- Email: [email protected]
Execution delayed
or dust/mist/fume devices in place of to filter to 1 to 5 11 aerosolised particles-the : Genetic testing HEPAs, OSHA has given its opinion that size of infectious TB droplet nuclei-with only HEPAs will be acceptable. Since over 99% efficiency. Moreover, they conWith demand for prenatal tests likely to OSHA has the power to define hazards and tend that the estimate of$49 million does grow, training in genetics for physicians not take into account re-use of respirators. to punish, hospital officials worry that and quality control in laboratories are two CDC’s preference will become OSHA’s According to a recent survey by the especially important concerns, says a report : American Hospital Association, patients from threatening directive. the US Institute of Medicine. At the
mist
TB control experts argue that HEPA little benefit beyond
respirators afford
administrative measures, engineering
con-
trols, and personal protection already written
into the 1990
guidelines.
And
they cite
with multidrug resistant TB have been admitted to hospitals in at least 39 states, and 27% of hospitals say they have no TB isolation rooms meeting the 1990 guidelines. Moreover, preliminary data from CDC and the Society of Hospital Epidemiologists of America shows that only a third of hospitals currently issue respirators for TB control. OSHA will begin enforcing HEPA requirements for hospital workers at high risk for exposure to TB in early 1994. Given past records of compliance and : resistance to the proposals, it is uncertain how hospitals will respond. :
successful eradication programmes based on old guidelines (see Lancet 1992; 340:: 1403). Hospital administrators also point out that, according to estimates by the Greater New York Hospital Association, its 162 member institutions would have spent US$49 million in 1992 for HEPAs, but only$36 million for dust/mist/fume and$8 million for dust/mist devices. Industrial hygienists from OSHA argue that the HEPA is the only approved respirator David H Frankel
Execution delayed the participation of doctors in executions in the US, Truog and Brennan’ cannot quite bring themselves to agree with the argument2 that medical societies should take a stand on capital punishment itself. Nonetheless the "degree of participation by physicians in capital punishment... [is] in clear conflict with the AMA’s recent guidelines" and "Medical societies should take the position that involvement in capital punishment is grounds for revoking a physician’s license". Only in the provision of medical care for condemned prisoners would a doctor’s participation in the execution process be acceptable, they say. Even that elementary provision may be denied in some countries. They include Jamaica,
Reviewing
according to lawyers representing two men who have been under sentence of death for
14 years.
Or, rather, had been. On Nov 2,
institution that has been around for a thousand years yet still retains a role in the judicial systems of sixteen countriesand, by influence some input into the US debate on the death penalty-stepped in. The Judicial Committee of the Privy Council, in London, decided that an execution delayed for more than 5 years amounts to a breach of Jamaica’s constitutional bar on "inhuman and degrading punishment’ 1.3 More than 100 other prisoners in Jamaica alone have been under that . threat for over 5 years. :
1993,
David 1
2
an
Sharp
Truog RD, Brennan TA. Participation of physicians in capital punishment. N Engl J Med 1993; 329: 1346-50. Editorial. Doctors and death
row.
Lancet
1993; 341: 209-10. 3
Mills H. Death
row prisoners escape the gallows. Independent Nov 3, 1993: 6.
time, the Committee on Assessing Risks, chaired by Dr Arno G Motulsky at the University of Washington, Seattle, warned that commercial pressure to expand the range of screening programmes should be resisted, pending the availability of more reliable data. Motulsky and colleagues advocate voluntary screening. Such programmes in
same
Genetic
and the District of Columbia have achieved recruitment rates equal to those of mandatory programmes. Legal requirements for screening should be applied only if there is strong and unequivocal evidence of treatment benefit. If voluntary testing programmes are to succeed, widespread public education is needed. In a personal addendum to the report, Motulsky commented that such initiatives may be impracticable; mandatory testing (eg, for phenylketonuria) may therefore be appropriate. Prenatal testing presents practical difficulties for counsellors: "the ability to diagnose genetic disorders far exceeds any ability to treat or cure them", the committee noted. Counselling should be "nondirective", thereby respecting the patient’s autonomy in decision making. Doctors must ensure that they do not stray into the public health debate about reducing the societal burden of disease. The committee opposed prenatal diagnosis for sex selection. The committee also recommend closure of a federal regulatory loophole that allows kits for genetic testing to bypass the Food and Drug Administration. Another suggestion is the formation of an organisation to monitor these public policy implications.
