مرکزی صفحہ BMJ Former FDA commissioner is fined $90 000 for failing to disclose conflicts of interest

Former FDA commissioner is fined $90 000 for failing to disclose conflicts of interest

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جلد:
334
زبان:
english
رسالہ:
BMJ
DOI:
10.1136/bmj.39142.592130.db
Date:
March, 2007
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1

UK recommendations for severe malaria are worrying

سال:
2007
زبان:
english
فائل:
PDF, 134 KB
2

Heart group's approval of fast food meals angers critics

سال:
2007
زبان:
english
فائل:
PDF, 638 KB
news

Mark Wilson/Getty Images

Janice Hopkins Tanne New York
Lester Crawford, former commissioner of the US
Food and Drug Administration, was last week
fined $89 377 (£45 800; €67 000), sentenced
to three years of supervised probation, and
required to do 50 hours of community service by
Judge Deborah Robinson of the US District Court
for the District of Columbia.
Last October Dr Crawford (below)���������
����������������
pleaded
guilty to two charges: failing to report that
he and his wife owned shares in companies
regulated by the agency and filing false financial
reports. The reports are required by US law. The
companies included Pepsico, Kimberly-Clark,
and Sysco. At the time Dr Crawford was head
of the FDA’s obesity working group (BMJ 2006;
333:874).
Each charge carried a possible one year prison
term and a $100 000 fine.
The judge increased the fine from the $50 000
that Dr Crawford and his lawyer had negotiated
in a plea agreement, the Associated Press news
agency reported. Dr Crawford and his wife made
about $39 000 from options and dividends from
companies regulated by the agency. They did,
however, pay tax on the income.
In March 2006 Dr Crawford joined Policy
Directions, a lobbying firm in Washington, DC.
He is prohibited from lobbying Congress for at
least a year.

492

Mark Pinder

Former FDA head is
fined $90 000 for
failing to disclose
conflicts of interest

Hospital doctors will get 2% pay
Michael Day London

British GPs will not receive a pay rise this year.
The decision, recommended by the Doctors’
and Dentists’ Review Body and accepted by the
UK government, prompted a furious response
from the British Medical Association.
Hamish Meldrum, chairman of the BMA’s
General Practitioners Committee, said: “This
is a black day for general practice. A zero
increase equates to a pay cut. A pension cap
has already been announced. It would not
surprise me if many GPs feel they should cut
their losses and leave the NHS.”
The health secretary, Patricia Hewitt, said
that GPs’ profits had risen by more th; an 50%
since the introduction of their new contract
and that they were “already well rewarded.”
However, below inflation rises for hospital doctors in 2007-8 mean that they, too,
would effectively have their pay cut, the
BMA warned.

Consultants will get a flat rate increase of
£1000 (€1470; $1925) a year, as will salaried
GPs, while trainee doctors will receive an
increase of £650. This amounts to an average
2% pay rise. The introduction of the award is
going to be staggered, with 1.5% to be given
in April and the remainder in November.
The BMA’s chairman, James Johnson,
said: “It looks as if doctors have been hit by
a double whammy. Not only does the review
body appear to have bowed to government
pressure, but the government has phased an
already miserly award.”
Jonathan Fielden, chairman of the BMA’s
consultants’ committee, said the rise, which
is less than the current rate of inflation of
2.7%, would make it “extremely difficult for
consultants to feel motivated.”
The greatest sense of anger was felt among
lower paid hospital doctors, however.
Ashok Pathak, chairman of the BMA’s
BMJ | 10 March 2007 | Volume 334

For the full versions of articles in this section see bmj.com
UK NEWS Report proposes a new harms index for drugs and alcohol, p 494
World NEWS ���������������������������������������������������������������
Heart group’s approval of fast food meals angers critics�������
, p 499
bmj.com Carruthers
���������������������������������������������������������������������
report calls for doctors to be more involved in NHS change

MRC wants to cut the
Doctors protest
from bench to
over NHS closures time
bedside
Owen Dyer London
Thousands turned out last weekend to protest
at cuts, deficits, and increasing private sector
involvement in the NHS.
The “Day of Action” was organised by NHS
Together, a collaboration of health service unions,
NHS staff bodies, and the Trades Union Congress.
A series of events took place across the country.
A “Rock for the NHS” concert took the stage at
Woking, while in Crawley protestors marched in
nightgowns and bandages. Other rallies were
held in Brighton, Maidstone, Gloucester, Preston,
Belfast, London, and Sunderland, where Dr
George Rae, chairman of the BMA’s northern
regional council (left) took part. In Tunbridge
Wells, a small crowd protested at the closure of
the Homoeopathic Hospital.
TUC general secretary Brendan Barber,
speaking at a rally in Sheffield, told the
government that it “is in danger of squandering
the political credit it deserves, and it is running
out of time to put it right.”

