Nadine Dorries - Fact and Fiction

Nadine Dorries MP wants women to see 'independent' counsellors before they have an abortion, not go to abortion providers like Marie Stopes International or the British Pregnancy Advisory Service because they have (she says) a vested financial interest which she compares with pension mis-selling. She is proposing an amendment to the Health and Social Care Bill on September 6th to ensure this happens, along with Frank Field MP.

She is also on record saying that her political blog is '70% fiction and 30% fact... I rely heavily on poetic licence'.

Let's take a look at her being poetry in motion.

Research by Education For Choice has found that 'independent' is a word that belongs in Dorries' 70% category. And her comments about the 'financial interests' of BPAS and others are based on about as much evidence. [ETA] On Newsnight last night, Dr Evan Harris pointed out that the Department of Health’s own website warns against independent advisers.

Dorries is being backed by the Right To Know campaign. Despite describing this as 'our campaign', she now says 'I have no idea how they're funded'. She's also being poetic about their motivations, saying 'They may be ideologically driven'.

She has said that abortions are currently done before women have time to think what they're doing. Does she really mean this? Has she thought through the implications of saying that women are incapable of making their own rational decisions? Be careful you don't get distracted by thinking about shoes or you might accidentally have an abortion.

Then she claimed that Dr Evan Harris 'lost it' on an interview with Sky TV - an interview which she refused to share with him, insisting on being recorded separately. In it, Evan pointed out yet more flaws in her argument. It's not obvious what he he lost. His bus pass, possibly.

Dorries is being advised by the Christian Medical Fellowship, whose own interesting relationship with the truth I've already covered, for example here. So not only are her words 70% fiction, she is also consorting with fictionalists (I've made that word up because I'm bored of calling them LIARS).

The Right To Know campaign are bandying about the 'fact' that 30% of women who have abortions go on to suffer mental health problems. This claim is based on a paper from the British Journal of Psychiatry. The paper's conclusion is, quite reasonably, that abortion is not without consequences for some women.

However, the paper also states ‘The evidence is consistent with the view that abortion may be associated with a small increase in risk of mental disorders’. That's may be. It also states that ‘the overall effects of abortion on mental health proved to be small’ and could be the result of ‘uncontrolled residual confounding’. This means there could have been other factors influencing the results that they failed to rule out. That's being honest because it's an academic paper not a work of fiction.

Most tellingly, the conclusion says: ‘Specifically, the results do not support strong pro-life positions that abortion has large and devastating effects on the mental health of women’.

So that's another bunch of fictionalists she's consorting with.

She claims that the number of abortions would be reduced by 60,000 a year if women had independent counselling. Presumably she arrived at this figure by thinking of a number and then adding a load of noughts as there is no evidence to back it up. Her story-telling stops at this point rather than considering what might happen to these 60,000 babies in terms of supporting both them and their parents. For her, the happy ending is a full-term pregnancy. In this respect, she's close to the Catholic Church's position.

Dorries wants us to go back to being a Christian nation with Christian values. But the ruling classes' relationship with these values has always been a marriage of convenience, using them to justify or condemn whatever and whenever it suited them. Moreover, 'Christian Britain' is a nostalgic idyll for a time and place that existed alongside the land of the Care Bears and belongs in the 70% of words put together in a sentence that look like they might be true but in fact aren't. Besides, back in the days of Yore when we were at least nominally a Christian nation, the only people who really benefited were upper middle class white men - much like the ones who still dominate the House of Lords and the Tory party.

The latest from Dorries is this gem 'I wonder why someone would provide a quote to a national newspaper when they obviously have no idea what they are talking about?' I'm not even going to go there.

She has also said 'I have chosen the 'fact' I wish to believe'. That would be the fact that is 70% fiction, presumably.

It's almost too easy to take her arguments apart. When her bill amendment was first raised, many people said it was nothing to worry about, it would disappear and pro-choice campaigners were getting worked up about nothing. But now it looks like the Government could turn her fictions into fact, which means that no one will live happily ever after.

There's a good analysis of the almost total lack of evidence for changing the current abortion counselling position on the Nothing Special blog.

Next time will be less of a tirade, honest.

