Britain becomes safe heaven for gay refugees

The UK Supreme Court issued a finding today that gay refugees from countries that discriminate against homosexuality may not be send back to their home countries if there is a risk that they might be persecuted at home. The new conservative-liberal government promised to implement the ruling immediately, adding that they already have stopped sending such refugees back to their home countries. Initially, UK Home Office officials came up with the ingenious idea that gay people, after their deportation, should simply hide their sexual orientation at home, and so they would be fine. Lower courts agreed with the Home Office proposition, but the justices of the Supreme Court decided that that would constitute a violation of these gay people's human rights.

Here are bits from the finding that I did truly enjoy (taken from the UK Guardian website):

Deputy court president Lord Hope said in his ruling: "The ultra-conservative interpretation of Islamic law that prevails in Iran is one example. The rampant homophobic teaching that rightwing evangelical Christian churches indulge in throughout much of sub-Saharan Africa is another."

A "huge gulf" had opened up in attitudes towards gay people, he said. "It is one of the most demanding social issues of our time. Our own government has pledged to do what it can to resolve the problem, but it seems likely to grow and to remain with us for many years." More gay and lesbian people were likely to have to seek protection in this country if it was denied in their home countries, he said.

Another member of the court, Lord Rodger, said normal behaviour of gay people must be protected just as it was for heterosexual people. "What is protected is the applicant's right to live freely and openly as a gay man. To illustrate the point with trivial stereotypical examples from British society: just as male heterosexuals are free to enjoy themselves playing rugby, drinking beer and talking about girls with their mates, so male homosexuals are to be free to enjoy themselves going to Kylie concerts, drinking exotically coloured cocktails and talking about boys with their straight female mates."

Leaving aside for a moment the characterization of gay men as being typically this or being typically that, the point is well taken that if this is how you express your identity you have every right in the universe to do so without risking your life. You can see how important this judgment is when you look at how bad the situation for gay people in many countries is.

German Federal Court on PID

Imagine my surprise when I read in today's paper about a judgment from Germany's Federal Court in a case determining the legality or otherwise of pre-implantation diagnosis. Just so you get the significance of this, here's a blurb from Wikipedia about the relevance of the Federal Court in Germany's legal pecking order: 'The Federal Court of Justice of Germany (German: Bundesgerichtshof, BGH) is the highestcourt in the system of ordinary jurisdiction (ordentliche Gerichtsbarkeit) in Germany. It is the supreme court (court of last resort) in all matters of criminal and private law. A decision handed down by the BGH can only be reversed by the Federal Constitutional Court of Germany in rare cases when the Constitutional Court rules on constitutionality (compatibility with the Basic Law for the Federal Republic of Germany).'

The Court determined that it is OK to check for serious genetic defects of embryos prior to implantation in couple with known serious genetic illnesses. In one of the cases the woman considering conceiving another child had already given birth to a disabled daughter, another woman went thru three failed pregnancies. It goes without saying that embryos that are non implanted after PID took place (ie after serious genetic defects have been diagnosed) will be destroyed.

Critics have trotted out the usual stuff like that this discriminates against the disabled, and that this takes us on a slippery slope to designer babies (ie selection in favor of blue eyed kids was mentioned). It is true that the court judgment takes a clear stance on the former issue. If at the embryonic stage it is possible to make a choice between a future seriously disabled child and a healthy (healthier) child, the latter is preferable and it is up to pregnant women to decline the implantation of the embryo known to be defective. On the latter issue, currently such choices would not be covered by the judgment, but frankly, what if someone chose blue eyes over brown eyes, or brown eyes over blue eyes, what danger would this really entail? If someone - like me - subscribes to the ethical stance (as I do) that women are very much entitled to make reproductive choices entailing abortions, for any reason or none, why should it matter that they decline the implantation of an embryo with the wrong eye color?

I do think my progressive friends need to think carefully about whether or not they support unconditionally a woman's right to make reproductive choices. If they do, the above mentioned slippery slope arguments must not faze them.

Jamaican papers are at it again – homophobia in 'reporting' action

Having just redeemed themselves in the eyes of regular readers with pretty sharp reporting about the Dudus' affair, Jamaica's journalism is back to its usual quality-wise lows.

Two of Jamaica's papers, the Observer and the Gleaner have a long and distinguished history of anti-gay agitprop. The Gleaner frequently does it under the guise of pseudo-openness perpetuated by one of its columnists. He's a quite eloquent chap who likes to gives his musings an air of scientific soundness when really he picks and chooses biased academic content usually from low-ranking academic journals likely gleaned from the Family Research Council's (or some other Christian fundamentalist organisation like it) treasure chest of anti-gay 'research'. You know, the kind of research 'demonstrating' that gays are more likely to rape little kids, murder your grannie and have a hotline to the devil. A long running Jamaican agitprop feature on that front has been this: Antigay violence in Jamaica ain't the real problem (empirical research undertaken by international human rights organisations be damned) but violent gay men beating each other up are the real problem.

Here's an example taken from the Observer. In last Sunday's edition, under the byline of 'DONNA HUSSEY-WHYTE Sunday Observer staff reporter', the campaign continues. Hussey-Whyte notes in her introductory line that 'Many may argue that the gay community is falsely accused of excessive violence against its own members, but the horrible wounds on Keron Brown's body tell a different story.” Her story is about a gay man who she reports has been abused pretty badly by his partner and that partner's mates. Assuming that the case is true – I have no way to verify it, but it's perfectly possible, of course, that a gay man was abused by his partner – nothing follows with regard to how the average gay person treats his or her partner(s).

No doubt Donna Hussey-Whyte doesn't know what inductive reasoning is, and even less why we know that such modes of analysis don't work as a scientific method. So, to her benefit: You can't really use anecdotal cases to make a general point. Say, assume I see someone jumping out of a 10^th floor window and ending up on the ground floor without injury. I shouldn't make that the story line of an article suggesting that generally speaking it's sensible to assume that jumping out of 10^th floor windows isn't a risky activity. I'm sure you get the drift. So, before Donna Hussey-Whyte's agitprop piece even goes into full swing, anyone who took Scientific Method 101 knows already that not only is her first sentence wrong, but more importantly, that anyone can know with certainty that her story can't prove her point about the gay community being pretty violent against its own members. It's not even clear what she means with gay community to be honest. Is her proposition that the average gay person is more likely, or a membership club called 'gay community' or is something else tickling her incisive reporting mind?

