Background-The clinical significance of the presence of non-tuberculous mycobacteria in the sputum of patients with cystic fibrosis is unclear. A retrospective case-control study was performed to assess possible risk factors for nontuberculous mycobacteria and its impact on clinical status in patients with cystic fibrosis. Methods-The records of all patients attending the Leeds cystic fibrosis clinics who were positive for non-tuberculous mycobacteria were examined. Each case was matched with two controls for sex, age, and respiratory function at the time of the first non-tuberculous mycobacteria isolate. Details of respiratory function, nutritional status, antibiotic and corticosteroid therapy, Shwachman-Kulczycki (S-K) score, Northern chest radiographic score, and the frequency of isolation of other bacteria and fungi were collected from two years before to two years after the first non-tuberculous mycobacteria isolate. The patients' genotype and the presence of diabetes mellitus were also recorded. Results-Non-tuberculous mycobacteria were isolated from 14 patients out of a cystic fibrosis population of 372 (prevalence = 3.8%). No significant eVect of nontuberculous mycobacteria was seen on respiratory function, nutritional status, or S-K score. There was a significant association with the number of intravenous antibiotic courses received before the first isolate with cases receiving, on average, twice as many courses as controls (cases 6.64, controls 2.86, 95% CI for diVerence 1.7 to 5.9). No significant diVerence was seen between cases and controls for Northern scores, previous steroid therapy, or the incidence of diabetes mellitus. Conclusions-Non-tuberculous mycobacteria infection in patients with cystic fibrosis is uncommon and its clinical impact appears to be minimal over a two year period. Frequent intravenous antibiotic usage is a possible risk factor for colonisation with non-tuberculous mycobacteria.

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Racial discrimination in distinction awards Discrimination is probably indirectEditor-Esmail et al attribute disparity between white and non-white award holders to discrimination. 1 Existence of direct discrimination in some spheres of the NHS does not imply it also affects distinction awards. The regional and central advisory committees on distinction awards are beyond reproach. Rubin's suggestion that several other factors may explain the skewed distributions is more plausible. 2 Disparity between groups of consultants is inevitable because of differences in abilities, training, and opportunities.The Commission for Racial Equality held that the criteria laid down for distinction awards could, however, result in indirect discrimination, not necessarily with discriminatory intent. For example, the weight given to work of national and international significance may make the awards less accessible to those in smaller district general hospitals or specialties, where ethnic minority consultants may be concentrated. The Department of Health has therefore issued criteria placing less emphasis on national and international recognition and making A awards available to consultants delivering "outstanding and sustained service to the NHS in an exceptionally hard