Women's Health Action Selections from Women's Health Watch February 2000

Women's Health Watch

edited by Sandra Coney

Selected articles from Women's Health Watch newsletters in February 2000

Contents

Issue 52, February 2000

The future of Ethics Committees -Where are they going
Editorial - Redrawing the Health Sector
Fruit and vegetables help prevent ischaemic stroke
Surgeon amputated healthy legs
The doctor's standard care -the re-use of single use devices
UK report urges strong action on surrogacy
LAM Trust seeks support
Adoption law reform is long overdue
Death of women's health movement pioneer
The future of National Women's Hospital
Ron Paterson, new Health and Disability Commissioner
Tampons safe say manufacturers
Women's groups win victory over Quinacrine Chemical Sterilisation
Gene therapy goes wrong
UK allows frozen eggs
New British guidelines for infertility treatment
Emergency pill made more available in Britain
Low birth weight babies can lead normal lives
Cereals good for heart
Drink tea to prevent hardening of the arteries

Editorial issue 52 - Redrawing the health sector

Sandra Coney has recently been appointed as a consumer representative on the New Zealand Health Strategy Sector Reference Group. She reviews where we're heading in health.

It's been full steam ahead with the energetic Minister of Health, Annette King, since the November election.

Nominations have been called for District Health Boards (DHBs) and new appointments will take their places in May. King reported that 1800 nominations were received from 1450 people.

King promises the disbandment of the Health Funding Authority (HFA) by the end of 2000.

A high-level New Zealand Health Strategy Sector Reference Group has been appointed and is meeting weekly to advise government on a New Zealand Health Strategy. This will provide the framework and overview to guide the work of the DHBs and the Ministry of Health (MOH) which will take over the national roles of the HFA.

An Expert Group is setting goals and targets for the strategy, while an Inter-agency Working Group (Ministry of Health, CCMAU, Treasury and Te Puni Kokiri) is developing the roles of DHBs. New legislation will be needed for the new structures and there will be an opportunity for submissions to select committee.

Rescuing the health sector is a big task. Ten years of health reforms have led to a high degree of fragmentation, loss of morale among workers in the sector, a changed culture that emphasises competition rather than cooperation, and a fairly profound loss of public confidence that health care will be there when needed.

Necessary cultural change won't be easy

The cultural change will probably be the most intransigent obstacle. The way of thinking in the sector has changed. Although the new government is a breath of fresh air, there has been rather a depressing whiff of the old ideology in some documents emerging so far.

The health reforms changed structures but they changed the whole approach to health from the highest level. Business methods have been applied right through and for ten managers have been trained and have 15 applied these methods. A rhetoric pervades health. It goes something like this - the public makes insatiable demands for health care - we can't afford to do everything the public wants - rationing of health care is inevitable - priority should be given to health interventions that produce the most health gains.

A parallel rhetoric is about people blaming. It says the government should not have to pay for ill health people have brought on their own heads. Behind this is a completely erroneous belief that most illness can be prevented by 'lifestyle' changes. Of course, some can, but not all. Cutting down on fat in the diet will help prevent heart disease, but it won't stop you getting breast cancer, or depressed, or being knocked down while crossing the road. There's also no recognition of why people adopt 'harmful' behaviour- smoking, drinking to excess, unsafe sex, for example - and that it often takes more than individual will to change.

There's also been a huge loss of democracy that won't just be saved by DHBs. The 'right' repressed debate and dialogue didn't welcome divergent views. It was a 'one way' approach. Yet you get the best decisions when you take into account a range of views. The one dissident could offer new ideas that provide the best way ahead.

There's also a danger that with a change of government that well-resourced interest groups, GPs for instance, will get the ear of the Minister while poorer groups - such as community groups - will be left behind. Yet unless the public's interests are to the forefront, provider self-interest will rule and we will get more distortions in the health system.

In the next few months there will be a number of documents released by Annette King for public consultation. Two of the most important are the New Zealand Health Strategy and the Primary Health Care Strategy.

