Three-way IVF 'needs more study'

19 April 2011 Last updated at 01:24 GMT By Pallab Ghosh Science correspondent, BBC News The technique is controversial because mitochondria carry their own genetic material More research is needed into a controversial fertility treatment, known as three-parent IVF, before it can be considered safe for clinical use, a review has concluded.

Mitochondrial transfer aims to replace a faulty part of a mother's egg with healthy material from a donor.

This means a baby would have a small amount of the donor's genetic material, and therefore three biological parents.

The Human Fertilisation and Embryology Authority (HFEA) carried out the study.

The HFEA is the UK's independent fertility treatment regulator and its conclusions are published in a scientific review of the technique commissioned by the Department for Health.

Inherited disorders

The proposed treatment is designed to help families with rare inherited disorders.

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Until the government makes clinical research and eventual treatment legal, this country risks losing its world-leading status”

End Quote Dr Evan Harris These disorders are due to faulty energy-generating components of cells called mitochondria. Mothers carrying these faulty mitochondria in their eggs are at risk of having children with the inherited disorder.

Under the transfer treatment, the idea is to replace the faulty mitochondria in the eggs or fertilised embryos with those from eggs or early embryos from a healthy, unaffected donor.

The hope is these methods will enable couples to have healthy children and eliminate the disease for subsequent generations, but the technique is controversial because mitochondria carry their own genetic material (DNA).

Although this is very small and only carries a few genes, the resulting child will have this genetic material from the donor, in addition to the majority of maternally- and paternally-inherited genes present, in the nucleus of the cell.

The scientific review has concluded the two main ways of carrying out mitochondrial transplants appear safe, but a little more research is needed before it can be tried out on people.

Legislation call

Medical charities and research organisations are to press the government to prepare the legislation that would make this procedure legal so the technique can be used in the clinic as soon as it gets the go-ahead from the research community.

Dr Evan Harris, who campaigns for medical research, said: "Without regulations making clinical work legal, it will be difficult to ensure the laboratory research is funded and done in this country and that trials on affected families can be planned.

"Until the government makes clinical research and eventual treatment legal, subject to strict regulation on safety, this country risks losing its world-leading status."

Dr Harris argued for the legalisation of mitochondrial transplantation during the passage of the 2008 Human Fertilisation and Embryology Act when he was science spokesman for the Liberal Democrats.

He has now called on the government to provide a timetable for consultation and the publication of the regulations.

The report, called scientific review of the safety and efficacy of methods to avoid mitochondrial disease through assisted conception, examines three approaches to treating mitochondrial disorders.

The first, which is permitted under current regulations, is known as pre-implantation genetic diagnosis, or PGD.

This involves testing very early stage embryos from the affected couple and implanting only those that seem unaffected by the genetic disorder.

The report authors concluded the technique was unreliable for some disorders and could not guarantee the resulting child would be healthy.

Pro-life groups

The two other techniques are not permitted and would require a change in legislation for its use in the clinic.

Research on human embryonic material however is permitted, provided it is not implanted into a woman's womb.

One technique, known as maternal spindle transfer, involves transplanting the nuclear genetic material (in the form of chromosomes) from an unfertilised egg carrying the abnormal mitochondria obtained from the "patient" (the mother) into an empty donor egg, which is then fertilised.

The other, known as pro-nuclear transfer, involves transplanting the genetic material from a fertilised egg from the patient into a healthy "empty" fertilised egg from a donor, which has had its nuclear genetic material removed.

Some pro-life groups object more to this technique as it involves the creation and destruction of embryos.

Experiments with monkeys and work with embryonic material show promise.

But the HFEA's scientific review says more work needs to be carried out to show that embryos produced by either technique will develop normally.

The report authors also want research that compares the effectiveness of each technique before clinical trials are given the go-ahead.

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Doctors defy their own advice, shows study

12 April 2011 Last updated at 00:43 GMT By Michelle Roberts Health reporter, BBC News Doctors may choose a different treatment if they were the patient Many doctors recommend treatments to their patients that they would not use themselves, a US study shows.

Experts asked nearly 1,000 US physicians to consider a medical scenario and pick a treatment.

But when doctors were asked to imagine themselves as the patient their answers differed significantly.

Doctors were far more likely to opt for a therapy carrying a higher chance of death but better odds of side-effect free survival, for example.

But for their patients, doctors tended to pick a treatment that erred on the side of survival, regardless of the quality of life, Archives of Internal Medicine reports.

Death risk

Faced with a choice of one of two operations to treat bowel cancer, for example, two-fifths of 242 physicians chose the surgical procedure with a higher rate of death, but a lower rate of adverse effects.

Conversely, when asked to make a recommendation for a patient, only a quarter of physicians chose this option.

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Our study does not suggest that physicians always make better decisions for others than they would make for themselves”

End Quote The research authors In another scenario, doctors were asked to imagine that either themselves or a patient was infected with a new case of bird flu.

They were told a drug treatment was available, and that without this treatment a person who contracted flu would have a 10% risk of death and 30% risk of needing hospital care.

Treatment would halve the rate of adverse events but also caused death in 1% of patients and permanent neurological paralysis in 4%.

Of nearly 700 doctors, about two-thirds chose to forgo the treatment when imagining they had been infected, to avoid its adverse effects.

However, when imagining that a patient had been infected, only half recommended not taking the treatment.

Dr Peter Ubel, from Duke University, North Carolina, and colleagues say: "When physicians make treatment recommendations, they think differently than when making decisions for themselves."

What is not clear is which is the best way to reach a treatment decision - putting yourself in the shoes of another or not.

Indeed, today doctors are often discouraged from giving their own personal opinion and instead are encouraged to present the relevant evidence and information so that the patient can make the choice for themselves.

"Our study does not suggest that physicians always make better decisions for others than they would make for themselves.

"At most, our study suggests that in some circumstances, the act of making a recommendation might improve decision making," say the researchers.

'Reliant on doctors'

Katherine Murphy, chief executive of UK-based The Patients Association, said it was "very telling" that the research had found many doctors may take a different course of action from the one they would advise their patients to follow.

"Doctors are of course human and will weigh up the options subjectively for themselves, no matter what they recommend to their patients.

"The difference is that doctors will have all the medical knowledge to back up their decision whereas patients are sometimes entirely reliant on their doctor for information.

"If the government is serious about making patient choice a reality, it must ensure that all patients have access to meaningful information in a variety of formats on all treatment options so they can come to a decision which is right for them."

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