US stroke legislation is revised after BMJ airs controversy
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《英国医生杂志》
Controversial federal legislation that would have designated hospitals as "stroke centres" only if they were prepared to administer alteplase for acute stroke has been radically altered.
A revised version of the Stroke Treatment and Ongoing Prevention Act, sponsored by Congresswoman Lois Capps, passed the US House Energy and Commerce Committee and will move to the full House of Representatives for a vote.
Provisions in the legislation that focused on getting patients to designated hospitals for treatment with alteplase were deleted. Funding for the entire five year programme was cut from approximately $665m (￡360m; �540m) to $95m. Up to seven grants totalling $50m will be awarded for pilot projects to establish networks for "stroke prevention, diagnosis, treatment, and rehabilitation."
The changes came after a report in the BMJ (2003;327:247) that, according to Congresswoman Capps?office, provoked "numerous emails" to Ms Capps, who said that until the report she was "unaware of any controversy" regarding alteplase for acute stroke.
Critics of the earlier version of the bill said the act was a "backdoor" political manoeuvre to curry support for a controversial treatment. The American College of Emergency Physicians responded to that plan with a unanimous vote to "make members of Congress aware that (1) standards of care in stroke treatment remain controversial; (2) the designation of stroke centers based on their ability/willingness to adhere to such standards of care may have many unintended negative consequences."
Dr Edgar Kenton, chairman of the American Academy of Neurology抯 practice committee, told the BMJ that the act should have been better funded, saying that "the enormity of the cost of over $50bn per year for stroke care of Americans cries for the insufficient funding of this bill."
He is also concerned that the addition of traumatic brain injury to the stroke act "simply dilutes the emphasis on stroke as a separate entity and funding stream."
Representatives of groups that supported the earlier version of the act, including the American Heart Association, the American Stroke Association, and the National Stroke Association, did not respond to inquiries regarding their view of the new act.
Dr Jerome Hoffman, one of the nine experts on a panel set up by the American Heart Association to develop guidelines for the use of alteplase for stroke, has voiced concerns about the widespread use of alteplase in community practice and says that the changes made to the act serve as testimony to the "best type of activism by doctors who are galvanised by a report in a scientific journal that takes on controversial issues."
"This led a congresswoman to take a far more nuanced approach to legislation," he said.
A Senate version of the stroke act, sponsored by Senators Bill Frist and Edward Kennedy, still contains the controversial provisions that would potentially divert patients to "stroke centres" that can administer alteplase for stroke, but no action has been taken on the bill and a spokesperson for Senator Frist said that he would not reintroduce the bill if it dies at the end of this year, as it will do automatically if it has not progressed.(New York Jeanne Lenzer)
A revised version of the Stroke Treatment and Ongoing Prevention Act, sponsored by Congresswoman Lois Capps, passed the US House Energy and Commerce Committee and will move to the full House of Representatives for a vote.
Provisions in the legislation that focused on getting patients to designated hospitals for treatment with alteplase were deleted. Funding for the entire five year programme was cut from approximately $665m (￡360m; �540m) to $95m. Up to seven grants totalling $50m will be awarded for pilot projects to establish networks for "stroke prevention, diagnosis, treatment, and rehabilitation."
The changes came after a report in the BMJ (2003;327:247) that, according to Congresswoman Capps?office, provoked "numerous emails" to Ms Capps, who said that until the report she was "unaware of any controversy" regarding alteplase for acute stroke.
Critics of the earlier version of the bill said the act was a "backdoor" political manoeuvre to curry support for a controversial treatment. The American College of Emergency Physicians responded to that plan with a unanimous vote to "make members of Congress aware that (1) standards of care in stroke treatment remain controversial; (2) the designation of stroke centers based on their ability/willingness to adhere to such standards of care may have many unintended negative consequences."
Dr Edgar Kenton, chairman of the American Academy of Neurology抯 practice committee, told the BMJ that the act should have been better funded, saying that "the enormity of the cost of over $50bn per year for stroke care of Americans cries for the insufficient funding of this bill."
He is also concerned that the addition of traumatic brain injury to the stroke act "simply dilutes the emphasis on stroke as a separate entity and funding stream."
Representatives of groups that supported the earlier version of the act, including the American Heart Association, the American Stroke Association, and the National Stroke Association, did not respond to inquiries regarding their view of the new act.
Dr Jerome Hoffman, one of the nine experts on a panel set up by the American Heart Association to develop guidelines for the use of alteplase for stroke, has voiced concerns about the widespread use of alteplase in community practice and says that the changes made to the act serve as testimony to the "best type of activism by doctors who are galvanised by a report in a scientific journal that takes on controversial issues."
"This led a congresswoman to take a far more nuanced approach to legislation," he said.
A Senate version of the stroke act, sponsored by Senators Bill Frist and Edward Kennedy, still contains the controversial provisions that would potentially divert patients to "stroke centres" that can administer alteplase for stroke, but no action has been taken on the bill and a spokesperson for Senator Frist said that he would not reintroduce the bill if it dies at the end of this year, as it will do automatically if it has not progressed.(New York Jeanne Lenzer)