24th May 2001
Russian women, or the young ones anyway, have long shapely legs of which they are very proud. I was asked to demonstrate Professor George Fegan's compression sclero therapy technique for the treatment of varicose veins at the Russian Association of Phlebology meeting in Rostov-on Don recently.
There were several hundred members at the meeting, mainly vascular surgeons from all over Russia and some neighbouring countries. An excellent interpreter had been provided and a Russian specialist had chosen five patients for me to treat. All were women and would have been a credit to any corp de ballet, from more than the legs point of view. Two had had previous operative treatment but of the five, if three had come to me in Ireland, I said I would have advised them to leave their legs alone. When asked why, because they did have some minor veins or telangiectasia, I said that if the patients had any marks on their legs that they didn't like afterwards they might sue me. Would you believe it the doctors present knew nothing about medical litigation and said surely if one did the best one could for a patient all would be well. Welcome to the free world is the answer to that. In the end I treated three patients and the Russian specialist very expertly treated the other two.
Our high level of litigation in all fields here is, I am sure, acting against patients' interests as well as doctors'. I have written before about the vaccine trials carried out in the 1960s and 70s and my concern that they were to be examined under the Child Abuse Act, 2000. Well, the Act has been extended to become the Child Abuse Act, 2000 (Additional Functions) Order 2001 to cover an investigation into the trials. The protection of the rights of children, particularly those in the care of the state, must be paramount but I do hope the health of other children due to a continued fall in immunisation does not follow putting these trials under any sort of heading of "abuse".
When we debated the extension of the Act in the Seanad I did ask the Minister for State, Dr. Tom Moffat, if it was not possible that in the future this Act could be used in unexpected ways. For example, recent figures have shown us that in 1980 we had 29,400 nurses working in the Health Service and by 1999, the most recent figures I could get, we have only 27,100. Surely all those children who have had vital operations cancelled due to lack of nurses and, therefore, shortage of beds could allege abuse because the State was not protecting their rights to essential medical treatment by ensuring staff were properly paid and available?
On several occasions recently I have asked on the Order of Business that the Minister for Finance, not the Minister for Health and Children, should come into the Seanad to discuss the Health Services. I have specifically asked for the Minister for Finance to take the debate because the Minister for Health appears to be addressing the problems in the Health Service but the Department of Finance just "notes" his requests. I am not holding my breath about Charlie McCreevy's arrival but while I am sorry for the patients being treated or not treated at present I am even more sorry for the demoralised staff.
The total Bill for medical defence, mainly paid for by the state, is horrific and legal advice is independently paid for by hospitals as well. Patients or their relations do not know that the vast majority of cases either do not come to court or fail and the enthusiasm for setting up tribunals seems to have really bedded in.
One of the most extraordinary facts about this new investigation into the vaccination trials is, I have been told, that changes are being made by the Department of Health and Children in infant vaccination schedules next month which seem to me to be based on the work undertaken in those trials.
In the 1960's trial oral polio vaccine was not available. We had just had a serious outbreak of polio, especially in Munster, with deaths in hundreds and morbidity in thousands. The trial was to see if a quadruple vaccine of diphtheria, tetanus, pertussis and polio gave as satisfactory an immunity as giving triple vaccine and the polio jabs separately. In other words an attempt was being made to reduce the number of injections the child received. I have been told that as and from June oral polio vaccine is to be abandoned due to the inadvertent infection of some adults by the faeces of children who had recently been given oral polio vaccine. And guess what - the children are to get a quadruple vaccine of the type based on Dr. Hillary's work where she showed it was effective!
Even more amazing, the new pertussis element in the vaccine is part of the pertussis cell only. And what was the basis of the 1970's trial? To see how low a level of pertussis organisms in the vaccine could be administered and still be effective! Now we see that even parts of cells can stimulate enough antibody reaction. Again Dr. Hillary's work was necessary. The reduction of the number of clinical trials done in this country will not be to our benefit in the long run.
Senator Mary Henry, MD
