RCGP get off the fence on euthanasia

The Royal College of General Practitioners (RCGP) Council met on 18 June and firmly rejected the College’s previous neutral position on euthanasia.

The College upset many of its members by sitting on the fence over euthanasia during the debate of Lord Joffe’s Assisted Dying for the Terminally Ill Bill in recent months. Grass-roots members of the RCGP reacted against this supposed neutrality and have been making their position clear. This is a strong signal to decision makers to consult more widely when representing their membership. The College will meet again on 16 September to frame a clear policy.

The House of Lords’ Select Committee scrutinising Joffe’s bill reported in April this year. In its deliberations the Committee heard more than 140 witnesses from the UK, The Netherlands, the US State of Oregon and Switzerland. It received 60 submissions of written evidence from organisations and more than 14,000 letters and emails from individuals. Their report is a large dossier of evidence and will act as a basis for further discussion.

In the final analysis, they were divided, but the report effectively recommends that Parliament discuss physician assisted suicide. The bill ran out of parliamentary time because of the General Election on 5 May but Lord Joffe proposes to introduce an amended version in the next Parliament. (rcgp.org.uk 2005; 18 June)

BMA votes disappointingly on moral issues

The British Medical Association (BMA) has reversed its opposition to assisted dying and affirmed the current 24 week limit on abortion. Delegates voted on 30 June at the end of the week-long Annual Representative Meeting.

Both issues caused heated debate from both sides when they were discussed earlier in the week. On abortion, people who supported the status quo submitted evidence that no babies born very prematurely survived without permanent disability. This comes even though most neonates born at 22-23 weeks survive. 77% of doctors who voted rejected a motion calling for ‘the upper limit of abortion [to be] reduced in light of evidence of both fetal developments and advances in neonatal care.’ Vivienne Nathanson, BMA’s head of science and ethics, claimed this result showed ‘compassion winning out’.

There was a slimmer majority in reversing the BMA’s previous opposition to assisted dying. The motion was agreed after only half an hour’s debate, even though the Royal College of General Practitioners (RCGP) now opposes euthanasia after its previous neutral position.

A wide number of groups heavily criticised the latest developments. On the abortion vote, CMF’s general secretary, Peter Saunders, said, ‘we are very saddened by the vote which flies in the face of parliamentary and public opinion.’ He also deplored the use of misleading decade-old statistics on survival of neonates to convince delegates to vote in favour of the current policy. On euthanasia, he said it was sad that fellow doctors didn’t have the courage to oppose the biased BMA ethics committee. A spokesman from Life stated that the result does not reflect the strong opposition of doctors to a change in the law. (cmf.org.uk 2005; 30 June, Guardian 2005; 1 July, bbc.co.uk 2005; 1 July)

G8 announce debt relief

The world’s eight richest countries (G8) have announced complete debt relief for 18 countries, including 15 African states, totalling £22 billion.

The deal was agreed by the G8 finance ministers on 10 June ahead of the annual summit taking place in Gleneagles, Scotland. The main countries benefiting are those that are highly indebted and have a history of good governance. Britain’s chancellor Gordon Brown hopes to see nine more countries join the scheme if they meet the criteria of good stewardship and tackle corruption. African leaders at a recent meeting also welcomed the move, but called for the G8 to cancel all debt across the continent.

Countries benefiting from the deal have given it a cautious welcome, which is estimated to save a combined £830 million annually. Singer Bob Geldof, a long-time campaigner against poverty and organiser of the Live8 concerts, hailed this step as ‘victory’, but went on to push for developed world governments to double aid budgets and act for trade justice.

While the G8 memo included phrases such as a ‘timetable to eliminate all trade-distorting subsidies in agriculture’ and called for ‘special and differential treatment for developing countries’, it remained vague on detail. Despite the G8 promise, member countries are divided over how to raise the funds. The United States has pledged £1 billion over ten years, but may allocate money from existing aid budgets. France and Germany have supported an international aviation tax, while Britain is aiming to team up with the Gates Foundation to increase spending on developing world healthcare. (bbc.co.uk 2005; 10,11,20 June)

Refugee doctors controversy

The Royal College of Physicians (RCP) has called for the government to take more action over the employment of refugee doctors as the NHS has failed to take advantage of their skills.

