Claire Anne Brule

Male Infertility and Exposure to Insecticides : A Study Confirms a Link

by Claire Anne Brule | November 24, 2023 | News

A recent study has just confirmed the links between male infertility and exposure to insecticides.

The collapse of male fertility has been widely documented by scientific research. A meta-analysis published in 2017 reported a decline of over 50 % in the average concentration of sperms in forty-year-old western males (between 1973 and 2011). Although this decline in the concentration of sperms is obviously associated with diminished fertility, it also has wider implications on male health and even on mortality, according to this study and other research.

What does the study claim?

The research scientists worked on a set of previously published studies, on American governmental and non-governmental web-sites. From a sample of 325 studies, they selected 20 studies by statistical sampling covering different populations worldwide. The aim of the studies was focussed on the link between two classes of widely used pesticides, namely organophosphates (OP) and N-methyl carbamates (NMC), and the concentration of sperms. The harmful effect of these substances on human health has been widely documented. The MSD Manual web-site for health professionals on its page concerning “intoxication” by these substances indicates that:

“In the long term, persistent after-effects of intoxication by organophosphates may include memory loss or Parkinson’s syndrome.”

Organophosphates (OP) constitute the most widely spread class of insecticides worldwide and represent some 30 % of the world market.

The study concludes that there is:

“Sufficient evidence that a greater exposure of male adults to OP and NMC insecticides is linked to a reduced concentration of sperms.”

In strict scientific terms, the link does not constitute a proof of the causality. Nevertheless, according to the main author, Dr Melissa Perry of G. Mason University in the United States:

“This review is the most complete evidence from over 25 years of research into male fertility and reproductive health. According to the data available, we must take regulatory measures in order to reduce the exposure to insecticides.”

The implications for male health

Spermatogenic anomalies, i.e. those affecting the production of sperms, are by far the most frequent causes of male infertility. Many factors are responsible including life style (sedentariness, alcohol, smoking, cannabis etc.), genetics, a history of certain infections, exposure in utero to toxic products and pollution. According to a report by the French Urology Association (AFU) dated 2021, “Around 15% of couples are confronted with infertility (i.e. some 60,000 new cases per year in France), of which 20% are strictly masculine caused and 40 % mixed, which include a masculine factor.”

Apart from the impact of this diminished sperm concentration on fertility, studies have established a link with other health problems. A Danish study published in 2017 concluded with “We found that the quality of sperm is a powerful universal biomarker for health. We were able to show that men with a poor sperm quality required more frequent hospitalisation, in particular for sugar diabetes and cardiovascular diseases.”

The “Movember” movement, launched in Australia in 2003, in French known as “Novembre Bleu (Blue November)” coming after “Octobre Rose (Pink October)”, was intended as an awareness campaign for male health problems, and to collect funds in aid of medical research. The study on the link between pesticides and male infertility, confirming previous studies, provides its contribution to such research. In view of the extensive use of pesticides in the industrialised nations, the solutions required in order to reverse the trend represent a major political challenge.

Oregon : The Inevitable Abuse of the Medical Assistance in Dying Model

by Claire Anne Brule | November 17, 2023 | End of life, Euthanasia and Suicide

A retrospective study over the last 25 years of the practice of medical assistance in dying in Oregon (United States) shows the constant rise in the number of cases over the last 25 years and an extensive interpretation of its application criteria.

Oregon was the first American State, in 1997 to pass a law authorising medical assistance in dying known as the “Death with Dignity act”. British scientists have analysed the evolutions in the legislation which is often presented as a “model” by studying the data in the annual reports issued between 1998 and 2022 by the Oregon Health Authority (OHA). Their analysis, published in October 2023 by BMJ Support Palliative care shows the abuse of the system through several factors: the number of people resorting to medical assistance in dying, the eligibility criteria, the socio-demographic characteristics, the reasons for resorting to medical assistance in dying and the information concerning the procedures for the act.

