- Email: [email protected]
Suicide in Australia prompts action
POLICY AND PEOPLE
Tax revolt against increase in national health insurance in Israel ll the Israeli health-insurance funds jointly congratulated Prime Minister Binyamin Netanyahu for personally intervening to solve the health-funding crisis. But this did not stop them mounting a protest against new fees that patients will have to pay as of Sept 1. The fees, which are in addition to the “comprehensive” Israeli national health-insurance payments, were approved by the Knesset Finance Committee. This protest has catapaulted into a “tax revolt”, ironically led by the Histadrut trade union, which already owes NIS 600 million (US$ 162 million) to the largest health fund— Kupat Holim Clalit—a debt that it was ordered to honour this week by the Israeli Supreme Court. The Israel Medical Association and virtually all professional and patients’ rights groups are protesting the approval, which was given only at the last minute after it was promised that there would be a
A
50% discount for very-low-income families, new immigrants during their first year in the country, and the elderly. Prescription drug prices will rise 10–15%, to a maximum of NIS 220 per quarter per person (NIS 200 per quarter for the chronically ill); but the global quarterly fee that caused the health issue to be dropped by this committee a month ago (see Lancet, July 25, p 297) was omitted. With the imposition of new fees, the Treasury agreed to transfer NIS 500 million to the health funds, NIS 300 million of which is already owed to hospitals. Israel Medical Association chairman, Yoram Blachar, declared that his members would “not serve as collection agents for the health funds or the Treasury”. He also said that doctors would not refuse treatment to anyone—and certainly not until it is confirmed that these fees do not violate the National Health Insurance
Call for DNA testing for foreign adoptions n Irish adoption group, in conjunction with an international organisation campaigning for children’s rights, has asked the Irish government to begin a policy of DNA testing in foreign adoption cases. Many prospective Irish parents are involved in foreign adoptions because of a shortage of Irish children for adoption. The Adopted People’s Association (APA) said it was deeply troubled “by consistent reports” from a number of countries that illegal child traffickers are buying or stealing children from their original parents and then offering the children for international adoption. The group said the traffickers pay another woman to pose as the stolen child’s mother for adoption purposes. APA says that compulsory DNA testing of the child and birth parents could help stamp out the trafficking. Such a policy is strongly advocated by Casa Alianza, the largest private non-governmental children’s aid organisation in the Americas. Casa Alianza, probably best known for its campaign against the shooting of street children in Latin America, has told the Irish organisation that illegal baby trafficking occurs in Central America especially in Guatemala. It believes that a policy of DNA testing carried out by an independent labora-
A
THE LANCET • Vol 352 • August 22, 1998
tory in the adopting parents’ country would prevent those involved trafficking rings from setting up their own bogus laboratories. In recent years there have been reports of Mexican children being smuggled into Guatemala for foreign adoption in addition to allegations involving stolen or sold Guatemalan children; and of illegal child trafficking in countries including Brazil, Chile, and the Ukraine. The US State Department has warned prospective adopting parents that “child trafficking is a serious problem in Guatemala”. Another organisation, the Adopted Parents’ Association of Ireland, warns there are some dubious lawyers particularly in South America “who are not above being involved in child-trafficking”. Karen Birchard
Law, which prohibits the publichealth system from withholding care from those citizens who cannot or will not pay for it. Despite the protests, Health Minister, Yehoshua Matza, has been pleading with his colleagues to approve the plan to revive the health system which “is impossible without the public’s participation”. Health-fund officials said the plan was a step in the right direction, but agreed with the government’s opposition that the plan offered no longterm solution to their deficits (estimated at NIS 1·2 billion). They suggest revising the formulas for allocating National Insurance taxes to the health funds to take into consideration the aging population and the introduction of new drugs and advanced technologies. Histadrut head, Amir Peretz, has proposed an employer tax of 0·5%. Rachelle H B Fishman
Suicide in Australia prompts action
A
ustralia’s rate of youth suicide is amongst the highest in the industrialised world, with young men and young people between 15 and 24 years of age in rural and regional areas most at risk. Each week, ten young Australians kill themselves and 1000 attempt to do so. Aboriginal and Torres Strait Islander youths are 40% more likely to commit suicide than the general community. The rate of male youth suicide has trebled since 1960, and there has been a doubling of the female rate since 1950. The Australian People’s Forum on Youth Suicide, the first of its kind in Australia, was launched in Parliament House, Canberra, on Aug 10. A memorial ceremony was held on the lawns of Parliament House where 2500 white crosses had been planted in the ground to symbolise the young lives lost to suicide in the past 5 years. The Forum included youth representatives, families of suicide victims, educationalists, counsellors, and community volunteers. Most attendees had been affected in a personal way by youth suicide, and young attendees in particular voiced their anger about what they saw as the alleviable causes of such suicides. The Forum was also a
