Three parent embryos? Calm down all!

The papers this morning are full of reports that researchers at Newcastle University have successfully produced ‘three parent’ embryos as a first step to preventing maternally transmitted mitochondrial disease.

There are about 50 different known mitochondrial diseases which are passed on in genes coded by mitochondrial (as opposed to nuclear) DNA. They range hugely both in severity and clinical features. For most there is presently no cure and little other than supportive treatment.

The Newcastle team have managed to produce about 80 embryos and to grow a small number up to the eight-cell and blastocyst stage using defective embryos left over from IVF. The embryos were produced by transferring the pro-nuclei from zygotes with abnormal mitochondria into zygotes with normal mitochondria from which the pro-nuclei hade been removed.

The work has been financed by the Medical Research Council, the Muscular Dystrophy Campaign and the Welcome Trust, and headed up by Alison Murdoch and Doug Turnbull.

The group are now pushing for a change in regulations to allow them to experiment using normal embryos – either ‘spare’ ones left over from IVF or new ones specifically produced for this research .

We need to be clear in the first instance that this ‘treatment’, even it were eventually to be shown to work (and there is considerable doubt about that), will do nothing for the thousands of people already suffering from mitochondrial disease or for those who will be born with it in the future. It is primarily about trying to prevent people with MCD being born. Or at least helping a very small number of mothers who carry the gene to have children who don’t.

It would be a great tragedy if in trying to resource this new unproven technology that we were distracted from finding effective treatments and proving supportive and palliative care to those who are already suffering with mitochondrial disease.

And we need to remind ourselves that there are already some solutions available for those couples who find themselves in the tragic position of carrying genes for mitochondrial disease – including adoption and egg donation (although I have serious ethical reservations about the latter)

But apart from that I have three big questions:

1.Will it work? I am very sceptical
2.Is it ethical? There are huge ethical issues
3.Is the debate being handled responsibly? No, there are huge vested interests involved

I have a great sense of déjà vu here. There is always in this country huge media hype about supposed breakthroughs in biotechnology and the IVF industry – especially the Newcastle group - is very skilled in arousing media interest.

But we have been here before with human reproductive cloning (the Korean debacle), so-called therapeutic cloning for embryonic stem cell research (which has thus far failed to deliver whilst technology using adult stem cells and cord blood though relatively unresourced goes from strength to strength) and animal hybrids . (now a farcical footnote in history)

We saw the false dawn most clearly with animal human hybrids where the biotechnology industry, scientists, patient interest groups and science journalists on the UK nationals duped both the public and parliament into legalising and licensing animal human hybrid research to produce stem cells. But even before the ink was dry on the 2008 HFE Act researchers and investors were recognising that the technology who almost certainly not deliver – that there where more effective ethical alternatives available (such as induced pluripotent stem cells or IPs)

Nonetheless the Prime Minister had already informed Parliament that animal human hybrid research would save millions of lives. He is noticeably very quiet about it now.

The Newcastle unit is a world leader in promising much and delivering little – but given the short attention span of the media and the gullibility of the public few people seem to realise, remember or care.

The UK broadsheets this morning largely transcribe the spin of the Newcastle unit’s press release – whilst giving scant attention to the questions of safety, efficacy and ethics being raised by commentators in scientific journals and blogs. Some questions that you will not hear asked or answered:

1. What will be the effect on the embryos of the small amount of abnormal cytoplasm containing defective mitochondria that is still being transferred?
2. Will any of these embryos survive beyond blastocyst stage? (cloned human embryos and animal-human hybrids produced by similar ‘nuclear replacement’ technology haven’t)
3. If they do survive will the nucleus from one embryo function properly with the cytoplasm of another?
4. Will the progeny be normal or be suffering from defects that are in fact worse than mitochondrial disease itself? (we know that cloning by nuclear replacement is possible in frogs, difficult in mammals, hugely problematic in non-human primates and currently not possible in humans)
5. Why are we proceeding with this work in humans when similar work in primates (published in Oregon last year) is less than one year old?
6. What about the hundreds of embryos that have already been destroyed in the research?
7. What will be the psychological effect on any progeny of the fact that their DNA is derived from three separate ‘parents’?
8. What will be the effect of the introduced transmissible DNA on future generations?

We also need to realise that the Newcastle scientists have a huge financial and research-based vested interests that make it very difficult for them to be balanced and objective in the way they present their findings. Getting the regulatory changes (which incidentally now no longer involve parliament but only approval from the Health minister) and research grants to continue and extend their work is dependent on them being able to sell their case to funders, the public and decision-makers. And they know that that is best achieved through attention-grabbing media headlines and press releases and heart grabbing (but highly extreme and unusual) human interest stories that are selective about the truth.

