Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 246-259)


17 OCTOBER 2007

  Q246 Chairman: We welcome our second panel to our inquiry this morning. Thank you all for coming. I introduce you for the record: Rev Dr John Fleming, bioethics consultant representing the Society for the Protection of Unborn Children; Dr Peter Saunders, General Secretary of the Christian Medical Fellowship; Anne Quesney, Director of Abortion Rights; and last Anne Weyman OBE, the Chief Executive of Family Planning Association. Welcome to you all. I am trying to be fairly strict in this inquiry. We are looking at the science and how that has changed so that we can inform any future changes to legislation. We expect there will be amendments to the Tissue and Embryos Bill in the new Parliament. That may or may not come about and, if it does, we hope that our inquiry will be able to inform any debate on that matter. Dr Fleming, how do you go about assessing the quality of evidence so that you can form a view? What criteria do you use in assessing the scientific evidence that is available? Is that a fair question?

  Dr Fleming: It is a fair question. The institute of which I am a member, Southern Cross Bioethics Institute, has on its staff people who are scientifically qualified. We are very careful in setting down certain criteria by which we assess the evidence. We do not set ourselves apart from the broader scientific community. We read the literature and we try to be as objective and fair with that literature as we can be because the establishing of scientific fact is a profoundly ethical issue. That is, we have to sort out what is true from what is untrue from what is controversial or controverted. For example, you will find in our submission here on the question of the link between breast cancer and abortion that our position is equivocal in the sense that we are not persuaded that that is the case. There may be some other groups that would and have taken a very different view but we try to be as objective as we can without fear or favour for any particular philosophical or ideological view that we might hold.

  Q247  Chairman: Would you not quote anything unless it was peer reviewed, for instance?

  Dr Fleming: We would cite stuff that was not peer reviewed but we would take into account that it is not peer reviewed. In other words, we are not going to exclude anything in advance on the basis that the sole repositories of all wisdom and knowledge are to be found in peer-reviewed journals, prestigious as they are; there is a body of information that we take into account as well. Where scientific data is concerned, we balance that with the more rigorous standards that would obtain in peer-reviewed journals.

  Q248  Chairman: Anne Quesney, how does your organisation evaluate the evidence? What are the criteria?

  Anne Quesney: We try to be as objective as possible by looking at historic evidence, by looking at international evidence and scientific evidence to see really what in the end we believe is in the best interest of women. To give you an example, if you go back to the situation prior to 1967, for instance, it is very clear that women's health and women's lives were not taken into account. I think it is very clear that access to abortion has been of huge benefit to women. Looking at scientific evidence across the board, I think it becomes very clear that that is a recognised fact.

  Q249  Chairman: In terms of evaluating the evidence, again it would be peer reviewed mostly and where it was not, you would make that clear?

  Anne Quesney: We try to look at a variety of reviews because I think you have to be critical in the field that is so complex. A lot of the time we tend to have a very scientific approach but in many ways abortion is also a very practical issue for women. That also needs to be taken into account.

  Dr Saunders: I am here representing the Alive & Kicking Alliance, which is 10 organisations, seven of which have made written submissions. I am also here in my capacity as General Secretary of the Christian Medical Fellowship, which is an organisation with 5,000 UK doctors and 1,000 UK medical students asmembers.

  Q250  Chairman: In terms of the evidence—

  Dr Saunders: As CMF, we are doctors who are trained in assessing scientific evidence. We quote almost exclusively peer-reviewed studies that have been published in journals but, like John Fleming, we would take other evidence into account if we felt that, although not yet peer reviewed and published, it was making an important contribution to the debate. Examples might be Ellie Lee's study from Southampton, EPICURE II, or the study from University College Hospital London that was reported earlier this week on neonatal survival rates and presented at a medical conference. Generally, we are looking to peer-reviewed studies but we do make some exceptions.

  Q251  Chairman: If EPICURE II for instance demonstrated, having been peer reviewed, that there was no evidence to suggest that babies born at 23 weeks had any greater chance of survival than they did a year ago or 10 years ago, would you accept that?

