FROM THE PRESS
Operation successful patient died
On October 5, the CDR hospitals at Chennai held a press conference to announce ‘the creation of medical history’ — on September 29, a patient with end stage renal disease received a cadaver kidney which had been flown in from Hyderabad.. They did not mention that the patient died four days before the press conference. The doctor, K S Nayak, later apologised for omitting this crucial fact, and explained that he had organised the press conference because the cadaver transplant was a significant medical event deserving public attention. Both hospital and doctor asserted that the transplant was successful even if the patient died. The patient’s relatives paid Rs 1.5 lakh to the hospital and Rs 60,000 to Tanuja Airways for a chartered flight. They also say they have a receipt of Rs 10,000 from the hospital for courier charges, though the courier company says they did not receive any payment for transporting the kidney.
Kidney transplanted. The Hindu, October 7,1998. Kidney transplant turns out to be a hoax, R J Rajendra Prasad, The Hindu, October 10, 1998, Omission of patient’s death regretted, The Hindu, October 14,1998
Should Aruna undergo tests?
Journalist Pinki Virani has written to the Bombay High Court asking that a panel be constituted to medically re-examine 50 year old Aruna Shanbagh, a nurse at Mumbai’s KEM hospital, who has been lying there in a semi-comatose state for 25 years, after a brutal assault and rape left her severely brain-damaged.
Re-examine nurse Aruna Shanbagh, says author, Express News Service. Indian Express, November 24,1998,
Vaccination melas
0n any given weekend between 35 and 40 mass vaccination camps are being held in the city of Bangalore. While some are organised by reputed service organisations, leading doctors and vaccine manufacturers worry that the camps are not always held under proper supervision, with the right doses. Paediatricians suggest that the vaccine should be used for selective risk groups like medical and dental personnel, and as an optional vaccine for the newborn and children Are the right amounts being injected? Not necessarily. Are they being given in the correct manner? Not always.
Are people made aware that the vaccine is of no use unl’ess the three dose regimen is completed? Apparently not. Do they know that older people benefit much less than children do? No. And the vaccines are not being given free.
Hepatitis-B vaccination ‘melas’ worry doctors. Sriranjan Chaudhuri. The Times of India, January 12, 1999,
What do you think?
On March 12, V N Prakash donated one of his kidneys to his brother V. N. Subramanyam at the Karnataka Nephrology and Transplant Institute, Bangalore. As a blood relative, Prakash is eligible to be a kidney donor. Only problem is: he is mentally disabled, deaf and mute, and could not have given his informed, convincing and meaningful consent to the donation which saved his brother’s life. His guardian and mother gave consent on his behalf.
Tissue matching found that Prakash was the perfect donor. Subramanyam is the only earning member of his family, works in a printing press earning Rs 800 a week, barely enough to meet the needs of his family consisting of him, his brother, mother, wife and child.
The team of surgeons took the decision to operate after soliciting responses to this situation, on the internet.
Disabled’s kidney suits kin, but doctors in a fix, Express News Service, Indian Express. March 12, 1999, Mentally challenged man gives kidney to sibling. Express News Service, Indian Express, March 16,1999.
Readers are called to send their comments on the subject.
Unlabelled blood for sale
In Hubli, a wardboy at the Karnataka Cancer institute took a patient’s relative to a nearby hospital and sold him two bottles of blood without labels, compatibility, serology status, seal, or any other information. The doctor reported the case to the Institute.
Circulation of untested blood stopped at Hubli. Chandrika Naik, Indian Express. February 26,1999.
CDC didn’t follow the rules
The US Centers for Disease Control (CDC) conducted medical research. projects in foreign countries without required agreements to avoid human rights abuses. In a number of instances, drugs were given, samples taken and research completed without the required agreements that patients were fully informed, monitored for safety told of known treatments and free to refuse experimental drugs. Among the violutions cited: children getting malaria drugs in Zambia and Malawi, whose guardians didn’t know they were getting experimental drugs; consent forms — but not in the local language for parents of babies vaccinated for diphtheria and meningitis, consent forms jbr rabies vaccine trials in Ethiopia not translated. The CDC’s deputy associate director jar science said the CDC was confident no subjects were harmed; language differences make it hard, and some countries object to the US imposing its own ethics rules abroad.
The Plains Dealer, reported in Monash Bioethics Review, January 1999
Doctors charged with torture
Brazil is to try a group o. f doctors charged with collaborating in torture carried out by the military regime that ruled from I964 to 1985. It is the first time doctors will have been called to account in this way since the Nuremberg trials after the Second World War The 26 accused, who include some of the most respected members of Brazil’s medical profession, are accused of assisting in torture sessions, giving directions to the torturers and signing false death certtficates.
The disciplinary proceedings, which began March 3 and are expected to continue through the year; are a result of a 13-year effort by the Brazilian human rights organization Torture Never Again. The group asked medical associations to revoke the licenses of110 doctors implicated by former political prisoners in violations. Some doctors have died and others been able to block the investigations against them. The remaining 26 face being struck off the medical register and the possibility of criminal proceedings. In the first of the cases heard, gynaecologist Jose Lino Coutinho, accused of overseeing the torture of 11 political prisoners in 1969, had his license revoked.
