I don’t think it’s much of a secret that there is animus between Dr. Gorski and myself since I quit the blog Science Based Medicine. It’s pretty obvious that’s why Jamie Bernstein asked Dr. Gorski to adjudicate our “kerfuffle.” (Just as an aside, why do men with substantive disagreements have principled arguments, but women have “kerfuffles”?)
That animus probably led Gorski to publish a screed instead of mediating privately. And it was probably what led him to write a long post about me instead of answering a simple question in a few sentences.
So I’m not telling you anything beyond what is obvious about the gusto with which he approached his task. I’ve never spoken publicly about that animus until now. The moderation policy was the proximate reason for my decision to leave SBM, but not the real reason. The reason why I quit SBM is because I felt Gorski was trying to force me out. Why? Because he felt threatened.
I write in a similar take no prisoners style, and I was attracting a tremendous amount of traffic. I threatened his dominance and popularity within the SBM universe.
Did Gorski ever say that to me? No, but it’s what I felt.
There was nothing wrong with what I wrote for SBM. Indeed, every word was approved by Gorski before it was published. Moreover, as far as I know, every word is still on the site years later.
It wasn’t because I didn’t draw traffic because I drew a lot, although curiously Gorski would never let me see the actual figures.
Nonetheless, despite having approved my posts before he published them, he developed a habit of entering the comment section to criticize me. I looked, but I couldn’t find evidence that he did that to the other members of SBM.
Gorski maintained a double standard for himself and me. He privately admonished me for re-using posts from my personal blog, yet he did it all the time.
I felt strongly that the more popular I became, the more likely I was to be forced out, so I quit. I didn’t need to write for SBM; they had asked me to do so. In fact, it was Gorski himself who asked me, and it was to him that I sent samples from my own blog illustrating my style and emphasizing that I wasn’t planning on changing it.
So now you know why I left SBM, and why Gorski figuratively licked his lips over the opportunity to criticize me.
No one should let that obscure the take away message of Gorski’s post: MANA’s homebirth paper does NOT show that homebirth is safe; it shows that homebirth dramatically increases the risk of perinatal death. For all his wordiness, Gorski disagrees with most of what Bernstein wrote.
It seems to me deeply unfortunate that Dr. Gorski was so keen to settle imagined scores with me that he lost sight of the big picture: irresponsible “practitioners” are lying about the risk of their product, in this case homebirth.
There is one important salutary benefit of the fact that Dr. Gorski approached his opportunity to kick me with so much delight that he actually wrote a screed about it. Going forward it’s going to be impossible for MANA to claim that their paper shows that homebirth is safe.
If I have to take a few public kicks to expose the mendacity of MANA and homebirth midwives, I’m willing (though not happy) to do so.
This argument hasn’t exactly been edifying for either party, but this response certainly doesn’t help your case. If you want to argue that Gorski has let himself be blinded by his loyalty to Jamie Bernstein and his animosity towards you, that he has been over generous to her argument and missed some of the context and background, by all means make that argument- you’d have some justification in doing so. But also a deal with his substantive points. There is an issue where this site can sometimes play fast and loose with comparator groups in order to get the most dramatic number for the sake of argument.
This just looks like firing off out of proportion, knee-jerk ad hominems in place of engaging with the argument.
So, CPM homebirth is safe?
You’ll notice I didn’t say that.
The issue is, MANA and CPMs don’t think anyone is high risk. They don’t risk people out who should be risked out.
This. Plus, I can’t understand the scientific rigour of Orac and his minions (no insult, that’s what he affectionately calls them, right?) in actually separating high risk homebirth and low risk homebirth. It might make sense only if MANA did the separation PRIOR to admitting women to their care. Given their (lack of) stance on the matter of the dangers of breech homebirth, I am not holding my breath.
I am waiting to see how many women will hear, “I’m afraid you’re high risk but hey, I can give you a great birthing experience against … insert a number… greater chance of your baby dying” and actually choose homebirth.
The comparison I’d like to see is high risk homebirth to situation that are not high risk in hospital. Say, breech. Not gonna happen, though, so I won’t whine demanding to see it. I’ll leave it to Orac, Bernstein, and co.
It’s not about what the average CPM client is like per se- it’s about comparing apples with apples and oranges with oranges. So you can compare low risk homebirth with low risk hospital birth, or homebirth and hospital birth within the same risk category, but you can’t compare low risk hospital birth with all risk home birth.
What I’m saying is if you’re applying any restrictions to the data your using, you have to apply the same restrictions to both cohorts to maintain a meaningful comparison.
Interestingly, we do have this kind of data: outcomes of all homebirths in an area and time period, as compared to all births in the same period and area. I’m referring to the study by Judith Rooks, CNM, on the 2012 birth statistics from Oregon:
http://www.skepticalob.com/2013/03/oregon-releases-official-homebirth-death-rates-and-they-are-hideous.html
Homebirth is popular in Oregon and the state licenses direct entry midwives but mandates that they collect and send data from their practice. So the numbers from Oregon are necessarily more comprehensive than from MANA’s survey (where participation by the midwives was entirely voluntary). And the results are devastating from homebirth as it’s practiced in the real world, with perinatal mortality about 9 times higher.
All this to show that it’s not as if we’re talking hypotheticals here…
Why? In order to be fair to midwives? Who is going to be fair to mothers who are told that THEIR breech, twins, being overdue, and lack of amniotic fluid is not high risk and after THEIR baby dies, they are told “Well, you were high risk, so you cannot be included in the stats” when they made the decision basing it on the lie that they were low risk?
A meaningful comparison is only as meaningful as the practitioners’ willingness to comply with requirements and results. MANA clearly doesn’t want it.
You saw the crowdsourcing article. Do you think that all those midwives’ high risk clients know that they are high risk when the midwives themselves don’t know it, so they cannot tell them?
Most of hospital high risk mothers know that they are high risk. If the various screenshots, lawsuits, and personal stories are anything to go by, most of the high risk homebirth mothers thought they were low risk.
Where do that place them? Stats don’t care about choice rape. Don’t we?
In order to make a statistically valid comparison. Isn’t that a key tenet of scepticism? You can’t just say that the subject matter is emotive, therefore you’re relieved of the responsibility to intellectual honesty.
But it isn’t a statistically valid comparison. The Oregon study is one. The Colorado study is one. Dr Grunebaum’s is one. This is just a comparison based on the very flawed MANA numbers.
Has Dr Amy tried to post it in a scientific journal or something?
And what intellectual honesty is demanded of midwives? Why can’t we take them to their word?
Hannah, I’ll ask you directly: where do you think Gavin Michael’s death should be placed? High risk homebirth, low risk homebirth? Alas, there isn’t a column about “high risk homebirth where the incompetent provider lied to the mother that she was still low risk”.
Gavin Michael died at the hospital; according to MANA’s criteria, he wouldn’t even be counted in their stats as a home birth death. The hospital stats take the hit for Christy Collin’s incompetence.
I know where he’s counted. I asked where he should be counted according to Hannah. I see she’s all for rigorous scientific comparisons but she still hasn’t answered me where the mothers who were lied to and thus made a choice that placed them in the wrong category should be counted.
If a friend of mine who happens to be blind is hit by a car while crossing the street, they’ll be counted among victims of accidents. If I stand there, cheering them on and assuring them that it’s a nice quiet street while it’s in fact a highway where there is a high risk a car would hit them and then it does, should they still be considered a victim of accident?
Sorry, I know you know, in my head I was replying to Hannah. Must have had one too many single malt scotches! 😉
Have one for me, too! If you’re in lack of those, ask Orac for one.
Hannah “In order to make a statistically valid comparison.”
How are you going to do that with the MANA paper? Did you skip over the line describing data collection (it’s on the second page)
“Participation in the project was voluntary, with an estimated 20% to 30% of active CPMs and a substantially lower proportion of CNMs contributing.”
