When ideology drives science – intellectual dishonesty in the ‘abortion/breast cancer’ and ‘change therapy' debates

In July 1949, the New England Journal of Medicine printed an article by Dr Leo Alexander titled 'Medical Science under Dictatorship'.

In it, he explains what happens to science when it 'becomes subordinated to the guiding philosophy' of a political ideology.

'Irrespective of other ideologic trappings', he argues, the 'guiding philosophic principle of recent dictatorships' is to replace 'moral, ethical and religious values' with 'rational utility'.

Alexander eloquently demonstrates how 'medical science in Nazi Germany collaborated with this Hegelian trend' and became the source of 'propaganda' which was 'highly effective in perverting public opinion and public conscience, in a remarkably short time'.

This expressed itself in a rapid decline in standards of professional ethics and led ultimately to the German medical profession's active participation in 'the mass extermination of the chronically sick' and of 'those considered socially disturbing or racially and ideologically unwanted'.

Britain is not Nazi Germany and is a democracy rather than a dictatorship. However, all democracies are also susceptible to influence by well organised minorities and it is very clear, in this post-Christian society, that the corridors of power are increasingly filled by those who do not subscribe to a Christian worldview and values.

In fact, many of those who occupy positions of influence in our 'mountains of culture' – universities, schools, media, judiciary, parliament institutions and entertainment industry – are actively hostile to Christianity and supportive of public policy directions consistent with a secular humanist agenda – eg. pro-choice on abortion, supportive of 'assisted dying', embryo research and same sex marriage.

These issues are of course highly political. But is there any evidence that the 'medical science' marshalled to support them is in any way being influenced or shaped by secular humanist ideology?

Two articles in the latest edition of Triple Helix would say 'yes'. They make the case that financial or ideological vested interests can be used to stifle the truth when medical issues become highly politicised. Both articles question the way that British Royal Colleges have handled scientific evidence in their support for a certain public policy direction.

Donna Harrison, Executive Director and Director of Research and Public Policy at the American Association of Pro-life Obstetricians and Gynaecologists (AAPLOG), argues that the Royal College of Obstetricians and Gynaecologists (RCOG) has misrepresented available scientific evidence to support its view that there is no link between abortion and breast cancer.

She explains why a link between abortion and breast cancer is entirely biologically plausible and points out how oft-quoted studies which deny such a link 'often resort to errant methodology which obscures the actual scientific question they were purported to answer'. She singles out for particular criticism a frequently cited meta-analysis by Beral et al on which the RCOG leans heavily in formulating its abortion guidance. She then cites a 2014 meta-analysis of 36 studies by Huang et al which looked specifically at the relationship between induced abortion (IA) and breast cancer. It found that IA is significantly associated with an increased risk of breast cancer among Chinese females, and that the risk of breast cancer increases as the number of IAs increases.

Peter May, retired GP from Southampton, takes issue with the Royal College of Psychiatrists (RCPsych) over their opposition to 'change therapies' for unwanted same sex attraction. He accuses the College of locking itself into a 'born gay' ideology by ignoring the evidence to the contrary. The College's argument that causation is 'biological' has led to the widespread belief that LGB people are being 'true to their nature' in homosexual behaviour. Yet twin studies do not support this view and in 2006, a major Danish study reported, 'population-based, prospective evidence that childhood family experiences are important determinants of heterosexual and homosexual marriage decisions in adulthood.'

The position of the RCOG on the abortion breast cancer link, and the RCPsych on the causation of homosexual orientation, have both been profoundly influential on public policy. In fact the latter has even helped shape policy within the Church of England.

These College positions will remain crucially influential this year with the Department of Health about to issue guidelines on abortion and Parliament about to consider legislation seeking to ban 'change therapies'.

It is part of the role of Triple Helix to highlight issues like this so that our readers can participate in these debates in a fully informed way. They have profound implications, not just for public policy, but also for fully informed consent.

As Peter May concludes, 'We have a mandate to be passionate and honest about truth and to strive to teach it accurately. All truth belongs to God, and all untruths deny him. We must insist that love and truth are essential values in public discourse.'

