People who live in glass houses shouldn’t throw stones.

Conservatives, who bemoan same-sex marriage as a potential cause of family breakdown, are hardly in position to point fingers. The sad state of opposite-sex marriage, particularly among conservatives themselves has caused and continues to cause family breakdown, and, indeed, societal breakdown. If conservatives spent more time tending to their own marriages, and less worrying about other people’s marriages, children, families and society would be better off.

To listen to conservatives, religious and political, you’d think that same-sex marriage represents a significant threat to health, wealth and morals. To my knowledge approximately zero people have been harmed by same-sex marriage. I guess it’s easier to pontificate about a non-threat rather than to face the real threat, the breakdown of opposite-sex marriage. Illegitimacy, divorce and child abandonment harm hundreds of thousands of children, and many adults each and every year. That represents a major threat to health, wealth and morals.

The statistics on the breakdown of opposite-sex marriage are incontrovertible; divorce breaks up a large proportion of families, illegitimacy (failure to marry) is a major risk factor for child poverty, poor health, and criminal activity. Child abandonment (usually by the father) leaves many children, betrayed, bereft and poverty stricken.

Why do conservatives, religious and political, waste their time trying to destroy or prevent same-sex marriages when opposite-sex marriages are clearly a source of so much pain and suffering? Perhaps it’s because those very same conservatives are responsible for so much of the devastation.

Which states have the highest rates of divorce? Conservative states. Which states have the highest rates of illegitimacy? Conservative states. It’s not a coincidence that the first divorced president (Ronald Reagan) was a conservative or that the first presidential candidate to parade an unwed pregnant teen child on national television was also a staunch conservative (Sarah Palin).

When it comes to health, wealth and morals, the issues that conservatives claim undergird their opposition to same sex marriage, conservative states lead the way … to the bottom. Health: States with the highest rate of infant mortality? Conservative states. Wealth: States with the highest rate of child poverty? Most are conservative states. Morals: Many of the states with the highest rate of teen drug abuse are conservative states. An unbiased observer might be forced to conclude that it is the breakdown of opposite-sex marriage that threatens the well being of Americans, particularly American children.

It is a curious fact about American conservatives, political and religious, that they fail to recognize that they are the problem, not the solution. The values that they claim drive them to oppose same-marriage are being undermined by their behavior, not the behavior of others. Their party stalwarts are drug addicts (Rush Limbaugh), philanderers (Newt Gingrich), and people who found divorce both personally and financially convenient (Ronald Reagan, John McCain).

It is not a stretch to argue that the people who really support family values are the people who are trying to form families, same-sex couples, not the people who loudly and stridently promote “family values” while conspicuously failing to practice them.

That’s not the official plan, of course. Bristol Palin has been hired by a national foundation ostensibly to “raise awareness” for teen pregnancy prevention. It seems a decidedly poor choice since Bristol Palin has done more to glamorize teen pregnancy than any other individual.

Palin’s story is hardly a cautionary tale. The typical teen pregnancy is shadowed by shame, fear and the specter of poverty. Bristol’s teen pregnancy differed not simply because her avowedly Fundamentalist mother, the governor of Alaska, has publicly supported her, both emotionally and financially. The principle difference is that Bristol’s unwed teen pregnancy catapulted her to a life of national celebrity.

Rather than being viewed as a source of shame to be hidden away, Bristol Palin and her boyfriend were proudly displayed at the Republican Party Convention. John McCain, attempting to bask in the light of her celebrity, actually went to the airport to greet her and the baby’s father when they arrived in Minnesota. She made multiple appearances on national TV and her story was breathlessly covered by celebrity publications like People Magazine. Bristol Palin has continued to bask in her new-found celebrity since the baby’s birth. In a February interview by Fox News, she declared that teen sexual abstinence is “not realistic at all.”

Prior to Bristol Palin’s appearance on the national stage, I had thought we reached a new low on the teen pregnancy front when Jamie Lynn Spears announced the impending birth of her baby and I had to explain it to my tween daughter. I wasn’t getting much support for my views and values when Spears was glamorized by being featured prominently on national magazine covers, complete with stories of her dreamy musings on how she was “ready” to become a mother.

