The ASRM - cough - I Mean HFEA Set to Enact Payment-for-Eggs Plan in Britain

The Observer in London points to a shocking move by the HFEA to increase the supply of eggs for embryonic stem cell research, following on the suggestions of the initial report by the new stem cell research association ISSCR:

Women who go through the medical procedure to harvest the eggs from their ovaries, which doctors describe as 'invasive' and possibly dangerous, will be paid 250 Pounds plus travel expenses, the existing maximum compensation for any egg or sperm donor. Anyone agreeing to donate will have to show that they are acting for altruistic reasons, for example because they have a close relative suffering with one of the conditions scientists are trying to develop new treatments for with the aid of human eggs.

What a fabulous decision, in light of the fact that HFEA was the last governmental organization to hold out for conservative policies with regard to this matter, against such outliers as the South Korean Hwang group, where payment for egg donation worked out so well that it resulted in the obvious oppression of women, including the most obvious donors - those who work in labs that need eggs.

Thankfully there were ethicists in the Hwang lab. Not so thankfully, they published a report claiming beyond a shadow of a doubt, on the basis of their very close observation of the egg donation process, that the Hwang group was doing a fabulous job, and that no coercion occurred, only to later back up a little bit, then retract their claim. Even less thankfully, the loudest claim to date by an ethicist to the effect that payment for eggs is a great idea is the same author of that article, whose observations led him to conclude that he was - quoting here - 100% certain of the ethical propriety of the Hwang group's procurement group. The group - remember them - that coerced at least one team member to donate eggs because she knocked a petri dish containing eggs onto the lab floor. Obviously it was a popular view among the ISCRR crowd who lack funding for stem cell research or a good supply of eggs - but a shortsighted view to say the least, and informed by zero research - except for that lovely article retracted from AJOB.

There are those who have suggested that perhaps there might be problems with payment:

There were also warnings last night that poor women could be tempted or coerced into taking part for the money. 'The HFEA could be unwittingly opening the door to barter or sale of eggs, including women in Britain as well as abroad, even though it is saying that women doing this would do so for purely altruistic reasons,' said Donna Dickenson, emeritus professor of medical ethics and humanities at the University of London and one of Britain's leading experts on the issue.

'The sum of £250 would still be enough of an inducement for women from eastern Europe, for example, to come to Britain to sell their eggs. That's clearly turning eggs into an object of trade and that's disturbing. Once the principle of egg donation for research is established, it will become harder to prohibit paid egg donation.'

But at the end of the day, HFEA will ignore the several leading stem cell researchers who begged it to reconsider on moral grounds despite the scientists support for embryonic stem cell research:

The HFEA, chaired by Shirley Harrison, is set to approve the policy despite a host of leading scientists voicing a range of concerns during the consultation process.

Some argued that the putative benefits of stem cell research had been exaggerated, while others highlighted the medical dangers to women who undergo the painful and invasive three-stage process to remove the eggs.

So a stunning move by Britain into the wild wild west of egg donation, and without data or careful regulations or a provision to re-examine the policy in short order on the basis of the experiences of women and clinics. At least it is stunning to me based on the work of our research group concerning the disposition of the Brits toward this sort of issue. To say nothing of the outstanding work by AAAS commissions chaired by among others Jonathan Moreno and Alta Charo, which counseled quite clearly of the issues here.

Pharmacy Says Happy Valentine's, Have Some Viagra

Valentine's Day. Hearts, candy, chocolates, roses; if your car isn't buried under a snowdrift somewhere in the Northeast, maybe a nice dinner out or a movie. It can get costly. And in Britain, as of the 14th of February, men can add another USD100 to the total Valentine's price: the cost of a pharmacist provided pack of Viagra.

That's right, a British pharmacy chain has decided to sell small samples of Viagra over-the-counter. If you're between 30 and 65, male, and are willing to sit through an hour long consultation with the pharmacist, take a blood pressure, glucose, and cholesterol test, you too can buy four pills of Viagra.

