BRITISH MEDICAL JOURNAL
713
18 MARCH 1978
CORRESPONDENCE British standard insulin syringe B F Brearley, FRCP, and J Mackie, MRCGP. 713 Television medicine K Sabbagh, MA; K E Halnan, FRCP, and T B Brewin, FRCR; J M S Pearce, FRCP; E J Trimmer, MRCGP; P A Gardiner, DOMS; C R Paterson, DM ...................... 713 Fatal chlormethiazole poisoning in chronic alcoholics I M Slessor, MB; Joan M Horder, MRCPATH 716 College of Anaesthetists P J F Baskett, FFARCS; J S M Zorab, FFARCS; J Hurdley, FFARCS; J M B Burn, FFARCS
........
......................
716
Cimetidine prophylaxis after renal transplantation ............. 717 C C Doherty, MRCP ....... Cimetidine and serum prolactin W L Burland, MB, and others; M C ............... 717 Bateson, MRCP .........
Relapse of duodenal ulceration after cimetidine treatment M Guslandi, MD, and others ............ 718 Household products and poisoning R Goulding, FRCP ...................... 718 Regional secure units and interim security for psychiatric patients J K W Morrice, FRCPSYCH; J T Hutchinson, FRCPSYCH .
...........................
Septic abortion and IUCDs E S B Wilson, MB; W G Mills, FRCOG.... Pelvic actinomycosis associated with IUCD M Barnham, MB, and others ............ Is pancreatic isotope scanning worth while? H J Testa, PHD, and others ...... Coronary heart disease, age, and sex H M Sinclair, FRCP .................... Diet and heart: the importance of metals Barbara Chipperfield, PHD, and J R
Chipperfield,
PHD
......................
718
719 719 720
720 720
Correspontdents are urged to write briefly so that readers may be offered as wide a selectioni of letters as possible. So many are being received that the omission of some is inevitable. Letters must be signed personally by all their authors.
British standard insulin syringe
SIR,-We have more than 10 different types of insulin in use in Britain, produced in strengths of 40 U/ml and 80 U/ml. Only one, soluble, is produced in a strength of 20 U/ml and this is rarely used. Surely it is time that the British standard insulin syringe, calibrated to deliver 20 U/ml, was relegated to the museum of antiquities. This relic is a source of great confusion. The graduations correspond to neither of the strengths of insulin commonly used in this country. Much medical and nursing time is taken up in explaining the difference between the number of units of insulin and the number of marks on the syringe. Obfuscation increases when patients talk of "double strength" insulin, meaning 80 U/ml. Various written reminders may increase the chance of error in a busy diabetic clinic or when the card is misplaced or misunderstood by the patient. Yet these errors may be serious and occasionally result in permanent damage or death. Most errors would be eradicated by using only one strength of insulin, with a syringe graduated to correspond to that strength. In 1973 U-100 insulin (100 U/ml) was introduced into the USA' (first by Eli Lilly and Co and later by E R Squibb and Sons). With a choice of large or small syringes, depending on the size of the dose, this has proved satisfactory. Now 80% of the units sold by Lilly are of U-100 insulin. In April 1974 U-100 insulin was introduced into
Allergic bronchopulmonary aspergillosis R J White, MD ......... ............... 721 Scan-demonstrated ilioportal shunt with resolution P G Bentley, FRCS, and P L Hill .......... 721 Ban on dental anaesthetics T M Young, FFARCS; J P N Hicks, FFARCS.. 721 Distinction awards C I Haines, MRCP ........ .............. 721 Payment of district management teams R Wann, MRCGP ...................... 722 Setting an example R R Charlwood, MRCGP ................ 722 Court Report and the school health service G V Lewis, MRCS ...................... 722 Points from Letters All doctors great and small (A M Evans); Pyloric obstruction during treatment with cimetidine (W Gazala and I Hatim); Medical treatment of open-angle glaucoma (E G Mackie); Shock after insertion of IUCD (F C R Picton) ........................ 722
provide syringes, either glass or disposable plastic, satisfactory for use with large or small doses. There may be some difficulty in the transition period, but this difficulty would not compare with the trouble that we have had for the past 25 years with the U-20 syringe. Patients in future would be spared the confusion of three strengths of insulin. Physicians and nursing staff would be spared time for more essential things. We would all be spared the complications that result from mistakes. It is time that this change was made.
