New figures will be officially released next week which will claim that there is no need to reduce the upper limit at which abortion takes place from 24 to 20 weeks.
1. To quantify survival to discharge from hospital and major complications of prematurity (Retinopathy of Prematurity, intra-cerebral haemorrhage, Chronic Lung Disease of Prematurity, laparotomy for NEC and/or perforation) in babies born before 27 completed weeks, by week of gestational age.
2. To compare outcomes for babies born <26 weeks gestational age in 2006 with those born in 1995.
3. To determine how problems before birth and management in labour influence condition at birth in those born before 27 completed weeks gestational age.
4. To establish whether predictors of death and poor neonatal outcomes in the 1995 cohort still hold and to identify other factors that determine these outcomes.
5. To find out how much the proportion of total births that are born alive and the proportion of livebirths admitted for intensive care at these gestational ages has changed since 1995 and to record significant changes in neonatal interventions.
The EPICure 2 team have been working very hard and data collection has now commenced. Information will be collected on babies born in 2006 throughout England and will finish when the last of the EPICure 2 babies is discharged from their Neonatal Unit.
All the information will then need to be analysed and the results will be published in medical journals and on the EPICure website
So, what the Epicure 2 study is doing is assessing whether any significant improvements have been made in clinical practice when dealing with extremely premature neonates and identifying which new practices, of those introduced or improved in the last eleven years, give the best outcomes under which conditions.
In short, the overall aim of the study, which Dorries is shamelessly misrepresenting, is to provide supporting evidence that will improve clinical practice in this area, and any implications its results might have for the current abortion debate are both incidental to the main purpose of the study and a matter of interpretation of the evidence it provides.
What has got Dorries in a strop here is that early results from the study appear to contradict one of the central planks of the argument being advanced in favour of reducing the upper limit on abortion; the claim that the number of neonates born prior to the current 24 week limit who survive to discharge from neonatal units has been increasing over the last 10-11 years, which the study states in not the case:
The EPICure 2 report, produced by a study group of neonatal experts, is based on analysis of all severely premature births across England in 2006. It found 40% of infants born before 23 weeks die on the labour ward, an increase of 8% since the last study was conducted in 1995. Of those who survived labour nearly 75% died in neo-natal units. But babies born after 24 weeks gestation had a better chance of survival than in the past, with 47% surviving at 24 weeks and 67% at 25 weeks.
So things have improved pretty significantly once you get over the 24 week boundary, but before 24 weeks, the chance of a neonate surviving to discharge hasn’t improved at all. Based on the figures given, a neonate born at 23 weeks gestation or slightly before – 22 weeks being the current boundary beyond which no neonate has survived – has around a 15% chance of being one of the ‘lucky’ survivors, and ‘lucky’ itself is a relative thing as 25% of those who do survive do so only at the cost of a life-limiting disability brought about by their prematurity.
Its 15% today and it was 15% in 1995, albeit that there appears to have been an increase in the numbers dying in the labour ward without ever being admitted to a neonatal unit, an increase that may be accounted for by improvements in the post-birth assessment of the condition of premature neonates, i.e. more neonates are dying in the labour ward simply because fewer hopeless cases are being shipped to neonatal ICUs.
I believe the research is paid for by the Department of Health.
Yes, the Department of Health does fund clinical studies of this kind via the Medical Research Council in order secure evidence which will inform and improve clinical practice – this is nothing out of the ordinary, so what of it?
(I should also point out that the first Epicure study, in 1995, was funded by Serono – now Merck Serono – a pharmaceutical/biotechnology company with interests in fertility treatment, and two follow-up studies were funded by Bliss, a charity for premature births/babies)
The Minister in charge of this area of health is Dawn Primarolo. Dawn is a pro-abortionist and is completely opposed to restricting the number of abortions which take place in any way and is very committed to making access to abortion much easier.
