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CDC head apologises again for misuse of funds
POLICY AND PEOPLE
ttempts to curb illegal use of opioids in developing countries are resulting in the denial of essential pain relief to cancer patients, according to the annual report of the Vienna-based United Nations International Narcotic Control Board (INCB), released on Feb 23. “People tend to forget that we are as concerned with promoting the proper use of narcotics as we are with dealing with their abuse”, said INCB Secretary, Herbert Schaepe. The report blames over-restrictive regulations and calls for governments to adopt a flexible and humanitarian approach. In some parts of the world, doctors can face long terms in jail for simple administrative errors in prescribing morphine. The report also points out that US doctors prescribe ten times more amphetamines than their European counterparts and notes, for the second year, the controversial use of methylphenidate in children with attention-deficit hyperactivity disorder in the USA. European doctors are three times more likely than their US colleagues to prescribe benzodiazepines. The experts cannot explain the trends, but note that doctors are often in the difficult position of providing pharmacological treatment for non-clinical reasons. Next year’s INCB report will focus on the general problem. Turning to drug misuse, the INCB is strongly critical of the practice in some developed countries of seeking increased protection against HIV-1 transmission by providing rooms for addicts to inject themselves. The report compares them to opium dens and warns that the practice may contravene international drug-control conventions. On a positive note, there has been considerable success in the interception of chemicals used in drug production, particularly the potassium permanganate used for processing cocaine. China is credited with intercepting more than a thousand tons on its way to illegal laboratories. However, the UNCB is pessimistic over the seriousness of Afghanistan’s Taliban government in tackling opium production. Last year, the country produced a record 4600 tons.
A
Nigel Glass
734
CDC head apologises again for misuse of funds
F
or the second time in as many years, the head of the US Centers for Disease Control and Prevention (CDC) has been forced to explain to Congress why funds intended for research into one disease ended up being spent on other things. Last year, CDC was unable to account for about US$13 million that Congress had “earmarked” for research on chronic fatigue syndrome. This time, the Washington Post newspaper—which also broke the earlier story—revealed that $7·5 million appropriated for each of the past several years to study hantavirus had in fact been used to study other infectious diseases, including Ebola and Lassa fever. While Congressional “earmarks” are technically suggestions for how money should be spent and are not legally binding on federal agencies, government officials ignore them at
their peril. “We have got to know if the agency makes a different determination than the one directed by the Congress” on how research funds are spent, said Congressman David Obey, at a hearing before the powerful House Appropriations Committee on Feb 10. At this hearing, CDC Director Jeffrey Koplan apologised to the committee and said that the CDC is taking steps to ensure such diversions of funding will not happen again. These steps include internal and outside audits of CDC spending and replacing the head of the agency’s viral division. It will not be known until later in the year, however, if Congress will find the actions sufficient or if it will punish the agency by reducing its budget. Julie Rovner
Indian policy aims for stable population by 2045 he long-awaited National Population Policy announced by the Indian government on Feb 17, aims to stabilise the population size by 2045. The immediate aims of the policy are to address the unmet needs of the health-care infrastructure and workers, of the family-planning ser-
T
Panos Pictures
UN drug board condemns morphine underuse
Education at a local level is vital
vices, and to integrate delivery of basic reproductive and child health care. The medium-term goal is to bring total fertility rates to replacement level by 2010. Currently India’s population increases by 15·5 million people each year, which means India could have a population of one billion people by May 11, 2000. The states of Bihar, Madhya Pradesh, Orissa, Rajasthan, and Uttar Pradesh constitute nearly 44% of the current total population. The population of these five states is expected to rise to 48% of the total for India by 2016. They will be targeted
by a special technology mission proposed by the Department of Family Welfare (DFW). A feature of the latest population control policy is decentralised planning and programme implementation. At village level, health-care services will be delivered through self-help groups and local governing bodies. At district and block levels private practitioners may be assigned to satellite populations of less than 5000 people to provide reproductive and child health-care services. To achieve this, an accreditation system for such practitioners will be developed by the Indian Medical Association. “This is a management paradigm shift. It’s a bottoms-up approach”, said DFW secretary Amulya Ratna Nanda. The new population policy includes a series of incentives, such as cash awards of about US$11 for the birth of a girl, though officials say there will be no coercion for limiting family size. “We are not promoting a one-child or two-child norm, but a small family norm”, declared Nanda. Local health care groups will be rewarded not for the number of family-planning operations, but for promoting the acceptance of small family unit and for achieving lower infant mortality rates. Dinesh C Sharma
