- Email: [email protected]
toronto Drug-company battles start in Canada
THE LANCET
DISPATCHES
WASHINGTON
Distrust and more studies of Gulf War syndrome in USA
T
he final report from the White House committee—which was specially appointed to restore the government’s credibility on the murky subject of illness in Gulf War veterans—is due later this month. But after many widely reported missteps and apparent deceits by the Pentagon, the restoration task may be “Mission Impossible”. Indications are that a majority of the committee will emphasise stress as the principal cause of the constellation of symptoms labelled Gulf War syndrome. These include respiratory distress, gastrointestinal and skin disorders, and fatigue. Stress may indeed be the underlying factor, though some specialists doubt this and they criticise the committee for its hasty conclusions. But at this late stage in the often-bungled, emotionladen issue of the health of the troops, there is little chance of closure with stress as the simple explanation—valid though it may be. The main competing explanation, exposure to chemical war agents, is especially appealing to a suspicious citizenry since the Pentagon, after long denying the possibility of such exposure, reversed its thoughts about this earlier this year. Confronted by reports that US troops may have been exposed to nerve and mustard gases when they blew up an Iraqi munitions dump in 1991 shortly after the end of the war, the Defense Department conceded that 400 soldiers may have been exposed to drifting gases. However, the Pentagon insists that there is a lack of evidence of exposure. The estimates of soldiers exposed—always of possible,
TORONTO
rather than actual exposure—eventually rose to 20 000. As the numbers went up, the Pentagon’s credibility went down. The plunge accelerated when, as if aiming to inflame its critics and further undermine public confidence, the Defense Department removed from the Internet some 200 health-
“As the numbers went up, the Pentagon’s credibility went down” related Gulf War documents, claiming they had been erroneously posted in violation of security requirements. After the inevitable outcry, the Internet documents were restored amid adverse press and television reports and scornful preliminary assessments by the White House group appointed to get to the bottom of it all—the Presidential Advisory Committee on Gulf War Veterans’ Illnesses. At a public hearing of the Committee in November—as an antidote to distrust, all of its meetings are open—doubt was expressed about the Pentagon’s “good faith” in investigating reports about the illness. And further doubt was expressed about the Pentagon’s ability to repair its reputation. The committee recommended that studies should be turned over to an independent, outside organisation. Although the Pentagon confesses to prior obtuseness on chemical exposure and related health issues, it has adamantly declined to let the issue go. Instead, the Pentagon announced
that the team assigned to track down possible episodes of chemical exposure would be expanded from 12 to 110 members. The White House committee seeming to relent a bit, indicated that it would tolerate the Pentagon’s continued role if they were overseen by an outside group such as the Institute of Medicine, the health-policy arm of the prestigious National Academy of Sciences. Studies conducted by the Department of Veterans Affairs and the US Naval Health Research Center have found no significant difference in rates of hospitalisation or death when Gulf War veterans and veterans who did not serve in the Gulf are compared. In television and press renditions, however, these results compete poorly against the sickly veteran who was sound and healthy prior to service in the Gulf. The studies continue, and, as reported last week in the New York Times, higher levels of disability have been found in relatively small samples of veterans studied by the Centers for Disease Control and a veterans’ hospital in Pennsylvania. Veterans’ organisations, always feared and courted in US politics, remain implacable on the issue of Gulf War syndrome. The only acceptable finding will be that the afflicted veterans were sickened by service in the Gulf War—not by mere stress—and that the government bears financial and moral responsibility for their plight. So far, 80 000 of the 700 000 who served in Gulf have requested physical examinations. Daniel S Greenberg
Drug-company battles start in Canada
C
anada’s generic drug industry has launched its opening salvos in the forthcoming battle over pharmaceutical patent legislation. It has unveiled a public-opinion survey that found 75% of Canadians believe the duration of market monopolies should be reduced to bring down prescription-drug costs. “The research clearly shows that Canadians are concerned about drug costs and their impact on the future viability of our health-care system”, Canadian Drug Manufacturers Association president Jack Kay said. “At a time when governments
Vol 348 • December 7, 1996
are struggling to contain costs . . . they’re overlooking simple solutions which would save hundreds of millions of dollars”. The CDMA argues that Canadians will pay an additional Can$7 billion (US$5 billion) for drugs by the year 2010—the result of 1992 legislation which extended patent protection of brand-name drugs to 20 years and eliminated the compulsory licensing system that allowed cheap generic drugs to be made for a royalty. The association says that the forthcoming review of those patent-law changes should curb the duration of mono-
polies and restore the generic industry's ability to market knockoffs of brand-name drugs. But federal Science Minister Jon Gerrard cautions that international trade agreements constrain Ottawa’s ability to revise patent law. “There are limits below which we could not go in terms of patent protection”. The review, “will look at to what extent the pharmaceutical companies have lived up to the obligations that they made with respect to prices, investments in research and so on”. Wayne Kondro
