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“Harrowing” report of child abuse in Wales released
POLICY AND PEOPLE
“Harrowing” report of child abuse in Wales released
S
tate authorities entirely failed in their duty to protect children in residential care in Wales in the 1970s and 1980s, according to a report released on Feb 15. The report, which is the result of an inquiry launched in 1996, catalogues the widespread physical and sexual abuse of children in staterun homes. The abuse included the activity of a paedophile ring that targeted hundreds of children in
residential care. In many cases, staff whose duty was to protect the children were, in fact, the abusers. Health Secretary, Alan Milburn, said: “This is a harrowing report. It reveals a systematic failure to care for some of the most vulnerable children in society.” 60 of the 72 recommendations made by the inquiry team, led by former judge Sir Ronald Waterhouse, apply to the work of the Department
of Health. Milburn stated: “The Department is currently acting on 43 of the recommendations and is urgently reviewing the remaining 17.” In addition, the government has instructed local authorities and health authorities to trace 28 former care workers who were named in the report. Sarah Ramsay
Irish media revelations prompt revised post-mortem guidelines ast week, Irish hospitals and pathologists received new guidelines on post-mortem practices as hospitals countrywide mounted internal investigations into instances of organ retention without the consent of next of kin. The new document states that: “current practice in autopsy pathology was developed many years ago at a time when medical practice was paternalistic and when the principles
L
Cash for pituitaries row Pharmacia & Upjohn confirmed that it had made donations to Irish hospitals on receiving pituitary glands from dead children and adults for 11 years, until 1985. This practice became public knowledge last week as part of an investigation into organ removal and retention procedures at Our Lady’s Hospital for Sick Children in Dublin. A company then known as Kabi Vitrum, which is now part of Pharmacia & Upjohn, used the pituitary glands to produce human growth hormone. The organs were flown by Kabi Vitrum to its parent company in Sweden, which processed them to process the hormone, which was then sold worldwide.
of informed consent were less developed.” The guidelines from the Faculty of Pathology of the Royal College of Physicians in Ireland include a new post-mortem consent form. In the past few weeks, pathologists have reported that families have been refusing discretionary necropsies in the wake of unfavourable media coverage of past practices such as keeping organs for research and the revelation last week that hospitals “sold” pituitary glands to a drug company. The Minister of Health has also launched an inquiry into organ retention. The new consent form covers issues such as the retention of tissue for educational and research purposes. Families will now be able to limit non-coroner’s necropsies by asking doctors to confine examinations to certain body areas. Each hospital should appoint a “designated bereavement officer” trained to discuss issues of consent with bereaved relatives. Senior staff or this officer must make the request for a necropsy and it will no longer be acceptable for juniors do this task. The guidelines state: “medical staff seeking consent should satisfy them-
selves that no closer relatives (who may therefore have a superior right over the disposition of the body) exist. Similarly, they should be satisfied that the patient had not made a living will specifically precluding a post-mortem examination. The pathologist should be directly informed of any disputes that may have arisen between relatives regarding the performance or extent of a post-mortem examination.” The new guidance, which is an interim measure, combines aspects of the practice codes of the American College of Pathologists and the Royal College of Pathologists in the UK. There is a tradition of quick burial practice in Ireland and this has been taken into account, with pathologists urged to accommodate the wishes of relatives wanting the organs to be returned and buried with the body. Where families express no wish to reclaim organs, “a sensitive, acceptable alternative arrangement should be put in place by the hospital, for instance, cremation, burial in a suitable plot or incineration”. In the past, tissue and organs have been sent to continental Europe for incineration. Karen Birchard
Third-generation oral contraceptives still popular in the Netherlands
D
espite warnings of increased risk of venous thrombosis with the use of third-generation oral contraceptives, the number of prescriptions has not decreased in the Netherlands since 1995. Thirdgeneration pills still account for 40–50% of all oral contraceptive prescriptions (Ned Tijdschr v Geneesk 2000; 144: 280-83). Pieter Kersemakers and colleagues at the University of Maastricht compared prescriptions
THE LANCET • Vol 355 • February 19, 2000
by general practitioners and gynaecologists in 1994-95 with those in 1996-97. As expected, gynaecologists, complying with their official guidelines, did not change their prescription behaviour. In 1996, the Dutch Society of General Practitioners advised GPs, who issue most prescriptions, to preferentially prescribe second-generation oral contraceptives. But, after a temporary reduction, the prescription of third-generation con-
traceptives by GPs has remained constant. Kersemakers thinks that the disregard of official guidelines may be explained by the uncertainty surrounding the issue in the 1990s. “With the new data, more directive guidelines can be formulated, which will probably decrease the use of the third generation contraceptives”, he said. Wim Weber
