Biomarker-driven care in asthma: are we there?

Clinical asthma management is limited by the lack of straightforward and clinically applicable techniques to assess control and appropriately adjust therapy. The availability of biomarkers associated with airway caliber, responsiveness, or inflammation has prompted interest in the application of these measures as surrogate asthma end points in clinical trials. Use of a biomarker as a surrogate outcome in practice is most appropriate in settings in which the effects of therapy on clinical disease, as experienced by patients, are fully captured by that biomarker. Recent studies suggest that although asthma therapies can alter various biomarkers, the relationship between these biomarker changes and important clinical outcomes is inconsistent. Because symptom-driven titration of therapy is feasible and effective, additional data demonstrating clinically important benefits of biomarker-driven care in asthma are needed to justify the logistic and economic burdens associated with clinical dissemination of these techniques.     

Facilitating informed choice in prenatal testing: how well are we doing?

There is a consensus that prenatal testing services need to provide the information and support necessary for women to make informed choices about prenatal testing. Informed choices are those based on relevant information that reflect the decision-maker's values. To date, most research has focused on the information provided to women deciding whether to undergo tests. This has highlighted the poor quality of information provided to many women. There is agreement on the need to provide information on three key aspects of any test: the condition for which testing is being offered, characteristics of the test, and the implications of testing. Very little research has been conducted on decisions after the diagnosis of a fetal abnormality and how information and emotional and decisional support are and should be provided. Research is now needed in four key areas: first, on the optimal ways of organizing services to facilitate choices that are not only based on relevant information, but also reflect the decision-maker's values; second, on the most effective ways of framing information needed for the different decisions involved in prenatal testing; third, on the most effective media in which to deliver information; and, fourth, to identify aspects of counseling that facilitate informed choices following diagnoses of fetal abnormality. If we value women's ability to make informed choices about prenatal tests as highly as we value reliable laboratory tests, evidence-based quality standards need to be developed for the information and support women are given at all stages of the process of prenatal testing.     

Juvenile toxicity: are we asking the right questions?

The recent increase in numbers of juvenile toxicity studies over the past few years has doubtless added to our knowledge of the development of organ systems in the young rodent, but it is perhaps rather more difficult to answer the questions as to whether this body of work has served us well in terms of assessing risk in the pediatric population. If there are shortcomings, are they the result of poor study design or poor sensitivity of the model, or are the wrong questions being posed? This article provides a superficial overview of the progress made thus far and considers which aspects of study design and model choice currently fail to adequately address the major issues surrounding pediatric toxicology.     

Medical Research: Are we doing enough in Africa?

As we look forward to the end of this Century and the beginning of the next, our politicians are busy telling us about their plans to turn our countries into New Industrialised Nations (NINS) by the year 2010 (or is it 2020?). Most of us dismiss this as mere political rhetoric. But as medical researchers, perhaps we ought to look at this 2020 business more carefully. Let us assume that a few African countries will indeed become New Industrialised Nations by the year 2020. Shall we, as medical researchers, have contributed to this industrialisation process through our research efforts? Perhaps to answer this question one needs to look at the state of medical research in most African countries at the moment. In the majority of our countries, research output in the form of publications in reputable medical journals has fallen in recent years. Perhaps the only exception is research on AIDS/HIV, but only because of external funding and/or collaboration with other centres outside Africa. In addition, most of the prominent African medical scientists trained in the sixties and seventies have either retired or will soon retire. What they have left or will soon leave behind are institutions which are so run down due to lack of resources that proper research and training no longer takes place. The tragedy of all this is that Africa is not producing enough well trained young medical scientists to continue with the good work started by those retiring now. Some countries in South East Asia have become New Industrialised Nations through aggressive training programmes and incentives for their young scientists (including medical scientists). Can African medical scientists be optimistic about the year 2020, given the meagre resources we are operating with at the present time? I am not.