Update on Life Issues – February 2024

This Update on Life Issues was first published on Dr John Ling’s website (www.johnling.co.uk) and is published here with permission.

Abortion

Decriminalising of abortion

Back in November 2023, those two Parliamentary ambassadors for extreme abortion, Diana Johnson and Stella Creasey, tabled amendments to the Government’s flagship Criminal Justice Bill with the aim of ‘decriminalising’ abortion. In other words, they wanted to repeal sections 58 and 59 of the 1861 Offences Against the Person Act (OAPA), which protects the unborn by making abortion a criminal offence with several severe punishments. In addition, they wanted to scupper section 1 of the 1929 Infant Life (Preservation) Act (ILPA), which gives the unborn protection after viability, that is, when a baby is ‘capable of being born alive’. And they wanted to rescind section 1 of the 1967 Abortion Act, which permits exceptions to these protective laws and so allows abortions to be performed under certain legal circumstances.

So currently preborn babies enjoy some legal protections. If abortion were to be decriminalised these legal safeguards would disappear and abortion would become even more freely available.

Diana Johnson’s proposed amendment, NC1 (New Clause 1) stated that no offence is committed ‘by a woman in relation to her own pregnancy’ with respect to these 1861 and 1929 Acts. In other words, it would remove any criminal culpability for the woman who aborts no matter what the circumstances.

Stella Creasy’s NC2 (New Clause 2) stated that no offence under the 1861 OAPA or any other legislation is committed by a person complying with the requirements of section 1 of the 1967 Abortion Act. Without a doubt, that is decriminalisation.

In plain English, Johnson and Creasy want abortion to become just a medical procedure with no criminal restrictions and no penalties. It would be abortion at any time, anywhere, by anyone, for any reason, right up to the moment of birth. This is grave, seriously grave.

The seemingly good news was that on 25 January 2024, though these two amendments were considered at the Committee stage of the Criminal Justice Bill, they were not taken to a vote and were therefore withdrawn. Such matters of conscience should rightly be considered by the whole House rather than just the members of a small committee.

However, this was unlikely to be the end of the matter. These, or similar amendments, were always likely to be tabled again by Johnson and Creasy at the Report stage of the Bill. Indeed, on 7 February 2024, Diana Johnson reintroduced her NC1. This amendment text now reads, ‘To move the following Clause – “Removal of women from the criminal law related to abortion”. For the purposes of sections 58 and 59 of the Offences Against the Person Act 1861 and the Infant Life (Preservation) Act 1929, no offence is committed by a woman acting in relation to her own pregnancy.’

None of this should come as a surprise because the endgame of these two MPs is a total decriminalisation of abortion. This too is grave, seriously grave.

Pro-life Bills in the Lords

There is rarely good news from Westminster concerning abortion. However, there are some members of the House of Lords who are willing to stand up and speak up for the unborn and their mothers. In early November 2023, a trio of pro-life sponsors won high places in the ballot for Private Members’ Bills.

The first was Lord Moylan with his Foetal Sentience Committee Bill [HL]. It is officially described as, ‘A Bill to make provision for a Foetal Sentience Committee to review current understanding of the sentience of the human foetus and to inform policy-making; and for connected purposes.’ Once the Committee has been established it would provide evidence-based, scientific expertise on the sentience of unborn children and report its finding at least annually. The Bill received its First Reading on 27 November 2023.

The second was Baroness Eaton and her At-Home Early Medical Abortion (Review) Bill [HL]. This would require the Government to conduct a review into the risks associated with the self-administration of the abortifacient procedure using mifepristone and misoprostol for at-home medical abortions, the infamous so-called pills-by-post, or DIY, abortions. It would specifically require the Government to assess whether in-person medical appointments should be re-instated. Such medical appointments are important to allow the gestational age of the pregnancy to be accurately determined. The Bill received its First Reading on 29 November 2023.

The third was Baroness O’Loan and her Abortion (Gestational Time Limit Reduction) Bill [HL]. It is, ‘A Bill to lower the gestational time limit for abortion from twenty-four weeks to twenty-two weeks.’ It had its First Reading on 7 December 2023.

Private Members’ Bills in either House at Westminster usually make little progress unless the Government provides Parliamentary time. So far none of these three pro-life Bills has been allocated a date for Second Reading. However, all is not lost because such Bills highlight important topics and can foster constructive chatter among our lawmakers.

Abortion and the French Constitution

In 1975, abortion was legalised in France. It remains a hot and unsettled issue. During 2022, 234,300 abortions were carried out there. In February 2022, the National Assembly voted to extend France’s legal upper limit for abortion from 12 to 14 weeks. In November 2022, the French National Assembly voted 337 to 32 to start the process of enshrining the right to abortion in its Constitution. In March 2023, President Emmanuel Macron announced that a Bill would be prepared ‘in the coming months’ guaranteeing French women a Constitutional right to access the means to end their pregnancies voluntarily. It is thought that the 2022 decision of the United States Supreme Court in the Dobbs case to overturn the Roe v. Wade ruling that gave US women a constitutional right to abortion galvanized the French to act.

In practice, Constitutional revision in France is a long process requiring either a referendum or an agreement by the National Assembly and Senate on an identical text that has to be voted on by the two houses meeting together at Versailles. Bearing in mind the French love of drawn-out bureaucracy, Macron’s promised revision was never going to happen in 2023. And probably not in 2024 either, but maybe in 2025.

Then on 23 January 2024, France’s lower house of Parliament, the National Assembly, overwhelmingly approved Macron’s pledge to add to Article 34 of the Constitution that ‘the law determines the conditions under which the freedom guaranteed to women to have access to a voluntary termination is exercised.’ The vote in favour was 493 versus 30.

The Bill next heads to the Senate, when, on 28 February, the text will begin to be scrutinised. There it will face resistance from conservative Republicans and other centre-right politicians. Many members of the Senate oppose even mentioning abortion in the Constitution, saying that it is not a Constitutional issue and that access to abortion is not threatened in France.

Medical ethics and lawmaking can be such a lugubrious and toxic mix, or as some would say, ‘un mélange lugubre et toxique’.

IVF + ARTs

Extending the 14-day rule

Currently, UK scientists are not allowed to use human embryos for research purposes beyond 14 days. This 14-day rule was recommended by the 1984 Warnock Report and incorporated in the 1990 Human Fertilisation and Embryology Act. Similar time limits apply in other countries, such as the USA, Japan and China. Some of these rules are legally binding, some are just guidelines. Other countries, such as Germany and Russia, ban all human embryo research.

