Friday, 18 August 2017

Two wrong attitudes that damage the body of Christ - Reflections on 1 Corinthians 12:1-31

In 1 Corinthians 12 the apostle Paul argues that the church is like a living, growing organism made up of diverse parts all of which interrelate and cooperate with each other.

In a previous blog post we considered spiritual gifts – their nature, distribution and function. In this post, we look at two wrong attitudes which threaten the integrity of the body.

‘I’m not needed’ (v14-20)

This is the temptation of the less visible members of the body. So the foot says, ‘I’m not part of the body because I’m not a hand’ and in so doing stops being a foot. This means that the hand is then more limited what it can do as it has to operate from a fixed base.

The last of the Ten Commandments says ‘you shall not covet’. The reason covetousness, or jealousy, is so utterly destructive is because it both cultivates a resentful better attitude about someone else while at the same time immobilising the person so that they are no longer contributing what they can uniquely give.

So, not only do they become transfixed on wishing that they were someone else, but, more tragically, they stop being the person that God made them to be.

One of my heroes is a Christian psychiatrist by the name of Marjory Foyle.

Marjorie went out as a young doctor to serve as a cross-cultural missionary in Southeast Asia.

She tried many different positions at the hospital but really struggled to find a role that really suited her.

That was, until she had what she called her ‘bean field experience’. Now the bean field was where you went to the toilet and also, perhaps like Isaac the patriarch, to meditate and pray.

And it was in the bean field one day that Marjory had her Eureka moment and realised exactly why God had placed her on the planet.

Her unique gift was to be a carer for the carers. That was the moment she realised it and from that time forward she put all her energy into achieving excellence in that role.

You may be familiar with the book ‘Honourably wounded’ referring to people who had been wounded psychologically or spiritually in the Lord’s service. It’s an absolute classic. Marjory wrote it.

I remember hearing Cliff Richard describing going out to offer help during one of the African famines and feeling grossly inadequate as he didn’t have medical or nursing training.

One of the nurses was very straight with him thankfully. She said, ‘are you capable even of putting on a bandage?’ ‘No’, he said. ‘Well’, she replied, ‘then you’re of no use to us here’.

‘Why don’t you go back to England and do what only you can do which is to use your gifts as a singer and entertainer to draw attention to the situation and financial need out here’.

It was an absolute game changer for Cliff Richard.

You might’ve heard it said ‘Dare to be a Daniel’. Perhaps we would all like to be Daniels facing down the lions. But in fact there was only one Daniel on the whole of the Bible and he had a unique role to play.

Could you bear to be a Baruch? Baruch was Jeremiah’s scribe. His job was to write down everything that Jeremiah said and then read it out in the marketplace. The job that was tedious, thankless and also dangerous. But if it wasn’t for Baruch we would not have the book of Jeremiah and all the wonderful prophecies about the new covenant that it contains.

We wouldn’t have Moses if it wasn’t for two midwives who risked the wrath of Pharaoh. We wouldn’t have David if his mighty men had not preserved his life on more than one occasion. We wouldn’t have Nehemiah’s great achievement if it wasn’t for the many others who helped him to rebuild the wall of Jerusalem.

Solomon could have achieved nothing if it wasn’t for the literally thousands of workers who gathered resources, carved stone, cut wood, managed his horses and organised the feeding and defence of the nation.

There would have been no Spurgeon without an unnamed man one day, when he was diverted by the snow and ended up in the wrong church, who preached the sermon which utterly transformed his life. We would have no John Wesley without his mother Susanna.

You see the point. We are all interdependent. We are all needed. We are all necessary. I don’t know whether you are spending time wishing you were someone else or had some gift or ability that you see someone else has.

Or perhaps that you think that you are unnecessary in God’s great plan.

Well the message of this passage is that you are needed and you are necessary but you need to be the person God has made you to be, with the gifts he has chosen to give you, to build up and serve others.

Be that person and help your children and fellow believers to do the same. Don’t try to press others into the wrong mould.

It was Samuel Johnson who sad, ‘Don’t send your ducks to eagle school! You will frustrate the ducks, frustrate the eagles and frustrate yourself. Almost every man wastes part of his life in an attempt to display qualities that he does not possess’

Don’t say ‘I’m not needed’. Instead find out what you are made to do and do it.

You’re not needed (v21-26)

This is perhaps the temptation of the more visible in church, perhaps those in leadership or so-called ‘gospel ministry’. They possess the gifts regard as most strategic for building up the body of Christ.

Their temptation is to look on others who don’t have those same gifts and think they are less important.

But the reality is that every highly visible member of the body of Christ needs an effective team of people around them, praying for them, helping them to take their opportunities, and perhaps most importantly of all, encouraging them and holding them accountable, knowing that from those to whom much has been given much will be expected.

Lewis Hamilton is a phenomenally gifted grand prix racing driver but he could do nothing without his team, his designers, his computer analysts, his managers and the people who supply the millions of pounds necessary for to take to the track. The man is extraordinarily talented but he needs a whole team in order that he can do anything at all.

One of the most important letters lessons Moses ever learnt, and he learned from his father in law, was that he needed to build an effective team and delegate responsibility.

This was a life changer, not only from Moses, but for the whole nation of Israel.

As Paul tells us here (v26) if one part of the body suffers, every part suffers with it; if one part of the body is honoured, then every part rejoices with it.

If one part suffers, every part suffers with it.

As doctors we are only all too acutely aware of this – an affliction in only one part of the body will adversely affect the whole and perhaps event threaten the body’s life: a narrowed coronary artery, an inflamed appendix, a blood vessel in the brain blocked by clot, some abnormally dividing cancer cells in one organ spreading everywhere.

And so it is with the church – one person’s suffering is borne by all.

‘If one part of the body is honoured, then every part rejoices with it.’

You may know that we Kiwis are very proud of our national rugby team , the All Blacks. We are still trying to get over the fact that they were able only to draw recently with the British Lions because we are so used to them winning virtually every game.

They are widely acknowledged to be the most successful team in world history, in any sport.

