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Get all the facts about benefits, whether you're traveling by car, taxi, train, rates and exceptions .on AFSA Group boat, bus, subway and even as passengers Accident Protection for loss of life, limb or on most commercial, private and military eyesight—direct by mail! No agent will call. planes you’d normally travel in. Just complete the coupon below and mail Moreover, protection is provided during today. No obligation. So don't delay on a business, pleasure and just plain day-to-day plan that can mean added security for you activities at home and abroad. and your family! AFSAINSURANCE PROGRAM UNDERWRITTEN BY 1666 Connecticut Ave. NW ■Washington, D.C. 20009 □ YES! Please rush full details on the Group Accident Insurance Plan avail¬ Mutual/TN able to me as a member of the American Foreign Service Association. I understand no agent will call. s^Omaha.xL/ Name People you can count on... Address MUTUAL OF OMAHA INSURANCE COMPANY HOME OFFICE: OMAHA, NEBRASKA City State ZIP Code FILL OUT AND MAIL TODAY! FOREIGN SERVICE JOURNAL JUNE 1978: Volume 55, No. 6 American Foreign Service Association Officers and Members of the Governing Board ISSN 0015-7279 LARS HYDLE, President PAUL von WARD, Vice President THOMAS O'CONNOR, Second Vice President FRANK CUMMINS, Secretary JAMES R. MEENAN, Treasurer RONALD L. NICHOLSON, AID Representative Warp and Woodworm PETER WOLCOTT, ICA Representative JOSEPH N. McBRIDE, KENNETH N. ROGERS, JAMES R. VANDIVIER, in the Service State Representatives EUGENE M. BRADERMAN & ROBERT G. CLEVELAND, JAMES HANSEN 6 Retired Representatives SALT — A Path to Journal Editorial Board JOEL M. WOLDMAN, Chairman Mutual Security JAMES F. O'CONNOR DAVID LEVINTOW HERBERT SCOVILLE, JR. 11 HARRIET P. CULLEY MICHAEL A. G. MICHAUD WESLEY N. PEDERSEN ARNOLD P. SCHIFFERDECKER Where Do I Hang My Head? NEIL A. BOYER PAT RENDAHL 14 Staff ALLEN B. MORELAND, Executive Director Housing in Washington: WILBUR P. CHASE, Counselor CATHERINE WAELDER, Counselor Myths and Realities CECIL B. SANNER, Membership and Circulation ANGELA PEDERSEN 17 CHRISTINA MARY LANTZ, Executive Secretary The Ashes of the Marshal Foreign Service Educational JOHN BOVEY 21 and Counseling Center Dining in D.C. BERNICE MUNSEY, Director/Counselor DONALD DRESDEN 30 AFSA Scholarship Programs LEE MIDTHUN FSJ Newsbreak 4 Journal Book Essay: Diplomatic Challenges: SHIRLEY R. NEWHALL, Editor ANDREW H. LUDWIG, Editorial Assistant The US and the UN MclVER ART & PUBLICATIONS, INC., Art Direction Neil Boyer 31 The Bookshelf 33 Advertising Representatives Letters to the Editor 45 JAMES C. SASMOR ASSOCIATES, 521 Fifth Ave., Suite 1700, New York, N Y. 10017 (212) 683-3421 AFSA News 46 ALBERT D. SHONK CO., 681 Market St., San Francisco, Calif. 94105 (415) 392-7144 JOSHUA B. POWERS, LTD., 46 Keyes House, Dolphin Sq., Cover: Caracas, by Ovaline Tyburski London SW1 01-834-8023/9. International Representatives. The FOREIGN SERVICE JOURNAL is the journal of professionals in with incomes over $15,000; $20 annually for less than $15,000. Associate foreign affairs, published twelve times a year by the American Foreign Members—Dues are $20 annually. Service Association, a non-profit organization. For subscription to the JOURNAL, one year (12 issues); $7.50; two years, Material appearing herein represents the opinions of the writers and is $12.00. For subscriptions going abroad, except Canada, add $1.00 annu¬ not intended to indicate the official views of the Department of State, the ally for overseas postage. United States Information Agency, the Agency for International Develop¬ Articles appearing in this journal are abstracted and indexed in Historical ment or the United States Government as a whole. Abstracts and/or America: History and Lite. While the Editorial Board of the JOURNAL is responsible for its general Microfilm copies of current as well as of back issues of the FOREIGN content, statements concerning the policy and administration of AFSA as SERVICE JOURNAL are available through the University Microfilm Library employee representative under Executive Order 11636 on the editorial Services, Ann Arbor, Michigan 48106 under a contract signed October 30, page and in the AFSA News, and all communications relating to these, are 1967. the responsibility of the AFSA Governing Board. Membership in the American Foreign Service Association is open to the ^American Foreign Service Association, 1978. The Foreign Service Jour¬ professionals in foreign affairs overseas or in Washington, as well as to nal is published twelve times a year by the American Foreign Service Association, 2101 E Street, N.W., Washington D C. 20037. Telephone (202) persons having an active interest in. or close association with foreign affairs. 