- Email: [email protected]
Passive smoking
786
Noticeboard Code for
infertility treatments
The Human Fertilisation &
Embryology Authority (HFEA), set following the Royal Assent of the Human Fertilisation and Embryology, has published proposals for a code of practice for centres offering infertility treatments and those carying up last November
research on human embryos.’ The authority’s principal task is to regulate, through a licensing system, any research or treatment that involves the creation, storage, and use of human embryos outside the body or the storage or donation of human eggs or sperm. Because these activities raise moral, ethical, and social questions, as well as scientific ones, the HFEA is consulting not only the treatment and research centres but also a wide range of professional organisations, religious groups, ethicists, and social interests. The consultation period ends on May 20. In drafting the code the HFEA has been guided by the right due to human life; the right of infertile people to be considered for treatment; the welfare of children, which may conflict with the interests of the adults involved; and the benefits that can flow from the responsible pursuit of medical and scientific knowledge. There has been widespread concern about the variable (and sometimes very low) success rates achieved with infertility treatments, which in private clinics can be very costly. The Authority, which will carry out annual checks of licensed premises, aims to "support the best clinical and scientific practice, while guarding against the undoubted risk of exploitation of people at a time when they may be particularly vulnerable". However, the HFEA says it has no hard evidence that patients are being deliberately misled about the chances of success. To reduce the chances of multiple births, the code proposes that no more than three eggs or embryos should be transferred in any out
one
cycle.
The HFEA code comes at a time when so-called "virgin births" have been hotly debated in the media, following publication of a letter in The Lancet (March 2, p 559) from a psychotherapist whose patient, though never having had sexual intercourse, was seeking assisted conception. The code does not exclude such women from consideration for treatment but says that "people seeking treatment are entitled to a fair and unprejudiced assessment of their situation and needs". One of the factors to be considered is the commitment of patients and "that of their husband or partner, if any, to having and bringing up a child or children". A patient who is refused treatment should be told the reason for refusal, the code says, and should be given the chance to reply. The 1990 Act imposes new obligations on centres offering in-vitro fertilisation and donor insemination to provide counselling for patients and to take account of the welfare of children bom as a result of infertility treatments. The scope of the HFEA code is thus more complex than the guidelines produced by a Voluntary (later
Interim) Licensing Authority. 1. Code of
practice: consultation document. Human Fertilisation & Embryology Authority, Clements House, 14-18 Gresham Street, London EC2V 7JE.
Passive smoking In a concerted effort to stimulate action against passive smoking, booklet! that outlines its health hazards and the measures that can be taken to reduce environmental tobacco smoke is being sent to groups such as members of parliament (British and European), employers’ organisations, and trade unions. The booklet, commissioned by the Health Education Authority, British Medical Association, Action on Smoking and Health, and the Coronary Prevention Group, and funded by the HEA, the two cancer charities that published it, the British Heart Foundation, the National Asthma Campaign, and the Department of Health, carries the endorsement of some thirty organisations, including the Royal Colleges of Physicians and Surgeons in England and Scotland. a
Existing methods of extracting the smoke as it is released into the air is unlikely to provide adequate protection. The booklet points out that although Britain, unlike several other countries, does not yet have comprehensive legislation to restrict smoking in enclosed places used by the public, existing health and safety legislation can sometimes be invoked. Employers, who are expected not only to provide employees with a safe environment but also to warn them of health hazards, will find it difficult to plead ignorance of the dangers of passive smoking as a mitigating factor because the courts have established that they must keep reasonably abreast of developing knowledge. The booklet also points out that in places such as hospitals, where a non-smoking policy is adopted, efforts should be made to ensure that the policies are implemented. 1. Passive Smoking: A Health Hazard. London: Imperial Cancer Research Fund and Cancer Research Campaign. 1991. Pp 17. £3.95 (including postage and packaging, from Passive Smoking, PO Box 4RP, London W1A 4RP). ISBN 0-901682063
Paternal radiation exposure and childhood leukaemia In 1990 Prof M. J. Gardner and his colleagues provided a much-needed stimulus to the faltering debate about whether (and, if so, how) there was a causative association between radiation, nuclear facilities, and leukaemia in childhood. It seemed that paternal radiation exposure had to be taken into account, even though there is no more radiobiological sense to that explanation than there is to some more direct environmental exposure. Last week the British Medical Journal published two more studies.!,2 We are no further forward, largely because the publications and commentaries have had to be ankle-deep in caveats. The study on the Dounreay area’ looks negative-ie, non-supportive of paternal radiation exposure as a factor-but the Committee on Medical Aspects of Radiation in the Environment comments that "... the findings in this small study fail to support but do not negate ...". The other study is cautiously positive on certain paternal occupations (including radiation work), but Prof P. G. Smith’s EMJ editorial notes that with exclusion of three cases already in Gardner’s study "the evidence suggesting an effect of preconception irradiation is much weaker". Urquhart JD, Black RJ, Muirhead MJ, et al. Case-control study of leukaemia and non-Hodgkin’s lymphoma in children in Caithness near the Dounreay nuclear installation. Br Med J 1991; 302: 687-92. 2. McKinney PA, Alexander FE, Cartwright RA, Parker L. Parental occupations of 1.
