abortion - 40 years on

The 40th anniversary of the 1967 Abortion Act will be on 27 October. Campaigners on both sides of the debate are lobbying for change and although there are dangers of further liberalisation, it is also perhaps the best opportunity for tightening up the law in 40 years.

The Human Tissue and Embryos Bill is due to be introduced into Parliament in November. Amongst other things, the whole of the existing abortion law will be up for debate. Pro-abortion MPs have vowed to bring in abortion on demand in the first trimester, scrapping the need for two doctors' signatures, perhaps also opening the way for nurse-performed abortions and abortions in the home. There have been calls to reduce the current upper limit of social abortions (now at 24 weeks) but this also comes with real concern that any reduction in the upper limit could be traded off by relaxing restrictions in the first trimester (where most abortions occur), thus increasing the overall numbers.

The BMA (British Medical Association) at its annual meeting in June backed calls from its ethics committee to remove the need for two doctors' signatures, but narrowly rejected the committee's proposals for nurse abortions and abortions in the home, mainly on safety grounds. There was disturbingly little debate on the ethics, despite a website petition at www.bmapetition.org.uk for a proper evidence-based review and members' consultation. This was signed by over 13,000 people, including over 950 BMA members. Two CMF student members, David Randall and Nick Riches, were active in the debate.

The House of Commons Science and Technology Committee are running a consultation on scientific developments pertinent to the abortion debate, in order to inform the autumn parliamentary debate. CMF have submitted data on improved neonatal survival at 23 and 24 weeks, as well as evidence linking abortion with premature delivery and mental illness.

Despite the worrying signs of growing liberalisation, there are many encouragements also. A recent public poll by the charity Life showed that 68% wanted the upper limit for abortion reduced to 13 weeks. Media stories are highlighting more of the damage done to women by abortion. Much of this information is pulled together on the new website, www.timeforchange.org.uk that also give details of protest events surrounding the 27 October anniversary of the Abortion Act.

With 6.7 million abortions in 40 years, surely it is time for change. Further information is available in the current issue of Triple Helix. (Triple Helix 2007; Autumn:3,4)

guidelines for doctors' personal beliefs

The GMC (General Medical Council) just closed its consultation on a policy document titled Personal Beliefs and Medical Practice. Designed as an adjunct to the current guidelines in Good Medical Practice, it aims to provide detailed practical information regarding faith issues.

However, the draft document elicited strong criticism from the BMA (British Medical Association). They are concerned that, although affirming current policy on personal beliefs and professional practice, the document appears to disoblige doctors from involvement in any procedure to which they have any ethical objection on moral, cultural, or religious bases.

The BMA is worried that this extends, by too much, the widely accepted rights of doctors to abstain from treatment provision involving contentious life and death issues. The only legal right currently for doctors not to participate in treatment is in the case of abortion, under the Abortion Act.

The BMA is also of the view that medical students should participate in teaching in all areas of their core curriculum and not abstain under the conscientious objection clause. (GMC 2007; 13 September, medicalnewstoday.com 2007; 14 September, Independent 2007; 29 September, bma.org.uk 2007; 29 September)

PGD for Alzheimer's

The Human Fertilisation and Embryology Authority (HFEA) have allowed a couple from London to have their embryos screened for early-onset Alzheimer's disease.

The husband, Charl de Beer, has a family history of this condition on his mother's side, while his father's side is unaffected, so he has a 50% chance of carrying the gene. He does not want to know whether he will be affected, but he wants to spare his child from the disease.

Pre-implantation genetic diagnosis (PGD) will be used to select the unaffected embryos, with affected or excess embryos being discarded. But there is a one in four risk of discarding healthy unaffected embryos.

PGD was previously licensed only for genetic disorders with almost 100% penetrance like cystic fibrosis and retinoblastoma. In May 2006, the HFEA consented to extend screening to include less penetrant conditions; decisions would be made on a case by case basis. Critics fear that this will lead to embryos being screened for trivial traits.

Dr David King, director of Human Genetics Alert said, 'I don't believe that it is better never to have been born than to live a healthy life for 45 years and die from Alzheimer's.'

