around scientific research. Fred Charatan Florida. 141, 142, 123. President Bush waits to speak at Southern Maine Technical College. 16779. 505. AP PHOTO.
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bmj.com news roundup Full versions of these stories are available at: bmj.com/content/vol324/issue7336/#NEWS_ROUNDUP
“No star” NHS trust slated by CHI report A trust which was given a “no star” rating for its performance by the Department of Health in September has come under attack again—this time from the Commission for Health Improvement. A commission report, published this week, criticises the Brighton Health Care NHS Trust for the long waits in accident and emergency, the poor environment for women in the breast screening clinic, and its system for admitting patients for elective surgery. Occupancy rates are so high that patients have to phone the hospital in the afternoon on the day of admission to see if a bed is available for them that night, it says. Sometimes they have to wait until 9 pm before knowing whether they can be admitted. But it did praise the trust for its friendly and dedicated staff, good training programme, and bereavement support group for patients, the Good Grief programme. Lynn Eaton London
Women more likely than men to die after heart surgery 15, 91
Women have as much as a three times higher risk than men of dying during or shortly after coronary artery bypass surgery, even though their coronary atherosclerosis may be less extensive and their heart pumping action may be better, a US study shows (Circulation 2002;105:1176-81). Authors of the study, led by Dr Viola Vaccarino of Emory University in Atlanta, Georgia, reviewed records of 51 187 patients in the National Cardiovascular Network database who underwent cardiac bypass surgery at 23 medical centres between October 1993 and December 1999. Thirty per cent (15 178) of these were women. “The younger the patients, the greater the mortality difference between women and men,” said 504
RAYMOND RUTTING
218, 219, 346, 204
Netherlands to run trials of marijuana in patients with multiple sclerosis 248, 210
The Dutch government has announced a small scale crossover trial into the effect of three sorts of medical marijuana, plus a placebo, on 16 patients with multiple sclerosis. Two foundations in Rotterdam, the Institute for Medical Marijuana and Maripharm, have been contracted by the government to produce the drug to a standard quality and provide metal pipes for inhalation. A Bureau for Medical Cannabis, set up by the ministry and the Amsterdam’s Free University medical centre, will run the year’s trial. The bureau also intends to make medicinal cannabis available through pharmacists on prescription by spring 2003. The Dutch cabinet recently agreed to change the law to permit this. Four trials of cannabis are taking place in the United Kingdom. The cannabis in multiple sclerosis (CAMS) study, which is sponsored by the Medical Research Council, started at Derriford Hospital, Plymouth, last year and aims to take in 660 participants in 40 centres. Three smaller phase II trials—in Guernsey, Oxford, and Norfolk— have been under way since autumn 2000, examining a sublingual spray developed from plants grown by G W Pharmaceuticals in Kent. The researchers expect to extend these trials to 2000 patients over two years and to enrol not only people with multiple sclerosis but also patients with various chronic pain syndromes, such as neuralgia and lower back pain. Tony Sheldon Utrecht
Dr Vaccarino, associate professor of medicine at Emory’s medical school and associate professor of epidemiology at its Rollins School of Public Health. She could not explain this difference. “In all age groups, women had less severe coronary artery disease and higher left ventricular ejection fraction and had less often a prior history of MI [myocardial infarction] or CABG [coronary artery bypass graft] compared with men,” said the study. “It seems paradoxical, but that’s what the data show,” said Dr Vaccarino. David Spurgeon Quebec
Israel stops private medical services in state hospitals 218, 25, 117
Private medical services launched without official approval six years ago in hospitals owned by the Israeli government will have to shut down by 30 April. The services, known by their Hebrew acronym “sharap,” have been provided in five of Israel’s largest state hospitals. The cancellation of the services is the result of a 49 page ruling by attorney general Elyakim Rubin-
stein and months of deliberations about the controversial subject. Sharap began informally, without official authorisation, in the mid-1990s in state hospitals in the metropolitan area of Tel Aviv and in Haifa. Patients who wanted to see specific doctors were told to deposit money in fictitious “research funds,” and the proceeds were then divided between the more experienced physicians. These payments sometimes also shortened the wait to see a doctor or have an operation. The attorney general’s ruling leaves the door open for a new form of private medical practice that would allow paying patients to choose their consultants or surgeons, but not to see them faster than patients who do not pay. Judy Siegel-Itzkovich Jerusalem
Surgeon criticised for transplant operation 99, 111
A senior surgeon in Germany has come under fire for going ahead with a kidney transplant operation using an organ from a living donor—despite the proposed operation being opposed by colleagues in psychological medicine and the ethics committee of the regional medical council. The surgical university hospital in Essen, where surgeon Christoph Broelsch is director, was approached by a dialysis patient from Israel who said his cousin from Moldavia, who was 30 years younger, wanted to donate his kidney. In 15 out of Germany’s 16 states, transplant law requires, in the case of living donors, that an independent committee ensures that there is no commercial basis to the donation and that there are emotional and personal ties between donor and recipient. None were found in this case, so the patient’s request was refused. He decided to resort to a hospital in the one state without such a rule, Thuringia. He went to the surgical university hospital in Jena, where he was accepted and where Professor Broelsh carried out the operation. The medical director of Essen University Hospital, Werner Havers, rejected any suspicion that the operation had involved any commercial trade in organs
BMJ VOLUME 324 2 MARCH 2002 bmj.com
