Apologies, in advance, for yet another post on the subject of abortion but having just watched the relevant segment of last night’s Newsnight and the comments of both Nadine Dorries and a representative of the Christian Medical Fellowship, there is a very specific point that needs dealing with.
Both Dorries and Mr CMF – there was no caption giving a name – referred to research into foetal pain by a Dr ‘Sunny’ Anand of the Department of Paediatrics, University of Arkansas Medical School, which the claim has been ignored by the Royal College of Obstetricians and Gynaecologists and Department of Health. They also claim/imply that Dr Anand has been excluded from giving evidence to the Science and Technology Committee and imply that this is because the committee is biased and endeavouring to ensure that only evidence in support of retaining the current 24 week upper limit on abortion.
There is not one single shred of truth in any of these claims and imputations, which I will now prove.
First let’s deal with Dr Anand, whose comments – by telephone – appear on Newsnight with a caption indicating that his name is ‘Dr K S ‘Sunny’ Anand’.
This is incorrect. A search on the PubMed database returns articles by what appear to be several doctors with the name Dr KS Anand, all living and working in India, none of whom work in the field of paediatrics and neonatal or foetal pain.
Dr ‘Sunny’ Anand is actually Dr K J Anand, and is listed as the author/co-author of 106 research papers, which is a good solid portfolio of published research.
As far as Dr Anand’s work on foetal and neonatal pain is concerned, there appear to be four specific papers that could been of specific interest to the Science and Technology Committee, these being:
Of these four papers, only the first – Pain assessment in preterm neonates – has actually been published, in March 2007 in the journal ‘Pediatrics’.
The remaining three papers, including the critical paper on foetal pain (and I will not use US spellings) have not, to date, been published. PubMed shows them to be ‘in review’ and due for publication in the journal, ‘Seminars in Perinatology’ on 31st October 2007.
The simple reason why Dr Anand’s work does not feature in submissions from the RCOG, BMA or DoH is because the research is not due to be published until next week.
In fact, in the submissions to the committee from all interested parties, including those of the Christian Medical Fellowship and other ‘pro-life’ organisations there is not one single reference to either Dr Anand or to any of these four research papers, nor, indeed, would one expect there to be given that one has been in print for only six months and the other three are not currently in print.
So far as the allegation that Dr Anand has been excluded or not invited to address the committee, well as member of the committee, herself, Nadine Dorries should know perfectly well that the process by which parliamentary committees invite witnesses – other than those from government, the civil service and other areas of the public sector, is by publishing an open call for written submissions to the committee. The committee states its brief and the information/opinions it is seeking, and it is then up to any interested party to submit their written views, opinions and evidence to the committee for consideration.
Based on the submissions received, the committee will then invite people to appear before the committee to give evidence in person.
As already noted, not only single submission to the committee FROM ANY SOURCE, refers to Dr Anand, his work or any published research paper on which he is cited as the author or co-author.
And Dr Anand, himself, has not made any written submission to the committee.
As I’ve said previously, interesting and valuable as Dr Anand’s work appear to be, in the context of debating abortion it is of limited value.
This is the published abstract from Anand’s paper of foetal pain:
Pain in the developing fetus is controversial because of the difficulty in measuring and interpreting pain during gestation. It has received increased attention lately because of recently introduced legislation that would require consideration of fetal pain during intentional termination of pregnancy. During development, sensory fibers are abundant by 20 weeks; a functional spinal reflex is present by 19 weeks; connections to the thalamus are present by 20 weeks; and connections to subplate neurons are present by 17 weeks with intensive differentiation by 25 weeks. These cells are important developmentally, but decline as a result of natural apoptosis. Mature thalamocortical projections are not present until 29 to 30 weeks, which has led many to believe the fetus does not experience emotional “pain” until then. Pain requires both nociception and emotional reaction or interpretation. Nociception causes physiologic stress, which in turn causes increases in catecholamines, cortisol, and other stress hormones. Physiological stress is different from the emotional pain felt by the more mature fetus or infant, and this stress is mitigated by pain medication such as opiates. The plasticity of the developing brain makes it vulnerable to the stressors that cause long-term developmental changes, ultimately leading to adverse neurological outcomes. Whereas evidence for conscious pain perception is indirect, evidence for the subconscious incorporation of pain into neurological development and plasticity is incontrovertible. Scientific data, not religious or political conviction, should guide the desperately needed research in this field. In the meantime, it seems prudent to avoid pain during gestation.
The critical information here lies in this passage:
Physiological stress is different from the emotional pain felt by the more mature fetus or infant, and this stress is mitigated by pain medication such as opiates. The plasticity of the developing brain makes it vulnerable to the stressors that cause long-term developmental changes, ultimately leading to adverse neurological outcomes. Whereas evidence for conscious pain perception is indirect, evidence for the subconscious incorporation of pain into neurological development and plasticity is incontrovertible.
