1370 where none exists. On food, for instance, the committee recommended a reduced fat intake and a switch to polyunsaturated foods. But the Government believes there is insufficient evidence to justify this line. Equally the committee’s call for a mass national breast-cancer screening service for women most at risk is turned down because of insufficient evidence about its effectiveness and safety. But the Government has agreed to large trials of two types of breast screening. Clearly, lack of resources has restricted the D.H.S.S. from doing as much as it would like in the area of preventive medicine. But of more fundamental importance is the question (which critics of the Government’s cautious approach should consider) of how far should the Government restrict liberty of the individual in deciding for himself whether to smoke fewer cigarettes, choose a more balanced diet, take more exercise, and drink less alcohol. The Medical Bill in the Lords
hopes that its Medical Bill would prove uncontroversial4 are not exactly being sustained by events in the House of Lords, where it has been revealed that even Sir Alec Merrison, whose committee provided the report from which the Bill has in part emerged, thinks it is an "extraordinarily feeble Bill". In the face of strong criticism of the Bill’s many omissions, the Government has now agreed to widen its scope-but only a little. It has refused to include registration of overseas doctors, but it has agreed to proposals on medical education and on the promotion of high standards of professional conduct. Leading the campaign to change the Bill is Lord Hunt of Fawley, a former President of the Royal College of General Practitioners; and he has received robust support. At the start of the Bill’s committee stage in the Lords last week he quoted a letter from Sir Alec Merrison, who made the point that his committee’s recommendations on education, not contained in the Bill, were put forward on the grounds that a doctor could not practise independently today without a postgraduate education, that his undergraduate and postgraduate education must be viewed as a whole, and that the General Medical Council must exercise supervision over postgraduate education. Another letter from Dr Elston Grey-Turner, Secretary of the British Medical Association, asserted that the Bill did not go far enough and that measures for the registration of overseas doctors and the promotion of high professional standards would be unlikely to meet opposition either among the profession or in the G.M.C. Lord Hunt argued that to keep all educational matters for a second Bill, which was unlikely to appear for three years, might be to keep the new enlarged G.M.C. "kicking its heels with relatively little to do for a long time". Lord Wells-Pestell, for the Government, said the idea of waiting three years for another Bill horrified him: the Government did not want to wait two years. He had been able to come to a working arrangement with Lord Hunt about the series of amendments being proposed. There were some the Government could accept in principle: the G.M.C. should have a statutory duty to give guidance to the medical profession on ethical conduct and behaviour; it Government
4.See ibid.
Nov. 19, 1977, p. 1089; ibid.Dec. 10, 1977, p. 1241.
should promote high standards of medical education and determine the standard of proficiency required from candidates at a qualifying examination; and there should be tighter controls over the preregistration year for newly qualified doctors. But the Government could not contemplate support for amendments dealing with the registration of doctors,. with the limited registration of overseas doctors, or with the progress from limited registration to full registration. These matters would have to be included in the later Bill. In the face of this firm rejection, Lord Hunt agreed to withdraw his amendments before they were debated.
Obituary HUGH NORWOOD ROBSON Kt., M.B. Edin., F.R.C.P., F.R.C.P.E., F.R.A.C.P., F.R.S.E.
