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PubMed2001

The role of toxicology in evaluating priorities in environmental health.

It is easy to assume that the straightforward explanation of a rational standpoint, based on sound scientific information, will inform public debate in areas of hazard evaluation. However, although toxicology generally provides the basic data that give reassurance, it is also used as a methodology for hazard identification. Once a hazard has been identified, pressure groups will present data that suit their case and ignore those that do not. Any pretence at analysis is abandoned, as shown by the recent MMR (measles--mumps--rubella) vaccine debate in the UK. Toxicologists should not suppose that comparative evaluations of risk, based on data, will result in a rational choice about environmental interventions -- data are few and opinions are a matter of faith. Thus, we might have to be protagonists in a propaganda war for science if irrational misuse of resources is to be avoided.

Environmental Health↗

PubMed1998

Lung cancer and smoking: a case-control study in Buenos Aires, Argentina.

The objective of this study was to examine the risks for lung cancer associated with lifestyle characteristics of smoking in a developing country where lung cancer is the first cause of mortality by cancer in men, tobacco propaganda is freely allowed, and there are no restrictions operating for smoking. The design was a case-control and hospital-based study. Two hundred men with lung cancer and 397 hospital controls were interviewed. Odds ratio (OR) for current smokers was 8.5, whereas former smokers displayed an OR of 5.3. The risk increased with duration of smoking and with the number of cigarettes smoked per day. The attributable risk for smoking was 85%. Smokers of black tobacco and more than 24 cigarettes/day showed a risk of 12.9 regarding non-smokers, and of 15.5 for 40 or more years duration of smoking. The proportion of cases diagnosed as adenocarcinoma was higher than the proportion of squamous cell carcinoma.

Adult↗

PubMed1997

Kidney failure and transplantation in China.

The incidence of chronic renal failure in China is approximately 120,000 cases per year; the vast majority of these new cases will die within a very short time because of the shortage of funds, dialysis machines, and organs for transplantation. This paper focuses on the reasons behind the organ shortage and the strategies proposed by the Chinese medical profession to increase the supply of transplantable kidneys. The data were gathered on multiple trips to China, Hong Kong and Taiwan between August 1993 and January 1995. During these trips the author spoke formally with nephrologists, urologists, dialysis and transplant nurses, and other individuals active in the field of organ procurement, and informally with others familiar with general hospital practice. The author also draws heavily on articles published in leading Chinese journals. The kidney shortage in China is produced by the same sorts of problems as exist in other countries, but the shortage is aggravated by certain beliefs and practices specific to Chinese populations. Live donation is hampered by traditional beliefs about the function of the kidney, while cadaver donation is hampered by reluctance to cut a body and a host of beliefs about ghosts, labeled "feudal superstitions" by the authorities. Cadaver donation is further restrained by the lack of legal recognition of "brain death". In response to the organ shortage, the Chinese medical community has expanded the range of eligible sources to include those condemned to death as criminals, a practice itself usually condemned by the wider international community. At the same time it has advocated: (1) enhancing corpse donation through propaganda work, administrative work, legal work, and incentives; (2) encouraging live donation; (3) familiarizing the public with the benefits of organ transplantation, and (4) pursuing the development of artificial organs.

Attitude to Death↗

PubMed1998

Tet offensive: winning hearts and minds for prevention. Discourse and ideology in Vietnam's "Health" Newspaper.

A quantitative content (CA) and qualitative discourse analysis (DA) was made of all 67 articles in the February 1995 ("Tet") issue of Suc Khoe ("Health"), a bi-weekly newspaper issued by Ministry of Health, Hanoi, Vietnam. The aim was to uncover discursive strategies used in the construction of health-related meaning during a period of rapid economic transition and latent ideological struggle in Vietnam. The DA was based on the work of i.a. Foucault, Fairclough, Thompson, and Fowler. The CA showed a strong domination of Western sources. There were four themes: prevention, cure, the Tet festival, and crime and punishment. In the two first, health-related groups, prevention (n = 31) dominated over cure (n = 22), modern (n = 19) over traditional (n = 13) medicine, and overall, the theme of continuity (prevention and crime/punishment) over change (cure and Tet), reflecting Vietnam's programmatic pluralism in the health field and its ideological struggle against outside influences. The DA revealed three mixed but unintegrated discourses in the material; "popular" (simplistic, authoritarian, and sentimentalizing), "expert" (technical, egalitarian, and uncritical), and "nationalist" (administrative, impersonal and propagandistic). Prevention was mainly expressed via the popular discourse, whereas cure was represented, prospectively, by the expert discourse, and retrospectively, by the nationalist discourse. This combined order of discourse functions, we suggest, as a disciplinary "Discourses of Order". A proposed integrative CA/DA model relates content themes and discursive foci to the classical rhetorical dichotomy hope/fear. We see "Health" as struggling to uphold traditional besieged values under the new economic policies by using preventive propaganda in both medical and political terms. These findings are compared with expressed editorial policy statements.

