confused as to what makes up the "public." Medical care practitioners in their daily encounters see many individuals who in the aggregate make up one kind of "public." It would seem that this is a very different "public" from that which is comprised of two graduate students at the Michigan School of Public Health. The authors of the article seem to think that the mission of medical care professionals is to improve the health of the public. This assumption is inaccurate. The mission of such professionals is to apply technical knowledge and skills to specific problems of illness or injury presented by individual patients. The mission of the public health profession is to improve the health of the public. We should examine, therefore, the quality of the outcomes of the activities of those whose profession is public health. The achievements of public health in the first half of this century were truly outstanding. But what have public health professionals done for us lately? Dental caries, a preventable condition, is the most common disease in the United States. Cancer of the lung, aggravated by cigarette smoking, kills a significant number of productive citizens. Habits of the affluent, malnutrition, air and water pollution, create significant morbidity. Automobile accident deaths, homicides and suicides, drug abuse, alcoholism and mental illness, all are public health problems of enormous consequence. Yet many practitioners of "public" health avoid truly concentrated confrontation with these public health problems in order to focus their attentions on that part of the health profession concerned with repairing the ravages of public health failures. If these failures are the results of our society's decision to allocate more resources in the repairable sector than the preventive sector, it does no good

1346 AJPH DECEMBER, 1975, Vol. 65, No. 12

to put the blame on the repairers. That the preventers have not made a good case for themselves is evident in experience-dealing with dental caries via the fluoridation of public waters, among others. In some instances, the repairers, in desperation, have seized the preventive initiative, as in the automobile accident field. Perhaps medical care quality assessment and assurance does require the added dimension of patient/public responsibility. After all, most of the preventive and repairable care given to patients is provided by the patients themselves or their families. In this spirit, it is agreed that there should be more accountability for quality of care by medical care specialists. It cannot end there, however. Let the public health professional also be accountable for the quality, the effectiveness, and the efficient use of resources in his actions. If these resources are used only to try to change the behavior of his medical care colleague, with the coexisting possibility that such behavioral change may well lower the quality of care, rather than improve it, then it will be a very wasteful and dangerous expenditure of resources. I am sure that the agenda of public health professionals has more urgent public health matters with the potential of a greater return on investment of their time than destructive criticism of medical care professionals. John G. Smillie, MD The Permanente Medical Group

Oakland, California

EMERGENCY AID FOR INSECT STING Recently I have been concerned seemingly in a one man crusade about the inadequate knowledge of the use of the insect sting emergency first aid kit,

and also about its being unavailable to those who should have it on hand in case of a severe insect sting reaction. For example, the following groups of people usually do not have the kit nor the knowledge of its use, and yet they are more likely to be faced with this situation: school nurses or principals, forest rangers, scout masters, golf pros, swimming instructors, and tennis pros. I feel that som-e-eaths could have been prevented by making this kit available to such people, with instructions for its use. One pharmaceutical firm manufactures such a kit, which contains a two-dose syringe for administration of two measured doses, 0.3 ml each, of epinephrine, two Chlo-amine tablets, each 4 mg chlorpheniramine maleate; two sterilizing swabs, tourniquet, and complete step-by-step instructions for its use. The instructions state that if the contents of the syringe become discolored or precipitate is present the syringe should not be used and a replacement syringe should be obtained from a physician. Most state laws prohibit sale of such kits without a prescription from a physician. We physicians train our insect allergy patients to use them and see that a kit is available to them. I think state laws should be changed so that persons in the kinds of key positions indicated above, after receiving appropriate training, could purchase the kits without prescription. I hope others feel likewise and will help to get the laws changed. I know of two instances where the use of this kit could have prevented death in the individual who suffered the severe reaction. I would appreciate hearing from others who know of similar cases in which the use of an insect sting kit would have prevented the death of a person. Claude A. Frazier, MD Doctors Park, Bldg. 4 Asheville, NC 28801

Letter: Emergency aid for insect sting.

confused as to what makes up the "public." Medical care practitioners in their daily encounters see many individuals who in the aggregate make up one...
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