Episode 81 – 22nd April 2011

[Direct MP3 Link] [Podcast Feed] [Add to iTunes]

DEAct Judicial Review (1:35) by James Firth
Local Elections Preview (8:49) by Alex Foster
Regenerating Margate (18:33) by Jon Treadway
Gay Blood Donation (27:32) by Salim Fadhley (ft Peter Tatchell)
Wikipedia & Academia (34:48) by Harriet Vickers (ft Charles Matthews)
The Christ Conundrum (40:33) by Liz Lutgendorff (ft Andrew Carruth)
Atlas Shrugged (49:11) by Paul Day
BHA Conference (54:45) by James O’Malley (ft Andrew Copson)

Follow-Up Links

See the video of the guinea pigs to watch whilst listening to James Firth’s piece about the Digital Economy Act after the break (this will make sense if you listen to the show):

8 thoughts on “Episode 81 – 22nd April 2011

  1. Not only does Alex have a great voice, but he’s also helped me and any other current or past candidate reminisce in the glory of clearing the paper hurdle to candidature.

    Additionally, we have the joys of the returning officer refusing to accept a nomination form as the ninth of the ten signatories required had entered the wrong electoral polling number, crossed out a digit and carried on. “No crossings-out allowed, you need to complete the whole sheet again.” Minor disagreement before the returning officer agreeing that, whilst we had clearly made a mistake, it was in her power to overlook a minor indiscretion like this.

    Reference to the empty and unchallenged seats, a major question brewing – especially in areas like Waverley where I’m standing, with 3 tiers of local democracy – is there enough public interest to make democracy work? The papers don’t follow the issues on council meeting agendas, the electorate don’t come along to meetings (except when a big issue hits the agenda, like a planning application for a supermarket).

    Something needs to be done to refresh and rejuvenate local politics. Strip out a few seats, create a few more unitary authorities, get bloggers to cover all council meetings, re-engage the public so people actually give a damn enough to go out and vote – or, dare I say, stand and challenge some of the uncontested seats.

  2. On the whole another great episode. First time I’ve been motivated write a ranty comment in response to an item though…

    For an item about making a change to a piece of public health policy, policy which is presumably based on expert advice from statistical epidemiologists, Salim Fadhley’s argument for loosening the rules on blood donation from men who’ve had sex with men was irresponsibly short on science, figures, statistics, or indeed anything other than vague comments about individual variation in sexual practices and an unsupported assertion that those whose job it is to protect the patients from disease transmission have allowed homophobia to affect their calculations.

    I am not an expert, but a little research suggests that men who’ve had sex with men (MSM) are sadly considerably more likely to carry blood borne viruses than most other groups, and account for 43% of the UK’s HIV infections (the bulk of the rest being from other groups excluded from donating – people who have had sex in certain countries outside the UK and injecting drug users http://www.avert.org/aids-uk.htm).

    The donor questionnaire is one of two imperfect methods the National Blood Service use to minimise the risk of out infected blood being given to patients (cheap antibody screenings being the other). We might assume that the current rules, by excluding maybe ~5% of potential donors (MSM), eliminate 43% of the remaining risk of HIV-infected blood being given to patients.

    Yes plenty of MSM will have a lower risk than some other people. Asserting that is not enough to change the policy. You’ve got to show that whittling down that 5% of excluded donors is cost-effective and accurate. So with what sort of accuracy could you calculate an individual’s personal risk? What would be the cost of calculating it sufficiently accurately (if this is even possible) and how does that compare to the cost of just recruiting more donors?

    My guess is that cost-effective system involving a questionnaire to screen what probably amounts to thousands of people per day for several diseases must be simple and necessarily rely on generalisations, not individual assessments.

    Just to pick three issues off the top of my head: how many people are mistakenly certain that their partner is faithful? How many people would lie to hide infidelity or prevent embarrassment (in my experience people often go to give blood with friends, partners or relatives)? How much more likely are genuine mistakes with a more complex questionnaire? All these issues issues obviously apply equally to heterosexuals and homosexuals, but when sex between men is much riskier than heterosexual sex (necessary generalities again), the numbers coming out of the actuarial calculation will be different for the two groups.

    I suspect that the people who advise on this aspect of policy are scientists and other experts, doing so on an informed basis considering the statistics and the practicalities. If you’re making an allegation that a public health decision is based on homophobia, you need a lot more evidence than Salim Fadhley’s piece had. Perhaps the Pod Delusion in a future edition we might hear from someone with a little expertise in the field?

  3. Underblog, thanks for the feedback. Criticism accepted – it was indeed short on science and statistics. Feel free to come back with some of your own!

    I see where you are going with your argument that a higher rate of AIDS amongst one group justifies excluding that group entirely. I suspect that you might find a higher rate of AIDS amongst poor people, would you justify the exclusion of that entire group on the same basis? I’m being silly of course, but it illustrates the point that these gross generalisations might actually mis-inform about the actual causes of risk.

