoking; BMJ 304: 1263. A epidemiological study is R. Peto et al., "Mortality from tobacco in developed countries: indirect estimation from national vital statistics", Lancet 339: 1268-78. Tobacco causes 20-30% of the deaths in developed countries in the age range 35-69 years of age, and it is therefore becoming the leading cause of death.
A special May issue of Trends in Pharmacological Sciences focused on neurobiological views on drug abuse. A study on the use of drugs by doctors is P.H. Hughes et al., "Prevalence of substance use among US physicians", JAMA 267: 2333-9. They had lower rate of illicit substances, but higher use of alcohol and controlled medications than the general public. The risks of firearms use in the USA is discussed in JAMA 267: 1171-4; NEJM 326: 1157-61.
The dangers of reduced fertility caused by environmental chemicals is discussed in R.M. Sharpe, "Are environmental chemicals a threat to male fertility?", Chemistry & Industry (3 Feb 1992), 88-91. A review of toxicology is G. Zbinden, "The three eras of experimental toxicology", TIPS 13: 221-3. On a possible link between vitamin K and childhood cancer see BMJ 304: 1264-5.
The debate over silicon breast implants, and the situation in the USA is described in Lancet 339: 1043; FDA Consumer (June 1992), 6-9. Related see BMJ 304: 1060, which asks whether breasts are redundant. Other silicone implants are discussed in JAMA 267: 2442, 4, 2578-9. In Japan a database on the inactive ingredients of drugs is available; Lancet 339: 983. On consumer protection in Japan, and economic protectionism in trading policy see J. Japanese Studies 18: 119-154.
The drinking water standards for several pesticides and other compounds, inorganic and organic, are being revised and set for more compounds in the USA, by the EPA; Chemistry & Engineering News (1 June 1992), 19. In the USA a new study of the health effects of farm chemicals is beginning; Science 256: 299. On the descriptions of mutations induced by a food mutagen see PNAS 89: 4850-4.
Mercury pollution in sediments of rivers in the UK, due to past small scale gold mining is reported in Nature 357: 369. It suggests that disturbance of river sediments in Brazil or Indonesia where mercury is still being used on a large scale, should be avioded for many years to come. On the Brazilian poisoning see BMJ 304: 1397. The effects of low level lead exposure are debated in Science 256: 294-5; 437-8; and lead in soli in Lancet 339: 921-2. Lead levels of preindustrial humans may have been about two orders of magnitude lower than commonly accepted limits today; NEJM 326: 1293-4.
Nuclear waste appears to form colloids in the ground which increases the cahnces of contamination; J.K. Bates et al., "Colloid formation during waste form reaction: implications for nuclear waste disposal", Science 256: 649-51. This may lead to modifications in the storage requirements needed for waste. The results of studies on survivors of tha atomic bombs in japan are in J.V. Neel & W.J. Schull, eds., The Children of the Atmoic Bomb Survivors: A Genetic Study (National Academy Press 1991, 530 pp., US$30), reviewed in Nature 357: 31. The place of residence appears to be as important as the place of birth in the incidence of cancer after exposure to low level radiation in the study; R.J. Black et al., "Incidence of leukaemia and other cancers in birth and schools cohorts in the Dounreay area", BMJ 304: 1401-5; see also 1393-4. On the fears of dilute radiation see JRSM 85: 311-3. The WHO Chernobyl programme is reported in Lancet 339: 924; as is a UK study suggesting that there is no carcinogenic hazard due to electromagnetic fields (see also BMJ 304: 938-9). On cancer risk and radon exposure indoors see Lancet 339: 1115.
Air pollution may be reduced in the USA by collective pledges made to the EPA, to reduce emissions by about half, by the end of 1995 (and 33% by the end of 1992), of 17 toxic chemicals; EST 26: 849. On modelling the indoor environment see EST 26: 851-8. On silicosis and dust damage to lungs see Science 256: 116-8; and on cancer risk see; P. Elliott et al., "Incidence of cancers of the larynx and lung near incinerators of waste solvents and oils in Great Britain", Lancet 339: 854-8.

A policy debate on health and the environment is R. Doll, "Health and the Environment in the 1990s", AJPH 82: 933-41, 931-2. A report on a seminar on environmental law is in IDHL 43: 410-2. The topic of fluoridation of water and its effectiveness in dental health is debated in JAMA 267: 3264-5. Chlorination and risk of cancer is reviewed in AJPH 82: 955-63; and the case of the cholera epidemic in Peru is reviewed in Lancet 340: 28-33; 20-1.
A book review concerning public health is in NEJM 326: 1786-7. Comments on public health policy in the UK are in BMJ 304: 1643-4, 305: 129-30, 135-6. The role of epidemiology in preventing occupational disease is reviewed in AJPH 82: 944-54. The role of food safety concerns in fish farming is discussed in FDA Consumer (July 1992), 18-22.
The trends in alcohol-related traffic fatalities, and seat belt and motorcycle helmets use in the USA are in JAMA 268: 301-18. See also homicide as the main cause of death in US black children; JAMA 267: 3048-53, 3054-8; BMJ 304: 1527; and other articles on firearm availability and health risk; JAMA 267: 2993, 3008-10; 3026-7, 3033-47, 3067-76; NEJM 327: 467-72 and on television violence; JAMA 267: 3059-63.
The dangers of silicone are not restricted to breast implants but to other medical uses; JAMA 268: 12-8. Opposing views on the FDA restrictions on silicone breast implants are in NEJM 326: 1695-8, 1713-5. As well as breast implants, male penile implants have also been controlled; US News & World Report (24 Aug 1992), 62-7. The risk of carcinogens in food in the USA is a legally contentious issue, and the EPA recommendations were recently challenged by a court case; Nature 358: 181; Science 256: 1609, 257: 322. The question was whether a negligible cancer risk is enough reason to ban the use of substances, and the court said yes, the EPA (reflecting the changing views of the scientific community) said no.
