News Review

Cloning Loophole Exposed

The Government has been forced to rush through emergency legislation to make human cloning illegal in the UK. The decision followed High Court action by the ProLife Alliance, which demonstrated that existing regulations did not outlaw the practice.

The ProLife Alliance successfully claimed that organisms created by cell nuclear replacement, the technique used to create Dolly the sheep, were not in fact 'embryos' as defined in the Human Fertilisation and Embryology Act (HFE Act) because they were not created by the fertilisation of an egg by a sperm. In effect, this means that the creation of such embryos, whether for therapeutic stem-cell research or reproductive cloning, is not regulated in the UK.

The organisation also warned that the ruling meant that human reproductive cloning based on cell nuclear replacement could potentially be carried out in the United Kingdom. Ministers came under further pressure to ban reproductive cloning outright after controversial Italian fertility doctor, Severino Antinori, said he would come to Britain to exploit the loophole.

Secretary of State for Health, Alan Milburn, announced that the government intends to appeal against the High Court ruling. Although the government wants to outlaw human cloning, it is keen to ensure that therapeutic cloning is still permitted. Mr Milburn added that the new law would still permit research for therapeutic purposes using stem cells from embryos created by fertilisation, as well as those created by nuclear transfer. (BMJ 2001;323:1203, Independent 2001;17 November)

Scientists clone first human embryo

Scientists in America have cloned the first human embryo. The results of the experiment, which the scientists are keen to point out was for therapeutic purposes only, were reported in the Journal of Regenerative Medicine.

The embryos were created by placing DNA from human skin cells into an enucleated human ovum. In order to harvest stem cells for medical use an embryo would need to consist of a minimum of 64 cells. However, the most developed embryo in the experiment only grew to six cells having been cultured for a week.

The volunteers who provided skin cells to be cloned suffered from a variety of conditions from diabetes to spinal cord injury. They included 40 year old Dr Judson Somerville who was paralysed in a cycling accident. He had hoped that treatment with stem cells might enable him to walk his daughter down the aisle at her wedding.

Scientists from the US company Advanced Cell Technology, Massachusetts who carried out the experiment were confident that the results prove that the technique is in fact viable. Vice president Robert Lanza said: 'This work sets the stage for human therapeutic cloning as a potentially limitless source of immune-compatible cells for tissue engineering and transplantation medicine'. The company hopes that stem cells will be used to treat a range of conditions within the next ten years.

However, the creation of embryos for research purposes is likely to become illegal in both the US and the UK. The US House of Representatives has voted to make it a criminal offence and it will be prohibited by the emergency legislation recently introduced in the UK. (BMJ 2001;323:1267)

US doctors approve sex selection for non-medical reasons

The American Society for Reproductive Medicine has ruled that helping couples to select the sex of their babies for 'gender variety' is proper and ethical. In a letter of advice to an infertility specialist, John Robertson, acting chairman of the society's ethics committee, stated that it was acceptable for a couple to choose an embryo of the opposite sex to an older sibling. Until now, the society, which sets the rules for reproductive medicine in the US, has allowed the practice only to avoid certain sex-linked genetic traits. The technique that would be used is pre-implantation genetic diagnosis, the same as is used to select embryos where children are at risk of a sex-linked genetic disorder. Embryos are tested outside the womb to determine which are male and which are female. The ruling represents a change in opinion since as recently as 1999, when the Society discouraged its members from using this method simply because a couple wanted a boy or a girl. The code of practice of the Human Fertilisation and Embryology Authority in the UK states that 'Centres should not select the sex of embryos for social reasons'. A spokesman said that this policy was made after a consultation exercise in 1993 when most respondents felt that sex selection should not be made for social reasons or for 'family balancing'. (BMJ 2001;323:828)

Parents select embryo so son can have stem cells

Two UK parents are seeking permission to select an embryo which could potentially donate stem cells for its two-year-old brother. Raj and Shahana Hashmi appealed to the Human Fertility and Embryology Authority after they failed to find a suitable bone marrow donor for their son, Zain, who suffers from thalassaemia. Doctors would be able to harvest and transfuse stem cells from the umbilical cord of a baby with compatible blood and tissue types. The cells would repopulate Zain's bone marrow and generate new, normal blood cells.

