NEWS Progress in reducing junior doctors' hours Real progress is being made in reducing junior doctors' hours, the ministerial group on junior doctors' hours heard at its last meeting. The numbers of doctors working more than 83 hours a week has fallen by 18% since last September, and the vague target that improvements should be made "as soon as practicable" has been replaced with the specific target that by April next year the average contracted hours for junior doctors must not exceed 83. The BMA had called for punitive rates for doctors working more than 72 hours a week; the need to reduce juniors' hours to be written into managers' contracts; and the dissemination of information on best and worst practice (14 March, p 660). There has been no response to these requests. Mrs Virginia Bottomley, chairing the meeting, said that the target was challenging but that she had every confidence that health authorities and trusts would meet it. New contracts to be issued in February and March next year will have to comply. The ministerial group received the second reports from the regional task forces covering the period September last year to February this year. These show that the number of doctors in hard pressed posts working over 83 hours had fallen from 4313 to 3541-a reduction of 18%. And the number in nonhard pressed posts working over 83 hours had gone down from 2123 to 1734-also an 18% reduction. The task forces reported that the reduction was consistent over all grades and different specialties. They expected substantial reductions in the numbers of doctors working over 83 hours before 1 April next year but thought that a hard core of posts would continue to be a problem. The next stage will be to bring down hours for those in hard pressed posts to a maximum of 72 a week and for all doctors on partial shifts and full shifts down to 64 and 56 respectively by 31 December 1994. Beyond that the aim is to bring down hours for the vast majority of non-hard pressed posts to a maximum of 72 a week by 31 December 1996. The intention of the new deal is to reduce working hours to a maximum average of 56 a week by the end of 1994. The reports showed that full shift working continued to increase and now operated for 5% of all posts but that there was little use of full shifts outside accident and emergency departments. The use of partial shifts had not increased by the end of February. Part of the new deal was to improve the living and working conditions of junior doctors, and the secretary of state said that she was encouraged by what had been done BMJ
VOLUME 304
16 MAY 1992
t 04
X 2
0:
z 0
O) Lookingforward working no more than 83 hours to
so
far. The task forces had put a lot of effort
into this aspect, and visiting teams, question-
naires, and invited bids were all being used to assess need. At least half the regions have allocated more than £100 000 for improvements. All this work could be thrown into chaos if the European Commission's proposals on the organisation of working time-which the United Kingdom government opposes-are agreed. They include an average working week of 48 hours, a minirmum rest period of 11 hours in every 24, and an uninterrupted rest period of 24 hours in every seven days. Although organisations, including hospitals, could opt out, they would have to provide compensatory rest periods.-LINDA BEECHAM, BMJ
France restricts freedom to smoke The French Ministry of Health has produced the final draft of a smoking bill that will forbid people to smoke in covered public places and workplaces, on public transport, and in schools and colleges. Specific areas may be made available to smokers and children under 16 will not be allowed into smoking areas. Smoking will be forbidden in communal
areas in workplaces, such as hallways, cafeterias, and meeting rooms. Employers, after consulting with medical and safety officers, may designate rooms for smokers. Under the new bill trains will be allowed to reserve only 30% of their seats for smokers. Currently half of all train seats are for smokers. Bar cars, now regularly filled with smoke, must remain smoke free. In aeroplanes smoking areas will be allowed only when the flight exceeds two hours and nonsmokers must be protected. It will be up to the management of restaurants, hotels, and places of entertainment to decide whether to provide room for smokers. Fines will range from £50 for individual law breakers to £450 for employers and companies. It is widely expected that in a country where discipline is often equated with deprivation of freedom and where breaking rules is a national pastime the new legislation will be difficult to enforce. As it is, legislation passed in 1976 to regulate the ventilation of smoking rooms is largely ignored. The smokers' lobby and the state tobacco monopoly have successfully opposed stiff increases in the cost of tobacco, and the 10% increase this month still leaves the price of a packet of cigarettes at about £1, one of the lowest rates in Europe. France has one of Europe's highest levels of tobacco addiction, with about 40% of adults smoking. It is estimated that an annual 54 000 deaths in the country are directly linked to smoking. -ALEXANDER DOROZYNSKI, medical journalist, Paris
1263
Headlines Improving sanitation: Since the United Nations launched the international drinking water supply and sanitation decade in 1980 an estimated additional 360 million urban residents in the developing countries have been given a safe water supply and urban sanitation facilities have been extended to an estimated additional 330 million people. Child deaths halved: Children in Britain are half as likely to die before they reach 14 than they were 20 years ago, according to the Office of Population Censuses and Surveys. Increased immunisations, the improved health of mothers, and better road safety have contributed to the drop.
