News Review

MRC announces UK stem cell bank

The Medical Research Council (MRC) has announced that the National Institute for Biological Standards and Control is to set up Europe's first stem cell bank. The UK Stem Cell Bank will be managed by the MRC and based in Hertfordshire. The biotechnology and biological sciences research council will contribute 25% of the cost of the £2.6m contract.

It is hoped that the bank will be up and running within a year and it will be responsible for managing existing and new adult, fetal and embryonic stem cell lines that will continue to multiply and survive indefinitely. The facility will supply lines to medical researchers enabling them to work towards using stem cells as possible new treatments for common diseases.

The launch of the bank was officially announced at an international stem cell conference - Stem Cells: Prospects for Research and Therapy - on 11 September, the first anniversary of the terrorist attacks in the USA, prompting accusations that the MRC had tried to 'bury the bad news'.

The use of stem cells for therapeutic purposes continues to create controversy and criticism. A spokesperson for the ProLife Alliance said: 'Like every caring member of our society we want to see ethical cures for human disease. But this bank will also be harvesting human stem cells from the fetus and the embryo and these can only be obtained through the deliberate destruction of human life.'
The discovery that stem cells can also be harvested from adults and have a similar ability to 'transdifferentiate' into other tissues, provides a possible alternative to using stem cells derived from embryos. For a comprehensive review of the latest developments in this field see BMJ 2002; 325:372-376. (Guardian 2002; 29 August, 9 September, BMJ 2002;325:562)

IVF mix-up

A mix-up during IVF treatment has resulted in a white woman giving birth to black twins. The woman has been shown to be the genetic mother of the twins, but her partner is not the genetic father. Her eggs were accidentally fertilised with the sperm of a black man attending the same clinic for treatment. A legal injunction has prevented the clinic from being named.

The case has raised questions about laboratory standards. Lord Winston, professor of fertility studies at Imperial College, London, asserts that this is a rare mistake and statistically less likely to happen than a woman taking the wrong baby home from hospital. However, Dr Sammy Lee of the Portland Hospital in London believes that IVF mix-ups are a regular occurrence. Normally these mistakes go unnoticed because it is rarely a 'black baby, white woman' birth, or vice versa.

Improvements should be sought to minimise the risk of this happening again. These could include the colour-coding of every sample, new standards for assessing staff, and independent quality control teams. However, in an already beleaguered NHS it is difficult to see where the money will come from for such new initiatives. The HFEA has been consistently under-funded by the government, since patients are expected to provide finances for their own treatment.

The future of the parents and children involved in the mix-up will have to be determined by the courts. Medical lawyers have confirmed that the birth mother (Mrs A) is definitely the legal mother. However, there is no legal precedent to determine who will be granted paternity of the children. Mrs A will also be able to sue for damages arising from the shock and violation of her bodily integrity. (Guardian 2002; 9 July, Independent 2002; 8 July)

HFEA u-turn on 'designer babies'

The parents of a three year old boy with Diamond Blackfan Anaemia (DBA) have been refused permission for pre-implantation genetic diagnosis (PGD) to ensure that their next child is a perfect match for a bone marrow transplant. The ruling, by the Human Fertilisation and Embryology Authority (HFEA), goes against an earlier landmark decision this February, when it allowed PGD to ensure any baby born would be a compatible donor for its elder brother who has thalassaemia.

There are factual differences between the two cases, however, that help explain the decisions. The thalassaemia case involved an inherited disease. The parents could therefore have PGD anyway to avoid having a child with the disease. The transplant to the existing child only involved taking blood from the umbilical cord of the new baby. DBA is heterogenous and rarely hereditary. Therefore PGD will not help to avoid having a second child with that disease. Furthermore, the transplant would involve removing cells from the baby, a procedure that the HFEA ruled no doctor in Britain could carry out.

The HFEA's refusal to allow this case to go ahead follows an attack by MPs condemning their previous decision. A report by the House of Commons science and technology committee accused the HFEA of overstepping its powers and acting undemocratically by taking a decision that should be the preserve of MPs. It further asserted that the public should have been consulted on a decision of such ethical importance. (Independent 2002; 18 July, 2, 4 August)

Fertility treatments recommended too soon

The test of clinical infertility used by doctors - no pregnancy after a year - is thought to be unsound. A study by the National Institute of Environmental Health in North Carolina, USA, indicates that most healthy couples who try for two years will conceive, even if in their late 30s.