This isn’t a study – it’s a self-selected survey.
Hannah, people have been bringing up the very data you’re asking for, both here and over at RI. I’ve posted links. You are at a blog where Dr. A regularly scrutinizes public health data related to childbirth. Why don’t you check those links, or use the search box at the right hand column and look for “Colorado”, “Oregon” or “Grunebaum”? Then come back and see if the criticism leveled at MANA and the homebirth movement is merely one of emotivity.
Well what is it you are tryin to compare? The outcomes of a particular class of provider or the outcomes of a particular set of criteria of birth location? Low risk homebirth is probably safe but that is not how these
Providers are acting and not the type of consent they are providing. If you asked the mother if they thought they were high risk or low
Risk, what do you think the mothers who gave birth with breech births or multiplies would be saying? Tell me, what do you think the outcomes of high risk patients vs low risk patients for someone like brzynski? If he’s telling people he can care for them a major part of the problem?
You’re assuming that CPMs even have the knowledge and training to actually identify who is high risk and who isn’t, and act appropriately. They routinely advise clients to avoid ultrasounds, glucose tolerance tests, and other standard screening procedures in favor of homeopathy and unicorn dust. No one with appropriate medical training screened the MANA study participants to see who was actually low risk.
Ok, am I an idiot? I can’t find anything on science based medicine about this. I wanted to read the post, but no luck. Anyone have a link?
It’s on Respectful Insolence, not Science Based Medicine.
I have no idea how much he hits the delete button, but I responded to his really half assed response to those of us posting on the thread:
“You have no idea what some of us have lost because of CPMs and their ilk, and you seem to have no compassion for loss mothers and other women preyed upon by charlatans. Where is your shame? I don’t care if calling us shills or minions is an in-joke, its totally disrespectful of women who are trying to counter dangerous alt-med midwifery. I am in the middle of a legal fight with a birth center over some egregious misconduct and have connected with so many other women like me because of anti-home birth groups. There is *nothing* out there for most women who are wronged by midwives. Even if you get something done they usually pack up shop and just start delivering babies somewhere else. By publicly posting these kinds of comments you are casting a much wider net than perhaps you had originally intended. If you wanted to get at dr amy personally send an email. Don’t use the very serious and real issue of out of hospital birth safety as a way for you to continue a personal issue with another blogger. You have authority as a physician and an influential writer- you can use it to be petty if you want, but its a pretty awful choice to make considering what you *could* be doing. You could be helping women who lost their babies from negligence and you’ve chosen not to. Shame on you, orac.”
Love your work. Well said. A pity I can’t upvote it on the SBM site!
To any “minions” who are reading:
I really, really appreciate the support, but be careful not to get sucked into furthering Gorski’s agenda. He wrote a post about me as payback for some slight, real or imagined. And in the comments he continues to talk about me, not about homebirth.
Please don’t let yourselves get sidetracked about what I do or do not think about CNMs or anything else. This is not about me. This is about babies who die preventable deaths because lay people pretend they are “midwives” and because enablers like the Journal of Midwifery and Women’s Health published a crappy paper about a survey that MANA did of its members that showed their death rates are hideous.
Don’t hesitate to remind people of what is at stake. It’s not about me (at least for everyone else in the world but Jamie Bernstein and David Gorski). It’s about babies who did not have to die, lay people who pretend to be “midwives” and a trade organization for homebirth midwives that has no hesitation to bury dead babies twice, first in tiny coffins in the ground, and then again by erasing their deaths from public consciousness.
Don’t let anyone, not Bernstein, not Gorski, not anyone else put the focus anywhere except on these charlatans and the babies who die at their hands.
Oh Amy, I heart you so much!
Well said. Thank you.
But, apparently, that’s just an “appeal to emotion” in their world.
Who knew you could flounce from your own blog?
Dr. Gorski comments:
“Oh, I know how quite well to respond, as all but one of the criticisms I’ve seen are pretty darned lame … I have a demanding day job that I will likely be at for another couple of hours today, after which I will be tired, still have to get dinner, after which I will be quite unlikely to be in the proper mood to spar with Dr. Amy’s shills and minions (again, that’s an in-joke, for those of you waiting to be outraged).
Athough you never know…if I sit back with a nice glass of wine or single malt scotch later I might change my mind. But probably not. So I wouldn’t expect me to be back until Saturday.”
I would have given it a 7/10 style points if he had stuck the landing, but instead he muffed it with “single malt Scotch.” I had to take off a point for above average insufferability.
Yeah, I thought that was quite rich.
He’s back, though. Complaining that Dr Amy didn’t include the video in her original post. In the light of the two posts actually being on the same page of SOB, I’d recommend glasses but I’ve discovered men can be pretty vain (or angry at this lowly jab at their perfection) when it comes to such matters.
Pity. I discovered the wonder of glasses about 10 years ago. My existence got improved by around 1000 percent and my world became about 2000 percent clearer.
If ”minion” means a strong-minded person who understands the science of health care and isn’t conned by pseudo-science, count me in!
Message to Gorski: the radical HB movement has a lot in common with the anti-vax movement. Don’t let your desire to one-up Amy stop you seeing it.
Sue, would you be willing to cross post your comment at Respectful Insolence? This is one thing I don’t think Dr Gorski has considered at all.
I just did a little CDC Wonder analysis for the post on RI since someone was claiming that the risk was “trivial” and found that if you compare low risk women (white, married, 20-44, at least HS education) with low risk pregnancies (39+ week delivery, 2500+ grams, some prenatal care) and remove CA from the cause of death, the ratio for mortality for CNM/in hospital to other midwife/out of hospital is 5.9. In other words, that Dr. Tuteur underestimates the risk. I promised I’d come back here and chastise her for it. So, consider yourself scolded for underestimating risk.
OT but can’t help thinking of it and it won’t go away. This whole thing keeps reminding me of the urban legend about Neil Armstrong saying, “good luck, Mister Gorsky” while on the moon. http://www.snopes.com/quotes/mrgorsky.asp
That post is just ridiculous. His commenters are as obtuse as he is. It seems as though every comment deliberately sidesteps the question supposedly being answered, but they are all such blowhards they think they are winning the conversation somehow. If this is the level of critical thinking being exercised, I’m done with Orac and SBM.
I wonder why Orac thinks homebirth is more risky if he supports Jamie’s groundbreaking conclusion that it’s only slightly or negligibly more risky. Which one is it, doc?
Reading through the comments on RI, Orac is driving me bananas. Commenters come in and criticize whatever part of the article/debate they want. Okay, cool. But the comments he’s choosing to reply really makes it apparent that he’s doing his best to fan the anti-SOB flames. Now, I’m not a fan of this post on SOB (I really think it’s time to let this whole thing die and write off parts of skeptical internet as dumb and hypocritical), but he’s only addressing issues like language and commenting policy.
It’s been pointed out to him more than once that his comment about MANA using deaths to 6 weeks means a comparison to CDC numbers being impossible is flat out wrong. Since then, he’s made cracks about minions, replied to other posters about stupid moderation policies (damn that was a huge derail), but not one statement rescinding his mistake. Orac made a big science mistake (taking Jaime at her lazy-ass word) and he won’t correct it!
I found RI and SBM through this site, but geeze these posts are bugging the crap out of me. To Orac: If you want to take the skeptical high ground, stay out of the emotional back-and-forth and fix your goddamn errors. Maybe even find an OB who’d care to weigh in. Oh wait, then you’d have to admit you were wrong and you’re not going to do that.
I posted a response under my normal SBM name. He replied to it. He quoted Dr. Amy at length, but didn’t explain why the quote challenged what I said — I, personally, think the quotes show that Amy was doing exactly what I said she was doing. He later mentioned that he had “disposed” of all the arguments supporting Dr. A. Perhaps I am a terrible writer, and therefore no one understands my arguments, but I really think that’s not the case, and I am getting very irritated at simply being talked over.
