484

information even though the life of family members is in danger". Other recommendations cover confidentiality, data protection, and state control of genetic services, while insisting that research projects involving medical genetic data should be carried out under the direct supervision of a physician. There should be equality of access to genetic testing, the guidelines suggest, "without financial consideration and without preconditions concerning eventual personal choices". Although the guidelines envisage the sale to the public of tests for genetic diseases or for predisposition to such diseases there should be statutory licensing schemes nationally. The guidelines urge that genetic testing, even when offered routinely, should be subject to express, free, and informed consent, with special safeguards for minors, those with mental disorders, and adults in guardianship. The Council of Europe studies on DNA analysis in criminal justice2 were prompted by the first exploitation of DNA technology in an immigration case in 1985. The memorandum explains that a conventional fingerprint is unique to the individual and that a suspect may be convicted solely on such evidence. The analogy with "DNA fingerprinting" is invalid, however, because a genetic profile will depend on several factors, such as the technique and the quality of the test material. At best, a profile may provide odds of several million to one against the DNA having originated from someone rather than the individual involved. At the other end of the scale, the differentiation may be low, and it is not possible to generalise."... it will be for the court to decide in any particular case". Having found that the issues raised were so new to some countries that no specific legislation had emerged, the panel’s immediate recommendation is that governments should proceed to a legal definition on recourse to DNA techniques. Data and samples should not be retained except in clearly defined cases, and defence lawyers should have equal access to the

technique. activity report and summary of the Ad Hoc Committee of Experts Bioethics (CAHBI) recommendation on genetic testing and screening for health care purposes. Strasbourg: Council of Europe,

1. Final on

1992. 2. Final activity report and summary of the use of analysis of deoxyribonucleis acid (DNA) within the framework of the criminal justice system. Strasbourg: Council of Europe, 1992.

Arthur

Bielarus: Political fallout from

Rogers

Chernobyl

Doctors and researchers in the Republic of Bielarus (ex-Byelorussian SSR) are becoming increasingly critical about the findings of international "experts" on the medical consequences of the explosion at the Chernobyl nuclear power plant in April, 1986. Bielarus caught some 70 % of the total fallout from the accident. Yet until February, 1989, Soviet government policy forbade any public mention of fallout hazards outside the 30 km zone surrounding the plant, and rumours of an increased incidence of congenital defects and leukaemia in the stricken areas were officially attributed to "radiophobia". Eventually, the full extent of the contamination was

admitted, the Soviet government asked the International Atomic

Energy Agency (IAEA) to carry out an expert survey. When the results of which were reported at an IAEA conference in May, 1991, doctors from both the

