What my brain tumor can teach us about the shocking lack of ethics at the heart of midwifery care

image

In the summer of 2000 I was diagnosed with a brain tumor.

I had developed double vision because a meningioma, a benign tumor, was pressing on cranial nerve VI, the one that controlled the movement of my left eye. The tumor was small, but it was located in an awkward place near the center of my brain. That meant that surgery to remove the tumor would likely damage the nerves that controlled sensation in my face and my hearing on the left side.

Surgery was, until shortly before that point, the only option for treatment. However, as a physician I had access to those who knew about the latest treatment options. A dear friend, a neuro-radiologist, told me about stereo-tactic (“gamma knife”) radiosurgery, which is not surgery at all, but a one day course of radiation to kill the tumor.

I consulted a neurosurgeon, widely reputed to be one of the best in the US, to find out what he recommended. He recommended surgery.

I asked him:

Which treatment had the highest cure rate?

He told me that surgery had a cure rate of 85% and the gamma knife had a cure rate of 95%.

Which treatment had the highest complication rate?

He told me that surgery would likely lead to loss of sensation on the left side of my face and deafness in my left ear. The gamma knife had no complications beyond local irritation.

If the gamma knife treatment failed, would that make subsequent surgery more risky?

He told me that it would have no effect.

So I asked him why he was recommending surgery if the gamma knife had a higher cure rate and a lower complication rate. He replied honestly:

“I don’t do the gamma knife.”

In other words, he was recommending what was best for him, not what was best for me. It could have been worse; had he believed that he couldn’t successfully perform the surgery or offer the gamma knife, he could have told me not to worry, my brain tumor didn’t need any treatment at all.

And that could be the unethical motto at the heart of contemporary midwifery theory: If she can’t do it, you don’t need it.

Consider the midwifery stories that have appeared in the news within the past few weeks.

1. An update from the inquest into the death of Australian homebirth advocate Caroline Lovell.

A Melbourne mother who died after the home birth of her daughter pleaded with her husband to call an ambulance because she felt she was going to die, the Victorian Coroners Court has heard…

Paramedic Marie Daley noted that Nick Lovell had told her at the scene that his wife had grabbed him by his shirt, looked him in the eye and pleaded with him for help,

“‘Nick I’m telling you, you need to call an ambulance, I’m going to die’…

But midwife Gaye Demanuele did not call an ambulance.

The inquest had previously heard that the now unregistered midwife Gaye Demanuele believed Ms Lovell was panicking and did not identify any physical symptoms, which she expressed to Mr Lovell when his wife started hyperventilating…

… [T]he obstetrician at the Austin on the night, Dr Claire Petterson, estimat[ed] Ms Lovell lost three litres of blood. The midwives estimated Ms Lovell had lost 400 millilitres in the birthing pool.

The midwife did know how to manage postpartum hemorrhage, so she insisted that the patient was not having a postpartum hemorrhage.

2. The failure of British midwives to consult a pediatrician for Joshua Titcombe as detailed in the Morecambe Bay Report. Joshua was seriously ill with an infection, but midwives insisted that he was fine. They couldn’t care for a neonatal infection so they insisted that there was no infection.

3. The New Zealand midwife who missed the homebirth (how often have we heard that story?) and then when the patient complained about severe perineal pain, the midwife insisted that the tear would heal itself if the patient was “ladylike” just kept her legs together The midwife didn’t know how to suture a tear so she insisted that the tear did not need to be sutured.

4. Oregon homebirth midwife Joanna Jech who ignored a mother’s pre-eclampsia, and when the patient went into labor and the fetal heart rate became undetectable, waited 19 minutes before calling 911. The baby was stillborn at the hospital. The midwife would have been required to transfer care of the patient to a physician if she diagnosed pre-eclampsia so she simply insisted that the patient didn’t have pre-eclampsia. She couldn’t treat fetal distress in labor so ignored it for 19 minutes before calling for emergency assistance.

These incidents, though they involved different midwives at different times and in different countries share a glaring ethical lapse: if the midwife couldn’t provide the appropriate care, she insisted that the patient didn’t need it.

As the story of my brain tumor indicates, this ethical lapse is not restricted to midwives, but in the case of midwives has seemingly become part of the professional ethos. The midwifery commitment to “normal birth” is a commitment to what benefits THEM, not what is safest for their patients. Their efforts to demonize obstetrical interventions benefits THEM, not mothers or babies. Their portrayal of the C-section rate as a medical crisis benefits THEM, not mothers or babies.

No doubt many of the midwives believe that “normal birth” is better, safer and healthier despite the fact that there is no scientific evidence to support that claim. It’s a classic example of “where you stand depends on where you sit.” Midwives need to confront their unethical behavior by acknowledging that their commitment to “normal birth” is a commitment to personal benefit, a factor that has no place in the ethical provision of health care.

  • nursechicrn

    I live in Portland and just read the board report on Joanna Jech. My jaw dropped while reading the findings. “Malpractice” is not a strong enough word. Her actions should be criminal and Andaluz should be shut down.

  • clementine

    No doubt many of the midwives believe that “normal birth” is better, safer and healthier despite the fact that there is no scientific evidence to support that claim. >>>if this isn’t the most revealing premise of your stupidity, I don’t know what is.

    • kt

      Then back it up with evidence, and not just by being rude and calling people stupid.

  • Daleth

    There aren’t enough stories like this in the media:

    “I had a drug-free childbirth—and it scarred me”

    http://www.todaysparent.com/blogs/odd-mama-out/i-had-a-drug-free-childbirth-and-it-scarred-me/

    • araikwao

      Predictably a lot of mother-blaming in the comments – women having been doing this for millennia, get over it; clearly you had a lot of issues and you would have been traumatised even if you had the drugs; I was traumatised by my hospital birth so I had a blissful home birth, you should too! But nice that some other women were able to share that they also had a rough time, whilst also horrible that they had to feel that way in the first place…

    • Amazed

      Wish Morose57 sees it. I think it’ll help her realize that blaming women for feeling bad about their experience goes both ways in about 3 seconds.

  • guest

    Did I miss something? Why is this Oregon Midwifery Board disciplinary order taking place six years later?

  • Adelaide

    OT: Your web address without the www (http://skepticalob.com/) has not been updated since Feb. 13th. I’m assuming this is a mistake and not on purpose.

  • Runnerchick

    I had a midwife that denied that gestational diabetes was real. She did not test me. My son was born weighing 10lbs 7oz. Within 12 hours of birth he became hypoglycemic and developed TTN. We spent 4 days in the NICU thanks to her, and I could have lost my son. That was my eye opening moment when I realized how dangerous home birth and home birth midwives were. She couldn’t treat it so it was easier to insist that the condition did not exist.

    • lilin

      It’s sad that the person you trusted let you down, but congratulate yourself at least that you changed your mind based on new information. As we’ve seen here, there are plenty of people who only cling more stubbornly when things go wrong.

      • Runnerchick

        Thank you. And I would add that if any of you are healthcare professionals that happen to deal with homebirthers on occasion, please treat them with dignity and respect. It was so much easier to see the light when we were treated warmly by the doctors and NICU staff at the hospital….it was not the dismissive browbeating I was told we would endure if we ever ventured to the hospital.

    • That’s completely fucking insane and I’m outraged for you.

  • MaineJen

    …I just don’t understand how these people are still permitted (in many cases) to practice. I can’t think of a single other profession that would let this kind of negligence slide. Not even making it to a birth? COme on, now.

    • Sue

      So much for “being with you right throughout labor” .

      • MaineJen

        So often, in these stories, they seem to dismiss the woman’s feelings altogether. “Think you’re in labor? Pleeeease, if those were real contractions you wouldn’t be able to talk through them. Call me in 12 hours…” Aren’t these the same people who are supposed to be listening to their clients so much better than OBs listen to their patients? Different women can have *such* different perceptions of the experience of labor…I don’t see how assessing a situation over the phone is at all adequate. At least go to the woman’s house and check out the situation in person.

        • JJ

          My last labor I thought I was just having early-labor cramping but knew I was having the baby that day so I called my midwife. She told me to check my cervix because she thought I just seemed irritated and thought I was hours from having the baby. I told her I did not know what I was feeling. (Looking back I think I was at 9cm). She told me to drink some water and take a shower. I started having 3 min apart contractions right away. In 30-40 minutes I felt the need to push some. My midwife arrived just before my child was born. This was my 3rd child and I still did not know how far along I was. I needed to be checked! I will be with an OB this time and she told me to come to the hospital right away.

          • Cobalt

            I started going in for every little twinge, because my labor pains aren’t strong enough to be reliable indicators of progress. If I ever get pregnant again I’ll be afraid to sneeze after 30 weeks.

          • MaineJen

            With my first baby I was all ready to have a few instances of “false labor,” I was all ready to time contractions, etc. Instead, my water broke all over my bedroom floor…and contractions were a no-show. I ended up being induced the next morning, for a 12 hour labor. Who knows how long I would have sat there waiting for natural labor.

