- Email: [email protected]
Australia tackles surrogacy issues
Brundtland sets out the challenges for WHO
W
ith completion of WHO’s reorganisation, Director General, Gro Harlem Brundtland looked forward with confidence to the realisation of her plans in her address to the World Health Assembly (May 18). If progress in improved health represented one of the century’s biggest social gains, she said, “more than a billion human beings have, nevertheless, been left behind in the health revolution. They must be brought on board . . . this can be done. We know what it will take and we can go a long way in the next decade”, she added. However, re-emerging infections, an ageing population, the growing burden of mental illness, health consequences of climate change, and the “tragic misery” of refugees are a challenge to the entire UN system and governments everywhere, she said. “This is a time for cool heads and warm hearts”, she continued. “With
vision, realism, and commitment, the world could end the first decade of the 21st century with some notable accomplishments. Health gains trigger economies to grow and poverty to be cut.” As examples she cited figures showing that a 5-year difference in life expectancy would yield an extra annual growth of 0·5%. In East Asia, life expectancy had increased by over 18 years in the two decades that preceded the economic take-off. The goal of halving the total of people living in absolute poverty by the year 2015 is attainable if major changes are effected in the use of government resources worldwide, she said. “In several regions we need more money for health. But equally importantly, we should have more health for our money . . . better health for all, securing equitable health services must guide the change”, said Brundtland. Many governments are
finding it difficult to shift resources away from costly curative services that benefit mainly wealthier and more influential people. WHO’s role is to be a catalyst to finding funds— unleashing the resources of national governments, development banks, and bilateral partners. New sources of funding have to be found, said Brundtland, particularly for the Roll Back Malaria initiative. Another killer, tobacco, is set to become the single largest cause of death and disability—causing 10% of the global burden of disease. It was the only product on the market which leads to death when used as intended. Brundtland urged WHO member states to start drafting a framework convention on tobacco. The HIV/AIDS pandemic is entering the 21st century in full force. Already the primary cause of death in Africa, it is on the rise in Asia and also in parts of Europe. “We must not walk away”, Brundtland concluded, “We need to confront it with renewed energy and commitment.” Alan McGregor
In-vitro fertilisation outcomes must be reported
O
ne reason for setting standards for reporting the outcome of in-vitro fertilisation (IVF) treatment is to stop clinics from adopting reporting practices that enhance their success rates, said David Adamson (Society for Assisted Reproductive Technology, Stanford, CA, USA) at the 11th World Congress on In-Vitro Fertilisation and Human Reproductive Genetics (Sydney, Australia; May 9–14). In the USA, where reporting is strictly governed, proper controls over reporting allow a clinic’s suc cess rate to be defined, which can be helpful to patients when deciding where to get treatment. “In addi tion, clinics’ results can be evalu ated and best practice developed, and can provide a firm base for appropriate and strong regulation”, said Adamson. Control of reported data is neces sary because some groups, such as the US health-maintenance organi sation, have removed IVF providers who have poor treatment success rates from their lists, and because data have sometimes been inappro priately interpreted, said Adamson.
1774
“It is also important to monitor reported data because this [IVF] is a complex subject and misinterpre tation . . . is easy”, he added. Adamson said the importanat aspects to responsible reporting of IVF outcomes were why reports should be made, who should be included in collecting what data, and how data should be collected. Also, only necessary, universal, val idated, and timely data should be
recorded, he added. Currently, all US IVF clinics must report specific information, subject to onsite independent vali dation, each year to the Centers for Disease Control and Prevention (CDC). The CDC consults with consumer and professional bodies in developing the reporting mecha nism, said Adamson. Peter Harrigan
Australia tackles surrogacy issues -
-
-
-
A Western Australian Parliamentary Select Committee has recommended changes to their Human Reproductive Technology Act in a report published on May 14. The committee agreed that surrogacy should be permitted where 100% of the genetic material belongs to the commissioning couple, or where the embryo is created from a donor egg and the commissioning father’s sperm, but recommended that surrogacy using the surrogate’s egg and donor sperm should not be permitted. Invitro fertilisation surrogacy arrangements using a donated embryo were regarded as permissible. It was also recommended that surrogacy arrangements should be non-commercial; that counselling should be mandatory for all parties, including the surrogate’s partner and children; and that selection criteria should be developed for potential surrogate mothers. It was recommended that counselling before posthumous use of embryos should be mandatory. Most of the select committee supported posthumous use of embryos by a surviving partner where there was written consent by the deceased partner and considered that access to treatment should not be available if either party was older than age 55 years. The committee suggested that another review be done in 5 years. Bebe Loff, Stephen Cordner
