- Email: [email protected]
Control of hepatitis B
1136
uninformed about drugs that have been in routine use in the west for years. Drugs donated from Britain or Germany are liable to cause bewilderment, because most doctors do not know what they are or how to use them. The need for effective education remains an important priority. Western doctors can help in two main ways, as discussed at a recent meeting on aid to and trade with the Soviet Union organised by the UK-USSR Medical Exchange Programme. First, we can provide doctors and pharmacists with professional information that is both relevant to their needs and independent of industry. We also have experience with continuing education. The British Postgraduate Medical Federation, the Open University, and the British Council may all be able to contribute to distance learning programmes. Perhaps some funding could come from the European Community. Pharmacists would give valuable advice on drug supply, quality control, bulk buying, and distribution. Secondly, industry is a source of technical knowledge and skills. Transfer of technology and the modernisation of the Soviet pharmaceutical industry are high priorities, and a few British companies have already established joint ventures.
Andrew Herxheimer
London
Conference Control of
hepatitis
B
About 400 million people are chronically infected with hepatitis B virus, and most of them live in the developing world. Chronic hepatitis B infection leads to chronic liver disease and primary liver cancer, the most common cancer in developing countries. Although a vaccine against hepatitis B virus has been available for at least 15 years, the world’s poorer countries have not benefited from it because of its prohibitive cost. This is particularly unfortunate because hepatitis B vaccine could be one of the first vaccines to prevent cancer. Delegates from more than fifty countries met in Yaounde, Cameroon, on Oct 7-9 to discuss issues related to hepatitis B vaccination in the developing world. The conference was sponsored by the World Health Organisation, the International Task Force for Hepatitis B Immunisation, the Cameroon Ministry of Health, and the University of Yaounde. More than 20 million doses of hepatitis B vaccine have now been administered the world over, and efficacy studies have shown it to be as good and as safe as the best available vaccines. The only plausible explanation for the vaccine’s high cost is its low demand. Integration of hepatitis B vaccination into the Expanded Programme on Immunisation would greatly increase consumption of the vaccine. Hepatitis B infection is a children’s issue because it kills parents of young children, is acquired in childhood, and can be prevented by immunisation soon after birth. In terms of mortality and morbidity, the burden of hepatitis B exceeds that of diphtheria, pertussis, polio, cholera, rotavirus diarrhoea, and AIDS. The Yaounde declaration, which emerged from the three days of deliberation, is a plea for urgent action to make hepatitis B immunisation available throughout the developing world. The declaration calls on manufacturers to provide hepatitis B vaccine at an affordable price. It also
urges the world and its leaders to recognise the importance, especially to children, of hepatitis B infection and its sequelae; to recognise the right of all children to protection from hepatitis B infection; and to support the development of hepatitis B vaccines in combination with other childhood
vaccines. Hepatitis
B
Projects,
Centre Universaire des Sciences de la Santé, B P 8445, Yaounde, Cameroon
Peter M. Ndumbe
Medicine and the Law Psychology of false confessions Unburden; acknowledge sinfulness; get it off one’s chest;
culpa; plead guilty. Confession of crime is widely encouraged by religious and secular authorities alike—but can confessions, even discounting political memoirs, be trusted? Recent events within the UK legal system have led to renewed interest in the psychology of false confession, the subject of a half-day session at last week’s quarterly meeting of the Royal College of Psychiatrists. Psychological analysis of retracted confessions indicates that breaches of existing police codes of practice, derived from provisions of the Police and Criminal Evidence Act 1984, may still lead to false confession-for example, when a mentally handicapped adult who does not understand legal processes is interviewed without an appropriate adult and/or a solicitor being present. But attempts at informal assessment of intelligence can be very misleading and, unless forensic medical examiners are routinely trained in such practice, full psychological testing before interrogation may be impracticable. Although (as chief-superintendent T. Williamson, commandant of Hendon Police College, observed) police, psychologists, and psychiatrists do not always see eye to eye, all parties seem to agree that weight of evidence is the most potent force for a true confession, followed by distress and a desire to unburden; shame, however, can act in a contrary direction. It is in everyone’s best interests (with the exception, perhaps, of genuine offenders) that background evidence is fully explored. Like Pooh-Bah, courts are becoming increasingly fond of corroborative detail, and unsupported confessions are frequently called into question. Not without cause; analysis of false confessions (whether partial or total retractions) indicates that the combination of coercive interrogation and a compliant, suggestible personality might readily lead to an unreliable self-incriminating confession.’ Such analysis, as Dr Gisli Gudjonsson observed, involves analysis of the characteristics of the defendant, circumstances of arrest and custody, mental state during custody and confinement, and factors related to interrogation. Changed police practices since implementation of the 1984 Act have reduced but not eliminated the potential for false confession. Unfortunately, audit of proper practice (and general police support for such procedures) is occasionally patchy-but some unexpected benefits are becoming apparent even to more sceptical officers. Recording or videotaping of interviews with suspects allows assessment of interrogating skills and ensures evidence is not overlooked or forgotten; some trainers now advocate a trend away from adversarial interviewing towards bland information gathering with emphasis on preparation before and data analysis after interrogation. mea
uninformed about drugs that have been in routine use in the west for years. Drugs donated from Britain or Germany are liable to cause bewilderment, because most doctors do not know what they are or how to use them. The need for effective education remains an important priority. Western doctors can help in two main ways, as discussed at a recent meeting on aid to and trade with the Soviet Union organised by the UK-USSR Medical Exchange Programme. First, we can provide doctors and pharmacists with professional information that is both relevant to their needs and independent of industry. We also have experience with continuing education. The British Postgraduate Medical Federation, the Open University, and the British Council may all be able to contribute to distance learning programmes. Perhaps some funding could come from the European Community. Pharmacists would give valuable advice on drug supply, quality control, bulk buying, and distribution. Secondly, industry is a source of technical knowledge and skills. Transfer of technology and the modernisation of the Soviet pharmaceutical industry are high priorities, and a few British companies have already established joint ventures.
