how many trees did you kill today?

1
1434 DIVERTICULUM ’A desire to take medicine is, perhaps, the great feature which distinguishes man from other animals.’ - William Osler (1849-1919) Fallen Men The Seychelles was a veritable island para- dise where nothing happened very quickly but everything got done. By virtue of its strategic location there was a big new airport extension (courtesy of Uncle Sam) and a spanking new hospital (courtesy of the French) where my colleague and I whiled away our student elective. The patients had the usual mixed bunch of conditions, but a small sub-group soon became apparent: men in their late thirties to early sixties who had been brought in with head injuries and broken bones and who, to a man, were inebriated to the point of being anaesthetised and smiled some- what incongruously during the assessment of their injuries. We naively assumed they had been victims of the rather haphazard lane discipline of the local drivers, so were rather sceptical when one of them took us into his confidence and, with furtive glances all around, told us he had fallen out of a tree. We had been warned not to sit under coconut trees for fear of falling objects, but had always assumed the objects in question to be coconuts, so we had the distinct impression we were being hood- winked. However, discrete inquiries of several highly trustworthy locals suggested that the man may have been telling the truth. Alcohol is heavily taxed in the Seychelles, so some of the more enterpris- ing locals brew their own potion from coconut juice. To reduce the risk of detection, the more adventurous brew the alcohol in a fruit that is still on the tree, returning a week or so later to drink their spoils. Unfortunately controlling fermen- tation is somewhat difficult when the vat is 20-30ft above your head, so the strength can be a bit variable, with the consequence that occasional batches are extremely powerful indeed, producing rapid intoxi- cation and making the descent from the bar a trifle hazardous. Inevitably accidents occur, hence the appearance of a steady trickle of inebriated men with fractures, although they were never so inebriated as to admit their crime to the waiting police. TJ J tacit Harrogate, UK How many trees did you kill today? Your grant application is finally ready to be sent off, an impressive bundle of paper; was it really necessary to prepare that many copies? Well, at least not 36, as your colleague had to do to satisfy the hunger of the American Heart Association. How many trees had to die for the ritual that you have observed so dutifully? : Let us look at the United States. The typical competitive grant proposal for the National Institutes of Health consists of: 7 application-form pages plus extension (whose curriculum vitae fits on a single page?), at least 10 pages; the research proposal itself, a maximum of 25; the reference list (1 at least); an average appli- cant will include one publication, say 7 pages; and one preprint covering, say, 30 pages. So far our total is 70 pages, single- sided. Now, the applicant is required to submit 6 copies of the application. Our estimate has run up to 420 sheets of 8-5 x 11 inch 20 lb white office paper. : 420 sheets of paper, what is that in trees? It’s not easy to find out, and the estimates differ by a factor of 30. According to the Handbook for Pulp and Paper Technology issued by the US paper industry, a tree 3 feet in diameter, 50 feet tall, would yield 393 000 sheets of 8-5 x 11 inch white office paper, or 935 NIH grant applications. The Chicago Recycling Coalition estimates 12 000 sheets (or 28 NIH grant applica- tions) per tree. But why don’t grant- awarding agencies follow the good example of some scientific journals and allow sub- mission of files stored on diskettes? This would lead to much, much less paper printed, carried, duplicated, xeroxed again, bound, mailed, received, carried, filed, and thrown away. Fewer trees felled. Less energy used to recycle paper. Less landfill space used (33 cubic yards per ton of paper). Fewer lower back injuries and cuts for those who have to carry and bind the bundles. More space in the notoriously crammed research offices. Worried about jobs in the paper industry? I don’t think that the contribution of the scientific com- munity will seriously endanger a commer- cial venture with an annual production volume of 80 million tons (no more tree equivalents at this point). And could, ahem, somebody please calculate the environ- mental costs of producing a computer and, say, a hundred diskettes? Gerald Zernig Ann Arbor, USA ’Never believe what a patient tells you his doctor has said.’ William Jenner (1815-1898) Headlong rush to the 21st century Those of us who reside on the west coast of . the United States tend to take a somewhat ambivalent pleasure in the reputation of our area as the birthplace of the new. Being on the cutting edge is all very well, but one does occasionally long for the comforts of the familiar and customary. Which brings me to The Lancet and its headlong rush towards the 21st century. : First, you abandoned the India paper edition airmailed to your American sub- scribers. I still miss its peculiar odor, and recall wistfully the exotic flavor of the advertisements; my favorite was one for a sulfonamide suggested for use in "Friday afternoon fevers". Then, barely 30 years later, your format began to change. More white space, octets, colored captions, Talk- ing Points, signed editorials ... traditions trembled. But of greatest concern to me was the apparent slow strangulation of In England Now. As a loyal reader and occa- sional contributor, I watched with dismay as its regular 1 to 3 columns per week shrank. When some issues arrived without even a paragraph from Peripatetic Corre- spondents, the prognosis seemed evident: medical humor in The Lancet was mo- ribund. : The announcement that Diverticulum would replace In England Now was reass- uring, but the newcomer is still a shock. Cartoons? And signed contributions? Well, we Westerners who crave tradition will clearly have to look elsewhere for stodgy sameness. The Lancet is no longer in the business. Elmer R Grossman Berkeley, USA When the balloon goes up Earlier this year, having undergone a barium enema and, as a result, been diag- nosed as suffering from diverticulitis, I think I can offer an operational definition of an iatrogenic disease: if you inflate the large intestine with compressed air to a high enough pressure, quite clearly any weak- nesses in the bowel wall will be revealed to the delight of the radiologist. Robert T Green London, UK A pointed remark As a junior doctor, I’m not a frequent patron of the store in Knightsbridge, London, that sells everything from a pin to an elephant. The commissionaire couldn’t be certain, but suggested I try millinery. "No, I’m terribly sorry. There isn’t really any demand for them, but perhaps haberdashery could help." "Yes, of course", said the elderly haberdashery lady, producing a box of them. "Is it white, red or both that you want?" I took a rather nice red one. "That will be eighty pence please." I gave her the money. "Thank you very much indeed doctor, and the best of luck. Where are you doing the exam?" inquired the shop assistant. I looked rather surprised. "Nowadays, we only really stock the hatpins for doctors taking the membership." Simon Dover Glasgow, UK ’Life is the art of drawing sufficient conclusions from insufficient premises.’ -Samuel Butler (1835-1902)

