I am horrifed by my most recent “award.” Not by the “award” itself; it’s the usual fact-free drivel that passes for humor among homebirth advocates:

I am very pleased to announce that the inaugural Wingnut Awards have been voted upon by JB [Joyous Birth] festival attendees, and that the following nominees have been successful in achieving the status of Wingnuttery…

The Wingnut Award for Online Contributions to the Homebirth Disinformation Campaign was awarded to Dr Amy. Congratulations Dr Amy! If anyone knows where we can send her certificate, please let us know!

… [C]ongratulations to the winners. Craptastic effort all round! Good thing there are still so many people happy to shoulder the burden of keeping women in our place or who knows what we might achieve?!

That’s your standard homebirth advocates’ charge against me, and, as usual, no one dares to site a specific instance of “disinformation” for fear that it will be shown that I am right and they are wrong.

No, I’m not horrified by the award; I’m horrified by the presenter, Janet Fraser, the leading Australian advocate of unassisted childbirth (stuntbirth). I’m distressed that any woman would consider sacrificing the life of her child for bragging rights, but I’m appalled that someone whose baby is actually dead as the result of her selfishness and self-absorption would go on being self-absorbed.

Janet Fraser, have you no shame? Your precious baby is dead and your refusal to seek prenatal care or assistance in birth is very likely to blame. And, amazingly, you are treating the entire subject as a big joke.

Fraser was interviewed in late March 2009, supposedly after labor with her third child had begun:

Janet Fraser is in labour… Has she called the hospital to let them know what’s happening? “When you go on a skiing trip, do you call the hospital to say, ‘I’m coming down the mountain, can you set aside a spot for me in the emergency room?’ I don’t think so,” says Fraser, whose breathing sounds strained.

This is pretty much where we end the conversation that started with me calling Fraser and asking if it was true that her organisation, Joyous Birth, was advocating that women go it alone giving birth at home, with no midwife or GP or bags of resuscitation gadgets.

“Free-birthing, plenty of women do it,” she says. In fact, Fraser is doing it right now. “I prefer to be an autonomous care-provider,” she says…

Janet Fraser’s son, 5, was planned as a home birth, but came into the world via an emergency caesarean after Fraser was transferred to hospital. Her daughter, 2, was born at home with a midwife attending.

Fraser is 40. She hasn’t seen a doctor or any health professional since becoming pregnant this time. No ultrasound, no genetic testing, no internal examinations, no stethoscope. Does she have any feeling for how long the labour will go? “I could do this for days. My daughter’s birth was 50-something hours. You just do it — it’s just birth, a normal physiological process.”

And death in childbirth is also a normal physiologic process, albeit less than ideal. It happens like this:

… [T]he natural water birth of her third child, a girl, at her home went horribly wrong in the early hours of March 27.

Ambulances were sent to the address following a triple-0 call made at 1.13am.

An ambulance service spokesman said paramedics were called to a Croydon Park address for a newborn baby who had suffered cardiac arrest and was not breathing.

Paramedics failed to revive the baby throughout the journey to the Royal Prince Alfred Hospital at Camperdown.

“They were basically working on the baby all the way to the hospital,” the spokesman said.

Looking at Fraser’s website and blog, I can find no mention of the dead baby. Indeed, I can find no evidence that Fraser has publicly mentioned the baby since her death. Not only was the baby’s life erased by her mother’s tragic self-absorption; the baby’s very existence has been blotted out to continue the illusion that unassisted childbirth is safe and “joyous.”

But a full term baby who dies in labor should not be forgotten so easily. Tell us, Ms. Fraser, how joyous is the birth if the baby is dead?

You may remember Gloria Lemay. She’s the Canadian lay midwife with no formal training who has learned nothing from presiding over a number of homebirth deaths. Now she has graced us with an obnoxious post entitled 7 Step Recipe for Creating an Autistic Child:

1.Allow ultrasound technicians to “date” your pregnancy, see if you have twins, check the growth of your baby. Even one ultrasound affects your baby’s brain. Multiple ultrasounds will move cells in the brain around and also affect future generations of your family.

2.Eat whatever you like in pregnancy. Don’t take the time and trouble to study the effects of over-processed, high fat diets. Don’t worry about buying organic produce and meat.

3.Let your physician induce you. Induction drugs over-ride Nature’s pace of the birth process. They cause prolonged periods of oxygen deprivation similar to holding a pillow over your child’s face. Any form of hurrying you into the birth process or, once into it, hurrying the process faster than it goes naturally will damage cells in the baby’s brain.

4.Take pain-killing drugs during your child’s birth. Every anesthetic goes immediately to the baby so choose whatever one you like. The longer the baby is medicated, the more brain damage is done.

