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TOKYO When impotence leads contraception
TOKYO
When impotence leads contraception
tale of two pills and double standards has gripped Japan for the past month, putting pressure on the government to approve low-dose oral contraceptives. Japan is the only country in the United Nations not to have approved “the pill”. This delay has raised eyebrows in the international community, but until recently it has caused hardly a ripple domestically. Unlike the west, where the introduction of oral contraceptives was a social battleground, the debate in Japan has been very subdued. Most women’s groups favour the pill, but have reservations about its safety and have tended to avoid confrontation with the authorities. With so little public input and few outspoken opponents, the story of the pill’s non-introduction has been a largely dull saga of bureaucratic inertia. All that changed on Jan 24 when the ministry granted a licence for sildenafil (Viagra) just 6 months after an application was submitted. The stark contrast in the treatment of an anti-impotence drug for men and the contraceptive pill for women sparked an uproar that has yet to die down. “The rapid approval for Viagra is a sign of men taking priority over women and trying to control their lives,” said law-maker Akiko Domoto, a leading advocate of greater reproductive rights. In recent weeks, these comments have been echoed in political meetings and the media. The conservative Sankei newspaper ran a large feature headlined: “Sexual discrimination in drugs? Viagra vs the Pill.” The issue was also raised earlier this month at
A
WELLINGTON
the Hague forum on population and development. Health officials argue that Viagra had to be approved quickly because of the growing health risks posed by unsupervised illegal imports. They also insist that the two drugs should not be compared because sildenafil is prescribed to treat an ailment, whereas the low-dose pill is an option for healthy women. This has made little impact with the ministry’s critics, who point out that oral contraceptives have been delayed because of concerns about morality, sexually-transmitted diseases, and health risks—all of which apply to
“The Japanese government is doing everything possible to increase the birthrate” sildenafil. Many note that Viagra has led to 130 deaths in 1 year worldwide, whereas the low-dose pill has been used safely by hundreds of millions of women for two decades. Critics argue that the ban on oral contraceptives creates its own risks because 70% of couples rely on condoms, which are less effective—Japan has a high rate of abortions: 338 000 in 1996. Women who want the pill are forced either to use medium or high-dose hormone preparations, which increase the risk of side effects, or to import the low-dose pill illegally, which usually means unsupervised use. Approval of sildenafil has also raised suspicions of a secret nationalist agenda to boost the population, which is ageing faster than any other
in the world. “The drug that lets you get pregnant is approved, but the one that would prevent pregnancy is not”, law-maker Mizuho Fukushima told reporters. “The Japanese government is doing everything possible to increase the birthrate.” The secretive and male-dominated Central Pharmaceutical Affairs Council (CPAC) has done nothing to allay such fears. The 24-member council comprises only three women and its deliberations are kept from the public. Senior Health Ministry official Toshiki Hirai says the Council has delayed approval because of opposition from politicians, but no lawmaker has been brave enough to take a public stand against the pill. “At the very least, the government owes it to the people to disclose the experts’ findings and deliberations about the pill, which have long been kept under wraps”, Michio Ozaki, head of the Council of Population Education, wrote in the Asahi newspaper earlier this month. The pill’s supporters may get more than that. According to local newspaper reports, the health ministry is so embarrassed by the furore surrounding sildenafil that it will recommend approval for low-dose oral contraceptives at a meeting of the CPAC on March 3. The pill’s proponents are quietly optimistic, but there have been many false dawns since 1965. “I won’t believe it until I see it”, says Reiko Nakayasu, a magazine editor. “But even if it is approved this time, it’s sad to think that it has taken Viagra to get things moving.” Jonathan Watts
Chemotherapy in children—where to draw the line?
