New Diagnostic Tool Helps Health Care Professionals Accurately Diagnose Hypoactive Sexual Desire Disorder (HSDD) In Women
Results from a study published today in the Journal of Sexual Medicine show that a new, easy to use five-question diagnostic tool can significantly reduce the time it takes to diagnose the most common form of female sexual dysfunction (FSD), generalised, acquired Hypoactive Sexual Desire Disorder* (HSDD). Unlike standard diagnostic procedures, which are often time-consuming and require an extensive diagnostic interview by a specially trained clinician, the Decreased Sexual Desire Screener (DSDS) enables clinicians who are not necessarily experts in female sexual dysfunction to diagnose the condition with high accuracy in a few minutes.
Nearly one in 10 women are known to experience low desire marked by distress or interpersonal difficulty – a condition that is medically referred to as Hypoactive Sexual Desire Disorder (HSDD). HSDD remains largely under-diagnosed. Physicians and patients are often embarrassed to talk about sexual health. Further reasons healthcare professionals report being reluctant to engage in the discussion include limited time and lack of training.1 This highlights the increasing need for simple diagnostic instruments that can be used in everyday practice by clinicians who are not specialists or experts in the field of FSD.
According to lead study author Dr Anita Clayton, M.D., Professor of Psychiatry and Neurobehavioral Sciences at the University of Virginia, “Discussing sexual issues, particularly low desire, often can be an uncomfortable conversation for women and health care professionals. This new tool can open up the dialogue, helping physicians and other clinicians to accurately diagnose generalised, acquired HSDD.”
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision, defines HSDD as the persistent lack (or absence) of sexual fantasies or desire for any form of sexual activity marked by distress or interpersonal difficulty and not better accounted for by another disorder (except another sexual dysfunction), direct physiological effects of a substance (including medications) or a general medical condition. Generalised, acquired HSDD is not limited to certain types of stimulation, situations or partners, and develops only after a period of normal functioning.
The introduction of the DSDS follows the recommendation from the US Food and Drug Administration (FDA) which notes that new diagnostic instruments should be developed and should be able to distinguish patients with FSD, or a specific component of FSD, from those without the disorder.
Consisting of five simple Yes or No questions, the DSDS was specifically developed for use by clinicians not necessarily trained in FSD, to identify generalised acquired HSDD in pre-, peri- and postmenopausal women in a time efficient manner. Diagnostic assessment by DSDS and a standard diagnostic interview, which takes about 45 minutes to complete, were in agreement in 85% of cases. Overall the study validates the DSDS as a quick, efficient and easy to use diagnostic tool in the field of FSD, for women with generalised acquired HSDD.
DSDS Validation Trial Results
The diagnoses made using a standard diagnostic interview and the DSDS agreed in 224 out of 263 cases, indicating that the DSDS had an accuracy of 85.2 percent. In total, 150 participants had a diagnosis of generalised, acquired HSDD by the DSDS, of whom 138 (92 percent) were also diagnosed as having generalised, acquired HSDD by standard diagnostic interview.
Standard Diagnostic Interview DSDS Accuracy
Generalised, acquired HSDD 165 138
No generalised, acquired HSDD 98 86
Total number of patients 263 224 85 %
The Questionnaire includes the following questions:
- In the past, was your level of sexual desire/interest good and satisfying to you?
- Has there been a decrease in your level of sexual desire/interest?
- Are you bothered by your decreased level of sexual desire/interest?
- Would you like your level of sexual desire/interest to increase?
If a woman answers “No” to any of these questions, then she does not qualify for the diagnosis of generalised, acquired HSDD.
In a fifth Yes or No question, women are asked to note any factors from the following list they feel may be contributing to a loss of sexual desire or interest.
- Medications, drugs or alcohol you are currently taking
- Pregnancy, recent childbirth, menopausal symptoms
- Other sexual issues you may be having (pain, decreased arousal or orgasm)
- Your partner’s sexual problems
- Dissatisfaction with your relationship or partner
- Stress or fatigue
Answering ‘No’ to all of the factors in question five, would qualify for the diagnosis of generalised, acquired HSDD.
