One of the greatest ironies of the train wreck Trump presidency is how conservatives have eagerly embraced previously despised attributes of liberals. After years of decrying political correctness, micro-aggressions and trigger warnings, we now have a president who thinks he is a special snowflake.

What’s a special snowflake?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Trump allows himself to be emasculated by Bannon and Putin because of his desperate need for flattery. [/pullquote]

According to the LA Times, a special snowflake is typically a millennial:

… who has been raised to see herself and her experiences as unique and therefore demanding of heightened levels of sensitivity and respect…

According to the stereotype, snowflakes drive professors crazy by recoiling at emotionally charged reading material and drive their bosses crazy by chafing at the concept of an office hierarchy. They can’t tell the difference between an awkward social interaction and a microaggression.

Sound familiar?

President Snowflake sees himself as special and not bound by the usual rules of social interaction. He finds facts intolerable, interprets every bit of criticism as a micro-aggression and is obsessed with the way the world views him.

President Snowflake’s actions, which are inexplicable to most mature adults, and virtually unprecedented in any government official who wishes to be taken seriously, make perfect sense when viewed from the prism of his heightened sense of both self-regard and grievance.

True, Trump is not a millennial. He came by his special snowflake status the old fashioned way: he had a rich father. Money is what initially gave Trump the conviction that he is deserving of special accommodations and his belief that rules are for other people not for him.

By accounts of many people who have known him throughout his life, he has always been a bully. He is thin-skinned, narcissistic and incredibly vindictive. Those traits have metastasized to full blown snowflake status.

He cannot tolerate facts he doesn’t like so he skips intelligence briefings; he cannot tolerate criticism so he surrounds himself with flunky losers like Sean Spicer and Kelly-Anne Conway; he is easy prey for anyone who flatters him, like Steve Bannon despite the fact that Bannon has made him look stupider, clumsier and even more obnoxious that he already looked. That also explains his avidity for Vladimir Putin who has played him like a fiddle. Trump may have committed outright treason because Putin, one of the greatest threats to humanity, has made him feel good about himself.

Trump consistently retreats to lies that his enablers sugarcoat as “alternative facts.” Partly that’s because lies are essential to any authoritarian state and Trump dreams of being a tin-pot dictator.  But I suspect that like most special snowflakes, he prefers to see the world as he imagines it should be rather than the way it is.

His obsession with Saturday Night Live parodies, individual reporters, and individual media outlets stems from his belief that anything that make him feel bad is an aggression that must be punished. Most politicians, when parodied on SNL take it as a sign that they have “arrived.” Trump, in contrast, evinces no understanding that this is part of the job of any president nor any understanding that it is his own words and personal behavior that make every parody so scathing.

Trump is such a special snowflake that he cannot tolerate disagreement of any kind. When Assistant Attorney General Sally Yates refused to implement his unconstitutional Muslim ban, he characterized it as a “betrayal.” When Federal judges blocked him, he attempted to defy them. When another Federal judge upheld a lower court ruling Trump demeaned him as a “so called” judge and sought to blame him for future terrorist attacks.

Trump’s attempts to muzzle the press by accusing them of lying — despite a complete lack of evidence — and his efforts to punish CNN in particular are political correctness of the highest order, just right wing correctness, not left wing correctness. Trump is triggered by the truth, but no warning is adequate; the truth must be abolished altogether.

The ultimate irony is that Trump is everything that he professes to despise. He is an ignorant, incompetent loser, a small man who appears even smaller in the awesome job of president. And he allows himself to be emasculated by Bannon and Putin because of his desperate need for flattery.

He is President Snowflake, endlessly tweeting his hostility to laws, people and even facts that bruise his fragile ego.

I’ve made no secret of my visceral disgust with Donald Trump and his effort to inaugurate American fascism and I can get behind nearly any non-violent protest of Trump’s policies and behavior … except one.

I’m very uncomfortable with complaints about paying for Melania Trump’s decision to stay in New York with her son. I’ve seen reports that her security detail will cost twice the budget for the National Endowment the Arts (unproven) or could pay for the re-settlement of dozens of refugees. While we might quibble about the actual size of the expenditure, there’s no question that it will be substantial.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We ought to give serious thought the meaning of the devastating inaugural clip.[/pullquote]

My discomfort stems from my belief that we must think very carefully about why a woman, under considerable public pressure to live in the White House, might choose to live apart from her husband: she might be afraid. Let me stress that I have no specific knowledge about the Trump’s marriage. Nonetheless I found the following clip from the inauguration utterly chilling:

https://youtu.be/96Mu0rnkFNY

As Slate noted:

In a dark and mesmerizing clip that’s been circulating on social media today, Donald Trump turns to face his wife Melania at the inauguration ceremony, and she smiles back at him widely. When Trump faces forward again, we get a split-second glimpse of Melania’s inner turmoil as her face melts into a frown.

No matter how corrupt, ignorant and irresponsible Trump is, and he is all those things, we should not take out our anger on his wife.

In the first place, it wasn’t her decision to run for President; it was his. It has been apparent from the earliest days of Trump’s campaign that she has been reticent to be a part of it. She is rarely seen, and far more rarely heard, both quite unusual for a presidential spouse. And the one time she agreed to a major public appearance, she was humiliated when she was given a speech to read that had been plagiarized from Michelle Obama.

Second, it is not her decision to receive Secret Service protection; it’s a Federal mandate. She could easily pay for her own security but has not been given that choice.