            With my second, if I had waited until 5-1-1 it would have been a dicey situation. I had 3 hours of mild contractions at home, arrived at the hospital dilated to 3 and 3-5 minutes apart…and 3 hours later I had my baby. Think the midwife would have made it? LOL

          • toni

            I popped to the bathroom and threaded my eyebrows half an hour before my son was born! I was pretty unhappy in the middle of ctx but not so much that it stopped me thinking about my caterpillars haha. There was no indication that I was about to deliver, no freaking out transition period. It’s a blessing in some ways of course but I think I’m just the kind of person that would not get to the hospital in time

        • Sue

          There are lots of stories of women being sent away from labor room triage, only to deliver on the way home or the way back. It isn’t an exact science. But at least the hospital looks at the person.

          Still hospitals and OBs seem to get all the derision, HBMWs retain their “caring” aura. Maybe more “HBMW didn’t make it to the delivery” stories need to get out.

          • Cobalt

            I know someone who was told by the nurse to come back when her contractions were 5-1-1. She went home, took a nap, and woke up in a puddle of blood. The placenta had detached and the baby was dead. She never saw her OB the first time she went in, just the nurse who told her it wasn’t “real” labor.

          • Mishimoo

            I have no words to describe how awful that is. I am so sorry for your friend/acquaintance.

          • Cobalt

            It got me pretty wound up, there was no reason for that baby to be lost. Monitoring at the hospital would probably have made all the difference, instead of the cascade of non-intervention.

          • Mishimoo

            Exactly! If they had just checked her or had her see her Ob/Gyn, the outcome could have been so much better. It is infuriating!!

            (I was a partial-abruption baby, the Ob/Gyn’s experience, instinct, and diplomacy are the only reasons that I’m alive.)

          • So sorry to hear this, that tis awful.

          • Amazed

            Terrible.

          • ERnurse

            I’m so sorry for your friend’s loss. That is horrible. I am 38 weeks pregnant and the hospital where I am delivering has a strict 5-1-1 rule. They made sure to tell us about it 87 times on our tour. Something like this happening is my biggest fear.

          • KarenJJ

            Wow that’s a bit scary. I had such a dysfunctional labour I don’t know that I’d ever have gotten to 5-1-1.

          • The Computer Ate My Nym

            I had dysfunctional labor too and ended up with continuous pain rather than any clear contraction pattern at all. I like to think that they’d assess that and find it a reason for admission, but the way things are going in medicine, I’m not sure.

          • Cobalt

            Administrators are making too many blanket policies, doctors are losing too much flexibility to treat individuals, and in this case a nurse looked at the “textbook” instead of the patient and decided a doctor wasn’t necessary.

          • Amy M

            Yeah, me too–pre term too. ERnurse, what about if your water breaks?

          • ERnurse

            If your water breaks, youre allowed to come in! But most women can labor for a long time before that happens. What concerns me is, if I am laboring at home for several hours, how do I know my baby is tolerating the contractions ok?

          • Cobalt

            They might give you a “kick count” to be aware of, but that’s not the same as monitoring. I’d probably go to my doctor’s office first and have them send me in if it was daytime. At night, if I couldn’t get a hold of my OB I would just go in and say whatever I needed to to get them to keep me until I saw a doctor. Tell the doctor how much this worries you, they should be able to give you specific reassurance.

          • Cobalt

            I’ve had two deliveries where 5-1-1 never came close to happening, but my doctor had sent me to the hospital after an exam in the office in which I was 5 or more cm dilated. The last baby, even after my OB had sent me in, the nurse told my sister I wasn’t really in labor and would be home in a few hours. My son was born right after her shift ended.

            Call or see your doctor first if you can, they can override the stupid protocol and make sure you get the proper exams and monitoring. And go anyway if you’re concerned, and insist on a full triage workup. Or schedule an induction and hope baby respects your plan!

          • just me

            My plan with my first, which never came into fruition due to being induced early bc of IUGR, was that if I went to the hospital thinking it was time and I was told to go home until X, I was going to plant my butt in the birth center waiting area (they have nice couches at our hospital) until X happened. I was that afraid of missing the signs or something bad happening. Even tho we are a 5 min drive away. With #2 I was induced also so never had to deal with the “is this it?” stress.

          • WordSpinner

            That was on the front page of the local newspaper yesterday.

        • The Computer Ate My Nym

          Er…doesn’t that contradict the “labor isn’t really painful” narrative?

        • Michele

          When I called my OB’s office because I thought I was in labor with #2 the on-call Dr told me to come in to the hospital and get checked out even though I thought my contractions were 10-15 minutes apart. When we got to the hospital I still thought my contractions were 10-12 minutes apart. After some monitoring, turned out they were really 4 minutes apart. An assessment over the phone wouldn’t have caught the fact that I am apparently bad at determining contractions when they vary in intensity…or the part where my blood pressure hit 180/110 after being normal all through pregnancy

    • The answer is very simple:no internal or external regulation.

      A doctor is regulated by being forced to meet state regulations fo licensure; he is also required to adhere to certain standards by the institution in which he practices, and can be censured by professional organizations such as the AMA, which worries about maintaining the reputation of the profession.

      Midwifery is largely exempt from all this, because of the perception that, since pregnant women aren’t ill, what harm can a midwife do?

      • Michelle

        What we have is two different situations, in the US most midwives have inadequate or no training and and if licenced this is lax and insufficient to regulate the profession. These are the ones that if they don’t know, they ignore, and often can just continue on causing mayhem. The other situation is that there is training and adequate regulation and ability to discipline there, but then they are failing to meet standards of practice. In this case, they know but ignore and this is worse IMO because that knowledge should enable them to practice with patients being safe in their care. These midwives can undergo disciplinary processes and be struck off or be subject to other orders, just like other health professionals doctors and nurses and sometimes they are, but the process is often lengthy and it can be a challenge to find the final result of investigations and disciplinary action.

        So the characterisation in the article (and I have to note it doesn’t appear that the homebirth was planned, rather the midwife failed to attend and take to the maternity unit in time, a failure of itself) that the “The midwife didn’t know how to suture a tear so she insisted that the tear did not need to be sutured.” isn’t quite correct. The midwife knew how to suture, and even said she had the equipment, but failed assess properly, do the suturing or refer on if it was outside what she could do. And that is another major failing, in among a long list of substandard care. http://www.hdc.org.nz/decisions–case-notes/commissioner%27s-decisions/2013/12hdc00301 is the case. It’s important, I think, to characterise these correctly as otherwise the criticism doesn’t hit the mark and it’s important that it does and that there are changes, and in particular changes in approach as a focus on normal at all costs, does cost dearly.

        • manabanana

          “in the US most midwives have inadequate or no training and and if
          licenced this is lax and insufficient to regulate the profession.”

          False: Most midwives in the US are CNMs.

          • guest

            Really? In my state, at least in terms of homebirth, direct entry (non-nurse) midwives outnumber CNMs by about 20 to 1.

          • Michelle

            According to a website americanpregnancy the US has CNM’s but also CPM’s, Direct Entry Midwives, CM, and scarily lay midwives. CNM’s can licenced in all states, but the others are not and that the figures I’ve seen on homebirth stats, the vast majority are done by the other type of midwife. So I suppose that is the difference.

          • Liz Leyden

            Most US homebirth midwives are not CNMs.

        • Wombat

          Seriously. I did more training and licensure to be a pharmacy technician than too many HB midwives. And my work isn’t as life-threatening since it is -required by law- to be supervised by someone much more trained and licensed.

          And I can be disciplined much more thouroughly too (though it is rare, it does happen) including removal of my ability to work in the field, period. Even in independent pharmacies there are no (legal) lay technicians – even if an indy did try it they’d be unlikely to get away with it for very long.

          I did not find my liscencing requirements overly burdensome (a little costly, but fairly straitforward training and test of skills to get and maintain) and I am not requesting to be the sole medical provider for two people, one of whom is a rather fragile newborn. With very little equipment, no less. And just to be clear, I live in TX, which is not ‘regulation happy’ in this area in the least. It is the minimally -effective- amount.

          Why is this too much to ask for midwives? Oh right, because if I tried to open a pharmacy in the comfort of my bedroom, I’d be arrested, not to even mention fines and loss of certification. Unfortunently, lay midwives are able to keep it relatively between themselves and the pregnant client (until something goes wrong, that is – and all too often too far wrong) so they skirt detection even in the states where the legislature has been brave enough to stand up and say that this isn’t ok.

          It’s time for this shit to start being treated like the serious crime that it is. The industry cannot out-lobby (not that I’m pro lobbying, but it can occasionally be a means to an end) true medical professionals. Add exposure of their blatently manipulated facts and statistics and it’s really rather sad it hasn’t already happened.

