980
Gynaecologists’ attitudes to abortion SIR,-We agree with Mr Stewart and Dr Cohn (Jan 20, p 173) that a better service would be provided for women seeking termination of pregnancy if these operations were done in special units within the National Health Service so that fewer doctors were involved. The mortality and morbidity of non-NHS abortions is known to be less than seen in those done in the NHS. This difference is probably mostly attributable to the greater skill of those in the private and charitable sector where a few people do about the same number of operations in a year as are done by the many NHS consultant and trainee gynaecologists. Another factor in favour of separate units is that it is more easily ensured that doctors and nurses not wanting to take part in this work do not have to do so. In our survey, however, most gynaecologists who replied did not think that medical or nursing staff attitudes affected their ability to run an abortion service, and only a few made comments such as "nursing staff do not allow late abortions". There was considerable support from those in England and Wales for the idea of separate abortion units although only a quarter favoured the creation of a subspeciality of "fertility control". In Scotland where gynaecologists do over 90% of the abortions in the NHS (compared with 40% in England and Wales) there was less support for this idea. We have full details of these responses, which also show that gynaecologists in England and Wales tend to overestimate the proportion of abortions that they do in their districts. We therefore suspect that the reasons for the discrepancy between the legal and personal limits may be more complex than your correspondents believe. Joint Academic Department of General Practice and Primary Care, London Hospital Medical College, London E1 1BB, UK
WENDY SAVAGE
Department of Sociology, Middlesex Polytechnic, London
COLIN FRANCOME
such evidence has been used in a British court, and it has been presented in several US cases. In July, 1989, the Court of Appeal set aside a sentence of three years’ imprisonment on a heroin addict for armed robbery, substituting a probation order with conditions which included the supervised administration of naltrexone and monitoring of hair samples. The three judges mentioned both hair analysis and naltrexone as reasons for making an exception in a case where a custodial sentence would otherwise have been unsurprising.l,2 In November, 1989, evidence of morphine concentrations in successive samples of hair supported the claim of a heroin addict that the relatively large amount of heroin found in his possession reflected his especially large heroin "habit". A sample of hair from the period shortly before his arrest gave a reading of 519 ng/per 10 g, the highest level the laboratory had ever recorded. By the time of his trial three months later, hair and urine analysis confirmed that he had stopped using heroin. He was sentenced to 18 months in prison, the judge indicating that this was the lightest custodial sentence he could impose; three months later, the Appeal Court set aside the prison sentence and substituted a probation order, citing the previous case as a precedent and adding identical conditions. As indicated by Strang and colleagues, much of the research in this area has been done by Dr A. M. Baumgartner, and we send our samples to his laboratory in Santa Monica, California. Quantitative analysis is available for cocaine and morphine and qualitative analysis for cannabis. The range of detectable drugs is being
expanded. At a time of increasing interest in non-custodial sentences for drug-related offenders, hair testing is an important development. However, its potential will not be realised unless some senior members of the Probation Service abandon their "philosophical objections" to the attachment of conditions, including medical treatment and monitoring, to probation orders.3,4 The Stapleford Centre, 25a Eccleston Street, London SW1W 9NP, UK
COLIN BREWER
1. R v Warburton Court of Appeal
(July 8, 1989) 89/2442/W2.
2. Brewer C. Probation-linked disulfiram
or naltrexone with chemical monitoring. symposium of Society for the Study of Addiction (Leicester, November, 1989). Br J Addict 1989; 84: 1389 (abstr).
DNA and the law SIR,-Mr Philip Webb (March 10,
p
Presented at annual
608) infers that the claims
relating to the very high power of exclusion of conventional blood tests are incorrect because in only 20% of cases are exclusions obtained. This is not true. What Webb does not explain is that the number of cases in which an exclusion of paternity is demonstrated depends not only on the efficiency of the test but also on the actual number of non-fathers in the cases investigated. If for instance in only 20% of the cases investigated the man tested is not the child’s father, then no matter how efficient the testing, even if it excluded 100% of wrongly named men, exclusions will be obtained in only 20% of cases. The fact that in as many as 20% of cases the man tested is wrongly named as the child’s father may surprise many people. Indeed our own experience of conventional testing with a power to exclude 99% of wrongly named men also shows exclusion of paternity in a similar percentage of cases. Webb cites the many cases referred for DNA profiling following "inconclusive" conventional testing. He does not indicate, however, how many of these cases have yielded exclusion of paternity by DNA profiling which was not disclosed by conventional testing or the potential efficiency of the conventional testing used. Department of Haematology, London Hospital Medical College, London E1 2AD, UK
P.