Sir Hugh Robson, principal and vice-chancellor of the University of Edinburgh and emeritus professor of medicine in the University of Adelaide, died on Dec. 11 at the age of 60. His leadership in public and university life in general, and in medical education in particular, found recognition and scope in a large number of important official appointments, both in the United Kingdom and Australia. He was born and educated in Scotland, graduating M.B. from the University of Edinburgh in 1941, and after service with the R.N.V.R. in 1942-46 he was lecturer in medicine at Edinburgh and then senior lecturer in the University of Aberdeen. At the age of 35 he was appointed professor of medicine in the University of Adelaide, South Australia. To his teaching and clinical duties in Australia (he was honorary or consultant physician to a number of Adelaide hospitals and consultant physician to the Royal Australian Navy) he added public service of various kinds. He was a member of many bodies, including the National Health and Medical Research Council of Australia, the Australian Drug Evaluation Committee, and the Papua and New Guinea Medical Research and Advisory Committee ; he was president of the Australian Society of Haematology and councillor for Australia of the International Society of Hæmatology. In the University of Adelaide he was dean of the Faculty of Medicine in 1959-61, chairman of the professorial board in 1961-63, and member of council in 1964-65; and he acted as external examiner for a number of universities in Australia and New Zealand. All this experience in Australia stood Professor Robson in good stead when he returned to Britain in 1966 to become vice-chancellor of the University of Sheffield. His return coincided with the beginning of a new phase in university education, and he was to guide Sheffield through several years of student unrest, rapid expansion of student numbers, and questioning both from Government and the public on the role of universities. His talents and experience were also put at the service of all the universities in the United Kingdom and Commonwealth, for he held office as vice-chairman and then chairman of the Committee of Vice-Chancellors and Principals of Universities of the United Kingdom and as a member of the Inter-University Council for Higher Education Overseas and of the United Nations University Founding Committee. Among many other organisations he served were the Central Committee on Postgraduate Medical Education, Great Britain, the Council for Postgraduate Medical Education in England and Wales, the Advisory Council on the Misuse of Drugs, the Northwick Park Advisory Committee, and the Advisory
1371 Medical Training for the E.E.C. He was and vice-chancellor of the University of and he became chairman of the Scottish Health Services Planning Council in the same year. One of Sir Hugh’s main contributions at Edinburgh was the fostering of cooperative working relationships between all parts of the university, and he was also successful in bringing about easier interaction and communication between the university and the city and region in which it was placed. He was knighted in 1974, and held honorary degrees from the Universities of Sheffield and Pennsylvania. He is survived by his wife, herself an Edinburgh medical graduate, two daughters, one of whom is also a doctor, and a
Committee
on
appointed principal Edinburgh in 1974,
son.
KEITH RIDLEY DOUGLAS PORTER M.B.E., M.R.C.S., L.D.S. R.C.S., F.R.C.P., F.F.C.M., D.P.H. Dr Keith Porter, regional medical officer of the South
East Thames Regional Health 5 at the age of 64.
Authority, died
on
Dec.
qualified in medicine in 1938 and in dentistry in 1939 Guy’s Hospital. During the war he became a lieut.-colonel
He at
awarded the M.B.E. as well as being mentioned in dispatches. After the war he spent a number of years in East Africa, working with the Overseas Food Corporation, before returning to a short but valuable period in general practice in England. His administrative career began with the regional hospital boards of the Oxford and Birmingham regions, and in 1964 he became senior administrative medical officer to the Northern Ireland Hospitals Authority. For the next 5 years he worked unstintingly in a very difficult environment to create an efficient hospital organisation in the province of Northern Ireland. His dedication to his work there won him great respect and many friends, while the organisation he helped to create still benefits in its present difficult task from the contribution he made in the late 1960s. He returned to England in 1969, initially as senior administrative medical officer of the South East Metropolitan Regional Hospital Board; in 1974, after the reorganisation of the National Health Service, he became regional medical officer of the new South East Thames Regional Health Authority. The characteristics which endeared Dr Porter to his colleagues were his quiet compassion and integrity. He was very generous with his time and as a result knew an enormous number of consultants in the region as individuals and friends. He was grossly overworked, yet he never complained. In the last two years of his life the pressures on him’increased enormously, for he was fighting to make sure that the present financial stringencies should not be allowed to reduce the quality of services which he hoped to achieve in the South East Thames region. He was due to retire in March of next year and was looking forward to enjoying his much loved family. Only two weeks before his death he was appointed honorary physician to Her Majesty the Queen. He will be honoured in the memory of those who had the good fortune to work with him and who knew him as a gentle and compassionate friend whose ability and devotion to service were a natural result of his personality. C.E.S. and
was
Dr FREDERICK STEPHEN CARTER, consultant paediatrician the States of Jersey, died on Dec. 1 at the age of 59.
to
Dr KEITH BLATCHLEY, formerly in general practice in Garden Suburb, London, died on Dec. 13 at the age of 74. He was also surgeon to the South Division, Metropolitan Police, and he worked as an assistant in obstetrics at Hampstead General Hospital and Charing Cross Hospital.
