It is a pity general practitioners are so dependent on the pharmaceutical companies for promotional literature encouraging people to have vaccinations, even though the Department of Health and Children produces some very good literature. Patients who have colostomies have a stoma with a bag attached and they have to learn how to deal with it. A patient recently pointed out to me that all the stoma care nurses are employed by the pharmaceutical companies. Naturally they will push their own product and encourage frequent use and frequent changing. It would be far better if the Department of Health and Children employed stoma care nurses. In areas like this more competition would be extremely useful.