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BREAKING THE NEWS
560 Not everybody shares this appraisal. If a university can gain as much as$20 million from Congress it’s unlikely that administrators will appreciate the suggestion that perhaps they don’t deserve the money. According to Senator Mark Hatfield of Oregon, the peer review system apportions most of the government’s research money year after year to the top 20 rich universities. The rest get the scraps. Schools like Johns Hopkins, MIT, Stanford, and the University of California are the beneficiaries of an old boy network. Criticism of the system as elitist has become so vocal that the National Science Foundation or US government agency, no longer uses the term peer review. It’s now known as merit review, semantically steering attention away from the person judging a proposal towards what is being judged. AAU representatives in Washington have a strong backing for their stance from member institutions: presidents and chancellors have voted 42 to 10 in favour of a moratorium on seeking earmarked money for research from congress. That probably won’t stop the practice. SPLENDOURS AND MISERIES OF SUNSHINE
"When the coster’s finished jumping on his mother He loves to lie a-basking in the sun" sang the police chief in The Pirates of Penzance. Now it is not only delinquent costers but the whole American nation who love to bask in the rays of our friendly neighbourhood star. Since we were told that the sun’s surface is no hotter than the centre of our planet, it doesn’t seem very dangerous. In Elizabethan times, poets would extol the whiteness of their mistresses’ skin: but today bronze is the favoured colour. The girl from Ipanema is tall and tan and young and lovely, and "I wish they all could be California girls," sang the Beach Boys. Northeners flock to Florida and the Caribbean every winter and spring, and by July a white body on a beach, even in New England, looks bleached. To be -
Personal
Paper
BREAKING THE NEWS THE consultant broke the news about my daughter’s cerebral palsy well. My husband and I were together, and he gave clear answers to our questions. When he didn’t know the answer he said so. The news was a devastating blow, and I can’t pretend to have come to terms with it fully even now, three years later, but the manner of its telling was good. Above all, we were left with hope for her future. Other parents aren’t so lucky. Friends of mine learned of their child’s severe brain damage from a junior doctor, in front of a dozen medical students, as the finale of a session in which their heads were measured while the consultant lectured the students on the technicalities of the child’s condition, before explaining it to the parents. Others are told that their child will be a vegetable. Some parents overhear conversations in the corridor. Others are never formally told about their child’s disability at all. Shared Concern1 is the first British training video made by consumers for doctors. It tackles the difficult subject of how to tell parents about their child’s disability. The film is the brain child of SOPHIE, a North London parents’ group, which worked with concerned paediatricians, midwives, and psychologists on ways of helping doctors convey distressing information to parents in the most sensitive way possible. Although it centres on handicap, its implications go further. Properly used, it should be a big help to doctors as they consider how to communicate bad news of all kinds to their patients. Shared Concern works hard to help professionals understand the parents’ point of view, while recognising that breaking bad news will take its toll on doctors as well. The idea that there is no one right way to do
that they are bronze all year round, many people patronise tanning salons such as Safe Sun of America, Endless Summer Corp, and Tanorama. Many of these are to be found in fitness clubs, and you can buy or rent tanning lamps to use at home. Sunshine does have health benefits-at a cost. In a moving article in the New Yorker, John Updike recorded his long struggle with psoriasis: the only way he could control it was to subject himself to sunburn every year. He did not mention the risk of malignancy. The American Cancer Society estimates that there will be 500 000 cases of skin cancer in the United States in 1987; the figure in 1972 was 118000. The estimated number of deaths for 1987 is 7800, including 5800 from melanoma-50% more than in 1972. Exposure to solar ultraviolet rays is recognised as the major sure
causative factor in all skin cancers. It is said that women who sunbathe nude or in bikinis have a fiftyfold greater chance of melanoma compared with women who sunbathe in one-piece bathing suits (though some one-piece suits are ingeniously designed to expose as much skin as bikinis). Now that every ailment of the President is front-page news, Mr Reagan’s three operations for skin cancer (fortunately basal-cell carcinoma, not melanoma: two in 1985 and one this year) have brought the risks of sun exposure into public consciousness, and articles in the press advise would-be sunbathers to use sunscreens such as PABA (aminobenzoic acid) and zinc oxide-especially children. Somebody must be paying attention, because the sun-care industry will do$400 million of business this year. Sun-worshippers devoted to a small beach in Rhode Island that permits nude sunbathing are out of favour with environmentalists because they have proliferated from a handful twenty years ago to thousands now-and that beach is also the home of the piping plover, an endangered species whose numbers have dwindled in proportion to the increase in Hoino sapiens. Sunbathers should be increasingly aware that they too are an endangered species.
the job is central to the film, which is not offering any kind of a blue-print solution. Instead, it offers positive guidelines towards an approach which will help make the unbearable easier to bear. Nicole Specker, one of the parents behind the project, stresses that very simple things can help parents overcome the devastating shock that inevitably accompanies news of a child’s handicap. Parents should, wherever possible, be told together, in a private place, with no more than two or three other people present. At least three-quarters of an hour should be set aside for the initial interview, which should be led by a senior doctor. Teamwork is vital, as are follow-up interviews, and establishing good links with general practitioners and other community services. Denigrating terms like "cabbage" should not be used, since they can disrupt the relationship between the parents and their baby. Parents should be told the truth, but should not be deprived of all hope. Nicole believes that these first sessions with doctors are crucial for establishing a trusting partnership between parents and professionals-a partnership upon which the many, many future medical consultations, assessments, and support services for the family should be based. Breaking bad news is hard, but the message of Shared Concern is that it is possible to do the job well. Perhaps the most important insight in the film comes from Alan Counsell, a teacher who has cerebral palsy himself: "What we should be talking about is individuality. Ezerv birth is a miracle". King’s Fund Institute, 126 Albert Street, London NW1
VIRGINIA BEARDSHAW
1. Shared Concern. Available for hire (£10.50 including postage and free guidance booklets) from CFL Vision, Chalfont Grove, Gerards Cross, Buckinghamshire
SL9 8IN.