The term medical assistance in dying (MAID) refers to “the self-administration of a lethal product”. The law in Oregon specifies that the prescription for the product must be provided by a doctor but that the latter’s presence at the moment of administration is optional. The person requesting MAID must be an adult, capable of taking and expressing medical decisions, and must have been diagnosed with a terminal phase disease with less than six months life expectancy. A 15-day cooling-off period is required before being able to conduct the MAID act.

Evolution of the “medical” practice

Over the last 25 years, 2,454 people have died through MAID, increasing from 16 in 1998 to 278 in 2022. That represents 0.6% of all deaths. In comparison to the population in France, that would equate to some 4,000 MAID acts per year. The average age of MAID patients is 72.5 years.

The data for 2022 provided in the latest annual report reveal that 431 prescriptions were issued by 146 doctors. The prescribing doctors represent 0.9 % of the total number of doctors in Oregon which indicates a concentration of this practice on a minority of doctors. Most of those doctors prescribe the act once or twice per year, apart from one doctor who prescribed 51, which corresponds to virtually one per week.

All the people having been provided with a prescription for MAID do not necessarily use it. However, there is a lack of data concerning the reasons for such non use: either the patients died from their disease, or they abandoned the idea of MAID. No information is provided on the products procured and not used. The proportion of deaths following the self-administration of the prescribed lethal product compared with the number of prescriptions has increased from 58% during the first ten years following legalisation to 67% over the last 5 years.

Over 25 years, a strong reduction was noted of the duration of the therapeutic relationship with the prescribing doctor. It has fallen from 18 weeks in 2010 to a mere 5 weeks in 2022. The psychiatric evaluations to verify the applicant’s ability to take such a decision have practically disappeared. From 28% during the first 3 years following legalisation, the figure has fallen to a mere 1% of those resorting to MAID in 2022. The authors are concerned about the possible influence of this reduction in psychological evaluations and the reduction of the therapeutic relationship on the diagnosis of treatable factors such as solitude, depression and anxiety influencing the request to die.

Although the figures indicate ready availability of palliative care (an average of 90.8% between 1998 and 2020), there is no information concerning what exactly this availability represents. The term “palliative care” refers to the provision of comforting care when no other treatments are covered by social security. It is not specified whether this includes multi-disciplinary care or that provided by a single non-specialist practitioner. This lack of information fails to identify whether the patients received adequate palliative care before resorting to MAID.

Finally, in recent years the lethal products used have evolved. Although a lack of data on dosages prevents any precise analysis, the feedback in the 2022 report appears to suggest that the products used could have a tendency to increase the time elapsed between the self-administration of the product and the ensuing death. According to the 2022 report, of the 165 patients for whom this indication is known, the time lapse varied from 3 minutes to 68 hours with an average value of 52 minutes.

The evolution in the eligibility criteria and processes is quite puzzling

The scientists point out the non-compliance with the criteria stipulated by the law. Such as for example the 15-day cooling-off period which a quarter of the patients were exempted from in 2022 due to the imminent terminal phase of their illness. Although the requests concerned cancer patients in 80% of cases during the first five years, they represented only 64% in 2022. Since 2010, some patients have been resorting to MAID due to multiple non-terminal pathologies (such as arthritis, complications following a fall, a hernia, sclerosis or mental anorexia) which do not correspond to the diagnosis of an illness leading to death within 6 months.

The reasons given by patients when asking to die vary from a fear of losing their autonomy to financial difficulties.

90% of them mention a loss of autonomy, as well as the loss of the ability to take part in the activities which make life enjoyable, 74% mention a loss of dignity and 27% the lack or a fear of the lack of pain relief. The feeling of being a burden on their entourage has increased from 30% during the first five years following legalisation to 46% in 2022.

Finally, financial considerations are on the increase. Concern on the cost of treatments sometimes leading to rejecting treatments and applying for MAID reached 8.1% in 2021. The authors also observed an evolution in the social categories of patients since 2008 based on medical insurance which is a life-style indicator in the United States. An average of 65% of MAID applicants had private medical insurance up till 2008. The trend then completely reversed: 79.5% of patients requesting MAID subscribe to public medical insurance including Medicaid which is granted to those living below the threshold of poverty. These indications merit a more detailed study insofar as the Medicaid proportion in the public insurance category could not be determined.

