I cannot begin to imagine the pain this woman is in:

Has anyone vaginally applied bloodroot salve for cervical precancerous cells? If so please share your story. I applied it on Sunday and I am in a lot of pain.

Putting bloodroot salve in your vagina is like putting battery acid in your vagina.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Bloodroot kills cancer cells, but so does battery acid.[/pullquote]

What is bloodroot?

Bloodroot is a plant containing the active ingredient sanguinairine, which is an escharotic. That means that it can produce an eschar. And escar is different from a scab. A scab is dried blood and serum located on top of the skin. An eschar, in contrast contains necrotic (dead) tissue. A cut will produce a scab. Ulcerated tissue will produce an eschar.

Why would anyone think that treating precancerous cells with bloodroot salve is a good idea?

Because bloodroot can kill cancer cells … but then so can battery acid.

According to Quackwatch [N.B. Do not scroll down unless you want to see some very unpleasant images]:

…Their use to treat cancer dates back hundreds of years, perhaps even to ancient times. Their use was fairly common during the 18th and 19th centuries. If a tumor is confined to the superficial layers of the skin, it would be possible to burn it off with a corrosive salve or paste. Unfortunately, products capable of accomplishing this can also burn the surrounding normal tissue and result in unnecessary scarring. For superficial cancers—for which the cure rate with standard treatment is nearly 100%—it makes much more sense to use standard methods that can destroy the cancer with little or no damage to the nearby tissues.

Yet naturopaths recommend it (despite the fact that it can destroy normal tissue) as the least invasive, most natural treatment for abnormal cells. Ironically, it is far more invasive and less natural than standard medical treatment, far less likely to be effective and far more likely to cause hideous side effects.

The active ingredient, sanguinairine, is a toxic quaternary ammonium salt. It’s natural in the same way that snake venom is natural … and snake venom is deadly.

Sanguinairine kills cells by destroying their ability to pump sodium and potassium in and out. It is equally deadly to normal cells as well as to abnormal cells.

The standard treatment for mild cases of abnormal cervical cells (cervical dysplasia) is cryotherapy: freezing the abnormal cells with a cold metal probe. Cryotherapy can be applied directly to a small portion of the cervix, killing the abnormal cells and sparing just about everything else.

How do gynecologists know precisely which tissue to freeze? It requires knowledge of the basic anatomy of the cervix.

The cervix is made of two types of cells. The inside of the cervix is lined with columnar cells and the outside of the cervix is covered with squamous cells. This illustration from Medscape shows the relationship. In the illustration we are looking at the cervix from the bottom up, as a gynecologist would see it during a speculum exam.

The two different types of cells meet at the squamous-columnar junction and the immediately surrounding area is known as the transformation zone (TZ). Cervical dysplasia always occurs in the transformation zone, so that’s the only area that needs to be treated.

The treatment of mild cervical dysplasia is simple. A cold metal probe sized to encompass the TZ is applied to the cervix. That’s it. The treatment is natural, focused and highly effective.

What about moderate or severe cervical dysplasia?

In those cases, it is important to determine whether the abnormal cells extend into deeper layers and actually represent cervical cancer. Therefore it is necessary to cut out the tissue of the TZ and send it to the pathologist for detailed examination. The area can be precisely cut out with electrocautery, laser or with a scalpel.

Where does a corrosive substance like bloodroot fit into these treatment options. It doesn’t.

There is no way to put bloodroot into the vagina without burning everything in the vagina. Even if it were painted on to the cervix so as to limit the damage to the affected area, it would need to be very carefully washed off to make sure it didn’t burn surrounding tissues.

If you want to know just how corrosive bloodroot salve can be, you can scroll down the QuackWatch article and see a hideous picture. An Idaho naturopath diagnosed a bump on Ruth Conrad’s nose as skin cancer and recommend bloodroot salve. It is so toxic that her entire nose sloughed off.

Now imagine putting something that could do that into your vagina. The scarring is bound to be horrific and the possibilities for further damage truly frightening extending to the possibility of a fistula between the vagina and the bladder or rectum or both.

The central problem in treating cancer is not how to kill cancer cells. Battery acid, bleach, lye and other corrosive substances kill cancer cells. The central problem in cancer treatment is killing cancerous cells WITHOUT killing too many normal cells as well.

The best way to kill mildly abornomal (precancerous) cervical cells is to carefully freeze them off or cut them out, sparing the normal tissue around them. Bloodroot salve is indiscriminately destructive, causes massive damage, and leaves tremendous scarring. That’s why you should never, ever put it in your vagina.

When one of my sons was in the third grade, we had an argument about arithmetic, specifically division.

He had been struggling over his homework, trying to determine the answer to a word problem:

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Whining that I don’t take your YouTube citation seriously is like whining that an MIT astrophysicist doesn’t take your styrofoam solar system model seriously.[/perfectpullquote]

If Jack has 18 pennies and wants to separate them into 3 groups, how many pennies will be in each group.

I pointed out that it was a division problem: 18 ÷ 3 = 6.

“No,” he wailed, “no it isn’t. That’s not the way my teacher explained it. You weren’t there. You didn’t hear what she said. You don’t know anything!”

I collected 18 pennies and put them on the table.

“Make 3 group out of these pennies and be sure each group has the same number of pennies,” I instructed.

It didn’t take him long to created three piles of 6 pennies each. He looked up at me with a shy smile and asked:

“How did you know?”

How did I know? I knew because I could draw on far greater arithmetic knowledge than he could. He knew very little about multiplication and division, fractions or percentages; and, of course, he knew nothing at all about algebra and calculus.

Arguing with anti-vaxxers reminds me of that episode because it is in many ways like arguing with 8 year olds. Their knowledge base is incredibly limited; their ability to go beyond basic sources of knowledge is profoundly restricted; and, on top of that, they have literally no idea how little they know.

Anti-vaxxers get incredibly frustrated arguing with me and for many of the same reasons that my 8 year old got frustrated. They don’t understand that what they’ve heard and read represents just a tiny fraction of the knowledge on the topic; their ability to go beyond plain language sources of knowledge into the scientific literature is profoundly restricted; and, on top of that, they have literally no idea how little they know.

They are proud of their “knowledge” garnered from websites, Facebook pages and YouTube videos. They don’t understand that citing YouTube is like citing Highlights Magazine. No doubt Highlights Magazine is filled with lots of accurate information about the solar system, for example, and perhaps after reading the magazine you could build a solar system model using string and stryrofoam balls. But that doesn’t make you an astro-physicist.

