- Email: [email protected]
French medical contracts agreed
purpose, states remain divided on a provivision that these interventions should not interfere with the germ cell line. Therefore the steering committee has
Transplant territorial battle
Arthur Rogers
An unprecedented battle between doctors : in Denmark has now been brought to an end-by the Minister of Health. The surgeons in Aarhus and Copenhagen have for months been discussing whether Denmark should have two centres for liver transplants or just one. The discussion, which at times led to mutual = accusations, arose after a political decision was made to have two centres for these transplants-at Aarhus Kommunehospital and the Rigshospitalet in Copenhagen. However, the surgeons in Copenhagen argued that the results in Aarhus have been poor, and that the small number of patients and donor organs mean that only one centre is needed. The surgeons in Copenhagen also claimed that the necessary skill can be achieved only if surgeons have ample work put their way. The surgeons in Aarhus reported that the surgeons in Copenhagen did a poor job on
Medical litigation and the NATO treaty
French medical contracts agreed
compromised by proposing
a
prohibition
the latter type of intervention and to re-examine the situation "in a few years time in the light of scientific developments". A major dispute concerns the use of embryos for non-therapeutic research. Some states consider the embryo to be a human being from the moment of its creation. In others, notably the UK and Denmark, research is authorised up to the 14th day of development (see also p 1477). Still others authorise research only on non-viable embryos. Consequently the draft text adopts a cautious approach by leaving the question of embryo research to national legislation. Where this principle is accep-ted in nat-ional law, the Anglo-Danish 14-day limit is prescribed. on
member of the US Airforce was The French government has agreed to a entitled to pursue through the English new medical contract that fixes for the courts a personal injury action relating to next 4 years the agreements between most treatment at a US military hospital in general practitioners and the social securiEngland. So decided the Court of Appeal ty organisations (see Lancet Oct 9, p 920). in London recently. The plaintiff had The new contract establishes, for the first been treated at the US military hospital, time, a connection between the remuneraLakenheath, after which he claimed to tion of general practitioners and governhave lost the use of an arm and was disment health expenditure. The intended savings for 1994 of FFr charged as medically unfit. His claim to 10-7 thousand million will reduce the compensation in the US was barred by a doctrine established in 1950, so he issued annual increase in the cost of health care a writ in England against both the US govfrom 6% to 3-4%. The novelty and keyernment and the UK Ministry of Defence. stone of the agreement is the system of The latter was struck out on the basis that practice guidelines. There are 24 catean agreement on the Status of Forces of gories of medical practice (eg, sciatica, Parties to the North Atlantic Treaty 1951 hypertension, obstetric ultrasound, hyper(SOFA) did not confer such right of cholesterolaemia, prescriptions for antibiaction against the UK. What, if any, releotics) for which diagnostic and vance did SOFA have to the claim, and therapeutic procedures have been preciseshould the conduct of the US government ly defined, and what the doctor can and here be regarded as falling under cannot do is spelt out. Social security will not pay for services outside these guideprivate/commercial law (in which case the US would not be immune from suit) or as lines. The plan was not challenged by the acta jure imperii, in other words the exerOrdre des Medecins (equivalent to UK cise of sovereign, immune authority? General Medical Council), which The Court of Appeal rejected the claim attached importance to the medical profession’s part in drawing up the practice unanimously. It held that SOFA was irrelevant to the claim. Furthermore it would guidelines. be astonishing if the plaintiff were able to The new contract includes the creation of "medical dossiers" for people aged over get compensation in a foreign court from the country in whose forces he served, in 15 with severe illness and all people over that of treatment the by respect provided age of 70, to be held by the patient, the purpose being to ensure continuity of country when compensation not available to him in that country’s own courts. medical care and to avoid overprescribing. Crown immunity from suit by members The idea of these dossiers came from the of the British armed services has lately general practitioners who suggest an been removed but under US law acta jure annual fee of FFr 200 per dossier. imperii still rules, it seems.