That’s just it! He’s *not* replying to the arguments being made. There have been several that he hasn’t even touched and won’t follow-up to the replies to his comments. It’s clear he has a blind spot and is refusing to acknowledge it.
It’s also clear that he actually understands the difference between CPMs and CNMs but is deliberately fanning the flames.
It does kind of feel like he’s enjoying the drama, huh? Which I wouldn’t care about so much if it wasn’t on a topic he’s misrepresenting. If he doesn’t care enough to get the facts straight, then he shouldn’t mention the survey AT ALL.
Yes! Safer Midwifery Utah had a fantastic analogy that he and his minions have ignored.
thank you Karen! I
I saw that and that reply in particular caused me to give up on the idea of commenting in that discussion.
If his balls were the size of his ego, he wouldn’t be able to sit, let alone walk.
Thank you. It makes me feel like perhaps I am not the crazy one here.
He should ask Dr. Grunebaum to weigh in.
Ha! Then I’m glad I posted on RI the link to the Grunebaum & al study on homebirth neonatal death rate. The person I was answering was probably far too defensive to profit from it, but I hope it gives others food for thought and shows that Dr. A is not the only one who is pushing against MANA’s deceptive “study”.
Your response over there was excellent, I just read it. My blood pressure spiked reading anon’s comments. :/
Thank you. It’s infuriating, indeed. I really admire Doula Dani, Trixie, ‘Nym and other regulars who keep explaining the facts of the matter with so much patience over there.
Edit: Oops. Dani, not Daniel.
I think home birth is the most dangerous woo in this country and I’m baffled that it isn’t covered by any other big-name skeptic. Babies die or become brain-injured for life–all the time. Double digits, every year (at least). What woo kills more people in this country (anti vax probably has a bigger death toll in the world)? The Hib breakout in, what, Michigan? hurt 5 kids, I don’t remember if they died. How many died in the recent Texas measles outbreak? Dr. Amy is one of the only voices speaking up against home birth, and is certainly the most notable one. How can that be when so many are hurt?
Instead we get a big flame war over moderation policies and not showing one’s work enough and that one person is meaner than the other.
I’ve passed occasional topics from here off to Orac, and he usually ignores them. At one point, he did make a comment on “placenta encapsulation,” but given that he talks a ton about supplement woo, I couldn’t understand why he wouldn’t do a hard-core takedown of it.
Moreover, as others have posted, HB MWs are also strongly correlated with anti-vax, so you would think that he would be strongly supportive of Dr Amy’s goal of getting rid of the CPM. However, he hasn’t bothered with it and, it appears, does not even recognize that the CNM and CPM are different.
I hang out in SOB these days instead of RI exactly because I am more interested in the issues like vaccination. I have always seen the relationship between HB and vaccination, not just in their connection, but the concept and fights are very, very similar.
Orac and Dr Amy should be teaming up, not arguing. But that means that Orac would have to actually give a shit about the issue, and he clearly doesn’t. I have never understood why.
Because he wouldn’t be the Most Knowleledgeable One and because it is women’s stuff, so it doesn’t matter much.
I think that I must have a problem. For some reason, despite being a guy (last I checked, which was 1/2 hr ago at the urinal) it matters a lot to me.
Then again, I have never seen it as “women’s stuff.” It’s about babies. And parenting.
It’s the same reason that I join Orac in the fight against anti-vax. Oh, sure, that does affect me and my kids, but it’s not about me. It’s about everyone else. I vaccinate not just because it protects my kids, but because it is good for society, and helps other kids, too. Same with fighting incompetent midwives. It saves babies’ lives.
I have no idea why that is a “women’s issue.” Why shouldn’t men be just as interested! We are parents, too.
The idea that parenting is a women’s issue pisses me off to no end. Unfortunately, way too many guys are perfectly content to accept it.
It’s because babies come out of vaginas and vaginas are scary and somewhat gross.
No, it’s because parenting is “women’s work.” It’s the attitude of way too many men, and fueled by AP.
(men love vaginas, btw)
Many men love vaginas when they are used for sex and are grossed out when vaginas are used for biological functions like menstruation or birth. Let’s not get it twisted.
Yeah, but that’s not why they don’t care about parenting.
Then again, in line with your comment above, maybe the problem is that they are thinking this is about vaginas? That would not be surprising since that is the NCB message, I guess.
So back to my original comment: I must be weird, then, because I don’t see it as about OB at all. It’s about babies dying unneedlessly.
Babies dying needlessly after they come out of vaginas.
“I don’t see it as about OB at all. It’s about babies dying needlessly.”
Yup. It’s why I get frustrated when debates devolve into arguments about trying to take away women’s rights, or whether OBs are old school or which theory or whatever. My perspective is, not enough is being done to keep babies (and mothers) from suffering preventable injuries and deaths at the hand of woo and incompetence. That’s issue number one for me.
A thousand times this ^^
Thanks.
Although I have to say, it’s funny to have someone give a “thousand times this” to a post that starts, “I think that I must have a problem.”
The first step is admitting it… No really, I’d forgotten about that part already, it was (of course) about the parenting stuff
Exactly. It isn’t a women’s issue, it is a human issue. Too often men are sidelined in the discussions of pregnancy, birth, and parenting and unfortunately many men help perpetuate this, along with many NCB enthusiasts.
People think I’m weird for being interested in homebirth and related issues even though I’m not a parent and probably won’t ever be. It’s not a mommy issue, it’s a human issue. Non-parents are aunts, uncles, family friends, and the immunocompromised people sitting in the hospital waiting room when a measles-infected kid wanders in.
It’s a public health issue. It doesn’t matter if you’re male or female, a parent or childless. CPMs and the NCB community are lying to pregnant women, their families, and all of society. We all have an interest in ensuring that accurate information is out there. It’s the babies who are most at risk and they don’t have a voice, so someone needs to speak for them.
As has been noted elsewhere, homebirth and NCB are like the gateway drug to anti-vax. Once the NCB types have their hooks in young families, they go merrily down the path of woo, completely unaware of the risks they are taking.
This is exactly right.
Agree 100%.
Before I was on the anti-NCB bandwagon I was on the anti-pit bull bandwagon, and before that the anti-sexism bandwagon. I think I got shot down about 99% of the time when I tried to introduce the topics on my own to skeptic writers. Skepticism is kind of a hard group of people to deal with because they usually only want to tackle the same subjects over and over and over again. The sexism discussions got some traction from elevator gate and PZ myers, but is still a point of contention in the community. I kinda gave up on actual impartiality from skeptic groups.
Home births don’t make for nearly as good stories as some high profile wellness warrior who is ‘treating’ her cancer with variety of dietary woo and ACM woo. She also talked her mother into doing the same (no)thing.
http://depletedcranium.com/jessica-ainscoughs-non-treatment-for-cancer-kills-her-mother/
A home birth is a one time event. Even celebrities don’t get much mileage out of it. It takes someone like Lisa Barrett and her trail of bodies to get anyone’s attention for long. That only happened courtesy of a coroner’s inquest.
Rikki Lake is probably the closest thing that birth has to a high profile celebrity, but even she is cagey enough not to promote home births as the perfect solution for everyone.
Note that Orac did take on AP once, kind of, when he discovered that Mayim Blalick was a major whacko in it. However, his main focus was her anti-vax views.
Of course, it happened after he saw it mentioned in a comment I had made, and I didn’t say anything that was already commonly known here (that’s where I learned about her looney-tunes).
I’ve been on a BBT Netflix binge lately and it’s a bit disorienting, her real life woo views and the rigid scientist she’s plays on the show. She’s obviously a very good actor! 🙂 Not to mention she is well-educated in real life, by which I mean “has an advance degree”, not that she uses those powers for good. I suppose you can lead a person to a college, but you can’t make them apply it.