National Blood Transfusion Service, Lancaster
D. LEE
J. LINCOLN
Hair analysis for drugs of abuse SIR,—Although I was interested to learn from Dr Strang and colleagues (March 24, p740) that hair analysis for opioids and other illicit drugs can now be done in Britain, this is not the first time that
3. Committee of Public Accounts. Seventh report: Home Office: control and management of probation services in England and Wales. London: H M Stationery Office, 1990. 4. Brewer C. Probation-linked supervised naltrexone: a new approach to the management of heroin-related offences. Law Soc Gaz 1986; 83: 985-86.
European charter on environment and
health
SIR,-When the UK Government adopted the European charter environment and health, at the first joint meeting of
on
Environment and Health Ministers of the member countries of the World Health Organisation’s (WHO) European region (March 17, p 652), it made a commitment on our behalf no less impressive than was its endorsement of the WHO "Targets for Health for All" in 1984. Lancet readers will have been pleased to note the Government’s acceptance that "The health of individuals and communities should take clear precedence over considerations of economy and trade". Of equal interest, however, are the thirty-one other entitlements and responsibilities, principles for public policy, strategic elements, and priorities that make up the charter. Together they constitute a wide-ranging national strategy for both health conscious environmental policy and environmentally sound health policy. The final section "The Way Forward" accepts the needs to "take all necessary steps to reverse negative trends as soon as possible" and to "promote the widest possible endorsement of the principles and attainment of the objectives of the Charter". It is clearly in the public interest that as many individuals and organisations as possible should request the charter from WHO and publicise it widely. It should also be noted that the European Commission has adopted the charter as a guideline for future action in areas that lie within its competence. 218 Allerton Road, Liverpool L186JN, UK
ALEX
SCOTT-SAMUEL,
Chairman, Public Health Alliance Executive Committee
Gynaecologists’ attitudes to abortion SIR,-We agree with Mr Stewart and Dr Cohn (Jan 20, p 173) that a better service would be provided for women seeking termination of pregnancy if these operations were done in special units within the National Health Service so that fewer doctors were involved. The mortality and morbidity of non-NHS abortions is known to be less than seen in those done in the NHS. This difference is probably mostly attributable to the greater skill of those in the private and charitable sector where a few people do about the same number of operations in a year as are done by the many NHS consultant and trainee gynaecologists. Another factor in favour of separate units is that it is more easily ensured that doctors and nurses not wanting to take part in this work do not have to do so. In our survey, however, most gynaecologists who replied did not think that medical or nursing staff attitudes affected their ability to run an abortion service, and only a few made comments such as "nursing staff do not allow late abortions". There was considerable support from those in England and Wales for the idea of separate abortion units although only a quarter favoured the creation of a subspeciality of "fertility control". In Scotland where gynaecologists do over 90% of the abortions in the NHS (compared with 40% in England and Wales) there was less support for this idea. We have full details of these responses, which also show that gynaecologists in England and Wales tend to overestimate the proportion of abortions that they do in their districts. We therefore suspect that the reasons for the discrepancy between the legal and personal limits may be more complex than your correspondents believe. Joint Academic Department of General Practice and Primary Care, London Hospital Medical College, London E1 1BB, UK
WENDY SAVAGE
Department of Sociology, Middlesex Polytechnic, London
COLIN FRANCOME
such evidence has been used in a British court, and it has been presented in several US cases. In July, 1989, the Court of Appeal set aside a sentence of three years’ imprisonment on a heroin addict for armed robbery, substituting a probation order with conditions which included the supervised administration of naltrexone and monitoring of hair samples. The three judges mentioned both hair analysis and naltrexone as reasons for making an exception in a case where a custodial sentence would otherwise have been unsurprising.l,2 In November, 1989, evidence of morphine concentrations in successive samples of hair supported the claim of a heroin addict that the relatively large amount of heroin found in his possession reflected his especially large heroin "habit". A sample of hair from the period shortly before his arrest gave a reading of 519 ng/per 10 g, the highest level the laboratory had ever recorded. By the time of his trial three months later, hair and urine analysis confirmed that he had stopped using heroin. He was sentenced to 18 months in prison, the judge indicating that this was the lightest custodial sentence he could impose; three months later, the Appeal Court set aside the prison sentence and substituted a probation order, citing the previous case as a precedent and adding identical conditions. As indicated by Strang and colleagues, much of the research in this area has been done by Dr A. M. Baumgartner, and we send our samples to his laboratory in Santa Monica, California. Quantitative analysis is available for cocaine and morphine and qualitative analysis for cannabis. The range of detectable drugs is being
expanded. At a time of increasing interest in non-custodial sentences for drug-related offenders, hair testing is an important development. However, its potential will not be realised unless some senior members of the Probation Service abandon their "philosophical objections" to the attachment of conditions, including medical treatment and monitoring, to probation orders.3,4 The Stapleford Centre, 25a Eccleston Street, London SW1W 9NP, UK
COLIN BREWER
1. R v Warburton Court of Appeal
(July 8, 1989) 89/2442/W2.
