116
Plans for MRC Clinical Research Centre SiR,—Dr Rees, the secretary of the Medical Research Council, cites (Nov 4, p 1102) the most serious problems at the Clinical Research Centre as the absence of postgraduate teaching and the failure to achieve effective integration between the staff of the CRC and the
hospital in their research activities. The first problem is entirely due to the MRC’s resistance to any form of postgraduate education. We were all informed that we were here to treat patients and do research, but not to teach. That activity was to remain confined to the Royal Postgraduate Medical School, only eight miles away. The Stoker report was the first indication of any revision of this policy, and it is no coincidence that the postgraduate centre at Northwick Park Hospital will not be opened until this year, twenty years on. The second issue is even more curious. The first consultants appointed to Northwick Park Hospital were all offered contracts with two sessions paid for research but little in the way of facilities. Despite this, a lot was achieved by collaboration with more fortunate CRC colleagues, a fact which can be corroborated by the peer reviews in 1975. Nevertheless, all five research contracts renewable at that time were terminated. Publication lists in CRC annual reports confirm that the collaborations established by that time have burgeoned and the names on those publications demonstrate the degree of Clinical Research Centre/Northwick Park Hospital integration, and one of the terminated five now holds his second professorial chair in the University of London. Perhaps Rees’ misconception is related to the fact that at least one member of the Stoker committee was unaware that there was a hospital on the site. As mentioned in an editorial note (Nov 4, p 1102) Northwick Park Hospital remains a first-class base for continuing clinical research, and the evidence for this is there for all to see. Perhaps it will do better without "The incompetence and insensitivity of the MRC management and its academic advisors". Northwick Park Hospital and Clinical Research Centre, Harrow, Middlesex HA1 3UJ, UK
J. M. GUMPEL E. B. RAFTERY
Fear of crime SIR,-I am puzzled by both your note (Dec 16, p 1466) about the Home Office report on fear of crime and by the report itself. If the chance of being mugged is 1-8% per annum, is it strange that one person in five is apprehensive? If this is so then we should also consider whether the figure of actual events is misleading. People who are in fear will not go about in what should be a normal fashion, which will reduce the number of the most easy victims. We have seen similar distortion occur with road accidents when there was fear of the new forms of prosecution from the new alcohol laws. This fear caused traffic density to fall for a while and so gave a misleading indication of the final benefits that would be obtained. Even if one discounts this effect, however, how do we condone a risk of mugging of 1 %? Is that civilised society?
pre-implantation embryo, morulae, blastocysts and implanted embryos?"2 The term was not used by the Department of Health and Social Security in its 1986 consultation document Legislation of Human Infertility Services and Embryo Research. Prof David Short from Aberdeen suggested that if a new term was needed then "early embryo" would be unobjectionable.3 David Davies, a member of the Warnock Committee, wrote: "Those who are introducing ’pre-embryo’ into the vocabulary know full well the research is indeed contentious and that fundamental issues have yet to be resolved ... they are themselves manipulating words to polarise an ethical discussion. The central issue is whether it is justifiable, once an egg has been fertilised, for anyone to perform experiments on the resulting embryo when those experiments are not in the best interests of that particular embryo. This is a complex and profound issue. The introduction of cosmetic words does not help".’ 18 Hmtlesham Avenue,
JOHN KELLY
Birmingham B15 2PH, UK
1. Edwards R, Steptoe P. A matter of life. London: Sphere, 1981. 2. Bock G, O’Connor M, eds. Human embryo research: yes or no? London: 1986. 3. Short D. Terms of reference: pre-embryo. Br Med J 1987; 294: 1693. 4. Davies D. Nature 1986; 320: 208.
Tavistock,
Adolescent pregnancy SiR,—Iendorse your editorial (Dec 2, p 1308) but in the context of changes in education and National Health Service funding in the UK I have two comments. When sex education in schools first became reasonably popular, many concerned people, especially from religious organisations, asked "What about the ’moral’ aspects?" They had a point. It is easy to incorporate reproductive education, provided this is started at an early age, and good progress has been made. Most young people, even from deprived backgrounds, know something about contraception when they have their first sexual experience. What is much more difficult is to affect the attitudes of young people. In my experience, this has to be done mostly by small peer groups, with perhaps an adult who can pose questions, guide the discussion, and provide factual information where this is lacking. This type of education is difficult and expensive since the groups must be small. The Bristol Young Mother Information Project mentioned in your editorial could meet this need. The development of attitudes to sexuality and sexual drive is the aspect which is lacking in most schools, presumably because it is more difficult and much more labour intensive. There is also a move among health authorities to try to restrict the role of community family-planning clinics, on the assumption that general practitioners can normally fulfil this role adequately. Our Wessex abortion studies have shown that most young people do not wish to consult their general practitioners about their sexualityand that for them, at least, the anonymity of specific clinics is an important service requirement.
