by Ben Goldacre
Pornography in Hospitals
Guardian, 25 September 2010
The Sun, of all people, is angry about pornography: ‘The hard-up NHS is blowing taxpayers’ cash on PORN for sperm donors, a report reveals today.’ The Telegraph immediately followed suit: ‘Some clinics provide pornography for men masturbating in clinic rooms to produce sperm for IVF with their partners.’
These articles were inspired by a report titled ‘Who said pornography was acceptable in the workplace’, produced by a right-wing thinktank called 2020health. The author, former Conservative parliamentary candidate Julia Manning, says pornography in this clinical setting is: a violation of the NHS constitution; a case of manipulation by the sex industry; strips women of their human status; an encouragement of ‘adultery of the mind’; a danger to men, as it introduces addictive material into their treatment (which ‘beggars belief’); and an abuse of taxpayers’ money.
The average spend on these magazines was £21.32 per health trust per year, with each clinic treating a large number of couples. For context, private clinics charge around £6,000 for a couple to have three cycles of IVF.
But the moral case may still stand: is the pornography necessary? Farmers, animal breeders and vets all have wide-ranging experience of getting viable sperm from male animals under artificial circumstances. As a result, they have examined this exact same question, in detail.
Hemsworth and Galloway showed in 1979 that sperm count in the ejaculate of a domestic boar (an actual boar, that’s not a euphemism for men) was significantly increased by allowing a ‘false mount’, or observation of another boar’s semen collection. We shouldn’t overstate this evidence: another study found that the effect seems not to be present in rams. But in 1984 Mader and colleagues studied twelve Hereford bulls, and found that watching another mating pair in action significantly increased frequency of ejaculation. In the same year Price and colleagues found semen collection from male dairy goats was faster with a ‘stimulus female’, which was present but unmountable.
This can hardly be a surprise. As long ago as 1955, Kerruish reported that insemination centres for cows did not provide ‘adequate sexual stimulation’ prior to semen collection: his regimen of intensive sexual stimulation resulted in a ‘marked improvement in sexual behaviour’ and – crucially for our question – an increase in the conception rate.
But it gets more interesting. There is already evidence from animal research that males increase the amount of sperm in their ejaculate when there is more competition around. In 2005, Kilgallon and Simmons conducted an experiment to see whether human males viewing ‘images depicting sperm competition’ also had a higher percentage of motile sperm in their ejaculates.
This wasn’t a perfect study: they compared ejaculate in fifty-two heterosexual men, looking at pornography with two men and one woman, against pornography with three women. I think it would have been better to compare images of one man and one woman, against two men and one woman, but there you go. They found that men viewing the ‘two men one woman’ pornography had a higher percentage of motile sperm. On a related note, Zbinden and colleagues found that male stickleback fish ejaculate more sperm after being shown a big rival than a small one.
But finally – and firmly on the question at hand – Yamamoto and colleagues in 2000 studied nineteen men masturbating into a jar, alone in a room, with or without ‘sexually stimulating videotaped visual images’. Sperm volume, total sperm count, sperm motility and percentage of morphologically normal sperm were all higher when the men had pornography. Meanwhile, some men find it impossible to ejaculate on the day it’s most needed for IVF, and sperm can only be retrieved by epididymal aspiration, or a needle inserted into the testicle. This is a seriously suboptimal outcome, with a small risk of unpleasant medical complications.
I’m not saying porn is brilliant. I absolutely agree that the objectification of women’s bodies is a bad thing, and I don’t particularly want to see porn lying around at work, although by the very nature of hospitals, you can see all kinds of dreadful things if you open the wrong door at the wrong time.
All I’m saying is: when there is a reasonable evidence base to show that pornography helps people overcome what they regard as a deeply painful problem (like ‘being childless’); when they’re going through the very strange and unpleasant experience of masturbating alone in a clinic room, with everyone outside knowing what they’re doing, and quite possibly some kind of queue; then however unpleasant you might find the intervention, research showing that pornography works, matters.
The Power of Ideas
The Atheist’s Guide to Christmas, 2009
I don’t mean to fill your Christmas with Aids and diarrhoea, but there is something awe-inspiring about the power of ideas alone to do great good, and great evil. Diarrhoea will be our happy ending. Aids will not.
There are the cheap shots. Africa is filled with miracle-cure peddlers: the Gambian president, Yahya Jammeh, claims he can personally cure HIV, Aids and asthma using magic and charms. The South African government fell for a cure built around nothing more than industrial solvent.
It’s all too easy to feel smug, and to forget that we have our own cultural idiosyncrasies. There’s compelling evidence, after all, that needle-exchange programmes reduce the spread of HIV, but the strategy has been rejected, time and again, in favour of ‘Just say no.’
