The Hazard of Politically Correct Research

The debate on female initiation rites continues. An earlier post by World Health Organization researchers discussed the hazards of the practice they call FGM (female genital mutiliation). Here’s a response from two Swedish scholars who have studied the topic over the past 10 years, Sara Johnsdotter, a senior lecturer in medical anthropology at Malmö University, and Birgitta Essen, a senior lecturer in international maternal health and associate professor in obstetrics and gynocology at Uppsala University:

One of the hazards for science is when politically correct results are uncritically welcomed, readily published and repeatedly cited; while politically embarrassing results are ignored or marginalized. Perhaps nowhere is this more obvious than in the study of “female genital mutilation,” where the roles of researchers and political activists often seem to be confused.

The WHO study on obstetric outcomes, published in the Lancet in 2006, has been critically discussed by other contributors here at TierneyLab (see for instance Prof. Shweder and Prof. Shell-Duncan). We agree that there is good reason to be skeptical about the results of this study and the method used. It is a serious weakness that the researchers fail to connect the results of their statistical analyses with current clinical evidence and findings on physiopathology. For instance, they report that women with FGM have an increased risk of Caesarean section, but they have not adjusted for obstetrically relevant risk factors like preeclampsia.

Other publications in leading medical journals suggest that the boundary between scientific research and activism has become blurred, to the detriment of scientific standards. The WHO study is one example of the uncritical rush to convey politically correct results.

Here is a second example, which we believe typifies the lack of rigor in many publications in this field. In an article published in the Lancet in 2005 by Almroth et al., the research group aims to show that FGM in childhood can cause infertility in adult women. The method used in the study was (ocular) examination of the tubes of 99 infertile Sudanese women through laparoscopy. The control group consisted of 180 Sudanese women who were pregnant for the first time, but were not subjected to any laparoscopy. A primary reported finding of the study was that 92% of the infertile Sudanese women had been subjected to the most extensive form of female circumcision, type III (infibulation), while this was true of only 85% of the fertile women. This 7% difference in the frequency of this type of genital surgery across the two groups of Sudanese women, claims Almroth et al, shows that there may be a causal link between FGM and infertility. The researchers hypothesize that the supposed causal link works this way: FGM gives rise to infections which ascend to the internal genitalia, resulting in inflammation and scarring, which in turn leads to infertility.

There are some obvious flaws with this Lancet publication. One is left worrying that publication standards might have been compromised for the sake of making medical claims in support of the ongoing eradication campaigns. The study makes no effort to actually test their main causal hypothesis. How might that have been done? One thing we know from prior scientific research is that the more episodes of salpingitis (infection of a woman’s tubes), the higher the risk of infertility. One episode of salpingitis manifolds the risk of extra-uterine pregnancy. We would therefore expect, if the hypothesis of Almroth et al. is correct, that Sudanese women have an extraordinary high incidence of extra-uterine pregnancies. The only study we have found on extrauterine pregnancies in Sudan (Saad et al. 2003) actually shows a low incidence of extrauterine pregnancies (5 extrauterine pregnancies in 1000 deliveries). Almroth and his colleagues do not comment on this implication or critically test their casual hypothesis. Moreover, the study fails to seriously consider the fact that so many Sudanese women are in fact fertile, despite having gone through the most extensive form genital alteration. Further, more than half of the infertile women had normal Fallopian tubes, independent of type of circumcision.

A major weakness of this study, which should have been viewed as a serious flaw and probably would have so viewed if this had not been a study whose results could be marshaled in support of a politically correct cause, is the fact that the fertile Sudanese women in the control group never went through laparoscopy. Thus we do not know anything about the condition of the tubes of the fertile women in the comparison group. We do not even know whether a majority of the fertile women might have gotten pregnant despite previous salpingitis. In principle, an ocular examination of both groups might well have given identical results for fertile and infertile Sudanese women.

We do not necessarily question the statistical correlation that was found in this Lancet study. But we do call for a broader and more rigorous discussion of all published findings on FGM, including those published in prestigious medical journals. When it comes to publications on the topic of “FGM” we don’t see the usual critical scientific discussion regarding possible bias, possible confounders, or weak links in the causal hypotheses used or in study design.

We suggest that this silence has to do with prevalent Western ideology concerning “female genital mutilation” and ongoing political projects. Activists, governmental bodies, funders and even editors of medical journals systematically welcome research results that can be used in preventive work while muting or hesitating to publish results that go against the grain of mainstream thinking regarding this issue. This blurring of the distinction between science and activism is so endemic that researchers often present their “hard facts” with explicit reference to their political agenda. The abstract of the article by Almroth et al. ends with a blunt comment: “The association between FGM and primary infertility is highly relevant for preventive work against this ancient practice.”

The key question is: Would we so readily accept research results that contradict existing medical knowledge in other fields than “female genital mutilation”? Would research results concerning, say, diabetes or asthma be accepted without the usual critical scrutiny?

SOURCE: The New York Times

AUTHOR: John Tierney

URL: Click here

DATE: 24/02/2008

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