Tobacco Documents Online

asdrenergic casual1v department. where further, d'ela.•sS would take piace.and possibly furthor errorsbs inext+erneneed lunror staff. Ltnfortunateh', the message of the British Hean Foundation report ts dtcpi% amhi.•alMt. doubtless re8ecting a "dissensu>'^ in the group. The overall result.. howcrcr. will bc to d iscounge genenl pnctitioners ftom pwnpating fullt' and expioning the maior benefits that tbromfwl+^tic treatment can confer. Rather tlun: "contracttng oua.'^' as the report suggests, I hope that gcnenl I pracuuoners will insist on local schemes to bolster their confidence in the full eul}•, nunage^ment of mvoeardial infarc- tton. , Fsnr<EX: atiTi, of the above aufomated methods. and the rather glib dismissal oCnecessarn' technician time shows a lack of undersunding for the problems off latwratories that will be asked to perform thesc investigations on a dav to da, basts„gtven the current volume of requests for markers of aicohol abuse. , Chenual puhologv ' departments that seek to sell this "fatr8s• stmpic, sensitive, and inexpensive" technique to their managerss and clinicians as an alternauve to cheaper current tests (albeit with known limtutwns) mav thus be hoist with their own pctard. L N' SANDLF G H HALL CMmwl Pa,k,dq. D<p.nmm,. Trauoed C af Hsinul... A4a~rAeun .U31 JSL 1 HafIGH n:rlu+suef•,nln.ascaf.er,+no.ardmlm(am.v,-L+.:n I9C;:n:au-t-, _ 2 Bnwslf Ho.n Founda,wn Cnrk npG[wp. Rok ei tli< 0ene<a1 , pra<u<,an<n ,n manaamt r•• •qh mn,c dut,mu.,wn. unrw~,~.oi,MOmep+,.. vo,m<n,. B'. ~LJJf9W,299.'S*-o. .2eAWua, Child sexual abuse SiR,-I am pleased that tnveseiganons for sexually uansmned discases including screentng tests for gonorshoea and HIV infenfon should'be done on sexuall'+ abused~children.' Ot-er rw-o veaZ five children (two g.rls. Shree bovs; aeed =-7!': ycars presented at this teachtne hospiul: not with a hfstory,of sexual abuse but with urethral or vaginal d:scharge proved to:bc due to Neuse+ia gonannoca. One 5 year old girl subse- quently admitted to sexual abuse br a 10 pnr old boy at:schoo4. The boy refused to be investigated by us. Tlie other,girl. aRed 79sycars, dcnied scxual. abuse and had an inuct hsaeen.,Three bo.^s were subsequenth• found to have contncted the disease through a parenvor older member of thefamily. Reports on sexual abuse in children in the developing countries arrnrc,=, but our experience show-s that doctors and. in particular,, paedia- trieians in these countries need to be aware of sexual abuse and d:atithe campaign against HIV infection and other sexually transmitted diseases for at risk subiects should include children who have deenn sextullv abused I: Deponn.m, ef PanLuno.. Bo: lal. uyPmn. Um.m,nn6 Pon ,Harcoun. , Pon Harmun. , Nit<rn FELICIA EKE 1 SaMerE: F. Aomrns R.. QuW t<saul~ abu.<-11. B, N.I J, 19r9LZ9ii%:-t_. S Autun.. 2('1tunEanim BO.. Srsuallrc van.nunnf : dnotr. an N,rrru. A' rer.-.- d [1t< t.exnu inraumn. ir<n A Mr.+. )avn,.J i.! Md>tw 1969.aa:-9.' Marker for alcohol abuse SIR,-Thc prospecuo[a morx re2iable marker for alcoholism as described by Mr A Kapur and callcaguess ismost wc7come.'Unforrunateh•, howes-cr~ their Last paragraph states that"thc cost of the test compares favourably with.that of other stand4rd~ lsbontoryy invesugauons." The gt,•en method does not specify the reagents closely enough for the cosuof consuaubles to be worked out; but let:allengc Mr, I:apurand eolle2gues.to produce artstrJtfor221p per specimen (the eurrcnt'eost of.