As a gynecologist and a mother, I have spent decades counseling young girls to avoid teenage pregnancy. My recommendations always include delaying sexual activity, using contraception, and considering future goals and the way that teen pregnancy tends to make them unachievable. I didn’t expect any help from the entertainment press, but I was surprised nonetheless by how easily Spears’ pregnancy was accepted, how her pre-baby planning and purchases were portrayed as normal events for a 16 year old, and how she and her baby appeared on national magazine covers. Despite that, I was blindsided by the willingness, even eagerness, of the Republican Party and the national press to glamorize Bristol Palin.

No family is perfect, poor decisions are made, and children should be loved and supported in their aftermath. Nonetheless, call me old fashioned, but I don’t think that being supportive of your child’s poor decisions means proudly parading her on a national stage. I certainly don’t think that being supportive means flying in her teenage boyfriend so he can appear with her in the national limelight. If that isn’t glamorizing teen pregnancy, I don’t know what is.

Bristol Palin hired to promote awareness of teen pregnancy? Does her story — get pregnant, have your pregnancy supported by your famous mother, have your boyfriend invited to join you on national television, be personally greeted at the airport by the Republican presidential candidate, give interviews to celebrity magazine — discourage teen pregnancy or promote it?

Pick up any newspaper or magazine and you can read about the latest scientific breakthroughs in cancer, Alzheimer’s or heart disease. Just keep in mind that what you are reading is probably not true.

The research was done just as reported. The results were written up just as the newspaper article states, and the quotes from the scientific researchers are accurate. Unfortunately, the odds are high that the research does not mean what the authors would like you to think it means, and the reason points to a fundamental failing of medical journalism.

Medical journalists are supposed to interpret the findings of recent medical publications and present them to the general public in ways that they can understand. They are supposed to provide context for the discovery, explaining what it might mean for disease treatment or cure. Yet, they rarely do. Instead, they simply copy the press release.

Most people are unaware that scientists issue press releases about their work and they are certainly unaware that medical journalists often copy them word for word. Instead of presenting an accurate representation of medical research, medical journalists have become complicit in transmitting inaccurate or deceptive “puff pieces” designed to hype the supposed discovery and hide any deficiencies in the research.

Imagine if a journalist reviewing the newest Ford cross-over vehicle didn’t bother to drive the car, but simply copied the Ford brochure word for word. Could you rely on the journalist’s evaluation? Of course not. Yet that is precisely what medical journalists are doing each and every day.

A paper in a recent issue of Annals of Internal Medicine confirms this disturbing trend. The paper, Press Releases by Academic Medical Centers: Not So Academic?, by Woloshin, and colleagues finds:

Of all 113 releases about human studies … [f]orty percent reported on inherently limited studies (for example, sample size <30, uncontrolled interventions, … or unpublished meeting reports). Fewer than half (42%) provided any relevant caveats… Among the 87 releases about animal or laboratory studies, most (64 of 87) explicitly claimed relevance to human health, yet 90% lacked caveats about extrapolating results to people… Twenty-nine percent of releases (58 of 200) were rated as exaggerating the finding’s importance… Almost all releases (195 of 200) included investigator quotes, 26% of which were judged to overstate research importance… Although 24% (47 of 200) of releases used the word “significant,” only 1 clearly distinguished statistical from clinical significance. All other cases were ambiguous …

Why is this a problem? The harm extends beyond the obvious point that it is deceptive, and a failure of medical journalists to do their job, which is to interpret the accuracy and relevance of scientific publications when writing about them. Because medical journalists credulously publish press release as if they were true, they are constantly publishing conflicting reports, contributing to the public’s distrust of medical research. Each day seems to bring a new report of a food, or a drug that will prevent or cure cancer. Within a week or a month or a year, the journalists are reporting that that food or drug does not prevent or cure cancer.

To the public, it looks like medical researchers are constantly making mistakes. Today they claim that a food will prevent cancer. Next month, the same food will be found to cause cancer. In reality, medical research never demonstrated either claim, but medical journalists reported preliminary findings or flawed research as if they were definitive even though that was untrue.

The Annals of Internal Medicine has done an important service in bringing this disturbing practice to light. You can’t believe what you read about medical research in newspapers and magazines because medical journalists are simply copying press releases, not analyzing the research for accuracy or relevance. Therefore, in the interest of accuracy and relevance, I must disclose an important caveat to this important scientific paper. In what surely is an unintentional irony, The Annals of Internal Medicine publicly unveiled the paper and its findings by issuing a press release.

