1356
of work have gone into solutions to these technical difficulties in the WHO programme so that now only occasional human errors or failure to use available technology cause such delays. The comment was also made that the "scheme was not under EC control". This programme like any other WHO activity is subject to scrutiny and control by any member state at each annual World Health Assembly. The EC countries (apart from Luxembourg) are programme members and can also make their claims on its operation at annual meetings of the 36 countries belonging to the programme. As far as we are aware the EC does not wish to emulate existing international systems, but if the WHO ADR database were to be replicated for the EC countries, the confusions created by tracking report duplications internationally would be exacerbated and inevitably a further delay in gathering international ADR data would occur. Finally, a little discussed way to make major progress in drug safety is facilities for rapid pharmacoepidemiological studies. The developments of databases such as VAMP in England and MEMO in Scotland should be encouraged elsewhere in Europe. Such databases can only operate properly if the current proposals by the Council of Europe and the EC on data protection are reconsidered with this in mind. Then perhaps our many signals could be analysed further and rapidly with respect to their importance for regulatory action. WHO Collaborating Centre for International Drug Monitoring, Box 26, S-751 03 Uppsala, Sweden
I. R. EDWARDS, Medical Director
Antismoking adverts and sports sponsorship SIR,- Your report (Oct 24, p 1027) about the Australian Cricket (ACB) fining a test cricketer 25% of his contract fee for
Board
participating in a public service antismoking advertisement reflects the anger raised worldwide by such action. The ACB deserves criticism, especially in view of its stated defence that it needed to protect the interests of its sponsors. A major issue is the role of the ACB not only in sports but also in society. In the USA, most professional athletes recognise that they wield powerful influence over an adulating population of young people. Some athletes have far exceeded expectations; quarterback Warren Moon, for example, formed the now very successful Crescent Moon Foundation. By contrast, the sence of social responsibility has only partly carried over to the governing organisations. Televised games of the National Football League are liberally sprinkled with players requesting support for the United Way, an umbrella group that distributes funds to non-profit groups. On the other hand, broadcasts of major league baseball games are punctuated with shots of players catapulting spitballs produced from great wads of chewing tobacco wedged into their mouths. The effect of such behaviour is that youngsters now believe that the act of chewing tobacco is synonymous with future careers in the major leagues. The actions of the ACB clearly demonstrate that this organisation senses no pangs of social irresponsibility. If the ACB is to side with a financial bedfellow rather than take an ethical highground, then the Australian public can certainly apply the same rules to cricket. Smoking-related disease incurs a huge cost to society and to government. The taxpayer, then, has every right to demand full withdrawal of any and all governmental support of cricket, including discontinuation of broadcasts on the Australian Broadcasting Commission, discontinuation of unreimbursed police presence at major matches, and the charging of appropriate ground maintenance fees at municipal ovals. Department of Pediatrics, Baylor College of Medicine,
STEPHEN J. ELLIOTT
Houston, Texas 77030, USA
Methods for increased SIR,—Professor John
and
poliovirus diagnosis
colleagues (Oct 17, p 975) report a antibody-bound poliovirus in stool specimens. They investigated 16 children with acute flaccid paralysis and exposed samples to the acid glycine buffer, pH 2-4, at room temperature for 3 h. Antibody-bound poliovirus type 1 was method
to
detect
dissociated in 6 samples. The enhanced sensitivity of the dissociation procedure would be proven by demonstration of poliovirus antibody as well as viral RNA genomes. IgM or IgA class antibodies should also be searched for in these 6 samples. This could be done by affniity immunoblotting or agarose electrophoresis, as was attempted in cerebrospinal fluid from 36 patients with post-poliomyelitis syndrome.’ Oligoclonal IgM bands specific to poliovirus were detected in 21 of these patients but in none of the controls. Furthermore, abnormally high values of IgM were detectable in 17 patients.’ To demonstrate poliovirus RNA, stool samples could be examined by polymerase chain reaction with poliovirus-specific primers,2 or by an in-situ transcription with pan-enteroviral and individual poliovirus-specific primer to capture poliovirus RNA.3 An appropriate modification of the easy-to-use 96-well, microtitreplate protocol that involves immobilisation of oligonucleotides for mRNA4 is essential for the development of a much needed practical procedure for the detection of poliovirus in areas without facilities for tissue culture. Developing countries would need simplified, one or two step procedures that did not depend on tissue culture for screening polioviruses in stool or other clinical specimens and to measure antibody concentrations. Immobilised oligonucleotide technology requires active support and innovative action. Centre for Logistical Research and Innovation, M-122 (part Greater Kailash-II, New Delhi 110048, India
2),
SUBHASH C. ARYA
1. Sharief MK,
Hentges R, Ciardi M. Intrathecal immune response in patients with the post-polio syndrome. N Engl J Med 1991; 325: 749-55. 2. Yang C-F de L, Holloway BP, Pallansch MA, Kew OM. Detection and identification of vaccine-related polioviruses by the polymerase chain reaction. Virus Res 1991; 20: 159-79. 3. Carstens JM, Tracy S, Chapman NM, Gauntt CJ. Detection of enteroviruses in cell cultures using in situ transcription. J Clin Microbiol 1992; 30: 25-35. 4. Mitsuhashi M, Keller C, Akitaya T. Gene manipulation in plastic plates. Nature 1992; 357: 519-20.
