The Mayonnaise Jar and the Coffee - a useful illustration if your life feels over-full

I used one version of this time-honoured illustration when speaking at the NCMDA Conference in Abuja, Nigeria this week - and then found someone quite independently had emailed me another version of it whilst I was away.

Well I guess we can't get too much of a good thing so I have re-posted it here with acknowledgement to Lifeline Aoteoroa, the crisis telephone helpline (like the UK's Samaritans) I used to do counselling sessions for when I was a medical student in New Zealand back in the 1980s.

When things in your life seem almost too much to handle, when 24 hours in a day are not enough, remember the mayonnaise jar..and the coffee..

A professor stood before his philosophy class and had some items in front of him.

When the class began, wordlessly, he picked up a very large and empty mayonnaise jar and proceeded to fill it with golf balls He then asked the students if the jar was full.

They agreed that it was.

The professor then picked up a box of pebbles and poured them into the jar. He shook the jar lightly. The pebbles rolled into the open areas between the golf balls. He then asked the students again if the jar was full.

They agreed it was.

The professor next picked up a box of sand and poured it into the jar. Of course, the sand filled up everything else. He asked once more if the jar was full.

The students responded with a resounding 'yes'. The professor then produced two cups of coffee from under the table and poured the entire contents into the jar, effectively filling the empty space between the sand

The students laughed.

'Now,' said the professor, as the laughter subsided, 'I want you to recognize that this jar represents your life.

The golf balls are the important things-your family, your children, your faith, your health, your friends, and your favourite passions-things that if everything else was lost and only they remained, your life would still be full.

The pebbles are the other things that matter like your job, your house, And your car.

The sand is everything else-the small stuff.

If you put the sand into the jar first,' he continued, 'there is no room for the pebbles or the golf balls.

The same goes for life. If you spend all your time and energy on the small stuff, you will never have room for the things that are important to you. Pay attention to the things that are critical to your happiness. Play with your children.Take time to get medical checkups. Take your partner out to dinner. Play another round of golf. There will always be time to clean the house and fix the disposal.'

Take care of the golf balls first, the things that really matter.Set your priorities. The rest is just sand.'

One of the students raised her hand and inquired what the coffee represented.

The professor smiled.

'I'm glad you asked. It just goes to show you that no matter how full your life may seem, there's always room for a couple of cups of coffee with a friend!'

Open letter to David Cameron about lack of transparency, bias and undue haste of RCOG abortion consultation

Dear David,

I am writing to express serious concern about the lack of transparency and undue haste surrounding the process by which the RCOG guideline ‘The care of women requesting induced abortion’ is currently being revised.

This RCOG guideline, which provides the basis for the ‘evidence-based counselling’ of women with crisis pregnancies was first published in 2000. An updated version followed in 2004 and that guideline served until this latest revision which took place during 2010.

This latest revision was prompted mainly by a recommendation of the House of Commons Science and Technology Committee which in 2007 had considered Scientific Developments relating to the Abortion Act 1967.

The latest revision (see draft) has been undertaken by a ‘multi-professional group’ which claims to be ‘supported by the Department of Health’. The group, as before, consists of representatives from the RCOG, the RCOG’s Faculty of Sexual and Reproductive Health (FSRH), the Royal College of General Practitioners (RCGP),and the abortion industry (namely the two largest abortion providers BPAS and Marie Stopes International).

The issues covered in the guideline are deeply controversial, are frequently in the news and have been the subject of recent debate in both Houses when the Human Fertilisation and Embryology Bill was under consideration in 2008.

The draft guideline as it stands draws a number of conclusions about fetal awareness, conscientious objection and long-term health risks of abortion (especially with respect to pre-term birth, mental illness and breast cancer) which I believe are inaccurate or over-simplified and are open to serious challenge on the basis of clinical and other evidence.

It also appears from p8 of the draft guideline that the RCOG may be intending to use it to put pressure on the government to liberalise the abortion law by regulation as opposed to by statute with respect to ‘home abortion’. This was made doubly clear by statements made by the British Pregnancy Advisory Service (BPAS) following their court defeat over ‘home abortion’ on Monday and is the tenor of a recent article by Zoe Williams in the Guardian.

It is therefore imperative that we get this right and do not rush it.

I have four main concerns about the process of consultation:

1.The lack of time available for consultation

According to the RCOG the draft guideline was posted on the RCOG website on 21 January. The deadline for responses is tomorrow18 February, leaving just 20 working days for stakeholders to make submissions. Following an intervention from your government after a parliamentary question by Nadine Dorries MP the RCOG have now agreed to accept submissions up until 25 February.

My understanding, based on enquiries amongst fellow MPs, leaders of stakeholder organisations, members and fellows of the Royal College and writers and researchers whose work is referred to in the document itself, is that very few people apart from those with a close connection to the abortion industry were aware of the consultation or the current peer review process.

Most now have very little opportunity to make a meaningful response by the deadline. In order to challenge the conclusions of the guideline before they are set in stone stakeholders require more time.

The Government Code of Practice on Consultation gives seven criteria that should be reproduced in consultation documents.

The first four of these do not appear to have been followed in this case. Specifically:

1. Formal consultation should take place at a stage when there is scope to influence the policy outcome.
2. Consultations should normally last for at least 12 weeks with consideration given to longer timescales where feasible and sensible.
3. Consultation documents should be clear about the consultation process, what is being proposed, the scope to influence and the expected costs and benefits of the proposals.
4. Consultation exercises should be designed to be accessible to, and clearly targeted at, those people the exercise is intended to reach.

2.Lack of transparency in the consultation process

This consultation appears to have been conducted in a way that gives stakeholders and peer reviewers little or no opportunity to influence the outcome in any meaningful way and I note that BPAS, one of the groups represented in the drafting group is already quoting the guidelines in the national press in a way that implies they have been finalised.

It seems also that the peer review process has been largely conducted as an ‘inside job’ with those on the committee contacting colleagues who most likely share similar views and would support their conclusions.