Safe smacking of children: A new code recommended by the Scottish Law Commission suggests that a "safe, disciplinary smack" would be condoned but it would become a criminal offence for a parent or childminder to strike a child with a stick or any object that would cause injury or inflict pain or discomfort "lasting more than a very short time."
Slavery in Brazil: Brazil's homeless are being lured hundreds of kilometres by the promise of work only to live in slave-like conditions and work for nothing, according to a recent report by the pastoral land commission of the Roman Catholic church. Antislavery groups criticise the Brazilian authorities for doing little to stop this abuse, which they say is on the increase. New drug may reverse parkinsonism: According to a report in Science, an experimental drug may reverse Parkinson's disease in animals. When monkeys were given GMI ganglioside -extracted from cows' brains-their motor function was restored to nearly normal.
crisis, was a member of an interim administration who governed the country for a year after a military coup in February 1991. That administration was praised by many international observers for revealing the A much praised AIDS awareness campaign, extent ofThailand's HIV and AIDS problem. which was launched in Thailand last year by Mr Mechai promised that Thailand would an interim government, will be greatly toned be in the vanguard of Asia's efforts to tackle down because it is undermining the country's the epidemic and emphasised that the country £2-5 billion a year tourist industry, the new had "totally rejected the head in the sand deputy public health minister has announced. approach" to AIDS adopted by many governMinistry officials also claimed that a projection ments in the region. Before leaving office he by the United Nations of the possible preva- outlined the level of infection, saying that, at lence of HIV infection in Thailand by the the end of 1991, between 200 000 and 400 000 year 2000-one in four adults-was "overThais were infected with HIV. He warned blown" and that the spread of AIDS in the that if an effective campaign was not maincountry had slowed considerably. tained and built on, between two million and Deputy Minister Charoon Ngamphichet four million Thais would be infected with the said that the previous government's public virus by 2000, with 180 000 suffering from relations campaign to highlight the threat to AIDS. In the third quarter of 1991 more than Thailand from HIV had "seriously affected 540 cases of AIDS or AIDS related syndrome tourism." In future a more cautious approach were recorded in Thailand. The country's would be exercised to avoid affecting the first case was recorded in 1984, when a lucrative industry, he added. The number of homosexual returning from the US fell ill. tourists arriving dropped to 5-1 million in Although the country has a well organised 1991. sex industry, which caters to American, The comments came after Elizabeth Reid, European, and Japanese male tourists and the director of the UN's HIV and AIDS nets the Thai economy £lbn a year, Mr development programme, told a conference Mechai asserts that it is not the cause of HIV in Melbourne on 28 April, "What we have in infection but rather a contributory factor. Thailand is one of the most rapidly spreading Ninety per cent of Thai males are believed epidemics that has ever been documented. to engage in commercial sex at some stage of Thailand has just acknowledged the problem their lives. At brothels in the north east of the and is looking to put in place efficient pro- country more than 80% of prostitutes tested grammes." She warned that, without an were HIV positive, and the Bangkok Metroeffective response, one in four Thai adults- politan Association estimates that 37% of the from a total population of 58 million-would capital's sex Workers are infected. be infected by the turn of the century. Ms In February this year the country's public Reid added that the spread of HIV would health ministry approved a request by the seriously undermine the development ofwhat World Health Organisation to test the AIDS was regarded as one of "the most effective vaccine GP160 in Thailand. The US Armed developing countries in the world." Forces Research Institute in Medical Science The programmes that the UN official is known to want to extend its clinical trials of referred to were a series of multimedia a vaccine to Thailand. -ALISON CLEMENTS, AIDS education and awareness initiatives freelance journalist, Bangkok masterminded by a former minister, Mechai Viravaidya. It now seems that this drive will be curtailed. Mr Mechai, known in Thailand as "Mr Condom" for his award winning work to promote birth control and latterly for his drive to tackle Thailand's looming AIDS
Thailand stifles AIDS campaign
Vitamin K and childhood cancer
Prison for fertility doctor: Dr Cecil B Jacobson, a fertility specialist in the US, has been sentenced to five years in prison after using his own sperm to inseminate his patients. He tricked other patients into believing that they were pregnant when they were not. US abortion clinics reject funding: Some US health clinics are turning down federal funds rather than comply with regulations to cease abortion counselling after Congress failed to override President Bush's veto of a measure that would repeal the gag rule. Thailand's well organised sex industry nets £1bn a year
1264
The Department of Health and the British Paediatric Association are setting up an expert working group to review the safety ofvitamin K injections for newborn babies. Last week Professor Jean Golding, of the Institute ofChild Health in Bristol, said in an interview with the Daily Mail that a study she had just completed had shown a link between intramuscular vitamin K and an increased risk of childhood cancer. There was no association, however, between cancer and oral vitamin K. The British Paediatric Associafion recommends intramuscular vitamin K for all newborn babies to prevent haemorrhagic disease of the newborn. The disease strikes within the first 10 weeks of life, with most cases in the first week, but is now extremely rare because of prevention with vitamin K. Last week the association said in a statement: "Before reported associations between cancer and early life events can be used to
BMJ
VOLUME
304
16 MAY 1992
!*FE,%x?..tX:taz-M!i!
