Wednesday, 29 July 2009

Beware the spinal trap

Sense about Science have asked as many people as possible to publish today the article by Simon Singh in The Guardian in April 2008 that sparked off the libel trial with the BCA. This is to prove that threatening libel or bringing a libel case against a science writer won’t necessarily shut down the debate. This is it -with the 'bogus' part removed.

Beware the spinal trap
Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.
You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.
But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.
If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial.

Sunday, 26 July 2009

The evidence against abstinence stacks up

According to a recent report by the Centres for Disease Control in America, the rates of teenage pregnancy and STIs increased under the Bush administration (2001-2009) - despite its massive funding of abstinence programmes. There is a summary of the report here.

Janet Collins of the CDC commented that: "It is disheartening that after years of improvement with respect to teen pregnancy and sexually transmitted diseases, we now see signs that progress is stalling and many of these trends are going in the wrong direction."

The report found that 88% of pregnancies in 15-17 year olds were unplanned. Rates of chlamydia, gonorrhea and syphillis were significantly up. Nearly a quarter of women aged 15-19 had HPV in 2003-4 and a third of adolescents had not received birth control instruction by the age of 18.

The blame cannot be laid entirely at the door of Bush's pro- abstinence stance, but evidence points strongly towards it. When he was governor of Texas in the 1990s, he spent $10 million a year on abstinence education. The state still had the fifth highest teen pregnancy rate in the US.

Under his presidency, the spending continued, despite much evidence that it didn't work, including one report by the Guttemacher Institute. This states that a 9 year, $8 million evaluation of federally-funded abstinence-only-until-marriage programmes had no beneficial impact on young people's sexual behaviour. By the end of his presidency, over $1 billion had been spent.

Two other interesting findings from the CDC report are that nine out of ten states with the highest increase in teenage births voted Republican in 2000 and 2004. Also, young Hispanic women have sex less often than others but give birth more. One possible reason for this is that the vast majority of them are Catholic and are receiving even less encouragement to use birth control.

George Monbiot has an article about the CDC report in The Guardian where he writes that: A study published by the American Journal of Public Health found that 86% of the decline in adolescent pregnancies in the US between 1991 and 2003 was caused by better use of contraceptives. Reduced sexual activity caused the remainder, but this "ironically … appears to have preceded recent intensive efforts on the part of the US government to promote abstinence-only policies". Since those intensive efforts began, sexual activity has increased.

President Obama has cut funding to abstinence-only programmes but the National Abstinence Education Association is still pressing for funding, as is the Abstinence Clearing House with its links to all the 'evidence' for abstinence working. Some groups blame the failure on underfunding and say that programmes did not go far enough.

There's a good summary of pro-abstinence responses here. Some groups are now trying to rebrand themselves, talking about a 'holistic approach' and 'healthy lifestyle choices' in an attempt to claw back funding. One Christian blogger blames the increases in teen pregnancy on the media, and says rates would have been much worse were it not for Bush. She also says that rates are much higher in Europe, a sign of our moral bankruptcy - so the US is not doing so badly after all. Dogma and ideology continue their battle against science and evidence.

However, even though Obama appears to be on the right track in his own country, many US funded HIV/AIDS initiatives in the third world are still promoting abstinence, particularly PEPFAR, as I reported here. The latest partners in that initiative include pro-abstinence religious groups.

Monday, 20 July 2009

Too Much Too Soon - Fear and Loathing in Sex Education

Norman Wells of the Family Education Trust has written a guidance document for parents about the Government's proposed plans for sex education - now called PSHE - and has whipped up a predictable reaction in The TelegraphThe Mail and The Express.

The FET's website makes no overt mention of religion, it promotes 'family values'. But reading between the lines, it is clear where these values come from. Wells writes that sex is not intended to be just about the joining of two bodies together, but the joining of two lives. In the context of faithful, lifelong marriage, sexual intimacy expresses the total self-giving of a husband and wife to each other.

