Lives are being lost because cancer is not being diagnosed early enough in older sufferers
Late diagnosis of cancer is far more common in the elderly than younger age groups, research shows. Patients with breast and bowel cancer in their 70s and 80s are twice as likely to be diagnosed with advanced-stage tumours, which are often terminal.
Experts say lives are being lost needlessly because the illness is not being picked up sooner.
The findings are yet further evidence of ageism in cancer care. Only yesterday, the Mail revealed how elderly women were being denied life-saving surgery for breast cancer because doctors do not think it is worthwhile.
This latest study carried out at Cambridge University showed that women over the age of 75 with breast cancer are two and a half times more likely to be diagnosed with advanced tumours than women in their 60s. Those over 80 suffering from bowel cancer are one and a half times more likely to be diagnosed with advanced tumours than those aged 60 to 69.
The authors looked at the records of nearly 33,000 patients diagnosed with breast and bowel cancer between 2006 and 2009 and compared the age and stage of the disease when it was first spotted.
The study did not explain why so many more elderly patients are diagnosed with late-stage cancer, but it may be because they are less likely to worry about the early-warning signs and see their GP.
Early diagnosis of cancer vastly improves a patient’s chance of survival. Once tumours spread to other areas of the body such as the lymph nodes under the arms, the lungs, liver or bones, it is often terminal.
The authors say it is crucial that the Government and doctors raise awareness of cancer symptoms among the elderly and ensure early warning signs are not missed by GPs in routine appointments.
Georgios Lyratzopoulos, lead researcher from the Cambridge Centre for Health Services Research at the university, presented the findings at the National Cancer Intelligence Centre’s annual conference in London. He said: ‘There is some evidence that the awareness of cancer significantly declines in older age groups.’ He added: ‘Age is the new deprivation. There is a growing body of thought that old age is more important than deprivation by some distance.’
There are around 48,000 cases of breast cancer a year in the UK and 40,000 of bowel cancer.
Sarah Woolnough, Cancer Research UK’s director of policy, said: ‘This analysis shows that cancer is often diagnosed late in older patients and that there are big variations in how different cancers are diagnosed. ‘It also highlights the scope for improvement, particularly in breast and bowel cancer.
‘Studies of this type are vital to help us better understand how to diagnose cancer as early as possible. When the disease is diagnosed early, it is almost always easier to treat successfully.’
One in five can’t see their GP within two days
More than 10 million people a year cannot get a doctors appointment within 48 hours, according to an official annual survey.
The proportion of patients who say they cannot get an appointment with a GP within two working days has risen from 15 to 20 per cent since early 2009. People waited longer to see their GP despite a fall in the number of patients wanting to see a doctor within 48 hours. The proportion of patients wanting to see a doctor “fairly quickly” dropped from 65 to 58 per cent from early 2009 and 2010/11 (the year ending March 2011).
Rising numbers are citing a lack of available appointments as the reason they cannot be seen. In early 2009, 79 per cent of those unable to see their GP within 48 hours said it was because “there weren’t any appointments”, but in 2010/11 that figure had risen to 84 per cent.
Labour brought in the two working day target to try to ensure that patients could see their GPs promptly. But last June Andrew Lansley, the current Health Secretary, pledged to scrap that target, saying it would reduce bureaucracy. It ceased being a target earlier this year.
Under Tony Blair, doctors were also told patients should be able to book advance appointments as well, after a patient told him it was impossible to do so for non-urgent matters. However, the latest survey results suggest this is actually becoming harder to do. Whereas in early 2009, 22 per cent said they could not book at appointment more than a fortnight ahead, by 2010/11 the proportion had risen to 26 per cent.
Gordon Brown’s government went further, trying to make surgeries open outside normal working hours by providing appointments before or after work, or on Saturdays. But the survey indicates that only a minority of surgeries offer extending opening hours.
Only 15 per cent of patients believe their local surgery is open before 8am, 18 per cent after 6.30pm and 13 per cent on Saturdays. By contrast, more than half (58 per cent) would like their surgery to open at additional times. Most want Saturday openings, while evening appointments are also popular.
Dr Clare Gerada, chair of the Royal College of GPs, said family doctors had experienced a “massively increased workload” over the last five years. They typically saw between 36 and 50 patients a day, she noted, adding: “GPs will always see a patient if it’s an emergency.”
