Lancet trophy

848

US experience suggests that it is not only doctors and manufacturers and suppliers who foot the bill for excessive litigation and huge awards but also society, patients, and consumers generally. High insurance premiums will be passed on. Defensive medical practices ensure that in the US patients are warned about every conceivable contraindication. In some areas women cannot find a doctor willing to deliver their babies. A news report shown on a transatlantic flight last October featured just such a case; the expectant mother had to travel fifty miles from her home before she could find a doctor willing to accept her. US obstetricians opt for caesarean section at the first sign of trouble. Americans themselves are starting to admit that their legal system is out of control and many are now seeking solutions other than litigation, notably in a medical context.2 It is therefore a matter of some anxiety to see further evidence of the export of the system to Britain.

Noticeboard The

changing face of cancer

In 1971 Herman Chernoff hit on the bright idea of using computer-drawn faces to represent multivariate data. Differences in facial features and expressions, he suggested, were easier to recognise and remember than variations in bar charts and sine curves. The features of a standard Chernoff face-face width, shape of ears, nose length, mouth curvature, and so on-are constructed from a maximum of 20 statistics, or up to 36 if an asymmetrical face is used. Because of their immediate visual appeal the information contained in a series of Chernoff faces can be easily assimilated and compared. Rahu has now shown how such faces can be used to represent cancer statistics in a user-friendly way and has applied the technique to present lung cancer statistics derived from volume V of Cancer Incidence in Five Continents.

Diana Brahams 1. Owles D. Product liability. New Law J 1989 (Aug 11): 1120. 2. Manuel BM. Professional liability: a no-fault solution. N Engl

J Med

1990; 322: 627-31.

Obituary

Two

lung

cancer

"faces".

Reproduced with permission from the International Journal

of

Epidemiology.

Nancy Swift Dr Nancy Swift, formerly consultant psychotherapist at the Royal Free and Maudsley Hospitals and head of the student health service at the Royal Free Hospital Medical School, died on Feb 3, aged 74. At Kingsley School in London she came under the influence of Susan Stebbing, and subsequently graduated with honours in philosophy. After the 1939-45 war, during which she drove ambulances in the East End of London, she went on to qualify in medicine. After a year as a research fellow at the Royal Cancer (now Marsden) Hospital, she chose psychiatry as her career, and, training at the Maudsley, came under the influence of Aubrey Lewis and Kraupl Taylor. Later she became the first woman consultant at the Maudsley. She was seen as outstanding not only by other psychotherapists and psychiatrists but also by physicians and surgeons. She was much in demand for her superb clinical skills and as a teacher of medical students and trainee psychiatrists-at the Maudsley it was said that six months with Nancy was worth years with anybody else. Nancy Swift had no formal training in psychotherapy, but to many she was the cynosure, her remarkable qualities close to those she had herself defined for the "ideal" therapist-"capable of warmth and concern but also of objectivity ... [having] learned to control personal judgement, values and emotional reactions without loss of sympathy ... integrity, high intelligence, power of intense concentration ... enlightened, mature and stable, capable both of reason and love". What influences shaped her extraordinary gifts and exemplary professionalism? She had certainly withstood personal deprivation, having lost her father in infancy and her husband, who was killed in action. But she had benefited from the warmth and robustness of her family and upbringing. Highly intelligent, broadly educated, and widely read, she was much influenced by unusually rigorous and demanding teachers. Stebbing, Lewis, and Taylor had encouraged such standards of intellectual probity that she was unable to commit herself to any one theory and incapable of taking refuge in supposition and jargon. She was a vivid example of the eclectic psychotherapist who resisted the perils of indoctrination. R. H.

Cawley

The cancer incidence faces used in Rahu’s example reflect 8 variables (see figure). The height of the forehead represents the period of registration, with a high forehead representing a long registration period. The dimensions of the eyes, nose, and chin are

determined, respectively, by histological verification, mortality/I incidence ratio, and relative frequency of cases registered from the death certificate only. The mouth curvature represents the age-standardised incidence rate, with a large smile indicating a small rate.

Ear size shows the proportion of new cases for the cancer site under study; hair length increases with the mean age at diagnosis; and wrinkles on the forehead demonstrate a time trend in incidence. Chemoff faces, Rahu argues, present data in an easily accessible form for the user who has a basic knowledge of cancer registration and statistical techniques and an understanding of graphical display. The faces can also be used to study a variety of statistics, or to study the same data from several aspects. Computer-drawn faces, he says, are an effective way of taking a first look at multivariate data and can be used to highlight unusual clusters or changes with time, thus helping to direct further research. 1. Rahu M.

Graphical

representation of

cancer

incidence data: Chernoff faces. Int

J Epidemiol 1989; 18: 763-67.

Lancet

trophy

year’s winner of the Lancet trophy is Dr M. A. Ansary, formerly of the University Teaching Hospital, Lusaka, Zambia, for his photographs in Colour Atlas of AIDS in the Tropics (published by Wolfe Medical), of which he is co-author. The trophy and a 75 cheque are awarded each year to a member of the Royal Photographic Society’s medical group for the best photographs published in a medical journal or book. The winners of the other medical group awards are: Stephen Shaylor, Charing Cross & Westminster Medical School (British Medical Journal award); Frances Sellins, Charing Cross & Westminster Medical Schools (Association of the British Pharmaceutical Industry colour trophy); Bryan Pereira, Charing This

Cross &

trophy);

Westminster Medical Schools (Pharmaceutical Juniors and James Morgan, Eastman Dental Hospital

849

(Westminster Hospital medal). Merit awards went to Kevin FitzPatrick (United Dental and Medical School, Guy’s Campus), Nicholas Geddes (Institute of Child Health), and the Photographic

another reason why moving the mentally handicapped into the community (which doorway or subway) needs reappraisal.

ill and the for many

mentally means

a

Department, The London Hospital. reproviding services for the residents of Darenth Park Hospital. Howard Glennerster. Psychiat Bull 1990; 14; 140-43.