You’re making it sound like she has a PhD in comparative literature. While studying her specific field in neuroscience doesn’t qualify her to give medical advice, she had to learn some actual science.
No, I’m not trying to say she didn’t study science. I meant that it was amazing that she could earn a degree in the sciences and still be against vaccines. My original comment wasn’t clear enough, probably. 🙂
Then again, a MW crowdsourcing the treatment of a 42 wk patient with no amniotic fluid through the FB page of the major trade magazine is as if not more horrifying as any single Bryzinksi cancer story or some patient dying from coffee enema treatment of cancer.
It’s not a lack of story that is the problem here.
He makes it quite clear in his opening sentence that he doesn’t give a fuck. He’s not experienced in “obstetrics” and then proceeds to explain his bona fides.
Gorski, THIS IS NOT ABOUT OBSTETRICS. This is about woo, bullshit, lies, subversion, smoke and mirrors, quackery, all of the things you write about. Why this is of no consequence just because you aren’t experienced in “obstetrics” is depressing as all get out — you don’t give a rat’s ass about any of it, but you’re stepping up to the plate for Jamie.
This may be a fussy point, but since the post was on RI rather than SBM (unless it was on both–I don’t check SBM regularly), we should probably refer to the author as Orac rather than Gorski. Yes, I know, his pseudonym is the web’s worst kept secret (likely intentionally), but I feel it should be respected, if only to annoy people who intentionally “out” pseuonomyous bloggers.
That’s a fair point. Plus, he doesn’t (I don’t think?) discuss issues in the skeptics community on SBM to the extent that he does on RI. Dr. Gorski is not my top choice to read on SBM, but that’s mainly b/c I’m most interested in vaccines (which he sometimes covers, and those posts are fine) and pediatric matters. There’s a pediatrician that regularly contributes there – Dr. John Snyder – and I really enjoy his posts. I think Clay Jones writes on pediatrics too.
I enjoy Dr. Gorski (and his “friend” Orac!) the most when he talks about cancer and cancer woo. Then his expertise really shines. On SBM, Dr. Snyder’s posts are generally very good, and ditto for Dr. Kimball Atwood. Jann Bellamy brings legal expertise, which can be a real eye-opener.
Both Gorski and Bernstein have made the error of stomping into an area where they are unfamiliar with the research, and challenging someone who is very familiar with it, without ensuring they were on firm ground.
”If there’s a topic that I don’t write about much, it’s obstetrics. The reason is that it’s not a major area of my interest, and it’s not an area where I have as much expertise as I do in, say, cancer or even vaccines. ” says Gorski
Amy may not have practiced for a while, but she must be about the most familiar person on earth with the literature in this area. A ”respectful insolent” might have contacted her to find out how she made her calculations, rather than preferring the opinion of the relatively uninformed acquaintance.
Dr. Amy you are so strong and brave. I don’t know how it feels to be under the microscope for every word you write- this kind of scrutiny from people who should be so supporting you and your message is crap. They suck. I’m all about ‘peer review’ but these folks are petty and jealous and looking to get at you. It must be hard enough to be attacked from all the HB/NCB crowd and get it again from Gorski’s ilk. I first read your articles over on SBM so I’m glad you were there for a while. Your blog is better. Amid of this negativity you continue to be a force for good in this world.
It’s amazing how they don’t “get” that the culture is the problem. Birth is dangerous anywhere. It’s the CPM culture that ups the ante. Credibility is a huge issue here. MANA deliberately muddied the results so that it would be confusing to those who have no idea that CPMs and CNMs are so devastatingly different. When Orac and friends don’t bother to dig further and patronizingly “assume” that Dr Amy’s numbers are legit, they are doing MANA such a favor.
Yes, yes, a million times, yes!
They do not care because it’s primarily a “womans issue”. Like most male skeptics, and all male skeptics that are in the public sphere, they would rather rant about CAM forever than take on killer MWs. Its really an embarrassment to the skeptical community.
Exactly. A lot of the mothering issues (the pressure to practice AP, natural childbirth, pressure to breastfeed) is ignored by commentators. The only people talking about these issues at all are on the “pro-woo” side which creates a situation where people only hear one side of the story. Which is why SOB is so important since it’s one of the few places that really talks about what is wrong with these things. Most sites, even female centered ones like Jezebel, tend to take an attitude that places the responsibility in the hands of the mother and allow her to do her own research. So they go try to do that research and find dozens of woo-tstic studies about why these things are good and no real dispute from the other side (other than SOB).
Orac did take Mayim Bialik to task for her views 2 years ago:
http://scienceblogs.com/insolence/2012/02/21/say-it-aint-so-amy-farrah-fowler/
But yeah, 2 years ago with very little mention since.
I’ve read and appreciated Orac in the past but he’s coming across as a ginormous cock in this post. Mr. White Knight riding to the fair maiden’s rescue against the nasty old witch. Gimme a break.
I have been a fan a long time as well, but this post really bugged me. Intellectually dishonest much?
Very much.
I’m hanging onto hope that this is a learning experience for him.
Well, if we’ve gone all personal, can I also point out that Dr. Gorski writes horribly? Every time I try to read, I bail because his writing makes me want to gouge out my eyeballs.
I usually need a tl;dr summary.
It’s why I stopped reading sbm and orac, actually. That and every time I comment there someone is nasty to me.
Just not enough time in the day. I came here via SBM. Plus the topics are more interesting to me and not covered much elsewhere.
I have to admit, I enjoy many of his regular commenters at R.I. more than his own posts. There are a few writers at SBM that I do really like, I just have to be in the right mind frame to read them.
Ah, he doesn’t write badly. For a surgeon. But, yeah, I used to read his stuff on a regular basis as he writes about a lot of topics that interest me, but…well, let’s just say that he seems to have a good deal of trouble getting to the point.
Wow, what a douchecanoe! He even refers to himself in the third person. I appreciate his advocacy for skepticism but I find his tone forced in places. He’s just naturally not as interesting as Amy and I could see why he wouldn’t like that.
He also succumbed to the same lazy “I don’t see it so I’m going to imply it might not be real” logic on the 0.38 number, which is just sloppy.
ps: Where is the video on how Amy got the CDC numbers? This seems to be a perpetual source of criticism so I would like to have it on hand. Others mentioned the video in the comments and that the comparison was with CNMs, which is a key point for non-experts. I missed that post.
He also succumbed to the same lazy “I don’t see it so I’m going to imply
it might not be real” logic on the 0.38 number, which is just sloppy.
Despite the fact that several people pointed him to links with which he could have verified the numbers quickly and easily. Heck, I offered to do the work FOR HIM. No response. No interest at all in the actual data. The only thing he responded to is when I took him up on his invitation to look up how often he used “kerfluffle” and then he seemed insulted that I’d done so.
I read that response and it ticked me off. Not impressed.
Edited for clarity: his response, not yours. 🙂
One thing that’s really bothering me about his post and the subsequent discussion in the comments is the use of the term “low risk home births” as if that means what any rational person would think it should. There’s talk that it isn’t “accurate” how Dr. Amy compared all hospital births to the low risk home births (although she has made it painfully clear her logic behind all her analysis) but seemingly NO acknowledgment that the CPMs et al consider just about every last darn thing “a variation of normal”, thus counting high risk as low risk. That is a very huge point. And that ties into ANOTHER issue being brought up in his comment section, which is midwifery care in other countries. For starters, in those countries they site, they absolutely don’t accept true high risk patients, so that takes care of that. Gah!
Exactly. The problem with Jamie and Orac’s comments is that they are totally removed from the actual world of what midwives are saying. They look at the numbers and say “well, for a low risk birth homebirth is fine” not understanding that according to NCB advocates ALL births are low risk births.