While she said patients should be able to book ahead, the further in advance they did, the higher the “did not attend” rate was, which risked wasting NHS resources. She also pointed out that every primary care trust in England offered at least one surgery with 8am to 8pm, 365 days a year care. However, there were “just not enough GPs” for large numbers of surgeries to offer Saturday or evening appointments, she remarked.
Although there are difficulties with seeing a GP, satisfaction with the service remains high. Nine in 10 said they were satisfied with the care they received, while 94 per cent said they trusted their doctor.
Lord Howe, the Health Minister, said: “I am pleased that the vast majority of patients have a strong sense of confidence and trust in their GPs, and that an increasing number of patients with long term conditions are being offered personalised care plans. “Our plans to modernise the NHS will free GPs and allow them to tailor services to local needs so that patients get the care they need, when they need it. “Where the GP Patient Survey highlights areas in need of improvement, I expect GP practices to address these as a matter of priority.”
Rising from the working class to the middle class
The story below by a British journalist is well worth reading for anybody who still has time to read a story. It is a classic moral tale of the sort that everybody should be told, I think. I doubt that it is the whole story about economic advancement though.
One cannot read extensively in the academic medical literature — as I do — without becoming aware of how central genes are to almost everything. And I think my own life-history offers a counter-narrative to the story below. Like the writer below, I was born to parents who had lived through the Great Depression, who never had much money but who treated their children well and kindly.
But my parents never had “ambitions” for me. They assumed that I would earn my living as my father did — through hard manual work. And it was only with great difficulty that my father was persuaded to give me two years of High School education. He thought that grade-school was “plenty”.
But my parents did give me “a pearl without price”: Their genes. Both had siblings who had done exceptionally well at grade-school so I got good genes for IQ from both sides. And life for me has been a breeze. I made mostly good decisions and ended up in very comfortable circumstances almost without effort. I did work quite hard in some ways but I enjoyed what I did far too much to call it “work”. By and large, I simply saw where the opportunities were and took those opportunities.
For the ambitious, however, mine is probably a much more discouraging tale than the one below, so I will not elaborate the tale any further
Just over a year ago, I was sitting in a fancy restaurant about to tuck into steak and chips. This wasn’t any old steak and chips: this was wagyu beef — the world’s most expensive steak — and thrice-cooked chips, served with an organic mushroom and Cropwell Bishop Stilton sauce.
As I picked up my knife and fork, a familiar voice inside my head began to talk: ‘How much did you say this cost?’ I cut into my steak and the voice spluttered: ‘One hundred quid! For steak and chips! Have you gone stark-raving mad?’
The voice was my father’s: a man whose idea of gourmet dining is a meat-and-potato pasty from Greggs. A voice that never fails to remind me just how far I’ve come since I left the council house where I grew up.
When I was a boy, Sunday lunch was boiled cow’s heart (it tasted every bit as dreadful as it sounds), with boiled cabbage and Oxo gravy. Teatimes were fish fingers. With chips. Beefburgers. With chips. Findus crispy pancakes. With chips. And if we didn’t clean our plates, we’d get it for breakfast the next morning.
Growing up, we didn’t have a car. Holidays were a week in a Blackpool caravan. And on the rare occasions we went out as a family, it was to the front step of my dad’s local pub, where my three brothers and I sat outside with a bottle of lemonade and four straws.
These days, Sunday lunch with my wife, Rebecca, 41, and our three children — my stepdaughter, Daisy, nine, and sons Tom, six, and Sam, three — invariably involves an outing to a nice restaurant. For tea, my children eat free-range chicken, pasta and broccoli. We drive a Volvo estate and my wife and I have enjoyed wonderful holidays in Corsica, Majorca and Amalfi.
I am currently working as a freelance writer and looking after our family, while my wife earns a good salary as a magazine editor. But our comfortable existence wasn’t always so comfortable: it took 30 years to reach this point. Now, though, I am so grateful that I will never have to look poverty in the eye again.
My middle-class life today is utterly unrecognisable from the world of my childhood. My story is the living embodiment of how hard work, not positive discrimination, can bring anyone success.
