Publicizing a crappy paper about c-sections and epigenetics is irresponsible

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I was at a conference this past weekend where a famous astrophysicist explained that being a practicing scientist means constantly trying to figure out how your own claims are wrong. It is easy, all too easy, to look at some data, draw a conclusion and stop there. But science demands that we look at all conclusions, even our own conclusions, to determine if there is an alternative explanation for the data we have in hand. All too often, there is.

That’s why the Karolinska Institute’s decision to create a publicity campaign for a new paper on the possibility that C-sections might lead to epigenetic changes in newborn DNA is thoroughly irresponsible and violates the fundamental principles of science.

The paper is entitled Cesarean delivery and hematopoietic stem cell epigenetics in the newborn infant: implications for future health?. Let me tell you exactly what it shows:

NOTHING!

It is a tiny set of preliminary observations, without demonstrated reproducibility, with no evidence provided that it is clinically relevant in any way.

To give you an idea of just how preliminary it is, and just how irresponsible it is to promote it, imagine if I published the following study:

Cesarean delivery and newborn blood type: implications for future health?

This was an observational study of 64 healthy, singleton, newborn infants (33 boys) born at term. Cord blood was sampled after elective CS (n = 27) and vaginal delivery. Blood type was determined in the standard fashion.

Results
Blood type of infants delivered by CS was more likely to be O+ than blood type from infants delivered vaginally. In relation to mode of delivery, a antigen specific analysis of multiple antigens (Duffy, Kell, etc.) showed difference of of 10% or greater in a number of different antigens.

Conclusion
A possible interpretation is that mode of delivery affects blood type.

Ridiculous, right?

We know that mode of delivery has no impact on blood type, but it is completely possible that if we looked at the blood types of 64 infants (27 born by elective C-section), we might get these exactly results simply by chance.

Why might we get these results by chance?

  • We looked at too few babies
  • We never checked the background rate of these findings
  • We assumed that differences of 10% were statistically relevant
  • We failed to look at the difference over time by sampling blood type before birth and at multiple intervals after birth

All these deficiencies would apply to the study of methylation of newborn DNA, plus:

The authors have not demonstrated that DNA methylation is a proxy for epigenetic changes

The result is that their paper shows an observed difference between tiny groups with no evidence that the observed difference has any relevance to anything at all.

There is nothing wrong with publishing a paper that simply relates observed differences. That is often what basic science is about. But there is something very wrong with speculating on the meaning of those difference without any evidence to support the speculation. And there is something grossly irresponsible about publicizing an observed difference that may simply reflect chance.

I understand that it is very difficult to get funding for basic science research. And I understand that implying that your basic research has relevance to a current area of speculation might improve your chances of funding. But trumpeting as finding of essentially nothing to a public by implying that it means something is unethical. It only serves to scare people and to undermine trust in the sciences when better quality data inevitably reveals something entirely different.

Responsible scientists should not publish data until they have reproduced it and until they have carefully considered and rejected all possible reasons why their conclusions are wrong. That’s science; this paper, in contrast, is just self-serving publicity.

  • DiomedesV

    I know it’s late to make this comment, but I want to explain why the false discovery issue makes this paper difficult to interpret. The authors tested 450,000 sites for methylation differences between C-section and VD babies. They selected a p-value of 0.01, ie, a 1/100 chance that a deviation from the null expectation (of no difference) between groups is due to chance.

    They had 343 sites with p-value less than 0.01. But just by chance, with 450,000 tests, they should expect 0.01*450,000=4500 deviations from the null expectation. Their number of “statistically significant” sites is *less* than the number of false positives they should expect.

    In other words, they have no statistical reason to think that any of their sites represent real differences. There could be real positives in there. But there is no good way to tell them apart from the false positives.

    Multiple testing and FDR is a complex problem that inevitably comes with the ability to sample so much of the genome. But it has to be dealt with, not ignored. The authors seem to think that, merely by selected a p-value of 0.01, they have addressed it. Not true.

    The authors claim to have a priori knowledge that some of the sites are clinically meaningful, but do not cite that knowledge. Why?

    Coupled with the conclusion of their earlier paper, that these differences fade after ~ 1 week, there’s not much here.

    I have no trouble believing that C-section babies have different methylation profiles than VD babies. The authors of this paper have not really demonstrated that, though. And they’ve provided no evidence or reason to believe that whatever differences they have found are clinically significant.