Even if there was a whole bunch of such cases, nothing would follow regarding the question of how the majority of gay people in Jamaica treat each other. Short of a representative survey, this bunch of cases would be just that, a bunch of anecdotes. The question is: Could such research even be undertaken in a society where gay people are hunted out of their houses, beaten up randomly in the streets, and where homosexual conduct and relationships are still illegal. The truth is, if we bothered investigating what amounts to an odd-indeed hypothesis to begin with, we would really have no means to undertake such a study in current-day Jamaica.

Anyhow, back to Donna Hussey-Whyte's agitprop piece: Just think of a counter example of similar disingenuity, think of the number of crimes committed by heterosexual people in Jamaica. Most of those crimes are committed against other heterosexual people. Would this tell us anything at all about a purported link between heterosexuality and violent behaviour? Not at all – that is unless you're Donna Hussey-Whyte. Oddly, she never filed this particular investigative report. Makes you wonder why...

Having said that, from societies more peaceful than the Jamaican we do know that gay people are – if anything – less prone to be violent than their straight counter parts. Is it possible that anti-gay violence and general societal homophobia cause possibly surplus violence among gay people that otherwise would not exist? This truly is an interesting question, if we accept the local media's as yet unsubstantiated premise that gay people in Jamaica are really more prone to abuse each other than they are in other countries. Do we know whether they are more prone to this sorts of behaviour than they are in other countries, or do we know whether they're more prone to violence than are heterosexual people in Jamaica? We know none of this, unless we believe that Donna's inductive 'reasoning' is a good substitute for actual evidence.

As ever, beware of Jamaica's newsmedia when it comes to the issue of homosexuality. Their reporting is by and large in the service of anti-gay prejudice. It's mostly propaganda, no more, no less.

Circumcision time again

The time honored barbarism of killing young (South) African men in that traditional practice of circumcision has again yielded a decent crop of dead men in South Africa. Reportedly about 150 young men died in circumcision ceremonies (or as a result of their participation) between the beginning of 2008 and the end of 2009. So-called traditional healers (elevated to a profession under the able guidance of the late Dr Beetroot, the former South African health minister and arch AIDS denialist Manto Tshabalala-Msimang) are frequently involved in botched circumcisions, causing so substantial numbers of avoidable deaths. The opposition DA party suggests that the actual circumcision should take place in a hospital. Now that's a thought.

Of course, there will be those who say that circumcision is always wrong, and - my own preferences to the contrary notwithstanding - there's some truth in that. The thing is though, since we have fairly strong evidence that circumcision dramatically reduces the risk of catching HIV there's probably a public health argument to be had - in Southern Africa - for undertaking circumcisions. Wouldn't it be nice though, if authorities in that country managed to have them conducted in such a way that not so many young men needlessly lose their lives over them?

G8 and G20 cost

What's the point of hosting these G8 and G20 events in big cities? Toronto was transformed into a police state for the duration of the event, the losses in terms of tourism revenue and productivity were/are large, and the list goes on.

I can see that there is an argument to be had that democratically elected heads of state should be able to meet even if there's violent protesters threatening to disrupt their meeting. In Canada, what was odd were marketing exercises (like a - get this - fake lake) that might have been of interest to tourists (who saw mostly violent protests on TV) but that were certainly of no interest to the attending heads of state (they got their own lakes). The photo shows an artist rendering of the lake ...

So, my question is this: if these heads of state believe it's worth meeting - the official results along would suggest that perhaps they might be mistaken - why can't they meet in some out-of-nowhere place? You know, all things considered, it might be cheaper building them a hotel in some place in the sticks and have em take their helicopters or planes there. Should be cheaper than shutting down multi-million people cities. What a waste!

Assisted dying OK in Germany under certain circumstances

Imagine my surprise when I read in today's paper about a judgment from Germany's Federal Court in an assisted dying case. Just so you get the significance of this, here's a blurb from Wikipedia about the relevance of the Federal Court in Germany's legal pecking order: 'The Federal Court of Justice of Germany (German: Bundesgerichtshof, BGH) is the highest court in the system of ordinary jurisdiction (ordentliche Gerichtsbarkeit) in Germany. It is the supreme court (court of last resort) in all matters of criminal and private law. A decision handed down by the BGH can only be reversed by the Federal Constitutional Court of Germany in rare cases when the Constitutional Court rules on constitutionality (compatibility with the Basic Law for the Federal Republic of Germany).'

So, today said court ruled that if someone competent has decided they wish to die, even if the nature of their illness does not suggest that their dying process has begun, whoever removes pro-actively their means of life-support has not broken German law. Further, in the case of unconscious patients the patients' likely intention is considered sufficient to make the removal of life support systems legal. In the case under consideration a reportedly a woman who had been in persistent vegetative state for 5 years had her means of life support terminated by her daughter based on the patient's expressed wishes. Part of the problem was that her wishes were only expressed verbally to her daughter prior to her coma, hence no written advance directive existed. The patient had no chance of an improvement of her clinical situation. I wonder whether different circumstances might have changed the verdict or whether this really suggests that self-determination takes priority over the purported sanctity of life in German law.

This, of course, is terrible news for those God people who believe that we are not entitled to make respect demanding decisions about how we wish to die.

Publicationethics.org on Ghostwriting

Publicationethics.org has a feature about several papers from the current issue of Bioethics on ghostwriting of medical journal articles.

Ghostauthors, ghost management and the manipulation of medical research

There are three articles in the June issue of Bioethics on different aspects of ghostwriting.

The first article, by Tobenna D Anekwe, “Profits and plagiarism: the case of medical ghostwriting” argues that “medical ghostwriting often involves plagiarism and, in those cases, can be treated as an act of research misconduct” and suggests measures to counter ghostwriting.

The second article, by Sergio Sismondo and Mathieu Doucet, “Publication ethics and the ghost management of medical publication" discusses the wider issue of management of the whole publication process, showing how “pharmaceutical companies engage in the ghost management of the scientific literature, by controlling or shaping several crucial steps in the research, writing, and publication of scientific articles."

The final article, by Carl Elliott and Amy Snow Landa, "What’s wrong with ghostwriting?" concludes that ghost authorship and ghost management are part of a much larger problem, “the manipulation of medical research for marketing purposes.”

Bioethics and Developing World Bioethics show improved impact factors

As you probably know, I am a co-editor of two peer reviewed international journals called Bioethics and Developing World Bioethics. Each year a commercial Canadian outfit called ISI (owned by Thomson Reuters) delivers its verdict on journals' impact (often confused with quality by journalists, academics and university administrators).

