Nuisances and human rights
1
544 Noticeboard The many faces of nitric oxide The horseshoe crab, 600 million years old and still going, made simple use of the abundant elements around it. Its primitive circulating cell, a platelet-cum-macrophage, can make nitric oxide from L-arginine. The number of human cells and systems that depend on this simplest of molecules goes well beyond that implied in "endothelium-derived relaxing factor", the term under which NO masqueraded for a few years. On Aug 24, at the International Society of Haematology congress in London, Dr Salvador Moncada ran through the list. We may need to think of the normal cardiovascular state as one of active vasodilatation, Moncada said, so that hypertension represents loss of this tone. But there is far more to NO than endogenous vasodilatation. Those studying the nervous system, both peripheral (penile erection has lately been in the news) and central, are becoming familiar with "nitrergic". Centrally NO may be involved in nociception, thermogenesis, epileptogenesis, glutamate toxicity, and even memory, besides blood pressure control. Endotoxin shock, transplant rejection, metastasis, infection and the action of glucocorticoids-all seem to have a role for NO synthase. It can be a two-edged sword, as dose-reponse studies of NO synthase inhibition in animal models of endotoxin shock have shown; and, possibly via superoxide anion, NO may be cytotoxic to the cells that produce it. Cytotoxicity against tumour cells and pathogens may involve iron-nitrosyl complexes. Cytokine involvement is evenly divided: five cytokines induce NO synthesis and five others inhibit it. Chronic renal failure is associated with high blood pressure and, puzzlingly, macrophage dysfunction. The macrophage has an inducible NO synthase system. A current focus of research interest is dimethylated arginine analogues, found in plasma and excreted in urine. Might these explain some of the grave consequences of chronic renal failure? NO has "far reaching implications for biology", Moncada concluded, without exaggeration. Primary health-care programme for Poland Per Blicher-Hansen, lecturer at the Institute of General Practice at the University of Copenhagen and his wife, also a GP, have gone to Poland to participate in a one-year project aimed at establishing a primary health-care system similar to that in Denmark. The two doctors will act as consultants for an Irish-Danish consortium that is to be funded (20 million ECU) by the European Community’s PHARE (Poland, Hungary, action for restructuring of economy). They will be directly involved in training the first generation of GPs, who in turn will become instructors themselves. Future supplies of GPs will be provided by the introduction of relevant undergraduate courses to Polish medical schools. In addition, Polish doctors will attend training programmes in Denmark, the UK, Ireland, the Netherlands, and Norway. The project, which will be coordinated by the Polish Minister of Health, Andrzej Wojtyla, will also include courses in health administration. To make implementation of the new health-care system feasible, the World Bank has granted a loan of$130 million. The loan will be used in modernising and building hospitals and primary health-care centres. Nuisances and human rights Does environmental nuisance represent a denial of human rights? The question has been raised in the European Court of Human Rights in Strasbourg by a Spanish mother in a complaint about an unlicensed waste treatment works built metres from her home. In a test case, which has been ruled admissible, Senora Gregoria Lopez Ostra maintains that the situation is an infringement of Article 8 of the European Convention on Human Rights, which guarantees respect for private and family life. Her complaint concerns a plant treating tannery waste adjoining her home at Lorca in the region of Murcia. The plant went into operation in July, 1988, without the permit required by the town council under regulations covering activities designated as unhygienic, injurious to health, or dangerous. Smells and pollution from the plant caused health problems and nuisance to many residents, according to Sra Lopez Ostra. "Numerous" complaints to the council, health authorities, and the regional environmental agency led the council to order only an incomplete shutdown of the works two months later. But the problems persisted. The Spanish government is contesting the complaint on the grounds that the case is still pending in national courts, where complaints have been lodged by other members of Sra Lopez Ostra’s family. Madrid also claims that, because of the incomplete shutdown, the plant is no longer a nuisance. The Strasbourg ruling on admissibility means that the Commission on Human Rights will first seek a friendly settlement of the dispute. But if that fails, a full hearing by the Court of Human Rights could lead to Spain being found in breach of the Convention. That ruling could mean Spain being fined and/or ordered to ensure compliance with the Convention. Hospital statistics—20 questions and answers For some, explanations about hospital statistics will always be tedious. So Anne Klassen and her colleagues from the Health Services Research Unit at Oxford University are to be applauded for their user’s guide1 to such data in the Oxford region. Their booklet is virtually the twenty questions most asked about health statistics. The answers provide reasonably short explanations with little jargon. The pre-Komer and Komer data sets are described, as are the changes that will follow the introduction of the internal market into the NHS in the UK-the hope is to disturb the Komer minimum data set