PREPARATIONS FOR WAR

952 influence their opinions and actions. Critics of formula company activities have been stigmatised as scientifically inept or as destroyers of private enterprise, and paediatricians and nutritionists have been seduced by grants and other forms of financial assistance. It is time for paediatricians and other health professionals not only to speak out in support of the W.H.O. code but also to think out the significance of accepting financial patronage—i.e., direct or indirect monetary support. While often wise in the ramifications of the Krebs cycle, health professionals are unaware of the subtleties of commercial manipulation. It is also a "not nice" matter to bring into the open, which is why we have termed the subject of the interaction between paediatricians and the food industry the "taboo zone".1 It is the underappreciated yet powerful psychological influence of financial support on behaviour which is at the core of this issue, especially when funds are scarce and assistance is on a possibly continuing basis. "Thou shalt take no gift; for the gift blindeth the wise and perverteth the words of the righteous" (Exodus, 23, 8). Generous-seeming assistance costs companies nothing: the expenses are either tax exempt contributions to worthy causes and/or are covered by product prices. Better to be poorer but certain that our judgments are uninfluenced. Perhaps commercial affiliations should be declared in any relevant publication (e.g., "Member of the Advisory Board of the Superlac Foundation" or "Controller of Megamix Formula Company research grants"). Sjolin’s uncompromising letter is a clarion call to action. The rise of inappropriate bottle feeding in developing countries has many causes but a major one is aggressive marketing by the infant food industry. The W.H.O. code is a compromise worked outbyW.H.O. with health professionals and the infant food industry over the past year. At the last minute, the industry seems to be backing out of this agreement and trying to persuade governments, notably the U.S.A., to vote against the code at the World Health Assembly in May. Advocacy by concerned paediatricians through all available channels now becomes vital.

PREPARATIONS FOR WAR

SIR,-In recent months there has been an increasingly belligerent foreign policy of the United States, which combines with a very unstable world political situation to increase greatly the danger of catastrophic war. All physicians must deplore this danger to human health, indeed to the very existence of the human race. The impact of the growing militarisation of our society is also manifest in the proposed transfer of resources from health and other human services to military spending. A shocking and graphic tone to the

illustration of this trend has recently come to our attention. The Department of Defense, apparently anticipating a war, has approached hospitals in the San Francisco Bay area and twelve other locations with a plan to make fifty or more beds in each hospital available immediately to the military in the event of war. To quote the document sent to participating hospitals: "a future large scale war overseas will probably begin and end very rapidly and produce casualties at a higher rate than any other war in history. The quickened pace and high intensity may not allow time to build the necessary military medical support base here in the U.S. to care for all the casualties returning in the early stages of the conflict ... Thus we have created the concept outlined in this handbook called the Civilian Military Contingency Hospital System (CMCHS), which provides a mechanism for civilian hospitals to agree in advance to supplement the military capability early in any large scale future conflict."

The programme has been endorsed by the American Medical Association, the American Hospital Association, and the Joint

Commission for Accreditation of Hospitals. The fifty undersigned physicians from Oakland, California, oppose the participation of civilian hospitals in this programme and call upon others to join us in this opposition. Public hospitals are being asked to expend manpower and resources in preparation for human slaughter, while patients are denied basic medical needs because of lack of funds. Physicians should join with others in our society in demanding that human welfare be given priority, and preparations for destruction cease. Please address correspondence on this matter 4252 Terrace St., Oakland, CA 94611, U.S.A. DAVID U. HIMMELSTEIN STEFFIE WOOLHANDLER ALICE A. JONES ERIC SWANN DENISE L’HEUREUX ALFRED LERNER K. DES ROSIER CAROL CAPENER DIRK H. VAN MEURS W. D. YEE KENNETH D. CHAN JUDITH WOFSY JAMIL SULIEMAN R. ENG WALTER STULLMAN M. MOREHART JAY BERNSTEIN

to:

Dr David

ALAN M. ESHELMAN MICHAEL CALLAHAM M. B. CHARLES P. G. HEMPHILL ALLAN BERNSTEIN D. G. CURRY A. GLASEROFF ANN LINDSEY SARA HARTLEY MARTHA ROPER DAVID SIEGEL NANCY LAZARUS KATHY BORGENICHT MARSHA S. JACKSTEIT VINCENT B. SCOTT JOHN CHRISTIANSEN DAVID CHIPKIN

CHARLES G. COX STEVEN SACKRIN JANE C. MATTHEWS HOWARD BACKER JOE V. SELBY DIANA OBRINSKY LAWRENCE SIROTT K. HENDRY ALAN STEINBACH HOWARD WAITZKIN KAY YATABE HERBERT SCHREIER SUE S. CHAN SUSAN D. LAMBERT JOHN L. GOLDENRIN W. BRUNER

BREAST MILK SUBSTITUTES AND THE W.H.O. CODE

SiR,-Professor Sjolin’s letter (March 14, p. 612) could not be timely; it comes from a respected Scandinavian paediatrician with a deserved reputation for scientific inquiry, humanism, and integrity. As the marketing tactics of the infant food companies continue largely unchanged in the Third World (with some minor cosmetic changes, such as limiting of radio coverage in some countries), Sjölin is right to note that the key to persuading governments of the need to accept the W.H.O. code of marketing of breast milk substitutes and to implement it lies in considerable measure with paediatricians and their associations. However, leading paediatricians and nutritionists have been the target of a varied, well-orchestrated, and massively funded campaign to more

School of Public Health,

DERRICK B. JELLIFFE E. F. PATRICE JELLIFFE

University of California, Los Angeles, California 90024, U.S.A

Himmelstem,

DENTAL EDUCATION

SIR,-As a dentist who, after working full time in academic, general practice, and school dentistry, studied medicine and am now working (from choice) as a registrar in psychiatry, I was most

.

r

interested to read your editorial on the Nuffield report on dental education (March 28, p. 706). The major point that needs stressing is that the content and variety of the academic dental course contrasts sharply with the repetitive nature of the work of most dentists who use little of this acquired knowledge. The practice of dentistry, except in hospital, becomes almost a reflex action and the intellect of the dentist is little stimulated so that boredom and frustration ensue only too often. The main job satisfaction then comes from the financial rewards. and, because of the system of payment in general practice dentistry (piecework), the standard of work almost inevitably declines. The increasing academic excellence of those being admitted to our dental schools is likely to exacerbate the frustration of future graduates, and it would be a real challenge to dental education if the realities of life as a dentist were brought home to sixth-formers before they applied for dental school. One answer would be to use dental ancillaries more. This would allow the dentist to devote a greater proportion of his time to the practice of more challenging and satisfying dentistry. The psychiatrically disturbed adult or child dental panent is another serious problem faced by dentists who are usually unprepared by their undergraduate education to cope with these patients One possible way of ameliorating the frustration of dentistry itself, and, especially, of dealing with disturbed dental patients. might be the inauguration of groups for dentists similar to the Bahr 1.

Jelliffe DB, Jelliffe EFP.

The taboo

zone.

Pediatrics 1981; 65: 814