          Maybe that’s just me though, since I pretty well think the same should happen to the chiropractic ‘doctors’ who claim they can treat everything from ADHD to cancer. That shit hastened the demise of my aunt after she got wooed by the woo (and there was a chance of remission with real treatment, albiet a small one). I’d personally be fine in a world without chiros (seen too many people have bad experiences even with sane ones) but I accept the plausability of helpfulness for musculoskeletal and related issues, especially if they refuse dangerous practices, like major cervical adjustment. But hey, at least even they have internal and external oversight and liscensure. Your move, HB midwives.

          Edit: And that really should have been a reply to @Antigonos CNM. I blame Disqusing on a phone at 1:30am :p

  • Guesteleh

    There’s a twitter chat going on right now under the tag #midwives. Here’s how some of the midwives are responding to @jamestitcombe:

    @JamesTitcombe @WeMidwives @SagefemmeSB @ediemoonbeam @corden1326 Learn lessons and moving on will promote #BetterBirths #WeMidwives— Hannah Horne (@hannhorne) March 17, 2015

    @JamesTitcombe @hannhorne @SagefemmeSB @ediemoonbeam @corden1326 and when does past end? We have to learn from present too. #WeMidwives— WeMidwives (@WeMidwives) March 17, 2015

    But here’s some hope:

    @hannhorne @JamesTitcombe @WeMidwives @SagefemmeSB @ediemoonbeam #wemidwives future midwives are listening ~ want change #betterbirths— ✨Cordy✨ (@corden1326) March 17, 2015

    • Amazed

      Look here. Congrats, midwives! You all wanted to be noticed and independent, didn’t you? Now you have your very own page on wikipedia.

      http://en.wikipedia.org/wiki/Furness_General_Hospital_scandal

      • Guesteleh

        Reading that makes that twitter chat even more appalling. No mention of the need to address the deficiencies that led to those deaths. More talk about normal birth, more dismissal of a loss father.

    • LibrarianSarah

      Wow that’s cold. I don’t have kids but I am pretty sure that losing a child due to someone else’s negligence isn’t something that you ever really “move on” from. I want to give John a warm blanket, a cup of hot cocoa and a hug.

      • Cobalt

        You can’t move on, because you can’t take your child on with you. Grief is an expression of love, and that love doesn’t have a clock attached. I’m sure the midwives would like to move on though, and strength to John Titcombe for not letting them.

  • Tosca

    Your specialist was an ethical violations amateur, Dr Amy. Here’s how he screwed up in ways midwives would never do…

    1. You asked him about the risks and benefits of a procedure he doesn’t offer. HE TOLD YOU THE TRUTH. Serious fail right there.

    2. He didn’t slander other service providers, to ensure you were too frightened of them to get a second opinion. Rolling my eyes.

    3. He didn’t let your condition deteriorate to the point of mortal peril while insisting nothing was wrong. Is the guy even trying here?

    4. He didn’t attempt to use physical force to prevent you, or your family members, from accessing more competent care once the mortal peril became too obvious to ignore. Shaking my head.

    5. He didn’t sabotage the efforts of said providers to rescue you, by failing to providing care handover or your medical records, or outright lying about your previous treatment. Seriously. This guy is bush league.

    • And he didn’t use facebook to shame doctors offering competant care.

      • Tosca

        Or even to crowd source how he should treat you! In real time! During an emergency!

        • KarenJJ

          Surely someone on facebook would have been able to help him out with his gamma knife surgery?

          • Samantha06

            I’m sure there’s a YouTube video for that…. plus he could have tried to get in contact with some of the local doulas… I mean, from what I’ve read on some blogs, some of them have actually had to teach Obstetricians how to deliver breech babies in head entrapment emergencies… so surely they must know how to do that gamma knife thing…..

        • And he calls himself a professional! The nerve.

    • CrownedMedwife

      …and his professional organizations didn’t promote health policies with Campaigns for Normal Neurology or Normal, Healthy Brain Tumors for Women and Families to demonize Neuro-Radiology Services.

      • Samantha06

        And there is no “Neurosurgeons in Chains” website. What’s with that?

        • The Bofa on the Sofa

          The guy probably even pays malpractice insurance. Do you KNOW how expensive that is?

          • Amazed

            I read the lists of mistakes he made and all of you documented and I have to shake my head in disgust.

            This. Guy. Is. A. Real. Failure.

    • KarenJJ

      He didn’t blame you for your tumour because you didn’t consume enough kale/beef/eggs/kombucha.

    • The Computer Ate My Nym

      He didn’t dump you on a radiation oncologist after botching the operation and expect them to fix everything.

  • toni

    OT: http://www.huffingtonpost.com/2015/03/16/kraft-singles-kids-eat-right_n_6879658.html

    this sentence struck me as a bit suspect: ‘Typically, the fewer ingredients a food contains, the healthier that food tends to be.’ It might generally be true, idk, but in this case… none of the ingredients in the cheese slices strike me as problematic. sounds like snobbery to me. I don’t think kraft singles taste good and I prefer ‘real cheese’ (i lived in Paris for four years) but is processed cheese actually bad for you?

    • I think they’re oversimplifying it. Processed food is typically bad for us because it contains a lot of chemicals that don’t do a lot for us nutritionally, but a lot of simple, natural products are bad for us as well because of high sugar, salt, and fat content.

      I think if you eat stuff like processed cheese in moderation, like if you’re someone who likes the occasional fish cake or noodle dish with gooey fake cheese deliciousness, it’s fine, but people who gorge on it will obviously have issues.

      • toni

        too much of anything is bad for you I get that.. but is fancy ‘real’ cheese nutritionally superior to kraft singles? also my son’s baby porridge has a shed load more stuff in it than mine which is just one ingredient (rolled oats) and has a lot more nutrients. also I was scolded by my friend’s mother when I was staying with them in the winter because I fed my son white bread which she called processed crap and told me to use their brown bread. but when I looked at the nutritional information box the brown bread had far fewer vitamins and minerals than the white bread we were eating.

        • toni

          the brown bread had more fibre was the only thing but my kiddo is not constipated so I don’t think he needs more than he’s getting(?)

        • AllieFoyle

          I don’t think a reasonable amount of that stuff is going to harm you, but I usually choose less processed foods because a) I prefer it (Kraft Singles vs. real cheese? no contest), and b) my kids tastes are developing and I’d rather give them a taste for real food, which is probably healthier in the long run, and also tastier.

          • fiftyfifty1

            “give them a taste for real food”
            What’s the opposite of real food? Do you mean like plastic fruit for centerpieces?
            If you eat it, and it provides sustenance (whether that be carbohydrates, fats, proteins, vitamins, minerals, fiber etc) it is real food. It might not be gourmet food, or it might not be sophisticated food, or it might not be home-cooked food, or any number of things, but REAL food it is.

          • AllieFoyle

            Sure, a Kraft single provides sustenance; it isn’t poison; in reasonable quantities it isn’t going to make you obese or unhealthy. There’s nothing inherently wrong with artificially created food products, but I find them bland and boring, and also often overly sweet, greasy, or salty. You make it sounds like some noxious elitism, but I don’t think there is anything especially gourmet or sophisticated about vegetables prepared simply, fruit, or a curry or stew.

            And while your experiences make you worry about the dangers of obsessive focusing on healthy eating (perfectly reasonable), do you not see people suffering on the other end of the nutritional spectrum? When I did social service work there were so many people suffering from diet-related health problems, and so many children eating very limited diets that had lots of calories but very little nutrition or variety. That is much more worrisome to me than overzealous healthful eating.

          • SuperGDZ

            I’m a bit of a food snob so I prepare a lot of food from scratch and don’t buy processed cheese or white bread because I don’t think they have much taste. My son was raised from infancy on “real food”, with sophisticated spices and flavour combinations. He eats them, including some foods not often liked by small kids – olives, curries and sushi, for example – but his favourite food is still a Happy Meal, and a few days after finishing his plate of (delicious) lentil and mushroom ragout he said “That was nice, but tomorrow you must buy sausages.”

        • Who?

          I get more antsy about the packaging than the food inside. Cheese comes in a packet, usually one layer. Singles come all wrapped up, inside another whole bag. More to throw away.

        • They fortify Kraft singles, I’d guess with calcium, vitamins A and D, and iron, but it also has more fat and sugar content, so I don’t know how exactly it would match up nutritionally against real cheese.

          I wouldn’t worry about white bread, either. That scolding was patronizing and undeserved.

          • SuperGDZ

            It’s far more effective serve up a plate containing one sandwich of white bread and Kraft cheese plus some carrot sticks and an apple than to serve up a plate containing two sandwiches of some obsessively sourced “healthy” bread and cheese.

          • I didn’t say it wouldn’t be?

          • SuperGDZ

            I was agreeing with you.

          • Apologies, you know how it is when reading comments.

          • AllieFoyle

            Effective in what way? And why would you have to “obsessively source” whole grain bread or regular cheese? They’re in the same grocery store aisles as the white bread and Kraft cheese.

          • SuperGDZ

            Effective in avoiding the negative consequences of overprocessed food, primarily calorie density.

