Community care or the underclass? SIR,-Mrs X, a landlady in Troon, is giving up. Her seven residents will have to move somewhere else-not perhaps obvious headline news. She is one of five landladies who have catered in south Ayrshire for psychiatric patients being rehabilitated. Her residents between them have put in over 100 years in Ailsa Hospital. Mrs X is a psychiatric nurse who found a way of caring in a domestic setting. In accordance with the ethos of the day she decided to become self employed. Mrs X’s tenants have been happy. They have a self-determination and self-respect they deserve. The food is good and they can come and go as they please. Some are in employment training, some come back to the hospital daily, some regard themselves as retired and have learnt to take their leisure. The psychiatric rehabilitation service in Ayrshire watches over five lodging houses of this kind and roughly fifty tenants. The scheme has been a great success. It has the almost universal approval of the residents and provides one of a range of rehabilitation options the service can offer. Mrs X reports a number of difficulties. She has had to negotiate endlessly with the local housing department and the Department of Social Security for each tenant. Funding often arrives weeks late-unfailingly so with every change to the regulations. She points out that there has been no increment in the past few years despite the cost of living rises. She feels she has to plead for her rights, as if seeking charity, and reminds one that she works 7 days a week, and is on call 24 hours a day. Are we living in a caring community, planning an extension to community care, or are we living in the society described in your June 2 editorial on the underclass? Ailsa

Hospital, Ayr KA6 6AB, UK

Research and



in the UK

SIR,-Your June 16 editorial gives much-needed publicity to ophthalmological research and to the Institute of Ophthalmology which, because of its association with Moorfields Eye Hospital, has an unrivalled opportunity to set the standards for the UK. However, your editorial presents a factually incorrect account ofa site visit, in February, to advise on research strengths and weaknesses and opportunities for future work. The visit, one of a series of assessments of British Postgraduate Medical Federation (BPMF) institutes, was planned in conjunction with the institute, including the documentation, programme, and composition of the review group. The background is important. The institute was not rated highly by the University Grant Committee and received a rating of 3 in the research selectivity exercise by the Universities Funding Council. The department of visual science was singled out for special commendation; without its contribution the U rating might have been lower. The importance of ensuring academic quality relates particularly to the institute’s relationship to Moorfields Special Health Authority (SHA). On May 25 the Department of Health announced that the SHAs, in recognition of their national role, would contract directly with the Department for the clinical services necessary to sustain their research, development, and teaching functions. The BPMF, as a postgraduate medical school providing the academic infrastructure for seven postgraduate hospitals, has to ensure that its research is nationally and internationally competitive and rated as such by independent reviewers. The special pleading in the editorial is unhelpful. The purpose of the site visit was to correct the very deficiencies identified. The aim is to strengthen ophthalmological research by creating a strong focus of activity at the Institute of Ophthalmology. This includes applied research in those areas detailed in the third paragraph of the editorial upon which "the Institute had built its enviable reputation during the first four decades of its existence". The assertion that the modification "would bolster neurobiology" at the expense of other work is absurd, given that a key component of future work will be based around the new Duke-Elder professor of ophthalmology, soon to be appointed.

We look forward to being invited to contribute to your columns when the impressive new research structure of the Institute of Ophthalmology is in place and the active members have been given their head to develop high quality research of which the specialty can be proud. British Postgraduate Medical Federation, 33 Millman Street, London WC1 N 3EJ, UK


Institute of London






Embryo research SIR,-I found your April 21 editorial on embryo experimentation and abortion puzzling and disturbing. On the one hand, you support a two week limit for experiments with preimplantation human lives, yet on the other you endorse abortion on demand up to 24 weeks. This inconsistency is ignored in your review of these important issues. If, as you assert, abortion of the unwanted or handicapped fetus is perfectly acceptable until 24 weeks, why not experiment with these individuals before termination? Why should the will of scientists be thwarted by an arbitrary two week limit? The logic of the view that scientists might be experimenting with two rather than one individual escapes me. You state that this is an important and difficult area but fail to discuss what is important or difficult about it. Religious points of view often do play a part in this debate. What is not apparent, however, is that many of those who support abortion and embryo experimentation also have a strong faith system. The core of this debate does not so much revolve around religion, science, or philosophy but rather around the notion of justice. How we treat the sick, the handicapped, the unwanted, both before and after birth, will determine the kind of society we will have. When our society assents to the mass destruction of individuals before they are born and to experimentation with preimplantation human lives then we have surely entered the twilight of justice. St Boniface General Hospital, Winnipeg, Manitoba, Canada R2H



Iron overload, free radical damage, and rhesus haemolytic disease SIR,-Dr Berger and colleagues (April 21, p 933) report the induction of reactive-oxygen-radical-mediated oxidative damage to biomolecules by iron-overload in infants with rhesus haemolytic disease. However, since the precise molecular nature of metal ions plays a dominant part in the determination of their activity in biological systems, Berger and colleagues’ aim would have been better served if they had used more selective analytical techniques. Indeed, we strongly believe analytical systems to identify precisely (and quantify) chemical components in biological matrices are the best methods to obtain a detailed molecular "picture" of abnormal metabolites that are mediators of, or derived from, the deleterious generation of reactive oxygen radical species. Data thus obtained enable the researcher to accurately correlate such abnormalities with various stages of the disease. In this context Berger et al state that vitamin C was measured as "total vitamin C", which presumably includes dehydroascorbate as well as ascorbate. These species differ strikingly in their ability to scavenge free radicals: for example, ascorbate itself is an excellent scavenger of the highly reactive hydroxyl radical (’OH), whereas dehydroascorbate is more lipophilic and therefore may affect membrane lipid peroxidation. Moreover, Berger and colleagues’ measurement of total plasma sulphydryl (-SH) groups mainly estimated the poorly reactive single -SH group of human albumin (cysteine-34), and hence is largely a reflection of the concentration of this protein in the plasma samples. Furthermore, much of the toxicity derived from the excess production of superoxide ion (02) and hydrogen peroxide (H202) in biological systems is attributable

Embryo research.

1530 Community care or the underclass? SIR,-Mrs X, a landlady in Troon, is giving up. Her seven residents will have to move somewhere else-not perhap...
174KB Sizes 0 Downloads 0 Views