Should organ donations be mandatory?
Mandatory organ donation, transplants before donor brain-death and government control of cadavers are ideas floated in a special issue of the Journal of Medical Ethics, edited by Australian bioethicist Julian Savulescu.

In his editorial in the magazine, which has a libertarian and utilitarian leaning, Savulescu begins with the assumption that "Body parts are valuable only and in so far as they make people's lives go better. And when mental life is absent or grossly diminished, we cease to exist in any significant sense." He concludes that when "meaningful mental life ceases, organs should be available".

In an accompanying article Saskatoon (Canada) forensic pathologist H.E. Emson contends that since our bodies are "on loan to the individual from the biomass" and constitute "a unique and invaluable resource", control over cadavers should be vested in the government as a trustee for potential organ recipients.

And prominent British bioethicist John Harris, of the University of Manchester, backs "automatic or mandatory availability of donor organs", provided that the issue is democratically decided. Because the benefits are so great to recipients and the harm done by overriding objections is so small, "we should remove altogether the habit of seeking the consent of either the deceased or relatives".

Radical views such as these are in advance of the position of the British Medical Association, which argues for an "opt-out" system. Two ethicists from the BMA say that "a shift to presumed consent for transplantation is not only feasible in this climate but is also the right and morally appropriate thing to do". It also appears to have the support of public opinion polls and politicians, says the BMA.

Other articles in a special free on-line issue support the creation of a market for organs. ~ Journal of Medical Ethics, Jun 1  

Overseas market for aborted foetal tissue
A Dutch biotech company has applied to Queen Elizabeth Hospital in Adelaide for access to foetal tissue from aborted foetuses to use in research programs. Sydney's Daily Telegraph, which uncovered the plan, alleged that "those behind the project were hoping to carry it out without the public knowing". It is believed to be the first proposed commercial collection of foetuses in Australia.

The abortion doctors who would provide the tissue would be remunerated for their time at an hourly rate.

The company, Crucell, which is involved in research and development of bio-pharmaceutical products, needs the tissue to create vaccines for infectious diseases such as HIV and ebola. A spokesman for the hospital said earlier this week that the application had been withdrawn, although Crucell says that it is proceeding.

Crucell also attempted to obtain foetal tissue in New Zealand last month but its application foundered. According to the New Zealand Herald, it had proposed taking cells from aborted New Zealand foetuses, flying them to Australia and growing lines of retinal cells, the building blocks used to construct eyes.

Australia and New Zealand are amongst only four countries which have been declared free from contamination by mad cow disease by the US Food and Drug Administration. This makes their foetal tissue particularly attractive for commercial medical research. ~ Daily Telegraph, Jun 10; New Zealand Herald, May 23  

Australian STD rates double in 10 years
Australian rates of chlamydia and gonorrhoea have doubled over the past 10 years, says the president of the Australasian College of Sexual Health Physicians, Anna McNulty. A report from the British Parliament this week estimated that one in every 10 young British women is infected with these STDs. Much the same could happen here soon, says Dr McNulty, especially amongst 15 to 25-year olds.

In the UK, a House of Commons health select committee reported that all STDs have increased over the past six years, but especially gonorrhoea (87%), chlamydia (108%) and syphilis (486%). Chlamydia is particularly insidious because it may have no symptoms but if left untreated, it can cause infertility. "Most young women will not find out they cannot have children until they try at around the age of 30. The personal cost to their happiness is going to be very large," commented Professor Michael Reiss of the Institute of Education at London University. ~ ABC on-line, Jun 13; Guardian, Jun 11  

NZ GPs call for ban on direct-to-consumer advertising
Advertising prescription drugs directly to patients should be banned, New Zealand GPs have told their health minister. "GPs are particularly upset by the misleading content of many of the advertisements and the commercial pressure this puts them under to prescribe advertised drugs, even when they're no better than existing alternatives or are not suitable for the patient," says Professor Les Toop, of the Christchurch School of Medicine.

