1218 Notes and News SOCIAL SERVICES COMMITTEE REPORT ON AIDS THE admirable and ceaseless activity of the House of Commons Social Services Committee has generated a reportl on AIDS. The committee began to hear evidence in February and it emerged last week with a list of 94 recommendations and conclusions, from which (for the moment) we mention only a few. While the prevalence of AIDS and HIV is so low in the population at large, the committee does not see the need for routine screening outside the context of blood donation or the donation of other body fluids, such as semen or organs for transplantation. It recommends that the DHSS gives priority to a carefully constructed programme of screening of volunteers, randomly selected in different areas of the country, to assess the prevalence of HIV. Turning to the financing of research on AIDS, the committee urges that every effort be made in the future to ensure that basic scientific research continues to receive proper resources. The Secretary of State for Education, the committee advocates, should take a much firmer line in ensuring that monies allocated from his budget - for clinical academic research are not abrogated for providing clinical care by default. "At present the NHS is relying on clinical academics. To fail to make full and proper recognition of their needs is not just stifling the present, it is mortgaging the future." The committee welcomes the Government’s decision to fund the MRC’s special programme of research towards a drug and a vaccine against AIDS. The MRC should continue to give high priority to funding research in Africa, not only of the epidemiology and virology of HIV infection but also of the likely accompanying epidemic of opportunistic infections such as tuberculosis and cryptosporidiosis. In the committee’s view the priorities for the UK Government must be: "Extending the health education campaign to educate all sectors of society with regard to the disease itself, how it can be avoided, and how it can be dealt with. This must include vigorous assessment of the effects of the campaign. "Investing in the future by providing sufficient resources, in terms of money, manpower, facilities, and training, for all relevant areas of research in order to obtain a greater understanding of the nature of the HIV virus and the disease, of its effect upon individuals and society at large, and to develop, test, and produce potential drugs, cures, and vaccines. No potentially valuable area of research should be overlooked and no other medical research should suffer. "Drawing up plans for the care and treatment of those infected with the HIV virus and suffering from the disease based on the broadest available information. Sufficient resources of money, manpower, facilities, and training must be provided to ensure that the health and social services can cope with the demands put upon them and that they make the most appropriate use of those resources. The role of the voluntary sector needs to be recognised and coordinated with that of the statutory sector. "Providing a moral lead; protecting those afflicted with the disease from discrimination and victimisation; and living up to our responsibilities to the Third World." The Secretary of State for Social Services, Mr Norman Fowler, has said that the committee’s assessment and recommendations will be carefully considered. One of the recommendations was that additional help should be given for the provision of hospice care and the Government would be providing contributions towards two London projects: the London Lighthouse in West London GC500 000 towards capital costs and C 100 000 to revenue costs for this year); and the Mildmay Mission Hospital in East London GC 150 000 to capital costs of a new AID S hospice ward and /;50 000 to immediate running costs). 1. House of Commons: third report from the Social Services Committee. Session 1986-87. Problems associated with AIDS. May 13, 1987. BEATING THE WAITING LISTS . THE College of Health’s 4th edition of its valuable Guide to Hospital Waiting Listsl offers patients in a long-wait district the chance to find another part of the country where patients in the specialty in which they seek treatment are admitted within a year. No-one visiting a bank or a supermarket, the guide points out, is allotted a particular queue and told to stay in it, irrespective of how fast other queues are moving. But this happens in the National Health Service and most patients have no idea of the length of the queue ahead or of the comparative length of queues in neighbouring districts. The guide records a 3% rise in the number of patients waiting for inpatient treatment in England and Wales since September, 1985. Most of these 724 350 cases are covered by the eight major surgical specialties (general, trauma and orthopaedics, ENT, gynaecology, ophthalmology, oral, plastic, and urology). An average 26% of non-urgent cases in these categories have been waiting for admission to hospital for over one year. The College of Health expresses concern that so many of the people facing these long waits believe that the only alternative is to go private and so avoid years of painful waiting: in the Trent region, in 1985, for instance, 921 patients had been waiting four years or more for general surgery, 864 had been waiting at least that long for orthopaedic surgery, 728 had been waiting the same length of time for gynaecological inpatient treatment, and 471 