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Defence of medically assisted pregnancies in France
Core-El-E2 and NS2 genes have been expressed in a recombinant vaccinia vector to infect HeLa cells, and the extracted glycosylated Eland E2 proteins have been used to vaccinate seven chimpanzees. The recombinant proteins seem to induce neutralising antibodies. Vaccination with these proteins may also induce resolution of acute infection. Vaccine trials are in progress. However, despite these encouraging first more cross-challenge and isolatespecific experiments will be required. Injection of naked DNA to trigger immune response generates antigen for presentation by MHC, and a CD8 T-cell response. This has been explored in several different models. Plasmids with DNA encoding E2 glycoprotein and C protein have been injected into HeLa cells and intramuscularly into mice. The cells expressed the proteins and the mice produced antibody. : Several investigators have an association between viral genotypes and response to interferon. Sustained responses are least likely in patients infected with type 1. Preliminary results of a trial of alpha interferon plus tribavirin in subjects without cirrhosis have shown that these patients showed a more rapid and more sustained alanine aminotransferase response than did those : treated with interferon alone. Antisense oligonucleotides complementary to the 5’ non-translated
therapy
results,
approach
Defence of medically assisted pregnancies in France
:
A controversy has broken out about medically assisted pregnancies after a report by ’, the council of the Ordre des Medecins. ’, This report, which has been unanimously: approved by the council, warns against the uncontrolled development of certain techniques used in treating infertility. It is particularly concerned about the frequent use of drugs intended to stimulate the ovary. It is estimated that, in France, there were 500 000 prescriptions for human chorionic gonadotropin in 1985, and around 3 million in 1992. This increase is disturbing in view of its possible association with breast cancer. "In a few years we may well be in the middle of a scandal of similar proportion to that caused by the thoughtless use of Distil- tozoa. bene [diethylstilboestrol] and the resulting J-Y Nau : disastrous consequences" the report says.
reported UK clinicians’ performance and pay dispute
:
;
training and career developopportunities for clinical staff together with better coordinated research and development are some of the promised benefits of a radical reorganisation of the English national blood service. The proposed changes include the amalgamation of five of the fifteen existing transfusion centres and the creation of three geographical zones led by administration
606
centres
in London, Bristol, and
Sarah
Leeds. This slimming down of the administration side of the service will, says the National Blood Authority, be balanced by an increase in the number of stockholding units to ensure that all hospitals are within two hours’ travelling time for emergency deliveries. A change already underway is the establishment of a national bloodtransfusion database, to increase efficiency and cost-effectiveness of blood collection and supply. : Although officials of the blood authority are keen to emphasise that the propos-
i
Increased
ment
;
!
als
are
not
just
a
this early stage, a of the population significant proportion the of notion local support pay. I am sure that most people, if the issues were put to them in a balanced and fair way, would agree that there is sense in relating some element of what clinicians are paid to the quality of the care they provide for patients. Indeed, NHS consultants themselves recognise this with their system of distinction awards". Discontent with the government’s determination to let hospital trusts devise the method whereby clinicians are rewarded (eg, linked to each individual’s work record or to a trust’s overall performance) has become increasingly vocal during this year. Delegates voted overwhelmingly to reject the government’s plans at a senior hospital staff conference in June and at the BMA annual meeting in July. The next public display of opposition is a oneday conference at the end of this month; medical representatives from each NHS trust and directly managed unit have been invited to attend. vey shows
The battle over how UK clinicians are to be paid in future continued unabated last week. The British Medical Association announced the results of an opinion poll they had commissioned, which they said revealed "considerable public support for the continuation of an independent review system for doctors’ pay". In the poll, 53% of the sample of 2033 adults thought that the present remuneration system, which was defined for them as meaning all doctors at the same level get paid the same region specifically impair in-vitro amount, should stay. In reality, doctors’ translation of HCV. The mechanism incomes do vary. For instance, consulof inhibition is uncertain, as is the tants in certain specialties are far more likely to have lucrative private practices on usefulness of this strategy in vivo. Other advances described at the top of their NHS work. : Julia Cumberlege, under-secretary of meeting include the role of the NS3 state for health, hit back at the BMA protease in the processing of HCV announcement, emphasising that the secproteins. These findings might lead ond largest subgroup of the sample (19%) to improvements in antiviral therapy. were those who agreed that doctors’ pay should be determined locally by the hospiGM Dusheiko tal units in which they practise. "The sur-
English transfusion shake-up planned
This unease was echoed in a notice issued last month by the national ethical committee cautioning against too frequent prescription of ovarian stimulants and about techniques such as intraovarian injection of spermatozoa, which have not been adequately tested in animal models. Doctors and biologists carrying out these techniques have now publicly protested at the bad image these reports are giving to their specialty. They have attempted, in press interviews, to refute the allegations made and to reassure their patients. The public authorities have yet to come to terms with the questions raised, but it looks as if they will not be able to stay silent for long. Two issues need to be speedily addressed-the freedom for doctors to prescribe ovarian stimulants and the regulation of centres offering intraovarian injection of sperma-
cost-cutting exercise,
that,
even at
Ramsay
savings in the order of £ 10 million are predicted in the approximately C130 million budget. The suggestion at the press launch that the service was being overhauled so that it might be more attractive to private buyers was strenuously denied. Formal consultation with trade unions, staff organisations, and other interested bodies starts on Sept 1. The consultation document is available from the National Blood Authority, Reeds Crescent, Watford WD1 1 QH, UK. Sarah
Ramsay
therapy
results,
approach
Defence of medically assisted pregnancies in France
:
A controversy has broken out about medically assisted pregnancies after a report by ’, the council of the Ordre des Medecins. ’, This report, which has been unanimously: approved by the council, warns against the uncontrolled development of certain techniques used in treating infertility. It is particularly concerned about the frequent use of drugs intended to stimulate the ovary. It is estimated that, in France, there were 500 000 prescriptions for human chorionic gonadotropin in 1985, and around 3 million in 1992. This increase is disturbing in view of its possible association with breast cancer. "In a few years we may well be in the middle of a scandal of similar proportion to that caused by the thoughtless use of Distil- tozoa. bene [diethylstilboestrol] and the resulting J-Y Nau : disastrous consequences" the report says.
