Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 1220 - 1232)



  Q1220  Dr Harris: You are not answering my question. My question was: do you think there was evidential development in the safety of PGD for the embryo produced between the first decision on the Whittakers and the decision on the Northern Ireland family where they changed their mind? Or are you not qualified to answer?

  Professor Templeton: I think I am not qualified to answer. I perfectly understand the question.

  Q1221  Dr Harris: Can I ask you a general question, then? Should the precautionary principle be that these things should not be allowed until someone else in the world shows they are safe, or should things be allowed—if there is good reason to do them, obviously—unless there is evidence that it is unsafe? How would you like to see us approach that?

  Professor Templeton: You cannot generalise about it. If we are talking about safety in relation to the welfare of the child, the fact that that child may have to live with something for the rest of its life, then that is a different dimension of decision making.

  Q1222  Chairman: What good would guidelines be, then, if you are making an individual basis?

  Professor Templeton: That is what I was saying previously. I think within the legislative framework you have to allow the policy-making body to dissect out and try and discuss these things, reflect what the view of society is, what the need is within society for this particular advance and then to weigh up safety and efficacy.

  Q1223  Dr Harris: There are two different approaches and they do not merge together; PGD is a good example, particularly when, as in the Whittaker case and the Ashby case, there is another child whose welfare might be considered. Should the precautionary principle operate, in your view, to say that we should not go ahead for the good reason of therapy for the other child until we are more certain that something is safe, or if there is no evidence that it is unsafe should we allow proceeding cautiously, collecting the evidence, database, follow-up and all of that? I think that is two options.

  Professor Templeton: Yes.

  Q1224  Dr Harris: The public say they want a precautionary approach, but I say which one? What do you think?

  Professor Templeton: There are two options but you are talking about two different approaches and I do not think life is like that. You take each case as it comes along and you weigh up the relative risks. For example—again coming back to cytoplasmic donation—there is no evidence that that is unsafe, but there is a lot of circumstantial evidence that it could be unsafe, and if it is unsafe it might have disastrous effects on your children. For that reason, certainly, I took the view—and still do—that it would inappropriate to allow this to happen while there is evidence that it might be unsafe, and certainly there is evidence that it would not do a lot of good. It is the safety issue.

  Q1225  Dr Harris: So you do more animal work, but at some point someone has got to start.

  Professor Templeton: Indeed, and it is exactly the same issue with egg freezing; that has been part of the issue: low success rates and safety and trying to weigh up when you think it is reasonable to promote that in clinical practice. I do not think guidelines and legislation in this particular area of ethical decisions about the appropriateness of treatment in individual family circumstances is going to be helpful.

  Q1226  Dr Harris: Has anyone got a different view on the question I asked, Dr Kennedy, Professor Regan?

  Dr Kennedy: No.

  Q1227  Dr Harris: Can I ask you finally, Dr Kennedy, you are an inspector and there are inspectors who are involved in running clinics in competition with other clinics. I am sure you are full of integrity but there is perception among the inspected, and perhaps among those looking on, that you have a vested interest in knocking out the competition, particularly in respect of some techniques that might put them above you in a league table, regardless of whether you are NHS or private yourself—presumably private clinics also provide inspectors Do you think that is an appropriate way forward and would you like to see that changed to a more seen-to-be independent inspection approach?

  Dr Kennedy: The general observation would be that the inspection process is rather too soft. There is a process to allow declaration of interest, but in answer to your question I think there should be a professional inspectorate which does not necessarily take from those involved in current clinical practice, so there is an independent professional inspectorate which inspects clinics and can do so completely objectively, and has the teeth to say this is right, this is wrong, this is what you have to put right.

  Professor Regan: Although you could add at that point that if you have individuals who are independent of clinical practice at the present time, are they the best individuals to be inspecting clinics?

  Dr Kennedy: If you have a professional inspectorate I think you overcome that because you appoint professional inspectors.

  Q1228  Chairman: The last question—just briefly, because then we have to go to Prime Minister's Questions—is on clinical trials. Are you happy with the state of them in this country, that they are well-funded or what? You have put a lot on evidence and without clinical trials there is no evidence. Are we playing at it or is there a real investment and concern about developing clinical trials?

  Professor Templeton: It is difficult, but the opportunities are there. I know, perhaps, of three that have gone to the MRC and have been turned down. I know that the NPU recently have put in a proposal to the MRC to set up a clinical trials centre, if you like, which has been turned down, and it is always difficult to know if the reason is the quality of the science or if there is a genuine bias against doing such trials. I am involved in two multi-centre trials that are appropriately funded; they are multi-centred, they do show good collaboration among the various centres in this country and that is a way forward. Perhaps we need to encourage the MRC to look again at some of the proposals that have come forward.

  Q1229  Chairman: Professor Regan, have you a point to make?

  Professor Regan: Yes, we do need more trials, particularly on the points I was making earlier, not just on the IVF treatment cycle but on the adjunctive therapies that are being offered. I think it is important to emphasise as well that unless we get more funding of the trials it is going to be progressively more difficult to recruit these patients and their clinicians to encourage those patients to go into trials. Many of them will say "I want to try this treatment anyway, I am prepared to take the risk because it might help me." It is very different when you are wishing to avail yourself of a treatment that may possibly help you achieve your live take-home baby from discussing the TNF alpha drug which may or may not be prescribed for your rheumatism.

  Q1230  Dr Harris: Why not a levy on private clinics that they could pass on to the patient that could contribute to NHS patient research? Should the private sector contribute?

  Professor Regan: Yes.

  Professor Templeton: Do you mean financially or by contributing patients?

  Q1231  Dr Harris: They can pass it on, obviously, to patients.

  Professor Templeton: The costs of the research?

  Dr Kennedy: The licence fee that currently is applied to patients throughout the UK for licensed treatments, you could divert that into research. That would be a very useful use of a licence fee.

  Dr Harris: Good idea.

  Q1232  Chairman: Thank you very much for coming and giving us your views and professional judgments and so on, it has been very helpful. Our report will finish some time early next year after we have seen the Minister and the Human Fertilisation and Embryology Authority, for both of whom we will have many questions to ask; you have helped us with that, thank you very much indeed.

  Professor Templeton: Thank you.

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