I note from the draft document (p12) that members of the drafting group itself, along with the DH and RCOG, suggested peer reviewers to consult and that the draft was also posted on the RCOG website and comments invited from ‘any member or fellow’.

The RCOG has been asked the following questions but so far no answers have been forthcoming:

1.Which individuals and organisations were formally notified about the consultation and when and how were they notified?
2.Which individuals were suggested by the DH and RCOG as perr reviewers and how and when were they notified?
3.How and when were fellows and members of the RCOG notified about the consultation other than by the document being placed on the College website?

3.Failure to consult with the Royal College of Psychiatrists

The Royal College of Psychiatrists in their Position statement on women's mental health in relation to induced abortion (14 March 2008) has indicated that there are significant mental health consequences of abortion for some women and is currently carrying out a major review of the literature which I believe is due to be completed this Spring. The guideline pre-empts this.

The RCPSych have also called for other colleges and professional bodies to incorporate this evidence into any guidelines for women considering abortion. This appears to be ignored by the RCOG guideline which fails to mention much of the recent evidence in this area, makes no reference to the RCPsych review or position paper and places an overreliance on a highly criticised review from the American Psychological Association.

4. Unbalance of the committee

The committee which has put the guideline together seems to be considerably unbalanced containing a significant number of people who might be said to have ideological and financial interests in abortion.

Of the 18 members I understand that eleven are identifiable as ‘pro-choice’ – most notably the representatives from Marie Stopes International and BPAS - two are members of the Department of Health, four are difficult to categorise, and one is a celebrity media doctor. A significant number of them receive payment for their involvement in abortion provision. There is notably no one with qualifications in mental health and no one from any group working to restrict abortion.

Committee members are as follows:

Professor Anna Glasier FRCOG (Chair), University of Edinburgh, RCOG nominee
Ms Toni Belfield, RCOG Consumers‟ Forum representative
Dr Sharon Cameron MRCOG, University of Edinburgh, RCOG nominee
Ms Joanne Fletcher, Royal College of Nursing nominee
Dr Katharine A Guthrie FRCOG, Faculty of Sexual and Reproductive Health Care nominee
Dr Sarah Jarvis, Royal College of General Practitioners nominee
Dr Patricia Lohr, British Pregnancy Advisory Service nominee
Ms Fiona Loveless, Marie Stopes International nominee
Dr Tahir Mahmood FRCOG, ex Vice President Standards
Dr Susan Mann, University College London, RCOG nominee
Dr R Kristina A Naidoo MRCOG, St Mary‟s Hospital, Manchester, RCOG nominee
Mr Kamal N Ojha MRCOG, St George‟s Hospital, London, RCOG nominee
Dr Kate Paterson, St Mary‟s Hospital, London, RCOG nominee
Dr Alison Richardson, Torbay Hospital, Torquay, RCOG nominee
Ms Jackie Routledge, North Lancashire PCT
Professor Allan Templeton FRCOG, University of Aberdeen, RCOG nominee
Ms Claudette Thompson, Department of Health
Ms Lisa Westall, Department of Health

Conclusions

These issues of process – a rushed consultation, lack of transparency, lack of wide consultation and unbalanced committee are very serious indeed and potentially a matter of huge potential embarrassment to the government at a time when we are trying to restore faith in official and parliamentary processes.

I would urge you as Prime Minister to request that:

1.The consultation period is lengthened to twelve weeks in accordance with the Government Code of Practice.
2.All RCOG College members and stakeholder individuals and organisations to be formally notified and invited to respond.
3.A full review of the committee membership be carried out focussing on their ideological and financial vested interests in abortion and in particular how much money each earns from abortion provision and that this information be made public.
4.An explanation be given as to why the Royal College of Psychiatrists has not been consulted in this review process nor their position even documented.
5.An explanation be given as to why no members of any groups ideologically opposed to abortion are represented on the committee or formally consulted.
6.An enquiry be carried out about the role of the main abortion providers and recipients of taxpayers money in this process (BPAS and MSI)
7.A full explanation be required form the RCOG with answers to the three questions posed under my second point above.

I would reiterate that I am most concerned about the lack of transparency in this consultation process and urge you to take steps to ensure that this clinical guideline undergoes proper peer review and that all stakeholders have an opportunity to contribute to the consultation.

I look forward to hearing from you at your very earliest convenience.

Yours sincerely

Peter Saunders

Philip Nitschke is back in the British Isles but is not finding a warm reception for his ‘how to commit suicide’ seminars

The Australian assisted suicide enthusiast Philip Nitschke (aka Dr Death), of Exit International, is again visiting the British Isles but his tour is not going at all well. Thus far two of his five meetings have been cancelled whilst protesters outnumbered attendees at a third.

His workshop on how to commit suicide, scheduled for the Sovereign Harbour Yacht Club in Eastbourne, East Sussex on 21 February was canceled by the club. A spokesman said that management had not realized the ‘significance’ of the event and wanted to avoid the publicity of ‘something this controversial.’

A second event, due to be held at the Community Arts Forum in Belfast on 19 February was also cancelled after it was learnt that Nitschke planned to demonstrate his new ‘deliverance voluntary euthanasia machine’. Centre representative Heather Floyd said the centre was ‘not suitable for something of this nature’.

He had, a few days before, been detained at Heathrow airport when the said machine was discovered in his luggage.

Nitschke’s controversial visit to Ireland last week also proved to be anti-climactic after only a handful of people turned out for his Dublin suicide workshop, over half of whom were journalists. The Australian had attempted to vet attendees of the lecture, but had so few takers that he eventually decided to open the venue to anyone.

Even so, according to Niamh Uí Bhriain of the Dublin-based Life Institute, only 20 people attended, 12 of whom were with the press. During the lecture, over 50 people demonstrated outside, carrying signs reading ‘Suicide “workshop” illegal and sick,’ and ‘Lock up your grannies, Dr. Death is here.’