increase, and GPs get nothing
staff and associate specialists negotiating
committee, said: “A pay rise of £1000 does
not even match inflation and will do nothing to address the low morale of a group of
doctors who haven’t had a significant pay
rise for years.”
Masood Ahmed, deputy chairman of the
Junior Doctors Committee, described their
pay award as “appalling.”
He said, “Junior doctors have put up with
a lot over the last few years: rising intensity
of work, demanding targets, long shifts without adequate rest facilities, and the shambolic
introduction of a new training system.”
Michael Rees, chairman of the BMA’s
Medical Academics Committee, said a flat
£1000 offer was not enough to tackle the
recruitment crisis in medical academia.
Steve Barnett, director of NHS Employers,
welcomed the award. “We see the sense of
taking an approach across the public sector

and believe this is a pragmatic settlement,”
he said. “The staging of increases will be
seen as sensible by many employers facing
financial pressures.”
However, Niall Dickson, chief executive
of the health charity the King’s Fund, criticised what he saw as a “stop start” approach
to doctors’ pay. “With many services under
considerable pressure, there will be genuine
relief today among those who have to balance the NHS books.
“But it is a pity that we now seem to have
a stop go approach to pay: one minute
­unprecedented rises, the next a real terms
pay cut. A more gradual and sustained investment in pay levels might have prevented
some of the anguish now being felt.”
Dentists will also recieve a 2% pay rise.
Nurses are to receive 2.5%. These awards
will also be staged, with 1.5% in April and
the rest in November.

BMJ | 10 March 2007 | Volume 334 				

Michael Day London

The UK Medical Research Council (MRC)
has signalled an all-out effort to cut the
time it currently takes to translate findings
of pure research into medical advances.
The MRC’s chief executive, Colin
­Blakemore, announced that it planned to
invent, develop, and market its own drugs—
with or without industry support—to speed
up advances against rare diseases and those
that mainly affect developing countries.
He said that the MRC was already ­holding
talks with the Association of the British
Pharmaceutical Industry on overhauling
“the monolithic clinical trials structure,”
which he believes is impeding progress.
His comments came at the launch of
the MRC’s six new translational medicine
centres, which are based at the ­University
of Bristol, the University of Cambridge,
King’s College London, Imperial
­College London, University College
London (together with the University of
­Newcastle), and the University of Oxford
(in ­partnership with the Wellcome Trust
Sanger Institute).
The six centres will focus on different
areas of medical research: epidemiology,
neuromuscular diseases, global health,
obesity, transplantation, and disease
­surveillance.
All, however, aim to “enable scientific
research to improve human health more
quickly and efficiently.” In effect the
centres will use their £15.5m (€23m;
$30m) of MRC funding over the next five
years to overhaul the organisation’s ability
to turn pure research into better treatments
or new health policy.
Mike Hanna, director of one of the six
centres, the MRC Centre for
Neuromuscular Diseases, which is based at
­University College London, hoped that his
new unit would provide “the
pharmaceutical industry with a portal
through which it can access information it
needs” to develop new drugs.
More information is available at www.mrc.ac.uk.
493

NEWS

Rambam Mediacl centre

Device brings non-invasive
assessment of arteries a step closer

An image generated by the hybrid device

Judy Siegel-Itzkovich Jerusalem
Non-invasive assessment of coronary artery
anatomy and physiology may soon become a
reality, says a new paper published online ahead
of print publication in the Journal of the American
College of Cardiology (www.sciencedirect.com).
A research team at the Israeli Rambam Medical
Centre, Haifa, has shown that a prototype hybrid
device that combines computed tomography
coronary angiography (CTCA) with single photon
emission computed tomography (SPECT) is

an accurate way of evaluating coronary artery
anatomy and blood flow within cardiac muscle.
It is hoped that the technique may lead to fewer
invasive investigations and interventions such as
angioplasties and stenting.
The Israeli team used GE Healthcare’s combined
CTCA and SPECT imaging device on 130 patients.
An accompanying editorial by William Wijns,
of the Aalst Cardiovascular Centre in Belgium,
described the research as “another validation
milestone in the search for a noninvasive imaging

