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Fight over US Surgeon General nominee
for Science and Education, Mr Ad Nuis, this week. Borst Eilers had been a member of the steering group, chaired by ex- : minister for economic affairs, Gijs Van: Aardenne, before becoming minister last: August. Part 1 of the BAGO exercise (Lancet 1993; 342: 734-35) had dealt :: with non-university medical research, the assignment being to "find" 10 million: guilders. Part 2 (Lancet 1994; 343: : : 531-32) had concentrated on research and on the best way of programming and financing medical research. : The existing Dutch system of medical . research in universities, says the steering group, leads to a huge dispersion of effort, quality, and manpower. The group believes that part 3 provides a for the best way of coping with international competition in medical research in .: the future. The group explains that the structural adaptation it recommends is necessary because the changes in academic medical research are going to be very drastic. These changes include the scaling: up and the growing complexity of the research, the multidisciplinary nature of much of the work, and the growing costs resulting from the need for expensive: apparatus. The adaptation will mean a transfer of expertise from the faculty to the institutes. However, the report says that faculties and academic hospitals should forge closer relationships to tackle tasks such as training of medical students, setting standards of patient care, and continuing medical education for all doctors. : At the moment the RGO says that the limited number of multidisciplinary institutes that it recommends should be estab-
academic setting, although in recommendations on chronic diseases, it had referred to the necessity of stronger ties between academic research and public health practice-ie, problemfocused research. BAGO part 3 includes a "model" of how gastroenterology research could be organised. In this model, 8 professors (1from each of the 8 medical faculties) should set up a forum for leading researchers in related disciplines to discuss priorities for research and where the research should be conducted. They should subordinate individual and local interests to national research strategy. This aspect of the model was the most sensitive in the two workshops that led up to the recommendations. As one RGO source said, researchers do not like the idea of giving up academic freedom and are not used to thinking in terms of what is best for "the reputation of the Netherlands", instead of "my institute". Because researchers are going to lose some of their autonomy, the RGO says that the government, especially the Ministry for Public Health, has some sort of . obligation to establish a "new relationship" between universities, medical facul ties, and academic hospitals. "The minister should have some influence in . the planning of such research", states the report. She should also have to be clear as to what the priorities in medical research should be. The government is expected to respond to the report in May. :
Fight over US Surgeon
Mr President, does he have the license to be as outspoken and blunt as Dr Elders did? Or are there some areas you’ve cautioned him that he shouldn’t be talking about? : Dr Foster: No comment (laughter) : President Clinton: (Laughing) I can’t do better than that! : But soon after the nomination was announced, conservatives and anti-abortion activists began questioning Foster’s involvement in abortions. Though Senate Republicans had been initially reassured by the Administration that Foster-apparently : by his own count-had done only one abortion in nearly four decades of practice, the nominee increased his estimate to "fewer than a dozen" after further questioning, and it now stands at at least 39, a . figure agreed upon after White House investigators reviewed Foster’s practice records since 1973, when abortion was made legal. : Controversy has also arisen over an article published by Foster in 1976 that cited "mental retardation" as a "relative indication" for removal of a normal
university
blueprint
;
;
Marjanke Spanjer
Question:
President Clinton nominees to replace Surgeon General Joycelyn Elders, dismissed for public statements on sex education and AIDS (Lancet 1994; 344:: 1695), seemed free from controversy. Dr Henry W Foster, Jr, an obstetrician and gynaecologist and Meharry Medical College’s former dean, is supported by the American Medical Association, American College of Obstetricians and Gynecologists, American College of Physicians, and the Association of American Medical Colleges. His academic credentials are considered impeccable. In 1972, at age 39, he was the youngest member ever admitted to the Institute of Medicine. His teenage-pregnancy-prevention programme, "I Have a Future", is copied nationally and received an award in 1991 from President Bush. Indeed, ’., during the press conference announcing Foster’s nomination, the political liabilities posed by Elders seemed deliberately and conspicuously to have been
442
an
same
General nominee
avoided.
lished in
:
CJD and albumin?
previous
(Southern Med J 1976; 69: 13-15.) "Recently I have begun to use hysterec-
discovery of two, apparently of Creutzfeldt-Jakob disassociated, has disturbed the French ease (CJD) health authorities. Extensive investigations done by Annick Alperovitch (unit 360, INSERM) into risks associated with blood The
recent
cases
that have indicated transfusions stable blood products (such as albumin) can transmit the infectious agent causing
CJD. Case A, now deceased, donated blood many times before getting CJD; case B, was a woman of 60 (also deceased), who, 2 years before getting the disease, had had a liver transplant and transfusion of albumin partly derived from A’s blood. For Prof Jean-Francois Girard, director-general of the health service, three hypotheses arise from these cases-they were both sporadic occurrences; B’s infection came from the donor liver; or the infection came from A’s
blood. Without
a biological marker for CJD they cannot be distinguished
Several weeks ago the USA Food and
Drug Administration concluded that all blood products given by a person who develops CJD should be withdrawn from the market, but not stable products such albumin. A year ago France ruled that all products that might have a connection with a donor with CJD or with a donor any of whose close relatives have CJD should be removed. The French authorities await recommendations from the European Commission of Specialist Pharmaceuticals. as
J-Y Nau tomy in patients with severe mental retardation. Hysterectomy can be done either for sterilisation or to eliminate the menses, which is of significant hygienic benefit in these severely handicapped individuals". But little attention is given to the other sentiments expressed in the article, in which Foster warns that obstetricians and
gynaecologists must guard vigilantly against the injudicious and indiscriminate removal of the normal uterus. Many sides are calling for Foster’s name to be withdrawn. Conservative Republicans, with support from anti-abortion activists, believe a man who has done abortions is unfit to be Surgeon General. Moderate Republicans, loathe to split their party but equally careful to support "ProChoice" sentiments favoured by most Americans, are tending away from Foster by accusing the Clinton administration of poor preparation. Even some of the President’s strongest supporters may ultimately yield to embarrassment. But for the time being, President Clinton vows to support his man to the end.
uterus.