5.Continue on with the interventions in birth by having a cesarean, forceps or vacuum pull out of your baby. None of these procedures are gentle. All involve incredible traction on the baby’s neck and head. Sometimes all three are used on the same baby. Risks of all 3 are increased when inductions and epidurals were brought into the birth.

6.Once your baby is born, feed him/her solutions made by pharma giants like Mead Johnson.

7.Be sure to inject your baby with every toxic pharmaceutical vaccine that your doctor recommends. Don’t do any research. 36 vaccines is the modern North American child’s recommended allotment of mercury preserved toxic waste.

How amazing. Scientists have been puzzling for years over the cause of autistic spectrum disorders and the latest evidence points to a genetic component, but Ms. Lemay, with NO RESEARCH of any kind, believes that she has solved the problem. And, coincidentally, it turns out that autism is caused by interventions in childbirth.

It’s all so simple. Autism is caused by ultrasound. Wait, no, it’s caused by eating the wrong food in pregnancy. Oops, I spoke too soon, it’s caused by pitocin. No, silly me, it’s caused by epidurals. Wrong again, it’s caused by C-section.

Hmmm, maybe it isn’t caused by interventions in childbirth after all. It’s caused by formula. Wait, no, it’s caused by mercury in vaccinations. Vaccines no longer have mercury in them? No problem, it must be caused by the vaccinations themselves.

Ms. Lemay is another winner of coveted “Skeptical OB Stupidity Trifecta award”. As an ignorant person with no formal training in science, statistics or medicine, she boldly goes were no stupid person has gone before. And, as a special bonus, she manages to be thoroughly offensive at the same time.

Here is a little background on Ms. Lemay. The following excerpt is taken from the judgment issued by the Supreme Court of Canada:

Sullivan and Lemay were hired by JV to provide private pre-natal classes and to act as midwives during a home birth. Although Sullivan and Lemay had some experience with home births and had done background reading, they had no formal medical qualifications.

After five hours of second stage labour, the child’s head emerged and no further contractions occurred. Sullivan and Lemay attempted to stimulate further contractions but were unsuccessful. Direct pressure was applied to the uterus, causing soreness to the mother’s stomach and back and some bruising. Approximately twenty minutes later, Emergency Services were called and the mother was transported to the hospital. Within two minutes of arrival, an intern delivered the baby using what the trial judge characterized as “a basic delivery technique”. The child showed no signs of life and resuscitation attempts were unsuccessful.

Sullivan and Lemay were jointly charged with one count of criminal negligence causing death to the child of JV contrary to s. 203 of the Criminal Code, and a second count of criminal negligence causing bodily harm to JV contrary to s. 204. They were tried in the County Court of Vancouver and were found guilty on the first charge and were acquitted on the second charge.

Lemay has also been convicted of criminal contempt of court for practicing midwifery without appropriate training and without a license. According to the College of Midwives of British Columbia:

On January 4, 2002, BC Supreme Court Justice Blair found Lemay guilty of criminal contempt of court for attending ten births over a five-month period in defiance or the court injunction. At sentencing, the judge rejected Lemay’s lawyer’s request to impose a conditional sentence. The judge said he was not satisfied a conditional sentence would protect the safety of the public. “This is not an isolated breach but a continued series of breaches,” the judge said in his oral reasons for judgement.

Late in January of 2002, just weeks after being found guilty, Lemay managed another labour planned to be a home birth, which was later investigated by the police after the parents filed a complaint. This non-progressive labour went on for more than two days. Lemay is alleged to have performed a number of restricted acts during that time, including artificially rupturing the membranes. When meconium was apparent, Lemay is said to have stayed at home with the labouring mother for many more hours.

During sentencing the judge made note of this incident, pointing out that when the fetus became compromised Lemay failed to accompany the mother to Burnaby Hospital and told the mother not to mention Lemay’s name to hospital staff. An emergency cesarean was required.

Justice Blair indicated that this incident exacerbated Lemay’s problem and was indicative of her character.

Justice Blair also noted Lemay was previously found in contempt of court for refusing to give testimony at an inquest probing the 1994 death of a newborn in her care. The inquest found that the baby died of cardiac arrest as a result of an infection acquired during this birth attended by Lemay.

Lemay, legally sanctioned for negligence in the death of two babies, and informally acknowledged to be present at other homebirth deaths is considered an “expert” in the homebirth community. Her inane pronouncements are what passes for “education” among homebirth advocates. The fact that she thinks she is in a position to offer “advice” to anyone is scandalous. The fact that anyone would take her “advice” is absurd.

Ms. Lemay is right about one thing, though. If you hire her as a midwife and your baby dies as a result of her idiocy, it will not develop autism. Somehow I doubt that is comforting to the parents of the many dead babies she has delivered.