Byelorussian and Ukrainian SSRs strongly disagreed with the findings. However, they were still not allowed to present their results in public (even although from 1990 some data had appeared in limited-run specialist journals), so others at the conference gained the impression that the Byelorussians and the Ukrainians had no hard data to go on. The ending of the Soviet Union has left the doctors and researchers free to speak out. And the records from the past 5 years that have reached the London-based Byelorussian Radiation Relief Committee make it clear that the Byelorussian doctors are not short of data. Although it is far too early to consider the possible genetic consequences of Chernobyl in man, the visiting experts have paid little attention to animal studies from the affected areas. Dr Ruza Hancarova of the Institute of Genetics of the Byelorussian Academy of Sciences has found a significant rise in chromosomal aberrations in small rodents-bank voles (Clethrionomys glareolus) and yellow-neck mice (Apodemus flavicollus)-living in contaminated areas during 1986-87. The 1986 radiation levels of caesium-137 in the test areas was 30 Ci/sq km and 3 Ci/sq km. "Regions of similar and higher contamination levels", Dr Hancarova concluded, "must be treated as zones of genetic risk". The Byelorussian scientists also point out that the visiting experts also did not take into account such topics as the pollution of water systems (where there is now a serious build-up of contaminated silt), the air transfer of "hot" particles, the migration of radionuclides in different types of soil, the synergic effect of "conventional" industrial pollution and exposure to radiation, or changes in the general morbidity patterns of the population of the contaminated zones (believed to be an important indicator, since one of the effects of ionising radiation is to suppress immunity). Nor did the visiting scientists pay heed to local necropsy evidence on persons who died of causes not directly related to the Chernobyl accident, which suggested that 70% of the population of Homiel province and 50% of that of Mahileu province had inhaled radionuclides into their lungs. The Byelorussian scientists do not blame the IAEA for the narrowness of their remit. What they want is for their own data to be correlated with those of the IAEA and used as an official supplement to it. However, since the IAEA is an intergovernmental organisation the Byelorussian researchers’ request can be made only through the Bielarus Government. In the meantime, it is the IAEA findings that are internationally accepted, while findings from local researchers still remain "unofficial". Nevertheless, it could be that "local" results are what would give a picture of the dynamics of contamination since the accident. Over the five years 1986-90, children living in the three most contaminated counties showed substantial changes in thyroid function. Immediately after the accident (May-June, 1986) one-third of the children examined had raised serum concentrations of tri-iodothyronine, thyroxine, and thyrotropin. 6 months later, the hormone concentrations had returned to normal. In 1988, an increasing number of children showed depressed serum concentrations of tri-iodothyronine and thyrotropin. A 1990 survey in one of the three counties (Chojnicki) showed that half of the children aged 6 years of age, who had been aged under 2 at the time of the accident at Chernobyl (the age group at maximum risk from radioiodine), had deviations in thyroid status. Concentrations of thyrotropin and thyroxine and the titre of microsomal antibodies correlated with doses above 400 cGy. Moreover, mass ultrasonic screening of the thyroid, done in 1990 on a third of the

485

children and adolescents of the same county, showed a rate of sonographic changes eight times higher than in the control group. The Byelorussians themselves are beginning to question and to try to pinpoint why it has been so difficult to present their case to the world. They observe that almost all the key figures in the nuclear establishment set up in the republic under the communist regime were Russian incomers, appointed by Moscow. (The director of the Institute of Radiation Medicine of the Byelorussian Ministry of Health, Dr Vladimir Matyukhin, for example, was formerly head of radiation medicine with the Soviet Far Eastern Fleet). Immediately after the failed coup last August, the leading Byelorussian daily Zviazva began publishing summaries of the meetings of the Soviet Ministry of Health, which had imposed a ban of secrecy on all matters relating to the medical consequences of the accident. Human rights campaigners are now starting to call for the prosecution of the officials concerned, since the secrecy, by preventing any preventive measures-such as iodine supplementation or even a warning to stay indoors-was, they say, an offence against the basic right to life and health. Such a prosecution would not be easy, since the decision-makers of that time were in Moscow, now, technically, in a foreign country. But in the months to come, the polictical "fallout" from

Chemobyl

may prove to be

no

less

significant

than the

radiation itself. Vera Rich

Noticeboard Irish abortion

case

In 1983 the people of the Republic of Ireland voted by two to one to amend Article 8 of the constitution, to include the words: "the state acknowledges the right to life of an unborn child, with due regard to the equal right of the life of the mother, guarantees in its laws to request, and, as far as practicable, by its laws to defend and vindicate that right". In the High Court in Dublin Mr Justice Costello has granted Ireland’s Attorney General an injunction preventing a 14-year-old rape victim from having her pregnancy terminated. She had left Ireland on Feb 6, but returned when the interim injunction was granted; the girl had threatened suicide. The judge’s ruling was published on Feb 17. According to The Independent (Feb 18), the Attorney General had directed that public discussion of the case and the issues raised would be in contempt of court. Officially 2000 women every year travel from the republic to the UK for abortions (and the British Pregnancy Advisory Service in London receives every week 25 such requests for help). The total number is thought to be well over 2000, probably double. An appeal to the Irish Supreme Court is possible but time is running out. The circumstances of the case are unusual in that it seems likely that an abortion outside Ireland could have been arranged smoothly. However, police advice was sought about forensic DNA testing on fetal material, and that set in motion the wheels of official

interference. Public discussion in Ireland has not, of course, been stifled. An Irish Times editorial thunders about "a nightmare brought on by a combination of political cowardice and sectarian triumphalism,

together with some genuinely but profoundly ill-informed idealism". All-party talks aimed at resolving the political crisis-but not, perhaps, the girl’s personal one-are being set in motion. A further referendum (only 54% of the electorate voted last time) is a

possibility.

