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Canada’s health and science ministers

Canada’s new Liberal government willconvene a National Forum of Health, aspromised during the campaign trail, to seekprescriptions for the ailing Medicare sys-tem, said newly appointed Minister ofHealth Diane Marleau. But although theforum is the Liberal’s "first priority" in thearea of health care, Marleau says it is too

early to predict when it will be held or whatit might accomplish.Many observers speculate that the intent

is to draft a so-called "core list" of health-care services that all provincial Medicareplans will be obliged to cover as they striveto constrain system costs. But when askedwhether that was a likely outcome, Marleauwas non-committal. She also ducked ques-tions as to whether cost reduction is the

primary aim of the exercise.But with all the provinces struggling to

pay their Medicare bills in the face of the

previous Conservative administration’s de-cision to withdraw slowly federal supportfor the system, much will depend on thenature of the federal-provincial cost-

sharing agreements that are struck whencurrent arrangements expire over the nextfew years.

Marleau’s selection as health ministersurprised many observers because of theminor role she played while the Liberalswere in opposition, as well as her relativeunfamiliarity with the field. An admini-strator of an accounting firm before beingelected to the Commons in 1988, Marleau’sinvolvement in health care was limited to astint as co-chair of a hospital cancer-careservices campaign and a term as chair of theSudbury chapter of the Canadian CancerSociety. In selecting Marleau, PrimeMinister Jean Chretien overlooked severalLiberals with far more experience in health :care, including Dr Hedy Fry, former presi-dent of the British Columbia MedicalAssociation, who had been ticketed for thepost until she was reprimanded last week bythe BC College of Physicians and Surgeonsfor admitting that she occasionally wroteprescriptions for gay or lesbian patientscovered by a drug plan on behalf of apartner who was not covered by a plan. :

Rarely has such a senior cabinet postgone to such a relative political neophyte,especially after an election in which Medi-care became a major issue when the right-

wing Reform Party (which in winning 52

seats came within 2 seats of becoming HerMajesty’s Loyal Opposition) advocatedthat Ottawa allow provinces to introduceuser fees and private insurance schemes, sothat wealthy Canadians could obtain betterquality care from private clinics instead ofrelying on the vicissitudes of the publicsystem. But Chretien and the Liberalsinsisted that they would never allow thesystem to be so compromised, and Marleauechoed that sentiment last week.

Chretien’s new cabinet was also marked

by a decision to strip the science ministry ofits cabinet status. In the future, scienceagencies such as the Medical ResearchCouncil will be governed by the industryministry. But with the creation of adjunct"junior" minister (secretary of state) posts,Chretien appointed newly-elected Dr JonGerrard to be secretary of state for science,research and development. Gerrard, headof paediatric haematology and oncology atthe Children’s Hospital of Winnipeg andprofessor at the University of Manitoba’sfaculty of medicine, will not sit at thecabinet table but will be tasked with 7 otherstate secretaries to "assist cabinet ministersin specific areas within their portfolios,particularly those related to job creationand economic growth".

Wayne Kondro

Europe’s blood trail

The UK is one of the wave of countries tobe affected by the latest health-relatedscandal in Germany. The Austrian phar-maceutical company, Immuno, has recalledfrom UK hospitals eight batches ofalbumin and immunoglobulin derivedfrom single-donor plasma supplied by UBPlasma, the company at the centre of theGerman tainted-blood story. Withdrawalof these products was purely precau-tionary, since the preparation of both pro-ducts involved inactivating steps, and eachof the batches was tested and passed by theUK National Institute for BiologicalStandards. Austrian, Swiss, Swedish, andItalian governments are also recalling pro-ducts derived from UB Plasma supplies. !The German situation first came to light

earlier this year when two senior civilservants were dismissed by Horst Seehofer,the health minister, for not informing himabout cases of transfusion-associated HIV

infection; the federal drug agency wasdissolved as a result (see Lancet Oct 16,p 980; Oct 23, p 1046). Subsequent investi-gations by the German authorities un-covered substandard testing practices atUB Plasma, a licensed plasmapheresiscentre in Koblenz that was supervised bythe local (Rhineland-Palatinate) health

authority. In the past two weeks, the

company has been closed down and four ofits employees have been arrested on chargesof fraud and actual bodily harm. The

Government discovered that in the pastyear only a third of donations to UB Plasmawere being screened for HIV. In addition,blood from several donors was beingpooled before testing, instead of batchesbeing individually analysed. Two othercompanies are now under investigation.Public and professional concern was raisedfurther when Seehofer recommended that

any person who had been treated withblood products since 1980 should be tested

for HIV infection. Widespread anxiety hasled to many patients cancelling theirbooked operations. Observers predict thatattention will focus next on the financialside of the blood-donation industry,

especially the part that financial incentivesto donors has played in this story. It is likelyto strengthen demands for self-sufficiencyin blood products in the EC.

Sarah Ramsay

EC Commission and blood self-sufficiency , ’ . ..

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EC health ministers will add further fuel to the ongoing row over blood products onDec 13 when they confirm Europe’s goal of self-sufficiency in blood products based onvoluntary, unpaid donations. However, they will stop short of backing the EuropeanParliament’s September call for an EC ban on commercial products collected from paidsources. 85% of commercial blood products for EC markets comes from plasma!’ ,;

pheresis programmes where sources are paid and 90% of the plasmapheresis collectionprogrammes are based in the USA. .:,’,’, The Dec 13 Health Council will consider an EC Commission report on the current-,-,

situation with blood products in Europe and underline the self-sufficiency target in theEC’s 1989 blood products directive (891381). Commission health officials say the resolution will go no further than the directive’s article 3, which says that EC membefstates "should take the necessary measures to promote, Community self-sufficiency".The blood products industry has been running scared since September with a’;

pan-European media campaign against what it views as the Parliament’s attempt to decommercialise plasma supplies. It claims that any ban would leave Europe 3.8 million litres of plasma short every year, since the private sector currently supplies 60 % of theEC’s 6-3 million litres annual plasma requirements. Patient welfare is not the companies’ only concern, since they stand to lose US$960 000 from a ban on imports wCommission health officials claim that self-sufficiency is not on the cards at this time

but will remain a stated goal of the EC for the future. They dismiss industry scaremongering that the EC could push ahead with a ban on plasma from paid sources.Sara Lewis