This presidential address delivered at the Annual Meeting of the Malaya Branch of the British Medical Association deals with the history of the impact of western medicine on Malaya. In the early years curative medicine monopolized attention. A Port Quarantine Service was established in 1900 but serious attention to preventive medicine had to wait till 1911 When the Health Service of the then Federated Malay States was founded. Rubber had brought amazing prosperity and disease prevention yielded increased dividends. The address provides much interesting information about Malaya, its peoples and their diseases, and the efforts made by research workers and health departments to control disease prevalence during the last 28 years: this does not lend itself to summary. For the future, outstanding tasks include the application of recently acquired knowledge and techniques to the control of malaria; an allout attack on tuberculosis; much more attention to nutrition and deficiency diseases, and an orientation of the work of the Health Services towards social medicine. Norman White.
Aristolochic acids (AAs) are a group of naturally occurring compounds present in many plant species of the Aristolochiaceae family. Exposure to AA is a significant risk factor for severe nephropathy, and urological and hepatobiliary cancers (among others) that are often recurrent and characterized by the prominent mutational fingerprint of AA. However, herbal medicinal products that contain AA continue to be manufactured and marketed worldwide with inadequate regulation, and possible environmental exposure routes receive little attention. As the trade of food and dietary supplements becomes increasingly globalized, we propose that further inaction on curtailing AA exposure will have far-reaching negative effects on the disease trends of AA-associated cancers. Our Review aims to systematically present the historical and current evidence for the mutagenicity and carcinogenicity of AA, and the effect of removing sources of AA exposure on cancer incidence trends. We discuss the persisting challenges of assessing the scale of AA-related carcinogenicity, and the obstacles that must be overcome in curbing AA exposure and preventing associated cancers. Overall, this Review aims to strengthen the case for the implementation of prevention measures against AA's multifaceted, detrimental and potentially fully preventable effects on human cancer development.