Mohammed Taranissi is Britain's most controversial doctor. He is the object, in equal measure, of much gratitude and much suspicion. He is also, according to the Sunday Times Rich List, the UK's richest doctor with a personal fortune of £38m. Forget cancer or heart disease or other big killers, medical fame and fortune in the 21st century comes from making babies. And Taranissi's Assisted Reproduction and Gynaecology Centre has secured thousands of these little bundles of joy for desperate parents.
But the Human Fertilisation and Embryology Authority (HFEA), which regulates in vitro fertilisation, is unimpressed by his achievements. In fact, they ranked Taranissi's London clinic second to bottom in their league table last week for compliance with their regulations. The one clinic that performed worse in the audit no longer has a licence to operate. Taranissi scored a whopping -29 against an ideal score of zero. Make no mistake - Taranissi has been served notice.
The bizarre disparity is that while the HFEA is giving Taranissi a public dressing down, his success rate continues to surge forward and is now almost double the national average. He manages to help 54% of women under 35 using their own eggs to get pregnant, against an average of 28%. Fellow fertility doctors are mystified - and more than a little suspicious. Tonight's Panorama will claim that Taranissi uses unnecessary and unproven therapies; interviewed in the programme, Professor Robert Winston says that Taranissi "makes you weep for the medical profession".
The current spat is only the latest round in an ongoing battle between Taranissi and the HFEA. He went to court over the case of a 47-year-old woman whom he wanted to implant with five embryos, but lost. In his next round with the HFEA over "saviour siblings" (selecting an embryo that can help a sick older sibling), the HFEA, after considerable media pressure, changed its policy.
It's a very public contest, with the tabloids rallying to Taranissi's side to take the HFEA to task for being obstructionist. But beyond the emotive coverage that IVF is always likely to inspire, the case of Taranissi reveals many of the reasons why assisted reproduction is rapidly becoming one of the hardest areas of medicine to regulate.
Take a closer look at the concerns about Taranissi's methods, and the complex issue of risk moves centre stage - and how those with different interests at stake weigh risk differently. A desperate woman may be only too happy to take considerable risks with her own health, perhaps even that of a future baby's. It may be understandable that the HFEA sees its job as preventing the latter, but is it also part of its remit to prevent the former? Charged by parliamentary statute to ensure that the welfare of the baby is paramount, how does the HFEA weigh the competing interests - of parents, future children and society?
Taranissi's clinic reportedly has a high rate for twins and triplets - so-called multiple births. Regulations have tightened on the number of embryos implanted in a woman to reduce the risk of a multiple birth (a limit of two for women under 40, and three for women over 40) as concern has grown over this side-effect of IVF.
During the 90s, IVF triplets increased from one in 500 live births to one in 20. Such multiple births run a much higher risk of prematurity and low birth weight, with possible long-term consequences such as cerebral palsy (triplets are 18 times more likely to have the condition). There are also the higher costs of expensive neonatal care: 50% of all twins and 90% of all triplets are born prematurely. Ruth Deech, the former chair of the HFEA, even made the sensible suggestion back in 2002 that the clinics that are making so much money out of IVF should contribute to the growing NHS bill for the consequences of their work.
But the different ways in which parents and the HFEA assess these risks often bring them into conflict. To a desperate couple, the risk of a premature baby is a small price to pay for a much longed for one. Besides, as fertility experts admit, such is the longing for a baby that some prospective parents don't even consider the risks outlined by their doctors. One expert reckoned that patients listened to about 10% of what they were being told.
There are concerns around the expensive hormones and antibodies that Taranissi uses, which push up the cost of a treatment to well above the usual IVF rate of around £2,500. Fellow fertility doctors argue that there is no research evidence for the use of some of them. But impatient couples are willing to take the risk rather than wait for the outcome of research programmes. So, despite press coverage full of patients who lavish praise on the man for his dedication to his work, the questions linger: what's the trick and why doesn't he let others in on the secret? Meanwhile, given his success rate and media support, the HFEA will have to tread carefully.
IVF involves both desperation and money - a combination guaranteed to outwit even the most astute of regulation regimes. Eighty per cent of IVF in the UK is private, despite attempts to get more NHS provision. And IVF represents an excellent business opportunity, as a professor from Harvard Business School, Deborah Spar, made clear at the HFEA's annual general meeting last year. Demand is steadily increasing - currently one in six couples have infertility problems and that is expected to rise, and many of these couples will pay almost anything for a baby.
Increasingly, this market is going global - well beyond the reach of any national regulations. "Fertility tourism" takes women to Cyprus, Spain, Italy and a widening range of countries - enticed by the promise of donated eggs, no age limits for treatment, and none of the HFEA's restrictions on the number of embryos to implant in the womb. In this wild west of IVF capitalism, eastern European women can sell their eggs; internet sites even offer "Ivy League" eggs for $25,000. Every human attribute ends up with a price tag.
In the United States, any attempt to regulate was scotched by the political impossibility of legislating on an issue that provokes such deep religious opposition - and the result is close to a free-for-all. Britain's model of pragmatism towards embryology and fertility has been widely admired around the world. For example, the 14-day limit on experimentation on the embryo has been widely adopted. But the only hope of holding the line is by advancing international regulation - and the chances of that look remote, claims Jonathan Glover, a renowned ethicist in this area, in his recent book, Choosing Children.
Meanwhile, another run-in with the HFEA and Taranissi may just decide to up sticks (as he has hinted in the press) and move his clinic somewhere more congenial - that will simply add the cost of accommodation and air tickets to the hefty bill for a baby. The HFEA looks as if it is in the uncomfortable position of a Canute trying to turn back the waves.
· Panorama is on BBC1 tonight at 8.30pm
m.bunting@theguardian.com