The current Minister of State for Public Health is, indeed, Dawn Primrolo, however she only took up the post in June 2007 as part of Gordon Brown’s post ‘coronation’ cabinet reshuffle, some six months after the Epicure 2 studies time-window for the inclusion of births in its study – the minister at the time the study was commissioned wa, most likely, Caroline Flint, who was Parliamentary Under Secretary for Public Health from May 2005 and Minister of State for Public Health from May 2006, at which time both she and the public health portfolio were promoted to full ministerial status.
Not that this has any relevance at all to the commissioning of the Epicure 2 study or its content as the Department of Health does not require ministerial assent to commission research studies of this kind.
The personal views of both Primarolo and Flint about abortion law have no bearing on either the design or the outcome of this study, not least because its relevance to the issue of abortion is entirely incidental to the study’s actual purpose.
Still, if we’re going to get in talking about conflicting interests in this debate then its worth pointing out the Parliamentary All-Party Pro-Life Group receives £250 per month in funding from CARE (Christian Action on Research and Education), which is currently subject to investigations by both the Charity Commission and the Parliamentary Standards Commission in relation to its sponsorship of a dozen research assistants working for MPs. It also has an administrator and a researcher funded by ‘Right to Life’ (amount not specified) and received donations totalling just under £10,500 from two other charities, Life and the Idreos Education Trust, of which the latter is by far the most interesting inasmuch as one of its two trustees is also the charity correspondent for Life, a Mr Martin Foley of Leamington Spa, not to mention that despite being registered as a charity for the following purposes:
The advancement of education of the public by the provision of for conducting research into bioethics issues including but not limited to abortion, euthanasia, embryo research and genetics and to dissemination the useful results thereof.
What makes the Idreos Trust so interesting is that its entry at the Charity Commission shows a total income between July 2004 and June 2007 of £7517 of which £7102 came in the first year. Income for 2005/6 was a mere £222, and for 2006-7 it fell again to £193. So far as expenditure goes, it spent £4457 in 2004/5, nothing in 2005/6 and another £4394 in 2006/7, giving a net loss over three years of £1334. So far as fulfilling its charitable purposes is concerned, it published a collection of essays on individual’s experiences of donor conception in 2006 and has a guide to ‘Christian Bioethics’ scheduled for publication in the US is August.
And yet it still managed to bung the All-Party Pro-Life group a donation of £4,000 in November 2007 – quite how that fits its charitable purposes, never mind the Charity Commission’s regulations on political activity.
The book’s author, Agneta Sutton, is the head of research and a member of the Executive Board at the Centre for Bioethics and Public Policy (CBPP) in London and Associate Lecturer at University College Chichester, UK, where she lectures in Christian Ethics, in addition to being a member of the US Centre for Bioethics and Human Dignity, and to make matters even more interesting, not only are the CBPP’s partner organisations listed by Sourcewatch as being:
All links are to Sourcewatch articles
…but a list of the CBPP’s Executive Board members throws up a few interesting and rather familiar names.
There’s Dr Peter Saunders and Dr Andrew Fergusson of the Christian Medical Fellowship, Dr Calum MacKellar, research director at the Scottish Council on Human Bioethics – the SCHB claims, on its website, to be ‘an independent, non-partisan, non-religious Scottish charity’ whose research director just happens to be a member of the Board of an Evangelical Christian ‘front’ organisation (???) – and our old ‘friend’ Professor John Wyatt of UCLH, the ‘patron saint’ of dubious statistics.
Does that all seem just a little incestuous to you?
It could have been in a field, or at the door of the best neo-natal unit, no account of circumstances is allowed for in the report.
Its doubtful that the Epicure 2 study includes any data on neonate born ‘in a field’ – a neonate born in such circumstances would, in any case, wind up very quickly in the ‘didn’t survive’ column but if you look at the objectives of the study you’ll very quickly see that Dorries assertion that that it fails to take into account any ‘circumstances’ is completely untrue – the study is designed specifically to assess everything from the extent to which pre-birth problems and ‘labour management’ impact on a neonates post-birth survival chances, evaluate changes in neonatal interventions and whether the various risk factors identified in the 1995 study remain valid.
