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Watchdog set up to monitor UK health care
US House blocks Oregon’s assisted suicide law
T
he US House of Representatives passed a bill on Oct 27 that would effectively block Oregon’s Death with Dignity Act, the nation’s only state law explicitly allowing physician-assisted suicide (see Lancet 1999; 353: 820). But opponents of the Pain Relief Promotion Act, which was passed by a vote of 271–156, argued that the measure could, if enacted, adversely affect the care of the terminally ill and other patients with chronic pain across the country. The primary purpose of the bill is to reverse a ruling by Attorney General Janet Reno in June, 1998, that Oregon’s assisted-suicide law did not conflict with the Federal Controlled Substances Act. Reno said that Oregon doctors who used Federally regulated drugs to aid a suicide attempt in compliance with Oregon’s law would not be subject to sanctions from the federal Drug Enforcement Administration, which enforces the Controlled Substances Act. An earlier version of the bill drew the ire of the medical community, which argued that by declaring assisted suicide an impermissible use of controlled substances, physicians would be deterred from using strong pain medications for those in intractable pain, in case
the medications hastened death and left the physician subject to potential sanction. The bill that the House passed attempted to address that problem, by declaring that alleviating pain is a “legitimate medical purpose” for the use of a federally controlled substance, “even if the use of such a substance may increase the risk of death”. This statement won this year’s bill the backing of the American Medical Association, although many other medical groups continued to oppose it. By providing a “safe harbour” for using federally regulated drugs, “we are creating additional protections under the law for doctors who use controlled substances to relieve pain”, said Republican senator Charles Canady. But others complained that by simultaneously making the use of controlled substances for assisted suicide explicitly illegal, the bill would put physicians in a situation in which US drug-enforcement agents—who are not medical professionals—would judge intent in providing narcotics. “This bill will so intimidate doctors that they will not prescribe adequate pain relief”, said Republican Steven Rothman. Julie Rovner
Watchdog set up to monitor UK health care is using the most up-to-date health new standards watchdog for the technologies and new drugs as UK’s National Health Service recommended in was launched by the national guidelines. Prime Minister, Tony All consultants will be Blair, on Oct 28. The required to participate Commission for in external audits of Health Improvement their work including (CHI) started work the outcome of on Nov 1 and will treatments. promote good practice “For the first time and help to ensure in over 50 years, the that there is high-qualNHS will be subject ity care in every hospi- CHI will review cancer care to external scrutiny”, tal and primary care said the Health Secretary, Alan group (PCG) in England and Wales. Milburn. The British Medical CHI will operate independently of Association has welcomed the creNHS Trusts and Health Authorities ation of the CHI. BMA chairman Ian and will be made up of multidiscipliBogle said that “the Commission’s nary teams including doctors and work overseeing clinical governance nurses. The Commission intends to and ensuring it is in place in the NHS review all hospitals and PCGs, which will run alongside the medical run doctor’s surgeries, in England profession’s own self-regulation and Wales over the next 4 years. measures, including revalidation”. CHI’s first review will examine standards of cancer treatment. The watchdog will ensure the NHS Haroon Ashraf
A
THE LANCET • Vol 354 • November 6, 1999
UK declaration made on research misconduct eading representatives of UK medicine and science last week took an important step towards establishing a “national panel” on research misconduct. At a Joint Consensus Conference on Misconduct in Biomedical Research, held at the Royal College of Physicians of Edinburgh, a committee chaired by Robert Kilpatrick agreed that a national panel would “develop and promote models of good [research] practice”; “provide assistance with the investigation of alleged research misconduct”; and “collect, collate, and publish information on incidents of research misconduct”. Donald Irvine (President, General Medical Council) and George Alberti (President, Royal College of Physicians of London) agreed to translate this view into a practical mechanism as soon as possible. Povl Riis of the Danish Committee on Scientific Dishonesty emphasised that such a panel has many positive contributions to make to science—eg, providing courses on research ethics for young scientists. That view was warmly received by the meeting, whose focus shifted from “how do we prevent research misconduct?” to “how do we promote good research?” A persistent theme of the conference was the importance of seeking public and patient input into processes for dealing with research misconduct. Patricia Wilkie argued that patients were not only enthusiastic about taking part in research but also wanted to be seen as collaborators with investigators rather than simply as “participants” in research. That view was also accepted by the consensus conference, and “public representation” was established as a key component of the national panel’s make up. While there was agreement that a UK national committee was necessary, Richard Peto and Rory Collins (Clinical Trial Service Unit, Oxford) expressed concern that such a panel should not attempt to over regulate research. Currently, there is intense international activity to revise current approaches to research integrity. On Oct 14, the US Office of Science and Technology Policy released a proposal for a new federal policy on research misconduct. And the UK’s General Medical Council is close to publishing its guidance on “Good Practice in Medical Research”.
