JANUARY 30, 2007
VOLUME 4 NO. 2

POLICY & POLITICS

Reproduction agency appointments spark controversy

Rising din of political wrangling threatens to drown out medical concerns


Assisted Human Reproduction Canada board of directors

-Dr Elinor Wilson (president), former CEO of Canadian Public Health Association

-Dr John Hamm (chair), former premier of Nova Scotia (PC) and family physician

-Dr Joseph Ayoub, hemato-oncologist

-Dr Franìoise Baylis, bioethics professor

-Roger Bilodeau, lawyer and former New Brunswick Deputy Minister of Justice (PC)

-Dr Albert Chudley, geneticist and pediatrician

-Theresa Kennedy, VP-Corporate Communications of Resverlogix biotech company

-Dr David Novak, Jewish Studies professor and rabbi

-Dr Suzanne Scorsone, Archdiocese of Toronto director of research and social anthropology PhD

-Barbara Slater, Ontario public health consultant

"No science is immune to the infection of politics and the corruption of power," wrote famed mathematician and philosopher Jacob Bronowski in 1971. Over 30 years later, Canada is proving Dr Bronowski correct: the dispute over Health Minister Tony Clement's appointments to the Assisted Human Reproduction Canada (AHRC) board of directors has largely left the purview of medicine and entered the realm of politics.

CHIMERIC UNITY
Established in principle in January 2006 in Vancouver, shortly before the federal elections, AHRC is mandated to "protect and promote the health and safety, human dignity and human rights of Canadians who use or are born of assisted human reproduction technologies, and to foster ethical principles in relation to assisted human reproduction and other related matters under the [Assisted Human Reproduction] Act," according to the description that accompanied Mr Clement's press release.

"Clearly the board could be very influential," said Dr Edward Hughes, president of the Canadian Fertility and Andrology Society. "The agency was established to control all areas of reproduction — not just fertility clinics but also clinicians in the community — so it is very broad-reaching."

The 2004 AHR Act deals with three important issues, according to Dr Hughes. It prohibits 10 ethically questionable activities like the creation of chimeras (part-human, part-animal); it also bars offering payment to sperm donors. The Act also safeguards patient privacy by banning the gathering and centralization of data on those using fertility services. Dr Hughes, who did not apply to be considered for board membership, stressed the difficulty of assessing the board's stance on any of those issues before it has even met.

Dr Hughes pointed out that stem-cell research is not prohibited by the Act nor will it be governed by the AHRC board, although the board could exert some influence in that matter. The board could also potentially recommend that governments fund elective single embryo transfer IVF (in vitro fertilization), which Dr Hughes said would be a positive change in improving access to safer alternatives to infertility treatments like ovulation induction therapy — the likely culprit, he said, of the sextuplet birth in Edmonton in early January that has already resulted in one of the infants dying.

The board will likely consider regulations on pre-implantation genetic diagnosis (PGD), a screening technique to select healthy embryos to implant that is already seeing limited use in Canada.

UNDER THE MICROSCOPE
Asked if he had been surprised at the appointments, Dr Hughes said, "Yes, deeply surprised." He had expected there would be representation of patients, clinicians, counsellors, researchers and nurses. "They are all important and have insight and experience that the board members won't have."

Beverly Hanck, executive director of the Infertility Awareness Association of Canada, recently wrote, "The current makeup of the board is so narrow in outlook and conservative in nature that the regulations will probably be too restrictive."

The prevailing criticism is that too many of the board's members have political and philosophical biases, as Ms Hanck wrote. Many of the people appointed would not have been approved by the equivalent British agency, which excludes anybody who was politically active in the preceding five years — a model that Dr Hughes favours.

Among the problems cited by critics are board member Dr Joseph Ayoub's 2005 speech at an anti-abortion conference; Franìoise Baylis's public support for a ban on using unfrozen embryos for stem-cell research; Dr Suzanne Scorsone's 1993 testimony against terminating pregnancies after prenatal diagnoses; and David Novak's support of the United States' ban on stem-cell research, all of which were reported in late December in the Globe & Mail.

Dr John Hamm, the former Tory Premier of Nova Scotia who chairs the board, told the Halifax Daily News that he and his colleagues will be open-minded and defended the board members' place on the board. "I don't think that the duties of the board necessarily require all of the experts in the world to be involved at the board level," he said.

AHRC board president Dr Elinor Wilson refused to comment for this story beyond saying that there "has been a lot of misinformation" in the media about the board and any politics behind the appointments, and said that speaking about the board before its first meeting would be premature.

FERTILE GROUND
As the controversy began to heat up, moving quickly in late December and early January from a simmering argument into a rolling boil of a political battle, the political rhetoric picked up. The criticism reached new heights on January 11 when two Liberal MPs — Health Critic Ruby Dhalla and former Public Health Minister and physician Carolyn Bennett — held a news conference in Ottawa to demand additions to the board, which has only filled 10 of its 13 spots. "This government is driven by right-wing ideology instead of trying to achieve public policy that meets the needs of Canadians... their tremendous insensitivity and lack of compassion is shameful," Dr Bennett said.

The Liberals have asked that the three remaining seats on the board go to a patient representative, a fertility doctor and a medical health professional with experience in infertility counselling.

In an interview several days after that press conference, Health Canada spokesperson Erik Waddell said, "There is room for three more [board members]. At this point, we are not filling anything immediately. In the future, if there is a need, we will." Mr Waddell then shot back at the Liberals: "The previous government didn't succeed in getting anyone appointed. We [the Conservative minority government] have had a year and we have appointed a board — we have taken clear action." Mr Waddell brushed aside claims of the members' inexperience in medical matters, instead pointing out "a rich diversity of perspectives." As for accusations of social-conservative bias, Mr Waddell said, "The board represents a wide range of interests, which is needed to effectively reflect the views of Canadians on assisted reproduction."

 

 

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