1586

entitled to take into account. The JCHMT was in a difficultposition: its skeleton argument contained selections fromthese soundings, which gave cause for concern, and thejudge was not persuaded that the decision not to grantaccreditation was irrational. The JCHMT had a discretion.The JCHMT invited the judge to say, nothwithstanding

his criticisms of JCHMT procedures and criteria, that thecommittee had come to the right result. He rejected thatsubmission, however, and required the committee to

reconsider and to give Goldstein an opportunity to answercriticisms.

Comment

There must be dissatisfaction with a system that allowsthe JCHMT to award EC specialisation on the basis oftraining completed but to reject it on detailed analysis of thattraining and on soundings from consultants. 1t is also

disturbing that such decisions seem to be made with theapplicant given no opportunity to answer allegations madeagainst him and that doctors trek from locum post to locumpost with no expectation of ever being considered trainedsatisfactorily for UK accreditation, yet entitled to EC

specialist recognition.The JCHMT’s reluctance to accept enrolment from

those not in "substantive senior registrar posts" may verywell reflect the true situation in British hospitals-namely,that positive instruction and improvement of skills and anassessment of progress, is not being adequately provided formany doctors and that short-term locum posts are

haphazardly filled. Dr Goldstein disputed the status theJCHMT had accorded to some of his posts; he consideredthat they were "substantive" in the ordinary meaning of theword. The posts were real and he occupied them, and theyentitled him to EC certification on completion of three yearspostgraduate specialist training, in accordance with ECdirective 75/363 (the second medical directive).

Diana Brahams

Noticeboard

Vasectomy and cancer

With about 50 million couples world wide relying on vasectomyfor fertility control, any uncertainty about its safety is of seriousconcern. The question of a link with prostate cancer, raised recentlyby a few epidemiological studies but not confirmed by others, wasdiscussed in an editorial in The Lancet on June 15 (p 1445). Thistopic and the possibility of an association between vasectomy andtesticular cancer were also discussed by specialists at a WHO

meeting in Geneva on Oct 24-25. The .conclusion reached at thismeeting was that, on the basis 04 existing biological and

epidemiological evidence, any causal .relation between vasectomyand risk of prostate or testicular cancep was unlikely and no changesin family planning policies concerning vasectomy are justified.The group that met in Geneva also made recommendations on

priorities for further research. For:prostate cancer epidemiologicalinvestigations should take priority over basic science studiesbecause there is no compelling hypothesis to suggest a biologicallink with vasectomy. Studies already in progress on the screening ordetection of prostate cancer should also collect information on

vasectomy, and these, together with other record linkage studies,should be used to evaluate a level of risk and latency period on whichto base the design of further analytical studies. Biases in past studiesshould be identified and avoided in future work. The descriptiveepidemiology of vasectomy and prostate cancer in geographically

defined areas should be determined, with information being drawnnot only from cancer registries but also from vasectomyprogrammes. Plans for new analytical studies will depend onfindings from the descriptive studies and existing epidemiologicalinvestigations.

For testicular cancer the group suggests that, because of theinconclusiveness of the evidence for an association with vasectomy,the lack of a clear biological basis for a link, and the uncertaintyabout its public-health impact, it is premature to launch any newepidemiological investigation. Current investigations should,however, collect data on socioeconomic class and on controls.

The background papers prepared for the meeting will be published in aforthcoming issue of the European Journal of Cancer.

Children in a new world order

The United Nations Children’s Fund (UNICEF) operates withan unshakeable optimism personified by its charismatic executivedirector, James Grant, who sees hope for the world, and especiallyits children, in the turbulent events of recent years-the"liberation" of Central and Eastern Europe, the rejection ofdictatorship in many Latin American countries, the reduction inarms expenditure, and the "narrowing of ideological divides". In its1992 report On the State of the World’s s Children1 UNICEF lists itsproposals for securing a place for children in a new world order"which will reflect mankind’s brightest hopes rather than its darkestfears".

In UNICEF’s view, "ending the absolute poverty of one quarterof mankind-the more than one billion people who still live and diewith preventable hunger, disease, and illiteracy-should rankalongside the related issues of preserving the peace and protectingthe environment as priority items on the agenda of that new worldorder". UNICEF indicts the governments of developing countriesfor spending, on average, only 12 % of their budgets on basic healthservices and education for their poorest citizens and those of richcountries for allocating only 10% of international aid to health,education, and family planning.The 1990 World Summit for Children, attended by

representatives from 159 countries, was a clear sign that children arebeginning to feature on the political agenda. The summit agreed ona programme to prevent 4 million child deaths a year, end mass

malnutrition, eradicate polio, and ensure clean water, familyplanning services, and education for all by the year 2000. So far 60nations have drawn up their plans, and UNICEF expects thenumber to exceed 100 early in 1992. The summit’s goals, saysUNICEF, could be met by reallocating 10% of militaryexpenditure in the developing world and 1% of that inindustrialised countries.

1. On the state of the world’s children 1992. Oxford: Oxford University Press forUNICEF, 1991 £4 ($7·50). ISBN 0-192622285.

Triazolam’s status in European CommunityThe European Community’s Committee for Proprietary

Medicinal Products (CPMP), with an Upjohn team on hand toanswer questions, met on Dec 11 to pronounce further on the use oftriazolam in member states. In the wake of the UK’s ban on this

drug in October the CPMP had issued interim recommendationson labelling and packaging changes for triazolam. It now endorsesthose proposals and confirms "the absolute importance of shortterm usage (not more than 10 days)". The CPMP has directed itsworking group to expand the review from triazolam to all

short-acting sleeping medications. In short, therefore, the CPMPhas not supported the decision of the UK drug-regulating body,against which the company is now to appeal to the MedicinesCommission, having failed on Dec 3 to persuade the Committeeon the Safety of Medicines. However, The Lancet has been toldthat the CPMP was divided in deciding not to act on its 4-manworking group’s advice that the drug be withdrawn. Upjohn,manufacturer of the ’Halcion’ brand, claims that the CPMP