1032 sary, make inquiries either before mine the post’s training status.
or at
the interview
Royal College of Physicians, 11 St Andrew’s Place, London NW1 4LE
to
deter-
R. F. ROBERTSON Chairman, J.C.H.M.T.
ANIMAL EXPERIMENTS
cles of the telegraph and the printing press working together the whole mass of the people have been admitted to his bedside." The account of Queen Victoria’s final illness in The Lancet in 1901 (vol. i) is much more modest, but surprisingly informative. 24 Abbey Road, London NW8 9AX
SIR,-In his Stephen Paget memorial lecture (Oct. 29, p. Sam Shuster quoted Ryder’s statement’ that "less than one-third of all licensed experiments on living animals can be seen to be medical". Shuster showed that the Press and antivivisectionists had mistakenly interpreted this statement to mean that more than two-thirds of experiments are performed for non-medical purposes. The responsibility for this misconception does not lie entirely with the Press or antivivisectionists. The Home Office states in its return for 1975: "Moreover the limited information which is all that the existing system has been able to produce has sometimes given a misleading impression of the character and purposes of the experiments and is responsible for a number of misconceptions".2 The "Houghton/Platt Committee" (which has developed into the Committee for the Reform of Animal Experimentation) in a paper submitted to the Home Secretary last year stated: "The case for more information is probably the most urgent reform needed. Without it there can be no fully informed discussion about the working of the Act". The Home Office return for 1975 includes some new additions from which it is possible to deduce that 2 333 237 of the total of 5 379 084 experiments were financed by commercial undertakings and were other than the mandatory testing of medicinal products. The figure which Professor Shuster quoted-that 75% of animals are used in drug testing or medical research-is open to question. It was derived from a pilot study by the Home Office, the purpose of which was to test the efficacy of the new return forms. The sample was small and not random, and the Home Office does not intend to publish the results. The forum proposed by Professor Shuster is much needed and the fuller returns promised by the Home Office will make
913) Prof.
TAXES AND THE N.H.S.
SIR,-Your Parliamentary correspondent has alluded (Oct. 22, p. 882) to the speech I made to the Conservative Party conference and suggested that I touched a "raw nerve" in referring to the lack of debate on the N.H.S. Perhaps a far more potent stimulus to inflamed nerves (or toes) was contained in my subsequent paragraph which asked "who is going to have the political courage to stand up at the time of the next election and ask the voters this question; do you want sophisticated hospital care for children and pensioners, for cancer, for major accidents, because if you do you must be prepared either to pay more in taxation to cover costs or you must accept some alternative form of finance for minor ailments and routine periodical check-ups?" I am concerned with the sound economic basis for financing medical care in Britain and other Common Market countries in the next quarter century. Our profession has an enormous public-relations exercise to carry out with patients and their relatives, to emphasise the advantages of an insurance based Health Service finance in which we guarantee payment of major hospital and diagnostic costs.
taxpayers would accept an increased payfor treatment of minor ailments, if they were made aware of the major improvements in the hospital and institutional services which could be made available to all at times of greatest need. I believe that
ment to
most
general practitioners
Christie Hospital & Holt Radium Institute, Manchester M20 9BX
informed debate possible. 9D Stanhope Road, London N6 SNE
P. R. EVANS
F. D. SKIDMORE
MANAGEMENT OF ALCOHOLISM STEWART BRITTEN
PUBLIC ILLNESS
SIR,-Your Round the World contribution from the United States (Oct. 1, p. 705) comments on the intimate clinical details of a well-known Senator’s illness, which had been described in the newspapers and on television, as a sad commentary on the taste of the media and on the general public’s craving for information. Let no one suppose that this is a new thing. We have only to consult The Lancet of 1881 (vol. ii) to find thirteen accounts of the fatal illness of President Garfield. They are, it is true, but a summary, for during his illness after he was shot bulletins were published by his doctors three times a day. This was in addition to separate bulletins from the physicians to the surgeons and yet another set sent by Secretary Blaine to the poet Longfellow who was American Minister in London at the time. Bulletins were published in the Boston Medical and Surgical Journal (now the New England Journal of Medicine) so that we may read about the President’s diet,’ dressings, bowel movements, nutrient and evacuating enemas, and so on. The temperature chart was eventually published in full. As the New York Tribune stated: "By the everyday mira1. Ryder, R. D. Victims of Science; p. 32. London, 1975. 2. Home Office. Experiments on Living Animals: Return of experiments performed in Great Britain under the Cruelty to Animals Act 1876, during 1975; p. 2. H.M. Stationery Office, 1976.
