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US government sues tobacco companies over federal health-care costs
South Africa and USA make uneasy peace over international drug patent laws outh African AIDS activists picketed pharmaceutical companies in Cape Town and Gauteng on Sept 22 in a demand for affordable drugs. The protesters demanded that the pharmaceutical industry association cut the price of zidovudine sold to the government from US$66 to $30 for a 1 month course for HIV-positive pregnant mothers; and unconditionally drop the price of essential drugs for AIDS-related diseases. The pickets were held in spite of the USA/South African trade deal on Sept 17, which could significantly cut the cost of AIDS treatment and which has been cautiously welcomed by AIDS
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groups. The governments have settled their differences over a section of South African medicine law which the USA believes would enable the South African health minister to violate international patent-protection agreements in the name of procuring AIDS drugs and other medicines at a reduced prices. But the pact may not be the last word on an issue that has strained diplomatic relations and dogged US vice-president Al Gore’s presidential campaign (Lancet 1999; 354: 1685). US Trade Representative Charlene Barshefsky said the USA had agreed to support South Africa’s efforts to
obtain cheaper AIDS drugs in exchange for promises that the measures would not violate patent rights. However, Barshefsky did not promise to remove South Africa from the list of countries providing inadequate protection for intellectual property rights although it is reported that South Africa’s position could be reviewed by October. Meanwhile, the South African pharmaceutical industry has suspended legal action against the government over implementing the medicines law, which has yet to be promulgated. Adele Baleta
US government sues tobacco companies over federal health-care costs he US government filed a suit against the major US tobacco companies on Sept 22 to recoup funds spent by the federal Medicare programme, and by programmes for veterans, military personnel, and other federal workers for smoking-related illnesses. “Smoking is the nation’s largest preventable cause of death and disease, and American taxpayers should not have to bear the responsibility for the staggering costs”, said Attorney General Janet Reno. The government spends more than $20 billion annually on smoking-related illnesses. The federal suit was filed about 10 months after the states settled with the tobacco companies to recover their smoking-related health-care costs; and a year and a half after the US Congress failed to implement an even stronger deal with the states that would have included significant new
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party. The third, the Federal regulation of the industry. Racketeer Influences and Corrupt The good news for the tobacc comOrganizations Act, was panies involved—Philip originally intended to Morris, RJ Reynolds, fight organised crime, Brown & Williamson, and permits triple damLorillard, and the ages to be assessed in Liggett Group—is that certain situations. The the Justice Department suit alleges that tobacco has ended its criminal executives entered into a investigation against the conspiracy in 1954 to heads of the companies. deny that smoking Federal officials had caused disease, that cigabeen trying to prove that rettes were addictive, and tobacco executives had that they marketed their lied when they testified Reno wants compensation products to children. in 1994 that they did not The tobacco companies pledged to know nicotine was addictive and that fight the suit rather than settle, as they tobacco use caused disease. did with the states. “We will not sucBut the civil suit could threaten the cumb to politically correct extortion”, companies even more. The suit is said Philip Morris attorney Greg based on three separate laws, two of Little. which authorise the federal government to seek reimbursement for health-care costs caused by a third Julie Rovner
Spanish medical college council calls for ethical medicine
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he General Council of Spain’s Official Medical Colleges (OMC) approved a new ethics code on Sept 25, which focuses on patients’ rights and doctors’ duty, while trying to adapt to current clinical practises and legislation. The so-called Y2000 ethics, which will come into force over the next 4 years, relaxes aspects of the code relating to abortion and palliative care, but includes warnings over “defensive medicine”. This medical practice has increased markedly in the past few years in Spain and according to the OMC contravenes their ethical principles.