Prior to the event she had written to Dublin’s Garda (police) Commissioner saying that the workshop contravened Ireland’s criminal code prohibition against counseling suicide, and asking that it be shut down.

Typically, Nitschke’s suicide workshops include information on how to commit suicide, for which he recommends the drug Nembutal. He has admitted that his organization, Exit International, has given information on how to obtain the drug from Mexico even to young people who have stated their intention to commit suicide. Nitschke is the inventor of the ‘exit bag,’ a plastic bag that he says can be fitted over a person’s head to suffocate them after taking the drugs.

The demonstration, which was supported by the Life Institute, was organized by Maria Mhic Meanmain whose elderly parents both died following debilitating illnesses. Mhic Meanmain said that Nitschke was ‘normalizing suicide, and bringing about a situation where elderly and sick people would feel they had a duty to die.’

Niamh Uí Bhriain said, ‘We’re losing more than 600 people a year due to suicide, and every case is a tragedy which leaves families devastated,’ she said. ‘Nitschke’s reckless and dangerous promotion of suicide will lead directly to the death of people in this country.’

Nitschke has only two remaining meetings scheduled, in Cardiff and London, on 24 and 26 February respectively.

His ‘workshops’ in the UK may now well be in breach of the Suicide Act, which after amendment in 2009, now makes ‘encouraging or assisting’ suicide a criminal offence.

In a 2001 interview on ‘National Review Online’ Nitschke was asked who would qualify for access to the ‘suicide pill’. He replied that ‘all people qualify, not just those with the training, knowledge or resources to find out how to “give away” their life and someone needs to provide this knowledge training or resource necessary to anyone who wants it, including the depressed, the elderly, bereaved, the troubled teen’.

In the same article Nitschke said that the so-called peaceful pill should be ‘available in the supermarket so that those old enough to understand death could obtain death peacefully at the time of their choosing’.

Philip Nitschke is an extremist and self-publicist who has not surprisingly courted huge controversy.

His visit is a timely reminder of the dangers of any change in the law to make assisted suicide more readily available.

A third of NHS trusts still offer homeopathy despite there being no scientific evidence for its effectiveness. Some Christian reflections.

I was a little surprised to read on the BBC website today that a third of NHS trusts still fund homeopathy despite repeated calls for them to stop.

GP magazine obtained data from two thirds of primary care trusts, showing 31% were paying for patients to use the highly-diluted remedies.

This news comes after doctors and the House of Commons' Health Committee called for NHS funding of homeopathy to end. However, the government has said it is up to local trusts to decide.

Previous estimates have put NHS spending on the treatment at £4m a year - this pays for four dedicated homeopathic hospitals and prescriptions. Given that there is no scientific evidence that homeopathy actually works this raises serious questions about whether, in a time of economic restraint, the money might not be better spent elsewhere.

Two years ago, one of the country's leading professors of complementary medicine’ offered a cash prize to anyone who could prove that homeopathy actually works.

Professor Edzard Ernst said he would award £10,000 to the first person who could show the controversial treatment is better than a placebo in a scientifically controlled trial.

The prize to this day remains unclaimed.

In an article in the Guardian this time last year, ‘No to homeopathy placebo’, he spelt out his objections in more detail.

'The first thing any critical mind has to note is that the two basic assumptions of homeopathy fly in the face of science. Like does not cure like and diluting remedies ad infinitum does not render them stronger but weaker. But perhaps there was something entirely new and undiscovered here, the stuff of Nobel prizes that revolutionises our understanding of nature?

The acid test, I thought, was whether homeopathic remedies behave differently from placebos when submitted to clinical trials. So we conducted several trials and published many summaries of the studies done worldwide. The results were sobering. Today there are about 200 clinical trials and the totality of this evidence fails to show that homeopathic remedies work.

But apart from the lack of scientific evidence for its efficacy, are there any other specifically Christian objections to its use?

In a 2003 review for Triple Helix, George Smith, after reviewing the scientific evidence raised reservations from a Christian perspective:

‘Can we, with integrity, prescribe a medicine that does not contain one molecule of effective remedy? Is it good practice to prescribe remedies that have been investigated without producing any consistent evidence of efficacy? Is it responsible to delay or withhold orthodox proven medical treatment whilst relying on an unproven alternative remedy? Is it acceptable to use a therapy that relies on the principle of vital force, clearly comparable with the Ch'i (yin and yang) of Eastern religions and the cosmic energy of New Age philosophies? Should we use a therapy that some practitioners mix with divination, astrology and pendulum swinging, which are clearly forbidden in the Bible?’

How should we assess alternative medicines like homeopathy? The following is a quick check list which I have found useful and enlarge upon in an overview previously published in Nucleus

1. Do the claims fit the facts?
The biblical injunction to ‘enquire, probe and investigate thoroughly’ (Dt 13:14ff) must surely be relevant here. We should always ask, ‘What is the evidence that this therapy really works?’

2. Is there a rational scientific basis?
We know how most orthodox drugs work. They may stimulate receptors (eg b agonists in asthma), modify cell transport (eg probenecid), block enzymes (eg allopurinol), replace missing compounds (eg vitamin B12) or chelate toxins (eg penicillamine). The action of any given drug is determined by its concentration at the site of action; and the actions are understandable in view of their known biochemical and physiological effects. By contrast the majority of alternative medicines have no rational scientific basis.

3. Is it the improvement due to the therapy or some other factor?
Transcendental Meditation lowers blood pressure, but why? Is it because it enables the Goddess Kundalini to migrate up the spine and unite with Brahman in the head (as Hindus believe); or is it simply that meditation induces relaxation and reduces the sympathetic output that raises blood pressure?

4. What is the worldview behind it?
What is the worldview behind the therapy? Yoga has its roots in Hinduism and therapeutic touch in New Age ideology. This alone should make us suspicious.

