stack257 BLACK BAGa<'s1 ar

NOtn THAT'S I.IHATI CALL A RAD|CAL

PANCREATECTOMY !!!

15 $AR 1981

rtgot$to$

Wherever you wantto 9o... 151 1 10884 I

|ililililililililfltilililt I I llilt till

. Worldwide flights.

. Special faresfor studentsand academics.

o Tours andshort breaks.

. Ski holidays.o European trains.

...we'll get you therc!

TheWorldbeatersrcE>

Unbeatable prices - unbeatable quality!Call in and see us about your electives.

Enquiries and BookingsE 0.272 294399 Et25 Queens RoadBRISTOL BS8 1QE.

ffi;EA.- 7z*dJ?;=A+tiE{*S:Yz^'1.Hri;rViS-:* Z;;--.7./

+\

BLACK BAGJoumal ofthe Medical Faculty of Bdstol Udve$ity

Editor Phil Stokes

Busiaess Managers Abi Beryer

Andlew Padkio

IllustratioDs RichardJennings

Typesetting YorkHouseTypographic

Printed by GPS Priuters

Lettas and eontibutio$ are uehome and shotM be sent uThe Edito, Black Bag, Dolphin House, B^tol RcJalInfimtry, Bristul2. Aryona i. ercsud in helping uirt theptoduttion ol the nseaziw shouA abo contzct the ditln.

Contents

Who treeds a space blalket atrYwaY?

by illike Polkey

Doctor Coles - The matr behind the myth

by S. Donim ........'..The loatrs issue

by Jonathan Fielden

Four rrheels good, two legs bad

by Bernhad Stacey

Overdosed.trd underteated?

by a B.istol Samaritan

A group home

by Phil Stokes

A surgeotr's guide to cboosi[t a carcer

by Manwatcher

Drug prescribiag ia the third rporld

by Paddy McMaster

The Modca Brittotr Hallby Susan Langley

A room of my own

SPRING T987

Editorial

This issu€ of Black Bas shows a marked swirs tosndent writitrg. Perhaps this is because you thoughtth€ last issue, larg€ly wriften by outsiders, was suchthat you ktr€w you could do better, or perhaps becausethey awakercd your i erest. Eittrer way its a healrhysigtr, though partly due to maDy promises of artidestmm'outsid€' coming to nought. It's reassuring Iotrote thst studetrts ar€ mor€ reliabl€ than (say) pro-fesrors in this wry.

Anyway, in this issue you will 6nd discussed thepossibility of loans mther than grants for medicalstudents as a test cese, the ebuse of freebies by doctorsand dnrg compenies, and a criticel ourside view of theteatment of overdoses. In a ligiter vein there ere a

number of offerirgs from under ridiculously trans-psrcnt pseudolyms, and the offer of €10 for a decentrhyme about someone on the stafl There will be onemore edition this academic year, before someone un-lock this door atld lets me go, so if there's somethingyou've be€n sittiDg on all year and walted to send in,now is rhe dme- More chairs wo'nd be rLice-

10

ll

l3

t4

t7

l8

m

I$(/HO NEEDS A SPACEBLANKET ANY'$TAY?

As students, the amount of largesse we receive from drug companies only runs to the occasional freelunch, but after qualification the possibilities for benefits increase enormously. Mia e polkey looks at

what is handed out, and how a system of controls might work to reduce the cost ofdrugs.

A friend of mine recently rtent to a slap up drugcompany lnnch, As well as free sampl€s, he elsoreturned with four l3 amp fuses, a "musicassettefor acne patients", and a space blanket. I fail to see

the benefit to patients, and therefore in the longer termto doctors, of meetings of this sort, I intend to dis-cuss here the interplay between drug companies anddoctols, the industry itself, and finally to ask how wemight impaove the situation.

M.Erial suppon to doctori by drug comp€ni€s rargesfrom a cup of coffee at hospital rneetirgs through pens

and books to symposia in exotic locations. In otberparls of the world the industry is more generous. OneAmerican physician was rccendy offer€d $100 to go todinner and heqr about a new IV globulin preparation.If he managed lo bring along a coleagu€ he wouldreceive a further $1001. On one Philippin€ island adoctor was offered two motor cars if he would set up apharmacy, which would have had a monopoly, sellingthe products of iusr one 6rm'?. In this countrv ethicalcodes restrict the actions of the industry, althoughttre recent censure ofBayer UK by tle Associadon of

Bdtish Phermaceutical Industries is e reminder thatthes€ are sometimes broken3. The ,,hpertension

screening uiel" set up by Bayer, which had no validscientmc protocol, and whose result$ were not evencollated, was run only with the aim of incr€asing theprescription of Adalat. Doctors were offe.ed ar ECCmachine if they would presclibe the druE to fiftypatients,

Doctors aim to improve the herlth and well-behg of(heir p|tients, while a drug company aims to make aprofit for its shsreholders. Clearly these aims sorne-umes overlap, bur equally rhey may be in opposirion;for example 6nal devetopmenr of a vaccine againsrmalaria has been delayed indefnirely because of com-m€rcial unviabilitya. Many would argue rhat drug repsare an important source of information. Yet such avielv is incredibly naive. Orw€ll once obseryed tllat justbecause something is printed in fie Daily Telegraphdoes not mean that ir is not true. Likewise a rep maybe correcr if he asserrs that his product rcpres€trts agenuine advance, or he may not. The doctor cannotknow without a rhorough and expen recourse to the

ftl suRE '(ouR Pno{ATRtCPATIENTS CAN DO !.IITI{OIJT TOUFOR FIY€ T,IINUI€S, TNHITE I TEL!'(0U AL! agour ci.rq NEuJ

ANTIDEPR€SSANTS

literature. But how many docto$ spend al1 aftemootrin the library after meetiry reps? A doctor gmuinelyinterested in updating his knowledge will attesd meet-ings with his colleagues in academic medicine, vrhoare paid to keep abreast of current developme s. Itis bizarre $at supposedly intelligent professionalsshould consider ftemselves immure from the effects ofmarketing. If they were, the industry would not wasteits money. The more cynical wil regad the bbndish-merts of the indusEf as "perk"- But geouirc perkoffered in the real world, such as the company car, arequit€ different. They represent a vray of raisilg their:come ot r-he conpanies employees. without having ropay the govem-oeent for it dfough taxation. Anywaytie position here is fundamentally dillereot since

doctors do not, ofcourse, work for the pharBacellticalindusrry.

The drug busi ess, like any oth€r, op€mt€s for profit,although its product could be argued to be more worth-while ftan most. Nevenheless the industy will take as

much as it catr. The most notorious exsmple itr thiscountry was publicised in fte 1973 report by the Mono-polies Commission on transfer pricing by Roche for lhesupply of Valium to the NHS. Roche had sold the rawmaterials to their British subsidiary at f922 p€r kilo,who had then sold to the NHS at a maryinal profit (andpaying only marginal ta{). Curiously the cost of themw materials to the parent compary was only f20 p€r

kilo, represeDting gross profireerings. This scandalended with Roche actually making a cash paymetrt tothe UK by way of compensatioo.

Dianna Melrose 6rst brought t-be ouLmgeous actions

of rh€ drug companies in the third world to oul aftetr-rion2. Four years later on the situatiotr is "cha4ed butnor improved"6. "Etrc€phabol", a viramh 86 d€riya-rive alleged to improve "the uptake and utilization ofglucose in the btain" is promoted in India for "strokes,orgadc brain s''odrome ot rhe elderly. post coocussionsyndrome, and pedtratal dislr€ss"- Dr Greenhalghinforms us that ma*€tiDg patlems bave cbtrged widrthe emphasis now on s€Iitrg products that are used itrrhe developed world, but for differetrt itrdicatiotrs.Thus Chloranrphenicol cotrstitutes an astotrishing llolo

of antimicrobiat prescriptions. Chlorampheniml is, ofcourse, only used in rhis coutry t'l srtrenn because ofils rare fatal side effects.