SIR,-Why is Dr Glatt (Oct. 15, p. 817) surprised at the Institute of Psychiatry workers’ finding that "advice is as good as treatment" in alcoholism? Since there is hardly any good scientific evidence of the superiority of the currently favoured modes of treatment of alcoholism (usually group but sometimes behavioural and psychotherapy) over no treatment at all-some studies, for example, show spontaneous-remission rates in excess of 50% over the usual trial periods-it is surely no wonder that such results are reported. Any studies suggest. ing that treatment helps are based on such highly selected samples (one of Dr Glatt’s main criticisms of the Institute’s findings) that no generalisations are possible. Psychiatric therapy in most alcoholic treatment centres (A.T.C.) in Britain today consists of letting the alcoholic talk himself out of his problem with "skilled" help, the key concepts being insight and support. But the few properly controlleo trials of the group (and, come to that, individual) psychotherapeutic approach in psychiatry 1have shown it to be usually worthless and sometimes harmful. Dr Glatt should read Clare’s excellent chapter on How Good is Treatment ?2 Thus the Rand Corporation Study’ suggested that recovery may be relatively independent of treatment techniques. Regular attendance at Alcoholics Anonymous was just about as good as treatment by an A.T.C., and a 1. Rachman, 2. Clare, A.
S. The Effects of Psychotherapy. Oxford, 1971. in Alcoholism New Knowledge and Responses (edited by G. Edwards and M. Grant); p. 279. London, 1977. 3. Armour, D. J., Polich, J. M., Stambul, H. B. Management of Alcoholism.
London, 1977.
or at
the interview
Royal College of Physicians, 11 St Andrew’s Place, London NW1 4LE
to
deter-
R. F. ROBERTSON Chairman, J.C.H.M.T.
ANIMAL EXPERIMENTS
cles of the telegraph and the printing press working together the whole mass of the people have been admitted to his bedside." The account of Queen Victoria’s final illness in The Lancet in 1901 (vol. i) is much more modest, but surprisingly informative. 24 Abbey Road, London NW8 9AX
SIR,-In his Stephen Paget memorial lecture (Oct. 29, p. Sam Shuster quoted Ryder’s statement’ that "less than one-third of all licensed experiments on living animals can be seen to be medical". Shuster showed that the Press and antivivisectionists had mistakenly interpreted this statement to mean that more than two-thirds of experiments are performed for non-medical purposes. The responsibility for this misconception does not lie entirely with the Press or antivivisectionists. The Home Office states in its return for 1975: "Moreover the limited information which is all that the existing system has been able to produce has sometimes given a misleading impression of the character and purposes of the experiments and is responsible for a number of misconceptions".2 The "Houghton/Platt Committee" (which has developed into the Committee for the Reform of Animal Experimentation) in a paper submitted to the Home Secretary last year stated: "The case for more information is probably the most urgent reform needed. Without it there can be no fully informed discussion about the working of the Act". The Home Office return for 1975 includes some new additions from which it is possible to deduce that 2 333 237 of the total of 5 379 084 experiments were financed by commercial undertakings and were other than the mandatory testing of medicinal products. The figure which Professor Shuster quoted-that 75% of animals are used in drug testing or medical research-is open to question. It was derived from a pilot study by the Home Office, the purpose of which was to test the efficacy of the new return forms. The sample was small and not random, and the Home Office does not intend to publish the results. The forum proposed by Professor Shuster is much needed and the fuller returns promised by the Home Office will make
913) Prof.
TAXES AND THE N.H.S.
