The AIDS Epidemic Presented by Jay Wopperer. HIV/AIDS-- Public Enemy #1?
PUBLIC INFORMATION CAMPAIGN ON AIDS
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297 Notes and News PUBLIC INFORMATION CAMPAIGN ON AIDS MARKET research has shown that about one-quarter of respondents to a survey had noticed the Government’s public information advertisements on AIDS published in the national press during March and April, a higher figure than that normally expected of press advertising. 1400 adults aged 18-64 were interviewed in their homes and 450 men were interviewed in gay bars or clubs during February and April of this year by the British Market Research Bureau. 94% of the people interviewed believed that the Government should be running the campaign against AIDS. Sir Donald Acheson, chief medical officer at the Department of Health and Social Security, finds these results encouraging, particularly because most of the people interviewed found the advertisements easy to understand and because they had faith in people changing their behaviour so as to become less at risk of AIDS. Sir Donald has emphasised, however, that there is no room for complacency; this is only the beginning of what would have to be a continuing campaign. He said: "There can be little doubt that a general improvement in people’s knowledge and attitude towards AIDS is taking place. This trend began well in advance of our campaign, although our research study has recorded some changes in perception and attitude between the February and April interviews. It is encouraging to note that these were all in the direction we would wish to see. We would hope that the next stage of our research, to be carried out later this year, will pick up further positive changes in people’s awareness about AIDS and the ways in which the infection can be transmitted". Sir Donald commented that the research had also shown that a majority of people still found much of the advice available about AIDS confusing. A further series of national newspaper advertisements appeared last week. INQUIRY INTO OBSTETRIC PRACTICE OF MRS SAVAGE THE final part of a report from the inquiryl.2 into allegations concerning the practice of Mrs Wendy Savage, an obstetrician at the London Hospital who has been suspended for the past 15 months, was made public last week. The report was compiled by Mr Christopher H. Beaumont, QC, Mr Leonard P. Harvey, consultant obstetrician, Hospital of St Cross, Rugby, and Prof Peter W. Howie, professor of obstetrics and gynaecology, University of Dundee. Their conclusions were: "Our report indicates that Mrs Savage, whilst she did in some instances fail to attain the highest possible standards of care, did not exhibit professional incompetence in her treatment or clinical management of any of the five cases which we had to consider. "Because in our view Mrs Savage’s treatment and clinical management of the five cases fell within the broad limits of acceptable obstetric practice, we find that she was not "at fault" within the meaning of HM 61 (112) and of our terms of reference. "We therefore consider that it would not be. appropriate for disciplinary action to be taken against Mrs Savage. We make no recommendation as to disciplinary action.. Furrher Obseruations "Although they are outside our strict terms of reference, there are a number of matters of concern which became apparent during the course of the proceedings, upon which we feel that it would be helpful to express our views. Our reason for referring to these matters m this way is because they have potential implications for patient care in the London Hospital." These matters of concern are referred to in part 1 of our report. In broad terms they can be categorised as: (a) poor working ’60nshiPs between Mrs Savage and some other obstetric 1 Editorial. The wrong kind of inquiry. Lancet 1986; i: 594. 2 Editorial Professional implications of the Savage case. Lancet 1986; i: 837. consultants; (b) poor communication between medical staff; (c) unsatisfactory cross-over arrangements between obstetric consultants. "We do not seek to apportion responsibility for those matters in any way. We recognise and respect the genuine differences of opinion and deeply held views of the individual consultants. A practical solution could be to separate the obstetric units at Whitechapel and Mile End. This could be achieved by Mrs Savage and another consultant (perhaps a new appointment) being responsible for Mile End, whilst the other present obstetric consultants would be responsible for Whitechapel. "We also recommend that when unfamiliar methods of management are being employed, the consultant concerned should be closely and personally involved at all stages." The day after these observations were published Tower Hamlets Health Authority unanimously agreed that in the light of the recommendations "the suspension of consultant obstetrician Mrs Wendy Savage’s honorary contract be lifted forthwith". The Authority also decided to set up an advisory panel with the following terms of reference: "to note part two of the Beaumont inquiry and (a) make recommendations on how professional working arrangements can properly be established within the department of obstetricsexcluding details of clinical care, and (b) in addition, make any other recommendations which may be helpful to the Authority in its resolution of the inquiry." The panel will be asked to make an initial report to the Authority at its September meeting. Dame Alison Munro (chairman, Chichester Health Authority) has agreed in principle to take part in the panel. The President of the Royal College of Obstetricians and Gynaecologists is