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Currently in the press

That outrageous. Chemo crime. Missourri: a wealthy Kansas pharmacist is accused of adultering chemotherapy drugs. Robert R. Courtney, 49, allegedly diluted prescriptions for Taxol and Gemzar filled at his Research Medical Tower Pharmacy in Kansas City. He denies the charges against him.

Taxol is used against advanced ovarian, breast and other cancers; Gemzar is used to treat pancreatic and some types of lung cancer. According to the FBI, some of the drugs dispensed by Courtney contained less that 40 % of the cancer-fighting dosages ordered by doctors.

Authorities note that dilution of expensive cancer drugs can produce hundred of dollars in savings per dose. In one instance alone, dilution would have saved the pharmacy about USD 780. "We are looking a possibly hundred of patients (affected)", said FBI spokeswoman Bridget Patton. (Reader's Digest, january 2002).

The Ultimate Sacrifice. A healthy man gives his brother half his liver-and dies. Should this kind of transplant be allowed? (Time. January 28, 2002).

Inguinal hernia operation: Professor Schumpelick notes that synthetic nets retract and migrate, which, in his opinion, represents a disproportionate risk for the patient (PULStyp Januar 2000).

"Hernias: sky open intervention is preferable to surgery by laparoscopy? " (M&H October 6, 1999).

Discover the extent of adverse events, i.e. contrary events such as medical accidents, critical incidents, complications... by reading the book published in march 2000 (National Academy Press) by Linda Kohn: " To err is human: building a safer health system ". In particular, a medical errors american specialist, Professor Donald Mr. Berwick of Medical Harward School, in Boston in the USA, shows there that these adverse events, of which close to three quarter are avoidable, arise from current hospital medical routine and thus we should quickly change the system.

In Switzerland, a national adviser who is anesthesiologist, Dr. P. Günter, asked, already two years ago, for a national commission charged to investigate the origin of medical accidents. His request was unfortunately put off indefinitely. Civil aviation kills far fewer people than medicine and yet the investigation into medical accidents is the responsability of the Cantonal Public Health Services in Switzerland.

In Switzerland, the Federal Office of Social Security (OFAS) sounded an alarm bell, at the end of September 2000. The OFAS estimates that, for 1,25 million in-patients, each year in Switzerland, 2.000 to 3.000 deaths are due to medical errors. That is 40 to 60 deaths per week. It makes medical accidents the fifth highest cause of death in our country, between diabetes (2.004 deaths in 1996) and suicide (1.431 cases).

As PatientProtect.com sees it, reality is much worse and these figures certainly are increasing. A small part of these errors are due to lack of care and incompetence, and in great part due to our health system's latent errors. Our health system is increasingly rich at latent hidden defects in its organization and design, structures, hierarchy which has more and more eliminated the true medicine professionals, i.e. doctors, specifications contracts, staff training, communication, procedures, equipment etc...

The majority of deaths due to medical errors occur after a succession of " small things " which did not function well, indeed which was made by halves, as it is more and more the case in public hospitals. After years of triumphing technological medicine, citizen is rediscovering that patients are vulnerable and mortals and that, doctors promise more than they can hold, while making, or letting believe that there are only successes.

" After the death of a 13 year old teenager, the court condemns two doctors of Vevey... the two doctors acted with guilty thoughtlessness" (Tribune of Geneva, January 13-14 2001). This teenager had only fractured one clavicle. "

Drama of Lugano. The victim whose leg was amputated in error last Friday is in a critical state." (Liberté, January 16 2001). It was about a 80 year old patient with the wrong leg amputated. "

Approximately 5000 people die each year in the British hospitals from nosocomial infections results... These infections cost British National Health Service (NHS) a billion pounds per annum (2,5 billions CHF). According to British estimates, these nosocomial infections affect approximately 100.000 patients each year. " One will be never able to completely prevent them, but the NHS could do more to fight them ", declared the parliamentary committee president David Davis. The study is of the opinion that it is in particular " inexcusable" that certain hospital employees still do not respect simplest preventive recommendations, like the fact of washing hands regularly. Always according to this document, nosocomial infections could be reduced 15 %, if official rules of hygiene were correctly observed." (Médecine&Hygiène. 2326. p:2530. December 13 2000).

Scratch pad: The insurers threaten. (Médecine&Hygiène April 2341,4 2001).Article by Doctor B. Kiefer, editor in chief.

