Tuesday, 14 December 2010

Who Killed Christmas?

Christmas is coming, the goose is getting fat and, inevitably, the sound of voices struggling to reach the high notes in Hark the Herald Angels Sing is joined by the voices accusing atheists, secularists and anyone else they can drag in of killing Christmas.

It's not like anyone is standing outside churches stopping people going in but yet again, we are cast as Alan Rickman's Sheriff of Nottingham telling his minion to 'call off Christmas'.

Archbishop Rowan Williams isn't resting very merry, being seriously dismayed about school nativity plays and public carol singing being banned. Some schools aren't doing nativity plays this year, which is a sign as clear as the Star of Bethlehem that we're all going to hell in a handcart, apparently. He said that 'most people of other religions and cultures both love the story and respect the message'. No empirical evidence to substantiate this claim was supplied.

Meanwhile, Local Government Secretary Eric Pickles is ding donging merrily about a 12 year old story. It is traditional to tell stories about the dead coming back at Christmas, after all. In 1998, Birmingham Council allegedly called their celebrations Winterval and banned all Christian elements from them. Except they didn't, they still used angels in their publicity materals and promoted carol concerts, among other things. Pickles commented that "Shoppers want to see Christmas lights, Christmas trees, carol services and nativity scenes, and councils should not hesitate in supporting them". Has he been down Oxford Street lately?

And then there's the Mail getting all deep and crisp and even about supermarkets not selling enough Christmas cards with religious imagery on. They're joined by the Evangelical Alliance whose Don Horrocks said: "There has been a rise in cards that say 'Season's greetings' or 'Happy holidays' which is evidence of the speeding up of the trend of stripping the religion out of Christian festivals'. Shame on you all for buying cards with robins on instead of a nativity scene surrounded by seasonally inappropriate snow for that particular part of the world.

Joining these three wise men is Archbishop Carey and his I'm Not Ashamed leaflet encouraging people to be proud of their religion. Mighty dread has seized his troubled mind about nativity plays, cards and 'winter lights' instead of Christmas lights too. Ironically, he also says in the leaflet: 'There are aspects of Christianity of which I am ashamed. I am ashamed of the way in which the external form of religion has got in the way of real faith'. Would that be external forms like trees, cards and small children with tea towels on their heads pretending to be shepherds washing their socks?

A few festive statistics:

According to a ComRes survey, 46% of people think that 'The birth of Jesus is irrelevant to my Christmas', 54% think it's over-rated (bah, humbug) and 61% think it's mainly for children.

When asked if they would be attending a Christmas church service this year, 36% said they would. However, only 5% of people go to church at Christmas and only 2.1% take communion in C of E churches - and that's the C of E's own data. The spirit may be willing, but the flesh is weak, especially when it's full of mulled wine.

What about all these Christmas traditions that we're supposedly banning or spurning? The Christmas tree was made popular by Prince Albert in 1834 and the first commercial Christmas cards came out in 1843 (and were never solely religious) - not exactly ancient traditions. These are hardly the 'religion' part of Christmas anyway.

Trees are a pagan solstice symbol and carols also have pagan roots, some of which still show through, like The Holly and the Ivy and Deck the Halls. And let's not even go into the fact that there is almost nothing about the whole Christmas story that wasn't pinched from earlier mythologies.

Yes, let's indulge for a moment, it is Christmas after all. As the Rt Rev John Davies, Bishop of the Church in Wales said: "If , in a strict sense, the stories are deemed not to be historically true in each and every detail, it does not mean that they do not convey truth, the most profound truth". Santa legends also convey profound truths about being nice not naughty. Some of the Scandinavian ones have dire warnings about what happens to children who don't behave that make hell look like a soft option. If you're going to promote some made-up ideas that have 'profound truths' then you've got to expect a bit of competition. Another Christmas morality tale about good and evil, sacrifice and redemption is Die Hard, which has the advantage that the saviour gets his shirt off. And if you like a heavy dose of saccharine and emotional manipulation with your profound truths, there's always Dickens.

Nativity plays in schools are also comparatively recent. In the past, religious Christmas drama was either a Mystery play or a Mummers play - a mixture of Christian and very pagan elements, both performed by adults. Culture evolves, traditions come and go. Trying to cling to a few fairly modern semi-pagan traditions is not going to bring people back into the churches or revive their interest in religion.

If Christianity was all peace on earth and goodwill to men (and women) then it might be more popular.

It's not all of us non-believers who are killing the Spirit of Christmas, it's the mass indifference of the public who would rather be at home with family and friends eating mince pies and watching Doctor Who come down from on high to save the world. There'll be carol singers around later, that's Christmassy enough. Who knows, they might even be in tune.


Saturday, 4 December 2010

United Nations Human Rights Fail

The UN general assembly passes a resolution every two years condemning extrajudicial, summary and arbitrary executions. The resolution specifies killing for racial, national, ethnic or religious reasons and the killing of refugees, street children and indigenous people, among other groups.

But this time, it has left sexual orientation off the list with an amendment replacing a resolution that has stood for the last ten years. Instead there is a rather feeble 'discriminatory reasons on any basis'.

There are 76 countries where homosexuality is a criminal offence, six where it's punishable by death, which are Saudi Arabia, Iran, Mauritania, Nigeria, Sudan and Yemen - and Uganda is considering adding the death penalty to its laws criminalising homosexuality.

The amendment passed by 79 votes to 70. Seventeen countries abstained and 26 were absent. The 79 were the six where homosexuality is punishable by death and the rest included Uganda, Zimbabwe, Tanzania, Lebanon, Kenya, Algeria, Tunisia, Jamaica, Malaysia, China and the Bahamas. South Africa also voted for it, despite being the first country to outlaw discrimination based on sexual orientation.

Two other countries in favour of removing sexual orientation from the list were the Russian Federation and Qatar where the next two FIFA World Cups will be held.

Britain and the US condemned the motion. But the resolution was approved by the committee, which includes all 192 member states with 165 in favour, 10 abstentions (including the USA) and no votes against. This means that even though 70 countries voted against the amendment, not one voted against the final resolution.

The Special Rapporteur on Extrajudicial, Summary or Arbitrary Executions has highlighted documented cases of extrajudicial killings on the grounds of sexual orientation including individuals facing the death penalty for consensual sex; individuals tortured to death by State actors because of their actual or perceived sexual orientation; paramilitary groups killing individuals because of their actual or perceived sexual orientation as part of “social cleansing” campaigns; individuals murdered by police officers with impunity because of their actual or perceived sexual orientation; and States failing to investigate hate crimes and killings of people because of their actual or perceived sexual orientation.

So not only can you be murdered for being gay, you could well be killed just because someone thinks you are, or it suits them to think you are. Being bi or transgender is just as dangerous.

There is a belief in many member states that homosexuality is a western disease, that being gay is a choice and that it's un-Christian or un-African or un-Islamic. Western countries are often reluctant to criticise or get involved with the laws and cultures of other countries for fear of being accused of cultural imperialism.

Any brutal practise that is claimed to be traditional, religious or cultural - such as FGM, for example - can be considered off-limits whereas actions like the killing of street children are widely condemned. Moral relativism rears its ugly head, especially when the religion card is played, so critics back off and do the dance of cultural appeasement.

It's much easier to come to the defence of children, indigenous peoples or other groups that are not condemned by orthodox religion, for a start. There are very few countries that disapprove of homosexuality for other than religious reasons (although China is one of them).

The fact that the UN previously included sexual orientation in the list didn't stop many countries actively persecuting and executing LGBT people but now that it is not even explicitly on the list, there will be even less incentive to respect their human rights or to be covert about the murders, LGBT rights workers will have an even harder job and lives will be lost as the West stands by and wrings its hands.

Tuesday, 23 November 2010

Did He Or Didn't He? The Pope and Condoms

The Pope's comments on condom use have been hailed by campaigning groups and the liberal media as a breakthrough, a long-overdue recognition of the gap between dogma and reality. But what did he actually say? And, more to the point, what did he actually mean?

Last year, Benedict said that condoms worsened the spread of AIDS and the Vatican did nothing to contradict Cardinal Trujillo who claimed that the virus could permeate condoms. They have consistently preached that abstinence is the only moral defense against HIV/AIDS while millions die around the world.

The Pope's latest message to the world was part of an interview with German Catholic journalist Peter Seewald for a new book, Light of the World: The Pope, the Church and the Signs of the Times.

It appears that the Pope said condom use can be acceptable in certain cases, where the protection of life was the primary aim, not the prevention of life (ie, contraception). He apparently said that male prostitutes could use condoms as a step towards 'acting responsibly' - because there is no chance of contraception between two men, presumably. Not that the Vatican has shifted its position on homosexuality one inch.