633
POLICY AND PEOPLE
time for parents to share their stories Familial and personal risk factors were debated as was the operation of the mental health and coronial systems. A National Youth Suicide Prevention Strategy was established in 1995 by the Federal Government with funding provided for 4 years. Projects generated by the Strategy have included training for general practitioners and other professionals, a national consultation with young people, a Foundation providing one-off grants to indigenous communities and an internet site for young people, their families, and professionals. Recommendations from the Forum will be presented to Government. The Minister for Family Services, Warwick Smith, stated that the recommendations will be considered by the recently established National Advisory Council on Youth Suicide Prevention whose responsibilities will include evaluation of the Strategy and dissemination of results as well as future planning. Bebe Loff, Stephen Cordner
High frequency radio keeps mosquitoes at bay ransmissions from Radio Salue in Saarbruecken, Germany, contain a high frequency tone that drives away mosquitoes, without spoiling the listening pleasure of its human audience. According to the radio station, more and more picnickers are tuning in to ward off the plagues of insects engendered in the summer heat. Salue’s Head of Entertainment Klaus Diettrich said: “We are getting a positive response from listeners and most say that the mosquitoes are staying away.” The station’s engineer added that listeners with better quality radios will get the most benefit. Listeners have not complained that the high frequency tone interfered with their enjoyment of Radio Salue’s programme of music and chat. However, some find their pets share the mosquitoes’ aversion to the stations subliminal message. Diettrich explained: “We have warned listeners that Radio Salue might not be too popular with their dogs and cats.” As the station keeps up with contemporary music styles, it must also
T
accommodate the mosquitoes particular audio tastes. The insects become inured to any one particular tone after a few minutes, and fly back to join the h u m a n listeners. Diettrich said: “We approached a specialist supplier of mosquito repellents and they advised us to alter the frequency of the tone every 10 minutes.” Computer users can keep the mosquitoes away from their personal computers by visiting Radio Salue’s audio homepage at (http://www.salue.de). Nigel Glass
AMA cracks down on US physicians selling goods from their offices he American Medical Association (AMA) has begun addressing, bit by bit, the apparently proliferating practice of physicians selling both health-related and nonhealth-related products from their offices. Not all of its members approve, while others say proposed prohibitions do not go far enough to ensure that the patient-physician relationship is not sullied by conflict of interest and sleazy salesmanship. At its interim meeting in May, AMA House of Delegates members voted to approve a ban on nonhealth-related goods, unless they were low cost and sold solely for the profit of a community organisation such as the Girl Scouts. The final text, published in the Aug 12 Journal of the American Medical Association, said, “the for-profit sale of goods to patients by physicians inherently creates a conflict of interest. . . Patients may purchase goods out of a misplaced desire to please or ‘get in good’ with their physicians”. The report was issued by the AMA’s Council on Ethical and Judicial Affairs (CEJA). But member opinion gets murkier on sales of non-prescription healthrelated goods such as child-safety
T
634
seats, vitamins, and skin-care products. Reportedly, some physicians are making as much as US$30 000 a month selling such items on the side. At the May meeting, the CEJA floated a proposal to prohibit sales of these items from offices and to bar endorsements of products that could be purchased elsewhere. But the prohibition would apply only if the physician stood to make a profit. Robert Tenery, CEJA chair and an ophthalmologist based in Memphis, TN, said doctors should be able to offer products to their patients, especially if they are not available elsewhere—just not at a profit. “We felt like the profit motive was the evil possibility here”, he said. But even with that fairly loose approach, a number of delegates objected. “There is a huge debate in this area”, said Tenery. The proposal was sent back to the CEJA for “clarification”, and will be revisited at the AMA’s full House of Delegates meeting in December, he said. Others see danger even if the profit motive is removed. “If it’s something you can’t get anywhere else, there is certainly an implicit medical claim being made by the doctor handing it
out”, said Sidney Wolfe, director of Public Citizen’s Health Research Group. “And, if it’s a claim, then it’s a drug according to the Food and Drug Administration, and if it’s a drug, then it has to be tested for safety and effectiveness.” Tenery admits there is some danger in having physicians sell health items. “If you go to your doctor and this is a health-related product, you automatically assume that the doctor knows more about that product than you do”, he said, noting that it could sway a patient’s purchasing decision. Other physician groups, such as the American College of Obstetricians and Gynecologists and the American Academy of Dermatology, have yet to take on physician office sales. But Harold Sox, a Dartmouth Medical School professor and president of the newly merged American College of Physicians/American Society of Internal Medicine, said that the trend bears watching. “The ACP/ASIM doesn’t have a policy on this issue, but it’s an issue that we should be considering taking up”, said Sox. Alicia Ault
