Mr Justice Collins said during the hearing: âThis case was pre- sented by the media as Professor. Meadow's evidence having caused a miscarriage of justice.
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bmj.com news roundup Full versions of these stories are available at: bmj.com/content/vol332/issue7535/#NEWS_ROUNDUP
Review says oseltamivir and zanamivir should be kept for epidemics of flu The neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza) may be effective in serious epidemic or pandemic influenza but must be used together with infection control procedures, says a Cochrane review published last week. The review said that these drugs should not be used for seasonal flu but should be kept for serious epidemics and that other antivirals should not be used at all for flu. The review, which was published online ahead of print publication on 19 January in the Lancet (www.thelancet.com, doi: 10.1016/S0140-6736(06)67 970-1), analysed data from randomised controlled trials of both classes of antivirals currently used to prevent or treat flu: the M2 ion channel inhibitors, amantadine and rimantadine, and two of the newer neuraminidase inhibitors, zanamivir and oseltamivir. The review showed that the neuraminidase inhibitors reduced flu symptoms and interrupted transmission of seasonal flu, in addition to reducing nasal shedding. However, they did not prevent asymptomatic infection. When used in prophylaxis, oral oseltamivir (75 mg daily) prevented 61% (95% confidence interval 15% to 82%) of cases of symptomatic flu, increasing to 73% (33% to 89%) at a higher dose (150 mg daily). Inhaled zanamivir (10 mg daily) prevented 62% of cases (15% to 83%). Susan Mayor London
Media’s treatment of Roy Meadow was “unfair,” says High Court judge 130, 351
The retired paediatrician Roy Meadow was unfairly found guilty of serious professional misconduct and struck off the medical register, his barrister told the High Court in London this week. Professor Meadow was 196
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604, 48, 154, 170
German doctors march in protest at health cuts 347, 129, 117
More than 20 000 doctors in Germany shut their practices last week and marched through Berlin (above) to demand changes in the healthcare system, better pay, and less bureaucracy. And they said that strikes and protests would continue until politicians took action. Only weeks ago hospital services were reduced to emergency services alone as thousands of young doctors went on strike with similar demands. Last week’s demonstration was part of a protest by the 100 000 GPs and specialists who run their own practices. “The German health system needs an increase in budget of about €7bn [£4.8bn; $8.6bn] just for outpatient and GP care,” said the president of the German Medical Association (Bundesärztekammer), Joerg-Dietrich Hoppe. He also demanded an easing in paperwork, which is cutting into time that could better be spent caring for patients. A third of doctors’ practices in Germany are struggling to survive economically, Dr Hoppe said, and in the next few years some rural areas will no longer have any GP care. Annette Tuffs Heidelberg
found last year to have given misleading statistical evidence at the trial of Sally Clark for the murder of her two sons. Mrs Clark was convicted in 1999 of murdering babies Christopher and Harry, but her convictions were quashed on a second appeal in 2003. Last July the General Medical Council concluded that Professor Meadow, an expert witness for the prosecution, had abused his position as a doctor and ordered his name to be erased from the register (BMJ 2005:331;177). This week, as Professor Meadow launched a High Court appeal against the GMC’s conclusions and penalty, the judge hearing the case accused the media of wrongly blaming him for Mrs Clark’s convictions. Mr Justice Collins said during the hearing: “This case was presented by the media as Professor
Meadow’s evidence having caused a miscarriage of justice. That’s unfair, manifestly unfair. “It may have contributed to it—who knows?—but the suggestion that it caused it is wrong and always has been.” The judge is expected to take several weeks before delivering judgment. Clare Dyer legal correspondent, BMJ
Three hospital PFI schemes are delayed while government looks at their cost 218, 116
Several private finance initiative (PFI) schemes for hospitals are likely to be reviewed as the UK government becomes increas-
ingly worried about the financial state of the NHS. In what is seen as a test case of the government’s resolve to cut back in a financially tight NHS, a last minute review was due to report—as the BMJ went to press—on the proposed £1.2bn ($2.1bn; €1.8bn) PFI scheme to refurbish St Bartholomew’s and the Royal London hospitals. The Department of Health and the Treasury initiated a review of the scheme’s affordability just before Christmas. This was despite initial approval from North East London Strategic Health Authority and nearby primary care trusts for the scheme. An agreement was due to be signed with the developer around the time the review was announced, and builders are on site ready to start work. Two other PFI schemes, at Plymouth Hospitals NHS Trust and at Hillingdon Hospital in Uxbridge, west London, are now also reported to have been halted while they are reviewed by the Department of Health. Adrian O’Dowd London
US agency wants to limit lawsuits against drug manufacturers 186
The US Food and Drug Administration has issued a policy statement that will make it harder for people to sue drug manufacturers. The statement, supporting an arrangement known as “preemption,” was inserted into the agency’s new guidelines on drug labelling. It asserts that complying with the FDA’s labelling requirements should pre-empt or supersede individual states’ liability statutes. The new statement means that, in the FDA’s opinion, as long as a drug company complies with federal labelling laws, the company should not be found in violation of statutes on “failure to warn.” The statement does not have the force of law but may be considered by the courts. The statement sparked an angry reaction from Edward
BMJ VOLUME 332 28 JANUARY 2006 bmj.com
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Twin study shows cannabis makes moving to hard drugs more likely
Jeanne Lenzer New York
The FDA’s statement is at www.fda.gov/bbs/topics/news/ 2005/NEW01272.html.