But what makes them so good? You could point to many things: the training schemes, New Zealand’s prioritisation of rugby above any other sport, the prestige of being chosen to represent the country or maybe even the fact that they all seem so wonderfully uniquely talented.

But actually, I think the key secret of success is that they are trained to believe that the team is far more important than any one of the players. And if you watch them on the field, you’ll see they get as much pleasure from helping someone else score, giving that winning pass, as they do in scoring themselves.

It’s this utter delight in seeing any individual exceed that is such a powerful motivator.

The success of any member of the team is the whole team’s success.  There is an unselfishness cultivated which leads them always to put the good of the team ahead of their own glory.

If one part is honoured (v26) every part rejoices with it.

It’s perhaps a very imperfect model but I think that it’s something of what Paul is saying here about the church.

In the next blog post we look at some practical applications of this teaching.

Friday, 11 August 2017

A navy of ordinary people – reflections on spiritual gifts in 1 Corinthians 12

A couple of weeks ago we went to see Dunkirk the movie. Although technically Dunkirk was a withdrawal or a retreat it paved the way for Britain’s recovery and eventual victory in WW2 against the Nazi threat when 330,000 soldiers were pulled off the French beaches to safety.

What people call the miracle of Dunkirk was effected when King George VI called the whole nation to prayer and three extraordinary things happened: Hitler inexplicably gave the order to his tanks not to advance further when the British and French troops were trapped between them and the sea, a storm grounded the Luftwaffe and the subsequent calm sea enabled a huge flotilla of small boats to reach the beach.

The most emotional moment of the whole film was the arrival of this flotilla out of the mist.
Certainly (alongside the providence of the halted tanks, the storm and the calm) what happened at Dunkirk is that many individuals, with extraordinary courage and at huge personal risk, joined together to offer whatever skills and resources they had in a selfless effort to rescue others.

And that is the perspective that Christopher Nolan offers in his film Dunkirk. Many ordinary people joined together to make the Dunkirk evacuation possible.

Director Christopher Nolan has said: ‘as a group of people we can achieve so much more than we can individually.’

An army of ordinary people, or perhaps more accurately, a navy of ordinary people.

And it’s this picture of the church – a group of diverse people engaged in a common task – that is the subject of 1 Corinthians 12.

The apostle Paul could have used a variety of different metaphors to capture this idea of a people of diverse origins and skills uniting together – an army, an orchestra – but in this passage, as we will see, he uses the metaphor of the body.  The church is the body of Christ.

Paul is responding to a question or perhaps series of questions that they have raised about the subject spiritual gifts. But he is also using this as an opportunity to teach them important theology and truth about what it means to belong to the church and how to behave within it especially with respect to working together.

In this passage the apostle Paul he makes it clear that despite their individual and corporate failings – these Christians in Corinth are ‘the body of Christ’ (v27). They have been baptised by one Spirit into one body (v13). They are people who recognise Jesus as Lord (v3) – the one who holds all authority in the universe, to whom they have given their lives. And despite their diverse backgrounds as both Jews and Greeks (v13) they have been given the one Spirit to drink.

And so Paul asks by addressing five questions about spiritual gifts

1.       What are spiritual gifts? (v7)

He starts in vs 4-6 by saying there are different ‘gifts’, different kinds of ‘service’, different ‘kinds of working’. We are told in verse seven that they are ‘manifestations of the spirit’. That’s the Holy Spirit, the third person the Trinity after the father and son. The Holy Spirit is the one who leads us to faith in Christ’s death and resurrection (v13) and who lives in us. And he gives special abilities - what are described in verses  4 & 5 as ‘gifts’, ‘services’ and ‘workings’. There are no less than eight specific references to the Holy Spirit in just the first eleven verses of this chapter.

2.       Who receives these gifts? (v7,11)

We are told that they are given ‘to each one’ (v7 & 11).

Not just to pastors, leaders, preachers or deacons but to every single member of the congregation.

You see, there is no division here between minister and congregation, between clergy and laity, between priests and pew sitters. Yes of course there was order and authority, and in Paul’s letter to Timothy and Titus - the pastoral epistles - a leadership structure consisting of elders and deacons on which our own church is modelled, but this leadership is plural and all members of the congregation are ministers in the sense that each one gift that benefit others.

Some have more than one gift. Paul it seems was an apostle, teacher, prophet, evangelist, pastor and teacher - but the point is that every member of Christ’s church has at least one gift. Each person is a minister of sorts.

This year 2017 is the 500th anniversary of the protestant reformation which began with Martin Luther nailing 95 theses to the church door in Wittenberg in 1517.

The whole aim of the reformation was to take the church back to the Bible and to the doctrines taught there.

One of the key truths that Luther rediscovered was what we now call ‘the priesthood of all believers’.

In his Address to the Nobility of the German Nation (1520), Luther criticised the traditional distinction between the ‘temporal’ and ‘spiritual’ orders—the laity and the clergy—arguing that all who belong to Christ through faith, baptism, and the Gospel shared in the priesthood of Jesus Christ. 

All baptised believers are called to be priests, Luther said, but not all are called to be pastors.

3.       What are these gifts for? (v7)

We are told that they are for ‘the common good’ (v7). In other words they are intended not for self -edification or glorification but to benefit others. And so you see that every member of the church is both incomplete and interdependent, having something that all others need and at the same time needing all others.

4.       What do these gifts include? (v8-10)

We see that they are extraordinarily diverse (v8-10). There are nine different gifts mentioned: wisdom, knowledge, faith, healing, miraculous powers, prophecy, distinguishing between spirits, speaking in tongues and the interpretation of tongues. And we see all of these gifts operating in the early church in the book of Acts.  

Is this list intended to be exhaustive? No it’s clear that these are just examples. And Paul is not giving us here any teaching about what these specific gifts are in order to satisfy our curiosity.

His prime purpose is to illustrate their diversity.

There are similar, but interestingly not identical lists of gifts in other parts of the New Testament. Some of these gifts are repeated and others are new.

So in Romans 12:6-8 the list includes prophecy, serving, encouragement, contribution to the needs of others, leadership and showing mercy.

In Ephesians 4:11 we read of apostles, prophets, evangelists, pastors and teachers. Almost exactly the same list appears later at the end of 1 Corinthians 12.

