Religious right can give you cancer

Published in Tribune, 29 June 2007

LIKE most cancers, cervical cancer is unpleasant, painful and deadly. It is the fifth most common form of cancer in women worldwide, and it kills about 1,000 women in Britain each year. The symptoms are harrowing, the treatment invasive and the death painful.

Most cancers are caused by an opaque mix of genetic and environmental factors, making it difficult for experts, let alone lay people, to make judgements about how to keep risks to a minimum. But cervical cancer is different. Research in the early 20th century revealed a strong correlation between sexual activity and cervical cancer – and eventually identified the culprit. It wasn’t the sex itself that caused the illness, but a sexually-transmitted infection caused by the human papillomavirus (HPV). Most strains of HPV are relatively harmless – they are the cause of veruccas and warts – but a handful can lead to cancers. So it should have given everyone great hope when a new vaccine was unveiled last year which trials show can protect from the HPV strains that cause more than two thirds of all cervical cancers worldwide.

Last week, a committee of experts convened by the British Department of Health recommended that the vaccine be rolled out to schools across Britain (the jab works best when given before a girl becomes sexually active), and that an immunisation campaign should begin as soon as practical. With a high take-up rate, in time, there could be around 700 fewer deaths a year, which supporters of the vaccine claim would more than justify the relatively high cost (just under £250 for a course of injections). Within a few years, girls will be routinely immunised against cervical cancer.

Problem solved? Not quite. As so often with vaccines, controversy lurks in the shadows. With most controversial immunisations, opponents claim dangerous side-effects of the drug – witness the furore over the measles, mumps and rubella vaccine (MMR) a few years ago, when some parents claimed the injection had made their children autistic. Although this type of anti-vaccination feeling is usually based on a misunderstanding of the risks of vaccination, it is at least rational in one sense: it recognises that vaccines do subject the individual to a (small) risk of side-effects, in return for a benefit to the whole of society. This goes to the core of how vaccines work: they work most effectively when enough people get inoculated that there are too few potential victims for the disease to spread efficiently – a concept known as “herd immunity”.

This is the unspoken – and morally repugnant – logic of the chattering classes’ opposition to MMR. It’s rather like trade union membership, where dues and, in certain workplaces, management bullying might make union membership seem arduous. It can be hard on the individual union member sometimes, but in a properly unionised workplace, everyone is stronger.

But the concerns that some have raised about the cervical cancer jab aren’t related to its side effects. Nor are they related to the technicalities of herd immunity, or the morality of some people relying on it. With this new vaccine, the alarm bells have been sounded by the Christian right. Taliban-style fundamentalist pressure groups like the Christian Institute have railed against this “sex jab” being given to teenage girls. Making sex less dangerous, they say, will cause a moral collapse and lead to ever more promiscuity among the young (presumably in the same way that tetanus vaccination leads people to dance on beds of rusty nails and seat belts encourage people to crash their cars for fun).

The answer, they say, is not to give girls a simple and almost painless jab – it is to make abstinence the goal of sex education in schools. And when this doesn’t stop the spread of HPV and cervical cancer (because, let’s face it, telling people not to have sex is probably a bit of a non-starter) we should presumably continue with the current barbarism of invasive and undignified butchery on the operating table, followed by the pain and sickness of chemotherapy, where, in seven out of 10 cases, a couple of injections would have done the job better.

This kind of opposition seems extreme, even from a callous fringe group such as the Christian Institute, who, judging by their hilarious PrayerLine telephone news service, have a strange obsession with gay sex, Peter Hain and Jerry Springer: The Opera (“Pray that the show will be cancelled,” its recorded voice intones, without the slightest hint of irony). Remember, this is a vaccine which has the potential to save 700 lives a year in this country alone – even if, from their twisted perspective, these deaths are caused by sin. The only possible conclusion to draw from the Institute’s opposition is that they believe in the death penalty for promiscuity. And it gets worse.

They appear not to care if this death penalty is unpredictable (not everyone who gets infected with HPV goes on to get cancer), nor do they appear to mind if bystanders get hurt (loyal wives of cheating husbands are a key “at-risk” group). And worst of all, they seem to be indifferent to this death penalty being entirely focused on women – after all, men don’t have a cervix. If that’s what a god of love wants, it would be truly terrifying to encounter a wrathful one.