According to Dr Simon Fishel, of the Centre for Assisted Reproduction in Nottingham, this would 'effectively cure' the toddler's condition. Dr Fischel has agreed to carry out the embryo selection if permission is granted. If the Hashmis are successful, it will be the first time that pre-implantation diagnostic genetics is used to benefit a sibling in the UK. Currently the technique is used for testing embryos at risk of a specific genetic disorder, such as cystic fibrosis.

The first use of the technology to help a relative worldwide was in the US in October 2000: a couple from Colorado screened 15 embryos to find a match for their six year old daughter, who was born with Fanconi's anaemia. (BMJ 2001;323:767)

Public approve pre-implantation diagnosis

A two-year public consultation on the use of pre-implantation genetic diagnosis (PGD) has shown general approval for the practice. It is used for couples at risk of producing children with genetic disorders; embryos generated by IVF technology are screened for a range of genetic disorders and affected embryos are discarded.

At present PGD is only licensed in five centres since it was introduced in 1990, but the report findings may lead to it being opened up across the country. The Human Fertilisation and Embryology Authority and the Human Genetics Commission have set out guidance on when PGD should be used.

Out of those responding to the survey, only 20% thought that PGD should be restricted as it discarded living beings and devalued disabled people. Less than half thought that starting a pregnancy whilst knowing that the baby had a genetic disorder could ever be compatible with 'the welfare of the child'. (Telegraph 2001;15 November:14)

Belgium set to decriminalise euthanasia

The Belgian Senate has strongly approved draft legislation to give terminally ill people the right to die making it the second country in the world to do so, after the Netherlands. The proposal is expected to be passed by the lower chamber before the end of the year. The large majority in the vote was attributed to the legal opinion of the country's Council of State that it was 'the right to life' and not 'life' itself that was at stake, and that this should be seen in the context of self-determination. Conscious patients over 18 with an incurable illness will be allowed to receive euthanasia if they have made voluntary and repeated requests to die. Each request will have to be registered with a committee of doctors and lay people. Parallel legislation will be introduced to provide for improved palliative care. Even the legislation's supporters acknowledge, however, that planned cuts in next year's health spending, in particular on nursing homes, will make this difficult. 72% of Belgians taking part in a newspaper survey earlier this year approved of decriminalising euthanasia. In a second survey, 42% of doctors said they would be prepared to honour a request for assisted suicide. (BMJ 2001;322:1024)

Compulsory palliative care training for Californian doctors

The governor of California, Gray Davis, has passed a new law requiring all doctors in the state to take courses in palliative care and pain management. The courses will be part of the continuing medical education that all doctors must take to renew their licenses, and must be completed within four years. Complaints of doctors mishandling pain treatment will also have to be reviewed by a pain specialist.

The law is the result of a successful legal action against Eden Medical Centre in northern California, brought by the daughter of a former patient, who accused the centre of 'elder abuse'. Her father, William Bergmann, was admitted in February 1998 with probable advanced lung cancer and bone fractures. Dr Wing Chin, an internist, prescribed too little pain relief, though nurses rated his pain as being between 7 and 10 on a scale of 0- 10, with 10 being the worst pain imaginable. Mr Bergmann was sent home, still in agony, after five days, and died later that month in a hospice. The plaintiff's lawyers described Dr Chin's behaviour as 'inexcusable' and the family was awarded $1.5m (£1m), which was subsequently reduced to $250,000. (BMJ 2001; 323:1088)

vCJD in Scotland linked to poor diet

The head of the Creutzfeld-Jakob Disease (CJD) surveillance unit in Edinburgh has suggested that the more frequent consumption of cheap meat products might explain the high rate of vCJD in Scotland and northern England compared to elsewhere in Britain.