The theory behind all of this, launched on Britain's National Impotence Day (a shared date with Valentine's), is that some men are just too shy to talk to their doctor about erectile dysfunction, and so are suffering in silence. This may very well be the case - but is an hour long visit with a pharmacist going to be easier than a doctor's visit? Is it going to be so easy that it suddenly makes going to the doctor a walk in the park? (If you decide you like the effects of the Viagra, you've to see a physician for a 'script.) For that matter, should pharmacists even be prescribing medications?

And does anyone else marvel at the fact that for USD100, you can have an hour of a pharmacist's time, several tests on your health done, and a mini-prescription filled? It's more time than most people ever spend with their physician, for a lot less money!

Woops: Another quick search of the news sites before posting shows that it really was just a big marketing push. The pharmacy isn't actually offering the OTC pills 'til Monday, and you have to schedule your appointment in advance. Sort of takes the spontaneity out of that one...
-Kelly Hills

In Brief

I'm at a grant meeting this week in New York so comments will be limited to news analysis this week.

A few interesting things out today:

A followup inquiry in Britain on its military's tests on service members during the 20th century is revealing:

The hearing was told how at 10.17 a.m. on the morning of May 6, 1953, Porton Down scientists had applied the liquid nerve gas on to the arms of Maddison and five others in a sealed gas chamber. After 20 minutes, Maddison complained that he was feeling ill. Soon after he slumped over the table and was carried out of the chamber and taken to Porton’s hospital, where he died at 11.00 a.m. The inquest examined what steps Porton took to ensure the safety of the human “guinea pigs”, but was supposed to take into account the differing “ethical climate” of the early 1950s and the “paranoid pressure” generated by the Cold War.

Another chronicle of Hurlbut's tempest in a teapot solution to stem cell ethics debates, this time from Religion News Service.

Baroness Warnock, described in Times online as Britain's leading medical ethics expert, spoke in defense of the proposed 'mental capacity bill', which would simplify euthanasia in Britain (or so many say). Warnock: "I don't see what is so horrible about the motive of not wanting to be an increasing nuisance." Needless to say, lots of people didn't like her comments.

Who will lead the California stem cell program? San Francisco Chronicle reports that it might be a real estate tycoon, Robert Kline. Also in the pool: Michael Friedman, CEO of City of Hope, and former UC president Richard Atkinson, a cognitive scientist. Weren't any actors available?

You knew that Ob-Gyns are sued quite frequently. But in Maryland, 70% have been sued at some point in their practice, bringing average insurance premiums to $150,000 per year. Maryland is typical for the U.S..

A profile of Vanderbilt's Pediatric Advanced Comfort Team is interesting. Mark Bliton of Vanderbilt is quoted.

Boston Globe does a great job on the sports steroids issue.

Close the Human Fertilisation and Embryo Authority?

Lord Robert Winston is arguably Britain's most distinguished and certainly most outspoken participant in the IVF debates. Today, he proposed something that will be seen as absolutely outrageous in the rest of the developed world, which admires Britain's HFEA. The HFEA is responsible for all sorts of regulations, research and policymaking in reproductive technology, ranging from the storage of embryos to the selection of sex to the cloning of embryos for stem cell research. Winston says shut them down.

And he has recruited some unlikely allies. The big problem in the critics' eyes is that HFEA believes its own publicity, thinking it cannot really improve much. Because of this, say Winston and others (including Josephine Quintavalle, spokesperson for Comment on Reproductive Ethics), they miss the need for big reforms. What's needed? A great big bioethics committee for HFEA. Hard to see why the HFEA would benefit from that, given that ethics committees of that sort very, very rarely work as intended. But perhaps the British critics of HFEA are as sharp as those who brought that 'brilliant' institution to life.

