I Think You'll Find It's a Bit More Complicated Than That (22 page)

But most interesting are the noises now being made by the coalition on crime and evidence. ‘We will conduct a full review of sentencing policy,’ they say, ‘to ensure that it is effective in deterring crime, protecting the public, punishing offenders and cutting reoffending. In particular, we will ensure that sentencing for drug use helps offenders come off drugs.’

These are grand promises. Compulsory addiction rehabilitation with ‘Drug Testing and Treatment Orders’ was introduced precisely ten years ago – as an alternative to custodial sentences or simple probation – for those who have committed drug-related crimes. Their implementation without adequate analysis is a graphic example of our failure to run simple trials of social policy.

Any judge making a decision on a criminal’s sentence is in the exact same position as a doctor making a decision on a patient’s treatment: both are choosing an intervention for an individual in front of them, with the intention of producing a particular set of positive outcomes (reduced crime, say, and reduced drug use); both get through a large number of individuals in a month; and in many important situations, neither yet knows which of the available interventions works best.

If you randomly assign a fairly large number of criminals, or patients, to one of two interventions, in situations where you don’t know which intervention would be best, and measure how well they’re doing a year or so later, you instantly discover which intervention is best. Add in the cost, and you know which is most cost-effective. The basic principles behind this idea are not new, and were first described in the Old Testament, Daniel 1:12.

Before being rolled out nationally in October 2000, DTTOs were extensively
piloted in three cities
by the Criminal Policy Research Unit of South Bank University, at considerable cost. What insights did this generate? There was no randomisation, and no ‘control’ group of identical criminals given traditional sentences for comparison. Because of that, the only new knowledge generated by these pilots was the revelation that it is possible to set up a DTTO service and run it in some buildings in some cities.

As it happens, when they did follow up the people who had passed through the service, they hadn’t done particularly well. But this finding wasn’t published until after the service had been rolled out. In any case, because there was no randomised comparison group, we have no idea how these participants would have turned out if they’d been given a traditional custodial sentence anyway, so there’s no sense in giving those results even a moment’s thought.

This is a tragedy, and not just because
drug use is estimated
– with the usual caveats about estimating more nebulous stuff – to be behind 85 per cent of shoplifting, 80 per cent of domestic burglaries, over half of all robberies, and so on. It is also a tragedy because it speaks to motives that will never go away.

We would need a very brave modern politician to say: ‘Look, I want to introduce a new policy, but I honestly don’t know if it will work’. We might need to be forgiving, ourselves, of someone who said this, and actively encourage them to try out their ideas on half of a group of people. We would need a political class that could react to deferred outcomes, with the results dripping out from new interventions over the course of years, perhaps long after the one initiating politician has moved on. Doing all this would revolutionise social policy, in far wider domains than just criminal sentencing. But for now, politicians – and we must share the blame – get further when they use rhetoric, and absolutes.

Pornography in Hospitals

Guardian
, 25 September 2010

The
Sun
, of all people, is
angry about pornography
: ‘The hard-up NHS is blowing taxpayers’ cash on PORN for sperm donors, a report reveals today.’ The
Telegraph
immediately followed suit
: ‘Some clinics provide pornography for men masturbating in clinic rooms to produce sperm for IVF with their partners.’

These articles were inspired by a report titled ‘
Who said pornography was acceptable
in the workplace’, produced by a right-wing thinktank called 2020health. The author, former Conservative parliamentary candidate Julia Manning, says pornography in this clinical setting is: a violation of the NHS constitution; a case of manipulation by the sex industry; strips women of their human status; an encouragement of ‘adultery of the mind’; a danger to men, as it introduces addictive material into their treatment (which ‘beggars belief’); and an abuse of taxpayers’ money.

The average spend on these magazines was £21.32 per health trust per year, with each clinic treating a large number of couples. For context, private clinics charge around £6,000 for a couple to have three cycles of IVF.

But the moral case may still stand: is the pornography necessary? Farmers, animal breeders and vets all have wide-ranging experience of getting viable sperm from male animals under artificial circumstances. As a result, they have examined this exact same question, in detail.

Hemsworth and Galloway
showed in 1979 that sperm count in the ejaculate of a domestic boar (an actual boar, that’s not a euphemism for men) was significantly increased by allowing a ‘false mount’, or observation of another boar’s semen collection. We shouldn’t overstate this evidence: another study found that the effect seems
not to be present in rams
. But in 1984
Mader and colleagues
studied twelve Hereford bulls, and found that watching another mating pair in action significantly increased frequency of ejaculation. In the same year
Price and colleagues
found semen collection from male dairy goats was faster with a ‘stimulus female’, which was present but unmountable.

This can hardly be a surprise. As long ago as 1955,
Kerruish reported
that insemination centres for cows did not provide ‘adequate sexual stimulation’ prior to semen collection: his regimen of intensive sexual stimulation resulted in a ‘marked improvement in sexual behaviour’ and – crucially for our question – an increase in the conception rate.

But it gets more interesting. There is already evidence from animal research that males increase the amount of sperm in their ejaculate when there is more competition around. In 2005,
Kilgallon and Simmons
conducted an experiment to see whether human males viewing ‘images depicting sperm competition’ also had a higher percentage of motile sperm in their ejaculates.

