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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where’s the outrage?

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

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

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

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

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

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

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

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

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

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

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

And as Kukla observes:

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

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

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

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

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

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

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

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

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

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

Vibrator use was associated with positive sexual functioning.

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

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

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

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

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

Why might the makers of Trojans commission a vibrator study?

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

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

What does it mean to be educated in a particular discipline? Whether that discipline is architecture, anthropology, or law, being educated generally means years of study, thousands of hours of experience, and intimate acquaintance with the specialist literature.

Medicine is like that, too. It involves four years of college, four years of medical school, 3-5 years of hands on training for 80+ hours per week, countless textbooks and intimate knowledge of the relevant medical literature. No layperson is educated in medicine. The idea is simply ludicrous. Therefore, when a layperson claims to be “educated” about a particular health topic, like childbirth, or vaccination, or autism, you can be virtually assured that a stream of absolute nonsense will follow.

When a lay person claims to be “educated” about health, she certainly doesn’t mean that she went to medical school, has hands on training caring for individuals with the condition, or is familiar with the specialist literature. So what does she mean? When a layperson proudly claims to be “educated” about a health topic she means that she has adopted a cultural construction of “education” that has little if anything to do with actual knowledge of the topic.

‘Trusting blindly can be the biggest risk of all’: organised resistance to childhood vaccination in the UK (Hobson-West, Sociology of Health & Illness Vol. 29 No. 2 2007, pp. 198–215) explores cultural construction of being “educated.” As the title indicates, the authors focus on vaccine rejectionism, but the principles apply equally to natural childbirth advocacy, autism cures, and any other form of alternative health.

When advocates of vaccine rejection or natural childbirth claim to be “educated,” they are not talking about actual scientific knowledge. Indeed, the scientific data is generally ignored. The claim of being “educated” on vaccine rejection or childbirth simply stands for a refusal to agree with health professionals and refusal to trust them. Agreement with doctors is constructed as a negative and refusal to trust is constructed as a positive cultural attribute. As the authors of the paper explain:

Clear dichotomies are constructed between blind faith and active resistance and uncritical following and critical thinking. Non-vaccinators or those who question aspects of vaccination policy are not described in terms of class, gender, location or politics, but are ‘free thinkers’ who have escaped from the disempowerment that is seen to characterise vaccination…

This characterization of vaccine rejectionists or natural childbirth advocates can be unpacked even further; not surprisingly, vaccine rejectionists and natural childbirth advocates are portrayed as laudatory and other parents are denigrated.

… instead of good and bad parent categories being a function of compliance or non-compliance with vaccination advice … the good parent becomes one who spends the time to become informed and educated about vaccination…

… [vaccine rejectionists] construct trust in others as passive and the easy option. Rather than trust in experts, the alternative scenario is of a parent who becomes the expert themselves, through a difficult process of personal education and empowerment…

When a vaccine rejectionist or natural childbirth advocate claims to be “educated” on a topic they don’t mean that they have any education on the topic at all. They simply mean that they are defying authority. In their world, trusting experts is a mark of credulity, while ignoring expert advice is a sign of independent thinking and self-education. But, of course, since they don’t really know anything about the topic, they are inevitably forced to rely on the advice of propagandists, charlatans and quacks.

The person who proudly claims to be “educated” on vaccination offers as proof the fact that he ignores the expert advice of pediatricians, immunologists and virologists and embraces the teachings of … washed up Playboy Playmate Jennifer McCarthy. In their delusion, vaccine rejectionists fail to appreciate the irony. Far from being “educated,” they are unbelievably credulous.

The woman who claims to be “educated” about childbirth offers as proof the fact that she ignores the advice of obstetricians and pediatricians and embraces the teachings of … washed up talk show host Ricki Lake. Amazingly, she has no idea of how utterly foolish she sounds.

If the goal of being “educated” isn’t acquiring knowledge, what is it? The ultimate goal is to become “empowered”:

Finally, the moral imperative to become informed is part of a broader shift, evident in the new public health, for which some kind of empowerment, personal responsibility and participation are expressed in highly positive terms.

So vaccine rejectionism, like natural childbirth, is about the mother and how she would like to see herself, not about vaccines and not about children. In the socially constructed world of vaccine rejectionists, parents are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) rejectionists who are “educated” and “empowered” by taking “personal responsibility”.