4
Amesbury Road, Birmingham B138LD,
G. T. WATTS
UK
Department of Human Reproduction and Obstetrics,
University of Southampton, Princess Anne Hospital, Southampton 509 4HA. UK
"Pre-embryos" SIR,-In your note on the Human Fertilisation and Embryology (Dec 2, p 1348) you mention the words "pre-embryo" and "early embryo". Pre-embryo was never used by the Warnock Committee, nor did it appear in scientific publications before 1986. Edwards and Steptoel described the test-tube embryo, even in the pre-implantation stage, as "a microscopic human being in its very early stages of development". At a Ciba Foundation Study Group in November, 1985, John Maddox, editor of Nature, was asked by the chairman what he thought of the word pre-embryo. He replied "I think it is a cosmetic trick". At the same study group, Professor Edwards, in his reply to the same question said, "It is almost an abbreviation of pre-implantation embryo. Why cannot
*Professor Dennis died
on
K. JOHN DENNIS* Dec 23, 1989.
Bill
we
stick
to
the
terms we
have used for many years such
as
Cholangiocarcinoma
in north-east Thailand
SiR,—Cholangiocarcmoma is rare in most parts of the world, with annual incidence of about 2 cases per 100 000 in western countries. By contrast it is the leading cancer in north-east Thailand.2’ Previous reports have been merely descriptive or have expressed cholangiocarcinoma as a percentage of total cancer.2,4J Recent work at Khon Kaen University has yielded estimates of incidence. In 1984 a hospital-based tumour registry was established at Srinagarind Hospital,3 one of two tertiary referral centres in Khon an
Plans for MRC Clinical Research Centre SiR,—Dr Rees, the secretary of the Medical Research Council, cites (Nov 4, p 1102) the most serious problems at the Clinical Research Centre as the absence of postgraduate teaching and the failure to achieve effective integration between the staff of the CRC and the
hospital in their research activities. The first problem is entirely due to the MRC’s resistance to any form of postgraduate education. We were all informed that we were here to treat patients and do research, but not to teach. That activity was to remain confined to the Royal Postgraduate Medical School, only eight miles away. The Stoker report was the first indication of any revision of this policy, and it is no coincidence that the postgraduate centre at Northwick Park Hospital will not be opened until this year, twenty years on. The second issue is even more curious. The first consultants appointed to Northwick Park Hospital were all offered contracts with two sessions paid for research but little in the way of facilities. Despite this, a lot was achieved by collaboration with more fortunate CRC colleagues, a fact which can be corroborated by the peer reviews in 1975. Nevertheless, all five research contracts renewable at that time were terminated. Publication lists in CRC annual reports confirm that the collaborations established by that time have burgeoned and the names on those publications demonstrate the degree of Clinical Research Centre/Northwick Park Hospital integration, and one of the terminated five now holds his second professorial chair in the University of London. Perhaps Rees’ misconception is related to the fact that at least one member of the Stoker committee was unaware that there was a hospital on the site. As mentioned in an editorial note (Nov 4, p 1102) Northwick Park Hospital remains a first-class base for continuing clinical research, and the evidence for this is there for all to see. Perhaps it will do better without "The incompetence and insensitivity of the MRC management and its academic advisors". Northwick Park Hospital and Clinical Research Centre, Harrow, Middlesex HA1 3UJ, UK
J. M. GUMPEL E. B. RAFTERY
Fear of crime SIR,-I am puzzled by both your note (Dec 16, p 1466) about the Home Office report on fear of crime and by the report itself. If the chance of being mugged is 1-8% per annum, is it strange that one person in five is apprehensive? If this is so then we should also consider whether the figure of actual events is misleading. People who are in fear will not go about in what should be a normal fashion, which will reduce the number of the most easy victims. We have seen similar distortion occur with road accidents when there was fear of the new forms of prosecution from the new alcohol laws. This fear caused traffic density to fall for a while and so gave a misleading indication of the final benefits that would be obtained. Even if one discounts this effect, however, how do we condone a risk of mugging of 1 %? Is that civilised society?