If sex is intended to be anything, who is doing the intending? Once the hand of God becomes clear, what follows is pretty inevitable.

Alongside the propaganda, there are a lot of factual inaccuracies, many of which appear to have been directly copied from the Christian Medical Forum's submission to BCAP that I wrote about recently (and also here). They both claim, for example, that there is no good evidence against abstinence, that condoms are not 100% effective and therefore should not be promoted at all, and that STIs and teen pregnancy are rising therefore sex education doesn't work. One of the FET trustees is Stammers - who wrote one of the papers the CMF cited in its submission.

It is true that STIs and teen pregnancy are a serious problem (although pregnancy is not as much of a problem as certain groups make out, as I mentioned in the previous link). It's also true that sex education is far from what it could be and that parents need to be much more involved and supported. This is hardly a new issue - anyone remember The Specials' Too Much Too Young

However. And it's a big however.

Wells' guidance is dangerously misleading. Its main target is not just the Government's plans for PSHE, it is sex itself. The usual mix of fear and loathing that has infected hard-line Christians since St Paul is in full flow here. Early on he says that behind plausible-sounding arguments and innocuous-sounding words there is a specific agenda at work to undermine the role of parents and to tear down traditional moral standards. Sex education is an ideological battlefield on which a war is being waged for the hearts and minds of our children.

This emotionally over-wrought opening sets the tone for the whole guidance. As if he doesn't have his own agenda. Frequent use of the word 'children' rather than 'teenagers' ups the emotional ante too.

Wells' three main points are:
  1. Parents should teach children about sex
  2. Sex should only ever happen within marriage
  3. Anyone who suggests otherwise (including the Government) is destroying the moral fabric of society.
His concern is that making PSHE statutory in the curriculum would inevitably reduce the influence of parents over what is taught. His modus operandi is to scare parents that the Government (who let's face it, most Telegraph, Express and Mail readers did not vote for) is going to turn their children into rabbits - pregnant, infected rabbits merrily having abortions with the schools colluding to keep parents in ignorance until society comes crashing down around us. I am not exaggerating.

It is a parent's right, he maintains, to teach children about sex in accordance with their religious beliefs. That's the parent's beliefs, not the child's. They should have the right to take children out of PSHE classes.

Parents should speak about sexual matters with modesty and restraint.  If the child's entire education consists of the parent saying 'no sex before marriage' then that is all they will learn. Any misinformation the parent gives, knowingly or not, will be all the child has to go on. Presumably there will be some additional information on the wedding night about what goes where.

There is no need even to teach children the correct names for body parts because all parents talk to their children about their bodies when they wash and dress them from their earliest days and are well able to decide whether to use the proper biological terms or other names for their private parts. So it's fine for a child to grow up thinking it has a woo-woo? Or that 'down there' is something no nice child ever talks about, let alone looks at or - heaven forfend - touches?

Many parents do not feel confident or comfortable talking about sex and schools need to give them full support. However, the religious position is that this support comes from faith, not the classroom - unless schools are free to peddle the religious line too. Wells' main reason for wanting sex education to come from God (via the parent) is that this will instil morality, not facts. He rails against the Government outlines: there is no recognition of moral absolutes and... young people are not to be given any clear moral direction... there is no such thing as objective right and wrong

Well, that's because there isn't. Only the most religious believe that there are divinely handed-down moral absolutes. And what are these moral values? Homophobia is quite clearly one of them; it is casually strewn throughout the guidance as PSHE will, he claims, equate marriage with same-sex civil partnerships and ... assume that both types of relationships are of equal benefit and stability... it is almost certain that homosexuality will be presented as a normal and natural lifestyle choice.

So what should young people be taught?

Wells does not want them given any information they could use because it is not informed choices we should be aiming for, but wise, moral and lawful choices.  It's the old argument that if you tell them about it, they will rush out and do it. Even mentioning the word 'gay' will of course instantly turn a child from the straight and narrow.