No doubt: she was right, Ruth Dreifuss, to put health insurers association in its place. Briefly, here is the background: Manfred Manser, boss of Helsana and sandwich man for this association ideas, explained in a punchy interview in SonntagsBlick that if Mrs. Dreifuss refused to give him guarantee to the round table which he wants to organize on drugs price, he would launch an initiative. However it is common knowledge, according to an article of M.-C. Petit Pierre in the Temps of March 27, that, in Mrs. Dreifuss entourage, one decided to make paper planes with this kind of kindnesses. One is probably wary that this takeover by force, disguised as round table, is only one beginning. What is prickly, besides it, is that insurers " require " to convene, for this famous round table, " the supervisor of the prices, pharmaceutical industry, consumers organizations and health insurers". And physicians? Not. Doctors are insurer employees, see you. They are not interlocutors but drudges under control, or almost. What would they come to make there? Well I'm blowed. Did one shout with this scandal, side of the FMH? Did one laugh, at least, in this stupid way of behaving, of these insurers who are caught for medicine nouveau riche, or for business leaders having made a successful OPA on health system? Not to our knowledge. It would make well, however. If not, arrogance could take the practice even to no more address the word to us. Small experiment. You go on Helsana insurer internet site (of which Manser is director), and you surf in the " report of company direction". What do you find? The same thing as if you read a bank report or a food for animals wholesaler report. " the benefit of the Helsana group add up to 35 millions... This amusing result is ascribable above all with a new series of efforts in the field of costs optimization". Good Ah, is said one: they reduced costs, therefore lowered their administrative expenses, or cut down on their support for hockey teams, or even shortened their TV spots. Nothing of all that. Let us read what follows: "Helsana considerably extended its activities in particular in audit fields, of benefits and allowances, and case management". Or, a little further: " Helsana carried out, these last years, a significant work aiming at intensifying benefits and allowances control ". To reduce costs, for those who would not have understood, that amount to supervising doctors. To earn money, rather than to imagine new types of collaborations, Helsana reinforces the police force. But all that is nothing. Behind, insidiously, there is the political arrogance which extends. There is Helsana, our country largest health insurer, which starts to roll mechanics, Blocher way. Visit the part " political context" of same Internet site. You will read tricks of the kind there: " health insurers could get angry, considering the lack of will of political authorities as well federal as cantonal to take, finally, steps which were discussed for a long time ". You read well: insurers threaten politicians to get angry. The text remainder is remarks in the same same vein. The insurers do not hide any more that they are rich to billions, that they have the long arm and a small patience, and that the democratic play slowness starts to annoy them. Always on this website, but in chapter " financial statement ", one learns that Helsana touched 3,5 billions swiss francs of premiums (private and public mixed...) for 1.454 million policy-holders, that reserves account for 23,8% of premiums and are assembled to 1.466 billion. Pff. To read these figures, one thinks that doctors are well little of thing, scattered in nature with their small private entreprises. One also thinks that insurers political threats are to be taken with seriously: they have the means of attracting with them, only money odor, all politicians they want. It is called lobbying. The Swiss make fun of american politicians and their bonds with industry. They are wrong. In our country, quantity of Parliament members touch money to serve soup to health insurers, but everyone don't give the damn. We do not have the right to know which - in particular which politician - sits in boards of directors of health insurances to which we are obliged to pay one's contribution. All that turns around these insurers is opaque: democracy does not have access there. Perhaps you wonder, to return from there to Helsana threat: what is it, insurers who are politically angry? Imagine that they cut lobbying funds. That they stop their formation seminars where politicians are paid with blows of tens of thousands of swiss francs. That they eject from their boards of directors the many members of Parliament who hustle themselves there to round their too small official seals. That would make very badly. At the bottom, their threat to be angry, it is really the serious one... Compete with: here is the insurers single war-horse of health. One can read the whole of their direction reports, peel their statutes, to get stuck with all their small and great reflexions, one will not find there a medicine vision. That this concept: compete with. That: to override the others and, incidentally, cause a drop in health costs. Does nothing prove that competition ever allowed the least reduction of health costs? Does it really matter: it will save swiss medicine, insurers are persuaded of it. As for them, however, no question of opening with clear rules. In their language, competition does not want to say: that the best wins. Competition wants to say: one arranges oneself between us, no State, no controls (or then, those of OFAS, where supervisors are as malicious as television gamesorganizers). No cultural approach, that obstructs when blows are given. Competition wants to still say: one gives to patients only the minimum, one benefits from their ignorance. One charm " customers ", one belittle physicians.

What will make of us the climatic reheating? Astonishing formula of Michel Petit, of UNO experts group for climate, in Libération of March 30: " One cannot say that earth will become intolerable, but it will be another world, and people are likely not to like ". Same thing for the medicine takeover by the insurers. It will be another world, perhaps not worth living, that one. Climatic reheating and future of medicine: true questions for democracy.