UK report proposes a new harms index to rate
dangers of drugs, tobacco, and alcohol
Susan Mayor London

Use of illegal drugs should be
managed primarily as a social
issue rather than as a criminal
offence, with a new legislative
framework setting drugs in
the wider context of substance
abuse, recommends a UK
report published this week.
The main aim of public
policy should be to reduce
the harm that drugs cause,
the report recommended.
To achieve this, the concept
of drugs should
�������������������
be extended
to include alcohol, tobacco,
solvents, and over the counter
and prescription drugs that
can be misused. The report
argues that all psychoactive
substances—not just illegal

drugs—can, and do, cause harm.
The report was developed
by the Royal Society for
the Encouragement of Arts,
Manufactures and Commerce’s
Commission on
��� Illegal
�������� Drugs,
�������
Communities and Public
Policy�����������������
, an independent
multidisciplinary body. ������
After�
reviewing available research,
holding public hearings, and
consulting with a wide range
of experts in the drugs field, it
���
recommended that the current
legislation, the Misuse of Drugs
Act 1971, should be scrapped
as it is out of date, unwieldy,
and full of anomalies.
The group, which includes
representatives from public
health, the police, the

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494

government, and drugs
services, called for a new
misuse of substances act
that sets drugs in the wider
context of substance misuse.
It considered that this would
achieve a better balance
between punishing drug users
who inflict harm on others for
profit, reducing the damage
done to users who harm only
themselves, and moderating
the penalties for activities that
it considered harmed no one.
The new legislation should
be centred on an evidence
based, regularly updated
index setting out the relative
risks of harm from individual
substances, the report
advises. For example, heroin
is currently ranked number
one in terms of danger, with
alcohol in fifth position, above
tobacco in ninth position and
cannabis at number 11 in a
“league table” (figure).
“The position of a substance
on our new harms index
would determine the gravity
of offences relating to it and
the consequent penalties,” the
commission explained.
Punishment should be
focused mainly on harmful
behaviours resulting from

drug use, rather than simply
possession of drugs. ����������
“The idea
of a drugs-free world, ��������
or even
of a drugs-free Britain, is almost
certainly a chimera,” the report
said. People have always used
substances to change the way
they see the world and feel,
and the commission considered
that there is every reason to
think they always will.
Demonising illegal drugs
and drug users, as happens at
the moment, does more harm
than good, the commission
argued. It suggested that
society’s approach to illegal
drugs and to those who use
them should be calm, rational,
and balanced. Basing the
management of drug use on
the criminal justice system
neglects other approaches
looking at individual health,
public health, families,
education, housing, and social
care. The report recommends
a more holistic system aimed
at harm reduction, and taking
a pragmatic rather than
moralistic stance.
Drugs—facing facts: the report
of the RSA Commission on Illegal
Drugs, Communities and Public
Policy is available on www.
rsadrugscommission.org.
BMJ | 10 March 2007 | Volume 334

NEWS

UK may allow
creation of “cybrids”
for stem cell research
Adrian O’Dowd London

The UK government looks increasingly
likely to change its mind and approve plans
for scientists to create part human, part
animal embryos for research purposes.
The health minister Caroline Flint told
MPs last week it was possible that the government might withdraw the ban on such
work when it was agreeing its draft bill that
will form the basis of new laws on fertility
treatment and embryo research.
Ms Flint was giving evidence to MPs on
the House of Commons Select Committee
on Science and Technology, which is holding an inquiry into the matter.
Two teams of scientists, at Newcastle University and King’s College London, have
submitted applications to the Human Fertilisation and Embryology Authority to create hybrid animal-human embryos known
as “cybrids” for stem cell research (BMJ
2007;334:112, 20 Jan).
The word “cybrid” was suggested at an
earlier session of the committee, at which
witnesses had said that the term “human
and animal hybrid embryos” was misleading, since the embryo would be almost
entirely human. The only part of the hybrid
to come from a animal will be the outer casing of the cell. They said a more accurate
term was “cybrids” or “pseudo-hybrids.”
The government is due to publish its
draft bill on fertility in May. It published
a white paper on the subject in December
(BMJ 2007;334:12, 6 Jan).
The MPs will publish their report in April.
BMJ | 10 March 2007 | Volume 334 			

FDA to review safety
of erythropoietin

completely normal, and there is no need for
intervention.”
The prototype device examines the heart
muscle and maps the flow of blood inside it
in one examination. It provides an accurate
diagnosis of narrowed coronary arteries—the
same level of accuracy as that in invasive
catheterisation but greater than that in ordinary
computed tomography alone. The authors say
that the technique will make many diagnostic
catheterisations—which pose risks to patients—
unnecessary. CTCA was developed to provide
anatomical details about the arteries and SPECT
provides an assessment of blood flow to the
heart, so that the healthy, damaged, and scarred
regions of heart muscle can be identified.

