Bill is passed by Congress, but wrangling continuesFrom the right of the political spectrum, the Medicare legislation that Congress passed last month is seen as a breakthrough for people who are elderly or poor. From the left, it's deplored as inadequate and menacing.

Speakers argue that corporate funds should be separated from science to prevent undue influenceAbacklash against academic science collaborating with industry has been building for years, inspired by instances of suppression of research unfavourable to corporate sponsors, hidden conflicts of interest, distorted clinical trials, and retaliation against uncooperative scientists.

Much is expected of the “wunderkind” of the US Senate—Bill Frist, the newly elected majority leaderThe new ingredient in America's turbulent health-care politics is the wunderkind of the US Senate, Republican Bill Frist, MD, who unexpectedly ascended to the majority leadership last month when Mississippi Senator Trent Lott self-destructed via his public reverie for racial segregation.

Aproposed government-sponsored survey to quantify shady practices in biomedical research was deplored last week by two professional organisations that largely encompass the life-sciences-the Federation of American Societies for Experimental Biology (FASEB) and the Association of American Medical Colleges (AAMC). They said the questions go beyond federal authority for policing misconduct and would inevitably produce misleading findings.

The long frustrated search for a new commissioner of the US Food and Drugs Administration (FDA) ended last week where it began 20 months ago, at the White House, with the nomination of the President's top health-policy adviser, Mark B McClellan, to fill the post. His chances of confirmation are considered quite good, though not certain.

With election day 3 months away, Congress moved cautiously last week toward passage of politically imperative legislation that has long divided the two major parties—a bill that would help cover rising pharmaceutical drug bills for the 40 million elderly and disabled persons enrolled in the federal Medicare insurance programme.

Though never without crises, the US medical system is ringing with especially urgent alarms about inequities in access to treatment and financially imperiled health facilities.As usual, those who can pay for care, personally or through insurance, are well attended in this medically advanced nation. But with the economy slowly and unevenly recovering from the cyber bust and other misfortunes, and costs inexorably rising, the ranks of the medically affluent appear to be shrinking, whereas doctors and medical institutions grapple with tighter government payment schedules.

Politics poked through only briefly last week as President Bush ceremonially introduced his nominees for director of the National Institutes of Health and Surgeon General of the United States, prominent positions for which presidential appointments have long been delayed by America's enduring entanglement in reproductive controversies.

Contrary to impressions conveyed by the press reports, counterter-rorism has not fully pre-empted the domestic political agenda here in the USA. Last week for example, President George W Bush signed a bipartisan bill that provides additional federal billions for the nation's schools, along with requirements for testing educational achievement. The civilian science agencies are receiving generous budget increases for their traditional research activities. And there is a growing cry for helping the needy to meet rapidly rising health-care costs, although as yet there is no consensus on how to do it.

Author's replySir—In recent years, the failings of many institutional review boards have repeatedly been spread on the public record by the Inspector General of the Department of Health and Human Services, the Office of Human Research Protections (and its predecessor), and in congressional hearings. Their findings included rubber-stamp reviews, conflicts of interest, and violation of federal criteria for institutional review board membership.