Katie Roiphe: Now I get it, Mom.

The response to my piece about Katie Roiphe has mirrored the response across the blogosphere. Instead of answering Roiphe's question, 'why are feminists dishonest about the passion of early motherhood,' most women have expressed hostility to Roiphe, her feelings and her reaction to those feelings. They view her essay as criticism, implied or overt, of themselves and their decisions to return to work.

Rather than interpreting Roiphe's essay through the prism of their own insecurities, feminists would find it more profitable to interpret it by recognizing the influence of the writings of her own mother. According to NNDB:

Anne Roiphe is an American feminist author known for such novels as Up the Sandbox and Lovingkindness. Her work is noteworthy for its examination of the conflict between the desire for family and relationships and that for career and self-determination...

Roiphe's principle contribution to feminist thought is her furthering of arguments introduced earlier by Betty Friedan regarding a woman's right to enjoy motherhood… Roiphe points out that although daycare may seem to be the answer to balancing work and career, it robs women of many of the joys and satisfactions of spending time with their children.

Roiphe further argues that the solution is not to relegate women to weekend/evening parenting, just as men have been traditionally, but rather to create a system in which both men and women can share in a full family life. She further advocates rethinking our current career track pacing such that a person's late 20s and early 30s might be more given over to family concerns (and joys), with the realization that life spans, and thus productive work years, for both genders have been greatly extended.

In light of her mother's work, I see Katie Roiphe's piece as a public acknowledgement of her mother's philosophical endeavors. Basically, she is saying, "Now I get it, Mom."

Personally, I think Katie (and Anne Roiphe) are correct in identifying this issue as one of the central failings in contemporary feminism, and the major reason why young women today often reject the label "feminist" even though they believe in the fundamental principles of feminism.

Many women don't want to "balance" family and career. They want to fully enjoy motherhood and then, when that phase is over, fully enjoy their career. Instead of acknowledging this reality, and thinking creatively about a solution, contemporary feminists have embraced the notion that women must slavishly copy men in their devotion to established career trajectories.

The response of feminists to Roiphe's essay mirrors the response of feminism to the power of mother love. They degrade it, deny it, diminish it and ridicule it. And the same reasoning underlies the similar responses; if you don't acknowledge its value, you don’t have to address the conflict.

The genesis of the "mommy wars" is the inability of contemporary feminism to acknowledge the power of mother love. Instead of trying to remake the working world to respect and support mother love, feminists have ducked the responsibility by denying that mother love is so very powerful, or by claiming that "real" feminists find career more compelling than being with their children.

The solution to the problem is not that complicated. Women should be able to cycle out and back into their careers by helping each other. Just as there is always a cohort of women who wish to scale back or leave work temporarily when their children are small, there is always a cohort of women who wish to ramp up or return to work when their children are older.

But feminists tend to sabotage the very cooperation that is essential to the success of such a system. Instead of acknowledging the power of mother love and making accommodations for it, older, more established women professionals tend to denigrate it, insisting that a "real" lawyer, doctor, etc. would not deign to leave the work force for something as trivial as being with one's children.

Unless and until feminists can acknowledge Katie Roiphe's feelings as real and admirable, and stop treating then as implied criticism of themselves and their choices, we will be unable to make progress. Mother love is real, powerful and worthy of respect. Feminism should acknowledge what is important to women, instead of pretending that the only thing that is important is being just like men.

"But what does that mean about me and my children?"

For most of my years as a practicing obstetrician, I worked part-time and only at night. I got the idea from a male colleague who, as he neared retirement, arranged to work only during the day. I was working part-time already, but I missed my children when I was working and figured that working only at night would be ideal for our family. Our large HMO practice was desperate for night coverage, so it seemed like a perfect fit.

Despite the fact that my new schedule would benefit the practice as a whole, my boss was reluctant to approve my request. Her response was quite illuminating. "My children are the same age as yours," she said," if you decide to work only at night, what does that mean about my children and me?"

I was reminded of that episode when I read about the recent uproar over Katie Roiphe's essay My Newborn is Like a Narcotic, in which she rhapsodizes about her love for her 6 week old son. On the face of it, the piece is rather uncontroversial. Roiphe is experiencing the same thing that many other new mothers experience, a love overwhelming in its all encompassing nature and power. Mother love IS like nothing else, and there is certainly nothing wrong in celebrating it.

Unfortunately, many feminists reacted with outrage, and their response seemed very much like that of my boss. "Katie Roiphe thinks that motherhood is more important than her work; what does that mean about my children and me?"

The passage that caused the most offense appears to be:

One of the minor dishonesties of the feminist movement has been to underestimate the passion of this time, to try for a rational, politically expedient assessment.

As can be expected in any discussion of motherhood and work, the response of feminists has been vicious. They range from the dismissive ("just wait until the baby is older"), to the pedantic ("Roiphe is battling a straw man") to the nasty ("she doesn't love her baby; she merely loves not working").

The response of feminists is so formulaic as to be a stereotype, right down to the humorlessness often attributed to them. Describing the experience of a friend after the birth of her second child Roiphe writes:

My friend looked down at her newborn and her tiny eyelashes... Here, sitting in the garden, looking at the eyelashes, would you trade the baby for the possibility of writing The House of Mirth? You would not.

This is what is understood by most people as humor through hyperbole. Predictably, feminists are livid. Katie Roiphe thinks a baby is more important than Edith Wharton's masterpiece!

Roiphe's comment is figurative, not literal in the same way that the claim "if my mother hates my new dress, I will kill myself" is figurative, not literal. It is a way to emphasize strong emotion. Just as a woman wouldn't really kill herself if her mother hated her new dress, Roiphe is not seriously suggesting that Wharton should have had a baby instead of writing a book. She is merely trying to convey how powerful her love for her new baby feels to her.

Feminists have a nasty habit of being too self-referential. They seem incapable of accepting Roiphe's piece for what it is, a paean to the intense feelings of early motherhood and her surprise that feminism has devoted so little attention to this important phase in a woman's life. Roiphe is not talking about other women. She is not chastising them because they did not feel as she does. She is not secretly criticizing their decisions to return to work, or to work the hours that they do. She's talking about herself. Any criticism of them, implied or overt, is in their imaginations.

Don't believe me? Try a little thought experiment. Imagine if a new father wrote the following:

One of the minor dishonesties of American male culture has been to underestimate the passion of new fatherhood.

Would feminists condemn that statement as criticizing fathers who do not feel overwhelmed with love for a newborn? Would they view the statement as implied criticism of men who work? No, they would do the opposite. They would celebrate that new father as a man who truly appreciates what was valuable in life.

Feminists need to get over themselves. Katie Roiphe was not talking about you and your children. She was talking about herself and her son. She was asking a perfectly valid question. Why are feminists afraid to celebrate the power of mother love? Instead of imagining personal slights, feminists should try to answer the question.

Dr. Andrew Weil, of Weil Supplements, Weil Baby, Andrew Weil for Origins, fears doctors’ recommendations are motivated by greed

You've got to give the guy credit for chutzpah. The man who heads a multimillion dollar industry peddling countless products fears that the profit motive is corrupting medicine.

... many physicians in high-medical-cost cities … have a diversified "revenue stream," the result of what one hospital administrator termed "entrepreneurial spirit." This "spirit" often manifested in physicians owning their own medical testing equipment, which meant the more tests they ordered, the more money they made. A 2002 University of North Carolina study showed doctors who own imaging equipment sent patients for roughly two to eight times more imaging tests than those who don't own.

That quote is from Andrew Weil, MD, writing in the Huffington Post, the same Andrew Weil who controls and profits from products licensed by Weil Lifestyle, LLC. Just contact Weil Lifestyle LLC, pay a hefty licensing fee plus royalties, and you can add Andrew Weil's name to your products too.

Weil Lifestyle LLC licenses the right to use Dr. Weil's name and likeness to companies philosophically aligned with his principles and committed to advancing integrative medicine. To qualify for licensing, the products themselves must also conform to the principles of integrative medicine. Current licensees are: Weil Nutritional Supplements (vitamins and supplements), Dr. Andrew Weil for Origins (skin-care products), Pet Promise (premium pet food), Dr. Andrew Weil for Tea (premium teas), Lucini Italia Organics(organic extra virgin olive oil and whole, peeled tomatoes), Weil by Nature's Path (organic cereals and nutrition bars), Weil for Vital Choice, Weil Baby™ (baby feeding systems), Weil by Vita Foods, and Orthaheel™.

The guy who is hawking tea, pet food, extra virgin olive oil and orthotics has the unmitigated gall to complain that doctors might profit from their recommendations. What, exactly, is he doing when he slaps his name on a product in exchange for a fee? He's profiting from his recommendation, obviously.

Does this man think that we are stupid? He counsels patients:

...[I]t's up to you to ask your physician if the tests or treatments ordered for you are truly essential. You might get an honest answer about the test's potential risks and benefits. Then, together, you can arrive at a decision that satisfies both of you.

Okay Dr. Weil, which of the products licensed and recommended by you are truly essential? It can't be the premium tea; it isn't the pet food; I doubt it's the skin care products. Maybe it's the newest product line Andrew Weil Gourmet Kitchen Products including bakeware, kitchen utensils, cutlery, gadgets and small appliances. If an Andrew Weil 10 cup Rice Cooker priced at $129.95 isn't essential, I don't know what is.

Dr. Weil proudly proclaims that he "donates all of his after-tax profits from royalties received by Weil Lifestyle, LLC from the sale of these products" to his foundation. How nice. He doesn't tell us what he does with the profits from licensing fees, book advances, personal appearance fees, etc. I guess we can assume that he simply keeps those for himself.

Does greed play a role in healthcare? Unfortunately, in the case of unethical practitioners it does play a role. Should greed play a role? Of course not. So please tell us, Dr. Weil, why we should pay the least bit of attention to your faux outrage? None of the products that you hawk are essential and most do not even provide the health benefits that you claim for them. The only thing they do is line your own pocket.

You're right, Dr. Weil. Patients shouldn't trust doctors who recommend treatments that provide financial benefit for the doctor and little if any health benefit for the patient. In other words, Dr. Weil, by your own logic, patients shouldn't trust you.

Doctors used to encourage VBAC; what changed?

When I was practicing, obstetricians encouraged VBAC (vaginal birth after cesarean section). I had a high rate of patients attempting VBAC and a high success rate as well. So when I first heard that ACOG had changed their guidelines, I was stunned. Why had ACOG changed?

They changed the guidelines for one and only one reason: they listened to women. Despite being counseled about the risks of VBAC, women who experienced a uterine rupture routinely sued their obstetrician and routinely won. ACOG was simply recognizing the reality that women believed that they did not and could not understand the risks of VBAC.

One of the most egregious cases involved a woman who claimed that her doctor withheld material information about the risks of VBAC. Although the obstetrician had told the patient that not only could a uterine rupture happen, she had seen one happen, the patient asserted that she wasn't adequately informed because the doctor did not mention that the baby in that case died:

... Flagg advised the plaintiff that, statistically, there were risks associated with the procedure, including uterine rupture and even a small chance of death of the child. Flagg reassured the plaintiff that all necessary steps would be taken to minimize or eliminate the risk to either the plaintiff or the plaintiff's decedent and that the risk was "very, very small . . . ." ... [T]he plaintiff asked ... whether Flagg had had any negative outcomes. In response, Flagg stated that one of her previous patients suffered a uterine rupture as a result of a VBAC delivery. She did not mention, however, that the uterine rupture had caused the infant's death and had placed the mother’s health at risk.

When patient lost her original lawsuit against the doctor, she was appealed using a new theory.

The plaintiff's informed consent claim rested on the allegation that Flagg had given an incomplete and misleading response to the plaintiff's inquiry about prior experience with VBAC deliveries. The plaintiff maintained that Flagg told the plaintiff that, in a prior VBAC delivery, she had one complication that resulted in a uterine rupture, but failed to tell the plaintiff that the uterine rupture resulted in an infant’s death. The plaintiff asserted that this evidence supported her claim that Flagg had not provided her with adequate information required for informed consent ... The plaintiff also claimed that if Flagg had informed her that the prior VBAC delivery resulted in the death of the infant, she would not have elected the VBAC procedure.

The Appeals Court agreed with the mother and granted a new trial on the theory that the mother had not given informed consent.

It is cases like these that led to the dramatically more stringent ACOG recommendations. Obstetricians wanted to offer VBACs but women insisted, and courts agreed, that the women weren't capable of understanding the risks. A journalist writing about his wife's successful VBAC gives us insight into the position of obstetricians:

Given his support of VBACs, I was surprised to learn that Burgee himself doesn't perform them. He did for two decades, but he stopped in 1990 when he reduced his practice to half-time while he got a law degree (so far unused). When he resumed his full-time practice, he didn't take them up again. He stopped, he says, partly because his legal education made him see his legal risks more starkly. Managing the cases thus seemed more complicated than ever: The OB in him would be pulling for the VBAC, while the surgeon, lawyer, and potential trial defendant would worry that he should wheel the mother to the O.R. Now he explains to his patients why he doesn't perform VBACs, outlines the odds as well as the arguments for and against, and offers the names of midwives and doctors who will perform the procedure...

Are doctors overreacting? It's hard to make that claim when you learn how lawyers are advising women. The title of this law firm's webpage is VBACs Too Often Result In Injury and Death:

While the promotion of VBACs may save insurance companies money, the risks simply cannot and should not be ignored. It is known that patients who fail a trial of labor are at increased risk for infection and death. Infants born by repeat caesarian delivery after a failed trial of labor also have increased rates of infection. Recent reports indicate that major maternal complications such as uterine rupture, hysterectomy, and operative injury were more prevalent in women who attempted a VBAC than those who underwent repeat caesarians.

If the uterine scar ruptures, it can be life-threatening for both the mother and the infant. For the mother, uterine rupture can require hysterectomy and can result in death.

For the infant, uterine rupture can result in both neurological damage and death. Uterine rupture can result in a sudden disruption in the blood flow to the fetus, resulting in deprivation of oxygen to the blood and tissues. This deprivation can lead to death of brain tissues and serious harm to other vital organs within only minutes. Accordingly, it is imperative that no VBAC be attempted at a facility where emergency staff are not capable of performing an emergency caesarian in minutes in order to prevent this potential harm or death to the infant and mother.

Contrary to the ravings of VBAC activists, obstetricians did not "take away" women's option for a VBAC. That was done by women themselves. If enough women claim that they cannot possibly understand the risks of VBAC and enough lawyers encourage lawsuits based on that theory, obstetricians and hospitals have no choice but to respond to their demands.

Have a problem with the decreasing VBAC rate? Take it up with the women and lawyers who are responsible instead of pretending that doctors are depriving women of choice.

This post first appeared on Homebirth Debate in September 2008.

Is Dr. Andrew Weil trying to torpedo healthcare reform?

Many advocates of "alternative" health are left wing idealists. Therefore, it comes as a surprise that, on the issue of healthcare reform, they are missing in action, or worse. Many appear determined to torpedo healthcare reform and the reasons why shed a lot of light on their belief that cossetting the "worried well" is more important than providing healthcare for the poor.

I guess we shouldn't be surprised. Although "alternative" health practitioners are forever insisting that their quackery provides effective treatment and even cure, they make no effort to offer compassionate, or free care. There is not a doctor alive who hasn't provided substantial amounts of free care to patients who cannot pay. Indeed, there are entire hospitals who consider it their mission to serve the underserved. In contrast, it appears that alternative health practitioners exist to help only those who can pay, and consider the poor unworthy of their concern.

Alternative health practitioners approach healthcare reform as would any special interest group. The most important question is: "What's in it for alternative health care practitioners?" They are irritated by the answer: Of the millions of dollars that would be expended providing healthcare to the underserved, not much would go to them. To their dismay, the President and Congress appear to believe that providing access to care for people who already have diseases like cancer and heart disease is more important than lining the pockets of charlatans.

They're fighting back. Dr. Andrew Weil appears to be leading the charge. His multi-million dollar financial empire is not enough. He needs more money, and therefore, he presents absurd drivel wit an apparently straight face. Writing on the Huffington Post recently (The Wrong Diagnosis), Dr. Weil offered this bit on inanity:

Washington is working on reform initiatives that focus on one problem: the fact that the system is too expensive (and consequently too exclusive.) Reform proposals, such as the "public option" for government insurance or calls for drug makers to drop prices, are aimed mostly at boosting affordability and access. Make it cheap enough, the thinking goes, and the 46 million Americans who can't afford coverage will finally get their fair share.

But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly.

It might be amusing prattle were it not so cruel and so selfish. Evidently we shouldn't worry about providing care to the underserved who already have cancer, heart disease and other life threatening conditions (you know, those pesky people with pre-existing conditions). Making cancer treatment, heart surgery and other life saving treatments available will "just spread the dysfunction." Sure it might save the lives of those who are currently suffering, but who cares about them? It won't provide Dr. Weil and his colleagues with more money and that's what counts.

Dr. Weil's prescription?

Most cases of disease should be managed in other, more affordable ways. Functional, cost-effective health care must be based on a new kind of medicine that relies on the human organism's innate capacity for self-regulation and healing. It would use inexpensive, low-tech interventions for the management of the commonest forms of disease. It would be a system that puts the health back into health care. And it would also happen to be far less expensive than what we have now.

In other words, give the money to Dr. Weil and his colleagues. Will their methods work? Do they offer relief for those who are already ill? Do they cost less?

To even ask those questions is to miss the point. Who cares what happens to poor people? They can't pay for alternative "treatments," they don't buy books, and it is too late to prevent the diseases they have. In other words, Dr. Weil and his colleagues can't make any money from their misery. Weil makes money from the worried well. Hence his emphasis on providing even more services for those who already have plenty.

In his zeal to mine healthcare reform for personal profit, Dr. Weil comes strikingly close to the insurance and pharmaceutical companies he claims to despise. They are considering how healthcare reform might be manipulated to line their own pockets. Dr. Weil fails to acknowledge to himself and others that his "prescription" for reform is just as transparently self-interested.He promotes only that which he and his colleagues can provide without regard to whether that is what is needed.

Anyone who opposes healthcare reform simply because it provides more money for others and not for him is selfish and cruel indeed.

Can you still be "Dr. Wonderful" after conviction for sexual exploitation of a patient?

It's probably the most egregious violation of professional conduct that any obstetrician-gynecologist can commit. I'm talking about the sexual exploitation of a patient.

You might think that such a doctor would be a pariah among patients, especially after a conviction, and the decision by the California Board of Medicine to place him on probation for 7 years, but you'd be wrong about this doctor. He is currently soliciting donations from patients and supporters for his latest legal woes, precipitated by routinely ignoring hospital policy, and women are proudly giving money.

What group of women would deliberately ignore a conviction for sexual exploitation and rally around a doctor in spite of it? Homebirth advocates, of course. They have chosen to ignore the behavior of Dr. Stuart Fischbein because he provides back up for homebirth midwives.

Dr. Fischbein is widely hailed within homebirth circles. He works with Ricki Lake on her website, and is routinely praised for his public "Letter to ACOG" condemning their stance on a variety of issues. I can only imagine what happened at the headquarters of ACOG when they received the letter. They must have been shocked and then laughed out loud at the audacity of a doctor convicted of sexual exploitation daring to lecture them on their responsibilities to patients.

The offense was described by the Ventura County Star:

His patient, identified in Medical Board records as S.K., was 14 years younger than he and earning her doctorate degree in psychology. She came to Fischbein's office in Century City with her fiancee. They wanted to have a baby.

... He performed surgery ... to remove a mass in her uterus and called her "sweet pea" in the recovery room. He sat at her bedside for long intimate talks, testifying in a hearing he viewed her as not just a patient, but as a woman...

S.K. said Fischbein told her he would be a better father than her fiancee. He persuaded her to leave him.

They talked about the ethics of doctor-patient relationships. She said he told her he dated "bushels" of patients. Fischbein denied the comment or any other relationship with a patient.

She said he advised her not to have sex for four to six weeks after surgery. Fischbein said in court he didn't remember the discussion.

Five days after she was released from the hospital and eight days after surgery, he called and asked to visit her at her home in Los Angeles. They had sex then and again two days later at Fischbein's home.

He testified it was consensual. She said she viewed him as a doctor who had performed a surgery that was going to enable her to have a baby. He had become a hero who seemed almost "godlike." And he was interested in her.

"I would have done anything he would have told me to do," said the woman, who is suing Fischbein. "I look back with my hindsight and with my mind today and say, How could I have done this?'"

The contrast between this description and the accolades of his supporters are jarring, to say the least.

The post by Rixa Freeze on her website Stand and Deliver is typical of the response of the homebirth community to Dr. Fischbein's latest legal difficulties.

...[A] wonderful obstetrician, Dr. Stuart Fischbein, is being threatened with disciplinary action by his hospital "for violating hospital policies." The hospital has already suspended the privileges of the two CNMs he works with, and now he faces a possible loss of his livelihood...

Dr. Fischbein is a vocal supporter of midwifery and home birth. His collaborative midwife practice had a primary c-section rate last year of only 5% ... and an overall rate of 12% ... compared to his colleagues' 29%...

So what can you do to help?

1. Contribute to Dr. Fischbein's Legal Aid Fund. Make Paypal Payment to angelfischs@yahoo.com or mail a check payable to Alan J. Sedley, Attorney at Law...

Dr. Fischbein claims that he is being faced with the loss of hospital privileges for repeatedly violating hospital policy on VBACs and breech deliveries. That is certainly possible since subjecting the hospital, nurses and other doctors to the risk of legal liability that they have chosen not to undertake is certainly a reason for losing privileges. However, the peer review process is protected by strict confidentiality on the part of the hospital. There is no way to know whether this is the primary or only cause for the peer review.

I take a dim view of soliciting money from patients and supporters for a legal defense when those patients and supporters have no way of knowing what the actual charges are. It seems only reasonable that if Dr. Fischbein is soliciting money for his legal defense, he should waive the hospital's mandated confidentiality, so that they can tell their side of the story.

Homebirth advocates have every right to forgive Dr. Fischbein for sexual exploitation. Yet I feel compelled to ask: Is homebirth so important that any doctor who supports it, even one who has acknowledged sexually exploiting a patient, is worthy of the designation "Dr. Wonderful?"

New data: homebirth with a direct entry midwife is the most dangerous form of planned birth in the US

In a recent post (Homebirth kills babies) I analyzed the data in the Linked Birth Infant Death database and demonstrated that homebirth with a direct entry midwife has almost triple the neonatal death rate of hospital birth for comparable risk women. Similar results were presented at the Pedatric Academic Societies May 2009 meeting.

According to the Medscape article:

Dr. Michael H. Malloy, at the University of Texas Medical Branch in Galveston, compared a range of adverse outcomes among infants by delivery attendant type and site of delivery occurring in the U.S. over a recent 5-year period...

The present analysis was limited to term (37-to-42 weeks), singleton, vaginal deliveries.

"I decided to restrict the analysis to this low-risk population because they would be the best candidates for home delivery," Dr. Malloy said.

During the study period, there were 10,330,214 (88.5%) hospital physician-attended births available for analysis; 1,237,129 (10.6%) hospital-CNMW births ... 13,529 (0.1%) home-CNMW births; 42,375 (0.4%) home-other nurse midwife ...

The number of neonatal deaths for each of the categories was respectively 6,992; 614... 14; 75

The neonatal death rates in each group were 0.68/1000 hospital MD births; 0.5/1000 hospital CNM births, 1/1000 home CNM births and 1.7/1000 homebirth direct entry midwives. These are almost exactly the same as the death rates that I calculated from the same database for the 2 year period 2003-2004.

In both cases, homebirth with a direct entry midwife has triple the rate of neonatal death as low risk hospital birth. In both cases, homebirth with a direct entry midwife (such as a CPM) is the most dangerous form of planned birth in the US.

As Dr. Malloy explains:

"However, while there were only 14 neonatal deaths occurring in association with a home-CNMW assisted delivery, the risk of death was more than two-fold higher for CNMW-home deliveries and four-fold higher for deliveries by other midwives versus CNMW-hospital deliveries.

The prevalence Apgar scores of less than 4 was eight times higher for CNMW-home deliveries than for CNMW-hospital deliveries. What's more, the risk of neonatal mortality and low Apgar scores was still increased for CNMW-home deliveries versus CNMW-hospital deliveries after adjusting for multiple potential confounders (including maternal age, race, education, parity, presence of one or more medical or labor complications, presence of an anomaly in infant, gestational age, and infant sex).

"The increased risk of low Apgar scores among infants delivered at home suggests that the causal pathway to the increased risk of neonatal mortality may be through the occurrence of asphyxiating conditions at birth that are not easily handled by the home environment," Dr. Malloy noted.

Overall, the results demonstrate that the safest setting for a delivery is an in-hospital delivery attended by a CNMW, and women who decide to deliver in the home "need to recognize the greater risk associated with that choice," he said.

Finally, as for why in-hospital CNMW deliveries had a lower risk of mortality in his study than in-hospital physician deliveries, Dr. Malloy said he assumes it's because physicians are delivering a higher risk population, which he could not completely control for in his logistic regression analysis.

Dr. Malloy would be expected to be very sympathetic to homebirth. He has published several papers on C-sections and neonatal mortality in association with Drs. MacDorman and Declerq alleging (and then forced to back track) on claims that C-sections increase the risk of neonatal death.

Dr. Malloy's data confirms what anyone can see for themselves. The existing US statistics on homebirth shows that homebirth with a direct entry midwife has triple the rate of neonatal mortality of low risk hospital birth. It is the most dangerous form of planned birth in the US.

If women want to have a homebirth, they can, but as Dr. Malloy states, they "need to recognize the greater risk associated with that choice."

WWJI: Who would Jesus insure?

Ahh, the irony. Christian Conservatives have a sordid history of trying to force religion into medicine.

According to them, Jesus does not allow abortions, so laws should prevent abortion, or, failing that, should place innumerable roadblocks in the way of women who want abortions.

According to them, Jesus wants all life to be preserved, so they mustered a public campaign to prevent Terri Schiavo's husband from honoring her wishes and allowing her to die.

According to them, Jesus considers homosexuality to be an abomination, so discrimination against gay people should be enshrined in law.

Since they appear to believe that medical decisions (even other people's medical decisions) should be made with regard to what Jesus would want, I’d like to know: who would Jesus insure? *

I’m no theologian, but I feel confident that Jesus would not approve of our current method of providing healthcare.

Would Jesus tie health insurance to employment? I doubt it. He made manifest his concern for the poor and downtrodden, so it is doubtful that he would want their miseries magnified by denying them access to healthcare.

Would Jesus allow pre-existing conditions to be exempted? Not likely. He ministered to the sick without regard for how long they had been sick before he arrived. It is impossible to imagine him declaring: "I'm here to relieve your suffering, but only new illnesses, not those that existed before I came to your valley."

