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Notes and News

AGHAST-INTERNATIONAL MOVEMENT TO FIGHTTOBACCO PROMOTION

THE International Organisation of Consumers’ Unions,l whichhas a membership of more than 120 consumer groups in over 50countries, has begun a worldwide campaign to combat tobaccoadvertising and promotion. IOCU has initiated several successfulcampaigns to fight the marketing practices of corporations in thepast, including IBFAN (International Baby Food Action Network),which was instrumental in the adoption by the 1981 World HealthAssembly of an international code of marketing for breastmilksubstitutes, the boycott of Nestle for its infant formula marketingpractices, and the eventual signed agreement by Nestle in January,1984, to abide by the code; HAI (Health Action International)which is concerned with the rational and safe use ofpharmaceuticalsand which initiated a campaign of adverse publicity against Ciba-Geigy’s antidiarrhoeal drug, ’Entero-Vioform’, following which thecompany announced worldwide withdrawal of the drug; and PAN(Pesticide Action Network) which has several aims including theimposition of import and export controls on hazardous pesticidesand the promotion of public education about the effects on health ofcertain crop chemicals.The success of the above movements suggests that more than

mere rhetoric will come out of AGHAST (Action Groups to HaltAdvertising and Sponsorship by Tobacco)-an acronym borrowedfrom one of the UK’s most active pressure groups, based in Bristol?The IOCU’s 11th world congress, held in Bangkok in December,resolved to eliminate "the marketing and promotional practices ofthose engaged in the manufacture and sale of tobacco products" andfor "other measures to reduce significantly the incidence of smokingworldwide". Simon Chapman is well known for his success inAustralia with MOP-UP (Movement Opposed to the Promotion ofUnhealthy Products), which ousted Paul Hogan fromadvertisements for Winfield cigarettes on the grounds that he was apersonality who particularly appealed to children, and whichpreceded BUGA-UP (Billboard Utilising Grafitiists AgainstUnhealthy Products), and is also associated with the InternationalUnion Against Cancer’s smoking control programme, theAustralian Consumers’ Association, and the Australian NationalHealth and Medical Research Council. He will coordinate the earlystages of AGHAST’s progress with Ruth Vermeer, from IOCU.They will begin by producing a detailed critique of the claim of thetobacco industry that the prevalence of smoking is unaffected bytobacco promotion.

THE SOCIETY OF PSYCHIATRISTS OF SOUTH AFRICA

AT the Society’s annual general meeting, held in Durban on Jan31, members (who are members ofthe Medical Association of SouthAfrica involved in psychiatry) drew up the following statement ofpolicy:(1) The Society of Psychiatrists recognises and deplores

potentially harmful psychological effects on the people of SouthAfrica as a result of any form of discrimination based on race, colour,gender, or creed. The Society does and will strive for the eliminationof all forms of discrimination that adversely affect mental health.

(2) The Society declares its opposition to any disparities in thequality of psychiatric services for all.

(3) The Society declares its commitment to insist that its memberspractise their profession as laid out in internationally acceptedethical codes in the declarations of Helsinki, Hawaii, and Tokyo andits determination to resist any form of abuse of psychiatricknowledge and skills for political ends or for any other purposecontrary to the best interests of the patients and their personalwelfare.

1 IOCU Central Office, 9 Emmastraat, 2595 EG, The Hague, Netherlands2. AGHAST, 93 Cromwell Road, Bristol BS6 5EE

(4) The Society has by its representation and actions been

responsible for many improvements in the services for all

psychiatric patients in South Africa. The Society steadfastlydeclares its intention to continue these efforts.

ADVISORY GROUP ON AIDS IN UK

THE members of the Government’s expert advisory group onAIDS announced last week (see p 530) are:Dr M. E. Abrams (DHSS) chairman; Prof M. Adler (professor of genito-

