and practices in order to achieve higher compliance. ... contraception could contravene the Offences. Against the ... of my replies and reinsert all my qualifying.
BRITISH MEDICAL JOURNAL
VOLUME 286
The new seat belt legislation was related to a licence to drive; we surely do not expect a licence to live which when revoked would allow euthanasia to be legalised by the back door. The cost of issuing regular information to the public is small compared with the cost of treating the children mutilated or killed by the lack of it. When addiction to barbiturates was being tackled it was easy to get regular publicity in the media because the British Medical Association made a lot of noise. Perhaps the BMA can show the Department of Health and Social Security the way to go about it. Perhaps the saving in workload would enable more doctors to attend BMA meetings.
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23 APRIL 1983
which resolved only after the catheter had been removed and replaced with a Trocath on the opposite side. We would therefore countenance caution with these sharp and comparatively long bevelled cannulas for those not experienced in their use. Our preference is for the McGaw Trocath (paediatric). M SEARLE H A LEE Wessex Regional Renal Unit, St Mary's Hospital, Portsmouth P03 6AD
Postcoital contraception
SIR,-The interest being generated by the S W V DAVIES recent attempts to restrict the availability of Turvey, postcoital contraception by reporting two Bedford MK43 8DB non-National Health Service clinics to the police (who then referred the matter to the Director of Public Prosecutions for clarificaSIR,-Dr C G D Brook (2 April, p 1082) tion of the legal position) may well bring suggests a review of our immunisation policies women seeking advice to general pracand practices in order to achieve higher titioners and family planning clinic doctors, compliance. It seems to me that exhortations not all of whom will be familiar with this do not have much effect. method of birth control. May we remind Compulsory vaccination is an anathema to your readers of the leading article on morning ? rewards many of us. Could we try financial after pills in the BMJ7 and that the dose We could, for example, offer a £5 premium recommended by Yuzpe2 is 100 ,ug of ethinylbond to every child who completes a course of oestradiol plus 500 ,eg of norgestrel (two triple and measles vaccination and a £15 tablets of Eugynon 50 or Ovran) given twice, premium bond to every girl leaving school at 12 hours apart, within 72 hours of unprotected 16 or over who has undergone rubella vaccina- intercourse at mid-cycle. tion. Obviously the scheme would cost money, We have all inserted intrauterine contrabut presumably there would be savings in ceptive devices, which are thought to act by caring for ill and disabled children. preventing implantation in at least some Dr Brook calls for review of advice contained cases. If the Director of Public Prosecutions in the Department of Health and Social were to decide that postcoital hormonal Security memorandum of 1982. If the public contraception could contravene the Offences finds that the DHSS and its expert advisers Against the Person Act 1861 we wonder change their posture every few months it is whether we, and thousands of other doctors, bound to lose confidence in professional should also be prosecuted? In view of the advice. fact that the Director of Public Prosecutions Readers will also recall that during the took no action in 1979 when Dr Colin Brewer recent whooping cough outbreak the National reported Professor Peter Huntingford to the Health Service ran out of vaccine. Those of us Director of Public Prosecutions after he had who exhorted the mothers to take their children inserted an intrauterine contraceptive device to be vaccinated looked a little silly when the prosecution seems unlikely. This leads us to mothers and the media asked: "Where is the ask why the antiabortion lobby are attacking vaccine ?" these clinics, which are providing a service J K ANAND that should reduce the number of abortions Peterborough Health Authority, performed surgically. Postcoital contraception Peterborough PEI lLN prescribed responsibly as pioneered by another non-NHS clinic3 is clearly in the interests of the woman's health and emotional well being, Peritoneal dialysis in infants should relieve pressure on the NHS, and should encouraged and made more widely SIR,-Our local paediatric unit has referred availablebewithin the NHS as well as in the four small infants (weight range 2-10 kg) for charitable and private sector. peritoneal dialysis in the last two years. We WENDY SAVAGE believe that the Avon