children with leukaemia in west Cumbria, north Humberside, and Gateshead. Br Med J 1991; 302: 681-87.
Maternal deaths in the UK The four countries of the United Kingdom have, for the first on confidential inquiries into maternal deaths into one publication, which covers deaths occurring in 1985-87. The report covers 265 deaths (212 England, 18 Wales, 25 Scotland, 10 Northern Ireland), of which 249 occurred in the first 42 days after delivery, and 139 (56%) of these were judged to be direct obstetric deaths. The mortality rate in the triennium covered (7-6 per 100 000 total births) was 18% lower than that in the previous triennium. The commonest causes of death were thromboembolism and hypertensive disorders of pregnancy. Although the death rate from hypertensive disorders was similar to that previously reported for England and Wales, there was a shift in the pattern of immediate cause of death, from cerebral complications to the acute respiratory distress syndrome. The explanation offered is that patients are now surviving the early period, when they are at greatest risk of cerebral haemorrhage from uncontrolled hypertension. Cardiac disease was the third commonest cause of death. Patients successfully operated on for congenital heart disease (who sometimes become pregnant against advice) form a newly identifiable group of patients: the additional circulatory load of pregnancy and labour probably proves too much for the heart.
time, pooled their reports
Noticeboard Code for
infertility treatments
The Human Fertilisation &
Embryology Authority (HFEA), set following the Royal Assent of the Human Fertilisation and Embryology, has published proposals for a code of practice for centres offering infertility treatments and those carying up last November
research on human embryos.’ The authority’s principal task is to regulate, through a licensing system, any research or treatment that involves the creation, storage, and use of human embryos outside the body or the storage or donation of human eggs or sperm. Because these activities raise moral, ethical, and social questions, as well as scientific ones, the HFEA is consulting not only the treatment and research centres but also a wide range of professional organisations, religious groups, ethicists, and social interests. The consultation period ends on May 20. In drafting the code the HFEA has been guided by the right due to human life; the right of infertile people to be considered for treatment; the welfare of children, which may conflict with the interests of the adults involved; and the benefits that can flow from the responsible pursuit of medical and scientific knowledge. There has been widespread concern about the variable (and sometimes very low) success rates achieved with infertility treatments, which in private clinics can be very costly. The Authority, which will carry out annual checks of licensed premises, aims to "support the best clinical and scientific practice, while guarding against the undoubted risk of exploitation of people at a time when they may be particularly vulnerable". However, the HFEA says it has no hard evidence that patients are being deliberately misled about the chances of success. To reduce the chances of multiple births, the code proposes that no more than three eggs or embryos should be transferred in any out
one
cycle.
The HFEA code comes at a time when so-called "virgin births" have been hotly debated in the media, following publication of a letter in The Lancet (March 2, p 559) from a psychotherapist whose patient, though never having had sexual intercourse, was seeking assisted conception. The code does not exclude such women from consideration for treatment but says that "people seeking treatment are entitled to a fair and unprejudiced assessment of their situation and needs". One of the factors to be considered is the commitment of patients and "that of their husband or partner, if any, to having and bringing up a child or children". A patient who is refused treatment should be told the reason for refusal, the code says, and should be given the chance to reply. The 1990 Act imposes new obligations on centres offering in-vitro fertilisation and donor insemination to provide counselling for patients and to take account of the welfare of children bom as a result of infertility treatments. The scope of the HFEA code is thus more complex than the guidelines produced by a Voluntary (later
Interim) Licensing Authority. 1. Code of
practice: consultation document. Human Fertilisation & Embryology Authority, Clements House, 14-18 Gresham Street, London EC2V 7JE.
