1698
BRITISH MEDICAL JOURNAL
months with different chemocherapy programmes, including LMF (chlorambucil, methotrexate, 5-fluorouracil), doxorubicin, vincristine, mitomycin C, and VP-16 213, unsuccessfully. After the patient's refusal of orchidectomy we introduced tamoxifen 40 mg/ day and noted the disappearance of all subcutaneous nodules after one month. No particular drug side effects were noted. Unfortunately no hormone receptors were determined in this case. As very few other reports' are to be found it would be interesting to collect any further information about this new alternative treatment to classical surgical orchidectomy2 s for metastatic male breast carcinoma. R ABELE
athlete's foot and jogger's nipples about as much as Dr Apley discusses railway gauges when travelling oni a train or weights and measures when conversing in a pub. Actually, to be honest, our conversation has changed a little bit recently. We've become somewhat puzzled, maybe even .confused, by reactions to running/jogging. We wonder why doctors, who for as long as we can remember have inlsisted that exercise was good for us, now spend so much time writing long letters which ridicule people who take up exercise. NORMAN HARRIS London SW13
P ALBERTO Urinary incontinence during treatment R MEGEVAND with depot phenothiazines Uniiversity Hospital, Geneva
2
3
Hecker, E, et al, European J7ournal of Cancer, 1974, 10, 747.. Norris, H J, and Taylor, H B, Cancer, 1969, 23, 1428. Neifeld, J P, et al, Cancer, 1976, 37, 992.
So we'll go no more a-jogging
SIR,-Dr John Apley (10 June, p 1548) in his counterblast to jogging has poured ridicule on the spectacle of paunchy pensioners padding round our streets and parks for two hours every day in an attempt to prolong their boring lives. To get the matter in perspective we should affirm that the main thrust of the argument in favour of exercise is to try to ensure that men and women live long enough to enjoy retirement. We are mainly concerned with the tragedy of those who die from heart attacks before the age of 65. In his detestation of jogging Dr Apley throws out the baby with the bath water. He questions the value of any exercise late in life and suggests that the older adults should settle for a "slow march" tempo. This is a pity because there are so many more acceptable alternatives to jogging such as swimming, hill walking, and cycling, all of which can be continued into advanced age. May I put in a plea to the medical profession to encourage the use of the bicycle by men and women of all ages ? Cycling is an exercise which has great advantages in that it is economical and purposeful, especially when used to go to work. Moreover, it can provide an infinitely graduated scale of exercise which is suitable for all levels of fitness. In addition, it has special characteristics which make it suitable for such conditions as intermittent claudication and arthritis of the hip joint. Doctors interested in the various aspects of cycling and health are invited to send for a copy of "Cycling: the healthy alternative," which may be obtained free from the British Cycling Bureau, Stanhope House, Stanhope Place, London W2 2HH. A W FOWLER Bridgend General Hospital,
Bridgend, Mid Glamorgan
SIR,-Dr John Apley (10 June, p 1548) asks many questions of joggers, including what they talk about. Athlete's foot, he wonders ? Or jogger's nipples? Well, I've been running/ jogging for about 20 years and doing quite a lot of talking in the process. When I was younger we probably talked more about girl friends; these days we tend to talk shop, batting ideas around. We probably talk about
SIR,-I wish to bring to the attention of your readers four cases of urinary incontinence occu-ring in patients receiving injectable depot phenothiazines. All were women below the age of 35 with no history of enuresis in adult life. Three of the patients had no previous history of urinary tract infection; one had had cystitis a few years ago which was treated successfully. The patients became enuretic within seven days of administration of the injection. The enuresis occurred mostly at night and stopped when the treatment was withdrawn, only to reappear when it was reinstated. Three out of the four were on fluphenazine decanoate and the other was on flupenthixol. A SHAIKH Psychiatric Unit, Whiston Hospital, Prescot, Mersevside
Treatment of tuberculosis SIR,-If Dr Anthony Seaton (3 June, p 1484) reads my original letter (22 April, p 1053) calmly he will see that our differences are over application rather than professional integrity. I decline to confuse bellicose irony with objectivity. Most importantly I was pointing out, as indeed my letter began, that his article (18 March, p 701) was a summary of United Kingdom attitudes and not necessarily appropriate for the BM7's international readership. Dr Seaton must surely have learnt that emphasis in the control of the mycobacterial diseases differs markedly even in countries as medically similar as the United States, where incidentally non-physicians increasingly play a primary role. For the greater part of the developing world a system of treatment and control dependent upon relative abundance of personnel and material is highly inappropriate. Most of the countries where the mycobacterial diseases are principal causes of sickness and death cannot afford regular supplies of the cheaper drugs, let alone rifampicin. Clearly we differ about whether or not one can ever afford to be dogmatic about the treatment of those pulmonary manifestations of thu infection by Mycobacterium tuberculosis known colloquially as "tuberculosis," I am humble in the face of so many equally dogmatically held but quite different opinions. The Madras experiments continue to deprive us of long-cherished "certainties." In the same issue as Dr Seaton's letter is a report by Dr J A Lunn and Dr A J Johnson (3 June,
