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Medical-training overhaul urged in California
THE LANCET
POLICY AND PEOPLE
US state officials and tobacco industry reach landmark agreement he tobacco industry and US attorneys general reached an agreement on June 20 that would severely restrict future litigation against manufacturers of cigarettes and smokeless tobacco products. The 68-page document is the result of 5 months of feverish negotiations. Manufacturers agreed to pay
T
US$368 billion to settle such claims over the next 25 years, and to reduce teenage smoking by 42% in 5 years, 58% in 7 years, and 67% in 10 years. If it does not meet these targets, it would be subject to additional penalties of up to US$2 billion a year. Before the deal, the hammer was to be further FDA regulation.
Canada’s British Columbia attacks tobacco companies Launching a “multi-pronged attack” on tobacco companies, the government in British Columbia, Canada, has introduced legislation to help individuals or governments to sue the tobacco industr y for health damages caused by smoking. The province’s Premier, Glen Clark, announced the tough antismoking package on June 17. It will essentially allow cour ts to use a diminished standard of proof in ascer taining the harmful effects of smoking, thereby making it easier to successfully pursue class-action suits against tobacco companies. The legislation permits the introduction of epidemiological evidence showing causal links to illness or death. It also allows judges to consider similar effects for similar products, essentially negating the need for complainants to demonstrate that an individual cigarette brand caused detrimental effects. In addition, the government will begin airing a series of harsh adver tisements demonstrating the harmful effects of smoking. And Health Minister, Joy McPhail, has asked the tobacco industr y to pay for increased costs associated with the province's smoking-prevention programme. Wayne Kondro
But the settlement curbs authority that FDA won earlier this year from a federal court, by barring regulation of nicotine content until 2009. The agency has held back on regulating nicotine because it has not had the scientific data. As part of the settlement, the industry has agreed to turn over more of its internal documents. And, the deal forces the agency to prove that lowering nicotine or altering cigarettes will not create a black market for high-powered products. The Clinton Administration has already indicated it will fight to preserve FDA’s jurisdiction, and a representative of the agency says that it is moving ahead with enforcement of a law prohibiting minors from purchasing cigarettes. The agreement has many hurdles before it becomes law. First, the White House will review it; then it will be passed on to Congress, where it will receive fine tuning and be subject to lobbying by special interests. Alicia Ault
French hospital-acquired bugs 7·6% of patients treated in French hospitals contract an infection during their stay, according to a study by the French Ministry of Health. Although the French hospital infection rates fall within the average for the whole of Europe, experts point that many hospital workers still do not wash their hands systematically and efficiently while working with patients. They also state that resistance to antibiotic therapy is much higher in France than in most other north European countries. UK health variations On June 25, the UK Economic and Social Research Council launched the £4-million Health Variations Programme. The programme consists of a series of 13 research projects throughout the country, and will aim to unravel the causes of inequalities in mortality and morbidity between social groups, including specific geographical and ethnic groups. Details of the programme can be viewed on the website (see http://www.lancs.ac.uk/users. apsocsi/hvp.htm).
1894
Medical-training overhaul urged in California business, management, and technical alifornian officials are now acumen necessary to work in manreviewing recommendations aged care; and by teaching doctors to from a commission that has called for work as part of a medical team. an overhaul of the state’s medicalThe commission’s report seems school system to train students somewhat redundant given what for practising in a managed-care is happening to environment. If the medical training in recommendations are general. Out of adopted, California necessity, schools in would become the California, as in the first state in the USA rest of the USA, have to approve such a begun to take steps major undertaking. to respond to the The 28-member changing health-care Commission on the market by encouragFuture of Medical ing primary-care Education was Learning managed care specialties, incorpoappointed nearly a rating managed-care principles into year ago by the University of their curriculums, and offering douCalifornia to assess the state’s ble degrees in medicine and business. academic medical system. California Even some managed-care plans are has the highest penetration of cooperating with medical schools to managed care in the USA. Physician provide training sites. Most manspecialists graduating from medical aged-care plans have been unwilling schools in the state are already having to share the burden of financing trouble getting jobs. medical education. But some are The report acknowledges this and coming forward. In March, Aetna US concludes that medical schools need Healthcare said it would help fund a to start responding to the needs of managed-care education project at managed care by reducing the numNew Medical College in Valhalla. ber of specialists they train and increasing training of generalists; by arming medical students with the Janet Firshein
C
Science Photo Librar y
News in brief
Vol 349 • June 28, 1997
POLICY AND PEOPLE
US state officials and tobacco industry reach landmark agreement he tobacco industry and US attorneys general reached an agreement on June 20 that would severely restrict future litigation against manufacturers of cigarettes and smokeless tobacco products. The 68-page document is the result of 5 months of feverish negotiations. Manufacturers agreed to pay
T
US$368 billion to settle such claims over the next 25 years, and to reduce teenage smoking by 42% in 5 years, 58% in 7 years, and 67% in 10 years. If it does not meet these targets, it would be subject to additional penalties of up to US$2 billion a year. Before the deal, the hammer was to be further FDA regulation.
