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THE LANCET ONCOLOGY: Experts warn of a European cancer epidemic in the next decade if weaknesses in cancer health systems and cancer research are not urgently addressed





Credit: The Lancet


Peer reviewed / Review, analysis and opinion

  • With an estimated one million cancer diagnoses missed across Europe in the last two years, the impact of the COVID-19 pandemic is predicted to set back European cancer outcomes by almost a decade.
  • A new Commission from The Lancet Oncology, “European Groundshot—addressing Europe’s cancer research challenges”, highlights the pivotal importance of cancer research in tackling the unprecedented challenges facing European cancer systems and makes key recommendations for how this can be achieved.
  • The Lancet Oncology Commission also identifies gaps in the European cancer research landscape and calls for a doubling of the European cancer research budget, as well as prioritisation of underserved cancer research areas, including prevention and early diagnosis, radiotherapy and surgery, implementation science, action on gender equality, and a deeper focus on survivorship

The COVID-19 pandemic has exposed weaknesses in cancer health systems and in the cancer research landscape across Europe, which, if not addressed as a matter of urgency, will set back cancer outcomes by almost a decade [1]. In a new report, authors emphasise that prioritising cancer research is crucial for European countries to deliver more affordable, higher quality, and more equitable cancer care, with patients treated in research-active hospitals having better outcomes than those who are not [2].

The new report, European Groundshot—addressing Europe’s cancer research challenges: a Lancet Oncology Commission, brings together a wide range of patient, scientific, and health-care experts with detailed knowledge of cancer research activity across Europe. Using accurate, timely, and granular data, the report shines a penetrating light on cancer research in Europe, highlighting current and future challenges and identifying gaps within the research landscape.

The Lancet Oncology Commission echoes the US Cancer Moonshot in setting out ambitious recommendations to develop a successful and resilient cancer research roadmap. However, the Lancet Oncology Commission argues that Europe cancer research should have a more grounded patient-focused, rather than techno-centric, approach and therefore a ‘Cancer Groundshot’ is a more appropriate aim.

“With the backdrop of the COVID-19 pandemic, Brexit, and the Russian invasion of Ukraine, it is more important than ever that Europe develops a resilient cancer research landscape to play a transformative role in improving prevention, diagnosis, treatment, and quality-of-life for current and future patients and those living beyond cancer,” says Professor Mark Lawler, Queen’s University Belfast, UK and Chair and lead author of the Commission.

He continues, “We estimate that approximately one million cancer diagnoses were missed across Europe during the COVID-19 pandemic. [1] We are in a race against time to find those missing cancers. Additionally, we saw a chilling effect on cancer research with laboratories shut down and clinical trials delayed or cancelled in the first pandemic wave. We are concerned that Europe is heading towards a cancer epidemic in the next decade if cancer health systems and cancer research are not urgently prioritised. Our European Groundshot Commission provides crucial findings on the current landscape of cancer research, exposes the key gaps, and demands the prioritisation of European cancer research agendas over the next decade”. [4]

European cancer research faces a triple threat

The European Groundshot Commission analysed data on the impact of the COVID-19 pandemic across Europe and found that clinicians saw 1·5 million fewer patients with cancer in the first year of the pandemic, with one in two patients with cancer not receiving surgery or chemotherapy in a timely manner. Additionally, 100 million cancer screening tests were missed, and it is estimated that up to one million European citizens might have an undiagnosed cancer due to the cancer backlog. Considering these findings, one of the European Groundshot Commission’s key recommendations is for the European cancer research community to accelerate the research response to the indirect impacts of the COVID-19 pandemic on cancer and that, now more than ever, there is a crucial need to ensure that cancer is appropriately protected and prioritised within current and future European research agendas.

The Russia invasion of Ukraine represents another huge challenge to cancer research in Europe. Russia and Ukraine are two of the largest contributors to clinical cancer research in the world, especially industry-sponsored clinical research. Many Ukrainian cancer clinical trials include cancer centres in central and eastern European countries and the conflict will likely result in many of these major trials being delayed or failing to recruit. An additional danger is that industry might consider it too high risk to run cancer clinical research in countries bordering Ukraine—loss of private sector investment would be hugely damaging to cancer research in central and eastern Europe. The European Groundshot Commission recommends that, as a matter of extreme urgency, the European cancer community must gather data on the impact of the conflict on patients, cancer services, medicines and other shortages, and workforce gaps, in Ukraine and in neighbouring countries, as well as developing a plan to mitigate the impact of the war on cancer research.

