389

Letters to the Editor LEVAMISOLE paragraph of your editorial on levamisole calls for the organisation of properly 152) (Jan. 18, p. controlled clinical trials of this drug. Such a trial has been in progress in this department over the past six months. Patients with carcinoma of stomach, carcinoma of the colon, and malignant melanoma who have either recurrent

SiR,—The final

residual disease or fall into a poor prognostic group are admitted to a double-blind trial of levamisole, 150 mg. daily for three days each week, against placebo. The immunological effects are being monitored by a battery of tests, including T and B cell estimation, D.N.C.B., Mantoux, or

and P.H.A. stimulation, and serum-immunoglobulins. Initial results show that in 19 patients who have been reassessed after one month 5 (25%) have had some increase in cellular immunity (as assessed by D.N.C.B. responsiveness). Although we do not know whether these patients are receiving levamisole or placebo (we have no indication to break the code), our previous experience would not lead us to expect such a result with a placebo and we are encouraged to continue the trial. You suggest that side-effects are few; but 2 patients have complained of giddiness, 2 of excessive tiredness, and 1 of a severe skin rash. All these patients attribute their symptoms to the tablets, since they disappear when the tablets are stopped. All these symptoms have been reported with levamisole, although a skin rash has only once been reported. We have broken the code for the patient with a skin rash and confirmed that she has received levamisole. University Department of Surgery, Heath Park, Cardiff CF4 4XN.

SIR,-In

D. J. T. WEBSTER L. E. HUGHES.

your editorial you conclude that " levamisole

exciting possibilities, and investigators ought organising properly controlled clinical trials ". Such a trial in lung cancer has been running in Amsterdam (Free University, Prof. E. Lopes Cardozo), Leuven (Free University, Prof. J. Cosemans), and Utrecht (St. Antonius Hospital, Prof. J. Swierenga) for almost three years now. Patients selected for this investigation are those with primary resectable bronchogenic carcinoma. Treatment with levamisole (50 mg. three times daily) or placebo begins three days before the operation, under strict doubleblind conditions, and every fortnight this three-day course of treatment is repeated. We have just received part of the first interim analysis of the data from patients who have may have now to be

been followed for at least one year after surgery. These preliminary data look very promising, since a clear correlation between the effect of levamisole and the diameter of the tumour has been found. The preliminary analysis also suggests that levamisole has no influence on intrathoracic recurrences, but that it diminishes the incidence of distant recurrences

We

rather

strikingly.

hope to publish this first interim analysis

more

extensively

and I find it hard to accept the view that private practice play,s an important role in the advancement of medicine. After all, disease is no respecter of financial frontiers, and an ischaemic limb in a bricklayer or a millionaire is much the same. However, there is one argument for private beds which is overlooked by the Health Departments. It is the personal involvement in our hospitals of the leaders of our society. To make it difficult for leaders of Government, industry labour, and the professions to come into our hospitals by denying them the privacy they need is to divert them to private clinics and nursing-homes outside the Health Service. They will then naturally become involved with the private sector, and because of ties of gratitude be inclined to devote time and money to its welfare. I realise that the health authorities will reply that our aim should be to make the hospital service so attractive that private hospitals will disappear. However, it is apparent that this utopian state of affairs will be long delayed. Until then, surely it is short-sighted to divert influential people away from the hospitals which badly need their help. There is the ethical difficulty of privileged accommodation for v.i.p.s. Do not let us be hypocrites in this matter. Even the railways have first-class compartments. Department of Surgery, Ninewells Hospital, DONALD DOUGLAS. Dundee DD2 1UD.

TREATMENT OF MATURITY-ONSET DIABETES

SiR.—Dr Clarke and Dr Campbell (Feb. 1, p. 246) found significantly reduced primary failure for chlorpropamide compared with glibenclamide in their " highly comparable groups " of 321 maturity-onset newly diagnosed diabetics. Their results should be interpreted with caution. Their patients fall into two distinct categories: (a) the predicted diet failures who were under ideal body-weight; and (b) the true diet failures in whom diet alone had failed to achieve satisfactory control of blood-glucose after four a

weeks.

However, although these patients represent two distinct populations of maturity-onset diabetics, as demonstrated by the fact that 26 of the 32 primary failures are in the predicted diet-failure group, they have not been analysed as such, and the authors have pooled the data on age, initial body-weight, and blood-glucose when they state that chlorpropamide and glibenclamide treated patients are highly comparable. It would have been much more meaningful to learn whether the patients were comparable in these variables in the predicted diet-failure and in the true diet-failure groups. This is all-important in this study, as treatments were only " more or less randomly allocated " and therefore bias may have been introduced. There is no statistical difference in the primary failurerates for the predicted diet failures and true diet failures when analysed separately, using the method described by Cox 1:

later. Study Group for Bronchogenic Carcinoma, Janssen Pharmaceutica, B-2340 Beerse, Belgium.

Predicted diet failures True diet failures

For the

W. AMERY.

V.I.P.s IN HOSPITAL

SiR,—As a life-long academic, I have no experience of private practice, and none of the hospitals in which I have worked has had private beds. This has not prevented me from enjoying a busy and satisfying life in clinical surgery, 1.

Pasricha, J. S., Nayyar, K. C. Toxicol. appl. Pharmac. 1971, 20, 602.

Finally, Dr Clarke and Dr Campbell were treating only maturity-onset diabetics of either normal or below-normal weight, and I believe most clinicians would prefer to use insulin in some of the more severely underweight patients described in this paper, especially since I do not consider a 2-hour postprandial blood-glucose of 180 mg. per 100 ml. representative of successful control. The clinical relevance of this study, which I have already questioned on statistical grounds, is limited to the type of 1.

Cox,

D. R. in

Analysis of Binary Data; p. 58. London,

1970.

Letter: V.I.P.s in hospital.

389 Letters to the Editor LEVAMISOLE paragraph of your editorial on levamisole calls for the organisation of properly 152) (Jan. 18, p. controlled cl...
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