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Kevorkian convicted of murder
Dutch face further fears of Legionnaires’ disease n outbreak of Legionnaires’ disease at the world’s largest indoor flower-bulb show claimed its 21st life on April 1. So far, 106 confirmed and 125 suspected cases of the atypical pneumonia have occurred in visitors to the Westfriese Flora (Bovenkarspel, Netherlands; Feb 21–28). A case-control study has pointed to the consumer-products exhibition, adjacent to the bulb show, as the suspected source of the outbreak, which started at the end of Fe b ru a ry.
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A sample of water from a whirlpool spa in that area was positive by PCR for Legionella pneumophila, but the agent has not been cultured. According to the April 1 issue of Eurosurveillance Weekly, a study of 1500 exhibition employees is helping in the investigation into the outbreak source. The outbreak has caused nationwide alarm because although the bacterium often affects the elderly and immunocompromised, some of the affected individuals at the
Westfriese Flora were young and healthy. It was also noted that twice as many men were infected as women. On April 2, the Ministry of Health announced that legionella had been isolated from the Thermae 2000 health spa in Valkenburg, a facility which was inspected as part of precautionary checks ordered by health authorities on all such baths after the outbreak in Bovenkarspel. Kelly Morris
Industrial chemicals are hazardous to hearing
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hemicals used in industry, such as toluene, styrene, xylene, trichloroethylene, lead, and carbon mono xide present a major risk to hear ing and balance even when used within the current per missib le levels, said scientists meeting at the 4th European Conference on Protection against Noise (Zakopone, P oland; March 20–23) The conference heard evidence for the synergistic effects of chemicals and noise. Recent evidence (Scand Audiol 1998; 27: 111–16) suggests that the risk of hearing damage because of noise in the w orkplace has quadr upled. The combination of noise and chemicals increases the relativ e risk of hearing damage by up to eleven times, even though exposure to noise or chemicals alone
ma y be within current acceptab le against chemicals. Morata’ s work in limits . Deepak Prasher, the conferthe Brazilian printing industr ies ence organiser, said that although where toluene is used has shown that noise is par ticularly hear ing can be affected har sh on the cochlea, by chemicals alone. She industr ial chemicals explained that previtended to affect the ously neurotoxic damcochlear structures and age had been the central nervous sysdocumented, but ototoxtem making it m uch icity had not been recogmore hazardous for nised. Mora ta is now worker s. involved in a field study Thais Mora ta, from with the Sw edish the National Institute for N ational Institute for Occupa tional Safety and Working Life on the Health (Cincinna ti, OH, interaction of noise and Preventable hearing loss USA), explained the styrene, which will help need for hearing protection from set new stra teg ies to prevent hear ing solvents, asphyxiants, and metals loss . because protection from noise with, A ndrew Forg e for example, earplugs, will not help
Medicare gets a cleaner bill of health he Medicare programme for the elderly and disabled got good news and bad news from its trustees’ annual report on March 30. The good news is that rather than going broke in 2008, as was projected in 1997 (see Lancet 1997; 3 4 9 : 1303), it now seems that Medicare’s Hospital Insurance Trust Fund will be able to continue to pay bills until the year 2015. The bad news is that since Medicare’s funding crisis looks less immediate, it seems less likely that President Clinton and Congress will want to make what could be painful political decisions, such as raising taxes and cutting benefits, which would be needed to solve Medicare’s long-term difficulties. Medicare’s trustees credited the continuing strong US economy with producing more revenue than expected for the programme in the form of a 2·9% payroll tax. But
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Medicare spending also increased at a slower rate, partly because of payment reductions imposed by the 1997 Balanced Budget A c t , a n d partly because of increased efforts to crack down on fraud by health-care providers. But with at least some of the pressure off, it will be even harder now for policy makers to reach a compromise on how to keep the programme solvent when the 75 million ‘baby b o o m e rs ’ become eligible for Medicare in the year 2010. While Clinton and Congress have both vowed to try to make needed changes this year, the failure of a high-level Medicare commission to reach consensus last month (see Lancet 1999; 3 5 3 : 1075) is not considered a good omen for their efforts. Julie Rovner
Kevorkian convicted of murder n March 26 assisted-suicide advocate Jack Kevorkian was convicted by a Michigan jury of seconddegree murder for delivering lethal injections to a man with amyotrophic lateral sclerosis (ALS). In this case (see Lancet 1998; 352: 1838) Kevorkian delivered the lethal drug himself and videotaped the event, thus daring prosecutors to charge him with first-degree murder, which they did. The judge ruled that even if the patient, Thomas Youk, consented to Kevorkian’s actions, this would not be a sufficient defence to the murder charge. Sentencing for Kevorkian,who could face 25 years in jail for the murder charge and another 7 years for a separate conviction for illegal delivery of a controlled substance, is scheduled for April 14.
