1111 Letters to the Editor Tropical medicine in and out of the tropics SIR-I was disturbed to read in your March 9 editorial’ that "there is no reason for academic departments to be in London, or in any other western city-rather they should be where they belong, in the tropics themselves". While the notion that the discipline was exploited by colonialists may have been true of the past, this view of research into tropical disease is a travesty of its track record in the UK over recent years. Illnesses and social problems that come under the conventional heading of "tropical medicine" (malnutrition, overpopulation, parasitic disease, and the like) demand a broad spectrum of skills. Much of the critical work towards an understanding of the pathophysiology of common tropical infections, and research directed at vaccine production or treatment require advanced basic science technology. Surely the richer western countries owe it to the developing world to carry out research of this type. This should certainly be linked to studies of more immediate problems in a tropical environment. The work of the UK Medical Research Council and Well come Trust units, set up in tropical countries in collaboration with local workers and with close ties to laboratories in British universities and research establishments, provides an excellent model. "Tropical medicine" should be replaced by "medicine in the tropics". The 1993 World Bank report emphasised how, as countries emerge from poverty, they rapidly change their pattern of illness; heart disease is now the commonest killer in the world. Often the pattern of diseases of western communities is completely different in emerging countries and each have much to learn from each other. The collaborative study of western disease thus provides both partners with an invaluable opportunity; if this is a genuine partnership there is no reason why medical practices of richer countries should be introduced into environments in which they are not applicable. And if even this sounds too altruistic we should remember that work in the tropics has a feedback for practice in the richer countries; the drive to control the high frequency of the inherited haemoglobin disorders in the developing countries led to the first successful prenatal diagnosis of disease by DNA analysis in the USA and UK. Medicine in the tropics covers a wide spectrum of diseases, and richer countries and the developing world should evolve partnerships to their mutual benefit. To remove this specialty from British universities and research institutions would be a retrograde step, not only for medical research but also for the education of medical students and graduates. It is now a very small world and the tragic death of one of the brightest young academics in Oxford from cerebral malaria only a few weeks ago does not encourage the belief that "tropical medicine" should be scrapped from the medical curriculum; if it "moves to the tropics" who will remain to teach it? D J Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford 0X3 9DU, UK 1 Editorial. Will tropical medicine move to the tropics? Lancet 1996; 347: 629. SiR-Your editorial rightly calls for tropical medicine schools to be situated where tropical medicine is practised and tropical patients are treated. If the schools fail to move they will become increasingly irrelevant to patient care. However, accusing collaborators of "foisting inappropriate technologies and obstructive political and financial structures" itself smacks a little of post-colonial paternalism ("We know what’s best for you"). Such an attitude is resented and often results in those in the West adopting a different agenda from those of us who live and work in the tropics. Such agendas are bound to fail unless they are truly the agendas of the home country. Those who live in the West may not always know what is best for tropical medicine even when they work in schools of tropical medicine. Even those who formerly worked in the tropics no longer have their ideas sharpened by the reality of shortages, power cuts, maladministration, and colourful pathology. Sadly, medical graduates keen to advance their careers are often encouraged to travel to the west for higher qualifications at a formidable cost. Both the graduates themselves and the western schools of "excellence" promote it for different, often selfish reasons. But the experience gained abroad is often of little relevance to the needs of the tropics, because it trains them in an environment which is both costly and impractical back home. Training overseas should be restricted to the acquisition of specific and appropriate skills. The solution is regional programmes where developing countries help each other in training and take pride in research directed at their own needs. Most clinical research is already carried out in the tropics. Many countries have established their own universities and research institutions, sometimes with the help of outside collaboration. This collaboration is not restricted to the schools of tropical medicine, which focus on infectious diseases and public health. For example, surgical research in the tropics is being done in the tropics, and tropical medicine schools have contributed little to surgery in recent years. It is therefore arrogant of The Lancet to imply that the initiative for collaboration is likely to come from the west. *David A K Watters, Surinder Kaul Department of Surgery, University of Papua New Guinea, PO Box 5623, Boroko, Port Moresby, Papua New Guinea SIR-Of course you are right to argue that tropical medicine should be conducted in the tropics but you underestimate how much has and is being done. You dismiss the considerable British contributions over the past 100 years by quoting, out of context, a sentence from Gordon Cook’s introduction to the latest edition of Manson’s Tropical Diseases. In his next sentence, Cook lists major areas of progress during the 19th century: public health (and hygiene), travel and exploration, natural history, evolutionary theory and a precise knowledge of the causation of disease (the ’germ theory’)". Those derided European specialists of the colonial era applied this new knowledge and scientific method to the study of tropical medicine in the tropics, and considerably improved the prevention and treatment of disease. Unfortunately, the distribution of these improvements was not, and is still not, equitable. This inequity results largely from economics and politics-factors over which researchers and practitioners in tropical medicine have very little