A lay person’s claims to be “educated” about a health topic is really a claim of defiance. The person is proudly defying the recommendations of health experts with years of education and years of training in order to credulously accept the bizarre conspiracy theories of people who have little or no education and training in the relevant discipline. When a vaccine rejectionist or a natural childbirth advocate claims to be “educated,” she means that she has thoroughly read and blindly accepted the propaganda of other people who are equally uneducated.

When someone tells you she is “educated” on a healthcare topic, beware! There is no surer mark of ignorance on the topic than the proud claim of being “educated.”

My personal motto as a parent is: “Raise the child you have, not the one you wish you had.” It’s a lot easier said than done.

One of the most difficult tasks of parenting is to accept that your child is not you, or an extension of you. From the time of birth of each child, parents cherish hopes and dreams for those children: academic success, athletic prowess, fame and fortune are all possible. And what parent has not promised herself, this child will have opportunities that I did not have? Who has not wondered, is this the child who will fulfill my unfulfilled ambitions to be the scholar or the athlete that I wanted to be, but could not?

It is challenging enough for the parent of the average child to come to grips with the fact that the child is not going to be what you dreamed she would be. She is not Einstein, and he is not the next Babe Ruth. Even more challenging is accepting that the child is not you. She doesn’t share your love for hiking; he doesn’t want to be a doctor; they want to make different choices than the ones that you made (or wish you made).

How much more difficult then, to manage this task when your child is disabled in some way. Hence, there is an overwhelming desire to deny the truth of a diagnosis, or, more commonly, to refuse even to have the child evaluated for a diagnosis. Of course, no one expresses their denial in this way. Instead, they claim that they don’t want the child to be “labeled.” Or, even more fashionably, people assert that learning and psychiatric disabilities are “over diagnosed” among children.

There are a number of assumptions in these claims, assumptions that are not justified by the scientific evidence. These include assuming that a diagnosis is nothing more than the personal impressions of the professional who evaluated the child; assuming that children are routinely being diagnosed with conditions that they do not actually have; and assuming that a diagnosis is a “label” that is embarrassing, must be shunned, and can only hurt a child.

I’d like to look at these assumptions, which are not true, and offer an alternative explanation for the fear of “labeling.” The real fear is not that the child will be “labeled,” but that the parent of the child will be “labeled” as having a less than perfect child. In other words, it is nothing more than denial.

What does the diagnosis of a learning or psychiatric disability entail? Those who fear “labeling” imply or assume that the diagnosis of the disability is arbitrary; the psychologist or learning specialist meets the child and on the basis of impressions drawn from that meeting, and impressions drawn from speaking with parents and teachers, arrives at a diagnosis. The reality is that the diagnosis is usually reached by neuro-psychological testing.

Neuro-psych testing is complex and comprehensive. There are a seemingly endless array of tests to diagnose every disability and every possible variation of a disability. A diagnosis is not an “impression,” it is a 15-20 page report detailing the tests and results, explaining the child’s observed difficulties by reference to the results, and detailing an intervention plan that will be geared toward the way the individual child learns.

The second assumption is that children being “over-diagnosed” with learning and psychiatric disabilities. In other words, children are routinely receiving diagnoses that are not true. Curiously, this assumption is only made in regard to children. No one claims that adults who receive a diagnosis are being “over-diagnosed.” This is supposedly a phenomenon that is restricted to children, yet no one offers an explanation as to why “over-diagnosis” is restricted to children.

Is there any scientific evidence that developmentally normal children are receiving diagnoses for disabilities that they don’t have? I couldn’t find any evidence in the psychiatric literature, but I did find copious claims within the education literature that this phenomenon is occurring. Those claims were not backed by any empirical evidence, however.

I don’t doubt that parents can shop around for professionals willing to give a diagnosis in the absence of comprehensive testing. Comprehensive testing is extremely expensive and cannot be guaranteed to give the desired result. A brief consultation with a psychologist or education specialist may do the trick in that case. Yet that is not an example of children being diagnosed with disabilities they do not have. It is an example of choosing a diagnosis in the absence of the correct evaluation.

