Document ExqjkkEX3Nd6qYL5Ky0ywV1pN

vi. m n. i CORRESPONDENCE MS Tabiu 1. Svrum Conoantratton* of SvivnHjm. Coppvr. and Bna in PHanta with Alcoholic Ckrhoaia and Control Subjects. Otn (No. or * MKTI) SttiMiM ' Com* mmttfrrUMr Xme Coatrok<40) Patterns Rb 1.53*0.23 0*4*0.20 t.0*3 5 11.1*5.01 13.0*3.0 9.3*3.t rtwds<H> NMM Sy Mm'i i-hm. trtet tfM0swWy MMM Mom nmnI vWws. |r<ftOI *y SmOmM'i MM. rkMk prophylactic aslanium supplementation should be con* Jan Aasbth, M.D. Aker Hospital Yrovak Thonaucm, Cand.Real. Jan Aumiom, M.D. Institute of Occupational Health Oslo, Norway Gunhar Norhum National Veterinary Institute I. lewd It, Tktoiassm Y. Lswguiyltr FJ. Direst ilstttotbsnwal atomic ab sorption ipnHonstrlt foewtafosttos of Mlewtxst m nr--. AaaiCWm Acta. I99R mm*. ___ _ 2 Imudt M, fovb W. Aotoutaisd trass saslysss sf sniK ssmpiss using tbs "hpuM-- mUmd" of Itoms AAS: s tsvisw. At Absotpt Nsosin. 197R 17-JCM3. i. apfosk AT. Mmsbslls aspssts of ssMum actio* sad loridty. CRC Ok ft-- TsafcsL 197* 4071*529. A MaB PM, Mackfonao AM. Cssksisy WOE, WHBams DR. Ahohahe best dkaaost tsvisw. Psrtiilsgy. I99fo 11:47747. mj, Mus ut --s*s m. AnH*. Utuanm.. ,ya.gnio puituuiui -M---N. M- u* u m' - m * Ims lojury. Pad Pros. 197); 32:197541. A Cmapsrti M, BsasdMti A. CkM E. flufras on in vitro psrwidmisw of Hear lipids is nhisul iwnid rota. Lipids. 1973:1:499-502. CANCER IN INDIA T Mr Attar: In 1979 we were invited by the World Health Organfootfon to address dm cancer problem in Indio, as the first reamtfodJoint facial Amarksa hesdth miiiicn to a third country. In -Mbs Incidence af emmar and ks martafity appear to have in* creased in resent years, wkb 500,099 to 790,000 now cases per gsor1-* and so sstlmasad mortality of 509^000 in 19^ fThangowrilu 39*9*9 to 199,099 writsmd only a fcw years artier.* The yean In 1999 m ovor 59 yaan cuwuwdy,* baa waked in a marbed inwaaee in the ska ef dm papufotfoa. Current psajictiaaa set the country^ papuladan at nearly 109 miWan by 1919. Cancer af amny types aaeun In India bt patients 10 to IS yeare younger tbon thaw in the linked States and mam Western ssuomie*. Bum dm tacidcaca af cancer k about 100:100,009 in htdb>>> and 399:199^99 In the linked States,1 k is passible that the sampitsties youthaf Indian patlsnti with cancer simply reflects the absaruatfons that racial or geographic dMhrsnces moy exist m the biafoglt btbouiarffiams forms sfcancer (Shanra V. Ptnanal cosnamnlcaeion); iberefon genetic or environmental factor* may be in* Akbnugb dm only pspulstl-- hand cancer registry is located in Bamboy and kmtodea only the papulation ef that area, individual hospital matMe* dearly indicate that the two organ sites moat commonly bmafoad are dm uterine cervix in women and the ora) cavhy in both seats. These two shea represent apprsuimoiety half the cancer cases in the country, with oropharyngeal cancer about 1.5 timet as prevalent at cervical cancer. Control of these two Unde of cancer would provide the major part of cancer control in India. There seem to be severe! causative factors in these two principal cancers. Oropharyngeal cancer appears to be associated with chew ing pan (a mixture ofbetel nuts and various seeds and spices, usual ly including tobacco in a betd leaf)* and smoking bods (a crude So* bacco cigarette).*1 Cervical cancer it probably related to the poor genital hygiene found in many women, the early age of tnarriaps and nulliparity.* It may or may not be related to the absence ofctr* cumchion among Hindu husbands. It is important to note thot both kinds of cancer are easily accessible for physical tntssitinmian and can be diagnased by cytologic techniques at the early stages of the disease. The cure rate for these neoplasms is very Wgk if they are treated surgically at Stage I or II. In most cases, patients go to a medical facility when the disease is far advanced and no longer amenable to curative treatment. .About SO to 90 per cent of patients are first seen at Stage III or IV. Came quertly, a large portion of India's resources for the monapement ef cancer is allocated to facilities for radiotherapy, to which cervical and oropharyngeal cancer are semkive and which only provide pah liatfoafofTforge proportion ef puttmm* supply of phyiiatfot dlitles and personnel is inadequate to treat the many puritan wise present with for advanced disease; the (May allows propemfon ef the disease and probably contributes to the high mowsIky rase. Philadelphia, PA 19129 Alton I. Scrtsca, M.D. The Metfical College of Pcimsylvatda Moscow, U.S.S.R. Yuri 1. Puckrov, M.D., Pn.D L.S.S R. Academy of Msdfoal Iiisnsss ipscM refsi--ce to Gujarat Stats. G^an* Mad I. 1979; 2554. 