THE LANCET • Vol 352 • August 22, 1998
Tax revolt against increase in national health insurance in Israel ll the Israeli health-insurance funds jointly congratulated Prime Minister Binyamin Netanyahu for personally intervening to solve the health-funding crisis. But this did not stop them mounting a protest against new fees that patients will have to pay as of Sept 1. The fees, which are in addition to the “comprehensive” Israeli national health-insurance payments, were approved by the Knesset Finance Committee. This protest has catapaulted into a “tax revolt”, ironically led by the Histadrut trade union, which already owes NIS 600 million (US$ 162 million) to the largest health fund— Kupat Holim Clalit—a debt that it was ordered to honour this week by the Israeli Supreme Court. The Israel Medical Association and virtually all professional and patients’ rights groups are protesting the approval, which was given only at the last minute after it was promised that there would be a
A
50% discount for very-low-income families, new immigrants during their first year in the country, and the elderly. Prescription drug prices will rise 10–15%, to a maximum of NIS 220 per quarter per person (NIS 200 per quarter for the chronically ill); but the global quarterly fee that caused the health issue to be dropped by this committee a month ago (see Lancet, July 25, p 297) was omitted. With the imposition of new fees, the Treasury agreed to transfer NIS 500 million to the health funds, NIS 300 million of which is already owed to hospitals. Israel Medical Association chairman, Yoram Blachar, declared that his members would “not serve as collection agents for the health funds or the Treasury”. He also said that doctors would not refuse treatment to anyone—and certainly not until it is confirmed that these fees do not violate the National Health Insurance
Call for DNA testing for foreign adoptions n Irish adoption group, in conjunction with an international organisation campaigning for children’s rights, has asked the Irish government to begin a policy of DNA testing in foreign adoption cases. Many prospective Irish parents are involved in foreign adoptions because of a shortage of Irish children for adoption. The Adopted People’s Association (APA) said it was deeply troubled “by consistent reports” from a number of countries that illegal child traffickers are buying or stealing children from their original parents and then offering the children for international adoption. The group said the traffickers pay another woman to pose as the stolen child’s mother for adoption purposes. APA says that compulsory DNA testing of the child and birth parents could help stamp out the trafficking. Such a policy is strongly advocated by Casa Alianza, the largest private non-governmental children’s aid organisation in the Americas. Casa Alianza, probably best known for its campaign against the shooting of street children in Latin America, has told the Irish organisation that illegal baby trafficking occurs in Central America especially in Guatemala. It believes that a policy of DNA testing carried out by an independent labora-
A
THE LANCET • Vol 352 • August 22, 1998
tory in the adopting parents’ country would prevent those involved trafficking rings from setting up their own bogus laboratories. In recent years there have been reports of Mexican children being smuggled into Guatemala for foreign adoption in addition to allegations involving stolen or sold Guatemalan children; and of illegal child trafficking in countries including Brazil, Chile, and the Ukraine. The US State Department has warned prospective adopting parents that “child trafficking is a serious problem in Guatemala”. Another organisation, the Adopted Parents’ Association of Ireland, warns there are some dubious lawyers particularly in South America “who are not above being involved in child-trafficking”. Karen Birchard
Law, which prohibits the publichealth system from withholding care from those citizens who cannot or will not pay for it. Despite the protests, Health Minister, Yehoshua Matza, has been pleading with his colleagues to approve the plan to revive the health system which “is impossible without the public’s participation”. Health-fund officials said the plan was a step in the right direction, but agreed with the government’s opposition that the plan offered no longterm solution to their deficits (estimated at NIS 1·2 billion). They suggest revising the formulas for allocating National Insurance taxes to the health funds to take into consideration the aging population and the introduction of new drugs and advanced technologies. Histadrut head, Amir Peretz, has proposed an employer tax of 0·5%. Rachelle H B Fishman
Suicide in Australia prompts action
A
ustralia’s rate of youth suicide is amongst the highest in the industrialised world, with young men and young people between 15 and 24 years of age in rural and regional areas most at risk. Each week, ten young Australians kill themselves and 1000 attempt to do so. Aboriginal and Torres Strait Islander youths are 40% more likely to commit suicide than the general community. The rate of male youth suicide has trebled since 1960, and there has been a doubling of the female rate since 1950. The Australian People’s Forum on Youth Suicide, the first of its kind in Australia, was launched in Parliament House, Canberra, on Aug 10. A memorial ceremony was held on the lawns of Parliament House where 2500 white crosses had been planted in the ground to symbolise the young lives lost to suicide in the past 5 years. The Forum included youth representatives, families of suicide victims, educationalists, counsellors, and community volunteers. Most attendees had been affected in a personal way by youth suicide, and young attendees in particular voiced their anger about what they saw as the alleviable causes of such suicides. The Forum was also a
