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plasia and cancer appear to be different phases of acontinuous, but not by necessity a relentlessly con-tinuous, process, since it may be that epithelial hyper-plasia,24 cystic disease,3 and even tiny carcinomas-possibly detectable mammographically and remov-able with acclaim-can regress or remain staticwithout life-threatening activity, as microscopiccancers in the prostate apparently do. The diag-nostic need for a biochemical, immunological, orhormonal assay indicating progressive development ofcancer is obvious, since any biopsy is operationallylimited both in the interpretation of the tissue

supplied and in its relevance to the patient as a whole.Doubt centres upon duct papillomatosis and evenpapillary carcinoma, which could not be related toinvasive cancer in one large investigation.25 Apocrinemetaplasia, sclerosing adenosis, fat necrosis, andinflammation are allegedly more common in benignthan in cancer-bearing breasts .22,26 Most of thesestudies have regarded cancer of the breast as a singleentity, so that the possible correlation of one or more"

benign " features with only one or two subgroupsof the totality of mammary cancers may have beenoverlooked.

In this uncertain situation most authorities cau-

tiously suggest that a relation may exist between some,not yet completely defined, forms of benign andmalignant diseases of the breast; thus contraryopinion, such as that developed from a study involving592 cancer-bearing breasts of which 7% had previousmicroscopically confirmed benign disease,27 shouldbe carefully considered. Histopathological detailwas omitted, and two groups of widely different sizeswere compared. Cancer occurred in 9-4% of onegroup of 425 breasts with previous benign disease,but this was less than a quarter the size of the other

group with no previous history of benign breastdisease and a cancer incidence of 28-8%. Althoughthe precancerous nature of fibrocystic disease is

questioned, it is clear that 9’4% of cancers in thealbeit small number of subjects with previousbenign disease is nearly twice the lifetime risk ofbreast cancer for all women in North America. 28Thus the prudence of encouraging all women in

regular self-examination of the breasts and of advisingregular medical examinations for those with anypossibility of special risk is obvious.Most pathologists do not take a particular interest

in the finer points of patient care; most surgeons donot fully comprehend the niceties of pathologicalclassifications; and most epidemiologists steer clearof the tenuous data generally associated with thissort of clinicopathological problem. Although it isunlikely that any change in currently accepted

25. McDivitt, R. W., Holleb, A. I., Foote, F. W., Jr. Archs Path. 1968,85, 117.

26. Foote, F. W., Stewart, F. W. Ann. Surg. 1945, 121, 6, 197.27. Devitt, J. E. Surgery Gynec. Obstet. 1972, 134, 803.28. Shimkin, M. B. J. Am. med. Ass. 1963, 183, 358.

management might immediately ensue, perhaps thetimes are ripe for a well-designed interdisciplinarystudy of benign and malignant breasts upon a smallerscale than the theoretical ideal.

Direction for Medical ResearchA WEEK ago we urged medical research-workers

to be more business-like-to accept the limitationsof their programmes, and to be ready to redesign aproject within a budget as the scene changes. 1Now the Government’s white-paper 2 takes a giantstep down the same road by its expressed intentionthat the whole framework of applied research shouldbe more business-like and governed by the " custo-mer/contractor principle "-a concept that will

increasingly affect relationships between ResearchCouncils and Government Departments. When theseintentions were first voiced in the Rothschild report, 3they were met with dismay by many scientists. In

particular there was criticism about the Govern-ment’s tactless memorandum which accepted LordROTHSCHILD’S proposals as soon as they were madeand about the apparently arbitrary manner in whichthe sums to be transferred from Research Councils to

Departments had been calculated. These criticismsremain unanswered, but the objective of the Govern-ment’s move-the attainment of partnership andcooperation in research-should be welcomed.

Comparing white-paper 2 with green,3 some im-portant concessions have been made. The transfer offunds from Research Council budgets to Depart-ments will be done over a three-year period startingin 1973-74, instead of all at once as ROTHSCHILDwanted. Of the three Research Councils affected,Agriculture and Natural Environment will lose muchless than Lord ROTHSCHILD prescribed, but theMedical Research Council will have to swallow thewhole pill-;{5i million, or a quarter of its budget at1971-72 prices. The movement of scientists withinthe Civil Service and between the Civil Service andthe world of science outside will be encouraged; theCouncil for Scientific Policy is to be more broadlybased; and the Department of Health, for example,will have full members on the M.R.C. as a right.Councils will be entitled to refuse work if the projectis not scientifically feasible or if the funds are in-sufficient.

When all is said and done, medical research is but asmall part of the Government’s total responsibility forresearch and development: it amounts in financialterms to about 5% of the total expenditure on1. Lancet, July 22, p. 169.2. Framework for Government Research and Development. Cmnd.