Increase in
birthweight in undernourished women
SIR,-Dr Garner and colleagues (Oct 24, p 1021) consider in communities in which there is chronic malnutrition. High-energy (1950 kj per day) supplementation of mothers’ diet in the last trimester of pregnancy produces babies that remain significantly heavier until 24 months of age and taller until 60 months of age compared with the children of mothers who receive a supplementation of only 218 kj per day.’ Significant weight gain is, however, only seen during the first six months of postnatal life and height gain only in the third postnatal month. Mortality rate is not affected by supplementation, so would the effort of implementing this on a wide scale be worth while? Without there being radical changes in the way societies assess priorities in maternal health and nutrition, such a programme is not sustainable. Gamer et al examine the increased risk of obstructed labour in small women having bigger babies, but this risk is unlikely to contribute significantly to mortality and morbidity rates with the small increases in birthweight recorded in another study.’ Prevention of maternal anaemia, malaria, and malnutrition will inevitably result in increased birthweight, and the beneficial effect on maternal morbidity and mortality of preventing these problems will far outweigh the increased risk of obstructed labour with bigger babies. Babies who are symmetrically growth retarded for gestational age perform poorly in developmental tests, and intellectual ability at school is impaired, compared with normal-birthweight babies or those with low birthweight but normal length and head circumference.2,3 They tend to show poor somatic growth, particularly in head circumference. This group of babies have had chronic intrauterine insults—eg, maternal malnutrition, maternal malaria, maternal smoking, maternal alcohol. 67% of lowbirthweight babies were in this group of symmetrical growth retardation in rural South Africa,4compared with 20% in the UK.3 .3 The impaired development that these children face is analogous to
increasing birthweight
maternal
of work have gone into solutions to these technical difficulties in the WHO programme so that now only occasional human errors or failure to use available technology cause such delays. The comment was also made that the "scheme was not under EC control". This programme like any other WHO activity is subject to scrutiny and control by any member state at each annual World Health Assembly. The EC countries (apart from Luxembourg) are programme members and can also make their claims on its operation at annual meetings of the 36 countries belonging to the programme. As far as we are aware the EC does not wish to emulate existing international systems, but if the WHO ADR database were to be replicated for the EC countries, the confusions created by tracking report duplications internationally would be exacerbated and inevitably a further delay in gathering international ADR data would occur. Finally, a little discussed way to make major progress in drug safety is facilities for rapid pharmacoepidemiological studies. The developments of databases such as VAMP in England and MEMO in Scotland should be encouraged elsewhere in Europe. Such databases can only operate properly if the current proposals by the Council of Europe and the EC on data protection are reconsidered with this in mind. Then perhaps our many signals could be analysed further and rapidly with respect to their importance for regulatory action. WHO Collaborating Centre for International Drug Monitoring, Box 26, S-751 03 Uppsala, Sweden
I. R. EDWARDS, Medical Director
Antismoking adverts and sports sponsorship SIR,- Your report (Oct 24, p 1027) about the Australian Cricket (ACB) fining a test cricketer 25% of his contract fee for
Board
participating in a public service antismoking advertisement reflects the anger raised worldwide by such action. The ACB deserves criticism, especially in view of its stated defence that it needed to protect the interests of its sponsors. A major issue is the role of the ACB not only in sports but also in society. In the USA, most professional athletes recognise that they wield powerful influence over an adulating population of young people. Some athletes have far exceeded expectations; quarterback Warren Moon, for example, formed the now very successful Crescent Moon Foundation. By contrast, the sence of social responsibility has only partly carried over to the governing organisations. Televised games of the National Football League are liberally sprinkled with players requesting support for the United Way, an umbrella group that distributes funds to non-profit groups. On the other hand, broadcasts of major league baseball games are punctuated with shots of players catapulting spitballs produced from great wads of chewing tobacco wedged into their mouths. The effect of such behaviour is that youngsters now believe that the act of chewing tobacco is synonymous with future careers in the major leagues. The actions of the ACB clearly demonstrate that this organisation senses no pangs of social irresponsibility. If the ACB is to side with a financial bedfellow rather than take an ethical highground, then the Australian public can certainly apply the same rules to cricket. Smoking-related disease incurs a huge cost to society and to government. The taxpayer, then, has every right to demand full withdrawal of any and all governmental support of cricket, including discontinuation of broadcasts on the Australian Broadcasting Commission, discontinuation of unreimbursed police presence at major matches, and the charging of appropriate ground maintenance fees at municipal ovals. Department of Pediatrics, Baylor College of Medicine,