Dorries’s beef is specifically that it uses national data to give a real picture of the current state of play vis-a-vis the survival chances of extremely premature neonates, rather than focus on the seemingly exceptional outcomes at a one or two high performing hospitals – assuming that the performance data at those hospitals is actually valid.
As both my own piece and Ben Goldacre’s assessments of John Wyatt’s UCLH data showed, there are a number of ways in which its possible to manipulate the data on neonatal survival rates to give a false picture of success when, in reality, your hospital is doing no better than any other.
One way is to simply exclude from consideration all neonates who don’t survive long enough to be admitted to the neonatal unit, which immediately biases the data in favour of a higher survival rate by limiting the neonates you include in your research only to those that started out with the best chance of making it, and although one might not like to think in such terms it is also possible to skew things even more in your favour if, in addition, your start to become even more selective in your decisions as to which neonates get rushed off for treatment and which are left to allow nature to take its inevitable course – remember, one of the most straightforward explanations of the 8% hike in labour wards deaths is simply that, over the last 10-11 years, fewer hopeless cases are being admitted to neonatal units.
Another way is simply to take advantage of the uncertainties that exist in determining the gestational age of foetuses. The differences in visible development in foetuses between 22 and 23 weeks and 23 and 24 weeks are pretty marginal, such that clinicians generally allow for a margin of error of around a week when making assessments of gestational age at this stage, so its unlikely to raise too many eyebrows if a 23 week old neonate is booked down as having been born at 22 weeks or a 24 week old foetus at 23 weeks, even though such recording errors may significantly inflate apparent survival rates, especially given the increasing gap between those rates at 23 and 24 weeks gestation.
And as I noted when covering Wyatt’s data in the context of the Telegraph’s dubious coverage, UCLH seems to have rather more admissions to its neonatal unit at 22 and 23 weeks gestation and rather fewers at 24 weeks than the national figures suggest it should have. Taking only births at 22-25 weeks gestation into account, Wyatt’s data is 8% above the national average at 22-23 weeks and 8% below average at 24 weeks, while UCLH’s 25 weeks percentage is about right.
What will be interesting, when the full Epicure 2 data is released, is whether or not it finds that the claims of hospitals like UCLH are actually backed up by verifiable differences in clinical interventions between it and other hospitals whose survival rates are at or around the national average as opposed to their being generated by statistical anomalies or differences in the manner in which extremely premature neonates are assess for transfer to the neonatal unit as this will either vindicate or knock holes in claims made by Wyatt and others.
Of course, to use the outcome of the birth of a poorly premature baby when arguing the case not to reduce the upper limit is nonsense, as 98% of babies aborted are perfectly healthy, not poorly. If they weren’t aborted they would go to term and be born perfectly normal and healthy.
The vast majority of aborted foetuses are notionally healthy, whether or not they’re aborted at 8 weeks, 15 weeks or 22 weeks gestation and most would, presumably, go to term, give or take the prevailing rates of miscarriage, stillbirth and complications in delivery. This is, however, of no relevance to the issue at hand because the simple fact – which Dorries is trying to cloud here – is that even a healthy foetus born at 22, 23 or 24 weeks gestation will become a ‘poorly premature baby’ because, providing it survives the birth (and many don’t), it will still be seriously underdeveloped and too immature to survive without massive clinical intervention. A neonate born at such an early stage will be ‘poorly’ regardless of whether there were problems in its development before being born prematurely or not – that’s extreme prematurity for you – and what the Epicure 2 study may show is to what extent complications arising from prematurity are the major factors in poor survival rates below 24 weeks, as opposed to other problems.
Dorries’ ‘poorly foetuses’ line is a load of nonsense and, again, a deliberate attempt to manipulate public sentiment by misrepresenting the facts.
I’m looking forward to shooting the figures down next week.
This I’ve got to see, especially as Nadine lacks the requisite number of appendages to do the maths for more than, say, one or two hospitals worth of data.