5. Does it involve the occult?
Are occult means of divination used in deciding on diagnosis or treatment? We should heed the biblical warnings about Mediums and Spiritists (Lv 9:31, 20:6; Acts 16:16-21), Astrology (Is 47:13-15), Magic Charms(Ezk 13:20-23), Diviner’s Wands (Ho 4:12),Sorcery (Acts 19:19), Witchcraft (Gal 5:20), Magic Arts (Rev 9:21, 21:8, 22:15) and the Occult(Dt 18:10-12) generally.

6. Is it medically safe?
Most alternative therapies have little in the way of side effects, but there are exceptions. Acupuncture, for example, may cause pneumothaorax or transmit infection. Chiropractic neck manipulation has been associated with vertebral artery obstruction and some herbal therapies result in toxicity or even death. But perhaps the greatest danger is that alternative therapies can create a false sense of security which leads to delay in diagnosis or in implementation of effective orthodox medicine.

7. Has it stood the test of time?
This is not an acid test – some bad things stand the test of time – but if something doesn’t then it is unlikely there is much in it. And perhaps that is the big question about homoepathy. Given all those dilutions, is there actually anything in it?

Latest developments in RCOG abortion guideline saga and my letter to the College President along with reply

Today we learnt, in response (pasted below) to a Parliamentary question by Nadine Dorries MP (pictured), that we have another week until 25 February to make submissions to the RCOG consultation on the new draft abortion guideline ‘The care of women requesting induced abortion’.

This is a tiny concession which does not address any of the concerns that have been expressed about transparency and process but at least it may help some to contribute who would otherwise not have been able to.

Record from Hansard

Nadine Dorries (Mid Bedfordshire) (Con): May we have a debate to discuss the relationship between the Royal College of Obstetricians and Gynaecologists and the Department of Health? I ask specifically for this because two members of staff from the Department are sitting on a working group looking into the emotive issue of the care of women during abortion, and if the findings of that group are to be credible, its manner of operations should be above reproach. It is not adhering to Government guidelines on consultation, and that is causing huge concern.

Sir George Young: I understand my hon. Friend’s deep concern on the subject, which she has made one of her special interests. My understanding is that the Royal College of Obstetricians and Gynaecologists is a professional body which is independent of Government, and it has set its own consultation periods. There is a consultation period of four weeks—as is standard for the college—and it ends tomorrow, although any responses received by 25 February will be accepted. However, I will, of course, pass on her comments to my right hon. Friend the Secretary of State for Health.

My letter to RCOG President Anne Martin

I wrote to the RCOG President Anne Martin and to Health Secretary Andrew Lansley today to complain about the undue haste and lack of transparency in the consultation on new abortion guidelines. I have pasted my letter to the RCOG along with the replies I received from the RCOG Director of Standards Mrs Charnjit Dhillon and the Department of Health. Perhaps not surprisingly the former has not answered any of my questions and seems not to know about the new deadline for submissions confirmed by the Departmnet of Health.

Dear Anne,

It has only just been drawn to my attention that the RCOG is conducting a consultation on the draft submission of the 2011 revision of ‘The care of women requesting induced abortion’.

This document has apparently been produced by a ‘multi-professional group’ ‘supported by the Department of Health.

I understand that the draft document was posted on the RCOG website on 21 January and that the deadline for responses is 18 February, leaving barely 21 working days for stakeholders to make submissions.

My initial enquiries amongst colleagues, including leaders of stakeholder organisations, members and fellows of the College and writers and researchers whose work is referred to in the document itself, have revealed that very few people were aware of the consultation or the peer review process. Most now have very little opportunity to make a meaningful response by the deadline.

As I’m sure you are aware the Government Code of Practice on Consultation gives seven criteria that should be reproduced in consultation documents.

The first four of these do not appear to have been followed in this case. Specifically:

1. Formal consultation should take place at a stage when there is scope to influence the policy outcome.
2. Consultations should normally last for at least 12 weeks with consideration given to longer timescales where feasible and sensible.
3. Consultation documents should be clear about the consultation process, what is being proposed, the scope to influence and the expected costs and benefits of the proposals.
4. Consultation exercises should be designed to be accessible to, and clearly targeted at, those people the exercise is intended to reach.

Instead this consultation appears to have been conducted in a way that gives stakeholders and peer reviewers little or no opportunity to influence the outcome in any meaningful way and I note that BPAS, one of the organisations represented in the drafting group, is already quoting the guidelines in the national press in a way that implies they have been finalised.

I note from the draft document (p12) that members of the drafting group itself, along with the DH and RCOG, suggested peer reviewers to consult and that the draft was also posted on the RCOG website and comments invited from ‘any member or fellow’.

I wonder if you could answer for me the following questions:

1.Which individuals and organisations were formally notified about the consultation and when and how were they notified?
2.Which individuals were suggested by the DH and RCOG and how and when were they notified?
3.How and when were fellows and members of the RCOG notified about the consultation other than by the document being placed on the College website?

I would also like formally to request that:

1.The consultation period should be lengthened to twelve week is accordance with the Government Code of Practice.
2.All RCOG College members and stakeholder individuals and organisations should be formally notified.

I am most concerned about the lack of transparency in this consultation process and look forward to hearing from you at your very earliest convenience.

Yours sincerely

Peter Saunders
Chief Executive, Christian Medical Fellowship

Reply from RCOG Director of Standards, Mrs Charnjit Dhillon

Dear Mr Saunders

Thank you for your e-mail about the consultation on our draft guideline The Care of women requesting induced abortion.

I should first say that this is not a consultation on a Department of Health policy document. This is a peer review process for an RCOG clinical guideline, and as such, it follows long-established RCOG procedures (also used for the two previous versions of this particular guideline).

Having said that, please do feel free to comment on individual recommendations as appropriate, even if it is a few days after 18 February 2011.

Yours sincerely

Mrs Charnjit Dhillon
Director of Standards
Royal College of Obstetricians and Gynaecologists
27 Sussex Place, Regent's Park
LONDON NW1 4RG

Reply from Department of Health confirming new deadline

Dear Mr Saunders,

Thank you for your email of 16 February to Andrew Lansley about the Royal College of Obstreticians and Gynaecologists' (RCOG's) consultation on the guidance, 'The care of women requesting induced abortion'. I have been asked to reply.