British Sperm Shortage

The Brits are getting antsy as their sperm supplies dry up on the cusp of new donor transparency regulations. A Danish sperm bank - Cryos International - is readying its supplies in order to corner the UK market. In part because they export "Scandanavian looks" all over the world, Cryos is the world's preeminent sperm bank. - Dominic Sisti

Little Updates from Thanksgiving Weekend

Several of the things that happened while we were gobbling:

Tulane may not be setting up the Big Easy Bioethics Center just yet but it is at least setting up a pretty interesting speakers' series. Don't go drunk, except maybe to the enhancement lecture.

There aren't many people working on the bioethics of IT-driven genomics, although much is being written in the popular literature. Most recently the fields have begun to set up conferences at which a lexicon is developed as well as a kind of institutional history of the ways in which all of the relevant fields (and there are many) have begun to converge. Ok a little plug: one of us has written a book about computational genomics and ethics, but only four people in his immediate family read it.

A symbol was paraded of the UK's problem establishing any kind of marrow registry enrollment among those of minority ethnic background. Asian families in particular do not often donate bone marrow.

Speaking of children in the UK who require special assistance, this piece in the News Telegraph chronicles the NHS' controversial decision to fund preimplantation diagnosis (and IVF) for families who seek to have a child in part to secure a donation. Covering the same story of Zain Hashmi, the piece highlights the problem for those of minority ethnic background.

China has a mess on its hands with DNA identification:

A non-regular investigation conducted recently in Zhejiang Province indicated that the requests for DNA identification of ones own children are rapidly increasing at a rate of 40 - 50% every year.

So George Annas isn't the only bioethicist playwright (although he is damn good): Christmas Carol has been adapted by Santina Maiolatesi of Chesapeake Research Review (along with Doris Baizley). No word on who will play Mini Tim.

Swiss News agency The Local discusses the off-label prescription of medications in children in the EU, in particular in Sweden, at Karolinska Institutet and elsewhere, noting a new European Commission regulation that requires that medical companies "begin testing medicines intended for children on children."

An Orlando judge has upheld the living will of a 73-year-old Florida man, after it was argued that his wife's durable power of attorney (a general, not a healthcare document) might trump the living will. His wife argued vehemently that she could not agree to disconnect his life support systems. The effect of the news is hard to judge, but it appears that we are in for more confusion about what these documents mean and how they relate to the legal system and to other legal instruments. Helpfully, the Florida legislature has not offered any specific instructions on how to interpret the role of any other documents, so the judge gets to make up new policy de novo!

Another piece on how sperm donors from Denmark are so hip.

Drug Policy Alliance offers its interpretation of the Monday Supreme Court deliberations on medical marijuana, which are to involve questions both of states' rights and of the scope of drug and medical policy.

Kangla Online reports that Imphal, India based Regional Institute of Medical Sciences has been admitted to the UNESCO bioethics world network. Imphal is in the northeast of India, a nation that is becoming an international bioethics powerhouse, in part due to the incredible focus on sex selection in the nation but also due to pretty innovative approaches to law and philosophy of medicine there.

You think you could be an unethical sort? The kind of person who would put the ring of Gyges to its most obvious use? Would you torture prisoners? You are human, so the answer is probably yes, or so new research on cruelty suggests.

Privacy, but Not So Much

Economist reports today on a new idea that really is half-baked. Because of rising complaints among British patients of abuse by physicians during intimate examinations, particularly sexual abuse, the Virtual Chaperone has been invented. It is a clever name, sort of, for a video camera and microphone in the examination room, recording every detail of the examination so as to protect both patient and physician. Sounds like the sort of solution a malpractice lawyer would work out.

One of my favorite passages in The Republic involves Socrates' discussion of a ring that allows the wearer to become invisible and undetectable. The discussion that ensues is about what sort of thing those with whom Socrates is in dialog would do with that kind of power. Eventually they are honest and admit that with that power they would be unable to resist using the power to get away with all sorts of evils. Socrates makes the interesting point that one can only be trustworthy when there is the temptation to violate the trust of someone, that is, there's no point in discussing whether or not you are a good person until you have the opportunity to be bad without anyone's knowing it. This is the essence of clinical trust. If you are going to violate patients unless there is a camera in the room, you really shouldn't be a physician. But that is no argument for cameras to root out dangerous docs.

