681

Young People in Scotland, and The Register of Helping Agencies.Some of the funds will go towards continuing support for training indrugs misuse for professionals and volunteers working with youngpeople.

UK AIDS CASES BY PATIENT CHARACTERISTICS

CUMULATIVE TOTALS UP TO END OF FEBRUARY, 1989*Males Females Total Deaths

Homosexual/bisexual 1726 - 1726 906Intravenous drugabuser 31 12 43 22

Homosexual/bisexualmale and intravenous

drug abuser 33 - 33 15

Haemophiliac 136 2 138 84Recipient of blood:Abroad 10 11 21 14UK 11 5 16 13

Heterosexual:

Partner(s) with aboverisk factors 5 10 15 7

OthersaKnown exposureabroad# 44 18 62 25No evidence of

exposure abroad 5 2 7 5Child of at-nsk orinfected parent 9 11 20 10

Other/undetermined 21 1 22 15Total 2031 72 2103 1116

*Table prepared from voluntarv confidential reports by clinicianssent directly to the PHLS Communicable Diseases SurveillanceCentre (01-200 6868) and to the Communicable Diseases (Scotland)Unit (041-946 7120).tPartner(s) not known to have above risk factor(s).+Includes persons, without other identified risks, from countrieswhere heterosexual transmission is common.

At Feb 1, 139 886 cases of AIDS had been reported to the WorldHealth Organisation’s Global Programme on AIDS (GPA). Thesefigures, reported from 144 countries (compared with 129 last year),represent an increase of 65 000 cases over the past year. Of the 177countries reporting to GPA, 33 have not yet reported any AIDScases.

SAVING MONEY, SAVING TIME?

MAKING some medicines more easily available could save

millions of pounds in general practitioners’ time and in convenienceto consumers-[2’ million per year in the case of loperamide and2-0 million for 1% topical hydrocortisone, according to theauthors of a report from the University of Aberdeen’s HealthEconomics Research Unit.’ Ryan and Yule have applied theeconomic theory of consumer surplus (the difference between whatconsumers have to sacrifice in terms of time and money to consumea good and their willingness to pay) to estimate the net benefit topatients and doctors of switching certain medicines from

prescription-only (POM) to over-the-counter (OTC). Into the

equation come the average waiting time at the general practitioner’ssurgery (costed at the Department of Transport’s valuation ofleisure time at 153’2p per hour, and more if the patient has takentime off work to visit the doctor), travelling expenses (to surgery andpharmacy or to pharmacy alone), and the difference between theprescription charge and the full cost of the OTC medicine. GPs’time is estimated at 19.19 per hour. The number of prescriptionsfor topical hydrocortisone appears to have been unchanged by theintroduction of an OTC substitute in 1987, but 46 700 hours ofGPs’ time (assuming a 5 min consultation was saved on everyprescription not written) were released from loperamideprescribing in the same year. All of which goes to show that allowingpatients to obtain their antidiarrhoeals direct from the chemist’sshop has given British GPs CO-9 million worth of extra time.

1 Ryan M, Yule B The economics of switching drugs from prescription-only toover-the-counter availability. Health Economics Research Unit, University ofAberdeen, discussion paper no 02/88. Copies available (price £2.50) from Mrs D.Ellis, HERU, University of Aberdeen Medical School, Foresterhill, AberdeenAB9 2ZD

WIZARDS OF IgCOME on a journey, through time and through the body. From

Jenner’s eighteenth century England to twenty-first centurypsychoimmunology. From the thymus and the chicken’s bursa ofFabricius via T and B cells to natural killer cells and complement.The Thorn in the Starfish’ by Robert Desowitz is an armchairjourney, but nonetheless rivetting. This is a book about

immunology, a jargon-ridden science--we are "in the midst ofimmunology’s Imperial Period", says Desowitz, who manages toblend laboratory science and clinical medicine into an

understandable and factual account. The story about Jenner’srosy-cheeked milkmaids is added to-he experimented on

workhouse children and his nephew infected a child with smallpoxas a "control". Besides the history we are offered an "owner’smanual" to the immune system, the immunological effects of

smoking (both harmful and, possibly, "beneficial" in asthma andulcerative colitis), AIDS, and a look at the future, includingtargeting of treatment with monoclonal antibodies. And let theauthor ride hobby-horses about dietary supplementation (selenium,zinc, vitamins) and disease in the "hungry" world. There may befierce argument about the former, but the prevention of millions ofchild deaths from diphtheria, pertussis, tetanus, measles, polio, andtuberculosis must be a priority for doctors. A fictitious day in the lifeof a health-worker in a developing country shows the practicaldifficulties in the field of, for instance, the WHO’s ExpandedProgramme on Immunisation. This book is science at its popularbest, written to be informative and interesting for both lay peopleand professionals. Books such as this should head students’ readinglists and be prominently displayed in health-food shops. And thethorn in the starfish? Elie Metchnikoff, a Russian scientist whoworked with Pasteur and was a co-winner with Erhlich in 1908 of aNobel prize, proposed the phagocyte theory of defence againstforeign bodies. Metchnikoff inserted rose thorns into starfish larvaeand the next day he observed mobile cells surrounding the thorns.

A VAIN SEARCH FOR BEAUTY

HYDROQUINONE, which i found in skin-lightening agents, hasbeen associated with hyperpigmentation of the skin. The lesions canrange from faint sooty macules to keloid-like nodules or cysts. Theextent to which these adverse effects occurred led South Africa to

legislate, in 1983, that skin-lightening agents should not containmore than 2% hydroquinone, and that they should contain asunscreen of at least sun protection factor 5, because the action ofhydroquinone is thought to be photoactivated.

Skin-lightening agents continue to be widely used in SouthAfrica, commonly because fairness of skin is equated with

beauty-nearly 20% of the 195 general outpatients aged over 12years surveyed by Hardwick et al2 were still using them at the time ofthe survey; 87 (45 %) had used them at some time. Despite the 1983regulations, more than 7 of the 12 subjects who had been usinglighteners since that date had hyperpigmentation.

According to the authors, South Africa plans to ban over-the-counter sales of preparations containing hydroquinone. Theysuggest that other countries follow suit.

THE WAY OF SOME FLESH

SOME New Zealanders, especially those of Polynesian origin, arereluctant to part with bits of their bodies, and requests to hospitalsfrom patients who want to take home their severed limbs andexcised organs are usually granted. But a police homicide inquirywas begun recently when part of a leg was found in a river, wedgedbetween two rocks The limb was traced to an 18-year-old girl, whohad undergone amputation at Auckland Hospital. Her father,wishing to fashion a bone necklace for his daughter as a memento ofher operation, had placed the leg in the river to allow the elements to

1 The Thorn in the Starfish By Robert S Desowitz. New York WR Norton, 1988Pp 270 £495 ISBN 0-393305562

2. Hardwick N, van Gelder LW, van der Merwe CA, van der Merwe MP. Exogenousochronosis; an epidemiological study Br J Dermatol 1989, 120: 229-38.

3 New Zealand Herald March 11