What about “labeling”? Is there evidence that “labeling” is harmful for children? I couldn’t find any. The question doesn’t even frame the issue correctly. Children with learning and psychiatric disabilities are already labeled: as “stupid,” “difficult,” “lazy” and “troublemakers.” A diagnosis replaces the existing labels that imply that a child is responsible for his own problems, with an explanation that changes everything.

For both the teacher, and for the child himself, there is a way to understand the difficulties that does not lay blame at the feet of the child. A diagnosis turns the “stupid” child into a child with dyslexia, and opens up a whole range of strategies for coping with the problem. A diagnosis turns the “difficult” child into a child with Asperger’s syndrome, who literally does not know how to react appropriately in daily situations, and opens up a different range of strategies, not to mention generating sympathy from teachers in place of disdain.

Claims that learning and psychiatric disabilities are over-diagnosed tell us more about the parents than about the children. The reality is that all too many children with serious disabilities are not diagnosed at all, because it is too damaging to the self-esteem of parents to acknowledge that a child has a problem. They claim that they don’t want their child to be labeled, but the reality is that they don’t want to be labeled as the parent of a child with a disability.

There are legitimate reasons to resist a child’s diagnosis, but that calls for a second opinion, not a rejection of the diagnosis itself. Any parent resisting a diagnosis needs to be brutally honest with him or herself: Do I truly believe that my child does not have this disability, or am I afraid to bear the sadness that comes with this Am I worried that my child will be labeled, or is my child already labeled as “stupid” or “lazy” or “disruptive”?

Many of us like to pretend that the children who use to be called a little “different” when we were kids, grew up to be happy, healthy adults. That was often not the case. There are many children who experienced unfathomable misery because they could not fit in and did not understand why.

While it is possible that some conditions can be over-diagnosed, it is equally if not more likely for them to be under-diagnosed. Too many children with disabilities, children who could be helped, are going without help because their parents wish the child didn’t have a disability, so they pretend that he doesn’t.

Raise the child you have, not the one you wish you had. It’s not easy, but it’s what every child deserves.

Jennifer Block refuses to debate the scientific evidence on the safety of homebirth. Amazingly enough she claims that as a non-scientist she isn’t really qualified to do so.

This is her complete statement:

In response to Amy Tuteur: It is my role as a journalist to report on the evidence base–that is, published, peer-reviewed research, and published, peer-reviewed critique of that research. I encourage you to publish your findings in a peer-reviewed journal. Non-scientists “debating” the science does a disservice to both the science and the women caught in the middle. (See brilliant comment above: “Who IS ‘winning’ the homebirth debate? Probably not women or babies, since they’ve become contested spaces rather than people.”)

Pulling numbers from the CDC Wonder web site to compare the outcomes of place of birth and birth attendant is not appropriate for a number of reasons, first because there’s been no analysis to control for confounding variables, and also because there’s no mechanism to separate births that were intended to happen out-of-hospital from those that were unattended accidents. Your statement about birth certificates doesn’t check out. This from Melissa Cheney:

“Oregon did not start collecting data on planned homebirth until 2008, and that data is not available to researchers yet. I know because I am first on the list to receive it. The US standard birth certificate is not used in all states and even with it, there is no way to distinguish between assisted and unassisted home deliveries. No one in the research world thinks vital records is adequate for tracking homebirth outcomes. It is simply not designed for that.”

In response to the accusation that the Midwives Alliance of North America is “hiding statistics,” it is my understanding that there are close to 18,000 records on planned, CPM-attended home births that the organization is working to make available to researchers, so that statistics can be gleaned. But like many databases, it will not be available in its raw form to the general public. Researchers will have to apply for access by submitting protocols, which is common in the research world.

My reply:

I’m disappointed in your unwillingness to debate, Ms. Block, but I’m hardly surprised; I predicted it.

“Non-scientists “debating” the science does a disservice to both the science and the women caught in the middle.”

I’m a little confused. You obviously think you know enough science to write a book promoting the safety of homebirth, run a website promoting the safety of homebirth, write articles in magazines and across web promoting the safety of homebirth, but you don’t think you know enough to debate the scientific evidence about the safety of homebirth? If you don’t know enough to debate me, how do you know homebirth is safe?

“It is my role as a journalist to report on the evidence base–that is, published, peer-reviewed research, and published, peer-reviewed critique of that research.”

Then why do you consistently ignore the overwhelming majority of papers published in peer review scientific journals that show that homebirth increases the risk of neonatal death?