It would appear that what Dr Anand has established is that a foetus can experience physiological stress similar to and consistent with what we understand to be pain from around 20 weeks gestation.
That does not mean ‘pain’ in the sense that we understand it as adults – there is no conscious response at this stage of even a rudimentary nature, but rather that subjected to external stimuli that could/would cause pain in a mature adult, the foetuses body will respond physiologically and biochemically (in terms of the production of certain hormones) in manner consistent with an adult individuals autonomic response to pain.
This, Dr Anand indicates, can affect the ongoing neurological development of the foetus and lead to adverse outcomes. What kind of adverse outcomes I cannot say, as the paper has not been published and I cannot, therefore, read and comment on Dr Anand’s precise findings…
…and nor can the Science and Technology Committee, the RCOG, BMA, etc.
This – if verified by peer review – is clearly relevant to doctors undertaking invasive clinical interventions during pregnancy where – and this is crucial – the intention is that the foetus will be carried to term and result in a live birth.
In the case of a second trimester abortion, the adverse outcomes indicated by Dr Anand are of no relevance whatsoever, because the foetus will not be developing to full term. It really doesn’t matter if this autonomic response would affect further neurological development, because such develop ceases with the termination of the pregnancy.
The development of the capacity, in the foetus, to respond autonomically to external stimuli of any kind, in addition, tells us nothing whatsoever about the foetuses notion ‘humanity’ – this is essentially a philosophical question in any case and on that cannot be resolved on a purely scientific basis at our current state of knowledge and understanding of how the brain works.
The relevance of Dr Anand’s work to clinical practice in abortion is NOT that it provides grounds for a reduction in the current upper limit of 24 weeks, It may, however, constitute an argument for the use of anaesthesia in second trimester abortions at or after 16-18 weeks gestation, not because this necessarily ensures that the foetus does not experience pain – it still not clear whether it does in any meaningful sense in any case and certain has no capacity to process pain at a conscious level until the third trimester, but such a practice could, and probably would, reassure both doctors conducting abortions, and more importantly, women undergoing abortions at this stage that the procedure is being carried out in as humane a manner as possible.
That’s the clinical relevance of Dr Anand’s work.
Now we come to big question.
Given that neither the Christian Medical Fellowship, or any other ‘pro-life’ group has included any reference to Dr Anand and his work in any of their submissions to the Science and Technology Committee:
1. Just when, exactly, did they become aware of his work and was this before or after the submitted their written evidence to the committee?
2. If before, why did they not include such references in their submission to the committee?
Dorries, one suspects, may not have been aware of Dr Anand’s work until whenever she saw last week’s Dispatches documentary on abortion.
However, the website of the Christian Medical Foundation has two references to Dr Anand in their student publication, ‘Nucleus’, which do not relate to the current ‘controversy’, one from October 2005 and another dating back to January 1998, and yet its submission to the committee not only fails to make any reference to Dr Anand, but it fails to make any reference to foetal pain at all.
This could be a simple oversight in the compilation of its submission.
It could also be that the CMF were unaware of Dr Anand’s recent, unpublished, work at the time the submission was drafted and forwarded to the committee.
Or, it could also be that, that the CMF is fully aware that, as scientific evidence, Dr Anand’s work is of strictly limited relevance and value in relation to abortion and amounts to, at best, a possible argument in favour of the use of anaesthesia in late second trimester abortions and, as such, it it not an argument that would stand up to scrutiny under questioning by a reasonable well-informed committee of the House of Commons.
It is, however, an argument that sounds persuasive to ‘the man/woman in the street’ – to the layperson lacking in sufficient background in the relevant sciences necessary to appreciate the limitations of Dr Anand’s work.
In that last possible scenario, a ‘pro-life’ group might quite easily come to the conclusion that it is not only better to omit any reference to Dr Anand, thereby ensuring that his work is NOT scrutinised by the committee, but also that, because his work does – admittedly – have considerable emotional ‘pull’ on those who do not fully understand or appreciate the science behind it or its limitation in relation to this specific date, there might be ample opportunity to stoke uneducated public sentiment and call into question, if not damage outright, the credibility of the committee, by holding the information on Dr Anand’s work until the last minut, before producing it like rabbit out of a hat.
In the circumstances, I believe that the committee would, if possible, be well advised to request copies of Dr Anand’s recent papers and to ask if he would provide a written submission to the committee on his work, one that commented specifically on how he views its scientific/clincial applicability, or otherwise, in the area of abortion.
And it should, of course, inquire as to whether, even at short notice, Dr Anand would be willing – and available – to appear before the committee to answer questions. From what I can see of his published work, he seems a very credible, diligent and professional researcher, the kinds whose opinions the committee should be seeking.
I also think that the committee should, if possible, recall the representative of the Christian Medical Foundation – who I believe has already given evidence – and make further inquiries as to when it became aware of Dr Anand’s work and why, if this was indeed before making its submission, it did not refer to it, Dr Anand or any other evidence or data on foetal pain.