Speaking in Glasgow, Professor James Ironside said that twice as many cases have been reported in Scotland and the north as in the south of England and Wales (2.71 cases per million people compared to 1.47 per million). Cheap products such as burgers and pies were more likely to contain mechanically-recovered meat, produced by scraping or sluicing off cattle bones, which carried the greatest risk of contamination with BSE. Most of the BSE-contaminated meat products entered the food chain in the late 1980s. Professor Ironside said that efforts to investigate links between diet and vCJD have been hindered by the food industry's.13 NEWS REVIEW unwillingness to disclose what kind of meat was used in their products. An alternative explanation for the increased incidence of vCJD in northern Britain is that people living in these areas have a higher genetic susceptibility to the disease. According to the Edinburgh surveillance unit, every person who has contracted the disease shared a common genetic factor that is present in about a third of the population. (BMJ 2001;323:590)

Health minister sued for withholding HIV drugs

A six-month-old South African baby is at the centre of a court case against her province's health minister regarding the failure to administer the antiretroviral drugs that might have prevented her from contracting HIV from her mother at birth. Her 19-year-old mother was not told that she was infected with the virus, nor that there were drugs that could prevent its transmission to her child. A single oral dose of nevaripine given during labour and a dose of syrup to the child halves the likelihood of HIV transmission.

The claim follows legal action against Pretoria brought by the Treatment Action Campaign, one of South Africa's leading AIDS rights groups, in August. They accused the government of violating the constitution and their promises, as well as racism, in its resistance to making these drugs available to HIV-positive mothers. President Thabo Mbeki is reportedly sceptical of their value. For years the government claimed they were too expensive and untested, and more recently that the infrastructure was inadequate to supply them. According to campaigners, this antiretroviral regime would save the lives of 35,000 babies every year. (Guardian 2001; 20 October)

Cannabis to be decriminalised

In the biggest shake up of British drugs policy in recent years, the Home Secretary has revealed plans to reclassify Cannabis from Class B to Class C, placing it in the same category as antidepressants and steroids.

He said the reclassification was necessary if the government's drug policy was to be taken seriously by young people.

Although David Blunkett was adamant that that his proposal was not the same as decriminalising the drug, cannabis campaigners believe that, in practice, users of the drug will no longer face prosecution.

Mr Blunkett also said that subject to the outcome of clinical trials to be completed in 2003 he would recommend the legal use of cannabis-based drugs (carrabinoids) for medicinal reasons. He also announced plans to make heroin more widely available on prescription where doctors considered it to be appropriate. (Independent 2001; 24 October)

MMR jab is safe

Parents who take their children to have separate measles, mumps and rubella vaccinations instead of the combined MMR may be at putting them at risk of the diseases and of unwanted side effects. A paper, published in Archives of Disease in Childhood is designed to stop the downward spiral in vaccination numbers and refute the research of Dr Andrew Wakefield which suggested a link between measles vaccination and autism. Public health doctors are concerned that the boycott of the MMR by many parents will lead to a measles epidemic.

The paper reviews the evidence against the autism theory, saying there is no basis for it, and finds that 'there is no case for the use of single vaccines'. The authors claim that there is 'a large body of evidence to show that MMR vaccine is highly effective and only rarely causes serious side effects'. The vaccine has been used in the US for nearly 30 years, in Scandinavia for nearly 20 years and in the UK since 1988.

They warn that giving the vaccines separately at intervals means children are not protected against all three diseases as early as possible. This puts them at greater risk of catching one of the diseases, allowing continued circulation of the infections. Children would have to have six injections instead of two, and it was possible some would not return for all of them. (Guardian 2001; 24 September, Lancet 1998; 351:611-2, Lancet 1998; 354:949, Department of Health website: www.dh.gov.uk)

MS patients welcome new interferon trial

The government is trying to forge a deal with the manufacturers of beta-interferon that will allow it to side-step official advice from the National Institute for Clinical Excellence (NICE) which advises that the drug is not effective, on both clinical and cost grounds.

A spokesman for the Multiple Sclerosis Society said: 'If this is confirmed, then it is very welcome news. It means that a lot of people who are presently being denied it look as though they will have a chance to try the drug.'

An interim report published by NICE in August, enraged MS sufferers and the drugs manufacturers have been lobbying for two years to ensure that beta interferon continues to be made available on the NHS.

