Identity cards for patients infected with HIV?

Dr A C Srivastava has written to us to describe a case that raises the suggestion that people infected with the human immuno-deficiency virus (HIV) should carry identity cards. We asked two physicians, a general practitioner working with patients with the acquired immune deficiency syndrome (AIDS), and a general practitioner with a special interest in medical ethics to respond to the broad issues raised by Dr Srivastava''s letter.     

Verapamil as a co-mutagen in the Salmonella/mammalian microsome mutagenicity test

Verapamil is a calcium-channel blocking agent, commonly used for chronic treatment of heart conditions. We have previously demonstrated that verapamil acts as a co-mutagen in a bacterial mutagenicity test for some experimental anilinoacridine antitumour drugs. Within the anilinoacridines series there are several compounds which are apparently non-mutagenic (or very weak mutagens) in the absence of verapamil, but strong mutagens in its presence. We have now tested a wider range of materials for verapamil enhancement of mutagenicity, to include some of those to which persons on verapamil therapy might be exposed through life-style or occupation. Some verapamil enhancement of mutagenicity was seen with most mutagenic compounds including anticancer drugs, antiparasitic agents, one biological stain and one hair dye. A number of tricyclic antidepressants and biological stains were tested and found to be non-mutagenic. If these results extrapolate to mammalian cells, long-term verapamil therapy could potentially increase the effects of certain environmental mutagens.     

Rural health care looks to the future. Issues in the institutionalization and management of rural health care: making technology appropriate

Experimental projects have demonstrated the technical feasibility of systems of accessible, affordable health care. These projects have relied extensively on non-professional community health workers. However, large-scale implementation of these schemes will require new management procedures that are both responsive to rural health needs and congruent with national institutions. This paper identifies the need to establish institutional mechanisms to mobilize essential inputs, promote acceptance by beneficiaries, maintain quality standards, recruit and retain field staff, and achieve accountability for resources. It then outlines methods for developing these institutions. It stresses the need for both formal, bureaucratic organizations and informal organizations of clients. It also identifies the need to consider administrative and institutional resources in determining the appropriateness of a health care technology.