Tim and Garry have both picked up on Nadine Dorries’ sudden decision to turn off the comments facility on her ‘blog’:

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Posted Thursday, 1 November 2007 at 00:00

I am no longer going to post comments on my blog.

Please don’t send any more comments – It’s a time thing, I don’t have any.

I have to rely on the patience of others to read and post the comments for me. I am never in front of a computer for more than a couple of minutes at a time and this has now made reading the comments before they are posted impossible.

Knowing that there are comments on my site which I may not even have had time to see, makes me uncomfortable.

Although, as both have rightly noted, what she is actually finding uncomfortable is the little matter of getting caught in the act of making an utter specious and dishonest allegation, in the inevitable Science and Technology Committee ‘minority report’ issued by Dorries/Bob Spink, in regards to an article by Dr Ben Goldacre which appeared in the Guardian (27 October) and on Ben’s always excellent Bad Science blog.

In the report, Dorries (and Spink) make the following comment:

We were greatly concerned to read in the Guardian on 27 October an article clearly aimed at undermining the credibility of Professor John Wyatt, which contained detailed information about Wyatt’s evidence, which was passed by him to the committee after his oral evidence session, and which could only have been passed on to the journalist concerned by a member of the Select Committee. There should be an enquiry about how this information got into the public domain and as to whether such a personal attack represents a serious breach of parliamentary procedure given that witnesses were told by the committee that any disclosure of personal interests would not prejudice the hearing of their evidence.

But as Ben happily explains:

My article did indeed contain detailed information about Prof Wyatt’s evidence, but I suspect any enquiry set up to examine how I managed to obtain that information would finish its work well before the first set of tea and biscuits arrived, since all the facts came from the written evidence published openly and in full during the select committee hearing. There’s nothing clever about what I do, let me promise you.

In fact as I made perfectly clear at the time, if you look here:

www.parliament.uk/documents/upload/SDAevidence.pdf

You will see in full all of the documents I used to write my article, examining the striking inconsistencies in Prof Wyatt’s unpublished claims.

And, as you’ll find from reading any of the relevant threads, a number of people have attempted to contact Nadine via her (heavily moderated) ‘blog’ comments to query the statement in the report in light of Ben’s startling admission that he used – gasp – publicly available information to question Dr Wyatt’s findings, comments that neither made it through moderation nor met with any response other than Nadine’s sudden decision to throw up the ‘too busy’ signs.

What no one – as yet – appears to have noticed is this statement earlier in the same report:

10. The committee has given too much space in its report to evidence on both sides that has not yet been published in peer-reviewed journals. These ‘findings’ should be removed from the report and should not be used to inform Parliament (eg. EPICure 2, Dr Ellie Lee, UCLH neonatal survival rates).

Let’s take each of these sets of ‘findings in turn.

EPICure2 is, effectively, a repetition of a previous longitudinal study(called EPICure, obviously) carried out in 1995 – a study which was most certainly published in a peer-reviewed journal (Costeloe K, Gibson AT, Marlow N, Wilkinson AR. The EPICure Study: Outcome to discharge from hospital for babies born at the threshold of viability. Pediatrics 2000 Oct;106(4):659-71), with a number of enhancements in terms of the amount and type of data being collected, as explained here:

EPICure 2 will collect information on all babies born in England during 2006 between the gestational ages of 22 weeks and 26 weeks + 6 days. All labour wards will record any birth between these gestations and this information will be sent to EPICure 2. A small section of the cord attached to the placenta will be looked at under a microscope to look for evidence of infection or inflammation occuring in the womb before the baby was born.

Information on babies and mothers after birth is already collected, by an organization called CEMACH, as part of our national statistics. We have worked with the people responsible for this to adapt their collection system during 2006 so that we can repeat EPICure. Two forms will be filled in by the people who looking after these babies on Neonatal Units. One will tell what happens during the first 28 days of life and the second covers day 29 until discharge from hospital.

EPICure 2 will include more details about mothers and their pregnancies than the original EPICure did. To do this we have additional help from obstetricians, lung specialists, pathologists as well as statisticians, epidemiologists and neonatologists.