My most difficult obstetric case was not a diagnostic dilemma, but rather an ethical one. Everyone involved agreed on the diagnosis, but the experts split neatly down the middle, each group offering a treatment plan diametrically opposed to the other. We had no difficulty agreeing on the nature and severity of the problem. We just couldn’t figure out what to do about it.

The patient was sent to me, the on call doctor, directly from the office where she had just had an ultrasound exam. The radiologist, an exceptionally skilled clinician, called me to tell me that this was an emergency that required immediate action. She insisted that without a C-section, the patient’s twins would both be dead in a matter of hours. These babies were exceptionally small because their placenta was failing. Oh, and there was an additional complicating factor. They were also very premature, only 27 weeks (more than 3 months early) by best estimate, so prematurely delivering them now would probably kill them.

The mother was a 24 year old woman with a history of 2 normal deliveries. She had shown up for her first prenatal appointment only 8 weeks before, knowing she was pregnant, but unsure when she conceived. The first ultrasound showed a twin pregnancy at approximately 19 weeks. The problems were apparent even then. Both babies were exceptionally small, less than half the expected weight for that point in pregnancy, and an abnormal placenta with sluggish blood flow was clearly the cause. She was counseled that the babies would probably die before they were old enough to survive outside the womb.

A repeat ultrasound at 23 weeks showed that the babies, both boys, were still alive, but had not grown much. Now an ultrasound at 27 weeks had demonstrated that each weighed less than a pound (as compared to an expected weight of two pounds) and both were near death. At 27 weeks of pregnancy, there was a theoretical possibility that they could survive if delivered now.

We called a perinatologist, an expert in pregnancy complications, to consult on the case. She confirmed the findings of the radiologist, and told the patient in no uncertain terms that she expected that the babies would die if not delivered soon. Then we called a neonatologist, a specialist in the care of newborn infants, and he was equally adamant that the babies should not be delivered.

The neonatologist described to the mother the daunting odds that her sons would face, the myriad of possible complications, and the lifetime handicaps that would be expected if they lived. He warned ominously that the NICU (neonatal intensive care unit) of this hospital, one of the finest in the world, have never had a baby that small survive. The neonatologist counseled her that these babies should not be delivered for several more weeks. Delivering them now, he claimed, was the equivalent of a death sentence.

The mother could not decide what to do. Her husband and family arrived, followed shortly by her minister. She asked me what I recommended and I hesitated. I believe that it is the job of a doctor to make a recommendation, even though the decision is up to the patient. She had heard a lot of highly technical and conflicting medical advice and needed help in sorting it out, but I wasn’t sure what to do, either. It seemed like any decision would be the wrong decision.

Ultimately I told the mother that I felt that her sons were going to die no matter what she chose. In the future, though, she would probably look back on this tragedy and wonder if she had done everything she could. So the best way to make the decision would be to imagine what would give her the most comfort during the rest of her life. Would she feel that she had done the most for her babies by keeping them inside and hoping they would survive long enough to have a better chance at life? Or would she feel that she had done the most for them if she had surgery today and consented to very aggressive and probably futile attempt to save them that way? The mother requested more time to pray on her decision.

When I returned, she had decided. She understood, she said, that it was likely her sons would not survive. Nonetheless, she would never forgive herself unless she did everything she possibly could for them. To her, doing everything meant submitting herself to a C-section and consenting to maximally aggressive treatment of the babies.

We assembled a surgical team and two separate neonatology teams, one for each baby. We headed to the operating room for the birth and death of her sons.

The surgery itself was uneventful. The first baby was pulled from the uterus and handed off to the neonatologist. He had only a heartbeat and no other signs of life. He weighed a mere 16 oz. The neonatologist promptly intubated him and began aggressive treatment measures. The baby never responded and died in the operating room.

The second baby was born. He squeaked as he was given to the neonatologist. This boy was even smaller than his brother, weighing in at only 15 oz. He too was promptly intubated, but needed surprisingly little assistance to stabilize despite his dire condition.

This tiny boy had a precarious existence in the NICU, but day by day continued to defy the odds. Ultimately, despite multiple complications and three months in intensive care, the baby became the smallest survivor to every leave our nursery. He went home with some visual impairment due to prematurity and some lung damage due to the long course on the respirator. The last time I saw him was shortly after his fifth birthday. He was small and he needed glasses, but in every other way he was a normal little boy.

