833
HLA-typing of the family members revealed no correlation HLA-type and either manifest disease or serological reactivity to M.F.C.F.
wrath’". The house-surgeon took the hint and apologised to the technician. When the technician telephoned back a few minutes later his attitude was very different.
Department of Dermatology, Division of Experimental Allergy, University Hospital, Utrecht, Netherlands
Cardiac Department, Aberdeen Royal Infirmary Aberdeen AB9 2ZB
between
G. DE RIDDER L. BERRENS
’
Commentary from Westminster
CHEMOTHERAPY IN BREAST CANCER
SiR,—The results of our first multimodal study in stage-u breast cancer, when analysed at Jan. 31, 1978, confirmed the trend already noted, showing a statistically significant benefit to patients given six courses of the two-day per month chemotherapy in addition to local standard therapy. The likelihood of progressive cancer being demonstrated in such patients two years after admission to the study is 2 5 times less than that of the control group who received no additional chemotherapy. As a result of this advantage we felt it unethical to continue with a no-chemotherapy group, and recruitment to that study has been terminated. Furthermore, whilst the chemotherapy utilised is certainly of at least short-term benefit to the patients it does fail to give complete protection and it does take up two days per month. In our latest trial we have as the control patients receiving two-day chemotherapy as previously. This is compared with a one-day regimen, both administered for six months. Furthermore, in view of the interest in anti-oestrogen compounds, tamoxifen for twelve months comprises the third limb of the study. When the six months of chemotherapy has been completed, patients in the chemotherapy groups are re-randomised to six months of tamoxifen or no further therapy. It is hoped that this design will answer a number of questions about the relative separate or combined roles of these treatments. Participation in this trial need not influence primary surgical treatment or policy on radiotherapy, provided that the intent is curative. Anyone interested in this project should contact the Chemotherapy Trial Secretariat, 127 Marlborough Park South, Belfast BT9 6HW. Northern Ireland Radiotherapy Centre, Belfast and Hume Street Hospital, Dublin
Charing
Cross
Hospital
G. A. EDELSTYN
Medical School, London
K. D. MACRAE
St. Thomas’ Hospital, London Royal Hospital, Wolverhampton
THELMA BATES G. KITCHEN N. T. NICOL MARGARET SPITTLE
Royal Infirmary, Leicester Middlesex
Hospital,
London
DETERIORATING RELATIONS
SIR,-Your Commentary from Westminster (March 18,
p.
deteriorating relations in the National Health Service makes sad reading. Your correspondent says that it is difficult to think of ways of improving relations. May I suggest one? It is that all members of staff, particularly the more senior and influential ones, should make it an unswerving practice to treat all other members of staff of whatever grade with courtesy, friendliness, and helpfulness. We owe much to the conscientious work of porters, ward maids, kitchen staff, telephonists, and others who do relatively uncongenial work for low pay. An anaesthetic colleague was in the ward one night waiting--seemingly interminably-for an emergency laboratory 617)
on
result before
decision could be made about an operation. The house-surgeon at length lost patience and telephoned the laboratory technician to ask why the ... he had not got the result yet. An even more irate voice came back which could be heard by all in the room. Whilst the tirade continued, the anesthetist whispered: "Remember, ’A soft answer turns away a
DAVID SHORT
From Our Parliamentary
Correspondent
Stormy Forecast Dr James Cameron, chairman of the B.M.A. Council, has been forecasting in recent speeches a long hot summer ahead and warning that this is the calm before the
Since he was referring to doctors’ pay, all the that he may be right. The report of the Review signs on Doctors’ and Dentists’ Remuneration went to Body the Prime Minister last week,- which means that its publication and the Gowernment’s response to it are only a matter of weeks away. At the same time Mr David Ennals, Secretary of State for Social Services, is considering this week the hospital consultants’ new contract which has been under negotiation for the past year. He is likely to make a formal Government offer towards the end of the month. These two events alone will ensure a lively period ahead. For the Government the overriding factor in reaching decisions will be the need to continue the battle against inflation and to apply the pay policy to doctors and consultants as it has been applied to every other section of the community. In other words, anyone expecting more than the global 10% increase is in for a disappointment. Last year’s report from the Review Body, which recommended the maximum phase-two rise of z208 a year, was dominated by concern about anomalies in the profession’s pay which had built up during four years of pay restraint. It warned the Government not to take for granted the medical profession’s continuing compliance with incomes policy if the injustices persisted indefinitely. Dr Cameron said last week that many doctors now thought the Review Body was on trial. "If the Government do not take the opportunity to give more than just a token increase to doctors then the whole future of British medicine could be in jeopardy. It has not been simply the buildings of the last century on which the health service has relied over the past 30 years. It has been the still considerable tradition of service that went with them. This goodwill has now run out". Doctors are hoping that the Review Body will go even further than last year and suggest a positive way of redressing the anomalies which have accumulated. The Conservative Opposition would like to see the profession given some sort of firemen’s deal-a 10% rise now with the promise of further increases for a substantial period ahead, underwritten by an agreement that they would not be thwarted by future pay restraint. But such an outcome storm.
are
seems
highly unlikely.
