- Email: [email protected]
Preventing international spread of HIV infection
846
drugs (eg, frusemide) differently. The UK reports far more most in the European Community but it has had its yellow-card reporting system in place for a very long time. On the other hand that system is voluntary; reporting is compulsory in some countries, and France in particular is far more flexible in accepting reports from non-clinicians. Key documentation seems to be missing from UK reports. Does that mean that UK reports are some
ADRs than
worthless? No, for the UK does not use ICD codes, and its data tend to be downgraded for that reason alone. Prescribing practice has to be taken into account too. For example, Sweden might seem to have a disastrous record in respect of antidepressant drugs as a class but between one-third and one-half of recorded ADRs are to clozapine, which other countries do not licence. And in the UK propranolol is recognised for portal hypertension, which is not an accepted indication for this drug in France or Germany. Edwards listed five record linkage systems for ADR surveillance in North America. This approach is hardly heard of in Europe. The exception is the UK, where prescription event monitoring is well established. Another system, the Tayside-based Medicines Evaluation and Monitoring Organisation (MEMO), was due to have been launched on the day Edwards spoke, but the event was cancelled through lack of support. International comparisons lead to more questions than answers, concluded Lindquist, wisely if defensively-but it was she who had begun by asking "Why bother?".
Court of Human
Rights hearing
for
microbiologist A long-running legal battle between consultant microbiologist Dr Royce Darnell and the Trent Regional Health Authority over his sacking in 19841,2 is to be the subject of a full hearing by the Court of Human Rights in Strasbourg. Darnell has won the first round of his Strasbourg appeal, with a unanimous ruling from the Commission on Human Rights that his case represented a violation of Article 6 of the European Convention on Human Rights, since his appeals against dismissal had not been concluded by the UK authorities "within a reasonable time". The case now goes to full Court, which could take a year to hand down a final judgment. Darnell was fired in May, 1984, after a three-year internal investigation into an alleged violation of staff-appointment procedures. He appealed to the Secretary of State within days of the decision, but Whitehall took until February, 1986, to confirm the termination of employment. Darnell then sought judicial review and won a ruling from the Divisional Court in July, 1986, that the Secretary of State had "failed to act with procedural fairness". The court declared that the sacking was invalid and that the minister should reconsider. Again, Whitehall took nearly two years to review the case, and confirmed Darnell’s dismissal in March, 1988. A further application for judicial review that year was rejected. Meanwhile, an appeal brought by Darnell to an industrial tribunal claiming unfair dismissal and seeking reinstatement had been put on ice pending the outcome of the other legal proceedings. After a six-year deferment, the tribunal finally ruled in 1990 that the dismissal had not been unfair. An appeal to the Employment Appeal Tribunal is still pending. 1. Brahams D. 2. Brahams D.
Suspended doctors m the Health Service. Lancet 1988; ii: 1205. Suspended doctors. HC(90)9 or the GMC? Lancet 1990, 335: 1089-90.
Life, death, and the RB gene Several types of human tumours are associated with inactivation of both copies of the retinoblastoma (RB) gene, and wild-type RB complementary DNA has a strong growth-suppressing effect when inserted into cells isolated from such tumours. Mutations that inactivate the RB gene result in unregulated cell growth, and the assumption has been that the wild-type RB gene suppresses tumorigenesis by controlling cell proliferation. In-vivo experiments in mice suggest a more positive role for the gene, as an initiator of differentiation rather than a negative regulator of cell
proliferation. 1-3 The three groups
reporting in Nature disrupted RB function in
different ways, but the consequences were similar, and disastroushomozygous mutants died in utero before the 16th day of gestation. The primary defect seemed to be an inability of neural tissue and erythrocytes to differentiate normally. Transfer of human RB complementary DNA into homozygous mutants corrected the developmental defects: animals with multiple copies of the human gene survived 6 months without obvious abnormalities. Why the mutant gene should affect cells from only two, unrelated, lineages is unclear. Another puzzle is how the loss of a gene that is
regarded as essential for normal development can be apparently normal life for at least 11 days of embryonic development, by which time many cell lineage
compatible
with
decisions will have been made. A further surprise in the mouse experiments is the absence of retinal tumours in animals carrying one mutant RB allele, since human beings who inherit a mutant RB have an 85% chance of having a second, somatic, mutation that leads to the development of tumours in early childhood. Heterozygous mice seemed to develop normally and had no retinoblastomas when examined at age up to 11 months. Heterozygotes with an inherited RB mutation were predisposed to malignancy, but the tumours found at necropsy were pituitary adenocarcinomas, not retinoblastomas.2.2 1. Lee
EY-HP, Chang C-Y, Hu N, et al. Mice deficient for Rb are nonviable and show defects in neurogenesis and haematopoiesis. Nature 1992; 359: 288-94. 2. Jacks T, Fazeli A, Schmitt EM, Bronson RT, Goodell MA, Weinberg RA. Efefcts of an RB mutation in the mouse. Nature 1992; 359: 295-300. 3. Clarke AR, Maandag ER, van Roon M, et al. Requirement for a functional RB-1 gene in murine development. Nature 1992; 359: 328-30.
