In England Now
1
381 possible if there were a Freedom of Information Act; legitimate commercial secrets would continue to be protected. Enforcement needs to be strengthened both inside and outside the committees. Not to take full advantage of the licence renewal system seems to waste an opportunity which should be taken in the interest of the public. Similarly not to enforce the requirements of the licensing authority as they relate to advertising, for example, seems indefensible. Finally it is no longer possible to ignore the issues raised by links between vested interests and the Government’s advisers. The exact position of a committee member who has close ties with a pharmaceutical company needs appraisal. The Medicines Act (Section 3, para 2b) requires "the Medicines Commission from time to time to review the committees established under Section 4 and to make recommendations to the Ministers with regard to any changes in their number or function". Such a review is now due and should include not only the formal remit of the committees but also the wider issues of their functioning. This might well require a critical examination of the Medicines Act itself. In England Now IT was, I thought, a fine chance for cooperation with my NHS colleagues. Our teaching district, probably one of the most over- resourced in the country, appeared not to have a BBC/Torch minicomputer to look at the new performance indicators on floppy disks1 that had fallen from on high into the hands of the planning office. Could our small, academic department help? I had answered the phone. Delighted, I said. Come over at once. My own Beeb was in use (I write directly onto it, using Wordstar), but we had bought three, to be able to link into a bigger network in the future. One has a colour screen, so we could all look at the wonders of DHSS high tech. The district information officer clutched the bright yellow and blue plastic pack happily. He pulled off the wrapper, releasing several booklets, a ring-binder, and the floppy disks. One of the discs called itself "Welcome", and a blue book gave clear instructions on starting up. "Press Break and B keys together, then release Break and then B..." We started the cookery. Quickly the screen buzzed into life. The Welcome disk spelled out what it was going to do. "Press ’return’ to go on to the next screen", it commanded. "Wonderful," exclaimed the locum district specialist in community medicine. "This is how I like computers." Then suddenly up on the screen: "Error 1060". Showing us all the wrinkles, I thought. But pressing various keys wouldn’t make the error go away. We searched through the manuals. No list of error commands anywhere. We were stuck. The only choice was to go back to the beginning. We pressed the Break key alone, then repeated the process, slowly getting to the same place... "Well, perhaps we don’t need a welcome. Let’s go onto another disk," said the SCM. I left them to it, returning to work in my own office. Half-an-hour later, two sad faces appeared round my door. "Couldn’t get any of them to work. Next one we tried, we got to one point with a table, and then it just vanished leaving a little white dot at the top of the screen." "Oh well," I said, reassuringly (I thought). "Try ringing up the DHSS. They’ve made such a fuss about these PIs, Mr Victor Paige having a press conference and all that. They’ll surely have someone at a telephone to deal with the bugs. Any new system will have teething problems, and they can’t let a flagship district like ours be defeated, can they?" I felt almost genial as I showed them out of the door. But inside, I wondered how many other people were being put off the new technology at a similarly early stage? MANY years ago I visited Radio City Music Hall in New York, and became one of the very few people ever to see a Radio City Rockette trip and fall on her nose during a high-kicking routine (fortunately without lasting physical damage, though the mental trauma must have been considerable). I found the experience both interesting and instructive, and I looked forward to making further such observations. 1 Note New performance indicators for NHS: Mr Paige commends his floppy disks Lancet 1985, ii: 285. After an age of waiting, one arrived recently. I live close to a Scottish salmon river, where the wildlife includes dippers, goosanders, red squirrels, and red and roe deer. There are otters, and an osprey occasionally comes to fish. At the top of the glen there is a pair of golden eagles. But, although agreeable, these phenomena are peripheral. The centre of my attention has always been the fly fishermen, haughty and aloof, who come from South of the border to spend an expensive week in waders in the middle of the current. I never wavered in my confidence that one day I would see one of them slip on a weed-covered stone and fall headlong. The moment, when it came, provided almost a carbon copy of the affair in New York. The cries of alarm, the flailing of the limbs, the loss of dignity, and the lack of serious injury were all according to pattern; I felt fulfilled. The victim stumbled out with his waders full of water and his mouth full of deplorable