In Government circles it is expected that the consultants may end up marginally more satisfied than the general practitioners. Negotiations on their new contract are now complete and this time there is rather more optimism on both sides about the outcome. The aim is
HLA-typing of the family members revealed no correlation HLA-type and either manifest disease or serological reactivity to M.F.C.F.
wrath’". The house-surgeon took the hint and apologised to the technician. When the technician telephoned back a few minutes later his attitude was very different.
Department of Dermatology, Division of Experimental Allergy, University Hospital, Utrecht, Netherlands
Cardiac Department, Aberdeen Royal Infirmary Aberdeen AB9 2ZB
between
G. DE RIDDER L. BERRENS
’
Commentary from Westminster
CHEMOTHERAPY IN BREAST CANCER
SiR,—The results of our first multimodal study in stage-u breast cancer, when analysed at Jan. 31, 1978, confirmed the trend already noted, showing a statistically significant benefit to patients given six courses of the two-day per month chemotherapy in addition to local standard therapy. The likelihood of progressive cancer being demonstrated in such patients two years after admission to the study is 2 5 times less than that of the control group who received no additional chemotherapy. As a result of this advantage we felt it unethical to continue with a no-chemotherapy group, and recruitment to that study has been terminated. Furthermore, whilst the chemotherapy utilised is certainly of at least short-term benefit to the patients it does fail to give complete protection and it does take up two days per month. In our latest trial we have as the control patients receiving two-day chemotherapy as previously. This is compared with a one-day regimen, both administered for six months. Furthermore, in view of the interest in anti-oestrogen compounds, tamoxifen for twelve months comprises the third limb of the study. When the six months of chemotherapy has been completed, patients in the chemotherapy groups are re-randomised to six months of tamoxifen or no further therapy. It is hoped that this design will answer a number of questions about the relative separate or combined roles of these treatments. Participation in this trial need not influence primary surgical treatment or policy on radiotherapy, provided that the intent is curative. Anyone interested in this project should contact the Chemotherapy Trial Secretariat, 127 Marlborough Park South, Belfast BT9 6HW. Northern Ireland Radiotherapy Centre, Belfast and Hume Street Hospital, Dublin
Charing
Cross
Hospital
G. A. EDELSTYN
Medical School, London
K. D. MACRAE
St. Thomas’ Hospital, London Royal Hospital, Wolverhampton
THELMA BATES G. KITCHEN N. T. NICOL MARGARET SPITTLE
Royal Infirmary, Leicester Middlesex
Hospital,
London
DETERIORATING RELATIONS
SIR,-Your Commentary from Westminster (March 18,
p.
deteriorating relations in the National Health Service makes sad reading. Your correspondent says that it is difficult to think of ways of improving relations. May I suggest one? It is that all members of staff, particularly the more senior and influential ones, should make it an unswerving practice to treat all other members of staff of whatever grade with courtesy, friendliness, and helpfulness. We owe much to the conscientious work of porters, ward maids, kitchen staff, telephonists, and others who do relatively uncongenial work for low pay. An anaesthetic colleague was in the ward one night waiting--seemingly interminably-for an emergency laboratory 617)
on
result before
decision could be made about an operation. The house-surgeon at length lost patience and telephoned the laboratory technician to ask why the ... he had not got the result yet. An even more irate voice came back which could be heard by all in the room. Whilst the tirade continued, the anesthetist whispered: "Remember, ’A soft answer turns away a
DAVID SHORT
From Our Parliamentary
Correspondent
Stormy Forecast Dr James Cameron, chairman of the B.M.A. Council, has been forecasting in recent speeches a long hot summer ahead and warning that this is the calm before the
Since he was referring to doctors’ pay, all the that he may be right. The report of the Review signs on Doctors’ and Dentists’ Remuneration went to Body the Prime Minister last week,- which means that its publication and the Gowernment’s response to it are only a matter of weeks away. At the same time Mr David Ennals, Secretary of State for Social Services, is considering this week the hospital consultants’ new contract which has been under negotiation for the past year. He is likely to make a formal Government offer towards the end of the month. These two events alone will ensure a lively period ahead. For the Government the overriding factor in reaching decisions will be the need to continue the battle against inflation and to apply the pay policy to doctors and consultants as it has been applied to every other section of the community. In other words, anyone expecting more than the global 10% increase is in for a disappointment. Last year’s report from the Review Body, which recommended the maximum phase-two rise of z208 a year, was dominated by concern about anomalies in the profession’s pay which had built up during four years of pay restraint. It warned the Government not to take for granted the medical profession’s continuing compliance with incomes policy if the injustices persisted indefinitely. Dr Cameron said last week that many doctors now thought the Review Body was on trial. "If the Government do not take the opportunity to give more than just a token increase to doctors then the whole future of British medicine could be in jeopardy. It has not been simply the buildings of the last century on which the health service has relied over the past 30 years. It has been the still considerable tradition of service that went with them. This goodwill has now run out". Doctors are hoping that the Review Body will go even further than last year and suggest a positive way of redressing the anomalies which have accumulated. The Conservative Opposition would like to see the profession given some sort of firemen’s deal-a 10% rise now with the promise of further increases for a substantial period ahead, underwritten by an agreement that they would not be thwarted by future pay restraint. But such an outcome storm.
are
seems
highly unlikely.
In Government circles it is expected that the consultants may end up marginally more satisfied than the general practitioners. Negotiations on their new contract are now complete and this time there is rather more optimism on both sides about the outcome. The aim is