Health Education↗

PubMed1974

Epidemic keratoconjunctivitis in the West of Scotland, 1967-72.

Outbreaks of epidemic keratoconjunctivitis have occurred among workers in shipyards and other industrial concerns in the West of Scotland in 1956, 1967 and 1971-72. In the most recent episode 220 persons were known to be affected and those mainly involved were shipyard personnel working on the open decks of ships under construction; only a few non-industrial workers were affected. As in previous outbreaks adenovirus type 8 was shown to be the causal organism. It is likely that spread of the virus was probably facilitated in some of the patients by such procedures as first aid measures to remove foreign bodies from the eye. A survey of the family contacts of those affected in 1971-72 revealed that only 2% were secondarily infected. This was probably due to propaganda measures to discourage the use of communal face towels, etc.Despite close virological surveillance over a period of 6 years of patients attending opthalmic clinics in the West of Scotland, there is as yet no clue to the whereabouts of adenovirus type 8 during interepidemic periods. It is suggested that travellers might be responsible for the introduction of the infection into an area.

Adenoviridae↗

PubMed1975

Tympanoplasty on only hearing ears.

The methods, results, and indications for operation on only hearing ears are discussed on the basis of 13 patients operated upon for chronic otitis media and its sequelae. Although good results were obtained, with an air-bone gas closure within 15 dB. in 77 per cent, this should not serve as propaganda for the general use of surgery on only hearing ears. On the other hand, they show that surgery on only hearing ears should not be rejected a priori and that on certain indications and under c ertain circumstanc es it may be carried out with minimal risk of aggravating the hearing loss. In most of the patients the indication for surgery was a progressing cholesteatoma, in some cases the sequelae of otitis, either in the form of myringoplasty or type II tympanoplasty, and one patient had the operation on a vital indication. To avoid postoperative exacerbation of the hearing, the patients must be strictly selected, the ears have to be pretreated conservatively, the Eustachian tube must be passable, the operation must be carried out by the most experienced otosurgeon, and thoroughly tested, very gentle operative methods must be used.

Adult↗

PubMed1984

Sin and mental illness in the Middle Ages.

The modern stereotype that in the Middle Ages there was a general belief that mental illness was caused by sin is reviewed. The authors examined 57 descriptions of mental illness (madness, possession, alcoholism, epilepsy, and combinations thereof) from pre-Crusade chronicles and saints' lives. In only 9 (16%) of these descriptions did the sources attribute the mental illness to sin or wrongdoing, and in these cases the medieval authors appeared to use this attribution for its propaganda value against an enemy of their patron saints, their monastery lands, or their religious values. The medieval sources indicate that the authors were well aware of the proximate causes of mental illness, such as humoral imbalance, intemperate diet and alcohol intake, overwork, and grief. The banality that, since God causes all things he also causes mental illness, was only used by medieval authors under special circumstances and in a minority of cases. It does not constitute evidence of superstitious and primitive notions about mental illness in the early Middle Ages.

Europe↗

PubMed2003

GM crops: science, politics and communication.

As the public debate in Europe about genetically modified (GM) crops heats up and the trade row between the United States and the European Union over GM food escalates, what better time to examine the issues with an international group of experts (Box 1). Their views are diverse, but they all agree that we need more impartial communication, less propaganda and an effective regulatory regime that is based on a careful case-by-case consideration of GM technology. It seems that GM crops are here to stay, so let us hope that these requirements are met and that the developing nations that perhaps have the most to gain from this technology can start to reap its benefits.

Communication↗

PubMed2000

[History of scientific and popular educational films in neurology and psychiatry in Germany 1985-1929].

Based on a survey of a variety of sources from medical and film history, an account is given of the history of scientific and popular educational films in neurology and psychiatry in Germany in the era of the silent film 1895-1929. A central event for the centralization of the production and distribution of medical scientific educational films was the foundation, in 1918, of the 'cultural department' of the Ufa film company which established, under the direction of the neurologist Curt Thomalla, a large medical film archive. Curt Thomalla was also the first who developed a dramatic type of popular educational film amalgamating medical and melodramatical features, thereby greatly increasing its mass impact, but also anticipating central elements of its later misuse by the Nazi film propaganda.