It has always been recognised that the 14-day rule was arbitrary and absurd with no robust basis in biology and so demands to extend it were inevitable. Indeed, like all other bioethical issues, this boundary rule has long been challenged. Those biological scientists at the forefront of the challenge claim pragmatically that a longer time limit would yield important biological information along with possible new treatments for serious human diseases – Parkinson’s, dementia, infertility, cancers, miscarriage and congenital abnormalities are commonly mentioned. Those who are opposed to any extension, including those who oppose the destruction of any human embryos pre-14 days, tend to use principled arguments – the human embryo is unique and special, and so forth.

Now the debate is hotting up. This has been driven in part because scientists can now routinely culture human embryos up to, and presumably, beyond 14 days. Furthermore, the production of ‘synthetic embryos’, made not from ova and sperm, but from stem cells, yet not real embryos, has provided a fillip for early human research. These novel structures are not subject to the regulation of the 14-day rule or the 1990 Act. Should they be? These are uncharted legal waters. The pro-experimenters want to examine still further the so-called embryonic ‘black box’ that exists between two and five weeks. Already the global bidding has started. For example, the Health Council of the Netherlands has recommended that the 14-day rule for embryo research should be extended to a 28-day rule. Others would vote for five weeks. And some want no limit – in 2021, the International Society for Stem Cell Research (ISSCR) abandoned the 14-day time limit for research on human embryos. It no longer specifies an upper limit for embryo experimentation.

Despite the obvious disagreements, the UK boffins have decided that now is the time for public discussion. This will be complex. Already a public dialogue has been conducted over the summer months of 2023 and funded by the Human Developmental Biology Initiative (HDBI) and Sciencewise. The former is a five-year, £10 million project funded by Wellcome, the global charitable foundation, to support research on early human embryo development. Sciencewise is a programme that enables policymakers to develop socially-informed policy, with a particular emphasis on science and technology.

This dialogue involved 70 members of the public engaging with scientists, regulators, ethicists, philosophers and people with lived experience to consider the ethical questions and societal implications of early human embryo research. They participated in one of three ways – the pilot group, the lived experience group and broad public north plus broad public south groups. Each of these groups took part in a combination of webinars and workshops on Zoom and in-person at Newcastle and London. Participants were recruited using a specification agreed by the project team. Nobody invited me! Were these bioethical rookies easy fodder for the persuasive scientists? After all, it is amazing that ’52 participants [of the 70 in total] had not heard of the 14-day rule.’

A report of this dialogue was published in October 2023 and entitled ‘Public Dialogue on Research Involving Human Embryos’. It summarises the structures and outcomes of the various groups. But it consists of 125 pages! In shorthand, there were four general areas of approval. 1] Support for improved fertility and health outcomes. 2] An appetite for review of the 14-day rule. 3] Confidence in current regulation. 4] Concerns about genetically engineering humans. Honestly, was there really a need for this expensive powwow?

Predictably, many participants supported some form of extension of the 14-day rule, for reasons including potential improvement of IVF treatments. This sounds like a vague endorsement of the scientists’ favoured position. There is a considerable mismatch here. If the debate is one of scientists versus non-scientists, then the former have significant advantages. First, they possess a long-learned, deep understanding of the issues – after all, that is their professional job. They are comfortable with the language and concepts of human embryo research. Second, they already have practised access to the media, both scientific and social. They are skilled in the use of modern platforms of communication. How can laity match such proficiency and funding? Third, non-scientist amateurs have work to do.

Some extremes of IVF

All assisted reproductive technologies (ARTs), ranging from IVF to surrogacy, are bound to push the recommended boundaries – it is a characteristic of all bioethical issues. And when the reproductive action has moved from the bedroom to the laboratory, we are in the hands of scientists and white-coated technicians. Their prime aim is typically to strive for success at any cost. Hence, common-sense restraints can be stupidly disregarded or jumped over. Here are three examples of extreme IVF based on age, regulation and cost.

Take, for example, the case of Safina Namukwaya, the 70-year-old Ugandan woman, who, in 2023, became the oldest child-bearer in Africa after she gave birth to twins following IVF treatment. The twins, born at the Women’s International and Fertility Centre Hospital in Kampala, were healthy and placed in incubators after a premature C-section delivery.

At the age of 70, women have undergone the menopause and become involuntarily infertile. However, IVF and other medical advances can make such unwise old-age births possible. For this particular IVF procedure, she had used a donor ovum and her partner’s sperm, though he abandoned her after he learned she was expecting twins.

Safina Namukwaya is now the oldest mother in Africa, but she is not the oldest child-bearer ever recorded. That title goes to Erramatti Mangayamma, a 73-year-old Indian woman who gave birth to IVF-conceived twins in 2019. In the UK, NHS-funded IVF is offered only to women under 43 years of age. While some private clinics may offer IVF treatments to older women, they will require the use of frozen ova previously obtained from the patient or from a donor.

Now consider the case of 24-year-old Jaclyn Frosolone from New York. She believed she had just one sister. Imagine her shock when she discovered that DNA testing revealed she has over 200 half-siblings! In 2021, she received the results of her 23andMe genetic test. She initially assumed the company had misplaced her sample. Eventually, she learned that she had been conceived via anonymous sperm donation − and that she shares a sperm-donating father with that multitude of half-siblings. Alarmingly, although his sperm is now classed as ‘restricted’, it is still being sold online.

However, there is another extremely cheerless side to this story. Jaclyn and many of her half-siblings are suffering from a long list of health issues. For instance, she lives with a brain-fluid-filled cyst in her spine that causes full-body tremors and threatens paralysis, anxiety, depression, supraventricular tachycardia, ADHD and severe vaginal pain and dermatitis, among other problems. None of these conditions was listed on the sperm donor’s profile.

In the USA, sperm donation is mostly unregulated and genetic screening is not required – US donors can opt to remain anonymous. This can leave donor-conceived people with an identity crisis – it is often called genealogical bewilderment. In other words, their medical and family histories are not what you thought they were. Experts reckon there may be millions of US donor-conceived people. Of course, not all of these individuals were conceived by IVF – some users of donor sperm self-fertilise – but a large proportion were. 

Putting aside the extreme bioethical, psychological, genetic, emotional, social and legal aspects of IVF [read about them in Chapter 3.3 of my 2004 book, Bioethical Issues], consider the financial costs. In England, accessing private fertility treatment can be cripplingly expensive. New data, recorded by Fertility Mapper and published in The Observer (22 January 2024), showed that the ‘postcode lottery’ still exists. It is no surprise that London is the most expensive place with an average cost of £6,150 per treatment cycle.

