IELTS Academic Reading Practice Test 356

Shortly before midnight on 25 July 1978, a baby girl was delivered by caesarean section at Oldham General Hospital, near Manchester, in the north of England. She weighed five pounds twelve ounces and was, by every account, healthy. Yet her birth was reported around the world, because Louise Joy Brown was the first person to be born after conception had taken place outside a human body. Newspapers quickly gave her a nickname she has never escaped: the world's first 'test-tube baby'.

The achievement was the work of two very different men. Patrick Steptoe was a gynaecologist at Oldham who had helped to develop laparoscopy, a technique for examining the abdomen through a thin tube inserted at the navel; he used it to inspect the reproductive organs and, eventually, to collect eggs from the ovaries. Robert Edwards was a physiologist at the University of Cambridge who had spent years studying how human eggs mature and how sperm fertilise them in the laboratory. In 1968 Edwards approached Steptoe, recognising that the surgeon could provide what the laboratory could not: eggs ready to be fertilised.

The procedure they devised was laborious and, by modern standards, crude. Working without the hormone drugs used in most clinics today, the team timed each attempt to the woman's natural menstrual cycle, testing her urine for the surge of hormones that precedes ovulation. Steptoe then passed a fine needle through the wall of the abdomen and drew fluid from a mature follicle in an ovary, hoping to find an egg among the cells he had collected. The egg was placed in a shallow dish of nutrient fluid and, a few hours later, mixed with sperm provided by the husband. About eighteen hours afterwards, if fertilisation had occurred, the resulting embryo was watched as it divided. Roughly two and a half days after fertilisation, the embryo consisted of eight cells. It was then drawn into a slender tube and deposited in the woman's womb.

For years, success eluded them. Some attempts produced no egg; in others the egg failed to fertilise, or the embryo stopped dividing before it could be transferred. The handful of pregnancies that did begin ended in miscarriage or in an ectopic pregnancy, in which the embryo develops outside the womb. By the time Lesley Brown joined the programme, the two men had worked together for a decade and had still not delivered a living child. Money was short, and not everyone at their institutions was comfortable with the work.

Lesley Brown, who lived in Bristol with her husband John, had been unable to conceive for years because her fallopian tubes were blocked, so that eggs could not travel from the ovary to the womb. The couple were among the patients accepted onto the programme. Lesley became pregnant on what proved to be the team's successful attempt, and the pregnancy was followed with anxiety by everyone involved. When she went into hospital to give birth, the corridors filled with journalists. The parents, who had kept their identities secret for as long as they could, asked only that their daughter be allowed an ordinary childhood.

The reaction was extraordinary. The story led news bulletins for days, and the phrase 'test-tube baby' entered common speech, although no test tube was involved and the embryo spent only a short time in the laboratory. Some commentators treated the birth as a triumph of modern medicine; others predicted a future of manufactured children, designed to order and reared without mothers. The scientific significance was quieter and more durable: it showed that an embryo conceived outside the body could implant and develop normally.

Opposition had been substantial, and it had practical consequences. Britain's Medical Research Council, the main public funder of medical science, declined to support the work, so the two men relied on private donations, including money raised by a well-wisher who had read about their efforts. Religious authorities objected that the technique interfered with the beginning of life, and some scientists argued that the risks to any child born this way were unknown. Edwards and Steptoe replied that they had proceeded cautiously, and that for couples with blocked tubes the alternative was not another treatment but childlessness.

Others soon followed. The second baby conceived in this way was born in Glasgow in 1979, and the Browns went on to have a second daughter, Natalie, who was also conceived by in vitro fertilisation and was born in 1982. In 1999 Natalie gave birth to a son, the first child known to have been born to a parent conceived by the technique. Clinics opened in many countries, and the number of births rose steadily; by the late 2010s an estimated eight million people or more had been born through assisted reproduction. Steptoe did not live to see most of this, dying in 1988, but Edwards received the 2010 Nobel Prize in Physiology or Medicine for the work.

The family's wish that Louise should grow up out of the public eye was largely respected, and her place in medical history is secure. Treatment for infertility is now routine, and the arguments that once surrounded it have faded, but the questions it raised about the beginning of human life have not gone away. They have simply been asked again, in the decades since, of each new technique.