1 Peter 4:10-11 speaks of speaking, serving and showing hospitality.

So in these five passages alone we see about 20 gifts and I expect that not even these are meant to be exhaustive, but simply illustrative of the diversity of God’s bountiful giving.

Of course as you might expect in different cultures, denominations and periods in church history different gifts are more prominent – as you might expect in a church which is worldwide.

Some of these gifts are more spectacular – prophecy, miracles, speaking in tongues – others are more familiar and may appear even more mundane – but all are gifts of God’s spirit.

Some are possessed by many individuals – other are much rarer.

In the Old Testament Exodus 35:31ff talks about Bezalel who was gifted with all kinds of crafts by the Holy Spirit. It was Bezalel who was responsible for virtually all of the decorative work in the Tabernacle.

Remarkably, a person with very similar gifting, Huram Abi, did all the ornate work in Solomon’s Temple.

So these were uniquely gifted individuals in arts and crafts, but needed thousands of others to help them fulfil their tasks,

5.       How are these gifts distributed? (v11)

We are told that they are distributed ‘as the spirit determines’ (v11)  they are gifts of grace not earned - you can’t earn a gift. You can only receive it. These gifts are given by virtue of God’s unmerited favour. It is God who arranges (v18) and apportions (v28). The Greek word charismata used in this passage simply means gifts of grace.

We see exactly the same idea in Romans 12:6. ‘Having gifts that differ according to the grace given us, let us use them’. And because they are gifts of grace there is therefore no pride in having them.

One of the most gifted preachers in the evangelical church today is John Piper. I recently had the privilege of being at a conference where he was giving the main Bible talks and went along to a question-and-answer session where we all got to ask our most burning questions.

One of the first questions John was asked was how he dealt with pride. The obvious implication was that the questioner felt he was head and shoulders above not just other Christians but above preachers as well.

His answer was very challenging. First, he said, ‘I know my own heart and there is very little to be proud of’. Second, he said, ‘I know that that any ability or gift I have is given to me by God, so what is there to boast about?’

So how do they these gifts work together?

Paul illustrates this by using a metaphor - the metaphor of the body.

Why should he choose the body? Elsewhere in the New Testament we see a building or a bride or an army used to illustrate the church.

However here uses the body because he wants to show that the church is like a living, growing organism made up of diverse parts all of which interrelate and cooperate with each other.

The key thing about the body, is every that part, whether visible or invisible, is dependent on every other part. All parts need to be working for the body to be functioning properly.

In part 2 of this blog we will look at two wrong attitudes which threaten the integrity of the body.

Friday, 4 August 2017

College climbs down over ban on Christian doctors and nurses training in sexual and reproductive health

Doctors and nurses wishing to practise in sexual and reproductive health have been granted more liberty to exercise freedom of conscience under new guidelines published earlier this year.

The Faculty of Sexual and Reproductive Healthcare (FSRH), a faculty of the Royal College of Obstetricians and Gynaecologists (RCOG), has relaxed its stance on conscience in new guidelines issued in April so that those with an ethical objection to certain procedures can now obtain qualifications which they were previously excluded from.

Christian doctors and nurses in the UK are practising in an environment that is increasingly hostile to their beliefs and values. We have accordingly come to expect new constraints on our freedom of conscience almost as a matter of course. So this is a refreshing backtrack by the College.

In April 2014 I highlighted the fact that the FRSH was barring doctors and nurses with pro-life views from receiving its degrees and diplomas and may also be breaking the law (see also here). The story was later picked up by the Telegraph.

Under the previous guidelines, now removed from the FSRH website but still accessible in the Telegraph, doctors and nurses who had a moral objection to prescribing ‘contraceptives’ which can act by killing human embryos (levonelle, ellaOne, IUCDs etc) were barred from receiving diplomas in sexual and reproductive health even if they undertook the necessary training.

The wording was as follows (emphasis mine):

‘Completing the syllabus means willingness during training to prescribe all forms of hormonal contraception, including emergency, and willingness to counsel and refer, if appropriate, for all intrauterine methods…Failure to complete the syllabus renders candidates ineligible for the award of a FSRH Diploma.’

It added:

‘Doctors who hold moral or religious reservations about any contraceptive methods will be unable to fulfil the syllabus for the membership … or speciality training…This will render them ineligible for the award of the examination or completion of training certificates.

However, the new guidance grants much more freedom.

It begins by underlining the faculty’s commitment to diversity:

‘The FSRH welcomes and values having a diverse membership, representing a wide range of personal, religious and non-religious views and beliefs.’

It then underlines the fact that there is already statutory protection for healthcare professionals (HCPs) to opt out of abortions and procedures authorised under the Human Fertilisation and Embryology Act (HFEA):

‘There are currently two specific statutory protections for HCPs who have a conscientious objection 1) to participating in abortion (Abortion Act 1967, s.4) 2) to technological procedures to achieve conception and pregnancy (Human Fertilisation and Embryology Act 1990, s.38) .’  

But it also recognises that both the Human Rights Act 1998 and Equality Act 2010 offer some conscience protection in areas other than abortion and IVF:

‘The Human Rights Act 1998 incorporates the European Convention on Human Rights (ECHR) into UK law. Article 9 of the ECHR protects “the freedom of thought, conscience and religion; this right includes … to manifest his religion or belief, in worship, teaching, practice and observance.”’

‘Part 5 of the Equality Act 2010 sets out provisions for non-discrimination in employment. Specifically, s.39 prohibits employers from discriminating against individuals on the basis of “protected characteristics” (of which religious belief is one) and places an obligation on employers to make ‘reasonable adjustments’ to accommodate religious beliefs.’

The guidance recognises that the rights to ‘freedom of thought, conscience and religion’ and to ‘religious beliefs’ are not absolute, but qualified, and also that NHS employers may interpret these in different ways than the faculty, but this is nonetheless a significant step forward.

