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Notes and News

INTERNATIONAL COUNCIL FOR CONTROL OFIODINE DEFICIENCY DISORDERS

IT is perhaps humiliating that such an august body as ICIDD isrequired to combat a group of disorders that should never exist. Theeffects of severe iodine deficiency are now known to extend farbeyond endemic goitre and cretinism to encompass permanentneuromotor impairment and increased neonatal mortality, amongother conditions. And huge numbers of people-over 400 million inAsia alone-are at risk. Yet despite overwhelming evidence of theconsequences of iodine deficiency and the availability of effectiveand relatively cheap preventive measures, governmental actionsworldwide have been far from impressive. In response to this urgentneed ICIDD has been created with funds provided by UNICEF andthe Australian government and will be formally established at aninaugural meeting in Kathmandu in March, 1986. It aims tocoordinate research and iodisation programmes with a view to

eradicating IDD. The plan is to generate IDD profiles for variouscountries at greatest risk, assess the epidemiology and level ofgovernmental input, and judge the potential for iodised salt (asopposed to iodised oil or other means) as prophylaxis. Armed withthis information ICIDD will formulate proposals with which it willattempt to influence officials and thereby lead to action. Centraldissemination of information is essential to progress in IDD controland in response to this ICIDD will publish a quarterly newslettercontaining abstracts of IDD work, progress reports, and news aboutforthcoming meetings, and so on. ICIDD also plans to establish alibrary and maintain a roster of consultants who may be available forspecific tasks such as programme design or monitoring. Thenewsletter, which is free of charge, will be sent to people andorganisations interested in the subject, and others who wish toreceive it are welcomed.

The newsletter is edited by the ICIDD Secretary, Dr J. T. Dunn, Box 511,University of Virginia Medical Center, Charlottesville, VA 22908, USA.Executive Director of ICIDD is Dr B. S. Hetzel, Division of HumanNutrition, CSIRO, Kintore Avenue, Adelaide, South Australia 5000.

FULL CITIZENSHIP FOR THE DISABLED

"THE disabled cannot be expected to be exempted from thesacrifices necessary for economic recovery" (Reg Prentice, Ministerfor the Disabled, 1979). In fact, under the ConservativeGovernment, suggests a bookl by three Labour MPs, MichaelMeacher, Margaret Beckett, and Alf Morris, disabled people havehad to make far more "sacrifices" than anyone else. As of Rightchronicles the events of the past few years. Mr Morris’s ChronicallySick and Disabled Persons Act 1970 transformed the loss of powersof local authorities into extensive and legally binding duties toprovide specific services for disabled people. Annual spending onbenefits and services for chronically sick and disabled people rose inthe first decade from 330 million to 3030 million. Under thepresent Government, however, flexibility in applying the Act isbeing sought and already some local authorities have to choosewhich duties (discretionary and legal) to fulfil. Rate-capping andcuts in rate support grant have made it impossible to stay within thelaw. One example (giving no information on need) is put forward tomake the point that levels of service for disabled people vary widelyacross Britain: there are 14 home-helps per 1000 population inLabour-controlled Camden and only 5 - 5 home-helps per 1000 inTory-controlled Wiltshire. Unemployment has hit disabled peopleparticularly severely. In some areas unemployment among disabledpeople is more than twice the rate among the able-bodied. Inaddition, disabled people are more than twice as likely as others to beamong the long-term unemployed. Few employers take seriouslytheir obligations under the 3% quota scheme and compliance hasbeen falling rapidly all over the country. Social security benefits

1. As of Right. Labour’s Call for Full Citzenship for All Disabled People. By MichaelMeacher, Margaret Beckett, and Alf Morris. Available (95p) from MichaelMeacher, MP, House of Commons, London SW1A 0AA

have been eroded by a series of measures, which have imposed lowerstandards of living on already deprived disabled people. Housingprogrammes have been hit by the cuts in house building andadaptation, by the shortages of improvement grants, and the ever-growing housing waiting lists.The Labour Party promises a comprehensive disability income

scheme whereby all disabled people would get the same levels ofbenefits whatever the cause or nature of their disability, like thosepayments available under industrial injuries and war pensionersschemes. The disability income scheme, which is still under

discussion, includes an invalidity pension paid at a rate similar tothat of retirement pension paid to all who are unable to work,regardless of their National Insurance contribution records ormarital status.

