A row between the Dutch government and senior medical advisers over the issue of prenatal testing for Down's syndrome was resolved this week after the junior health minister, Clémence Ross, declared her confidence in the advisers' integrity.
Ms Ross had rejected the Dutch health council's advice to introduce routine prenatal screening for Down's syndrome for all pregnant women. She then raised concerns about the research it had used, in particular that of Howard Cuckle, professor of reproductive epidemiology at Leeds University. A spokesman for the minister said Ross was “surprised” by Professor Cuckle's declared interests. These include a directorship of a supplier of software for interpreting Down's syndrome screening tests.
An internal government memorandum attacking the composition and objectivity of the council's advisory committee was then leaked to the media. A statement issued by the ministry said that the secretary general (the senior civil servant) at the ministry did not know about the memorandum but the council was not satisfied and demanded a meeting.
Professor Johannes Knottnerus, the council's chair, refuted the criticism, saying that it used renowned experts in their field who used the latest data and followed a normal procedure for declaring interests. “It is for the minister and the politicians to decide what direction to take, but it is unacceptable to question the integrity of the committee,” he said.
The council was aware that Professor Cuckle had declared an interest in the Lancet as director of Logical Medical Systems (Lancet 2001;358:1658-9), but it stressed that there was a difference between a declaration and a conflict of interests. It was normal for top scientists to have other interests.
Knottnerus said that Professor Cuckle was a recognised international expert in his field, he followed the normal procedures for declaring interests, and his papers were peer reviewed. “I have not the slightest doubt about his scientific integrity,” he said.
Professor Cuckle, head of the International Down's Syndrome Screening Group, explained his contribution was to model the consequence of varying Down's syndrome screening strategies on the detection and false-positive rates. The modelled rates used have been published, and the model parameters are based on meta-analyses from results found in an extremely large amount of literature. “There is nothing new or controversial in this,” he said.
He did not feel his directorship of a software supplier was relevant to the report as he had, “simply supplied an objective analysis using all available published information.”
After a meeting between the health council and the minister on Monday, a statement was issued saying Ross had no doubts about the scientific integrity of the council or of Professor Cuckle.
In its report the council had advised scrapping the current Dutch policy in which only women aged 36 or older qualify for free prenatal testing for Down's syndrome. The report concluded that an improved system of testing, which involved a blood test combined with a nuchal translucency measurement by ultrasound, removed any advantages to having a younger age limit on testing (www.gr.nl). Ross rejected the advice, arguing that the benefits for younger women did not outweigh the costs and that the outcome of tests in younger women was less reliable.