No glowing report for nuclear consultation

Published in Tribune, 1 June 2007

IN A fanfare of no publicity at all, the Government’s “consultation exercise” on nuclear power has been launched. Hidden away on the fourth page of Google results when you search for “nuclear consultation”, is a link to a drearily-designed page on the website of the Department of Trade and Industry. If you register your name and email address, as well as details of your profession, and click “open, sesame”, the drab, detail- and-graphic-free page cracks open, and an Ali Baba’s cave of interactive e-government is revealed. Inside, the glittering jewels of open and free debate on the future nuclear power plant-building programme shine in the warm glow of good intentions... well, not quite.

First of all, I suspect, most people don’t realise the consultation is on. Most of those who do will have no idea how to contribute (and the nicely hidden spot in Google hardly helps). Those who get to the website will, more often than not, turn away when the site asks for their personal details before they even get to see the section which asks for their views.

But let us for a moment imagine that a few educated and tech-savvy citizens, wishing to make their voices heard on this issue, manage to find their way through the maze of obfuscation and actually do contribute to the process. What will they find?

A chance to submit their opinions in their own words? Carefully designed multiple-choice questions like those used by opinion pollsters? A balanced presentation of the opposing views to help them come to a conclusion? Nothing of the sort.

What appears instead to be the sum total of the DTI’s consultation is a set of 18 precise and loaded questions (which you can answer with up to 3,000 characters each). Among the enlightening (and uniformly circumlocutious) questions are gems like “What are the implications for the management of existing nuclear waste of taking a decision to allow energy companies to build new nuclear power stations?” and “Do you agree or disagree with the Government’s views on reprocessing? What are your reasons? Are there any significant considerations that you believe are missing? If so, what are they?”

But don’t answer just yet. Should you need help, a 136-point bullet list of helpful information is included – every word of it as incomprehensible as the last.

Even if we assume goodwill on the part of the Government – and the secretive history of the nuclear sector in Britain should warn us not to – this is no way to run a public consultation.
Quite apart from the blatant obfuscation, the exercise is flawed in a more insidious manner: it makes the question of nuclear power seem an entirely technocratic one. Are the plants safe? Is the technology proven? Will the new power stations be cost effective? All these seem like simple questions with yes-or-no answers.

But in fact, as is so often the case with scientific and technical issues, the facts of the argument are inseparable from what people make of them, and the most worthwhile questions are not simple technical ones but complex, socially framed ones. Even those questions in the consultation which are not blatantly loaded (many of them plug the suggestion that nuclear is an obvious solution to global warming, something many environmentalists take issue with) do not reflect the complex tapestry of scientific and social factors that must inform any decision the government takes on nuclear power.

Most people are not technically trained, and will not be able to come up with meaningful answers to the questions the DTI asks. And so they are excluded from a process which values technical expertise above lay opinion, experience and knowledge.

All of this matters because public opposition to scientific and technical projects, whether they are new vaccines, chemical factories or agricultural sciences, is often driven by a feeling of disenfranchisement. The first step towards convincing people is to listen to them, not to lecture them. The mantra of “the experts must know best” is harmful – and not just because it alienates people: it is also quite untrue.

In the aftermath of the Chernobyl explosion, when radioactive pollution settled on the hills of Cumbria, numerous hill farms were contaminated by radioactive particles in the rain. It became painfully and rapidly clear the government experts sent to advise local farmers on how to deal with the aftermath were useless. Grazing patterns, animal behaviour, the lay of the land – in all these areas, the hill farmers’ knowledge far outstripped that of the professionals. After months of trying to impose their solutions on increasingly frustrated farmers, whose sheep their half-baked experiments were slowly killing, the “experts” had to engage with the locals when they finally understood the limitations of their knowledge. But the acrimony – and months of wasted work – could have been avoided, had they come in with a little less arrogance and a little more respect for the views of normal people.

And so, by failing to hold a genuine, bona fide consultation exercise, the Government risks not only alienating those it could hope to bring on side: it also loses out on the local knowledge that might make the difference between safe power and nuclear disaster.