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Round the World
1182
supported by the Oxford R.H.A. and the of Health and Social Security.
gramme is ment
Requests for reprints should be addressed Keble Road, Oxford.
to
Depart-
A. E.
B.,
8
REFERENCES
Report of the Committee on Senior Nursing Staff Structure. Ministry of Health. H.M. Stationery Office, 1966. 2. Community Hospitals: Their Role and Development in the National Health Service. Department of Health and Social Security, 1974. 3. Oddie, J. A., Hasler, J. C., Vine, S. M., Bennett, A. E. Lancet, 1971, ii, 308. 4. Bennett, A. E. (editor) Community Hospitals: Progress in Development and Evaluation. Oxford Regional Hospital Board, 1974. 5. Community Hospitals: the Pattern of Medical Working. Report of an ad hoc working-party (chairman A. E. Bennett). Oxford Regional Hospital Board, 1973. 1.
Round the World United States THE CRUNCH COMES
The malpraxis crisis came on May Day in Northern California when hundreds of doctors ceased practising, and surgeons and anaesthetists, high-risk individuals, refused to perform operations or to give anaesthetics save in frank emergency situations. It came as a shock to many that obstetric deliveries and cancer surgery were not considered There was a 75% cut in hospital admissions, least in those hospitals not now covered by malpraxis insurance. Faced with demands by the Argonaut Insurance Company for premium increases of from 250% to 400%, or more, the physicians have simply quit work, as they are threatening to do on July 1 in New York State, where the same insurance company is withdrawing its coverage and where patients are being refused bookings for consultation after July 1. With rises of up two$20,000 per dnnum to be paid before a physician sees a patient, many physicians have no option but to quit work, and others who have paid up are passing these charges on to the patients. The effects of the close-down of practice in Northern California will fall rapidly on the hospitals, which are still suffering from lost revenue from the recent nurses’ strike; hospital employees are now being laid off as quickly as possible. The legislatures in both of our most populous States will really have to get down to work and come up with some solutions, regardless of the protests of interested lawyers, and of the patients’ rights advocates-who are now calling for the full disclosure of all possible risks of every treatment under all conditions. The lawyers, including those who should know much better, are trying to claim that it is all a plot by the physicians against the patients. At any rate, it’s the patients who are going to suffer, and who are suffering in California.
emergencies. at
TROUBLES OVER APES
The Founding Fathers, conscious of the religious tyrannies their forefathers had escaped, laid down in the First Amendment that Congress should not pass any legislation tending directly or indirectly to the establishment of religion. This Amendment has been the subject of constant attack by religious groups of all persuasions, and courts of the country have through history been constantly thwarting attempts by special interests to negate the Amendment. It was thus not really surprising that the U.S. Court of Appeals of the 6th Circuit on April 10 struck down as unconstitutional a law passed by the legislature of the State of Tennessee which required that
the
biology, and thus the textbooks used, should time in teaching to the Biblical explanation of give equal man’s origin and to the explanations that develop from the darwinian concepts of man’s evolution, an enactment clearly in violation of the First Amendment. The only recourse of the losers is appeal to the U.S. Supreme (an Court. Behind this episode lies a long history of tragic local conflict between science and religion, which many years ago unjustly made Tennessee a laughing-stock over the Scopes " Monkey " trial, when the sceptic Clarence Darrow tore to shreds the views of the Biblical Fundamentalist Populist William Jennings Bryan; the verdict, in fact, was unsatisfactory to both sides, and the result was not a clear-cut resolution of the conflict but an uneasy truce, in which the teaching of evolution in schools and school textbooks was played down, and even in college textbooks given inadequate attention-to the detriment, so it has been recently alleged, of scientific education in this country. Which interests were to blame-those of the publishers, who feared that textbooks might be banned by obscurantist school boards (there is quite a tradition of such book-burning in this country), or of the authors, who feared loss of royalties, or of the biologists, who were all for a quiet life-is also a matter of dispute. Only with Sputnik I and the furore it created here did the situation alter, and now the teaching of evolution is again under attack, though of a different type. But the conflict is not purely an intellectual one, for those who wish to protect" their supposedly innocent children from " godless books on evolution in classroom or school library, or from indecent literature, have taken to violence, and some have resorted to bombings, shootings, and arson to protect their
teachers of
children. The conflict between science and at least that type of religious thought that is firmly textually rooted is of long standing, but the principal offence was that darwinian evolution suggested that man was not so much made in the image of God, but was a modified improved version of an ape, the exact way in which he was improved being to some not altogether clear. It was of no significance that few humans look- less like apes than the tall, handsome, horse-riding inhabitants of Tennessee; possible ape ancestry, however remote, was not to be discussed, let alone taught to innocent schoolchildren. Hence the Scopes trial. But though it became clear that this attitude could not be maintained, at least by law, it was possible to give away as little as possible by virtue of local control of school boards. But as State, if not federal, involvement increased, the ability of local individuals to determine what should be taught declined. So a new line developed, sponsored by the Creation Research Society, in which
scientists, chiefly from the physical sciences, are concerned, and which developed in the notorious Orange County of California. Pouncing on inadequacies and gaps in the evolutionary concept of man’s biological history,
various
with which scientists have been grappling for more than a century, it was claimed that there was no more real substance to the evolutionary theory than to the Biblical explanation, and that equal attention in schools should be given to both. There have been battles over this in California, and the proposals have only been enacted into law in Tennessee-and have been struck down. There is, of course, much more to this matter. It is bound up with new attempts by local individuals to determine, through the local school boards, exactly what shall be taught in the local schools, and teachers and educationists are fighting hard against such proposals, which often involve racial and economic factors. Another influence is the anti-scientific and, indeed, anti-intellectualist feelings never far below the surface here: the " knownothings " were not just a political party.
