02 August 2010
ByAppeared in BioNews 569
Using archival material and supported by the Wellcome Trust, we have reconstructed the original negotiations and attempted to explain the decision. A paper published in Human Reproduction reports our results.
We suggest that the rejection can be understood in the context of the institutional procedures and attitudes at the time. But we also find that Dr Edwards and Mr Steptoe had surprisingly strong support.
Dr Edwards, a physiologist at the University of Cambridge, and Mr Steptoe, a gynaecologist at Oldham General Hospital, sought state funding for their increasingly promising and heavily publicised research programme, primarily to bring Mr Steptoe to Cambridge.
A preliminary application proposed an extensive programme of scientific and clinical work on human conception. The bid satisfied a strategic policy only recently developed within the MRC to encourage joint clinical and scientific research in UK academic departments of obstetrics and gynaecology, which were then considered weak. This weakness had made it difficult to recruit high-quality reproductive scientists and clinicians to the MRC's newly opened flagship enterprise, the Clinical Research Centre (CRC) at Northwick Park Hospital in west London. Its first director, Professor Graham Bull, seized the opportunity presented by Dr Edwards and Mr Steptoe to offer them both positions at the CRC, with a full set of staffed laboratories plus 20 research beds in obstetrics and gynaecology.
Dr Edwards was tempted, but declined. He told the MRC he preferred to remain in Cambridge, where he found the intellectual atmosphere more stimulating, and wished to apply for a five-year grant or even an MRC unit there. Crucially, he did not fully appreciate the strategic reasons behind the initial enthusiasm at the MRC, nor how much more difficult it would be to gain funding as an external applicant.
This course of action was to prove ill-advised for several reasons. Perhaps most importantly, there was then no academic department of obstetrics and gynaecology at the University of Cambridge, which was in the process of establishing a Clinical School. The local hospital consultant obstetricians and gynaecologists were reportedly hostile to the prospect of Mr Steptoe's moving there. Moreover, although thin in obstetricians and gynaecologists, Cambridge was thick with reproductive physiologists.
The emergent Clinical School decided to back another local 'young turk', Dr Roger Short, as its star. He was influential at the MRC and threatening to leave Cambridge for Edinburgh (and soon did). Dr Edwards' bid was therefore given somewhat ambivalent local support at his home institution.
Newmarket General Hospital threw a lifeline, however, again driven in part by local logistical problems. Short of consultant cover, the East Anglian Regional Hospital Board offered Mr Steptoe a part-time consultant's position, so that the rest of his time could be spent on the MRC research. The board even offered to build a 20-bed research ward - if the MRC paid.
Mr Steptoe was all set to come, although in the end he and Dr Edwards preferred a clinical research base closer to the central Cambridge laboratories. They identified a large house nearby, recently vacated, ironically, as a home for unmarried mothers. Dr Edwards' and Mr Steptoe's application to the MRC, submitted in February 1971, proposed this arrangement, with a half-time MRC position in Cambridge for Mr Steptoe, plus a part-time NHS consultant position in Newmarket.
MRC officers and referees were worried about the scale and scope, but there was also significant backing. The proposal was sent out to clinical and scientific referees. Some clinical referees were alarmed about patient safety in the proposed set-up, adrift from hospital support. There was a mixture of praise for and criticism of Mr Steptoe as an innovative if over-enthusiastic clinician. The scientific referees admired Dr Edwards as a scientist of imagination, industry and flair, but again worried about his over-enthusiasm.
They were concerned IVF embryos might be abnormal and that their replacement could lead to the birth of deformed babies. With one exception, they placed a much higher premium on limiting fertility than on alleviating infertility. There was also no enthusiasm for PGD; they preferred amniocentesis and termination. Only one referee raised the moral status of the embryo as an issue. Overall, the referees preferred primate studies first.
Several criticisms were made of Dr Edwards and Mr Steptoe for their 'inappropriate' use of the media to discuss the scientific, ethical and political issues raised by their research. The MRC could not fund the work based on such reports and the Clinical Research Board accordingly rejected the application.
Dr Edwards was shocked. He clearly still believed that the offer to join the CRC conveyed support, and - by miscommunication on one side or the other - had not understood from MRC staff how to structure the bid in a way that was likely to succeed. He articulated in a rebuttal several arguments that would have strengthened the original application. They thus came too late.
Following the rejection of their application, Dr Edwards and Mr Steptoe became embattled and isolated in their attempts to pursue their research with private funds under far-from-ideal conditions. They continued to engage with the media, in part in response to public attacks, and this fuelled further peer opposition, as well as concern at the MRC. In 1974, the then secretary articulated its policy on human IVF and embryo transfer at a press conference and so effectively blocked support for the next five years.
When the change in policy came, it was based on surprisingly thin evidence - two out of seven pregnancies delivered successfully to term. The MRC was now willing to fund research focused on ensuring this 'experimental therapy' was conducted safely.
Overall, the story that emerges is of research that challenged social attitudes, values and priorities. At the same time, the bid did not succeed in taking advantage of opportunities created by significant institutional innovations in the reproductive sciences and in clinical research. There was a tension between strategic planning and caution about a specific research proposal that appeared to meet many, but by no means all, strategic criteria.
More generally, the story confirms the fundamental ambivalence that continues to surround innovations in bioscience and biomedicine. It also shows the depth of ongoing conflict between faith in the benefits of scientific progress and reluctance to endorse innovations that go 'too far' - especially when they concern human reproduction.
The story of the MRC's non-funding of IVF also belies the cliché that science 'races ahead' of society. The standard view, that ethical consideration of bioscience and biomedicine can only be reactive, is contradicted by the evidence of extensive ethical debate surrounding the prehistory of clinical IVF - much of it actively stimulated by Dr Edwards himself.
Although attitudes to the media have changed significantly since the 1970s, scientists and clinicians engaged in high-profile work still face a dilemma. If they encourage public discussion of their work - which they may see as both necessary to securing support and desirable to ensure full ethical debate - must they inevitably weaken their standing among their peers?
Finally, our study questions the myth of two courageous mavericks pitted against a conservative establishment. This does capture important elements of truth: Dr Edwards and Mr Steptoe were outsiders and did pioneer—against prevailing wisdom—new ideas, therapies, values, public discourses and ethical thinking. But the process of decision-making was more complex than the myth allows. Our research provides a fuller understanding of the birth of the IVF revolution.