Meaningful debates need clear information

October 27th, 2007 by Ben Goldacre in badscience, references, religion, statistics | 42 Comments »

Ben Goldacre
The Guardian
Saturday October 27 2007

Where do all those numbers in the newspapers come from? Here’s a funny thing. The Commons committee on science and technology is taking evidence on “scientific developments relating to the Abortion Act 1967”.

Scientific and medical expert bodies giving evidence say that survival in births below 24 weeks has not significantly improved since the 1990s, when it was only 10-20%. But one expert, a professor of neonatal medicine, says survival at 22 and 23 weeks has improved. In fact, he says survival rates in this group can be phenomenally high: 42% of children born at 23 weeks at some top specialist centres. He is quoted widely: the Independent, Telegraph, Channel 4, on Newsnight, by Tory MPs, and so on. The figure has a life of its own.

In the media, you get one expert saying one thing, and another saying something else. Who do you believe? The devil is in the detail. One option is to examine the messenger. John Wyatt is a member of the Christian Medical Fellowship. He didn’t declare that when he went to give evidence. You don’t have to. He did declare it when asked.

Prof Wyatt has relevant research experience but there were half a dozen other medics without any relevant background who submitted evidence (or their view of it) to the committee who, when asked if they had anything to declare, did mention membership of Christian or evangelical groups with an established position on abortion. I don’t care for an argument that rests on competing ideologies, so let’s look at Prof Wyatt’s evidence, because it has been hugely reported and it goes against the evidence from a huge study called Epicure. Epicure contains all of the data for every premature birth in 1995 and 2006. It shows a modest improvement in survival for births at 24 weeks, but no significant improvement in the 10-20% rate for births at 22 and 23 weeks.

For the next bit, you need to understand one simple piece of primary school maths, which is central to medical statistics. In the sum 3/20, 3 is the numerator and 20 is the denominator: 15% survive; 3 out of 20. For Epicure, the numerator is survival to discharge from hospital, and the denominator is all births where there is a sign of life, carefully defined: 3 out of 20.

There are two ways you could get a higher survival percentage. One would be a genuine increase in the number of babies surviving, an increase in the numerator: 8 out of 20 live births survive, 40%. But you could also see an increase in the survival percentage by changing the denominator. Let’s say, instead of counting as your denominator “all births where there is a sign of life in the delivery room” you counted “all babies admitted to neonatal intensive care”. Now that’s a different kettle of fish altogether. To be admitted to neonatal ICU, the doctors have to think you’ve got a chance. Often you have to be transferred from another hospital, in an ambulance, and for that you really do have to be more well. Therefore, if your denominator is “neonatal ICU admissions”, your survival rates will be higher, but you are not comparing like with like. That may partly explain Prof Wyatt’s figure for a very high survival rate in 23-week babies. But it’s not clear.

First in his written evidence he said that the data was from a “prospectively defined” study (where they say in advance what they plan to collect). Then he was asked in the committee, when giving his oral evidence: “What was the denominator for that? Was that … 42% survival at 23 weeks of all babies showing signs of life in the delivery room, or was it a proportion of those admitted to neonatal intensive care directly or by transfer?” Prof Wyatt replied: “The denominator was all babies born alive in the labour ward in the hospital at UCL [University College London].” This later turned out not to be true.

Then he was asked to send the reference for the claim. He did so. It was merely an abstract for an academic conference presentation three years ago. It did not contain the figures he was quoting. He then says he has done the raw figures on a spreadsheet, especially for the committee, bespoke, if you will, and sent them in. They are entered into the record as a memo, on October 18. They show new, different, although broadly comparable figures: 50% survive at 22 weeks, then down to 46% at 23 weeks, then up to 82% at 24 weeks, then down again to 77% at 25 weeks. (That bouncing around is because the raw numbers are so small that there is a lot of random noise).

And the denominator? Prof Wyatt is clear: “I have provided the numbers and percentage of infants born alive at University College London Hospitals who survived to one year of age.” The committee asked for clarification of this. Finally, October 23, another memo arrived, from Prof Wyatt, entered into the record, for all to see. For the widely quoted 42% survival rate at 23 weeks, Prof Wyatt admitted that the denominator was all babies admitted to the neonatal intensive care unit. But in his new special analysis, giving this new “46% survive at 23 weeks” figure, the figures in the previous paragraph, he claimed, the denominator was “all live births”. Has he undone a prospectively designed study, and retrospectively re-designed it? Or is this now a completely different source of data to the original reference?

