1337
(England and Wales) or a procurator fiscal in emergency departments in England worked (Scotland). Having and in Scotland we have noted striking differences in the application of the two reporting systems. A coroner will usually ask for a post-mortem examination in cases of uncertainty; a procurator fiscal, after discussion with the doctors concerned, may encourage certification of death without a necropsy. Therefore, in Scotland, more often than in England, part I of the death certificate will sometimes be based on the clinician’s "best guess" as to the cause of death, and in the absence of evidence to the contrary this is inevitably myocardial infarcdon/ischaemic heart disease. Although Scotland does have many reasons for a high prevalence of heart disease this apparent difference in legal practice may falsely increase published CHD mortality rates in some areas. be notified to
a coroner
Accident and
Emergency Department, Glasgow Royal Infirmary, Glasgow G4 OSF, UK
CHRISTOPHER MOULTON ALAN PENNYCOOK
1. Marmot MG.
Lifestyle and national and international trends in coronary heart disease mortality. Postgrad MedJ 1985; 60: 3-8. 2. Tunstall-Pedoe H, Smith WCS, Crombie IK. Levels and trends of coronary heart disease mortality in Scotland compared with some other countries. Health Bull (Scot) 1986; 44: 153-61. 3. Arrundale J, Cole SK. Death certification and mortality statistics. Health Bull (Edinb) 1991; 49: 82-90. 4. Tunstall-Pedoe H, Smith WCS, Crombie IK, Tavendale R. Coronary risk factor and lifestyle variation across Scotland: results from the Scottish Heart Health Study. Scot Med J 1989; 34: 556-60.
The Italian system for academic promotion is haphazard because people with no strong scientific background may be promoted to full professor while well-qualified scientists are rejected. We are not saying that other criteria are irrelevant to the appointment of professors of paediatrics. We simply wish to stress that publications in international journals, citations, and impact factors should be primary threshold criteria in validating the scientific maturity of candidates, which is required by the Italian law on academic promotion. The selection criteria must be modified, if only to reduce outflow of research workers from Italy. 3,4 Department of Allergy and Clinical Immunology, University "La Sapienza", 00185 Rome, Italy
F. AIUTI
Department of Pathology, University "La Sapienza"
C. BARONI
Department of Paediatrics, University of Cagliari
A. CAO
Department of Molecular Genetics, University "La Sapienza", Rome
A. FANTONI
1. Gaetani GF, Ferraris AM. Academic promotion in Italy. Nature 1991; 353: 10. 2. Fabbri LM. Rank injustices and academic promotion. Lancet 1987; ii: 860. 3. Amati P. Cammarano B, Fantoni A, Macino G. Troubles at Rome University. Nature 1990; 345: 658. 4. Cantani A. Problems of Rome University. Nature 1990; 346: 788.
Social Academic
promotion in Italy
SiR,—The unusual system of academic promotion to professor in Italian medical schools has received attention in scientific joumals.1,2 It has been reported that the winners of national competitions for both associate professor and full professor have significantly lower "scientific maturity" than the losers, as judged by the number of papers in international scientific journals, the number of citations, and impact factors. 1,2We report here the results of a national competition for full professors of paediatrics. Some of the winners had produced publications of low scientific value as judged on the above indices and did not have a single full paper in any language other than Italian. After almost 3 years of discussions a committee of five Italian full professors of paediatrics, appointed to promote 25 new full professors out of 74 candidates, released its verdict in September, 1991. After the first year, two members of the committee resigned and were replaced. We have evaluated, using the MEDLINE database, the scientific impact factor (SIF) of publications from 1960 to 1988 (1988 was the deadline for applications), the citation half-lives (HL), and the number of citations (provided in the Science Citation Index) of 5 winners and 5 losers. The 5 failures were selected in that they were given by a National University Council of Italian professors from different faculties and by the Minister of University and Scientific Research as examples of misjudgment. The 5 successes comprise 2 candidates also named by the minister and the council and 3 more selected at random. These scores for quantity and quality of scientific output were higher in the losers than in the winners, and 2 very well-known scientists were rejected:
inequalities in health
SiR.—Ms Whitehead and Mr Dahlgren’s report (Oct 26, p 1059) is encouraging and contains many good ideas. The main trouble in the UK is the lack of any national lead and commitment. Eleven years on1,2 the Department of Health plainly does not know what to do about a situation that shows little or no sign of resolving.3,4 There are several aspects of the issue of inequalities. The most sensitivethe worst and possibly deteriorating health of the poorest sections of the population-could also be the most critical to the Department’s strategic hopes for improving the health of the nation. Traditionally, the approach to such an impasse is the setting up of an independent committee of inquiry to assess and recommend. In the present instance a Royal Commission on social inequalities in health alone could have the necessary authority across government. Perhaps we should now be advocating this? Department of
Public Health and London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK
Policy,
J. N. MORRIS
Department of Health. The health of the nation: a consultative document for health in England. London: HM Stationery Office, 1991. 2. Waldegrave W. The Independent, June 5, 1991. 3. Davey Smith G, Bartley M, Blane D. The Black report on socioeconomic inequalities in health 10 years on. Br Med J 1990; 301: 373-77. 4. Morris JN. Inequalities in health: ten years and little further on. Lancet 1990; 336: 1.