Preventing international spread of HIV infection Its limited resources mean that the European project AIDS and Mobility (A & M)1 set up in October, 1990, at the request of the WHO, will continue to confine its activities to small-scale innovative pilot projects for preventing the spread of human immunodeficiency virus infection by travellers or among migrants. Information has been gathered on characteristics of the target groups, existing AIDS prevention measures for these groups, and the needs of AIDS prevention organisations. Projects targeted at Polish and Romanian sex workers moving to and from Germany or the Netherlands will be assessed next year, when a project aimed at young tourists in Greece is scheduled to start. Migrants are not considered a risk but as people who need information in an appropriate way. This year activities have been aimed at Turkish migrants. The target group for next year is expected to be the Arabic-speaking community; the workshop for the project is scheduled for the first half of 1993. 1. Information available from National Committee 1093 KP Amsterdam, Netherlands.
In
on
AIDS
Control, Polderweg 92,
England Now
Many GPs did minor surgery long before the 1990 contract introduced a sessional fee for it. We believed we were giving our patients a quick and convenient service, while releasing the real surgeons to tackle their waiting lists. We did not expect any thanks. What I certainly did not expect was to have to shell out my own to the hospital I thought I was helping. A patient whom I had referred to a local surgeon was booked for a Kveim test. My patient asked if it was really necessary for him to travel twice more to the hospital--once to have the injection and then again to have the biopsy-not to mention a third visit to hear the result. I sympathised. I was only too happy to do the test myself. It was then that I ran up against a manager who could not appreciate that so much of what is good in the NHS comes from the goodwill of its workers. He insisted that I could have the Kveim agent only on a commercial basis. I would have to pay for it. The hospital would save money, my patient would save time and money, but I would lose both. I learnt one thing from the experience: for a GP, Kveim does not pay.
drugs (eg, frusemide) differently. The UK reports far more most in the European Community but it has had its yellow-card reporting system in place for a very long time. On the other hand that system is voluntary; reporting is compulsory in some countries, and France in particular is far more flexible in accepting reports from non-clinicians. Key documentation seems to be missing from UK reports. Does that mean that UK reports are some
ADRs than
worthless? No, for the UK does not use ICD codes, and its data tend to be downgraded for that reason alone. Prescribing practice has to be taken into account too. For example, Sweden might seem to have a disastrous record in respect of antidepressant drugs as a class but between one-third and one-half of recorded ADRs are to clozapine, which other countries do not licence. And in the UK propranolol is recognised for portal hypertension, which is not an accepted indication for this drug in France or Germany. Edwards listed five record linkage systems for ADR surveillance in North America. This approach is hardly heard of in Europe. The exception is the UK, where prescription event monitoring is well established. Another system, the Tayside-based Medicines Evaluation and Monitoring Organisation (MEMO), was due to have been launched on the day Edwards spoke, but the event was cancelled through lack of support. International comparisons lead to more questions than answers, concluded Lindquist, wisely if defensively-but it was she who had begun by asking "Why bother?".
Court of Human
Rights hearing
for
microbiologist A long-running legal battle between consultant microbiologist Dr Royce Darnell and the Trent Regional Health Authority over his sacking in 19841,2 is to be the subject of a full hearing by the Court of Human Rights in Strasbourg. Darnell has won the first round of his Strasbourg appeal, with a unanimous ruling from the Commission on Human Rights that his case represented a violation of Article 6 of the European Convention on Human Rights, since his appeals against dismissal had not been concluded by the UK authorities "within a reasonable time". The case now goes to full Court, which could take a year to hand down a final judgment. Darnell was fired in May, 1984, after a three-year internal investigation into an alleged violation of staff-appointment procedures. He appealed to the Secretary of State within days of the decision, but Whitehall took until February, 1986, to confirm the termination of employment. Darnell then sought judicial review and won a ruling from the Divisional Court in July, 1986, that the Secretary of State had "failed to act with procedural fairness". The court declared that the sacking was invalid and that the minister should reconsider. Again, Whitehall took nearly two years to review the case, and confirmed Darnell’s dismissal in March, 1988. A further application for judicial review that year was rejected. Meanwhile, an appeal brought by Darnell to an industrial tribunal claiming unfair dismissal and seeking reinstatement had been put on ice pending the outcome of the other legal proceedings. After a six-year deferment, the tribunal finally ruled in 1990 that the dismissal had not been unfair. An appeal to the Employment Appeal Tribunal is still pending. 1. Brahams D. 2. Brahams D.