It’s about parents who want nothing but the best for their children; who lead by example, and provide a secure and loving home which instils in their children enough confidence to achieve whatever they want to achieve.
And it is a story shared by most of my now middle-class friends, who make their livings as marketing consultants, company directors, television executives, sales directors and journalists. None of us was born with a silver spoon in our mouth: we all grew up in working-class homes. None of us was given a leg up by a family friend, an internship at an uncle’s firm, or a place we didn’t earn through merit at a university.
But, according to the Government, people like me and my friends should not exist. Working class kids, they say, can escape their backgrounds only through social engineering.
Nick Clegg, the Deputy Prime Minister, recently unveiled the Coalition’s Social Mobility Strategy that aims to ensure everyone has a fair opportunity to fulfil their potential, regardless of the circumstances of their birth.
I don’t doubt Mr Clegg is well intentioned, but isn’t this a bit rich coming from a man who has reached high office largely thanks to his wealthy parents? Perhaps it’s the guilt of having a £7,000-a-term Westminster School education that’s talking here.
Because, to my mind, social engineering isn’t the best way to propel a child out of a council estate and onto better things. There is a much more effective solution — and my friends and I are living proof of it.
I didn’t end up eating £100 steaks because someone put a ‘Poor Kid’ sign around my neck and sent me to be taught with the children of millionaires. No, I got there thanks to my mum and dad, who worked their socks off to ensure their children were well-fed, well-clothed and well educated.
I was born in 1964 in the back-to-back terraces of Bradford, Manchester. Six of us — my mother, father and four sons all under five years old — shared two bedrooms. We had an outside toilet and bathed in a bucket in front of the fire on a Sunday evening. Our ‘garden’ was a postage-stamp-sized flagstoned yard where the bins lived.
But my parents wanted more for us, and their opportunity came when these slums were bulldozed in the late Sixties and we were relocated to a three-bedroom council house with a garden with grass on a new estate called Hattersley, 12 miles east of Manchester.
For my parents, our council house represented a massive step up. My father was an engineering fitter at Dunlop’s tyre factory. At one stage, my mother had three jobs: working as a shop assistant, packing bacon in a factory, and taking in neighbours’ ironing.
Both worked long hours and came home exhausted. My father’s skin was grey, ingrained with grime from the huge machines; my mother’s legs ached with varicose veins.
But they slaved away uncomplainingly for the sake of their boys — myself and my brothers, Michael, Alan and David. They did all they could to ensure that their sons would go further in the world than they had. And we boys knew and respected that.
After a 50-hour week, my father would flop down on the settee and tell me: ‘When you leave school, don’t do a dirty job like mine. Do something you enjoy, that’s clean, that’s easy. I didn’t have a choice, but you do. ‘Be a football commentator, or a disc jockey. You can do that — you talk rubbish most of the time!’
People didn’t tend to leave the comprehensive school I attended for glamorous careers. By and large, people who grew up on our estate tended to stay on the estate, or move within a stone’s throw of it. Most of my classmates got jobs in the local factories — Walls or McVitie’s; or, like my brothers, got a trade as painters and decorators, electricians or mechanics. Some went on to drive buses; others to work in pubs and hairdressers. They became nurses, not doctors; classroom assistants, not teachers.
A significant number ended up on benefits [welfare]. And a few found themselves in court. Some of the boys I went to school with grew up to be small-time crooks and drug dealers. Some barely made it to manhood before overdosing on heroin.
Behind our council house front door, my parents were never the type to sit us down before bedtime to check we’d done our homework, or have long discussions about what we wanted to be when we grew up. Instead, they led by example and practised what they preached.
Neither my father nor mother (child-bearing aside) had a day of unemployment in their lives. And that work ethic was instilled in us.
My mother would insist that after school we were set to work dusting and Hoovering, making the beds and doing the washing up. And one of us would always make sure there was a piping hot cup of tea on the table waiting for her when she finished her shift at the factory. Hard work was the way out of poverty, not crime or scrounging off social security, we were endlessly told.
Sometimes my mother would tell me about the tough life she’d had as a little girl, growing up in the slums during World War II. Then she’d pause, blink back tears and her face would glower as she said: ‘And I’ll be damned if any of my lads has to go through the same as I did.’ She meant it as encouragement, of course; but it felt like a threat, too: ‘Do better than I did — or else!’