Two new health strategies on drawing board

The Health Strategy will be owned by the Minister of Health, with advice from the Sector Reference Group. This group (See box for membership) is very large with a wide-ranging membership, mostly health professionals. It will be very important to set a strong direction for the whole health sector if the 22 DHBs are not to fly off in a myriad of different directions, obstructing the ability to set and carry through regional and national health strategies and programmes.

Another group, the Expert Group, will provide advice on goals and targets (see below for membership). Hopefully there will be some dialogue between these two groups, so that the direction taken by the Reference Group is reflected in the goals and targets.

It will be important for the Expert group not to just take a 'big killer' approach, ranking goals by where the largest numbers of deaths are, but uses a broader definition of health, that focuses on overall wellbeing, rather than just absence of disease.

For example, women don't die in childbirth in New Zealand, so that pregnancy and birth may rank very low if narrow criteria are adopted in devising goals, yet such things as breast-feeding rates and child-rearing practices will have a major effect on child and family health.

The Primary Health Care Strategy has been promised for some weeks but has got held up in the system. There were worrying hints in Annette King's paper to the Cabinet Business Committee that Labour was simply carrying on the direction National was taking the primary health sector.

This mentioned capitation-based funding for primary health care and primary health taking responsibility for the health of defined populations.

There are many problems with this approach, none of which have been discussed with the public. It involves enrolment with a single provider, whereas New Zealanders prefer to use a number of providers for different purposes. Although capitation is the process in the UK, where primary medical care is free, in New Zealand most patients pay their entire GP fee, and even those with Community Services Cards, pay a significant co-payment. As long as GPs are able to set their charges, and charge additional fees, consumers are at risk of high consultation fees and having costs shifted on to them.

Consumers stand to lose choice in return for nothing, and there are major issues around allocating unique identifiers, privacy and data matching, that have not been addressed.

There are also anxieties about the untested but popular idea of 'population health', which means IPAs adopting a quasi-public health approach, a method quite outside their training or methods of service delivery.

Public health's place in the new system

The future of public health will need to be resolved by the new government. A strong determinants of health focus is promised in the health strategy, but there also needs to be strong leadership in public health to prevent it being submerged by hospital and GP services, a particular worry when the DHBs are based on hospitals and each board is required to have a primary health committee.

For the last few years, public health has been largely in the hands of the public health team at the HFA, and they have built up a good team with considerable expertise. They have been successful in shifting public health money away from hospitals, so that now 55% of public health money goes to HHS compared to 85% in 1994. This has enabled resources to be redirected to non government organisations (NGOs) and Maori providers, The HFA has also increasingly funded public health advocacy and lobbying which the MOH, being closer to government, might draw the line at.

The HFA has been able to purchase nationally, regionally and locally, and it is not clear how this will be continued with DHBs, NGOs and other groups at a recent public health meeting in Auckland were dismayed at the prospect of having to gain funding from multiple DHBs. One approach would be for DHBs to combine for public health at some level.

The future of the breast and cervical screening programmes is also a worry if the HFA team is broken up. It takes several years for personnel to develop expertise in screening and this now exists in the HFA. In the wake of Gisborne, significant strides have been made in amalgamating personal and public health aspects of cervical screening.

One solution here would be an independent cancer control agency, such as was called for at last year's Cancer Control Workshop, that could implement national cancer screening and be capable of surviving political changes.

Annette King has an unenviable task, but as an editorial in New Zealand Doctor noted, she is, unlike her predecessors, encouragingly enthusiastic about her portfolio. It will be a busy year in health -when isn't it! - with a strong need for consumers and community groups to keep saying their bit.

