Reforming Italys academic

appointments system
In 1994, the Italian Minister for University and Scientific Research had to revoke
new appointments for full-time professorships of otolaryngology, medical
and psychobiology, amongst others,
because of irregularities in the way the
successful candidates were chosen. Some
other appointments, such as those for

oncology,

appointments system is. In human . old limits and defining minimum teaching
and clinical activity, was addressed.
physiology, for example, successful candidates had total impact factor scores of:
During the lively discussions at the
10-12 for publications listed in their CV,
meeting, many participants called for less
whereas some unsuccessful candidates
subjective and more objective evaluation
had scores of 250. Similar findings were of candidates, though some participants
obtained for the concorsi for general and expressed reservations about the use of
inorganic chemistry. Merit seems to be a . criteria such as the citation rating, which
fortuitous factor in the concorsi.
: might favour candidates working on popThe Italian speakers focussed on criteular topics. But as the secretary of FIRU
ria for objectivity in assessing CVs,
pointed out, imperfect regulations are better than no regulations, and he hoped that
though it was also pointed out that developing a fair and efficient system based on the Minister of University and Scientific
merit must start with the appropriate Research would do something to rectify
the situation. It was also widely felt that
choice of members of the selection comfar
too
are
mittee, who,
often,
nothing more meetings with European colleagues
. on the
more than "academic politicians" who
topic might help accelerate the
have long since abandoned any scientific change.
the

internal medicine, are being queried, but

official action has yet been taken. That
the system in Italy is based largely on
patronage has been recognised (Lancet :
1988; i: 123, 1991; 338: 1337, Nature :
1991; 353: 10, 1993; 366: 293) and is
work. In addition, the role that academic
increasingly being debated in public. Contributing to the debate, and offering sugfunding organisations and scientific socigestions for improving the system, was the eties could play, by setting quality threshmeeting held last month in Bologna by the
University of Bologna and the Federno

Brian F G Johnson, Dario

Laura Calza

Braga,

azione Italiana Ricercatori Universitori,

CONFERENCE
on Recruitment and Academic Promotion
in European Universities. The debate has
been stirred up not only by
indignation and by concern that the system is damaging the image that others
hold of Italian academics, but also by the
realisation that Italy is performing
Although information on how the acceleration of the clinical course of
in the competition for European Union neural, behavioural, and immune sys- HIV infection
(Margaret Kemeny,
research funding.
tems interact is in the early stages of Los
Angeles). These associations
There were descriptions of the systems
were
not
substantiated in HIV studbeing interpreted (Lancet, Jan 14,
in France, the Netherlands, Austria, and
these interactions have been ies presented by Lawrence Jacobsthe UK. These revealed several features in p 99),
to have relevance for a broad berg (New York) and Constantine
shown
common-academic careers proceeds over
well-designated and fully monitored steps; range of human diseases, as indicated Lyketsos (Baltimore). Explanations
there is usually a continuous assessment at the first meeting of the recently offered for the discrepancy were: difconstituted
ferences in other variables related to
of merit and progress through both teachResearch Society held in November immunity such as intake of alcohol,
ing and research; there is student participation in the assessment of teaching in Miami, USA. These diseases recreational substances, and/or preability; selection committees always coninclude infectious diseases, cancers,
scribed anti-retroviral medicines; the
tain representatives from other departand
autoimmune
diseases.
of epidemiological studies; and
limits
allergies,
ments within the faculty/university; and
A workshop on methodological
variability in the choice of psychologsenior appointments are always subject to
issues in psychoneuroimmune studies
ical and immune measures. It was
external assessments.
: of HIV-1infection laid the
groundsuggested that functional immune
In Italy, appointments are not made
work
for
behavioural
intervention
measures
(NKCC, lymphocyte prolifinstitution by institution, but nationally.
erative
to
The number of vacancies throughout the strategies such as bereavement supmitogens),
response
country for, say, professors of medicine, is port groups. One set of studies cytokine levels (Thl vs Th2), and
determined, and a selection committee is demonstrated the usefulness of a other phenotypic immune measures
appointed to select the required number theory-driven model predicting dele(activated, cytotoxic CD8 lymphocyte
of people. The various institutions then terious effects for stressful life
events counts) be routinely considered (in
take their pick from the list of successful and beneficial effects for
addition to CD4 lymphocyte counts)
availability
candidates. The appointments, based on a
of social support and use of active for evaluating immunity in future
complex exchange of favours and votes,
coping strategies (Goodkin, Miami).
psychoneuroimmune studies of HIV
are for life and subjected, rarely, to feeble
this
Multivariate
modAn area identified for further study
:
analyses
using
controls. Candidates with good curricula
was the relations between psychovitae (CV) tend to get left out in the con- : el revealed that lower levels of life
stressors and higher frequencies of neuroimmune changes, HIV-1 viral
corsi (the competition for academic promotion), at all levels of recruitment, active coping were associated with load, and clinical outcomes (eg, longbecause they are seen as a threat to the increases in CD4 lymphocyte counts,
term survival, mortality, CDC clini"establishment". Data on comparisons of and that bereavement within the cal
stage change, and progression to
impact factors and citation ratings of pub6 months was associated with AIDS).
Another
was
prior
putative
lications listed in the CVs (obtained from .
decreases in natural killer-cell cytostressor-associated
neuroendocrine
the Ministry of University and Scientific
and subsequently mechanisms-eg,
the
association
Research) of successful and unsuccessful toxicity (NKCC)
in
with
decreases
in
between
increases
cortisol
concenlymphocyte prolifcandidates were presented at the meeting.
to
erative
tration
and
HIV-1
infecresponses
phytohaemaggluproductive
Although the limitations of these indices
tinin
reduced
secretion
of
as an assessment of ability were acknowl(Goodkin, Miami). Anticipation tion, apoptosis,
edged, the results showed how topsy-turvy of negative events was associated withThl-derived cytokines, increased

