Thursday 22 December 2016

Christmas - The miracle of the incarnation

Many people today are sceptical of the miraculous elements of the life of Jesus Christ: the virgin birth, the healing miracles and the resurrection. They ‘know’ that such things are scientifically impossible.

But the real miracle, on which all rests, and which we celebrate at Christmas, is actually the incarnation, the Word becoming flesh. C S Lewis, in his classic book ‘Miracles’, calls it ‘the grand miracle’.

If we can accept the incarnation - the idea that God could become a human being - then all other aspects of Jesus’ life follow on naturally. They are exactly what we would expect if God were walking on the planet.

Apologist Josh McDowell has suggested that if God became a man we would expect to see the following things.

He would have an unusual entry into life - which is exactly what we find in the virgin birth.

He would be morally perfect. When Jesus challenged others to find him guilty of sin no-one could answer.  

If God became a man, we’d expect him to perform astounding miracles. The gospel accounts are full of them: he heals those who are deaf, blind and paralysed; he calms storms, walks on water and turns water into wine. According to eyewitnesses Jesus healed diseases for which even today there is no treatment; instantaneously, irreversibly and unambiguously. 

We'd expect him to speak the greatest words ever spoken. People responded to Jesus in amazement. ‘How did this man get such learning without having been taught? ‘No one ever spoke the way this man does’.

Psychiatrist James Fisher has written: ‘If you were to take the sum total of all the authoritative articles ever written by the most qualified of psychologists and psychiatrists on the subject of mental hygiene - if you were to combine them and refine them and cleave out all the excess verbiage - if you were to have these unadulterated bits of pure scientific knowledge concisely expressed by the most capable of living poets, you would have an awkward and incomplete summation of the Sermon on the Mount.’

If God became a man, we would expect him to have a lasting and universal influence. Why is it that all religions try to accommodate Jesus somehow, to find a place for him? In the words of historian Kenneth Latourette, it is simply because ‘measured by his effect on history, Jesus is the most influential life ever lived’, profoundly shaping our worldview, our laws, our history, our culture.

We would expect him to satisfy the spiritual hunger in man. Millions testify that Jesus Christ has filled the spiritual vacuum in their lives; that his promise that those who come to him will not thirst or hunger is amazingly true.

Finally if God became a man, we would expect him to exercise power over death. The resurrection of Jesus Christ is the best attested historical fact in all of antiquity; over 500 witnesses to his rising from the dead. It is the only logical explanation for the empty tomb, the dramatic change in the disciples and the spread of the early church.

But what does the incarnation mean for us personally? 

First, it reminds us that Jesus understands us. He knows what it is like to be a human being. He knows hunger and thirst, pain and sorrow, bereavement and loss, rejection and betrayal. As the writer of Hebrews tells us he can sympathise with our weaknesses because he has been tempted in every way as we are, and much more.

Second, it reminds us that Jesus can help us:
‘because he himself suffered when he was tempted, he is able to help those who are being tempted’. What are our areas of weakness? What do we despair over? What is it that is stopping us growing as Christians? What is it we are fighting that perhaps no-one else sees or knows about? He is able to help us. 

Third, the incarnation is a model for us in our own Christian lives. We are called to walk in Jesus’ footsteps. The cross is a pattern for us to follow. We are to carry the cross, to take our share of suffering, to bear the burdens of others. 

Fourth, the incarnation helps us in our evangelism. It challenges us to cross social barriers as Jesus did, to make ourselves accessible and vulnerable, in the way that Jesus was, to be, in the words of Paul, 'all things to all people'. 

But finally, and most importantly the incarnation reminds us of why Jesus came, because Christmas is the prelude to Easter. The same Jesus who grew in the womb and lay in the manger was sent to die on a cross and rise from the dead in order to reconcile us to God. 

Christmas starts and ends with Jesus Christ. Let’s keep him at the centre. 

Monday 31 October 2016

Biotechnology Company seeks to profit from search-and-destroy technology for babies with Down’s syndrome

The government yesterday approved a new test for pregnant women that will make it much easier to detect and destroy babies with Down's Syndrome (DS) (see previous CMF blog posts here, here, here and here).

According to the BBC, the non-invasive prenatal test (NIPT) will be rolled out by the NHS from 2018.

NIPT involves taking a sample of blood from the pregnant woman which is then examined for abnormal fetal DNA. It is called 'non-invasive' because it doesn't involve 'invading' the mother's womb. It therefore carries no risk of miscarrying a 'normal' pregnancy.

It is claimed that NIPT will cut the number of women who need invasive tests like amniocentesis and chorion villus biopsy, which carry a 1-2% risk of miscarriage.

The move to make NIPT available on the NHS is extremely controversial and has led to the launch of the ‘Don’t screen us out’ campaign (DSUO). DSUO describes itself ‘as a grass-roots initiative supported by a collection of people with Down’s syndrome, families and Down’s Syndrome advocate groups led by Saving Downs Syndrome’.

They say that, given the fact that 90% of babies who are prenatally diagnosed with Down’s syndrome are currently aborted, the result will be ‘a profound increase in the number of children with Down’s syndrome screened out by termination’. 

new study published in the British Medical Journal on 4 July 2016 backs up their concerns. 

The lead author professor Lyn Chitty and her colleagues calculate that in an annual UK screening population of 698,500, offering NIPT (as a contingent test to women with a Down’s syndrome screening risk of at least 1/150) would increase detection by 195 cases with 3,368 fewer invasive tests but, crucially, only 17 fewer procedure related miscarriages.

If rolling out NIPT will result in 195 more babies with Down’s syndrome being detected, then assuming that 90% will then be aborted (the standard quoted figure), that means almost 180 more abortions for Down’s syndrome each year.

Most people are unaware that abortion is legal in Britain right up until birth for babies with disabilities. Last year a record number of 230 babies with special needs were aborted beyond 24 weeks, the age at which most will survive in a neonatal unit if born prematurely.