Whining that I don’t take your YouTube citations seriously is no different from showing up at an MIT astrophysics class and whining that they don’t take your styrofoam solar system model seriously. The other astrophysics students would laugh at you and your lack of both knowledge and sophistication. Anti-vaxxers should understand that when you cite YouTube, those who have advanced knowledge of these topics are laughing at you for the same reason: you are merely displaying your lack of both knowledge and sophistication.

Most 8 year olds, when told by authority figures that Highlights Magazine or a third grade classroom don’t represent the limits of knowledge on a topic, will generally accept that when they know more, things will look different. In contrast, most anti-vaxxers, when told by science authorities that the websites, Facebook pages and YouTube videos that they’ve seen don’t represent the limits of knowledge on the topic of vaccination, refuse to accept that if they knew more, things would look very different.

Partly that’s because defiance of authority is an integral component of anti-vax advocacy. They literally believe they know more than authorities. That makes about as much sense as the third grader who thinks he knows more about division than someone who took college calculus. And most of the gambits favored by anti-vaxxers sound as foolish coming out of their mouths as they would if a 3rd grader berated his teacher.

Can you imagine a 3rd grader whining to the teacher: “Just because you have a degree in mathematics doesn’t mean you know more arithmetic than me”?

Ridiculous, right? And it’s equally ridiculous for anti-vaxxers to whine: “Just because you have a degree in medicine doesn’t mean you know more immunology than me!”

Can you imagine a 3rd grader whining: “You might have a fancy degree, but I bet you didn’t learn any division in your math PhD program”?

Hilarious, right? And it’s equally hilarious when anti-vaxxers whine: “Medical schools only spend one day on immunology!”

Can you imagine a 3rd grader whining: “You’re just a shill for the math textbook industry?”

Sounds idiotic, right? And it’s equally idiotic for anti-vaxxers to whine to nearly all the doctors, research scientists and public health officials in the world, “you’re just a shill for Big Pharma.”

It can be charming when 3rd graders fail to understand how little they know about a topic despite the fact that they’ve completed 2nd grade. It’s not charming when someone with a only a high school diploma or an undergraduate degree in art fails to understand how little he knows about immunology.

It’s the Dunning-Kruger effect, first described in a classic paper Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments:

…[T]hose with limited knowledge in a domain suffer a dual burden: Not only do they reach mistaken conclusions and make regrettable errors, but their incompetence robs them of the ability to realize it.

Anti-vaxxers suffer from this dual burden. Not only do they reach mistaken conclusions and make regrettable errors, but their incompetence robs them of the ability to realize it.

They need to understand the depth and breadth of their own ignorance. Citing YouTube merely confirms their profound ignorance.

In a move sure to have far reaching implications, leading anti-vaxxers announced that they are merging their organizations with the Flat Earth Society.

Spokesperson Gull E. Bull explained that this exciting merger grew out of a chance encounter that occurred in the lobby of Trump Tower.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The merger grew out of a chance encounter in the lobby of Trump Tower.[/pullquote]

Andrew Fakefield, a leading anti-vax researcher, was awaiting his interview with President-Elect Donald Trump for a senior position at the FDA, while Flat Earth Society executive Steven Frawde was about to be vetted for leadership of NASA.

Fakefield and Frawde got to talking and realized that they had a startling amount in common above and beyond their personal friendship with Mr. Trump.

As Fakefield pointed out, both movements are made up of people who are “educated” and have done their own “research.”

Frawde concurred:

The members of the Flat Earth Society are not sheeple like most of the benighted folks who have accepted the assertion that the world is round. They know that astrophysicists are hiding the truth. Anti-vaxxers have equally incisive intelligence. The idea that injecting pieces of dead viruses into the human body to prevent infection with lives viruses makes as much sense as the absurd claim that the flat ground we walk upon is actually curved.

But the similarities don’t end there.

1. The glaring absence of RCTs

Fakefield notes that just as there has never been a randomized controlled double blind trial (RCT) to prove that vaccines are effective, there has never been a randomized controlled double blind to prove that the earth, or any other planet, is round. Considering that RCTs are widely recognized as the gold standard of research, the omission is particularly glaring.

2. Correlation is not causation

Sure, various vaccine preventable diseases began to disappear after the introduction of the relevant vaccines, but that was almost certainly due to improved sanitation and clean water. Sure, satellite and GPS technology rest on the assumption that the earth is round, but it could equally be explained by invoking anti-gravity ray guns that precisely position satellites above a flat earth.

3. Massive, corrupt government efforts to fool the populace

The unholy cabal of Big Medicine, Big Pharma and Big Government is widely recognized as responsible for the vaccine industry. As Fakefield points out, vaccines are a money making venture and manufacturers are greedy. That’s why they keep introducing more vaccines and insisting on boosters for diseases like tetanus.

Space missions involve even more money. Defense contractors, engineers and astrophysicists make billions while the American public is fleeced to support them. Just consider the massive expense required to stage the fake moon landings or to create the photographs supposedly sent back from deep space probes.

4. Poisons

Frawde notes that it’s tough to determine which is more dangerous: vaccine ingredients or the massive chemtrails created by space missions.

We’ve heard a lot about vaccine injuries, but I think going forward we are going to learn that chemtrail injuries are a greater problem. After all, vaccine injuries affect only those who were injected whereas chemtrails poison everyone.

According to Fakefield, there is some disagreement on this point.

The latest research from my esteemed colleague Dr. Bob Snears shows that vaccine shedding is a large and growing problem and may ultimately affect more people than chemtrails.

What will the new organization be named?

Frawde explained that their initial choice was Flax, a combination of Flat earth and anti-vax, but that was eventually dropped due to concerns that the name might be thought to promote Big Linen.

Fakefield told us that they ultimately settled on Morons United.

While it doesn’t directly reference either vaccines or earth, we think it captures the essence of what we have in common.

George Orwell introduced the concept of “doublespeak” in his masterpiece 1984.

Doublespeak is language that deliberately obscures, disguises, distorts, or reverses the meaning of words… It may also refer to intentional ambiguity in language or to actual inversions of meaning (e.g., “I just want you to know that, when we talk about war, we’re really talking about peace.” …

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]They believe themselves to be educated though most of them are dumb as rocks.[/pullquote]

The Thinking Moms’ Revolution (TMR), a website and Facebook page, is an example of doublespeak. There’s not much thinking going on at The Thinking Moms’ Revolution. Just as websites that include “truth” in the name are generally lying, the The Thinking Moms’ Revolution is actually about feeling, not thinking. The anonymous authors of site “feel” that vaccines cause autism despite the fact that there’s copious scientific evidence proving that they don’t; they “feel” that breastmilk is the elixir of life, despite the fact that in industrialized countries the benefits of breastfeeding are trivial; they “feel” that they are educated despite the fact that most of them are dumb as rocks.