Sandra Coney

Membership of the Reference Group & Expert Advisory Group

The members of the Reference Group are:

Dr Karen Poutasi, Ministry of Health (Chair)

Lynette Stewart, Te Tai Tokerau Maori MPO

Jane Holden, Royal NZ Foundation for the Blind

Claire Austin, Age Concern

Prof Colin Tukuitonga, Maori and Pacific Health Unit, Auckland School of Medicine

Dr John Broughton, Department of Preventative and Social Medicine, Otago School of Medicine

Dr U Manukulasuriya, General Practitioner

Alison Paterson, Waitamata Health Ltd

Dr Pippa Mackay, New Zealand Medical Association

Prof Mason Durie, National Health Committee

Stuart Bruce, Office of the Minister of Health

Dr David Bawden, Tikipunga Medical Centre

Cheryl Hamilton, Health Promotion Forum

Pauline Hinds, Lakeland Health

Sandra Coney, Women's Health Action

Dr Barbara Disley, Mental Health Commission

Brenda Wilson New Zealand Nurses Organisation

Karen Guilliland, New Zealand College of Midwives

The members of the expert Advisory Group are:

Dr Don Matheson, Project Manager, New Zealand Health Strategy (Chair)

Assoc Prof Charlotte Paul, Department of Preventative and Social Medicine, Otago School of Medicine

Prof Norm Sharpe, Auckland School of Medicine

Dr Barry Gribben, Department of General Practice and Primary Healthcare, Auckland School of Medicine

Dr Chris Cunningham, Health Research, School of Maori Studies, Massey University

Ratana Walker, Research Manager for Maori Health, Health Funding Authority

Dr Toni Ashton, Department of Community Health, University of Auckland.

The future of ethics committees - Where are they going?

Health Minister Annette King has confirmed regional research and treatment ethics committees will be funded by the Ministry of Health, leading to fears about loss of independence. Penny St John reports.

The committees, which were set up following the Cartwright Inquiry to safeguard the interests of health consumers, are currently funded and administered by the Health Funding Authority. The impending demise of the HFA means a decision must be made about a future home for regional ethics committees.

Concerns about committees coming under the wing of the Ministry of Health centre around the Ministry's increased role in policy and funding decisions under the new health regime. Regional ethics committee chair of chairs, Sharron Cole, believes there may be some tension if ethics committees are put in a position of having to make negative comments about the body which is funding and administering them.

'There will have to be ring-fencing and fire walls to ensure the independence of ethics committees.'

Other bodies such as the office of the Health and Disability Commissioner would be a better home for the regional ethics committees, according to Women's Heath Action director, Sandra Coney. Ms Coney wants the committees strengthened, and is worried ethics have not been a prime function of the Ministry. She doesn't think the HFA thought ethics were very important either and says the committees have kept going because of the commitment of members.

'Regional committees have not had a very comfortable home in the past and they need support.'

Health Minister Annette King says she is willing to consider alternative homes for the committees such as the office of the Health and Disability Commissioner. Mrs King says the Ministry will fund the committees but its is important people realise they are currently funded by the HFA through the funding directorate of the Ministry of Health. Ensuring committees remain independent is the most important factor, rather than worrying where the money comes from, according to Mrs King.

'The Health and Disability Commissioner is funded by a line item in the budget and funding comes through the Minister. No one accuses the Commissioner of being in the Ministry's pocket.'

Screening the work of regional ethics committees is not on the government's agenda, Mrs King says. She also questions why people perceive the Ministry as being more problematic for the independence of ethics committees than the HFA.

'I would imagine the HFA did not think about ethics committees until it was a requirement.'

Mrs King accepts there has been criticism of the Ministry but says people should realise a lot of these criticisms relate to past performance. She says she is struggling to understand what the problem is if the Ministry is instructed to fund and provide administration for independent committees.

National Standard review

Finding a suitable home is not the only problem regional ethics committees are facing. The Ministry of Health is reviewing the National Standard which governs the work of regional committees and Sharron Cole is worried the draft she has seen makes no mention of service delivery and clinical issues. The draft Standard refers to research and innovative techniques but Ms Cole points out service delivery and clinical issues are a significant part of ethics committee work.

