1
864 INDICATIONS FOR DIPYRIDAMOLE THE drug-regulating authorities in the UK seem reluctant to use the weapon of prosecution in their battle against promotional claims that exceed the indications given in the data sheet for a drug. In its April 6 issue the Drug and Therapeutics Bulletin provides an example. Advertisements and, apparently, claims made by Boehringer Ingelheim representatives imply that dipyridamole (’Persantin’) prevents stroke and myocardial infarction. The manufacturers (Guardian, April 9) have denied that advertisements contravene the Medicines Act. There is no convincing clinical trial evidence that dipyridamole alone is effective in preventing recurrence of stroke or myocardial infarction. A one-year course of the drug would cost the NHS about D 77 per patient, at 100 mg four times a day. The Bulletin claims that the NHS spends f5 million on this drug per annum. Since there are some agreed indications for this agent it would be interesting to know how many prescribers are, in practice, being misled. THE HOSPITAL STORY LAST year there was a scene in a television programme, The Nation’s Health, where, because of a complicated set of managerial mishaps, painters were decorating the hospital kitchen while it was still in use. Paint spattered into food destined for the wards and, with the dramatic logic necessary for this dark vision of the NHS, many patients eventually succumbed to food poisoning. This assault on the NHS’s performance, when time after time the worst that could happen did so with tragic consequences, provoked professional defensiveness. Despite the one-sidedness, the caricature, and the hostility, however, the programme was instructive: the configuration of meagre resources, conflicting interests and ambitions, and lack of communication underlined the importance of hospital management-on which the patient’s fate ultimately depends. In contrast, Dr Courtenay C. Wade, honorary consultant physician in community medicine, Charing Cross Hospital, London, adopts a gentle approach to education in hospital management. His book2 describes aspects of life in a district general hospital. The hospital is fictional, but the stories are not and events are described by the participants. When an acute medical ward is closed because of food poisoning, the story is told by the ward sister, the hospital control-of-infection doctor, a patient, one of the domestic staff, a nursing officer, and a student nurse. The student asked a string of questions. Do we have to change our dresses before leaving the ward? Are the patients going to be eating off plastic plates? Are bedpans to be emptied as usual? Supposing I tell someone the ward is closed and that person ignores me? ("This happened once and the man thanked me for being on the ball but said that he was the control-of-infection doctor.") Dr Wade’s anecdotes and the inclusion of cartoons successfully illustrate the ripple effects which flow in a hospital. The book will be particularly useful in telling nurses, managers, and prospective inpatients about the importance of all the elements which contribute to the effective working of the hospital. Some of Dr Wade’s anecdotes are no less worrying than the starker incidents in The Nation’s Health. One patient, recalling a night of increasing pain after partial gastrectomy, related how he had to shout for help after the bell push had repeatedly failed to bring a response because it had not been plugged in. London School of Hygiene and Tropical Medicine Dr K. P. W. J. McAdam, associate professor of medicine at Tufts New England Medical Center, has been appointed to the Wellcome chair of clinical tropical medicine. The Royal College of Surgeons of England triennial Lister medal for 1984 has been awarded to Prof Roy Calne, FRS, professor of surgery in the University of Cambridge. 1. The Nation’s Health. Written by G. F. Newman, produced by Irving Teitelbaum, and directed by Les Blair (Euston Films Production, Channel 4). 