2. Wahl PM. Problem ofc--m. Report ofiliv Nsdowsl Sswissr--C--r CostroL Now DsIM, Psesmksr 3*23, I97A 3. Mkrov O. CstsbBshawm of rsploost causer esatm in fodfo. WHO As dpamsat Repot*. March-May, I97A 4. Sutxkk Al, ftMbkov VI. Tbs hssMb sat* $jmm in Mis. Am lass-- MsA (ia press). 5. Dutta M. Poskat book of keskib ststhtics of Mk. Now Dsfofe Csalsal Bureau sf Mssitk latsfogsacs. Directorms O--srsl sf Hsahb Scmosss, Mtsisiry of Hsohb sod Family Writes. 1979:12. 6. TMrd National Causer Survey (NMtoaal Cmm lasduns Maosp--b 41). Wssbiagtsa. D.C.: Covcram--t Priadag Office. I97A 7. SsngvM LD, R-- KCM, KhmoAsr VR. lattlq and <hh f mb-- ia triad-- to esnear of tbs upper sfonemary tnm. brMsdJ. 1995: 1:1111-4. I. LMkre UK, WaM PN. Ptabhahar AK. Rani A. CslmiMulri fSnsn In tks indurtfoo of prscanecro-- sod omesrowMo-- of xtasiosunk Report of National Ssmisiar on Can--r CenuoL New Psfoi, Dssnubar 2-23, I97A ro^wThwiutfryu | 7s (As RRm-lpV^Mt iftim Ht the Jmmmt, Rapa lag* Jose, CaltL) we have had sn interest in tbs psmibilky dmt tbsmhaI pollutants are present in the mUk of dssmrs to the bank. We as* studying methods of colletliwp, processing, and dfotributing humaw milk to sick infants unable to obtain suBkhot mBh hem their mothsta. In 1979 we analyaed 25 sampfos of milk from apptovtd dmwts. This study was dsns in conjunction with the Enviromnsnsal Hsabh Agency (Wanasch--, Wash.). A careful history of dm donor wo taken, which included place of birth, exposure tv podddes, and history of smoking. The level (in parts per bflMon) sf^pDDT was I90AI49, and that of p,p*l.l-dichioro*2^*t-- cthykne (DDE) 2130*1459. llte foBowing reskhm were not found at the level sf sensitivity of the test methods used: dieldrtn (at 1 ppb), hcptachfor, hcpiocMor spowlds, onychlordane, s,p-DDT, 2-ben-- beamhlo ride, heuacMo-bcntene (at I ppb), TNC (at I ppb), cbfordanc (at 30 ppb), Mirex (at 30 ppb), and pafyeMsrfn--sd Mphxny# (aR HONS 001532 *46 THE NEW ENGLAND JOURNAL OF MEDICINE Or. t*, iMO DOT keels found in the samples ~wr* similar Imit in various report* sumtnariaed by Repn et al. Other pesticides reported by Savage* were not found t detectable We rporvU** that careful screening and selection of donors to a milk bank may reduce the risk of contamination with chemical pol- San Jose, CA 95128 Jamks R. Hasson M.D. Mabia Tsmia Asquith The Institute for Medical Research *Sa*gs EP. Natiowal study to duenaiae Iswis of rMeriamed hydrocar bon inteeticiaas in hnasao wW, I97S-I97*. nipplsmaotsn report to the NationalMilk Study. l9TS-t979.SpriagHaM.Vau Nations!Tsdmkai Infor mation Serrice. 1977. The above letter woe referred to the author* of the article in ques tion. one of whom offers the following reply: 7s Mr Ettsr: 1 thank Dr. Harrad and Ms. Asquith for their com- sensiriritkt, laboratories vary to an entraardtoary degree in the dcterminations aftrace amount* of chemicals, This is true ofany hightecfioolagy, relatively new procedure for which no national quality aeaorance program mists. Thus. Harrod and Asquith's finding* may represent a different laboratory technique or different levels. Secondly, it should be emphasised that with aur current ignorance af iOneso attributable to chemicals at these levels in breast milk, "speculation" about screening is indeed speculation. An otherwise quriifitd donor should nut be barred from participating in a pi cigram solely on the basis ofsmall amounts af ehentieal contami nants in her milk. Research Triangle Farit, NC 27709 Walts* J. Rooax, M.D. Marions* Institute of Environmental Health Sciences STOOL CAMOUFLAGE BY COLORED TOILET WATER 7a fo Ufo; Same patients are unable to report hcraotochcsia or merino: seme nuty not he able to see well enough because of post not lead to a costly compulsum toward dunliiwn for dmt reasons. Tint of aN, the literature on plannod behoworal change makes it dear (hat simply providing lafarmatlsa to an a massive efforts are mounted to promote behavioral change with she latest behavior-management techniques, a high |iiirtnisgi of the cases revert back to base-line behavior levels within a year.