447
significant difference between the groups in their exposure to some of the minor stresses, and the patients seemed to have crossed green lines more frequently. Such a small study, with patients included in a way that must have been highly selective, is unlikely to provide convincing evidence for the effect of stress on coronary disease, but the Lebanese researchers do give a clear definition of stress. Whether war stress is the same as psychosocial factors or whether it is comparable to the stress of having a type A personality is uncertain. The possible relation between stress and coronary disease has been argued since the time of0sler/" who seems to have been the first to have considered stress to be the cause of coronary disease. Investigators, however, have found no way of coping with the fact that one man’s stress is another man’s stimulus. 1. Marmot MG. Look after your heart: stress and cardiovascular disease—a
studiable case? Health Trends 1987; 19: 21-24. F, Kornitzer M, Dramaix M. Evaluation of type A personality. Postgrad Med J 1986; 62: 781-83. 3. Kannel WB, Eaker ED. Psychosocial and other features of coronary heart disease: insights from the Framingham study. Am Heart J 1986; 5: 1066-73. 4. Marmot MG, Shipley MJ, Rose G. Inequalities in death-specific explanations of a general pattern? Lancet 1984; i: 1003-06. 5. Moser KA, Fox AJ, Jones DR. Unemployment and mortality in the OPCS Longitudinal Study. Lancet 1984; ii: 1324-29. 6. Alfredsson L, Karasek R, Theorell T. Myocardial infarction risk and psycho-social work environment-an analysis of male Swedish working force. Soc Sci Med 1982; 16: 463-67. 7. Bianchi G, Fergusson D, Walshe J. Psychiatric antecedents of myocardial infarction. Med J Aust 1978; i: 297-301. 8. Sibai AM, Armenian HK, Alam S. Wartime determinants of arteriographically confirmed coronary artery disease in Beirut. Am J Epidemiol 1989; 130: 623-31. 9. Holmes DR, Elveback LR, Frye RL, Kottke BA, Elleeson RD. Association of risk factor variable and coronary artery disease documented with angiography. Circulation 1981; 3: 293-95. 10. Osler W. The Lumleian lectures on angina pectoris. Lancet 1910; i: 697, 2. Kittel
839-44, 973.
(eating
local
shellfish, for example) while others, such
as
maternal exposure to X rays and maternal age, are not. The relative risks with 95% confidence intervals exceeding unity number 17, 12 of which refer, with considerable interdependence, to work at and occupational radiation in the Sellafield facility. It is this aspect that captured the headlines in the newspapers of Feb 16. We are indeed back with the handful of leukaemia cases. "... we know", say Gardner et al "that three of the five Seascale [a village close to Sellafield] cases had fathers whose accumulated preconceptual radiation dose was in the group with an estimated sixfold to eightfold relative risk of leukaemia and the father of the fourth was in the group just below the cut off value used". These five cases (and no others) lived 4 km or less from Sellafield. The total paternal radiation doses, from film badges, do not take into account internal contamination; they were, for the above four cases, 97, 102, 162, and 188 mSv over 6-13 years. Gardner et al, without further discussion, dismiss as a "hypothesis" (it was a stage on from that) the study on unbuilt nuclear power stations.4 Japanese A-bomb data conflict with their finding, the children of fathers exposed, to a single high dose, in 1945 do not seem to have been at risk of leukaemia.6 A radiobiological explanation for the latest Sellafield data, especially in the absence of data on internal contamination, remains elusive. If total doses of 100 mSv or so do really damage the paternal germ cell line to increase the chance of childhood leukaemia/lymphoma there would be enormous implications not just for occupational annual dose limits, already being cut from 50 to 15 mSv, but also for how we look at natural radiation and at leukaemogenesis in general. 1. 2. 3. 4.
