- Email: [email protected]
Blood shortages
the need
first meeting included: for limitations on the source of embryos (eg, surgically removed ovaries, aborted fetal ovaries); the need for intensive investigation in laboratory-animal models before human experimentation; the relative research into human gametogenesis, newspapers were called for. Muller experimental value of non-viable vs viable seemed resistant to these appeals; he embryos; the willingness of participants in materno-embryo interactions, the influences of genomic imprinting on embryo prefers to design a policy before seeking in-vitro fertilisation (IVF) programmes to : donate their spare embryos for research; wider public opinion. development, and stem-cell formation. The panel’s concern stems from events and the importance of collecting data on This first meeting also revealed some: early conflicts-eg, about the definition of following publication of the last US report the long-term outcome of IVF compared terms such as pre-embryo, embryo, and on embryo research in 1979. Although with non-IVF pregnancies. other opinions had been sought during The next meeting will be held on fetus, the value of implantation and gasof the trulation its 14. Comments should be sent to as markers March preparation report, publication developmental led to 12600 letters which Ms research should not take (12300 beyond opposing Peggy Schnoor, National Institutes of place, notions of personhood, and the such research) being sent to Congress. In Health, Room 218, Building 1, 9000 social context of embryo research. Most the face of this hostility, the political Rockville Pike, Bethesda, Maryland. important was concern by several panel response was to stall. No one wants a rep: etition of that outcome. members that the restriction of subseThe main issues that emerged from this Richard Horton quent meetings to one day would reduce.
Colorado), an expert adviser to the panel, : opportunities for public input. Only 2 existing human embryo research. hours were set aside for the public at last Although most work has focused on week’s meeting, and commissioned preimproving the chances of pregnancy after sentations and panel discussion are likely new to diminish future public participation. conception, laboratory-assisted research prospects include those on basic Efforts to reach out to the public through reviewed
for the contraceptive 1712% more in the US than it did in the UK. Other drugs Drug manufacturers charged on average that cost considerably more in the US 60% more in the US than they did in the were: Ativan 1 mg, 1154% higher; Valium 5 mg, 1031% higher; Compazine 10 mg, UK for 77 commonly prescribed prescrip945% higher; Inderal 40 mg, 872% tion drugs, according to a study by the US : General Accounting Office (GAO), a higher; and Triphasil, 836% higher. Democratic Congressman Henry A research and investigative agency of the Waxman of California, who released the US Congress. GAO looked at the 1991 of most 200 commonly dispensed report, said the GAO’s findings support prices 77 preparations proand identified provisions in President Clinton’s healthdrugs duced by the same manufacturers and reform packages that will allow Medicare, sold in the same dosage forms in both the US government’s medical insurance countries. Of the 5 most commonly preplan for the elderly, to deny reimbursement for drugs deemed overpriced, and scribed drugs in the US-Amoxil 250 mg, that will establish an advisory committee Premarin 0-625 mg, Zantac 150 mg, with power to review the "reasonableness" Lanoxin 0-25 mg, and Xanax 0-5 mgof prices for new "breakthrough" drugs. : only Amoxil was cheaper in the US, costPharmaceutical industry representatives ing US$16.50 per 100, or 40% less than: the UK price of US$27.30 per 100. For attacked the GAO study methods as well the 4 other drugs, the US prices ran from as Waxman’s conclusions. It was not fair 58% (for Zantac) to 278% (for Xanax) to compare prices in the free-market US higher. The highest price differential the health-care system with prices in "the
US
vs
UK
drug prices
US reel reform
GAO found
was
Nordette, which
lence
.
cost
Manufacturers Association. He also said, "Americans, who demand and receive the most advanced healthcare in the world, simply would not put up with the quality of medical care provided by the British socialised system", which he called "one of the worst systems among major industrialised countries". Allnutt warned that if the US adopted British-style price controls it would devastate the drug industry, destroying profits, and drying up revenues essential for the development of innovative new drugs, crippling not only US firms but large UK firms that depend on the huge US market for 50% of their sales.