So far as giving ‘too much space’ to preliminary data from EPICure 2, the majority report includes this information on EPICure 2:

33. To assess recent advances in neonate survival on a national level, a new EPICure study is underway, dubbed EPICure 2, which will assess outcomes for every baby born at 26 weeks 6 days of gestation or less in England during 2006. The new study will include more variables than the original, including a breakdown of newly developed geographically-based neonatal networks and of individual neonatal intensive care units (NICUs). Although the results of this study are not yet published or peer-reviewed, we have been told that they show considerable improvements at 24 and 25 weeks of gestation. However, we were also told by the BAPM that:

early indications are that, for infants below 24 weeks of gestation, the survival to discharge home was very similar between the cohort of 1995 and that of 2006. Headline figures of approximately 10-15% survival were found. This is important for those working in perinatal care, who in general, do not believe that the survival for babies born below 24 weeks of gestation has improved to such an extent that they would see any value in redefining the lower limit of viability. Naturally a small number of these infants below 24 weeks of gestation do survive but BAPM would be concerned that a lowering of the legal definition of viability would imply that quality survival has improved for infants below the present limit of 24 weeks. The evidence for the UK population, to date does not support this.

34. This view was confirmed in oral evidence by Professor Neil Marlow who is one of the lead investigators of the Epicure study.

Following which, the report goes on to note – in bold:

35. Caution needs to be applied to unpublished data (see footnote 34) but the least the Committee is able to conclude is that we have not heard any evidence from Epicure that survival rates below 24 weeks gestation have significantly improved and we draw this to the attention of the House.

36. We understand that the EPICure 2 results will not be published for some time. It is unfortunate that the published data may not be available in time fully to inform debate in the House. We hope that the emerging findings are published as soon as possible.

And, for further clarity, footnote 34 reads as follows:

Note to reader: We place high value on the scientific publication and peer review process and note that these data have not been peer reviewed or published. However, we can be sure that the design of the study is good, since it was awarded competitive funding that is rigorously peer reviewed from the Medical Research Council, and there is not other study like it to which we could turn.

So, yes, the data from EPICure 2 have not yet been published and peer-reviewed, hence information on its preliminary findings is citing with accompanying, and entirely appropriate, cautions, which is exactly as it should be.

Dorries seems particularly keen to exclude the evidence from consideration – enough to object to its inclusion not once, but twice:

Reasons for late presentations

We asked for evidence by Dr Ellie Lee should be removed as it is based almost entirely on data from a study which has not been published in a peer-reviewed journal.

Why is that?

Well, obviously, to understand that you have to know what this evidence is, which turns out to be the following paper:

Second trimester abortions in England and Wales, Ingham R, Lee E, Clements S, Stone N (2007) (pdf)

It’s not a peer-reviewed journal paper, true, but then its not a clinical study either.

What it is, is a social policy study (Lee is a sociologist not an MD) looking at the underlying reasons behind second trimester abortions, one that tries to find answers to the question of why some women delay the decision to have an abortion until a relatively late (but currently legal) stage in pregnancy (i.e. beyond 13 weeks gestation).

The report, itself, was published in April this year, is freely available from the website of the Centre for Sexual Health Research (and has been since April) and received some coverage from the BBC at the time of publication – and having read the paper there is nothing in its contents or construction that a reasonably competent undergraduate, clinician or even MP couldn’t understand or evaluate.

It is however – and this is why I suspect that Dorries is so keen to have it excluded – the only piece of substantive evidence that gives any kind of voice to women who have faced up and taken the decision to have an abortion, this being the single most important ‘voice’ in the debate and yet the one most often not heard.

What the majority report of the committee had to say on the subject of Lee’s evidence was:

66. There are a number of findings from this study, and others like it, that are worth consideration:

a) many women who present for late abortions do so because they did not know they were pregnant or did not know that their pregnancy was as far advanced as it was;

i. abortions at over 18 weeks of gestation are particularly associated with women who take a long time to discover that they are pregnant;

ii. women who had an abortion at over 21 weeks had reached a gestation of at least 18 weeks 2.5 days prior to taking a pregnancy test, compared with 9 weeks of gestation for those who had abortions at 13-15 weeks;

b) many women present for late abortions because they struggle to take the decision to have an abortion.