RCOG is a professional body independent of Governement and therefore they set their own consultation periods. The Department of Health understands that a consultation process of four weeks is standard practice for College.

I have been advised by Department of Health officials that although the consultation for these guidelines formally ended today (18 February), any responses received by 25 February will be accepted.

I hope this reply is helpful.

Yours sincerely,

Joe Laking
Customer Service Centre
Department of Health

New RCOG draft guidance on abortion perpetuates myth that abortion has few physical or psychological consequences for women

I never cease to be amazed by the accelerating rate at which new government and other official ‘consultations’ on important matters of public policy are appearing.

The faster they come, the less they are publicised and the shorter the deadlines – meaning that it is less and less possible to make an intelligent response within the specified time frame.

Is this some kind of plot to wave through controversial policy quietly whilst appearing take notice of stakeholders’ opinions? That is certainly the impression created.

The latest consultation to come to my attention (and I cannot believe how I missed this until now) is from the RCOG (Royal College of Obstetricians and Gynaecologists) which is revising its controversial document ‘The Care of Women Requesting Induced Abortion’

This RCOG guideline, which provides the basis for the supposed ‘evidence-based counselling’ of women with crisis pregnancies was first published in 2000. An updated version followed in 2004 and that guideline served until this latest revision which took place during 2010.

This latest revision was prompted mainly by a recommendation of the House of Commons Science and Technology Committee which in 2007 had considered Scientific Developments relating to the Abortion Act 1967.

The latest revision (see draft) has been undertaken by a ‘multi-professional group’ which, as before, consists of representatives from the RCOG, the RCOG’s Faculty of Sexual and Reproductive Health (FSRH), the Royal College of General Practitioners (RCGP),and the abortion industry (namely the two largest abortion providers BPAS and Marie Stopes International). The participants are almost exclusively ‘pro-choice’.

There are, as before, no psychiatrists on the panel, which is rather odd given that the Royal College of Psychiatrists has recently changed its position on the link between abortion and mental illness (it now acknowledges one) and is presently in the process of reviewing the scientific literature again.

The RCOG has been heavily criticized in the past for underplaying the physical and psychological consequences of abortion for women and this new document appears to continue in that vein.

Among the draft document’s recommendations are the following: Women should be informed that induced abortion is not associated with an increase in breast cancer; Women should be informed that there are no proven associations between induced abortion and subsequent ectopic pregnancy, placenta praevia or infertility; Women should be informed that induced abortion is associated with a small increase in risk of subsequent preterm birth, which increases with the number of abortions; Women should be informed that most women who have abortions do not experience adverse psychological sequelae.

These areas are all hugely controversial – see our own CMF review of the literature.

The closing date for submissions is February 18th. Details here.

There is more information about the consultation document(s) on the RCOG website.

I also received this morning from AAPLOG an update on the scientific evidence for the link between abortion and preterm birth – a connection which has been constantly underplayed by the RCOG. The new draft continues this misreporting.

The AAPLOG report reads as follows:

One of the most egregious educational omissions from current medical education/residency program, or just plain from the American medical literature in general, is the association of induced abortion with subsequent preterm birth. It is a kind of ‘denial by silence’.

There are at least 119 articles in the world literature attesting to this association, and very few indeed that contest the association. (see review) And even the admission of the association is trivialized. Iams, a MFM Professor from Ohio State, allows that abortion is followed by ‘a very small but apparently real increase in the risk of subsequent spontaneous preterm birth (PTB)’.

‘Apparently real’ is an interesting way to say ‘119 studies, and all of the recent major studies’. Do we believe in evidence based medicine? ‘Very small’ - (and here Iams references the 2009 BJOG Shaw study that found a 36% increase in PTB subsequent to abortion)—how big is ‘very small?’ With nearly any other serious complication, a 36% increase with one exposure (in this case, to abortion) would be extremely significant. Not so, here. Rather, it is a ‘very small’ association.

And-same Shaw study- women with more than one prior abortion raised their 'preemie' delivery risk by 93% - a HUGE increase (almost double the 'preemie' risk when compared to women with zero prior abortions). See our analysis of Iams article

We see here an example of a new principle, the ‘abortion distortion’. In legal, and medical, and societal, and governmental arenas-(as in ‘Philadelphia Dept of Public Health’)-, the rules and standards change when the topic is abortion. Overwhelming medical evidence becomes ‘apparently real’, a 36% increase becomes a ‘very small’ increase, Philadelphia public health department responsibilities to women's health become a joke. Worse. An unspeakable travesty.

I do hope that the RCOG will be challenged about the scientific bias in its draft guidance and consider a further revision in the light of new evidence, but on the basis of its past performance I am not holding my breath.

Asking this group to comment objectively and honestly about the physical and psychological consequences of abortion for women is like asking Philip Morris or BAT to review the health consequences of smoking or Macdonald’s to outline the adverse effects of fast food consumption. There are simply too many financial and ideological vested interests at stake that threaten a fair assessment.

I have just read in the draft guidance that ‘All members of the Group made formal declarations of interest and this record is kept on file. The College was of the opinion that in each case the interests declared did not conflict with the guideline development process.’

I guess that is meant to reassure us. But in reality this group is as unbalanced as the discredited Falconer Commission on so-called ‘assisted dying’.

Home Secretary Theresa May under pressure to apologise to Dr Hans-Christian Raabe after embarrassing disclosure

The Home Secretary Theresa May (pictured) is coming under pressure from a variety of sources to offer an apology to Dr Hans-Christian Raabe.

Raabe, a Manchester GP, was sacked by the Home Office from the Advisory Council on the Misuse of Drugs (ACMD) last Monday for failing to declare that he had co-authored a paper in 2005 suggesting that there was an association between homosexuality and paedophilia.

