News Review

Abortions increase in Russia

The economic crisis in Russia has caused the price of contraceptives to soar, leading to a rise in the already huge number of abortions performed. Russia's population is on the decline, dropping by about half a million every year, largely due to the very high abortion rates. In 1997, 2.5 million abortions were carried out, twice the number of children born in the same period. 1998 figures show the same trend (only Romania carries out more abortions than the number of live births). Abortion is available free on demand at most hospitals and clinics in the first twelve weeks of pregnancy and all that is required to qualify women for abortion up to 22 weeks are social indicators such as cramped living conditions or marital difficulties. This relaxed abortion law and the soaring price of contraceptives have encouraged more women to risk becoming pregnant and to use abortion as a form of contraception. There is a concurrent explosion in sexually transmitted diseases as Russians are reluctant to use barrier methods of contraception. 1 in 8 couples now suffer infertility, as abortions are performed badly, with 40% of operations resulting in complications requiring antibiotics or hospital admission (Sunday Telegraph 1999; 24 January)

Abortion may be recriminalised in the US

Abortion may be recriminalised in the US in the next few years according to the American Journal of Public Health. Calculations from data collected in the 1970s, when abortion was first legalised, suggest that as many as 440,000 extra births might occur each year (Am J Pub Hlth 1999;89:199-203).

Economic crash linked to health decline in Asia

A picture of declining women's health is emerging in Asia after the recent economic crash. Health care and education programmes have been reduced drastically, especially those for AIDS and sexually transmitted diseases, birth control, prenatal and antenatal care. Many newly unemployed women are turning to the sex industry to make money (BMJ 1999;318:420, 13 February).

Pakistan pregnancy complications

Up to 30,000 women die in Pakistan every year from complications of pregnancy and 1 in 10 children do not reach their first birthday. Several charities have collaborated to deliver a £29.4 million loan to rural Pakistani health projects (BMJ 1999;318:892, 3 April).

Senegal bans genital mutilation

The Senegalese parliament has joined several other African countries in banning female genital mutilation. UNICEF estimates that about 130 million females in Africa alone have been subjected to some form of genital mutilation (BMJ 1999;318:348, 6 February).

US anti-abortion activists blacklist abortion doctors

US anti-abortion activists have been putting up 'wanted'-style posters and operating a website known as 'the Nuremberg Files'. This lists the names, addresses and personal details of 255 doctors who have been or are performing abortions. The website and posters display blood-dripping fetuses, announce the doctors are 'guilty of crimes against humanity', label them 'baby butchers' and list them as 'working', 'wounded' or 'fatality'. The American Coalition of Life Activists, the Advocates for Life Ministries and prominent members of the US anti-abortion movement have been successfully sued for $108 million by the listed doctors and several family-planning groups, over the incitement and threats of violence made. In the last 20 years, there have been seven murders, 15 attempted murders, 154 arson incidents and 39 bombings involving abortion workers or clinics, according to the National Abortion Federation (BMJ 1999;318:214, 23 January), (BMJ 1999;318:415, 13 February), (Daily Telegraph 1999; 9 January), (Daily Telegraph 1999; February 4).

Cardinal Hume speaks out on abortion

In the UK, Cardinal Basil Hume has cautioned anti-abortionists against militancy and intolerance and warned about the current rise in abortion. He has also highlighted the dangers of eugenics and genetic science, called for an end to society's obsession with sex, an end to pornography and has encouraged people to put the intimacy back into marriage. The Scottish Roman Catholic Cardinal has offered amnesty to women who have had abortions and the medical staff involved by granting parish priests permission to absolve them from their sin. Roman Catholics who aid or have abortions are automatically excommunicated unless forgiveness is sought from a bishop. This promise came as the 107th baby was born under a two-year old Glasgow pro-life scheme aiming to encourage women considering abortion to give birth instead (Daily Telegraph 1999; 11 March), (Sunday Telegraph 1999; 21 March).