Consider yesterday’s Facebook post about me:

We’ve known for quite a while that Amy Tuteur has gone utterly off the so-called “skeptical” deepend, but this is beyond the pale, even for her:

“Therefore, it is a thousand times more important to promote vaccination than to promote breastfeeding. No mother would refuse to do it if she only understood the benefits and got the proper support. That’s why I propose an immediate overhaul of the Baby Friendly Hospital Initiative to promote vaccination instead of breastfeeding.”

We have no qualms in calling this piece utter bullshit. In today’s era, your child is FAR more likely to be healthy if you breastfeed and don’t vaccinate at all than if you vaccinate on the CDC schedule and don’t breastfeed. Of course, that is an extremely unpopular view at the increasingly corrupt CDC, and while anecdotal evidence abounds, the science to support is currently scant but starting to accrue.
I can’t wait till the vaccinated vs. unvaccinated study from Dr. Paul Thomas’s practice is published. He promotes a modified vaccine schedule within his own practice, and among those children who were vaccinated on that schedule there is no autism. However, early analysis is showing that the fully unvaccinated children in his practice are by far the healthiest. — Prof

LOOK BEYOND THE HEADLINES. #parentsdothework

I will give the anonymous Prof credit for one thing. When I challenged her, she did not delete my comments. That’s quite unusual in the world of pseudoscience since the last thing quacks want is for readers to get information that hasn’t been vetted for ideological purity.

Beyond that, the post and subsequent comments are remarkable advertisement for the ignorance of science, statistics and even basic logic that characterizes the site.

TMR was quoting a recent post on The Skeptical OB, Vaccination is far more baby friendly than breastfeeding:

There’s a simple thing that every mother can do to keep her baby as healthy as possible. That’s why we should have a ten step hospital based program to support it.

No, it’s not breastfeeding; it’s vaccination, which saves a thousand times more lives in practice than breastfeeding ever could in theory.”

That blew Prof’s mind even though it is glaringly obvious if you think about it for more the 5 seconds. For most of human existence all babies were breastfed and mortality from infectious diseases was astronomical. The incidence of those disease dropped precipitously when vaccines were introduced.

Prof insists, “In today’s era, your child is FAR more likely to be healthy if you breastfeed and don’t vaccinate at all than if you vaccinate on the CDC schedule and don’t breastfeed.” is pure nonsense. She just made it up to reflect what she “feels.”

1. The scientific evidence shows us the opposite of Prof’s claim. This CDC chart, created prior to the rise of the anti-vax movement, makes the case in spectacular terms.

The baseline 20th Century mortality occurred at a time when nearly all babies were breastfed. Obviously breastfeeding doesn’t have much of a protective effect against these disease. Consider that most mothers in the early 20th Century had survived most of these diseases and therefore had acquired natural immunity. Yet whatever natural immunity they had acquired either could not be transmitted through breastmilk (it passes through the placenta) or was ineffective at preventing hundreds of thousands of deaths each year.

2. No, the observed declines of vaccine preventable diseases did not occur in response to the technology of improved sanitation and clean water.

If sanitation and water purification were responsible for the majority of the decline in deaths we would see the incidence of individual vaccine preventable diseases falling in parallel with each other. But that’s not what we see at all. The incidence of an individual disease declines precipitously in the immediate aftermath of the introduction of the vaccine.

3. A TMR reader posted these graphs taken from an anti-vax quack book claiming that the death rate of vaccine preventable diseases began to decline in the US prior to the introduction of vaccines.

Of course the death rate began to decline; antibiotics and better medical care were introduced.

Keep in mind that death rate and incidence, though related, are not the same thing. Vaccination dramatically reduces the incidence of disease, which, not surprisingly reduces the death rate. Better medical care can also reduce the death rate but has little impact on the incidence. Medical care can prevent a child dying from a vaccine preventable disease; the appropriate vaccine can wipe the disease from the population altogether.

Ironically, these graphs also illustrate that breastfeeding played no role in the decline of vaccine preventable diseases. In 1900 nearly all babies were breastfed; by 1970 American breastfeeding rates were less than 25%. The death rates of these disease declined precipitously nearly in parallel with the decline in breastfeeding.

4. Many TMR readers have trouble with elementary logic. People made claims about individual vaccines though we were discussing vaccines in the aggregate. People posted papers that suggest breastfeeding “might” do this or that without realizing that such papers aren’t proof of anything. Someone posted an article from what appears to be a pay for play journal, paid for by an anti-vax organization.

At no point did anyone post any data that showed breastfeeding had any impact on the incidence of or death rates from vaccine preventable diseases.

Indeed, Prof tried desperately to backpedal to cover the fact that she could find even a shred of evidence for her claim.

No one on this thread is discussing a particular scientific point, Amy, therefore there is no need to quote “relevant” studies…

Of course there’s a need to quote scientific studies if you are actually promoting thinking about the topic, but there’s precious little thinking going on at TMR.

I despair for the future of our country.

It’s not simply because I am a liberal, though political liberalism is my bones. It’s not just because Trump is an ignorant, narcissistic bully, though he most certainly is. It’s because Trump and his supporters remind me of a group that I have written about and dealt with for decades: anti-vaxxers.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Both believe that truth is irrelevant and feelings are everything.[/pullquote]

Anti-vaxxers have taught me about the damage and death that can be caused by movements based on ignorance and selfishness, built on bald-faced lies, whose life blood is social media. Trumpism is anti-vax to the max.

At first glance, you might think that the analogy is facile. What connection could there be between pseudoscience and a political movement?

Consider the following

1. Truth is irrelevant.

This, of course, is the bedrock of both anti-vax pseudoscience and Trumpism. The truth does not matter in the least.

Vaccines are settled science. Physicians, researchers and public health officials around the world are in agreement that vaccines are safe, effective and one of the most successful public health efforts of all time, having saved and continuing to save millions of lives each year. Yet anti-vaxxers cling fiercely to delusions that vaccines are unsafe, ineffective and cause “vaccine injuries” including autism and just about any other poorly understood syndrome that you care to name.

The causes of lower middle class economic floundering are equally well understood: automation, irreversible globalization, the switch to a technology based economy among others. Yet Trumpists cling fiercely to delusions that Mexicans are stealing their jobs, black people are stealing their benefits, gay people are stealing their religious freedom and Democrats are stealing their guns.

2. Feelings are everything

Both anti-vax advocacy and Trumpism represent the rise of what comedian Steven Colbert has described as “truthiness.”