The study analysed data from seven major European cities, including London. Even in women aged 35-39, fewer than one in ten failed to conceive after two years, unless the male partner was over 40. Thus while older couples may take longer to conceive naturally, they still have a good chance of succeeding

One implication of this is that couples may be undergoing infertility treatments too soon. Standard practice in Britain is to refer couples for medical tests and fertility treatment if they are unsuccessful after a year. This subjects people to the financial, emotional and physical burdens of infertility treatment, perhaps unnecessarily. (Guardian 2002, 4 July)

Gamete donor anonymity should be maintained

Government proposals to remove gamete donor anonymity were rejected by doctors at the annual conference of the British Medical Association in Harrogate this July. The availability of infertility treatment in the UK is limited by a shortage of donated gametes. The current system for donations enables complete donor anonymity, so long as the donation is through a licensed fertility clinic. This protects donors from responsibility towards any future child that may be born from the donated material. However, there have been calls from some campaigners to remove this clause and instead give children the legal right to trace their genetic parents.

The fear that removing donor anonymity would reduce the number of donations may be unfounded. When Scandinavian countries removed anonymity from their schemes there was an initial drop in donations, followed by a return to normal levels in the long term.

However, questions remain about the extent of information that children should have access to. Since 1991 the HFEA has collected information from donors so that future children will have access to limited data. The removal of anonymity would enable actual identification of parents, with the prospect of a 'knock on the door' in future years. Dr Mohamed Taranissi of the Assisted Reproduction and Gynaecology Centre in London believes that there are genetic reasons for knowing the identity of the donor. This would not place any responsibility on donors towards the child, but simply give the child access to their genetic make-up. Such access may be particularly helpful for disease studies. Any change to the law would not be retrospective but would only apply to future donors. (bbc.co.uk 2002; 16 May, Guardian 2002; 5 July)

Accusations over easy abortions

The Pro-Life Alliance has accused the government of supporting the abortion pill because it is the cheaper alternative to other methods. This follows a decision to make the RU-486 abortion drug more easily accessible during the first nine weeks of pregnancy.

The drug, also known as mifepristone, will be available free on the NHS from family planning clinics to women of all ages, including under-age girls. Prior to the July announcement, mifepristone was only available in hospital wards or through special day units.
The Department of Health denied that its decision was motivated by cost-cutting, but rather fuelled by a desire to reduce the need for surgery and so make abortion less traumatic for women. Ministers believe that the scheme will reduce waits of up to five weeks to end a pregnancy, making the system faster so that government targets are met. Ian Johns of the British Pregnancy Advisory Service has asserted that this will enable women to consider the real issues about abortion rather than having their time taken up with practicalities.

Meanwhile, a spokeswoman for Marie Stopes International has asserted that the requirement for two doctors to sign an abortion certificate should be abolished so as to help meet the 'huge abortion need'. Support for this also came from the Family Planning Association, who argued that sex education should start in primary school.

In another development, Sainsbury's supermarkets have announced that five of its stores are providing the abortifacient morning-after pill free of charge to girls under 16. Sainsbury's chief executive, Sir Peter Davis, said: 'We feel it is a responsibility to offer choice to our customers. We don't feel that it is right for us to tell our customers…how they should or shouldn't act.' Earlier this year, Tesco stores gave up a similar bid after pressure from pro-life organisations. (Times 2002; 8 July, spuc.org.uk 2002; 11 July, 22 August)

Cloning latest

In South Korea an investigation has been launched into claims by Clonaid that a woman is two months into pregnancy following implantation of a cloned embryo. South Korea currently has no law banning human cloning. Investigators will instead concentrate on other laws about medical practice that may have been violated by Clonaid. Two draft bills, about cloning and stem cell research, are currently on the fast track for approval by the National Assembly.
Meanwhile, Professor Ian Wilmut, whose team created Dolly the cloned sheep, has called for a ban on reproductive human cloning due to the high degree of abnormality. He admitted that 99% of animal cloning attempts ended in failure, whilst the offspring of cloned animals were frequently genetically or physically abnormal. (bbc.co.uk 2002; 12, 26 July, spuc.org.uk 2002; 19 August)

Assisted suicide for visitors to Switzerland

A Swiss euthanasia charity, Dignitas, has begun to accept foreigners into its membership and offers physician-assisted suicide (PAS) to those that can travel to Switzerland.