Would Jesus consider it a priority to preserve existing insurance companies? Would he reject a public option for health insurance because it threatened the profits of insurance giants? Once again, not likely. He would not put profits ahead of the life and health of innocent people.

Who would Jesus insure? The conclusion is inescapable. He would insure everyone. He would insist that it was the moral responsibility of those who have health insurance to make it available to those who don't. And the way we do that is by providing a public option for health insurance, exactly the same option that the elderly now enjoy.

So I have a suggestion. For those who believe that we should make healthcare decisions based on what Jesus would do, how about making healthcare insurance decisions based on what Jesus would do? Obama may be anathema to many Conservative Christians, but it is impossible to deny that his plan for healthcare reform bears the closest resemblance to what Jesus would do.

WWJI: Who would Jesus insure? Everyone, of course.


* I know that is "whom would Jesus insure" is grammatically correct, but "who would Jesus insure" sounds better.

Masturbatory insanity: the rise and fall of an idea

The history of medicine is replete with theories that reflect religious beliefs rather than scientific facts. One of the most interesting, and most instructive examples of this phenomenon is the claim that masturbation causes insanity.

Masturbatory insanity pre-occupied medical professionals for almost 250 years. It arose apparently de novo in Europe in the early eighteenth century, and was not finally put to rest until the middle of the twentieth century. Its history of the idea is recounted exhaustively in the scientific paper Masturbatory Insanity: The History of an Idea by E.H. Hare published in the Journal of Mental Science in January, 1962.

Classical medical professionals made no reference to any harmful effects of masturbation. It was not until the early eighteenth century that the idea gained currency upon publication of the book Onania, or the Heinous Sin of Self-Pollution. The author is believed to have been a "clergyman turned quack" and not a reputable medical professional. Like most quacks he advertised an extremely expensive secret remedy.

The assertions gained wide popularity, though. Voltaire, writing in his Dictionnaire Philosophiqe in 1764 reports that the book was then in its 80th edition.

The idea passed into the realm of official medical thought with Tissot's Onania, or a Treatise upon the Disorders produced by Masturbation in 1758. According to Tissot:

...[L]oss of semen ... occasions general debility and so opens the way to consumption, deterioration of eyesight, disorders of digestion, impotence, and so on…[T]he more serious effects are on the nervous system and this is due to the sexual act causing an increased flow of blood to the brain. "This increase of blood explains how these excesses produce insanity. The quantity of blood distending the nerves weakens them; and they are less able to resist impressions, whereby they are enfeebled."

During the following years anatomical and pathological study revealed that disease was caused by structural abnormality or derangement, and the claim that masturbation could cause "deterioration of the eyesight, disorders of digestion, etc." lost currency. But medical professionals refused to give up the idea that masturbation was harmful and the locus of harm became mental health.

According to Esquirol, writing in 1838:

... it (masturbation) may be a forerunner of mania, of dementia and even of senile dementia; it leads to melancholy and suicide; … it is a grave obstacle to cure in those of the insane who frequently resort to it during their illness

The view that masturbation causes insanity was refined over time to a specific form of insanity. In his classification of mental disorders written in 1863, Skae asserts:

The third natural family I would assign to the masturbators… I think it cannot be denied that that vice produces a group of symptoms which are quite characteristic and easily recognized, and give to the cases a special natural history: the peculiar imbecility and shy habits of the very youthful victim; the suspicion and fear and dread and suicidal impulses and scared look and feeble body of the older offenders, passing gradually into Dementia or Fatuity.

This theory was elaborated by Spitzka (1887):

... the typical age of onset of masturbatic insanity is between 13 and 20 years; it is at least five times as common in males as in females because of the greater rarity of masturbation in females; in the majority of cases there is a rapid decline into agitated dementia, but where deterioration is less rapid "the obtrusive selfishness, cunning, deception, maliciousness and cruelty of such patients" is such that "the [doctor] may find it impossible to reconcile himself to regarding them as anything else than repulsive eye-sores and a source of contamination to other patients, physically and morally."

In retrospect, Spitzka and others were describing schizophrenia. As Hare explains how masturbation came to be associated with a specific form of insanity:

Nor is it difficult, from our present standpoint, to see how this came about. Masturbation is most commonly and most frequently practised during adolescence and therefore most likely to be observed when mental disease insidiously deprives an adolescent of his normal social inhibitions.

As the field of psychiatry developed, it was recognized that excessive or public masturbation was a symptom of serious psychiatric illness, not its cause. Even then, the psychiatric profession only gradually gave up the notion of masturbation as harmful, downgrading it from psychosis to neurosis and ultimately acknowledging it as normal behavior.

The story of masturbatory insanity is a cautionary tale. It reflects the injection of religion into medicine, characterizing a behavior as harmful because religion says it is harmful, rather than relying on scientific evidence. We may imagine that, in our purported sophistication, we would never fall prey to such ludicrous theories. But, in fact, similar efforts are ongoing, with religious conservatives trying to persuade the public that homosexuality is deviant behavior and that abortion is physically harmful.

The story of masturbatory insanity should remind us to be aware of the intersection of religion and culture with contemporary medicine. Great harm can occur when religion is confused with medicine and medicine is harnessed for religious ends.

Alternative health and the conceit of the brilliant heretic

A pervasive theme in "alternative" health is the notion of the brilliant heretic. Believers argue that science is transformed by brilliant heretics whose fabulous theories are initially rejected, but ultimately accepted as the new orthodoxy.

Alternative health practitioners, with no embarrassment at their own presumption, routinely liken themselves to Galileo and Darwin. Today their brilliant theories of homeopathy, therapeutic touch and the like are rejected but ultimately they will be acknowledged as truth. As usual, their claim is based on a lack of knowledge about science, and ignorance of history.

As explained in The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession by Paul Wolpe, alternative health practitioners believe:

[Alternative health] is the inevitable (or desirable) next step in the history of medicine, and like other heroes of medical history who were initially rejected by the orthodoxy of the day ... the [alternative health practitioner] is simply ahead of his time. Innovation is always initially resisted … Holistic heretics portray themselves as mavericks, leaders, with every expectation that soon all of medicine will, by necessity, follow in their footsteps.

It is a breathtaking conceit, and it betrays a profound lack of understanding of the history of science.

1. The conceit rests on the notion that revolutionary ideas are dreamed up by mavericks, but nothing could be further from the truth. Revolutionary scientific ideas are not dreamed up; they are the inevitable result of massive data collection. Galileo did not dream up the idea of a sun-centered solar system. He collected data with his new telescope, data never before available, and the sun-centered solar system was the only theory consistent with the data he had collected.

Similarly, Darwin did not dream up evolution. He collected data during his years of exploration on the Beagle, much of it previously unavailable. A theory of evolution was the only theory consistent with the data that he had collected.

In contrast, belief in alternative health has no basis in scientific fact. It has been dreamed up by its various adherents and practitioners. Far from depending on scientific evidence, it eschews the need for scientific evidence.

2. The notion of the heretical maverick betrays a lack of historical knowledge. Galileo and Darwin were considered heretics by religious leaders, not by other scientists. Their ideas swept across the scientific world precisely because of their explanatory power and the data that they had to back them up.

In the world of science, it was already well established that the orthodoxy could not explain what everyone had observed. Long before Galileo, scientists understood that the Biblical theory of the earth-centered universe did not accord with astronomical evidence. Long before Darwin, fossil discoveries had called into question the Biblical creation story.

Mainstream medical science has been astoundingly successful in both theory and practice. The power of the germ theory of disease or the molecular structure of DNA rests on their ability to explain what we observe, are confirmed by experimental data, and result in highly effective treatments and cure.

In contrast, alternative medicine exists independent of scientific observation. Its theories have poor explanatory power and are directly contradicted by copious scientific evidence. The treatments of alternative health are notoriously ineffective. Although anecdotes abound, scientific studies of “alternative” health treatments have yet to identify a single one that works.

3. New theories may be resisted by older scientists because they upset the orthodoxy, but they are not resisted by the scientific world. That's the point of peer reviewed scientific journals. Scientists present their evidence, and other scientists decide whether that evidence supports a new theory.

For example, early in my medical career a scientist claimed that ulcers were caused not by acid, but by the H. pylori bacteria. The initial reaction of the medical world was disbelief. However, when doctors saw the data, and when the original studies were quickly reproduced by other scientists, doctors accepted the theory, created treatments based on the discovery and moved on.

In medicine, as in all science, the data comes first, the theory follows. In “alternative” health, the theory exists independent of the evidence, and no one even bothers to collect evidence. The idea that alternative health will ultimately be accepted as true is ludicrous.

The idea that heroic geniuses dream up new scientific theories that are initially rejected but ultimately embraced by other scientists is a fairy tale. It betrays a lack of understanding about how science works, and a lack of knowledge about what actually happened to people like Galileo and Darwin.

"Toxins": the new evil humours

They say that everything old is new again and that is certainly true in the world of "alternative" health. One of the axiomatic premises of contemporary "alternative" health puts its believers behind the times ... by approximately 500 years.

A fundamental premise held by believers in "alternative" health is that we are swimming in a world of "toxins" and those "toxins" are causing disease. Like most premises in "alternative" health it has no basis in scientific fact; makes intuitive sense only if you are ignorant of medicine, science and statistics; and speaks to primitive fears and impulses.

The preoccupation with "toxins" is a direct lineal descendant of the obsession with evil humours and miasmas as causes of disease. It is hardly surprising that prior to the invention of the microscope the real causes of disease went undiscovered. The idea that disease is caused by tiny organisms that invade the body is not amenable to discovery in the absence of scientific instruments and scientific reasoning. And it goes without saying that the same people who were unaware that bacteria and viruses cause disease could not possibly imagine chromosomal defects, inborn errors of metabolism or genetic predispositions to disease.

Instead, people imagined that diseases were caused by excess evil humours, substances that were named, but never seen or identified in any way accessible to the senses. It was recognized that some diseases were contagious, and in that case, people invoked the idea of "miasmas" that somehow transmitted disease.

Even religion got into the act. Rather than attributing disease to evil humors of miasmas, religious authorities often claimed that disease was attributable to evil demons or to sin itself.

These theories shared several important features. The evil humours, miasmas, etc. were invisible, but all around us. They constantly threatened people, and those people had no way of fending off the threat. Indeed, they were often completely unaware of the threat that was actively harming them.

Evil humours, miasmas, demons, etc. were put to rest by the germ theory of disease. That was the first big breakthrough in our understanding that each disease was separate and has its own specific cause. The search for causes has taken us beyond bacteria and viruses, through errors of metabolism and chromosomal aberrations, right down to the level of the gene itself. We now understand that tiny defects in individual genes can cause disease or can increase the propensity to a specific disease.

But fear and superstition never die and the "alternative" health community has used that fear and superstition to resurrected primitive beliefs. It is axiomatic in the "alternative" health community that disease is caused by evil humours and miasmas. They just don't call it that anymore; they call it "toxins."

Toxins serve the same explanatory purpose as evil humours and miasmas. They are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence. They are no longer viewed as evil in themselves, but it is axiomatic that they have be released into our environment by "evil" corporations.

There's just one problem. "Toxins" are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.

Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).

Nonetheless, "alternative" health advocates persist in subscribing to primitive theories of disease. For those who have limited understanding of science, primitive theories apparently make more sense.

Hence the obsession with "toxins" in foods, in vaccines, even "toxins" arising in the body itself. The height of idiocy is the belief in "detoxifying" diets and colon cleansing. The human body does not produce "toxins." That's just a superstition of the "alternative" health community. The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed for that purpose such as the kidneys.

"Alternative" health practitioners are nothing more than quacks and charlatans and their "remedies" are nothing more than snake oil. The fact that anyone in this day and age still believes in such crackpot theories is a tribute to the power of ignorance and superstition.

Evil humours and miasmas have not died, they've been reincarnated as "toxins."

The playbook for challenging conventional medicine

The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession, by Paul Wolpe, is about doctors who promote "alternative" medicine, but it applies to any practitioner who challenges the fundamentals of any branch of medicine. According to Wolpe, an attack on an established discipline in medicine includes four specific elements. The critic:

must portray the discourse as in crisis, must provide an alternative ideology to rescue the discourse, must legitimize their ideology through appeal to a reframed historical myth, and must portray the orthodoxy as a betrayer of the discourse.

The authors applies his analysis to "alternative" medicine in general, but we are will look at homebirth midwifery in particular.

The first step is to portray the particular discipline as "in crisis".

... Modern medicine’s conquering of infecious disease set up a quasi-religious belief in its ability to reduce suffering and disease now seems stalled by a of medical economic, organizational, and social problems. [Critics try] to portray the biomedical orthodoxy as responsible for the problems confronting organized medicine .., and suggests that orthodoxy is ill suited to solve the developing challenges to care...

This is certainly the tactic adopted by homebirth midwifery. The "crisis" is the rising C-section rate, which is portrayed as unjustified, intolerable, unaffordable and injurious. A secondary "crisis" (which is fabricated) is the rate of infant mortality (the wrong statistic) and the rate of maternal mortality (which is falsely portrayed as rising).

As Wolpe points out, the critic "rarely paints its opponent in terms of benign neglect", but, rather, claims that it is evil. Therefore, the rising C-section rate is never portrayed by homebirth advocates as the regrettable but inevitable result of the desire to prevent all possible neonatal death and injury, but, instead, is characterized as the result of the obstetrician's desire to get rich, to "get home for dinner", or simply to ruin a woman's birth experience.

Next, the critic offers the new philosophy, positioning it as the replacement for the old:

... The heretical ideology is drawn as much as possible from existing strains in the discourse, strains usually ignored, slighted, or marginalized in the orthodox ideology... The heretic draws from the marginalized or folk knowledge of the tradition and elevates the constructs found there to primary importance...

... [G]reat pains are usually taken ... to show that the alien ideas are not in fact alien at all, but have existed in the discourse in a different form. [Critics] often import foreign, folk, and traditional forms of healing into their practices, [carefully describing] them as wholly compatible with Western medicine, scientifically valid, or historically present in other forms. (The 'placebo' effect, for example, is elevated to a central place in holistic medicine, and described as demonstrating the 'power of the mind', which is in turn said to be a central tenet of Eastern and Native healing forms. The orthodoxy is censured for slighting this most important healing modality.) ...

What does the critic offer instead?

The [critic] blurs the line between disease and health as it is usually drawn in Western medicine, and extends the range of therapeutic intervention beyond the bounds of manifest pathology. At one end is a concentration on pre-morbid states, or prevention...

Attention to the pre-morbid state is complemented by an expansion of the post-morbid state. The goal of holistic health is more than the absence of disease; it is a state of optimal functioning, often referred to as 'wellness'... [which] greatly expands the role of the HMD in medical intervention ...

In the words of homebirth midwifery: pregnancy is "not a disease", but nonetheless it requires extensive prenatal visits, preparation and education. In addition:

The [alternative practitioner] caters to the consumer; the customer is always right, and the seller does not know better than the buyer what the buyer really want or needs...

And:

The use of touch and intimacy, the central role of patient education, and the use of Eastern and Native American medical forms and philosophies all serve to create a ritualized encounter that opens the way for ideological display. [Alternative providers] try to forge affective connections with patients by sharing their own feelings and experiences and using noninstrumental touching to develop intimacy.

Third, the critic attempts to gain legitimacy by "rewriting" the history of the discipline:

Heretics try to rewrite the discourse's historiography to emphasize their own ideological positions. In doing so, they make heroes out of the orthodoxy’s secondary players and emphasize heretical themes in the orthodoxy’s heroes.

Hence the rewriting of the history of Semmelweis and puerperal sepsis to make Semmelweis the "discoverer" of puerperal sepsis, and to protray him as the man who could have cured puerperal sepsis if other orthodox physicians had not stood in his way and hounded him to insanity.

Another favored theme:

... Holistic heretics portray themselves as mavericks, leaders, with every expectation that soon all of medicine will, by necessity, follow in their footsteps.

Ultimately:

Biomedicine is portrayed as a bureaucratic juggernaut whose judgments are accepted uncritically by adherents. Technological wizardry is used as proof of sophistication without truly exploring all roads to healing their patients...

Promiscuous use of drugs and surgery represent not cures, but substitutes for curative action. They are distributed without thought and without recognition of their power to do harm...

The heretical attack both blames the orthodoxy for the crisis and for failing to accept the heretic's remedial ideological position. The orthodoxy has betrayed the discourse through its inaction, and no longer deserves to be its guardian. The heretic is the true keeper of the flame, the savior of the discourse, and should ascend to the position of power in place of the orthodoxy.

The inherent risks of childbirth

Natural childbirth advocates, like many Americans, have trouble evaluating risk. They have difficulty understanding relative risk (how one risk compares to another risk) and they have difficulty evaluating sources for the accuracy of their claims. There is an additional component to risk assessment for natural childbirth advocates. They are often factually misinformed about the actual risks. Nowhere is that more apparent than in their almost complete lack of knowledge about the inherent risks of pregnancy and childbirth.

The first clue to this serious misunderstanding is the claim that childbirth must be safe because it is "natural". Natural does not mean safe, and we are pretty clear about that in other areas of life. For example, natural disasters, such as hurricanes and earthquakes are 100% natural. Nonetheless, we know that they are responsible for a tremendous amount of death, suffering and destruction. Natural means one thing only: it happens in nature. It tells us absolutely nothing about whether it causes death or other serious effects.

The second clue to this serious misunderstanding is the claim that childbirth must be safe because "we are still here". This is evidence of basic lack of knowledge about biology. The fact that "we are still here" only tells us that in every generation, the number of people who lived exceeded the number who died. It doesn't tell us anything about the ratio. So, for example the population will grow at a certain rate if each couple has 3 surviving children. It does not matter whether the couple had 3 children, all of whom survived, or 10 children, 7 of whom died.