Benedict has caused a right old flap at HQ with spokesmen falling over themselves to explain what he 'really' meant. Rev Federico Lombardi said the remarks were unprecedented but that they were given 'colloquially', not as part of official church teaching. In case that wasn't clear, Sandro Magister, a Vatican reporter, explained that there is a 'graduated spectrum of authority' between official church teaching and conversational papal remarks.

The Vatican newspaper, L'Osservatore Romano, broke an embargo to say that condom use was justified in some cases. But then the Rev Joseph Fession whose Ignatius Press published the English version weighed in and said that the Italian translation was wrong. The German and English versions talk about male prostitutes while the Italian version refers to female prostitutes. The Pope approved only the German version.

Confusion reigns. Asked by the website of the US-based National Catholic Register whether Benedict's statement indicated that in some cases condoms were permissible, Cardinal Raymond Burke said: "No, it's not." Again, get your act together, guys. Did some of you not get the memo?

But at a press conference in the Vatican to mark the launch of the book, Lombardi said: "I personally asked the pope if there was a serious, important problem in the choice of the masculine over the feminine," Lombardi said. "He told me: 'No.'"

However, a spokesman for the charity Caritas said that bishops conferences in Southern Africa in 2000 and in Chad in 2002 had already sent out pastoral letters to church workers advising them to follow their conscience when advising married couples where one partner was infected.

Other Catholic outlets jumped in to say that the Pope had not changed the church's teaching on condom use and that L'Osservatore - the Vatican's own newspaper, remember - had betrayed him. Blaming the media for getting the wrong end of the stick or going for sensational headlines is often entirely justified, but in this case, it's the Vatican's own mouthpiece that is getting the blame. The right hand really doesn't know what the left hand is doing. You'd really think that after nearly 2000 years at this game they would have got their act together.

What the Pope said was (probably, until the next refutation or 'clarification'):

'There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be the first step in the direction of a moralization, a first assumption of responsibility, on the way towards recovering an awareness that not everything is allowed and that one cannot do whatever one wants. But it is not really the way to deal with the evil of HIV infection, that can really lie only in a humanization of sexuality'. The Pope added that the church can never regard condom use as a 'real or moral solution'.

What the 'humanization of sexuality' might be is anyone's guess. Presumably, he means sex only between a lady and a gentleman who are married and want to make babies.

Condoms still absolutely cannot be used for contraception. One of the pope's most senior officials, Cardinal Rino Fisichella, told the press conference it was "intrinsically an evil". Could we get some 'clarification' on that?

Maybe this has opened a debate. Maybe the Catholic Church will be forced to discuss condoms and HIV/AIDS. Maybe charity workers on the frontline will continue ignoring HQ and taking the more humane course of action. Whatever happens, the Vatican comes out of this looking like a bunch of amateurs who can't even give a consistent message.

The Pope explained earlier in the book why nothing a Pope says in an interview should be regarded as authoritative. Except for all the other parts of the book that the Vatican doesn't disagree with. So what it boils down to is that the Pope was just having a bit of a chat, what he said doesn't count because he wasn't wearing his big Popey hat at the time and didn't start the sentence with 'Simon says...'

If there are any further 'clarifications', I'll post them here.

Wednesday, 17 November 2010

Why I Am Not A Humanist

The talk at Skeptics in the Pub last night was Objections to Humanism. Here are some of mine:

Andrew Copson of the BHA spoke at length about evolution, science, morality without religion and the value of optimism. While there was nothing much to disagree with, nor was there anything specific or unique to humanism. I asked in the Q&A what is added by claiming as humanist the acceptance of evolution, the value of scientific enquiry and so on. The reply (eventually) was that 'It's just a word thing' and that humanism is a useful label. But labels are useful only if they make it clear what something is.

There are plenty of people who accept evolution and subscribe to a non-religious moral code but who do not call themselves humanist. It is however a useful bit of soft soap if you're a politician who can't bring themselves to admit publicly that you're an atheist.

According to the BHA website: 'Humanism is the view that we can make sense of the world using reason, experience and shared human values and that we can live good lives without religious or superstitious beliefs'.

Although they make no claim to be the sole purveyors of this view, they also make no claim to say anything original or to add anything to these views. In other words, humanism has no USP.

The website continues: 'Humanists seek to make the best of the one life we have by creating meaning and purpose for ourselves. We choose to take responsibility for our actions and work with others for the common good'.

Again, nothing unique there, no added value.

One argument against humanism by some believers is that it denies the 'specialness' of humanity. This is an argument levelled against evolutionists and atheists too - even its accusers can't find anything original about it to attack.

Copson countered this by quoting (and agreeing with) another humanist (whose name I didn't catch) who said: 'It is love that makes sex human'.

Does this mean that sex without love is not human or is less than fully human? Billions of people throughout history might disagree with him. Condemning or at least dismissing sex without love is sailing close to certain religious points of view. Moreover, it is rather prudish and twee. Or maybe whoever said it just wasn't having the right kind of sex.

It was said that it is the bond between us that makes us special. There was no real explanation of what 'special' means. He did allow that we are possibly special only to each other but this still supports an anthropocentric view. Why do we need to see ourselves as special? Certainly we are different from other animals but they are also very different from each other.

There was also a retrospective look at various philosophers and others throughout history whose ideas were described as humanist in some form. This is like firing shots at a wall and then drawing a target round them. The people mentioned were not humanists, most of them existed before the term was coined. Democritus and Epicurus, for example, were cited as forefathers of humanism but they are just as much the precursors of scientific rationalism. Nothing is gained by tagging them as proto-humanists except to try and give humanism some sort of historical weight and worth.

The BHA have claimed that there are 17 million humanists in the UK after a poll found that 36% of people have a naturalistic world view. This will be news to 16.999 million of them. Nothing is gained for the cause if people are humanist without knowing it and trying to claim 17 million kind of looks a bit needy.

Humanism as a world view is sometimes accused of being 'just' an alternative to religion. Although Copson denied this, many humanists say that humanism gives them an identity, a worldview and set of moral values/rules similar to those provided by religion but without any supernatural element. In this case, humanism appears to be the methadone to the opiate of religion.

The BHA provide non-religious celebrants for funerals and other ceremonies. This is a much-needed service but could quite easily exist independently of humanism. They just happen to be the organisation behind this service, but they need not be.

There were possibly stronger reasons for joining a humanist group in the past when religious people and values dominated and non-believers of any kind were often isolated. But with current technology, wherever you live and whatever you believe, you can find like-minded people. There is of course still a value for some people in meeting up with others who share their worldview - we are social animals after all - but humanism is no more significant a definition than being a member of any other special interest club that contributes to or informs your identity and relationship with others.

The non-religious are still under-represented in some areas of public life while religious groups are accorded privileges so it can be useful to have a term to set yourself apart and distance yourself from claims made by religious leaders to represent the whole of society. But humanist does this no better than atheist, agnostic, non-believer, rationalist, freethinker, secularist and others.

To identify as humanist is to identify as either atheist or agnostic along with some or all of a rather vague set of ethical and pro-science statements. But for me, it's such an inchoate, nebulous concept that I can't engage with it at all.

Friday, 12 November 2010

Freedom of Expression Under Seige

There's a scene near the end of the Rutles movie, All You Need is Cash, where Eric Manchester, the Rutle Corp Press Agent (played by Michael Palin), says: Suddenly, everyone became amazingly litigious. I remember I'd get up in the morning. Sue someone. Check in the papers that I hadn't been fired. Go to the office. Sue someone. Pick up the morning's writs. Sue the bank. Go out for lunch. Sue the restaurant. Get back in, collect the writs that had been received that afternoon. Read the papers. Phone the papers. Sue the papers. Then go home. Sue the wife.

Freedom of expression is currently under attack and it's no joke.

Firstly, there's Twittergate. Paul Chambers tweeted a not especially funny remark and has lost his job, got a criminal record and is facing a fine of thousands of pounds after an appeal at the Crown Court failed. Martin Robbins covers the story here. Chambers tweeted: Crap! Robin Hood airport is closed. You've got a week to get your shit together, otherwise I'm blowing the airport sky high!! He was found guilty under section 127 of the 2003 Communications Act:

Improper use of public electronic communications network
A person is guilty of an offence if he—
sends by means of a public electronic communications network a message or other matter that is grossly offensive or of an indecent, obscene or menacing character; or
causes any such message or matter to be so sent.
A person is guilty of an offence if, for the purpose of causing annoyance, inconvenience or needless anxiety to another, he—
sends by means of a public electronic communications network, a message that he knows to be false,
causes such a message to be sent; or
persistently makes use of a public electronic communications network.
A person guilty of an offence under this section shall be liable, on summary conviction, to imprisonment for a term not exceeding six months or to a fine not exceeding level 5 on the standard scale, or to both.
Subsections (1) and (2) do not apply to anything done in the course of providing a programme service (within the meaning of the Broadcasting Act 1990 (c. 42)).

