Swine flu controversy.
The swine flu vaccination program was suspended in December 1976 by then Assistant Secretary for Health Dr. Theodore Cooper, who acted after reviewing studies showing a possible connection between use of the swine flu vaccine and the development of a severe neurological disorder called the Guillain-Barr‚ syndrome. According to statistics compiled by the Center for Disease Control, of 1,104 cases of Guillain-Barr‚ syndrome reported in late 1976, 535, including 28 resulting in death, had apparently followed inoculation of the patient against swine flu. Early in February, however, HEW Secretary Califano partially lifted the moratorium on the use of the vaccine because of an outbreak of A-Victoria influenza, against which one type of swine flu vaccine (the bivalent) was effective. Later, the Public Health Service advised that elderly persons and those with chronic illnesses receive inoculations against A-Victoria and B-Hong Kong influenza to prepare for the 1977-1978 flu season. The general suspension of the swine flu inoculation program remained in force, however.
Meanwhile, a group of consumer organizations, later joined by the Pharmaceutical Manufacturers' Association, urged Califano to establish a national immunization commission to develop and oversee a national vaccination policy.
The Food and Drug Administration proposed on March 9 that the artificial sweetener saccharin be banned in itself and as a food additive. Recently released Canadian studies had linked administration of large quantities of saccharin to laboratory animals with development of bladder cancer. Although a storm of protest from diabetics, dieters, and soft-drink manufacturers followed this announcement, the FDA's case apparently was strengthened in June, when a report was released of a Canadian epidemiological study that appeared to demonstrate a definite association between consumption of saccharin and the development of bladder cancer in human males. Though the FDA had by that time already modified its proposal, to permit the sale of saccharin as an over-the-counter drug, Congress acted to delay implementation of the proposed ban. In September and October both houses gave approval to measures appropriating funds for further saccharin studies and postponing any FDA ban until such studies were completed.
The Center for Disease Control reported an increase of 12 percent in the number of legal abortions in the United States in 1975. About one-third of those having abortions were teenagers. According to the CDC statistics, the ratio of abortions to live births in 1975 was 272 per 1,000.
Meanwhile, Congress was sharply divided over whether to continue for fiscal 1978 a ban on the use of federal medicaid funds to pay for most abortions for poor women. (The ban, first voted for fiscal 1977, was actually not in effect until late in the fiscal year because of court challenges.) After the Senate modified the ban by approving all 'medically necessary' medicaid abortions, the House voted to adhere to the original terms of the ban, which prohibited the use of federal medicaid funds for all abortions except those required to save the mother's life. The ensuing deadlock over this issue stalled passage of the $60.3 billion appropriations bill to operate the Departments of Labor and HEW during the fiscal year beginning October 1. A House concession, on October 12, allowed federal funding of medical procedures for victims of rape and incest, but a final agreement between both houses was still awaited.
The Federal Trade Commission has recently begun to gather information on the alleged lack of competition in the delivery and financing of health-care services. In one of its first actions in this area, the FTC on April 20 ordered the Minnesota State Medical Society to refrain from developing and publicizing 'relative value scales' and dollar conversion factors to guide physicians in setting fees. Relative value scales had been used to equate certain medical services and to rate some services as inherently more valuable than others. According to the FTC, publication of the scales amounted to illegal price fixing by the medical society.
In a related matter, the FTC indicated its concern about the American Medical Association's role in the Liaison Committee on Graduate Medical Education, the accrediting agency for medical schools. The commission focused its attention on a possible conflict of interest by the AMA in exerting influence over medical education. The FTC also issued a staff report which concluded that health maintenance organizations could stimulate competition in their areas of operation, and thus reduce health-care costs.
Foreign doctor phaseout.
Under a federal statute that took effect on January 10, foreign medical school graduates will be barred after 1980 from completing their medical education in the United States. Although the bill provides for waivers on a case-by-case basis if health services would otherwise be adversely affected, the American Hospital Association foresaw major problems resulting from the ban, particularly in big-city public hospitals, whose staffs traditionally have included significant percentages of foreign doctors. Presently, foreign medical school graduates make up 30 percent of the 50,000 interns and residents in U.S. hospitals, and as much as 80 percent of the house staffs at some metropolitan hospitals. In order to soften the impact of the ban, recruitment of foreign doctors will be phased out gradually over the next two years.
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