had been waiting for plastic surgery. The report observes that about a quarter of all hip replacements are carried out privately. Moreover, well over half of the 47 561 urgent cases awaiting admission in England at the end of September, 1986, had been waiting for over one month. The Government has reaffirmed its hopeful targets: urgent patients should not have to wait longer than one month for admission; non-urgent patients should be admitted within a year; and patients should also not have to wait longer than three months for a first outpatient appointment. It was announced in February that an extra £ 25 million was to be made available to ensure that 100 000 more operations, including 5000 hip replacements, would be carried out in 1987. The College points out that about half of this money will need to be spent on hip replacements (average cost 2500) alone to achieve the stated goal. Surgeons have written to the College warning that many elderly patients waiting for operations die before they reach the top of the waiting list. The Department of Health and Social Security figures, on which the guide is based, exclude people waiting for admission to hospital for day surgery, which accounted, in 1985, for nearly 1 million cases. There are no figures for the whole country, but in Trent region in 1985 there were 7289 patients on the day-case waiting list. So the true waiting list figures could well be even higher than the official total of 724 350. A REMIT FOR THE NEW HEALTH EDUCATION AUTHORITY DRAWING up a national policy to improve the public health, based on the World Health Organisation’s goal of Health for All by the Year 2000, is a daunting task. But the Government has endorsed the WHO strategy and the European targets set to achieve it, and there has been a growing, if haphazard, commitment to health promotion in response to Britain’s appalling toll of deaths due to coronary heart disease. The Health Education Authority is the only national organisation responsible for health promotion in England, established, ministers stated last November, "to ensure that the prevention of ill health and the promotion of good health play a more central role in the National Health Service". Based on the national health policies developed in the United States, Canada, Australia, Sweden, and Finland, a list of 7 priorities for Britain has been drawn up by the King’s Fund Institute. Its report2 emphasises that these must be addressed in the light of the social and regional disparities in health, which are one of Britain’s most persistent health problems. AIDS, smoking control, diet, alcohol abuse, coronary 1. Guide to Hospital Waiting Lists 1987. Available (£4.50 or £3.50 to members) from the College of Health, 14 Buckingham Street, London WC2N 6DS (01-839 2413). 2. Healthy Public Policy a Role for the HEA. King’s Fund Institute. Available (£2) from the Institute, 126 Albert Street, London NW1 7NF
Transcript
1218
Notes and News
SOCIAL SERVICES COMMITTEE REPORT ON AIDS
THE admirable and ceaseless activity of the House of CommonsSocial Services Committee has generated a reportl on AIDS. Thecommittee began to hear evidence in February and it emerged lastweek with a list of 94 recommendations and conclusions, fromwhich (for the moment) we mention only a few.While the prevalence of AIDS and HIV is so low in the
population at large, the committee does not see the need for routinescreening outside the context of blood donation or the donation ofother body fluids, such as semen or organs for transplantation. Itrecommends that the DHSS gives priority to a carefullyconstructed programme of screening of volunteers, randomlyselected in different areas of the country, to assess the prevalence ofHIV.
Turning to the financing of research on AIDS, the committeeurges that every effort be made in the future to ensure that basicscientific research continues to receive proper resources. The
Secretary of State for Education, the committee advocates, shouldtake a much firmer line in ensuring that monies allocated from hisbudget - for clinical academic research are not abrogated for
providing clinical care by default. "At present the NHS is relying onclinical academics. To fail to make full and proper recognition oftheir needs is not just stifling the present, it is mortgaging thefuture." The committee welcomes the Government’s decision tofund the MRC’s special programme of research towards a drug anda vaccine against AIDS. The MRC should continue to give highpriority to funding research in Africa, not only of the epidemiologyand virology of HIV infection but also of the likely accompanyingepidemic of opportunistic infections such as tuberculosis andcryptosporidiosis.
In the committee’s view the priorities for the UK Governmentmust be:
"Extending the health education campaign to educate all sectorsof society with regard to the disease itself, how it can be avoided, andhow it can be dealt with. This must include vigorous assessment ofthe effects of the campaign.
"Investing in the future by providing sufficient resources, interms of money, manpower, facilities, and training, for all relevantareas of research in order to obtain a greater understanding of thenature of the HIV virus and the disease, of its effect uponindividuals and society at large, and to develop, test, and producepotential drugs, cures, and vaccines. No potentially valuable area ofresearch should be overlooked and no other medical research shouldsuffer.