Maryland
Richard Horton 1
Institute of Medicine. Assessing genetic for health and social
risks: implications policy. via IVF with nine embryos. The Washington: National Academy Press. 1993. $45 incident led doctors and several politicians (plus $4 shipping). to demand government control and registration of private physicians who treat The interests of the child are more imporchildlessness, and to a recommendation News in brief tant than a person’s right to have a child, from the panel that embryo selection be and experts should concentrate more on : abolished. research into the causes of childlessness The panel recommended that donor : Remoxlprlde and aplastic anaemia than in developing new techniques to cure The Committee on Safety of Medicines has anonymity should be abolished, in the it. These conclusions were drawn by a lay child’s interests. Some experts pointed out received 8 reports of aplastic anaemia suspanel after a 2 day consensus conference that their experience was that removal of pected to be due to remoxipride (Curr with a panel of experts on technology and Problems Pharmacovig Nov 1993, p 9). 5 anonymity would deter people from dochildlessness. The conference had been nating semen or ova; others disagreed, were from the UK (see p 1244); the 4 organised by three parliamentary comciting Swedish studies. : women had received 150-600 mg remoximittees. In-vitro fertilisation (IVF), artiThe chairman of the parliamentary pride daily for 3-6 months (1died), and the ficial insemination, and ova donation have man had received 600 mg daily for 8 research committee said that serious conbeen intensely discussed after last year’s sideration will be given to the consensus months. Around 10 000 patients in the UK legislation making ovum donation legal document in future legislation on this topic. have received remoxipride. The CSM when the donated ovum is a spare from a recommends that remoxipride therapy be woman having IVF. Discussion intensified given only when other neuroleptics are not this summer when a woman became preg- Kaare Skovmand tolerated.
Reproductive technology
nant
1231
mist
TB control experts argue that HEPA little benefit beyond
respirators afford
administrative measures, engineering
con-
trols, and personal protection already written
into the 1990
guidelines.
And
they cite
with multidrug resistant TB have been admitted to hospitals in at least 39 states, and 27% of hospitals say they have no TB isolation rooms meeting the 1990 guidelines. Moreover, preliminary data from CDC and the Society of Hospital Epidemiologists of America shows that only a third of hospitals currently issue respirators for TB control. OSHA will begin enforcing HEPA requirements for hospital workers at high risk for exposure to TB in early 1994. Given past records of compliance and : resistance to the proposals, it is uncertain how hospitals will respond. :
successful eradication programmes based on old guidelines (see Lancet 1992; 340:: 1403). Hospital administrators also point out that, according to estimates by the Greater New York Hospital Association, its 162 member institutions would have spent US$49 million in 1992 for HEPAs, but only$36 million for dust/mist/fume and$8 million for dust/mist devices. Industrial hygienists from OSHA argue that the HEPA is the only approved respirator David H Frankel
Execution delayed the participation of doctors in executions in the US, Truog and Brennan’ cannot quite bring themselves to agree with the argument2 that medical societies should take a stand on capital punishment itself. Nonetheless the "degree of participation by physicians in capital punishment... [is] in clear conflict with the AMA’s recent guidelines" and "Medical societies should take the position that involvement in capital punishment is grounds for revoking a physician’s license". Only in the provision of medical care for condemned prisoners would a doctor’s participation in the execution process be acceptable, they say. Even that elementary provision may be denied in some countries. They include Jamaica,
Reviewing
according to lawyers representing two men who have been under sentence of death for
14 years.