WHEN A DOCTOR IS SICK

A TELEPHONE number (01-580 3160) published in the medicalpress bears witness to a depressingly common situation-when adoctor’s competence to practise is in question because of physical ormental illness or alcohol or drug abuse. The telephone number isthe only outward sign of a new organisation created by the BritishMedical Association, the Royal Colleges and Faculties, the JointConsultants’ Committee, and other professional bodies. The

formality of the General Medical Council’s procedures may havedeterred many doctors from turning to the GMC when there arefears about a colleague’s fitness to practise. Any doctor worriedabout another doctor’s health may now telephone the number givenabove (office hours only). The questions asked will be no more thanthe specialty of the sick doctor and the area in which he or she works.The name of a national adviser in the specialty will be given to thecaller who, only when speaking to the national adviser, need disclosethe sick doctor’s name. The adviser will then make contact with thedoctor named or appoint someone else in the specialty to handle thesensitive occasion. No permanent records of any of theseconsultations will be kept. The National Counselling and WelfareService for Sick Doctors has been funded by the Department ofHealth and Social Security and is expected to cost about 4000 ayear. The 70 national advisers are voluntary and have beennominated by the Royal Colleges and Faculties and the BMA. ProfKenneth Rawnsley, a former President of the Royal College ofPsychiatrists, is chairman of the Service’s management committee.

UNFIT TO DRIVE

AT a press conference to mark publication of the 4th edition of thehandbook for doctors, Medical Aspects of Fitness to Drive, it it

emerged that up to 500 000 of the 25 million people in Britainowning valid driving licenses might be driving with a medicalcondition that put themselves and other motorists at risk. The sortof medical condition that might render a driver suddenlyincompetent includes epilepsy, stroke, hypoglycaemia, and the side-effects of certain drugs. The guide is written to help doctors helppatients to keep within the law, and a copy has been sent to allgeneral practitioners by the Department of Transport. GPs areresponsible for advising patients about their fitness to drive. Anypatient warned not to drive is then required by law to notify theDriver and Vehicle Licensing Centre, Swansea, that they have adisability likely to affect fitness to drive. This disability is thenassessed by the Centre. It is suggested that up to 500 000 people aredriving around with a heart condition, epilepsy, or nervous disorderthat could cause loss of consciousness at the wheel. It is believed thatas many as 70% of Britain’s epileptics have not notified the DVLC.Anyone who had an accident as a result of an undisclosed medicalcondition, would be likely to lose all cover by the insurancecompany. However, research carried out by the Transport andRoad Research Laboratory indicates that only 1 - 7% of road trafficaccidents might be caused by illness, 4% by drugs, and 7% byfatigue. One third of all fatal accidents are associated with alcohol.Some conditions, such as blindness, may simply preclude driving,but most medical conditions (multiple sclerosis, for instance) will

1 Medical Aspects of Fitness to Drive. A Guide for Medical Practitioners Available (£3)from the Medical Commission on Accident Prevention, 35-43 Lincoln’s Inn Fields,London WC2A 3PN (01-242 3176).

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fall into a grey area when the DVLC may appear somewhat arbitraryin its assessment of fitness to drive. Most drivers fear notificationsince they believe it automatically means being debarred fromdriving. In many cases the Centre simply makes stipulations, suchas permitting an automatic car only to be driven. Dr Andrew Raffle,formerly chief medical officer at London Transport and editor ofthe handbook, advised old people who drive to take advantage oftechnological advances in car design, particularly power steeringand automatic transmission, to maintain the quality of their driving.

MARRIAGE GUIDANCE

IN more than 100 centres in the UK marriage guidancecounsellors work alongside doctors in general practice. In its latestreportl the Marriage Guidance Council examines the results of asurvey of "outpost" counselling that consisted of informalinterviews with GPs and counsellors, observation duringcounselling sessions in two practices over a 15-month period, andpostal questionnaires to all those in surgery counselling. Mostparticipants were satisfied with their role in general practice but feltthat time was wasted because of poor surgery organisation andinappropriate referrals; one-third of counsellors mentionedreferrals that were for non-marital problems. A wide variety oforganisational structures was reported, some of which workedbetter than others. The MGC recommends that guidelines be issuedfor the organisation of communication, feedback, confidentiality,and financial arrangements. Non-remuneration was regarded bysome as a sign that they are not regarded as professionals but othersfelt it gave them the freedom to retain the advantages of being anindependent practitioner in the medical setting. They felt they wereable to make decisions about the suitability of referrals anddetermine the extent of confidentiality. For surgery counselling toconstitute a positive contribution to primary health care, marriageguidance counsellors need to remain independent so they maypreserve their generic approach to marital problems.