Before going on to briefly reference the issue of ‘abortion tourism’.

As far as its final ‘recommendations’ are concerned, what the committee had to say, quite reasonably, is:

69. We believe that consideration of these matters and the production of guidance would be better enhanced by better collection of data relating to the reasons why women present for late abortions and how many women travel overseas for late abortions, and appropriate analysis of such data, with due regard to the need to protect the confidentiality of patients.

70. We invite Members of Parliament to consider what research has to say about the impact that an alteration on the upper time limit would have on those women who present late for abortions.

Quite – and by implication of course, considering the evidence on why some women present late for abortion is something that Dorries apparently thinks MPs should not have the opportunity of doing.

However most interesting of all Dorries states that amongst the unpublished findings that should not, in her opinion, be used to inform parliament is the data of UCLH (University College London Hospital) neonatal survival rates.

Now, on the 23rd October, Dorries has this to say on her ‘blog’:

I believe that the RCOG may have deliberately attempted to mislead the Science & Technology Committee in its submission.

It failed to mention how in the UK at good neonatal units such as UCH London and Hope hospital in Salford, 43% of 23 weekers live.

And yet a mere week later she want the data on survival rates at UCLH excluded from the committee’s majority report.

Why?

Well, because this is the data provided by Professor Wyatt. Remember him? The same Professor Wyatt that Ben Goldacre wrote about in the article that prompted Dorries to include this in the report:

We were greatly concerned to read in the Guardian on 27 October an article clearly aimed at undermining the credibility of Professor John Wyatt…

So in the same report, she’s concerned that Ben Goldacre was trying to (allegedly) undermine Professor Wyatt’s credibility while at the same time arguing that Wyatt’s evidence – which she was talking up less than a week later and castigating the RCOG for (allegedly) ignoring – should have been excluded from the report.

It’s perfectly evident what’s going on here – irrespective of Wyatt’s personal or professional credibility, the evidence he gave to the committee has been picked apart and discredited both by Ben Goldacre and by the committee itself (pp 18-22 of the majority report) which arrived at the same basic conclusions as Goldacre.

As with the other evidence she wants excluded from the majority report, its not the publication/peer review status she finds problematic, but the fact that the evidence undermines her own preferred stance and the arguments she would prefer MPs (and the public, of course) to consider.

Another tendentious argument deployed by Dorries in the minority report and well worth noting is this one:

3. Some witnesses who have been given prominence in the Committee Report included very few, if any, scientific references in their written submissions (See especially Derbyshire and RCN submissions).

…the significance of which only becomes apparent when one digs into the majority report and the written evidence provided to the committee, although its alluded to here:

4. Some key witnesses who would have given a contrary view to the RCOG consensus, especially on upper limits, were either ignored or not invited to submit evidence (see especially Professor Stuart Campbell and Dr KJ Anand)

Neither Campbell or Anand appeared as witnesses before the committee, but this does not mean that their work was not raised and addressed.

So far as Campbell’s 3D ultrasound system is concerned, three written submissions referred to it direct, two of which – those of the Family Planning Association and – wait for it – the Royal College of Nursing put it in its proper context, as follows:

2.2.2 One of the key technological developments since 1990 has been the ability to view the developing foetus in increasing detail via 3D and 4D ultrasound scanning. These images provide a three-dimensional view of the foetus and have been used to demonstrate the close resemblance of the foetus to a neonate, in an attempt to strengthen the claims of those opposed to abortion that killing a foetus is analogous to killing a neonate. The RCN’s view is that 3D and 4D imaging only serves to reveal what is already known, but with greater clarity.