Publishers invariably get excited about their journals as good impact factors mean 'better' journals mean better marketing opportunities mean more money. There is plenty of evidence to go around that the impact factor is highly unreliable (in fact, ISI failed to reproduce, on request, its own impact factors in several test cases). Still, much like donors, students and government funders take notoriously nonsensical university rankings as their gospel, academics use high-ranked journals as preferred outlets and so this stuff becomes a self-fulfilling prophecy. In many universities academics are receiving bonuses for publishing in high-ranking journals. The idea is that a high-ranking journal is difficult to get into and voila, another quality standard is born. Duly, once you're high-ranking individual national science agencies begin dumping A's and similar rankings on you. More incentives for academics working under the influence of these agencies to publish in 'A' ranked journals. Of course, this all translates into creating self-fulfilling prophecies. It seems it hasn't occurred to anyone yet that a 'journal' publishing one article per year that gets cited a lot would have a stratospheric impact factor, and it would be difficult to get published in. So that useless journal with its one article per volume would be very 'prestigious' on the relevant counts.

This year ISI has increased the number of non-English journals it ranks, but there's an inherent bias in its ranking of these journals as ISI has no way to actually measure the citations of these journals reliably. As a result of the new inclusion policies these journals rank consistently low and assist in artificially boosting the group ranking of English language journals. For instance, a little-known English language bioethics journal that normally would have been safely ensconded on the bottom of the ranking is now being surpassed in the race to the bottom by Italian and German language bioethics journals.

Anyhow, this is just to report that Bioethics increased its impact factor to 1.136 while Developing World Bioethics, in its first entry scored a nice 1.256. Both journals managed to 'beat' quite a few very well-known competing publications. So all is good on the journals front. In a list of 34 journals in the 'ethics' category we made it to ranks 7 and 9 respectively,

Should someone smack her or her parents?

I am not in favor of corporal punishment (really). Still, in the case of the recently rescued teenage woman who was determined to sail around the world, I can't help but think some should smack her for attempting this or her parents for permitting her to attempt this. Her voyage floundered in bad weather and a major rescue operation had to be launched, involving planes, boats and whatnot. I hope someone, someone please bankrupt this family for its selfish conduct. Sue them for the resources wasted in this unnecessary rescue mission. This woman should have entertained herself (and her ego) by staying at home and doing something useful (for crying out loud: help in the local homeless shelter, teach younger folks locally how to sail etc etc). Beats me why this kind of stuff happens again and again and again. What drove this family to permit her ill-prepared daughter to undertake this trip? And why should anyone other than the family pay for rescuing this person out of her self-inflicted problems?

On a more personal note, I will be away for about a week (working away from my homebase). I am likely unable to update the blog during this week.

More corruption at UN?

Turns out what most interested observers have been arguing for a long time has been proven correct. The WHO's panic mongering in relation to the swine flu pandemic was just that, panic mongering. The primary beneficiaries were pharmaceutical companies whose products were stockpiled by many countries that responded to WHO recommendations. Finally, in-depth reports accuse WHO of exaggerating the real danger. The reports also note that on the WHO committee writing the report served several scientists who arguably had a conflict of interest (related to their relationships with pharmaceutical companies). The Washington Post wonders whether or not the WHO advert for flu medicines (aka its flu guidance) informed its member countries of these commercial conflicts of interest.

Do not trust a word BP is uttering

April 28 2010, BP - against the opinions of many qualified scientists - insists that a maximum of 5000 barrels of oil per day flows into the sea. The company is duly supported by US Pres (yes we can walk on vacuous pronouncements) Obama's experts. Well, today the company announces that its current fix results into them pumping 10000 barrels of oil per day to a ship above the leak. In case you still watch the live video from the leak, you will have noticed that despite this effort oil is leaking in large quantities into the ocean. 5000 barrels a day, BP, really?

Offense ain't a good reason for censorship

This debate about whether it's acceptable (with reference to free speech) to draw cartoons of the Muslim's prophet Muhammad or not is just weird. Let's be clear about what I mean by acceptable: Acceptable in the sense of unacceptable being a sufficient reason to prohibit (or prevent by threat of violence) someone else from drawing a cartoon of the prophet (both depicting him negatively or positively). Islam seems to have a prohibition to depict the prophet. That's all quite all right for adherents of that ideology who voluntarily agree not to draw such cartoons. However, what about the majority of people on the planet who happen to be adherents of other ideologies (or none)? Should they be bound (as in legally, or by threat of force) by such a prohibition?

The main rationale that I could find as a justification for declaring depictions of the prophet unacceptable (by my above definition) is that it offends Muslims. So, a lot has been made of good neighborly behavior (Christians, no doubt wouldn't appreciate cartoons of their Jesus as a gay guy who surrounds himself mostly with men, for instance - btw, I am not suggesting Jesus was gay, hey, I'm not even qualified to judge whether or not there's a historical Jesus to begin with). There's probably a point to be made that it would be nice if people stopped depicting the figureheads of major ideologies (religious or otherwise) as pinheads of some sort or other. Less people would be upset (the standard burning of flags and people by some Muslims in developing countries that routinely follows rumors of a new cartoon is, of course, distinctly unhinged and undoubtedly explainable by the low levels of education in such places), and so our world would be a more peaceful place.

However, is that a sufficient reason to declare such cartoons unacceptable (by my above definition)? I don't think so. One reason for this is that the most radical adherents of such ideologies would otherwise be able to dictate to the majority what kinds of cartoons may or may not be drawn and seen. Very clearly those most fanatic about the ideological convictions would also be most likely to be most offended by such speech acts (a cartoon is a kind of speech act after all). Should we really determine the permissibility of speech acts by whoever is the most fanatic? I don't think so.

The bottom line, to me, seems to be that no one has a right not to be offended. Freedom of speech is not absolute, but the right to offend must surely be included in any definition of free speech. All the time honored rationales for free speech are sufficient to justify this conclusion, but just as well, we got to realize that the consequences of allowing the most radical adherents of any given ideology to determine what's too offensive in public debate, are plain unpalatable.

Gay men of integrity and spineless homosexuals

You might find this a very odd comparison, but it's kind of apt I think.