To further demonstrate this financial postcode variation, Fertility Mapper reported that the average advertised cost across six English cities varied considerably. Brighton was the most expensive at £4,590, followed by London at £3,910, Bristol at £3,795, Birmingham at £3,710, Manchester at £3,650 and then Leeds at £3,475. These figures are for ‘basic’ IVF and do not include the additional costs, such as blood tests, screenings and the storage of surplus embryos. Even within cities the variations can be significant. For example, in London prices ranged from £3,745 to £13,408 across 35 private clinics.

Private treatment numbers account for about 60% of all IVF cycles and are increasing, whereas cycles funded by the NHS are decreasing. Moreover, private fertility clinics are not regulated when it comes to the amount they can charge, so they can set their own prices. Some have a substantial menu of ‘add-ons’ which are often regarded of unproven efficacy, but as ‘nice little earners’.

And because IVF treatment cycles are only about 25% effective, a would-be IVF-mother might require four cycles. Those would cost an extreme £16,000 or so, a figure that is borne out by anecdotal evidence. However, costs can spiral and some couples have spent twice that figure. There have been persistent calls for clinics to be more transparent in their pricing and more straightforward in their marketing. But once on that treatment conveyor belt, who dare stop?

IVF can be a success, or it can be a heartbreak and an empty wallet. You have been warned. There is a case to answer that all IVF is extreme.

Surrogacy condemned

Miriam Cates has been the Conservative MP for Penistone and Stocksbridge in South Yorkshire since 2019. She is known for her promotion of family-centred policies. Writing in a magazine recently, she condemned surrogacy. Emphasising the need to prioritise children’s welfare, she caught the media headlines with, ‘You can’t take a puppy off its mother in this country before it’s weaned. You’re not allowed to.’

Explaining her opposition to surrogacy, she stated, ‘You have to look at it from the baby’s point of view. Of course, adults have a strong desire to be parents, both men and women. Of course, it’s a sadness if that’s unfulfilled for whatever reason – they can’t conceive, don’t have a partner, whatever it is. But to deliberately bring a child into the world in order to separate it from its mother at birth I think is just ethically not acceptable.’ She wants surrogacy banned.

As an evangelical Christian, Mirian Cates is probably well aware that Pope Francis has also recently condemned commercial surrogacy. At the start of this year, he demanded a global ban on the practice. He described it as ‘deplorable’ and ‘a grave violation of the dignity of the woman and the child.’ He continued, ‘A child is always a gift and never the basis of a commercial contract.’

In addition, the European Union is also moving towards a ban on commercial surrogacy. A new EU directive, published in January 2024, described the ‘exploitation of surrogacy’ as a form of human trafficking. In March 2023, the Casablanca Declaration – signed by 100 experts from 75 countries – had called for the universal abolition of surrogacy. Olivia Maurel, the child of a surrogate mother and spokesperson for the Declaration, welcomed the EU directive and stated, ‘At last, surrogacy has been named by Europe for what it is, a new form of trafficking.’

Euthanasia and Assisted Suicide

Assisted suicide in the UK

The pressure is arguably mounting for a change in UK law. Here are seven recent events that indicate this may be so.

First, there is the Rantzen effect. Over the Christmas period the broadcaster, Esther Rantzen, disclosed that she had joined the Dignitas ‘clinic’ in Switzerland. She plans to end her own life there if her current ‘miracle’ treatment cannot cure her stage 4 lung cancer.

Second, in January, the Labour leader, Sir Keir Starmer, indicated that he continues to support an assisted dying law. Moreover, if he were prime minister, he would be likely to provide the Government time for such a bill to become law.

Third, the public remains broadly sympathetic to a law change – with consistently around 75% in favour. However, Dignity in Dying’s own polling has found this support cooling in recent years, from a high of 84% in 2019 to 78% in 2023.

Fourth, on 31 October 2023, the Isle of Man’s Assisted Dying Bill passed its Second Reading by 17 votes to 7. Is the Isle of Man on the path to becoming the first part of the British Isles to legalise assisted dying? Could assisted suicide be available for terminally ill Manx Islanders by 2025?

Fifth, recent events in Scotland are regrettable. Liam McArthur’s Assisted Dying for Terminally Ill Adults (Scotland) Bill is expected to be tabled shortly at the Scottish Parliament. An initial vote on its general principles could take place later this year.

Sixth, at Westminster, the Health and Social Care Committee is preparing its important report on its inquiry into assisted dying/assisted suicide following a public consultation last year. Publication is expected later this year, though the Committee’s website states, ‘No upcoming events scheduled.’

Seventh, Dignity in Dying’s public petition ‘calls for the Government to allocate Parliamentary time for assisted dying to be fully debated in the House of Commons and to give MPs a vote on the issue.’ This petition has passed the 100,000-signature threshold meaning it must now be debated by MPs.

Canada is still in the vanguard

It used to be that the Netherlands and then Belgium were the global leaders in pursuing the legalisation of assisted suicide and euthanasia, and subsequently in expanding the eligibility criteria. Now Canada has claimed that title. It started the killing in 2016 and euphemistically called it medical assistance in dying (MAID).

If ever there was an example of a slippery slope in bioethical issues, Canada is it. Back in 2016, the criterion for MAID was a terminal illness. By 2021, the criteria included people who were suffering from non-terminal conditions. As of 17 March 2024, the net was expected to include people suffering solely from mental illness, classified as a ‘grievous and irremediable condition’, and therefore creating a new cohort of people eligible for MAID. 

Hooray, Canada has since had doubts about taking this next awful step. In October 2023, Members of Parliament voted in favour of scrutinising the relevant amendment. As a result, the proposed expansion of criteria was put on hold until 21 January 2024. However, on 1 February 2024, legislation was tabled to delay the ‘mental illness’ criterion until 2027. The government agreed that the Canadian health system had not had time to prepare properly for this expansion. A review in two years will reassess its readiness.

Meanwhile, the number of MAID deaths in Canada has risen significantly from 1,018 when first introduced in 2016 to more than 13,241 in 2022. In that latter year, MAID deaths accounted for about 4.1% of all Canadian deaths.

Commenting on this proposed ‘mental illness’ expansion of MAID, Albert Mohler the US church minister and broadcaster, stated in The Briefing on 31 January 2024, ‘My diagnosis is: this is the culture of death and all morally sane people need to recognize it for what it is. It is evil.’

The AMA speaks up and resists

The American Medical Association (AMA), founded in 1847, is the largest association of physicians and medical students in the USA with a membership of 271,660 in 2022. Its mission is to ‘promote the art and science of medicine and the betterment of public health.’