VOLUME 304
16 MAY 1992
t 04
X 2
0:
z 0
O) Lookingforward working no more than 83 hours to
so
far. The task forces had put a lot of effort
into this aspect, and visiting teams, question-
naires, and invited bids were all being used to assess need. At least half the regions have allocated more than £100 000 for improvements. All this work could be thrown into chaos if the European Commission's proposals on the organisation of working time-which the United Kingdom government opposes-are agreed. They include an average working week of 48 hours, a minirmum rest period of 11 hours in every 24, and an uninterrupted rest period of 24 hours in every seven days. Although organisations, including hospitals, could opt out, they would have to provide compensatory rest periods.-LINDA BEECHAM, BMJ
France restricts freedom to smoke The French Ministry of Health has produced the final draft of a smoking bill that will forbid people to smoke in covered public places and workplaces, on public transport, and in schools and colleges. Specific areas may be made available to smokers and children under 16 will not be allowed into smoking areas. Smoking will be forbidden in communal
areas in workplaces, such as hallways, cafeterias, and meeting rooms. Employers, after consulting with medical and safety officers, may designate rooms for smokers. Under the new bill trains will be allowed to reserve only 30% of their seats for smokers. Currently half of all train seats are for smokers. Bar cars, now regularly filled with smoke, must remain smoke free. In aeroplanes smoking areas will be allowed only when the flight exceeds two hours and nonsmokers must be protected. It will be up to the management of restaurants, hotels, and places of entertainment to decide whether to provide room for smokers. Fines will range from £50 for individual law breakers to £450 for employers and companies. It is widely expected that in a country where discipline is often equated with deprivation of freedom and where breaking rules is a national pastime the new legislation will be difficult to enforce. As it is, legislation passed in 1976 to regulate the ventilation of smoking rooms is largely ignored. The smokers' lobby and the state tobacco monopoly have successfully opposed stiff increases in the cost of tobacco, and the 10% increase this month still leaves the price of a packet of cigarettes at about £1, one of the lowest rates in Europe. France has one of Europe's highest levels of tobacco addiction, with about 40% of adults smoking. It is estimated that an annual 54 000 deaths in the country are directly linked to smoking. -ALEXANDER DOROZYNSKI, medical journalist, Paris
1263
Headlines Improving sanitation: Since the United Nations launched the international drinking water supply and sanitation decade in 1980 an estimated additional 360 million urban residents in the developing countries have been given a safe water supply and urban sanitation facilities have been extended to an estimated additional 330 million people. Child deaths halved: Children in Britain are half as likely to die before they reach 14 than they were 20 years ago, according to the Office of Population Censuses and Surveys. Increased immunisations, the improved health of mothers, and better road safety have contributed to the drop.
Safe smacking of children: A new code recommended by the Scottish Law Commission suggests that a "safe, disciplinary smack" would be condoned but it would become a criminal offence for a parent or childminder to strike a child with a stick or any object that would cause injury or inflict pain or discomfort "lasting more than a very short time."