Third, we ought to consider the possibility that she is protecting her child. Both the Clintons and Obamas went to extraordinary lengths to protect their young children when they occupied the White House even though they never had to wonder if they were up to the demands of public appearances. Melania may feel that her son needs the additional protection that will be afforded by living elsewhere so that he cannot be forced to participate in public displays. If that’s the case, she is showing tremendous resolve to put her son’s wellbeing above politics and that deserves our admiration, not contempt.

Fourth, and most important, we ought to give serious thought the meaning of the devastating inaugural clip. I don’t presume to know what Melania was thinking, but I do know what I can see.

As Slate explains:

Jezebel, which posted the Melania/Melancholia video on Monday, shows the exchange taking place during Franklin Graham’s speech on Inauguration Day, then zooms in further on Melania’s devastating grimace…

If you watch the video of Graham’s speech from another angle, it looks like Trump may have been saying something to his son Barron. Perhaps, then, Melania is frowning as a reaction to her son being scolded. You could interpret that look a lot of ways, to be honest. But there’s something about her complete about-face that seems to reveal a deeper truth.

If the clip of Donald Trump ripping up his notes after one of the presidential debates distilled the essence of a man who knew he’d screwed up big time, this clip is its sad sequel, a vision of what that “perverted version of charisma” does to all the people who have to live with it.

As a physician, the clip raises multiple red flags for me. The contrast between the smile when her husband is looking at her, and the apparently intense sadness as soon as he looks away is agonizing.

The “Free Melania” signs at the Women’s Marches were supposed to be a humorous allusion to the Trump marriage, but they may contain more truth than we will ever know. For that reason, both Melania and Barron Trump should be off limits for political protests and jokes. What we are witnessing may not be the least bit funny.

I’m beginning to think Republicans in general, and Trump supporters in particular are intellectually incapable of recognizing Trump’s burgeoning fascism until one of his enablers pistol-whips them. In the hope that it’s not too late yet and at least some Republicans are capable of following an intellectual argument, I offer Italian philosopher and novelist Umberto Eco’s defining characteristics of fascism, or as he put it Eternal Fascism: Fourteen Ways of Looking at a Blackshirt. For the sake of brevity, I include only some of the fourteen features.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Thinking is a form of emasculation.[/pullquote]

A Cult of Traditionalism expressed most obviously in the slogan Make America Great Again. Sure it’s a longing for a past that never existed, but it is obviously backward looking not forward looking.

Rejection of Modernism expressed as a distrust scientists and other educated elites as well as an appeal to irrationality.

Action for Action’s sake:

Action being beautiful in itself, it must be taken before, or without, reflection. Thinking is a form of emasculation…

Trump has released a series of executive orders that are shockingly inept both intellectually and pragmatically. The Muslim travel ban is paradigmatic. It makes no sense from a practical standpoint since the terrorism we have experienced has never been associated with individuals from the banned countries, but rather from their neighbors who are not banned. Nonetheless, Trump supporters praise it as action even though it is doomed to be entirely ineffective.

Disagreement as treason:

Trump’s fired Assistant Attorney General Sally Yates because she refused to carry out what she viewed as unconstitutional Muslim travel ban. The firing was legal but the language was extraordinary.

The acting Attorney General, Sally Yates, has betrayed the Department of Justice by refusing to enforce a legal order designed to protect the citizens of the United States…

Yates owes no allegiance to the Justice Department. She owes allegiance to the Consitution.

Trump’s reaction to a Federal judge who halted enforcement of the travel ban is even more outrageous:

The opinion of this so-called judge, which essentially takes law-enforcement away from our country is ridiculous and will be overturned.

Trump appears to reject the great system of American jurisprudence designed by the Founding Fathers and based on checks and balances. The Judiciary is charged to serve as a constraint on the action of Congress and the President not to rubber stamp it.

The Demonization of Difference:

…Fascism grows up and seeks consensus by exploiting and exacerbating the natural fear of difference. The first appeal of a fascist or prematurely fascist movement is an appeal against the intruders. Thus … Fascism is racist by definition.

Trump has grounded his Presidency in bigotry and xenophobia.

An Appeal to Social Frustration:

…[O]ne of the most typical features of the historical fascism was the appeal to a frustrated middle class, a class suffering from an economic crisis or feelings of political humiliation, and frightened by the pressure of lower social groups.

The slogan Make America Great Again has nothing to do with making America great and everything to do with assuaging the social frustration of white, blue collar workers and returning them to the center of American life.

A Racialist Nationalism:

…[A]t the root of the … Fascist psychology there is the obsession with a plot, possibly an international one. The followers must feel besieged. The easiest way to solve the plot is the appeal to xenophobia. But the plot must also come from the inside …

The Muslims are purportedly threatening America from the outside and Mexicans, African-Americans and liberals of all races are purportedly threatening America from the inside.

A Sense of Humiliation:

…[F]ollowers must feel humiliated by the ostentatious wealth and force of their enemies.

The Erosion of Individual Rights:

For … Fascism, however, individuals as individuals have no rights, and the People is conceived as a quality, a monolithic entity expressing the Common Will. Since no large quantity of human beings can have a common will, the Leader pretends to be their interpreter…

Orwellian Newspeak:

Trump and his minions have a new name for this type of propaganda: alternative facts.

Thus, in the face of photographic evidence that Trump’s inauguration was poorly attended, thePress Secretary Sean Spicer could claim with a straight face:

That was the largest audience to ever witness an inauguration — PERIOD!

As George Orwell himself famously wrote in 1984:

In the end the Party would announce that two and two made five, and you would have to believe it… [T]he logic of their position demanded it… [T]he very existence of external reality was tacitly denied by their philosophy.

