1116
5. Gal
D, Friedman M, Mitrani-Rosenbaum S. Transmissibility and
treatment
6.
failures of different types of human
papillomavirus. Obstet
Gynecol 1989; 73: 308-11. Tyring SK, Cauda R, Baron S, Whitely RJ. Condyloma acuminatum: epidemiological, clinical and therapeutic aspects. Eur J Epidemiol 1987; 3: 209-15.
7. Bergeron C, Ferenczy A, Richart R. Underwear: contamination by human papillomaviruses. Am J Obstet Gynecol 1990; 162: 25-29. 8. von Krogh G. Podophyllotoxin for condylomata acuminata eradication. Clinical and experimental comparative studies on podophyllum lignans, colchicine and 5-fluorouracil. Acta Derm Venereol 1981; 98 (suppl): 1-48. 9. Larsen J, Petersen CS. The patient with refractory genital warts in the STD-clinic. Dan Med Bull 1990; 37: 194-95. 10. Baggish MS. Improved laser techniques for the elimination of genital and extragenital warts. Am J Obstet Gynecol 1985; 153: 545-50. 11. Reichman RC, Oakes D, Bonnez W, et al. Treatment of condyloma acuminatum
with
three
different
interferons
administered
intralesionally. Ann Intern Med 1988; 108: 675-79. 12. Zouboulis CC, Stadler R, Ikenberg H, Orfanos CE. Short-term systemic recombinant
interferon-&ggr;
treatment is ineffective in
recalcitrant
condylomata acuminata. J Am Acad Dermatol 1991; 24: 302-03. 13. Eron LJ, Judson F, Tucker S, et al. Interferon therapy for condylomata acuminata. N Engl J Med 1986; 315: 1059-64. 14. Condylomata International Collaborative Study Group. Recurrent condylomata acuminata treated with recombinant interferon alfa-2a: a multicenter double-blind placebo-controlled clinical trial. JAMA 1991; 265: 2684-87. SA, Hughes CE, Trofatter K. Interferon for the therapy of condyloma acuminatum. Am J Obstet Gynecol 1985; 153: 157-63. 16. Schonfeld A, Nitke S, Schattner A, et al. Intramuscular human interferon-&bgr; injections in treatment of condylomata acuminata. Lancet 1984; i: 1038-42. 17. Petersen CS, Bjerring P, Larsen J, et al. Systemic interferon alpha-2b increases the cure rate in laser treated patients with multiple persistent genital warts: a placebo-controlled study. Genitourin Med 1991; 67: 15. Gall
99-102. 18.
Mitao M, Nagai N, Silverstein SJ, Crum CP. Latent papillomavirus and recurring genital warts. N Engl J Med 1985; 313:
Ferenczy A, 784-88.
19. Gissmann L. Linking HPV to cancer. Clin Obstet Gynecol 1989; 32: 141-47. 20. Kinghom GR. Genital warts: incidence of associated genital infections. Br J Dermatol 1978; 99: 405-09. 21. Steele K. Wart charming practices among patients attending wart clinics. Br J Gen Pract 1990; 40: 517-18.
Not
a
classless society
Life in inner cities is often tough for the underprivileged people who congregate there. In the USA the health indicators of these urban areas are very poor. Grisso and colleaguesl found that, during the course of a year, no less than 10% of the estimated
population of 31
032 inner city women aged 15 years and older in western Philadelphia, Pennsylvania, sustained injuries that ended in death or in a visit to an accident and emergency department. For those aged 25-34, the figures were even higher-16%. Falls, violence, and motor vehicle accidents were the main cause of injury; violence was the leading cause of death for the 25-34-year group. The overwhelming majority of residents and injured women in the low-income area under study (median family income $11 810 vs US median family income in 1989 of $34 213) were blacks. This study of injuries-the first to be carried out in an inner city area-confirms earlier observations that, for most types of injuries, black women and men have higher injury rates than their white counterparts. For example, homicide rates in blacks are 1 ’38 times higher than in whites.22 Black/white mortality differentials in the USA have lately featured in medical and lay publications, in
which concern has been expressed about the perceived deterioration of the health conditions of blacks and other minorities. On average blacks live 2190 days less than whites. In response, the US Government has called for a national effort to reduce these mortality differentials.3 Yet the primary focus on race as the subject of analysis and stimulation for change is insufficient to solve the problems of minorities, or those of the rest of the US population. Navarro4 has argued that class should also be considered in US Government mortality statistics. He believes that ignoring class differentials reinforces the widely held perception that race is the determining factor in explaining the poor predicament of minority groups. That the notion is false was confirmed by Grisso et al, who found that in the low-income community being