633
POLICY AND PEOPLE
time for parents to share their stories Familial and personal risk factors were debated as was the operation of the mental health and coronial systems. A National Youth Suicide Prevention Strategy was established in 1995 by the Federal Government with funding provided for 4 years. Projects generated by the Strategy have included training for general practitioners and other professionals, a national consultation with young people, a Foundation providing one-off grants to indigenous communities and an internet site for young people, their families, and professionals. Recommendations from the Forum will be presented to Government. The Minister for Family Services, Warwick Smith, stated that the recommendations will be considered by the recently established National Advisory Council on Youth Suicide Prevention whose responsibilities will include evaluation of the Strategy and dissemination of results as well as future planning. Bebe Loff, Stephen Cordner
High frequency radio keeps mosquitoes at bay ransmissions from Radio Salue in Saarbruecken, Germany, contain a high frequency tone that drives away mosquitoes, without spoiling the listening pleasure of its human audience. According to the radio station, more and more picnickers are tuning in to ward off the plagues of insects engendered in the summer heat. Salue’s Head of Entertainment Klaus Diettrich said: “We are getting a positive response from listeners and most say that the mosquitoes are staying away.” The station’s engineer added that listeners with better quality radios will get the most benefit. Listeners have not complained that the high frequency tone interfered with their enjoyment of Radio Salue’s programme of music and chat. However, some find their pets share the mosquitoes’ aversion to the stations subliminal message. Diettrich explained: “We have warned listeners that Radio Salue might not be too popular with their dogs and cats.” As the station keeps up with contemporary music styles, it must also
T
accommodate the mosquitoes particular audio tastes. The insects become inured to any one particular tone after a few minutes, and fly back to join the h u m a n listeners. Diettrich said: “We approached a specialist supplier of mosquito repellents and they advised us to alter the frequency of the tone every 10 minutes.” Computer users can keep the mosquitoes away from their personal computers by visiting Radio Salue’s audio homepage at (http://www.salue.de). Nigel Glass
AMA cracks down on US physicians selling goods from their offices he American Medical Association (AMA) has begun addressing, bit by bit, the apparently proliferating practice of physicians selling both health-related and nonhealth-related products from their offices. Not all of its members approve, while others say proposed prohibitions do not go far enough to ensure that the patient-physician relationship is not sullied by conflict of interest and sleazy salesmanship. At its interim meeting in May, AMA House of Delegates members voted to approve a ban on nonhealth-related goods, unless they were low cost and sold solely for the profit of a community organisation such as the Girl Scouts. The final text, published in the Aug 12 Journal of the American Medical Association, said, “the for-profit sale of goods to patients by physicians inherently creates a conflict of interest. . . Patients may purchase goods out of a misplaced desire to please or ‘get in good’ with their physicians”. The report was issued by the AMA’s Council on Ethical and Judicial Affairs (CEJA). But member opinion gets murkier on sales of non-prescription healthrelated goods such as child-safety
T
634
seats, vitamins, and skin-care products. Reportedly, some physicians are making as much as US$30 000 a month selling such items on the side. At the May meeting, the CEJA floated a proposal to prohibit sales of these items from offices and to bar endorsements of products that could be purchased elsewhere. But the prohibition would apply only if the physician stood to make a profit. Robert Tenery, CEJA chair and an ophthalmologist based in Memphis, TN, said doctors should be able to offer products to their patients, especially if they are not available elsewhere—just not at a profit. “We felt like the profit motive was the evil possibility here”, he said. But even with that fairly loose approach, a number of delegates objected. “There is a huge debate in this area”, said Tenery. The proposal was sent back to the CEJA for “clarification”, and will be revisited at the AMA’s full House of Delegates meeting in December, he said. Others see danger even if the profit motive is removed. “If it’s something you can’t get anywhere else, there is certainly an implicit medical claim being made by the doctor handing it
out”, said Sidney Wolfe, director of Public Citizen’s Health Research Group. “And, if it’s a claim, then it’s a drug according to the Food and Drug Administration, and if it’s a drug, then it has to be tested for safety and effectiveness.” Tenery admits there is some danger in having physicians sell health items. “If you go to your doctor and this is a health-related product, you automatically assume that the doctor knows more about that product than you do”, he said, noting that it could sway a patient’s purchasing decision. Other physician groups, such as the American College of Obstetricians and Gynecologists and the American Academy of Dermatology, have yet to take on physician office sales. But Harold Sox, a Dartmouth Medical School professor and president of the newly merged American College of Physicians/American Society of Internal Medicine, said that the trend bears watching. “The ACP/ASIM doesn’t have a policy on this issue, but it’s an issue that we should be considering taking up”, said Sox. Alicia Ault
THE LANCET • Vol 352 • August 22, 1998