The fear is that ethics committees may not get funding for clinical ethics and service delivery work if these are not included in the National Standard. Ms Cole worries funders could argue committees are not contracted to provide this advice.

Ethics committees are being approached by a wide range of groups seeking opinions on service delivery and clinical issues, according to Ms Cole. GP groups introducing new integrated care projects have sought ethical opinions, clinicians seek opinions on procedures and recent minutes of the Wellington Ethics Committee show PHARMAC has put in a request for an ethical opinion.

Standard modelled on Australian version

Ms Cole believes the working group may have modelled its new standard on the Australian version but points out that in Australia research ethics committees and clinical ethics committees are separate bodies. In New Zealand regional committees deal with all issues.

However the Ministry of Health argues Ms Cole is incorrect. The Group Director of Regulation Development, Gail Powell, says the National Standard is being revised to provide greater clarity and guidance about the provision of advice on service issues. The review of the Standard aims to provide a clearer and more practical framework in which ethics committees will operate. This includes the development of a set of ethical principles to guide committees and to ensure New Zealand is in line with the approach taken overseas. A working group made up of 12 members (Carmel Peteru, Dr Bruce Scoggins, Nadja Tollemache, Marge Scott, Kay Worrall, Jenny Maher, Rosemary De Luca, Carol Algie, Professor Donald Evans, Sandy Barry, Neil Pearce and Martin Wilkinson) is contributing to the review.

The Ministry says it intends to distribute a draft of the revised Standard for consultation to regional ethics committees, health professional groups and other interested parties in May.

Consumer groups want Committees strengthened

In fact health consumer groups like Women's Health Action want regional committees strengthened so they can consider more service delivery and clinical issues. Ms Coney is concerned ethics committees are popping up which may not conform to the National Standard, do not have lay members and do not publicly release their findings. These new ethics committees may be a response to under-funded regional ethics committees being snowed under and taking too long to consider issues, Ms Coney believes.

Major changes in the health system such as rationing decisions and the booking system should be considered by ethics committees, according to Ms Coney. At the moment the Ministry of Health can contract for ethical advice for the Minister of Health on issues of national importance. Until last year this advice was to be provided by a committee called NACHDSE but this body was disbanded last year following a review. It is understood NACHDSE was never asked for an opinion.

Ms Powell believes the Ministry would contract in advice when regional ethics committees raise an issue they want considered at national level.

'At this stage the Minister of Health has not been approached with any requests.'

An assessment of the expertise required to address a particular issue will be made on a case-by-case basis, Ms Powell says. Any advisory group would consist of a balance of lay and professional members and could include representatives from regional ethics committees.

Tampons safe say manufacturers

New Zealand tampon manufacturers vehemently deny rumours about tampon safety which are being circulated on the Internet by an American manufacturer of cotton tampons.

Over the last couple of months Women's Health Action has received a number of queries from women concerned by allegations that tampons contain dangerous traces of asbestos and dioxin.

Both Johnson and Johnson, the manufacturers of Carefree Tampons and Proctor and Gamble, which make Tampax say there is, and has never, been asbestos nor dioxin in their tampons.

The methods used to analyse for dioxin are the most advanced government-approved testing methods available and can detect even minute amount of dioxin.

Tampons are made from a blend of cotton and rayon fibres. Rayon is formed from cellulose which comes from wood pulp. Although the wood pulp must under go a bleaching process in order to convert it into a soft, highly absorbent substance, molecular chlorine is not used in the process, therefore no dioxins are produced.

Marilyn Grant, consumer service manager for Johnson and Johnson, says there is no evidence to suggest that cotton tampons are safer than rayon tampons, as suggested by the net myths. 'Both cotton and rayon are pure cellulose fibre. One is spun by a plant and the other by a machine using cellulose from wood pulp. The advantage of rayon is its consistency, cleanliness and absence of impurities. Cotton during its growth can be exposed to pesticides and other environment contaminants.'

As Proctor and Gamble's Jaime Malder states, there is absolutely no scientific evidence that tampons lead to the development of endometriosis or cancer, as suggested by the net myths.