UPDATE 1 September 2011: The Government has done a U turn on abortion counselling but the free vote could still go either way next week. This means that MPs can vote according to their conscience rather than the party line.

UPDATE 2 September 2011: It's gone up from 30% to 'twice as likely' to suffer mental health problems post-abortion. She's done a loaves and fishes job on the stats.

Pro-choice groups are supporting an amendment by the Libdem MP Julian Huppert:

All organisations offering information or advice in relation to unplanned pregnancy choices must follow current evidence-based guidance produced by a professional medical organisation specified by the secretary of state.

Doctor Jesus - Curing Cancer With Ribena

Ofcom has ruled against the evangelical channel Believe TV for promoting Ribena and an olive-oil soap as a cure for cancer and other diseases, including heart disease, ovarian cysts and a bit of an achey back. The soap can also 'grow new kidneys'.

There's no need for a scientific analysis of why these things can't cure cancer or anything else. There's no need for randomised, double-blind, placebo-controlled, peer reviewed testing. Whether it's olive oil, Ribena or any other substance, these are just props. They have no inherent curative properties, which is why they are not cures for specific problems. Paul Lewis of Believe TV has also claimed that a bath with Miracle Olive Oil Soap can help if you're behind with your mortgage. What really cures is faith - it's the active ingredient. God can work through anything if you believe. If they don't work, it's because of a lack of faith.

It's the products' USP and a marketing ploy that must be the envy of all advertisers - if a product doesn't work, there's no money-back guarantee because it's the consumer who's faulty, not the product.

What's more, if a tumour or a bad back does disappear, it can't be proven that it wasn't cured by faith even if the patient was receiving conventional treatment at the same time.

This is where miracle cures are different from other forms of alternative medicine, which always have some sort of pseudo-science theory behind them.

Many adverts involve an element of faith, which could be described as the triumph of hope over reason. We believe that products will make us more successful, more attractive or thinner, that they will make us live longer. We have faith that the companies will do what the adverts say they will. If they don't work, we often have legal recourse or we can switch to another brand.

Paul Lewis and others like him are not selling a lifestyle, they're selling life. The stakes are much higher than promising shinier hair. And there is no other brand, he has a monopoly.

There is a kind of transformative magic at work like the one that changes the communion wine and wafer into the real body of Christ. Any bit of bread or bottle of wine will do. It's the same process that shamen and witch doctors have used for millennia, an infusion of magic.

As cultural norms evolve, so does who we trust and believe. Miracle workers are culture-specific; the shaman evolves into the tele-evangelist. Their props are also culture-specific; Ribena wouldn't work in a culture where it wasn't a known brand, for example. The transferable commodity between cultures and down through history is faith, the human propensity to believe the unbelievable.

Paul Lewis knows that people who buy Miracle Olive Oil Soap wouldn't rub a toad on themselves because that's not the current cultural practice. He and others like him know that they can operate only within certain cultural parameters using culturally familiar artefacts and familiar practices like taking a bath. Olive oil is a benign substance (with Biblical connotations) and while Ribena may seem an odd choice, it's comfortingly familiar with overtones of childhood nostalgia. It's just good marketing sense.

With culturally-embedded practices and a clause to prevent claims for refunds, it's a win-win situation. It's also why, no matter how many times Ofcom or the Advertising Standards Authority ban the promotion of a cure, there will always be another one.

The Doctor Jesus series is here, here, here, here and here.

Bell, Book and Candle

Exorcism is not just unscientific - the concept of evil makes us all Bart Simpson.

BBC's Sunday Morning Live today had a discussion about exorcism and a woman claiming that it cured her alcoholism. Leaving aside the scientific aspect - regular readers will know what I'd say on that - there is another aspect to consider.

Belief that bad things are caused by an outside agency is the supernatural equivalent of the Bart Simpson defence - a bigger boy made me do it.

The word 'evil' is problematic. It's used by non-believers to describe certain sorts of human behaviour and by believers to describe the agency of the devil. Both use it to identify something that is allegedly inhuman, alien or Other. And that's the problem. Whether it's alcoholism, homosexuality, mental illness, unruly children, child abuse or serial killing, 'evil' sources the cause as something outside human nature.

