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Tainted-blood revelation shocks Japanese
POLICY AND PEOPLE
South Africa to bring traditional healers into mainstream medicine outh Africa’s traditional healers, who were ousted by “white Man’s medicine” during the apartheid years are a step closer to being elevated to their rightful place in the health-care system. On Aug 5, in a bold move to legitimise traditional medicine, South Africa’s parliament proposed that a statutory council be set up to regulate the 350 000 traditional healers. A report by a parliamentary committee on social services proposes that the special council present its recommendations within 3 years for the drafting of final legislation. Despite past attempts to discredit traditional healers, they are consulted by more than 80% of the population, instead of, or as well as, orthodox doctors who number about 250 000 countrywide. In its struggle to expand health care to the black majority, the government has realised the benefits of recruiting this large workforce into primary health care. The national HIV/AIDS pro-
S
gramme last year enlisted the services of three traditional healers as consultants to mobilise other traditional healers around the issue of sexually transmitted diseases and HIV/AIDS. The parliamentary committee’s proposals include setting up norms and standards for traditional healers and giving them medical certificates so that they can claim costs from their patient’s medical aid scheme. The council will look at the registration of all qualifying traditional healers, promote training, research, professionalism, and the creation of a traditional medicine database. It will be responsible for developing an ethical code of conduct and maintaining discipline in the profession. Another function will be to facilitate co-operation among traditional healers, the orthodox medical profession, and the government. The committee’s report also proposes that the profession be divided into four categories: the inyanga (tra-
Tainted-blood revelation shocks Japanese he Japanese government’s AIDS team was aware of the risks posed by untreated blood products a year before it approved their use in 1984, according to a tape recording played during the trial of a senior Health and Welfare Ministry official. In the case being heard at the Tokyo District Court, Akihito Matsumura, a former head of the ministry’s Biologics and Antibiotics Division, is charged with professional negligence resulting in the death through AIDS of haemophiliacs treated with tainted blood-clotting agents in the 1980s. Matsumura was a member of the AIDS study team set up in 1983 to consider whether it was safe to continue use of untreated blood products from overseas. According to the recording of the panel’s first meeting played on July 31, one member raised concerns about the untreated coagulents and proposed cryoprecipitate products as a safer alternative. He was overruled, however, by the panel’s chairman, Takeshi Abe, a former vice-president of Teikyo University who has also been arrested in connection with the scandal. It was not until 1985 that Japan approved the use of treated blood products, by which time several hundred haemophiliacs had been infected with HIV. The government
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refused to acknowledge that it was aware of the risks until former Health Minister Naoto Kan launched an internal inquiry in 1996 that revealed the study group’s concerns. Kan, now leader of the main opposition party, has apologised to the victims and an out-of-court settlement has been reached. The scandal has shocked Japan, where medical authorities are held in high regard and malpractice suits are rare. Jonathan Watts
Canada’s HCV poll Canadians overwhelmingly favour payments for all those who contracted hepatitis C via tainted blood, a national poll indicates. The survey of 1640 Canadians done by ICR National Data Collection on behalf of the Hemophilia Society indicates that 83% of Canadians believe it is “unfair” to restrict compensation to only those people infected through tainted blood between 1986 and 1990. The respondents selected “compassion” and fulfilling a “moral obligation” as a more significant consideration than legal liability, even if a precedent was set leading to compensation for other harms caused by the health system. Wayne Kondro
ditional doctors or herbalists); the sangoma (diviner); birth attendants or midwives; and traditional surgeons who mainly do circumcisions. Spiritual healers were not included because their training and accreditation was “unclear” and “ill-defined”. Meetings are scheduled for later this year and early next year to discuss how to implement the recommendations in the report. Adele Baleta
Drugs in brief Intermittent claudication On July 9, US FDA advisers gave cautious backing to cilostozal (Pletal, Otsuka America Pharmaceutical), a phosphodiesterase-III inhibitor, as a treatment for intermittent claudication. Several panelists said, given a potential increase in relative risk of mortality seen in trials, cilostozal should not be approved without more data. In eight phase-III studies of almost 2700 patients, nine (0·6%) died from a cardiac event. After 24 weeks of treatment, walking distance was significantly increased. Rheumatoid arthritis On Aug 7 FDA advisers recommended approval of leflunomide (Arava, Hoechst AG), a pyrimidine synthesis inhibitor, for relief of symptoms and reduction of joint deterioration in rheumatoid arthritis. The drug will likely gain FDA approval within a month because it is receiving expedited review. About 50% of patients on leflunomide responded (with a 20% increase in joint function from baseline) compared with 20–30% of patients on placebo. In another study leflunomide and methotrexate gave similar results.