And then there is the Church. In May 2009, as I write this, the Congolese Bishops’ Conference have triumphantly announced that they ‘say no to condoms!’ This idiocy goes to the heart of the Catholic faith. In March, on his flight to Cameroon, Pope Benedict XVI explained that condoms worsen the Aids problem, and he has been supported, in the past year
alone, by Cardinal George Pell of Sydney, Australia, and Cardinal Cormac Murphy O’Connor, the Archbishop of Westminster. ‘It is quite ridiculous to go on about Aids in Africa and condoms, and the Catholic Church,’ says O’Connor. ‘I talk to priests who say, “My diocese is flooded with condoms and there is more Aids because of them.” ’
Some have been imaginative in promoting their message. In 2007, Archbishop Francisco Chimoio of Mozambique announced that European condom manufacturers were deliberately infecting condoms with HIV to spread Aids in Africa. It is estimated that one in six people in Mozambique is HIV positive. Cardinal Alfonso López Trujillo of Colombia famously claimed that the HIV virus can pass through tiny holes in the rubber of condoms (air molecules are smaller than the HIV virus: blow a condom up, as a home experiment, to test if Trujillo’s claim is true). ‘The condom is a cork,’ said Bishop Demetrio Fernandez of Spain, ‘and not always effective.’ In 2005 Bishop Elio Sgreccia, president of the Pontifical Academy for Life, explained that scientific research has never proven condoms ‘immunise against infection’. He’s right, I suppose. All this explains why the Pope has proclaimed: ‘The most effective presence on the front in the battle against HIV/Aids is in fact the Catholic Church and her institutions.’
Casanova testing condoms
Meanwhile, development charities funded by US Christian groups refuse to engage with birth control, and any suggestion of abortion – even in countries where being in control of your own fertility could mean the difference between success and failure in life – is met with a cold, pious stare. These moral principles are so deeply entrenched that under George W. Bush, the US Presidential Emergency Plan for Aids Relief insisted that every recipient of international aid money must sign a declaration expressly promising not to have any involvement with sex workers, even though they are a key vector for HIV.
Equally, there are heartbreaking tales of Westerners with a whiff of science going off to the developing world. Matthias Rath is a German vitamin-pill salesman who moved into South Africa five years ago, taking out full-page adverts in national newspapers: ‘The answer to the Aids epidemic is here,’ he announced. The answer, of course, was a vitamin pill. He explained that antiretroviral medications were a conspiracy by the pharmaceutical industr
y to kill patients and make money. ‘Why should South Africans continue to be poisoned?’ he asked.
And he had taken his ideas to the right place. In South Africa alone, 300,000 people die every year from the virus; that’s one every two minutes. There are 1.2 million Aids orphans, and more than half of all pregnant women are HIV positive. And South Africa was headed by President Thabo Mbeki, an ‘Aids dissident’, as they prefer to be known. In the most crucial period of the Aids epidemic, the South African government variously claimed that HIV was not the cause of Aids, and that antiretroviral medications were not an effective treatment. It refused to roll out effective antiretroviral medication, it refused to accept gifts of money to give out ARV treatment, and it refused gifts of the pills themselves.
Mbeki’s Health Minister would appear on television to talk up the risks of antiretroviral medication and talk down its benefits, promoting garlic and sweet African potato as effective treatments for Aids. The South African government’s stall at the 2006 World Aids Conference in Toronto was described by other delegates as ‘the salad stall’, because that’s all it contained. It has been estimated that between 2000 and 2005, around 350,000 people with Aids died unnecessarily in South Africa as a result of these ideas. That’s quite a death toll, for some ideas.
How does this happen? Perhaps Aids is just too big to think about clearly. Twenty-five million people have died of it so far, three million in the past year: these figures are so vast, so overwhelming, that it’s hard to mount an appropriate emotional response.
Perhaps the undeniable crimes of the pharmaceutical industry make conspiracy theories about its effective products believable, lending them a kind of poetic truth. It does, after all, adhere to cruel and murderous pricing policies, and only this year, regulations were explicitly changed so that clinical trials conducted by American companies on people in the developing world are no longer subject to the same high ethical standards as those conducted on US citizens.
Pharmaceutical companies, of course, are not all bad, just as there are many good people in the Catholic Church (the overwhelming majority, I would imagine). And a cheap, single dose of the drug Nevirapine, we should remember, has been shown to reduce the risk of a pregnant mother passing on HIV to her baby by half.
But we are mistaken if we imagine that medicine moves forward through technology. In the past that was probably true: antibiotics, intensive care units, and all the tools and technologies of modern medicine are dazzling. But much of the power lies with simple ideas.
So, let me tell you about diarrhoea. What are our two biggest weapons against torrential watery stool? One is telling people to wash their hands: it’s been demonstrated that this can halve the spread of diarrhoea, and so it could save a million lives a year. The other is even simpler, and even more powerful: telling people to rehydrate, using water with added sugar and salt. This is new, it has been carefully researched and refined, and despite being a simple idea which anyone can follow, it has caused deaths from diarrhoea to plummet, saving at least fifty million lives since its universal adoption in the 1980s.
We can go higher. A hundred million people died in the last century from smoking. Around a billion are expected to die this century (because the cigarette industry has been so successful in China). But equally, tens of millions of lives will be saved, because Richard Doll and his colleagues diligently collected and analysed data on the smoking habits and deaths of a few thousand doctors fifty years ago to pull out just one key fact: smoking kills.
With this idea, with handwashing, with rehydration fluid, and with the methods and principles that gave us these ideas, a small group of softly-spoken saints have saved more people than you would meet in a thousand lifetimes.