I think that the fact that homebirth is a women’s issue also keeps the skeptics from really caring. Vaccines could impact the innocent in society. If a homebirth goes bad then the only people harmed are those who believed in it, which many people think is only fair. My attempts to deal with the homebirth issue in my policy classes is met with a total lack of caring from other people because they feel like people who choose homebirth get what they deserve (totally missing the fact that many times the women who choose homebirth are mistakenly thinking they are making the safest choice). I don’t agree with this line of thinking, but I’ve seen it enough to think that it also motivates the lack of attention the issue gets from the skeptical community.
Very obvious when Orac is just blindly accepting that Dr. Amy “hates” CNMs… even though I think her only qualm is with ACNM for supporting their OOH members. But if it vilifies the person you want vilified, who cares? >:(
I was really stumped by that comment – what point was he trying to make? B/c it’s CPMs Dr. Amy rightfully vilifies, and there’s no equivalent in Orac’s example of ARNPs and NPs, except maybe candy stripers?
I think the point he was trying to make is that he REALLY dislikes Amy Tuteur to the point that he’s willing to risk his reputation to vilify her.
I’m honestly kind of pissed because I usually go to him as a source for vaccine information… now I can’t because it’ll take me too long to scrutinize it since I can’t wholly trust his to be an objective analysis 🙁
I understand. I’m discouraged by the whole thing.
I feel the same way now. I’ve linked to his various posts many times. I have a strong enough background in vaccines to know whether those posts are as crap as this one, but other topics I’m pretty much just turned off to now.
“The problem with Jamie and Orac’s comments is that they are totally removed from the actual world of what midwives are saying.”
Yes! And don’t you know, that’s exactly why MANA was thrilled to promote Jamie’s post(s): to continue the ruse and lend legitimacy.
And I think you’re onto something about the level of concern about home birth. That’s why I jump on any chance I get to correct someone who says “people should be able to choose what they want, once educated about the options.” But there is MISeducation going on that needs to be addressed and that’s completely lost in what Jamie, and now Orac, have written.
It’s infuriating because it’s so lazy!!! Find out what the context is, plz!!
I wrote a comment about this and then removed myself from the discussion because it was disgusting to watch a smart man deliberately playing the fool just for the sake of being contrary. He might not have any particular knowledge about obstetrics but hey, I have none about medicine at all and even I could see this argument was bull. I mean, how hard it is to see that midwives and company – to my shock, I now have to include Gorski in this lying clique – want to do stats only on dream births, sweeping real ones under the rug.
So he’s pulled his dick out in the comments for the proverbial pissing match…and it’s just as ridiculous as one would assume.
I think I’ll pass on reading the comments. Pity since those are usually worth a quick read.
I do hate it when people I respect embarrass themselves in public.
Do look for what Lilady and EpiRen had to say. Hers was thorough and his was short and sweet.
Cap or quote for those burned out on rage-reading?
Ren said, “Everyone could have just handled all this in two simple sentences: ‘This was not a study. It was a survey with a low response rate and no objective way to verify the data.’ The end. No need for anything else.”
Lilady, at comment 93, wrote a long and thorough takedown of the obligatory cookie-cutter NCB myth comment upthread.
Loved both of them. But to me, the current crown-holder is Chris Hickie, at comment 180:
“From a pediatric point of view, I don’t get why, after 9 months of pregnancy, where–if you are at all in touch with science-based medicine you’ve been getting prenatal care all along–that you would then go and risk it all with an at-home birth. Bad stuff can happen during the delivery. You need someone trained and experienced in every possible complication that could occur during the delivery. And, after the delivery, wouldn’t you want someone who knows how to resuscitate a newborn if needed? You don’t get that by having your baby at home. You do get that by having your baby in a hospital.”
I’ll repeat myself from other posts: you cannot plan for any eventuality but when it’s such a dangerous one and you have some idea when it would take place, you minimize the risk. You have to cross the street 1345682345678 times in your life. You only give birth a few times – or maybe 20, if you’re Michelle Duggar. Plan ahead, for Pete’s sake! We’re talking about a few days of your life against your child’s health for the rest of their life, provided that they have one, which, if we go by the MANA rates, is not a sure thing at all with homehippwives. No one is asking you to marry your OB or move home permanently to the hospital.
Agreed. I really appreciated both.
Harvey “Blind” Pew:
It sounded as though there was a bit of a squabble.
Moon:
Squabble? They’re all dead!
Harvey “Blind” Pew:
Oh! Must have been more of a tiff then.
Orac should care about home birth midwives purely because they are often the first introduction people have into anti-vax nonsense.
I can’t believe we have to ask a physician to take perinatal and neonatal mortality seriously. In what world is the welfare of women and babies inconsequential?
He agrees he finds the MANA numbers alarming, although I’m underwhelmed at how much effort (read: little) he put into distinguishing that. As a whole, it feels like it’s more important to defend Jamie’s side than to draw light to the actual issue.
Yes this exactly.
I’m baffled by what he thinks he is defending in Jamie? He couldn’t find the numbers either, but got similar numbers. So the problem isn’t Dr Amy’s maths but something else?
I know, I really don’t get it. I don’t understand how he could find more offense with Dr. Amy’s tone than Jamie’s, not to mention her self-admitted lack of research. It’s hard not to see it as a personal thing.
Seriously. And Amy wasn’t the one putting obnoxious Little Mermaid gifs into her posts.
Orac is Jamie’s fanboi:
http://scienceblogs.com/insolence/2011/05/29/expelled-2011-edition/
Anti vax and a whole world of useless woo.
Don’t test for GD. Follow this diet to prevent pre-e. Want to induce labor? My goodness, the list for that is a long one and it’s usually when women are the most anxious and desperate.
He’s jealous b/c your numbers are better than his. What some female skeptics fail to grasp is that the numbers show that you are much more likely to lose your child from failure to hire a CNM/OB than from failure to Vax, right now in the 2G plus 14 in the US. There is this weird thing where they stump for Vax all day long but also are into HomeBirth. It doesn’t make numerical sense & IMO undercuts their point.
Should read: what some skeptics . . . It certainly is not just females . . .
True, but I think in most of human history, the score is about equal between vaccine preventable illness and death in childbirth. Just a guess.
In all fairness he did state “I agreed that the MANA study showed alarmingly high neonatal mortality rates.” Sadly, it’s lost amongst the other things he’s saying. But I think it’s important to point it out – he’s not pro-home birth.
To be fair, hiring a home birth midwife doesn’t directly endanger other people’s children, only your own. (Of course, you DON’T have the moral right to endanger your children any way you please, but the widespread threat to public health isn’t there.)
Then again, there is the diversion of resources to cope with home birth disasters: The ambulance ride, the NICU bed, the six L&D staff members who have to drop everything to try to save a baby who came in with a heart rate of 80, the 14 pints of blood to save a mother who came in already bled white…
I mentioned this upthread but I think the fact that homebirth only impacts the homebirther and their family leads to a lot of skeptics to just not caring about it. There’s also the fact that there is a large minority of the skeptical movement that overlaps with libertarian thought which may be against midwife regulation and would instead just say people should be able to choose whatever they want and then will just have to live with the consequences.
They don’t understand that the vast majority of peopel choosing homebirth think that they have made the best and safest decision for their child. There needs to be voices on the hospital birth side speaking the truth and not just snickering and saying “do whatever you want. We don’t care.”
One can be libertarian ang against formal banning of CPMs without being against informed consent for mothers and that includes proper studies and refutation of bogus studies.
You can do whatever you want, but fraud should still be illegal.
Ah, but an increased rate of brain damaged children from homebirth does affect other children. More public school money has to go into providing special services for them!
I feel like Gorski would never tolerate such shoddy work from others. Not going to the source on a point of confusion, non sequiturs regarding the character/tone of the person (rather than the argument), cherry-picking quotes (which allowed him to “not know” how Dr. Amy got the 2.06/1000 rate when she stated it on her blog)… pathetic.
