News Review

'Designer baby' given the go ahead

A family from Leeds has been given permission to create a baby who will act as a bone marrow donor for their first child. Shahana and Raj Hashmi's son Zain suffers from thalassaemia, and without a bone marrow transplant, his outlook is bleak. No compatible donor has been found within the family or in the national pool.

The couple will undergo conventional IVF treatment but the embryos will be screened twice prior to implantation: once to make sure that any baby will not suffer from thalassaemia and once to make sure the baby would be a compatible donor for Zain.

Assuming all goes well with the pregnancy, when the compatible baby is born, blood will be taken from its umbilical cord and frozen. Cells from this blood will provide the replacement for Zain's bone marrow. Screening embryos in this way has drawn criticism from the pro-life lobby. Peter Garrett, a spokesperson for the charity Life, said: 'Should we allow a child to be manufactured in order to serve the medical needs of an older brother? Whilst the term 'designer baby' is often overused, it is all too appropriate in this case.' Also of concern is the destruction of other embryos, many of them completely healthy, in order to select the desired match.

Following the landmark ruling, six more couples registered at the Park Hospital Centre for Assisted Reproduction in Nottingham have revealed their plans to select embryos in a similar fashion. They all have children with illnesses whose only chance of survival is the birth of a brother or sister who can act as a donor.

It is likely that many more couples will follow suit in the next few years, despite the government's insistance that the decision would not set a precedent. Simon Fishel, director of the Park Hospital clinic, insisted that the door had now been opened for other parents. 'It was an ethical precedent, and the authority has for the first time set the strict criteria by which other cases will be considered,' he said. 'We have half a dozen other patients who are keen to go forward. I would be very surprised if I haven't put in another application within three months.' (Guardian 2002; 23,24 February)

Cloning loophole closed

The Court of Appeal has overturned a High Court decision which exposed a fundamental loophole in the UK legislation regarding cloning. When the Human Fertilisation and Embryology Act was drawn up in 1990 cloning was very much a technique of the future and it merely defines an embryo as 'a live human embryo where fertilisation is complete.' Following a landmark case brought about by the Pro-Life Alliance last November, Mr Justice Crane ruled that the Act did not cover embryos created by cloning, but only those created by fertilisation, leaving research on cloned embryos unregulated.

In the wake of this decision the government was forced to rush through legislation banning the use of cloning to produce a baby and the Appeal Court decision has now brought further research on cloned embryos, for example that aiming to grow human tissue for transplant, under tight regulation. The three judges ruled that an embryo produced by cell nuclear replacement - the process used to produce Dolly the sheep - was of the same genus as one produced by fertilisation. This means that cloning embryos to produce tissue for human transplant is now legal under the HFE Act.

In a case estimated to have cost £100,000, the original challenge to the Act was brought to the High Court by the Pro-Life Alliance who aimed to provoke a new debate by exposing the apparent loophole. However, the Appeal Court judge, Lord Phillips, said that the challenge had 'caused the baby to be expelled with the bathwater,' prompting an appeal by the government. (BMJ 2002; 324:190)

UK cloning decision

A House of Lords committee has ruled to permit therapeutic cloning and embryonic stem cell research. The decision on 27 February has dismayed pro-life groups worldwide.

The committee chairman was the Bishop of Oxford, the Rt Rev Richard Harries. He stated that, 'we were satisfied on the basis of the scientific evidence that as yet research on adult stem cells has not, as some claim, made research on embryonic stem cells unnecessary.' This biased view of the scientific evidence available is not surprising, as SPUC's Anthony Ozimic observed that the committee 'was stacked with supporters of human cloning, many with close links to bodies with a vested interest in embryo research. Only pro-cloning scientists were explicitly invited by the committee to give evidence.'

In fact, recent breakthroughs on adult stem cells are breathtaking. A team from Minnesota announced in January the discovery of the Multipotent Adult Progenitor Cell (MAPC), that can be reliably cultured from human bone marrow and has been demonstrated in mice to differentiate into every kind of adult body tissue. They also avoid the worrying tendency of embryonic stem cells to form neoplastic growths.