When you’ve got a mother as proud and determined as mine was, you don’t need positive discrimination, university targets and diversity tsars to spur you on. The prospect of disappointing her was all I needed.
So, from the age of 14, I decided I wanted to be a journalist. A decade later, I’d left school with seven O-levels and two A-levels, finished (nearly) top of the class at journalism college and got a job on my local newspaper. In my day, you could become a journalist without a degree — virtually unheard of these days.
My career took me via Liverpool and Birmingham and Washington DC to London, where I rose to become an executive at a magazine publishing company.
When I went home to visit my folks, I could feel pride pour from them. They weren’t the kind to boast, but I knew they felt they had achieved something for themselves via myself and my brothers.
When I eventually had children of my own, I was determined they, too, would have more than I had. Like most kids today, my children have it all: boxes and boxes of Lego, train sets, Scalextric, remote-controlled cars, iPods, Nintendos, laptops, Wiis, bikes and scooters. They have more chocolate than Willy Wonka. And whereas I still speak pure Mancunian [English with a Manchester accent], to the ears of my old friends back in Hattersley, my kids sound very posh.
By metropolitan London standards, we’re not posh, just ordinary. But I’m aware I’m spoiling my kids in a way my parents couldn’t dream of. My parents worked unbelievably hard to improve their lives because their own beginnings were quite appalling. I wonder what incentives my children will have to improve their lot, when they already have very nice lives?
We live in a very desirable part of North London, in a catchment area for great schools, but our flat has no garden. Some of our kids’ friends live in £1million houses with wrap-around lawns. We drive a ten-year-old Volvo; their friends get ferried around in huge 4x4s. We holiday in Europe; their friends go skiing in Colorado.
I’m not saying these things would make them happy, but they would be a step up from the flat we live in now, which is a step up from the council house I grew up in, which was a step up from the slum terraces where my parents were raised.
And if that means my wife and I have to work until we’re 65 and beyond to put our kids through university, then so be it. If it means we have nothing left for our retirement, then fine. We will sacrifice everything to ensure that our offspring can go on and outperform us.
A year ago, just weeks after I’d tasted that divine wagyu steak, I bought the finest piece of fillet I could get my hands on and drove to Manchester to see my dad. I wanted him to taste a similar steak that was the best of the best. A token from my life for the man who made it all possible.
I cooked it for him and served it with chips and a glass of a decent red wine. Dad took a bite. He chewed it, swallowed then gave his verdict. ‘Not bad,’ he said. ‘How much did it cost?’
When I told him, his eyes widened. ‘How much!’ he spluttered. ‘You need your head examined! You can get a Holland’s meat pie, chips and curry sauce for £3.60 at the chippy.’ And then he smiled. ‘Beautiful bit of steak, this,’ he said, finishing every morsel. ‘Thanks, son.’
I had a lump in my throat as I thought to myself that my dear dad should never thank me for anything. He and my mum — who sadly passed away last year following a battle with Alzheimer’s — sacrificed everything to enable me to go out, make money and enjoy the finer things in life.
And they taught me, too, the three things a child needs to make a success of their life: Love, encouragement and an unbreakable work ethic.
The BBC will make an on-air apology after its governing body said a Panorama programme about Primark probably faked a scene about the retailer’s working practices.
The findings of the BBC Trust’s investigation into the episode “Primark: On The Rack” were released yesterday, saying there had been ‘serious editorial failings’ in the programme.
It added it was ‘more likely than not’ that shots of three young boys in the Indian city of Bangalore in a workshop ‘testing the stitching’ on Primark tops were ‘not authentic’.
The scenes were said to have shown the youngsters inspecting vest-tops and making sure ‘sequins don’t end up falling off in the hands of customers back in Britain’.
But on closer inspection the BBC Trust claimed there were inconsistencies and improbabilities.
The programme, broadcast in June 2008, had sought to investigate whether Primark could make ‘cheap, fast fashion without breaking ethical guidelines’.
However the report said: ‘Having carefully scrutinised all of the relevant evidence, the committee concluded that, on the balance of probabilities, it was more likely than not that the Bangalore footage was not authentic.’
