- Email: [email protected]
PERSUASIVE RESEARCH
459
Letters to the Editor PERSUASIVE RESEARCH SIR,-I had hoped for a comment from you on our report that would help us in our further researches by appraising its strengths as well as its weaknesses. We could derive little guidance from your querulous editorial (Aug. 17) which seems compounded largely of inconsis-
tencies and confusions. An example of inconsistency is the warning to your readers about placing too much credence on our conclusions followed by the advice that, apart from revealing "ignorance about existing health services and the alternatives, the conclusions seem slight". Again, your note does not seem to be able to decide whether you prefer no social surveys, better surveys, or perhaps surveys that support your own opinions. Misapprehensions are more numerous. You deplore the " vociferous demand for social research " and want " more critical assessment of the assumptions made and the methods employed ". Yet your main contribution is to stigmatise the quota sample as a " highly structured group of people ... which hardly seems adequate for serious social research ". The sample, which was selected by our technical advisers, Mass Observation who conducted the survey, would generally be regarded as adequate (2000) and there are good arguments for confining it in the first place, at least, to male heads of households between the ages twenty-one and sixty-four, as spokesmen for families most likely to be concerned with decisions about choice of welfare services, methods of payment by insurance, and opportunities for contracting out. With Mass Observation we are now exploring the possible effect on our findings of alternative approaches, including the comparative views of a sample of men and women. You chided us, perhaps ungenerously, about not inquiring into knowledge about specialists’ fees, but gave no credit foror even mention of-the large amount of information on public knowledge and conduct which the report details for the first time. Nor did you tell your readers that we inquired into the extent to which people were covered by private insurance against hospital treatment, specialists’ fees, and medicines, and the preference between State and private general practitioners and specialists. And your comments dealt hardly adequately with the voucher question in which we specifically mentioned specialists’ fees. However imperfect and incomplete, ours is the first survey to attempt to discover public preferences in welfare services with some consciousness of relative costs and the alternatives available, and we hope to remove the imperfections and inadequacies in further research. From your concluding paragraph it would seem that you are chiefly prompted by discomfort at the finding that between half and two-thirds of the sample preferred public welfare policy to concentrate on people in need and to permit contracting out. Like many others, you appear to be surprised-even shocked-yet these findings, though conducted in more detail then any before, are not substantially in conflict with more limited earlier surveys: indeed, they broadly confirm the findings, for example, of Socialist Commentary in 1960 that 50% of a national sample (of 724 people aged eighteen and over) would pay more for social service benefits and 40% would not; or of New Society in March this year that 53% of some 7000 readers were in favour of concentrating State benefits on people in most need. Some of your readers may have noticed a paradox: in the following note on a pamphlet on general practice, enthusiasm for its conclusions is not diminished by the fact (which you do not state) that it rests in part on interviews with 107
patients. Institute of Economic Affairs, London, S.W.1.
RALPH HARRIS General Director.
to comment on the doubts of Aug. 17 about the scientific expressed in your leader value of the inquiry carried out by the Institute of Economic Affairs. But I can, perhaps, provide a clue to the answer to your " down-to-earth " question as to whether a significant number of people are, in reality, prepared to face the implications of providing for their own health outside the National Health Service. The clue is that well over one million people belong to B.U.P.A. alone, solely in order to enable them to meet private bed charges and specialists’ fees. In the past twelve months there were over 100,000 new enrolments, which is a record. This is happening despite severe discouragement, such as having to pay twice and an inadequate supply of private beds. It would therefore seem that the conclusions about health drawn from this piece of research are not entirely without concrete support. The Institute is surely entitled to credit for attempting to discover whether the consumer really is getting what he wants from the National Health Service. Too often it is assumed that what the N.H.S. is providing is what the consumer wants, or at least ought
SIR,-Iam
not
qualified
to want. British United Provident Association, Essex
Provident House, Street, London, W.C.2.
E. F. WEBB General
Manager.
