FROM THE PRESS
HIV/AIDS programme mismanaged
Critics of India's ambitious World Bank- funded AIDS control programme feel
vindicated by the revelation in Parliament that the number of HIV-infected
people in the country has snowballed to eight million. Health activists and
non-governmental organisations have long protested against alleged mismanagement
of anti-AIDS funds. Anti-AIDS activist Purushottaman Mulloli thinks that current
donor-promoted H1V/ AIDS programmes cannot work in India in the absence of an
effective primary health care system. The government's AIDS control efforts have
also come under fire for targeting "high-risk" groups, leading to social
ostracism of the group. Efforts will not get far without a change in medical
professionals' attitudes, say activists. "Doctors remain unwilling to work
with HIV positive people while society reacts with paranoia as the epidemic
unfolds," complains Siddharth Vatsyayan of the AIDS Awareness Group.
According to John Roegner of the NAZ Foundation (India Trust), hospitals and
doctors in the Indian capital regularly turn away AIDS patients.
HIV spreads despite World Bank project Ranjit Dev Raj Inter Press
Service, May 2,1999
Government doctors banned from conference
Israel 's health
minister banned 200 public JLsector doctors from attending a conference in
Turkey, organised and paid for by Teva, Israel's leading pharmaceutical company.
He argued that the trip was aimed at promoting sales of a new anti-hypertension
drug, Cardura-XL, which Teva markets in Israel for Pfizer, and would have
violated "public and ethical considerations." Teva said that it had acted within
government guidelines. The company was forced to cancel the conference and is
considering legal action against the ministry. The health ministry issued
guidelines in 1993, but the director general. Professor Gabi Barabash, said:
"There are loopholes that have to be closed.
Doctors banned from drug company trip Judy Siegel-Itzkovich, Jerusalem
BMJ August 8,1998; 317: 370.
IMA acts against sex selective abortionsTne Indian Medical
Association and the Medical Council of India have asked doctors to stop
participating in sex determination and selective abortion of female fetuses. The
IMA will circulate a set of directives to all its 1,700 branches. It has said
that it will launch independent investigations against doctors suspected of
being involved in such practices. The medical council has promised to revoke
licences of doctors found guilty. This is the first time since the Indian
parliament outlawed prenatal sex determination that medical institutions are
trying to step up pressure on doctors. Not a single doctor has been convicted
under the 1994 act.
Non-government organisations such as the Voluntary Health Association of
India estimate that hundreds of thousands of foetuses are aborted each year only
because they are female. The practice has spread across urban and rural India
through easy access to non-invasive sex determination based on ultrasonography.
Social activists and legal experts, however, are sceptical. "This is a
situation where there is social sanction to an outlawed practice," says
Anita Roy, a federal police officer.
Indian medical authorities act on antenatal sex selection Ganapati Mudur,
New Delhi BMJ August 14,1999; 319: 401
WMA opposes national health database
The World Medical Association
(WMA) I council meeting in Santiago, Chile. affirmed its support of the
Icelandic Medical Association in its fight against the implementation of a
national health database in Iceland.
In December 1998 Iceland passed legislation providing for the creation of a
national health sector database covering the country's population. Patients had
untilJune 17 to opt out the database, which would allow a private company to
link their medical records with genealogical and genetic data.
The WMA council said that it stood fully behind the position taken by the
Icelandic Medical Association in opposing the legislation, and it especially
wished to point to the need to protect the integrity of patient data and have
open access to all scientific data. The council is urging all national medical
associations and governments to ensure that science is furthered by continued
research without breaching medical ethics and patient confidentiality.
The Icelandic government has defended the development of the database on the
grounds that patients' rights of confidentiality are fully protected and that
rights to develop new drugs or lest candidate drugs are not being given
exclusively to one company. Icelandic health authorities will have access to the
scientific information, provided that they comply with specific regulations.