2. Tales from Chirgwin Hospital: a Question of Management. Courtenay C. Wade. Basingstoke, Hants: Macmillan Press. Pp 146. £4.95. A public meeting on Essential Drugs for the Third World will take place at the London School of Hygiene and Tropical Medicine, London, on Monday, April 30, at 6.30pm: Oxfam, 4 Replingham Road, Southfields, London SW18 (01-874 7335). The British Psycho-Analytical Society’s 18th Ernest Jones lecture will be given by Prof Frank Kermode who will speak on the subject of Questions of Interpretation at the Universityof London, Institute of Education, Logan Hall, Bedford Way, London WC1, on Wednesday, May 9, at 8.15 pm. The 147th annual general meeting of the Royal Medical Benevolent Fund will be held at the Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1, on Thursday, May 10, at 2pm. A joint scientific meeting of the Royal College of Obstetricians and Gynaecologists and the British Association for Perinatal Paediatrics on Birth Asphyxia at Term will take place at the Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW 4RG (01-262 5425), on Friday, May 11. A panel discussion of the World Federation for Cancer Care on Cancer Pain-Can it be Relieved? will be held in the Gloucester Hotel, London, on Wednesday, May 16, at 2pm: World Federation for Cancer Care, 28 Belgrave Square, London SW1X 8QG (01-235 9438). The annual spring meeting of the Medical Society for the Study of Venereal Diseases will be held in Manchester on May 18-20: Dr M. A. Waugh, Department of Genito-Urinary Medicine, The General Infirmary, Great George Street, Leeds LSl 3EX, West Yorkshire. Corrections Cancer, Warts, and Sunshine in Renal Transplant Patients.-We apologise to Dr J. Boyle and colleagues for an error in the table accompanying this paper (March 31, p 702). The number ofhigh-exposedrenaltransplant patients with warts was 9 (not 20 as printed) and the number of normal-exposed patients with warts was 20 (not 9). Griffiths Report and Clinical Budgeting.-The third paragraph of Dr Peter Draper’s letter (April 7, p 7-96) should have begun "The trials of clinical budgeting now taking place in the UK ...". We apologise to Dr Draper for this error. Intestinal Spirochaetes.-In reference 10 of this editorial (March 31, p 720) the second author should be Thomas, MEM. Diary of the Week APRIL 15 TO 21 I Monday, 16th INSTITUTE OF LARYNGOLOGY AND OTOLOGY, Royal National Throat, Nose and Ear Hospital, 330/332 Gray’s Inn Road, London WC1X SEE 5.30 pm ProfH. F. Willebrand (Sweden): Auxiliary Means for an Easier Understanding of the Anatomy of the Temporal Bone. ST GEORGE’S HOSPITAL MEDICAL SCHOOL, 3rd Floor, Lanesborough Wing, Cranmer Terrace, London SW17 ORE 12.30 pm Prof John Hearn: Early Embryonic Development 10 Primates. MANCHESTER MEDICAL SOCIETY, John Rylands University Library, Oxford Road, Manchester M13 9PP 5.30 pm Prof J. P. Rood: Which Local Anaesthetic? Tuesday, 17th MANCHESTER MEDICAL SOCIETY 5.30 pm Dr S. Shafer: So-called Borderline Phenomena Observed during Intensive Psychotherapy. Wednesday, 18th WELLCOME INSTITUTE FOR THE HISTORY OF MEDICINE, 183 Euston Road, London NW 2BP 5.30 pm Dr Valerie Fildes: The Wet Nursmg of London’s Children, 1538-1800. ROYAL FREE HOSPITAL SCHOOL OF MEDICINE, Pond Street, London NW3 5 pm Dr Caroline Riely (USA): Liver Disease m Pregnancy. ROYAL MASONIC HOSPITAL, Ravenscourt Park, London W6 OTN 7 pm Dr R. A. Parkins: Clinical Aspects of Inflammatory Bowel Disease. CLINICAL RESEARCH CENTRE, Watford Road, Harrow, Middlesex HA1 3UJ 4.40 pm Prof R. E. Steiner: NMR and its Clinical Application. MANCHESTER MEDICAL SOCIETY 5 pm Dr E. Gowland: Problems in Diagnosing Disorders of the Thyroid. Thursday, 19th QUEEN CHARLOTTE’S MATERNITY HOSPITAL, Goldhawk Road, London W6 OXG 12.15 pm Dr L. Dubowitz: Neurological Assessment in the Newborn. MANCHESTER MEDICAL SOCIETY 8.30 pm Prof A. R. Hunter: How it all Began-in this Area.

