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Junior doctors strike against specialist proposals
Philippines birth rate affects economy
T
he prospects for development and alleviation of poverty in the Philippines will remain poor unless the country’s spiralling population growth can be brought under control warned a report by the Asian Development Bank (ADB). The Phillipines, a staunchly Catholic country, has the highest population growth rate in the region—despite being one of the first to implement a population-control policy in the 1970s. The growth rate is currently 2·3% per year, compared with a population fall of 1·9% in India, 1·5% in Indonesia, 1·3% in China, and 0·9% in Thailand. All efforts at population control in the Philippines have been thwarted by the influential Catholic church. Last year, the Archbishop of Manila, Cardinal Jaime Sin, said that condoms were “evil” and “fit only for animals”.
Also, family planning is usually only available for 6-month periods and abortion is illegal. But the number of abortions is increasing and some politicians have suggested making abortion punishable by death. Population growth targets were not met by the previous administration, and the current president Joseph Estrada—who has at least 11 children by four different women—has yet to tackle the population issue, despite his electoral pledges to wipe out poverty. The ADB warned that at this rate the country’s situation could only remain static or deteriorate. 22 million Filipinos out of a population of 74 million are malnourished, including 3·8 million children aged 1–5 years years, and 11 500 children are dying each year.
unior doctors from Spanish public hospitals held a national strike on May 5 in protest against a Royal Bill that may allow doctors to obtain specialist status without passing any of the recognised national exams. The government proposed the Bill to solve the problem of doctors who were effectively working as specialists, but who did not receive the title because they had not applied for the exam, or had simply failed it. The government had hoped the Bill will be approved before summer. According
Domestic violence guidelines On April 30, the Spanish Ministry of Health issued doctors with guidelines for dealing with cases of domestic violence, which could help the judicial system bring swifter prosecutions. Doctors must now give a detailed description of a patient’s psychological and physical injuries, which will be kept with the patient's medical records. Doctors will then put the patient in contact with the social services to ensure his or her safety. In Spain, during 1998 more than 19 000 people were injured and 45 people died because of violence in the home (see Lancet 1998; 352: 1365). Xavier Bosch
THELANCET • Vol 353 • May 15, 1999
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to the proposal, more than 3000 MDlevel doctors who qualified before January, 1995, could become specialists if they can prove they have worked in the role for at least one and half times the period it takes junior doctors to become specialists, which is about 4–5 years. The junior doctors, or MIRs, have to pass a competitive national exam, which only allocates posts to 1–2% of applicants. They argue that the exam is the only way to get the title. A MIR representative, Fernando Leon (Madrid Medical College), said that the magnitude of the strike— about 80% of junior doctors went on strike according to the Ministry of Health—is proportional to the potential damage caused by giving titles to doctors who are not qualified as specialists. The MIRs have announced that they will strike for 3 days a week in May, and then indefinitely if the government does not rectify the situation. Several Spanish medical organisations have backed the strike, stating that the MIR system is a guarantee of quality health care and that the government’s proposals do not maintain these standards.
he UK Department of Health has refused doctors complete freedom to prescribe the antiimpotence drug sildenafil (Viagra) at the National Health Service’s (NHS) expense, despite a legal challenge by the drug’s manufacturer (Pfizer). The Department’s policy will only allow general practitioners (GPs) to prescribe the drug for men whose erectile dysfunction (ED) is caused by certain types of severe disease. The Department’s announcement places sildenafil on a “grey list” of high-cost drugs. GPs can prescribe the drug at the NHS’s expense only if the patient’s impotence is caused by prostate cancer, renal failure, polio, spina bifida, Parkinson’s disease, or severe pelvic injury. Other patients can obtain sildenafil from specialist clinics but only in “exceptional cases of extreme distress”. The BMA’s GP committee chairman, John Chisholm, insisted that prescribing sildenifil came within the competence of GPs and said it was “perverse” that men with severe distress from ED would have to be referred to “an already overwhelmed specialist service”. But the NHS Confederation, which represents senior NHS managers, welcomed the Department’s decision. “All publicly-funded health care has to work within financial constraints”, said chief executive Stephen Thornton. “There will be many other lifestyle drugs for which similar decisions will be needed.” Pfizer’s chairman, Ken Moran, said that the ruling was “arbitrary, unfair, and discriminatory”. The policy would exclude many men from low-income groups who cannot afford to buy sildenafil privately, he said. “Treatment of ED was funded by the NHS until last September [when Viagra was licensed] and it makes no sense to change this when all that has happened is the licensing of an effective oral treatment”, he added. Pfizer is continuing its court action, which claims that the Department of Health had no legal right to issue the restrictive guidelines in September, 1998. The Department’s policy limits Viagra availability to only 15% of men with ED.