A
serving
not
Diana Brahams
1482
Jean-Yves Nau
out organs, and that their own results were "poor" because they often put transplants in very ill patients. The Danish Medical Association strongly urged the surgeons to make peace, but in vain. The chief of the National Board of Health was apparently more successful in urging both parties to stop the fight, when he brought the two heads of units together face-to-face. The board held the view that the fight could only discredit the whole transplant-programme, and that it would probably reduce the number of organ donors. The Minister of Health stopped the dispute by declaring that there shall be two centres, and that the smaller centre in Aarhus shall work as an independent centre. He said that the surgeons of the two centres must cooperate to put available donor organs to the best use-if they do not obey this order, strong action will be taken against them.
taking
Kaare Skovmand
News in brief League tables
in UK An "intormation
revolution" is set to sweep through the 1 health services of England and Wales. ] From June, 1994, league tables of individ1ual hospitals’ performances will be made The hospitals will be ranked . public. :according to their achievements in six j indicator areas, which include the number Iof accident and emergency patients seen and the number of cancelled . immediately , The Department of Health is operations. I whether mortality figures for deciding jindividual hospitals should also be pub] lished. IFinal split in drug industry More than 100 firms will leave the German federal association of pharmaceutical industry by the beginning of next year; 370 will stay. A proposed reform of the association’s statutes, which could have stopped the departure, did not get the necessary twothirds majority. 24 of the departing firms have entered the Verband forschender Arzneimittelhersteller, the association of drug firms involved in research. Together they hold about 60% of the drug market share. ’
’
’
Ethics of genetic screening The first report of the UK Nuffield Council on Bioethics was published on Dec 7.1 It discusses the ethical consequences of screening programmes and recommends a series of safegurads. The controversial subject of insurance and genetic testing is highlighted (see Lancet Jan 23, p 224). The Council calls for action from government, health professionals, employers, and the insurance industry. 1 Genetic
screening: ethical issues. Nuffield Council on Bioethics. London: Nuffield Foundation. 1993. Pp 115. 6. ISBN 0-952270102.
Transplant territorial battle
Arthur Rogers
An unprecedented battle between doctors : in Denmark has now been brought to an end-by the Minister of Health. The surgeons in Aarhus and Copenhagen have for months been discussing whether Denmark should have two centres for liver transplants or just one. The discussion, which at times led to mutual = accusations, arose after a political decision was made to have two centres for these transplants-at Aarhus Kommunehospital and the Rigshospitalet in Copenhagen. However, the surgeons in Copenhagen argued that the results in Aarhus have been poor, and that the small number of patients and donor organs mean that only one centre is needed. The surgeons in Copenhagen also claimed that the necessary skill can be achieved only if surgeons have ample work put their way. The surgeons in Aarhus reported that the surgeons in Copenhagen did a poor job on
Medical litigation and the NATO treaty
French medical contracts agreed
compromised by proposing
a
prohibition
the latter type of intervention and to re-examine the situation "in a few years time in the light of scientific developments". A major dispute concerns the use of embryos for non-therapeutic research. Some states consider the embryo to be a human being from the moment of its creation. In others, notably the UK and Denmark, research is authorised up to the 14th day of development (see also p 1477). Still others authorise research only on non-viable embryos. Consequently the draft text adopts a cautious approach by leaving the question of embryo research to national legislation. Where this principle is accep-ted in nat-ional law, the Anglo-Danish 14-day limit is prescribed. on