On the one hand there are Malawians Steven Monjeza, 26, and Tiwonge Chimbalanga, 33. They, were arrested in December 2009 after they threw themselves an engagement party at the Blantyre lodge where Mr. Chimbalanga worked as a cook and a housekeeper. They were eventually found guilty of some 'unnatural' (a contradiction in terms) or other by a Malawian court and sentenced to 14 years jail by a Christian judge keen on 'deterring' others from engaging in homosexual conduct in that country. Well, Malawi, being just another more or less failed African state depending on Western hand-outs, was told literally by the world (from the Canadian foreign minister to the newly elected UK Prime Minister to very many other people) to get a grip. The current UK's international development minister (ie the guy in charge of the Malawian international aid) is an openly gay man. The UN general secretary told Malawi's president that this verdict violated international human rights. Duly, and no doubt to the great disappointment of US evangelicals that usually have a hand in these sorts of homophobic actions, the Malawian president pardoned the gay men and they'd be free by now. There are a lot of aspects to this that are worth commenting on. However, I mean to compare the integrity with which these gay men have conducted themselves with the deeply embarrassing conduct of other gay men. Think of David Laws, the former UK Treasury Chief. He was caught with his hands in the till, well, sort of. Laws resigned after it became public knowledge today that as an MP he had himself reimbursed from the public purse for 'renting' a room in his same-sex partners properties. 'The Daily Telegraph disclosed that he claimed as much as £950 a month in parliamentary expenses for eight years to rent rooms in two London properties.The houses were owned by his partner, James Lundie, a political lobbyist. In 2006, MPs were banned from “leasing accommodation from a partner”. ' Laws says that he kept his sexual orientation a secret from both his family and the public, and hence did not disclose that his partner was his partner. Laws was probably not motivated by greed, being an independently wealthy former investment banker.

So, here's this rich guy then who doesn't have to worry about losing his job, who doesn't have to worry about jail sentences, who lives in a society where the civil rights of gay people are very well protected, and yet he engages in embarrassing shenanigans to hide what doesn't need to be hidden. He serves in a conservative-liberal government with other openly gay ministers, yet he remains in the closet. Worse, he's a member of the Liberal Democrats, so by any stretch of imagination he had no reason to worry about negative political repercussions if his sexual orientation ever became public knowledge. Compare Laws' lack of personal integrity with how the two Malawian gay men have conducted themselves under much much more difficult circumstances.

Strange times.

I have to be honest, I have no sympathy for gay people who choose to hide their sexual orientation (by means of living a life designed to deceive everyone around them, from their families to their business partners, friends etc etc) when there is no good reason to do so. All other things being equal, anyone who, like Laws, is independently wealthy, has little reason to reside in a closet. If you live in places where your life might be threatened or other serious repercussions are to be feared, you might have a reason to keep your sexual orientation a secret, but otherwise, you do not deserve any sympathy when you are found out (Laws being a case in point). This deceitful behavior is offensive to other gay people who are open about who they are.

Industry greed vs patient needs

Another chapter in the never-ending story of patient survival needs vs pharmaceutical industry greed. The Danish company Novo Nordisk, the world's leading supplier of insulin has decided to stop supplying near-bankrupt Greece with insulin, because the Greek government in a desperate attempt at saving money decreed a 25% price cut on all medicines. Patients are being held hostage here by a profit-driven organisation, to the extent that their well-being is at stake. So far for the myth that pharmaceutical companies are in the business of health... - One would hope that eventually the important lesson is learned by the powers that are that we cannot leave drug R&D more or less exclusively in the hands of for-profit operators. That the patients of whole societies can be held hostage by organizations such as Novo Nordisk, without recourse, is surely unacceptable.

Montreal's environmental rip-off

Montreal has this widely hailed scheme where you can rent bikes to travel about town. I think London is considering using the same scheme. The bikes are called Bixi, and they're kind of public bikes. The idea is great. There's plenty (I will get back to that one) locations (bike-racks) all over Montreal where you slot in your credit card and you can use the bikes. The idea is that you use them for short trips, quasi from bike-rack to bike-rack. You pay for the time that you use them. That's all dandy, until you realize that there's no bike-racks in lots of places. So, while working in Montreal last week I duly used the Bixi. Well, after a 15 minute ride I ended up where I had to go (by no means an off-the-beaten track location) and, surprise surprise, there were no bike-racks anywhere close by. In other words, I had no bike-rack to return my Bixi to, and had to keep on paying until my work meeting was over and I was able to return to where I picked it up. The result was a bill of 39.50 $. For that I could have rented a car for a full day or probably used a comfy limousine service forth and back. It's been a complete and utter waste of time and money! I suspect the rip-off scheme is hugely profitable for the city of Montreal.

So, here's my advice to Montreal, THINK prior to instituting such schemes. I for one won't touch your green bike scheme ever again. Let the buyer beware!

Apologies for the brief hiatus

Folks,

I have been away for a week on Barbados. Sand, palmtrees, lukewarm water and rum ain't exactly my cup of tea, so I's worried about being bored out of my mind. Thankfully I got plenty of lifts around the porous island, but still, a week was more than enough. My suspicion about life on such places was kind of confirmed. All pretty to look at, but the reality is nonetheless dead boring. I've had a great time though and took my fair share of photos. Good enough for a week-long trip, but imagine you had to live there. Invariably there's an overwhelming number of God people, so there were training sessions preparing people for the Rapture on offer. How cool is that? In case you didn't know, it's coming on October 21, 2011. Oi wei. I uploaded my photos on a low-to medium-level size only, so they're not print quality. Feel free to browse. - We flew on JetBlue, and it's been a great experience. Highly recommended, just don't expect any service from their ground staff in Barbados. They're badly trained and pretty much useless. Other than that, beats air Canada at any time, both in terms of in-flight experience and in terms of price (by a long long stretch).

Well, coming back home I face more US brabrabra. Obama's Supreme Court nominee is rumored to be a lesbian woman. Bill O'Reilly, funny man at Fox News, decided that we've a right to know as she might have to vote on gay marriage. I kinda wonder why the same logic shouldn't apply to heterosexual, bisexual and other-sexual members of the court?

A study that should not have been done

Here is a piece Sean Philpott and I have published today in the Hastings Center Forum.

The New England Journal of Medicine in February published the results of a deeply flawed clinical trial in South Africa. The SAPIT (Starting Antiretroviral Therapy at Three Points in Tuberculosis Therapy) trial was designed to determine the most effective way to treat patients infected with HIV and tuberculosis. But it raises a number of disturbing questions about the oft-debated and vexing issue of appropriate standards of care in clinical trials undertaken in developing countries like South Africa. It also raises serious concerns about the quality of ethical review undertaken in those countries, and it highlights some surprising deficiencies in existing U.S. regulations regarding when ethical review should be undertaken by American IRBs.