“Whilst there has been a lot of news coverage on the Russian invasion of Ukraine, what has gone relatively unreported is its profound and continuing impact on clinical cancer research. We hope that our European Groundshot Commission will help to direct the necessary attention to the concerning and significant impact that the conflict will have on cancer research, including but not limited to clinical trials in Europe. There is already a burgeoning east-west divide in European cancer research and it’s crucial the Russia-Ukraine war does not cause this gap to grow,” says Dr Andreas Charalambous, President of the European Cancer Organisation” [4]

The European Groundshot Commission also predicts that Brexit will continue to negatively impact European cancer research. The Commission analysed data comparing EU28 (UK included) versus EU27 (UK not included) research activity and found a significant gap, one the Commission suggests is extremely unlikely to be bridged by increased research activity from the remaining EU27. Another key recommendation from the European Groundshot Commission is for European cancer research funders and the European cancer research community to mitigate the impact of Brexit and other political challenges by ensuring that the UK can continue to collaborate with European partners and contribute to European cancer research and innovation activities.

“UK cancer research in the post-Brexit world stands at a crossroads where strategic decisions will determine whether we continue to thrive and partner internationally or whether isolationism will reduce our world standing,” says Professor Richard Sullivan, co-lead for the Commission and Professor of Cancer & Global Health at Institute of Cancer Policy, King’s College London. [4]

Professor Lawler adds, “If the UK is not involved in EU collaborative cancer research and not part of Horizon Europe’s research community, this will have an extremely detrimental effect on European cancer research activity. Ultimately, patients with cancer will the pay the price for this decision in terms of health-care outcomes.” [4]

Gaps in European cancer research and its funding

The European Groundshot Commission analysis into investment in cancer research in Europe in 2010–19 found that the total amount of investment, excluding the private sector, was about €20–22 billion, about €26 per head. The minimum equivalent figure for the USA over the same period was US $80·5 billion (around €76 billion and €234 per head). Considering this dramatic gap in spend per head, the European Groundshot Commission calls for a doubling of the European cancer research budget to €50 per capita by 2030.

The European Groundshot Commission argues that cancer prevention research in particular has not had the funding it deserves. A greater focus on preventing cancer would reduce the number of people who develop cancer and therefore allow more resources to be available for those who do require treatment. The report calls for a significant reprioritisation of cancer prevention, cancer screening, and early cancer detection research to reduce the burden of cancer for European citizens and enable those who do develop cancer access to more resources and the best treatments available.

“It is estimated that 40% of cancers in Europe could be prevented if primary prevention strategies made better use of our current understanding of cancer risk factors. There are already evidence-based and cost-effective cancer preventive interventions available [5], and we want to see more effective implementation and communication of these across Europe. Additionally, up to one third of cancer cases in Europe are more likely to have a better outcome if they are detected early but, disappointingly, we find that rates of screening tests vary widely between different European countries. More research is needed to understand why people do not participate in cancer screening programmes across Europe,” says Anna Schmutz, International Agency for Research on Cancer, France [4]

Gender equity in cancer research is another crucial gap identified in the European Groundshot Commission, with senior female authors making up less than a third of all authors for those European countries contributing the most cancer research outputs. The gender of principal investigators in Europe was also determined for 22, 291 cancer research projects: the majority of principal investigators were men with less than 33% women, reflecting the gender inequality that exists.

“Our data on female authors clearly illustrate the significant gender gap that exists in the European cancer research community. Greater research is needed into the reasons for why some European countries or regions have greater gender inequality in cancer research than others. Strategies based on these data would then hopefully improve the gender balance in cancer research in Europe,” says Professor Yolande Lievens, Ghent University Hospital, Ghent. [4]

The Commissioners hope that the findings and recommendations in this report will help the European cancer research community as they work towards a more equitable agenda where all citizens and patients, no matter where they live, will benefit equally from advances in cancer research.

