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DOCTORS AND THE DRUG MAKERS
580 DOCTORS AND THE DRUG MAKERS
SIR,-As chairman of the Association of the British Pharmaceutical Industry (ABPI) Code of Practice Committee, I read with interest Professor Rawlins’ article (Aug 4, p 276) and. welcome the positive comments he makes regarding our work. However, certain of the matters he raises call for a reply. Rawlins asserts that the committee is "over-represented by industry". Surely this is only proper for a self-policing body operated by a trade association to enforce the standards it requires of its members. There are three independent members including myself, and case-reports are now made public so justice can be seen to be done. These reports are sent to the Department of Health and Social Security, the British Medical Association, and the Pharmaceutical Society of Great Britain, and copies are available on request from the ABPI. The ABPI believes it to be important that doctors and pharmacists should see such reports before they are printed in national newspapers. Records for the last six months reveal an average time lapse of 3 months from receipt of a complaint until notification of the outcome. In many instances the advertisement has been withdrawn in the interim. Rawlins’ most recent complaint, which was dealt with in 4 months, was based entirely upon hearsay evidence which presented the committee with some difficulty in determining the facts. Others have already commented on the mechanism to act within a few days where public safety is concerned (Aug 18, p 404). I cannot envisage speedier action through recourse to any other forum. "Bringing the industry into disrepute" is sufficient ground for upholding a complaint. Clause 2 of the code provides that "methods of promotion must never be such as to bring discredit upon, or reduce confidence in, the pharmaceutical industry". The committee can, and does, rule a breach of clause 2 in isolation but usually, if an activity is likely to discredit the industry, other breaches will also have occurred. The ABPI has always had the power to expel a member company if gross abuse of the code has occurred. Most companies readily give the undertakings required of them following an adverse finding and they can be asked to withdraw material from those to whom it was sent and to ensure that there is no recurrence. I always welcome open discussion of these matters, but regret the degree of sensationalism which sometimes accompanies it. That there are problems of the kind discussed by Rawlins is undoubted and if they are brought to the attention of the committee it will always do its best to handle such complaints promptly, fairly, and
from entering any of these schools located in the Caribbean, thereby ensuring that these institutions are totally "offshore" in its clientele. Finally, the ministers recommended that member states in which such schools are established should seek means of ensuring that their nationals pursue medical training at the University of the West Indies and, in line with this position, negotiate that scholarships granted by offshore medical schools be tenable at the University of the West Indies or, where this course is not available to the student, at a university of the governments’ choice. Eastern Caribbean Medical Scheme,
Department of Medicine, University of the West Indies, Port
of Spain,
MRS WARNOCK’S BRAVE NEW WORLD
SIR,-I respect the views on the human embryo held by Dr Heley and her medical colleagues of LIFE (Aug 4, p 290). I admire, indeed marvel, at their belief they can convert the rest of the world. As far as I can see there will always be an unbridgable gap. But their arguments against in-vitro fertilisation gain nothing from colourful vituperation-"ableak and nightmarish future ... test-tube adultery". When was the future ever not a nightmare to the pessimist? Hope, not despair, is the better side of human nature. We only strive out of optimism. Is conception from a sudden passing passion preferable to that in a test-tube? The test-tube baby is wanted, planned, worked for, born out of enduring love, to be loved. What better? Dr Heley wants the medical profession to campaign against the Warnock Committee’s recommendations. I hope, on the other hand, most doctors will campaign to help the childless through every means endorsed by Warnock. The fertile are assisted in every way, as much out of expediency as compassion. The infertile deserve no less. There are lay organisations working for the childless. Perhaps it is time for concerted medical action. I would be glad to hear from-or join-interested doctors. University Department of Obstetrics and Gynaecology, Bristol Maternity Hospital, Bristol BS2 8EG
REFEREEING
effectively. 1 King’s Bench Walk, Temple, London EC4Y
7DB
PHILIP J. COX
OFFSHORE MEDICAL SCHOOLS
SIR,-Dr Imperato (June 2, p 1238) might be interested to know that, at a two-day conference of Caribbean (CARICOM) ministers of health in Dominica last month, the ministers issued a special declaration expressing concern about the operations of offshore medical schools in the Caribbean region. They emphasised the inadequacies of these schools-the lack of proper training facilities, the use of itinerant lecturers, training programmes not geared to produce doctors for the Caribbean, and the instability inherent in the fact that these schools, established by entrepreneurs, will not continue if they are not financially viable. -