An interesting paper which suggests that red wine consumption may be a reason for low incidence of heart disease in France, despite their high cholesterol diet is S. Renaud & M. De Lorgeril, "Wine, alcohol, platelets, and the French paradox for coronary heart disease", Lancet 339: 1523-6. As a result, the sales of red wine in the USA have rocketed! An official statement from the National Heart Foundation of Australia on diet and coronary disease is in MJA 156: S9-16. A positive role for the results of randomised clinical trials of cardiovascular drugs is suggested in a study in NEJM 327: 241-7. Also on diet and prevention of disease see Biotechnology 10: 719. The link between diet and cancer is discussed in Lancet 340: 162-4. The drug taxol is discussed in Lancet 339: 1447-8.
A disturbing legal case happened in the US, when a cigarette company, making Camel cigarettes, R.J. Reynolds, obtained a court order to obtain all the personal files of a researcher who published a study in JAMA last year showing how children of 3 years could recognise the Camel advertisement. They then published many files in their local newspaper; Science 256: 1620-1. Papers on tobacco use include JAMA 267: 3255-8, 3282-6, 268: 524-5 AJPH 82: 1171-3; BMJ 305: 2; NEJM 327: 132-3; and on tobacco litigation; Lancet 340: 230-1; BMJ 305: 9, 426-7. Workplace smoking restrictions are associated with reduced tobacco consumption, and reduce second hand smoke damage; J. Occupational Medicine 34: 693-7; JAMA 268: 749-52; Lancet 340: 360-1; Science 257: 471, 607. The causes of asthma deaths in New Zealand are debated in BMJ 304: 1634.
The risks of leukemia after radiation therapy for breast cancer is reviewed in NEJM 326: 1745-51. A study in Sweden has found no increased leukaemia incidence after iodine-131 exposure in medical treatment; Lancet 340: 1-4; and a study in Chernobyl has found no increased incidence of thyroid nodules; JAMA 268: 616-9. Retrospective studies that look at health risk at nuclear weapons facilities are reviewed in EST 26: 1270-7.
The dangers of electromagnetic fields are reviewed in JAMA 268: 620-9; Science 257: 468-9, 488.
A report on the atmospheric concentrations of lead and cadmium over Hungary is in Ambio 21: 324-6. The sources of lead can be examined by electron microscopy; EST 26: 1513-23. Metal bioavailability is discussed in EST 26: 1298-9. The annual release of toxic substances in the USA is generally falling, in 1990 companies released 4.8 billion lb of toxic chemicals, compared to 7 billion lb in 1987; EST 26: 1473. A paper from a study in Hawaii looked at pesticide runoff from golf courses, also a big concern among some Japanese; Bull. Environ, Contam. Toxicology 49: 179-85. They found that degradation before it reached drinking water meant that the levels were below water standard limits.
Exposure to carcinogenic polycyclic aromatic hydrocarbons is reviewed in EST 26: 1278-83. Styrene may be rapidly biodegraded in many environments according to a study in EST 26: 1540-4. Biological effects of pollution are reviewed in EST 26: 1476-84, and a study on the world's largest landfill rubbish site; EST 26: 1486-94.

The FDA decision to impose user fees to help finance speedier safety decisions has been supported by the US biotechnology industry; GEN (15 Sept 1992), 3; Lancet 340: 718; Nature 358: 616, 359: 563; Bio 10: 935. The FDA ban on silicone breast implants has been relaxed; JAMA 268: 1390, 1536.
The EC is considering reclassifying vitamins, minerals, amino acids, fish liver oils, yeasts and other nutrients as drugs rather than foods. This would require special examination of their safety; BMJ 305: 491, 711-2. Similar moves are underway in several countries. The safety of a new food, a red seed from a plant Vicia sativa , grown in Australia, is questioned in Nature 359: 357-8; NS (3 Oct 1992), 9.
An editorial on reactions to food additives is in JRSM 85: 513-5, while an editorial on fat and coronary heart disease, questioning the evidence of a link is in JRSM 85: 515-6. A survey of commercials regarding food supplements is R.M. Philien et al., "Survey of advertising for nutritional supplements in health and bodybuilding magazines", JAMA 268: 1008-11. Most were claimed to promote muscle growth, and many were identified. A comparison of US and Mexican pesticide standards is in EST 26: 1900-1.
In the last issue of the newsletter, EEIN 2: 63, a study from Chernobyl that found no increased incidence of thyroid nodules was reported; however, two letters in Nature 359: 21-2; BMJ 305: 601-2, report significantly increased incidence of thyroid cancer in the region, following the radiation exposure. In Ukraine a study has shown that removal of grass turf that was contaminated in the Chernobyl accident was an effective way to allow noncontaminated agriculture to resume; NS (26 Sept 1992), 18. A general article is P.M.S. Jones, "The real costs of nuclear power", OECD Observer (Oct/Nov 1992), 8-11, which previews an upcoming OECD report.
The question of whether there is any health effect of electromagnetic radiation (emf) is not being actively researched in the USA by the EPA; Nature 359: 3. More on this question in EST 26: 1714-6. Two Swedish studies suggest links between emfs and leukemia, in children and electric workers; Time (26 Oct 1992), 43.
Some studies suggest that the trigger that can cause latent viruses to switch on may be UV light ; Science 257: 1211-2. This is suggested for the HIV virus, based on mice experiments. The conclusion may be to avoid sunlamps and UV light.