There are about 500,000 people suffering from Alzheimer's in the UK, and fewer than 5% have a strong family history of early-onset Alzheimer's. (careandhealth.com 2007; 22 September, telegraph.co.uk 2007; 21 September)

adult testicular stem cells

Functional tissues have been created from mouse testicular stem cells. This could lead to the development of a new source of therapeutic stem cells for human organ regeneration.

The use of embryonic stem cell therapies is controversial, with the risk of immune rejection and ethical concerns. In considering the alternatives, researchers are wondering if human testicular cells are pluripotent (able to differentiate into any fetal or adult cell type), which would increase their potential for organ regeneration. Until now, scientists have been unable to isolate these cells to prove the hypothesis.

A team of scientists from Weill Cornell medical college, USA, identified a unique cell surface marker expressed by spermatogonial stem and progenitor cells (SPCs). The marker, GPR125, was used to harvest a large number of SPCs from adult mouse testes, which the researchers then propagated and reprogrammed. They were able to produce several different cell types including brain, contractile cardiac tissue and endothelial cells.

Research will now focus on the possibility of human testicular cells sharing this pluripotent property. But the possibility of implanted cells derived from SPCs triggering cancer has been raised. (medicalnewstoday.com 2007; 22 September)

hybrid embryos allowed

In September, the HFEA (Human Fertilisation and Embryology Authority) ruled that it would consider applications for research involving the combination of genetic matter from human cells and animal embryos. Researchers hope that these techniques will further the investigation and treatment of several conditions, including Alzheimer's, Parkinson's and motor neurone disease, although they recognise that useful treatments would be decades away.

A government white paper, proposing that the use of hybrid embryos should not be allowed, was published in December 2006, following public consultation. It was due to form part of an update of the 1990 Human Fertilisation and Embryology Act.

However, the House of Commons Science and Technology Committee held their own consultation with leading scientists in early 2007 and announced their support for the use of hybrids in medical research.

Following this, Tony Blair was sent a letter signed by 223 patient organisations and medical charities, asking for the ban to be revoked. A lead researcher who had applied for an HFEA licence, Dr Stephen Minger, said, '[the use of hybrids] is a way of creating research material we don't have in the areas of catastrophic illness where there is almost no therapy whatsoever'.

A further public consultation was then held and the findings published in the summer. 61% of the 2,000 questioned supported the creation of interspecies embryos if it aided the treatment of diseases, whilst only a small minority were opposed to all embryo research.

Dr David King, director of Human Genetics Alert, believes that the experiments will be, 'scientifically useless and morally very problematic', and that the HFEA has ignored strong public opposition in their decision.

Furthermore, CMF's head of communications, Dr Andrew Fergusson, said, 'Creating hybrids is unnecessary and unethical. It would diminish human dignity, blur moral boundaries, and cross the fundamental line that has always separated humans from animals. The possible ends do not justify the means.'

(Guardian 2007; 6 September, medicalnewstoday.com 2007; 18 May, Independent 2007; 6 September, news.bbc.co.uk 2007; 5 September, BioNews 2007; 10 April, www.cmf.org.uk 2007; 17 May)

egg freezing available to all women

In the past, only cancer patients about to undergo chemotherapy would be offered the option of freezing their eggs for use at a later stage. Due to the development of a new IVF technique, vitrification, the option may now be available to any woman who wishes to delay motherhood.

The Japanese researchers who developed this technique claim that vitrification has a success rate of about 90% compared to 50% using traditional methods.

The availability of vitrification in Britain could mean that thousands of British women may start freezing their eggs in order to postpone starting a family until a more convenient time.

CARE Fertility will offer vitrification from September 2007. Dr Simon Fishel, managing director, believes that 'this new technology makes it ethical...to offer egg freezing to all women'.