Independent Advisory Group (chairman Sir Douglas Black). London: H M Stationery Office, 1984. Committee on Medical Aspects of Radiation in the Environment. Second and third reports. London: H M Stationery Office, 1988 and 1989. Smith PG, Douglas AJ, Mortality of workers at the Sellafield plant of British Nuclear Fuels. Br Med J 1986; 293: 845-54. Cook-Mozaffari P, Darby S, Doll R. Cancer near potential sites of nuclear
installations. Lancet 1989; ii: 1145-47. MJ, Snee MP, Hall AJ, Powell CA, Downes S, Terrell JD. Results of case-control study of leukaemia and lymphoma among young people near Sellafield nuclear plant in West Cumbria. Br Med J 1990; 300: 423-29. 6. Ishimura T, Ichimaru M, Mihami M. Leukaemia incidence among individuals exposed in vitro, children of atomic bomb survivors and their controls, Hiroshima and nagasaki, 1945-1979 (RERF Tech Rep 11-81). Hiroshima: Radiation Effects Research Foundation, 1981. 5. Gardner
CHILDHOOD LEUKAEMIA, RADIATION, AND THE PATERNAL GERM CELL A handful of leukaemias and lymphomas in young people living on the coastal strip west of the English Lake Disrict has generated much puzzlement. In the 5 zyears since an official inquiry1 showed that there was indeed an increase in risk near the Sellafield nuclear facility in West Cumbria the perplexity has, if anything, increased. Straightforward exposure to radiation became even less likely with the realisation that the risk was associated with nuclear facilities in Britain which have had cleaner environment records than Sellafield, the oldest.2 We also learned that workers at Sellafield, whose exposure would surely be greater than that of their families, were not at increased risk of haematological malignancy.3 Then it emerged that mortality from leukaemia was unusually high around phantom nuclear power stations-ones never built or built later. In last week’s BM_7 Prof M. J. Gardner and his colleagues return to the Black inquiry-rather to one of its proposals, for a case-control study based on the Sellafield plant.s In a very thorough investigation Gardner et al tabulate no fewer than 150 relative risks with their 95 % confidence intervals. These cover possible risk factors that could be relevant to leukaemia under the age of 25 ; some are relevant to Sellafield
MODERN VACCINES: CURRENT PRACTICE AND NEW APPROACHES "Thank you, doctor, for sparing my child the miseries of measles, whooping cough, mumps, polio, and diphtheria". Such words are seldom heard; but gratitude is not the best index of good medicine. For all its lack of glamour, vaccination offers more for human life and health than any other medical activity, and the scope for further achievements is vast. With the guidance of Prof Richard Moxon The Lancet has commissioned seventeen articles from around the world on the fundamentals of immunisation, the new technologies, the areas of controversy in practice, and the best hopes for the future. Immunoprophylaxis is ready for a forward surge. On the next page Professor Moxon sets the scene.
significant difference between the groups in their exposure to some of the minor stresses, and the patients seemed to have crossed green lines more frequently. Such a small study, with patients included in a way that must have been highly selective, is unlikely to provide convincing evidence for the effect of stress on coronary disease, but the Lebanese researchers do give a clear definition of stress. Whether war stress is the same as psychosocial factors or whether it is comparable to the stress of having a type A personality is uncertain. The possible relation between stress and coronary disease has been argued since the time of0sler/" who seems to have been the first to have considered stress to be the cause of coronary disease. Investigators, however, have found no way of coping with the fact that one man’s stress is another man’s stimulus. 1. Marmot MG. Look after your heart: stress and cardiovascular disease—a
studiable case? Health Trends 1987; 19: 21-24. F, Kornitzer M, Dramaix M. Evaluation of type A personality. Postgrad Med J 1986; 62: 781-83. 3. Kannel WB, Eaker ED. Psychosocial and other features of coronary heart disease: insights from the Framingham study. Am Heart J 1986; 5: 1066-73. 4. Marmot MG, Shipley MJ, Rose G. Inequalities in death-specific explanations of a general pattern? Lancet 1984; i: 1003-06. 5. Moser KA, Fox AJ, Jones DR. Unemployment and mortality in the OPCS Longitudinal Study. Lancet 1984; ii: 1324-29. 6. Alfredsson L, Karasek R, Theorell T. Myocardial infarction risk and psycho-social work environment-an analysis of male Swedish working force. Soc Sci Med 1982; 16: 463-67. 7. Bianchi G, Fergusson D, Walshe J. Psychiatric antecedents of myocardial infarction. Med J Aust 1978; i: 297-301. 8. Sibai AM, Armenian HK, Alam S. Wartime determinants of arteriographically confirmed coronary artery disease in Beirut. Am J Epidemiol 1989; 130: 623-31. 9. Holmes DR, Elveback LR, Frye RL, Kottke BA, Elleeson RD. Association of risk factor variable and coronary artery disease documented with angiography. Circulation 1981; 3: 293-95. 10. Osler W. The Lumleian lectures on angina pectoris. Lancet 1910; i: 697, 2. Kittel
839-44, 973.
