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a three-year period of capital expenditure, but it believes the sum tobe insufficient; it also calls for areas with low land value to besubsidised to enable them to meet the bridging loan repayments.The deficiencies of the dowry system, whereby a health authority

discharging a patient from a long-stay hospital should transfermoney during the patient’s lifetime to another agency to look afterthat patient in the community, led the committee to recommendthat the system be replaced by one of targeted specific grants. FromApril, 1991, there will be a grant specifically for the development ofsocial care services for people with mental illness but, because theallocation is to be made on the recommendation of the regionalhealth authority, the committee would like the Government toensure that the social as well as health aspects of a care package areassessed for eligibility for the grant. Moreover, the committeerecommends that the Government reconsider its decision to makelocal authorities contribute 30% of the grant. ,

Another major recommendation was that the Government

publish details of how the Department of Health plans to monitorthe Government’s instruction that no hospital beds are reduced orhospitals closed before adequate alternative services are available inthe community. The committee’s report closes with two case-studies of hospital closures.

1. Community care services for people with a mental handicap and people with a mentalillness. House of Commons Social Services Committee, Eleventh Report HC 664.1990. Pp 83.

Post-marketing surveillance of vaccinesin the USA

The new US Department of Health and Human Services (DHHS)Vaccine Adverse Event Reporting System (VAERS)’ became fullyoperational on Nov 1. It replaces the systems operated by theCenters for Disease Control and the Food and DrugAdministration and will accept all reports of suspected adversereactions from any vaccine, not merely those that all health-careproviders and manufacturers have since 1988 been required by lawto report.

1 Vaccine Adverse Event Reporting System—US. MMWR 1990, 39: 730-33

Thalassaemia International Federation

In 1985 the Thalassaemia International Federation (TIF) wasformed in Milan to bring together patients’ and parents’associations from countries where thalassaemia is prevalent.Associations from 19 countries are now affiliated. The headquartersof TIF is in Nicosia, Cyprus, and there is an information centre inMilan, Italy.TIF’s conferences bring together patients and their families and

doctors engaged in thalassaemia research and patient management.The first was held in Cyprus in 1986. Others have been held inAthens (1987, in association with the International Conference onThalassaemia in Crete), Sardinia (1989, concurrently with theInternational Congress on Thalassaemia), and New York (this year,concurrently with the fifth Cooley’s Anaemia Symposium). Thenext meeting is scheduled for Nice in 1991.TIF has been busy promoting educational aids. For instance, the

Cooley’s Anaemia Foundation (a member association) has printedand distributed 5000 copies of a Short Guide to the Management ofThalassaemial to doctors in the USA, and the United KingdomThalassaemia Society has distributed the guide in Britain. A bookfor patients, What is Thalassaemia?, has been translated into Greek,French, Italian, Turkish, and Hindi and is being distributed topatients worldwide. TIF has also been promoting and collaboratingin scientific work on haemoglobinopathies. An example is aninvolvement in the WHO working group concerned withpsychological factors in thalassaemia and sickle cell anaemia.At the conferences health professionals have a chance to meet

patients and their families away from the consulting-room setting,and are also able to take advantage of the educational materialproduced, by TIF. Patients can learn about the disease, itstreatment, and the progress of research, and they have the

opportunity to ask individual doctors specific questions in aninformal setting. Moreover, the chance to meet families from othercountries relieves the isolation that so many patients and theirfamilies experience.

TIF’s scientific advisers are: Dr Mary Petrou (UK), DrBemadene Modell(UK), Dr Mike Angastiniotis (Cyprus), and Dr Guiseppe Masera (Italy).The address of the Thalassaemia International Federation’s headquarters isPO Box 8503, Nicosia, Cyprus (tel 72-429141). The Information Centre forThalassaemia Associations is at the Clinica Pediatrica, Universita di Milano,Ospedale San Gerardo Dei Tintori, via Donizetti 106, 20052 Monza, Italy.Educational aids and further information are available from the UKThalassaemia Society, 107 Nightingale Lane, London N8 (tel 081-348 0437).

1. Cao A, Gabutti V, Masera G, Modell B, Sirchia G, Vullo C. A short guide to themanagement of thalassaemia. Reprinted from Thalassaermia today-theMediterranean experience, edited by G Sirchia and A Zanella. CentreTransfusional Ospedale Maggiore Policlinico di Milano, 1987.

2. Vullo R, Modell B. What is thalassaemia? Printed by the Cooley’s AnaemiaFoundation for the Thalassaemia International Federation.