Even though many non-believers use it as a catch-all with a whole range of nuances, there is still too often a sense that this is not regular human behaviour. But it is, everything humans do is human nature, we can't just pick the bits we like or easily understand. Neither is it evidence of our 'animal nature', something to be tamed or that we must rise above, it's part of human complexity.

A secular authority uses the judicial system to deal with this 'evil', some religions use exorcism.

Exorcism - or deliverance as some churches call it - is founded on a victim mentality that is perversely comforting. We are not responsible. We are at the mercy of supernatural attacks and only God can protect or liberate us. In addition, sometimes it's the most religious who are the most assailed so it becomes almost a badge of piety to be possessed. The woman on Sunday Morning Live who blamed possession for her alcoholism was handing over responsibility. She saw alcoholism and other afflictions not as a disease or as a choice but as something that was inflicted on her, something which she had no power herself to overcome.

Like many of us, she wanted to blame someone or something for what happened to her. No one can help being born with a propensity for alcoholism or psychopathic behaviour but 'blaming' our genes or environment isn't satisfying. As humans, we look for something with human-like intentions because that is both easier to conceptualise and to distance from ourselves.

One response to her was that whatever gets you clean is good. But this way of thinking leaves people like her open to further possessions. Anytime something bad happens, responsibility is handed over to the devil. If God doesn't deliver you the first time, keep going until he does. Not only does this attitude make us victims, it infantilizes us, holding us in a suspended state of child-like irresponsibility, pushing away both blame and understanding.

A watered-down and more secular version of this Devil-think is the idea of luck, which looks to ascribe outside causes to agencies that can be propitiated or neutralised through ritual. It may appear less harmful than a belief in possession, but it's part of a continuum, a position that acknowledges science but then over-rides it. It's like instances where people know there is a scientific reason for something happening - livestock dying or being burgled, for example - but then go on to ask why here, why now, why me? And the answer is something Outside.

Calling behaviour evil can be a way of saying 'it couldn't happen here, we're not like that'. But as we saw in Norway recently, it can and does happen in all of our 'heres'. Putting photos of killers with red-eye in the paper and calling them the face of evil really doesn't help prevent that. We're all capable of behaviour that we're not proud of and the only way to prevent it, either as an individual or a society, is to recognise it, not to think of it a some sort of alien invader.

We're not Mediaeval peasants who can execute a pig for killing a child or blame a curse for making our crops fail but our minds haven't changed in just a few hundred years. Belief in exorcism or even (bad) luck is still a kind of contamination theory: something infects us or attacks us or breeds inside us - something that can be contagious and that has a cure of the same order. Whether we think it's the devil or some sort of allegedly secular evil, this is sci-fi/horror movie thinking.

Max von Sydow is not going to turn up to fix us and neither is Sigourney Weaver. The Alien is us.

Lying for Jesus (Yet Again)

The pro-choice charity Education for Choice has first-hand evidence that pregnancy crisis centres based on a 'Christian ethos' are using scare-mongering, emotional blackmail and lies to try and put women off having abortions. The Guardian coverage of the story tactfully talks about 'inaccurate information' but let's call it like it is. Lying.

EfC sent women undercover to centres including some run by the organisation Life. One of the undercover EfC women was given a leaflet that claimed 85% of abortions are carried out using vacuum aspiration. It stated that 'the unborn child is sucked down the tube' and that 'the woman should wear some protection. She has to dispose of the corpse.'

Another centre tried to persuade the woman to put off the decision and another handed out its 10-step 'road to abortion recovery', including steps entitled 'guilt and shame' and 'forgiveness'. The EfC women were shown baby clothes and talked to in emotive terms to manipulate them. There were also the usual lies about mental illness and cancer caused by abortion.

I'm confident in calling these lies because I've looked at some of the research the claims about cancer and mental illness are based on.

The Government is considering farming out services to 'independent' organisations, which would include those with religious motivations. In this instance, it appears that 'independent' mean 'independent of scientific fact and the NHS's own guidance on abortion'.

MP Nadine Dorries wants women to be forced to go for counselling before they can have an abortion - and this counselling cannot be provided by any organisation that also carries out abortions, for example Marie Stopes International.