“Pulling numbers from the CDC Wonder web site to compare the outcomes of place of birth and birth attendant is not appropriate for a number of reasons”

Then you’d better call Johnson and Daviss and tell them to retract the BMJ 2005 paper since they used the CDC data for 2000 in their paper.

“it is my understanding that there are close to 18,000 records on planned, CPM-attended home births that the organization is working to make available to researchers, so that statistics can be gleaned. But like many databases, it will not be available in its raw form to the general public.”

That’s flat out false, as you are almost certainly aware. MANA has ALREADY offered the raw data publicly back in 2006. According to an announcement placed in the NARM (North American Registry of Midwives) Summer 2006 Bulletin.

‘… aggregate statistics describing births contained in the Midwives Alliance (MANA) database … These items include number of births, numbers of transfers, cesarean sections, etc…

The data made available from the Midwives Alliance Statistics Project can be very useful for lobbying or regulatory purposes. It puts the control of the data in the hands of the midwives. Having state level data can be useful when trying to get a bill passed, but it can also be useful to show that midwives are involved in self-assessment and accountability. In other words, it shows your numbers but also that you are on top of things and will be in the future. It is much stronger than just a flash of numbers at bill-passing time, and might boost your chances of avoiding your regulatory board feeling the need to monitor you in some other way …’

So the numbers are freely available to anyone who wants to use them to lobby on behalf of homebirth, but they remain hidden from the general public.

Finally, Ms. Block, this is not about the right to have a homebirth. Any woman can have a homebirth if she chooses. This is about the right to have accurate information so women can make informed decisions. Your 3 page Babble article is typical of homebirth advocacy information: it is filled with mistruths, half truths and outright deceptions. And it is notable for the dramatic omissions such as the failure to mention that CPMs (certified professional midwives) do not meet the educational and training standards for midwives in ANY first world country (unlike CNMs who meet and exceed those standards).

Women are ethically entitled to accurate information. If you are willing to publicly proclaim that homebirth is safe, you ought to be prepared to defend that claim publicly. Your unwillingness to do so, indeed your claim that as a non-scientist you are not qualified to do so, speaks volumes.

Homebirth advocate Jennifer Block must be grateful to RH Reality Check for getting her off the hook. They deleted the data that I posted so she did not have to address it. Block has decided to respond publicly, this time on Babble.comm Who’s winning the homebirth debate?

Well, she didn’t actually respond. How could she? The data is quite clear on the point that homebirth increases the risk of neonatal death. So she did what homebirth advocates love to do, she tried to think up reasons why no one should bother to address the scientific facts:

…So omnipresent has Dr. Amy been on the boards that she began to take on a mythical status among the home birth community. Some activists believed she wasn’t real, that her picture and bio were fake, that she was a mere avatar for some sort of underground ACOG propaganda machine …

But “Dr. Amy” is real. I sat with her, face to face, for nearly three hours at a Starbucks off Route 1 south of Boston a couple years ago. She is not a researcher, not an epidemiologist, and probably not on anyone’s payroll; she is an obstetrician-gynecologist who left private practice more than a decade ago because, she told me, she’d had it with HMOs and wanted to spend more time with her four kids (she let her license lapse in 2003, according to the Massachusetts Board of Medicine). And for some reason, which I never quite got to the bottom of, she believes in every cell that Home Birth Kills Babies (that’s in fact the title of her most recent post on her new site, The Skeptical OB), and no amount of research evidence will convince her otherwise.

Interestingly, Ms. Block, in yet another 3 page screed, doesn’t bother to present any actual evidence. That’s not surprising. There is none.

Here’s my response:

Dear Ms. Block,

Let’s make it very easy for women to compare and contrast the claims:

I challenge you to a public debate on the safety of homebirth in any neutral forum of your choosing, whether print, other media or a public appearance.

We can address these specific points:

1. All the existing scientific evidence (including the Johnson and Daviss BMJ 2005 study) shows that homebirth with a direct entry midwife has nearly triple the rate of neonatal death for comparable risk women in the hospital.

2. American direct entry midwives do not meet the standards for licensing in ANY first world country. They do not meet the standards in the Netherlands, the UK, Canada, Australia, anywhere.