It’s not often that you find scary stories in scientific journals, but a new paper in the journal Microbiology offers a scary story indeed. Effect of subinhibitory concentrations of chloride on the competitiveness of Pseudomonas aeruginosa grown in continuous culture does not sound particularly menacing, but this paper raises the spectre that the antibacterial cleansers used every day to clean our homes and ourselves may lead to bacteria that are resistant not only to the cleansers but to powerful antibiotics as well.

Americans have become obsessed with “germs.” While there are certainly harmful bacteria and viruses that we would do well to avoid, the environment is full of bacteria and viruses that are harmless to humans. Antibacterial cleansers target all bacteria, regardless of whether or not they are harmful. That might be appropriate in the setting of the operating room, but it is excessive in non-medical settings. Yet manufacturers of anti-bacterial cleansers suggest otherwise:

Some days it seems like the kitchen is more than the center of your house—it’s the entire house. It’s the room where you and your family gather and where your “stuff” tends to end up too. No matter how much it becomes the hub of your home, the kitchen is still where you prepare and eat your meals—and where you are probably most concerned about bacteria and other germs spreading from surface to surface. That’s why we’ve invented a simple solution that will help you easily keep your kitchen clean and disinfected.

Clorox® Disinfecting Kitchen Cleaner kills 99.9% of common household the bacteria and other germs that can make your family sick. Plus, its bleach-free formula also cleans countertops, tabletops, and tough surfaces like stainless steel to a streak-free shine. It’s an effective formula you can use on almost any surface.*

Well, maybe antibacterial cleansers aren’t really necessary in the home, but there’s no harm, right? Actually, it seems like the widespread use of these cleansers has the potential to cause serious harm.

The active ingredient in Chlorox Disinfecting Kitchen Cleaner, and many other antibacterial cleansers, is benzalkonium chloride. The authors of the new paper suspected that Pseudomonas aeruginosa bacteria can become resistant to benzalkonium chloride if they are exposed to low concentrations of the chemical. In addition, they postulated that if bacteria became resistant to benzalkomium chloride,they would also become resistant against antibiotics that kill bacteria in similar ways.

If Pseudomonas is exposed to high concentrations of benzalkonium chloride, all the bacteria will die. However, if the bacteria are exposed to lower concentrations of benzalkonium chloride, some bacteria will die, but others will become resistant to the antibacterial cleanser. That, in itself, is worrying. If we continually wipe down our kitchen counters with benzalkonium chloride, Pseudomonas will eventually become resistant, making the antibacterial cleanser useless.

Even more concerning is the fact that the bacteria that became resistant to benzalkonium chloride also became resistant to the antibiotic ciprofloxin, even though the bacteria had not been exposed to ciprofloxin. It seems that the adaptation that allowed the bacteria to resist the effects of benzalkonium chloride also allows the bacteria to resist the action of ciprofloxin.

In other words, the use of the antibacterial cleanser eventually rendered the cleanser ineffective. That’s disturbing, but not surprising. What is surprising is that the bacteria that were resistant to the cleanser could no longer be killed by the antibiotic ciprofloxin. In attempting to make our environment safer, we may actually be making it far more dangerous.

The problem of antibiotic resistance has been known for decades and we have learned that antibiotics should only be used when absolutely necessary in order to limit the possibility of bacteria becoming resistant. This paper suggests that the same warning should apply to antibacterial cleansers as well. They should only be used when absolutely necessary, and not used indiscriminately to “keep your kitchen clean and disinfected.” The use of antibacterial cleansers is not merely unnecessary; it has the potential to be very harmful.

Ricki Lake tweeted her followers this morning:

152 comments on our site
@mybestbirth.com taking on Dr.
Amy,AKA ‘The Skeptical OB’Check
out the amazing dialogue taking place. add your 2¢

Ms. Lake is referring to the post, Amy Tuteur, aka “The Skeptical OB,” Has a Blatant Issue With Home Birth, and the comment thread that extended for several weeks and 152 entries thusfar. I’m a bit surprised that Ms. Lake is proudly pointing to the discussion since I presented the scientific evidence on a number of aspects of homebirth and no one had an effective response. Here’s the latest comment I left on her site:

“I’m so glad that Ricki Lake tweeted her followers to check out this post. It gives me an opportunity to summarize what I have said and to point out the many inaccurate claims that Ms. Lake has made about homebirth.

I’d be happy to discuss with Ms. Lake any of the following facts that I presented (Ms. Epstein promptly disappeared from the comment thread when I offered to debate her):

1. Childbirth is INHERENTLY dangerous. It is and has always been one of the leading causes of death of both young women and babies.

2. The best study of American homebirth midwifery (Johnson and Daviss, BMJ 2005) actually shows that homebirth with a CPM has triple the neonatal death rate of hospital birth for comparable risk women. The authors hid this by failing to compare homebirth in 2000 with low risk hospital birth in 2000.