Michael
McCarthy
public education campaign forBlood agreed
young viewers. The cable group
also to issue annual reports on television violence compiled by independent authorities. :
Threatened by the President, the Attorney General, and a mood of Congressional Network companies have announced and public impatience, the television that they support independent monitoring industry has agreed to attempt to lessen but not violence ratings and broadcastthe impact of television violence (see Lancet, Jan 15, p 127). The National blocking technologies. Nor do they agree to limit violent programming to late-night Cable Television Association’s plan, hours. It has been suggested that networks Voices Against Violence, proposes a television violence ratings system and supports will not go along with the cable industry because they profit from advertising the development of technologies that perinstead of from viewer subscriptions, so mit parents-to viewers-particularly any ratings system that puts advertisers off block undesirable cablecasts from their could reduce the value of marketable time. homes. The plan also calls for warning However, the network companies’ public messages at the start of the programme, a response is that self-regulation is the moratorium on violence that is gratuitous : proper way to deal with the issue. or without human consequence, "responsible scheduling" of violent programming to non-children’s hours, and an antivio- David H Frankel
408
highly regulated, socialised British system, which controls costs by severely rationing care and limiting access to advanced technologies", said Robert F Allnutt, executive vice president of the Pharmaceutical
shortages
Last month US blood bank inventories fell to their lowest level since the 1939-45 war, according to the American Association of Blood Banks, an umbrella organisation for 2400 US blood centres. The shortage forced blood banks in 40 US cities to issue urgent public appeals for donations, and at one point the nation’s blood banks had less than one day’s supply on hand, said association spokeswoman Marcia Lane. Stocks were so low, she said, that if there had been heavy casualties in the Jan 17 Los Angeles earthquake, there was a real danger that the national blood supply network would not have been able to respond quickly to the need. Lane ascribed the low stocks in January to the seasonal fall in donations over
the holiday period; the winter cold snap in . the eastern seaboard (severe enough to UK donation drive force the closure of most federal offices),: The UK Department of Health has launched a 10-week newspaper advertising which kept donors away from donation: campaign aimed at the recruitment of new blood donors and improving the response of centres and forced the cancellation of existing donors. Parliamentary secretary at the department Tom Sackville, explained scheduled blood drives; and a nationwide: that there had been "several potentially dangerous blood shortages last year". As part of£ influenza epidemic. : the campaign a "daily blood index" will be published, to encourage public involvement Blood bank inventories are back to norin ensuring that 10 000 units of blood are collected each day. At the launch, it was mal, Lane said, but blood bank officials: emphasised that all equipment used to collect blood is new, sealed, sterile, and see the January crisis as a warning that : discarded after use. Since 1985, when HIV testing of donated blood was introduced, more must be done to increase blood colthere has been an overall decline in the number of blood donations in the UK, lections in the US, where, despite a growSarah Ramsay ing population, donations have for several years plateaued at about 14 million units a year. "It is increasingly hard to maintain who in the past were easily reached by is possible to contract AIDS through an adequate pool of donors". Lane said. workplace blood drives. Third, aggressive blood donation. is not she but For the past decade blood bank officials clear, why added, Exactly screening of donors who may be at risk for blood bank officials suspect several causor been working to ensure safety of the other infechave HIV, hepatitis, carrying es. First, younger Americans are not stepUS blood supply, Lane said, but now it is tious diseases has shrunk the donor pool. ping in to replace older donors. Second, But perhaps most frustrating to blood time to ensure its adequacy. in recent years, big US manufacturers banks, said Lane, is the persistent, irrahave shed tens of thousands of workers, tional fear held by many Americans that it Michael McCarthy
:
blood sampling, preparation, storage, and of products from a given donor. All the transfusion of blood-derived products. : blood units will have to be labelled with France the identity of the donor, whereas donors The Minister of Health has to be promptused to anonymous. All results of biologily informed of any epidemiologically releNew regulations on blood products have vant information. A hospital or clinic cal tests done will be kept unit by unit, as been issued by the French Conseil d’Etat. (public or private) can choose only one will the transfusion centre at which the The decree specifies procedures that the transfusion centre to fulfil its needs for blood was taken or prepared, and the preAgence Française du Sang, which blood products. Except for emergencies, a scribing doctor. Autologous blood transreplaced the old blood transfusion service transfusion centre may not give away or fusions will also be recorded. Each after the troubles with transfusion-associsell to another transfusion centre its own transfusion centre will appoint a ated HIV infection (see Lancet 1992; 339:: short-lived blood products. In the past, "haemovigilance" officer, who will be 1408), has to follow during the processing transfusion centres in the south of the responsible for such data and will alert the of blood and blood products, for quality country, where there is a chronic shortage Agence Françcaise du Sang of any suscontrol, and when accidents occur. These of blood donors, have often obtained pected or known undesirable effect of a long-awaited regulations parallel those blood products from centres in Alsace and transfusion. Any breach in transfusion issued by the Commission Nationale de Lorraine, and at a discount price. The security rules will also be reported. Pharmacovigilance to guide the Agence Minister of Health is now entitled to forRegional haemovigilance supervisors will du Medicament. According to the decree, bid or strictly limit blood products conoversee hospitals and transfusion centres. the two agencies will share information on cessions between hospitals or transfusion The decree does not specify what punitive any transfusion-related adverse effect. It centres. This measure is one of several power supervisors will have. specifies the type of information that the aimed at facilitating the tracing of the Agence du Sang has to gather donor of a given product, or all recipientsJean-Michel Bader
"Haemovigilance"
in
during
haul of the health system to stop the Histadrut from skimming off Kupat Cholim Clalit fees for political funding". On the surface, Israelis should have no Haim Ramon resigned his cabinet post of: Foreign Minister Shimon Peres, generMinister of Health in Israel’s Labour-led ally accepted within Labour as the "true complaints about the quality of their health services. More than 8% of their boss", stood unflinchingly behind the Hisgovernment this week when his healthreform bill was widely defeated by a vote tadrut ; in fact, he quietly but tenaciously gross national product is allocated to the led the aggressive and costly Histadrutconvention of health, just slightly lower than that in the among 3000-strong Labour government delegates. If it had flnanced advertising campaign that forced US. They have the highest number of the issue out of ministerial committee doctors per head in the world, 1 for succeeded, it would have dissected the onto the plenum floor. Peres and his approximately every 365 persons (US 1 in Kupat Cholim Clalit, the general sick fund, and Israel’s largest, from the Hiscamp warned Prime Minister Itzhak Rabin 700). Hospital clinics are less than 20 tadrut, Israel’s federation of trade unions. away from supporting Ramon with the minutes away from 90% of the popula"I fought for [these] reforms. At least five ominous advice that the Histadrut would tion. And Israeli doctors boast an internaof my predecessors tried to enact such legcollapse without its sick-fund support, and tionally recognised level of professional and now I them their failthat Labour would be next to fall. On the expertise. islation, join [in ure to do so] ", he said to a group of 500 convention floor, Ramon accused Rabin Although not required by law, 97% of of "cheating the electorate" when the working or retired Israelis belong to a sick hospital directors, health ministry officials, and health worker union leaders who Prime Minister withdrew his support for fund, one of the best insured rates world accorded him a hero’s welcome at a wide. About 70% of the populace, some the proposal. Ramon reminded the bellifarewell meeting held in Chaim Sheba-Tel 3-4 million people, are Clalit members, cose party caucus of Histadrut-dominated Hashomer Hospital. He will probably capdelegates and the public at large that most by default-since its founding in italise on his public recognitionin the Rabin had lured voters in the 1992 1937, membership dues for the powerful national campaign with "a thorough over- Histadrut union of unions and Clalit sick 1996 Labour leadership battle.