In reality, one can already predict in advance what Dorries will have to say – it’ll be whatever’s in the press releases put out by the likes of CARE, the Christian Institute, Christian Medical Fellowship and/or the ‘Alive and Kicking’ campaign, because despite making absurd claims about herself such as this one:
Being of neither the pro-abortion or pro-life lobby, one thing I have noticed over the last year is that the BBC is very pro-abortion. No surprise there then.
Dorries is nothing more than the parliamentary mouthpiece of the Christian right, in fact her role in this campaign is precisely that of maintaining the pretence of being ‘independent’ of any formal lobby for tactical reasons, i.e. as an attempt to con the public into thinking that her efforts to introduce restrictions on access to abortion are not motivated by her religious beliefs, in the sure knowledge – in the pro-life lobby – that religious views on abortion and abortion law hold very little traction with the public.
In short, her claim that she is not part of the ‘pro-life lobby’ is a complete sham, one that holds the public, and particularly her constituents, in complete and utter contempt.
Whatever Dorries eventually put out on her website will amount to no more than a paraphrase of a press release by one of the organisations listed above in response to the first publication of Epicure 2 data, although she may be carefully fed the content in advance of any of these organisations commenting publicly in order to maintain the fiction that she’s operating independently. As to the detail, well we can expect this to be business as usual – Wyatt’s data from UCLH will get a mention as will the other seemingly high performing neonatal unit in Salford, and pretty much everything else will be her staple diet of smears and conspiracy theories.
Three of the four reporters I have spoken to today have decided not to run the story. As one said, “my own paper has run dozens of stories of premature babies surviving and going home, these figures seem very strange”.
It’s not the figures that are ‘strange’ merely are reflection of the prejudices of journalists in the face of documentary evidence. Leaving aside any questions of personal motives on the part of the journalists that Dorries has contacted, the fact is that statistical evidence of this kind does not a ‘good’ news story make. Few people engage emotionally with statistical evidence unless that evidence supports and validates their preconceived ideas and prejudices, hence the popularity of organisations like Migration Watch and the Taxpayers’ Alliance with the likes of the Daily Mail.
Now a good ‘seriously premature baby survives’ story, that’s a very different matter, especially if there’s a few photos and a decent if slightly bizarre birth-weight comparison to be made – hospitals weigh premature neonates in kilogrammes and measure their length in centimetres, the press weigh them in bags of sugar and measure them in hands or by reference to the size of common pet animals. All good ‘human interest’ fodder and human interest stories sell newspapers, statistical evidence doesn’t.
The journalist who’s being quoted by Dorries may well have run ‘dozens’ of survival stories. but over what period of time and how does this relate to the actual survival rates? Is/Was the journalist even aware of what the actual survival rates are or is their judgement based solely on what they seem coming in to the newsdesk?
Based on data recently released to David Amess via a written parliamentary question, of 435 live births at 22 and 23 weeks gestation in 2005, some 52 survived for more than a year, 8 of which were born at 22 weeks gestation. That’s the facts – and even without checking I would expect that all eight births at 22 weeks and most of those at 23 weeks were reported by the press, if not nationally, then at least locally, while very few of the 383 babies who didn’t survive to discharge got any significant press attention at all, particularly the 338 that didn’t manage to hang on for more than a week.
The reality is that the actual survival rate that year was a matter of just under 12% but as the press will report only the most newsworthy premature births, the 52 survivors and a few near misses where a baby hangs on for a few weeks/months before dying, what people read in their newspaper is a long was from reality.
To wrap up, while casting around for information for this piece I happened across something that piqued my sense of irony. Having seemingly not been updated since last November, the Christian Institute’s homepage is current trailing as its ‘weekly podcast’ a lecture/talk by Rev Prof Robert McCallum entitled ‘You Shall Not Bear False Witness‘, which seems strangely apt given the extent to which Dorries and her supporters are doing precisely that when it comes to the current abortion debate.
Mind you, the lecture is also subtitled in parentheses as ‘(The 9th and 10th commandments)’, the latter being the one about not coveting your neighbour’s wife, house, male or female slave, ox and/or donkey, so she may be able to get by just by skipping the first bit and moving straight on to the business about coveting and why its a bad idea.