Jeanne Lenzer Boston

Looking at life and death
Annabel Ferriman London
This memento mori (“remember that you
must die”) figure from 1800 was used for
spiritual contemplation. It is just one of the
million objects from across the globe collected
by Sir Henry Wellcome, the pharmacist,
entrepreneur, and philanthropist who founded
the Wellcome Trust.
It will be on show at a public event in London
on Thursday, to publicise and celebrate
the opening later this year of the Wellcome
Collection, a new £30m public
venue for the Wellcome
Trust. The event,
which includes the
showing of a specially
commissioned short
film, and the sampling
of life affirming food
and drink, such as chilli
chocolate and tequila,
will explore the fine line
between life and
death. An angelic
gatekeeper will
greet visitors
and guide them
to the heart of the
installation.
A Matter of Life
and Death is being
held on 15 March
2007, 19 30-22 00,
at Shoreditch Town
Hall, London. Tickets
are free. Book
in advance by
emailing events@
wellcome.ac.uk

Courtesy of the Wellcome

strategy that will eventually provide integrated
evaluation of anatomy and physiology in
patients with coronary artery disease.”
The Rambam cardiologist Shmuel Rispler, a
member of the research team, said: “Not all
cases of narrowed coronary arteries require
intervention, since they may have completely
normal blood flow.
“But when you discover coronary arteries
that arouse concern by being more than 50%
blocked, you [would] have referred the patient
until now for an invasive catheterisation,
in which the anatomy (narrowed arteries)
is compared with the physiology (quality
and speed of blood flow). In many cases of
catheterisation you find that blood flow is

Concerns about the safety of a class of drugs
used to treat anaemia have triggered a
federal alert in the United States. The
alert comes after recent studies reported a
higher incidence of fatal cancers and cardio‑
vascular events among patients who were
treated with drugs known as erythropoiesis
stimulating agents when the drugs were used
to raise haemoglobin concentrations to more
than 120 g/l.
The US Food and Drug Administration
issued the alert on 16 February, urging doctors “not to [give doses] to exceed haemo‑
globin levels of 12 g/dl” when treating
patients with anaemia resulting from chronic
renal failure, cancer or cancer chemo‑
therapy, or HIV or AIDS.
The agency has scheduled an advisory
committee meeting for 10 May to assess the
risks of the drugs, which include epoetin alfa
(made by Ortho Biotech and sold in the US
under the brand name Procrit and also by
Amgen under the brand name Epogen) and
darbepoetin alfa (made by Amgen and sold
as Aranesp).
One of the studies cited by the agency
randomised 1432 patients to receive epoetin alfa at doses calculated to achieve haemoglobin concentrations of either 113 g/l
or 135 g/l (New England Journal of Medicine
2006;355:2085-98). The researchers found
222 cardiovascular events—including deaths,
myocardial infarction, and hospitalisation
for congestive heart failure and stroke—at 16
months among patients in the arm with the
higher target concentration, whereas only
97 events occurred among the patients in
the lower target arm (hazard ratio 1.34 (95%
confidence interval 1.03 to 1.74)).
Regarding the safety of the drugs at lower
target haemoglobin concentrations, Ajay
Singh, lead investigator of the New England
Journal of Medicine study, said that he would
be “surprised” if any problems emerged,
since 20 years of experience with the drugs
had failed to show a higher risk of death at
lower concentrations. Nevertheless, he said,
“We need more studies to determine the lowest optimal haemoglobin level—should it be
10 or 11 g/dl or some other number?”
Global sales of erythropoiesis stimulating agents have soared over the past several years. Total sales were $8.1bn (£4.2bn;
€6.2bn) in 2002—an 18% jump from 2001.
The FDA’s alert is at www.fda.gov/cder/drug/
InfoSheets/HCP/RHE2007HCP.htm.
495

