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A new image for plastic surgery?We recently received a strange request from a television

company. Could we, it asked, publish an appeal for three plasticsurgeons to appear on a quiz show. The idea, we were told, was togive the show a "facelift"--chocolate moulders, ballroom dancers,and funeral directors were apparently failing to attract the viewers.This misunderstanding of what plastic surgery is all about appearsto be widespread. The British Association of Plastic Surgeons(BAPS) has cornmentedl that many people, including doctors,regard plastic surgery as "unnecessary, frivolous, or trivial",because they equate it with cosmetic surgery. Women’s magazineshave perpetuated this misconception, and several have publishedguides to cosmetic surgery-telling readers where to find a surgeonto reduce their thighs, redesign their noses, or cure their earlobefatigue. One magazine even suggested that plastic surgeons areforever searching for new operations in order to extract more cashfrom their well-heeled patients. Life for the average NationalHealth Service plastic surgeon is very different, however-a typicalone will spend 20% of his time correcting congenital abnormalities,20% on managing the late effects of bums, 20% on reconstructionsafter ablation of neoplasia, and 40% on repairs following trauma. Ina recent questionnaire the BAPS sought its members’ views on aproposal to change the name of the specialty to "plastic andreconstructive surgery" in an attempt to improve its image. Theresults have not been published, but the proposal is thought to havehad strong support.

British plastic surgeons have more to worry about than theirimage. Gross understaffmg in NHS plastic surgery is another

concern, reflected in exceptionally long waiting lists. Research andteaching are also suffering, according to the BAPS, because plasticsurgeons are having to devote too much of their time to servicecommitments. Despite a 44% increase in the number of plasticsurgery consultant posts between 1976 and 1985, the UK still hasonly one plastic surgeon per 500 000 population-only half the levelrecommended by the BAPS in 1976 in its evidence to the RoyalCommission on the NHS and well below the ratios achieved in

many other countries (in Europe, North America, and Australasia itapproaches 1 per 100 000 population), including some third worldones. The BAPS now estimates that the ratio in the UK should be 1

per 125 000 to account for the rising incidence of skin cancers, theintroduction of new microsurgical techniques, increasing longevityof the population, and other factors that are adding to the plasticsurgeon’s workload.Between 1975 and 1984 the average plastic surgeon’s waiting list

increased by 18% (from 393 to 463 patients), despite the rise in thenumber of consultants. In 1990, 52% of NHS plastic-surgerypatients had waited over a year for treatment, compared with 29%awaiting oral surgery, the specialty with the next longest waitingtimes. The Department of Health has promised 25-5 million toregional health authorities that achieve agreed reductions in some ofthe worst waiting lists, but plastic surgery does not figure among itstargets. More evidence that plastic surgery is not taken seriously inthe UK?

1. British Association of Plastic Surgeons. Plastic Surgery in Great Britain. London,1986.

Tracking the tsetse flyThe tsetse fly, often blamed for preventing tropical Africa from

joining in the agricultural revolution that began in the Middle East6000 years ago, still blights the African landscape today. As a vectorof cattle diseases it precludes mixed farming in an area of some 10million km2; and it has an even more direct effect on the humanpopulation by exposing 25 million people to the risk of

trypanosomiasis. Weather satellites may seem an unlikely weaponagainst this African scourge, but a report from two Oxford

zoologists shows how data collected by meteorological satellites canbe used to predict the fluctuating fortunes of tsetse populationsacross the continent and pinpoint areas of high infestation.1 The

critical measurement is the normalised difference vegetation index(NDVI), a measure of intercepted photosynthetically activeradiation that indicates the level of vegetation cover. The NDVI inturn reflects recent rainfall and saturation deficit, which quicklyaffect tsetse breeding and mortality. Rogers and Randolph’ foundan inverse relation between mortality and the previous month’sNVDI for two species of tsetse, Glossina morsitans in Nigeria and Gfuscipes in Uganda. A more detailed survey in the Ivory Coastshowed that tsetse abundance, as well as mortality, was strikinglyrelated to NDVI.

Monthly NDVIs, which are available for the whole of Africa, canthus be used to fill some notable gaps in our knowledge of tsetsedistribution. The small number of hard-pressed entomologistsworking in tsetse control (each has to cover an estimated 50 000 kmzon average2) will find this new index a valuable aid. Annuallyaveraged NDVIs indicate where tsetse survival will be highest andrisk of trypanosomiasis transmission greatest. The long-term aim isto produce maps of high risk of disease transmission by tsetse flies,and other insect vectors too.

1. Rogers DJ, Randolph SE. Mortality rates and population density of tsetse fliescorrelated with satellite imagery. Nature 1991; 351: 739-41.

2. Brady J. Seeing flies from space. Nature 1991; 351: 695.

Popular p53The tumour suppressor gene, p53, mutations of which are

implicated in many inherited and sporadic human malignancies, haswon a coveted place in the Institute for Scientific Information’s"hot topic" list of most cited papers.! 102 papers on the p53 genewere published in 1990, compared with 50 in 1989, and 4 recentpapers are among the 10 most cited reports in medicine in ISI’scurrent pop chart. Research on the p53 gene, which was discoveredin 1979, focused at first on its ability to transform normal cells intomalignant ones, but interest later switched to its tumour-

suppressing role. The p53 paper most often cited in the earlymonths of 1991 was one by Finlay et aP at Princeton demonstrating,for the first time, that overexpression of wild-type p53 suppressesthe development of transformed cells in culture.

1. Anon. Scientists focus on role of p53 gene m cancer initiation and suppression. ScienceWatch April, 1991.

2. Finlay CA, Hinds PW, Levine AJ The p53 proto-oncogene can act as a suppressor oftransformation. Cell 1989; 57: 1083-93.

Cancer epidemiology studies

The latest Directory of On-Going Research in Cancer

Epidemiologyl not only serves as a detailed list of current projectsand investigators, intended to facilitate direct contacts betweenscientists and to avoid unnecessary duplication of work, but it canalso be compared with its fourteen predecessors to assess researchtrends. Since the first directory in 1976, the proportion of studiesinto diet or nutrition has increased from 9% to 17% of projects,alcohol is now the main variable of interest in 10% (up from 4%),neck-and-neck with ionising radiation, but smoking still leads thefield with 21 % (from 12 ). The types of study are also changing:35% are case-control studies, up from 27% in 1976, but these arenow matched by cohort studies (up from 16%). The directory, alsoavailable on computer disc, includes descriptions of 1147 researchprojects (slightly fewer than in recent years), 208 of which are newlyregistered. Despite all this research activity, international trends incancer mortality seem to suggest increasing mortality from

site-specific cancer, excluding those linked with smoking andhazardous occupational exposures, in elderly people fromindustrialised countries.2,3

1. Coleman M, Wahrendorf J, eds. Directory of on-going research in cancer

epidemiology 1991. Lyon: IARC Sci Publ, 110. 1991 Pp 753. £36. ISBN92-83221109.

2. Davis DL, Hoel D, eds. Trends m cancer mortality in industrial countries. Ann NYAcad Sci 1990; 609. Pp 347. $90. ISBN 0-897666437.

3. Davis DL, Hoel D, Fox J, Lopez A. International trends in cancer mortality in France,West Germany, Italy, Japan, England and Wales, and the USA. Lancet 1990; 336:474-81.