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Australia's euthanasia law moves forward
THE LANCET
POLICY AND PEOPLE
Canadian settlement guarantees world medical isotope supply
T
new reactor. MDS promptly filed suit against AECL and the federal government seeking $300 million in damages. Nordion commandeers a projected 80% of the world market for medical isotopes. The MDS subsidiary purifies and processes the isotopes before selling them to pharmaceutical firms. Under the terms of the agreement, Ottawa will provide $5 million from general revenues and $12·5 million through AECL towards construction of the two Maple reactors, which are now scheduled to be operational by the end of the year 2001. Nordion will own the reactors, while AECL will operate them on a contract-forservices basis. The $100-million interest-free loan will be repaid over a 20-year term.
he world’s primary supply of medical isotopes has been assured as a result of an out-of-court settlement reached between the Canadian government and a medical supplier involved in controversy over construction of a new nuclear reactor. The Canadian government will provide Can$17·5 million and an interest-free $100million loan to the Toronto-based MDS Health Group under an out-of-court settlement reached last month. The money will pay for two Maple nuclear reactors and a processing facility for the production of medical isotopes. The settlement was in
response to a legal suit seeking $300 million in damages for a federal decision to forego construction of a nuclear reactor at an Atomic Energy of Canada Ltd site. MDS had purchased isotope supplier Nordion International from AECL in 1991 on the proviso that the federal agency would provide molybdenum-99 medical isotopes at a fixed price for a 23-year period, as well as build a Maple X-10 reactor to replace a decaying research reactor that was being used to produce the isotopes. But 1993 federal budget cuts prompted AECL to announce that it could neither supply the isotopes at the predetermined price nor build a
Australia’s euthanasia law moves forward
UK’s Prodigy shows glimmer of promise
A
2–1 majority of Australia’s Northern Territory Supreme Court ruled on July 24 that the Rights of the Terminally Ill Act 1995 is valid. The Act came into operation at the beginning of July despite a challenge by president of the Territory’s branch of the Australian Medical Association, Chris Wake, and Aboriginal leader, the Reverend Djiniyini Gondarra (see Lancet June 29, p 1777). The Court held that the Territory’s power to make laws for the “peace, order and good government of the territory” was “of the same quality as that enjoyed by the states” and that the right to make laws to assist suicide came within the ambit of its power for the “maintenance of law and order and the administration of justice”. The dissenting judge said that the Act was invalid because the power of the executive of the Territory did not include the “legislative establishment of institutional termination of human life other than as punishment”. The AMA says that it will immediately seek leave to appeal to the High Court. High Court action, as well as debate in the Federal parliament of a private member’s bill to override the law, means that the Act still faces a number of hurdles before its provisions can be used with confidence.
Kathy Ettershank
328
T
he UK Department of Health’s pilot scheme for computerassisted prescribing by general practitioners, which was vehemently opposed by the pharmaceutical industry, has won a fair measure of support from general practitioners who have been testing the system in their day-to-day practice. According to an interim report published on July 29, 94% of GPs (in 137 practices) taking part in the pilot scheme thought Prodigy (Prescribing RatiOnally with Decision-support In General Practice) worth continuing, although nearly 40% wanted to see the guidelines and software “significantly improved”. Almost as many would be content with “some improvement”, and 16% would accept the system as it stands. Prodigy, which recommends preferred treatments, and for most
Wayne Kondro
drugs presents only generic names, incorporates therapeutic advice on 244 main diagnoses or symptoms (eg, hypertension, cough)—enough to cover most GP consultations. Prodigy has had some impact on GPs’ prescribing habits: in 30 test practices the average prescription cost rose by 4·8% (from £13·16 to £13·79) in the year ending with the 3-month period December, 1995, to February, 1996, compared with 5·9% (from £13·22 to £14) for all other practices in England. But the increase in generic prescribing in the same period was only 0·3% higher in participating practices (rising 3·2% from 57·6 to 60·8% of the total) than the rest (where it rose by 2·9%, from 54·3 to 57·2%). The final report is due in July, 1997. Dorothy Bonn
German transplant surgeon donates his kidney
L
ast week transplant surgeon Jochen Hoyer of Lübeck, Germany, announced at a press conference that he has donated one of his kidneys to an anonymous recipient in Munich. Hoyer said that he wanted to highlight living donation, which accounts for only 5% of all transplantions a year. An interdisciplinary expert group in Munich commented that altruistic
organ donation should be possible. However, the transplantation law, which is under discussion in parliament, will allow kidney donation by only blood relatives or other family members. Bavarian Health Minister Barbara Stamm criticised Hoyer’s participation in unrelated living donation, which has been rejected by politicians because of its risk of commercialisation. M
Vol 348 • August 3, 1996
POLICY AND PEOPLE
Canadian settlement guarantees world medical isotope supply
T
new reactor. MDS promptly filed suit against AECL and the federal government seeking $300 million in damages. Nordion commandeers a projected 80% of the world market for medical isotopes. The MDS subsidiary purifies and processes the isotopes before selling them to pharmaceutical firms. Under the terms of the agreement, Ottawa will provide $5 million from general revenues and $12·5 million through AECL towards construction of the two Maple reactors, which are now scheduled to be operational by the end of the year 2001. Nordion will own the reactors, while AECL will operate them on a contract-forservices basis. The $100-million interest-free loan will be repaid over a 20-year term.
