Child health services
These and other sampling problems
Should be combined
EDITOR,-It is reported in Medicopolitical Digest'
that Loretta Light, chairing the community health
doctors subcommittee, felt that the guidance in
EL(93)28 on implementation of the joint working
party report on medical services for children2
does not represent the spirit or the letter of the
report and that she was concerned at the advice
that community health doctors could help with
difficulties in safety net cover in paediatrics.
As primary care increases its child health
responsibilities and hospital stays shorten with
greater home care of sick children, community
child health doctors will be undertaking a more
specialist role supporting primary care. It is
important that they are trained for this wider range
of responsibilities.
The joint working party agreed that child health
doctors should have more experience in hospital
paediatrics. Hospital paediatric duties, including
on call, could be envisaged for some child health
staff grade posts, especially in smaller districts.
This proposal is, however, for the future work
force and only now for those with appropriate
experience or "who are willing to undergo training
to work in hospital." The executive letter and
report acknowledged this.
The report and executive letter emphasised
that staffing arrangements and competition with
demands from acute care should not detract from
the service provided in the community but rather
enhance it. On call duties with compensating time
off in lieu could be arranged without detriment to
community services already provided by a medical
work force with an appreciable proportion of part
time staff.
The British Paediatric Association does not
accept Loretta Light's criticism that undue weight
was given in the circular to its views. The joint
working party accepted that the child health
service should be consultant led. It accepted the
concept and terminology offered by the British
Paediatric Association's document Towards a
Combined Child Health Service': its principles had
been supported by the secretary of state and it was
circulated to health authorities by the Department
of Health.
The aim will be for all to work in single managed
service: this is important for children and families
as well as for the doctors working in it and has
advantages that greatly outweigh disadvantages.
The British Paediatric Association welcomes the
guidance offered in the executive letter, which
offers an opportunity to safeguard the community
health services for children.
RODERICKI MAcFAUL
British Paediatric Association,
London NWI 4LB
I Beecham L. Call for withdrawal of advice on child health
services. BM_ 1993;396: 1347.
2 J7oint Working Party Report on Medical Services for Children.
London: BMA/Department of Health/Conference of Medical
Royal Colleges and Faculties. 1992.
3 Towards a combined child health service. London: British Paedia-
tric Association, 1991.
Community child health resources must be
protected
EDrrOR,-The Department of Health's executive
letter EL(93)28 alters the emphasis from the view
expressed by the joint working party on medical
services for children on a future pattern of service
towards the British Paediatric Association's
objective for more flexible deployment of existing
medical staff. The joint working party's report
sets aims and objectives for the future, and the
paragraph that Roderick MacFaul quotes is
headed "Future working patterns." MacFaul
seems now to be defending the department's
BMJ VOLUME 307 3 juLY 1993
actions in, effectively, repudiating aspects of the
report.
Crucially, the executive letter ignores the joint
working party's statements that community child
health services should be protected. For example,
the report says that community services should not
be "overlooked as a result of the demands created
by the acute element in the hospital service" and
that working patterns should be "monitored to
ensure that the balance of duties between the
two sectors is maintained." By contrast, the
department's executive letter merely asks pur-
chasers to "monitor the health and development of
their child population" to ensure that community
services are not crowded out.
Our concern about the option to participate
in acute paediatric work-although we do not
envisage more than a handful of community
health doctors volunteering-is that the specialist
community duties (which the report says should be
carried out "for the foreseeable future" by "a
senior post below consultant level") might suffer.
The joint working party thought that if "com-
munity staff were given the option of working in
hospital including (subject to training) 'safety net'
duties, there would be a continuing need in a
combined child health service for the resources
currently available within the existing medical staff
complement."
Finally, the reason we are uncomfortable with
the prominence that the department gives to the
British Paediatric Association's views on the
management of the combined child health services
is that these were explicitly not endorsed by
the joint working party. The danger is that a
single management structure might result in
community child health services being run by
hospital paediatric departments, with community
staff redeployed to support the acute sector.
We want to put this unfortunate circular behind
us and concentrate on securing the proper imple-
mentation of the joint working party's report,
which is so important to doctors in the community
child health services and, more importantly, the
children and their families who need their services.