~ eonsurvbles for a y-glutamvltransfense est.mauon tnthisdepartment):.t( full blood;count (utcludingmean eorpuscular volumc;, performed bv our hacrvtolog%- department rcprescntseven bettcr s-alime at I lp for consumables. The isolation and ideatnncauon of earbohvdnte derietenl tnns- ferrtn sS patemlimore abour intensive than cither I. 1:apun A. 4dJ'4 SS.IfoN-Q'nJ .1 . TntnDR OrMni dra,r d<n.«nu ,nwslrmn r. mart<. foe d.,MM ahw.. Br tft:.l 19a4_79a±,.it. IFAUtu.,, ~ Passive smoking and cardiorespiratory health in Scotiand S1R.-Mr David J Hole and colleagues.' when discussing results from theu prospective stud•', sutr that studies of eotirur•,e in passive smokers suggest thrtthc dose recnred maybe "equivalent to smoking up, to three eigarettes a diy," To supporn this mislhding statement they cite a solinrv study in Japan r in which unnan' cotimnc eoneentntions in non-smokers averaged g'. of those in smokers. This contrasts shatTly with evidence from CGestern , populations," which indicates thar avenge eoai.nine concentrations in non-smokers exposed to environmental tobacco smoke arc about 0-;°% of those in smokers.' Blott and: Fnumteni speculated that Japanese peoplc might have especullc hcar.^, exposure to en.iron- mental'tobacco smoke.' Other studies in Japant (and absttacts presented by S Umemun an& colleagues aad E Higashi and colleagues, inter- natiorul confercncc on indoor air quality, Tokyo, 196i ) have, however, sustained earlier suspicions- that the metliodology ' used in the original stud}= wasfaulty. Rrhen estimating passive exposure rtlarlve to ~ that from active smoking nicotine based indices are of dubious value, panlv, because nicotine in~envtronmantal tobacco smoke, unlike that in mainstream smokc, is largcJv in the vapour phase and need not be absorbed by the lunrrs,• Based' on measutments of retained pareicul4te tnalter, exposurc to environmental tobacco smoke averngesat aboun0 0590 of tAe exposure of a person wtio~ smokes 20 cigarettes each dity'-that is, 0•01 ngarettes a dar. That such tnututc doses should'elicit.observable health effects is surprising, and: epidemiologial, studies that repon associations with exposure to rn.ironmental tobacco smoke have been eriticall.• examined fou possible bias. One tmponant bias arises because some smokers den)• present orput smoking. Mr Holt andlcotleagues rrder to one of mvy papers.' but'. aruonunateiy havetotallr mii- understood how such bias arises. They statc that diffbrrnual ntesn of misclassi5cauon implc that someone ia their'double smoking group"'has to be-'more likeiyto pretend to be a non-smoker than, someone in, the single smnktnggroup." Th,s tsuntruc because rl os•erlooksthe fan thatsmukcrs tend to cohabit with smokers,. The taoie shows hov: differential mulasst.