“This European Groundshot has a significant patient focus, which is very welcome” said Teodora Kolarova, Bulgarian patient advocate and Executive Director of the International Neuroendocrine Cancer Alliance, “Too often the patient viewpoint is ignored, but it is front and centre in this Commission. Patients need to be active participants in research, co-creating with their scientific and clinical colleagues. Another welcome focus is on central and eastern Europe—it is crucial that we see a critical upsurge in research in this region, so that the east–west divide is narrowed, not widened.” [4]

Prof Lawler adds “Gathering data and turning them into cancer intelligence has been our North Star in this Commission. Too often, opinion, even expert opinion, has trumped data in the genesis and implementation of cancer research policies. Simply continuing to dedicate resource and effort to a narrow research agenda is no longer desirable or viable: we must follow the data and act on what they reveal. We have an unrivalled opportunity to reimagine cancer research and its implementation so as to achieve our ambitious 70: 35 Vision, an average of 70% 10-year survival for patients treated for cancer in Europe by 2035. Let’s grasp this opportunity.” [4]

Writing in a linked Comment, Márcia Costa and David Collingridge, Editors at The Lancet Oncology, say, “European leaders must break down the political barriers that divide the continent, rising above popularism, to work together in the common pursuit of harmonising cancer research missions and national cancer plans, strengthening health systems, and supporting all patients with cancer, including those from neighbouring countries in need of international aid. The research, data, recommendations, and actions summarised in the European Groundshot Commission could be powerful drivers of change if all actors are willing to listen and to put artificial divisions to one side. After all, we are all Europeans, irrespective of the politics, and we deserve better.”


There is a press briefing organised by the European Cancer Organisation at 10:30am GMT / 11:30am CET on Monday 14th November. Contact Marilena Madsen ( for details to join or to receive the recording.

The European Groundshot Commission report will be launched on Wednesday 16th November at The European Cancer Summit 2022.

There will be a free and open to all Lancet webinar at 9:00am GMT on Friday 18th November. You can register here.

A full list of authors and their funding information can be found in the report. 

[1] Lawler M, Crul M. Data must underpin our response to the covid-19 pandemic’s disastrous impact on cancer. BMJ. 2022; 376:o282.
[2] Selby P, Liu L, Downing A, Bank Is, Wilson R, Stephens R, Meunier F, Rochon J, Morris E, Seymour M, Gregory W, Lawler M, Boaz A. How can clinical research improve European health outcomes in cancer? J Cancer Policy 2019; 20: 100182, 1-6.
[3] Freeman V, Hughes S, Carle C, Campbell D, Egger S, Hui H, Yap S, Deandrea S, Caruana M, Onyeka TC, IJzerman MJ, Ginsburg O, Bray F, Sullivan R, Aggarwal A, Peacock SJ, Chan KKW, Hanna TP, Soerjomataram I, O’Connell DL, Steinberg J, Canfell K.J Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence. J Cancer Policy. 2022; 33:100340.
[4] Quotes direct from authors and cannot be found in text of Commission.


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EUR/AUD bearish breakdown supported by additional China fiscal stimulus and AU inflation

Weak PMI readings from the Eurozone, an increase in China’s budget deficit ratio, and renewed inflationary pressures in Australia may trigger a persistent…



  • Weak PMI readings from the Eurozone, an increase in China’s budget deficit ratio, and renewed inflationary pressures in Australia may trigger a persistent bearish sentiment loop in EUR/AUD.
  • Watch the key short-term resistance at 1.6700 for EUR/AUD.
  • A break below 1.6250 key medium-term support on the EUR/AUD may trigger a multi-week bearish impulsive down move.

The Euro (EUR) tumbled overnight throughout the US session as it erased its prior gains against the US dollar recorded on Monday, 23 October; the EUR/USD shed -104 pips from yesterday’s intraday high of 1.0695 to close the US session at 1.0591, its weakest performance in the past seven sessions.

Yesterday’s resurgence of the USD dollar strength has been attributed to a robust set of October flash manufacturing and services PMI data from the US in contrast with weak readings seen in the UK and Eurozone that represented stagflation risks.

Interestingly, the Aussie dollar (AUD) has outperformed the US dollar where the AUD/USD managed to squeeze out a minor daily gain of 21 pips by the close of yesterday’s US session. The resilient movement of the AUD/USD has been impacted by positive news flow out from China, Australia’s key trading partner.