According to Wikipedia:

Truthiness is a quality characterizing a “truth” that a person making an argument or assertion claims to know intuitively “from the gut” or because it “feels right” without regard to evidence, logic, intellectual examination, or facts.

Anti-vaxxers are quite explicit in their reliance on “truthiness” over truth. Vaccines cause autism because some parents feel that vaccines caused their children’s autism. Never mind that copious scientific evidence has shown that there is no causal connection between vaccines and autism. In the view of anti-vaxxers, if they feel it, it must be true.

Trumpists are, if anything, more dependent on truthiness than anti-vaxxers. They feel that Mexicans are stealing their jobs so we should built a wall to keep Mexicans out; they feel that black people are getting more than their fair share so they should be knocked down a peg or two; they feel that religious freedom means they ought to be free to force the government to advance their religious beliefs and prejudices despite the fact that America was founded explicitly on a separation between Church and State; they feel that Democrats are coming for their guns, their only source of power in their purportedly powerless existence, so common-sense gun laws must be opposed with extraordinary vehemence.

Democrats, and even many Republicans, have been astounded that Trump can lie with impunity. But that’s only to be expected when people give feelings priority over facts.

3. It makes no difference if others are harmed.

We told anti-vaxxers for years that decreasing immunization rates would lead to injuries, illnesses and deaths of innocent children from vaccine preventable diseases that would inevitably come roaring back. And that’s precisely what happened. No matter. Unless and until anti-vaxxers are personally harmed by vaccine preventable diseases, they don’t care.

You can point out to them that anti-vax is immoral, relying as it does on the fact that anti-vaxxers are free riders, enjoying the benefits of herd immunity while refusing to accept the burdens of supporting that immunity through vaccination. They could not care less.

You can point out to Trumpists, that much of Trumpism is immoral and certainly anti-Christian, relying as it does on vicious prejudice against, Hispanics, blacks, Muslims, etc. They could not care less.

4. Support for and legitimation of ignorance is critical

Social media is the life-blood of both anti-vax advocacy and Trumpism for two reasons. First, social media allows for the unimpeded distribution of fake news. Second, social media promotes social cohesion among believers.

Fake news did not originate with this election or even with politics itself. Fake news has long been prominent in alternative health, particularly anti-vax. Fake news is a never ending stream of lies, prejudice and conspiracy theories constantly pumped out by anti-vaxxers to support each other in their delusions. No claim is too ridiculous since truth doesn’t matter; only feelings matter. Anti-vaxxers feel victimized so they present a never ending litany of grievance.

Alt-right fake news is a never ending stream of lies, prejudice and conspiracy theories constantly pumped out by Trumpists to support each other in their delusions. No claim is too ridiculous since truth doesn’t matter; only feelings matter. Trumpists feel victimized so they present a never ending litany of grievance.

Perhaps even more remarkable that Trumpists’ overwrought sense of grievance is their utter unwillingness to explore or even acknowledge that they have been victimized by many of their ideological confrères. The Republican party has been practicing a never ending charade of bait and switch on their own voters for years. They tell them that reducing taxes will solve their financial difficulties when the truth — that tax reductions benefit the rich, not the poor — has long been glaringly obvious.

Republican policy has allowed economic inequality to grow. It has led to the wealth of the country becoming ever more concentrated in the hands of kleptocrats like Trump. It has led to the personal bankruptcies that destroy middle and lower class families in contrast to the business bankruptcies that allow failed businessmen like Trump to avoid the cost of their mistakes. It has led to the outsourcing of jobs that provide further benefits for Trump and his ilk. No matter.

5. Solidarity builds self image.

I’ve written repeatedly about the social dimension of anti-vax advocacy. Anti-vax is not about vaccines and it’s not about children. It’s about anti-vax parents and how they wish to see themselves. Social media allows anti-vaxxers to cocoon themselves within supportive communities where ignorance, gullibility and penchant for conspiracy theories are normalized.

Similarly, social media allows the alt-right to cocoon themselves within supportive communities where ignorance, gullibility and a penchant for conspiracy theories are also normalized.

In both anti-vax and the alt-right, social media communities provides a platform from which to lash out at the “enemy” and be cheered for doing so, no matter how ugly, vicious or factually wrong the attack. Just as Facebook emboldens anti-vaxxers, Twitter emboldens racists, misogynists, homophobes and anti-Semities. Social media empowers individual bigots to become verbal lynch mobs, doxxing, smearing and threatening.

The conclusion I draw from the similarity between anti-vaxxers and Trumpists is that defeating both will involve different tactics than might ordinarily be used:

Anti-vaxxers have demonstrated beyond doubt that they are fact resistant. Therefore, arguing facts with them is doomed to failure and may even reinforce their sense of grievance. Sadly, they seem to respond only to two things: personal pain and social humiliation.

The biggest blow to the anti-vax movement has been reality itself. Only the growing threat of vaccine preventable illness to the children of anti-vaxxers can shake their faith in lies and conspiracy theories. I fear that only serious harm to the economy, judicial system, standing of the US in the world, etc. can shake Trumpists from the fantasy world of grievance in which they live.

In the meantime, the best weapon we have available is social humiliation.

Both anti-vaxxers and Trumpists are desperate to see themselves as the good guys: smart, savvy, clear-eyed, and poised to save world from itself. We should make it clear to both groups, in all possible ways, that they are none of the above. In truth they are contemptible; their ignorance and prejudice should be fought continually and with every means at our disposal.

Last month I noted that the mainstream media has suddenly discovered fake news and has written extensively on the willingness of people to believe complete lies.

I pointed out that while fake news may be relatively new within the political context, it has been a potent force in alternative health for decades. Most alternative health websites, blogs and Facebook pages are fake news sites creating a never ending stream of false stories about vaccines, food, cancer, and just about any health issue you can name.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vaccine advocacy is no more about vaccines than birtherism is about Obama or Kenya.[/pullquote]

Why does anyone believe fake news, whether in the context of politics or science?

No doubt ignorance plays an important role, particularly in fake science news where most readers lack the basic knowledge of science that would allow them to critically evaluate the scientific merits of various fake claims.

But the real problem — in both anti-vax and political fake news — isn’t ignorance and we ignore the real problem at our own peril. The real problem is the social dimension of fake news. Anti-vax websites, like all fake news website, are rumor communities where social affirmation is as important, if not more important, than the rumors.

In The Persistence of Rumor Communities: Public Resistance to Official Debunking in the Internet Age, a paper presented in 2012, Professors Jill Edy and Erin Baird describe rumor communities and their members:

Community members limit the scope of conflict by asserting authority to speak publicly and rejecting contributors with countering opinions as irrelevant. They sustain their threatened community by denying scientific evidence and demanding unattainable levels of scientific proof, and they socialize conflict by recruiting bystanders to enter the fray using appeals to wider social values.