The WHO has introduced lower levels for lead exposure; NS (19 Sept 1992), 4. A paper on detrimental effects of lead is W.G. Sciarillo et al., "Lead exposure and child behavior", AJPH 82: 1356-60.
Greenpeace is calling for an end to the ocean dumping of waste by Britain; BMJ 305: 439. The pollution problems in the former USSR due to toxic waste dumping are discused in Lancet 340: 417-8. Toxic waste is being exported to Somalia, following agreements with the Italian and Swiss governments, even though there is still a war there; NS (19 Sept 1992), 5. Australia and PCB export was discussed in the environment section. We should also keep our eyes on the plutonium import to Japan from France, which is just beginning at the beginning of November.
The drug Halcion has been controversial due to its possible adverse psychological side effects, as reported earlier in the year. It has been used in Britain to acquit a prisoner of an attempted murder charge in a prison following their drinking of tea spiked with the drug which is said to have lead to there attack on a fellow prisoner; BMJ 305: 672. A directory of banned substances is available from the WHO, Products banned, fourth edition, 769pp., US$95.
The risks of overwork are long known in many countries, but many would like to make a new disease of it and associate it with Japan , called karoshi; Lancet 340: 598. The Japanese government has been convinced and is setting up health checks, for overworked employees. The cause of death may be strokes, but heart attacks are common in the West are they not? I remain unconvinced of it being any different from death cases from overwork in other countries.
France is to be commended for introducing fines for smoking in public places, from the 1 November. About 40% of adults smoke, and new regulations are intended to stop this and to protect non-smoker's. Smoking areas must be set aside in restaurants and offices, with fines of FF3,000-6,000 for noncompliance, while individuals who smoke in the wrong place may face a fine of FF600-FF1300. There is concern that it is being introduced to quickly for places to comply; Japan Times (1 Nov 1992), 18. Comments on how to introduce a non-smoking area are in BMJ 305: 823-5.
A link between cataracts in the eyes and smoking has been shown by studies using men and women; JAMA 268: 989-93, 994-8, 1025-6. Letters on tobacco dangers are in Lancet 340: 666-8. The September issue of American J. of Public Health 82: 1203+ contains several papers on the dangers of smoking, and on smoking habits. The British insurance industry is reportedly going to further increase the premiums for smokers following studies which find that the number of smokers who die is a given period is significantly greater than the number of non-smokers (they already pay about 30% more); Times (17 Oct 1992), 26. A statistical link between suicide and smoking is considered spurious in G.D. Smith et al., "Smoking as 'independent' risk factor for suicide: illustration of an artifact from observational epidemiology?", Lancet 340: 709-12. The Gadchiroli area of Maharashtra state in India has made the sale of alcoholic drinks illegal, in efforts to widen a community ban that has been reportedly reducing the incidence of alcoholism; Lancet 340: 720.

A review by Ames and co-workers stressing the need to reassess the value of carcinogen testing is L.S. Gold et al., "Rodent carcinogens: setting Priorities", Science 258: 261-65. It includes a list of numerous natural compounds which we all consume which are cancer risks. A report on the approval of user fees in the USA by the FDA is in GEN (1 Nov 1992), 1, 3, 28; Biotechnology 10: 1409. High-tech methods for examining food safety are discused in FDA Consumer (Nov 1992), 7-13. The FDA intends to introduce guidelines for therapies using living cells in early 1993; Biotechnology 10: 1402. Even persons with a low caffeine consumption may experience withdrawal symptoms when they stop consuming; NEJM 327: 1109-14, 1160-1. A possible protective role for some compounds in soy sauce is reported in Cancer Research 52: 1754; NS (21 Nov 1992), 14.
Letters on the adverse effects of environmental pollution on health are in Lancet 340: 1030-1, 1220-2. Air pollution is linked with infant mortality in the Czech republic; Lancet 340: 1010-4. Genetic damage has been shown in a study F.P. Perera et al., "Molecular and genetic damage in humans from environmental pollution in Poland ", Nature 360: 256-8; BMJ 305: 1315. Adducts between DNA and polycyclic aromatic hydrocarbons were found in people living near pollution sites. Techniques for measuring DNA-carcinogen adducts are reviewed in Nature 360: 189; and the strategy of molecular studies of populations in Nature 360: 207-8. On dioxin see Science 258: 19. The 1991 US FDA report on pesticide monitoring says that 66.8+% of foods in the USA had no detectable pesticide residues, and 31.6% were below acceptable limits; FDA Consumer (Nov 1992), 4-5.
Antibodies to silicone have been detected in patients that have inflammatory reactions; JAMA 268: 1821-2; Lancet 340: 510-3. This is significant because silicone was considered immunologically unreactive. A clinical study of breast implants is underway by the FDA. See also CMAJ 147: 1127. The spreading habit of using anabolic steroids for body building is discussed in BMJ 305: 1241-2.
The importance of drug labelling to reduce deaths is clearly shown in the case of warnings on aspirin packets about the possibility of children who have chicken-pox or flu symptoms contracting Reye's syndrome ; Lancet 340: 1042. The death rate has fallen ten-fold since 1986 in the USA. It is still to be mandatory in Japan, though aspirin is not widely used. The FDA in the USA has decided to include more pediatric labelling on drugs; JAMA 268: 2491.