The guidance says that it applies to all FSRH qualifications and training, but a closer reading suggests that those seeking to sit the membership examination of the Faculty of Sexual & Reproductive Healthcare (MFSRH) will need to undergo ‘practical assessment of the provision of contraception (all methods including emergency contraception)’ and those seeking a Letter of Competence in Intrauterine Techniques (LoC IUT) will need to demonstrate ‘practical competence in the relevant live procedures’.

However, with respect to the Diploma of the Faculty of Sexual & Reproductive Healthcare (DFSRH and NDFSRH), holder must simply be ‘competent and willing to advise on all forms of contraception and manage SRH consultations, including providing evidence-based information on the options for unplanned pregnancy’. But there is no duty actually to provide all treatments.

‘The FSRH requires all Diplomates to provide patients with the full range of contraception choices, including emergency contraception and support of a woman with an unplanned pregnancy and appropriate onward referral. HCPs who plan to opt out of providing aspects of care because of their personal beliefs may still be awarded the Diploma, or recertified, if they can demonstrate commitment in their practice to the principles of care in section 5 of this document. For example, if a HCP chooses not to prescribe emergency contraception because of their personal beliefs, she/he has a personal responsibility to ensure that arrangements are made for a prescription to be issued by a colleague without delay, ensuring that the care and outcomes of the patient are never compromised or delayed.’

Although some would see referral to another doctor or nurse as a form of complicity, this is nonetheless a big improvement on the previous guidance.

Previously doctors or nurses who refused to fit coils or prescribe the morning after pill (MAP) were also barred from receiving the diploma signifying expertise in the management of infertility, cervical cancer or sexually transmitted infections. This effectively meant that many thousands of doctors and nurses were not able to obtain qualifications to pursue a career in gynaecology and sexual health.

This is no longer the case.

Quite why the faculty has relaxed its guidance is not clear, but I wonder if they have been conferring with the General Pharmaceutical Council (GPhC) who also similarly relaxed their guidance on dispensing drugs after receiving submissions from Christian Medical Fellowship and the Christian Institute earlier this year.

The GPhC’s attention was drawn to the fact that their proposed new guidance might well be illegal under Equality legislation (I made the same point about the FSRH in 2014).

The GPhC backtracked after the Christian Institute made it clear, in pre-action legal correspondence exchanged with the Council’s lawyers, that they ‘were fully prepared to litigate’.

Perhaps the FSRH also, on reflection, thought it wise to protect themselves by erring on the side of caution and taking themselves out of the legal firing line.

However, whatever the reason, the climb down is most welcome and will enable many more doctors and nurses to obtain diplomas in sexual and reproductive health. That can only be good for patient care. 

Thursday, 3 August 2017

DNA editing – a significant advance but many questions remained unanswered

You can see my Sky News interview on this story here.

Scientists have, for the first time shown that it is possible to correct gene mutations in human embryos successfully using a gene editing tool potentially opening the door to treatment for over 10,000 single gene disorders.

The US and the South Korean researchers used a new technology called Crispr which was only developed in 2013.

The research appears in the journal Nature and has been covered by numerous media outlets and science magazines. The BBC report is somewhat simplistic and it’s well worth reading the original paper and coverage by the New York Times, Scientific American and Science News which give more detail.

Crispr technology has been used for human embryos before but the results have never been quite this good (see previous blog posts by CMF authors here, here, here, here and here).

What is new about this study is that the researchers managed to avert two important safety problems. First, they managed to produce embryos in which all cells, rather than just some, were mutation free. Second, they avoided creating unwanted extra mutations (‘off target’ effects) elsewhere in the genome.

The breakthrough was achieved by carrying out the gene editing at an earlier stage in development before fertilisation had taken place.

The study involved a condition called hypertrophic cardiomyopathy (HCM) a disease affecting about one in 500 people which causes thickening of the heart muscle and can cause sudden heart rhythm disturbances and heart failure.

HCM is caused by a mutation in a gene called MYBPC3 and is autosomal dominant, meaning that if one parent has a mutated copy there is a 50% chance of passing the disease on to children.

Researchers first tried editing the DNA in affected embryos (ie. after fertilisation), but of 54 embryos produced, 13 were ‘mosaics’ with some repaired and some unrepaired cells.  

So they then tried to correct the faulty gene before fertilisation. Along with the man’s affected sperm, the researchers then injected into an egg the DNA cutting enzyme Cas9, a piece of RNA to direct the enzyme to the faulty gene, and another piece of normal DNA to be used in the repair.

In 72% of 58 embryos the faulty DNA was excised and replaced with a copy of normal DNA from the egg, which the embryo used for the repair instead of the introduced DNA. In the remainder, the faulty DNA was excised but not replaced.   

So what we make of this?

There is no doubt that this research represents a significant step forward in gene editing technology.

Up until now, the approach to disability in the developing embryo and fetus has essentially been one of ‘search and destroy’. That is, embryos or foetuses are examined for genetic abnormalities and, if found to be affected, are discarded or aborted.

Gene editing, instead, offers the possibility of correcting a genetic abnormality in an individual embryo in order that that individual will then grow and develop normally. It is essentially guided molecular microsurgery and seems to have extraordinary precision. So, in principle, it holds great promise.

However, there are still huge ethical, technological and legislative hurdles remaining before this technology could be considered safe and appropriate for clinical use.

The key questions are around safety, ethics and necessity.

First, any change to the DNA in sperm, egg or a one celled embryo (so-called germline editing) will inevitably be passed down from generation to generation. If any errors are introduced they may be almost impossible to detect or eradicate. This is why over 40 countries currently ban all germline therapy.

But the key question is this: if it were possible to repair an abnormal gene in egg, sperm or embryo safely, would it still be wrong to attempt it given that this could mean, not only curing the affected individual, but eradicating the abnormal gene from the whole family? The question is most poignant when applied to diseases like Tay Sachs which are invariably fatal in childhood, but caused by an identifiable single gene mutation.

Second, this technology is already involving unethical practices in its development. Dozens of human embryos produced were discarded and it is likely that many hundreds and thousands more will be lost as the technology is refined. In addition, thousands of human eggs will be needed for research and young women, possibly driven by financial incentives, will be vulnerable to the well-recognised complications of egg harvesting. Twelve egg donors were used in this research. Preventing serious illness is a noble aim of course, but the end does not justify the means. There is a huge difference between editing a gene to help an individual and using that individual as a means to developing a technique that might possibly help others in the future. Why have we jumped straight to human research before testing this technique exhaustively in higher animals and non-human primates if we are so far from refining it?