P
olice and social and welfare agencies in New Zealand are searching for a boy aged 3 years after his family discontinued his chemotherapy in a case that is sparking controversy. Liam Williams-Holloway had had two courses of treatment for neu roblastoma when his parents stopped treatment and sought an alternative cure. He was due to resume chemotherapy at Dunedin Hospital, Wellington, in late January, where doctors had given him a 50-50 chance of survival. When the family did not return for their appointment, doctors at Healthcare Otago successfully got a
THE LANCET • Vol 353 • March 6, 1999
court order to have custody of Liam given to the Children and Young Persons and Their Families Agency. But the family had disap peared. Considerable public interest in the case was generated when the agency passed family photos and details to the media. Public opinion is divided on the case but there is much public sympathy for Liam’s parents and their right to seek an alternative cure. Through their lawyer, the parents said that they wanted non-invasive treatment for Liam and that they had no option but to remain in hiding because of Healthcare Otago’s “uncompro-
mising approach”. On Feb 23, the police went to the Rainbow Health Clinic, Rotorua, where Liam was thought to be receiving treatment. From the clinic’s records police found that Liam had been treated with quan tum vibrational therapy to boost his immune system, but the family were still not found. Civil liberties groups have urged Lia m ’s parents to attempt to get the court order revoked. Meanwhile, on Feb 26 the Family Court issued a order ban ning any further publicity about the case, which the media is appealing. Sandra Coney
819
When impotence leads contraception
tale of two pills and double standards has gripped Japan for the past month, putting pressure on the government to approve low-dose oral contraceptives. Japan is the only country in the United Nations not to have approved “the pill”. This delay has raised eyebrows in the international community, but until recently it has caused hardly a ripple domestically. Unlike the west, where the introduction of oral contraceptives was a social battleground, the debate in Japan has been very subdued. Most women’s groups favour the pill, but have reservations about its safety and have tended to avoid confrontation with the authorities. With so little public input and few outspoken opponents, the story of the pill’s non-introduction has been a largely dull saga of bureaucratic inertia. All that changed on Jan 24 when the ministry granted a licence for sildenafil (Viagra) just 6 months after an application was submitted. The stark contrast in the treatment of an anti-impotence drug for men and the contraceptive pill for women sparked an uproar that has yet to die down. “The rapid approval for Viagra is a sign of men taking priority over women and trying to control their lives,” said law-maker Akiko Domoto, a leading advocate of greater reproductive rights. In recent weeks, these comments have been echoed in political meetings and the media. The conservative Sankei newspaper ran a large feature headlined: “Sexual discrimination in drugs? Viagra vs the Pill.” The issue was also raised earlier this month at
A
WELLINGTON
the Hague forum on population and development. Health officials argue that Viagra had to be approved quickly because of the growing health risks posed by unsupervised illegal imports. They also insist that the two drugs should not be compared because sildenafil is prescribed to treat an ailment, whereas the low-dose pill is an option for healthy women. This has made little impact with the ministry’s critics, who point out that oral contraceptives have been delayed because of concerns about morality, sexually-transmitted diseases, and health risks—all of which apply to
“The Japanese government is doing everything possible to increase the birthrate” sildenafil. Many note that Viagra has led to 130 deaths in 1 year worldwide, whereas the low-dose pill has been used safely by hundreds of millions of women for two decades. Critics argue that the ban on oral contraceptives creates its own risks because 70% of couples rely on condoms, which are less effective—Japan has a high rate of abortions: 338 000 in 1996. Women who want the pill are forced either to use medium or high-dose hormone preparations, which increase the risk of side effects, or to import the low-dose pill illegally, which usually means unsupervised use. Approval of sildenafil has also raised suspicions of a secret nationalist agenda to boost the population, which is ageing faster than any other
in the world. “The drug that lets you get pregnant is approved, but the one that would prevent pregnancy is not”, law-maker Mizuho Fukushima told reporters. “The Japanese government is doing everything possible to increase the birthrate.” The secretive and male-dominated Central Pharmaceutical Affairs Council (CPAC) has done nothing to allay such fears. The 24-member council comprises only three women and its deliberations are kept from the public. Senior Health Ministry official Toshiki Hirai says the Council has delayed approval because of opposition from politicians, but no lawmaker has been brave enough to take a public stand against the pill. “At the very least, the government owes it to the people to disclose the experts’ findings and deliberations about the pill, which have long been kept under wraps”, Michio Ozaki, head of the Council of Population Education, wrote in the Asahi newspaper earlier this month. The pill’s supporters may get more than that. According to local newspaper reports, the health ministry is so embarrassed by the furore surrounding sildenafil that it will recommend approval for low-dose oral contraceptives at a meeting of the CPAC on March 3. The pill’s proponents are quietly optimistic, but there have been many false dawns since 1965. “I won’t believe it until I see it”, says Reiko Nakayasu, a magazine editor. “But even if it is approved this time, it’s sad to think that it has taken Viagra to get things moving.” Jonathan Watts
Chemotherapy in children—where to draw the line?
P
olice and social and welfare agencies in New Zealand are searching for a boy aged 3 years after his family discontinued his chemotherapy in a case that is sparking controversy. Liam Williams-Holloway had had two courses of treatment for neu roblastoma when his parents stopped treatment and sought an alternative cure. He was due to resume chemotherapy at Dunedin Hospital, Wellington, in late January, where doctors had given him a 50-50 chance of survival. When the family did not return for their appointment, doctors at Healthcare Otago successfully got a
THE LANCET • Vol 353 • March 6, 1999
court order to have custody of Liam given to the Children and Young Persons and Their Families Agency. But the family had disap peared. Considerable public interest in the case was generated when the agency passed family photos and details to the media. Public opinion is divided on the case but there is much public sympathy for Liam’s parents and their right to seek an alternative cure. Through their lawyer, the parents said that they wanted non-invasive treatment for Liam and that they had no option but to remain in hiding because of Healthcare Otago’s “uncompro-
mising approach”. On Feb 23, the police went to the Rainbow Health Clinic, Rotorua, where Liam was thought to be receiving treatment. From the clinic’s records police found that Liam had been treated with quan tum vibrational therapy to boost his immune system, but the family were still not found. Civil liberties groups have urged Lia m ’s parents to attempt to get the court order revoked. Meanwhile, on Feb 26 the Family Court issued a order ban ning any further publicity about the case, which the media is appealing. Sandra Coney
819