Wells is so anti-choice it's not funny. Contrary to the prevalent view among sex educators, young people do not need to learn about a wide range of 'sexualities' and sexual behaviours; they do not need detailed information about the full range of contraceptive methods; and they do not need to be presented with a menu of sexual options from which they can make 'informed choices' when they feel they are 'ready' to become sexually active. Modern sex education is characterised by a lack of honesty, a lack of modesty, a lack of any moral framework worthy of the name, and a lack of respect for marriage as the proper context for sexual expression.

A lack of honesty? Is keeping young people in ignorance honest? Not only does it risk their health, it also means that they are likely to pick up what sex knowledge they do get in the playground or through experimentation.

He continues: Teenagers need to be taught that reproduction is one of the primary functions of sexual intercourse and sex should therefore be set in the context of a faithful, lifelong relationship (ie marriage), which provides the most stable environment in which to raise children

Wells believes that if parents teach about sex in a (Christian) moral, modest and respectful way, this will prompt young people to save themselves until marriage (that word 'saved' again). Abstinence is the only way. This stance is woefully ignorant of human nature and teenage nature in particular. A bit of a moral lecture, maybe some praying and some vague information about the mechanics of sex (if they're lucky) is hardly going to quench teenage hormones. And is terrifying them with the wrath of God really going to produce mature, healthy and responsible adults?

My particular favourite part of the guidance is there are some sexual practices that it may be better not to know anything about at all, at any age. Sadly, he does not go into any further details.

There is much more to say about this pernicious document. The excellent Dr Petra Boynton will be analysing it in her blog.

Thursday, 16 July 2009

Chocolate News

My inner nerd has been taking over far too much of late, diverting me from the true subject of this blog, which is of course the carb-based snack. So...

Important news from the world of chocolate (which is one of the major food groups):

About half of American women crave chocolate, and approximately half of the cravers crave it specifically around the onset of menstruation. This study examines whether the primary cause of this "perimenstrual" craving is a direct effect of hormonal changes around the perimenstrum, or rather if the craving is a general response in some individuals to stress or other notable events. Insofar as there is a direct hormonal effect, one would predict a substantial decrease of 38% in total chocolate craving in women post-menopause, corresponding to the proportion of women pre-menopause who report craving chocolate exclusively perimenstrually. Based on a survey of pre- and postmenopausal alumnae of the same University, we report a significant but small decrease in prevalence of chocolate cravings post-menopause. The decrease is only 13.4% and thereby much smaller than a 38% drop predicted by a purely hormonal explanation, suggesting that female reproductive hormones are not the principal cause of perimenstrual chocolate craving.

Damn. Damn. Damn.

More news. The Swiss have invented a low calorie chocolate that doesn't melt in hot weather - 90% lower cal than the average chocolate 'product', they claim. However, part of the reason it's less fattening may be because it's full of air bubbles so most of it isn't chocolate.

According to a spokesperson: "It's called Vulcano because it can be eaten when it's hot, and it's airy and full of bubbles, like volcanic rock." Or like Aero?

The main reason for making a chocolate that melts at higher temperatures is so that it can be sold in hot countries - it's heat-resistant up to 55C (131F) whereas most chocolate starts to melt at 30C. We are reassured that: "It does melt in the mouth, but it is the enzymes in saliva rather than the heat of the tongue that causes it to dissolve." Hhm. I'm liking the sound of it less. And the grammar of the press release not at all.  Not while there is Green & Black's in the world and this shop.

Monday, 13 July 2009

Lying for Jesus? :2 Condoms

Following on from my previous post, the second part of the Christian Medical Fellowship's submission to BCAP concerns condom advertising on TV.

They note that the Government's Independent Advisory Group on Sexual Health and HIV wrote to BCAP requesting a review of scheduling restrictions on condom advertising, noting that the UK had the highest teenage pregnancy rate in Europe and spiralling rates of sexually transmitted infections.