THE LANCET • Vol 355 • February 26, 2000
ttempts to curb illegal use of opioids in developing countries are resulting in the denial of essential pain relief to cancer patients, according to the annual report of the Vienna-based United Nations International Narcotic Control Board (INCB), released on Feb 23. “People tend to forget that we are as concerned with promoting the proper use of narcotics as we are with dealing with their abuse”, said INCB Secretary, Herbert Schaepe. The report blames over-restrictive regulations and calls for governments to adopt a flexible and humanitarian approach. In some parts of the world, doctors can face long terms in jail for simple administrative errors in prescribing morphine. The report also points out that US doctors prescribe ten times more amphetamines than their European counterparts and notes, for the second year, the controversial use of methylphenidate in children with attention-deficit hyperactivity disorder in the USA. European doctors are three times more likely than their US colleagues to prescribe benzodiazepines. The experts cannot explain the trends, but note that doctors are often in the difficult position of providing pharmacological treatment for non-clinical reasons. Next year’s INCB report will focus on the general problem. Turning to drug misuse, the INCB is strongly critical of the practice in some developed countries of seeking increased protection against HIV-1 transmission by providing rooms for addicts to inject themselves. The report compares them to opium dens and warns that the practice may contravene international drug-control conventions. On a positive note, there has been considerable success in the interception of chemicals used in drug production, particularly the potassium permanganate used for processing cocaine. China is credited with intercepting more than a thousand tons on its way to illegal laboratories. However, the UNCB is pessimistic over the seriousness of Afghanistan’s Taliban government in tackling opium production. Last year, the country produced a record 4600 tons.
A
Nigel Glass
734
CDC head apologises again for misuse of funds
F
or the second time in as many years, the head of the US Centers for Disease Control and Prevention (CDC) has been forced to explain to Congress why funds intended for research into one disease ended up being spent on other things. Last year, CDC was unable to account for about US$13 million that Congress had “earmarked” for research on chronic fatigue syndrome. This time, the Washington Post newspaper—which also broke the earlier story—revealed that $7·5 million appropriated for each of the past several years to study hantavirus had in fact been used to study other infectious diseases, including Ebola and Lassa fever. While Congressional “earmarks” are technically suggestions for how money should be spent and are not legally binding on federal agencies, government officials ignore them at
their peril. “We have got to know if the agency makes a different determination than the one directed by the Congress” on how research funds are spent, said Congressman David Obey, at a hearing before the powerful House Appropriations Committee on Feb 10. At this hearing, CDC Director Jeffrey Koplan apologised to the committee and said that the CDC is taking steps to ensure such diversions of funding will not happen again. These steps include internal and outside audits of CDC spending and replacing the head of the agency’s viral division. It will not be known until later in the year, however, if Congress will find the actions sufficient or if it will punish the agency by reducing its budget. Julie Rovner
Indian policy aims for stable population by 2045 he long-awaited National Population Policy announced by the Indian government on Feb 17, aims to stabilise the population size by 2045. The immediate aims of the policy are to address the unmet needs of the health-care infrastructure and workers, of the family-planning ser-
T
Panos Pictures
UN drug board condemns morphine underuse
Education at a local level is vital
vices, and to integrate delivery of basic reproductive and child health care. The medium-term goal is to bring total fertility rates to replacement level by 2010. Currently India’s population increases by 15·5 million people each year, which means India could have a population of one billion people by May 11, 2000. The states of Bihar, Madhya Pradesh, Orissa, Rajasthan, and Uttar Pradesh constitute nearly 44% of the current total population. The population of these five states is expected to rise to 48% of the total for India by 2016. They will be targeted
by a special technology mission proposed by the Department of Family Welfare (DFW). A feature of the latest population control policy is decentralised planning and programme implementation. At village level, health-care services will be delivered through self-help groups and local governing bodies. At district and block levels private practitioners may be assigned to satellite populations of less than 5000 people to provide reproductive and child health-care services. To achieve this, an accreditation system for such practitioners will be developed by the Indian Medical Association. “This is a management paradigm shift. It’s a bottoms-up approach”, said DFW secretary Amulya Ratna Nanda. The new population policy includes a series of incentives, such as cash awards of about US$11 for the birth of a girl, though officials say there will be no coercion for limiting family size. “We are not promoting a one-child or two-child norm, but a small family norm”, declared Nanda. Local health care groups will be rewarded not for the number of family-planning operations, but for promoting the acceptance of small family unit and for achieving lower infant mortality rates. Dinesh C Sharma
THE LANCET • Vol 355 • February 26, 2000