Canada and the old strengths discontinued (U-80 in December 1974, U-40 in June 1975). The change was regarded as "having been accomplished relatively free of complications." In Britain a trial of U-100 insulin was undertaken to assess its acceptability,2 in which 110 diabetic patients, already accustomed to using the U-40 and U-80 insulins, B F BREARLEY were given U-100 insulin with a suitably JOHN MACKIE graduated syringe; 83% either preferred the Green Hospital, U-100 insulin or at least had no preference. Diabetic Clinic, Sharoe There were some mechanical problems with Fulwood, Preston, Lancs the syringes used in this trial owing to corMoss, J M, and Galloway, J A, J7ournal of the American Medical Association, 1977, 238, 1823. rectable features in their design. There is no Sheldon, J, et al, British Medical J7ournal, 1976, 21, doubt that these can soon be remedied to 1319. Television medicine
SIR,-Perhaps the time has come in this correspondence to point out what the real issues are. They are: (1) should television in its institutional role as "honest reporter" be allowed the same freedom to deal with medical topics as it has to deal with, say, politics, gardening, civil engineering, physics, sport, or foreign affairs ? and (2) can it ever be right for a television programme to leave the viewer with a "committed" view of a medical topic? If you answer "no" to both questions then you are on the side of a type of censorship that operates nowhere else in the press today. Over the years we have come to accept in most areas that the benefits of an open society outweigh
the disadvantages. In the case of medicine this means that it is valuable to society for there to be outside observers of what doctors do and say, capable of assessing the wider significance, able to spot the vested interest lurking beneath the "objective" research, ready to report on whatever is judged to be of wider interest to the public. Of course such observers must be informed and able to make such judgments, but they do not need to be doctors, provided they have access to good medical advice. The acceptance of the freedom of the media to report medicine implies the possibility that in a proportion of cases the journalist covering the field as an "honest
714
reporter" will get it wrong, in somebody's terms, and occasionally get it wrong entirely. However, it is no more reasonable to attack television because of incompetent producers than it is to attack medicine for its incompetent doctors. What has to be done in both cases is to advocate local rather than systemic treatment and, in the case of television, do as much as possible to help the individual producer "get it right" rather than organise a boycott of him and all his colleagues. I would urge doctors to adopt a more critical approach to the individual journalist at the time when their co-operation is first sought, by making an assessment of that journalist's understanding of the field and his ability to act responsibly. This does not, by the way, mean saying "no" on the phone if you don't like the organisation he works for, nor does it mean withholding co-operation if he doesn't appear to accept all your arguments. But I often come across doctors who have entrusted themselves to, say, a regional news magazine or a topical current affairs programme and then, because of dissatisfaction with the experience, have refused to co-operate with any other television producer who approaches them. Turning to the topic of balance, I am continually amazed at the lack of insight doctors have into their own profession and indeed into their own personalities. Medicine in theory and practice is itself unbalanced. There are weekly examples in your columns and elsewhere of fundamental disagreements between doctors about every aspect of medicine from alpha-fetoprotein to zoonoses. It can hardly be otherwise. However unpleasant it may be to admit it, there are large areas of medicine that lack the calm and ordered background that science can provide, where data analysis produces hypotheses and leads to further results that unambiguously enable us to reach a conclusion. The reason for this state of affairs is obvious. In an experiment in physics, for example, the components such as electrons, electromagnetic forces, magnetometers, cyclotrons, and so on all behave in a fairly reliable manner. This is not true of medicine, where the important factors in the study of disease and therapy can be fickle, unreliable, forgetful, mysterious, emotional, mendacious, worried, and ignorant And that's only the doctors I'm talking about-the patients can be all that, and more. Is it surprising that we don't know whether three days or three weeks is the best length of time to