In 2007 almost two million people died of TB and over nine million people were newly infected. TB-related morbidity and death is profound among people living with HIV/AIDS; nearly 7 percent of new cases and over a quarter of all TB-related deaths occur among people living with HIV/AIDS. Doctors treating TB in this population face a difficult challenge. Serious side effects can occur with concurrent HIV and TB treatment, leading some clinicians to suggest that antiretroviral therapy for HIV be delayed for several weeks after treatment for TB is started. But serious side effects are also a risk of delaying ART therapy. Guidelines state that ART therapy should be started as soon as possible, but there is disagreement over when that should be.
In the SAPIT trial, 642 individuals co-infected with HIV and TB were randomized to receive one of three treatments: early integrated ART (started during the intensive phase of TB therapy), late integrated ART (started during the continuation phase of TB therapy), or sequential ART (started after completion of TB therapy).
Individuals randomized to the two integrated arms received ART within three months of study entry. Antiretroviral treatment of individuals randomized to the sequential treatment arm, however, was delayed on average for almost nine months. For several unlucky study participants, ART was delayed even longer; mean time to initiation of ART in this group was six to 11 months (260±71 days), regardless of CD4 cell count, an indicator of HIV disease progression, at study entry. This matters, as patients with CD4 cell counts lower than 200 cells per cubic millimeter face a significantly increased risk of death.
Forty-four months after the first SAPIT participants were enrolled, the study’s Data Safety Monitoring Board stopped the sequential treatment arm and required that all of its participants be started on ART immediately. In its interim analysis, the DSMB had found that participants in the sequential treatment arm had a much higher rate of death than participants in the integrated treatment arms.
The majority of these deaths occurred among patients with CD4 counts below 200 cells per cubic millimeter at study entry. Twenty-seven of 213 participants, or 12.7 percent, in the sequential therapy arm died during the abbreviated treatment and observation period, of whom 21 had CD4 counts of less than 200 per cubic millimeter at study entry, while only 25 of 429, or 5.8 percent, in the integrated therapy arms died over the course of the study. Integrated HIV and TB treatment thus reduced the likelihood of death among study participants by more than twofold.
The trial conclusively showed that integrated HIV and TB treatment is more effective than sequential treatment. The question is whether obtaining that data justified the 10 or more preventable deaths that occurred among trial participants. Even before the study began, years of observational data had shown that the risk of HIV-related death among patients not receiving ART therapy was highest during the first few weeks of TB treatment, calling into question the need to conduct a randomized, controlled trial in which ART was delayed by as long as 11 months for some study participants.
The side effects of concurrent HIV and TB treatment can often be managed by observant clinicians; given this, the WHO Global TB/HIV Working Group recommended as far back as 2003 that “any decision on treatment should be individualized, based on response to anti-TB therapy, side-effects, and readiness for ART.” More recently, based primarily on data from the SAPIT trial, WHO urged that ART be given within eight weeks of starting TB treatment in co-infected individuals.
Current treatment guidelines recommend that patients infected with both TB and HIV should start ART as soon as possible. Where CD4 testing is routinely available, these guidelines recommend starting ART when CD4 cell counts drop below 350 cells per cubic millimeter, and they require ART once cell counts drop below 200 cellsper cubic millimeter. Where routine CD4 testing is not available, these guidelines suggest that HIV-infected individuals with TB should start ART immediately.
In a recent article in The Lancet, several of the SAPIT investigators argued that “an estimated 10,000 deaths could be prevented every year by the initiation of ART in HIV/tuberculosis co-infected patients with CD4-cell counts below 500 cells per cubic millimeter.” However, the level of care provided to participants in the sequential treatment arm of the SAPIT trial fell considerably below this standard. The level of treatment provided to these volunteers even violated existing domestic standards of care for patients in South Africa, which recommend starting patients with CD4 cell counts of less than 200 per cubic millimeter on ART after just two months of TB treatment.
Although the SAPIT investigators noted that trial participants’ primary care physicians were free to start them on ART as necessary – in keeping with the 2003 recommendations of the WHO Global TB/HIV Working Group – this ignores the reality of public sector HIV care and treatment in South Africa. It is unlikely that most of the study participants even had a primary care doctor, let alone a physician who would initiate ART despite the restrictions imposed by the SAPIT protocol. Who then could have started these patients on life-preserving treatment if not the clinician-investigators on the study? Individualized treatment decisions based on medical need were not made in the sequential arm of the study, despite the ethical obligation of study clinicians to ensure the safety and well being of individual study participants.
Aggravating these problems, the trial design violated the golden rule of ethical study design and conduct: No clinical equipoise existed between the trial arms. Given decades of research showing that untreated patients with CD4 cell counts of less than 200 cells per cubic millimeter are at great risk of HIV-related complications and death, coupled with observational data showing that this risk is even higher during the first few weeks of TB treatment for co-infected individuals, the sequential treatment arm never should have been considered a viable treatment strategy. Patients randomized into the sequential arm were knowingly subjected to substandard clinical care.
The fundamental ethical (and legal) issue is this: the SAPIT study caused foreseeable harms and preventable deaths for a substantial number of impoverished and poorly educated South African trial participants. In doing so, the trial violated the Declaration of Helsinki’s requirements on standards of care of the then-applicable 2000 revision:

The benefits, risks, burdens and effectiveness of a new method should be tested against those of the best current prophylactic, diagnostic, and therapeutic methods. This does not exclude the use of placebo, or no treatment, in studies where no proven prophylactic, diagnostic or therapeutic method exists.

For the South African researchers involved with the SAPIT trial, the Declaration of Helsinki is not only a moral exhortation but also a legally binding obligation. South Africa’s Good Clinical Practice Guidelines require that all investigators “follow fully the guidelines set out” in the Declaration of Helsinki, in addition to other national research ethics guidelines.
Organizations such as the Welcome Trust in the U.K. and the National Institutes of Health in the U.S. have directed millions of dollars to train members of African ethical review committees, and yet this trial was reviewed and approved by a committee in South Africa. The failure of this research ethics committee to recognize the clinical, ethical, and legal deficiencies in this study is shameful and, we hope, will be investigated by the relevant South African authorities.
Another issue is worth noting. As published in the New England Journal of Medicine, the study boasts a large number of authors. This is not an uncommon practice for large clinical trials like SAPIT. The authors of the article are located in South Africa and the U.S., and some authors list both South African and U.S. institutional affiliations. It is unfortunate, however, that U.S. research ethics guidelines (at least as interpreted by the American institutions involved) did not require these authors to submit the study protocol for ethical review by committees in the U.S.
If, as these institutions suggest, the study investigators were not acting on behalf of the U.S. institutions or were not engaged in what these universities define as human subjects research, it is worth asking why these institutions are listed on the published research papers. If they want to share in the academic glory associated with a study published in a prestigious journal like the New England Journal of Medicine, then they have the obligation to ensure that the trial meets accepted standards of ethical conduct and the responsibility to protect the rights and safety of all study participants. Further review might have made an appreciable difference to the ethical design and conduct of this study.
Sean Philpott is an assistant professor of bioethics at Union Graduate College and a former science and ethics officer for the Global Campaign for Microbicides. Udo Schüklenk holds the Ontario Research Chair in Bioethics at Queen's University, Canada, and is the joint editor-in-chief of BIOETHICS. 

