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mechanism fundamental to very early forms of life. Themost informative revelation came from S. Chan (Chicago),who showed that the genome of the protochordateAmphioxus contains a sequence that structurally representsan intermediate transitional form between the insulin/IGFmolecules and the more divergent hormones ofinvertebrates.To those of us whose daily lives are firmly rooted in

clinical practice, this meeting conveyed the extraordinaryingenuity and excitement currently applied to thefundamental science of insulin and its receptor.

UMDS Medway Hospital,Gillingham, Kent R. H. JONES

Department of Endocrinologyand Chemical Pathology,

UMDS St Thomas’ Hospital, London SE1 7EH P. H. SÖNKSEN

Obituary

HENRICUS KUYPERSMD, PhD, Leiden, FRS

Prof Hans Kuypers, head of the department of humanand veterinary anatomy at Cambridge University and one ofthe most distinguished neuroscientists of his generation,died on Sept 26, aged 64.Many of the most remarkable advances in modem neuroscience

have arisen from the use of greatly improved techniques for thetracing of fibre connections within the brain. Hans Kuyperscontributed much to the development and application of these newmethods. One of the first advances was made forty years ago by theneuroanatomist W. Nauta, who devised a silver impregnationtechnique which selectively stained degenerating nerve fibres.

Kuypers worked for a period in Nauta’s laboratory in Switzerlandin the early 1950s and was quick to apply this new method, whichallowed fibre connections to be identified with a precision nothitherto possible. The use of the Nauta silver stain was soonsuperseded by other more powerful neuroanatomical tracingtechniques, which make use of markers that are selectivelyaccumulated by nerve endings and transported retrogradely alongtheir axons to label the nerve cells’ bodies. Kuypers discovered aseries of fluorescent dyes that behave in this way, and these havebeen widely adopted. He also used combinations of dye injectionsinto widely separated areas of the brain to demonstrate in the mostgraphic way the enormous breadth and complexity of neuronalprojection fields in the brain. Within the past few years he pioneeredthe use of retroviruses as a tracing technique.Not content with neuroanatomy as a simply descriptive science,

he included behavioural and electrophysiological experiments in hiswork. He showed, for example, that in primates but not in othermammals some motor neurons in the cerebral cortex projectdirectly to the output cells in the spinal cord. These pathways areparticularly important for the execution of fine and dextrousmovements, as in the control of individual finger muscles. In a seriesof papers that spanned his career he succeeded in constructing anoverall picture of the mammalian motor system which has beenwidely accepted and which represents his major scientificachievement.Hans Kuypers epitomised modem neuroscience in his

multidisciplinary approach to research. He helped to advance thisnew approach to brain research, particularly as a founding memberof the European Neuroscience Association, and later as its

president. He was a man of great enthusiasm and intellectual vigour.During the last five years he revitalised the department of anatomyin Cambridge, making it one of the most highly acclaimed in thecountry.

L. L. I.S. D. I.

Notes and News

EUROPE AGAINST CANCER

1989 is European Year of Information on Cancer, and in the UKthe week Oct 9-16 has seen the start of a nationwide assault on the

public’s attitudes to cancer. By the time you have opened your copyof The Lancet the first delivery of leaflets setting out the EuropeanCommunity’s ten-point code for avoiding cancer will have droppedthrough letterboxes all over the country. People are being told thatthey should give up smoking, drink less alcohol, avoid excessive sunexposure, eat healthily, and follow health and safety regulations atwork; and women are being encouraged to have regular cervicalsmears and examine their breasts frequently. Nothing novel here, sois the exercise worth while? The scientific content of the campaign(for instance, its poorly substantiated dietary advice) has alreadybeen criticised in the editorial columns of The Lancet.1 Can we alsoask whether the campaign is actually going to have the impact that isintended? Have British readers noticed, for instance, the ’EuropeAgainst Cancer’ postmarks that have been gracing their letters forthe past six weeks? Since most people depend on the media forinformation about health, it was disappointing that few journalistsattended Monday’s press conference. Most of the audience wererepresentatives of the health education and cancer agencies-peoplewho were already well acquainted with the campaign and its aims.Perhaps the journalists were already busy at their word processors,tapping out their stories. A nice idea, but a quick telephone surveyamong the health editors of a few national newspapers and a cursoryglance at a number of women’s magazines reveals not a single cancerfeature on the horizon. The slick presentation at the Royal Collegeof Physicians, masterminded (at considerable cost) by a public-relations agency, had apparently missed its target. Will the UKoffice of the European Community and its partners in this