supported by the Oxford R.H.A. and the of Health and Social Security.
gramme is ment
Requests for reprints should be addressed Keble Road, Oxford.
to
Depart-
A. E.
B.,
8
REFERENCES
Report of the Committee on Senior Nursing Staff Structure. Ministry of Health. H.M. Stationery Office, 1966. 2. Community Hospitals: Their Role and Development in the National Health Service. Department of Health and Social Security, 1974. 3. Oddie, J. A., Hasler, J. C., Vine, S. M., Bennett, A. E. Lancet, 1971, ii, 308. 4. Bennett, A. E. (editor) Community Hospitals: Progress in Development and Evaluation. Oxford Regional Hospital Board, 1974. 5. Community Hospitals: the Pattern of Medical Working. Report of an ad hoc working-party (chairman A. E. Bennett). Oxford Regional Hospital Board, 1973. 1.
Round the World United States THE CRUNCH COMES
The malpraxis crisis came on May Day in Northern California when hundreds of doctors ceased practising, and surgeons and anaesthetists, high-risk individuals, refused to perform operations or to give anaesthetics save in frank emergency situations. It came as a shock to many that obstetric deliveries and cancer surgery were not considered There was a 75% cut in hospital admissions, least in those hospitals not now covered by malpraxis insurance. Faced with demands by the Argonaut Insurance Company for premium increases of from 250% to 400%, or more, the physicians have simply quit work, as they are threatening to do on July 1 in New York State, where the same insurance company is withdrawing its coverage and where patients are being refused bookings for consultation after July 1. With rises of up two$20,000 per dnnum to be paid before a physician sees a patient, many physicians have no option but to quit work, and others who have paid up are passing these charges on to the patients. The effects of the close-down of practice in Northern California will fall rapidly on the hospitals, which are still suffering from lost revenue from the recent nurses’ strike; hospital employees are now being laid off as quickly as possible. The legislatures in both of our most populous States will really have to get down to work and come up with some solutions, regardless of the protests of interested lawyers, and of the patients’ rights advocates-who are now calling for the full disclosure of all possible risks of every treatment under all conditions. The lawyers, including those who should know much better, are trying to claim that it is all a plot by the physicians against the patients. At any rate, it’s the patients who are going to suffer, and who are suffering in California.
emergencies. at
TROUBLES OVER APES
The Founding Fathers, conscious of the religious tyrannies their forefathers had escaped, laid down in the First Amendment that Congress should not pass any legislation tending directly or indirectly to the establishment of religion. This Amendment has been the subject of constant attack by religious groups of all persuasions, and courts of the country have through history been constantly thwarting attempts by special interests to negate the Amendment. It was thus not really surprising that the U.S. Court of Appeals of the 6th Circuit on April 10 struck down as unconstitutional a law passed by the legislature of the State of Tennessee which required that
the
biology, and thus the textbooks used, should time in teaching to the Biblical explanation of give equal man’s origin and to the explanations that develop from the darwinian concepts of man’s evolution, an enactment clearly in violation of the First Amendment. The only recourse of the losers is appeal to the U.S. Supreme (an Court. Behind this episode lies a long history of tragic local conflict between science and religion, which many years ago unjustly made Tennessee a laughing-stock over the Scopes " Monkey " trial, when the sceptic Clarence Darrow tore to shreds the views of the Biblical Fundamentalist Populist William Jennings Bryan; the verdict, in fact, was unsatisfactory to both sides, and the result was not a clear-cut resolution of the conflict but an uneasy truce, in which the teaching of evolution in schools and school textbooks was played down, and even in college textbooks given inadequate attention-to the detriment, so it has been recently alleged, of scientific education in this country. Which interests were to blame-those of the publishers, who feared that textbooks might be banned by obscurantist school boards (there is quite a tradition of such book-burning in this country), or of the authors, who feared loss of royalties, or of the biologists, who were all for a quiet life-is also a matter of dispute. Only with Sputnik I and the furore it created here did the situation alter, and now the teaching of evolution is again under attack, though of a different type. But the conflict is not purely an intellectual one, for those who wish to protect" their supposedly innocent children from " godless books on evolution in classroom or school library, or from indecent literature, have taken to violence, and some have resorted to bombings, shootings, and arson to protect their
teachers of
children. The conflict between science and at least that type of religious thought that is firmly textually rooted is of long standing, but the principal offence was that darwinian evolution suggested that man was not so much made in the image of God, but was a modified improved version of an ape, the exact way in which he was improved being to some not altogether clear. It was of no significance that few humans look- less like apes than the tall, handsome, horse-riding inhabitants of Tennessee; possible ape ancestry, however remote, was not to be discussed, let alone taught to innocent schoolchildren. Hence the Scopes trial. But though it became clear that this attitude could not be maintained, at least by law, it was possible to give away as little as possible by virtue of local control of school boards. But as State, if not federal, involvement increased, the ability of local individuals to determine what should be taught declined. So a new line developed, sponsored by the Creation Research Society, in which
scientists, chiefly from the physical sciences, are concerned, and which developed in the notorious Orange County of California. Pouncing on inadequacies and gaps in the evolutionary concept of man’s biological history,
various
with which scientists have been grappling for more than a century, it was claimed that there was no more real substance to the evolutionary theory than to the Biblical explanation, and that equal attention in schools should be given to both. There have been battles over this in California, and the proposals have only been enacted into law in Tennessee-and have been struck down. There is, of course, much more to this matter. It is bound up with new attempts by local individuals to determine, through the local school boards, exactly what shall be taught in the local schools, and teachers and educationists are fighting hard against such proposals, which often involve racial and economic factors. Another influence is the anti-scientific and, indeed, anti-intellectualist feelings never far below the surface here: the " knownothings " were not just a political party.