1341

political involvement in Africa). Citizens who go abroad are nowscreened, but the exemption of visitors to the country from

screening represents potential for introduction of infection.Development of their own serological tests (validated with

collaboration from Brazil and Sweden) and the provision of facilitiesfor the tests cost approximately US$3 million, while the programmeof screening all individuals aged 15 and above has cost [2m per yearsince 1986. The educational programme takes second place in HIVcontrol.The quarantine policy is said to be under constant revision. Since

there is no immediate prospect of an effective vaccine or othermeans of eradicating the infection, there are tentative plans toreintroduce selected infected individuals to the community. In themean time, even when their views are specifically sought, membersof the public do not express their disagreement with the policy.

1. Perez-Stable EJ. Cuba’s response to the HIV epidemic. Am J Publ Health 1991; 81:563-87.

Trials progress report

Do patients with symptomless prostate cancer require immediatetherapy? 700 patients have been recruited to a study of immediate vsdeferred prostatectomy or hormone therapy, the only randomisedtrial in the 40 years of hormone treatment for prostate cancer toexamine this question-but 2000 are needed for an unequivocalanswer to be obtained. Similarly, 400 patients are required for thetrial to confirm whether the superior survival rates obtained byJapanese surgeons for advanced gastric cancer is the result oftheir practice of radical resections involving extended

lymphadenectomy. The trial required the recruitment of surgeonsable and willing to do the operations in a standardised manner. Thestudy was begun in October, 1985, but cases are not beingaccumulated as fast as the expected rate of 4 per surgeon per year.311 patients were recruited in the first 3 years, but only 153 weresuitable for randomisation to standard resection or to radical

procedures. More participants are needed. Dutch surgeons areabout to start a similar trial, and there are plans to pool the UK andthe Dutch data.

Attracting participants for their trials was one of the aims of theMedical Research Council’s Cancer Therapy Committee in

producing the report of the activities of their working parties.Another was to show participants the achievements of the trialsorganisation to which they have contributed. Publications of thiskind are bound to be of interest to many, whether or not past,present, or potential trial participants. The descriptions of the workof the various working groups are a good summary of the issues thatneed to be settled. Data from completed trials are presented in clearand simple tabular or diagrammatic form (these tables andillustrations are available as teaching slides). And there must havebeen many a time when one has wondered what stage a trial has

reached; such information is usually hard to obtain elsewhere.

1. Medical Research Council Cancer Therapy Committee Report 1990. London. MRC.1991. Pp 109.

In England Now

I met Kieran again at a meeting recently, and we spent half anhour catching up on each other’s news. Kieran is the occupationalphysician for Lincaster Health Authority and is outspoken on mosttopics. "Playing the devil’s advocate", he calls it, but he invariablyends up in court or on the television, which, of course, as a goodIrishman, he relishes.

"Solvents", he said after a while. "Oh yes?" I replied, sensing aKieran specialty. "Yes, solvents. A solicitor rang yesterday for myexpert opinion." Kieran recognises himself as an expert in

everything from blue-green algae to electromagnetic fields, so a newexpertise came as no surprise. I plugged him further.

"The solicitor represents two octogenarian sisters who have run asmall dry-cleaning business for sixty years. They claim the

dry-cleaning fluid has caused mental deterioration and they want tosue the company that makes the solvent. The solicitor sought myservices but that is the only sensible thing he has done so far.

"First I asked him whether he had the datasheet on the solvent; hehadn’t. Had exposure levels been measured? No. Which neurologistexamined the old girls? They hadn’t seen one. What were the resultsof the psychometric assessments, CT scans, EEGs, and relevantblood tests? Were they necessary, he asked? And no, he hadn’tapproached the manufacturer. He did have a letter from the generalpractitioner, who was sure that the dementia was due to solvent,however."When I told him that probably wasn’t much use and there was

no good evidence that exposure to solvent caused dementia, he gotquite annoyed and asked if I could recommend any other experts.""And did you?" "Of course. There are three other experts I know,but didn’t tell him that two work for the manufacturers and the thirdis an academic in Japan."

"

This all seemed a bit disappointing for Kieran. I’m still waitingfor another incident on the scale of the body mass index at

pre-employment screening episode. That ended with a

confrontation between Kieran and fifty overweight and very angrydomestics on live television. He obviously detected mydespondency and so kindly reassured me that he felt there wasbound to be more mileage in this one.

Funnily enough, I bumped into Kieran shopping with his wife afew weeks later. "Any more on the solvents?", I asked eagerly. No.came the somewhat muted reply. Then I noticed that Kieran wasbeardless. His beard has always been his pride and joy, which hestrokes while passing some expert comment on television. "What onearth happened to your beard?", I exclaimed, incredulous that Ihadn’t noticed its absence sooner. Kieran took a sudden interest inan adjacent tobacconists’, which is also strange for a man who has anasthma attack when exposed to cigarette smoke. I turned myquestions to his wife.

"Kieran managed to stick a carpet tile to his face at the weekend",she obliged. "The staff at Lincaster General had quite a jobdetaching him from it." I was still not much wiser but persisted."He was laying carpet tiles in the hall", she explained. "All went

quiet for a long time, so I went to investigate and found himunconscious with his face stuck to the floor. The hospital thought hemust have been overcome by the solvent in the glue as he hadn’topened the windows."

I looked around to see Kieran through the shop window about tobuy a pipe.

I’ve decided not to mention solvents for a while at least untilKieran’s beard grows back, but I am just wondering if that pipe isthe first sign of dementia.

* * *

It is true, or so it seems to me, that the older you get the quickertime passes. My psychologist colleagues have an explanation:something to do with the proportion of time one has been alive-ie,at age 10, one year is a tenth of one’s life, whereas at 60 it is but asixtieth and thus appears to pass more quickly. Well, maybe. But Ithink that, as with so many things these days, market forces have alot to do with it.Once the nation drags itself back to work in January, the shops

shriek "Valentine’s Day" at us; on Feb 15, out come the Easter cardsand chocolate eggs. On Easter Tuesday this year, our local

newsagent brought out the 1992 calendars, and that has really upsetmy internal clock. Normally, at this time of year, one has a briefrespite until, in August, the first Christmas cards appear, a preludeto the Season of III Will, with crowded shops, inflated prices, andinflamed tempers. So we have reached the end of another year,whilst somewhere are warehouses packed with Valentine cards,Easter bunnies, and witches’ masks-to say nothing of 1993calendars-ready to begin the giddy cycle once again. Thus, thanksto market forces, we are constantly looking weeks or months ahead,never able to enjoy the fleeting seconds as they pass, merelyregarding them as padding between one pseudo-festival and thenext.

Or is it just that I am getting older?