For anyone with the wit to see it, Trump’s embrace of these fascist principles is chilling. But many people don’t want to see what is right in front of their faces. As Eco concludes:

…It would be so much easier for us if there appeared on the world scene somebody saying, “I want to reopen Auschwitz, I want the Blackshirts to parade again in the Italian squares.” Life is not that simple… Our duty is to uncover [fascism] and to point our finger at any of its new instances — every day, in every part of the world…

That’s what I intend to do and so do millions of other true American patriots, those who love our country and its values of freedom and toleration.

Why is there so much crappy medical research?

The latest example, complete with press release, was just published in the British Medical Journal (BMJ). It’s entitled Early death after discharge from emergency departments: analysis of national US insurance claims data.

The authors found:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s not clear that the death rate exceeds the background rate of death of Medicare patients.[/pullquote]

Among discharged patients, 0.12% (12 375/10 093 678, in the 20% sample over 2007-12) died within seven days, or 10 093 per year nationally. Mean age at death was 69. Leading causes of death on death certi cates were atherosclerotic heart disease (13.6%), myocardial infarction (10.3%), and chronic obstructive pulmonary disease …

Every year, a substantial number of Medicare beneficiaries die soon after discharge from emergency departments, despite no diagnosis of a life limiting illnesses recorded in their claims. Further research is needed to explore whether these deaths were preventable.

The press release is hardly judicious:

These early deaths were concentrated in hospitals that admitted few patients to the hospital from the ED, hospitals that are often viewed as models by policy makers because of their low costs. By contrast, deaths were far less frequent in large, university-affiliated EDs with higher admission rates and higher costs, even though the population served by these EDs was generally less healthy when they walked in the front door of the ED.

The lead author elaborates in The Boston Globe STAT section:

The study’s lead author said that while the data reflect a fraction of Medicare patient deaths, the finding raises questions about the adequacy of hospital resources in rural and underserved areas and whether the US government’s quest to cut costs — and reduce inpatient admissions from ERs — is also cutting out essential care.

“There’s no doubt there’s a lot of unnecessary hospital admissions, but this study suggests there’s also avoidable harm from sending people home that shouldn’t go home,” said Dr. Ziad Obermeyer, an emergency medicine physician and professor at Harvard Medical School.

The implication is that people are dying preventable deaths because they were discharged from the emergency room instead of being admitted to the hospital.

Is that what the data shows? There’s no way to be sure because the single most important piece of information necessary to reach that conclusion is MISSING from the paper. How many Medicare patients die in a typical week? Quite a few, it turns out.

That’s not surprising. Medicare patients are age 65 and older. They did because everyone dies. Does the rate of death after being discharged from the ER exceed the background rate of death? The authors don’t tell us; indeed they don’t appear to have bothered to check, an inexcusable omission in a paper of this type.

Approximately 4.5% of Medicare patients die each year, for a baseline death rate of 0.09%/week. The study patients represent a subset of Medicare patients [those aged ≥ 90, receiving palliative or hospice care, or with a diagnosis of a life limiting illnesses, either during emergency department visits (for example, myocardial infarction) or in the year before (for example, malignancy) were excluded]. Nonetheless, the baseline Medicare death rate in the group being studied represents a substantial proportion of the death rate reported in the week after discharge from the ER.

Therefore, the implication that 10,000 patients die preventable deaths each year as a result of being discharged from the emergency room is flat out false. The majority of those patients almost certainly would have died anyway.

The authors do tell us how the admitted patients fared, although they do so in a misleading manner.

This chart compares the death rates of patients admitted from the ER compared to those discharged from the ER, divided into quintiles based on the admission rate.

There’s a glaringly obvious problem. The scale from admitted patients is different from that of discharge patients, making it look as if the death rate in discharged patients is higher than admitted patients when it is actually far lower. The death rate for admitted patients was generally 20X higher than for discharged patients! The only exception is the lowest quintile that admitted the fewest patients from the emergency room; in that quintile, the death rate of admitted patients was only double that of discharged patients.

It’s hardly unexpected that getting admitted was associated with a massively increased risk of dying. These patients were sicker. But it also suggests that getting admitted did not necessarily prevent death. We’ve already seen that the majority of the purported 10,000 people who die in the week after ER discharge were going to die anyway. Now we can see that admitting them to the hospital would not necessarily have prevented their deaths, either.

The authors know, or should know this. Indeed, they admit in the abstract that they have no idea whether the deaths they observed were preventable at all, then proceed to imply the exact opposite.

What does this paper tell us? NOTHING!

It’s just another crappy paper that spins a fairy tale from an observation stripped of context. For all we know, every single one of those 10,000 people who died would have died regardless. The authors certainly haven’t demonstrated otherwise.

In an op-ed piece in today’s New York Times, a geology professor Robert S. Young decries the planned Scientists’ March on Washington in a display of shocking naïveté:

Among scientists, understandably, there is growing fear that fact-based decision making is losing its seat at the policy-making table. There’s also overwhelming frustration with the politicization of science by climate change skeptics and others who see it as threatening to their interests or beliefs.

But trying to recreate the pointedly political Women’s March will serve only to reinforce the narrative from skeptical conservatives that scientists are an interest group and politicize their data, research and findings for their own ends.

With all due respect, Prof. Young, you’ve completely missed the point! Science has become politicized by politicians and a Scientists’ March on Washington is a declaration that scientists intend to take it back.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Science has become politicized; a Scientists’ March on Washington is a declaration that scientists intend to take it back.[/pullquote]

Whether it’s creationism, climate change denial or anti-vaccine activism, those who fear science have attempted to silence scientists by falsely declaring that it is political and by moving to suppress it as if it were political speech.