studied, white women and black women had similar rates of injury. National data show that differentials in homicide rates by income group are much larger than black/white differentials. The homicide rates in the lowest per caput income area of residence are almost double those in the highest per caput income area,s and most residents in the low-income and highincome areas are white. Although within each residential area blacks are likely to have worse rates than whites, the reality that class differentials are much greater than race differentials cannot be denied. If race is not the main reason why the mortality rates are higher for blacks than for whites, racism probably is. Because of racial discrimination, blacks and other minorities have low-income jobs, live in poor housing (the death rate due to house fires is 4-6 times higher in low-income areas than in upper-income areas), and reside in poor areas. They share these conditions with millions of whites who are also part of the unskilled working sector of the population. The overwhelming majority of black women and men and other ethnic minorities are members of the burgeoning low-paid working class-the class that, for most causes of death, has higher mortality rates than do the middle and upper classes, who earn more. Publication of mortality statistics by class as well as race would help to show that the poor conditions of blacks and other minorities are not based on the genetic, psychological, or cultural factors that are frequently held to be responsible for their plight and would help to unite rather than divide those at the bottom of the social scale. Will the US Government pick up this gauntlet? 1. Grisso
JA, Wishner AR, Schwarz DF, Weene BA, Holmes JH, Sutton RL. A population based study of injuries in inner-city women. Am J Epidemiol 1991; 134: 59-68. 2. Baker SP, O’Neill B, Ginsburg M, Li G. Table 1, number of deaths and death rates by sex and race, 69 causes. Injury fact book. 2nd ed. Oxford: Oxford University Press (in press). 3. Goals for the nation for the year 2000. Washington, DC: Public Health Service, US Department of Health and Human Services, 1989. 4. Navarro V. Race or class versus race and class: mortality differentials in the United States. Lancet 1990; 337: 1238-40. 5. Baker SP, O’Neill B, Ginsburg M, Li G. Table 8, death rates per 100 000 population by per capita income of area of residence and place of residence, 69 causes, 1980-1986. Injury fact book. 2nd ed. Oxford: Oxford University Press (in press).
5. Gal
D, Friedman M, Mitrani-Rosenbaum S. Transmissibility and
treatment
6.
failures of different types of human
papillomavirus. Obstet
Gynecol 1989; 73: 308-11. Tyring SK, Cauda R, Baron S, Whitely RJ. Condyloma acuminatum: epidemiological, clinical and therapeutic aspects. Eur J Epidemiol 1987; 3: 209-15.
7. Bergeron C, Ferenczy A, Richart R. Underwear: contamination by human papillomaviruses. Am J Obstet Gynecol 1990; 162: 25-29. 8. von Krogh G. Podophyllotoxin for condylomata acuminata eradication. Clinical and experimental comparative studies on podophyllum lignans, colchicine and 5-fluorouracil. Acta Derm Venereol 1981; 98 (suppl): 1-48. 9. Larsen J, Petersen CS. The patient with refractory genital warts in the STD-clinic. Dan Med Bull 1990; 37: 194-95. 10. Baggish MS. Improved laser techniques for the elimination of genital and extragenital warts. Am J Obstet Gynecol 1985; 153: 545-50. 11. Reichman RC, Oakes D, Bonnez W, et al. Treatment of condyloma acuminatum
with
three
different
interferons
administered
intralesionally. Ann Intern Med 1988; 108: 675-79. 12. Zouboulis CC, Stadler R, Ikenberg H, Orfanos CE. Short-term systemic recombinant
interferon-&ggr;
treatment is ineffective in
recalcitrant
condylomata acuminata. J Am Acad Dermatol 1991; 24: 302-03. 13. Eron LJ, Judson F, Tucker S, et al. Interferon therapy for condylomata acuminata. N Engl J Med 1986; 315: 1059-64. 14. Condylomata International Collaborative Study Group. Recurrent condylomata acuminata treated with recombinant interferon alfa-2a: a multicenter double-blind placebo-controlled clinical trial. JAMA 1991; 265: 2684-87. SA, Hughes CE, Trofatter K. Interferon for the therapy of condyloma acuminatum. Am J Obstet Gynecol 1985; 153: 157-63. 16. Schonfeld A, Nitke S, Schattner A, et al. Intramuscular human interferon-&bgr; injections in treatment of condylomata acuminata. Lancet 1984; i: 1038-42. 17. Petersen CS, Bjerring P, Larsen J, et al. Systemic interferon alpha-2b increases the cure rate in laser treated patients with multiple persistent genital warts: a placebo-controlled study. Genitourin Med 1991; 67: 15. Gall
99-102. 18.