Drill baby drill -2-

As an addendum to my April 29 post.

Turns out that the platform actually had a so-called blowout-preventer to prevent the disaster that happened. A German news agency has investigated these so-called blowout-preventers. There are at least 171 known cases where they failed to do their job. It's a bit of a misnomer then to call them blowout-preventers, isn't it? Makes you wonder why drill baby drill President Obama notices only now that there's a problem and he wants to investigate... and where is drill baby drill Sarah Palin? Lost in an oil spill?

World Medical Association demonstrates complete lack of judgment

The World Medical Association (WMA), the international organisation representing the world's doctors, has a long-standing tradition of issuing guidelines on everything from conflict of interest, to dual loyalties, standards of care in clinical research and other such issues. Many of these documents are quite sensible actually, and by virtue of the WMA's claim to represent the world's doctors, carry some moral weight.

Recently though the organization completely shot itself in the foot. It elected Ketan Desai, the
president of the Medical Council of India as its President elect. Well, here's bits and piece from the British Medical Journal about this lovely medical professional that makes you wonder whether he's such a good choice... - you might want to keep in mind that the current allegation are just that, allegations. However, the incoming President of the WMA was found guilty by the High Court in Delhi of corruption charges and abuse of power in 2001. Obviously the good doc is a wily operator, how else would he have managed to sneak back into positions of power in the medical profession in India. You might want to check his CV that's kindly on display at the WMA website (note the breaks in appointments to regulatory medical bodies in India that he held in 2001, when he was found guilty of corruption and abuse of power by the Delhi High Court, only picking up a few years later and straight going back for power). Anyhow, that's for India to resolve.

Published 29 April 2010, doi:10.1136/bmj.c2355

Cite this as: BMJ 2010;340:c2355

Top education regulator in India is arrested on bribery allegations

Ganapati Mudur

India’s Central Bureau of Investigation has arrested Ketan Desai, the president of the Medical Council of India, on allegations of bribery in a fresh case that threatens to sully the image of the country’s top agency involved in regulating medical education. Dr Desai is also president elect of the World Medical Association. (Emphasis as in BMJ)

Investigators said last week that Dr Desai had sought 20 million rupees (£296 000; €350 000; $450 000) as a bribe from a private medical college in the northern Indian town of Patiala for approving admissions of students in the college for the academic year 2010-11. The council has the responsibility of inspecting and approving colleges.

See also:
prior BMJ reporting:

BMJ VOLUME 323 15 DECEMBER 2001

Head of the Medical Council of India removed for corruption

Rohit Sharma Mumbai

The High Court in Delhi has ordered that Dr Ketan Desai, the president of the Medical Council of India, be removed from his post after it found him guilty of corrupt practices and abuse of power.

Besides heading the council, which regulates the medical profession in India, Dr Desai also heads the Indian Medical Association, which represents India’s doctors.

Minutes of the council meetings showed that all critical decisions were concentrated in Dr Desai’s hands. Dr Bhalla presented details from an income tax raid at Dr Desai’s house last year, which showed unexplained receipt of 6.5 million rupees (£95 000; $136 000) via bank drafts in the names of his wife, daughters, and himself from several people in Delhi.

Drill baby drill

Bad news for Mr Obama. Just after selling the American public out to private health insurance companies he's caved in to another demand from neocons. He issued licenses to drill at the US coasts for oil. Self-sufficiency is the magic word here, and you can't blame the US for trying. What boggles the mind, however, is that these oil drilling platforms do not even have safety mechanisms that seal the borehole in case there's a catastrophic accident. Incompetence on a grand scale! Or is it just another exercise in terms of environmental corner cutting that these oil companies are so well-known for.

The environmental disaster that is at the moment unfolding in the USA is painful to watch. How can it be that in the 12st century they drill in highly fragile marine environments without having most basic safety switch-off's in place? I am the first to admit that I am not an expert in these matters, but it seems obvious to me that you should not get a permission to drill for oil in such an environment unless you are able to ensure that there's no major spill in case something goes wrong.

Post scriptum May 03 2010: Turns out that the platform had a so-called blowout-preventer to prevent the disaster that happened. A German news agency has investigated these so-called blowout-preventers. There are at least 171 known cases where they failed to do their job. It's a bit of a misnomer then to call them blowout-preventers, isn't it? Makes you wonder why drill baby drill President Obama notices only now that there's a problem and he wants to investigate...

Britain does away with conscientious objection nonsense

A victory for sanity in Britain. A Christian counsellor (photo to the left), employed by the state, lost a court case that's essentially focused on conscientious objection. The guidance counsellor refused to provide services to gay couples, on religious reasons. The Guardian reports 'Lord Justice Laws said legislation to protect views held purely on religious grounds could not be justified. He said it was an irrational idea "but it is also divisive, capricious and arbitrary". Laws is correct here. The truth of religious belief cannot be established, there's competing and importantly conflicting religious beliefs about. Surely the question of whether someone receives professional services without a great deal of fuzz must not depend on whatever private beliefs a professional services provider holds.

Says Laws, "We do not live in a society where all the people share uniform religious beliefs. The precepts of any one religion – any belief system – cannot, by force of their religious origins, sound any louder in the general law than the precepts of any other. If they did, those out in the cold would be less than citizens and our constitution would be on the way to a theocracy, which is of necessity autocratic....The law of a theocracy is dictated without option to the people, not made by their judges and governments. The individual conscience is free to accept such dictated law, but the state, if its people are to be free, has the burdensome duty of thinking for itself."

Church people like the evangelical former archbishop of Canterbury, Lord Carey suggested that rulings such as these could lead to 'public unrest' because special rules and special dispensation ain't provided to him and his fellow religious believers. Says Carey, "The comparison of a Christian, in effect, with a 'bigot' (ie, a person with an irrational dislike to homosexuals) begs further questions. It is further evidence of a disparaging attitude to the Christian faith and its values." Makes you wonder how else you'd described someone who irrationally discriminates against fellow citizens. 'Bigot' seems an appropriate description, adding 'God' as justification does precious little to change that situation.