3. The CDC statistics for linked birth infant death show that homebirth with an American homebirth midwife is the MOST DANGEROUS form of planned birth in the US. Planned homebirth with a homebirth midwife has triple the neonatal death rate of low risk hospital birth.

4. The recent publication of the Dutch and Canadian studies is bad news for American homebirth. The studies shows that homebirth with an American direct entry midwife has more than triple the death rate of homebirth with a Canadian midwife or a Dutch midwife. The central lesson of both studies is that homebirth can only be safe when practiced by highly educated, highly trained midwives under rigorously controlled conditions, a position in direct opposition to the philosophy of American homebirth.

5. The Colorado Midwives Association reported its own mortality statistics. Colorado LICENSED midwives have an appalling rate of perinatal mortality of approximately 8/1000 (and rising), far exceeding the perinatal mortality rate for low risk births in Colorado.

6. Homebirth advocates like to quote US infant mortality statistics, but infant mortality is a measure of pediatric care. According to the World Health Organization, the correct measure of obstetric care is PERINATAL mortality and according to the World Health Organization, the US has one of the LOWEST perinatal mortality rates in the world, LOWER than Denmark, the UK and The Netherlands.

That’s just a few of the facts that I have presented. I would be happy to discuss them publicly with you any time Ms. Lake. A public discussion, in print or in person, would give all women the opportunity to evaluate your claims and my claims for themselves. If you are sure that you have made accurate claims you have nothing to fear.

I’d be happy to debate you in any neutral forum of your choice, Ms. Lake. How about it?”

Imagine an argument that goes like this.

Jane: Australians are thieves.
John: Can you prove that?
Jane: Are you saying that no Australians have ever stolen anything?

Jane has committed the fallacy of the lonely fact. Knowing that at least one Australian has stolen something, she has concluded that all Australians are thieves. The example of the Australians shows that it is an absurd “argument” but it is a favorite of “natural” childbirth advocates and lactivists.

For example:

NCB Advocate: Obstetrics is not evidence based.
Me: Can you prove that?
NCB Advocate: Are you saying that no principle of obstetrics has ever been proven wrong? Look at what happened with episiotomies.

Or:

NCB Advocate: C-sections are usually unnecessary.
Me: Can you prove that?
NCB Advocate: Are you saying all C-sections are necessary? I know for a fact that my cousin’s C-section was unnecessary.

Or a slightly different formulation:

Me: The benefits of breastfeeding have been overstated.
Lactivist: So you’re saying that breastfeeding is no better than bottle feeding?

In every case, the reasoning is based on the assumption that a specific example tells us something about the whole. The fact that episiotomies were used even though scientific evidence later showed them to have no benefit is used to justify the assumption that everything in obstetrics is used even though there is no scientific evidence to support it. A single (or a few) unnecessary C-sections are used to justify the assumption that all (or most) C-sections are unnecessary. In the third example, a single criticism of the benefits of breastfeeding is used to justify the assumption that I believe that breast feeding has no benefit at all.

The fallacy of the lonely fact is often used by “natural” childbirth advocates, lactivists, and many proponents of alternative health. It is meant to substitute for a lack of actual evidence. “Natural” childbirth advocates don’t know whether specific obstetric recommendations lack evidence, and they don’t want to bother finding out. They use one example and generalize to everything else. C-section activists don’t know what proportion of C-sections are unnecessary. The fact that some may be unnecessary is enough for them to assume that all (or most) are unnecessary. Lactivists routinely overstate the benefits of breastfeeding, and when question, don’t bother to find out the magnitude of the benefits. They prefer to claim that anyone who questions any benefits questions all benefits and therefore can be dismissed.

The fallacy of the lonely fact is a fallacy because it is based on the assumption that a specific example (episiotomies, for instance) can be generalized to the every possible example (all of obstetrics). Just as the fact that one or even more than one Australian stole something doesn’t make all Australians thieves, a single example can never be assumed to apply universally.

At first glance, the graph above appears to represent an indictment of contemporary obstetric practice. From 1970-1980, the C-section rate rose precipitously, and the neonatal mortality rate also dropped precipitously. Since then, the C-section rate has continued to rise ever faster, but neonatal mortality, although continuing, has declined at ever slower rates. Yet this is exactly what we would predict if the C-section rate were following the law of diminishing returns.

According to Wikipedia, the law of diminishing returns (also known as the law of marginal utility) means:

… in a production system with fixed and variable inputs (say factory size and labor), there will be a point beyond which each additional unit of the variable input (i.e., man-hours) yields smaller and smaller increases in outputs, also reducing each worker’s mean productivity. Conversely, producing one more unit of output will cost increasingly more (owing to the major amount of variable inputs being used, to little effect).

In the case of Cesarean sections, the law of diminishing returns would predict that there will be a point beyond which each addition increase in C-section rate yields smaller and smaller decreases in neonatal mortality rate.