What did we learn from this case? To this day, I don’t really know. Never before and never since have I been in a situation with such stark choices and so little hope. The mother made the choice that she thought would give her the most comfort and to our amazement, and hers, a tiny boy survived seemingly insurmountable odds as a result, in the process making history at our hospital.

Following up on her film “The Business of Being Born.” self proclaimed childbirth expert, actress Ricki Lake has published a new book. Hopefully, it is more accurate than her movie, but I have my doubts, given her deceptions and misrepresentations about homebirth.

Childbirth is and has always been one of the leading causes of death of young women and babies in every time, place and culture. Finally, for the first time in human history, that has changed if you happen to be living in the right place. American obstetrics has been spectacularly successful in lowering the neonatal mortality rate 90% and the maternal mortality rate 99% in the past 100 years. In response, homebirth advocates like Ricki Lake have suddenly discovered the joys of giving birth at home.

Homebirth advocacy is supposed to be about “empowering” women to make “informed” health care decisions. How that could happen when homebirth advocacy is based almost entirely on mistruths, half truths and outright lies? Ricki Lake is out front in spreading these deceptions and she ought to stop. In a recent piece on the Huffington Post (Docs: Pay No Attention to Ricki Lake’s Homebirth), Lake claimed:

“In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, ‘low-risk’ women, babies were born just as safely at home under a midwife’s care as in the hospital.”

That’s flat out false. All the existing scientific evidence shows that homebirth increases the risk of neonatal death. Sure, there are papers that claim that homebirth is a safe as hospital birth, but they do so by comparing homebirth to high risk hospital birth (instead of low risk hospital birth) or by comparing homebirth in one year to hospital birth decades before (as in the Johnson and Daviss BMJ 2005 study that Lake mentions).

Johnson and Daviss claimed to show that homebirth with a CPM in 2000 was as safe as hospital birth, but they compared it to hospital birth in a bunch of out of date studies extending back to 1969. Johnson and Daviss simply left out the fact that homebirth in 2000 had almost triple the neonatal mortality as moderate risk hospital birth in 2000.

In an interview on the Today Show, Lake declared:

“The fact that we have the second-worst infant mortality rate in the developed world is a statistic that I think people need to know about”

However, infant mortality is not the correct statistic to evaluate obstetric care since it includes deaths up to one year. According to the World Health Organization, the correct statistic to evaluate obstetric care is perinatal mortality, death from 28 weeks of pregnancy to 28 days of life. The World Health Organization 2006 report on perinatal mortality shows that the US has one of the lowest rates in the world, lower than Denmark, the UK and the Netherlands.

Lake continued:

“Home births and midwives are more common in Japan and Europe than in the United States …”

What Lake neglects to mention is that American homebirth midwives belong to a second, inferior class of midwives with less education and training than ANY midwives in the industrialized world. American CNMs and European midwives deservedly have excellent reputations. They have rigorous educational requirements and extensive hospital based training in the diagnosis and management of childbirth complications.

Homebirth midwives (direct entry midwives including CPMs) try to trade on the reputation of other midwives. However, homebirth midwives have grossly deficient education requirements (they can obtain their education by correspondence course) and grossly deficient training, lacking any training in the diagnosis and management of complications. American women need to understand that American homebirth midwives cannot meet the requirements to be licensed in ANY first world country.

Lake also neglects to mention that American homebirth midwives are currently hiding their safety statistics from the public. The Midwives Alliance of North America (MANA) the trade union for direct entry midwives has been collecting extensive statistics on the safety of homebirth since 2001. Those statistics have been publicly offered to anyone who can prove they will use them for the “advancement of midwifery”. Even then you must sign a legal non-disclosure agreement preventing you from revealing any data to anyone else. It does not take a rocket scientist to suspect that MANA is suppressing its OWN data because it shows that homebirth with a direct entry midwife increases the risk of neonatal death, and possibly the risk of brain damage as well.

In order for women to make an informed decision about homebirth, they need to know the truth about homebirth. And the truth is that all the existing scientific evidence to date shows that homebirth increases the risk of neonatal death, that American homebirth midwives cannot meet the licensing requirement for any country in the industrialized world, and that the homebirth midwives trade union is hiding 7 years of their own data on the safety of homebirth.