491-93.
Access to
patient records
SIR,—The Access to Health Record Act 1990 came into effect on Nov 1, 1991. There is much concern about the extra workload for doctors and record departments.! We have questioned the first 100 consecutive patients attending a busy oncology clinic in this centre. All patients had cancer (excluding squamous and basal cell carcinomas of skin). 17 were new referrals and 83 were attending for
follow-up (table). 91 % of patients
declined the offer records. The reasons stated were:
to
inspect
their medical
3 winners of the 5 evaluated by us are co-workers of members of the
committee. The Minister for University and Scientific Research has
postponed validation of these appointments and the committee has been asked
candidates.
to
look
again
at
the
same
same
list of
The oldest of the 9 patients who wished to inspect their records 83 and the youngest 35. Average inspection time was 5 min, apart from 1 patient who spent 55 min looking through his records. was
(England and Wales) or a procurator fiscal in emergency departments in England worked (Scotland). Having and in Scotland we have noted striking differences in the application of the two reporting systems. A coroner will usually ask for a post-mortem examination in cases of uncertainty; a procurator fiscal, after discussion with the doctors concerned, may encourage certification of death without a necropsy. Therefore, in Scotland, more often than in England, part I of the death certificate will sometimes be based on the clinician’s "best guess" as to the cause of death, and in the absence of evidence to the contrary this is inevitably myocardial infarcdon/ischaemic heart disease. Although Scotland does have many reasons for a high prevalence of heart disease this apparent difference in legal practice may falsely increase published CHD mortality rates in some areas. be notified to
a coroner
Accident and
Emergency Department, Glasgow Royal Infirmary, Glasgow G4 OSF, UK
CHRISTOPHER MOULTON ALAN PENNYCOOK
1. Marmot MG.
Lifestyle and national and international trends in coronary heart disease mortality. Postgrad MedJ 1985; 60: 3-8. 2. Tunstall-Pedoe H, Smith WCS, Crombie IK. Levels and trends of coronary heart disease mortality in Scotland compared with some other countries. Health Bull (Scot) 1986; 44: 153-61. 3. Arrundale J, Cole SK. Death certification and mortality statistics. Health Bull (Edinb) 1991; 49: 82-90. 4. Tunstall-Pedoe H, Smith WCS, Crombie IK, Tavendale R. Coronary risk factor and lifestyle variation across Scotland: results from the Scottish Heart Health Study. Scot Med J 1989; 34: 556-60.