The only submission to treat Campbell’s work uncritically is that of the Scottish Council on Human Bioethics, which sounds impressive although its not as official as its name suggests, as this shows:

Formed in 1997 the Scottish Council on Human Bioethics is an independent, non-partisan group composed of doctors, lawyers, psychologists, ethicists and other professionals from disciplines associated with medical ethics.

It’s a voluntary organisation, although independent, non-partisan, blah, blah still sounds good… especially when its submission to the Science and Technology builds on that statement with an important addition:

The Scottish Council on Human Bioethics (SCHB) is an independent, non-partisan, non-religious registered Scottish charity comprising doctors, lawyers, psychologists, ethicists and other professionals from disciplines associated with medical ethics.

Non-religious too? Sounds even better or at least it would sound good is others weren’t carelessly giving the game away:

The Scottish Council for Human Bioethics, with whom CARE for Scotland works closely, is inviting applications for a number of studentships in the area of bioethics.

CARE is ‘Christian Action Research and Education’ a “well-established mainstream Christian charity with 100,000 supporters which provides resources and helps to bring Christian insight and experience to matters of public policy and practical caring initiatives” according to its own website, and if that’s not enough of a give away then the advert for studentships concludes with this testimonial:

“This is an excellent programme in which the highest confidence can be placed. Its aim of giving a grounding in the ethical principles of medicine as understood in the Hippocratic/Judaeo-Christian tradition make it unique in the United Kingdom.”

– Dr Robert Song, Durham University

Dr Song, I might add, is a senior lecturer in Durham University’s School of Theology and Religion and the fact that SCHB describes itself as a “non-religious”charity doesn’t actually mean that its ‘non-religious’ it just means that its not registered the purpose of promoting religion as one of its charitable objects.

As for Dr Anand’s work, this segment of the majority report explains much:

Although we did not receive evidence from Professor Sunny Anand, nor did any of those originally submitting evidence refer to his work or publications, we did consider a review article co-authored by him which was published recently,  together with submission from Dr Stuart Derbyshire which offers commentary upon it and refers to Dr Anand’s earlier work in this area.

And the committee’s conclusions after reading Anand’s paper and Derbyshire’s commentary?

We note that the main thrust of his important previous work has been to show neonates have better outcomes when provided with anaesthesia and analgesia during surgery and other stressful procedures and that noxious stimuli during gestation can have a detrimental impact on the long-term development of an infant; we have been unable to see the direct relevance of this work to the question of abortion.

Which, from my own reading of some of Anand’s work is much as I expected.

Notice how the two submissions that Dorries picks out for specific criticism for not including many references (Derbyshire’s provides an overview of his professional status and the RCN is, of course, the RCN) are the two that most clearly address the limitations of the work of her ‘pet’ experts, Professor Campbell and Dr Anand?

(And by ‘pet’ I mean only that she’s picked up on their work as being useful to her position and am not implying any relationship between any of the parties).

Lack of copious references is not necessarily a valid criticism of a submission – it all depends who’s making the submission and their level of eminence and expertise in the relevant field. Would, for example, a committee investigating developments in IVF and human fertility question the validity of a submission by Robert Winston because he didn’t submit a formal journal paper with 20 or 30 references to published works?

Of course it wouldn’t.

As with most of what Dorries has had to say as a member of this committee, about those taking a pro-choice view of abortion, there is little or no substance to her comments and, lacking any substantive evidence to support her own position, she has resorted, instead, to little more than launching a series of thinly – and not so thinly – veiled ad-hominem attacks on individuals and organisations whose work and opinions threaten to undermine her efforts to impose greater restrictions on access to abortions.

If anyone has brought the whole committee process into disrepute then its Nadine Dorries, and its she – if anyone – who deserves to be investigated.

The Code of Conduct for MPs states, quite clearly, that:

Members shall at all times conduct themselves in a manner which will tend to maintain and strengthen the public’s trust and confidence in the integrity of Parliament and never undertake any action which would bring the House of Commons, or its Members generally, into disrepute.

And so far as I can see, Dorries’ ‘minority report’ and her antics while serving as a member of this committee have done little else but bring the committee and parliament into disrepute.