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How much can it cost?
Cross-culture communication needed ommunication between foreign patients and hospital staff must be improved, warned patients’ advocates from Homerton Hospital (Hackney, London, UK), at a Forum on Medical Communication held on March 4. Five patients’ advocates who specialise in women’s health and represent ethnic-minority groups in Hackney—including Somali, Vietnamese, and Punjabi people—asked that doctors be more aware of women’s cultural and religious backgrounds when giving treatment. One Punjabi advocate, Amrik Kaur Devgun, suggested doctors needed to handle certain Sikh issues that arose during health care sensitively. For example, when informing a Sikh woman about her still-birth, doctors must realise that she faces added pressure because her community will blame her for the loss. Also, after a baby’s birth a Sikh family might want to bury the placenta at home, for religious reasons. A Vietnamese patientadvocate, Mien Ly, said that many Vietnamese patients used herbal therapies. Doctors must be aware that their Vietnamese patients may be
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using alternative therapies before they come to the hospital. Margaret Yeboah, who represented West African patients, warned that traditional West-African beliefs sometimes conflicted with western
Staff and patients must communicate
medicine. For example, being an overweight woman in West African culture is seen as beautiful; and having normal, rather than caesarean, deliveries is important to women who will be judged on this basis. Hackney started patients’ advocacy projects over 20 years ago when it became clear that Asian and Turkish patients, particularly women who were having babies, could not communicate with those looking after
EC focuses scientific research for all Europeans
S
cientific research will need to focus on what will be of service to the Euro citizen, stated the European Commission (EC) offi cials at the Fifth Framework pro gramme of scientific research (FP5) in Essen, Germany, last week. The meeting gathered 5000 researchers from over 60 countries to hear what funding opportunities, which will commence this week, were being made available to them during 1999–2002. In the past 3 years FP4 research followed a science-driven approach. The emphasis has now shifted to a more problem-solving approach, which will involve to a greater extent industry, academia, and end-users in the management of scientific research. The new pro grammes will support research and technological development as part of community research policy and will constitute a strategic plan for transnational collaboration, partic ularly between universities and industry. Centres of excellence will also be established. Research for the next 3 years will be divided into four thematic pro
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grammes: quality-of-life and man agement of living resources; userfriendly information society; competitive and sustainable growth; and energy, environment, and sustainable development. The programmes are subdivided into 23 key action plans each focusing on issues of socioeconomics. One of the plans focuses on food, nutrition, and health, and aims to prevent diet-mediated illnesses by improv ing the safety of the food chain. Other plans will examine the reduc tion of health effects, such as aller gies related to environmental factors. The funding for these pro grammes will be Euros1496 million (US$1·7 billion). Edith Cresson, EC commissioner for Science, Research, and Development, said the “main objective is to draw the maximum benefits from the progress of sci ence and technology, and harness them to improve our economic competitiveness, to guarantee a high quality of life in Europe, and to create jobs”. Deepak Prasher
them. Today the advocates’ roles include taking case histories and advising women on their diet. Their primary role is to ensure that patients understand the treatment being offered, so choices can be made. There is still much ignorance and racism amongst health-care professionals, said Janet Richardson of City Hackney Community Council. But she continued, “the real problem now is that there has just been a cut in the advocacy budget”. She says there are many people arriving in Hackney all the time and that “they are the ones that really need help”, because they do not have a community base to rely on. “We have had some Bosnians . . . , Polish, Albanians, south Americans, and now some Russians; whenever there seems to be civil unrest people come over”, she added. Richardson says that last year’s budget cuts meant that one full-time advocacy post was lost and sessional workers who provide cover were also dropped. “So in the case of our Vietnamese speaking advocate when she is away there is no-one to cover”. Haroon Ashraf
How much can it cost? -
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he Swiss are asking themselves where the limits lie regarding the cost of medical care. The issue has become particularly relevant in Switzerland this year with the marketing of NovoSeven, an antihaemorrhage drug developed by Novo Nordisk (Denmark), which currently costs about US$34 300 for 1 day’s treatment. Esther Meili, haematologist at Zurich University Hospital, says NovoSeven is superior to any medication currently available. The first three times she used it to stop postnatal haemorrhage, which otherwise would have been fatal, the drug was provided by the manufacturers. On the third occasion the cost ($480 000) was met by the hospital. At Basle Hospital, a doctor who envisaged using this drug for a patient was prevented from doing so because of budgetary issues. Despite the patient’s minister offering to pay for the treatment the hospital vetoed the issue. The Swiss Medical Federation and the Academy of Medical Science will shortly produce a report dealing with these issues.
