Sense prevails

October 31st, 2007 by Ben Goldacre in bad science, religion | 16 Comments »

Ooh ooh I just got this in email at 00:01 and I hereby am posting it before the BBC or anyone. They lose valuable minutes by pretending not to copy and paste the press release, while I find that kind of theatre slightly childish. Meanwhile, pasted below is what our Parliamentary Science and Technology Committee on the Abortion Act recommended, after carefully reviewing the scientific evidence. The report itself is a masterful and surprisingly readable precis, which I’ll post as soon as the link goes live.

Select committee work is probably the only place where politicians do the kind of thing you’d like politicians to do, sitting down and sifting through the evidence on a policy. Bravo.

SCIENCE AND TECHNOLOGY COMMITTEE

COMMITTEE OFFICE, HOUSE OF COMMONS

7 Millbank, London SW1P 3JA

Tel. Nos. 020 7219 email: scitechcom@parliament.uk

PRESS NOTICE

No. 66 of Session 2006-07

31 October 2007

PUBLICATION OF REPORT

SCIENTIFIC DEVELOPMENTS RELATING TO THE ABORTION ACT 1967

The Science and Technology Committee today sets out its conclusions on scientific developments which ought to be considered in any new Parliamentary debate relating to the Abortion Act 1967.

The Committee decided to hold its inquiry in order to inform parliamentary and public debate after it was ruled that abortion would fall within the remit of the Human Tissue and Embryos Bill, which is likely to be presented to the House in the 2007/8 session.

The Committee makes clear that its conclusions and recommendations are restricted to those issues capable of scientific evaluation and recognises that other factors also come into play when abortion law reform is being considered by Parliament.

The Committee concludes that while survival rates at 24 weeks (the current upper limit for abortion) and over have improved since 1990, survival rates (viability) have not done so below that gestational point. The Committee concludes that there is no scientific basis – on the grounds on viability – to reduce the upper time limit.

The Committee supports the removal of the requirement for two doctors signatures before an abortion can be carried out. The Committee is concerned that the requirement for two signatures may be causing delays in access to abortion services and found no evidence of its value in terms of safety.

Nurses and midwives with suitable training and professional guidance, should not be prevented by law from carrying out all stages of early medical and early surgical abortion. The Committee says that it found there is no evidence that this would compromise patient safety or quality of care.

On the issue of foetal pain, the Committee says the evidence suggests that while foetuses have physiological reactions to stimuli, this does not indicate that pain is consciously felt, especially not below 24 weeks. It further concludes that these factors may be relevant to clinical practice but do not appear to be relevant to the question of abortion law.

While new 4D imaging techniques are a useful tool in diagnosis of foetal abnormality, there is no evidence they provide any scientific insights on the question of foetal sentience or viability.

Any debate on the impact an alteration to the upper time limit would have on those women who present late for abortion would be better informed if there was improved collection of information relating to the reasons why women come forward at this late stage and about how many women travel overseas for late abortions.

On the question of the merits of clarification or a definition of “seriously handicapped”, the Committee does not consider that an exhaustive list of abnormalities is feasible, but believes that guidance on what “serious handicap” means would be helpful; and further that data collection in this area be improved.

The Committee concludes there is no evidence relating to safety, effectiveness or patient acceptability that should deter Parliament from passing regulations which would enable women, who chose to do so, taking the second stage of early medical abortion at home. The Committee would like to see the necessary legislative change that would enable this to be pursued or at least piloted.

It also recommends that the clinical guidelines on abortion provision, including health risks associated with abortion, should ultimately be taken over by the National Institute for Health and Clinical Excellence (NICE).

Chairman of the Committee Phil Willis said: “Abortion is a complex issue. Legislative decisions are informed by ethical , moral, religious and political views, case law, scientific and medical evidence. As a Science and Technology Committee, we have focused on the science, and have done so rigorously.

“In our inquiry we have attempted to sift the evidence on scientific and medical developments since the last amendment of the law in 1990 and since the 1967 Act.

“We urge all MPs and the public to study the evidence we have taken and the conclusions we have reached.”

The Report is published at electronically at 0001 on Wednesday 31 October 2007.

