Thursday, January 18, 2007


The bureaucrats are trying to justify their existence -- and how better to show your wisdom than by persecuting success? In a non-envious world they would be bending over backwards to help this guy rather than trying to trip him up with paperwork.

Two IVF clinics run by Britain's most successful fertility doctor were raided yesterday by regulators and police following allegations that he treated patients without a valid licence. Inspection teams from the Human Fertilisation and Embryology Authority (HFEA) were granted a warrant to search the two London clinics run by Mohammed Taranissi to determine whether he has committed a criminal offence.

Mr Taranissi, whose personal wealth is estimated at 38 million pounds, operates the Assisted Reproduction and Gynaecology Centre (ARGC) and the Reproductive Genetics Institute (RGI). The ARGC has long topped league tables for IVF success rates and has an active licence. The licence held by RGI has expired. If there is evidence that he treated patients illegally he could become the first doctor to be prosecuted. The teams are also investigating allegations about the types of therapy he recommends and the information given to patients.

Mr Taranissi vigorously denied any wrongdoing and said that he had co-operated fully with the inspections. He accused the HFEA of changing its procedures to refuse the RGI a licence. The only patients treated since its application for renewal was turned down were seen with the authority's knowledge and approval, he said.

Angela McNab, chief executive of the HFEA, said: "Since January 2006, the RGI has not had a licence. Providing treatment in a centre which does not have a licence is potentially a criminal act." The HFEA needed a warrant because the RGI's licence had run out and the regulator did not have an automatic right to inspect it. The RGI's licence expired in December 2005, but for the first six months of 2006 it operated under "special directions" from the HFEA.

In June, Mr Taranissi was offered a three-year licence, on condition that he transfer no more than two embryos to patients aged over 40. He accepted the offer, but indicated that he wished to make representations about the condition. The HFEA interpreted this as a refusal of the licence. The offer was then withdrawn.

Mr Taranissi said that he then stopped taking new patients at RGI and finished treating patients whose cycles had begun. This was done with the knowledge and approval of the HFEA, he said. He told The Times: "It is very odd the way they have portrayed the licence situation. All of a sudden, they said to me because you have made representations, you have effectively refused the licence. "There is no issue of patient safety here, it is about the interpretation of a signed paper. It is different from a backstreet clinic, where there is a very serious issue of patient safety."

The HFEA said that its action was taken independently of allegations made against Mr Taranissi by the BBC One Panorama programme last night. It claimed that a young undercover reporter had been offered IVF at the ARGC even though neither she nor her partner had a history of infertility. Mr Taranissi said that the BBC failed to report visits by three other reporters who were given appropriate advice, and that the 26-year-old reporter had been seen by a junior doctor no longer with the clinic. He said that her notes indicated that the doctor had discussed options including natural conception with the woman and that his comments had been taken out of context.


More background:

The charity Infertility Network UK was due to spend yesterday compiling a report for the Department of Health into the inconsistent availability of in vitro fertilisation (IVF) treatment on the NHS. Instead, it spent the day handling a torrent of calls from worried patients who had seen a BBC Panorama programme questioning the propriety of the man said to be the most successful IVF technician in Britain, the private practitioner Mohammed Taranissi.

Which is a shame, because the muddle of treatment on the NHS is a far greater scandal than the continued operation by Mr Taranissi of a private clinic whose licence was under review. And under review not because he had done anything wrong, but because the Human Fertilisation and Embryology Authority (HFEA), the regulatory body for IVF clinics, had suddenly reduced the number of embryos Mr Taranissi was allowed to transplant, and he had objected.

Women over 40 are allowed to have three embryos transplanted during IVF; the HFEA wanted Mr Taranissi to transfer no more than two. Because twins and triplets are far more likely to have health problems than lone babies, the HFEA wants to encourage people away from multiple embryo transfers. About one in four IVF pregnancies produces twins, more than ten times the rate for natural conceptions. Half are born prematurely, with low birth weight, and subsequently run a much higher risk of cerebral palsy (18 times as high in the case of triplets). Neonatal and first-year care for twins and triplets is expensive for the NHS.

There is a public policy issue worth debating here, but the HFEA has not had that debate publicly, and it isn't official policy yet, so what right it had abruptly to curtail Mr Taranissi's freedom to operate is unclear. Those who know a lot more about the sector than I do say that the HFEA is suspicious of Mr Taranissi's success rates and have long suspected him of fiddling his figures or some such. The surgeon's friends insist his success rate is due to his absolute dedication and in particular his willingness to implant embryos at precisely the correct moment, whether that be 3am or Christmas Day.

The other allegation against Mr Taranissi's clinic is that IVF was inappropriately offered to a 26-year-old who had tried for only a year to conceive. The clinic says the doctor's comments were taken out of context by the BBC, which has refused to show them unedited tapes. It cannot be pure coincidence that the HFEA raided Mr Taranissi's clinics on the day that Panorama was due to broadcast its allegations. The HFEA was pandering to the cameras; sick behaviour from an unelected regulatory authority that appears to be out of its depth.

I could argue at length about the costs of private IVF treatment, success rates (23.6 per cent for women of 35-37, just 10.6 per cent at 40-42), proper regulation and the social engineering it represents - babies on a plate for people wealthy enough to afford them - but that would be missing the point here. The real scandal is in NHS units up and down the country. Three years ago the Government said that all infertile couples where the woman is under 40 would be offered one cycle of IVF within a year, as a first step towards implementing official guidelines that stated that three cycles of treatment should be offered. Research by the National Institute for Health and Clinical Excellence (NICE), which drew up the guidelines, showed that the cost per live birth of IVF rises from o12,000 when the woman is 24 years old to 13,000 pounds if she is 35, just over 20,000 at 39 but 38,000 at 42. Hence the age 40 cut-off.

But, surprise surprise, what the Government promised hasn't happened. Local health managers have interpreted the guidelines in wildly different ways. A year ago a survey by NICE found that only 40 per cent of primary care trusts would confirm that they even offer IVF treatment. Those that do offer it have waits of up to five years and a bewildering array of conditions that the patient must meet.

Research carried out by Infertility Network UK two years ago, and now being updated by them for the Department of Health, found, for instance, that in Durham you must wait four or five years, have a body mass index not greater than 30 and have no surviving children in your current relationship, before you are allowed IVF treatment on the NHS. Thames Valley will not treat a woman unless she is 36 and has never paid for any IVF treatment privately. In Norwich you have to have a body mass index no more than 34, no children from a previous relationship and must be a couple who have lived in Norfolk for at least two years. In Southampton City there are no social eligibility criteria; in North Dorset you must have been in a stable relationship for at least three years. In Rowley Regis and Tipton there must be no children on the maternal side; in Mendip there must be no children living with the couple and "no access to children from previous relationship". And in Cherwell Vale the couple must be non-smokers.

There is an astonishing degree of social manipulation going on in a complicated postcode lottery five years after the Prime Minister promised couples could expect "the same level of high-quality services" for IVF wherever they lived. Some services are being cut: Luton has stopped funding new fertility treatment for now, and York is considering doing the same.

And then, of course, if you do get your treatment paid for, there are all the pitfalls of sloppy NHS service to negotiate: lost X-rays, long queues, rude receptionists, dismissive doctors. It must be particularly painful to be treated to the NHS's special brand of production-line treatment when you are in the sensitive process of trying to get your own little production line moving. So the popularity of Mr Taranissi's and all the other private IVF clinics is easily explained. But what a pity Panorama couldn't find the time to investigate that



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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