Anti-vax rumor communities survive and thrive despite the fact that vaccines have been repeatedly shown to be safe, effective and wildly successful at saving lives. Why? Because they create a shared social identity that becomes critically important to members and that is aggressively defended in the face of mountains of evidence.

Anti-vaccine advocacy is no more about vaccines than birtherism (the lie that President Obama was born in Kenya and therefore not an American citizen) is about Obama or Kenya. Birtherism created a social community of racists who felt both powerlessness and rage at the reality of a black president; participants found others with similar views, shared those views, argued against outsiders, and acquired far more power and influence than individual crackpots writing or acting alone.

Similarly, anti-vax advocacy creates a social community of conspiracy theorists who feel both powerlessness and rage at the medical and pharmaceutical industries, allowing them to share those views, argue against outsiders and acquire far more power and influence than individual anti-vax crackpots writing or acting alone.

As Edy and Baird note in their latest paper Rumor Communities: The Social Dimensions of Internet Political Misperceptions that our failure to understand the social dimension of anti-vax advocacy (or any other form of fake news) is a result of our failure to understand how information is communicated.

Communication is conceptualized as transmitting inaccurate or accurate information, and public opinion is conceptualized as the aggregation of individual opinions. Yet political misperceptions have social as well as psychological dimensions. They are not only spread from person to person; they generate communities of believers and both draw from and contribute to political culture. They persist in part because they give concrete form to otherwise inexpressible social concerns, not because they are true in any kind of modernist sense…

The similarities between fake news anti-vax communities or fake news creationist communities and fake news alt-right political communities are striking.

These include:

1. Sustaining ambiguity

…[A]mbiguity sustains rumors: once a problem is resolved or ambiguity is replaced with authoritative knowledge, the rumoring process ends. Thus, to keep a rumor alive, ambiguity must be sustained, and one way to do so is to publicly raise doubts about debunking messages by counterarguing them.

That’s why creationist groups want to “teach the controversy.” Sustaining ambiguity is vital for them.

2. Argument as a way of creating and reinforcing social cohesion:

An individual believer may be unaware of others who share his or her point of view, and such social isolation … makes such people vulnerable to persuasion or at the very least to compliance. Group solidarity, on the other hand, empowers individuals to resist persuasive efforts even when the resisting group is very small, provided the resistance is publicly expressed. As Krassa observes: “It will not overcome my ‘fear of social isolation’ and thereby ease the psychological barriers to my voicing my own view if there are 10,000 who agree with me but I am ignorant of their existence”. Publicly voicing counterarguments affirms a community’s existence and provides individual members resources to continue psychologically and publicly resisting and counterarguing debunking efforts.

3. The ability to elevate the social status of the group:

The public nature of these counterarguments also sustains the community with the promise that believers are not isolated “cranks” but rather members of a group of concerned citizens.

4. The ability to harness social anxieties:

Appeals to broader social anxieties took a variety of forms, but one of the more common was that big businesses placed profit over people.

Alt-right rumor communities harness the social anxiety of middle and lower middle class white people who feel they are losing out in the contemporary economy.

5. The normalization of crackpots:

Traditional research on conspiracy theories might point out the byzantine webs of secrecy required to enact the posited conspiracy, but the specific claims of the vaccines-cause-autism rumor community suggest a different narrative paradigm. The believers publicly represent themselves as normal, reasonable people belonging to legitimate social groups such as parents or friends and relatives of those with autism. The concerns and anxieties they express are widely shared throughout the society: that powerful social entities take advantage of the powerless and cannot be held accountable.

The factors make it nearly impossible to fight fake news with facts:

A modernist take on these types of appeals might classify them as conspiracy theories, amplifying the unlikely and elaborate connections between social actors implied in such theories. However, the essential appeal of many conspiracy theories is that they speak to deep-rooted beliefs about how the social world works. The more effectively they embrace those beliefs, the greater their likely staying power and the greater the risk they will not only survive but potentially spread to broader publics.

We must turn our attention to the social dimension of anti-vax advocacy (as well as alt-right advocacy) if we hope to have any chance of successfully fighting it.

Sociologist Jan MacVarish’s latest book is entitled Neuroparenting. Neuroparenting:

… relies on the authority of nature as providing an eternal, universal, cultureless blueprint for child-rearing but also on the authority of science, as nature’s modern interpreter.

That’s also an excellent description of natural parenting. Both rely on assumptions about human beings, nature, culture and science that are rarely examined, let alone challenged.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural parenting is a cultural conceit.[/pullquote]

Let’s see if we can tease out some of these assumptions so that we can critique them, starting with the assumptions that MacVarish notes.

1. “Nature” in natural parenting is assumed to be eternal, universal and cultureless.

Nothing could be further from the truth.

While the physical laws of nature — those of physics, chemistry and biology — are indeed eternal, universal and cultureless, the nature of human behavior is none of those things.

For example, for most of the millions of years of hominin existence, human beings didn’t yet have the power of speech yet for contemporary human beings speech is entirely natural. That’s just one example of the way in which the “nature” of humanity has changed over the years.

Moreover, what we know about human existence in nature is necessarily limited to what we learn from fossils, yet fossils are so limited that they may not be representative of what actually happened at the time those individuals were alive.

Human culture has existed for a very long time. The oldest known cave paintings were created more than 35,000 years ago. The idea that there is a human natural essence, independent of culture, that has persisted unchanged for more than 35,000 years is ludicrous. The only thing more ludicrous is the idea that human culture is universal through time and space.

Therefore, looking to nature as the authority on the best way to raise children is foolish in the extreme since nature is neither universal nor static.

2. Science is assumed to be the modern interpreter of nature.

Yes, science is an excellent interpreter of static natural principles, but human beings are far more than their physics, chemistry and biology. Parenting is not merely a biological concept, but also a cultural one.

Consider that less than 100 years ago, parenting culture was radically different from what it is today. In indigenous cultures, parenting is radically different from what it is in industrialized countries. Moreover, indigenous cultures are no more likely to represent what occurred in nature 100,000 years ago than contemporary elephants are likely to represent wooly mammoth existence.

3. Natural is assumed, without any justification, to be best.

Yet this only applies to parenting. Natural parenting advocates will smugly inform you that unmedicated vaginal birth, breastfeeding and co-sleeping are best because they are natural.

But rape is natural in all human cultures; that doesn’t make it best.

Murder and war are natural in all human cultures; that doesn’t make either of them best.

