Breast cancer screening review set up amid fears risks outweigh benefits
Independent inquiry attempts to put to rest concerns by scientists following open letter to government's cancer chief
An independent investigation into breast cancer screening has been set up by the government's cancer chief to try to settle the growing controversy around its usefulness and potential harms.
Prof Sir Mike Richards's move is an attempt to put to rest the criticisms of a number of scientists, who say the NHS screening programme wrongly identifies cancers that might never harm women, leading to unnecessary and potentially damaging treatment with surgery, drugs and radiation therapy.
They also contest the official NHS position, which is that although there is some over-treatment as a result of screening, mammograms save lives.
Richards's decision came to light in an open letter to Susan Bewley, professor of complex obstetrics at King's College London, who had written to him with her concerns over routine screening.
She herself, she wrote, had decided not to be screened even though she had a family history of breast cancer "as the NHS breast screening programme was not telling the whole truth".
The NHS leaflets on screening, she wrote, "exaggerated benefits and did not spell out the risks. Journals showed a reputable and growing body of international opinion acknowledging that breast cancer screening was not as good as used to be thought.
"The distress of over-diagnosis and decision-making when finding lesions that might (or might not) be cancer that might (or might not) require mutilating surgery is increasingly being exposed. The oft-repeated statement that '1,400 lives a year are saved' has not been subjected to proper scrutiny. Even cancer charities use lower estimates," she wrote.
A big change since the early years of screening is that the NHS is now much better at treating breast cancer, Bewley said. That meant screening is "only of marginal benefit, at best".
The medical profession needed to find ways to cope with the complexity of the issue and the public needed better information, she added.
"Trust is at stake if the public is not told the full story. In the past few years British women have not been told about the genuine doubts. Those millions of women passing through the breast screening treadmill have been unaware of the problems, criticism and real numerical risks they face," she wrote.
In his reply, Richards assured her that he took the current controversy "very seriously".
While he listed the evidence that supports screening – including a World Health Organisation paper from 2002, which said it reduced deaths in 50- to 69-year-old women by 35% – he admitted that he and Harpal Kumar, chief executive of Cancer Research UK, were setting up a review of the breast cancer screening studies. He said they were seeking independent scientists who had not been involved in the controversy to undertake it.
A second independent team was working on an improved screening leaflet that would include both risks and benefits, he said.
He told Bewley he was prepared to make changes to the screening programme if the evidence showed they were necessary.
"Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK national screening committee and then ministers," he wrote.
"You also have my assurance that I am fully committed to the public being given information in a format that they find acceptable and understandable and that enables them to make truly informed choices."
The chief critics of breast screening have been scientists from the reputable Cochrane collaboration, based in the Nordic countries, whose studies of the original trials used to support the introduction of screening have been published in leading medical journals including the British Medical Journal – which on Wednesday will publish the exchange of letters between Richards and Bewley – and the Lancet.
Most of the large-scale trials of screening were flawed, not least because it was hard to assign women randomly to be screened or not. A well-run major trial in Malmo, Sweden, however, produced results that appeared to show screening saved lives.
But in recent years, work by the Nordic Cochrane Collaboration authors has disputed the mortality findings. The most recent paper found that many of the early-stage cancers spotted at screening – too small to be detected other than by x-ray – either would not have gone on to cause problems or might even have regressed.
Breast cancerCancerHealthWomenMedical researchSarah Boseleyguardian.co.ukOvarian cancer risk almost halved after 10 years on the pill, study shows
Women who have been on the pill for 10 or more years cut their risk of ovarian cancer by about 45%
Taking the contraceptive pill for 10 years almost halves a woman's risk of ovarian cancer, according to research.
A study investigating reproductive factors in ovarian cancer found that women who had been on the pill for 10 or more years cut their risk of ovarian cancer by about 45%.
Getting pregnant was the next most protective behaviour, reducing a woman's risk by 29% compared with those who had never been pregnant.
The bigger the family she had, the less likely a woman was to get ovarian cancer. Each baby reduced her risk by a further 8%.
The study, published in the British Journal of Cancer, is part of a programme of research looking at the links between diet, lifestyle and cancer. The European Prospective Investigation of Cancer (Epic) is following more than one million people across Europe, including the UK.