reported UK clinicians’ performance and pay dispute
:
;
training and career developopportunities for clinical staff together with better coordinated research and development are some of the promised benefits of a radical reorganisation of the English national blood service. The proposed changes include the amalgamation of five of the fifteen existing transfusion centres and the creation of three geographical zones led by administration
606
centres
in London, Bristol, and
Sarah
Leeds. This slimming down of the administration side of the service will, says the National Blood Authority, be balanced by an increase in the number of stockholding units to ensure that all hospitals are within two hours’ travelling time for emergency deliveries. A change already underway is the establishment of a national bloodtransfusion database, to increase efficiency and cost-effectiveness of blood collection and supply. : Although officials of the blood authority are keen to emphasise that the propos-
i
Increased
ment
;
!
als
are
not
just
a
this early stage, a of the population significant proportion the of notion local support pay. I am sure that most people, if the issues were put to them in a balanced and fair way, would agree that there is sense in relating some element of what clinicians are paid to the quality of the care they provide for patients. Indeed, NHS consultants themselves recognise this with their system of distinction awards". Discontent with the government’s determination to let hospital trusts devise the method whereby clinicians are rewarded (eg, linked to each individual’s work record or to a trust’s overall performance) has become increasingly vocal during this year. Delegates voted overwhelmingly to reject the government’s plans at a senior hospital staff conference in June and at the BMA annual meeting in July. The next public display of opposition is a oneday conference at the end of this month; medical representatives from each NHS trust and directly managed unit have been invited to attend. vey shows
The battle over how UK clinicians are to be paid in future continued unabated last week. The British Medical Association announced the results of an opinion poll they had commissioned, which they said revealed "considerable public support for the continuation of an independent review system for doctors’ pay". In the poll, 53% of the sample of 2033 adults thought that the present remuneration system, which was defined for them as meaning all doctors at the same level get paid the same region specifically impair in-vitro amount, should stay. In reality, doctors’ translation of HCV. The mechanism incomes do vary. For instance, consulof inhibition is uncertain, as is the tants in certain specialties are far more likely to have lucrative private practices on usefulness of this strategy in vivo. Other advances described at the top of their NHS work. : Julia Cumberlege, under-secretary of meeting include the role of the NS3 state for health, hit back at the BMA protease in the processing of HCV announcement, emphasising that the secproteins. These findings might lead ond largest subgroup of the sample (19%) to improvements in antiviral therapy. were those who agreed that doctors’ pay should be determined locally by the hospiGM Dusheiko tal units in which they practise. "The sur-
English transfusion shake-up planned
This unease was echoed in a notice issued last month by the national ethical committee cautioning against too frequent prescription of ovarian stimulants and about techniques such as intraovarian injection of spermatozoa, which have not been adequately tested in animal models. Doctors and biologists carrying out these techniques have now publicly protested at the bad image these reports are giving to their specialty. They have attempted, in press interviews, to refute the allegations made and to reassure their patients. The public authorities have yet to come to terms with the questions raised, but it looks as if they will not be able to stay silent for long. Two issues need to be speedily addressed-the freedom for doctors to prescribe ovarian stimulants and the regulation of centres offering intraovarian injection of sperma-
cost-cutting exercise,
that,
even at
Ramsay
savings in the order of £ 10 million are predicted in the approximately C130 million budget. The suggestion at the press launch that the service was being overhauled so that it might be more attractive to private buyers was strenuously denied. Formal consultation with trade unions, staff organisations, and other interested bodies starts on Sept 1. The consultation document is available from the National Blood Authority, Reeds Crescent, Watford WD1 1 QH, UK. Sarah
Ramsay