Infectious waste - mismatch between science and policy

Article Abstract:

Incidents of hypodermic syringes washing ashore in some coastal states have caused great public concern about the disposal of medical waste. In 1988, Congress enacted the Medical Waste Tracking Act, a two-year trial program that required many health care providers to keep detailed records of medical waste from initial generation to final disposal. Although this Act has now expired, similar laws may be passed. This provides an excellent example of how a perceived threat and subsequent legislation may be disproportionate to scientific evidence of risk. With the exception of 'sharps', which include hypodermic needles and scalpel blades, there is virtually no evidence for disease transmission from medical wastes. Indeed, the amount of disease-causing bacteria is far greater in common ordinary garbage, which is normally disposed of in landfills with little or no regulation. Certainly, garbage is not sterilized before disposal, as is most medical waste. Concern over syringes on the beaches has focussed attention on hospitals and large clinics, but the Environmental Protection Agency has found that the majority of syringes found in such locations come from individuals. There are about 2 million diabetics in the US, and an estimated 1.2 million intravenous drug users. Together, these groups use over 1 billion syringes per year, and are not regulated by legislation regarding medical waste disposal. Perhaps the best way of eliminating any possibility of infection spread is by incinerating medical wastes. However, this alternative is often impossible due to clean air regulations. An analysis of the economics of compliance with the Medical Waste Tracking Act indicates that the costs would be about $1.3 billion per year. For purposes of comparison, this is seven times the amount spent on immunizing children against disease. Current medical waste policies have grown from perceptions that are inconsistent with scientific evidence. Before enormous sums of money are spent, scientific considerations should prevail over fear. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, Medical wastes, editorial, Infectious wastes

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Results of a randomized trial of partner notification in cases of HIV infection in North Carolina

Article Abstract:

A study of HIV-infected patients in North Carolina found that asking patients to contact people with whom they have had sex or shared needles may be asking too much. Seventy-four HIV-infected patients were asked for the names and location of sex partners and needle-sharing partners. Thirty-five were asked to contact these people themselves (the patient-referral group), and 39 gave the information to a public health counselor (the provider-referral group). While the counselors succeeded in notifying 50% of the contacts named by the provider-referral group, only seven percent of the contacts were notified by the patients in the patient-referral group. Even though patients in the provider-referral group could notify contacts themselves if they wished, few chose to do so.

HIV infection, HIV infections, North Carolina

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Evaluation of the notification procedure for physician-assisted death in the Netherlands

Article Abstract:

It appears that most physicians in the Netherlands are following the guidelines for euthanasia and physician-assisted suicide formulated by the courts and the medical profession. These practices are technically illegal in the Netherlands but have wide public support. A notification procedure was begun in 1991 that requires all physicians who perform these procedures to report the case to the coroner, who reports it to prosecutors. The prosecutor only takes legal action if the doctor violated the guidelines. Of the 6,324 cases reported between 1991 and 1995, only 13 resulted in legal action against the physician.

Netherlands, Social policy, Assisted suicide, Euthanasia

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