The Testiculating Dr Pemberton

Over at the Daily Telegraph Max Pemberton, who’s also a doctor, has written an opinion piece on abortion which, amongst other things, neatly illustrates the kind of problems that can easily arise if you’re gullible enough to believe everything you read in the newspapers.

The problems with Pemberton’s article begin in the very first paragraph:

There can be few medical procedures so politically charged as abortion. Simply uttering the term polarises people. Battle lines are drawn and there is an expectation that you will join one camp or the other. For or against, pro-life or pro-choice: the narrative rarely extends beyond this simple dichotomy. And, if you are pro-choice, any criticism of abortion is considered a heresy.

That may well be true of the media’s narrative on abortion, especially in the Telegraph which has developed a very noticeable Roman Catholic bias in recent years, but it is certainly not the case when you talk to people online. I’ve been writing about abortion, on and off, from a variety of different perspectives and narratives that characterise abortion debates are rarely very simple ones, at least on the pro-choice side where there is no great shortage of ethical discussion and debate.

Where there is a problem is on the anti-abortion side, where the ‘debate’ – such as it is – is characterised by the same systematic dishonesty that Education for Choice recently exposed in its approach to pre-abortion counselling through it’s network of so-called ‘Crisis Pregnancy Centres’. In Britain, the native anti-abortion lobby knows it cannot win the moral and ethical argument on abortion and gain sufficient public support to return UK law back to where it stood prior to the 1967 Abortion Act, as indicated by this slide taken from a presentation prepared by Peter Saunders of the Christian Medical Fellowship as part of the now-defunct ‘Alive and Kicking’ anti-abortion campaign.

allornothing

So far as establishing a relationship between the contents of this presentation and that of the Education for Choice report, you may wish to note that there is specific slide in the presentation which refers to the fictional ‘post-abortion syndrome’ while the previous slide [41] makes reference to “an acknowledged link between abortion of the first pregnancy and breast cancer” when this claimed link had been specifically refuted by what was, at the time the presentation was developed (2006), a very recent large scale meta-analysis of the epidemiological evidence on abortion and breast cancer:

… the totality of the worldwide epidemiological evidence indicates that pregnancies ending as either spontaneous or induced abortions do not have adverse effects on women’s subsequent risk of developing breast cancer.

Beral V, Bull D, Doll R et al (2004) Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83000 women with breast cancer from 16 countries. Lancet 363:1007–1016

And, of course, the presentation also makes reference to the direct involvement of both LIFE and CareConfidential in that campaign and these are two of the organisations whose CPCs were found to be giving women false information.

Moving on…

I unreservedly support a woman’s right to terminate her pregnancy, and I have no moral issue with abortion. But it’s precisely because I support a woman’s right to choose that I feel uncomfortable about the way that abortion services are run. That there is a financial incentive for pregnancy advisory services to undertake terminations is plain wrong. It is fair to ask, how can they offer independent advice when so much of their income comes from terminations?

And could ask the exact same question of any doctor in private practice or indeed of the pharmaceutical industry, in fact Dr Ben Goldacre has asked that question of the pharmaceutical industry and its relationship with medical practitioners in his excellent and thought-provoking book ‘Bad Pharma‘, which has given rise to the All Trials campaign.

In respect of doctors in private practice Pemberton will, no doubt, point to GMC regulation and its guidance on standards and ethics as offering a bulwark against doctors being influenced in their clinical practice by financial interests and incentives, and independent abortion service providers are also closely regulated, currently under a set of interim procedures published in July 2012 while a consultation was carried out on permanent revisions – that consultation concluded at the beginning of February with the final updated guidelines being scheduled to come into effect from 31st May 2014.

Independent sector abortion providers operate with a fully regulated system in which they are subject to spot inspections by the Care Quality Commission to practice guidelines issued by the British Medical Association and the Royal College of Obstetricians and Gynaecologists plus, in the case of pre-abortion counselling, whichever Code(s) of Ethics may be applicable to the work of counselling staff depending on their individual professional membership(s).

