According to experts, tests for genetic diseases are a mixed blessing for the public. In a recent article James Evans, the Director of Cancer Genetic Services at the University of North Carolina, states that such tests are imprecise and can cause anxiety and discrimination while not always offering any clear benefit. Genetic tests are wrongly portrayed by the media as being able to predict with certainty whether or not a person will develop certain conditions. But in many illnesses, particularly where other factors play a role in disease aetiology, this is far from true and merely leads to increased ‘anxiety, stigmatisation and discrimination’. (Times 2001; 27 April)

The UK government has put forward a £30m package to encourage integration of genetic tests into every day general practice. The money will be used to double the number of consultant geneticists, support staff and genetic counsellors. It is predicted that the demand for such tests will rise by 80% a year. The government, which plans to cut waiting lists from a year to three months, is hoping that this will change NHS strategy from one of treatment to one of prevention, with treatments tailored to the individual’s genetic profile. The government is also setting up a voluntary genetics database, which will initially be used to study cardiovascular disease, psychiatric illness and cancer. 500,000 volunteers will be asked for blood samples as soon as funding has been arranged. At the present time, this genetic information will remain anonymous. (BMJ 2001; 322:1018, 28 April)

Insurance companies have bowed to pressure from the UK Government and have agreed to a two year moratorium on the use of positive genetic screening tests to assess their potential customers. A Commons science and technology committee report had urged the Government and the industry to ‘calm public fears about the risk of a genetic underclass’ and called for the moratorium.

While currently insurance companies rarely use genetic test data when assessing applications there are fears of discrimination on genetic grounds. The Association of British Insurers’ code of practice, which governs the use of such tests, states that applicants cannot be asked to take a genetic test as a condition of gaining insurance. But companies can ask about previous tests and impose higher premiums based on them.

Last year 50 of 150,000 applications for Norwich Union insurance involved genetic data. The proportion was similar for other firms. The committee suggested that this small number could allow insurers to ignore all genetic test results with relative impunity, allowing time to establish their scientific and actuarial relevance. (Telegraph 2001; 4 April, Telegraph 2001; 24 April)

The Human Fertilisation and Embryology Act of 1990, designed to prevent the cloning of humans, has already become ‘out of date’ according to Health Secretary Alan Milburn. The 1990 act defines an embryo as a ‘live human embryo where fertilisation is complete’, and does not foresee the possibility that a mammal could be produced without an egg needing to be fertilised, using cell nuclear replacement, as demonstrated by the creation of Dolly the sheep in 1997. Although the Human Fertilisation and Embryology Authority currently bans reproductive cloning, there is no legislation to stop it changing its stance. The new law, part of the Government’s bill that also restricts insurance companies’ use of genetic testing, is designed to send a clear signal to the international community of Britain’s opposition to reproductive cloning. (Times 2001; 16 April)

The Welsh Assembly has ruled that from April 1 there will be no prescription charges for people under the age of 25 who claim prescriptions in the Principality. It is estimated that the measure will cost around £5 million a year. In England, the upper age limit is 16 and the current standard prescription charge has just been increased to £6.10. Restrictions may have to be put in place if English residents abuse the system and this could put pressure on the British government to equalise the law for the whole of the UK. (Telegraph 2001; 3 April, BMJ 2001; 322:692, 28 April)

A third of young evangelical Christians believe in living together with a partner before marriage. The findings of a survey commissioned by the Evangelical Alliance, have shocked church leaders, who expected fewer than 10 per cent to support cohabitation. In total, 33 per cent of Christians aged 18 to 35 supported living together, compared with 82 per cent of non-Christians. The survey also shows that Christians in the 18-35 age group are the most rapidly declining age group among churchgoers. About 330,000 regularly attend services - one in ten of all churchgoers. Only the over-80s represent a smaller proportion. The survey also found that more than one in ten young Christians had taken illegal drugs, smoked and drunk excessive amounts of alcohol. The same number said it was acceptable to steal small items, such as stationery from work. One third said it was sometimes necessary to tell a lie.

In another startling survey of 15,000 children between the ages of 13 and 15 conducted by Rev Prof Leslie Francis of Bangor University, 82 per cent of those interviewed who reported to be Anglican thought that divorce was acceptable, and 85% of Roman Catholic teenagers disagreed with their Church’s teaching on sex outside of marriage. This compares poorly to Muslim children, where 58% thought divorce was OK, and 51% thought that sex outside of marriage was fine. (Telegraph 2001; 14 March, Times 2001; 7 May)