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Julie Rovner
THELANCET • Vol 353 • April 10,1999
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A sample of water from a whirlpool spa in that area was positive by PCR for Legionella pneumophila, but the agent has not been cultured. According to the April 1 issue of Eurosurveillance Weekly, a study of 1500 exhibition employees is helping in the investigation into the outbreak source. The outbreak has caused nationwide alarm because although the bacterium often affects the elderly and immunocompromised, some of the affected individuals at the
Westfriese Flora were young and healthy. It was also noted that twice as many men were infected as women. On April 2, the Ministry of Health announced that legionella had been isolated from the Thermae 2000 health spa in Valkenburg, a facility which was inspected as part of precautionary checks ordered by health authorities on all such baths after the outbreak in Bovenkarspel. Kelly Morris
Industrial chemicals are hazardous to hearing
C
hemicals used in industry, such as toluene, styrene, xylene, trichloroethylene, lead, and carbon mono xide present a major risk to hear ing and balance even when used within the current per missib le levels, said scientists meeting at the 4th European Conference on Protection against Noise (Zakopone, P oland; March 20–23) The conference heard evidence for the synergistic effects of chemicals and noise. Recent evidence (Scand Audiol 1998; 27: 111–16) suggests that the risk of hearing damage because of noise in the w orkplace has quadr upled. The combination of noise and chemicals increases the relativ e risk of hearing damage by up to eleven times, even though exposure to noise or chemicals alone
ma y be within current acceptab le against chemicals. Morata’ s work in limits . Deepak Prasher, the conferthe Brazilian printing industr ies ence organiser, said that although where toluene is used has shown that noise is par ticularly hear ing can be affected har sh on the cochlea, by chemicals alone. She industr ial chemicals explained that previtended to affect the ously neurotoxic damcochlear structures and age had been the central nervous sysdocumented, but ototoxtem making it m uch icity had not been recogmore hazardous for nised. Mora ta is now worker s. involved in a field study Thais Mora ta, from with the Sw edish the National Institute for N ational Institute for Occupa tional Safety and Working Life on the Health (Cincinna ti, OH, interaction of noise and Preventable hearing loss USA), explained the styrene, which will help need for hearing protection from set new stra teg ies to prevent hear ing solvents, asphyxiants, and metals loss . because protection from noise with, A ndrew Forg e for example, earplugs, will not help
Medicare gets a cleaner bill of health he Medicare programme for the elderly and disabled got good news and bad news from its trustees’ annual report on March 30. The good news is that rather than going broke in 2008, as was projected in 1997 (see Lancet 1997; 3 4 9 : 1303), it now seems that Medicare’s Hospital Insurance Trust Fund will be able to continue to pay bills until the year 2015. The bad news is that since Medicare’s funding crisis looks less immediate, it seems less likely that President Clinton and Congress will want to make what could be painful political decisions, such as raising taxes and cutting benefits, which would be needed to solve Medicare’s long-term difficulties. Medicare’s trustees credited the continuing strong US economy with producing more revenue than expected for the programme in the form of a 2·9% payroll tax. But
T
1250
Medicare spending also increased at a slower rate, partly because of payment reductions imposed by the 1997 Balanced Budget A c t , a n d partly because of increased efforts to crack down on fraud by health-care providers. But with at least some of the pressure off, it will be even harder now for policy makers to reach a compromise on how to keep the programme solvent when the 75 million ‘baby b o o m e rs ’ become eligible for Medicare in the year 2010. While Clinton and Congress have both vowed to try to make needed changes this year, the failure of a high-level Medicare commission to reach consensus last month (see Lancet 1999; 3 5 3 : 1075) is not considered a good omen for their efforts. Julie Rovner
Kevorkian convicted of murder n March 26 assisted-suicide advocate Jack Kevorkian was convicted by a Michigan jury of seconddegree murder for delivering lethal injections to a man with amyotrophic lateral sclerosis (ALS). In this case (see Lancet 1998; 352: 1838) Kevorkian delivered the lethal drug himself and videotaped the event, thus daring prosecutors to charge him with first-degree murder, which they did. The judge ruled that even if the patient, Thomas Youk, consented to Kevorkian’s actions, this would not be a sufficient defence to the murder charge. Sentencing for Kevorkian,who could face 25 years in jail for the murder charge and another 7 years for a separate conviction for illegal delivery of a controlled substance, is scheduled for April 14.
O
Julie Rovner
THELANCET • Vol 353 • April 10,1999