- Email: [email protected]
VIVISECTION
498 VIVISECTION
diarrhoea, malnutrition, and deprivation
SIR,-I was surprised to see you use the word "vivisection" (Jan. 13, p. 115). The report of the Departmental Committee on Experimental Animals (Cmnd 2641) states in section 8, p. 2: "At an early stage we concluded that ’vivisection’ was no longer an accurate description of animal experiments as a whole and we have tried to avoid the use of it in this Report." The views of the Departmental Committee have long been accepted by those involved in the use of live animals for experimental purposes, and perhaps, therefore, The Lancet might also consider avoiding the use of such an inaccurate and emo-
to which W.H.O. Director-General Dr Halfdan Mahler refers. For accurate assessment of priorities in less obvious matters and for evaluation of corrective policies, a firmer data base is necessary. In this respect, there would appear to be a lack of relevant epidemiological information-and not just in developing countries-about some very elementary questions.
Department of Community Medicine, University ofGlasgow Glasgow, University of
Ruchill Hospital, Glasgow G20 9NB
GORDON T. STEWART
tive word. M.R.C. Laboratory Animals Centre, Medical Research Council Laboratories, Carshalton, Surrey SM5 4EF
UNEMPLOYMENT AND HEALTH
JOHN BLEBY
are our health-policy makers in of the kind which characterises the work of the Unit for the Study of Health Policy (U.S.H.P.) (Feb. 17, p. 373). I strongly support the call of Dr Draper and his colleagues for a greater awareness within the medical profession of the adverse effects on health of unemployment. It is, however, necessary to recognise that the relationship is a complex one. Eyer,’ who sees the adverse effects of employment in the growth economy as even greater than those of unemployment, has challenged Dr Harvey Brenner’s interpretation of historical epidemiology cited by Draper and his colleagues. From another viewpoint, the interdisciplinary approach to health advocated by Canada’s recent Minister of Health, Mr M. Lalonde, also earns the approval of U.S.H.P., but is seen by Illich2 as creating "a new corporate biocracy" which has further strengthened the disabling dependence of the public on the professional. While the comments of these radical critics cannot go unanswered, it is high time that the views of the U.S.H.P. team on the mutual interdependence of health, environment, and political economy-views increasingly shared by medical and other health workers-are accorded practical recognition by those who claim that prevention is everybody’s business.
SIR,-How sadly lacking
imagination
A HEALTHY START
SIR,-Anyone who shares the reservations previously expressed in your columns1,2 will surely be surprised at your, unqualified endorsement (Feb. 17, p. 394) of W.H.O.’s benevolent wish to ensure "Health for All by 2000", as expressed in the Alma-Ata Conference3 and in the slogan "A Healthy Child, a Sure Future" adopted for the Year of the Child.4 The sad lesson of the post-world-war n boom in the goodintention industry, especially among the multinational corporations, is that good intentions expressed only in general terms are liable to be overoptimistic, misleading, and costly unless they provide the wherewithal to promote good practice and-equally important-to discourage bad practice in more specific terms. In this respect, W.H.O. support for primary health care could be just another good intention unless the small print and the technical details are consistent with the facts of life (and death) in the target areas.5 This is where some serious questions arise. According to W.H.O., the infant-mortality rate (I.M.R.) together with a few simple measurements provide "reliable indicators of the health of the child population". If this is so, W.H.O.’s own statistics6 of I.M.R. (the simple measurements are lacking) indicate that children are much healthier in the Canal Zone of Panama, in Hong Kong, and in Singapore (1974) than in West Germany, the U.S.S.R., Austria, Bulgaria, or Hungary:
Liverpool Liverpool
Area Health L3 9NG
Authority (Teaching)
ALEX SCOTT-SAMUEL
DISCHARGING THE ELDERLY SIR,--Your
review
(jan, , Y. aio
va
am a mv.amaa,y
,
The healthiest place to be born would appear to be the Spanish Sahara while developing countries like Thailand, Mozambique, and Honduras have I.M.R.s not very different from some of the so-called developed countries. If these figures are even roughly accurate, where is W.H.O. going to start? If they are not accurate should it not start in Geneva? Exact numerical data may not be required to justify priority in developing countries in attacking the vicious cycle of 1 Robertson, J. S. Lancet, 1978, ii, 1144. 2. Davis, J. A. ibid 3 Lancet, 1978, ii, 1040. 4. Division of Public Information, W. H. O., Geneva 27, Switzerland. 5. Fendall, N. R. E Lancet, 1978, ii, 1308. 6 W H.O. Statistics Annual 1973-1976; vol. I. Geneva.
auu
Pat Gay’s study drew attention to a vulnerable group of people who often fall, with occasional disastrous results, into the gap between hospital and community care. These are the elderly patients, being discharged in increasing numbers from our hospitals. I agree that there is considerable potential for volunteers in their care, if only hospitals will accept and encourage this, but there is much room for improvement in the whole area of planning for discharge and ensuring that aftercare, both voluntary and statutory and that provided by many devoted relatives, works effectively. The Continuing Care Project-based in Birmingham and funded by the National Corporation for the Care of Old People-has been working to promote improvements in aftercare for elderly patients. Research has highlighted the enormous problems that can be encountered by this group of patients (e.g., the delay in arrival of essential services at just the time they are needed most, immediately after discharge.) The source of these problems is often poor communication between hospital and community and lack of information on patients’ home circumstances, coupled with misunderstanding among professionals of each other’s roles and potential contribution to the situation. These problems may be worse in a pressured surgical unit where there is no time to get to know patients well. A good geriatric unit with an emphasis on rehabilitation and 1. Eyer, J.Int. J. Hlth Serv. 1977, 7, 125 2. Illich, I. The Right to Useful Unemployment; p. 90. London, 1978.