Both heterosexuality and homosexuality are both natural; the former is better for reproducing the species than the latter but that doesn’t make heterosexuality better than homosexuality.

Nature is rarely the arbiter of what is best in general, so why would we imagine that it is the arbiter of what is best in parenting?

4. Human beings are assumed, without any justification, to be no different than animals.

Most of the research on the important of “bonding” has been done in lower order animals. There is no scientific evidence that it has any applicability to human beings, yet natural parenting advocate invoke it routinely.

5. Anything less that perfect intellectual, social and economic success is problematized.

We live in arguably the healthiest, wealthiest culture that has ever existed yet we fret endlessly about problems, particularly social problems.

Some people are poor? We treat it as a problem despite the fact that in every culture some individuals are more successful than others.

Some people have lower intellectual achievement than others? We treat that as a problem despite the fact that it is the inevitable result of the fact that all human beings are not alike.

Some people are criminals? We treat that as a problem despite the fact that there has never been a human society without members who flout the rules.

We don’t merely treat these entirely natural phenomena as problems, we treat them as parenting problems. If only they had been breastfed; if only their parents had spent more time during infancy engaging verbally with them; if only their parents had been more “nurturing.” Yet there is no scientific evidence that parenting has much if anything to do with many of these problems.

6. Parenting is deterministic.

Children are assumed to be blank slates on which parents write. Therefore, the right inputs will create the right outputs. Moreover, what parents write on the blank slates of infancy is assumed to be determinative of the adults those infants will become.

This is an especially irresponsible assumption since we have no accurate theory of human causation. Two children can be raised in the same home, by the same parents, in the same way yet develop into very different adults. Regardless of the fact that the unsuccessful child may have a wildly successful sibling, many will still blame the parents, particularly the mother, for a child or adult who struggles.

***

These erroneous assumptions have created the cultural conceit among natural parenting advocates that nature provides the blueprint for parenting and that science is to be invoked when it finds the natural to be beneficial (e.g. breastfeeding) and easily ignored when it find technology to be superior (e.g. vaccination).

Defensive medicine works.

A recent study shows that obstetricians who have higher C-section rates are far less likely to be sued than those who have low C-section rates. Why?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is a potential solution but insurers won’t pay for it.[/pullquote]

There are two possible reasons: obstetricians who have higher C-section rates may have better outcomes and obstetricians who aggressively try to prevent bad outcomes are less likely to be sued when a bad outcome does occur.

This has important implications for those attempting to reduce the practice of defensive medicine.

According to Wikipedia:

Defensive medicine … refers to the practice of recommending a diagnostic test or treatment that is not necessarily the best option for the patient, but … to protect the physician against the patient as potential plaintiff …

There’s a lot of handwringing about defensive medicine among those who wish to reform healthcare. They aren’t so much scandalized by the possibility of patients receiving unneeded treatment (although they are concerned about it) as they are horrified by the increased cost of potentially unnecessary treatments. It is an article of faith among reformers that defensive medicine could be eliminated resulting in decreased spending and no impact on the quality of medical care. They may be wrong.

The paper is Physician spending and subsequent risk of malpractice claims: observational study published in the BMJ.

Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim. For example, among internists, the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% (95% confidence interval 1.2% to 1.7%) in the bottom spending fifth ($19 725 (£12 800; €17 400) per hospital admission) to 0.3% (0.2% to 0.5%) in the top fifth ($39 379 per hospital admission). In six of the specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents…

The results were especially striking in obstetrics:

Increasing average risk adjusted caesarean rates for each obstetrician year was associated with decreases in the probability that an obstetrician experienced an alleged malpractice incident in the subsequent year. For example, the average adjusted caesarean rate for each obstetrician increased from 5.1% in the bottom fifth of obstetrician years to 31.6% in the top fifth, whereas the probability an obstetrician experienced an alleged malpractice incident in the subsequent year decreased from 5.7% (95% confidence interval 4.6% to 6.8%) in the bottom fifth of caesarean delivery rates to 2.7% (1.9% to 3.6%) in the top fifth. In within physician analyses, which relied on variation in risk adjusted caesarean rates within the same obstetrician over time, greater caesarean rates continued to be negatively correlated with the probability of facing an alleged malpractice incident in the subsequent year (increased risk adjusted caesarean rate from the bottom fifth to the top fifth was associated with a −1.5 percentage point (95% confidence interval to −3.6 to −0.6) change in malpractice claims in the subsequent year).

I created the following graph to illustrate the results.

Obstetricians know this and if affects the threshold for performing a C-section. Consider that the most dreaded possible outcome for any obstetrician is the preventable loss of a baby or mother. The second most dreaded outcome is a malpractice lawsuit. Is it any surprise then that obstetricians are willing to perform C-sections when there is any doubt about the baby’s wellbeing?

Doctors blame lawyers.

Law professor Sandra Johnson writing in Regulating Physician Behavior: Taking Doctors’ “Bad Law” Claims Seriously notes:

Doctors frequently claim that the very law intended to improve the lot of their patients is instead making the doctors provide poor care. These “bad law” claims are levied against malpractice litigation that makes doctors practice “defensive medicine”; … against antitrust laws that prevent doctors from organizing themselves in ways that would produce more cost-effective and accessible care; and against regulations that impede important medical research. These “bad law” claims assert that the law’s effort to promote patient health and well-being has actually caused significant harm.

Healthcare reformers blame doctors:

Medicine’s complaints … [have come] to be characterized as the work of a self serving guild, rather than a profession motivated by altruism and armed with expertise, or at least as the work of the recalcitrant “bad apples” who continued to resist improvements that the more enlightened among them embraced. These narratives marginalized physicians’ … claims and diminished them as a source of legitimate information about the effectiveness of reform efforts.

Rather than addressing the substance of doctors’ arguments, experts and lay people have denied that there the complaints are legitimate, ascribing them to greed and self interest. Yet in the case of medical liability, as in other areas of medical “reform,” doctors are often right.

We tell obstetricians “Make sure all babies are born perfect or we will try to destroy you professionally and economically in malpractice suits!” and then piously express shock and horror that obstetricians will perform C-sections in order to guarantee perfect babies.

There is a potential solution to this problem but insurers and reformers don’t want to pay for it:

It has been shown repeatedly that doctors who have good relationships with patients are less likely to get sued by those patients regardless of outcome. But creating a relationship with a patient — being available, listening to and thinking about patient concerns, answering any and all questions and making sure patients understand the answers — takes lots of time. Insurers won’t pay for physician time; they pay for physician procedures. Moreover, insurers and reformers are constantly pressuring doctors to be more “efficient,” in other words to spend less time with each patient.