Following the repeal of Section 28 in Scotland, the law banning the promotion of homosexuality in schools, the Scottish Executive has published new guidelines on sex education placing a greater emphasis on the value of marriage. Schools will be ordered to teach that churches and large sections of society view marriage as the ideal relationship and that marriage and parenthood play a vital role in a family environment. The Church of Scotland is welcoming the fact that children will not just be taught about ‘romance and sexuality’. However, many groups are pushing for an endorsement of marriage in law; as local authorities are still only legally bound to promote stable family life, leaving parents with little power to force schools to promote marriage if they choose not to. (Telegraph 2001; 23 March)

President Bush has supported a law making violence against unborn children a crime. Although this falls short of a ban on medical abortions, it effectively grants the fetus separate legal status from the mother. The proposed law would mean that the killing or injuring of an unborn baby during a violent attack on its mother could result in a long prison sentence. The Unborn Victims of Violence Act would make it an offence to harm a fetus at any point from conception, regardless of whether the attacker knew that the woman was pregnant or whether the woman herself was seriously hurt. For the first time in nationwide American law, it would acknowledge that a fetus of any age could be an independent victim of crime. Even though the bill does not extend to medical abortion, its backers say it is necessary because, according to Tom Delay, the Republican majority whip, ‘under current law, when an unborn victim is murdered in our society, no one has died’. This follows Bush’s blocking of funds destined for international family-planning groups offering abortion and abortion counselling. (Telegraph 2001; 29 April)

In a challenge to recent legislation allowing the sale of the morning-after pill ver the counter of pharmacies, the Society for the Protection of Unborn Children (SPUC) is arguing that the pill effectively causes a miscarriage of a fertilised embryo in the uterus. The high court has agreed to hear SPUC’s challenge that the health secretary has broken the law, by allowing over-the-counter sales of the pill. This is because the pill is available without prescription, contradicting the Abortion Act that allows only doctors to terminate pregnancies. (Telegraph 2001; 3 May)

High street chemists are being warned by letter that they could face legal action if they sell the morning-after pill to women who then experience adverse side-effects.

The pro-life organisation, Life, has asked members in all its British branches to copy the warning letter and deliver it by hand to local pharmacies. The campaign is the latest problem facing the Government in its bid to halve teenage pregnancies by 2010 by taking Levonelle off prescription for women aged 16 and over. Life’s letter says that use of Levonelle ‘does nothing to address the issues of low aspirations or peer pressure. It makes girls readily available to persuasive men. It will encourage sexual activity and provides no protection against sexually transmitted diseases.’

Dr Liam Fox, shadow health secretary has expressed concern about the availability of the morning-after pill without a prescription: ‘My worry is not about the ability of pharmacists but about whether the high street chemist is the appropriate place for it to be given’. Judy McRae, chairman of the Royal College of Nursing’s school nurses forum, argued that any ‘backwards’ step ‘would completely undermine the hard work school nurses and family planning nurses have done with young people’. (Telegraph 2001, 3 January; Telegraph 2001, 24 January)

An adoptive mother tried to win her ten year old daughter’s affection by agreeing to a rebirthing ritual in Colorado. The girl was wrapped in tight flannel sheeting, and was encouraged to fight her way out into her mother’s arms, while four adults prevented her escape. The child fought for an hour to get out, crying for help 16 times before vomiting and choking to death. Members of the jury wept on being shown a video of this bizarre ritual. Two of the therapists involved have been found guilty of child abuse. The British Rebirthing Society has distanced itself from this case, claiming that it does not endorse the use of flannel sheeting. (Telegraph 2001; 24 April, BMJ 2001;322:1014, 28 April)

Medicine has long been seen as a profession with an extremely high suicide rate but a new study has shown that suicide rates among women doctors are on the increase. The report in the Journal of Epidemiology and Community Health found that the suicide rate was 13.6 per 100,000 women doctors per year between 1991 and 1995, double the national rate of 6.3 in the female population. Almost as surprising was the finding that the suicide rate among male doctors was 14.28 per 100,000, substantially lower that the male average of 21 in the same period. (Electronic Telegraph 2001; 15 March)

According to new guidelines, decisions about whether or not to attempt resuscitation should be reached in consultation, where possible, with the patient and close relatives. Decisions Relating to Cardiopulmonary Resuscitation, a joint statement from the BMA, the Resuscitation Council (UK), and the Royal College of Nursing, comes after public concern about ‘do not resuscitate’ (DNR) orders which were previously written in notes without patients’ or their relatives’ knowledge. The statement emphasises that a patient’s informed decision should be respected and that ‘all reasonable efforts’ should be made to attempt to revive a patient if their wishes cannot be ascertained. It also recommends a change to the term ‘do not attempt resuscitation’ (DNAR), to highlight the fact that cardiopulmonary resuscitation is frequently unsuccessful. The guidance recommends that resuscitation should not be attempted in all cases of cardiac or respiratory failure, for example it may be considered inappropriate for patients in whom cardiopulmonary arrest clearly represents a terminal event in their illness. (BMJ 2001;322:509, 3 March)

The Netherlands has become the first country in the world to pass a law decriminalising voluntary euthanasia. Dutch doctors carrying out the practice under strict conditions will no longer be judged automatically as criminals when the law comes into force this autumn.

