Physician associates ‘should be banned from diagnosing patients'
The review examined six patient deaths that coroners' reports had directly linked to physician associates (PAs).
The report's author said misdiagnosing patients and giving them the wrong treatment plan was 'catastrophic'.
The review found there was 'inconclusive' evidence that physician associates were safely deployed in the NHS, but equally none to suggest it was so unsafe that the role should be abolished.
It said the role should be renamed as 'physician assistant' to reduce confusion among the public who have often mistaken them for doctors.
The review proposes giving all NHS staff, including the renamed physician assistants, their own uniforms and lanyards that clearly state their job, because of the vast range of roles operating within the health service, and a tendency for PAs to wear doctors' scrubs and stethoscopes.
The recommendations make up part of an independent review of PAs and anaesthesia associates (AAs) by Prof Gillian Leng, the president of the Royal Society of Medicine.
Wes Streeting, the Health Secretary, ordered the review last year after a series of scandals involving PAs either causing patient harm or death, practising beyond what they are qualified to do, or being used in place of doctors.
Doctors have also criticised the NHS plans to increase the around 3,500 PAs employed to more than 10,000 as an attempt to replace them.
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The Independent
20 minutes ago
- The Independent
Healthy babies born in Britain after scientists used DNA from three people to avoid genetic disease
Eight healthy babies were born in Britain with the help of an experimental technique that uses DNA from three people to help mothers avoid passing devastating rare diseases to their children, researchers reported Wednesday. Most DNA is found in the nucleus of our cells, and it's that genetic material — some inherited from mom, some from dad — that makes us who we are. But there's also some DNA outside of the cell's nucleus, in structures called mitochondria. Dangerous mutations there can cause a range of diseases in children that can lead to muscle weakness, seizures, developmental delays, major organ failure and death. Testing during the in vitro fertilization process can usually identify whether these mutations are present. But in rare cases, it's not clear. Researchers have been developing a technique that tries to avoid the problem by using the healthy mitochondria from a donor egg. They reported in 2023 that the first babies had been born using this method, where scientists take genetic material from the mother's egg or embryo, which is then transferred into a donor egg or embryo that has healthy mitochondria but the rest of its key DNA removed. The latest research 'marks an important milestone,' said Dr. Zev Williams, who directs the Columbia University Fertility Center and was not involved in the work. 'Expanding the range of reproductive options … will empower more couples to pursue safe and healthy pregnancies.' Using this method means the embryo has DNA from three people — from the mother's egg, the father's sperm and the donor's mitochondria — and it required a 2016 U.K. law change to approve it. It is also allowed in Australia but not in many other countries, including the U.S. Experts at Britain's Newcastle University and Monash University in Australia reported in the New England Journal of Medicine Wednesday that they performed the new technique in fertilized embryos from 22 patients, which resulted in eight babies that appear to be free of mitochondrial diseases. One woman is still pregnant. One of the eight babies born had slightly higher than expected levels of abnormal mitochondria, said Robin Lovell-Badge, a stem cell and developmental genetics scientist at the Francis Crick Institute who was not involved in the research. He said it was still not considered a high enough level to cause disease, but should be monitored as the baby develops. Dr. Andy Greenfield, a reproductive health expert at the University of Oxford, called the work 'a triumph of scientific innovation,' and said the method of exchanging mitochondria would only be used for a small number of women for whom other ways of avoiding passing on genetic diseases, like testing embryos at an early stage, was not effective. Lovell-Badge said the amount of DNA from the donor is insignificant, noting that any resulting child would have no traits from the woman who donated the healthy mitochondria. The genetic material from the donated egg makes up less than 1% of the baby born after this technique. 'If you had a bone marrow transplant from a donor … you will have much more DNA from another person,' he said. In the U.K., every couple seeking a baby born through donated mitochondria must be approved by the country's fertility regulator. As of this month, 35 patients have been authorized to undergo the technique. Critics have previously raised concerns, warning that it's impossible to know the impact these sorts of novel techniques might have on future generations. 'Currently, pronuclear transfer is not permitted for clinical use in the U.S., largely due to regulatory restrictions on techniques that result in heritable changes to the embryo," Williams, of Columbia, said in an email. 'Whether that will change remains uncertain and will depend on evolving scientific, ethical, and policy discussions." For about a decade, Congress has included provisions in annual funding bills banning the Food and Drug Administration from accepting applications for clinical research involving techniques, 'in which a human embryo is intentionally created or modified to include a heritable genetic modification.' But in countries where the technique is allowed, advocates say it could provide a promising alternative for some families. Liz Curtis, whose daughter Lily died of a mitochondrial disease in 2006, now works with other families affected by them. She said it was devastating to be told there was no treatment for her eight-month-old baby and that death was inevitable. She said the diagnosis 'turned our world upside down, and yet nobody could tell us very much about it, what it was or how it was going to affect Lily.' Curtis later founded the Lily Foundation in her daughter's name to raise awareness and support research into the disease, including the latest work done at Newcastle University. 'It's super exciting for families that don't have much hope in their lives,' Curtis said. ___ Ungar reported from Erie, Pennsylvania. ——- The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