China’s national legislature has just approved a budgetary plan to raise the fiscal deficit ratio for 2023 to around 3.8% of its GDP which was above the initial 3% set in March and set to issue additional sovereign debt worth 1 trillion yuan in Q4. This latest round of additional fiscal stimulus suggests that China’s top policymakers are expanding their initial targeted measures to address the ongoing severe liquidity crunch in the domestic property market as well as to reverse the persistent weak sentiment inherent in the stock market.

In addition, the latest set of Australia’s inflation data surpassed expectations has also reinforced another layer of positive feedback loop in the Aussie dollar which in turn may put Australia’s central bank, RBA on a “hawkish guard” against cutting its policy cash rate too soon.

The less lagging monthly CPI Indicator has risen to an annualized rate of 5.6% in September, above consensus estimates of 5.4%, and surpassed August’s reading of 5.2% which has translated into a second consecutive month of uptick in inflationary growth.

In the lens of technical analysis, a potential bearish configuration setup has emerged in the EUR/AUD cross pair from a short to medium-term perspective.

Major uptrend phase of EUR/AUD is weakening


Fig 1: EUR/AUD medium-term trend as of 25 Oct 2023 (Source: TradingView, click to enlarge chart)

Even though the price actions of the EUR/AUD have been oscillating within a major ascending channel since its 25 August 2023 low of 1.4285 and traded above the key 200-day moving average so far, the momentum of this up movement is showing signs of bullish exhaustion.

Yesterday (24 October) price action ended with a daily bearish reversal “Marubozu” candlestick coupled with the daily RSI momentum indicator that retreated right at a significant parallel resistance in place since March 2023 at the 65 level which suggests a revival of medium-term bearish momentum.

EUR/AUD bears are now attacking the minor ascending support

Fig 2: EUR/AUD minor short-term trend as of 25 Oct 2023 (Source: TradingView, click to enlarge chart)

The EUR/AUD has now staged a bearish price action follow-through via the breakdown of its minor ascending support from its 29 September 2023 low after a momentum bearish breakdown that was flashed earlier yesterday (24 October) during the European session as seen from the 4-hour RSI momentum indicator.

Watch the 1.6700 key short-term pivotal resistance (also the 50-day moving average) for a further potential slide toward the intermediate supports of 1.6460 and 1.6320 in the first step.

On the other hand, a clearance above 1.6700 invalidates the bearish tone to see the next intermediate resistance coming in at 1.6890.

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GigXR partners with NUS Medicine to deliver holographic clinical scenarios for gastroenterology training

GigXR, Inc., a global provider of holographic healthcare training, announced today its partnership with the Yong Loo Lin School of Medicine, National University…



GigXR, Inc., a global provider of holographic healthcare training, announced today its partnership with the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), one of the world’s leading medical schools, to introduce a new gastrointestinal module for the award-winning HoloScenarios application. Created to better prepare medical and nursing students in diagnosing and treating acute gastrointestinal diseases, HoloScenarios: Gastrointestinal delivers evidence-based, robust clinical simulations that present hyperrealistic holographic simulated patients and medical equipment to be used in any physical learning environment, accessed anywhere in the world.

Credit: Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), and GigXR

GigXR, Inc., a global provider of holographic healthcare training, announced today its partnership with the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), one of the world’s leading medical schools, to introduce a new gastrointestinal module for the award-winning HoloScenarios application. Created to better prepare medical and nursing students in diagnosing and treating acute gastrointestinal diseases, HoloScenarios: Gastrointestinal delivers evidence-based, robust clinical simulations that present hyperrealistic holographic simulated patients and medical equipment to be used in any physical learning environment, accessed anywhere in the world.

Going beyond linear step-based training traditionally seen with virtual reality (VR), HoloScenarios: Gastrointestinal uses mixed reality (MR) to simulate the entire patient journey, while including branching logic to catalyze variance in learning experiences. From taking basic medical history to performing invasive testing and emergency procedures, the new module empowers learners to master vital medical decision-making and manual skills as they would see them in real-life clinical scenarios and patient care.

