Cloning debate slow

Whether a United Nations body will recommend that some human cloning be allowed is -- at this point -- still too close to call, according to a Canadian researcher who just returned from Paris where the group is meeting.

"It could go either way," Rosario Isasi, a postdoctoral fellow at the Centre de recherche en droit public at the University of Montreal and a law and bioethics expert, told me this afternoon.

Isasi, who had to return to Canada before the International Bioethics Committee could make a decision, has been working the phones and sending e-mails to find out what happened. No announcement has been made by the committee, which is part of UNESCO.

Isasi was an expert witness when the United Nations last dealt with the issue in 2005 in the form of a vote in the General Assembly that led to a complete ban on human cloning. She said attitudes among member nations seem to have changed little in the ensuing years.

Stem cell researchers have held out hope that the UN would move to allow therapeutic cloning, which they could use in their research, while still banning reproductive cloning. Religious groups, particularly the Catholic church, have opposed any cloning.

Canada is set to review next March its laws banning all human cloning.

Placebo effect

Some interesting ethical questions are being raised about doctors prescribing placebos to patients, following a study was released last week in the British Medical Journal on the issue.

Like, what right do patients have to know details of what they are being prescribed, and what impact do placebos have on general public health?

University of Pennsylvania ethicist Arthur Caplan warns that the so-called placebo effect -- people getting better simply because they believe a medicine will work -- could be undermined by doctors prescribing them so much. The doctor-patient relationship could also be hurt.

"The real issue is whether widespread analysis of the practice of using placebos will undermine the value of placebo...and whether patients in any way begin to distrust their doctors suspecting them of resorting to placebos and thus lying to them."

The problem is that telling people they are getting a placebo would also likely undermine the effect, so  honesty suffers along with a patient's right to know.

The study found that few of the placebos prescribed are actually "sugar pills."

Many, in fact, are antibiotics that doctors know won't work in all cases -- such as for viral infections. But by prescribing them when they are not needed, doctors may be contributing to the over-presence of anti-biotics in society -- which many blame for the emergence of so-called superbugs resistant to anti-biotics. Caplan would like to see more discussion about what constitutes a placebo.

"Too many doctors give antibiotics as a kind of placebo, especially to kids of demanding or helicoptering parents -- knowing they don't work against viral diseases (and) thereby creating real public health problems!"

Doctors and faith in the US

The US President's Council on Bioethics meets in a few weeks to discuss the right of doctors to refuse to provide treatment based on their personal beliefs, including religious.

The meeting, Nov. 20 and 21 in Arlington, Va., will also discuss medical futility, and the future of public bioethics and national bioethics commissions in the United States.

The question of a doctor's right to refuse treatment has been a hot topic lately, after a California court ruled a doctor could not refuse to artificially inseminate a lesbian.

In Ontario, the Ontario College of Physicians and Surgeons was heavily criticized by Ontario Medical Association and the Catholic church after it released a policy paper on the issue warning doctors about the risks in refusing service.

Kidney sales considered in Singapore

Singapore's health minister, Khaw Boon Wan, says his city-state could become the second country in the world -- after Iran -- to allow the sale of live kidneys for transplant.

"We should not reject any idea just because it is radical or controversial. We may be able to find an acceptable way to allow a meaningful compensation for some living, unrelated kidney donors without breaching ethical principles or hurting the sensitivities of others."

The Singapore Medical Association has come out against the idea. Professor A. Vathsala, director of adult renal transplantation program at Singapore's National University Hospital, says the practice is wrong.

"It is not a good idea to legalize payment for organ donors as such payment institutionalizes the belief that the wealthy ill have property rights to the body parts of the poor."

Supporters say paying donors for their kidneys could help solve a severe shortage in Singapore, where the waiting list for a kidney transplant is up to nine years. Lee Wei Ling, director of the National Neuroscience Institute and daughter of Singapore founder Lee Kuan Yewm, supports the idea.

"If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?"

The World Health Organization opposes commercial sale of organs, says Luc Noel, a WHO coordinator for essential health technologies.

"Rich people have no reason to sell a kidney. That is the flaw that is unacceptable in any scheme involving purchasing a kidney: it's exploitative."