Ricki Lake should stop spreading misinformation about homebirth, should stop claiming that homebirth is as safe as hospital birth, and should use her influence to demand that homebirth midwives release the safety data that they are hiding.

I have arrived; I’ve got my own iPhone App. For those who have been living under a rock, “iPhone App” is short for iPhone application, tiny applications that can be accessed only through an iPhone, and purchased through the iTunes Store.

The “Am I Pregnant Quiz” was developed in response to the requests of the millions of readers of my primary website, Ask Dr. Amy. It provides women with an immediate and personalized answer to the question “Am I Pregnant?” based on the responses to 10 questions about menstrual cycle and symptoms. It’s not a substitute for a pregnancy test, of course, but it provides guidance for women are wondering about their chances of pregnancy this month.

Each month over 50,000 women ask themselves “Am I Pregnant?” Hopefully, the “Am I Pregnant Quiz” iPhone app can help them find out the answer.

Others have pointed out the tendency of mainstream websites like the Huffington Post to present “alternative” medicine quackery as medical news. (See, for example, Orac’s Fire Marshal Bill discusses vaccines and autism on The Huffington Post, and Steve Novella’s, The Huffington Post’s War on Science.) Even articles that are purportedly written by “doctors” are pseudoscientific nonsense. (See “Dr.” Patricia Fitzgerald’s Jenny McCarthy’s Autism Crusade: Healing, Hope… And Controversy). So how are lay people supposed to distinguish quackery from scientific medicine?

Rory Coker, professor of physics and University of Texas Austin, has written a very informative article for the website Quackwatch. The article, Distinguishing Science from Pseudoscience, was not written with “alternative” health in mind, but accurately captures the essence of “alternative” medicine. Using these principles, the average person can distinguish quackery from scientific medicine.

You know it’s quackery because:

1. “Pseudoscience displays an indifference to facts.

Instead of bothering to consult reference works or investigating directly, its advocates simply spout bogus “facts” where needed. These fictions are often central to the pseudoscientist’s argument and conclusions. Moreover, pseudoscientists rarely revise. The first edition of a pseudoscience book is almost always the last, even though the book remains in print for decades or even centuries…”

Homebirth advocates, both professional and amateur, routinely make up “facts” to suit themselves. For example, homebirth advocates routinely claim that the US does poorly on measures of obstetric care (false), that Cytotec was used “experimentally” for labor induction (false) or that homebirth is “as safe as life gets” (only if life is filled with easily preventable infant deaths).

Cory points out that pseudoscientists rarely revise their books even though new scientific studies are constantly published. Williams Obstetrics has been through 3 editions (20th, 21st and 22nd) since Henci Goer published “The Thinking Woman’s Guide to a Better Birth” which represents itself as an analysis of the scientific evidence, yet she has not revised it.

2. “Pseudoscience begins with a hypothesis … and then looks only for items which appear to support it.

Conflicting evidence is ignored… [T]he aim of pseudoscience is to rationalize strongly held beliefs, rather than to investigate or to test alternative possibilities. Pseudoscience specializes in jumping to “congenial conclusions,” grinding ideological axes, appealing to preconceived ideas and to widespread misunderstandings.”

“Alternative” health doesn’t merely appeal to widespread misunderstandings, it actively seeks to create widespread misunderstanding.

3. “Pseudoscience relies heavily on subjective validation.

Joe Blow puts jello on his head and his headache goes away. To pseudoscience, this means jello cures headaches… This phenomenon, called subjective validation, is one of the foundations of popular support for pseudoscience…”

Jenny McCarthy believes that her son had autism. She provided him with “therapy.” He seems better. Jenny McCarthy believes that the therapy “cured” his autism.

4. “Pseudoscience always avoids putting its claims to a meaningful test.

Pseudoscientists never carry out careful, methodical experiments themselves … Pseudoscientists also never follow up. If one pseudoscientist claims to have done an experiment … no other pseudoscientist ever tries to duplicate it or to check him,.. Further, where a pseudoscientist claims to have done an experiment with a remarkable result, he himself never repeats it to check his results and procedures…”

A corollary to this is also often found in vaccine rejectionism, the claim that the vaccine quack “hasn’t had time” to publish the results.