Hampstead
Notes and News
QUALITY CONTROL OF PHARMACEUTICAL PREPARATIONS COUNTRIES which rely on imported drugs often lack the technical resources for effective quality control of these drugs. Yet drugs must be accurately identified and their degradation-through conditions of handling and storage not anticipated in the expiry dates-must be efficiently monitored. In its latest report’ the World Health Organisation’s expert committee on specifications for pharmaceutical preparations proposes the development of simplified tests for widely used drugs which require stable, easily obtainable reagents and unsophisticated laboratory equipment, which can be done by relatively untrained staff, and which provide a warning of unsuitability pending more thorough investigation. Test-tube reactions (precipitation, evolution of gases) can be useful, but they are grossly non-specific; the potentially most valuable chromatographic techniques must themselves first be standardised. It is intended that these tests be developed first for starting materials for drugs-a first generation of such tests are now used in Europe at peripheral levels of drug distribution-and later adapted for drugs in dosage form which have been subjected to extremes of climate.
Quality control in all countries demands agreed analytical criteria. The committee has reviewed the most valuable criteria--objective standards of identity, purity, and strength-and the report discusses the physicocochemical and biological tests most useful in establishing these standards. A set of standards (and the analytical methods used to obtain them) together form quality specifications for assessing drug integrity. Selection of specifications varies according to their intended use. Pharmacopreial specifications must be sufficient to permit a legally definitive judgment on drug quality. The specifications of manufacturers may differ-not least because analytical methods are geared to factory production methods-but in a dispute about whether or not drugs meet pharmacopoeial requirements only the analytical procedures recommended in the pharmacopceia are conclusive. Particular problems in quality control are posed by plastic packaging for pharmaceutical preparations. Properties of the packaging-flexibility, collapsibility, clarity, temperature resistance, and permeability to water--determine what happens to a preparation during storage, particularly in hot and dry climates. In its requirements for plastic packaging (a revision of those in its previous report) the committee comments the choice of different types of material and on methods of sterilisation. It describes in detail tests designed to detect contamination of pharmaceutical preparations by lingering byproducts of plastic manufacture and plastic additives (lubricants, antioxidants, antimould agents) which leach out during storage. These tests mainly require liquid extracts of the plastic and they include both physicochemical assays (e.g., for nonvolatile residues of evaporation and heavy metals) and biological assays in vitro (hamiolysis) or in vivo (toxicity; intracutaneous and intraocular activity). The procedures apply to plastic-packed preparations for parenteral and ophthalmic use; but the committee suggests that the plastics used for devices such as contact lenses, catheters, and prostheses should have similar quality requirements. The committee recommends an international review of the quality control of pharmaceutical preparations, including the means of ensuring the satisfactory quality of those supplied to areas with limited technical on
resources.
1. Wld Hlth
Org.
tech.
Rep. Ser. 1977, no. 614.
hopes that its Medical Bill would prove uncontroversial4 are not exactly being sustained by events in the House of Lords, where it has been revealed that even Sir Alec Merrison, whose committee provided the report from which the Bill has in part emerged, thinks it is an "extraordinarily feeble Bill". In the face of strong criticism of the Bill’s many omissions, the Government has now agreed to widen its scope-but only a little. It has refused to include registration of overseas doctors, but it has agreed to proposals on medical education and on the promotion of high standards of professional conduct. Leading the campaign to change the Bill is Lord Hunt of Fawley, a former President of the Royal College of General Practitioners; and he has received robust support. At the start of the Bill’s committee stage in the Lords last week he quoted a letter from Sir Alec Merrison, who made the point that his committee’s recommendations on education, not contained in the Bill, were put forward on the grounds that a doctor could not practise independently today without a postgraduate education, that his undergraduate and postgraduate education must be viewed as a whole, and that the General Medical Council must exercise supervision over postgraduate education. Another letter from Dr Elston Grey-Turner, Secretary of the British Medical Association, asserted that the Bill did not go far enough and that measures for the registration of overseas doctors and the promotion of high professional standards would be unlikely to meet opposition either among the profession or in the G.M.C. Lord Hunt argued that to keep all educational matters for a second Bill, which was unlikely to appear for three years, might be to keep the new enlarged G.M.C. "kicking its heels with relatively little to do for a long time". Lord Wells-Pestell, for the Government, said the idea of waiting three years for another Bill horrified him: the Government did not want to wait two years. He had been able to come to a working arrangement with Lord Hunt about the series of amendments being proposed. There were some the Government could accept in principle: the G.M.C. should have a statutory duty to give guidance to the medical profession on ethical conduct and behaviour; it Government
4.See ibid.