NEWS

in brief
Nigerian doctors threaten to strike:
Doctors in Nigeria’s public hospitals have
threatened to go on strike in protest over
a new salary structure, which will see
all doctors lose between 18% and 30%
of their salaries. The Nigerian Medical
Association has extended its earlier 21
day ultimatum to the government by a
further seven days. During this period the
doctors will not provide any emergency
services outside normal working hours.
Incidence of alcohol poisoning in exUSSR worries experts: Acute alcohol
poisoning has reached unprecedented
levels in parts of the former Soviet Union,
says a report from the Stockholm Centre
on Health of Societies in Transition, the
London School of Hygiene and Tropical
Medicine, and others (European Journal
of Public Health, doi: 10.1093/eurpub/
ckl275).
Israeli bill will allow more egg
donation: A detailed Israeli government
bill to allow altruistic donations of human
ova, not only by women undergoing fertility
treatment, is due to be passed by the
Knesset (parliament).
German court rules on IVF payments:
Only married couples in Germany are
entitled to compensation for in vitro
fertilisation treatment by their health
insurance company, the German
Constitutional Court ruled last week.
Reproduction experts have complained
that the number of babies born after IVF
will decrease even further. Since 2004 the
number has more then halved, as couples
now have to pay half the costs of the first
three treatment cycles (one cycle costs up
to €1800 (£1220; $2360) and the whole
cost of all subsequent cycles.
Advertising of weight loss drug is to
stop: The Australian government’s drug
regulator has revoked permission for
Roche to advertise its over the counter
drug for weight loss, orlistat (Xenical). The
move came after the Australian Consumer
Association showed that 80% of 30
pharmacies breached guidelines.
Charities funded by US must oppose
prostitution: Charities that accept US
government funding for international
disease prevention must communicate
the message the government wants,
a federal appeals court has ruled. DKT
International, the charity that lost the
case, did not want to have to condemn
the sex trade, as it would impede its
work with vulnerable groups, it said
(BMJ 2005;331:420).

496

Medical school accepts tobacco
company funding for research
Lynne Eaton London

A string of medical experts have lined up to
criticise the decision by the University of Virginia School of Medicine to accept funding
for medical research from tobacco company
Philip Morris—to the tune of $20m.
The American Medical Association, the
American Public Health Association, and the
editor of the academic journal Tobacco have
all condemned the news.
“A medical school taking funding from the
tobacco industry is like a peace studies school
taking funding from terrorists,” said Tobacco
Control’s editor Simon Chapman, professor of
public health at the University of Sydney.
Georges Benjamin, executive director of
the American Public Health Association,
said he too was against the move.
“There is a growing body of evidence that
this kind of arrangement results in biased
studies in favour of the funder”. The real
­reason he suspects the tobacco industry
does this is to help their image and improve
the marketing for their deadly product. “If
Big Tobacco is really interested in helping
­people, they should stop operations and go
into another line of business,” he said.
Ron Davis, president elect of the American
Medical Association, said it was his organisation’s policy to discourage medical schools
from accepting research funding from the
tobacco industry.

“How can the research be ‘independent’
when it is conducted via a ‘a significant
deepening of the partnership’ between the
two organisations?” he asked, referring to
the university’s press statement on the deal
(www.virginia.edu/uvatoday/newsRelease.
php?id=1469).
Meanwhile Peter Lurie, deputy director
general of Public Citizen, a consumer advocacy organisation, slated the decision: “For a
medical school in particular to accept money
from a tobacco company is to risk becoming a pawn in a public relations game,” he
said. “There is no such thing as money from
any body that does not come without strings
attached.”
A spokesperson from Philip Morris, whose
headquarters are in Richmond, some 70
miles away from the University of Virginia,
issued a firm rebuttal to the allegations. “This
has nothing to do with PR,” said David
­Sutton. “It is to do with research.”
He said the research was independent, carried out by an external third party, and that
the company did not review the research. It
encouraged publication of the findings. “We
require disclosure of the fact that funding
comes from Philip Morris,” he said. “It is
very transparent.”
The company has previously donated
$2.3m (£1.2m; €1.8m) to the university, but
this is the first grant to the medical school.

Dutch inspectors slam
standards of preoperative care
Tony Sheldon Utrecht

Serious shortcomings in preoperative care
in the Netherlands are putting patients in
­danger, a report from the Netherlands Health
Care Inspectorate says this week.
The inspectorate, the government body
charged with maintaining safety, regularly
receives reports of errors relating to preoperative care, so it decided to investigate all
the 94 hospitals in the Netherlands.
Its report, Preoperatief Traject (Preoperative
Process), asks whether the information needed
for responsible treatment is reliable and
accessible to staff, and it answers “No.”
The report says that half of the serious

complications in general surgery are avoidable. Examples it cites include a patient with
a fractured hip who underwent an operation
for a stomach complaint, a patient’s notes
that recorded the wrong side for a hernia
operation, and a patient with diabetes who
had the wrong toe amputated.
Organisations representing hospital consultants have accused the inspectorate of causing
“unnecessary unrest” to patients. But the report
insists that changes are “urgently required.”
“Patients’ files are incomplete and information
not properly communicated,” it states.
Preoperatief Traject and an English summary are
available at www.igz.nl.
BMJ | 10 March 2007 | Volume 334