As well as apologising on BBC1, the corporation is under pressure to hand back a Royal Television Society Award it won for the programme. It will also have to display an apology on the Panorama website for a week and was told the footage can never be repeated or sold abroad.
The BBC could still be hit with a fine for breaching broadcasting as media regulator Ofcom said it would consider any complaint made to it by Primark.
The trust’s Editorial Standards Committee examined evidence such as the unedited ‘rushes’ of the programme and emails to the production team from the freelance journalist Dan McDougall, who obtained the footage.
Yesterday’s ruling noted six points that indicated the footage might not be genuine in the 45-second clip. This included the size of needles used, which it was claimed would have been ‘inappropriate’ for ‘delicate’ work they were doing.
The BBC Trust also found it odd that in the Bangalore scene there appeared to be no other garments visible in shot – which would be unusual if it was a ‘quality control process’.
It added that the way it had been filmed – with a tight focus on the boys and less on their surrounding environment – added to concerns. There were also said to be ‘inconsistencies’ in the evidence such as the email trail.
The report also found the corporation had broken its ‘accountability’ guidelines over how it handled the complaints process, which went on for three years.
Primark described the finding as ‘extraordinary’, claiming shoppers had been ‘fed a lie’. It even suggested the BBC had been in possession of enough evidence to prove the scenes were not real before it broadcast them.
However, defenders of the programme pointed out the BBC Trust agreed that overall the programme had obtained ‘clear evidence’ work was being outsourced from other factories in India which contravened Primark’s ethical trading principles. David Thomson of international aid agency World Vision stressed the ‘key concern’ should be that ‘Panorama proved Primark was breaking its own policies’.
Helen Boaden, BBC director of news, said: ‘This is a very, very serious ruling and extremely chastening, and we need to learn from it.’
Mr McDougall ‘vigorously’ rejected the ruling. He said: ‘I have rarely seen a finding so unjust in outcome, flawed in process, and deeply damaging to independent investigative journalism.’
If only Britain’s politicians were on the side of the ordinary people – and not the green fanatics and council jobsworths
(“Jobsworth” is British slang for an obstructive government employee, usually a local government employee who refuses some request or service on trivial or technical grounds)
About a year ago, Oxford City Council kindly gave me a slop bucket. It has sat unused outside our back door. The idea of scraping old potato peelings and fish bones into this small receptacle, inevitably creating an almighty mess and stink, was a bridge too far.
Now, however, we shall all be forced to use them. The Tory Environment Secretary Caroline Spelman has decreed that every household in England must press a slop bucket into action. This is despite the fact that in opposition she led the anti-slop bucket movement on the grounds that they created an unholy pong. Just one more broken Tory promise.
Don’t get me wrong: I’m not a recycling ‘denier’. The responsibility for getting rid of waste in our house has somehow largely been devolved to me, and every week I spend some time conscientiously sorting newspapers, cartons and bits of plastic into the correct wheelie bin.
Sometimes I find myself devoting a fair bit of intellectual energy to wondering whether, say, a tattered piece of cellophane is recyclable or not.
I try to ignore the newspaper reports that there are vast warehouses full of unsorted rubbish, and ships laden with the stuff on the high seas to China, where it all ends up in a landfill site as big as the Gobi Desert. I attempt to discount stories that recycled paper is sometimes rejected by paper mills because it contains shards of glass or other unsuitable materials.
We are all in this together, I repeat to myself, as I dutifully drop the right thing into the right bin.
And, in common with many of my fellow citizens, my spirits have been sustained during this melancholy process by the solemn promise made by the Tories in opposition, and indeed in government, that they would at least restore weekly bin collections.
I have looked forward to the time when visitors to our house will not hold their noses as they pass our smelly bin, emptied every fortnight.
Recently encountering a plump rat who was shamelessly sunning himself on the pavement outside our house, I comforted myself with the thought that he would have a rough time of it once Eric Pickles, the Communities Secretary, had fulfilled his pledge to insist on a weekly round.
Mr Pickles, whose Pickwickian girth and manner have always endeared him to me, declared in an interview with the Mail last year that ‘it’s a basic right for every English man and woman to be able to put the remnants of their chicken tikka masala in their bin without having to wait a fortnight for it to be collected’.
He looks as though he has consumed a good few chicken tikka masalas in his time, and therefore spoke from the heart.