Or, rather, had been. On Nov 2,
institution that has been around for a thousand years yet still retains a role in the judicial systems of sixteen countriesand, by influence some input into the US debate on the death penalty-stepped in. The Judicial Committee of the Privy Council, in London, decided that an execution delayed for more than 5 years amounts to a breach of Jamaica’s constitutional bar on "inhuman and degrading punishment’ 1.3 More than 100 other prisoners in Jamaica alone have been under that . threat for over 5 years. :
1993,
David 1
2
an
Sharp
Truog RD, Brennan TA. Participation of physicians in capital punishment. N Engl J Med 1993; 329: 1346-50. Editorial. Doctors and death
row.
Lancet
1993; 341: 209-10. 3
Mills H. Death
row prisoners escape the gallows. Independent Nov 3, 1993: 6.
time, the Committee on Assessing Risks, chaired by Dr Arno G Motulsky at the University of Washington, Seattle, warned that commercial pressure to expand the range of screening programmes should be resisted, pending the availability of more reliable data. Motulsky and colleagues advocate voluntary screening. Such programmes in
same
Genetic
and the District of Columbia have achieved recruitment rates equal to those of mandatory programmes. Legal requirements for screening should be applied only if there is strong and unequivocal evidence of treatment benefit. If voluntary testing programmes are to succeed, widespread public education is needed. In a personal addendum to the report, Motulsky commented that such initiatives may be impracticable; mandatory testing (eg, for phenylketonuria) may therefore be appropriate. Prenatal testing presents practical difficulties for counsellors: "the ability to diagnose genetic disorders far exceeds any ability to treat or cure them", the committee noted. Counselling should be "nondirective", thereby respecting the patient’s autonomy in decision making. Doctors must ensure that they do not stray into the public health debate about reducing the societal burden of disease. The committee opposed prenatal diagnosis for sex selection. The committee also recommend closure of a federal regulatory loophole that allows kits for genetic testing to bypass the Food and Drug Administration. Another suggestion is the formation of an organisation to monitor these public policy implications.
Maryland
Richard Horton 1
Institute of Medicine. Assessing genetic for health and social
risks: implications policy. via IVF with nine embryos. The Washington: National Academy Press. 1993. $45 incident led doctors and several politicians (plus $4 shipping). to demand government control and registration of private physicians who treat The interests of the child are more imporchildlessness, and to a recommendation News in brief tant than a person’s right to have a child, from the panel that embryo selection be and experts should concentrate more on : abolished. research into the causes of childlessness The panel recommended that donor : Remoxlprlde and aplastic anaemia than in developing new techniques to cure The Committee on Safety of Medicines has anonymity should be abolished, in the it. These conclusions were drawn by a lay child’s interests. Some experts pointed out received 8 reports of aplastic anaemia suspanel after a 2 day consensus conference that their experience was that removal of pected to be due to remoxipride (Curr with a panel of experts on technology and Problems Pharmacovig Nov 1993, p 9). 5 anonymity would deter people from dochildlessness. The conference had been nating semen or ova; others disagreed, were from the UK (see p 1244); the 4 organised by three parliamentary comciting Swedish studies. : women had received 150-600 mg remoximittees. In-vitro fertilisation (IVF), artiThe chairman of the parliamentary pride daily for 3-6 months (1died), and the ficial insemination, and ova donation have man had received 600 mg daily for 8 research committee said that serious conbeen intensely discussed after last year’s sideration will be given to the consensus months. Around 10 000 patients in the UK legislation making ovum donation legal document in future legislation on this topic. have received remoxipride. The CSM when the donated ovum is a spare from a recommends that remoxipride therapy be woman having IVF. Discussion intensified given only when other neuroleptics are not this summer when a woman became preg- Kaare Skovmand tolerated.
Reproductive technology
nant
1231