At its November 2023 interim meeting, AMA delegates made three major decisions. They voted first, not to adopt a resolution which would have changed the AMA’s position of opposition to assisted dying of any kind to one of neutrality. Second, delegates voted not to adopt a proposal that would have removed the AMA’s current position that it ‘strongly opposes any bill to legalize physician-assisted suicide or euthanasia.’ And third, not to adopt a proposal that would have removed the AMA’s current position that assisted suicide ‘is fundamentally inconsistent with the physician’s professional role.’

Two other proposals were referred to the AMA Board for further study. They were the first, to create a new AMA policy that would oppose the criminalization of health care professionals who participate in assisted suicide. Second, to change AMA terminology from physician-assisted suicide to the Canadian term ‘medical aid in dying’ (MAID). Both are almost certain to return unsupported.

One of the attendees expressed the position of many delegates when she stated, ‘It is not within the realm of medicine to decide when we enter this world and when we leave it. This is God’s work. In medicine, we try to cure and when cure is not possible, we try to relieve suffering as much as possible. Killing our patients will never be part of the noble pursuit of medicine.’

The AMA’s current code of ethics states that ‘Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.’

Well said AMA. Bravo for resisting the feeble utilitarian ethics of those who favour any form of assisted suicide or euthanasia.

Genetic Engineering

First gene therapy trial for Hunter syndrome

A new and revolutionary gene therapy for Hunter syndrome is taking an innovative approach to transporting a key enzyme across the blood-brain barrier. The two-year trial will be carried out at the Royal Manchester Children’s Hospital. It has two main aims – to reduce or remove reliance on enzyme infusions, and to treat the brain-related decline that is not prevented by existing treatments.

People with Hunter syndrome lack a working copy of the gene that encodes for an essential enzyme, namely iduronate-2-sulfatase (IDS). IDS is necessary to break down complex sugar molecules and when it does not function, molecules, called glycosaminoglycans, accumulate in tissues all around the body causing a wide variety of symptoms. These include heart and lung problems, hearing impairment, bone and joint issues, and progressive developmental decline including loss of memory function and learning ability.

Hunter is a rare, very serious, even lethal, inherited disorder. It is thought that about 80 people in the UK, predominantly boys and men, are affected by the condition. Hunter syndrome is currently incurable, and children with a severe form of the condition usually die in their teens, although there is also a form with milder cognitive decline where patients can live to adulthood and middle age.

This combined Phase 1 and 2 clinical trial is now open for recruitment. It initially aims to enlist five infants between 3 and 12 months old who have a confirmed diagnosis of severe Hunter syndrome, and who must be enrolled before developmental decline begins. The children participating in the trial will continue to receive standard treatments, but if the gene therapy is successful, it is hoped that these will become unnecessary.

The gene therapy was developed by Professor Brian Bigger and his team at the University of Manchester. It involves removing blood-making stem cells, known as autologous haematopoietic stem cells (HSC), from the children’s bone marrow. Into these cells is inserted a working copy of the IDS gene before they are infused back into the patients. The treated cells should then repopulate the bone marrow and begin to produce blood cells capable of synthesising the IDS enzyme so it can circulate throughout the whole body, including the brain.

The current standard treatment for Hunter syndrome involves enzyme replacement therapy where the patients receive infusions of the IDS enzyme, usually once a week. These infusions can help break down the dangerous accumulated glycosaminoglycans and can help alleviate symptoms and slow disease progression. However, the replacement enzyme does not cross the blood-brain barrier, so the standard treatment does not help with cognitive or developmental symptoms. To overcome this limitation, the IDS gene that is inserted into the blood cells has an extra molecule, a proprietary ApoEII-tagged sequence, which can bind to receptors on the blood-brain barrier and move the enzyme into the brain more efficiently.

According to Professor Bigger, ‘This is a next generation stem-cell gene therapy approach, which allows transit of the IDS enzyme into the brain … where it is most needed.’ ‘In mice, the treatment resulted in a dramatic improvement … including normalisation of working memory problems. But this trial will be the first time the approach is tried in humans. The team hopes to bring the same benefit to affected children.’

This is wonderful genetic engineering therapy, a pleasure to write and read about. It is scientific, ethical and properly tested in Phase I trials and now moving into a Phase 2 clinical trial. If only all medicine was as delightful and principled.

CAR-T-cell therapy and autoimmune diseases

Genetically engineered immune cells have given 15 people with autoimmune disorders (AIDs) a new lease of life, free from fresh symptoms or the need for additional treatments. These results suggest that so-called CAR-T-cell therapy [CAR, chimeric antigen receptor] might one day treat a range of other conditions caused by rogue immune cells that produce antibodies that attack the body’s own tissues.

All 15 participants in a small clinical trial had one of three autoimmune diseases (AIDs), namely systemic lupus erythematosus, systemic sclerosis, or idiopathic inflammatory myositis. The procedure was that T-cells were first removed from the person being treated, then genetically engineered to produce proteins called chimeric antigen receptors (CARs) and finally reintroduced into the person’s body. In many T-cell therapies, the T-cells are tailored to recognise a protein made by immune cells called B cells. When reintroduced, the CAR-T-cells will target the B cells for destruction – a useful feature well-known by those treating cancers caused by abnormal B cells.

The participants were treated with a single infusion of CD19 CAR-T cells. All 15 entirely stopped taking immunosuppressive drugs. All have remained disease-free, or nearly so since their treatments began. The first participants were treated more than two years ago. This information is according to results presented at the American Society of Haematology meeting in San Diego on 9 December 2023. The presentation was entitled, ‘CD19-Targeted CAR-T Cells in Refractory Systemic Autoimmune Diseases: A Monocentric Experience from the First Fifteen Patients’ by Fabian Meuller and colleagues, mostly from the University of Erlangen, Germany.

It was therefore concluded that the CAR-T-cells can ‘induce persistent, drug-free remission in three distinct autoantibody dependent AIDs.’ However, this was only a Phase 2 trial and although the treatments were well tolerated, longer follow up is needed before disease cures can be claimed.

Other groups have since taken up the Erlangen approach and reported similarly positive results. For example, another research team has already added a fourth autoimmune disorder called myasthenia gravis to the list of successes. Researchers are beginning to wonder how long the final list will be. T-cells are now regularly being engineered to recognise cancer cells, but now they may possibly/probably provide treatments for other immune cells.

The lead author of this 2023 study, Fabian Meuller, has been caught smiling as he marvels at the remarkable recoveries he has seen. For instance, there is the man who struggled to walk 10 metres before his treatment and now routinely walks 10 kilometres around town. Medicine can be cheery and breath-taking.

CRISPR gene editing and Alzheimer’s

On 11 December 2023, the journal Nature published an important article by Tosin Thomson entitled, ‘How CRISPR gene editing could help treat Alzheimer’s.’ The following is based on that work.