What is currently happening in Newcastle may be legal in Britain – but it is illegal in almost every other Western country for good public safety and ethical reasons. Britain is regarded by many as a rogue state in all this.

So I’m not letting myself be carried away by the hype and spin. And I’m not holding my breath about the promises of therapies in three years. And I will be actively opposing any extension of the licence to enable these researchers to be extending their work to use and more ‘spare’ embryos with all that that involves.

DPP guidelines due out soon - will they just be a licence for legalisation of assisted suicide by stealth?

Attempts in the House of Lords both in 2006 (Joffe) and 2009 (Falconer) failed to legalise assisted suicide in this country. The medical profession (BMA and Royal Colleges), faith groups and disability groups also remain firmly opposed to a change in the law.

However we are now seeing fresh attempts to change the law in Scotland with Margo MacDonald’s End of Life Assistance (Scotland) Bill and we expect new attempts from Westminster after the election in May.

The greater immediate danger however is legalisation by stealth through the legal system.

The pro-euthanasia lobby have tried to make a case for ‘clarification’ of the law through the Debbie Purdy case. This led to a Supreme Court Judgement last summer requiring the Director of Public Prosecutions to produce prosecution guidance for assisted suicide. His draft guidance was published on 23 September 2009 and a consultation on it closed on 16 December. The definitive guidance is due any day now.

This guidance is expected to make it less likely that assisters who are ‘motivated wholly by compassion’ or are ‘loved ones’ will be prosecuted. In addition it is less likely that cases involving ‘victims’ who are terminally or chronically ill or disabled will end up in court.

If so the result will be that some of Britain's most vulnerable people will have less legal protection than others and that it will be easier for family members and 'friends' with an interest in a person's death to get away with subtle coercion to assisted suicide on the basis that they were acting compassionately.

The whole process could very easily lead to euthanasia by stealth. The general pattern we are now beginning to see (most clearly evidenced in the cases that have gone to the Dignitas clinic) involves police not investigating, the CPS not prosecuting, juries delivering perverse verdicts and judges giving light sentences.

All this has been fuelled by a toxic cocktail of emotive hard cases, media hype, celebrity endorsement and ill-informed public opinion.

This is exactly the same pattern that we hve seen in the Netherlands over the last 30years with judges initially either not prosecuting or bringing light sentences (eg the Postma case), a set of guidelines which if followed meant doctors could effectively escape prosecution, and a later law change giving statutory force to this earlier legal sanction.

The rates of assisted suicide and euthanasia (both voluntary and involuntary) were thereby already high in the Netherlands long before the law was eventually changed.

There is a real danger that we will see exactly the same process operating in the UK.

Dog bloggers, MPs expenses, abandoned wheelchairs and an Old Testament prophet

The Cambridgeshire police recently failed to respond to a 999 call about a teenager who was being beaten up with a baseball bat – allegedly because they were short-staffed. But they could still afford to maintain a German Shepherd puppy called Lukas who writes a blog.

Judge Sean Enright said the police response ‘smacked of indifference’. And Matthew Elliott, chief executive of the Taxpayers’ Alliance, commented that: ‘Policing isn’t about PR and fancy websites. It’s about keeping people safe and reassuring the public that crime is being dealt with firmly and strongly.’

Prime Minister Gordon Brown, commenting on the four MPs today charged with theft over parliamentary expenses said he was ‘very angry about what has happened…These are very serious criminal allegations. All criminal allegations have got to be investigated. It’s a matter now for the courts.’

Two views on policing and the courts with which I concur: police are there to ensure public safety and reassure the public that crime is being dealt with firmly and strongly; and the courts are there to investigate all serious criminal investigations.

And yet when it comes to the serious crime of assisting with suicide it seems that the police and the courts have a different view. There have been 134 cases of people now taking ‘loved ones’ to the Dignitas facility in Switzerland to end their lives. Virtually all have been ‘assisted’ but only around ten cases have been investigated and in only two was there apparently enough evidence to bring a prosecution. But in both of the latter no prosecution was brought because it was felt ‘not to be in the public interest’.

The draft DPP prosecution guidelines (soon to be finalised) tell us why. They stipulate that if the ‘victim’ of assisted suicide is terminally or chronically ill or disabled or if the ‘assister’ is a spouse or close relative acting ‘compassionately’ then prosecution is unlikely.