personal Clinical

aspects of psychoneuroimmunology

poorly

Psychoneuroimmunology

183

secretion of Th2-derived cytokines,

decreases in IL-2 production, and
slowed maturation of HIV-1-specific
cytotoxic CD8 lymphocytes. In
addition, studies of immunological
mediating mechanisms were recommended-eg, increases in IL-10 and
tumour
necosis factor
(TNF)-a
inducing NF-KB binding to the longterminal repeat of HIV-1, increasing
viral replication. Another immunological mechanism pertains to the
Clerici and Shearer hypothesis-that
progression of HIV-11 disease is
potentiated by a Thl to Th2 shift in
CD4 subsets. This hypothesis has
not been confirmed by some recent
studies. According to Nancy Klimas
(Miami), clinically relevant changes
in overall cytokine patterns are associated with CD8 cells predominantly
and also with NK cells, especially later in disease.
In chronic fatigue syndrome,
cross-sectional and longitudinal studies of the relation between cytokines
and clinical status have shown that
patients show fluctuations between
two
largely non-overlapping subgroups of abnormalities-one with
increased TNF-a, and the other with
increased soluble TNF-a-receptor-1,
decreased NKCC and lymphocyte
proliferative activities, greater cognitive impairment, and poor functional
.

tible

mice

stressed by physical effect was simulated by IFN-a treata relation between ment in non-autoimmune mice.
increased growth of Mycobacterzum ;
David Shapiers (Shreveport) findavium complex and M- tuberculosis : ing that chronic intracerebroventricular administration of IFN-a was
(related to hypothalamic-pituitaryaxis
adrenal
associated with parkinsonian features
activation) and suppression
of
in rats suggested a relation to
macrophage
activity.
decreased
Induction of the gene
fluid
cerebrospinal
resistance to mycobacterial infectiondopamine, as is the case in HIV-1associated dementia complex.
(Nramp) was augmented by interferIn breast cancer patients, 10-year
on (IFN)--y and abrogated by corti:
costerone at physiological concentpostoperative survival has been
inhibrations ; mifepristone (RU486)
reported to be increased when masited this effect of corticosterone.
tectomy had been done on days 6-8
of the menstrual cycle. Shamgar
Kiecolt-Glaser
Janice
(Columbus)

restraint, there is

controlling

described

Ben-Eliyahu

an investigation among pricaregivers of Alzheimers disease patients; compared with controls