How much protection a woman would get from taking the pill depends on her individual risk of ovarian cancer, because some of the causes will be genetic. But the study calculated that 28 in 100,000 women who used the pill for 12 months or less would get ovarian cancer – a rate that dropped to 15 per 100,000 among those who took it for 10 years or more.
The risk for women who have never been pregnant was calculated at 34 per 100,000 per year – dropping to 24 per 100,000 after one full-term pregnancy.
Experts at Cancer Research UK, which part-funded the study, acknowledged that women's choices and inclinations over having children had changed.
"These days it is not uncommon for women to have fewer children or none at all," said Sara Hiom, the charity's director of health information. "Women tend to be unaware that these reproductive factors have a protective effect on their risk of ovarian cancer.
"Nobody can expect women to start living like their Victorian counterparts to reduce their risk of the disease. But there are other things that can be done to lower the risk of ovarian cancer, like stopping smoking and maintaining a healthy weight."
She added: "As with most cancers, the risk of developing ovarian cancer increases with age – most cases are in women who are past their menopause. Inherited faulty genes can also play a significant role, and women who think they may have a family history should discuss this with their doctor.
"Treatment for ovarian cancer is better if the disease is caught as early as possible. So all women should be aware of the signs of ovarian cancer, like pain in the lower tummy, bloating, increased tummy size, difficulty eating or feeling full. If these symptoms are new and happen on most days then it's worth getting checked out by your doctor without delay."
Ovarian cancerCancerHealthMedical researchSarah Boseleyguardian.co.ukMalaria vaccine could save millions of children’s lives
Researchers 'on the cusp' of a vaccine after widescale African trial shows the risk of malaria cut in half
Millions of children's lives could be saved by a new vaccine shown to halve the risk of malaria in the first large-scale trials across seven African countries.
The long-awaited results of the largest-ever malaria vaccine study, involving 15,460 babies and small children, show that it could massively reduce the impact of the much-feared killer disease. Malaria takes nearly 800,000 lives a year – mostly children under five. It damages many more.
The vaccine has been in development for two decades – the brainchild of scientists at the UK drug company GlaxoSmithKline, which has promised to sell it at no more than a fraction over cost-price, with the excess being ploughed back into further tropical disease research.
"This data brings us to the cusp of having the world's first malaria vaccine, which has the potential to significantly improve the outlook for children living in malaria endemic regions across Africa," said GSK's chief executive, Andrew Witty.
"The addition of a malaria vaccine to existing control interventions, such as bed nets and insecticide spraying, could potentially help prevent millions of cases of this debilitating disease. It could also reduce the burden on hospital services, freeing up much-needed beds to treat other patients who often live in remote villages, with little or no access to healthcare."
Witty told the Guardian he was thrilled for the scientists, who were thought by many of their peers to be attempting the impossible when they started work on a vaccine 25 years ago. "When the team was first shown the data, quite a number of them broke down in tears," he said. "It was the emotion of what they had achieved – the first vaccine against a parasitic form of infection. They were overwhelmed. It says something about the amount of heart that has gone into this project."
In an indication of the weight of expectation around this vaccine, still known only as RTS,S, the results were announced at a malaria forum in Seattle called by Bill and Melinda Gates, attended by the World Health Organisation director general, Margaret Chan, and the UK development secretary, Andrew Mitchell. The results were published at the same time online by the New England Journal of Medicine.
Mitchell said a vaccine "offers real hope for the future", adding: "An effective, long-lasting and cost-effective vaccine would make a major contribution to malaria control … but we must not lose sight of the fact that over 2,000 people die from malaria every day and they need help now. Britain's focus remains on driving down this terrible loss of life by preventing and treating malaria with the tools we have now and tackling resistance."
Small-scale studies, in a few hundred children, have shown promising results in the past, but a trial of this size is needed to prove the vaccine's usefulness across populations. It is being carried out in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania.
The early data from five- to 17-month-old children is the first of three important results; the outcome from the vaccination of newborn babies will be published next year. These figures are crucial, because the malaria vaccine needs to be incorporated into the infant immunisation schedule, alongside the usual diphtheria and measles jabs. Earlier small-scale trials suggest the results in six- to 12-week-old babies will also show around 50% protection.
The third important outcome, on how well the protection lasts, will not be known until 2014. The data so far, over 22 months, suggests there may be a drop in the numbers protected from severe malaria.
