The IVF meddlers must go, writes Lord Winston, upon his retirement. We discussed his new effort to reveal as illusion the claim that HFEA is the model for regulating reproductive technology. But this is much more direct, and although written as an op ed in a British paper, it is the most accessible for an American audience. He writes:
My retirement from clinical medicine eases a burden. I no longer look over my shoulder at the regulatory body, the Human Fertilisation and Embryology Authority (HFEA), whose workings the government is to review. I can speak plainly because I no longer have a conflict of interests. I believe there is a strong case for abolishing this body.
The authority regulates medical teams and IVF procedures. But why should this one treatment area be singled out? No other medical field is similarly regulated and patients do not suffer in consequence. Is the reason for regulating IVF so strictly because it deals with the beginnings of life, and with small babies? Yet we do not have a regulatory body for obstetrics or midwifery. Neonatal paediatrics is not regulated like this, neither is abortion. All these clinical areas involve just as weighty ethical and medical implications.
Some say special regulations are needed to prevent “evil practices” like human cloning. But cloning is a criminal offence. And it is unthinkable that it could be conducted in the UK without discovery, so there is little need for any authority to prevent it.
Other fertility medicine is unregulated. Tubal surgery, drugs and artificial insemination without donor sperm do not require the meddlesome activities of people who feel they know what is in the best interest of patients. Yet there is little evidence to suggest that clinical practice in these areas is deficient. There are already adequate mechanisms to control doctors, nurses and laboratory workers in all branches of medicine.
The 1990 Act emphasises that clinicians must regard the welfare of any child that might be born after treatment. This is unique to IVF; it doesn’t apply to other fertility practice. It is undesirable in principle because it risks injustice, and unworkable in practice because nobody can forecast the future. Of course, a serious history of child abuse might be a good reason for refusing treatment. But only in a tiny minority of cases could we ascertain that a baby might be born into a really adverse environment.
Caroline Flint, the minister responsible for the government review, asserts that the presence of a regulatory body has “instilled public confidence in the safe and ethical use” of IVF. But where is her evidence? Regulatory bodies may well increase public anxieties by focusing on controversial issues which are seen to be more threatening than they really are. One reason why Dr Zavos came to Britain to announce his work on “human cloning” was because he felt he was likely to get maximum publicity. He wanted the controversy that would be stimulated by the presence of the HFEA.
Some authority members boast that the British system is a model of regulation that other countries envy. This boast seems flatly untrue. Over 15 years, many countries peered hesitantly at the British system and then rejected it. There is not a single member country of the European Union with a precisely similar body. There is no evidence that practice in France, Singapore or Australia is more flawed without an equivalent body. As far as I am aware, only Canada has recently established a body along the lines of the HFEA.
So if clinical practice does not need special regulation, surely research, and particularly research on embryos, does? I remain unconvinced. Research in different areas of medicine and on human tissues is so tightly regulated now that the HFEA is superfluous. It is extraordinary that, after having gained institutional committee and local or national ethical committee approval for any research, my colleagues still have to seek HFEA approval. These different committees have been known to disagree with points raised by the authority. This degree of bureaucracy inhibits UK research.
Flint claims that Britain continues “to lead the world in developing new treatments to alleviate infertility”. Try saying that to Australian scientists or American, Chinese, Israeli, Singaporean or Swedish experts. IVF success rates have not improved much in the UK over years. And a main reason is that few British clinics are conducting internationally competitive research.
Let me be clear. I am not opposed to regulation. But in the modern UK healthcare system there are now quite enough safeguards without the HFEA. The authority is not a great British success. And it is a costly body: the HFEA charges Hammersmith about 130,000 annually for its licence. These costs inevitably are passed to the patients who already pay large sums for their treatment. What do they get in return?