Obstetric anaesthesia and analgesia

AT a time when the profession is coming under increasing criticism for its failure to influence significantly the ravages of our modern plagues while maintaining and increasing our interest in the newer and more sophisticated medical technologies, which in themselves play a relatively small part in the total promotion of health, this publication provides a most helpful and useful corrective to our thinking. It is the record of a symposium held in the Royal College of Physicians in December 1978 concerned with the prospects and application of methods for prevention of disease. There are twelve chapters by a distinguished group of experts in their special field. The introduction on 'lessons from past achievements' by Sir John Brotherson is of a high standard and sets the tone for the chapters which follow. These concern a variety of topics such as 'problems in prevention of renal disease', 'health education', two chapters on 'ischaemic heart disease-is diet important' to the concluding chapter on the 'prevention of iatrogenic disease' (The Lilly Lecture) by Sir Eric Scowen. There is much to ponder on in this excellent and timely publication and all the contributions are of a commendable standard and interest. It is highly recommended for all interested in the promotion of health in the community. WITH the growing realisation that the health care of the nation now lacks sufficient resources to meet all the expectations of the founders of the NHS, there has been an increasing debate over the last decade on how to allocate fairly scarce resources to the differing health needs of the Community. Each region within the United Kingdom in turn has published reports on the deliberations of working parties set up to determine health care priorities and the most equitable way of sharing resources for health. In 1975 a group of health care professionals from different disciplines in Scotland came together under the aegis of the Edinburgh Medical Group to study over a period of two years, the ethical aspects of resource allocation in the field of health care. They attempted to identify the moral issues involved seeking consensus where possible and identifying and clarifying areas of disagreement. Among topics discussed were the 'comparison of need', 'personal responsibility for health', 'the limits of health care', 'who decides' and 'the problems of priorities'. Like all who have studied these subjects they found that yardsticks by which to measure effectiveness and benefits of …