Third, there is the danger of mission creep. The initial motivation might be to prevent or treat serious life-threatening illnesses caused by single gene mutations. However, there will inevitably be huge pressure to use this technology for far less serious genetic conditions or to modify, design and manufacture human lives to our preferences. The genie will truly be out of the bottle for designer babies and the vested ideological and financial interests will be very difficult to resist.

Fourth, is the danger of rogue scientists. It will be very difficult to offer proper surveillance or regulation to prevent abuses given that this is effectively ‘portakabin technology’ that will be almost impossible to police. We could be opening up a Pandora’s box of truly frightening possibilities.

Fifth, our understanding of the way genes produce physical traits, including genetic diseases, is still very rudimentary. What we do know is that our previous understanding of ‘one gene producing one trait’ is a gross oversimplification. Genes interact together in very complex ways and by editing one gene we may simply be altering one step in a complex process with knock-on effects elsewhere: rather as pulling a single thread from a knitted garment can lead to further spontaneous unravelling. This again underlines the importance of rigorous research being done in animals and especially nonhuman primates, before it is even contemplated in human beings.

Sixth, there are alternative ethical approaches to the prevention and treatment of many single gene disorders. I’m not advocating preimplantation diagnosis or abortion because, as noted above, both are eugenic practices involving the destruction of individuals with special needs. But, for example, parents known to be carrying deleterious genes can obviously avoid passing them on to their offspring by opting for  adoption. The vast majority of single gene disorders are neither serious nor life-threatening and even for those that are there often supportive treatments available (see also my previous blog post ‘13 solutions to mitochondrial disease assessed’).

Why am I more open to this technique than the three parent embryo for mitochondrial disease? Don’t both involve germline therapy? Don’t both promise to eradicate defective genes? Yes, but the similarities end there. Three parent embryo techniques do not work for single gene disorders, they introduce a third parent and they involve cell-nuclear replacement ‘cloning’ technology.

By contrast, gene editing is precise, anatomical and appears to work. It resonates much better with ‘restoration of a masterpiece’ (the human embryo) to its original unspoilt state than the unnatural fusing of tissues from three individuals we see in so-called ‘mitochondrial replacement’. It is more Michelangelo than Picasso. In fact DNA editing has already been successfully employed to treat mitochondrial disease in mice.

But the real questions are ‘is it safe’, ‘will it work’ and ‘can it be developed by ethical means’? And we are a long way from knowing the answers. We need to find these answers, but not by using human embryos as a means to an end.

Instead we need to employ techniques that treat the human embryo with the respect and care that it deserves as a very young, yet complete, human life.  

Monday, 24 July 2017

Justine Greening’s transgender proposals are unscientific and dangerous but also part of a greater social strategy

Men and women will be able to change their gender without a doctor’s report and amend their birth certificate accordingly under new government proposals.

Yesterday Justine Greening (pictured), the education secretary and minister for women and equalities, said (£): ‘What we want to try to do is streamline the process, make it easier, de-medicalise it and make it less intrusive.’

She told Sophy Ridge on Sunday on Sky News that the state needed to ‘stop treating people changing their gender as if it’s some medical problem that needs fixing. Actually this is a choice that people are making and we need to try and make that choice more straightforward than it already is.’

Currently, under the Gender Recognition Act 2004 people need to be over 18, have been diagnosed with gender dysphoria, have lived in their new gender identity for two years and have obtained a certificate from a gender recognition panel before being able, legally, to change their gender.

But Greening wants to scrap all that and has the support of both the PM Theresa May and the opposition leader Jeremy Corbyn, ironically making this perhaps the first issue of public policy that the two have agreed on since the general election.

The government will launch a consultation on the Gender Recognition Bill, to be published in the autumn. The consultation will also consider whether a person whose gender is ‘non-binary’ — neither exclusively male nor female — should be able to define themselves as ‘X’ on their birth certificate.

I have written on the highly controversial issue of gender dysphoria before on this blog (also here and in much more detail here).

The key issue is that Greening is begging the question of what gender dysphoria actually is.

Is a ‘trans woman’ really a woman trapped in a man’s body? Or is ‘she’ really just a man who has an unshakeable false belief that he is a woman? Is a biological male who has had female hormones and gender reassignment surgery really a woman, or is he just a feminised man?

As recently as 2013 doctors called this condition ‘gender identity disorder. Many doctors, like me, feel it should still be called that. We believe that giving sex hormones and gender reassignment surgery to transgender people is not only clinically inappropriate but an abuse of professional privilege.

The key question is this. If there is a disconnection between the body and mind, do you shape the body to fit the mind or do you shape the mind to fit the body? Do you try to help the person to become reconciled with their body through counselling and psychotherapy? Or do you give them hormones and surgery so that their body conforms to their chosen gender identity?

Well, it depends on whether you think the real problem is in the body or the mind. And I, like many other doctors, am in the latter category. I think we’re being seduced and even coerced into thinking that the body, rather than the mind, is the real problem when there is actually no scientific evidence to back that up.

Everyone can see that a woman with anorexia nervosa is not fat, but she has an unshakeable belief that she is, so she is radically dieting and regularly purging herself. How do we help someone in this situation?

Well, we certainly don’t affirm her belief that she is fat or encourage her to diet or, least of all, offer her liposuction. And yet anorexia nervosa has a lot of similarities to gender dysphoria. You have a person who is deeply dissatisfied with the body that they’ve been given and may be obsessively preoccupied and distressed by it.

A high proportion of people who suffer from gender identity disorder also suffer from other mental health conditions like depression, anxiety, substance abuse, self-harm, suicidal thoughts, personality disorders and autism (see also here and here). In many of them these problems do not resolve with gender reassignment. In fact hormones and surgery deal only very superficially with what is often a very deep psychosocial problem that doesn’t lend itself to quick technological fixes.

