Notes and News
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453 laboratories had been built to the highest modern standards and completely equipped, a large scientific staff was recruited, and new departments of virology, anaerobic bacteriology, immunology, and pathology were developed. During the next twelve years of intense activity his advice was often sought by foreign Governments and he made many trips abroad. Though retirement at the age of 65 was compulsory, Hugh Mulligan had no intention of resting and at once accepted appointment as visiting lecturer in the newly formed department of biology at the University of Salford, where he taught for the next ten years. Again he was in demand as a visiting teacher of tropical medicine at Brown University, Providence, Rhode Island, and as a consultant in trypanosomiasis control by the World Health Organisation. The last few years of his very full life were devoted to the compilation of an account of every aspect of research performed by the medical officers of the Honourable East India Company and the later Indian Medical Service, and this record will be published posthumously. His scientific publications, certainly exceeding 50 in number, reflect his industry and wide scientific interests: all are written with great clarity and fluency. Mulligan was a handsome, highly intelligent, and very active man who, though very modest, had a commanding presence and personality, coupled with great charm. He had a rich but somewhat cryptic sense of humour, examples of which are treasured by his many friends. Above all, he was intensely loyal to his country, his Service, his friends, and his subordinates. He was a proud and devoted family man, and he is survived by his wife, Rita, two sons (the elder of whom was the famous Irish scrum-half of the’60s), and a daughter. Members of his former Service will recall his name with pride and affection. J. H. W. ANTHONY FRANCIS JOSEPH MALONEY B.Sc., M.B.Edin., F.R.C.P.E., F.R.C.Path. Dr Maloney, senior lecturer in neuropathology in the University of Edinburgh and honorary consultant pathologist to the Lothian Health Board, died on May 13, 1982. He was 61. He was born in Edinburgh in 1920 and was educated at Edinburgh Academy and at the University of Edinburgh, graduating in medicine in 1942. During the 1939-45 war, he served in the Royal Army Medical Corps in Italy and was mentioned in despatches. He achieved the rank of major, and after demobilisation he returned to the University of Edinburgh and spent a year in the honours school of pathology. He received his early postgraduate training in pathology in Edinburgh and was appointed in 1950 to a lectureship in neuropathology in the University of Leeds. In 1953 he returned to the University of Edinburgh as senior lecturer in neuropathology. For almost 30 years in this appointment Maloney provided a superb service in neuropathology in the South-East Region of Scotland. He was a popular teacher with medical students, he contributed much to the training of many young pathologists, and he was a key figure in the postgraduate training of neurosurgeons and neurologists. He was particularly interested in head injuries and in the pathological effects of stereotactic surgery in Parkinsonism. Tony Maloney was highly respected as a neuropathologist by all his colleagues, both pathological and clinical. He was a man of many fine personal qualities-he was straightforward, courteous, loyal, and always ready to help those in need. He had a passion for clocks, about which he was very knowledgeable, and for traditional jazz, and he loved the peace and beauty of the Caithness coast where he spent many happy family holidays. He is survived by his wife, two daughters, and a son who is pursuing a career in pathology. A. C. Notes and News DRUG POLICY IN BANGLADESH AN article on the pharmaceutical market in Sri Lanka, published in The Health Services (Aug. 6, p. 18), contained a memorble remark attributed to one representative of a drug company: "What we do for the public good is a byproduct of what we do for our own private good". The author of the article, Prof. N. D. W. Lionel (department of pharmacology, University of Colombo), concluded that the widespread practice of self-medication in Sri Lanka prevailed largely because regulations to control the market did not exist or were difficult to implement. A national drug policy in line with World Health Organisation advice has been attempted by the Government of Bangladesh. A report produced for Oxfam by Dianna Melrose indicates that drugs sold over the counter in Bangladesh in 1978-that is, vitamin and tonic preparations, cough and cold remedies, digestants, laxatives, and analgesics-accounted for 33% of the market in terms of production, while antibiotics, antiparasitic drugs, and dermatological preparations accounted for under 23% of the market. Most of the bulk drugs