News
Bush moves to tighten security around scientific research India faces drug resistant leishmaniasis 154, 200
Annette Tuffs Heidelberg
Judge criticises expert witness for misrepresenting research findings 25
A UK judge has strongly criticised an expert witness in a personal injury case, accusing him of misusing the works of others, misrepresenting his critics, and abandoning any claim to objectivity. Judge John Griffith Williams, recorder of Cardiff, sitting as a High Court judge, said that Peter Behan, emeritus professor of neurology at Glasgow University, “demonstrated a capacity to use his interpretation of the evidence to suit his purposes which conflicts with his duty to the court as an expert witness.” Professor Behan was representing Christine Perry, a former post office worker who alleged that she developed multiple sclerosis as a result of falling over a mailbag at work. Judge Griffith Williams accepted the evidence of the Post Office’s expert, Alastair Compston, professor of neurology at Cambridge University, that the injury experienced by Ms Perry was a chance coincidence unrelated to her multiple sclerosis. In his judgment, the judge said Professor Behan was “guilty of overstating his case, but of greater significance is … that he has put a gloss on the facts of this case to bring them within the criteria which he contends must be met.” In Professor Behan’s report to the court, said the judge, he had misrepresented the conclusions of three papers on the relation between trauma and multiple sclerosis. In one study that said a particular mechanism was “possible,” he had changed the word to “probable.” Professor Behan’s performance as an expert witness was also criticised by Mrs Justice Smith in 1997 and by Mr Justice Garland in 2000. Clare Dyer legal correspondent, BMJ
Untreated patients and drug resistant strains of the Leishmania donovani parasite are obstructing India’s efforts to control leishmaniasis, doctors cautioned at a conference in New Delhi last week. India’s health ministry has announced a control plan that is aimed at reducing the incidence of leishmaniasis to 25% by the year 2005 and declaring India free of the infection by 2012. “Less than 10% of the infected seek medical treatment, and 60% of cases in Bihar, the worst affected state, are resistant to the first line drug,” said Dr Philippe Desjeux, coordinator of leishmaniasis control at the World Health Organization in Geneva. Ganapati Mudur New Delhi
More clinics for younger people needed to reduce sex infections 32, 60
Sex education in schools needs to be improved and the number of clinics for young people increased if the substantial rise in sexually transmitted infection in the United Kingdom is to be tackled properly, the BMA has said. The association’s Board of Science and Education is calling for a substantial investment in education services, improved training for healthcare staff, and better prevention and treatment services after reports of a large rise in infections, particularly among teenage women and among men who have sex with men. “We need to get the message across to young people that there is still no cure for HIV/AIDS and that sexually transmitted infections, especially if left untreated, can be very serious, can cause infertility, and can sometimes lead to death,” said Dr Vivienne Nathanson, BMA’s head of science and ethics.
Fred Charatan Florida 141, 142, 123
In the wake of the anthrax attacks last October (BMJ 2001;323:942, 951), the Bush administration has been taking measures to improve secrecy about science research, in the hope of keeping biological weapons out of hostile hands. The move has been criticised by some scientists who think that it will threaten scientific advance and the spread of important information. Explaining the new policy, Tom Ridge, director of homeland security, said: “We’re working hard for a set of guidelines so terrorists can’t use information that this country produces against us.” He added that scientists were being closely consulted about any new guidelines. Last month, the government began to withdraw from circulation nearly 7000 technical documents that dealt mainly with the production of biological and chemical weapons. The documents, some of which were published as far back as the 1940s and ’50s, can no longer be purchased from government outlets or ordered on the internet. The Pentagon’s Defence Technical Information Center has custody of many reports, which are available to the public through the Scientific and Technical Information Network. For $50 (£35; €57) a year, the network provides citations to unclassified, unlimited documents. The US Department of Commerce’s National Technical Information Service sells military documents and other kinds of
federal documents. A spokeswoman said that 6619 documents had been removed from circulation and that the figure would rise as new candidate documents were identified for security review. The Federation of American Societies for Experimental Biology, representing 19 societies and over 66 000 scientists, was critical of the Bush administration’s move. “It comes down to a riskbenefit ratio,” said the federation’s president, Robert Rich. “I think the risk of forgone advances is much greater than the information getting into the wrong hands.” The American Society of Microbiology has over 40 000 members and is the world’s largest organisation that performs microbe research. It has been asked by the White House to limit potentially dangerous information in the 11 journals it publishes, which include Infection and Immunity, the Journal of Bacteriology, and the Journal of Virology. The society’s president, Dr Abigail Salyers, in an article to be published in March, wrote, “Terrorism feeds on fear, and fear feeds on ignorance.” The best defence against anthrax or any other infectious disease, Dr Salyers added, was information that can bolster public safety. But the Sun Sentinel, south Florida’s largest newspaper, wrote in a January editorial, “It’s just plain stupid to be making this kind of information available.”
AP PHOTO/RON EDWARDS
but said that Professor Broelsch should have abided by the vote of his Essen colleagues and the transplant operation should not have gone ahead.
Lynn Eaton London
The BMA’s report, Sexually Transmitted Infections, is available at www.bma.org.uk
BMJ VOLUME 324 2 MARCH 2002 bmj.com
President Bush waits to speak at Southern Maine Technical College 16779 505