And so we end up with a system where more C-sections = fewer law suits.

Defensive medicine works, but building patient relationships also works. Insurers will pay for defensive medicine but they won’t pay for building relationships between doctors and patients.

Who’s really at fault for the increase in defensive medicine?

A new paper in The Proceedings of the National Academy of Science is getting a lot of buzz.

According to the BBC, Caesarean births ‘affecting human evolution’:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is no cliff-edge in fitness. A mother who needs a C-section for a  7 pound baby could subsequently deliver an 8 pound baby vaginally.[/pullquote]

Researchers estimate cases where the baby cannot fit down the birth canal have increased from 30 in 1,000 in the 1960s to 36 in 1,000 births today.

Historically, these genes would not have been passed from mother to child as both would have died in labour.

Researchers in Austria say the trend is likely to continue, but not to the extent that non-surgical births will become obsolete.

In other words C-sections, by saving the lives of babies and mothers who would otherwise die and allowing for the persistence of genes for overly large fetal heads and overly small maternal pelves.

At first blush, the paper appears persuasive, but there’s a very serious problem here and I was not surprised to find that there were no obstetricians among the authors. That’s because the authors don’t seem to understand feto-pelvic disproportion:

The maternal pelvis is not a basketball hoop; the shape matters nearly as much as the size.

A very common cause of feto-pelvic disproportion is the position of the baby, not the size.

Both the baby’s size and the size of the mother’s pelvis are greatly affected by nutrition. Indeed, the apparent increase in feto-pelvic disproportion is far more likely to be due to improved nutrition than evolutionary pressure occurring over the minute time period of less than 100 years.

When you take these factors into account, the paper, Cliff-edge model of obstetric selection in humans by Mitterroecker et al. is not merely incorrect; it is foolish.

According to the authors:

The strikingly high incidence of obstructed labor due to the disproportion of fetal size and the mother’s pelvic dimensions has puzzled evolutionary scientists for decades. Here we propose that these high rates are a direct consequence of the distinct characteristics of human obstetric selection. Neonatal size relative to the birth-relevant maternal dimensions is highly variable and positively associated with reproductive success until it reaches a critical value, beyond which natural delivery becomes impossible. As a consequence, the symmetric phenotype distribution cannot match the highly asymmetric, cliff-edged fitness distribution well: The optimal phenotype distribution that maximizes population mean fitness entails a fraction of individuals falling beyond the “fitness edge” (i.e., those with fetopelvic disproportion). Using a simple mathematical model, we show that weak directional selection for a large neonate, a narrow pelvic canal, or both is sufficient to account for the considerable incidence of fetopelvic disproportion. Based on this model, we predict that the regular use of Caesarean sections throughout the last decades has led to an evolutionary increase of fetopelvic disproportion rates by 10 to 20%.

The authors reference “the obstetric dilemma,” the observation that there are two opposing evolutionary pressures on the relationship between the mother’s pelvis and the size of the baby’s head. In simple terms, a large head is an evolutionary advantage for a baby, but a large pelvis is an evolutionary disadvantage for the mother since it interferes with her ability to walk and run.

Not only are the needs of the mother and baby directly opposed at the time of birth, but the contribution of the father’s genes means that there is no coordination between the size of the mother’s pelvis and the size of the baby’s head, particularly if the father had a large head at birth.

The authors postulate an obstetric “fitness” function, D:

Successful labor requires the match of the neonatal head and shoulder dimensions with the dimensions of the maternal pelvic inlet, midplane, and outlet. Consider an idealized variable, D, that represents the difference between the size of the neonate and the size of the maternal pelvic canal. A negative value indicates a pelvic canal that can accommodate the newborn, whereas fetopelvic disproportion occurs if D > 0. In practice, this composite quantity cannot be inferred from the usual clinical measurements, but it is conceivable that D can be expressed as a function of a finite set of appropriate morphological measurements.

Using this idealized variable D, the authors created a mathematical model.

We present a mathematical model that explains the high rates of fetopelvic disproportion by the dis- crepancy between a wide symmetric phenotype distribution and an asymmetric, “cliff-edged” fitness function.

But there is no cliff-edge in fitness. There is are multiple factors that can be combined kaleidoscopically to lead to a variety of outcomes. To put it is real world terms: A mother who has feto-pelvic disproportion with an 7 pound baby and requires a C-section could subsequently deliver an 8 pound baby is a successful vaginal birth.

How can that be?

1. The maternal pelvis is not a hoop.

The pelvis is a bony passage with an inlet and an outlet having different dimensions and a multiple bony protuberances jutting out at various places and at multiple angles. The baby’s head does not pass through like a ball going through a hoop. The baby’s head must negotiate the bony tube that is the pelvis, twisting this way and that to make it through.

You can see what I mean in the illustration above (from Shoulder Dystocia Info.com). There are bony protuberances that jut into the pelvis from either side (the ischial spines) and the bottom of the sacrum and the coccyx, located in the back of the pelvis, jut forward. How does the baby negotiate these obstacles? During labor, the dimension of the baby’s head occupies the largest dimension of the mother’s pelvis. But because of the multiple obstacles, the largest part of the mother’s pelvis is different from top to middle to bottom. Therefore, the baby is forced to twist and turn its head in order to fit.

This illustration (from the textbook Human Labor & Birth) shows what happens. We are looking up from below and the fetal skull is passing through the mother’s pelvis. The lines on top of the skull demarcate the different bones of the fetal skull.

Clearly there is a great deal of potential for a mismatch between the size of the pelvis and the size of the baby’s head. Over time, babies have evolved so that the bones of the skull are not fused and can slide over each other, reducing the diameter of the head. This is called “molding” and accounts for the typical conehead of the newborn. But there is a limit to the amount of molding that the head can undergo and ultimately, the baby may not fit through.

2. One of the most common causes of feto-pelvic disproproportion is the position of the baby, not the size of its head.

The illustration above shows the baby’s head entering the pelvis in the optimal position, but babies don’t always cooperate. If the head is in anything other than the ideal position the fit will be even tighter. That’s why babies in the OP position (facing frontwards) and babies with asynclitic heads (the head titled to one side) are much more difficult to deliver vaginally. Their heads no longer in the smallest possible diameter. It’s like trying to put on a turtleneck face first  instead of starting from the back of your head. It’s much more difficult.

And it’s far more difficult (and sometimes impossible) to deliver a baby vaginally if it presents brow first or face first. Moreover, 3-4% of babies are breech, meaning bottom or feet are coming first. The head is less likely to fit if the feet come first.

3. Genes are not the only determinants of the size of the baby’s head and the size of the maternal pelvis. Nutrition plays a critical role.