“Alternative” medicine advocates are also very careful never to appear in any venue where they could be questioned by scientific peers, yet they speak extensively at gatherings of laypeople.

5. “Pseudoscience often contradicts itself, even in its own terms.

Such logical contradictions are simply ignored or rationalized away…”

Childbirth is painless. Childbirth is very painful, but the pain can be managed with the right attitude. Not only is childbirth not painful, it is actually pleasurable. Homebirth advocates can’t make up their minds which one of these claims is preferable.

6. “Pseudoscience deliberately creates mystery where none exists, by omitting crucial information and important details.

Anything can be made “mysterious” by omitting what is known about it or presenting completely imaginary details…”

Vaccine rejectionism relies very heavily on misrepresenting what vaccine rejectionists don’t know as “unknown”. Homebirth advocates prefer to claim that there is no scientific evidence for obstetrics practices when copious evidence exists and is easily accessible to anyone who bothers to look.

7. “Pseudoscience does not progress.

… within a given topic, no progress is made… New theories are seldom proposed, and old concepts are rarely modified or discarded in light of new “discoveries,” since pseudoscience rarely makes new “discoveries.” … No natural phenomena or processes previously unknown to science have ever been discovered by pseudoscientists…”

“Alternative” medicine never changes. It always amounts to nothing more than rejection of conventional practice.

8. “Pseudoscience appeals to false authority, to emotion, sentiment, or distrust of established fact.

A high-school dropout is accepted as an expert on archaeology … A psychoanalyst is accepted as an expert on all of human history, not to mention physics, astronomy, and mythology, even though his claims are inconsistent with everything known in all four fields…”

Henci Goer and Ina May Gaskin have no training in their supposed areas of “expertise”. Marsden Wagner is a pediatrician and Michel Odent is a general surgeon, yet they are touted as experts on birth even though obstetricians disagree with them.

Actors Jenny McCarthy and Jim Carrey are “experts” on autism.

9. “Pseudoscience appeals to the truth-criteria of scientific methodology while simultaneously denying their validity.

Thus, a procedurally invalid experiment which seems to show that astrology works is advanced as “proof” that astrology is correct, while thousands of procedurally sound experiments that show it does not work are ignored…”

Vaccine rejectionists cite poorly done or discredited research as proof of their claims, while routinely ignoring thousands of medical studies that thoroughly debunk their claims.

HuffPo presents Patricia Fitzgerald, its Wellness Editor, as “Dr.” when her “doctorate” is in homeopathic medicine.

10. “Pseudoscientists often appeal to the ancient human habit of magical thinking.

Magic, sorcery, witchcraft—these are based on spurious similarity, false analogy, false cause-and-effect connections, etc. That is, inexplicable influences and connections between things are assumed from the beginning—not found by investigation.”

For example, birth “affirmations” can purportedly influence whether a baby will be breech or will fit.

11. “Pseudoscience relies heavily on anachronistic thinking.

The older the idea, the more attractive it is to pseudoscience—it’s the wisdom of the ancients!—especially if the idea is transparently wrong and has long been discarded by science…”

“Alternative” health practitioners love to claim that Chinese medicine or herbs are effective because they are ancient. Meanwhile, the Chinese die in droves of conditions that are easily treatable by real medicine, and herbs are less effective (or ineffective) compared to medication.

The Huffington Post has learned that presenting quackery as scientific medicine draws readers and perhaps that is why they promote quackery in their pages. Or perhaps Arianna Huffington is a devotee of “alternative” health quackery. Either way, Huffington Post is promoting pseudoscience as if it were science. The average person can use the above principles to tell the difference.

I yield to no one in my passionate commitment to the well being of children, but this incident leaves me distinctly uncomfortable. Prosecutors in North Dakota have filed charges of felony child neglect against Stacey Anvarinia. Was she abusing her 6 week old baby? No. Had she neglected to care for the baby? No. It was because she was breastfeeding the baby. The police officers and prosecutors decided, in their wisdom, that since Ms. Anvarinia appeared to be intoxicated, her breast milk posed imminent threat to the health of her baby.

Since when is breastfeeding while drunk a crime? Is it even a danger to the baby’s health? There is certainly a theoretical risk that a baby can be harmed by breastfeeding from a chronically intoxicated mother. Ethanol (alcohol) passes from the mother’s blood stream into her breast milk. However, it is diluted, and the baby receives only a tiny fraction of what the mother consumed. There is no scientific evidence that breastfeeding during a single episode of intoxication is harmful to the baby in any way.