The Independent
20 minutes ago
- The Independent
Eight babies born from pioneering IVF technique to prevent devastating disease
Eight babies have been born in the UK thanks to a groundbreaking three-person IVF technique to prevent devastating disease, world-first data shows. Four boys and four girls, including one set of identical twins, have been delivered and are all doing well following treatment by a team in Newcastle, who pioneered the technique. One other woman is currently pregnant. The scientific method, known as mitochondrial donation treatment, is designed to prevent children from being born with devastating mitochondrial diseases that are passed down from their mothers. These illnesses can be fatal and often cause devastating damage to organs including the brain, muscle, liver, heart and kidney. Of the eight babies born, three are now aged under six months, two are aged six to 12 months, one is 12 to 18 months old, one is aged 18 to 24 months and one child is aged over two. All the babies are healthy and are meeting their milestones, according to the team from Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University and Newcastle Fertility Centre. None of the eight babies shows signs of having mitochondrial DNA disease, which tends to affect around one in 5,000 births. The scientists said disease-causing mitochondrial DNA mutations, picked up in three of the children, are either undetectable or present at levels that are very unlikely to cause disease. The main lab method used by the team, known as pronuclear transfer (PNT), involves taking the egg from an affected mother, sperm from her partner and an egg from a donor who is free from disease. The mother of a baby girl born through mitochondrial donation said: 'As parents, all we ever wanted was to give our child a healthy start in life. 'Mitochondrial donation IVF made that possible. After years of uncertainty, this treatment gave us hope – and then it gave us our baby. 'We look at them now, full of life and possibility, and we're overwhelmed with gratitude. Science gave us a chance.' The mother of a baby boy added: 'We are now proud parents to a healthy baby, a true mitochondrial replacement success. This breakthrough has lifted the heavy cloud of fear that once loomed over us. 'Thanks to this incredible advancement and the support we received, our little family is complete. 'The emotional burden of mitochondrial disease has been lifted, and in its place is hope, joy, and deep gratitude.' Professor Sir Doug Turnbull, from Newcastle University and part of the team of researchers, said: 'Mitochondrial disease can have a devastating impact on families. 'Today's news offers fresh hope to many more women at risk of passing on this condition who now have the chance to have children growing up without this terrible disease.' In all the cases, the Newcastle team used the PNT technique after the egg was fertilised. For this, scientists transplanted the nuclear genome (which contains all the genes essential for a person's characteristics, such as hair colour and height) from the egg carrying the mitochondrial DNA mutation into an egg donated by an unaffected woman that had had its nuclear genome removed. Thanks to the procedure, the resulting baby inherits its parents' nuclear DNA, but the mitochondrial DNA is mainly inherited from the donated egg. Scientific progress in this area led Parliament to change the law in 2015 to permit mitochondrial donation treatment. Two years later, the Newcastle clinic became the first and only national centre licensed to perform it, with the first cases approved in 2018. Approval is given on a case-by-case basis by the UK's Human Fertilisation and Embryology Authority (HFEA). The new findings on the eight births, published in the New England Journal of Medicine, show that all the babies are developing normally. Aged 18 months, tests are carried out in areas such as gross motor skills, fine motor skills, cognitive and social development and language skills to check the babies are hitting milestones. The researchers will also check the children when they are aged five. Professor Bobby McFarland, director of the NHS Highly Specialised Service for Rare Mitochondrial Disorders at Newcastle Hospitals NHS Foundation Trust, said he was confident the children would carry on developing normally. He added: 'If we're not picking up subtle signs of problems at five, then we're really very clear that is not going to be a problem.' He added: 'In my work…I see children in intensive care units up and down this country and that's not pleasant. 'It's very difficult for families to deal with these diseases, they are devastating… 'To see babies born at the end of this is just amazing really.' Mary Herbert, professor of reproductive biology at Newcastle University, added: 'PNT happens in the small hours of the morning – those long nights. And it has paid off. 