Christians are not alone in these concerns. Stephanie Davies-Arai, of Transgender Trend, a parents’ support group, told The Sunday Times: ‘This has huge implications for women. There will be legal cases. The most worrying thing is if any man can identify as a woman with no tests and gain access to spaces where women might be getting undressed or feel vulnerable — like women’s hospital wards, refuges and rape crisis centres — women will just stop going to these facilities.’

Feminist Sarah Ditum, in a recent blog post outlines some of the problems self-declaration of gender could cause: ‘The issues break down into three sections: monitoring (how does self-identification change the way we can measure discrimination according to sex), services (how does self-identification change the way we deliver sex-segregated services), and cultural (the most nebulous category, dealing with how we collectively understand gender).’

And social commentator Melanie Phillips argues in the Spectator that it’s dangerous and wrong to tell all children they’re ‘gender fluid’. ‘What started as a baffling skirmish on the wilder shores of victim culture’, she says, ‘has now turned into something more menacing’.

By contrast, Greening, who has no medical or psychiatric training at all, thinks gender dysphoria is not a medical condition at all.

What she is proposing is effectively to bring in the key proposals of a highly controversial report by the Women and Equalities Committee of the House of Commons on Gender Equality, which was originally published in January 2016.

In essence the report recommends reducing the age limit for hormone treatment and surgery to 16 and completely removing the process of gender recognition from its current medical and legal framework – basing gender change on self-declaration alone.

Imagine what chaos would arise if people could ‘self-declare’ on other biological realities: a Caucasian man declaring himself black, a 50 year old declaring himself 65 in order to collect a pension early or a five foot ten man declaring himself to be a six foot four Chinese woman (watch this).

Where has this new thinking come from?

Justine Greening and Maria Miller, and a small group of feminist MPs, are using their influence to politicise the radical and controversial ideology of Judith Butler (pictured right), the American philosopher and gender theorist responsible for popularising ‘queer theory’ (watch university students fed this ideology trying to explain it here).

We are being sold the notion that gender has no biological basis at all but is simply a social construct and the product of a biased society. The cultural, medical and legal changes which we are now observing – resulting in the promotion of transgender ideology at all levels of society - are being driven by a process insiders know as ‘gender mainstreaming’.

This latest move to normalise ‘gender dysphoria’ is unscientific and dangerous but needs to be understood as part of a greater social strategy whereby powerful elites are claiming the authority to change men’s and women’s sexual identity through political strategies and legal measures.

Gender dysphoria is a real medical condition which needs careful diagnosis and even more careful management.

It is extraordinary that the leaders of both major political parties are unwittingly backing this bizarre social experiment which will simply open a Pandora’s box of confusion, abuse and litigation.

This move by the education secretary is quite simply lunacy and the fact that May and Corbyn are backing it so uncritically betrays an astonishing lack of discernment amongst our political leaders. 

Why the rush to change blood donation deferral policies for men who have sex with men?

Commercial sex workers and men who have sex with men (MSM) in Britain and Scotland are to be allowed to donate blood three months after they last had sex (see also here, here and here).

The rule changes will come into force at blood donation centres in Scotland in November and in England in early 2018.

The Government accepted the recommendations of the advisory committee on the safety of blood, tissues and organs (SaBTO) and are introducing the changes under ‘equalities reforms’.

The rule change will allow more people to donate blood without compromising blood supply safety, experts say.  

Gay rights advocacy groups have praised the move as a triumph for science over prejudice and stigmatisation. Education Secretary Justine Greening (who is herself ‘gay’) has said the changes ‘would build on the progress made in tackling prejudice in the 50 years since the partial decriminalisation of homosexuality’.

All blood that is donated in the UK undergoes a mandatory test for HIV, Hepatitis B and C, and some other viruses.

During the HIV/AIDS epidemic of the 1980s, most of the developed world instituted a permanent ban on blood donations from men who have sex with men (MSM). This is because of the high risk of transmission from sex practices, such as anal intercourse, which are used in high frequency by this group.

People do not easily forget the 'tainted blood scandal', where around 4,670 British haemophiliacs were infected with Hepatitis C - and a further 1,243 co-infected with HIV. More than 2,000 people have died because of their HIV and Hepatitis C infections, while many others are terminally ill.

They were infected through contaminated clotting factor products, which were supplied by the National Health Service in the 1970s and 80s.

International comparisons

In recent years, countries around the world have revised their blood donation policies regarding gay and bisexual men, and other men who have sex with men (MSM).

As of 2015, Austria, Germany and Belgium still had lifetime bans for MSM who wish to donate blood.

The lifetime ban on MSM donating blood was lifted in 2011 in England, Scotland, and Wales, and in 2016 in Northern Ireland and was replaced with a one-year deferral period for sexually active MSM.

The United States lifted the lifetime ban on MSM from donating blood in 2015, replacing it with a one year deferral policy allowing MSM to donate if they abstain from sex for 12 months.

Other countries followed suit, while Italy and Spain have implemented deferral policies based on individual risk assessments regardless of sexual orientation.

Canada reduced its lifetime deferral for MSM to five years in 2013 and to one year in 2016.
Japan, the Netherlands, Australia and New Zealand all have one-year deferrals for MSM blood donation.

In Italy and Spain, donors are screened for high-risk sexual behaviour regardless of the sex of their partners or their sexual orientation. Deferrals are made based on individual risk.

But thus far no one has adopted a three month policy.

The American Red Cross policy is especially sobering:

‘If you ever tested positive for hepatitis B or hepatitis C, at any age, you are not eligible to donate, even if you were never sick or jaundiced from the infection. You should not give blood if you have AIDS or have ever had a positive HIV test, or if you have done something that puts you at risk for becoming infected with HIV. You are at risk for getting infected if you… are a male who has had sexual contact with another male, in the last 12 months’

Scientific basis

Britain’s proposed new policy does have a scientific basis. The nucleic acid test (NAT) used to screen blood can detect HIV in just 9–11 days after infection. New technological advances greatly decrease the risk of HIV-infected blood escaping detection; however, they cannot completely eliminate the risk of HIV in the blood supply. Therefore, NAT technology should be used in conjunction with comprehensive individual risk assessments that can adequately screen potential donors for low- and high-risk sexual behaviours.