An RCP study revealed that 85% of refugee doctors questioned did not have posts in the NHS, while just over half were working in an unskilled capacity in unrelated areas, such as security guards or chefs. An RCP spokesman, Professor Roger Williams, said that refugee doctors are a ‘resource that is not leaving the UK, they are here to rebuild their lives and they need our support’. The Council for Assisting Refugee Academics has estimated that it could take as little as £1,000 to prepare a foreign-qualified doctor to work here compared with £250,000 to train a doctor from scratch.

Meanwhile, leading doctors in the UK and Africa have published an article in the Lancet highlighting the damage caused by emigration of African healthcare professionals to developing countries - in particular the UK. Dr John Eastwood from St George’s Hospital in London suggested a World Health Organisation brokered agreement, with a minimum annual number of trainees in the developed world to reduce reliance on staff from developing countries. He urged the government to take a lead on the issue, given that Britain currently holds the G8 presidency.

While the UK has a policy of not actively recruiting doctors from sub-Saharan countries, they are not prevented from applying for posts. Dr Edwin Borman, spokesman for the BMA commented that the shortages of doctors and nurses were having a ‘devastating effect on the developing world’. Health minister Lord Warner acknowledged that there had been too much dependence on overseas doctors, but that this was now changing with increasing numbers of places at medical schools.

While a third of working doctors in the UK are trained overseas, only 5% of those in France and Germany were from abroad. (Guardian 2005; 23 April; bbc.co.uk 2005; 26, 27 May, Lancet 2005; 365:1893-1900)

Attack of the cloners

A research group from Newcastle has created the UK’s first cloned human embryo as part of their efforts to find new treatments for diabetes.

The Newcastle team used 36 surplus eggs donated from eleven women after IVF treatment. The nucleus within the egg was replaced with DNA from an embryonic stem cell. The newly recombinant cell was then given a small electric shock to promote cell division. Of all the eggs used, three developed into early stage embryos, while one formed a blastocyst, which survived for five days, but no stem cells were generated. The team hopes to use the cells from sufferers of type I diabetes mellitus to generate the cloned embryos. Dr Miodrag Stojkovic, leading the research, hoped that with the new technology they would be able to study ‘the very roots of the disease.’

Meanwhile, a South Korean team has taken things a step further by making embryonic stem cells from the skin cells of volunteers.

Julia Millington from the ProLife Alliance called the cloning of embryos for research purposes ‘profoundly unethical’, while a spokesman for the charity Life condemned the procedure of collecting eggs from women as ‘unsafe and inefficient’: it claimed that drugs used to promote fertility were dangerous and risky for would-be mothers.

The Human Fertilisation and Embryology Authority (HFEA) has approved further research by the Newcastle group to create more clones. Peng Voong, from the Lawyers’ Christian Fellowship, has launched a legal challenge in the High Court against the licence they have issued. He claims that the HFEA unlawfully withheld information about the licence and hence that it was invalid from the start. The High Court is still to decide whether or not to grant a judicial review on the basis of Mr Voong’s challenge. (Guardian 2005; 20 May, bbc.co.uk 2005; 20 May)

Every IVF embryo to be screened?

Embryos created by in vitro fertilisation (IVF) should be screened for genetic abnormalities by preimplantation genetic diagnosis (PGD) before implantation, said experts at the sixth international symposium on PGD in May. Evidence was produced showing that embryo screening improves the chances of women over 35 having a healthy baby by IVF.

Dr Yury Verlinsky, leader in the field of PGD and director of the Reproductive Genetics Institute in Chicago, claims his findings mean only normal embryos should be used in IVF treatment. In his study of 709 couples, 81% successfully had a baby after PGD compared to 11% without PGD. Speaking at the London conference he said, ‘40-70 percent of embryos have chromosomal abnormalities. So by selecting to transfer a normal embryo we fulfil our dreams to have a healthy child.’ IVF pioneer Professor Robert Edwards agrees: ‘The time has come that when we transfer an embryo we should only be transferring normal embryos. The days of implanting abnormal embryos are gone.’ This raises the question of what is normality. If chromosomally abnormal embryos are to be discarded, what about those with single gene defects or those with a propensity to obesity? We would be starting down another slippery slope.