Last February, police in India broke up a black-market organ ring that may have taken as many as 500 kidneys from poor laborers and sold them to foreigners from the U.S., the U.K. and elsewhere. A Canadian doctor, Amit Kumar, is at the centre of that investigation.

Noel said any legalizing of kidney sales would hurt Singapore's carefully crafted image as a high-end provider of care for medical tourists.

"That sounds like a nightmare. I seriously do not think Singapore would like to create this image. They don't want to be the place where you can obtain the parts of another person."

Wombs for rent, eggs for sale, in India

Lax rules governing fertility services in India are leading to a boom in medical tourism catering to foreign couples wanting a custom-order baby.

Advertisements openly solicit Indian women to sell their eggs to childless foreign couples, or become surrogate mothers.

"We are actively recruiting egg donors! Our patients are happy to pay generously for your generosity! They pay you up to rupees 40,000 ($800 US) every time you donate."

The in-vitro fertilization clinics then charge foreign couples up to $4,500, including medicines, to implant the embryos in the mother. Some clinics cost half that. "Nearly half of our patients come from overseas. Of them, nearly half are of Indian origin," said Aniruddha Malpani, whose IVF clinic in Mumbai is considered among the country's best.

The Indian Society for Assisted Reproduction says there are some 400 IVF clinics in the country, providing an estimated 30,000 assisted reproductive treatments a year.

Most egg donors are housewives paid between 6,000 and 40,000 rupees ($120 to $800), depending on their education level. Many are poor.

Critics like Puneet Bedi, a specialist in foetal medicine at New Delhi's Apollo hospital, say the absence of regulation poses health dangers, as well as ethical issues about "rent-a-womb" exploitation.

"This business is like any other outsourcing industry. The only difference is the treatment offered here is very poor. Doctors here take short cuts, they implant more embryos than needed which multiplies risk to the mother."

A draft bill on assisted reproduction is expected to be tabled in parliament soon, but women's health activists argue that it is aimed more at promoting a lucrative business than addressing health and ethical concerns.

Medical companies are offering deals that bundle health and travel services for foreigners, from arranging the medical visa to making clinic appointments to providing recuperation holidays.

Malpani said the industry can regulate itself and spread benefits to many. "It's a market economy. The bad doctors will be weeded out and benefits will trickle down to people in smaller towns."

Animal/human hybrids, saviour siblings OK in UK

In an overwelming vote, Britain's House of Commons has voted to allow the creation of animal/human hybrids and paved the way for tissue from the mentally ill and Alzheimer's patients to be used in the experiments.

The vote was 355 to 129.

The controversial Human Fertilisation and Embryology Bill was only able to pass after sections that would liberalize access to abortion were set aside following a wave of protest. The new abortion laws could now be delayed up to two years.

A last minute amendment to the bill would allow researchers to take tissue from the infirm to create the animal/human hybrids, which would then be used for medical research.

David Jones, director of the Centre for Bioethics and Emerging Technologies at St Mary's University College in London, warned a person with Alzheimer's opposed to such experiments could find themselves being used once they loose the capacity to object.

"I think it is totally objectionable, and I really worry that this will create a backlash against medical research."

Even without the abortion measures, the discussion was heated.

Recalling Soviet leader Joseph Stalin's efforts to create "the ultimate soldier" by crossing men and apes, Conservative MP Nadine Dorries warned that scientists would try to create a "humanzee" -- a hybrid of a human and a chimpanzee:

"Of all the experimental possibilities debated in the course of this Bill, surely none is quite so utterly repulsive as the possibility of seeking to inseminate animals with human sperm."

The bill would also allow for so-called "saviour siblings" -- children born to provide stem cells for an ailing older brother or sister. The birth of one such boy in Spain recently was condemned by the Catholic Church there. Parents screen several embryos before a saviour sibling is born. Any embryos that can't help the older child are destroyed.

Drug safety warnings

Almost a quarter of biological medications approved for everything from anemia to rheumatoid arthritis to hepatitis to cancer since 1995 have triggered safety warnings after entering the market, a new study has found.

The study, published in the Journal of the American Medical Association, says closer monitoring of such medicines is needed.

"Health care professionals should be aware of the specific risks related to the relatively new class of biologicals to be able to provide a link between the use of the biological and the patient presenting with a clinical problem."