It is important to keep this in context. The risk of getting HIV from a blood transfusion is lower than the risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient.

The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million although if you receive blood during a transfusion that contains hepatitis, you'll likely develop the virus.

But the cost of infection is great and just one infection would be a tragedy.

Are we applying the same risk management principles in all areas of population health or do we make a special case of leniency when it involves the LGBT lobby I wonder? I raised similar questions about the speed at which approval the HIV prevention drug PrEP was railroaded through late last year.

Reason for caution

I argued back in 2011 that allowing sexually active gay men to donate blood was simply not worth the risk and would recommend that readers revisit that article.

Whilst detection technology has moved on one has to question why going down to a three month deferral period after last sexual contact for both men who have sex with men and commercial sex workers is necessary now given that NHS Blood and Transplant have said there is not currently a shortage of blood in the UK.

Also given that MSM make up just a tiny proportion of the UK population and that far fewer of them will abstinent from sex for a three month period, what is the urgency with this measure?

It would seem sensible to err on the side of caution rather than rushing into this especially given that the majority of the international community are being much more cautious.

The push for this seems to be coming much more from gay rights advocacy groups like the National AIDS Trust and Terence Higgins Trust rather than from any pressing need. And it seems that the aim to avoid stigma for gay and bisexual men is the main driver rather than to address any real clinical priority.

People will be reluctant to question the policy in these circumstances for fear of being accused of discrimination but the powerful media support for this relatively insignificant story speaks volumes about just how powerful the gay rights advocacy media machinery is and the level of priority the mainstream media, and especially the BBC, gives to its stories. 

Boots chemist should not have capitulated to pressure from BPAS over emergency contraception

Last night I waded into the debate on whether Boots should reduce the price of the so-called ‘morning-after pill’ and criticised the high street chemist for ‘capitulating in the face of political pressure’. 

Let me explain why.

Boots had originally defied calls to slash the price of ‘emergency contraception’ – with its chief pharmacist saying it did not want to ‘incentivise inappropriate use’.

But late on Friday night Boots released a statement to say it was ‘truly sorry’ about its ‘poor choice of words’, and was looking at cheaper alternatives (see here, here, here, here and here).

The about-face was the result of a high-level campaign on social media by abortion provider BPAS and a group of 35 Labour women MPs.

It all began when BPAS (the British Pregnancy Advisory Service) wrote to Boots’ head pharmacist, Marc Donovan, pointing out that generic versions of the Levonelle brand of emergency hormonal contraception can be bought cheaply by pharmacies and can retail for as little as £5.50 in France. By comparison, Boots charges £26.75 for its own version.

Mr Donovan wrote back to say that if Boots did make the pill cheap it could be ‘accused of incentivising inappropriate use’.

This led to an explosion on social media from Labour women MPs calling for women to boycott the chemist and forcing Boots to back down.

I have three main concerns about this whole furore.

First, public policy decisions about women’s health should not be made on the hoof after twitter rants especially when these are strongly ideologically motivated. They should rather be made after proper and robust debate on the facts. The knee-jerk assumption of most people is that making emergency contraception readily available either free or cheap over the counter without prescription will reduce unplanned pregnancies and safeguard women’s health. In fact there is no evidence to suggest that this is actually true (see below).

This latest broadside needs to be seen for what it is – part of a high level campaign by  abortion industry leader BPAS – which receives £30miliion of taxpayers money annually – to advance its agenda of abortion on demand up to birth and free contraception for all. They are prepared to bully, blackmail and boycott to achieve their agenda and sadly few are willing to stand up to them. If MPs wish to influence pharmacy practice they should raise it in the House of Commons in a responsible way, not form a social media lynch mob.

Second, all the evidence suggests that ready availability of emergency contraception does nothing to reduce abortion rates and actually increases rates of sexually transmitted diseases.

For a start levonelle is not 100% effective in any given case.  Its success rate is relatively low (95% within 24 hours of sexual intercourse, 85% from 25-48 hours and 58% from 49-72 hours). 

A 2012 study in Washington State showed that free access to emergency contraception caused a statistically significant increase in STI rates (specifically gonorrhoea rates) and no change in birth and abortion rates.

The results were almost identical to those of a British study published in the Journal of Health Economics (full text) in December 2010 and reported in the Daily Telegraph in January 2011. (See my previous blogs on this here and here).  The researchers found that rates of pregnancy among girls under 16 remained the same, but that rates of sexually transmitted infections increased by 12%.

In fact, in a systematic review published in 2007, twenty-three studies published between 1998 and 2006 measured the effect of increased EC access on EC use, unintended pregnancy, and abortion. Not a single study among the 23 found a reduction in unintended pregnancies or abortions following increased access to emergency contraception (see also fact sheet here).

The phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as ‘risk compensation’. The term has been applied to the fact that the wearing of seatbelts does not decrease the frequency of some forms of road traffic injuries since drivers are thereby encouraged to drive more recklessly. In the same way ready access to emergency contraception encourages young people to take more risks and can also be used as a tool by abusers to negotiate for sex.

In 2015 the total number of new STI diagnoses in England was 434,456. This included more than 129,000 diagnoses of chlamydia (a major cause of infertility) in 15-24-year-olds.  Young females are more at risk of a diagnosis than young males. The male diagnosis rate among 15 to 19-year olds was 824.4 per 100,000 population and 1,693.8 among 20-24-year-olds compared to 2,436.8 among 15 to 19-year-old females and 2,557 among females aged 20-24. Gonorrhoea is also most common among the 20-24 age group, with a rate of 269.5 per 100,000 population.

So making the emergency contraceptive pill available over the counter free or cheap, without prescription, is sadly an ill-conceived knee-jerk response to Britain’s spiralling epidemic of unplanned pregnancy, abortion and sexually transmitted disease amongst teenagers. It is also not evidence-based.

