1087
last-minute proposals that the President cobbled together for the campaign. But even the Clinton plan inspires serious misgivings. At the heart of it is a commitment to establish "national spending targets" for health care, a task that would be entrusted to a board of "consumers and providers people who know what they’re talking about", Clinton said on Sept 24 in his major speech on health policy. With a financial ceiling in place, he explained, the health industry and its customers would be guided toward economies in care, which would be provided in a context of "managed competition"-ie, large networks of hospitals, physicians, and other providers competing for insured patients. The spending targets, however, would rely on voluntary compliance, which has so far exerted little influence over health-care spending here. The Bush plan, by contrast, would subsidise health insurance for the poor and provide some tax relief, through credits, for the middle classes. But, apart from paperwork reform, also included in Clinton’s programme, there’s virtually no attention to cost restraint. "It can’t go on like this" is the ancient refrain of American health-care economics. Simple arithmetical projections indicate that, if it does, the United States will soon pass beyond the CBO forecast of 18% of national wealth for health care and quickly arrive at the point where all of the nation’s wealth is consumed by health care. That’s absurd, of course. But back in 1965, when a mere 6% of gross domestic product went into health care, specialists dourly predicted that it could not go on like this. Daniel S.
executive of the French monopoly for foreign blood imports, and director of a blood transfusion centre. "He refused to listen, removed or bypassed the opponents of his
policy." Allain and Garretta have lodged an appeal. Allain, in a short statement after sentence was passed, said he was flabbergasted and that he was a scapegoat. "During the critical period of the 6 first months of 1985,did what was in my power to protect the haemophiliacs against HIV infection. My warnings were not heard by the decisionmakers at CNTS". As a lowly cog in the context of CNTS bureaucracy Allain did indeed fight against his seniors’ tardiness in negotiations over heat-treated products and even tried to go public, though the newspaper (Le Matin) did not publish. He became professor of transfusion medicine in Cambridge, UK, and director at the East Anglia blood transfusion service, but stepped down from his National Health Service post over the weekend to allow for an independent inquiry. He has received strong support from haematologists in the region and from academics. The haemophilia associations have failed in their demand for former health ministers Georgina Dufoix and Edmond Herve and for former Prime Minister Laurent Fabius to be tried by the Haute Cour, the only judicial body able to try members of government. The demand was rejected on grounds that referral to the Haute Cour could be made only if a minister were charged with personal responsibility for a criminal action.
Jean-Michel Bader
Greenberg
Round the World France: Prison sentences for doctors Prison sentences were handed down on Oct 23 to three of the four doctors charged in connection with the distribution, by the former transfusion service, of HIV-contaminated blood (see Lancet Aug 8, p 360). The hearing, before a tribunal which declined an invitation to arrange for independent technical advice, ended 12 weeks ago. The doctors had been charged with deception over the quality of a product. Dr Michel Garretta, ex-director of the Centre National de Transfusion Sanguine (CNTS), was given a prison sentence of 4 years and fined FFr500 000. He was not present at the hearing and an international warrant for his arrest was issued. Prof Jean-Pierre Allain, ex-research director of CNTS, was given a 4 year sentence (2 years of which were suspended), this being a harsher penalty than the prosecutor had sought. Prof Jacques Roux, formerly general director of health at the Ministry of Social Affairs, was given a suspended sentence of 4 years. Prof Robert Netter, former director of the health services national laboratory was found not guilty. The prosecutor had presented Garretta as "the main organiser of the scandal of the contaminated blood", and all four defendants had been said to have been at the centre of "both full power and knowledge". They "knew perfectly well that the CNTS was selling, between March and October, 1985, blood products infected by HIV and had done nothing to stop it". The President of the Court, Judge Jean-Louis Mazieres, noted in his judgment that Garretta was "at the same time judge and party", having been on the Minister of Health’s council on blood transfusion policy,
USA: NIH reopens the Kemron
case
The US National Institutes of Health will be setting up a panel to design a clinical trial to assess the value of low-dose oral interferon-alpha (IFN-M), and to carry out that study, "if it can be designed". The announcement was made after a meeting entitled Low-dose Alpha Interferon as Therapy for HIV
Infection and AIDS
among
African-American
Patients, hosted by the National Medical Association,
a
primarily African-American Physicians, in Washington on Oct 26. Participants included representatives of NIH and several clinicians who are proponents of the controversial drug called Kemron (or Immunex, or Immuviron), a low-dose oral IFN-cx, for which Davy Koech of the Kenyan Medical Research Institute obtained exceptional results about 21years ago. In April, 1992, NIH’s AIDS Research Advisory Committee, after examining 13 completed or ongoing clinical trials, group
of
found that it could not recommend low-dose IFN-K for HIV infection and advised a review of the position after completion of trials in progress (see Lancet May 2, p 1106). Proponents of the drug continue to claim that they see symptom improvement, decreases in the rate of CD4 + cell decline, and an enhancement of the quality of life in patients receiving the therapy. They have complained that NIH is too concerned with arcane scientific criteria, and too little concerned with patients’ suffering. They were not touting the drug as a cure, only as a treatment, much like approved anti-HIV drugs. Walter W. Shervington of the NMA emphasised that, for the sake of its credibility, the study should include both blacks and whites since many African-Americans perceive that the white medical establishment is denying them access to a promising AIDS therapy that was developed in Africa.