First off, it's western Europe. Secondly, as a PubMed article shows, such claims about pregnancy have been inflated by the media: International comparisons suggest that the rate is moderate and that the past six decades have seen a decline rather than a rise (...) We believe that the selective reporting of international and time comparisons by public policy makers results in a 'manufactured risk' and has more to do with moral panic than with public health.

This does not bode well for what follows. But back to the CMF with an open mind. Things can only get better.

Or not. They continue that: The presupposition in this proposal is that more condom advertising to an ever wider range of young people will reduce unintended pregnancy and offer some protection against sexually transmitted infections. Briefly, the evidence shows, instead, a correlation between the government's policy of increasing promotion of contraception and the very rises Baroness Gould [of the AIG] notes. (..) The negative effect of the 'message' trumps any possible positive medical benefits. (my bold)

Does the evidence show that promoting contraception correlates directly with an increase in STIs? It could well be that there are other confounding factors involved, for instance that contraception is not being promoted in the most effective way or that there are reasons for promotions being ignored. Did the rise occur before, during or after the promotion? Or it could be that the evidence doesn't show that at all. No trumps on the table just yet.

The CMF conclude that: Further promotion of condom advertising to children aged 10-16 is unnecessary and unethical.

Why is it unethical? Two papers are cited in defence of their assertion. One is Are condoms the answer to rising rates of non-HIV sexually transmitted infection? No by Stephen Genius. This is a response to a previous piece called Are condoms the answer to rising rates of non-HIV sexually transmitted infection? Yes by Steiner and Cates.

The Steiner/Cates article is a balanced one citing strong evidence that condom use is effective in reducing STIs and unwanted pregnancy but making it very clear that condoms are not the whole story; better sex education about risk avoidance and reduction is essential, with condoms as part of the package. It warns that We need to focus on ensuring consistent and correct condom use rather than denigrating condoms as being less than perfect.

However, Genius' response does just that. His basic position is that condoms cannot be the definitive answer to sexually transmitted infection because they provide insufficient protection against transmission of many common diseases [such as] "Skin to skin" and "skin to sore" infections.

But no one is saying that they are. As all students are taught right from the start - answer the question in front of you, not some other question that you've prepared better for.

Ironically, Genius states early on that A fundamental tenet of medicine is adherence to scientific fact and experiential evidence to develop treatments and programmes that maximise and sustain health and later that Political correctness and ideological interests need to be usurped by sound science. But then he proceeds to cherry-pick data that back up his anti-condom stance. He doesn't even address the main point of the piece he is responding to, which is that condoms can work as part of an educational package. His response is that any package must be a moral one only.

Genius' other objection is that many people do not bother with condoms or do not use them properly, particularly if they are drunk or have taken drugs: protection is usually compromised by compliance issues, incorrect use, or mechanical failure. One of the supportive responses to his article adds that When you talk to young people, it is still considered uncool to carry condoms with you.

So his two arguments against promoting condoms are that they don't protect and most people don't use them properly anyway (which is irrelevant if they don't work).

Instead of recognising that the rising rate of infection is a complex problem, Genius is against anything at all that may reduce risk except for abstinence because: The more that sexual behaviour is trivialized, the greater will be the numbers of those involved in casual behaviour. The correct strategy is to promote responsible sexual choices by young people and television can have great power for good here (...) Those for whom condom knowledge is relevant will find it anyway, and the ever increasing trivialization of sexual behaviour will damage more and more children and young people.

Rather than seeing condom adverts as a way to make condom use more acceptable and more widespread, he disingenuously and consistently tries to discredit condoms to give his moral position some scientific authority. His simple solution to a complex situation is: Just say No.

His other point about condom knowledge being easy to find is the same point that the CMF make about abortions, which I dealt with in the last post.

This promotion of abstinence and warnings about 'trivializing' sex is based on as little reality as the Catholic Church's attempt to prevent teenage girls having the HPV vaccine because it would encourage them to have sex. After protests they reluctantly allowed the vaccine as long as no sex ed accompanied it, thus leaving them vulnerable to every other kind of infection, along with pregnancy.

