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Press releases Saturday 15 July 2006
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(1) ELECTRONIC PATIENT RECORD “SERIOUS THREAT” TO PATIENT CONFIDENTIALITY
(2) WHAT’S WRONG WITH SELLING KIDNEYS?
(3) TACKLE "AESTHETIC" GENITAL SURGERY IN RICH COUNTRIES BEFORE CRITICISING TRADITIONAL PRACTICES
(4) BRITISH GOVERNMENT VIOLATING RIGHT OF FAILED ASYLUM SEEKERS TO HEALTH CARE
(1) ELECTRONIC PATIENT RECORD “SERIOUS THREAT” TO
PATIENT CONFIDENTIALITY
(Letters: To opt in or opt
out of electronic patient records?)
http://bmj.com/cgi/content/full/333/7559/146
Doctors in this week’s BMJ have their say on whether patients should have to opt in or out of electronic patient records.
The medical profession is concerned that, in the proposed summary care record, data will be accessed with no further input from the patient, and this is not being made sufficiently clear to the public, write Drs Paul Cundy and Alan Hassey in a letter to this week's journal.
"Patients and clinicians must have confidence that information will be secure and shared only with patient consent," they say.
Another letter argues that the electronic patient record is incompatible with the doctor-patient relationship, and is a direct and serious threat to patient confidentiality. The author, Michael Foley, suggests that the huge sums of money being invested in its development might be more usefully spent on improving patient care than on compromising their privacy.
In another letter, two junior doctors warn that poor training of locum doctors in using hospital computer systems also poses a risk to confidentiality.
Amir Ismail and Muhammad Ismail say that doctors frequently share passwords as it is difficult and often time consuming to attain their own passwords, especially when very short term locums are being undertaken. “This should be avoided at all costs as it compromises data security,” they warn.
They believe that locum doctors should ensure that they are given basic training in using these systems as part of their induction at a new hospital, as well as individual passwords. And they conclude that ensuring adequate training at this stage in developing computerised health care is crucial to its eventual success.
If patients’ health records are made universally available confidentiality is put at risk and the potential consequences are serious, adds Anthony Winston, Consultant in Eating Disorders, in a final letter. “When serious harm can result from a course of action explicit consent is required. The Royal College of General Practitioners is right to insist on opting in,” he writes.
Contacts:
Dr Paul Cundy, Joint Chair, Joint
IT Committee of the General Practitioners Committee and the Royal College
of General Practitioners, BMA House, London, UK
Email: cunpr@globalnet.co.uk
Amir Ismail, MSc Student, Faculty
of Medicine, Imperial College London, Hammersmith Hospital Campus, London,
UK
Email: amirismail@doctors.net.uk
Anthony Winston, Consultant in
Eating Disorders, Woodleigh Beeches Centre, Warwick Hospital, Warwick, UK
Email: Anthony.Winston@swarkpct.nhs.uk
(2) WHAT’S WRONG WITH SELLING KIDNEYS?
(Personal View: Thinking
the unthinkable: selling kidneys)
http://bmj.com/cgi/content/full/333/7557/51
(Thinking the unthinkable:
selling kidneys)
http://bmj.com/cgi/content/full/333/7559/149
Doctors in this week’s BMJ debate the issue of selling kidneys.
A personal view article, published earlier this month, asked what’s wrong with a market in body parts?
Sue Rabbitt Roff of Dundee University Medical School argued that we already permit the sale of body parts and fluids, and we have also already determined “tariffs” for the value of certain body parts in compensation models for workers’ accidents, criminal injury, or injury incurred during military service.
If we are not shy about reaching these values, why do we shrink from constructing a regulated exchange system for body parts that would undercut the existing illegal trade, which is so hazardous for the vendors, she asks?
The recommended value of a kidney is $40,000 (£22,000; €32,000), which is close to the annual average income in the UK and US, she adds. If such a sum were part of a package that involved the highest level of clinical care and follow-up, would it be any more reprehensible than the “vending” that is currently permitted for other body materials?
Responding to this article in a letter, doctors in India offer several points in favour of the regulated sale of kidneys.
Firstly, regulated sale will bridge the gap between demand and supply of kidneys for transplantation, they say. Secondly, it will reduce if not abolish the rampant illegal kidney trade.
Thirdly, monetary compensation of donors is well known and well accepted and, fourthly, a collateral benefit of the regulated kidney trade may be redistribution of some wealth in this seemingly unjust world, they write.
Dealing in human spare parts superficially seems to be indecent and immoral. But how can denying the sale of a part of a human body be denied in a world where body and soul are sold and resold daily? With proper and honest checks, they believe that this business has the potential of producing more benefit than harm.