Her original intention was to make this change an amendment to the Health and Social Care Bill but it is now possible that the change will be made without a parliamentary vote. It appears that her ally Frank Field MP could be working with the Department of Health to introduce these new counselling arrangements via regulatory change instead.

If practices at the organisations investigated are anything to go by, this would be very bad news indeed for women and their partners. Only two out of the ten centres EfC visited gave accurate advice and only one mentioned centres which provided abortions. These are not good odds for someone who chooses to go for counselling and even worse odds for anyone being forced to have it.

A couple of weeks ago I wrote about a consultation on advertising pregnancy advice centres. The proposal is that they must state whether or not they will refer for abortion. Perhaps they should also be required to display their beliefs on large signs outside the building. Then women would really be able to make an informed choice about whether to go in or not. Some would and that's up to them.

This Government is constantly banging on about transparency so any proposal to use organisations that base their activities on lies, subterfuge and ulterior motives masked as offering 'choice' does not bode well for the Big Society.

Memento Mori - Dealing With Death

Some evolved survival mechanisms are the skeleton in the cupboard.



The death of celebrities or large numbers of regular people provokes an outpouring of shock, public grief and an intimate examination of their lives which, with the benefit of hindsight, led inevitably to their deaths.

The reaction that we are pleased to have is that the death of Amy Winehouse and the deaths in Norway provoke empathy both for the dead and for their families.

At the same time as feeling empathy, we have another reaction that it's not always quite as comfortable to admit to. Publicly-reported deaths always serve as a memento mori, a reminder of the fragility of life. The death of young people provokes particularly complex reactions; both Winehouse and most of the Norwegian dead were young.

News of any death creates cognitive dissonance, the discomfort caused by holding conflicting ideas simultaneously. So empathy for the dead and grieving creates and becomes entangled with fear of our own death. It's uncomfortable to feel sorry and afraid at the same time; we want the empathy but not the fear. Humans are (as far as we know) the only animals to be aware that we will die and we have to deal with that when we're reminded of it.

Memento mori means roughly 'remember you will die'. It's also used as a term for artefacts. These date back to antiquity but became widespread in Mediaeval times. They were a means of reminding people that death - and Judgement - were never far away to keep them close to the Church. Images of skulls, skeletons and the Grim Reaper are widespread in religious art for this purpose. The Book of Common Prayer still has the line 'In the midst of life we are in death. Earth to earth, ashes to ashes, dust to dust'. Carpe diem and all that.

As well as being aware we will die, we also have the ability to push this thought away. At the same time as empathizing, we also remind ourselves that Winehouse was an addict whose life was a mess and that we don't live in Norway.

We start to collect reasons why such deaths could never happen to us - this is the survival mechanism. This reaction can tip over into blaming the victim - Winehouse brought it on herself, for example. Some of the coverage majors on the 'fact' that she'd been on an 'ecstasy and booze binge'. Her many appearances while drunk or drugged are poked into, along with comments on her appearance - 'Amy also appeared unhealthily thin, with scabs on her face and marks on her arms, wearing scruffy clothes' in the Sun, for example. Her 'friends' are quoted as saying they were afraid for her before her death, that it was inevitable.

The shock of Norway is that it was Norway - a low-profile country where nothing much ever happens from an outside perspective. But it was Norway and we don't live there, we dodged the bullet through the good luck of geography. Calling the massacre of over 80 people (at the time of writing) a national tragedy helps bind their nation together but it also serves for the rest of us as a comfort that it wasn't our nation.

There is sometimes a certain Schadenfreude in our response too, a pleasure in the suffering of others. It's a comfort for us not being rich and famous to see how screwed up the lives of celebs are. But on this occasion the Norwegian deaths complicate the freude because the dead were not rich and famous, they were nobodies like us - and that brings it closer to home. This weekend, the Schadenfreude is less pleasure and more relief. We're not rich and famous but at least we're not Norwegian. It's not a laudable response but it's a human one just as much as the emotions and reactions we're more proud to own.

However, our success in telling ourselves that it couldn't happen here can come back to bite us when it does, especially when the perpetrators are home-grown. Freud might have called it the return of the repressed. The Norwegians had successfully insulated themselves; according to the BBC, 'Norway has had problems with neo-Nazi groups in the past but the assumption was that such groups had been largely eliminated and did not pose a significant threat'. We're all human, we're all fragile but this time it wasn't us and couldn't have been us - until it is.