unnary medicine at the Middlesex Hospital, London); Prof A. L. Bloom(professor ofhaematology, Welsh National School of Medicine) ; Dr J. D. Cash(consultant adviser in blood transfusion, Scotland); Dr Marcela Contreras(director, North London Blood Transfusion Centre); Dr N. S. Galbraith(epidemiologist, director of the PHLS Communicable Disease SurveillanceCentre); Prof Alasdair Geddes (consultant physician, East BirminghamHospital); Dr Harold Gunson (director, North Western Blood TransfusionService); Miss Elizabeth Jenner (St Mary’s Hospital, London) (nursingrepresentative); Dr D. B. L. McClelland (regional director, Edinburgh and SEScotland Blood Transfusion Service); Dr Philip Mortimer (consultantvirologist, Virus Reference Laboratory, Central Public Health Laboratory);Dr D. Pereira-Gray (general medical practitioner); Dr A. J. Pinching (clinicalimmunologist, St Mary’s Hospital Medical School); Dr P. Rodin (consultantin genitounnary medicine, London Hospital); Dr R. Tedder (consultantvirologist, Middlesex Hospital); Dr D. A. J. Tyrrell (chairman, AdvisoryCommittee on Dangerous Pathogens, and director, MRC Common ColdUnit); ProfR. Weiss (Institute of Cancer Research); Mr Richard Wells (RoyalCollege of Nursing) (nursing representative); Dr J. E. M. Whitehead (director,Public Health Laboratory Service); Prof A. J. Zuckerman (professor ofmicrobiology at London School of Hygiene and Tropical Medicine); DrM. Sibellas, DHSS, medical secretary; Mr T. W. S. Murray, DHSS,administrative secretary.

COMMONEST CAUSE OF DRUG-INDUCED DEATH

DEXTROPROPOXYPHENE may seem an unlikely candidate for thistitle; indeed, in normal therapeutic doses it is seldom associated withserious adverse effects. If the therapeutic range is exceeded,however, it becomes highly dangerous, especially if taken in

combination with alcohol. Thus, dextropropoxyphene-related self-poisoning is implicated in over 300 deaths annually in England andWales. The principal offenders are combined preparations of thedrug and paracetamol (eg, ’Distalgesic’, ’Cosalgesic’) but the

toxicity of paracetamol can now be treated effectively by sulphydrylcompounds. This leaves the dextropropoxyphene componentwhich causes severe respiratory depression-fatal apnoea can occurwithin 1 hour of ingestion. Not surprisingly, most deaths occurbefore the patient reaches hospital. The Committee on Safety ofMedicines believes that dextropropoxyphene should continue to beavailable but urges doctors to take precautions-eg, restriction ofnumbers of tablets prescribed, avoidance of the drug in patientsthought to be at risk of self-poisoning or to abuse alcohol, and strictadvice to patients about the dangers. The Committee also notes thatdoctors should inform patients of their right to receive an

information leaflet from the dispensing pharmacist, although onewonders how many would read this or alter their use as a result.

Nevertheless, dextropropoxyphene is clearly the cause of a largenumber of avoidable deaths; this is an area where general practi-tioners can make a special contribution because of their closeknowledge of the patient and family circumstances.

SPINAL INJURIES UNITS

THERE are eight spinal injuries units in England, all of whichwere visited by a Royal College of Surgeons working party, whichhas now prepared a report.2 The working party was set up to studythe funding and operation of the units; and the report concentrateson allocation, desirable trends, and long-term strategy. The workingparty came away impressed by the success of the units, and notedthat in total numbers provision of beds was adequate, even if

1. Committee on Safety of Medicines. Curr Probl 1985, no 14. Issued by Committee onSafety of Medicines, Market Towers, 1 Nine Elms Lane, London SW8 5NQ

2 Report of the Working Party on Spinal Injuries Units. London: Royal College ofSurgeons, October, 1984

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regional distribution was far from ideal. If facilities were madeavailable for home and hostel discharge, beds could be released formore patients with non-traumatic spinal paralysis, who wouldundoubtedly benefit from the units’ help. As medical care improves,tetraplegia is taking over from paraplegia as the condition mostoften treated-a change partly related to the increase in sport andmotorcycle injuries. Moreover, the number of patients who requirespecialist care at home or in hospital will continue to increase asmortality falls. The working party recommended that the skill builtup in the units should be disseminated more widely to cope withhome and hostel care of discharged patients and non-traumaticcases.

It is recommended that the medical team be reorganised so thatthe consultant-in-charge devotes most of his time to spinal injuries;he must be the overall manager and have a deputy predominantlyemployed by the unit even if he has different specialist interests.Neurology and rehabilitation, together with orthopaedics andurology, form the basis of care, plus ready availability of

anaesthesia, neurosurgery, plastic surgery, and radiology. By thesestandards, the units in the north of England are seriously under-staffed. A unit size of 50 beds is believed to be ideal, but the presentsize and distribution (larger at Stoke Mandeville, and smaller atHexham, Pinderfields, Stanmore, and Southport) is unlikely tochange. The rebuilding of Stoke Mandeville by voluntary subscrip-tion and the new units at Odstock and Stanmore have also focusedattention on the deficiencies of the older northern units; the DHSSstandard at two new units has set 1985-86 funding at f30 000 peravailable bed, meaning that Oswestry, Lodge Moor, Pinderfields,and Southport will be underfunded unless more money is forth-coming. Nursing, physiotherapy, remedial gymnastics, and

occupational therapy facilities are also unevenly distributed, andthe working party recommends that numbers should be brought upto standard.The report encourages further charitable support, which should

be directed to the most profitable ends-a sad but true commentperhaps on the possibility of additional funds being made availableby the DHSS.