last-minute proposals that the President cobbled together for the campaign. But even the Clinton plan inspires serious misgivings. At the heart of it is a commitment to establish "national spending targets" for health care, a task that would be entrusted to a board of "consumers and providers people who know what they’re talking about", Clinton said on Sept 24 in his major speech on health policy. With a financial ceiling in place, he explained, the health industry and its customers would be guided toward economies in care, which would be provided in a context of "managed competition"-ie, large networks of hospitals, physicians, and other providers competing for insured patients. The spending targets, however, would rely on voluntary compliance, which has so far exerted little influence over health-care spending here. The Bush plan, by contrast, would subsidise health insurance for the poor and provide some tax relief, through credits, for the middle classes. But, apart from paperwork reform, also included in Clinton’s programme, there’s virtually no attention to cost restraint. "It can’t go on like this" is the ancient refrain of American health-care economics. Simple arithmetical projections indicate that, if it does, the United States will soon pass beyond the CBO forecast of 18% of national wealth for health care and quickly arrive at the point where all of the nation’s wealth is consumed by health care. That’s absurd, of course. But back in 1965, when a mere 6% of gross domestic product went into health care, specialists dourly predicted that it could not go on like this. Daniel S.
executive of the French monopoly for foreign blood imports, and director of a blood transfusion centre. "He refused to listen, removed or bypassed the opponents of his
policy." Allain and Garretta have lodged an appeal. Allain, in a short statement after sentence was passed, said he was flabbergasted and that he was a scapegoat. "During the critical period of the 6 first months of 1985,did what was in my power to protect the haemophiliacs against HIV infection. My warnings were not heard by the decisionmakers at CNTS". As a lowly cog in the context of CNTS bureaucracy Allain did indeed fight against his seniors’ tardiness in negotiations over heat-treated products and even tried to go public, though the newspaper (Le Matin) did not publish. He became professor of transfusion medicine in Cambridge, UK, and director at the East Anglia blood transfusion service, but stepped down from his National Health Service post over the weekend to allow for an independent inquiry. He has received strong support from haematologists in the region and from academics. The haemophilia associations have failed in their demand for former health ministers Georgina Dufoix and Edmond Herve and for former Prime Minister Laurent Fabius to be tried by the Haute Cour, the only judicial body able to try members of government. The demand was rejected on grounds that referral to the Haute Cour could be made only if a minister were charged with personal responsibility for a criminal action.
Jean-Michel Bader
Greenberg
Round the World France: Prison sentences for doctors Prison sentences were handed down on Oct 23 to three of the four doctors charged in connection with the distribution, by the former transfusion service, of HIV-contaminated blood (see Lancet Aug 8, p 360). The hearing, before a tribunal which declined an invitation to arrange for independent technical advice, ended 12 weeks ago. The doctors had been charged with deception over the quality of a product. Dr Michel Garretta, ex-director of the Centre National de Transfusion Sanguine (CNTS), was given a prison sentence of 4 years and fined FFr500 000. He was not present at the hearing and an international warrant for his arrest was issued. Prof Jean-Pierre Allain, ex-research director of CNTS, was given a 4 year sentence (2 years of which were suspended), this being a harsher penalty than the prosecutor had sought. Prof Jacques Roux, formerly general director of health at the Ministry of Social Affairs, was given a suspended sentence of 4 years. Prof Robert Netter, former director of the health services national laboratory was found not guilty. The prosecutor had presented Garretta as "the main organiser of the scandal of the contaminated blood", and all four defendants had been said to have been at the centre of "both full power and knowledge". They "knew perfectly well that the CNTS was selling, between March and October, 1985, blood products infected by HIV and had done nothing to stop it". The President of the Court, Judge Jean-Louis Mazieres, noted in his judgment that Garretta was "at the same time judge and party", having been on the Minister of Health’s council on blood transfusion policy,
USA: NIH reopens the Kemron
case
The US National Institutes of Health will be setting up a panel to design a clinical trial to assess the value of low-dose oral interferon-alpha (IFN-M), and to carry out that study, "if it can be designed". The announcement was made after a meeting entitled Low-dose Alpha Interferon as Therapy for HIV
Infection and AIDS
among
African-American
Patients, hosted by the National Medical Association,
a
primarily African-American Physicians, in Washington on Oct 26. Participants included representatives of NIH and several clinicians who are proponents of the controversial drug called Kemron (or Immunex, or Immuviron), a low-dose oral IFN-cx, for which Davy Koech of the Kenyan Medical Research Institute obtained exceptional results about 21years ago. In April, 1992, NIH’s AIDS Research Advisory Committee, after examining 13 completed or ongoing clinical trials, group
of
found that it could not recommend low-dose IFN-K for HIV infection and advised a review of the position after completion of trials in progress (see Lancet May 2, p 1106). Proponents of the drug continue to claim that they see symptom improvement, decreases in the rate of CD4 + cell decline, and an enhancement of the quality of life in patients receiving the therapy. They have complained that NIH is too concerned with arcane scientific criteria, and too little concerned with patients’ suffering. They were not touting the drug as a cure, only as a treatment, much like approved anti-HIV drugs. Walter W. Shervington of the NMA emphasised that, for the sake of its credibility, the study should include both blacks and whites since many African-Americans perceive that the white medical establishment is denying them access to a promising AIDS therapy that was developed in Africa.
