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The Pharmaceutical Journal
Vol 271 No 7266 p346
13 September 2003

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Onlooker

Forward with the WHO [more]
New hope in malaria [more]
Power of beauty [more]
Stemming the flood [more]


Forward with the WHO

On taking over the duties of Director-General of the World Health Organization on 21 July, Dr Jong-wook Lee promised to make to make the control of HIV/AIDS a priority of the organisation. Prevention of further spread, appropriate care and effective treatment must be concentrated in those poor and hitherto neglected countries where the ravages of AIDS are severe.

The WHO department concerned with these will be working jointly on the control of HIV, malaria and tuberculosis, which are held responsible for a quarter of deaths yearly worldwide. The goal is to provide antiretroviral drugs to three million people in developing countries by the end of 2005. In pursuing this course it will be necessary to manipulate political will and provide resources. Dr Lee is an expert when it comes to communicable diseases and was formerly in charge of the anti-tuberculosis programme of WHO.

The recent epidemic of severe acute respiratory syndrome (SARS) has underlined the necessity for WHO to co-ordinate the international response to outbreaks of infection. At the same time it has shown severe weaknesses in the global surveillance of diseases. Dr Lee has admitted that there has been a tendency in the past to concentrate WHO resources in Geneva, with the result that therapeutic programmes have been driven largely by headquarters priorities rather than by the individual needs of affected countries.

Measures are now being undertaken to analyse the work performed in different areas of the globe and to devise steps that will move resources from WHO headquarters to the various regions. The shortage of skilled and experienced health-care staff will have to be made good by recruiting young health workers and giving them the opportunity to work within the WHO structure to develop leadership in their fields of endeavour. Many of the former senior staff of WHO are due to be replaced or moved to other more appropriate situations.

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New hope in malaria

Traditional Chinese medicine has long employed the plant Artemisia annua as an antipyretic. It has now been recognised as possessing useful antimalarial activity. This is important, since in most parts of the world malarial parasites have developed resistance to established antimalarial drugs, including chloroquine, which has for long been the main standby.

The plant is known as qinghao or sweet wormwood, and extracts of it have helped many patients in south-east Asia to deal with the infection. The active principles, known as artemisinins, upset the calcium metabolism of Plasmodium falciparum, disabling the calcium pump that introduces the element into its cell membranes. Once the pump is thrown out of gear the parasite dies within hours, although the precise mechanism remains unknown. The gene responsible for the calcium pump can be studied in different malarial parasites to discover whether it is likely to mutate to raise resistance to artemisinins.

The manufacture of artemisinins in China and Vietnam is proceeding, and these compounds are proving valuable in areas in Asia where resistance to other drugs has been a problem in dealing with malaria. In parts of Africa, too, the compound has shown promise. Combined therapy is under study, to prevent if possible the rise of resistance in exposed parasites. A trial of artemisinins in combination with amodiaquine is being undertaken with children in Gabon. Current formulations require a week’s therapy to be effective, but it is hoped to develop formulations that will be effective in three or four days.

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Power of beauty

A strange sunrise or sunset is a greater element in the education of a man thanmost people think. ... The artist, too, whether in colours or words, gains a becoming humility. He feels the abject powerlessness of his brush or pen to express, in anything like their pristine beauty, many of the things he meets with.
— John Buchan: ‘Scholar-gypsies’ (1896).

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Stemming the flood

Venice is a remarkable city, with a tremendous appeal to the senses and the emotions. Shelley wrote of it in 1818: Underneath Day’s azure eyes / Ocean’s nursling, Venice lies, / A peopled labyrinth of walls, / Amphitrite’s destined halls.” Today there are grave doubts over the ability of the authorities to preserve this gem of the Adriatic, in the face of repeated threats from the primeval elements.

The city sits in a lagoon separated from the Adriatic Sea by nothing more substantial than a string of barrier islands . When the terrain consisted of mud flats rising tides tended to be dissipated. But after humans had diverted rivers, widened the mouths of lagoons, drained channels and built on the flats, equilibrium was upset.

Today, in a sea surge, there is little to protect the streets and squares from floods, and the city regularly experiences winter floods. In November 1966 a period of incessant rain for two days, a prolonged low-pressure system, causing the sea level to rise dramatically, and a powerful wind forcing waves into Venice’s canals, resulted in alarming flooding.

In 2001 engineers proposed possible solutions, including the construction of 78 hollow metal gates, each 20m high and 5m thick, at the three main inlets of the lagoon. These would normally lie flat, but could rise when inflated with air to meet the emergency of a high tide. Construction of these gates is planned to be commenced in 2006 and completed by 2011. Meanwhile, stone reefs are devised to counter oncoming tides.

There have been many arguments over the scheme, which might upset the ecosystem of the lagoons and will certainly be expensive. If, as some argue, a freak flood might occur only every 165 years, it would waste resources. And environmentalists fear that the sea-grasses of the lagoons might become choked by mud. Prolonged gate closure would impede the flow of sewage from the city, some argue, while others think that natural tidal clearance would continue, even if gates had to be closed for five days.

In an effort to achieve objectivity, an international meeting to discuss the Venetian problem is planned for September in Cambridge. Yet many remain worried over what might happen during the period between deciding on plans and implementing them. Nous verrons!

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