1. The costs of hospital closure:

The quest to map the human genome has raised many problems, not all of them to do with the very real technical difficulties of sequencing the mere 2% of it that is not junk. As with any scientific discovery, the sequencing of a previously unviolated length of DNA or the isolation of a new gene probe will raise the possibility of commercial exploitation. Then the whisper "patent" can be faintly heard behind locked laboratory doors. But whom does a patent protect? The owners of the knowledge, who have a monopoly on its use for making profit? Or the public, who are given access to knowledge that might otherwise be closely guarded? A bit of both, perhaps, but participants at a Ciba Foundation symposium last year1 concluded that in the long term patenting the human genome would do more harm than good. The discovery of therapeutic uses for research probes, they found, could lead them unwittingly into infringements of the patent laws. Sidney Brenner saw no need for patents: God, he said, kept evolution a good trade secret without one.

The

symposium proceedings have now been published.2

1. Anonymous. Using human genetic information. Lancet 1989; ii: 58-59. 2. Human genetic information: science, law and ethics. Ciba Foundation symposium no 149. Chichester: John Wiley & Sons. Pp 211. £35.95. ISBN 0-471921432.

ERIC The Enuresis Resource and Information Centre (ERIC), an organisation funded partly by the Children’s Society, has published two books, one about the treatment of enuresis and the other about encopresis. The advice given is sensible, practical, and wellpresented. The guides will be useful for parents and professionals, although some parents might find the concepts discussed-,eg, reward systems-and language used beyond their comprehension. The Centre’s earlier book, "Eric’s Wet to Dry Bedtime Book",2 is written for 7-14-year-olds. to Encopresis (Soiling). Both by Christina Blackwell. £9.50 plus £1.05 postage and £7.00 plus £1.00 postage, respectively, from the Enuresis Resource and Information Centre (ERIC), 65 St Michael’s Hill, Bristol BS2 8DZ. 2. Eric’s Wet to Dry Bedtime Book. By Richard J. Butler. Published by Nottingham Rehab, £3.99 including postage, available from ERIC.

1. A Guide to Enuresis and A Guide

European Commission Research to evaluate the of the Fourth Medical and Health Research Programme (1987-91) of the Directorate-General XII. Panel members would welcome the opinions of participants and nonparticipants about the success of the programme. In particular they would appreciate views about the efficiency of the programme’s management processes and an assessment of how the programme has facilitated the development of scientific research across the Community. Please address replies to Prof Alan Maynard, University of York, Centre for Health Economics, York YO 1 5DD,

The

European Commission has appointed a panel

performance

Drug information In the US of A, Patients do have a way Of requiring more information. The answer, it seems, Is to give it in reams; Hence the PDI II compilation.1 Whereas, in the UK, Chemists hide drugs away In Martindale’s magnum opus. In the United States No-one’s interest abates, As shown by the 10th Pharmacopious.

1. United States Pharmacopeia Drug Information, 10th ed (3 vols). 1990. Distributed by

USPC, 12 601 Twinbrook Parkway, Rockville, Maryland 20852, USA. US $184 (includes monthly updates). Pp 5002. ISBN 0-913595446.

England. Artois-Baillet Latour

prize

Nominations are invited for the 1990-91 Artois-Baillet Latour health prize (value Belg fr 5 million) for "an important contribution to the monoclonal antibodies as diagnostic and therapeutic tools in human medicine". Proposers should send their nominations, together with an account of the candidate’s work (at least three pages, written in English) to the Secretary General, National Fund for Scientific Research, rue d’Egmont 5, B-1050, Brussels, Belgium, by July 1, 1990.

G-6-PD deficiency

Liverpool Health Authority has produced an information leaflet on glucose-6-phosphate-dehydrogenase (G-6-PD) deficiency. What is G6PD Deficiency? describes what the disorder is, how it is identified, and the foods and medicines that should be avoided by people who have the disorder. The leaflet is available from Liverpool Health Authority Centre for Inherited Blood Disorders, Abercromby Health Centre, Grove Street, Liverpool L7 7HG (051-7089370).

Costly community care The closure of Darenth Park Hospital had some undesirable social consequences (Jan 20, p 159), and the financial outcome, reported in the Psychiatric Bulletin,l was not as predicted by those advocating the wholesale change to community care. The cost of looking after the residents in the old hospital (1987-88) would have been care in alternative facilities cost £ 25 000-yet

16 500, whereas

In It

England

was a

Now

staff-round in the women’s ward. With my entourage of

colleagues and nursing staff I moved from bed to bed. The house-physician enjoyed the prerogative of being first speakerpresenting to us the essentials of the history and findings. I listened carefully to the subsequent discussion of the differential diagnosis; the score, I thought, was 40-15 in favour of the HP-a graduate in science and medicine and a girl of outstanding ability. The cross-fire included references to recent medical literature, but we had moved a long way from the relatively simple problem created by the occupant of the bed that we surrounded. It was then that I noted that the patient-agrey-haired woman-was showing signs of anxiety. I sat down at her bedside and, turning to the staff, told them to move along the ward to the next patient. It was abundantly clear that Mrs G needed