There can be few medical jobs more political than the US Surgeon- General, as debate on Capital Hill showed this month. The Bush administration, which is often accused of allowing ideology to trump science, has nominated Dr James W. Holsinger Jr, a Kentucky physician, for the job. But he is being slowly roasted in Senate hearings over alleged hostility towards homosexuality. Back in 1991 he wrote a paper arguing that sex between men was contrary to nature's design and was associated with infectious diseases and cancer. "Ideology with a veneer of science," says Senator Edward Kennedy.
Holsinger insists that he would be an advocate for the health of all Americans, regardless of sexual orientation, and that he wants to campaign against child obesity. But his words on homosexuality 16 years ago appears to have sunk him.
His predecessor, Richard H. Carmona, who served from 2002 to 2006, stoked the fires by complaining that Bush administration officials had taken advantage of his political naivete. They repeatedly tried to weaken or suppress important public health reports because of political considerations. He claims to have been muzzled on issues like stem cells, emergency contraception, sex education, and second- hand cigarette smoke. He was ordered to mention the President three times on every page of his speeches. Dr Carmona now has a less political job as the chairman of Canyon Ranch, a resort and residential development company.
Interference in the surgeon-general's job began long before George W. Bush according to the testimony of previous incumbents. Dr David Satcher, surgeon-general in the Clinton administration, had been discouraged from issuing a report on needle exchange. Dr C. Everett Koop, surgeon-general in the Reagan administration, complained that he had been told not to discuss the AIDS crisis. ~ New York Times, Jul 11, 12; LA Times, Jul 13
IDEOLOGICAL TYRANNY: THE VOICE OF EXPERIENCE
As claims and counter-claims about ideology and science whistle through the air, Nature took the unusual step of publishing an op-ed by the former staff director of the House Committee on Science, David Goldston. He is now a visiting lecturer at the Woodrow Wilson School of Public and International Affairs at Princeton University. Here are a couple of relevant paragraphs:
"Policy-making needs to be informed by both science and values. Is stem-cell research ethical? That's not a science question, although one needs to understand the potential of stem-cell research to answer it. Should clean-air standards be strengthened? That is not a science question, but one needs to know what researchers think the health impacts of dirtier air would be.
"Often, when scientists complain that Congress is ignoring science, what they really mean is that Congress is making policy calls they don't like. The notion that Congress would make different decisions [with better scientific advice] ... is another way of saying: "If you knew what I know, you'd think what I think." That's a dangerous fallacy. And it's a fallacy Congress itself tends to perpetuate, because in today's polarised environment, politicians on all sides like to claim that their views are the only ones backed by science." ~ Nature, Jul 12
DEBATE: SHOULD MEDICAL JOURNALS CARRY DRUG ADS?
The American Journal of Medicine once ran advertisements for Camel cigarettes, but eventually kicked the habit. Now there are calls for medical journals to kick their addiction to drug company advertising, too. In a debate in the BMJ, Gareth Williams, of the University of Bristol, and Richard Smith, a former BMJ editor, cross swords on the touchy topic.
Dr Williams argues that " As a minimum, drug advertisements should be vetted independently and much more stringently than at present and barred from publication if they make inflated or substantiated claims. Ideally, though, drug advertising should be banned completely from medical journals. This would be a big financial hit on some journals -- some of which raise 20-30% of their income from advertising -- but comes at a time when doctors, institutions, and patients are under increasing pressure to re-examine the morality of their links with the drug industry."
Dr Smith, on the other hand, takes a more pragmatic view. Paradoxically, he contends that drug advertising maintains the financial independence of the major journals. Competing advertisers police one another. And other sources of income, including subscriptions and classified advertising, help to balance the potential influence of the drug companies.
However, he does regard reprint sales commissioned by drug companies to promote their products as a moral scourge. These are immensely profitable. "Editors know the trials that will attract such profits, and the conflict of interest is huge." ~ BMJ, Jul 14
WHAT'S ANOTHER PARENT, MORE OR LESS?
Court rulings in Canada and the US and IVF technology are paving the way for multiple parents, according to an op-ed in the New York Times. In January, an Ontario court found that a boy can legally have three parents: the biological mother and father, plus the mother's lesbian partner. In April, a Pennsylvania court found that a sperm donor and two lesbians were all responsible for supporting two children after the lesbian couple had split up.
It's not just a North American thing. Expert commissions in New Zealand and Australia have also proposed that sperm or egg donors enjoy the privilege of being a legal parent.
Family scholar Elizabeth Marquardt says that these cases have been overlooked, partly because so many children are already growing up in chaotic households with multiple parent figures. But these are the first cases which support the notion of multiple legal parents. She feels that this points to a worrying trend. As a polygamist argued in Newsweek, "If Heather can have two mommies, she should also be able to have two mommies and a daddy." And if three, why not five? ~ New York Times, Jul 16
INDIAN MINISTER WANTS PREGNANCY REGISTER TO STOP ABORTIONS
Sex-selective abortion is a huge issue in India, where the sex ratio has sunk to 927 girls to 1000 boys. Now the women and child development minister, Renuka Chowdhury, has come up with an unprecedented solution. All pregnant women should register with the government and seek its permission for an "acceptable and valid" abortion.
The minister wants to tackle organised foeticide rackets in Punjab, Haryana and Uttar Pradesh: "With this, mysterious abortions will become difficult." A government official explained that this information gathered would help identify areas where there are large gaps between pregnancies and births.
