- Email: [email protected]
WHOSE RIGHT TO INFORM?
467 Poor remuneration and a contract based only on hours in these specialties will have the following effects: 1 Discouragement to doctors entering these specialties. 2 Enlistment of doctors with a 9-5 attitude. 3 Emigration of doctors established in these specialties,
and hence loss of the more valuable element. 4) Discouragement of temporary passage in these specialties of those clinicians trying to widen their view. This will further hamper attempts to train the physician to work as part of a team and in cooperation with those in these specialties. The result--a lower quality of medical staff in these supporting services and further handicaps to the physician. The basic salary, thankfully, still takes into account qualities in medicine that are worth the money-namely, experience and grade. Having gained under the new contract, we should direct future negotiations towards increases in the basic salary and not to overtime. The real issue in the current dispute between the junior hospital doctors and the Department of Health has not been brought out clearly in the Press. The issue is not the futile question of supplementary money not being paid for annual and study leave, but the unilateral inclusion of the clause, concerned with this, by Mr David Ennals and his Department, into our contract without prior agreement with the profession. The excuse, the pay policy, is not valid, because the contract was agreed under the pay policy in February. The step taken sets a precedent whereby employers can insert at random any alterations thev like into a contract. The Marsden Group supports the one-day stoppage on Aug 31 recommended by the B.4.A, only because it is clear that this step has been taken as a last resort. Without intervention at this time, further negotiations would be meaningless. P. R. S. Roval Marsden Hospital, London SW3 6JJ
TASKER,
Chairman, National Committee of the Marsden Group,
CALL TO YOUNG SURGEONS
SIR,-The gloom in the hospital services of the N.H.S. is nowhere more obvious than amongst young consultants. These men and women have seen spectacular and justifiable improvements in the pay and conditions of hospital junior staff, whilst their own income and professional status within the hospital community have steadily deteriorated. These young consultants represent the future basis for hospital care in the U.K., and the increasing frustration they experience in applying their talents-talents gained after many years of intensive training-must result in lower standards of hospital care. This situation must not continue, and we are appealing for support from a selected group—namely, fellows of the Royal College of Surgeons of England who obtained their fellowship between the years 1963 and 1973, since this group will represent the greater body of young consultant surgeons or those soon to achieve consultant status. However, any other fellow of the College may if he wishes, be included in the discussions that it is hoped this group will be having. We urge all young fellows to attend the annual general meeting of the Royal College of Surgeons in Leeds on Friday, Sept. 24. At ’this meeting Ae are putting forward the motion that: "The young fellows of this College protest their right to a career in surgery. They earnestly request the President and Council to convey to the Rova) Commission on the National Health Service their mounting concern at the erosion of their freedom and incenvaes to practise their profession to the highest standards". Those who cannot attend are asked to communicate with us s) that their views may be presented in absentia. Our aim is ". :nabte the President and Council to bring home to the Royal Commission the dangers of the continued unrest and job dissataction that exist amongst surgical trainees and young con- ants The President has kindly agreed to meet separately
with ances
representatives of the young fellows, to hear their grievin more detail. It is anticipated that further meetings will
be held with other interested bodies. Many associations are making attempts, notably through the Royal Commission, to influence Government opinion, but we believe that this loosely defined association of young surgeons will provide the means of delivering a sharp warning that, unless something is done soon, the long-term effects of unrest amongst young consultants, and surgeons especially, may have serious consequences for the N.H.S. St. Martin’s Hospital, Bath BA2 5RR
PATRICK SMITH
University Hospital of South Manchester, Manchester M20 8LR
DAVID SKIDMORE
WHOSE RIGHT TO INFORM?