            Which grocery store do you shop at where there is only one variety of wholegrain bread and “regular” cheese? There are dozens of varieties of both, many claiming unique health benefits (low GI! low fat! multigrain! gluten free!).

          • AllieFoyle

            I don’t understand. I was just trying to point out that you don’t have to expend a great deal of time or energy to buy the less processed option (assuming that you have access to a grocery store with a decent selection and a reasonable food budget, which isn’t true for everyone).

            There are plenty of unhealthy ways to eat even if you’re avoiding processed foods, and some processed foods are perfectly nutritious, but aiming for less-processed in general is pretty reasonable and achievable.

        • Francesca Violi

          I think the problem with regular consumption of heavily processed food is that you get used to it: lots of salt /sugar, artificial flavours, fats, and other ingredients carefully concocted to make a food more palatable, give a better look and texture. So then it’s harder to enjoy the simpler flavours of foods which should be the base of our everyday diet. Vegetables, fruits, pasta, rice, cereals, meat or fish prepared in a simple and healthy way, drinks like water or plain juice, will tend to taste dull in comparison.

      • fiftyfifty1

        ” Processed food is typically bad for us because it contains a lot of chemicals that don’t do a lot for us nutritionally”
        Which chemicals? What specifically do they do that is a problem?

        • Alcharisi

          Not to mention that my favorite food-snob approved treats, like brine pickles, gravlax, and dark chocolate, are processed, too. What the hell else would you call grinding, fermentation, etc.?

        • Cobalt

          In processed foods, there is typically not a good balance of nutrients (all of which are, technically, chemicals). A lot of fat, salt and sugar, so it’s easy to eat more of those than the body typically needs, while not having as much in the way of fiber or a variety of vitamins, so you have to consume a bunch of other stuff to meet your overall nutrition needs, which may put you over your energy needs. The caloric density of the processed stuff is usually higher too, so it’s easier to overeat even if you don’t do any extra eating to get what isn’t in the boxed foods.

          You can make a Big Mac part of a balanced diet, but it’s easier for a lot of people to not try to.

          • AllieFoyle

            Exactly. The issue isn’t that one Kraft Single is going to make you ill or obese or kill you with Toxinz; it’s that a diet of mostly processed food isn’t particularly healthy in the long run. And the Huffpo article isn’t just a diatribe against chemicals–it’s a response to the dietetic association making Kraft Singles the first food it endorsed as being especially healthy. In my opinion, that is pretty outrageous.

          • Poogles

            “it’s a response to the dietetic association making Kraft Singles the first food it endorsed as being especially healthy. In my opinion, that is pretty outrageous.”

            Except that after I looked into a little bit more, it is not the case that the label means the association is endorsing or supporting Kraft singles – it’s the opposite actually – Kraft is putting the label on thier product themselves to support the “Kids Eat Right” program.

            “Contrary to recent published reports, this collaboration does not constitute any endorsement or nutritional seal of approval by the Academy, its Foundation or Kids Eat Right. The Academy Foundation does not endorse any products, brands or services. The Kids Eat Right logo on KRAFT Singles packaging identifies the brand as a proud supporter of Kids Eat Right.”

            http://www.prnewswire.com/news-releases/statement-from-academy-of-nutrition-and-dietetics-foundation-on-new-kids-eat-right-nutrition-education-campaign-300050423.html

          • AllieFoyle

            The NYT did a piece on it as well: http://well.blogs.nytimes.com/2015/03/12/a-cheese-product-wins-kids-nutrition-seal/?_r=0

            The labeling certainly creates the impression that Kraft Singles have been endorsed, no matter what the actual nature of the relationship between Kraft and the academy.

          • Poogles

            “The labeling certainly creates the impression that Kraft Singles have been endorsed”

            Oh, certainly, which is why Kraft did it, I’m sure.

        • Food coloring, preservatives, flavor enhancers, etc. The goal is to be inexpensive to produce, not use up a lot of resources, and be flavorful. This is one of the reasons why people at a lower socio-economic level are at a higher risk of obesity; it’s fast and dirt cheap compared to healthful food that actually tastes good.

          And as I said, it doesn’t do much for us nutritionally. Micronutrient malnutrition is a concern.

          • SuperGDZ

            I half agree – the problem is not so much that the colouring and flavour enhancers are bad for you but that using them means you don’t have to use a food ingredient (fruit or veg) that would have provided the colouring or flavour, leaving more room for the calorific stuff.

            I don’t have any beef with preservatives though. Botulism sucks, and preservatives in food products can only improve access to foods that would otherwise spoil quickly – fruit, veg, meat, fish.

          • That’s my whole point, though. The question was pertaining to what chemicals are used in such foods and I felt it important to specify that I didn’t mean in the vague, uneducated “TOXIIINS” sense.

    • The Computer Ate My Nym

      I made flour free brownies the other day. They contained but 5 ingredients so were super healthy by this standard. Of course, those 5 ingredients were sugar, chocolate, butter, eggs, and ground almonds.

      • The Bofa on the Sofa

        The thing I guess I don’t understand is, what counts as an “ingredient”? Is butter a single ingredient? Or is it more? For example, butter (like all fats) is made up of a mixture of triglycerides, and this site

        http://www.eatwisconsincheese.com/dairy/butter/butter-basics/composition-of-butter

        lists at least 12 different fatty acids, along with a bunch of vitamins and minerals.

        Now, if it were margarine, and these things were all added to the formula, they would have to be listed as separate ingredients. But if it’s butter, you can just call them all “butter” and that makes it just one? No, it doesn’t work that way.

        I’ve seen ads that say, “Our only ingredient is milk.” Is that really better than a mixture of water, lactose, various triglycerides made up of 3 out of a set of 15 – 20 fatty acids, casein and whey proteins and vitamin and mineral ash?

        • fiftyfifty1

          Yes, all this ingredient counting bullshit goes back to Micheal Pollan and his In Defense of Food book. He also is the one who came up with the rule that if you can’t pronounce it you shouldn’t eat it. He does a lot of talk about “real food” and a lot of fear mongering about “processed foods”. Very silly and snobby and based on no science at all.
          Of course I am jaded. My practice is half time eating disorders in addition to primary care. I spend a lot of time listening to parents crow about how their family eats “real foods” and “whole foods”, and how they “eat clean” and how they don’t feed “crap” and “shit” and “junk” to their kids, and how they agree with the referring pediatrician that little Emily needs to eat more, sure, but really there can’t be much of a problem because she eats “so healthy” like everyone in their family does. And how they’ve told her time and again that there is nothing too wrong with eating fats just as long as they are “good fats” like maybe a slice of avocado. And how some dark chocolate almonds might be OK as a special treat. Food prudes to the core.

          • The Bofa on the Sofa

            He also is the one who came up with the rule that if you can’t pronounce it you shouldn’t eat it.

            I can pronounce just about anything written down. In fact, so can my kindergartener, because, you know, he understands the concept of phonics.

            So what does that say in terms of eating?

          • Woo-hoo! Twinkies and cheese curls for dinner!

          • The Bofa on the Sofa

            Yeah, it’s not like I can’t pronounce :”white fluff.”

          • “PBJ”

          • The Bofa on the Sofa

            I use the long pronunciation.

            Of course, now that it is Lent, there are only two words I need to say: Jelly Beans

          • fiftyfifty1

            Oh come on Bofa, you know you say “white fwuff”.

          • The Bofa on the Sofa

            Only when my mouth is full…
            (to be fair, I don’t like twinkies, but not because of the fluff; give me a Suzy-Q any day over a Twinkie)

          • Roadstergal

            I remember hearing a Wait Wait, Don’t Tell Me where Pollan was going on about his ‘number of ingredients’ business, and Paula Poundstone put Twinkies on the happy list, because they only have two ingredients – cake and crème filling…

          • She also nailed down why people like Fitbits and other step counters: because wearing a pedometer constantly means that walking to the fridge counts toward your “exercise.”

          • Mishimoo

            I like mine because it reassures me that I’m not dreaming that I’m waking up a lot at night, I genuinely AM waking a lot. It’s also a good lifehack to make me tidy more, and surprisingly, eat better because I know how many calories I’ve eaten vs. burnt which really helps to lower my food guilt.

          • The Bofa on the Sofa

            …crème filling

            Love that. “crème” as opposed to creme…

            Weird Al had a song in the early 90s that I don’t think ever got released…

            “I like the white stuff, baby, in the middle of the Oreo….”

            (Right Stuff by New Kids)

            He sang it in concert

          • araikwao

            I’ve heard that before!!(never been to a concert though..)

          • SporkParade

            It was released on the Food Album, together with “Eat It” and “Addicted to Spuds.”

          • KarenJJ

            Reminds me of a “Four Ingredients” cookbook that was popular in Australia for a while which would list “salad” as an ingredient. It also had a recipe “Pea and Ham Soup” which called for peas and ham (we make pea and ham soup with bacon bones and dried peas and it’s delicious, I can’t imagine Pea and Ham soup made with peas and ham).