The desire to read these stories or watch the news coverage may seem callous, something we shouldn't do, something tabloid and nasty for the better-educated to tut about - but it is part of the survival mechanism, the distancing process, insulating ourselves from death. Even the more rational media play into this, for example by listing other musicians who died young of overdoses or suicide - Hendrix, Cobain, Joplin etc, mentioning the 27 Club - some 38 musicians who died age 27.

The media aren't really doing anything that we don't all do, even if on an unconscious level. We may not like all of our instincts, and some we should probably not give in to, but covering them up or identifying them as something other people do, people we look down on, is not realistic. Doing that is also another human response though. Human beings are complicated buggers.

Always Let Your Conscience Be Your Guide? Part 3

Should students be accepted for medical school if they have no intention of treating certain people or conditions?

A survey shows that a significant number of medical students think doctors should be able to refuse any procedure that contradicts their beliefs. The procedure that causes the most contention is, as always, abortion.

Not all of the respondents were religious; non-religious students thought opt-outs should be a right too - 35% thought there was a place for conscientious objection. The survey also found a prevelance among the religious to object to certain procedures and patients.

In general, support for a doctor's right to refuse any procedure that troubles their beliefs was highest among Muslim medical students at 76.2% while 54.5% of Jewish students thought the same, as did 51.2% of Protestants and 46.3% of Catholics.

More than double the number of Muslim students than non-believers would refuse an abortion when contraception failed. A higher percentage of Muslim students than others would object to prescribing contraception. Nearly eight percent of them also stated they would object to ‘intimately examining a person of the opposite sex’. The survey didn't ask how students would feel about examining LGBT people which, along with not exploring the reasons for objections in the non-religious, is a limitation.

Doctors opting out of treating certain patients is only part of the problem. Some students are refusing even to learn certain areas of medicine in the first place.

It was reported in the Sunday Times four years ago that some Muslim medical students were refusing to attend lectures or answer exam questions on alcohol-related or sexually transmitted diseases because they claimed it offended their religious beliefs. This was corroborated by both the BMA and the GMC. Professor Peter Rubin, chairman of the GMC’s education committee, said: “prejudicing treatment on the grounds of patients’ gender or their responsibility for their condition would run counter to the most basic principles of ethical medical practice”.

GMC guidelines recognise the right of freedom of expression for medical students but state that this 'cannot compromise the fundamental purpose of the medical course: to train doctors who have the core knowledge, skills, attitudes and behaviour that are necessary at graduation'.

The GMC also specifically states that a foundation level doctor cannot practise while refusing to examine patients on grounds of gender or those patients whose illness can be attributed to their lifestyle. Guidance drawn up by the GMC advises doctors to refer a patient to a colleague if they object to a certain procedure or treatment. They must also give patients enough information so they can seek treatment elsewhere within the NHS. In some situations, doctors' consciences can (and should) be accommodated but the foundation level doctor is often the first one to see acute patients and any delay in treatment could have serious implications.

The research paper on the survey concluded that ‘Once qualified as doctors, if all these respondents acted on their conscience and refused to perform certain procedures, it may become impossible for conscientious objectors to be accommodated in medicine’. It also states that ‘The views of large numbers of Muslim students are contrary to GMC guidelines, and thus the medical profession needs to think about how it will deal with the conflict’.

Although Muslim students are clearly a growing problem, Muslims are not the only ones to object to certain procedures. The Christian Medical Fellowship, which has 4000 members, is also strongly anti-abortion, for example. Almost a third of the students surveyed wouldn’t perform an abortion for a congenitally malformed foetus after 24 weeks, a quarter wouldn’t for failed contraception before 24 weeks and a fifth wouldn’t even perform an abortion on a minor who had been raped.

Some of the reporting of this survey has gone straight to worse-case scenario and ignored the finding that a lower percentage of students would refuse to carry out a procedure than actually objected to it. However, the percentages are still significant and the situation needs to be addressed while respondents are still students. If the number of medical students prepared to carry out a termination when they qualify is shrinking, then women will find it hard to access abortion safely and quickly in the future.The UK may be drifting towards the situation in Italy where nearly 70% of gynaecologists refuse to perform abortions and 50% of anaesthetists refuse to assist on moral grounds even though abortion is legal.