1577
DISPATCHES
WASHINGTON
Distrust and more studies of Gulf War syndrome in USA
T
he final report from the White House committee—which was specially appointed to restore the government’s credibility on the murky subject of illness in Gulf War veterans—is due later this month. But after many widely reported missteps and apparent deceits by the Pentagon, the restoration task may be “Mission Impossible”. Indications are that a majority of the committee will emphasise stress as the principal cause of the constellation of symptoms labelled Gulf War syndrome. These include respiratory distress, gastrointestinal and skin disorders, and fatigue. Stress may indeed be the underlying factor, though some specialists doubt this and they criticise the committee for its hasty conclusions. But at this late stage in the often-bungled, emotionladen issue of the health of the troops, there is little chance of closure with stress as the simple explanation—valid though it may be. The main competing explanation, exposure to chemical war agents, is especially appealing to a suspicious citizenry since the Pentagon, after long denying the possibility of such exposure, reversed its thoughts about this earlier this year. Confronted by reports that US troops may have been exposed to nerve and mustard gases when they blew up an Iraqi munitions dump in 1991 shortly after the end of the war, the Defense Department conceded that 400 soldiers may have been exposed to drifting gases. However, the Pentagon insists that there is a lack of evidence of exposure. The estimates of soldiers exposed—always of possible,
TORONTO
rather than actual exposure—eventually rose to 20 000. As the numbers went up, the Pentagon’s credibility went down. The plunge accelerated when, as if aiming to inflame its critics and further undermine public confidence, the Defense Department removed from the Internet some 200 health-
“As the numbers went up, the Pentagon’s credibility went down” related Gulf War documents, claiming they had been erroneously posted in violation of security requirements. After the inevitable outcry, the Internet documents were restored amid adverse press and television reports and scornful preliminary assessments by the White House group appointed to get to the bottom of it all—the Presidential Advisory Committee on Gulf War Veterans’ Illnesses. At a public hearing of the Committee in November—as an antidote to distrust, all of its meetings are open—doubt was expressed about the Pentagon’s “good faith” in investigating reports about the illness. And further doubt was expressed about the Pentagon’s ability to repair its reputation. The committee recommended that studies should be turned over to an independent, outside organisation. Although the Pentagon confesses to prior obtuseness on chemical exposure and related health issues, it has adamantly declined to let the issue go. Instead, the Pentagon announced
that the team assigned to track down possible episodes of chemical exposure would be expanded from 12 to 110 members. The White House committee seeming to relent a bit, indicated that it would tolerate the Pentagon’s continued role if they were overseen by an outside group such as the Institute of Medicine, the health-policy arm of the prestigious National Academy of Sciences. Studies conducted by the Department of Veterans Affairs and the US Naval Health Research Center have found no significant difference in rates of hospitalisation or death when Gulf War veterans and veterans who did not serve in the Gulf are compared. In television and press renditions, however, these results compete poorly against the sickly veteran who was sound and healthy prior to service in the Gulf. The studies continue, and, as reported last week in the New York Times, higher levels of disability have been found in relatively small samples of veterans studied by the Centers for Disease Control and a veterans’ hospital in Pennsylvania. Veterans’ organisations, always feared and courted in US politics, remain implacable on the issue of Gulf War syndrome. The only acceptable finding will be that the afflicted veterans were sickened by service in the Gulf War—not by mere stress—and that the government bears financial and moral responsibility for their plight. So far, 80 000 of the 700 000 who served in Gulf have requested physical examinations. Daniel S Greenberg
Drug-company battles start in Canada
C
anada’s generic drug industry has launched its opening salvos in the forthcoming battle over pharmaceutical patent legislation. It has unveiled a public-opinion survey that found 75% of Canadians believe the duration of market monopolies should be reduced to bring down prescription-drug costs. “The research clearly shows that Canadians are concerned about drug costs and their impact on the future viability of our health-care system”, Canadian Drug Manufacturers Association president Jack Kay said. “At a time when governments
Vol 348 • December 7, 1996
are struggling to contain costs . . . they’re overlooking simple solutions which would save hundreds of millions of dollars”. The CDMA argues that Canadians will pay an additional Can$7 billion (US$5 billion) for drugs by the year 2010—the result of 1992 legislation which extended patent protection of brand-name drugs to 20 years and eliminated the compulsory licensing system that allowed cheap generic drugs to be made for a royalty. The association says that the forthcoming review of those patent-law changes should curb the duration of mono-
polies and restore the generic industry's ability to market knockoffs of brand-name drugs. But federal Science Minister Jon Gerrard cautions that international trade agreements constrain Ottawa’s ability to revise patent law. “There are limits below which we could not go in terms of patent protection”. The review, “will look at to what extent the pharmaceutical companies have lived up to the obligations that they made with respect to prices, investments in research and so on”. Wayne Kondro
1577