The Secretary of the British Fertility Society, Dr Allan Pacey, urged caution because there are not enough studies to determine whether these results will translate into genuine success rates for women. (timesonline.co.uk 2007; 2 September, ivf.net 2007; 3 September, carefertilityweb.co.uk 2007)

half price IVF for donating 'surplus' eggs

Women are to be offered IVF (in vitro fertilisation) treatment at half price, if they agree to donate 'surplus' eggs towards embryonic stem cell research. The MRC (Medical Research Council) is subsidising IVF treatment and partly funding a study, at the North East England Stem Cell Institute, which aims to increase the efficiency of therapeutic cloning.

Women undergoing treatment at the Newcastle Fertility Centre may agree to donate some of their extra eggs to this study, and in return receive IVF treatment at £1,500, down from the normal price of £3,000. This is the first time the MRC has paid research participants, as it is not usually MRC policy. Critics say that desperate women may feel coerced into taking part for financial reasons.

Josephine Quintavalle of Comment on Reproductive Ethics says that there would be a 'tendency...to over-stimulate women to produce more eggs, when targeted treatment using less stimulation is becoming the gold standard'.

The MRC defended their decision by stating that 'the women would be taking no additional risks to their health by providing surplus eggs for research'. The researchers claim that this

is necessary to provide sufficient human eggs to make progress. (mrc.ac.uk 2007; 13 September, news.bbc.co.uk 2007; 13 September, BMJ 2007; 22 September, thisislondon.co.uk 2007; 29 September)

UK short of training posts

The junior doctors' recruitment crisis is expected to be worse next year, according to a recent government document. Three applicants will be competing for every training post compared with this year, when 33,000 doctors applied for around 22,000 training posts.

Doctors who were unable to secure coveted run-through jobs (all the way to consultant level) took on short term contracts in the months immediately after the MTAS (Medical Training Application Service) crisis. They are expected to reapply next year along with many of the 10,000 candidates who failed to get any kind of job.

Despite terminating the flawed MTAS application system in May 2007, the Department of Health recognised, 'There are many lessons to be learned from problems with junior doctors' recruitment this year. We are determined to listen to the voices of doctors and make changes to the process in 2008 and subsequent years.'

The MMC (Modernising Medical Careers) team has produced a consultation paper proposing improvements for recruitment in 2008. For example: staggering the start of these training jobs to avoid the rush of doctors (including fresh graduates) beginning work on 1 August. Recommendations were taken from junior doctors, the BMA, royal colleges and other stakeholders.

In addition, an independent review of MMC and MTAS is being undertaken by Sir John Tooke, chair of the Council of Heads of Medical Schools and chair of the UK Health Education Advisory Committee. He aims to revise the training process for implementation in the 2009 intake of junior doctors and he will report on an interim basis in the following months. CMF has made a submission to the Tooke inquiry that can be viewed at www.cmf.org.uk. (BMJ 2007; 22 September, mmc.nhs.uk 2007, telegraph.co.uk 2007; 17 September)

and finally… 'questioning' HIV

As medical students, we are aware that HIV causes AIDS. This consensus of the scientific community is based on two decades of robust research. However, the internet is now being exploited to spread misinformation denying that HIV is the cause of AIDS.

A distrust of scientific authority characterises HIV denialists, who posit conspiracy theories. They often stand to gain from their stance due to the profitable nature of 'alternative' therapies that they peddle. Their tactics include the portrayal of scientific consensus as unquestioned dogma and the constant demanding of more evidence.

Amusingly unbelievable as this may be to mainstream scientists, the general public may be harmed by this misinformation. HIV positive patients, for example, are being urged to use unproven remedies instead of antiretroviral medication.

Even more outlandish is the recent accusation that European condom manufacturers are infecting their products with HIV to kill Africans. Francisco Chimoio, the Roman Catholic archbishop of Mozambique, has made statements to this effect, which may undermine the government's AIDS education campaign. Chimoio rightly believes abstinence to be the best way to combat AIDS, but at the cost of truth? (medicalnewstoday.com 2007; 17 August, PLoS Med 2007; 21 August, Guardian 2007; 27 September)

TiJesunimi Abiola, Jenny Chui, Hugh Ip, Sophie Marnham and Jemima Tagal