leave patients in bed after an operation ? Is it surprising that in 1978 after 30 years of prescribing a bland diet for stomach ulcers it is still possible for reasonable doubt to be cast on this treatment, and for doubt to be justified ? What this means is that any medical programme which attempts to present the state of the art (and it is an art) in a particular area will inevitably offend some doctors somewhere who will see views with which they disagree. Others, of course, will welcome such a programme as being an unbiased view of their own field. Apart from the offence caused to doctors by television, there is of course the possibility of harm done to patients. Dr David Delvin (25 February, p 504) put his finger on it when he talked about never having seen harm done unnecessarily to patients. This is true, and it is important to face the corollary, which is that harm is occasionally done necessarily to patients. This comes about because it has to be accepted that a proportion of people
BRITISH MEDICAL JOURNAL
watching even the most perfectly balanced, well-presented, totally authoritative programme will react in a totally unpredictable way. Unless the programme confines its words to Basic English and extracts a guarantee of total concentration from the audience before it starts it is always going to confuse some and worry others who miss the qualifications, and the summing up, and the "balance" through answering the doorbell, putting the kettle on, or going for a pee. In addition to those there will be others who just do not understand what is being said to them through pre-existing worries or hypersensitivity to the topic being dealt with. These are the people like Dr R H J Kerr-Wilson's (25 February, p 505) patient who "wished she hadn't seen it on television" or Professor Fletcher's cleaner who "didn't want her baby killed in that way" (11 February, p 349). (By the way, were no babies killed by overuse of induction ?) To avoid such harm in the only way possible, by banning all medical television programmes, would, I believe, result in the greater harm of an ill-informed or uninformed public. "The tide of public and professional opinion is moving away from the paternalistic concept of the doctor as a benevolent shepherd caring for his flock in all weathers. Patients are demanding a say in the way that their babies are born and their cancers and neuroses managed. Provided they are properly informed, we should encourage that trend" (leading article, 28 May 1977, p 1374). To believe that harm to patients could be avoided by the cumbersome deliberations of a scrutinising committee is to assume greater knowledge of the psychology of communication than exists at present or is ever likely to exist. It is difficult enough to ensure that an individual patient comes out of the doctor's surgery having received the message the doctor thought he was transmitting. The solution, if there is one, is for more co-operation, rather than less, between doctors and the media. There are some doctors who have got this message already and are setting up contacts with television producers, making suggestions for new topics, praising good programmes and criticising bad ones, and even, dare I say it, actually watching television so as to have an informed basis for their opinion. There are some who realise that Panorama is not Horizon and that Nationwide is not Inside Medicine, and that the level at which a current affairs programme is able to deal with a particular topic after five days' research is rather different from a Horizon after three months, and that doctors can make useful contributions at either level. There are some who realise that if you trust producers they will become increasingly trustworthy and that you will all get on better if you ask them questions like "How long will the programme be ?", "How much will I be edited ?" and "Will you let me know if the line of the programme changes before transmission ?" I and most of my colleagues are happy to answer such questions as honestly as we can. In closing I would just remind your readers of how much in your special correspondent's original article has since been shown to be factually incorrect-ranging from a major criticism about the omission from a programme of a statement that was actually given some prominence, to the minor error of getting the name of the programme series wrong. Had he shown a transcript to those he was criticising, as we are often urged to do, your correspondent would have written a better article. Since one
18 MARCH 1978