The WHO has said that if the results are satisfactory, it will recommend its use and the vaccine may begin to be rolled out as early as 2015, but it will need to be used in conjunction with all the other existing tools of malaria prevention, such as bed nets and insecticide spraying on the inside of homes.
Questions remain over the price of the vaccine and whether donors will be willing to pay. Dr Regina Rabinovitch, from the Bill and Melinda Gates Foundation, declined to say if they would fund it, saying they would want to look at the final data on efficacy, duration and safety. "Would I prefer to see a 100% effective vaccine? Certainly," she told a press conference.
Witty says he is exhorting everybody involved in the vaccine's production to pare their costs to the bone. "We are absolutely dedicated to making it as low as possible," he said.
Christopher Elias, president and chief executive of Path, a non-profit organisation that has helped fund the study, with the assistance of the Gates Foundation, said such high-quality science was moving the fight against malaria on.
"The Path malaria vaccine initiative's mission is to deliver a vaccine to the children of Africa so that instead of carrying near lifeless babies to crowded paediatric wards, mothers will carry their infants past noisy school playgrounds to bustling immunisation clinics. Today, we are an important step closer to realising that vision, and we look forward to continuing our drive, together with our partners, to bring this vaccine home to the children of Africa."
Bill Gates said a vaccine is the simplest, most cost-effective way to save lives. "These results demonstrate the power of working with partners to create a malaria vaccine that has the potential to protect millions of children from this devastating disease," he said. All the children in the trial received three doses either of vaccine or an ineffective placebo. The analysis published in the journal relates to the first 6,000 children, aged five to 17 months, to be immunised. Over the 12 months after immunisation, the vaccine reduced their risk of developing clinical malaria – meaning the high fevers and chills that need medical treatment – by 56%, and of developing severe malaria by 47%.
Severe malaria affects the brain, kidneys and blood and can kill. Most children still suffered malaria, but fewer and less serious bouts. For every 1,000 children who received the vaccine there were 750 cases of malaria over a year, compared with 1,500 per 1,000 children who were given a dummy jab. Side-effects were roughly the same in both the vaccine and placebo groups and relatively high, at around 20%, but investigators say this has to do with other health problems among rural African children.
MalariaVaccines and immunisationImmunologyInfectious diseasesGlaxoSmithKlineWorld Health OrganisationHealthPharmaceuticals industryAfricaMedical researchSarah Boseleyguardian.co.ukStudy adds to cot death concerns over co-sleeping
Nearly two-thirds of babies whose cot deaths were referred to Great Ormond Street for autopsy were co-sleeping with parent
Nearly two-thirds of small babies whose sudden, unexplained deaths were referred to London's leading children's hospital for autopsy were co-sleeping with a parent at the time, according to a study.
The authors of the paper, from Great Ormond Street hospital, say asphyxia might have been the cause of death in a minority of cases. Their study highlights sleeping on a sofa as a particular danger.
It was not able, however, to take account of every parent's drinking and smoking habits, which are known to influence the risk of cot death.
Martin Weber and colleagues, whose paper is published online by the Journal of Paediatrics and Child Health, say their autopsies of babies who died over a 10-year period show co-sleeping was a factor in deaths of those aged less than six months, but not in those who were older.
They studied 1,500 autopsies of babies less than a year old, carried out between 1996 and 2005, of which 546 were initially considered sudden and unexplained deaths in infancy, or cot deaths. The sleeping arrangements were recorded in 314 cases.
The autopsies found reasons for some of the deaths. Among those that were explained, 44% of infants had been sleeping with a parent; among the still unexplained deaths, that rose to 59%, nearly two-thirds. Those infants were more likely to show possible signs of asphyxia than the babies whose deaths were explained.
About 18% of the babies who died were sleeping with a parent on a sofa.
The authors say their study shows that co-sleeping is a common practice. They also acknowledge it is a controversial risk factor in cot death. "It is normal practice in many cultures and, despite recommendations to the contrary, it is still commonly practised in the UK," they say.
There is already strong evidence of a link between co-sleeping and cot death where the parent smokes, drinks or has taken drugs, they add.
The Foundation for the Study of Infant Deaths called for the collection and publication of local and national data on baby deaths so that researchers could investigate further.