The second article the CMF cite in support of their submission is written by Stammers, a trustee of Family Education Trust and Challenge Teams UK; both charities provide abstinence centred sex education packages to secondary schools in the UK. He is also a (volunteer) web doctor for Love for Life, the largest provider of abstinence centred sex education to schools in Northern Ireland, and did paid consultation work for them in the past.

Right away, the card are on the table this time. But again, let us not jump to conclusions before looking at the evidence. Being a Christian does not preclude being a good scientist...

Stammers position is that abstinence taught by parents is the answer, the only answer. He thinks, rather quaintly, that 'saved sex' is a more useful term than abstinence and asserts that: The false assumption that "young teens will have sex anyway" is an insult to many young people who have the capacity to rise to a far more effective challenge than just "use a condom every time".

He also says that Of course, to be involved in this way, parents have to be with their children and claims that the lower rate of single parenthood in the Netherlands is an important factor in the lower rate of teenage pregnancy.

This all fits neatly with the CMF'S own stated position that they are advocating marriage as God's intention for human sexual relationships.

So, saved sex and happy families will save society. Not condoms or sex education. Don't do it until you're married, then stay married and teach your children not to do it either. Easy.

Responses to this article in the BMJ are mixed, some in support of the moral stance, some pointing out the flaws in Stammers' argument and his biased starting point. To pick just one of the responses that challenge him:

Stammers' editorial on sex education raises a number of interesting public health issues. However, in the light of our recent investigation into abstinence-based programmes for HIV prevention in high-income countries, several of his assertions appear flawed on key methodological principles.

Recent research also contests Stammers' suggestion that declines in adolescent pregnancy rates (specifially, US adolescent pregnancy rates) are primarily attributable to delayed first sex.

It is interesting to note the contradiction between Stammers' suggestion that sex education studies assessing condom use make "false claims of success", and his acceptance of attitudinal outcomes of an abstinence-only programme trial as indications of "greatly enhanced" effectiveness.

The most methodologically rigorous systematic reviews to date have documented no behavioural or biological evidence that abstinence-only programmes can reduce sexual risk with respect to HIV infection or pregnancy, as compared to a range of control groups. (my highlighting, references to support this extract in the link above)

Flawed methodology, out of date information, cherry picking and pot calling the kettle black, then.

Whereas the part of the CMF submission dealing with abortion made overtly (and unsubstantiated) medical claims against it, this section tries to prohibit or severely limit condom adverts on moral grounds, using a spurious efficacy argument. At best, this is a muddled message; the efficacy of condoms is entirely separate from the moral question but the submission mixes the two. Not only that, the submission itself does not use the A word even though it is the principle message of the two papers. Why not, if this is their real agenda? Perhaps because it would undermine their attempt to appear scientific.

The CMF's moral recipe also appears ignorant of teenage behaviour. Teenagers do not need encouragement to have sex. Some do resist, for whatever reason, but it cannot be assumed that they will. For those who don't, there must be a safer way.

The CMF's preaching is masked as concern for teenagers and for society - the ever increasing trivialization of sexual behaviour will damage more and more children and young people - in the same way that their abortion propaganda indulged in hand-wringing about the dangers to women.

The mission is to save teenagers from themselves. The idea that the teenage sexual urge is something base to be overcome through the Grace of God is a primitive idea, harking back to Calvin and nodding to Descartes with his mind/body dualism. It also has echoes of Freud's concept of the id, the dark and lusty part of our nature to be smacked into submission if we are to be socialized (and, in religious terms, saved - that word again). And then there is the fear/hatred of sex that has permeated religion ever since St Paul. If you must have sex, wait until you're married and then do it only for procreative purposes, never ever for recreational ones. It is easy to caricature the CMF position because they lay themselves open to it with their disingenuous submission and their questionable evidence. But this should not distract from the real dangers that their position entails.