Statistical evidence linking passive smoking and significant increased risk of lung cancer is presented in R.C. Brownson et al., "Passive smoking and lung cancer in nonsmoking women", AJPH 82: 1525-30; D. Trichopoulos et al., "Active and passive smoking and pathological indicators or lung cancer risk in an autopsy study", JAMA 268: 1697-1701. Smoking bans in public places should be implemented, and one pressure tool to bring this about may be legal suits for damage due to unsafe workplaces; BMJ 305: 910. Comments on how to give up smoking are in JAMA 268: 1645-6; NS (31 Oct 1992), 6, and a review on the use of the nicotine patch is in JAMA 268: 2687-94. Comments on the statistical link between smoking and suicide is in Lancet 340: 1095-6. The use of statistics to campaign against smoking is discussed in Lancet 340: 1208-9. On advertising bans see BMJ 305: 1110-1, 1115, 1118, 1231. US legal cases for smoking damages are reported in BMJ 305: 1315. In Japan , a survey of 11,429 (from 16,000 asked) found that 60.4% of men smoke and 36.1% of women smoke. The effect of pet birds on lung cancer may not be strong - but it is still recommended to avoid keeping them in living areas, reports a new study; BMJ 305: 970-1, 986-9, 989-92. Fibreglass particles may also cause lung cancer; NS (24 Oct 1992), 4.
A study has shown that mice can be saved from lethal effects of irradiation by recombinant rat stem cell factor; PNAS 89: 9464-8. Such an approach may be potentially useful for human also. There is discussion about the amount of radiation emitted in the Hiroshima atomic bomb, following neutron studies in concrete which suggest that there may have been ten times more radiation than previously thought; Science 258: 394-5; Health Physics (Oct 1992), 421-6. Several articles on the development of nuclear weapons and power are in NS (28 Nov 1992), 21-44. An Austrian study from 1985-9 finds no statistically significant difference in birth defect rates, abortion rates or counseling that might have been thought following Chernobyl ; AJOG 167: 1025-31. Relatives of workers at the Sellafield nuclear reprocessing plant in the UK are involved in the largest personal injury court case in the UK; BMJ 305: 1113-4. On risk management see EST 26: 2336-8.
Scandinavian studies suggest a link between electro-magnetic field radiation from high voltage lines and cancer; Lancet 340: 1218-9; NS (31 Oct 1992), 4. The US study on emf is still controversial; Nature 360: 288.
High or low body weight are associated with higher mortality, except for cancer; JAMA 268: 2045-9. A study suggesting a smaller role for dietary fat or protective effects of fibre in avoiding breast cancer is JAMA 268: 2037-44, 2080-1. A comparative study of elderly Hawaiian Japanese, and Australian men's health is in MJA 157: 188-90. A study of the causes of death in the UK suggests that occupation of one spouse may affect the diseases of both spouses; SSM 35: 1525-33. The dangers of hypertension for health mean that it should be treated; BMJ 305: 845-6. Cardiovascular disease in developing countries is preventable, if environmental factors such as diet are educated; BMJ 305: 1170-1 Several studies on the dietary influences on development of diabetes are in BMJ 305: 1057-62; Lancet 340: 925-9; JAMA 268: 1890-5; Science 258: 766-70. On the dangers of driving with diabetes see BMJ 305: 1265.
The adverse effects of lead exposure in childhood on later intelligence level are reported and are reviewed in NEJM 327: 1279-84, 1308-9. The IQ level equivalence of lead-exposed children was a reduction of about 4-5 points at age 7 in children. Lead also stunts growth of children; Pediatrics 88: 886-92. A letter on the natural lead levels in humans is in AJPH 82: 1565-6. Concern about particulate lead from crumbling water pipes in the UK is in NS (21 Nov 1992), 4. The risk of psychiatric disorders and exposure to solvents is discussed in Br. J. Industrial Medicine 49: 820-5.
The risks of gun ownership are being tested in epidemioloigcal research; Science 258: 213-5; and on violence see Lancet 340: 1339-40. A book review on The Rise of the Gunbelt. The Military Remapping of Industrial America, is in Science 258: 1168-9. There are positive effects of using cycle helmets in reducing head injuries; BMJ 305: 843-4, 881-3; CMAJ 147: 1058-60.

The anticancer drug Taxol has been approved by the FDA for use in woman with ovarian cancer; Science 259: 181. Screening for chemicals that cause cancer are discussed in Lancet 340 (1992), 1409-10. In the UK, drug companies want to keep drug safety data secret , but this is under challenge; NS (9 Jan 1993), 5; BMJ 306: 81-2. A comment on the importance of informing consumers is in BMJ 306: 71. The FDA has decided to take no action against UpJohn regarding the data it supplied about Halcion; BMJ 305 (1992), 1383.
In the UK two anesthetists were convicted of manslaughter for overprescribing tranquilisers; Lancet 340 (1992), 1462. Even if approved, the dosages are obviously important! Letters on the misuse of anabolic drugs are in BMJ 306: 61-2. Letters clarifying the WHO clofibrate/ cholesterol trial are in Lancet 340 (1992), 1405-6. Book reviews on herbal medicine are in NEJM 328: 215-8; see also BMJ 305 (1992), 1583-5.
A Japanese television company has decided that a commercial saying "Bye Bye Nuclear "contravenes the broadcast law, and only showed it twice, despite having signed a contract to show it six times a month; Yomuiri Shinbun (17 Feb 1993), 26. Their decision was upheld by the court; despite the protests of the advertiser. The TV company wanted to soften the commercial to "Let's think about nuclear". This is a case showing how sensitive the nuclear issue is.
The import of plutonium by Japan has raised concern even in Japan, which has made the government even more sensitive. In Britain the Sellafield nuclear reactor has been the source of much concern; BMJ 306: 89-94, 87. However, more public support has been found since the site was opened to the public, Biotechnology 10 (1992), 1509. It is considered a good example of public relations. In some countries nuclear sites are closed and in others they are open. A report of the increased 137-Cs contamination of mushrooms caused by the Chernobyl accident is in AEM 59: 134-9. Parts of the East German countryside have high radiation levels so will be useful to study the effects of low level radiation on human health; Science 259: 448-51. Pollution in Russia is reported in NS (2 Jan 1993), 9.