as little as possible, with new data on providers and contracts. Health service indicators of performance are critically discussed, and the different classifications and codings are detailed. These include the Read codes, named after their GP developer, James Read. There are over 250 000 codes in this system, including 150 000 synonyms. Read codes are used by some hospitals and GPs’ computers, and will probably feature more and more in medical audit and possibly outpatient clinics. Cynics, of course, are always looking for shortcomings and may well turn to the question about what is not available. These issues, which include person-based data, case severity, outpatient procedure, GP referrals, and private hospital data, are dealt with adequately, as are concerns about accuracy, completeness, and timeliness of the data. The booklet describes who can access hospital data (anyone with a bona fide request, including researchers and students), and where and how. Usually the information about patients is made available on magnetic tape, but discs for a PC might be available (a large-size hard disc will be required). The ability to manipulate large amounts of information, most probably in a database program, is also necessary. The UK Data Protection Act must be adhered to, and local ethics committee approval would be required if confidential data are requested. 1. Klassen A, Wood N, Coulter A. Hospital statistics in the Oxford Region a user’s guide. Oxford: Health Services Research Unit, University of Oxford, July, 1992 UK clinical research The British Association for the Advancement of Science, meeting this past week in Southampton, heard further gloomy news of the world standing of academic clinical medicine in the UK. David A. Pendlebury, from the Institute for Scientific Information, gave figures on citations per paper, enlarging on a report in the current issue of Science Warch. The decline in citation impact of British science generally may be levelling off but for clinical science the position is worsening. The figures are relative (impact remains above the world average) and there are exceptions. Surgery and medical technology gained when 1981-85 was compared with 1987-91, oncology, neurology, and gastroenterology suffered badly. British clinical research is a sick man and an "alamiing decline in his vital signs has been noted". 1 1 Anon Critical condition: clinical research in UK fading fast. Science Watch 1992, 8 (no 6): 1-2
Transcript of Nuisances and human rights
544
Noticeboard
The many faces of nitric oxide
The horseshoe crab, 600 million years old and still going, madesimple use of the abundant elements around it. Its primitivecirculating cell, a platelet-cum-macrophage, can make nitric oxidefrom L-arginine. The number of human cells and systems thatdepend on this simplest of molecules goes well beyond that impliedin "endothelium-derived relaxing factor", the term under whichNO masqueraded for a few years. On Aug 24, at the InternationalSociety of Haematology congress in London, Dr SalvadorMoncada ran through the list. We may need to think of the normalcardiovascular state as one of active vasodilatation, Moncada said, sothat hypertension represents loss of this tone. But there is far moreto NO than endogenous vasodilatation. Those studying the nervoussystem, both peripheral (penile erection has lately been in the news)and central, are becoming familiar with "nitrergic". Centrally NOmay be involved in nociception, thermogenesis, epileptogenesis,glutamate toxicity, and even memory, besides blood pressurecontrol. Endotoxin shock, transplant rejection, metastasis, infectionand the action of glucocorticoids-all seem to have a role for NOsynthase. It can be a two-edged sword, as dose-reponse studies ofNO synthase inhibition in animal models of endotoxin shock haveshown; and, possibly via superoxide anion, NO may be cytotoxic tothe cells that produce it. Cytotoxicity against tumour cells andpathogens may involve iron-nitrosyl complexes. Cytokineinvolvement is evenly divided: five cytokines induce NO synthesisand five others inhibit it. Chronic renal failure is associated with
high blood pressure and, puzzlingly, macrophage dysfunction. Themacrophage has an inducible NO synthase system. A current focusof research interest is dimethylated arginine analogues, found inplasma and excreted in urine. Might these explain some of the graveconsequences of chronic renal failure? NO has "far reachingimplications for biology", Moncada concluded, without
exaggeration.
Primary health-care programme for Poland
Per Blicher-Hansen, lecturer at the Institute of General Practiceat the University of Copenhagen and his wife, also a GP, have goneto Poland to participate in a one-year project aimed at establishing aprimary health-care system similar to that in Denmark. The twodoctors will act as consultants for an Irish-Danish consortium that isto be funded (20 million ECU) by the European Community’sPHARE (Poland, Hungary, action for restructuring of economy).They will be directly involved in training the first generation ofGPs, who in turn will become instructors themselves. Futuresupplies of GPs will be provided by the introduction of relevantundergraduate courses to Polish medical schools. In addition,Polish doctors will attend training programmes in Denmark, theUK, Ireland, the Netherlands, and Norway. The project, whichwill be coordinated by the Polish Minister of Health, AndrzejWojtyla, will also include courses in health administration. To makeimplementation of the new health-care system feasible, the WorldBank has granted a loan of$130 million. The loan will be used inmodernising and building hospitals and primary health-carecentres.