House of Lords rejects lowering of homosexual age of consent

In April, the House of Lords threw out Commons-approved legislation to lower the age of consent for homosexuals to 16, prompting the government to invoke the Parliament Act. It will be six months before the Bill can be submitted again, when the rarely used constitutional procedure will be used to force it through both Houses (Daily Telegraph 1999; 14 April), (Daily Telegraph 1999; 15 April).

American research fails to validate gay gene

Meanwhile, Canadian and US scientists have failed to validate previous research connecting male homosexuality to the Xq28 gene. They are now looking elsewhere in the human genome (BMJ 1999; 318:1362, 15 May).

Schizophrenia inadequately treated in UK

The UK National Schizophrenia Fellowship has claimed that 1 in 3 people with severe mental illness are turned away from care when they need it, and 1 in 4 are refused hospital admission (BMJ 1999;318:1094, 24 April).

Japanese double standards on viagra

The Japanese government has approved the use of Viagra after six months of discussion, but has taken forty years to approve the contraceptive pill. After the embarrassing publicity and the subsequently increased pressure from women's and family planning groups, the government finally concluded its extremely lengthy deliberations, but stopped short of committing itself outright to approving the Pill (The Daily Telegraph 1999; 4 March).

Viagra restrictions in UK

The UK government has finally announced restrictions on prescribing the anti-impotence pill Viagra. Men who have undergone radical prostatectomy or pelvic surgery will qualify along with those suffering from spinal cord injuries, diabetes, multiple sclerosis, single gene neurological disease, kidney failure, spina bifida, Parkinson's disease and severe pelvic injury. Other men who are severely distressed by their impotence may be treated with Viagra only in exceptional circumstances. GPs will be allowed to prescribe Viagra privately but are banned from charging for the consultation. The restrictions come into effect on 1 July 1999. This is a landmark decision as this is the closest the Government have come to admitting that some NHS treatments will have to be rationed (BMJ 1999;318:1305, 15 May).

Witch-hunting in India

Hundreds of women are being hunted down and denounced as witches in India. If the local witchdoctor is unable to cure a disease, he may demand sacrifices of animals, or even of a child. If the sacrifice fails, the witchdoctor will often point to a lone woman in the village, branding her as a witch responsible for the family's problems. The women are often low-caste, or are widows with a little property but no male relatives to protect them. They are humiliated, ostracised, have their heads shaved, are persecuted, beaten, tortured and even killed (Sunday Telegraph 1999; 18 April).

UN Sanctions on Iraq damage health

The sanctions imposed upon Iraq by the United Nations, which include food and medicine, have caused enormous deficiencies in cancer treatment facilities. Analgesia is in very short supply, radiation sources are so old patients have to spend an hour under radiotherapy machines, and children are dying of curable cancers because drugs have run out. Requests for help are consistently blocked by US and British advisers on the grounds that these medicines or equipment may be converted into weapons (BMJ 1999;318:203, 16 January).

Worsening crisis in transplant surgery

There is a worsening crisis in transplant surgery with waiting lists rising, a severe shortage of transplant surgeons and an inadequate supply of organs available for transplant (BMJ 1999;318:350, 6 February).

BMA debate on organ donation

Accordingly, the BMA will begin the debate on presumed organ donation at its annual meeting in the hope that this scheme will help alleviate the problem. Safeguards will be implemented to ensure that people are given a real opportunity to opt out (BMJ 1999;318:1131, 9 January).

Indian doctors take kidney without consent

In India, doctors have removed a healthy kidney from a deaf and mute man and given it to his brother, who is suffering from end-stage renal failure. The operation followed a six-week debate on the ethics of taking an organ from a donor unable to communicate or give consent for the operation (BMJ 1999;318:753, 20 March).

