I miss her cold feet

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<ul><li><p>1516</p><p>overdose in Canada, with no conscious suicidal intent and noalcohol involvement, the patient had to be physicallyrestrained and it took 48 hours for his symptoms to clear.3Triazolam has powerful amnestic effects and thedefendants failure to recall much of what happened seemsunsurprising.We learned of this case as a result of the publicity</p><p>surrounding the withdrawal of triazolam in the UK on Oct2, and we have reported it to the CSM. Was the CSMpreviously aware of this case and, if so, what did it concludeabout the role of triazolam? There seem to us to be groundsfor the Home Secretary to ask for this mans conviction to bereviewed.</p><p>Social Audit Ltd,Box 111,London NW1 8XG, UK</p><p>CHARLES MEDAWARELAINE RASSABY</p><p>1. Brahams D. Drug-company data and the public interest. Lancet 1991;338: 502.</p><p>2. Greenblatt DJ, Divoll M, Abernethy DR, Locniskar A, Shader RI.Pharmacokinetics of benzodiazepine hypnotics. IntPharmacopsychiatry 1982; 17 (suppl 2): 70-75.</p><p>3. Trappler B, Bezeredi T. Triazolam intoxication. Can Med Assoc J 1982;126: 893-94.</p><p>Noticeboard</p><p>Consumer concerns about pharmaceuticalsMedicines are probably the most important products that the</p><p>public consumes, yet they form a sector over which the consumerhas little influence, says the government-funded NationalConsumer Council. Instead, people are expected to trustunquestioningly the medicines they are prescribed, adds the NCC.To redress this imbalance the Council has issued a consultation</p><p>document, on which it seeks the views of manufacturers,government and health service policymakers, health professionals,and other consumer organisations.The NCC is calling for more information for the public on drug</p><p>action and safety, which the Council suggests might be given in theform of a non-technically worded version of something like theData Sheet Compendium, as happens in Sweden and the USA; andfor tougher penalties for breaches of advertising codes because itsees promotional data as one of the most important sources ofinformation on new drugs for the doctor. The dominant concernthough, says the NCC, is the lack of transparency surrounding drugregulatory procedures (see also Lancet Nov 10, 1990, p 1180, andNov 2, 1991, p 1113), which the Council believes need to bechanged radically. The Council points to the procedure in the USA,where the Food and Drug Administration has to publish a summaryof its basis for approval of a drug, which would indicate whatpreclinical and clinical studies had been done, for example. TheEuropean Commission has also stated its intention to increase theopenness of the drug regulatory process. Yet in the UK theinformation passing between the pharmaceutical industry and theregulators remains confidential. Such acquiescence with theindustrys desire to keep what it claims is commercial informationconfidential, and the terms on which drug prices are negotiated,contribute to the NCCs view that the Department of Health isunable to represent consumers as well as it could. Furthermore,there is concern about conflict of interest because of the ways so</p><p>many of the experts appointed to the regulatory authorities arebeholden to the industry. Consumer representation on regulatorybodies is thus vital, says the Council.The broad range of issues brought up in the document also</p><p>includes redress for patients in the case of medical accidents, drugpricing structures, parallel imports (which the Council supports as ameans of strengthening competition within the UK market),generic preparations (overemphasis on which, the NCC cautions,can have unforeseen consequences on research and development, ashas happened in Canada), and how the licensing of applications fordrugs classed as representing an important therapeutic gain might</p><p>be speeded up. Responses to the long list of questions framed at theend of the document will form the basis of the Councilsrecommendations to be published next year.</p><p>1. National Consumer Council. Pharmaceuticals a consumer prescription. Availablefrom NCC, 20 Grosvenor Gardens, London SW1W 0DH. 1991. Pp 149 4.</p><p>Screening for Downs syndromeUntil recently maternal age was the principal determinant of</p><p>whether or not a woman was offered antenatal diagnosis for Downssyndrome. This practice has had little impact on the prevalence ofDowns syndrome births, since most affected pregnancies are inyoung women. Now, however, various maternal blood markers areavailable for screening women of all ages. These markers, which canbe used singly or together, include alpha-fetoprotein, humanchorionic gonadotropin (the free alpha and beta subunits, as well asthe intact molecule), unconjugated oestriol, pregnancy-specificbeta1-glycoprotein, and neutrophil alkaline phosphatase. OnOct 22, at a one-day meeting in Brussels, a European DownsSyndrome Screening Research Group was formed to monitor theintroduction of new screening techniques and carry outcollaborative research.