938
King concentrate in the beams in preaching to sub-Saharan Africa? Centre for Heatlh Economics, University of York, York YO1 5DD, UK
his
own
backyard rather than
ROY A. CARR-HILL
Department of Community Health, Eduardo Mondlane University,
Mapulo
ANNA NUURA
Health Systems Research, WHO Sub-Regional Office, Harare, Zimbabwe
CORLEEN VARHERISSER
1. Teitelbaum M. Analysing the demographic transition. J Demogr Stud 32: 569-82. 2. Wisner B. Power and need. London: Earthscan, 1989. 3 Carr-Hill RA. Social conditions in Sub-Saharan Africa. London: Macmillan (in
press). 4. Editorial.
Ecologist 1990; 17: 6.
SiR,—Dr King, having made a perceptive diagnosis of impending ecological disaster, both local (due to poverty) and global (due to affluence), prescribes passive euthanasia of children in the developing world. That he lives in the affluent world may have something to do with his gentler prescription for its people-eg, giving up gas-guzzling motorcars and using public transport. Despite this, his article and the accompanying editorial highlight the most important issue facing humanity-namely, the interrelated problems of poverty and population growth. Neither can be solved in isolation. Population growth is easier to manage. Use of the retail market to distribute contraceptives, especially the much underused contraceptive pill, is far more likely to be fruitful than reliance on the incompetent, inefficient, and usually corrupt state apparatus. The contraceptive pill could be "spiked" with physiological doses of nutritional supplements, such as iron, without ill-effects. Voluntary sterilisation will be effective too, if a large enough financial reward is provided to make it attractive to the impoverished. The greatest threat
comes not
from industrialisation
or even
population but from poverty. Even the most cursory visit to the developing world will show the widespread destruction of the habitat brought upon it by the poor trying to obtain the most basic needs of life such as food and fuel-a direct consequence of primitive and wasteful technology. Technical and financial assistance and the introduction of innovative technology targeted at the poorest of the poor may enable such people to increase the productivity of land many-fold. The obsession with "green" issues should not deny such people access to modem technology, including irrigation projects, chemical fertilisers, and pesticides; barren land is never green. Even on a limited scale, such technology can be spectacularly successful, as shown by the green revolution. Most developing countries could increase food production simply by using irrigation and fertilisers. What holds them back is a lack of political leadership and democratic institutions at the grassroots. King himself identifies lack of political representation as an impediment to development. It is hardly likely that a people with a representative democracy conducive to the alleviation of poverty would promote passive infanticide as a means of population control. Such a policy would be counterproductive because even benign family-planning programmes would be sullied by association with such ideas and thus resisted by the very people who are the potential victims of genocide and the beneficiaries of population control. King should not prescribe medicines that he is unwilling to take himself. General Infirmary at Leeds, Leeds LS1 3EX, UK
1988 the flow was in the other direction: World Bank figures showed the poorer countries paid the richer L23 billion more than they received in new loans. This relationship between countries results in the 80 000 preventable childhood deaths every day and over 1 billion people living on less than c4 per week. The neo-malthusian argument is that the global balance has been upset and that the only way forward is to reduce population, by family planning preferably but if not by childhood mortality or starvauon. These arguments must be rejected. If the world’s arable land were cultivated as efficiently as Dutch farms, our planet could feed 67 billion people, over six times the projected world population m 2010. The problem is not population but resource distribution. 0-5% of world spending on arms invested in agriculture in Africa would produce enough food to feed the population of that continent. Yet the world’s "free market" keeps this money locked up in bombs and bullets and at the same time it ruthlessly cuts production in the fertile farmlands of the USA. The solutions lie outside medicine, in the sphere of politics, but doctors should not collude with politicians who deliberately impoverish the third world to make larger profits in the first. Chrisp Street Health Centre,
KAMBIZ BOOMLA
London E146PG, UK
SiR,—Dr King is right to draw our attention to population growth and the exhaustion of the resources of our planet. It is so tempting to ignore this basic truth and to attribute the ills of the world to dictators such as Saddam Hussein, rather than to see them as the result of economic pressures. Sadly this is an example of the motorway paradox, where the extra car coming onto a crowded road is still cheaper for its driver even though its effect on other drivers would make it economic to send him by helicopter. People will continue to bear large families as long as this benefits them personally. Child labour increases income and secures an income on retirement. The solution must be to alter the economics of life in the third world by banning child exploitation and by providing state pensions loaded against those with more than two children. Funds for this could come from the developed world. Such pensions could be related to the average income for the country as a whole and thus ensure the elderly a dignified end. I fear, however, that we are too shortsighted to see beyond the narrow horizons of our country and this century. Department of Geriatric Medicine, St George’s Hospital Medical School, London SW17 ORE, UK
Function of
J. M. KELLETT
cystic fibrosis gene product
SiR,—Your Sept 1 editorial discusses the genetic heterogeneity of cystic fibrosis (CF) at the molecular level as well as the (indirect; evidence1 that the gene probably does not code for an aberrent epithelial-membrane chloride channel that fails to respond to secretory stimuli in this disease. The uncertainty2 as to whether the faulty chloride channel is coded for by the CF gene is now resolved. This gene cannot code for this anion channel because of the finding that the homozygous non-sense mutation is phenotypically less severe than is the disease associated with point deletions (as in A F508). This would not be possible were the CF gene to code for the chloride channel itself since in this case the non-sense mutation (product absent) would have to give maximum dysfunction (greater than or equal to that associated with point deletions with altered product). The function of CFTR (the gene product) therefore remains to be elucidated.