    My view is that a screening system should be based on behaviour rather than sexual identity. That way anybody who participates in high-risk activities should not be welcome at all to give blood. People whose sexual activity is low-risk should be welcome. In my view (and I think Peter’s as well), unprotected promiscuous sex is a high-risk activity regardless of which gender prefer.

  4. Salim, thanks for your response.

    You say that the screening system should be based on sexual behaviour rather than sexual identity. I agree, and this is precisely the current situation. The question asks if you are a man who has had sex with men (MSM), not if you are a homosexual. Straight men who’ve had homosexual sex may not donate. Lesbians may donate, as may homosexuals who have never had sex with a man. Other high risk activities are also banned.

    Now I would imagine the question does exclude the vast majority of homosexual men, along with some straight men. You may think it broader than necessary, but it still a question about sexual history rather than sexuality.

    As for providing figures of my own, I will try but am no an expert. I think on a public health issue like this it would have been good to hear from one. I’m sure you wouldn’t dream of criticising, say, a vaccination programme without listening to experts in the field and don’t see why this should be any different. I have no doubt you have good intentions – and arguing a case that can at first superficial glance appear homophobic is not a particularly fun position to be in – but I do think anyone considering calling for a change to public health policy has a responsibility to research the area quite thoroughly before doing so.

    I did provide one figure. 43% of HIV cases in the UK affect men who’ve had sex with men. You can almost halve the risk by excluding a relatively small group. Where the numbers are similarly compelling – intravenous drug users, anyone who’s ever worked as a prostitute, people who’ve had sex in certain parts of the world, even people who’ve had tattoos recently, they are similarly excluded. I doubt the numbers are comparable for “poor people”. If they were, and if there was no more efficient and accurate way of assessing that risk, I would support their exclusion from blood donation. Not particularly pleasant, but we have a duty to protect the recipients of donated blood – amongst whom there will be homosexuals, poor people, drug addicts, people working as prostitutes, people who have sex in parts of the world with high rates of HIV, members of every other conceivable group.

    Here’s another figure: the current risk of HIV transmission from blood transfusion is 1 in 5 million in the UK. If I’ve done the maths right, then without the ban on donations from MSM we might expect that to increase to 1 in 2.85 million. And there are of course other equally significant blood borne infections to consider too. (http://www.blood.co.uk/pdf/Final_Version_Will_I_Need.pdf).

    Is it possible to refine the questions further to allow more MSM to donate whilst letting an acceptably tiny amount of extra HIV-infected blood through the net? I don’t know. I speculated that there may be all sorts of difficulties with increasing the complexity of the questionnaire. It seems unwise to dismiss that possibility and assume homophobia instead without a pretty strong case.

    By the way, it is wrong to say that unprotected sex between men is no riskier than unprotected heterosexual sex. Firstly, because the MSM group has a much higher incidence of HIV, your partner is statistically more likely to have the virus (yes, a generalisation, but that’s what statistics are). Secondly, the transmission rates for different sexual acts vary. (http://books.google.co.uk/books?id=wpvux6RS-jsC&pg=PA1098).

    If you and the Pod Delusion spam filter will excuse me for getting specific for a second, receptive anal sex is the most risky type of intercourse if your partner is +ve, and over five times riskier than receptive vaginal sex. Being the insertive partner in anal or vaginal sex is less risky still.

    “Ahh, but, straight people can have anal sex too” you might say. True. But the receptive partner in hetero anal sex is a female, who is less likely to pass the virus on if she does catch it because, to be blunt, she don’t have a penis. Female to male transmission appears to be comparatively rare, with a risk of less than 0.1% per sexual encounter for both anal and vaginal sex.

    By the way, these figures suggest to me that you might not need to assume higher levels of promiscuity amongst MSM to explain the difference in HIV rates. It could just be down to the unfortunate combination of biology and maths. The unique characteristic of the MSM group, that men can partake in both receptive anal sex (most risk of getting the infection) and insertive anal sex (most risk of then transmitting that infection to another partner) could be enough to account for the difference for all I know. In any case, promiscuity is even more risky for homosexuals than for heterosexuals. Not that I’d make moral judgements about promiscuity. No-one should care what I think on the matter, but like most people if asked I’d say it’s fine for consenting adults to do whatever they want as long as everyone involved knows the score and is informed about the risks.

    In summary, I don’t think you have shown that the current policy is motivated by stereotype and homophobia as opposed to statistics, or that it’s possible to design and equally effective and safe questionnaire that excludes fewer MSM.

    Finally, I just want to say thanks for putting in the time and effort to contribute stuff to the Pod Delusion, which I really enjoy listening to. I hope you don’t let rants like this don’t discourage you from doing so at all, even if on this subject I would encourage a more cautious approach in future. Cheers!

Leave a Reply

Your email address will not be published. Required fields are marked *