Third, the emergency contraceptive levonelle is already available free from Brook centres, some pharmacies , most sexual health clinics, most NHS walk-in centres,  most GP surgeries and some hospital accident and emergency (A&E) departments. For pharmacies it is a free market. Boots’ own  price tag was based on the cost of the medicine and the regulated mandatory consultation with the pharmacist. It is surely only fair that as a retail pharmacy they don’t compromise or undervalue this professional service.

It is regrettable that Boots has capitulated in the face of political pressure and failed to support its chief UK pharmacist in his legitimate concerns over incentivising the inappropriate use of emergency contraception. It is settled science that making so-called emergency contraception more easily available does not reduce pregnancy rates in a population and actually raises rates of sexually transmitted diseases. 

By appeasing this cartel of radical feminist MPs Boots is encouraging more reckless sexual behaviour and thereby exposing young people to an increased risk of sexually transmitted infections. They are also encouraging MPs and sections of the media to force changes in medical practice through bullying, name calling and blackmail rather than sound evidenced-based argument. The same campaign is going to target Lloyd’s Pharmacy next. This is bad medicine, bad leadership and bad public policy.

But perhaps the most frightening aspect of this whole episode is the deafening silence of other sitting MPs at Westminster who by their failure to speak out have signalled complicity with both process and practice.

The best way to counter the epidemic of unplanned pregnancy and sexually transmitted disease is to promote real behaviour change. The government would be well advised to enter into dialogue with leaders of communities in Britain where rates of sexually transmitted diseases and unplanned pregnancy are low, especially Christian faith communities, to learn about what actually works.

Church-based programmes such as Love for Life (Northern Ireland), Love2last (Sheffield), Challenge Team, Romance Academy or Lovewise (Newcastle) are getting great results and have much wisdom to pass on.

Sunday, 16 July 2017

The Conway Case – a change in the law to allow assisted suicide is dangerous and unnecessary

Watch my Sky News interview on the Conway case here.

A 67-year-old Shropshire man with motor neurone disease (MND) is seeking to overturn the law banning assisted suicide.

Noel Conway is backed by the former Voluntary Euthanasia Society (now rebranded Dignity in Dying (DID)), whose lawyers will argue that the current blanket ban on assisted suicide under the Suicide Act is incompatible with his rights under sections 8 and 14 the Human Rights Act (respect for private and family life and protection from discrimination).

The four day hearing in the high court, involving three senior judges, begins on Monday 17 July.

Mr Conway's case is substantially the same as that of Tony Nicklinson and Paul Lamb in 2014, except that his condition is terminal.

There have been over ten attempts to legalise assisted suicide through British Parliaments since 2003, all of which have failed. The last of these was the Marris Bill in 2015 which was defeated by an overwhelming majority of 330 to 118 in the House of Commons amidst concerns about public safety.

Frustrated at their lack of success in parliament has led DID and other campaigners to pursue their agenda through the courts.

Conway is bringing his case against the Secretary State for Justice. Three other organisations have been granted permission to intervene in the case – Humanists UK (formerly the British Humanists’ Association (BHA)) on the side of Conway and Not Dead Yet UK and Care Not Killing (CNK) on the side of the defendant.

A change in the law is opposed by every major disability rights organisation and doctors' group, including the BMA, Royal College of GPs and the Association for Palliative Medicine, who have looked at this issue in detail and concluded that there is no safe system of assisted suicide and euthanasia anywhere in the world.

Laws in the Netherlands and Belgium that were only meant to apply to mentally competent terminally ill adults, have been extended to include the elderly, disabled, those with mental health problems and even non-mentally competent children.

While in Oregon, the model often cited by those wanting to change the law, there are examples of cancer patients being denied lifesaving and life extending drugs, yet offered the lethal cocktail of barbiturates to end their own lives.

Article 8 of the Human Rights Act 1998 (Right to respect for private and family life) states (8(1)) that ‘Everyone has the right to respect for his private and family life, his home and his correspondence.E+W+S+N.I.

However, this right is not unlimited but is qualified in 8(2). CNK will argue that a blanket prohibition on euthanasia and assisted suicide is ‘necessary in a democratic society in the interests of public safety for the prevention of disorder or crime, for the protection of health or morals, and for the protection of the rights and freedoms of others.’

CNK will also argue that to pursue this case in court is institutionally inappropriate given that parliament has repeatedly, rigorously and comprehensively considered this issue and decided not to change the law.

Legalising assisted suicide and/or euthanasia is dangerous because any law allowing either or both will place pressure on vulnerable people to end their lives in fear of being a burden upon relatives, carers or a state that is short of resources. Especially vulnerable are those who are elderly, disabled, sick or mentally ill. The evidence from other jurisdictions demonstrates that the so called ‘right to die’ may subtly become the ‘duty to die’.

The legalisation of assisted suicide and/or euthanasia is uncontrollable in practice because any law allowing either or both will be subject to incremental extension. We have observed in jurisdictions like Belgium and the Netherlands that over time there is an expansion of categories to be included beyond those originally intended and without any further change in the law: a shift from terminal conditions to chronic conditions, from physical illnesses to mental illnesses and from adults to children.

The essential problem is that the two major arguments for euthanasia - autonomy and compassion - can be applied to a very wide range of people. This means that any law which attempts to limit them, for argument’s sake to mentally competent people who are terminally ill, will in time be interpreted more liberally by sympathetic or ideologically motivated ‘assisters’ and may also be open to legal challenge under equality legislation on grounds of discrimination.

The legalisation of assisted suicide and/or euthanasia is also unnecessary because requests for euthanasia or assisted suicide are extremely rare when people’s physical, social, psychological and spiritual needs are adequately met. The overwhelming majority of people with terminal illnesses, including those with MND, want ‘assisted living’ not ‘assisted suicide’.

The safest law is one like Britain’s current law, which gives blanket prohibition on all assisted suicide and euthanasia. This deters exploitation and abuse through the penalties that it holds in reserve, but at the same time gives some discretion to prosecutors and judges to temper justice with mercy in hard cases.

Leaving the law as it is will mean that some people who desperately wish help to end their lives will not have access to such a service. But part of living in a free democratic society is that we recognise that personal autonomy is not absolute. And one of the primary roles of government and the courts is to protect the most vulnerable even sometimes at the expense of not granting liberties to the desperate.