I don’t blame Prof Wyatt, but the figure has taken on a life of its own. There may have been yet another mistake here, about the denominator. I don’t know. I’m quite prepared to believe that UCL may have unusually good results. But science is about clarity and transparency, especially for public policy. You need to be very clear on things like: what do you define as a “live birth”, how do you decide on what gestational age was, and so on. Even if this data stands up eventually, right now it is non-peer reviewed, non-published, utterly chaotic, personal communication of data, from 1996 to 2000, with no clear source, and with no information about how it was collected or analysed. That would be fine if it hadn’t suddenly become central to the debate on abortion.


Here is the oral evidence:

Here are the memos, Prof Wyatt’s are the last two in this PDF, and one earlier one:

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42 Responses

  1. jackpt said,

    October 27, 2007 at 1:39 am

    Good article. I think if we cast aside all ideological arguments all we’ve got to go on is the evidence, so examining stuff like this is especially important. It’s clear the detail, or lack thereof, wasn’t scrutinised adequately by those producing the headlines.

    It would be very interesting to compare news about emotive issues with mundane news to see if emotion scews examination. It’s very ‘common sense’, and therefore untrustworthy, but I suspect the greater the emotion, the more the money and therefore the hastier the examination. For all subject matters.

  2. Dean Morrison said,

    October 27, 2007 at 4:36 am

    Of course – if you were a detective – you’d look for motivation – if you were a scientist – you’d cut the crap and make sure you used the same demoninator.

    The rules for a “Committed Christian” might be different – but clearly ‘clarity of truth’ means something different here…

  3. woodchopper said,

    October 27, 2007 at 4:45 am

    A good article on an apposite subject. I just wonder how long it will take before politically moivated people start posting dodgy stats on this board. That seems to be the norm wherever abortion is discussed.

  4. Nellie Dean said,

    October 27, 2007 at 6:39 am

    And there’s the matter of how many very premature babies grow with handicaps, and the nature of these handicaps.

  5. hairnet said,

    October 27, 2007 at 10:02 am

    Nicely doen, In my opinion you are free to dislike someone on ideological grounds but to counter their argument requires something rigorous and undeniable.

  6. igb said,

    October 27, 2007 at 10:22 am

    “And there’s the matter of how many very premature babies grow with handicaps, and the nature of these handicaps”

    And there’s the matter of if it matters at all. Since in abortion we’re all supposed to put our ideological cards on the table: no one rational believes that abortion is a good and desirable thing, but I believe that a woman’s right to choose trumps all other concerns.

    However, since I doubt many people would advocate abortion at nine months, and few outside the very religious object to the progesterone-only pill, what we’re really discussing is the extent to which what we’re aborting looks more like a baby and less like cells, and that’s really a taste and squeamishness issue more than a moral one.

    Survival had there been a birth at that moment seems like a red herring: almost all of the `social’ abortions would have resulted in the healthy birth of a healthy baby to a healthy mother, and there’s no reason to believe that at the point the mother walked into the clinic she was on the point of going into premature labour.

    It’s not like the terminal care versus euthenasia argument, where whatever happens the patient is going die, and we’re haggling about weeks or possibly days: the end result of a woman 24 weeks pregnant not having an abortion is not a 24-week birth: in the vast majority of cases it’s a full-term-ish delivery.

    The reason why the anti-abortion lobby want to reduce the time limit is they want to reduce the window of opportunity (historically they wanted to get below the cutoff for amniocentesis, but I think CVS and other tests have made that less of a goal). The reason why people who advocate choice for women are prepared to play this viability game is because we know in our hearts that a great many of the pregnancies would have resulted in healthy outcomes, and we have the humanity to recognise that the abortion was about choice, not about terminating a pregnancy that wasn’t going have a healthy outcome.

    Any abortion post 12 weeks is probably (>90%?) terminating a pregnancy that would have gone successfully to term. Let’s stop doing the work of the people who thought The Handmaid’s Tale was a positive story for women and concentrate on the real issue: abortion is a messy business, but women have the right to choose what they do with their own bodies unless we’re damn sure there’s a reason to stop them.