of the two main points in your leading article was that "doctor-viewers" believe that television programmes too often misinform, it is unfortunate that your special correspondent's article was as misinformed as it was. When we in television make that sort of mistake it is presented as evidence of our total incompetence to deal with the topics responsibly-"Good lord, they even confused the Lancet with the BM7; how can you expect to believe anything else they put out ?"-and yet I'm sure you would agree, sir, that it is nothing of the sort. It is an almost inevitable consequence of honest reporting executed to a deadline. KARL SABBAGH Executive Producer, Science and Features Department, BBC TV London W14
***Our special correspondent writes: "I must apologise for the error over the mention of the fetal mortality rate in the programme on thalassaemia. Nevertheless, I was merely reporting what I was told, and before publication the text was shown to those interviewed. I wonder, however, whether this important point was sufficiently emphasised in the programme if two medical men (one of them an actual participant) were not aware that the facts had been stated."-ED, BM7. SIR,-Having agreed only recently to a sudden request by a BBC television team (from the "Tonight" programme) to film a ward round, patients having radiotherapy, and so on (for transmission in another part of the UK and, of course, only with the permission of the patients concerned) we were interested in the views of your special correspondent (11 February, p 348) and of Mr John Garfield (p 360). Mr Garfield writes with eloquence and sincerity but seems to us seriously to underestimate the very damaging effects that would almost certainly follow any concerted refusal by doctors to co-operate with television producers when they decide to air a medical subject of interest to the public. To refuse might help to preserve our dignity, he feels, but might we not find ourselves landed with something much worse than a loss of dignitya deep public suspicion of our motives and a feeling that we had something to hide ? Professor Charles Fletcher has written' that medical programmes "have been found to reassure those people who fear what they imagine may be being enacted behind the bleak walls of hospitals." If such fears are true of medicine in general they are even more true of cancer and of radiotherapy. We constantly see patients who have delayed seeking medical advice for months. Quite apart from the possibility of losing a chance of cure, they have often suffered much unnecessary mental and physical anguish due to anxiety that cancer is present combined with an intense fear of the treatment that may be advised for it. So often when such patients find friendly hospital staff and begin to show a response to their treatment (which they often find far easier than they had expected) they wish they had come sooner. It would make little sense for us to refuse to allow something of this truth to be conveyed to the public in the form of an unrehearsed documentary film. If we take no part, others will. With regard to cutting and editing we suffered from this in two ways, Firstly,
713
18 MARCH 1978
CORRESPONDENCE British standard insulin syringe B F Brearley, FRCP, and J Mackie, MRCGP. 713 Television medicine K Sabbagh, MA; K E Halnan, FRCP, and T B Brewin, FRCR; J M S Pearce, FRCP; E J Trimmer, MRCGP; P A Gardiner, DOMS; C R Paterson, DM ...................... 713 Fatal chlormethiazole poisoning in chronic alcoholics I M Slessor, MB; Joan M Horder, MRCPATH 716 College of Anaesthetists P J F Baskett, FFARCS; J S M Zorab, FFARCS; J Hurdley, FFARCS; J M B Burn, FFARCS
........
......................
716
Cimetidine prophylaxis after renal transplantation ............. 717 C C Doherty, MRCP ....... Cimetidine and serum prolactin W L Burland, MB, and others; M C ............... 717 Bateson, MRCP .........
Relapse of duodenal ulceration after cimetidine treatment M Guslandi, MD, and others ............ 718 Household products and poisoning R Goulding, FRCP ...................... 718 Regional secure units and interim security for psychiatric patients J K W Morrice, FRCPSYCH; J T Hutchinson, FRCPSYCH .
...........................
Septic abortion and IUCDs E S B Wilson, MB; W G Mills, FRCOG.... Pelvic actinomycosis associated with IUCD M Barnham, MB, and others ............ Is pancreatic isotope scanning worth while? H J Testa, PHD, and others ...... Coronary heart disease, age, and sex H M Sinclair, FRCP .................... Diet and heart: the importance of metals Barbara Chipperfield, PHD, and J R
Chipperfield,
PHD
......................
718
719 719 720
720 720
Correspontdents are urged to write briefly so that readers may be offered as wide a selectioni of letters as possible. So many are being received that the omission of some is inevitable. Letters must be signed personally by all their authors.