Slavery in Brazil: Brazil's homeless are being lured hundreds of kilometres by the promise of work only to live in slave-like conditions and work for nothing, according to a recent report by the pastoral land commission of the Roman Catholic church. Antislavery groups criticise the Brazilian authorities for doing little to stop this abuse, which they say is on the increase. New drug may reverse parkinsonism: According to a report in Science, an experimental drug may reverse Parkinson's disease in animals. When monkeys were given GMI ganglioside -extracted from cows' brains-their motor function was restored to nearly normal.
crisis, was a member of an interim administration who governed the country for a year after a military coup in February 1991. That administration was praised by many international observers for revealing the A much praised AIDS awareness campaign, extent ofThailand's HIV and AIDS problem. which was launched in Thailand last year by Mr Mechai promised that Thailand would an interim government, will be greatly toned be in the vanguard of Asia's efforts to tackle down because it is undermining the country's the epidemic and emphasised that the country £2-5 billion a year tourist industry, the new had "totally rejected the head in the sand deputy public health minister has announced. approach" to AIDS adopted by many governMinistry officials also claimed that a projection ments in the region. Before leaving office he by the United Nations of the possible preva- outlined the level of infection, saying that, at lence of HIV infection in Thailand by the the end of 1991, between 200 000 and 400 000 year 2000-one in four adults-was "overThais were infected with HIV. He warned blown" and that the spread of AIDS in the that if an effective campaign was not maincountry had slowed considerably. tained and built on, between two million and Deputy Minister Charoon Ngamphichet four million Thais would be infected with the said that the previous government's public virus by 2000, with 180 000 suffering from relations campaign to highlight the threat to AIDS. In the third quarter of 1991 more than Thailand from HIV had "seriously affected 540 cases of AIDS or AIDS related syndrome tourism." In future a more cautious approach were recorded in Thailand. The country's would be exercised to avoid affecting the first case was recorded in 1984, when a lucrative industry, he added. The number of homosexual returning from the US fell ill. tourists arriving dropped to 5-1 million in Although the country has a well organised 1991. sex industry, which caters to American, The comments came after Elizabeth Reid, European, and Japanese male tourists and the director of the UN's HIV and AIDS nets the Thai economy £lbn a year, Mr development programme, told a conference Mechai asserts that it is not the cause of HIV in Melbourne on 28 April, "What we have in infection but rather a contributory factor. Thailand is one of the most rapidly spreading Ninety per cent of Thai males are believed epidemics that has ever been documented. to engage in commercial sex at some stage of Thailand has just acknowledged the problem their lives. At brothels in the north east of the and is looking to put in place efficient pro- country more than 80% of prostitutes tested grammes." She warned that, without an were HIV positive, and the Bangkok Metroeffective response, one in four Thai adults- politan Association estimates that 37% of the from a total population of 58 million-would capital's sex Workers are infected. be infected by the turn of the century. Ms In February this year the country's public Reid added that the spread of HIV would health ministry approved a request by the seriously undermine the development ofwhat World Health Organisation to test the AIDS was regarded as one of "the most effective vaccine GP160 in Thailand. The US Armed developing countries in the world." Forces Research Institute in Medical Science The programmes that the UN official is known to want to extend its clinical trials of referred to were a series of multimedia a vaccine to Thailand. -ALISON CLEMENTS, AIDS education and awareness initiatives freelance journalist, Bangkok masterminded by a former minister, Mechai Viravaidya. It now seems that this drive will be curtailed. Mr Mechai, known in Thailand as "Mr Condom" for his award winning work to promote birth control and latterly for his drive to tackle Thailand's looming AIDS
Thailand stifles AIDS campaign
Vitamin K and childhood cancer
Prison for fertility doctor: Dr Cecil B Jacobson, a fertility specialist in the US, has been sentenced to five years in prison after using his own sperm to inseminate his patients. He tricked other patients into believing that they were pregnant when they were not. US abortion clinics reject funding: Some US health clinics are turning down federal funds rather than comply with regulations to cease abortion counselling after Congress failed to override President Bush's veto of a measure that would repeal the gag rule. Thailand's well organised sex industry nets £1bn a year
1264
The Department of Health and the British Paediatric Association are setting up an expert working group to review the safety ofvitamin K injections for newborn babies. Last week Professor Jean Golding, of the Institute ofChild Health in Bristol, said in an interview with the Daily Mail that a study she had just completed had shown a link between intramuscular vitamin K and an increased risk of childhood cancer. There was no association, however, between cancer and oral vitamin K. The British Paediatric Associafion recommends intramuscular vitamin K for all newborn babies to prevent haemorrhagic disease of the newborn. The disease strikes within the first 10 weeks of life, with most cases in the first week, but is now extremely rare because of prevention with vitamin K. Last week the association said in a statement: "Before reported associations between cancer and early life events can be used to
BMJ
VOLUME
304
16 MAY 1992
!*FE,%x?..tX:taz-M!i!
