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AMA wins favours in Medicare reform bill
THE LANCET
POLICY AND PEOPLE
Clinton wants human cloning banned—for the time being at least
P
But the proposed law is not a complete ban on human cloning research nor is it supposed to be the last word on the issue. Instead, the law would allow the use of humancloning techniques in laboratory experiments and would allow the cloning of animals. The legislation will also call for Congress to revisit the topic in 5 years, when more is known about safety and ethics.
resident of the USA, Bill Clinton, announced on June 6 that he was sending legislation to Congress that would outlaw the use of human-cloning techniques to create a child. “Attempting to clone a human being is unacceptably dangerous to the child and morally unacceptable to our society”, Clinton said. Until that legislation is passed, Clinton said, he would continue the ban he ordered earlier this year
banning the use of all federal funding for human-cloning research. He also asked that the private sector voluntarily refrain from using the technique. Clinton issued the ban last March after news broke that Ian Wilmut and his colleagues at the Roslin Institute, Edinburgh, UK, had successfully cloned an adult sheep, demonstrating for the first time that it was possible to clone an adult mammal.
AMA wins favours in Medicare reform bill
Abortion takes centre-stage in Polish politics
T
Julie Rovner
1752
The tribunal’s ruling requires pars Pope John Paul II continues his liamentary review of the current law pilgrimage to his native Poland, within 6 months. Democratic Left political leaders are calling for a referAlliance leader Josef Oleksy said that endum on abortion to be held at the the referendum should coincide with same time as national elections later the elections, partly to this year. A constituincrease voter turnout. tional tribunal ruling According to official rejected a law passed Polish sources, research last October by parliaindicates that most ment, which signifiPoles support restricted cantly liberalised access access to abortion, but to the procedure. The opinions differ widely law allowed abortion in on when exceptions the first trimester for should be made. The women who for situation is further personal or economic complicated by the reasons feel they cannot presence of John Paul support a child. II, who has been on an The law was an Papal politics in Poland extended visit to Poland attempt to loosen the since the beginning of June, and has restrictions imposed in 1993 by the spoken repeatedly against abortion. government of former Solidarity “It is a very difficult time for us”, leader, Lech Walesa, which permitted said one official in Washington who termination of pregnancy only in the requested anonymity. “Some parties case of rape, incest, severe defect, or may try to ride this question as a when the life of the mother was in fundamental political issue.” danger. That law in turn had reversed long-standing communist-era policy allowing abortion on demand. Josh Hamilton, Rober t Ivker
A
AP
he American Medical Association denied that the organisation’s last-minute endorsement of a Republican-backed abortion bill pending in Congress last month came with the promise of later favours. Nevertheless, the Medicare reform bill, unveiled by Republican healthcare leaders on June 3, included nearly all of the AMA’s priority items. Not surprising was the inclusion in the bill of a provision to limit noneconomic damages for “pain and suffering” in medical malpractice suits to $250 000—a top AMA priority. The House passed such a provision three separate times in 1995 and 1996; the Senate rejected it each time. Also in the bill are provisions to allow doctors and hospitals to join together as “provider service organisations”, to compete with insurance companies to serve Medicare patients. The AMA was also pleased that such enterprises would be certifiable by the federal government if they are rejected by states, which are considered more partial to insurance interests. Doctors would also benefit from a proposal to allow up to 500 000 Medicare beneficiaries to set up “medical savings accounts”. The physicians who serve such patients would not be subject to Medicare’s regular fee caps. And physicians would be able to ask the Justice Department for “advisory opinions” on whether certain business arrangements violate a ban on referrals to entities in which the physician has a financial interest. The bill would also delay by 1 year a change in Medicare’s physician-fee schedule that has badly divided the medical community.
Michael McCar thy
Combination DPT/Hib vaccine fails FDA test hysicians awaiting a vaccine against diphtheria, pertussis, tetanus (DPT), and Haemophilus influenzae type b (Hib), may have to wait longer. On June 5, a US Food and Drug Administration advisory committee found that the Pasteur Mérieux Connaught vaccine TriHIBit, which has an acellular pertussis component, might not protect fully against Hib. The committee was unanimous that TriHIBit, tested in 4300 infants, provided immune responses to diphtheria and tetanus toxoids, and to two acellular pertussis
P
components, and that it seemed to have the same local and systemic reaction rates as separate vaccines. But the panel was split on whether the Hib response was adequate. The committee also heard from FDA scientists that there seems to be a growing US adult pertussis caseload, partly due to waning immunity. The panel had preliminary discussions on whether it might be appropriate to begin booster shots in adolescents and young adults. Alicia Ault
Vol 349 • June 14, 1997
POLICY AND PEOPLE
Clinton wants human cloning banned—for the time being at least
P
But the proposed law is not a complete ban on human cloning research nor is it supposed to be the last word on the issue. Instead, the law would allow the use of humancloning techniques in laboratory experiments and would allow the cloning of animals. The legislation will also call for Congress to revisit the topic in 5 years, when more is known about safety and ethics.