Antibodies are among the most versatile proteins the human body produces. Each is a Y-shaped molecule made by cells of the immune system, and each is built to recognise one particular target, usually a protein or a sugar on the surface of a bacterium, a virus or a rogue cell of the body itself. Because the targets are so varied, the immune system maintains an enormous repertoire of antibodies. Since the 1980s, medicine has learned to pick out a single antibody, manufacture it in industrial quantities and inject it as a drug.

The structure explains the function. An antibody consists of four chains of amino acids, two long heavy chains and two shorter light chains, arranged in the familiar Y. The tips of the arms carry the variable regions, which differ from one antibody to the next and form the site that grips the target. The stem is made of constant regions, which barely vary and which determine what happens after the target has been seized: whether immune cells are summoned, whether complement proteins are triggered, or whether the target is simply blocked.

For most of the twentieth century, antibodies could be obtained only in mixtures, extracted from the blood of animals or of people who had recovered from an infection. The breakthrough came in 1975, when Georges Köhler and César Milstein, working in Cambridge, fused an antibody-producing cell from a mouse with a myeloma, a tumour cell that divides indefinitely in culture. The resulting hybridoma multiplied like a cancer cell but secreted the antibody of the original cell, producing an unlimited supply of identical molecules. The two men shared the 1984 Nobel Prize in Physiology or Medicine with the immunologist Niels Jerne.

There was a difficulty. A mouse antibody is a foreign protein to a human patient, and the immune system may raise antibodies against the treatment itself, clearing it from the blood before it can act. Genetic engineering solved the problem in stages. In chimeric antibodies, the mouse variable regions were grafted onto human constant regions. Humanised antibodies go further, so that only the small loops that touch the target remain of mouse origin. Fully human antibodies can now be obtained from mice engineered with human immunoglobulin genes, or from libraries of antibody fragments displayed on bacteriophages.

As drugs, antibodies act in several distinct ways. Some block a receptor: trastuzumab, approved in the late 1990s, attaches to the HER2 protein that drives the growth of a proportion of breast cancers and interrupts the signal that tells the cells to divide. Some mop up a molecule circulating in the blood: adalimumab binds TNF-alpha, a signalling protein that sustains inflammation in rheumatoid arthritis and Crohn's disease.

Some flag a cell for destruction, so that immune cells attack it: rituximab marks B lymphocytes, which multiply excessively in some lymphomas. A fourth group, known as checkpoint inhibitors, releases the brakes on T cells so that the immune system attacks a tumour more vigorously.

Antibodies are also used to prevent disease rather than to treat it. Anti-D immunoglobulin is given to Rh-negative women during and after pregnancy when the baby may be Rh-positive. The injected antibodies destroy fetal red cells that have entered the mother's circulation before her immune system can learn to make its own, so that a later pregnancy is not attacked. Palivizumab, given monthly through the winter to babies born prematurely, supplies ready-made antibodies against respiratory syncytial virus, a common infection that can be serious in infancy.

Making these molecules is not like making aspirin. Because antibodies are proteins, they must be produced by living cells, usually Chinese hamster ovary cells into which the relevant gene has been inserted. The cells are grown in steel tanks called bioreactors, sometimes holding thousands of litres. The antibody is then harvested and purified from the liquid. The process is demanding, easily disturbed and expensive, which is one reason antibody drugs cost so much; cheaper copies, known as biosimilars, have appeared only as the original patents expire.

The size of antibodies also limits them. A protein of this kind is digested in the stomach, so it cannot be swallowed and must be given by injection or infusion, usually in a clinic. Antibodies cross from blood into the brain only poorly, which has kept them out of most neurological disease. Because they alter immune function, they can leave patients more vulnerable to infection, and some, particularly the drugs that release the brakes on immune cells, cause serious inflammatory side effects.

Research is now directed at the remaining weaknesses. Bispecific antibodies are engineered to grip two targets at once, so that a T cell can be brought into contact with a tumour cell. Antibody-drug conjugates attach a toxic drug to an antibody so that it reaches only the cells carrying the target. Modified constant regions are being designed to survive longer in the blood, and the same technology was deployed at speed during the coronavirus pandemic, when several antibodies were developed as treatments for infected patients.