Neither company have any plans to market an all cotton tampon and advise women concerned by the myths to visit the FDA's web page on tampons.

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	Women's Health Watch edited by Sandra Coney Selected articles from Women's Health Watch newsletters in February 2000 Contents Issue 52, February 2000 The future of Ethics Committees -Where are they going Editorial - Redrawing the Health Sector Fruit and vegetables help prevent ischaemic stroke Surgeon amputated healthy legs The doctor's standard care -the re-use of single use devices UK report urges strong action on surrogacy LAM Trust seeks support Adoption law reform is long overdue Death of women's health movement pioneer The future of National Women's Hospital Ron Paterson, new Health and Disability Commissioner Tampons safe say manufacturers Women's groups win victory over Quinacrine Chemical Sterilisation Gene therapy goes wrong UK allows frozen eggs New British guidelines for infertility treatment Emergency pill made more available in Britain Low birth weight babies can lead normal lives Cereals good for heart Drink tea to prevent hardening of the arteries Editorial issue 52 - Redrawing the health sector Sandra Coney has recently been appointed as a consumer representative on the New Zealand Health Strategy Sector Reference Group. She reviews where we're heading in health. It's been full steam ahead with the energetic Minister of Health, Annette King, since the November election. Nominations have been called for District Health Boards (DHBs) and new appointments will take their places in May. King reported that 1800 nominations were received from 1450 people. King promises the disbandment of the Health Funding Authority (HFA) by the end of 2000. A high-level New Zealand Health Strategy Sector Reference Group has been appointed and is meeting weekly to advise government on a New Zealand Health Strategy. This will provide the framework and overview to guide the work of the DHBs and the Ministry of Health (MOH) which will take over the national roles of the HFA. An Expert Group is setting goals and targets for the strategy, while an Inter-agency Working Group (Ministry of Health, CCMAU, Treasury and Te Puni Kokiri) is developing the roles of DHBs. New legislation will be needed for the new structures and there will be an opportunity for submissions to select committee. Rescuing the health sector is a big task. Ten years of health reforms have led to a high degree of fragmentation, loss of morale among workers in the sector, a changed culture that emphasises competition rather than cooperation, and a fairly profound loss of public confidence that health care will be there when needed. Necessary cultural change won't be easy The cultural change will probably be the most intransigent obstacle. The way of thinking in the sector has changed. Although the new government is a breath of fresh air, there has been rather a depressing whiff of the old ideology in some documents emerging so far. The health reforms changed structures but they changed the whole approach to health from the highest level. Business methods have been applied right through and for ten managers have been trained and have 15 applied these methods. A rhetoric pervades health. It goes something like this - the public makes insatiable demands for health care - we can't afford to do everything the public wants - rationing of health care is inevitable - priority should be given to health interventions that produce the most health gains. A parallel rhetoric is about people blaming. It says the government should not have to pay for ill health people have brought on their own heads. Behind this is a completely erroneous belief that most illness can be prevented by 'lifestyle' changes. Of course, some can, but not all. Cutting down on fat in the diet will help prevent heart disease, but it won't stop you getting breast cancer, or depressed, or being knocked down while crossing the road. There's also no recognition of why people adopt 'harmful' behaviour- smoking, drinking to excess, unsafe sex, for example - and that it often takes more than individual will to change. There's also been a huge loss of democracy that won't just be saved by DHBs. The 'right' repressed debate and dialogue didn't welcome divergent views. It was a 'one way' approach. Yet you get the best decisions when you take into account a range of views. The one dissident could offer new ideas that provide the best way ahead. There's also a danger that with a change of government that well-resourced interest groups, GPs for instance, will get the ear of the Minister while poorer groups - such as community groups - will be left behind. Yet unless the public's interests are to the forefront, provider self-interest will rule and we will get more distortions in the health system. In the next few months there will be a number of documents released by Annette King for public consultation. Two of the most important are the New Zealand Health Strategy