Alzheimer’s disease is the most common form of dementia. About 900,000 people in the UK are living with dementia, and two-thirds of them have Alzheimer’s. Moreover, it is a health issue of global concern with an estimated in excess of 55 million people affected, a figure that is projected to nearly triple by 2050. According to Professor Tara Spires-Jones, who studies neurodegeneration at the University of Edinburgh, ‘We do not fully understand how the brain works, which makes the challenge of understanding and treating brain diseases like Alzheimer’s very difficult.’

Although there are now some treatments that can slow the progression of Alzheimer’s, these often do not benefit people who are in the later stages, or who have mutations that raise the risk of the disease. New approaches are required. Last year, a gene therapy that uses the CRISPR–Cas9 gene-editing tool was granted clinical approval in the US. It treats the blood conditions of sickle-cell disease and β-thalassaemia and it works by precisely cutting out a faulty gene in the stem cells of sufferers. Now, scientists in search of new treatments for Alzheimer’s are hoping to deploy similar strategies against forms of the disease that are caused by genetic mutations.

Much of Alzheimer’s research is driven by the amyloid hypothesis, the idea that the build-up of amyloid-β proteins in the brain, which eventually form clumps called plaques, is the main cause of the disease. Amyloid plaques trigger another brain protein, called tau, to clump together and spread inside neurons. It is usually well into this process that symptoms, such as memory loss, start to appear. Usually, the more tau is present, the more severe the symptoms are.

The current use of antibody drugs, such as aducanumab and lecanemab target these amyloid plaques and have been shown in clinical trials to slow cognitive decline in some people. Although both drugs have been approved by the US Food and Drug Administration (FDA), concerns remain about their safety and efficacy.

Enter CRISPR gene editing. Could it instigate alternative treatments in cases where the disease is associated with particular genetic variants? One gene that has been linked to late-onset Alzheimer’s is apolipoprotein E (APOE), which codes for a lipid transport protein in the brain that seems to affect the uptake of tau protein by neurons. People who have a variant of the gene called APOE4 have the highest risk of developing Alzheimer’s, while those with the APOE3 and APOE2 variants are at medium and low risk, respectively. Having one copy of APOE4 increases a person’s risk of getting Alzheimer’s disease threefold. Having two copies increases the risk twelvefold.

In 2019, a rare APOE variant called Christchurch was found in a woman who, although genetically predisposed to developing Alzheimer’s earlier in life, had shown no symptoms until her seventies. Yadong Huang, a neuropathologist at Gladstone Institutes in San Francisco, California, and his colleagues used a CRISPR system to engineer the Christchurch gene variant into mice carrying human APOE4. These mice were then cross-bred, producing offspring with either one or two copies of the engineered variant.

In a study, published on 13 November 2023 in Nature Neuroscience, the team found that mice with one copy of the APOE4-Christchurch variant were partially protected against Alzheimer’s. Mice with two copies showed none of the expected signs of the disease. Huang commented, ‘Our study suggests potential therapeutic interventions for APOE4-related Alzheimer’s disease by mimicking the beneficial effects of the Christchurch mutation.’

Another potential target for gene-editing interventions is a protein called presenilin-1 (PS1), which is crucial for producing an enzyme involved in amyloid-β production called γ-secretase. Mutations in PSEN1, the gene that codes for PS1, increase the amount of a toxic type of amyloid-β called amyloid-β 42 that is produced in the brain and has been linked to early-onset Alzheimer’s.

In a proof-of-concept study published last year in Molecular Therapy Nucleic Acids, scientists used a CRISPR system to cut, and therefore disrupt, the mutant version of the PSEN1 gene in human cells. The team was able to disrupt half of all mutant PSEN1 genes in cultured cells, which resulted in an overall reduction in both PS1 and amyloid-β 42. ‘This approach is well suited to reducing levels of toxic proteins where a mutant form of a gene is involved in their production’, said study co-author Martin Ingelsson from the University of Toronto, Canada. That team is now making use of a super-precise gene-editing technique called prime editing, which allows a single DNA base pair to be replaced. Ingelsson has said, ‘I feel convinced that we will one day be able to alter disease-causing genes with surgical precision.’

These novel gene-editing strategies are showing promise in early studies, but CRISPR-based therapies still have a long way to go. As with any new treatment, safety concerns will have to be addressed. As Spires-Jones has confirmed, ‘Gene editing is not always perfect. There could be off-target effects including mutations in healthy genes or damage to entire chromosomes.’

Moreover, it is one thing to experiment on CRISPR systems using cells and animal models, but it is quite another to take Alzheimer’s gene-editing strategies to the clinic where real human beings are patients. To date there has been no clinical trials using any kind of CRISPR technology in the brain. There are extensive groundworks that first need to be dug. The preclinical Phases must precede the clinical Phase 3. While these advances in genetic engineering are exciting, they are also frustratingly slow in moving from laboratory bench to hospital bed.

Effective treatment for Alzheimer’s is a vision for many. Among them is Professor Subhojit Roy, a neuroscientist at the University of California, San Diego. He hopes that, ‘there will be a day when a neurologist looking at an Alzheimer’s disease patient would prescribe a one-time CRISPR injection, perhaps in combination with other antibody-based therapies.’ May that day come soon because there are countless patients, carers and families awaiting it too.

Stem-cell Technologies

Everyone likes to hear about medical advances, especially those backed by evidence-based science, ethical practices, proof of concept and clinical trials. Stem-cell technologies often fit this bill.

Multiple sclerosis (MS) is a chronic neuroinflammatory condition that affects over two million people worldwide. Although disease-modifying therapies (DMTs) have made a substantial impact on the severity and frequency of MS relapses, two-thirds of patients eventually advance into a debilitating secondary progressive phase within 25 to 30 years of their diagnosis. During this stage neurologic function worsens and disability increases. What have stem-cell technologies got to offer MS sufferers?

MS and stem-cell technologies – Part 1

Here is a small but heart-warming MS story. During 2017, at the age of 49, Professor Robert Douglas-Fairhurst of Magdalen College, Oxford, was diagnosed with MS, a condition that is generally regarded as treatable but incurable. Disease-modifying drugs, such as alemtuzumab, ocrelizumab, ofatumumab and cladribine, can effectively slow its advance and help reduce relapses.

But in 2019, Douglas-Fairhurst opted for a more radical treatment known as autologous haematopoietic stem-cell transplantation (AHSCT). MS is caused by the immune system attacking the lining of the nerve cells of the brain and spinal cord. AHSCT uses chemotherapy and radiotherapy to effectively wipe out that immune system, then it reboots it using the patient’s own haematopoietic stem cells previously harvested from his or her bone marrow. Once infused those stem cells should regrow the bone marrow and ‘reset’ the immune system. For Douglas-Fairhurst, this procedure was largely successful, but expensive (£80,000), yet ethical because it used ‘adult’ stem cells rather than ‘embryonic’ stem cells which require the destruction of human embryos.