to be invited to nominate a member from "the broad spectrum of obstetric care". Mr John Alway (district general manager, Tower Hamlets Health Authority) will also take part. An editorial appears on p 257. FOOD AND HEALTH: THE FARMING CONNECTION James Erlichman’s book, Gluttons for Punishment/ may convert many meat-eating readers to vegetarianism. The author, chemicals correspondent on The Guardian, traces the means by which profit-hungry livestock farmers increase the growth of their animals via liberal use of antibiotics and hormones. In 1980, many infants in Italy consumed babyfbod containing veal, some of which had been heavily contaminated with stilbenes (diethylstilboestrol), the female growth hormone, which had the effect of producing breasts iri baby boys and well-developed sexual organs in baby girls. The drug had been banned in Italy, after evidence of vaginal cancer in the daughters of women treated in pregnancy with stilbenes in the’70s, and in France. Only in Britain was continued use of the drug permitted (it was finally banned in 1982), although throughout Europe stilbenes were used-illegally by livestock farmers. They are easy to manufacture, cheap to buy, offer rapid weight gain, and can be concealed from inspection. The infants who suffered thelarche had consumed meat taken from an area close to the injection site. So far as can be known at present, the infants returned to normal when their diet was changed. In Puerto Rico, many more cases of thelarche have been reported but the source of the female growth hormone remains unclear. What is clear is the existence of a thriving black market in illicit growth hormones and antibiotics. Erlichman recalls how for about 20 years many of us sat down regularly to the Sunday capon, an uncastrated cock whose weight gain has been speeded up by hexoestrol (a member of the stilbenes family of female growth hormones), before the drug was banned. In its place growth- promoting antibiotics were used and continue to be used in pig, poultry, and cattle farming, resulting in a series of outbreaks of fatal food poisoning caused by antibiotic-resistant strains of salmonella. The chain leading to human tragedy is made more complicated by such new farming procedures as feeding beef-cattle chicken litter (including faecal droppings) and so transmitting sahnonella to cattle and then humans. Vegetarians, nevertheless, are unlikely to remain complacent as they read through the book. Erlichman goes on to 1. Gluttons for Punishment. By James Erlichman. Harmondsworth: Penguin Books, 1986. Pp 157. £2.95.
Transcript of PUBLIC INFORMATION CAMPAIGN ON AIDS
297
Notes and News
PUBLIC INFORMATION CAMPAIGN ON AIDS
MARKET research has shown that about one-quarter of
respondents to a survey had noticed the Government’s publicinformation advertisements on AIDS published in the nationalpress during March and April, a higher figure than that normallyexpected of press advertising. 1400 adults aged 18-64 were
interviewed in their homes and 450 men were interviewed in gaybars or clubs during February and April of this year by the BritishMarket Research Bureau. 94% of the people interviewed believedthat the Government should be running the campaign againstAIDS. Sir Donald Acheson, chief medical officer at the
Department of Health and Social Security, finds these resultsencouraging, particularly because most of the people interviewedfound the advertisements easy to understand and because they hadfaith in people changing their behaviour so as to become less at riskof AIDS. Sir Donald has emphasised, however, that there is noroom for complacency; this is only the beginning of what wouldhave to be a continuing campaign. He said: "There can be littledoubt that a general improvement in people’s knowledge andattitude towards AIDS is taking place. This trend began well inadvance of our campaign, although our research study has recordedsome changes in perception and attitude between the February andApril interviews. It is encouraging to note that these were all in thedirection we would wish to see. We would hope that the next stageof our research, to be carried out later this year, will pick up furtherpositive changes in people’s awareness about AIDS and the ways inwhich the infection can be transmitted". Sir Donald commentedthat the research had also shown that a majority of people still foundmuch of the advice available about AIDS confusing. A furtherseries of national newspaper advertisements appeared last week.
INQUIRY INTO OBSTETRIC PRACTICE OFMRS SAVAGE
THE final part of a report from the inquiryl.2 into allegationsconcerning the practice of Mrs Wendy Savage, an obstetrician at theLondon Hospital who has been suspended for the past 15 months,was made public last week. The report was compiled by MrChristopher H. Beaumont, QC, Mr Leonard P. Harvey, consultantobstetrician, Hospital of St Cross, Rugby, and Prof Peter W.Howie, professor of obstetrics and gynaecology, University ofDundee. Their conclusions were:"Our report indicates that Mrs Savage, whilst she did in some
instances fail to attain the highest possible standards of care, did notexhibit professional incompetence in her treatment or clinical
management of any of the five cases which we had to consider."Because in our view Mrs Savage’s treatment and clinical
management of the five cases fell within the broad limits of
acceptable obstetric practice, we find that she was not "at fault"within the meaning of HM 61 (112) and of our terms of reference."We therefore consider that it would not be. appropriate for
disciplinary action to be taken against Mrs Savage. We make norecommendation as to disciplinary action..