SIR,-Your Parliamentary correspondent has alluded (Oct. 22, p. 882) to the speech I made to the Conservative Party conference and suggested that I touched a "raw nerve" in referring to the lack of debate on the N.H.S. Perhaps a far more potent stimulus to inflamed nerves (or toes) was contained in my subsequent paragraph which asked "who is going to have the political courage to stand up at the time of the next election and ask the voters this question; do you want sophisticated hospital care for children and pensioners, for cancer, for major accidents, because if you do you must be prepared either to pay more in taxation to cover costs or you must accept some alternative form of finance for minor ailments and routine periodical check-ups?" I am concerned with the sound economic basis for financing medical care in Britain and other Common Market countries in the next quarter century. Our profession has an enormous public-relations exercise to carry out with patients and their relatives, to emphasise the advantages of an insurance based Health Service finance in which we guarantee payment of major hospital and diagnostic costs.
taxpayers would accept an increased payfor treatment of minor ailments, if they were made aware of the major improvements in the hospital and institutional services which could be made available to all at times of greatest need. I believe that
ment to
most
general practitioners
Christie Hospital & Holt Radium Institute, Manchester M20 9BX
informed debate possible. 9D Stanhope Road, London N6 SNE
P. R. EVANS
F. D. SKIDMORE
MANAGEMENT OF ALCOHOLISM STEWART BRITTEN
PUBLIC ILLNESS
SIR,-Your Round the World contribution from the United States (Oct. 1, p. 705) comments on the intimate clinical details of a well-known Senator’s illness, which had been described in the newspapers and on television, as a sad commentary on the taste of the media and on the general public’s craving for information. Let no one suppose that this is a new thing. We have only to consult The Lancet of 1881 (vol. ii) to find thirteen accounts of the fatal illness of President Garfield. They are, it is true, but a summary, for during his illness after he was shot bulletins were published by his doctors three times a day. This was in addition to separate bulletins from the physicians to the surgeons and yet another set sent by Secretary Blaine to the poet Longfellow who was American Minister in London at the time. Bulletins were published in the Boston Medical and Surgical Journal (now the New England Journal of Medicine) so that we may read about the President’s diet,’ dressings, bowel movements, nutrient and evacuating enemas, and so on. The temperature chart was eventually published in full. As the New York Tribune stated: "By the everyday mira1. Ryder, R. D. Victims of Science; p. 32. London, 1975. 2. Home Office. Experiments on Living Animals: Return of experiments performed in Great Britain under the Cruelty to Animals Act 1876, during 1975; p. 2. H.M. Stationery Office, 1976.
SIR,-Why is Dr Glatt (Oct. 15, p. 817) surprised at the Institute of Psychiatry workers’ finding that "advice is as good as treatment" in alcoholism? Since there is hardly any good scientific evidence of the superiority of the currently favoured modes of treatment of alcoholism (usually group but sometimes behavioural and psychotherapy) over no treatment at all-some studies, for example, show spontaneous-remission rates in excess of 50% over the usual trial periods-it is surely no wonder that such results are reported. Any studies suggest. ing that treatment helps are based on such highly selected samples (one of Dr Glatt’s main criticisms of the Institute’s findings) that no generalisations are possible. Psychiatric therapy in most alcoholic treatment centres (A.T.C.) in Britain today consists of letting the alcoholic talk himself out of his problem with "skilled" help, the key concepts being insight and support. But the few properly controlleo trials of the group (and, come to that, individual) psychotherapeutic approach in psychiatry 1have shown it to be usually worthless and sometimes harmful. Dr Glatt should read Clare’s excellent chapter on How Good is Treatment ?2 Thus the Rand Corporation Study’ suggested that recovery may be relatively independent of treatment techniques. Regular attendance at Alcoholics Anonymous was just about as good as treatment by an A.T.C., and a 1. Rachman, 2. Clare, A.
S. The Effects of Psychotherapy. Oxford, 1971. in Alcoholism New Knowledge and Responses (edited by G. Edwards and M. Grant); p. 279. London, 1977. 3. Armour, D. J., Polich, J. M., Stambul, H. B. Management of Alcoholism.
London, 1977.