  Dr Saunders: If EPICURE II is published in a peer-reviewed journal, then I think it becomes part of the body evidence that one must consider in coming to conclusions about the viability of neonates at the threshold of life. We have quite serious reservations about the first EPICURE study for two reasons. Firstly, we believe that it was a lowest common denominator study that averages survival rates across a whole range of different units, from centres of excellence to regional hospitals; and, secondly, because we believe that EPICURE is not just now providing evidence about neonatal survival but has actually taken the position of a guideline in the sense, as was reported in the Sunday Times last week, that some neonatologists are simply not "trying hard enough" for babies at the threshold because they believe that they will not survive. We think that along with EPICURE, we need to take into account the best studies from centres of excellence. One of the ones that has been quoted this week and is in our own evidence is Hoekstra's study from Minneapolis which showed survival rates for 22 weeks, 23 weeks and 24 weeks.[1]

  Q252 Chairman: I am not getting into that. I am trying to establish principally how you actually assess your evidence. That is all I am trying to do at the moment. How does the fpa assess their evidence? The point I am trying to get at is: how do we get a level playing field for this committee to decide on the evidence? It is important that we get your views on this.

  Anne Weyman: The whole rationale behind fpa's work is the provision of information, particularly to the public, which is based on the best evidence that is available. That is on a whole range of topics: contraception, sexually-transmitted infections, abortion, pregnancy choices and the different routes women can take if they have an unintended pregnancy, and on planning of pregnancy. There is a whole range of areas. It is a complex task to assess the evidence. Obviously we work from published studies. We also work very much with professionals who have great expertise in the field. We have expert advisers whom we consult when we are looking at evidence and putting forward information. Obviously we want to go for the most reliable scientific evidence, the peer-reviewed studies. Sometimes you have to look at other information because you do not have a full range of information from the peer-reviewed studies. That is the way that the professional bodies also work when they produce guidance for professional practice. You have a hierarchy and you have to assess the quality of that evidence for any statements that you going to make and any views that you are going to form.

  Q253  Dr Harris: I think what our inquiry is going to do is not recommend how people should vote on changing the law. What we are going to try to do is say what we think the evidence says in so far as the science, although there will be other factors—feminism and the sanctity of life—which other people will use to trump that sometimes, perhaps frequently. That is why we are concentrating on the science side of this. In so far as the science is concerned, just to follow up what Mr Willis was saying, Dr Saunders, if you were trying to judge the science of where viability was and EPICURE II was published in a peer-reviewed journal and it suggested that viability was still 24 weeks, if I can use that shorthand, would you give that more credence in any way in your view on the narrow question of where viability is, not where the upper time limit should be, than an unpublished, un-peer-reviewed case study from one hospital, like that you have cited from the Sunday Times? Would you accept that there is a difference in quality there for that narrow question?

  Dr Saunders: EPICURE I has been published in a peer-reviewed journal; EPICURE II has not. The study referred to on Monday was presented at a scientific meeting and gave figures for University College Hospital London. However, there are a number of other peer-reviewed studies from centres of excellence around the world.

  Q254  Dr Harris: I am talking about this country. I should have made that clear. I will put the question again. For this country, for where viability is for women in this country, in the narrow question of viability, talking theoretically now since you have taken me down EPICURE I, if there was a peer-reviewed published study that said 24 weeks was still the case and that was across the country multi-centre, would you give that greater weight than an individual non-peer-reviewed, non-journal published report from one hospital, whether that is more or less?

  Dr Saunders: I think that there is a much bigger body of evidence than you are implying. I think that any doctor coming to a conclusion—Could I finish, please?

  Q255  Dr Harris: I would love you to finish but I would really love you to answer my question, which is not asking you to look at the evidence. I am asking you a theoretical question. I am not asking you to search the world or your mind for other studies. I am just asking: if there was a peer-reviewed study that was national, that was published, would you give that greater weight than an unpublished, non-peer-reviewed report from a single hospital on the narrow question of viability? I have asked this three times now.