In 2023, Douglas-Fairhurst was interviewed by the journalist Stephen Bleach, another MS sufferer. The subsequent article was published in the 10 December edition of The Sunday Times. Four years after his AHSCT treatment it seems to have halted but not reversed Douglas-Fairhurst’s descent into disability. Remarkably it has enabled him to enjoy his life even more. He acknowledged, ‘I’m not going to pretend that MS is a gift. I’m not glad it happened to me. But there are side benefits and you can recognise and even relish them.’

Douglas-Fairhurst has written a 2023 book, Metamorphosis: A Life in Pieces, about his experience of living with the disease ‘that sometimes reduced his brain to a lump of warm paste.’ And yet, reflecting on his condition, the Oxford professor admitted, ‘It’s strange but I’m happier now than I was before I was diagnosed with multiple sclerosis. I think that’s because I’ve come to appreciate just how fragile it all is. I was sleepwalking through much of my life. I was on autopilot. Now I take pleasure in small things.’

MS and stem-cell technologies – Part 2

A more detailed account of a novel treatment for patients with MS was published in Cell Stem Cell (2023, 30: 1597-1609) by Maurizio Leone and colleagues under the title of ‘Phase 1 clinical trial of intracerebroventricular transplantation of allogenic neural stem cells in people with progressive multiple sclerosis.’

The treatment consisted of injecting neural stem cells into the brains of patients with secondary progressive MS. This publication reported the first-year results from 15 patients enrolled on a Phase 1 clinical trial to determine the feasibility, safety and tolerability of the treatment. It demonstrated that the treatment was safe with no serious adverse events and that it may stop the disease from causing further damage.

In a healthy brain, a subset of immune cells, called microglial cells protects the brain from infection and removes damaged neurons. When MS occurs, microglial cells attack and damage the myelin sheath that protects nerve fibres. This results in disruption of signalling between the brain and the spinal cord, causing chronic inflammation.

All of the patients in the trial had high levels of disability, with most requiring a wheelchair. During the 12-months of follow-up after treatment no patients reported any increase in disability or symptom deterioration. Furthermore, brain scans showed that those patients who received higher doses of stem cells experienced less brain shrinkage. The researchers suggested this may be because the transplanted stem cells dampened the autoimmune response and reduced the inflammation that drives MS, rather than rebuilding the damaged tissues. These patients also had higher levels of metabolite compounds called acylcarnitines in their cerebrospinal fluid, which are associated with neuroprotection.

Professor Stefano Pluchino from the University of Cambridge, the co-leader of the study, commented, ‘We desperately need to develop new treatments for secondary progressive MS, and I am cautiously very excited about our findings, which are a step towards developing a cell therapy for treating MS. Caitlin Astbury, research communications manager at the MS Society, observed, ‘This was a very small, early-stage study and we need further clinical trials to find out if this treatment has a beneficial effect on the condition. But this is an encouraging step towards a new way of treating some people with MS.’

Spoiler alert! There is a serious objection concerning the ethical basis of this work. This current study used neural stem cells derived from the brain tissue of a miscarried foetal donor. However, the researchers hope to be able to derive stem cells directly from patients in future studies to avoid ethical complications associated with the use of foetal tissue.

Stem-cell recipient meets stem-cell donor

Here is yet another heart-warming adult stem-cell story. The donor was 41-year-old Allan McPike from Glasgow. The donee was six-year-old Ryan Brand from Caerphilly.

At eight months old, Ryan was diagnosed with Diamond-Blackfan anaemia (DBA). His treatment required monthly blood transfusions. DBA is a rare disorder that stops the body from producing red blood cells. It can lead to delayed growth and it can put people at a higher risk of developing later-onset diseases, such as cancer of the blood and bone marrow. The cure is a bone marrow transplant, but finding a suitable donor is usually complex and often impossible.

As Ryan’s mother, Sam Brand, said, ‘They told us if he didn’t have a [stem-cell] transplant he would die.’ Then, when Ryan was 11 years old, he met Allan, the man who transformed his life when he was six. And on meeting Allan, she stated, ‘He saved my son’s life, you can’t really ask much more.’ Following his stem-cell donation in 2017, Ryan is no longer required to undergo blood transfusions every month. 

Allan McPike was persuaded to sign up to the Anthony Nolan stem cell donor register by his late cousin, Elaine Davidson, who had a brain tumour. Allan recounted, ‘At the time, me being scared of needles, I was cajoled into signing up. I thought well, I can’t say no given everything that she’s going through. I went along and donated [by a simple mouth swab] on the day. But nothing happened for 10 years. A decade later Allan was contacted and told he was a match for Ryan. Then in June 2017, the donor’s stem cells were infused into the recipient’s bone marrow. The great remedial deed was done.

Following Ryan’s transplant, his mother was, ‘really excited but at the same time really nervous’ about getting in touch with Mr McPike. They met last November in Edinburgh. Mrs Brand reported that the donor and donee got on like ‘a house on fire’. ‘I really wanted to say thank you,’ she said. ‘He’s got a family of his own and something so small that he’s done has made such a big impact. If it hadn’t been for him, Ryan wouldn’t be here today.’ Mr McPike said, ‘It was great. It was good to finally see him and meet the family as well. They’ve been through an awful lot. When you see the pictures of Ryan when he was really unwell to what he is now it’s a massive, massive difference. Signing the register is a worthwhile thing to do when you see the results that signing up can achieve. There’s nothing really to fear about it. I always say to Sam that Ryan did the hard work, I did the easy part.’

Henny Braund, chief executive of the Anthony Nolan charity, said, ‘It’s wonderful to hear that Ryan is living life to the full and was able to meet his donor Allan. Shirley Nolan, [Anthony’s mother], was so determined to save her son’s life that nearly 50 years ago she set up the world’s first stem-cell register, bringing hope to patients in need.’

And so, another wonderful curative stem-cell tale is told. This is adult stem-cell technology at its best.

Miscellaneous

Paper-mill articles

Another piece by Richard Van Noorden, a Features Editor at Nature, appeared in Nature (6 November 2023). It drew attention to the problem of so-called paper-mills. These are businesses that churn out fake or poor-quality journal research papers or even sell authorships. Does it matter? Yes, of course, it does. They are corrupting the very integrity of science and scientific research and scientific reporting. For example, most drug approvals and medical treatments are based on results published in scientific journals. Would you be happy to trust a drug treatment that is based on results from falsified paper-mill research? Moreover, paper-mill research can be dangerous even if nobody reads it because it can still get aggregated into mainstream review articles. There is potential danger here.