World Medical Association opposes Icelandic gene database Nigel Duncan,
Santiago, Chile BMJ April 24,1999; 318: 1096
Investigation into mental hospitals
The National Human
Rights Commission (NHRC) has constituted a central advisory group to look into
the functioning of the Ranchi, Agra and Gwalior mental hospitals. The hospital
managements came under the scrutiny of the supreme court through a writ
petition. In a November 1997 order, the apex court asked the NHRC to involve
itself in the supervision of the functioning of these mental hospitals in the
same manner in which the Commission was requested to undertake similar work in
respect of the Agra Protective Home. The NHRC has set up a central advisory
group headed by the NHRC's chairman, justice MN Ventatachalaiah. to advise the
Commission on the duties and responsibilities envisaged by the supreme court's
order, the various steps to be taken to achieve these objectives and to review
the progress of work.
NHRC sets up advisory group to supervise mental hospitals. Man Mohan. The
Times of India, June 15,1999.
WHO guidelines questioned
The May 1999 issue of the
Bulletin on Drug and Health Information carries an open letter to the director
of WHO, questioning WHO guidelines which specify normal blood pressure as below
130/85 mmHg, and optimal blood pressure as below 120/80 mmHg. It notes that the
only trial looking at optimal blood pressure contains "no evidence to recommend
aiming for a blood pressure below 140/90 in non-diabetics". The trial was co-
sponsored by the WHO and Astra, a pharmaceutical company. The letter adds: "We
fear that the new recommendations will be used to encourage an increased use of
anti-hypertensive drugs, at great expense, and for little benefit." The letter,
which was written by Therapeutics Initiative, a group of Canada- based family
doctors, can be signed on the Internet athttp://www.uib.no/isf/letter/index, htm.
Open letter to Director-General Gro Harlem Brundtiand. BODHl 1999
May-June; VI (2): 33- 34.
Delinquent Maharashtra doctors face action
Over 250
medical officers in Maharashtra face civil and criminal proceedings for
dereliction of duty following a state government directive to the director of
health services. This followed a department survey revealing that many medical
officers attached to the public health centres, rural and district hospitals had
left the headquarters without their superiors' written permission. They were
also found carrying out private practice in blatant violation of Maharashtra
Civil Service rules.
Under section 168 of the Indian Penal Code, a public
servant unlawfully engaged in a trade is liable to simple imprisonment for a
term which may extend to one year or with a fine or both. Medical officers
drawing non- private practicing allowance are barred from private practice.
"
We found that while the doctors were not reporting to the public health
centres, they were actually seeing patients at their official residence and
collecting money from poor patients. In some cases, a section of the medical
officers were running full-fledged nursing homes in the names of their
relatives," an officer said. The state is also considering the suspension
of registration of the erring officers. Specific instructions have been issued
to the director of health services that the salary bill of medical officers who
leave the headquarters without permission should be withheld.
Doctors to face action for negligence.Prafulla Marpakwar, Indian
Express, June 27,1999
SA doctors against unethical colleagues
A group of South
African doctors from the University of Cape Town's Health and Human Rights
project is considering forcing the Health Professions Council to investigate the
doctor who headed the apartheid government's chemical and biological warfare
programme. They are also asking the council to lake action against doctors
implicated in unethical conduct before the Truth and Reconciliation Commission.
Dr Wouter Basson is being tried for crimes associated with his role at the
head of the programme. At present, he retains his job in the public health
sector as a cardiologist. The Health Professions Council says it will conduct an
inquiry into his conduct after the criminal trial. The South African Medical
Association, the voluntary professional association for doctors, has allowed Dr
Basson to remain a member but has initiated an investigation into his
membership.
Among those who have now complained to the council is Professor Joe Veriava,
who was instrumental in compelling the council to inquire into the death of the
political activist Sleven Biko. Up until that time the council had refused to
take action against the doctors who attended to Mr Biko after he was fatally
assaulted while in police custody.
South African doctors demand action on '"unethical" colleagues Pat Sidley
BMj September 4,1999; 319: 594
Indian children die of hunger
Gross malnutrition accounts for 55
per cent of all deaths of Indian children under the age of five. according to a
recent UNICEF study. Thirty-seven per cent of babies born in West Bengal weighed
less than the threshold 2.5 kg; 56.8 per cent of children under the age of five
were underweight, and all of them ran a high risk of infection and death.
Malnutrition kills 55 per cent of kids, says UN study. Press Trust of
India. Indian Express, September 3, 1999.