Then there's Dalia Nield who is under threat of being sued for saying that a cream which claims to increase bust size 'by up to 8.4%' is unlikely to work. Nield is a prominent plastic surgeon and has serious concerns about both the efficacy and the safety of Boob Job cream. According to the website, 'Boob Job works with your natural fat cells. As the fat cells move around the body after eating, boob job 'blocks' the fat into the area where the product has been applied, so the bust and décolleté areas. You will see a gradual increase in cup size within 56 days as well as gaining an instant lifting and firming effect.'.

Then there is the couple suing the RSPB which said that the couple's research may have harmed the black grouse that they were studying and that their methods were 'untried and untested'.

The Campaign for Libel Reform lists many others who either have been sued or who are threatened.

It's important to remember that it's not just the UK's shameful libel laws that are threatening freedom of expression. There is 'defamation of religion', a tactic used by some religious groups to shut down any criticism or even discussion of beliefs and practices. These religious groups claim the right not to be offended, questioned, challenged or called to account. The National Secular Society has written a document about the dangers here (in the interests of full disclosure, I wrote some of it).

As Resolution 1510 (2006)4 of the Parliamentary Assembly of the Council of Europe points out: 'What is likely to cause substantial offence to persons of a particular religious persuasion will vary significantly from time to time and from place to place'. Offence is a good tactic because it's so subjective, personal and nebulous.

Another tactic is to claim so-called Christianophobia or Islamophobia or to conflate race with religion, stifling debate with accusations of persecution and racism.

Resolution 1510 (2006) by the Parliamentary Assembly of the Council of Europe states that:
1. The Parliamentary Assembly of the Council of Europe reaffirms that there cannot be a democratic society without the fundamental right to freedom of expression. The progress of society and the development of every individual depend on the possibility of receiving and imparting information and ideas. This freedom is not only applicable to expressions that are favourably received or regarded as inoffensive but also to those that may shock, offend or disturb the state or any sector of the population, in accordance with Article 10 of the European Convention on Human Rights (ETS No. 5).

In the UK, the crime of religiously aggravated offence introduced in 2006 represents a new kind of blasphemy law and the crime of religiously aggravated insulting behaviour carries a sentence of up to 7 years in prison. The original blasphemy law was abolished in March 2008. Professional offence-takers in religious communities have already begun to exploit this new avenue of restricting criticism and comment.

A sample of attempts by religious groups to stifle freedom of expression:

Waterstones bookshop was threatened by Christian Voice and cancelled a reading at a Cardiff branch by Welsh poet Patrick Jones.

A statue by the artist Terrence Koh at the Baltic Centre for Contemporary Art in Gateshead provoked outrage and condemnation by Christians.

Behzti, a play depicting rape in a Sikh temple, provoked violent protests and thousands of pounds of damage at the Birmingham Repertory Theatre in December 2004. The theatre was forced to cancel the play on safety grounds and playwright Gurpreet Kaur Bhatti fled into hiding after receiving death threats.

The London exhibition of the work of Maqbool Fida Husain was closed after threats of violence from Hindu fundamentalists in 2006.

Jerry Springer – the Opera provoked street protests, threats to theatres and the publicizing of private addresses of BBC executives after it was shown on television - even though most of the complainants hadn't even seen it.

And of course, there was the Danish cartoons incident. More recently, religious groups tried to get a TV advert for Marie Stopes clinics banned and an ice cream ad was banned by the ASA after just six complaints because it showed two priests about to kiss.

Freedom of expression, scientific debate and even the ability to make flippant remarks on Twitter can no longer be taken for granted. Do not criticise me, do not question me, do not challenge me and, above all, do not offend me. Dark days.

Wednesday, 10 November 2010

Mass Blog for Libel Reform

Today marks the first anniversary of the Free Speech Is Not For Sale report. I'm joining hundreds of other bloggers all over the world in solidarity against England’s draconian libel laws.

Like most bloggers, I don’t get paid for my writing, so if someone decided to sue me for libel, I would be in deep trouble and would have to sell some of my internal organs (assuming anyone would want them after the heavy use they've had).

Wikipedia has a good page on the history of English libel laws here. In particular, note “McLibel” and Simon Singh vs the BCA cases, both of which really brought this issue into the public sphere. These were occasions when big institutions (McDonalds and the British Chiropractic Association) decided to sue for vast sums of money when someone dared to speak out against them. The publicity from these cases was enough that eventually the claimants backed down, but for many lower profile cases, this isn’t necessarily going to happen, and the defendants involved could be financially ruined, the costs really are astronomical.

The Libel Reform Campaign website has a list of people who have been sued for libel in England a) over the most trivial things and b) involving people with no direct links to England in the first place. If you post something online on your Blogger or WordPress site, or on Twitter, or even allow comments to be published on your blog, then there is a high chance that you are also at risk of being sued.

If you haven’t already done so, please sign the petition to reform these heinous laws. It doesn’t matter where you live or what nationality you are, anyone can sign it, and if you’d like to make a donation when you’re done, even better.

We’ve got to put an end to things like this.

As a footnote, I didn't have time to write my own blog on this today as I was busy writing about SEX so I pretty much cut and pasted Carmen's and changed a few words, so if she gets sued, so do I...

Monday, 8 November 2010

What is Love?

In July last year I wrote about a guide for parents by the Family Education Trust(aka Family & Youth Concern) about Sex and Relationships Education (SRE). Not content with trying to cause fear and loathing in parents, now they have written a leaflet for teenagers called What is Love?

The leaflet would be easily dismissed as the work of yet another small but vocal Christian group trying to impose their moralistic values on young people were it not being sent to all secondary schools.

For anyone unfamiliar with the FET, run by Norman Wells, it's a Christian organisation with a certain not entirely unexpected agenda. There is no mention of faith in the leaflet, however. Is that because the FET has realised young people don't like being preached at and is trying to be covert?

So what is love? In a nutshell, love is just saying no to the ugly sex until you are safely up the aisle. Or terrible, terrible things will fall upon you.

The leaflet is full of super advice. Here's a selection of it:

'First of all, we need to recognise that not all love is true. There is such a thing as false love and many people confuse it for the real thing'.

Because young people respond so well to being patronised... With any luck, most of them will stop reading at this point.

What is this false love? It's 'physical attraction, infatuation or lust'.

Just in case you've never heard of lust, there's a helpful definition: 'Lust is the longing to use another person for the fulfilment of your own selfish desires... You will never find love through sexual encounters based on lust. Lust will leave you empty, frustrated and unfulfilled every time'.

Just in case we can't understand that, there's a case study about Tom and Jen who spend a lot of time chatting online and texting and 'who find in each other the fulfilment of their sexual desires'. Call me cynical but I strongly suspect they are Made Up. It sounds to me like they're having a pretty good time. But no, their relationship is doomed to fail because they are being Selfish.

Poor Tom and Jen don't know that true love 'will last a lifetime', it is 'more powerful than the strongest feelings and emotions'. Huh? Love is not a feeling or emotion?

So what should they do? 'When you truly love someone, you will keep yourself exclusively for them. This is one of the reasons why sexual intimacy belongs in marriage'.

Here we go. The abstinence message. Once more, with feeling: all the evidence says abstinence teaching doesn't work.

The Government has been consulting on guidelines for SRE. The second reading of the Bill is on 11 February 2011. The consultation document clearly states that 'research evidence does not support the use of an approach to sex and relationships education that only teaches abstinence' and 'that schools should use a range of evidence-based teaching methods'. Has the FET squeaked in under the wire before the Government guidelines are finalised in case abstinence-only teaching is banned and no school would be allowed to use or distribute this leaflet?

SRE is not just about sex, it covers all kinds of relationships and how to negotiate them, how to cope with bullying, how to be a responsible adult and so on.

In the document for parents about sex education, the FET mixes propaganda with what I shall charitably call factual inaccuracies, such as: there is no good evidence against abstinence, that teenage pregnancies are rising therefore sex education doesn't work and should be abandoned, that there are moral absolutes, that homosexuality is not a 'normal and natural lifestyle'. The FET believes that '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'. He adds that 'there are some sexual practices that it may be better not to know anything about at all, at any age'.

The FET policy is to treat young people like mushrooms - keep them in the dark and throw horseshit at them.

The parents' guide also states that: 'Modern sex education is characterised by a lack of honesty...'

That's an interesting definition of 'honesty' from an organisation that has a rather malleable relationship with the truth and evidence.