Yet there is obviously a market for this crookery – its customers are presumably mostly unscrupulous researchers who need extra journal publications, without the exertion of conducting the research, to pad out their CVs. The scale of such untrustworthy science is unknown. Some reckon there are hundreds of thousands of these bogus ‘paper-mill’ articles lurking in the literature. Others reckon that between 1.5% and 2% of all scientific papers published, for instance, during 2022, closely resembled paper-mill works. Among papers focussed on biology and medicine that rate rises to 3%. Another measure of scientific fraud is indicated by the number of retractions of scientific papers. In 2023, there were more than 10,000 retracted – some for minor errors, some for deliberate deceit. The general public has little idea of the intense competition that can exist among scientists, especially those working on ’hot’ topics. Publications, egos and grants are just some of the features that can drive scientists. The laboratory can be an obsessive place. Cutting a few corners here and there can easily lead to full-on fraud assisted by paper-mill articles.

What can be done? Already there has been a considerable increase in policing the literature for fabricated science. For example, Adam Day, is the director of the scholarly data-services company Clear Skies, based in London. Using machine-learning software he has developed a tracker called the Papermill Alarm. There is a cross-publisher initiative called the STM Integrity Hub, which aims to help publishers combat fraudulent science.

Recently, a high-profile group of funders, academic publishers and research organisations launched an effort to banish, or at least, minimise the number of paper mills. In a Consensus Statement, released on 19 January 2024, the group, under the name of United2Act, outlined five actions to address the problem. These were headlined as, Education and awareness, Improve post-publication corrections, Research paper mills, Enable the development of trust markers, and Continue to facilitate dialogue between stakeholders about the systematic manipulation of the publication process.

It is a valiant start, but it has a long, long way to go. The rewards for the cheats are currently greater than those for the detectives.

Chatty mums

Beware, the foetus is listening and learning. And expectant mothers who are particularly chatty can boost their unborn babies’ language skills. This is the conclusion of a group of researchers from Italy and France who found that ‘language exposure before birth may help newborns acquire language with ease’ after birth.

The study, entitled, ‘Prenatal experience with language shapes the brain’ was conducted by Benedetta Mariani and colleagues and published in Science Advances (22 November 2023).

Previous research has shown that newborn babies prefer the sound of their mother’s voice to the voices of other women. However, the current researchers concluded that, ‘These results provide the most compelling evidence to date that language experience shapes the functional organisation of the infant brain, even before birth.’

Their experimental design was intriguing. Scientists from the University of Padua in Italy and universities in France worked with 33 French newborns aged between one and five days old. These babies’ mothers were native French speakers who spoke French at least 80% of the time during the last trimester of their pregnancies.

To measure their brain activities, small caps with ten electronic sensors were put on the babies’ heads while they rested in their bassinets. Measurements were made at rest for three minutes of silence followed by seven minutes of recordings from the story of Goldilocks and the Three Bears in French, Spanish and English in a random order. Lastly, there was another session of silence.

Perhaps unsurprisingly, as a measure of recognition, their native language [French] provoked the strongest responses in the babies’ brains – signals known as long-range temporal correlations. Moreover, their native language also created activity in parts of the brain associated with the learning and processing of language and speech. This would suggest that the wiring of their brains had been altered by the language they heard while in the womb. This implies that babies can begin to acquire language-recognition skills before birth that make it easier for them to pick up language skills as infants.

When does this preborn education start? That question was beyond the scope of this present study. However, it is generally recognised that babies can hear sounds from outside of their mother’s bodies by about seven months of gestation and presumably inside their mothers’ bodies even earlier. It is the foundation for learning. So, expectant mums, speak (and sing) to your baby bump!

Of family and marriage

What is a family? Many probably think this is a dumb question. They would reply, ‘A family is a dad and a mum, maybe some children, perhaps even a dog.’ And most people would think this is a good answer. However, it would cause many progressives out there to choke on their buckwheat porridge.

In 1948, the Universal Declaration of Human Rights (UDHR) asserted that ‘Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family.’

However, the aforementioned progressives and other avocado toastie-eating reformists regard this statement as outrageously anachronistic. Yet, just two generations ago, the right ‘to marry’ and ‘to found a family’ (in that order is best) were inextricably linked. They were not only rights, they are also aspirations. Wow, what changes have since befallen these two fundamental entitlements! Their demise is tragic.

First, ‘to marry’. Marriage has always been the great instigator and stabiliser of deep human relationships. It runs from Genesis 2:24 through Proverbs 18:22 and onto Ephesians 5:22-33 with many useful adjuncts along the way.

Consider the magnificent pattern of vows made by the intending couple, ‘I, John, take you, Wendy, to be my wife, to have and to hold from this day forward; for better, for worse, for richer, for poorer, in sickness and in health, to love and to cherish, till death us do part, according to God’s holy law. In the presence of God, I make this vow.’ Solemn words indeed.

So here are the five basic characteristics of true marriage. First, it is between one man and one woman – never same-sex. Second, it is a covenant, a solemn promise, a binding oath. Third, it is lifelong – until death separates, so no divorce. Fourth, it is an exclusive relationship – no others, so no adultery. Fifth, it is publicly declared – not a private matter, but legal and civic.

But steadfast marriage is falling out of favour. The latest statistics from the Office for National Statistics (ONS), estimate that the proportion of people, over the age of 16 in England and Wales, who are married or in a civil partnership is, for the first time, less than 50%. The 2022 figure was 49.4%. Moreover, cohabiting couples have risen to 22.7% and estimates for civil partnerships reached 222,000, while same-sex ‘marriages’ increased to 167,000.

Traditional marriage is therefore no longer the default foundational relationship for family building. Why is this? For the most part, we now live in a world with an increasingly woke agenda, in an overwhelmingly virtue-signalling culture of EDI (equality, diversity and inclusion), within outspoken LBGTQ+ communities, and in a non-gendered world, where even the words ‘father’ and ‘mother’ are becoming unwelcome. Living under such modern constraints, none of which are supportive of time-honoured marriage, is not easy. Nevertheless, most Christians and other ‘morally sensitive’ people still rightly struggle to hold to the surprising resilience of institutionalised monogamy.

Yet marriage is never merely a piece of paper or a Victorian middle-class invention. Marriage is the age-old institution by which human society regulates sexual activity and minimises its unwanted social conflicts. It turns sex from merely a sensual indulgence into a form of social bonding that brings biblical, biological, legal and social stability to the pleasures of procreational relationships. As the popular Frank Sinatra song, sort of, states, ‘Family and marriage go together like a horse and carriage.’