Rejection of Israeli health-reform bill
409
first meeting included: for limitations on the source of embryos (eg, surgically removed ovaries, aborted fetal ovaries); the need for intensive investigation in laboratory-animal models before human experimentation; the relative research into human gametogenesis, newspapers were called for. Muller experimental value of non-viable vs viable seemed resistant to these appeals; he embryos; the willingness of participants in materno-embryo interactions, the influences of genomic imprinting on embryo prefers to design a policy before seeking in-vitro fertilisation (IVF) programmes to : donate their spare embryos for research; wider public opinion. development, and stem-cell formation. The panel’s concern stems from events and the importance of collecting data on This first meeting also revealed some: early conflicts-eg, about the definition of following publication of the last US report the long-term outcome of IVF compared terms such as pre-embryo, embryo, and on embryo research in 1979. Although with non-IVF pregnancies. other opinions had been sought during The next meeting will be held on fetus, the value of implantation and gasof the trulation its 14. Comments should be sent to as markers March preparation report, publication developmental led to 12600 letters which Ms research should not take (12300 beyond opposing Peggy Schnoor, National Institutes of place, notions of personhood, and the such research) being sent to Congress. In Health, Room 218, Building 1, 9000 social context of embryo research. Most the face of this hostility, the political Rockville Pike, Bethesda, Maryland. important was concern by several panel response was to stall. No one wants a rep: etition of that outcome. members that the restriction of subseThe main issues that emerged from this Richard Horton quent meetings to one day would reduce.
Colorado), an expert adviser to the panel, : opportunities for public input. Only 2 existing human embryo research. hours were set aside for the public at last Although most work has focused on week’s meeting, and commissioned preimproving the chances of pregnancy after sentations and panel discussion are likely new to diminish future public participation. conception, laboratory-assisted research prospects include those on basic Efforts to reach out to the public through reviewed
for the contraceptive 1712% more in the US than it did in the UK. Other drugs Drug manufacturers charged on average that cost considerably more in the US 60% more in the US than they did in the were: Ativan 1 mg, 1154% higher; Valium 5 mg, 1031% higher; Compazine 10 mg, UK for 77 commonly prescribed prescrip945% higher; Inderal 40 mg, 872% tion drugs, according to a study by the US : General Accounting Office (GAO), a higher; and Triphasil, 836% higher. Democratic Congressman Henry A research and investigative agency of the Waxman of California, who released the US Congress. GAO looked at the 1991 of most 200 commonly dispensed report, said the GAO’s findings support prices 77 preparations proand identified provisions in President Clinton’s healthdrugs duced by the same manufacturers and reform packages that will allow Medicare, sold in the same dosage forms in both the US government’s medical insurance countries. Of the 5 most commonly preplan for the elderly, to deny reimbursement for drugs deemed overpriced, and scribed drugs in the US-Amoxil 250 mg, that will establish an advisory committee Premarin 0-625 mg, Zantac 150 mg, with power to review the "reasonableness" Lanoxin 0-25 mg, and Xanax 0-5 mgof prices for new "breakthrough" drugs. : only Amoxil was cheaper in the US, costPharmaceutical industry representatives ing US$16.50 per 100, or 40% less than: the UK price of US$27.30 per 100. For attacked the GAO study methods as well the 4 other drugs, the US prices ran from as Waxman’s conclusions. It was not fair 58% (for Zantac) to 278% (for Xanax) to compare prices in the free-market US higher. The highest price differential the health-care system with prices in "the
US
vs
UK
drug prices
US reel reform
GAO found
was
Nordette, which
lence
.
cost
Manufacturers Association. He also said, "Americans, who demand and receive the most advanced healthcare in the world, simply would not put up with the quality of medical care provided by the British socialised system", which he called "one of the worst systems among major industrialised countries". Allnutt warned that if the US adopted British-style price controls it would devastate the drug industry, destroying profits, and drying up revenues essential for the development of innovative new drugs, crippling not only US firms but large UK firms that depend on the huge US market for 50% of their sales.