STEPHEN J. ELLIOTT
Houston, Texas 77030, USA
Methods for increased SIR,—Professor John
and
poliovirus diagnosis
colleagues (Oct 17, p 975) report a antibody-bound poliovirus in stool specimens. They investigated 16 children with acute flaccid paralysis and exposed samples to the acid glycine buffer, pH 2-4, at room temperature for 3 h. Antibody-bound poliovirus type 1 was method
to
detect
dissociated in 6 samples. The enhanced sensitivity of the dissociation procedure would be proven by demonstration of poliovirus antibody as well as viral RNA genomes. IgM or IgA class antibodies should also be searched for in these 6 samples. This could be done by affniity immunoblotting or agarose electrophoresis, as was attempted in cerebrospinal fluid from 36 patients with post-poliomyelitis syndrome.’ Oligoclonal IgM bands specific to poliovirus were detected in 21 of these patients but in none of the controls. Furthermore, abnormally high values of IgM were detectable in 17 patients.’ To demonstrate poliovirus RNA, stool samples could be examined by polymerase chain reaction with poliovirus-specific primers,2 or by an in-situ transcription with pan-enteroviral and individual poliovirus-specific primer to capture poliovirus RNA.3 An appropriate modification of the easy-to-use 96-well, microtitreplate protocol that involves immobilisation of oligonucleotides for mRNA4 is essential for the development of a much needed practical procedure for the detection of poliovirus in areas without facilities for tissue culture. Developing countries would need simplified, one or two step procedures that did not depend on tissue culture for screening polioviruses in stool or other clinical specimens and to measure antibody concentrations. Immobilised oligonucleotide technology requires active support and innovative action. Centre for Logistical Research and Innovation, M-122 (part Greater Kailash-II, New Delhi 110048, India
2),
SUBHASH C. ARYA
1. Sharief MK,
Hentges R, Ciardi M. Intrathecal immune response in patients with the post-polio syndrome. N Engl J Med 1991; 325: 749-55. 2. Yang C-F de L, Holloway BP, Pallansch MA, Kew OM. Detection and identification of vaccine-related polioviruses by the polymerase chain reaction. Virus Res 1991; 20: 159-79. 3. Carstens JM, Tracy S, Chapman NM, Gauntt CJ. Detection of enteroviruses in cell cultures using in situ transcription. J Clin Microbiol 1992; 30: 25-35. 4. Mitsuhashi M, Keller C, Akitaya T. Gene manipulation in plastic plates. Nature 1992; 357: 519-20.
Increase in
birthweight in undernourished women
SIR,-Dr Garner and colleagues (Oct 24, p 1021) consider in communities in which there is chronic malnutrition. High-energy (1950 kj per day) supplementation of mothers’ diet in the last trimester of pregnancy produces babies that remain significantly heavier until 24 months of age and taller until 60 months of age compared with the children of mothers who receive a supplementation of only 218 kj per day.’ Significant weight gain is, however, only seen during the first six months of postnatal life and height gain only in the third postnatal month. Mortality rate is not affected by supplementation, so would the effort of implementing this on a wide scale be worth while? Without there being radical changes in the way societies assess priorities in maternal health and nutrition, such a programme is not sustainable. Gamer et al examine the increased risk of obstructed labour in small women having bigger babies, but this risk is unlikely to contribute significantly to mortality and morbidity rates with the small increases in birthweight recorded in another study.’ Prevention of maternal anaemia, malaria, and malnutrition will inevitably result in increased birthweight, and the beneficial effect on maternal morbidity and mortality of preventing these problems will far outweigh the increased risk of obstructed labour with bigger babies. Babies who are symmetrically growth retarded for gestational age perform poorly in developmental tests, and intellectual ability at school is impaired, compared with normal-birthweight babies or those with low birthweight but normal length and head circumference.2,3 They tend to show poor somatic growth, particularly in head circumference. This group of babies have had chronic intrauterine insults—eg, maternal malnutrition, maternal malaria, maternal smoking, maternal alcohol. 67% of lowbirthweight babies were in this group of symmetrical growth retardation in rural South Africa,4compared with 20% in the UK.3 .3 The impaired development that these children face is analogous to
increasing birthweight
maternal