The conference noted the decision of Barbados to establish mechanisms for determining and enforcing academic standards to which offshore medical schools must adhere, to limit activities of offshore medical schools to preclinical training, and to grant the regional University of the West Indies exclusive right to use the government medical institutions for clinical training. The ministers also recognised the high international standing of the University of the West Indies’ degrees and urged member states to desist from any steps which would impair that standing. The conference urged that any further establishment of offshore medical schools in the Caribbean should be viewed with extreme caution and that member countries in which these schools are not established should take specific action to discourage their nationals
COURTENAY BARTHOLOMEW
Trinidad, West Indies
MICHAEL G. R. HULL
REQUESTS FOR EMERGENCY MICROBIOLOGY
SiR,—Dr Harrison and Professor Speller (Aug 18, p 406) rightly that emergency requests should not be singled out for criticism or for cuts when resources for pathology services are being conserved. We should not, however, underestimate the cumulative value of a consistent policy of referral which, besides saving some state
money, conserves medical laboratory scientific officer (MLSO) services and provides opportunities for training less experienced residential hospital medical staff. Our microbiology specimen workload increased from 65 000 in 1971 to 130 000 in 1983, more as a result of increased number of investigations per patient than an increase in the number of new patients tested.’ The number of emergency calls has remained stable, as expected for a population that has not increased significantly over this period; we believe that our system of referral of out-of-hours requests has contributed to this. The emergency "on-call" service is manned on a paid but volunteer basis by a small number of MLSOs. Requests for examination of cerebrospinal fluid are accepted without referral as are urine samples where a negative finding is to be followed by surgery (eg, appendicectomy) that night. Blood for culture can be taken and incubated and swabs held in transport media without the need to call out technical help. For other requests the doctor is referred to a consultant microbiologist. About half of these referrals do not reach the consultant, presumably because the house-officer, on reflection, regards the test as not truly essential. Of requests referred useful discussion on immediate therapy and action takes place in all instances; about 1 in 3 of the requests are refused. The MLSO providing the emergency
SIR,-As chairman of the Association of the British Pharmaceutical Industry (ABPI) Code of Practice Committee, I read with interest Professor Rawlins’ article (Aug 4, p 276) and. welcome the positive comments he makes regarding our work. However, certain of the matters he raises call for a reply. Rawlins asserts that the committee is "over-represented by industry". Surely this is only proper for a self-policing body operated by a trade association to enforce the standards it requires of its members. There are three independent members including myself, and case-reports are now made public so justice can be seen to be done. These reports are sent to the Department of Health and Social Security, the British Medical Association, and the Pharmaceutical Society of Great Britain, and copies are available on request from the ABPI. The ABPI believes it to be important that doctors and pharmacists should see such reports before they are printed in national newspapers. Records for the last six months reveal an average time lapse of 3 months from receipt of a complaint until notification of the outcome. In many instances the advertisement has been withdrawn in the interim. Rawlins’ most recent complaint, which was dealt with in 4 months, was based entirely upon hearsay evidence which presented the committee with some difficulty in determining the facts. Others have already commented on the mechanism to act within a few days where public safety is concerned (Aug 18, p 404). I cannot envisage speedier action through recourse to any other forum. "Bringing the industry into disrepute" is sufficient ground for upholding a complaint. Clause 2 of the code provides that "methods of promotion must never be such as to bring discredit upon, or reduce confidence in, the pharmaceutical industry". The committee can, and does, rule a breach of clause 2 in isolation but usually, if an activity is likely to discredit the industry, other breaches will also have occurred. The ABPI has always had the power to expel a member company if gross abuse of the code has occurred. Most companies readily give the undertakings required of them following an adverse finding and they can be asked to withdraw material from those to whom it was sent and to ensure that there is no recurrence. I always welcome open discussion of these matters, but regret the degree of sensationalism which sometimes accompanies it. That there are problems of the kind discussed by Rawlins is undoubted and if they are brought to the attention of the committee it will always do its best to handle such complaints promptly, fairly, and