In October 2020, as the first effective vaccines against Covid-19 were being tested, the governments of India and South Africa wrote to the World Trade Organization with an unusual request. They proposed that certain intellectual-property rules be set aside for the duration of the pandemic, so that any country could make vaccines, treatments and diagnostic tests without the risk of infringing patents. More than a hundred member states eventually supported the idea, and campaigners argued that products developed partly with public money should not be rationed by price. The argument that followed went to the heart of how medical knowledge is owned.

Patents are a bargain. In return for publishing the details of an invention, the holder is granted a period of exclusivity, generally twenty years, during which others may not make or sell it without permission. The purpose is to make research worth funding: a drug costs a great deal to develop and very little to copy. Since 1995, when the World Trade Organization was established, its agreement on Trade-Related Aspects of Intellectual Property Rights, known as TRIPS, has required member countries to offer such protection. The same agreement contains safeguards. A government may issue a compulsory licence, allowing a local firm to produce a patented medicine without the owner's consent, provided the owner is paid a royalty and the licence is used mainly for domestic supply. A declaration agreed at Doha in 2001 confirmed that countries were free to use these flexibilities in a public-health emergency.

Those who backed the waiver pointed to a stark inequality. By the middle of 2021, rich countries had bought up most of the available doses, while health workers in much of Africa and South Asia went unprotected. Capacity existed: the Serum Institute of India, the world's largest vaccine manufacturer, was producing the Oxford-AstraZeneca vaccine under a voluntary licence but was exporting little during a devastating national wave of infection. If patents were suspended, supporters argued, established plants in Brazil, India and South Africa could make far more. They noted, too, that the technologies behind several vaccines had been supported by public funding, and that the firms' profits rested on collective investment.

Opponents of the waiver, including most large pharmaceutical companies and several European governments, replied that patents were not the binding constraint. Making a vaccine requires trained staff, specialised equipment, reliable supplies of lipids, enzymes and other ingredients, and the approval of regulators — none of which a waiver could conjure up. Removing protection, they warned, would discourage the investment on which future vaccines depend, and would not in itself transfer the know-how held inside companies. They also pointed out that voluntary licensing had already widened access: AstraZeneca had licensed its vaccine to the Serum Institute and promised to supply it without profit during the pandemic, and the Medicines Patent Pool, a United Nations-backed body, was negotiating further agreements. On this view, the obstacle was capacity and money, not law.

History offers only partial guidance. Compulsory licences have been used, but rarely and cautiously. In 2007 Brazil issued one for efavirenz, an antiretroviral drug, after failing to agree a lower price with its manufacturer, and began importing a generic version; Thailand had done something similar for an HIV medicine a few months earlier. Such actions can work for a single product within a single country. They are much harder to use for vaccines, which are biological products made by complex processes that a generic manufacturer cannot simply copy from a patent document, and which are needed across borders, since the TRIPS rules have limited exports under compulsory licence.

In the event, the negotiation was slow. The United States endorsed a waiver in May 2021, but the European Union resisted, proposing instead that existing flexibilities be used more actively. Only in June 2022, at a ministerial conference in Geneva, did members reach agreement, and the decision was much narrower than the original proposal. It clarified some of the procedural rules for compulsory licensing and waived certain patent obligations, but only for vaccines, and only for five years. Treatments and diagnostic tests were left out, despite protests from campaigners, and members have since argued without reaching agreement about extending it.

Meanwhile a different approach was attracting attention. In 2021 the World Health Organization chose a consortium in South Africa to host a technology-transfer hub for mRNA vaccines, with the aim of teaching manufacturers in low- and middle-income countries to produce them, and a handful of companies agreed to share their processes. A separate initiative, the Covid-19 Technology Access Pool, invited firms to donate licences and knowledge voluntarily; it attracted strikingly few participants. Such schemes have been praised in principle and undersubscribed in practice. Knowledge that is not written down is hard to move, and moving it takes time, money and willing partners.

My own view is that the waiver was right in principle and limited in effect. It was right because a pandemic is precisely the circumstance in which the ordinary calculus of patent protection should give way to the claims of public health, and because the exclusivity enjoyed by a handful of firms was never intended to decide who receives treatment. But a piece of paper at the WTO cannot build a factory, train a technician or supply a lipid nanoparticle. If the aim is genuinely to widen production, a waiver needs to be paired with funded, binding arrangements for technology transfer. It also needs investment in regional manufacturing. Otherwise the argument about patents will remain what it has too often been: a dispute about a symbol.