"Drawing up plans for the care and treatment of those infectedwith the HIV virus and suffering from the disease based on thebroadest available information. Sufficient resources of money,manpower, facilities, and training must be provided to ensure thatthe health and social services can cope with the demands put uponthem and that they make the most appropriate use of thoseresources. The role of the voluntary sector needs to be recognisedand coordinated with that of the statutory sector.
"Providing a moral lead; protecting those afflicted with thedisease from discrimination and victimisation; and living up to ourresponsibilities to the Third World."The Secretary of State for Social Services, Mr Norman Fowler,
has said that the committee’s assessment and recommendations willbe carefully considered. One of the recommendations was thatadditional help should be given for the provision of hospice care andthe Government would be providing contributions towards twoLondon projects: the London Lighthouse in West London
GC500 000 towards capital costs and C 100 000 to revenue costs forthis year); and the Mildmay Mission Hospital in East LondonGC 150 000 to capital costs of a new AID S hospice ward and /;50 000to immediate running costs).1. House of Commons: third report from the Social Services Committee. Session
1986-87. Problems associated with AIDS. May 13, 1987.
BEATING THE WAITING LISTS
. THE College of Health’s 4th edition of its valuable Guide toHospital Waiting Listsl offers patients in a long-wait district thechance to find another part of the country where patients in thespecialty in which they seek treatment are admitted within a year.No-one visiting a bank or a supermarket, the guide points out, isallotted a particular queue and told to stay in it, irrespective of howfast other queues are moving. But this happens in the NationalHealth Service and most patients have no idea of the length of thequeue ahead or of the comparative length of queues in neighbouringdistricts. The guide records a 3% rise in the number of patientswaiting for inpatient treatment in England and Wales since
September, 1985. Most of these 724 350 cases are covered
by the eight major surgical specialties (general, trauma andorthopaedics, ENT, gynaecology, ophthalmology, oral, plastic, andurology). An average 26% of non-urgent cases in these categorieshave been waiting for admission to hospital for over one year. TheCollege of Health expresses concern that so many of the peoplefacing these long waits believe that the only alternative is to goprivate and so avoid years of painful waiting: in the Trent region, in1985, for instance, 921 patients had been waiting four years or morefor general surgery, 864 had been waiting at least that long fororthopaedic surgery, 728 had been waiting the same length of timefor gynaecological inpatient treatment, and 471 had been waiting forplastic surgery. The report observes that about a quarter of all hipreplacements are carried out privately. Moreover, well over half ofthe 47 561 urgent cases awaiting admission in England at the end ofSeptember, 1986, had been waiting for over one month.The Government has reaffirmed its hopeful targets: urgent
patients should not have to wait longer than one month foradmission; non-urgent patients should be admitted within a year;and patients should also not have to wait longer than three monthsfor a first outpatient appointment. It was announced in Februarythat an extra £ 25 million was to be made available to ensure that100 000 more operations, including 5000 hip replacements, wouldbe carried out in 1987. The College points out that about half of thismoney will need to be spent on hip replacements (average cost2500) alone to achieve the stated goal. Surgeons have written to theCollege warning that many elderly patients waiting for operationsdie before they reach the top of the waiting list. The Department ofHealth and Social Security figures, on which the guide is based,exclude people waiting for admission to hospital for day surgery,which accounted, in 1985, for nearly 1 million cases. There are nofigures for the whole country, but in Trent region in 1985 there were7289 patients on the day-case waiting list. So the true waiting listfigures could well be even higher than the official total of 724 350.
A REMIT FOR THE NEW HEALTH EDUCATIONAUTHORITY
DRAWING up a national policy to improve the public health,based on the World Health Organisation’s goal of Health for All bythe Year 2000, is a daunting task. But the Government has endorsedthe WHO strategy and the European targets set to achieve it, andthere has been a growing, if haphazard, commitment to healthpromotion in response to Britain’s appalling toll of deaths due tocoronary heart disease. The Health Education Authority is the onlynational organisation responsible for health promotion in England,established, ministers stated last November, "to ensure that theprevention of ill health and the promotion of good health play amore central role in the National Health Service". Based on thenational health policies developed in the United States, Canada,Australia, Sweden, and Finland, a list of 7 priorities for Britain hasbeen drawn up by the King’s Fund Institute. Its report2 emphasisesthat these must be addressed in the light of the social and regionaldisparities in health, which are one of Britain’s most persistent healthproblems. AIDS, smoking control, diet, alcohol abuse, coronary
1. Guide to Hospital Waiting Lists 1987. Available (£4.50 or £3.50 to members) from theCollege of Health, 14 Buckingham Street, London WC2N 6DS (01-839 2413).