3. The Midwives Alliance of North America, the group that collected the statistics for the BMJ 2205 study) has continue to collect safety statistic from 2001-2008. They are currently hiding those statistics from the public. They should be required to release those statistics so women can decide for themselves if CPMs are safe practitioners.

4. According to the World Health Organization, the US has one of the lowest levels of perinatal mortality in the world, lower than Denmark, the UK and the Netherlands.

I welcome publicly debating you or any other homebirth advocate in any neutral setting. I’m not holding my breath though; neither you nor any other homebirth advocate will agree to a public debate because you know my data is correct and my case is airtight. No one in the world of homebirth advocacy can risk the embarrassment.

How about it, Ms. Block? If you are so sure about what the scientific evidence shows, you should welcome an opportunity to discuss it point by point. Perhaps the folks at Babble.com might be interested in hosting the debate.

After all, don’t women deserve the opportunity to analyze both your claims and my claims and reach their own conclusion about what the scientific evidence shows?

Arianna Huffington has created a home for cranks and charlatans of all types on the health page of the Huffington Post. On HuffPo Health there is no claim too absurd to justify publication, even if (perhaps especially if) it has already been thoroughly debunked and is presented by an entertainment celebrity. In other words, HuffPo Health is a post-fact zone.

The term was coined by Farhad Manjoo in his 2008 book True Enough: Learning to Live in a Post-Fact Society. As Manjoo explains, we live in a society that not only promotes belief over fact, but justifies belief in utterly discredited claims by promoting belief AS fact.

…[I]n order to avoid cognitive dissonance, we all seek out information that jibes with our beliefs and avoid information that conflicts with them. While the theory is controversial, there’s ample evidence that selective exposure plays a role in how people parse the news today. Survey data show that folks on the right and folks on the left now swim in very different news pools. Right-wing blogs link to righty sites, while left-wing blogs link to lefty sites.

In a post-fact world, it does not matter if a claim is objectively demonstrated as untrue. The claimants just go on making the claim as if it were true. The Republican Right has fabricated a claim that Barack Obama was not born a US citizen, a claim that has absolutely no basis in reality. It has been discredited thoroughly and repeatedly in the mainstream media, yet the “birthers” continue to receive sympathetic treatment in the right wing media.

Similarly, on HuffPo Health, it doesn’t matter that the claim that vaccination causes autism has been thoroughly and repeatedly discredited in the scientific literature and it doesn’t matter that national and international data shows that as the vaccination level has dropped off in first world countries the incidence of autism diagnoses has continue to rise. On HuffPo Health, vaccine rejectionists, particularly celebrity vaccine rejectionists, continue to receive sympathetic treatment.

Arianna Huffington offers a platform for alternative health nonsense because she believes in alternative health nonsense. In the post-fact world belief is the same as fact.

How can the reader tell the difference between scientific fact and belief masquerading as fact? Consider the approach recommended by Edzard Ernst, Professor of Complementary Medicine in the UK. Ernst has spent his career analyzing the claims of alternative and complementary medicine and has found most to be absurd

When confronted with a ‘suspicious claim’, my advice is to first check whether it is testable and whether it has already been tested…

Often a review of the scientific literature will show that the claim has been debunked. But what happens if the evidence is contradictory or incomplete? According to Ernst we should first consider if a claim is scientifically plausible:

Plausibility relates to the question whether the claim and its underlying assumptions are in agreement with the known facts. If, for instance, homeopaths tell us that less is more or that nothing is something, we have little difficulty in showing that this is not supported by the known laws of nature…

Finally we should examine the claim for specific hallmarks of charlatanism:

Intolerance: Many PACs are consumed with evangelic zeal and find it hard to accept or even consider well-reasoned criticism or debate…

Selectivity: Most PACs tend to ignore facts that contradict their own assumptions. Instead they favor selected anomalous data or anecdotal findings which apparently support their notions… In arguing their case, PACs often seem to first formulate their conclusions, then selectively identify those bits of information that apparently confirm them.

Paranoia: Many PACs believe in conspiracy theories which posit that ‘the establishment’ is determined to suppress their views or findings… Anyone who points out what the evidence really shows is likely to be accused of being part of the conspiracy…

Utilizing this approach makes it clear that HuffPo Health does not simply present belief over facts; it presents beliefs (especially Arianna Huffington’s beliefs) as if they are facts.