Hard copies of the Report can be obtained from TSO outlets and from the Parliamentary Bookshop, 12 Bridge Street, Parliament Square, London SW1A 2JX (020 7219 3890) by quoting the appropriate HC number from Tuesday 6 November 2007.

 


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16 Responses



  1. Ben Goldacre said,

    October 31, 2007 at 1:13 am

    More undigested press release action:

    Responding to the Science and Technology Select Committee Report on Abortion, Dr Evan Harris*, Liberal Democrat MP on the Committee said,

    “This thorough report – after a rigorous enquiry into a set of very narrow scientific issues – sets out clear conclusions on what the scientific evidence can tell us about abortion law reform.”

    “The medical evidence is stark about how the threshold of viability has not reduced below 24 weeks, and that is why our conclusions are so firm. For many parliamentarians – like Lord David Steel himself and Gordon Brown – who have said they will follow the science on this question, this will make to a difference to how they vote on the question of the upper time limit.”

    “The Committee had no alternative – given the medical and scientific facts – but to argue for the end of the 40 year requirement for two doctors signatures, the old-fashioned ban on nurses performing abortions, and the unnecessary restriction of choice for women about where they have early medical abortion.”

    “I am pleased the Committee argues for the GMC to make clear that doctors who conscientiously object must alert their patients in advance and ensure another doctor takes the consultation if abortion is a possibility”.

    “The so called “minority report” is a amusing mish-mash of paranoid conspiracy theories, pseudo-scientific clap-trap and anti-abortion zealotry. The few recognisably scientific arguments it makes are completely dealt with in the Committee’s report and rebutted by the totality of the scientific literature”

    I now totally badly want a copy of the “minority report”.

  2. monkeytown said,

    October 31, 2007 at 11:33 am

    A Daily Mail classic on the subject:

    www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=490815&in_page_id=1770

  3. Dr Aust said,

    October 31, 2007 at 11:41 am

    Yaay Evan Harris. Give that man a medal, say I.

    Talking of Dr Harris, I read Amanda “F*!kwit Harpie” Platell’s Daily Mail diatribe about him that Ben mini-blogged. It made me genuinely angry, and I penned a suitable trenchant “comment”, which (surprise surprise) hasn’t appeared. In fact, NO comments on Platell’s “opinion” have appeared, which suggests to me that any commenters all thought she was flatly bonkers, or “channeling” the ghost of Private Eye’s Glenda Slagg. On reflection, these days Platell and Glenda Slagg appear to be wholly indistinguishable.

    As a general point, from my own experience, and that of people on the BadScience Forum, most comments on the Mail’s website that point out the Mail’s idiocies never make it past the paper’s “moderators”.

  4. Ambrielle said,

    October 31, 2007 at 11:45 am

    Ah, what the hell is the ‘minority report’? Was this a CMF thing?

  5. Ambrielle said,

    October 31, 2007 at 11:53 am

    Oops. My bad. Didn’t read Ben’s other post first. :)

  6. Bogusman said,

    October 31, 2007 at 11:55 am

    Well done for putting up the press release in full. Speaking as a layperson it appears to me to indicate that the committee has done a thorough and considered job. It certainly tells me more than the Today program did this morning.

    As for the minority report – well the world has room for other opinions, but I would be interested to know how much they are informed by religious belief, how much by the sort of populist Daily Mail view and how much by the need to cultivate a particularly backwoods constituency.

  7. Dr Aust said,

    October 31, 2007 at 6:07 pm

    Yes, interesting Q, bogusman. A few years ago I would have said “Daily Mail readers” in a flash, but I wonder if we are not seeing a distant echo of the neo-con religiosity and cloaking oneself in bogus piety that has been stuffing up the USA these last seven years. The Tory party is always alive to the influence of the US right. Apart from anything else, money talks, and the anti-abortion people are well-funded and vocal.

    I would have suspected these sort of views would have been a bit embarrassing to “Citizen Dave”, though.

    Another of the ironies here is that the Daily Mail readers frothing at the mouth about “Dr Death” and the Select Committee will no doubt be the same people shocked and appalled by the idea of classes to try and give kids realistic (continental-style) sex ed instruction… one of the “interventions” which might actually do something to reduce teenage pregnancy and termination rates.