Xavier Bosch
Peter Mitchell
Adam Easton
Junior doctors strike against specialist proposals
J
UK government restricts the use of sildenafil
1687
T
he prospects for development and alleviation of poverty in the Philippines will remain poor unless the country’s spiralling population growth can be brought under control warned a report by the Asian Development Bank (ADB). The Phillipines, a staunchly Catholic country, has the highest population growth rate in the region—despite being one of the first to implement a population-control policy in the 1970s. The growth rate is currently 2·3% per year, compared with a population fall of 1·9% in India, 1·5% in Indonesia, 1·3% in China, and 0·9% in Thailand. All efforts at population control in the Philippines have been thwarted by the influential Catholic church. Last year, the Archbishop of Manila, Cardinal Jaime Sin, said that condoms were “evil” and “fit only for animals”.
Also, family planning is usually only available for 6-month periods and abortion is illegal. But the number of abortions is increasing and some politicians have suggested making abortion punishable by death. Population growth targets were not met by the previous administration, and the current president Joseph Estrada—who has at least 11 children by four different women—has yet to tackle the population issue, despite his electoral pledges to wipe out poverty. The ADB warned that at this rate the country’s situation could only remain static or deteriorate. 22 million Filipinos out of a population of 74 million are malnourished, including 3·8 million children aged 1–5 years years, and 11 500 children are dying each year.
unior doctors from Spanish public hospitals held a national strike on May 5 in protest against a Royal Bill that may allow doctors to obtain specialist status without passing any of the recognised national exams. The government proposed the Bill to solve the problem of doctors who were effectively working as specialists, but who did not receive the title because they had not applied for the exam, or had simply failed it. The government had hoped the Bill will be approved before summer. According
Domestic violence guidelines On April 30, the Spanish Ministry of Health issued doctors with guidelines for dealing with cases of domestic violence, which could help the judicial system bring swifter prosecutions. Doctors must now give a detailed description of a patient’s psychological and physical injuries, which will be kept with the patient's medical records. Doctors will then put the patient in contact with the social services to ensure his or her safety. In Spain, during 1998 more than 19 000 people were injured and 45 people died because of violence in the home (see Lancet 1998; 352: 1365). Xavier Bosch
THELANCET • Vol 353 • May 15, 1999
T
to the proposal, more than 3000 MDlevel doctors who qualified before January, 1995, could become specialists if they can prove they have worked in the role for at least one and half times the period it takes junior doctors to become specialists, which is about 4–5 years. The junior doctors, or MIRs, have to pass a competitive national exam, which only allocates posts to 1–2% of applicants. They argue that the exam is the only way to get the title. A MIR representative, Fernando Leon (Madrid Medical College), said that the magnitude of the strike— about 80% of junior doctors went on strike according to the Ministry of Health—is proportional to the potential damage caused by giving titles to doctors who are not qualified as specialists. The MIRs have announced that they will strike for 3 days a week in May, and then indefinitely if the government does not rectify the situation. Several Spanish medical organisations have backed the strike, stating that the MIR system is a guarantee of quality health care and that the government’s proposals do not maintain these standards.
he UK Department of Health has refused doctors complete freedom to prescribe the antiimpotence drug sildenafil (Viagra) at the National Health Service’s (NHS) expense, despite a legal challenge by the drug’s manufacturer (Pfizer). The Department’s policy will only allow general practitioners (GPs) to prescribe the drug for men whose erectile dysfunction (ED) is caused by certain types of severe disease. The Department’s announcement places sildenafil on a “grey list” of high-cost drugs. GPs can prescribe the drug at the NHS’s expense only if the patient’s impotence is caused by prostate cancer, renal failure, polio, spina bifida, Parkinson’s disease, or severe pelvic injury. Other patients can obtain sildenafil from specialist clinics but only in “exceptional cases of extreme distress”. The BMA’s GP committee chairman, John Chisholm, insisted that prescribing sildenifil came within the competence of GPs and said it was “perverse” that men with severe distress from ED would have to be referred to “an already overwhelmed specialist service”. But the NHS Confederation, which represents senior NHS managers, welcomed the Department’s decision. “All publicly-funded health care has to work within financial constraints”, said chief executive Stephen Thornton. “There will be many other lifestyle drugs for which similar decisions will be needed.” Pfizer’s chairman, Ken Moran, said that the ruling was “arbitrary, unfair, and discriminatory”. The policy would exclude many men from low-income groups who cannot afford to buy sildenafil privately, he said. “Treatment of ED was funded by the NHS until last September [when Viagra was licensed] and it makes no sense to change this when all that has happened is the licensing of an effective oral treatment”, he added. Pfizer is continuing its court action, which claims that the Department of Health had no legal right to issue the restrictive guidelines in September, 1998. The Department’s policy limits Viagra availability to only 15% of men with ED.
Xavier Bosch
Peter Mitchell
Adam Easton
Junior doctors strike against specialist proposals
J
UK government restricts the use of sildenafil
1687