BRITISH MEDICAL JOURNAL
1214
7 MAY 1977
CORRESPONDENCI Commitment to oncology W H Bond, FRCS, FRCR; Eve Wiltshaw, MD, and others; S Dische, FRCR .......... Hygiene in NHS hospitals G A J Ayliffe, MD, and B J Collins, AIMLS. . Coronary heart disease and the menopause A Elkeles, FFRRCSI; P G T Bye, MB ...... Useless warning A W Fowler, FRCS .................... Breath, alcohol, and the law B M Wright, MB ............... Night visiting by general practitioners I C Gilchrist, MRCGP; M J Buxton, BA, and R E Klein,MA ............... New strategies for drug monitoring D L Crombie, FRCGP ............... Cutting the drug bill M M Lubel, MB, and A K Sinha, MB....
Staffing in the medical laboratory service 1214 1 M Talbot, FRCPATH, and others; Anne .......... Green, MSC, and others ...... 1215 Experiments with computers T J R Benson, MSC, and A D Cundy, BSC. Pelusions of parasitosis J Roberts, FRCGP, and Raine E I Roberts, 1215 MRCGP; A Munro, MD; R Edwards, FRES.. of bone metastases 1216 Detection N W Garvie, MRCP .1220 Raised mean cell volume and 1216 Mycoplasma pneumoniae infection .......... R R Khaund, MRCPATH ...... Gross oedema during treatment for 1217 depression S K Pathak, MB .1220 1217 Test antiserum for group B meningococci 1218 J B Robbins, MD .1220
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Correspondents are urged to write briefly so that readers may be offered as wide a selection of letters as possible. So many are being received that the omission of some is inevitable. Letters should be signed personally by all their authors.
Commitment to oncology SIR,-I and many others in the specialty of radiotherapy find it difficult to understand the true objectives behind your leading article under the above title (2 April, p 864), inspired as it clearly was by a very sanctimonious document emanating from the Department of Health and Social Security issued to regional medical officers for consideration by their advisory committees on radiotherapy and oncology. Why is it that the superior position of the radiotherapist as an authority on cancer and his experience of oncology and chemotherapy are not accepted ? There is no other group of specialists who spend their whole time dealing with malignancy and the physical and psychological problems that the disease presents. Is it that, as with all the advice and opinions emanating from the DHSS, only the conditions observed in London are considered, where the radiotherapist unhappily does not hold the position of respect accorded to him in the provinces with few open clinics and limited opportunity for total care of the patient? Provincial practice concentrates the care of malignancy in the hands of the radiotherapist, who for many years has included chemotherapy in his armamentarium. Radiotherapy has always been oncology and as a group it is likely that radiotherapists have vastly more experience in the use of chemotherapeutic agents than any other consultants- including the medical oncologists advertised in your article. Do the DHSS and the BMA have some strange idea that the training of a radiotherapist differs so very much from that postulated for a medical oncologist ? My colleagues, with the FRCS or the MRCP, are not failed surgeons or physicians, they too "saw the needs of this branch of medicine and felt compelled to enter it," their interest in oncology was no less than those who "felt compelled to enter it before there was any assurance of a career." But unlike
the medical oncologist they have more to offer than the administration of one or more of the 30-odd active antimitotics in various combinations. Radiotherapists are trained to assess the whole patient problem and to undertake or advise hormonal manipulation, chemotherapy, radiotherapy, surgery, and general physicianly management in an effort to give the best possible life to the patient. Their training too includes "pharmacology, biochemistry, and cell biology" and they too will set out "on long courses of training to become proficient as general physicians"-and surgeons-because they too recognise "the need to maintain a strong link with the parent discipline." Radiotherapy departments are able to absorb the physical and psychological problems of cancer chemotherapy, few are without full statistical support for the organisation of controlled trials, and they can all offer more than the limited armament of the medical oncologist. Rather than encourage the medical oncologist, with his limited ability and uncertain position in cancer management both the DHSS and the BMA should foster the radiotherapist and promote the concept of "radiotherapist and clinical oncologist" recommended by the Royal College of Radiologists. Chemotherapy is not an established science; it remains an empirical art with a success rate far lower than that achieved by either radiotherapy or surgery. There is no need for a medical oncologist; those interested in the management of malignant disease would be far wiser to become complete oncologists by seeking the fellowship of the Royal College of Radiologists which, combined with a full training in medicine or surgery, results in a broader and more balanced attack to be made on the disease. W H BoND Queen Elizabeth Hospital, Birmingham
"Insects and history" J L Cloudsley-Thompson, DSC .......... 1220 Gluten-free diet in dermatitis herpetiformis R C Heading, MRCP, and R StC Barnetson, MRCP
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.....................