enterprise at the Department of Health and the Health EducationAuthority have better luck with the general public?

EASIER VISAS PLEASE

A CONFERENCE in Vienna in 1974 led to the creation of theInternational Council for New Initiatives in East-West

Cooperation1 (known as the Vienna Council), which has sought tonarrow the divide between the political East and the political Westby promoting dialogue on matters of economics, commerce,technology, and finance. It has taken opportunities to extend itsaffairs beyond the immediate scope of a forum for decision makersin industry and business. The Council’s latest venture was a

conference on collaboration in health issues, held on Oct 2-3 at theRoyal College of Physicians of London. The programme wasarranged under the direction of Prof M. H. Lessof (Guy’s Hospital),and it drew participants from 17 European countries Theproceedings naturally attracted the notice of many businessmenseeking to extend the markets for their products. But the industrialpresence was certainly not intrusive; and the meeting went someway to sustain the instinctive and sometimes frustrated view thatcloser contact between the peoples of the world, in all their races andencampments, is a boon for international goodwill and an abater ofsuspicion and strife. Among the providers of health care,

cooperation across the boundaries has certainly had its triumphs,hard won perhaps by a few devoted individuals who havesurmounted deep-rooted obstacles and converted those whose localpreoccupations left them with scant enthusiasm for internationalget-togethers.

1. Hofburg Congress Centre, Heldenplatz, 1014 Vienna.2. Austria, Bulgaria, Czechoslovakia, Finland, France, Federal Republic of Germany,

German Democratic Republic, Hungary, Italy, Netherlands, Norway, Poland,Sweden, Switzerland, UK, USSR, Yugoslavia.

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For the establishment of more joint East-West ventures inmedical investigation and of more new friendships, these presentdays seem favourable to a degree that would have looked highlyimprobable a few years ago. And yet it can still be a heavy palaver toarrange at short notice merely the mechanics of a visa for a journeyfrom, say, Manchester to Leningrad so that collaborators may meetregularly. So, the conference was asked by Prof Lewis Wolpert,FRS (University College and Middlesex School of Medicine), whynot make it bureaucratically much easier for everyone engaged inthis team work to sit down and talk? Long-term visas, rather thanone-visit stamps, should be more readily granted, enabling teams tomeet more or less instantly if need be. As he heard this request at theconference, Dr Alexander Kondrusev, a deputy minister at theSoviet Ministry of Health, nodded amiably. The British, Soviet,and other governments should step towards the dismantling of thetit-for-tat nuisance imposed by standard single-entry visas.The strongest form of medical exchange is probably the

construction of partnerships in epidemiological and other research;and the conference heard of many examples of the kind of inquiriesto which such combined operations could be more widely applied.Prof Michael Marmot (University College and Middlesex School ofMedicine) gave as one illustration East-West comparisons of trendsin ischaemic heart disease; and Prof T. D. Spector (StBartholomew’s Hospital Medical College) pointed to the

opportunities for exploring the international epidemic of

osteoporosis. Prof D. W. van Bekkum (Radiobiological InstituteTNO, Rijswijk, Netherlands) raised the prospect of extending therange of the International Bone Marrow Transplant Registry andthe Registry of the European Cooperative Group for Bone MarrowTransplantation. Dr Kjell Strandberg (WHO Collaborating Centrefor International Drug Monitoring, Uppsala, Sweden) describedthe work of the WHO drug monitoring programme, whoseheadquarters in Uppsala now receives reports on adverse drugreactions from 28 countries. If more countries took part and if theWHO centre was given more resources, the programme could movemore readily towards its aims of wider access to data and intensifiedreview of signals detected in the reports reaching Uppsala.

