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Press releases Saturday 17 May 2008

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(1) Inject rational argument into embryo debate, says expert
(2) Top grades not always needed to become a doctor
(3) General practitioners filling the gap left by inadequate dental services, says doctor

(1) Inject rational argument into embryo debate, says expert
(Personal View: Can a cell have a soul?)
www.bmj.com/cgi/content/extract/336/7653/1132

In the week that the UK parliament debates controversial amendments to the 1990 Human Fertilisation and Embryology Act, Professor John Burn asks at what point a cell becomes a human.

Burn is Medical Director of the Institute of Human Genetics at Newcastle University, where some of the most controversial stem cell research takes place.

The fact that stem cells have a potential role in the treatment of incurable diseases such as paraplegia and Parkinson's Disease means that we should avoid erecting blanket legal barriers, writes Professor Burn.

Concerns about the misuse of funds, threats to the structure of the family, and the dangers of admixed (hybrid) embryos can all be adequately addressed without an act of parliament, he argues. Stem cell research is done in a highly regulated environment, with statutory bodies such as the Human Fertilisation and Embryology Authority (HFEA) having access to the requisite expertise. The authority has already proved its ability to reach reasoned conclusions on similarly touchy subjects.

But there is one argument against stem cell research that cannot be addressed by a committee, Burn says - the question of when human life begins.

The Catholic church's position is clear: from the moment of conception an embryo is a human being, entitled to full human status. It equates the deliberate generation of embryonic stem cells to murder. Like some of his predecessors, Pope Benedict XVI has declared that "ensoulment" might occur at conception. But, writes Burn, if souls are delivered, it is difficult to see how this could occur before 14 days. It is only then that the primitive streak forms, and a single embryo could be said to exist. Before this, the cells that make up the embryo could result in up to five identical embryos.

The Catholic church is more supportive of research on adult stem cells, but Burn says that recent research with induced pluripotent stem cells - adult stem cells which are made to act like embryonic ones - could be regarded as resulting in "instant ensoulment".

Burn also claims that the tabloid horror of admixed embryos (the cow-human hybrids) is misplaced. Adult stem cells are used, and "admixed embryos use tissue from the abattoir to preserve precious human eggs and advance laboratory research that offers real hope."

"Just as protests about cadaver organ donation were addressed rationally and led to the widespread acceptance that the definition of death could no longer depend on biblical interpretation, so medical need dictates that the origin of human individuality must be defined with similar pragmatic precision. A cell cannot have a soul", concludes Burn.

Notes to editors: *Nature 2008; 451: 141–6

Contact:
John Burn, Medical Director of the Institute of Human Genetics, Newcastle University, Newcastle, UK
Email: karen.bidewell@ncl.ac.uk

(2) Top grades not always needed to become a doctor
(Analysis: Widening participation in medicine)
www.bmj.com/cgi/content/short/336/7653/1111
(Editorial: Increasing diversity among clinicians)
www.bmj.com/cgi/content/extract/336/7653/1082

Top A-level results are not always necessary for students to succeed in medicine, according to the authors of a paper in this week's BMJ. Students with average grades, who come from economically and educationally deprived areas, can do well at medical school provided they have extra academic and pastoral support during their first two years.

Becoming a doctor has traditionally been seen as the preserve of the professional middle classes - over three quarters of conventional medical students come from this background. Yet it is now acknowledged that the UK needs more doctors who better represent the diverse social and ethnic population of the country. As such, widening participation initiatives have become an important component of most UK Higher Education Institutions.

The paper, written by the academics behind such an initiative at King's College London, analyses their success. The Extended Medical Degree Programme (EMDP) began in 2001. Its remit was to enable bright students from low-achieving state schools in Inner London to become doctors. Initially ten extra places were made available for these students each year and the first cohort graduated in 2007. To be accepted students needed to get CCC at A level, rather than the traditional AAB.

Students on the EMDP course are given an extra year of studying - the first two years of the traditional five year degree are spread over three - to allow for more academic and pastoral support.

Most of the students are the first in their family to go to university and come from different backgrounds from the majority of students. To help them adjust, EMDP students are also given extra support including an induction week, student mentors and personalised learning programmes.

Nine out of ten students so far accepted on to the EMDP programme are from ethnic minorities and just under a third (31%) from middle-class families. This compares with 51% and 76% respectively for students from "conventional" backgrounds.

The data shows that, despite the lower entry grades, the exam results of these students have been spread fairly evenly throughout the entire year group of 360-400 students. First time pass rates have generally been slightly lower for EMDP students, however in the clinical years (years 4-6) first time pass rates are identical for both conventional and EMDP students (93%). Of those who opted to do an intercalated BSc, 12% got a first, 76% an upper second and 12% a lower second, compared with 28%, 65% and 7% respectively among conventional students.

Over 200 students are now on this programme and doing well, so the authors say they can safely conclude that "medical students can succeed without AAB at A level" (as long as these results were obtained from a low achieving school) and as a result the widening participation programme is creating "a new type of doctor…[that] better reflects the social diversity of London's population."

In an accompanying editorial, Hugh Ip and Chris McManus discuss whether the more diverse population of doctors resulting from the widening participation initiative will better serve a diverse population of patients. They also question if the £190 000 spent each year on the EMDP programme is money well spent.

Contacts:
Analysis: Pamela Garlick, Senior lecturer in Medical Education, EMDP Course Director, Kings College London, UK
Email: pamela.garlick@kcl.ac.uk
Editorial: Hugh Ip, Student editor, BMJ Editorial, BMA House, London, UK
Email: hughip@gmail.com

(3) General practitioners filling the gap left by inadequate dental services, says doctor
(Letter: General practitioners are doing dentists' work)
www.bmj.com/cgi/content/full/336/7653/1088

A shortage of NHS dentists means that general practitioners (GPs) have been left to do dentists' work without adequate remuneration, argues a doctor in a letter in this week's BMJ.

An increasing number of patients are visiting GP surgeries with what are fundamentally dental problems, writes Alastair Bint from St Luke’s Surgery in Guilford, UK.

Dr Bint recorded a 1600% rise in the number of dental related consultations over the last 10 years in his own practice of over 10 000 registered patients.

Recent reports in the press have highlighted the continuing problem of patients being unable to register with an NHS dentist, or to see to a dentist out of basic working hours.

Despite the Minister of State for Health Services, Ben Bradshaw, advising people who cannot get dental treatment to go to their GP or primary care trust, there is no provision in the NHS contract for GPs to be compensated for dental work, he writes.

"Once again…GPs are left to pick up work that should be performed by other professionals without adequate remuneration", he concludes.

Contact:
Alastair Bint, St Luke's Surgery, Guilford, UK
Email: al@bint69.fsnet.co.uk

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