What's more, saying that sex belongs only in marriage and is only for reproduction isn't going to play too well with the very many children of single parents.

Research (as opposed to made-up stuff) shows that young people want honest, complete, fact-based sex education from people they trust, as Dr Petra Boynton has written about.

The message that postponing sex until you're ready is a good one but for most people, that won't be after they're married. Far better to teach young people how to negotiate sex so that it is pleasurable and safe rather than just telling them not to do it, which leaves them utterly unprepared when it does happen.

Not surprisingly, there is no mention of love between people of the same sex in the leaflet.

But what happens if we ignore you, oh wise ones?

'Where a sexual relationship is pursued to express passing feelings and emotions, it is ugly and destructive and will lead to misery and regret'. And of course you will get an STI.

This is starting to sound like a 70s teen slasher movie, the sort where a bunch of teenagers get together and anyone who dares to have sex gets killed by the possibly dead guy in the mask while the virgins survive. Maybe starring Jamie Lee Curtis.

Why do we need such sage words now?

'Young people today often expect to have a series of short-term relationships before they finally settle down with someone for life. Such casual relationships frequently prove to be a training ground for divorce rather than for happy and fulfilling marriages. But it hasn't always been like that, and it doesn't have to remain like that'.

Where is the evidence to back up these statements? It really isn't hard to look things up these days and get some statistics to back up your arguments. Except when they don't exist.

In what time and place were young people all chaste? In the Victorian era when the orphanages were bursting at the seams with illegitimate babies and an estimated 10% of the urban population had syphillis which, in one part of London, also killed 57% of infants? In Mediaeval times which needed legislation like the Special Bastardy Act of 1235? After the war when we were celebrating the survival of British Values? Compare the rates in 1945 with before and after here. Or maybe the FET is thinking about some other lost time and place, like Narnia.

Finally, there are some handy tips for finding true love. One of them is:

'It's a good test to ask yourself 'How does he treat his mum?' or 'How does she treat her dad?' It is quite likely that they will treat you the same way'.

This is deeply deeply creepy in many ways.

So hey kids - Don't do the ugly sex. Don't think about sex. Don't learn about sex. Sex is only ever to make babies after you get married. And don't enjoy it too much even then - which you probably won't if you've never learnt anything about it.

With any luck, the leaflets will get no further than the bins of schools around the country.

Thursday, 28 October 2010

Choose Life

A look at the latest round of anti-abortion campaigns

For some reason, Christian anti-abortion groups have chosen the 43rd anniversary of the Abortion Act to launch their latest campaign.

Christian Concern's Choose Life campaign includes adverts on London buses that feature a foetus, a vigil outside Parliament, a national Service of Lament led by former Bishop of Rochester Nazir-Ali and screening an American documentary about what they call the 'abortion industry', showing 'the devestating effects abortion has on women'. Presumably, the people who chose the slogan have never seen Trainspotting.

Christian Concern (CC) said that 'For too long abortion has been a taboo subject, a situation that only compounds the problems that abortion brings. It is time for society to face up to the hidden scale and consequences of abortion'.

It's ironic then, that Christian groups objected to a recent TV advert by Marie Stopes attempting to make the subject less taboo.

Catholic groups are supporting CC even though polls have shown that the majority of UK Catholics support a woman's right to abortion and contraception.

Not given to subtle tactics, CC likes big numbers: 'MPs and Lords who voted in the 1967 Act never imagined that within four decades seven million babies would have been aborted, or that the reasons for abortion would have been so relaxed over the years'. They like emotive language too. A tiny ball of cells is a long way off being a baby.

They have also commissioned a poll by ComRes.

The poll asks:
1. How many abortions do you estimate take place in Britain each year?

Only 3% of the 1000 respondents were roughly in the right area. It's not clear whether they were told how their responses would be used.

2. In fact, according to Government figures just over 200,000 abortions took place in Britain last year. Which if these statements best sums up your view on this statistic?
It is too high and ways should be found to reduce it
It is a reasonable number and no action needs to be taken to reduce it
Don't know

Two thirds (66%) of respondents thought it was too high.

They're right, it is too high. There is no supplementary question to find out whether people thought this for moral, religious or other reasons, which allows CC to interpret the results any way they like. Pro-choice supporters would say that the solution lies in education, contraception and unbiased open discussion. The Government is currently reviewing SRE (sex education); a government poll has found that 90% of parents are in favour of children being taught about contraception although 80% of teachers don't feel equipped to teach SRE well. So one way to reduce the abortion rate would seem to be to train teachers better to equip young women to avoid unwanted pregnancy.

Religious group Family and Youth Concern are objecting to the poll because it was backed by Durex, claiming that Durex has a vested interest. It's entirely possible that they do but FYC have interests of their own: 'young people do not need to be presented with a menu of sexual options from which they can make ‘informed choices’. Rather, the whole issue needs to be approached with honesty, modesty and within a clear moral framework that shows a proper respect for parents and for marriage.' Their interest is to promote sex only within marriage and only for 'childbearing'. Condoms reduce unwanted pregnancies, not abstinence and preaching.

Back to the poll. Education is not one of the options it offers. It continues (Warning - the dice are loaded):

3.Would you support or oppose each of these possible changes to the law on abortion?
A compulsory cooling off period between diagnosis of pregnancy and abortion, to ensure a mother is sure of her decision
78% of respondents supported this proposal.

A cooling off period would mean prolonging the suffering of many women and their partners, increasing health risks (if it's compulsory) and it also assumes that women have abortions on a whim. A cooling off period would also give pro-life advocates longer to work on the women. The use of the word 'mothers' is emotive and makes their intentions clear - a woman is a 'mother' from the moment of conception. However, around one in four pregnancies miscarry naturally, many in the first few weeks when the woman doesn't even know she is pregnant.

A woman's right, enshrined in law, to be informed of all the physical, psychological and emotional risks associated with abortion
89% of respondents supported this.

A legal duty on doctors to provide access to advice and information about alternatives to abortion, such as adoption.
82% supported this.

Of course women should be given all the options, presented in an even-handed, unbiased way, as well as being told about any consequences but only the real consequences, not the made-up, morally loaded, manipulative ones (I'll get to those in a moment).

4. Would you support or oppose each of these possible changes to the law on abortion?
A reduction in the number of weeks' pregnancy at which an abortion can be conducted, which currently is 24 weeks or just under six months, to a limit of 20 weeks or less.
61% agreed with the reduction.

This is what the questionnaire has been leading up to. CC want to reduce the number of abortions not by helping women (and their partners) to avoid becoming pregnant in the first place but by making it much harder for them to have an abortion when they do. The questionnaire does not inform the respondents how many abortions currently happen after 20 weeks so that they could make an informed choice about their response. In 2007, 89% of terminations happened before 13 weeks. In 2005, only 1.3% happened between 20 and 24 weeks. So CC's campaign to reduce the limit would have very little effect on the figures, which makes their poll little more than emotive propaganda.

Foetal viability was examined by the House of Commons Select Committee on Science and Technology in 2007. Foetal viability means survival of foetuses who are alive at variable times during the pregnancy or the capability of surviving the neonatal period and growing up into an adult. The Committee concluded that:

'While survival rates at 24 weeks and over have improved they have not done so below that gestational point. Put another way, we have seen no good evidence to suggest that foetal viability has improved significantly since the abortion time limit was last set, and seen some good evidence to suggest that it has not.'

This conclusion is shared by the British Medical Association and the Royal College of Obstetricians and Gynaecologists.

A spokesperson from Marie Stopes International told me: "Having an unplanned pregnancy is often a very difficult experience for a woman and her partner. At Marie Stopes International we provide couples with non-judgemental information about all their options to ensure women can make the right decision for them."

It's not like Marie Stopes and similar clinics are forcing abortions on women or that doctors are pushing them as the easy option. They are pro-choice, which means that any choice a woman makes is supported, not just the forced so-called choice that CC are promoting.

The spokesperson added: “Fortunately, in Britain, women have access to safe abortion care unlike in many developing countries where abortion remains illegal and complications from backyard abortions claim the lives of tens of thousands of women each year and leave more than two million women with lasting health problems.

“Encouragingly public support remains exceptionally high for the right to access safe abortion care with a recent YouGov survey finding that less than 9 per cent of people opposed the right to an abortion.

“We are working hard to reduce the number of unintended pregnancies by educating women about more reliable contraception methods such as the implant and IUD and provide them with access to contraception.”

With less than 9% opposing abortion, Christian Concern are not representing the moral majority or protecting millions of morally feeble women from themselves. They are yet another vocal religious minority group.

