Wednesday, August 01, 2007

Shortsighted British attitude to IVF

If a country wants to keep its population up, it should promote IVF

INFERTILITY is normally seen as a private matter. If a couple are infertile and wish they were not, that is sad. But there is understandable resistance in many countries to the idea that treatments intended to deal with this sadness--known collectively as assisted reproductive technologies, or ARTs--should be paid for out of public funds. Such funds are scarce, and infertility is not a life-threatening condition.

However, two papers presented to the "State of the ART" conference held earlier this month in Lyon argue that in Europe, at least, there may be a public interest in promoting ARTs after all. The low fertility rate in many of that continent's more developed countries means their populations are ageing and shrinking. If governments want to change this, ARTs--most significantly in-vitro fertilisation (IVF)--could offer at least part of a way to do so.

As the conference heard, IVF does seem to be keeping up the numbers in at least one country. Tina Jensen of the University of Southern Denmark has just finished a study of more than 700,000 Danish women. She found that young women in Denmark have a significantly lower natural conception rate than in past decades. That is partly, but not entirely, because they are having their children later in life. The rest of the cause is unknown, though reduced sperm quality in men may be a factor.

Whatever the cause, she also found that the effect has been almost completely compensated for by an increasing use of ARTs. Denmark's native population is more or less stable, but some 3.9% of babies born there in 2003 (the most recent year for which figures are available) were the result of IVF. The comparable figure for another northern European country, Britain, was 1.5%. Without IVF, then, the number of Danes would be shrinking fast.

That it is not may have something to do with the fact that in Denmark the taxpayer will cover up to six cycles of IVF treatment. In Britain, by contrast, couples are supposed to be entitled to three cycles. In practice, many of the local trusts that dish the money out do not pay for any cycles at all.

Jonathan Grant, the head of the Cambridge branch of the Rand Corporation (an American think-tank), believes this is shortsighted. His paper showed that if Britain supported IVF at the Danish level then its birth rate would probably increase by about 10,000 a year. The cost of offering six cycles to couples (and doing so in practice, rather than just in theory) would be an extra GBP250m-430m ($500m-860m) a year. That is not trivial, but Dr Grant reckons it is cheaper than other ways of boosting the birth rate.

Some countries, for example, have tried to bribe women into having more children by increasing child benefits. According to his calculations, raising such benefits costs between GBP50,000 and GBP100,000 a year for each additional birth procured. Ten thousand extra births each year would thus cost between GBP500m and GBP1 billion. There are, of course, some disadvantages to promoting IVF. In particular, women who use it tend to be older than those who conceive naturally, and that can lead to congenital problems in their children. But if the countries of Europe do wish to keep their populations up, making IVF more widely available might be a good way of doing so.


NHS tells woman of 108 told to wait 18 months for hearing aid

A woman aged 108 has been told she must wait 18 months before the Health Service will give her the hearing aid she needs. Former piano teacher Olive Beal, one of the oldest people in Britain, has poor eyesight and uses a wheelchair. The delay could mean she will be unable to communicate and listen to the music she loves.

Now her family have said that realistically Mrs Beal is unlikely ever to receive the digital hearing aid that will save her from isolation. The one-time suffragette is one of hundreds of thousands of older people made to wait up to two years and sometimes more for modern digital hearing aids that make a dramatic difference to their ability to hear and communicate.

The case of Mrs Beal comes just a few days after the Mail revealed how another centenarian, Esme Collins, has been threatened with eviction from the nursing home where she has lived for ten years in a dispute between home owners and the local council over her fees. The Daily Mail's Dignity for the Elderly campaign has highlighted the way the elderly are made to pay high bills while their needs and interests are sidelined in the system meant to care for them.

Mrs Beal, who lives in a care home in Deal in Kent, has used an old-fashioned analogue hearing aid for the last five years. She has now been assessed as needing a more modern digital hearing aid which cuts out background noise and makes it easier to hear conversation or music. These cost around 1,000 pounds on the private market. But Eastern and Coastal Kent Primary Care Trust have told her family she must wait 18 months before she gets one on the NHS. By then Mrs Beal will be aged 110. She said yesterday: 'I could be dead by then.'

Her grand- daughter Maria Scott, 52, said: 'I spoke to her doctor some time ago about getting her a new hearing aid, as the existing one did not seem to be working for her. 'After a hearing test they said, "Yes, she does need a digital hearing aid, but there is an 18-month waiting list". 'I would have thought they would take her age into account as she probably has not got 18 months to wait. 'Olive worked hard from the age of 16 to her late 60s and paid taxes. She has been healthy all her life and lived with her daughter until 15 years ago - she has never sponged off the state. 'Her eyesight is falling, and if she cannot hear then she will be isolated from the outside world. 'Her analogue hearing aid does not filter out background noise so it makes it very difficult for her to hear clearly. But the digital one would allow her to hear people talking to her and to CDs. She loves music hall numbers.'

Mrs Beal went to school in London with Christabel Pankhurst, daughter of suffragette leader Emily, and helped at suffragette demonstrations. She brought up four children but only her eldest son, now in his eighties, survives. Her youngest son was a World War Two soldier killed in Normandy on the day after the D-Day landings. She was widowed 45 years ago.

Donna Tipping of the Royal National Institute for the Deaf said: 'I am afraid this is a common problem. 'In some parts of the country waiting times are more than two years, which is shocking. 'The new digital hearing aids can really transform people's lives. 'It is an issue of quality of life, with isolation, frustration and withdrawing from society caused by loss of hearing, and it is sad because this is reversible.'

A spokesman for Eastern and Coastal Kent Primary Care Trust said: 'We are reducing waiting times. 'The priority is given to patients who do not have an existing hearing aid, but we accept our service needs improving. We apologise to any patient kept waiting for a new or replacement hearing aid.'



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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