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This article focuses on the continual placebo-controlled trials in women to assess the efficacy and safety of antiretroviral drugs despite the results that have shown that the antiretroviral drugs prevent sexual transmission of HIV. The authors state their belief that to undertake more placebo-controlled trials would be short-sighted and unethical and to delay implementation would cost the lives of the women whom the drugs are intended to benefit. They conclude that a broader perspective of study design and of the assessment of scientific evidence than presently exists would provide a constructive way forward to learn how best to implement new interventions to improve public health.

Analysis of published data indicates that the increased rate of trisomy 21 pregnancies with advancing maternal age is due to failure of a postulated maternal screening process between fertilisation and recognition. This mechanism may also operate in other trisomies.

Written in 1955 this article discusses medical care in the township of Alexandra which contained 80000 African and colored people in a 1 1/2 square mile area and lies on Johannesburgs outskirts. The townships population consisted mainly of unskilled underpaid labor and its health committee had an annual budget of 1 pound/individual in contrast with 28 pounds in adjacent Johannesburg. Social and living conditions in the township were very poor. The Alexandra Health Center and University Clinic had a staff of 4 physicians; 4 sisters; 25 nurses; and rotating medical students. Despite clinic overloads an attempt was made to ensure continuity between individual patients and physicians by dividing the towship into 3 areas and assigning each to a physician/sister/nurses/students team. Because of the high number of casualties due to disordered community life curative care almost completely replaced preventive care so the staff tried to use every patient contact as an opportunity for patient teaching. Also a total of 16500 home visits were made in 1953; this was considered an important aspect. 548 new cases of tuberculosis were noted in 1953; the patients were cooperative and the cure rates were high despite the fact that patients hesitated to seek treatment. Prenatal and postnatal encounters were encouraged for pregnant women. A flat fee was charged for all treatment. Breastfeeding was encouraged. Well-baby clinic statistics show 1429 mothers attending in 1953 with 10941 repeat attendances. The main component was nutrition education of mothers seen to be an important strategy for attacking infant mortality due to diarrhea malnutrition and whooping cough. In general the emphasis on home care which was very necessary given the difficulty in finding hospital beds for Africans showed good results. Patients were happier and less stresed and family members could be instructed in caring for the sick.