24 JUNE 1978
p 1451) attacking yet another tuberculosis shibboleth. On the subject of contacts, given appropriate resources, where did I suggest they should not be investigated ? I merely pointed out that the unqualified advice that these persons should be "visited" deserved more than the final cursory paragraph. Can there be any health care system affluent enough to employ physician specialists to inspect the tablets in a patient's pocket? How can the physician ever expect to retain the confidence of the medical team if he so openly distrusts pharmacologists, pharmacists, all but "sensible" bacteriologists, nurses, other health workers, and, not least, the patients ? Physicians practising at the primary level, where most "tuberculosis" should be treated, cannot be effective and may not even survive with such attitudes. I am satisfied that on other points Dr Seaton has apparently modified his "dogmatic" stance. DEREK ROBINSON School of Tropical Medicine,
Liverpool
Abortion law reform SIR,-Minerva observes (3 June, p 1492) that the "abuses and inconsistencies" in the operation of the 1967 Abortion Act "are the result of individual prejudices and beliefs rather than the wording agreed by Parliament." Not surprisingly, as a woman she sympathises "with the aims of groups such as Doctors for a Woman's Choice on Abortion". How strange then that she does not believe that the main aim of this group, which is to change the law to allow the woman to make the abortion decision, would be helpful. Surely it is only by removing the decision from doctors that their individual prejudices and beliefs can be avoided. Minerva's concern seems to result from a common misunderstanding of the implications of "a woman's right to choose." She says she is chary of proposals to compel people to carry out actions against their will. So is DWCA. Although we believe that no woman should be forced to continue a pregnancy against her will, nor do we believe that any doctor should be forced to perform an abortion against his or her will. Rather the doctor should make his or her views known to the woman, allowing her to seek help elsewhere from a doctor who is willing. Women are now allowed to make the abortion decision in a number of countries, including the United States, France, Sweden, East Germany, and Denmark' and, most recently, Italy. In none of these countries are doctors compelled to perform abortions. In Britain there are sufficient doctors willing to perform abortions, although at present they are distributed unevenly around the country. If women were able to make the abortion decision there would be fewer delays-they could be openly encouraged to seek help early and would not be delayed by having to find two doctors willing to support their request. At present nearly 80% of abortions are performed in the first trimester. In countries with abortion on request the figure is over 900,. A further and perhaps obvious advantage of a woman's right to choose is that few women will choose to have an illegal abortion when a legal one is easily available. And as for the myth that women would use abortion as an
BRITISH MEDICAL JOURNAL
months with different chemocherapy programmes, including LMF (chlorambucil, methotrexate, 5-fluorouracil), doxorubicin, vincristine, mitomycin C, and VP-16 213, unsuccessfully. After the patient's refusal of orchidectomy we introduced tamoxifen 40 mg/ day and noted the disappearance of all subcutaneous nodules after one month. No particular drug side effects were noted. Unfortunately no hormone receptors were determined in this case. As very few other reports' are to be found it would be interesting to collect any further information about this new alternative treatment to classical surgical orchidectomy2 s for metastatic male breast carcinoma. R ABELE
athlete's foot and jogger's nipples about as much as Dr Apley discusses railway gauges when travelling oni a train or weights and measures when conversing in a pub. Actually, to be honest, our conversation has changed a little bit recently. We've become somewhat puzzled, maybe even .confused, by reactions to running/jogging. We wonder why doctors, who for as long as we can remember have inlsisted that exercise was good for us, now spend so much time writing long letters which ridicule people who take up exercise. NORMAN HARRIS London SW13
P ALBERTO Urinary incontinence during treatment R MEGEVAND with depot phenothiazines Uniiversity Hospital, Geneva
2
3
Hecker, E, et al, European J7ournal of Cancer, 1974, 10, 747.. Norris, H J, and Taylor, H B, Cancer, 1969, 23, 1428. Neifeld, J P, et al, Cancer, 1976, 37, 992.