This editorial initially appeared in the Spring 2014 edition of Triple Helix

Radio Four debate on ‘change therapies’ for unwanted same-sex attraction

This morning I took part in a short documentary on the Radio Four Sunday programme on ‘change therapies’ for those with unwanted feelings of same sex attraction.

The presenter was Ed Stourton (pictured).

‘Change therapy’ (more accurately SOCEs - sexual orientation change efforts) is aimed at altering the strength and direction of sexual feelings and is currently banned in the UK by counselling organisations such as the BACP and UKCP. ‘Change therapists’, however, continue to practise under auspices of professional counselling bodies in the US and Canada.

The UK ban is primarily on the basis of the argument that sexual orientation is biologically caused and fixed, that change is therefore impossible and that therapy aimed at change is harmful (I have previously critiqued this view here, here and here).

The Sunday Programme item was prompted by a debate earlier in the week in the Houses of Parliament where Professor Michael King of the Royal College of Psychiatrists and Gay Rights Activist Peter Tatchell took on Consultant Psychiatrist Joseph Berger and therapist Mike Davidson (See my previous reviews of the arguments Tatchell and King presented).

The Sunday Programme piece was reported by Trevor Barnes and featured six interviewees – Mike Davidson, Di Hodgson, Pamela Gawler-Wright , myself and two clients who had experienced change therapy. It was commendably well-balanced.

You can listen to the whole (8 minute) piece on I-Player here (starts at 30.50 and ends at 38.30).

The programme began by playing an interview of a man who had not found ‘change therapy’ helpful and ‘left very quickly’.

This was followed by the testimony of ‘Robert’, a 55 year-old man, now divorced, who had struggled for years with a promiscuous homosexual lifestyle. He explained how he had sought Christian therapy to help him to change:

‘I had been allowing myself to be labelled by an activity. In fact I realised I was in bondage to that addiction in my life. Through the help of counselling, through the help of my pastor, through the help of an accountability elder that I had within my church I came to understand that my identity is not in the things I did, for example in the act of homosexuality. My true identity is in Christ’

I argued that with some groups of people, as with Robert, counselling and other forms of therapy can be successful :

‘The evidence shows that some people will experience a change in the strength or direction of their sexual feelings either spontaneously or with therapy from a skilled therapist. People who experience a dissonance between their feelings and their values or desires will sometimes seek professional help and if they can harmonise their lifestyle choices with their values then they do feel better.’

Di Hodgson, chair of the Diversity, Equalities and Social Responsibility Committee of the UK Council for Psychotherapy (UKCP), questioned the very principles underlying the therapy:

‘I think there is very conflicting evidence. But in some ways, to me, that’s really not the right question to ask, if I may say, because whether or not something works doesn’t mean that it is ethical or in the public interest or the right thing to do for someone. So we have taken a view in a way which is regardless of the scientific findings. We still believe that it is unethical to seek to agree or to work towards changing someone’s sexual orientation through psychotherapy.’

I thought this was quite an extraordinary admission by someone speaking on behalf of an organisation that seeks to de-register therapists who practise ‘change therapy’ on the pretext that it does not work.

A psychotherapist, Pamela Gawler-Wright, was then interviewed. She claimed that she had personally met many people who had been harmed by ‘change therapy’.

Mike Davidson, a therapist who has been suspended by the UKCP for practising ‘change therapy’, conceded that it is not for everyone but argued that clients should not be banned from seeking it:

‘Any therapy in the wrong hands is potentially damaging but therapy that overrides a person’s right to choose the pathway that suits them and is consistent with their own values is damaging. So I’m not arguing that everybody should change, or that everybody can change, but I think people need to have the right to explore the possibility if that is what they want.’

He went on to argue that much of the objection to ‘change therapy’ is not actually evidence-based but rather ideology-driven.

‘I think one of the reasons that there is such a reaction to this is that it is perceived to be a threat to the idea that homosexuality is innate and therefore unchangeable. Anything that comes along that demonstrates that actually the reverse is true, that in some cases it can be changed - and certainly homosexual feelings can be reduced and sometimes eliminated - is a threat to that ideological position.’

‘Robert’ later gave more of his testimony:

‘Through Christian counselling I now have a true understanding of my identity. My identity is not based on an activity. It’s based actually on a relationship with Jesus Christ . It’s that knowledge that is the source of my liberation. It’s that knowledge that is the source of my freedom. Is it wrong for a Christian counsellor to help me find that?’