Nuisances and human rightsDoes environmental nuisance represent a denial of human rights?
The question has been raised in the European Court of HumanRights in Strasbourg by a Spanish mother in a complaint about anunlicensed waste treatment works built metres from her home. In atest case, which has been ruled admissible, Senora Gregoria LopezOstra maintains that the situation is an infringement of Article 8 ofthe European Convention on Human Rights, which guaranteesrespect for private and family life. Her complaint concerns a planttreating tannery waste adjoining her home at Lorca in the region ofMurcia. The plant went into operation in July, 1988, without thepermit required by the town council under regulations coveringactivities designated as unhygienic, injurious to health, or
dangerous. Smells and pollution from the plant caused healthproblems and nuisance to many residents, according to Sra LopezOstra. "Numerous" complaints to the council, health authorities,and the regional environmental agency led the council to order onlyan incomplete shutdown of the works two months later. But theproblems persisted.The Spanish government is contesting the complaint on the
grounds that the case is still pending in national courts, wherecomplaints have been lodged by other members of Sra LopezOstra’s family. Madrid also claims that, because of the incompleteshutdown, the plant is no longer a nuisance. The Strasbourg rulingon admissibility means that the Commission on Human Rights willfirst seek a friendly settlement of the dispute. But if that fails, a fullhearing by the Court of Human Rights could lead to Spain beingfound in breach of the Convention. That ruling could mean Spainbeing fined and/or ordered to ensure compliance with theConvention.
Hospital statistics—20 questions and answers
For some, explanations about hospital statistics will always betedious. So Anne Klassen and her colleagues from the HealthServices Research Unit at Oxford University are to be applaudedfor their user’s guide1 to such data in the Oxford region. Theirbooklet is virtually the twenty questions most asked about healthstatistics. The answers provide reasonably short explanations withlittle jargon. The pre-Komer and Komer data sets are described, asare the changes that will follow the introduction of the internalmarket into the NHS in the UK-the hope is to disturb the Komerminimum data set as little as possible, with new data on providersand contracts. Health service indicators of performance are criticallydiscussed, and the different classifications and codings are detailed.These include the Read codes, named after their GP developer,James Read. There are over 250 000 codes in this system, including150 000 synonyms. Read codes are used by some hospitals and GPs’computers, and will probably feature more and more in medicalaudit and possibly outpatient clinics.
Cynics, of course, are always looking for shortcomings and maywell turn to the question about what is not available. These issues,which include person-based data, case severity, outpatientprocedure, GP referrals, and private hospital data, are dealt withadequately, as are concerns about accuracy, completeness, andtimeliness of the data. The booklet describes who can access hospitaldata (anyone with a bona fide request, including researchers andstudents), and where and how. Usually the information aboutpatients is made available on magnetic tape, but discs for a PC mightbe available (a large-size hard disc will be required). The ability tomanipulate large amounts of information, most probably in adatabase program, is also necessary. The UK Data Protection Actmust be adhered to, and local ethics committee approval would berequired if confidential data are requested.
1. Klassen A, Wood N, Coulter A. Hospital statistics in the Oxford Region a user’sguide. Oxford: Health Services Research Unit, University of Oxford, July, 1992
UK clinical research
The British Association for the Advancement of Science,meeting this past week in Southampton, heard further gloomy newsof the world standing of academic clinical medicine in the UK.David A. Pendlebury, from the Institute for Scientific Information,gave figures on citations per paper, enlarging on a report in thecurrent issue of Science Warch. The decline in citation impact ofBritish science generally may be levelling off but for clinical sciencethe position is worsening. The figures are relative (impact remainsabove the world average) and there are exceptions. Surgery andmedical technology gained when 1981-85 was compared with1987-91, oncology, neurology, and gastroenterology sufferedbadly. British clinical research is a sick man and an "alamiingdecline in his vital signs has been noted". 1
1 Anon Critical condition: clinical research in UK fading fast. Science Watch 1992, 8 (no6): 1-2
