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Ontario prepares for strike action
THE LANCET
POLICY AND PEOPLE
German nephrologists demand painkiller ban
L
Ontario prepares for strike action
ast week at their annual conference in Berlin, German nephrologists insisted that pharmaceutical manufacturers withdraw combination painkillers from the market. In a public statement, they criticised earlier statements that these drugs are harmless and useful. Those comments were made by scientists working for the manufacturers of the combination products and were not based an any new scientific evidence. Most of the drugs in question contain acetylsalicylic acid, paracetamol, and caffeine (APC). The manufacturers argue that the addition of caffeine reduces drug intake. But, both of the German nephrological societies have stated that caffeine can cause physical addiction. In Germany up to 10% of about 42 000 dialysis patients have suffered from kidney failure due to analgesic nephropathy despite the fact that
phenacetin has been banned many years ago. APC combinations are dangerous and unnecessary, even for the treatment of headache, and should be entirely withdrawn, the German nephrologists have said. By giving this advice they are following the example to their American colleagues of the National Kidney Foundation who made a similar statement in January. These drugs should not be sold over the counter and advertisements and commercials should be withdrawn according to the nephrologists. They add that the drugs should at least be labelled warning that regular use can lead to renal failure and renal disease. The nephrologists also want the federal drug agency to pay more attention to the risks of APC combinations and take steps to reduce the harm caused. Annette Tuffs
Wayne Kondro
US abortion veto sustained
Popular US health provisions signed
First use of Australian euthanasia laws
D
O
n Sept 26, President Clinton signed into law legislation which limits insurance company discrimination against people with mental illness and ensures that newly delivered mothers and their infants are guaranteed at least a 48hour hospital stay. Members of Congress opposed to these popular measures were loath to say so. But they extracted concessions behind closed doors. These two laws will not come into effect until Jan 1, 1998, and the mental-health provision will end on Sept 30, 2001. Supporters hailed the mentalhealth legislation for its precedential value. Indeed, the language was nearly identical to a proposal jettisoned from health-insurance legislation in August (see Lancet, Aug 10, p 398). Senator Pete Domenici (Republican, New Mexico), the key proponent of the new law, called it “one step against the discrimination and one step against the stigma that is predicated on concepts from the Dark Ages”.
A
Julie Rovner
Kathy Ettershank
espite anti-abortion activists, the US Senate voted on Sept 26 to sustain President Clinton’s April veto of a bill that would outlaw a specific procedure used to perform late-term abortions. The 57–41 vote was nine short of the two-thirds margin needed to override the veto. The House voted narrowly to override the veto but both houses must concur or the bill dies. Abortion foes are confident of a victory in the November elections. “Every time we vote and every time this debate takes place, more and more Americans come over to our side”, said Gary Bauer, president of the Family Research Council, a US anti-abortion organisation. Others argue that the procedure may be necessary for women who discover major fetal anomalies late in pregnancy. “These decisions must be made by women in consultation with their doctors, not by politicians and lobbyists in the halls of Congress,” said Vicki Saporta, Executive Director of the National Abortion Federation.
F
aced with the looming threat of a strike by the province’s physicians, Ontario Health Minister Jim Wilson says that residents will be allowed to freely venture to the USA for medical treatment if they cannot receive it in their own communities. Outlining provincial contingency plans, in the event of either a widespread strike or a more limited withdrawal of emergency services at hospitals, Wilson told reporters the province will waive existing restrictions on the amount of money it pays for out-of-province medical services should Ontario’s 8000 medical specialists proceed with plans to stop working on Nov 1. “In an emergency situation, we expect the patient to be served first and who pays the bills sorted out later”, Wilson said on Sept 24. The province is also negotiating with US immigration officials to more readily allow Ontario residents and refugees to cross the border for medical treatment.
Darwin man recently became the first person in the world to die under legislation legalising euthanasia. The man, whose doctor obtained the required authorisations under the Northern Territory’s Rights of the Terminally Ill Act, died with the aid of a computer-linked machine that administered lethal drugs. The death has sparked division among the nation’s politicians over an upcoming private member’s bill that, if enacted, allows the Federal government to override the Territory legislation. Both major parties will allow their members a conscience vote on the issue when it is debated in parliament at the end of October. Both the Prime Minister and the Federal Opposition leader suppprt the bill. Ironically, some of the Territory’s politicians who were vocal advocates against the Act before it became law are now defending its existence because of another principle—the right of a state or territory parliament to make a new law without the Federal Parliament’s interference.