Prof. Young’s central claim is nothing short of absurd.

A march by scientists, while well intentioned, will serve only to trivialize and politicize the science we care so much about, turn scientists into another group caught up in the culture wars and further drive the wedge between scientists and a certain segment of the American electorate.

Wrong again! Scientists did not put themselves in the midst of the culture wars; they were deliberately placed there. It’s not hard to understand why. When you can’t discredit the science — and the purveyors of creationism, climate denial and anti-vax nonsense can’t discredit the science — the next best thing is to discredit the scientists. How? By insisting that they are not searching for truth but rather for political or economic advantage.

Prof. Young insists:

Rather than marching on Washington and in other locations around the country, I suggest that my fellow scientists march into local civic groups, churches, schools, county fairs and, privately, into the offices of elected officials. Make contact with that part of America that doesn’t know any scientists. Put a face on the debate. Help them understand what we do, and how we do it. Give them your email, or better yet, your phone number.

Why should it be one or the other? It shouldn’t. We can simultaneously seek to help lay people understand science while making a strong stand that science exists outside of politics and therefore scientists should never be censured by politicians.

Scientists marching in opposition to a newly elected Republican president will only cement the divide.

It is impossible to increase the divide between a newly elected Republican president who seeks to suppress scientists for political advantage and scientist who venerate truth regardless of which politicians seek to use and abuse them to score political points.

Young declares:

Believe me, I understand the desire to impart to everyone how important science is to every sector of our economy, the health of our planet and the future of our families.

That reflects a fundamental misunderstanding of of a Scientists’ March. It’s not to convince everyone that science is important to our economy or to anything else. It is to take a stand against a president who is already subverting science by censoring scientists.

The goal is to speak truth to power in the most basic sense of the phrase — to speak scientific truth to Trump, an ignorant bully drunk on power.

There’s an appalling amount of bad research out there and more is added with the publication of new papers every month.

How can we tell good research from bad?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Are the authors reporting the primary finding or have they replaced it with a secondary finding?[/pullquote]

One way is to look at whether the results hold up to statistical analysis: Are the findings statistically significant? Is the study large enough to have sufficient statistical power? What happens when you correct for confounding variables?

Those analyses require grounding in statistics. But there’s an even simpler way to tell good research from bad. Are the authors reporting the primary finding or have they replaced it with a secondary finding? In other words, have they engaged in “spin”?

A paper in this months edition of Obstetrics and Gynecology, entitled It’s All How You Spin It: Interpretive Bias in Research Findings in the Obstetrics and Gynecology Literature, explains:

Spin is a classic concept in fields such as marketing, journalism, and politics, where it is defined as a form of propaganda to influence public opinion. The concept of spin in the medical literature has been described as the manipulation of language to convince the reader of the likely truth of the result.

This is particular problem when the authors have undertaken a long, complicated investigation and arrived at results that are not statistically significant. There’s tremendous pressure to get some sort of publication out of the work.

One way to do that is to ignore the primary finding and look for a secondary finding that is statistically significant and present that instead. In fact, many such papers imply in the abstract that the secondary finding was what the authors were looking for.

What’s wrong with spinning research in this way?

Because many readers decide from the abstract whether to obtain further information from the full-text article, the authors evaluated the abstract for the following: 1) Was the primary outcome stated? 2) Was the effect size reported (ie, the sample size to discern the magnitude of the treatment effect)? 3) Was a precision estimate included (ie, confidence interval or P value)?

By promoting the secondary outcome in the abstract, the authors fail to acknowledge that there was no difference in the primary finding and thereby mislead readers as to the findicts. That’s spin.

There are many ways to spin research findings so that negative findings are presented as positive findings.

Three major types of spin strategies were identified that highlighted that the experimental treatment was beneficial despite a statistically nonsignificant difference for the primary outcome: 1) emphasizing statistically significant secondary results despite a nonsignificant primary outcome (such as within-group comparisons, secondary outcomes, or subgroup analysis); 2) interpreting statistically nonsignificant primary results as showing treatment equivalence or comparable effectiveness when the study was not designed to assess equivalence or noninferiority (such trials require specific design and larger sample size than superiority trials); and 3) emphasizing the beneficial effect of the treatment despite statistically nonsignificant results (eg, trending results).

Spin is disappointingly common:

the literature from other medical specialties such as oncology, anesthesiology, intensive care medicine, surgery, and psychiatry has noted rates of spin ranging from 59% to 66%.

It occurs less in the OB-GYN literature, but is still a big problem:

I reviewed a decade (January 2006 through December 2015) of the tables of contents of the journals Obstetrics & Gynecology and the American Journal of Obstetrics & Gynecology to identify RCTs. In this time period, there were 503 RCTs, of which, half (50%, n=251) noted a nonsignificant primary outcome (P≥.05).

Spin was employed in fully HALF of all OB-GYN RCTs. A substantial proportion of the spin occurred in the abstracts. Simply put, the abstracts misrepresented the findings of the study. That’s why reading the abstract is never enough and why journalists should never use the press release to report on findings of a study, but MUST read the entire paper.

It seems to me that spin is a particular problem in breastfeeding research. That’s why the bulk of breastfeeding research is weak and conflicting. It doesn’t reflect what the authors were attempting to prove, but rather an incidental finding that the authors choose to highlight while attempting to minimize the fact that they found the opposite of what they wanted.

For example, the authors might undertake to determine if breastfeeding increases IQ as determined by specialized testing. The results show that breastfeeding does not increase IQ. Like most negative findings, that’s unlikely to get published, so the authors search the subtest, find one with a statistically significant difference and declare that breastfeeding increases (for example) gross motor ability.