Drug companies c:tr show disregad for doctorsparticipating in clinical reseaich for them, atrd thosewho do should thereforc be cauuous as rc how theirreputations will be used. P6zer recendy withdrew a$adv€rtisemeot in which s€veDteen Fomifttrt Catradirnrheumatologlsts app€ared to endo$e the compa.oy's

contentiofl tlat Felderc was superior to other non-saeroidal-anti-infammatories in the ueatment of rheu-matoid ardrritisT'3.

ft is not my intention here ro criticise co aborariveclinical work in specialised fields. It nay only be hopedrhar risks are nor b€ing taken for fte sake of drugs thatare chemicaly similar to, arxd no morc emcacious dlan,exisring ooes. However, given Lhal it bas beetr esri-mated that Fomotion accounts for 20% of the totalcost of a drug, anyding whicb reduces lbeir cost is,in the present economic climate, to be welcomed. Itwould be faolish of course to s€ver contact between the

industry atrd the profession totally, bur it is possible

to forc€ itrdusEy to support th€ profession in a lesspanisan way. The Swedes enioy a rigidly tegulatedsyst@, at l€ast:s far as hospital doctors are concemede.

In Swedish hospitals reps are oot allowed ro speak toindividual doctors, but must address the whole depart-ment, atrd sre not usually alowed to speak morc thanrwice a year. Before th€ meeting the scientific standardof rhe material is checked by the head of department.No fr€e gifts are allowed, and if th€ presentauon is ofpoor quality tie rep is not allowed back. Drug com-paaies may not pay for doctors m€rcly to attend meer-ings. Tho6e sp€aling trIay oDly bave their expenses paid

if local commine€s are conv bced that it is appropriate-In Briraitr th€rc is oo prospect of central control

and ir is rherefore up ro hdividual doctors to de.idetheir own practice. Because of th€ unethica.l aspects ofrhe industry and its mark€ting practices, I propose a

reduction of exposure to promotional activities- As

a simple 6I5t step I would suggest that doctors do

not meet reps olr a one to oDe basis. A typical medicaltraioing for a drug rep lasts about sevm we€ks. Theprocess of such a rep trying to convince docbrs, withprobably litde erperieDce of th€ scientific method, oft}le advanrages of Fadasricapam is so parhelic as tobe lawhable, hile a mass of space blanke6 metelydegndes the profession.

r- Mubs, D.M. 0986) N. Ens. J- M.d.t/5(9) 5m2- Mdrw, D. (1982) Biaer PiIs, olful. Amn 0986) BMJ 292 644, M.ct@ie (1984) N- Scidtist 2484 45, Mompolis cmni$iM ReFn O97l) H.M.S-O.6- Gt€hsleh, T. 0986) L@et (8493) I31a-1t207. v€isl]u, M.H- (1985) I. Rnem r2(J) 615

8, K@s, G-R. (1986) J. Rheun lj(r) 224e. SEith, R. O98s) BMJ 290 ,148450

CompetitionWrile a te ing rhyme about a member of staff and winyours€fclo. A couple ofexamples app€ar below ro setyour mind iorking-

I suppos€ it is jusr possible that Mr I-€aper migltsel€d his fenale hous€men or1 the g/ou[ds thatthey are bright.But persomlly I think he

iust consults his little winkie.

Tbe wods ofMr Coopercame dnging rbrough my stuporas he told me wirh the F€cisiotr ol a Vernier"Your €xam isn't completefrom the hesd to th€ feetunril you've checked they havml got a herda"

Sptrd your entries (which should be printable!) to TheEdiror, Black Bag, Dophin House, BRI. As well as flofor the best otre, we hope to print a selectiotr in th€ nexrissue.

-

f)JIT-aJBIT4A

ASSOCIATE JIIEMBEITSHIP

Open to all medical students for an annualsubscription of t74.16 (or€1.18 per month)

. Receipt of BMJ in the clinical years

. r Discounts on all insurances and on consumer goods throughBMA Services Ltd'

. Flepresentation of each medical school on national AssociateMembers Committee

r Use of the BMA LibrarY

o Receipt of BMA News Fleview monthly

t Perconal advisory service

o Guidance notes from BMA local offices e.g' on Medical Students inHospitals, First House Job etc.

c Free advice from local offices e.g. on pre registration contracts etc'

You can't aftord not to ioin 'Contacl Mrg G. Wilson

ReEional Officerl5l Whiteladies FloadBlstol BS8 2RA

Tel: 736636 or 739677

DR COLES:THE MAN BEHIND THE MYTH

Myths and legends fom an imponant pan of atry cul-ture. Which of us has not been thrilled by impossibletales ofKing Arhur, Bigfoot or theAbomiDable Strow-mar? For the bistoriaq however, such legends presenta more challengiDg task - that of discoveriry the grainof Euth, if any, q'hich lies behhd the romantic folk-tale. Here, we will egmine iust one such local legend;that of $e mysterious DOCTOR COLES.

We all know the leg€nd; drc benevoletrt if somewhatnebulous fgure of the wise old doctor, whose evervigilanr eye keep6 conshnt watch over his belovedflock of students and patients, exening, Iike th€ HoIyGhost, a]l invisible but benign induence over us all.

A childish fable? The opiurr ofthe medicsl students?Or mighr we fild, as in so rnatry legetrds, a nugaet offact behind rhe clords of obfuscation? Many havesought for it, and various schools of thought contendfor the most likely interprctation of the m''rh.

The historical approach is orc of the most popular.For example it is often claimed that far back in the verydistahr past, ahere was an actual living penon calledColes who realy did work as some kind of doflor inBristol - a tradlEoa rememb€red to this day in thecharmilgly quaint local custom of keeping the name'D.R. Coles'on the N.H.S- pay-roll.

Others sug.gest that the real Dr. Coles was indeeda clinical dea! at the tum of the ce ury, and diedheroically at his post in 1908, from a surfeit of tea andbiscuits- To $rppofi ttris are garbled repons fromstudents who claim to have penetrat€d as far as hisoffice, ard sefn a musty skehton in &lwardian costume,stil propp€d in a chair with its fe€t on the table, ardLbe remai$ of a digestive stil cleoched between irsfleshless iaws.

Matry p€ople, howeyer, claim that the figure of Dr.Coles is completely fictiiious, and that no such p€rsonever existed- Some cydcs blame the fable otr th€ B.R.I.pbysicians, whom they accuse of fosteriry the mythof Dr. Coles as a Puck-like spriE who trips mefiilydllough lie wards afier dffk, admidstering spuriousand uwholesome Dedicatioos ro his unlucky victims.

Less plausible are rhe th€ories of rhose who lookto the Bible for 3tr explaBtion, seeing the CliaicalDean as a quasireligious motif fm some deeper, morespiritual idea. They suggest for ifftatrce, thar MissBryden is in fact a Hish Priestess, iealously guardiqhe that on the Day of Judgement wiil rerum again tothis world, to breck the seven seals on the Book ofGrades, atrd read out the tram€s ofthos€ who are saved,atrd thos€ who arc consiged to everlasting tormen!alrd pedition.