Diary of the Week

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864

INDICATIONS FOR DIPYRIDAMOLE

THE drug-regulating authorities in the UK seem reluctant to usethe weapon of prosecution in their battle against promotional claimsthat exceed the indications given in the data sheet for a drug. In itsApril 6 issue the Drug and Therapeutics Bulletin provides anexample. Advertisements and, apparently, claims made byBoehringer Ingelheim representatives imply that dipyridamole(’Persantin’) prevents stroke and myocardial infarction. Themanufacturers (Guardian, April 9) have denied that advertisementscontravene the Medicines Act. There is no convincing clinical trialevidence that dipyridamole alone is effective in preventingrecurrence of stroke or myocardial infarction. A one-year course ofthe drug would cost the NHS about D 77 per patient, at 100 mg fourtimes a day. The Bulletin claims that the NHS spends f5 million onthis drug per annum. Since there are some agreed indications forthis agent it would be interesting to know how many prescribers are,in practice, being misled.

THE HOSPITAL STORY

LAST year there was a scene in a television programme, TheNation’s Health, where, because of a complicated set of managerialmishaps, painters were decorating the hospital kitchen while it wasstill in use. Paint spattered into food destined for the wards and,with the dramatic logic necessary for this dark vision of the NHS,many patients eventually succumbed to food poisoning. Thisassault on the NHS’s performance, when time after time the worstthat could happen did so with tragic consequences, provokedprofessional defensiveness. Despite the one-sidedness, the

caricature, and the hostility, however, the programme was

instructive: the configuration of meagre resources, conflictinginterests and ambitions, and lack of communication underlined theimportance of hospital management-on which the patient’s fateultimately depends.In contrast, Dr Courtenay C. Wade, honorary consultant

physician in community medicine, Charing Cross Hospital,London, adopts a gentle approach to education in hospitalmanagement. His book2 describes aspects of life in a district generalhospital. The hospital is fictional, but the stories are not and eventsare described by the participants. When an acute medical ward isclosed because of food poisoning, the story is told by the ward sister,the hospital control-of-infection doctor, a patient, one of thedomestic staff, a nursing officer, and a student nurse. The studentasked a string of questions. Do we have to change our dresses beforeleaving the ward? Are the patients going to be eating off plasticplates? Are bedpans to be emptied as usual? Supposing I tellsomeone the ward is closed and that person ignores me? ("Thishappened once and the man thanked me for being on the ball butsaid that he was the control-of-infection doctor.") Dr Wade’sanecdotes and the inclusion of cartoons successfully illustrate theripple effects which flow in a hospital. The book will be particularlyuseful in telling nurses, managers, and prospective inpatients aboutthe importance of all the elements which contribute to the effectiveworking of the hospital. Some of Dr Wade’s anecdotes are no lessworrying than the starker incidents in The Nation’s Health. Onepatient, recalling a night of increasing pain after partialgastrectomy, related how he had to shout for help after the bell pushhad repeatedly failed to bring a response because it had not beenplugged in.

London School of Hygiene and Tropical MedicineDr K. P. W. J. McAdam, associate professor of medicine at Tufts

New England Medical Center, has been appointed to the Wellcomechair of clinical tropical medicine.

The Royal College of Surgeons of England triennial Lister medal for 1984has been awarded to Prof Roy Calne, FRS, professor of surgery in theUniversity of Cambridge.

1. The Nation’s Health. Written by G. F. Newman, produced by Irving Teitelbaum, anddirected by Les Blair (Euston Films Production, Channel 4).

2. Tales from Chirgwin Hospital: a Question of Management. Courtenay C. Wade.Basingstoke, Hants: Macmillan Press. Pp 146. £4.95.

A public meeting on Essential Drugs for the Third World will take placeat the London School of Hygiene and Tropical Medicine, London, onMonday, April 30, at 6.30pm: Oxfam, 4 Replingham Road, Southfields,London SW18 (01-874 7335).The British Psycho-Analytical Society’s 18th Ernest Jones lecture will

be given by Prof Frank Kermode who will speak on the subject of Questionsof Interpretation at the Universityof London, Institute of Education, LoganHall, Bedford Way, London WC1, on Wednesday, May 9, at 8.15 pm.The 147th annual general meeting of the Royal Medical Benevolent

Fund will be held at the Royal College of Obstetricians and Gynaecologists, 27Sussex Place, Regent’s Park, London NW1, on Thursday, May 10, at 2pm.A joint scientific meeting of the Royal College of Obstetricians and

Gynaecologists and the British Association for Perinatal Paediatrics on BirthAsphyxia at Term will take place at the Royal College of Obstetricians andGynaecologists, 27 Sussex Place, Regent’s Park, London NW 4RG (01-2625425), on Friday, May 11.