338-4045 Membership dues are: Active Members—Dues range from $39 to $65 Second-class postage paid at Washington, D.C and at additional post annually. Retired Active Members—Dues are $35 annually for members office. The fact that, for the most part, OCs have not had obvious pjgj NEWSBREAK effects upon mortality patterns from circulatory diseases does not rule out the possibility that their use may substantially affect mortality among certain subgroups particularly at risk of circu¬ THE BITTER PILL latory diseases, such as women over age 35 who are heavy cigarette smokers. A slight increase in mortality rates fora large The continuing controversy over the safety of the oral proportion of women or a substantial increase for a small pro¬ contraceptive pill has erupted in AID’s Bureau for Popu¬ portion of OC users would be difficult or impossible to detect in lation and Humanitarian Assistance. Charges and coun¬ such a study of age-specific mortality trends. tercharges are flying regarding the shredding of the Data from other sources suggest that, where OC use alters January 1978 Population Reports on “Oral Contracep¬ the risks of developing circulatory system disease, it does so tive Use and Circulatory Disease Mortality,” prepared only to a small degree in most users but may increase risks by Ward Rinehart, Dr. R. T. Ravenholt, Director of appreciably for only a small proportion of women—particularly AID’s Office of Population, and Dr. J. Joseph Speidel, older women who are heavy cigarette smokers or those with Deputy Director.* The report was shredded and a new other predisposing conditions. Mortality rate trends, in combi¬ one prepared by direction of Assistant Administrator of nation with these new analyses of other data on OC use, imply that a fruitful course for further research may be to further the bureau, Sander M. Levin (with a new introduction identify those women who cannot use OCs safely and who and conclusion, still bearing the names of the three au¬ would be taking fewer risks if they chose another contraceptive thors but without their consent). Dr. Ravenholt says that method. the new report will also have to be destroyed since it contains three factual errors in the front page summary. Conclusion This will bring the cost to the Agency for the two reports Mortality trends among females of reproductive age in the to $25,000, with no publication to show for the money. United States, England and Wales, Denmark, and Japan from Administrator Levin says that the Introduction and all diseases of the circulatory system, ischemic heart disease, Summary of the original report “seem to understate the cerebrovascular disease, and hypertensive disease have been possible risks” of the pill. Dr. Ravenholt, whose career generally favorable during the oral contraceptive era. These findings suggest that any adverse effects of OC use upon the in population planning started in 1966 and whose biog¬ arterial system, if they exist, must be of modest proportions; raphic sketch lists some 107 publications, charges that though this does not rule out the possibility, consistent with this judgment was made by someone without experience previous cohort and case-control studies, of substantial attack and education in the biomedical, epidemiological, public rates of certain circulatory diseases among a number of sub¬ health and family planning sciences and urged that ines¬ groups, such as older women who are heavy cigarette smokers capably and truly technical matters be delegated to the or, to a lesser degree, those who have other predisposing condi¬ technical staff. tions. These generally favorable findings with respect to the The Journal has obtained one of the few remaining impact of OC use upon arterial disease are in contrast to the copies of the original report that escaped the shredder. In consistent body of evidence linking OC use to increased occur¬ the public interest we are publishing below the introduc¬ rence of venous thrombosis and embolism. tion and conclusion of the report that has excited such The suggestion that all OC users are subject to substantial risk from circulatory disease is not borne out by the analysis controversy. presented in this Report (60). The data from recent cohort and case-comparison studies are more consistent with the conclu¬ Introduction sion that risks of major circulatory system diseases, particularly Mortality trends from four countries—-the United States, En¬ heart attack and hemorrhagic stroke, are associated with OC gland and Wales, Denmark, and Japan—suggest that oral con¬ use in only a relatively small subgroup of women who have traceptives (OCs) have not contributed substantially to deaths other predisposing conditions, particularly older women who from most circulatory system diseases in women.
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