"The study strengthens what previous research has shown, that co-sleeping is associated with a significant number of unexpected deaths of babies in the UK, but it also highlights the need for more research which examines the relationship between co-sleeping and other risk factors," said Francine Bates, FSID's chief executive.
ChildrenHealthMedical researchSarah Boseleyguardian.co.ukAlessandra Luchini: nanoparticle traps detect diseases before our bodies do
A brilliant molecular-level test for signs of cancers developed by Alessandra Luchini promises far-reaching applications
Alessandra Luchini is an engineer at George Mason University, Washington DC. Enabled by a grant from the Italian health service, she travelled to the US to study the molecular signs that some cancers release into the bloodstream. She was recently named in Popular Science's 'Brilliant 10' – an award for the achievements of scientists under 30.
Why did you choose this line of research?
We know that cancers have biomarkers that exist in the blood and body fluid in very low concentration, but they are volatile and degrade very quickly. So we were looking for something that current technology did not allow us to seek. We needed to figure out some kind of answer to that.
Why did you alight on nanoparticles as a tool to solve this?
Nanoparticles have been used for the opposite function: drug delivery, where they are loaded with a drug and then inserted in the body of the patient to deliver the medicine directly to the target. So we used the same concept but engineered them for the opposite goal – to capture things that are present in the body fluids.
You're working with bodily fluids outside of the body, such as blood samples?
Everything we've done so far is outside the body, but ongoing projects are injecting the particle inside the body.
What would be the advantage of studying the biomarkers inside the body?
As we know from experiments, every time we extract body fluids or tissue from the body of a patient they undergo some kind of modification, so the sample is close enough to what's going on inside the body but not exactly the same thing. One characteristic of the nanoparticle trap is that when it captures the target biomarkers they are preserved from degradation. So in vitro study would give the researcher a completely different level of understanding.
Does the trap itself hold some bait for the protein?
This is one of the key aspects of the technology. We were able to find some organic reactive dyes which proved to have a very high affinity for proteins. So binding these dyes to the nanoparticle is what makes the capturing and preservation possible.
Which cancers have you had the most success in detecting?
We are analysing a spectrum of cancers: breast, ovary, melanoma, prostate and lung – for which there is a great need of early diagnosis.
In years to come, is this something that could be available in hospitals?
That's the hope we have. The first clinical trial is on the detection of Lyme disease. A fraction of patients get a skin rash but for those without the rash it is very difficult to diagnose. So with the particles we are able to capture the antigens that come from the spirochaete that is the causative agent of Lyme disease. If we see in the urine a piece of the bacteria of the spirochaete, we are sure that the patient has Lyme disease. We are gathering all the evidence and then we will need to go first for FDA approval before it is available in clinics.
How much earlier will you be able to detect Lyme disease?
Lyme disease has a window of two to three weeks before seroconversion [production of antibodies in the host blood, indicating infection]. With our tests, we're able to detect it before seroconversion, because we're not looking for the antibodies, we just look for the spirochaete. I would say here, yes, by weeks, and earlier diagnosis would be beneficial for the prognosis.
Can you also use this technique for testing athletes for growth hormones?
We discovered the doping world features the same challenges as the biomarker discovery world. We are looking for something that is extremely dilute and volatile as well. One of the problems of detecting human growth hormone is that it metabolises very quickly. We see traces in the blood for only a few hours after the patient has been infected.
Here we are testing if the growth hormone remains in the urine longer. So basically we have a larger window of detection for the doping.
Medical researchCancerMedicineHealthResearchNanotechnologyIan Tuckerguardian.co.ukContagion won’t spread disease prevention
We're too frightened of viruses to let them scare us, so instead we choose to shriek at phantoms
Steven Soderbergh says that since making Contagion he's been washing his hands more often. Will cinemagoers follow suit?
The film is so eager to promote disease prevention that it sometimes sounds like a public information video. Kate Winslet's fervent medic warns us grimly: "The average person touches their face three to five times every waking minute. In between, we're touching doorknobs, water fountains and each other." If that kind of stuff doesn't get to you, wait till you see Gwyneth Paltrow's cranial autopsy.
Were Contagion to succeed in raising infection awareness, it would do us all a good turn. For unlike the begetters of apocalypse that cinema generally favours, disease really does confront us with an under-appreciated threat. Life as we know it won't be brought to a halt by asteroid impact, a new ice age, nuclear holocaust or alien invasion. A bug could do the job no sweat.