J. P. SEBASTIAN Department of Human Anatomy, University of Oxford,
SiR,—So, neo-malthusianism raises its ugly head in this last decade of our century, with Dr King’s call for third-world children with diarrhoea to be left to die without the benefit of oral rehydration. Why is this inhumanity being proposed by a member of a supposedly liberal profession? Until 1984, bankers from the world’s richer countries were lending poorer countries more than they got back in interest. By
Oxford OX1 3QX, UK
C. A. R. BOYD
1 Hyde SC, Emsley P, Hartshom MJ, et al. Structural model of ATP-binding proteins associated with cystic fibrosis. Nature 1990; 346: 362-65 2 Welsh MJ. Abnormal regulation of ion channels m cystic fibrosis epithelia FASEB 1990; 4: 2718-25 3. Kerem B-S, Zielenski J, Markiewicz D, et al. Identification of mutations in regions corresponding to the two putative nucleotide (ATP) binding foldsof the cystic fibrosis gene Proc Natl Acad Sci USA (in press).
King concentrate in the beams in preaching to sub-Saharan Africa? Centre for Heatlh Economics, University of York, York YO1 5DD, UK
his
own
backyard rather than
ROY A. CARR-HILL
Department of Community Health, Eduardo Mondlane University,
Mapulo
ANNA NUURA
Health Systems Research, WHO Sub-Regional Office, Harare, Zimbabwe
CORLEEN VARHERISSER
1. Teitelbaum M. Analysing the demographic transition. J Demogr Stud 32: 569-82. 2. Wisner B. Power and need. London: Earthscan, 1989. 3 Carr-Hill RA. Social conditions in Sub-Saharan Africa. London: Macmillan (in
press). 4. Editorial.
Ecologist 1990; 17: 6.
SiR,—Dr King, having made a perceptive diagnosis of impending ecological disaster, both local (due to poverty) and global (due to affluence), prescribes passive euthanasia of children in the developing world. That he lives in the affluent world may have something to do with his gentler prescription for its people-eg, giving up gas-guzzling motorcars and using public transport. Despite this, his article and the accompanying editorial highlight the most important issue facing humanity-namely, the interrelated problems of poverty and population growth. Neither can be solved in isolation. Population growth is easier to manage. Use of the retail market to distribute contraceptives, especially the much underused contraceptive pill, is far more likely to be fruitful than reliance on the incompetent, inefficient, and usually corrupt state apparatus. The contraceptive pill could be "spiked" with physiological doses of nutritional supplements, such as iron, without ill-effects. Voluntary sterilisation will be effective too, if a large enough financial reward is provided to make it attractive to the impoverished. The greatest threat
comes not
from industrialisation
or even
population but from poverty. Even the most cursory visit to the developing world will show the widespread destruction of the habitat brought upon it by the poor trying to obtain the most basic needs of life such as food and fuel-a direct consequence of primitive and wasteful technology. Technical and financial assistance and the introduction of innovative technology targeted at the poorest of the poor may enable such people to increase the productivity of land many-fold. The obsession with "green" issues should not deny such people access to modem technology, including irrigation projects, chemical fertilisers, and pesticides; barren land is never green. Even on a limited scale, such technology can be spectacularly successful, as shown by the green revolution. Most developing countries could increase food production simply by using irrigation and fertilisers. What holds them back is a lack of political leadership and democratic institutions at the grassroots. King himself identifies lack of political representation as an impediment to development. It is hardly likely that a people with a representative democracy conducive to the alleviation of poverty would promote passive infanticide as a means of population control. Such a policy would be counterproductive because even benign family-planning programmes would be sullied by association with such ideas and thus resisted by the very people who are the potential victims of genocide and the beneficiaries of population control. King should not prescribe medicines that he is unwilling to take himself. General Infirmary at Leeds, Leeds LS1 3EX, UK
