It has not occurred to European governments that pregnancy is a private matter

Universal European regulations for fertility treatment are needed to reduce legal differences between countries that are encouraging “reproductive tourism”, one of the Continent’s most senior IVF specialists said yesterday. National laws banning infertility therapies that are available elsewhere in the European Union are denying couples the chance to start a family and driving others to seek expensive treatment abroad, according to Professor Paul Devroey, of Brussels Free University.

Many assisted reproduction techniques that are considered to be best practice in some EU member states are heavily restricted or outlawed in others, and safety measures introduced in parts of Europe are contravened routinely elsewhere. Germany and Italy, for example, ban embryo-freezing, egg donation and embryo-screening for inherited diseases, forcing couples who need these services to pay for treatment in countries that permit them, such as Britain, Spain and Belgium.

Thousands of British couples who require donated eggs have become fertility tourists, travelling to Spain, Cyprus and Eastern Europe. Britain has a long waiting list, mainly because donors can be paid a maximum of just 250 pounds for expenses and lost earnings.

Rules on the maximum number of embryos that can be transferred to a woman’s womb also differ widely, despite the scientific consensus that the safest policy is to limit implants. In Britain, Scandinavia and the Low Countries, only one or two embryos may be used, to prevent multiple births, by far the biggest hazard of IVF treatment. Germany and Italy insist that every embryo created is implanted, increasing that risk.

Professor Devroey, chairman of the European Society of Human Reproduction and Embryology (ESHRE), told The Times that there was an urgent need for uniformity based on the best scientific advice, to secure access to effective treatments and to protect patients. He is setting up a task force to compare legislation and to propose a basic set of standards, and he wants the European Commission and the European Parliament to consider how rules might be harmonised. “The human right to reproduction and access to assisted reproductive technology \ for infertile couples should be preserved in similar legislation throughout Europe as part of a unified strategy to address human infertility,” Professor Devroey said. “These laws should aim to ensure that ART treatment is safe, constructive and reimbursed. The reality, however, is that legislation varies greatly between countries in Europe. Some countries, such as Belgium and the UK, take a very rational and liberal approach to ART and implement practice guidelines or/and legislation in response to published data. In contrast, other countries appear to dismiss or misuse scientific findings, which may increase the risk to the mother or child.”

Speaking at State of the ART, a satellite meeting held before the ESHRE annual conference in Lyons, which opens today, Professor Devroey said he accepted that countries would want to set their own policies on controversial issues such as treatment for lesbians and single women. Similar standards should apply, though, when the scientific evidence was clear. “There is only one human body and human reproductive system,” he said. “It is quite astonishing that well-proven treatments are not allowed in some countries, some of which also have laws on embryo transfer that are not in the best interests of patients’ health. What this has done is to build medical tourism into a billion-euro market. It’s very sad for me to see patients coming to my clinic because their countries’ own laws are needlessly restrictive, and sadder still for the patients.”

Bill Ledger, of the University of Sheffield, said that he agreed with Professor Devroey’s sentiments but doubted whether EU action would be possible or desirable. “He is absolutely right that some countries have over-restrictive policies that are bad for patients, but I am not sure that going to the EU is the best way to resolve this,” Professor Ledger said. “It is hard to see politically how Germany and Italy will be persuaded to take another line, and once Brussels gets involved you never know what you will end up with. It could be that the more conservative countries will try to overturn the liberal systems we have in Britain, Belgium and the Netherlands, as they have attempted with stem-cell research.” The EU would do better to look into basic clinical standards for fertility treatment, so that IVF patients in every country could be assured of high-quality care, he said.

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HEALTHCARE AND LIFESPAN

Not as closely connected as many critics say

Health care actually has a fairly small effect on our health and life expectancy! This sounds silly to a lot of people. They know that life expectancy has increased dramatically in the last 100 years, and is better in the rich world than in poorer countries. They figure modern health care is responsible for this, and that without it, you would die young. This is not the case.

One way to separate out various factors is to look at history. According to the Census Bureau, white male life expectancy at birth in 1900 was about 48 years. It’s now about 76 years (28 year increase). For white women, it went from 51 years to 81 years (30 year increase). But remember that there was very little of what we'd call effective medicine in the early part of the century. According to Wikipedia, penicillin was not used to treat disease until 1942. What they had were public health measures, such as malaria and hookworm eradication, improved sanitation, improved water supplies and food supplies. Most people didn't have access to a doctor, and there wasn't much the doctor could do for you anyway. (read The Youngest Science, by Lewis Thomas).

Despite that, by 1940, life expectancy was at 63 years for men, 67 years for women. So 15 of the 28 years for men and 16 of the 30 years for women was due to public health measures, not any kind of advanced medicine. Even today, this is the main difference between rich and poor countries.

After 1940, antibiotics and vaccines become available, and going to a doctor becomes worthwhile. Primary care is the next tier of the medical system. It includes some prenatal care, giving birth in a (clean) hospital, treatment of infections, etc. Let's say that era goes to 1970. By then, male life expectancy is 68 and female is 75 years. So we've gotten another 5 years for men and 8 years for women from primary care (the extra gains for women are probably a result of reducing the risk of childbirth.)

That leaves 8 years improvement for men and 6 years for women since 1970, which covers the era of intense high-tech care in the U.S. All the expensive stuff, from MRIs to cancer treatments to organ transplants, is in this category (Wikipedia says that transplants routinely failed until the discovery of cyclosporine in 1970.) So of all the improvements we've had in life expectancy, public health and primary care (the cheap stuff) have been responsible for most of it.

This sounds surprising, but it should agree with your intuition. Most people are healthy most of their lives. Their mothers get a little prenatal care, they get some vaccinations, maybe some mild childhood ailments (infections, etc.), perhaps a broken bone. Then nothing much until old age. Sometime after age 60, they die of one of the big three – heart disease, cancer or stroke. None of these is particularly treatable even now. Half of all cancer patients survive less than 5 years, as do half of heart attack victims.

Much more here

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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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH INTERNATIONAL and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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