2. Healthy Public Policy a Role for the HEA. King’s Fund Institute. Available (£2) fromthe Institute, 126 Albert Street, London NW1 7NF
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heart disease, ageing well, and preventive health services (such asscreening) are the 7 areas which, if sensitively tackled, could mosterode Britain’s burden of ill-health. The King’s Fund warns,however, that "individuals’ abilities to make healthy choices areheavily constrained by their social and economic circumstances".Information about health should be conveyed through a variety ofmeans adopting both a community-based approach and centraldirective. The latter will test the Health Education Authority’sindependence. The advocacy of public health combines a range ofmeasures, including legal, fiscal, and economic ones. There must bemajor changes in the British diet and smoking habits if there is to beany reduction in deaths from coronary heart disease and lung,breast, and bowel cancer. Publication of the report has been timedto precede the HEA meeting on May 26, when its future
programme will be decided. The report is the first in a series to be
produced by the King’s Fund Institute for Health Policy Analysis.
CLINICAL TRIALS
IN 1973 the Medico-Pharmaceutical Forum published a bookleton the design and conduct of clinical trials. Increasing interest in thesubject encouraged them to convene a working party to repeat theexercise, and the result is a readable report on all aspects of theorganisation and practice of the various types of trial. The newbooklet is presented as a reference source not only for health careprofessionals but also for consumers. In the opening section, thesuggestion that non-patient volunteer is a more satisfactory termthan "normal" or "healthy" to describe that group of individualsseems eminently sensible. Intention-to-treat analysis is put intoproper perspective; the use of confidence intervals is deemedessential (of course Lancet readers should be well aware of this2); andgreat store is put by ethics committees. "Bad science is unethical"the report declares. "Ethics committees... have a duty not just toensure that studies are ethically acceptable but to satisfy themselvesthat they are scientifically sound. " An onerous task indeed.
RECORD LINKAGE AND DRUG SAFETY
THE first annual lecture of the Centre for Medicines Research, anorganisation set up in 1981 by the British pharmaceutical industry,was given last July by Dr Hugh H. Tilson of Burroughs Wellcome,USA.3 Post-marketing surveillance, he argues, still needs a
notification system such as the UK’s "yellow cards" and the abilityto mount an ad-hoc investigation when an alarm bell rings, but thefuture of pharmacoepidemiology lies in record linkage. In the UKthis could be achieved by linking prescription records with anindividual patient’s file. Tilson mentions seven such data sourcesin North America (eg, the Group Health Cooperative of PugetSound, in Seattle, and Kaiser Permanente health plans). These arecoordinated health plans with automated pharmacies. Anotherwell-known source is the Boston Collaborative Drug SurveillanceProgram, from which Wellcome once got a preliminary answer onthe safety of allopurinol in twenty minutes. Focuses of interest inthis approach in the UK include Dundee and the Centre forMedicines Research itself. The drug industry’s involvement in suchmonitoring has been limited, and Tilson would like to see "moreaggressive roles for industry in the partnership in adverse reactionsurveillance". He sees no grounds for the opposing view-namely,that manufacturers’ vested interests might lead them to "harass thephysician, try to talk him out of the causal relationship, try to paintthe reaction in its best light, or even misuse the report of an adversereaction as an opportunity to sell more drug".
ACCESS TO MEDICAL RECORDS, NEW YORK
IN January, 1987, the Department of Health of the State of NewYork explained how a change in the State’s public health law,permitting patients access to their medical records, was to be put
1 Clinical trials. Obtainable from the Medico-Pharmaceutical Forum, 1 WimpoleStreet, London W1M 8AE. Price £5.
2 Editorial. Report with confidence Lancet 1987; i. 488.3 Post-marketing Surveillance the Way Forward By Hugh H. Tilson, MD. Obtainable
from Centre for Medicines Research, Woodmansterne Road, Carshalton, SurreySM5 4DS.
into practice. Within 10 days of a written request for access a"provider" (physician, nurse, social worker, or other) must providean opportunity to inspect records. Reasonable fees may be chargedfor inspection and copying. Access may be denied, and sevengrounds for doing so are listed in the Department of Health’smemorandum. One is that the information sought may, in thepractitioner’s view, substantially harm the patient or others.Another is information in the form of "personal notes andobservations". Those who would interpret this provision as
covering all handwritten records will find that escape route blocked,for such notes are "speculations, impressions (other than tentativeor actual diagnosis) and reminders". If a request for access is deniedthe practitioner must say why and tell the patient of his or her rightof appeal to a medical record access review committee of three to fivepractitioners.