The new law liberalises the existing legislation, in particular allowing children aged 12 to 16 years to request euthanasia with the consent of their parents and for those aged 16-18 to do so without requiring parental consent.

The legislation states that doctors must be ‘convinced’ that the patient’s request is voluntary and well-considered and that he or she faces ‘unremitting and unbearable’ suffering. Doctors must also have advised patients of their prospects and reached a firm conclusion that there is ‘no reasonable alternative solution’.

Senators have been inundated by 60,000 letters on the topic from the public. The spokeswoman for the opposition Christian Democratic party expressed fears that unless doctors were given legal rights not to co-operate on moral grounds, euthanasia could become a ‘viable treatment option’, creating a culture in which ‘doctors have to defend their choices not to commit euthanasia’. (BMJ 2001;322:947, 21 April)

Belgium is to be the next country to consider legalising euthanasia. In some areas it is planning to go even further than its Dutch neighbours. Whereas in the Netherlands a second doctor must review any decision, in Belgium he or she would only need to consider the diagnosis that had been made. (BMJ 2001;322:947, 21 April)

Two German MEPs are now trying to mobilise European public opinion against the new Dutch legislation. Dr Peter Liese, the chairman of the Christian Democratic working group for bioethics in the European parliament, and his compatriot, Hiltrud Breyer, the Green party’s spokeswoman on the temporary committee for human genetics, are calling for alternative treatment for people at the end of their lives.

They support each patient’s right to reject life prolonging measures such as artificial respiration. However they insist that this is totally different from active euthanasia. ‘If the state starts to allow medical doctors to give pills or an injection to their patients with the sole aim of killing the patients, the misuse of this method is inevitable,’ they pointed out. Instead, they want increased EU and national funds for research into effective pain relief and improved palliative care as well as political support from the European Parliament to put pressure on national authorities to provide more hospices. (BMJ 2001;322:638, 17 March)

Meanwhile, an Australian euthanasia campaigner has seized on Holland’s decision to legalise the practice by proposing a mercy-killing clinic on board a Dutch-registered ship. Dr Philip Nitschke who gained international notoriety by helping four cancer patients to die when euthanasia was briefly legalised in the Northern Territory in 1996, hopes to supervise suicides legally by mooring a boat outside territorial waters and operating under Dutch law. Dr Nitschke, a GP based in Darwin Australia, said: ‘We’re looking at how the change in Dutch law impacts on the international law of the sea.’

Although Australia’s federal parliament overturned the Northern Territory’s euthanasia law less than a year after it was introduced, following a public outcry, Dr Nitschke still runs clinics across the country where he advises terminally ill patients how to commit suicide. (Telegraph 2001; 12 April)

Two new UK medical schools are planned as part of a programme to boost student numbers, bringing the total number of medical places to 5984 by 2005—an increase of 2235 since 1997. Other new medical schools already announced include the University of East Anglia (first intake October 2002); the Universities of Exeter and Plymouth (October 2002); Durham University (September 2001); Keele and Manchester Universities (first intake either 2003 or 2004); and Warwick and Leicester Universities (started October 2000)

The Department of Health hopes that the latest two new medical schools, one based jointly at the universities of Brighton and Sussex and the other at the universities of Hull and York, will attract more students from lower income families. However, the BMA has warned that students will be able to afford to embark on a degree in medicine only if more funding is made available to support their studies, as levels of debt are putting many people off a medical career.

The BMA’s Medical Academic Staff Committee is also worried that, with the increasing clinical pressures on doctors in the NHS, few would have time to teach students. In 1992 there were 1246 whole time equivalent medical academics, but by 1999 that number had fallen by 16% to 1047. (BMJ 2001;322:816, 7 April)

The Evangelical Alliance published a report on transsexuality in January calling for sex-change operations to be stopped and an independent inquiry to be carried out by the Chief Medical Officer. The 100-page document, which includes contributions from doctors, lawyers and theologians, argues that sex-change operations are unnecessary and that transsexuals should be given holistic treatment for their spiritual and their mental health.

An alliance spokesman said: ‘Transsexuals are, we believe, confused about their identity and the correct response is an holistic one, which emphasises psychosomatic unity without recourse to surgery. It is a condition that cannot be cured by the surgeon getting the knife out.’ Clare McNab, a transsexual and spokesman for Press for Change, attacked the report yesterday for failing to include positive evidence from transsexuals.

There are estimated to be 2,500 to 5,000 transsexuals in Britain. The NHS conducts sex-change operations for men and women who are diagnosed with gender dysphoria, a recognised medical condition. (Telegraph 2001, 13 January)