Rev Harries' views on the status of the embryo are consistent with that of the Warnock Report, that development of the primitive streak (14 days) marks the point beyond which no research should be done. He has suggested that the church has historically been divided on the status of the early embryo, a point disputed by other church leaders. (Guardian 2002; 28 February, www.cbsnews.com 2002; 27 February, www.stemcellresearch.org)

Chinese claim first place in cloning race

A Chinese scientist claims to have beaten western scientists by cloning a human embryo in 1999. Lu Guangxiu, of Viangya Medical College, says she and her team have since grown cloned human embryos to the stage where stem cells could be harvested and then cultured.

Professor Lu's work has not been subject to peer review; however she has published a paper in a Chinese journal. There are no laws controlling research on embryos in China.

The huge number of IVF clinics around the world and the ease of access to scientific publications on the internet, together with the growing number of skilled biomedical graduates and lack of regulation outside traditional scientific countries, make it likely that future stem cell and cloning breakthroughs will be made in countries such as China.

The accelerating pace of research around the world, and the enthusiasm of some governments to back such medical science, endangers the US initiative to bring about a worldwide ban on human cloning of any kind. It also shows that once cloning technology is developed policing its use will be impossible. (Guardian 2002; 8 March)

Dolly has arthritis

Dolly the cloned sheep is suffering from arthritis in her left hind leg, scientists have reported. The discovery has raised more questions about the viability of using genetically modified animals to develop treatments for human illness.

It had been suspected that Dolly might age prematurely and investigators had already discovered that her telomeres - DNA fragments on the ends of chromosomes which shorten with each cell division and act as a marker for age - are about 20% shorter than would be expected for a sheep of her age. This latest discovery has aroused further fears that the sheep is old before her time and hence that any organs harvested from cloned animals in the future might have a shorter life span than average.

Arthritis is not uncommon in sheep, but the typical age at onset is about ten -Dolly is five years old. Dolly's affected joints are also abnormal locations for arthritis in sheep, who typically develop arthritis in their forelegs. However, experts have noted that she has spent much of her life overweight and also has an unusual habit of standing on her hind legs to receive treats! (BMJ 2002; 324:67)

Japanese researchers have also followed the misfortune of a group of cloned mice, noting that out of twelve clones, ten had died by one year from pneumonia and liver disease. They have linked these problems to the cloning process. (Guardian 2002; 11 February)

Scientists clone a cat

Scientists in the US have cloned a cat for the first time. The kitten, named cc, was born at Texas A&M University on December 22 2001.

She is not an exact copy of her mother, Rainbow, as intra-uterine events, rather than genes determine the pattern of colours on a cat's coat. Researchers at the university have also been trying to clone a dog, but with no success as yet. In the past, scientists around the world have cloned sheep, mice, cattle, goats and pigs.

The kitten was cloned from cumulus cells, which surround egg cells before ovulation. The embryo was then implanted into a surrogate and carried to term. Out of 87 cloned embryos transferred to eight female cats, there was only one live clone. (Guardian 2002; 15 February)

Couple must choose between Siamese twins

A Hertfordshire couple are expecting Siamese twin girls who share one heart. According to the Sun, their mother, Tina May, and her fiancé, Dennis Smith will be forced to choose which of their daughters will be given the chance to live.

The couple, who have already named their twins Courtney and Natasha, were initially offered a termination when it became apparent Ms May was carrying conjoint twins following a routine scan in November.

Doctors at Queen Charlotte's and Chelsea Hospital in London believe that the dominant twin Natasha could survive because the shared heart is further inside her body than her sister's. Ms May is due to have a Caesarean section at the end of April and the twins will then be transferred to Great Ormond Street Hospital in London where they will be cared for until they are strong enough for an operation. The girls also share a liver which will have to be divided but this will regenerate.

A similar case has recently arisen in Italy with another pair of conjoint twins who share a heart. The ProLife Alliance has urged UK surgeons to follow the example of their Italian counterparts who plan to save both babies by giving the weaker twin a heart/lung transplant if necessary.

