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the Hospital Association of Pennsylvania, the PennsylvaniaRadiology Society, the Pennsylvania Association of ClinicalPathologists, and the North Penn Hospital, alleging that hisrequests for X-ray examinations and laboratory requisitionsfor his patients were not honoured and that prior X-ray andlaboratory reports were not made available to him. In the pastthe A.M.A. has campaigned vigorously against Medicare,Medicaid, and National Health Insurance, maintaining thattheir introduction would lower the quality of medical careavailable to the American public. On this occasion, when,many would think, the A.M.A. had an opportunity to maintainhealth standards, they chose to seek a settlement. TheA.M.A.’s Principle of Medical Ethics of 1966 contains the fol-lowing : "The physician should practise a method of healing

founded on a scientific basis; and he should not voluntarily as-sociate professionally with anyone who violates this principle",and later "it is the position of the medical profession thatchiropractic is an unscientific cult." But in 1977 the JudicialCouncil’s interpretation of the Principles was revised; and thenew version is often ambiguous and obscure. The A.M.A.,J.C.A.H., and A.H.A. now seem willing to take as bedfellowsthe chiropractors, many of whom regularly advertise in localnewspapers that they can cure almost everything by manipu-lation. The American College of Physicians, the American Col-lege of Surgeons, and the American College of Radiology havetaken up the banner and opposed the chiropractors. In the pastthe colleges have eschewed politics, but they now feel com-pelled to take a stand.

In England Now

A SOCRATIC DIALOGUE ON RESOURCE ALLOCATION

Socrates: Is it true that the healing of certain ailments canbe achieved only by complex machines and by persons ofspecial training and experience who use them?Eryximachus: It is true. For example, when powerful rays haveto be generated by machines to treat some forms of malignantdisease.S. And these machines are expensive?E. Very.S. I have heard that in some parts of the country less moneyis spent on the health of each citizen than in other parts. Andit has been decided by those whose task it is to make such de-cisions that this is improper, and steps are being taken to cor-rect this imbalance. By giving more money to those who haveless?E. Yes.S. That is by increasing the total?E. No.S. No! How then?E. By reducing the share of those with more and transferringthe savings to those with less.S. I see. But if certain diseases require for their treatment verycomplex and expensive machines, surely it is not economicallypossible to have such machines in every part of the land?E. That is so.S. Then if these machines are as expensive and as complex asyou imply, there can be only a few, strategically placed. Wouldyou say that "strategically placed" means where road and railand air terminals are situated? In other words, where there arelarge cities?E. Yes.S. It would not be sensible to have such machines in peripheralplaces where transport would make their efficient use difficultor impossible. And what applies to these machines will, I sup-pose, also apply to all the complex and expensive techniqueswhich doctors and other scientists have devised. Tell me, inorder that these techniques can in time be advanced and im-proved, will people need to be trained in the places where thesetechniques are applied?E. By all means.S. And such education is expensive?E. Yes.S. Then it strikes me as inevitable that more money will needto be spent in the centres than in the periphery.E. So it would seem.S. As I see it, the cost of health per citizen will be higher inthe large cities than in smaller cities. But if it has been decidedthat money is to be taken from the centres and given to theperiphery there will not be enough money for these expensivemachines and complex techniques and specially trained staff inthe centres.E. That is so.

S. But, as we have decided, there will not be enough money toestablish such machines and techniques everywhere. So itlooks as if it has been decided that if every place cannot havesuch machines no place should have them.E. Well-I suppose so. We have just heard that in one areamoney has been spent far above the limits decreed by higherauthority. Perhaps all areas might do that.S. That would lead to chaos. If order prevails, what will

happen to those patients who have the diseases which onlythese machines and techniques can help?E. I would rather not answer that question, Socrates. Youmust put it to those who make the decisions.

GOING through an old diary the other day, I came on areference to "Wicked Willie", who was our family doctor whenthe children were small. There was nothing wicked about him.He was a delightful character; it was his mischievous twinklingeyes that had earned him his nickname. He was full of in-

genuity. One of his ploys was a great success with us. For somereason our children all had to have an injection. Willie beganby assembling the dolls and Teddy bears. "Watch," he said,"and you will see that it does not really hurt at all. That’s agood, brave boy" (patting a Teddy on the head as he withdrewthe needle from its arm). He then ’turned to our eldest. "Teddydid not cry, so I am sure you won’t, either." In fact none ofthe children dared to do so. I have not met anyone else whoused this gambit. Maybe it ought to be better known.

I’ve always had a soft spot for phrenology and phrenol-ogists. Consider how the great nineteenth-century phrenologist,George Combe, selected his wife. According to the Dictionaryof National Biography, "he examined her head and tookSpurzheim’s advice as to his own fitness for a married life. Her’anterior lobe was large; her Benevolence, Conscientiousness,Firmness, Self-esteem, and Love of Approbation amply devel-oped ; whilst her Veneration and Wonder were equally moderatewith his own’; and the marriage was thoroughly happy." Orwhat about John Epps? In his Diary he records how he wishedto join the Edinburgh Phrenological Society: "I felt a strongdesire to become a member of the Society, and made the neces-sary application. A subcommittee was appointed to examinemy head, it being a custom to admit no-one as a member ofthe society unless his organisation, after being examined,detailed, and reported by the subcommittee, was approved bythe society at large. The examination of my head was so farsatisfactory that I was elected a member. The subcommittee

kindly detailed to me the results of their examination, men-tioning the points in which my mental organisation requiredalteration." If anyone wants my views on ParliamentaryReform, then I’m going to suggest...