HoloScenarios: Gastrointestinal is created in collaboration with renowned medical professionals and educators from NUS Medicine who specialize in the fields of Gastrointestinal (GI) Surgery and holographic medical training. The module is delivered by the Gig Immersive Learning Platform, the enterprise-scale platform enabling the creation, curation, and sharing of immersive training applications and modules made by the world’s preeminent healthcare institutions and MR developers.

“Gastrointestinal pathologies can be complex and challenging to diagnose. This module will allow learners to form a deeper understanding and appreciation of the gastrointestinal tract, especially the three-dimensional understanding of anatomy and body functions,” said Associate Professor Alfred Kow Wei Chieh from the school’s Department of Surgery and Assistant Dean (Education) at NUS Medicine. “We believe mixed reality is the next evolution in healthcare training, and collaborating with immersive platform innovators like GigXR helps us to bring this vital content to more learners globally and, ultimately, improve patient care.”

With international medical and surgical credentials that include MBBS (S’pore), M Med (Surg), FRCSEd (Gen Surg), FAMS, and FACS, Associate Professor Kow has trained thousands of healthcare professionals and advanced surgical fellows. He received the 2023 REAL Advancing in Liver Transplantation Award for his contributions to global liver transplantation education and is a founding member of The Holomedicine® Association.

“GigXR has one of the most advanced and comprehensive platforms in mixed reality, especially in medical training, and enables the exchange of developments, innovation, and expertise with a wider community across Asia and beyond,” added Associate Professor Kow. He is also the Head and Senior Consultant of the Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, at Singapore’s National University Hospital (NUH), the teaching hospital of NUS Medicine.

The new module also delivers enhanced realism in training learners to more accurately diagnose and treat acute gastrointestinal diseases. Whereas VR has been widely used in gastroenterology training for linear step-based skills, such as in endoscopic procedures, it is limited in its ability to simulate fully realized clinical scenarios. Holographic patient simulation in MR merges hyper-realistic holograms in physical learning spaces that accurately reflect the clinical environment and tools with which learners will care for real patients.

With HoloScenarios: Gastrointestinal, learners can interact with the holographic simulated patients, holographic medical equipment, instructors, and each other. This allows them to master both technical and soft skills, such as patient empathy and team communication, in hyper-realistic, safe-to-fail environments that reduce cognitive load. If the holographic patient displays the need for further care, such as a definitive surgery, learners can discuss a definitive treatment plan.

To gain a deeper evaluation of outward symptoms, co-located learners can safely walk around the patient hologram that is displayed on top of their real-world surroundings. Whereas VR locks learners into a virtual “box,” MR enables clear visibility and awareness of physical surroundings. This allows learners to move freely without fear of physical collisions and safety so they can fully focus on learning key gastrointestinal treatment, diagnostic, and communication skills with peers and instructors.

“In healthcare, educators are not only trying to help learners master and retain vital knowledge, but recall and apply it when a patient’s life may be at risk,” said Dr. Gao Yujia, MBBS (S’Pore), MRCS, FRCSEd, Consultant and Assistant Group Chief Technology Officer at Singapore’s National University Health System, and Vice Chairman of The Holomedicine® Association. “With HoloScenarios: Gastrointestinal, learners will have the ability to not only visualize the presentation of a given disease in 3D but better understand how to apply key learnings in the clinical context and within team environments.” Dr Gao is also the Director of Undergraduate Medical Education for Surgery at NUS Medicine.

With scenarios across gastrointestinal pathologies that include gastrointestinal bleeding, intestinal obstruction, and chronic liver failure, learners can master complex and potentially critical situations. They can learn, for example, how to stabilize patients who are dehydrated, bleeding, or septic, as well as the types of diagnostic procedures that may then be required to get a definitive diagnosis. Using mixed reality headsets or any Android, iOS smartphone or tablet, learners can access HoloScenearios: Gastrointestinal from anywhere for remotely distributed, yet highly immersive simulation.

“Immersive technology has accelerated the sharing of expertise for teaching, training, and simulation. Mixed reality, with its natural propensity to facilitate hyperrealistic, safe, and collaborative learning, continues to accelerate both the quality and scale of training outcomes,” said Jared Mermey, CEO of GigXR. “We are immensely proud to partner with NUS Medicine which has been at the forefront of adopting mixed reality in both clinical and educational use cases. By bringing their esteemed expertise onto our platform with the co-creation of HoloScenarios’ newest module, we believe clinical breakthroughs in diagnosing and treating gastrointestinal diseases will take a giant leap forward.”