    • DiomedesV

      Given that their number of “statistically significant” sites is so much less than their false discovery rate, the pattern they’re seeing is
      actually one of striking homogeneity. This homogeneity, if real, begs for study.

  • Rebecca

    In 2009 the same group published a similar study on the white blood cells from 16 newborns. Here they reported that “Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.”

    The main difference in this study is they are looking at the hematopoietic stem cells, from which white blood cells are made. And their sample size is slightly less tiny.

  • Jaz Black

    Actually, it could be argued that not publishing it is irresponsible as women are choosing it more often these days and need to know the risks.

    • Young CC Prof

      But this study ISN’T evidence of a risk. It’s evidence of a biochemical difference immediately after birth. There’s no evidence that it persists, in fact another study a few years ago found that such changes tend to fade within days. Even if it does persist, we have no idea what the actual effects are. They may be positive, negative, a little of both, or negligible.

      The publicity campaign, however, implied that it was likely that these changes would persist and cause harm. Many many women need c-sections, and there’s enough scary misinformation out there already.

  • ChadwicktheJones

    Seems like a fair amount of post hoc ergo propter hoc at play.

  • Anonymous

    Sorry but this is pretty shoddy scientific journalism. Epigenetic changes during C section is not a new thing and this is not the first paper published about it: http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2009.01371.x/abstract

    ^ this was published in 2009 5 years before the paper mentioned in this article. The difference being that the 2009 paper was talking about epigenetic changes in white blood cells and the 2014 paper is talking about epigenetic changes in stem cells.

    “The authors have not demonstrated that DNA methylation is a proxy for epigenetic changes”

    DNA methylation as a proxy for epigenetic change is very well published and is one of the main underlying principles of epigenetics – that methylation of DNA will lead to epigenetic changes.

    • Young CC Prof

      And that 2009 article showed that although there were differences after birth, by 3-5 days old, those differences had gotten much smaller and were no longer statistically significant.

      The reason that the Karolinska Institute was irresponsible was that the paper implied that these methylation changes were likely to lead to lifelong health problems, when in fact they may not last more than a few days.

  • Anonymous

    This is good. Next time I want to show any of the interns an example on how NOT to do a study I can whip out this paper.

  • http://www.europeanmama.eu/ Olga Mecking

    Oh I was waiting for a reply like that. The article this post talks about is making the round on Facebook and everyone is so excited about this “study” I had a feeling that it doesn’t mean anything but it’s good to see it confirmed.

  • Meerkat

    A friend of mine posted an article about this study on FB yesterday, saying that all moms should be aware of this. The post got a ton of comments, majority of which were in two categories. Pregnant women were saying that this is yet another reason to avoid evil C-section (which probably means they will fight their doctor tooth and nail if they need one as an emergency) and women who already had their C-sections were trying to justify their “shortcoming.” Nobody listened to a couple of people who said the same thing Dr. Amy did. So yeah, the article is making rounds on Facebook, freaking women out.
    I was actually curious about something that was in the abstract of this study. “Cesarean section (CS) has been associated with a greater risk for asthma, diabetes, and cancer later in life.” Is that really true? I have never heard of this before.

    • Young CC Prof

      There have been some studies that suggested things like that, but they were poorly controlled for confounders, especially maternal health status. Never heard of the supposed cancer link, either.

      • Elizabeth A

        Oh, I’m sure that if I hadn’t had a c-section, I never would have gotten cancer. I’d have died in childbirth before the malignancy was detectable.

    • Sue

      Not only is this poor research methodology, but it’s test-based, not patient-based. We don’t want to know whether tests change, but whether there is any impact on health.

  • DiomedesV

    Also: “A subset of CpGs, a priori clinically relevant, or CpGs exhibiting the
    largest DNA methylation differences in relation to the mode of delivery,
    was validated (Supplementary Table 1). The selected CpGs are associated with the genes COLEC11, PCK2, PGBD5, and HLA-F.”

    What made them choose those genes? Why didn’t they choose PGBD5? It seems to be random. There are other genes with similar or greater differences. Where’s the reference for “a priori clinically relevant”?

  • DiomedesV

    It’s a strange paper. A few comments:

    1) The authors perform a power calculation to determine whether they have sampled enough individuals in each group to detect a difference. They base their power calculation on data they collected for an earlier paper (http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2009.01371.x/full). Fine. In this earlier paper, they studied methylation profiles of leukocytes in VD and CS babies. But note in the abstract of that paper: “On postnatal days 3–5, DNA-methylation had decreased in the CS group
    (p = 0.01) and was no longer significantly different from that of VD
    (p = 0.10).” This is never mentioned in the paper under discussion.