were imported and paid for in foreign exchange. The report emphasises that malnu- trition must be treated with food and not with vitamins. A British doctor who has worked in Bangladesh points out: "Bangladesh is a poor country and can ill afford to spend foregin exchange on non- essential items. The nutritional problems of the poor will not be solved by expensively packaged multi-vitamins which will only divert limited resources from other more relevant purchases". The expert committee which reported to the Government of Bangladesh in May2 recommended the withdrawal of 1742 preparations marketed by 176 companies, including 8 multinationals which control over 80% of the market in Bangladesh. Under the Martial Law Ordinance of June 7, 240 products were to be withdrawn immediately and the remainder by December, 1982. A phased withdrawal of different categories of drugs over 3, 6, and 9 months has since modified the Ordinance. 150 drugs have been defined by the Government as essential to the needs of the people, and the international companies must now consider how to restructure local production of these essential drugs. At present 90 of these drugs are not produced at all in Bangladesh because, as the expert committee put it, "though the multinationals have all the technologies and know-how to produce sophisticated essential drugs and basic pharmaceutical raw materials, in Bangladesh these companies are engaged mostly in formulation of simple drugs including many useless products", such as vitamin mixtures, tonics, and gripe water. In the Oxfam report Dianna Melrose emphasises the high cost of finished drugs in Bangladesh by comparing the purchasing power of families in the U.K. and Bangladesh. One 60 ml bottle of Beecham’s ampicillin syrup (’Penbritin’) would cost a rural family in Bangladesh the equivalent of about 60p, or 6% of their monthly income; in the U.K. a similar percentage would mean that a family might pay £ 35 for the same bottle. One of the reasons for the high prices is that local companies often import raw materials from their parent companies. Along with I.C.I. and Squibb, Dianna Melrose reports, the Wellcome Foundation "also cites the ’stamp of Wellcome’s quality control’ in explanation of the fact that trimethoprim was imported into Bangladesh on its behalf at five times the price paid for this drug by the local manufacturers." Appendices to the Oxfam report list the products recommended for withdrawal, and whether they are on the W.H.O. list of essential drugs or available on the U.K. market; and comparisons of prices are also provided. The author finally quotes from a Financial Times Survey (June, 1982): "The pharmaceutical industry has passed throught the recession almost unscathed". Calling for the support of the drug- 1. Medicines and the Poor in Bangladesh: a working paper by Dianna Melrose. Available, £1, from Oxfam Public Affairs Unit, 274 Banbury Road, Oxford OX2 7DZ. 2. See Lancet, June 19, 1982, p. 1405.
Transcript of Notes and News
453
laboratories had been built to the highest modern standards andcompletely equipped, a large scientific staff was recruited, and newdepartments of virology, anaerobic bacteriology, immunology, andpathology were developed. During the next twelve years of intenseactivity his advice was often sought by foreign Governments and hemade many trips abroad.
Though retirement at the age of 65 was compulsory, HughMulligan had no intention of resting and at once acceptedappointment as visiting lecturer in the newly formed department ofbiology at the University of Salford, where he taught for the next tenyears. Again he was in demand as a visiting teacher of tropicalmedicine at Brown University, Providence, Rhode Island, and as aconsultant in trypanosomiasis control by the World Health
Organisation.The last few years of his very full life were devoted to the
compilation of an account of every aspect of research performed bythe medical officers of the Honourable East India Company and thelater Indian Medical Service, and this record will be publishedposthumously. His scientific publications, certainly exceeding 50 innumber, reflect his industry and wide scientific interests: all arewritten with great clarity and fluency.Mulligan was a handsome, highly intelligent, and very active man
who, though very modest, had a commanding presence andpersonality, coupled with great charm. He had a rich but somewhatcryptic sense of humour, examples of which are treasured by hismany friends. Above all, he was intensely loyal to his country, hisService, his friends, and his subordinates. He was a proud anddevoted family man, and he is survived by his wife, Rita, two sons(the elder of whom was the famous Irish scrum-half of the’60s), anda daughter. Members of his former Service will recall his name withpride and affection.
J. H. W.
ANTHONY FRANCIS JOSEPH MALONEYB.Sc., M.B.Edin., F.R.C.P.E., F.R.C.Path.