and the Primary Health Care Strategy. Two new health strategies on drawing board The Health Strategy will be owned by the Minister of Health, with advice from the Sector Reference Group. This group (See box for membership) is very large with a wide-ranging membership, mostly health professionals. It will be very important to set a strong direction for the whole health sector if the 22 DHBs are not to fly off in a myriad of different directions, obstructing the ability to set and carry through regional and national health strategies and programmes. Another group, the Expert Group, will provide advice on goals and targets (see below for membership). Hopefully there will be some dialogue between these two groups, so that the direction taken by the Reference Group is reflected in the goals and targets. It will be important for the Expert group not to just take a 'big killer' approach, ranking goals by where the largest numbers of deaths are, but uses a broader definition of health, that focuses on overall wellbeing, rather than just absence of disease. For example, women don't die in childbirth in New Zealand, so that pregnancy and birth may rank very low if narrow criteria are adopted in devising goals, yet such things as breast-feeding rates and child-rearing practices will have a major effect on child and family health. The Primary Health Care Strategy has been promised for some weeks but has got held up in the system. There were worrying hints in Annette King's paper to the Cabinet Business Committee that Labour was simply carrying on the direction National was taking the primary health sector. This mentioned capitation-based funding for primary health care and primary health taking responsibility for the health of defined populations. There are many problems with this approach, none of which have been discussed with the public. It involves enrolment with a single provider, whereas New Zealanders prefer to use a number of providers for different purposes. Although capitation is the process in the UK, where primary medical care is free, in New Zealand most patients pay their entire GP fee, and even those with Community Services Cards, pay a significant co-payment. As long as GPs are able to set their charges, and charge additional fees, consumers are at risk of high consultation fees and having costs shifted on to them. Consumers stand to lose choice in return for nothing, and there are major issues around allocating unique identifiers, privacy and data matching, that have not been addressed. There are also anxieties about the untested but popular idea of 'population health', which means IPAs adopting a quasi-public health approach, a method quite outside their training or methods of service delivery. Public health's place in the new system The future of public health will need to be resolved by the new government. A strong determinants of health focus is promised in the health strategy, but there also needs to be strong leadership in public health to prevent it being submerged by hospital and GP services, a particular worry when the DHBs are based on hospitals and each board is required to have a primary health committee. For the last few years, public health has been largely in the hands of the public health team at the HFA, and they have built up a good team with considerable expertise. They have been successful in shifting public health money away from hospitals, so that now 55% of public health money goes to HHS compared to 85% in 1994. This has enabled resources to be redirected to non government organisations (NGOs) and Maori providers, The HFA has also increasingly funded public health advocacy and lobbying which the MOH, being closer to government, might draw the line at. The HFA has been able to purchase nationally, regionally and locally, and it is not clear how this will be continued with DHBs, NGOs and other groups at a recent public health meeting in Auckland were dismayed at the prospect of having to gain funding from multiple DHBs. One approach would be for DHBs to combine for public health at some level. The future of the breast and cervical screening programmes is also a worry if the HFA team is broken up. It takes several years for personnel to develop expertise in screening and this now exists in the HFA. In the wake of Gisborne, significant strides have been made in amalgamating personal and public health aspects of cervical screening. One solution here would be an independent cancer control agency, such as was called for at last year's Cancer Control Workshop, that could implement national cancer screening and be capable of surviving political changes. Annette King has an unenviable task, but as an editorial in New Zealand Doctor noted, she is, unlike her predecessors, encouragingly enthusiastic about her portfolio. It will be a busy year in health -when isn't it! - with a strong need for consumers and community groups to keep saying their bit. Sandra Coney Membership of the Reference Group & Expert Advisory Group The members of the Reference