As I reported in my last blog there are actually a significant number of articles in peer-reviewed journals supporting Dr Raabe’s view and one of these papers was even cited approvingly in a Home Office document in 1998.

In other words Dr Raabe was sacked from the ACMD by the Home Office for expressing a view that the Home Office has itself expressed.

In yesterday’s Mail on Sunday columnist Peter Hitchens launched an attack on the Home Office, citing the sacking as an example of ‘a militant and highly intolerant political correctness’ that is being expressed ‘from Downing Street downwards’.

He asked Home Office Minister James Brokenshire, the MP directly responsible for the sacking, why ‘being controversial’ was a sackable offence and exposed the hypocrisy of the dismissal in the starkest terms.

‘Who said these words? ‘Approximately 20 to 33 per cent of child sexual abuse is homosexual in nature.’ I will tell you. It was the Home Office, on Page 14 of Sex Offending Against Children: Understanding The Risk, published by the Policing and Reducing Crime Unit in 1998. I have a copy.

For saying roughly the same thing, Dr Hans-Christian Raabe has just been sacked – by the Home Office – from the Advisory Council on the Misuse of Drugs (ACMD). That’s right. He has been sacked from a body to do with drugs, for having unfashionable views about sex, views that the Home Office has itself espoused.

Hitchens also accused the government of caving in under pressure:

…a campaign to remove Dr Raabe, boosted by anonymous misty threats of resignations from the ACMD, roared rapidly into action. And… preferring political correctness to an honest, decent doctor worth dozens of any of them, this Government swiftly bowed to that campaign.

I note that the two people originally bringing Dr Raabe’s views to light – BBC Home Affairs Editor Mark Easton and former Liberal Democrat MP Evan Harris – have both now also criticised the Home Office for the sacking - in spite of playing a major role in fuelling the witch-hunt which led to it (for an account of the latter see Vlad's blog).

Dr Harris said: ‘No adviser should be dismissed purely for holding and expressing entirely lawful views on another subject, no matter how objectionable.’

And last week Mr Easton said: ‘You cannot simply sack somebody appointed to a government advisory body because he/she has strong religious views that are irrelevant to the job in hand. That would seem to be discriminatory.’

According to the Independent on Sunday Dr Raabe has said that he is considering taking legal action against the Home Office unless he receives an apology.

Adding to the furore, anti-drugs campaigners have called on the Home Secretary, Theresa May, to apologise for ‘an unjustifiable personal and professional attack by her ministry’.

David Raynes, from the National Drug Prevention Alliance, described Dr Raabe’s sacking as ‘a vicious and personal witch hunt orchestrated by pro-drugs campaigners’ and said ‘there remains a cabal of people on the committee who are sympathetic to the legalisation of all drugs. It can ill afford to lose people who act as a balance against this view’.

I previously expressed concern about the way four Conservative candidates were treated by the party leadership during the 2010 general election for expressing or holding views on homosexuality which, although shared by a significant number of British people, were, to a greater or lesser extent, out of harmony with current Conservative Party policy.

This latest incident gives further credence to the concern that those in public office are only now tolerated if they tow the line on this controversial issue – regardless of their personal convictions, religious beliefs or interpretation of the available scientific evidence – even if the views they hold have been previously endorsed by the Home Office itself.

This debate will not go away. I see that Melanie Phillips today in a piece on the government proposal to allow gay couples to marry in churches, makes further reference to Dr Raabe's case and highlights growing concerns about the present goverment pushing its new equalities agenda.

She concludes that 'the so-called "culture war" now raging between those determined to destroy Western moral codes and those struggling to defend them is simply the most urgent domestic issue we face' and identifies the impetus for these developments as coming from the Prime Minister himself.

Pinch yourself — a Conservative Prime Minister effectively endorsing the idea that upholding Biblical morality and the bedrock values of Western civilisation is bigotry. He may be a Conservative, but he is no conservative. True conservatives seek to conserve what is most precious in a society and defend it against those who would destroy it.

David Cameron needs the Christian churches to help him realise his vision of a 'big society' where citizens take on welfare roles the governmnet is no longer able or willing to finance. But at the same time he risks shooting himself in the foot by backing the extreme agenda of a strident minority within the gay rights movement.

He is of course entitled to own personal convictions. But he must not allow these convictions to become politicised to the extent that he ends up marginalising and demonising those who hold different views.

There are many people in Britain who take the traditional view that the only context for sex is a lifelong committed relationship bewteen a man and a woman - marriage. They also believe that the new orthodoxy backed by David Cameron and others is more 'ideology-driven' than 'evidence-based'.

These people are not 'homophobic' - they neither fear nor dislike those who choose a homosexual lifestyle. They simply do not share the extreme LGBT lobby's world-view or presuppositions. If you like, they are homosceptic.

In a democratic and multicultural society such people should be free to hold, express and act in accordance with their beliefs and convictions rather than being pushed out of public life. And David Cameron, in pursing his 'muscular liberalism', should attempt to embrace them rather than exclude them.

In sacking Dr Raabe, the Home Office has demonstrated intolerance, cowardice, ignorance and an unwillingness to investigate complaints properly.

A Christian GP has been sacked as a government drugs adviser after it emerged he wrote a study linking homosexuality to paedophilia.

Dr Hans-Christian Raabe, of Manchester, was appointed to the Advisory Council on the Misuse of Drugs (ACMD) less than a month ago.

The Home Office confirmed that Dr Raabe (pictured), who was appointed to the ACMD by James Brokenshire, drugs minister, had been dismissed and would not continue with the unpaid, three-year post. Recruitment for a new adviser will apparently begin shortly.

Sources said he had been sacked after not ‘disclosing’ a paper he had written, which had linked homosexuality to child sex offences, during interviews for the role.

The campaign to remove Dr Raabe gained considerable momentum after former Liberal Democrat MP Evan Harris blogged about his past publications, BBC home editor Mark Easton highlighted the case and the British Medical Journal ran an article titled ‘New appointment of evangelical Christian to advisory body sparks controversy’. The latter has provoked some interesting responses.