  7. moonglum said,

    October 27, 2007 at 10:35 am

    excellent article and i guess its time to introduce another figure from an article by john wyatt from the christian medical fellowship

    “An extremely premature baby is born at 23 weeks of gestation, 17 weeks before term. The baby weighs just 500 grams. With full intensive care approximately 50% of these babies will survive, but many will have long-term developmental problems.”

    now to go shopping and argue that i have approximatley paid them the required amount.

  8. Ephiny said,

    October 27, 2007 at 10:40 am

    I agree that survival of premature babies is a red herring when it comes to women’s reproductive rights; it is an entirely separate issue in my view. But if the anti-choice crowd are misrepresenting the statistics, or even just lying, to bolster their position, then that needs to be countered.

  9. Gimpy said,

    October 27, 2007 at 11:59 am

    igb: I agree with you that support for abortion is primarily an ideological argument over the rights of a woman vs those of a foetus. However, I find it interesting that both sides of the debate are becoming keen to invoke science in support of their argument. All the science in the world won’t change the fact that the alternatives to legal abortion are even more unpalatable. The fuss over term limits seems to me like the anti-abortion crowd seeking an opening to restrict abortions that lacks an ideological basis. While science can inform ideological decisions it cannot make them yet attempts are now being made to use it in arguments instead of ideology. This probably applies to both sides, I notice the pro-abortion Guardian are running Ben’s column in CiF today despite normally not doing so. This seems a cynical attempt to get comments on an article which is ostensibly contentious given their title of “Some numbers in abortion debate just can’t be relied on” compared to Ben’s more benign choice. I notice that Ben hasn’t expressed an ideological opinion, he has merely highlighted the misuse of statistics in pursuing an agenda. While interesting and informative I don’t see how it merits special treatment from The Guardian as it will have no effect on ideological positions. Unless of course The Guardian are using science to make a point in a wider ideological debate. Which I find a little cynical.

    Maybe I’m just bitter that last weeks far more contentious and important column on dodgy legal shenanigans wasn’t open to discussion in The Guardian.

  10. simongates said,

    October 27, 2007 at 8:00 pm

    Another point that hasn’t made much headway is the uncertainty around the “46%” estimate due to the small sample size (only 13 babies). By my calculation the 95% confidence interval around this is 23% to 71% i.e. it would be quite easy to get 6/13 survivals to 1 year by chance if the real underlying survival rate was not much over 20%.

  11. simongates said,

    October 27, 2007 at 8:03 pm

    …and a small study from one centre could be susceptible to all sorts of bias and non-representativeness. You need a big national study to give a precise answer that is likely to be widely applicable… oh hang on, that’s Epicure.

  12. emmer said,

    October 27, 2007 at 9:32 pm

    All the media links in Ben’s article (Independent/Telegraph/Channel 4) do mention the Epicure study. It is only the Telegraph that portrays the two studies as conflicting – the headline is “scientists clash…” The Independent interprets Wyatt’s very different results as suggesting that viability may be far more likely when babies are born at specialist centres – not that the Epicure figures are contestable.

  13. Sili said,

    October 27, 2007 at 10:05 pm

    Not to detract from the column, which I liked, but a slight typo/braino:

    “In the sum 3/20, 3 is the numerator and 20 is the denominator …”

    That should be “fraction” not “sum”.

    Thanks for the enlightenment. I was put off by the mini-blogs link to the crazed lady in the Daily Hate. Glad to see some light shed on the issue.

  14. Robert Carnegie said,

    October 28, 2007 at 12:58 am

    He’s got more evidence than Andrew Wakefield had – that was only twelve kids, if I’ve got it right.

  15. fraedrill said,

    October 28, 2007 at 5:31 am

    i think it is wonderful that fetuses exposed to life so early can survive. it is probably one of the fundamental questions of humanity as to when a fetus becomes a human being and one that will never be settled to everyone’s satisfaction. i am an atheist, though not a militant one (although i don’t think any prominent atheists are militant). ultimately, i imagine that, in the unbounded expanse of influences toward the survival of a particular embryo, i must arbitrarily assign most weight to the mother. This is said because there is a lack of ultimate responsibility. One might say I am flapping, but there genuinely is an absence of superpower who tells me I am right – In this absence, all that remains is the mother – – AND HER RIGHTS – – if to abort is to preserve the rights of the mother, then I say I agree with that decision.