    I was really quite shocked by the level of ad hom vituperation the Mail directed at Evan Harris. I used to be solidly with the late Dennis Potter (who of course named his cancer “Rupert”) that Mr Murdoch and The Sun were the greatest blight on both UK journalism and reasoned public debate, but I’m coming around to the conclusion that the Mail is worse, if only because it seems to think it is a “serious” paper.

  8. Robert Carnegie said,

    November 1, 2007 at 3:58 am

    The committee seems to conclude that the foetus at the stage where termination currently is permitted does not “consciously” feel pain. I’m not sure how this is tested, I’d suppose applying a neutral stimulus then a “painful” one, then seeing if the foetus moves to withdraw from the repeated neutral stimulus. The committee also considers this irrelevant to correct abortion law even if the foetus did contain a conscious mind capable of experiencing pain (which apparently it does not), and I do not agree with the last, that if there -is- sentience then it is of no interest to Parliament.

    I also suppose that the main non-clinical risk of taking the “morning after pill” at home, if that’s what they’re talking about, is that the pill is not taken by the patient but passed on to someone else to be misused. Like having a friend sit your driving test. Of course the importance of this question depends on whether the drugs are available black-market anyway.

    Let’s see if I’ve got this straight, officially you don’t get to have an abortion just because you don’t want to have a baby – yes? A BBC News Online story says “Almost all (abortions) are permitted on the grounds that pregnancy would damage the physical or mental health of the woman. Only 1% of abortions are carried out on the grounds that the child would be born with a serious disability.” It seems that “damage the physical or mental health of the woman” means in practice “she doesn’t want it”, plus I suppose risk of diabetes, high blood pressure, fallen arches, possible grave complications and subsequent profound sleep deprivation, all liable to appear during or after any normal pregnancy, and not to be belittled.

    And I’m not sure how I feel about it. But if and when it intimately involves someone else’s body and isn’t my business in any way, fine.

  9. lucys said,

    November 1, 2007 at 1:13 pm

    Hi Robert,

    One thing I can clear up for you: the morning after pill isn’t the same thing as an abortion pill.

    As I understand it, it prevents implantation of a fertilised egg, rather than getting rid of it once it is already in the womb. That is why it becomes less effective the longer the gap between unprotected sex and taking the pill.

    You can buy it from pharmacies, too. So not the same as an early stage abortion at all.

    Cheers,

    Lucy

  10. RS said,

    November 1, 2007 at 2:49 pm

    “I’m not sure how this is tested”

    One line of evidence is that the pain pathways haven’t developed yet.

    “I do not agree with the last, that if there -is- sentience then it is of no interest to Parliament.”

    Me neither, but then I don’t eat animals either.

    “Of course the importance of this question depends on whether the drugs are available black-market anyway.”

    Do you mean the morning after pill? Since it is available over the counter at pharmacists for £20, and obviously it is also taken at home as well.

    “It seems that “damage the physical or mental health of the woman” means in practice “she doesn’t want it””

    Yep, although you’d think we’d change the law to actually say that wouldn’t you?

  11. Robert Carnegie said,

    November 2, 2007 at 1:56 am

    Resuming – I’m not fully informed about drugs used in “family planning” and abortion, where I’m presuming there is overlap. I’m not going to worry about that either. They exist, they’re effective and reasonably safe where properly prescribed, they’re only used on very early pregnancy, and in one particular application, currently two treatments are given under clinical supervision – yes?

    Let’s suppose that only one doctor is involved now – that makes sense. The abuse of the system that I am imagining involves administering the drugs to someone other than the patient who presents to the doctor. It needs method and motive. Well, I imagine that if you set out to bamboozle a pregnancy test at a family GP, it’s not more difficult than getting past the performance-enhancing drugs tests in sport, the Olympics or Tour de France, read Matt Seaton. You bring someone else’s urine sample, for instance. Someone unscrupulous somewhere will be bottling and selling the stuff.

    And what do you do with an off-licence abortion drug? Sell it to someone who doesn’t want to see the family doctor about their abortion – someone who doesn’t want their partner to know – an immigrant without legal access to the NHS – someone who is too far on to use that treatment legitimately, but wants to, for any of these reasons. Or you could administer it to a pregnant woman without her knowledge – say your rich and elderly father’s young girlfriend. Make sure the inheritance doesn’t go astray.

