1284

Cystic fibrosis screening: research alternatives needed report has drawn attention to a hiccup in the of a cystic fibrosis (CF) screening test based upon detection of the specific mutation(s). Apparently, 25 % of those with a defective gene have multiple, different mutations, making it almost impossible to develop a gene-based test that would be more than 75 % reliable-a disappointing development. The drive towards a CF-carrier test may have been impeded by overzealous emphasis on the identification of the CF gene. Research into other means of carrier testing has been discouraged or even suppressed. The line of argument seems to have been that alternative approaches were no longer needed because the CF gene would soon be identified and a reliable screening test would follow. Research into alternatives has been stifled by loss of financial and academic support and is no longer readily available. The study of circulating CF factors, with a view to a carrier test, started some 20 years ago with the observation by Spock et aP of a ciliary dyskinesia factor in blood of CF homozygotes and heterozygotes. Such factors apparently develop as a result of the genetic dysfunction so they are present whatever the specific mutation that causes the abnormal gene. Work on the ciliary dyskinesia factor has been suppressed by lack of funds and by difficulty in publishing on the topic. Another circulating CF factor is the CF-lectin factor that I have been investigating for the past ten years,2with the object of developing a reliable, simple screening test for CF carriers and then identifying the factor so that its relation to the gene defect might be established. Publication has been difficult, primarily because of the attitude of peer reviewers mentioned. Even though the development of a test for CF-lectin factor is almost complete (the requirements for its performance have been clarified and it is more than 95% reliable), research has almost come to a standstill because of lack of funds and loss of technical staff. Medical science must return to the days when scientifically sound multiple approaches were encouraged not discouraged. This issue is not unique to CF. Advisers should not ignore data presented in support of a research project; they should make objective decisions on the basis of the facts and ignore fashionable trends.

SIR,-A

news

development

Respiratory Disease Division, UCLA School of Medicine, Medical Center, Sepulveda, California 91343, USA 1.

people’s". Pathology Department, Western General Hospital, Edinburgh EH4 2XU, UK

fibrosis of the pancreas. Pediatr Res 1967; 1: 173-77. J, Schwartzman MN. Assay of a urinary CF-lectin factor diagnostic test for cystic fibrosis. Am J Med Sci 1990; 299: 103-06.

2. Lieberman

as a

second

laboratory services

SIR,-Every health services manager should read your excellent editorial on the lamentable attempts to reorganise laboratory services in Glasgow (May 5, p 1066). Unfortunately, your penetrating comments may come too late to influence moves to "rationalise" laboratory services by the Lothian Health Board. The measures proposed could prove even more catastrophic than those in Glasgow, yet they have had no publicity. Lothian has three major acute hospitals (north Edinburgh, south Edinburgh, and West Lothian) all with their own laboratories on site. To avoid competitive tendering the health board has initiated a review of laboratory services. The proposals or options are well advanced for clinical chemistry and include the appointment of a laboratory manager and centralisation of the service on one site. Approval of these proposals (as seems likely) would suggest that the Lothian Health Board or its advisory committee has very little conception of the role of a modern laboratory service in hospital practice. As your editorial states, most people with first-hand experience of laboratories know that laboratory medicine is an integral component of clinical medicine. A centralised service would set back hospital medicine in Edinburgh 30 years. There is evidence that the other laboratory disciplines would quickly follow a similar reorganisation. A manager overseeing a centralised laboratory could hardly understand the role of that service.

J. N. WEBB

Charity and the NHS SiR,—Malcolm Dean (May 5, p 1085) cites the Worthing waiting list initiative as demonstrating a need for the reassessment of charities in the National Health Service. There are just two things that he should remember. Firstly, although "donation poaching had become endemic" the all-powerful media support given to national campaigns has resulted in enormous sums of money being siphoned from local charitable activities, and we see, as Dean explains, that many of the larger teaching and postgraduate hospitals have considerable trust funds which allow them to spend the income in pretty well any way that they decide is consistent with the charitable fund. Secondly, why shouldn’t the people of Worthing with serious sometimes debilitating conditions not contribute, if they wish, to a charitable fund where they can actually see in their daily life the results that their contributions have produced? Furthermore, until some sort of attempt has been made to prove the truth of his statement, "Affluent Worthing will always be able to raise four or five times as much as troubled Wigan", this does not in fact form a reliable argument. Creekside, Greenacres, Birdham, Chichester, West Sussex PO20 7HL, UK

JACK LIEBERMAN

Spock A, Heick H, Cress H, Logan WS. Abnormal serum factor in patients with cystic

Centralised

The deplorable events in Edinburgh do not end here. The stimulus for reorganising the laboratories was, presumably, financial savings and cost-effectiveness. These have been ignored completely. The cost of the reorganisation remains uncalculated; given the problems the Lothian Health Board has with their finances the cost may prove incalculable. The planned centralisation would be clinically disastrous; the managerial implications could prove a nightmare for heads of department of National Health Service laboratories trying to run an efficient and cost-effective service; and the health board cannot demonstrate any economic benefits. It was Bismarck who said, in effect, that "fools learn by their own experience, wise men by other

M. W. N. NICHOLLS

Embryo research SiR,—This reply to your April 21 editorial is delayed. I did not want "screaming match" and also wondered how to convey

to be part of a

the calm fairness and moral fortitude expressed by Cardinal Hume in The Times of March 16. Laws code for society’s attitudes, actions, and conventions which are believed to be ethical. Ethics is concerned with the moral positions which ought to be adopted by a society, a group, or an individual. However, laws may not always embrace what is morally right. My study of medical ethics has highlighted the differences between utilitarianism, which judges actions to be correct according to their consequences, and deontology, which relies on moral rules which are absolute. We are essentially a utilitarian society, justifying research on human embryos of less than 14 days’ development either by devaluing them ("not people") or by being convinced that the benefits far outweigh the harm done to the developing embryo (its death); and we justify abortion by emphasising compassion on those who do not want to have a child. Your editorial rejects the suggestion that the Human Fertilisation and Embryology Bill, if enacted, will cause "incalculable harm" to society. Hume went deeper than that. He was arguing that abandoning respect for human life, fundamental human dignity, and basic and unconditional respect for each other (independent of our state of development, degree of handicap, or of how much we are "wanted") would harm our society. Moral absolutism is not popular today: we prefer the nebulous concept of actions being "acceptable" or "unacceptable" rather than "right" or "wrong". Abortion is "acceptable" because 54% of the British citizens interviewed in 1987 believed "a woman should not be forced to carry a child she does not want" and because an Act of Parliament

Centralised laboratory services.

1284 Cystic fibrosis screening: research alternatives needed report has drawn attention to a hiccup in the of a cystic fibrosis (CF) screening test b...
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