Imagine a hypothetical first world country that has 1 million births per year. In this hypothetical country, we are able to analyze the number of lives saved by C-sections and we are able to analyze it in hindsight so that we know which C-sections were necessary. As the C-section rate rises, the numbers of lives saved drops off (diminishing returns). In our hypothetical country, we can chart how many lives are saved for each percentage point of the C-section rate. Each percentage point of the C-section rate represents 10,000 C-sections. Our chart might look something like this:

We can see the law of diminishing returns in action here. At a C-section rate from 0-5%, every C-section is necessary, and every C-section saves the life of both mother and baby. From 6-10% every C-section is necessary and saves the life of the baby. From 11-15% half the C-sections are necessary, resulting in a savings of 5000 lives. At rates higher than 15%, retrospective analysis reveals that far fewer C-sections are life saving. By the time a C-section rate of 35-40% is reached, only one additional baby will be saved every other year.

The results can be expressed another way. We can determine retrospectively how many C-sections were unnecessary. Here’s that chart:

So the law of diminishing returns tells us that, beyond a certain point, we will have to do more C-sections to save one neonatal life. In other words, beyond a certain point, we will have to do more unnecessary (in retrospect) C-sections for each life we save.

Of course, that tells us about C-sections in the aggregate, but the decision to perform a C-section is made on a case by case basis. Moreover, in court, the decision to find an obstetrician guilty of malpractice for not performing a C-section is also made on a case by case basis. The parents and the court really don’t care how many unnecessary C-sections you have to do to save one baby, if that baby is their baby.

Yet the C-section rate can be too high. When you get to the point that you are saving 1 baby every 10 years, the C-section rate is clearly too high. However, a tremendous premium is placed on the life of each and every baby. That societal value is reflected in the fact that our judicial system operates as if we believe that if a C-section had even a remote chance of preventing the death or disability, that C-section should have been done, and because it wasn’t done, the parents should be compensated.

The above graph represents what we appear to believe about the value of the life of each baby. Personally, I think the standard should be different. The number of unnecessary C-sections done to save one baby every decade should not be unlimited. The standard for determining fault in an obstetric malpractice case should not be to show that a C-section “might” have prevented a baby’s death or disability; the standard should be that the doctor could have reasonably foreseen (based on the evidence available) that a C-section was necessary to prevent the baby’s death or disability.

C-sections come with costs. We have not even talked about the financial costs, because, in my judgment, these are secondary. However, very large numbers of unnecessary C-sections will result in unnecessary complications and unnecessary deaths. If the C-section rate continues to rise, these unnecessary complications and unnecessary deaths will increase from relatively uncommon occurrences, to occurrences that far outweight the number of babies’ lives saved.

We, as a society, need to think about where we draw the line, because we, as a society, through our punishments and incentives, determine how high the C-section rate should be. The graph above is not an indictment of obstetrics. It is a warning to us to consider what we truly value. Do we really believe that it is worth any number of C-sections to save one baby’s life? We certainly act as though we do.

On its website, Midwifery Today features a timeline entitle The History of Midwifery and Childbirth In America. The timeline extends from 1660 to the late 1990’s. It contains interesting tidbits of information about childbirth practices, interspersed with general historical events. It seems quite comprehensive with the exception of one curious omission. It barely mentions mortality statistcs.

To my mind, the history of childbirth is a continuing effort to master its inherent dangers. Childbirth is and has always been, in every time, place and culture, one of the leading causes of death of young women and the leading cause of death of newborns. Indeed, the primary purpose of a childbirth attendant is to increase the chance that the mother will live, at least, and hopefully the baby will live too.

The secondary purpose of a childbirth attendant is to comfort the mother as she endures the excruciating pain of labor. The history of childbirth has also been a continuing effort to master the pain of childbirth. That’s another curious omission from the Midwifery Timeline. It makes no mention of chloroform, general anesthesia or epidurals, arguably among the most important advances in the history of childbirth.

I suspect that the reason for these glaring omissions reflects the direct entry midwifery obsession with process. The outcome, whether or not the mother or baby lived, is virtually irrelevant.

Perhaps another reason why the timeline is silent on the issue of mortality statistics is that they illustrate the spectacular success of modern American obstetrics. For hundreds of years midwives presided over childbirth and had almost no impact on the appalling rates of maternal and neonatal mortality. It was only with the advent of modern obstetrics that the mortality rates began to fall.

I thought it might be interesting to look at the statistics that the Midwifery Today timeline left out. I took as the starting point the timeline itself. It faithfully chronicles the movement of birth from the home to the hospital starting in 1900. In every decade, it reports the ever increasing percentage of hospital births. Yet it is silent on massive declines in maternal and infant mortality that occurred simultaneously. For each point in the timeline where the percentage of hospital deliveries is mentioned, I looked up the corresponding maternal and neonatal mortality rates. The above graph is the result.