          • Laura

            and tater tots with Kool-Aid! (very easy to pronounce you know….)

          • Followed by a double helping of Alka-Seltzer. That may not be good for cancer, but it works wonders with mild depression.

          • LibrarianSarah

            It is fortunate that you don’t have a speech impediment or else you would starve to death. 🙁

          • The Bofa on the Sofa

            I’m only half joking about my kindergartener being able to read anything. He does struggle with “big words.” BUT then again, when he does have trouble pronouncing a word, we help him figure it out AND we help him learn what it means. We don’t just say, “ooooo, big words are the boogeyman!!!!”

            This whole “don’t eat anything with stuff you can’t pronounce” is literally just so friggin’ juvenile, and just seems to be playing down the lowest levels of illiteracy.

            Personally, I expect more from people. I think they are capable of much, much more than what this approach seems to imply.

          • Who?

            It’s infantilising actually. ‘You keep away from anything with those nasty big words in it. You should be scared of those words, never mind what they mean. I’ll tell you what is good for you.’

            Creepy.

          • The Bofa on the Sofa

            I almost went with infantilizing.

          • Sue

            We taught our (ex-toddler, now teenager) to pronounce and spell antidisestablishmentarianism. It made a great party trick for a while!

          • AllieFoyle

            But why? Most people are not chemists, and people have varying levels of education and literacy. There’s a lot of research supporting the idea that eating a diet of heavily processed foods is not particularly healthy. For your average person, aiming to eat less processed food seems perfectly reasonable.

          • The Bofa on the Sofa

            But what does not eating heavily processed foods have to do with “words I can’t pronounce”?

          • AllieFoyle

            If a product has a lot of unfamiliar ingredients it’s likely to be highly processed. Not being able to pronounce something doesn’t make someone an idiot.

          • The Bofa on the Sofa

            But it TREATS people like idiots!

            As I said, it plays to the lowest levels of illiteracy, treating people like they are kindergarteners.

          • AllieFoyle

            What treats people like idiots? A rule of thumb that people use voluntarily because they find it helpful in making food choices? Not everyone is familiar with chemical nomenclature.

          • SuperGDZ

            Totally, OT, but I have real difficulty pronouncing anything I haven’t seen written down, or don’t know how to spell, no matter how many times I hear it. It’s a real problem learning foreign language by most popular teaching methods (by hearing and speaking).

          • SF Mom & Psychologist

            I am not medical professional and have not read the research about foods, diets and health impact. But my 42-year-old brother was diagnosed with a malignant brain tumor last year. He had surgery, radiation and chemo, and the head of neuro-oncology at the Cleveland Clinic was adamant that my brother significantly reduce processed food in his diet (and clean up his eating habits in general). The doctor stressed this as an extremely important part of combating inflammation, IIRC. (Other recs included major reduction of alcohol.) It surprised me somewhat, and made me curious about the research.

            Sorry to hear about your brain tumor, Dr. Amy. I hope it’s treating you OK these days. My brother has been “stable” for a year, thankfully. It’s a crappy thing for anyone to go through.

          • KarenJJ

            ” The doctor stressed this as an extremely important part of combating inflammation,”

            I get so hideously confused with “inflammation” – my levels of inflammation (which are normally chronically high) are reduced with a biologics medication and with that comes a theoretical increased risk of cancer. Maybe it depends on the cancer, or the recovery or something else.

            Is inflammation protective of cancer or can it cause cancer?
            Is inflammation an “immune system booster” or does it reduce your immunity?

            It seems that everything these days is being blamed on “inflammation”, and definitely my high levels of inflammation have caused significant issues, but they are rarely the issues that are reported in the media.

          • Roadstergal

            It’s just one of those buzzwords that people like to use. It’s an immune response characterized by a certain set of cytokines, basically. Like most things in the immune system, it’s useful in moderation and can be a big problem not in moderation – it can cause acute harm if excessive in the short term, and can cause cancer if chronic.

            I’m not aware of any good information on diet having an effect on inflammation (except, of course, the direct 1:1 of celiac and IBD, where the inflammation is a direct reaction to the food as an antigen), and would get rather pushy for citations from a doc who claimed that reducing my intake of processed food would do fuck-all for inflammation.

            Which biologic are you on, if you don’t mind me asking?

          • SF Mom & Psychologist

            It’s possible that my memory is wrong – perhaps it wasn’t about inflammation. My point was less about inflammation and more that he had a highly specialized, nationally regarded doctor recommending that he cut way back on processed foods.
            And while I can certainly see how some patients might find a benefit in getting pushy for citations, he’s a lawyer, not a scientist. Rather than trying to sort through research, I think he was more focused on figuring out how much life insurance he had for his wife and 4 kids, getting as much QT with them as possible, recovering from surgery and trying to get back to work. I think he was fine to take the advice to eat a healthier diet.

          • Roadstergal

            Cutting back on processed foods as part of a general lifestyle shift to be in better shape to deal with the ravages of disease and treatment is a very different deal from cutting back ‘to reduce inflammation,’ for sure.

          • SF Mom & Psychologist

            According to my mother (that sounds comical!), who is a physician and attended the follow up appointment, the neuro-oncologist did recommend cutting processed foods, increasing vitamin D, reducing alcohol and exercising 5-6 times/week. Dr. Mom says reducing inflammation was discussed as a potential benefit, along with strengthening immune system. He is not a “cure” candidate, so all efforts are aimed at slowing tumor re-growth.
            Now I feel like I’m arguing a point, which I’m not interested or equipped for. But I did want to clarify what recommendations were given and why.

          • fiftyfifty1

            Don’t worry. nobody means to put you on trial. These pseudoscience nutrition recommendations are just so frustrating for many of us. I understand the pressure oncologists are under to provide alternative-health-style nutrition recs complete with all the buzz words like “inflammation reducing” and “immune boosting” “antioxidants” etc. The truth is that “Try to eat because you need the nutrition and try not to get dehydrated” is about the only evidence-based advice except for a very few other recs for specific conditions (e.g. reduce alcohol for breast cancer). But if oncologists just give this common sense advice they are accused of being close-minded and not holistic. And then bullshit for-profit cancer centers are all to happy to fill the void and give people what they want. An example of that is the recent add blitz on NPR for Cancer Treatment Centers of America “where every patient receives individualized nutritional advice for optimal blah blah blah…” (why the hell can people advertise on NPR anyway !?).

          • KarenJJ

            “Dr. Mom says reducing inflammation was discussed as a potential benefit, along with strengthening immune system”

            That’s one of the big ones I’ve always found confusing. Inflammation is part of the immune system and is a kind of a “first response” system for the immune system (how it was described to me by a specialist). So you are trying to “boost” the immune system by reducing a part of it?

            Hopefully someone else knows what this is about..

          • Who?

            It’s confusing. Like the woman who was telling me she was treating her daughter’s hay fever by using natural products to boost her immune system. She went all quiet after I asked whether that was the best idea, since hayfever is surely the immune system working too hard already?

            I may start screaming uncontrollably if I hear ‘boosting the immune system’ one more time in a social setting. All you have to do is drop a shirtload of money on supplements, apparently.

            Maybe I need to not be around those people for a while…

          • KarenJJ

            Anakinra.

            While we’re at it. The following article caused a buzz in patient support groups for these rare genetic inflammation diseases. Some severely affected kids have brain inflammation that is not always well controlled even on medication and some parents are desperately trying to find things they can do themselves (diet is a biggie as is supplements) to try and ease the inflammation in conjunction with trialing different dosages/medication etc.

            http://news.yale.edu/2015/02/16/anti-inflammatory-mechanism-dieting-and-fasting-revealed

          • QuantumMechanic

            Don’t know if the neuro-oncology head is involved or if the specific recommendations are woo-full, but I do recall several posts from Gorski over at RI in the past year about how woo has been invading the Cleveland Clinic.

          • This hurts my metaphorical heart. My parents handed down an entirely different set of food issues to me, but unintended consequences of orthorexia are something that health foodies will have to live with.

          • SuperGDZ

            Yup, my parents were (and still are) ultra-healthy eaters (by whatever they define as “healthy” at any given time), and are perceptibly ashamed of their one overweight daughter (me). As a child I acquired the habit of raiding the fridge and cupboard when nobody was looking – in the middle of the night, for example, and eating everything I could lay my hands on – a habit that has stuck with me for 30 years.

          • Guesteleh

            Michael Pollan once made a statement that food should be more expensive to force obese people to eat less. Elitist prick. Michael Pollan can go fuck goats.

          • Who?

            Poor goats, though…

            Perhaps himself, instead?

          • Guesteleh

            He’d only fuck free range grass fed goats anyway.

          • Who?

            Yes but the goats can’t help having a goose for an owner.