It's not just Christian Concern who are ramping up their campaigning. American-style protests are also becoming more common in the UK. A Texas-based group called 40 Days For Life has been holding protests outside Marie Stopes clinics in London. The campaigners are planning to hold 40 days of protest in the US, Australia, Denmark, Canada and Northern Ireland as well as the UK.

Some of the leaflets they are handing out to women outside the clinics warn about an increased risk of breast cancer following abortion. This is an old favourite of pro-lifers. As I wrote in July last year for example, the Christian Medical Fellowship (CMF) have long spread this lie.

There has also been increased activity in Europe by pro-life lobbyists, for example in scuppering the McCafferty report recommending that doctors' conscientious objection to abortion (among other things) should not be upheld at the price of women's health and well-being.

Tory MP Therese Coffey has tabled an early day motion that would force women who want an abortion on mental health grounds to get counselling and be warned of risks to their mental health. The psychological toll of abortion is another favourite of the pro-life campaigners. The CMF are also keen on the fact that abortion makes you mentally ill - even though the 'evidence' they cite says the complete opposite of what they claim.

CC and others like this two-pronged attack: abortion kills babies and threatens women's sanity and health. They're not much bothered about the effect of unwanted children on women's health.

In Northern Ireland, pro-choice campaigners at the first all-Ireland conference on abortion and clinical practice have called for the laws to be modernised. NI is the only part of the UK where abortion is still illegal. Protesters were of course out in force, led by a group called Precious Life.

One consequence of abortion being illegal in the Republic is that abortifacients are increasingly being illegally imported, despite the health risks of self-administering.

UPDATE: A Vatican official has said that voting for a pro-choice political candidate can never be morally justified.

Religious pressure is not going to stop women having abortions. Yes, there are too many at the moment. Abortion should be safe, legal and rare. The solution will be found in education, not indoctrination.

One bit of good news is that Education For Choice has launched the A Word Campaign to help educate young people so they can make an informed choice about abortion and contraception. They say: 'EFC believes that young people should not be lied to. School should be a place where they can learn to recognise the difference between values and evidence and to avoid conflating opinion and fact, sermons and science.'

Finally, in America, one couple going to an abortion clinic fought back against protesters and filmed the encounter.

Wednesday, 20 October 2010

HRT Cancer Scare - here we go again

Scare stories about HRT come round every few years. This time, according to the Daily Mail, HRT can now treble the chance of dying of breast cancer. Other shock headlines include 'Study shows HRT even riskier than thought'. The Washington Post goes with 'Hormones also raise death risk of cancer' and talks about 'powerful evidence'.

Menopause is still a taboo subject that a lot of women don't feel comfortable talking about, which makes it easier for myths and misunderstandings to spread.

If you read through to the end of some of the articles they do mention the stats but the headlines are what will stick in people's minds and may be the only part of the story they see - they are what's known as the take-away. A lot of people aren't that good at interpreting stats even if they get that far.

The headlines are based on research published in the Journal of the American Medical Association (JAMA). A study of 12,788 women for 11 years looked at women taking a combination of oestrogen and progesterone in a randomized placebo controlled trial.

Rowan Chlebowski of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center who led the analysis commented in the Washington Post that 'the risk in the study was low and barely met the threshold for being considered statistically significant' but he was 'confident that the risk was real'.

Barely Statistically Significant Cancer Risk! is not a headline you're likely to see. Even if such a headline existed, it's the C word that readers would remember. For cancer, there is no such thing as bad publicity.

The figures are these: in the placebo group there were 0.01% deaths and in the HRT group there were 0.03% deaths a year. That's 12 and 25 women in 12,000. The research also found that combination HRT was associated with more invasive breast cancers (0.42% of cases per year in the group as opposed to 0.34% in the placebo group).

With any apparently alarming statistics, it's the explanation of absolute and relative risk that rarely gets a look-in. If a disease kills two people in ten thousand one year and four people the next then the mortality rate has increased 100%. The chance of dying is still only four in ten thousand but that doesn't make for a good headline.

During the 2008 HRT breast cancer scare, also based on research by Rowan Chlebowski, Behind The Headlines pointed out something news stories glossed over: "In addition, the authors of the study point out that the differences seen should be interpreted with caution, as they may have resulted from differences in health seeking behaviours in the two groups of women after the trial. Women who had been told that they had been taking combined HRT at the end of the trial and knew of the cancer risk may have been more likely to seek medical attention for any suspicious symptoms than women who knew they had only received placebo.

BTH also pointed out that, despite predictable scare headlines: 'the study was not directly investigating any link between breast cancer and HRT. Instead it looked at whether HRT increased the chances of detecting an abnormality on a mammogram that then required a biopsy for further investigation; this would not necessarily involve a diagnosis of breast cancer.

'The main finding of the study was that the diagnostic accuracy of mammography was decreased in women who had taken combination HRT.

'This study only investigated one type and one dosage of combination HRT'.

There are many different types and levels of dosage. For example, the combination of estradiol and dydrogesterone (oestrogen/progesterone) sold as Femoston in the UK increases the risk for women in their 50s of having a stroke from 3 in 1000 to 4 in 1000. The risk of blood clots goes up from 3 in 1000 to 7 in 1000. And the risk of breast cancer goes up from 32 in 1000 by the age of 65 to 38 in 1000 if they take it for 5 years.

The risks of HRT are real in the sense that they do exist and the latest research seems to indicate that they are higher than previously believed. Risks also have to be offset against benefits - any good GP will explain this. Some of the risks can be considerably lessened by lifestyle changes and regular check-ups. There is a good basic introduction to HRT here.

Here's another risk: in 2004, the lifetime risk of dying in a motor vehicle accident was 1 in 82 in the US and 1 in 240 in the UK. Killer Cars!

Sunday, 10 October 2010

Always let your conscience be your guide? Part 2

On October 7 the Parliamentary Assembly of the Council of Europe debated 'Women's access to lawful medical care'. The main concern was doctors' conscientious objection affecting women's access to abortion and family planning (including contraception and fertility treatment).

While recognising the right of individuals to follow their (usually religious) conscience, the debate and planned resolution happened because of a growing concern about the increasing and largely unregulated practice of refusing abortions. The intention was to get members states to introduce clear and comprehensive regulations. It did not go to plan.

In the majority of member states, there is little or no effective regulation in this area. The draft resolution proposed that only individuals should be allowed to opt out, not public or state institutions - hospitals and clinics. It also proposed that objecting doctors must give women full and unbiased information about all the options and refer them to a practitioner who would give them the procedure with the absolute minimum of delay. In emergencies or where there was no other doctor/clinic to refer women to, then the doctors should set aside their beliefs, put the patient's welfare first and carry out the procedure.

Under international human rights law, member states have a duty to ensure that healthcare providers' exercise of conscientious objection does not harm the health and rights of their patients.

Before the debate, Rapporteur Christine McCafferty prepared a report on the current situation in Europe. The report called for all medical personnel to state in advance any objections and a register of objectors to be established (as is currently the case in Norway).

Then the pro-life religious lobby weighed in. The resolution as adopted was so watered down that the religious lobby hailed it as a victory. The provisional Resolution 1763, re-titled 'The right to conscientious objection in lawful medical care' now begins: No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which could cause the death of a human foetus or embryo, for any reason.

It effectively gives primacy to conscience.

However, it was not quite the whitewash they are claiming as the vote was won by 56 votes to 51.

Sophia Kuby, a pro-life advocate and head of the group European Dignity Watch that lobbied hard against the McCafferty Report, said the vote “is a victory for common sense and for freedom” and “a great victory for Europe. Europe has made clear tonight that freedom of conscience constitutes a pillar of a democratic society that needs to be defended, at times also against a radical minority that wishes to limit freedom and impose a unique pro-abortion thinking in Europe. It is a great sign of hope that a majority has clearly voted against a radical pro-abortion, anti-freedom, anti-diversity lobby that tries to establish unhealthy and suffocating legislation.”

Not freedom for women but freedom for believers. Diversity is hardly well served if only certain people or organisations benefit. And it's ironic that the word 'healthy' was used when it's women's reproductive health under threat. It's not clear in what way lobbying to protect women's legal right to abortion is 'unique'. The McCafferty report did not for one minute suggest that doctors could not object, just that the situation should be regulated to protect both conscience and health needs. There was no promotion of abortion.

Gregor Puppinck, the director of the European Centre for Law and Justice (a Christian organisation), commented: "The Council of Europe reaffirms the fundamental value of human conscience, and of liberty in the face of attempts at ideological manipulation of science and of medicine. Independence of science and of medicine is also an essential value at the heart of democracies."