NEWS

In the US no central
agency coordinates the
government’s public
education campaigns

US public service ads
could learn from UK
Janice Hopkins Tanne New York

The way public service
messages in the United States
are communicated to the public
has evolved without much
planning and might benefit
from the UK model, said Vicky
Rideout, vice president and
director of the programme
for the study of entertainment

media and health at the nonprofit Kaiser Family Foundation.
She was speaking late last
month at a conference in
Washington, DC, that compared
public service advertising in the
UK and the US.
The US system is “part paid,
part donated, part run through
other agencies, [and] part run

through the government…
Until very recently I had
absolutely no idea that in
Great Britain public service
advertising is overseen by a
600 person government agency
with a mandate to coordinate,
implement, and oversee all
of the government’s public
education efforts,” she said.
Alan Bishop, chief executive
of the UK Central Office of
Information (COI) and a former
group director with Saatchi &
Saatchi, said that Clement Atlee,
the UK’s prime minister from
1945 to 1951, set two goals for
the office: keeping together
experienced people from
Winston Churchill’s Ministry
of Information, to avoid
duplication and to centralise
purchasing; and informing the
public about matters where
government action affected their
daily lives. The COI must also
ensure that messages are not
politicised or biased.
The COI reports to the
Cabinet Office and is also
accountable to parliament, Mr
Bishop said. It usually works
with the larger government
departments—offering
them project management
to produce campaigns,
contracting with advertising
agencies to make the public
service messages, evaluating
the agencies’ work, and buying
advertising space and air time.
A recent example of its work

is the advertisement about
passive smoking (left).
The BBC and other
television stations donate some
time for government messages.
“We pay the advertising
agencies or the production
companies in the same way
they would be paid in the
commercial market; it’s not
voluntary work,” he said.
Mr Bishop showed several
UK public service messages:
on the promotion of condom
use, safety of teenagers on the
streets, the dangers of smoking,
army recruitment, adult
learning, the new government
trust fund for children, and
global warming.
In the US, Ms Rideout
explained, no central agency
coordinates the government’s
public education campaigns.
Many campaigns funded by
the government contract with
the non-profit Ad Council,
which is not affiliated to the
government. Between 2003 and
2005 more than 100 different
campaigns were sponsored
by the US government. In
health care, the Department of
Health and Human Services
alone spent $32m (£17m;
€24m) developing 64 different
campaigns, and this sum did
not include purchasing air time.
The Ad Council, like the
COI, grew out of government
communication efforts relating
to the second world war.
A webcast and transcript of the
conference and a video of UK
public service advertisements are
available at www.kff.org/entmedia/
entmedia022707pkg.cfm.

Heathrow doctor’s case at GMC will be heard in private
Owen Dyer London
Allegations against a senior clinical medical health
officer at Heathrow airport’s health control unit
are to be heard in private, the General Medical
Council decided last week. The allegations include
complaints that he alarmed passengers when
he boarded an aircraft in full protective clothing
to examine a patient with minor respiratory
symptoms.

Egidius Panis, a Dutch national, is accused
of several other charges relating to his work
at Heathrow, where he was employed by the
Hillingdon Primary Care Trust from 1997 to 2005.
But several of the charges have been withdrawn
from the public record on the grounds of medical
confidentiality.
The GMC’s fitness to practise panel ruled that
the media and public will be excluded from

BMJ | 10 March 2007 | Volume 334 				

the hearing. Michael Whitehouse, chairing the
panel, said that this was necessary “because
the allegations against Dr Panis concern issues
relating to both misconduct and health.”
“The particular circumstances of Dr Panis’s case
outweigh the public interest in holding the hearing
in public,” Professor Whitehouse said. Dr Panis
will be neither present nor legally represented at
the hearing.