Designed specifically for pedagogy, the Gig Immersive Learning Platform is trusted by over 70 enterprise-scale healthcare institutions across four continents to build full immersive curricula utilizing a robust content catalog – all of which is managed from a single dashboard. Third-party content developed by leading 3D medical partners, including DICOM Director, 3D4Medical by Elsevier, and ANIMA RES, seamlessly integrates with the platform to provide complementary, in-depth anatomy applications that empower learners with a broader physical context for the pathologies that they study.

“The Gig Immersive Learning Platform has quickly become the premier educational, social network for sharing healthcare training expertise in the immersive format, spanning global healthcare institutions and the Department of Defense to content developers and enterprises large and small,” said David King Lassman, Founder of GigXR. “HoloScenarios: Gastrointestinal marks the latest milestone in our rapidly expanding catalog, which now boasts a dozen different licensable training modules that span holographic simulated patients, clinical scenarios, anatomy, pathophysiology, and 3D medical imaging.”

NUS joins the University of Cambridge and Cambridge University Hospitals (CUH) NHS Foundation Trust, University of Michigan, and Morlen Health, a subsidiary of Northwest Permanente, P.C., as the world-class institutions partnering with GigXR to co-create holographic healthcare training. These simulations include modules centered around Respiratory diseases, Basic Life Support, Advanced Cardiac Life Support, Neurology scenarios, and now, with NUS, Gastrointestinal diseases.

GigXR and NUS Medicine plan to launch HoloScenarios: Gastro in Spring 2024. For more information on GigXR, visit or email For more information on NUS, visit

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Public support for extending the 14-day rule on human embryo research indicated by foundational dialogue project

The findings of a foundational UK public dialogue on human embryo research are published today, Wednesday 25th October 2023, as part of the Wellcome-funded…



The findings of a foundational UK public dialogue on human embryo research are published today, Wednesday 25th October 2023, as part of the Wellcome-funded Human Developmental Biology Initiative (HDBI). The HDBI is an ambitious scientific endeavour to advance our understanding of human development. The dialogue project, which was co-funded by UKRI Sciencewise programme, engaged a diverse group of the public to consider how early human embryo research can be used to its fullest, the 14-day rule and the fast-paced field of stem cell-based embryo models.

Credit: Dr Matteo Molè (Babraham Institute)

The findings of a foundational UK public dialogue on human embryo research are published today, Wednesday 25th October 2023, as part of the Wellcome-funded Human Developmental Biology Initiative (HDBI). The HDBI is an ambitious scientific endeavour to advance our understanding of human development. The dialogue project, which was co-funded by UKRI Sciencewise programme, engaged a diverse group of the public to consider how early human embryo research can be used to its fullest, the 14-day rule and the fast-paced field of stem cell-based embryo models.

Headline findings include:

  • Appetite for review of the 14-day rule: Participants recognised that extending the 14-day rule could open up ways to achieve benefits in fertility and health, with participant support for reviewing this, including national discussion.
  • Confidence in regulation: There was a high level of confidence in how human embryo research is regulated, despite a low level of awareness of the regulators and statutes themselves. This included strong desire to see robust regulation governing any changes to the 14-day rule and further regulation for the use of stem cell-based embryo models.
  • Support for improved fertility and health outcomes: The strongest hopes for future human embryo research were where new knowledge would deliver improvements in understanding miscarriage, preventing health conditions such as spina bifida and raising the success rates of IVF procedures.
  • Concerns about genetically engineering humans: The public expressed concerns on the application of developments in this field to genetically alter or engineer humans.

The dialogue engaged a group of 70 people broadly reflective of the UK population in over 15 hours of activities including a series of online and face-to-face workshops with scientists, ethicists, philosophers, policy makers and people with relevant lived experience (such as embryo donors from IVF procedures).

Dr Peter Rugg-Gunn, scientific lead for the HDBI and senior group leader at the Babraham Institute, said: “Recent scientific advances bring incredible new opportunities to study and understand the earliest stages of human development. To ensure this research remains aligned with society’s values and expectations, we must listen and respond to public desires and concerns. This public dialogue is an important first step and as a scientist I am reassured by the findings but there is still a long way to go to fully understand this complex issue.” 

