Accounting for susceptibility in risk assessment: The need for full disclosure

Many Environmental Laws create the unrealistic expectation that science can be used to determine ‘safety'. The many uncertainties surrounding environmental risks, as well as individual, group and societal differences about what is considered ‘safe', make it inevitable that policy decisions must be made. It is appropriate that such decisions be shaped by politics and social issues, as well as be informed by science and economics, but care should be taken to distinguish between policy and fact. Not much is known about the nature and magnitude of environmental susceptibilities. Credible environmental decisions require that scientists, risk assessors and decision-makers acknowledge this, and that they take care to distinguish policy calls from scientific fact.     

Cannabis laws: an analysis of costs

There is evidence that the use of cannabis is increasing in Australia, with stable black-market prices, despite the 9-year National Campaign Against Drug Abuse, increasing expenditure to enforce the laws against cannabis use, and the seizure of large plantations of cannabis plants. Recent government data are used to estimate the conservative cost of drug-law enforcement against cannabis use as being $329m in 1991-92. Alternatives to the existing regime are examined, including expiation, decriminalization, and legalization.     

Surrogacy: Ethical,legal, and social aspects

In considering the interrelated ethical, legal and social aspects of surrogacy we acknowledge that society has long accepted the delegation of various parental functions and explore the role of a surrogate in relationship to this as well as alluding to commoner comparisons with prostitution and adultery. In particular, the birth mother rule, the public antipathy to commercial surrogacy and restrictive legislation are explored and found to be inappropriate. It is concluded that the regulation, surveillance and assessment needed to ensure the best outcome for all concerned would perhaps be easiest achieved in programmes that are formally licensed under permissive legislation and adequately funded by commercial means.     

The role of law enforcement in minimizing the harm resulting from illicit drugs

Illicit drugs have become a major global problem in recent decades following considerable recent political change, including the collapse of communism and the formation of international super-states to increase trade. Despite increasing collaboration between law enforcement authorities in different countries, illicit drug problems appear likely to increase in the future because of the vast profits available, continuing (and increasing) demand and more permissive attitudes concerning drugs among young people. While rejecting legalization or decriminalization, the search for more effective responses by law enforcement authorities and the community generally must be stepped up. Police services continue to play an important role restricting the availability of illicit drugs but increasing emphasis needs to be given to reducing demand, including more available and more effective preventive drug education in schools. Police also need to work with harm reduction approaches devised to reduce the negative consequences of drug use for those who continue to use illicit drugs. New measures proposed in Britain are outlined. These stress the importance of a multi-sectoral approach operating at both national and local levels with the objective of reducing drug-related crime, reducing the acceptability and availability of illicit drugs and reducing the harmful consequences of illicit drug use. Harm reduction requires a commitment for close collaboration between police and drug treatment services to maximize the effectiveness of needle-exchange schemes and other harm reduction approaches. Cautioning, now commonly used in Britain for selected minor drug offences, has a number of benefits including reducing criminal justice costs. Greater emphasis must be placed on diversion schemes involving close links between police and drug treatment services. Future progress requires firm commitments to providing adequate and effective drug treatment services, conducting research to develop and evaluate more effective diversion schemes, improving collaboration between sectors and effective leadership. In addition to the major costs of illicit drug use to the community, the huge cost to individuals must remain a major focus driving the search for more effective responses to the problems resulting from illicit drugs.     

Harnessing harm reduction in Australia: an interview with the Hon. Neal Blewett. Interview by Steve Allsop

The National Campaign Against Drug Abuse (NCADA) was established in April 1985. Aiming to provide a national framework to minimize the harmful consequences of drug use, the original 3-year programme was extended to 1997. A key figure in the NCADA, Dr Neal Blewett, was interviewed to gain his perspective on the development and implementation of the Campaign over its first 10 years.     

