386 whether a particular treatment is better than its predecessors. Under such conditions it is often ethical and desirable that the patient has the opportunity of being treated under the closely controlled conditions which a clinical trial affords. Department of Psychiatry, Charing Cross Hospital Medical School,
STEVEN R. HIRSCH
London W6 8RF
SCIENCE AND RAPPORT WITH CHINA
SIR,-Your
note on cancer
in China
(Jan. 20,
p.
170)
sug-
gests that the success of the U.S. cancer delegation was probably an effect rather than a cause of the new rapport between East and West. True in part, but scientific delegations to and from China, by opening new horizons, may well have been a contributing cause to the movement away from the Chinese tradition of self-reliance. Clinical Epidemiology Branch, National Cancer Institute, Bethesda, Maryland 20014, U.S.A.
ROBERT W. MILLER
concentrations
1. 2.
Lund, B., and others. Lancet, 1978, ii, 73 Nordin, B. E. C. ibid. 1978, u, 1259.
Serum-creatinine concentrations before and after lx-OHD3 therapy.
higher
after
for the increased serum-creatinine. Our results suggest that 1-OHDg may produce small increases in serum-creatinine in people with normal renal function, and that this is independent of plasma calcium, phosphate, or parathyroid hormone. The tendency for plasma-urea also to rise suggests that the rise in serum-creatinine is genuine, and not an artefact of interference with the measurement of creatinine. The mechanism of this effect and its clinical significance remain to be determined. However, it seems advisable to monitor serum-creatinine in patients receiving la-OHD,.
account
VITAMIN-D ANALOGUES AND RENAL FUNCTION
SIR,-It has been suggested that treatment of bone disease with ly-hydroxy vitamin D3 (la-OHD3) in patients with chronic renal failure may hasten the decline of renal function, although others have claimed that renal function is not adversely affected if hypercalcsemia is avoided and plasma-phosphate is controlled. Lund, Nordin, and their colleaguesl·2 have reported rises in serum-creatinine associated with lx-OHD3 in elderly and postmenopausal osteoporotic patients; however, renal function was restored when the hypercalcxmia was corrected. We have measured serum-creatinine levels in fasting bloodsamples from twelve patients with bone disease after jejunoileal bypass for obesity before and after treatment with oral la-OHD3, 2 p.g daily, given for 4-9 months (mean 6-6). The serum-creatinine after treatment was 70-0+13-0mol/1 (mean±s.D.), significantly higher than the pretreatment value of 37-7+11.0 mol/1 (P