Pamela Gawler-Wright responded by outlining her concerns that ‘change therapists’ start from a belief that homosexuality is wrong, is caused by unhappiness, and causes unhappiness. She objected to what she saw as the underlying ideology and ethical framework.

I concluded by arguing for a more even-handed approach:

‘People already can have ‘gay affirmative therapy’ which affirms their feelings and helps them to harmonise their lifestyle choices with those feelings. So we think there should be a level playing field and that people who would like to harmonise their lifestyle choices with their values should be able to have professional help for that as well.’

The programme, perhaps for the first time, gave an opportunity for those of us who support appropriate ‘change therapy’ to give our side of the argument. It also brought out clearly the point that objections to change therapy seem to be based much more on ideological grounds than on evidence.

I have previously on this site critiqued the arguments that have been used to discredit ‘change therapy’ (see links above) and would recommend to anyone wanting to know more detail about the evidence to read the booklet ‘Unwanted Same Sex Attraction’ which is available on the CMF website.

Some ‘change therapies’ are harmful and some ‘therapists’ are not properly trained but I cannot see why people seeking this kind of help should not in a free society have access to professional accredited therapists who are in sympathy with their values.

Change therapists are free to practise in the US and Canada under the auspices of their professional bodies but not in the UK. This seems to be primarily because those people who oppose ‘change therapy’, on seemingly ideological as much as evidence-based grounds, have managed to get into positions of power in the UK organisations that accredit therapists and put these bans in place (more on this here).

My hope is that this Radio Four documentary will be one small step towards that beginning to change.

Professor Michael King applies double standard to evidence on homosexual change therapies

A woman who is happily married with children falls in love with another woman but is desperate to keep her marriage together. Should she be able to accept professional help to deal with her unwanted feelings of same sex attraction?

A bisexual man wants to marry his girlfriend but is worried that his residual feelings of erotic attraction to other men might jeopardise the relationship. Should he be able to seek professional help?

Currently in Britain the answer is ‘no’ but these questions were at the very heart of a fascinating debate that took place in the House of Commons this week under the title ‘Sexual reorientation therapy: Freedom to change?’

The event was subtitled ‘Should people be able to change their sexual orientation?’ and was billed as being ‘a debate about the legitimacy and freedom to offer sexual reorientation when many professional bodies are banning such therapies’.

‘Change therapy’ is psychotherapy or cognitive therapy aimed helping people who wish to change the strength or direction of their sexual desires. These therapies are more correctly termed SOCEs (sexual orientation change efforts).

When a person’s sexual desires and values don’t match up they might seek professional help either to help them overcome guilt so that they can participate freely in same sex behaviour (gay affirmative therapy) or alternatively to deal with feelings of same sex attraction so that they can abstain (change therapy). But only the first kind of therapy is currently approved by professional bodies. Is this fair and justified? We were about to find out.

Dr Michael Davidson of CORE Issues (who is about to undergo a disciplinary procedure for using change therapy) and Canadian psychiatrist Dr Joseph Berger (who uses it regularly) were supporting change therapy.

Psychiatrist Professor Michael King (who is its most vehement UK critic) and gay rights campaigner Peter Tatchell were against it.

Although members of the mainstream press were present the debate has so far been reported only by Christian Concern, Pink News and Gay Star News.

Tatchell and King essentially argued that homosexual orientation was biologically caused and fixed, that change was impossible and that change therapies were damaging and unethical.

I have already blogged about Peter Tatchell’s inconsistent views on the causes of homosexuality and now turn my attention to Michael King.

Michael King (pictured) is professor of psychiatry at University College London (UCL) and is head of the UCL mental health sciences unit which specialises in ‘psychiatric epidemiology, molecular genetics, health services research and randomised trials of complex treatments in primary and secondary health care’.

He also chairs the Royal College of Psychiatrists' Gay, Lesbian and Bisexual Special Interest Group which has advised the College on its Social Inclusion Report and its submission to the Church of England Listening Exercise on Human Sexuality. King was lead author of this latter submission. His website www.treatmentshomosexuality.org.uk was set up in 2008 as a discussion forum but appears to have attracted little interest.