  16. coatgal said,

    October 28, 2007 at 9:26 am

    Prominent militant athiest = Richard Dawkins

    On another note, I wonder whether the demonisation of abortion is what stops many women seeking an abortion early on… in which case, those who claim their objections are not to abortion but to late abortion, but still side with those who stigmatise the whole practice as ‘evil’, may actually be – in part – the cause of the late abortions they claim to be against?

  17. emmer said,

    October 28, 2007 at 12:52 pm

    The memos make interesting reading. If you look on pages 11/12 there is an analysis of the factors that lead to women having late abortions. There usually seems to be a combination of reasons, but this quote is relevent to coatgal’s point: “There is also
    evidence that some referring doctors’ disapproval of abortion also causes delays (MSI 2005).
    Ingham et al. (2007) found this was important for very late abortion; a significant reason
    given by women who had had an abortion at 18+ weeks, as opposed to 13-17 weeks, was:
    ‘The person I first asked made it hard for me to get further appointments’”

    I appreciate this might not be the place to ask how the Government works, but I’m a little confused by the diversity of the written evidence in terms of the credibility and impartiality of the contributors. Who decides who gets to submit written evidence, and is the evidence checked for accuracy and relevence before it’s submitted to the select committee? Given that Wyatt’s “chaotic, non peer-reviewed” etc evidence got through, it doesn’t seem a very reliable sample.

  18. Dr T. fortunei said,

    October 28, 2007 at 1:09 pm

    I agree totally with earlier comments that survival rates of babies born at 20-24 weeks is something of a red herring. And there is another side effect of bolstering the apparent survival rates of those babies is one that hasn’t been touched on at all in this debate. How on earth are parents whose very much wanted babies are born prematurely supposed to make informed decisions about the care of their babies when these numbers are being bandied around? what makes me so angry that I can hardly type is that the debate is not about when and how you get a termination but why so many people who would restrict a woman’s right to choose would also restrict a woman’s right to contraception? there simply wouldn’t be that many unwanted pregancies if there was a more open attitude to sex education and contraception in this country…It’s a no-brainer.

  19. Robert Carnegie said,

    October 28, 2007 at 2:55 pm

    I wonder if members of the Christian Medical Fellowship elsewhere collected statistics from other hospitals that didn’t agree with their argument. Those would be ones that you don’t hear about. After all, you wouldn’t need to have many experimenters with a protocol design of tossing three coins in order to find one who concludes that coins always come up heads. And the numbers in the premature birth statistic aren’t much larger.

  20. RS said,

    October 28, 2007 at 8:16 pm

    Although I happen to believe that the survival rate of foetuses is irrelevant to the abortion debate there is a fairly diverse range of figures for 24 weeks and less survival.

    Some derived from all births, and some from PICU admissions – obviously the latter are higher. But you could probably mount an argument that the higher figures are more representative in the abortion debate (if you think they are relevant at all) because those babies which are actually born premature are generally much less well than those babies which make it to term (most babies) and thus the foetal death rate overestimates what it would be if, for some bizarre reason, you chose to c-section or induce them early.

  21. emmer said,

    October 28, 2007 at 8:58 pm

    I’ve been having visions of that too – women being unable to access abortion beyond an arbitrary period, but having the right to choose immediate induction/cesarian instead. Bonkers.

  22. Robert Carnegie said,

    October 29, 2007 at 1:28 am

    21: I dunno – are premature births often due to poor development in the womb, or sudden onset of difficulties interrupting the term of a previously healthy foetus? In the latter case, I imagine they are typical of any foetus at the same stage.

    Then again, multiple births – twins and so on – get a rough deal. Some do have problems as a result.

  23. MarkE said,

    October 29, 2007 at 1:34 pm

    8: The Select Committee is not a government body, but a parliamentary one. Anyone can send in evidence: there are details of how to do it on the parliamentary website, see, which gives the terms of reference of the inquiry.

