Embed Size (px)
the patient’s interests to do so and if the patient cannot be judgedcapable of giving or withholding consent to disclosure. Advice ondisclosure in connection with judicial proceedings has been
expanded; in response to orders from a judge, presiding officer tothe court, coroner, Procurator Fiscal, or similar officer, doctorsshould first establish the precise extent of the information that needsto be disclosed and should not hesitate to make known his or her
objections to the proposed disclosure, especially when theinformation required is of a confidential nature. Should informationbe needed in connection with the Council’s proposed performancereview procedures the advice is that information may be disclosed atthe direction of the chairman of a committee of the Council that is
investigating a doctor’s fitness to practise if disclosure should be inthe public interest and every reasonable effort has been made toobtain the patient’s consent. The paragraph on disclosure in thepublic interest remains restricted to the principle of disclosure, eventhough there had been debate on whether there should be specificmention of patients unfit to drive.The new guidance will appear in the next revision of Professional
Conduct and Discipline: Fitness to Practise. Meanwhile, copies areavailable from the General Medical Council, 44 Hallam Street,London WIN 6AE.
DNA fingerprintsA new computer technique virtually removes the element of
doubt from DNA fingerprinting, the reliability of which waschallenged in a recent report from the USA.1 The method currentlyused depends on visual comparison of the lengths of DNAsequences and is subject to observer error. The techniquedeveloped by Jeffreys et a1,2 based on the assay of sequencevariation, rather than length differences, in minisatellite alleles, isobjective and gives a far more detailed analysis of allelic variation.Farr and Goodfellow3 estimate that the new method of DNA typingwill be several orders of magnitude more sensitive than the old.
Jeffreys’ polymerase chain reaction (PCR) based approach, calledminisatellite variant repeat (MRV) mapping, interprets variabilitywithin pairs of alleles as a simple ternary code, and the technique canbe used on any minisatellite locus provided that variant repeats arenot of abnormal length (which would throw the MVR ladders of thepaired alleles out of register). Jeffreys et al have already identified anumber of minisatellites that are suitable for MVR-PCR. The
technique can be applied to mixed DNA samples-for example,from semen-bearing vaginal swabs in rape victims. It is particularlysuitable for forensic work because it can be used on degraded DNA.
1 Shapiro MM. Imprints on DNA fingerprints. Nature 1991; 353: 121-22.2. Jeffreys AJ, MacLeod A, Tamaki K, Neil DL, Monckton DG. Minisatellite repeat
coding as a digital approach to DNA typing. Nature 1991; 354: 204-09.3. Farr CJ, Goodfellow PN. New variations on the theme. Nature 1991; 354: 184.
Register of radiation research
To fulfil its responsibility to keep radiobiology under generalreview the Medical Research Council’s Committee on the Effects of
Ionising Radiation (CEIR) has published a register of research onthe biological effects of radiation being carried out in the UK. Theregister, which is to be published annually, will cover four mainareas-molecular and cellular radiobiology, radioprotection,clinical applications, and epidemiology. The register is intended toinclude clear, concise accounts of all relevant research, but the firstissue, compiled from invited contributions (from individuals andinstitutions) is inevitably incomplete, and the publisher would liketo hear from investigators who wish to have their studies included infuture editions or who wish to update their existing submissions.The Register of UK Research on the Biological Effects of IonisingRadiation will collect together abstracts (of not more than 250words) on current research only and will not include studies thathave already been completed and published. Abstract forms andcopies of the register can be obtained from the CEIR Secretariat,MRC Radiobiology Unit, Chilton, Didcot OXll ORD, UK(telephone 0235 834393, fax 0235 834918).
Urban living and asthma
Childhood asthma should be added to the list of so-called"diseases of civilisation", according to the authors of a study in 2000primary school children in Zimbabwe.! Keeley and colleaguesfound a 50-fold difference in prevalence of reversible airwaysobstruction (defined as peak expiratory flow below the 2-5th centilefor height before exercise, a rise of more than 15 % after salbutamolinhalation, and a fall of 15% or more after exercise, with asubsequent rise after salbutamol) between children in a rural area(0-1%) and children in a rich urban area (5-8%). In children from apoor urban area the prevalence was 3-1 %. In northern Harare, theonly study area where there were white children, the prevalence wasvery similar between white (5-3%) and black children (5-9%). Theauthors attribute the differences to the far greater exposure of urbanchildren to atmospheric pollution, such as car emissions, and tochemical additives in manufactured foods and drinks.
All the studies were carried out in a 3-week period at the end ofthe rainy season, when the prevalence of asthma was relatively high.Indicators of nutritional status were not significantly differentbetween black and white children in the rich urban area of northernHarare but were lower in the (black) children of urban southernHarare and lower still in rural Wedza. Urban living and highermaterial standards of living, say Keeley et al, appear to be associatedwith a higher prevalence of childhood asthma.
1. Keeley DJ, Neill P, Gallivan S. Companson of the prevalence of reversible airwaysobstruction in rural and urban Zimbabwean children. Thorax 1991; 46: 549-53.
Chief Scientist at Scottish health departmentProf Ian Bouchier, professor of medicine at the University of
Edinburgh, will succeed Prof Roy Weir, who is retiring, as ChiefScientist in the Scottish Office Home and Health Department asfrom April 1, 1992.
In England Now
Last month I was external examiner for a non-universitylicensing qualification. A psychiatric long case was included, andthe registrar’s case sheet described the patient as "wearingold-fashioned clothes". Edwardian dress? Elizabethan? Woad? Itracked the patient down and found him wearing a tweed jacket withelbow patches, check shirt, club tie, and corduroy trousers. Exactlywhat colleagues describe as my country pursuits weekend wear. Oldfashioned? I searched for the registrar partly for remonstrance andpartly out of curiosity to see what he was wearing. He was notavailable, having gone off duty, presumably having clocked up his72 hours-or perhaps psychiatrists have some dispensation thatallows them to finish their working week on Tuesday afternoonbecause of their demanding patients. I cooled down by recalling thatone should not be judgmental about people-or that is what
psychiatrists tell us.
* * *
My wife and I settled quickly into our Dublin hotel. I was there togive a paper at a conference; she to browse through the shops,galleries, and antique dealers’ stores. The meeting was short and wehad booked for a few extra days. Dublin is one of my favourite cities,bringing back memories of my student days, when for a short timewe left post-war austerity Britain to enjoy the luxuries of a fullystocked, charmingly populated, exuberant metropolis and to learnsome midwifery besides.On our first evening, at dinner, being something of a man of the
world, I gave the waiter a sensible number of punts withinstructions to look after our welfare during our stay. He wasdelighted and assured us that our comfort would be his mainconcern while we were there. The trouble was, we never saw him
again. On inquiry, I found that he was a locum (as it were) and hadbeen engaged for that evening only.