A panel discussion of the World Federation for Cancer Care on CancerPain-Can it be Relieved? will be held in the Gloucester Hotel, London, onWednesday, May 16, at 2pm: World Federation for Cancer Care, 28 BelgraveSquare, London SW1X 8QG (01-235 9438).

The annual spring meeting of the Medical Society for the Study ofVenereal Diseases will be held in Manchester on May 18-20: Dr M. A.Waugh, Department of Genito-Urinary Medicine, The General Infirmary,Great George Street, Leeds LSl 3EX, West Yorkshire.

Corrections

Cancer, Warts, and Sunshine in Renal Transplant Patients.-We apologise toDr J. Boyle and colleagues for an error in the table accompanying this paper(March 31, p 702). The number ofhigh-exposedrenaltransplant patients withwarts was 9 (not 20 as printed) and the number of normal-exposed patients withwarts was 20 (not 9).

Griffiths Report and Clinical Budgeting.-The third paragraph of Dr PeterDraper’s letter (April 7, p 7-96) should have begun "The trials of clinicalbudgeting now taking place in the UK ...". We apologise to Dr Draper for thiserror.

Intestinal Spirochaetes.-In reference 10 of this editorial (March 31, p 720)the second author should be Thomas, MEM.

Diary of the Week

APRIL 15 TO 21 I

Monday, 16thINSTITUTE OF LARYNGOLOGY AND OTOLOGY, Royal National Throat, Nose

and Ear Hospital, 330/332 Gray’s Inn Road, London WC1X SEE5.30 pm ProfH. F. Willebrand (Sweden): Auxiliary Means for an Easier Understanding

of the Anatomy of the Temporal Bone.ST GEORGE’S HOSPITAL MEDICAL SCHOOL, 3rd Floor, Lanesborough Wing,

Cranmer Terrace, London SW17 ORE12.30 pm Prof John Hearn: Early Embryonic Development 10 Primates.

MANCHESTER MEDICAL SOCIETY, John Rylands University Library, OxfordRoad, Manchester M13 9PP

5.30 pm Prof J. P. Rood: Which Local Anaesthetic?

Tuesday, 17thMANCHESTER MEDICAL SOCIETY

5.30 pm Dr S. Shafer: So-called Borderline Phenomena Observed during IntensivePsychotherapy.

Wednesday, 18thWELLCOME INSTITUTE FOR THE HISTORY OF MEDICINE, 183 Euston Road,

London NW 2BP5.30 pm Dr Valerie Fildes: The Wet Nursmg of London’s Children, 1538-1800.

ROYAL FREE HOSPITAL SCHOOL OF MEDICINE, Pond Street, London NW35 pm Dr Caroline Riely (USA): Liver Disease m Pregnancy.

ROYAL MASONIC HOSPITAL, Ravenscourt Park, London W6 OTN7 pm Dr R. A. Parkins: Clinical Aspects of Inflammatory Bowel Disease.

CLINICAL RESEARCH CENTRE, Watford Road, Harrow, Middlesex HA1 3UJ4.40 pm Prof R. E. Steiner: NMR and its Clinical Application.

MANCHESTER MEDICAL SOCIETY5 pm Dr E. Gowland: Problems in Diagnosing Disorders of the Thyroid.

Thursday, 19thQUEEN CHARLOTTE’S MATERNITY HOSPITAL, Goldhawk Road, London W6

OXG12.15 pm Dr L. Dubowitz: Neurological Assessment in the Newborn.

MANCHESTER MEDICAL SOCIETY8.30 pm Prof A. R. Hunter: How it all Began-in this Area.