          • toni
          • Laura

            Or at least eat goat cheese, drink goat milk- raw and unpasteurized, of course! And how about goat meat? Is that any good? Goat jerky? All natural, organic grass fed, free roaming blah blah bah bah

          • demodocus’ spouse

            Well, you can get goat meat at my local Indian eatery. Haven’t been feeling out-of-the-box enough to try it. Their Aloo Matar, though, mmmmMMMMMmmm

          • The Bofa on the Sofa

            I don’t like goat, not even at the Indian place.

          • demodocus’ spouse

            Out of *my* box, that is. Obviously it’s ordinary elsewhere

          • karenJJ

            Goat curry is yum.

          • Liz Leyden

            I’ve had Jamaican Curry Goat. It’s like lamb, but really bony.

          • Laura

            “Food prudes” – that’s a new and very brilliant one! What is your recommendation to these “food prude” families and their food-obsessed, eating-disordered children?

          • AllieFoyle

            Maybe they’re just trying to do the right thing by their children. It’s hard. We’re all told over and over again about the dangers of obesity and heart disease and diabetes, and food issues are in the news all the time. It’s not always easy to figure out the line between healthful and problematic, and it varies from child to child. What’s good for one kid might push another into an eating disorder. One year my pediatrician expressed concern that one of my kids was overweight and one was dropping too low on the curve. Two kids in the same family, eating basically the same stuff. What exactly am I supposed to do with that?

          • SuperGDZ

            The problem is that food obsession and over-thinking food lies at the root of all kinds of eating disorders – overeating as well as undereating. Being overweight or underweight does not necessarily indicate an eating disorder, though. Fiftyfifty1 was referring specifically to children with eating disorders, and an unhealthy obsession with food in the parents is a huge smoking gun.

          • AllieFoyle

            But eating disorders have been around for a long time, centuries at least, and definitely well before the current trend toward avocados and unprocessed foods. Obsessiveness and rigidity is problematic, but that’s nothing new–it’s just the popular thinking about nutrition has changed and people are now obsessing about different foods. When I was a teenager it was fat that people obsessed about. Virtuous eating meant carrot sticks, diet drinks, fat-free cottage cheese, and maybe a rice cake or two. Quinoa and avocados are probably an improvement. Choosing unprocessed foods as a rule of thumb can be a perfectly healthy strategy and doesn’t necessarily translate into eating-disorders, paranoia, or science illiteracy.

          • SuperGDZ

            Yes, obsessions with food purity are not new, this is just how they manifest themselves now. There is a difference between choosing unprocessed foods as a rule of thumb and obsessively restricting your diet.

          • Sue

            “if you can’t pronounce it you shouldn’t eat it”

            Thank goodness I have a reasonable aptitude for language!

          • Amazed

            I am so sad for all those babies who cannot pronounce “breastmilk” or “formula”. On the other hand, I suppose it’s good for business. SOMEONE has to make a living by making tiny, tiny coffins.

          • Cobalt

            Crossing off the quinoa, kombucha, agave, mochi, and acai right now. Cake, however, is moving to the top of the list.

          • Who?

            Sounds like a sensible approach in the circumstances.

          • DiomedesV

            Oh my god. That sounds incredibly frustrating.

            I have a kid who is generally uninterested in food. She’s not picky. She eats a well rounded diet, she just doesn’t eat much of anything. I’m constantly encountering *other people* who praise her for “dainty eating” (as early as 1 year old!). Somewhere she got the idea that if you eat too much you could get sick. A couple of times I made the mistake of chastising her for asking me to unwrap a new food item, then promptly looking at and telling me she didn’t want it (I told her she should not waste food) and now she’s always asking me if I’m upset that she’s “wasting food.” I have reiterated over and again that there’s a difference between opening something that will go bad and then not even taking a bite, and not finishing her plate (which she never has to do) but I fear that just a few negative messages like that from me has done some damage.

            We’re so rigid about never expressing any opinion at home about what food is “good” or “bad” or ever talking about our bodies at all or those of other people, and yet she still seems overly sensitive to these things. It worries me. The thing that especially frustrates me is that if she were a boy, I feel that other people would be more inclined to urge her to eat (also not good, in my opinion).

          • Cobalt

            Some people just have those sensitivities, don’t beat yourself up about it. You’re presenting a very reasonable attitude towards food and eating, and that’s really the best long term influence available.

            I got my bony kid hooked on Nutella to up her calorie intake. I’d been trying whole milk, extra butter, chocolate milk, etc., but Nutella she eats!

          • DiomedesV

            Yes, I tried nutella, too! No dice yet. But I’m hopeful!

          • Who?

            It is hard to manage the fussy small eaters. I used to tell my two that things were just as wasted in them as in the bin if they didn’t want them, but that it is good to try new things with an open mind.

            They both liked the idea of ‘treats’ when they were little, and we were careful to monitor their intake since tiny appetites can end up eating not much at all if they have filled up elsewhere. And I have a personal loathing for fizzy drinks so we rarely ever have those.

            Both were cured by adolescence, and now eat very well rounded diets, do lots of exercise, and are fit and healthy and healthy weights, after years of being too skinny. The boy put on 15kg in 12 months when he was 13+, which was an interesting year of adjusting hems and buying new pants!

            All of which means, stay true to what you are doing, which sounds great, and she will work things out for herself over time.

          • anh

            we have a parent distro at work and a woman posted on it asking about how to get her kids to eat more veggies. A profound sanctimommy said that no adults in the house, to include their poor au pair, were allowed to express any opinions about food at the table and all adults were required to clean their plates and eat all their veggies. I felt so bad for their au pair

          • On another forum I remember reading a cri de coeur fom a mother who had just had the most shattering experience: she sent her child to school every day with a home- baked whole wheat pita with home- made hummus for his mid-morning snack, unlike all those inferior Israeli mothers who put a small chocolate milk and a roll (white flour, from a bakery) into their children’s bags, often with chocolate spread inside.

            One day the child Came home with the “healthy” snack, and the truth came out: he’d been tossing it into the garbage every day and his friends had all been giving him a bit of their ” commercial and unhealthy” snacks so he wouldn’t go hungry. The mother was asking the forum for advice — should she insist that his teacher make sure he ate the food she sent? Contact the Ministry of Education? Have a PTA meeting to educate parents about the harm that chocolate milk was doing to their children?

            We veteran Israelis told her to learn to live with it.

          • SporkParade

            Was she an Anglo? I seriously can’t deal with other Anglo moms anymore. The crunchiness is driving me batty. “How can I expose my child to peanuts without giving them Bamba, which is processed and eeeevil?”

          • lawyer jane

            OT – what does “anglo” mean in Israel? Non-Jewish or Jewish from the US/UK?

          • SporkParade

            Yes, plus Canada, South Africa and Australia. 🙂

          • For the uninitiated, in Israel anyone whose mother tongue is English is an “Anglo”. Yes, she is American. And she is upset about other things — that the State Religious School her daughter is in won’t let her wear tzitzit [ritual fringes] and her son can’t be the “Abba shel Shabbat” and light Sabbath candles [Fridays most schools have a little special ceremony in honor of the Sabbath which begins that evening]

            I wrote that I wondered about that humous in a typical unairconditioned classroom where the ambient temp is well above 85F for a good part of the school year.

          • SporkParade

            At least that’s relatively normal. She could be complaining about how the public health nurses dared to have an opinion on her child’s development. Or bragging about how she only uses antibiotics as a last resort when her child has an eye infection. Or asking what the paperwork involved is for an unattended homebirth, only it won’t really be unattended because she’ll have an American CPM who isn’t qualified to practice in Israel pretending to be her doula.

          • Medwife

            Oh my god, pita and fresh homemade hummus? That sounds amazing. Just stick a box of chocolate milk in that bag and the kid might have felt less like a freak.

          • DiomedesV

            The parents of the other kids should be proud of raising such giving children!

          • Liz Leyden

            Pollan also said “if your grandmother wouldn’t recognize it as food, don’t eat it.” I don’t know about his grandmother, but mine grew up in Georgia in the 1920s, where people fried everything in bacon fat. Grandma just turned 93, and doesn’t recognize sushi, mangoes, avocadoes, or parmesan cheese as food. She only started eating yogurt 3 years ago. My little sister the Paleo Evangelist, has tried expanding Grandma’s palate a bit, but she still loves her collard greens fried in bacon fat

          • Bombshellrisa

            My grandmother wouldn’t recognize quinoa, coconut oil or coconut sugar.

          • Who?

            That’s okay I bet I’ve got a couple of decades on your grandma and I don’t recognise any of them as food either.

        • just me

          This is my pet peeve with that ice cream commercial with 5 ingredients…

        • AllieFoyle

          But margarine IS demonstrably bad for you.

          If margarine was made by recombining the constituents of butter there would be no problem. It would be nutritionally equivalent to butter. But what would be the point? No one would do it because it would almost certainly be more expensive to produce than regular old butter.

          The average person may not know anything about the chemistry of lipids, but choosing the least processed food in this case, just as a rule of thumb, would actually lead to the healthier choice.