Finally, we come lo the most controversial area ofthe debate - the sGcalled "sightings". As in the case ofth€ I-och Ness motrsler, the Coles legend is fuelled byiftermift€trt atrd coDfus€d rcpons from people whob€lieve they have actually caught a glimpse of him.A few studetrts who daim to have gained entrance !o

the inner sarctum of his ofice muner strangely of a

murky shap€ ha]f p€rceived in the gloom' which (*teysay) seemed almost to lod while they were explainingtheir elective plans. Othe$, who have clearly had analtog€ther mor€ harowitrg experience, are so shafteredby what th€y have s€etr that they babble insanely of aharnless ad aseeable old m!tr, som€what brusqueperhaps, bur (according rc rhem) wholy hunan. G.ecenrs'uggestiotrs rbrt this is in fact a hologam have yet m beinvestigated),

Virrually a[ the e4€rts have dismissed such sight-ings as deluded trolts€nse. So why is the mJ'th of Dr.Coles so pffsisteDt? The atrtimpotogists will tell us6ar irrarional rrust in such a fgure is an inevitablehuEan weakftss. Their opponetrE might reply tharwe live in an age of reason, and should tllrow off theshackles of superstition ard consig:i our naive andprimiLive faith in Dr- C,oles to the dustbin of harory.

\0hatever lbe trulh of lbe mrlter, one thing is certaljl:the vilal evidence needed to solve the problem maysooD be lost to us forever- For yeals Miss Bryden hasjealously guarded the terible s€cret which lurks behindthar door marked 'Clinical De3n'. Now, however, shehas evidently decided lhat more drastic measures arene.essary. Studmts vrill have aoticed the gmdual bnck-ing up of corddors ard passages which once led rothe Dean's o(ice. Where once we could freely etrterDolphin House, v,/e now face a barricade of cement. Atthe undoubted insdgation of ldiss Brydm, a concretecurtain is inexorably desceoding aromd her office, andthat of the Clinical Dern. EveD the entrarces which areleft are controlled by combination locks whos€ secretsare known only to tie initiated few. Already it requiresthe irtrepid dadng ofan Ind;ana Jones iust !o get as faras Miss Bryden. If we don'a establish the exislerce orotherwise of Dr. Coles very soon, i! will be too late - heand Miss Bryden will be utterly cut off ftom theourside world - entomH together tor aI ererniry.

S. Donim (Ms)

Somefhing wrong?A surgeon and his son were travelling alotrg th€ M4 roBristol, when a blow-out rnade them swerve off rhercad, hirting cars as they crent, atrd enrling up in themiddle of a tangled heap of metal. Th€ farher waskilled ourright, but the son, though badly itriured, \r'asrescued and driven in an ambula.Dce to hospital. Need-irg urgent surgery, he wmt straiSht to theaffe- Asugeon scrubbed up, but on entering th€ room wasseen to halt, turtr pale alrd say - "l can't do thisoperation, ttrat's my son!"

If sonzth;ns str;hes Jou as be;ns ,ot'g hqe, and Jounaed an exblanarim, ftn ash anl uonan in me"4nnz.

$"tt{Atitr;,a

gh-r/'"r/ 8*Vr^<ttTAKE AWAY FOOD CENTRE

156 Whitcladies RoadBlackboy HillTel: 730819

PASTA GAI,OREBERBEI T CENTRE

Eesh Pasta or Sauc€s to actompanyall made on the pEmises daily'

Or Ey oul HOt LITNCH TAIE-AWAY&om 95P

We also stock ltdian Salamb andChe€ses and a wide rango of

unuaud d€licatesaen

Tel2?3184

BLACKBOYCAFE

Top ofBlackbov Hill

Open 7 days aweek all day

Tel: 7 3+7 57

qAR8trR $lOPPark nace - o{f Queens RoadClifton. Bristol.-(0272)73615?

Mr. s* nrons B.rttr Sklp

HOURSOF BUSINESS

Monday io Friday 8am.6.l0pm

Saruiday 8am'lpmFIIFE PARI(ING K]R CARNAGES

THE LOANS ISSUE"lX/e haoe concludBd that thate is an urgent ,Eed fot at inoease, in real ams, in satdent awards . . ."

"We recomma l that stude a@atds be indeased abooe thc generul lcoel of prices unt the leoel of awardsopproximates to the costs whih studenc indt-"

Thes€ ab6tracis from the important series offtcommen-dations made in the 6fst rcport ofthe Educarion, Scienceand Ans Com ttee (ESAC)r, recendy published,s€rved to add furher con$ov€$y to the topic.l debateover how to furd studeDts. The rccommerldations, allessentially in favour of imploving the prese$ syslemrather tian charging ir , were ajl $e more impona.Dt inthat thev reEesent the fiIst major depaftu€ of a CoFsenative domi[aled mmminee away from advocatinga change to a loals system. To be relisric thes€ will notin thems€lves become gpvemment policy, altboughtley will be stroog iDdicatioos to the 'Waldell Ioquiry'into student financial supporr of an increasing ground-swell of opinion on the backbeDches. The publicationof the !(alden report is eagerly awaited as the 6rststatement of policy on this subiect from rhis govem-ment since 1979; we have a[ floutrd€I€d in a void ofnon-policy for roo long. However, despire th€ rcminalimpaniality of this wide rarging review, Mr Waldetrhas made his bias tovrards loalrs as well knowtr as b;sstubbormess ao acc€pt altemative points ofview.

It is in drc light of the likely pmpocal ofa loans systemby the Sp€cial Review rbat this aficle is written, to out-line some of the maiD issues involved- A poitrt of palti-cular imporrarce to medical stud€nts itr all this is rhatKennetl Baler (Secretary of State for Education) has

already suggested medical students as a possible tdalgroup, alory wirl ""g'ners atrd other 'graratrt€€d irtueincome' stud€trts. The gleqt exp€trs€ of the medicalcou$€ (about !40,0m tuition atrd f12,000 maiDr€nance)

makes the possibl€ savitrgs amthff atdactiotr for thispilot scheme.

The Prcsert SystemAs we are all too axffe, rhe present level of gant doesn'tmeet the expenses lhat eveD t[e 'averagd studetrt in-curs. ID facr the DES is oD recod as sBtitrg tiat thesludetrt glant is not €veD designed to me€t €xpetrdi-ture2, and no accurate calculatiotrs of studetrt ou.layare rn fact made. The ressoD the presetrt sysrem has

lasted so long is its trumerous merits; the availability ofthe glant has cotrEibuted to the expansiotr of highereducation and, in th€ past, encouraged access fiom awider rangE of social goupsi il has helped ninimisevisible disparities betweetr studenrs; it assu€s atraward for all qualified studetrts once they ar€ acceptedoD a couls€, and it aIows, until recedy, a wide choiceotwbere ro srudy without fffffial restrictions.

But these, and other, benefb of the system have allbeen undermircd by ahe consistent reduction io thevalue of the gmnt since its ifimduction b 1962, andthe precipitate fall sitrce 1979. In this iater period tleDES now admits to a decrease of 13% in rcal terms,

though the NUS estimates a 20% cuta. These esrimatesare bas€d on th€ r€tail pdc€ index, and are thus pmbablyutrdercstimates as the maitr articles of srudent exp€ndi-tEre (board ad books) bave mcreased in excess ofinfation.

The inad€quacy of Lbe slan r is sbowr bv lhe increas-ing depe[dence of smdenrs on welfare benefits5, wherethe DHSS estimates that half the srudent population in1985 claimed housidg beiefir6. These benefits can beclaim€d b€caus€ snrdent incomes fal below rne quafi&-ing 'hardship' levels. The NUS estimates tha. half thestudetrts itr the country have recours€ to the banks foradditioml 6nance; BMA surv€ys in Bristol revealedthat 70% ofr€spotrdents had overdrafts.

For medical studetrts the situation is further em-binercd by the clinical grant, vrhere b€yond a 30 lveekyear our allowance is se! at t5 per week less ftan thebasic gatrt :nd we are not deemed to ne€d books orclothing duriry these exEa week. In addition, thercmoyat of the C90 equipment grant (1986) asd thealteration of [avel grants (1985) - described by eventhe DES as 'rollgh justice' - add a corsiderable extraburden. Medical students ar€ also hit by the dramaticiffreases in parcntal contibution, atr ircrease of 300o/o

siDce 1979 while govemment €xpenditure over thesame pericd only increased by 4l%7. The gov€rnmertis iacrersingly passing the buck to paretrts, who arc lessand less wiling to accept it. 43% of parents fail to payal Lbeir cootriburioo, a p€rcetrrage which increaseswith mlrse tength3, again to our detriment.