Conjoint twins occur once in about 100,000 pregnancies and only 19 sets have been dealt with at British hospitals since 1984. (BBC News 2002; 4 February)

Doctor reprimanded for giving rape victim anti-retrovirals

A senior hospital doctor in South Africa has been criticized for supplying antiretroviral drugs to a rape victim - a nine month-old baby. She was given Zidovudine, which if given soon enough can stop the virus replicating, having been gang raped by several men.

The doctor in question was reprimanded by health department officials, who pointed out that giving antiretroviral drugs in cases of rape is not department policy. Although Zidovudine is on the essential drugs list, it is only sanctioned for use by hospital staff that are injured while dealing with contaminated blood.

More than 67,000 cases of rape and sexual assaults against children, including dozens of babies, were reported in South Africa last year - an 80% increase on the previous year. There is speculation that the increase is due to a widespread myth that having sex with children provides a cure for AIDS. Some of the victims were as young as six months-old and a number died from their injuries while others contracted HIV. The country has the highest number of HIV-positive citizens in the world - official figures suggest that one in nine South Africans is infected with the virus.

The nine month-old girl at the center of the case was allegedly raped by six men in the Northern Cape province. Police say that at least one of the men, who are aged between 24 and 66, is HIV positive. The baby was tested for the virus and given anti-retroviral drugs as a precaution. (BMJ 2002; 324:191, Telegraph 2001; 11 November)

SPUC challenge the morning-after pill

The Society for the Protection of Unborn Children has launched an application at the High Court challenging the legality of the morning-after pill, Levonelle-2, being dispensed by pharmacists without a doctor's prescription.

The organisation says that the pill breaches the 1861 Offences Against the Person Act as it causes a miscarriage. The Act prohibits the supply of any poison or 'other noxious thing' with intent to cause a miscarriage. The case will hinge on the legal definition of a miscarriage and whether implantation is necessary before a miscarriage can occur. Levonelle-2 acts on the lining of the womb to prevent implantation of the fertilised egg.

According to the Department of Health, if the challenge succeeds, it could endanger contraception for millions of women in Britain. The Family Planning Association and Schering Healthcare, who distribute the drug in the UK, have echoed these concerns. If the challenge succeeds, emergency legislation may be necessary to amend the Offences Against the Person Act. (BMJ 2002; 324:381, Ananova 2002; 12 February)

Morning-after pill advert sparks criticism

The first advertisement for the morning-after pill has been widely criticised by both religious and pro-life groups. Due to appear in magazines for young women later this year it reads: 'Split Condom. Oops. Emergency Contraception!!! Quick. Pharmacy. Buy Levonelle . . . Phew.'

The campaign is the first since the morning-after pill, which can prevent pregnancy if it is taken up to 72 hours after sex, was licensed for sale over the counter last year. However, a spokesman for the Church of England, said: 'It's not contraception, because conception has already taken place. It's actually nearer to abortion. It would be better if the need to take it did not arise - in other words, don't get pregnant.'

In response a spokesman for the drug company marketing Levonelle said: 'Of course we are used to hearing some negative opinions about it. But we want to be responsible and try very hard not to offend.' (Telegraph 2002; 24 January)

Irish reject tougher abortion law

On 7 March the Republic of Ireland voted against a government proposal to tighten the country's abortion laws. The constitutional amendment, which would have removed the threat of maternal suicide as a reason to allow abortion, was rejected by a margin of under one percent.

Bertie Ahern, the Irish Premier, who had the support of the Church for his strong pro-life stance, admitted that he was very disappointed. He insisted that the close result reflected a wide spectrum of opinion on what is a very contentious issue.

The contest also reflected much confusion surrounding the proposal, and led to division in the pro-life camp as the bill only protected life from the moment of implantation, not from fertilisation. The vote arose out of a 1992 Supreme Court judgement, which ruled that a suicidal 14 year-old, who became pregnant after being raped, could have an abortion. Mr Ahern wanted to make sure that the case could not be used to liberalise Ireland's tight anti-abortion laws.