635
“Harrowing” report of child abuse in Wales released
S
tate authorities entirely failed in their duty to protect children in residential care in Wales in the 1970s and 1980s, according to a report released on Feb 15. The report, which is the result of an inquiry launched in 1996, catalogues the widespread physical and sexual abuse of children in staterun homes. The abuse included the activity of a paedophile ring that targeted hundreds of children in
residential care. In many cases, staff whose duty was to protect the children were, in fact, the abusers. Health Secretary, Alan Milburn, said: “This is a harrowing report. It reveals a systematic failure to care for some of the most vulnerable children in society.” 60 of the 72 recommendations made by the inquiry team, led by former judge Sir Ronald Waterhouse, apply to the work of the Department
of Health. Milburn stated: “The Department is currently acting on 43 of the recommendations and is urgently reviewing the remaining 17.” In addition, the government has instructed local authorities and health authorities to trace 28 former care workers who were named in the report. Sarah Ramsay
Irish media revelations prompt revised post-mortem guidelines ast week, Irish hospitals and pathologists received new guidelines on post-mortem practices as hospitals countrywide mounted internal investigations into instances of organ retention without the consent of next of kin. The new document states that: “current practice in autopsy pathology was developed many years ago at a time when medical practice was paternalistic and when the principles
L
Cash for pituitaries row Pharmacia & Upjohn confirmed that it had made donations to Irish hospitals on receiving pituitary glands from dead children and adults for 11 years, until 1985. This practice became public knowledge last week as part of an investigation into organ removal and retention procedures at Our Lady’s Hospital for Sick Children in Dublin. A company then known as Kabi Vitrum, which is now part of Pharmacia & Upjohn, used the pituitary glands to produce human growth hormone. The organs were flown by Kabi Vitrum to its parent company in Sweden, which processed them to process the hormone, which was then sold worldwide.
of informed consent were less developed.” The guidelines from the Faculty of Pathology of the Royal College of Physicians in Ireland include a new post-mortem consent form. In the past few weeks, pathologists have reported that families have been refusing discretionary necropsies in the wake of unfavourable media coverage of past practices such as keeping organs for research and the revelation last week that hospitals “sold” pituitary glands to a drug company. The Minister of Health has also launched an inquiry into organ retention. The new consent form covers issues such as the retention of tissue for educational and research purposes. Families will now be able to limit non-coroner’s necropsies by asking doctors to confine examinations to certain body areas. Each hospital should appoint a “designated bereavement officer” trained to discuss issues of consent with bereaved relatives. Senior staff or this officer must make the request for a necropsy and it will no longer be acceptable for juniors do this task. The guidelines state: “medical staff seeking consent should satisfy them-
selves that no closer relatives (who may therefore have a superior right over the disposition of the body) exist. Similarly, they should be satisfied that the patient had not made a living will specifically precluding a post-mortem examination. The pathologist should be directly informed of any disputes that may have arisen between relatives regarding the performance or extent of a post-mortem examination.” The new guidance, which is an interim measure, combines aspects of the practice codes of the American College of Pathologists and the Royal College of Pathologists in the UK. There is a tradition of quick burial practice in Ireland and this has been taken into account, with pathologists urged to accommodate the wishes of relatives wanting the organs to be returned and buried with the body. Where families express no wish to reclaim organs, “a sensitive, acceptable alternative arrangement should be put in place by the hospital, for instance, cremation, burial in a suitable plot or incineration”. In the past, tissue and organs have been sent to continental Europe for incineration. Karen Birchard
Third-generation oral contraceptives still popular in the Netherlands
D
espite warnings of increased risk of venous thrombosis with the use of third-generation oral contraceptives, the number of prescriptions has not decreased in the Netherlands since 1995. Thirdgeneration pills still account for 40–50% of all oral contraceptive prescriptions (Ned Tijdschr v Geneesk 2000; 144: 280-83). Pieter Kersemakers and colleagues at the University of Maastricht compared prescriptions
THE LANCET • Vol 355 • February 19, 2000
by general practitioners and gynaecologists in 1994-95 with those in 1996-97. As expected, gynaecologists, complying with their official guidelines, did not change their prescription behaviour. In 1996, the Dutch Society of General Practitioners advised GPs, who issue most prescriptions, to preferentially prescribe second-generation oral contraceptives. But, after a temporary reduction, the prescription of third-generation con-
traceptives by GPs has remained constant. Kersemakers thinks that the disregard of official guidelines may be explained by the uncertainty surrounding the issue in the 1990s. “With the new data, more directive guidelines can be formulated, which will probably decrease the use of the third generation contraceptives”, he said. Wim Weber
635