Dr Peter Brinsden, medical director of Bourn Hill Clinic in Cambridge is concerned with the cost of screening embryos, noting that IVF is already expensive. Dr Verlinsky argues that the costs of looking after a sick child should be considered and that the number of treatment cycles could be significantly reduced with PGD. (BMJ 2005; 28 May, BioNews 2005; 13 June)

Sex education strategies

Only one third of sexually active teenagers are using condoms regularly, according to a study by the sexual health charity, Brook.

Two thirds of teenagers said that school was a prime provider of information on sex. The findings prompted the charity’s chief executive, Jan Barlow, to call for sex education to become a compulsory part of the national curriculum. Secondary schools are required to include it in their education programme, but the content is not regulated, which has led to charges of information being ‘too biological’.

The Department of Health issued a statement claiming that ‘sexual health was a priority’, while being ‘keen to improve access to sexual health care services.’ The Department for Education maintained that there were no plans to alter current sex education teaching. Statistics indicate that between 1995 and 2003, sexually transmitted infections (STIs) are soaring: chlamydia infections have risen 409% in boys and 252% in girls between the ages of 16-19.

Dr Trevor Stammers, general practice tutor at St George’s Hospital Medical School, published an editorial in the Postgraduate Medical Journal questioning the value of sex education programmes that don’t include abstinence-based schemes. (bbc.co.uk 2005; 18 May, Guardian 2005; 19 May, Postgrad Med J 2005; 81:273-275)

Leicester hospitals: Bibles are here to stay

University of Leicester NHS Trust has backed down from plans to remove Bibles from the bedsides of patients. Officials initally planned to remove the Bibles over concerns that they would offend ethnic minorities, and could help spread MRSA.

Ian Mair, an executive director of Gideons International -who provide Bibles widely in hotels, hospitals and prisons -said that they were ‘delighted with the latest decision’. The initial plans, he said, were both ‘sad’ and ‘ridiculous’. Since the organisation had heard of the move on grounds of MRSA, they had commissioned a microbiologist and surgeon to assess the risk to patients of infection. ‘Doctors told us to claim an MRSA risk is nonsense – and it is ridiculous to think having Bibles in lockers discriminates against other religions,’ said Mr Mair. The local Church of England diocese had encouraged officials to vote against a ban, and questioned the right of the NHS trust to remove Bibles when Gideons International had been putting Bibles in hospitals and other institutions for over a century.

Pauline Tagg, hospital director of nursing, had complained earlier that they are neither disposable nor have a wipeable cover. The proposal has angered Christians and Muslims, while other leaders of religious faiths were bemused that a bedside Bible would cause offence.

The Trust chairman, Philip Hammersley, said at a board meeting, ‘I can confirm that Gideons Bibles will remain in patient bedside lockers. In addition, information will also be placed in all lockers advising patients that other religious texts are available on request.’ A spokesman for the NHS trust refused to say who originally recommended the move. (Telegraph 2005; 3 June, bbc.co.uk 2005; 3, 9 June)

And finally… no more Mr Slice Guy

Surgeons may soon be addressed as ’Dr’ rather than the tradition ‘Mr/Miss’ that sets them apart from their physician colleagues.

The tradition of calling surgeons Mr remains from the past, when unqualified barber surgeons were those who were apprenticed into surgery without a university education. By the 18th century, some surgeons of the Great Company of Barbers and Surgeons gained university qualifications and were called Dr, while others were still called Mr. Mr was kept as a status symbol when the Royal College of Surgeons (RCS) was established in 1745.

However, the introduction of non-medically qualified surgical care could result in patient confusion over who is attending to them. The late Mr Hugh Phillips, then President of the RCS said, ‘All I am interested in is that people know who is treating them. It is terribly important to identify doctors, and one way of doing it is to call them doctors.’

It is thought that some surgeons will object to the change. However, anaesthetist Dr Sean McHale observed: ‘Even now some of my surgical friends manage to call themselves Dr when booking restaurant tables.’ (BMJ 2005; 14 May)