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therefore they do not oppose experimentation on embryos that areconceived in vitro provided that an embryo possibly damaged by anexperiment is not allowed to become implanted. Their view is thatdecisions about what is done to a fetus/embryo in utero should bemade by the woman since it is part of her body and cannot developinto a human being without her. Proper regulation of in-uteroprocedures is essential and counselling services should be widelyand freely available: the authors propose a "public donationagency" that would be under full public control and to which peoplecould give their gametes for research; to prevent exploitation,individuals would be denied the right of ownership of donatedgametes. Such an agency, they say, could also make surrogacyarrangements, since the authors see surrogacy as another form ofdonation by women for women with no contractual obligation.Finally, if women are to have more control over reproductivetechnologies and future developments, they must be allowed toparticipate more in policy-making.

1. Birke L, Himmelweit S, Vines G. Tomorrow’s child: reproductive technologies in the90s. London: Virago Press, 1990. Pp 340. £9.99. ISBN 1-853811459.

Do prescription charges affect use of prescribeddrugs?The most notable changes in government policy on prescriptioncharges have occurred since 1979, when annual increases have beenover and above the rate of inflation, says a discussion paperpublished by the Health Economics Research Unit (HERU) atAberdeen University.1 Although the increasing charges are aimed atgenerating revenue to help meet the costs of health care, as well as toreduce the frivolous use of NHS prescriptions, little attention hasbeen given to the effect these charges have on the utilisation of NHSprescriptions.According to the economic theory of demand, as prescription

charges increase, the use of NHS drugs should fall-becausepatients are deterred from consulting their doctor, because doctorsprescribe less, or because of an increase in non-compliance, withpatients failing to get their prescriptions dispensed. Because of thelack of information on changes in consultation rates and non-compliance, the paper was based on number of prescription itemsdispensed rather than the quantity of drugs prescribed perprescription, and on the utilisaton of NHS prescribed drugs ratherthan the patient demand for them.The utilisation of NHS prescribed drugs (both exempt and

non-exempt) is thought to be influenced by independent variablessuch as prescription charges, the price of substitutes, non-exemptand exempt income level, the retail price index, the number ofgeneral practitioners, new claims for sickness and invalidity benefitas a proxy for the general health of the population, the introductionof the limited list in April, 1985, and seasonal fluctuations inutilisation. Regression analysis suggests that increases in

prescription charges do reduce the utilisation of NHS drugs, andthat it cannot be assumed that this finding represents a reduction inthe careless use of prescribed drugs. Although increases in

prescription charges provide more revenue for health care services,the paper says that policy-makers should be aware that it may not bethe most cost-effective way of achieving revenue savings. Theauthor concludes that a better approach may be to direct

revenue-saving policies at general practitioners-for example, bythe proposed introduction of drug budgets, and by encouraging theuse of generic drugs.1. Ryan M. Estimating the effects of prescription charges on the use of NHS prescribed

drugs in England, 1979-1985. University of Aberdeen: Health EconomicsResearch Unit, 1989. Pp 28. £2.50.

Christmas prizewinnersThree readers sent all-correct answers to the quiz in our issue of Dec23/30-namely, Dr Riidiger Hoffmann (Neustadt, West

Germany); Dr N. M. Davidson (Edinburgh, Scotland); and DrRichard Plotz (Providence, RI, USA). To them go our

congratulations and, eventually, prizes. Those who remainbemused will find the answers in the following places: (1) ii, 94; (2)ii, 1019; (3) i, 771; (4) i, 1393; (5) i, 1366; (6) i, 894; (7) i, 626; (8) ii,1130; (9) i, 374; (10) ii, 796.

In England Now

Alcohol is a wonderful drug. Soothing in moderation, powerful atunleashing inhibitions in excess, and unfortunately addictive ordementing for some in the long term. As our hospital was withinview of the local brewery and we could smell the malt if an east windwas blowing, we had our fair share of alcohol-induced pathology.One poor soul, having just been discharged from our medical ward,went across the str t to the local for a few pints. When getting downfrom the bar stool some 12 pints later he managed to fall backwardsand break some bones, thus warranting a further stay with oursurgical colleagues.The more tragic of the alcoholic patients were those with

dementia, though they were always good for a story. I remember inparticular Mr R, who had destroyed more white matter thanhepatocytes and whose comic stories more than made up for hisshort-term memory deficit.Our hospital was old with many structural faults, and thus we

were not overly surprised during a rainy night to be called by apatient from Mr R’s ward complaining bitterly that his slumbershad been disturbed with the ****** roof leaking. We weresurprised, however, to discover that the origin of the leak was notour aged roof but rather Mr R, standing on the bedside locker, andquietly relieving himself over the poor patient below!

* * *

It is bad enough to be called in as a doctor when you’re on holiday,but it’s worse being an amateur vet. We rented a nice house inArdnamurchan, which had a small farm next door. A small farmwith a big farmer, over six feet but a softie. He asked if I would mindlooking at his cow. I showed reluctance and disclaimed all

knowledge, but he insisted. The cow was listless and seemed to bebreathing fast. "Well", I said unwisely, "she might have

pneumonia." "Supposing she has?", asked the farmer. "What doyou suppose the vet would be giving her?" "Some kind of penicillin,probably." "I can’t afford to get him here, it’s thirty miles across theferry. I’ll phone surgery and ask them to put some penicillin on thebus. When it comes, can I depend on you to give it to her? I couldn’tbring myself to stick needles into the poor beast."Twice a day, said the bottle. Until the fourth day, when I had to

go (genuinely, this is a true story) to Inverness to meet my uncle. Sowhat did softie do on the fourth day? He was not soft in the othersense-he discovered that my wife was a nurse and he persuadedher to give the injections.

Sticking to the truth, the cow did get better. Which proves anythesis that you care to choose.

International Diary

Any Room at the Top-Why Not? is the subject of the annual generalmeeting to be held in London on Wednesday, Feb 21: Dr Hilary Thomas,Meetings Secretary, Medical Women’s Federation London Association, 88Ockendon Road, London N1 3NW (01-354 1354).

A short course on Mental Health in Old Age will be held at Harlech,Gwynedd, on March 28-30: British Association for Service to the Elderly,119 Hassell Street, Newcastle, Staffs ST5 lAX (0782-661033).

An international symposium on Systemic and Regional Hemodynamicsin Liver Diseases is to be held in Bari, Italy, on June 3-5: ScientificSecretary, Dr C. Sabba, Institute of Clinica Medica I, University of Ban,Policlinico P.33a G Cesare, 70124 Bari.

A conference on Cycling and the Healthy City is to take place in Londonon Wednesday, June 27: Adrian Davis, Co-ordinator, London Road SafetyAlert, Friends of the Earth, 26-28 Underwood Street, London N1 7JQ(01-490 1555).

An educational course on Gynaecological Endocrinology and

Infertility will take place in London on June 28-29: Sally I Barber,Postgraduate Education Department, Royal College of Obstetricians andGynaecologists, 27 Sussex Place, Regent’s Park, London NW2 4RG (01-2625425 ext 207).