British standard insulin syringe
SIR,-We have more than 10 different types of insulin in use in Britain, produced in strengths of 40 U/ml and 80 U/ml. Only one, soluble, is produced in a strength of 20 U/ml and this is rarely used. Surely it is time that the British standard insulin syringe, calibrated to deliver 20 U/ml, was relegated to the museum of antiquities. This relic is a source of great confusion. The graduations correspond to neither of the strengths of insulin commonly used in this country. Much medical and nursing time is taken up in explaining the difference between the number of units of insulin and the number of marks on the syringe. Obfuscation increases when patients talk of "double strength" insulin, meaning 80 U/ml. Various written reminders may increase the chance of error in a busy diabetic clinic or when the card is misplaced or misunderstood by the patient. Yet these errors may be serious and occasionally result in permanent damage or death. Most errors would be eradicated by using only one strength of insulin, with a syringe graduated to correspond to that strength. In 1973 U-100 insulin (100 U/ml) was introduced into the USA' (first by Eli Lilly and Co and later by E R Squibb and Sons). With a choice of large or small syringes, depending on the size of the dose, this has proved satisfactory. Now 80% of the units sold by Lilly are of U-100 insulin. In April 1974 U-100 insulin was introduced into
Allergic bronchopulmonary aspergillosis R J White, MD ......... ............... 721 Scan-demonstrated ilioportal shunt with resolution P G Bentley, FRCS, and P L Hill .......... 721 Ban on dental anaesthetics T M Young, FFARCS; J P N Hicks, FFARCS.. 721 Distinction awards C I Haines, MRCP ........ .............. 721 Payment of district management teams R Wann, MRCGP ...................... 722 Setting an example R R Charlwood, MRCGP ................ 722 Court Report and the school health service G V Lewis, MRCS ...................... 722 Points from Letters All doctors great and small (A M Evans); Pyloric obstruction during treatment with cimetidine (W Gazala and I Hatim); Medical treatment of open-angle glaucoma (E G Mackie); Shock after insertion of IUCD (F C R Picton) ........................ 722
provide syringes, either glass or disposable plastic, satisfactory for use with large or small doses. There may be some difficulty in the transition period, but this difficulty would not compare with the trouble that we have had for the past 25 years with the U-20 syringe. Patients in future would be spared the confusion of three strengths of insulin. Physicians and nursing staff would be spared time for more essential things. We would all be spared the complications that result from mistakes. It is time that this change was made.
Canada and the old strengths discontinued (U-80 in December 1974, U-40 in June 1975). The change was regarded as "having been accomplished relatively free of complications." In Britain a trial of U-100 insulin was undertaken to assess its acceptability,2 in which 110 diabetic patients, already accustomed to using the U-40 and U-80 insulins, B F BREARLEY were given U-100 insulin with a suitably JOHN MACKIE graduated syringe; 83% either preferred the Green Hospital, U-100 insulin or at least had no preference. Diabetic Clinic, Sharoe There were some mechanical problems with Fulwood, Preston, Lancs the syringes used in this trial owing to corMoss, J M, and Galloway, J A, J7ournal of the American Medical Association, 1977, 238, 1823. rectable features in their design. There is no Sheldon, J, et al, British Medical J7ournal, 1976, 21, doubt that these can soon be remedied to 1319. Television medicine
SIR,-Perhaps the time has come in this correspondence to point out what the real issues are. They are: (1) should television in its institutional role as "honest reporter" be allowed the same freedom to deal with medical topics as it has to deal with, say, politics, gardening, civil engineering, physics, sport, or foreign affairs ? and (2) can it ever be right for a television programme to leave the viewer with a "committed" view of a medical topic? If you answer "no" to both questions then you are on the side of a type of censorship that operates nowhere else in the press today. Over the years we have come to accept in most areas that the benefits of an open society outweigh
the disadvantages. In the case of medicine this means that it is valuable to society for there to be outside observers of what doctors do and say, capable of assessing the wider significance, able to spot the vested interest lurking beneath the "objective" research, ready to report on whatever is judged to be of wider interest to the public. Of course such observers must be informed and able to make such judgments, but they do not need to be doctors, provided they have access to good medical advice. The acceptance of the freedom of the media to report medicine implies the possibility that in a proportion of cases the journalist covering the field as an "honest
714
