Four in 10 cigarettes tested by the Dutch product safety board contain too much tar and other chemicals, but manufacturers are rarely being fined, the AD said on Wednesday. Of the 100 plus cigarettes tested in 2017, 43 did not meet official Dutch standards, which say smoke should not contain more than 10 milligrams of tar, 1 milligram of nicotine and 10 milligrams of carbon monoxide, the AD said. Nevertheless, just one fine was handed out because the NVWA maintains a 20% margin of error, the AD said. The paper bases its claims on documents released under freedom of information legislation to anti-smoking campaign group Rookpreventie. The makers of Lexington cigarettes received the only fine but brands such as Camel Original and Lucky Strike Original Red also failed to meet the legal standards, the AD said. Margin of error In some cases, smoke was found to contain almost 30% more tar than is legal. However, the makers were not fined because the NVWA maintains a margin of error of 20% for tar and nicotine and 25% for carbon monoxide, a spokesman for the organisation told the paper. The campaign group says the safety watchdog should take action and the margin of 20% is far too high. 'It is as if you are driving 145 kph in a 130 kph zone and the police note that you are speeding but do nothing about it,' the foundation's lawyer Phon van den Biesen told the paper. The testing was carried out using the controversial ISO method which experts consider records lower cigarette emissions than smokers really inhale. Campaigners want a switch to the new Canadian method which they say gives a more accurate picture. Tests last year on 100 cigarettes using the Canadian method by the Dutch public health institute RIVM found they contained up to 26 times more tar and nicotine than indicated on their packaging.   More >

More than 100 pre-school daycare centres spread all over the Netherlands say their policy is to refuse children who have not been vaccinated, according to broadcaster NOS. Of those creches, some 25 say they have actually banned children who are not vaccinated, NOS said. The broadcaster says it is illegal to ban children who have not been vaccinated because of anti-discrimination laws. However, daycare centres can refuse to admit children if there is a serious health issue, such as a measles outbreak. 'As owner, I do not want to be held responsible by parents if I expose their young babies to infectious diseases,' one creche owner in Amsterdam said. The NOS report follows the news that four children under the age of four have developed measles at a crèche in The Hague, none of whom were vaccinated against the disease. The children in The Hague bring the total measles cases in the Netherlands to 13 so far this year, compared with an average annual infection rate of 10 to 20. Junior social affairs minister Tamara van Ark has set up a committee to look into the legal implications of banning non-vaccinated children from daycare, describing the issues as 'complex'. Safe levels At the moment 90.2% of Dutch children are vaccinated against potentially serious illnesses such as measles, polio and whooping cough. This is below the level of 95% the World Health Organisation considers safe. The last measles epidemic in the Netherlands hit the Dutch Bible belt in 2013. In total, 2,600 people were diagnosed with measles and the outbreak was concentrated in families with young children who had not been vaccinated for religious reasons. One girl, who had not been vaccinated, died. The NOS contacted 3,600 daycare centres and 500 responded. Of them 105 said they banned non-vaccinated children. School teacher Meanwhile it was reported on Monday that a teacher at a secondary school in Zoetermeer had been diagnosed with a possible case of measles. The teacher, who was not named, works at the Oranje Nassau College. The school told the Telegraaf most of its pupils have been vaccinated and school activities are continuing as normal. The health board GGD Haaglanden later said the teacher may not have measles, but further tests were being done to eliminate the virus as a cause of his illness.   More >

The owner of a fertility clinic used his own sperm to father 49 children, according to DNA tests revealed on Friday. Jan Karbaat died in 2017, and after his death dozens of people came forward to say that they suspected that he had used his own sperm to impregnate their mothers, without their knowledge. A court case gave permission for materials containing his DNA to be collected and then the 49 Dutch people fought for the right to test their own DNA against these samples. Tim Bueters, lawyer for the group, has said that he is happy that an end has come to their uncertainty, reports the NOS . The doctor, who had a clinic in Barendrecht, had recognised 22 children.  More >

Junior health minister Paul Blokhuis has set aside €2m to fund around 1,000 new drinking water fountains in school playgrounds. The commitment is part of the agreement on preventing obesity and poor health signed by the minister, companies and other organisations last year. 'Having a fountain means it is easier for children to drink water and carry on playing football than to go and buy a can of something at the supermarket,' Blokhuis said. Schools can register for the subsidy, which will cover 75% of the cost. The rest has to be paid by the school itself or by other organisations such as the local council. Amsterdam city council is currently doubling the number of water fountains in parks and public places to 500 as part of the city's campaign to combat obesity.   More >