But an e-letter from a heart specialist warns that a fixed compensation model with the price set by experts may increase the supply of organs but it is unlikely to preclude a (black) market from developing.
Alternatively, where the market price of kidneys is lower than the offered price, kidney brokers could operate, making a profit on the supply of the organ to a recipient where the price was higher, he writes.
The core argument for commodifying human kidneys for transplantation rests on the need to increase the supply of available organs. This is set against the likely result of a net flow of organs from the poor to the rich together with a debasement of the intrinsic societal value of altruistic organ donation, he concludes.
Contacts:
Sue Rabbitt Roff, Senior Research
Fellow, Centre for Medical Education, Dundee University Medical School, Scotland,
UK
Email: s.l.roff@dundee.ac.uk
Professor Kuldip Anand, Department
of Medicine, Command Hospital, Kolkata, India
Email: kpkpa49@yahoo.co.in
Raj Mohindra, Specialist Registrar,
Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
Email: rajm@dial.pipex.com
(3) TACKLE "AESTHETIC" GENITAL SURGERY IN RICH COUNTRIES BEFORE CRITICISING TRADITIONAL PRACTICES
(Editorial: Female genital
mutilation: whose problem, whose solution?)
http://bmj.com/cgi/content/full/333/7559/106
We need to tackle "aesthetic" genital surgery in rich countries before criticising traditional practices, argues a senior doctor in this week’s BMJ.
A study published on bmj.com last month found that mutilations among girls and women in Sudan did not readily fit into the World Health Organisation’s classification system.
Responding to this study in an editorial, Ronán Conroy of the Royal College of Surgeons in Ireland suggests that “our own sexually repressive use of female genital mutilation may be at the root of our misunderstanding of its role in other cultures.”
The literature on female genital mutilation is long on polemic and short on data, he writes. European and American writers often assume that female genital mutilation is forced on unwilling young girls, but this is at odds with the high social value placed on it in societies that practise it.
The high moral tone with which those in richer countries criticise female genital mutilation would also be more credible if we in the rich North had not practised it and did not continue to practise it, he adds.
The practice of female genital mutilation is on the increase nowhere in the world except our so called developed societies, he says. “Designer laser vaginoplasty” and “laser vaginal rejuvenation” are growth areas in plastic surgery, representing the latest chapter in the surgical victimisation of women in our culture.
And this burgeoning industry is able to operate without the slightest attention being paid to it by medical researchers.
It is Western medicine which, by a process of disease mongering, is driving the advance of female genital mutilation by promoting the fear in women that what is a natural biological variation is a defect, a problem requiring a knife, he concludes.
Contact:
Ronán Conroy, Department
of Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
Email: rconroy@rcsi.ie
(4) BRITISH GOVERNMENT VIOLATING RIGHT OF FAILED ASYLUM SEEKERS TO HEALTH CARE
(Editorial: Failed asylum
seekers and healthcare)
http://bmj.com/cgi/content/full/333/7559/109
The British government is violating the right of failed asylum seekers to health care, according to an editorial in this week’s BMJ.
Since the start of the National Health Service, British doctors have taken pride in working in a service whose core principles include healthcare as a basic human right and a universal service for all based on clinical need, not ability to pay.
Yet the reality is different, writes Peter Hall of Doctors for Human Rights. Destitute failed asylum seekers are being refused hospital treatment and being hounded by debt collectors if they have received emergency treatment,
In restricting their access to free secondary healthcare, the British government is violating the right of failed asylum seekers to the highest attainable standard of health, guaranteed by the International Covenant on Economic, Social and Cultural Rights.
In 2002, the Committee on Economic, Social and Cultural Rights, which monitors states’ compliance with the covenant, asked the UK to ensure that its obligations under the covenant were taken into account in national legislation and policy on health and education. Yet within two years the government had blocked access to free NHS hospital health care for most failed asylum seekers and expressed an intention to deny them access to free NHS primary care.
Denial of access to health care by one of the richest countries on earth is inhumane because it jeopardises their health and illegal because it violates international law, says the author.
But where do these regulations leave doctors, he asks? Conforming with legislation that denies access to health care goes against the instincts of many doctors, affronts common decency, and infringes international and domestic ethical codes.
In its 2002 report, the Committee on Economic, Social and Cultural Rights, urged the UK government to ensure that health professionals be educated in economic, social, and cultural rights and the public be informed of the requirements of the covenant, but neither recommendation has been followed.
The government needs to observe its obligations under the covenant. In the meantime, health professionals who have cooperated in limiting access should understand they have knowingly been made complicit in the abuse of a fundamental human right, he concludes.
Contact:
Peter Hall, Chair, Doctors for Human
Rights, Abbots Langley, Hertfordshire, UK
Email: peterhall@doctorsforhumanrights.org
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