Other likely areas examined at the conference as objectives forjoint action were: international trends and birth prevalence ofcongenital malformations, the epidemiology of AIDS, clinical trials,genetic diseases, radiological safety in the nuclear industry, healthservices research, biomedical engineering, and post-marketing drugsurveillance.

SPARE THE ROD?

IN July a law was passed in Austria making it a civil offence to hitchildren. This brings the number of countries with legal measuresto protect the child to five-the others being Sweden, Finland,Denmark, and Norway. In Sweden the offence is criminal, althoughin the ten years of the law’s existence only one person has ever beenprosecuted: the parent of an eleven-year-old who complained to thepolice of being beaten at home was fined a token sum of around [,10.Attitudes in Sweden and the other Scandinavian nations have

gradually shifted away from the notion that sparing the rod spoilsthe child. But in Britain, according to a new report,1 physicalpunishment is still commonly used to discipline children. Theauthors, John and Elizabeth Newson, joint directors of the childdevelopment research unit, Nottingham University, describe asurvey of 700 families, whose mothers were interviewed at homewhen the children reached their first, fourth, seventh, eleventh, andsixteenth birthdays. 200 families were also followed up when thechildren were nineteen. Despite media preoccupation withchildhood abuse, little has changed since 1958, when 62% ofmothers disclosed that they smacked their one-year old. In 1985, thefigure was 63%, and only in social classes I and II did the majorityof mothers not smack their babies. At the age of four, most children

1. The Extent of Parental Physical Punishment in the UK. By John and ElizabethNewson. Available (£2.50) from APPROACH (the Association for the Protectionof All Children), 77 Holloway Road, London N7 8JZ.

in all classes (68%) were smacked (for disobedience, lies, orsmacking the mother) at least once a week. Half of all motherssmacked only when angry but 83% of mothers believed in itseffectiveness. At seven, smacking was no longer seen as necessaryand it decreased, especially among girls, although an average of 41 %of boys across the classes were still smacked once a week or more.97% of white-collar parents favour the use of a strap, cane, slipper,or other implement on their boys.The survey drew a connection between suggested subsequent

"troublesomeness" (as the children grew older and smackingbecame rarer) and past experience of physical punishment. TheNewsons ask "are these children delinquent because they aresmacked or are they smacked because they are delinquent?" Butthey are careful to say only that "spare the rod and spoil the child" isnot supported by their finding that children were more likely to betroublesome at sixteen if at seven they were smacked frequently, orbeaten, in the parental belief that such measures instil "goodness".The report is published by Epoch, a charity associated with thecampaign to end the phycial punishment of children. According tocampaign spokesman, Peter Newell, very few parents give theiroffspring only the occasional wallop. And the notion that this ispermissible gives reasonable encouragement to the many whoregularly hit their children.

PRIORITIES FOR HEALTH PROMOTION

THE reasons why people die prematurely and the policies thatshould be adopted to reduce this mortality are outlined in adiscussion paper from the Centre for Health Economics, YorkUniversity.1 Godfrey and colleagues abitrarily draw the line at age65, below which death is premature; and they choose "avoidable lifeyears lost" to assess priorities for health promotion and diseaseprevention. In England and Wales in 1986, more than 40 000 peopleyounger than 65 died from neoplasms and nearly 43 000 fromcirculatory disorders-976 000 and 919 000 life years lost,respectively. Many of these deaths are due to preventableillness—eg, smoking-induced lung cancer and cardiovascular

disease, diet-induced colorectal cancer, and alcohol-related trafficaccidents-and these are just some of the areas that can be targettedto reduce premature mortality. Although there have beensubstantial behaviour changes in the past decade, most healthpromotion interventions have not been evaluated carefully, so thatcosts and outcomes of alternative policies are not known. The reportconcludes that an economic appraisal of such policies, together withthe analysis of mortality and morbidity, could lead to more efficientuse of society’s scarce resources in reducing the burden of illness.