All the same, Soderbergh's example seems unlikely to be followed. After the press show I attended, we were all given bottles of anti-bacterial handwash. Cute gimmick, we chortled, as we tossed them unopened into the bin. Ours is a world in which nurses and doctors can't be persuaded to wash their hands, let alone the staff at your local sandwich bar. In the face of such insouciance, even Hollywood's persuasive powers are unlikely to prevail.
Yet Contagion boasts impressive medical credentials, whatever its deficiencies as drama. Previous virus disaster films, like The Andromeda Strain or Outbreak, played fast and loose with the science. This one, the first major example of the sub-genre in over a decade, coming as it does in the wake of Sars, bird flu and swine flu, busts a gut to keep it real. An expert consultant coached Paltrow through her impressive seizure, taught Winslet how to grow bacterial cultures and demanded a reshoot whenever he spotted a gaffe.
As a result, Contagion may be the most soundly based apocalypse movie that the big screen's ever hosted. If anything, it underplays its situation's possibilities. The film's virus kills only 30% of its victims, while little old rabies can manage 100%. It obediently succumbs to a vaccine without mutating to dodge its pursuers, as so many viruses annoyingly insist on doing. The social breakdown it engenders barely surpasses what goes on around Clapham Junction during one of our summertime riots.
In particular, the potential for hardcore horror is more or less side-stepped. Paltrow and Winslet's characters depart this life in relative dignity compared with what might happen in the real world. If you fall prey to Ebola, your organs liquefy and then rot, you bleed from all your orifices, your tongue falls out, your brain disintegrates and you go mad. It would have been nice to see Paltrow taking a shot at that.
Perhaps Soderbergh calculated that restraint would enhance credibility. Perhaps he was right. More likely, it wouldn't have made much difference either way. Oddly, the genuine dangers posed by disease seem to frighten us far less than childish fancies.
Viruses are invisible, pitiless, ferocious, proven mass killers. The 1918 flu epidemic dispatched over 20 million people. Another such epidemic is expected before too long, and because communications have improved so much, it could be much more devastating. Yet Contagion is far less likely to be eliciting shrieks at your local multiplex than Paranormal Activity 3.
On the face of it, this constitutes a malfunction of humanity's self-defence mechanism. Of course, when our instincts were taking shape we weren't to know we should be worrying about pathogens rather than sabre-toothed tigers. Yet we've learned to frighten ourselves with plenty of new bugaboos, from terrorists to paedophiles, which don't begin to match the threat we face from flu.
Maybe we choose not to fear disease because it's just too scary to contemplate. Other perils, however apparently forbidding, enshrine a source of comfort. They draw us together in the face of the malevolent Other. Disease is different.
The tagline for Contagion runs: "Don't talk to anyone. Don't touch anyone. Stay away from other people!" If disease is our real foe, then so are our fellows, friends, nearest and dearest. No wonder we go looking for other terrors.
Infectious diseasesMedical researchMicrobiologyHealthSteven SoderberghKate WinsletGwyneth PaltrowDavid Coxguardian.co.ukContagion film is not far from the truth, warns virus scientist
Dr Ian Lipkin, expert who advised on Soderbergh's movie, says we must be better prepared for outbreak of deadly disease
It's a classic Hollywood tale: scientists race against time to decode a killer virus that is spreading across the world. But the scientist who advised Oscar-winning director Steven Soderbergh on his new thriller, Contagion, says the events and themes of his latest film carry a very real warning for our times.
Dr Ian Lipkin, professor of epidemiology, neurology and pathology at New York's Columbia University, was recruited as a senior technical adviser on Soderbergh's blockbuster. The film, which opened in cinemas on Friday, charts the emergence of a deadly infectious disease that ignites a pandemic.
Scientists are first alerted after Beth Emhoff, played by Gwyneth Paltrow, becomes sick after returning from a business trip to Hong Kong and dies two days later. As the virus quickly spreads and the death toll rises, it is down to a team of scientists – including Dr Erin Mears, played by Kate Winslet – to decode the virus so that a vaccine can be produced.
According to Lipkin, the plot is anything but unrealistic. Virus outbreaks are an increasing threat in the 21st century, he says, because of greater international trade and travel, urbanisation, loss of wildlife habitats and inadequate investment in infrastructure for surveillance, vaccine production and distribution.