Sniffer dogs hunt drugs in Manchester School

A high school in Manchester has carried out the first random search for drugs by sniffer dogs, with the result that two boys were suspended. The dog searches are being complemented by education classes for pupils. There is controversy about whether this infringes pupils' rights and many groups believe that this approach is not the answer to the drug problem in Britain's schoolchildren (Daily Telegraph 1999; 20 April).

David Moor cleared of murder

Dr David Moor, the Newcastle GP charged with murdering an elderly patient, was unanimously cleared by a jury in May. Dr Moor gave Joseph Liddell a lethal dose of diamorphine under the double effect law. This states that doctors may give medication that they know will shorten life if their primary intention is to relieve suffering and not to kill (BMJ 1999;318:1306, 15 May).

There is much discussion over whether this marks a legal watershed similar to cases in Holland that led to the decriminalisation of euthanasia in the 1980s. Dr Andrew Fergusson, CMF General Secretary and chairman of Healthcare Opposed to Euthanasia (HOPE) was concerned that this would add to the considerable confusion about what is acceptable medical practice in the grey area between life and death. Anti-euthanasia groups, such as Alert, led by Dr Peggy Norris, see this verdict as the beginning of a slippery slope to the routine dispatching of terminally-ill patients that allegedly now occurs in Holland (Daily Telegraph 1999; 12 May).

Euthanasia control ineffective in Holland

A British and a Dutch doctor have claimed that the practice of euthanasia is not being effectively controlled in Holland. If all cases of 'explicit intention to end a life' are taken into account, there were 24,500 deaths in 1995, far more than the official figure of 3,200. A clear majority of cases is going unreported and unchecked (Daily Telegraph 1999; 17 February).

Jack Kevorkian convicted and sentenced

In the US, Jack Kevorkian, 'Dr Death', who helped an elderly man commit suicide and then broadcast the event on national television, was convicted of second degree murder and sentenced to 10 to 25 years in prison in March. Kevorkian claims to have assisted in over 130 deaths and has already stood trial three times. He had challenged the authorities to convict him, hoping to prove that euthanasia 'is not a crime, ever' (BMJ 1999;318:1094, 24 April), (Daily Telegraph 1999; 14 April).

Oregon data on physician assisted suicide

Data are now available from Oregon, where there has been one year of legally permissible physician-assisted suicide. Proponents claim that the data show excellent adherence to all required safeguards and a very limited use of assisted suicide by a small group of terminally ill patients whose suffering could be relieved no other way. Opponents claim that the Oregon law is powerless to police or detect cases falling outside legal guidelines and that many deaths may have occurred where the guidelines were ignored (BMJ 1999;318:953-954, 10 April).

High Court rules on withdrawal of treatment

A woman has failed in her attempt to win a High Court ruling that doctors cannot give or refuse treatment against a parent's wishes without first getting a court's permission. Mrs Glass's severely ill son was admitted to a Portsmouth hospital with a recurrent attack of breathing problems, and doctors decided not to intervene but gave him a low dose of diamorphine. However, his mother accused the doctors of unlawful conduct in giving diamorphine (which she believed could depress the child's breathing and hasten his death) against her will. The BMA medical ethics committee said that every effort should be made to reach a consensus between everyone involved in difficult situations, and if this proves impossible, then further advice, possibly involving the courts, should be sought (BMJ 1999;318:1167, 1 May).

BMA guidelines on withdrawal of treatment

The BMA is drawing up guidelines on when doctors can withhold or withdraw treatment from patients who are not in the process of dying. None of these patients will have given any indication of whether or not they want treatment to be withheld (eg those with Alzheimer's, those suffering severe strokes and babies with multiple handicaps) (Daily Telegraph 1999; 17 February).

Philip Morris loses tobacco lawsuits

Tobacco company Philip Morris, which makes Marlboro cigarettes, has just lost two major lawsuits by smokers, who have been awarded œ30 million and œ50 million in damages. This follows disclosures of documents which show that tobacco companies have lied for decades about the hazards and addictiveness of smoking and have deliberately targeted young people (BMJ 1999;318:1086, 17 April), (BMJ 1999;318:481, 20 February).