In total last year there were 3,213 babies with disabilities aborted in this country, over 1,000 of them more than halfway through pregnancy. 689 of these had Down’s syndrome. 11 had cleft lip or palate. 

Sally Phillips drew attention to the issue dramatically in a BBC documentary ‘A World Without Down’s Syndrome’, which aired on 5 October. ‘What’s so dreadful, to the world, about Down’s syndrome? she asked. The Bridget Jones actress, who has a son with the condition, questioned the ethics of pregnancy screening and abortion and asked why affected babies are viewed as a ‘burden’ in society. The programme understandably prompted fierce debate. 

On Friday 21 October, Lord Shinkwin’s Abortion (Disability Equality) Bill had its second reading in the House of Lords. Lord Shinkwin (pictured below) is arguing that the current situation is profoundly discriminatory - eugenic even.  He wants to remove ‘ground E’ (1(1)(d)), which enables any baby with a significant risk of a serious abnormality to be aborted, from the Abortion Act altogether. 

At the weekend, 279 medical professionals signed a letter accusing the Royal College of Obstetricians and Gynaecologists (RCOG) of 'advocating that women with a prenatal diagnosis of Down's syndrome should end their pregnancy'. They said: 'We utterly reject the implicit premise that the value of a human being is based on their economic contribution to society.' (see full text here)

The move to introduce NIPT into the NHS is also backed by powerful commercial interests.

In March 2015 the St George’s University Hospitals NHS Foundation Trust revealed that it was joining forces with the British firm, Premaitha Health to bring in this new screening test. Premaitha, which describes the test (marketed as ‘Iona’) as its ‘flagship product’, along with its shareholders, now stands to make a lot of money. Millions of pounds in fact. Each NIPT test costs between £400 and £900 pounds. Do the maths!

Premaitha admitted this much in a 
press release earlier this year: 'Premaitha anticipates that the endorsement by the NHS will accelerate private payer market growth in the UK'. More importantly, it will put them in pole position to pitch for NHS hospital tenders. 

On 27 October at its AGM the company was even bolder. Non-executive Chairman Adam Reynolds, claimed that ‘the international landscape for non-invasive prenatal testing is evolving very considerably in Premaitha’s favour’. He added that the company was ‘exceptionally well placed to win significant market share as awareness of the availability of NIPT increases’.

In the light of all this, people may be surprised to hear that Premaitha’s share price rose by only 10.81% today to 10.25p. This is in spite of brokers Finn Cap and Panmure Gordon having target prices of 20p and 24p respectively on the stock.

But in an ironic twist, enthusiasm for buying the shares has been curbed by unresolved legal action. US biotechnology giant Illumina has launched patent infringement proceedings against Premaitha and others.

Nevertheless Premaitha has ‘absolutely no doubt that the developed world is moving’ towards ‘widescale adoption of NIPT’ and that it ‘is well placed to gain a large share of the market’.

So here we have it – a global drama involving pregnant women anxious about having disabled children, campaigners concerned about the eradication of people with disabilities, millions of pounds of taxpayers' money up for grabs, biotechnology companies hungry for profits and salivating shareholders seeking a quick buck.

But, caught in this toxic web of vested interests, the real victims in this whole drama are babies with a common genetic abnormality whose eradication will lift a perceived burden from some and make others very rich indeed.

The real test of an administration is in what it values – and in particular how it treats the most vulnerable members of society, especially when it costs something emotionally and financially to do so.

The British government, by this reckoning, is not heading in a good direction. Nor are biotech companies and their shareholders who are keen to profit from the search and destroy conveyor belt.

But disabled people and their families will not go quietly and I suspect we have not heard the last of this yet.  

Friday 21 October 2016

The Culture of Life - Keynote Speech for Alliance of Prolife Students Celebration and Fundraiser

I gave the keynote address at Alliance of Pro-life Students Celebration and Fundraiser in London on 20 October 2016. Here is a full transcript.

Tomorrow, 21 October, Lord Shinkwin’s Abortion (Disability Equality) Bill will have its second reading in the House of Lords.

Most people are unaware that abortion is legal in Britain right up until birth for babies with disabilities. Last year a record number of 230 babies with special needs were aborted beyond 24 weeks, the age at which most will survive in a neonatal unit if born prematurely.

In total last year there were 3,213 babies with disabilities aborted in this country, over 1,000 of them more than halfway through pregnancy. 689 of these had Down’s syndrome. 11 had cleft lip or palate.

Lord Shinkwin is arguing that this is profoundly discriminatory - eugenic even.  He wants to remove ‘ground E’ (1(1)(d)), which enables any baby with a significant risk of a serious abnormality to be aborted, from the Abortion Act altogether.

He is supported by the ‘Were all Equal’ campaign – who argue that the current law is out of date – it promotes inequality, reinforces negative stereotypes and is inconsistent with disability discrimination legislation for after birth.

One of their most powerful spokespeople is actress and Bridget Jones star Sally Phillips, who has argued powerfully that children like her eleven-year-old son Ollie, who has Down’s syndrome, have as much right to live as anyone else.

But, of course, the present law also discriminates on the basis of age.

We would be horrified if a woman could have her newborn baby daughter put down simply because she was the result of an unplanned pregnancy, posed an economic burden or was socially inconvenient.

But the law allows exactly this for babies just a few weeks younger – 200,000 of them every year in Britain. Under the Abortion Act over eight million preborn babies have been ‘terminated’ since 1967 – one in every five pregnancies ends in abortion and one in every three British women will have an abortion: eight million British citizens who were never given the chance to live.

This year the ‘We Trust Women’ campaign was launched by pro-abortion activists aiming to decriminalise abortion altogether. A new bill attempting to liberalise the law in Northern Ireland was lodged on 19 October. There are similar moves already underway on the Isle of Man.

Back in 2008 a whole host of amendments to the Human Fertilisation and Embryology Bill were tabled in the Westminster Parliament. MPs were seeking to remove the two doctor provision, allow nurse and home abortions, allow abortion on demand up until three months gestation and extend the Abortion Act to Northern Ireland. 

