Conjoined twins separated
The Maltese conjoined twins Jodie and Mary (Triple Helix 2000; Autumn:3-coming soon) were separated in a 20 hour operation in Manchester on 6-7 November, resulting in the death of the weaker twin Mary. The Court of Appeal judges had previously ruled that Mary's life could be killed 'in defence of Jodie' during the procedure because she was an 'unjust aggressor' threatening Jodie's life. A commentary of the case by Professor John Wyatt, chairman of the CMF Study Group, has been published in the CMF Student Journal (Nucleus 2001; January:2-4) and is available on the CMF website at www.cmf.org.uk
Euthanasia in the Netherlands
The Netherlands officially legalised euthanasia on 28 November, although it has been legally sanctioned for some years. In 1995, physicians in the Netherlands received 9,700 explicit requests for euthanasia or physician assisted suicide, of which 37% were granted and carried out. A recent survey of Dutch physicians has shown that, of those 'assisted', the most common reasons given for the request were 'loss of dignity' (56%) and 'unbearable or hopeless suffering' (74%). In a third of cases life was estimated to have been shortened by more than a month. (BMJ 2000; 321:865, 7 October)
Acupuncture report challenged
The British Medical Association's recent endorsement of acupuncture (Triple Helix 2000; Autumn:16) has come under stinging attack in the correspondence columns of the British Medical Journal. The BMA's conclusion that acupuncture was effective for back pain, dental pain and migraine is said to be based on studies that were inconclusive, inadequately randomised or not blind. The authors of the BMA report are accused of bowing to the pressure of public opinion and changing their stance in the absence of scientific evidence. This, say the challengers, is harmful both to the public's health and the economy of the NHS. (BMJ 2000; 321:1220-1221, 11 November). The biblical injunction to 'enquire, probe and investigate thoroughly' (Deuteronomy 13:14ff) must surely be relevant here.
Blatant patent discrimination
95% of people infected with HIV worldwide live in the world's poorest countries, but patent protections on treatments mean that the annual cost to treat a patient with AIDS is up to 100 times the gross national product per capita. (BMJ 2000; 321:833, 30 September). At the AIDS 2000 Summer conference in Durban, Jeffrey Sachs, director of the Center for International Development at Harvard, clashed with the world's global agencies over funding. 'It will take ten years to negotiate the conditions of the (World Bank's $500m) grant with the 40 recipient countries, and by then half the sum is used up by salaries for the World Bank consultants', he said. The North has the drugs but few patients; the South has the patients and no drugs. (BMJ 2000; 321:1357, 25 November)
Three BMJ editorials point out the link between Britain's recent floods, fuel price protests and the crumbling rail network. The floods are a symptom of global warming, which in turn is a consequence of exhaust emissions of greenhouse gases. Rises in fuel prices might encourage more to use public transport, or to walk (BMJ 321: 1168, 11 November). Eutychus has opted for the more eco-friendly approach of typing his column at home after a frustrating month of commuting delays. The link between human behaviour and natural disasters has, of course, been pointed out before (Ezekiel 14:12-23).
Three recent high-profile cases of pre-implantation diagnosis (PGD) have highlighted concerns about embryos being used as a means to an end. They include: Colorado infant Molly Nash (whose Fanconi anaemia was treated with a stem cell transplant from the umbilical cord of her specially 'created' sibling Adam); a Spanish haemophilia case where only male non-carriers of the gene were implanted; and the Masterton case (in which a British couple were denied permission to produce a female baby by PGD to replace a daughter who died following burns).
Research funding inequality
Of the £37bn spent annually worldwide on health research, only 10% goes for the diseases affecting 90% of the world's people, according to estimates from the World Health Organisation. Between 1975 and 1997, of the 1233 new medicines patented, only 1% were for tropical diseases. (BMJ 2000; 321:787, 30 September)
Hope for refugee doctors
Up to 2,000 doctors with refugee status in the United Kingdom will be offered appropriate training and opportunities to work for the NHS under a scheme announced in early November. Refugee doctors are keen to work, but the obstacles they face are currently overwhelming. The scheme could help make up some of the extra 7,500 NHS doctors that the government plans to have in place by 2004. The Report of the Working Group on Refugee Doctors and Dentists can be found at www.dh.gov.uk
Training abroad for paediatricians?
Christian doctors who have worked in developing countries have long recognised the rich opportunities for medical training such experience offers. Now, a joint venture between the Royal College of Paediatrics and Child Health and VSO (Voluntary Service Overseas) will give specialist registrars a broader specialist training with a year in the Gambia. Could Christian doctors be instrumental in encouraging other royal colleges to adopt this model as a means to providing better care and training for those in the developing world? (www.vso.org.uk; BMJ Classified 2000; p3, 28 October)