ACCEPTANCE OF STERILISATION

THE introduction to a source book2 on sterilisation-now themost common method of contraception worldwide-statessomewhat unnecessarily that sterilisation has the qualities of "longcontinuation and high effectiveness". These qualities are judged bythe authors to be the "key advantage" of this method of birthcontrol. The book, produced in New York by the Association forVoluntary Sterilization, offers extensive information on surgicalprocedures, the law and regulations surrounding sterilisation, andits incidence and prevalence throughout the world. The Associa-tion’s perception of the global importance of birth control

presupposes a positive appraisal of sterilisation. The question askedby the authors is how best to extend uptake of safe and regret-freesterilisation. What is not asked is why men and women all over theworld more or less gladly accept the drastic step of sterilisation. Is itnot because they are glad to relinquish the burden of contraception?Because no safe, effective, acceptable, but reversible method ofcontraception exists, people who have had children are content toterminate their fertility for ever.

UNDERDIAGNOSIS OF ASTHMA?

GENERAL practitioners often hesitate to call a wheezy childasthmatic, because of the stigma attached to the label. A film,3 madefor doctors by a pharmaceutical firm and now available to thegeneral public, questions this attitude. Asthma, though one of thecommonest childhood illnesses (one figure is that 10-15% of

1 De Groot M Marriage guidance counsellors in the medical setting. National MarriageGuidance Council, 1985. Pp 31. Price £1.50

2 Voluntary Sterilization, an International Fact Book. By John A. Ross, Sawon Hong,and Douglas H. Huber Available free from the Association for VoluntarySterilization, 122 East 42nd Street, New York, NY 10168, USA.

3 Asthma in the Family is available as a video from Fisons Pharmaceuticals Head Office,Derby Road, Loughborough, or from the Asthma Society, St Thomas’ Hospital,London SE1 7EH.

children in the UK are asthmatic), may often be genuinelyundiagnosed and the treatment given is then inappropriate. Thefilm (made by Fisons Pharmaceuticals, makers of sodium

cromoglycate, ’Intal’) shows a group of asthmatic children on anadventure holiday demonstrating, it is said, that correct

management of the condition permits plenty of strenuous exercise(as it does, according to the Fisons advertisement, for a famouscricketer). The children themselves spoke of a sense of relief atknowing there was a reason for their previously unexplainedbreathlessness on slight provocation.

SOCIAL PROBLEMS IN GENERAL PRACTICE

GENERAL practitioners are frequently aware while assessing theirpatients’ presenting symptoms that the underlying malaise is notalways organic in origin. The patient may also be aware that thereasons for his or her visit may have more to do with a need to talk to

anyone professional and detached rather than the necessity of seeinga doctor. Estimates have been made that suggest that up to one-thirdof patients present with difficulties that are the result of inability tocope with demanding and conflicting life problems. Suchbehavioural difficulties require more than a 15-minute consultation.A two-part report’ from the British Association for Counselling oncounselling in general practice points out that while there are norecognised NHS salaries for counsellors working within generalpractice, a growing number of counsellors are becoming attached toprimary care teams. This development has arisen from a recognitionof the practical benefits for both patients and doctors of having anon-medical member of the primary care team. The report offersadvice in selecting a counsellor, and outlines the different

counselling approaches and aims.

Meeting of WHO Collaborating Centres on AIDS

The first meeting of the directors of the World Health

Organisation collaborating centres on AIDS took place in Genevaon Sept 25-26. The chairman of the meeting, Prof FriedrichDeinhardt (Munich), observed that dissemination of accurateinformation was essential, both on transmission of the virus and onprevention of the disease. Professor Deinhardt also noted that thegeneral public were comparing AIDS to the great plagues of theMiddle Ages. He emphasised that AIDS in no way resembled theseinfectious diseases since there was no evidence that it could be

spread through casual contact with an infected person. AIDS wasprimarily a sexually transmitted disease.

National Alcohol Forum

The Health Education Council, Alcohol Concern, the Wine andSpirit Association, the Brewers’ Society, and the Scotch WhiskyAssociation have joined up to form a national alcohol forum tooperate independently of Government and discuss measures toprevent the misuse of alcohol. Sir John Crofton, past president ofthe Royal College of Physicians of Edinburgh and Vice Principal ofEdinburgh University, and chairman of the 1985 report from theScottish Health Education Coordinating Committee on healtheducation in the prevention of alcohol-related problems, is to chairthe new organisation.A survey conducted by the Office of Population, Censuses and

Surveys has found wide regional variations in social drinkingpatterns, which suggest the importance of tailoring health educationcampaigns to regional customs.

Compensation Payment for Radiation-linked Diseases

British Nuclear Fuels and the Union of Construction, AlliedTrades and Technicians have announced that f31 000compensation has been paid to relatives ofa former radiation workerat BNFL’s Sellafield plant who had died of stomach cancer.

