On the eve of Sept 30, 2013, the world's eyes looked towards the USA with a sense of deja vu. Would political grandstanding and bloody-mindedness hold the American people to ransom again? At 10 minutes to midnight, that realisation came to pass: orders were made to shutdown government, and force tens of thousands of federal workers in to an indeterminable length of unpaid leave. The shutdown brought with it a number of less foreseen consequences, not least, the inability to start new government-sponsored clinical trials at the National Institutes of Health (NIH) Clinical Center, meaning hundreds of patients are left without treatment. For some of these people, especially those with advanced cancers, the consequences could be fatal. Ironically, this latest round of political brinkmanship is caused by the lack of acceptance by right-wing Republican extremists of a basic human right-that they undoubtedly enjoy themselves-access to affordable health care. In the aftermath of the shutdown, stories of individual patients due to enroll on to new clinical trials, but now unable to do so, played out across many US newspapers and television stations-patients for whom options are fast running out. But this is just the tip of the iceberg: 200 new patients, including approximately 30 children, enter clinical trials at the NIH Clinical Center each week. Reports suggest the NIH has registered just 5% of the normal volume of applicants during the shutdown. It is absurd that medical interventions for life-threatening diseases are affected in this way. And trials are nottheonly medical services affected. Research at NIH institutions, including the National Cancer Institute, is suspended, along with 75% of staff-14 700 people-furloughed until further notice.
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