member of the US Airforce was The French government has agreed to a entitled to pursue through the English new medical contract that fixes for the courts a personal injury action relating to next 4 years the agreements between most treatment at a US military hospital in general practitioners and the social securiEngland. So decided the Court of Appeal ty organisations (see Lancet Oct 9, p 920). in London recently. The plaintiff had The new contract establishes, for the first been treated at the US military hospital, time, a connection between the remuneraLakenheath, after which he claimed to tion of general practitioners and governhave lost the use of an arm and was disment health expenditure. The intended savings for 1994 of FFr charged as medically unfit. His claim to 10-7 thousand million will reduce the compensation in the US was barred by a doctrine established in 1950, so he issued annual increase in the cost of health care a writ in England against both the US govfrom 6% to 3-4%. The novelty and keyernment and the UK Ministry of Defence. stone of the agreement is the system of The latter was struck out on the basis that practice guidelines. There are 24 catean agreement on the Status of Forces of gories of medical practice (eg, sciatica, Parties to the North Atlantic Treaty 1951 hypertension, obstetric ultrasound, hyper(SOFA) did not confer such right of cholesterolaemia, prescriptions for antibiaction against the UK. What, if any, releotics) for which diagnostic and vance did SOFA have to the claim, and therapeutic procedures have been preciseshould the conduct of the US government ly defined, and what the doctor can and here be regarded as falling under cannot do is spelt out. Social security will not pay for services outside these guideprivate/commercial law (in which case the US would not be immune from suit) or as lines. The plan was not challenged by the acta jure imperii, in other words the exerOrdre des Medecins (equivalent to UK cise of sovereign, immune authority? General Medical Council), which The Court of Appeal rejected the claim attached importance to the medical profession’s part in drawing up the practice unanimously. It held that SOFA was irrelevant to the claim. Furthermore it would guidelines. be astonishing if the plaintiff were able to The new contract includes the creation of "medical dossiers" for people aged over get compensation in a foreign court from the country in whose forces he served, in 15 with severe illness and all people over that of treatment the by respect provided age of 70, to be held by the patient, the purpose being to ensure continuity of country when compensation not available to him in that country’s own courts. medical care and to avoid overprescribing. Crown immunity from suit by members The idea of these dossiers came from the of the British armed services has lately general practitioners who suggest an been removed but under US law acta jure annual fee of FFr 200 per dossier. imperii still rules, it seems.
A
serving
not
Diana Brahams
1482
Jean-Yves Nau
out organs, and that their own results were "poor" because they often put transplants in very ill patients. The Danish Medical Association strongly urged the surgeons to make peace, but in vain. The chief of the National Board of Health was apparently more successful in urging both parties to stop the fight, when he brought the two heads of units together face-to-face. The board held the view that the fight could only discredit the whole transplant-programme, and that it would probably reduce the number of organ donors. The Minister of Health stopped the dispute by declaring that there shall be two centres, and that the smaller centre in Aarhus shall work as an independent centre. He said that the surgeons of the two centres must cooperate to put available donor organs to the best use-if they do not obey this order, strong action will be taken against them.
taking
Kaare Skovmand
News in brief League tables
in UK An "intormation
revolution" is set to sweep through the 1 health services of England and Wales. ] From June, 1994, league tables of individ1ual hospitals’ performances will be made The hospitals will be ranked . public. :according to their achievements in six j indicator areas, which include the number Iof accident and emergency patients seen and the number of cancelled . immediately , The Department of Health is operations. I whether mortality figures for deciding jindividual hospitals should also be pub] lished. IFinal split in drug industry More than 100 firms will leave the German federal association of pharmaceutical industry by the beginning of next year; 370 will stay. A proposed reform of the association’s statutes, which could have stopped the departure, did not get the necessary twothirds majority. 24 of the departing firms have entered the Verband forschender Arzneimittelhersteller, the association of drug firms involved in research. Together they hold about 60% of the drug market share. ’
’
’
Ethics of genetic screening The first report of the UK Nuffield Council on Bioethics was published on Dec 7.1 It discusses the ethical consequences of screening programmes and recommends a series of safegurads. The controversial subject of insurance and genetic testing is highlighted (see Lancet Jan 23, p 224). The Council calls for action from government, health professionals, employers, and the insurance industry. 1 Genetic
screening: ethical issues. Nuffield Council on Bioethics. London: Nuffield Foundation. 1993. Pp 115. 6. ISBN 0-952270102.