Tte Loaff Syst€mThe nuny problems of th€ present syst€m have be€neffectively by-pass€d by the govemm€nt in th€ir id€o-logical rush tovrards a system of loatrs. while its advo-cst€s call loans a p3lrace3, opporcnts are worded at ttreadditional problems tbat such a syst€m q'ould €ntail.Loans were advocat€d itr 1958 by the committ€e set upto make ttcommm&tions for the hitial student fiDaftesystem. They were rciect€d then itr favour of gratrts,as thev have been by various successive governments.

The pres€4 government has had two abortive attemptsto futroduce dem, and is now in the tbmws of its thirda.nd most calculared move. The case rlat advocates of aloa.ns systern will have to prove is tbat the inroductionof loans q,ill be of beoeft to education, govemment,tle corntry, and the studefts.

The basic ploviso tbat has b€€n put forward constatrdyby the loatrs lobby is Lhfl the pr€s€trr system is inequi I -able be.ause the maiority arc forkitrg out for a sma[,elitGt minority, who will b€neft geatly in terms ofincome atrd status as a Esult. However, the extra €duca-Lion r€ceiyed by Lhe studeot is of ben€6t ro sociery as

a whole, enabling them ro join the highly skiled sec-

tion of the workforce which we currendy lack so much.

Indeed rhe green paper on higher €ducatioD (1985)e

estimated ttre rare of relurn on univ€rsity degees at 5

to 8%. The present income tax sysEm is also designed

ro recoup more from rhe high earners' rhus relurningmore to the €ountry from ihose who have beneftted as

which Loans Systeh?Sir Keith Joseph found thar back bench opposidon to

the idea ofabolishing the state payment offees in falourof a loans system was too strong. So it se€ms that ftegovemment would condnue to cover tuition fees. Theproportion of loans to gxants for maintenance is also

likely to be a difficult subiect. An all loan system wouldsubiect students and parents to a large immediate debt'and miglt therefore be politicatly undesirable. So its€ems tlar a mixed rEants and loans system would be

rcquired.

The Costslr is sugge$ed that the cost of inlroducing a loans

sysrem for mainrenaDce would be C500mrr. Even ifexaggerated this is of th€ same order as that of parental

contribution (f300n)t'z. The loDg term costs arc

equally difficult to predict in ttre absence of concreteproposals. Real returns on loalls would not start forabour ren y€ars afrer the initiation of the scheme, allow-

ing for graduation, finding a job, and clearing the inter€st

charges accumulated. If the governm€nt decided toadminister and finance loans itself it is doubdul, fromobse|ations abroad, that there would be a significa

saving on admirustration. In countries wher€ som€ orall the adminisEatior is done by the barks this is onlvdone under sufferance and government pr€ssurerl. Inlhis country the baDks are adama:rtly r€sisting such

Th€ cosls of financing loans are dimcuh to predict

because of the variability in means of repayment. IfinrerBt mtes arc subsidised then the coct must be bom'by the govemment. In Denmark where mtes are notsubsidised, the higl cosl of loatrs encourages stud€nts

ro take time off to work and thus pay off some of theirtoan b€fore graduation, lengdrening their course. Repay-

ments have to be d€layed until eamings have teach€d

a threshold level, and loans can be defaulted if eam'ings never r€ach this. The govemment has to statrd as

gllaranlor for such defaults, and these can be consider_

able, nearly ll% in rhe American scheme, while 14% ofSwedish students defaultu. These costs make Swedm's

srstem of 93.5% loan and 6.50lo cxart, believed to be

one of the most efficient, mote costly per stud€trt than

the British systemr3. It is telliag to note that orc ofrhestaunchest opponents of loaas in this country is the

Treasury itselt becaus€ it fears ihe extra costs.

Access to EducationI-eaving aside the social and cultural attitudes to educa-

tion and debt, there is scaDt evidence to suggest that

loans per s€ improve access to educatiotr In America,the participation from low income families is decreqs-

ing. In Sweden low incomepaniciparion in higher educa-

lm decreased as the loan elemmt was increasedr3.

Similar oroblems hav€ been s€€n in Canada and Den-

mark. r$d other EuroDean countriesro. The wary

approach of low income fanilies to lostrs was con-

trasr€d to hiaher incode families usiDg loans as a

cheap investment.

c-nclusionson close scrutiny the claims made for a loatrs system

fail to show my sig!ficant adva[tage over the present

system. The solutiotr to curcnt problems must liein l.lle overhaul of rhe currmr system to ensure its€mciency in me€ting stud€ot needs, keeping admini-stration cosrs dowtr, end alowing access to highereducation. The direct and indirecr benefts to society

of good numbe$ of graduates should be calculated end

used to refute the claims tbat th€ costs of$ants arc toohigh. We can iustifably say that we cannot alford notto meet this cost.

As medrcal students, we n€€d parity in the level ofouf grant, and proper reimburs€ment of our equip'ment and tnvel expmditure. D€spite the short termattractions of a loan trow, sootr to be peid off by a se€h-ingly large salary, opening the door ro loans will soon

lead to the dismantling of our ef&cient end univenslyadmiftd grants s''stefl. The weight of evidenc€ ftomall concemed bodies prompted the ESAC to conclud€its recenr reportr "h the view of fie commirce an

av'/ard system, analagous to that idtroduced in 1962,

vrill contilu€ to be ess€ntial in the years ah€ad ifnational requir€ments ere to be met".

Jonatlun Fieuen

1 Fi6i rcpon ft@ ih€ Edudtion, So@ce dd Ans C@mitc,'t986r"7

2. ESAC ReFn, EemiDtion of DES eirnelB3. DEs. 'Grsts lo Stud.nts'4. ESAC Repon. Crmntr of DireloB o( Polttechnics5. lfbite PaFr 1985, "Refom of scial Seurily"6, ESAC Repori, "Studerts dd Bmefts"7. ESAC ReFn, Memotudd by NUS8, NUS Incon€ ed E:penditure Sw€y 1983

9. Greo PaFr on Hichd Edu@tio!, HMSO 1985

10. Lloyds Bek Fron@ic BulLtin 1986

ll. BMA Aswiate Mmbes paps on l@s12. Tih€s editorial lu1l8713. NUS rcpon or "stud{r L@s, !h. Csts dd Crmequoc6"14. SDP r@ch p.Fr d l@6

I'm sorry I didn't clerk mypatient'but...

Thev w€Ie talkitrg to tle doctor

They vrere talking to the truls€

They were talking to themself

They felt too illI felt too illThey werc haviry atr MThey were haviry atr MSUThey were having an MI (that's eroug[ excuses. Ed.)

Daf in Sr).ll

TheMedical Protection

Society

....a friend in deed !

Founded L892

lrndon Ofrice50 Hdlam Street,London WIN 6DETblephone: 0l-637 0541

Northern Regional Ofrrce30 Park Squa&Ireds LSI 2PFTi:lephone Leeds 0532 442115

FOUR \THEELS GOOD, T\7O LEGSBAD

Feel you know everything about the body? Or as much as you can take? Then let Bemhard Sncry takeyou on a rapid tour of a very different aaatomy.