Nov. 19, 1977, p. 1089; ibid.Dec. 10, 1977, p. 1241.
should promote high standards of medical education and determine the standard of proficiency required from candidates at a qualifying examination; and there should be tighter controls over the preregistration year for newly qualified doctors. But the Government could not contemplate support for amendments dealing with the registration of doctors,. with the limited registration of overseas doctors, or with the progress from limited registration to full registration. These matters would have to be included in the later Bill. In the face of this firm rejection, Lord Hunt agreed to withdraw his amendments before they were debated.
Obituary HUGH NORWOOD ROBSON Kt., M.B. Edin., F.R.C.P., F.R.C.P.E., F.R.A.C.P., F.R.S.E.
Sir Hugh Robson, principal and vice-chancellor of the University of Edinburgh and emeritus professor of medicine in the University of Adelaide, died on Dec. 11 at the age of 60. His leadership in public and university life in general, and in medical education in particular, found recognition and scope in a large number of important official appointments, both in the United Kingdom and Australia. He was born and educated in Scotland, graduating M.B. from the University of Edinburgh in 1941, and after service with the R.N.V.R. in 1942-46 he was lecturer in medicine at Edinburgh and then senior lecturer in the University of Aberdeen. At the age of 35 he was appointed professor of medicine in the University of Adelaide, South Australia. To his teaching and clinical duties in Australia (he was honorary or consultant physician to a number of Adelaide hospitals and consultant physician to the Royal Australian Navy) he added public service of various kinds. He was a member of many bodies, including the National Health and Medical Research Council of Australia, the Australian Drug Evaluation Committee, and the Papua and New Guinea Medical Research and Advisory Committee ; he was president of the Australian Society of Haematology and councillor for Australia of the International Society of Hæmatology. In the University of Adelaide he was dean of the Faculty of Medicine in 1959-61, chairman of the professorial board in 1961-63, and member of council in 1964-65; and he acted as external examiner for a number of universities in Australia and New Zealand. All this experience in Australia stood Professor Robson in good stead when he returned to Britain in 1966 to become vice-chancellor of the University of Sheffield. His return coincided with the beginning of a new phase in university education, and he was to guide Sheffield through several years of student unrest, rapid expansion of student numbers, and questioning both from Government and the public on the role of universities. His talents and experience were also put at the service of all the universities in the United Kingdom and Commonwealth, for he held office as vice-chairman and then chairman of the Committee of Vice-Chancellors and Principals of Universities of the United Kingdom and as a member of the Inter-University Council for Higher Education Overseas and of the United Nations University Founding Committee. Among many other organisations he served were the Central Committee on Postgraduate Medical Education, Great Britain, the Council for Postgraduate Medical Education in England and Wales, the Advisory Council on the Misuse of Drugs, the Northwick Park Advisory Committee, and the Advisory
1371 Medical Training for the E.E.C. He was and vice-chancellor of the University of and he became chairman of the Scottish Health Services Planning Council in the same year. One of Sir Hugh’s main contributions at Edinburgh was the fostering of cooperative working relationships between all parts of the university, and he was also successful in bringing about easier interaction and communication between the university and the city and region in which it was placed. He was knighted in 1974, and held honorary degrees from the Universities of Sheffield and Pennsylvania. He is survived by his wife, herself an Edinburgh medical graduate, two daughters, one of whom is also a doctor, and a
Committee
on
appointed principal Edinburgh in 1974,
son.
KEITH RIDLEY DOUGLAS PORTER M.B.E., M.R.C.S., L.D.S. R.C.S., F.R.C.P., F.F.C.M., D.P.H. Dr Keith Porter, regional medical officer of the South
East Thames Regional Health 5 at the age of 64.
Authority, died
on
Dec.