Unbiased commentators recognise that condoms are not the whole answer and that this is a complex issue; they see condoms as an essential part of a package based on evidence and real life, not just religious wishful thinking.

Addendum: Dr Petra Boyton has written in her latest blog about intitatives to reduce teenage pregnancy, something the CMF think are a waste of time.

Thursday, 9 July 2009

Lying for Jesus? The Christian Medical Fellowship on Abortion

I recently wrote a response for the National Secular Society to the BCAP Broadcast Advertising Standards Code consultation about advertising for family planning and abortion centres, and for condoms. Since then, the Christian Medical Forum has published its response. I was expecting moralising but not quite such an interesting relationship with evidence.

The CMF have, according to their website, more than 4,500 British doctors as members. All are Christians who desire their professional and personal lives to be governed by the Christian faith as revealed in the Bible. It exists to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.

There are many areas in their submission to deal with, particularly their stance on condom adverts, which I plan to come back to. For now I'm going to focus on abortion advertising.

The CMF say there is no need to advertise abortion centres on TV because: Any woman considering abortion will be sufficiently motivated and will easily be able (with the help of friends if necessary) to find information about abortion providers from the wide range of sources currently available.

This argument could be applied to any product. No need for any TV adverts at all. But young women and those living in communities, religious or otherwise, that do not approve of abortion - or who condemn and punish it - are not going to find it easy to get information and support, and may even be afraid to go to their GP in case their families find out.

Once the CMF has made its pro-life stance clear with: Abortion is always a procedure with a 50% mortality - the life of the fetus is intentionally ended, they mostly avoid the explicitly moralistic angle and turn to highlighting the medical 'risks' of abortion (they are doctors, after all).

They baldly state that: Breast cancer rates are rising in Europe and North America and are projected to rise further. Then they say: There is evidence suggesting that having an abortion may increase a woman's risk of breast cancer in later life. However, it is undisputed that a full term pregnancy protects against subsequent breast cancer. The link is therefore biologically plausible.

Is this a plausible link? Is it even logical? Being childless also increases the risk, as does living longer, having it in the family - and being a nun. Should convents be banned from recruiting and are all childless women (wilfully barren wombs) including nuns somehow complicit in their own cancer?

There are many sources that cast doubt on the CMF 'evidence'. For example, The New England Journal of Medicine published the largest-scale study ever on this subject - with 1.5 million participants - which concluded that there is no independent link between abortion and breast cancer. Clearly if abortion does increase the risk of breast cancer, it does so by an undetectably small margin. Another source says In March 2003 the National Cancer Institute (NCI) declared emphatically that 'newer studies consistently showed no association between induced and spontaneous abortions and breast cancer risk'. NCI convened a symposium of over 100 of the world's leading experts to review existing studies on the relationship between pregnancy, abortion, miscarriage and breast cancer risk and concluded that having an abortion does not increase a woman's subsequent risk of developing breast cancer.

The CMF have used weasel-words 'may cause' and 'plausible' but once the spectre of cancer is raised, it is hard to exorcise. Playing on women's fears is a low tactic, especially women who may already be vulnerable because of an unwanted pregnancy.

Then there are the mental-health consequences. The first of these is: increased psychiatric hospitalisation - admission rates were higher post-abortion than post-partum when those with a priori psychiatric history were excluded.

However, the paper they cite to back up this assertion says in its conclusion: The observed associations may be the result of less social support for women who have an abortion compared with women who deliver; reactions to abortion itself or common risk factors among mentally ill women and those who have abortions have not yet been identified. And Our data controls for socioeconomic status by using only women from the lowest socioeconomic group in the United States. This strength, however, also limits our ability to draw any conclusions from these findings regarding women of other socioeconomic groups. And This suggests that social support following an abortion may be a significant mediator of adjustment. And Differences in earlier mental health history, more than a year before the pregnancy, may also have influenced the results.

Did the CMF actually read the paper? Four separate statements in one study that contradict them.