Suspended doctors m the Health Service. Lancet 1988; ii: 1205. Suspended doctors. HC(90)9 or the GMC? Lancet 1990, 335: 1089-90.
Life, death, and the RB gene Several types of human tumours are associated with inactivation of both copies of the retinoblastoma (RB) gene, and wild-type RB complementary DNA has a strong growth-suppressing effect when inserted into cells isolated from such tumours. Mutations that inactivate the RB gene result in unregulated cell growth, and the assumption has been that the wild-type RB gene suppresses tumorigenesis by controlling cell proliferation. In-vivo experiments in mice suggest a more positive role for the gene, as an initiator of differentiation rather than a negative regulator of cell
proliferation. 1-3 The three groups
reporting in Nature disrupted RB function in
different ways, but the consequences were similar, and disastroushomozygous mutants died in utero before the 16th day of gestation. The primary defect seemed to be an inability of neural tissue and erythrocytes to differentiate normally. Transfer of human RB complementary DNA into homozygous mutants corrected the developmental defects: animals with multiple copies of the human gene survived 6 months without obvious abnormalities. Why the mutant gene should affect cells from only two, unrelated, lineages is unclear. Another puzzle is how the loss of a gene that is
regarded as essential for normal development can be apparently normal life for at least 11 days of embryonic development, by which time many cell lineage
compatible
with
decisions will have been made. A further surprise in the mouse experiments is the absence of retinal tumours in animals carrying one mutant RB allele, since human beings who inherit a mutant RB have an 85% chance of having a second, somatic, mutation that leads to the development of tumours in early childhood. Heterozygous mice seemed to develop normally and had no retinoblastomas when examined at age up to 11 months. Heterozygotes with an inherited RB mutation were predisposed to malignancy, but the tumours found at necropsy were pituitary adenocarcinomas, not retinoblastomas.2.2 1. Lee
EY-HP, Chang C-Y, Hu N, et al. Mice deficient for Rb are nonviable and show defects in neurogenesis and haematopoiesis. Nature 1992; 359: 288-94. 2. Jacks T, Fazeli A, Schmitt EM, Bronson RT, Goodell MA, Weinberg RA. Efefcts of an RB mutation in the mouse. Nature 1992; 359: 295-300. 3. Clarke AR, Maandag ER, van Roon M, et al. Requirement for a functional RB-1 gene in murine development. Nature 1992; 359: 328-30.
Preventing international spread of HIV infection Its limited resources mean that the European project AIDS and Mobility (A & M)1 set up in October, 1990, at the request of the WHO, will continue to confine its activities to small-scale innovative pilot projects for preventing the spread of human immunodeficiency virus infection by travellers or among migrants. Information has been gathered on characteristics of the target groups, existing AIDS prevention measures for these groups, and the needs of AIDS prevention organisations. Projects targeted at Polish and Romanian sex workers moving to and from Germany or the Netherlands will be assessed next year, when a project aimed at young tourists in Greece is scheduled to start. Migrants are not considered a risk but as people who need information in an appropriate way. This year activities have been aimed at Turkish migrants. The target group for next year is expected to be the Arabic-speaking community; the workshop for the project is scheduled for the first half of 1993. 1. Information available from National Committee 1093 KP Amsterdam, Netherlands.
In
on
AIDS
Control, Polderweg 92,
England Now
Many GPs did minor surgery long before the 1990 contract introduced a sessional fee for it. We believed we were giving our patients a quick and convenient service, while releasing the real surgeons to tackle their waiting lists. We did not expect any thanks. What I certainly did not expect was to have to shell out my own to the hospital I thought I was helping. A patient whom I had referred to a local surgeon was booked for a Kveim test. My patient asked if it was really necessary for him to travel twice more to the hospital--once to have the injection and then again to have the biopsy-not to mention a third visit to hear the result. I sympathised. I was only too happy to do the test myself. It was then that I ran up against a manager who could not appreciate that so much of what is good in the NHS comes from the goodwill of its workers. He insisted that I could have the Kveim agent only on a commercial basis. I would have to pay for it. The hospital would save money, my patient would save time and money, but I would lose both. I learnt one thing from the experience: for a GP, Kveim does not pay.