Presently around 80,000 people suffer from MS in the UK, most of whom cannot be helped by beta interferon. An annual course of treatment costs between £7,000 and £10,000. (Guardian 2001;31 October)

Blasphemy law to be consigned to history

Home Secretary, David Blunkett has provoked further controversy following the announcement of his plans to abandon UK laws against blasphemy. The legislation was last used successfully 24 years ago against a poem published by Gay News that depicted Christ as a homosexual.

In a speech to the parliamentary Joint Committee on Human Rights Mr Blunkett said: 'It is my own view that there will come a moment when it will be appropriate for the blasphemy law to find its place in history.' His supporters include former cabinet minister Frank Dobson, who believes that the legal definition of blasphemy is discriminatory because it protects only Christianity, and possibly only the Church of England. He added, 'Surely, after all this time, the Church of England can stick up for itself.'

The last person jailed for blasphemy was John William Gott, a secularist sentenced to nine months' hard labour in 1921 for publishing a pamphlet comparing Christ to a circus clown. The attempted prosecution of the author Salman Rushdie following the publication of his controversial novel The Satanic Verses confirmed that the law did not extend to the protection of Islam. (Independent 2001;15 November)

Surveys reveal Britain becoming more liberal

The number of couples marrying in the UK is at its lowest level since 1917 and our divorce rate is currently the highest in the European Union. The results of the annual British Social Attitudes survey also show that more than 15 per cent of couples now cohabit compared with five per cent in 1986, and by 2021, the number is expected to reach 30 per cent. This means that a quarter of children are now born to cohabitants.

The report, published by the National Centre for Social Research, states that marriage is 'no longer seen as having any advantage over cohabitation in everyday life'. Only 54 per cent of adults now think that 'people who want to have children ought to get married' compared with 70 per cent in 1989. Similarly, it appears that 62 per cent of adults think there is 'nothing wrong' with sex before marriage compared with 42 per cent 12 years ago.

It also suggests that opinions amongst church groups have softened as just over half of Catholics and two-thirds of Anglicans interviewed now believe people should marry before having children.

The authors of the report warn that government policy has not kept pace with this social change as family law still concentrates on the legal rights of married people, treating cohabitants as inferior. However its publication comes at a time when a private members bill, the Relationship (Civil Registration) bill, is being introduced in the House of Commons by backbench MP Jane Griffiths. Although it is widely expected to fail, if the bill were passed it would allow same-sex and heterosexual cohabiting partners the same legal rights as married couples.

According to a second report, published in the Lancet, young people have more partners before settling down; men and women are more likely to have affairs; and twice as many women have homosexual encounters as ten years ago. The three year study of the sex lives of more than 11,000 people aged from 16 to 44, conducted by University College London (UCL), the London School of Hygiene and Tropical Medicine (LSHTM) and the National Centre for Social Research aimed to provide an accurate picture of sexual lifestyles in Britain today.

Compared to a decade ago, twice as many men now pay for sex and despite a significant increase in condom use, the incidence of sexually transmitted diseases has more than doubled. 41 per cent of men and 23 per cent of women aged 25 to 34 have apparently had more than ten sexual partners. The average age of first intercourse is now 16 and 30 per cent of men and 26 per cent of girls had sex under the age of 16. (Independent 2001;26 November, 30 November) (Observer 2001;25 November)

Rising population and consumption threaten health and planet

According to a new report published by the United Nations Population Fund, the increasing population of the world and rising consumption of energy and land are threatening the wellbeing of both people and the planet.

The global population is now 6.1 billion, three times as big as 70 years ago, and is predicted to rise to 9.3 billion by 2050. 86% of total private consumption is accounted for by the 20% of people who live in industrialised countries. It is claimed in the document that each of these individuals requires four times the area of productive earth to support their lifestyle as a person in a developing country, which is double the area that is sustainable.

Over half the world's population does not have enough to eat, and overfishing by industrial nations is threatening the main source of protein for almost a billion people in the developing world. Water shortages are faced today by 508 million people, and this is likely to rise to 3 billion by 2050.

The report calls for urgent strategies to stem wasteful consumption and population growth, including increased funding for reproductive health and family planning programmes. It is in favour of international agreements, such as the Kyoto protocol against climate change. (BMJ 2001;323:1088) (www.unfpa.org/ swp/2001/english/index.html)