OP News : March 2004

Survey of training in toxicology in medical schools

OPIN has written to 31 medical schools in Britain to find how much effort is put into the training of medical students in toxicology. These letters were sent out in January, and at the time of writing we have received seven replies.

Here is part of our letter:

The OP Information Network has for the past twelve years supported people, mostly farmers, exposed to organophosphates (OPs) in the course of their work and we have worked with scientists, doctors, politicians, academics and others to raise awareness of the nature of the poisoning from which these people suffer…

OP sufferers who turn to their GPs for help, and who may subsequently be referred to consultants, have often expressed to us the disappointment they feel at the treatment they have received from the medical profession. We have been surprised by the number of doctors, consultants and GPs who have asked OP-exposed patients to request our organisation to provide them with scientific papers relating to the clinical effects of such exposure. This situation is obviously highly unsatisfactory.

In 1992 the British Medical Association published a report Pesticides, Chemicals and Health. In its section on the training of doctors, the report cites the results of a survey of 24 medical schools into the amount of time devoted to teaching toxicology: the survey found that the total time in a course for new medical students ranged between one and ten hours, and two of the schools provided no training at all. The report comments: "A teaching time of less than ten hours in an entire undergraduate course cannot equip a medical student to practise in this chemical age."

What priority is given in your medical school to teaching the basic principles of toxicology, as well as in the science and law relevant to pesticides and in environmental and occupational health?

And here are extracts from two interesting replies. First, from the University of Oxford:

Taking the different areas of the course where these issues are covered, I judge that about ten hours of toxicology are delivered as core to the students. As it happens, we have recently appointed an international expert in organophosphate poisoning to our faculty, so I anticipate that this topic will receive more attention in the future… The volume of knowledge in medicine is expanding so rapidly that we do not view covering all important topics in medicine as an achievable, or even desirable, objective of our medical course. Instead, we hope to equip our graduates with the skills to search for and identify information when faced with new problems during their careers. We would be very pleased if our graduates, faced with a toxicological problem, recognised the limitations of their knowledge and turned to resources such as yours for help. In my view, providing access to high quality information is an excellent way to improve the care of people suffering from poisoning, and probably more effective than trying to increase the amount of didactic teaching that medical students receive in this area.

From the University of Norwich:

Clearly, organophosphates are an important source of problem at present, but one can conceive that good sense will prevail and the organophosphates will disappear from use in due course. The information the students have on organophosphates will, therefore, become redundant.

We, therefore, attempt to teach the students principles of recognising when there is a problem which they do not understand and tracking down reliable information on it, rapidly and efficiently. I am, therefore, not horrified by the thought that doctors contact your organisation for up to date information. I would regard this as minimum best practice. Having said that, we do have a Professor of Health Protection and we do throughout our course emphasise the problems of environmental pollution and toxic chemicals. Situated as we are in a rural community, it is very likely that the students will come into contact with patients suffering from the effect of toxic chemicals throughout their course.

We have a highly integrated course and the students start clinical teaching in first year. In the first unit we emphasise health in the community and health at work, and in both of these modules the students are introduced to the idea of environmental pollution as a cause of illness. We have lectures and seminars dealing with both the basic principles of toxicology and the law in relation to toxic chemicals. The remainder of the course is system-based and whenever chemical exposure is relevant to a given set of symptoms or diseases, the matter is re-visited.

The complete texts of our letter and all the replies are reproduced in our redesigned website which has now moved to www.opin.info.

OP book

OPIN is in the initial stages of planning a book of essays on OPs, which was the outcome of the series of articles published in the Farmers Guardian in December 2003. We have approached a group of eight OP experts who have all agreed to contribute a chapter and we have put a proposal to a well-known publisher and gained an initially favourable response. There will also be a chapter on case histories of OP sufferers. The working title is "Occupational Poisoning - a history of the effects of exposure to OPs in British agriculture".

SHAPE survey update

Tony Fletcher, supervisor of the project, says of progress on the final report: "The SHAPE study has an advisory committee of representatives of the support groups, as well as independent scientists and the project funders (DEFRA). The advisory committee needs to be consulted on the draft final report and I am in the process of preparing the drafts for this consultation round. This process has unfortunately taken me more time than I had anticipated (because of having to devote much time to other ongoing projects), but I can inform you that the drafts are going out for consultation during March and I expect you will therefore be able to report on the interim conclusions in the next OPIN news."

New OPIN website

We have redesigned the OPIN website, which has now moved to www.opin.info. There is more information on our website than we can print here.

All Party OP Group briefing

The All Party Group on OPs, which is chaired by Paul Tyler MP, met the Chief Veterinary Officer and scientists from the Veterinary Medicines Directorate and the Medical Research Council to discuss research into human health effects and alternatives to OP sheep dips to control sheep scab mite. At a separate briefing for the media the main points as reported in Farmers Guardian (30 January 2004) are:

• some of the work in the £1.4m government-funded programme, which includes research into the health effects of low-level exposure, might not be complete until 2005/6 because of delays introduced by the foot-and mouth outbreak;
• claims by the All Party Group on OPs that DEFRA ignores the precautionary principle by allowing OP sheepdips to be sold while knowledge about low-level exposure was incomplete were denied;
• research on alternatives to chemical methods to control scab, such as vaccines, was unlikely to produce a replacement for OPs for 'at least five years';
• DEFRA has "no indication as to how widespread OP poisoning is".

MIND and OPIN

Welsh MIND and OPIN are co-operating to share information and publications in order to assist attempts to ensure that doctors understand the chronic effects of OP exposure, and the need for sympathetic handling of OP cases. Leaflet for rural GPs The chairman of the DEFRA Medical and Scientific Panel, Dr Len Levy, has suggested that OPIN write a short description of symptoms of OP exposure. We have prepared this using information in the HSE document MS17. The hope is that this paper will be circulated to rural doctors.

Media

Recently OPIN has helped HTV Bristol and BBC Plymouth with their preparation of TV programmes. We have provided background material for an article about organophosphates which is to appear soon in The Ecologist journal; and we keep in touch with Farmers Guardian.

Finally…

Thanks to all those who have sent in donations, which help a lot with the cost of producing and mailing the newsletter.