needs of minorities or of helping them to understand health priorities in the context of limited resources) and even colleagues left behind (who might gain experience of "acting up"), others stressed negative effects such as the deviation from standard career paths. 83% thought that providing cover for absent staff and the current staff shortages formed the greatest obstacle. The report proposes that agreement should be made with the Department of Health for release of health personnel for emergencies overseas; that health service managers and units be given information on the nature and benefits of emergency relief work; that a database of units willing to release staff be set up and linked to the IHE register; and that a framework for releasing National Health Service staff, taking into account cost, cover, and mutual benefits, be drawn up and piloted.
The BPA’s guidance on assessment of potential harms, benefits, and costs is given in the form of lists of questions for researchers and ethics committees to consider. On the assessment of potential harm the guidelines point out that researchers sometimes underestimate the risk of pain if the effects are brief.
Vivien Choo 1. British Paediatric Association. Guidelines for the ethical conduct of medical research involving children. 1992. Pp 18. London: BPA (5 St Andrew’s Place, London NW1 4LB). 2. National Council on Bioethics in Human Research. Report on reseach involving children. 1992. Pp 64. Ottawa: NCBRH (774 Echo Drive, Ottawa, Canada K1S
Vivien Choo 1. International Health Exchange. Recruiting health workers for emergencies and disaster relief m developing countries. London: IHE (Africa Centre, 38 King Street, London WC2E 8JT). 1993. Pp 20.
price preterm birth?
Medical advances in neonatal intensive care have presented a dilemma. Survival rates of very low birthweight preterm babies in the UK may have improved, but around 20% of these babies have significant disability. Perhaps, suggests an Office of Health Economics report,’ part of the limited resources put into ensuring the survival of increasingly lower birthweight babies would be better spent on research into the causes (and ultimately the prevention) of preterm birth. These causes are poorly understood and in most countries preterm delivery rates have remained relatively constant. The most effective prevention seems to be a comprehensive population approach such as that used in France, which resulted in a reduction of preterm births from 8-2% of all births to 5-6% between 1972 and 1981. This programme involved risk assessment of all pregnant women and, if necessary, intervention such as work leave, the cost of which was met by the social security system. Antenatal care for all women was also modified, with earlier booking and more frequent appointments with the obstetrics team rather than the general practitioner. The reduction in the number of preterm births occurred in women with non-high-risk pregnancies. This success, points out the author of the report, shows that a population (rather than high-risk) approach to preterm birth has much to offer.
Sarah Ramsay 1. Born too soon by Jane Griffin. 1993. 12 Whitehall, London, UK.
Pp 60. £5. London: Office of Health Economics,
Distress due to venepuncture In children other than possibly in very small infants venesection by an experienced person carries very little risk of physical harm. However, mindful of how upset children can be at the sight of a needle, the British Paediatric Association’s Ethics Advisory Committee, in updating the Association’s guidelines on ethical conduct of research involving children, classed venesection as a low
rather than a minimal risk procedure (on a scale of minimal, low, and high).1 When the revised guidelines were first published in August last year, some people were concerned that this classification would discourage important research that could benefit children. Hence the guidelines are now being distributed with an accompanying commentary pointing out the importance of recognising distress induced by fear of needles and of accepting such distress as an indication of withholding consent to participate in the research. The Consent Panel Task Force of Canadian National Council on Bioethics in Human Research also puts venepuncture in children on its second level of harm (their grades being negligible, minimal, moderate, and substantial).2 Both the British and the Canadian panels support the premise that research that is not of intended benefit to the child is not necessarily unethical, as long as the child is subjected to no more than the lowest level of risk. Hence children could be subjects in observations and measurements of normal development or in the assessment of diagnostic methods, or healthy or placebo controls.
It’s been ages since I last saw Kieran so when I happened to be at Linbridge University the other week I called into the occupational health department. As I opened his door I was immediately blinded by a very bright light. It took a second for my pupils to adjust and then to my horror I found myself staring down the barrel of a gun. As fear that this was where I bought it engulfed me, the light suddenly went out, my retinas recovered, and Kieran appeared. "What on earth ...", I stammered. "Bird shit", said Kieran calmly, oblivious to the fact that my myocardium was still contemplating fibrillation. "Droppings, guano...", he continued as I concluded that making a run for it was the best option. "Psittacosis", he said finally, which for some reason seemed to make everything all right. I returned to sinus rhythm, although still not sure what Kieran was doing or talking about. "We’ve had an outbreak of psittacosis", explained Kieran. "Well, a case at least. One of the University maintenance engineers has had quite a nasty illness two weeks after clearing up pigeon droppings in of the boiler houses. We did a COSHH assessment on the stuff and managed to grow chlamdyia. A survey of the other maintenance men has shown a lot of unexplained upper respiratory tract symptoms. So in accordance with EC directive 91/784 we are going to try and eradicate the source of the hazard." "What, kill all the pigeons?", I exclaimed as I caught site ofa cardboard cutout hawk in the window. "Yes, of course. You use the gun at night whilst they’re sleeping; the light searches them out. But just listen to this!" Kieran fiddled with a black box on his desk and I leapt out of my skin as the room suddenly filled with horrible high-pitched shrieking noises. "Impressive, isn’t it? That’s a PAL sound emitter; makes the pigeons think there’s a hawk about, like the cardboard cutouts. Soon have the blighters eradicated", Kieran shouted gleefully waving the gun around as though he had just shot a lion. My shattered nervous system could stand no more so I made my excuses and left him to his plans for mass avicide. At the University again a couple of weeks later, I was pleased to note encouraging signs of birdlife. More importantly, the peace of the campus was not interrupted by the sounds of a searchlightguided elephant gun or the recorded screechings of a hawk about to dismember things in its food-chain. Nonetheless, I decided to check with Kieran’s secretary first before entering in case he was trying out a ground-to-air missile or some other weapon of pigeon destruction. Jeanne solemnly advised against seeing him. "A very sad example of mouth-to-beak resuscitation", she warned solemnly. "Mouthto-beak resuscitation?", I said incredulously. She explained. "Kieran’s prize ’case’ of psittacosis got wind of the plans to rid the university of all bird life and admitted that he was an exotic bird importer in his spare time. His last bird arrived in the country moribund and the birds are so expensive that he tried to resuscitate it. I don’t know who is the more embarrassed, but its fair to say that they are both as sick as a parrot." The poor woman didn’t even smile. As I left I noticed workmen in Kieran’s office replacing a pane of glass, and on the floor was what suspiciously looked like the cardboard cutout of a hawk that had been shot several times. I just hope that the birdman of Linbridge hasn’t done anything else with that gun. one