1. Counselling in General Practice: A Guide for General Practitioners; A Guide forCounsellors Available from the British Association for Counselling, 37a SheepStreet, Rugby, Warwickshire CV21 3BX (0788 78328).

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A memorial service for the late Dr James Henry Cyriax will be held at AllSouls Church, Langham Place, London Wl, on Wednesday, Oct 23, at 5pm.

Dr Mary Lyon, of the Medical Research Council Radiobiology Unit,Chilton, Didcot, Oxfordshire, is one of the recipients of the 1985 GairdnerFoundation international awards.

Christopher Robbins, formerly director of the Coronary Prevention Groupand author of a recent book Eating for Health, has been appointed assistanthead of the British Medical Association’s public affairs division.

Papers are invited for a new journal focusing on patient non-compliance.The 7ournal of Compliance in Health Care will be published twice a year:Springer Publishing Company, 536 Broadway, New York NY 10012, USA.

Graduates of the Armed Forces Medical College, Pune, India, arerequested to send their particulars (years of joining, academic qualifications,present position, and so on) as soon as possible to the Training Officer(Graduate Wing), Armed Forces Medical College, Pune 411001, India. Thecollege will celebrate its silver jubilee in 1987.

A collegiate members’ symposium on What is Killing Us?

Environmental Influences on Health and Disease will be held at the

Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2IJQ on Fri, Oct 18.

The Medical Defence Union centenary lecture on Consent and

Confidentiality: Then and Now (inaugural Lawson Tait lecture) will begiven by Dr Clifford Hawkins on Wednesday, Oct 23, at the BirminghamMedical Institute: President, Birmingham Medical Institute, 36 HarborneRoad, Birmingham B 15 3AF.

A study day organised by the British Association for Service to the Elderly onCommunity Care-Myth or Reality? will take place at Dyffryn HouseConference Centre, Cardiff, on Thursday, Oct 31: BASE, 3 Keele Farmhouse,Keele, Staffordshire ST5 5AR (0782 727280).

The 418th meeting of the Nutrition Society on NutrientRecommendations for Man-Theory and Practice will be held at theSouthern General Hospital, Glasgow, on Friday, Nov 1: Dr J. L. Clapperton,Hannah Research Institute, Ayr KA6 5HL.

The third one-day seminar on Growth in Children: the Importance ofEarly Assessment will take place in Aberdeen on Friday, Nov 1: ChildGrowth Foundation, 2 Mayfield Avenue, London W4 (01-995 0257).

The third RIPA lunchtime seminar on strategic management in the NHS,entitled Management Budgeting-Providing Incentives for

Participation, will be held at the Royal Institute of Public Administration, 3Birdcage Walk, London SW1H 9JH, on Tuesday, Nov 5.

A one-day conference on 90 Years of X-rays-a Celebration, organisedby the British Institute of Radiology, the National Radiological ProtectionBoard, and the British Association for the Advancement of Science, will takeplace at the Royal Society, London, on Friday, Nov 8: Conference Organiser,British Association for the Advancement of Science, 23 Saville Row, LondonWIX lAB (01-734 6010 ext 377).

A study day organised by the British Association for Service to the Elderly onDealing with Confusion will be held at the Exchange Club, Sheffield, onFriday, Nov 5: BASE, 3 Keele Farmhouse, Keele, Staffordshire ST5 5QR(0782 627280).

A one-day conference, organised by the Royal Institute of Public

Administration, on the Family and the Workplace: Who is Doing WhatAbout Childcare? will take place at Peter Runge House, 3 Carlton HouseTerrace, London SWI, on Friday, Nov 8: Pepperell Unit, Industrial Society,Robert Hyde House, 48 Bryanston Square, London WIH 7LN (01-262 2401ext 55).

A postgraduate weekend course in Radiotherapy and Oncology will beheld at the British Institute of Radiobiology, London, on Saturday, Nov 16:Meetings Secretary, Royal College of Radiobiologists, 38 Portland Place,London WIN 3DG.

The Royal College of Obstetricians and Gynaecologists’ annual Christmaslecture for young people entitled We Have the Technology will be held inthe college on Wednesday, Dec 11: Secretary, RCOG, 27 Sussex Place,Regent’s Park, London NW 4RG.

A meeting on Iron, Copper, Zinc, and Sulphur-Involvement inDisease and Therapy will be held at the Clinical Research Centre, Harrow,on Dec 16-17: Dr R. N. F. Thorneley, AFRC Unit of Nitrogen Fixation,University of Sussex, Brighton BN1 9RQ.