It's not clear how routinely putting religious conscience before women's rights makes science and medicine independent. Puppinck fails to see that he is trying to manipulate medicine to suit his own ideology. He also cites the Nuremberg trials, implicitly comparing pro-choice groups with Nazis.

Putting a doctor's beliefs always and inevitably before a patient's needs creates a hierarchy of values and rights.

The women most likely to be affected are those in remote or rural areas where it's hard to get to another doctor or hospital, often because there is no public or cheap transport, women on low incomes who cannot afford to travel long distances or go private, young women still living at home who may not want their parents to know and other vulnerable groups like women with learning difficulties. Unwanted teenage pregnancies can ruin young women's education prospects and cause social stigma both for her and the child.

Other risks include raised maternal mortality rates, the increase of unsafe and illegal abortions and an increase in HIV/AIDS and other STIs where practitioners refuse to supply information about contraception or condoms. It's not just women who suffer; their partners and children also suffer if the woman's health is affected, a family that cannot afford a child (or another child) will be pushed further into hardship and couples can be denied fertility treatments. It's not clear how some - if not all - doctors would explain their conscientious objections to patients without expressing personal judgement. Not every patient in a vulnerable condition would feel able to complain or stand up to such a response.

The European Centre for Law and Justice developed out of the American version, founded by evangelical Christians, but they are not the only religious influence at work. The Catholic Church is also, not surprisingly, involved.

I wrote about two of the more extreme versions of Catholic influence in May - in the US a nun was excommunicated for allowing a life-saving abortion in the hospital where she worked and last year there was the case of an abortion given to a nine year old Brazilian girl pregnant with twins after being raped, allegedly by her stepfather. The doctor, the medical team and the child's mother were excommunicated by Archbishop Don Jose Cardoso Sobrinho of Recife who said that "A graver act than rape is abortion, to eliminate an innocent life". The child was not excommunicated because she was a minor.

British organisations also lobbied against the McCafferty Report. Anthony Ozimic from one of them, the Society for the Protection of Unborn Children (SPUC) said, in characteristic emotive style, “This evening witnessed an incredible victory for the right of staff in medical institutions to refuse to be complicit in the killing of unborn children and other unethical practices."

McCafferty's report includes examples of the current situation and of how conscience clauses are being abused. In Croatia, for example, it is reported that doctors refuse abortions but then offer them privately - and charge for them. In Italy, nearly 70% of gynaecologists refuse to perform abortions on moral grounds and 50% of anaesthetists refuse to assist even though abortion is legal. In Slovakia and Poland, conscience clauses are often abused by top management who have unwritten policies banning abortions or sterilisations throughout the hospital whatever the rest of the staff think. There is a detailed report on how Slovakia is falling in with Vatican policy here. Another tactic is delaying so that the pregnancy goes beyond the legal limit for abortion.

It's not just Catholic countries where religious conscience is imposed to the detriment of women. In the UK in 2003, a High Court judgement found a doctor negligent for failing to give proper advice to a woman about her raised risk of having a baby with Down's Syndrome because he was a devout Catholic. Also in the UK, religious groups lobbied against a TV advert for the private Marie Stopes clinics as I reported in May.

The doctrine that religious groups attempt to impose on reproductive rights is not even supported by the majority of believers in some countries. In the UK, for example, seven out of ten Catholics support abortion and nine in ten support contraception.

The resolution has to be ratified by the Committee of Ministers, who include William Hague, before it becomes formal policy. His email address is haguew@parliament.uk should you want to write to him urging him not to pass this resolution as it stands. Conscientious objection can also affect other areas such as end of life choices.

The full Parliamentary Assembly document is here.

Part 1 was about conscience opt-out for pharmacists dispensing emergency contraception (morning after pill).

Wednesday, 6 October 2010

Master of all you survey

Torture numbers and they'll confess to anything
Greg Easterbrook

Since Domesday Book was compiled in 1086, large-scale data collection by survey has been part of government in this country. Can surveys based on self-reported information ever be reliable, whether it's an 11th century peasant reporting how many ducks she has to a Norman or a 21st century woman giving personal information over the phone or online? Are such surveys inherently any more reliable and honest than the 'personality' quizzes in teenage magazines? Not least among the factors influencing responses are the way questions are framed and how the respondent thinks the information will be used.

A recent survey for the Office for National Statistics (ONS) based on interviews with 450,000 people for an Integrated Household Survey (IHS) has been reported as finding that 71% of people in the UK are Christian and 20% have no religion, 1.5% are gay or bi and nearly 80% perceive themselves to be in good health. (All IHS statistics are considered experimental until assessed by the UK Statistics Authority).

The IHS asked respondents 'What is your religion, even if you are not currently practising?' with the intention of discovering 'religious affiliation - that is identification with a religion irrespective of actual practice or belief'. Not surprisingly, this has been reported as 71% are Christian.

Another survey by the ONS in 2008 found that only 22% described themselves as Christian and 45% said they had no religion.

The 2011 census will include the question 'What is your religion?'. This question was asked in the 2001 census and before that only in 1851. There has been controversy about the result of the 2001 census where 71% of people self-reported as Christian. Many of these, it is believed, identify as culturally rather than religiously Christian. Most of them rarely go anywhere near a church. According to a survey done by the Church of England, only 5% go at Christmas and 2.8% at Easter - the most important Christian festival.

Less seriously, 0.8% of people put their religion as Jedi in 2001 which offically makes them a bigger group than Sikhs, Jews or Buddhists in the UK.

The ONS deputy director said that the religion question in the next census would be 'a fabulous insight into societal changes to see how people register their religion'. Registering it is of course not the same as actively practicing it. And is 'fabulous' the best word to use for such a serious project?

Both religious and non-religious groups use these surveys in their campaigns to demand or challenge legal, financial and educational privileges, and governments use the findings to decide on funding, among other things, so they are more important than being of passing cultural interest. The widely differing findings are hardly a solid basis for policy or anything other than reflecting how variable survey findings can be.

People can and do change their minds about what they believe (although probably not so many of them in such a short space of time) but sexuality is a little less mutable.

The gay/bisexual statistic in the survey has led to headlines like 'Only one in 100 Britons is gay despite long-held myth' in the Mail.

It's inevitable that some groups will use stats to serve their own agenda and affected people will challenge them, especially if they have fought hard for equality.

One response to these findings on Facebook was '‎2,185,072 gay men and lesbians are currently registered on Gaydar in the UK - equating to 6.7 per cent of the UK population'.

More officially, in 2005, HM Treasury and the Department of Trade and Industry did a survey to help the Government analyse the financial implications of the Civil Partnerships Act (pensions, inheritance, tax benefits). They found that there were 3.6 m gay people in the UK – around 6% of the population. This figure was greeted by some gay rights activists as realistic.

If there are now only 1.5%, where have the other 4.5% gone since 2005? It should be noted that 3% of IHS respondents either said 'Don't know' or refused to answer. Again, the differences in survey results make basing any action on them a leap in the dark.

As to the 80% who 'perceived themselves to be in good health', what does this prove? Feeling well and being well are not the same thing at all for a start.

Even when stats are not used to tax the hell out of conquered Anglo Saxon peasants with very good reasons to be creative in their self-reporting, surveys are not like scientific tests. They are not reproducible in lab conditions, the methodology can be peer-reviewed but there can't be placebo questions, double blinding or a control group. At best, they can provide useful demographics, at worst they tell us nothing and can be used for propaganda. If you don't like the findings of the current survey, just hold on and there'll be another one along shortly.

Sunday, 19 September 2010

Pain Relief, Placebo and Profit

Glucosamine and chondroitin have no effect on osteoarthritis of the hip and knee. Researchers at Bern University in Switzerland ran a meta-analysis of ten trials on the two treatments and found that they perform no better than placebo - as reported in the BMJ.

The analysis confirmed what the BMJ reported nearly ten years ago. It concluded that: Our findings indicate that glucosamine, chondroitin, and their combination do not result in a relevant reduction of joint pain nor affect joint space narrowing compared with placebo. Some patients, however, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, regression to the mean, or the placebo effect. We are confident that neither of the preparations is dangerous. Therefore, we see no harm in having patients continue these preparations as long as they perceive a benefit and cover the costs of treatment themselves. Coverage of costs by health authorities or health insurers for these preparations and novel prescriptions to patients who have not received other treatments should be discouraged.

The global glucosamine market was worth £1.3bn in 2008.

The findings have been reported by the Telegraph, Independent, Mail and BBC among others. It is unlikely that now the truth is out, sales will fall. Evidence that something doesn't work has made no impact on other products. Reports like the ones here and here that antioxidants don't work have not stopped countless products being sold that proudly proclaim they contain them. Marketing rarely lets the facts get in the way of making money.