reporter" will get it wrong, in somebody's terms, and occasionally get it wrong entirely. However, it is no more reasonable to attack television because of incompetent producers than it is to attack medicine for its incompetent doctors. What has to be done in both cases is to advocate local rather than systemic treatment and, in the case of television, do as much as possible to help the individual producer "get it right" rather than organise a boycott of him and all his colleagues. I would urge doctors to adopt a more critical approach to the individual journalist at the time when their co-operation is first sought, by making an assessment of that journalist's understanding of the field and his ability to act responsibly. This does not, by the way, mean saying "no" on the phone if you don't like the organisation he works for, nor does it mean withholding co-operation if he doesn't appear to accept all your arguments. But I often come across doctors who have entrusted themselves to, say, a regional news magazine or a topical current affairs programme and then, because of dissatisfaction with the experience, have refused to co-operate with any other television producer who approaches them. Turning to the topic of balance, I am continually amazed at the lack of insight doctors have into their own profession and indeed into their own personalities. Medicine in theory and practice is itself unbalanced. There are weekly examples in your columns and elsewhere of fundamental disagreements between doctors about every aspect of medicine from alpha-fetoprotein to zoonoses. It can hardly be otherwise. However unpleasant it may be to admit it, there are large areas of medicine that lack the calm and ordered background that science can provide, where data analysis produces hypotheses and leads to further results that unambiguously enable us to reach a conclusion. The reason for this state of affairs is obvious. In an experiment in physics, for example, the components such as electrons, electromagnetic forces, magnetometers, cyclotrons, and so on all behave in a fairly reliable manner. This is not true of medicine, where the important factors in the study of disease and therapy can be fickle, unreliable, forgetful, mysterious, emotional, mendacious, worried, and ignorant And that's only the doctors I'm talking about-the patients can be all that, and more. Is it surprising that we don't know whether three days or three weeks is the best length of time to leave patients in bed after an operation ? Is it surprising that in 1978 after 30 years of prescribing a bland diet for stomach ulcers it is still possible for reasonable doubt to be cast on this treatment, and for doubt to be justified ? What this means is that any medical programme which attempts to present the state of the art (and it is an art) in a particular area will inevitably offend some doctors somewhere who will see views with which they disagree. Others, of course, will welcome such a programme as being an unbiased view of their own field. Apart from the offence caused to doctors by television, there is of course the possibility of harm done to patients. Dr David Delvin (25 February, p 504) put his finger on it when he talked about never having seen harm done unnecessarily to patients. This is true, and it is important to face the corollary, which is that harm is occasionally done necessarily to patients. This comes about because it has to be accepted that a proportion of people
BRITISH MEDICAL JOURNAL
watching even the most perfectly balanced, well-presented, totally authoritative programme will react in a totally unpredictable way. Unless the programme confines its words to Basic English and extracts a guarantee of total concentration from the audience before it starts it is always going to confuse some and worry others who miss the qualifications, and the summing up, and the "balance" through answering the doorbell, putting the kettle on, or going for a pee. In addition to those there will be others who just do not understand what is being said to them through pre-existing worries or hypersensitivity to the topic being dealt with. These are the people like Dr R H J Kerr-Wilson's (25 February, p 505) patient who "wished she hadn't seen it on television" or Professor Fletcher's cleaner who "didn't want her baby killed in that way" (11 February, p 349). (By the way, were no babies killed by overuse of induction ?) To avoid such harm in the only way possible, by banning all medical television programmes, would, I believe, result in the greater harm of an ill-informed or uninformed public. "The tide of public and professional opinion is moving away from the paternalistic concept of the doctor as a benevolent shepherd caring for his flock in all weathers. Patients are demanding a say in the way that their babies are born and their cancers and neuroses managed. Provided they are properly informed, we should encourage that trend" (leading article, 28 May 1977, p 1374). To believe that harm to patients could be avoided by the cumbersome deliberations of a scrutinising committee is to assume greater