Lancet 16 Jun 2007 Vol 334

In the stories of Russia 120 years ago, by Turgenev, Chekhov and Tolstoy, there is a recurring scene: the landowner or his bailiff meets a crowd of discontented peasants and eventually placates them by handing around buckets of vodka. In fact the saddest two stories of Chekhov describe the agonised hazy disbelief of a man who has inadvertently beaten his wife to death in a drunken stupor, and another an abused wife who chances to meet and exchange a few halting words with the husband whom she loved and who used to beat her in drunken rages and then deserted her. Drinking for the sake of oblivion is still common in Russia, and sometimes the oblivion is permanent, either due to the adulteration of the alcohol or the sheer quantity. This study blames it for nearly half the mortality in working Russian men. Maybe Tolstoy was right in calling for the abolition of vodka factories.

Most doctors would ardently advocate the abolition of cigarette factories, but should this extend to the destruction of all tobacco plantations as well? Maybe not, according to this Swedish article, because snus provides a way to get the nicotine kick from tobacco without all the harm of smoking it. I never really believe modelling studies, however, and I certainly can’t see the case for widening the use of snus when there are now such good drugs for helping people to break their nicotine addiction altogether. But I’m happy to note from the paper on p.2015 that snus carries very little risk of cancer, except perhaps of the pancreas.

I suspect that the term amyotrophic lateral sclerosis (ALS) will eventually replace its British synonym, motor neuron disease (MND). By either name it’s nasty and largely inexplicable, sometimes starting with bulbar features, sometimes in the cervical distribution, and sometimes in the legs. Eventually 50% of patients get distressing bouts of uncontrollable weeping or laughing. We are really no nearer an effective treatment, and the best news in this paper is that over 90% of sufferers die peacefully in their sleep.