Going to work on an egg

Infertile couples can go to Robert Winston to have their IVF eggs screened for cancer. Lucy Hodges asks him how, with public debate on the ethics of this in an embryonic state, he can justify such a service.

The new Labour peer Lord Winston almost chokes on his buttered teacake when I tell him critics are raising objections to his screening of embryos for inherited forms of cancer and other diseases.

Don't people want the right to decide what should be done with their fertilised eggs, asks the 55-year-old eminent obstetrician and gynaecologist, as we take tea in the House of Lords tea room.

For couples who want a baby and are in danger of passing on cystic fibrosis or an inherited form of bowel cancer, he offers the chance to have a child without an inherited defect and eventually to eliminate a particular gene risk in that family. How can that be wrong? he wonders. "I think if you ask people who are well informed and not scared they would say this is perfectly moral." How can one justify preventing couples having the choice? "This is very silly," he adds.

Ennobled last year, Professor Robert Winston has been working magic with infertile couples since the early 1970s, when he came to prominence for his surgical skills. Using pioneering microsurgery techniques, he achieved stunning results in opening up blocked fallopian tubes, excising endometriosis and fibroids.

In the 1980s the first babies were born through in vitro fertilisation, whereby eggs are fertilised outside the mother's body and the resulting embryos implanted back into the womb. Winston promptly established the first National Health Service IVF clinic at the Hammersmith Hospital, London. Since then his research has become increasingly concerned with improving the quality of embryos.

For women who have given birth to healthy babies following his treatment, he is, indeed, a magician. Those who have been treated but have not conceived may have more mixed feelings (the success rate of IVF treatment is notoriously low). To his critics in the world of medical ethics, however, he is someone to be watched.

Richard Nicholson, editor of the Bulletin of Medical Ethics, believes Winston's latest work is an ethical minefield. "What is the point of going down the road of more and more sophisticated technological fixes which are inevitably very expensive and not going to be available to more than a small and select part of the population? Is this really a benefit for the population as a whole or for the scientists who find themselves capable of doing it?" He questions whether society should be trying to enhance the quality of human stock. Is this not the start of a slide down the slippery slope which leads to designer babies - those, say, with blue eyes and blond hair or with superior intellects?

Screening for cystic fibrosis is acceptable, according to Nicholson, because the condition is apparent before birth. But patients with muscular dystrophy die in their teens and those with the inherited form of bowel disease called familial adencamatocs polyposis do not develop the cancer until much later.

Moreover, he says, screening for an inherited form of breast cancer - which Winston is planning to do shortly - would not necessarily prevent a women getting breast cancer because 95 per cent of breast cancer is not genetically determined. Medical ethics experts are asking just where people like Winston want to stop. When is a genetic disorder sufficiently unimportant to cease to inspect fertilised eggs? What if some genes taken together predispose towards major depression in mid-life?

Winston rejects the "slippery slope" argument. You could argue that you should not be transplanting kidneys because you might be creating a trade in kidneys. You could argue that you should not be training surgeons because they might do more surgery than you want. You could argue for banning the motorcar on the grounds that some people drive too fast. "You don't go into medical practice for huge profit or massive self-esteem but because you want to help someone who is suffering from disease," he says.

He also rejects the cost argument - that embryo screening is ridiculously expensive - on the grounds that prevention of a disease is cheaper than treatment later in life. The cost of keeping a cystic fibrosis patient alive is high (Pounds 15,000 to Pounds 20,000), he points out, whereas the cost of screening an embryo is relatively low (Pounds 2,000).

Winston points out that the diseases he screened for are particularly horrific. They are mostly cancers of young people, they tend to metastasize and spread very rapidly, they are not very amenable to therapy and they often affect multiple organs completely unpredictably. The families he treats invariably have lost four or five members before the age of 40 with these cancers.

How can one justify denying these couples the choice of whether to have a child free of such a gene, he asks. It is for that and other reasons that the Hammersmith Hospital's ethical committee and the national ethical committee have approved the work. And that is why Parliament has no trouble with it, according to Lord Winston.

With embryologist Alan Handyside and geneticist Joy Delhanty, of University College, London, he has used a DNA amplification technique to isolate the gene which causes cystic fibrosis, the commonest single gene disorder in the United Kingdom. It is effective and very accurate, says Lord Winston. The first couple of babies were born in 1992 after screening.

Winston and his team are hoping shortly to help a couple whose offspring risk inheriting a form of bowel cancer. They have identified the gene and are ready to implant an embryo into the womb of the wife who carries the disease and who has five family members who have died of it.

In the next few months they think they can do the same for the breast cancer gene BRCA1 and for one of the genes which causes a brain cancer. A woman with the breast cancer gene, who has had a double mastectomy, and wants to have a baby free of it, has been identified for treatment.

An Orthodox Jew with a wife and three children, Winston is genuinely perplexed by why people should object to screening for inherited disease when such techniques actually prevent abortions. Although he recognises that this kind of work could lead to designer babies, he does not believe his screening is morally dubious. Nature destroys defective embryos anyway, he points out. Only one in five human fertilised eggs survives and becomes a baby.

"The commonest reason for embryos not surviving is because they're genetically defective," he says. "What we're doing is using a method of selection which enhances a natural one."

Educated at St Paul's School in London, and at Cambridge and London universities where he read medicine, Winston was not sure that he wanted to pursue a medical career. After four years' drudgery at the London Hospital, where he qualified as a doctor, he threw it in, set up his own theatre company and shot off to the Edinburgh Festival where he directed an award-winning production of a Pirandello play.

His 20-year-old daughter, Tanya, is doing what he would have loved to have done - a degree in drama. She rings him up frequently on his mobile telephone for help with her essays. Winston likes to tell the story of how she called him while he was in Greece, playing hookey from a medical conference. He was standing in blissful solitude by the Temple of Apollo when the phone went. "Dad," she said. "Tell me. Is spectacle an art form?" Winston's foray into professional dramatics was short-lived. Soon he was back in medicine and becoming interested in fertility at Hammersmith Hospital. There followed a prestigious Wellcome research fellowship, a visiting professorship at the University of Louven in Belgium, and a year at the University of Texas at San Antonio. He became a professor at the Hammersmith in the mid-1980s.

Asked what have been the high points of his life, he says his children have worked out best. Workwise, he got a great buzz from the instant celebrity that followed a conference in Argentina in 1974 where he presented the results of his microsurgical techniques. He made a film with a Hammersmith photographer which was "astonishingly seductive", he says. Hundreds of postgraduates from 80 countries flocked to the Hammersmith to learn.

In the 1980s he concentrated on improving IVF techniques. His latest interest is developing techniques to mature eggs outside the body. "That will revolutionise human reproduction," he says. "It could be the most important thing I have ever worked on."

IVF would be about 85 per cent cheaper, because you would simply take a needle biopsy of the eggs, mature them in a test tube and the woman would not need drugs or monitoring. That brave new world is at least five years off, Winston reckons.

As a recently appointed Labour peer, Winston has a new life as a politician, following in the footsteps of his formidable mother who was an independent councillor and later mayor of Southgate. His work informs his politics and vice versa. He believes in the values of New Labour, he says, and Tony Blair is a charismatic leader, underrated by the press.

"I have concerns about the health service, for example, in the universities," he says. "There's a very serious decline because of the underfunding. The latest cut emanating from this last budget is very serious. A 30 per cent cut in building and equipment is desperate. We're in a society that is going to have to spend more and more on science and technology and the big issue is that we have to build on our higher education."