The royalties from The Atheist’s Guide to Christmas will go to the Terrence Higgins Trust. I have seen the work they do up close, working in an HIV clinic in South London. THT offers practical support, but the most powerful work their staff do, to my mind, is in sharing information, destigmatising, informing, preventing infections and improving compliance with treatment regimes. Through the application of common sense, wit, compassion and evidence, they save lives. This is the future of medicine.
And it’s eight teaspoons of sugar and one of salt in a litre of water, if you ever need to know.
Merry Xmas.
‘Exams Are Getting Easier’
Guardian, 21 August 2010
Pass rates are at 98 per cent. A quarter of grades are an A or higher. This week, every newspaper in the country was filled with people asserting that exams are definitely getting easier, and other people asserting that exams are definitely not getting easier. The question is always simple: how do you know?
Firstly, the idea of kids getting cleverer is not ludicrous. ‘The Flynn Effect’ is a term coined to describe the gradual improvement in IQ scores. This has been an important problem for IQ researchers, since IQ tests are peer referenced: that is, your performance is compared against everyone else, and the scores are rejigged so that the average IQ is always 100. Because of the trend to higher scores, year on year, you have to be careful not to use older tests on current populations, or their scores come out spuriously high, by the standards of the weaker average population of the past. Regardless of what you think about IQ tests, the tasks in them are at least relatively consistent. That said, there’s also some evidence that the Flynn effect has slowed in developed countries recently.
But ideally, we want research that addresses exams directly. One approach would be to measure current kids’ performance on the exams of the past. This is what the Royal Society of Chemistry did in its report ‘The Five Decade Challenge’ in 2008, running the project as a competition for sixteen-year-olds, which netted them 1,300 self-selecting higher-ability kids. They sat tests taken from the numerical and analytical components of O-level and GCSE exams over the past half-century, and it was found that performance against each decade rose over time: the average score for the 1960s questions was 15 per cent, rising to 35 per cent for the current exams (though with a giant leap around the introduction of GCSEs, after which the score remained fairly stable).
There are often many possible explanations for a finding. These results could mean that exams have got easier, but it’s also possible that syllabuses have changed, so modern kids are less prepared for older-style questions. When the researchers looked at specific questions, they found that some things had been removed from the GCSE syllabus – because they’d moved up to A-level – but that’s drifting unwelcomely towards anecdote.
Another approach would be to compare performance on a consistent test, over the years, against performance on A-levels. Robert Coe at Durham University produced a study of just this for the Office of National Statistics in 2007. Every year since 1988 a few thousand children have been given the Test of Developed Abilities, a consistent test (with a blip in 2002) of general maths and verbal reasoning skills. The scores saw a modest decline over the 1990s, and have been fairly flat for the past decade. But the clever thing is what the researchers did next: they worked out the A-level scores for children, accounting for their TDA scores, and found that children with the same TDA score were getting higher and higher exam results. From 1988 to 2006, for the same TDA score, A-level results rose by an average of two grades in each subject.
It could be that exams are easier. It could be that teaching and learning have improved, or that teaching has become more exam-focused, so kids at the same TDA level do better in A-levels: this is hard to measure. It could be that TDA scores are as irrelevant as shoe size, so the finding is spurious.
Alternatively, it could be that exams are different: they might be easier, say, with respect to verbal reasoning and maths, but harder with respect to something else. This, again, is hard to quantify. If the content and goals of exams change, then that poses difficulties for measuring their consistency over time, and it might be something to declare loudly (or to consult employers and the public about, since they seem concerned).
> Our last study thinks more clearly along those lines: some people do have clear goals from education, and they can measure students against this yardstick, over time. ‘Measuring the Mathematics Problem’ is a report done for the Engineering Council and other august bodies in 2000, analysing data from sixty university maths, physics and engineering departments which gave diagnostic tests on basic maths skills to their new undergraduates each year. These were tests on things that mattered to university educators, and if something educational matters to them, we might think it matters overall. They found strong evidence of a steady decline in scores on their own tests, over the preceding decade, among students accepted onto degree courses where they would need good maths skills.
Sadly they didn’t control for A-level grade, so we can’t be sure how far they were comparing like with like, but there are various plausible explanations for their finding. Maybe maths syllabuses changed, and were less useful for maths and engineering degrees. Maybe the cleverest kids are doing English these days, or becoming lawyers instead. Or maybe exams got easier.
If you know of more research, I’d be interested to see it, but the main thing that strikes me here is the paucity of work in the field. There’s a man called Rupert Sheldrake who believes that pets are psychic: they know when their owners are coming home, that sort of thing. Obviously we disagree on a lot, but we chat, and are friendly, and once when we were talking he came out with an excellent suggestion: maybe 1 per cent – or even 0.01 per cent – of the total UK research budget could be given to the public, so that they could decide what their research obsessions were. Maybe most of this money would get spent on psychic pets, or research into which vegetables cure cancer, but since we’re all clearly preoccupied with the idea, I’d like to think that some of it, possibly, might get spent on good-quality, robust research to find out whether exams are getting easier.