Thankfully all these measures failed when the economic crisis struck, leading the prime minister Gordon Brown to cut time in debating abortion amendments in order to save the nations’ banks.

Last year 38% of all abortions were repeats and 95 British women had their eighth abortion or greater – evidence that abortion is simply being used as a form of birth control.

Over 98% of British abortions have been carried out on mental health grounds although, according to a major recent systematic review, there is actually no medical evidence that continuing a pregnancy poses any greater risk to a mother’s mental health than having an abortion. If anything the opposite is true. This means that 98% of British abortions are technically illegal and that the 500 doctors every day who put their signature to a statutory document ticking the mental health box are actually committing perjury.

And yet the law is not upheld. The police do not investigate. The CPS does not prosecute. Courts do not convict or sentence and parliament turns a blind eye.

In fact judges rule against those who attempt to apply the law.

Aisling Hubert, who attempted to bring a private prosecution against two doctors, who authorised abortion purely on grounds that the baby was female, has been ordered to pay court costs of £47,000.

People who maintain silent vigils outside abortion clinics or offer counselling to women with crisis pregnancies are threatened and intimidated and driven out of the public square.

And sadly the medical profession have colluded with this whole sorry state of affairs.
Abortion is against the Hippocratic Oath, against the Declaration of Geneva and against the International Code of Medical Ethics. In 1947 the British Medical Association called it the ‘greatest crime’.

And yet now the Royal College of Obstetricians and Gynaecologists calls abortion ‘a basic healthcare need’ and the British Medical Association is pushing to liberalise the law even further. Meanwhile, the General Medical Council (GMC) refuses to give up the names of 67 doctors who are known illegally to have pre-signed abortion authorisation forms without even seeing the women who would use them.   

In 1967 Britain was the first Western country outside Scandinavia to legalise abortion. And in so doing this country paved the way for the legalisation of abortion throughout the English speaking world.

Today, authorities quote 43 million abortions as the annual figure worldwide.

This is an astounding figure. 55 million people died in the entire five years of the Second World War. 57 million people each year from all causes other than abortion. This means that of every 100 human deaths on this planet 43 of them involve babies in the womb being killed by healthcare workers.

There is no one more innocent, more vulnerable and killed in greater numbers than the baby in the womb. Ironically, what should be the safest sanctuary on earth has become a more dangerous place that even Mosul or Aleppo.

The right to life is the most fundamental of all human rights and the right on which all other rights are based. It is meaningless to speak of the right to food and clothing, the right to free speech, the right to education, the right to own property, the right to fair compensation for work, the right to freedom from harassment, the right not to be abused or sexually violated - if you are not alive. The right to life is the foundation on which all other rights are built.

So when we are talking about abortion we are talking about the deprivation of the most fundamental of all rights from the most innocent, vulnerable and helpless of all human beings for the most trivial of all reasons and in the greatest of all numbers.

That alone must make abortion one of the most serious human rights abuses in the world today. And also the least defended.

The Alliance of Prolife Students supports the right to life of all human beings from fertilisation until natural death. In so doing it stands against discrimination on the basis of mental and physical disability, against discrimination on the basis of age, against discrimination on the basis of size and against discrimination on the basis of neurological capacity.

This is the only possible position to take for those who are opposed to all discrimination.  And if consistently held it must also lead to a defence of human embryos.

Human embryos from the moment of fertilisation are human lives. They are not potential human lives. They are human lives with potential. They are potential children and adults. As human lives they are worthy of our empathy, wonder, compassion and protection including legal protection.

Sadly, but not surprisingly in the wake of the Abortion Act, the first Human Fertilisation and Embryology Act of 1990 rendered human embryos non-persons and deprived them of legal protection.

The HFE Act made it legal to freeze, experiment upon, select and dispose of human embryos. In 2012 the Daily Telegraph reported on 20 years of this activity.  More than 3.5 million embryos created, 840,000 put in storage, 5,900 set aside for research, 1.4 million implanted – of which fewer than one in six led to pregnancy and 1.7 million were discarded unused.

The Warnock report (1984) which led to the HFE Act of 1990 said that the human embryo had a ‘special status’, but from these figures it is evident that the human embryo in practice has no status at all.

It is true that IVF and related techniques have led to many childless couples being able to have children. But the figures demonstrate that a large proportion of the embryos which have been created in British laboratories in the last 20 years are not even given a chance to live. It is right to seek treatments for infertility but we cannot and must not allow the end to justify the means. And we must be pursuing infertility treatments which respect the humanity of the human embryo.

We should also be promoting adoption.
In 2009, which is the last year for which I have adoption figures, there 203,444 abortions on UK residents and just 91 adoptions involving babies under one year. 91!

That’s a ratio of 2,235 abortions performed for every baby adopted. 

And yet when Martin Narey, the adoption czar, suggested in 2011 that adoption was a ‘golden option’ and a real alternative to abortion he faced howls of derision from the politically correct.

Baby adoption is a win-win option because it provides an unwanted baby with a loving home and a childless couple with a baby to love and care for.

We know that abortion kills babies. But it also hurts women.

I first came face to face with the hurt caused women when I was training as a general surgeon in New Zealand.

I was on acute call and was asked to see a 14 year old girl with abdominal pain.  Her GP wondered if she had appendicitis but it was very clear on examining her that she did not need surgery.

I asked her if she had had any abortions or miscarriages and she looked very uncomfortable and glanced awkwardly at her father who was in the cubicle. So I asked her again later when he was no longer present and she burst into tears.

It turned out that she had become pregnant to her 15 year old boyfriend and that her father had threatened her that if she did not have an abortion he would take her boyfriend to court for carnal knowledge. So, wanting to protect her boyfriend from prosecution, she reluctantly consented.

She then told me that she had been plagued with guilt over the abortion ever since, and was often tearful in class but unable to tell anyone why. ‘Whenever I think about the abortion I get this pain in my tummy that I have now’, she said. ‘You are the first person that I have ever told about it and I don’t know what to do.’