497

NEWS

Polish politicians
argue over right to
expel sick foreigners

Henning Christoph/StillPictures

Jane Burgermeister Vienna

Adolescent boys gather for a circumcision ceremony in Mali

Unhygienic circumcisions may
increase risk of HIV in Africa
Peter Moszynski London

Circumcision could increase the
transmission of HIV in Africa unless it
is done in hygienic conditions, says new
research.
The study, published in this month’s
Annals of Epidemiology (2007;17:217-26),
may raise questions about how to interpret
the recent trials of male circumcision in
Kenya and Uganda, which appeared to
show that circumcising men halves their
risk of acquiring HIV infection (Lancet
2007;369:643-56, 617-9, 615, 708-13).
The team, led by Devon Brewer,
director of the Seattle based research
organisation Interdisciplinary Scientific
Research, examined data from national
surveys of young people who had never
had sexual intercourse in Kenya, Tanzania,
and Lesotho. Dr Brewer said, “We found
that circumcised virgins and adolescents
were consistently and substantially more
likely to be infected with HIV than their
uncircumcised counterparts.”
He said that this finding indicates that
HIV is being transmitted non-sexually to
a much greater degree than previously
realised and that widespread male
circumcision may not be as much of
a panacea as is currently hoped.
“A key problem with nearly all prior
research on circumcision in Africa is that
researchers have treated circumcision
498

only as an anatomic characteristic and
not also as a potential exposure to others’
blood during the circumcision operation,”
he said. “Over the last 20 years many
Africans, including children, have warned
that HIV can spread through circumcision
procedures.”
Other researchers have dismissed Dr
Brewer’s findings. Daniel Halperin, senior
research scientist at Harvard University
School of Public Health, said, “The HIV
virus is extremely fragile, dying easily and
quickly once exposed to air. One of the
important epidemiological points that the
authors neglected to note is that traditional
male circumcision is practised in many
groups throughout Africa, yet those groups
which still perform ritual circumcision very
consistently have HIV rates several times
lower than those that don’t.”
Dr Brewer insisted that the adage “first
do no harm” was central to the debate.
“The level of investment required to
undertake this kind of invasive procedure
safely is simply not yet present across most
of Africa,” he said.
WHO recommends: “To ensure safe
and clean operations, male circumcision
should only be performed by welltrained practitioners in sanitary settings
under conditions of informed consent,
confidentiality, proper counselling and
safety.”

The Polish government has issued a decree
ordering foreigners who have contracted
major infectious diseases to be expelled from
the country.
The decree issued by the leader of the centre right coalition, Prime Minister ­Jaroslaw
Kaczynski, of the Law and Justice Party,
came into effect in February 2007. But it is
opposed by Poland’s health minister, who
says that foreign patients threatened with
expulsion will have the right to appeal, and
that in practice none would have to leave.
The decree applies to all foreigners—
including EU citizens—who are given a
diagnosis of infectious diseases such as
­tuberculosis, hepatitis, and severe acute
­respiratory syndrome (SARS).
A Ministry of the Interior spokesman,
Witold Lisicki, said the measure had been
introduced to protect Polish citizens.
“We have the right to protect our citizens and to counter the threat of an epidemic,” he told the Austrian newspaper
Die Presse (www.diepresse.at/home/politik/­
aussenpolitik/112539/index.do).
But a spokesman for the Polish Health
Ministry, Pawel Trzcinski, told the BMJ that
the ministry opposed the decree and said
that in practice no foreign patients would
have to leave the country.
“The minister of health, Zbigniew Religa,
as a doctor and a person, is against the
decree on moral grounds. Patients threatened with expulsion will be able to make
use of a right to appeal given to them by our
country’s code of civil law,” he said.
Mr Trzcinski also criticised the view that
expelling foreigners with infectious diseases would significantly improve infection
­control.
“As far as I know we don’t have a particular crisis with infectious diseases in Poland
at the moment … and so the decree does
not seem necessary from the point of view
of disease control,” he said.
Doctors’ associations in Poland have
also criticised the decree on humanitarian
grounds.
A spokesman for the Polish Chamber of
Physicians and Dentists, Tomasz Korkosz,
said that the right of patients to treatment irrespective of nationality should be
respected.
BMJ | 10 March 2007 | Volume 334

NEWS

Heart group’s approval of fast food meals
angers critics, who say it is “a sales ploy”
Melissa Sweet Sydney

