'More pay' call for sperm donors

19 October 2010 Last updated at 20:22 ET By Adam Brimelow Health Correspondent, BBC News

Men who donate sperm for IVF should possibly be reimbursed more than women who donate eggs, a leading fertility campaigner has suggested.

Laura Witjens, who chairs the UK's National Gamete Donation Trust and has donated her own eggs, says most people are not aware of the "serious commitment" involved in sperm donation.

She argues it is wrong to see it as less worthy than egg donation.

But fertility experts say donating eggs is invasive and carries greater risks.

Fertility clinics are not allowed to pay for eggs and sperm, but they can compensate donors up to �250 for loss of earnings plus expenses.

That limit is about to be reviewed by the fertility watchdog, the Human Fertilisation and Embryology Authority, particularly for women, who have hormone treatment and an operation to take out the eggs.

The question of reimbursement is being debated at the Royal Society of Medicine later.

Ms Witjens argues that sperm donors, who are asked to avoid sex and alcohol for several months while making regular visits to a clinic, should receive "at least the same payment if not more than egg donors".

'Heroes'

In an article for the BBC News website's "Scrubbing Up" column, she says it is wrong that most attention is paid to egg donors who enjoy "elevated status", while sperm donors may be subjected to "jokes or smutty comments".

"Assuming [sperm donors] follow the guidelines, it means we're asking healthy men aged between 20 and 45 (and their partners) to have very limited sexual activity for months on end. This has a significant impact on their normal life," Ms Witjens writes.

"Just like egg donors, to the families these guys help, they are heroes. And that's something that deserves recognition from us all."

She acknowledges that donating eggs involves risks and is much more intrusive; 10 years ago she donated her own eggs for use in IVF treatment.

But Ms Witjens concludes that payment should not be based solely on medical risk, and that sperm donors should be rewarded for their "commitment, dedication and selflessness".

Many fertility experts disagree with higher reimbursement for sperm donors.

Dr Allan Pacey, a senior lecturer in andrology at Sheffield University, says he is personally uncomfortable with the debate over money, arguing that "the clue is in the name - donations".

But he says: "We have argued historically that women should be paid more because they take more risk."

'Woefully inadequate'

However, he agrees that sperm donors are not treated well enough. "In society we tend to sneer. That chips away at potential donors."

Sarah Norcross, director of Progress Educational Trust, also disagrees with the idea of offering more for sperm donors, arguing that women face a "much more intrusive procedure".

She said: "There's always a risk attached, much higher than for a man turning up and doing the business in a jar."

However she agrees that the level of compensation for men and women should increase, describing the current limit as "woefully inadequate".

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'Tipsy' alcohol gene discovered

19 October 2010 Last updated at 21:01 ET By Michelle Roberts Health reporter, BBC News

Experts say they have found a "tipsy" gene that explains why some people feel alcohol's effects quicker than others.

The US researchers believe 10% to 20% of people have this gene - called CYP2E1 - and that it may offer some protection against alcoholism.

That is because people who react strongly to alcohol are less likely to become addicted, studies show.

The University of North Carolina said the study aims to help fight addiction, not pave the way for a cheap night out.

Ultimately, people could be given CYP2E1-like drugs to make them more sensitive to alcohol - not to get them drunk more quickly, but to put them off drinking to inebriation, the Alcoholism: Clinical and Experimental Research journal reported.

Straight to the head

Lead researcher Professor Kirk Wilhelmsen said: "Obviously we are a long way off having a treatment, but the gene we have found tells us a lot about how alcohol affects the brain."

Most of the alcohol people consume is broken down in the liver, but some is metabolised in the brain by an enzyme which the CYP2E1 gene provides coded instructions for.

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Alcoholism is a very complex disease, and there are lots of complicated reasons why people drink. This may be just one of the reasons"

End Quote Professor Kirk Wilhelmsen, who led the research

People who have the "tipsy" version of CYP2E1 break down alcohol more readily, which explains why they feel the effects of alcohol much quicker than others.

The researchers made their discovery by studying more than 200 pairs of students who were siblings and who had one alcohol-dependent parent but who did not have a drink problem themselves.

They gave the students a mixture of grain alcohol and soda that was equivalent to about three average alcoholic drinks. At regular intervals the students were then asked whether they felt drunk, sober, sleepy or awake.

The researchers then compared the findings with gene test results from the students.

This revealed that CYP2E1 on chromosome 10 appears to dictate whether a person can hold their drink better than others.

Professor Wilhelmsen says more research is now needed to see if the findings could be used to make new treatments to tackle alcohol addiction.

"Alcoholism is a very complex disease, and there are lots of complicated reasons why people drink. This may be just one of the reasons," he added.

Don Shenker, of the charity Alcohol Concern, said that, in most cases, alcohol abuse stemmed from social problems, with alcohol used as a prop.

Professor Colin Drummond, an expert in addiction at London's Institute of Psychiatry, said it was likely to be combination of genes and environment.

