Monday, 19 May 2008

Andrew Lansley and Nadine Dorries, perhaps unsurprisingly, don't read this blog...

During the second reading debate of the Human Fertilisation and Embryology bill, there was an interesting exchange between Andrew Lansley (the shadow health secretary) and Nadine Dorries MP, on the recent research into survival rates of extremely premature infants.

Lansley talks about the Trent study, that showed no increase in survival rates for infants born before 24 weeks:

The authors also report that no babies born at 22 weeks survived. Like other studies, they suggest that this might represent the limit of viability. I cannot say whether they are right, but I note that, of 150 babies born alive at 22 weeks over the whole period of the study in Trent, only 24 were admitted to intensive care. In the latest period, 2000-05, only nine were admitted to intensive care. From my point of view—I am not a scientist, but I can read statistics—in order to draw any conclusion from such a small number of cases, one would need to assess why those babies were being born so prematurely. Were they failing to thrive? Were they twins or other multiple births? Were they suffering from a genetic defect?

Abortions at 22 weeks would be of a foetus that was otherwise healthy, unless they were carried out on the specific ground of a prospective abnormality or handicap of the child concerned. So while such a baby would require intensive care, and doubtless very large numbers might not survive, I do not regard that study as providing conclusive evidence that a baby cannot be sustained at 22 weeks.

I would personally be loth to move from the principle of linking the time limit for abortion to the viability of the foetus. That is where it was established in 1967; it has moved over time. It is arguable, but I would argue personally that the evidence would support a further reduction—in my view, to 22 weeks—in order to ensure a prospective legal framework that could accommodate improving medical science.

To which Dorries has this to say:

I am sure that my hon. Friend is aware of other studies—for example, in University College hospital, London, and in other countries—showing that if poorly babies who are born prematurely receive immediate good neonatal care from a specialist dedicated team of staff, the outcomes are very much better. University College hospital figures are much better than those emerging from the Trent study. One conclusion from the Trent study is that anyone going into premature labour should go to University College hospital and not to the Trent region.

This is exactly what you can't conclude from a comparison of the Trent and University College studies. It's difficult to compare the studies, because the Trent study includes all infants 'alive at the onset of labour', while the UCLH study included only infants that were born alive. Another issue with the UCLH study is that the numbers of infants admitted to the neonatal intensive care unit varies wildly between the different time periods of the study. This may be because the number of subjects is so small, leading to a large amount of statistical noise. Or it may be because those time periods are not directly comparable, perhaps due to differing policies on which infants should go to the neonatal intensive care unit through time.

And Lansley replies:
My hon. Friend may have gathered from what I said that I am effectively arguing that in circumstances where neonatal intensive care was provided to all such babies born at 22 weeks and where the foetus was otherwise healthy—or rather the baby was healthy at that stage—the prospects for survival at 22 weeks may well be far greater than suggested by the negative view expressed in the study from Nottingham and Leicester. It is not for me to say any more than that, but I think that it provides a basis for reducing the limit—albeit, in my view, by just two weeks.

In fact, the Trent study (Nottingham and Leicester) is more likely to give an accurate idea of the prospects for survival, because it is a multi-centre study (including 16 hospitals in the Trent health region) while the University College study concentrates on a single hospital. So the Trent study is less likely to be confounded by selection bias, and includes a much larger number of subjects, leading to statistically more robust results. It's difficult to see how Lansley can come to the conclusion that the study 'provides a basis for reducing the limit', given that it shows there has been no change in survival rates before 24 weeks since the early 1990s. Happily, the lead author of the Trent study, Prof. David Field of Leicester University, has pointed this out.

There may be other reasons for seeking a reduction in the limit for abortions, but the Trent study is not one of them. To suggest otherwise is simply to misrepresent the research.


HolfordWatch said...

Well, they ought to read this blog. This constant parroting of things that they ought to know are untrue/inaccurate is wearing thin.

Is one of the issue that, as blogs, we don't have an easy way to submit complaints to newspapers and similar? Do we need a way that allows the League of Concerned Nerds (tm, Ben Goldacre, age 33 11/12 and 3/4 or thereabouts) to send letters to individuals and organisations?

In that way, we could complain to Jayney Goddard and her organisation about her distortions on The Wright Stuff, to Nadine Dorries about this material, and various other outrages of the day. If we had enough people who were able to comment, it would also permit press releases.

Paul Wilson said...

To be fair, I could hardly expect folks like Lansley and Dorries, who after all are very busy people, to read what is a fairly obscure blog. It might be an idea for them read Bad Science, though...

Lansley seems to be at least trying to make an honest argument that some infants born at 22 weeks do survive. But that hasn't changed since the last time the abortion limit was amended to 24 weeks.

Dorries, on the other hand, is not attempting to make an honest appraisal of the evidence.

You could imagine that something like Bad Science Blogs could put out press releases on some issues. But it would have to become a more centralised, organised thing, and I think that would probably go against the spirit in which it came about.

HolfordWatch said...

I do expect our elected representatives to instruct their research staff to carry out a thorough search, particularly when they are discussing such important matters.

And yes - anything that abhors 'centralisation or organisation' would end up being like herding cats.

So - carry on grumbling into the cornflakes and discussing with the members of the same choir (mostly) rather than attempt a contribution to the level of public discourse?

No merit to the idea at all? In which case, are we complaining/blogging as a method of venting, and for the benefit of some people who know how to conduct a blog search, or what?

Related to this post but something that I've been musing for a while.

Paul Wilson said...

Loads of issues here, I think.

In this case, Prof Field (the lead author of the Trent research) has stepped up to the plate and pointed out that his study cannot sustain Lansley's interpretation of it. It's perhaps a pity that, at least in the published comments, he has concentrated on Lansley rather than the far more egregious Dorries. However, that's a side issue. Prof Field is obviously a more authoritative voice in this debate than I am, and rightly so. I'm really just an amateur with a reasonable ability to look at research, stemming from my day job as a geologist. So the question is why would anyone be paricularly interested in what I have to say?

Doing press releases would be a good thing, I think, but you would have to be something other than just a bunch of bloggers, because no-one is going to take that seriously. Even so, Nadine Dorries seems to have become the go-to media person on abortion limits, despite her comments being almost entirely useless in terms of constructive debate. Would it be possible to create some umbrella organisation that becomes the go-to on scientific issues, by pooling expertise?

Of course, there would be nothing stopping me from writing letters to the editor and such like (and I have done this in the past). But what you're really talking about is something a level or two above that, I think. I don't think letters to the editor really do much to advance debate.

Just some disconnected thoughts, really. But it's an issue I've been thinking about to. What's the best way of converting blogging into useful results?

HolfordWatch said...

Yes, we (loosely speaking) are just a group of bloggers and the League of Concerned Nerds (tm). On the other hand, the Taxpayer's Alliance is pretty small yet remarkably effective: "The TaxPayers' Alliance, which claims to be "Britain's independent grassroots campaign for lower taxes", has popped up in our papers more than three times every day this year...
They boast 18,000 registered supporters of whom 3,000 have donated money, but their real success is media coverage. As well as providing comment, says Elliott, the TPA uses freedom of information laws to compile headline-grabbing reports, always giving an obvious "top line". "One journalist told me the TPA now does the work newspapers used to when journalists had the time to do investigations," he says".
They have an effective core staff of 3 (not paid afaik), one of whom is Wat Tyler from Burning Our Money.

For a more grassroots, less organised approach to a different audience than reads newspapers etc., I've been wondering about a cross between Captain Disillusion on YouTube and Jaime Pretell's debunking text and video reviews on Amazon.

Both of which are examples of going to where some people get their information from?