Australians eating at any of the 750 McDonald’s
outlets across the country can now choose
from a range of nine meal combinations that
have been given a tick of approval by the
National Heart Foundation.
McDonald’s and the foundation say that
the new meals will give consumers healthier
choices, but some public health experts and
nutritionists fear that the deal may encourage consumption of fast food and add to
public confusion about mixed nutritional
messages.
The meals, available since 28 February,
have been reformulated to have less salt,
saturated fat, trans fats, and energy, as
well as more vegetables, than standard
McDonald’s fare.
One such meal comprises the McChicken
burger, salad and Italian dressing, and water.
It has 48% fewer kilojoules, 49% less saturated fat, 9% less salt, and an extra 1.5 servings of vegetables than a meal of McChicken
burger, fries, and coke. McDonald’s says that
it is cheaper to buy the meal combinations
approved by the foundation than to buy the
individual items separately.
Susan Anderson, national manager of the
foundation’s “tick food” information programme, said that as well as improving the
choices for the one million Australians who
eat at McDonald’s each day, the programme
is likely to encourage other fast food outlets
to provide healthier options. The foundation is maintaining its recommendation that
people should not have takeaway food more
than once a week.
But Mike Daube, Western Australian president of the National Heart Foundation and
a national board member and professor of

HOW DO THE TICK MEALS COMPARE?
DIFFERENCE
kJ

Saturated
fat (g)

Salt (mg)

McChicken Burger, salad, Italian dressing, and water
versus
McChicken Burger, fries, and coke

Down 48%

Down 49%

Down 9%

Added 1.5 servings

3 nuggets, sweet & sour sauce, salad, Italian dressing, and OJ
versus
3 nuggets with BBQ sauce, fries, and coke

Down 65%

Down 69%

Down20%

Added 1.5 servings

Hamburger, salad, Italian dressing, and OJ
versus
Hamburger, fries, and coke

Down 61%

Down 37%

Down 10%

Added 1.5 servings

Thai Chicken Deli Choice Roll, apple, and water
versus
Thai Chicken Deli Choice Roll, fries, and coke

Down 46%

Down 72%

Down 38%

Increased to 1 serving

Tick approved McDonald’s meal
versus
Popular McDonald’s medium meal*

Vegetables �
(1 serving = 75g)

* As at June 2006; OJ = orange juice

health policy at Curtin University in Perth,
blamed for contributing to Australia’s growhas expressed “serious concerns.” Professor
ing weight problem, but others believe that
Daube, who has been pushing for a tax on
it is a clever corporate move to reposition
junk foods, said that he was speaking in a
the McDonald’s brand in the wake of the
private capacity and not on behalf of the
damning documentary film Super Size Me.
foundation.
Rosemary Stanton, a prominent nutrition“My concerns are the possible impact on
ist and longstanding critic of the tick proour reputation, any prospect that it may be
gramme, said that the history of new food
used to promote McDonald’s
products showed that the
more broadly, and the use “Research demonstrates programme was more likely
that McDonald’s and others that ticks and other
to increase McDonald’s total
may make of it to prevent health labels increase
sales rather than encourage
curbs on their marketing,” product sales ”
existing customers to buy the
he said.
healthier products. “I see the
Since the tick programme began in 1989,
tick as overwhelmingly a marketing ploy,”
more than 1200 food products have been
she said.
accredited after being independently tested
Marion Nestle, professor of nutrition, food
to ensure that they meet the foundation’s
studies, and public health at New York Uninutrition standards.
versity, was similarly sceptical: “I am not
McDonald’s is only the second company
aware of research demonstrating that these
to join the programme since it was extended
programmes help people eat more healthlast year to include meals eaten out. It paid
fully. On the other hand, substantial research
the foundation $A330�����
 ����
000 �����������
(£133������
 �����
000;
demonstrates that ticks and other health
€195������
 �����
000; �����
$256 000)
����� ����������������������
to join the programme
labels increase product sales.”
for 12 months, covering the cost of random
Tim Gill, codirector of the New South
audits. On average, two McDonald’s outlets
Wales Centre for Public Health Nutrition
will face unannounced audits every week.
at the University of Sydney, said it was
Ms Anderson said McDonald’s deserved
crucial that the programme’s impact on
credit for submitting itself to an independMcDonald’s total sales was evaluated and
ent evaluation and for making “some fairly
made public. “You’ve got to give some credit
significant changes to their procedures and
to McDonald’s that they’ve made some steps
ingredients.”
in the right direction, but to me the risk of
She said, “The only business we may end
confusion as to what should be considered
up driving to McDonald’s are those people
appropriate food choices from this message
looking for healthier options.”
is enormous,” he said.
Some public health experts have welMelissa Sweet is a freelance health writer in New
comed the move as a pragmatic attempt
South Wales. In 1999 she contributed articles to a
to engage with an industry that is often
history of the National Heart Foundation.

BMJ | 10 March 2007 | Volume 334 				

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