THE LANCET • Vol 352 • August 15, 1998
South Africa to bring traditional healers into mainstream medicine outh Africa’s traditional healers, who were ousted by “white Man’s medicine” during the apartheid years are a step closer to being elevated to their rightful place in the health-care system. On Aug 5, in a bold move to legitimise traditional medicine, South Africa’s parliament proposed that a statutory council be set up to regulate the 350 000 traditional healers. A report by a parliamentary committee on social services proposes that the special council present its recommendations within 3 years for the drafting of final legislation. Despite past attempts to discredit traditional healers, they are consulted by more than 80% of the population, instead of, or as well as, orthodox doctors who number about 250 000 countrywide. In its struggle to expand health care to the black majority, the government has realised the benefits of recruiting this large workforce into primary health care. The national HIV/AIDS pro-
S
gramme last year enlisted the services of three traditional healers as consultants to mobilise other traditional healers around the issue of sexually transmitted diseases and HIV/AIDS. The parliamentary committee’s proposals include setting up norms and standards for traditional healers and giving them medical certificates so that they can claim costs from their patient’s medical aid scheme. The council will look at the registration of all qualifying traditional healers, promote training, research, professionalism, and the creation of a traditional medicine database. It will be responsible for developing an ethical code of conduct and maintaining discipline in the profession. Another function will be to facilitate co-operation among traditional healers, the orthodox medical profession, and the government. The committee’s report also proposes that the profession be divided into four categories: the inyanga (tra-
Tainted-blood revelation shocks Japanese he Japanese government’s AIDS team was aware of the risks posed by untreated blood products a year before it approved their use in 1984, according to a tape recording played during the trial of a senior Health and Welfare Ministry official. In the case being heard at the Tokyo District Court, Akihito Matsumura, a former head of the ministry’s Biologics and Antibiotics Division, is charged with professional negligence resulting in the death through AIDS of haemophiliacs treated with tainted blood-clotting agents in the 1980s. Matsumura was a member of the AIDS study team set up in 1983 to consider whether it was safe to continue use of untreated blood products from overseas. According to the recording of the panel’s first meeting played on July 31, one member raised concerns about the untreated coagulents and proposed cryoprecipitate products as a safer alternative. He was overruled, however, by the panel’s chairman, Takeshi Abe, a former vice-president of Teikyo University who has also been arrested in connection with the scandal. It was not until 1985 that Japan approved the use of treated blood products, by which time several hundred haemophiliacs had been infected with HIV. The government
T
554
refused to acknowledge that it was aware of the risks until former Health Minister Naoto Kan launched an internal inquiry in 1996 that revealed the study group’s concerns. Kan, now leader of the main opposition party, has apologised to the victims and an out-of-court settlement has been reached. The scandal has shocked Japan, where medical authorities are held in high regard and malpractice suits are rare. Jonathan Watts
Canada’s HCV poll Canadians overwhelmingly favour payments for all those who contracted hepatitis C via tainted blood, a national poll indicates. The survey of 1640 Canadians done by ICR National Data Collection on behalf of the Hemophilia Society indicates that 83% of Canadians believe it is “unfair” to restrict compensation to only those people infected through tainted blood between 1986 and 1990. The respondents selected “compassion” and fulfilling a “moral obligation” as a more significant consideration than legal liability, even if a precedent was set leading to compensation for other harms caused by the health system. Wayne Kondro
ditional doctors or herbalists); the sangoma (diviner); birth attendants or midwives; and traditional surgeons who mainly do circumcisions. Spiritual healers were not included because their training and accreditation was “unclear” and “ill-defined”. Meetings are scheduled for later this year and early next year to discuss how to implement the recommendations in the report. Adele Baleta
Drugs in brief Intermittent claudication On July 9, US FDA advisers gave cautious backing to cilostozal (Pletal, Otsuka America Pharmaceutical), a phosphodiesterase-III inhibitor, as a treatment for intermittent claudication. Several panelists said, given a potential increase in relative risk of mortality seen in trials, cilostozal should not be approved without more data. In eight phase-III studies of almost 2700 patients, nine (0·6%) died from a cardiac event. After 24 weeks of treatment, walking distance was significantly increased. Rheumatoid arthritis On Aug 7 FDA advisers recommended approval of leflunomide (Arava, Hoechst AG), a pyrimidine synthesis inhibitor, for relief of symptoms and reduction of joint deterioration in rheumatoid arthritis. The drug will likely gain FDA approval within a month because it is receiving expedited review. About 50% of patients on leflunomide responded (with a 20% increase in joint function from baseline) compared with 20–30% of patients on placebo. In another study leflunomide and methotrexate gave similar results.
THE LANCET • Vol 352 • August 15, 1998