* With ruch results among persons who are prrsmnetl) jspktsriniid ks promoting behavioral change, we should not get too upset with even the most mischievous efforts at public mfeinfcrmstiaa w with the resulting untidiness in the health-education literature. Secondly, any such attempt to censor the health-rotated infer mation that it available to the public wifl only encooragr a variety of `'liberation" groups to produce underground or afisraarim pub lications. Many people in our society not only host ao interest in scientific respectability but actively rebel agrimt it. H nanaeianrific health-education materials are available, it is heratne a marbit soists for them materials, l.e., a considerable number *f people we willing to purchase that kind of product, for whatevsr reason. Urn fete some restrictive and Qppressivr censorship ie imposed, the wmL ability of a house-tidying magnum ague wiR do Knls tuaffsn that market and may only further twomagr it. Finally, even though it would take 10 years to pmttae. thfo prop eet would be outdated themmute it mm produtid bacataesfdte great advances in nwdkal and beakhknovriedga andin behnwarah social, and educational pracricesi This would lead So an unendbtg series of 10-year efforts, cadi with substantial budgets: a very costly product with Kttle justification or need. Charleston. WV 25304 Tom OtaanowsUL PW.D. Wcr VlrgWn IMecnity Medkal Ccntv 1. Marsloa MV. CompHaMe with statical tsgiaMn: a icrie* oftheKnew tore. Ners Res. 1*70; 1*312-23. 2. Watkkt JO. Roberts DE, WBNaan TF. Mtkt DA, Cayfo V. OOssevo- brtt*. (9*7; IfcW-S. 3. AmkoM RC, Adsboaeje FO, CaOea BR, Csffes J, Carts K. fetio RC. Patients aad prmriptiaws: *wpf*k*Mfaa sod tsaplasn orth m* 9:4g-5l. 4. Rresoegor NA. sd. Tbs hikoriarsl sterns ofsmoking. (NIP* wmwk monogrspfc 2d). Wsiklngtoa, D.Cj OovennoMS PriaOag OKfo I9VR (DHEW puMfosdaa oa. (ADM|7MRZ) Soma people timpif pay no attention to their facta. 1 recently cared for a woman whose meieno was mashed by blue tariff water. In her bathrssm a pepulor toilet cleaner and deuduriier hod been placed bi the toifot took. This product contains blue dye to indicate its level of effectiveness, but unfortunately it may eamauflage an abnormal stool. Whan Inquiring about hsmoiochstia or merino, the clinician should be alert for conforing loriratiao in the commode? Marshfield, Wl 54449 Roognr G. NonrtnsT, M.D., F.A.C.F. Marshfield CUnk BRINGING ORDER TO HEALTH-EDUCATION LITERATURE 7a Mr fitter In his Sounding Board in theJune 2d issue, Davies castigated the health-education (iterator* for consumer* (and, by intpWtatitn, health educators) for having an "untidy" house. I think that Darias' home sitatting proposal is unfounded. Much of the dfoenky in health education materials tab* because the hems ere designed for differing groups with differing needs, differing cul tural characteristics and skiffs, and differing Reals for changes in health beharier. This hind of diversity in the availability of materi el* is valuable, if perhaps untidy, since k demonstrates sincere at tempts to reach new populations with useful information. We must also recognise that a certain psrctntage of this material u pro duced by charlatans; recognition of this problem, however, should 7 (hr fitter: As a librarian, I take exception tosmut *fthe mow ments in Dr. Dories' Sounding Board. He singles euf arinerafeand vitamins as examples to include asnong die intirsits ef "sohfess, faddists, and opportunfota." Further in Ida article, he says, "Feed* first time, people will be able to go to the puhRc Mfeary, safest a book on health care that is filled fit the Uhrary for fieri* edbem tion, and knew that what they road fe sefentifitaRy aeeepmbfe." Are we to infer that ritamina and mmerafe am Moctaptakfe'To delete one type d mssvial hi favor of 0M*er io mneonfiipt and censorship is anathema to |tri Ubvosrimfiip. Furthermore; "seb entifkafiy acceptable" is a subjective term What lasoloDr. Dhrim may not be so to another. Have them not hems mtdferi regimme that began with great fanfare aad were suboeqncntiy nddbfiown and discredited? Falmouth, ME 04104 Rom Tnninmr 12 Wasson St 7s sir fitter; The Health Education Censor tforaryksFbMbnrgfi Is one of a growing number of rosomoes with mariy siosod and retrievablr health education moteriri "that can be fecased by anyaao with reasonable intelligence." The Cevmmmisy llvehh fidbsmm tion Network at Mt. Auburn lla^itri in Cambrics, Maaa* the Ptanetr** Health Reamrch Center m San Frantiam, and the Cem ter for Medkal Consumers and Health Cam Information m New York ar* others that immediately come to mind. We agree with Dr. Dorics that it is dUficuit to obtain amberito- HONS 001533