5046. H.M. Stationery Office. 13p.3. A Framework for Government Research and Development. Cmnd.

4814. H.M. Stationery Office, 1971. See Lancet, 1971, ii,pp. 1241, 1251.

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research, though new understanding of the control ofthe environment together with research in the

agricultural and food sciences can also contribute tothe improvement of the health of the community.The scientists-and the medical scientists especially-no doubt believe that the system that has enabledthem to make such tremendous advances in the pastthirty years could serve equally well for the future.The Government’s advisers argue that after so much

progress there is likely to be a period of comparativelydiminishing returns, and that there must be morecontrol of the direction of science, perhaps moreeconomy, and certainly more relevance to the needsof people. The scientist, for his part, is reluctant tocredit Government Departments with the ability toset priorities and to discriminate between the trivialand the important. The Government, too, seems tohave its doubts, for it is rightly insisting that beforeany money is transferred the Departments must haveappointed chief scientists helped, in the case of

Health, by a small team of scientists working part-time in the Department.

Customer and contractor are not master and ser-vant : both have a choice, and long may this inde-pendence of action continue. Although the M.R.C. isbeing deprived of the direct use of a quarter of itspresent budget, this money or most of it may wellreturn to the Council’s coffers if the M.R.C. is

prepared to seek solutions to problems identified bythe health authority. (The white-paper is less explicitthan was Lord ROTHSCHILD about the guaranteesthat this money would indeed find its way back to theResearch Councils and about the size of the " 10%general research surcharge ".) Certainly, the M.R.C.,like any other contractor, can expect the customer torepeat or even increase his investment as long as thereis satisfaction on both sides.

Of late, the M.R.C. has become much more openabout its scientific policy making-witness the

twenty-three pages devoted to this topic in its latestannual report (see p. 222)-and it is now moreaware than formerly of the need for close workingwith the Department of Health. But this change ofheart has come too late to avoid Lord ROTHSCHILD’Swrath. Maybe also the Government thinks it candiscern popular unease with, for example, the

image of the medical scientist applying computerisedaids, electronics, and the remote control of theintensive-care unit at the expense of the more human

approach. Just as the Health Departments are nowspending vast sums (El 3 million in the current

year) on research into the community’s needs forhealth and welfare and the most efficient ways of

delivering care,4 so too there must be routes to ensurethat the gaps in knowledge which the practisingdoctor sees in his contacts with the patient, the family,

4. McLachlan, G. (editor). Portfolio for Health. London, 1971.

and the community are brought to the attention of thescientists, so that they too can perceive a pattern ofneed for the population as a whole. The white-paperoffers one such route.

ROOTS OF DELINQUENCY

TWENTY years ago the late Sir Cyril Burt 1 indicatedthat " The mental and moral harm that an uncongenialoccupation works upon older youths may with youngerchildren be effected by an uncongenial education ".He asked: " Why is it that the school is not blamedfor a child’s delinquency more frequently than hishome ?"-a query that has a contemporary ring inthe light of much recent research on home/schoolrelations. Although we have known for a number ofyears that schools have different delinquency-rates, itis only lately that attention has moved from home andneighbourhood and been directed to the part that theschool itself plays, either in failing to check delin-quency or at a more serious level in actually promotingantisocial behaviour.

Power and his colleagues,2 in a paper summarisingtheir ten-year study of delinquency in one largeLondon borough, have shown that over a long periodschools which have not been reorganised reveal a

remarkably consistent delinquency-rate. Some schoolsseem to produce many more delinquents than othersin similar localities, and the reasons for this appear tolie more in the schools themselves than in the neigh-bourhood or the home.

Partridge 8 and Hargreaves 4 have shown thatinternal streaming, differential attitudes towardsconformist and non-conformist pupils, and antiquatedand oversevere disciplinary methods result in a stateof constant resentment and hostility which almostcertainly has positively criminogenic consequences.The less able and less conforming boys are denigratedby the school, and stereotyped as toughs and trouble-makers, and come to accept these labels for themselvesand find that they can only achieve status and groupapproval by associating with other social rejects invandalism and other delinquent acts.

Clearly much more thorough psychological and

sociological research needs to be done in schools withhigh and with low delinquency-rates before reliablepolicy changes can be made. Unfortunately, inLondon permission to enter schools for furtherresearch of this nature has been withheld. This is a

great pity, since there is undoubtedly something ofconsiderable xtiological significance in the educationalexperience which careful and sympathetic studymight uncover to the advantage of teachers and pupilsalike. We can, however, understand why some

teachers and educational authorities are adopting adefensive stance. Some of the activities of college

1. Burt, C. The Causes and Treatment of Backwardness. London,1952.

2. Power, M. J., Benn, R. T., Morris, J. N. Br. J. Crimin. 1972, 12.3. Partridge, J. Middle School. London, 1966.4. Hargreaves, D. H. Social Relations in a Secondary School. London,

1967.