1342 dies his output is lost but then so is his consumption. What the net loss to " the community " amounts to is by no means a straightforward question. When all of the above objections are taken into account it would seem that even the cost of a programme confined to working males is certain to far exceed its economic benefits. Mr Longmore and Miss Rehahn go on to detail the to cardiovascular large loss of economic output attributable disease. But since, as they say, " the nature and availability of treatments are speculative ", this is not much help. A consultant alchemist could as well set out the large profits from turning base metals into gold! Neither tabulation would constitute a necessary nor a sufficient condition for more research moneys without some indication of the likely success of such further research. The benefits, even when they are correctly computed, are useless for decisionmaking purposes without some indication of likely costs. In my view criteria of " economic efficiency " (in the sense of lost production) have only a limited part to play in distributing funds for health services. Nor would such criteria, I believe, when properly applied, be likely to increase the amount of money going to a service whose clients will tend more and more to be " non-productive ". International Institute for Applied
Systems Analysis, Schloss Laxenburg, Austria.
CAREER PREFERENCES OF 1973 GRADUATES SiR,—We have previously reported analyses of the career preferences of 1971 and 1972 graduates from the medical schools of Manchester and Sheffield, as elicited during the second preregistration post.l,2 We have now carried out a similar inquiry among 1973 graduates. The response-rate (90-6% overall) was even better than in previous years. The proportions of responders claiming to have made up their minds with varying degrees of firmness about their future careers were similar to those in the surveys of 1971 and 1972 graduates. The actual career preferences, however (see table), show a significant change: there is an increase in preferences for medicine among Sheffield graduates and for psychiatry among In this context "medicine" Manchester graduates. includes the medical specialties, but the rise from Sheffield is not due to a significantly increased interest in cardiology, neurology, &c. The popularity of surgery as a first choice of career shows a considerable decline; this was most noticeable between 1971 and 1972 in Manchester, and between 1972 and 1973 in Sheffield. Altogether, surgery was the first 1. 2.
choice of only 7-8% of responders in 1973, compared with 19-9% in 1971. Paediatrics retains its popularity and was the third commonest option as a first choice of career among 1973 responders. It was given as a first choice by 8-2% of responders in 1971, 9-5% in 1972, and 10-7% in 1973. In future analyses, it will be shown separately from medicine. Distributions of age, sex, marital status, nationality, probable intentions concerning emigration, and estimated chances of success in the chosen career showed no significant differences from the previous years’ surveys. There was, however, a notable increase in the output of the Manchester medical school, so that the proportional distribution of responders is correspondingly changed. As in previous surveys, the responder’s estimate of his chance of succeeding was highly correlated with the choice of career. We hesitate to draw conclusions from what are still relatively limited data. The range of variation between individual yearly samples is again obvious-for example, in preferences for general practice among Sheffield graduates. The increased interest in psychiatry from Manchester is seen among some of the first graduates to have been subjected to a revised clinical curriculum in which there is increased emphasis on this subject. Other curricular changes do not appear to be mirrored in the same way, and it will be interesting to see whether this change, and the increased interest in medicine in Sheffield, are quixotic or sustained. For statistical purposes, we should like to note that we now weighting system when two or three options are bracketed as equal choices: 1 for a straight choice, for each of a pair of equal preferences, andfor each of three. This differs from the random allocation to one or other option which we used in the previous two studies. The differences are not great, and we can readily supply details.
University Hospital of South Manchester,
Withington Hospital, Manchester M20 8LR.
MORTALITY FROM LUNG CANCER
SIR,-One would be happy to accept the encouraging conclusion of Dr Gray and Mr Hill (May 31, p. 1252) that recent health educational activity and changes in the tar content of cigarettes have already produced a favourable effect on mortality from lung cancer, were it not for the fact that the pattern of age-specific mortality-rates they describe from Australia is precisely the pattern that has prevailed in a number of western European countries, including the United Kingdom, for some considerable time.1
McLaughlin, C., Parkhouse, J. Lancet, 1972, ii, 1018. McLaughlin, C., Parkhouse, J. ibid. 1974, i, 870.
Smith, A. Supplement to the Annual Report of General for Scotland, 1963.
CAREER PREFERENCES OF
JAMES PARKHOUES CYNTHIA MCLAUGHLIN.
The figures shown include ties of 2 choices and ties of 3 choices, which each contributeand are calculated.
l, respectively, to the totals from which the percentages