It’s one of those instances of skeptics attacking the writings of another skeptic just to push the façade that they’re actually skeptical… which in my experience, most self-identified skeptics are not. They’re just trying to validate their own presumptions under the banner of almighty Science[TM], not actually to be open-minded/skeptical to the breadth of possibilities to discover truth.
After reading Orac’s post, I will say that in the unlikely event that I’m ever reviewing one of Gorski’s paper (we’re really not in the same subfield so it won’t happen), I would double check the math. I’d advise any other reviewers to do the same.
You have all of us here supporting you and your work!! You’ve been vital to all of this. Glad I got to meet and know you!
Thanks, Bambi. Even though it is personally unpleasant, I look upon Dr. Gorski’s post as a good thing overall since it highlights the increased death rate of homebirth.
Dr. Amy, I just want to second how amazing you are. You never shrink from attacks, which is rare. I know I couldn’t take the kind of attacks and insults you get constantly, and I’m pretty thick skinned myself. I admire that, and your unwavering dedication to leading the charge in this “kerfuffle.” Thank you for your strength and endurance!
Before I queried whether lay people can be skeptics, due to not having the background information to debunk something and therefore running the risk of being opinionated blowhards. In the end we have to trust the information and critique of others. Now I suspect that any attempt of debunking outside your field doesn’t work very well either. Once again there is an argument of “not being able to find the numbers” and using it to imply that someone is sloppy or misleading or misrepresenting the risk of something.
Dr Gorski has just lost a lot of point with a lot of people.
And I am not talking about what he had written about, neither. I am talking about HOW he had written about it.
“Kerfuffle”? Really? Why? Because Dr Amy doesn’t have a penis? Even when he is debating quacks like Adams he admits it is a DEBATE for goodness sake. But Dr Amy doesn’t have a penis, you see. So it is a “Kerfuffle”.
I can’t even begin to explain how disgusted this make me.
Girls, girls, step aside, let the big man deal with this, you’re all making fools of yourselves.
… and let the big man make a fool of himself in the process.
I find it frustrating how they are complaining of Dr Amy handing out vitriol again. It’s a way to minimise an argument and ignore the underlying issues.
Well, they spilled a liberal amount of vitriol again. Dr Amy might be vitriolic and what not but she’s also right. Them? Vitriolic only.
Except they’ve worded their vitriol in a more lady-like manner.
I have never found Dr T vitriolic. Uncompromising and direct, yes. But not vitriolic. Seriously, some of these special delicate flowers should come and live in the UK for a few months.
Me too. I’ve worked on some pretty remote mining locations though where “you fucking cunt” was a friendly term of endearment for your good mates and colleagues.
I call it “no nonsense” kind of voice, But of course, people love nonsense, as long as it’s magical and empowering.
Are you Aussie, KarenJJ?
Yes. That obvious now is it?
“Guest” above was me, and it should have been replying to you, not to myself. No idea what happened there.
“remote mining locations” where “you fucking cunt” is a friendly term of endearment…..plenty of places here in the UK where the latter is true, but paired with the former….. 😉
One of the commenters summed it all up very well: http://scienceblogs.com/insolence/2014/03/13/neonatal-death-rates-after-home-births-and-a-strange-skeptic-kerfuffle/#comment-319940
Thinking about the use of the term “vitriol” it seems to me to be a way of calling Dr Amy irrational and overly emotional.
I’m disappointed that he wrote this as a defence of a friend rather than as an issue in it’s own right. I was hoping that (similar to Steven Novella’s blog post) he’d take a look at the issue of whether MANA’s conclusions were justified in its data. Instead he’s looking at the issue as to whether an obgyn skeptic is misrepresenting her data because he too can’t find the numbers Dr Amy used from the CDC database.
He seems to be saying “oh I couldn’t find them too, so Jamie’s not THAT hopeless people, Dr Amy just gets touchy”. Well, I don’t care actually. I care that MANA released a paper that was designed to obfuscate and mislead on their death rates. A paper we’d been waiting for for a very long time. That they are now complaining of Dr Amy’s tone and method of argument rather then the data makes it look like a personal vendetta from Elsye at skepchick, Jamie Bernstein and David Gorski. I find the behaviour inexplicable from skeptics.
The only discussion I’ve found mildly interesting from Grounded Parents has been in the comments about whether relative risk is the correct metric to use or not. Given that Dr Amy has given both relative risks and absolute numbers it’s not a criticism of her post (although they are trying to use it against her by saying that Dr Amy is misrepresenting the risk of homebirth by even giving us the relative risk to start with) but the whole topic of representing risks sounds interesting.
And there is a video that Dr. Amy made to show how she got the CDC numbers she used!!!
“He seems to be saying “oh I couldn’t find them too, so Jamie’s not THAT hopeless people, Dr Amy just gets touchy”. Well, I don’t care actually. I care that MANA released a paper that was designed to obfuscate and mislead on their death rates.”
Yes, this!! I feel exactly this same way. It also bothers me that MANA’s paper is being referred to as a “study”. I believe that tripped up a lot of people on GP and now on RI. Can we call this a clusterf#%*? I think that’s more fitting than kerfuffle. 🙂
I just didn’t get it. If you read Orac’s post, you’d get the impression that the argument was over whether the HB was 5.5 times higher than a hospital or 3.5 times higher.
If that was all it was, this wouldn’t be an argument, or a “kerfluffle.”
Now, I haven’t followed this topic closely, but my impression is that it goes way beyond whether it’s a 450% increase or a 250% increase, because neither is acceptable.
It IS mostly about that. One of the claims in Jamie’s original point was that Dr. Amy was taking numbers that showed an increase and exaggerating the impact for effect.
Yeah, but if that’s the case, the conclusion is, “I’m not getting exactly the same thing, but clearly this is still bad.” It’s about far more than just the numbers.
Oh, well, yes. They are trying to justify it by saying that Dr. Amy is harming the credibility of the anti-homebirth movement by overstating real risks, but they are also still clearly refusing to acknowledge any number of arguments that she may have actually UNDERestimated the real risk. It’s about making Dr. Amy look like a zealot.
The whole thing is just about payback for real or imagined slights. It makes no sense if you try to evaluate Bernstein’s or Gorski’s arguments on their merits.
I suspect that this is not working out the way that either Bernstein or Gorski had hoped.
What harms the skeptic movement more is when people quibble over technicalities as opposed to focusing on the big picture.
The big picture: the MANA report shows HB to be more dangerous than hospital birth, and directly contradicts their assertion that there is “no increase in adverse outcomes.’ As Novella says, “…unless you consider death an adverse outcome.”
Whether the risk increase is 450% or 250% is friggin immaterial.
As I said, Jaime’s conclusion should have been, “I didn’t get her number (perhaps she can show me what I should have done differently), but that doesn’t matter – it’s obvious that HB is killing babies.”
That it went any different from this shows that it’s not about what is the right number.
It isn’t. Numbers are squeezed in there, true enough. But it’s mainly what a zealot Dr Amy is and how cruel she was to poor Jamie.
You know, this morning I made a little experiment: tried to remember as much as I could from Orac’s article. Guess what my general impression was after one reading of the article and my first 8 hour long sleep in three days? The knight in shining armour rushing to save Princess Jamie from her evil stepmother. Ah yes, there was some warning about what was it, homebirth? It got lost in the lovely fairy tale.
Exactly. What further frustrates me is that, in response to a few commenters basically saying “but you need to know this as well to understand the relevance; yes, she didn’t put that in the one post in question [if it was just one post, I don’t even track that exactly] but that’s not because she’s trying to hide something. It’s not her writing style to present the entire history of a topic in every post.” His response? That doesn’t excuse the invalid comparison of groups, I don’t have the time or interest to read all of her posts, etc.
