From nucleus - winter 1999 - News Review [pp7-13]
The World Medical Association is planning to discuss cloning of human embryos at its annual general meeting in October. New advances in cloning have been coming so rapidly that a fresh debate is needed. In the UK, the Government has retained a ban on cloning embryos for reproductive purposes, although techniques involving replacement of the cell nucleus in order to clone tissues may be permitted in the future, after more debate. The prospect that human embryos will be routinely cloned has drawn closer because of efforts to develop commercial treatments for a range of ailments, from diabetes to heart disease, by using cloning to generate a patient's own cells and tissue. Current research plans to dismantle early cloned human embryos before 14 days as a source of stem cells. These will then be used to grow tissues for transplant and organ repair, rather than implanting the cloned embryos into a surrogate mother to produce a cloned human. Critics argue that such work marks an important step towards the first cloned baby, and it is not illegal in the US to attempt to clone human beings. Lord Winston has suggested that scientists use spare embryos from IVF treatments (that would otherwise be destined for destruction) for growing human tissues, thus side-stepping the need for actual cloning of new embryos (BMJ 1999;319:8, 3 July), (Telegraph 1999; 18 June), (Telegraph 1999; 15 June), (Telegraph 1999; 25 June), (Telegraph 1999; 1 July).
The Nuffield Council on Bioethics, which examines ethical issues raised by developments in medicine and biology, has firmly rejected calls for a postponement of the commercial planting of genetically modified (GM) crops. It argues that the technology has the potential to bring about important benefits such as improved nutrition, enhanced pest resistance, increased yields, and new products such as vaccines. People in well-developed countries are concerned about the possible risks of eating genetically modified foods. However, the group says that more weight should be given to the life-or-death concerns of the hungry. There is concern that the big industrial companies may restrict competition, thereby making it difficult for developing countries to gain access to the new technologies (BMJ 1999;318:1506, 5 June).
Gordon Brown, the Chancellor of the Exchequer, has proposed a plan of debt relief for 36 Third World countries to the G7 industrial summit in Cologne. The relief could be up to $60 billion, and will be partly financed by a partial sale of the International Monetary Fund's 103 million ounces of gold reserves (Telegraph 1999; 13 June).
The six billionth person was born on Monday 26 July. Statistically, he or she had less than one chance in ten of being born into prosperity and a one-in-three chance of being born into extreme poverty. If the baby was born in Africa, the odds are that life will bring malnutrition, inadequate schooling, poor sanitation, unsafe drinking water and a life-span shortened by the cumulative effects of grinding poverty and debilitating disease. A baby girl will be worse off than a boy born almost anywhere as girls have to contend with poorer education, early marriage and childbirth and a higher risk of contracting HIV than boys. The richest one fifth of humanity has 82 times the income of the poorest fifth - and consumes 86% of the world's resources (Telegraph 1999; 23 July).
A study by the pro-abortion group Marie Stopes International has revealed that the number of GPs who support 'abortion on demand' has increased over the past 25 years. 60% of family doctors now believe a woman should be able automatically to have an abortion in the first three months of pregnancy if she wants it. In 1973, the figure was 24%. Pro-abortion campaigners will use the figures to support a call for the law to be changed in favour of abortion on demand for women in their first three months of pregnancy. They also want GPs to be obliged to declare any conscientious objections to abortion and to refer women to a doctor who does not hold the same view.
More than eight out of ten GPs described themselves as 'broadly pro-choice', with most of the rest - one in five - 'broadly anti-abortion'. Of the latter group, a fifth said they supported a woman's 'right to choose'. Three-quarters of GPs thought women should be entitled to free NHS abortions. The report stated; 'We are disturbed by the finding that a significant minority of GPs may be imposing their own moral standards and values on women, causing distress, delay and financial hardship'. Life, a leading pro-life charity, said the report was 'extremely suspect' (Telegraph 1999; 23 June).
New figures from the WHO have put the worldwide number of abortions at 50 million a year, with 30 million occurring in the developing world. 40% are unsafe and 90% of the unsafe abortions occur in the Third World. Data gathered from many countries show that the deaths are caused more by social and legal considerations than inadequate health care. Abortion is illegal in 94% of the developing countries studied, making it necessary for women to seek illegal and dangerous help (BMJ 1999;318:1509, 5 June).
Of the 600,000 maternal deaths worldwide every year, between one third and a half result from abortion complications, and millions of women are left traumatised and mutilated; victims of inertia and fatalism (BMJ 1999;318:1526, 5 June).
There were a record 170,000 abortions in England and Wales alone last year, and the British Pregnancy Advisory Service (BPAS) has just launched a scheme to prescribe the 'morning-after pill' to women before they have unprotected sex and risk unplanned pregnancy (Telegraph 1999; 3 July).