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Alan McGregor
THE LANCET • Vol 353 • March 13, 1999
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using alternative therapies before they come to the hospital. Margaret Yeboah, who represented West African patients, warned that traditional West-African beliefs sometimes conflicted with western
Staff and patients must communicate
medicine. For example, being an overweight woman in West African culture is seen as beautiful; and having normal, rather than caesarean, deliveries is important to women who will be judged on this basis. Hackney started patients’ advocacy projects over 20 years ago when it became clear that Asian and Turkish patients, particularly women who were having babies, could not communicate with those looking after
EC focuses scientific research for all Europeans
S
cientific research will need to focus on what will be of service to the Euro citizen, stated the European Commission (EC) offi cials at the Fifth Framework pro gramme of scientific research (FP5) in Essen, Germany, last week. The meeting gathered 5000 researchers from over 60 countries to hear what funding opportunities, which will commence this week, were being made available to them during 1999–2002. In the past 3 years FP4 research followed a science-driven approach. The emphasis has now shifted to a more problem-solving approach, which will involve to a greater extent industry, academia, and end-users in the management of scientific research. The new pro grammes will support research and technological development as part of community research policy and will constitute a strategic plan for transnational collaboration, partic ularly between universities and industry. Centres of excellence will also be established. Research for the next 3 years will be divided into four thematic pro
910
-
-
-
-
grammes: quality-of-life and man agement of living resources; userfriendly information society; competitive and sustainable growth; and energy, environment, and sustainable development. The programmes are subdivided into 23 key action plans each focusing on issues of socioeconomics. One of the plans focuses on food, nutrition, and health, and aims to prevent diet-mediated illnesses by improv ing the safety of the food chain. Other plans will examine the reduc tion of health effects, such as aller gies related to environmental factors. The funding for these pro grammes will be Euros1496 million (US$1·7 billion). Edith Cresson, EC commissioner for Science, Research, and Development, said the “main objective is to draw the maximum benefits from the progress of sci ence and technology, and harness them to improve our economic competitiveness, to guarantee a high quality of life in Europe, and to create jobs”. Deepak Prasher
them. Today the advocates’ roles include taking case histories and advising women on their diet. Their primary role is to ensure that patients understand the treatment being offered, so choices can be made. There is still much ignorance and racism amongst health-care professionals, said Janet Richardson of City Hackney Community Council. But she continued, “the real problem now is that there has just been a cut in the advocacy budget”. She says there are many people arriving in Hackney all the time and that “they are the ones that really need help”, because they do not have a community base to rely on. “We have had some Bosnians . . . , Polish, Albanians, south Americans, and now some Russians; whenever there seems to be civil unrest people come over”, she added. Richardson says that last year’s budget cuts meant that one full-time advocacy post was lost and sessional workers who provide cover were also dropped. “So in the case of our Vietnamese speaking advocate when she is away there is no-one to cover”. Haroon Ashraf
How much can it cost? -
-
-
he Swiss are asking themselves where the limits lie regarding the cost of medical care. The issue has become particularly relevant in Switzerland this year with the marketing of NovoSeven, an antihaemorrhage drug developed by Novo Nordisk (Denmark), which currently costs about US$34 300 for 1 day’s treatment. Esther Meili, haematologist at Zurich University Hospital, says NovoSeven is superior to any medication currently available. The first three times she used it to stop postnatal haemorrhage, which otherwise would have been fatal, the drug was provided by the manufacturers. On the third occasion the cost ($480 000) was met by the hospital. At Basle Hospital, a doctor who envisaged using this drug for a patient was prevented from doing so because of budgetary issues. Despite the patient’s minister offering to pay for the treatment the hospital vetoed the issue. The Swiss Medical Federation and the Academy of Medical Science will shortly produce a report dealing with these issues.
T
Alan McGregor
THE LANCET • Vol 353 • March 13, 1999