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Vol 272 No 7305 p820
26 June 2004

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Onlooker

Writer who saw himself more as a doctor more
Violent crimes in Sweden are found to be linked to substance misuse more
Bush administration is neglecting the financial demands of research more


Writer who saw himself more as a doctor

A century ago, on 2 July 1904, Anton Pavlovitch Chekhov died from tuberculosis in the south German spa of Badenweiler. He had suffered from the disease for nearly 20 years.

Chekhov came of lowly stock, being the third son of a country shopkeeper and the grandson of a serf. He was born in 1860 in the port of Taganrog, and spent a rather miserable childhood in the remote provinces of Russia. However, he managed to study medicine at Moscow University and qualified in June 1884.

Despite persistent ill-health Anton succeeded in supporting his family by the dual practice of medicine and writing. Despite his times and background he was a generous man, keeping himself much to himself but freely treating the local peasants for their everyday ailments, particularly during times of famine and cholera epidemics.

When he acquired a rural estate in Melikhovo he planted trees, helped to build schools, and provided books for the local library.

He had far-reaching interests. In 1890 he ventured on a hazardous journey across Siberia to Sakhalin, where he undertook a survey of some 10,000 convicts and settlers and their diseases. He also did some travelling in western Europe, in France and Italy in particular.

However, after suffering a massive lung haemorrhage in 1897 Chekhov retreated to Yalta, and occasionally Nice, marrying the actress Olga Knipper in 1901.

Chekhov regarded himself as a doctor rather than a writer. His full-length plays ‘The wood demon’ (1889) and ‘The seagull’ (1896) were failures initially. On the other hand, his ‘Uncle Vanya’ (1897), ‘The three sisters’ (1901) and ‘The cherry orchard’ (1904) brought loud acclaim. His short stories show his belief that worldly success is achieved only at the cost of loss of spiritual essence, and his heroes are struggling people, eventually overcome by malign forces. He presents a picture of middle-class life and peasant violence attributable to vodka, intoxication, where violent husbands beat their wives and daughters without mercy. Nevertheless, reading Chekhov is almost addictive.

Sometimes Chekhov grows prophetic, as in this remark in ‘Uncle Vanya’: “Man has been endowed with reason, with the power to create, so that he can add to what he has been given. But up to now he has not been a creator, only a destroyer. Forests keep disappearing, rivers dry up, wild lives become extinct, the climate is ruined, and the land grows poorer and uglier every day.” That, written in 1897, is a remarkable forecast for our own times. Yet still we do not heed.

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Violent crimes in Sweden are found to be linked to substance misuse

An intriguing report of investigations by researchers at the Karolinska Institute in Stockholm and the University of Oxford into the associations between substance misuse and violent crime appears in the 22 May issue of the BMJ.

The population impact of individuals diagnosed with drug misuse disorders on the distribution of violent offences is unknown and, in order to estimate the impact, the researchers analysed the Swedish national psychiatric and crime registers from 1988 to 2000.

The unique identification number carried by Swedish citizens enabled connections to be made. Information was extracted on all individuals who had committed homicide, aggravated assault, common assault, robbery, threatening behaviour and harassment, arson and sexual offences during the study period. Conviction data included those whose court ruling involved a “mental health disposal”, non-custodial sentence, caution, fine or finding of legal insanity.

Individuals numbering 127,789 and representing 1.9 per cent of the population were discharged from hospitals with diagnoses of substance abuse and committed 80,215 violent crimes. The researchers found that, overall, 16 per cent of all violent crimes committed in Sweden were linked to people whose hospital discharges mentioned misuse of alcohol, while more than 10 per cent were committed by those diagnosed as having misused other drugs.

In the overall population the attributable risk fraction for patients discharged with a main diagnosis of substance abuse was 23.3 per cent, increased to 24.7 per cent if secondary diagnoses of alcohol and drugs were taken into account.

It is evident that treatments aimed at alcohol and drugs misusers could have an effect in reducing violent offences. Integration of mental health and substance misuse services should be extended to the criminal justice system, and would prove highly cost-effective in the long run.

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Bush administration is neglecting the financial demands of research

A report from Washington published in The Lancet for 15 May accuses the Bush administration of failing to meet the financial demands for scientific research. A warning has been issued that the situation might become far worse during the next few years unless steps are taken to remedy it.

A complication is that it appears that the White House ignores scientific advice that does not match its political preferences, and that science and politics are at odds. At a conference sponsored by the American Association for the Advancement of Science at the end of April, 22 scientific societies and higher education authorities surveyed those aspects of the budget which concern science and calculated that considerations of space, defence and homeland security threaten to absorb all growth in the coming fiscal year, leaving other research and development activities at a standstill. Forecasts issued by the White House foretell a decline in non-defence spending power between 2005 and 2009. Senators talk of disturbing signs that America’s dominant position in the world of science is being shaken, with the prospect of dismal implications for every aspect of US society. The number of science doctorates and research papers has fallen, whereas elsewhere in the civilised world this has increased.

Thus, it is concluded that the sciences are suffering a serious decline under the Bush administration.

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