L
Richard Horton
1623
T
he US House of Representatives passed a bill on Oct 27 that would effectively block Oregon’s Death with Dignity Act, the nation’s only state law explicitly allowing physician-assisted suicide (see Lancet 1999; 353: 820). But opponents of the Pain Relief Promotion Act, which was passed by a vote of 271–156, argued that the measure could, if enacted, adversely affect the care of the terminally ill and other patients with chronic pain across the country. The primary purpose of the bill is to reverse a ruling by Attorney General Janet Reno in June, 1998, that Oregon’s assisted-suicide law did not conflict with the Federal Controlled Substances Act. Reno said that Oregon doctors who used Federally regulated drugs to aid a suicide attempt in compliance with Oregon’s law would not be subject to sanctions from the federal Drug Enforcement Administration, which enforces the Controlled Substances Act. An earlier version of the bill drew the ire of the medical community, which argued that by declaring assisted suicide an impermissible use of controlled substances, physicians would be deterred from using strong pain medications for those in intractable pain, in case
the medications hastened death and left the physician subject to potential sanction. The bill that the House passed attempted to address that problem, by declaring that alleviating pain is a “legitimate medical purpose” for the use of a federally controlled substance, “even if the use of such a substance may increase the risk of death”. This statement won this year’s bill the backing of the American Medical Association, although many other medical groups continued to oppose it. By providing a “safe harbour” for using federally regulated drugs, “we are creating additional protections under the law for doctors who use controlled substances to relieve pain”, said Republican senator Charles Canady. But others complained that by simultaneously making the use of controlled substances for assisted suicide explicitly illegal, the bill would put physicians in a situation in which US drug-enforcement agents—who are not medical professionals—would judge intent in providing narcotics. “This bill will so intimidate doctors that they will not prescribe adequate pain relief”, said Republican Steven Rothman. Julie Rovner
Watchdog set up to monitor UK health care is using the most up-to-date health new standards watchdog for the technologies and new drugs as UK’s National Health Service recommended in was launched by the national guidelines. Prime Minister, Tony All consultants will be Blair, on Oct 28. The required to participate Commission for in external audits of Health Improvement their work including (CHI) started work the outcome of on Nov 1 and will treatments. promote good practice “For the first time and help to ensure in over 50 years, the that there is high-qualNHS will be subject ity care in every hospi- CHI will review cancer care to external scrutiny”, tal and primary care said the Health Secretary, Alan group (PCG) in England and Wales. Milburn. The British Medical CHI will operate independently of Association has welcomed the creNHS Trusts and Health Authorities ation of the CHI. BMA chairman Ian and will be made up of multidiscipliBogle said that “the Commission’s nary teams including doctors and work overseeing clinical governance nurses. The Commission intends to and ensuring it is in place in the NHS review all hospitals and PCGs, which will run alongside the medical run doctor’s surgeries, in England profession’s own self-regulation and Wales over the next 4 years. measures, including revalidation”. CHI’s first review will examine standards of cancer treatment. The watchdog will ensure the NHS Haroon Ashraf
A
THE LANCET • Vol 354 • November 6, 1999
UK declaration made on research misconduct eading representatives of UK medicine and science last week took an important step towards establishing a “national panel” on research misconduct. At a Joint Consensus Conference on Misconduct in Biomedical Research, held at the Royal College of Physicians of Edinburgh, a committee chaired by Robert Kilpatrick agreed that a national panel would “develop and promote models of good [research] practice”; “provide assistance with the investigation of alleged research misconduct”; and “collect, collate, and publish information on incidents of research misconduct”. Donald Irvine (President, General Medical Council) and George Alberti (President, Royal College of Physicians of London) agreed to translate this view into a practical mechanism as soon as possible. Povl Riis of the Danish Committee on Scientific Dishonesty emphasised that such a panel has many positive contributions to make to science—eg, providing courses on research ethics for young scientists. That view was warmly received by the meeting, whose focus shifted from “how do we prevent research misconduct?” to “how do we promote good research?” A persistent theme of the conference was the importance of seeking public and patient input into processes for dealing with research misconduct. Patricia Wilkie argued that patients were not only enthusiastic about taking part in research but also wanted to be seen as collaborators with investigators rather than simply as “participants” in research. That view was also accepted by the consensus conference, and “public representation” was established as a key component of the national panel’s make up. While there was agreement that a UK national committee was necessary, Richard Peto and Rory Collins (Clinical Trial Service Unit, Oxford) expressed concern that such a panel should not attempt to over regulate research. Currently, there is intense international activity to revise current approaches to research integrity. On Oct 14, the US Office of Science and Technology Policy released a proposal for a new federal policy on research misconduct. And the UK’s General Medical Council is close to publishing its guidance on “Good Practice in Medical Research”.
L
Richard Horton
1623