Since the late 1980s, at least 10,000 children have been abducted from their families in Northern Uganda by 'The Lord's Resistance Army'. Recently, the terrorist group has begun stealing babies to swell the ranks. The children are being trained to become killers in an attempt to overthrow the Government and rule according to the Ten Commandments; they are indoctrinated and terrorised to carry out massacres and abduct their own siblings, and young girls are forced to become sex slaves. Sudan provides bases for the rebels to carry out their raids, and the UN and the Western world are being lobbied by Ugandan parents to take a hand in the crisis (Telegraph 1999; 27 June).
In Hungary, a gynaecologist has been charged with running a transatlantic scheme to sell babies. He has allegedly encouraged impoverished pregnant women to give up their newborns to adoption in the US in return for a trip there, where they would receive cash rewards (BMJ 1999;318:1578, 12 June).
Official figures show that 200 babies have been killed by their mothers in Hungary in the last ten years, although doctors admit the rate could be ten times higher. In an effort to combat this alarmingly high rate of infanticide, health officials are placing incubators inside the entrance of hospitals, and already, babies are being left in them. A bigger programme has also been set up to counsel and advise pregnant women as early as possible, as many arrive at hospital desperate and well beyond the point where abortion is allowed. As a result, more than 300 have been persuaded to have their babies at the hospital. They can choose to keep the baby, leave it behind for adoption or send it to a temporary orphanage. Most of these babies end up going for adoption (Telegraph 1999; 27 June).
Six large charities (including Christian Aid and the NSPCC) have formed EPCAT UK, a coalition to launch a campaign calling for a change in the law to stop paedophiles from travelling abroad to abuse children. It seems that sex abusers have infiltrated charities and aid agencies in an attempt to gain access to vulnerable children. A number of British and Canadian paedophiles targeted an aid agency working with orphans of the Ethiopian famine. The Home Office is reviewing the situation (Guardian 1999; 28 July).
A genetic study carried out at the Whitehead Institute near Boston in the US has shown that the technique of intracytoplasmic sperm injection (ICSI) may pass on infertility from father to son. ICSI involves injecting a sperm directly into an egg. About 6,500 British babies have been born this way since 1992. Deletions on the AZFc region of the Y chromosome appear to account for infertility in about 10% of those men who produce inadequate amounts of sperm, and it seems that sons born to these men by the IVF method have the same Y chromosome deletion and are likely to be infertile as well. The Institute has offered to evaluate the sex of embryos created by the ICSI technique and then return only the females so the couples could avoid having an infertile son (Telegraph 1999; 8 July).
The UN has estimated that one in five adults in Zambia are infected with HIV and that 300,000 children have become orphans through AIDS. However, Zambia's government have reacted to the report with anger and deny the existence of any pandemic. It has also attempted to ban all AIDS statistics compiled by independent organisations. Local studies using anonymous antenatal screening and tests on donated blood seem to confirm the UN's findings, and 25-30% of women booking in clinics in urban areas are HIV positive (BMJ 1999;319:338, 7 August).
A major new AIDS epidemic may be beginning in Russia, a country that lacks the funds to control the disease. A dramatic twelve-fold increase in the number of new HIV cases in Moscow has been recorded over the last six months by Russia's official AIDS prevention centre, as compared to the same period in 1998. The main reason for this epidemic may be the introduction of the virus to Moscow's population of drug users (Telegraph 1999; 2 July).
In the UK, a Government initiative to encourage all pregnant women to have an HIV test was welcomed, but with a warning that no one should be coerced into the new screening programme. Better counselling and increased availability of support are vital and it is hoped that by 2000 at least 50% of pregnant women would be expected to be tested, rising to 90% by 2002. Such an initiative could help reduce the risk of vertical transmission of HIV from one in six to less than one in 20. Currently about 50 babies a year are born with HIV to mothers who were unaware that they were affected. In 1997, 265 women with HIV gave birth in Britain, the majority in London, and 62 of their babies were infected (Telegraph 1999; 14 August).
In 35 countries, the rate at which children have been orphaned by Aids has doubled, tripled or even quadrupled from 1994-1997 according to the annual UNICEF report. There are nearly ten million Aids orphans in developing countries. In Uganda, 1.1 million children under 15 have lost their parents through Aids, amounting to 11% of the country's total child population (Telegraph 1999; 23 July).
The Government has drawn up drafts of legislation to ban tobacco advertising in Britain by 10 December of this year. Most tobacco sponsorship would be ended by July 2003, although, as expected, a three or six-year exemption is to be granted to wean global events, such as Formula 1 motor racing and snooker, from their dependence on tobacco revenue. The Government is determined to prevent tobacco manufacturers getting round the ban by 'brand stretching' their products and promoting other goods such as clothing, footwear and coffee houses. ASH, the anti-smoking lobby, joined the BMA in calling for vigilance against any tobacco companies ready to use 'every possible trick' to preserve advertising by other means. The aim of the legislation is to protect children from tobacco which kills 120,000 Britons every year (Telegraph 1999; 18 June), (Guardian 1999; 18 June).