Emergency treatment of hypercalcaemia J A Child, MD ................. The anaesthetist's visit E LI Lloyd, FFARCS ................. What to tell the employer J M Goldman, MRCP ................. Closure of GP maternity units A R Dewsbury, MRCGP ................ Urgent action needed J A Aitken, AMRCPSYCH, and C J Hughes, MB
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1221
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SIR,-Your leading article (2 April, p 864) correctly points out the growing need for medical oncology as a specialty while highlighting the somewhat bleak career prospects for those interested in it. Although the creation of and appointments to oncology posts are a local affair, it is important that doctors contemplating this career should know of the possible opportunities in Britain and of the most likely ways of exerting pressure to increase them. The Oncology Club' provides a monthly meeting for would-be oncologists to discuss (among other things) this kind of issue. Although the outlook may be far from bright at present, we feel that co-ordinated effort and co-operation may be a useful force to improve it and eventually to establish a specialty of medical oncology sufficiently secure to meet the increasing demand for it. EVE WILTSHAW President,
ROBERT BUCKMAN DAVID MITCHELL Secretaries, The Oncology Club c'o Royal Marsden Hospital, London SW3 I
Wiltshaw, E, et al, Lancet, 1977, 1, 699.
SIR,-In your leading article (2 April, p 864) "Commitment to oncology" there is a strong demand for the creation of a separate specialty of medical oncology, presumably to reach down to the district hospital level. The setting up of separate specialties of medical oncology, surgical oncology, and radiotherapeutic oncology on the American pattern can however, be questioned. The organisation of discrete medical specialties within oncology does not necessarily lead to the good co-operation which is so important in management, and can often be wasteful in resources. There tends to be an exclusion of those general and specialised physicians and surgeons who must continue to contribute to the treatment of patients with malignant disease. A more rational and economic scheme is to set up a single specialty of oncology to embrace those who now practise in "medical oncology" and
1214
7 MAY 1977
CORRESPONDENCI Commitment to oncology W H Bond, FRCS, FRCR; Eve Wiltshaw, MD, and others; S Dische, FRCR .......... Hygiene in NHS hospitals G A J Ayliffe, MD, and B J Collins, AIMLS. . Coronary heart disease and the menopause A Elkeles, FFRRCSI; P G T Bye, MB ...... Useless warning A W Fowler, FRCS .................... Breath, alcohol, and the law B M Wright, MB ............... Night visiting by general practitioners I C Gilchrist, MRCGP; M J Buxton, BA, and R E Klein,MA ............... New strategies for drug monitoring D L Crombie, FRCGP ............... Cutting the drug bill M M Lubel, MB, and A K Sinha, MB....
Staffing in the medical laboratory service 1214 1 M Talbot, FRCPATH, and others; Anne .......... Green, MSC, and others ...... 1215 Experiments with computers T J R Benson, MSC, and A D Cundy, BSC. Pelusions of parasitosis J Roberts, FRCGP, and Raine E I Roberts, 1215 MRCGP; A Munro, MD; R Edwards, FRES.. of bone metastases 1216 Detection N W Garvie, MRCP .1220 Raised mean cell volume and 1216 Mycoplasma pneumoniae infection .......... R R Khaund, MRCPATH ...... Gross oedema during treatment for 1217 depression S K Pathak, MB .1220 1217 Test antiserum for group B meningococci 1218 J B Robbins, MD .1220
1218 1218 1219
1220
Correspondents are urged to write briefly so that readers may be offered as wide a selection of letters as possible. So many are being received that the omission of some is inevitable. Letters should be signed personally by all their authors.