A television report detailed the journey of Sigrid Casey from Germany to Zurich, where she received the assistance necessary to end her own life. The prescribing doctor had received the patient's medical notes prior to their first meeting in order to aid his assessment of her capacity to make such a decision. After spending an hour with her he provided the necessary dose of an agent similar to that used by vets when 'putting down' animals.

Dignitas owns a flat where foreign patients spend their last hours, and a hospice nurse is present with the patient throughout. The nurse was tearful as she described how she sat with patients in their final moments. She is not paid a salary for her work since Swiss law does not allow anyone to profit from PAS. Additionally she cannot actually help the patient take the drug, or she could be found guilty of murder under Swiss law - the final act must be the patient's alone.

Dignitas was set up by Ludwig Minelli, a lawyer who believes that the terminally ill have a right to die when they choose. 'To live with dignity, to die with dignity. That is our motto' he said. The group has not yet fallen foul of the law. They inform the local authorities of each death and ensure that there are two witnesses present. So far they have assisted 109 people to end their lives, and accept the mentally ill and clinically depressed into their program.

Dignitas currently purports to have four British members, for a membership cost of £10 each. Anyone travelling from this country to Switzerland as a companion to someone seeking assisted suicide there, risks being detained on their return. Under the Suicide Act 1961, the companion may be guilty of aiding and abetting a suicide, which carries a maximum sentence of 14 years. (Newsnight, BBC2, 11 August 2002)

New archbishop provokes mixed reactions

The new Archbishop of Canterbury, Rowan Williams, may be set to cause a stir in his role over the coming years. Newspapers have been quick to label him a 'liberal' because of his reported views on homosexuality and remarriage within the church - he claims to have ordained homosexual priests knowingly. One conservative evangelical, the Reverend David Holloway, has said that, 'We need this appointment like we need a hole in the head.'

Those within church academia reject this view however. Dr Nicholas Lash, Emeritus Professor of Divinity at Cambridge says that, 'The term "liberal" makes no sense when applied to him…He's the best theologian in Britain and thoroughly orthodox,' while his counterpart at Oxford, the Reverend Sir Professor Maurice Wiles, asserts that, 'I am a liberal. Rowan is more within the orthodox tradition'. They highlight his ability to consider others' opinions, think them through thoroughly and engage in dialogue about relevant issues.
His willingness to be outspoken may prove valuable in medical ethics.

The Society for the Protection of the Unborn Child (SPUC) has welcomed the appointment, as Dr Williams has been a member of their organisation for years and holds very positive pro-life views. SPUC's national director, John Smeaton hopes that, 'Dr Williams' appointment may be part of a new beginning in the 21st century.' (Independent 2002; 20 July, bbc.co.uk 2002; 23 July)

GP struck off for trading human organs

A London GP has been struck off by the General Medical Council (GMC) having been accused of illegally trafficking human organs. Dr Bhagat Singh Makkar was found guilty of serious professional misconduct after offering to 'fix' a kidney transplant via the black market in return for a fee. He was caught on tape by a journalist posing as the son of a seriously ill man.

At the time, the doctor was not aware that the conversation was being recorded but at the hearing he vehemently denied taking part in the trade of human organs from live donors. Whilst researching a piece for the Sunday Times on organ trafficking, freelance journalist Paul Samrai contacted Dr Makkar after getting his name from a doctor in Jalandhar, northern India. Dr Makkar reportedly gave the journalist a leaflet about his company, Health International Services, and told him that he was retiring from general practice to 'manage operations'. He was also recorded saying: 'In south India, like in Bombay, Hyderabad, the donor will be less expensive than Punjab... in Bombay there are loads of poor people.' He had previously told Samrai that a kidney would cost him three times more in Britain than anywhere else in the world, and said that payment for the operation should be made to him directly, with the price including his own 'administrative costs'.

Prof Peter Richards, the chairman of the GMC committee, said that Dr Makkar had acted with a 'reprehensible disregard' for the interests of potential donors. The GP denied serious professional misconduct or participating in the trade in human organs from live donors, and later claimed that at the time of the conversation with Samrai he had been 'tired, confused and upset after a long day dealing with emotional patients'.

As in most of the world, the trade in human organs is illegal in both the UK and India. However, the Voluntary Health Association estimates that more than 2,000 Indian people sell their organs each year. According to one surgeon, many of those travelling to the country in search of a kidney come from the UK and patients can expect to pay between £10,000 and £15,000. After their operation, many return to the UK suffering from serious complications. (Guardian 2002; August 31, BMJ 2002; 325:510)