Boots sells Ladycare Magnets that allegedly treat the symptoms of menopause through magnotherapy even though there is absolutely no evidence they work and plenty that they can't possibly.

A Boots spokesman notoriously said that Boots doesn’t sell homeopathic remedies because they work, they sell them because people like to buy them: "I have no evidence to suggest that [homeopathic remedies] are efficacious. It's about consumer choice and a large number of our customers think they work."

There are plenty of other products that don't or can't work - the beauty industry is full of them, for example.

There are two issues here. One is freedom of choice. The research recommends that the NHS does not spend money on glucosamine and chondroitin but if people want to buy a product, that's up to them. However, if they think they are buying one thing (a medically-proven treatment) and they're getting another (a placebo) then arguably they are being mis-sold. It could also be argued that it's up to all of us to inform ourselves about what we're buying. But checking out the fat content on the back of a pizza in the supermarket is not the same as reading small print on apparently medical products, checking out academic research or even, in some cases, understanding media reports of research. Most people don't have the time, the will or the ability to do it. They're much more likely to buy on the recommendation of someone they know and trust (it worked for me). What's more, there may well not be any small print to check out.

The second issue is the ethics of placebo, which has been much discussed. Does it matter if feeling better is not the same as being better? Pain is one of the conditions that placebos work on particularly well and osteoarthritis can be very painful. Medical treatments for long-term pain can have side-effects while glucosamine and chondroitin apparently don't. How many of us actually know how any of the prescription medicines we get from the doctor work? If I had a long-term condition that medicine couldn't cure but which could be managed, then I think I'd rather get my placebo from a doctor who has fully diagnosed my condition, assessed all available treatments and will continue to monitor my progress than be left to the mercies of advertising and anecdote.

This leaves patients in a dilemma. If they do research their condition and possible treatments and find out that the only treatments that may help are placebos, will they still work? In order to save the NHS money, would it be ethical for doctors to recommend patients buy specific over-the-counter treatments rather than giving prescriptions? This way, patients get medical care but the NHS doesn't foot the bill for placebos. But then there is the question of what happens to people on low incomes. One potentially discriminatory effect of the Bern researchers' proposal is that the benefits of placebo will be available only to people who can afford them. This is the status quo as GPs are currently being advised not to prescribe glucosamine, but if over-the-counter is the only way people can buy placebos, is this equitable?

The placebo debate is not going to be resolved any time soon but the fact that yet more products have been proven to have no real effect means that it's not a debate that can be ignored. In the meantime, the manufacturers continue to make billions. One aspect that can be dealt with more simply is regulating labelling; claims like 'Promotes Natural Cartilage Regeneration' should be removed as this is demonstrably not true unless they are using a meaning of 'promotes' unknown to any other English speaker.

Tuesday, 7 September 2010

One for all or all for one?

Do we relate more easily to individual people in need than to groups?

Jonah Lehrer suggests that we find it much easier to relate to individuals in need than to groups of people because of the 'identifiable victim effect'. He cites the Chilean miners as an example - a group of people who fail to interest most of us as much as a single famine victim.

Lehrer also mentions a paper which 'tested recent claims that analytical processing might undermine support for identified victims by suppressing emotional responses'. It found that ' Less-analytic processors donated more to a single identified victim than to requests describing statistical victims or a combination of both; more-analytic processors showed no differences.'

In other words, less analytical people are more likely to give to an individual or to a campaign using images of a single person.

While this may be true for some people in some instances, charitable giving appears to be much more complex - and more interesting - than this. It's true that charities know the value of showing a cute animal or big-eyed starving child with flies crawling on it (because animals are individuals too in this instance). But charitable responses to major disasters like the tsunami or the current situation in Pakistan appear to contradict the identifiable victim response. For example, the British people have given considerable and unexpected amounts to relief in Pakistan - does this make us more analytical than other nations? It could be said that people who give to large groups far away have a stronger emotional response or more empathy as it extends to more than one individual.

The type of victim is relevant too. For example, a homeless person on the street is an individual, sometimes familiar and living in the potential giver's neighbourhood. But for many passers-by, when they are begged at there's a judgmental/analytical process which happens. Is the beggar just going to spend the money on alcohol? Does s/he deserve our hard-earned money? Is s/he a helpless victim who had no part in their own downfall? Women begging on the street with babies are clearly trying to create an emotional response but some people may not respond to this, even wondering if it is really that woman's child, perhaps recalling some media story about begging rings and scams. Any individual doesn't do it for us, it must be the right individual.

The concept of the deserving poor comes into play and perhaps over-rides the individuality of the beggar and prevents identification; it's an idea that's been around since the 16th century. This is where sad puppies and starving children score - they are clearly innocent victims. But at some level, there is always an analytical process going on before we connect emotionally and decide whether we are being played and whether to act on generous feelings.

There's also media coverage. The Chilean miners are currently being ousted from the headlines by cricket scandals and footballers' private lives. What's more, the miners are alive and apparently in no immediate danger. There's no daily drama or death toll to tug our heart strings.

Time is a factor, too. A long-drawn out situation that appears insoluble is less attractive than a sudden, unforeseen natural disaster with shock value or something that appears to need a quick(ish) fix where it's easier to feel a difference is being made.

In addition, Lehrer says that we don't identify with statistics but I think that numbers do have an effect sometimes. Perhaps part of the problem is that the miners are neither one small child trapped down a well nor are there millions of them in imminent danger. There are too many of them and not enough.

It's true that millions of children around the world are daily at risk from preventable disease and hunger and yet people give money to the local donkey sanctuary because they saw a picture of a poorly donkey in the local paper but this is as much about marketing as generosity and empathy. Some research by Richard Wiseman found that the colour of a charity donation box and the wording on it affect how likely people are to give, for example. Using the word 'disaster' is good marketing, too.

There's possibly also a peer pressure effect. If everyone in your office is putting money into a collection tin, then resisting is going to be harder than if the tin is just in a shop or you get a mail shot at home. Telethons tap into something similar - look how much money everyone is giving, don't you want to be part of this virtuous group too? In such situations, what the collection is for becomes secondary, whether it's to sponsor a single child or for a major disaster.

For some people, charity is a religous duty, neither an emotional/empathic nor an analytical response.

There is a fair bit of research showing that women are more charitable than men, so gender is another factor (so are older people and Northerners in the UK).

One research paper looks at the gender difference in more detail. It calls the ability to identify or empathize with others 'the inclusion of others in the self'. It also looks at moral identity - the importance of being fair, kind, just, generous etc to self-identity. What it found was that men with stronger moral identity were more likely to give to individuals or to an in-group (local charities, for example) whereas women were more likely to give to an out-group (eg overseas charities) as their moral indentity increased. In other words, these women are responding to large groups more than men. Does this mean men are less analytical?

So it looks like charitable giving and relating to people in need isn't just about individuals versus groups but is much more complex - which is hardly surprising given that human instincts and motives for doing anything are complex. And just to confuse matters further, one of the biggest charities in the UK in terms of giving is the National Trust, which doesn't help humans at all.

Wednesday, 25 August 2010

Middle Age Spread

Once again, there are stories in the press about the rise of Sexually Transmitted Infections (STIs) in young people (under 24), with half a million new cases in the UK in the last year, a rise of 3% from the 2008 figures. There's an excellent analysis of the data and the media response by Dr Petra Boynton who also deals adeptly with an ill-informed response to the data by a Tory MP.

Although the problem is much more serious with the under 24s, they are not the only group at risk from not using condoms and from poor sex education. As Dr Boynton points out in her blog: 'Sexual health messaging - particularly through education and public health campaigns often overemphasises morality discourses of 'risk' or 'responsibility'... Such an approach also assumes older adults act in different (and more 'appropriate) ways than younger people, which is neither fair nor true'.

The Family Planning Association (FPA) has collected data showing that STIs are also on the increase in the 45-64 age group.

Statistics vary according to different sources. The Royal College of Nursing has noted a 93% increase in gonorrhea between 1999 and 2008 in this age group. A survey done in the West Midlands found that the most commonly diagnosed infection among the over 45s was genital warts – accounting for almost half (45 per cent) of the diagnoses – while herpes was the next most common (19 per cent). Cases of chlamydia, herpes, warts, gonorrhoea and syphilis all rose sharply between 1996 and 2003.

To go back to the actual numbers rather than percentages, according to the HPA's data, Table 4e(ii) shows that chlamydia increased from 1091 cases in 2002 to 2638 cases in 2008. Their data also shows an increase in herpes cases from 1613 to 2903 in the same age group over the same period. These are huge increases in percentage terms but still a small incidence in the population as a whole. So if you see shock headlines about huge increases in grannies with STIs, check the baseline figures.

However, whichever stats you look at, there is an undeniable increase.