Another claimed link is for increased death rates from injury, suicide and homicide. As evidence, they cite this study which says that: It is unlikely that induced abortion itself causes death due to injury; instead it is more likely that induced abortions and deaths due to injury share common risk factors. It also notes that: Beginning in the mid-1990s, some studies reported that the check-up recommended to occur a few weeks after an induced abortion was also omitted, which ties in with what was noted earlier about post-abortion support making a big difference.

What's more, the study looked at 1,141,267 women who were pregnant or who had been one year before their deaths, from 1987-2000, and found that 82 died after giving birth and 92 after an abortion. Ninety two. Out of 1.1 million. It's a call for more support, it is not against abortion.

Just to make it even clearer, the time of greatest distress is likely to be before the abortion. While some women may experience sensations of regret, sadness and guilt after an abortion, the overwhelming responses are relief and happiness. In another study of 5,295 women over eight years, researchers concluded that the most important predictor of emotional well-being in post-abortion women was their well-being before the abortion and also noted that the incidence of diagnosed psychiatric illness and hospitalization is considerably lower following abortion than following childbirth

There are two further CMF reasons for not advertising abortion clinics. One is that people will start to see abortion as a form of contraception (that old one). The other is that men will stop using condoms, which will put them at a greater risk of STIs. Not women, just men. This is highly ironic given that the submission rails against condom adverts.

Mixed messages, misogyny, cherry-picking, biased reporting of evidence, dodgy methodology - whatever happened to Exodus 20:16?

Sunday, 5 July 2009

Circumcision and HIV/AIDS: UPDATES

Rather than lots of short posts with updates and additional information, this post will collect them all together.

July 5 2009

The debate continues with two pieces in the Observer today, both by the same journalist, Alex Renton. They are both strongly pro-circumcision and, although detailed, don't look at the case against. Renton is a food journalist.

July 16 2009

A piece on the BBC website about how research from John Hopkins School of Public Health found that circumcision does not prevent HIV positive men transmitting  the virus to women:

"Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed."

The trial was stopped because of the rates of infection. However, they continue to recommend circumcision, in conjunction with condom use. They suggest both circumcising earlier (ie circumcising boys)  and continuing to circumcise HIV positive men in order not to stigmatize them.

"Women are disproportionately affected by HIV in sub-Saharan Africa, and - as this study shows - will still be at risk whether their partners are circumcised or not (...) The best way to guard against HIV is by always using a condom".

July 20

The link to the source article for the BBC story above, in The Lancet .

Friday, 3 July 2009

What's your star sign? Women and Woo.

Research shows that women are more likely to be religious, to believe in the supernatural and to buy into complementary/alternative medicine (CAM). Is this because we are more gullible or more child-like?

Men are of course not immune to these beliefs. Most religious leaders are male, as are many psychics, ghost hunters and practitioners of CAM. Unless they are all charlatans, at least some of them must practice what they preach.

The human brain looks for patterns, causes and connections, which is a very useful evolved survival mechanism and has got us this far. But a side-effect is that we also see them where there are none. Just as small children think they are the centre of everything, we can feel that we are, if not the centre, then strongly connected to others. And if to others, why not to the universe, to something 'bigger than ourselves'?

One reason for apparent female gullibility could be our psychology and evolution although this does of course apply to the average woman. As Simon Baron Cohen's book The Essential Difference describes, there are people who are system-based and people who are empathy-based in the way they relate to the world and other people. The systemizers tend to be male but are not exclusively so. For example, a quarter of women have better spatial skills than half of men even though this is generally considered a male trait. It's possible to have either sort of brain or, more precisely, to be more than averagely systemizing or empathizing whatever sex you are.

If the scale is systems at one and end empathy at the other, the people towards the extreme systems end are mostly male - which is why more men have autism/Asperger's. There are very few female train spotters. But there are she-nerds.