A series of papers on the risks of EMF radiation are in EST 27: 42-58; Science 258 (1992), 1724-5. A paper on how EMFs interact with cells is W. Grundler et al., "Mechanisms of electromagnetic interaction with cellular systems", Naturwissenschaften 79 (1992), 551-9. A book review on risk perception is in NS (12 Dec 1992), 44. The high costs of risk regulation are being discussed in the US Congress; Science 259: 159.
From March, Japan Railways stations within 70km of Tokyo will be officially non-smoking, with designated smoking areas only, extending restrictions. Although smoking is common in Japan, it is less than Greece, and a little more than the USA. The UK is getting closer to a smoking ban; BMJ 306: 291; following revelations that the 1962 UK government rejected an antismoking campaign; BMJ 306: 163. Poland intends to ban Methods that physicians can use to help people stop smoking are summarised in MJA 157 (1992), 463-7, 688-92. A legal case, the Cipollone case in the USA, is reviewed in NEJM 327 (1992), 1604-7. The use of statistics in anti-smoking campaigns is examined in Lancet 341: 58-9. The Australian court decision awarding damages for passive smoking has been upheld on appeal; BMJ 306: 120-2; Lancet 341: 167. The chemistry of damage caused by radicals in smoke to health is being further discovered; Science 258: 1875-6. Smoking is associated with increased risk of Graves disease; JAMA 269: 479-82, 518-9. The risk of suffering a stroke decreases in women soon after cessation, and the benefits appear to be independent of the age of starting or the number of cigarettes smoked; I. Kawachi et al., "Smoking cessation and decreased risk of stroke in women", JAMA 269: 232.
A letter on the prohibition of alcohol in parts of India is in Lancet 340 (1992), 1414-5. Letters on alcohol abuse by native Americans are in JAMA 269: 471. The dangers of solvent abuse are reviewed in NS (6 Feb 1993), 21-3. Estimating alcohol-related deaths is discussed in MJA 157 (1992), 557-60.
An Australian study has found that pet owners have lower risk for cardiovascular disease; MJA 157 (1992), 298-301. A study of the shapes of mannequins over time finds them to be getting thinner, and presenting an unrealisticly thin size for women; BMJ 305 (1992), 1575-6. The waist/hip circumference ratio may be a better measure than body mass for death risk in older women; JAMA 269: 483. Also on heart disease see JAMA 268 (1992), 3085-91, 269: 449-50, 505-10; AJHG 51 (1992), 1295-1310; Lancet 340: 1421-5.
Letters on the risks of suicide and the relationship to gun ownership are in NEJM 327 (1992), 1878-81; Science 259: 161; JAMA 268 (1992), 3069-74. The effects of violence on children who witness it may be great; JAMA 269: 262-4. The proportion of cyclists who wore helmets in Christchurch, New Zealand, in 1991 was found to be 46%, but may be increasing.

A US court ruling that no carcinogen should be used as a pesticide is criticised in an editorial in Science 259: 1235. As research has shown, naturally occuring food makes up 99.99% of carcinogens in most people's diet and it is a waste of money to try to eliminate chemical pesticides while the natural carcinogens are seldom researched. However, women exposed to DDT are found to have a higher breast cancer rate. Some natural medicines may also contain worse poisons, as in cases of arsenic and mercury intoxication found in Indian ethnic remedies; BMJ 306: 506-7; and in problems with Chinese herb slimming routines, Lancet 341: 387-91, 892-3. Vasectomies are also reported to increase prostrate cancer risk.
Descriptions of the MRSA (methicillin resistant Staphylcoccus aureus ) infections and deaths in Japan are in Lancet 341: 483; NS (13 Feb 1993), 10; BMJ 306: 740. There have been over 100 cases in the last 6 months, and a number of law suits are underway. The obvious factor is the overuse of antibiotics in Japan (supporting Japanese industry and doctors profits!), the average use is 3 times the USA and 20 times the U.K. A commentary on multidrug resistance is JAMA 269: 1840-2.
Abuse of cigarette lighter fluid is causing many deaths in young people in the UK. Between 1988 and 1990, 398 children died due to lighter fluid abuse; NS (6 Feb 1993), 21-3. The effects of recreational drugs on sleep are reviewed in BMJ 306: 573-5. The use of antibodies to degrade cocaine is being suggested as a means to reduce the dependence on cocaine in drug treatment programs; Science 259: 1828, 1899-901. In men at high risk for ischaemic heart disease it is a health advantage to consume alcohol, according to a study in Lancet 341: 392-6. Moves to protect boxers medically, if they will not stop - the best protection, are discussed in JAMA 269: 1083.
The adverse genetic effects of smoking on sperm means smoking affects more than children; NS (6 March 1992), 10. Letters on a genetic influence on the desire to smoke are in NEJM 328: 353-4. Discussions of advertising bans on cigarettes include; JAMA 269: 724, 793-4, 1362; Lancet 341: 564, and the legal side, JAMA 269: 904-9. Sports clubs at school increase the smoking rate in children, JAMA 269: 1391-5. The use of a nicotine inhaler to stop smoking is reported safe in JAMA 269: 1268-71. On passive smoking see JAMA 269: 852, 1388; Lancet 341: 525-6, 552. Smoking is also associated with risk of cervical neoplasia; BMJ 306: 749-52.