SIR,-Your editorial (Aug. 14, p. 351) quite rightly implied that all rights come with responsibilities-and prescribing can be no exception. I doubt if any of your readers disagrees with your expression of such a principle, but I think you inadver-
tently referred to a far more fundamental one. You reported that the Government’s first effort to persuade the profession to be more responsible in its own prescribing has already been undertaken and involves the free distribution of the independent--and indeed excellent-fortnightly Drug and Therapeutics Bulletin to many thousands of senior medical students and hospital junior doctors. In these difficult economic times I am surprised to learn that the D.H.S.S. is using taxpayers’ money in this way at the same time that its Minister of State, Dr David Owen, is urging the pharmaceutical industry to reduce its promotional expenditure in a number of ways, one of which proposes a scheme which would penalise pharmaceutical compnaies who spend money on advertising "in journals which do not derive a substantial proportion of their revenue from subscriptions". While the D.H.S.S. might claim that it sees no paradoxes in these two methods of prosecuting its aim to reduce the N.H.S. drugs bill, is it not alarming that a Government Department is moving in a direction which will bring it nearer to approving, even controlling, the sources of information available to doctors? Is the right to inform a professional group of people soon to be Government-given? .
Medical Education 73 Wells Street, London W1P 3RD
(International) Ltd,
IgE, PARASITES,
SIMON CAMPBELL-SMITH
AND ALLERGY
SIR,-I was interested to read of Dr Lasch’s experience in Gaza (July 31, p. 255), where he finds asthma to be common among a heavily parasitised population. He is right to criticise a generalisation about the relationship between allergy and parasites based on any single study. Nevertheless, apart from my study in the Gambia,l there have also been reports of a low prevalence of allergic illness in rural communities of several countries, among them EthiopiaRhodesia,3 and New Guinea.4In a recent Nigerian study6 the majority of asthmatics were found to have urban or Europeanised backgrounds. Where IgE levels have been measured, they have invariably been higher in rural normal controls than in
asthmatics, whatever their background. 1. 2. 3. 4. 5. 6.
Godfrey, R. C. Clin. Allergy, 1975, 5, 201. Johansson, S. G. O., Mellbin, T., Vahlquist, B. Lancet, 1968, i, 1118. Merrett, T. G., Merrett, J., Cookson, J. B. Clin. Allergy, 1976, 6, 131. Woolcock, A. J., Blackburn, C. R. Aust. Ann. Med. 1967, 16, 11. Anderson, H. R. Clin. Allergy, 1974, 4, 171. Warrell, D. A., Fawcett, I. W., Harrison, B. D. W., Agaman, A. J., Ibu, J. O., Pope, H. M., Maberley, D. J. Q. Jl. Med. 1975, 44, 325.
and hence loss of the more valuable element. 4) Discouragement of temporary passage in these specialties of those clinicians trying to widen their view. This will further hamper attempts to train the physician to work as part of a team and in cooperation with those in these specialties. The result--a lower quality of medical staff in these supporting services and further handicaps to the physician. The basic salary, thankfully, still takes into account qualities in medicine that are worth the money-namely, experience and grade. Having gained under the new contract, we should direct future negotiations towards increases in the basic salary and not to overtime. The real issue in the current dispute between the junior hospital doctors and the Department of Health has not been brought out clearly in the Press. The issue is not the futile question of supplementary money not being paid for annual and study leave, but the unilateral inclusion of the clause, concerned with this, by Mr David Ennals and his Department, into our contract without prior agreement with the profession. The excuse, the pay policy, is not valid, because the contract was agreed under the pay policy in February. The step taken sets a precedent whereby employers can insert at random any alterations thev like into a contract. The Marsden Group supports the one-day stoppage on Aug 31 recommended by the B.4.A, only because it is clear that this step has been taken as a last resort. Without intervention at this time, further negotiations would be meaningless. P. R. S. Roval Marsden Hospital, London SW3 6JJ
TASKER,
Chairman, National Committee of the Marsden Group,
CALL TO YOUNG SURGEONS
