Out of Africa: Necessity is the mother of invention. In cash starved Africa, where giving
the $ 12000/- year triple therapy for patients with AIDS is an impossible dream, scientists
have stumbled across another old useful drug. Diana Dickinson, who used
a combination of Hydroxyurea with low dose DDI in her AIDS clinic in
Botswana, found that most of 150 odd patients in whom it was tried,
improved clinically. In the 70% of the 98 patients who could afford testing, HIV virus levels became undetectable after 6 months of treatment. Only 8% reported side effects such as low counts and hyperpigmentation. Another physician Steve Miller from Johannesburg, reports significant fall in virus levels in '68% of the 127 patients in whom he tried the combination. Hydroxyurea acts by slowing the rate of synthesis of nucleic acids and the cost of the new drug combination is one tenth that of the standard triple chemotherapy currently used in the West. Now developed countries are interested in using it as salvage therapy (New Scientist I May, 1999).
Clones are illness prone: Though many cloned animals have been known to die at birth or shortly after, long term problems may also be in store. A calf cloned from the ear of another cloned cow recently died at 7 months of severe resistant anemia. Initially it had also required diuretics for an enlarged heart. French scientists who reported the case warn
that diverse medical and 'not merely ethical problems of cloned organisms may need close monitoring (BMJ 8 May '99).
Vaccine worries: Is today's child becoming a mere pincushion for various vaccines and is the rising incidence of diabetes, asthma and autism linked in any way to immunization? Does the Haemophilus influenzae
vaccine increase the risk. of IDDM in children due to formation of islet cell antibodies? This last ghost has temporarily been laid to rest by a well designed cohort study of children in Norway. In the 3 groups studied, one received no H. influenzae vaccine, one received 3 doses in infancy and one received the vaccine at 2 years of age. There was no increase in the rates of IDDM among vaccine recipients (BMJ 1 May '99). In Medicine, as in everything
else one must be careful that today's solution isn't tomorrow's problem.
Economics of AIDS: It is said that more people live off AIDS than die from it. The re- cent arrest of Dr. 1.S. Gilada the Director of an NGO
working on AIDS related issues is a case in point. He was held for conducting illegal trials of the Bovine Immunodeficiency Virus vaccine on HIV. infected patients in Mumbai. The police began an inquiry after
the Bombay High Court was petitioned by
one of the patients (now deceased) who received the vaccine. Though
consent was obtained, patients were under the misconception that it was some kind of treatment not a vaccine. International aid agencies and pharmaceutical companies are pumping in big money in exchange for vaccine trials, secret serum
transfers, etc. and there are many who are using it to further personal gains. But the Indian Government is firmly resisting phase I vac- cine trials till th ere is good evidence of its safety and relevance to Indan conditions (BMJ 15 May '99, The Sunday Times 2 May '99).
Buddhist economics: After Gro Bruntland took over as Director General of WHO some of the needless bureaucracy has been trimmed and 10 separate programs have been pruned to 10. Her focus has been on 2 key projects: Roll Back Malaria and the Tobacco Free Initiative. She has come a long way from the medical student in Norway who after a mas- ters in Public Health from Harvard, settled down in a job handling children's health is- sues. How she was suddenly asked to join the cabinet and finally became Norway's Prime Minister thrice, is now history. She came into international limelight initially as the envi- ronment Minister, who cajoled industries to adopt environmentally friendly methods by showing policy makers that it made good business sense to protect the environment. She is now using parallel logic to convince government's and corporations of the
economic advantages of alleviation of poverty and control of malaria and tobacco use (Scientific American June 99).
The home ahead: Hitting the markets by 2003 AD, is the home of the future which was recently unveiled by the Japanese electronics giant Matsushita. The emphasis is on health. Bathrooms will be made of bacteria resistant materials, electronic chips in the commode will automatically calculate weight, fat con- tent, urine sugar, etc., The information may be relayed to one's personal physician or life insurance companies. In the bedroom the data from the electro cardiogram, thermometer, blood pressure machine may be either stored or appropriate consultations with specialists via the internet may be made. It may even be linked to the refrigerator and microwave so that the food cooked is healthy (Lancet 8 May '99). One fears the tyranny of machines on hapless mankind has begun!
Gouri Rao Passi,
Choithram Hospital and Research Center, Indore 452 001, India.