</p><p>In several European countries marker screening has so far beenused only in research projects, whereas in other countries testing isalready in routine clinical use in some centres. On the whole thedecision as to whether the service should be introduced in a givencentre is not based on questions of proven efficacy; nor, in mostcountries, is the ethics of abortion a major issue. Rather, it dependson who is going to pay for the test-governments, insuranceagencies, or private individuals.Most centres have experience of only a few Downs syndrome</p><p>births each year, but a Europe-wide network of research workerswould quickly be able to accumulate enough data to address specificissues, such as the feasibility of first-trimester screening, the testingof newer markers (preliminary data on some were presented at themeeting), the role of ultrasound, the psychosocial consequences ofscreening, assay improvement, and the incidental diagnosis of othertypes of aneuploidy.</p><p>For further information please contact Prof H. Cuckle, Institute ofEpidemiology and Health Services Research, Academic Obstetrics andGynaecology Unit, St Jamess University Hospital, Leeds LS9 7TF, UK.</p><p>Sponsorship in the NHS</p><p>Accepting sponsorship from commercial companies is a growingtrend within the NHS. In the case of stoma care, the trend has been</p><p>worrying enough for the launch of the Campaign of ImpartialStomacare (CI S)--93 (32%) of the 380 stoma care nursing posts areprivately funded by companies making stoma appliances. TheRoyal College of Nursing already has guidelines on commercial stillsponsorship, which CIS advises nurses to follow. The CIS will actas a lifeline to stoma care nurses who feel under pressure to putforward their sponsors products. It also seeks to ensure thathospital managers are fully aware of all the implications ofsponsorship before they embark on such deals.</p><p>CIS is based at 5-11 Iheobalds Road, London WC1X 8SH, UK (tel:071-4133124).</p><p>I miss her cold feet</p><p>"A raw, untidy, destructive force" is how psychiatrist Dr PamelaAshurst described grief at a Royal College of Psychiatrists pressconference to launch its leaflet on bereavement, the fourth in itsHelp is at Hand series. To know that this strange andoverwhelming force is likely to be at work for up to two years afterthe death of someone close is no comfort to the newly bereaved, butlearning that the grieving process will follow a well-known andpredictable pattern may help. The sequence of disbelief, numbness,agitation, anger, and guilt soon gives way to sadness and depression,but in the normal course of events these eventually clear, sleepimproves, and energy returns to normal. The leaflet offers advice onwhere to turn for help (bereavement counselling or psychotherapy,for instance) if the depression continues or if the bereaved personbecomes stuck at some stage of the grieving process. The leaflet also</p></li><li><p>1517</p><p>suggests how friends and relatives can help a person who hasrecently suffered the loss of someone close-perhaps simply byoffering warmth and kindness or by taking on a few householdchores. The grief of children and the importance of allowing them tomoum, the leaflet points out, must not be overlooked: many youngpeople will not speak of their grief for fear of adding to the burden ofthe adults around them.The leaflet, intended primarily for laymen, would be useful</p><p>reading for junior doctors, who need to be able to deal sensitivelywith bereaved families but may not themselves have experiencedthe loss of a close relative.</p><p>Help is at Hand leaflets on bereavement, depression, anxiety and phobias,and anorexia and bulimia are available from the Royal College ofPsychiatrists, 17 Belgrave Square, London SW1X 8PG, UK. A stampedaddressed envelope should be sent with requestss.</p><p>Decision against UK accreditationOn Dec 10,1991, the High Court quashed a decision by the Joint</p><p>Committee on Higher Medical Training (JCHMT) to refuse DrAnthony J. Goldstein, a European Community certified specialistin rheumatology, accreditation in his chosen specialty in the UK.The JCHMT includes representatives from the medical RoyalColleges, the Association of Clinical Professors, and the Conferenceof Postgraduate Deans; it was established in 1970 withresponsibilities for setting guidelines on training in medicalspecialties and for awarding certificates of accreditation to thosewho have completed approved higher medical training. TheJCHMTs functions are described in a handbook that is publishedperiodically. Dr Goldstein argued that he had completed histraining while employed in approved posts in accordance with the1984 JCHMT handbook. The decision by the committee to refusehim accreditation was, he claimed, unlawful. The court decided thatthe JCHMT must reconsider the issue of Dr Goldsteinsaccreditation. Mr Justice Rose found that the committee appliedcriteria not included in the 1984 handbook (but which were in the1988/89 handbook) and, in so doing, denied the applicant thelegitimate expectations that he was entitled to at the start of histraining. That Dr Goldstein should be awarded Europeancertification (a decision made by the General Medical Council onadvice from the JCHMT) but not UK accreditation, despitecompleting posts approved for both procedures, was perverse.Furthermore, according to broad principles of natural justice, DrGoldstein should be allowed to answer any professional criticismsmade against him that might adversely influence the JCHMTsfinal decision.