Germany↗

PubMed1998

[The relevance of ethology for psychiatry].

Darwin's evolutionary theory was the starting point for ethology, associated with an impact on scientific psychiatry. Psychiatry and ethology have common scientific and methodological prerequisites: inductive and deductive methods and "gestalt theory" as a basis for observing and describing behaviour patterns with subsequent causal analysis. There have been early endeavours to anchor ethological thinking in psychiatry but this tendency did not prevail for the following reasons: on the one hand, the methodology of ethology was immature or not applicable to man, whereas on the other hand the dominating experiential phenomenological school of Karl Jaspers and Kurt Schneider stressed the privileged position of human thinking, perception, and feeling. These fundamental categories of human existence did not appear amenable to any causal ethological analysis. Psychiatry and evolutionary biology were linked in an atrocious manner during the Nazi regime, both being abused for propaganda purposes and genocide. More recently, there is a "reconciliation" of both disciplines. In psychiatric nosology, operational, behaviour-oriented diagnostic systems have been introduced; ethology has opened up for theories of learning; new subsections like human ethology and sociobiology have evolved. The seeming incompatibility of (behavioural) biological psychiatry and experiential phenomenological psychopathology may be overcome on the basis of Konrad Lorenz' evolutionary epistemology. The functional analysis of human feeling and behaviour in psychotic disorders on the basis of Jackson's theory of the evolution and dissolution of the nervous system may serve as an example. The significance of an "ethological psychiatry" for diagnostic and therapeutical processes of psychiatric disorders derive from prognostic possibilities and the analysis of non-verbal communication in therapist-patient-interactions, but have not yet been systematically investigated.

Animals↗

PubMed1985

[Home childbirth and clinical delivery in the 3d Reich. On a memorial to the German Society of Gynecology 1939].

There have always been controversies on the pros and cons of home delivery and childbirth in a hospital. During the Nazi regime, the official "health command" policy monitored by the Nazi party promoted home delivery under midwife supervision, both by pertinacious propaganda and partly also by decrees and ordinances. The official line of argument against clinical obstetrics consisted of a queer and highly questionable mélange of ideology and distored facts brought forward by the so-called "Reichsgesundheitsführer" Dr. Leonardo Conti and his mother, Mrs Nanna Conti as head of the Party-sponsored Midwives Association. The "Midwives Law" was promulgated on 21 December 1938 prescribing compulsory consultation of a midwife for every delivery. By the end of 1939 gynaecologists eventually rallied in protest against legislative measures to restrict clinical obstetrics, by means of a memorandum penned by the German Association for Gynaecology. This memorandum was scheduled for circulation among all the members of the association. The pressure exercised by this memorandum resulted in tough negotiations amounting to a tug-of-war between representatives of the German Association for Gynaecology and Dr. Conti. This led eventually not only to an abandonment of the attacks against clinical obstetrics but also to an official and unreserved recognition of its achievements. In addition, the "Reichsgesundheitsführer" issued "Directives for regulating obstetrics procedures" in 1940/41 in which it was laid down that it would be left to the decision of the expectant mother to choose where she would prefer to deliver her child.

Delivery, Obstetric↗

PubMed1993

[Itinerant and established oculists of the 18th century].

BACKGROUND: The formation of scientific surgery in the 18th century was associated by the development of ophthalmology as a special branch of medicine and accompanied with a large number of more or less qualified oculists. A lot of them travelled practising throughout Europe, propagating their profession by handbills, announcements and booklets. In 1748 Frederick II of Prussia appointed Joseph Hillmer (born about 1720) from Vienna, who was a contemporary of John Taylor (1703-1772) as oculist and charlatan, an ordinary professor for ophthalmiatrics at the Berlin Collegium Medico-Chirurgicum. In 1752 C. E. Eschenbach, in the course of critizing Taylor's charlatanism, had called his century the "Okulisten-seculum". By the way many documents on travelling oculists have been delivered, first of all as to the English oculist, but the most important in medical and historical view concerning Hillmer. MATERIAL AND METHODS: Researches on 25 oculist, based on documents and newspapers from 1558 to 1806 (especially concentrated upon Berlin as Hillmer's residence) reveal the transformation of the ancient ophthalmiatry into ophthalmology. RESULTS: There have been resident oculists before the 18th century; their small number corresponded to the poor demographical situation at the time. For the last reason they practised partially travelling. Local medical authorities reglemented them by permission for practising within a given time. CONCLUSIONS: Many propagandistic publications about oculistic charlatans, mainly from their own hand, might make us believe, above all the early ophthalmology would have been characterized by travelling oculists, because their respectable and resident colleagues are documented less impressive, for the reason that they have not made as much propaganda, as charlatans made.