Canada’s British Columbia attacks tobacco companies Launching a “multi-pronged attack” on tobacco companies, the government in British Columbia, Canada, has introduced legislation to help individuals or governments to sue the tobacco industr y for health damages caused by smoking. The province’s Premier, Glen Clark, announced the tough antismoking package on June 17. It will essentially allow cour ts to use a diminished standard of proof in ascer taining the harmful effects of smoking, thereby making it easier to successfully pursue class-action suits against tobacco companies. The legislation permits the introduction of epidemiological evidence showing causal links to illness or death. It also allows judges to consider similar effects for similar products, essentially negating the need for complainants to demonstrate that an individual cigarette brand caused detrimental effects. In addition, the government will begin airing a series of harsh adver tisements demonstrating the harmful effects of smoking. And Health Minister, Joy McPhail, has asked the tobacco industr y to pay for increased costs associated with the province's smoking-prevention programme. Wayne Kondro
But the settlement curbs authority that FDA won earlier this year from a federal court, by barring regulation of nicotine content until 2009. The agency has held back on regulating nicotine because it has not had the scientific data. As part of the settlement, the industry has agreed to turn over more of its internal documents. And, the deal forces the agency to prove that lowering nicotine or altering cigarettes will not create a black market for high-powered products. The Clinton Administration has already indicated it will fight to preserve FDA’s jurisdiction, and a representative of the agency says that it is moving ahead with enforcement of a law prohibiting minors from purchasing cigarettes. The agreement has many hurdles before it becomes law. First, the White House will review it; then it will be passed on to Congress, where it will receive fine tuning and be subject to lobbying by special interests. Alicia Ault
French hospital-acquired bugs 7·6% of patients treated in French hospitals contract an infection during their stay, according to a study by the French Ministry of Health. Although the French hospital infection rates fall within the average for the whole of Europe, experts point that many hospital workers still do not wash their hands systematically and efficiently while working with patients. They also state that resistance to antibiotic therapy is much higher in France than in most other north European countries. UK health variations On June 25, the UK Economic and Social Research Council launched the £4-million Health Variations Programme. The programme consists of a series of 13 research projects throughout the country, and will aim to unravel the causes of inequalities in mortality and morbidity between social groups, including specific geographical and ethnic groups. Details of the programme can be viewed on the website (see http://www.lancs.ac.uk/users. apsocsi/hvp.htm).
1894
Medical-training overhaul urged in California business, management, and technical alifornian officials are now acumen necessary to work in manreviewing recommendations aged care; and by teaching doctors to from a commission that has called for work as part of a medical team. an overhaul of the state’s medicalThe commission’s report seems school system to train students somewhat redundant given what for practising in a managed-care is happening to environment. If the medical training in recommendations are general. Out of adopted, California necessity, schools in would become the California, as in the first state in the USA rest of the USA, have to approve such a begun to take steps major undertaking. to respond to the The 28-member changing health-care Commission on the market by encouragFuture of Medical ing primary-care Education was Learning managed care specialties, incorpoappointed nearly a rating managed-care principles into year ago by the University of their curriculums, and offering douCalifornia to assess the state’s ble degrees in medicine and business. academic medical system. California Even some managed-care plans are has the highest penetration of cooperating with medical schools to managed care in the USA. Physician provide training sites. Most manspecialists graduating from medical aged-care plans have been unwilling schools in the state are already having to share the burden of financing trouble getting jobs. medical education. But some are The report acknowledges this and coming forward. In March, Aetna US concludes that medical schools need Healthcare said it would help fund a to start responding to the needs of managed-care education project at managed care by reducing the numNew Medical College in Valhalla. ber of specialists they train and increasing training of generalists; by arming medical students with the Janet Firshein
C
Science Photo Librar y
News in brief
Vol 349 • June 28, 1997