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Physicians were encouraged to withhold stress ulcer prophylaxis in all patients except those who had major burns, head injury, endoscopic or radiographic evidence of peptic ulcer or gastritis within the previous 6 weeks, organ transplants, or upper gastrointestinal bleeding 3 to 42 days before admission. Those patients received stress ulcer prophylaxis after admission to the ICU and were thus excluded from the study.8 The investigators found that respiratory failure requiring mechanical ventilation for longer than 48 hours odds ratio 15.6 ; and coagulopathy odds ratio 4.3 ; were strong independent risk factors for clinically important bleeding. Critically ill patients in the ICU who require mechanical ventilation for more than 48 hours or who have coagulopathy will benefit from stress ulcer prophylaxis.8 Findings from other studies20-22 suggest that older age, repair of abdominal aortic rate or the appearance of material that looks like coffee grounds in the gastric aspirate. In patients without a nasogastric tube, hematemesis or melena may be the first sign of gastric bleeding. Unexplained hypotension or a decrease greater than 2 g dL hemoglobin level should also prompt evaluation for bleeding in the upper gastrointestinal tract.23.
Technology has revolutionised much of biology from palaeontology to bioinformatics, from forensics to genetics. Genetically engineered drugs such as insulin, erythropoietin, plasminogen activator, GM-CSF and many, many others produced by a flourishing biotechnology industry have saved or extended the span of millions of lives. None of this would have happened, at least not so swiftly or spectacularly, if work on recombinant DNA had been governed by legislation rather than regulated by guidelines. Asilomar was a success because scientists took the matter into their own hands and were transparent about their dealings. Unfortunately, Asilomar was the last time that scientists could take that degree of responsibility to shape their future. In many countries, decisions about what research is done including decisions about stemcell work are nowadays encased in legislation rather than set by guideline. Even if the legislation is benign, it nevertheless has several problems. By its nature, it is usually highly inflexible and therefore cannot easily be modified to meet changing needs as science evolves. It also stifles the financial investment that is necessary for commercialisation. Venture capitalists are wary of risking money on areas of science that in the eyes of government need tight regulation. In Australia, the recent legislative debate about stem-cell research and cloning technology became a highly emotional affair: a mixture of personal views on morality, unhealthy anti-intellectualism and enlightened pragmatism. In some respects the debate reflected the decline in public confidence that science can deliver on its promises. It was also the debate that we never needed to have. Science may no longer be an entirely self-governing enterprise, but neither should its progress be restricted by moral confusion. The next time the stem-cell Act is reviewed in Australia, we need to follow the example set by Asilomar. We need an overlying law saying that stem-cell research and researchers should strictly follow a set of guidelines that can be reviewed and extended or diluted as the need arises. Scientists can then get back to what they do best solving chunks of the unknown and fulfilling realistic promises instead of political lobbying and carteolol.

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