SIR,-The gloom in the hospital services of the N.H.S. is nowhere more obvious than amongst young consultants. These men and women have seen spectacular and justifiable improvements in the pay and conditions of hospital junior staff, whilst their own income and professional status within the hospital community have steadily deteriorated. These young consultants represent the future basis for hospital care in the U.K., and the increasing frustration they experience in applying their talents-talents gained after many years of intensive training-must result in lower standards of hospital care. This situation must not continue, and we are appealing for support from a selected group—namely, fellows of the Royal College of Surgeons of England who obtained their fellowship between the years 1963 and 1973, since this group will represent the greater body of young consultant surgeons or those soon to achieve consultant status. However, any other fellow of the College may if he wishes, be included in the discussions that it is hoped this group will be having. We urge all young fellows to attend the annual general meeting of the Royal College of Surgeons in Leeds on Friday, Sept. 24. At ’this meeting Ae are putting forward the motion that: "The young fellows of this College protest their right to a career in surgery. They earnestly request the President and Council to convey to the Rova) Commission on the National Health Service their mounting concern at the erosion of their freedom and incenvaes to practise their profession to the highest standards". Those who cannot attend are asked to communicate with us s) that their views may be presented in absentia. Our aim is ". :nabte the President and Council to bring home to the Royal Commission the dangers of the continued unrest and job dissataction that exist amongst surgical trainees and young con- ants The President has kindly agreed to meet separately
with ances
representatives of the young fellows, to hear their grievin more detail. It is anticipated that further meetings will
be held with other interested bodies. Many associations are making attempts, notably through the Royal Commission, to influence Government opinion, but we believe that this loosely defined association of young surgeons will provide the means of delivering a sharp warning that, unless something is done soon, the long-term effects of unrest amongst young consultants, and surgeons especially, may have serious consequences for the N.H.S. St. Martin’s Hospital, Bath BA2 5RR
PATRICK SMITH
University Hospital of South Manchester, Manchester M20 8LR
DAVID SKIDMORE
WHOSE RIGHT TO INFORM?
SIR,-Your editorial (Aug. 14, p. 351) quite rightly implied that all rights come with responsibilities-and prescribing can be no exception. I doubt if any of your readers disagrees with your expression of such a principle, but I think you inadver-
tently referred to a far more fundamental one. You reported that the Government’s first effort to persuade the profession to be more responsible in its own prescribing has already been undertaken and involves the free distribution of the independent--and indeed excellent-fortnightly Drug and Therapeutics Bulletin to many thousands of senior medical students and hospital junior doctors. In these difficult economic times I am surprised to learn that the D.H.S.S. is using taxpayers’ money in this way at the same time that its Minister of State, Dr David Owen, is urging the pharmaceutical industry to reduce its promotional expenditure in a number of ways, one of which proposes a scheme which would penalise pharmaceutical compnaies who spend money on advertising "in journals which do not derive a substantial proportion of their revenue from subscriptions". While the D.H.S.S. might claim that it sees no paradoxes in these two methods of prosecuting its aim to reduce the N.H.S. drugs bill, is it not alarming that a Government Department is moving in a direction which will bring it nearer to approving, even controlling, the sources of information available to doctors? Is the right to inform a professional group of people soon to be Government-given? .
Medical Education 73 Wells Street, London W1P 3RD
(International) Ltd,
IgE, PARASITES,
SIMON CAMPBELL-SMITH
AND ALLERGY
SIR,-I was interested to read of Dr Lasch’s experience in Gaza (July 31, p. 255), where he finds asthma to be common among a heavily parasitised population. He is right to criticise a generalisation about the relationship between allergy and parasites based on any single study. Nevertheless, apart from my study in the Gambia,l there have also been reports of a low prevalence of allergic illness in rural communities of several countries, among them EthiopiaRhodesia,3 and New Guinea.4In a recent Nigerian study6 the majority of asthmatics were found to have urban or Europeanised backgrounds. Where IgE levels have been measured, they have invariably been higher in rural normal controls than in
asthmatics, whatever their background. 1. 2. 3. 4. 5. 6.
Godfrey, R. C. Clin. Allergy, 1975, 5, 201. Johansson, S. G. O., Mellbin, T., Vahlquist, B. Lancet, 1968, i, 1118. Merrett, T. G., Merrett, J., Cookson, J. B. Clin. Allergy, 1976, 6, 131. Woolcock, A. J., Blackburn, C. R. Aust. Ann. Med. 1967, 16, 11. Anderson, H. R. Clin. Allergy, 1974, 4, 171. Warrell, D. A., Fawcett, I. W., Harrison, B. D. W., Agaman, A. J., Ibu, J. O., Pope, H. M., Maberley, D. J. Q. Jl. Med. 1975, 44, 325.