The police officers made no attempt to prove that Ms. Anvarinia was actually drunk. She just “seemed” intoxicated to them. To my knowledge, they did not obtain evidence of the amount of ethanol, if any, in the baby’s bloodstream. So North Dakota has leveled a felony charge against Ms. Anvarinia without evidence that the “crime” in question was even committed. More disturbing, though, is that they made up the “crime”” to suit the circumstances, and likely influenced by the pervasive American hysteria over what children eat.

Let’’s be clear. They didn’t charge Ms. Anvarinia because she was drunk in her own home. They didn’t charge her because they thought that she was too drunk to care for her infant. They charged her because she was breastfeeding. Had she been bottlefeeding the baby, they would have ignored her drunkenness, though arguably the baby faced health risks from a drunken mother mixing formula. Mixing formula powder with water in the wrong proportions can be harmful to a baby.

Ms. Anvarinia was charged with felony child neglect solely because she was breastfeeding. Since there is no scientific evidence that breastfeeding while intoxicated is harmful to an infant, the officers and prosecutors simply made up the “crime.” In that, I suspect, they were influenced by the current American hysteria over what children eat. Not a day passes when Americans aren’t bombarded with messages about the “dangers” of childhood obesity, the “dangers” of sugar, the “dangers” of salt, etc.

Moreover, Americans seem chronically unable to understand the concept of risk. They routinely obsess about trivial or even non-existent risks, and they wrongly ascribe far more risk to “dangers” they perceive as uncontrollable (alcohol inadvertently given to a baby through breastmilk) than those over which they think they have control (rolling over and suffocating a baby sleeping in the same bed). Couple that with lack of familiarity with breastfeeding, and suddenly it is a “crime” to breastfeed while intoxicated.

This incident is deeply troubling for another reason. It is an attempt to criminalize mothering if it does not meet entirely arbitrary standards. Will they be charging mothers who smoke with felony child neglect, since second hand smoke poses a real, not theoretical, risk to an infant’s health? Will they be monitoring the dietary intake of women who breastfeed to make sure that the breast milk contains nutrients in the recommended amounts and doesn’t contain any non-approved prescription or over the counter medications?

The case against Ms. Anvarinia will almost certainly be dismissed because prosecutors lack the evidence needed to try her for endangering her child. They have no evidence that she was drunk or that any alcohol was transmitted to the child. Nonetheless, the mere fact that she was accused is deeply troubling. She was not charged because she was drunk, and she was not charged because she posed a threat to her child simply by being drunk. She was charged because she was mothering (breastfeeding) while drunk, a moral “deficiency” that the officers and prosecutors decided merited the designation of “crime.”

Babies are born in hospital delivery rooms all day, every day and no one thinks twice about it. Give birth to a baby anywhere else in the hospital, even the emergency room, and pandemonium occurs. Staff members appear from all parts of the hospital … to watch. You’d think these doctors and nurses had never seen a birth before, they are so excited, calling encouragement and cheering. Of course it can be a bit embarrassing to notice, after the baby is born, that you have attracted a crowd of complete strangers who have become fixated on your fully exposed nether regions.

Such was the case of the mother who gave birth to her 5th child at the elevator bank on the labor floor. I was a medical student at the time, and we could hear the screaming as the elevator rose from the first floor and the doors opened. The orderly and the nurse managed to get the stretcher out of the elevator, but it was too late to go farther. The nurse delivered the baby on the threshold of the labor ward. Within moments a crowd that seemed to include a substantial portion of the hospital staff had gathered to watch.

The baby was healthy and vigorous, encouraging a festive atmosphere. Various staff members were admiring him and celebrating the opportunity to see a baby being born. At first we didn’t notice the mother’s distress.

“I’m so embarrassed,” she wept. She gestured to her legs splayed open and the pile of bloody sheets between them. “Everyone is looking at me.”

Actually, everyone was looking at the baby, but we understood her point. The crowd of observers began to break up and drift away, chatting happily about what they had just witnessed.

The nurse tried to comfort the mother.

“Don’t cry, honey,” she soothed. “You shouldn’t be embarrassed. This is nothing. Last year a woman gave birth to a baby on the hospital’s front lawn.”