Problems of government secrecy in the UK regarding drugs and health hazards is discussed in BMJ 306: 478, 721-2; Lancet 341: 598-9, 883-4; although, the UK is relatively open. Letters on the silicone breast implant controversy are in NEJM 328: 732-5. One third of US women in a trial were found to have antibodies against silicone; NS (27 March 1992), 12. Letters on the interaction of EMF with circadian rhythms are in JAMA 269: 868-9; and on EMFs, Science 260: 13-6; EST 27: 580. In Taiwan, buildings with high radiation levels have been found to be associated with steel rods; Lancet 341: 750. A book review of The Children of Atomic Bomb Survivors: A Genetic Study, is in AJHG 52: 633-4.
Studies showing an increasing cancer incidence in younger Swedes are worrying; Lancet 341: 773-7. Papers on the health effects of the environment are in JAMA 269: 1049, 1481, 5; Nature 362: 706. The importance of fresh air in buildings is shown in NEJM 328: 821-7, 877-8. In the UK many water companies are giving up fluoridation , despite of the dental advantages; BMJ 306: 666-7.
A symposium report on epidemiology and ethics is in JME 18 (1992), 193-6. A study of the effects of population mixing caused by the North sea oil industry in Scotland on cancer rate is in BMJ 306: 743-8. A review of the epidemiology of carcinogens, and a shift from fats to hormones, is in Science 259: 618-21. The use of hormones to prevent cancer in women is reviewed in B.E. Henderson et al., "Hormonal chemoprevention of cancer in women", Science 259: 633-8. A discussion of the dose response of cytotoxic drugs is in Lancet 341: 614-6.
Extracts from two papers published in 1893 in JAMA on medical food ethics are in JAMA 269: 1071, 1244. A positive effect for calcium supplements (1000mg, in addition to 750mg in diet) is shown in studies reported in NEJM 328: 460-4, 503-5, and on post-menopausal hormone replacement therapy, p. 1115-7. A study suggesting that consumption of partially hydrogenated vegetable oils is a risk factor for coronary heart disease is Lancet 341: 581-5.
Studies on the effects of lead on children are in JAMA 269: 1614-6, 1641-6, 1647-54, 1679-81.

In Japan , researchers at the National Food Institute and Eisai Pharmaceutical Co. have performed an experiment showing that royal jelly (the food for bee queens and eggs) protects mice against lethal bacteria; GEN (1 May 1993), 32. Maybe we will have to eat more royal jelly to save getting bacterial infections, but only one third of the mice who ate the jelly survived (all the controls died).
The DNA level changes induced by smoking in the cervix are reported in BMJ 306: 1444-8. On passive smoking risks see NEJM 328: 1708-9; Lancet 341: 965; The increased risk of asthma after exposure to smoke is further shown in NEJM 328: 1665-9; see also JAMA 269: 1994-5. Also on the risks of smoking see Lancet 341: 1523-4; BMJ 306: 999, 1567-70; A study shows that even if you quit smoking at 60 years old the lungs may recover and lengthen life and increase health expectancy, JAMA 269: 2785, 2741-8. Smoking cessation also decreases risk of stroke, JAMA 269: 2213-4. Letters on access to heart surgery for smokers are in BMJ 306: 1408-9 following provocative papers, M.J. Underwood et al., "Should smokers be offered coronary bypass surgery?", BMJ 306: 1047-50.
In Japan it is found that in the last six years more young people smoke. In High School students, 37% of male and 15% of female students had smoked within a month of a survey; Yomiuri Shinbun (1 June 1993), 16. On US smoking rates in 1991 see JAMA 269: 1931.
Italy has relaxed its law on drugs, abolishing a law that imposed penalties on personal drug use; BMJ 306: 1289. Italy has more than 300,000 people registered as drug dependent, the most serious drug problem in Europe. Drug use in ancient populations are discussed in Lancet 341: 503, 1157. On methadone therapy see JAMA 269: 1995-6. Alcohol drinking appears to increase bone mineral density; BMJ 306: 1506-9.
The US Congress has approved more funding of research on the health effects of EMF ; Science 260: 1579; see also Science 260: 13-6; EST 27: 1018-20. Comments on nuclear radiation damage to health and genes are in BMJ 306: 1153-8; 1412; Science 260: 283.
Health effects and avoiding pesticide use are discussed in Science 260: 1409-10. A strong association between DDT and breast cancer is suggested in J. National Cancer Institute 85: 598-99, 648-2; Lancet 341: 1407. There is an urgent need for more research on the effects of organochlorine pesticides.
The failure of any victim of the Bhopal disaster to receive compensation yet is reported in Lancet 341: 1205-6. Germany is establishing cancer registries to make use of the bleak conditions caused by pollution in the Eastern part of the country. Increasing incidence of cancer can be measured by good data, as is discussed in Lancet 341: 1409-10. On air pollution see JAMA 269: 2493, 2721. A study of hip fracture rates suggests that fluoridation of water does not affect the incidence, AJPH 83: 743-5.
A survey in the USA suggests that health habits are getting worse after a general improvement in past years, JAMA 269: 2061-2. The benefits of vegetables and fruit in reducing cancer are reported from a large survey in Iowa, USA, in Cancer Research 53: 536-43. A Japanese study has shown that alpha-carotene reduces cancer in mice. The soyabean product, tofu, appears to help prevent cancer; US News & World Report (31 May 1993), 77. In Japan many people consume tofu and other soyabean products, they are some of the cheapest foods. Most of the control of enzymes that detoxify carcinogens has been localised at the molecular level to a 41bp enhancer sequence, PNAS 90: 2965-9. On cytotoxicity testing methods see Nature 363: 189-90.