So we'll go no more a-jogging
SIR,-Dr John Apley (10 June, p 1548) in his counterblast to jogging has poured ridicule on the spectacle of paunchy pensioners padding round our streets and parks for two hours every day in an attempt to prolong their boring lives. To get the matter in perspective we should affirm that the main thrust of the argument in favour of exercise is to try to ensure that men and women live long enough to enjoy retirement. We are mainly concerned with the tragedy of those who die from heart attacks before the age of 65. In his detestation of jogging Dr Apley throws out the baby with the bath water. He questions the value of any exercise late in life and suggests that the older adults should settle for a "slow march" tempo. This is a pity because there are so many more acceptable alternatives to jogging such as swimming, hill walking, and cycling, all of which can be continued into advanced age. May I put in a plea to the medical profession to encourage the use of the bicycle by men and women of all ages ? Cycling is an exercise which has great advantages in that it is economical and purposeful, especially when used to go to work. Moreover, it can provide an infinitely graduated scale of exercise which is suitable for all levels of fitness. In addition, it has special characteristics which make it suitable for such conditions as intermittent claudication and arthritis of the hip joint. Doctors interested in the various aspects of cycling and health are invited to send for a copy of "Cycling: the healthy alternative," which may be obtained free from the British Cycling Bureau, Stanhope House, Stanhope Place, London W2 2HH. A W FOWLER Bridgend General Hospital,
Bridgend, Mid Glamorgan
SIR,-Dr John Apley (10 June, p 1548) asks many questions of joggers, including what they talk about. Athlete's foot, he wonders ? Or jogger's nipples? Well, I've been running/ jogging for about 20 years and doing quite a lot of talking in the process. When I was younger we probably talked more about girl friends; these days we tend to talk shop, batting ideas around. We probably talk about
SIR,-I wish to bring to the attention of your readers four cases of urinary incontinence occu-ring in patients receiving injectable depot phenothiazines. All were women below the age of 35 with no history of enuresis in adult life. Three of the patients had no previous history of urinary tract infection; one had had cystitis a few years ago which was treated successfully. The patients became enuretic within seven days of administration of the injection. The enuresis occurred mostly at night and stopped when the treatment was withdrawn, only to reappear when it was reinstated. Three out of the four were on fluphenazine decanoate and the other was on flupenthixol. A SHAIKH Psychiatric Unit, Whiston Hospital, Prescot, Mersevside
Treatment of tuberculosis SIR,-If Dr Anthony Seaton (3 June, p 1484) reads my original letter (22 April, p 1053) calmly he will see that our differences are over application rather than professional integrity. I decline to confuse bellicose irony with objectivity. Most importantly I was pointing out, as indeed my letter began, that his article (18 March, p 701) was a summary of United Kingdom attitudes and not necessarily appropriate for the BM7's international readership. Dr Seaton must surely have learnt that emphasis in the control of the mycobacterial diseases differs markedly even in countries as medically similar as the United States, where incidentally non-physicians increasingly play a primary role. For the greater part of the developing world a system of treatment and control dependent upon relative abundance of personnel and material is highly inappropriate. Most of the countries where the mycobacterial diseases are principal causes of sickness and death cannot afford regular supplies of the cheaper drugs, let alone rifampicin. Clearly we differ about whether or not one can ever afford to be dogmatic about the treatment of those pulmonary manifestations of thu infection by Mycobacterium tuberculosis known colloquially as "tuberculosis," I am humble in the face of so many equally dogmatically held but quite different opinions. The Madras experiments continue to deprive us of long-cherished "certainties." In the same issue as Dr Seaton's letter is a report by Dr J A Lunn and Dr A J Johnson (3 June,
24 JUNE 1978
p 1451) attacking yet another tuberculosis shibboleth. On the subject of contacts, given appropriate resources, where did I suggest they should not be investigated ? I merely pointed out that the unqualified advice that these persons should be "visited" deserved more than the final cursory paragraph. Can there be any health care system affluent enough to employ physician specialists to inspect the tablets in a patient's pocket? How can the physician ever expect to retain the confidence of the medical team if he so openly distrusts pharmacologists, pharmacists, all but "sensible" bacteriologists, nurses, other health workers, and, not least, the patients ? Physicians practising at the primary level, where most "tuberculosis" should be treated, cannot be effective and may not even survive with such attitudes. I am satisfied that on other points Dr Seaton has apparently modified his "dogmatic" stance. DEREK ROBINSON School of Tropical Medicine,
Liverpool
Abortion law reform SIR,-Minerva observes (3 June, p 1492) that the "abuses and inconsistencies" in the operation of the 1967 Abortion Act "are the result of individual prejudices and beliefs rather than the wording agreed by Parliament." Not surprisingly, as a woman she sympathises "with the aims of groups such as Doctors for a Woman's Choice on Abortion". How strange then that she does not believe that the main aim of this group, which is to change the law to allow the woman to make the abortion decision, would be helpful. Surely it is only by removing the decision from doctors that their individual prejudices and beliefs can be avoided. Minerva's concern seems to result from a common misunderstanding of the implications of "a woman's right to choose." She says she is chary of proposals to compel people to carry out actions against their will. So is DWCA. Although we believe that no woman should be forced to continue a pregnancy against her will, nor do we believe that any doctor should be forced to perform an abortion against his or her will. Rather the doctor should make his or her views known to the woman, allowing her to seek help elsewhere from a doctor who is willing. Women are now allowed to make the abortion decision in a number of countries, including the United States, France, Sweden, East Germany, and Denmark' and, most recently, Italy. In none of these countries are doctors compelled to perform abortions. In Britain there are sufficient doctors willing to perform abortions, although at present they are distributed unevenly around the country. If women were able to make the abortion decision there would be fewer delays-they could be openly encouraged to seek help early and would not be delayed by having to find two doctors willing to support their request. At present nearly 80% of abortions are performed in the first trimester. In countries with abortion on request the figure is over 900,. A further and perhaps obvious advantage of a woman's right to choose is that few women will choose to have an illegal abortion when a legal one is easily available. And as for the myth that women would use abortion as an