THE INVISIBLE FRONTLINE

FAMILIES urgently need help when they discover a close relativeis abusing drugs, but they are generally left to fend for themselveswithout help from health care professionals. Some families haveresponded in the last ten years by forming self-help support groups,and in 1987 about 90 groups were listed as meeting regularly. Astudy2 published by the Policy Studies Institute says that the needfor help for drug users’ families is likely to grow and that familysupport of the kind provided by self-help groups may become animportant element in helping families with a member with HIVinfection, whether drug-related or not. The advantages of self-helpgroups are becoming well recognised, and the study shows thatthese groups are able to offer immediate support to families, longer-term benefits to individuals within the group, indirect help to themisuser, and benefits to the wider community. Group participationnot only helps to reduce feelings of isolation, guilt, and shame but

1. Godfrey C, Hardman G, Maynard A. Priorities for health promotion: an economicapproach. Centre for Health Economics Discussion paper S9. University of YorkCentre for Health Economics Consortium, 1989.

2. Getting together: a study of self-help groups for drug users’ families. Pat Gay. PolicyStudies Institute, 100 Park Village East, London NW1 3SR. 1989. £5.95. ISBN0-853744076.

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also restores self-esteem and provides an opportunity for personalgrowth. Rehabilitation is neither swift nor straightforward.Nevertheless nearly half of all drug abusers eventually shed thehabit of misuse, and it is important that resources are available toenable families to find out about the problems associated withrecovery.Many groups have been successfully established, but some have

found it difficult to survive without diversifying their activities toprovide a wider range of services-for example, telephone helplinesor home visiting. Although self-help groups already confer realbenefits to their participants, the report says that they are unlikely torealise their full potential unless the relation between these groupsand health care professionals is greatly improved. Once

professionals acknowledge that drug misuse is more than a medicalproblem, the family can be an important resource for them intreatment and rehabilitation. The study concludes that, for a smallfinancial cost, a coordinating agency could have a vital role inhelping and strengthening existing groups and giving new ones abetter chance of survival.

GOLD FINGER?

AN unusual hazard of marriage or engagement was recentlydescribed by Dr E. M. Callary in the Canadian Medical Associationjournal. Gold rings, bought 30-40 years previously, were

associated with skin cancer of the ring finger in 2 patients, 1 of whomalso had skin changes in the adjacent middle and little fingers. Bothpatients had symptoms of chronic skin irritation beneath the ring formany years, ascribed to contact dermatitis. One ring emitted both pand y radiation at a dose of 0-027 cGy/h, or 240 cGy/year; the otherdelivered a dose of 1 43 cGy/h, or 240 cGy/week. In both, theradioactivity was compatible with contamination of the gold bydecay products of radon. Small hollow gold "seeds" containingradon were used in early forms of cancer radiotherapy-and some ofthe radioactive gold was made into jewellery in the 1930s and 1940s.The message? A 20-year itch may represent radiation, not contact,dermatitis.

NOBEL PRIZE FOR MEDICINE

THis year’s Nobel prize for medicine is shared by Dr MichaelBishop and Dr Harold Varmus, of the department of microbiologyand immunology, University of California School of Medicine, SanFrancisco, for their discovery of the cellular origin of retroviraloncogenes.

Cancer Contacts

People with cancer want to be more involved in their treatmentand care, and therefore communications between health

professionals and their patients need to improve. Help is There, anew leaflet launched by the Cancer Relief Macmillan Fund, is anat-a-glance directory of national organisations that provideinformation and support for patients with cancer and their families.Each entry is accompanied by a brief description complemented bysymbols that show their main services. Help is There is available freeof charge from radiotherapy centres in local hospitals, hospital socialwork departments, breast cancer screening units, citizens advicebureaux, doctors’ surgeries, and public libraries or from CancerRelief Macmillan Fund, ’Help is There’, Anchor House, 15/19Britten Steet, London SW3 3TZ (enclose a stamped self-addressedenvelope).