qualified in medicine in 1938 and in dentistry in 1939 Guy’s Hospital. During the war he became a lieut.-colonel
He at
awarded the M.B.E. as well as being mentioned in dispatches. After the war he spent a number of years in East Africa, working with the Overseas Food Corporation, before returning to a short but valuable period in general practice in England. His administrative career began with the regional hospital boards of the Oxford and Birmingham regions, and in 1964 he became senior administrative medical officer to the Northern Ireland Hospitals Authority. For the next 5 years he worked unstintingly in a very difficult environment to create an efficient hospital organisation in the province of Northern Ireland. His dedication to his work there won him great respect and many friends, while the organisation he helped to create still benefits in its present difficult task from the contribution he made in the late 1960s. He returned to England in 1969, initially as senior administrative medical officer of the South East Metropolitan Regional Hospital Board; in 1974, after the reorganisation of the National Health Service, he became regional medical officer of the new South East Thames Regional Health Authority. The characteristics which endeared Dr Porter to his colleagues were his quiet compassion and integrity. He was very generous with his time and as a result knew an enormous number of consultants in the region as individuals and friends. He was grossly overworked, yet he never complained. In the last two years of his life the pressures on him’increased enormously, for he was fighting to make sure that the present financial stringencies should not be allowed to reduce the quality of services which he hoped to achieve in the South East Thames region. He was due to retire in March of next year and was looking forward to enjoying his much loved family. Only two weeks before his death he was appointed honorary physician to Her Majesty the Queen. He will be honoured in the memory of those who had the good fortune to work with him and who knew him as a gentle and compassionate friend whose ability and devotion to service were a natural result of his personality. C.E.S. and
was
Dr FREDERICK STEPHEN CARTER, consultant paediatrician the States of Jersey, died on Dec. 1 at the age of 59.
to
Dr KEITH BLATCHLEY, formerly in general practice in Garden Suburb, London, died on Dec. 13 at the age of 74. He was also surgeon to the South Division, Metropolitan Police, and he worked as an assistant in obstetrics at Hampstead General Hospital and Charing Cross Hospital.
Hampstead
Notes and News
QUALITY CONTROL OF PHARMACEUTICAL PREPARATIONS COUNTRIES which rely on imported drugs often lack the technical resources for effective quality control of these drugs. Yet drugs must be accurately identified and their degradation-through conditions of handling and storage not anticipated in the expiry dates-must be efficiently monitored. In its latest report’ the World Health Organisation’s expert committee on specifications for pharmaceutical preparations proposes the development of simplified tests for widely used drugs which require stable, easily obtainable reagents and unsophisticated laboratory equipment, which can be done by relatively untrained staff, and which provide a warning of unsuitability pending more thorough investigation. Test-tube reactions (precipitation, evolution of gases) can be useful, but they are grossly non-specific; the potentially most valuable chromatographic techniques must themselves first be standardised. It is intended that these tests be developed first for starting materials for drugs-a first generation of such tests are now used in Europe at peripheral levels of drug distribution-and later adapted for drugs in dosage form which have been subjected to extremes of climate.
Quality control in all countries demands agreed analytical criteria. The committee has reviewed the most valuable criteria--objective standards of identity, purity, and strength-and the report discusses the physicocochemical and biological tests most useful in establishing these standards. A set of standards (and the analytical methods used to obtain them) together form quality specifications for assessing drug integrity. Selection of specifications varies according to their intended use. Pharmacopreial specifications must be sufficient to permit a legally definitive judgment on drug quality. The specifications of manufacturers may differ-not least because analytical methods are geared to factory production methods-but in a dispute about whether or not drugs meet pharmacopoeial requirements only the analytical procedures recommended in the pharmacopceia are conclusive. Particular problems in quality control are posed by plastic packaging for pharmaceutical preparations. Properties of the packaging-flexibility, collapsibility, clarity, temperature resistance, and permeability to water--determine what happens to a preparation during storage, particularly in hot and dry climates. In its requirements for plastic packaging (a revision of those in its previous report) the committee comments the choice of different types of material and on methods of sterilisation. It describes in detail tests designed to detect contamination of pharmaceutical preparations by lingering byproducts of plastic manufacture and plastic additives (lubricants, antioxidants, antimould agents) which leach out during storage. These tests mainly require liquid extracts of the plastic and they include both physicochemical assays (e.g., for nonvolatile residues of evaporation and heavy metals) and biological assays in vitro (hamiolysis) or in vivo (toxicity; intracutaneous and intraocular activity). The procedures apply to plastic-packed preparations for parenteral and ophthalmic use; but the committee suggests that the plastics used for devices such as contact lenses, catheters, and prostheses should have similar quality requirements. The committee recommends an international review of the quality control of pharmaceutical preparations, including the means of ensuring the satisfactory quality of those supplied to areas with limited technical on
resources.
1. Wld Hlth
Org.
tech.
Rep. Ser. 1977, no. 614.