"Scientists have been accused of overreacting and crying wolf over the threat of virus outbreaks after the influenza pandemic of 2009," Lipkin told the Observer. "Sars [Severe Acute Respiratory Syndrome] didn't progress beyond a few locations, but outbreaks and pandemics will occur and we need to get our heads out of the sand and realise the real risks that we face. More than three-quarters of all emerging infectious diseases originate when microbes jump from wildlife to humans.
"Our vulnerability to such diseases has been heightened by the growth in international travel and the globalisation of food production. In addition, deforestation and urbanisation continue to displace wildlife, increasing the probability that wild creatures will come in contact with domesticated animals and humans."
Lipkin says societies need to be more proactive in combating the dangers. "People need to understand that science is critical to address these kinds of challenges and respond in real time," he said. "We need to be prepared. We need better bio-surveillance, with better detection and better ability to develop vaccines. However, our public health system is underfunded and overwhelmed, and we need more scientists."
Lipkin added: "When I was a kid, the launching of Sputnik made us aware that the United States was falling behind the Soviet Union in the race for space. Now all of us are in a battle that is potentially devastating, only it is not against another country but against microbes."
In Contagion, Soderbergh draws on real-life disease outbreaks, including the 2003 Sars epidemic, which started in Hong Kong and spread to 37 countries, infecting more than 8,400 people and causing 916 deaths.
Lipkin assisted the World Health Organisation and the Chinese ministry of health in managing the Sars outbreak, at some personal peril – he became ill and was quarantined on returning to the US.
"The events portrayed in this film are based largely on real experiences," said Lipkin. "For example, there are scenes in the movie where at the height of the pandemic the streets are deserted, there are food and supply shortages and political instability, and this directly comes out of my vivid memories of what it was like in Beijing during the Sars crisis.
"I was also able to advise actors from personal experience what it feels like to be quarantined – an eerie experience where you are behind glass and cut off from loved ones."
Lipkin is one of the world's foremost microbe hunters and over the past decade has identified more than 400 new viruses. But unlike British cosmologist Dr Martin Rees, who controversially predicted in his book Our Final Hour that civilisation had no more than a 50% chance of surviving until 2100, Lipkin is an optimist.
"Since the Sars outbreak, there has been increased investment to look at wildlife around the world and there is better integration between the different public health agencies both nationally and internationally," Lipkin said. "So there is reason to be optimistic, and I believe we can address the problems.
"We are one world – humans and animals – and we need to take care of one another. We also, for example, need to insist that people move away from technologies that slow down the production of vaccines so that we can develop a vaccine in three months instead of six."
Contagion pays tribute to the scientists and public health officials who dedicate their lives to trying to solve the problem of emerging viruses. Winslet's character is based on Italian scientist Carlo Urbani, who was the first to identify Sars and became infected with the disease while treating patients and died aged 46, leaving his wife and three children.
"The most moving portions of the film were those where I saw people who were very similar to people whom I've known, people who didn't have well-known names, who died in the service of science and public health," said Lipkin. "The film is in some ways a living memorial to them."
Infectious diseasesMedical researchMicrobiologyHealthSteven SoderberghSarsWorld Health Organisationguardian.co.ukScience Weekly podcast: How Columbus changed the biology of Earth
This week on Science Weekly we have an extended interview with science writer and journalist Charles C. Mann about his new book 1493: Uncovering The New World Columbus Created published by Granta this week. Charles reveals the global ecological consequences of Christopher Columbus's discovery of the Americas, "the most momentous biological event since the death of the dinosaurs".
We also unravel the startling news of the creation of an effective vaccine against malaria. Alok Jha meets Colin Sutherland from the London School of Hygiene and Tropical Medicine to find out how the vaccine works and when we might see its widespread use.
Guardian science correspondent Ian Sample joins Alok to discuss some of this week's science news including developments in European patent law and embryonic stem cell research, and why the Berkeley Earth Project's conclusions on global warming are nothing to break into a sweat about.
Subscribe for free via iTunes to ensure every episode gets delivered. (Here is the non-iTunes URL feed).
