They should be seen because they are a good resourceEditor-The role of drug company representatives is changing, but Griffith's advice not to see them would deprive general practitioners of a good resource, which would be costly to replace.1 They offer many useful services that may not be easily accessible from other sources in the wider NHS, including up to date information on products and the provision of papers relating to a particular product or disease.As primary care groups develop, this contact with individual doctors is likely to diminish, but the representatives' role in helping with the development of a formulary in each primary care group could be vital. Their ability to supply up to date information about particular products is also of great benefit to hospital pharmacists in NHS hospital trusts, who are often responsible for maintaining the hospital formulary under the guidance of the drug and therapeutics committee.Pharmaceutical representatives are frequently a vital financial resource in the provision of sponsorship for meetings as part of continuing professional development.Indeed, half of general practitioners' postgraduate education is sponsored by the pharmaceutical industry, and much of that sponsorship is initiated by the representatives. The standard of continuing professional development is unlikely to be maintained without that sponsorship. Griffith suggests that doctors feel obliged to see representatives and that junior doctors need education on the pitfalls of doing so. There is no evidence for these statements. Indeed, younger doctors frequently have better skills in critical appraisal and are thus more likely to question the representative hard. If he or she does not have evidence based knowledge of the product then younger doctors are unlikely to use it. Doctors could, though, usefully be given education about the Association of the British Pharmaceutical Industry's code of practice, which spells out what doctors may and may not expect from representatives as well as the penalties for doctors who try to induce representatives to break the code.Pharmaceutical representatives are well trained and obliged to pass an examination within two years of beginning work. They can be a valuable resource in the provision of information and papers. Rather than stop seeing representatives as Griffith advocates, doctors should turn the representatives' visit into a positive occasion, ask questions, demand information, and make use of them. Richard Tiner medical directorAssociation of the British Pharmaceutical Industry, London SW1A 2DY JJack@abpi.org.uk 1 Griffith D. Reasons for not seeing drug representatives.

The life expectancy of women with cystic fibrosis has doubled in the last 20 years. A major implication of this is the advent of previously unseen reproductive health problems. We review the management problems presented by these women throughout their reproductive lives, including pregnancy.

There is conflicting evidence in the published literature regarding the effects of clomiphene citrate (CC) on endometrial development and its impact on conception. CC is an anti-oestrogen that is commonly used in assisted reproduction to induce ovulation for a range of conditions. The setting was the Reproductive Medicine department at the Royal Blackburn Hospital (RBH). This retrospective cohort study set out to assess the relationship between endometrial thickness (EMT) as measured by trans-vaginal ultrasound scan and pregnancy rates in 81 sub-fertile women treated with CC and to review some of the current literature. Using analysis of logistic regression, the results showed a 14% increase in the odds of conception for each millimetre increase in EMT when the confounding variables of age, basal follicle-stimulating hormone level and body mass index were corrected for. There is good evidence of a positive relationship between greater EMT (within normal limits) and the probability of success. EMT on its own cannot thus far be used to estimate the probability of conception, rather it seems that changes on a microscopic level give better clues to endometrial quality. Taking into account the limitations of patient selection and some missing data, this study should be viewed as a pilot for future investigation.

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