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WERNER'S SYNDROME
1152
NIGHT-CALL SERVICES His question on cortisone preparations is easily answered. " No preparation of cortisone should be marketed unless SiR,—" Postgraduate (Nov. 11) has made a plea for there have been satisfactory clinical trials which have the N.H.S. to take over the private night-call services. proved its reliability. No doubt a regulation of this sort While I would rather not comment about this remedy, would lead to fewer preparations being introduced and, if I should like to confirm the poor rates of pay and to warn intending recruits of the tricks used by the so, so much the better. It is the responsibility of manufacturers not to market anything until they have had unscrupulous organisers of some of these services to make adequate clinical trials. It is not the responsibility of the the low rates of pay even lower. doctors to pick and choose between advertised preparaWhen I joined one of these night-call services for occasional tions to discover which claims are false. evening work, I was told that the rate of pay was 6s. 8d. per call Mr. Hebert’s approach is one that I have come to consider characteristic of drug firms who do not admit the true responsibilities of the industry, although I have no knowledge of Mr. Hebert’s affiliations. On the minor point that doctors don’t use the opportunities at present available for prescribing by generic name plus manufacturer’s name. This does not, of course, give any indication of what they would do if a complete revision of marketing technique took place, coupled, as no doubt it would be, with authoritative guidance in the Prescriber’s Journal. One reason for doctors not prescribing as suggested is, of course, the fact that they almost never have the necessary facts on which to make a decision on whose cortisone, aspirin, or phenobarbitone is reliable and whose is not. Such information is seldom easily acquired in a routine clinical practice.
The professor of medicine of the University of Illinois has put the subject very clearly. " If drugs are not up to standard they should not be on the market at all. The prevention of the use of substandard drugs should not have to depend upon the vigor of the advertising campaigns of the companies whose drugs are up to standard." In this recent article’- and in another2 by the director of revision of the U.S. Pharmacopaeia the whole problem is discussed in detail, and constructive suggestions for a solution made. It only remains, I repeat, for the drug firms to take the matter seriously and to begin discussions with the medical profession with the real intention of doing something about it and not merely of defending the
with a guaranteed minimum of Elper session. A bonus of 1 guinea was offered for 10 or more calls in one session. When the first cheque arrived, it was found to be less than the expected amount. Inquiries revealed that a deduction for car insurance " was made from each session. Later, the El1 After about minimum session was abolished. guaranteed per a year and with no prior warning, the organisers suddenly refused to pay a bonus any more. I had rather foolishly trusted the organisers and had no form of written contract. Thus I lost several guineas due to me. Another source of underpayment is the omission of the names of patients you have visited from the organisation’s records, and this led to frequent disputes. May I advise anybody intending to work for one of "
organisations to get some form of written contract signed before they start work and to keep a record of all the work that they do. these
ANOTHER POSTGRADUATE.
Public Health Iodine 131 in Milk THE latest
from the
figures Radiobiogical Laboratory AveraJ
Agricultural
.
Research Council
are:
Levels of Iodine 131 in Milk Throughout the United KinJ
status quo.
(Nov. 11) refers to the delay in giving generic name as a reason for retaining trade names. It is hard to believe that this difficulty could not easily be overcome. A name for a drug has to be chosen, let it be the generic name. Or, failing that, at least let us not have trade names invented by anyone other than the Dr. Schmeidler
a
drug
a
The
mean results
for
samples collected
on
(Oct. 2, 16, 23, and 30) from depots which handle 40% of the country’s total milk production were:
four dates more than
initial 1 cii,,(’ovprpr nf the ciriicr
University College Hospital Medical School, D. R. LAURENCE. London, W.C.1.
WERNER’S SYNDROME SIR,-Many forms of constitutional disorder are likely to be investigated for evidence of chromosome abnormalities. One which has a potentially high research importance at present is Werner’s syndrome (precocious senility of the adult, adult progeria). This condition has been blamed on every endocrine gland in turn, but it appears likely that it will turn out to be a pleiotropic tissue defect,33 possibly the lack of an enzyme system. Since any new light on this condition might provide a clue to one or more of the timekeeping systems of normal senescence, may I urge any clinician who has access to a case to get in touch with the cytologists and let them look at its chromosomes ? Department of Zoology, University College London, ALEX COMFORT. London, W.C.2. 1. Dowling, H. F. New Engl. J. Med. 1961, 264, 75. 2. Miller, L. C. J. Amer. med. Ass. 1961, 177, 27. 3. Boyd, M. W. J., Grant, A. P. Brit. med. J. 1959, ii, 920.
The Medical Research Council has stated that the " acceptable radiation dose " would not be exceeded for infants under one year of age, the most susceptible group of the population, unless the average concentration of iodine 131 in milk rose above 130 C per litre over a period of one year, or higher concentrations were maintained for correspondingly shorter times. In making its recommendation the Medical Research Council made allowance for the likely extent of variation in the concentration of radioactive iodine in local milk supplies. Even in the regions where the highest levels have been observed, an annual average of 130 .,C per litre will not be reached unless the present levels are maintained for a further six or seven months or are substantially increased. The total quantity of iodine 131 which has so far entered milk in these regions is less than a fifth of the total which would give rise to the annual level specified by the Medical Research Council. Measurements are being continued.