About the DSDS Validation Trial
The prospective, non-treatment study involved 263 women ages 18 to 50 years recruited from 27 centers in the United States and Canada. The study population included women with HSDD, women with other types of FSD, and women with no FSD. None of the participants were receiving any medication or psychological therapy for sexual dysfunction, or any medication that could cause sexual dysfunction or affect the central nervous system. Primary endpoints included the sensitivity and specificity of the DSDS relative to the standard diagnostic interview.
In the study, participants were asked to fill out the DSDS. Then, clinicians who are not specialists or experts in the field of female sexual dysfunction reviewed the responses and determined whether they met the criteria for generalised, acquired HSDD. Subsequently, clinicians who are experts in FSD conducted a standard diagnostic interview with each participant. Results of the interview and those of the DSDS were then compared.
The five DSDS questions were well understood by 85% of subjects included in a debriefing exercise post questionnaire completion. In 93% of cases clinicians not specialised in female sexual dysfunction considered the DSDS questions adequate to diagnose HSDD.
Funding for the study was provided by Boehringer Ingelheim.
It’s a paradox that has flummoxed women for generations – their apparent ability to store fat more efficiently than men, despite eating proportionally fewer calories.
While it has long been suspected that female sex hormones are responsible, a University of New South Wales (UNSW) research review has for the first time drawn a link between one hormone – oestrogen – and its impact on fat storage for childbearing.
On average, women have 6 to 11 percent more body fat than men. Studies show oestrogen reduces a woman’s ability to burn energy after eating, resulting in more fat being stored around the body. The likely reason is to prime women for childbearing, the review suggests.
“Female puberty and early pregnancy – times of increased oestrogen – could be seen as states of efficient fat storage in preparation for fertility, foetal development and lactation,” the study’s author Associate Professor Anthony O’Sullivan, from UNSW’s St George Clinical School, said.
The findings, which appear in Obesity Reviews, the journal of the prestigious International Association for the Study of Obesity, may have implications for dietary advice given to women during pregnancy and the design of exercise regimes.
“From an energy balance point of view there is no explanation why women should be fatter than men, particularly since men consume more calories proportionately,” Associate Professor O’Sullivan said. “In fact, women burn off more fat than men during exercise, but they don’t lose body fat with exercise as much suggesting women are more efficient fat storers at other times. The question is why does this paradox exist?”
An obvious answer is that fat storage by women gives an evolutionary benefit, he said. However, additional research was needed to provide more insights into the role of oestrogen in the regulation of body fat.
Associate Professor O’Sullivan stressed that while oestrogen’s effects on postprandial fatty acid oxidation provide a mechanism for fat accumulation, the findings do not explain why some women are obese. Factors contributing to obesity are complex and include both genetic and environmental factors, he said.
Source: Anthony O’Sullivan
University of New South Wales
An international team of scientists, led by Monash University researchers, has uncovered the workings of a superbug that kills elderly hospital patients worldwide – a discovery that has the potential to save lives and health care systems billions of dollars each year.
The research published in the prestigious scientific journal Nature, unravelled ways to genetically modify the bacterium Clostridium difficile and solved the mystery surrounding its toxicity.
Professor Julian Rood from the Department of Microbiology and lead author, microbiologist Dr Dena Lyras, made a major scientific breakthrough which allowed mutants of the superbug to be made. They then identified which of two suspected toxic proteins was essential for the bacterium to cause severe disease.
“Contrary to previously accepted scientific belief, our results show that toxin B, which was considered the less important toxin is actually the toxin that causes disease,” Professor Rood said.
“This discovery will lead to new methods for the control and prevention of this disease”.
Professor Rood and Dr Lyras have been working toward this result for more than a decade. Dr Lyras said strains of Clostridium difficile are found in almost every hospital in Australia.
“It is the major cause of diarrhoea in hospital patients undergoing antibiotic therapy. The antibiotics destroy the ‘good’ bacteria in the gut, allowing a ‘bad’ bacterium to grow in the colon, where it causes a chronic bowel infection that is very difficult to treat,” Dr Lyras said.
“The disease produces two types of Toxins, known as A and B. Worldwide research has tended to focus on these purified toxins in isolation from the bug. This only resulted in part of the story being told. We took a big picture approach and through genetic modification of the bug, together with infection studies with our US collaborators, we were able to see the whole picture,” Dr Lyras said.