Its alright for them docto$ of course, only one macbine

and two models, bua io ask me to lecture on cars .

well I ask you, there's hundreds oftypes, all dilferentl;ke. Bur I lldo mc hesr' Sid Spamer. at vouFervice.And seeing how you lot don\ understand normal words

like up. down. front and back. I'lleven throw in your

posh talk, all for the usual consideradon, catch ml'drift, guv . . ? (yes, aldghl, but get on wi(h it. Ed )

Wcll, to start with, most cars are unlike us in lhatthey go on all fours, although they have been knowtr to

assumc the more erect position, albeir briefly - e g.

Bmnd's Hatcb. Like us though they can go backwards

and forwards, and one rather better (han the other.

This enables the observant studenl !o perform the

esscntial lask ofdisdnguishing anterior from posterior'

The former is usually cheractedsed by two white lum!nous discs, whereas the letter has dumerous red ones

and a sign $aying 'Windsurfers do it standing up'.The v€nllsl sloping sspect of the car houses the

engine (from the Latin eng- to go) and the Greek iru

- sometimes). This is more or less constant except

in certain dumpling-shaped German cars wherc it has

herniated to the rear early in life. This presents noproblems cxcept perhaps to the witless petrol attendantcaught napping on Candid Camera. The engine itselfconsists of between four and twelve cvlinders andpistons, This is where the action is The car's flexors

end extensors, Here we encountd another drfference

between us and them. 17, havc blood, tle, have petrol

Which makes them smart€r than us, or have you ever

heard of four-star being screened for AIDS? Anylvay,

this petrol (from the Greek for overpriced) is csrried

from the storage tank posteriorly along the deep dorsal

fuel line - an unpaired midline stlucture. Thrombus

in $is is not unknown, and causes the car to shudder(an unintention tremor) and finally stop. On the hard

Th€ most posterior-rnferior part is a small black tubeprotuding from beneath the car's equivalent of DNA(irs unique, inexplicable, number plate). Ttris tube has

thrce functions:I . To expel waste gases without any of the social con-

straints imposed upon its biped cousins.2. To emit a series of loud explosions whenever il feels

unwell. Motor anthropologi$ts suggest that this isanalagous to our doctor's certificate.

3. To enable the best man at a wedding to stuff a

potato in it, thus wreaking havoc with the innards,not to mention the honeymoon, in a prank so

childish it sdll puzzles the anthropologists.During a car's life this tube can atherosclerose, with

a rcsult nor dissimilar to that achieved by the best man,excepr thet it happens after the honeymoon.

An interesting aspect of motor anatomy is thesimilarily between all four points of contact withthe ground. Being all exactly the same, they make

'identify precisely' questions in spo!-tests totallyimpossible. The one consolation for the disillusionedstudent is that a transplant on to the wrong axle (hip)doesn't matter a damn. However lysis of these wheelsdoes matter; air channels in the membnne open andair flows down a pressure gradient. Quickly. This has

an inlibitory influence on the movement of the cer,which will either grind to a lop-sided halt, or overtunspectacularly if a fi camera is pointing at it.

lnside. ro the right of the midline sits the brain, ordriver. This is where the maior decisions are taken,unless he is drunk. when the orlly utterances emergingfrom under his beer sodden moustache will be phrases

such as 'Vow, this motorway has six lanes!' Suchdrivers can usually be found the following morning ina ditch, with thei cars shortened antero-postenorly.

Finaly in this whirlwind tour of ihe four-wheeler wecome to the three insignficant looking pedals near theddver's feet (provided they are sitting in lhe rightplace). The most medial of these is there solely tocontuse learnen (cf Folamen of Wimslow). It alone isresponsible for uDdignfi ed kangaroo impersonations,fathers writing children out of their wils etc.

The median p€dal slows everything dowtr (cf punc"turcs and Fdday afternoons), and is used whenapproachiDg a red light. If, however, a green lightis showing, the lateral pedal is depressed, allowingthe car ro pass al man-ner of fiings. pedestrians.push-bikes, but rot, alas, exams. A fe\ cars haveonly th€ median ard lateral pedals, and are those thatmost rcsemble their driverc, Iinguistically at least,beins bipeds.

FULLY LICENSED

MAKEABLINETOBUMBLES

Alternoon Snacks

56 PARK ROW,BRISTOL

t0

OVERDOSED ANDUNDERTREATED?

Does the patient with self inflicted damage get a fair deal in hospital? A member of the BristolSamaritans tlinks not, and writes here of some of the problems tley have encountered, both in

casualry and on the wards.

People who cal oD the Sanaritans include some whohave laken overdoses, and some who evetr motinueto swallow pills while talking to us. In these cases'

they will oft€tr €ventually agree to go to hospital,but possibly only if we can either take them or accom-pany thern. For this rcason Sa.malitals tend to s€e howpatients who have overdosed are ueated itr hospital,and in this article I want to describe some of drcproblems I have seen aris€, atrd ask how they mightbe avoided. Being medically unqualified obviouslymakes me unable to comment oD the medical treat-ment dispensed, but it is the other side of the coin,namely how such patienls are cercd for, that I want toconcentlaie on,

The casuahy department is lhe frst port of call forthe patients we bring to hospital, and wbere the firsttreatbent is administered. This seems frequendy toinclude a wesh out of the stomach by weter induc€dvomidng. This is a highly unplessrnt procedure toundergo, and if not explained end performed with as

much consideration as possible, could have a drama-tically edverse effect on them. Remembering thatsomeone who has been prepsred to take theL own lifeis alrerdy likely to be $uffering from feelings of isola-tion and reiection, any further peinfu.l experience, ifinsensitively administered, can be s€en to be poten-

tially disasterous. I have heard stallcommenting howsuch a paiaful shock would make fteir patient less

likely to try suicide in future, but I would maintain tha!it cotld h.rease the likelihood while making it less

likely that the patient will come to hospital afterwards.Casualty wards cen be intimidating for the most

well-balanc€d individuals, and if you coupl€ this wilh ageneral wariress of the m€dical professioo (oft en mani-fested amoog call€rs to the Samaritans by atr utrwilling-ness to go to hospital unaccomparxied) and aD acuieemotional disturbance, the[ an overdos€ patient dc-serves a lot of effor! to make them as comfortabl€ andinformed about lheir position as possible.

I have always expeccd, from my non-medical pointofview, that someone suffici€ntly disturbed to artemptsuicide would merir a psychiatric investigation, and yetthis seems not to happ€n a[ the tim€. I've known ofSamaritans having to rcpeatedly reques! such a refemlon the parienfs behaif beforc the duty psychiairistis caled, as if a purely m€dicql assessment aDd treat-ment of an overdose was suffci€nt. Aldrough I've b€€rpl€ased to see such sympath€tic treaErcnt and ieferralmary times, when th€ opposite happ€ns I am left fe€l-ing thar the staffs motivation is realy ju$ to removethe pauent from the premises as quickly as possible'withour realy coDsidering what may bapp€tr later.

The orher environment itr which Samaritatrs can

view th€ €are of overdoses is on a medical ward, after

they have been admitted, when they still ring us andask us to visit them, Here the same story app€ars fromtime lo time as well, all lhe medical tr€atment in theworld, but a wall of silence and non-communicarions€parating them from the rest of the ward . This seems

less likely to occur if their mood has changed, theyregxet their arrempred suicide, and are anxious roappear as lhe convendonally smiling and gratefulpatient. But someone whose life drives fiem to try andkill themselves is likely to remain deprcssed and difi-cuh to deel with. They don\ smile, and they don\ feelgratcful. Despite their awkwardness they surely have agreater need ofconsideration and explanation from thestaff, ifthey are toavoid funher depression, alienadonand attempts on their own life.

Fortunately, this is far from the way that many over-dose patients are treated, and I've been privileged tose€ somc very compassionate and unde$tanding careadminister€d, but I have se€n iust the opposite as well.Such poor care can be changed very simply, withoutinvestment itr manpower or machinery, but iust by amor€ sympathetic understanding of the problems ofsomeone who tri€s to kill themself, on the part of you,the carers.