^-.:a- tion can arlsc, assuming 2% om the fndc.:sun,nts bad denied~ smoktng, The higher proporttun of smokcn (I $:6°e'p in the obsen-ed passive smoking group eompared~ w^rth the observed control group (6-g <) would ousc substantial bias for an end poim~stronglp related to active smoktng...Thusif. nskwere increased 20 times in smok'ers. and no1 bv exposure ro: environmental tobacco smokc., the relative risks: observed would be 6+90 for active smoking and; 1-7a for passive smokfnc. noc?0 and 1 rapectively, Marv studles have shown i higher ntess of denial of smoking than: assumed in the tablc,"so this source of bsas is r.id'end, important. It can explain the many, positive assocsauonsreponed in the Scottish stud.-,' most of1whtch wsn not statistically srgnlDcant. The results for lung ancer, from the Scottish studt• were based on onlj• nine deaths among xlf reported non-smokers.. This contnsts with over 2000 deaths in:other published studta. Clnrlj;, the new data contribute little to the overall iptcture. Evidence on enrtronmental tobacco smoke and heann disease hasprcctousl.'been re••tessed and considered tnconclusn•e."' Although the Scottish study reported more deaths from hcart dfsease than from lung cancer. it should not r-..a erulll affect 1lits .•iew. PN tn Suusu_-, and cwnw,cnr. Suuon.Surrr. SAL`SDA, PETERN 1EE 1: HokD11 G,1ti, CR. Chnvra. C. Ha+.hmrnr Cat., Pa- unuunt and cud,onspm- :wliM,n.a tn.<ui ttyull,an Irv tnr - ofScmtanJ. B. .tt.: ~: 19a0:9Darl.'. I: Ama u., 2ma,su<un S. Tutwuao T. 1:.unn N. r. a:. EBraa d rmven. mrnul amex<o armi:< on un,un- <amux n:rnwn mnon-. vrwl'er+: .4 E n<b J.11 , 19.+.3] c:5:432 3 IIS' DnPanm<m~ of Hn1eh anJ Human Stmcn..Th+ M.ln1. r.+..ai Rak,,i1t.,.llanlae,.l+ PuN. Hralin.S-<. 0f6c< m Smowra and Hka7tA.. 1916:10S-i. +' l-n' P\. A. H,rnv,n<.eartlaru,wn for,Br vxr<>,aed.nak of qwr. oncrr u. nan.<euukrn numrd to <molrn. In: PrmR. 3:i<k P¢"_ rd+. J,.an.. .d ..A,..n .a. 4- . t.ondoo. Sdvr*. 1911: t+ast. 5 Bta tt'J. Fnumrm:l. Paw.<v,winrand l.nr nsrr: )wrvl' ./ iai- ~'a.nu/ Qew ~ Jwu.n,ua 97n..^. o'+!9A Murnmu+tu.~riUn.<mmS.Ob1aT.Tom~uH.Eu,manmor' prnonal <zt`m,ur<.,m,eea:rc +motr .,,e: a -i, dr.ewwrd : nmo,u,e y<rwoal moemw. E r.w.w Rn 19H J5'.21 a-Z ~. 7Adltmn. F_ Scnnn G. Hdkr ~. D..Pasv.. v,watmt..\'E.rl7' .Mrs1915312:.719.._0_ t Ronw,l. AprerduaD~E•rws...ewrr!.nA+r.ar..Mr..Nanrwr rayvn+:.wd .,vtnu.4rnna..rrrtn.: aasWnn,an.: \uwnal. Ao.1M+, Prct<. 19Lm:.9.:i3:.. 9lse PN. A1~.-WuAnewr. u a fr,or m rv+•~•<:cnokant nsl. Leun 196E:u't,"10 Spnnrcr-\'<rl.a. 1911 . 11 Sa,~ n~l, Rn<.rcn Caun:T E...^-e+..•o, r.w.M.cw..+.r<ar~n^•.o+ ,.r a.va. rhrm. Q'aNinpnn. Nluona/ Aodnnn P+ess<,19{e:_S: ~f _ Donating drugs to the Third World SIR,-Asdirector of lntermrc, the organisation appros•ed by the BMA Board of Science and Education for promoting the salvacingof suitable medical aamples for use in the Th1rd u'orld^ 1 am happv : to: ansa•er the cnucumsecpressed~ by Dr Frances Grffhths.' DIIJrrrnnel wurlsnirireraon rauarcf'by 1!.:ef fndtz rubJ<cu demnnttmnA,ng: rreardlae.oJ ionoi^9w'i ~mwkine: Aebiu Ea>aure6rewF' Smokrntsu,r ofindraauo,ec, SmotmRw,r ofkolue„ee ^'Iruc:" d,a,nbuuen Pn -rc EffMfoi Ot-.d .hntna.x d<nu4 d,unDU,imrrrnot<d: Cnmroli Non»n.nwer Nonamoio 399 -,9 +25. tr! Pssu.rrmounhmn-er:nour Smntrr 205 ' ~3d. L,, It.o Sinrleanmien.$nmu[!:mn.t:nmkc:r lu9 DouDic:amrcrn SmotaSmota 199, -ib t5 = `.b dt¢nre D, Ho,c r. _... 1 Dua irom nbk I oi H - n.a Zlmnnr M•,-- n: ••., 742 B>t1J vOLzvF M !t' :E:.T_>u;t'R , (98'