"It is well recognised that alcohol dependence runs in families," he said.

He said research suggests having an alcoholic parent quadruples a person's risk of developing a drinking problem.

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Organ donation errors 'avoidable'

19 October 2010 Last updated at 06:35 ET By Michelle Roberts Health reporter, BBC News

An independent review finds avoidable errors led to the wrong organs being removed from 25 NHS donors in the UK.

Sir Gordon Duff, who led the review, says the blunder was due to faulty computer software used by UK Transplant to record donor wishes.

As many as 800,000 people on the UK donor register may have had their preferences about which organs they wished to donate recorded incorrectly.

He said new measures should avoid another error occurring.

Sir Gordon praised the actions already taken by NHS Blood and Transplant (NHSBT) to safeguard the system.

But he said in his report that the longer-term solution would be to enlist the help of experts to create a more secure, interactive system with better data verification and cross reference functions.

With over 17 million registrants, there is a growing need for the register to become more interactive, he said, and urged the NHSBT to have a redesign "as soon as resources allow".

The error originated when faulty data conversion software was used to upload data on donation wishes from the Driver and Vehicle Licensing Agency (DVLA) when it moved to a new computer system.

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We would like to take this opportunity to reiterate our unreserved apologies to the families of those people"

End Quote NHS Blood and Transplant

The issue only came to light in 2009 when NHS Blood and Transplant started to write to donors to check their organ donor preferences in the event of death - some withhold consent for certain parts of the body like the eyes, for example.

Many donors wrote back to say their information was incorrect.

Regrettable

Sir Gordon Duff said: "People who generously agree to donate their organs should be reassured that the error has been dealt with effectively and that steps have been taken to minimise the risk of it happening again."

Public health minister Anne Milton said: "Organ Transplants are vital and I know that NHS Blood and Transplant will make sure such a situation never arises again."

NHSBT said it sincerely regretted that the error was not uncovered earlier and that the donations of 25 individuals were affected by it.

A spokesman said: "We would like to take this opportunity to reiterate our unreserved apologies to the families of those people.

"After discovering the error, the NHSBT Board carried out its own investigations resulting in a detailed remedial action plan.

"We accept in full the recommendations of Professor Sir Gordon Duff, which will contribute significantly to strengthening the Organ Donor Register and public confidence in it as a way to record organ donation wishes.

"Since the error related to the way in which we received data from one of our partners, our immediate focus has been to take forward those actions that relate to our working arrangements with partner organisations."

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Ex doctors' leader denies claims

19 October 2010 Last updated at 06:57 ET By Jane Dreaper Health correspondent, BBC News

A surgeon and ex head of the British Medical Association has denied putting representing doctors above patients.

James Johnson is facing a General Medical Council hearing over operations on 14 patients in Cheshire.

He is also alleged to have accidentally struck a needle into the forehead of a female doctor who was assisting him.

He told the hearing he did the same amount of surgery as his colleagues - despite working a "100-hour week most of the time" to include his BMA duties.

Time-consuming

Mr Johnson told the GMC panel in Manchester: "It was certainly a busy life.

"But colleagues at Halton hospital were used to my rather unusual way of life.

"I always made myself available. We had a well-honed system for dealing with problems.

"The work I did for various organisations was very time-consuming, but my first loyalty was and is to my patients.

"If I had to choose between them, without the slightest shadow of a doubt, I would have chosen the clinical work, which I always found rewarding and highly satisfactory."

Mr Johnson was BMA chairman from 2003 to 2007, when he resigned amid a row about a controversial new system for allocating junior doctors to training posts.

The panel has heard claims that the stresses on his time meant his patients missed out on care.

He was said to have behaved "like a caricature of surgical arrogance".

Mr Johnson, who has been a vascular surgeon since 1985, denies this and is continuing to give evidence in his defence.

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Scenes of nature 'reduces pain'

19 October 2010 Last updated at 03:43 ET By Dave Lee BBC World Service

Cancer patients who have to endure excruciating procedures on a daily basis may be able to lessen their pain - by being transported to Zambia.

The patient need not even leave their bed.

Just simply showing relaxing pictures of idyllic scenes and playing out relaxing sounds at a patient's bed is enough reduce the feeling of pain for many patients.

This is according to researchers from Johns Hopkins University in Baltimore, United States.

They set up a series of tests analysing patients undergoing bone marrow aspiration and biopsy (BMAB) - known to be a particularly painful form of cancer treatment.

A large needle is inserted into the back of the pelvic bone and bone marrow is drawn out. It can sometimes take up to ten minutes, and is often performed with just a local anaesthetic.

For some cancer sufferers, BMAB is a regular unwanted experience - and techniques such as hypnosis or sedation have been tested to try and help patients deal with the pain.

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However, the researchers believe they have come up with a cheap, inexpensive way of making painful procedures like BMAB more bearable.

