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The government's target to halve infections of methicillin resistant Staphylococcus aureus (MRSA) in the blood by 2008 is looking uncertain, a UK government minister hinted last week. The health minister Andy Burnham, giving evidence to MPs in the parliamentary health committee, said that the results he had received showed progress towards the target but that this was not good enough. The former health secretary John Reid announced in 2004 a new target to halve rates of MRSA infection in the blood by 2008. Mr Burnham was pessimistic about how well NHS organisations …

The South African government has effectively sidelined its controversial health minister, Manto Tshabalala-Msimang, as the country's public face of policy on HIV and AIDS. Dr Tshabalala-Msimang has denied that she has in any way been sidelined or silenced, claiming that she can and does say what she wants as the minister responsible for health. However, the cabinet seems to have given the task of developing policy on AIDS to the deputy president, Phumzile Mlambo-Ngcuka. A cabinet statement issued after a meeting at which President Thabo Mbeki was reportedly not present confirmed the deputy's role in the drawing up and presenting of AIDS policies. President Mbeki's absence …

A new wave of fighting in Somalia has sparked an exodus into Kenya, amid warnings of a mounting humanitarian emergency and fears that the situation could spark a regional crisis. The World Food Programme has reported that Somalis fleeing renewed conflict between the …

Male and female relatives of women who receive a diagnosis of breast cancer before the age of 50 are at a higher risk of developing a number of malignancies, a new study has found. The study, which looked at cancer in first degree relatives of women with early onset breast cancer, showed a higher rate of cancers of the breast, ovaries, and cervix among the relatives than national rates, adjusted for age, sex, and time. Among relatives aged under 50 the risk of cancers of the colon and gall bladder were higher, says the study, which was published online ahead of print publication in the European Journal of Cancer on …

Age should not determine whether or not patients are treated for anaemia associated with chronic kidney disease, recommends a guideline published last week. Anaemia is important because it contributes significantly to the heavy burden of symptoms associated with chronic kidney disease, the guideline warns, even though kidney disease is not the most common cause of anaemia. In the United Kingdom around 100 000 people currently have anaemia of chronic kidney disease. The guideline was developed by the National Institute for Health and Clinical Excellence (NICE), the body that advises on use of treatments by the NHS in England and Wales, and the National Collaborating Centre for Chronic Conditions, a multi-professional centre that helps develop clinical guidance for the NHS. The guideline argues that the condition deserves more attention because it is potentially reversible with the appropriate treatment, including erythropoietin. Erythopoietin is a hormone produced by the kidneys that stimulates the formation …

The founder and medical director of a private day hospital was cleared this week by the General Medical Council of falsely claiming on her curriculum vitae to have been employed by five major NHS hospitals. Jean Monro, medical director of Breakspear Hospital in Hemel Hempstead, was accused by the GMC's fitness to practise panel of writing a “dishonest” CV with intent to mislead. Dr Monro claimed to have been medical director of the “allergy and environmental medicine department” of the Middlesex Hospital, the London Welbeck Hospital, the Lister Hospital, the St John and St Elizabeth Hospital, and the Nightingale Hospital. In …

Members of the BMA are calling for a year's delay of the government's proposed new arrangements for advertising and filling posts at specialist training level. They argue that too few posts will be made available, forcing more intense competition—and ultimately driving newly qualified doctors to look for medical posts outside the United Kingdom. The new specialist posts will be offered to medical graduates who gained their degrees in summer 2005 and who have been in the first intake of the two year foundation programme. The new posts will be known as specialist …

People whose blood has a concentration of lead that is high but that is still considered safe have a higher risk of death from many causes than people with a low concentration, a new study shows. The 14 000 people in the study, which was published online on 18 September in Circulation (http://circ.ahajournals.org, doi:10.1161/circulationaha.106.628321), were recruited from 1988 to 1994 and followed for 12 years. Compared with participants whose blood lead concentration was

The pesticide dicophane (DDT) should once more play a part in controlling malaria, the World Health Organization has announced. DDT has been banned for agricultural use in many countries since the 1970s because of fears about its harmful effects on the environment and human health. Almost 30 years ago, widespread indoor spraying with DDT and other insecticides to control malaria were phased out. But WHO is now recommending the use of indoor residual spraying, not only in epidemic areas, but also in areas with constant and high rates of transmission of malaria, which includes all of Africa. “The scientific and programmatic evidence clearly supports this reassessment,” said Dr Anarfi Asamoa-Baah, assistant director general at WHO for HIV/AIDS, tuberculosis, and malaria. “Indoor residual spraying is useful to quickly reduce …