Statistics show that in the US, more people die from Clostridium difficile infections than all other intestinal infections combined, with most deaths involving patients aged 65 years or over. The disease is believed to have contributed to more than 8,000 deaths in the UK in 2007. A less aggressive form of the bacteria is present in Australia but statistics in 1995-dollars show the cost of managing the disease to be around $1.25 million dollars per hospital, per year.
Their research lays the foundation to find better ways to treat the superbug.
“We are now beginning to understand the workings of the superbug, which allows us to work on treatments for it. We are confident our research will pave the way for future drugs to try to wipe out this disease. I can’t put a time frame on how quickly drugs could be developed, but we’re certainly on that road to discovery,” Dr Lyras said.
Source: Dr. Dena Lyras
Bavarian Nordic Has Essentially Agreed A Pathway For The Licensure Of IMVAMUNE(R) With The FDA After Successful End Of Phase II Meeting
Following the completion of the Phase II clinical development of IMVAMUNE®, a third-generation smallpox vaccine, Bavarian Nordic has held an end of Phase II meeting with the FDA to discuss the Phase III development. The meeting was a success and there was an open and highly constructive discussion with the FDA.
This meeting represented the first ever formal discussions with the agency to license a vaccine under the new legislation of the animal rule – a new regulatory path which allows the efficacy of products for indications like smallpox to be established in suitable animal efficacy models. This marks a major regulatory milestone in the successful development of IMVAMUNE®.
The animal efficacy models and phase III protocol have essentially been agreed with the agency – outlining a clear path for licensure of IMVAMUNE®. Once all protocols have been agreed with the FDA a Vaccines Related Biological Product Advisory Committee (VRBPAC) will be scheduled to ratify the license strategy. This exceptional review path will likely push the initiation of the Phase III studies into late 2010, leading to the submission of a BLA in 2013.
The outcome of the meeting has no impact on the delivery of vaccines to the Strategic National Stockpile (SNS) under the RFP-3 contract with the US government, which is still expected to be initiated in 2009.
In clinical trials to-date, IMVAMUNE® has shown to be safe and well tolerated in more than 2,400 people including more than 900 immune compromised people, either infected with HIV or diagnosed with atopic dermatitis. These clinical studies have demonstrated that IMVAMUNE® induces a fast and strong immune response, which is comparable to that induced by traditional smallpox vaccines. However, the efficacy of IMVAMUNE® cannot be established in the clinic, because smallpox no longer exist in the general population and will have to rely on the animal rule. To this end Bavarian Nordic has developed a number of efficacy models and has demonstrated IMVAMUNE® induces a comparable, if not superior, efficacy to that of traditional smallpox vaccines.
Anders Hedegaard, President & CEO of Bavarian Nordic, said: “We are delighted with the outcome of the meeting with the FDA, as our plans to license IMVAMUNE® were essentially agreed with the FDA. Although the final protocols still have to be formally agreed with the agency there is now a clear path to registering IMVAMUNE®.”
This announcement includes “forward-looking statements” that involve risks, uncertainties and other factors, many of which are outside of our control that could cause actual results to differ materially from the results discussed in the forward-looking statements. Forward-looking statements include statements concerning our plans, objectives, goals, future events, performance and/or other information that is not historical information. We undertake no obligation to publicly update or revise forward-looking statements to reflect subsequent events or circumstances after the date made, except as required by law.
About Bavarian Nordic
Bavarian Nordic A/S is a leading industrial biotechnology company developing and producing novel vaccines for the treatment and prevention of life-threatening diseases with a large unmet medical need. The company’s business strategy is focused in three areas: biodefence, cancer and infectious diseases. Bavarian Nordic’s proprietary and patented technology MVA-BN® is one of the world’s safest, multivalent vaccine vectors. Bavarian Nordic has ongoing contracts with the US government for the late-stage development and procurement of the company’s third-generation smallpox vaccine, IMVAMUNE®.
A Brown University study of stroke victims has produced evidence that the frontal lobe of the human brain controls decision-making along a continuum from abstract to concrete, from front to back.
Abstract actions can be controlled at an abstract level, such as deciding to make a sandwich, or at more concrete and specific levels, such as choosing a sequence of movements that make the sandwich.
The scientific data supports preexisting theories that abstract decisions about action take place in the front of the frontal lobe, the back portion controls the capacity for concrete decisions, and the progression from front to back forms a gradient from abstract to concrete.
The Brown researchers are among the first to show that specific areas of the frontal cortex are needed for different levels of abstract decision.
