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French insurance fund tackles tobacco companies
US experts take the threat of bioterrorism seriously cientists and public-health officials at the National Symposium on Medical and Public Health Response to Bioterrorism (Arlington, VA, USA; Feb 16–17) agreed that initial recognition and response to a bioterrorist act will come not from traditional terrorist response units—such as police, fire, or emergency medical services—but from individual physicians and public-health The enemy within agencies. From the government perspective, Donna Shalala, US Secretary of Health and Human Services (HHS), addressed the need for improvements in several key areas, such as epidemiology and disease surveillance, stockpiling of pharmaceuticals and
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vaccines, vaccine research, and planning for the massive emergency medical response that would be required in the event of a bioterrorism incident. Towards these ends, President Bill Clinton has proposed increasing the HHS bioterrorism budget from US$158 million this fiscal year to $230 million for the fiscal year 2000. From the medical perspective, bioterrorism seems less manageable. D A Henderson (Johns Hopkins Center for Civilian Biodefense Studies, Baltimore, MD, USA) expressed concern that clandestine stocks of smallpox virus now exist outside the two internationallyapproved storage locations in Russia
and the USA. Although post-exposure vaccination can protect against smallpox, a disease with a 30% mortality rate, Henderson warned that current vaccine stockpiles would prove inadequate in the event of a major epidemic. The supply of smallpox vaccine is estimated to be only 50-100 million doses worldwide, with 6-7 million doses in the USA. Since production facilities were dismantled after the disease was considered eradicated in 1980, a sufficient supply could not be produced for at least another 2-3 years. Smallpox and anthrax received the most attention. Several speakers warned that agents such as plague, botulinum toxin, and even common pathogens like salmonella can also be used as bioterrorist weapons. David H Frankel
French insurance fund tackles tobacco companies
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n February 15, a local office of the French national healthinsurance fund decided to sue four tobacco companies—the French state-owned company SEITA, Philip Morris, Reynolds, and Rothmans. The office, based in Saint-Nazaire, believes that healthcare needed because of alcohol and tobacco consumption creates an extra expense of FFR70 million in its area alone, where mortality rates related to alcohol and tobacco are 14% higher than the French national average. Francis Caballero, a lawyer
acting for the Saint-Nazaire office and counsellor for the French committee against tobacco smok ing, announced that he will lodge the complaint in court within the next few weeks. Caballero is also suing SEITA for FFR2·3 million on behalf of the families of two cancer patients “killed by cigarettes”, but observers doubt the chances of such a claim. The introduction of tougher smoking regulations in 1991, and substantial tobacco-price increases since then, has had little effect on smokers. Smoking has only been
reduced by 5% since 1990, and smoking bans in public places are often violated. Many specialists believe the government and health authorities have failed to include adequate education and prevention campaigns—especially aimed at teenagers—in their smoking regula tions. Following the Saint-Naziare office’s announcement, another health-insurance office in southern France has declared it will consider undertaking similar legal actions against tobacco companies. Denis Durand de Bousingen
Suicide rates in Ireland continue to rise reland’s suicide rate, which is among the highest in the world for young people, is getting worse. Provisional figures from the Central Statistics Office suggest that more than 500 people may have committed suicide in the Republic last year. If that total is confirmed, the number of Irish people taking their lives will have doubled in just over a decade. When the provisional figure was released, a statement by the Archdiocese of Dublin noted that “almost one in four suicides occur among those aged between 15 and 24”. Last year, a report on child-care services by the Eastern Health Board
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said that “15% of boys thought their lives were not worth living most of the time and 18% thought their lives were not worth living sometimes”. According to WHO figures released last year, Ireland also has the highest male-to-female suicide ratio in the world for 15 to 24-year-olds. The problem is also worsening north of the border, where suicides among males aged 16–24 are now outstripping road-traffic deaths. Belfast is also seeing an increase in violence, and alcohol and drug abuse. The number of antidepressants being prescribed to adults and children has also increased. A controversial survey by research students at the University