We hear a lot about choice from the pro-abortion lobby but the reality for many women, like this poor girl, is that they feel they have no choice. They choose an abortion to protect other people – parents, boyfriends, spouses – because they don’t want to create a burden for others. Sometimes, as in this tragic case, they are threatened and coerced to have an abortion against their will.

There are some wonderful initiatives in the UK offering support to pregnant women in crisis – food, money, emotional support, counselling and antenatal care -  they are doing a fantastic job and need our strongest support.

This young lady was the tip of a huge iceberg of women damaged by abortion – many of them suffer from guilt and grief – but many also have physical complications – bleeding, infections, mental health problems.  

There are over 70 scientific studies now showing a link between abortion and premature birth in subsequent pregnancies. And there is an ongoing debate about the link between abortion and breast cancer – of three major scientific meta-analyses – studies of studies – two support a link.

Abortion kills babies and hurts women. And it is also driven by powerful commercial interests. 68% of abortions are now carried out by independent facilities like BPAS and Marie Stopes but are fully funded by the British taxpayer.

Abortion also has huge demographic effects.

We know that because of female feticide in China and India there are now 160 million missing women in the world. This means that many men face no possibility of ever finding a female partner and this alone has had a huge effect in fuelling sexual abuse, pornography and human trafficking.

Abortion in Russia - there were at one point two abortions for every live birth - led to such a shortage of young people that Vladimir Putin sought to tighten the abortion laws and provide financial incentives to women to keep their babies.

He was worried that there would not be enough people in the working population to support the growing number of elderly people.

In Japan in 1950 35% of people were under the age of 15 and 5% were over the age of 65. This is a healthy demographic which ensures that families and strong and that vulnerable people are well provided for.

By 2050 the figures will be reversed - only 8% will be under 15 and 40% will be over 65. This is an extremely unhealthy demographic which places more pressure on families and resources. Add in unemployment, economic recession and family breakdown and you have a very toxic brew indeed. 
We see a similar pattern all over the Western world – fewer children, growing numbers of elderly people, growing debt and family breakdown.

This has led some commentators to make the chilling prediction that the generation that killed its children through abortion – will in turn be killed by its children – through euthanasia.

Vulnerable elderly, sick and disabled people are at great risk from the advance of legalised euthanasia.

Euthanasia is now legal in Belgium, Luxembourg, the Netherlands and Canada. Assisted suicide – euthanasia one step back – is legal in Switzerland and in five US states – the latest being California. It is said that what California does today the world does tomorrow.

The Democrat Party is working hand in glove with Compassion and Choices – the pro-assisted suicide pressure group – to legalise assisted suicide in the US state by state. When they capture enough states they will go for a Supreme Court case to impose it everywhere – as happened with the Roe vs Wade judgement on abortion in 1973 and the Obergefell judgement for same sex marriage in 2014.

In the UK since 1992 we have been fighting the legalisation of euthanasia and assisted suicide. We have been amazingly successful in both parliament and the courts.

There have been over a dozen attempts to legalise assisted suicide through British parliaments in the last twelve years. Every single one of them has spectacularly failed. Our biggest victories ever were over the Harvie Bill in Scotland and the Marris Bill in Westminster just last year. Marris’s Bill, which supposedly had more safeguards than any bill in history was defeated by a massive 330 votes to 118 with only the Green Party supporting it.

MPs from all sides of the house were convinced by the arguments that the bill was not safe. 

Vulnerable people would inevitably have been put under pressure to choose early death so as not to be an emotional and financial burden on families and carers. MPs saw that the right to die can so easily become the duty to die.

We have seen this worked out across the North Sea. In the Netherlands euthanasia numbers have increased by between 10 and 20% every year so that now over 4% of all deaths are due to euthanasia. What started with the terminally ill has now spread to the chronically ill. What started with physical illness has spread to those with dementia and mental health problems. What started with adults now involves children. Euthanasia is legal for twelve year olds and babies with disabilities are being euthanised under the Groningen protocol.

In Belgium they are practising organ donation euthanasia. Half of Belgium’s euthanasia nurses have killed without consent even though both nurse euthanasia and involuntary euthanasia are illegal. But a third of cases in Belgium are now involuntary and yet there has been not one conviction. We should have learnt the lessons from abortion.

Euthanasia and assisted suicide cannot be controlled. Once you legalise it for some there will inevitably be incremental extension as more cases which stretch the legal boundaries are brought to bear.

It’s only for the terminally ill we hear. It’s only for adults. It’s only for those unbearably suffering. No. It is clear from what we see now in other jurisdictions that it is only the beginning. 

We have shown in Britain how this can be fought. We have shown that when people of faith and no faith, when disabled people and able bodied people stand together and marshal strong arguments we can win. We have proved that with assisted suicide. But the issue will not go away and we can only keep on winning and push back if we win the battle for the hearts and minds of the next generation.

This is why the work of the Alliance of Prolife Students is so crucial and why their vision to build, support and connect prolife societies in universities is so important.

They are in a unique position to equip students with up to date prolife education and resources. They have a unique mission to build pro-life communities in the universities and other tertiary instructions of England, Wales and Scotland.

They need to build on their success and momentum of the past few years and take their movement to the next level.

They must not be intimidated. It will need courage, good leadership and resources – both human and financial. And they will need our support to stand alongside us and to help fulfil their vision of a society where the value of human life is always affirmed, a society free from unethical practices in science and medicine.

Let me close by telling you the story of another 15 year old girl who into my care after a road traffic accident. I was up all night putting her broken limbs back together. The next day the nurses did a pregnancy test and found she was pregnant. They arranged for her to have an abortion.

I didn’t find out until after she had left the hospital. So I wrote her a letter. I told her that I understood that she must feel desperate. But I urged her to think again. I said that abortion may seem like the only way out in a crisis pregnancy but that it only exchanges one problem for a whole set of new problems. I said she had three choices – abortion, adoption or keeping the baby – and that anyone of them would change her life for ever. I offered to help her in any way I could.