How does the average reader or journalist protect herself from research spin?

There’s are two threshold question that must always be asked: What were the authors attempting to find? And did they find it? If they didn’t find it, that what the headline should reflect. The fact that they were able to slice and dice their data to come up with a secondary finding that is statistically significant is ofree meaningless and should be reported as such.

I’m honored to be entrusted with publishing this incredibly powerful post from a mother who wishes to remain anonymous.

It took me just under three years to go from bright-eyed and expectant to waking up in a mental hospital in severe withdrawal from benzos (aka anti-anxiety medication). It’s not the whole story – what ever is, really? – but a big part of it centers around the current cult of attachment parenting that, at least in my circle, reigns supreme.

I wanted to be a wonderful mother. I live in on the East Coast – a very progressive little state where attachment parenting is heralded as something akin to the next coming of Christ. Of course you must breastfeed. You must have a doula. A birthing plan. Birthing music. Co-sleeping. Lots of eye contact. The idea is, if you don’t, you don’t care.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]I checked myself into the hospital… Seven days later, I was released. I went home and tried to make sense of what had happened in our lives.[/pullquote]

I cared so much. So, I set about doing it all. My plans started to go afoul when my son was frank breech. He wouldn’t budge and we were coming down to the wire. My mother, a pushy and progressive obstetrics nurse in Boston, begged me to get a risky inversion (which could have put the baby in danger). She also implored me to attempt to deliver feet first vaginally (also very risky). Having worked on a labor floor before (thanks to nepotism), I knew I didn’t want risk when it comes to my child. I decided to go ahead with the Cesarian.

So, I started my son’s life with guilt. Lots of it. I remember dining out with friends who’d also had a baby around the same time and also had a c-section. Theirs had been entirely unplanned and the friend talked to me about her grief around the c-section. I couldn’t relate and that felt funny. I mean, it hurt like hell after but I was just so happy everyone was safe. What more could I ask? But…grief? What was there to grieve? We had ushered a new life into the world. That being said, I started to think something was wrong with me for not experiencing c-section grief and not being able to understand it…I mean, didn’t I care?

Next, we breastfed. Here’s the thing: my son cried around 20 hours out of every 24 hours a day while we breastfed. I was absolutely desperate to breastfeed. What sane person doesn’t breastfeed? I eliminated everything from my diet and went down to just eating white rice (i’ve since lost two teeth as a result). My mother was ruthless about it – I felt that if I even suggested formula she’d call the police on me! My mother-in-law was quite different (and not necessarily in a good way). She’d bring us cases of formula and suggest we try it. Well, we did and that didn’t stop the crying. Finally, one night at 3 am after a particularly hard stretch of our son crying for basically 40 hours, my husband suggested SOY formula. I agreed, he bought it and then magic happened: within 20 minutes, my son’s crying stopped. That was it. 8 weeks of round the clock crying and it was over. Just like that. Wow.

So, we went to the pediatrician and told her. She responded with great skepticism and told me she had a room I could go into to “latch-feed” asap before my milk dried up. I had enough confidence in myself to decline her offer – but I went home upset. Was I monstrous? Was I selfish because I couldn’t deal with the constant crying anymore? My motherly instinct told me my son shouldn’t have to cry like he had been but my pediatrician was acting like it was a medical emergency. I felt ashamed. I felt lazy. I felt like I wasn’t strong enough (in retrospect though, who is strong enough to endure 8 weeks of round the clock crying?).

I took on my mothering duties with a vengeance. The original plan had been that I would go back to work, but attachment parenting or not, that didn’t feel right for our situation. I restructured everything so I could stay at home. I found small writing jobs (for everything from beauty salons to software companies) that paid peanuts so that we could have enough money to make ends meet. I woke up every day at 4am to make the proverbial bacon.

During the days, I took my son out. We went to playgroups and gyms until he grew more and ended up getting so focused on things like a single set of car keys that he couldn’t no longer be in group environments like that. I remember packing up our things to leave, time and time again, and staring out at the sea of babies who didn’t need to leave. Where had I gone wrong? Was it because I hadn’t always eaten organic? Was it the traumatic c-section (although nothing had gone wrong)? Had I not made enough eye contact? Was I too stressed?

At around 8 months, my son went through a major sleep regression. He just… stopped… sleeping. It was like the colic days without the crying. Co-sleeping, which I had enjoyed as had he, became a total no-go. Instead of soothing him, it made him even more wired. Still, I kept at it. There he and I would be, night after night. He’d be bouncing in his crib (he couldn’t be right next to me because of safety due to his level of energy) and I would be on the floor next to him – awake and unrested. Finally, sick and bone tired, I looked into crying it out. I felt like an actual monster.

Crying it out wasn’t as easy as the books say it is. Not for us. It took a month of our son screaming day and night while I rocked him in his stroller. Back and forth. I would catch fifteen minutes of sleep at a time when he slept. It was unbelievably hard and it must sound like an exaggeration to the reader who doesn’t know me.

Finally, it worked. He started sleeping like clockwork. I could breathe again. I could think again. I started trying to teach him Spanish and French in addition to English ( I wanted to be super mom). He was learning it, too. It was a beautiful but short-lived time.

At around 14 months, he started to walk. He also stopped talking. He hadn’t been a prolific talker, but he had talked. Slowly, this went away. Eventually, it completely disappeared.

I would go into my pediatrician with my concerns about this. She would suggest I read to him more. I did. I followed our son around the house with book after book. He paid me absolutely no attention and I felt silly, but still I persevered.

