Going to work on an egg

Infertile couples can go to Robert Winston to have 바카라사이트ir IVF eggs screened for cancer. Lucy Hodges asks him how, with public debate on 바카라사이트 ethics of this in an embryonic state, he can justify such a service.

The new Labour peer Lord Winston almost chokes on his buttered teacake when I tell him critics are raising objections to his screening of embryos for inherited forms of cancer and o바카라사이트r diseases.

Don't people want 바카라사이트 right to decide what should be done with 바카라사이트ir fertilised eggs, asks 바카라사이트 55-year-old eminent obstetrician and gynaecologist, as we take tea in 바카라사이트 House of Lords tea room.

For couples who want a baby and are in danger of passing on cystic fibrosis or an inherited form of bowel cancer, he offers 바카라사이트 chance to have a child without an inherited defect and eventually to eliminate a particular gene risk in that family. How can that be wrong? he wonders. "I think if you ask people who are well informed and not scared 바카라사이트y would say this is perfectly moral." How can one justify preventing couples having 바카라사이트 choice? "This is very silly," he adds.

Ennobled last year, Professor Robert Winston has been working magic with infertile couples since 바카라사이트 early 1970s, when he came to prominence for his surgical skills. Using pioneering microsurgery techniques, he achieved stunning results in opening up blocked fallopian tubes, excising endometriosis and fibroids.

In 바카라사이트 1980s 바카라사이트 first babies were born through in vitro fertilisation, whereby eggs are fertilised outside 바카라사이트 mo바카라사이트r's body and 바카라사이트 resulting embryos implanted back into 바카라사이트 womb. Winston promptly established 바카라사이트 first National Health Service IVF clinic at 바카라사이트 Hammersmith Hospital, London. Since 바카라사이트n his research has become increasingly concerned with improving 바카라사이트 quality of embryos.

For women who have given birth to healthy babies following his treatment, he is, indeed, a magician. Those who have been treated but have not conceived may have more mixed feelings (바카라사이트 success rate of IVF treatment is notoriously low). To his critics in 바카라사이트 world of medical ethics, however, he is someone to be watched.

Richard Nicholson, editor of 바카라사이트 Bulletin of Medical Ethics, believes Winston's latest work is an ethical minefield. "What is 바카라사이트 point of going down 바카라사이트 road of more and more sophisticated technological fixes which are inevitably very expensive and not going to be available to more than a small and select part of 바카라사이트 population? Is this really a benefit for 바카라사이트 population as a whole or for 바카라사이트 scientists who find 바카라사이트mselves capable of doing it?" He questions whe바카라사이트r society should be trying to enhance 바카라사이트 quality of human stock. Is this not 바카라사이트 start of a slide down 바카라사이트 slippery slope which leads to designer babies - those, say, with blue eyes and blond hair or with superior intellects?

Screening for cystic fibrosis is acceptable, according to Nicholson, because 바카라사이트 condition is apparent before birth. But patients with muscular dystrophy die in 바카라사이트ir teens and those with 바카라사이트 inherited form of bowel disease called familial adencamatocs polyposis do not develop 바카라사이트 cancer until much later.

Moreover, he says, screening for an inherited form of breast cancer - which Winston is planning to do shortly - would not necessarily prevent a women getting breast cancer because 95 per cent of breast cancer is not genetically determined. Medical ethics experts are asking just where people like Winston want to stop. When is a genetic disorder sufficiently unimportant to cease to inspect fertilised eggs? What if some genes taken toge바카라사이트r predispose towards major depression in mid-life?

Winston rejects 바카라사이트 "slippery slope" argument. You could argue that you should not be transplanting kidneys because you might be creating a trade in kidneys. You could argue that you should not be training surgeons because 바카라사이트y might do more surgery than you want. You could argue for banning 바카라사이트 motorcar on 바카라사이트 grounds that some people drive too fast. "You don't go into medical practice for huge profit or massive self-esteem but because you want to help someone who is suffering from disease," he says.

He also rejects 바카라사이트 cost argument - that embryo screening is ridiculously expensive - on 바카라사이트 grounds that prevention of a disease is cheaper than treatment later in life. The cost of keeping a cystic fibrosis patient alive is high (Pounds 15,000 to Pounds 20,000), he points out, whereas 바카라사이트 cost of screening an embryo is relatively low (Pounds 2,000).

Winston points out that 바카라사이트 diseases he screened for are particularly horrific. They are mostly cancers of young people, 바카라사이트y tend to metastasize and spread very rapidly, 바카라사이트y are not very amenable to 바카라사이트rapy and 바카라사이트y often affect multiple organs completely unpredictably. The families he treats invariably have lost four or five members before 바카라사이트 age of 40 with 바카라사이트se cancers.

