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US academics forbidden to attend Cuban coma conference
Newsdesk US academics forbidden to attend Cuban coma conference US scientists and clinicians are waiting to see if their government’s surprise decision not to issue licences for travel to Cuba for a meeting on coma and brain death (March 9–12) will set a precedent for the future. “The situation with future conferences is quite up in the air”, says Bob Guild, programme director of Marazul Charters of Edgewater, New Jersey, who was charged with arranging the travel for the 70-odd US researchers due to attend the Fourth International Symposium on Coma and Death in Havana. The US Treasury Department’s Office of Foreign Assets Control (OFAC), which oversees restrictions on travel to Cuba, warned Guild and the delegates prior to the conference that they were unlikely to receive authorisation to go. But it did not publish its official decision until March 11, one day before the close of the 4 day conference. OFAC issues two types of travel licences: a general licence and a
specific licence. The general licence allows professionals to attend a Cuban conference if it is sponsored by an international organisation not based in the USA, or if they are conducting full-time academic, non-commercial research with a high likelihood of public dissemination. Although the conference was endorsed by the London-based World Federation of Neurology, the scientists were refused under both these categories, and on March 4 they were also warned that they would not be eligible for the specific licence. “I was flabbergasted and angry when the government cancelled the Americans from going at the last minute”, says Ronald Cranford, a neurologist and medical ethicist at the University of Minnesota, who received OFAC’s letter warning him that if he went to Cuba he could be in violation of the Trading with the Enemy Act. Steven Miles, a bioethicist also at the University of Minnesota, was the
only American to attend the conference because, for reasons that are unclear to him, his existing licence was not revoked. “Issues like SARS, or the international organ trade, show that it is not possible to pretend that the medical issues of richer and poorer countries can be separated”, he says. Guild says the decision could affect other conferences to be held in Cuba this year, including the Pan-American Congress of Child and Adolescent Mental Health (March 29 to April 2). “OFAC is taking a very narrow view of what constitutes an international meeting taking place in Cuba, and it has taken a verbal position that research cannot be conducted at meetings”, he says. Guild is now calling on scientists to write to the Treasury Department to refute this. The decision follows another from OFAC stating that US publishers editing texts from trade-embargoed nations could be liable to prosecution. Laura Spinney
Heart association urges passage of US stroke legislation Legislation that would provide funding for stroke education campaigns, stroke care systems, and medical professional development programmes on new stroke therapies “should be passed quickly”, says American Heart Association spokesperson Larry Goldstein, chair of the American Stroke Association Advisory Committee and director of the Duke University Center for Cerebrovascular Disease. “Anything that can improve outcomes for stroke patients is something we need to embrace”, he insists. The Stroke Treatment and Ongoing Prevention (STOP) act has undergone numerous revisions since it was first proposed during the 107th congress (2001–02). But the revisions are not the result of controversies surrounding treatment with alteplase (tPA), says Goldstein. Contrary to a recent news report (BMJ 2004; 328: 604), neither the original bill nor subsequent versions stipulate that
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hospitals must use alteplase or any other stroke treatments in order to be designated stroke centres. “I’m not sure where that came from, but to my knowledge, it’s not true. I’ve been involved in the legislation and I just read through all the versions again. The only place tPA is mentioned is in some of the background information, which says that drug has been studied as a treatment for stroke and found to be efficacious when properly administered. In fact, the House [of Representatives] did not want any statements at all that might suggest the federal government is dictating standards of care—and this is stated explicitly in the current version.” A revised version of the bill was introduced in the 108th congress because “that is just the nature of the way congress does business”, he adds. “There’s a new majority part in the senate, leadership in the house has changed, and so now there’s a new piece of legislation.” Funding
has been cut, as the news report suggests, “but everything is being cut back in the current fiscal climate. The mere fact that congress is trying to move the bill forward is a testament to how important people think it is.” Goldstein acknowledges that alteplase use in acute stroke “is an ongoing debate, because many hospitals don’t have physicians who have been trained to use it or the organisation in place to use it safely”. Several studies suggest that if protocols are not followed closely, the chance of complications goes up. “But the news article suggests that STOP is a stroke-tPA bill, and that’s not what it’s about”, he emphasises. “It’s very comprehensive and attacks the growing problem of stroke on a number of levels. I’d hate for anything as important as this to be derailed because of misinterpreted information.” Marilynn Larkin
THE LANCET Neurology Vol 3 May 2004
http://neurology.thelancet.com
For personal use. Only reproduce with permission The Lancet Publishing Group.