When journalist Melanie Philips wrote in his defence she was allegedly subjected to death threats.

Hans-Christian Raabe has said his dismissal came as a result of his views ‘completely unrelated to drug policy’ and has added: ‘I have been discriminated against because of my opinions and beliefs, which are in keeping with the teaching of the major churches.’

Others, however, have claimed that he was dismissed not for his religious views but for making claims that are at odds with the scientific evidence.

Bridget Phillipson, a Labour member of the Commons Home Affairs Select Committee, said it was an ‘absolute outrage’ the government had appointed ‘someone with such horrific opinions to this senior role’.

It seems that the specific comments for which Dr Raabe is being criticized appeared in a paper titled ‘Gay Marriage And Homosexuality: Some Medical Comments’ which he co-authored in February 2005.

It contains the statement: ‘Any attempts to legalise gay marriage should be aware of the link between homosexuality and paedophilia. While the majority of homosexuals are not involved in paedophilia, it is of grave concern that there is a disproportionately greater number of homosexuals among paedophiles and an overlap between the gay movement and the movement to make paedophilia acceptable.’

What I find particularly bizarre about this whole incident is that people with apparently no knowledge at all of the subject under debate, let alone expert knowledge, feel qualified to express strong opinions about Dr Raabe’s character and scientific expertise.

I do not pretend to be an expert in this area myself - far from it - but a brief search of the medical literature will confirm that there certainly have been papers published in peer-reviewed scientific journals which report an association between homosexuality and paedophilia and which also consider that this is an issue worthy of investigation and not off-limits to scientific enquiry.

The papers Dr Raabe quotes were written by Freund, who, though careful to point out that his first study should not be interpreted as indicating that gay men are more likely to be paedophiles, none the less concludes: 'homosexual development notably does not result in androphilia but in homosexual paedophilia' (1) Freund's data in a second paper also show that a) around 80% of the victims of paedophilia are boys molested by adult males and b) although most gay men are not paedophiles, 35% of paedophiles are homosexual whilst only 2% of adult men overall are homosexual.(2,3)

Even more interesting is a study by Bradford et al. Rather ironically an official Home Office document published in 1998 (5) quotes this (2nd para, p14) approvingly as follows: 'Bradford et al. (1988) suggested reasonably that approximately 20 to 33% of child sexual abuse is homosexual in nature and about 10% mixed.'

So let's get this right. The Home Office has sacked Dr Raabe for saying what a Home Office document says.

Given that official figures released last year showed only one per cent of the population is homosexual, it is not surprising that supporters of Dr Raabe say same-sex child abuse is significantly over-represented.

So was Dr Raabe sacked for disclosing an inconvenient truth that was totally irrelevant to his appointment? The answer appears to be yes. His concerns were not directed at the majority of the homosexual population but a small, highly dangerous and criminal portion of them.

I have not read any of these studies, and am therefore not in a position to comment on their scientific rigour. I simply want to make the point that such studies most certainly do exist.

These findings are as one might expect disputed by other authors – and the matter is understandably a contentious one – but I notice that a major review on the subject of paedophilia published in 2007 and available on line, which reviews all 554 papers published on Medline on pedophilia, also acknowledges that the jury is still out on the matter:’ The main evidence in favor of a relationship between pedophilia and homosexuality is the common cause of fraternal birth order and postnatal learning… It seems to be questionable logic to view these two conditions as completely unrelated.’(6)

That Dr Raabe should be sacked from his role as a drugs advisor on the basis of his expressed opinions on an entirely unrelated issue (homosexuality) is itself at very least unfair. But the fact that the data he quoted were actually derived from peer-reviewed scientific journal articles (including one quoted approvingly by the Home Office itself!), and on a matter where experts agree that there is a diversity of learned opinion, makes his dismissal both outrageous and inexcusable.

In bowing to political pressure on this matter the Home Office has demonstrated intolerance, ignorance, cowardice and an unwillingness to investigate complaints properly.

1.Freund K, Watson RI. The proportions of heterosexual and homosexual paedophiles among sex offenders against children. J Sex Mar Ther 1992;18:34-43

2.Freund K et al. Paedophilia and heterosexuality vs homosexuality. J Sex Mar Ther 1984;10:193-200

3.Blanchard R et al. Fraternal birth order and sexual orientation in pedophiles. Archives of Sexual Behavior 2000; 29: 463-78

4. Bradford JMW, Bloomberg D, and Bourget D. (1988)The heterogeneity/homogeneity of pedophilia. Psychiatric Journal of the University of Ottawa 1988; 13: 217-226.

5. Grubin D. Sex offending against children: Understanding the risk. Police Research Series. Paper 99. Home Office, 1998.

6.Hughes JR. Review of Medical Reports on Pedophilia. Clinical Pediatrics 2007; 46(8)

Senior neonatologist brands official RCOG report on fetal awareness as ‘Emperor’s new clothes’ in leading journal editorial

Here is another story that you are unlikely to read about in any newspaper. In June 2010, the Royal College of Obstetricians and Gynaecologists (RCOG) published Fetal Awareness – Review of Research and Recommendations for Practice.

The College’s purpose was to update their 1997 publication in the light of more recent evidence, and also to provide ‘information for women and parents’.

The main conclusion of the report was that fetuses under 24 weeks could not feel pain and therefore did not require pain relief when undergoing surgical procedures (or abortion).

I criticized the report on this blog at the time suggesting that the RCOG had simply cherry picked experts guaranteed to deliver convenient conclusions in order to justify its historic position that babies killed by late abortion are not really sentient human beings worthy of any respect.

I was therefore fascinated to read an editorial in a leading medical journal this week (Ward Platt M. Arch Dis Child Fetal Neonatal Ed (2011)) launching a serious attack on the RCOG report. In fact Martin Ward Platt, of the Newcastle Neonatal Service, has called the report ‘an emperor with no clothes’.