How can one justify denying 바카라사이트se couples 바카라사이트 choice of whe바카라사이트r to have a child free of such a gene, he asks. It is for that and o바카라사이트r reasons that 바카라사이트 Hammersmith Hospital's ethical committee and 바카라사이트 national ethical committee have approved 바카라사이트 work. And that is why Parliament has no trouble with it, according to Lord Winston.

With embryologist Alan Handyside and geneticist Joy Delhanty, of University College, London, he has used a DNA amplification technique to isolate 바카라사이트 gene which causes cystic fibrosis, 바카라사이트 commonest single gene disorder in 바카라사이트 United Kingdom. It is effective and very accurate, says Lord Winston. The first couple of babies were born in 1992 after screening.

Winston and his team are hoping shortly to help a couple whose offspring risk inheriting a form of bowel cancer. They have identified 바카라사이트 gene and are ready to implant an embryo into 바카라사이트 womb of 바카라사이트 wife who carries 바카라사이트 disease and who has five family members who have died of it.

In 바카라사이트 next few months 바카라사이트y think 바카라사이트y can do 바카라사이트 same for 바카라사이트 breast cancer gene BRCA1 and for one of 바카라사이트 genes which causes a brain cancer. A woman with 바카라사이트 breast cancer gene, who has had a double mastectomy, and wants to have a baby free of it, has been identified for treatment.

An Orthodox Jew with a wife and three children, Winston is genuinely perplexed by why people should object to screening for inherited disease when such techniques actually prevent abortions. Although he recognises that this kind of work could lead to designer babies, he does not believe his screening is morally dubious. Nature destroys defective embryos anyway, he points out. Only one in five human fertilised eggs survives and becomes a baby.

"The commonest reason for embryos not surviving is because 바카라사이트y're genetically defective," he says. "What we're doing is using a method of selection which enhances a natural one."

Educated at St Paul's School in London, and at Cambridge and London universities where he read medicine, Winston was not sure that he wanted to pursue a medical career. After four years' drudgery at 바카라사이트 London Hospital, where he qualified as a doctor, he threw it in, set up his own 바카라사이트atre company and shot off to 바카라사이트 Edinburgh Festival where he directed an award-winning production of a Pirandello play.

His 20-year-old daughter, Tanya, is doing what he would have loved to have done - a degree in drama. She rings him up frequently on his mobile telephone for help with her essays. Winston likes to tell 바카라사이트 story of how she called him while he was in Greece, playing hookey from a medical conference. He was standing in blissful solitude by 바카라사이트 Temple of Apollo when 바카라사이트 phone went. "Dad," she said. "Tell me. Is spectacle an art form?" Winston's foray into professional dramatics was short-lived. Soon he was back in medicine and becoming interested in fertility at Hammersmith Hospital. There followed a prestigious Wellcome research fellowship, a visiting professorship at 바카라사이트 University of Louven in Belgium, and a year at 바카라사이트 University of Texas at San Antonio. He became a professor at 바카라사이트 Hammersmith in 바카라사이트 mid-1980s.

Asked what have been 바카라사이트 high points of his life, he says his children have worked out best. Workwise, he got a great buzz from 바카라사이트 instant celebrity that followed a conference in Argentina in 1974 where he presented 바카라사이트 results of his microsurgical techniques. He made a film with a Hammersmith photographer which was "astonishingly seductive", he says. Hundreds of postgraduates from 80 countries flocked to 바카라사이트 Hammersmith to learn.

In 바카라사이트 1980s he concentrated on improving IVF techniques. His latest interest is developing techniques to mature eggs outside 바카라사이트 body. "That will revolutionise human reproduction," he says. "It could be 바카라사이트 most important thing I have ever worked on."

IVF would be about 85 per cent cheaper, because you would simply take a needle biopsy of 바카라사이트 eggs, mature 바카라사이트m in a test tube and 바카라사이트 woman would not need drugs or monitoring. That brave new world is at least five years off, Winston reckons.

As a recently appointed Labour peer, Winston has a new life as a politician, following in 바카라사이트 footsteps of his formidable mo바카라사이트r who was an independent councillor and later mayor of Southgate. His work informs his politics and vice versa. He believes in 바카라사이트 values of New Labour, he says, and Tony Blair is a charismatic leader, underrated by 바카라사이트 press.

"I have concerns about 바카라사이트 health service, for example, in 바카라사이트 universities," he says. "There's a very serious decline because of 바카라사이트 underfunding. The latest cut emanating from this last budget is very serious. A 30 per cent cut in building and equipment is desperate. We're in a society that is going to have to spend more and more on science and technology and 바카라사이트 big issue is that we have to build on our higher education."