"When the coster’s finished jumping on his mother He loves to lie a-basking in the sun" sang the police chief in The Pirates of Penzance. Now it is not only delinquent costers but the whole American nation who love to bask in the rays of our friendly neighbourhood star. Since we were told that the sun’s surface is no hotter than the centre of our planet, it doesn’t seem very dangerous. In Elizabethan times, poets would extol the whiteness of their mistresses’ skin: but today bronze is the favoured colour. The girl from Ipanema is tall and tan and young and lovely, and "I wish they all could be California girls," sang the Beach Boys. Northeners flock to Florida and the Caribbean every winter and spring, and by July a white body on a beach, even in New England, looks bleached. To be -
Personal
Paper
BREAKING THE NEWS THE consultant broke the news about my daughter’s cerebral palsy well. My husband and I were together, and he gave clear answers to our questions. When he didn’t know the answer he said so. The news was a devastating blow, and I can’t pretend to have come to terms with it fully even now, three years later, but the manner of its telling was good. Above all, we were left with hope for her future. Other parents aren’t so lucky. Friends of mine learned of their child’s severe brain damage from a junior doctor, in front of a dozen medical students, as the finale of a session in which their heads were measured while the consultant lectured the students on the technicalities of the child’s condition, before explaining it to the parents. Others are told that their child will be a vegetable. Some parents overhear conversations in the corridor. Others are never formally told about their child’s disability at all. Shared Concern1 is the first British training video made by consumers for doctors. It tackles the difficult subject of how to tell parents about their child’s disability. The film is the brain child of SOPHIE, a North London parents’ group, which worked with concerned paediatricians, midwives, and psychologists on ways of helping doctors convey distressing information to parents in the most sensitive way possible. Although it centres on handicap, its implications go further. Properly used, it should be a big help to doctors as they consider how to communicate bad news of all kinds to their patients. Shared Concern works hard to help professionals understand the parents’ point of view, while recognising that breaking bad news will take its toll on doctors as well. The idea that there is no one right way to do
that they are bronze all year round, many people patronise tanning salons such as Safe Sun of America, Endless Summer Corp, and Tanorama. Many of these are to be found in fitness clubs, and you can buy or rent tanning lamps to use at home. Sunshine does have health benefits-at a cost. In a moving article in the New Yorker, John Updike recorded his long struggle with psoriasis: the only way he could control it was to subject himself to sunburn every year. He did not mention the risk of malignancy. The American Cancer Society estimates that there will be 500 000 cases of skin cancer in the United States in 1987; the figure in 1972 was 118000. The estimated number of deaths for 1987 is 7800, including 5800 from melanoma-50% more than in 1972. Exposure to solar ultraviolet rays is recognised as the major sure
causative factor in all skin cancers. It is said that women who sunbathe nude or in bikinis have a fiftyfold greater chance of melanoma compared with women who sunbathe in one-piece bathing suits (though some one-piece suits are ingeniously designed to expose as much skin as bikinis). Now that every ailment of the President is front-page news, Mr Reagan’s three operations for skin cancer (fortunately basal-cell carcinoma, not melanoma: two in 1985 and one this year) have brought the risks of sun exposure into public consciousness, and articles in the press advise would-be sunbathers to use sunscreens such as PABA (aminobenzoic acid) and zinc oxide-especially children. Somebody must be paying attention, because the sun-care industry will do$400 million of business this year. Sun-worshippers devoted to a small beach in Rhode Island that permits nude sunbathing are out of favour with environmentalists because they have proliferated from a handful twenty years ago to thousands now-and that beach is also the home of the piping plover, an endangered species whose numbers have dwindled in proportion to the increase in Hoino sapiens. Sunbathers should be increasingly aware that they too are an endangered species.
the job is central to the film, which is not offering any kind of a blue-print solution. Instead, it offers positive guidelines towards an approach which will help make the unbearable easier to bear. Nicole Specker, one of the parents behind the project, stresses that very simple things can help parents overcome the devastating shock that inevitably accompanies news of a child’s handicap. Parents should, wherever possible, be told together, in a private place, with no more than two or three other people present. At least three-quarters of an hour should be set aside for the initial interview, which should be led by a senior doctor. Teamwork is vital, as are follow-up interviews, and establishing good links with general practitioners and other community services. Denigrating terms like "cabbage" should not be used, since they can disrupt the relationship between the parents and their baby. Parents should be told the truth, but should not be deprived of all hope. Nicole believes that these first sessions with doctors are crucial for establishing a trusting partnership between parents and professionals-a partnership upon which the many, many future medical consultations, assessments, and support services for the family should be based. Breaking bad news is hard, but the message of Shared Concern is that it is possible to do the job well. Perhaps the most important insight in the film comes from Alan Counsell, a teacher who has cerebral palsy himself: "What we should be talking about is individuality. Ezerv birth is a miracle". King’s Fund Institute, 126 Albert Street, London NW1
VIRGINIA BEARDSHAW
1. Shared Concern. Available for hire (£10.50 including postage and free guidance booklets) from CFL Vision, Chalfont Grove, Gerards Cross, Buckinghamshire
SL9 8IN.