Cells

surviving

a

exposure

In radiation biology there are grays and grays: allowance has to be made for the type of radiation. The ot particle, in terms of biological effects dose for dose, is more potent than X radiation. This complicates the interpretation of environmental radiation risks. Even so, it is still widely held that radiation from nuclear power facilities cannot explain leukaemia among children in the neighbourhood. That view might need revision in the light of findings from the MRC Radiobiology Unit. A hit on the nucleus will prove fatal to a cell; other cells may escape altogether-but what of those merely wounded by an a particle? More dangerous apparently, for chromosome damage can appear in the progeny several divisions later. Wright and colleagues’ studied mouse bone-marrow stem cells in culture and exposed them to radiation doses from the a-emitter plutonium-238. The changes were not seen when X rays were used. According to Dr Eric Wright "We do not yet know whether the type of damage we have demonstrated reflects damage to stem cells that may lead to leukaemia", but it will be in that context that bodies such as the UK Committee on Medical Aspects of Radiation and the Environment will no doubt wish to examine these findings. 1. Kadhim MA, Macdonald DA, Goodhead EG. Transmission of chromosomal irradiation. Nature 1992; 355: 738-40

DT, Lorimore SA, Marsden SJ, Wright instability after plutonium &agr;-particle

A decade of AIDS research

Investigators of the acquired immunodeficiency syndrome (AIDS) may need to examine their research priorities. Ten years ago, AIDS was a newly described condition about which little was known. However, in the past decade, research into the disease has increased dramatically. Elford and colleagues1 report a search of the MEDLINE database on CD-ROM (compact disc read-only memory) that shows that between 1981 and 1990 more than 30 000 papers were indexed under the headings AIDS or HIV (human immunodeficiency virus). There was a 50-60% increase per year between 1983 (646 papers) and 1988 (6801) in publications indexed under these headings, but between 1988 and 1989 the rate of growth fell to 6%. The annual rate of growth of all papers on MEDLINE between 1981 (265 205) and 1990 (373 000) was about 3-6%. What were the main preoccupations of the AIDS papers indexed MEDLINE? Aetiology was the subject of 25% of all AIDS publications in 1983 but only 3% in 1990; at the same time, papers on HIV increased from 2 to 37 % of the total. Prevention and control were the subjects of 6% of paper in 1984,18% in 1988, and 12% in 1990. 1% of publications in 1983 were about drug therapy compared with 7% in 1990. The epidemiology of AIDS/HIV was consistently the concern of about 10% of papers throughout the decade. English was the language of the overwhelming majority (82 %) of papers on AIDS. Since many cases of AIDS occur in countries where English is not the first language (the francophone countries of Africa for example), this finding raises questions about the accessibility of published research in these countries. AIDS in sub-Saharan Africa was discussed by only 3% of AIDS/HIV papers indexed by MEDLINE between 1982 and 1990-over the same period, a quarter of all AIDS cases were reported from Africa. Because of its origin in the USA, MEDLINE may be biased towards English-language publications, and the database does not index all journals that deal with AIDS and HIV. However, a search in The Lancet office of the AIDS CD-ROM database (Maxwell Electronic Publishing, Cambridge, Massachusetts, USA), which covers published research on AIDS additional to that indexed by MEDLINE, showed that only about 4% of papers discussed AIDS/HIV in sub-Saharan Africa. Thus, the limitations of the MEDLINE database are unlikely to account for the patterns of AIDS/HIV research described by Elford and colleagues. There is a clear need to give priority in future AIDS research to those countries that will have to bear the greatest burden of this disease. on

1. Elford

the

J, Bor R, Summers P Research into HIV and AIDS between

epidemic curve AIDS 1991; 5:

1515-19.

1981 and 1990: