I presume decent sanitation will be the next thing they go after

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Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.

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153 Responses

  1. Avatar Chris
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    says:

    Why isn’t this post about Tylenol?!

    Only slightly more seriously, I kind of enjoyed watching you rage, given your usual mild-manneredness. I share your frustration, of course, and I wonder how long these silly woo trends will last (and how long I’ll have to deal with a large “Gluten Free” section in my grocery store). At some point, there has to be a real backlash that squashes it, right?Report

    • Avatar dragonfrog in reply to Chris
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      says:

      and how long I’ll have to deal with a large “Gluten Free” section in my grocery store

      I’m so sorry for your suffering at the hands of the mafia of celiac disease sufferers. How dare they purchase pasta where you and I can see it? Had they any sense of propriety, they would stick with rice and potatoes, so us decent folks wouldn’t have to shield our children’s eyes every time we go shopping.Report

      • Avatar Chris in reply to dragonfrog
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        says:

        dragon, if you have celiac disease, I understand. Do you think the vast majority of people freaking out about gluten right now have celiac disease? If so, I have a bridge I’d like to sell you.Report

      • Avatar morat20 in reply to dragonfrog
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        says:

        I think celiac disease is in the public consciousness.

        Stomach problems are often hard to diagnose. Heck, they’re hard to describe. Like anything that can’t be pinned down, described, or filed neatly away — it’s scary.

        My stomach hurts. Is it gas? Appendicitis? Ulcer? Bad food? Heart attack? Gall bladder? When should I see a doctor? It’s not as straightforward as “I have a headache” — your stomach is this nebulous area consisting of multiple organs that can all present weirdly and often as someone suffering you’re just uncomfortable. I mean, agonizing pain is straightforward. “I feel awful, stomach wise” is in some ways harder to handle.

        I empathize with those folks. I’ve had stomach problems for a few weeks (still ongoing). Pretty sure (ie, doc is pretty sure) it’s from aspirin causing an ulcer, but I have to admit the weird vagueness of the symptoms and the discomfort (good god, am I TIRED of feeling bloated or pains I can only describe in analogies like “It’s sorta like I pulled a muscle, but nothing at all like that, and it comes and goes and it’s really mild. Or maybe like a bruise. Or like a weird skin fold”)

        I’m so sick of feeling bloated, though, that if you told me wheat did it I’d cut out wheat without a second thought just in freaking case.Report

      • Avatar Kim in reply to dragonfrog
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        says:

        A good deal of stuff in the gluten free section has gluten in it.
        Plenty of people can’t tell.Report

      • Avatar dragonfrog in reply to dragonfrog
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        says:

        @kim – seriously? That is seriously disappointing.

        I’m pretty sure that’s not the case at our grocery store – the gluten free “section” is spread across the store – the gluten free perogies are next to the other perogies; pizza crust with pizza crust; flour with flour, etc.

        My wife actually has a wheat allergy, not celiac disease – but “gluten free” is a subset of “wheat free” that is reliably available.Report

      • Avatar Pierre Corneille in reply to dragonfrog
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        says:

        @chris

        Speaking only from my personal, anecdotal experience, most of the people I know who have voiced their preference for gluten-free foods at least claim to have some physical reaction to it. Perhaps in different social circles this dynamic works differently. Indeed, it wouldn’t surprise me, given certain friends I have who think that “organic” means “automatically good for you or at least better.” But personally, I just don’t see it. But then I’m a glutenphile.Report

      • Avatar Chris in reply to dragonfrog
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        says:

        Pierre, right. A lot of people have decided that gluten, or wheat, is the source of many ills, and there are many “experts” promoting this view. I think they’ve been sold a bill of goods. This is why I lump them in with the anti-vaccine crowd (not merely because there is a lot of actual overlap): woo sold to people that has little, if anything, to do with actual medical science.Report

      • Avatar Troublesome Frog in reply to dragonfrog
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        says:

        I’m kind of split on this one. If it became trendy to roll around in a wheelchair instead of walking and throw fits when businesses don’t accommodate it, we’d see a lot better wheelchair accessibility everywhere. That’s awesome for people who need it and I’d be glad of it.

        But I don’t think it would stop me from twitching a bit every time I saw some able bodied college kid rolling around in a wheelchair and rolling his eyes at people who were walking.Report

      • Avatar Pierre Corneille in reply to dragonfrog
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        says:

        @chris

        Yeah, I certainly see where you’re coming from (and sorry for not responding sooner). I guess I personally find it hard to understand that someone wouldn’t want to eat the types of foods that have gluten unless it made them sick. Gluten is one of the key ingredients to my suite of junk food favorites.Report

  2. Avatar Froggy
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    says:

    I realize parents have rights, but at what point do we pass parental rights and move into the territory of child endangerment (or with vaccines, herd endangerment)? Serious question — but “credulous” parents are making so many ill-informed choices these days, I wonder.

    And the flip side — clearly the medical and scientific community (the latter of which I’m part of) isn’t doing a good job of showing we are credible enough to be listened to or trusted. We can make jokes about parents being whackadoodle all day, but the reality is that people trust us less, which manifests in cases like this and in the general distrust of science, at least in the US. How do we regain credibility to make cases like this less common?Report

    • Avatar Froggy in reply to Froggy
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      says:

      To clarify — I’m not suggesting we do charge parents. I’m more questioning what the legality is.Report

    • Avatar Chris in reply to Froggy
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      says:

      I think the public perception of science and medicine is an excellent thing to look at. With medicine, I think the distrust stems from perceptions of pharmaceutical companies and physicians’ relationships with pharmaceutical companies. I’m not sure how to deal with that, but I suspect Russell has some good thoughts. With science, I think scientists and its spokespeople have done a really good job of being terrible at public relations. There’s a tendency among scientists, at least the most vocal, to call anyone who doesn’t trust science stupid and delusional. It’s been one of my biggest complaints about the response to creationists, and I see it in their response to woo as well. I mean, I understand thinking that the purveyors of woo are stupid or delusional or evil, but they’re not the ones you want to convince. You want to convince they people that they’ve convinced, and the “stupid” and “delusional” are rarely limited to the purveyors. One of the surest ways to get someone to ignore your message is to call them stupid.Report

    • Avatar Kazzy in reply to Froggy
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      says:

      @froggy

      I think part of the issue with “credibility” is scientific illiteracy coupled with the power of narrative. You can cite statistics which will quickly go over people’s heads. Cut to a mom whose child got picked up by an eagle after a vitamin K injection and suddenly people can see just how dangerous vitamin K and its links to being grabbed by an eagle are!

      Could medical professionals and scientists make their cases a bit more accessible to the layman? Probably. But as long as people remain undereducated on certain topics and (more importantly) other people are prepared to exploit and abuse that undereducatedness, their effectiveness will be limited.Report

    • Avatar Russell Saunders in reply to Froggy
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      says:

      That is a real and serious concern.

      I think it’s because, in large part, to the general public “science” has been confused with “certainty” for a long time. That uncertainty is both necessary and ever-present within the scientific process is poorly understood or accepted. That there are areas where there is more uncertainty (which women should get mammograms and when?) and less uncertainty (do vaccines cause autism?), since the chance the consensus is wrong will always be non-zero, there’s just enough squeak room for the buffoons and frauds to got a toe in.Report

      • Avatar Patrick in reply to Russell Saunders
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        says:

        I’ll link to this old post.

        Science is a *de-constructive* process -> you are attempting to *derive* a logically consistent system given a bunch of experimental data and a bunch of additional theories that are supported in turn by experimental data.

        This is one of the fundamental disconnects between a large percentage of non-scientists and people who practice science for a living; people who don’t understand how science actually works think that science is axiomatic; something is either true, or it is not true. Science isn’t like that, kids. As my high school AP Physics instructor said in class one day, “If you’re looking for Truth, go take a Philosophy class”.Report

      • Avatar Will H. in reply to Russell Saunders
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        says:

        Hand-in-hand with this, training typically falls among two types: those trained in how to think, and those trained in what to think.
        The latter are woefully limited when presented with data not supported by a recognized range of options.Report

      • @russell-saunders

        That’s an excellent comment. I think a similar argument can be made about history, which is often conflated with capital T “Truth” instead of linking it with interpretations or ways of understanding the past.

        However, the consequences of not knowing what history is and isn’t (and I’m not sure I can really say what it is or isn’t) are probably not as life endangering as the consequences of seeing science as “certainty.” But refusing to acknowledge the unstable foundations of what we consider history to be does, in my opinion, lead indirectly to undercurrents that, for example, continue to insist that the CSA was misunderstood or that the Holocaust never happened. (I say all this with what I hope is due respect….I don’t endorse those views at all, just offering one thought on how and why such views might be enabled by a certain constrained view of what history is.)Report

    • Avatar Burt Likko in reply to Froggy
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      says:

      I wish I could give you a clear answer to that question, @froggy . However, the national law interpreting the extent of parental rights under the due process clauses of the Constitution, is anemic. I can tell you that you can teach your child German if you want to, and you can send your child to a Catholic school instead of a public school if you want to. After that, there really isn’t that much guidance.

      Most of these kinds of legal rules are delegated to the several states. As we have seen in a different post this morning, the legislatures of the various states span a spectrum from “good faith professionals trying to actually govern wisely and sometimes failing,” to “mouth breathing meth lab denizens pandering to credulous dunderheads.” So, as always, YMMV.Report

      • Avatar Kazzy in reply to Burt Likko
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        says:

        I would also assume that intent matters, no? Deliberately harming your child is, in most cases, illegal. But thinking you are doing what is right for your child but ultimately doing them harm is a trickier matter. Prosecuting that opens up a real Pandora’s box.Report

      • Avatar Kim in reply to Burt Likko
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        says:

        I think the deliberate harm of a child is best shown in eliminating incestuous marriage.
        Considering that first cousins can marry, we have set ourselves a decent threshhold on “what is too dangerous” and what is not.Report

      • Avatar Chris in reply to Burt Likko
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        says:

        I think the deliberate harm of a child is best shown in eliminating incestuous marriage.

        This sentence may be my favorite you’ve ever written.Report

      • Avatar J@m3z Aitch in reply to Burt Likko
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        says:

        Considering that first cousins can marry,

        Depends on what state your in now, doesn’t it? Never forget that America is a federalist country.Report

      • Avatar Kim in reply to Burt Likko
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        says:

        Chris,
        *headdesk*Report

      • Avatar Kim in reply to Burt Likko
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        says:

        James,
        Okay, so make my point as being second cousins can marry (that’s legal pretty much anywhere, right?).
        We see pronounced birth defects and illnesses caused by the equivalent of five generations removed inbreeding. Yet it’s still legal.Report

      • Avatar J@m3z Aitch in reply to Burt Likko
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        says:

        Kim,

        From what I’ve read, the increased risk of birth defects in first-cousin marriages has traditionally been overstated, and that of second-cousin marriages is essentially nil.Report

      • Avatar Kim in reply to Burt Likko
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        says:

        James,
        That’s using American stats. In America, most parents/grandparents/etc come from different stocks. So, a first cousin marriage is not nearly the problem it “used to be”.

        Well, except for certain populations. Care to guess what population in NYC is the most inbred?Report

      • Avatar J@m3z Aitch in reply to Burt Likko
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        says:

        Oh, for god’s sake, Kim. Unless you’re talking very limited populations, it just doesn’t matter. Welsh cousins are no more at risk from marrying first cousins as all-American mongrels like my kids (for whom at least 6 different ethnic heritages are known, and possibly more).

        Maybe we should ban African-Americans from intermarrying because of their increased risk of sickle-cell anemia, eh?Report

      • Avatar Kim in reply to Burt Likko
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        says:

        James,
        I’m sorry, but you’re talking to someone in a “very limited population” as you so kindly put it. That five generations removed? That’s American Jewry. And you do see a pronounced incidence of genetic diseases, large and small.

        Yes, Wales has had population migration all around it. You’d actually have to be talking something like an Indian Reservation, or something where you didn’t see much migration…

        Blacks in this country are pretty muttish (dat’s a virtue. hybrid vigor)…Report

      • Avatar Will H. in reply to Burt Likko
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        says:

        @kim :
        From the data I’ve seen, excessive rate of dwarfism among certain Aimish communities (those in Ohio, iirc) suggests that these are among the least genetically diverse in the nation.

        Some states recognize first-cousin marriages, others don’t; even those legal in other states. Chart here.

        Really, the whole issue reminds me more of the maladies of Ferdinand and the assumption of Franz Joseph; a time when in-breeding truly changed outcomes on a global level.

        @kazzy :
        “Harm” is doing a lot of heavy lifting here.
        Brings to mind supervisory liability post-Ashcroft v. Iqbal.Report

    • Avatar dragonfrog in reply to Froggy
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      says:

      Personally, I trust science – I don’t trust medical practice to be aligned with science, or medical practitioners to be abreast of, or even understand the principles of, science – Russell is someone who clearly does grok science; I just don’t by default trust a medical practioner to be like Russell.

      For instance, regarding child birth and early childhood medicine:

      We opposed conventional medical wisdom in having a home birth with midwives – we felt we were on the right side of science, and the medical establishment hadn’t caught up (studies of midwife-attended homebirths in Canada have found they are in fact the safest of the sensible birth options, followed by midwife-attended hospital births, with obstetrician-attended hospital births last of the three scenarios studied).

      We opposed conventional medical wisdom in sharing our bed with our baby – we felt we were at the very least not on the wrong side of science, and the medical establishment’s strong recommendations against were on very shaky ground (if you exclude studies that conflate responsible bed sharing with bed sharing by smokers or heavy drinkers, couch sharing, waterbed sharing, and other obviously dangerous things, the backing for the “babies need cribs” side evaporates very rapidly)

      Depending on the hospital, we could have been either opposing or siding with the locally conventional medical wisdom in having lots of skin to skin contact after birth – we’ve seen nurses ruin perfectly good early breastfeeding sessions by swaddling the baby, which immediately put it to sleep – only once a lactation consultant came in and told them off did the mother even realize why she was having such a hard time of breastfeeding. Meanwhile the nurses at another hospital in town made a point of unwrapping the baby for nursing, precisely to let it nurse effectively.

      The same goes for early cord clamping – some hospitals around here cut the cord pretty much immediately, others wait to make sure the baby has gotten all its cord blood.

      A friend of ours had her first child with an ob-gyn of whom we later found out that the nursing staff at that hospital talk about any vaginal birth she oversees as a “failed C-section”, so enthusiastic is she about pushing the spiral of interventions leading inevitably to a totally predictable “emergency” caesarian.

      I don’t think we should have to do all this research, just to be able to trust the advice of the medical professionals around us. You shouldn’t have to go to, or be able to parse, articles in the Cochrane Review and BMJ, to feel confident when you accept, and when you stand up to, your medical provider’s advice. You shouldn’t need a doula just to feel someone is in the room who’s not going to bully you into medically unsupported interventions, in the interest of making your birth expedient for the hospital’s scheduling department.

      We did get both the vitamin K shot, and the full range of vaccines – but I’m not at all surprised lots of parents don’t, and I think the medical industry holds some of the blame for that.Report

      • Avatar DavidTC in reply to dragonfrog
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        says:

        The medical industry seems a bit biased towards medical intervention, _especially_ when it comes to births. There’s really no reason to give as many c-sections as we do. Other countries have much less c-sections and just as few, or even fewer, problems.

        However, the whole problem behind home births is the risk of complications. I find it rather baffling that we haven’t managed a sane compromise to that yet, where women could give birth in a nice, reasonably environment of their own choosing, at their own pace…located within the walls of a hospital if something goes wrong.

        Or something like hospice care, except the end result is supposed to be birth, and moving out, instead of death. Women move in when eight and a half weeks pregnant, it’s sorta like a motel with outside doors and no restricted visiting hours (In fact, the spouse may be expected to move in also), but there is always a doctor there, multiple places for the actual birth, including things like water births, etc…

        I honestly don’t understand why women don’t demand this. Instead, activists in the field tend to push for home births and whatnot. Which may be safe 95% of the time, but that last 5% makes people hesitate. If the way it worked was that the 5% could just be wheeled down the hall into an operating room, pretty much everyone would love the setup.

        It probably doesn’t exist because of soaring medical costs, actually, and the fact that hospitals seem to exist in some sort of alternate universe where every single thing (Including regular household items.) costs 100 times more than they should.Report

      • Avatar Kim in reply to dragonfrog
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        says:

        David,
        one assumes some level of lawsuit to be the problem.
        also, the idea of a reasonable care facility seems anathema to a lot of American healthcare.
        (Take ERs. They are required to treat EVERYONE — including people without real problems. If one was able to triage the hypochondriacs (and the legit “people in need” who only really want 3 hots and a cot)… you could save everyone tons of money.)Report

      • Avatar dragonfrog in reply to dragonfrog
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        says:

        @davidtc
        However, the whole problem behind home births is the risk of complications. I find it rather baffling that we haven’t managed a sane compromise to that yet, where women could give birth in a nice, reasonably environment of their own choosing, at their own pace…located within the walls of a hospital if something goes wrong.

        Except that, as I said, home births with a qualified midwife, at least in Canada, seem to be safer than hospital births. And that holds true even when you consider only hospital births under the care of a midwife – so the intervention-happiness of the care provider seems to be only part of the increased safety of the midwife & homebirth combination.Report

      • Avatar Wagon in reply to dragonfrog
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        Yeah, my wife says the only reason for scheduling sections, which is a common practice where we live, is 1) there’s less liability potential for the hospital (which I don’t understand or necessarily believe), and 2) it’s easier on the doctor’s schedule. She also says that the use of pitocin to induce labor increases the likelihood that an epidural will be administered because the drug intensifies the contractions. Then, she says that the epidural dulls things to a degree that it makes a section more likely. She argues that medical care providers create the need for sections by not using natural childbirth methods, and she cites statistics for births in Europe with midwives. There’s a documentary series on the topic – The Business of Being Born – that discusses all of this. I’m all in favor of natural childbirth and avoiding cutting on my wife if possible. I’m also all in favor of her being as comfortable as possible and getting to do her delivery as she wishes. Thankfully, she has no interest in a home birth, and our doctor is very attentive to her wishes re: inducing labor, epidural, etc. I would have to draw the line at home birth. I’m too risk-averse.Report

      • Avatar dragonfrog in reply to dragonfrog
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        says:

        Part of that is probably that a responsible midwife would only recommend a home birth when there is a hospital that’s close by. So, in as many cases as possible, you get the benefit of not being in the building where all the sick people congregate and cough their germs all over the place, while at the same time having the facilities for treating sick people quickly accessible for the tiny percentage of cases where they’re needed…

        A quote from I forget whom, heard around when we were expecting: Having an obstetrician attend a healthy childbirth is like having a pediatric surgeon babysit a healthy 5 year old. i.e. Don’t be surprised when the most reasonable approach to the current situation seems to be surgery.Report

      • Avatar Rod in reply to dragonfrog
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        says:

        Our first was born in a “birthing suite” at Sentara hospital in Virginia. It was in the hospital but decorated more nicely, somewhat between a nice hotel room and a bedroom. The second was a more straightforward hospital birth environment.

        Both births had complications, the second requiring emergency C-section (placental abrupta [sic?]).

        I understand the impulse to favor “natural” births. After all, women have been giving birth for uncounted millennia in caves, tents, yurts, barns, etc. They also died in depressing numbers doing so.Report

      • Avatar DavidTC in reply to dragonfrog
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        says:

        @dragonfrog
        Except that, as I said, home births with a qualified midwife, at least in Canada, seem to be safer than hospital births.

        ‘Safer’ in the sense of success? Or safer in the sense of not needing medical attention? Those aren’t really the same things.

        In addition that question, I feel I must defend hospital births by pointing out three things:

        Firstly, there are whole classes of births that basically can’t allowed to be home births. Aka, pregnancies with known complications. Which, obviously, are more likely to have medical problems.

        Likewise, I’d be interested to know if a home birth that was going okay, but went wrong and required the women being rushed to the hospital, counted as a ‘home birth’ or a ‘hospital birth’.

        Hospitals handle all births that are known in advance to be problematic, plus all births that become sufficiently problematic during the birth. Of course those births are ‘less safe’, statistically.

        It’s like pointing out that hospitals have incredibly high mortality rates per capita compared to any other location on the planet. Well, yeah, because that’s where they put the people likely to die. Likewise, they put all births there that are going to be problematic, so of course births there are more problematic on average.

        And that’s ignoring any sort of selection skew by women. Certain genetic makeup allow easier birth than others, and people whose families (or they previously) had easier births might be self-selecting home births more often. Whereas people whose families (or they previously) had problems during childbirth might be more comfortable in a hospital. Correlation and causality might, in fact, be the other way around for at least some portion of the population…they’re selecting home births because, normally, childbirth is easy for them.

        There’s all sorts of possible explanations of what is going on. Having a midwife coach a woman through childbirth in a relaxing environment might, or might not, be part of it. Where this happens might, or might not, be relevant.

        OTOH, there’s no reason _not_ to mimic home birth as much as possible, especially if it can be done without creating the specific risks that home birth has. The traditional way to get babies out of women, letting them come out naturally in their own time, as practiced for millions of years, can’t be _that_ wrong.

        So, in as many cases as possible, you get the benefit of not being in the building where all the sick people congregate and cough their germs all over the place, while at the same time having the facilities for treating sick people quickly accessible for the tiny percentage of cases where they’re needed…

        Yeah, having babies in _hospitals_ seems epicly stupid. (Putting _anyone_ in a hospital who does not have a disease is rather stupid if avoidable.) As does trying to schedule busy doctors to do it.

        The obvious solution seems to be to have some sort of live-in childbirth clinic staffed by midwives right next to a hospital. Where there can be ‘home birth’, or at least ‘home-like birth’ (Like I said, women and their spouse should _move in_, like it’s a motel room, well in advance.), without all the problems of hospitals, but with all the benefits of emergency care if needed. As @wagon pointed out, the lack of quick medical care in case something goes wrong is the deal breaker for quite a lot of people.Report

      • Avatar Kim in reply to dragonfrog
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        says:

        David,
        Just wanted to note that not everyone who intends to go to the hospital actually makes it there.
        A coworker of mine just delivered his baby in his garage. (no midwife, the ambulance arrived later).Report

      • Avatar dragonfrog in reply to dragonfrog
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        says:

        Lots of folks seem to think the basis for deciding on home birth was intuition, desire for scented candles, or some vaguely defined sense that “natural” somehow means “not dead”. Along with that assumption goes an equally unexamined counter-assumption – that a hospital birth is the safest, the most risk-averse, choice.

        In our case, the basis for choosing home birth was in large part risk-aversion, coupled with the thing that’s missing in what I describe above – actual quantitative risk analysis. We looked at the real studies of birth risk, instead of going “of course a hospital is safer because modern medicine so it must be.” We looked at the actual data, found out which was the safer option, and chose that.

        Risk aversion is not enough to be sure you’re choosing the safest course. You have to make your decisions based on risk data, not your own assumptions about what the risk data would of course be if you bothered to look them up.Report

      • Avatar dragonfrog in reply to dragonfrog
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        says:

        @davidtc

        Safer in the sense of:

        The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

        http://www.cmaj.ca/content/181/6-7/377.abstractReport

      • Avatar dragonfrog in reply to dragonfrog
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        says:

        Oh, and – they made the groups based on what the initial plan was – if a woman planned a home birth and then had to change plans, either during labour or due to complications arising before labour, they counted her in the home birth group. If she planned a hospital birth but gave birth at home because the car wouldn’t start, I guess they would have counted her in the hospital birth group too.Report

      • Avatar Chris in reply to dragonfrog
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        says:

        Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates.

        http://dhmh.md.gov/midwives/Documents/Wax-etal.pdfReport

      • Avatar Jonathan McLeod in reply to dragonfrog
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        says:

        @davidtc Just to tag in here from @dragonfrog, homebirths are safer in that they require less medical intervention and have safer/better outcomes.

        However, and this is key, this applies to low-risk pregnancies. There are certain situations in which a homebirth is not considered safer (for instance, my wife developed Pre-E and HELLP syndrome, that necessitated going to the hospital).

        Also keep in mind, location matters. dragonfrog and I are in locations where the midwives who attend homebirths are highly-trained, medical professionals who operate under the guidance of a professional college. I know that’s not the case everywhere, so outcomes may vary by location.Report

      • Avatar J@m3z Aitch in reply to dragonfrog
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        says:

        The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician.

        It’s worth noting that most people who learn well before the birth that their child is at high risk, or that they themselves are for some reason high risk, is likely not only to plan a hospital birth but to have a physician attending. So those higher numbers for hospitals and physician attendees are skewed to some unknown degree by known risk causing planned hospital birth and physician attendance, rather than hospital birth and physician attendance necessarily causing higher risk.Report

      • Avatar Chris in reply to dragonfrog
        Ignored
        says:

        Home births are not safer. Home births produce statistically fewer perinatal deaths, which is to say, fewer deaths during child birth, but this is outweighed by the increased rate in neonatal deaths, which is to say, deaths in the period after birth. When you add to this fact that the statistics dragonfrog cites do not take into account differences in prenatal health (of the mother or the fetus), it’s clear that dragonfrog’s data does not suggest that home birth is safer at all.Report

      • Avatar DavidTC in reply to dragonfrog
        Ignored
        says:

        @dragonfrog
        As I pointed out, that doesn’t mean that births happening at home are safer _because_ they are happening at home. It could, just as easily, mean that births that are known in advance to be more difficult are choosing a hospital to happen in.

        And, yes, I realize that the study only included hospital births that met eligibility requirement for home births, but just because the birth _could_ have happened at home doesn’t mean, at some point, it was not mentioned that the birth could be problematic due to some specific thing, but not enough to disallow home birth, but they choose the hospital anyway, and, tada, it was indeed problematic.

        Nor does there appear to be any way to measure the self-selection I mentioned…someone whose female relatives had medical problems during birth is probably more likely to select a hospital birth, _and_ is more likely to have medical problems herself.

        And there’s no indication they dealt with income levels. Infant survival is associated with prenatal care and nutrition levels, and that, obviously, is better the higher income the mother is. And while I am unsure about Canada, in the US home birth is associated with higher income levels.

        It’s a cliche, but correlation does not equal causation.

        That may seem nitpicking, but that study is talking about a mortality rate difference of 30 out of 100,000…in a country where the mortality rate is actually 478 out of 100,000. So, yeah, some _very small_ bias directing safe births towards home and problematic births towards hospitals could be explaining that rather small difference.

        And, looking at that, it’s rather ignoring the other rather large elephant in the room that pro-home birth people need to cope with…if births that could have happened at home, but did not, have a 64 out of 100,000 mortality rate, and the _average_ mortality rate is 478 out of 100,000, that means there are a hell of a lot of births that could not happen at home to get that average up that high!Report

      • Avatar DavidTC in reply to dragonfrog
        Ignored
        says:

        And now that some people have pointed out that this only include perinatal deaths and not neonatal, I went back and read some of the comments on it.

        It included a grand total of exactly 7 deaths.

        And it included deaths that happen well in advance of actually arriving at the hospital! Read the comment ‘Why include stillbirths before 28 weeks?’

        Apparently, if you’ve chosen to have a home birth, your baby is less likely to die before it. (Or, as I pointed out, you’re more likely to be wealthy, and have better health care overall.)

        This study is actually near complete nonsense.Report

      • Avatar Kim in reply to dragonfrog
        Ignored
        says:

        Yes, folks, it’s possible to have a safer homebirth than at the hospital. An immunocompromised patient, among others.

        People ought to know if they’re in this category, though.Report

  3. Avatar Kazzy
    Ignored
    says:

    “[W]hy on earth do you think we would give an injection that carried that kind of risk???!?”

    Well, have you ever met a pediatrician? Some of them are men. And they like children. Clearly, they cannot be trusted.Report

  4. Avatar Jonathan McLeod
    Ignored
    says:

    I’m pretty much on the low-interventionist/healthy-skepticism side of things. We had a great midwife who supported this, and encouraged us to ask questions about why we might or might not want certain things. It’s good for clients to be informed and all that.

    Vitamin K was a no-brainer.Report

  5. Avatar Griff
    Ignored
    says:

    Stopping in to poke the bear. NB three of the top four Google autocomplete suggestions for “vitamin K shot” are: “vitamin K shot and leukemia”, “vitamin K shot alternatives”, and “vitamin K shot for dogs”. Also, as further fodder, see this blog post and comment thread: http://www.thehealthyhomeeconomist.com/skip-that-newborn-vitamin-k-shot/

    Favorite comment: “Why fix something that isn’t broken to start with? The placenta contains huge amounts of Vit K yet none of it transfers to the baby. Is this a flaw in our design? I don’t think so. There is obviously a good reason it doesn’t transfer, just because we don’t know why yet, doesn’t give us the right to pump it into them (along with a whole lot of other poisons) at 100 times the dose that is *required* … HD of the newborn happens to a very tiny group of babies, who have trauma at birth (and let’s face it, who causes most of birth trauma these days?? um let me think, interventions, Dr’s, Ob’s, Paed’s, even some pushy medically minded midwives who have no clue about the true workings of birth..) … The chances of this actually happening is soooooo small, to poison EVERY baby is ludicrous at best, CRIMINAL at worst.”Report

    • Avatar Kazzy in reply to Griff
      Ignored
      says:

      I especially like how they juxtapose “medically minded” with “no clue about the true workings of birth”.Report

      • Avatar Chris in reply to Kazzy
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        says:

        “Medically-minded” as a negative quality for a midwife is kind of striking there.Report

      • Avatar Jonathan McLeod in reply to Kazzy
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        says:

        It’s pretty horrific.Report

      • Avatar Russell Saunders in reply to Kazzy
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        says:

        Back in the comments of my midwifery post, I got into a contretemps with a midwife who took issue with my describing appropriate training as “medical.” Even though I was writing approvingly of the large number of midwives who are actually trained in medical care, calling knowledge of medicine “medical” was something something patronizing or something.Report

      • Avatar Jonathan McLeod in reply to Kazzy
        Ignored
        says:

        I was thinking of that very back-and-forth, Russell. That mentality is one of the worst things happening in midwifery/birth today. It causes so much harm – both for those who embrace it, and for those who want a competent midwife, but can’t/don’t find one (or find one they think is competent).Report

      • Avatar dragonfrog in reply to Kazzy
        Ignored
        says:

        It seems to me it can be a bit difficult to have a useful conversation about midwifery in a geographically disparate forum.

        Where I live, midwives have a four year medical degree in midwifery and have passed professional exams and completed internships, just as nurses or doctors have. In parts of the US, you can apparently call yourself a midwife if you can spell the word.Report

      • Avatar Jonathan McLeod in reply to Kazzy
        Ignored
        says:

        @dragonfrog You’re absolutely right, and the difference has caused some heated discussions (particularly between Russ and my wife). I’m in Canada also, so I get that the US system (at least in some states) is really messed up. As such, the doc and I have a lot of common ground in our opinions, even if we, superficially, appear on opposite sides of the issue.

        In the particular thread, one interlocutor strenuously objected to the use of the term “medical” being applied to any midwife – even the ones with medical training, medical degrees, hospital privileges, etc.Report

    • Avatar Russell Saunders in reply to Griff
      Ignored
      says:

      It probably wasn’t clear in the OP (and I edited just a bit in an attempt to clarify that it’s a different source), but my “tribute to scientific illeracy” link is to that post.Report

    • Avatar J@m3z Aitch in reply to Griff
      Ignored
      says:

      If it’s natural, it must be good!

      I ran into that attitude a lot in Eugene, Oregon, and my normal response was, “sure, like snake venom and nightshade.” I suppose it wasn’t the best way to make friends.Report

      • Avatar Kazzy in reply to J@m3z Aitch
        Ignored
        says:

        “Newman O’s are organic. That means I can eat as many as I want and not gain weight.”Report

      • Avatar Russell Saunders in reply to J@m3z Aitch
        Ignored
        says:

        My favorite counter-example when trying to refute the “natural = good” fallacy is amoebic dysentery.Report

      • Avatar Kazzy in reply to J@m3z Aitch
        Ignored
        says:

        @russell-saunders

        Two responses:

        1.) When I first started food shopping for myself and was trying to make healthier choices, I remember assuming that “organic”, “all-natural”, etc. were synonymous of “part of a healthy diet”. Fortunately, reading a few food labels indicated this wasn’t necessarily the case. Largely because of differing interpretations of the word “healthy”. Organic food, some argue, is healthier because of toxins and whathaveyou; but that does not mean it is healthier in terms of lower fat or less sodium, etc.

        2.) That said, I generally try to trend toward more natural products over less natural products. It’s not a hard and fast rule, but I try to purchase things in either their natural state (produce, proteins) or with ingredients that I can pronounce. Your comment here gives me a bit of pause. Is there more to it than that? I will say that this does not hold true for baby stuff. Formula? I don’t know what any of that shit is… I just trust our system to keep bad formula off the shelves. Baby food? I prefer the one that says “Apples and water” as ingredients to the one that says something else, though not so far as to make all my own.Report

      • Avatar Coke-Encrusted Hollywood Exec in reply to J@m3z Aitch
        Ignored
        says:

        Hey, don’t knock snake venom & nightshade until you’ve tried it! If he’d kept to that natural stuff, Belushi might still be alive today!Report

      • Avatar Russell Saunders in reply to J@m3z Aitch
        Ignored
        says:

        @kazzy There’s absolutely nothing wrong with choosing foods that have a minimum of artificial or processed ingredients. Being able to trace what you’re eating back the the plant or animal that existed in nature before it became food is fine, and is relatively consistent with the dietary advice I give. (I like this book, despite some qualms I have with Pollan himself.)

        It’s not that there’s anything wrong with natural foods and products, per se. It’s that: 1) As you note, plenty of things are marketed as “natural” or even are natural by some nebulous definition and still not that good for you, or even downright harmful. 2) The obverse assumption that “artificial = bad” means that even things like synthetic vitamin K are treated as some kind of horrible toxin instead of a perfectly safe, healthy medication that saves a few lives here and there.Report

      • Avatar Kazzy in reply to J@m3z Aitch
        Ignored
        says:

        So what is amoebic dysentery? I feel like dysentery was a very bad thing in “Oregon Trail”.

        I’ll check out “Food Rules”. I generally harken back to an article I read in NYT Magazine about 7 years ago (perhaps written by Pollan, given what I’ve come to know about him since) which basically said, “Eat more food, eat less stuff.”Report

      • Avatar Glyph in reply to J@m3z Aitch
        Ignored
        says:

        Dysentery is – and I don’t use this word lightly – a total shitshow.Report

      • Avatar Mad Rocket Scientist in reply to J@m3z Aitch
        Ignored
        says:

        Having ‘enjoyed’ dysentery once upon a time, I can tell you the Glyph is not far off the mark.Report

  6. Avatar North
    Ignored
    says:

    Give em hell Doc. My blood pressure rose just reading about it.

    What would the libertarian position be on mandatory vaccinations? I mean on one hand it’s rank statism, directly intervening in medical decisions etc… on the other hand herd immunity is a form of commons, there’s a serious free rider problem that comes along with the vaccine decision and your unvaccinated brat could kill dozens of people who are either too young to be vaccinated, too allergic to be vaccinated or who are in the small minority of people who get vaccinated but it doesn’t take.

    Hmm and last question, is this a mainly American phenomenon? I’ve heard a tiny bit about it rattling around in Canada but what about Europe?Report

    • Avatar Jaybird in reply to North
      Ignored
      says:

      I’ve seen libertarians argue that PCP should be legalized/decriminalized and antibiotics administered under the watchful eye of a trained professional as if they were schedule 2 or 3.

      Under that attitude, I could see vaccination as being a price of admission to civil society.Report

    • Avatar Caleb in reply to North
      Ignored
      says:

      @ North

      What would the libertarian position be on mandatory vaccinations? I mean on one hand it’s rank statism, directly intervening in medical decisions etc… on the other hand herd immunity is a form of commons, there’s a serious free rider problem …

      I’m sure others would have different answers, but mine would be some type of court-enforced liability scheme. Of course, causation analysis would be an issue, so the solution might be something like a common pool of liability for a given area. There are plenty of other possible structures, of course.

      The key, however, would be not having state-mandated action (thou must); but state-enforced transfer of risk of harm (if thou does this, thou must pay for all foreseeable costs.)Report

      • Avatar North in reply to Caleb
        Ignored
        says:

        Hmm interesting I think that your big problem is, as you note, determining causation. Also I fear that simple monetary incentives wouldn’t be very efficacious; we’re talking about people swimming in new parenting hormones and likely thinking they’re protecting junior from having his brain melted by Big Pharma.Report

      • Avatar Kazzy in reply to Caleb
        Ignored
        says:

        What if folks — individuals — simply refused to accommodate unvaccinated children? It wouldn’t necessarily resolve the vitamin K issue, but if every restaurant said, “We don’t want to put our diners or employees at harm. Your children must be vaccinated in order to set foot in our door,” and other businesses followed suit, maybe you’d get somewhere. To enforce it, we’d have to indulging some “Papers, please”, but perhaps only long enough to end this nonsense. The anti-vaxxers have enough of a following to drive the blogosphere wild, but I doubt there is enough to run their own grocery stores, restaurants, stores, etc.

        This is a crazy idea, I recognize, but sometimes you have to fight fire with fire.Report

      • Avatar North in reply to Caleb
        Ignored
        says:

        You run into the same dilemma though Kazzy, herd immunity so pervasive now that no restaurant or business would be willing to impose such a requirement on their own. The cost/benefit ratio is enormously skewed against such civic mindedness.Report

      • Avatar Caleb in reply to Caleb
        Ignored
        says:

        @ North

        we’re talking about people swimming in new parenting hormones and likely thinking they’re protecting junior from having his brain melted by Big Pharma.

        True. But the liability-compensation system we have now encompases persons who do not act “rationally” with respect to the system. If people acted “rationally” within the system we have now, heedlessly reckless behavior would be much less common. But we do not. Yet, the system still has a purpose. The purpose of the system is compensative as well as incentivizing.

        @ Kazzy

        Yes, I admit my solution requires a bit more…”À la carte”… approach to civil interaction. Such is the case with a political philosophy which echews ‘totalitarianism’. (Please realize that this term is used only technically, and not at all pejoratively. It is simply a rejection of the idea that any given society can wholly encompass the entire spectrum of any one human’s needs given certain presuppositions.) Anyway, the idea is that social groups of humans interact with one another only along terms conditionally specified, rather than ultimately determined.Report

      • Avatar DavidTC in reply to Caleb
        Ignored
        says:

        @north
        You run into the same dilemma though Kazzy, herd immunity so pervasive now that no restaurant or business would be willing to impose such a requirement on their own. The cost/benefit ratio is enormously skewed against such civic mindedness.

        What we actually need is a pro-vax movement that demands a specific type of business (I think restaurant is a good choice), _require_ such a requirement, or the _pro-vax_ people will not patronize it.

        Actually, you know what might work well? Considering how screwy the labor market it, how much it’s a buyer’s market, perhaps this hypothetical pro-vox movement should put pressure on businesses to _refuse to hire non-vaccinated people_. Especially for any sort of position that interacts with the public.

        Granted, this wouldn’t entirely solve the problem, as the problem is really parents not vaccinating kids, but _any_ pushback from the non-stupidity community would be a start.Report

      • Avatar North in reply to Caleb
        Ignored
        says:

        David, I believe that could be a solution but suspect that the problem would first have to become more pronounced. We are, happily, blessedly, fortunately, living in a society where the system of vaccinations is still quite functional and herd immunity is high. The anti-vaxxers and the outbreaks they’ve caused are at most just a small leak in that barrier and the doc and I are both staring at them going “what the hell are you idiots thinking?!?”I think the damn would have to break significantly more before a large social movement of pro-vaxxers (distinct from general society) would arise.Report

    • Avatar J@m3z Aitch in reply to North
      Ignored
      says:

      North,

      The difficulty with the herd immunity approach is that each unimmunized individual’s probability of being a causal factor is so low. It’s easy to justify if we look at the group level, but harder if we look at the individual level (and of course I nearly always look at the individual level). I would accept Jaybird’s point about admission to civil society, though, if anyone actually had a realistic alternative.

      And children are a perpetual bugaboo–in my opinion, at least–for us libertarianish folks. We’re rather disinclined to let the state dictate too much in the way of child-rearing, but on the other hand we do recognize that children cannot make their own informed choices and that they deserve protection from harm no less than adults do. I think we can legitimately set rules on what parents can and can’t do to their children, just as we can set rules on what adults can and can’t do to each other, with the guiding principle being harm.Report

      • Avatar North in reply to J@m3z Aitch
        Ignored
        says:

        Prof,

        Yes so it’s a quintessential prisoners dilemma yes?

        But with children in this case vaccination is an affirmative action, or are you talking about setting rules like “you can’t deny your child appropriate vaccination protection”?

        Also would you consider herd immunity or antibiotic efficacy (thanks Jaybird) a form of commons? Or are commons only naturally occurring things?Report

      • Avatar J@m3z Aitch in reply to J@m3z Aitch
        Ignored
        says:

        Hmm, not sure it’s technically a PD, but in that general realm. But PD’s can potentially justify government regulation, they don’t automatically do so. At that point we get into questions of what standards we should apply to our judgement, and you’ll have a hard time getting liberals and libertarians to agree on those, probably.

        As to the commons issue, there’s no doubt it’s possible to artificially create a commons. The city could condemn my house, tear it down, and create an urban garden open to all comers with no controls, and they’d have created a commons. Education and research has elements of the commons, although they’re not quite true commons. I’d see herd immunity as being commons-like without being quite a true commons. Good enough for analogy purposes, not quite good enough as a precise technical definition. (Maybe: it depends if we define “not getting vaccinated” as “withdrawing resource units from the commons.” I wouldn’t, but I’d say the analogy is probably close enough for most purposes.)

        But I’d throw on top of that, why is our first response always “require X” or “ban X”? Are there more positive ways to get people to comply with what we want them to do? Why is it that human instincts always seem to default to punitive measures?Report

      • Avatar North in reply to J@m3z Aitch
        Ignored
        says:

        Well the liberal tent has gotten so big lately and the libertarians are so diverse you can often find a lot of overlap but yes getting ‘em to agree overall is near impossible.

        Do you think antibiotic resistance is more of a commons? You’re definitely drawing out resource units there: using antibiotics on a kid to deal with an infection potentially reduces it a tiny bit, using the same antibiotic on a herd so they can be economically fattened in a feed lot potentially reduces it significantly.

        As to why one defaults to require or ban X thinking I suppose I do it for a couple reasons. Firstly because it’s comparatively simple (and simplicity has a definite appeal for various obvious reasons- especially when talking about regulation). Secondly because the subject is especially emotionally fraught and rife with irrationalism and thus I suspect that mild economic nudges are especially liable to rebound off of the psyches of vaccine doubting parents.Report

      • Avatar J@m3z Aitch in reply to J@m3z Aitch
        Ignored
        says:

        Agh, don’t get me started on antibiotic resistance! That’s one of the few things that genuinely scares the shit out of me for my kids’ and potential grandkids’ generations. I’ve heard of educated upper middle class parents who put their kids on prophylactic antibiotics. And while I’m not at all reflexively anti-confined animal operations, the amount of antibiotics used in them (I’ve seen it first-hand, in what I believe to be nearly a model facility) is disturbing.

        Yes, that probably is well modeled as a commons. Each unit of lost antibiotic effectiveness is essentially a unit withdrawn from the common pool of resistance.Report

      • Avatar North in reply to J@m3z Aitch
        Ignored
        says:

        Agreed, it’s scary as heck. You’d think there’d be more money in developing new antibiotics. I suppose they need a few more of the old ones to become defunct first or something?

        Thanks for clarifying about the commons.Report

      • Avatar Russell Saunders in reply to J@m3z Aitch
        Ignored
        says:

        I’m far from an expert in the field, but my understanding is that there are only so many different ways to kill bacteria, and most of the antibiotics already on the market exploit these various pathways to killing bacteria.Report

      • Avatar Pierre Corneille in reply to J@m3z Aitch
        Ignored
        says:

        @jm3z-aitch

        But I’d throw on top of that, why is our first response always “require X” or “ban X”? Are there more positive ways to get people to comply with what we want them to do? Why is it that human instincts always seem to default to punitive measures?

        I once raised something like this with a friend of mine when we were discussing anti-vaxxers. I suggested there might be a way to incentivize people to get vaccines without necessarily requiring them, and he got very angry with me, accusing me of be an anti-vaccinationist, which I’m not. To be fair to him, I didn’t have any ideas as to what kinds of incentives might be out there that would actually work. But the fact that I raised the possibility of a non-mandatory approach raised his ire. Of course, vaccines are an emotional and in some ways life-and-death issue in a way that many regulations are not.Report

      • Avatar J@m3z Aitch in reply to J@m3z Aitch
        Ignored
        says:

        Pierre,

        I just find it interesting that command-and-control seems to be an instinctive human response to everything. It’s how most people parent, how most teachers set up their classes, etc.

        There’s no doubt it works well in some cases, so I’m not simoly opposed to it. But it demonstrably doesn’t work well in some cases, and in some cases where it works reasonably well incentive-based approaches work even better.

        But I’ve seen people react angrily to the idea of rewarding good behavior. “Why should people be rewarded for just doing what’s right?” It seems to me that the instinctive reversion to command and control methods is based more on some kind of moralistic instinct, one strong enough that it can sometimes override the concern for actually producing the desired outcome.

        It seems to me that after we define our desired outcome, our next stop ought to be, “what’s the best technique for achieving that outcome,” rather than “we should ban/require X.” But that’s not what humans tend to do, and I find that both intriguing and disturbing.Report

      • Avatar Pierre Corneille in reply to J@m3z Aitch
        Ignored
        says:

        @jm3z-aitch

        In fairness to my friend, on almost any other topic, he would probably agree with me (and you). This is just one of those issues. And since he was a father of a newborn, I should cut him a lot of slack.Report

      • Avatar J@m3z Aitch in reply to J@m3z Aitch
        Ignored
        says:

        And I’m open to the possibility that command and control is the best solution to ensuring vaccination. I just think we ought to analyze the alternatives before rejecting them.Report

      • Avatar Kazzy in reply to J@m3z Aitch
        Ignored
        says:

        @jm3z-aitch

        “[C]command-and-control [is] how most teachers set up their classes.”

        There are no doubt children who need to experience a certain amount of “command-and-control” in order to understand how to balance the needs, wants, and expectations of others with their own. These are usually children who experience none of this at hone… children who one way or another are able to always get their way and do what they want and spin out when this ceases to be as they enter classrooms with other people. I have one such student this year who I need to constantly talk to about how he simply can’t do whatever he wants whenever he wants, especially when it comes to things like physicality with other and safe/appropriate use of materials. This seems to literally be a foreign concept to him. As such, I need to make it more familiar.

        BUT… the knee-jerk response many teachers have to children exhibiting behaviors they do not desire for those children that basically boils down to “command-and-control” is alarming to me. As I wrote about a while back, there is an inverse relationship that I see between a teacher’s talent and confidence in that talent and their willingness to employ an authoritative approach. The best teachers and the ones most confident in their abilities are the ones most willing to cede control to their students. My general approach is to set broad parameters as necessary for a healthily functioning space where learning and growth can take place and give the children freedom within that. So, yes, blocks need to stay in the block area lest they interfere with other work in other spaces and, yes, we are going to limit the number of children in that space so that each can work productively and, no, you can’t throw the blocks or beat each other over the head with them but, otherwise, give it a go. Should you want to build a skyscraper or a pony house or a battleship with (gasp!) gun turrets, the space is yours.Report

    • Avatar Mad Rocket Scientist in reply to North
      Ignored
      says:

      Refuse to vaccinate your kids, then you go on a list. Your kids will not be allowed to attend public school, or participate in any group activity that requires vaccinations. Should there be an outbreak of a disease your child is not vaccinated against, authorities will be stopping by for a sample of your child’s blood to test for the presence of anti-bodies or other evidence of infection (or being a carrier) & you may find yourself in court defending civil challenges of harm.Report

      • Avatar Kazzy in reply to Mad Rocket Scientist
        Ignored
        says:

        Technically, many schools do have vaccination requirements (even public schools). These requirements are easily skirted, formally or otherwise.Report

      • This is why school choice is so important!

        [That’s only half in jest: I’m a libertarian; I support school choice; I think this demonstrates issues with a one-size-fits-all public school system.)Report

      • Avatar Mad Rocket Scientist in reply to Mad Rocket Scientist
        Ignored
        says:

        @kazzy I’d make them less easily skirted. Or rather, un-skirtable short of fraud.

        @jonathan-mcleod Agreed! Let the parents find a private school that will take their kids, or maybe a home school co-op, where they can have Chicken Pox & Measles parties!

        (Aside – way back when, when my mom ran a day care center, if one of her kids got Chicken Pox, she would ask the other parents if they were OK with the child staying at the center or not. Often this would result in all the kids who hadn’t yet had Chicken Pox, getting it. This was, of course, before the advent of the Chicken Pox vaccine.)Report

      • Avatar Kazzy in reply to Mad Rocket Scientist
        Ignored
        says:

        I agree, @mad-rocket-scientist . You do run the risk that some parents will double-down on the harm done by their children by pulling them out of school*. But schools must protect the children they have first and foremost.

        * While I have my reservations about home schooling, I will not go so far as to say that it is by default harmful to children. But the odds of a conspiracy-theory driven parent who planned to enroll their child in school only to be rejected because of failing to vaccine setting up a positive home schooling environment… well, I’m skeptical.Report

      • Avatar J@m3z Aitch in reply to Mad Rocket Scientist
        Ignored
        says:

        Refuse to vaccinate your kids, then you go on a list.

        A government list! What kind of libertarian are you, anyway?Report

      • Avatar Mad Rocket Scientist in reply to Mad Rocket Scientist
        Ignored
        says:

        @jm3z-aitch

        Touche’!Report

  7. Avatar Caleb
    Ignored
    says:

    This post immediately brought to mind my sister-in-law, who has been falling down the woo rabbit-hole for a while. She just had her second child, and was considering foregoing all neonatal injections. Fortunately, my mother (who is a doc, and not a person to be crossed lightly) rather forcefully dispelled her of those delusions.

    The thing is, my sister-in-law is, by all accounts, very intelligent. She graduated top of her class from a top-5 engineering school with her ee degree, and went on to work for GE while they paid for her masters. She may be many things, but stupid is not one of them.

    Yet she continues to fall hard for any number of woo-peddlers she reads online. This leads me to think there are other dynamics at play than just cynicism on the part of the sellers and low intelligence on the part of the buyers. I don’t know what those are. But, from my one anecdotal source, I have a speculation: fear.

    My sister-in-law is a very fearful person. It runs in the family, unfortunately. I’m constantly putting my wife at ease over trivial threats. My sister-in-law is the same way: constantly worrying over and trying to mitigate statistically miniscule or inherently uncertain sources of danger. It seems that fear does an end-run around around the rational part of the human psyche and demands a response, regardless of whether or not the threat is real, likely, or even addressable.Report

    • Avatar North in reply to Caleb
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      says:

      That makes sense to me. Some other contributing factors perhaps:

      There’s been a significant decline in respect for authority. Physicians and medical organizations aren’t deferred to like they used to be. For the record as a personal beneficiary of this cultural decline in respect for authority I can see both sides of this.

      The Internet 1: A little information can be a dangerous thing. You read a few wikipedia articles or some things on Webmd and you feel informed. Once you feel informed you feel confident in making all kinds of decisions you’d otherwise subcontract to professionals.

      The Internet 2 : The internet lets people form communities around all kinds of concepts (it’s not just for furries anymore). So people can form crunchy naturalism fetishizing networks that look dimly on things like vaccines.Report

      • Avatar LeeEsq in reply to North
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        says:

        One of the bad things about the Internet is that it makes it easier for believers in something stupid to find each other and offer their support against authority. This is true even if the authority figure is right.

        Years ago, I remember hearing that the Internet is making it more difficult to treat anorexics because they use it to form communities and reinforce each other.Report

      • Avatar North in reply to North
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        says:

        That’s both fascinating, believable and depressing all at once Lee.Report

    • Avatar Mark Thompson in reply to Caleb
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      says:

      I suspect this is pretty close to the truth. But what gives the fear enough weight to allow it to lead to actual decisionmaking is that someone with the fear can now go on Google and see that someone with an “MD” after their name or at least a “Dr.” before it is promoting a position that validates their fear. Suddenly, in their minds, there appear to even an intelligent layperson to be a “legitimate debate” in the scientific community, and they automatically trust the side of that “debate” which most captures and aligns with their own preconceptions and fears.

      Honestly, I’m not sure if there’s really a way for the legitimate medical community to effectively counter this impulse other than to defrock the snake oil salesmen and then seek criminal charges or civil penalties if they thereafter utilize the offending prefixes and/or suffixes. Even that probably won’t help much, though.Report

      • Avatar North in reply to Mark Thompson
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        says:

        My own fear is that people are going to have to learn the old way: vaccines go out of fashion, herd immunity collapses, the old scourges return and maul the crap out of people and then every person with two brain cells knocking together in their heads limps franticly back into the pro-vaccine camp.

        I do not think it’s coincidental that the anti-vaccine movement has become a thing at roughly the same time that the last generations to personally writhe en masse through polio and the other vaccine defeated plagues have died off or are so old they don’t have the capacity to throw a chair at their descendants while screaming “what the hell are you thinking?!?!? Do you know what those diseases do!??!!? I’d like to tell you about my brother Jimmy but I can’t because he coughed himself to death when he was 6!!!”Report

      • Avatar J@m3z Aitch in reply to Mark Thompson
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        says:

        someone with the fear can now go on Google and see that someone with an “MD” after their name or at least a “Dr.” before it is promoting a position that validates their fear.

        I’m Dr. Hanley. Trust me, bourbon is good for your baby.Report

      • Avatar LeeEsq in reply to Mark Thompson
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        says:

        It doesn’t seem so much that people do not trust authority figures as the Internet makes it easier for hucksters to challenge them. Before the Internet, a person would hear a bit off woo and ask their doctor about it. The doctor would than tell them what they heard is bull. Now people just do a google search and call it a day.Report

    • Avatar veronica dire in reply to Caleb
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      says:

      I think at root it is identical to conspiratorial thinking, which like the woo crowd is actually a game for the hyper-intelligent, since who can better built a tower of intricate rationalization better than an absolute genius.

      So here is the thing: it feels good to be anointed with secret knowledge, to stand out from the common lot, to be a hierophant.

      Being average just sucks. And growing up that spechal-smartie-pants kid gives one an insatiable appetite for this. So when you step out into the world, of course you are the one who sees what others do not.

      It’s intoxicating.Report

      • Avatar North in reply to veronica dire
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        says:

        You’re magnificently spot on with that point Veronica. See hipsters, the history of.Report

      • Avatar Jonathan McLeod in reply to veronica dire
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        says:

        Definitely. And contrarian thinking is very attractive.

        …no, wait, no it’s not.Report

      • Avatar Glyph in reply to veronica dire
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        says:

        If you’ve ever seen Errol Morris’ Mr. Death, it gives a vivid example of this. The subject, Fred Leuchter, is a Holocaust denier. I don’t think he’s particularly anti-Semitic, but he is used by anti-Semites; and at root of his problem is that he was an average guy, with just enough knowledge to misinterpret a situation; then be rewarded for that misinterpretation by respect from a crowd of (unsavory) people. Now he’s “special”, an “expert”. And that intoxication is part of what prevents him from seeing that he is missing part of the picture.Report

      • Avatar NewDealer in reply to veronica dire
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        says:

        I concur with the spot on theory and there is often an overlap between anti-vaxxers and the conspiracy crowd.

        I saw an article about this a few months ago. Do you know all the ads on websites like “Find out the little secret that can radically lower your car insurance?” These ads are not aimed at most people. They often link to 30 minute videos of pure woo and are aimed at people who want secret knowledge.Report

      • Avatar LeeEsq in reply to veronica dire
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        says:

        The Bolsheviks launched one of the biggest literary campaigns in history because they believed people who could read would be easier to propagandize.Report

      • Avatar LeeEsq in reply to veronica dire
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        says:

        More importantly, I also think that a lot of people think that conspiracy theorie and woo are fun. Real life can be very boring, especially if your living a relatively comfortable existence. A lot of people find that it lacks meaning. Conspiracy theories make life a bit more interesting, its like being in a novel or movie and your on the side of light and good against the forces of dark and evil. You can be a hero without actually having to do anything courageous or dangerous if you believe in a conspiracy theory or woo because simply knowing the “trurth” allows you to be a hero without having to risk life or limb or comfort like real heroes often have to do.Report

      • Avatar Chris in reply to veronica dire
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        says:

        It’s been my experience that the more woo-susceptible parents are, in many ways, more involved in parenting than your average non-woo-believing parent. I think one of the factors that contributes to their woo-sensitivity, in addition to the desire to be different and to raise themselves above the average parent, is that they spend so much time wading through parenting information that they get lost, and the really salient sob stories about a child developing autistic symptoms a couple weeks after a round of vaccinations, or a kid getting sick after a vitamin K shot, or whatever, tend to stand out.Report

      • Avatar Kim in reply to veronica dire
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        says:

        Lee,
        Actual conspiracies are hilarious.
        Or Sad.
        I can’t imagine why folks would
        want to come up with theories
        about what other people are doing.

        This world is creative enough as it is.

        I mean, what first world country bans World War II Video Games (with subsequent black market?)
        What first world country has legal birth control — but still a brisk blackmarket?
        Which first world country has banned specific brands of flashlights?Report

      • Avatar Caleb in reply to veronica dire
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        says:

        @ veronica dire

        So here is the thing: it feels good to be anointed with secret knowledge, to stand out from the common lot, to be a hierophant.

        I suspect this very well may be a part of it too. “Special knowledge” has always had a human psychological attraction, whether or not the particular piece of knowledge is true or accurate.

        Yet, in my case, I have yet to encounter the hallmarks of arrogance which usually accompany the adherents of occult knowledge. If a conversation (or, even more rarely, a debate) is initiated over the matter, it is by me. They recognize, I think, (if only subconsciously) my ability to defeat them evidentially. Their refuge is not in my ability to prove myself right, but in my inability to prove them wrong. That inability lies not within my abilities or within scientifically established knowledge. It lies within the nature of the premises of which they adopt.

        The premises that they adopt, then, are the ones that interest me. The construction of a premise which is true but can be proved false is simple. The construction of a premise which could be true but can’t be proved false is a different matter.

        It pays not to confuse the two.Report

      • Avatar Patrick in reply to veronica dire
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        says:

        @veronica-dire

        You… didn’t go to Caltech, did you?

        Or did you?Report

      • Avatar veronica dire in reply to veronica dire
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        says:

        @patrick — Nope. I’m very much an East Coast girl.Report

    • Avatar Jonathan McLeod in reply to Caleb
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      says:

      There’s also an issue of lack of respect given to patients. Sure, it’s wise to defer to medical professionals in these matters, but there is too much of a ‘because I said so’ mentality in the OB realm. If pregnant women aren’t getting sufficient information about what is being done, it’s understandable that they may rebel against that.

      Further, if you throw in some high profile situations where the medical community is empirically wrong, but it clings to its position longer than it should, people will begin to question more and more of what they’re being told by OBs. Sadly, this questioning will then lead them to the conspiracy theorists, anti-vaxers, anti-Vitamin K types. But part of the blame should be placed on the hubris of the medical community.

      Russell, in his posts, generally displays humility in his knowledge, skill and expertise. He rightly notes that “the chance the consensus is wrong will always be non-zero”. Not all doctors display this same characteristic.Report

      • Avatar morat20 in reply to Jonathan McLeod
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        says:

        My Dad stalked out of a cardiologists office because he (the Doctor) responded to a question with “You don’t need to worry about that, that’s my job”.

        I have no idea what the question WAS, but a harmless “That’s an unlikely blah-blah, but the tests will sort it out” would have made my father feel much better. And instead he got a blithe dismissal.Report

      • @jonathan-mcleod

        I think there’s a lot of truth to this: “There’s also an issue of lack of respect given to patients. Sure, it’s wise to defer to medical professionals in these matters, but there is too much of a ‘because I said so’ mentality in the OB realm.”

        I think one of the reasons why Dr. Oz is so popular, despite his flirtations with homeopathy, etc., that Russell pointed out a while ago, is that he treats the people on his show with a large amount of respect, at least in my opinion. I’ve seen a handful of episodes, and he seems to listen to his audience members with respect, and that’s probably worth a lot.Report

    • Avatar Mad Rocket Scientist in reply to Caleb
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      says:

      Even when you understand statistics & probabilities, it can be hard to sort out the truth from the hype. Even worse when the hype aligns with your biases.

      IMHO, the mainstream media has done more harm to the credibility of medicine & science than scientists ever could. Journalists inability to avoid turning the sound, ordinary results of a study (with the ever present caveats, etc.) into a load of sensationalist horsepucky has so damaged the public trust in science. It’s even worse when they never report on the 5 studies that follow 6 months later that utterly trash the initial study.

      Oddly enough, reports dishonesty in this regard never lashes back onto them, but onto the scientific establishment.

      Of course, the problem also stems from journals that lock away their content such that the public can never see it.

      Someday, I’d like to see a huge database of all scientific studies ever done, with links to every study that cites them, with special flags for studies that directly (or indirectly) support or refute the results presented.Report

    • Avatar Patrick in reply to Caleb
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      says:

      re: “fear”

      I wrote about this too!

      Ah, the old days.Report

  8. Avatar Lab Rat
    Ignored
    says:

    Yet no one notices about 1 in 500 people should have leukemia since practically everyone has had this shot. This is why I sometimes despair that science education and outreach can work. This level of credulity can’t be anything but intentional ignorance, right?Report

  9. Avatar LeeEsq
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    says:

    Another problem is that media is declining to fulfill their role as a gate keeper. Until recently, major media outlets felt it important to not give charlatans a platform if not attack them harshly. The easier entry into the media market has ended the gate keeper function.Report

  10. Avatar Kim
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    says:

    gotta comment in mod. plz fix.Report

  11. Avatar Wagon
    Ignored
    says:

    I’m certainly not going to make apologies for the anti-vaxers and folks like the ones described above.

    But, I will say this: I understand the lack of trust. Medical malpractice happens. And when people are having to make medical decisions, they are frequently doing so under two big stressors: 1) the fear of losing their or a loved one’s health, potentially life; and 2) wondering how they’re going to pay for it.

    My wife and I went through fertility treatments this year. We spent over a quarter of our yearly income on it. Last year, we spent probably about fifteen percent of our yearly income. At every point when we were faced with a decision, we had to think about the cost (because none of it was covered by insurance) and the potential benefit. Now, this was somewhat refreshing. Because fertility issues are not covered by insurance in most states, specialists have to be up-front and clear with their prices. At every step, we had a range of possible costs, and our doctor explained potential variances. It was far, far different than any other medical care situation I’ve been in, because we made every decision on a cost/benefit basis, playing percentages as much in our favor as we could within our means. When my dad had heart surgery a couple of years ago, I don’t recall him telling me about any discussion with his cardiologist about treatment options. The doctor just said, “We’re going to do a stint, etc. etc. Here’s the consent form.” Then my dad got the bill, paid his share, and that was it.

    So, I know we’re comparing apples and oranges in different specialties. Fertility clinics have a lot of competition. Dermatologists don’t. Fertility treatment is elective treatment. When you’ve got heart problems, it’s not something you can just live with in most cases. But when I know that a clinic is a business, and that doctors are trying to make a buck just like everyone else, and read about malpractice cases, and I know how that plumber gigged me on his labor charges last week even though the same problem resurfaced this week, and I know how my last mechanic told me I needed a new Johnson Rod and charged me $500 for it even though there’s no such thing…. Of course, I’m going to distrust my doctor. Why should he/she be any different than every other person out to sell me something? And how do I know that what I’m being told is true, and that it will actually save my kid’s life, or prevent this disease?

    Again, I’m not defending anti-vaxers. They’re reckless fools. But, I understand it, on a certain level. Life is chaotic, and people are generally cruel, selfish, vicious creatures. And when a doctor is explaining this tumor and its growth, it’s like a mechanic explaining why the emissions system in your car is doing this thing that needs fixing. You don’t understand what he’s talking about, but you’d like to look into it to confirm before you sign on the dotted line, mortgage your house, and gamble with your child’s life.Report

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