She came back to the fracture clinic six weeks later. Whilst I was reviewing her x-rays she was on the edge of her chair wanting to tell me something.  Eventually, she could hold it in no longer and blurted out, ‘I’m keeping the baby. I just wanted you to know. Thank you for your letter. I showed it to my gran and she said she would support me. My boyfriend did too. I’m keeping the baby.’

Two years later I received a card in the post. When I opened it, out fell the picture of a little boy. There was a note which said, ‘You probably don’t remember me but I was the pregnant girl who broke her leg that you operated on in hospital. I just want to thank you for helping me avoid making what would have been the worst decision of my whole life. This is my son. He is my pride and joy. I wanted you to have this picture. Thank you so much.’

I know it was not an easy decision for her. But I’m sure that in choosing life she made the best decision – both for her and for her little boy, and for her whole family: because life affirming decisions are always the best decisions.

We need to stand for life. We need to resist the culture of death. We need to be a voice for those who have no voice whether they are embryos, elderly or disabled people or preborn babies.

We need to be trained. We need to put in the hours to know the arguments and produce the resources. Overall we need to be willing make a stand and be courageous. We must not allow ourselves to be silenced or intimidated. The battle will not be easy but we need to stand together and fight it. And we need to equip the next generation of prolife soldiers to take the baton from us.

That is why the work of the Alliance of Prolife Students is so important. I urge you to support them.  

Thank you.

For a video of this talk, and opportunities to give to the Alliance of Pro-Life Students, please visit their website 

Tuesday 13 September 2016

Eugenics – could NIPT for Down’s Syndrome bring us full-circle?

Is it wrong to kill disabled people if caring for them costs more than identifying and destroying them?

The Nazis believed killing in these circumstances was not only right but a public duty and the German public was softened up to accept it through a skilful propaganda campaign which began in the classroom.

Leo Alexander, an American psychiatrist who gave evidence at the Nuremberg trials, described the process in his classic article ‘Medical Science under dictatorship’, published in the New England Journal of Medicine in 1949:

‘Acceptance of this ideology was implanted even in the children. A widely used high-school mathematics text, "Mathematics in the Service of National Political Education," includes problems stated in distorted terms of the cost of caring for and rehabilitating the chronically sick and crippled. One of the problems asked, for instance, how many new housing units could be built and how many marriage-allowance loans could be given to newly married couples for the amount of money it cost the state to care for the “crippled, the criminal and the insane”’

In a seminal article in the 1996 British Medical Journal, ‘Not a slippery slope or sudden subversion: German medicine and National Socialism in 1933’, Hartmut Hanauske-Abel outlined just how meticulously they went about it:

‘The 70 273 futile or terminal patients "disinfected" (murdered) in German killing hospitals up to 1 September 1941 are calculated to free up "4 781 339.72 kg of bread, 19 754 325.27 kg of potatoes . . .," a total of "33 733 003.40 kg" of 17 categories of food, plus "2 124 568 eggs." Projected over 10 years, these savings are predicted to amount to "400 244 520 kg" of 20 categories of food worth "141 775 573.80 Reichsmarks." Removal of these patients from the wards saves estimated hospital expenses of "245 955.50 Reichsmarks per day," or "88 543 980.00 Reichsmarks per year.’

We are shocked by the shameful cold-bloodedness of these calculations and the deliberate way in which the ‘disinfecting’ was carried out. We are thankful we have learnt the lessons of history. But have we?

There is evidence that these kinds of cost-benefit decisions might be creeping back. In the 1990s, the past-president of the European Bank for Reconstruction and Development, Jacques Attali, made the following pronouncement in L'Avenir de la vie:

'As soon as he goes beyond 60-65 years of age man lives beyond his capacity to produce, and he costs society a lot of money... euthanasia will be one of the essential instruments of our future societies.'

But the area where ‘cost-benefit’ calculations are most evident, and discussed quite shamelessly in the medical literature, is prenatal diagnosis and abortion for congenital abnormalities.

About 1% of all abortions in Britain are performed under Ground D of the Abortion Act 1967, effectively for fetal illness or disability. And one of the commonest causes, accounting for about one in three of all these abortions, is chromosomal abnormality. The most common cause of this is trisomy 21 (T21) or Down’s Syndrome. Currently about 90% of all babies with Down's Syndrome detected before birth are 'terminated'.

We don’t hear people openly saying that we should kill babies with Down’s Syndrome before birth because of the burden they create for society. We don’t use that language. But the sentiments are strongly and deeply felt and the issue has been debated in medical journals for many years. Most recently we see it in evidence given by medical bodies to the UK National Screening Committee’s (UKNSC) recent consultation on screening for fetal DNA (cfDNA) in pregnancy.

The NHS is close to introducing a new test for pregnant women that will make it much easier to detect and search out any babies with Down's Syndrome (DS) (see previous CMF blog posts here and here).

The new test, NIPT (non-invasive prenatal screening), involves taking a sample of blood from the pregnant woman which is then examined for abnormal fetal DNA. It is called 'non-invasive' because it doesn't involve 'invading' the mother's womb, as chorion villus screening and amniocentesis do. It, therefore, carries no risk of miscarrying a 'normal' pregnancy.

In their evidence to the consultation the Royal College of Obstetricians and Gynaecologists (RCOG) addressed the cost-benefit issue as follows (emphasis mine):

‘The UKNSC is consulting on offering cfDNA testing to women with a 1 in 150 or greater risk of trisomy. The decision NOT to offer cfDNA testing to all women (primary screen) is based upon the cost (“the UKNSC were concerned that this represented a large opportunity cost and that these resources might be better used by the NHS”). If the decision has been made primarily on cost grounds, then a more rigorous economic analysis has to be made that includes the lifetime costs of caring for children and adults with Down’s syndrome (bearing in mind that cfDNA testing as a primary screen test will identify approximately 289 more babies with trisomies). Such an economic analysis may (or may not) suggest that cfDNA testing for all is cost-effective.’

In other words, the RCOG thinks NIPT will be cost-effective if it costs less to detect and kill babies with Down’s Syndrome than it does to provide them with a lifetime of care and support.

