From Texas, the state where Michael Dell pioneered custom-built computers, come custom-built embryos. Commercialisation of the IVF process has achieved a new milestone with the world's first embryo bank at an innovative adoption agency in San Antonio. The

The embryos are created with the eggs and sperm of rigorously screened, "qualified" donors who have never met each other. Conception occurs as the embryo bank fills its orders. Customers can even specify the eye and hair colour that they would like their baby to have.

Jennalee Ryan, the director, says that her program is superior to both normal adoption and "adopting" surplus embryos in IVF clinics. Babies offered for adoption tend to come from lower class women, she says, who often have a history of drug or alcohol abuse. IVF embryos come from couples with fertility problems and the pregnancy rate is, at best, about 30%. Furthermore, adopting couples may have to deal with vexatious genetic parents. Often an adopting couple has to jump through hoops to prove that they will be good parents.

This new system skirts all these problems, offering a high probability of intelligent, healthy babies, without any interference from the biological parents. Most of her sperm donors have PhDs and most egg donors have had some tertiary education. All donors are medically screened and the medical quality of embryos is graded. With "proven" donors, the success rate for a pregnancy is around 70%, compared to IVF rates of about 30%. The centre can arrange for qualified surrogate mothers, if necessary. However, Ms Ryan told the London Daily Mail that most clients on her waiting list were not fussy about the characteristics of their embryos. They were happy just to get a child.

Like Dell's computers, the other advantage of buying embryos through the Abraham Center of Life is price. At about half the cost of adoption, it is "a cost-effective, highly successful option to infertility", says Ms Ryan. For US$10,000, customers will get two embryos.

Critics react. Ms Ryan acknowledged that there was some opposition to custom-built embryos, especially from religious groups. "But what I say to them is Jesus was not conceived in the normal way either. I don't lose any sleep over what we are doing. I feel what we are doing is positive. We are helping couples and putting good genes back into the universe."

The US media, for some reason, has largely ignored this novel business, despite a Ms Ryan's press release. However, Josephine Quintavalle of the British lobby group Comment on Reproductive Ethics, told the Daily Mail that it represented the "absolute commercialisation of human life... It is heartbreaking to see children reduced in this way to the equivalent of a special offer supermarket commodity: cut price, tailor-made human embryos, complete with door-to-door delivery."

Even utilitarian bioethicist Arthur Caplan, of the University of Pennslyvania, was revolted by Ms Ryan's entrepreneurial plans. "How do we get to the point where you go to jail if you go up to someone on the street and say, 'Do you want to buy my child for $10,000?' You'd think they were barbaric, immoral heinous people. But if they come down the street and say, 'Hey, there's an Internet site. Do you want to buy an egg, sperm and surrogate mother?' We think they're just entrepreneurs. What's going on here?" ~ Daily Mail, Aug 4   

PRESSURE MAINTAINED FOR AUSTRALIAN THERAPEUTIC CLONING

Australian supporters of therapeutic cloning are pressing for a conscience vote in Federal Parliament despite opposition from Prime Minister John Howard and some prominent colleagues. Opponents had hoped that Howard would stop the push at a meeting of MPs from the governing coalition at the beginning of the new session. However, he left the matter unresolved and told MPs that he would hold a meeting to discuss the issue in a couple of weeks.

The influential health minister, Tony Abbott, says there must be limits on what scientists are allowed to do. "In my view, therapeutic cloning, so called, is a bridge too far," he said recently. He predicted a slippery slope: that scientists would eventually call for an extension of time for growing embryos in the lab. "In a few years time, they would be saying, let's let it go for 30 days. And a few years beyond that, we would have scientists of high standing telling us that we ought to let it go for three months and so on. I just think that it will be better for all of us if we don't go down this path."

If the issue were decided by a conscience vote in Parliament, the odds are that it would pass, as most of the media coverage has been favourable, focusing more upon the possibility of cures, the sincerity of scientists and the fear of passing up early entry into a huge new industry. "Australia stands to go backwards, socially and economically, if we don't act," wrote the premiers of the states of Victoria and Queensland. The acting chair of the Lockhart Committee, which recommended that the government legalise therapeutic cloning, agrees. She feels that moral objections will evaporate as soon as cures are delivered.

Surprisingly, one of the scientists who cloned Dolly the sheep opposes liberalisation. Dr Alan Colman, who is now working in Singapore, said that procuring the eggs needed for therapeutic cloning posed ethical problems for him. "I'm not one to slow down research but you have to ask is it worth pursuing with current techniques or better to wait for other technologies," Dr Colman told the Australian. "(Stem cell cloning) is a technique that could be useful but I think it's a bit crude and inefficient at the moment. The balance of probability of the process working against the aspect of human donors giving eggs is just not good enough." ~ Australian, Aug 3; Age, Aug 7; news.com.au, Aug 2   

CONSCIENTIOUS OBJECTION GROWS IN THE US

However, bioethicists of a utilitarian persuasion argue that a health care worker's first responsibility is do what they are asked. "As soon as you become a licensed professional, you take on certain obligations to act like a professional, which means your patients come first," said R. Alta Charo, a bioethicist and lawyer at the University of Wisconsin at Madison. "You are not supposed to use your professional status as a vehicle for cultural conquest." ~ Washington Post, July 16   

NIP AND TUCK IN BRAZIL

Brazilian expertise is being exported, not always with the happiest of outcomes. In Boston, a woman died and another was hospitalised after cosmetic surgery at the hands of Luiz Carlos Riberio, who claims to be a doctor. He and his wife could be charged with manslaughter or murder. Apparently the couple had been visiting Boston from Brazil for at least two years on short-term work visas. They had set up a clinic in the basement of a condominium where they performed liposuction, lip plumping and nose sculpting for low- income Brazilian migrants. ~ Guardian, Aug 7; Boston Globe, Aug 1   

IS THERE A CONSTITUTIONAL RIGHT TO EXPERIMENTAL DRUGS?

The movement for access before approval is gathering strength. Kansas Senator Sam Brownback introduced a bill last November which would allow patients who have exhausted all other treatment option to receive experimental drugs, provided that they waive the right to sue the manufacturer and allow collection of their clinical data. The Society for Clinical Trials opposes the bill. Although it purports to cover only the dying, warns Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center, and a member of the Society's board, "it's not at all clear that things would stop there". ~ NEJM, Aug 3   

EXPLOITATION IN PAKISTAN

When they pick up a pair of surgical scissors, doctors may be supporting child labour in Pakistan, a British doctors claims in the British Medical Journal. London-based surgeon Mahmood Bhutta says that Pakistan produces about 20% of the world's surgical instruments, mostly in the city of Sialkot. About 50,000 people work there producing stainless steel instruments, of whom about 7,700 are children. A pair of scissors may cost about US$80, but the German companies which market them pay the manufacturer only about $1.25. Dr Bhutta proposes that adult employees receive a fair wage so that their children will not have to work. He opposes a boycott because this could send workers deeper into poverty. ~ news@nature.com, July 28   

IN BRIEF: Thailand; drug trial