LINDSEY DAVIES
LORETTA LIGHT
Committee for Public Health Medicine
and Community Health,
BMA,
London WC 1 H 9JP
Homosexuality in the US
EDITOR,-The title of the news item "Homo-
sexuality declines in US"' was misleading if
it was meant to imply that the 1% exclusive
homosexuality rate reported recently for American
men represents a decline in prevalence from the
widely accepted 10% figure that dates back to
Alfred Kinsey's famous research in the 1940s. One
of the reasons for the importance of this latest
finding (published in the March-April issue of
Family Planning Perspectives2) is that it confirms
the error of Kinsey's conclusions on this subject,
not a change in male sexual behaviour. The new
figure also throws the spotlight on the important
question of why, before the sexual revolution and
the liberalising forces of the 1960s and 1970s,
Kinsey and his team in a "carefully planned
population survey" obtained such dramatically
higher numbers for exclusive homosexuality,
predominant homosexuality, and homosexual
experience in American men (4%, 10%, and 37%,
respectively).'
It is now known that Kinsey's high homo-
sexuality rates were no accident. In his sample of
5300 men he had approximately 25% prisoners, an
additional high percentage of sex offenders (he had
the histories of 1400), and a considerable number
of male prostitutes (he had the histories of "several
hundred").
are fully documented in the 1990 re-examination of
his research, Kinsey, Sex and Fraud.4 Why did
Kinsey resort to this deception? In a little known
1964 publication, The Hom Book, Kinsey's former
bibliographer Gershon Legman put it very suc-
cinctly: "Kinsey's purpose was to 'validate' types
of behavior previously thought to be deviant
by showing how common they were." Legman
described this as "pure propaganda ... ridiculously
far from the mathematical or statistical science
pretended."'" Just how far is more clear than ever.
EDWARD W EICHEI.
New York, NY 10014,
USA
J G MUIR
Cary, NC 27511,
USA
1 McBride G. Homosexuality declines in US. BMJ 1993;306:
1 150-1. (1 May.)
2 Billy JOG, Tanfer K, Grady WR, Klepinger DH. The sexual
behavior of men in the United States. Fam Plann Perspect
1993;25:52-60.
3 Kinsey AC, Pomeroy WB, Martin CE. Sexual behavior in the
human male. Philadelphia: Saunders, 1948:650-1.
4 Reisman JA, Eichel EW. Kinsey, sex and fraud. Lafayette,
Louisiana: Iluntington House, 1990.
5 Legman G. The horn book: studies in erotic folklore and bibliography.
New Hyde Park, New York: University Books, 1964:125-6.
Use computers to detect
inappropriate prescriptions
EDITOR,-D K Raynor and colleagues describe an
apposite application of microcomputers to generate
attractive, clear, and helpful reminder charts to
improve patients' compliance with drug treatment
prescribed for them from a district general
hospital.' I am, however, concerned that in their
sample chart a a blocker (atenolol) and beclo-
methasone inhaler have been prescribed to the
same patient. Clearly, one would not wish these
two drugs to be prescribed concomitantly because
of potentially unfavourable interactions.
Gosney et al reported a high incidence of
prescription of contraindicated drugs for residents
of local authority part III homes.2 They commented
that mistakes may arise because of lack of know-
ledge of other drugs the patient is taking at the time
of prescribing. They suggested that computer
aided checks on prescribing such as that offered by
"LIFE SAVE," a microcomputer based aid to
prescribing that detects prescribing of contra-
indicated and interacting drugs, may be useful to
prevent such potentially dangerous interactions.'
Pharmacies considering incorporating computer
generated reminder charts to encourage patients'
compliance may also like to consider using com-
puter detection of undesirable interactions to
detect inappropriate prescriptions.
CHRIS VALENTINE
MRC HIV Clinical Trials Centre,
Royal Brompton National Heart and Lung Hospital,
London SW3 6NP
I Raynor RK, Booth TG, Blenkinsopp A. Effects of computer
generated reminder charts on patients compliance with drug
regimens. BMJ 1993;306:1 158-61. (1 May.)
2 Gosney M, Vellodi C, Tallis R, Edmund E, Al-Hamouz S.
Inappropriate prescribing in part III residential home. Health
Trends 1989;21:129-31.
3 Tallis RC, Edmund E, O'Halloran A. A computer system for
preventing the prescription of contra-indicated drugs. British
Journal ofPhannacy Practice 1984;6:223-8.
Puffing patients first
EDITOR,-People with hearing problems have
frequent aural examinations. They will be keenly
interested in Alison Overend and colleagues' paper
looking at the proportion of auriscopes that were
contaminated by pathogenic bacteria. '
61