Dr Maloney, senior lecturer in neuropathology in theUniversity of Edinburgh and honorary consultant
pathologist to the Lothian Health Board, died on May 13,1982. He was 61.
He was born in Edinburgh in 1920 and was educated at
Edinburgh Academy and at the University of Edinburgh,graduating in medicine in 1942. During the 1939-45 war, he servedin the Royal Army Medical Corps in Italy and was mentioned indespatches. He achieved the rank of major, and after demobilisationhe returned to the University of Edinburgh and spent a year in thehonours school of pathology. He received his early postgraduatetraining in pathology in Edinburgh and was appointed in 1950 to alectureship in neuropathology in the University of Leeds. In 1953he returned to the University of Edinburgh as senior lecturer inneuropathology.For almost 30 years in this appointment Maloney provided a
superb service in neuropathology in the South-East Region ofScotland. He was a popular teacher with medical students, hecontributed much to the training of many young pathologists, andhe was a key figure in the postgraduate training of neurosurgeonsand neurologists. He was particularly interested in head injuries andin the pathological effects of stereotactic surgery in Parkinsonism.
Tony Maloney was highly respected as a neuropathologist by allhis colleagues, both pathological and clinical. He was a man of manyfine personal qualities-he was straightforward, courteous, loyal,and always ready to help those in need. He had a passion for clocks,about which he was very knowledgeable, and for traditional jazz,and he loved the peace and beauty of the Caithness coast where hespent many happy family holidays. He is survived by his wife, twodaughters, and a son who is pursuing a career in pathology.
A. C.
Notes and News
DRUG POLICY IN BANGLADESH
AN article on the pharmaceutical market in Sri Lanka, publishedin The Health Services (Aug. 6, p. 18), contained a memorble remarkattributed to one representative of a drug company: "What we dofor the public good is a byproduct of what we do for our own privategood". The author of the article, Prof. N. D. W. Lionel (departmentof pharmacology, University of Colombo), concluded that thewidespread practice of self-medication in Sri Lanka prevailedlargely because regulations to control the market did not exist orwere difficult to implement. A national drug policy in line withWorld Health Organisation advice has been attempted by theGovernment of Bangladesh. A report produced for Oxfam byDianna Melrose indicates that drugs sold over the counter inBangladesh in 1978-that is, vitamin and tonic preparations, coughand cold remedies, digestants, laxatives, and analgesics-accountedfor 33% of the market in terms of production, while antibiotics,antiparasitic drugs, and dermatological preparations accounted forunder 23% of the market. Most of the bulk drugs were imported andpaid for in foreign exchange. The report emphasises that malnu-trition must be treated with food and not with vitamins. A Britishdoctor who has worked in Bangladesh points out: "Bangladesh is apoor country and can ill afford to spend foregin exchange on non-essential items. The nutritional problems of the poor will not besolved by expensively packaged multi-vitamins which will onlydivert limited resources from other more relevant purchases".The expert committee which reported to the Government of
Bangladesh in May2 recommended the withdrawal of 1742
preparations marketed by 176 companies, including 8multinationals which control over 80% of the market in Bangladesh.Under the Martial Law Ordinance of June 7, 240 products were tobe withdrawn immediately and the remainder by December, 1982.A phased withdrawal of different categories of drugs over 3, 6, and 9months has since modified the Ordinance. 150 drugs have beendefined by the Government as essential to the needs of the people,and the international companies must now consider how to
restructure local production of these essential drugs. At present 90of these drugs are not produced at all in Bangladesh because, as theexpert committee put it, "though the multinationals have all thetechnologies and know-how to produce sophisticated essentialdrugs and basic pharmaceutical raw materials, in Bangladesh thesecompanies are engaged mostly in formulation of simple drugsincluding many useless products", such as vitamin mixtures, tonics,and gripe water.In the Oxfam report Dianna Melrose emphasises the high cost of
finished drugs in Bangladesh by comparing the purchasing power offamilies in the U.K. and Bangladesh. One 60 ml bottle of Beecham’sampicillin syrup (’Penbritin’) would cost a rural family in
Bangladesh the equivalent of about 60p, or 6% of their monthlyincome; in the U.K. a similar percentage would mean that a familymight pay £ 35 for the same bottle. One of the reasons for the highprices is that local companies often import raw materials from theirparent companies. Along with I.C.I. and Squibb, Dianna Melrosereports, the Wellcome Foundation "also cites the ’stamp ofWellcome’s quality control’ in explanation of the fact that
trimethoprim was imported into Bangladesh on its behalf at fivetimes the price paid for this drug by the local manufacturers."Appendices to the Oxfam report list the products recommendedfor withdrawal, and whether they are on the W.H.O. list of essentialdrugs or available on the U.K. market; and comparisons of pricesare also provided.The author finally quotes from a Financial Times Survey (June,
1982): "The pharmaceutical industry has passed throught therecession almost unscathed". Calling for the support of the drug-
1. Medicines and the Poor in Bangladesh: a working paper by Dianna Melrose. Available,£1, from Oxfam Public Affairs Unit, 274 Banbury Road, Oxford OX2 7DZ.