NIGHT-CALL SERVICES His question on cortisone preparations is easily answered. " No preparation of cortisone should be marketed unless SiR,—" Postgraduate (Nov. 11) has made a plea for there have been satisfactory clinical trials which have the N.H.S. to take over the private night-call services. proved its reliability. No doubt a regulation of this sort While I would rather not comment about this remedy, would lead to fewer preparations being introduced and, if I should like to confirm the poor rates of pay and to warn intending recruits of the tricks used by the so, so much the better. It is the responsibility of manufacturers not to market anything until they have had unscrupulous organisers of some of these services to make adequate clinical trials. It is not the responsibility of the the low rates of pay even lower. doctors to pick and choose between advertised preparaWhen I joined one of these night-call services for occasional tions to discover which claims are false. evening work, I was told that the rate of pay was 6s. 8d. per call Mr. Hebert’s approach is one that I have come to consider characteristic of drug firms who do not admit the true responsibilities of the industry, although I have no knowledge of Mr. Hebert’s affiliations. On the minor point that doctors don’t use the opportunities at present available for prescribing by generic name plus manufacturer’s name. This does not, of course, give any indication of what they would do if a complete revision of marketing technique took place, coupled, as no doubt it would be, with authoritative guidance in the Prescriber’s Journal. One reason for doctors not prescribing as suggested is, of course, the fact that they almost never have the necessary facts on which to make a decision on whose cortisone, aspirin, or phenobarbitone is reliable and whose is not. Such information is seldom easily acquired in a routine clinical practice.
The professor of medicine of the University of Illinois has put the subject very clearly. " If drugs are not up to standard they should not be on the market at all. The prevention of the use of substandard drugs should not have to depend upon the vigor of the advertising campaigns of the companies whose drugs are up to standard." In this recent article’- and in another2 by the director of revision of the U.S. Pharmacopaeia the whole problem is discussed in detail, and constructive suggestions for a solution made. It only remains, I repeat, for the drug firms to take the matter seriously and to begin discussions with the medical profession with the real intention of doing something about it and not merely of defending the
with a guaranteed minimum of Elper session. A bonus of 1 guinea was offered for 10 or more calls in one session. When the first cheque arrived, it was found to be less than the expected amount. Inquiries revealed that a deduction for car insurance " was made from each session. Later, the El1 After about minimum session was abolished. guaranteed per a year and with no prior warning, the organisers suddenly refused to pay a bonus any more. I had rather foolishly trusted the organisers and had no form of written contract. Thus I lost several guineas due to me. Another source of underpayment is the omission of the names of patients you have visited from the organisation’s records, and this led to frequent disputes. May I advise anybody intending to work for one of "
organisations to get some form of written contract signed before they start work and to keep a record of all the work that they do. these
ANOTHER POSTGRADUATE.
Public Health Iodine 131 in Milk THE latest
from the
figures Radiobiogical Laboratory AveraJ
Agricultural
.
Research Council
are:
Levels of Iodine 131 in Milk Throughout the United KinJ
status quo.
(Nov. 11) refers to the delay in giving generic name as a reason for retaining trade names. It is hard to believe that this difficulty could not easily be overcome. A name for a drug has to be chosen, let it be the generic name. Or, failing that, at least let us not have trade names invented by anyone other than the Dr. Schmeidler
a
drug
a
The
mean results
for
samples collected
on
(Oct. 2, 16, 23, and 30) from depots which handle 40% of the country’s total milk production were:
four dates more than
initial 1 cii,,(’ovprpr nf the ciriicr
University College Hospital Medical School, D. R. LAURENCE. London, W.C.1.
WERNER’S SYNDROME SIR,-Many forms of constitutional disorder are likely to be investigated for evidence of chromosome abnormalities. One which has a potentially high research importance at present is Werner’s syndrome (precocious senility of the adult, adult progeria). This condition has been blamed on every endocrine gland in turn, but it appears likely that it will turn out to be a pleiotropic tissue defect,33 possibly the lack of an enzyme system. Since any new light on this condition might provide a clue to one or more of the timekeeping systems of normal senescence, may I urge any clinician who has access to a case to get in touch with the cytologists and let them look at its chromosomes ? Department of Zoology, University College London, ALEX COMFORT. London, W.C.2. 1. Dowling, H. F. New Engl. J. Med. 1961, 264, 75. 2. Miller, L. C. J. Amer. med. Ass. 1961, 177, 27. 3. Boyd, M. W. J., Grant, A. P. Brit. med. J. 1959, ii, 920.
The Medical Research Council has stated that the " acceptable radiation dose " would not be exceeded for infants under one year of age, the most susceptible group of the population, unless the average concentration of iodine 131 in milk rose above 130 C per litre over a period of one year, or higher concentrations were maintained for correspondingly shorter times. In making its recommendation the Medical Research Council made allowance for the likely extent of variation in the concentration of radioactive iodine in local milk supplies. Even in the regions where the highest levels have been observed, an annual average of 130 .,C per litre will not be reached unless the present levels are maintained for a further six or seven months or are substantially increased. The total quantity of iodine 131 which has so far entered milk in these regions is less than a fifth of the total which would give rise to the annual level specified by the Medical Research Council. Measurements are being continued.