COMPLAINTS FROM PATIENTS

UNEXPECTEDLY, the Government has given its blessing to a privatemember’s Bill which seeks to set up a new procedure for patients tocomplain to health authorities about their hospital treatment. TheConservative MP, Mr Michael McNair-Wilson, introduced the Billafter hospital treatment for a kidney ailment during which, he says,medical staff were often high-handed, callously aloof, and

unreasonably unwilling to discuss his illness with him. His HospitalComplaints Procedure Bill would have failed to become law, but theGovernment has decided to support it, and it will almost certainly beenacted before the summer recess.

BRAVE NEW WORLD

As long ago as 1967, Patrick Steptoe and Robert Edwards began todiscuss the ethics of research on human embryos; in 1971 they askedfor a commission to examine in-vitro fertilisation; and LouiseBrown was born in 1978. But it was not until 1984 that the Warnockcommittee finally produced a report on human fertilisation andembryology. Dr Edwards felt justified in accusing politicians andmoral philosophers of lagging far behind scientists. His spiriteddefence of research into human embryos, threatened by Mr EnochPowell’s Bill which is now at the committee stage of Parliament, wasdelivered in London on Feb 19, at the Townswomen’s Guild forumon the Warnock report. He emphasised the scientist’s duty to try andalleviate the misery of infertility (affecting perhaps 10% of couples)and to try to prevent disease. Research into embryos, he claimed,might improve our understanding of cancer, diabetes, blood andheart disorders, and could break hereditary chains of haemophilia ormuscular dystrophy. He had never, however, created an embryosimply for research purposes. Mr Powell’s Bill required all embryosto be returned to the woman’s womb but Edwards underlined that

he considered this to be actually unethical when embryos wereabnormal. Although he admired the parents of Down’s syndromechildren, Edwards felt it his duty to prevent the conception of suchchildren. He was also perturbed about other aspects of the Bill. Alicensing procedure through which a woman must pass in order totry to conceive was unacceptable, especially the bureaucracy of a4-month right of permission, renewable and presumably refusableon expiry, when time is valuable for older women attempting toconceive. He pointed out that the very name of the Bill (forprotection of the unborn child), was an emotive misnomer; anembryo could hardly be considered a child. Moreover, he queried,how could people debate the rights of the embryo when 4-month-oldfetuses were still being aborted?

POSTNATAL AND NEONATAL CARE

HAVING offered guidance on good practice before and duringchildbirth, the Maternity Services Advisory Committee nowcompletes its work with a report on care of the mother and baby. IThe subject-matter includes stillbirth, neonatal death, handicap,and malformation as well as the care of healthy mothers and babies,and many of the chapters end with a check-list that will cause heart-searching in some maternity units. The emphasis is on practicerather than facilities. Paediatricians on the committee wanted adeclaration on the minimum numbers of cots that should be

provided in each region for every thousand births, but the consensuswas that provision should be made in the light of regionalcircumstances and resources. There are, however, some quite firmwords on staffing and equipment, and the regions are urged to adopta strategy for the care of low-birthweight babies based on localincidence and distribution. In the right hands, this document couldbe a valuable lever for improvement of the service to mothers andbabies.

WHAT’S IN A PAPADUM?

A FAIR amount of sodium among other things-2850 mg per 100 gto be precise. This is but one of many items to be found in the secondsupplement to McCance and Widdowson’s The Composition ofFoods. lmmigram Foods2 presents tabulated information on energycontent, fat, protein, carbohydrate, minerals, vitamins, and fibre of357 foods commonly used by Asian, West Indian, and Chineseimmigrants in the United Kingdom (and by many indigenousgroups as well). Both raw and cooked foods and mixed dishes areincluded. Recipes for the cooked foods and systematic names for fishand plant foods appear in appendices. This informative volumeseems certain to become an important reference source for anyonewith an interest in ethnic nutrition.

Prevention of Neural Tube Defects: Medical ResearchCouncil Vitamin Study

During 1984 the MRC study of vitamin supplementation in theprophylaxis of recurrent neural tube defects recruited 320 patients,making a total of 357 to the end of 1984. The independent datamonitoring committee (chaired by Prof Peter Armitage), whichregularly reviews the evidence, has not recommended modificationor termination of the study.