We know from the biology of other animals that reproduction has a tremendous amount of wastage. We've all seen nature shows about sea turtles who lay hundreds of eggs, with the result that only a few baby turtles survive the treacherous walk across the beach to the safety of the ocean. We know that some animals, like salmon, give up their own lives in the process of reproduction. The fact is, there is a tremendous amount of wastage in human reproduction also. The miscarriage rate for established pregnancies is 20%. That means that 1 in 5 pregnancies will not survive to result in a live birth. Pregnancy and childbirth also have a "wastage" rate. In nature, many women and babies did not survive the process. That is a natural part of human reproduction.

Let's take a look at historical evidence about death in pregnancy and childbirth. Irvine Loudon is one of the premier historians working to understand the history of human pregnancy and birth. In the article Maternal mortality in the past and its relevance to developing countries today, there is extensive exploration of the historical data on maternal mortality in the United Kingdom. Looking at the maternal mortality data for 1872-1876, we find a maternal mortality rate of approximately 400/100,000 with the following causes:

cause of death %
Puerperal fever 55.5
Hemorrhage 22.5
Eclampsia 11.6
Miscarriage and abortion 4.0
Postpartum psychosis 2.5
Embolism 2.0
Ectopic 0.2
Other 0.8

By contrast, the maternal mortality rate today is in the range of 10/100,000.

What were maternal mortality rates prior to the late 19th century? According to the works of other historians which Louden quotes:

They found maternal mortality rates were certainly higher at 400-500 per 100000 births throughout the 19th century. It was a bit higher at the beginning of the 19th century and was up to perhaps 1000 per 100000 births in the early part of the 18th century. I have a graph in my book [Loudon I. Death in childbirth. Oxford: Clarendon Press, 1992] that shows maternal mortality stretching back in history and, as you go back, it goes up very slightly and then we lose track because there really are no data as yet.

This data is fairly consistent with the maternal mortality rates that we see today in parts of the world that don't have access to modern obstetrics.

What conclusion can we draw from this data?

Giving birth is and has always been inherently dangerous. From the early 18th century on back, 1% or more of births resulted in the death of the mother. To put a 1% maternal mortality rate in perspective, it is twice as high as the mortality rate for receiving a kidney transplant, and a bit less than half the mortality rate of having "triple bypass" heart surgery.What's really amazing to consider is that the chance of the baby dying was always dramatically higher.

Jon and Kate back together again?

It's only a matter of time until Kate begs Jon to come home.

Jon’s finally gotten Kate's attention. Not by moving out, or gallivanting around with tarty women. She doesn't care about that. He's gotten her attention by threatening what she loves most in this world and I don't mean her children. Jon has jeopardized Kate's diva-dom, the gravy train she has ridden to celebrity and a bizarre haircut.

The ratings for Jon and Kate Plus Eight have dropped like a rock. From a high of 10.5 million viewers at the end of last season, only 3.5 million viewers tuned in for the most recent episode. People aren't interested in watching a couple going through a messy divorce, and that's hardly surprising. As I wrote last spring (Why are we fascinated with big families?):

I suspect we are fascinated because we stand in awe of the commitment required to deliberately choose a large family: the commitment to parenting as a lifestyle choice and the commitment to marriage that lies at the core of the decision to have many, many children.

In contemporary America, such a commitment is not only unfashionable; it is unfathomable.

If contemporary America could be distilled to one imperative, it would be this: The highest calling is self-actualization. Or, more colloquially, "it's all about me." In other words, being happy (and being happy is considered the highest state of being) requires doing what you want, when you want to, unfettered by obligations and commitments. Children are an obligation, a temporary detour on the road to a life devoted to self.

By separating and planning to divorce, Jon and Kate have demonstrated that they are just like everyone else. Both of them abandoned their commitment, and decided "it's all about me."

Kate put stardom ahead of being with her husband and family. He asked to her to stop traveling and spend more time with him and the kids. She needed the rush of attention, the entourage and the extra money that came from turning the children into an industry, not merely a TV show. The books and the speaking tours were necessary steps in building that industry. Visions of celebrity endorsements danced in her head.

Jon, for his part, has decided to meet this rejection with a startling display of immaturity, self-absorption and naivite. He is relying upon Michael Lohan for advice. You may remember him as the dysfunctional father of Lindsay Lohan, newly released from jail. Perfect! They can trade tips about how divorced dads can still profit from their children's celebrity while failing to act like real fathers and stick around to raise their kids.

Jon and Kate have destroyed the main appeal of their show by putting their own desires ahead of the needs of their children, and the viewers have been quick to react. The drop in ratings is only a part of it.

While Jon and Kate have been very careful to keep their religious fundamentalism out of the TV show (probably on the advice of the network), the books and speaking engagements directly exploited that element. The books are published by a Christian publisher and are filled with Biblical quotes and testimonials about the role of their faith in their lives. The audiences for their speaking tours were conservative Christians. Needless to say, divorce will kill that market completely.

Kate wanted a divorce because Jon was interfering with the building of her personal celebrity and her financial empire. But forcing Jon out, though good for a temporary boost in ratings, will destroy the show and the money and celebrity that go with it. I suspect that it is only a matter of time before Kate begs Jon to come back.

The possibility of getting back together, with its inherent tension and doubt, would be a ratings bonanza, and the effort to repair their marriage back together would rescue her standing within the conservative Christian community. Imagine the rapturous greeting Kate would get if she claimed that it was their strong religious faith that led to a reconciliation.

Oh, and it might be good for the children, too, but who cares about them?

Natural childbirth and the rise of Momzilla

We've all heard about bridezillas, the women who are so obsessed with having the perfect wedding that they become tyrants toward everyone else. There's an argument to be made that many homebirth and "natural" childbirth advocates are "momzillas" who justify their hypersensitivity, obsessive need for control, and rudeness to everyone else with the all purpose excuse "It's my special day."

Consider:

Obsessive need for control - One of the hallmarks of the bridezillas is the obsessive need for control. No detail is too small for consideration, planning and decrees.

Momzillas? It's difficult to imagine anything more obsessive than birth plans. Birthplans, in addition to being useless for their stated purpose of improving the birth, are attempts to plan the unplannable. You might as well have a "weather plan" for the day of birth for all the good it's going to do you. Birthplans, like obsessive wedding plans, have the added drawback of irritating everyone around you. The need to ruminate on every aspect of the day, and share those ruminations with everyone else is boring at best and narcissistic at worst.

Hyersensitivity - Bridezillas spend a lot of time being angry. Things aren't going according to plan. People are not taking their desires as seriously as they take them. People don't behave as instructed. Everything is perceived as a slight. Flowers the wrong color? Have a fit. Napkins not folded just so? Accuse the caterer of incompetence. Groom expresses a different preference that has not been preapproved? Who does he think he is? After all, it's not about him. It's all about, exclusively concerned with, revolving only around Bridezilla.

Homebirth and "natural" childbirth advocates spend a lot of time being angry. The birth is not going according to plan. The hospital staff are not taking their desires as seriously as they take them. The hosptial staff is not behaving as instructed. Everything is a slight. Offered an epidural? Have a fit. Labor support not exactly as desired? Accuse the nurses of evil intentions. Baby needs something different than the preapproved birth plan? Who does that baby think he is? After all, birth is not about the baby. It's all about, exclusively concerned with, revolving only around Momzilla.

Outsize feelings of disappointment - Bridezillas are psychologically very fragile, and make no apologies for their fragility. Cake filling the wrong flavor? The wedding is ruined.

Momzillas are psychologically very fragile and make no apologies for their fragility. Baby need resuscitation before being placed skin to skin with Momzilla? The birth is ruined. C-section needed to deliver a healthy baby? That no longer qualifies as a birth at all!

Using others as characters in performance art - This is perhaps the worst of the many unattractive traits of Bridezilla. Everyone, from the guests, to the bridesmaids, to the groom himself, are nothing more than bit players in Bridezilla's ultimate piece of performance art, her wedding. Bridezilla feels free to dictate what the guests should wear, how much the bridesmaids should weigh, and every possible details of the groom's existence. What if those people feel badly about the way they're treated? Bridezilla doesn't care. It's her day and that means she's entitled to use people any way she wants.

Momzilla is the same. Everyone, medical personnel, her partner, even the baby are nothing more than bit players in Momzilla's ultimate piece of performance art, "her" birth. Momzilla feels free to dictate what everyone involve is allowed to do or say. What if her requests compromise the obligation of medical personnel to provide safe care? Momzilla doesn't care. It's her day and that means she's entitled to use people any way she wants.

Bridezillas are narcissists. They have an outsize view of their own importance, a hypersensitivity to slights, a feeling a being persecuted when things don't go their own way, and an insensitivity to others who work with or for them. Homebirth and "natural" childbirth advocates often behave like narcissists, too. They have an outsize view of their own importance, a hypersensitivity to slights, a feeling of being persecuted when the birth does not go as planned, and an imperiousness and insensitivity to others who work with or for them.

Ultimately, both bridezillas and momzillas are psychologically fragile. Instead of integrating the inevitable disappointments associated with a wedding or birth, they get psychologically "stuck." They experience their disappointments as narcissistic injuries and respond with rage and accusations of persecution. They have no time for and no interest in the feelings of others, and feel entitled to use other people for their own ends.

