New Research in Tuberous Sclerosis

care-may actually prove harder than reshaping acute services and redirecting medical students. The biggest barrier, however, may be London itself. The report touches on the fact that health services cannot be seen in isolation: poverty, unreliable transport, violence, collapsed social services, rotten housing, and poor education all work against the sort of health service that the commission wants to see. Ministers have said that the political will exists to change London's health care, but they will need a lot of it to overcome the barriers and promote these radicaland untestedsolutions. Unless he adopts completely the London Commission's ideas and analysis Tomlinson is unlikely to be as radical, and ministers might well be tempted by a smaller investment of political will. The daiiger is that anything less might not be enough. JANE SMITH Deputy editor, BMJ