I’d like to say that my perseverance paid off – but it didn’t. He didn’t talk. In fact, he started making less and less eye contact.

I beat myself up at every turn. If attachment babies were more engaged and happier, what did that say about what I had done? How had I failed so miserably and so fast? Hadn’t I tried? Clearly, it seemed to me, everyone else had tried much harder. Maybe, I thought in my darker moments, I didn’t even know the meaning of trying.

It was a bleak time. Eventually, our pediatrician referred us to early intervention. The words had a terrible register – were they intervening with my terrible parenting? The nice ladies came every week and suggested our son had anxiety. Again, I felt horrible. Anxiety? In a two year old? Oh, dear.

It was around that time that I met a new friend: Benzodiazepines. Well, we don’t speak anymore so maybe I should call them an enemy. At the time, though, they felt more friendly. My fears and self-doubt started to go away. I could hang in there. I could be present.

At around 2 and a half years old, we got referred to a neurologist to start evaluating our son for autism. It was at that time that my benzo abuse really ramped up. I remember the doctor pulling our son’s pants down and our son hobbling around the room because he didn’t know to pull them up. I went out to the car after and popped an extra pill. I was in so much pain.

I rejected autism one thousand percent. It wasn’t autism, it was me: it was my countless failures as a mother. It was the c-section, I hadn’t done enough skin-to-skin, it was the breastfeeding, it was the formula, it was the co-sleeping, it was the crying it out, it was my stress. I cried and popped pills for the next few days. It was a low moment and not one that I am proud of but do feel it is important to share.

Four days later, I checked myself into the hospital. I spent the next two days in a state of delirium and sweat. Seven days later, I was released. I went home and tried to make sense of what had happened in our lives. A few weeks later, our beautiful boy was diagnosed with autism.

Since then (our son just turned five), it still hasn’t been easy. I still have a whole lot of self-blame. Should I have not vaccinated? Should I have used formula from the beginning (had the crying somehow damaged our son)? Should I have been wealthier so that I wouldn’t have had to work at all? I struggle. I go to therapy every week and talk about all of it. I stay far away from pills and anything addictive (other than crime drama television shows).

My husband begs me to see that autism is likely genetic. We both come from multi-generations of engineers and math nerds. Quiet people who preferred computers to parties. I am trying. But, on social media, I see friends share scary posts about breastfeeding being best or vaccines causing autism, and I momentarily crumble.

When I look back at my attempts at attachment parenting and my results (or lack thereof), I see that my son most likely was born different. I also see that there is an incredibly unhealthy social pressure put on mothers to “know better and do better” and to do the “best”. The montessori school I had once dreamed of for my son has been replaced by his IEP. I blame myself – but thanks to people like The Skeptical OB and their message that there is no perfect in parenting, I am starting to blame myself less and less. I am starting to be able to breathe, and to fall asleep more easily. I am starting to enjoy all of the wonderful quirks that come along with raising a child with autism. I am starting to tune out the endless sea of opinions that come with that and trust myself. He doesn’t talk yet but his smile – and his smile never went away – says so much. It says everything.

I oppose censorship.

I guess that’s not surprising since a rival blogger tried to force my blog off the internet because she disagreed with what I wrote. She was initially so successful that I had no choice but to sue her in Federal Court in 2013. The case, Tuteur v. Crosley-Corcoran, was ultimately settled confidentially, but you will notice that my blog is still here.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Gay’s move is a terrible philosophical mistake, and an utterly bone-headed move on a practical level.[/pullquote]

In is inevitable then that I cannot join in the general Leftist glee that feminist scholar Roxane Gay has withdrawn her work from publisher Simon & Shuster to protest their publication of a forthcoming book by Milo Yiannopoulos. Don’t get me wrong; I have the utmost contempt for Yiannopoulos and his lazy fascism. I intend to fight back against Yiannopoulos and his ilk with my heart and soul. But I think it is absolutely critical that the Left should not betray its own values in an effort to stymie the Right.

According to The Week:

Bestselling author Roxane Gay will no longer publish her forthcoming book with Simon & Schuster after the publishing house’s decision to reportedly buy alt-right personality Milo Yiannopoulos’ book in a $250,000 deal last month, BuzzFeed News reports. Gay’s book, How to Be Heard, was scheduled to be published by the Simon & Schuster imprint TED Books in March 2018.

“I can’t in good conscience let them publish it while they also publish Milo,” Gay said Wednesday. “So I told my agent over the weekend to pull the project.”

Don’t get me wrong. Gay is well within her rights to do this, but I think she is making a terrible mistake, both philosophically and practically.

It is philosophically wrong to use financial leverage to attempt to censor another author’s work, and that’s just what Gaye is trying to do. Gaye wants to send a signal that publishing houses will feel financial pain if they publish works by hard right/fascist authors. Perhaps it has escaped her notice but some of the most profitable published works are from conservative authors. How would we feel if Ann Coulter threatened to pull her work any company willing to publish Gay? I hope we would be outraged. It’s no less an outrage when Gay attempts to do the same thing to Yiannopoulos.

Free speech and the free exchange of ideas is at the heart of democracy. I may disagree with you profoundly but I will defend to the death your right to express yourself. That principle appears to face its greatest threat ever in the person of Donald Trump. It is at this critical moment that we must stand forcefully and unambiguously for that right and not invoke special privileges for ourselves that we would not see extended to our political opponents.

Gay’s move is a terrible philosophical mistake, but it is also an utterly bone-headed move on a practical level.