The use of antioxidants such as vitamin E to reduce heart disease are shown in M.J. Stampfer et al., "Vitamin E consumption and risk of coronary heart disease in women", NEJM 328: 1444-9, "..in men", p. 1450-6, and p.1487-9; Newsweek (31 May 1993), 55; Time (31 May 1993), 33. A general comment on vitamins is in Newsweek (7 June 1993), 32-9. Effects of genes and environment are both involved in lipid levels, D.A. Heller et al., "Genetic and environmental influences on serum lipid levels in twins", NEJM 328: 1150-6. The need for exercise to reduce blood pressure has been studied in various research and shown to be effective; Lancet 341: 1248-9; but such studies may be methodologically difficult, NEJM 328: 1494-6. A survey of heart disease within Japan shows that Okinawa has the lowest incidence, Lancet 341: 1185. Current cholesterol-lowering drugs are said to have little effect on mortality; BMJ 306: 1367-73. Maybe food intake is a better solution! An editorial asking whether epidemiologists cause epidemics is in Lancet 341: 993-4.
The links between occupation and lung disease are explored further in papers on asbestos and lung cancer, Br. J. Industrial Medicine 50: 481-4; BMJ 306: 1503-6; and on radon and cancer, showing that only lung cancer is at increased risk in uranium miners, Lancet 341: 919-23. A study in New York shows that many yound people are injured at work, JAMA 269: 2754-9. A study in the UK shows that mental health problems at work cause 30 times as many lost days as industrial disputes; BMJ 306: 1082-3. On chronic fatigue syndrome see BMJ 306: 1557-8.
A report on a BMA report calling for a ban on boxing is in BMJ 306: 1561-2. The esae of buying guns in the USA is criticised in an editorial titled "As easy as buying a toothbrush", Lancet 341: 1375-6. A study of air bags in cars found that they may save about 18% more lives compared to seat belts in accidents; AJPH 83: 661-6. The use of bicycle helmet laws is discussed in AJPH 83: 644-6, 667-74, 728-30, together with surveys of use. A call for mandatory use in the USA is made, note that in some places in New Zealand and Australia they are already compulsory.
On antibiotic prescribing see Lancet 341: 1208. The drug industry in Canada is becoming more closely connected to the MRC; Lancet 341: 1402; Nature 362: 780. On drug promotion and safety see Lancet 341: 1507-8. The EC is trying to control drug prices; BMJ 306: 1501. Spain has issued a new list of drugs that are covered by national health, Lancet 341: 1083.
The drug Halcion is being reintroduced to Britain in smaller doses following a review of its saftey; BMJ 306: 1085. Anabolic steriods have a bad affect on the behaviour of people; JAMA 269: 2760-4. Comments on drugs to increase mind and memory are in NS (17 April 1993), 20-6. On Lyme disease see JAMA 269: 2724, 6; and on aspirin and Reye's syndrome, Lancet 341: 968.

A letter on the ancient use of cannabis is Nature 364: 680. There are growing calls for greater legalised use of marijuana for medical purposes in the USA, at present about 9 people only are legalised to use it. On the drug legalisation debate, SA (July 1993), 18-9. Letters on race and crack cocaine are JAMA 270: 45-8. On drug addiction, Lancet 342: 297; Science 260: 1814-6; Newsweek (23 Aug 1993), 53. In Zurich the government will control daily distribution of methadone to about 700 drug addicts.
International harmonization of drug approvals is still being attempted, JAMA 270: 302. Prescribing rights in Australasia are discussed in New Ethicals (July 1993), 9-16. On pharmaceutical policy and advertisements, see three papers in Int. J. Health Sciences 23: 147-84; Biotechnology 11: 839-40. Upjohn may fight a ban on the sleeping pill, trizolam, BMJ 306: 1633; Lancet 341: 1587. A study of Dutch prescribing of benzodiazepines found that more were given to women patients, probably due to sexism, BMJ 307: 363-6.
Chronic, but not acute, alcohol abuse has a bad effect on the outcome from trauma (accidents etc.), JAMA 270: 51-6, 93-4. Alcohol also has a continuing role in boating accidents, JAMA 270: 91-2. A survey by the Univ. of Auckland in New Zealand found 86% of people supported health warnings being shown on television adverts of alcohol, with 7% opposed; Dominion (17 Aug 1993), 5.
In the UK two hospitals offering cardiac bypass surgery have policies not to treat smokers who do not require nonurgent surgery. In April one of the patients who was turned away, gave up smoking and was later put on the waiting list, but he recently died, causing the issue to become more contentious. The hospitals are also reluctant to treat very fat people with very bad heart disease. No New Zealand hospitals have this policy, but smokers tend to be more likely to be refused. In NZ there is much debate about relocating funds from Dunedin to Christchurch (the countries second largest city) to set up a heart unit. At the moment patients have to travel 400km to Dunedin, where the undergraduate medical school is. Canadian doctors are involved in a continuing campaign to stop pharmacists from selling cigarettes, where 22% of the total sales of tobacco are from; CMAJ 148: 2030.
A review of employee exposure to smoking in restaurants, finding the smoke a health hazard, is JAMA 270: 490-3. In Thai-land Buddhist monks are helping efforts to stop smoking, BMJ 307: 282. In China children are being used to try to stop smoking, Science 260: 1718; JAMA 269: 2972. The law banning smoking in Californian restaurants is discussed in Lancet 342: 231. There is already a ban in Los Angeles; BMJ 307: 9; and in a US Navy aircraft carrier, JAMA 269: 2960. On industry and advertisement bans, JAMA 270: 321-3, 479-86, 806. The nicotine content of vegetables is presented in NEJM 329: 437. Also on smoking hazards, BMJ 307: 326-7; SSM 37: 571-2. Air pollution kills people at levels below the current legal limits, JAMA 269: 3087-8.