In a similar vein, the British Maternal & Fetal Medicine Society (BMFMS) asks (p20), ‘Why isn’t the cost of caring for a child with T21 included in the analysis?’

One might argue that these doctors' groups are different from the Nazis - they are not dragging adults and children with Down’s Syndrome to the gas chamber - and clearly that is true.

But my point is that their reasoning is the same reasoning that the Nazis used – that if the cost of care is higher than the cost of killing then homicide is justifiable on economic grounds.

Why do they fail to see this more clearly? I wonder if it is because these doctors (the leaders of the RCOG and Fetal Medicine Society) attribute little if any value to life before birth. In other words, they view a baby in the womb in a similar way to how Hitler viewed Jewish people; as a drain on resources and surplus to requirement. Not real people. So, they reason that if we have the technology, and can make it safe for the mother - and she wants it - then what’s wrong with it? The baby’s life has no moral value but it does nevertheless carry an economic cost.

Autonomy says ‘we can choose’. Technology says ‘we can do it’. Moral relativism says ‘why not?’

The ‘Don’t screen us out’ campaign (DSUO) is trying to change these perceptions. DSUO describes itself ‘as a grass-roots initiative supported by a collection of people with Down’s syndrome, families and Down’s Syndrome advocate groups led by Saving Downs Syndrome’.

They argue that NIPT does harm to babies with Down’s syndrome and the Down’s syndrome community, violates the Convention of the rights of persons with disabilities and enables eugenic discrimination.

These are strong charges indeed. But if we look at it logically – their argument does make sense. Why are attitudes to disabled people outside the womb so different to the attitudes (expressed above) to those inside the womb?

The key question is this - should the weak be sacrificed for the strong or should the strong make sacrifices for the weak? The Christian answer is clear - bearing one another's burdens is at the very heart of the Gospel. We walk in the steps of the all-powerful creator who laid aside everything and entered this world at great personal cost to rescue, care and serve.

There is no doubt that providing life-time support for people with Down's Syndrome can be costly in emotional and economic terms - but many families will testify that there are great rewards too and that they have much to teach us.

If we are going to talk about cost, then the cost of bringing up a so-called 'average' child in the UK (in goods, university, school and preschool fees, lost parental earnings etc) is around £230,000. Yet no one is seriously suggesting that we apply the economic argument to 'average' children.

So what does this tell us about our attitudes to people with Down's Syndrome? Why are we not up in arms against these doctors who seem to value these people's lives so cheaply? Is it perhaps that it is not just the doctors who are making these assessments? And yet is not the real measure of what kind of a society we are seen in the way we treat those with special needs?  

Monday 12 September 2016

Is Professor Basky Thilaganathan deliberately misleading parliament over the results of NIPT for Down’s syndrome?

Here's a new story involving disabled people, taxpayers' money, apparent scientific deception, a biotechnology company looking for profits and the NHS.

The NHS is close to introducing a new test for pregnant women that will make it much easier to detect and search out any babies with Down's Syndrome (DS) (see previous CMF blog posts here and here).

Jeremy Hunt, the Health Secretary, is expected to respond to a recommendation from the National Screening Committee for the roll-out of non-invasive prenatal testing (NIPT) any time now. NIPT involves taking a sample of blood from the pregnant woman which is then examined for abnormal fetal DNA. It is called 'non-invasive' because it doesn't involve 'invading' the mother's womb, as chorion villus screening and amniocentesis do. It therefore carries no risk of miscarrying a 'normal' pregnancy.

The Nuffield Council of Bioethics is also expected to publish a report on the new technology this autumn (see CMF's submissions to both Nuffield and the UK National Screening Committee).

The move to make NIPT available on the NHS is extremely controversial and has led to the launch of the ‘Don’t screen us out’ campaign (DSUO). DSUO describes itself ‘as a grass-roots initiative supported by a collection of people with Down’s syndrome, families and Down’s Syndrome advocate groups led by Saving Downs Syndrome’.

They argue that the result will be ‘a profound increase in the number of children with Down’s syndrome screened out by termination’.

They say that, given the fact that 90% of babies who are prenatally diagnosed with Down’s syndrome are currently aborted, making the test available on the NHS is projected to lead to 92 more babies with Down’s syndrome being aborted each year (90% of the 102 more children with Down’s syndrome who would be detected annually by NIPT according to the National Institute for Health and Research RAPID evaluation study  projections).

The same RAPID study also predicts that 25 miscarriages would be prevented by implementation of the technology because fewer women would go on to undergo more invasive chorion villus sampling (CVS ) or amniocentesis in order to diagnose the condition. So it is a trade-off of 25 'normal' babies saved for 92 babies with Down's syndrome aborted.

Don’t Screen us Out have launched an open letter to Jeremy Hunt demanding that his department stop ignoring the concerns of people with Down’s syndrome, their families and the wider community and start consulting them on the proposals. But thus far the health minister has not responded.

The move to introduce NIPT into the NHS is backed by powerful commercial interests. In March 2015 the St George’s University Hospitals NHS Foundation Trust revealed that it was joining forces with the British firm, Premaitha Health to bring in this new screening test. Clearly, if the health secretary gives the green light to pay for this new test to be rolled out on the NHS, then Premaitha, which describes the test as its ‘flagship product’, along with its shareholders, stands to make a lot of money. Millions in fact.

Premaitha admitted this much in a press release earlier this year: 'Premaitha anticipates that the endorsement by the NHS will accelerate private payer market growth in the UK'. More importantly, it will put them in pole position to pitch for NHS hospital tenders. 

Understandably, St Georges, which has a commercial relationship with Premaitha, is defending the test. Earlier this summer, Professor Basky Thilaganathan (pictured), head of the fetal medicine unit at the trust, said: ‘NIPT screening is an absolute sea change in how we have been doing things in the last 50 years. It has the potential to virtually eradicate invasive testing.’

According to the Evening Standard on 12 August, he dismissed claims from DSUO that extending the test would lead to an increase in abortions and claimed that more than 300 miscarriages a year could be prevented if the NIPT (non-invasive prenatal test) was used across the NHS. 