Yiannopoulos got a $250,000 advance of his book. That’s not much more than I got for my book. In other words, Simon and Shuster are not expecting a chart busting bestseller. He would not be able to afford a massive publicity campaign, but now Gay has handed him a million dollars worth of free publicity. This is the BEST THING that could have happened to his book and there is no doubt that he will exploit it to the last penny.

He also could offer a better demonstration of Left Wing hypocrisy than a this. And at this moment in time, when the Left Wing is caught on it’s back foot, that’s likely to be terribly damaging. It feeds into every stereotype relentlessly promoted by Yiannopoulos and his cronies. Why give them this gift?

I understand the righteous rage. It’s hard to be more angered than I am by the new Trump despotism. But free peoples have always understood that freedom to say, write and think things that offend others is a precious freedom. We should not betray that freedom by carving out special exceptions for censorship for ourselves, for we are the ones who will almost certainly suffer most from such hypocrisy.

 

Edited to correct Dr. Gay’s profession; she is a feminist scholar.

In the on going effort to demonize cesareans, the natural childbirth community seized on a tiny study and spun it into the claim that C-sections change the infant microbiome. A new, far larger study, shows that it does not.

As the Houston Chronicle explains:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The infant gut microbiome is probably determined in utero.[/pullquote]

In a new study of 160 pregnant mothers and their babies published Monday, Aagaard and a team of Baylor researchers found that any differences in the microbiome of babies born via C-section are not the result of the birthing process …

“We do not see a lasting association between cesarean delivery and a distinct microbiome community or its function in infants beyond the neonatal period,” Aagaard said…

Where did the erroneous claim come from. It started with a 2010 paper by Dominguez-Bello that involved only 9 mothers (10 babies) that looked at swabs of the baby’s skin, mouth and nose and meconium within the first 24 hours after birth. You don’t have to be a scientist to understand that an observational study involving 10 babies for only 24 hours cannot be extrapolated to the population at large.

But Dominguez-Bello did just that anyway. Instead of undertaking a larger study to replicate her findings, she moved on the studying vaginal “seeding,” wiping C-section babies with their mother’s vaginal secretions. That study involved 18 mothers, 11 of whom delivered by C-section; only 4 babies were swabbed. The authors collected 6 sets of samples (oral, anal, skin) over 30 days. The authors claimed to find “partial restoration” of the infant microbiome.

In contrast, the new study by Aagaard et al. is far more robust. This study differed from the original studies in critical ways:

• More participants: At 81 participants, this study is 9X larger than the original study.

• More sample sites: Skin, mouth, nose and stool.

• Longer follow up: The sampling was continued to 6 weeks of age.

What did they find?

1. The infant microbiome is not homogenous. As with the adult microbiome, it differs substantially depending on where in or on the body you take samples.

We found that the neonatal microbiota and its associated functional pathways were relatively homogeneous across all body sites at delivery, with the notable exception of the neonatal meconium. However, by 6 weeks after delivery, the infant microbiota structure and function had substantially expanded and diversified, with the body site serving as the primary determinant of the composition of the bacterial community and its functional capacity.

2. Although there were some differences in microbiota between cesarean and vaginally born infants immediately after birth, these differences were restricted to the mouth, nose and skin. Gut bacteria did not differ based on mode of delivery.

Although minor variations in the neonatal (immediately at birth) microbiota community structure were associated with the cesarean mode of delivery in some body sites (oral gingiva, nares and skin; R2 = 0.038), this was not true for neonatal stool (meconium; Mann–Whitney P > 0.05), and there was no observable difference in community function regardless of delivery mode.

3. The infant microbiome changes rapidly in the first 6 weeks. By 6 weeks of age there was no detectable difference between babies born by C-section and those born vaginally.

For infants at 6 weeks of age, the microbiota structure and function had expanded and diversified with demonstrable body site specificity (P < 0.001, R2 = 0.189) but without discernable differences in community structure or function between infants delivered vaginally or by cesarean surgery (P = 0.057, R2 = 0.007).

4. The environment in the uterus is probably not sterile as previously thought. Thus the composition of the infant microbiome may be determined in utero, not at the time of birth.

unlike the skin, oral cavity or nares microbiota, the neonatal gut microbiota at the time of delivery did not significantly vary by mode of delivery. The content of the first meconium is hypothesized to reflect the in utero environment (in which the infant is swallowing amniotic fluid continuously from mid to late gestation), and thus we speculate that these microbes were similarly transmitted from the mother to the fetus during gestation, suggesting that seeding of the early microbiota may occur earlier than was previously thought.

The authors conclude:

In summary, we undertook the largest study to date … to analyze both the composition and function of the neonatal and infant microbiota with paired maternal–infant subjects across multiple body sites. We observed that by 6 weeks of age, the microbial community structure and function had significantly expanded and diversified. We further demonstrated that there was no discernable effect of the cesarean mode of delivery on the early microbiota beyond the immediate neonatal period (and never inclusive of that in the meconium or stool) …

In other words, C-sections do not change the infant gut microbiome.

Remember the joke about the drunk man searching unsuccessfully for his keys under the streetlight?

After a few minutes the policeman asks if he is sure he lost them here, and the drunk replies, no, and that he lost them in the park. The policeman asks why he is searching here, and the drunk replies, “this is where the light is.”