World AIDS DayWorld AIDS Day 1989, on Dec 1, will focus on events based on

the theme AIDS and Youth. More information can be had fromWHO Global Programme on AIDS, 1211 Geneva 27, Switzerland.

Infant Feeding Bottles

After discussion with the Department of Health and theDepartment of Trade and Industry, the Infant Feeding Bottle andTeat Marketing Standards Committee (IBFAT) has drawn up adraft voluntary Code of Practice for the Marketing of Infant

1. Callary EM. Cancer caused by radioactive gold rings. Can Med Assoc J 1989; 141: 507

Feeding Bottles and Teats in the United Kingdom. Modelledclosely on the Food Manufacturers’ Federation’s code of practicefor the marketing of infant formulae, the IBFAT code makesprovision for a monitoring committee with a majority of

independent members nominated by the government. The codeallows for educational services and information related to infant

feeding bottles to be provided only to the health care system (butmothers as consumers may acquire information directly from themanufacturers), and labelling and promotional literature must notimply that artificial feeding is equivalent or superior to

breastfeeding. Inquiries (and comments on the draft code, whichshould be received by Jan 3, 1990) should be sent to Mrs N.Bateson, Department of Health, Room C202, Alexander FlemingHouse, Elephant and Castle, London SE1 6BY.

Arthritis Information

A booklet for patients wiith arthritis describes the different formsof the disease, how they affect children and young people as well asthe elderly, and how to make the most of available treatments.Information for People with Arthritis can be obtained free of chargefrom Arthritis Care, 5 Grosvenor Crescent, London SW1X 7ER.Please send a large self-addressed envelope.

Royal College of RadiologistsDr J. O. M. C. Craig has been elected president of the college.

King’s College London

Dr Norman Noah, consultant epidemiologist at the PublicHealth Laboratory Service Communicable Disease SurveillanceCentre, has been appointed to the chair of community medicinefrom Oct 30.

University of GlasgowProf John Reid, professor of materia medica in the university, has

been appointed to the Regius chair of medicine and therapeutics insuccession to Sir Abraham Goldberg, who retired from the Regiuschair of medicine on Sept 30. The change in title of the Regius chairreflects a major reorganisation and restructuring of clinical medicinein the faculty of medicine, part of which is the merging of thedepartments of materia medica and medicine.

A seminar entitled Randomised Trials in Individual Patients is totake place at the University of Oxford at 5.00 pm, on Tuesday, Oct 17: MikeMurphy, Department of Community Medicine and General Practice,Radcliffe Infirmary, Oxford OX2 6HE (0865 511293).

A lecture on Cholesterol and Ischaemic Heart Disease by ProfMichael Oliver will take place in the Paul Wood Lecture Theatre, NationalHeart and Lung Institute, London, at 5.00 pm, on Thursday, Oct 19: MissFay Jeffery, Postgraduate Centre, National Heart and Lung Institute,Dovehouse Street, London SW3 6LY (01-3518172).

A lecture entitled Cellular Biochemistry and Human Disease-Some Insights through NMR by Prof G. K. Radda is to be held at theClinical Research Centre, Harrow, on Thursday, Oct 19: Director’s Office,Clinical Research Centre, Watford Road, Harrow, Middlesex HAl 3UJ(01-869 3457).

A symposium on Launching the Antibiotic Era will be held in theCaspary Auditorium, Rockefeller University, New York City, on Monday,Oct 23: Caspary Auditorium, Rockefeller University, York Avenue at 66thStreet, New York City, USA (212-570 8967).

Corrections

Further Proposals on Medicines.-In line 4 of the section headed GeneralPoints in this summary of the European Community proposals (Sept 23,p 752) the word "linked" should read "limited".

Stones and Kilogranu.-There is an error in the second sentence of thiseditorial (Oct 7, p 844). The correct version is as follows. Race is also

important: North American Indians have more cholelithiasis than do

Caucasians, who themselves have more than blacks or Japanese.