The report is exceedingly timely, following notable scientific advances in human developmental biology presented at conferences and in leading scientific journals in recent months. As well as generating excitement in scientific fields and with the public, announcement of these breakthroughs also prompted some concerns and criticisms, with the view that these findings raised significant ethical issues. The dialogue provides insight into public considerations following deliberation on early human embryo research. The hope is that it will act as a foundational reference point that others in the sectors can build upon, such as in any future review of the law on embryo research.

Professor Robin Lovell-Badge, co-chair of the HDBI Oversight group, senior group leader and head of the Laboratory of Stem Cell Biology and Developmental Genetics at the Francis Crick Institute, said: “We have learnt a lot about human development before 14 days, but there are areas of investigation that could change how we understand development, and associated diseases, that lie beyond our current window of knowledge. Despite low awareness of current laws, members of the public quickly recognised many of the critical issues researchers are keenly aware of when it comes to growing embryos beyond the current limit. This dialogue also reinforced the fact that the public are in support of research that will yield better health outcomes, and in this case, increase the success of IVF procedures.

Other countries will be looking to the UK to see how we deal with the 14-day rule; we are not there yet with any mandate to make a change, but this does give a strong pointer. The next step will be to delve deeper into some of the topics raised through this dialogue as they apply to specific areas of research, as well as feeding into policy changes.”

The 14-day rule and the regulation of stem cell-based models

When considering the regulation of research involving human embryos, the dialogue explored participant’s views on the 14-day rule. Introduced in 1990, the 14-day rule is a limit enforced by statute in the UK. It applies to early human embryos that are donated by consent to research and embryos that are created for research from donated sperm and eggs. It limits the amount of time early human embryos can be developed in a laboratory for scientific study to 14 days after fertilisation. Due to technical advances, it is now possible to grow embryos in the lab past 14 days, but researchers are not allowed to by the law. If the law changed, it would open up this ‘black box’ of development with researchers able to investigate this crucial time in development from 14-28 days after fertilisation.

Professor Bobbie Farsides, co-chair of the HDBI Oversight group and Professor of Clinical and Biomedical Ethics at the Brighton and Sussex Medical School, said: “It has been a fascinating experience to support HDBI in the undertaking of this exercise.  I commend the participants for the care and mutual respect they have shown throughout. Their engagement and commitment to a subject few of them had previously considered allowed for a wide range of views to be expressed and considered. I hope the scientists involved will be encouraged by the high level of interest in their work, and will want to keep the public conversation going around these important subjects.”

The dialogue included participant discussion on what a change to the 14-day rule might look like, and identified points that should be considered, such as defining what the benefits of extending the rule would be and potential mis-alignment with human embryo research regulations in other countries.

Participants acknowledged the astonishing possibilities of stem cell-based embryo models. The majority of participants would like to see these models further regulated. Work in establishing potential governance mechanisms is already underway. In recognition of the need for additional guidance and regulation in this area, the Cambridge Reproduction initiative launched a project in March 2023 to develop a governance framework for research using stem cell-based embryo models and to promote responsible, transparent and accountable research.

Future steps

A key outcome from the public dialogue is the identification of areas for further exploration, with participants proposing how future national conversations might be shaped. It is hoped that the project acts as a reference base for both widening engagement with the subject and also prompting deeper exploration of areas of concern.

Dr Michael Norman, HDBI Public Dialogue coordinator and Public Engagement Manager at the Babraham Institute, said: “This dialogue shows that people want the public to work closely with scientists and the government to shape both future embryo research legislation and scientific research direction. It is crucial that others in the sector build on these high quality, two-way engagement methodologies that allow for a genuine exchange of views and information to ensure that the public’s desires and concerns are listened to and respected. Transparency and openness around science is vital for public trust and through this we, as a society, can shape UK research in way that enriches the outcomes for all.”

Public Participant (Broad public group, south) said: “I do think that an extension of this public dialogue, and educating a wider society has a benefit in itself. This is really complex and sensitive and the wider you talk about it before decisions are made, the better.”

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