Commitment to oncology SIR,-I and many others in the specialty of radiotherapy find it difficult to understand the true objectives behind your leading article under the above title (2 April, p 864), inspired as it clearly was by a very sanctimonious document emanating from the Department of Health and Social Security issued to regional medical officers for consideration by their advisory committees on radiotherapy and oncology. Why is it that the superior position of the radiotherapist as an authority on cancer and his experience of oncology and chemotherapy are not accepted ? There is no other group of specialists who spend their whole time dealing with malignancy and the physical and psychological problems that the disease presents. Is it that, as with all the advice and opinions emanating from the DHSS, only the conditions observed in London are considered, where the radiotherapist unhappily does not hold the position of respect accorded to him in the provinces with few open clinics and limited opportunity for total care of the patient? Provincial practice concentrates the care of malignancy in the hands of the radiotherapist, who for many years has included chemotherapy in his armamentarium. Radiotherapy has always been oncology and as a group it is likely that radiotherapists have vastly more experience in the use of chemotherapeutic agents than any other consultants- including the medical oncologists advertised in your article. Do the DHSS and the BMA have some strange idea that the training of a radiotherapist differs so very much from that postulated for a medical oncologist ? My colleagues, with the FRCS or the MRCP, are not failed surgeons or physicians, they too "saw the needs of this branch of medicine and felt compelled to enter it," their interest in oncology was no less than those who "felt compelled to enter it before there was any assurance of a career." But unlike
the medical oncologist they have more to offer than the administration of one or more of the 30-odd active antimitotics in various combinations. Radiotherapists are trained to assess the whole patient problem and to undertake or advise hormonal manipulation, chemotherapy, radiotherapy, surgery, and general physicianly management in an effort to give the best possible life to the patient. Their training too includes "pharmacology, biochemistry, and cell biology" and they too will set out "on long courses of training to become proficient as general physicians"-and surgeons-because they too recognise "the need to maintain a strong link with the parent discipline." Radiotherapy departments are able to absorb the physical and psychological problems of cancer chemotherapy, few are without full statistical support for the organisation of controlled trials, and they can all offer more than the limited armament of the medical oncologist. Rather than encourage the medical oncologist, with his limited ability and uncertain position in cancer management both the DHSS and the BMA should foster the radiotherapist and promote the concept of "radiotherapist and clinical oncologist" recommended by the Royal College of Radiologists. Chemotherapy is not an established science; it remains an empirical art with a success rate far lower than that achieved by either radiotherapy or surgery. There is no need for a medical oncologist; those interested in the management of malignant disease would be far wiser to become complete oncologists by seeking the fellowship of the Royal College of Radiologists which, combined with a full training in medicine or surgery, results in a broader and more balanced attack to be made on the disease. W H BoND Queen Elizabeth Hospital, Birmingham
"Insects and history" J L Cloudsley-Thompson, DSC .......... 1220 Gluten-free diet in dermatitis herpetiformis R C Heading, MRCP, and R StC Barnetson, MRCP
.........
.....................
Emergency treatment of hypercalcaemia J A Child, MD ................. The anaesthetist's visit E LI Lloyd, FFARCS ................. What to tell the employer J M Goldman, MRCP ................. Closure of GP maternity units A R Dewsbury, MRCGP ................ Urgent action needed J A Aitken, AMRCPSYCH, and C J Hughes, MB
................................
1220
1221
1221 1221
1221 1221
SIR,-Your leading article (2 April, p 864) correctly points out the growing need for medical oncology as a specialty while highlighting the somewhat bleak career prospects for those interested in it. Although the creation of and appointments to oncology posts are a local affair, it is important that doctors contemplating this career should know of the possible opportunities in Britain and of the most likely ways of exerting pressure to increase them. The Oncology Club' provides a monthly meeting for would-be oncologists to discuss (among other things) this kind of issue. Although the outlook may be far from bright at present, we feel that co-ordinated effort and co-operation may be a useful force to improve it and eventually to establish a specialty of medical oncology sufficiently secure to meet the increasing demand for it. EVE WILTSHAW President,
ROBERT BUCKMAN DAVID MITCHELL Secretaries, The Oncology Club c'o Royal Marsden Hospital, London SW3 I
Wiltshaw, E, et al, Lancet, 1977, 1, 699.
SIR,-In your leading article (2 April, p 864) "Commitment to oncology" there is a strong demand for the creation of a separate specialty of medical oncology, presumably to reach down to the district hospital level. The setting up of separate specialties of medical oncology, surgical oncology, and radiotherapeutic oncology on the American pattern can however, be questioned. The organisation of discrete medical specialties within oncology does not necessarily lead to the good co-operation which is so important in management, and can often be wasteful in resources. There tends to be an exclusion of those general and specialised physicians and surgeons who must continue to contribute to the treatment of patients with malignant disease. A more rational and economic scheme is to set up a single specialty of oncology to embrace those who now practise in "medical oncology" and