Group are: Dr Karen Poutasi, Ministry of Health (Chair) Lynette Stewart, Te Tai Tokerau Maori MPO Jane Holden, Royal NZ Foundation for the Blind Claire Austin, Age Concern Prof Colin Tukuitonga, Maori and Pacific Health Unit, Auckland School of Medicine Dr John Broughton, Department of Preventative and Social Medicine, Otago School of Medicine Dr U Manukulasuriya, General Practitioner Alison Paterson, Waitamata Health Ltd Dr Pippa Mackay, New Zealand Medical Association Prof Mason Durie, National Health Committee Stuart Bruce, Office of the Minister of Health Dr David Bawden, Tikipunga Medical Centre Cheryl Hamilton, Health Promotion Forum Pauline Hinds, Lakeland Health Sandra Coney, Women's Health Action Dr Barbara Disley, Mental Health Commission Brenda Wilson New Zealand Nurses Organisation Karen Guilliland, New Zealand College of Midwives The members of the expert Advisory Group are: Dr Don Matheson, Project Manager, New Zealand Health Strategy (Chair) Assoc Prof Charlotte Paul, Department of Preventative and Social Medicine, Otago School of Medicine Prof Norm Sharpe, Auckland School of Medicine Dr Barry Gribben, Department of General Practice and Primary Healthcare, Auckland School of Medicine Dr Chris Cunningham, Health Research, School of Maori Studies, Massey University Ratana Walker, Research Manager for Maori Health, Health Funding Authority Dr Toni Ashton, Department of Community Health, University of Auckland. The future of ethics committees - Where are they going? Health Minister Annette King has confirmed regional research and treatment ethics committees will be funded by the Ministry of Health, leading to fears about loss of independence. Penny St John reports. The committees, which were set up following the Cartwright Inquiry to safeguard the interests of health consumers, are currently funded and administered by the Health Funding Authority. The impending demise of the HFA means a decision must be made about a future home for regional ethics committees. Concerns about committees coming under the wing of the Ministry of Health centre around the Ministry's increased role in policy and funding decisions under the new health regime. Regional ethics committee chair of chairs, Sharron Cole, believes there may be some tension if ethics committees are put in a position of having to make negative comments about the body which is funding and administering them. 'There will have to be ring-fencing and fire walls to ensure the independence of ethics committees.' Other bodies such as the office of the Health and Disability Commissioner would be a better home for the regional ethics committees, according to Women's Heath Action director, Sandra Coney. Ms Coney wants the committees strengthened, and is worried ethics have not been a prime function of the Ministry. She doesn't think the HFA thought ethics were very important either and says the committees have kept going because of the commitment of members. 'Regional committees have not had a very comfortable home in the past and they need support.' Health Minister Annette King says she is willing to consider alternative homes for the committees such as the office of the Health and Disability Commissioner. Mrs King says the Ministry will fund the committees but its is important people realise they are currently funded by the HFA through the funding directorate of the Ministry of Health. Ensuring committees remain independent is the most important factor, rather than worrying where the money comes from, according to Mrs King. 'The Health and Disability Commissioner is funded by a line item in the budget and funding comes through the Minister. No one accuses the Commissioner of being in the Ministry's pocket.' Screening the work of regional ethics committees is not on the government's agenda, Mrs King says. She also questions why people perceive the Ministry as being more problematic for the independence of ethics committees than the HFA. 'I would imagine the HFA did not think about ethics committees until it was a requirement.' Mrs King accepts there has been criticism of the Ministry but says people should realise a lot of these criticisms relate to past performance. She says she is struggling to understand what the problem is if the Ministry is instructed to fund and provide administration for independent committees. National Standard review Finding a suitable home is not the only problem regional ethics committees are facing. The Ministry of Health is reviewing the National Standard which governs the work of regional committees and Sharron Cole is worried the draft she has seen makes no mention of service delivery and clinical issues. The draft Standard refers to research and innovative techniques but Ms Cole points out service delivery and clinical issues are a significant part of ethics committee work. The fear is that ethics committees may not get funding for clinical ethics and service delivery work if these are not included in the National Standard. Ms Cole worries funders could argue committees are