2. See Lancet, June 19, 1982, p. 1405.
454
producing nations of the West, Dianna Melrose speaks on behalf ofthe poor of Bangladesh. They rely heavily on essential drugs and thedistribution of any doubtful or possibly harmful preparations,which drain the country’s resources, must be curbed. The latestnews we have is that a further review of drugs in Bangladesh hasbeen set in hand, which may lead to a modification of theGovernment’s line.Some weeks ago a commentary2 on this subject from one of our
correspondents in the Round the World column was interpreted bythe Bangladesh Times and by others as reflecting The Lancet’seditorial support for the Government’s drug policy. Such support isnot necessarily implied by items in Round the World, but readersmight reasonably infer that the Editor would be reluctant to publishin this section of the journal news of events of which he totallydisapproved without giving at least a hint of his opinion.Dr A. M. M. Khan, President of the Bangladesh Association of
Pharmaceutical Industries, wrote to The Lancet on July 13 askingwhether the journal’s opinion was reflected in the Round the Worldarticle of June 19. Our reply-to the effect that such was notnecessarily the case-was published in a Bangladesh periodicalknown as The Pulse and, once again, a mistaken interpretation seemsto have been placed upon what The Lancet had said, this time in apersonal letter to Dr Khan which was in no way intended to expressdisapproval of the Government’s actions. These confusions reflectthe intense political and commercial pressures operating in thisdebate in Bangladesh.
MOSQUITO CONTROL
IN two respects at least, the oil crisis of the 1970s was good formosquitoes: oil-based insecticides became yet more expensive; andhydroelectric schemes became more attractive, so that vast
reservoirs were constructed, notably in Africa. Accordingly, thethoughts of the World Health Organisation have turned
increasingly to environmental means of controlling these diseasevectors. Among the more exotic possibilities are predators ofmosquito eggs or larvae such as the Gambusia fish and mosquitoes ofthe genus Toxorhynchites. Both these have considerable potential.Of more established value are techniques for drainage and formanagement of irrigation which make life difficult for mosquitoes.W.H.O. has now produced a document3 on mosquito control, basedon the work of nearly fifty experts. Well-written and
comprehensive, it paints a hopeful picture at a time when theinsecticide scene looks bleak. Vector control workers should read it.
A CATALOGUE OF DRUG ABUSE
AN excellent short guide to the non-medical use of drugs has beenprepared by the Institute for the Study of Drug Dependence. Alarge-format booklet has been designed for the use of medicalpractitioners, social workers, and teachers, and it offers
unprejudiced information based on existing knowledge of thevariety of drugs used by the human race for their widely differingeffects. The drugs covered include the legal substances, such asalcohol, tobacco, caffeine, and solvents, and the illegal substances,such as heroin, cocaine, amphetamines, and cannabis. Details ofdrug legislation are also given. The short-term effects of thedifferent drugs, their general availability, and the hazards of long-term abuse are included. Frequent quotations from individuals’drug experiences enliven the text.