Brazil’s torture doctors face trial, Christina Lamb, The Sunday Telegraph, Brazil Rights Group Hopes to Bar Doctors Linked to Torture Larry Rohter, New York Times, March 11th 1999.
Forcible sterilisation
The Latin American und Curibhean Committee for the Defence of Womens rights alleges that 250,000 women have been forcibly sterilised in Peru since I996, as part of a government policy to reduce the country’s birth rate.
John Reynolds and Bioethics Newsfeed, December 28, 1998, quoted in Monash Bioethics Review, January 1999
Nestle ”went too far”
The Advertising Standards Authority has upheld a complaint against Nestle over its marketing of infant formula in developing countries. The complaint concerned a I996 newspaper advertisement in which Nestle’ claimed that it had marketed infant formula “ethically and responsibly both before and since the introduction of the international code of marketing of breast milk substitutes in 1981. The standards authority’s ruling, which has not been oficially released pending an appeal by Nestle, found that Nestle could not adequately support its claims and that the advertisement “went too far”
The original complaint was brought by Baby Milk Action,a non-profit organisation which campaigns against inappropriate infant feeding, objecting to an advertisement in the oxford Independent, a student neivspaper that was published in 1996. The standards authority examined submissions from Baby Milk Action and Nestle for nearly two years. Mike Brady,campaign coordinator for Baby Milk Action, said: Nestle’s challenges delayed the case progressing to the [authority’s] council. A spokeswomen for Nestle said: “We don’t think it is appropriate to comment as the matter is under appeal”
Advertising Standards Authority finds against Nestle Annabel Ferriman, BMJ, February 13, 1999
Babies get adult drugs
Many of the drugs used to treat AI-r1eonate.s and children have been tested only in adults, forcing doctors and pharmacists to calculate the appropriate, safe doses themselves. Ninety per cent of patients in a neonatal intensive care unit in the east Midlunds were given drugs that were either unlicensed or used in ways other than those for which they had been tested — termed “of label use”. Only just over one third of prescriptions given to the70 babies admitted over 13 weeks were for licensed drugs used in a licensed way, the research showed, including nine of the 10 most commonly prescribed drugs in neonatal intensive care (Archives of Disease in Childhood (fetal and neonatal edition) 1991;80:142-4F).
Newborns prescribed drugs only tested in adults,Caroline White, BMJ, February 27, 1999
Still “discussing” the complaint
More than five years have passed since a Bangalore-based woman was molested by a doctor on the pretext of examining her for a sexually transmitted disease, but the Karnataka Medical Council is still “discussing” the couple’s complaint. When the man went to the doctor for a skin irritation, the doctor sent him to a local diagnostic center, which falsely stated that the man had an STD. The doctor moleted the woman twice on the pretext of examining. The couple become suspicious and went to two other doctors who told them they were completely healthy, and they complained to the Karnataka Medical Council. However, after various deliberations, there has been no word from the Council since February 1998.
Medical Council sits on molestation case, Express News Service. Indian Express. February 12, 1999.
Codeine: the latest best-seller
The South Asia Drug Demand Reduction report, of the United Nations Internatio-nal Drug Control Programme, states that over-the-counter drugs are seriously misused across India, Bangladesh, and Nepal. The biggest threat is the mounting misuse of pharmaceutical agents like buprenorphine, diazepam, antihistamines, and cough syrups containing codeine. India accounts for nearly 3 million drug misusers. India’s pharmaceutical industry produces large amounts of psychotropic substances for medicinal purposes. But, the report said, they are sold without valid prescriptions, illegally transported to neighbouring countries, ancl sold for profit.,’
Abuse of OTC drugs rising in South Asia, Ganapati Mudur, BMJ, February 27, 1999
HIV vaccine trials
The first clinical trial of an HIV vaccine in Africa has been launched in Uganda, to evaluate the safety and durability of immune response to a vaccine based on an attenuated canarypox virus.
Researchers involved in phase-I of the double-blind trial are enrolling 40 healthy, HIV-negative adults aged 18 to 40 years who are at low risk of becoming HIV infected. They will be assigned randomly to a group of 20 who will receive the HIV vaccine, 10 controls who receive an experimental canarypox vaccine for rabies, or 10 controls who will receive a placebo injection. The trial will last one year with an additional year of follow-up to monitor adverse effects and immune responses. The National Institute of Allergy and Infectious Diseases is sponsoring the trial.
Separately, another group announced large-scale efficacy tests of a second vaccine in Thailand. The vaccine is designed to protect against two strains of HIV prevalent in Thailand and will be administered to 2500 intravenous drug users in Bangkok who are healthy but have a high risk of infection. The company will also test a similarly engineered vaccine on 5000 volunteers in the United States, making this the first vaccine to enter the final efficacy phase of human testing.
HIV Vaccine Trial in Africa, JAMA, March 10, 1999
Testing the HlV vaccine in India
The vaccine will be tested in India as well. The National AIDS Control Organisation with the US National Institutes of Health and the United Nation AIDS Programme will set up an ‘umbrella’ organisation to take up all aspects of AIDS vaccine research on “a mission mode”. In Pune, over 2,500 sex workers and STD clinic patients have been recruited for the HIV vaccine trial, while another group of injecting drug users is being formed in Manipur.