NRGmNq T0 CRrllclltl 0t Tt{t tBsENCt 0fAIIY ILLUSTMTIOI,IS Of IiONEN N 1lI LASTrssur , BLrcK 8rG lJourD gKt T0 TA(t THls0PP0RTUNTTY m irkE rntNo6 s( r[usrrlrLNc SUCCISfUL udMN 00d0R, lr1lx a NufrROf RTPR€STMATIV€StlsrlY o€Rtookm nNoNTt cR0urs.

L,L. :, -.

:.:. f. L. :,-.:, :-, \

I\

IIII

wholefood takeawzrys. snad<s.bread.' .organtc foods.rice.'fr€e ran€le e€l€ls.

.l'u{de rarge of wholefoods.

?a Th6 Mall,Clif[on, Brlstol. T€l '741.260

IIIIIIIII

COTHAM INDIAN TANDOORIRESTAURANT

34 COTHAM HI LLBRISTOL, 856 6LA

We are specialists in:Charcoal Tandoori, BirianY,

Curry Dish€s & Thali

For Reservation and Take AwayTelephone:

Brisrol 741390OPEN DAILY {lncluding Holidaysl

l2 noon to 2,3O p.m.6.(X) p.m. to 1 1.30 p.m.

Bffi@flSftdcmfiffi€Nrefl39 QUEENS ROAD ' CLIFTON (On the Triangle)

Also atUBU Travel. Univ. S.U.Queens Road. Tel: 741178 Tel=292494

WE AI.SO IIAVE MAI{Y FI.IGHIS OPEI{ TO ATI.!ffi ffiryZ\\A-{*i

ff'.?FBraL l!t-H rollgq{AN4l

tA* t*t6' ttl" ' ' -"o*' W

1t/*a/il,P4*'6

r€,a?@qteeltl

-B ueazL\A.t\tN3tpe.tj ssra- 2, +l 21*lA

-,*{:!*=%ffi'H"

\.M.w*,

t2

A GROUP HOME

Vhat is it like livirg with a group of meotally handi-capped p€ople? AIrd bow compatible is it wir! a llllday's work in hospial? The answels sr€ tbat it is larselyvery etrioyable, ard fits pedecdy $eI with the life ofa (moderately) conscientious srudetrt. The SCA gtouphome itr Mortpelier wil shordy enter its f:fth ye3r, stillmaintaining a household of studeds and hardiczpp€dpeople living on an equd basis. The ploblems for thos€labelled 'handicapped' stem not so mucb from aDy iD-ability as fron the fact llar they hsve been insriru-tiotul.ised all tbeir lives, always living witi someone iDauthority over them, never amongst ordimry p€ople.This is a pmbl€m that the house rlies to tackle, andthe commmts of thos€ workitrg i! Mental Hadd.icap inAvon who have se€n the effect over four yeals on theoliginal occupanis describe the improvements in theirconfidence atrd extroversion es rcmarkable. Whetherthe noD-students will ever be eble to move out on theirown into the community is still uncerrain, but thepositive sides of a period speDt living in rhe grouphome, as a half-way stege to the coEmutity as a *hole,can be se€n as ends in themselves.

However, the benefits of living in such a hous€ cutbofi wa,s, and the hundreds of studenis to ha\,E passed

through over the years, either living !he.e or,ust se€-irlg the place as regllar visitors, have all gained a morereqlislic view of mental handicap. Ard iusr es $tudentsmay hsve mi$taken notions of lEndicrps, the s€me

JOHN WRIGHT & SO,VS(BOOKSELLING) LTD

Your local bookseller stocking allthe maior Medical, Veterinary, Dental,

applies to other people's nouolN ofus, and both sets otmiscoaceptions can be best altered by experience.

Each summer the $udents in ihe hous€ move out, sothat this sunm€r a turther six students will be neededfor the folo*ing year. If you might be inreresred, andthe prospect of large communal meals, visils to pubs,and plenty oftine spent iust beiry therc doesn't appallyou too much, then do get in touch with us, eirher viaClare Mockridge in tbe SCAoficeat the Union, or jus(rhg us on 421837 and invite yourself over to se€. Youcenaidy don't treed to commit yours€lf to livhg rhereinitially. The house was first s€t up by m€dical srudents,and althougi these days it has a mix of students fromdiffermt disciplines, it would be sad to se€ no medicsahere next year. So be bold and come and see; you'venoahjng ao lose but your inhibitions.

Phil Stokes

FLIPPERHAIIDCIilCI{ENBAR

ltt Clttt trdtct no.d.Tct Erlrtol Ttt2oa

CIIARGRIIITD IIAMBI'RGENSFIII,EI''ACTDT POTATOES

STEAK SANDWICEES

WHOLEMEAL VEGEIABLE PASTIES

NOW OPEN FOR STJNDAY LUNCII()Ftritgllorr.:

Illor-Thlrr;: lrrrn.lr.topnrFti.ndsd: rr.n 12 inidrightSundr!,: 12 noon .ll.toprn

BEST QUAIJTY IITID PruGES INI'OWN!

il''.J."Hirtr'UE&;ttrr-

Psychology, Nursing and AlliedHealth books.

Special order serice for titlespublished world wide.

44 Triangte West, BRISTOL BSe I EX.TEL: 0272 - 634471 Ext 34

la nember of Etigate Grcup of Compeniesl

A SURGEON'S GUIDE TOCHOOSING A CAREER

It has, alas, never been possible for everyone ilr medi-

cine to achi€ve theii ambiliotr of pracucing surg€ry'

bur today's greater competition means that more than

ever will you have to consider second rate specialities

for a carecr, should you fail to make it in your fustchoice, the only branch of medicine tlut actuallv cures

anyone, gen€ral surgBry. This is obviously a souce ofgreat disappointmmt to soEe people, but mor€ and

more I see students coping with it, to the exEnt thatsome peopl€ even come to medical school without the

slighrest wi5h lo be surgeons. For such eccentrics. as

well as thc remainder of you, I have compiled a short

guide to the l€sser caree$ open to disappointed would-

be surS€ons, which wilt give you a doqm to earth assess-

m€nt of what you are letting yous€lf in for.General Medicine For a long time thes€ chaps have

been proclaiming themselv€s the s€nior speciality.

Being a physician can tro doubl pmvide vou withan inreresting ard remun€rative tim€, seeing whathappens to padeDts wheD you drug ttrem up to the

eyebals with the latest poison dished out by unscrupu_

lous, m€an-mitd€d drug companies, who never take t/J

out lo lunch. In the end, of cou$e, we'll have to sort

your patient's Foblems out for you, but tlere's no

reason why you shouldn't enioy youlself in rhe mean_

time. Just look at Professor Read.

Orthopaedics You can still even call yourselfa surgeon

if you should choose dris bunch, though you'll obviously

be sittiDg b€low the sala at the Christmas beano. None-

theless, if you're mechanically minded, and vou make

kirchen cabinets in your spare tjme. then this exten-

sion of carpentry could wel b€ for you. Over tle years

you may find that some of the sawdust accumulates

betlveen your eals, but you shouldn't 6nd that this

affecb the quality of your work ir any wav.

G€neral hactice A pl€asant life this; GPs make excel-

lent company at the golf club. always ar appreciarive

audience for our latest surglcal anecdotes lf you

weren\ around when the brains were being hatrded

out, thaCs noi your fault, and you'll probablv fnd thatIife as a GP suits you v€ry well.veaereolos/ No way.Atraesthetics Another good refuge for you ifyou have

dimculty holding a knile still aii€r an eveniog of 6ne

clarets. At least you get to enter tlle lFllowed shdreof the theatre, where if you fnd our snee$ al your

expense too cutting, you can always rake refuge in a

draught of some bizarre mi-nd-betding gas.