Carey also claims, “It is, of course, but a short step from the dismissal of a sincere Christian from employment to a religious bar to any employment by Christians." This is utter nonsense, of course, a good teaching case for showing how unsubstantiated slippery slope claims are used for rhetorical gain. There is no short step of any kind here. All the court is saying is that Christians got to do their jobs like like everyone else, muslim or atheist, communist or liberal. If they don't feel like doing particular jobs they'd try to find other jobs. It's really a bit like a communist saying that she has conscientious objections to working for Deutsche Bank. We'd think that's funny, too, and suggest that perhaps she's in the wrong job.

The crux of it is, of course, that if you offer public services (particularly so if you're in the pay of taxpayers) you can't choose who you offer these services to, based on arbitrary criteria such as skin color, sex or sexual orientation. Nobody forced you to enter a profession that would require you to provide services to people whom your religious ideology tells you to discriminate again. Do something else, like for instance working in a church - if there is one not subsidized one way or another by the state - and enjoy the intellectual incest that goes with interacting with people like yourself. You certainly are not entitled to have your prejudiced life sponsored by tax monies.

Gordon Brown and Britain's ordinary voters

Badly behind in the polls, the current UK Prime Minister Gordon Brown is on the campaign trail meeting 'ordinary voters'. Reportedly one such voter, a woman, berated him about immigration and whatnot. Brown got back into his limo and bickers about the disaster this encounter had been and refers to the woman as a 'bigot'. What's played time and again on the UK news is that he called an 'ordinary voter' a bigot and Brown is criticized for doing that. Brown duly called the woman and apologized, eventually he went back to her town and apologized 'behind closed curtains' for about 45 min. She's still miffed and seemingly enjoying her minute of fame on the UK's national news front.

Well, frankly, while I'm not a Brown fan, without knowing what exactly the woman said it's difficult telling whether or not calling her a bigot is a reasonable response to what transpired during the encounter. Bits and piece of what is reported suggest that she's in fact a bigot. That's what ticks me off about the reports about this story. The British media, from left to right, gang up on Brown without restraint these days (he really has become a punching bag for all of Britain's woes). It ain't right.

Hypocrisy

Hypocrisy is a funny thing, I think. During the last few weeks a couple of events made me wonder why we are so often so deeply dishonest and hypocritical. For instance, the Polish President Lech Kaczynski died in a plane crash. That guy was well and truly widely reviled in much of Europe, being the ardent nationalist that he was. He was opposed to the European federalist project, he was opposed to friendly relations with neighboring Germany, his claims to notoriety included prohibiting a gay rights march while he's mayor of Warsaw, and of course attacking the reproductive rights of women. The usual stuff of neanderthal nationalist Catholic Polish politics. He wasn't even greatly loved by very many Polish people. Yet suddenly, when his plane crashed, listening to the eulogies of European and other political leaders you'd have thought a great guy had died, while really a small-minded conservative nationalist departed for his Catholic heaven.

In South Africa, in order to maintain good race relations, Black political leaders had to pretend that they regretted that the militant Afrikkkaaner leader Eugene Terreblanche was clubbed to death by some of his staff. Seriously, this guy spent a life-time working toward preventing the South African majority population from participation in a multi-ethnic democracy. Terreblanche was an unreconstructed vile racist. Is it unfortunate that he was murdered? Of course it was. Is it a great loss that he's gone? Not really. Good riddance is probably the most appropriate response that one should muster in response to the murder. When you think about the larger number of black people that get killed in South Africa, and that are never mentioned in the mass media, why this pretense that it somehow matters more that a miscreant such as Terreblanche was killed? Unlike in the murders of most black people, the local police even quickly apprehended the people who killed him.

Well, and that standard bearer of hypocrisy is at it again, too. This story is most amusing, I got to say. The Pope invited himself to a visit to Britain (paid for by UK taxpayers). Some cheeky UK foreign department staff suggested in a written document that 'the Pope should open an abortion clinic, bless a homosexual marriage and launch his own range of condoms while he is here.' Truth be told, if the Pope and his minions were not so pre-occupied with covering their own tracks in thousands and thousands of child abuse cases the world all over, they might have realized that it seems a tad bit hypocritical to demand that the culprits in the UK Foreign Office be penalized harshly for their practical joke, when the Pope at the same time has pro-actively colluded with senior church management over decades in protecting pedophiles in his organisation's ranks from any kind of punishment. What was it again, sitting in glasshouses and throwing stones??? The church truly never ceases to amaze me. Dr Ratzinger is reportedly considering canceling his trip. For some reason this is of concern to government ministers in the country as opposed to reason for celebration. A Catholic bishop said in an interview that these comments were a sign that Catholic teachings were not taken seriously. He missed probably that actually the junior officials in the UK foreign affairs department are aware of Catholic teachings, they do take them seriously, and they clearly reject them. They're right to do so. - I hope, if Dr Ratzinger decides to go ahead, someone will execute a citizen's arrest, seeing the great man's involvement in the church's pedophile sex scandals.

Check this site out - very funny

This really is a neat site. Check out some of the episodes! Truly hilarious stuff. Thanks to Raul Kumar for pointing this gem out to me!

Partners and things

There is something going on in the politically correct English speaking world that puzzles me. It's the deliberate hiding of one's loved one's sex. Say you're straight and you are married, or you got a girlfriend or boyfriend, or you're in a legally recognized relationship of some sort. Invariably your progressive friends will refer to their other halfs as 'partner'. The good intention behind it seems to be that nobody will know (or inquire) about the sex of the person you're with. So, in case you're gay or bi-sexual nobody will find out. How so? Well, whenever your conversation gets to your other half, you'd sneak in the 'partner', thereby leaving open whether or not your partner is of the same or other sex. From conversation with colleagues and friends, I do know that the ambivalent nature of the 'partner' leads to continuing gossip and speculation about whether he or she is gay or straight or something else altogether.

What troubles me about this matter is this: If you live in a country, like Canada, where homosexuality is decriminalized and where in fact gay relationships have more or less equal legal standing to folks in straight relationships, you're sending a troublesome message about the desirability of hiding your sexual orientation. As I see it, with the exceptions of those who are not in relationships (nothing at all wrong with that!), those who live in relationships will find themselves pretty much invariably with folks of the other or of the same sex. What's the point of pretending that we are in a relationship with a mysterious neutral (aka 'partner'), when REALLY we are not? Would we not be better off if people were encouraged not to hide their sexual orientation away by means of kind of neutralizing us for the purpose of our conversations? Why not say that I live with my wife, husband, boyfriend, girlfriend, male/female significant other, name it?