'It's fair to say it's rewarding. In science though, periods of joy are fleeting and brief because you're always thinking what is the next challenge? How do we optimise it further?' She said the slight DNA mutations seen in three of the children are 'way, way below the threshold that would cause disease'. Peter Thompson, chief executive of the HFEA, said: 'Ten years ago, the UK was the first country in the world to licence mitochondrial donation treatment to avoid passing the condition to children. 'For the first time, families with severe inherited mitochondrial illness have the possibility of a healthy child. 'Although it's still early days, it is wonderful news that mitochondrial donation treatment has led to eight babies being born. 'Only people who are at a very high risk of passing a serious mitochondrial disease onto their children are eligible for this treatment in the UK, and every application for mitochondrial donation treatment is individually assessed in accordance with the law.' Dr Andy Greenfield, from the University of Oxford, said: 'It is a triumph of scientific innovation in the IVF clinic – a world-first that shows that the UK is an excellent environment in which to push boundaries in IVF; a tour de force by the embryologists who painstakingly developed and optimised the micromanipulation methods; an example of the value of clinical expertise, developed over decades of working with children and adults suffering from these devastating diseases, being used to support a new intervention and subsequent follow-up, potentially for many years.' Beth Thompson, executive director for policy and partnerships at Wellcome, said: 'This is a remarkable scientific achievement, which has been years in the making. 'The pioneering work behind mitochondrial donation is a powerful example of how discovery research can change lives.' Professor Dagan Wells, from the University of Oxford, said the study showed established methods for avoiding mitochondrial DNA diseases, such as preimplantation genetic testing, perform well and will be suitable for most women at risk of having an affected child. 'A minority of patients are unable to produce any embryos free of mitochondrial disease, and for those women the study provides hope that they may be able to have healthy children in the future,' he added.
The Guardian
21 minutes ago
- The Guardian
‘We'd never heard of it': a woman tells of her daughter's death of mitochondrial disease
When I had my 20 week scan, Lily had a strange heartbeat. It would beat and then stop and then start beating again. The sonographer had never seen it before. I was referred by my local hospital to St George's to see a specialist and it happened again. I went back every day for a week, and then every other day for another week, but they never saw it again. I had another scan nearer Lily's due date and that time there was no blood flow between the placenta and the baby. I had to have an emergency caesarean. That was at 35 weeks. She was so tiny, 3lb 8oz, but they couldn't find anything wrong with her. After four or five weeks I was allowed to bring her home. She wasn't putting on weight. One day, when she was about seven weeks old, I was out with the kids for the day, and when I took her out of the pushchair she had stopped breathing, she was grey and foaming around the mouth. We got her to a hospital and she started breathing again. She was discharged, but a friend of mine who's a paediatric nurse advised me to take her to East Surrey hospital, where she was born and they had all her notes. We were there for 10 days while they did more tests. The doctors thought she might have a metabolic disease and blue-lighted us to the Royal Brompton to see a specialist. They agreed, but we were allowed home. We had to get a taxi back and on the way Lily stopped breathing again. I had a nurse with me who performed CPR. Lily had two cardiac arrests a couple of nights later at East Surrey and ended up at Evelina children's hospital on life support. Lily had a lumbar puncture and some more tests. They strongly suspected she had mitochondrial disease. We were told: 'I'm really sorry, there's no treatment, there's nothing we can do, Lily's going to die.' We had a muscle biopsy to confirm the diagnosis but they didn't think the result would come back before she died. Lily didn't die when they turned off life support. We took her home and she survived for six months. I used to sit up in bed with her on my tummy because I was so frightened of waking up and her not being here. I couldn't bear the thought of her being on her own. We had never heard of mitochondrial disease. After Lily died, we asked for donations instead of flowers at her funeral and there was nowhere to send them. There was no active charity dedicated to mitochondrial diseases. We thought, it's never going to change unless we do something. We just did it, we set up The Lily Foundation. We knew that in order to treat it or to find a cure, we had to be able to diagnose it properly. So we raised money for a gene-testing programme. That was a hugely successful project and it's now a routine test for mitochondrial disease. The charity has now raised more than £11m and supports more than 1,300 families and patients across the UK. Our website is full of information and we run annual meet-ups for families, for adults and for young adults. We have closed Facebook groups that bring people together. People go on there for practical advice and support as well. For parents to have an opportunity to have a baby free of these diseases that's genetically theirs, what they have done in Newcastle is not only an incredible piece of science to be celebrated, but an amazing step forward for families. It is such a tightly regulated, robust process from beginning to end, and that's something we should be extremely proud of. There will always be learning. It's a new technique and I hope it opens doors for more in the future. This is about giving families a choice when every other option has been ruled out.