Irish doctors can only abort a pregnancy if a woman's life is in immediate danger. Abortion is not legal in cases of rape, incest or foetal abnormality. (Guardian 2002; 8 March)

Abortion ship loses licence

The Dutch government has refused a licence to a ship which offered abortion at sea for women in countries where the procedure is banned. The health minister said that she admired the work of the ship, which is registered in Amsterdam by the Women on the Waves foundation but added that she had no choice because it could not guarantee hospital admissions in the case of an emergency. Dutch government health inspectors were also unable regularly to visit the ship and ensure standards were adequate. A spokesperson added: 'It doesn't make any difference that the organisation is only using the abortion pill. If it goes wrong, patients need to be cared for in a proper clinic and at sea, it's just impossible.'

Last year, the ship provoked protests when it sailed to Ireland to carry out abortions off the Irish coast. However, no abortions were carried out. The organisation said it could not meet the high demand from Irish women. (BMJ 2002; 324: 442, Ananova 2002; 9 February)

Diane Pretty latest

The European Court of Human Rights in Strasbourg has said it will expedite an application for a hearing from Diane Pretty, the 43 year-old woman with motor neurone disease who has been refused a guarantee by the British Appeal Court that her husband would not be prosecuted if he assisted her suicide. (Guardian 2002; 24 January)

Marriage is good for your health

Getting married can make you healthier, live longer and boost your earning potential whilst being single can take up to three years off your life. According to researchers from the University of Warwick, the differences arise because married couples are less stressed and eat more healthily. Married workers also earn between ten and 20 percent more than single people, with the gap widening with age. (Metro 2002; 29 January,)

Diane Blood to have a second baby

Diane Blood, the widow who fought a court battle for the right to have her late husband's child, is pregnant again using his sperm. Having undergone treatment at the same Belgian clinic where she conceived her son Liam, she is expecting her second baby in July.

She had been trying to start a family with her husband before his death from meningitis in 1995. She persuaded doctors to take and store a sample of his sperm before his death. However, the Human Fertilisation and Embryology Authority denied her permission to use it, as her husband had not given written consent. In 1997 an appeal court ruled that she could take the sperm abroad for treatment. Her son Liam was born in December 1998.

Having announced her pregnancy she is about to embark on a new court battle under the Human Rights Act to obtain permission for her husband to be named as the father of her children. Currently the law does not allow a dead father to be named on a birth certificate. A private member's bill to change the law was talked out last year, and the government has not kept its promise of August 2000 to introduce retrospective legislation.

Her challenge follows a similar case in which a woman from Coventry whose daughter was born in similar circumstances managed to get her late husband named on the birth certificate. Donna Cairn's husband Colin died from cancer two years before his daughter was born, but he is listed on the birth certificate, with his occupation as 'warehouseman, deceased'. (Guardian 2002; 9 February)

And finally: a just dessert?

King Herod the Great, who ordered the massacre of all first-born baby boys following the birth of Jesus, got his come-uppance for his brutality according to scientists in America. Over 2,000 years after his death in 4BC at the age of 69, a team of researchers has analysed his symptoms and suggested that he died in agony from chronic kidney disease and Fournier's gangrene, a rare condition affecting the male genitalia.

This would have left him in extreme pain, suffering severe convulsions and abdominal cramps. 'The texts that we depend on for close description of Herod's last days list several major features of the disease that caused his death - among them intense itching, painful intestinal problems, breathlessness, convulsions in every limb and gangrene of the genitalia,' said Jan Hirschmann, professor of medicine at the University of Washington, who led the study.

The findings were revealed at the annual Historical Clinical Pathologic Conference where scientists and historians join forces to diagnose the afflictions of famous historical figures.

For an alternative diagnosis see Differential Diagnosis. Nucleus 1993; January. (Times 2002; 26 January)

Correction

In the July issue of last year we quoted a media report which incorrectly stated that amniocentesis results in the death of four healthy fetuses for every one diagnosed with Down's syndrome. The original paper, published in the Journal of the American Medical Association, in fact stated that an average of about 50- 100 invasive tests were required to diagnose one case of Down's where recommended screening procedures are followed. (See Barratt H. Prenatal testing for all? Nucleus 2001; July:2-4)