BLOOD-GROUPS AND DISEASE

1135 If after all the doctor’s skill and care the patient is nothing bettered but rather made worse, could doctors not be more honest about it ? Would they care to be known as " psychologically overlaid " ? I know I wouldn’t. MARY KAY. Slough. BLOOD-GROUPS AND DISEASE

SIR,-Ishould like to draw attention to certain points which may be of importance in evaluating the results of studies on the distribution of blood-groups in different diseases.

somebody ultimately collects all the materials reported world literature, the point is established, Q.E.D.

In general, scientific research without a working hypothesis and basic idea will hardly ever produce results, whatever it may appear to do at first glance. This is likely to be true also of blood-group research. Finnish Red Cross Blood Transfusion Service, Helsinki.

magazine. (2) Selective factors.-One selective factor

was discussed above: the material is divided up in order to make the differences emerge. Mention is omitted of previous unsuccessful in attempts dividing up the material. It must also be regarded as probable that the authors have at their disposal several sets of material and concentrate on those which show up the differences most distinctly. Finally, it is certain that the materials in which differences are shown tend to appear in print more readily than those in which no differences are found. This may lead to a flow of reports resulting finally in the conclusion that the differences observed are correct. Indeed, the publication of another study indicating differences in agreement with the study published is more likely than a new report finding no differences. Courtesy alone may prevent the publication of the latter. When

1.

Lancet, 1960, i,

194.

H. R. NEVANLLINA.

Parliament

(1) Absence of a basic idea.-Investigations on the distribution of the blood-groups are generally performed without The frequencies obtained are then a working hypothesis. with those of a control material or an entire populacompared The significance of the differences, moreover, is tion. calculated by various statistical methods. " Statistically significant " differences in these circumstances are affected by the number of factors considered in the investigation. In blood-group studies the material is divided into at least four (often eight or more) parts, depending on the number of blood-group factors observed. The material can be divided still further by the patients’ age, year of birth, sex, or any other easily recognisable attribute. The number of the combinations can rise to the hundreds, but generally only a part of them are reported. It is only to be expected, then, that " statistically significant" differences will be established in nearly every material. It is naturally impossible to predict the combinations in which the differences will occur, nor can these differences usually be established in other authors’ materials. This has happened, for example, in the investigation by Yates and Pearce1 in which it was found that the blood-group distribution of astrocytomas changed after 1945. At first the authors failed to find any major differences from the control material. Small manipulation, however, brought.out a significant difference in the 0 group when the material was divided (obviously independently of the patient’s age) by the year of examination. This is the procedure often applied in clinical-statistical studies. Provided there are sufficient factors to be examined, the result is that differences and coincidences are almost always encountered. Clinical experience and common-sense, however, usually reveal the real reason for these differences and obviate the need for mathematical study. There is no sentiment involved in the study of blood-groups, and It is hardly surprising, little experience to draw on. then, that common sense is often forgotten in analysing the results. An unexpected distribution of blood-groups is in fact comparable with the way the cards fall when dealt. For a player to get a hand of 13 spades is rare but not impossible. The dealer cannot be blamed (though he might be suspected); but the result, statistically confirmed, is not published in a bridge

in the

QUESTION

TIME

Children and the Courts IN answer to a question Mr. DENNIS VospER, an undersecretary of State to the Home Office, said that between Jan. 1, 1950, and Dec. 31, 1959, 32,550 children were brought before juvenile courts in England and Wales as being in need of care or protection and were dealt with in the following ways: Ordered to be sent to an approved school Committed to the care of a fit person.... Parent ordered to enter into a recognisance to ..

exercise proper

Supervision order No order made

and guardianship alone........

care

..

..........

2385

13,577 683

11,542 4363

Mr. ALAN BROWN: Is the Minister aware that Britain is now minority of countries in which child victims of lack of protection or of cruelty or neglect can still be brought before courts of summary criminal jurisdiction ? Would he consider setting up courts of guardianship before which this class of children could be brought? Mr. VOSPER: The Ingleby Committee is shortly to report. It is considering the whole question and I would rather not make a further comment at this stage. Miss ALICE BACON: Is the Minister aware that magistrates in juvenile courts find themselves in an extremely difficult position because they have nowhere to send juvenile offenders on remand ? Is he aware that recently a magistrate said that he never slept at night after he had been working at the juvenile court ? Does not the Minister agree that even before the Ingleby Committee reports one of the most urgent things to be considered is the provision of more remand homes ?-Mr. VOSPER: A Bill is before the House dealing in detail with this subject. The Home Secretary is giving consideration to that aspect of the matter in advance of the Ingleby Committee recommendations. Mr. SYDNEY SILVERMAN: Should not the right hon. Gentleman also be asked to consider whether the juvenile courts are in any difficulty at all ? In the case of very young people, juvenile persons who are not yet convicted and are on remand, if there is any real difficulty in finding a suitable place for them to go, is it not infinitely better to send them home than to send them to jail ?-Mr. VOSPER: In general there is no difficulty in finding a place in a remand home. The difficulty arises with those people who are so unruly that the remand home itself is not suitable. among the

Consultants’ Letters Mr. W. GRIFFITHS asked the Minister of Health whether he was aware that the National Health Service patients of some general medical practitioners in Manchester, having been referred to certain consultants, were not seen by these consultants but by a registrar; and what steps were taken to ensure that all consultants attended regularly and promptly the sessions at the hospital in accordance with their contracts. -Miss PITT replied: If the hon. Member will give me details of what he has in mind, I will have inquiries made. Mr. GRIFFITHS: Is the hon. Lady aware that these complaints originate not from me but from members of the medical profession in Manchester, and from patients ? Is she further