Given that most people are about average, then most women have more empathy than most men. This means that we value relationships, connections, communication and feelings more. We need to make emotional connections and look for them in relationships of all kinds.

This could also lead us to look for and make them in the wrong places. For example, imagining that certain phenomena are caused by an agent rather than by chance. If we have a certain feeling, or something happens, we may look for who caused it rather than what. We may feel a connection with dead people too, more readily seeing ghosts or believing the dead are communicating with us. Empathy leads us to ascribe emotional states to them just as we do to the living.

The Virgin Mary is popular with women who identify with her and feel an empathic connection. The Catholic Church promoted her mostly for the female half of the congregation, to replace the goddesses of earlier religions. Father, Son and Holy Mother are a family and women are interested in family matters (they are the real Trinity, most regular people have no relationship at all with the Holy Ghost or really understand what it is) . Obviously, this is far from the whole story with religion, but it's a contributing factor to the gender difference.

Women who are not religious may feel that there is 'something out there', some non-specific consciousness with which they can connect and have a relationship. It's much more comforting to believe that the universe has a personality than that it's just stuff floating around with no purpose or intention. But comfort is not the cause of the thinking, which is evolved, instinctive and mostly unconscious.

Being psychic is again about connections and communication. Tarot readers never tell you that you're a terrible person, which would create a distance between you and them, and make you feel socially unacceptable; they comfort and guide you. Mediums maintain emotional links with dead loved ones, often helping to restore broken connections. You pay them but you have a trust relationship with them. Horoscopes take a kind of cosmic parental interest in your life and give you guidance and warnings just like your mum did when you were a kid. They all show you patterns, ascribe causes and link things up to apparently give them meaning on a personal level, not a theoretical, abstract one.

In the past, for example in Victorian times, women had little power and were often restricted to the home and a narrow social circle. Becoming a medium was a way of meeting people and getting out of the house. It was also a good way of getting attention, being the centre of a network of connections, communicating and being listened to. In earlier times again, having religious visions made you the centre of attention (although not always in a good way, as Joan of Arc found out). This is often not a conscious, calculating activity.

Even though many men succumb to supernatural or irrational beliefs, some of the areas they buy into are different. For example, they are more likely to believe in UFOs and conspiracy theories than women - apparently fact-based phenomena that they can catalogue. The choice of fiction is different too, with women more likely to watch soaps, which are about 'real' people and men more likely to go for sci-fi/fantasy. Men's delusions, when they differ from ours, reflect their system-based thinking. Faulty input results in faulty output. Men are also more likely to think that a comb-over will fool everyone, which is strong evidence for a tendency towards belief based on no reality at all.

The main market for CAM is middle class, middle aged women who use it on themselves and their families. Two of the reasons cited for using it are that it is 'holistic' and 'natural'. Setting aside the fact that plenty of natural things are very unpleasant indeed, these responses are again about feeling connections. Science is perceived by these women as being cold and impersonal or arrogant and 'science doesn't know everything'. This is a real reflection on medical practice where doctors are often too busy (and sometimes too badly trained) to bring out the empathy with the stethoscope. CAM practitioners appear to relate to them as individuals, not a set of symptoms. It's also a way of bonding with Nature.

The average female brain has evolved to be interested in people as a survival mechanism, instinct bonds women to their families and close associates, helping them all to thrive. In social animals, the ability to relate to and bond with others is essential for group stability and the benefits that confers. A side effect of this is that some of us extend beyond what is strictly necessary, embracing the whole universe, seen and unseen, in our personal network. God, the dead and Nature are our close personal friends. If we didn't do this, the human race probably wouldn't be here now.

It's not always useful to buy into supernatural thinking, we may get ripped off, make bad decisions, risk our own health and our families' but it's also a way of being that has major advantages in the same way that being a systems thinker has advantages and disadvantages. There is no point in pretending that men and women work the same way; the problem comes when one way of relating to the world and other people is seen as better or more rational - or saner. This is also why gods may come and go but religion is not likely to go away any time soon.