951 interact with psychotic decompensation, but judged it to be a major contributing factor. A premenstrual increase in admission rate has also been f...

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951 interact with psychotic decompensation, but judged it to be a major contributing factor. A premenstrual increase in admission rate has also been found for depressives16 and some workers have even suggested that


premenstrual symptoms of depression or elation subtle indicators of bipolar affective disturbance. 17

may be

For the future, much attention needs to be given to definition and methodology if we are to avoid useless expansion of the published work. However, the most fundamental issue is the medicalisation of a constellation of symptoms that seems near-universal in women. There is a danger that premenstrual tension could become part of the "expropriation of health" for which Illich 18 castigates the medical profession.

EDUCATION IN PREVENTING FOODBORNE DISEASE EPIDEMICS on the scale of the toxic illness associated with adulterated cooking oil in Spain in 1981,1 which affected some 20 000 persons with over 350 deaths, are very rare. Far more suffering is caused by readily controlled bacterial foodborne infections and intoxications than by chemical pollutants. For example, about 4’ 6 million children under 5 years of age in Africa, Asia (excluding China), and Latin America die each year from acute diarrhoeal disease2 and a


proportion of these cases are associated with the consumption of contaminated food.3 Foodborne disease also continues to be troublesome in developed countries; in Europe it is a major cause of morbidity, probably second only in importance to respiratory tract infections.4 Most industrialised countries now have safe water supplies, good sanitation, comprehensive legislation, and well-trained enforcement officers. How, then, do we account for the continuing morbidity from food-poisoning and other foodborne diseases? Although sanitation and legislation are essential basic measures for the prevention of foodborne disease, ultimate success depends on human attitudes. The failures in food hygiene that lead most often to outbreaks of foodborne disease5,6 will be avoided only if all food handlers understand the importance of the unfailing observance of correct hygienic practices. In the long term, health education be the most effective and cost beneficial strategy. In the developing countries alteration of attitudes by health education is even more important, in view of the living conditions. The World Health Organisation has published detailed guidance on the practical application of the principles of hygiene in aviation catering,’ and similar information is soon to be published on safe food handling in restaurants, hotels, institutions, and other places where meals are prepared on a large scale.8 However, it is important to find a means of

seems to

16 Abranowitz ES, Baker AH, Fleischer SS. Onset of depressive psychiatric crisis m the menstrual cycle. AmJ Psychiatry 1982; 139: 475-78. 17 McCulle JN, Reich T, Wetzel RD. Pre-menstrual symptoms as an indicator of bipolar affective disorder. Br J Psychiatry 1971; 119: 527-28. 18 Illich I. Medical nemesis: the expropriation of health London: Calder & Boyars, 1975. 1 Editorial. Toxic oil syndrome. Lancet 1983, i: 1257-58. 2 Snyder JD, Merson MH. The magnitude of the global problem of acute diarrhoeal disease. a review of active surveillance data. Bull WHO 1982; 60: 605-13. 3

The role of food in the epidemiology of acute enteric infections and intoxications. WHO

Wkly Epidem Rec 1983; 58: 241-43. safety in Europe. WHO Chron 1978; 32: 472-74. 5 Bryan FL. Factors that contribute to outbreaks of foodborne

message over to those people who do not readily read textbooks and manuals. In Britain much educational work is done by local authority environmental health officers, professional staff of the Department of Health, and bodies such as the Royal Institute of Public Health and Hygiene, and the Royal Society of Health. Allen and Kaferstein9 have now provided a challenging reminder of what else needs to be done and suggest another approach-that of seeking more cooperation between WHO and the food and related industries. When trouble arises the food itself, and the producer or retailer, are likely to be blamed rather than any mishandling of the product by the customer. They suggest various ways in which industry could participate in a campaign to educate the customer in the basic principles of food hygiene-such as incorporating hygiene advice on labels, in advertisements, and in other promotional material-and, as an instance of effective health education by the private sector, they cite the way in which advertising of fluoride toothpastes has promoted an interest in dental hygiene. We can never achieve absolute microbial safety of food, but advances can still be made. It has been suggested that the answer lies in microbiological criteria for food, but there is much doubt as to the true value of end-product specifications in ensuring the safety of food.’° Weknow how to prevent most outbreaks of foodborne disease; now we must try to ensure that all food handlers and consumers share that understanding. In Britain many of the large companies producing, distributing, and selling food are very conscious of the importance of good hygiene. It remains to be seen how the food and related industries throughout the world will respond to the request from WH09 for more cooperation and financial support to extend this work.

getting the

GMC PROFESSIONAL CONDUCT COMMITTEE: RIGHT OF APPEAL A COMMENTARY on p 979 by a legal correspondent raises doubts about the handling and the outcome of proceedings before the professional conduct committee of the General Medical Council on July 5 and 6. At the time, some journalists and other observers at the hearing expressed bewilderment at the decision of the committee. An impression of injustice was widespread;and speculation was heard about the motives behind the charge, which arose from the treatment of drug dependence in a private patient. The doctor concerned was found guilty of serious professional misconduct in the prescription of certain drugs for one particular patient "otherwise than in the course of bona fide treatment". She was admonished, and no suspension or erasure from the Medical Register was decreed. In such circumstances, the doctor exposed to this public censure had no right of appeal to the Privy Council, as she would have had if she had been suspended or if her name had been erased. Whatever the force of the evidence presented in support of a charge (and, in the transcript-of these recent proceedings, the evidence did not emerge as compelling), the right of appeal should be available to all who are pronounced guilty by the GMC committee and not only to those on whom the penalty of suspension or erasure is imposed.

4 Food


disease. J

Food Protect

41: 816-27.

6 Roberts D. Factors contributing to outbreaks of food poisoning in England and Wales 1970-79 J Hyg 1982; 89: 491-98. 7 Bailey J. Guide to hygiene and sanitation in aviation. Geneva: WHO, 1977. 8 Charles RHG. Mass catering. Copenhagen: WHO, 1983.

RJL, Kaferstem FK. Foodborne disease, food hygiene and consumer education. Lebensmittelhyg 1983; 34: 86-89. 10. Charles RHG. Use of microbiological criteria for control of the safety of food Environ Hlth 1983; 91: 142-45 1. O’Donnell M. Br Med J 1983; 287: 990. 9. Allen