A cellular approach to interviewingToo often a job interview has all the spontaneity of an eighteenthcentury gavotte: the moves may be intricate, but they are

predictable and well rehearsed. Dr Lawrence Brandt and Dr LidiaPousada at the Montefiore Medical Center in New York haveintroduced some eccentric steps into their interviews.’ For five

years they have been asking candidates for a variety of medical posts,"If you could be any cell in the human body, which would youchoose to be, and why?" Among 137 responses the neuron provedtwice as popular as any other cell; candidates admired the cell’sability to be in control, to be stimulated and stimulating, and to bethe centre of all things. Fans of the hepatocyte liked to be versatile,able to regenerate, and exposed to various stimuli. Those who sawthemselves as leucocytes ranged from the aggressive/hostile typewho admired killer lymphocytes to team members of the helper Tcell variety. Myocardial cells, erythrocytes, stem, germline, muscle,retinal, and epithelial cells were all favoured by some candidates,while one well-groomed interviewee chose the eosinophil on purelyaesthetic grounds. Brandt and Pousada report that apparently shyand retiring applicants "blossomed and came alive" when askedabout cellular preferences, whereas "coolly poised, well-rehearsedpersons became flustered when creative thought was called for".The possibilities for this line of questioning seem endless:

microbiologists may be asked to identify with a particularbacterium, and molecular biologists with a restriction enzyme. Theformal ritual of the old job interview may be in the process of beingsuperseded by something more waltz-like.

1 Brandt LJ, Pousada L. Interviewing m the 1990s—the hard cell versus the soft cell.N Engl J Med 1990; 323: 838.

A peace dividend

The UK-USSR Medical Exchange Programme has now

relaunched its efforts to provide fellowships for both UK and Sovietdoctors who wish to share the skills and experience that they havederived from their respective health care systems. Althoughuniversity based centres in Moscow and Leningrad may haveresources similar to those in the UK, the organisation of bothprovincial hospitals and primary care is often poor-a situationofficially acknowledged by the Soviet Minister of Health, YevgeniChazov. The Medical Exchange Programme now plans to shift itsemphasis from that of providing travelling fellowships for exchangebetween comparable centres to one of targeting areas of especialconcern to Soviet medicine-paediatrics, obstetrics and

gynaecology, oncology, primary care, public health, and healthservice management. The aim is to sponsor UK senior registrarsand lecturers for 2 weeks at a cost of 600. They will teach westernpractices and establish channels for future communication. Doctorsfrom the USSR will be sponsored for 6 months (5000) to extendtheir clinical training. A recent meeting at the Royal College ofPhysicians, attended by the President of the College (Prof M.Turner-Warwick) and immediate past-president (Sir RaymondHoffenberg) together with Lord Jellicoe and representatives of the

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Soviet Embassy and UK Department of Health, introduced leadingindustrialists to this scheme with the hope of encouraging them tofund such sponsorships.The dissemination of new research material from the USSR has

been difficult because of geographical and language barriers.

However, a new monthly peer-reviewed journal, Biomedical Science(edited by Prof R. V. Petrov and Prof B. T. Donovan with editorialboards composed of Soviet and international advisors), nowpublishes this previously inaccessible research to an English-speaking audience. Biomedical Science is a collaborative projectbetween the Academy of Sciences of the USSR and two Britishpublishers. All manuscripts submitted are translated in the UK,and about 50% are accepted for publication.Further information on the UK-USSR Medical Exchange Programme canbe obtained by writing to 9d, Stanhope Road, London N6 5NE, UK.

Injectable contraceptives

Injectable hormonal contraceptives are among the most effectiveforms of fertility control, and the World Health Organisationregards them as well suited to the needs of women in developingcountries who require an effective and reversible method of

contraception that does not interfere with lactation and can beadministered by non-physicians. New guidelines from WHOIconcentrate on the two most widely used short-acting (2 to 3 month)progestagenic injectables, depot-medroxyprogesterone acetate

(DMPA,’Depo-Provera’) and norethisterone enantate (NET-EN).Despite the unwillingness of the US Food and DrugAdministration to allow the sale of depo-provera in the UnitedStates (its manufacturer, Upjohn, gave up the struggle andwithdrew its marketing application in 1984), WHO and theInternational Planned Parenthood Federation are convinced of its

safety, and the preparation is now licensed in more than 80countries. NET-EN is licensed in over 30 countries, and one orother injectable contraceptive has been used by at least 30 millionwomen world wide. The guidelines provide technical informationon the use of injectables, advice on organising a programme offeringthis form of contraception, and a list of indicators for evaluatingsuch a programme. Injectable Contraceptives also describes thehistory of the development of the preparations, their mode of action,advantages (including non-contraceptive ones such as a tendencytowards improvement of iron-deficiency anaemia and

endometriosis), disadvantages (eg, irregular bleeding, thecommonest reason for discontinuation), and contraindications

(such as cardiovascular disease and suspected pregnancy). Theguidelines give explicit instructions for the sterilisation of needlesand syringes and for the safe use of disposable equipment.1. Injectable contraceptives: their role in family planning care. Geneva: World Health

Organisation. 1990. Pp 117. Sw fr 14 70 ISBN 92-4544023.

