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2-3% for people who have been addicted for more than threeyears. "One has to face up to the fact," she adds, "that wehave a large and increasing proportion of addicts who will gettheir drugs come what may. Most countries which have -applied repressive measures to the problem have met withutter disaster." The medical profession, she thinks, would dowell to consider a solution which is more realistic but less

satisfactory for politicians who wish to convince theelectorate they are governing effectively. That solutionwould mean accepting that the country’s population ofaddicts will not decrease noticeably in the foreseeable future.But those addicts could be treated more sympathetically,weaned away from the dangers of injection, and allowedeasier, controlled, access to maintenance doses of their drugs.Such an approach would not lessen the numbers of addicts,but it would certainly remove many of the causes of thecriminality which the Home Secretary is so worried about. Itwould also greatly reduce the numbers of deaths from

hepatitis, septicaemia, and valvular heart disease which resultfrom injection itself, rather than addiction. It may not be anattractive political response, but, Dr Dally thinks, it would bea responsible medical response.

RODNEY DEITCH

National Health Service

ACCEPTANCE OF FUNDING, GIFTS, ANDHOSPITALITY BY NHS STAFF

THE Secretary of State for Social Services has sent to healthauthorities a draft circular bringing up to date the guidance to NHSstaff on acceptance of funding, gifts, and hospitality. He pointed outthat NHS staff, like the employees of any other public bodies, wereexpected to maintain scrupulous standards of impartiality andhonesty in their dealings with the commercial sector. He was confi-dent that the overwhelming majority did so, but from time to time"we need to modernise our existing guidance to staff, so that theyknow exactly what is and is not permissible". The main newfeatures of the draft guidance relate to soliciting or acceptance ofsponsorship for educational conferences and visits and of financialsupport for individual hospitals or units.On the funding of educational conferences and visits, the draft

proposes: "Whenever an officer wishes to attend an educationalconference or other occasion that is to be financed wholly or partlyfrom promotional or commercial sources he should seek approvalfrom the employing authority to accept a subsidised or free place orother assistance with the costs of attendance. The employingauthority should establish that the trip is confined to bona fide

medical, educational, scientific or technical purposes, should seethat reasonable limitation is put on the time to be spent for recrea-tional purposes, and that funding is limited to the participanthimself. The employing authority may then approve acceptance ofsuch cost of travel and hotel expenses as they think reasonable. Inthe case of hospital medical or dental staff the employing authoritymay wish to seek the advice of the regional study leave committee".Turning to the soliciting or accepting of financial support, the

draft continues: "Many individual institutions and units within theNHS have succeeded in raising substantial sums of money forservice developments or specific projects and Ministers wish tocontinue to encourage such practice. There are nonetheless dangersto be avoided in soliciting financial help. It should not be sought forthe purpose of benefiting individual members of staff eg, by helpingtowards the cost of attendance at a conference, course or otheroccasion. Nor should a unit solicit or accept financial support from amanufacturer or supplier who may then, or at some stage in thefuture, be competing with others to supply their product to thatunit. In all cases the employing authority should be consulted beforeany financial support is solicited or accepted". The draft circularwill now be a matter for consultation.

Notes and News

CANCER ON THE MAP

Edmund Clerihew Bentley was quite wrong: it is epidemiologythat is about both maps and chaps (and their spouses), according to acancer research team from a Medical Research Council Unit in

Southampton. Theirs is not the first attempt at mapping disease,but it is the first in such detail. Technically, it is a considerableachievement, in terms of computer skills and accurate handling ofcolour registrations (paper expansion in the summer heatwave putpaid to the first print-run). Scientifically, the atlas confirms, at aglance, several known associations-the "hot spots" for asbestos-associated pleural mesotheliomas are as expected; the county mapspick up the nasal cancers of Buckinghamshire furniture workers;the variation of melanoma death-rates with latitude is confirmed;and Nottingham looks like a city where cigarettes are all too readilyavailable to men and women. But for every association confirmedthere are dozens of new challenges. Why are women in some parts ofWales at increased risk of death from oesophageal cancer, a burdenthat is soon lightened, it seems, on emigration? US incidencefigures2 suggest that non-melanoma skin cancer, like the much moreserious melanoma, is related to exposure to ultraviolet light. TheSouthampton team’s county maps suggest the reverse (especially forwomen) for death from "other cancer of the skin". So are the south-western and home counties not only sunnier but also better servedby their dermatologists? Dr Martin Gardner, introducing his atlaslast week, emphasised that, despite the disturbing reds and

reassuring greens on the maps, it is behaviour and occupation thatmatters not place of residence per se. He is aware of the dangers ofoversimple interpretation; indeed he and his colleagues have alreadysuffered one such experience. If the common cancers are largelyavoidable these maps should focus the minds of hypothesisgenerators: they tell us little by themselves.

WHO CARES FOR HOSPITAL WORKERS?

HOSPITAL Health and Safety Committees would do well to try toget a recent television programme shown to staff in their hospital.The programme, 3 Who Cares for the Carers?, examined

occupational hazards faced by various categories of hospitalworkers. Back strain is a risk not only to nurses lifting heavy patientsbut also to porters moving oxygen cylinders, whether full or empty,and to kitchen workers carrying items such as bulky tureens of soup.Similarly, cuts and sometimes subsequent infection by "sharpes"can happen not only to doctors and nurses, but also to laundryworkers who come across suture needles in soiled linen. Nurses arenot always protected against sprays and spillage while drawingdrugs into syringes; the example shown on the programmeillustrated the problems arising when using cytotoxic drugs. Andthere may be risks that women hospital workers face when theybecome pregnant.The film showed what health authorities can, with the right

enthusiasm and motivation, do in the way of preventive medicine. Itdiscussed the powers of the Health and Safety Inspectorate inenforcing safety procedures drawn up by health authorities. It is apity the film did not show the work of Health and SafetyCommittees and the difficulties these sometimes have in trying topersuade health authorities to provide essential safety measures.

SAFE HANDLING OF CYTOTOXIC DRUGS

THE WHO reports on occupational hazards in hospitalsmentioned that an area of concern is the effect of cytotoxic drugs on

1. Atlas of Cancer Mortality in England and Wales 1968-78. By M. J. Gardner, P. D.Winter, C. P. Taylor, and E. D. Acheson, MRC Environmental EpidemiologyUnit, Southampton. Chichester and New York: John Wiley & Sons. 1983. Pp 116.£45 (£35 before March 1, 1984); $85 ($65).

2. Scotto J, Fears TR, Fraumeni JF Jr. Incidence of nonmelanoma skin cancer in theUnited States. Washington DC: US Government Printing Office, 1983.

3 Who Cares for the Carers, 3rd in series Picture of Health—Who Cares? Channel 4,Dec 2.

4. See: Occupational hazards in hospitals- Lancet 1983; ii: 1321.