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Contraceptive pill approved in Japan
German health-care reform put on the agenda
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health system and will turn it into a state-ruled system controlled by economics. They have launched protests and public-information campaigns (L a n c e t 1999; 3 5 3 : 1950), and intend to sue the government for contradicting constitutional law. Health Minister, Andrea Fischer, says that criticisms are exaggerated and only justified by the profession’s wish to defend its own interests. The tension between Fischer and the GMA arose after Fischer accused doctors of “prescribing too many drugs for purely political reasons”. She added that “prescription of antibiotics is not necessary to treat influenza”. The GMA said “thousands of patients would have died last winter if doctors had followed Mrs Fischer’s advice” and asked her to apologise for her allegations. She finally apologised to doctors, in an icy and tense atmosphere, during her opening address in Cottbus. Fischer expressed her wishes to resume discussions with the medical profession. Nevertheless, GMA elect new president doctors intend to carry on On June 4, the GMA elected Jörg Dietrich their protests and have just Hoppe as its new president. Hoppe is a senior created an “alliance for hospital doctor in Düren and has been vice health” together with other president of the GMA since 1991. Karsten health professionals who also Vilmar, who has led the GMA for 21 years, was reject Fischer’s plans.
t its 102nd annual congress (Cottbus; June 1–5), the German Medical Association (GMA) rejected cost-cutting reforms of the health system, which are due to be implemented next year. The GMA fears that health care will be rationed and quality of care compromised. As part of the reforms doctors who spend beyond their budgets will have to refund the difference. The government also intends to reduce the number of medical practices, and will create a system of referring general practitioners (GPs) to limit direct access of patients to specialists. Patients who register with a referring GP will have their health-insurance fees reduced. Other areas of reform are in hospital financing and organisation, drug reimbursement schemes, and the financial and administrative role of health-insurance companies. Medical associations and trade unions think the reforms threaten the principles of the free German
remain before the development of EU legislation in this field could be considered”. Spanish deputy, Jose Valverde, who raised the question, received a similarly bleak response to his motion to introduce a standard EU prescription form. Such a form would enable patients in border regions to buy medications in a neighbouring state and allow travellers to collect a prescription outside their home state. The Commission said that the EU’s powers on health affairs remain too limited to contemplate legislation, even after treaty reforms which came into force on May 1. Arthur Rogers
Megan Rowling
Denis Durand de Bousingen
Plans for European Union health cards flounder lans by the European Parliament (EP) to introduce health cards are unlikely to go ahead in the foreseeable future, says the European Commission. Members of the EP have argued for years that citizens of the European Union (EU)—free to travel, reside, and work anywhere in the 15 member states—would benefit from a standardised electronic card that holds information about medical history, blood type, allergies, and reciprocal health-care entitlements. However, in the written replies to EP questions, published ahead of this week’s euroelections (June 10–13), the Commission reiterated its view that “major legal, political, and technical obstacles 2048
T
he low-dose contraceptive pill has finally been approved in Japan, more than 30 years after it was introduced in the USA. On June 2, the Central Pharmaceutical Affairs Council, an advisory body to the Japanese government, gave the green light to 16 types of pill manufactured by nine companies. Sales are expected to start in late August. The pharmaceutical firms first filed for approval in 1990 and 1991. But for nearly a decade the government prevaricated, citing health concerns and possible side-effects. While the decision is a triumph for campaigners some people are wary. In Japan, condoms account for about 75% of contraception and about 330 000 abortions are done each year. A shift in favour of the pill is expected to be slow, mainly because of practical concerns: lowdose pills will require a doctor’s prescription; will not be covered by the national-health insurance scheme; and a month’s supply will cost about 3000 yen (US$25). Many women are put off by the prospect of doctors recommending tests for sexually transmitted diseases before giving a prescription. Survey results show that less than 10% of women are keen to use the pill. According to Kunio Kitamura, head of the Japan Family Planning Association, this is about 2 million women —only ten times the number who are currently prescribed high and medium dose brands to treat menstrual disorders. “Awareness about the pill is poor, and usage will depend on how well Japanese women become informed, through the media and other channels”, said Kitamura. Pharmaceutical firms are conservative in their estimates of the size of the potential market. Annual pill sales are expected to grow to only 20–30 billion yen over the next few years—a tenth of the US market. Schering AG, and its Japanese partner Yamanouchi Pharmaceuticals, have stated their aim to get the top market share, mainly via sales of Triquilar. But Akzo Nobel affiliate, Japan Organon, which plans to sell Marvelon, is still trying to persuade the government that the third-generation pill does not carry a higher risk of phlebothrombosis than other brands.
named honorary president of the GMA.