And yet the vast majority of terminally and chronically ill or disabled people do not want to die – instead they want good care and help to live as independently as possible. Furthermore their rates of suicide are not significantly higher than those of the general population. So why should we remove legal protection from them and not others? And why should we exempt ‘loved ones’ from investigation ahead of time when in fact many cases of financial, emotional and physical abuse of elderly and disabled people happen in the context of so-called ‘loving families’. That seems both discriminatory and naïve.

I suspect it has something to do with the value our society gives to vulnerable people and the fact that we live in an increasingly materialistic culture where assisted suicide is seen simply, as Terry Pratchett has demonstrated this week, as just another celebrity endorsed life-style choice.

I was struck today by the story of the disabled fundraiser who was abandoned by ‘friends’ for three hours in his wheelchair on an exposed plateau on Mt Snowdon. He was eventually saved when rescue workers reached him and brought him down. Presumably he had become an encumbrance in their attempt to reach the summit.

The danger of changing the law to allow assisted suicide for vulnerable people is simply that we then will more easily view them as encumbrances holding us back from reaching our financial and life-style goals; and may therefore try less hard to persuade them that they are not a ‘burden’ and that their lives are genuinely worth living – making it in turn more likely that they will ‘choose' the decent thing.

The prophet Ezekiel condemned those in Jerusalem for being ‘arrogant, overfed and unconcerned’ and thereby distracted from attending to the needs of others. Like the Cambridge police and their blogging dog; or the ambitious climbers pushing for the summit. I wonder what he might have said about us today?

Margo MacDonald MSP is seriously misleading the Scottish People and Parliament

Margo MacDonald claims that about 50 Scots a year would die if her ‘end of life assistance’ bill were to be enacted.

She makes this remarkable claim on the basis that experience in the few countries where assisted death has been legalised shows that it accounts for only one in every 2,000’ deaths - though, interestingly, she names no specific country or source. The facts tell a very different story.

A select committee of the Westminster Parliament investigated the death rate from euthanasia and assisted suicide in Oregon and The Netherlands as part of its examination of Lord Joffe’s Assisted Dying Bill.

It found that, in the US State of Oregon, where physician assisted-suicide (but not euthanasia) is legal for the terminally ill only, the rate was 1 in 714 deaths. Given that there are some 55,000 deaths a year in Scotland, we might expect therefore about 80 deaths a year with an Oregon-type law. In fact, deaths from assisted suicide have risen steadily in Oregon since the law there was enacted 13 years ago. By 2008, the number of Oregonians who were committing suicide every year with drugs legally supplied by their doctors had risen nearly fourfold!

More important, however, Ms MacDonald’s proposed law, like that in The Netherlands, allows both assisted suicide and euthanasia and it would license the practice not only for the terminally ill but for anyone who is ‘permanently physically incapacitated to such an extent as not to be able to live independently’ and who ‘finds life intolerable’.

In The Netherlands the select committee assessed that one in every 38 deaths was the result of legislation similar to what Ms MacDonald is now proposing. This would translate into nearly 1,500 deaths of Scots every year. All this information is publicly available in the 2005 report of the House of Lords select committee, whose in-depth investigation of 'assisted dying' heard from nearly 150 expert witnesses in four countries.

Ms MacDonald's estimates, which are wide of the mark by a factor of 30 – or 3,000 percent, are seriously misleading. The Scottish public and Parliament would be well advised to approach her bill with great caution and in knowledge of the facts rather than the spin.

The government needs to invest more in cord blood

More than two years ago CMF welcomed a new bill which encouraged the donation at childbirth of umbilical cord blood and its storage for public use. It also called on the government to invest more actively in developing the NHS cord stem cell bank.

MP David Burrowes' Umbilical Cord Blood (Donation) Bill aimed to increase awareness of the value of umbilical cord blood in treating diseases and to promote further research for new treatment methods using cord blood stem cells. The Bill required doctors to inform all parents of the benefits of collection and storage of cord blood, and sought to promote collection from specific shortage groups, such as minority ones including mixed race families and families where there was a history of cord blood treatable diseases.

Sadly the bill was not granted parliamentary time to progress. The government instead was at the time pursuing its agenda of cytoplasmic animal human hybrid (cybrid) research through the Human Fertilisation and Embryology Bill – a bill that is now law. Very shortly after this bill was passed new research suggested that this avenue of research was very unlikely ever to be successful – and at the time I predicted animal human hybrid research would become a ‘farcical footnote in history’.

Today scientists reported exciting new developments suggesting that cord blood may well hold the answer for people with leukemia requiring bone marrow transplants and quite possibly also for those suffering from other similar diseases. The BBC website carried the story of Natalie Salama-Levy who is unable to donate cord blood from her baby due at the Royal Free Hospital in London next month because the hospital lacks the facilities to collect and store it. Ironically Natalie's husband Lionel is the chair of 'The cord blood charity’ and was inspired to become involved following the death of a close friend from leukaemia.