The proposal has had a mixed reaction. "We cannot give elementary health services in a satisfactory way to most of our citizens, and to talk about registering pregnancies is ridiculous," said Alok Mukhopadhyay, head of the Voluntary Health Association. But UNICEF welcomed it as a way of offering quality ante-natal care. "Registering pregnancies is good," said Marzio Babille, UNICEF's head of health in India. ~ Reuters India, Jul 13; Hindustan Times, Jul 18
UK TO PONDER OPT-OUT ORGAN DONATION
Britain should adopt an opt-out policy on organ donation to beat its organ shortage crisis, says its chief medical officer, Sir Liam Donaldson. "Every day at least one patient dies while on the transplant waiting list," says Sir Liam." There are something like 7,000 people on the waiting list at any one time. There is a shortage of organs in this country and the situation is getting worse."
The opt-out system seems to work. In Spain, the number of donations has soared and waiting lists have shortened. In Britain, it is estimated that one in ten people on an organ donor waiting list will die. However, there are counter examples. Sweden has an opt-out system and its donation rate is lower than the UK's.
Anyone who has reservations about donating organs will be able to register their objections with the government. Sir Liam proposed his scheme in his annual state of the nation's health. It has the strong backing of the British Medical Association. But it is far from certain that the idea will be welcomed in Parliament, as it was recently rejected during debates on another act.
"It is dangerous to presume patients' wishes at a time when difficult decisions need to be made immediately," said Katherine Murphy, of Patients Association, a lobby group. "It is not always possible to contact a next of kin in time so we must not take for granted that presumed consent for all is the answer." ~ Guardian, London Telegraph, Jul 18;
NIMBY SPOILSPORTS EVICT DIGNITAS
After 700 people committed suicide at Getrud Strasse 84, in Zurich, Switzerland, over the past nine years, the residents of the apartment block have had enough. They asked that Dignitas, the well- known assisted suicide organisation, vacate its headquarters on the fourth floor and its suicide flat on the ground floor. The head of Dignitas, Ludwig Minelli, is now looking for new accommodation. If other neighbours prove to be as prickly, he may end up using a caravan, which would give Dignitas the possibility of offering mobile euthanasia.
"Not in my back yard" sounds a bit mean-spirited, but the neighbours say that they were fed up. Three or four times a week, during office hours, ambulances were pulling up to remove Dignitas clients in charcoal- coloured body bags. Often other tenants found themselves in the lift with a corpse, or had to push by them in a narrow corridor. One woman complained to the Guardian about being forced to alter her timetable so as not to "bump into a corpse while I'm taking out the rubbish". ~ Guardian, Jul 13
EUTHANASIA ACTIVIST BARES SOUL
After American Jack Kevorkian, Australia's Dr Philip Nitschke is arguably the best-known advocate of euthanasia in the English- speaking world. As a doctor in the Northern Territory in 1996, he helped four people to die before the Federal government stepped in and quashed the law in 1997. Ten years later, Dr Nitschke is standing as a candidate for Federal Parliament. His opponent is a government minister, Kevin Andrews, who had led the campaign against the law as a new MP.
The campaign is a quixotic one, but promotes Nitschke's controversial views. In a long interview with ABC journalist Monica Attard, he revealed how he felt when he became the first doctor to legally participate in euthanasia. Here are a few paragraphs:
"The very first time with Bob Dent, he said 'Come around on Sunday. I've decided Sunday is the day to die. I want to die about two o'clock.' He said, "Can you come around for lunch beforehand?"
"And I remember feeling very chilled at the time and that was about Wednesday when he told me. I didn't do much sleeping from that time. I went around there around midday. Couldn't eat my food and everything. You tried to talk about didn't seem to make much sense.
"You run every sentence you're about to say past yourself and you edit it and you decide it's not worth saying. Everything has some future component and so you just don't say it. These are very, very difficult times.
"I can only imagine that it's obviously is something like what people go through leading up to an execution and it's very, very hard going. The fact that he wanted it makes it… there are still aspects of it that do make you feel like it's one of the grim situations.
"And I found myself covered in sweat. My shirt was drenched in sweat and I didn't know why and my mouth was so dry I couldn't eat my sandwich...
"I had plenty of opportunity to question [the morality of the issue] and I did question it. Having said that I questioned it, I was never in any doubt. Those periods didn't make me feel any more doubtful. The fact that I was having such a hard time of it didn't really make me question the concept." ~ ABC, Jul 15
IN BRIEF: fertility drugs; doctor cleared
FERTILITY DRUGS: More than 90% of women using fertility drugs to stimulate their ovaries may be receiving the wrong dosage. Geoffrey Trew, of Hammersmith Hospital in London, found that 75% of women in a small study were given too high a dose and 15% too low a dose. ~ New Scientist, Jul 16
DOCTOR CLEARED: A British neonatologist who gave two babies lethal doses of a drug has been cleared of an act "tantamount to euthanasia". The General Medical Council found that Dr Michael Munro had misled investigators and kept inadequate records of the cases. But the chairwoman of the GMC's fitness-to-practice panel found that the charges were not serious enough to warrant an official warning. The two cases, both of premature babies, occurred in 2005 and the parents supported what Dr Munro did. ~ BMJ, Jul 14
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