Unexpectedly, this produced a further flood of tears.

The nurse was surprised, “What’s wrong, dear?”

It took a minute for the mother to calm down enough to tell us.

“That was me last time!”

The current popularity of “alternative” health is a sad testament to the pervasive appeal of pseudoscience among Americans. As a general matter, “alternative” health is the belief that simple measures (nutritional supplements, herbs, laying on of hands) are effective in preventing and treating serious illness. “Alternative” health promotes the happy fantasy that we have more control over our health than we actually do.

Like most claims of pseudoscience, “alternative” health rests on the twin pillars of lack of knowledge and magical thinking. Lack of knowledge is easy to explain. If you don’t have a fund of basic scientific knowledge, if you don’t understand the scientific method, and if you don’t understand statistics, which is the language of science, you are not going to have a real understanding of health. Most “alternative” health advocates are woefully undereducated about human physiology, have little basic knowledge of science and no knowledge of statistics.

“Alternative” health advocacy depends in large part on a few celebrity “scholars” who filter and interpret all information about health, scientific papers and statistical analysis. The average consumer of supplements and alternative treatments has not read a single medical textbook, a single book of statistics or a single scientific paper. Interestingly, they don’t even think it is necessary. Indeed, the average consumer who claims to have done “research” into alternative health has only “researched” the opinions of other advocates.

If lack of knowledge were the only problem, it would be easy to solve. A little more education would go a long way. Learning the truth about “alternative” health, the fact that virtually none of it has been tested for efficacy or safety, should put a serious dent in the sale of supplements, herbs, and “alternative” remedies. However, the belief in “alternative” health reflects the appeal of pseudoscience itself.

Barry Beyerstein, a professor of psychology at Simon Fraser University, wrote extensively on this topic. His paper, Distinguishing Science from Pseudoscience, is one of the best expositions of the issue that I have read. As Beyerstein explains:

The prestige and influence of science in this century is so great that very few fields outside of religion and the arts wish to be seen as overtly unscientific. As a result, many endeavors that lack the essential characteristics of a science have begun to masquerade as one in order to enhance their economic, social and political status. While these pseudosciences are at pains to resemble genuine sciences on the surface, closer examination of the contents, methods and attitudes reveals them to be mere parodies. The roots of most pseudosciences are traceable to ancient magical beliefs, but their devotees tyically play this down as they adopt the outward appearance of scientific rigor. Analysis of the perspectives and practices of these scientific poseurs is likely to expose a mystical worldview that has merely been restated in scientific-sounding jargon.

How does it work in practice?

Pseudoscientists use a number of rhetorical ploys to advance their cause. These sales gambits are well-known to social psychologists who specialize in persuasion techniques…

Bogus science prospers in the marketplace by selling false hope … Wild claims … are likely to surface wherever proven techniques offer no quick and easy route to a highly desirable end.

Most claims of “alternative” medicine fit into this category. Nutritional claims are paradigmatic. Wouldn’t it be nice if preventing, treating and curing serious illness involved nothing more arduous or uncomfortable than changing what you eat. Sound to good to be true? That’s because it is.

According to Carl Sagan:

Pseudoscience is easier to contrive than science because distracting confrontations with reality … are more readily avoided. The standards of argument, what passes for evidence, are much more relaxed. In part for these same reasons, it is much easier to present pseudoscience to the general public than science. But this isn’t enough to explain its popularity…

Pseudoscience speaks to powerful emotional needs that science often leaves unfulfilled. It caters to fantasies about personal powers we lack and long for… In some of its manifestations, it offers satisfaction of spiritual hungers, cures for disease, promises that death is not the end. It reassures us of our cosmic centrality and importance. It vouchsafes that we are hooked up with, tied to, the Universe…

At the heart of some pseudoscience … is the idea that wishing makes it so. How satisfying it would be, as in folklore and children’s stories, to fulfill our heart’s desire just by wishing. How seductive this notion is, especially when compared with the hard work and good luck usually required to achieve our hopes…

“Alternative” health, like all pseudoscience, depends on a lack of basic knowledge of science and a desperate wish that difficult problems can be solved with simple solutions. Lack of knowledge, superstition and desperation have created a financial bonanza for purveyors and advocates of “alternative” health.