970

mifepristone/prostaglandin combination. This death represents amortality of 1 ’3 per 100 000 abortions, which is very similar to thatfor vacuum aspiration conducted in early pregnancy. However, theconfidence intervals on a single event in a large series are wide: inthis case, from a low of 0.025 to a high of 5-8 deaths per 100 000procedures. The French Ministry of Health is considering advisingdoctors that smoking more than 20 cigarettes a day for 2 years ormore "needs to become an absolute contraindication" to medicallyinduced abortion. There have been four deaths with sulprostone incases not associated with abortion and Roussel is recommending theuse of alternative prostaglandins with mifepristone.

No smooth cut in junior doctors’ hours

Official acceptance last December by the UK Ministerial Groupon Junior Doctors’ Hours that the working week for doctors-in-training is too long was a turning point in the junior doctors’protracted fight for reasonable working hours (see Lancet 1990; 336:543-45). But the Group only set out broad principles for reform.The details were to be worked out by the junior doctors’

representatives and their employers, the Department of Health. Adraft agreement has now been drawn up. However, the consultantsare not entirely happy about some of the proposals. For instance,they fear that the timetable-a maximum average working week of83 hours by August and of 72 hours by the end of 1994 for allspecialties-is impractical. They are likewise uneasy about therigidity of the wording which, they worry, could leave gaps inmedical cover should any of the plans prove unworkable.The juniors’ negotiators were due to meet the consultants’

representatives on Wednesday, April 17, after we went to press. Wehope that an implementation package acceptable to all partiesconcemed-health service as well as training bodies (the RoyalColleges)— can be signed on May 13 as planned.

Condom sales in Ireland

On April 16 the Irish Government announced proposals forchanges in the law on condom sales in the republic. The legal age forbuying condoms will be reduced from 18 to 17, and the range ofapproved outlets for the sale of these contraceptives will be widened;bars and discotheques may be included as registered outlets. Thelegal age for marriage is 16; couples who marry before age 17 willthus have to rely on other methods of contraception or get someoneelse to buy condoms for them. Although the Irish Family PlanningAssociation welcomes the decision to widen the availability ofcondoms, it disagrees with the Government’s belief that condomsfrom vending machines (which are not included in the proposedoutlets) are of inadequate quality.

The HGG societyThe hypogammaglobulinaemia society-a UK patient-support

organisation-will launch a new education campaign next week thataims to improve the awareness of the general public about primaryimmunodeficiency diseases. The society hopes to encouragefinancial donations that will enable research into these conditions tobe effectively funded. The charity also consults with a panel ofimmunologists chaired by Dr Helen Chapel of the John RadcliffeHospital, Oxford; their function is to keep the society and itsmembers abreast of recent research findings, to ensure the factualaccuracy of all publicity material, and to offer advice to affectedindividuals and their families. Further information can be obtainedfrom The Secretary, The HGG Society, 74 Beverley Road,Whyteleafe, Surrey CR3 ODX, UK.

In England NowWhen I was young I was keen to make progress in my career as

rapidly as possible. I got into the habit of applying for posts whichwere the next rung up the career ladder before I was really ready todo so. Before each interview I would rehearse my answer to the

expected question, "But doctor, do you think you have thenecessary experience for this very senior district/area/regionalpost?", which was an apparently spontaneous rendition of "No, butdon’t you agree that the obverse of experience is habit!"

In fact this question was never posed. Instead the members of theselection panel, surmising, rightly, that I had not done anything ofnote in the brief period since qualifying, would ask what I intendedto do in my evidently glittering future career. They would listenwith rapt attention to the good ideas I had culled from the voguepublications and from the current gurus. Invariably they wouldoffer me the post over the heads of other candidates of patentlygreater experience and talent. They were heady days being a youngTurk on the make.Now that I am much older some things are different. My

yearning for change remains-a dangerous weakness in the medicalprofession; but selection panels behave differently. Instead of

bedazzling them with what I am going to do I now bemuse themwith what I have actually done. Invariably, however, they are notinterested. Whereas yesteryear they would smile and nod

encouragement now they look bored and unbelieving.Is it that they dislike inveterate movers; that they distrust

done-it-alls; or is it that they are demonstrating a deep instinctwithin the species to indulge the innocent confidence of youth andto repel the uncertainty of experience; to prefer the gambolling lambto the wary old ram? The answer is plain; but is it right?

TRUST A DREAM(With apologies to William Wordsworth)We wandered loosely in a crowdThat moves ahead with plans and schemes,Though over all there hung a cloudThat lingered o’er our splendid dreams,At hospital where plans aboundTo benefit the place around.

Continuous as the folk who waitAnd grumble as they seek our care,The plans stretch onward to the timeWhen all facilities are there ...Ten thousand saw we in a flashAll "patients followed by their cash".

The prospect may be tough, but allConfront the pits and snares in glee.A doctor could not but be gladIn such a trusting company.We gazed and gazed-and gaily thoughtWhat cash to hospital they’d brought.

But oft, when nightly wings unfold,The cloud returns to cool my mind,I see those patients-chronic, old-Who do not "carry cash behind".And then such cares my heart displease-I trust we’ll also care for these.

International Diary

A meeting of the International Collaborative Group on HereditaryNon-Polyposis Colorectal Cancer will be held in Turin, Italy, mSeptember: Foundation for the Detection of Hereditary Tumours, cloUniversity Hospital, Rijnsburgerweg 10, building no 50, 2333 AA Leiden,Netherlands (tel 31-71261955, fax 31-712122137).

18th course entitled Temporal Bone Dissection will be held in

Barcelona on Nov 11-13: Clinica Claros, Los Vergos 31, 08017 Barcelona,Spain (3 280 66 44).

5th international symposium of Anaesthesia and Intensive Care is to beheld at the Dead Sea, Israel on Nov 13-15: Dr G. Gurman, Division ofAnaesthesiology, Soroka Medical Centre, Beer-Sheva 84101, Israel.