    2) Nowhere do the authors meaningfully discuss the FDR (false discovery rate). From the Methods: “Differentially
    methylated positions (DMPs) were defined as those that exhibited a 10%
    or greater difference in the DNA methylation between the VD and CS, at a
    value of P < .01.This
    definition was chosen to disclose the most important set of DMPs while
    considering the following: (1) most differences in methylation are mild;
    (2) we investigated a large number of probes that required multiple
    testing; and (3) we had only a small number of samples." As far as I can tell, their one and only correction for multiple testing was to set the p-value to 0.01. That's lower than 0.05, sure. But they still need to discuss FDR. They should have mentioned that at 0.01, 1% of their sites are false positives. That's 3-4 of the sites, which isn't that much, but why not just rank the sites by p-value then give the corresponding q-value (FDR)?

    3). Most of the differences in methylation are subtle, as can be seen from the Supplementary Table.

    4). They state in the Discussion that stress in labor is important and good and then cite a paper published in Scientific American: http://www.nature.com/scientificamerican/journal/v254/n4/pdf/scientificamerican0486-100.pdf. Presumably there's more of a paper trail on stress in labor and its beneficial effects, right? That paper is from the 1980s, when CS rates were lower, and primarily focuses on catecholamines and their role in preparing infants for breathing on their own. We know that CS-delivered infants are more likely to experience TTN and other breathing problems, but evidence linking CS to long-term problems of that nature is pretty weak, as I understand it. Aside from breathing, where is the evidence that stress in labor is important?

    In actuality, all they've demonstrated are some pretty subtle methylation differences in cord blood stem cells at birth. Emerging evidence indicates that methylation is dynamic, as they well know, because that is exactly what they found in an earlier paper. It is erroneous to claim that a difference at birth will have any meaningful differences for anything, let alone long-term health outcomes.

    And I haven't even addressed the issues involved in sample selection.

  • Jessica S.

    Geez, people really have it out for c-sections, don’t they?

    • KarenJJ

      That’s what I thought. Who knows whether the different rates of methylation were due to oxygen saturation (for example) and that the c-section babies had higher oxygen levels in their cord blood and that this may indicate beneficial outcomes of c-sections?

      But no, that’s not one possibility because c-sections = bad and must be avoided for all sorts of imaginary reasons.

      • Sue

        How would there be a feasible mechanism? Not all CS births are equal, and VBs are widely variant – in timing, mechanics, duration of hypoxia etc etc. Wouldn’t all of these confounders make more difference than the mode of entry into room air?

  • anion

    Now all we need to do is figure out what mode of delivery results in babies with that one really rare blood type that’s always in demand, and we can specially breed potential donors!

    In fact, each mother could volunteer for a particular mode of delivery that results in a particular blood type, and we can fill all the blood banks. No more, “We’ve got plenty of O today, but no AB.” Just smooth sailing on calm, blood-filled seas. Progress!

    I wonder if there’s a way to use this fantastic new knowledge of how delivery creates specific DNA/blood type to breed tissue and organ donors, too? No more getting pregnant and leaving it to chance, we can pick what type of baby we want and boom, a forceps delivery while standing on our heads it is. In fact, is the reason my babies are both girls that they were sections, since it seems the very DNA of the body can be changed in an instant by the method of delivery? Man, if only I’d known. Why does science take so long?!?

  • Hannah

    I thought this court judgement that has just been released might interest people here:

    http://www.judiciary.gov.uk/wp-content/uploads/2014/07/mh-trust-and-acute-trust-v-council-and-other.pdf

    An application for caesarean in a non-consenting woman. The recent antecedent for this was the Alessandra Pacchieri case, which is presumably why the judge gave such a thorough ruling.

    • Medwife

      That woman’s life is a tragedy. Wow.

      • Lisa from NY

        So sad. I hope they get permission to tie her tubes and prevent her from future complications.

        • Dr Kitty

          I think that the court is more likely to agree to Nexplanon post partum.

          It would appear any decision about contraception is being delayed until after the birth of this baby, and another abdominal surgery under GA would be more restrictive and dangerous than a SDI. Nexplanon, although not permanent, has similar failure rates to TL.