The Italian system for academic promotion is haphazard because people with no strong scientific background may be promoted to full professor while well-qualified scientists are rejected. We are not saying that other criteria are irrelevant to the appointment of professors of paediatrics. We simply wish to stress that publications in international journals, citations, and impact factors should be primary threshold criteria in validating the scientific maturity of candidates, which is required by the Italian law on academic promotion. The selection criteria must be modified, if only to reduce outflow of research workers from Italy. 3,4 Department of Allergy and Clinical Immunology, University "La Sapienza", 00185 Rome, Italy
F. AIUTI
Department of Pathology, University "La Sapienza"
C. BARONI
Department of Paediatrics, University of Cagliari
A. CAO
Department of Molecular Genetics, University "La Sapienza", Rome
A. FANTONI
1. Gaetani GF, Ferraris AM. Academic promotion in Italy. Nature 1991; 353: 10. 2. Fabbri LM. Rank injustices and academic promotion. Lancet 1987; ii: 860. 3. Amati P. Cammarano B, Fantoni A, Macino G. Troubles at Rome University. Nature 1990; 345: 658. 4. Cantani A. Problems of Rome University. Nature 1990; 346: 788.
Social Academic
promotion in Italy
SiR,—The unusual system of academic promotion to professor in Italian medical schools has received attention in scientific joumals.1,2 It has been reported that the winners of national competitions for both associate professor and full professor have significantly lower "scientific maturity" than the losers, as judged by the number of papers in international scientific journals, the number of citations, and impact factors. 1,2We report here the results of a national competition for full professors of paediatrics. Some of the winners had produced publications of low scientific value as judged on the above indices and did not have a single full paper in any language other than Italian. After almost 3 years of discussions a committee of five Italian full professors of paediatrics, appointed to promote 25 new full professors out of 74 candidates, released its verdict in September, 1991. After the first year, two members of the committee resigned and were replaced. We have evaluated, using the MEDLINE database, the scientific impact factor (SIF) of publications from 1960 to 1988 (1988 was the deadline for applications), the citation half-lives (HL), and the number of citations (provided in the Science Citation Index) of 5 winners and 5 losers. The 5 failures were selected in that they were given by a National University Council of Italian professors from different faculties and by the Minister of University and Scientific Research as examples of misjudgment. The 5 successes comprise 2 candidates also named by the minister and the council and 3 more selected at random. These scores for quantity and quality of scientific output were higher in the losers than in the winners, and 2 very well-known scientists were rejected:
inequalities in health
SiR.—Ms Whitehead and Mr Dahlgren’s report (Oct 26, p 1059) is encouraging and contains many good ideas. The main trouble in the UK is the lack of any national lead and commitment. Eleven years on1,2 the Department of Health plainly does not know what to do about a situation that shows little or no sign of resolving.3,4 There are several aspects of the issue of inequalities. The most sensitivethe worst and possibly deteriorating health of the poorest sections of the population-could also be the most critical to the Department’s strategic hopes for improving the health of the nation. Traditionally, the approach to such an impasse is the setting up of an independent committee of inquiry to assess and recommend. In the present instance a Royal Commission on social inequalities in health alone could have the necessary authority across government. Perhaps we should now be advocating this? Department of
Public Health and London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK
Policy,
J. N. MORRIS
Department of Health. The health of the nation: a consultative document for health in England. London: HM Stationery Office, 1991. 2. Waldegrave W. The Independent, June 5, 1991. 3. Davey Smith G, Bartley M, Blane D. The Black report on socioeconomic inequalities in health 10 years on. Br Med J 1990; 301: 373-77. 4. Morris JN. Inequalities in health: ten years and little further on. Lancet 1990; 336: 1.
491-93.
Access to
patient records
SIR,—The Access to Health Record Act 1990 came into effect on Nov 1, 1991. There is much concern about the extra workload for doctors and record departments.! We have questioned the first 100 consecutive patients attending a busy oncology clinic in this centre. All patients had cancer (excluding squamous and basal cell carcinomas of skin). 17 were new referrals and 83 were attending for
follow-up (table). 91 % of patients
declined the offer records. The reasons stated were:
to
inspect
their medical
3 winners of the 5 evaluated by us are co-workers of members of the
committee. The Minister for University and Scientific Research has
postponed validation of these appointments and the committee has been asked
candidates.
to
look
again
at
the
same
same
list of
The oldest of the 9 patients who wished to inspect their records 83 and the youngest 35. Average inspection time was 5 min, apart from 1 patient who spent 55 min looking through his records. was