language; I have never seen a man so wet. Unfortunately I had not reckoned with Nemesis, and there was a sequel. A few days later, returning from my weekly visit to the supermarket with a shopping bag in either hand, I tripped over a protruding flagstone and fell forwards in exactly the same attitude as my two examplars, breaking my spectacles, cracking a rib, and bursting a bag of tomatoes all over my sweater. Whether this was a judgment or not, my appetite for this sort of thing has been temporarily sated. SERENDIPITY means, of course, the faculty of making happy and unexpected discoveries by accident. There does not seem to be a similar word in the strictly medical vocabulary. Such a term would be useful. How often have we stumbled on a diagnosis by accident and then taken credit for a good examination? Like the man whose chest we X-rayed routinely to find a peculiar thin line stretching from one lung to the other through the mediastinum. Technical fault, said the report, but lungs normal. Only when the patient commented on the number of technical errors his X-rays caused, did the penny drop. A thoracotomy revealed a bicycle spoke lying within the chest cavity, a relic of a road accident some thirty years previously. It produced some pleural pain and an interesting publication. GAMES EDITORS PLAY THE Roman goddess Minerva, clad in a smart lightweight suit and playing for the Brztish Medical Journal, was but one of the factors that seemed to stack the odds against The Lancet in this year’s sportive contest between the medical weeklies. Another was the venue, Regent’s Park, because a large part of the Adam Street team arrived in a state of collapse after ascending the ninety-seven steps from the local underground. And then there was the presence, in the Tavistock Square contingent, of a pair of fit-looking students from Manchester. Happily, the latter agreed to make up numbers on The Lancet side, and the resulting evenly matched competition drew cries of astonishment from the neighbouring Royal College of Physicians and zoo. The game was a version of rounders, and the result was declared an honourable draw; though modesty forbids mention of the scores.
Transcript of In England Now
381
possible if there were a Freedom of Information Act;legitimate commercial secrets would continue to be
protected.Enforcement needs to be strengthened both inside and
outside the committees. Not to take full advantage of thelicence renewal system seems to waste an opportunity whichshould be taken in the interest of the public. Similarly not toenforce the requirements of the licensing authority as theyrelate to advertising, for example, seems indefensible.
Finally it is no longer possible to ignore the issues raised bylinks between vested interests and the Government’s
advisers. The exact position of a committee member who hasclose ties with a pharmaceutical company needs appraisal.The Medicines Act (Section 3, para 2b) requires "the
Medicines Commission from time to time to review thecommittees established under Section 4 and to makerecommendations to the Ministers with regard to anychanges in their number or function". Such a review is nowdue and should include not only the formal remit of thecommittees but also the wider issues of their functioning.This might well require a critical examination of theMedicines Act itself.
In England Now
IT was, I thought, a fine chance for cooperation with my NHScolleagues. Our teaching district, probably one of the most over-resourced in the country, appeared not to have a BBC/Torchminicomputer to look at the new performance indicators on floppydisks1 that had fallen from on high into the hands of the planningoffice. Could our small, academic department help?
I had answered the phone. Delighted, I said. Come over at once.My own Beeb was in use (I write directly onto it, using Wordstar),but we had bought three, to be able to link into a bigger network inthe future. One has a colour screen, so we could all look at thewonders of DHSS high tech.The district information officer clutched the bright yellow and
blue plastic pack happily. He pulled off the wrapper, releasingseveral booklets, a ring-binder, and the floppy disks. One of the discscalled itself "Welcome", and a blue book gave clear instructions onstarting up."Press Break and B keys together, then release Break and then
B..." We started the cookery. Quickly the screen buzzed into life.The Welcome disk spelled out what it was going to do. "Press’return’ to go on to the next screen", it commanded. "Wonderful,"exclaimed the locum district specialist in community medicine."This is how I like computers."Then suddenly up on the screen: "Error 1060". Showing us all
the wrinkles, I thought. But pressing various keys wouldn’t makethe error go away. We searched through the manuals. No list oferror commands anywhere. We were stuck. The only choice was togo back to the beginning. We pressed the Break key alone, thenrepeated the process, slowly getting to the same place... "Well,perhaps we don’t need a welcome. Let’s go onto another disk," saidthe SCM. I left them to it, returning to work in my own office.Half-an-hour later, two sad faces appeared round my door.