Basically, I wonder, whether real progress lies in hiding away who we are by being 'partners' (in a sex neutral manner). Interestingly, this strategy won't work in may countries. Both in German and French speaking countries this wouldn't work for simple reasons of grammar. You might have a partner in Germany, but if the partner is female it's a 'Partnerin', and if the partner is male it's 'Partner'. So, no obfuscation there.

Anyhow, I'm not entirely sure that I got this one right. You got any views/arguments to share on this one?

Nice review of 50 Voices of Disbelief

Our book got a nice review at Metapsychology. Check it out. Roger Chao writes (in part):

Overall, this book is well suited for a mainstream audience, interested in questioning the power that religion holds over our lives. Being an item of non-fiction for a general audience, it has surprisingly good references at the end of some chapters (by academic writers that is), which will also serve to guide the reader if further information is wanted. Thus, I recommend this book to anyone (regardless of their views concerning religion) interested in understanding why different people hold certain views concerning religion.

I also noticed that we've got now some 13 or so customer reviews on amazon.com . Virtually all of them are very positive.

Addendum: April 14, 2010
Here's another review of the book, on the website of the Diocese of Brandon of the Anglican Church in Canada. As you'd expect of such a site, the review is somewhat mixed, but, considering where the reviewer is coming from it seems fair enough. Its praise for gay rights activist Peter Tatchell, one of the volume's contributors, took me well and truly by surprise.

Some speech deserves to be marginalised

says my good buddy Russell Blackford on his blog. Check it out.

On Moral Authority - in lieu of an Easter sermon

Interesting, now we know that the Roman Catholic Church hierarchy all the way up to its CEO, the Pope, has been busy protecting child sexual abusers the world all over (the Irish government report on the abuse in the country mentions that child sexual abuse in Catholic outfits reached endemic proportions with confirmed cases now exceeding 15,000). We also know that the current Pope thought nothing was problematic about bringing into the fold of the church a known holocaust denying bishop. The list goes on and on and on. If this wasn't the 'church' but some Islamic outfit, no doubt they would be under security services' surveillance, but hey, it's the 'church', so it's kinda different I presume.

Part of the church (any church's actually) rationale for interfering regularly with the democratic state's policy making has to do with its claim to possess special 'moral authority'. So the church has been ever since busy writing high-minded documents protecting the 'unborn' (aka taking away women's rights to control their own bodies for the duration of their pregnancy). The church also issues, in the age of AIDS no less, guidance prohibiting all means of modern birth control such as using the pill or condoms to prevent pregnancy or sexually transmitted illnesses. They tell dying people that these patients have no moral claim to determining how they end their lives, even though this obsession with earthly living should be non-existent, considering that eternal paradise that is supposedly awaiting the deceased. Then there's endless documents going on about homosexuality and how terrible this 'disorder' is, and last but by no means least the church issues guidance documents inventing ever more reasons for religious conscience based objections to the provision of particular professional services by its members (aka special societal treatment for its professional members). In retrospect it is surprising that the church has rarely, if ever, commented on that small matter of pedophilia. Presumably an oversight.

In any event, the Roman Catholic church went recently out of its way to recruit right-wing outliers of the Anglican church. These outliers are opposed to women priests as well as openly gay priests. The pope saw an opportunity to increase the reactionary contingent among his preaching staff by offering such Anglican outliers a job in his organisation. It should not surprise anyone that the CEO of the competing Anglican church saw an opportunity to get even. He said in an interview that the Irish Catholic church had lost 'all credibility' over its handling of the child abuse scandal. He is right, of course, the Irish Catholic church lost indeed all credibility, as has the rest of the worldwide church. Being the Archbishop of Canterbury he then quickly recanted a day later, saying that he regretted his comments (but not withdrawing them).

What puzzles me is the proposition that the Roman Catholic church (or any other church for that matter) has special moral authority at all. I can see that it would have some authority over folks subscribing to its ideology. After all, if you're Catholic and your church offers a baseline normative guidance that it considers binding for its members, that surely is fair game. It's a bit like being voluntarily a member of the Communist party and embracing capitalism. Doesn't really work. The thing is though, that routinely you see its colourfully dressed senior staff come out in public telling all of us what we must and must not do, regardless of whether we have chosen to join their ranks. In other words, it uses its claimed moral authority to influence how people who do not subscribe to its views should live (indeed, even how they should die). And, interestingly, it is reported in the mass media as if there was any moral competence that these preaching guys have. This truly reminds me of the naked emperor case, except this time they're wearing dresses. The nakedness that we ought to call to the public's attention is that they do not have any moral authority at all in secular, multi-cultural societies. So, if they think that the 'unborn' is of infinite value and that abortions are always wrong they got to argue their case beyond their ideological base (aka believers). Their senior management staff happily use words such as 'genocide' and 'holocaust' in the context of abortion, presumably to make clear how 'wrong' abortion really is. Of course, this ain't answer the question of what it is that is wrong, ethically, about abortion - if anything.

It is insufficient for them to come out and quote the pope or any of their church documents that are relying on their religious scripture when they try to influence public policy. This is so, because too many people just don't buy into the biblical fairy tales. Now, it's perfectly possible that there are other, non-biblical reasons for why abortion might be ethically problematic, but these need to be explicated and defended.

What this boils down to is this: Religious folks must engage in proper ethical analysis and argument just like everyone else who wishes to make an ethical argument in public discourse. No matter how much they would like us to believe that raising their arms to the sky, wearing dresses and saying 'God' is somehow sufficient to claim moral authority, it clearly won't do in lieu of a proper argument. The reason for this is obvious, by engaging in such activities you actually avoid public scrutiny. This is unacceptable in the context of public debate in a democracy. It's high time we called them on this each time they pop up in the public domain and decide it's time to tell us how we ought to live our lives. Reminding them of their own endemic historical moral failings is perhaps the perfect hook on which to hang doubts about their moral authority (just in case you prefer a historical as opposed to a straightforward normative argument). Which reminds me, why I should suffer as a result of their sectarian celebrations - I can't even buy food today, the gym is closed, etc etc. Why is it seen to be fair game that their celebrations may impact legitimately on my life and that of Muslims, Buddhists, Hindus and any number of others who are not Christian God people?

And here ends my Easter sermon.