Ironically, the behavior of momzillas often fails to produce the perfect birth, just as the behavior of bridezillas cannot produce the perfect wedding. Because of their psychological neediness and fragility, they are unable to appreciate that every change in plan is not the "fault" of someone, unable to accept that unwillingness of providers to follow commands is not a sign of persecution and, worst of all, unable to enjoy what they have.

Why won't the mainstream media report the truth about healthcare reform?

I used to be saddened by the idea that the mainstream media is dying. I have been a news junkie since I was a child, and newspapers, news magazines and the evening news were fixed points of reference for decades. But in the last few years I have canceled my daily newspaper subscription, almost never read popular news magazines, and have stopped watching the evening news altogether.

Partly this is because so-called news organizations have stopped reporting the actual news. The New York Times fills is Health pages with recipes, Time Magazine devotes more print to book and movie reviews than to international news, and the evening news has degenerated into a series of commercials for Viagra and antacids punctuated by brief interludes of celebrity newscasters pitching heartwarming stories and celebrity updates.

However, the primary reason why I consider the mainstream media essentially useless is because even (perhaps especially) when reporting hard news, the MSM routinely allows itself to be intimidated by the Conservative Right. News organizations like The New York Times and CBS News justify caving in to right wing intimidation by claiming "balance." In the interests of “fairness” they must report "both sides." But both sides are not necessarily equally worthy of print, particularly if one "side" is factually false.

Nothing illustrated this better than the media's treatment of the right wing zealots who questioned the patriotism of presidential candidate John Kerry. The "Swift Boat Veterans for Truth" (a truly Orwellian name) fabricated a story of John Kerrey's service in Vietnam that had absolutely no basis in reality. Although their claims were immediately identified as falsehoods and acknowledged as such by the mainstream media, the "Swift Boat Veterans" continue to receive extensive media coverage in the interests of “balance.” In other words, the mainstream media were intimidated into giving widespread and continuous publicity to outright lies.

Exactly the same treatment is now being accorded to the Conservative Republican assault against meaningful healthcare reform. Most of the Republican attack is nothing more than outright lies. The mainstream media appears to be well aware of this. Sidebar articles analyzing the claims repeatedly and inevitably acknowledge them to be lies, yet the mainstream media continues to print them.

The mainstream media appears to be so intimidated by the Conservative Right Wing that it won't describe intimidation for what it really is. Conservatives have vowed to defeat healthcare reform by disrupting efforts of Congressman and Senators to publicly explain the legislation to their constituents. They have made good on their threats to quash free speech and yet the mainstream media offer only the most lukewarm descriptions of their tactics of intimidation.

Today's New York Times reports "dissent" and a town meeting filled with "rowdy" moments. But the "dissent" was manufactured by political operatives and bare knuckle attempts to intimidate Senators and voters is not "rowdy" behavior, it is a profound threat to the democratic process.

Today's Washington Post, reporting on President Obama's most recent efforts to rally support:

President Obama began a personal effort Tuesday to reclaim momentum for his health-care initiative with a direct rebuttal of what he called "scare tactics," rumors and misrepresentations.

The writer employed scare quotes, as if the efforts to scare the American public had not already been advertised and acknowledged in advance. As to the rumors and misrepresentations of the Republican Right, they are rumors and misrepresentations. The reporters at the Post are well aware of this, yet they shrink from reporting the truth, for fear of offending the very people who are manufacturing the rumors and misrepresentations.

What is wrong with the mainstream media? Why do they accord lies the same status as the truth? Why won’t they acknowledge the concerted effort to derail discussion for what it is, intimidation? Why don't they exercise judgment instead of channeling the PR representatives of the Republican Right Wing?

I don't know the answers to these questions, but I do know this: when the mainstream media refuses to call a lie, when it is intimidated into ignoring intimidation, it has sounded its own death knell.

Andrew Weil, healthcare reform, and my cousin Janet

President Obama believes that the primary goal of healthcare reform is to provide access to the millions of Americans who currently have no health insurance. Dr. Andrew Weil, writing in today’s Huffington Post (The Wrong Diagnosis), thinks he knows better, as the title of his article implies.

But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly.

It sounds great, but it means nothing. It is widely recognized by healthcare economists that preventive care does not save money. Everyone from the Congressional Budget Office on down has acknowledged this. Preventive care saves lives, but it does not save money.

But there's a deeper problem with Dr. Weil's pronouncement. Those who cannot seek even basic care for their "disease management" are suffering horrifically and are not helped by fancy words about "staying healthy." Instead of worrying about how to get more for those who already have plenty, let's focus our attention on those who have none.

I wish Dr. Weil could have met my cousin Janet, but it's too late now. Janet is dead. She died because she didn’t have health insurance. Perhaps he would think twice about pandering to the "worried well" and start thinking about people who are dying because they have no access to any healthcare at all.

My cousin Janet was a lovely, vivacious, and kind person. She would give you the shirt off her back, even when, as was often the case, the shirt on her back was all she had. Janet suffered from intermittent bouts of debilitating mental illness. Although she was bright, educated and hard working, her frequent relapses made it difficult for her to hold a steady job. As a result, she often supported herself by menial work such as cleaning houses. And as a result, she never had health insurance.

Janet was an enthusiastic proponent of alternative health and preventive care. She tried to care for herself every way that she knew how. She had no other choice.

When she called me early one bleak Sunday morning to tell me that she had a lump in her breast, I began calculating how we might get her access to healthcare. Early stage breast cancer is highly curable, and Janet was otherwise young (mid 40's) and healthy. I started to explain that it was very possible that the lump was benign and might not require any care beyond surgical removal.

But Janet interrupted me. She didn't think that was likely. Why not? Well, the lump had been there for 5 years. How big was it? The size of a lemon!

"Oh, Janet," I cried, "why didn’t you go to the doctor?"

"I couldn't," she explained. "I didn’t have any health insurance and I had no money to pay a doctor."

Ultimately, through the efforts of family, we got Janet to a doctor. An evaluation showed that she had stage IV breast cancer, with metastases in her spine and skull. The state where she lived, unlike mine, provided no aid for people without health insurance, but Janet qualified for money from a foundation that exists specifically to help breast cancer patients who have no other means to pay.

Janet found an excellent oncologist, who was honest about her grim prognosis, but felt that with aggressive treatment she could enjoy 3-4 years of high quality life. The oncologist was right. Janet lived almost 4 more years and died at the age of only 50, leaving her mother, family and friends bereft.

It's a shame that Dr. Weil is ignoring people like Janet. Prattling about wasting time on "disease management" sounds great to people who have no diseases, but is unutterably cruel to those who are suffering and need help now.

The many problems with Dr. Bob's alternative vaccine schedule

As we struggle to reform the healthcare system, provide care for all, reduce disease and hold down cost, there are those who, for the sake of profit, would rather do the opposite. No, I'm not talking about drug companies or entrenched healthcare interests, although they are working mightily to undermine healthcare reform. I'm talking about people like "Dr. Bob" Sears, panderer to vaccine rejectionists.

Vaccination is preventive medical care at its finest, minimizing disease, relatively inexpensive and available to all. Vaccine rejectionists, and those who pander to them, are actively undermining extraordinarily effective preventive care; their actions will inevitably lead to increased disease, increased medical costs, and harm to innocent children. Indeed, in the case of measles, it has already begun to happen.

Even something as apparently harmless as an "alternate" vaccine schedule is dangerous. It increases the interval during which children are vulnerable, it leads to missed vaccination, and it massively increases the time and money required to provide healthcare to all of America’s children. Every minute spent refuting the nonsense of people like "Dr. Bob" is a minute where effective medical care is not being provided to many others in need.

The heart of pediatric care is prevention, so it is not surprising that the American Academy of Pediatrics is alarmed about the growing trend of withholding vaccination and alternate vaccine schedules. They have published a point-by-point refutation of the vaccine-rejectionism of Dr. Robert Sears, a man who has made a fortune by pandering to the fears of vaccine rejectionists.

The paper is entitled The problem with Dr. Bob's alternative vaccine schedule and the authors are forthright in explaining they wrote the paper:

Many books misrepresenting the science of vaccines or vaccine safety have been published. None has been as influential as that published by Dr Robert Sears, The Vaccine Book: Making the Right Decision for Your Child...

Sears' book ... has already sold more than 40,000 copies… The popularity of Sears' book centers in part on 2 schedules, called alternative and selective, that offer parents a way to avoid giving their children several vaccines at one time. Sears' book is unique… Unfortunately, Sears sounds many antivaccine messages.

Dr. Sears makes two types of claims, opinion claims and empirical (factual claims). The opinion claims are designed to undermine trust in medical and public health officials. The empirical claims are factual claims that, in most cases, are false.

Dr. Sears makes two main opinion claims. First, he says that he, as a physician, knows very little about vaccines and it assumes that every other physician knows as little as he. I'm not sure where he went to medical school, but he ought to ask for his money back. It is simply impossible to believe that he didn’t learn about vaccines. Moreover, if he didn't learn about vaccines in medical school, and he has no formal training in immunology or virology, why should we pay any attention to what he says about vaccines?