As the percentage of births in the hospital rose, the maternal and neonatal mortality plunged. The graph is a powerful way of demonstrating that the association is dramatic. During the 1900’s, for the first time in history, using the tools of modern obstetrics, the terrible inherent dangers of childbirth were mastered. Could we do even better? No doubt, and the search continues to make birth even safer than it is today. As Dr. Atul Gawande wrote in his New Yorker article (The Score, How childbirth went industrial), “Nothing else in medicine has saved lives on the scale that obstetrics has.” The graph makes that very clear indeed.

Infant and maternal mortality rates abstracted from CDC on Infant and Maternal Mortality in the United States: 1900-1999. Although neonatal mortality is a much better measure of obstetric practice, neonatal mortality figures were not collected in the earlier part of the century. Therefore, infant mortality statistics are used as a proxy, albeit imperfect.

Proponents of “alternative” medicine often disagree profoundly on treatment methods. Sick? In pain? Try this homeopathic remedy that contains no active ingredients. Stick needles into acupressure points. Wear magnetic foot pads to pull the toxins out of your body.

But on one point all proponents of “alternative” medicine agree. Since the source of all your troubles is a weak immune system, the key to treating and preventing all illness is “strengthening the immune system.” Indeed, this belief is so widespread, it appears that the only people who don’t subscribe to it are people who actually know something about the immune system, doctors, immunologists, microbiologists, etc. The idea that disease can be treated and prevented by “strengthening the immune system” depends on a profoundly flawed, almost cartoon like, view of the immune system itself.

The immune system is tremendously complicated, involving as it does innate cellular immunity and humoral (antibody) immunity. Multiple poorly understood organs make up the immune system. Anyone actually know what the spleen is for? And how about lymph nodes and bone marrow? Those are also quite complex. It is the interactions of these types of immunity, within the various organs of the immune system and throughout the body that determine whether and how we can fight off disease.

The “alternative” medicine view of the immune system, which is the same as the lay view of the immune system, is cartoon like in its simplicity. The individual components of the system, and their specific functions are never discussed or even mentioned. Too complicated. The cascade of events that occurs when the body’s outer defenses of skin or other tissues are penetrated by a foreign substance is completely ignored. Also, too complicated.

Instead, the immune system is conceptualized as a unitary entity that it either weak or strong. If you get sick, your immune system must be weak. In order to prevent illness, or to treat it once it occurs, you must “strengthen” your immune system. And how do you do that? The way you do everything in “alternative” medicine: you eat the right foods, and take vitamins and supplements.

But, of course, as doctors know, illness is not caused by a weak immune system. The specific mechanisms of illness depend on the specific causes. One possible cause is a failure of innate cellular immunity to find and destroy bacteria that penetrate the barrier of the skin. Another possible cause is the inability of the humoral (antibody) system to create antibody fast enough to overwhelm a viral invader. Instead, the invader gets a tremendous head start before the body can fight back and the virus overwhelms the host. Yet another factor is the presence or absence of various immune system organs. For example, it is well known that removal of the spleen leaves people particularly vulnerable to infection by the pneumococcus bacteria.

In every case, the disease results from a complex interaction between the disease causing agent and a specific component of the immune system. Moreover, there is no evidence that nutrition, vitamins or supplements can do anything to change the balance in these interactions, since the fundamental problem is not malnutrition, or vitamin or mineral deficiency.

It’s not as though we don’t know what a truly weakened immune system looks like. Chemotherapy (which preferentially kills fast growing cells) and certain disease like AIDS, knock out one or more components of the immune system, rendering people more susceptible to disease. If enough of the immune system is compromised or destroyed, the individual becomes vulnerable to infections that would otherwise be harmless or never occur in the first place.

In addition to ignoring what a weakened immune system looks like, and imagining that nutrition is the source of “strength” of the immune system, advocates of “alternative” medicine and lay people have another naïve belief about the immune system. They appear to think that the immune system can be overwhelmed by too much information. Ignoring the fact that each individual faces hundreds, thousands or more immune challenges each day, “alternative” medicine advocates argue that vaccines, particularly those designed to immunize against more than one disease at a time, “overwhelm” the immune system, particularly what they imagine to be the “underdeveloped” immune system of small children.

Ironically, the truth is exactly the opposite. Vaccines are one of the few things, if not the only thing, that can strengthen the immune system by giving it a head start against a microscopic invader. Humoral (antibody) immunity takes time to ramp up if the body has never seen the invader before. It’s as if the body can’t start making weapons until it has already been invaded. Vaccines act like a picture of the enemy. Vaccines allow the body to “see” what the invader looks like before the invasion, and to stockpile weapons for the coming fight. When the assault ultimately occurs (when the person is exposed to the disease), the counterattack can begin without delay, and therefore it is much more likely to be successful.