Second, ‘to found a family’. Think of this biologically. It is an irrefutable fact of life that each of us has a father and a mother. Nowadays, they might be just social, genetic, biological or legal parents – but yes, we are still, just about, family. In other words, nitty-gritty biology and the Bible tell us that ever since the post-Adamic generation, we have all been the products of sperm plus ova.

Furthermore, the God-ordained structure of a traditional family is father-mother-child – it is a neat and wholesome threesome. This has been challenged by the current bandwagon of assisted reproduction technologies (ARTs) with their abnormal nature of fertility treatments, especially IVF. Whereas sperm and ova are still required, they are not now quite equivalent to a Daddy and a Mummy. The historic, conventional family configuration has been harmfully defied and redefined.

Yet, every human society still has its roots in naturally-created and traditionally-structured family life. Only an obtuse few would argue that strong family life is not beneficial for a society. Furthermore, the physical and procreative relationship is reserved for within the marriage covenant only (Matthew 19:4-6 and Hebrews 13:4), and the intrusion of any third party – surrogates and sometimes ova and sperm donors – subverts this. For instance, babies can now have five ‘parents’ – two commissioning parents, two genetic donors, plus a surrogate. How times have changed! Deliberately creating ‘patchwork families’ is never a good idea.

That 1948 Universal Declaration of Human Rights (UDHR) aspired to secure the right of all ‘to marry‘ and ‘to found a family’. That was laudable. But there is often a yawning gulf between aim and actuality, between programme and praxis. If you desire a family, get married. If you get married, desire children. At least, think about them seriously before embarking on either.

USA + Elsewhere

Michael Johnson

Ah, that faux pomp, ersatz ceremony and short-lived history of the US political system, where nothing much is older than 250 years. And so it is, according to the Founding Fathers that Congress has two structures, the House of Representatives and the Senate. Both have an elected Speaker. On 25 October 2023, the House elected a new one. His name is James Michael Johnson, otherwise known as Mike Johnson.

Johnson is the 56th speaker and the Republican representative for Louisiana. He now holds this weighty constitutional office, the most senior role in US politics after the president and vice president. Johnson is a little-known lawmaker, who attracted the support of all 220 Republican members in attendance, surpassing the 215-vote total that was required to win. His appointment brings to an end three weeks of a stalled House amid chaos and infighting among the Republicans. By contrast, all 209 Democrats quietly voted for Representative Hakeem Jeffries to be their party’s House leader.

Who is this unfamiliar Johnson? What does he stand for? He is an evangelical Christian and a staunch supporter of Donald Trump. No wonder The New York Times (30 October 2023) described him as ‘a right-wing fever dream come to life.’ And it continued, ‘He holds all of the extreme Christian nationalist values. They are, the unborn, marriage between a man and a woman, and LGBT issues.’ It concluded, ‘He’s a nut.’ To such insults and to explain his beliefs, Johnson’s routine repost is, ‘Pick up a Bible and you’ll find my worldview.’ That has stunned many on the left. And it reassures them than he is indeed an extremist, at least in their eyes and minds.

Johnson’s ability to lead the fractured House Republicans will soon be tested by a series of urgent deadlines. If winning the Speakership was a Herculean task, leading the House may be even more difficult. US politics, especially in a year of a presidential election, is nothing if not fascinating. And lively.

USA post-Dobbs

Some sectors of the US are still reeling from the landmark judgement in the Dobbs v. Jackson Women’s Health Organization case that uprooted Roe v. Wade on 24 June 2022.

For example, the 2022 annual survey produced by Operation Rescue, a US-based pro-life organisation, revealed a colossal 88 abortion clinic closures. And in 2023, another 49 abortion clinics had closed or halted abortions. In other words, a total of 137 clinic closures have occurred in the two years post-Dobbs.

At the end of 2023, 14 states, alphabetically ranging from Alabama to West Virginia, were reported to be abortion free, with laws in place that protect vast numbers of innocent unborn children. Indiana became abortion free in 2023. Accordingly, 7 Indiana abortion clinics were forced to close. Recent abortion statistics for this state showed over 8,000 abortions were performed in 2021. Imagine 8,000 such preborns now being protected in 2024.

After the overturning of Roe v. Wade, some clinics packed up and moved to other states where there were few or no abortion restrictions, states, like New Mexico and Illinois. In addition, there were 53 clinics that either opened or resumed aborting during 2023.

There are two novel aspects that bring new challenges to the US pro-life community post-Dobbs. One is the rise in medically dangerous mail-order abortions. And the other is the total of 670 abortion clinics still operating and concentrated in just 36 States. California has 162 such facilities, followed by 77 in New York and 50 in Florida.

Whatever the vicissitudes of abortion clinics, it cannot be denied that post-Dobbs there are hundreds and thousands of daughters, sons and grandchildren alive today who would not have lived otherwise.

Abortion in Argentina

On 19 November 2023, Javier Milei, an avowed anti-abortion politician, was elected president of Argentina, securing 55.6% of the national vote. He assumed office on 10 December 2023.

During his presidential campaign, Milei vowed to launch a referendum on Argentina’s abortion law. In addition, his vice-president, Victoria Villarruel, also backed a repeal of the nation’s 2020 abortion law that legalised abortion up to 14 weeks. Villarruel, also an outspoken pro-life campaigner, has used her position as a writer and politician to condemn abortion and affirm ‘the right to life, because life begins at conception’, stating that her stance is not ‘a matter of religion but of pure biology.’

The congresswoman has also explained that the ‘disastrous’ 2020 law was passed because ‘there was a lobby here that was also promoted from abroad. Abortion is big business and there is a lobby that promotes this issue.’ Milei is expected to give Villarruel, a lawyer, a significant role in his new government, saying, ‘Obviously, she will not have a decorative role … She is a brilliant woman.’

Pro-life groups around the world have lauded Villarruel as signifying ‘a new era’ in abortion across Argentina. The 40 Days for Life organisation has stated that, ‘we’re thrilled to anticipate her impact on upholding the sanctity of life.’ The UK’s pro-life organisation, SPUC (the Society for the Protection of Unborn Children) has said, ‘Victoria Villarruel is a new type of unashamedly pro-life politician who is not afraid to push back against the abortion lobby and its harmful ideology that has harmed so many women and unborn children. To make a world where abortion is unthinkable, it is vital that pro-life leaders stand up and be counted, as Villarruel has done. We hope that she can help steer Argentina towards a brighter future for all lives, including the unborn.’

Some pushback against a world that is seemingly besotted by abortion would be most welcome, anywhere and soon.