    • Melissa

      The detail with the BBQ tongs was horrifying.

      • Smoochagator

        I must have stopped reading before getting to that point, and I’m glad I did. Dear God.

        • Young CC Prof

          Repeated unassisted VBA2C, one of which caused her to have a stroke. Horrible.

          • meg

            But hey, at least that HBAmultiC made her a proper Birth Goddess(tm)!

          • Dr Kitty

            Meg, considering the lady in question has a learning disability, ASD and a delusional disorder, I don’t think that is something she’s bothered about.

          • meg

            I was being sarcastic.

          • Hannah

            To clarify, the stroke wasn’t during one of the VBACs. It occurred at 29 weeks during the pregnancy with her fourth child, who was subsequently delivered my emergency caesarean. This was after her unattended VBA2C, during which her partner used the barbeque tongs as makeshift forceps and then didn’t report the birth for 5-10 days during which time they tried to feed the baby cup-a-soup, and before her unattended VBA3C.

      • Dr Kitty

        Summary
        Child 1: delivered by Emergency CS for foetal distress, removed from parental custody for abuse/ neglect
        Child 2: elective CS at term for breech, post partum psychosis, removed from parental custody.
        Child 3: UBAC, birth concealed from authorities for 5-10 days, child dehydrated and malnourished, abrasions on scalp from BBQ tongs that father allegedly applied to aid delivery (father also learning disabled). Post partum complications: bladder distension requiring catheterisation, post partum psychosis. Child removed from parental custody.
        Child 4: delivered at 29 weeks by CS after mother found unconscious and seizing by social workers during a visit. She had suffered a thrombo-embolic stroke, her partner had not called for help. PPH. Child removed from custody.
        Child 5: UBAC, authorities not informed for several hours, infant found in filthy home, multiple neglected animals removed from home.

    • Dr Kitty

      Thanks, I’ve just read all 38 pages of the judgement.

      Things that struck me:

      Everyone was in agreement that a hospital Spontaneous VBAC would be best, BUT the lack of co-operation likely to be encountered during labour and the high chance the patient would not come in voluntarily a the onset of labour, nor tell the authorities when labour began made it an impossible option. RCS was ONLY decided upon because it was deemed to be safer and less restrictive than keeping her in hospital against her wishes until labour began spontaneously, or taking her to hospital against her wishes and inducing her labour ( with all the risks of a sedated induced labour).

      Social services had done EVERYTHING possible to get her help and assistance, including calling to her home on a daily basis to try and gain admittance.

      This court hearing was very much a last resort.

  • Zornorph

    You just blinded me, Dr. Amy. With science!

    • The Bofa, Being of the Sofa

      She’s tidied up, and I can’t find anything!!!!!

      • anion

        OH MY GOD IS THAT WHAT HE SAYS??

        I never could figure that out! OMG!

        You, sir, are poetry in motion.

        • The Bofa, Being of the Sofa

          All my tubes and wires
          And careful notes!
          And antiquated notions…

  • Carrie Looney

    I work with methylation/epigenetics a bit (not to mention gut flora), so this is all quite fun…

    Unfortunately, my institution doesn’t have a subscription to this paper. :( I’d love to go over it. It looks like a serious fishing expedition.

    “the degree of DNA methylation in 3 loci correlated to the duration of labor” I wonder if these changes are simply related to stress? Hypoxia has been shown to affect methylation in numerous systems.

  • carr528

    OMG, all four of my c-section babies are O+!!!! If only I’d been willing to trust birth more, I wouldn’t have had to suffer those darn RhoGam shots. I’m sure it had nothing to do with the fact that I’m O- and my husband is O+.

    Come to think of it, I’m a c-section baby. How come I didn’t get the magic O+ blood??

    • Amy M

      I know, right?! My children, sister and I were all vaginal births, yet we all have asthma…HOW DID THAT HAPPEN!!! (hint: probably something to do with genetics, as our mom is also asthmatic.)

    • Trixie

      This reminds me of an internet crazy person article I read once about how you can change your blood type with special teas and therefore avoid evil interventions like Rhogam.
      My c-section baby is A+.