of Ulster last year suggested that 16 people in Northern Ireland were attempting suicide every day. In February this year, the Irish Suicidology Association announced that it was considering becoming a cross-border operation. John Connolly, the association secretary, said “suicide knows no borders, geographical, religious, or political”. Last week, the British Office of National Statistics noted that death rates among second-generation Irish migrants living in England and Wales is 20% higher than for the rest of the population. Karen Birchard
THE LANCET • Vol 353 • February 27, 1999
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vaccines, vaccine research, and planning for the massive emergency medical response that would be required in the event of a bioterrorism incident. Towards these ends, President Bill Clinton has proposed increasing the HHS bioterrorism budget from US$158 million this fiscal year to $230 million for the fiscal year 2000. From the medical perspective, bioterrorism seems less manageable. D A Henderson (Johns Hopkins Center for Civilian Biodefense Studies, Baltimore, MD, USA) expressed concern that clandestine stocks of smallpox virus now exist outside the two internationallyapproved storage locations in Russia
and the USA. Although post-exposure vaccination can protect against smallpox, a disease with a 30% mortality rate, Henderson warned that current vaccine stockpiles would prove inadequate in the event of a major epidemic. The supply of smallpox vaccine is estimated to be only 50-100 million doses worldwide, with 6-7 million doses in the USA. Since production facilities were dismantled after the disease was considered eradicated in 1980, a sufficient supply could not be produced for at least another 2-3 years. Smallpox and anthrax received the most attention. Several speakers warned that agents such as plague, botulinum toxin, and even common pathogens like salmonella can also be used as bioterrorist weapons. David H Frankel
French insurance fund tackles tobacco companies
O
n February 15, a local office of the French national healthinsurance fund decided to sue four tobacco companies—the French state-owned company SEITA, Philip Morris, Reynolds, and Rothmans. The office, based in Saint-Nazaire, believes that healthcare needed because of alcohol and tobacco consumption creates an extra expense of FFR70 million in its area alone, where mortality rates related to alcohol and tobacco are 14% higher than the French national average. Francis Caballero, a lawyer
acting for the Saint-Nazaire office and counsellor for the French committee against tobacco smok ing, announced that he will lodge the complaint in court within the next few weeks. Caballero is also suing SEITA for FFR2·3 million on behalf of the families of two cancer patients “killed by cigarettes”, but observers doubt the chances of such a claim. The introduction of tougher smoking regulations in 1991, and substantial tobacco-price increases since then, has had little effect on smokers. Smoking has only been
reduced by 5% since 1990, and smoking bans in public places are often violated. Many specialists believe the government and health authorities have failed to include adequate education and prevention campaigns—especially aimed at teenagers—in their smoking regula tions. Following the Saint-Naziare office’s announcement, another health-insurance office in southern France has declared it will consider undertaking similar legal actions against tobacco companies. Denis Durand de Bousingen
Suicide rates in Ireland continue to rise reland’s suicide rate, which is among the highest in the world for young people, is getting worse. Provisional figures from the Central Statistics Office suggest that more than 500 people may have committed suicide in the Republic last year. If that total is confirmed, the number of Irish people taking their lives will have doubled in just over a decade. When the provisional figure was released, a statement by the Archdiocese of Dublin noted that “almost one in four suicides occur among those aged between 15 and 24”. Last year, a report on child-care services by the Eastern Health Board
I
734
said that “15% of boys thought their lives were not worth living most of the time and 18% thought their lives were not worth living sometimes”. According to WHO figures released last year, Ireland also has the highest male-to-female suicide ratio in the world for 15 to 24-year-olds. The problem is also worsening north of the border, where suicides among males aged 16–24 are now outstripping road-traffic deaths. Belfast is also seeing an increase in violence, and alcohol and drug abuse. The number of antidepressants being prescribed to adults and children has also increased. A controversial survey by research students at the University
of Ulster last year suggested that 16 people in Northern Ireland were attempting suicide every day. In February this year, the Irish Suicidology Association announced that it was considering becoming a cross-border operation. John Connolly, the association secretary, said “suicide knows no borders, geographical, religious, or political”. Last week, the British Office of National Statistics noted that death rates among second-generation Irish migrants living in England and Wales is 20% higher than for the rest of the population. Karen Birchard
THE LANCET • Vol 353 • February 27, 1999