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1434

DIVERTICULUM

’A desire to take medicine is, perhaps,the great feature which distinguishesman from other animals.’- William Osler (1849-1919)

Fallen MenThe Seychelles was a veritable island para-dise where nothing happened very quicklybut everything got done. By virtue of itsstrategic location there was a big newairport extension (courtesy of Uncle Sam)and a spanking new hospital (courtesy ofthe French) where my colleague and Iwhiled away our student elective. The

patients had the usual mixed bunch ofconditions, but a small sub-group soonbecame apparent: men in their late thirtiesto early sixties who had been brought inwith head injuries and broken bones andwho, to a man, were inebriated to the pointof being anaesthetised and smiled some-what incongruously during the assessmentof their injuries. We naively assumed theyhad been victims of the rather haphazardlane discipline of the local drivers, so wererather sceptical when one of them took usinto his confidence and, with furtive

glances all around, told us he had fallen outof a tree. We had been warned not to situnder coconut trees for fear of fallingobjects, but had always assumed the objectsin question to be coconuts, so we had thedistinct impression we were being hood-winked. However, discrete inquiries ofseveral highly trustworthy locals suggestedthat the man may have been telling thetruth. Alcohol is heavily taxed in the

Seychelles, so some of the more enterpris-ing locals brew their own potion fromcoconut juice. To reduce the risk of

detection, the more adventurous brew thealcohol in a fruit that is still on the tree,returning a week or so later to drink theirspoils. Unfortunately controlling fermen-tation is somewhat difficult when the vat is20-30ft above your head, so the strengthcan be a bit variable, with the consequencethat occasional batches are extremelypowerful indeed, producing rapid intoxi-cation and making the descent from the bara trifle hazardous. Inevitably accidents

occur, hence the appearance of a steadytrickle of inebriated men with fractures,although they were never so inebriated as toadmit their crime to the waiting police.

TJ J tacit Harrogate, UK

How many trees did youkill today?Your grant application is finally ready to besent off, an impressive bundle of paper; wasit really necessary to prepare that manycopies? Well, at least not 36, as your

colleague had to do to satisfy the hunger ofthe American Heart Association. How

many trees had to die for the ritual that youhave observed so dutifully?