But DSUO have been questioning the evidence for his claims. And a new study published in the British Medical Journal on 4 July 2016 backs up their concerns.

The new BMJ study evaluates the outcomes and costs of implementing NIPT for Down’s syndrome into NHS maternity care and covers eight diverse maternity units. The lead author is Lyn Chitty, Professor of Genetics and Genomic Medicine, UCL Institute of Child Health, London.

Chitty and her colleagues calculate that in an annual screening population of 698,500, offering NIPT (as a contingent test to women with a Down’s syndrome screening risk of at least 1/150) would increase detection by 195 cases with 3,368 fewer invasive tests and, crucially, only 17 fewer procedure related miscarriages (not 300!).

Chitty’s projected decrease in miscarriages (17) is very close to the figure given by the RAPID study (25), and the difference is not statistically significant. But both figures are a far cry from Basky Thilaganathan’s 300, a number almost 20 times higher.

Furthermore, if rolling out NIPT will result in 195 more babies with Down’s syndrome being detected (Chitty), then assuming that 90% will then be aborted (the standard quoted figure), that means almost 180 more abortions for Down’s syndrome each year. Even if the percentage is only ~70% going on to abort, as Chitty suggests for the group having NIPT, we are still talking about over 130 more abortions each year of these affected babies.

DSUO argue that this does harm to babies with Down’s syndrome and the Down’s syndrome community, violates the Convention of the rights of persons with disabilities and enables eugenic discrimination. These are strong charges.

It is quite extraordinary, in the face of the facts just presented, that Prof Thilaganathan can both deny that the test will result in more deaths of babies with Down’s syndrome, and claim that the miscarriages prevented will be almost 20 times higher than the RAPID and Chitty studies predict.

Does he know something we don’t, or is he deliberately misleading the public and parliament in order to advance an ideological and commercial agenda?

The burden of proof is upon Thilaganathan and St Georges to reveal the scientific evidence supporting his claims, or if there actually isn’t any, publically to apologise to DSUO, the public, people with Down’s syndrome and their families and parliament itself for telling lies. 

At very least these latest developments should lead Jeremy Hunt to reflect more on the concerns raised by DSUO and the communities of Down's syndrome families they represent before deciding to invest scarce health service resources on this new venture. More questions need answering and more public scrutiny is required.

Meanwhile I'll be taking a closer look at some of the commercial interests and ideological drivers behind the scenes driving these new tests. Watch this space.

Friday 5 August 2016

How should Christians respond to new biotechnologies?

In recent years we have seen an explosion of new biotechnologies bursting on the scene, with promise (or threat) of much more.

In vitro fertilisation (IVF) has opened the door to embryo experimentation, egg and sperm donation, surrogacy, embryo selection, pre-implantation genetic diagnosis, embryonic cloning, animal human hybrids, mitochondrial replacement and now gene editing.

Nanotechnology opens the possibility of ‘engineering’ minute biochemical systems at an atomic level.

Cybernetics merges human tissue with mechanical or electrical devices in order to restore lost function or enhance human abilities. With retinal implants, cyborgs – part human, part machine – may be just around the corner.

New drug treatments and enhancements are taking human performance to new levels: viagra to enhance sexual performance and modafanil to heighten concentration and memory.  

Humanoid Japanese robots can blink, smile, walk, talk, express anger, sing and provide healthcare.

Most of these so-called ‘advances’ have been justified on the grounds that they will prevent human suffering or lead to new treatments. Undoubtedly many will. But what biblical principles should we use to evaluate these diverse new biotechnologies from a Christian perspective?

First, as Christians, we must pray to be like the ‘Men of Issachar’ (1 Chronicles 12:32) who both ‘understood the times’ and ‘knew what to do’. John Stott popularised the principle of double-listening saying that as Christians we must approach the world with the Bible in one hand and the newspaper in the other – listening both to God’s Word and God’s World.

Second, we must realise that ethical approaches based on a secular worldview are inadequate for dealing with these dilemmas. We cannot simply rely on uncritically accepting the world’s principles. It’s not enough, as some moral philosophers are saying today, to say that we should just do good, respect choice and act fairly. How are we to define ‘good’, ‘bad’ or justice without any agreed moral framework? What do when choice and justice conflict? And what is it that defines a person to whom we owe these responsibilities? Are humans with severe dementia ‘persons’ with right? Are fetuses? Are embryos? These key questions need to be answered from a biblical perspective first.

Third, we need to embrace a biblical view of humanity.  Thomas Sydenham taught that human beings have dignity because they are created in the image of God and because the Son of God became a man. We are not just the product of matter, chance and time in a godless and purposeless universe, but the product of intelligent divine design. We are godlike beings made for the purpose of knowing, loving and serving our creator forever.

Fourth we need to understand that there are limits to what we can legitimately do technologically to human beings. Professor of Neonatology John Wyatt has described human beings as ‘flawed masterpieces’. On the one hand, we are masterpieces made in the image of almighty God – analogous to the creation of a great painter or sculptor. On the other hand, we have become cracked and flawed over time – needing restoration and ultimately re-creation. In attempting to restore the human body we must be guided by the creator’s intentions. There is a difference between restoration and enhancement and there are also limits to our powers of restoration.

Fifth, we must keep an eternal perspective. The ultimate goal of the secular transhumanists is immortality and the elimination of disease. The most extreme amongst them believe that perfect health and unlimited lifespans are within our grasp using some of these new tools.  But as Christians, whilst we value the blessings of medicine, we look forward ultimately to the resurrection rather than the genetic revolution or cybernetics for our restored bodies. We need to be good stewards of technology but we should not seek to ‘build heaven on earth’.