So I’m back to “I don’t get it.” Why is he writing about this then? Is it about the survey? Is it Dr. Amy’s post about whether women can be skeptics? (Of course she thinks they can!) Is it his history with her? It’s very convoluted.
Kerfuffle, tiff, spat, catfight….we have a large and varied vocabulary for minimizing the importance of women’s voices.
“And it was probably what led him to write a long post about me instead of answering a simple question in a few sentences.”
Now to be fair, when has Dr. Gorski ever been able to limit himself to just a few sentences on any subject? 😉
I was a daily reader of SBM, RI and Dr. Amy’s blog when all this went down, and I really did get the distinct impression that Dr. Amy was being left out to dry in the comments in the way that I never saw with the other posters on SBM. And I’m unhappy to read that Dr. Gorski approved all posts before publishing when I have clear memories of him jumping in in the comments to criticize Dr. Amy.
I don’t know how much comment moderation the other posters were really engaged in at the time – I mean, hadn’t most of the pro-Reiki, pro-acupuncture, etc people already packed up their toys and gone home by that point in SBM’s run? Still, to an outsider, it really looked like Dr. Gorski and a good portion of the commentariat had a double standard for Dr. Amy and the issue of homebirth/NCB beliefs compared to other posters and other kinds of woo. I think it was easy to pick on Dr. Amy at the time because she was really a lone voice in the wilderness on the issue. But in recent years many more voices have joined the fray and the pile of evidence that home birth in America with a CPM is NOT “as safe or safer” than hospital birth has grown immensely. I’d say Dr. Amy has certainly been vindicated as the one who was on the science-based side of this issue.
Why is Dr. Gorski getting involved in something that doesn’t involve him or his interests at all? I appreciate his work on vaccines, CAM, alt med, etc., but this…he just looks like a guy sticking up for his friend, and his mistakes are only compounding Jamie’s.
This is exactly it.
Orac’s position should have been simply, “I don’t know enough about it. Regular commentor CC Math Prof (who is a commentor at RI, btw, but he just blew her off) has provided more information about it. I defer to her.”
That’s MY position, coming from both a skeptic (hey, I’ve been on JREF forums from almost the beginning; I remember when Orac and PZMyers were posting there), long time reader of RI and a person who understands statistics as well as any non-degree statistician can (and I’ve got the street cred – I’ve presented a paper at the JSM).
The difference between Orac and me is that he is high profile with his blog. That doesn’t make him more qualified than me, nor certainly not more qualified than Brooke Oroscz. The wise move on his part was to say, “People who know more about it than I do have weighed in. I don’t have anything better to add.”
Ah, but Bofa, you don’t have an ego the size of a house.
What makes it even more gross is that his ego was puffed up when a woman asked him to white knight for her. What a tool.
This is like watching Mom and Dad fight, and I really like both of them.
I was just about to post the same thing! 🙂
Does that make us siblings?
Ha!
Yeah, well Dad’s sort of a glassbowl, isn’t he?
A hax-phile, huh?
WWCHD.
An acronym to live by.
aha. Something else to Google. I know who you are talking about but don’t get the glass bowl reference.
It’s how she calls someone an asshole while remaining fit to print.
LOL, auntbea! Not only a Phile, but an actual LW!!
NUH-UH! Are you the originator of Bacon Pants?!?!?
Hardly! No, in 2010 I was dating a very nice man for about 10 weeks when he suddenly had a stroke and was going to need extended care. He was estranged from his family and I was under pressure to step in to the role of caregiver….but I’m a single working mom, and did I mention we’d only been dating 10 weeks? Carolyn was REALLY helpful in figuring out what I needed to do and how to do it. Oddly enough someone asked a similar question in The Ethicist a few months later and got a completely opposite response, so I was glad I wrote to Carolyn, not the NYT.
Long time lurker here delurking for long enough to say I wish I’d thought to use glassbowl as a username!
I’ve know (or at least suspected) this animus since the whole SBM debacle, but I always admired that Amy rises above it- she has never before mentioned it before and includes Orac on her blogroll. It shows that she recognizes that two people can hold different views on things and be unable to work together, but still value their contributions.
That Orac couldn’t do the same is disappointing.
I don’t know anything about this dispute, but thank you for taking the kicks. You must be saving lives with all the work that you do. I believe in kind and considerate care, and that it is vitally important to reduce trauma to the mother also, but pretending that homebirth is the only way you can get this, and that birth is safe as long as the mother does the right things, is just craziness, and people should know that so they can make safer choices.
I missed all of those years and found you here, on your own site. I’m perfectly happy with what you’ve built. For whatever that’s worth… I’m glad that it ended up this way.
So when you wrote:
“But that wasn’t the issue. The sticking point was the lack of a moderation policy. Every comment thread spun out of control because certain people (almost all of whom came from here) were free to post garbage that they could never get away with on this site.
Interestingly, I rarely remove comments here (can’t remember the last time I did) and I almost never ban people, yet people are able to control their behavior because they know it could happen.”
That was really a more minor point and that the real sticking point was because Dr. Gorski felt threatened by your success? Why not say so at the time instead of blaming the moderation policy?
The moderation policy was an issue. They wouldn’t let me moderate comments on my posts although they did moderate on theirs. I thought that Gorski enjoyed it when my comment threads got out of control and actually egged on commentors.
I don’t pretend to answer for Dr. Amy, but it’s not rare, when you quit a group, to quietly agree not to air the laundry in public, especially if you ended that collaboration for personal disagreements, but still have common goals with them and respect the work they do.
I can understand not burning bridges, etc., but if there’s more to the split, just say that there’s more to it that doesn’t need to be public. Reading this post and seeing that back then she said the issue was the moderation policy, but now saying the moderation policy wasn’t the real issue, doesn’t instill me with a high opinion of Dr. Tuteur. Even worse, she makes a rather serious charge by implying that Dr. Gorski was being petty and vindictive. I would hope that Dr. Tuteur has some damn good evidence beyond just “I felt he was threatened by my success.”
From the outside, this post gives the impression that Dr. Tuteur is vain and self-centered and that Dr. Gorski is a petty, vindictive jerk (with hints that he might also be misogynistic). I suspect that neither of those impressions is true, in which case, more care in word choice and framing may be called for.
As a loyal commenter here I will say that this particular post is one i wish Dr. Amy hadn’t written. I agree that it does not show her in the best light, nor was it necessary. everyone here is frustrated that there seem to challenges to Dr Amy ‘ s analysis coming from all over the skeptic community that are not, in fact, skeptical. I’m not sure what other polite reputations anyone here has left.
I agree, it’s moved well into the personal territory on both sides. It would be much better if everyone could get back to the issue of whether the conclusions in MANA’s paper are supported by the data or not. Why is that not an issue of curiousity for other skeptics (apart from Dr Amy and Steven Novella what other skeptics have commented on this part)? Surely other people’s interpretations of whether they think Dr Amy’s risk is overstated or not is a personal issue, but the issue of MANA not stating the risk AT ALL is surely an issue?
“Why is that not an issue of curiousity for other skeptics (apart from Dr Amy and Steven Novella what other skeptics have commented on this part)? Surely other people’s interpretations of whether they think Dr Amy’s risk is overstated or not is a personal issue, but the issue of MANA not stating the risk AT ALL is surely an issue?”
Too true. :-/
Todd, you read the original post, Orac’s. I am surprised you couldn’t see that it was brimming not so veiled attacks against Dr Tuteur’s character because it was so much more important to play the knight in shining armour to his poor friend Jamie who only wanted to know the truth (but not enough to actually click on Dr Amy’s links before proclaiming her a liar). Did you read Jamie’s replies on GP when faced with critics of her post? I did. I suppose Orac also did.
You’ll know them through their company…
It’s gotten pretty nasty on both sides, yes. And personal. But it was Orac’s post that started it, not this one.