Babies to order in the US
British couples desperate for a
family are spending tens of thousands of pounds on perfect babies-to-order.
Faced with two- year waiting lists in the UK, they are selecting their ideal
offspring from advertisements on the Internet and travelling to the US for
treatment. The business is attracting those who fear that a shortage of egg
donors in this country may force them to remain childless.
Fertility experts believe what the number of Britons using US facilities will
rise dramatically because the Net has made information on donors so accessible.
Parents are choosing the genes they want their child to inherit.
An Indian couple asked a clinic for an egg from a Caucasian mother; a
dark-skinned woman asked specifically for a tall Nordic donor. The sale of eggs
is big business in America. While the British system pays a donor only £15 plus
expenses, market economics operates in the US and genes can fetch high prices.
In Britain, doctors insist that the donor must be close to the would-be parents'
own genetic backgrounds. If the couple ask for a donor very different from
themselves, most doctors will question whether they will make suitable
parents.
In the US, agencies advertise for eggs in student newspapers at Ivy League
universities. Up to $50,000 is offered for preferred characteristics. Some US
egg donor agencies advertise directly on the Internet with soft-focus
photographs of their donors on the web.
The donation procedure itself is complicated and while the process does not
deplete the donor's reserve, it can be painful and sometimes leads to hyper
stimulation, and in rare cases, stroke.
James Yeandel of the UK's Human Fertilisation and Embryology Authority said,
"The number of people searching the Internet for egg donors is alarming, but I
think the cost will be prohibitive for most British couples." The 68 licensed
clinics in Britain charge about £3000 per cycle; US clinics at least three times
that.
In search of the perfect baby. Nicole Vcash, Observer News Service, Indian
Express, August 18,1999.
Protest against ruling on HIV marriage
Lawyer Anand
Grover called for public protest against the Supreme Court ruling suspending the
AIDS-affected person's right to marry. He said the right to marry is a
fundamental right and no court of law can 'suspend' it. The apex court did not
take cognisance of the fact that HIV-positive people get married with full, free
and informed consent of their partner who may or may not have HIV positive
status. "The restriction on the marriages of HIV- infected persons can have
serious repercussions. The isolation of such persons will drive the epidemic
underground, as doctors and hospitals will not maintain confidentiality with
regard to their HIV status," he said. He said the apex court was right in making
it a moral and legal right for an HIV-positive person to disclose his/her status
to the prospective spouse.
Lawyer calls for protest on SC ruling in HIV marriage case. Indian
Express, September 5,1999.
HIV patient denied treatment
'The National Human
Rights Commission -L (NHRC) has issued notices to the Ministry of Health and
Delhi government on a complaint filed by the All India Lawyers Forum for Civil
Liberty (AILFCL) about the alleged denial of treatment to an HIV patient in
Safdarjung hospital, Delhi.
In a letter to the NHRC chairman MN
Venkatachalaiah, AILFCL chairman KK Nigam and president OP Saxena asked the NHRC
to issue guidelines to the Centre and state governments to provide medical
facilities to AIDS patients.
Notices to government for denying treatment to HIV patient. Press Trust
of India. Indian Express. August 31,1999.
Kidney on the net
Online bidding for a human kidney topped US
$5.7 million before executives at the Internet auction house EBay yanked the
illegal posting." Fully functional kidney for sale," read the posting.
"You can choose either kidney. Buyer pays all transplant and medical costs.
Of course, only one for sale, as I need the other to live. Serious bids
only." Selling human organs is illegal in the United States, punishable by
up to five years in prison or a $50,000 fine. Ebay said it shut down the auction
as soon as the company heard of it. Nevertheless the auction appears to mark an
uncomfortable intersection of the frenzied atmosphere of Internet bidding, a
possible hoax and the desperate shortage of organ donors in the United States.
There are 42,907 patients waiting for kidney transplants in the United Slates,
according to the United Network of Organ Sharing. The average waif exceeds three
years. But experts said both the kidney offering and the seven bids it fetched
were probably hoaxes.
Kidney draws $5.7 million bid on Ebay. The Times of India (Bombay Times),
September 4,1999.
