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Appeals Court Panel Says Pharmacists Must Distribute Emergency Contraception Under Washington State Regulation
A three-judge panel of the U.S. Circuit Court of Appeals for the 9th Circuit on Wednesday unanimously ruled to lift an injunction blocking Washington state officials from penalizing pharmacists who refused to dispense the emergency contraception pill Plan B, the Los Angeles Times reports (Williams, Los Angeles Times, 7/9). The panel said the district court judge who issued the injunction refused to consider women"s need for EC (Egelko, San Francisco Chronicle, 7/9). The panel"s ruling is part of a larger case before the district court involving the constitutionality of a 2007 state regulation requiring pharmacies to stock and dispense EC. Joyce Roper, an assistant attorney general for Washington state, said the appeals court ruling means that the 2007 regulation will take immediate effect.The plaintiffs in the case, Stromans -- a supermarket pharmacy owner -- and two pharmacists employed elsewhere, argued that the state regulation requiring pharmacists to stock and dispense EC violated their First Amendment right to freedom of religion (Los Angeles Times, 7/9). The regulation said that pharmacies must stock and fill legally prescribed prescriptions but allowed individual pharmacists to object on moral or religious grounds if another pharmacist was available, in person or by telephone, to fill the order (San Francisco Chronicle, 7/9). The plaintiffs argued that the regulation would force them to choose between following their religious beliefs and keeping their jobs. They contended that EC prevents implantation of a fertilized egg, which they equated with abortion. The U.S. District Court in Seattle awarded the plaintiffs the temporary injunction in November 2007, pending trial on the constitutionality of the regulation (Los Angeles Times, 7/9). Plan B contains a high dose of a drug found in most birth control pills that generally prevents ovulation or the fertilization of an egg. Recent research suggests that it does not prevent a fertilized egg from implanting in the uterus (Woodward, AP/Seattle Post-Intelligencer, 7/8). FDA in April lowered the age limit for nonprescription purchase of Plan B from 18 to 17 (San Francisco Chronicle, 7/9). Appeals Panel Returns Case to District CourtThe appeals court panel ruled that the freedom to exercise one"s religion "does not relieve an individual of the obligation to comply with a valid and neutral law of general applicability." The panel added, "Any refusal to dispense -- regardless of whether it is motivated by religion, morals, conscience, ethics, discriminatory prejudices or personal distaste for a patient -- violates the rules" (Los Angeles Times, 7/9). The panel ordered the district judge to reconsider the 2007 regulation under Supreme Court standards that allow states to pass neutral laws that may affect religious practices. According to the panel, the regulation does not aim to interfere with religious practices or beliefs and is intended to promote patients" health. In addition, the panel said the district court judge did not consider how the injunction would affect "sexually active women of childbearing age who will be denied reasonable access to Plan B" (San Francisco Chronicle, 7/9). According to the Times, the panel"s ruling could foretell future judgments in the case, including that a patient"s right to timely medication surpasses a pharmacist"s personal beliefs (Los Angeles Times, 7/9).
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2009/040 NICE Issues Final Guidance On The Use Of Cetuximab For The Treatment Of Head And Neck Cancer
The National Institute for Health and Clinical Excellence (NICE) has published guidance on cetuximab for the treatment of recurrent and/or metastatic (where the cancer has spread) squamous cell cancer of the head and neck. The guidance does not recommend cetuximab in combination with platinum- based chemotherapy as a treatment option for patients with this type of head and neck cancer.
News of the day
Medtronic-Supported Clinical Trial Shows ICD Patients Less Likely To Develop Need For Pacing When Device Uses MVP(R) Mode
MVP® (Managed Ventricular Pacing), exclusive programming on Medtronic pacemakers, which is proven to be effective in reducing unnecessary pacing in pacemaker patients, was applied in the MVP Trial of implantable cardioverter-defibrillator (ICD) patients. Data from MVP trial, sponsored by Medtronic, Inc. (NYSE: MDT), were presented today as a late breaking clinical trial at Heart Rhythm 2009, the annual scientific sessions of the Heart Rhythm Society.
Cardiovascular

Action Needed Now To Stop NHS Wales Becoming Unsafe For Staff And Patients - Says British Medical Association Cymru Wales

Doctors" leaders are warning that unless urgent action is taken to plug the gap in the shortage of middle grade doctors, the NHS in Wales could become unsafe both for staff and patients. The problem has been highlighted most recently within Hywel Dda NHS Trust, where 62 posts remain vacant. But this situation is by no means isolated to Hywel Dda, with Abertawe Bro Morgannwg Trust having had to move some specialist services because they were inadequately staffed and similar problems are also affecting North Wales too. Dr Richard Lewis, Welsh Secretary of the BMA says: "We are facing unprecedented levels of a lack of middle grade and junior doctors right across Wales, which is clearly unacceptable to both our members and people needing hospital treatment and this does not look like changing in the immediate future. "There are a variety of reasons for this shortage, one being that Wales does not top the list of places where many junior doctors desire to work. Also, changes to the rules regarding immigration have caused problems with recruitment across the whole of the UK, not just Wales. "The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas. This is compromising consultants" ability to deliver routine daily work and there is no evidence that hospitals are adjusting services to take these shortfalls into account. Inevitably, the rates of work being undertaken cannot be sustained with the current levels of staffing. Hospital managers really need to address this now, working with clinical colleagues. "These problems come as no surprise however to us at the BMA, having predicted that these shortages would happen at some point. That is why we have, for some time now been trying to meet with representatives from the Welsh Assembly Government, to see how we can work together, drawing on the experience of front line doctors, especially juniors, to look for some solutions to the situation. "BMA Cymru Wales has also worked in partnership with the Wales Deanery for Postgraduate Medical and Dental Education, to produce a DVD for students, giving an invaluable insight into medical training here. "The aim of the video is to promote Wales as a primary destination to study medicine and to attract more junior doctors to apply, to complete their postgraduate training here. However, the positive effects of this will not be seen immediately. "The initiative to provide free accommodation for F1 doctors has been welcomed by BMA Cymru Wales and has had some impact. Yet, we believe far more effort should have been put into anticipating and planning for the current shortages, especially the impact of the European Working Time Directive which has been known about for more than 13 years! Whilst it is very late in the day, BMA Cymru Wales urges the Welsh Assembly Government and employers to focus on the actions we have been highlighting for some considerable time. We do not believe sufficient, co-ordinated efforts to recruit and retain doctors to Wales has been made. "While in the short term, we have to have contingency plans put in place as soon as possible to ensure the safety of both NHS staff and patients, we need far more sustainable solutions if NHS Wales is to deliver and maintain the quality and capacity of services the people of Wales deserve." British Medical Association Cymru Wales


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