*** certainly deplore the demand for social but its research; hypothesis and method should be able to withstand searching criticism, which can reveal the kind of " imperfections and inadequacies " acknowledged by Mr. Harris. The " consumer commentary " on general " practice to which he refers specifically states that it is not a research document."-ED. L. We
do
not
NEOMYCIN RESISTANCE IN NEWLY RECOGNISED STRAINS OF STAPHYLOCOCCUS AUREUS SIR,-We are most interested in the strains of Staphy-
lococcus aureus described by Mr. Robertson (Aug. 17) and in his important observation that these organisms are resistant to neomycin and kanamycin. This new epidemic variety of Staph. aureus has been called " type A " by Temple and Blackburnbut we thought it should be regarded as non-typable.2 It has been responsible for cases of surgical sepsis in many hospitals in Yorkshire and adjacent counties,34 in the Glasgow area,! and in Liver-
pool.5 In two large hospitals in Leeds during the six months ended last March we isolated 552 strains of Staph. aureus which were resistant to penicillin (1-5 units), streptomycin (10 µg.) and tetracycline (10 µg.) when tested withMultodisks’ (Oxoid). Using the glycerol-monacetate medium described by Willis and Turner 6 to determine the pigment variety of the strains, 378 of them were found to be yellow and the other 174 orange or buff. The strains were phagetyped through the kindness of Dr. G. B. Ludlam. In view of the observations of Cohen et al.,7 at the Johns Hopkins Hospital, that many tetracycline-resistant staphyloccocci were also resistant to neomycin, and were phagetypable only at 1000 R.T.D., we recently tested our 552 strains for resistance to neomycin (10 tg.) and kanamycin (7-5 (Jog.) by the disc diffusion technique. Our findings are shown in the table. We also examined a further 25 strains of Staph. aureus 1. 2. 3. 4. 5. 6. 7.
Temple, N. E. I., Blackburn, E. A. Lancet, 1963, i, 581. Jacobs, S. I., Willis, A. T., Ludlam, G. B., Goodburn, G. M. ibid. p. 972. Willis, A. T., Jacobs, S. I., Goodburn, G. M. ibid. July 13, 1963, p. 67. Willis, A. T., Jacobs, S. I., Goodburn, G. M. J. Path. Bact. (in the press). Turner, G. C. Lancet, 1963, i, 1156. Willis, A. T., Turner, G. C. J. Path. Bact. 1962, 64, 337. Cohen, L. S., Fekety, F. R., Cluff, L. E. New Engl. J. Med. 1962, 266 367.
Letters to the Editor PERSUASIVE RESEARCH SIR,-I had hoped for a comment from you on our report that would help us in our further researches by appraising its strengths as well as its weaknesses. We could derive little guidance from your querulous editorial (Aug. 17) which seems compounded largely of inconsis-
tencies and confusions. An example of inconsistency is the warning to your readers about placing too much credence on our conclusions followed by the advice that, apart from revealing "ignorance about existing health services and the alternatives, the conclusions seem slight". Again, your note does not seem to be able to decide whether you prefer no social surveys, better surveys, or perhaps surveys that support your own opinions. Misapprehensions are more numerous. You deplore the " vociferous demand for social research " and want " more critical assessment of the assumptions made and the methods employed ". Yet your main contribution is to stigmatise the quota sample as a " highly structured group of people ... which hardly seems adequate for serious social research ". The sample, which was selected by our technical advisers, Mass Observation who conducted the survey, would generally be regarded as adequate (2000) and there are good arguments for confining it in the first place, at least, to male heads of households between the ages twenty-one and sixty-four, as spokesmen for families most likely to be concerned with decisions about choice of welfare services, methods of payment by insurance, and opportunities for contracting out. With Mass Observation we are now exploring the possible effect on our findings of alternative approaches, including the comparative views of a sample of men and women. You chided us, perhaps ungenerously, about not inquiring into knowledge about specialists’ fees, but gave no credit foror even mention of-the large amount of information on public knowledge and conduct which the report details for the first time. Nor did you tell your readers that we inquired into the extent to which people were covered by private insurance against hospital treatment, specialists’ fees, and medicines, and the preference between State and private general practitioners and specialists. And your comments dealt hardly adequately with the voucher question in which we specifically mentioned specialists’ fees. However imperfect and incomplete, ours is the first survey to attempt to discover public preferences in welfare services with some consciousness of relative costs and the alternatives available, and we hope to remove the imperfections and inadequacies in further research. From your concluding paragraph it would seem that you are chiefly prompted by discomfort at the finding that between half and two-thirds of the sample preferred public welfare policy to concentrate on people in need and to permit contracting out. Like many others, you appear to be surprised-even shocked-yet these findings, though conducted in more detail then any before, are not substantially in conflict with more limited earlier surveys: indeed, they broadly confirm the findings, for example, of Socialist Commentary in 1960 that 50% of a national sample (of 724 people aged eighteen and over) would pay more for social service benefits and 40% would not; or of New Society in March this year that 53% of some 7000 readers were in favour of concentrating State benefits on people in most need. Some of your readers may have noticed a paradox: in the following note on a pamphlet on general practice, enthusiasm for its conclusions is not diminished by the fact (which you do not state) that it rests in part on interviews with 107
patients. Institute of Economic Affairs, London, S.W.1.