Patholo$ If during your training you find yours€lf

faitrting in the fteates, bembling at venflons' orthrowilg a fit at the mere thought of talking to a

parienr, $en thjs ;s Lhe career for you. The patjents

are dead, the atmospherc deadenbg, and the conversa_

tion deadly. Should you still feel yourself a surgeon

nanqu6 you can even make believe ar post_mortems,

conjuring an admidng group of trurses, anaesth€tists

and assistaDts from th€ bare walls. At least the oth€r

corpses around you will do as a passable imitauon ofstudents in theatle.

commudty Mediche What is this?Radiology A dangerous one this, with all those lowflying X-rays and alpha partides buzzing aroud.If you feel attmcted to dark rooms, narcolepsy, and

expensive machir:es, then maybe it will do for you, butmy advice is ro buy a generous amount of led under-

wear before you go. Hydra-headed children that glow

in the dark are all very well in Gre€k mythologv' bulnot so good in real life.Psychiatry Surgeons have a reputation for being rude

about psychiaarists, but I want to be completely objec-

tive about this. As it is numerically impossible for allm€dicsl students to b€come surgeoN, therc has to be

some suitable dust-bin of a speciality in wlrch to throwall th€ perverts, communisls, women elc. who wouldonly clutter up the place otheruise. Penonally, I wouldsay that a lifeiime of psychiatry is suitable punishment

for them, and at least stops them from getting near an

operating theatre.Administratior These iumped"up batrl clerks typifyall that's wrong with the health service toalay. Com-plet€ly unqualified, they take decisions, appear on the

tely, ard tell you tlat you can't park where you like. Ifyou can face a lifetime with such unspeakables, thenyou'[ be miles from an op€ratitrg theatre, but secure

in th€ knowledg€ that you're fightiry in th€ front linero west control of the heatth s€rvice back from the

bu€aucratic pinko€s.

FACINGFINALMBdePend on

IREATI'IEIIT A]lD Pno(tNOSISeditor: Richard L. Hawkins

'a new fonhula tn medtcal infonnation'

MEDICINE (336pP) and SURGERY (304pp)available now 99.95 each

FreeDor LM l?. Heinemann MedicalBools. Depr TP'STUD22 Bedford SquaR. trndon WClB 3BR0l-637 33 .

l4

MANWATCSER (FRCS)

TheArmvoffers medicalstudents much more than

just 86p40 ayear.Ifyou are a student,male or female,at

a Briiish medical school, you could beeligible for a Cadetship with the Roya.lArmy Medical Corps.

You'll need tohavepassed your secondMB or equivalent. And you'll be requiredto attend arr A.rmy selection board

But you'll get lti04O to continue yourmedical studies in the fust year. This in-creases each year thereafter.

When you become Fully Registered,toprepare you for your first appointment as aRegimental Medical Office4 we will sendyou on an introductory course which lastsabout four months.

This course includes training at Sandhursl training in administration and fieldmedical organisation at the RAMC Tiain-ing Centre and in the various aspects ofMilitary Medicine at the Roya.l ArmyMedical College at Millbark

Then,it's six years in the Army, startingwith the rank of Captain. By converthg toa Regular Commission you can, of course,stay longer, r:ntil youte 60 ifyou wish.

As a doctor in the Army your practicewill be much the same as a good civilianone: fi:lly equipped and professionallysta.ffed. You could be working in a grouppractice or on your own; ihough you'll beentirely responsible for your own patients,be they soldiers or theirfamilies,rather likea busv G.P

B'ut don t ttrink thal because you're inthe Army your chances for study will bein any way limited.

Wlile still in clinical training, a

number of selected cadets may, with theapproval of their Dean, undertake electiveattachments at Military Medical Units inGermany Clprus, Hong Kong, Nepalor USA.

Andyor-fll have the same opporturritiesas in civilial life for your post-graduatetraining in General Practice, Commr.rnityand Occupational Medicine or one of theHospital Specialities.

But a doctor's life in the Army doesn'tstop there. As an oftcer, you'll be able totake advantage of a very wide range ofsporting facilities.

Youlll almost certainly travel abroad,and your social life will be busy too. Manyof those you meet and work with will be-mme lifelong friends.

Finally, should you decide to leave theArmy on completion ofyour Short Serviceengagement we will give you a very usefultax-free gratuity

How much depends on the length ofyour initial Cadetship and the amountspent by the Army on your medical train-ing. Regular and Special Regular Commis-sions are pensionable.

For firther deiails please contact MajorGenera.l (Retd.) R. N. Evans CB FEARCS,Dept. O70t Royal Army Medical College,Mlbad<, London SWI 4\J. Tel: 0L8349060, Ext 210.

He'll send you our brochure,'Doctor inthe Arm/ and arrange an interview.

# nnmcofficert6

DRUG PRESCRIBING INTHE THIRD \TORLD

"Orabolin" (ethylesninol - arubolic steroid) "Envtes nnrmal ganth", "Stinulates tPpetite" ' " Ptumousoptinal weighf' . Oryaror. (Baryladesh) Lul.

"Birctaf' (ampicillin) "Thz anibiotie effectioe agairct all gram posititte and gam negathte bacteria ofpructical hqortntce" - Bayer (Indotesia).

DIAcNosIs: Inapplopdatemark€titrgTREATMENT: MLAM (Medical Lobby for Approp.iate

Marketing)DosE: Take l0 minutes every month.

The incidence of this dost sedous conditiotr is stillvery high aDd immediate ection should be taken by allmedical personBel. It is more preveledt, morc severe

and more innuential in Third World countries because

of limited access !o scientifc informrtion. The meinpredisposing factor is the codmerciel intercst of themultinetional drug company involved. Its mecroscopiceppearance takes the form of glossy literature, smansuits and free satrrples, while in microscopic print are

the cautions and side-effects. The pethway ofspread isextremely rapid, with iet travel, from the primary site,often found in V/esrem Europe - i.ociudiDg some inEngland, to seconderies in Thftd World countri€s.

The mdignency of the problem should Dot be utder-6tim4!ed es tie net result is often fatal due to iDapprc-pdate lreetment. Accolding to a study iD Chile deathfies dnong idallts fed Dilk substitut€6 instead ofb$as! milk were tbrce tiEes hig!e!. The Boat coeEoocause of deeth worldwide in cbildren ulder tbrce isdehydradon fmm diarrhoql dis€ase. The altidiarrboeddrug 'Lomotil' is coDtra-ildicated in childrcn urderfour iD Britaio, wbile ill Brazil and India it has b€enrecommended for neonates. But a$ a lesult oflobbyingSearle has revis€d its product labeUiog rh$ughout th€world.

This lobbyiag includes a centralis€d letter crmpaig!from the M€dical Lobby for Appropriate Marketing(MLAM) in a similar fashion to that run for Dany years

by Armesty Intemational. Every mondr MLAM dis-uibutes a l€tter to a drug comprny containing quotes

from their advenising, a recent literanfe suntrMry,aod questions for the company to answer. Memberssign tbe letters and post them on to th€ compatry

Another example of such lobbyiry in the case of sdrug company's double sta ards was the DArketingof phenylbutazone and oxypbeDbutaznoe. AloD€ or incombination with prednisolonethey nrere promoted for itrdications itrduding "spnins,bruis€s" atrd "vinl infectiotrs". MLAM wrot€ to cibrC€igy about l-he hich itrcidence of htal aplastic aaeemia

alrd tie existence of safer alternatives. Britafu haddecid€d to baD systenic oxlphmbutazoDe and stricdylimit the us€ of phenylbutazone. Ciba G€igy iDformed

several Westem natrons of the precautions necessary,yet ir Indotresiar Malaysia and Thailand the drugswere promoted with no mention of precautions andsere even recomBeoded for long-tem teatment andqdte irappropliatf uses such gs "tension headache".FiDally bowever Cibe Geigy announced a worldwidewithdrawal of oxylhetrbutazone and strict contm-indicarions to the use of phenylbutazoDe.