HOSPITAL AND HEALTH SERVICES YEAR BOOK
THE 1987 edition of The Hospitals and Health Services YearBookl provides reassuringly much the same vast amount ofinformation as its predecessors. However, added to this year’sedition are most of the general managers of district units and seniordistrict officers. Also to be gleaned are the revenue budgets for allthe health authorities. Liverpool city (population 491 500), forexample, has for 1986-87 c274.18 to spend on each of its
inhabitants, whereas Cornwall (population 443 800) manages on161.47. Does this discrepancy reflect Cornwall’s efficiency orLiverpool’s ill-health-or simply the underfunding of rural areas?
SPLENECTOMY WARNING CARD -
Dr J. M. Dudley and colleagues (United Medical and DentalSchools, St Thomas’ Campus, London SE 1 7EH) have devised thefollowing warning card for patients without a functioning spleen:2
The card, 10 x 7 cm when folded, includes the addresses andtelephone numbers of the patient’s consultant and generalpractitioner.
1. Available from the Institute of Health Services Management, 75 Portland Place,London W1N 4AN. £48.90. Pp 996.
Disposable single-use syringes and needles will be available fordiabetics on general-practitioner prescription from Sept 1. Sincediabetics are exempt from prescription charges, they will be free foradults as well as for children. To ensure effective arrangements forsafe disposal of the equipment after use, supplies of a needle-clipping device will also be available.
Extra Money for PHLS
The 1987-88 budget for the Public Health Laboratory Servicewill be jC39’5 million, an increase of £ 48 million over last year’sallocation. The extra money includes £ 25 million in recognition ofthe additional work the service is currently undertaking, particu-larly that on AIDS (see Lancet, May 16, p 1158).
Royal College of PathologistsProf Dillwyn Williams has been made president-elect of the
college. He will take up office on Nov 17, 1987.Professor Williams is professor and head of the department of pathology in
the University of Wales College of Medicine. He has also served as head of aWorld Health Organisation centre for the pathology of endocrine tumoursand is an adviser to the US National Institutes of Health on problems relatedto radiation and thyroid cancer.
Precautions Against Legionnaires’ Disease
The Department of Health and Social Security, in new
guidelines aimed at reducing the risk of outbreaks of legionnaires’disease in hospitals, asks health authorities to install dry-cooledair-conditioning systems in new hospital buildings and to replaceexisting wet-spray systems when upgrading is required, unless thisis absolutely precluded by space or weight considerations. Theguidelines also give recommendations for the safe operation andmaintenance of wet-spray systems while they continue to be used.Advice on the avoidance of legionella infection originating from hotand cold water systems is based on the results of a surveyundertaken by the Public Health Laboratory Service at the requestof the DHSS.
International Association for Adolescent Health
Individuals and organisations interested in adolescent health areinvited to join the newly established International Association forAdolescent Health, which has been formed to promote partnershipbetween adolescents and professionals keen to improve adolescenthealth around the world. The association is committed to a policy ofeducation, research, the advancement of health promotion, and theprovision of high quality health care. Further information may be
obtained from Dr M. G. Williams, Chairman, Interim Committee,International Association for Adolescent Health, Canberra Collegeof Advanced Education, PO Box 1, Belconnen ACT, Australia2616.
The latest edition of the Handbook of Research and Development,which gives details of research commissioned by the Department of Healthand Social Security, is now available ([5.50) from HMSO PublicationsCentre, PO Box 276, London SW8 5DT.
The review of the Health and Lifestyle Survey, a preliminary report of anationwide survey of the physical and mental health, attitudes, and lifestyle ofa random sample of 9003 British adults, by Dr Brian Cox and others (seeLancet May 2, p 1046), is available free from the Health Promotion ResearchTrust (Information Office, Assets House, 17 Elverton Street, London SW 1P2PG). The report itself, available from the same office, costs jl6.