Michael
McCarthy
public education campaign forBlood agreed
young viewers. The cable group
also to issue annual reports on television violence compiled by independent authorities. :
Threatened by the President, the Attorney General, and a mood of Congressional Network companies have announced and public impatience, the television that they support independent monitoring industry has agreed to attempt to lessen but not violence ratings and broadcastthe impact of television violence (see Lancet, Jan 15, p 127). The National blocking technologies. Nor do they agree to limit violent programming to late-night Cable Television Association’s plan, hours. It has been suggested that networks Voices Against Violence, proposes a television violence ratings system and supports will not go along with the cable industry because they profit from advertising the development of technologies that perinstead of from viewer subscriptions, so mit parents-to viewers-particularly any ratings system that puts advertisers off block undesirable cablecasts from their could reduce the value of marketable time. homes. The plan also calls for warning However, the network companies’ public messages at the start of the programme, a response is that self-regulation is the moratorium on violence that is gratuitous : proper way to deal with the issue. or without human consequence, "responsible scheduling" of violent programming to non-children’s hours, and an antivio- David H Frankel
408
highly regulated, socialised British system, which controls costs by severely rationing care and limiting access to advanced technologies", said Robert F Allnutt, executive vice president of the Pharmaceutical
shortages
Last month US blood bank inventories fell to their lowest level since the 1939-45 war, according to the American Association of Blood Banks, an umbrella organisation for 2400 US blood centres. The shortage forced blood banks in 40 US cities to issue urgent public appeals for donations, and at one point the nation’s blood banks had less than one day’s supply on hand, said association spokeswoman Marcia Lane. Stocks were so low, she said, that if there had been heavy casualties in the Jan 17 Los Angeles earthquake, there was a real danger that the national blood supply network would not have been able to respond quickly to the need. Lane ascribed the low stocks in January to the seasonal fall in donations over
the holiday period; the winter cold snap in . the eastern seaboard (severe enough to UK donation drive force the closure of most federal offices),: The UK Department of Health has launched a 10-week newspaper advertising which kept donors away from donation: campaign aimed at the recruitment of new blood donors and improving the response of centres and forced the cancellation of existing donors. Parliamentary secretary at the department Tom Sackville, explained scheduled blood drives; and a nationwide: that there had been "several potentially dangerous blood shortages last year". As part of£ influenza epidemic. : the campaign a "daily blood index" will be published, to encourage public involvement Blood bank inventories are back to norin ensuring that 10 000 units of blood are collected each day. At the launch, it was mal, Lane said, but blood bank officials: emphasised that all equipment used to collect blood is new, sealed, sterile, and see the January crisis as a warning that : discarded after use. Since 1985, when HIV testing of donated blood was introduced, more must be done to increase blood colthere has been an overall decline in the number of blood donations in the UK, lections in the US, where, despite a growSarah Ramsay ing population, donations have for several years plateaued at about 14 million units a year. "It is increasingly hard to maintain who in the past were easily reached by is possible to contract AIDS through an adequate pool of donors". Lane said. workplace blood drives. Third, aggressive blood donation. is not she but For the past decade blood bank officials clear, why added, Exactly screening of donors who may be at risk for blood bank officials suspect several causor been working to ensure safety of the other infechave HIV, hepatitis, carrying es. First, younger Americans are not stepUS blood supply, Lane said, but now it is tious diseases has shrunk the donor pool. ping in to replace older donors. Second, But perhaps most frustrating to blood time to ensure its adequacy. in recent years, big US manufacturers banks, said Lane, is the persistent, irrahave shed tens of thousands of workers, tional fear held by many Americans that it Michael McCarthy
:
blood sampling, preparation, storage, and of products from a given donor. All the transfusion of blood-derived products. : blood units will have to be labelled with France the identity of the donor, whereas donors The Minister of Health has to be promptused to anonymous. All results of biologily informed of any epidemiologically releNew regulations on blood products have vant information. A hospital or clinic cal tests done will be kept unit by unit, as been issued by the French Conseil d’Etat. (public or private) can choose only one will the transfusion centre at which the The decree specifies procedures that the transfusion centre to fulfil its needs for blood was taken or prepared, and the preAgence Française du Sang, which blood products. Except for emergencies, a scribing doctor. Autologous blood transreplaced the old blood transfusion service transfusion centre may not give away or fusions will also be recorded. Each after the troubles with transfusion-associsell to another transfusion centre its own transfusion centre will appoint a ated HIV infection (see Lancet 1992; 339:: short-lived blood products. In the past, "haemovigilance" officer, who will be 1408), has to follow during the processing transfusion centres in the south of the responsible for such data and will alert the of blood and blood products, for quality country, where there is a chronic shortage Agence Françcaise du Sang of any suscontrol, and when accidents occur. These of blood donors, have often obtained pected or known undesirable effect of a long-awaited regulations parallel those blood products from centres in Alsace and transfusion. Any breach in transfusion issued by the Commission Nationale de Lorraine, and at a discount price. The security rules will also be reported. Pharmacovigilance to guide the Agence Minister of Health is now entitled to forRegional haemovigilance supervisors will du Medicament. According to the decree, bid or strictly limit blood products conoversee hospitals and transfusion centres. the two agencies will share information on cessions between hospitals or transfusion The decree does not specify what punitive any transfusion-related adverse effect. It centres. This measure is one of several power supervisors will have. specifies the type of information that the aimed at facilitating the tracing of the Agence du Sang has to gather donor of a given product, or all recipientsJean-Michel Bader
"Haemovigilance"
in
during
haul of the health system to stop the Histadrut from skimming off Kupat Cholim Clalit fees for political funding". On the surface, Israelis should have no Haim Ramon resigned his cabinet post of: Foreign Minister Shimon Peres, generMinister of Health in Israel’s Labour-led ally accepted within Labour as the "true complaints about the quality of their health services. More than 8% of their boss", stood unflinchingly behind the Hisgovernment this week when his healthreform bill was widely defeated by a vote tadrut ; in fact, he quietly but tenaciously gross national product is allocated to the led the aggressive and costly Histadrutconvention of health, just slightly lower than that in the among 3000-strong Labour government delegates. If it had flnanced advertising campaign that forced US. They have the highest number of the issue out of ministerial committee doctors per head in the world, 1 for succeeded, it would have dissected the onto the plenum floor. Peres and his approximately every 365 persons (US 1 in Kupat Cholim Clalit, the general sick fund, and Israel’s largest, from the Hiscamp warned Prime Minister Itzhak Rabin 700). Hospital clinics are less than 20 tadrut, Israel’s federation of trade unions. away from supporting Ramon with the minutes away from 90% of the popula"I fought for [these] reforms. At least five ominous advice that the Histadrut would tion. And Israeli doctors boast an internaof my predecessors tried to enact such legcollapse without its sick-fund support, and tionally recognised level of professional and now I them their failthat Labour would be next to fall. On the expertise. islation, join [in ure to do so] ", he said to a group of 500 convention floor, Ramon accused Rabin Although not required by law, 97% of of "cheating the electorate" when the working or retired Israelis belong to a sick hospital directors, health ministry officials, and health worker union leaders who Prime Minister withdrew his support for fund, one of the best insured rates world accorded him a hero’s welcome at a wide. About 70% of the populace, some the proposal. Ramon reminded the bellifarewell meeting held in Chaim Sheba-Tel 3-4 million people, are Clalit members, cose party caucus of Histadrut-dominated Hashomer Hospital. He will probably capdelegates and the public at large that most by default-since its founding in italise on his public recognitionin the Rabin had lured voters in the 1992 1937, membership dues for the powerful national campaign with "a thorough over- Histadrut union of unions and Clalit sick 1996 Labour leadership battle.
Rejection of Israeli health-reform bill
409