It is well known that the average size of babies is getting bigger, just as the average size of adults is getting bigger, as a result of improved nutrition. For most of the past hundred thousand years or so, humans lived a substistence existence and stunting of growth was common at all ages. Now, very few people starve in industrialized countries. Indeed, people are far more likely to be obese that at any time in human history. Obese babies have trouble surviving birth not merely because their heads might be bigger, but also because their shoulders are bigger and can get stuck during the process of birth (shoulder dystocia), a potentially deadly complication.

In contrast, better nutrition (and pregnancy delayed far beyond the teenage years) means that women who give birth are likely to have a larger pelvis and one that is not constrained by nutritional deficiencies like rickets.

Given these factors, the authors’ conclusions are fanciful.

The authors give a nod to other factors:

The success of labor is … influenced … by numerous other factors, including flexibility of the pelvic ligaments, orientation of the neonate, and efficiency of uterine contractions. However, as long as these factors are statistically independent of the discrepancy between neonatal and maternal dimensions, the selection gradient and evolutionary trajectory of D can be modeled independently of other factors.

That’s yet another faulty assumption. These factors are intimately intertwined. For example, the orientation of the baby is dependent of the shape of the mother’s pelvis. And the strength of the uterine contractions may be dependent on the size of the baby; a distended uterus may be less likely to contract effectively.

That’s why a mother who has a C-section for feto-pelvic disproportion with a 7 lb baby might subsequently deliver an 8 pound baby vaginally. That would be impossible if the cliff-edge theory of fitness were true.

And that doesn’t even take into account that C-sections have only become routinely survivable in the past 80 years or so, not even a blink in the eye of evolution and far too short a period of time for evolutionary pressures to have produced changes like those proposed.

Are C-sections changing the maternal pelvis? Maybe, but this paper doesn’t show it.

Indeed it doesn’t show anything at all.

I’ve written before that the philosophy of natural childbirth is the philosophy of a cult.

Like most cults, has its own mythology, in this case a mythology that is both racist and sexist. The cult was started by Grantly Dick-Read, author of Childbirth Without Fear, and a eugenicist who was preoccupied with visions of “race suicide” as non-white people became an ever larger part of the population of first world countries. Dick-Read thought that white women of the “civilized” races were being diverted by the quest for economic and political equality, when they really should be home spitting out babies. He believed that it was fear of the excruciating pain of labor that discourage these women from having more children. He fabricated out of whole cloth the bizarre notion that “primitive” (read: black) women gave birth without pain because they didn’t fear childbirth and understood that their primary role was to reproduce.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The vicious response to those who question the principle of natural childbirth advocacy.[/pullquote]

To this day, natural childbirth advocates fantasize that they are emulating exotic brown foreigners and becoming better at birth than they are themselves. There is no historical basis to the claim that unmedicated vaginal birth is safest, and no scientific basis for the claim that it is superior in any way to childbirth with pain relief. No matter; cult membership requires belief regardless of inconvenient facts.

The fundamental principles of natural childbirth advocacy are cultural constructs:

• Birth is depicted as inherently safe though it is actually inherently dangerous.
• Birth is depicted as an individual achievement thought it is purely a matter of luck.
• While historically a bad birth experience involved a dead baby, dead mother or both, a bad birth experience is now depicted as one in which a mother’s birth plan was not fulfilled in all details.

In other words, natural childbirth is a cult. As defined by Google, a cult is:

a system of religious veneration and devotion directed toward a particular figure or object.

In the case of natural childbirth, the object of the cult is unmedicated childbirth without interventions. Unmedicated vaginal birth is understood by cult members to be venerated with trust, worshipped with affirmations, and often viewed as more important that the ostensible purpose of childbirth, a live, healthy baby.

And, like all cults, it reacts viciously to criticism.

How else to explain the nauseating, gut churning cruelty of natural childbirth advocates toward James Titcombe?

James and his wife Hoa lost their newborn son Joshua to midwifery negligence followed by a brazen attempt at cover up. Throughout his multi-year quest to learn the truth about Joshua’s death and hold the midwives accountable for it, James was subjected to vicious attacks by the natural childbirth community.

His sin? He dared question the cult of natural childbirth.

You might think his status as the father of a dead baby would protect him; you would be wrong.

Despite the fact that James was fully vindicated and received a royal honor from Queen Elizabeth for his relentless quest on behalf of victims of midwifery negligence, any time he questions the fundamental principles of the natural childbirth cult, he is subjected to viciousness from natural childbirth advocates.

The latest example occurred over the past few days. Apparently James dared to question the notion that vaginal birth is empowering.

Professional homebirth advocate and author Milli Hill responded by accusing him of being an enemy of women and their choices:

What had James done to arouse Hill’s wrath?

He had dared question the notion that vaginal birth is inherently empowering when he pointed out, commenting about a VBAC birth story, that babies die when their mothers ignore medical advice for C-section in pursuit of a vaginal birth.

The mother who wrote the story, Michelle Quashie, did feel empowered by her vaginal birth and she’s entitled to feel whatever she wants. But, there is every reason to question a cult of birth that privileges process over outcome and leads to preventable deaths of babies as a result.

For that matter, a woman who fits into a size 2 dress is entitled to feel proud that she can do so. That doesn’t change the fact that there is every reason to question the cultural constructs that women should be judged by their weight, that thinness is superior, and that leads to women starving themselves literally to death to meet these cultural “achievements” set by the fashion and entertainment industries.

My invocation of empowerment through weight loss is deliberate. For many years, the fashion and entertainment industries turned a blind eye to the harm they did to women by setting arbitrary standards of beauty through thinness. Ultimately, though, they began to understand that the drive to achieve thinness could lead vulnerable young women to death through anorexia. There is a growing effort to temper the cultural message that thin is superior, and emphasize instead that different weights are healthy for different women.

But cults like natural childbirth cannot even tolerate questioning, let alone criticism.

Imagine if a father who lost his daughter to anorexia was subjected to taunting by the fashion industry that his efforts to prevent future tragedies were efforts to efforts to harm women.

Heartless, vicious and ugly are just a few word that come to mind to describe such behavior.

The same words — heartless, vicious and ugly — describe Milli Hill’s taunting of James Titcombe.

Women are entitled to their feelings, but the rest of us are entitled to question the cultural constructs on which those feelings are based. And no one is more entitled to question those cultural constructs than those who have lost precious children as a result.

Grow up and grow a heart, Milli Hill, and stop taunting James Titcombe.

If you want to argue about the principles of natural childbirth advocacy, feel free to argue with me — but apparently you don’t get as much joy out of intellectual debate as you do from heartless cruelty.