Furrher Obseruations
"Although they are outside our strict terms of reference, there area number of matters of concern which became apparent during thecourse of the proceedings, upon which we feel that it would behelpful to express our views. Our reason for referring to thesematters m this way is because they have potential implications forpatient care in the London Hospital."These matters of concern are referred to in part 1 of our report.
In broad terms they can be categorised as: (a) poor working’60nshiPs between Mrs Savage and some other obstetric
1 Editorial. The wrong kind of inquiry. Lancet 1986; i: 594.2 Editorial Professional implications of the Savage case. Lancet 1986; i: 837.
consultants; (b) poor communication between medical staff; (c)unsatisfactory cross-over arrangements between obstetricconsultants."We do not seek to apportion responsibility for those matters in
any way. We recognise and respect the genuine differences ofopinion and deeply held views of the individual consultants. Apractical solution could be to separate the obstetric units at
Whitechapel and Mile End. This could be achieved by Mrs Savageand another consultant (perhaps a new appointment) beingresponsible for Mile End, whilst the other present obstetricconsultants would be responsible for Whitechapel."We also recommend that when unfamiliar methods of
management are being employed, the consultant concerned shouldbe closely and personally involved at all stages."The day after these observations were published Tower Hamlets
Health Authority unanimously agreed that in the light of therecommendations "the suspension of consultant obstetrician MrsWendy Savage’s honorary contract be lifted forthwith". The
Authority also decided to set up an advisory panel with thefollowing terms of reference: "to note part two of the Beaumontinquiry and (a) make recommendations on how professionalworking arrangements can properly be established within thedepartment of obstetricsexcluding details of clinical care, and (b) inaddition, make any other recommendations which may be helpful tothe Authority in its resolution of the inquiry." The panel will beasked to make an initial report to the Authority at its Septembermeeting. Dame Alison Munro (chairman, Chichester Health
Authority) has agreed in principle to take part in the panel. ThePresident of the Royal College of Obstetricians and Gynaecologistsis to be invited to nominate a member from "the broad spectrum ofobstetric care". Mr John Alway (district general manager, TowerHamlets Health Authority) will also take part.An editorial appears on p 257.
FOOD AND HEALTH: THE FARMING CONNECTION
James Erlichman’s book, Gluttons for Punishment/ may convertmany meat-eating readers to vegetarianism. The author, chemicalscorrespondent on The Guardian, traces the means by whichprofit-hungry livestock farmers increase the growth of their animalsvia liberal use of antibiotics and hormones. In 1980, many infants inItaly consumed babyfbod containing veal, some of which had beenheavily contaminated with stilbenes (diethylstilboestrol), the femalegrowth hormone, which had the effect of producing breasts iri babyboys and well-developed sexual organs in baby girls. The drug hadbeen banned in Italy, after evidence of vaginal cancer in thedaughters of women treated in pregnancy with stilbenes in the’70s,and in France. Only in Britain was continued use of the drugpermitted (it was finally banned in 1982), although throughoutEurope stilbenes were used-illegally by livestock farmers. They areeasy to manufacture, cheap to buy, offer rapid weight gain, and canbe concealed from inspection. The infants who suffered thelarchehad consumed meat taken from an area close to the injection site. Sofar as can be known at present, the infants returned to normal whentheir diet was changed. In Puerto Rico, many more cases ofthelarche have been reported but the source of the female growthhormone remains unclear.What is clear is the existence of a thriving black market in illicit
growth hormones and antibiotics. Erlichman recalls how for about20 years many of us sat down regularly to the Sunday capon, anuncastrated cock whose weight gain has been speeded up byhexoestrol (a member of the stilbenes family of female growthhormones), before the drug was banned. In its place growth-promoting antibiotics were used and continue to be used in pig,poultry, and cattle farming, resulting in a series of outbreaks of fatalfood poisoning caused by antibiotic-resistant strains of salmonella.The chain leading to human tragedy is made more complicated bysuch new farming procedures as feeding beef-cattle chicken litter(including faecal droppings) and so transmitting sahnonella to cattleand then humans. Vegetarians, nevertheless, are unlikely to remaincomplacent as they read through the book. Erlichman goes on to
1. Gluttons for Punishment. By James Erlichman. Harmondsworth: Penguin Books,1986. Pp 157. £2.95.