The quality of smoking cessation services provided by the 303 primary care trusts in England is variable, with services in deprived areas outperforming those in richer parts of the country, says a report from the health service watchdog. The review, from the Healthcare Commission, shows that half of the trusts in the poorest parts of England scored “excellent” in their efforts to reduce the impact of smoking, with only 2% of trusts being graded as “fair,” the lowest grade. Of trusts in wealthier areas less than 20% were graded as excellent, and a quarter were rated …

People with antibodies to Porphyromonas gingivalis , the organism most strongly associated with periodontal disease, were more likely to have a stroke, a new study has found. Women who were exposed to the pathogen were up to 2.3 times more likely than other women to have a stroke, shows the research, which was published online ahead of print publication on 26 July in Atherosclerosis (http://www.sciencedirect.com/, doi: 10.1016/j.atherosclerosis.2006.06.027). “We found that systemic exposure to a main periodontal pathogen, P. gingivalis , was an independent risk factor for …

Doctors and other professionals working in the field of public health need to prepare “for the unimaginable and unexpected” and work with greater flexibility if they are going to provide a service that is fit for the future, delegates at the UK Health Protection Agency's annual conference in Warwick this week were told. Stephen Palmer, director of local and regional services at the agency, said that in the future work to protect public health would need to be undertaken within a paradigm of sustainable communities. This would require “integration across separate domains, so that we specialise not just in …

The healthy volunteers who took part in the clinical trial of the anti-CD28 monoclonal antibody TGN1412 had multiple organ failure similar to that seen in septic shock but with several unique features, says a report published last week by Dr Suntharalingam and his colleagues, who cared for the six men after they were transferred to the NHS ( New England Journal of Medicine 2006;355:1018-28). Within 90 minutes of receiving a single intravenous dose of TGN1412 all six volunteers had a systemic inflammatory response characterised by a rapid …

Public heath services in England will be thrown into crisis if jobs in the specialty are cut in the latest round of reorganisation of the NHS, said Rod Griffiths, president of the faculty of public health at the Royal College of Physicians. The crisis could result in incidents on the scale of the disaster at Stanley Royd Hospital in Wakefield in 1984, in which 19 people died of salmonella poisoning, or worse, he told the UK Health Protection Agency's annual conference in Warwick this week, referring to an article in last week's BMJ (2006;333:557). Professor Griffiths warned that …

After years of drought torrential rainfall in the Ethiopian highlands has caused widespread flooding, displacing tens of thousands of people and bringing epidemics of waterborne disease in its wake. Last week the development agency ActionAid said that more than 600 people had died and warned of outbreaks of diseases such as malaria, cholera, and diarrhoea because of “poor sanitation and overcrowding in makeshift shelters.” The agency reported, “Although the level of the water appears to be receding in the town of Dire Dawa [in Ethiopia's eastern highlands], the death toll could rise substantially in the …

In the next half century, the United States will face an “enormous” burden of stroke, estimated at a total $2.2 trillion. The cost will disproportionately affect its Hispanic and African-American populations, a study published online on 16 August in Neurology has found (doi: 10.1212/01.wnl.0000237024.16438.20). “Stroke is the third leading cause of death in the United States and the leading cause of adult disability,” the study says. The study looked at the projected costs of ischaemic stroke from 2005 to 2050 in non-Hispanic white, Hispanic, and African-American people. The greatest economic effect will be lost earnings, the authors conclude, followed by the cost of rehabilitation. Hispanic and African-American US citizens have higher incidences of ischaemic stroke than their …

Until women take control of HIV prevention, it will be impossible to halt the global spread of HIV/AIDS, several speakers claimed at the 16th international AIDS conference in Toronto this week. Of the 39 million people in the world currently living with HIV or AIDS, half are women. Of the 45 million new cases expected between 2002 and 2010, 70% are likely to be in women in the developing world, says UNAIDS. Signalling an urgent need to prioritise methods of prevention that take control away from men, while acknowledging the remoteness of an effective HIV vaccine and the soaring costs of treatments, advocates urged greater investment in microbicide research. Microbicide gels and creams can be applied before sex to prevent HIV and other sexually transmitted viruses from attaching to vaginal walls. Relatively inexpensive and easy to manufacture and distribute, they are designed to be used by women without the cooperation, consent, or knowledge of their partners. Women's health …