resident of the USA, Bill Clinton, announced on June 6 that he was sending legislation to Congress that would outlaw the use of human-cloning techniques to create a child. “Attempting to clone a human being is unacceptably dangerous to the child and morally unacceptable to our society”, Clinton said. Until that legislation is passed, Clinton said, he would continue the ban he ordered earlier this year
banning the use of all federal funding for human-cloning research. He also asked that the private sector voluntarily refrain from using the technique. Clinton issued the ban last March after news broke that Ian Wilmut and his colleagues at the Roslin Institute, Edinburgh, UK, had successfully cloned an adult sheep, demonstrating for the first time that it was possible to clone an adult mammal.
AMA wins favours in Medicare reform bill
Abortion takes centre-stage in Polish politics
T
Julie Rovner
1752
The tribunal’s ruling requires pars Pope John Paul II continues his liamentary review of the current law pilgrimage to his native Poland, within 6 months. Democratic Left political leaders are calling for a referAlliance leader Josef Oleksy said that endum on abortion to be held at the the referendum should coincide with same time as national elections later the elections, partly to this year. A constituincrease voter turnout. tional tribunal ruling According to official rejected a law passed Polish sources, research last October by parliaindicates that most ment, which signifiPoles support restricted cantly liberalised access access to abortion, but to the procedure. The opinions differ widely law allowed abortion in on when exceptions the first trimester for should be made. The women who for situation is further personal or economic complicated by the reasons feel they cannot presence of John Paul support a child. II, who has been on an The law was an Papal politics in Poland extended visit to Poland attempt to loosen the since the beginning of June, and has restrictions imposed in 1993 by the spoken repeatedly against abortion. government of former Solidarity “It is a very difficult time for us”, leader, Lech Walesa, which permitted said one official in Washington who termination of pregnancy only in the requested anonymity. “Some parties case of rape, incest, severe defect, or may try to ride this question as a when the life of the mother was in fundamental political issue.” danger. That law in turn had reversed long-standing communist-era policy allowing abortion on demand. Josh Hamilton, Rober t Ivker
A
AP
he American Medical Association denied that the organisation’s last-minute endorsement of a Republican-backed abortion bill pending in Congress last month came with the promise of later favours. Nevertheless, the Medicare reform bill, unveiled by Republican healthcare leaders on June 3, included nearly all of the AMA’s priority items. Not surprising was the inclusion in the bill of a provision to limit noneconomic damages for “pain and suffering” in medical malpractice suits to $250 000—a top AMA priority. The House passed such a provision three separate times in 1995 and 1996; the Senate rejected it each time. Also in the bill are provisions to allow doctors and hospitals to join together as “provider service organisations”, to compete with insurance companies to serve Medicare patients. The AMA was also pleased that such enterprises would be certifiable by the federal government if they are rejected by states, which are considered more partial to insurance interests. Doctors would also benefit from a proposal to allow up to 500 000 Medicare beneficiaries to set up “medical savings accounts”. The physicians who serve such patients would not be subject to Medicare’s regular fee caps. And physicians would be able to ask the Justice Department for “advisory opinions” on whether certain business arrangements violate a ban on referrals to entities in which the physician has a financial interest. The bill would also delay by 1 year a change in Medicare’s physician-fee schedule that has badly divided the medical community.
Michael McCar thy
Combination DPT/Hib vaccine fails FDA test hysicians awaiting a vaccine against diphtheria, pertussis, tetanus (DPT), and Haemophilus influenzae type b (Hib), may have to wait longer. On June 5, a US Food and Drug Administration advisory committee found that the Pasteur Mérieux Connaught vaccine TriHIBit, which has an acellular pertussis component, might not protect fully against Hib. The committee was unanimous that TriHIBit, tested in 4300 infants, provided immune responses to diphtheria and tetanus toxoids, and to two acellular pertussis
P
components, and that it seemed to have the same local and systemic reaction rates as separate vaccines. But the panel was split on whether the Hib response was adequate. The committee also heard from FDA scientists that there seems to be a growing US adult pertussis caseload, partly due to waning immunity. The panel had preliminary discussions on whether it might be appropriate to begin booster shots in adolescents and young adults. Alicia Ault
Vol 349 • June 14, 1997