The BMJ Today: Will the mitochondrial horse fall at the last hurdle?

Suddenly last week, the Church of England and the Catholic Church weighed into the debate about mitochondrial replacement—the use of the mitochondria from a healthy woman to replace the faulty mitochondria in the egg of a woman wishing to have a baby.

The Churches’ message was dramatic: by voting on this issue in the House of Commons on Tuesday (3 February), the UK was possibly rushing into approving a dangerous new technique without enough research and consultation.

The Churches failed entirely to point out just how many consultations had already taken place. Since the potential of mitochondrial replacement was first recognised in 2000, the Human Fertilisation and Embryology Authority has conducted three scientific reviews on the procedure and an 18 month consultation exercise with the public, the Nuffield Council on Bioethics conducted an ethical review in 2012, and the Commons Science and Technology committee held an evidence session in 2014. The Department of Health has run a public consultation on draft regulations. In every case, public opinion had supported the idea and the safety of the technique has been confirmed.

Today The BMJ publishes a news story pointing out how many women could benefit from the technique. A research article in the New England Journal of Medicine, summarised in The BMJ, says that 2473 women are at risk for transmitting mitochondrial DNA in the UK and the average number of births per year among the risk group is 152.

You wonder just how many more inquiries the Churches require. It took the Church of England almost 2000 years to agree to ordain women. Are their procedures just a little slow for the women anxiously waiting for the chance to have a healthy child?

On a different topic, another news story on today raises the question: when is population screening not population screening? From the government’s response to the health select committee’s report on screening, the answer seems to be when it is a “risk awareness, risk assessment, and risk management programme.”

The issue at stake in this case is the scheme to provide five yearly checks in primary care for people aged 40 to 74. The government seems to have discovered that if you introduce a new type of screening, but call it something else, you can avoid the annoyance of having to get your initiative approved by the National Screening Committee. That pesky committee pedantically insists on considering whether the scheme is evidence based. In this particular instance, the health select committee last year said that these checks had been introduced “without a rigorous evidence base.”

In its reply published in The BMJ today, the government says that although it agrees that a strong evidence base is important for new initiatives, the health check programme was not designed as a screening programme but as “a risk awareness, risk assessment, and risk management programme.” So, it did not have to go to the screening committee. So I hope that’s now clear.

Annabel Ferriman is senior news editor, The BMJ.