Friday, 9 May 2008

Yes, but what about the evidence? Nadine Dorries and the BMJ

This morning my Grauniad was carrying a story about new research, published in the BMJ, that suggests survival rates for premature babies born before 24 weeks are very low and have not improved, despite advances in medical care.

Now, I haven't actually read the whole study, but I've glanced at the abstract. It's a cohort study that looks at births of babies between 20 and 26 weeks in the Trent health region in the UK over two time periods: 1994-9 and 2000-5. The study found that although there was a significant increase in the number of surviving babies in 2000-5, this was attributable to an increase in survival rates for babies born at 24 and 25 weeks. There was no significant increase in survival rates for babies born before 24 weeks.

This is an important finding because the House of Commons will soon debate whether to lower the lower the legal cut-off point for most abortions from 24 weeks to 20 weeks. One of the arguments has been that advances in medical science mean that more and more babies born before 24 weeks are surviving. The research shows that this appears not to be the case.

What to do if you're on the side of the debate that wants a reduction to 20 weeks? If you're Nadine Dorries MP, you go in for some textbook fallacious reasoning, relying in particular on ad hominem and argument from incredulity.

No improvement in neo-natal care in twelve years? Really? So where has all the money that has been pumped into neo-natal services gone then? A baby born at 23 weeks today stands no better a chance of living than it did in 1996? This report is the most desperate piece of tosh produced by the pro-choice lobby and it smells of one thing, desperation.

Well, the evidence seems to suggest that a baby born at 23 weeks today really does stand no better chance of living than it did in 1996. It's no good just saying you don't believe it; you need to explain why that interpretation of the evidence is incorrect. Dorries also describes the British Medical Journal as the "trade magazine" of the British Medical Association. Because the BMA funds a pro-choice group, research published in the BMJ can be dismissed as emanating from the "pro-abortion lobby". In fact, the BMJ is a peer-reviewed medical journal, publishing "original scientific studies, review and educational articles, and papers commenting on the clinical, scientific, social, political, and economic factors affecting health." It is something more than a trade magazine, and for Dorries to describe it as such is disingenuous to say the least.

As I say, I have not read the whole paper. For all I know, there may be some problems with it. But Dorries is simply not contributing to a useful debate by dismissing the study out of hand. The paper gives us the evidence, and it is up to us, as a society, to decide what to do about it. We can't do that by falling back on fallacious reasoning that supports our pre-conceptions.

Update: Dorries continues to mis-represent the BMJ paper, writing that "For the BMA to argue that the survival rates of neo nates born 12 years ago should endorse the 24 week limit today, is, as I said yesterday, an act of desperation, but one that suits me and the media opportunities such a biased piece of 'research' provides." First of all, it is not the BMA that is doing the arguing. The research was conducted by a team working in the Department of Health Sciences at the University of Leicester. Second, the paper compares data from 1994-9 to data from 2000-5. Where Dorries gets '12 years ago' from is anyone's guess. Again, it is no good simply stating that the work is 'biased'. You need to explain why it is biased. I'm fairly sure that Dorries can't do this.


Anonymous said...

I love it when people respond to studies by asking questions of the study that can be answered by the study itself. Nadine asks: "So where has all the money that has been pumped into neo-natal services gone then?"
Erm, the study showed a significant increase in the number of surviving babies, [...] attributable to an increase in survival rates for babies born at 24 and 25 weeks. The money 'pumped into neo-natal services' might just have had something to do with this increase in survival rates.

Nadine seems to think (or to want us to think) that if you put money into neo-natal services then that money will automatically lead to an increase in survival rates for babies born at <24 weeks. We've seen the government put money into services before and yet there has been no obvious benefit - let alone an obvious benefit specific to one particular group or section of the services being funded. I'm afraid it is just not that simple. Nadine, on the other hand, really is just that simple.

I agree that Dorries is falling back on fallacious reasoning that supports her pre-conceptions - and well done for calling her on it.

Paul Wilson said...

Cheers jdc. That point you make regarding 'money pumped into neo-natal services' is a good one. It seems to have increased survival rates for the 24 and 25 week births.

Dorries is just saying that her argument must be true because it must be true.

Stephen said...

I caught a mention of this in the news headlines on the Today programme quoting Nadine as saying (paraphrasing from memory),"Ah yes there may be no increase in survival 23 weeks and eariler, and an increase in survival for 24 weeks and older....but that's not the point: the majority of abortions are performed on healthy, viable foetuses...". Where does that come from? What information does she have to support that? I suspect - none.

Paul Wilson said...


Yes, that assertion appears to be, to put it politely, total bollocks. According to the editorial that accompanies the BMJ paper, "Of the 193,700 abortions that were recorded in 2006, 2% were at 20 weeks’ gestation or over." The editorial references this report of the House of Commons Science and Technology Committee (see page 10).

This would seem to suggest that the vast majority of abortions are performed on foetuses that are not 'viable'.

censored said...

In this case the money does appear to be well-spent, to improve survival rates at 24-25 weeks.

But studies like this that need to be done in order to prove that.

To take the extremes - babies "born" at 8 weeks are simply not going to survive no matter how much money you spend and how much you wish the cluster of cells is a baby.

Likewise at 40 weeks, you don't need investment as the baby will probably survive.

It's just those grey areas in the middle that you need the statistics for, and not just wishful thinking. And what good is spending millions of pounds if there really isn't much hope anyway?

Le Canard Noir said...

We should be careful of not falling into Nadine's trap of thinking that if survival rates improve <24 weeks then we should lower the time limit for abortions. It is a non-sequitur.

Paul Wilson said...

Le Canard Noir:

I agree entirely, which is what I was trying to get at when I wrote "The paper gives us the evidence, and it is up to us, as a society, to decide what to do about it."

If it was found that survival rates were increasing for babies born before 24 weeks, that doesn't mean the limit should be reduced to 20 weeks. We should bear that evidence in mind, but it's up to us to decide whether, and on what grounds, a change should be made.

pj said...

Dorries is clearly bonkers - but she does have a point about one thing - if you accept that viability has anything to do with abortion - foetuses born prematurely are likely to be less healthy, and thus viable, than those that are electively aborted (this is going to be more likely to be true for earlier abortions as many late abortion are for foetal abnormalities after the 20wk scan).

Dr Aust said...

None of this is a surprise, because Mad Nad is an Evangelical Christian zealot and is, judging from her statements on this and the "Hand of Hope", and other things, either a fool or a liar.

Her response in this case consists in effect of saying "nyah-nyah, not listening, if it doesn't agree with me it must be wrong, nyah nyah"

Just the kind of respect for facts that one wants in our elected representatives.

I really hope every national newspaper and TV station publicizes her latest idiotic outburst as widely as possible, together in every case with one or other BMA talking head or other eminent doctor standing up to say she is wrong. Robert Winston would be good. The more public scorn and ridicule the woman attracts the better. As I have said before, I simply cannot believe the Tories put her on the Education and Skills Select Committee. I know they are a bit short of working class women Tories, but if Nadine is the best they can do they have a problem.

And were I a betting man I might have a small wager that Mad Nad will be featuring in Ben Goldacre's column tomorrow.

Dr Aust said...

PS If anyone wants to read a discussion of what the survival chances really are of a pre-24 wk baby, and see the real numbers, then the BMJ produced an informative paper based around the 1995 statistics some years ago, which can be found here.

The numbers are sobering, and not in a way that would make Nadine happy.