As a general matter, a detailed understanding of system function is not necessary for lay people to understand what the system does. People do not need to know about all the different clotting factors to understand that blood should clot when you are cut and that something is wrong if it doesn’t clot. No one would invoke the idea of a “weak” clotting system to explain why a hemophiliac is bleeding to death, and no one would recommend eating the right foods, or taking vitamins or supplements to treat hemophilia.

Ordinarily, a detailed understanding of immune system function would not be necessary for lay people to understand what the system does. Unfortunately, a detailed understanding of the immune system has been replaced with a cartoon like caricature of the immune system, leading lay people to believe that it is either weak or strong, and that it can be strengthened by eating right. It is this cartoon like view that makes lay people vulnerable to the claims of “alternative” medicine practitioners and it is this cartoon like view that must be changed.

The hallmark of homeopathy is the belief that tiny doses of medicinal substances have big effects. It’s like insisting that the less salt you put in water, the more salty the water will taste. In other words, it defies common sense, is scientifically unfounded, and has been thoroughly debunked.

Even more inane than the concept of homeopathy are its proponents’ attempts to explain how it works. Homeopathy is, perhaps, the paradigmatic pseudoscience, and like most pseudosciences, it invokes science while at the same time ignoring the scientific evidence.

One of the best (and inadvertently funniest) examples can be found on today’s Huffington Post. Dana Ullman has written How Homeopathic Medicines Work: Nanopharmacology At Its Best.

Pseudoscience advocates have learned the benefits of clothing pseudoscience in “scientese,” language that sounds scientific but makes no sense. “Nano” sounds scientific, so Ullman insists that homeopathy is “nanopharmacology.’ As Ullman breathlessly explains:

Although the word “nano” also means one-billionth of a size, that is not its only definition. In fact, “nano” derives from the word “dwarf,” and “nano” is the only word in the English language that is used on common parlance as denoting extremely small AND yet extremely powerful.

Sounds cool and so scientific, doesn’t it? Just a few minor problems, though. First, nano does not mean powerful and has nothing to do with power. Second, there is a scientific discipline of nanopharmacology and it means something very different than what Ullman pretends it means.

According to Nanopharmacology.com:

Nanopharmacology is the use of nanotechnology for — discovery of new pharmacological molecular entities; selection of pharmaceuticals for specific individuals to maximize effectiveness and minimize side effects; and delivery of pharmaceuticals to targeted locations or tissues within the body. Nanotechnology will generally be defined as the science of constructing and assembling objects on a scale littler than one hundred nanometers. The end results of nanotechnology may be miniature particles (in powders, lotions or coatings) or macro-scale objects with nanoscale modules and unique characteristics.

In other words, nanopharmacology refers to the size of the medication delivery system, NOT the dilution of the medication.

How does homeopathy work? Well, it doesn’t work; copious scientific evidence has thoroughly debunked homeopathy. Ullman ignores that point to speculate on various possibilities, each more ridiculous than the last.

Scientists at several universities and hospitals in France and Belgium have discovered that the vigorous shaking of the water in glass bottles causes extremely small amounts of silica fragments or chips to fall into the water. Perhaps these silica chips may help to store the information in the water, with each medicine that is initially placed in the water creating its own pharmacological effect.

Or, perhaps these silica fragments do nothing. Certainly it doesn’t help water “store information” since that is a chemical impossibility.

Or maybe it’s the bubbles:

Further, the micro-bubbles and the nano-bubbles that are caused by the shaking may burst and thereby produce microenvironments of higher temperature and pressure.

If it’s not the silica fragments or the bubbles, maybe it’s the waves:

Normal radio waves simply do not penetrate water, so submarines must use an extremely low-frequency radio wave. The radio waves used by submarines to penetrate water are so low that a single wavelength is typically several miles long!

If one considers that the human body is 70-80 percent water, perhaps the best way to provide pharmacological information to the body and into intercellular fluids is with nanodoses. Like the extremely low-frequency radio waves, it may be necessary to use extremely low (and activated) doses for a person to receive the medicinal effect.

Of course every self-respecting quack must invoke, and profoundly misinterpret, quantum mechanics:

Quantum physics does not disprove Newtonian physics; quantum physics simply extends our understanding of extremely small and extremely large systems. Likewise, homeopathy does not disprove conventional pharmacology; instead, it extends our understanding of extremely small doses of medicinal agents.

But quantum physics is involves sub-atomic particles of very small size, NOT small numbers of particles.

Homeopathy is nothing more than pseudoscience, and a particularly inane pseudoscience at that. It is not involve nanopharmacology. However, we can say that belief in homeopathy is evidence of mega-stupidity, best defined as startling gullibility combined with a profound deficit of scientific knowledge.