Hypnotism to increase sperm count
A doctor practicing
hypnotism in Nashik recently created a flutter in medical circles by claiming
that his therapy had increased the sperm count in a patient, who later fathered
a child. The doctor's haste in going to town about his success invited criticism
and the attention of the medical fraternity, which responded with scepticism.
But the most practical response was from the Andhashraddha Nirmulan Samiti,
which asked the doctor for a public debate on the issue. At the public meeting,
the doctor cut a sorry figure and was not able to give a satisfactory scientific
answer to the 'miracle'. He made a rather sheepish exit saying he would conduct
the experiment on at least 200 patients and involve medical experts to establish
his claim.
Miracle gone bust. Rakshit Sonawane, Indian Express, Nashik Diary, August
18, 1999.
Norplant case
American Home Products Corp., the
parent ofNorplant maker Wyeth-Ayerst Laboratories, will pay a reported $54
million-plus to more than 36,000 women ($1,500 per woman) to settle claims that
the implantable contraceptive device caused headaches, irregular menstrual
bleeding, nausea and depression. The company called the move to end five years
of litigation a "pure business decision ". It did not admit any wrongdoing. The
settlement covers most of the thousands of lawsuits filed against the company
but not the claims by hundreds of other women who had different types of
injuries including scarring from having the implants removed. The company has
prevailed in most of its Norplant lawsuits winning three verdicts, 20 summary
judgments and the dismissal of almost 14,000 claims.
Drug firm offers to settle Norplant case. Amy Westfeldt, Associated
Press, The Times of India, August 28,1999.
Hospital also liable
The Consumer Disputes Redressal
Forum, Dadar, Mumbai, has ordered the Lilavati Hospital to pay S P Bhanushali Rs
1,25,489 as compensation in a case of post-operative medical negligence, and
held that the hospital is liable for actions of its honorary doctors. If also
defined what constitutes specialist or expert care. The complainant's father. Mr
Padmakar Vaman Bhanushali. underwent coronary artery bypass grafting at the
hospital on October 31, 1997. On November 3, he contacted Dr Panda because of a
fever associated with rash and chills, but no quick remedial action was taken.
On November 7, he was examined by one Dr D'Silva who asked him to undergo some
investigations and stop the drug Augmentin. He was subsequently admitted to
Lilavati on November 11 after liver function tests showed abnormal results, but
died on November 12, 1997. The cause of death was given as 'terminal
cardiorespiratory arrest with blood transfusion induced graft versus host
reaction with ischaemic heart disease." The court ruled: "A reasonable prudent
doctor who professes to be an expert in the field ought to have the patient
immediately admitted, investigated and more importantly, kept under close
observation." That this was not done "amounts to negligence." Although Dr
D'Silva is not a party in the case, the court ruled that the relationship of Dr
Panda and Lilavati hospital is "that of a principal and an agent and that of Dr
D'Silva and Lilavati Hospital is that of an employee and employer. By the law of
vicarious liability, therefore, for all acts of omission and commission of the
agent... the principal will be liable"
'Honorary docs answerable'. Express News Service, Indian Express, August
7,1999.
NEJM editor steps down
In August 1999, Jerome P.
Kassirer, editor-in-chief of the New England Journal of Medicine, stepped down
after a highly successful tenure of eight years, Dr Kassirer's exit ended a
long-standing struggle between him and the Massachusetts Medical Society, which
owns and publishes the NEJM. DrMarciu Angel!, interim editor- in-chief of the
NEJM, writes in the September 2. 1999 issue that the main bone of contention was
the Society's "ambitious plans to expand its role as a medical publisher, both
in print and on line, by launching and acquiring new publications, repackaging
the Journal's content for consumers, and entering into joint arrangements
('co-branding') with various information-based commercial enterprises. Kassirer
privately questioned the wisdom of many of these ventures, but what he strongly
opposed in his capacity as editor- in-chief was the use of the Journal's name to
promote products for which he and Ins staff had no responsibility. To him. these
activities threatened the Journal's credibility. To the society's leadership and
publishing staff, such leveraging not only was good business practice, but also
furthered the society's educational mission."
For more details, read the September 2, 1999 editorial on the NEJM web
site (http://www.nejm.org)
