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Syphilis cases are increasing in Czech Republic
European Union gets tough on women’s health
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he European Parliament sup ported a demand for legalisa tion of abortion across Europe on March 9. Although the vote had no legisla tive effect, the reference to abortion in a resolution on women’s health led to protests from male speakers from regions of the European Union (EU) where there has been strong resistance to legalisation. Irish member John Cushnahan argued, “the European Union has absolutely no competence in this area. It cannot interfere in the pol icy of individual member states in this sensitive area”. Yet the resolu tion barely strayed beyond what is already permitted in most EU member states. It called on states
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“to legalise induced abortion in certain circumstances, at least in cases of forced pregnancy and rape, and where the health of the woman is endangered, on the principle that it must be the woman herself who takes the final decision, and to ensure that voluntary abortions are carried out in a medically safe way, and that psychological and social support is provided”. The Women’s Right’s Committee had succeeded in securing fresh debating time on March 8— International Women’s Day—for renewed discussion of a EU survey of women’s health, published in May 1997. An earlier wide-ranging report on this document was referred back to the Committee last
July (see Lancet 1998; 352: 631). recast resolution from the commit tee ran to only 25 points, on issues including the attention required to ‘new’ disorders such as anorexia and bulimia, and requests for study of the causes of toxic shock syn drome. During the March 8 debate, Commissioner Anita Gradin announced that the EU has initi ated infringement proceedings against “several” EU national gov ernments for their failure to imple ment the full requirements of a 1995 Directive on health and safety rules for pregnant women and nursing mothers in the workplace—and the 1996 Parental Leave Directive.
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Arthur Rogers
Former French ministers acquitted in infected-blood trial he French blood-scandal trial ended on March 9 with the acquittal of former Prime Minister Laurent Fabius and former Social Minister Georgina Dufoix, but the former Health Minister Edmond Hervé was declared guilty of unintentional manslaughter but exempt from any sentence (see Lancet 1999; 352: 652). After 4 weeks of debates, the Court found no evidence that Fabius and Dufoix would have postponed the introduction of compulsory blood screening, and conversely, found that Fabius had accelerated the introduction of screening. Hervé was blamed for not
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having ordered systematic blood screening for all patients having had a transfusion before August 1985, and for not having destroyed all untested blood stocks after Aug 1, 1985. The trial has been strongly criticised by the victims and their families, who claim the truth behind the scandal has remained hidden. Criticism was levelled at the Court of Justice of the Republic, which was specially created to judge ministers for acts committed while in government, and the complicated rules and procedures it had to follow, which did not help when trying to understand the scientific and contro-
versial issues at hand. Trial observers also questioned the attitude of the Court’s president, Christian Le Gunehec, and the judges’ lack of scientific knowledge. The victims, the public, and the media are not satisfied with the trial’s findings, and reform of the Court’s rules and organisation is now being considered by many lawyers and politicians. A second blood trial could take place in the next few months, involving medical experts in charge of health policy from 1983–85. With the exception of Michel Garretta, head of the French Blood Transfusion Center, until 1985, and three of his colleagues who all were sentenced in 1993, no other blood specialists or civil servants have been investigated. Denis Durand de Bousingen
Syphilis cases are increasing in Czech Republic yphilis cases rose by 10% in the Czech Republic during 1997 reveals the Ministry of Health’s latest statistics. The number of cases treated rose from 551 to 607 out of a population of 10·3 million. The diagnosis of syphilis cases amongst newborn babies is also at the highest levels for the past 20 years, with 16 cases being reported out of 120 500 births. Prague’s Senior Medical Officer of Health, Vladimir Polanecky, called for an improvement in prenatal care and said, “this phenomena represents a warning signal for the medical
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community and society as a whole”. Since the end of Communist rule, there has been a drastic decline in routine free prenatal examinations. Previously, expectant mothers were obliged to be examined twice during pregnancy for diseases that might be passed on to the child, otherwise they forfeited maternity benefits. However this policy was discontinued in 1989. Marie Richterov, a specialist in transmitted diseases and based in the northern city of Most, said 90% of her patients suffering from syphilis were pregnant; and most of them
only turned up for an examination towards the end of their pregnancy. Richterov added that many sufferers are also illegal immigrants working as prostitutes and do not want to draw attention to themselves. Most has the highest levels of syphilis in the Republic with 27 cases per 100 000. WHO reports a near ten-fold increase in syphilis in eastern Europe over the 7 years following the fall of the ‘iron curtain’ in 1987, and blames the increasing gap between the rich and poor for the rise in cases. Nigel Glass