specific licence. The general licence allows professionals to attend a Cuban conference if it is sponsored by an international organisation not based in the USA, or if they are conducting full-time academic, non-commercial research with a high likelihood of public dissemination. Although the conference was endorsed by the London-based World Federation of Neurology, the scientists were refused under both these categories, and on March 4 they were also warned that they would not be eligible for the specific licence. “I was flabbergasted and angry when the government cancelled the Americans from going at the last minute”, says Ronald Cranford, a neurologist and medical ethicist at the University of Minnesota, who received OFAC’s letter warning him that if he went to Cuba he could be in violation of the Trading with the Enemy Act. Steven Miles, a bioethicist also at the University of Minnesota, was the
only American to attend the conference because, for reasons that are unclear to him, his existing licence was not revoked. “Issues like SARS, or the international organ trade, show that it is not possible to pretend that the medical issues of richer and poorer countries can be separated”, he says. Guild says the decision could affect other conferences to be held in Cuba this year, including the Pan-American Congress of Child and Adolescent Mental Health (March 29 to April 2). “OFAC is taking a very narrow view of what constitutes an international meeting taking place in Cuba, and it has taken a verbal position that research cannot be conducted at meetings”, he says. Guild is now calling on scientists to write to the Treasury Department to refute this. The decision follows another from OFAC stating that US publishers editing texts from trade-embargoed nations could be liable to prosecution. Laura Spinney
Heart association urges passage of US stroke legislation Legislation that would provide funding for stroke education campaigns, stroke care systems, and medical professional development programmes on new stroke therapies “should be passed quickly”, says American Heart Association spokesperson Larry Goldstein, chair of the American Stroke Association Advisory Committee and director of the Duke University Center for Cerebrovascular Disease. “Anything that can improve outcomes for stroke patients is something we need to embrace”, he insists. The Stroke Treatment and Ongoing Prevention (STOP) act has undergone numerous revisions since it was first proposed during the 107th congress (2001–02). But the revisions are not the result of controversies surrounding treatment with alteplase (tPA), says Goldstein. Contrary to a recent news report (BMJ 2004; 328: 604), neither the original bill nor subsequent versions stipulate that
260
hospitals must use alteplase or any other stroke treatments in order to be designated stroke centres. “I’m not sure where that came from, but to my knowledge, it’s not true. I’ve been involved in the legislation and I just read through all the versions again. The only place tPA is mentioned is in some of the background information, which says that drug has been studied as a treatment for stroke and found to be efficacious when properly administered. In fact, the House [of Representatives] did not want any statements at all that might suggest the federal government is dictating standards of care—and this is stated explicitly in the current version.” A revised version of the bill was introduced in the 108th congress because “that is just the nature of the way congress does business”, he adds. “There’s a new majority part in the senate, leadership in the house has changed, and so now there’s a new piece of legislation.” Funding
has been cut, as the news report suggests, “but everything is being cut back in the current fiscal climate. The mere fact that congress is trying to move the bill forward is a testament to how important people think it is.” Goldstein acknowledges that alteplase use in acute stroke “is an ongoing debate, because many hospitals don’t have physicians who have been trained to use it or the organisation in place to use it safely”. Several studies suggest that if protocols are not followed closely, the chance of complications goes up. “But the news article suggests that STOP is a stroke-tPA bill, and that’s not what it’s about”, he emphasises. “It’s very comprehensive and attacks the growing problem of stroke on a number of levels. I’d hate for anything as important as this to be derailed because of misinterpreted information.” Marilynn Larkin
THE LANCET Neurology Vol 3 May 2004
http://neurology.thelancet.com
For personal use. Only reproduce with permission The Lancet Publishing Group.