P
Contraceptive pill approved in Japan
THE LANCET • Vol 353 • June 12, 1999
A
health system and will turn it into a state-ruled system controlled by economics. They have launched protests and public-information campaigns (L a n c e t 1999; 3 5 3 : 1950), and intend to sue the government for contradicting constitutional law. Health Minister, Andrea Fischer, says that criticisms are exaggerated and only justified by the profession’s wish to defend its own interests. The tension between Fischer and the GMA arose after Fischer accused doctors of “prescribing too many drugs for purely political reasons”. She added that “prescription of antibiotics is not necessary to treat influenza”. The GMA said “thousands of patients would have died last winter if doctors had followed Mrs Fischer’s advice” and asked her to apologise for her allegations. She finally apologised to doctors, in an icy and tense atmosphere, during her opening address in Cottbus. Fischer expressed her wishes to resume discussions with the medical profession. Nevertheless, GMA elect new president doctors intend to carry on On June 4, the GMA elected Jörg Dietrich their protests and have just Hoppe as its new president. Hoppe is a senior created an “alliance for hospital doctor in Düren and has been vice health” together with other president of the GMA since 1991. Karsten health professionals who also Vilmar, who has led the GMA for 21 years, was reject Fischer’s plans.
t its 102nd annual congress (Cottbus; June 1–5), the German Medical Association (GMA) rejected cost-cutting reforms of the health system, which are due to be implemented next year. The GMA fears that health care will be rationed and quality of care compromised. As part of the reforms doctors who spend beyond their budgets will have to refund the difference. The government also intends to reduce the number of medical practices, and will create a system of referring general practitioners (GPs) to limit direct access of patients to specialists. Patients who register with a referring GP will have their health-insurance fees reduced. Other areas of reform are in hospital financing and organisation, drug reimbursement schemes, and the financial and administrative role of health-insurance companies. Medical associations and trade unions think the reforms threaten the principles of the free German
remain before the development of EU legislation in this field could be considered”. Spanish deputy, Jose Valverde, who raised the question, received a similarly bleak response to his motion to introduce a standard EU prescription form. Such a form would enable patients in border regions to buy medications in a neighbouring state and allow travellers to collect a prescription outside their home state. The Commission said that the EU’s powers on health affairs remain too limited to contemplate legislation, even after treaty reforms which came into force on May 1. Arthur Rogers
Megan Rowling
Denis Durand de Bousingen
Plans for European Union health cards flounder lans by the European Parliament (EP) to introduce health cards are unlikely to go ahead in the foreseeable future, says the European Commission. Members of the EP have argued for years that citizens of the European Union (EU)—free to travel, reside, and work anywhere in the 15 member states—would benefit from a standardised electronic card that holds information about medical history, blood type, allergies, and reciprocal health-care entitlements. However, in the written replies to EP questions, published ahead of this week’s euroelections (June 10–13), the Commission reiterated its view that “major legal, political, and technical obstacles 2048
T
he low-dose contraceptive pill has finally been approved in Japan, more than 30 years after it was introduced in the USA. On June 2, the Central Pharmaceutical Affairs Council, an advisory body to the Japanese government, gave the green light to 16 types of pill manufactured by nine companies. Sales are expected to start in late August. The pharmaceutical firms first filed for approval in 1990 and 1991. But for nearly a decade the government prevaricated, citing health concerns and possible side-effects. While the decision is a triumph for campaigners some people are wary. In Japan, condoms account for about 75% of contraception and about 330 000 abortions are done each year. A shift in favour of the pill is expected to be slow, mainly because of practical concerns: lowdose pills will require a doctor’s prescription; will not be covered by the national-health insurance scheme; and a month’s supply will cost about 3000 yen (US$25). Many women are put off by the prospect of doctors recommending tests for sexually transmitted diseases before giving a prescription. Survey results show that less than 10% of women are keen to use the pill. According to Kunio Kitamura, head of the Japan Family Planning Association, this is about 2 million women —only ten times the number who are currently prescribed high and medium dose brands to treat menstrual disorders. “Awareness about the pill is poor, and usage will depend on how well Japanese women become informed, through the media and other channels”, said Kitamura. Pharmaceutical firms are conservative in their estimates of the size of the potential market. Annual pill sales are expected to grow to only 20–30 billion yen over the next few years—a tenth of the US market. Schering AG, and its Japanese partner Yamanouchi Pharmaceuticals, have stated their aim to get the top market share, mainly via sales of Triquilar. But Akzo Nobel affiliate, Japan Organon, which plans to sell Marvelon, is still trying to persuade the government that the third-generation pill does not carry a higher risk of phlebothrombosis than other brands.
named honorary president of the GMA.
P
Contraceptive pill approved in Japan
THE LANCET • Vol 353 • June 12, 1999