  24. jodyaberdein said,

    October 29, 2007 at 8:21 pm

    Those interested in the aborting issue with regard to the health of women might consider fetching out the Lancet from October 13th 2007

  25. emmer said,

    October 29, 2007 at 8:33 pm

    24: Mark I can’t make your link work…

  26. pv said,

    October 30, 2007 at 1:23 am

    emmer said,

    October 29, 2007 at 8:33 pm

    24: Mark I can’t make your link work…

    Is this the one you want:

  27. clobbered said,

    October 30, 2007 at 8:10 am

    Re #10. It is clear to anybody living in the US that the pivot of the abortion debate is ideological, not practical or scientific.

    Although pro-choice, I do find the very high rates of abortion in the US disturbing; were I their president, my solution to this would be to have somebody stand at the school gates, church steps and social security offices handing out free contraception and sex ed materials to anybody even vaguely interested in it.

    Instead, the evangelical right prefer to preach abstinence (which demonstrably does not work), with the possibility of pregnancy/STD/cervical cancer as a threat to ensure compliance. This is not dissimilar with their approach to AIDS prevention in Africa (preach abstinence instead of distributing free condoms).

    Meanwhile, the liberal so-called-left does not want to espouse the “abortion is bad, let’s really try to tackle it” because they believe (correctly for all I know) that that position will undermine the slim legal margin that keeps abortion legal.

    So everybody in their right mind dislikes the idea of frequent abortions, abortion as contraception, late abortions etc. yet there is no political will to reduce their numbers in a way that does preserve the fundamental right to chose.

    Ironic, no?

  28. tomrees said,

    October 30, 2007 at 1:04 pm

    On a related note with regard to changing abortion law in the hope of keeping more babies alive – a pertinent study in the Lancet earlier this month showed that there are *fewer* abortions in countries where it is legal.

  29. RS said,

    October 30, 2007 at 1:33 pm

    Yeah, but that is driven largely by lower overall birth rates – probably because other forms of contraception are available and widely used.

    I think it would be quite a leap to assume that the study shows that abortion rates would go down if you legalised it in those countries where it is presently illegal.

  30. tomrees said,

    October 30, 2007 at 4:06 pm

    Yes – that’s precisely the point they make. Abortion rates are low because contraception is widely available.

    But it’s wrong to think the two aren’t linked. The religious mindset is in favour of making both abortion and contraception illegal. The consequence is that abortion is more frequent and more dangerous.

    In Western Europe, with more enlightened (i.e. less religious) attitudes towards sex and reproduction, abortion is less frequent and safer.

  31. emilypk said,

    November 2, 2007 at 8:13 pm

    A similar issue re: being aware of what a statistic really is based on–

  32. Squander Two said,

    November 6, 2007 at 2:42 pm

    While I agree with the reasoning that premature survival rates should be immaterial to the abortion issue, let’s be fair here: it wasn’t the pro-life crowd who brought them up in the first place. The discussion of survival rates has arisen as a response to the claim often made by the pro-choice crowd that foetuses at a certain stage of development can’t be considered to be human beings in their own right since they have no life independent of their mother. Obviously, the pro-life crowd don’t actually think that’s material: most of them believe that life begins at conception. But they’re doing what they can: aiming for the compromise to shift a little more in their direction in a democratic society in which a decent compromise is negotiated. Fair enough.

    I find it interesting when people claim that preaching abstinence doesn’t work — not because they’re necessarily wrong, but firstly because it’s a misrepresentation: no-one’s preaching abstinence except the papal hierarchy to its priests; what is preached by Christians and Jews to their followers is fidelity, a different thing entirely — and, after all, most abortions are not being carried out by happily married couples. And secondly because, even if preaching fidelity doesn’t work either, those who point this out never acknowledge that there might be any other preaching going on. The fact is that preaching fidelity is a minority pursuit in a society in which preaching promiscuity is popular and prevalent. Regarding it in isolation is ridiculous.

    To my mind, the question isn’t simply “Does preaching fidelity work?” but “To what extent does preaching fidelity work, and what factors increase or decrease its efficacy?”

  33. Robert Carnegie said,

    November 7, 2007 at 12:08 am

    Funny, I don’t think that schoolkids are being given fidelity rings to wear. You have to have a lavishly expensive church ceremony before you are allowed to practise fidelity. And… the survival or non-survival of the foetus is the whole point of termination. It wasn’t introduced as a debating point. It’s the fundamental question.