      • anion

        I’m pretty sure both of my c-section babies are A+, though I don’t actually know offhand about my younger. I’m A+, though, and I seem to think my husband is as well, so…

      • Mac Sherbert

        I believe the paper work said my C-section baby had B-. Not sure how that happened…Now I want to go find what her brother’s is. ;)

  • perpetual lurker

    Uh oh. Third sentence of the article: “In up to 15% of deliveries, CS may be indicated according to recommendations from the World Health Organization. However, most countries exceed this recommendation, suggesting that many women are undergoing CS without a medical indication” Isn’t this one of your red flags, Dr. Amy?

    • Jessica S.

      Surprise, surprise!

  • sue

    Before even looking at the power and limitations of a study, one needs to know that the research question is even plausible.

    How could the method of exit from the uterus, occurring over a matter of hours, possibly affect DNA? And blood group? Isn’t that simple Mendelian inheritance?

    Should be easy for the science journalists to debunk, if they are not blinded by ideology.

    • attitude devant

      I disagree with your last sentence, sue. Most journalists have very little training in science and just regurgitate what they are told. Very frustrating.

      • Jessica S.

        This is very true.

    • Sue

      Oops – I missed the irony about the blood types – silly me.

      Another thought though: are there any studies comparing the long-term outcomes of cesarea-delivered babies with those who had indications for Caesar but didn’t get one, or were late?

  • attitude devant

    I was so disgusted to see this splashed everywhere. Methylation as evidence of….what exactly? And the author saying labor is good because it stresses babies? Well, dear, the baby I delivered by c/s this morning was plenty stressed (I make that claim based on the repetitive bradycardias and the thick meconium), that WHY I did it!

    • Montserrat Blanco

      EXACTLY!!!!!! Most of C-sections are performed due to babies in stressful conditions. Couldn’t it be that stress pre-delivery is what is causing the changes in methylation??????

      • araikwao

        I think these were pre-labour c-sections.

      • Dr Jay

        Most c-sections are performed for previous section (elective) and failure to progress. :) Only about 10% are performed for fetal distress (thankfully).

  • Giliell

    Wait, I always thought that blood types were simple genetics, decided when egg and sperm fuse… How could a c-section possibly affect this?

    • Young CC Prof

      The blood type bit is Dr. Amy’s parody. The actual article is less silly, but not a whole lot more meaningful.

      • Giliell

        Thanks. That’s what you get from reading while tired. Silly me

        • anion

          Duh, it appears I made the same mistake. *feels silly*

  • doctorex

    Yeah, even as a qualitative researcher, that n isn’t large enough and the analysis methods are semi-infuriating. And we don’t generally even make any claims about causation because we bloody well know we can’t prove them. Oh, the things I would give to mandate that kids demonstrate basic scientific and statistical literacy before graduating from high school.

    • Jessica S.

      Amen to that!

  • itry2brational

    I’d say promoting obesity is a heck of a lot less responsible and scientific.

    • Alcharisi

      *blink* What does that have to do with the price of tea in China?

      • Young CC Prof

        itry2brational shows up to rail about the evils of obesity every time there’s a post comparing NCB idealized childbirth to idealized body shapes in the media.

        • attitude devant

          Yawn

        • Alcharisi

          Ah, thanks for the context.

        • itry2brational

          Indeed, the first tactic when you have no argument, attack your opponent and not their argument.

          Young, there has been only 1 obesity post that I’ve commented on…I guess that’s “every” one to you.

          I make no such comparison either. 2nd tactic when you have no argument, lie about your opponent’s position/actions.

          I compared the increased risks associated with NCB and its advocacy with the increased risks of obesity and its advocacy. Get it straight.

          • Young CC Prof

            Perhaps I was thinking of someone else who posted lots of comments on various posts discussing weight issues. If so, I apologize.

          • itry2brational

            TY.

          • anion

            No, you didn’t actually compare anything, you just dropped in, made a bizarrely off-topic statement, and acted like we should all magically know what it meant.

            Obesity isn’t the focus of this blog. If you want to talk about obesity, go find people who actually give a damn about it, instead of coming here where we’re all gathered to discuss something else.

            It’s like you walked into a party for fans of hockey and started insisting we all care about cricket instead.

            Tl;dr” We don’t care. Go away, boring person.

          • itry2brational

            You do not know what you’re talking about.

          • anion

            I don’t know what I’m talking about, really? I’m telling you what the focus of this blog is, a blog where I’ve been reading and participating for months and whose focus is clearly visible from even a cursory glance, and I “don’t know what [I'm] talking about?” I’m telling you we’re not discussing obesity but something else in this comment thread, a fact which is easily proven by simply, I don’t know, looking at the comments here, but I “don’t know what [I'm] talking about.”

            “Reality” doesn’t mean “whatever ‘itry2berational’ wants it to be.” We do not owe you our attention or interest just because you want us to give them to you. We get it, you hate fatties. Yay for you. That still doesn’t mean we have to agree or listen to you or that you’re right to post about it anywhere you please and then pretend it’s relevant.

          • Trixie

            This is a person who
            1) assumed I had a son
            2) assumed I circumsized said son
            3) started yelling at me for ruining imaginary circumsized son’s life

          • anion

            Won’t someone think of the imaginary children’s imaginary penises?

          • itry2brational

            This is a person who is a three time liar. :/

          • itry2brational

            You’ve been following for months? Wow! Want a sticker? I’ve been following for years. Your problem is that you’ve lost the ability to be critical and objective about what you read here.
            My point isn’t even about obesity, it’s about Dr. Tuteur promoting it. Her and her blog are always relevant in every blog post she makes.
            Its this misguided reactionary hatred that you have which is blinding you. I don’t hate “fatties”. I oppose people who misguide women into making risky health decisions which affect more lives than their own. If I’m objective and fair, that places me in opposition to both NCB -and- people who promote obesity. It just so happens that one has greater potential for harm.

            The location of your birth can change in an instant but the risks and complications increased by obesity cannot. Better and safer outcomes for women and babies is supposed to be this blog’s goal and that is always “on-topic”.

          • Amy Tuteur, MD

            You seem to be confused. You have apparently equated my refusal to demonize obesity with “promotion” of obesity. It is precisely this moralization of body weight that I abhor.

          • itry2brational

            ACOG’s Committee Opinion on Obesity in Pregnancy is no moralization. Your advice to “reject”, “say no”, “be subversive”, and declaring that “women are not meant to be” xyz IS moralization. By definition.

            You’re trying to tell me you wrote an entire article of ‘refusing to demonize obesity’? Hardly. That’s like an NCBer saying: “You seem to be confused. You have apparently equated my refusal to demonize NCB with “promotion” of NCB.”
            Promoting acceptance of a thing is promotion of that thing. You’re an activist, your article is activism, activism is promotion.

            This rhetoric of “demonize obesity” is a shaming tactic used to dismiss discussion of obesity which does not fit the “fat acceptance” narrative. Disagreement or dissent from the narrative is branded negatively, its hate etc. ACOG’s position on obesity and pregnancy does not fit with this/your narrative. ACOG’s position is very well supported by studies with large population sizes…and common sense. You have a fallacious appeal to an ancient figurine which proves nothing and counter-cultural moralizations.

            That’s why I find it rich, and far more irresponsible, for you to defy ACOG on obesity while at the same time claiming ACOG is irresponsible for publishing a preliminary paper which happens to have 39 supporting reference papers.
            Exposing the lies and risks of NCB is a noble thing but it is very much overshadowed by your more recent advice and activism.

          • Amy Tuteur, MD

            QED.

          • itry2brational

            You should be ashamed of yourself.

          • Amy Tuteur, MD

            Because you say so? Who appointed you arbiter of attitudes toward obesity? Oh, wait. You appointed yourself.

        • attitude devant

          Actually, you ought to click on itry’s Discus profile and read the rather bizarre stuff he has posted here and everywhere else. It’s…um….interesting.

          • Mishimoo

            RoK? Say no more.

          • attitude devant

            Exactly. MRA runs deep with this one.

          • Smoochagator

            Just discovered RoK by checking out itry’s disqus profile. I just… can’t even… AHHHHHHHHHHH

          • itry2brational

            Do you think ACOG will change their stance on obesity based on my Disqus profile or a comment I made on RoK? lol

        • Trixie

          Oh wait, is this the same person who brings up circumcision all the time for no reason?

          • attitude devant

            That would be the one.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      You aren’t trying hard enough.

    • AgentOrange5

      That article is NOT promoting obesity. The article clearly says that reaching a healthy weight should be encouraged before a woman gets pregnant. Reality is, obese women get pregnant and the majority are able to have healthy pregnancies with proper medical support.