Cataract Extraction↗

PubMed2001

Regulating moral dissent in an open society: The Dutch experience with pragmatic tolerance.

In pluralistic modern societies, moral dissent will, to an increasing extent, be an inescapable fact in our lives. Moral dissent, however, involves various serious dangers: escalation of conflicts, the use of violence, flourishing of radical extremism and even civil war. There are basically two ways in which these threats can be addressed: coercive enforcement of consensus or tolerance. First, we could try to eliminate moral dissent by using more dictatorial forms of consensus formation, like propaganda, indoctrination and terror. This, however, would endanger or even destroy the open society. Therefore, from a moral point of view, tolerance appears to be the more desirable antidote to the unwanted effects of moral dissent. This paper aims to contribute to the discussions about the regulation of moral dissent and the formation of moral consensus by analyzing one of the most important and idiosyncratic elements of the Dutch way of handling these issues: pragmatic tolerance. First, some general thoughts are developed about moral consensus, moral dissent and tolerance as a means of regulating dissent. In addition, the characteristic Dutch policy of pragmatic tolerance is described. Finally, some of the pros and cons of pragmatic tolerance are analyzed from an ethical perspective.

Attitude to Health↗

PubMed1991

Least bad solutions to the 'drugs problem'.

This paper examines the current difficulties being faced in Australia by policy-makers attempting to regulate the non-medical use of illegal drugs, and it is suggested that the difficulties centre upon two aspects. First, existing prohibitions are unsuccessful, with use levels rising and, in some arenas (e.g. cocaine use in the USA), quite out of control. On the other hand, a move towards decriminalization or legalization is difficult because past propaganda has been so vehement that a change now apparently risks sending the wrong messages to young people. This dilemma means that there is no solution, including inertia, which is risk-free, nor is there one free of difficulties. It is thus relevant to think in terms of 'least bad' rather than 'best' when formulating a system to face these problems. The exploration of what this least bad solution might be begins with the examination of the prominent myths (such as 'the drug-free society', 'the evil pusher', 'the user as victim' and 'the young person as cultural dope') that hinder our reasoning. Secondly, by suggesting that, in a climate of increasing crime related to drugs, inability of prohibitions to control that use and escalating health risks attendant on use (including the AIDS problem), the central policy thrust must be harm reduction and damage minimization rather than illusory goals such as widespread abstinence. The paper concludes with a discussion of some relevant evidence on alternative options.

Journal Article↗

PubMed1997

Effect of antimicrobial use and other risk factors on antimicrobial resistance in pneumococci.

Penicillin-resistant and multi-resistant pneumococci have spread globally and reached high prevalence in many countries. Antimicrobial use is considered a major driving force for resistance, although the influence in the community has not been as clearly demonstrated. Other risk factors may be important, and only with a clear understanding of the risk factors can effective control measures be introduced. The main habitat of the pneumococcus is the nasopharynx of children. Carriage increases from birth and is maximal at pre-school age. Antimicrobial use in children is likely to have a significant influence on the susceptibility of pneumococci. Most studies looking for risk factors for resistance in pneumococci have identified antimicrobial use as a risk factor, especially the following aspects: ongoing, recent, repeated, frequent, and prophylactic antibiotic use. The effect of individual classes of antimicrobials has not been studied in detail but use of beta-lactam antibiotics and trimethoprim-sulpha has been associated with increased risk. Other risk factors are young age, nosocomial acquisition, prior hospitalization, and HIV infection. Day-care centers can facilitate the spread of resistant pneumococci and an Icelandic study showed that carriage of resistant pneumococci was associated with young age, domicile in an area with high antimicrobial consumption, recent antimicrobial use, frequent antimicrobial use, and use of trimethoprim-sulpha. The rapid increase of penicillin-resistant pneumococci in Iceland was met with propaganda against overuse of antimicrobials, which lead to reduction of antimicrobial use and subsequently a reduced incidence of penicillin-resistant pneumococci. This reduction may be related to reduced antimicrobial use. Reducing antimicrobial use should be considered important for programs aimed at reducing antimicrobial resistance.