knowledge of the psychology of communication than exists at present or is ever likely to exist. It is difficult enough to ensure that an individual patient comes out of the doctor's surgery having received the message the doctor thought he was transmitting. The solution, if there is one, is for more co-operation, rather than less, between doctors and the media. There are some doctors who have got this message already and are setting up contacts with television producers, making suggestions for new topics, praising good programmes and criticising bad ones, and even, dare I say it, actually watching television so as to have an informed basis for their opinion. There are some who realise that Panorama is not Horizon and that Nationwide is not Inside Medicine, and that the level at which a current affairs programme is able to deal with a particular topic after five days' research is rather different from a Horizon after three months, and that doctors can make useful contributions at either level. There are some who realise that if you trust producers they will become increasingly trustworthy and that you will all get on better if you ask them questions like "How long will the programme be ?", "How much will I be edited ?" and "Will you let me know if the line of the programme changes before transmission ?" I and most of my colleagues are happy to answer such questions as honestly as we can. In closing I would just remind your readers of how much in your special correspondent's original article has since been shown to be factually incorrect-ranging from a major criticism about the omission from a programme of a statement that was actually given some prominence, to the minor error of getting the name of the programme series wrong. Had he shown a transcript to those he was criticising, as we are often urged to do, your correspondent would have written a better article. Since one
18 MARCH 1978
of the two main points in your leading article was that "doctor-viewers" believe that television programmes too often misinform, it is unfortunate that your special correspondent's article was as misinformed as it was. When we in television make that sort of mistake it is presented as evidence of our total incompetence to deal with the topics responsibly-"Good lord, they even confused the Lancet with the BM7; how can you expect to believe anything else they put out ?"-and yet I'm sure you would agree, sir, that it is nothing of the sort. It is an almost inevitable consequence of honest reporting executed to a deadline. KARL SABBAGH Executive Producer, Science and Features Department, BBC TV London W14
***Our special correspondent writes: "I must apologise for the error over the mention of the fetal mortality rate in the programme on thalassaemia. Nevertheless, I was merely reporting what I was told, and before publication the text was shown to those interviewed. I wonder, however, whether this important point was sufficiently emphasised in the programme if two medical men (one of them an actual participant) were not aware that the facts had been stated."-ED, BM7. SIR,-Having agreed only recently to a sudden request by a BBC television team (from the "Tonight" programme) to film a ward round, patients having radiotherapy, and so on (for transmission in another part of the UK and, of course, only with the permission of the patients concerned) we were interested in the views of your special correspondent (11 February, p 348) and of Mr John Garfield (p 360). Mr Garfield writes with eloquence and sincerity but seems to us seriously to underestimate the very damaging effects that would almost certainly follow any concerted refusal by doctors to co-operate with television producers when they decide to air a medical subject of interest to the public. To refuse might help to preserve our dignity, he feels, but might we not find ourselves landed with something much worse than a loss of dignitya deep public suspicion of our motives and a feeling that we had something to hide ? Professor Charles Fletcher has written' that medical programmes "have been found to reassure those people who fear what they imagine may be being enacted behind the bleak walls of hospitals." If such fears are true of medicine in general they are even more true of cancer and of radiotherapy. We constantly see patients who have delayed seeking medical advice for months. Quite apart from the possibility of losing a chance of cure, they have often suffered much unnecessary mental and physical anguish due to anxiety that cancer is present combined with an intense fear of the treatment that may be advised for it. So often when such patients find friendly hospital staff and begin to show a response to their treatment (which they often find far easier than they had expected) they wish they had come sooner. It would make little sense for us to refuse to allow something of this truth to be conveyed to the public in the form of an unrehearsed documentary film. If we take no part, others will. With regard to cutting and editing we suffered from this in two ways, Firstly,