Is that so very different to the system in which doctors practice? No, of course not, and just as a doctor who fails to adhere to the GMC codes runs the risk of losing his or her license to practice medicine so an independent abortion service provider that failed to abide by the regulations governing its services would also risk losing its licence.

There is a serious question here that needs to be put to Max; how would he feel if his professional judgment as doctor was constantly being questioned and second guessed in public on the strength of his professional relationship with the pharmaceutical industry, i.e. on the assumption that he attended presentations put on by drug companies, received their promotional literature and even reads journals which are owned by pharmaceutical companies and individual journal papers which are, in some cases, ghost written by researchers working for ‘Big Pharma’?

All this talk of independent sector abortion service providers and financial incentives is based on nothing than innuendo, which is deliberately spread by anti-abortion organisations and lobbyists as part of efforts to sway public opinion to their side of the abortion debate on the back of absolutely no evidence whatsoever of either the two largest independent sector providers, BPAS and Marie Stopes International, ever having operated under a conflict of interest.

Many women seeking advice are scared, upset and vulnerable. While doctors would argue that they remain impartial in the advice they give, research suggests that, although many think they are impartial, in fact they can be easily swayed by subtle external pressures. Why do we think it will be any different with abortion?

Because doctors, with the best will in world, are not for the most part trained professional counsellors and the role most often occupied by the doctor is that giving advice to their patients and making recommendation as to the most effective and appropriate treatment options to meet their patient’s clinical needs. I don’t expect doctors to be impartial because most are not trained to be impartial, they are trained to identify the best treatment(s) for their patients needs based on the best available evidence and recommend those treatments because that it what is in their patient’s best clinical interests.

Non-directive counselling, which is what women enquiring about an abortion may need if they are uncertain about their decision, is based on a very different skill set to that which most doctors possess because the two roles are very different.

To make inferences about counselling practice based on research carried on doctors is akin to evaluating the work of a hospital cardiology department using the hospital statistics for cancer mortality; it’s comparing apples and oranges.

Okay, we can skip the nest bit, which is about the dodgy information being given out by CPCs, which brings us to:

What an unforgivable mess. Where are the voices from women’s groups condemning this whole set-up [CPC]?

Where are the media doctors who are paying attention to the abortion debate? After all this is not the first occasion on which Education for Choice has caught CPCs up to no good:

Women receiving advice from pregnancy counselling centres run by faith-based and anti-abortion organisations are subjected to scaremongering, emotive language and inaccurate information about abortion, according to an undercover investigation by a pro-choice charity.

A survey of 10 centres operated by Christian and anti-abortion organisations found evidence in most of them of poor practice and factually incorrect advice, while the quality of counselling differs widely. Advice ranged from scaremongering – linking abortion with breast cancer, for example – to actions apparently designed to steer women away from abortion, such as showing them baby clothes and talking about “the child”.

Abortion: pregnancy counselling centres found wanting“. The Guardian. 2 August 2011.

Where are the voices from women’s groups? Out here on the Internet where perhaps the best place to start would be the Abortion Rights campaign – there’s no lack of women’s voices, and a few men’s voices as well, just a lack of doctors with columns in the Daily Telegraph who can be arsed to pay attention.

Where were the feminists after this newspaper also uncovered doctors who were willing to terminate pregnancies for women who did not want to have a baby girl? A few muted whimpers – but nothing more.

Last month, another investigation suggested that the practice has become so widespread within some communities that it is said to have led to the “disappearance” of between 1,400 and 4,700 females. Why aren’t men and women who consider themselves supporters of women’s rights up in arms about this?

What was exposed is pure misogyny, and yet, because it relates to abortion, ideological confusion creeps in. Why can’t you criticise the way abortion services are run while still supporting a woman’s right to choose?