Child↗

PubMed1994

Nationalism, race, and gender: the politics of family planning in Zimbabwe, 1957-1990.

In line with a general tendency of nationalists to hold pro-natalist views, African nationalists in Zimbabwe took a hostile position to family planning upon its introduction in 1957, arguing that it was part of a conspiracy to control the black population. However, it was only after the unilateral declaration of independence in 1965 by the white settlers under Ian Smith that an official policy aimed at reducing African fertility emerged. The African nationalists waged a consistent propaganda campaign against this policy, and the facilities that were established under it, as well as their personnel, became military targets during the guerrilla war in the late 1970s. After independence in 1980, the triumphant nationalists tried to maintain their pro-natalist position. But, with a postwar 'baby boom' pushing the birth rate close to four per cent by the mid-1980s, the officials in charge of economic and social development concluded that society could not sustain such a high fertility rate. Consequently, there was a reversal of policy, and by 1990 Zimbabwe had become an internationally recognized leader of family planning among developing countries. For the most part, however, these changes have taken place without any real input by African women, who remained largely excluded from the male-dominated circles in which decisions about family planning were made.

Family Planning Services↗

PubMed2001

Recognition of social parasites as nest-mates: adoption of colony-specific host cuticular odours by the paper wasp parasite Polistes sulcifer.

Colonies of the polistine wasp Polistes dominulus are parasitized by the permanent worker-less social parasite Polistes sulcifer. After usurpation of the host colony, parasite females are characterized by a change in the relative proportions of their cuticular hydrocarbons to match those of the host species. In this paper we present evidence from field data and laboratory experiments that P. sulcifer females adopt a colony-specific host odour that facilitates their acceptance by host females of the usurped colony. Presentation experiments demonstrate that parasite females are recognized as foreign individuals by workers of other parasitized nests. We show that the modification of parasite cuticular compounds is sufficient for this recognition. This provides evidence that, after invasion, P. sulcifer queens do not require appeasement or propaganda substances for their acceptance by host colonies. Furthermore, multivariate discriminant analysis of the cuticular hydrocarbon proportions of the parasites after usurpation assigns the parasites together with P. dominulus females of their own host colony. To the authors' knowledge, this is the first confirmation that social parasites adopt colony-specific host odours.

Animals↗

PubMed1979

Strategies, systems, value judgements and dieldrin in control of locust hoppers.

The physiology and field biology of locusts have been extensively studied, and ecological control of Red Locusts has been investigated by field experiment. No fruitful or even promising non-insecticidal method of control has emerged. An effective and economical system requires an insecticide that is: (i) effective at very small area dosages, as a stomach poison placed on the natural vegetation can be, if it is also cumulative; (ii) persistent enough in sunshine and rain to retain effectiveness over the locust's non-feeding periods; (iii) capable of being well distributed by well-tried methods; and (iv) not dangerous to users or consumers and posing a minimal overall risk. Only one insecticide, dieldrin, satisfies all these requirements. Dieldrin is not in the small class of insecticides that are dangerous to man by skin absorption (such as parathion, arsenicals, DNC) and, at the area dosages needed for locust control, is not dangerous to stock. The Sayer exhaust sprayer in a Land Rover, with work rates of the order of square kilometres per hour is excellent for many situations; aircraft spraying at he rate of square kilometres per minute is quicker and less subject to difficulties of terrain, but requires trained and appropriately directed aircrew. Apart from checking, aircraft methods require no party on the ground to find, assess and control locust hoppers. Several ideas about dieldrin are found to be based on insufficient evidence and are probably not true: for example that dieldrin in the atmosphere at a few parts in a million million (10(12)) becomes concentrated in a food web and harmful to man, or that dieldrin is carcinogenic in man. It is noteworthy, however, that one species of antelope in South Africa is exceptionally susceptible to dieldrin poisoning, though harm occurs at area dosages considerably greater than are required in the method of aircraft spraying of Courshee & McDonald (1963). To attack tsetse flies, emissions two orders of magnitude greater have been used. Care must be taken with any insecticide, but the risks of using dieldrin as properly used in locust hopper control have been exaggerated by propaganda. If harm is to be expected, then a quantitative comparison of that with the undoubted benefits of locust control is required to enable one to make a value judgement.

Aircraft↗