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racial differences in susceptibility to dental caries, but weassert that there is now little doubt that sugar (in the form ofsucrose) is the main cause of dental caries in man.When it has proved possible to devise a sucrose-free diet (as

in the Vipeholm study) dental caries is dramatically reduced.The subjects receiving between-meal sucrose in a sticky formhad an annual caries rate 8-10 times higher than the controlgroup. It is no criticism of the Vipeholm study that the experi-mental conditions are remote from normal experience.Your contributors ignore the Turku sugar studies in which

the "experimental" subjects ate a diet normal in every wayexcept for the total substitution of sucrose by xylitol. After oneyear the subjects on the "normal" sucrose diet developed 5new carious surfaces each, those whose sucrose was substitutedby xylitol only 0-5.Both the Vipeholm and Turku studies are controlled clinical

trials, currently considered as being the best means of produc-ing evidence of the effect of a drug or chemical.Dr Walker and Dr Cleaton-Jones do not seem to believe that

sugar control would greatly reduce dental caries in children.Bradford and Crabb3 have shown, however, that the deciduousdentition of the children of dental teachers, who control theirchildren’s sugar intake, has less than half the caries of similarbut less-controlled children and about a sixth of the caries ofchildren at large. Among the 5 children of 3 preventive den-tists known to us who practise sugar control, none has anycaries. It is also noteworthy that sufferers from hereditaryfructose intolerance who need to rigorously control their suc-rose intake, have a much lower caries incidence.4There is now a great deal of supportive evidence drawn

from mammals as diverse as rats and dentists’ children to showthat sucrose causes caries.We feel that all these studies support and underline the very

strong correlation between refined sugar and dental decay.

Department of Dental Health,Dental School, Park Place,Dundee DD1 4HR.

A. J. W. MCKENDRICKG. S. ROBERTSR. DUGUID

A PROFESSION DESTROYING ITSELF?

SIR,-The article by Professor Dudley (Nov. 15, p. 972) andthe letter from members of the junior staff of the RoyalMarsden Hospital (p. 986) set out respectively the diagnosisand prognosis and the therapeutic regimen most likely to im-prove our current professional malaise.

If medicine is to remain a profession (which I believe to bein the interest of the public quite as much as ourselves), wemust re-emphasise as the motive for our work that disin-terested concern for our clients which distinguishes the profes-sions (of which ours was and could remain the noblest); butthis means our being given pay and conditions of work that ’tenable us to focus our attention on our patients rather than onthe bank manager, the Jones’s, or the clock. In this connection,I have a suspicion that those who work south of the Trent donot understand how much inferior the staffing of our hospitalsis and has long been in the North of England at all levels,which accounts for, if it does not excuse, the greater militancyof our junior staff and the backing they are being given by thevery consultants on whom the brunt of the resulting crisis hasfallen.

If in the present state of the nation we are to make the bestuse of the limited funds available for the N.H.S., it will be

necessary to transfer staff and resources from the South to theNorth in proportion to our higher morbidity and lower alloca-tion of money per head of population.From my relatively comfortable situation in a university

department, I know how easy it is to moralise after a goodnight’s sleep and on a full stomach; but whoever enunciates

1. Gustafsson, B. E., Quensel, C. E., Lanke, L. S., Lundqyist, C., Grahnen, H.,Bonow, B. E., Krasse, B. Acta odont. scand. 1954, 11, 232.

2. Scheimn, A., Mäkinen, K. K., YLitalo, K. ibid. 1974, 32, 383.3 Bradford, E. W., Crabb, H. S. M. Br. dent. J. 1961, 111, 273.4. Marthaler, T. M. Caries Res. 1967, 1, 222.

what is right and true, it remains so and needs to be said forthe sake of our patients, ourselves, and our profession. I hopethat those who are contemplating strike action will think againbefore it is too late to save our reputation.University of Manchester,Department of Child Health,St. Mary’s Hospital, Manchester M13 0JH. JOHN A. DAVIS

SIR,-Professor Dudley’s article (Nov. 15, p. 972) should becompulsory reading for every doctor in the country. He hopesthat, by arriving at a diagnosis of our ills, we will be able toavert the premature demise of a profession which has, untilnow, played an important part in society.

History records the basic need of a "profession" to whompeople in distress and suffering can turn for help. In modernsociety the medical profession has more and more occupied thisrole, whether it was for the alleviation of physical suffering, orof mental distress, which so often cannot be strictly defined aseither physical or functional. This privileged position, whichthe medical man gradually assumed, was one of his functionsin modern society, but one difficult to maintain, as the

"magic" of medicine gave place to scientific method. Yet theneed of many people to turn, however irrationally, to some-body for help, remains, and in fact increases with the pressuresof the modern world. It is for this reason that doctors must ex-amine carefully their position in society and the image theycreate in the public mind. The present, apparently selfish, pur-suit of material rewards, demanding to be treated in the sameway as other members of society (such as being paid for everyhour of his service and every small duty performed) under-mines the image which society has created for him, and thuserodes the position which enables him to discharge his func-tion. Perhaps this is the inevitable result of "progress", but Ifear both society and medicine will suffer in consequence. Thisdoes not mean that modern society should accept any privi-leged position some doctors would seem to claim, but that theprofession should earn public esteem by its idealism and theservice it provides, rather than become simply repair mechan-ics of the human body, which it may well do by insisting onmaterial ends only.

Let us hope that an analysis and appraisal of all the symp-toms and the factual evidence will enable us to assess and diag-nose the trouble of the profession’s diseased body, so that it

may survive the difficult times ahead.

Worthing Hospital. K. S. RODAN

THE JUNIOR DOCTORS’ CONTRACT

SiR,—I am writing to congratulate Dr Tasker and his col-leagues at the Royal Marsden Hospital on a very sensible andconstructive letter (Nov. 15, p. 986). It is time we had a littlelight and less heat.Any contract, whether it is for a fixed number of hours or

sessional in such a way that it will require a procedure ofclocking on and off, can only be to the detriment of a profes-sion, which, I have always liked to feel, is a caring one. I amwholetime and am paid on the basis of a so-called 11-sessioncontract. I no more expect to be paid extra for the many weekswhen, because there is work requiring to be done, I do wellover 11 sessions, than I do to have my salary reduced for theodd weeks when, because demands are less heavy, I can havethe luxury of only working 10 sessions.The other point I would make is that, to one who was for

many years in general practice, there seems little doubt thatmuch of what goes by the name of casualty and emergencywork after 5 P.M., with which the hospital is called upon todeal, is the result of the progressive failure over recent yearsof general practitioners to fulfil their role in providing a

24-hour service.

Bolton General Hospital,Farnworth,Bolton BL4 0JS. R. TEPPER