The authors of the study concluded that the data remain limited and that the doctors are present in a mere 25% of cases at the moment of swallowing the lethal product and in 28 % of cases in 2022, the patients are alone. More detailed studies are obviously needed.

Currently 10 out of 50 States in the US have adopted legislation authorising MAID: in addition to Oregon, they are the states of Washington, California, Colorado, New Mexico, Maine, Vermont, New Jersey, District of Columbia (Washington DC), and Hawaii. The State of Montana tolerates it as a result of precedent. The American Medical Association (AMA) reaffirmed its opposition to MAID on 14^th November following renewed pressures to adopt a more neutral position.

Abortion in the French Constitution : a Freedom or a Right, the Wrong Debate ?

by Claire Anne Brule | November 17, 2023 | Abortion

On 29^th October 2023, President Macron announced that a bill to register abortion in the French Constitution would be submitted to the cabinet during December. According to information in La Tribune, the text to appear under article 34 of the constitution would be as follows: “The Law determines the conditions under which a woman’s freedom is exercised, which is guaranteed to her, to have recourse to an abortion“. Beyond the symbolic significance of the said addition in the constitution, the choice of the word “freedom” rather than “right” is causing debate. Does the choice of one rather than the other term in any way modify the impact of the registration in the constitution?

Reminder of the facts

In November 2022 a constitutional bill, which was adopted at its first reading by the French National Assembly provided that “the Law guarantees the effectivity and equal access to the right to resort to abortion“. The French Senate then adopted it under the following terms: “The Law determines the conditions under which women’s freedom to end their pregnancy may be exercised”.

Freedom, right: which definition?

According to Anne-Charlène Bezzina, Master of conferences in public law at Rouen University, “Freedom is a ‘faculty to’, it is a subjective notion, it is ‘I can resort to’. For example, with freedom of speech, if I wish to speak or publish, I do so, but I expect nothing in return. Whereas a ‘subjective right to’, suggests a credit: the State must guarantee it. That is the case with the right to strike for example.”

For the supporters of registration of a right, the word “freedom” does not go far enough.

According to Mathilde Philip-Gay, Professor of public law at Jean Moulin Lyon 3 university, “The right to abortion, is a guarantee that if a person so wishes or if it is necessary, they can proceed with an abortion. Freedom is guaranteed by Law, whereas a right must be guaranteed in itself.” According to her, although “the choice of the word “freedom” may be symbolically important – since it enables the term “abortion” to be registered in the Constitution – legally, there is no major difference” compared with the current situation.

This position is also supported by Jean-Marie Burguburu, a lawyer and President of the CNCDH (National Consultative Commission on Human Rights). In a notice adopted on 28^th September 2023, the CNCDH states: “It is the right itself which must be established and not the power to legislate on the subject. The wording adopted must incorporate a “guarantee” in order to avoid any regression relative to the current state of the law. It must express a clear establishment of the right to wilfully terminate their pregnancy for any person who so wishes.”

In fact, the Constitution does not recognise any distinction between the notions of freedom and right.

According to constitutional standards, rights and freedom may only be exercised in the context of laws which regulate them. The Constitution affords equal protection to “the rights and freedoms which it guarantees” in particular through the possibility of raising a Priority Preliminary Ruling on Constitutionality (PPRC) under article 61-1. Furthermore, nothing in the Constitution indicates that the rights and freedoms which it contains have any different significance. The rights and freedoms which it guarantees, are indeed understood, indistinctly, from the provisions of the very fundamental law itself, including its preamble and the texts to which it cross-refers, as well as non-written principles emerging from Constitutional Council precedents.