British American Tobacco (BAT) has denied that it benefited from, encouraged, and attempted to control smuggling of tobacco into China, allegations reported in an online journal. Contraband has been a hugely profitable and integral part of the company's operations in China over the past two decades, claims the report by Kelley Lee from the London School of Hygiene and Tropical Medicine, and Jeff Collin, of the University of Edinburgh, published online on 18 July in PLoS Medicine (http://medicine.plosjournals.org, doi: 10.1371/journal.pmed.0030228). The illicit trade is described in the report as being worth billions of dollars, and the report says that internal documents of the company show that at one point significant profits were coming from “transit” trade to China—which, alleges an accompanying article by Thomas Novotny (doi:10.1371/journal.pmed.0030279), is a code word for smuggled cigarettes. The accompanying article claims that the documents show evidence of BAT's efforts to build a market presence in competition with other …

Five years after the report from the inquiry into the Bristol children’s heart surgery scandal, reforms have still failed to secure a safe health service, the former chairman of the inquiry warned last week. In a lecture in central London Ian Kennedy said that safety would be the number one consideration in any patient centred service, yet government reforms had not given it a high enough priority. Professor Kennedy called for a “cultural change” in the NHS to make it “patient centred,” rather than “patient led” (the government’s catchphrase), with professionals informing the public and helping patients make local choices about provision of services. The Bristol inquiry was set up after a number of babies died or were brain damaged after heart surgery in the early 1990s. The report blamed not only poor surgery but a catalogue of systems failures, and it made a raft of safety recommendations that had implications throughout the NHS. A surgeon and the medical director were struck off the medical register after the affair, and another surgeon was banned from operating on children for three years. After the Bristol inquiry report the government launched a number of initiatives to improve safety, including setting up the Healthcare Commission, the regulatory body that Professor Kennedy now chairs. It also established the National Patient Safety Agency to collect information on mistakes made by staff. Yet the National Audit Office recently reported that nearly one million incidents and near misses were flagged up in one year, of which 30% were avoidable. Professor Kennedy said the picture was one of “pockets of activity, but poor overall coordination and limited analysis and dissemination of any lessons.” He said, “Every month that goes by in which bad, unsafe practice is not identified and rooted out and good practice shared is a month in which more patients die or are harmed unnecessarily.” He highlighted an initiative instigated in the United States by the Institute for Health Improvement to prevent 100 000 unnecessary deaths in hospitals over a period of 18 months and then in every year thereafter (BMJ 2006;332:1468, 24 Jun). Last month the institute’s president, Don Berwick, announced that the campaign “had succeeded in avoiding the taking of 122 300 lives.” Dr Berwick pinpointed six changes in practice, including using evidence based care to prevent deaths from heart attacks, preventing infections while patients were being treated through central lines or ventilators, and preventing errors in drug treatment. The programme was entirely voluntary, he added, and this illustrated the fact that “change comes about not by being imposed from above but by being facilitated and then owned and supported by those who have to change.” More than 50 US healthcare organisations serve as “nodes” for the campaign, leading initiatives on a state and local level, coordinating technical assistance, and providing peer to peer opportunities for learning.