Passive smoking In a concerted effort to stimulate action against passive smoking, booklet! that outlines its health hazards and the measures that can be taken to reduce environmental tobacco smoke is being sent to groups such as members of parliament (British and European), employers’ organisations, and trade unions. The booklet, commissioned by the Health Education Authority, British Medical Association, Action on Smoking and Health, and the Coronary Prevention Group, and funded by the HEA, the two cancer charities that published it, the British Heart Foundation, the National Asthma Campaign, and the Department of Health, carries the endorsement of some thirty organisations, including the Royal Colleges of Physicians and Surgeons in England and Scotland. a
Existing methods of extracting the smoke as it is released into the air is unlikely to provide adequate protection. The booklet points out that although Britain, unlike several other countries, does not yet have comprehensive legislation to restrict smoking in enclosed places used by the public, existing health and safety legislation can sometimes be invoked. Employers, who are expected not only to provide employees with a safe environment but also to warn them of health hazards, will find it difficult to plead ignorance of the dangers of passive smoking as a mitigating factor because the courts have established that they must keep reasonably abreast of developing knowledge. The booklet also points out that in places such as hospitals, where a non-smoking policy is adopted, efforts should be made to ensure that the policies are implemented. 1. Passive Smoking: A Health Hazard. London: Imperial Cancer Research Fund and Cancer Research Campaign. 1991. Pp 17. £3.95 (including postage and packaging, from Passive Smoking, PO Box 4RP, London W1A 4RP). ISBN 0-901682063
Paternal radiation exposure and childhood leukaemia In 1990 Prof M. J. Gardner and his colleagues provided a much-needed stimulus to the faltering debate about whether (and, if so, how) there was a causative association between radiation, nuclear facilities, and leukaemia in childhood. It seemed that paternal radiation exposure had to be taken into account, even though there is no more radiobiological sense to that explanation than there is to some more direct environmental exposure. Last week the British Medical Journal published two more studies.!,2 We are no further forward, largely because the publications and commentaries have had to be ankle-deep in caveats. The study on the Dounreay area’ looks negative-ie, non-supportive of paternal radiation exposure as a factor-but the Committee on Medical Aspects of Radiation in the Environment comments that "... the findings in this small study fail to support but do not negate ...". The other study is cautiously positive on certain paternal occupations (including radiation work), but Prof P. G. Smith’s EMJ editorial notes that with exclusion of three cases already in Gardner’s study "the evidence suggesting an effect of preconception irradiation is much weaker". Urquhart JD, Black RJ, Muirhead MJ, et al. Case-control study of leukaemia and non-Hodgkin’s lymphoma in children in Caithness near the Dounreay nuclear installation. Br Med J 1991; 302: 687-92. 2. McKinney PA, Alexander FE, Cartwright RA, Parker L. Parental occupations of 1.
children with leukaemia in west Cumbria, north Humberside, and Gateshead. Br Med J 1991; 302: 681-87.
Maternal deaths in the UK The four countries of the United Kingdom have, for the first on confidential inquiries into maternal deaths into one publication, which covers deaths occurring in 1985-87. The report covers 265 deaths (212 England, 18 Wales, 25 Scotland, 10 Northern Ireland), of which 249 occurred in the first 42 days after delivery, and 139 (56%) of these were judged to be direct obstetric deaths. The mortality rate in the triennium covered (7-6 per 100 000 total births) was 18% lower than that in the previous triennium. The commonest causes of death were thromboembolism and hypertensive disorders of pregnancy. Although the death rate from hypertensive disorders was similar to that previously reported for England and Wales, there was a shift in the pattern of immediate cause of death, from cerebral complications to the acute respiratory distress syndrome. The explanation offered is that patients are now surviving the early period, when they are at greatest risk of cerebral haemorrhage from uncontrolled hypertension. Cardiac disease was the third commonest cause of death. Patients successfully operated on for congenital heart disease (who sometimes become pregnant against advice) form a newly identifiable group of patients: the additional circulatory load of pregnancy and labour probably proves too much for the heart.
time, pooled their reports