Mitao M, Nagai N, Silverstein SJ, Crum CP. Latent papillomavirus and recurring genital warts. N Engl J Med 1985; 313:
Ferenczy A, 784-88.
19. Gissmann L. Linking HPV to cancer. Clin Obstet Gynecol 1989; 32: 141-47. 20. Kinghom GR. Genital warts: incidence of associated genital infections. Br J Dermatol 1978; 99: 405-09. 21. Steele K. Wart charming practices among patients attending wart clinics. Br J Gen Pract 1990; 40: 517-18.
Not
a
classless society
Life in inner cities is often tough for the underprivileged people who congregate there. In the USA the health indicators of these urban areas are very poor. Grisso and colleaguesl found that, during the course of a year, no less than 10% of the estimated
population of 31
032 inner city women aged 15 years and older in western Philadelphia, Pennsylvania, sustained injuries that ended in death or in a visit to an accident and emergency department. For those aged 25-34, the figures were even higher-16%. Falls, violence, and motor vehicle accidents were the main cause of injury; violence was the leading cause of death for the 25-34-year group. The overwhelming majority of residents and injured women in the low-income area under study (median family income $11 810 vs US median family income in 1989 of $34 213) were blacks. This study of injuries-the first to be carried out in an inner city area-confirms earlier observations that, for most types of injuries, black women and men have higher injury rates than their white counterparts. For example, homicide rates in blacks are 1 ’38 times higher than in whites.22 Black/white mortality differentials in the USA have lately featured in medical and lay publications, in
which concern has been expressed about the perceived deterioration of the health conditions of blacks and other minorities. On average blacks live 2190 days less than whites. In response, the US Government has called for a national effort to reduce these mortality differentials.3 Yet the primary focus on race as the subject of analysis and stimulation for change is insufficient to solve the problems of minorities, or those of the rest of the US population. Navarro4 has argued that class should also be considered in US Government mortality statistics. He believes that ignoring class differentials reinforces the widely held perception that race is the determining factor in explaining the poor predicament of minority groups. That the notion is false was confirmed by Grisso et al, who found that in the low-income community being studied, white women and black women had similar rates of injury. National data show that differentials in homicide rates by income group are much larger than black/white differentials. The homicide rates in the lowest per caput income area of residence are almost double those in the highest per caput income area,s and most residents in the low-income and highincome areas are white. Although within each residential area blacks are likely to have worse rates than whites, the reality that class differentials are much greater than race differentials cannot be denied. If race is not the main reason why the mortality rates are higher for blacks than for whites, racism probably is. Because of racial discrimination, blacks and other minorities have low-income jobs, live in poor housing (the death rate due to house fires is 4-6 times higher in low-income areas than in upper-income areas), and reside in poor areas. They share these conditions with millions of whites who are also part of the unskilled working sector of the population. The overwhelming majority of black women and men and other ethnic minorities are members of the burgeoning low-paid working class-the class that, for most causes of death, has higher mortality rates than do the middle and upper classes, who earn more. Publication of mortality statistics by class as well as race would help to show that the poor conditions of blacks and other minorities are not based on the genetic, psychological, or cultural factors that are frequently held to be responsible for their plight and would help to unite rather than divide those at the bottom of the social scale. Will the US Government pick up this gauntlet? 1. Grisso
JA, Wishner AR, Schwarz DF, Weene BA, Holmes JH, Sutton RL. A population based study of injuries in inner-city women. Am J Epidemiol 1991; 134: 59-68. 2. Baker SP, O’Neill B, Ginsburg M, Li G. Table 1, number of deaths and death rates by sex and race, 69 causes. Injury fact book. 2nd ed. Oxford: Oxford University Press (in press). 3. Goals for the nation for the year 2000. Washington, DC: Public Health Service, US Department of Health and Human Services, 1989. 4. Navarro V. Race or class versus race and class: mortality differentials in the United States. Lancet 1990; 337: 1238-40. 5. Baker SP, O’Neill B, Ginsburg M, Li G. Table 8, death rates per 100 000 population by per capita income of area of residence and place of residence, 69 causes, 1980-1986. Injury fact book. 2nd ed. Oxford: Oxford University Press (in press).