    Male genital mutilation turns out to be satisfyingly effective, if you accept the latest statistics from Africa. Of course the word “satisfying” stands out like a sore, ah, thumb.

  34. Squander Two said,

    November 7, 2007 at 4:56 pm

    No, they’re being given chastity rings to wear. Chastity and abstinence are not the same thing.

    And a marriage license costs about 50 quid. Any lavishly expensive ceremony is purely optional, as is having it in a church.

  35. Squander Two said,

    November 8, 2007 at 5:22 pm

    Robert, you appear to be arguing with something I haven’t said and don’t think. Either that, or you think that the only people who ever preach chastity or fidelity are in religious organisations and do so for religious reasons. (Though I might add that, though the wedding ceremony itself isn’t optional to the church, making it lavishly expensive certainly is.)

    All I suggested was that it is grossly simplistic to say simply “Preaching chastity doesn’t work.” That preaching does not exist in a vacuum; it is one of many competing ideals being preached at us.

    For the record, I’m a staunch atheist who have always honoured my marriage vows and have every intention of continuing to do so, and have zero unwanted children and zero STDs. The suggested ideal (aka “preaching”) of fidelity seems to have worked on me, at least — which is why I think claims that it Doesn’t Work Full Stop are missing something.

  36. Robert Carnegie said,

    November 9, 2007 at 1:05 am

    “Preaching” is a particular profession and isn’t secular. And I certainly presumed that we were discussing people who say “…and no you can’t have any condoms”. As a missionary programme it is your own money you’re spending and you can amuse yourself any way that you want – well, your own and, usually, the American household taxpayer’s – but as -effective- disease control it stinks. Good heavens, look at all the things that rich Westerners do that are bad for their health and will probably kill them; eat red meat and too much chocolate, drink alcohol. And you don’t need religion to put across the message that an agent of disease is produced in the bodies of people suffering the disease and is shared by body-to-body contact, that contact with an infected person is risky, that contact with fewer people – as well as following safer sex practice – reduces risk of receiving the infection unawares yourself.

  37. Squander Two said,

    November 9, 2007 at 12:36 pm

    > “Preaching” is a particular profession and isn’t secular.

    That’ll be news to anyone who’s ever met a communist.

    But let’s not get bogged down in semantics. In my experience, when people say that preaching chastity doesn’t work, their objection is not that the advice would be perfectly good if only it weren’t coming from a religion, and they tend not to back the same advice if it comes from non-religious organisations. Call it something other than “preaching”, if you like.

    > And I certainly presumed that we were discussing people who say “…and no you can’t have any condoms”.

    Why? (And isn’t that another mischaracterisation? I think there’s a significant difference between “can’t have” and “shouldn’t use”.)

    By the way, though I admit I did mention in passing my lack of disease, this thread is about unwanted pregnancies. Disease prevention is not a common reason for abortions. Again, I think you’re arguing with something I haven’t said.

  38. Robert Carnegie said,

    November 11, 2007 at 1:53 am

    Hmm, okay rewind – what organisations are we talking about? If it’s religious teaching applied to family planning and sexual health (in the Third World and America for instance) then I think I win the Internet today. If it’s rationalist, humanist or Spiritualist groups with the same argument (and without a racially selective angle), then I guess I lose.

    What I think the message should be, if we’re not also donating to pharmacies, is like Tom Lehrer’s proposed theme song for [Oedipus Rex]: you shouldn’t love too much.

  39. Squander Two said,

    November 11, 2007 at 4:01 pm

    I wasn’t talking about any organisations. I was simply responding to the oft-repeated claim that telling people not to have loads of promiscuous premarital sex does not and cannot work.

  40. Robert Carnegie said,

    November 14, 2007 at 1:04 am

    Well, missionaries usually have someone back home paying their expenses – that counts as organisation.

    And they’ve been at it in Africa for hundreds of years. And Africans have been at it for hundreds of years as well. If the threat of the eternal fires of hell didn’t persuade you that the missionary position was right, the prospect of mere earthly sickness isn’t going to change minds either. Although of course, if you’re sceptically minded, you don’t see people literally going to hell, and you do see people dying of AIDS. (Unless you’re excessively sceptically minded.)

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