Hypophosphataemia and hypokalaemia.

Correspondence BRM= Most of Dr. Birdwood's missionary zeal is harmless, and some of it is a useful reminder of our age-old obligations to the sick. But I must protest at his attack on health centres and at what is suspiciously like a sneer at the Royal College of General Practitioners' "ideal"; his experience of both must be lamentably small and/or distorted. Health centres-of all shapes and sizes-are modern medical devices designed to enhance the delivery of primary, personal, continuous, comprehensive, family care. As one who has visited, and will continue to visit, many health centres in Britain, I can assert that, despite some unfortunate errors in design, the bringing to bear on every individual patient's problems of the whole range of caring professions and their relevant technologies holds better promise of making and keeping people well than does the traditional, fragmented, isolated system we have known until recently. I challenge Dr. Birdwood to produce evidence-real evidence-that the health centre concept reduces the personal element in care. Any institution which tries to provide leadership, especially in the educational field, must expect to be criticized, and a good institution should welcome well-reasoned constructive criticism. To swipe, as Dr. Birdwood does, at a carefully thought out set of objectives (including group practice , team care, and health centres) published by the Royal College of General Practitioners, and to do it almost as an aside in a backward-looking article, is to my mind irresponsible. It has been my good fortune to meet, listen to, and argue with, many of the office-bearers of that College and such experience makes me confident that these men, and the doctors they represent , will never allow the humane element of general practice to suffer from a surfeit of technology. show the right road-and that is forward into the new general practice where humanity uses technology and not backward to where the one smothers the other.-I am, SIR,-We would like to add our observations on hypophosphataemia and its association with hypokalaemia to those of Dr. D. C. Anderson and colleagues (15 Novem-ber, p. 402). Seven out of fourteen patients treated bv us for idiopathic hypercalciurial have shown a persistent fall of over 1 mg./100 ml. in plasma phosphate immediately following commencement of therapy with bendro-fluazide 5 mg. per day. In two patients bendrofluazide was stopped after two and four years' treatment and the low plasma phosphate rapidly returned to …