The finding, detailed March 1 in the journal Nature Neuroscience, represents a huge leap in comprehending how the brain supports higher level cognition and intelligent behavior. It could lead to advances in everything from the treatment of strokes to understanding how humans develop thought. Researchers from the University of California-Berkeley also participated in the study.
“It is among the strongest evidence to date for a systemic organization of the frontal cortex,” said lead author David Badre, an assistant professor of cognitive and linguistic sciences at Brown University.
The frontal cortex of brain has been long known to affect the internal control of behavior. It controls the capacity to plan, reason, conduct higher-level thinking and connect what we know about the world to how we behave.
Badre and his collaborators came to their conclusion by studying stroke victims who suffered damage to different parts of the frontal lobe. The patients all suffered a stroke at least six months prior to testing. All were screened with an MRI or CT scan to determine where any lesions existed in the brain post-stroke.
The scientists recruited 11 patients – seven men and four women, ranging from age 45 to 73. A 12th patient was recruited but could not perform any of the tests involved.
Researchers gave the patients four different tests that ultimately required selecting a finger-press response. For example, the first test would show a color such as red, which required an index finger push. Blue would trigger the middle finger. The test would then become more difficult by adding more alternate finger presses.
Patients faced greater challenges in selecting a response as subsequent, progressive tests became more complex, with more abstract options.
Badre and colleagues found that damage at a given location affected more abstract decisions but left intact the capacity for more concrete decisions. “If there is damage in a given spot, it will affect all higher (decision-making) functions but not lower functions,” Badre said.
The National Institutes of Health, Veterans Administration Research Service and a National Research Service Award supported the research.
Source: Mark Hollmer
By altering just one gene in HIV-1, scientists have succeeded in infecting pig-tailed macaque monkeys with a human version of the virus that has until now been impossible to study directly in animals. The new strain of HIV has already been used to demonstrate one method for preventing infection and, with a little tweaking, could be a valuable model for vetting vaccine candidates.
A team of researchers led by Paul Bieniasz and Theodora Hatziioannou at The Rockefeller University showed that two pig-tailed macaques, given a common antiretroviral treatment one week before and one week after being exposed to the newly engineered HIV, had no signs of infection. “We’re not saying we can save the world with antiretroviral pills. But this model will allow us to start studying the best way to administer prophylaxis and do other experiments on preventing HIV-1 infection that could not be easily done on humans,” says Bieniasz, head of the Aaron Diamond AIDS Research Center Laboratory of Retrovirology at Rockefeller and a Howard Hughes Medical Institute investigator.
The findings, published in the Proceedings of the National Academy of Sciences, show that the engineered virus injected into a pig-tailed macaque initially spreads almost as ferociously as it does in people and the virus remains detectable for at least six months. But it does not make the monkeys sick. Rather, it behaves as it is thought to behave in a group of HIV-positive people whose exceptional immune systems are generally able to keep the virus in check. These fortunate few are called long-term nonprogressors.
The animal model grew out of years of research into the molecular cloak-and-dagger fight between HIV and the cells of the host it infects. In particular, Bieniasz, who is also a scientist at the Aaron Diamond AIDS Research Center, Hatziioannou and colleagues have studied two groups of rapidly evolving genes, APOBEC3 and TRIM5, which produce unusual classes of defensive proteins with distinctive capabilities to fight retroviruses such as HIV. These genes, shared by humans and their simian forebears, have evolved mutations specific to each species’ unique history of retroviral battles. In most simians, the APOBEC3 and TRIM5 proteins actually kill HIV on sight, making it impossible for researchers to study the virus in an animal model. Instead, they have studied HIV’s cousin, simian immunodeficiency virus (SIV), which causes an AIDS-like disease in certain monkey species. But SIV shares only about half of its amino acid sequence with HIV, making it a very imperfect substitute for testing anti-HIV drugs and vaccines. Several labs have engineered hybrids called SHIVs – SIVs that contain pieces of HIV DNA – but these have problematic differences, too.