Andrew Herxheimer
London
Conference Control of
hepatitis
B
About 400 million people are chronically infected with hepatitis B virus, and most of them live in the developing world. Chronic hepatitis B infection leads to chronic liver disease and primary liver cancer, the most common cancer in developing countries. Although a vaccine against hepatitis B virus has been available for at least 15 years, the world’s poorer countries have not benefited from it because of its prohibitive cost. This is particularly unfortunate because hepatitis B vaccine could be one of the first vaccines to prevent cancer. Delegates from more than fifty countries met in Yaounde, Cameroon, on Oct 7-9 to discuss issues related to hepatitis B vaccination in the developing world. The conference was sponsored by the World Health Organisation, the International Task Force for Hepatitis B Immunisation, the Cameroon Ministry of Health, and the University of Yaounde. More than 20 million doses of hepatitis B vaccine have now been administered the world over, and efficacy studies have shown it to be as good and as safe as the best available vaccines. The only plausible explanation for the vaccine’s high cost is its low demand. Integration of hepatitis B vaccination into the Expanded Programme on Immunisation would greatly increase consumption of the vaccine. Hepatitis B infection is a children’s issue because it kills parents of young children, is acquired in childhood, and can be prevented by immunisation soon after birth. In terms of mortality and morbidity, the burden of hepatitis B exceeds that of diphtheria, pertussis, polio, cholera, rotavirus diarrhoea, and AIDS. The Yaounde declaration, which emerged from the three days of deliberation, is a plea for urgent action to make hepatitis B immunisation available throughout the developing world. The declaration calls on manufacturers to provide hepatitis B vaccine at an affordable price. It also
urges the world and its leaders to recognise the importance, especially to children, of hepatitis B infection and its sequelae; to recognise the right of all children to protection from hepatitis B infection; and to support the development of hepatitis B vaccines in combination with other childhood
vaccines. Hepatitis
B
Projects,
Centre Universaire des Sciences de la Santé, B P 8445, Yaounde, Cameroon
Peter M. Ndumbe
Medicine and the Law Psychology of false confessions Unburden; acknowledge sinfulness; get it off one’s chest;
culpa; plead guilty. Confession of crime is widely encouraged by religious and secular authorities alike—but can confessions, even discounting political memoirs, be trusted? Recent events within the UK legal system have led to renewed interest in the psychology of false confession, the subject of a half-day session at last week’s quarterly meeting of the Royal College of Psychiatrists. Psychological analysis of retracted confessions indicates that breaches of existing police codes of practice, derived from provisions of the Police and Criminal Evidence Act 1984, may still lead to false confession-for example, when a mentally handicapped adult who does not understand legal processes is interviewed without an appropriate adult and/or a solicitor being present. But attempts at informal assessment of intelligence can be very misleading and, unless forensic medical examiners are routinely trained in such practice, full psychological testing before interrogation may be impracticable. Although (as chief-superintendent T. Williamson, commandant of Hendon Police College, observed) police, psychologists, and psychiatrists do not always see eye to eye, all parties seem to agree that weight of evidence is the most potent force for a true confession, followed by distress and a desire to unburden; shame, however, can act in a contrary direction. It is in everyone’s best interests (with the exception, perhaps, of genuine offenders) that background evidence is fully explored. Like Pooh-Bah, courts are becoming increasingly fond of corroborative detail, and unsupported confessions are frequently called into question. Not without cause; analysis of false confessions (whether partial or total retractions) indicates that the combination of coercive interrogation and a compliant, suggestible personality might readily lead to an unreliable self-incriminating confession.’ Such analysis, as Dr Gisli Gudjonsson observed, involves analysis of the characteristics of the defendant, circumstances of arrest and custody, mental state during custody and confinement, and factors related to interrogation. Changed police practices since implementation of the 1984 Act have reduced but not eliminated the potential for false confession. Unfortunately, audit of proper practice (and general police support for such procedures) is occasionally patchy-but some unexpected benefits are becoming apparent even to more sceptical officers. Recording or videotaping of interviews with suspects allows assessment of interrogating skills and ensures evidence is not overlooked or forgotten; some trainers now advocate a trend away from adversarial interviewing towards bland information gathering with emphasis on preparation before and data analysis after interrogation. mea