</p><p>Swiss francs for epidemiologyAbout a year ago the Helmut Horten Foundation announced a</p><p>new international prize for "medicine or biology of benefit tohuman health". A prize committee including Sir Colin Dollery ofthe UK, Nobel laureate Francois Jacob of France, and Prof LloydSmith of the USA considered 157 nominations from biomedicalscientists throughout the world, and the prize of one million Swissfrancs was awarded on Nov 29, in Lugano, to Sir Richard Doll andRichard Peto of Oxford University. The successful nominationoriginated in America.</p><p>Serving as "laudatio", Dollery recalled Dolls early work with SirAustin Bradford Hill, who had established the statistical basis ofrandomised controlled clinical trials. Of Dolls many contributions,in spheres ranging from the safety of the contraceptive pill anddeaths from asthma to the hazards of ionizing radiation, none hadsurpassed his exposure of the health hazards of tobacco. Replying,Doll remarked that "It was the direct human relevance of</p><p>epidemiology that attracted both Richard Peto and me to it as ascientific discipline and we have tried to use it in our research and inour writings to assess major hazards and to help society develop asense of proportion about the major and minor risks of daily life".Turning to Peto, Dollery declared that, "If Bradford Hill is thegrandfather and Richard Doll is the father, then Richard Peto is theson in this distinguished lineage of statisticians andepidemiologists". Peto had revolutionised the study of the chronic</p><p>diseases of the developed world in two ways-by organising massivemulticentre clinical trials, and by developing and implementing thescience of meta-analysis which pools evidence from many relatedtrials.With his global view of disease and death, Peto then urged that we</p><p>take seriously all the major avoidable causes of premature death.Although the control of infective disease remains the mostimportant priority, the more successful it is the more people willsurvive to middle age, and the more important will become thecontrol of the large avoidable causes of premature death fromchronic disease. He illustrated the power of his work with data onheart attacks, breast cancer, and hypertension and indicated thefuture toll of tobacco smoking world wide if existing patternscontinue. The President of Switzerland declared that he hoped hecould convince his Minister of Health of the importance of theabove issues; the Minister of Health expressed himself pleased thatthe President had been exposed to these crucial matters.</p><p>Wellcome Trust</p><p>The Wellcome Trust is keen to promote work in the history of20th-century medicine, particularly medical science. As part of thisinitiative the Wellcome Institute for the History of Medicine ishoping to find relatively experienced clinicians and biomedicalscientists interested in taking short sabbatical leave from theirregular work to engage in historical research. The projects willprobably take 3 or 4 months full time, or possibly longer if done on apart-time basis. This should be sufficient for a researcher toproduce a detailed study of a limited area in the history of clinicalmedicine or the biomedical sciences. For example, a pharmacologistmight be interested in the history of specific blocking agents; acardiologist in changing ideas on the mechanisms of heart failure; oran anaesthetist in the growth of blood gas analysis. The institutehopes to recruit about six people each year and to publish theirstudies in an annual volume. Projects will be based at the WellcomeInstitute, and researchers will be introduced to historical skills bythe institutes academic staff, with whom they will continually liaise.The Wellcome Trust will be asked to fund locums or provideresearch fellowships for clinicians and scientists who would like toundertake this sort of research. Readers who are interested in suchwork should write to Dr Christopher Lawrence or Dr Tilli Tansey,Wellcome Institute for the History of Medicine, 183 Euston Road,London NW1 2NB.</p><p>Campaign to reduce cot deaths</p><p>The UK Department of Health has launched a nationalcampaign in the press and on television to reinforce advice aimed atreducing the number of cot deaths. A steady increase in suddenunexplained infant deaths has continued for the past forty years.Current recommendations are that babies should be kept warm butnot overheated and that adequate ventilation should be ensured.Furthermore, a prone sleeping position might be a contributoryfactor in some cases.</p><p>International Diary</p><p>1992</p><p>A conference entitled Nutrition and Ageing-Improving the Qualityof Life is to take place in London on Friday, March...</p></li></ul>