Now, Bieniasz and Hatziioannou, working with Vineet KewalRamani and Jeffrey Lifson at the National Cancer Institute in Maryland, have developed a strain they call simian-tropic HIV-1 (stHIV-1), which shares about 95 percent of its genome with the human version. It differs only in the one HIV-1 gene that fails to deal with the pig-tailed macaques’ APOBEC3 defenses. (The scientists did not need to overcome their TRIM5 defenses because macaque TRIM5 proteins are extremely unusual and not effective against HIV). The new research marks a major advancement of experiments the Bieniasz and Hatziioannou team published in 2006 that showed that HIV engineered to hide from both the APOBEC3 and TRIM5 proteins in rhesus macaques could grow in their cells, at least in a test tube. But that strain’s growth was poor, and it failed to take root in the actual animals.
The new virus, stHIV-1, spreads almost as quickly after injection as HIV-1 initially does in humans and it persists for several months, after which it is controlled. Bieniasz and colleagues showed that that control is in part thanks to a specific class of immune system T cells that if blocked, allow a resurgence of the virus. The team demonstrated the use of the model by showing that a commonly used antiretroviral drug combination taken briefly before and after an injection of two million infectious units of stHIV-1 effectively protected the monkeys from the virus.
Though the work is an important advance, for stHIV-1 to be useful for testing vaccines, the scientists must modify the protein envelope that surrounds the virus so that it targets the same set of immune cells in monkeys as it does in humans. In addition, says Hatziioannou, an assistant professor at ADARC, they want the infection to run its full course and cause disease, to make it as faithful to HIV-1 as possible. “This model, even as is, should be useful for studying pre- or postexposure treatments,” she says. “But to have a really authentic model, we need to make it pathogenic, to make it hotter.”
Source: Brett Norman
France Biotech Publishes 3rd Edition Of Its Review Of Product Development Pipelines In French Life Science Companies
France Biotech has published the 3rd edition of its annual Drug Pipeline Review. The survey was part-funded by the French Ministry of the Economy, Industry & Finance.
The study summarizes and analyses data collected in 2008 on 227 healthcare products under development, including 158 drugs (at 51 life science companies), 41 in vitro diagnostics (at 22 companies) and 28 medical devices (at 17 companies). This year’s review included in vitro diagnostics and medical devices for the first time. In all, 85 French life science SMEs developing healthcare products participated in the survey. Most were incorporated fairly recently – 45% in the last 5 years, half of which are developing drugs.
“The dynamic growth of France’s life science industry – as revealed by the increasing number of very innovative products in the pipeline – may well slacken off. In fact, with a 79% drop in investment in 2008, our innovative SMEs are going to have trouble funding all their drug development programs because the latter are very resource-intensive! To help our innovative SMEs generate jobs and economic growth and become tomorrow’s business champions, France Biotech has asked the French government (on February 5) to implement a stimulus plan based on innovation”, commented Philippe Pouletty MD, Chairman of France Biotech.
Click here to view the key results.
A study of individuals presenting to an Oxfordshire hospital suggests that an increasing number of armed forces personnel are self-harming. Their self-harm appears to be in response to relationship and employment problems – with alcohol playing a major role in most cases.
Little is known about self-harm in the armed forces. It is important to know more because self-harm, as well as indicating distress, is generally linked with risk of suicide. However, the research found that armed forces personnel were less likely to have self-harmed before and their acts involved lower suicide intent than other self-harm patients.
Researchers investigated all armed forces personnel who attended a hospital in Oxford after self-harming between 1989 and 2003 – 166 in total. These individuals were matched with civilians who had also presented to the hospital following self-harm to provide a comparison or control group. The findings are published in the March issue of the British Journal of Psychiatry.
The number of service personnel presenting to the hospital increased substantially during the 15-year study period, with an increase of 80% between 1989-1993 and 1994-1998. There was a further 41% increase between 1994-1998 and 1999-2003.
Three-quarters of the service personnel were male. However, this is lower than the proportion of males in the Army and RAF (94.3% in 1990 and 91.4% in 2003). Therefore, the risk of self-harm in female personnel is much higher.
The personnel who self-harmed were mainly young. Two-thirds were under 25-years-old. Women in particular were young, with nearly three-quarters aged between 16 and 24-years-old.
The most common method of self-harm was overdosing on painkillers, tranquillisers, sedatives or antidepressants. Self-injury, including cutting, was less common.
Alcohol played a significant role in many of the cases of self-harm – particularly for the female personnel. Two-thirds of personnel had been drinking in the six hours before they self-harmed.