Department of Health research

The Department of Health is apparently so pleased with its

new-style Yearbook of Research and Development’ that it has

produced a second edition2 only seven months after the first. Thelatest volume explains in some detail how the department spent c60million on research and development in 1989-90. 24 million ofthat went on three directly commissioned research programmesconcerned, respectively, with health and personal social services(including 1 million for the Medical Research Council’s AIDSprogramme); National Health Service information technology; andNHS equipment, supplies, building, and engineering (theresponsibility of the NHS Procurement Directorate). The yearbookincludes nine reports on AIDS research and ten on child-care

projects and reviews of the work of Department of Health researchunits, such as the Blind Mobility Research Unit at Nottingham andOxford’s National Perinatal Epidemiology Research Unit.The yearbook starts with a valediction from Prof Francis

O’Grady, who was chief scientist of the DH from 1986 untilAugust, 1990. His part-time post has been replaced with that of afull-time director of research and development, who has

responsibility for all research in the NHS, including the chief

scientist’s duties of overseeing the health and personal socialservices research programme. Professor O’Grady promises the firstincumbent, Prof Michael Peckham, who will take up his post on Jan1, 1991, a legacy of confusion, conflict, and "a widespreadperception that the Department’s research programme has failed tomatch expectations".

1. Anon. Government-funded health research. Lancet 1990; 335: 6532. Department of Health. DH yearbook of research and development 1990. London.

HM Stationery Office. Pp 199. £14. ISBN 0113213204.

Human Fertilisation and Embryology Act

The Human Fertilisation and Embryology Act, the culmination ofseveral years of consultation and public debate that started with thesetting up of the Warnock committee in 1982, received RoyalAssent on Nov 1. The Act allows embryo research to continue,within a strict framework of statutory controls. In the summer of1991 a statutory body, the Human Fertilisation and EmbryologyAuthority, chaired by Prof Colin Campbell, will assume

responsibility for the licensing of centres carrying out infertilitytreatments involving the use of human embryos and gametes andwill keep developments in research and treatment under review. Inthe mean-time the Interim Licensing Authority, set up in 1985, willcontinue to administer a voluntary licensing system.The Act prohibits some areas of research, including cloning and

the creation of hybrids, and permits the storage of sperm, eggs, andembryos only under strict control. The Act also makes clear thatsurrogacy arrangements are unenforceable.The Act makes some changes to the law on abortion, introducing

for the first time a statutory time limit of 24 weeks for mostabortions. Abortions after 24 weeks (which will be allowed only tosave the mother’s life; or where there is a substantial risk of seriousfetal handicap; or where the woman’s health is likely to suffer gravepermanent injury) must be done in National Health Servicehospitals.

In England Now

With an atypical display of compliance my octogenarian aunt agreedto go into hospital for a second attack on her Dupuytren’scontracture; but, when she arrived and was in bed, the surgicalregistrar doubted the need for reoperation and, after a behind-the-scenes dialogue with the consultant, invited her to get up and gohome. Which she cheerfully began to do. In the corridor sheencountered the consultant. "I don’t like", he said, "the look of thatlump on your face. Get back into bed, and we’ll remove it." Whichthey did. "It’s all perfectly simple" she said when neighboursinquired about the unexpected location of the surgical dressing. Butplease read me the label on this tube of ointment which I have to puton the wound." EYE OINTMENT, it said.

International Diary

1990

The annual meeting of the Clinical Autonomic Research Society is totake place in London on Friday, Nov 16: Dr David Jordan, HonorarySecretary, Department of Physiology, Royal Free Hospital Medical School,Rowland Hill Street, London NW3 2PF, UK (071-794 0500 ext 4304).

A seminar entitled General Practice and the Law will take place inLondon on Wednesday, Nov 28: Dr J. D. Hickey, Assistant Secretary,Medical Protection Society, 50 Hallam Street, London WIN 6DE, UK(071-637 0541).

1991

4th international symposium on the Biology, Immunology and Surgeryof the Greater Omentum will take place in Utrecht on May 30-June 1:Secretariat 4th International Omentum Symposium, Mrs W. J Buys,Utrecht Cancer Research Centre, Servaasbolwerk 14, 3512 NK Utrecht,Netherlands (030-314688).