He notes that the RCOG report caused a considerable furore in the media last June, where it was widely portrayed as being a political rather than a scientific document that aimed to shore up the pre-existing position of the RCOG rather than to take a dispassionate view of the scientific evidence.

Ward Platt supports the current abortion law and is not addressing this political debate, but does proceed to take the RCOG to task over the science.

He summarises the scientific argument in the RCOG document as follows:

•The fetus is rendered unconscious during intrauterine life by endogenous substances.
•And the fetus at under 24 weeks does not have the neuroanatomical apparatus that would allow pain perception at a cortical level.
•Therefore the fetus is neither aware, nor can feel pain, under 24 weeks.

After reviewing the evidence he then concludes:

So, what is the evidence that the human fetus lacks ‘awareness’? In a word, there is none… I have looked at the references in the report, and the references in the references, and when I finally got back to the primary literature I found no evidence for the contention that human lack awareness, or exist in some different conscious state, beyond the unwarranted extrapolation from sheep. In contradiction to the notion of the ‘unaware’ fetus, the everyday experience of pregnancy – the felt behaviours and responses of the unborn baby, especially to sound – as well as much primary research literature on the human fetus, contains strong evidence for an opposite view.

There is an extensive literature, in humans, on fetal sleep and wakefulness, fetal motility, fetal memory, fetal hearing, fetal breathing and its control and fetal behaviour – and these are just examples that scratch the surface. None of this work is easily reconciled with the notion of a permanently unconscious human fetus.

With regard to how we treat babies of similar gestation born prematurely he argues as follows:

Over the last 20 or more years, researchers have accumulated good observational, experimental and pathophysiological reasons to consider that babies at these gestations do feel pain, that they benefit from analgesia, and that pain experiences in early life cast neurophysiological and behavioural shadows far down childhood.

Equally importantly, babies have a right to receive humane treatment. We work from an ethical imperative that even though these babies cannot verbalise their experiences, and cannot remember them in any way comparable to a child or adult, they should not be subject to pain or distress if we can possibly prevent or treat it. From this argument, there is no reason not to treat the 23-week fetus like a 24- or 25-week fetus, just as we do for babies.

He then reviews the RCOG’s argument that the fetus under 24 weeks is not neurologically developed enough to feel pain:

One notices statements in the report such as: ‘Interpretation of existing data indicates that cortical processing of pain perception, and therefore the ability of the fetus to feel pain, cannot occur before 24 weeks of gestation’. We could rewrite this as ‘in theory they can’t feel pain, therefore they don’t’. It is the substitution of wishful thinking for empirical enquiry.

He concludes:

…it seems that this report constructs a theoretical viewpoint and then tries to squeeze the contrary observations of the real world into it – just like the naked emperor in Hans Anderson’s story, who in his vanity, and because enough courtiers agreed with him, considered himself clothed… In preparing this editorial I noticed that there seems to be no scientific literature on fetal behaviours that uses the maternal experience of quickening, or other aspects of fetal responsiveness, as its basis. This is a huge methodological gap… a sensible debate needs a solid base of rigorous empirical enquiry. As it stands, the report is an emperor with no clothes. We need to dress him.

This editorial by a consultant neonatologist in a leading peer-reviewed journal is hugely significant. The RCOG currently recommends that fetuses do not require analgesia for interventions occurring before 24 weeks, based on the belief that fetuses at this age are neither aware nor can feel pain.

Dr Ward Platt, however, argues that there is actually no real evidence for this belief. Rather there is strong evidence to support the opposite view.

This raises serious questions for those who would argue that we should treat babies in the womb any differently from babies of the same age in a neonatal unit. It is also relevant to the abortion debate.

It does look very much as though the RCOG, rather than taking a dispassionate view of the scientific evidence, has indeed cherry-picked ‘experts’ guaranteed to deliver politically convenient conclusions.

I wonder how they will respond. I expect that all we may hear is a deafening silence.

Morning-after pills don’t cut teen pregnancy rates and actually increase the incidence of sexually transmitted infections

Morning-after pills don’t cut teen pregnancy according to a new study due to be published in the Journal of Health Economics. Furthermore it appears that they actually increase the risk of sexually transmitted disease.

These findings are the latest nails in the coffin of the Labour government’s teenage pregnancy strategy, dreamt up by the now defunct Teenage Pregnancy Independent Advisory Group (TPIAG) which was set up in 2000 to advise the government on how to cut teenage pregnancy.

Part of its strategy was to make morning-after pills free over the counter to teenagers.

The new research, by professors Sourafel Girma and David Paton of Nottingham University, compared areas of England where the scheme was introduced with others that declined to provide the morning-after pill free from chemists.

The academics found that rates of pregnancy among girls under 16 remained the same, but that rates of sexually transmitted infections increased by 12%.

Britain has the highest rate of teenage pregnancy in Western Europe. In 2008, the latest year for which figures are available, more than 7,500 girls in England and Wales became pregnant. Nearly two thirds of these pregnancies ended in abortion.

Rates of sexually transmitted diseases are also rising. In 2009 there were 12,000 more cases than the previous year, when 470,701 cases were reported. The number of infections in 16-to 19 year-olds seen at genito-urinary medicine clinics rose from 46,856 in 2003 to 58,133 in 2007.

Norman Wells, director of the Family Education Trust, is reported in the Sunday Times as saying, ‘International research has consistently failed to find any evidence that emergency birth control schemes achieve a reduction in teenage conception and abortion rates. But now we have evidence showing that not only are such schemes failing to do any good, but they may in fact be doing harm.’

The phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as ‘risk compensation’.

The term has been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers are thereby encouraged to drive more recklessly.

In the same way it has been argued that making condoms readily available actually increases rather than decreases rates of pregnancy and sexually transmitted infections because condoms encourage teenagers to take more sexual risks in the false belief that they will not suffer harm.

Whilst condoms offer some protection against sexually transmitted infections the morning-after pill offers none.

Last October it was announced that the TPIAG was one of 192 government quangos to be scrapped.

Not a moment too soon!