Hepatitis and HIV Risk among Drug-Using Men Who Have Sex with Men: Demonstration of Hart's Law of Inverse Access and Application to HIV

Objectives: The first 215 drug-using men who have sex with men (DU-MSM) evaluated for possible participation in a controlled behavioral intervention study were tested for Hart's law of inverse access, which predicts that access to prevention resources varies inversely to need. Methods: Hepatitis B vaccination, mental health, and substance abuse treatment were used to measure health resource use; hepatitis B (HBV) and HIV infections and unsafe sex measured preventive care needs. Socioeconomic status indicators included education, ethnicity, and income. Results: HBV-vaccinated men were more likely to be white and college educated. HBV-infected men were more likely to be black, older, HIV-positive, and have higher rates of substance use with sex. When stratified according to socioeconomic status indicators, levels of HBV vaccination were inverse to the rates of HBV and HIV infection. This relationship was not found for psychosocial treatment utilization. Conclusions: Demonstration of Hart's law among high-risk DU-MSM has important implications for future HIV prevention efforts among high-risk individuals. Combining HIV, hepatitis, and substance abuse prevention in primary care and substance abuse treatment settings is discussed.     

Wielding the implement of law: Distilling new rights and responsibilities in the age of the ‘new genetics’

The law has, to date, been slow to respond to advances in genetics, but in many ways this may be propitious. History teaches us that there is an ever-present risk that the law will be used merely to embody knee-jerk reactions to new developments in medicine and science, frequently to the detriment of all interested parties. Adequate and appropriate legal responses to genetic research can only come once a full debate on the problems to be addressed has taken place, and when society as a whole is appraised of the options at hand. This article offers an overview of the problems which are thrown up for the law by 'new genetics', including the problem of reconciling competing claims to genetic information from family members, insurers and employers, as well as the dilemma of determining how to regulate the potential range of uses of new genetic knowledge. The article offers some views on how we might use the law to proceed sensibly and productively in the future.     

《伤寒论》研究层面探索与剖析

从伤寒的体质、病因、病理、诊法、辨证、治则、治法、方药及其临床等方面对《伤寒论》研究层面进行分析,对《伤寒论〗研究思路、方法及未来研究发展趋势进行了讨论。     

<内经>各学术流派概述

《内经》中存在着多种学术流派,其学派划分方法目前有两种,即以《内经》中的医家名称为纲和以各专题中的不同学说为纲划分。这两种方法均存在不足之处。以阴阳、五行为纲来探讨《内经》中的医学流派应是今后研究的方向之一。     

Brain Death and Organ Donation in Germany: Analysis of Procurement in a Neurosurgical Unit and Review of Press Reports

Summary  Objective. A prospective study was undertaken to determine the number of potential organ donors in a neurosurgical intensive care unit and to record the actual number of organ donations. The reasons for refusal of organ donations were analysed with respect to the controversial public discussion of the brain death concept and the transplantation law in Germany.  Methods. From 1994 to 1997, the number of cases of brain death, and the number of cases in which relatives consented or refused to organ donation as well as the number of actual organ explantations was recorded. Over the same period, press reports of 5 German language newspapers were analysed with regard to the authors' position on brain death and transplantation law, their qualification, intention, and mode of presentation.  Results. Annually, about 70 deaths occurred on the department's intensive care unit of which almost 30% of the patients were determined to have suffered brain death without any obvious contraindications against organ donation. The refusal rate of relatives rose from 56% up to 78%, and the rate of organ donors thus decreased from 5% in 1994 to 4% presently in the department. About 100 reports were published each year in the analysed newspapers, of which about 90% voiced approval of organ transplantation. During the review period, the depiction became more objective (57% in 1994 to 82% in 1997) and the suspicious attitude toward the technique of brain death diagnosis declined. Whereas 50% of the articles rejected the brain death concept in 1994, this figure decreased to 39% in 1997 and conversely the concept of consent rose from 33% in 1994 to 56% in 1997.  Conclusion. In Germany, the relatives refusal rate in organ donation is continuously high, presumable due to a depressing 39% of press reports rejecting the brain death concept, and resulting in a very low number of organ donations. There is hope that the transplantation law which has finally passed German parliament in 1997, confirming the brain death concept as well as the legal principle of prior consent by the donor or consent by the relatives will eventually result in an increase of organ donation especially when supported by an educational campaign which is embodied in the transplantation law.