New Zealand and the US are the only countries where drug companies are allowed to target patients as well as doctors. A recent study at Harvard University and the Massachusetts Institute of Technology showed that consumer advertising works well for drug companies. In 2000 it accounted for about 12% of the growth in spending on prescription drugs. For every US$1 spent on advertising, they reaped $4.20 in sales. Both in NZ and the US, many critics of consumer advertising say that it adds unnecessarily to public health costs and the direct cost to patients. ~ BMJ, Jun 14; Boston Globe, Jun 12  

German nurses charged with geriatric murders

US biotech finds method for purifying embryo stem cells
Share of the US biotech firm Geron Corp rose nearly 15% this week after it announced that it had found a method for screening potentially cancer-causing cells out of populations of embryonic stem cells. Geron says that its patented method inserts a "suicide gene" into a cell which activates only when the cell does not develop properly.

The discovery is important because the US Food and Drug Administration may insist on extra precautions for medications developed with embryonic stem cells. Some cells could develop into unwanted cell types or become cancerous. "You may be able to get 99.999% purity, but it takes only one cell to cause a problem," says Robert Lanza, of Advanced Cell Technology, one of Geron's rivals. ~ Los Angeles Times, Jun 11  

Adult stem cells "safer", claim US scientists
Therapies using adult stem cells are promising, have a track record of success and are probably safer, scientists have told a US Senate panel. The panel is chaired by a staunch opponent of human embryonic stem cell (hESC) research, Senator Sam Brownback.

"There is abundant evidence that adult stem cells can be used as a therapy and are readily available in people," Dr Jean Peduzzi- Nelson of the University of Alabama at Birmingham told the Senate Commerce science subcommittee. "The conclusion from the preclinical studies is that adult stem cells work just as well, if not better, than embryonic stem cells and are probably safer."

Dr David Hess, head of the neurology department at the Medical College of Georgia, cited the advantages of obtaining adult stem cells from bone marrow, saying they are easily isolated, will not be rejected by the patient from which they are taken and avoid the ethical concerns of embryonic stem cells. "The field is moving fast," he said. "Bone marrow derived stem cells are already being tested in small numbers of patients with heart attacks."

However, not all witnesses before the panel opposed hESC research. "It's entirely too early to rule out any one of these areas of research in favour of any other," said Dr John McDonald, of the Washington University School of Medicine. ~ AP, Jun 12  

Latest Australian IVF statistics
IVF treatment is responsible for more babies than ever in Australia. The latest figures from the Australian Institute of Health and Welfare show that 4,801 IVF babies were born in 2000 -- 1.9% of all births, or nearly 1 in 50 babies. In 1992, they accounted for only 0.9% of all births.

About one in five IVF pregnancies results in twins. IVF pregnancy rates have doubled over the past decade, with the overall chance of pregnancy with each IVF cycle being nearly 21% in 2001. However, the average age of IVF mothers was 33.6 -- more than 4.5 years older than the average age of Australian mothers. ~ AIHW media release, Jun 13  

UK may crack down on multiple IVF embryo implants
A UK study has called for a crackdown on the number of embryos implanted in IVF procedures. According to a report in the London Sunday Times, the National Health Service spends about US$98.7 million each year providing care for multiple-birth infants born after IVF treatment. The cost is born entirely by the taxpayer. "These patients are suffering embryo overdose," says study co-author Christopher Jones, of Oxford University. "Women are designed to carry one baby at a time, not a litter."

Suzi Leather, the chair of the Human Fertilisation and Embryology Authority, which regulates IVF in the UK, says that the findings are "shocking". "The clinics have a moral responsibility for this problem. It is vital that we abolish the risk of triplets and reduce the number of twins to naturally occurring levels." The British figures for multiple pregnancies are higher than Australia's, but roughly comparable. ~ kaisernetwork.org, Jun 11

IN BRIEF: parthenogenesis; adult stem cells; Japanese birth rate; death row kidney transplant