1988 the flow was in the other direction: World Bank figures showed the poorer countries paid the richer L23 billion more than they received in new loans. This relationship between countries results in the 80 000 preventable childhood deaths every day and over 1 billion people living on less than c4 per week. The neo-malthusian argument is that the global balance has been upset and that the only way forward is to reduce population, by family planning preferably but if not by childhood mortality or starvauon. These arguments must be rejected. If the world’s arable land were cultivated as efficiently as Dutch farms, our planet could feed 67 billion people, over six times the projected world population m 2010. The problem is not population but resource distribution. 0-5% of world spending on arms invested in agriculture in Africa would produce enough food to feed the population of that continent. Yet the world’s "free market" keeps this money locked up in bombs and bullets and at the same time it ruthlessly cuts production in the fertile farmlands of the USA. The solutions lie outside medicine, in the sphere of politics, but doctors should not collude with politicians who deliberately impoverish the third world to make larger profits in the first. Chrisp Street Health Centre,
KAMBIZ BOOMLA
London E146PG, UK
SiR,—Dr King is right to draw our attention to population growth and the exhaustion of the resources of our planet. It is so tempting to ignore this basic truth and to attribute the ills of the world to dictators such as Saddam Hussein, rather than to see them as the result of economic pressures. Sadly this is an example of the motorway paradox, where the extra car coming onto a crowded road is still cheaper for its driver even though its effect on other drivers would make it economic to send him by helicopter. People will continue to bear large families as long as this benefits them personally. Child labour increases income and secures an income on retirement. The solution must be to alter the economics of life in the third world by banning child exploitation and by providing state pensions loaded against those with more than two children. Funds for this could come from the developed world. Such pensions could be related to the average income for the country as a whole and thus ensure the elderly a dignified end. I fear, however, that we are too shortsighted to see beyond the narrow horizons of our country and this century. Department of Geriatric Medicine, St George’s Hospital Medical School, London SW17 ORE, UK
Function of
J. M. KELLETT
cystic fibrosis gene product
SiR,—Your Sept 1 editorial discusses the genetic heterogeneity of cystic fibrosis (CF) at the molecular level as well as the (indirect; evidence1 that the gene probably does not code for an aberrent epithelial-membrane chloride channel that fails to respond to secretory stimuli in this disease. The uncertainty2 as to whether the faulty chloride channel is coded for by the CF gene is now resolved. This gene cannot code for this anion channel because of the finding that the homozygous non-sense mutation is phenotypically less severe than is the disease associated with point deletions (as in A F508). This would not be possible were the CF gene to code for the chloride channel itself since in this case the non-sense mutation (product absent) would have to give maximum dysfunction (greater than or equal to that associated with point deletions with altered product). The function of CFTR (the gene product) therefore remains to be elucidated.
J. P. SEBASTIAN Department of Human Anatomy, University of Oxford,
SiR,—So, neo-malthusianism raises its ugly head in this last decade of our century, with Dr King’s call for third-world children with diarrhoea to be left to die without the benefit of oral rehydration. Why is this inhumanity being proposed by a member of a supposedly liberal profession? Until 1984, bankers from the world’s richer countries were lending poorer countries more than they got back in interest. By
Oxford OX1 3QX, UK
C. A. R. BOYD
1 Hyde SC, Emsley P, Hartshom MJ, et al. Structural model of ATP-binding proteins associated with cystic fibrosis. Nature 1990; 346: 362-65 2 Welsh MJ. Abnormal regulation of ion channels m cystic fibrosis epithelia FASEB 1990; 4: 2718-25 3. Kerem B-S, Zielenski J, Markiewicz D, et al. Identification of mutations in regions corresponding to the two putative nucleotide (ATP) binding foldsof the cystic fibrosis gene Proc Natl Acad Sci USA (in press).