Sixth, we must learn to embrace a wider love. Jesus told the parable of the Good Samaritan in response to the question ‘Who is my neighbour?’ In telling the parable he taught the expert in the law who asked it what was he needed to do actually to be a neighbour even to those with whom he felt no human bond, regardless of age, size or degree of deformity.  The baby with special needs trapped inside a non-functioning and dying body is as valuable as the greatest athlete. The embryo in the petri dish is as important as the colleague in the laboratory who lends us a pencil. The child scraping an existence on a rubbish heap is as important as a world famous scientist.

Seventh, we must keep ends and means in balance. In God’s economy, the end never justifies the means – we must do God’s work God’s way. It can be very tempting to dispense with biblical principles such as the sanctity of life or the purity of the marriage bond in finding solutions to some of the vexing challenges in medicine and society. But we can’t justify breaking God’s commands in pursuit of some perceived greater good. This principle has profound implications for what we do with fetuses and embryos in particular.

Finally, in all this, we must keep the cross of Christ central – being prepared to follow in the footsteps that Jesus himself walked. Carrying the cross means two things. First, it calls us to stand up for the truth whatever the world may throw at us – to risk reputation, credibility and career if the situation calls for it. But carrying the cross also involves being part of the solution. Jesus did not live in blissful disengagement from the world, like the Buddha. By contrast, his life was one of painful engagement and involvement. He became part of the solution – and this must surely mean that we must be committed as his followers to fulfilling our role as God’s stewards, to use our God-govern gifts and abilities in God’s way to help provide just and compassionate solutions for human suffering whatever it may cost. That is our mission. 

Tuesday 2 August 2016

High Court rules in favour of NHS providing 'HIV prevention drug' but big questions remain

The High Court has today ruled that the NHS in England can fund a drug that can reduce the chance of people catching HIV whilst engaging in high-risk sexual activities.

NHS England had previously argued that local councils should provide PrEP ('pre-exposure prophylaxis') as 'health prevention' is their responsibility.

But Mr Justice Green said that NHS England had ‘erred’ and that both it and the local authorities were able to fund the drugs. Summing up, he said:

‘No one doubts that preventative medicine makes powerful sense. But one governmental body says it has no power to provide the service and the local authorities say that they have no money. The clamant [the National Aids Trust] is caught between the two and the potential victims of this disagreement are those who will contract HIV/Aids but who would not were the preventative policy to be fully implemented.’

The ruling has understandably evoked praise from gay rights campaigners and AIDS charities but consternation from NHS England which intends to appeal the decision. They are concerned about the effectiveness of the strategy, the precedent it creates for funding other 'disease prevention' measures and the way resources might be drawn from other health priorities were it to get the go-ahead.

The once a day pill known as PrEP, trade-named Truvada, consists of two antiretroviral medications used for the treatment of HIV/AIDS (tenofovir and emtricitabine or TDF-FTC) and costs £400 a month per person. The total cost to the health service could be in the order of £10-20m.

It is currently used in the US, Canada, Australia and France to help protect the most at-risk gay men.

According to the CDC (Centers for Disease Control) PrEP is for people who do not have HIV but who are at substantial risk of getting it.  It should be used in combination with other 'HIV prevention' methods, such as condoms, but even in these circumstances is not foolproof.

The CDC reports studies have shown PrEP reduces the risk of getting HIV from sex by more than 90% when used consistently. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70% when used consistently.

But these figures are what is achievable with good adherence (consistent use), and many of those most at risk are very likely not to adhere with taking the pills regularly.

An authoritative Cochrane review is far less reassuring. Overall, results from four trials (Baeten 2012Van Damme 2012Grant 2010Thigpen 2012) that compared TDF-FTC versus placebo showed a reduction in the risk of acquiring HIV infection by about 51%.

Marked differences between the studies were attributed to differences in levels of adherence.

As one major review has concluded:

‘The efficacy of PrEP is dependent on adherence, and adherence to PrEP medications in efficacy studies has been variable, raising questions about whether persons who are prescribed PrEP in clinical settings will be adherent enough to derive protection.’

Furthermore the drug’s use may in fact lead to a paradoxical increase in other sexually transmitted infections (gonorrhoea, chlamydia etc) by encouraging more high risk behaviour from those who have been lulled into a false sense of security.

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

I have previously blogged on the fact, surprising to some, that morning-after pills don’t actually cut teen pregnancy rates and instead increase the incidence of sexually transmitted infections (see also here). 

The term ‘risk compensation’ has also been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers, feeling more secure, are thereby encouraged to drive more recklessly.

In the same way making PrEP freely available to already promiscuous homosexuals could well encourage more sexual risk-taking and more sexually transmitted disease as a result. Any effect on decreasing HIV transmission rates is then cancelled out by rising levels of promiscuity.

Many will be shocked at the levels of promiscuity reported in these high-risk groups. In one study in the Cochrane database, during screening, participants reported an average of 12 coital acts per week with an average of 21 sexual partners in the previous 30 days.

It is only when these facts are known that the highly addictive nature of high-risk sexual activity, especially amongst male homosexuals, becomes evident. PrEP is not a prevention strategy at all. It is rather a harm reduction strategy aimed at lessening the damage that people addicted to high-risk sexual behaviours are doing to themselves. More akin to clean needles for drug addicts, filter cigarettes for smokers, protective gloves for compulsive burglars or seatbelts for habitual joy-riders.

As has been recently argued with respect to PrEP for drug addicts, 'PrEP is not ready for our community and our community is not ready for PrEP'. We need instead to address the underlying structural drivers and social context of the HIV epidemic and ask what it is that actually leads people to behave in this way. 

PrEP may reduce the risk of HIV transmission significantly but it does not eradicate it. That is because it is not actually a 'prevention' strategy at all but a 'harm reduction' strategy. And lack of adherence and ‘risk displacement’ simply add to the problem. This means that those who rely on PrEP for protection against HIV are still effectively playing Russian roulette, with the willing assistance and collaboration of health professionals.

NHS England is right to challenge this judgement. We will need much more evidence that PrEP is truly effective in practice before embarking on this strategy, which brings us back to the bottom line in all this: The only way of preventing HIV infections, as opposed to reducing the chance of catching them, is by avoiding the high-risk sexual behaviours that lead to them.