The armed forces personnel said they were facing a number of problems. Almost two-thirds had relationship problems with a partner. More than two-fifths (44%) said they had problems with their job, such as finding it stressful, boring or repetitive. A substantial majority (17%) wanted to leave the service, and more than one in ten were facing disciplinary problems. A quarter of personnel also said they had problems with alcohol.
The researchers found some clear differences between the armed forces group and the control group. Very few of the armed forces personnel who self-harmed had a history of psychiatric problems, compared to the control group. In addition, the service personnel were less likely to have self-harmed before and were less likely to have high suicide intent.
Writing in the British Journal of Psychiatry, the authors of the study concluded: “Self-harm by armed forces personnel may often be a response to interpersonal and employment problems complicated by alcohol misuse, with relatively low suicide intent.”
They believe strategies aimed at reducing heavy drinking within the armed forces could help to prevent cases of self-harm in future.
Hawton K, Harriss L, Casey D, Simkin S, Harrison K, Bray I and Blatchley N (2009), Self-harm in UK armed forces personnel: descriptive and case-control study of general hospital presentations, British Journal of Psychiatry, 194: 266-272
The Royal College of Psychiatrists
Children who are unhappy at school, complain of aches and pains or skip school for trivial reasons are more likely to be permanently off work sick when they are adults, new research suggests.
The research, published in the March issue of the British Journal of Psychiatry, shows a strong association between childhood temperament and sickness absence in middle age.
Researchers studied over 7,100 people who were born in Aberdeen between 1950 and 1955. During the 1960s, data was collected on the children’s educational performance and how regularly they attended primary school. Teachers were asked to assess each child’s behaviour, temperament and reasons for missing school. In 2001, the researchers followed up the participants to find out their current employment status.
At the 2001 follow-up, 392 of the participants (5.5%) said they were ‘permanently sick or disabled’. There was no evidence that those children who were regularly absent from school because of poor physical health were more likely to be sick or disabled in later life. However, there was a link between the children’s temperament at school – as reported by their teachers – and long-term sickness absence.
A quarter of the children whose teachers reported them as ‘often appearing miserable, unhappy, tearful or distressed’ or ‘often complaining of aches and pains’ were permanently sick or disabled 40 years later.
In addition, over 10% of the children whose teachers described them as ‘tending to be fearful or afraid of new things or new situations’ or ‘tending to be absent from school for trivial reasons’ were out of work in adulthood.
The researchers believe there are a ‘range of vulnerabilities’ established in childhood that influence behaviour in later life. For example, children who show signs of problematic behaviour and temperament may be more likely to have symptoms of depression and anxiety in later life. They may also have unexplained physical symptoms, and be less able to manage or tolerate minor discomfort and pain.
Childhood temperament and long-term sickness absence in adult life
Henderson M, Hotopf M and Leon DA (2009)
British Journal of Psychiatry, 194: 220-223
The Royal College of Psychiatrists
The health consequences of the government’s new data-sharing proposals could be “staggering” warns an expert in an editorial published on http://www.bmj.com today.
Dr Vivienne Nathanson, Director of Professional Activities at the British Medical Association (BMA) expresses concerns about Clause 152 of the Coroners and Justice Bill which, in its current form, appears to grant the government unprecedented powers to access people’s confidential medical records, and share them with third parties.
Simply it means that laws that currently limit health data sharing could be set aside, including the protections of the Data Protection Act, says Dr Nathanson. Even the Venereal Diseases Regulations and the provisions of the Human Fertilisation and Embryology Act would not be immune to the potential for removal.
Health data is not privileged in the manner of legal information, but for many years it has been recognised as special, and as sensitive, she writes. Research shows that patients expect the health professional with whom they share information will hold it in confidence, and share it sparingly and on a need to know basis, usually those also involved in offering them care.
Yet Dr Nathanson believes that data in the current draft of the Bill suggests blindness to the special sensitivity of health data.
If the current draft legislation goes through with minimal changes, the effect could be to to undermine doctor and patient confidence in the future control of data that neither is willing to record the most sensitive information, she warns.
She concludes: “This week many of the leading medical organisations have written a joint letter to the Justice Secretary seeking the complete removal of health data from the provisions of the Bill. We are seeking a meeting, to provide him with the reasons behind our concerns and to emphasise why we can see no problems in the health sector to which this legislation is an acceptable solution.”