    • doctorex

      I actually do scientific research about obesity for a living. You are so off-base in your comments here and in other threads that I am going to do you the courtesy of assuming that you are not. If you are, you’re easily thirty years out of date on your science. Your premise that “promoting obesity” is something Dr. Amy ever did is wrong. Your premise that BMI is based on science is also wrong. It might be useful for some things, but it’s not originally based in science. Your premise that you can tell the BMI of a statue by looking at it is, actually, worse than wrong: it’s idiotic. Statues don’t have BMIs, and even if you were talking about a human, you can’t tell BMI by sight.

      Most alarming, though, your premise that encouraging overweight or obese women to be ashamed about their bodies is “scientific” and “responsible” is *completely* wrong, extremely irresponsible, and scientifically bogus. We have evidence about this. Shaming people about their weight creates precisely the inverse relationship to improving health or nutrition outcomes to the one you are imagining here. Yes, absolutely, providers need to encourage healthy nutrition and exercise and be honest about risk assessments, but body shame doesn’t enable that one single bit. Instead, it just makes heavy people, especially women, less likely to seek out needed medical care, meaning serious diseases are caught later and are harder, more expensive, or impossible to treat. The evidence shows this overwhelmingly.

      If you want to be a bigot about overweight and obesity or leave underlying revulsions about it based on upbringing unexamined, then you can certainly do that. It’s within your rights. But, please, for the love of science, stop pretending that’s an evidence-based approach to providing good healthcare, because it really, really isn’t and pretending it is hurts people. Racists also thought they had a lot of evidence justifying their beliefs before it was rightly assessed as bunk. In the meantime, I’ll keep my fingers crossed that you are not actually getting anywhere near patient care with those beliefs.

  • Trixie

    Famous astrophysicist? NdGT? If so, super jealous.

    • Amy

      That’s what I was wondering. Omg I love NdGT.

    • Amy Tuteur, MD

      No, not him, but a rock star in the world of astrophysics nontheless.

      • Trixie

        Okay, super jealous, regardless. My kids have the first names of famous astrophysicists.

  • guest

    Remember this video, where a colleague surprises Stanford physics professor Andre Linde with the new proof of his theory of the Big Bang. The video was striking because it demonstrated what a true scientist Linde is, because he is always filled with doubt about his own research. When his colleague comes with proof, Linde says, “Let us hope that this is not a trick. I always leave with this feeling, what if I am tricked? What if I believe in this just because it is beautiful?” You have got to love the people who really pursue science.

    • guest

      Ack. Google Stanford Andre Linde video. It’s on youtube.

      • Trixie

        I loved that video, and also his wife was so sweet.

  • Young CC Prof

    Yeah, publicizing that paper was a bad bad move. Nothing wrong with writing it, but sending it into the news cycle was absurd. Most of the reporters and a vast majority of the readers don’t have any idea what it means or doesn’t mean. And yes, there did seem to be some women who became more anxious about prior or future c-sections.

    First, I’d want to see the basic biochemical findings confirmed.

    Then, I’d want evidence that these differences persist for, say, a week after birth. A year would be better, but a week isn’t too much to ask, I think.

    Then, I’d want some connection to a meaningful health outcome. I would be very surprised if such a connection was found, since folks have repeatedly used epidemiological data to try and find differences, and nothing has really panned out.

  • Amy M

    But what if they had thousands of samples in the study and controlled for the other factors you mentioned above: what difference does it make if the Csection babies’ DNA is differently methylated? Isn’t that a massive leap to say or even imply that this difference is the CAUSE of health problems down the line? That’s ridiculous. That would be akin to saying that nothing else we do to maintain our health (diet, exercise, medical care, etc) matters, its all down to method of womb-exit, and we can start by 1)denying all Csections (’cause even if the baby dies, that’s less expensive than caring for one with those pesky health problems it is certain to have) and 2)cutting back on healthcare programs because in the future, all the vaginally born people (no more Csections, see #1) will be disease free. This should annoy even the most ardent lactivists, because it discounts breastfeeding too—no need to tout breastfeeding so hard, since vaginal birth is the cure-all now. You know, with all the epigenetics n’ shit.

    • Amy M

      Plus, that’s a wicked ex-vivo study there. It’s a hell of lot of extrapolation to say that how cells behaved in the incubator after they were removed from the umbilical cord: “The functional relevance of differentially methylated loci involved
      processes such as immunoglobulin biosynthetic process, regulation of
      glycolysis and ketone metabolism, and regulation of the response to
      food.” is a direct link to T2D. But, someone feel free to correct me if I am misinterpreting what they are trying to say here.