not contracted to provide this advice. Ethics committees are being approached by a wide range of groups seeking opinions on service delivery and clinical issues, according to Ms Cole. GP groups introducing new integrated care projects have sought ethical opinions, clinicians seek opinions on procedures and recent minutes of the Wellington Ethics Committee show PHARMAC has put in a request for an ethical opinion. Standard modelled on Australian version Ms Cole believes the working group may have modelled its new standard on the Australian version but points out that in Australia research ethics committees and clinical ethics committees are separate bodies. In New Zealand regional committees deal with all issues. However the Ministry of Health argues Ms Cole is incorrect. The Group Director of Regulation Development, Gail Powell, says the National Standard is being revised to provide greater clarity and guidance about the provision of advice on service issues. The review of the Standard aims to provide a clearer and more practical framework in which ethics committees will operate. This includes the development of a set of ethical principles to guide committees and to ensure New Zealand is in line with the approach taken overseas. A working group made up of 12 members (Carmel Peteru, Dr Bruce Scoggins, Nadja Tollemache, Marge Scott, Kay Worrall, Jenny Maher, Rosemary De Luca, Carol Algie, Professor Donald Evans, Sandy Barry, Neil Pearce and Martin Wilkinson) is contributing to the review. The Ministry says it intends to distribute a draft of the revised Standard for consultation to regional ethics committees, health professional groups and other interested parties in May. Consumer groups want Committees strengthened In fact health consumer groups like Women's Health Action want regional committees strengthened so they can consider more service delivery and clinical issues. Ms Coney is concerned ethics committees are popping up which may not conform to the National Standard, do not have lay members and do not publicly release their findings. These new ethics committees may be a response to under-funded regional ethics committees being snowed under and taking too long to consider issues, Ms Coney believes. Major changes in the health system such as rationing decisions and the booking system should be considered by ethics committees, according to Ms Coney. At the moment the Ministry of Health can contract for ethical advice for the Minister of Health on issues of national importance. Until last year this advice was to be provided by a committee called NACHDSE but this body was disbanded last year following a review. It is understood NACHDSE was never asked for an opinion. Ms Powell believes the Ministry would contract in advice when regional ethics committees raise an issue they want considered at national level. 'At this stage the Minister of Health has not been approached with any requests.' An assessment of the expertise required to address a particular issue will be made on a case-by-case basis, Ms Powell says. Any advisory group would consist of a balance of lay and professional members and could include representatives from regional ethics committees. Tampons safe say manufacturers New Zealand tampon manufacturers vehemently deny rumours about tampon safety which are being circulated on the Internet by an American manufacturer of cotton tampons. Over the last couple of months Women's Health Action has received a number of queries from women concerned by allegations that tampons contain dangerous traces of asbestos and dioxin. Both Johnson and Johnson, the manufacturers of Carefree Tampons and Proctor and Gamble, which make Tampax say there is, and has never, been asbestos nor dioxin in their tampons. The methods used to analyse for dioxin are the most advanced government-approved testing methods available and can detect even minute amount of dioxin. Tampons are made from a blend of cotton and rayon fibres. Rayon is formed from cellulose which comes from wood pulp. Although the wood pulp must under go a bleaching process in order to convert it into a soft, highly absorbent substance, molecular chlorine is not used in the process, therefore no dioxins are produced. Marilyn Grant, consumer service manager for Johnson and Johnson, says there is no evidence to suggest that cotton tampons are safer than rayon tampons, as suggested by the net myths. 'Both cotton and rayon are pure cellulose fibre. One is spun by a plant and the other by a machine using cellulose from wood pulp. The advantage of rayon is its consistency, cleanliness and absence of impurities. Cotton during its growth can be exposed to pesticides and other environment contaminants.' As Proctor and Gamble's Jaime Malder states, there is absolutely no scientific evidence that tampons lead to the development of endometriosis or cancer, as suggested by the net myths. Neither company have any plans to market an all cotton tampon and advise women concerned by the myths to visit the FDA's web page on tampons.