Through its decision in 2001, the Constitutional Council considered that the law on abortion is compliant with the Constitution insofar as it preserves the equilibrium “that compliance with the Constitution involves between, on the one hand, safeguarding of human dignity against any form of degradation and, on the other hand, women’s freedom under article 2 of the Declaration on Human and Citizens’ Rights”. This constitutional precedent establishes a form of equilibrium between several constitutional freedoms, rights and principles: The 2001 decision was therefore taken by evaluating the law on abortion with regard to the principle of safeguarding human dignity, the right to life or even with regard to the freedom of conscience of health workers.

Registration of abortion in the Constitution without registering the other principles associated with it constitutes a fracture which makes the latter more vulnerable.

According to Guillaume Drago, Professor of public law at Paris II Panthéon-Assas university, apart from the freedom of conscience for health workers who may, in accordance with the 1975 law, refuse to undertake abortions and which is a constitutional freedom, the registration of abortion in the constitution contradicts certain constitutional principles such as “the personal freedom of health workers, the protection of health, mentioned in paragraphs 10 and 11 of the Preamble to the 1946 Constitution, incorporated in the constitutionality block, and the constitutional protection of the greater interests of children again mentioned by the 2019 Constitutional Council.”

For those seeking ever more, the bill as submitted does not go far enough: they dispute the choice of the word freedom and deplore that such constitutional freedom should appear in article 34, which defines what is within the competence of the legislator, rather than as in article 1 or 2 which refer to a fundamental right.

Irrespective of which wording is adopted, freedom or right, one can but be concerned for the consequences of registration in the Constitution on the legal framework which currently controls abortion. The symbolic impact is powerful and the threats to the right to life, the freedom of conscience and the freedom of speech are far from insignificant. In future, the way in which the Constitutional Council could weigh up these different principles in its precedents remains uncertain.

European Project on the Human Brain : 3 Questions for Dr Grégoire Hinzelin, the Neurologist

by Claire Anne Brule | November 9, 2023 | News, Uncategorized

What exactly is the European project on the human brain ?

The project on the human brain was launched in Europe at the end of 2013 for a period of 10 years. Its initial ambition was aimed at numerous research themes, at the point of convergence of several disciplines: neurology, medical computing, information and communication technology. In neurology, the aim is to establish an atlas as detailed as possible of the brain, to enable more accurate medical treatments. Better modelling of the operating mode of the brain is also expected: this is useful both for medical research and for the technologies which aim to emulate that operating mode in computer science.

One of the aims is for example to work on an Artificial Intelligence replicating the brain in the hope of achieving energy saving. It is known that the brain is far more efficient in terms of energy consumption than computers for the processing of information and for calculations. AlphaGo, by DeepMind (a subsidiary of Google) which in 2016 beat the world champion of Go, consumed 20,000 watts per day, whereas a human brain consumes between 20 and 40 watts! The human brain combines both the processing of information and storage in its network of neurons, whereas computers are designed by separating the processing units from the memory. This research to find energy-saving solutions would be applicable to numerous cognitive tasks: image and voice recognition, as well as for drones, satellites etc. In order to recognise a chat, a child requires 12 iterations, an AI machine currently requires some 15,000.

Another objective was to obtain the most complete as possible atlas of the brain, in 3D, to be made available to the research teams.

The project was granted 607 million euros of European funding, and the collaboration of more than 500 research scientists in 19 nations.

What are the achievements and advances of the project?

The detailed mapping of the brain has not modified our current understanding of its operation but it has enabled its considerable refinement. This mapping will enable for example more precise operations on brain tumours. Similarly for cerebral re-education which is dependent on the plasticity of the brain.

Measurement of consciousness may also be refined. Following serious brain lesions, the patient may be declared unconscious, but that diagnosis is not always correct, because certain patients may be conscious but incapable of showing it.

In France, research scientists have developed customised brain models of epileptic patients who do not respond to medicines. Such virtual brain models help to identify the zones of the brain where the convulsions appear.