Julie Rovner
952
Vol 348 • October 5, 1996
POLICY AND PEOPLE
German nephrologists demand painkiller ban
L
Ontario prepares for strike action
ast week at their annual conference in Berlin, German nephrologists insisted that pharmaceutical manufacturers withdraw combination painkillers from the market. In a public statement, they criticised earlier statements that these drugs are harmless and useful. Those comments were made by scientists working for the manufacturers of the combination products and were not based an any new scientific evidence. Most of the drugs in question contain acetylsalicylic acid, paracetamol, and caffeine (APC). The manufacturers argue that the addition of caffeine reduces drug intake. But, both of the German nephrological societies have stated that caffeine can cause physical addiction. In Germany up to 10% of about 42 000 dialysis patients have suffered from kidney failure due to analgesic nephropathy despite the fact that
phenacetin has been banned many years ago. APC combinations are dangerous and unnecessary, even for the treatment of headache, and should be entirely withdrawn, the German nephrologists have said. By giving this advice they are following the example to their American colleagues of the National Kidney Foundation who made a similar statement in January. These drugs should not be sold over the counter and advertisements and commercials should be withdrawn according to the nephrologists. They add that the drugs should at least be labelled warning that regular use can lead to renal failure and renal disease. The nephrologists also want the federal drug agency to pay more attention to the risks of APC combinations and take steps to reduce the harm caused. Annette Tuffs
Wayne Kondro
US abortion veto sustained
Popular US health provisions signed
First use of Australian euthanasia laws
D
O
n Sept 26, President Clinton signed into law legislation which limits insurance company discrimination against people with mental illness and ensures that newly delivered mothers and their infants are guaranteed at least a 48hour hospital stay. Members of Congress opposed to these popular measures were loath to say so. But they extracted concessions behind closed doors. These two laws will not come into effect until Jan 1, 1998, and the mental-health provision will end on Sept 30, 2001. Supporters hailed the mentalhealth legislation for its precedential value. Indeed, the language was nearly identical to a proposal jettisoned from health-insurance legislation in August (see Lancet, Aug 10, p 398). Senator Pete Domenici (Republican, New Mexico), the key proponent of the new law, called it “one step against the discrimination and one step against the stigma that is predicated on concepts from the Dark Ages”.
A
Julie Rovner
Kathy Ettershank
espite anti-abortion activists, the US Senate voted on Sept 26 to sustain President Clinton’s April veto of a bill that would outlaw a specific procedure used to perform late-term abortions. The 57–41 vote was nine short of the two-thirds margin needed to override the veto. The House voted narrowly to override the veto but both houses must concur or the bill dies. Abortion foes are confident of a victory in the November elections. “Every time we vote and every time this debate takes place, more and more Americans come over to our side”, said Gary Bauer, president of the Family Research Council, a US anti-abortion organisation. Others argue that the procedure may be necessary for women who discover major fetal anomalies late in pregnancy. “These decisions must be made by women in consultation with their doctors, not by politicians and lobbyists in the halls of Congress,” said Vicki Saporta, Executive Director of the National Abortion Federation.
F
aced with the looming threat of a strike by the province’s physicians, Ontario Health Minister Jim Wilson says that residents will be allowed to freely venture to the USA for medical treatment if they cannot receive it in their own communities. Outlining provincial contingency plans, in the event of either a widespread strike or a more limited withdrawal of emergency services at hospitals, Wilson told reporters the province will waive existing restrictions on the amount of money it pays for out-of-province medical services should Ontario’s 8000 medical specialists proceed with plans to stop working on Nov 1. “In an emergency situation, we expect the patient to be served first and who pays the bills sorted out later”, Wilson said on Sept 24. The province is also negotiating with US immigration officials to more readily allow Ontario residents and refugees to cross the border for medical treatment.
Darwin man recently became the first person in the world to die under legislation legalising euthanasia. The man, whose doctor obtained the required authorisations under the Northern Territory’s Rights of the Terminally Ill Act, died with the aid of a computer-linked machine that administered lethal drugs. The death has sparked division among the nation’s politicians over an upcoming private member’s bill that, if enacted, allows the Federal government to override the Territory legislation. Both major parties will allow their members a conscience vote on the issue when it is debated in parliament at the end of October. Both the Prime Minister and the Federal Opposition leader suppprt the bill. Ironically, some of the Territory’s politicians who were vocal advocates against the Act before it became law are now defending its existence because of another principle—the right of a state or territory parliament to make a new law without the Federal Parliament’s interference.
Julie Rovner
952
Vol 348 • October 5, 1996