Dutch Health Council Research Articles

Regulating teratogenicity as a health risk

The development of scientific knowledge and regulatory policy with respect to teratogenicity is reviewed. The current debate on the definition of teratogenicity and on perceived risks, as illustrated by the Dutch Health Council report on teratogenicity, originates from the increased regulatory demands and from incoherent development of teratology as a scientific discipline. Barriers in the development of knowledge are discussed with respect to their consequences for regulatory policy. Special emphasis is given to behavioural effects, to the rise of monitoring and registration systems, and to epidemiological research. From a regulatory perspective, knowledge on the public perception of teratogenicity as a health risk is inadequate. It is concluded that the present situation is ambivalent and poses a real problem for regulatory policy. The positions vary from refining the original and very strict definition stressing severity and low risk, to stressing the need for a more comprehensive definition; in the latter case teratogenicity is seen as a top of the iceberg problem to be treated as part of the reproductive toxicity health issue.

Predicting the dynamic effects of rubella vaccination programmes.

In the Netherlands, prepubertal girls have been vaccinated against rubella since 1974 (the UK strategy). Recently the Dutch Health Council advocated the introduction of an elimination strategy: vaccination of 1- and 9-year-old children. Dynamic effects of both strategies are studied using deterministic and stochastic models. Estimates of several epidemiological parameters are given. All computations and simulations were performed using as much field data as possible. Under the old strategy a new equilibrium is expected around the years 1995 to 2000; the new strategy is estimated to eliminate rubella (CRS) in large parts of the population 3 to 5 years after its initiation. Possible consequences of the new strategy on a cluster of people who refuse vaccination are investigated.

Ethics and New Reproductive Technologies: An International Review of Committee Statements

Walters examines the statements of advisory committees in eight countries on new practices involving human reproduction: clinical in vitro fertilization; surrogate motherhood; and human embryo research. He analyzes the positions taken by the committees on the general acceptability of the new technologies, as well as on specific issues involved in assisted human reproduction. In chronological order, the statements examined are those of the U.S. Ethics Advisory Board; the Waller committee in Victoria, Australia; a South Australian committee; the Demack committee in Queensland; Britain's Council for Science and Society; Britain's Warnock committee; a Tasmania, Australia, committee; the Ontario Law Reform Commission; Australia's Family Law Council; West Germany's Benda committee; the American Fertility Society; a Western Australia committee; the Dutch Health Council; and the National Ethics Committee of France.