Indian health officials have cast doubts on a United Nations report that predicts the spread of HIV in India will slow down the country’s economic growth and reduce its gross domestic product by 11 trillion rupees (£127bn; €186bn; $234bn) by 2016. The report from the UN Development Programme, which was published in New Delhi last week, said that the HIV epidemic would increase pressure on the public health system and create devastating social and economic problems among households affected by HIV. Health officials in India said that although they agree about the effect of the disease on individual households the report’s predictions of how it will affect the national economy are based on gloomy forecasts. The study assumed that the prevalence of HIV in India will rise from the current 0.9%, or 5.2 million HIV infected people, to 2.9%, or 19 million, by 2016. But one senior government official said that the basis for such a projection is unclear, and Sujatha Rao, director general of India’s National AIDS Control Organisation, said that such a rise is unlikely, saying, “We have a strong HIV prevention and control programme in place.” The report, which was based on a study by India’s National Council of Applied Economic Research, said the epidemic will force the government to increase annual health spending by 10% by 2012 and by 15% by 2016. The report also predicted a 10% rise in health spending by households affected by HIV. “Treatment and hospitalisation will devastate families affected by HIV,” said Basanta Pradhan, chief economist at the council, who surveyed more than 2000 households affected by HIV and 6000 unaffected households in six states with a high prevalence of the infection. Rates of illness and hospital admission were three times higher among HIV households, the findings showed. But Dr Pradhan admitted that the study had described “a very pessimistic scenario.” Earlier this year Indian and Canadian public health specialists reported what they described as the first signs of a fall in the number of new HIV infections in south India (Lancet 2006;367:1164-72). They found that the prevalence of HIV infection among young women aged between 15 and 24 had dropped by more than a third—from 1.7% to 1.1%—over the past four years in four states with a high prevalence of HIV. “New cases appear to be declining in south India,” said Rajesh Kumar, head of community medicine at the Postgraduate Institute of Medical Education and Research in Chandigarh. The researchers attributed this fall to greater use of condoms among men and commercial sex workers and a consequently lower rate of transmission across the community. But Dr Kumar cautioned that the burden of HIV would remain high, because of the cumulative number of cases.

Funding from the European Union will be available for research involving human embryonic stem cells for at least the next seven years, under an agreement reached in Brussels this week. The decision was taken only after the European Commission gave a firm guarantee that “projects which include research activities which destroy human embryos, including for the procurement of stem cells,” would not be eligible for EU funding. The commission’s statement continued: “The exclusion of funding of this step of research will not prevent [European] Community funding of subsequent steps involving human embryonic stem cells.” The two sentence declaration does not change existing policy. The EU already refuses to fund activities where embryos would be destroyed. It is currently financing nine projects involving embryonic stem cell projects, all of which would satisfy the rules of the new multi-annual European research framework programme, which will come into force in January. Janez Potoenik, the EU’s commissioner for research and one of the main architects of the agreement, noted: “We clarified what we are doing and committed ourselves to continue in that direction in future.” The pledge was sufficient to satisfy Germany, Italy, and Luxembourg, which had originally opposed the funding deal. Other opponents—Poland, Austria, Slovakia, Lithuania, and Malta—stood their ground but did not have enough votes at the Brussels meeting of EU science ministers to block the agreement. The legislation lists three other areas that will not qualify for EU funding: research aimed at human cloning for reproductive purposes, research intended to modify the genetic heritage of human beings, and research to create human embryos solely for the purpose of research. The agreement, which must now be formally approved by the European parliament after its summer recess, will not change the status of stem cell research in Europe. Under the principle of ethical subsidiarity it is up to each individual government, not the EU, to determine whether such research may or may not take place in each country. In Ireland such research is banned and will remain so, but its representative, Micheal Martin, endorsed the agreement. “We have to face up to the challenges of contemporary science, and we have to respect the rights of other member states. It is a delicate but workable compromise between different viewpoints,” he said. David Sainsbury, Britain’s science minister, also welcomed the deal, describing it as “symbolically very significant.” He said that it may increase the number of disillusioned scientists in the field of regenerative medicine leaving the United States for Europe. The amount of EU money expected to be available for stem cell experimentation between 2007 and 2013 is likely to be €50m (£34m; $63m), out of a total research budget €54bn. Each application for an EU grant will have to be individually approved by national representatives.

More than one in five complaints to the parliamentary and health service ombudsman Ann Abraham in England last year related to the removal of patients from GP lists. Many of the people complaining said that they had not had a warning of removal or been given the opportunity to put their side of the story. The figures from the ombudsman published last week show that less than half the complaints made against GPs in 2005-6 were upheld …

The German coalition government—and in particular the chancellor, Angela Merkel—has been heavily criticised for plans to reform the country's underfunded health system by raising the fees paid by members of state health insurance schemes. Under the proposal healthcare insurance fees paid by employees and their employers will rise by around 0.5% by 2007. In addition, for the first time in the national health system's 150 year history, tax revenues will be used to help finance it. The government will spend €1.5bn (£1bn; $1.9bn) in 2007 and €3bn a year from 2008 onwards, mainly to help fund children's health insurance. The …