"Couldn’t get any of them to work. Next one we tried, we got to onepoint with a table, and then it just vanished leaving a little white dotat the top of the screen." "Oh well," I said, reassuringly (I thought)."Try ringing up the DHSS. They’ve made such a fuss about thesePIs, Mr Victor Paige having a press conference and all that. They’llsurely have someone at a telephone to deal with the bugs. Any newsystem will have teething problems, and they can’t let a flagshipdistrict like ours be defeated, can they?"
I felt almost genial as I showed them out of the door. But inside, Iwondered how many other people were being put off the newtechnology at a similarly early stage?
MANY years ago I visited Radio City Music Hall in New York, andbecame one of the very few people ever to see a Radio City Rockettetrip and fall on her nose during a high-kicking routine (fortunatelywithout lasting physical damage, though the mental trauma musthave been considerable). I found the experience both interesting andinstructive, and I looked forward to making further suchobservations.
1 Note New performance indicators for NHS: Mr Paige commends his floppy disksLancet 1985, ii: 285.
After an age of waiting, one arrived recently. I live close to aScottish salmon river, where the wildlife includes dippers,goosanders, red squirrels, and red and roe deer. There are otters,and an osprey occasionally comes to fish. At the top of the glen thereis a pair of golden eagles. But, although agreeable, these phenomenaare peripheral. The centre of my attention has always been the flyfishermen, haughty and aloof, who come from South of the borderto spend an expensive week in waders in the middle of the current. Inever wavered in my confidence that one day I would see one ofthem slip on a weed-covered stone and fall headlong.The moment, when it came, provided almost a carbon copy of the
affair in New York. The cries of alarm, the flailing of the limbs, theloss of dignity, and the lack of serious injury were all according topattern; I felt fulfilled. The victim stumbled out with his waders fullof water and his mouth full of deplorable language; I have never seena man so wet.
Unfortunately I had not reckoned with Nemesis, and there was asequel. A few days later, returning from my weekly visit to thesupermarket with a shopping bag in either hand, I tripped over aprotruding flagstone and fell forwards in exactly the same attitude asmy two examplars, breaking my spectacles, cracking a rib, andbursting a bag of tomatoes all over my sweater. Whether this was ajudgment or not, my appetite for this sort of thing has beentemporarily sated.
SERENDIPITY means, of course, the faculty of making happy andunexpected discoveries by accident. There does not seem to be asimilar word in the strictly medical vocabulary. Such a term wouldbe useful. How often have we stumbled on a diagnosis by accidentand then taken credit for a good examination? Like the man whosechest we X-rayed routinely to find a peculiar thin line stretchingfrom one lung to the other through the mediastinum. Technicalfault, said the report, but lungs normal. Only when the patientcommented on the number of technical errors his X-rays caused, didthe penny drop. A thoracotomy revealed a bicycle spoke lyingwithin the chest cavity, a relic of a road accident some thirty yearspreviously. It produced some pleural pain and an interestingpublication.
GAMES EDITORS PLAY
THE Roman goddess Minerva, clad in a smart lightweight suit andplaying for the Brztish Medical Journal, was but one of the factorsthat seemed to stack the odds against The Lancet in this year’ssportive contest between the medical weeklies. Another was thevenue, Regent’s Park, because a large part of the Adam Street teamarrived in a state of collapse after ascending the ninety-seven stepsfrom the local underground. And then there was the presence, in theTavistock Square contingent, of a pair of fit-looking students fromManchester. Happily, the latter agreed to make up numbers on TheLancet side, and the resulting evenly matched competition drewcries of astonishment from the neighbouring Royal College ofPhysicians and zoo. The game was a version of rounders, and theresult was declared an honourable draw; though modesty forbidsmention of the scores.
