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In two recent papers, a radical change of the review system for medical ethics review committees was proposed. The current systems in Great Britain and Australia were described and it was suggested that the extended roles and responsibilities of the medical ethics review committees could not be fulfilled by the present committees. It was proposed that professional medical ethics committees be established with full time members who would receive an appropriate honorarium. The Netherlands has a decentralised system of medical ethics review, which is based on peer review. A radical change of the current system of medical ethics review is not warranted. There is however a need for further improvements to the current peer-review system. An important aspect of this improvement is an honorarium for the members as well as a budget for training and for the adequate scientific and administrative support of the committee by a secretariat. The fees levied for reviewing each protocol could in part finance the committee and its secretariat. However, these fees will probably not meet all of the costs. Therefore the centres involved in medical research should consider supporting their committees. It is in their interest to demonstrate their wish to protect those persons who consent to participate as research subjects. This will maintain the confidence of both the public and future participants in clinical trials. Furthermore, an efficient and adequate system of ethical review will support a balanced view towards medical research with human subjects and will also contribute to a positive image of the centre also as an attractive environment for medical professionals.

A randomized controlled trial that is stopped prematurely because of a striking benefit or a strong untoward effect is most probably suffering from a 'random high'. At premature stopping the conclusions will often either be too optimistic or too pessimistic. In the early phases of an investigation the intermediate results show wider fluctuations around the hypothetical 'truth' than in the later phases. Subjective arguments involved in the stopping of a trial may be eliminated by a so-called triple blind design: the data monitoring and safety committee receives the intermediate results but is not told which data are from the experimental group and which ones from the placebo group.

The fact that certain rulings of disciplinary committees evoked much criticism among colleagues is distressing in itself, but such criticism should be interpreted with due caution, as different explanations are conceivable. For instance, the published abstract of the committee ruling may have gaps with regard to facts and motivation. It is also possible that the committee has good grounds to accentuate the professional standards, which understandably may meet some resistance among the medical profession. Finally, it is theoretically possible that the disciplinary tribunal is not fully informed about relevant professional standards and current practice. It is precisely to minimize such possible communication breakdowns that disciplinary powers have largely been entrusted to persons from the medical profession.

The Act on Formal Admissions to Psychiatric Hospitals (BOPZ) enables psychogeriatric patients to complain. According to a BOPZ evaluation study concerning the right to complain, which was held in 1995 and 1996, the current procedure to complain appears to be inadequate for psychogeriatric patients. The Act on the right to complain, which came into force recently, didn't improve this procedural inadequacy. We suggest to improve the right to complain both at the level of government as at the institutional level. The right to complain could thus contribute substantially to the legal position of the psychogeriatric patient and the quality of health care. The introduction of a client informant is recommended.

To describe the transfusion practices in Dutch hospitals.Descriptive.Late in 1995 a questionnaire was sent to the heads of the transfusion laboratories of all Dutch hospitals.The response was 91% (117/128). A large variation was found not only in the ways transfusion medicine was organised but also in laboratory methods used.The implementation of the consensus agreements on blood transfusion in the Netherlands (1983, revised in 1989) is poor. Continuous education of the participants should be encouraged. Implementation of these agreements could be facilitated by active participation of the blood bank in the transfusion committees of each hospital.

In 1987, the Dutch Secretary of State for Public Health stated before Parliament that in the near future a legal basis will be given to the review-organisation of (intended) experimental studies on animals. The Department of Health Law of the State University of the province of Limburg recently carried out investigations to test the desirability and framework of such a review-organisation. Standards and criteria are laid down in Dutch as well as in international laws, regulations and codes of conduct. In the United States, Canada and several European countries, systems of regulation and review are operative. In the Netherlands, governmental and private initiatives have led to the establishment of experimental-study review committees. However, the functioning and effectiveness of these committees varies markedly. On the basis of the literature and opinions of experts, a concept of a modification of the existing Experimental Studies in Animals Act was formulated, in which experimental study review committees can find a legal basis.

To detect the standards applied by research review boards the files of 22 boards were analysed. Furthermore, three research protocols arranged for the purpose were submitted to 21 boards. The most remarkable finding is the great variation and inconsistency in the standards applied by the boards. Sometimes this leads to incompatible decisions on the same research project. In other cases decisions of boards are against Dutch law. Inconsistency exists between various boards, as well as within boards. Several instruments are proposed to reduce both forms of inconsistency.