IN 1998, an abnormal prion protein was detected in the appendix of a patient
who later developed variant Creutzfeldt-Jakob disease (vCJD). In response,
Kenneth Calman, who was Britain鈥檚 Chief Medical Officer at the time, proposed
that any appendix and tonsil tissue removed during routine surgery should be
tested for the prion material.
At the end of June this year, Nick Brown, the minister of agriculture,
fisheries and food, sent a shiver down the spine of many MPs when he announced
that a Holstein cow had developed BSE. The cow was born three weeks after bovine
material was banned from animal feed in 1996. Most of us had thought that the
BSE problem had been finally laid to rest in Britain.
Michael Day recently reported expert opinion on the reliability of tests like
those proposed by Calman to detect signs of a possible epidemic of human BSE
(6 May, p 5).
The general view was that such tests are the best we have at the
moment, and that we should 鈥減roceed with caution鈥� until better tests became
available. I asked Yvette Cooper, the junior health minister, what government
policy is on future testing.
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Cooper replied that a joint Medical Research Council/Department of Health
steering group was established in 1998 to coordinate studies of tissue tests and
advise whether wider studies might be required. Various other studies followed,
but no further signs were detected of the rogue prion protein associated with
vCJD. However, as the current Chief Medical Officer warns, these early results
should not be taken as indicating an all-clear.
Researchers at the Prion Unit of St Mary鈥檚 Hospital in London will soon
undertake another study examining some 2000 tonsils in the London area, said
Cooper. The government has said that it will spend around 拢27 million over
the next year on CJD/BSE research. It recognises the need to develop a reliable
diagnostic test capable of detecting the abnormal prion protein at the
pre-clinical phase of the disease, the minister added.
JOANNA MARCHANT reports recent complaints that the World Health Organization
could be underestimating the threat of infectious disease by shifting its
emphasis to chronic conditions
(1 April, p 16).
That idea left me wondering
whether Britain鈥檚 Department for International Development (DFID) should devote
more of its resources to the new infectious diseases, and whether our
representatives at the WHO should be arguing for the organisation to take a
different approach. I decided to ask George Alberti, president of the Royal
College of Physicians, what he thought.
Alberti replied that a balance has to be struck between the attention we pay
to infectious diseases and non-infectious diseases, rather than saying that one
is more important than the other. However, we ignore non-communicable diseases
at our peril. 鈥淭he picture that we are seeing is that as soon as economies begin
to improve or Westernise then non-communicable diseases increase at an alarming
rate,鈥� he added.
Alberti went on to say that the DFID does indeed devote a lot of resources to
dealing with infectious diseases. As does the WHO, which is committed to big
battles against malaria, tuberculosis and AIDS, he said. Alberti made clear that
the WHO is also aware of the need to look at emerging infections. On the other
hand, he did not think it inappropriate that the WHO also has a relatively small
unit working long-term on non-infectious diseases. 鈥淲e should remember that the
WHO represents all countries, not just developing ones. Countries in the former
Eastern Europe have large mortality and morbidity from heart disease and so on,
and we do need to take care of this as well. A balanced view is needed.鈥�
Coming as I do from Scotland, with our shocking heart disease figures, I have
to agree.