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Evidence shows that a large proportion of maternal deaths is due to women giving birth too often, too early, too late, and too close together. Family planning can help to prevent these deaths. However, there are some ‘humanisms’ who oppose abortion, who always close their eyes, and sing ‘protect life’ loudly. It seems that they are mostly concerned with their own lives. I would like to ask these people: ‘When you see a woman go to a back-street in Asia to get a terrible abortion, then where is your ‘humanism’?’ It is also clear that women in all countries. developed and developing, need access to safe and affordable abortions, without such access, many will have to resort to dangerous ‘back-street’ abortions. This volume uses a large body of facts to cry out: ‘People, do your best to save women’s lives, women are your mothers, sisters, wives and daughters.’

From the point of research, this volume offers some simple and easy indicators such as sex ratio of reproductive, age mortality rates, index of son preference, etc. This book would have been strengthened with the inclusion of case studies which would give the reader a better understanding of the countries or areas where the maternal mortality is high.

In summary, this book is very useful for people who work in public health, family planning, maternal-child health care, and human rights.

Professor S. Wang Department of Health Statistics

and Medical Demography Beijing Medical University

Beijing, The People’s Republic of China

*****

General Practice and Primary Health Care 194Os-1980s By J. Fry The Nuffield Provincial Hospitals Trust, London, 1988 116 pp., ISBN 0-900574-69-O

This little book, of 115 pages, is a gem, and I would recommend it for any general practi- tioner/family physician who is interested in the history and background of his/her profession, but in particular, developed or developing countries who are looking for direction in implementing their own primary health care program. The book starts with a definition of general practice and primary health care, and then summarizes the background of British general practice from 1750 to 1948 and the national health service from 5 July 1948 and thereafter. Dr. Fry then contrasts the changing trends in society, with changing trends and data of general practice, and quite accurately depicts general practice in the United Kingdom.

The final chapter, ‘at the Crossroads of Time: Future Hopes, Qualms and Dilemmas’, is worth the book itself. Dr. Fry projects what’s to be done, who might do it, how it should be done, how to administer well and give better value for money, how to achieve changes, future hopes and needs, the insoluble equation examined, general practice, what may happen, and an agenda for the future. This book should provide good reading for medical students, practislng physicians, faculties and for health care planners.

Talking and Listening to Patients. A Modern Approach By C. Fletcher and P. Freeling The Nuffield Provincial Hospitals Trust, London, 1988 68 pp., ISBN o-900574-70-4

This small book is primarily a how-to-interview book and discusses the interview, reasons and

evidence for poor interviewing, the importance of good interviewing skills, and learning good interviewing. When I initially read the book, I felt that this was an outstanding book for medical students and residents. But upon reflection, it would be a good book for those of us in general and family practice, and for all physicians to review their interviewing techniques, and should provide a mechanism for better communication between the patient and the physician.

253

Professor R. Gerard College of Human Medicine

Michigan State University East Lansing, Michigan, U.S.A.

Brookings Dialogues on Public Policy. Toward a National Policy on Drug and Aids Testin By M. Falco and W. Cikins ( l? ds.) The Brookings Institution, Washington DC, 1989 81 pp., ISBN 0-8157-2733-X. $12.95.

This volume is the product of two Brookings conferences on drug and AIDS testing, at which the participants addressed themselves to the ever-increasing political pressure and public fear created by the spread of AIDS and the (ab)use of illicit drugs in the USA.

On tirst reading the title ‘Toward a National Policy on Drug and AIDS Testing’ it might seem unreasonable to combine an epidemiological public health issue with the sociopolitical problem of increasing drug (ab)usage. Yet as one begins to consider the wider policy implications of mandatory testing for either HIV antibodies or drug metabolites, one appreciates that coercive testing for either inevitably overrides fundamental individual rights. Consequently any such testing programmes must share certain policy issues.

In the first chapter, Mathea Falco introduces some of the topics on which the conference discussions focused. These she divides into two broad groups: the ‘Zero-tolerance’ argument which condemns any illicit drug use and any sexual activity outside a strictly monogamous marriage; and the ‘Differentiated tolerance’ argument which distinguishes among behaviour and seeks to protect individual rights as well as public health. After this introductory chapter three further authors present a review of the considerations of particular groups of panellists focusing in turn on the medical, private, and political implications of mandatory HIV testing.

June Osborne begins her review of the medical considerations of drug and HIV antibody testing by outlining the parameters within which a programme of diagnostic HIV tests and drug detection tests should be set. It was agreed that without clarity of purpose such tests could have a negative effect on public and individual well-being. Therefore, the primary goals of any testing programme must include behaviour modification through counselling and access to rehabilitation treatment for drug abusers. The collection of epidemiological data should always play a secondary role. Extensive, accessible and compassionate counselling must be inextricably linked to any mandatory testing, since. without it testing would become a counterproductive mechanism for the control of AIDS or drugs abuse.

Osborne goes on to provide a brief history of HIV in the USA as well as a summary of the modes of HIV transmission. Transmission is the key issue which has linked HIV and drugs, since it has been recognised that the sharing of needles in intravenous drug use provides one of the major infection routes. The panellists therefore discussed in some detail the nature of this transmission route and the extent to which drug detection testing could reduce its impact.

Russel Iulculno of the American Council for Life Insurance reviews the private sector discussions on Drug and HIV testing. The debate here focuses on the role of markets. On the whole, insurers