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Alok JhaIan SampleJason PhippsEgg and sperm donors to be paid more compensation
Human Fertilisation and Embryology Authority approves higher payments in effort to end shortages
Compensation paid to egg and sperm donors will increase under proposals approved by the UK's fertility regulator.
The Human Fertilisation and Embryology Authority (HFEA) has agreed to much higher payments in an effort to tackle serious shortages of both eggs and sperm, which are prompting growing numbers of British couples to seek fertility treatment abroad.
Since 2006 anyone who donates either sperm or eggs has received travel expenses they have incurred and compensation for loss of earnings of up to £61.28 a day but no more than £250 in total for each cycle of donation.
At its monthly meeting the authority ratified plans for raising that to a set figure of £750 for egg donors and paying sperm donors £35 for each visit to a clinic.
It believes the new fees will better reward people's altruism in helping others start families without setting sums so high that they would become bribes.
Professor Lisa Jardine, the HFEA's chairman, denied that the £750 payment would induce people to donate eggs purely for money. "I find it very hard to see the £750 as an inducement," she said. "I think it is a fair reflection of the effort and the time and the discomfort and the pain of some of it. I can't see any room there for inducement."
The new payments will start in mid-2012.
The authority said: "These figures are based broadly on comparators within the EU, a sense of what time and lifestyle alterations donors are required to make, and an acknowledgement of the communal and incredibly generous act people perform through the act of donation."
The HFEA move follows an in-depth review of donor compensation. It wants the UK to move to a system intended to pay "both egg and sperm donors a fixed sum, which reasonably compensates them for any financial losses as well as recognising their time, commitment and dedication to helping others form a family".
The physical rigours of donation, disruption to donors, and the need to improve childless Britons' chances of accessing the eggs or sperm they need, justify the move, the HFEA papers made clear.
An egg donor has to be examined, screened to ensure she is not carrying any serious genetic or infectious condition, undergo a series of hormone injections and then have eggs collected while either sedated or under general anaesthetic. She will also need time off work to recover and may experience side-effects such as tiredness, abdominal pain, bloating, mood swings and headaches.
Donation of sperm is also time-consuming, though less physically demanding. But donors have to refrain from sexual intercourse or drinking for at least three days before they donate, and return to the fertility clinic six months after their last donation to undergo a final round of screening tests.
The changes were welcomed by fertility campaigners, doctors who help childless couples and fertility clinics, which have been having problems recruiting enough donors.
Clare Lewis-Jones, chief executive of Infertility Network UK, said: "We hope that today's announcement to increase the payment to donors will help encourage more people to become donors. The balance between coercing people to donate by offering large sums of money, and paying enough to ensure donors are compensated for their expenses and the wonderful gift they are giving is a fine one."
Dr Allan Pacey, an expert in male fertility at Sheffield University, said the £250 cap "has arguably discriminated against egg donors, many of which have told me that they were 'out of pocket' at the end of their donation and did not feel they had been adequately compensated".
The HFEA also pledged to do more to promote donor recruitment, care for donors better and to raise awareness of the need for both forms of donation, steps which experts argued were needed.
Dr Thomas Mathews, medical director of Bourn Hall IVF clinic, welcomed the modernisation of the payment rules. "While it is vital that donation is voluntary and willingly entered into, we also need to understand that donation entails a commitment of time and inconvenience and this should be acknowledged," he said.
Laura Witjens, chair of the National Gamete Donation Trust (NGDT), said: "No amount of money will ever repay what an egg donor does to help childless couples. This priceless gift changes lives and donors truly do it to help others. The NGDT believes that altruistic motives should remain at the core of donation and that payment, although intended as an expression of gratitude, should never facilitate coercion.
"We therefore welcome the outcome of the HFEA donation consultation, where a balance is being struck between recognising the wonderful gift of donation yet not affecting the purity of donors' motives. It is in line with our recommendations to the HFEA and we are grateful they've been taken to heart."
The £750 payment to egg donors is based on the existing system in Spain, which gives women a fixed sum that equates to the average time out of pocket their act of donation involves.
The £35-a-time fees for sperm donors are modelled on Denmark's. The European sperm bank offers donors £30 a visit.