One cause is heterosexual couples of that generation splitting up and starting to have casual sex again. For some of them, the thought of dating again is daunting enough, let alone the idea of buying and using condoms. Some people may never have used them. Women who have been through the menopause are mostly of a generation whose main concern was avoiding pregnancy; being on the Pill was considered enough protection and greatly superior to using condoms. The Pill was also seen as empowering women as they didn't have to rely on the man to provide contraception. In addition, the powerful HIV/AIDS adverts of the 80s are now a distant memory and may have come from a time when they thought the campaign didn't relate to them in their steady relationships (which they assumed/hoped were faithful).

A poll by the Royal Pharmaceutical Society of Great Britain found that almost 20% of the 45-54 age group admitted to having unprotected sex in the last five years with someone other than a long-term partner. And a Saga survey of around 8000 people found one in ten not using condoms even though they don't know the sexual history of their partner. Again, a sharp rise from a small number to a slightly larger number is a trend but not a crisis although it is a trend that needs addressing.

While some middle aged people had excellent sex education from schools or parents, many didn't. STIs were often seen as something only the promiscuous got. They may not know, for example, how STIs can be transmitted through non-penetrative sex or that they are at risk at all. And while some people may have plenty of experience, both in having sex and talking about it, not everyone does.

Part of the problem is that sex is often portrayed by the media as something for younger people; the thought of older people having sex or expressing any kind of sexuality can be a bit of a joke or cause (younger) people to wrinkle their noses.

There is a gender bias too, just as there is with younger people where boys are portrayed as predators and girls as victims or 'morally loose'. Older men who are still active are admired (see how many Hollywood stars are still getting the girl in movies well into their sixties) while active older women are a bit distasteful. The alleged Cougar phenomenon in the media is really about women in their forties - maybe early fifties - who look much younger, not grannies. The most explicit portrayal you're likely to see on TV is an advert for a denture product with an older couple kissing (no tongues). None of this helps some older people feel confident in talking about sex openly or seeking advice.

It's encouraging to anyone approaching this age group that the fun doesn't have to stop. But while some are happily embracing their new sexual activity, some older people who grew up in a time when sex was less openly discussed may also find it harder to talk to GPs and health professionals about sex-related matters, especially if they are much younger. They may not even want to admit they are having sex again.

The current government coalition is doing little in the way of public health campaigning for sexual health services for any age group but the Family Planning Association is trying to address the problem for older people with a Sexual Health Week from 13-19 September specifically aimed at people over 50.

So far there has been no media hype or hysteria about older sex as there has been once again with young people, laden with high-handed moral judgements and shock horror headlines. This may change once the campaign launches.

The facts are that there is a small but significant upward trend that is indicative of poor education and campaigning. Just as teenagers need to be equipped to have responsible sex in a factual, non-moralising way, so do older people. The week in September is a good start but without a sustained campaign, it could just come and go without making much of an impact. So, there is not a huge new phenomenon, the very fabric of our society is not at risk from feckless pensioners and irresponsible baby boomers but the government is failing both young and old

Wednesday, 11 August 2010

Food Allergies - Fact, Fiction and Fad

There are two common responses when the subject of food allergies comes up. The first, mostly but not entirely from older people, is "Stuff and nonsense. They didn't exist when I was young, we ate whatever was put in front of us. You don't see starving people in the third world with allergies". The second is: "I feel much better and have lost lots of weight since I stopped eating wheat. I know I'm allergic/intolerant because I sent my poo/blood/hair away to be analyzed".

According to one source, 25% of adults think they have a food allergy although studies show that only about 2% really do. Which means that at least nine out of ten are making a big fat fuss about nothing. Recent news said that up to 8% of children now have allergies although a spokesperson from Allergy UK said: "Parents often look for alternative ways to diagnose their children, using tests which aren't scientific at all. Parents tend to think it's an allergy without taking proper medical advice".

It's mostly middle class people with a bit of spare cash who have latched onto food allergies and intolerances (the two are often used interchangeably). Not the life-threatening A&E kind of allergy but the feeling a bit bloaty and tired, self-dramatizing kind which are not allergies at all. Some people will happily say they're 'a bit allergic' to something without any medical evidence whereas they would never say 'I'm a bit diabetic' and not bother going to the doctor. One reason people might well feel better and lose weight by giving up wheat is that by not eating bread, pasta, pastry and pizza they are also cutting back on the high fat, high salt ingredients that go with them - cheese, highly salted meats, mayo, creamy sauces and so on. Or maybe they really are lactose intolerant and have accidentally cut most dairy out of their diet by giving up these foods. That's the trouble with self-diagnosis.

Saying 'I'm allergic to dairy' or 'I'm gluten intolerant' has become a bit of a middle-class mantra, not that different from telling people your star sign in some circles, as if that makes you more interesting and special. People are more than happy to discuss the details of their alleged intolerances in company where they wouldn't dream of mentioning an ingrown toenail or dandruff - two equally unpleasant but minor complaints. I've heard lengthy conversations about how cutting something out of a diet has changed someone's life, usually followed by a discussion of how they found out they had an allergy/intolerance. Inevitably, this does not involve a visit to the doctor. It involves posting some bodily fluid or excresence off for analysis. There are often endless conversations sharing the love and comparing notes on what foods they can't eat and how they got 'diagnosed'. While eating dinner. Of course, the host/ess has been thoughtfully supplied in advance with a list of all the things the guests can't eat.

A food allergy is an adverse immune response to a food protein. The body identifies a protein as something threatening, the immune system thinks it's under attack and triggers an allergic reaction which can range from mildly unpleasant to life-threatening.

In answer to the people who think that allergies are a modern fad - they're not. In the olden days, anyone with a serious allergy wouldn't make it through childhood and in days before the NHS and proper testing, the cause of death mostly went undiagnosed. The same still goes for parts of the third world. These people are often heard saying things like a certain food doesn't agree with them or 'I like it but it doesn't like me' without thinking that this could be a mild allergy. But going on and on about them is a modern fad, part of a more general obsession with food in our over-stocked culture. It's what used to be called being a fussy eater, perhaps followed by a smack on the bottie that quickly put paid to that bit of wilfulness.

An intolerance doesn't involve an immune reaction. It happens when the body is unable to deal with a certain type of food, usually because it doesn't produce enough of the chemical or enzyme needed to digest it. For example, a shortage of the enzyme lactase causes problems breaking down milk sugar (lactose) into simpler forms that can be absorbed into the bloodstream. There's a strong genetic pattern to food intolerances. Lactose intolerance is less common among northern and western Europeans (10 to 15 per cent are affected) than in Asian, African, native American and Mediterranean populations (70 to 90 per cent are affected). Symptoms include nausea, bloating, abdominal pain and diarrhoea, hours or days after. Which are pretty unpleasant. But those nasty squitty, pukey symptoms don't tend to get mentioned in dinner party conversations, which are more likely to involve weight loss and the person's skin improving. If you have regular cramping and throwing up, you'd probably hightail it to the doctor.

There are plenty of ways to get diagnosed. One involves getting medical advice. The rest don't. Some of these are pretty expensive, often hundreds of pounds. NICE has issued draft guidelines for doctors on diagnosis and treatment of allergies, which contain the advice 'Do not use the following alternative diagnostic tests in the diagnosis of food allergy: vega testing, applied kinesiology, hair analysis'. The guidelines also say that 'it was reported that many people with allergies practice self-care, using alternative sources of support rather than NHS services (for example, complementary services with non-validated tests and treatments)'.

Briefly, kinesiology uses 'energy* fields' in the body to diagnose allergy and intolerance, vega testing involves measuring electromagnetic conductivity in the body using a Wheatstone bridge galvanometer - the same device Scientologists use outside their centres to 'test' passers-by. Hair analysis tests for heavy metals that allegedly cause allergies or involves dowsing - swinging a pendulum over the hair; an allergy is diagnosed if an altered swing is noticed. And then there are the poo samples. Post your poo off to a lab in the UK or US and find out how many different foods you're allergic or intolerant to. As one UK hospital states, samples more than 8 hours old will not be processed as they have degraded too much, so sending poo through the UK postal service to another city, let alone to the States, is hardly going to ensure it arrives in prime condition. And I really don't want to think about what collecting your own poo sample involves. Or what postal workers might make of poorly wrapped packages.

There are some excellent analyses of why all these alternative testing methods are nonsense on stilts on Quackwatch and Holford Watch.

If you really are allergic or seriously intolerant, it can be very unpleasant indeed. If you think you might be or that your child is, see a doctor. Otherwise, kindly shut the fuck up. Or am I being intolerant?

* As soon as you hear 'energy fields', you know you're in quackland.