“Natural” childbirth advocacy is riddled with fallacious arguments and one of the most common types is known as the “argument from ignorance.” It could more properly be described as the “appeal to ignorance”; ignorance in this setting refers not to a characteristic of the person offering the argument but as a description of the quality of the evidence. Specifically, there is no evidence.

To understand how an argument from ignorance is structured, why it is a fallacy, and who might invoke an argument from ignorance, let’s start with an easily understood example from outside the realm of childbirth.

… there is nothing in the files to disprove his Communist associations.

This line was famously uttered by Senator Joseph McCarthy when accusing individuals of being secret Communist sympathizers and therefore unfit to participate in American public life. What’s wrong with this argument?

1. Arguments from ignorance typically share the same structure:

Person 1: I assert A.
Person 2: Where is your evidence for A?
Person 1: I find no evidence for “not A” so A must be true.

The argument of McCarthy followed the same structure:

McCarthy: “John” is a Communist.
John: I am not a Communist and there is no evidence to show that I am a Communist.
McCarthy: But there’s no evidence to show you are not a Communist, so you must be a Communist.

What’s wrong with this structure? It’s easy to see when the argument is about Communist sympathies. We understand that if a person is falsely accused of being a Communist, there will, of course, be no evidence that he is a Communist. Therefore, the claim that the lack of evidence “proves” he is a Communist is demonstrably false.

2. Arguments from ignorance place the burden of proof on the wrong person.

In logical argument, the burden of proof is on the person making the claim. If McCarthy wants to claim that John is a Communist, McCarthy must provide the proof. It is not up to John to prove that he is not a Communist. Indeed, there is no way to prove that you are not a Communist since there is likely to be no evidence of any kind.

3. Arguments from ignorance are usually invoked when the person making the claim has no evidence for the claim.

It is a tactic of desperation. If the person making the claim had evidence, he would present it. An argument from ignorance is an implicit acknowledgment that there is no evidence for the claim.

4. The person making the claim generally has a specific ideological reason for doing so.

McCarthy wanted to shame the Truman administration and punish those he did not like. He was not interested in following evidence where it led. He had determined the conclusion in advance and created an “argument” that allowed only for that predetermined conclusion.

What I find particularly instructive about the McCarthy example is that we understand that if the person is truly not a Communist, the fallacious argument will be impossible to disprove. In other words, the more likely it is that he is not guilty, the more difficult it will be to prove that he is not guilty.

Let’s turn to ways in which “natural” childbirth advocates use the argument from ignorance. They almost always deploy it when confronted with evidence that undermines their ideological beliefs. They have a predetermined conclusion in mind, and they are committed to ignoring any evidence that stands in the way of that conclusion.

“Natural” childbirth advocates are sure that modern obstetrics is harmful, not helpful. The evidence is not on their side, however. The neonatal mortality rate has dropped 90% and the maternal mortality rate has dropped 99% since the inception of modern obstetrics. “Natural” childbirth advocates don’t want to accept the evidence and often make the following argument from ignorance to me:

NC Advocate: Improvements in sanitation are the true cause of the decline in neonatal and maternal mortality.
AT: Where is the evidence for that claim?
NC Advocate: Can you show that sanitation didn’t cause the decline in mortality rates? If you can’t then it is perfectly reasonable to assume that sanitation did cause the decline in mortality rates.

Of course, if sanitation didn’t cause the decline, there would be no evidence to show that it didn’t cause the decline. So it is entirely unreasonable to conclude that the lack of evidence about sanitation shows that modern obstetrics cannot take credit for the decline in mortality rates.

Homebirth advocates make a similar argument when confronted with the data that homebirth increases the neonatal mortality rate compared to low risk hospital birth. Their predetermined conclusion is that homebirth is as safe or safer than hospital birth and they must reach that conclusion regardless of the evidence. Hence the following argument:

HB Advocate: Well the data may show that homebirth increases the risk of neonatal death, but hospital birth increases the risk of postneonatal death even more. Lots of babies hurt by obstetrics interventions die from those interventions, but only after 28 days has passed.
AT: Where is the evidence that hospital birth increases the postneonatal mortality rate?
HB Advocate: Where is the proof that hospital birth doesn’t increase postneonatal mortality. If you can’t present proof, then it is perfectly reasonable to assume that hospital birth increases the risk of postneonatal mortality.

In this case, it is actually possible to prove that hospital birth does NOT have a higher ponstneonatal mortality rate than homebirth. Indeed, in the few data sources available, homebirth has a higher postneonatal mortality rate as well as a higher neonatal mortality rate. So homebirth advocates have used ignorance of the existing data to speculate on what that data shows.

The bottom line is straightforward. Any claim requires proof presented by the person who makes the claim. Those who don’t believe the claim are not required to provide evidence that it is not true. Lack of evidence that the claim is not true in not proof that it is true or even a plausible reason to suspect that it might be true.