MLAM'S President Professor Garry KneeboDestress€s ther MLAM'S eims erc benign, well-meeningend well-iftentioned. It is a non-proft organisation6.oe.oced entirely by members' subscriptions. It you arcinter€sted in helping to lobby thc phadaceuticalindustry in this way, thetr writc for fu(her details toMLAM, 232 Sr Maryarer$ Road, Bladford BD7 2BU.

Padd! McMatat

t7

DRUCS! ARE !E oTFERINGIIIE TIIIRD LIORI.D ]IIE RI6H]RIM€DIES TOR 'IliE RIGI{I

DtSEASES?

THE MONICA BRITTON HALLHaving made the long trek out to Frenchay, have you ever then sat around for half a day between

teaching sessions, without thinking of visiting the museum of rnedical history there? Here Susaz

Iazglqy, Assistant Curator, describes the museum and its current exhibition, on the history ofpharmacy.

Before rhe middle ages, comrption h the world of heal-

ing, and the misuse of drugs, were conmonplace. Theword "pharmacopolos", or druggist, was associared

with poisoners and unscrupulous traders who travelledthe country often providing poisons on demand formonetary gain. The current exhibition at the MoniceBritton Museum charts lhe development of pharmacy

from these bcginnings to the present day. Becrusepharmacy was initially uncontrolled, physicians werer€luctant to trust toitsproducts, preferring to dispcnseth€ own medicines. one of these, Claudius Galen,prcparcd his own lozenges and pills, rhe quality of hispreparations earning him the descripuon of'1he fatherof pharmacy" and the admiration of generations ofpharmacists. Dudng the medieval p€riod, grrilds weresel up rc lrv ro regllale pharmacv, a-lrd the repulationof aporhecaries gradually improved. The function oftle two prcfessions of the apothecary aDd the physicianalso became more clearly defned, and in 1617 fteaporhecaries separated from the Grocers Crmpany toform their own society. The Phartrncy Acr of 1868

inrroduced schedules of poisons, a since then theprofession has become increasingly scientific, underahe regulation of the Pharroaceurical Society.

The exhibition includes pill tiles and old phama-

cists equipment for the storage and hanufacture ofdrugs, togedFr with displats on the history of phamacy

and its relation to lhe growth of medicine.One of the most interesting permanent exhibits

on display features the famous Bristol Irish Giant,O'Brien. Before the condition of acromegaly was d€-

scribed, acromegelic giants were the subject of muchcuriosity and edmiretion. One of the best known wss

atl lrishman, Patrick Coner, who was born in Kinsalearound 1760 and brought to Bristol by a sp€culativeshowman when he was 19. He changed his name toO'Brien afrel the legendary Irish king Brien Boru,and cras atr imhediate success. H€ died in 1806 and his

will showed that the former p€nniless bricklay€r frohCoumy Cork died here wiih a fortune, owDing several

propenies in Kingsdown atrd elsewhere.The Monica Briaon Ha[ is a purpose built museum

for Lhe displrv of medical history. and owes irs e'Ristence

to a rctired Bristol industrialist who doDat€d the morleyfor its consruc[on itr memory of his wife, who hadbe€n very acrlve in the city's civic affairs. when tlecurrcnt phamacy exhibition ends, it will be followedby a display of "Bristol's Contribuuon to the Develop-metrt of Anaesthesia".

r955

An established traditionnow in Bristolat31 BerkeleySq.(opposite George's main bookshop).

Open seven days a week1 1 .30am to midnight for fine pizzas.

Przzr 3sou.g

'3oprn

XP s??,isfi*

I lS,Whiielodies Rood,Clihon, Bristol BS8 2RPPhone737144

23, Reqeni Sfreet,Kinqswood, Bnsrol BSB4HWPho-ne6l2833

I0. South Porode,Weston super More,Phone4l5987

0.llv.sll0l)NDsChina, Glass, Tableware, Cards and Cifts

DtoilysllsRESTAURANT & KEBAB Hr,USE

FfrIENDLY ATMOSPHfSI

IUUY UCENSTI/

TRADMOilATGREEI(FOOD SEPARATE ROOtl AIIAILABLE 28PARI($T.

CONIII{EI'ITAL CUISIN E FOR BRISTOL

OPEI'IEVERYDAY, PRIVATE PARTIES Tel:?79500

A ROOM OF MY O\TN

Here, amonSst these four walls - three ofbrick' one ofov€rpriced srrnies - is Sylvia's dornain. Il is r fascinat-

ing world, centdng alound a bubbling ceuldron ofsoup and s microwave lhat has seen betie! times. In lhe

mid$ ofthis staDds Sylvia, calm, unflsppable, sermelybisecling a "brunch" for a weiglt-w.tchiry filst year,

ignoring the queue which sE€tches out tltrouSh the door,past lhe pig€on-holes where no letter ever arrives

"Is tbat it, dear?" she asks, lookilg 3t your ftugalselectio! whrch is a vain attempt at comptomise betwee!the calls of youl rumbling innards, tle last l€cture otr

atherosa, aIId your under-nourished wallet. However,behind the ptacid exterid lurks a volatile alter-ego

Give h€r a csuse and she will rise to fght for it withthe dedicstion of a mod€ft day Joan of Arc. Many willrcmelrlb€r, inde.d arc uable to foryet, dre geat "Bring

Back Hula Hoops" csmpai8rr of'86, hailed as one ofrhe greatest apoliriel, non-violeot prot€sts since Candhi.

During a lull i! rhe rush, she conlemplates the msg_

nificent view from her king size window. On a cleet dayshe can see most of the way lo Bath where, no doubt,lesrcr beings sell inferior sendwiches at lower pric$With sn €ffon she wreDches herself from the sublimeto the ridiculous, as another Oliver Twist approach€sginS€rly. He look ar th€ peltry s€lection that remains

aft€r the vultures hav€ struck. Sylvia motions him tothe chocolate cake whos€ anti-aphrodisiac qualities are

as hfamous as the seU-by dates on the yoghuns. Heleav€s €mpty-halded, mumbling an apology, and

Sylvia rcturns to the position i.n which we found her,gazing with mpt contempletion at Avor's daily routineotr the other side of the window.

20

FREE! SINGLE VISION LENSESWITH ALL FRAMES!'

NHS VOUCHERS WELCOME AND FREEEYE TESTING

under the NHS Park Street (Opticians) Ltd.Redeem your voucher and receive your

FREE SPECTACLES.

WE CAN SUPPLY YOUR SPECTACLESWHILE-U-WAIT!

FramesComplete with FREE SINGLE VISION LENSES

from €'14.25Over 1000 Frames on Display. Designer Frames reasonably priced.

Soft Contact Lenses from f69Available including one year's FREE After Care Service

Wide range of Tinted Lenses stocked.

LADIES: Now you can change the colour of your eyeswith Cosmetic Tinted Lenses.

'Subject to type of prescription

EYE TREND40 Park Street, Bristol. Tel 290812(Late night Thursdays until Bpm)

IF YOU CAN FINO THE SAME SPECTACLES ANYWHERE CHEAPER, BRING US THEPROOF AND WE WILL MATCH THE PRICE.

8""#

helpsyou

xrtrfn(tThe Oiginal Elixi

TOR TEE PREVENTION OR

sleepniglit

Ih. M.di.r I O.l€ nc. U nion

Lrbeland Slander, Complainis and Clarrs

Press Diffculties, Ethical lssues Inqueils

P0hce Inquiries, Disciplirarl Cases eri