This wasn’t a perfect study: they compared ejaculate in fifty-two heterosexual men, looking at pornography with two men and one woman, against pornography with three women. I think it would have been better to compare images of one man and one woman, against two men and one woman, but there you go. They found that men viewing the ‘two men one woman’ pornography had a higher percentage of motile sperm. On a related note,
Zbinden and colleagues
found that male stickleback fish ejaculate more sperm after being shown a big rival than a small one.

But finally – and firmly on the question at hand –
Yamamoto and colleagues
in 2000 studied nineteen men masturbating into a jar, alone in a room, with or without ‘sexually stimulating videotaped visual images’. Sperm volume, total sperm count, sperm motility and percentage of morphologically normal sperm were all higher when the men had pornography. Meanwhile, some men find it
impossible to ejaculate
on the day it’s most needed for IVF, and sperm can only be retrieved by epididymal aspiration, or a needle inserted into the testicle. This is a seriously suboptimal outcome, with a small risk of unpleasant medical complications.

I’m not saying porn is brilliant. I absolutely agree that the objectification of women’s bodies is a bad thing, and I don’t particularly want to see porn lying around at work, although by the very nature of hospitals, you can see all kinds of dreadful things if you open the wrong door at the wrong time.

All I’m saying is: when there is a reasonable evidence base to show that pornography helps people overcome what they regard as a deeply painful problem (like ‘being childless’); when they’re going through the very strange and unpleasant experience of masturbating alone in a clinic room, with everyone outside knowing what they’re doing, and quite possibly some kind of queue; then however unpleasant you might find the intervention, research showing that pornography works, matters.

The Power of Ideas

The Atheist’s Guide to Christmas,
2009

I don’t mean to fill your Christmas with Aids and diarrhoea, but there is something awe-inspiring about the power of ideas alone to do great good, and great evil. Diarrhoea will be our happy ending. Aids will not.

There are the cheap shots. Africa is filled with miracle-cure peddlers: the Gambian president, Yahya Jammeh, claims he can personally cure HIV, Aids and asthma using magic and charms. The South African government fell for a cure built around nothing more than industrial solvent.

It’s all too easy to feel smug, and to forget that we have our own cultural idiosyncrasies. There’s compelling evidence, after all, that needle-exchange programmes reduce the spread of HIV, but the strategy has been rejected, time and again, in favour of ‘Just say no.’

And then there is the Church. In May 2009, as I write this, the Congolese Bishops’ Conference have triumphantly announced that they ‘say no to condoms!’ This idiocy goes to the heart of the Catholic faith. In March, on his flight to Cameroon, Pope Benedict XVI explained that condoms worsen the Aids problem, and he has been supported, in the past year

alone, by Cardinal George Pell of Sydney, Australia, and Cardinal Cormac Murphy O’Connor, the Archbishop of Westminster. ‘It is quite ridiculous to go on about Aids in Africa and condoms, and the Catholic Church,’ says O’Connor. ‘I talk to priests who say, “My diocese is flooded with condoms and there is more Aids because of them.” ’

Some have been imaginative in promoting their message. In 2007, Archbishop Francisco Chimoio of Mozambique announced that European condom manufacturers were deliberately infecting condoms with HIV to spread Aids in Africa. It is estimated that one in six people in Mozambique is HIV positive. Cardinal Alfonso López Trujillo of Colombia famously claimed that the HIV virus can pass through tiny holes in the rubber of condoms (air molecules are smaller than the HIV virus: blow a condom up, as a home experiment, to test if Trujillo’s claim is true). ‘The condom is a cork,’ said Bishop Demetrio Fernandez of Spain, ‘and not always effective.’ In 2005 Bishop Elio Sgreccia, president of the Pontifical Academy for Life, explained that scientific research has never proven condoms ‘immunise against infection’. He’s right, I suppose. All this explains why the Pope has proclaimed: ‘The most effective presence on the front in the battle against HIV/Aids is in fact the Catholic Church and her institutions.’

Casanova testing condoms

Meanwhile, development charities funded by US Christian groups refuse to engage with birth control, and any suggestion of abortion – even in countries where being in control of your own fertility could mean the difference between success and failure in life – is met with a cold, pious stare. These moral principles are so deeply entrenched that under George W. Bush, the US Presidential Emergency Plan for Aids Relief insisted that every recipient of international aid money must sign a declaration expressly promising not to have any involvement with sex workers, even though they are a key vector for HIV.

Equally, there are heartbreaking tales of Westerners with a whiff of science going off to the developing world. Matthias Rath is a German vitamin-pill salesman who moved into South Africa five years ago, taking out full-page adverts in national newspapers: ‘The answer to the Aids epidemic is here,’ he announced. The answer, of course, was a vitamin pill. He explained that antiretroviral medications were a conspiracy by the pharmaceutical industry to kill patients and make money. ‘Why should South Africans continue to be poisoned?’ he asked.

And he had taken his ideas to the right place. In South Africa alone, 300,000 people die every year from the virus; that’s one every two minutes. There are 1.2 million Aids orphans, and more than half of all pregnant women are HIV positive. And South Africa was headed by President Thabo Mbeki, an ‘Aids dissident’, as they prefer to be known. In the most crucial period of the Aids epidemic, the South African government variously claimed that HIV was not the cause of Aids, and that antiretroviral medications were not an effective treatment. It refused to roll out effective antiretroviral medication, it refused to accept gifts of money to give out ARV treatment, and it refused gifts of the pills themselves.