    • Smoochagator

      What I find disturbing about the line of thinking you propose (which I know you don’t actually advocate, but surely someone will…) is how backwards it is. So, medical science has advanced in such a way that we can correct or prevent issues in childbirth by choosing C sections. Yay! moms and babies live! But perhaps that medical intervention causes issues down the road (or not… but, let’s just allow for the possibility that a C section radically alters the course of the child’s life forever). Thankfully, medical science has also advanced in other areas so that those OTHER issues can be studied and addressed. The answer is not to go backwards and stop using the technology available to us just because it might cause some problems, especially if you’re weighing a child’s chance at living AT ALL against whether he/she might develop some other health problem at all.
      I see this reasoning in a friend’s anti-vaccine views. She says that since vaccines were introduced, we have more people being diagnosed with autism, ADHD, depression, more cancer and heart disease and blah blah blah. Even if you accept that those conditions are all modern epidemics that our grandparents didn’t have to deal with (which I do not), it’s absolutely preposterous to say that it’s better to go back in time to an era when children died of vaccine-preventalbe diseases because they didn’t live long enough to endure the pain and suffering of colon cancer at age fifty.

      • Young CC Prof

        Good point. Even when interventions really do cause problems down the road, we deal with it. Cancer survivors often live with ongoing problems as a direct result of treatment. Do we say, “Oh, no, we should have just let nature take its course!” NO! Doctors figure out how to manage the problem.

        • Carrie Looney

          And it’s not like we don’t keep working on these interventions to make them _better_ in the future, as well as support those who had to make do with suboptiomal interventions.
          As an example, I was at DDW a couple of months ago, and one of the speakers was talking about (speaking at a very very high level) a molecule present in breast milk that is of benefit for one of the complications of prematurity. The research that he did found that the molecule is actually only present in some women’s breast milk. He came across as a gung-ho Breast Is Best type, but the conclusion from the data he was presenting was unavoidable – breast milk is only useful in that setting if you’re one of the lucky ones to have that milk composition, and supplementing formula with that molecule would potentially benefit more preemies.

          • Young CC Prof

            Interesting! Do you have a link or any key words I would use to find information about this molecule?

          • The Bofa, Being of the Sofa

            Albuterol?

            (actually, I need to ask – I have been seeing commercials lately for a “soothing” formula (“If you aren’t exclusively breastfeeding….”) and I could have sworn they claimed the special ingredient was albuterol. Did I hear that right?)

          • Young CC Prof

            I seriously hope they aren’t putting albuterol in baby formula! That’s an asthma medicine with stimulant side effects.

            They put prebiotics and probiotics and a special type of fat called ARA, but no stimulants.

          • The Bofa, Being of the Sofa

            Albuterol for asthma inhaled. If it is albuterol ( and I could be completely wrong, I am just remembering what I heard in passing in a commercial) it would be ingested, and so I wouldn’t necessarily assume the effects are the same.

          • Young CC Prof

            Oh, yes they are the same! Albuterol also comes in tablet form, and it works the same way, although the ratio of good effects to side effects is actually worse. Putting it in baby formula would be breaking several laws.

          • Carrie Looney

            It was a specific oligosaccharide that was associated with a lowered risk of developing necrotising enterocolitis. This paper was cited, and some human data was also presented (not yet published, as far as I can tell – it’s not my area, so I’m not up on it).
            http://www.ncbi.nlm.nih.gov/pubmed/22138535
            Here’s a free review by the same fellow.
            http://www.ncbi.nlm.nih.gov/pubmed/22585916

      • Amy M

        Absolutely. I do not, for a minute, believe my children have asthma because they were formula fed. I believe they have asthma because it runs strongly on both sides of the family (including both their parents), plus they were a little premature. However, even if formula feeding increased their chances of being asthmatic? I can live with that—I’ve lived with asthma for more than 30yrs, and I know how to deal with it (what can be done at home, when to see a doctor, etc). (Luckily, the boys ended up with a very mild version.)

        Is breastfeeding great? Sure. Would it prevent asthma? No. And would avoiding formula have worked for us? Nope—for a number of reasons, BFing was not an option, at least not EBF. If we’d relied on that, we’d have starved children.

        You do a Csection to save the child in front in you, just like you formula feed if BFing isn’t working for whatever reason. If there are downstream consequences, worry about that later, instead of sacrificing this current child on the altar of “potential, ill-defined problems” that even if they exist, can probably be addressed.