NZORD Newsletter 2004 #11 - 2 November 2004

Hello everyone,

In this issue:
1 - Comments on PGD guidelines needed by 12 November 2004.
2 - Paediatric Society scores DHB performance in Child and Youth Health.
3 - National Health Committee recommendations on antenatal HIV screening stir controversy.
4 - Other screening information.
5 - Beware of certain herbal remedies.
6 - Nominations sought for Child and Youth Mortality Review committee.
7 - New advice on prescribing anti-depressants.
8 - Research indicates high stress on doctors.
9 - Snippets.
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1 - Comments on PGD guidelines needed by 12 November 2004.
Don’t forget to make your written submission on the draft guidelines for pre-implantation genetic diagnosis. The guidelines seem a well balanced set of rules to govern this new procedure. Well, maybe a little tight in a few places, but broadly acceptable. However it is important not to take them for granted until finally approved. The committee should hear messages of support for access to this procedure for those at risk of inherited diseases. Critics will inevitably submit, and a one-sided set of submissions would not be helpful to our collective interests. Please take some time to send your written comments to NECAHR, even if it is simply a brief letter to support the main themes in the guidelines as written. Follow this link to the draft guidelines [now at the website of the Ethics Committee on Assisted Reproductive Technology]. Post your submission to the National Ethics Committee on Assisted Human Reproduction, PO Box 5013, Wellington, or email them to tanith_robb@moh.govt.nz

2 - Paediatric Society scores DHB performance in Child and Youth Health.
A detailed analysis of the performance of District Health Boards in providing for Child and Youth Health, has found pockets of progress and some significant advances in the past twelve months. Unfortunately these are counterbalanced by problem areas, especially in access to specialist services, and disability support services for families of children with special needs. NZORD shares the concerns of the reports authors, the Paediatric Society of New Zealand, and calls for stronger commitment to a co-ordinated improvement of services for children and young people. It is frustrating that many improvements are achievable by greater commitment to improve the health of our youngest generation by implementing Ministry of Health strategies, yet that commitment seems to be lacking among some DHBs.

Read the report at the Paediatric Society website.

3 - National Health Committee recommendations on antenatal HIV screening stir controversy.
Transmission of HIV from HIV-positive mothers to their babies can be dramatically reduced if ante-natal screening identifies pregnancies at risk of this. But a National Health Committee report advises against a programme to screen all pregnancies, and suggests instead a pilot programme in the Auckland area only. Find the NHC report and recommendations at this link http://www.nhc.health.govt.nz/moh.nsf/pagescm/676/$File/hivscreening.pdf Many clinicians have expressed frustration at this “soft” recommendation.

Is this the best way to protect babies from HIV transmission? Should we be more assertive in implementing such programmes, even though the numbers are very small? What are the ethical implications for transmission of HIV to babies where the mother is not included in the pilot programme? And what other screening programmes could have similar benefits for child health and are yet to be implemented? How long will they all be waiting in line for implementation?

Part of the current transmission rate could be related to inadequate risk screening by those responsible for managing the pregnancy, and that raises even greater concerns about proper antenatal care.

Despite the controversy, one positive recommendation in the NHC report is that there should be a thorough review of all antenatal screening policies. This fits neatly with NZORD’s concern that we can do more, and we can do better, and the need to sort out our priorities is urgent.

4 - Other screening information.
Information on antenatal screening for Down Syndrome (link updated 2007), screening for colorectal cancer and screening for prostate cancer is now available from the National Screening Unit webpages.

5 - Beware of certain herbal remedies.
The Director-General of Health has issued a warning under the Health Act about certain herbal remedies containing undeclared pharmaceuticals. This is the ninth warning or recall of herbal products since 2000 and indicates a crisis of confidence in the manufacture of many complementary and alternative medicines.

Interaction with other drugs is always a possibility. People who take prescription medicine are strongly advised to tell their doctor of any health supplements or herbal remedies they take, to identify any interaction risk there may be.

A list of recent product alerts about complementary and alternative medicines can be found at this link http://www.cam.org.nz/safety.htm

6 - Nominations sought for Child and Youth Mortality Review committee.
In its current call for nominations the Ministry is looking in particular for candidates with knowledge of health and social issues facing Pacific children and young people. It is also indicating it needs a committee including clinicians, health service providers, child and youth advocacy groups, and people representing Maori and Pacific peoples' interests. Further details about the committee role and application process can be found by clicking onto this link on the Ministry’s website [link is no longer active; website of the Child and Youth Mortality Review Committee can be found here].

7 - New advice on prescribing anti-depressants.
Medsafe has published a recommendation from the Medicines Adverse Reactions Committee warning of precautions that should be taken when prescribing anti-depressants and most of the concerns relate to their use in young people. Read more here on the Ministry’s website. See also comments from PHARMAC that identifies a nearly 40% increase in the use of these drugs over the past three years. That link is http://www.pharmac.co.nz/pdf/271004.pdf

8 - Research indicates high stress on doctors.
Research on hospital doctors finds stress levels up to three times that of the general population. See this NZ Herald article for more details. Such finding should be of great concern to all of us and suggests an urgent need for better systems and supports for clinicians to do their work. The findings suggest “top-down” management systems contribute to the problem, but my comment is that public eagerness to complain about health services must also add to the problem. There seem to be regular complaints about health services appearing in our daily newspapers, and a culture of blaming and trial by media previously only seen on US television. It would help the professional staff and the whole community if complaints and publicity were reserved for only the most serious of incidents. See also this NZ Herald commentary by Health and Disability Commissioner, Ron Paterson, expressing concern about media coverage of health complaints.

9 - Snippets.

  • New Zealand scores well in an international study comparing NZ, Australia, Canada, Britain and the USA, on primary health care access. See http://www.beehive.govt.nz/ViewDocument.cfm?DocumentID=21332 for more details.
  • The complementary medicine Glucosamine has been found in a Canadian study to have no benefit for arthritis. Those who felt better after using it actually numbered less than those feeling better after taking a placebo. See this NZ Herald article for more details.
  • The Meningococcal B Immunisation programme is rolling out strongly and has delivered well in excess of 200,000 doses. Its safety has also been confirmed by an independent safety monitoring board. More information is available at this link http://www.immunise.moh.govt.nz/mediareleases/151004.html (Link is no longer active - The MeNZB vaccination programme ended in June 2008 as cases of meningococcal disease declined, though the vaccine is still available for people considered to be at heightened risk.  See the Ministry of Health website for more information.)
  • The Antibiotic Resistance Steering Group, reconvened in June this year by the New Zealand Food Safety Authority, has now appointed an expert panel to address issues surrounding antibiotic resistance in New Zealand. Read more at http://www.nzfsa.govt.nz/publications/media-releases/2004-10-18.htm
  • Pharmac rejects blame for drug shortages. See this NZ Herald article for more details.

Regards, John

John Forman
Executive Director