Now Mr Pickles has been overruled by the bossy-sounding Mrs Spelman and is reported to be furious — though not so furious that he is thinking about resigning. And, to be fair, why should he? If a minister in the Coalition stood down every time a pledge was broken, there wouldn’t be anyone left.
But I do worry that this habit of making promises to win votes, and then almost casually breaking them, is likely to be injurious to democracy.
Mrs Spelman idiotically tries to justify herself by saying that ‘in opposition you don’t have a chance to see the Government’s books’. Surely we all knew enough to be aware that there was a gaping black hole.
Ministers say it would cost the Government £132.5million a year to restore weekly collections since cash-strapped councils do not have the money. I accept this is quite a large amount. On the other hand, there are two quangos overseeing rubbish policy that cost £50million a year. Couldn’t they be closed down, and their funding be diverted? And shouldn’t a promise be a promise?
My strong suspicion is that it is not primarily a matter of cash. Mrs Spelman has gone native. Like many of her ministerial colleagues she is only nominally a Tory — if by ‘Tory’ we mean someone who instinctively sides with the individual against the might of the State.
She likes bossing us about. She subscribes to the notion that Whitehall — or Brussels — always knows what’s best for us. If you don’t want to shovel fish bones into a slop bucket, tough.
In short, she has bought into the whole recycling racket, behind which stands the European Union with its Landfill Directive which has set targets for reducing the amount of waste sent to our landfill sites by 65 per cent by 2015, set against a 1995 baseline. Please don’t ask what business it is of the EU to dictate what we do with our rubbish.
Most of us can agree that there is far too much needless packaging produced by our supermarkets, as well as too many plastic bags.
We don’t want the earth of England to be filled with broken bottles and drink cans. Let’s recycle if it works — but don’t let it become a system for oppressing the individual so that the very people who pay for rubbish collection end up by being bullied, penalised and even fined.
Anyone but the most blinkered recycler can surely see that the proliferation of bins is disfiguring the urban landscape — in other words, creating a form of aesthetic pollution that in its way is quite as obnoxious as the physical pollution of landfill sites, just as swathes of wind farms promoted by green zealots are despoiling England every bit as much as the power stations they are supposed to replace, if not more.
One overmighty local authority, Newcastle-under-Lyme in Staffordshire, insists that residents use no fewer than nine separate bags, bins and buckets to satisfy its recycling requirements.
A friend of mine tells me he has to have seven. I suppose I should be grateful that our own council only demands three, though like many others it has recently started charging for the removal of garden waste, this being another way of squeezing extra cash from already hard-pressed council tax payers.
Eric Pickles has turned out to be as much use as a burst balloon. Mrs Spelman behaves as one might have expected. Instead of knocking some sense into Whitehall bureaucrats, and making councils behave in a civilised manner, she has ratcheted up the recycling nonsense one more notch by forcing us to use slop buckets. And she calls herself a Tory!
Would it be hopelessly naive at five minutes to midnight to request David Cameron to think again and honour his modest, but oft repeated, pledge? In the circumstances it does not seem much to ask.
Unlike me, I don’t suppose he does much recycling these days, but there is nothing he could do more likely to re-establish his credentials as a Tory, and show that he is on the side of the ordinary people of England against the green fanatics, council busybodies and bureaucrats, than to give us back the weekly bin collections he promised.
FAS: the gestation of a dubious idea
It is moralism, not evidence, that underpins the advice that pregnant women should abstain from alcohol
A new scheme, announced on Sunday, that will ‘train midwives to give pregnant women advice on the dangers of alcohol’ has provoked controversy because the drinks firm Diageo, whose brands include Smirnoff and Guinness, is reportedly stumping up £4million to fund it. But it is the content of the scheme, not the organisation that is funding it, that should be provoking comment.
UK public health minister Anne Milton has claimed the scheme is ‘a great example of how business can work with NHS staff to provide women with valuable information’. But some doctors have raised ethical objections to the involvement of the drinks industry in the scheme. Vivienne Nathanson, long-time advocate of complete abstinence from alcohol during pregnancy and head of science and ethics at the British Medical Association, has so far been the main voice of criticism arguing that there is a conflict of interest, ‘because it’s in the interest of the drinks industry for people to continue to drink and it’s in the interests of health for people to drink much less, and certainly not to drink in pregnancy or to drink really minimally’.