          • The Bofa on the Sofa

            But margarine being less healthy has NOTHING to do with the “number of ingredients”

            Butter is not nutritious nor healthy. It’s flavoring. The fats give it a specific texture and consistency that make it useful for baking.

          • AllieFoyle

            It’s nutritious in the sense that it is an energy source. It’s not some magical health food that you should consume in enormous quantities, but it is healthier than the more processed alternative. It’s just an example of how choosing less processed foods in general can be a good strategy for ordinary people who want to eat healthfully.

          • The Bofa on the Sofa

            It’s nutritious in the sense that it is an energy source.

            So is margarine.

            But no one is (or should be) using butter or margarine as an energy source.

          • AllieFoyle

            Why not?

      • anotheramy

        Sounds healthy to me! 😉

      • Who?

        I’d eat those brownies.

        • I made similar ones, but with cashew meal. They didn’t slice up into brownies very well, but were still delicious.

        • The Computer Ate My Nym

          … too late. They actually did work reasonably well, meaning I now have a dessert I can serve my friend with celiac disease (the real deal, unfortunately…she has to be very careful to have NO gluten in her diet at all.)

      • Mishimoo

        Mine involve sugar, eggs, chocolate, cocoa, and butter. So healthy 😉

        • Amazed

          My new favourite snack includes cream (NOT light), butter, cocoa, vanilla, and chocolate. SO healthy, too!

        • Cobalt

          My favorite chocolate chip cookie recipe starts out with blending two sticks of butter with a pile of sugar. It is really hard not to just eat it like that, maybe with some chocolate chips thrown in.

          • Who?

            Just making a new recipe-coconut cake-butter, sugar, eggs, flour, dessicated coconut, lemon syrup on the cooked cake then chocolate ganache (creme fraiche and melted choc) on the top, served with sour cherries alongside.

            Hours and hours until I can eat it, but v excited already.

          • araikwao

            Lemon syrup and chocolate ganache? Interesting…

          • Who?

            Against my better judgment-I (almost) always follow the recipe first time.

            I don’t think it needed the ganache, next time I’ll do the cake and syrup and serve it with creme fraiche or yoghurt (the bit of bite would be good) and fruit. The cake itself was delicious. The remains are calling from the fridge right now.

          • araikwao

            I try to follow the recipe the first time, too, although all things I expect not to work usually don’t, leaving me wishing that I’d just followed my instincts in the first place.

      • Sue

        According to the fructose-is-poison people, Nym, you SHOULD have used dextrose or rice malt syrup instead of “sugar”, cos SUGAR IS 50% POISON!

        • Who?

          Liquid instead of granules will mess up a lot of baking. Unless you’re making one of those unbaked pretend sweet things-there is a recipe going around for an unbaked paleo caramel slice which really should be a capital offence-why you would even bother is beyond me.

        • Medwife

          She should have used evaporated cane juice.

    • Roadstergal

      I take anything written in the HuffPo with a heaping cup full of salt…

      That quote sounds very Food-Babe-ish.

      • The Bofa on the Sofa

        HuffPo science section is very much FOS.

    • Mac Sherbert

      That seems to be the thing in “Healthy” eating these days. I have a friend that had cancer diagnoses a few years ago, but doing fine now. She’s very serious about what she eats and I do get that. However, she claims you shouldn’t eat anything if you can’t produce the ingredients or know what the ingredients are. My husband has a background in chemistry and can tell what everything listed actually is! So, I guess he can be out there eating all kinds of things, but those of us with less scientific knowledge are suck with just veggies. 😉

      • demodocus’ spouse

        Since I have a black thumb and couldn’t keep a goldfish alive, I’m doomed

        • Mac Sherbert

          lol!!!! 🙂 …I’ve got to remember my password so I can edit!!

        • I keep cats alive for a long time. Plants, OTOH, I kill easily. A Wiccan priestess taught me to use cotton gardening gloves. Works.

          I thought *everyone* killed goldfish?

          • Mishimoo

            I kill chamomile but can save crispy lavender. I don’t have a goldfish, I have a dickfish 😛 (He’s 7+ years old and likes to splash people when he’s bored. He’s rather good at getting tank water in my coffee)

      • Sue

        There is SOMETHING to the principle of avoiding over-processed foods. The problem with food-faddists, like all faddists, is that they take everything literally and to the extreme. Real life doesn’t work like that.

        • namaste863

          Ugh, I live in Northern California, pretty much the heart of foodfadville. I have a cousin on a Vegan Raw kick, an aunt who has an alkaline water maker, and there are at least four brands of gluten-free flower sold in my local supermarket. If I never see Kale or Quinoa again it’ll be far too soon.

          • Roadstergal

            I live in NorCal. I walk around with a big jar of gluten to keep the unvaccinated away from me.

          • namaste863

            That is a GREAT idea!

        • Mac Sherbert

          Naturally, there is something to eating healthy. My point is that people are often afraid of things simply because they don’t understand them. I’m sure you could find people that would not drink H2O because they don’t know what that is (Trust me I went to High School with some of them).

          Also, there are plenty of natural foods that in large amounts would also be bad for you. There are many “health foods” that can cause your blood sugar to spike for example.

      • Box of Salt

        “she claims you shouldn’t eat anything if you can’t produce the ingredients or know what the ingredients are”

        Ask her about cobalamin. Ask her about how she’s going to produce it.

        Spoiler: B-12. There was a Nobel prize awarded for making it in the lab. And, no, it’s not produced by plants.

    • Allie P

      This “fewer ingredients” schtick is a food babe maxim. I can make a salad with 17 kinds of vegetables, but apparently a stick of butter is healthier for me. SMH.

      • SporkParade

        It actually started with a food scientist (maybe Brian Wansink?). His point was that processed foods tend to be less healthful than home cooked foods, but since no one is going to cook everything at home, you can follow a general principal that, the greater the number of ingredients, the less nutritionally sound. But he never intended that to be taken as an absolute rule.

    • Box of Salt

      toni “this sentence struck me as a bit suspect: ‘Typically, the fewer
      ingredients a food contains, the healthier that food tends to be”

      This was followed by:
      “they boast the kind of short ingredient lists that can only come from a whole food: avocado is made of avocado”

      Whoever wrote that isn’t worth reading.

      Here’s a site promoting the nutritional content of avocados:

      http://www.avocadocentral.com/nutrition/avocado-nutrition-health-facts-label

      Just one ingredient?

      Again: not worth reading.

  • Lana Muniz

    OT: See what the data shows about OOH birth safety based on setting and type of midwife. My latest post is up at babyMed. You can follow updates from my blog on the Home Birth USA Fb page, and from @HomebirthUSA on twitter.

    http://www.babymed.com/blogs/lana-muniz/safer-home-birth-requires-educated-regulated-midwives

  • Stephanie

    Most people don’t know how to ask beyond what would the surgeon recommend. They hear the recommendation of surgery, or natural birth and go o.k, without thinking to follow up, or go to other sources.

    So when a midwife tells them home birth is safe, they go o.k. without following up with how safe, how safe compared to a hospital, am I a good candidate…

  • Sarah

    I’m surprised the radiologist didn’t tell you to squirt breastmilk into the tumour.

    • Cartman36

      LMAO! That is awesome

  • Ash

    re:Joanna Jech.

    What is the purpose of doing laboratory testing and measuring vital signs if you will not act on them? The mom survived, at this level of negligence she AND the baby could have died.

  • Amazed

    At least the doctor gave you honest reply about the risks and benefits. I think you made a truly informed decision, instead of being a sheeple!

  • Your experience speaks volumes regarding the differences between “provider centered care” and “patient centered care”. It is nearly Orwellian how women have been sold on midwifery and natural childbirth and breastfeeding – where feminism is reduced to biological essentialism and where process trumps outcome.

  • Mom2Many

    Glad you’re okay now, Dr. Amy! Hopefully the lasting effects were minimal? Can’t imagine that was an easy time for you, and I am so thankful that you have been able to spend so many years educating and teaching. You are truly inspirational, and I have often thought about how valuable your voice continues to be.

    • Amy Tuteur, MD

      Thanks. I chose to have the gamma knife treatment: only one day of radiation. My double vision started to resolve after 3 months and was completely gone by 6 months. The side effects were minimal. I was extremely fortunate that I had access to the latest treatment options and was able to avoid brain surgery!

      • The Bofa on the Sofa

        Because everything turned out ok, I can post this and say, you can say it WAS a tumor!

        https://www.youtube.com/watch?v=Tb5IZ8Mni3I

        • Amy

          You’re missing the part where that tiny cute boy informs the class, “My daddy is a gynecologist and he looks at vaginas all day long.”

          • The Bofa on the Sofa

            “cynegologist” actually

            I SO wanted to have my son go to school on the first day, raise his hand and say, “Boys have a penis. Girls have a vagina.” Unfortunately, he’s not tiny and cute enough to pull it off.