: Let us look at the United States. The

typical competitive grant proposal for theNational Institutes of Health consists of: 7

application-form pages plus extension

(whose curriculum vitae fits on a singlepage?), at least 10 pages; the research

proposal itself, a maximum of 25; the

reference list (1 at least); an average appli-cant will include one publication, say 7pages; and one preprint covering, say, 30pages. So far our total is 70 pages, single-sided. Now, the applicant is required tosubmit 6 copies of the application. Ourestimate has run up to 420 sheets of 8-5 x 11inch 20 lb white office paper.

: 420 sheets of paper, what is that in trees?It’s not easy to find out, and the estimatesdiffer by a factor of 30. According to theHandbook for Pulp and Paper Technologyissued by the US paper industry, a tree 3feet in diameter, 50 feet tall, would yield393 000 sheets of 8-5 x 11 inch white office

paper, or 935 NIH grant applications. TheChicago Recycling Coalition estimates12 000 sheets (or 28 NIH grant applica-tions) per tree. But why don’t grant-awarding agencies follow the good exampleof some scientific journals and allow sub-mission of files stored on diskettes? Thiswould lead to much, much less paper

printed, carried, duplicated, xeroxed again,bound, mailed, received, carried, filed, andthrown away. Fewer trees felled. Less

energy used to recycle paper. Less landfillspace used (33 cubic yards per ton ofpaper). Fewer lower back injuries and cutsfor those who have to carry and bind thebundles. More space in the notoriouslycrammed research offices. Worried about

jobs in the paper industry? I don’t thinkthat the contribution of the scientific com-

munity will seriously endanger a commer-cial venture with an annual productionvolume of 80 million tons (no more treeequivalents at this point). And could, ahem,somebody please calculate the environ-mental costs of producing a computer and,say, a hundred diskettes?

Gerald Zernig Ann Arbor, USA

’Never believe what a patient tells youhis doctor has said.’William Jenner (1815-1898)

Headlong rush to the21st centuryThose of us who reside on the west coast of .

the United States tend to take a somewhatambivalent pleasure in the reputation ofour area as the birthplace of the new. Beingon the cutting edge is all very well, but onedoes occasionally long for the comforts ofthe familiar and customary. Which bringsme to The Lancet and its headlong rushtowards the 21st century. :

First, you abandoned the India paperedition airmailed to your American sub-scribers. I still miss its peculiar odor, andrecall wistfully the exotic flavor of the

advertisements; my favorite was one for asulfonamide suggested for use in "Fridayafternoon fevers". Then, barely 30 yearslater, your format began to change. Morewhite space, octets, colored captions, Talk-ing Points, signed editorials ... traditionstrembled. But of greatest concern to me wasthe apparent slow strangulation of In

England Now. As a loyal reader and occa-sional contributor, I watched with dismayas its regular 1 to 3 columns per weekshrank. When some issues arrived withouteven a paragraph from Peripatetic Corre-spondents, the prognosis seemed evident:medical humor in The Lancet was mo-ribund.

: The announcement that Diverticulumwould replace In England Now was reass-uring, but the newcomer is still a shock.Cartoons? And signed contributions? Well,we Westerners who crave tradition will

clearly have to look elsewhere for stodgysameness. The Lancet is no longer in thebusiness.

Elmer R Grossman Berkeley, USA

When the balloon goes upEarlier this year, having undergone a

barium enema and, as a result, been diag-nosed as suffering from diverticulitis, I

think I can offer an operational definition ofan iatrogenic disease: if you inflate the largeintestine with compressed air to a highenough pressure, quite clearly any weak-nesses in the bowel wall will be revealed tothe delight of the radiologist.

Robert T Green London, UK

A pointed remarkAs a junior doctor, I’m not a frequentpatron of the store in Knightsbridge,London, that sells everything from a pin toan elephant.The commissionaire couldn’t be certain,

but suggested I try millinery. "No, I’mterribly sorry. There isn’t really anydemand for them, but perhapshaberdashery could help."

"Yes, of course", said the elderlyhaberdashery lady, producing a box ofthem. "Is it white, red or both that youwant?" I took a rather nice red one. "Thatwill be eighty pence please." I gave her themoney."Thank you very much indeed doctor,

and the best of luck. Where are you doingthe exam?" inquired the shop assistant. Ilooked rather surprised. "Nowadays, weonly really stock the hatpins for doctorstaking the membership."

Simon Dover Glasgow, UK

’Life is the art of drawing sufficientconclusions from insufficientpremises.’-Samuel Butler (1835-1902)