(eating
local
shellfish, for example) while others, such
as
maternal exposure to X rays and maternal age, are not. The relative risks with 95% confidence intervals exceeding unity number 17, 12 of which refer, with considerable interdependence, to work at and occupational radiation in the Sellafield facility. It is this aspect that captured the headlines in the newspapers of Feb 16. We are indeed back with the handful of leukaemia cases. "... we know", say Gardner et al "that three of the five Seascale [a village close to Sellafield] cases had fathers whose accumulated preconceptual radiation dose was in the group with an estimated sixfold to eightfold relative risk of leukaemia and the father of the fourth was in the group just below the cut off value used". These five cases (and no others) lived 4 km or less from Sellafield. The total paternal radiation doses, from film badges, do not take into account internal contamination; they were, for the above four cases, 97, 102, 162, and 188 mSv over 6-13 years. Gardner et al, without further discussion, dismiss as a "hypothesis" (it was a stage on from that) the study on unbuilt nuclear power stations.4 Japanese A-bomb data conflict with their finding, the children of fathers exposed, to a single high dose, in 1945 do not seem to have been at risk of leukaemia.6 A radiobiological explanation for the latest Sellafield data, especially in the absence of data on internal contamination, remains elusive. If total doses of 100 mSv or so do really damage the paternal germ cell line to increase the chance of childhood leukaemia/lymphoma there would be enormous implications not just for occupational annual dose limits, already being cut from 50 to 15 mSv, but also for how we look at natural radiation and at leukaemogenesis in general. 1. 2. 3. 4.
Independent Advisory Group (chairman Sir Douglas Black). London: H M Stationery Office, 1984. Committee on Medical Aspects of Radiation in the Environment. Second and third reports. London: H M Stationery Office, 1988 and 1989. Smith PG, Douglas AJ, Mortality of workers at the Sellafield plant of British Nuclear Fuels. Br Med J 1986; 293: 845-54. Cook-Mozaffari P, Darby S, Doll R. Cancer near potential sites of nuclear
installations. Lancet 1989; ii: 1145-47. MJ, Snee MP, Hall AJ, Powell CA, Downes S, Terrell JD. Results of case-control study of leukaemia and lymphoma among young people near Sellafield nuclear plant in West Cumbria. Br Med J 1990; 300: 423-29. 6. Ishimura T, Ichimaru M, Mihami M. Leukaemia incidence among individuals exposed in vitro, children of atomic bomb survivors and their controls, Hiroshima and nagasaki, 1945-1979 (RERF Tech Rep 11-81). Hiroshima: Radiation Effects Research Foundation, 1981. 5. Gardner
CHILDHOOD LEUKAEMIA, RADIATION, AND THE PATERNAL GERM CELL A handful of leukaemias and lymphomas in young people living on the coastal strip west of the English Lake Disrict has generated much puzzlement. In the 5 zyears since an official inquiry1 showed that there was indeed an increase in risk near the Sellafield nuclear facility in West Cumbria the perplexity has, if anything, increased. Straightforward exposure to radiation became even less likely with the realisation that the risk was associated with nuclear facilities in Britain which have had cleaner environment records than Sellafield, the oldest.2 We also learned that workers at Sellafield, whose exposure would surely be greater than that of their families, were not at increased risk of haematological malignancy.3 Then it emerged that mortality from leukaemia was unusually high around phantom nuclear power stations-ones never built or built later. In last week’s BM_7 Prof M. J. Gardner and his colleagues return to the Black inquiry-rather to one of its proposals, for a case-control study based on the Sellafield plant.s In a very thorough investigation Gardner et al tabulate no fewer than 150 relative risks with their 95 % confidence intervals. These cover possible risk factors that could be relevant to leukaemia under the age of 25 ; some are relevant to Sellafield
MODERN VACCINES: CURRENT PRACTICE AND NEW APPROACHES "Thank you, doctor, for sparing my child the miseries of measles, whooping cough, mumps, polio, and diphtheria". Such words are seldom heard; but gratitude is not the best index of good medicine. For all its lack of glamour, vaccination offers more for human life and health than any other medical activity, and the scope for further achievements is vast. With the guidance of Prof Richard Moxon The Lancet has commissioned seventeen articles from around the world on the fundamentals of immunisation, the new technologies, the areas of controversy in practice, and the best hopes for the future. Immunoprophylaxis is ready for a forward surge. On the next page Professor Moxon sets the scene.
