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Reproductive science: is there something we’re missing?

Reproductive science: is there something we’re missing?

Thirty
years after the first test-tube baby, Nature
asks various experts for their views on what the next thirty years of
reproductive medicine will bring.
Some of the more startling predictions are:

  • No more infertility, with both children and 100-year-olds able to have children
  • Embryos created from stem cells, increasing the ease of embryo research and genetic engineering of children
  • … with the resulting greater availability of embryos making it easier to create cloned humans
  • Artificial wombs, enabling babies to develop outside the mother’s body
  • … which, some worry, could become compulsory as an alternative to abortion, or to avoid premature birth or fetal alcohol syndrome
  • ‘Genetic cassettes’ implanted in embryos to counteract the effects of inherited diseases
  • Increase in litigation following evidence that IVF babies may later suffer adverse effects from the environment in which they were grown as embryos

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Testing alternative therapies

The journal Science is today reporting on a controversial plan by the US National Institute of Mental Health (NIMH) to test an alternative treatment for autism on children. The treatment, known as chelation therapy, involves the use of drugs that remove heavy metals from the blood. It’s based on a the theory – unsupported by conventional science – that mercury in vaccines triggers autism.

Chelation therapy is widely used, but its benefits and effects are not well understood. The NIMH have therefore argued that there is a "public health imperative" to test the drug. But opponents claim that any such study would be unethical, since the quality of the trial is likely to be poor, and any results – especially negative ones – would be unlikely to alter the behaviour of parents who support the therapy.

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Care for the Dying and Cost-effectiveness

Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.

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Unpopular policy and public rationality

The BBC
reports that the Japanese
town of Kamikatsu
has become the first ‘zero waste’ town. Residents
compost all of their food waste, and must sort the rest of their rubbish into
34 different categories—all of which they must take to public waste centres,
since there are no rubbish collections from people’s homes. It seems that the inhabitants of the town are
generally enthusiastic about the scheme, which offers small financial rewards
for recycling, and has encouraged people to make an effort to reduce the
rubbish they produce.

This is one
of those relatively rare, uplifting stories about a scheme designed to reduce
environmental damage that is not only successful, but supported by the
community. Could something similar work
in the UK? Recently, many UK councils reduced domestic refuse
collections from once-weekly to once-fortnightly, with recyclable waste being
collected in the intervening weeks. Whilst this has boosted the amount of rubbish being recycled,
some news reports
reveal that the new measures are unpopular, and some councils have bowed to
public pressure by re-introducing weekly collections. Given the environmental impact of adding to
landfill waste sites, ought the government to placate the public by relaxing
measures designed to reduce waste, or should unpopular measures be enforced
regardless of public opinion?

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Paying to top up NHS treatment

The BBC has this week published a story on co-payment in the UK’s National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab – a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That’s because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.

Should co-payments be banned?

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Sport, Sudden Cardiac Death and Liberty

Sport, like life, is dangerous. Several fit young footballers have died of sudden unexpected heart attacks. Doctors are now calling for mandatory testing using ECGs of all athletes. Italy has been pursuing mandatory testing for 25 years. This has revealed over 5% have some abnormality. Some people have congenital heart rhythm abnormalities which place them at high risk of sudden heart attack during or after sport. The call for mandatory testing is a sensible one. The interesting question is what is to be done with the results.

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Activists and acts of mercy

In Germany this week, and in Australia recently, there has been public
concern and significant media attention about the actions of euthanasia
activists. A former government official and lawyer, Roger Kusch, went
public in Germany with a video of an elderly woman who he had helped to
die. In Australia, Phillip Nitschke has been criticised for his
involvement and subsequent comments about the death of Graeme Wylie a
man suffering from Alzheimer’s disease whose partner and close friend
have been found guilty of manslaughter.

Opponents of euthanasia have used these cases to argue against liberalisation of laws on assisted suicide or euthanasia.

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