Large intakes of vitamin C or E did not protect women from breast cancer but a low intake of vitamin A was found to be associated with increased risk of breast cancer; NEJM 329: 234-40. On preventive medicine, JAMA 270: 251-2, 319-20; NEJM 329: 352-4. On behaviour and health, JAMA 270: 798-9; NEJM 328: 1852-3; BMJ 306: 1657-60; FDA Consumer (Jul/Aug 1993), 30-3. On diet and health, Lancet 342: 104; AJPH 83: 944-5. A comparison of black and white men and women over 30 years in South Carolina, USA has found that the risk factors and incidence of coronary disease are basically the same; NEJM 329: 73-8.
On the general issues of risk analysis see a review in SA (July 1993), 24-30; also book reviews in Nature 364: 587; Science 261: 407. The US is cutting the use of pesticides , BMJ 307: 282-3; JAMA 270: 802-3; Science 260: 1409-10; EST 27: 1466-7. The risks of pesticides in Sudan and data are in Bulletin of WHO 71: 317-21. The effects of Agent Orange in soldiers from Vietnam are being reassessed, Science 261: 679; BMJ 307: 403; Nature 364: 373, but the evidence is difficult to analyse. Lead poisoning due to ethnic remedies in California is reviewed in JAMA 270: 808. Lead levels in children in the USA are falling, JAMA 270: 69-71, 827-30. On the risks of chlorine, Science 261: 152-4.
On nuclear radiation dangers: JAMA 270: 647-9; BMJ 307: 7, 444-5; Lancet 342: 47. A meeting report on the breast implant controversy is in CMAJ 148: 1801-2.
Child car seats will become compulsory in New Zealand by 1 April, 1994. The current usage for children under 7 years is about 70-80%. There are rental schemes from Plunkett, to save costs. On helmet use in cycles, JAMA 269: 2967.
Suicide and psychology is discussed in BMJ 306: 1626-7, 1637-41; 307: 188-90. International correlations between gun ownership and homicide and suicide rates are reported in CMAJ 148: 1721-5. Also on gun laws, Lancet 342: 111-2, 108.
Compensation of occupational diseases raises ethical issues, CMAJ 148: 1903-5.

The US is expected to drop the "Delaney clause" (that zero-risk is required for cancer-causing substances in food, or pesticides ). It is an expensive ideal, and more health benefits could be seen by other changes and health monitoring, Nature 365: 381; Biotechnology 11: 1105-6. Also on pesticide risk assessment, EST 27: 1719-28, 1742-4; Science 261: 814-5, 1509, 1614. A report on the Seveso, Italy, case of dioxin exposure suggests cancer cases were related to the accident, Science 261: 1383; see also SA (Sept 1993), 15-6. Human exposure studies under different environmental conditions are reported in EST 27: 1733-5. A federal court in new Jersey recently ordered a company to withdraw millions of tablets and products following a FDA decision. This strengthens the regulatory power of the FDA, FDA Consumer (Sept 1993), 40. General comments on public health medicine are in AJPH 83: 1205-7.
In the USA it has been calculated that there were 434,000 deaths attributable to smoking (premature), and a breakdown by disease is in JAMA 270: 1408-10. Changes in the gene pools related to the observation that Alzheimer's is less in smokers than non-smokers are proposed in Lancet 342: 793-4. A special issue of AJPH (Sept 1993) includes many papers on health effects and smoking. India is predicting a surge in the number of diseases caused by smoking, BMJ 307: 702. Also on smoking see SSM 37: 571-4; BMJ 307: 518-9, 573. Low tar cigarettes have been found to be as dangerous as the normal ones, JAMA 270: 1399.
A study looking at the effects of EMFs on cows is reported in SA (Sept 1993), 111. A study that also does not find any association between EMFs and biological factors is J.M. Lee et al., "Melatonin secretion and puberty in female lambs exposed to environmental electric and magnetic fields", Biology of Reproduction 49: 857-64. In the UK a court case for a childhood cancer case, supposedly linked to EMF, is being planned, BMJ 307: 583. A Danish study concluding that there is a very small, if any, cancer risk from EMF is in BMJ 307: 891-5, 884-5.
A study finding that retinoblastoma is 20 times more common in children whose mothers have lived in Seascale, UK (near Sellafield nuclear reprocessing plant) is discussed in BMJ 307: 461-2. A review of an EPA study on radon is in Science 261: 1514-5. A brief report of child leukemia since Chernobyl finding no increased incidence so far is Nature 365: 702. In Japan a new facility using radioactive ions to treat cancer is reviewed in Science 261: 1270.
On silicone breast implants and a court case in the USA, BMJ 307: 582. A survey of anabolic steriod use in the USA is in JAMA 270: 1217-21; and of alcohol-related hospital admissions for elderly people in the USA, JAMA 270: 1222-5. The morphine receptor has been cloned, with should allow further design of better analgesics, JAMA 270: 1165-6. Medical uses of marijuana are discussed following the identification of a new class of receptors that are not present in the brain, Nature 365: 12. because they are not in the brain, there would be no concern about psychological drug abuse.
A review is B.N. Ames, " Oxidants , antioxidants, and the degenerative diseases of aging", PNAS 90: 7915-22. They conclude since only 9% of Americans eat the recommended amount of vegetables and fruits, the capacity to increase health by diet is enormous. Very low calorie diets are reviewed in JAMA 270: 967-74. They are found generally safe, but no better in long term weight control than some other control methods. A paper on the health effects of overeating in China is in SSM 37: 761-70; and on the important social and economic consequences of overweight in adolescence see a study in NEJM 329: 1008-12. Trends in intestinal cancer in Japan are in Lancet 342: 752. In a sample of poor children in Paris one tenth were found to be suffering from lead poisoning; BMJ 307: 523.

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