diarrhoea, malnutrition, and deprivation
SIR,-I was surprised to see you use the word "vivisection" (Jan. 13, p. 115). The report of the Departmental Committee on Experimental Animals (Cmnd 2641) states in section 8, p. 2: "At an early stage we concluded that ’vivisection’ was no longer an accurate description of animal experiments as a whole and we have tried to avoid the use of it in this Report." The views of the Departmental Committee have long been accepted by those involved in the use of live animals for experimental purposes, and perhaps, therefore, The Lancet might also consider avoiding the use of such an inaccurate and emo-
to which W.H.O. Director-General Dr Halfdan Mahler refers. For accurate assessment of priorities in less obvious matters and for evaluation of corrective policies, a firmer data base is necessary. In this respect, there would appear to be a lack of relevant epidemiological information-and not just in developing countries-about some very elementary questions.
Department of Community Medicine, University ofGlasgow Glasgow, University of
Ruchill Hospital, Glasgow G20 9NB
GORDON T. STEWART
tive word. M.R.C. Laboratory Animals Centre, Medical Research Council Laboratories, Carshalton, Surrey SM5 4EF
UNEMPLOYMENT AND HEALTH
JOHN BLEBY
are our health-policy makers in of the kind which characterises the work of the Unit for the Study of Health Policy (U.S.H.P.) (Feb. 17, p. 373). I strongly support the call of Dr Draper and his colleagues for a greater awareness within the medical profession of the adverse effects on health of unemployment. It is, however, necessary to recognise that the relationship is a complex one. Eyer,’ who sees the adverse effects of employment in the growth economy as even greater than those of unemployment, has challenged Dr Harvey Brenner’s interpretation of historical epidemiology cited by Draper and his colleagues. From another viewpoint, the interdisciplinary approach to health advocated by Canada’s recent Minister of Health, Mr M. Lalonde, also earns the approval of U.S.H.P., but is seen by Illich2 as creating "a new corporate biocracy" which has further strengthened the disabling dependence of the public on the professional. While the comments of these radical critics cannot go unanswered, it is high time that the views of the U.S.H.P. team on the mutual interdependence of health, environment, and political economy-views increasingly shared by medical and other health workers-are accorded practical recognition by those who claim that prevention is everybody’s business.
SIR,-How sadly lacking
imagination
A HEALTHY START
SIR,-Anyone who shares the reservations previously expressed in your columns1,2 will surely be surprised at your, unqualified endorsement (Feb. 17, p. 394) of W.H.O.’s benevolent wish to ensure "Health for All by 2000", as expressed in the Alma-Ata Conference3 and in the slogan "A Healthy Child, a Sure Future" adopted for the Year of the Child.4 The sad lesson of the post-world-war n boom in the goodintention industry, especially among the multinational corporations, is that good intentions expressed only in general terms are liable to be overoptimistic, misleading, and costly unless they provide the wherewithal to promote good practice and-equally important-to discourage bad practice in more specific terms. In this respect, W.H.O. support for primary health care could be just another good intention unless the small print and the technical details are consistent with the facts of life (and death) in the target areas.5 This is where some serious questions arise. According to W.H.O., the infant-mortality rate (I.M.R.) together with a few simple measurements provide "reliable indicators of the health of the child population". If this is so, W.H.O.’s own statistics6 of I.M.R. (the simple measurements are lacking) indicate that children are much healthier in the Canal Zone of Panama, in Hong Kong, and in Singapore (1974) than in West Germany, the U.S.S.R., Austria, Bulgaria, or Hungary:
Liverpool Liverpool
Area Health L3 9NG
Authority (Teaching)
ALEX SCOTT-SAMUEL
DISCHARGING THE ELDERLY SIR,--Your
review
(jan, , Y. aio
va
am a mv.amaa,y
,
The healthiest place to be born would appear to be the Spanish Sahara while developing countries like Thailand, Mozambique, and Honduras have I.M.R.s not very different from some of the so-called developed countries. If these figures are even roughly accurate, where is W.H.O. going to start? If they are not accurate should it not start in Geneva? Exact numerical data may not be required to justify priority in developing countries in attacking the vicious cycle of 1 Robertson, J. S. Lancet, 1978, ii, 1144. 2. Davis, J. A. ibid 3 Lancet, 1978, ii, 1040. 4. Division of Public Information, W. H. O., Geneva 27, Switzerland. 5. Fendall, N. R. E Lancet, 1978, ii, 1308. 6 W H.O. Statistics Annual 1973-1976; vol. I. Geneva.
auu
Pat Gay’s study drew attention to a vulnerable group of people who often fall, with occasional disastrous results, into the gap between hospital and community care. These are the elderly patients, being discharged in increasing numbers from our hospitals. I agree that there is considerable potential for volunteers in their care, if only hospitals will accept and encourage this, but there is much room for improvement in the whole area of planning for discharge and ensuring that aftercare, both voluntary and statutory and that provided by many devoted relatives, works effectively. The Continuing Care Project-based in Birmingham and funded by the National Corporation for the Care of Old People-has been working to promote improvements in aftercare for elderly patients. Research has highlighted the enormous problems that can be encountered by this group of patients (e.g., the delay in arrival of essential services at just the time they are needed most, immediately after discharge.) The source of these problems is often poor communication between hospital and community and lack of information on patients’ home circumstances, coupled with misunderstanding among professionals of each other’s roles and potential contribution to the situation. These problems may be worse in a pressured surgical unit where there is no time to get to know patients well. A good geriatric unit with an emphasis on rehabilitation and 1. Eyer, J.Int. J. Hlth Serv. 1977, 7, 125 2. Illich, I. The Right to Useful Unemployment; p. 90. London, 1978.