THE LANCET • Vol 354 • October 2, 1999
The new code states that “the doctor must not indicate (or order) diagnostic procedures or treatments which are only aimed to his or her self-protection”. The OMC’s ethics commission, led by Rafael Muñoz-Garrido, note that Spanish doctors are increasingly submitting their patients to unnecessary diagnostic tests to avoid subsequent complications or potential lawsuits. Defensive medicine is considered by most observers to be a consequence of the progressive judicialisation of the medical profession. The ethics code also states that the opinion of under-age patients
must be taken into account and be weighted according to a person’s age and maturity. The code also deals with information technology and the mediums used by patients to make medical consultations. The code makes it clear that medicine practised by means of consultations carried out exclusively via phone, letter, radio, press, or the internet are unethical. To make a diagnosis the first contact between a patient and a doctor must be a face to face meeting. Xavier Bosch
1189
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groups. The governments have settled their differences over a section of South African medicine law which the USA believes would enable the South African health minister to violate international patent-protection agreements in the name of procuring AIDS drugs and other medicines at a reduced prices. But the pact may not be the last word on an issue that has strained diplomatic relations and dogged US vice-president Al Gore’s presidential campaign (Lancet 1999; 354: 1685). US Trade Representative Charlene Barshefsky said the USA had agreed to support South Africa’s efforts to
obtain cheaper AIDS drugs in exchange for promises that the measures would not violate patent rights. However, Barshefsky did not promise to remove South Africa from the list of countries providing inadequate protection for intellectual property rights although it is reported that South Africa’s position could be reviewed by October. Meanwhile, the South African pharmaceutical industry has suspended legal action against the government over implementing the medicines law, which has yet to be promulgated. Adele Baleta
US government sues tobacco companies over federal health-care costs he US government filed a suit against the major US tobacco companies on Sept 22 to recoup funds spent by the federal Medicare programme, and by programmes for veterans, military personnel, and other federal workers for smoking-related illnesses. “Smoking is the nation’s largest preventable cause of death and disease, and American taxpayers should not have to bear the responsibility for the staggering costs”, said Attorney General Janet Reno. The government spends more than $20 billion annually on smoking-related illnesses. The federal suit was filed about 10 months after the states settled with the tobacco companies to recover their smoking-related health-care costs; and a year and a half after the US Congress failed to implement an even stronger deal with the states that would have included significant new
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party. The third, the Federal regulation of the industry. Racketeer Influences and Corrupt The good news for the tobacc comOrganizations Act, was panies involved—Philip originally intended to Morris, RJ Reynolds, fight organised crime, Brown & Williamson, and permits triple damLorillard, and the ages to be assessed in Liggett Group—is that certain situations. The the Justice Department suit alleges that tobacco has ended its criminal executives entered into a investigation against the conspiracy in 1954 to heads of the companies. deny that smoking Federal officials had caused disease, that cigabeen trying to prove that rettes were addictive, and tobacco executives had that they marketed their lied when they testified Reno wants compensation products to children. in 1994 that they did not The tobacco companies pledged to know nicotine was addictive and that fight the suit rather than settle, as they tobacco use caused disease. did with the states. “We will not sucBut the civil suit could threaten the cumb to politically correct extortion”, companies even more. The suit is said Philip Morris attorney Greg based on three separate laws, two of Little. which authorise the federal government to seek reimbursement for health-care costs caused by a third Julie Rovner
Spanish medical college council calls for ethical medicine
T
he General Council of Spain’s Official Medical Colleges (OMC) approved a new ethics code on Sept 25, which focuses on patients’ rights and doctors’ duty, while trying to adapt to current clinical practises and legislation. The so-called Y2000 ethics, which will come into force over the next 4 years, relaxes aspects of the code relating to abortion and palliative care, but includes warnings over “defensive medicine”. This medical practice has increased markedly in the past few years in Spain and according to the OMC contravenes their ethical principles.
THE LANCET • Vol 354 • October 2, 1999
The new code states that “the doctor must not indicate (or order) diagnostic procedures or treatments which are only aimed to his or her self-protection”. The OMC’s ethics commission, led by Rafael Muñoz-Garrido, note that Spanish doctors are increasingly submitting their patients to unnecessary diagnostic tests to avoid subsequent complications or potential lawsuits. Defensive medicine is considered by most observers to be a consequence of the progressive judicialisation of the medical profession. The ethics code also states that the opinion of under-age patients
must be taken into account and be weighted according to a person’s age and maturity. The code also deals with information technology and the mediums used by patients to make medical consultations. The code makes it clear that medicine practised by means of consultations carried out exclusively via phone, letter, radio, press, or the internet are unethical. To make a diagnosis the first contact between a patient and a doctor must be a face to face meeting. Xavier Bosch
1189