At the intersection between neuroscience, robotics and computing, a project like SpiNNaker seeks to replicate the functioning of the human brain. The difference compared with super-computers, is that the brain does not have powerful calculation processors but small integrated processors like in mobile telephones interconnected between each other, in order to achieve the high degree of connectivity of the neurons within the brain. According to one of the directors of this project, Professor Steve Furber: “SpiNNaker allows its users to explore hypotheses and theories on the functioning of the brain. Because the way in which the brain functions as a processor of information is still a mystery for science, and it is one of the major challenges of neuroscience to attempt to start to use convincing explanations on the way in which the brain conducts its work. But until such explanations become available, science advances by putting forward theories and subsequently by testing those theories, and computer models are a good means of testing theories”.

What are the limits of this type of project?

The dream of modelling the thought process remains a utopia which cannot currently be achieved.

For the SpiNNaker project for example, according to its director, “Even with a million processors, we are a long way from achieving the scale of the complete human brain. Optimistically, we can model something like one percent of the human brain, or maybe 0.1 percent”.

Brain implants which are currently all the talk have been the subject of research for decades by units in Grenoble and Lausanne for example. Some results have been achieved but such implants require strict precautions: what about infections, durability, psychological effects of the implant?

One must also distinguish between the ability to repair and the ability to predict. We know the old dream of being able to detect lies, or to identify emotions by monitoring the brain. Current experiments, using powerful machines, to decipher the messages from the brain are conducted with the patient’s consent. It is not possible at the moment to read the brain against the will of the patient.

Furthermore, the operating mode of the brain makes considerable use of an ability to forget, not merely storage of information as in a super-computer. For a machine to approach the brain, it would require better understanding of how the brain forgets.

Finally, the question of sense remains a question intimately linked to humanity. In an all-digital society which could be coming, what would be the sense of these machines which would tell us what to do, what to choose, how to find one’s bearings, on roads and in life? Increasing the power of machines is achieved at the cost of a reduction in the human experience. The perfecting of machines must not be allowed to occult the singularity of each human being, whose brain is in fact unique.

European Parliament : Parliamentary Committee Vote on a Controversial Proposal on Filiation

by Claire Anne Brule | November 8, 2023 | European legislation, News, Surrogacy

On 7^th November 2023, the European Parliamentary commission on legal affairs voted for a proposed rule initiated by the European Commission concerning the recognition of filiation certificates between European Union member states.

The Commission, during its consultation of associations and citizens, indicated that the initiative was not intended to harmonise national legislations regarding the establishment of parenthood. However, it could seriously encroach on their national sovereignty for the establishment of filiation and on children’s rights. All the more so since the proposal goes so far as to establish a European filiation certificate.

During the legal affairs commission, an amendment worsened the text by maintaining that member states could not recognise such filiation if it is incompatible with law and order but only in exceptional circumstances, following a case by case examination.

In March 2023, the French Senate issued a substantiated recommendation criticising the proposal on several counts. The recommendation underlines the ambiguity regarding its objective: “Is it concerned with “filiation”, i.e. a clear legal concept establishing the link between a child and its parents, as indicated in the French version of the text, or, according to the English version, is it concerned with “parenthood”, a less precise and undefined concept? Additionally, the authors of the recommendation recall the absence of consensus regarding the establishment of filiation within the EU. The senators also point out that the French Government rejects any automatic recognition of filiations resulting from surrogate motherhood conducted in another state, whether or not an EU member state.

In 2021, in response to the consultation by the European Commission, Alliance VITA issued an advice against the systemic recognition of filiations within the EU by maintaining the principle of subsidiarity of the States on the subject. In an analytical memorandum published in January 2023 intended for the members of parliament and of the Commission, Alliance VITA analysed the manner in which this proposal infringes the attributions established by the European Union Treaty and French public order regarding surrogate motherhood. Indeed, the French penal code penalises filiation infringements resulting from substitution motherhood.

Even if the text were to be approved during a plenary session next December, in order for such a ruling to be adopted, would require a unanimous vote by the European Council (art. 81-3- European Union Operating Treaty). Several States have already voiced their disagreement.

As already asserted by Alliance VITA, the pretext of freedom of movement within the European Union must not mask the interference which this proposed ruling would constitute for the States regarding the filiation and the safeguard of children’s rights.