he world’s primary supply of medical isotopes has been assured as a result of an out-of-court settlement reached between the Canadian government and a medical supplier involved in controversy over construction of a new nuclear reactor. The Canadian government will provide Can$17·5 million and an interest-free $100million loan to the Toronto-based MDS Health Group under an out-of-court settlement reached last month. The money will pay for two Maple nuclear reactors and a processing facility for the production of medical isotopes. The settlement was in
response to a legal suit seeking $300 million in damages for a federal decision to forego construction of a nuclear reactor at an Atomic Energy of Canada Ltd site. MDS had purchased isotope supplier Nordion International from AECL in 1991 on the proviso that the federal agency would provide molybdenum-99 medical isotopes at a fixed price for a 23-year period, as well as build a Maple X-10 reactor to replace a decaying research reactor that was being used to produce the isotopes. But 1993 federal budget cuts prompted AECL to announce that it could neither supply the isotopes at the predetermined price nor build a
Australia’s euthanasia law moves forward
UK’s Prodigy shows glimmer of promise
A
2–1 majority of Australia’s Northern Territory Supreme Court ruled on July 24 that the Rights of the Terminally Ill Act 1995 is valid. The Act came into operation at the beginning of July despite a challenge by president of the Territory’s branch of the Australian Medical Association, Chris Wake, and Aboriginal leader, the Reverend Djiniyini Gondarra (see Lancet June 29, p 1777). The Court held that the Territory’s power to make laws for the “peace, order and good government of the territory” was “of the same quality as that enjoyed by the states” and that the right to make laws to assist suicide came within the ambit of its power for the “maintenance of law and order and the administration of justice”. The dissenting judge said that the Act was invalid because the power of the executive of the Territory did not include the “legislative establishment of institutional termination of human life other than as punishment”. The AMA says that it will immediately seek leave to appeal to the High Court. High Court action, as well as debate in the Federal parliament of a private member’s bill to override the law, means that the Act still faces a number of hurdles before its provisions can be used with confidence.
Kathy Ettershank
328
T
he UK Department of Health’s pilot scheme for computerassisted prescribing by general practitioners, which was vehemently opposed by the pharmaceutical industry, has won a fair measure of support from general practitioners who have been testing the system in their day-to-day practice. According to an interim report published on July 29, 94% of GPs (in 137 practices) taking part in the pilot scheme thought Prodigy (Prescribing RatiOnally with Decision-support In General Practice) worth continuing, although nearly 40% wanted to see the guidelines and software “significantly improved”. Almost as many would be content with “some improvement”, and 16% would accept the system as it stands. Prodigy, which recommends preferred treatments, and for most
Wayne Kondro
drugs presents only generic names, incorporates therapeutic advice on 244 main diagnoses or symptoms (eg, hypertension, cough)—enough to cover most GP consultations. Prodigy has had some impact on GPs’ prescribing habits: in 30 test practices the average prescription cost rose by 4·8% (from £13·16 to £13·79) in the year ending with the 3-month period December, 1995, to February, 1996, compared with 5·9% (from £13·22 to £14) for all other practices in England. But the increase in generic prescribing in the same period was only 0·3% higher in participating practices (rising 3·2% from 57·6 to 60·8% of the total) than the rest (where it rose by 2·9%, from 54·3 to 57·2%). The final report is due in July, 1997. Dorothy Bonn
German transplant surgeon donates his kidney
L
ast week transplant surgeon Jochen Hoyer of Lübeck, Germany, announced at a press conference that he has donated one of his kidneys to an anonymous recipient in Munich. Hoyer said that he wanted to highlight living donation, which accounts for only 5% of all transplantions a year. An interdisciplinary expert group in Munich commented that altruistic
organ donation should be possible. However, the transplantation law, which is under discussion in parliament, will allow kidney donation by only blood relatives or other family members. Bavarian Health Minister Barbara Stamm criticised Hoyer’s participation in unrelated living donation, which has been rejected by politicians because of its risk of commercialisation. M
Vol 348 • August 3, 1996