The government has made an extra £750m (€1.1bn; $1.4bn) available to new and existing community hospitals in England over the next five years in a bid to regenerate diagnostic and outpatient treatment services closer to where people live. Some of the money will go towards saving some of the local hospitals currently threatened with closure, said the secretary of state for health, Patricia Hewitt. But campaigning groups such as Community Hospitals Acting Nationally Together (CHANT) have said the extra cash comes too late for many of the 70 community hospitals that are set to close because of financial problems in the NHS. CHANT said that 10 community hospitals closed in the first six months of this year. The announcement of extra funding for community services follows the white paper published in January …

Women who took the drug diethylstilbestrol during pregnancy have an increased risk of death from breast cancer ( British Journal of Cancer 2006;95:107-11). Results from the largest study to date of mortality outcomes in women who were exposed to the drug also show increased mortality from all causes. Diethylstilbestrol is a powerful non-steroidal oestrogen that was used to prevent pregnancy loss and complications for almost 30 years. The highest rates of breast cancer mortality were in women who had been in clinical trial with the drug and …

Twelve medical institutions in the UK and Ireland are to share an £84m (€121m; $155m) award to boost clinical research facilities over the next five years. The award, the largest of its type, comes from a consortium of research funders led by the Wellcome Trust, and will help make the United Kingdom a world leader in clinical research, says the trust's director Mark Walport. The money will go to developing existing clinical research facilities and setting up new ones. The facilities would give the UK a greatly enhanced capacity to do first class research in key areas including …

The importance of the links between AIDS, nutrition, and food security is only just being realised, a conference in London was told last week. The disease is having a devastating impact on the availability of food. And a shortage of food is increasing deaths from the disease, the conference heard. In April last year, the World Health Organization held a consultation meeting in Durban, South Africa, on nutrition and HIV/AIDS in Africa, at which participants concluded that “the HIV epidemic is increasingly driven by, and contributes to, factors that also …

A hard hitting report from the UK House of Commons' Science and Technology Committee claims that the use of new high powered magnetic resonance imaging (MRI) scanners could be threatened by new European Union legislation. The committee maintains that both the European Commission and the UK government had failed to consult sufficiently with the medical community and manufacturers when the EU electromagnetic fields directive, which comes into force in April 2008, was unanimously adopted by governments two years ago. The principal aim of the …

A public inquiry into the South Wales outbreak of Escherichia coli opened in Cardiff last week. The outbreak led to the death of a 5 year old and to 150 other people being taken ill. Hugh Pennington, professor emeritus of medical microbiology at Aberdeen University, who has been appointed to lead the inquiry, said that it would be independent, and inquisitorial rather than adversarial. “It is a means of seeking out the facts in a way that would …

Doctors have called on the BMA to “vigorously” challenge the government over the thousands of jobs cuts being proposed in hospitals in England because of the financial crisis in the NHS. Speaking at the BMA's annual representative meeting in Belfast, Anthea Mowat, an associate specialist anaesthetist at the Pilgrim Hospital in Boston, Lincolnshire, who put forward the motion, delivered a long list of proposed job cuts and redundancies in the NHS, some of which would be compulsory. “In the east, Norfolk and Norwich [University …

Drug companies continue to pull the wool over the eyes of patients and doctors, concludes a new report from Consumers International. The report lambasts the industry for its lack of transparency and unscrupulous marketing. Consumers International has called on governments to rein in the industry's practices that “misinform consumers about the benefits of the drugs they are buying.” It warns that drug companies are adopting new ways to influence consumers, such as sponsoring patients' groups and funding disease awareness campaigns, as well as using old methods such as offering hospitality to medical experts or “opinion leaders.” Richard Lloyd, the …

The ethics bureau of the Israel Medical Association has released a position paper to guide its members on how to act when their medical training clashes with their patients' faith and beliefs. Avinoam Reches, chairman of the ethics bureau and a senior neurologist at Hadassah University Medical Centre in Jerusalem, said he hopes the guidelines—published in the latest issue of the association's Hebrew language magazine, Zman Harefuah— would help colleagues in a country where religion and faith in general …

Doctors at the annual meeting of BMA representatives in Belfast condemned suggestions that primary care health services might be provided on supermarket premises. The government has since denied that it might be proposing schemes where the public could get a “check-up at the checkout” as a way of boosting access to GP services. This was not contained in its health White Paper published Our Health, Our Care, Our Say: a New Direction for Community Services , published in February, said …