Fertility problemsReproductionEthicsBiologyMedical researchDenis Campbellguardian.co.uk
Expenses for egg donors, or profit? Depends on whether you have ovaries | Zoe Williams
Egg donation is not like getting gum balls out of a slot machine. Reasonable compensation could be 10 times the £750 on offer
The Human Fertilisation and Embryology Authority on Wednesday voted to triple the amount it gives to women who donate their eggs: it is now £750, a flat fee that Professor Lisa Jardine said was purely intended as compensation for women. "What we're trying to avoid," she told the Today programme yesterday, "is the clinic having to collect bus tickets and train tickets."
Dr David King, of Human Genetic Alert, argued that this amounted to paying women. "I do not believe there is any such thing as 'I'm an altruistic donor but yes I'd like some cash please'." King's line – that £750 is too much to reasonably constitute expenses – we'll come to shortly. There is a legitimate question underneath it: in countries where egg donors and surrogates are paid, this often started as an expenses agreement, sliding by degrees into a commercial one. So it is fair to ask whether this is the first step on the path towards monetising the mechanics of assisted reproduction – and what would be so wrong with that.
Now, an egg is inert and can't rightly be compared to a baby as a sales proposition, but it's instructive to review the baby-selling taboo, just to remind ourselves why the HFEA exists at all, and it's not all a free-for-all. Catherine Hakim, in her memorable book Honey Money, wrote that "women in Britain have been prohibited from charging fully commercial fees for surrogate pregnancies, an activity that is exclusively and peculiarly female. If men could produce babies, this would probably be one of the highest-paid occupations in the world, but men ensure that women are not allowed to exploit this unique ability."
I don't agree with that. Indeed, what I find memorable about the book is how wrong it is, on such a wide variety of matters. But there is undeniably a branch of revisionist feminism that sees reproductive ethics as a smokescreen for eroding the value proposition of the female apparatus.
I think we balk at commercialising babies for the same reason that there's no provision under law for financial compensation if you lose a loved one. We understand, collectively, that we can't be priced: that money is a metaphor created by us for the bestowing of value, and if we start applying it to ourselves, the tail's wagging the dog. The argument usually made against buying humans is one of dignity, but I think what you'd lose is not dignity but quiddity: you have no essential self if you can be bartered in a market of your own creation, measured up alongside a speedboat (and, guttingly, worth a lot less).
But an egg is more like a kidney than a baby – and you're not allowed to buy and sell those either, for different reasons. The worry with body components is that people who are desperate will jeopardise their health without realising, having been blinded to the risks by dire financial circumstances. It's a more straightforward case, aimed at protecting the poor, but it does make me think: if you're that worried about the pressures of poverty, why not focus on social justice? Why would you concentrate on the hypothetical health risk to a hypothetically struggling egg donor? It seems a bit niche.
By which I mean, I don't really believe it. I think this is a smokescreen for a paternalistic worldview in which any decision a woman makes about her own reproductive organs is bound to be freighted with a (peculiar) combination of idiocy and Machiavellianism. Too much money may confuse and excite her, leading her to make poor choices. Nevertheless, even though I divine this tacit misogynistic subtext, I do agree with the stated objection: we can't start harvesting body parts for money. The flow of life's advantages, from poor to rich, has already gone far enough.
So if this new £750 sum were a move in the direction of selling babies, or human components, it would be egregious. However, you need only look at the mechanics of egg donation to realise that the figure could be 10 times that amount and still constitute reasonable expenses.
There's a tendency to talk about this as if it were as easy as gum balls flying out of a slot machine; but if it were re-termed "an IVF process without a baby at the end", its inconveniences might be taken a little more seriously. The drugs to stimulate egg production carry some risk to health, so the compensation should be seen as an insurance against lost earnings in the immediate or long term. As a friend said of pregnancy: "You get fat and you can't drink, which are the worst two things that can happen to a woman". It may in the case of egg donation last only six weeks, rather than nine months, but you don't have to be a body double for this to interfere with the smooth running of your life and work.
As a feminist, I trenchantly deny that a sudden influx of turbo-hormones will mess with your rational mind, but let's imagine that it would: this could reasonably mean days off work. Other members of your household might argue that they spend additional funds just getting away from you, and should be compensated for that. I can't abide an essentialist take on gender, but here, dispiritedly, I conclude that it's warranted: you would only think £750 was way beyond reasonable expenses – into the territory of profit – if you didn't have ovaries.
ReproductionFertility problemsBiologyWomenGenderMedical researchEthicsZoe Williamsguardian.co.uk