from entering any of these schools located in the Caribbean, thereby ensuring that these institutions are totally "offshore" in its clientele. Finally, the ministers recommended that member states in which such schools are established should seek means of ensuring that their nationals pursue medical training at the University of the West Indies and, in line with this position, negotiate that scholarships granted by offshore medical schools be tenable at the University of the West Indies or, where this course is not available to the student, at a university of the governments’ choice. Eastern Caribbean Medical Scheme,
Department of Medicine, University of the West Indies, Port
of Spain,
MRS WARNOCK’S BRAVE NEW WORLD
SIR,-I respect the views on the human embryo held by Dr Heley and her medical colleagues of LIFE (Aug 4, p 290). I admire, indeed marvel, at their belief they can convert the rest of the world. As far as I can see there will always be an unbridgable gap. But their arguments against in-vitro fertilisation gain nothing from colourful vituperation-"ableak and nightmarish future ... test-tube adultery". When was the future ever not a nightmare to the pessimist? Hope, not despair, is the better side of human nature. We only strive out of optimism. Is conception from a sudden passing passion preferable to that in a test-tube? The test-tube baby is wanted, planned, worked for, born out of enduring love, to be loved. What better? Dr Heley wants the medical profession to campaign against the Warnock Committee’s recommendations. I hope, on the other hand, most doctors will campaign to help the childless through every means endorsed by Warnock. The fertile are assisted in every way, as much out of expediency as compassion. The infertile deserve no less. There are lay organisations working for the childless. Perhaps it is time for concerted medical action. I would be glad to hear from-or join-interested doctors. University Department of Obstetrics and Gynaecology, Bristol Maternity Hospital, Bristol BS2 8EG
REFEREEING
effectively. 1 King’s Bench Walk, Temple, London EC4Y
7DB
PHILIP J. COX
OFFSHORE MEDICAL SCHOOLS
SIR,-Dr Imperato (June 2, p 1238) might be interested to know that, at a two-day conference of Caribbean (CARICOM) ministers of health in Dominica last month, the ministers issued a special declaration expressing concern about the operations of offshore medical schools in the Caribbean region. They emphasised the inadequacies of these schools-the lack of proper training facilities, the use of itinerant lecturers, training programmes not geared to produce doctors for the Caribbean, and the instability inherent in the fact that these schools, established by entrepreneurs, will not continue if they are not financially viable. -
The conference noted the decision of Barbados to establish mechanisms for determining and enforcing academic standards to which offshore medical schools must adhere, to limit activities of offshore medical schools to preclinical training, and to grant the regional University of the West Indies exclusive right to use the government medical institutions for clinical training. The ministers also recognised the high international standing of the University of the West Indies’ degrees and urged member states to desist from any steps which would impair that standing. The conference urged that any further establishment of offshore medical schools in the Caribbean should be viewed with extreme caution and that member countries in which these schools are not established should take specific action to discourage their nationals
COURTENAY BARTHOLOMEW
Trinidad, West Indies
MICHAEL G. R. HULL
REQUESTS FOR EMERGENCY MICROBIOLOGY
SiR,—Dr Harrison and Professor Speller (Aug 18, p 406) rightly that emergency requests should not be singled out for criticism or for cuts when resources for pathology services are being conserved. We should not, however, underestimate the cumulative value of a consistent policy of referral which, besides saving some state
money, conserves medical laboratory scientific officer (MLSO) services and provides opportunities for training less experienced residential hospital medical staff. Our microbiology specimen workload increased from 65 000 in 1971 to 130 000 in 1983, more as a result of increased number of investigations per patient than an increase in the number of new patients tested.’ The number of emergency calls has remained stable, as expected for a population that has not increased significantly over this period; we believe that our system of referral of out-of-hours requests has contributed to this. The emergency "on-call" service is manned on a paid but volunteer basis by a small number of MLSOs. Requests for examination of cerebrospinal fluid are accepted without referral as are urine samples where a negative finding is to be followed by surgery (eg, appendicectomy) that night. Blood for culture can be taken and incubated and swabs held in transport media without the need to call out technical help. For other requests the doctor is referred to a consultant microbiologist. About half of these referrals do not reach the consultant, presumably because the house-officer, on reflection, regards the test as not truly essential. Of requests referred useful discussion on immediate therapy and action takes place in all instances; about 1 in 3 of the requests are refused. The MLSO providing the emergency