"We wanted to find a way to improve their experience," explained Noah Lechtzin from the department of medicine at Johns Hopkins University in Baltimore.

"So we did a study in which patients were assigned to either standard care, to have the procedure done with a nature scene and accompanying nature sounds, or a city scene and city sounds.

"We measured pain during the procedure."

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Our scene was a very open picture that had running water, the sounds had birds chirping and wind rustling through trees"

End Quote Noah Lechtzin Johns Hopkins University

The nature scene consisted of typically relaxing images, such as Victoria Falls in Zambia, painted onto bed curtains surrounding the patient as he or she is being treated.

The city scene had pictures of your average urban environment. Busy streets, people rushing - an altogether more stressful experience.

To add to the atmosphere and help with the process, the nature scene added sounds of birds chirping and wind rustling through trees was played to the patient through headphones.

For the city scene, the noise of traffic was played instead.

The found these two simple additions to the hospital environment changed the way patients reacted to the invasive treatment.

Pain Scale

The severity of pain was measured using a ten point scale known as the Hopkins Pain Rating Instrument. Before and after a procedure, patients are asked to indicate how uncomfortable they felt.

Anything above a four is classed as moderate to severe pain.

A control group - which had neither nature nor city scenes - on average marked BMAB as 5.7 on the pain scale.

But, those patients exposed to the nature sounds and images recorded an average of 3.9 on the pain scale - a significant reduction.

The city scene had no significant effect on the ranking - patients found the treatment just as painful.

This, Mr Lechtzin says, shows that the reduction in pain is not simply just a case of distracting the patient.

"I certainly do think distraction must play a role. But there is a lot of thought that there's specific elements to nature that people relate to and have particularly a soothing effect."

He insists that the choice of picture is very important if the theory is to work to its full potential.

"I think there are certain elements of nature that are beneficial and others that could be frightening.

"You wouldn't want to have rocks that potentially dangerous animals could hide behind, whereas our scene was a very open picture that had running water, the sounds had birds chirping and wind rustling through trees - so I think there are certain elements that are helpful."

His hope now is that hospitals will see these findings as a way of cheaply and easily helping patients deal with BMAB and other painful experiences - even if by just adopting the idea of displaying a particular picture.

"It's a large mural that can hang on a hospital curtain, it can be wheeled on a stand from bed-to-bed. Fairly inexpensive, doesn't require any training and is easy to use."

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Fracture warning over bone drugs

18 October 2010 Last updated at 20:24 ET By Michelle Roberts Health reporter, BBC News

US regulators are warning patients that drugs used to protect brittle bones may increase fracture risk in rare cases.

The Food and Drugs Administration (FDA) says all drugs in the bisphosphonate class must carry an alert on their label about this unusual side effect.

They say patients should keep taking the pills unless they are told by their doctor to stop.

In the UK, only one bisphosphonate drug - alendronate - carries the warning but regulators are reviewing this decision.

Nearly three million people in the UK have osteoporosis, a condition that makes the bones brittle and causes about 230,000 fractures a year.

Bisphosphonates are given to more than half a million of these patients in a bid to strengthen their bones and reduce their risk of a fracture.

But experts are becoming increasingly concerned that the drugs may cause the very thing they are trying to prevent after finding a link between their use and an unusual type of leg fracture.

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At present it is uncertain whether these fractures are directly related to treatment but an association has not been excluded"

End Quote A spokesman for the National Osteoporosis Society

The FDA says it is not clear whether bisphosphonates are the cause of these thigh bone breaks, but they are concerned enough to tell manufacturers to add warnings to medication packets.

FDA medical officer Theresa Kehoe said they would continue to monitor the safety of the drugs, adding: "In the interim, it's important for patients and health care professionals to have all the safety information available when determining the best course of treatment for osteoporosis."

The FDA says patients should keep taking their medication unless they are advised by their doctor to stop.

Under review

The UK's drug regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), said it had begun to look at the possible increased risk of fractures in patients taking bisphosphonates in case it was an effect common to all members of that drug family, not just alendronate.

A spokeswoman said: "The committee will now review all available data thoroughly, including published data, non-clinical and clinical data, and post-marketing reports, to clarify whether atypical stress fractures are a class effect of bisphosphonates, and will assess their impact on the balance of risks and benefits of these medicines."

A spokesman for the National Osteoporosis Society said: "At present it is uncertain whether these fractures are directly related to treatment but an association has not been excluded.

"Bisphosphonates slow down the rate at which bone is destroyed and replaced, by reducing the activity of osteoclast cells that break down bone.

"Although this is a useful process to prevent bone loss and fractures, there are concerns that over a prolonged period of time, this may result in bones becoming 'older' and more brittle."

He said it should be remembered that these unusual fractures are rare and that in the vast majority of patients the benefits of treatment will far outweigh the risks.

A recent study, published last month in the British Medical Journal, linked bisphosphonate use to cancer of the gullet.

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