pre-implantation embryo, morulae, blastocysts and implanted embryos?"2 The term was not used by the Department of Health and Social Security in its 1986 consultation document Legislation of Human Infertility Services and Embryo Research. Prof David Short from Aberdeen suggested that if a new term was needed then "early embryo" would be unobjectionable.3 David Davies, a member of the Warnock Committee, wrote: "Those who are introducing ’pre-embryo’ into the vocabulary know full well the research is indeed contentious and that fundamental issues have yet to be resolved ... they are themselves manipulating words to polarise an ethical discussion. The central issue is whether it is justifiable, once an egg has been fertilised, for anyone to perform experiments on the resulting embryo when those experiments are not in the best interests of that particular embryo. This is a complex and profound issue. The introduction of cosmetic words does not help".’ 18 Hmtlesham Avenue,
JOHN KELLY
Birmingham B15 2PH, UK
1. Edwards R, Steptoe P. A matter of life. London: Sphere, 1981. 2. Bock G, O’Connor M, eds. Human embryo research: yes or no? London: 1986. 3. Short D. Terms of reference: pre-embryo. Br Med J 1987; 294: 1693. 4. Davies D. Nature 1986; 320: 208.
Tavistock,
Adolescent pregnancy SiR,—Iendorse your editorial (Dec 2, p 1308) but in the context of changes in education and National Health Service funding in the UK I have two comments. When sex education in schools first became reasonably popular, many concerned people, especially from religious organisations, asked "What about the ’moral’ aspects?" They had a point. It is easy to incorporate reproductive education, provided this is started at an early age, and good progress has been made. Most young people, even from deprived backgrounds, know something about contraception when they have their first sexual experience. What is much more difficult is to affect the attitudes of young people. In my experience, this has to be done mostly by small peer groups, with perhaps an adult who can pose questions, guide the discussion, and provide factual information where this is lacking. This type of education is difficult and expensive since the groups must be small. The Bristol Young Mother Information Project mentioned in your editorial could meet this need. The development of attitudes to sexuality and sexual drive is the aspect which is lacking in most schools, presumably because it is more difficult and much more labour intensive. There is also a move among health authorities to try to restrict the role of community family-planning clinics, on the assumption that general practitioners can normally fulfil this role adequately. Our Wessex abortion studies have shown that most young people do not wish to consult their general practitioners about their sexualityand that for them, at least, the anonymity of specific clinics is an important service requirement.
4
Amesbury Road, Birmingham B138LD,
G. T. WATTS
UK
Department of Human Reproduction and Obstetrics,
University of Southampton, Princess Anne Hospital, Southampton 509 4HA. UK
"Pre-embryos" SIR,-In your note on the Human Fertilisation and Embryology (Dec 2, p 1348) you mention the words "pre-embryo" and "early embryo". Pre-embryo was never used by the Warnock Committee, nor did it appear in scientific publications before 1986. Edwards and Steptoel described the test-tube embryo, even in the pre-implantation stage, as "a microscopic human being in its very early stages of development". At a Ciba Foundation Study Group in November, 1985, John Maddox, editor of Nature, was asked by the chairman what he thought of the word pre-embryo. He replied "I think it is a cosmetic trick". At the same study group, Professor Edwards, in his reply to the same question said, "It is almost an abbreviation of pre-implantation embryo. Why cannot
*Professor Dennis died
on
K. JOHN DENNIS* Dec 23, 1989.
Bill
we
stick
to
the
terms we
have used for many years such
as
Cholangiocarcinoma
in north-east Thailand
SiR,—Cholangiocarcmoma is rare in most parts of the world, with annual incidence of about 2 cases per 100 000 in western countries. By contrast it is the leading cancer in north-east Thailand.2’ Previous reports have been merely descriptive or have expressed cholangiocarcinoma as a percentage of total cancer.2,4J Recent work at Khon Kaen University has yielded estimates of incidence. In 1984 a hospital-based tumour registry was established at Srinagarind Hospital,3 one of two tertiary referral centres in Khon an
