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Remembrance of things past

At nine, he suffered what seemed a minor injury to his left eye when a stick he and a playmate were throwing hit his lower lid. He could still see through it, but with diminished sight. Though his right eye was fine, premonitions of blindness began to haunt him. At school he became obsessed with re-reading a story “about a blind swan and another about a boy who had lost both eyes at different times”.

In Jackson he practiced almost being blind, holding a hand over his right eye, getting around as best he could with only his diminished left. When he visited the Institute for the Blind, he told a boy there that he did not know how long it would be before he himself would be a resident. He had a nightmare; “I dreamed I was blind and in the rotunda—the second story—where the capitol met and some of the boys had hung me over that place for fun”. Two days later he was demonstrating, for the children of the state senator at whose home he boarded, a crossbow that he had bought as a present to send to his brother. It was a fragile contraption, dependent on worn rubber bands. When the children asked him to shoot it, he said he “did not want to as it was not shooting well”. They insisted. “I had it standing there on the floor. I dropped the arrow down the barrel. I glanced down in the barrel to see if it was right and while I was looking at it, it went off. It shot me in the right eye blinding me on the instant.” His father took him to New Orleans for medical treatment. Whatever sight he had in his left eye and the flickers of sight briefly restored in his right eye gradually faded out. (Fred Kaplan.Gore Vidal, a biography. New York: Anchor Books, 2000:8-9.)

Limited potential for genital herpes vaccine

A recent report of large clinical trials of a vaccine against herpes simplex virus type 2, the strain responsible for most cases of genital herpes, was disappointing. Although the vaccine was effective in preventing new infection in a high percentage of women as long as they had not been previously infected with herpes simplex virus 1, it was completely ineffective in men. Moreover, since 70% of patients have been infected with herpes simplex virus 1 by the age of 30, this vaccine would seem to be only potentially useful in vaccinating adolescent girls. Nevertheless, its potential should not be minimised. Vaccinating adolescent girls with this vaccine promises to, if not to eliminate, greatly reduce neonatal herpetic encephalopathy, a devastating disease that causes significant damage to the central nervous system, especially the primary visual cortex. (JAMA 2000;Oct:1913–14.)

Scientific publication trends in the developed and developing world

One way to assess scientific progress in different countries is to analyse the publication rate in scientific journals. A recent study has done just this looking at this science citation index (SCI) of 160 nations from 1991 to 1998. During that period 85% of all scientific papers originated from three regions—Western Europe, North America, and Asia (Hong Kong, Indonesia, Malaysia, China, Singapore, South Korea, Taiwan, Vietnam and, in particular, Japan). Moreover, 70% were attributable to just Western Europe and North America. In contrast, the African continent as a whole produced only 1% of worldwide scientific publications during this period. This study also looked at the trends in publications from different areas to detect which portions of the world seemed to have an increase in scientific publications from 1991 to 1998. During this period, Western Europe increased from 34.1% to 38.5% of the total. This actually placed the continent of Europe ahead of North America. In contrast, eastern Europe had the lowest rate of increase with less than 1%. Other regions with strong publication growth included Asia and Oceania. Noteworthy is Japan which rose to the number two nation in producing scientific papers behind only the USA. If the present trend continues 10 years from now, the Asiatic region will collectively produce as many papers as the USA.

One of the conclusions of this study is that the ability of poor nations to participate in scientific endeavours is becoming less not more possible with time. The authors suggest that in a developing world, collaboration with developed nations provides a strategy to address these disparities. For example, this study showed that papers from Latin America, Africa, eastern Europe, and the Middle East had a foreign co-author on at least 50% of the publications. Worldwide, the most solicited partners for scientific collaboration were the USA, UK, Germany, France, Japan, and Italy. The study emphasises that scientific progress as judged by scientific publication rates is becoming increasingly concentrated in the developed world. For small economies collaboration with developed nations may be the best approach to increased scientific progress. The economic scientific gap between developed and undeveloped nations has grown dangerously large and the challenge to stimulate scientific productivity in developing nations lies not only with those nations, but with the developed ones as well. (American Scientist 2000;Nov–Dec:526–33.)

New antibacterial drugs and insects

Insects use a small peptide molecule to fight off bacteria. Most of these act by punching a hole in the wall of bacterial cells. However, they are not specific in this ability and would therefore be toxic to most mammalian cells as well. Recently, however, investigators at the Wistar Institute in Philadelphia have isolated a group of insect peptides that target specific molecules inside bacterial cells. The peptide that is present in the European sap sucking insect Pyrrhocoris apterous is called pyrrhocoricin. This peptide seems to target a “heat shock protein” referred to as DnaK. This is an essential protein in cells and when it is activated the bacterium dies. Although all species have their own version of DnaK, there is enough difference from one species to the next that the human equivalent called Hsp70 appears to be unaffected by pyrrhocoricin. Likewise, DnaK seems to have a slightly different structure in every bacterial species. This, of course, means that each peptide produced by an insect is only active against a narrow range of pathogens. Researchers hope to tailor artificial peptides to match well known pathogens and thus produce a broad spectrum of new antibiotic drugs. (New Scientist2000;Nov:17.)

A major public health crisis faces most developed countries

There is a growing group of multiply disabled children who were born prematurely. Infants weighing less than 1500 g now represent 1.5% of all live births in the USA. Some of these children suffer from severe hypoxic injuries and/or intraventricular haemorrhaging and develop specific pathological processes responsible for motor and visual disabilities—for example, periventricular leucomalacia or hypoxic encephalopathy. A significant number of these premature children did not suffer from any identifiable perinatal trauma which could be correlated with central nervous system damage but yet later in life they are found to have significant developmental delays. A recent study from Yale University suggests that in preterm infants regionally specific long term reduction in brain volume is associated with poorer cognitive and motor outcomes. This study was performed on children at 8 years of age who underwent magnetic imaging studies. Regional cortical volumes in these children were found to be significantly smaller than in controls. The abnormalities were primarily found in the sensorimotor cortex but also involved premotor, parieto-occipital-subgenual, and mid-temporal region, as well as the cerebellum. This reduction in volume appears in both white and grey matter. These reductions in brain volume do not appear to have been the consequence of acute destructive haemorrhagic or hypoxic regions. At the present time the specific pathophysiology for this reduction in brain volume is not fully understood but it does correlate well with the developmental delays so frequently found in premature infants. (JAMA 2000;Oct: 1939–47.)

Recommended reading

The Trail of Trust: The Collapse of Global Public Health. Laurie Garrett. New York: Hyperion, 2000 ($30.00).

The author of this book is a medical writer forNews Day and her style of writing is sometimes breathless. This was apparent in her previous best sellerThe Coming Plague. Nevertheless, in this present book Ms Garrett convincingly argues that the attention to public health in both the developing and developed worlds has decreased rather than increased over time. She is convinced that in the Western world physicians and medical systems are enamoured with expensive high technology therapies and uninterested in the fundamentals of public health. This is obviously a simplified thesis that the author documents in a number of circumstances where inattention to public health has significant consequences throughout the world. Not surprisingly, she turns much of her attention to the infectious diseases she discussed in her previous book. Despite the fact that her antiscientific view of the future of molecular and genomic medicine is off putting this is a book well worth reading.

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