Valproate and Foetal Anticonvulsant Syndrome

Debate between Philippa Whitford and Liz McInnes

Thursday 19th October 2017 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

I am pleased that we are having this important debate, and I pay tribute to the right hon. Member for North Norfolk (Norman Lamb) for securing it and for setting out so clearly the issues involved.

My career before I was elected was as an NHS clinical scientist. Working in a biochemistry laboratory, I was very familiar with sodium valproate as part of the battery of anticonvulsant drugs for which we regularly tested patients to help their clinicians better monitor their treatment and ensure that their dosage was at the optimum level. Until I met Emma Murphy, however, and became aware of her campaign, I was not aware of what appeared to be a systematic failure to inform women of the potentially damaging effects of taking valproate during pregnancy.

Only after watching a television programme about foetal anticonvulsant syndrome did Emma herself became aware that her own children’s health problems were probably attributable to the anti-epileptic drugs she had taken while pregnant, which had been prescribed to her from the age of 12. Like everyone in the House, I pay tribute to Emma Murphy and Janet Williams for their great campaigning work.

The damage to the developing foetus is thought to be caused in the first trimester of pregnancy when the anti-epileptic drug crosses the placenta into the foetus, and the effects depend upon the dosage and the drug. Sodium valproate, or Epilim, is indicated in 80% of cases of foetal anticonvulsant syndrome. Experts such as Dr Peter Turnpenny, clinical geneticist at the Royal Devon and Exeter Hospital, say that Epilim may affect about 560 babies every year. He adds:

“About 10% of foetuses exposed to sodium valproate will have a major congenital malformation such as cleft palate. 12% are likely to be diagnosed with a neurodevelopmental disorder.”

Reports linking valproate to birth defects started to appear, most notably, in 1981, with a paper by H. Nau entitled “Valproic Acid and its Metabolites”. In 1983, the British Medical Journal published an article in which the Royal Liverpool Hospital cited two cases suggesting a link between birth defects and valproate taken during pregnancy. The American Journal of Medical Genetics cited seven cases in 1984 of children born with malformations to mothers taking valproate, and the Journal of Paediatrics cited 26 cases in 1986. The list goes on. It would appear that the evidence was steadily building up with the publication of more and more cases linking valproate to birth defects. The Committee on Safety of Medicines and the Medicines and Healthcare Products Regulatory Agency noted those reports, and, I hope, monitored the use of valproate, particularly during pregnancy.

[Dr Whitford]

We have heard about various scandals. In the case of Vioxx, which was mentioned by the hon. Member for Newport West (Paul Flynn), trials did not show a problem but real-world use did. Does the hon. Lady think that we need some kind of reform of the reporting system? There is something that we call a yellow card, and patients can now fill it in themselves, but many of them do not realise that. I feel that there is not enough “flagging up” when patients suspect that they are suffering from side-effects.

[Liz McInnes]

The hon. Lady is absolutely right. She and I are well aware of the yellow card system, because we have both worked in the NHS, but how many people out there know that they can report side-effects of drugs, or even suspected side-effects? We really have a job to do in conveying that message to the general public, and we also need people to collate the information and act on it.

A definitive paper stating that there was a clear link between valproate taken during pregnancy and birth defects was published in 1995. It was entitled “Foetal Valproate Syndrome”, and was written by geneticists at St Mary’s Hospital, Manchester. It is clear that the evidence has been building up for a long time, so why does it appear that women were not warned about the potential dangers of taking the drug in pregnancy?

Transitional State Pension Arrangements for Women

Debate between Philippa Whitford and Liz McInnes

Monday 1st February 2016 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I am grateful to the Petitions Committee and all those who signed the petition for bringing about the debate. I know that my constituents would want me to pass on their thanks to my hon. Friend the Member for Warrington North (Helen Jones) for her excellent opening speech and ensuring that we have the debate.

I want briefly to tell the story of one of my constituents who, despite the protestations from the Government Members, tells me she was never informed in 1995 that her state pension age was changing from 60 to 65. From her own reading and information picked up from various sources—I do not know whether that includes the Financial Times—she was led to believe that she would receive her state pension at 62. She told me that although she was unhappy with a two-year deferment of her state pension, she was fit and healthy at the time and did not understand the magnitude of the changes. Her view is that we lived in a different world at that time, and she said:

“The welfare state had not been mauled…There were safety nets to assist the poor and the sick that have now been removed.”

Like a lot of working-class, low-waged people at that time, she was depending on her state pension as her main source of income at retirement, although she hoped to be able to save a little bit of money to supplement that. As time progressed, she unfortunately began to suffer with serious health issues and was forced to give up work. She was born in 1957 and is doubly unhappy that she now has to wait until she is 66 to receive her state pension. She has little in the way of private pension provision and is forced to live on minimal income, while suffering from ill health, with the prospect of having to wait until 2023—seven more years—before she qualifies for her state pension.

[Dr Philippa Whitford]

Given increasing multi-morbid health conditions, there will be women in the 60 to 66 age group with ill health who are suffering due to the cut in support and are then put in the employment and support allowance work-related activity group with absolutely no chance of getting a job or decent support.

[Liz McInnes]

The hon. Lady is, of course, absolutely right. Several Members have mentioned the lack of support that is available to women born in the ’50s who find themselves in that situation.

Many women have visited my surgeries, such as Barbara, who was born in 1955. She said to me:

“Women born in the 1950s were more likely to give up work when bringing up their children because there was no provision for maternity leave. They are unlikely to have had the option to develop their own personal occupational pension to the same level, even if they have one. It also remains to be seen whether the majority of women affected will be able to remain in paid employment into their mid to late 60s to lessen these effects.”

I also met Lorraine, who worked in education but, because she worked part time, was not even allowed to join the occupational pension scheme. She is now 59 and has had to give up work completely to care for five elderly relatives. She also does respite fostering. This woman does so much for society and ultimately saves the Government money by caring for all these people, yet her reward is to wait until she is 66 before she qualifies for her state pension.

Jackie introduced herself to me as “June ’54 and furious!”—she allowed me to quote her on that. She pointed out that raising the state pension also denies entitlement to concessionary travel and heating allowances. She started work in 1971, when the pension age was 60, but had to take early retirement from the police service to look after an elderly relative. She will not get her state pension until she is 66. She tells me—I believe her—that she did not receive any letters informing her of that.

The Government try to justify the increase in pension age by stating that life expectancy is increasing, yet there is a real north-south divide regarding life expectancy, as several hon. Members have said. Women born in the 1950s deserve to be treated fairly. Many of them worked part time and brought up families. Many were denied access to private and workplace pensions, so the state pension was key to their financial plans for retirement. I call on the Government to reconsider the unequal treatment of women born in the’50s, to consider the inadequate notice that those women were given of the increase in the state pension age and to revisit the transitional arrangements made for them.