2. Brewer C. Probation-linked disulfiram
or naltrexone with chemical monitoring. symposium of Society for the Study of Addiction (Leicester, November, 1989). Br J Addict 1989; 84: 1389 (abstr).
DNA and the law SIR,-Mr Philip Webb (March 10,
p
Presented at annual
608) infers that the claims
relating to the very high power of exclusion of conventional blood tests are incorrect because in only 20% of cases are exclusions obtained. This is not true. What Webb does not explain is that the number of cases in which an exclusion of paternity is demonstrated depends not only on the efficiency of the test but also on the actual number of non-fathers in the cases investigated. If for instance in only 20% of the cases investigated the man tested is not the child’s father, then no matter how efficient the testing, even if it excluded 100% of wrongly named men, exclusions will be obtained in only 20% of cases. The fact that in as many as 20% of cases the man tested is wrongly named as the child’s father may surprise many people. Indeed our own experience of conventional testing with a power to exclude 99% of wrongly named men also shows exclusion of paternity in a similar percentage of cases. Webb cites the many cases referred for DNA profiling following "inconclusive" conventional testing. He does not indicate, however, how many of these cases have yielded exclusion of paternity by DNA profiling which was not disclosed by conventional testing or the potential efficiency of the conventional testing used. Department of Haematology, London Hospital Medical College, London E1 2AD, UK
P.
National Blood Transfusion Service, Lancaster
D. LEE
J. LINCOLN
Hair analysis for drugs of abuse SIR,—Although I was interested to learn from Dr Strang and colleagues (March 24, p740) that hair analysis for opioids and other illicit drugs can now be done in Britain, this is not the first time that
3. Committee of Public Accounts. Seventh report: Home Office: control and management of probation services in England and Wales. London: H M Stationery Office, 1990. 4. Brewer C. Probation-linked supervised naltrexone: a new approach to the management of heroin-related offences. Law Soc Gaz 1986; 83: 985-86.
European charter on environment and
health
SIR,-When the UK Government adopted the European charter environment and health, at the first joint meeting of
on
Environment and Health Ministers of the member countries of the World Health Organisation’s (WHO) European region (March 17, p 652), it made a commitment on our behalf no less impressive than was its endorsement of the WHO "Targets for Health for All" in 1984. Lancet readers will have been pleased to note the Government’s acceptance that "The health of individuals and communities should take clear precedence over considerations of economy and trade". Of equal interest, however, are the thirty-one other entitlements and responsibilities, principles for public policy, strategic elements, and priorities that make up the charter. Together they constitute a wide-ranging national strategy for both health conscious environmental policy and environmentally sound health policy. The final section "The Way Forward" accepts the needs to "take all necessary steps to reverse negative trends as soon as possible" and to "promote the widest possible endorsement of the principles and attainment of the objectives of the Charter". It is clearly in the public interest that as many individuals and organisations as possible should request the charter from WHO and publicise it widely. It should also be noted that the European Commission has adopted the charter as a guideline for future action in areas that lie within its competence. 218 Allerton Road, Liverpool L186JN, UK
ALEX
SCOTT-SAMUEL,
Chairman, Public Health Alliance Executive Committee