Food manufacturers should be forced by law to adopt a “traffic light” system to signal the nutritious content of all their products, doctors agreed at the BMA's annual conference of representatives in Belfast this week. The system, which the Food Standards Agency first proposed in July 2004, has been rejected by some supermarkets. …

The BMA voted by 59% to 41% against affiliating with the pressure group Keep Our NHS Public at its annual representative meeting in Belfast, but it reaffirmed the group's aims and principles. Wendy Savage, an obstetrician and gynaecologist, said in proposing a motion in favour of affiliation that the group had been set up in 2005 because of “an urgent need to defend the NHS” and prevent it adopting the wasteful, inequitable systems of the United States. Professor Savage told the meeting that if representatives did not believe that the government was creating a market, they should …

The World Health Organization has produced a book that gives a clear overview of the essential health features and systems of the 12 countries on the European Union's eastern and southern borders. The 248 page publication gives basic information for each of the countries, covering their demography, prevalent diseases, and health risks, and explains how the country's health sector is being reformed, organised, and financed. The book follows the same format as an earlier WHO publication that presented the health characteristics of the 10 countries that joined the European Union in May 2004. That book …

Doctors in German university hospitals last week agreed a 16% pay rise with their employers, after a strike that has lasted three months. They have suspended strike action and are expected to call off the strike permanently when the deal is approved by members of the hospital doctors' union, the Marburger Bund. However, the doctors are divided, because those in eastern Germany have been offered a rise that is only 88% of that of their colleagues in western …

The Dutch health minister, Hans Hoogervorst, has ordered an investigation into a book's claim that the drug industry has a strong influence on medical guidelines issued to doctors. The book, by the investigative journalist Joop Bouma, draws on interviews and research over six years to illustrate what he believes to be aggressive marketing practices by the industry. It highlights the pressures put on Dutch bodies whose job is to issue professional treatment standards and prescribing guidelines: the College of General Practitioners and the Institute for Healthcare Improvement. In 2004 GlaxoSmithKline, for example, is said to have requested changes to the institute's draft guidelines for treating tobacco addiction, which cast doubts on the effectiveness of its antismoking drug bupropion (Zyban). The institute said, in its draft, that it was concerned that research …

Short term financial cuts in some trusts in England are threatening the major gains brought by the new consultant contract, the BMA warned at the latest hearing of the parliamentary health select committee into workforce planning. The deputy chairman of the BMA's consultants' committee, Jonathan Fielden, said that the new contract had fostered collaboration between consultants and managers and helped make dramatic improvements in some areas of work, such as meeting emergency department targets and cutting numbers of cancelled operations. “Unfortunately, that partnership is put under stress by centrally driven short term measures,” said Dr Fielden. “Where relations are fractured you will …

Fewer Canadians are dying in hospital within 30 days of having a first heart attack than in the past, but the number of Canadians dying in hospital within 30 days of a first stroke is stable, a report has found. Also, inhospital mortality within 30 days of admission with a new acute myocardial infarction or stroke differ significantly between men and women in Canada, the report from the Canadian Institute for Health Information says. The institute's analysis shows that patients admitted to hospital with a new stroke were more likely to die within 30 days than patients admitted with …

An estimated 23% of all premature deaths can be attributed to environmental factors that are modifiable and preventable, a report from the World Health Organization says. “Many measures can indeed be taken almost immediately to reduce this environmental disease burden,” said Maria Neira, WHO's director for public health and the environment. “A few examples include the promotion of safe household water storage and better hygiene measures, the use of cleaner fuels, and safer, more judicious use and management of toxic substances in the home and workplace.” The study analysed how different diseases—85 of the 102 major diseases—are affected by environmental risks and by how much. The report concludes: “A better understanding of the disease impacts …

Problems associated with multiple births after assisted conception techniques, including in vitro fertilisation, may account for more than 220 perinatal and infant deaths a year in England and Wales, new research indicates. The United Kingdom urgently needs to move towards single embryo transfers for in vitro fertilisation, conclude the authors of the study, which aimed to quantify the excess number of deaths associated with multiple births after assisted conception ( Br J Obstet Gynaecol 2006;113:738-41). The chance of a multiple birth after in vitro fertilisation is around 45%, says the report. It adds that multiple birth is largely thought …