The second opinion claims is that public health agencies and pharmaceutical companies are not trustworthy. It is hardly news that pharmaceutical companies exist to make a profit. That tells us nothing, though, about whether a specific product is safe and effective. Moreover, Dr. Sears provides no evidence that public health agencies are not trustworthy. Most importantly, Dr. Sears does not address his personal conflict of interest; why should anyone believe him if he makes a profit on each alternate vaccine schedule that is sold?

Most of Sears' empirical claims are easy to address. They're flat out false or disingenuous. For example, Sears asserts that vaccine-preventable diseases are not that bad, though most are deadly, and he asserts that vaccination has eliminated acute diseases but caused chronic diseases. There’s simply no scientific evidence to support that claim.

Sears' assertion that natural infection is better than vaccination is disingenuous. It's true for those who survive the natural infection. It's not particularly relevant for the thousands or millions who die. Moreover, for certain infections, survival may be accompanied by permanent disability such as severe scarring (smallpox) or paralysis (polio). That's a steep price to pay for natural immunity.

One of the most disingenuous claims is also unethical. As the paper describes:

Perhaps the most disingenuous comment in the book is directed at parents who are afraid of the measles-mumps- rubella (MMR) vaccine. "I also warn [parents] not to share their fears with their neighbors," writes Sears, "because if too many people avoid the MMR, we’ll likely see the diseases increase significantly." In other words, hide in the herd, but do not tell the herd you're hiding; otherwise, outbreaks will ensue...

This is why vaccine rejectionism is unethical. Dr. Sears' warning implicitly acknowledges that vaccines are highly effective and that their effectiveness is dependent on herd immunity. Those are the benefits of vaccination. But vaccines also have burdens: side effects. Therefore, he advises parents to foist the burdens on others and claim the benefits for themselves ... and that's unethical.

The bottom line is rather straightforward. The only person who benefits from Dr. Bob's alternative vaccine schedule is Dr. Bob. Children receive less protection, preventable disease is not prevented, and physicians waste massive amounts of time on refuting nonsense when they could be providing care to other children.

"Dr. Bob" should be ashamed, but I doubt he is.

Free Stacey Anvarinia!

Where's the outrage?

North Dakota mother Stacey Anvarinia was charged with felony child neglect for an action, breastfeeding while intoxicated, which is not a crime and does not pose a risk to her baby.

She was charged without any evidence that she was drunk; police never bothered to perform a breathalyzer test or obtain a blood alcohol level.

Perhaps most remarkable, the police did not find, nor did they even allege, any actual harm to the child.

This young woman is living a nightmare of Kafka-esqe proportions. She called police for help after allegedly being beaten by her boyfriend. Not only was the assault ignored, but she was arrested for a crime invented by police, without evidence, on the basis of their "impressions." On Friday she was sentenced to 18 months in prison (12 months suspended) for her non-crime, possibly extending the separation she and her infant daughter have already endured.

Stacey Anvarinia was arrested and charged with felony child neglect for breastfeeding while intoxicated. There's just one problem. Breastfeeding while drunk is not a crime. In fact, it is not even dangerous. Any alcohol that the mother drinks is diluted in her blood volume. Only a tiny amount even reaches the breastmilk. Everyone from the American Academy of Pediatrics to La Leche League considers occasional alcohol use compatible with safe breastfeeding.

So why aren't feminists rushing to her defense? Some have commented on the injustice of her arrest, but most have been silent, and many appear to privately condemn her as a bad mother. But even bad mothers have legal rights and there is good cause to believe that Stacey Arivinia's rights have been trampled.

I fear that feminists, like the police officers themselves, have been affected by a perverse American social phenomenon. When it comes to mothering, we have been defining deviancy up.

This is the opposite of a phenomenon described by sociologist Sen. Daniel Patrick Moynihan. In the paper Defining Deviancy Down (American Scholar, Winter 1993) Moynihan asserts that as the level of crime and other forms of social deviancy rose, American society responded by defining deviancy down, accepting everyday crimes as “normal” and reserving concern only for spectacular crimes.

When it comes to the "crimes" of mothering, American society has been defining deviancy up. There was a time when the crime of child abuse meant physically abusing a child and the crime of child neglect meant failing to feed a child or seek appropriate medical attention. In the past quarter century, though, we have become obsessed defining mothering by certain ritualized performances.

A quote from feminist scholar Rebecca Kukla's paper Measuring Motherhood seems particularly apt in this context:

As a culture, we have a tendency to measure motherhood in terms of a set of signal moments that have become the focus of special social attention and anxiety … "Good" mothers are those who pass a series of tests — … they do not let a sip of alcohol cross their lips during pregnancy, they give birth vaginally without pain medication, they do not offer their child an artificial nipple during the first six months, they feed their children maximally nutritious meals with every bite, and so on...

And as Kukla observes:

Thus to the extent that we take "proper" maternal performance during these key moments as a measure of mothering as a whole, we will re-inscribe social privilege. We will read a deficient maternal character into the bodies and actions of underprivileged and socially marginalized women, whereas privileged women with socially normative home and work lives will tend to serve as our models of proper maternal character.

It is not a coincidence that Stacey Anvarinia is an underprivileged and socially marginalized woman. Her real crime was that she was not "performing motherhood" in the ways socially sanctioned by privileged, middle and upper class women. That's why she was arrested in the first place, and that’s why feminist protest has been muted.

It's time to end this farce. Is Stacey Anvarinia a good mother? That is a decision that should be made by Child Protective Services. The key point is that she committed no crime and it is inappropriate and unjust to evaluate her mothering within the criminal justice system. And it is especially abhorrent to punish her “bad” mothering with jail time and by tearing her apart from her infant.

Feminists should rally to her cause. While they may not personally approve of her choices, they should be loath to accept the criminalization of mothering behavior simply because it is socially disfavored. Breastfeeding while intoxicated is not a crime and there is no scientific evidence to support a claim that it is harmful.

Guess who funded a new study of women who use vibrators?

Rarely do you read a scientific paper whose keywords are listed as vibrator; female sexual function; masturbation; orgasm; sex toy, but this is such a paper.

Prevalence and Characteristics of Vibrator Use by Women in the United States: Results from a Nationally Representative Study was published in the May issue of the Journal of Sexual Medicine. According to the authors:

The objectives of this study were ... to determine the lifetime and recent prevalence of women's vibrator use during masturbation and partnered sex; ... to examine the relationship between vibrator use and female sexual function; and to assess the prevalence and severity of side effects of vibrator use.

The study found that vibrator use is quite common. Over 52% of women indicated that they had used a vibrator at least once. The authors were certainly thorough; they solicited a great deal of information on how vibrators are used and even thought to ask whether women put a condom on the vibrator and whether or when they cleaned it:

...[N]early half of women [users] had ever used a vibrator during masturbation alone, and one-fifth had done so during the previous month. More than a third of women had used a vibrator during intercourse, and 40.9% had used a vibrator during foreplay or sex play with a partner.

The vast majority of vibrator users had used a vibrator to stimulate their clitoris, and 64.0% had used one inside their vagina. A total of 41.0% of ever users had used a lubricant with a vibrator. Few had put a condom over a vibrator before using it. More than half had ever cleaned a vibrator both before and after use, one-fourth had cleaned it only after using it, 4.6% had cleaned a vibrator before use ... The remaining ever users (13.8%) had never cleaned a vibrator before or after use.

Vibrator use was associated with positive sexual functioning.

Vibrator use was significantly related to several aspects of sexual function (i.e., desire, arousal, lubrication, orgasm, pain, overall function) with recent vibrator users scoring higher on most sexual function domains, indicating more positive sexual function.

Few women experienced side effects. Over 71% reported no side effects, 16.5% reported occasional genital numbness, 3.0% reported pain, 9.9% reported irritation and irritation or swelling was reported by 8.0% of users. Only of 1.1% of users reported experiencing tears or cuts.

The authors conclude with the implications for doctors and other practitioners:

...[T]he data indicate that the women who have used vibrators—and particularly those who have done so most recently— experience more positive sexual function in terms of desire, arousal, lubrication, orgasm, and pain… It may be that using a vibrator facilitates orgasm and arousal (and, consequently, facilitates sufficient vaginal lubrication), and that having a more comfortable, pleasurable sexual experience thus helps a woman to feel more desirous of subsequent sexual activity. Alternatively, it may be that women who are more comfortable with their sexuality, or have more positive sexual function, are women who are also more comfortable with the use of vibrators...

All of this is interesting and important information. The most intriguing fact about the study, though, is buried in the fine print at the end. The study was funded by the makers of Trojan condoms. That explains the question about whether women put a condom on the vibrator before use.

Why might the makers of Trojans commission a vibrator study?

...[G]iven the possible risk of transmitting infections through sharing toys, clinicians and educators might discuss options for safe toy use with their patients or clients including toy cleaning, condom use, and not sharing toys.

In other words, the makers of Trojans are exploring a new market for their product. It's not enough to provide condoms for penises. Trojans wants to convince women that vibrators need condoms, too.