      • just me

        I’m kind of horrified that if you hadn’t known which Qs to ask or that the gamma knife treatment existed he would’ve just done the surgery.

        • AllieFoyle

          Yes, that is chilling. He knows that a safer procedure exists and….doesn’t recommend it?

          • Guesteleh

            I hope that changes in how doctors are compensated will do away with the pressure to “hold onto” patients instead of referring. Older doctors are generally self-employed and bill per procedure but most younger doctors get a salary and work for a medical group so it doesn’t affect their income at all if they refer out.

          • The Computer Ate My Nym

            Except that it does. It’s very hard for a hospital or practice to make money on the “thinking specialties” (ID, hematology, etc) because there is massive compensation for procedures but very little compensation for providing the advice necessary to make the procedures safe. So specialties where most of the work is providing advice and medical treatment rather than procedures are in real trouble in terms of their compensation and tend to get devalued by hospitals and group practices.

          • Dr Kitty

            Grumble grumble…UK general practice has 90% of the patient contacts and gets 8% of the NHS budget…

            Our system doesn’t really reward us for doing more for less either…
            And GP is almost ALL talking and prescribing and very little “doing”.
            I think we’re massively devalued by the powers that be, and many of our hospital colleagues.

          • araikwao

            YES!more and more seems to be expected of GPs and yet our government just (unsuccessfully, phew!) tried to CUT Medicare rebates to make GPs less inclined to churn through patients???!! And specialists can be horribly dismissive of GPs, it’s dreadfully snobbish. A good GP is just gold (unfortunately I ‘ve seen a bunch of inept stuff too, but it just highlights how important and wonderful the good ones are), and the difference between life and death, or a miserable life and a better one, for so many.and they get to do heaps of fun procedures, I think! So yay for GPs – you have an incredibly tough but completely vital job.

          • Dr Kitty

            Thank you.
            Sometimes I envy my hospital colleagues who get 30 minutes in clinic to see and sort heart failure…and just heart failure.

            I get 10 minutes for “my ankles are swollen and I can’t catch a breath and we can’t sell our house and move to a bungalow like I want to, and my husband’s memory isn’t great and my daughter is depressed and my sister has breast cancer and I’m tired all the time”.
            Uh huh…GP is easy.

          • The Computer Ate My Nym

            Consult cardiology, social work, and psychiatry and send them for a mammogram?

            My complaint from the other side is that it’s really hard to get patients to stick to the point in a specialty clinic visit. They want me to deal with their knee pain and cholesterol when I’m really only here to talk about their anemia. (Grumble.)

          • Dr Kitty

            Oh Lord no!
            Echo, BNP, routine bloods including TFTs, arrange memory clinic referral for husband, refer to CBT, give numbers for cancer support groups and services, check last mammogram result and arrange another if needed, commiserate about the local housing market, refer to OT for home assessment for aids and appliances to make living in a 2 storey dwelling workable, rv in offer tissues and sympathy and review in 1 week when we’ll discuss blood results, cardiology referral and if she’d like to try any medication for mood, fatigue or heart failure…

            It doesn’t take 10 minutes though!

          • The Computer Ate My Nym

            Nah! Surely you can do all that in 5. Especially with a patient that is crying and will feel betrayed if you rush her in any way. No problem.

          • The Computer Ate My Nym

            And then, of course, comes the puzzlement about why more doctors aren’t becoming GPs. Even when I was in medical school, there was a lot of pressure to go into primary care…but they couldn’t hide the fact that GPs were expected to maintain a specialist’s knowledge of…everything (GPs in the US are sued for failing to diagnose or treat very rare diseases even after they appropriately refer to a specialist…because they should have been able to treat it themselves), that GPs make way less money for way more time working, and the fact that the GPs are not respected within the hospital system. In short, all the incentives are towards specialization. And still the powers that be can’t figure out why it’s so hard to get GPs…

          • Liz Leyden

            Plus, in the US it’s common for new docs to have 6 figures of medical school debt.

          • The Computer Ate My Nym

            I think part of the problem is that it’s harder to explain to the patient and way harder to explain to the insurance company or conservative politician what you’re doing with medical care rather than procedures. If you charge someone $10K (or 5000 pounds) for taking out their gall bladder they’ll usually think “expensive, but they did take out my gall bladder and save my life” whereas if you charge someone $100 (or 50 pounds) for an office visit to determine whether they can safely undergo an operation to take their gall bladder out they’ll say, “$100 is outrageous! All they did was talk to me for 10 minutes!”

            Well, eventually this will change, because it will have to. As medicine gets more complex, the thinking part of the work will become more important, not less. The procedures can be and are being taken over by automation, the decisions about when and how to do the procedures are not. But I fear it will take a Libby Zion type case to bring it to the attention of the powers that be.

          • fiftyfifty1

            I still can’t understand why he didn’t refer. She said he was considered a top neurosurgeon. Top neurosurgeons have no end of business. Neurosurgeons are in constant demand. What could have been motivating him to try to keep her?

          • LibrarianSarah

            Yeah it would be one thing if he didn’t know much about it but since he was able to answer all of Dr. Amy’s questions it was obvious he knew that the gamma knife treatment was the better option which leads to the obvious question. If he knew that the gamma knife procedure is the safer, more effective option why isn’t he busting his ass trying to learn how to do it?

          • The Computer Ate My Nym

            He’s not a radiation oncologist. It’s a technique used by a completely different specialty. What he should be doing is finding the radiation oncologist nearby with the most experience in gamma knife and sending people with this problem there and getting referrals back for those 5% who fail gamma knife.

          • LibrarianSarah

            Ah that makes sense. I considered that was probably the case right after I posted my comment and then figured

        • Allie P

          Yeah I’m kind of shocked he didn’t refer out to a specialist.

      • SF Mom & Psychologist

        With my bother’s brain tumor (malignant, dx’d a year ago, stable at present), he had a similar experience. He lives in a small city, and the neurosurgeon there tried to convince him to get treated locally – said there wouldn’t be much difference. NOT TRUE! Fortunately, he had some strong connections advising him to get the most advanced treatment, so he traveled to the Cleveland Clinic (and lived there for 8 weeks). His treatment was incredible – they actually woke him DURING his brain surgery to test sensation!

        The craziest part is that he went home 48 hours after his surgery. Same amount of time you’d stay after a vaginal delivery…

        • Guesteleh

          I know of a study that demonstrated the poorer outcomes in black men with prostate cancer can be explained in part by the fact they are less likely to be treated at a National Cancer Center. It really is scary that local docs aren’t acknowledging their limitations.

          • demodocus’ spouse

            I wonder how similar outcomes are for black men in Cleveland.

          • The Computer Ate My Nym

            Probably depends on their insurance type and whether the Cleveland Clinic is willing to take Medicaid.

          • demodocus’ spouse

            I know our satellite campus of the Clinic does take medicaid in the Emergency Department, don’t know about the rest. There’s also Case Western University Hospital and Metrohealth, both of which are no slouches, and I believe Metro does take Medicaid.

          • Liz Leyden

            Some people just want to stick with what they know. My mother’s colon cancer was already metastatic when it was diagnosed, but I wonder if things might have turned out differently if she had been treated at Dana Farber, instead of her local hospital.

            On the other hand, a Cleveland Clinic doc failed to find my (black) aunt’s uterine cancer. It was finally diagnosed during her autopsy.

          • demodocus’ spouse

            Your poor aunt! I’ve noticed opinions vary quite a bit around here whether the Clinic or University hospital is better or whether to go elsewhere entirely. My local is a satellite of CC.

  • Amy M

    How the extreme lactivist LCs? Based on yesterday’s post and discussion, I think its unethical to condone the withholding of formula from a hungry baby in the name of breastfeeding, but if LCs just told everyone to supplement for a couple of days while establishing nursing, they’d be out of a job I guess. What point would there be to have a whole certification program with classes that the teachers or institutions can charge money for, if any nurse or mother or friend could just help out with temporary formula supplementation?

    • anh

      exactly. I wonder how many of these LCs see a new mom and and tell immediately she has IGT, but instead of saying “you’re never going to produce a full milk supply” they instead tell her to do a million things, and meet three more times with her for weighed feedings or other nonsense

      • yentavegan

        and their need to take charge so that they can charge impacts ALL the information/advice given to a mother. Rather than suggest a mother take her infant to a doctor LC’s recommend chiropracters, natruropaths and cranial sacral therapists. It is like the underside of a rock and watching what dreggs crawl out…

    • slandy09

      An IBCLC told me when my daughter had lost weight at 2 weeks (thanks to me stupidly following a pediatrician’s bad advice) that if my daughter did not start gaining weight in the following two days, I would need to supplement with formula. She was very non-woo and just gave it to me straight. I didn’t end up needing to supplement, but I am grateful that she wouldn’t have shied away from helping me figure out supplementation had I needed to.

      • Amy M

        I’m not saying they are all like that, I said the extreme lactivist ones. It’s great you found one that was genuinely helpful! 🙂