When Adrienne Cullen went into hospital in 2011 for a cryotherapy procedure, she trusted them to do their best for her. But two years later, it emerged that on that day, a biopsy had been taken showing she had cervical cancer – and had then gone missing. A cancer with a 90%-95% survival rate if it had been treated at once, had become a death sentence. And while being treated for multiple secondary tumours, the Irishwoman living in Voorschoten began a traumatising journey to fight for an investigation, apology and record-breaking medical compensation of €545,000 from University Medical Centre Utrecht. Cullen’s book about her experiences, ‘Deny, Dismiss, Dehumanise: what happened when I went to hospital’, has just been published in English and will come out in Dutch later this year. On her last page, she writes hopefully that she has been promised a full investigation and ‘all I needed now was to stay alive long enough for the enquiry to conclude.’ She died, though, on 31st December 2018, and UMC Utrecht is yet to publish or share with her family an independent, forensic investigation about what went wrong – at a time when medical records were being digitised, and some of them were allegedly prepared for scanning by prisoners in Belgian jails. Openness At a mini-symposium to launch the book in Amsterdam last week, Dr Volkert Wreesmann – a consultant surgeon and whistleblower about problems at UMC Utrecht – said that Cullen’s story of the hospital’s ‘indifference’ to its medical negligence caused her severe ‘secondary harm’ and highlights how Dutch medical care urgently needs proper open disclosure systems. ‘These problems are widespread,’ he said. ‘I think this book will serve as an important warning to patients, physicians, hospital leaders, regulatory authorities and politicians at a time when policies favour centralisation of power at the expense of liberties of individuals. Adrienne’s Orwellian struggle is an example of the grave consequences such policies inflict at individual level.’ He said that Cullen’s family will ask the president of Ireland to pass a copy of the book on to the Dutch king and queen on their upcoming visit to the country, to see if they would address the issue of patient autonomy and openness in Dutch healthcare. Terror Cullen’s book describes her treatment in a series of Dutch hospitals where she develops a terror of the institutions and post traumatic stress disorder – and is repeatedly confronted with staff appearing to mock her for not speaking Dutch. She describes her dealings with her doctors from UMC Utrecht, who apologise and whom she personally forgives, but also her battles with its legal department. She refuses to sign a gagging clause and wins compensation for her family for lost income due to her early death – the highest in Dutch history, although low by some countries’ standards. She also launches UMC Utrecht’s inaugural Adrienne Cullen lecture on open disclosure after serious harm, speaking with her two UMC Utrecht doctors, Prof Huub van der Vaart and Prof Arie Franx. Peter Cluskey, her husband and a journalist, said that he hoped her story and fight would bring lasting change to patient rights and transparency in the Netherlands. ‘Adrienne summed up her treatment by UMC Utrecht in what she called her “3Ds”, deny, dismiss, dehumanise,’ he said. ‘She took the view that when hospitals behave badly, nothing gets through to them except being publicly shamed. However, that was the point at which change could happen and bridges could be built. Once she got their attention, she did change things; I hope they stay changed.’ Tragic Eric Trinthamer, a spokesman for UMC Utrecht, said that the investigation into how Cullen’s results were lost is still ongoing and will be discussed with her husband and then sent to the Dutch healthcare inspectorate, the IGJ. ‘It is extremely sad that Mrs Cullen was deprived of the chance of surviving her cancer because of the mistakes made in our hospital,’ he said. ‘The UMC Utrecht works every day on improvements to achieve an open, safe culture where every employee in the hospital can report an emergency… [to investigate and] learn how to prevent the same incident from occurring again. 'In addition, after an emergency, it is important to ask the patient or family what he or she needs from the hospital. We will not forget the lessons of paying attention and listening.’ A letter to Cluskey from Dutch prime minister Mark Rutte in January - published in the book - described Cullen's death as 'indescribably tragic', adding: 'I have great respect for Adrienne's tireless efforts to achieve official acknowledgement and increase transparency in cases of medical errors.' The second Adrienne Cullen lecture on open disclosure after serious harm will be on Friday May 10th at 13.30 at the UMC Utrecht  More >

The number of people in the Netherlands prescribed heavy opiate painkillers has risen 55% in the past seven years, according research published by the Dutch health insurers association ZN. By 2017, the last year for which figures are available, over one million people were being prescribed painkillers such as Oxycodon and Tramadol, and 218,000 people had been taking them for more than three months, ZN said. The bulk of the increase - described a silent epidemic by some experts - is due to the use of Oxycodon, which is associated with thousands of deaths in the US. Experts say the drugs, which are highly addictive, should only be prescribed long term to terminal cancer patients. In most cases, the drugs are prescribed by a family doctor and 60% of the patients are female. The research was carried out on the basis of pharmacy invoices submitted to health insurers for payment. Health minister Bruno Bruins said the rise in opioid use is 'worrying'. 'We are not yet in a situation like in the US but we do need to take steps,' he said. 'I want to deal with this before it has an impact on society and I will meet all the organisations involved next week.' Last August, toxicology centre NVIV said the number of people overdosing on the powerful painkiller oxycodon in the Netherlands has gone up six fold in ten years. In 2008 some 43 people overdosed on the drug, which is twice as powerful as morphine and highly addictive when used longer term. That figure jumped to 280 in 2017 and 215 in the first six months of 2018. It is unclear how many of the overdoses resulted in death.  More >