RALPH HARRIS General Director.
to comment on the doubts of Aug. 17 about the scientific expressed in your leader value of the inquiry carried out by the Institute of Economic Affairs. But I can, perhaps, provide a clue to the answer to your " down-to-earth " question as to whether a significant number of people are, in reality, prepared to face the implications of providing for their own health outside the National Health Service. The clue is that well over one million people belong to B.U.P.A. alone, solely in order to enable them to meet private bed charges and specialists’ fees. In the past twelve months there were over 100,000 new enrolments, which is a record. This is happening despite severe discouragement, such as having to pay twice and an inadequate supply of private beds. It would therefore seem that the conclusions about health drawn from this piece of research are not entirely without concrete support. The Institute is surely entitled to credit for attempting to discover whether the consumer really is getting what he wants from the National Health Service. Too often it is assumed that what the N.H.S. is providing is what the consumer wants, or at least ought
SIR,-Iam
not
qualified
to want. British United Provident Association, Essex
Provident House, Street, London, W.C.2.
E. F. WEBB General
Manager.
*** certainly deplore the demand for social but its research; hypothesis and method should be able to withstand searching criticism, which can reveal the kind of " imperfections and inadequacies " acknowledged by Mr. Harris. The " consumer commentary " on general " practice to which he refers specifically states that it is not a research document."-ED. L. We
do
not
NEOMYCIN RESISTANCE IN NEWLY RECOGNISED STRAINS OF STAPHYLOCOCCUS AUREUS SIR,-We are most interested in the strains of Staphy-
lococcus aureus described by Mr. Robertson (Aug. 17) and in his important observation that these organisms are resistant to neomycin and kanamycin. This new epidemic variety of Staph. aureus has been called " type A " by Temple and Blackburnbut we thought it should be regarded as non-typable.2 It has been responsible for cases of surgical sepsis in many hospitals in Yorkshire and adjacent counties,34 in the Glasgow area,! and in Liver-
pool.5 In two large hospitals in Leeds during the six months ended last March we isolated 552 strains of Staph. aureus which were resistant to penicillin (1-5 units), streptomycin (10 µg.) and tetracycline (10 µg.) when tested withMultodisks’ (Oxoid). Using the glycerol-monacetate medium described by Willis and Turner 6 to determine the pigment variety of the strains, 378 of them were found to be yellow and the other 174 orange or buff. The strains were phagetyped through the kindness of Dr. G. B. Ludlam. In view of the observations of Cohen et al.,7 at the Johns Hopkins Hospital, that many tetracycline-resistant staphyloccocci were also resistant to neomycin, and were phagetypable only at 1000 R.T.D., we recently tested our 552 strains for resistance to neomycin (10 tg.) and kanamycin (7-5 (Jog.) by the disc diffusion technique. Our findings are shown in the table. We also examined a further 25 strains of Staph. aureus 1. 2. 3. 4. 5. 6. 7.
Temple, N. E. I., Blackburn, E. A. Lancet, 1963, i, 581. Jacobs, S. I., Willis, A. T., Ludlam, G. B., Goodburn, G. M. ibid. p. 972. Willis, A. T., Jacobs, S. I., Goodburn, G. M. ibid. July 13, 1963, p. 67. Willis, A. T., Jacobs, S. I., Goodburn, G. M. J. Path. Bact. (in the press). Turner, G. C. Lancet, 1963, i, 1156. Willis, A. T., Turner, G. C. J. Path. Bact. 1962, 64, 337. Cohen, L. S., Fekety, F. R., Cluff, L. E. New Engl. J. Med. 1962, 266 367.