THE LANCET • Vol 353 • May 22, 1999
W
ith completion of WHO’s reorganisation, Director General, Gro Harlem Brundtland looked forward with confidence to the realisation of her plans in her address to the World Health Assembly (May 18). If progress in improved health represented one of the century’s biggest social gains, she said, “more than a billion human beings have, nevertheless, been left behind in the health revolution. They must be brought on board . . . this can be done. We know what it will take and we can go a long way in the next decade”, she added. However, re-emerging infections, an ageing population, the growing burden of mental illness, health consequences of climate change, and the “tragic misery” of refugees are a challenge to the entire UN system and governments everywhere, she said. “This is a time for cool heads and warm hearts”, she continued. “With
vision, realism, and commitment, the world could end the first decade of the 21st century with some notable accomplishments. Health gains trigger economies to grow and poverty to be cut.” As examples she cited figures showing that a 5-year difference in life expectancy would yield an extra annual growth of 0·5%. In East Asia, life expectancy had increased by over 18 years in the two decades that preceded the economic take-off. The goal of halving the total of people living in absolute poverty by the year 2015 is attainable if major changes are effected in the use of government resources worldwide, she said. “In several regions we need more money for health. But equally importantly, we should have more health for our money . . . better health for all, securing equitable health services must guide the change”, said Brundtland. Many governments are
finding it difficult to shift resources away from costly curative services that benefit mainly wealthier and more influential people. WHO’s role is to be a catalyst to finding funds— unleashing the resources of national governments, development banks, and bilateral partners. New sources of funding have to be found, said Brundtland, particularly for the Roll Back Malaria initiative. Another killer, tobacco, is set to become the single largest cause of death and disability—causing 10% of the global burden of disease. It was the only product on the market which leads to death when used as intended. Brundtland urged WHO member states to start drafting a framework convention on tobacco. The HIV/AIDS pandemic is entering the 21st century in full force. Already the primary cause of death in Africa, it is on the rise in Asia and also in parts of Europe. “We must not walk away”, Brundtland concluded, “We need to confront it with renewed energy and commitment.” Alan McGregor
In-vitro fertilisation outcomes must be reported
O
ne reason for setting standards for reporting the outcome of in-vitro fertilisation (IVF) treatment is to stop clinics from adopting reporting practices that enhance their success rates, said David Adamson (Society for Assisted Reproductive Technology, Stanford, CA, USA) at the 11th World Congress on In-Vitro Fertilisation and Human Reproductive Genetics (Sydney, Australia; May 9–14). In the USA, where reporting is strictly governed, proper controls over reporting allow a clinic’s suc cess rate to be defined, which can be helpful to patients when deciding where to get treatment. “In addi tion, clinics’ results can be evalu ated and best practice developed, and can provide a firm base for appropriate and strong regulation”, said Adamson. Control of reported data is neces sary because some groups, such as the US health-maintenance organi sation, have removed IVF providers who have poor treatment success rates from their lists, and because data have sometimes been inappro priately interpreted, said Adamson.
1774
“It is also important to monitor reported data because this [IVF] is a complex subject and misinterpre tation . . . is easy”, he added. Adamson said the importanat aspects to responsible reporting of IVF outcomes were why reports should be made, who should be included in collecting what data, and how data should be collected. Also, only necessary, universal, val idated, and timely data should be
recorded, he added. Currently, all US IVF clinics must report specific information, subject to onsite independent vali dation, each year to the Centers for Disease Control and Prevention (CDC). The CDC consults with consumer and professional bodies in developing the reporting mecha nism, said Adamson. Peter Harrigan
Australia tackles surrogacy issues -
-
-
-
A Western Australian Parliamentary Select Committee has recommended changes to their Human Reproductive Technology Act in a report published on May 14. The committee agreed that surrogacy should be permitted where 100% of the genetic material belongs to the commissioning couple, or where the embryo is created from a donor egg and the commissioning father’s sperm, but recommended that surrogacy using the surrogate’s egg and donor sperm should not be permitted. Invitro fertilisation surrogacy arrangements using a donated embryo were regarded as permissible. It was also recommended that surrogacy arrangements should be non-commercial; that counselling should be mandatory for all parties, including the surrogate’s partner and children; and that selection criteria should be developed for potential surrogate mothers. It was recommended that counselling before posthumous use of embryos should be mandatory. Most of the select committee supported posthumous use of embryos by a surviving partner where there was written consent by the deceased partner and considered that access to treatment should not be available if either party was older than age 55 years. The committee suggested that another review be done in 5 years. Bebe Loff, Stephen Cordner
THE LANCET • Vol 353 • May 22, 1999