David H Frankel
academic setting, although in recommendations on chronic diseases, it had referred to the necessity of stronger ties between academic research and public health practice-ie, problemfocused research. BAGO part 3 includes a "model" of how gastroenterology research could be organised. In this model, 8 professors (1from each of the 8 medical faculties) should set up a forum for leading researchers in related disciplines to discuss priorities for research and where the research should be conducted. They should subordinate individual and local interests to national research strategy. This aspect of the model was the most sensitive in the two workshops that led up to the recommendations. As one RGO source said, researchers do not like the idea of giving up academic freedom and are not used to thinking in terms of what is best for "the reputation of the Netherlands", instead of "my institute". Because researchers are going to lose some of their autonomy, the RGO says that the government, especially the Ministry for Public Health, has some sort of . obligation to establish a "new relationship" between universities, medical facul ties, and academic hospitals. "The minister should have some influence in . the planning of such research", states the report. She should also have to be clear as to what the priorities in medical research should be. The government is expected to respond to the report in May. :
Fight over US Surgeon
Mr President, does he have the license to be as outspoken and blunt as Dr Elders did? Or are there some areas you’ve cautioned him that he shouldn’t be talking about? : Dr Foster: No comment (laughter) : President Clinton: (Laughing) I can’t do better than that! : But soon after the nomination was announced, conservatives and anti-abortion activists began questioning Foster’s involvement in abortions. Though Senate Republicans had been initially reassured by the Administration that Foster-apparently : by his own count-had done only one abortion in nearly four decades of practice, the nominee increased his estimate to "fewer than a dozen" after further questioning, and it now stands at at least 39, a . figure agreed upon after White House investigators reviewed Foster’s practice records since 1973, when abortion was made legal. : Controversy has also arisen over an article published by Foster in 1976 that cited "mental retardation" as a "relative indication" for removal of a normal
university
blueprint
;
;
Marjanke Spanjer
Question:
President Clinton nominees to replace Surgeon General Joycelyn Elders, dismissed for public statements on sex education and AIDS (Lancet 1994; 344:: 1695), seemed free from controversy. Dr Henry W Foster, Jr, an obstetrician and gynaecologist and Meharry Medical College’s former dean, is supported by the American Medical Association, American College of Obstetricians and Gynecologists, American College of Physicians, and the Association of American Medical Colleges. His academic credentials are considered impeccable. In 1972, at age 39, he was the youngest member ever admitted to the Institute of Medicine. His teenage-pregnancy-prevention programme, "I Have a Future", is copied nationally and received an award in 1991 from President Bush. Indeed, ’., during the press conference announcing Foster’s nomination, the political liabilities posed by Elders seemed deliberately and conspicuously to have been
442
an
same
General nominee
avoided.
lished in
:
CJD and albumin?
previous
(Southern Med J 1976; 69: 13-15.) "Recently I have begun to use hysterec-
discovery of two, apparently of Creutzfeldt-Jakob disassociated, has disturbed the French ease (CJD) health authorities. Extensive investigations done by Annick Alperovitch (unit 360, INSERM) into risks associated with blood The
recent
cases
that have indicated transfusions stable blood products (such as albumin) can transmit the infectious agent causing
CJD. Case A, now deceased, donated blood many times before getting CJD; case B, was a woman of 60 (also deceased), who, 2 years before getting the disease, had had a liver transplant and transfusion of albumin partly derived from A’s blood. For Prof Jean-Francois Girard, director-general of the health service, three hypotheses arise from these cases-they were both sporadic occurrences; B’s infection came from the donor liver; or the infection came from A’s
blood. Without
a biological marker for CJD they cannot be distinguished
Several weeks ago the USA Food and
Drug Administration concluded that all blood products given by a person who develops CJD should be withdrawn from the market, but not stable products such albumin. A year ago France ruled that all products that might have a connection with a donor with CJD or with a donor any of whose close relatives have CJD should be removed. The French authorities await recommendations from the European Commission of Specialist Pharmaceuticals. as
J-Y Nau tomy in patients with severe mental retardation. Hysterectomy can be done either for sterilisation or to eliminate the menses, which is of significant hygienic benefit in these severely handicapped individuals". But little attention is given to the other sentiments expressed in the article, in which Foster warns that obstetricians and
gynaecologists must guard vigilantly against the injudicious and indiscriminate removal of the normal uterus. Many sides are calling for Foster’s name to be withdrawn. Conservative Republicans, with support from anti-abortion activists, believe a man who has done abortions is unfit to be Surgeon General. Moderate Republicans, loathe to split their party but equally careful to support "ProChoice" sentiments favoured by most Americans, are tending away from Foster by accusing the Clinton administration of poor preparation. Even some of the President’s strongest supporters may ultimately yield to embarrassment. But for the time being, President Clinton vows to support his man to the end.
uterus.
David H Frankel