(non-caregivers), those aged 70 and
over had significantly lower antibody

(Tel-Aviv)

reported

increased

metastatic efficiency of
parenterally administered syngeneic
NK-sensitive mammary-tumour cells
during the pre-oestrus/oestrus phase
to
trivalent
influenza
in rats. This effect seemed to be on
vacciresponses
nation and twice the number of
NK cells and to be mediated by
infections.
The
oestradiol and partly blocked by
upper respiratory
that
chronic
stresfindings suggest
progesterone. Thus, perhaps the
sors may contribute to the ageing of
phase of the menstrual cycle, progesthe immune response.
terone supplementation, and oestroRoger Booth (Auckland) demongen blockers might be considered
strated the effect of hypnosis on before
Yehuda
Shavit
surgery.
immediate hypersensitivity reactions. : (Jerusalem) showed that high-dose
The reduction in wheal size with
(fentanyl)
suppressed
analgesia
NKCC longer in surgical patients
"positive emotional state" and the
absence of this effect with "negative
than did a balanced anaesthesia regiemotional state" are consistent with
men. Hence, to prevent "surgical
stress", perhaps IFN-y and IL-2, as
psychoneuroimmune reactions.
In a murine model of systemic
well as behavioural interventions,
status (Roberto Patarca, Miami).
; lupus erythematosus, Lisa Schrott might be justified pre-operatively,
Protection against disease may also
(Denver) found that, when put in a
especially when high doses of narbe affected by psychoneuroimmune
"conflictual" situation, the mice
cotic anaesthetics are used.
showed impaired avoidance learning,
interactions. Bruce Zwilling (Columwhich correlated with increased
Karl Goodkin, Mary Ann Fletcher,
bus) reviewed his recent studies
in
concentrations.
This
Nicholas Cohen
showing that,
genetically suscep-autoantibody

Epidemiology training in

mary

underdeveloped in Pakistan. McCormick, and education, and

former scientist at the US Centers for

Pakistan
Disease Control and Prevention, said at a
recent celebration of AKUs 1Oth anniverTen years ago when the Aga Khan Unisary : "Our principal goal now is not to .
train just for primary care. We cant make
versity was founded in Karachi, a principal goal of the medical school was to train enough impact that way because there is
not enough data to demonstrate the
primary-care physicians who would supthe
basic
health-care
services
needed
results. But adding epidemiology shows
ply
so badly in Pakistan and most developing
us, and the students and residents not
countries. Although students had to
only where the health problems are but, .
of
their
5
in
what to do to prevent them". The result
years training
spend 20%
urban katchi abadi (slums) and rural vilhas been a substantial increase in family
the
aim
not
achieved.
The
was
lages,
practice residencies. 6 graduates each year
intense exposure to human misery greatly
now take part.
:
Dr David Fraser, a former CDC epiimproved infant and maternal mortality
and infectious disease control at the traindemiologist, who now oversees health,
education, and housing in Asia and Africa
ing sites, but nearly all the graduates went
on to specialty training.
for the Aga Khan Foundation, says that
The new approach, says Dr Joseph
Pakistan may become a "leader in efficient ways to use scarce resources". "The
McCormick, chairman of community
health sciences, is to add a scientific base
idea is to organise the village into a probto the training module. The scientific tool
lem-solving group which results in the :
being applied is epidemiology, a subject production of better crops, better health
a

184

new

opportunities

to

make money. There is synchrony between

health and wealth". He suggested that
western nations could apply the same
module to attract more family practitioners and solve urgent community health

problems.
International health experts say previefforts to organise communities in
this way often do not succeed because
they misjudge the size of the task, misjudge the ability to organise a community
and provide it with specialty care, and fail
to recognise that physicians are only one
member of the team.
But there are signs at AKU that at least
physicians are showing a new interest. 5
AKU graduates have joined the faculty
and the first modest wave of Pakistanis
trained in the west has returned home.
ous

Harry Nelson