While the GMC is holding out against students' right to pick and choose what they learn, the question remains - why do people want to become doctors if they are only going to treat certain patients or conditions, and where do they think they will practice this limited form of medicine? It's not just women's needs that are taking second place to beliefs; the provision of universal healthcare is being challenged too. Perhaps medical students need to be triaged when they apply to colleges and clearer limits set on the conscience to make sure that patients' needs always come first.

I wrote a response to the GMC consultation on conscience opt-outs for the National Secular Society some time ago.

In Part 1 I looked at the affect on women of pharmacists being able to opt out of selling emergency contraception if it's against their beliefs. I also wrote a consultation response for the NSS on this subject. It's not just in the UK where conscience is becoming a problem. In Part 2 I looked at the debate in the Parliamentary Assembly of the Council of Europe on doctors' opt-outs.

Update 3 August 2011
In related news, a Christian midwife is refusing to wear trousers because Deuteronomy 22:5 says that it's wrong to wear the clothes of the opposite sex. Trousers are part of the uniform for hygiene purposes and the hospital is so far sticking to its guns saying that wearing them is 'proportionate'. Let's hope she never wears clothes of mixed fibres and doesn't have pierced ears.

Barking Up The Wrong Tree

I was taught at school always to read the question before answering an exam. Basic, really.

In 2009, the Broadcast Committee of Advertising Practice (BCAP) ran a consultation on changing the rules for advertising Post Conception Advice Services (PCAS). I wrote a response for the National Secular Society, sent it off and waited to see what happened.

The new rules would allow more PCAS to advertise and would also ensure that adverts were not misleading about the services they offered - principally whether they would refer a woman for abortion or not (some can't if they're run by nurses and some won't if they're Pro-Life). There were certain restrictions about when adverts could be run - not close to children's programmes, for example.

BCAP were well aware that adverts might cause offence to some people who have a moral or religious objection to abortion but considered there were strong public health grounds to justify showing them and that the 'specific consumer interest in question is that of pregnant women'. It took into account the fact that 'these are legally available services offering a range of advice and that providers should be permitted an appropriate level of freedom of expression to advertise'. it also stated that 'offence taken by some members of the audience is not in itself sufficient reason to prohibit a particular category of advertising'.

I wondered why there had been no results of the consultation published.

This week, we got an email from BCAP saying they were running the consultation again.

The new consultation notes explain that the 2009 consultation resulted in 27,000 responses from people stating they were offended by the proposals, mostly on religious or moral grounds. However, 'most respondents appeared to have misunderstood what was being proposed' and 'few respondents commented on the specific question of whether it is appropriate to allow a broader range of PCAS (including commercial services) to advertise and whether it is sensible to require services that do not refer for termination to say so'.

27,000 is an awful lot of 'offended' people. So offended that they didn't bother to read the questions properly. Or maybe they did and just wanted to have a rant anyway.

Some of these responses were:

* BCAP's proposal will encourage promiscuity among young people and divorce sex from mature relationships.

* BCAP's proposal will promote abortion as a means of birth control.

* BCAP's proposals are in conflict with the Audio Visual Media Services principle that audiovisual commercial communications shall not cause moral detriment to minors.

* Abortion providers mislead women into thinking that abortion is a quick-fix solution to a problem pregnancy with no harmful consequences.

The consultation notes also say - 'you need only write a second time should you feel that your understanding of the proposal has changed'.

This is a polite way of saying - rant as much as you like, we'll still ignore you. Maybe it will make a difference, maybe they will get another 27,000 misguided rants. The NSS response does not need to be submitted again.

If you believe abortion is wrong for moral or religious reasons, that's your prerogative, as is saying so publicly. Replying to a consultation that exists only in your head is neither persuasive nor productive. All you achieve by barking up the wrong tree is frightening the squirrels. Don't be surprised if they throw nuts at you.

If you want to respond to this public consultation, it's here.

I'll be attending the Pro-Choice rally next Saturday.