King’s views have been extraordinarily influential and his submission to the Church of England is widely quoted.

The British Association for Counselling & Psychotherapy (BACP) makes reference to it in its September 2012 statement of ethical practice and, according to the Guardian, has written to its 30,000 members saying that it is unethical for them to attempt to ‘convert’ gay people to being heterosexual.

The UK Council for Psychotherapy (UKCP), representing training organisations and over 7,500 individual therapists, has welcomed the BACP’s stance and in fact issued a similar statement in 2011.

The Pan American Health Organisation (PAHO) - a regional branch of the WHO - released a similar statement in May 2012 claiming that ‘therapies’ to change sexual orientation ‘lack medical justification and represent a serious threat to the health and well-being of affected people’.

King’s argument at the debate went as follows:

He first asked if homosexuality was a condition that needed treatment and said that it had been removed from the Diagnostic Screening Manual of mental health conditions (DSM III) in 1973 ending ‘millennia of prejudice, stigma and oppression’.

He then said that we did not know the cause of homosexuality (contrary to Tatchell’s ‘new’ view) but that it ‘had nothing to do with a person’s relationship to their father’.

He added that there was no evidence, in terms of randomised controlled trials, showing that change therapies worked and that all published studies purporting to show their effectiveness fell below this ‘gold standard’.

He concluded, on the basis of his first three points, that the use of change therapies was unethical.

He then turned to the question of whether those offering change therapy should be free to practise, and argued that all the relevant professional organisations (RCPsych, BACP and UKCP) had issued warnings about change therapies and did not accept them.

Finally he asked whether patients should be free to seek change therapy and said that this question was being raised in the context of a homophobic culture. People who wanted to reduce same sex desire should be able to pursue this but ‘did not need to rush to psychotherapists to do it’.

So in summary he argued that change therapies were ineffective, harmful, unethical and should not be allowed.

I was unable to get a question in to King during the plenary (I had used my one allowed question on Tatchell earlier!) so I asked King afterwards if there were randomised controlled trials which showed that change therapies were harmful or that showed gay affirmative therapies were effective.

He said there were not, but that there were cases studies and series of cases showing this.

I reminded him that there were also cases studies and series of cases showing that some change therapies were helpful for some people. He did not deny this (see CMF’s publication ‘Unwanted same Sex Attraction').

I then asked if he was applying a double standard by approving ‘gay affirmative’ therapies on the basis of case studies alone but barring change therapies (for which there were also supportive case studies) on the different basis that there were no randomised controlled trials supporting them.

He seemed unable to answer this question.

I then asked him if he was being less than fully transparent in his presentation of the evidence and less than even-handed in suggesting that change therapies should be banned whilst gay affirmative therapies supported. Again there was no real answer.

I then said to King that I actually agreed with him that some ‘change therapies’ were harmful and that some ‘therapists’ were not properly trained but that I could not see why people, like those whose case histories I outlined above, should not in a free society have access to professional accredited therapists who were in sympathy with their values.

I still fail to understand why change therapists are free to practise in the US and Canada under the auspices of their professional bodies but not in the UK. It seems to be primarily because of the actions of people like King.

Oh and one other thing. I was interested to listen in on King’s heated exchange with another questioner after the debate. Here he was turning from science to theology.

He said he was a ‘Christian’ and had been in a monogamous gay partnership for 30 years. He added that ‘Jesus said nothing about homosexuality’ and asked why God would have any objection to permanent monogamous gay partnerships. He said that he went to a ‘wonderfully inclusive church’ in Bayswater which welcomed him and that evangelical Christians were obsessed with sex.

I wondered if King's passionately held convictions about Christianity and his own life-style choices had had any influence on his reading and presentation of the evidence and why he had not declared any of these personal interests in his scientific writings on therapies for unwanted same sex attraction.

I also wondered why he and others were so determined to drive anyone offering change therapy from the public square.

Later that day I attended a fascinating talk which went through King’s submission to the Church of England in some detail arguing that he had misinterpreted and misrepresented the scientific papers he had quoted. King had been personally invited to attend this presentation but had opted not to.

I will return to that paper in more detail later.