Smoking amongst teenagers is showing no signs of decreasing. About eight million Californian teenagers experimented with smoking between 1988 and 1998 because of the encouragement of tobacco advertisements. Cancer prevention experts have estimated that the tobacco companies' campaigns in that period will generate about three million new smokers in the state, over 800,000 of whom will eventually die from their habit (BMJ 1999;318:1708, 19 June).
A WHO report released in June shows that the health of half the world's children is endangered by passive smoking. 700 million children breathe air polluted by tobacco smoke and experience numerous health problems as a result. 70% of children who have two smoking parents have a higher incidence of many medical problems. If one parent smokes, they are 30% more likely to have those medical conditions than are the children of non-smokers, and their cot-death rate is five times higher (Guardian 1999; 17 June).
Australia has managed to reduce its smoking rate to its lowest level since records began. 22% of the adult population now smoke, compared to 25% in the early 1990's. The decline is believed to be due to 'scare campaigns' where TV viewers see the results of smoking inside the body of a smoker. Evidence has emerged that the advertisements had a powerful effect on teenagers and similar campaigns are now being run world-wide (BMJ 1999;318:1508, 5 June).
The Sisters of Charity who run one of Sydney's inner city hospitals are beginning an 18-month trial of the country's first legal and medically supervised heroin injecting room. An estimated 50,000 visits a year by drug users are expected at the centre, which will be staffed by a medical supervisor, a registered nurse, and security staff. The controversial plan will include the provision of clean needles and syringes; users must supply their own drugs. They will be encouraged to seek counselling and treatment for their habit. Such an approach would also help control the spread of HIV amongst intravenous drug users (BMJ 1999;319:400, 14 August).
The UK Committee on Safety of Medicines has banned the Chinese herb Aristolochia after two people developed kidney failure after using it by mistake. The herb is used to treat eczema, urinary problems, swelling and rheumatic conditions (Telegraph 1999; 29 July).
The first clinical trial of cannabis began in July. Patients suffering from conditions such as multiple sclerosis, neuralgia and glaucoma are taking the drug through an inhaler similar to those used by asthma sufferers. Cannabis provides pain relief in small quantities when it is heated, and the dosage is being carefully controlled so no side-effects are experienced (Telegraph 1999; 13 June).
The BMA's Scottish committee for public health has renewed calls for the legalisation of cannabis for medicinal and recreational purposes, claiming that it is no more dangerous than alcohol or cigarettes (Telegraph 1999; 21 June).
Scientists at the Imperial Cancer Research Fund have managed to create a human tumour in a culture dish for the first time. They have discovered that only three genetic changes are required to turn a normal human cell into a cancerous one. The telomerase gene must be turned on so cells can proliferate indefinitely, the Ras gene must be activated to produce a molecule that regulates cell behaviour, and a virus protein that de-activates the brakes that normally stop the cell from replicating out of control must be activated too. This knowledge could pave the way for more effective therapies (Telegraph 1999; 29 July).
Scientists from Elan Pharmaceuticals in San Francisco have forecast a vaccine for Alzheimer's disease in the wake of their successful immunisation of mice against an imitation of the disease. A protein building block amyloid b peptide was injected into the mice's immune systems to prevent new plaques forming and significantly slowed the progression of existing ones. This raises the possibility of similar vaccines being developed for other plaque-involving brain diseases such as CJD (Telegraph 1999; 15 July).
The American Medical Association has issued a report on the practice of prescribing drugs via the Internet and has declared that relying solely on a patient-completed on-line questionnaire falls well below a minimum standard of medical care. At least 400 'instant-prescription' websites exist, and the terms used in the questionnaires are often beyond the technical comprehension of a lay person. No mechanism exists to ensure that the questions have been answered correctly or to confirm the history by physical examination (BMJ 1999;319:213, 24 July).
The UN have disclosed that half a million women and girls are entering Western Europe each year to become prostitutes. Most are from eastern Europe and the former Soviet Union, where criminal gangs are making vast profits from the traffic. The report estimates that 15,000 Russians and Eastern Europeans work in the red-light districts of Germany. In the Netherlands, 57% of foreign prostitutes are under 21. Lithuania has become a centre for the export of women from the old Soviet empire to brothels all over the EU. This trade in women is worth $7 billion a year.
Prostitution on the Internet is thriving too, and pornography makes up 69% of the on-line content market in Western Europe and the USA. Between 50-70% of the sites that sell online services involve pornography and it makes up about 10% of all the economic activity on the Internet (Telegraph 1999; 13 July), (Telegraph 1999; 17 June).