Occupational Exposure to Halogenated AliphaticHydrocarbons and n-Hexane

The Industrial Injuries Advisory Council is to investigatewhether the effects of occupational exposure to halogenatedaliphatic hydrocarbons and to n-hexane should be prescribed asoccupational disease under the industrial injuries scheme. Evidenceof the chronic toxicity of these substances, in particular of

methylene chloride, carbon tetrachloride, trichloromethane,

1. Maternity Services Advisory Committee Maternity care in action. Part III: Care ofthemother and baby (postnatal and neonatal care) A guide to good practice and a planfor action London HM Stationery Office, 1985. 95p

2. Tan SP, Wenlock RW, Buss DH. Immigrant Foods. Second Supplement to McCanceand Widdowson’s The Composition of Foods. London HM Stationery Office,1985: Pp 74. £4.50

536

methyl chloride, and trichloroethylene, and of the possible link ofn-hexane to neuropathy should be submitted to the Secretary,Industrial Injuries Advisory Council, Friars House, 157-168

Blackfriars Road, London SE1 8EU (01-703 6380), from whomfurther information about the investigations may also be obtained.

Addictive Behaviours Research GroupThe University of Dundee department of psychiatry (Ninewells

Hospital, Dundee DD1 9SY) has recently established a group,under the direction of Dr Nick Heather, to study the range ofaddictive behaviour from addiction to opioids, alcohol, and

cigarettes, tranquilliser and solvent abuse, to eating disorders andpathological gambling. Recent evidence suggests that thesebehaviours may be regarded as a family of learned disorders,displaying similar general characteristics and amenable to similarmethods of intervention. The Dundee group will concentrate on the

development and evaluation of treatment for addictive behaviours,including a range of self-help and other types of intervention, butnot precluding more theoretical research into the basis of

dependence and the process of change.

Royal College of Physicians of London and BritishCardiac Society: Travelling Fellowship in CardiologyDr Waldo Fernandez, associate professor of medicine,

Universidad San Marcos, Lima, Peru, is the first holder of a

travelling fellowship created by the Royal College of Physicians andthe British Cardiac Society to enable a senior cardiologist to visit theUK. Dr Fernandez will spend six weeks in the spring visiting centresin London, Oxford, Cambridge, and Birmingham and attending thespring meeting of the British Cardiac Society.

WHO Centre for Quality Assessment in Blood CoagulationTestingThe University Hospital of South Manchester, Withington, has

been designated WHO Centre for Quality Assessment in BloodCoagulation Testing, under the direction of Dr Leon Pollerconsultant haematologist at the hospital.

An exhibition, The Pest Anatomized-Five Centuries of Plague inWestern Europe, will be held at the Wellcome Institute for the History ofMedicine (1st Floor), 183 Euston Road, London NWI 2BP, from March4-May 24.

A Financial 7’:;M Conference on Private Health Care, at which MrKenneth Clarke, Minister of Health, will present the Government’s attitudetowards private health care in Britain and Mr Michael Meacher, Labourspokesman on Health and Social Security, will present the Opposition’s pointof view, will take place in London on March 25-26: FT Conference

Organisation, Minster House, Arthur Street, London EC4R 9AX (01-6211355).

The 4th joint meeting of the British Endocrine Societies will be held atthe University of Oxford on March 25-29: Administrative Assistant, Societyfor Endocrinology, 23 Richmond Hill, Bristol BS8 1EN (0272 734662).

A 4-day course on Medicine and Sexuality will take place in centralLondon on March 28-29 and April 25-26: Mrs Elva Macklin, BritishPostgraduate Medical Federation, University of London, Central Office, 33Millman Street, London WC1N 3EJ (01-831 6222).

A meeting on the Chemistry and Analysis of Lipids will be held at theUniversity of Newcastle upon Tyne on April 17-19: Dr D. T. Coxon, FoodResearch Institute, Colney Lane, Norwich NR4 7UA (0603-56122).

The medical group of the Royal Photographic Society will hold its annualexhibition on April 18-May 1 in the medical school library of St George’sHospital, London SW17.

The annual symposium of the Biological Council on Leukotrienes-theirBiological Significance will be held at the Royal Institution, London, onApril 1-2: Joan Kruger, c/o Department of Pharmacology, Institute of BasicMedical Sciences, 35/43 Lincoln’s Inn Fields, London WC2A 3PN.

The British Dietetic Association study conference will take place at theUniversity of Keele on April 15-19: Conference Secretary, 65 ClaremontRoad, Tamworth, Staffordshire B79 8EW.

Correction

Arthnris and Parvovlrus Infectzon.-In this editorial last week (p 437) wemisrepresented Dr White and his colleagues both geographically andnumerically. They are based at Bath, not Bristol, and in the sixth paragraph wemeant to say that, in 17 of their patients, symptoms had persisted for more thantwo rnonths, not years.