University of EdinburghDr L. J. Kinlen, who is a Gibb fellow of the Cancer Research
Campaign in the department of community medicine and generalpractice, University of Oxford, has been appointed director of a new
3 World Health Organisation Manual on environmental management for mosquitocontrol with special emphasis on malaria vectors. WHO Offest Publication no. 66.Geneva World Health Organisation. Pp. 283 Sw. fr 22
4. Drug Abuse Briefing a guide to the effects of diugs and to the social and legal factsabout their non-medical use in Britain. Available, £1.20 including postage, fromISDD Library and Information Service, Kingsbury House, 3 Blackburn Road,London NW6 1XA.
cancer epidemiology unit funded by the Cancer ResearchCampaign. The unit will work towards identification of the causalfactors involved in the high incidence of cancer in Scotland.
Association of Surgeons of Great Britain and IrelandA scheme has been established by the Association for the
provision of help to surgeons in need of medical advice. It will act asa discreet warning at an early stage in any surgeon’s illness, offereffective psychiatric help, and so safeguard his or her career.Further information may be obtained from Prof. J. S. P. Lumley,Honorary Secretary to the Association, Royal College of Surgeons,35/43 Lincoln’s Inn Fields, London WC2A 3PN.
Donald Hunter Memorial Lecture
The Faculty of Occupational Medicine has established a lecture incommemoration of Dr Donald Hunter. Applications are invitedfrom physicians wishing to deliver the second lecture, which will begiven at the annual provincial meeting of the Society of
Occupational Medicine in Leeds on July 12, 1984. Furtherinformation is available from the Registrar, Faculty of OccupationalMedicine, Royal College of Physicians, St Andrew’s Place, LondonNW1 4LE.
Hemochromatosis Research Foundation
This foundation has been set up to promote the study ofhereditary haemochromatosis, an autosomal recessive disease thataffects about 2-3 per 1000 population in Western countries. Detailsfrom the Hemochromatosis Research Foundation, Inc., P.O. Box8569, Albany, N.Y. 12208, U.S.A.
Prof. John Marshall, professor of clinical neurology, University of London,physician to the National Hospital for Nervous Diseases, London, andneurologist to the West Middlesex Hospital, has been appointed to succeed DrDavid Davies as chairman of the Attendance Allowance Board for 5 years,with effect from Oct. 19.
Mr J. C. S. Ling, formerly director of the information division, New York, ofthe United Nations Children’s Fund (UNICEF) has been appointed directorof the new World Health Organisation division of public information andeducation for health.
Prof. Norman Beischer (Melbourne) will speak on C.H20 Tolerance inPregnancy at the Institute of Obstetrics and Gynaecology, QueenCharlotte’s Maternity Hospital, Goldhawk Road, London W6 OXG, onMonday, Aug. 23, at 12.30 P.M.
A conference on Ethical Issues in Caring will take place at Owen’s Park,University of Manchester, on Sept. 10-12. Registration forms are availablefrom Dr John Harris, Department of Education, University of Manchester,Oxford Road, Manchester M 13 9PL.
An evening seminar on Space Medicine will be held at Northwick ParkHospital, Watford Road, Harrow, Middlesex HA 3UJ, on Tuesday, Sept. 21at 8.15 P.M. Details are available from Mrs Joan Marx, Northwick ParkHospital.A meeting on You Offer by They Need-National Health Service
Therapy and Multi-ethnic Groups will take place at the Royal Society ofHealth, 13 Grosvenor Place, London SW 1X 7EN, on Wednesday, Oct. 13 at at
7 P.M. Further information may be obtained from the conference departmentof the Society.The 7th annual general meeting of the Pancreatic Society of Great
Britain and Ireland will be held in Bonham Carter House, 52 Gower Street,London WC on Friday, Nov. 12. Details are available from the Secretary tothe Society, Private Consulting Rooms, University College Hospital, GraftonWay, London WC1E 6AU.
Correction
Epidemic of Meningococcal Meningitis in Bamako, Mali. EpidemiologicalFeatures andanalysis of VaccIne Efficacy.-We apologise to Dr Binkin and DrBand for a serious error introduced by a misplaced line of type into theDiscussion in their article (Aug. 7, p. 315). The first two sentences of the sixthparagraph of the Discussion (p. 317) should have read: "The case-fatality rateamong those in whom meningitis developed more than 14 days aftervaccination was higher than that of the unvaccinated. Since the total numberofpatients in the former group was small, however, this finding could have beendue to chance."
