Health Check: 'Half the babies born very prematurely will suffer severe disabilities. Is it right to save them just because we can?'

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Indy Lifestyle Online

To many this will seem heartless, but should we be saving extremely premature babies?

To many this will seem heartless, but should we be saving extremely premature babies? They are the tiny scraps of humanity born at less than 26 weeks gestation, that you see festooned with tubes and wires in intensive care units.

They enter the world with immature organs and skin that is so under-developed that it does not even provide a protective barrier. That any survive at all is a miracle of modern medicine. So the fact that half grow up and go to primary school without any significant disability, as revealed by research published last week, is a triumph.

But for the other half it is a different story. They and their parents face a heart-rending struggle in the face of disabilities including cerebral palsy, severe cognitive impairment, blindness and deafness.

It is hard not to think of these babies as the tragic legacy of medical intervention that failed. But to a mother in her 40s, who has tried for a baby for years and for whom this is the last chance, the infant in her arms, however damaged, may represent a dream finally fulfilled.

The study of more than 300 of these very premature babies born in 1995 in the UK and Ireland, published in the New England Journal of Medicine, showed that 46 per cent had developed severe or moderate disabilities by the time they reached six.

The researchers from Nottingham and London insisted that the main value of the findings would be to help parents make the desperately difficult decisions about how hard to strive to save their babies and when to withdraw medical care.

We must hope that they will, though for the mother admitted to hospital in labour after just 24 weeks who is asked to make critical decisions that will affect the lives of her baby and herself while her body is wracked by contractions, I suspect they will be academic.

Far more important will be their impact on doctors, and the advice they give to parents. All premature baby units already withdraw care from babies, in consultation with the parents, where they feel the outcome is likely to be hopeless - either death, or a disability so severe that it is not compatible with a reasonable quality of life.

But some units are more interventionist than others and a baby saved in one might be allowed to die in another. Holland has a national policy not to save babies born at less than 25 weeks. British specialists criticise the Dutch approach for its inhumanity and insist every case must be treated on its merits. Yet in practice most operate a similar bar but set at a lower level of 22 or 23 weeks. Given the extremely poor outcome for these babies - 12 per cent survive with no disability at 23 weeks - it is surely time to extend it nationally than to leave parents to face the current lottery.

Medical technology can now achieve so much, in this area as in many others, that we have to ask whether it is right that we should be saving lives just because we can.

* How safe is your painkiller? Powerful drugs taken by 1.4 million people in Britain called Cox-2 inhibitors are the subject of an urgent safety review because of fears they may raise the risk of heart attacks. One, Vioxx, has already been removed from the market by its manufacturer, Merck, in the largest withdrawal of a prescription drug in history.

The drugs were launched in the US in the late 1990s and rapidly became the most heavily promoted ever, with billions of dollars spent on advertising them directly to the public. Their popularity soared and they were soon being taken by millions of people before their damaging side effects emerged.

Had they been introduced more gradually, over a longer period, there would have been time to spot the problems before they had caused widespread damage. Vioxx alone is estimated to have caused 27,000 heart attacks in the four years it was on the market, of which 7,000 were fatal.

Blame for the extent of the disaster is now being heaped on the practice of advertising drugs direct to consumers, which is permitted in the US but banned here. There is, however, growing pressure for direct-to-consumer advertising of drugs to be introduced in the UK.

The story of Vioxx and the Cox-2 inhibitors provides a powerful argument for resisting any such move.

* Four out of ten Britons spend sleepless nights worrying about their work or home life, according to a shock survey published last week. Only four out of ten? Doesn't everybody suffer from the heebie jeebies from time to time?

As ever, the virtue of such pointless research, normally dreamed up to promote some commercial enterprise, lies in reassuring people that their experience is not abnormal. So the next time you find yourself tossing and turning at night, remember - about 24 million people across Britain are doing the same thing.

And if you need help to nod off, try counting them...

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