Doctors and lethal injection

Almost all executions in the United States are now performed by lethal injection (155/160 since 2000) and doctors have helped in the development of this method, an article in the BMJ reports. Lethal injection is unique because it simulates a medical procedure - the intravenous induction of general anaesthesia. Medical professionals' organisations in the United States forbid participation in executions, but most doctors are unaware of the guidelines and are willing to participate. Their involvement creates a profound conflict of roles that is morally unacceptable, says Jonathan Groner, trauma medical director in Columbus, Ohio and author of the report. 'When doctors enter the death chamber, they harm not only their relationship with their own patients but the relationships of all doctors with their patients. Doctors take an oath to be healers, not killers, and they should not participate in executions under any circumstance. Lethal injection has a deeply corrupting influence on medicine as a whole.' (British Medical Journal 2002; 325:1026-8, 2 November)

Prevention not cure

Treatment of HIV/AIDS with antiretroviral drugs in rural African settings is not a practical option given issues of cost, compliance, monitoring facilities, drug interactions with TB medication and the availability of clean drinking water. In a letter to the BMJ doctors at St Anne's Mission Hospital in central Malawi eloquently argue for prevention as the only realistic approach: 'Education on preventing HIV has to be the main way forward, especially when all our resources are so scarce.' (British Medical Journal 2002; 325:838, 12 October)

Feminist attacks abortion pill

Feminist icon Germaine Greer has stunned her fans by attacking the abortion pill at a Sydney obstetricians and gynaecologists conference. Dr Greer said she had been asked to speak at the 'Best for Women' event to bring pressure to bear to improve access to RU-486. 'Of course we need also access to amputation but we need even more to make sure that as few people are in a situation where they need amputations as possible.' (www.davidalton.com)

The cost of tobacco

A Los Angeles court made the biggest individual damages award in US legal history on 4 October to a 64-year-old woman with lung cancer. The Philip Morris tobacco company was ordered to pay $28 billion (£18bn) to Betty Bullock of Newport Beach, California, who claimed she had believed the company when it said there was no evidence that smoking caused cancer, in spite of being told otherwise by her doctor. A Miami judge ordered the tobacco industry to pay $145 billion in punitive damages to 500,000 sick Florida smokers on 14 July. Appeal on both cases is pending. (The Times 2002; 5 October:17)

Being difficult

Being difficult is not necessarily a bad thing, and the NHS needs more difficult doctors, according to Coventry paediatrician Charles Essex. He cites two role models: Jesus Christ and the little boy who suggested that the emperor was wearing no clothes. He also quotes George Bernard Shaw on the 'unreasonable man': 'The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.' (British Medical Journal 2002; 325:1177, 16 November)

Essential reading for medical students

Primo Levi was an Italian chemist, who wrote of his experiences and reflections on life in a Nazi concentration camp. A recent review in the Lancet (2002; 360:882) recommends that all medical students should read his books, which enable 'those who were not witnesses (to) digest what happened, and hopefully, ensure that it is never repeated'. Sir William Osler recommended to his students 'a list of ten books which you may make close friends', and prescribed reading for half an hour before going to sleep. His 'top ten' included the Old and New Testaments, Shakespeare, Religio Medici, Don Quixote and Marcus Aurelius. (British Medical Journal 2002; 325:867, 19 October)

IVF price-hike

Private fees for in vitro fertilisation are to be raised by £100 per cycle under new government plans to introduce tighter regulation in the wake of recent high profile infertility botch-ups. Currently about 24,000 women pay £2,500 per cycle; or about £12,500 per live birth, if we accept a take-home baby rate of 20%. Only about 4,000 women, who have their treatment funded by the NHS, will not have to pay. So far over 50,000 babies have been born through IVF in the UK (The Times 2002; 26 November:3)

New sex laws

Offences such as buggery, gross indecency and soliciting by men are to axed under new Home Office proposals to reform 'archaic, incoherent and discriminatory' sex laws. The changes are outlined in a white paper, Protecting the Public, published by Home Secretary David Blunkett, which also includes measures to protect children from sex abuse and exploitation. Bestiality is to stay an offence with a two year term, and necrophilia is to become an offence with a maximum two year term. (The Times 2002; 20 November:4)

Brain dead?

Disquiet amongst anaesthetists over organ harvesting procedures is reflected in lack of consensus on practice, according to Cambridgeshire anaesthetist David Hill. He argues in the BMJ that, 'Some give full anaesthesia to organ donors (because they respond to surgery much like any other patient), whereas others withhold anaesthesia (which might look like an admission that the donors are still alive) but suppress the response to surgery by other means'. Are the 'brain dead' really dead; and is properly informed consent being given? (British Medical Journal 2002; 325:836, 12 October)

GPs increasingly say 'no' to abortion

One of four GP practices has a doctor who refuses to give consent to abortion, according to a nationwide audit of GP practices by the Teenage Pregnancy Unit. The audit of 40% of all practices (around 4,000) also found that 15% of GPs would refuse to see a patient under 16 years without their parents being present. (GP 2002; 7 October)

Avoidable deaths

The main avoidable hazards to health worldwide are malnutrition, poor water supply and sanitation, unsafe sex, physical inactivity and alcohol and tobacco, which together accounted for 15.5 million deaths in 1990, or 30.6% of all deaths. (British Medical Journal 2002; 325:928, 26 October)