GPs facing removal from primary care trusts’ lists may get legal representation 130, 25
The Department of Health in England is to appeal against a High Court ruling last week that it fears could turn the new procedure for striking misbehaving or badly performing doctors off primary care trusts’ lists into a lengthy, expensive, and legalistic process. The judgment from Mr Justice Toulson came in test cases brought by two GPs who argued that a refusal to let them have legal representation, call witnesses, and cross examine witnesses through their lawyers at the oral hearing to decide on their removal would deny them a fair hearing. The judge ruled that what is fair depended on the individual case and the complexity of the allegations. In the case of the two GPs, it meant that they were entitled to cross examine witnesses making accusations
against them, if the witnesses were willing, unless there were exceptional circumstances making it impossible. The judge was told that the 2004 regulations were brought in to replace an earlier procedure that was so expensive and complex that trusts were reluctant to use it. The new regulations state simply that a doctor threatened with removal from a primary care trust’s “performers list” is entitled to an oral hearing before a trust panel. A doctor’s lawyer can be present, but only the chairperson may question witnesses. Clare Dyer legal correspondent, BMJ
Health department gives £12m backing to Dr Foster company 167, 218
The Department of Health in England is paying the healthcare research company Dr Foster £12m ($21m; €17m) to set up a public-private venture aimed at making better use of medical records. The NHS and Dr Foster will each have a 50% stake in the new company, called Dr Foster Intelligence. Patricia Hewitt, the secretary of state for health, hailed the deal as a “welcome example of the public and private sectors combining to work in partnership” to boost the care of patients. Observers said the move showed that ministers were keen to use the NHS’s own data on hospital outcomes to obtain much needed boosts in productivity. Alan Maynard, professor of health economics at York University, said there were “masses of data to be exploited.” He said: “I think the government has decided it wants to make the most of this data. If the Dr Foster partnership helps and ultimately improves productivity, [that is] all well and good.” Opponents of the deal, however, said the government had not put the deal out to competitive tender and had provided little evidence of what the public could expect to get for its £12m. Michael Day London
BMJ VOLUME 332 28 JANUARY 2006 bmj.com
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The chance of Dutch teenagers using hard drugs later in life is six times greater among those who use cannabis than among those who don’t. This is the conclusion of a study from Amsterdam’s Free University. The authors of the study, which was published online ahead of print on 10 January in Behavior Genetics (www.springerlink.com, doi: 10.1007/s10519005-9023-x), say that preventing teenagers under 18 using cannabis can be important in ensuring that they don’t move to hard drugs later. The study casts doubt on one of the main arguments underpinning the tolerant policy towards cannabis in the Netherlands. This policy is designed to separate the markets of soft and hard drugs, thus protecting cannabis users from the criminal environment of hard drugs. Its findings are similar to that of another study that was conducted in Australia, where cannabis remains illegal (JAMA 2003;289:427-33). The new study was able to use data from an ongoing study on health related behaviour among twins. Of a total study group of more than 6000 twins, 219 same sex pairs were selected in which one twin reported using cannabis by the age of 18 and the other did not. This meant the researchers could control for potentially confounding family factors, such as genetics or environmental factors, that could predispose young people to early cannabis use or later illicit drug use.
The results showed that the twin who used cannabis before the age of 18 had a greater risk of later use of other drugs and drug dependency. Of this group, 6.4% reported regular use of ecstasy and 5.1% reported regular use of hard drugs. None of their cotwins reported such regular use. One of the authors, the biological psychologist Jacqueline Vink, said that by comparing twins who grew up with the same biological parents and in the same environment, “familial factors” could be ruled out as a cause of the association. However, she said, “There could be some unique environmental factors, such as having different friends or experiences.” Meanwhile, the researchers point out the success of the Dutch policy of tolerance on overall prevalence of cannabis use. The proportion of adults who have ever used cannabis in the Netherlands is 12.3%—half the rate in the United States and less than a third of the similar estimate for Australia. “Compared with other countries the Dutch policy seems to be right—but for reasons other than that which was intended. We still see that people who use cannabis at an early age face a significantly elevated risk of using illicit drugs and developing drug dependency later in life,” said Dr Vink. Data for 2003 from Utrecht based Trimbos Institute for mental health and addiction shows that a fifth of Dutch 12 to 18 year olds reported having used cannabis.
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Kennedy, the Democrat senator for Massachusetts. “It’s a typical abuse by the Bush administration: take a regulation to improve the information that doctors and patients receive about prescription drugs and turn it into a protection against liability for the drug industry,” he said. Scott Gottlieb, the FDA’s deputy commissioner for medical and scientific affairs, said, “What we are saying is that if a sponsor brings us all their evidence, everything they know about a drug, and we decide what should and should not be included in the label based on our scientific review, then that federal process should have some merit in these ‘failure to warn’ cases in the state courts.” Proponents of pre-emption argue that lawsuits are threatening the financial stability of drug companies and create expenses that are passed on to consumers.
Despite the fact that some coffee shops in Amsterdam can legally serve cannabis, the national usage rate is half that of the United States 197