Cameras cannot protect a patient from a physician, and there is simply no way to justify the additional invasion of privacy - from a camera designed only to protect physicians from charges of sexual abuse. Think about it - the physician has you naked. They do exams that are intimate. If they are drawing enjoyment from that, beyond what is appropriate for a clinician, how in the world are you going to prevent that by exposing the patient to a further violation of privacy? The risk is also pretty obvious that the tapes will be stolen: keep in mind that the cameras are supposed to be super-discrete (says the Economist), so how long do you think it will be before those videos are traded among residents, or even uploaded or sold as porn tapes? This is a really stupid idea, and the Economist appears to have thought about it for all of fifteen minutes.

Britain? Stem Cell Leaders? Meet California.

They are running scared in Britain. After months of believing their own press about a purported mass exodus of stem cell researchers, there are some pretty scared venture capitalists now in London. Financial Times' Clive Cookson delivers a eulogy for the era of mass optimism, complete with lots and lots of quotes from folks like Roger Pederson. The UK, by the way, spends just over 25% of the annual amount California has just allocated for stem cell research.

The 'Pyrric Victories of the Pro-life Lobby'

Times Online London opines about the legal maneuvering of the anti-abortion lobby in the UK.

1 in 3 UK Physicians Asked for Assisted Suicide

Medix UK polling on behalf of the Voluntary Euthanasia Society found this this week. The Guardian also reports more in depth.

Around the World News

It is a huge day for bioethics news.

Interesting non-U.S. perspective on the positioning of Bush and Kerry on embryonic stem cell research and abortion, finds that there is great confusion and deception in both campaigns.

Jakarta Post announces a national bioethics body for Indonesia.

They must love George in the U.K., where he has just attacked their stem cell policy, reports The Times London.

LifeNews reports that the Dutch law extending euthanasia to children is being attacked in several ways in public policy forums.

Kass Will Now Officially Say Anything

The Independent UK reports on Leon Kass' latest extraordinary statements. Kass is on the stump, although this time not so much for the President as against every nation that wants to do hES research using nuclear transfer. He is speaking on behalf of all the, um, yet to be created. "Britain is wrong. A woman's body should not be a laboratory for research or a factory for spare body parts. No child should be forced to say, 'My father or mother is an embryonic stem cell'." For what it is worth, there is no evidence that producing 5 day-old blastocyst-like organisms through nuclear transfer would make reproductive cloning any more likely to work. But the metaphor is great: little people alone and alienated, crying out "my mommy is a cell! my mommy is a cell!" The other members of the Presidential Bioethics Council must be so proud of this heroic effort.

Who Stole My Husband's Brain?

A report of the NHS in Britain today that at least 21,000 brains were harvested from deceased patients between 1970-1999. The study was motivated by a campaign by a woman from Manchester who discovered that her husband's brain was removed after he committed suicide in 1987. The study seems not to have provided any insight into the exact percentage of tens of thousands of brains that were harvested without consent, but it is clear that "there had been widespread failure to do so..." Researchers are fearful that the outrage concerning "stolen brains" will radically reduce the amount of brain tissue available in the U.K..

Please, Someone, Teach These Journalists?

In the fiftieth poorly-researched assisted reproductive technology piece of the year, New Scientist lets us all in on the big news of the week: the Brits have "applied for a license" for something that is "banned" - yes banned - in the U.S., supposedly: "creating children with three parents." You have to be curious as to whether they just make these little snippets up...three person reproduction isn't banned in any national or even in any state law. The truly interesting thing is that New Scientist was able to miss any of the facts about the multiple egg issues in either the literature or even among those who work on these questions all the time. So get ready for a spate of "three moms" pieces!