THE LANCET • Vol 353 • March 20, 1999
T
he European Parliament sup ported a demand for legalisa tion of abortion across Europe on March 9. Although the vote had no legisla tive effect, the reference to abortion in a resolution on women’s health led to protests from male speakers from regions of the European Union (EU) where there has been strong resistance to legalisation. Irish member John Cushnahan argued, “the European Union has absolutely no competence in this area. It cannot interfere in the pol icy of individual member states in this sensitive area”. Yet the resolu tion barely strayed beyond what is already permitted in most EU member states. It called on states
-
-
-
“to legalise induced abortion in certain circumstances, at least in cases of forced pregnancy and rape, and where the health of the woman is endangered, on the principle that it must be the woman herself who takes the final decision, and to ensure that voluntary abortions are carried out in a medically safe way, and that psychological and social support is provided”. The Women’s Right’s Committee had succeeded in securing fresh debating time on March 8— International Women’s Day—for renewed discussion of a EU survey of women’s health, published in May 1997. An earlier wide-ranging report on this document was referred back to the Committee last
July (see Lancet 1998; 352: 631). recast resolution from the commit tee ran to only 25 points, on issues including the attention required to ‘new’ disorders such as anorexia and bulimia, and requests for study of the causes of toxic shock syn drome. During the March 8 debate, Commissioner Anita Gradin announced that the EU has initi ated infringement proceedings against “several” EU national gov ernments for their failure to imple ment the full requirements of a 1995 Directive on health and safety rules for pregnant women and nursing mothers in the workplace—and the 1996 Parental Leave Directive.
A -
-
-
Arthur Rogers
Former French ministers acquitted in infected-blood trial he French blood-scandal trial ended on March 9 with the acquittal of former Prime Minister Laurent Fabius and former Social Minister Georgina Dufoix, but the former Health Minister Edmond Hervé was declared guilty of unintentional manslaughter but exempt from any sentence (see Lancet 1999; 352: 652). After 4 weeks of debates, the Court found no evidence that Fabius and Dufoix would have postponed the introduction of compulsory blood screening, and conversely, found that Fabius had accelerated the introduction of screening. Hervé was blamed for not
T
having ordered systematic blood screening for all patients having had a transfusion before August 1985, and for not having destroyed all untested blood stocks after Aug 1, 1985. The trial has been strongly criticised by the victims and their families, who claim the truth behind the scandal has remained hidden. Criticism was levelled at the Court of Justice of the Republic, which was specially created to judge ministers for acts committed while in government, and the complicated rules and procedures it had to follow, which did not help when trying to understand the scientific and contro-
versial issues at hand. Trial observers also questioned the attitude of the Court’s president, Christian Le Gunehec, and the judges’ lack of scientific knowledge. The victims, the public, and the media are not satisfied with the trial’s findings, and reform of the Court’s rules and organisation is now being considered by many lawyers and politicians. A second blood trial could take place in the next few months, involving medical experts in charge of health policy from 1983–85. With the exception of Michel Garretta, head of the French Blood Transfusion Center, until 1985, and three of his colleagues who all were sentenced in 1993, no other blood specialists or civil servants have been investigated. Denis Durand de Bousingen
Syphilis cases are increasing in Czech Republic yphilis cases rose by 10% in the Czech Republic during 1997 reveals the Ministry of Health’s latest statistics. The number of cases treated rose from 551 to 607 out of a population of 10·3 million. The diagnosis of syphilis cases amongst newborn babies is also at the highest levels for the past 20 years, with 16 cases being reported out of 120 500 births. Prague’s Senior Medical Officer of Health, Vladimir Polanecky, called for an improvement in prenatal care and said, “this phenomena represents a warning signal for the medical
S
992
community and society as a whole”. Since the end of Communist rule, there has been a drastic decline in routine free prenatal examinations. Previously, expectant mothers were obliged to be examined twice during pregnancy for diseases that might be passed on to the child, otherwise they forfeited maternity benefits. However this policy was discontinued in 1989. Marie Richterov, a specialist in transmitted diseases and based in the northern city of Most, said 90% of her patients suffering from syphilis were pregnant; and most of them
only turned up for an examination towards the end of their pregnancy. Richterov added that many sufferers are also illegal immigrants working as prostitutes and do not want to draw attention to themselves. Most has the highest levels of syphilis in the Republic with 27 cases per 100 000. WHO reports a near ten-fold increase in syphilis in eastern Europe over the 7 years following the fall of the ‘iron curtain’ in 1987, and blames the increasing gap between the rich and poor for the rise in cases. Nigel Glass
THE LANCET • Vol 353 • March 20, 1999