In reality, however, the scheme does not throw up any conflicts of interest. In general pregnant women are not heavy drinkers; promoting alcohol abstinence for this group is not going to dent sales. What it will do is to remove any doubt about Diageo’s willingness to embrace the state-approved mantra of ‘responsible drinking’. After all, what better way for Diageo to demonstrate its commitment to ‘responsible drinking’ than to make a great show of protecting the defenceless unborn baby, and ‘empowering women’ with information about having a healthy pregnancy? Diageo can be entirely relied upon to be ‘on message’.
Besides, arguments over the origin of the funding miss the point. What should really be at the centre of the debate are the ideas and claims about alcohol and pregnancy that midwives are going to be educating women about. The real scandal is that the Liberal-Conservative government now overtly authorises the ‘abstinence is the only true way’ message, and is funding an organisation called the National Organisation on Fetal Alcohol Syndrome (NoFAS UK) to train midwives to promote that idea. It raises important questions about the nature of health policy and the obsession with intervening in the ‘early years’ of a child’s life – which now seems to include pregnancy, too.
NoFAS UK is the London-based affiliate of a North American lobbying organisation, NoFAS, established in 2003. Hitherto its activities have included an annual ‘pregnant pause’ where people involved with NoFAS UK (including men with balloons up their jumpers pretending to be pregnant) stand perfectly still at London’s Victoria train station for nine minutes, at nine minutes past nine on 9 September, to show passers-by that ‘women only need to pause from drinking alcohol for nine months in pregnancy to ensure that their babies will be born without the alcohol-related brain damage known as Fetal Alcohol Spectrum Disorder (FASD)’. NoFAS’s website also features its ‘alcohol and egg’ video, in which someone breaks an egg into a glass, pours in vodka and invites the viewer to see the egg ‘cook’. These offerings may seem strange, but NoFAS now seems to be taken seriously enough to train the nation’s midwives.
The core belief of the organisation is that alcohol is a dangerous substance, and that any alcohol consumed during pregnancy can harm the developing fetus. In promoting this outlook, NoFAS is involved in what sociologists call moral entrepreneurship. The organisation’s aim is to foster high levels of concern about a hitherto unrecognised problem and ensure that the ‘wrong’ of drinking anything at all in pregnancy is taken seriously. As sociologists have noted, one distinctive feature of today’s moral entrepreneurs is that they increasingly present their claims in medical or scientific terms. In turn, the solution to problems becomes new codes of conduct for behaviour, apparently sanctioned by the authority of medical science.
In her informative book on the development of FAS as a social problem in the US, Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder, Elizabeth Mitchell Armstrong points to the rise of what she calls medical entrepreneurs, individuals with a powerful sense of mission regarding their assessment of ‘the evidence’ who seek to ‘impress their… vision on the rest of society’.
A particular understanding of the relation between alcohol consumption and fetal development emerged in the US. Those who originally coined the term Fetal Alcohol Syndrome in the early 1970s (a term used to describe a rarely occurring set of distinct problems found in babies born to some alcoholic women) engaged in ‘subtle broadening of the problem’ from the outset. They commented, for example, that no case of FAS had ever ‘been reported in a human being with a negative maternal history of ethanol use’. In other words, the knowledge that consumption of high levels of alcohol in pregnancy was associated with developmental problems in the fetus was taken to mean that FAS could only be avoided for sure if no alcohol is consumed. This point has been made in another way by historian Janet Golden, who explains that abstinence advocates shifted the definition of the problem that needed to be addressed away from maternal alcoholism (a serious problem for individuals requiring careful treatment and specialist intervention) to consumption of alcohol as a substance (a general behaviour to which the response is public health campaigns promoting abstinence for all).
British medical entrepreneurs around this issue have a similarly broad attitude to evidence about FAS. For example, the psychiatrist Raja Mukherjee, routinely a key speaker at NoFAS’s training events, justified abstinence advocacy in a 2005 commentary subtitled ‘abstinence from alcohol is the only safe message in pregnancy’. His case for abstinence was made through reference to ‘emerging evidence’ of an ‘inconclusive nature’ (studies on rat brains, observational studies of children’s behaviour and unpublished evidence). Thus in a departure from conventional justifications for policy, it was the inconclusive nature of the evidence – what is unknown rather that what is known – that formed the basis for the argument for policy change.