We see this behavior all to often in science. Researchers interrogate the data that they have to answer a specific question when the answer is nowhere to be found in that data. Yesterday’s piece in the NYTimes, Does Breast Milk Have a Gender Bias?, illustrates both the “drunkard’s search” as well as the shoddy nature of most breastfeeding research.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]This is a “drunkard’s search.” The authors used the data they had instead of the data that is required.[/perfectpullquote]

According to Nancy Segal and Satoshi Kanazawa:

In 1973, the biologist Robert Trivers and the computer scientist Dan Willard made a striking prediction about parents and their offspring. According to the principles of evolutionary theory, they argued, the male-to-female ratio of offspring should not be 50-50 (as chance would dictate), but rather should vary as a function of how good (or bad) the conditions are in which the parents find themselves…

In short: If things are good, you have more boys, and give them more stuff. If things are bad, you have more girls, and give more of your stuff to them.

Is this hypothesis correct? In new research of ours, to be published in the April issue of The Journal of Experimental Child Psychology, we suggest that in the case of breast-feeding, at least, it appears to be.

The first red flag is the journal. What is a paper on breastmilk composition doing in The Journal of Experimental Child Psychology when the issue under investigation has nothing to do with child psychology? Almost certainly because the authors couldn’t get it into one of the relevant journals.

The second, glaring red flag is the nature of the study itself. The authors were trying to discern if breastmilk produced for male babies has a different composition or amount than breastmilk produced for female babies. Obviously, the only way to determine that is to compare the composition and volume of the two types of breastmilk.

That’s where the principle of the drunkard’s search comes in. The authors are psychologists, not chemists and they can’t investigate the actual composition of breastmilk. They do have a giant data base of information on adolescents, so they decide to look there.

They offer a Rube Goldberg version of reasoning to explain what they did.

The aim of our research was to figure out how to study the divergent effects of breast milk on sons and daughters on a much larger scale. Our solution: to look at twins.

In light of the emerging evidence of sex-specific variation in breast milk quality, the Trivers-Willard hypothesis implies that breast-feeding may be less beneficial for opposite-sex twins than for same-sex twins. Same-sex twins, after all, can benefit from their mother’s sex-tailored breast milk just as non-twins can. However, the breast milk of mothers of opposite-sex twins cannot be tailored for either sex. Perhaps it is selectively tailored for the wrong sex part of the time, or for neither sex all of the time.

Thus, the Trivers-Willard hypothesis led us to surmise that opposite-sex twins would be disadvantaged for health and growth. This would be reflected in their being shorter and weighing less than same-sex twins.

What??!!

There are so many unwarranted assumptions here that it’s hard to keep track.

Unwarranted assumption #1:Assuming gender specific breastmilk confers benefits. This is a version of the white hat bias that plagues all breastfeeding research: if it’s in breastmilk it must provide a benefit. But that doesn’t have to be true. If breastmilk plays a role in regulating gender composition of a population isn’t doesn’t necessarily have to provide gender specific benefits. It’s only necessary to provide benefits to one gender.

Unwarranted assumption #2: Assuming that looking at adolescent height and weight should tell us whether breastmilk is gender specific. This assumption is just bizarre. If the point of gender specific variations in breastmilk is to regulate the gender composition of the population, we would expect to see the differences in infancy and childhood, not adolescence.

Unwarranted assumption #3: Assuming that the benefits of gender specific breastmilk would be expressed in physical characteristics? Why? The point is supposed to be a survival advantage for one gender over another. What would make height and weight the relevant variables to look at. Wouldn’t survival rates be far more important?

Unwarranted assumption #4: Assuming that it makes any sense at all to look at anything besides the chemical composition and volume of breastmilk to determine whether there are gender specific differences in breastmilk. The authors undertook a drunkard’s search of the data in their possession instead of searching for the answer in the only place it can possibly be: in the composition and volume of breastmilk itself.

And if all that isn’t bad enough, the authors looked at only one twin in each pair, breastfeeding history depended on maternal recall more than a decade after the fact, and zygosity of same sex twins was determined by the mother’s impression instead of genetic testing.

What did they find?

The Wave I sample included 779 twins for whom the sex of their co-twin could be determined; of these, 546 respondents (277 females and 269 males) had same-sex twins and 233 respondents (120 females and 113 males) had opposite-sex twins…

The results showed that, among the ever-breastfed twins, same-sex twins were marginally significantly taller, F(1, 176) = 3.784, p = .053, significantly heavier, F(1, 170) = 5.400, p = .021, and significantly larger (either taller or heavier), F(1, 165) = 5.900, p = .016, than opposite-sex twins. In sharp contrast, among never-breastfed twins, same-sex/opposite-sex twin status was not significantly associated with height, F(1, 275) = 0.228, p = .633, weight, F(1, 266) = 0.417, p = .519, or body size, F(1, 259) = 0.798, p = .373.

The authors’ reasoning is extremely tortured:

The analysis of the Add Health data showed that breastfed same-sex twins were consistently taller and heavier than their opposite-sex counterparts throughout adolescence and early adulthood (from Age 16 to 29). In contrast, never-breastfed same-sex twins were no taller or heavier, and might even have tended to be shorter and lighter, than their opposite-sex counterparts. Our results are consistent with the recent findings that human breast milk may be tailored for each sex to facilitate its health and growth most efficiently. Same-sex twins can benefit from such sex-tailored breast milk, just as singletons can, but opposite-sex twins cannot do so and, therefore, may be at a disadvantage.

That reasoning would only apply if all four of their unwarranted assumptions were true and there’s no evidence that any of them are.

This is shoddy research, not surprising when you consider that it is a drunkard’s search. The authors used the data they had instead of the data that is required. The authors presume to draw conclusions about gender specificity of breastmilk without looking at breastmilk and without looking at infant and child outcomes. There is simply no reason for believing that adolescent height and weight tell us anything about breastmilk and it is irresponsible for the authors to imoly that there is.