    And, I mean, look at the unintended consequences of bi-weekly refuse collection and the proposal to charge for rubbish collection by weight. We should be careful about this. Asking the patient to pop into the office isn’t too much, gives the process some dignity… home births are one thing, home terminations – I don’t quite see the point. Well, I suppose if it’s up the doctor’s, your mind might not be on the road driving home afterwards, I wonder if there are statistics. Of course when we bring in my other pet idea, robot cars, it won’t be an issue. (Except for my other other idea when the robots decide to wipe us out for frankly obvious reasons.)

  12. Robert Carnegie said,

    November 2, 2007 at 2:15 am

    On sentience, in the correct sense, awareness…

    It is a faculty possessed by human beings. It’s fairly futile to try to draw a line on the foetal development chart, and to say, “After here, this is one of us”, but at the other end of life, the rare persistent vegetative state, consciousness in the philosophical, going on about it for hours in bizarre abstract terms, sense, is a notable issue. And so I regret not really knowing how such patients do in such tests. We don’t worry about switching them off… well, we do, we agonise about it at length, but we do it.

    I had in mind a test with distinct stimulus A followed by painful stimulus B, and whether the foetus learns to react to stimulus A by anticipating stimulus B. Difficult to do ethically if there is no real definite purpose, I suppose, even if the foetus isn’t a person. It isn’t an animal either, I assume… unless an animal foetus is used, I suppose. And yes, of course humans are animals, but mostly not in the eyes of the law.

    And I’m suspicious on principle of an argument that a function is in one particular part of brain anatomy. After all, ontogeny recapitulates over a hundred years of speculative and often fallacious arguments. The other day I was hearing about an aperture in the foetal heart which allows the bypass of the lungs. This matters because quite a lot of us have it for the rest of our lives and it can end up causing trouble. It was in fact BBC’s [Case Notes] upon headache that I was listening to, where plugging the thing with one of those cocktail umbrella jobs and letting it heal was tried for migraine, a lot of whose sufferers have the hole. The repair doesn’t seem to help with it, though, they said.

    The point of bringing that up was that the foetus is constructed differently from the mature human being in that respect. (Except when the mature human being is one of the many who still have the foetal heart thing.)

  13. RS said,

    November 2, 2007 at 2:47 pm

    “I imagine that if you set out to bamboozle a pregnancy test at a family GP”

    They’ll take your word for it – this is a health service not a fascist state!

    “someone who doesn’t want their partner to know – an immigrant without legal access to the NHS”

    Both of those could just go to a GP, the NHS doesn’t really try very hard to keep out immigrants for obvious reasons.

    “someone who is too far on to use that treatment legitimately”

    Then they’d need more than just mifepristone and misoprostol, that baby ain’t coming out! If they’re distressed enough to do that what will stop them trying something infinitely more dangerous?

    “Or you could administer it to a pregnant woman without her knowledge”

    And how many other drugs could that be said of? How widespread do you think deliberate poisoning of people is? Should we restructure the entire NHS to have supervised administration?

    “I mean, look at the unintended consequences of bi-weekly refuse collection”

    Yeah, why didn’t those doctors think of that?!

  14. RS said,

    November 2, 2007 at 3:12 pm

    I’d also point out that the proposal is to allow the second pill to be taken at home:

    “Medical abortions take place in two stages. First, a single dose of mifepristone is given
    orally, which blocks the pregnancy hormones so that the pregnancy ceases to be viable.
    Upto 48 hours later—and conventionally 24–48 hours later—a second drug, either
    misoprostol or gemeprost, is then administered vaginally or is swallowed. It causes the
    uterus to contract and to expel the pregnancy much like a miscarriage. Women are now
    offered the option of going straight home after taking the second pill, which most do, in
    order to make themselves comfortable before this process starts. In the UK misoprostol is
    treated as an abortifacient, and therefore women must visit a clinic to obtain the second
    pill. In the USA, the second stage of a medical abortion is frequently self-administered by
    the woman in her own home.”

  15. emilypk said,

    November 2, 2007 at 8:58 pm

    The evidence is more to do with consciousness than response to noxious stimuli (pain is not the correct word because it implies conscious experience). Currently the evidence suggests that foetuses are not conscious in the ‘awake’ sense of the word until their blood oxygen spike with the onset of respiration.

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