Added value of interferon-gamma release assays in screening for tuberculous infection in the Netherlands.

BACKGROUND: Interferon-gamma release assays (IGRAs) are reported to be more specific for the diagnosis of latent tuberculous infection (LTBI) than the tuberculin skin test (TST). The two-step procedure, TST followed by an IGRA, is reported to be cost-effective in high-income countries, but it requires more financial resources. OBJECTIVE: To assess the added value of IGRA compared to TST alone in the Netherlands. METHODS: Test results and background data on persons tested with an IGRA were recorded by the Public Municipal Health Services in a web-based database. The number of persons diagnosed with LTBI using different screening algorithms was calculated. RESULTS: In those tested with an IGRA, at least 60% of persons who would have been diagnosed with LTBI based on TST alone had a negative IGRA. Among those with a TST reaction below the cut-off for the diagnosis of LTBI, 13% had a positive IGRA. For 41% of persons tested with an IGRA after TST, the IGRA influenced whether or not an LTBI diagnosis would be made. CONCLUSION: With the IGRA as reference standard, a high proportion of persons in low-prevalence settings are treated unnecessarily for LTBI if tested with TST alone, while a small proportion eligible for preventive treatment are missed. Incremental costs of the two-step strategy seem to be balanced by the improved targeting of preventive treatment.

[Laqueur and Organon. The university laboratory and the pharmaceutical industry in the Netherlands]. / Laqueur en Organon. Het universitaire laboratorium en de farmaceutische industrie in Nederland.

Since the 1970s cooperation between universities and pharmaceutical firms is business as usual. This has not always been the case. The first alliances between academic scientists and the pharmaceutical industry can be traced back to the 1920s. Compared to the U.S. and most other European countries, the creation of networks between the Dutch academy and industry shows a rather peculiar pattern that is illustrative in clarifying how the relationships between scientists and the pharmaceutical companies were built. Dutch scientists could not ally themselves with the pharmaceutical industry, simply because no Dutch pharmaceutical company specialized in organpreparations existed prior to the 1920s. This situation forced scientists to opt for the strongest form of alliance they could create, namely to take part in the founding of a pharmaceutical company. Ernst Laqueur, a professor in pharmacology at the University of Amsterdam, was one of the three founders of Organon, the Dutch pharmaceutical firm that was founded in 1923. Based on an analysis of the early history of sex endocrinology, this paper examines the creation of networks between Laqueur and Organon. The paper concludes that the university laboratory played a crucial role in the development of Organon. Organon was dependent on Laqueurs laboratory for the provision of the required biological essay techniques in order to manufacture standardized hormone products, Moreover, Laqueur mediated all the contacts between Organon and the clinic, required for the clinical testing of hormones and the provision of raw materials for the making of hormones into chemicals and drugs.

Menopause, only for women? The social construction of menopause as an exclusively female condition.

Over the last three decades the menopause has continued to interest the medical profession, the pharmaceutical industry and the mass media. Although there exist many different views on the menopause, there is one common denominator. Menopause is depicted as an exclusively female condition. The medical discourse on menopause seems to exclude men. However, a closer look at the history of the medical sciences reveals that there have been and still are, attempts to classify symptoms of ageing men as male menopause or climacterium. Despite these attempts to put men on the menopausal agenda, most attention is focused on women. How can we understand this almost exclusive focus on female bodies? Why does there exist such an emphasis on the medicalization of the third age of women rather than of men? Maybe we might be inclined to think of a male conspiracy, as has been suggested by feminists: women take the pills, while men cash the bills. We might consider the enormous profits of the pharmaceutical industry. This paper is concerned with finding an alternative explanation for the almost exclusive attention for the female menopause. Based on historical data and more recent discussions in medical journals, the paper shows that the medicalization of the female menopause and the relative silence around the male climacterium can be understood in terms of the social and cultural processes that underly the classification of health problems as specific diseases. The imbalance in medical treatment of climacteric health problems in women and men is not simply rooted in biological sex differences, but can be ascribed to men's attitudes towards health problems and organizational infrastructures of the medical institutions.

From population control politics to chemicals: the WHO as an intermediary organization in contraceptive development.

Studies of laboratory work have rarely focused on the role of intermediary organizations in developing R&D activities. Most studies focus on a single university-based research laboratory or an industrial R&D unit. Moreover the rejection by social constructivist scholars of universalistic, deterministic explanations of the development of science and technology has led to an overemphasis on the local features of scientific and technological work. Based on a case study of the role of the World Health Organization (WHO) in contraceptive R&D, this paper suggests that an analysis of the role of intermediary organizations enables us to go beyond a too-narrow focus on the micro-sociological dynamics of laboratory work, to include the macro- and meso-sociological dimensions of science and technology. First, a focus on intermediary organizations enables us to learn more about the manner in which locally specific laboratory cultures are transformed into translocal research practices. This paper shows how literary technologies, and to an even greater extent material technologies, are important tools in accomplishing standardization of local laboratory cultures. Second, a focus on intermediary organizations enables us to study how concerns that go beyond the laboratory--in this case, population control policies and the agenda of the WHO--help to shape laboratory practices.

Female or male: the classification of homosexuality and gender.

During this century the issue of homosexuality has been a recurrent theme on the research agenda of biologists. Historically, the life sciences have conceptualized homosexuals as persons with characteristics of the opposite sex. This paper discusses how the discourse on homosexuality became entangled with the discourse on gender.

A pressor effect of noncardioselective beta blockers in mildly hypertensive patients during surgery under anesthesia.

Sixty-two patients with mild hypertension were randomly assigned to receive no treatment, or 160 mg propranolol, or 200 mg metoprolol daily starting one week before elective surgery under anesthesia. The last dose was given two hours before anesthesia. Anesthesia consisted of induction with midazolam (2.5-5 mg) followed by thiopental (250-500 mg) and was maintained with 60% inspired N2O in oxygen and 0.4% enflurane inspired. Airway carbon dioxide was monitored continuously by a CO2 analyzer. Preoperative blood pressures were equally reduced by the two beta blockers. During anesthesia, however, blood pressure further decreased in the metoprolol group but not in the propranolol group. The authors conclude that propranolol is less effective than metoprolol in mildly hypertensive patients during surgery under anesthesia, owing probably to a pressor response from propranolol during the stress of surgery. They also conclude, however, that the amount of blood pressure reduction by cardioselective beta blockade (metoprolol) may not be needed and that anesthesia itself is an effective means of reducing the blood pressure.