The study, led by Thijs Giezen of Utrecht University in the Netherlands, looked at 174 biological medicines approved in the US or the European Union between January 1995 and June 2007. As of June, regulatory actions were taken involving 41, or 24 per cent, of the medicines, including:

• Genentech Inc's cancer drug Herceptin due to a heart inflammation called cardiomyopathy and lung problems
• Schering-Plough Corp's arthritis treatment Remicade due to increased risk of infections and rare cases of a type of lymphoma
• ImClone Systems Inc's cancer drug Erbitux due to serious and sometimes fatal reactions in about three per cent of patients

Just last week, the U.S. Food and Drug Administration ordered warnings for Genentech's psoriasis drug Raptiva, saying patients given the once-weekly injections are at risk for life-threatening infections.

Chemical-based drugs also periodically draw safety warnings from regulators but there is no recent similar data to compare the rates, the researchers said.

British fertility bill delayed

A British bill that would allow researchers to take tissue from the mentally ill and Alheimer's patients to use in animal/human hybrid experiments may not be voted on today, as expected, as the bill's sections on abortion continue to cause controversy.

The bill, among other things, would liberlize abortion laws in the country -- leading activists on both sides of that debate to demonstrate outside Parliament today.

Procedural delays today, however, have led to speculation the broad-based fertility bill may be shelved for up to two years.

Baroness Ruth Deech, former chairwoman of the Human Fertilisation and Embryology Authority, said said the abortion reform should be treated under separate legislation.

"It would be tragic if it were to be hijacked by abortion provisions which really have nothing to do with the rest of the bill. What we are facing now is the possibility that there will be so much contention that the liberalizing amendments won't get through and the whole bill might fall."

Today's procedural motion means that amendments directly relating to the bill will be debated first, effectively removing any time to consider abortion changes before debate is cut off.

Embryos from the infirm

Medical ethicists and religious leaders in Britain are outraged their government is trying to bring in provisions to allow human tissue from the mentally infirm to be taken without their consent and used to create human/animal hybrid embryos, for stem cell research.

The provisions are part of a last-minute amendment to an already controversial bill governing the creation of such embryos. The amendment would allow tissue to be used from people who lack the "mental capacity" to give consent, children whose parents give permission, and anyone who has previously donated samples to hospitals for medical research but can no longer be traced. Parliament votes on the bill Wednesday.

David Jones, director of the Centre for Bioethics and Emerging Technologies at St Mary's University College in London, said a person with strong ethical concerns about the issue could have their wishes overruled if they developed a disease such as Alzheimers.

"In May we had a public debate about whether or not it is a good thing to create hybrid embryos. Now it transpires that just weeks later, with no public debate at all, the government inserted these amendments which cross a fundamental line in medical ethics by presuming consent in many cases. I think it is totally objectionable, and I really worry that this will create a backlash against medical research."

John Haldane, director of the Centre for Philosophy and Public Affairs at the University of St Andrews, said the proposal would sweep away 25 years of progress in medical ethics.

"The most intimate thing over which you have control is your body and its fate; and this is total violation of that basic right."

Jim McManus of the Catholic Bishops Conference of England and Wales called the idea "macabre," adding: "This is a reckless step backwards, and it rides roughshod over a basic human right."

Spanish saviour sibling

Little Javier was born last week into a world of controversy.

That's because the little Spanish boy was conceived for one reason only: to provide stem cells for his older brother, Andrés, who suffers from a congenital form of anaemia. Stem cells from Javier's umbilical cord will be used in a bone marrow transfer to his six-year-old sibling in hopes of curing his condition.

Javier was screened before birth to ensure he was free of the condition, which has led the Roman Catholic Church in Spain to condemn the situation, since such screenings mean other embryos that were not free of the condition were discarded.

“You cannot kill one human being to save another,” the Spanish Bishops' Conference said in a statement.

Parents Soledad Puertas and Andrés Mariscal said they wanted only what is the best for their son.

Spain legalized stem-cell research in 2006 and Andalusia, in the south, where Javier was born, became the first region to allow embryo screening as a public health right.

Despite the position of the church, the majority of Spanish people are in favour of the use of embryos to cure illnesses.