Following this logic, NoFAS promotes the notion of alcohol harm as a ‘spectrum’ (called Fetal Alcohol Spectrum Disorder, FASD), with varying amounts of harm caused by different levels of alcohol consumption. According to advocates of FASD as a concept, alcohol causes a variety of problems including intellectual, memory, mood and attention disorders. It is also argued that often FASD goes ‘undiagnosed’, or is misdiagnosed, ‘for example as autism or attention deficit hyperactivity disorder (ADHD)’, or that autism and ADHD are in fact symptoms of FASD. Further, we are told that FASD, when undiagnosed, can lead to ‘secondary disabilities’ that can include loneliness, school expulsions, addictions, chronic unemployment, promiscuity, unplanned pregnancies, poverty, criminality, prison, homelessness, depression and suicide.
The starting point is a presumption that any alcohol is damaging. It follows that when we consider problems children have, we should work backwards to maternal alcohol-consumption as the cause. Hence if a child of any age has problems and the mother drank at all during pregnancy, the suggestion is that there is likely to be a causal connection.
In the US, the medical entrepreneurs’ idea that alcohol consumption explains pretty much everything that ‘goes wrong’ with children gained traction with policymakers very rapidly. The US was the first country where alcohol abstinence advocacy became the official approach (in 1981). For some years, this was widely considered an ‘American’ view. For example, a Guardian article in 1991 notes: ‘The case for abstinence is not based on evidence. It is based on the logic of better safe than sorry. It is tempting, especially for an expectant mother, to say that any risk, however small or theoretical, is too great. But that is absurd. Everything about light drinking during pregnancy makes it the kind of theoretical risk that Americans are unlikely to evaluate sensibly. Doctors are innately cautious and made more so by lawyers hovering overhead with malpractice lawsuits.’
By 2007, however, the English Department of Health (DH) decided to advise women to abstain from alcohol in pregnancy. As was noted at the time, the DH did so in contradiction to the findings of its own review of studies on the subject, which found no evidence linking ‘low to moderate’ levels of alcohol consumption with the sorts of problems that feature in descriptions of FASD.
There is no question that 2007 marked a turning point in official approaches to this issue. As was argued on spiked at the time, there was an official admission that there was ‘no new evidence’ to explain the revised advice and that the chief merit of the new policy was that it was ‘clear and unambiguous’ rather than truthful.
Not commented on at the time, however, was the fact that ‘evidence’ as defined by NoFAS was already incorporated into official thinking and cited in the new advice: ‘The National Organisation on Fetal Alcohol Syndrome [NoFAS] estimates for the UK as a whole that there are more than 6,000 children born each year with Fetal Alcohol Spectrum Disorder [FASD].’ No account of the origin of the statistic ‘more than 6,000 children born each year with FASD’ can be found on the NoFAS website. According to the NHS Information Centre, the figure was generated by extrapolating estimates of the incidence of FASD for ‘Western countries’ and combining these with the official estimate of 700,000 live births in Britain each year. In other words, it is a ‘guesstimate’ of the incidence of a condition whose existence itself is questionable.
Armstrong’s analysis suggests that whether or not medical entrepreneurs achieve their goals depends on whether their vision resonates with already-existing policy concerns. US studies argue that wider cultural conditions in that country explain why FAS expanded and why the case for abstinence made sense to policymakers from the early 1980s onwards.
The same is true for Britain more recently. An approach that has no basis in conventional understandings of evidence has taken root, from the mid-2000s onwards, in the context of an official view that the way to solve any and all social problems is to ‘intervene early’. Educating pregnant women about their behaviour has emerged as the ultimate exemplar of the belief that the way to ‘get to the causes of problems’ is to change the way parents raise their child (and to go further by extending programmes to modify parenting practices backwards to the womb).
It would be a real pity if the debate about the new training scheme for midwives stays stuck in its current groove about who should fund this drive to monitor and modify behaviour in pregnancy and parenting. Other questions entirely need to be raised about where we will end up if this evidence-lite, early-intervention policy is continued.