Diary of the Week

MARCH 3 TO 9

Monday, 4thKING’S COLLEGE LONDON, Strand, London WC2R 2LS

1.05 pm Mrs Brenda Hoggett: Consent to Medical and Psychiatric Treatment of Minors.MANCHESTER MEDICAL SOCIETY, Theatre 3, Stopford Building, University of

Manchester, Oxford Road, Manchester M13 9PP5.30 pm Dr J. Pickstone: University History of Medicine Lecture.

Tuesday, 5thROYAL COLLEGE OF SURGEONS, Nicolson Street, Edinburgh EH8 9DW

6 pm Mr D. W. Lamb: Problems of the Upper Limb.ICRF CANCER EPIDEMIOLOGY AND CLINICAL TRIALS UNIT, Ida Green

Seminar Room, Observer’s House, Green College, Oxford5 pm John Feightner: Prevention and Health Maintenance-the Canadian Approach.

BRITISH MEDICAL INSTITUTE, 36 Harborne Road, Edgbaston, Birmingham7 30 pm Prof M. R. Bond: Psychiatric Management of Patients with Chronic Pain-An

Inpatient Programme.WEST OF ENGLAND EYE INFIRMARY, Magdalen Street, Exeter

8.45 am Mr K. M Paghero: The Confused Patient.

Wednesday, 6thNUFFIELD DEPARTMENT OF CLINICAL MEDICINE, Lecture Theatre 1,

Academic Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU5 pm Dr David Nathan: Reactivation of the Fetal Globin Genes: an Approach to the

Treatment of Inherited Anaemias.BIRMINGHAM MEDICAL INSTITUTE, 36 Harborne Road, Edgbaston, Birmingham

11.30 am Symposium. The Menopause in Perspective.INSTITUTE OF DERMATOLOGY, St John’s Hospital for Diseases of the Skin,

Lisle Street, Leicester Square, London WC2H 7BJ4.45 pm Dr P. M. Dowd: Disorders of Mucus Membranes.

INSTITUTE OF ORTHOPAEDICS, Royal National Orthopaedic Hospital, 45-51Bolsover Street, London W 1P 8AQ

6 pm Dr Barbara Ansell: The Hip in Juvenile Arthritis.7 pm Mr M. Swann: Surgical Management of the Rheumatoid Hip in Childhood.

INSTITUTE OF SPORTS MEDICINE, c/o School of Engineering and Science,Polytechnic of Central London, 115 Cavendish Street, London W1M 8JS

6 pm Seminar: Cricket Injuries.ROYAL FREE HOSPITAL, Academic Department of Medicine, 10th Floor, Royal Free

Hospital, Pond Street, London NW35 pm Dr T. S. Slater’ Free Radical Mechanisms in Liver Injury.

ROYAL MASONIC HOSPITAL, Ravenscourt Park, London W6 OTN7 pm Dr A T. Richardson: Rheumatoid Arthritis and its Variants.

CHACE POSTGRADUATE MEDICAL CENTRE, Chase Farm Hospital, TheRidgway, Enfield, Middlesex

1 pm Mr R. M. Hardmg: Aviation Medicine.

Thursday, 7thROYAL COLLEGE OF SURGEONS, Lincoln’s Inn Fields, London WC2A 3PN

6 pm Dr S Dische: Concerning Anaemia, Oxygen, Radiotherapy, and OncologyROYAL COLLEGE OF PHYSICIANS (Rupert Beckett Lecture Theatre, University of

Leeds, Leeds LS2 9JT)5.30 pm Sir John Walton: The Inflammatory Myopathies.

WEST OF ENGLAND EYE INFIRMARY, Magdalen Street, Exeter7.30 pm Prof Gnmley Evans. Preventing Fates Worse than Death.

Friday, SthINSTITUTE OF DERMATOLOGY, St John’s Hospital for Diseases of the Shn,

Lisle Street, Leicester Square, London WC2H 7BJ2.30 pm Dr J. Petttt: Dermatology in the Third World-the Search for Affordable

Therapies.ROYAL COLLEGE OF SURGEONS, 35-43 Lincoln’s Inn Fields, London WC2A 3P

5 pm Prof A Watson: The Current Status of Resection in the Management ofOesophageal Carcinoma.

Saturday, 9thNUFFIELD ORTHOPAEDIC CENTRE, Headington, Oxford8.30 am Dr T A. Terrar: The Chemistry of Neuromuscular Junctions. ,

9.30 am Mr S. P. Frostick’ Peripheral Nerve Repair 1985-the Fact and the Fiction