The second in the series of symposia on the history of medicine on theHistory of Clinical Trials will take place at the Wellcome Institute for theHistory of Medicine, London, on Tuesday, Dec 17: Secretary, Academic Unit,Wellcome Institute for the History of Medicine, 183 Euston Road, LondonNWI 2BP (01-387 4477 ext 3253).

A symposium on the Management of Paraquat Poisoning will take placeat Guy’s Hospital, London SE 1, on Monday, Jan 27: Dr G. N. Volans, PoisonsUnit, New Cross Hospital, Avonley Road, London SE14.

The newly elected president of the Craniofacial Society of GreatBritain, Mr Olda Pospisil, consultant maxillofaeial surgeon, Walton

Hospital, Liverpool, will preside at the next scientific meeting of the Society,which is to be held in Liverpool on April 17-18.

Diary of the Week

OCT 13 TO 19

Monday, 14thST GEORGE’S HOSPITAL MEDICAL SCHOOL, Department of Obstetrics and

Gynaecology, Cranmer Terrace, London SW7 ORE12.30 pm Dr Clive Harmer: Place of Radiotherapy tn the Treatment of Gynaecological

Malignancy.

Tuesday, 15thINSTITUTE OF DERMATOLOGY, 5 Lisle Street, London WC2H 7BJ4.45 pm Dr I. Sarkany: Physiology of Itching.

UNIVERSITY OF OXFORD, Ida Green Seminar Room, Observer’s House, GreenCollege, Oxford

5 pm Tina Posner: The Consequences of an Abnormal Cervical Smear: Women’sExperience.

LONDON MEDICAL GROUP5.45 pm (King’s College Hospital, Denmark Hill, London, SE5 9RS) Illustrated

symposium: Parental Rejection of Handicapped Babies.

Wednesday, 16thCHACE POSTGRADUATE MEDICAL CENTRE, Chase Farm Hospital, The

Ridgeway, Enfield, Middlesex. I

1 pm Dr R. V. Mummery: Antibiotics-Confusion Abounds.ROYAL FREE HOSPITAL SCHOOL OF MEDICINE, Seminar Room, 10th Floor,

Royal Free Hospital, Pond Street, London NW3 2QG5 pm Prof Rachel Rosser (The Middlesex Hospital, Mortimer St, London WIN 8AA):

Measuring Disability and Distress.

Wednesday 16thWELLCOME INSTITUTE FOR THE HISTORY OF MEDICINE, Seminar Room,

2nd Floor, 183 Euston Road, London NWl 2BP5.30 pm Dr Divian Nutton: Hospitals in Antiquity.

INSTITUTE OF NEUROLOGY, The National Hospital, Queen Square, LondonWCIN 3BG

6 pm Dr 1. R. Young: Flexibility as the Essence of Magnetic Resonance Imaging.7 pm Dr 1. F. Moseley. Clinical Applications ofNMR Imaging.

INSTITUTE OF ORTHOPAEDICS, Royal National Orthopaedic Hospital, 45-51Bolsover Street, London WIP 8AQ

6pm Dr A. A. Amis and Mr P. Wade: Mechanical Factors in Tendon Repair.7 pm Mr F. D. Burke: Flexor Tendon Injuries and Their Prognosis.

Thursday, 17thBIRMINGHAM MEDICAL INSTITUTE, 36 Harborne Road, Edgbaston, Birmingham

B15 3AF10 am BMI symposium: Psychiatry and Physical Disorder: the Interface.

EXETER POSTGRADUATE MEDICAL CENTRE, Royal Devon and Exeter

Hospital, Barrack Road, Exeter EX2 5DW12.45 pm Dr K. Sweeney: Abnormal Smears a Cause for Concern?

LONDON MEDICAL GROUP5.45 pm (The London Hospital, Whitechapel, London El 4LL) Symposium: Not To Be

Resuscitated: Should Patients’ Wishes be Respected or Doctors’Inclinations?

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

6 pm Paediatrics Colloquium on Deafness, Language and Learning.MANCHESTER MEDICAL SOCIETY8.15 pm Dr B. Foster: The Forgotten Anaesthetic.

Friday, 18thHILLINGDON HOSPITAL POSTGRADUATE CENTRE, Uxbridge, Middlesex

UB8 3NN9.30 am Conference: Health Problems in Ethnic Minorities.

Saturday, 19thNUFFIELD ORTHOPAEDIC CENTRE, Oxford8 30 am Dr D. Anson: BasicPrinciples in the Production of Recombinant Proteins.9.30 am Dr Anson: Expression of Factor IX.