In 2008 only three NHS hospitals were collecting cord blood. It seems that the situation has not improved much since. Cord blood has already cured around 10,000 people around the world, but despite this our own UK cord blood banking facilities are woefully behind the times. We should instead be making this simple and uncontroversial technology much more readily accessible.

The Anthony Nolan Trust said today that 50,000 cord bloods would meet the UK's need for transplant and research purposes but the NHS has collected only 13,000 cords over 13 years and of these only 279 have been suitable for transplant.

In 2006 the number of live births in England and Wales reached 669,601 compared with 645,835 in 2005. The number of live births has been increasing every year since 2001. If the government had been more active in encouraging the storage of cord blood in the last five years, rather than over-hyping hopes about hybrid embryonic stem cells, we could potentially have had millions of samples of stem cells banked for treatment by now. Instead they intend to invest only £10 million to increase the size of the bank to 20,000 stored units by 2013.

Helping Haiti

Following the devastating earthquake that struck Haiti on Tuesday 12 January, causing tragic loss of life and massive destruction, CMF members have been asking how they should respond to this disaster.

The UK Department of Health reports that the initial acute medical response is now well underway with 14 field hospitals, one US hospital ship and 800 Cuban doctors. The UN Disaster Assessment and Coordination (UNDAC) Team leader has announced that other than those teams already en route, no further Search and Rescue (SAR) teams are currently required.

CMF is therefore encouraging members primarily to:

1. Pray for all involved

2. Give via the following routes:
Disasters Emergency Committee (DEC) - representing UK agencies responding
International Health Partners - supplying drug packs
CMDA - our US sister organisation

The Department of Health has advised that individuals should not try to go to assist unless registered with an agency which is part of the Global Health Cluster response. However, if you have the appropriate language (French), skills and experience you can contact aid agencies for inclusion on their roster:
Médecins Sans Frontières
Merlin
Save the Children

Meanwhile regular updates are available on the evolving situation at:
BBC
DFID
WHO

In the midst of this tragedy there are encouraging reports of local Christians being at the forefront of aid and relief, and of Christians praising God in the disaster:

God is our refuge and strength, an ever-present help in trouble (Psalm 46:1)

The brain is like a muscle – use it or lose it

Some years ago on a trip to India I shared a room with a doctor at a Christian Medical Conference in New Delhi where we were both speaking. He was a travelling evangelist and Bible teacher from Kerala who had put many long train trips to good use by memorising Scripture and could tell you what was in every chapter of every book in the Bible. A while later at a UCCF conference at Hothorpe Hall I watched someone else recite the entire book of Acts ‘word perfect’ whilst acting it out.

Such feats of memory are rare in our literary culture where people rely far more on books or internet search engines than memory to recall facts. But in oral cultures it is not uncommon at all to find people who can recite vast tracts of information from memory.

If like me you are frustrated by your apparent loss of memory with advancing years then you will be heartened by the growing volume of research showing that fogged memory and slowed wit are not inevitable consequences of getting old. Rather, there are steps people can take to protect their brains.

A UCLA research study published in the June 2006 issue of the American Journal of Geriatric Psychiatry found that people can improve cognitive function and brain efficiency through simple lifestyle changes such as incorporating memory exercises, healthy eating, physical fitness and stress reduction into their daily lives.

The International Longevity Center released in 2001 a report which includes (in pages 14–16) recommendations for keeping the mind in good functionality until advanced age. Some of these are to stay intellectually active through learning, training or reading, to keep physically active so to promote blood circulation to the brain, to socialize, to reduce stress, to keep sleep time regular, to avoid depression or emotional instability and to observe good nutrition.

There is also some interesting recent work from Dr Amir Soas of Case Western Reserve University Medical School in Cleveland. ‘Read, read, read,’ Soas says. Do crossword puzzles. Pull out the chessboard or Scrabble. Learn a foreign language or a new hobby. Anything that stimulates the brain to think.’ He also advises cutting back on TV. ‘When you watch television, your brain goes into neutral.’ Case Western now plans to study whether people who contract Alzheimer’s watched more TV throughout life than healthy seniors.

I was interested to see a Newsweek article just this month reporting on further new research showing how the use of mental exercises had increased both intellectual performance and IQ in children.

I am encouraged by all this that my resignation to increasing failing memory with advancing years need not become a self-fulfilling prophecy and am setting my mind specifically to using my memory more proactively this year.

I’m starting by doing some well-overdue learning of the content, chapter by chapter, of some Bible books. And it seems to be working.