Because the Independent’s ‘investigation’ was a complete and utter shambles from start to finish because the journalist who did the ‘investigation’ and obtained the data set that the newspaper used from the Office for National Statistics hadn’t got the first idea what he was doing in his efforts to replicate a Canadian study carried out by academic economists from Columbia University and the University of British Columbia and produced a great steaming pile of garbage that, amongst other thing, mistakenly claims to have found evidence of sex selective abortion in Muslim communities in the UK when there is no actual evidence of such practices in Muslim communities anywhere in the world.

The Independent’s ‘investigation’ is littered with very basic and obvious errors, as indeed was the CMAJ editorial written by Rajendra Kale, the author of the signature comment piece which accompanied the Indy’s ‘investigation’, which put Filipinos in the frame as practising sex selective abortions when the research he was citing clearly stated otherwise:

Some readers might be skeptical about whether female feticide is in fact taking place in Canada and the United States. Research in Canada has found the strongest evidence of sex selection at higher parities if previous children were girls among Asians — that is people from India, China, Korea, Vietnam and Philippines.

Kale, R. “It’s a girl!” – could be a death sentence. CMAJ 2012.

We find high sex ratios to be entirely driven by immigrants who are neither Christian nor Muslim, the highest sex ratio being found for Sikhs. For this group, there are more than 2 boys per girl for the third child if the two elder children were girls, implying a sex ratio that is 100% above the normal above for this group. By contrast, Asian immigrants who are Christian or Muslim (mainly from Pakistan, Bangladesh, the Philippines and Hong Kong) exhibit normal sex ratios, irrespective of parity and sex mix of previous children.

Almond D, Edlund L, Milligan KO. O Sister, where art thou? The role of son preference and sex choice: evidence from immigrants to Canada. NBER Working Paper No. 15391. Cambridge(MA): The National Bureau of Economic Research; 2009

That’s why there was no major outcry amongst supporters of women’s right about the Independent’s ‘investigation’ because the Indy’s figures are not just wrong, they’re not even wrong.

Nor, indeed, is there are ideological confusion over sex selective abortion – that’s yet another canard spread by the anti-abortion lobby – because as those of us who are pro-choice know perfectly well the problem here is not the availability of legal abortion or the alleged willingness of a very small number of doctors to perform such abortions but the culture that impels some women to choose to abort female foetuses.

And, actually while we are on the subject of sex selective abortion there are some very interesting and pertinent comments about the Telegraph’s investigation, to which Pemberton refers, to be found an interview with former DPP Kier Starmer published in The Guardian last October:

Take the decision on sex-selective abortion, in which he[Starmer] ruled not to prosecute two doctors who had been had by a media sting operation (two journalists, pretending to be carrying a female foetus, asked two doctors for an abortion on those grounds).

“In order to make the sting work, the undercover team asked for an abortion based on gender, but then immediately mixed in other reasons. So in both cases, there was reference to previous failed female pregnancies. Chromosomal defects were referenced. In one of the cases, the doctor was told there was a test in France.

“She said, ‘What is this test? And how pregnant were you?’ And the journalist said, ‘I was in France. I was eight weeks’ pregnant.’ When the doctor was then arrested, she said, ‘I didn’t believe her. I don’t think there is a test at that point of gestation. I just assumed she was lying and wanted an abortion for some other reason’.”

It’s a fascinating case – a sex-selective abortion charge would never have stuck because the journalists were just too sloppy, but the CPS could have charged the doctors with not asking enough questions.

Now that is interesting because, of course, there is no mention whatsoever in the original Telegraph story of its journalists making claims about supposed chromosomal defects in order to get their targets to agree to perform an abortion nor, indeed, when the case was dropped did the Telegraph get around to mentioning that their own journalists had botched their attempted sting, instead they chose to publish an innuendo laden editorial which sought to suggest that the case had been dropped for political reasons and not because they’d fouled up.

Permberton concludes his article by claiming that, for him, all this a “clear example of how farming out services from the NHS to independent providers can go cataclysmically wrong” – it isn’t. What it is, is a clear example of how easily even intelligent people can be rooked into testiculating* in print by a combination of media incompetence and dishonesty.

* Testiculating (verb) – Waving your arms around and talking total bollocks.