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Dominic Wilkinson

Preventing birth to teenage parents is discriminatory

The UK government announced this week a multi-million pound program to make contraception more easily available to young people and to reduce teenage pregnancies. Britain has the highest teenage pregnancy rate in Europe.

If they are effective, these measures will prevent the birth of a large number of children whose lives would have been worth living. Is it discriminatory to try to prevent the birth of children to teenage mothers? What message does this send to those children in the community who have been born to teenagers about how we value their lives?

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The bread of life: should we enhance our food?

A new study from the US suggests that folic acid supplements may
substantially reduce the risk of premature birth. This has reinforced
calls for the fortification of flour with folic acid. Although this
reported effect on preterm births is new, there are well documented
public health benefits of folic acid.(1) The food standards agency in
the UK finally decided in May last year that folic acid would be added
to either flour or bread, after years of lobbying.

Supplementing bread and flour is an effective way of providing health
supplements on a population level. But how much should we add to food
staples in the name of public health? Should additives be limited to
those that prevent serious disease, or if available, should we add
things to food that enhance health?

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Paying for better health: Should patients be able to pay for expensive cancer drugs?

In the last month there have been a number of cases of patients with terminal cancer appealing for access to novel drugs that are not currently funded under the NHS. In Scotland yesterday a man with terminal bowel cancer succeeded in his battle to get NHS funding for a new and expensive drug cetuximab. This follows the recent publicity over two patients with breast cancer who have been fighting to be allowed to pay privately for another new drug bevacizumab.

These drugs are genetically engineered antibodies developed by a US biotech company to target growth factors commonly found in tumour cells. The drugs have been shown to improve survival of patients with some cancers, but evidence is lacking in other types of cancer.

This sort of dilemma is not unique to the UK. There is similar debate about access to bevacizumab in Canada and Australia. Some of the debate is about the science, and whether or not the drugs have been conclusively proven to be of benefit. However there are also ethical questions about the rationing of expensive treatments in public health care systems. It is generally accepted that there are finite resources available for healthcare, and that not all treatments can be afforded. But if public funding isn’t available for health treatment should patients be able to pay privately to access them?

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To push or not to push? Choosing to deliver by caesarean section.

Research published this week in the British Medical Journal shows that babies born by elective caesarean section are more likely to have breathing trouble after birth. This is especially the case for babies who are mildly premature (1 to 3 weeks early).

These results are important, since the rates of elective caesarean sections are high in the UK (as in many countries). These rates are higher in middle class mothers, a group  that has been labelled “too posh to push”.  But how should doctors respond to a request for a caesarean section by a mother (where there is no medical indication)? Do the increased risks of caesarean section justify placing restrictions on maternal choice?

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Private genetic tests, and the case for ‘Genetic education’

An advisory body to the UK government, the Human Genetics Commission has called for more regulation of genetic tests that are available for the public to buy privately.

The completion of the human genome project, and the advances (and economies) in genetic technology have led to a burgeoning industry in private genetic tests. In the US especially, but increasingly also in Europe it is possible to order a wide range of tests for genes associated with risk of disease.

It is argued that tests with significant health implications should not be advertised to the public, and should be available only through a medical practitioner. But is this attitude to testing unduly paternalistic? Is greater regulation a realistic response?

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Is this the end of the debate for human embryo research?

Two landmark papers published this week have demonstrated that stem cells (“Induced Pluripotent Stem Cells”) capable of developing into a wide range of different tissues can be made from human skin cells. It has been claimed in some quarters that this breakthrough will end the debate about the use of embryonic stem cells.

This news comes fast on the heels of the successful generation of stem cells from cloned monkey embryos, discussed in this blog last week (see also Raffaela Hillerbrand’s post), and was anticipated in the weekend papers by the news that a pioneer in cloning research had decided to move his research efforts into the same work on “induced pluripotent cells”.

But is this discovery really likely to end the ethical debate about research using human embryos?

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