Læknablaðið - 01.06.1973, Blaðsíða 51

LÆKNABLAÐIÐ
125
British electors of the benefits to children’s
teeth of fluoridation of water supplies. We
have to find better ways of informing
people. It is fantastic that uninformed
opposition to a harmless addition to drink-
ing water should be allowed to impose on
our children double the amount of dental
caries thsy would otherwise suffer.
Much of the traditional work in personal
preventive medicine must continue and in
the supervision of child health in Britam
it could certainly be greatly improved with
closer coilaboration between those work-
ing in public health, general practice and
hospital paediatrics. Our infant mortality
is currently up to a third greater than
yours and it could be substantially re-
duced if the same kind of attention was
given to it as has been given over 20 years
to maternal mortality. Perhaps most of
all in the traditiona! field we have failed
to develop effective methods of health
education. The wide-spred misuse of drugs
is an example of this failure and although
the heroin problem has been contained,
that of the increase in venereal disease has
not. There we are faced with the absurd
situation that two communicable diseases,
readily treatable, have not been eliminat-
ed but instead one has been increasing
over the last 16 years to a level wh.ich has
reached the highest found at the end of
the war. This is a major failure of com-
munication which it must be the object of
preventive medicine in the future to
remedy.
During the last 25 years there has been
rapid development in the pharmaceutical
industry, producing first powerful drugs
against the infections, the results of which
have alreadv been mentioned, and second-
ly a wide variety of drugs with powerful
effects on physiological function, narrow
margins of safety and possibility of serious
toxic effects or of addiction. Every country
using these drugs reauires assurance of
their margins of safety and some of them
have lethal effects in long-term use, quite
aside from the occurrence of idiosyncrasy.
The situation was dramatically brought
to public notice with the thalidomide
incident when a good tranquillising drug
proved to have unsuspected teratogenic ef-
fects. In Britain, at least, one of the most
effeetive developments in preventive medi-
cine in the 1960s was the introduction of
machinery for screening new drugs before
they were released for general use and
for monitoring the adverse effects of drugs
already in use. This machinery made it
possible to identify the very small hazard
of serious thrombo-embolic effects from
use of oestrogen-progestogen mixtures as
oral contraceptives and to reduce those ef-
fects sharply when pills of the smaller
oestrogen dose became available. In 1970
our records show a sharp reduction in
deaths from thrombo-embolic disease in
women in the relevant age group. This is
obviously a continuing commitment which
will increase in complexity as more is
learned of interatction between drugs and
other substances, naturally or artificially
intrcduced into the environment.
World population control has become
an issue of great importance. The term is
little liked, but that must be the objective
of familv planning for most nations in the
future. The newer methods of contra-
ception are more certain and act over
periods which make user failure less like-
ly. They are expensive and they are not
wholly free from risk, but in comparison
with the risks of pregnancy they are small
indeed. When one considers the danger
of abortion which legally or illegally is
an alternative used in most countries,
contraception is obviously to be preferred
as a method of control. Abortion has been
for some years the largest single cause of
maternal deaths in Britain where the
maternal mortality is now as low as 16
per 100,000 births. Part of this is due to
terminations necessary on medical grounds
late in pregnancy and part to the per-
sistence of illicit terminations despite the
existence of a legal means. 34 women
died after abortion in England and Wales
last year and that number could almost
certainly be hailved. It is estimated that
between 2 and 300,000 pregnancies which
are unwanted occur each year, some of
them terminated bv abortion and we have
the capacity, if it is sensibly used, to pre-
vent those pregnancies. Effective use of
family planning must surely be one of