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.