Tobacco companies proleet interests

Tobacco companies have also tried to disrupt the sale of nicotine replacement products in different parts of the world (BMJ 1999;318:1026, 17 April).

UK Government acts to curb smoking through NHS

The UK Government has launched the first concerted attempt to make smoking cessation a core function of the NHS. Health authorities and primary care groups must now plan and develop a service to help smokers to quit, some with free nicotine patches. £60 million has been made available for this initiative over the next three years (BMJ 1999;318:1096, 24 April).

AIDS vaccine developed in US

A DNA vaccine that protects monkeys from AIDS has been developed in the US. After exposure to infection, vaccinated animals were found to have negligible levels of virus in their blood, while unvaccinated animals had viral loads of up to one billion. This looks promising for the development of a similar human vaccine (Daily Telegraph 1999; 27 April).

Lysozyme acts as antidote for HIV

Meanwhile, lysozyme, the enzyme found in tears and saliva and the urine of pregnant women, has been found to act as an antidote to the HIV virus. The enzyme breaks down the virus's outer shell and this may explain why HIV is not transmitted by kissing. The ribonucleases found in pregnant women's urine are also potent anti-HIV agents (Daily Telegraph 1999; 6 March).

AIDS update in Southern Africa

AIDS is now the fourth most common cause of death worldwide, (BMJ 1999; 318:1370, 22 May). The epidemic of AIDS in Southern Africa is worsening, with more than 1,200 Zimbabweans dying from AIDS each week (Daily Telegraph 1999; Monday 19 March), and 1,800 new infections with HIV occur daily in South Africa. Plans are underway to make AIDS a notifiable disease. This has met with protest, as the stigma of having AIDS is such that people's lives are endangered. A young AIDS worker in Kwa-Zulu Natal was recently murdered after she openly admitted she had AIDS (BMJ 1999;318:1308, 15 May).

UK falls behind in perinatal AIDS prevention

Fewer than 30% of HIV positive mothers are diagnosed before giving birth in the UK, despite the recommendation that antenatal testing should be routine, especially in London, where two thirds of HIV positive births occur. Drug treatment during pregnancy and birth, as well as avoiding breast-feeding would reduce the transmission to babies to around 1%. France and the US have such a policy and the number of new cases of childhood HIV infection and AIDS has fallen dramatically (BMJ 1999;318:145, 16 January).

Cloned calf develops fatal complications

A two month-old calf cloned from genes taken from the ear of an adult cow has died after developing serious heart, lymphoid tissue and blood problems. The cloning process seems to have interfered with the normal genetic functioning of the developing animal and the study seems to lend weight to fears that cloning humans may carry considerable health risks (BMJ 1999;318:1230, 8 May).

US doctors create artificial liver from cloned human cells

US doctors have used cloned human cells to create an artificial liver, which is about to begin controlled trials. The prospect of being able to clone any type of cell from a patient, such as brain cells for Alzheimer's disease or muscle tissue for heart repair, is drawing closer. (Daily Telegraph 1999; 6 April).

Bladders grown in laboratory successfully implanted

Bladders grown in the laboratory by an American team with tissue engineering techniques have been successfully implanted and shown to function in animals. The ability to implant new bladders would potentially be useful in babies with congenital bladder conditions and in people who have lost their bladders to trauma or cancer (BMJ 1999;318:350, 6 February).

Down's people treated as second class citizens

A campaign to end medical discrimination against people with Down's Syndrome was launched in March. 1 in 1000 children is born with the disease. Archaic conceptions about the disease and insensitive and ignorant remarks made by health professionals are widespread. Mothers are being told that their babies should have been aborted and one consultant suggested to other doctors in the presence of a new mother that 'perhaps ante-natal testing should be insisted upon so that Down's babies aren't born' (Sunday Telegraph 1999; 7 March).