  Dr Saunders: Yes, I would but I think when we are coming to conclusions about viability, it would be quite inappropriate and irresponsible to ignore the vast amount of international data about foetal viability from the very best international centres and concentrate just on UK data that has been very widely criticised.

  Dr Harris: You have to understand that we have your written evidence. You have made that point in your written evidence. We just have to get through this oral session.

  Chairman: Dr Harris, I am coming on to viability in a minute.

  Dr Harris: I want to ask several questions. Lots of our submissions have selected papers, as it their right, and interpreted them. Do you accept that there is a practice which is to say: Let us have an independent body do the systematic review—not ourselves, whether it is fpa, Abortion Rights or your organisations with an agenda—that controls essentially for the instinct just to select the argument on either side that supports it? Do you think that is a legitimate thing to do? Do you think the Royal College of Obstetricians and Gynaecologists is a reasonably independent organisation that can look at the whole literature and not be tempted? I put that to Dr Saunders and to Dr Fleming.

  Q256  Chairman: Can you answer that question as briefly as you can?

  Dr Saunders: Yes, I do think there should be independent panels which look objectively at all of the studies that are available. I think there is a temptation for people on both sides of this argument to cherry-pick the studies that back up their position. I think that criticism could be made of several of the written submissions that have been made. I have serious reservations about the Royal College of Obstetrics and Gynaecology guidance on abortion, firstly, because it was published in September 2004.

  Q257  Dr Harris: I was not asking about the guidance but about whether they are independent enough to set up a panel that would do it. Dr Fleming?

  Rev Dr Fleming: Yes, I do think in principle it is a good idea to have clearing houses where data is assessed and has as objective an account as possible given of the data because of the tendency of all organisations to cherry-pick those studies which may support a pre-existing position. You mentioned in your question about organisations with an agenda. With great respect, I do not know of an organisation that does not have one and if you do I would be very glad to know what it is. RCOG is not what I would regard as a body that would be good for that. I think it ought to be some sort of body which has clearly a representative collection of individuals, where the various agendas, as you put it, can rub against each other to some extent. If you are going to be absolutely honest about this, not one of us here does not have an agenda. If we accept that that is the case in all honesty and we then say okay, how can we derive some kind of clearing-house or houses which can look at the evidence in the best way possible—

  Q258  Dr Harris: What comparative group should we be using to distinguish between the health risks of abortion versus covariate factors? In other words, if you are looking at women who have had abortions, what is the best comparator group? Is it all women? Is it women who are mothers? Is it women with pregnancies that are wanted? Is it women who have unwanted pregnancies but cannot get an abortion? Which do you think is the right comparison?

  Rev Dr Fleming: The answer is all of those. I think any research worth its salt has got to take account of the various conditions of the persons involved from whom you are seeking information otherwise you are likely to come to lopsided conclusions. I do not think that any reasonable research can just simply ignore particular groups of women. If there is a medical procedure being done on a group of women, presumably with their full knowledge and consent, then any adverse outcomes have to be measured against those who have not had such a procedure, whatever the procedure might be and then you are going to have to look at the sub-groups where there might be confounders which you have to take into account.

  Q259  Dr Harris: How do you take into account confounders in choosing the right comparator group? How does one deal with confounders? The suggestion is that it is best to compare women who have abortions with women who have all the same backgrounds and have unwanted pregnancies and where a higher proportion of them have drugs misuse issues and domestic violence issues and so forth but who cannot get abortions to see whether the abortion itself has had an impact on that group of women. Do you think that is powerful or do you think it is flawed?

  Rev Dr Fleming: It depends on the risks you are after. If you are after the psychological sequelae, that might be the case. If you are after the physical risks to the women of a particular medical procedure, that might not be so appropriate. You really need to determine what are the risk areas that you want to examine before you can decide how you are going to do it.

1   Note from the Witness: As 32%, 66% and 81% respectively. Back

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