An exhibition on Malaria is on display at the Wellcome TropicalInstitute, 200 Euston Road, London NW1 2BQ (weekdays, excepting Bankholidays, 10am—4pm ; admission free).
A symposium entitled Toxic Effects on Endocrine Systems is to beheld in London on Wednesday, May 27: Scientific Meetings Officer, RoyalCollege of Pathologists, 2 Carlton House Terrace, London SWIY 5AF(01-930 5861).
An afternoon meeting on Organising Hospitals to Manage the AIDSCrisis will take place at the King’s Fund Centre, London NW 1, on Tuesday,June 9: Susan Hodge, King’s Fund Centre, 126 Albert Street, London NW1 17NF.
An evening meeting entitled Biological Effect of Low DoseIrradiation and Interstitial Radiotherapy of Carcinoma of theProstate is to be held at the Chester Beatty Research Institute, LondonSW3, on Thursday, June 11: Dr J. Ledermann, Department of MedicalOncology, Charing Cross Hospital, Fulham Palace Road, London W6(01-748 2040).
A meeting on Sexuality in Later Life will take place at the Herbert GrayCollege, Rugby, on June 15-16: British Association for Service to the Elderly,119 Hassell Street, Newcastle under Lyme, Staffordshire ST5 1AX
(0782-661033).
A conference entitled Dire Straits--Young People in the CareSystem is to be held in Swanwick, Derbyshire, on June 15-18: ConferenceOrganiser, British Agencies for Adoption and Fostering, 11 SouthwarkStreet, London SEl IRQ (01-407 8800).
Correction
Reversible Hypertension Associated with Unrecognised High Pressure ChronicRetention of Urine.—We apologise to Mr D. A. Jones and colleagues for thegarbled introduction to their article (May 9, p 1052). The introduction shouldhave read: There is a discrete group of patients in whom chronic retention ofurine, with hydroureter and hydronephrosis, develops without pain or thetypical symptoms associated with bladder outflow tract obstruction.’.2
International Diary1987
3rd International conference on AIDS: Washington DC, USA, June 1-5(III International Conference on AIDS, 655 15th Street, NW, Suite 300,Washington, DC 20005, USA).
69th annual meeting of the Endocrine Society: Indianapolis, Indiana,June 10-12 (Endocrine Society, Annual Meeting Office, 1800 DiagonalRoad, Suite 220, Alexandria, VA 22314, USA).
International symposium on Disability Education: Jerusalem, Israel,July 26-31 (VIP International Conference Services Limited, 42 NorthAudley Street, Mayfair, London W1A 4PY, UK).
Course on Twin Methodology: Leuven, Belgium, Aug 24-29 (Course onTwin Methodology, Centre for Human Genetics, University HospitalGasthuisberg, Herestraat 49, B-3000 Leuven).A conference on Mountain Medicine: London, UK, Nov 19-20 (Dr
Charles Clarke, International Union of Alpinist Associations MountainMedicine Centre, St Bartholomew’s Hospital, 38 Little Britain, LondonEC1A 7BE).
Diary of the WeekMAY 24 To 30
Tuesday, 26thICRF CANCER EPIDEMIOLOGY AND CLINICAL TRIALS UNIT, Ida Green
Seminar Room, Observer’s House, Green College, Oxford5 pm Dr Marianne Ewertz: Female Breast Cancer-Results from a Case-control Study
in Denmark.
Wednesday, 27thINSTITUTE OF ORTHOPAEDICS, Royal National Orthopaedic Hospital, 45--51
Bolsover Street, London W1P 8AQ6 pm Dr P. M. Le Quesne: Diagnosis of the Peripheral Nerve Lesions.7 pm Mr G. L. W. Bonney: latrogenic Nerve Injuries.
WELLCOME INSTITUTE FOR THE HISTORY OF MEDICINE, 183 EustonRoad, London NWl 2BP
5 30 pm Prof Toby Gelfand (Ottawa): The Rothschild Hospital of Paris, 1852-1900.DURHAM POSTGRADUATE MEDICAL CENTRE, Dryburn Hospital, Durham
1.15 pm Dr D. Gregory: A Practice Formulary of Drugs.
Friday, 29thCARDIOTHORACIC INSTITUTE, Fulham Road, London SW3 6HP
8 am Dr Fred Pearce: Some Properties of Human Lung Mast Cells.