peritoneal dialysis Press Officer system will be of great value for the reasons and 12 others stated by Dr M D C Donaldson and others (5 March, p 759) but wish to express a Doctors for a Woman's Choice on Abortion, cautionary note about the Wallis No 14147 London Ni cannula. Rowlands S. Morning after pills. BMJ 1982;285: 322-3. Our considerable experience with adults led Yuzpe AA, Lancee WJ. Ethinyl estradiol and dlus to use the paediatric version of the McGaw norgestrol as a postcoital contraceptive. Fertil Steril 1977 ;28 :932-6. Trocath catheter in the first three cases without Post-colital contraception: methods, services and prosincident. Our technique is to blunt disect pects. Helene Grahame, ed. London: Pregnancy Advisory Service, 1983. through a small incision down to the peritoneum and introduce the Trocath in a controlled way, using the infant's vocally induced abdominal wall tone. In the fourth Competitive spectacles case, because of the sharpness and length of the bevel of the Wallis catheter, penetration SIR,-My previous letter (5 February, p 472) of the parietal peritoneum was not detected was simply to record that the majority of our and the needle was advanced too far, causing ophthalmologists had voted against retention life threatening intraperitoneal haemorrhage, of the opticians' monopoly on the sale of
reading glasses. In a poll bv the Repeal Group of the House of Lords of all home based members of the Ophthalmological Society of the United Kingdom 189 were against the monopoly, 145 in favour of its retention, and 23 were undecided-not just a "vociferous few" as had been suggested in an earlier letter' but a silent majority. This poll almost coincided with reports from the Office of Fair Trading,2 and the Consumer's Association,3 both of which clearly recommended that the monopoly should end, as had also been advocated extensively by the lay and medical press, almost without exception, during recent years. We fully understand the doubts expressed by the vociferous minority. We do not question the optician's training or dedication, nor do we belittle the usefulness of his screening and of the occasional damaging eye disease this may disclose (as subsequent letters implied). A leading article in The Times4 said: "Any monopoly is against the public interest, unless there is a public benefit that outweighs that disadvantage." Like The Times, we, the majority, decided that on balance this monopoly did more harm than good. Now Mr R P Crick (26 March, p 1055) attacks me at length for "urging the president of the Faculty of Ophthalmologists to change his view" (I just admitted the hope that as a result of this poll the faculty's attitude might be more compromising-rather different), and he blames the verdict of the Office of Fair Trading on my misinformation. It would be tedious to dispute in detail his rendering of the Office of Fair Trading secretary's resume of my replies and reinsert all my qualifying words and phrases, and we can agree to differ over the need to notify the earliest lens opacity, etc, for this clinical skirmishing has gone on long enough and it is the principle of the monopoly that really matters. In any event I was not, as he says, "the sole named ophthalmologist adviser"; the names of the others interviewed are all clearly listed (p 169-71), including one most distinguished glaucoma specialist, who also attended the subsequent press release in the House of Lords to confirm his view that the monopoly was unjustified.5 Mr Crick must not cavil if such views seemed more convincing to the Office of Fair Trading than those expressed by Mr Crick and by the 20 or so optician groups who also submitted evidence. PATRICK TREVOR-ROPER London NW1
Fison L. Spectacle problems. Br MedJ 1981;282:995. Director General of Fair Trading. Opticians and Competition, London; HMSO, 1983. Anonymous. Opticians' prices. Which ? 1983, March 1:102. 4Anonymous. An optical monopoly. The Times 1981: Jan 12. Anonymous. Rugby to have another try in the House of Lords, (report on the Repeal Committee Poll). The Optician 1983, Feb 18:7.
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SIR,-If the wrong spectacles could damage a person's eyes there would be some justification for the opticians' monopoly-rather along the lines of the wrong drugs being harmful justifying the doctors' monopoly of prescribing many medicines. But the wrong glasses do not damage eyes, at least no well informed person now seriously believes they do. Hence the original grounds cited for a monopoly no longer exist. An attempt is now being made to perpetuate the monopoly by inventing new grounds: the non-detection of diseases which might result