And still, I don’t care about his attacks against Dr Amy nearly as much as I care about his attacks against safety. We should count only low-risk homebirths? If you care to go through some of Dr Amy’s previous posts, you’ll find screenshots from Midwifery Today showing that midwives don’t know what high-risk looks like. I care about the fact that Orac is defending their incompetence by insisting that we count only the stats of what homebirth should look like, not what it looks like.
I am wondering what Orac will think if I compose a study showing the outcomes for vaccinated people who also got some woo preventive treatment and insist that these are outcomes for the woo preventive treatment. Is he going to endorse my study? Is he even going to call it a study?
Amazed,
I did read Dr. Tuteur’s original post and Jamie’s. I also read the comments responding to Jamie’s post. Can you please point to anyplace that Orac or Jamie said, in all seriousness, that Dr. Tuteur was lying? Because, I couldn’t find it. The term “misleading” was used in a comment from Jamie responding to Dr. Tuteur’s comment, but I read that more as snarkiness in response to snarkiness.
Also, please point to anywhere that Orac is “defending” incompetent midwives. If you read Orac’s post (hell, if you read this response by Dr. Tuteur) you would see that Orac agrees with Dr. Tuteur’s position that home births performed by incompetent midwives are dangerous and that the MANA data show an increased risk in home births vs. hospital births. Apparently, you are reading some other post than I read.
From what I have seen, the problem that Jamie and Orac have had with Dr. Tuteur’s original post had to do more with how she came to her conclusions, rather than necessarily what her conclusions were. Both Orac and Jamie agreed that the increased risk of home birth is probably not worth whatever perceived benefits there might be. The issue is that Dr. Tuteur was not clear in how she came to her numbers and conclusions. Yes, she made several subsequent posts to clear up confusion (e.g., only after apparently receiving several questions about how she got her CDC figure from WONDER did she make the video showing how she went about it). But that initial post was never updated with links to the new stuff, nor did it include links to previous posts on the subject that may have cleared up how she came to the conclusions she made.
Instead, she left it to readers to make assumptions about what she did, and if a reader makes the wrong assumptions, they will likely get a different result than Dr. Tuteur. Personally, I do not like to make assupmtions about what other people are thinking or know. When I encounter anti-vaxers who make claims, I insist that they state their source and (if they make any calculations) how they came to whatever result they’re claiming. Why? Because I don’t want them to have the room to discount my criticism that I based on guessing their source or how they did something.
Bottom line: show your work. If you add up data to get a figure that doesn’t appear in the paper, just a brief note saying what you did should suffice. If you quote something, link to the source document that has the quote, rather than to a page that links to the source document. A reader should not have to go hunting around to find out what you did. And if someone criticizes how you came about your results, then calmly explain what you did and where you got your info. If the criticism is based on a misunderstanding, it’s a lot easier to clear it up with a calm response instead of “You’re WRONG! You’re WRONG!…WRONG…WRONG…WRONG.” (Shouting doesn’t tend to make people want to listen to you.)
And as an aside, those commenting in defense of Dr. Tuteur should really stop the line of comments that basically run, “You’re criticizing Dr. Amy? Why are you defending baby-killers!” It’s dishonest and incorrect.
Her explanation as to how she got the numbers was in the comments in her original post. It seems like your criticism here boils down to being upset that she didn’t update the original post, even though she made an entire video within the next day or so clearly showing her work? Jamie stated that she couldn’t be bothered to click through the links that would have shown her where the numbers came from. That is intellectual laziness.
Trixie,
My problem is that the post is unclear and needed corrections. Dr. Tuteur did not show her work or adequately explain how she got to her conclusions. The reader should not have to guess what the author is doing. If a clarification is needed, by all means, address it in the comment that points out the necessary correction, but then go back and fix the post. It’s not hard, doesn’t take much time, and makes your post stronger.
Fair enough.
No, actually not fair enough. So you have a problem with Dr Tuteur not mending her original post but you don’t see one with an author claiming that she couldn’t be bothered to look at the links the post she criticized contained?
Jamie did click on the link that Dr. Tuteur provided. Should she have explored the other links on that site? Sure, but it would have been better from a journalistic and basic writing perspective if Dr. Tuteur had linked to the original source document, rather than some site that had a link (among other links) to the source, then leave it to the reader to click around trying to find the source Dr. Tuteur was referencing.
Great. Once again Dr Tuteur’s lapse is far greater than Jamie’s sloppiness.
You know what, Todd? Dr Tuteur might not have mended her original post but when she’s going to expose someone, like, say, babykiller Christy Collins (yes, I am not shy to use the word), she actually contacts them and ask them about their own version.
You’re pulling an Orac here: let’s bite at Dr Tuteur’s lapse and acknowledge that Jamie was sloppy only when asked to. You’re ahead of him, though: he still won’t acknowledge that she was sloppy.
Amazed,
I am not saying that anyone’s actions were worse or better than anyone else’s. Pointing out where Dr. Tuteur was less accurate than she could or should have been is not the same as saying that her lapse was worse, let alone “far greater”, than what Jamie did. Some of Dr. Tuteur’s defenders seem to hold the position that she did absolutely nothing wrong, in the same way that some of Jamie’s supporters think she did nothing wrong.
Fine. She should go update it. Agree with you there. More importantly, no one is objecting to Gorski’s take-down of the MANA study. I think he did a fine job with that.
But do you really not understand why Jamie’s post got our backs up? And why we are frustrated that Gorski is not taking Jamie to task for a sloppy analysis?
She caricatures Dr. Amy as saying, “OMGZ YOU GUYS THAT’S A 5.5X INCREASE IN BABY DEATHS!” With the implication being that this is unreasonable thing for Dr. Amy to say. Her justification for thinking this is unreasonable, as far as explains it in the article is that she doesn’t understand where the numbers came from. If she truly didn’t find the numbers, fine, but a) there were links that she admits she didn’t click on and b) there were several very polite and clear comments that explained the numbers, including the 5.5X increase which she refused to acknowledge.
If she wants to disagree with the logic behind the numbers, that’s fine, but at no point has she said, oh, oops, I see what you did now. I’ll go change my post to reflect it. Which is, I believe, exactly how you define responsible skepticism.
See my reply to Amazed just above. Also, Jamie’s post references Dr. Tuteur’s original post, and it is still accurate in reference to that original post which Dr. Tuteur has not updated. It would be good, certainly, for Jamie to add an addendum to her post summarizing the information that came to light afterward so that readers can see where the misunderstanding occurred without wading through hundreds of comments.
Are you also posting on Jamie’s blog about the fact that she never corrected her work?
I would post a comment on her original post if the comments weren’t closed. For what it’s worth, I have found a way to contact Jamie to suggest that she put an addendum on her post, but thanks for implying I’m being unfair or hypocritical.
Fair enough. I wasn’t implying, I was asking. It is interesting to not that Dr. Amy has not, and will not, close comments critical of her and her methods, but Jaime has deleted critical comments pointing out her errors, and closed commenting altogether.
From what I understand, Jamie does not have moderation power on GP (heck, she couldn’t even edit her own post; she had to ask the admins to add her correction about that decimal error!), so she can’t delete comments or close commenting.
Todd, I am a translator. And when I come to a point I am not sure what the author of a book meant here or there, I contact them and ask, instead of making assumptions of my own. When it isn’t clear, contact the author. And never, never be too lazy to click on links and then proclaim that someone was misleading or that you couldn’t find it. When you won’t look for something, you won’t find it. No excuse for not doing it. Jamie didn’t do it. Orac defended her laziness.
Orac defended homebirth midwives by insisting that we should look only at real low-risk homebirths. But midwives claim that all their births are low-risk. I suppose he thought he was being “fair”. Yeah, he was fair to people who weren’t fair. Fair to the principles of academic research? Sure. But not fair to the reality of the situation. They take those high-risk pregnancies, pretending that they’re low-risk, and then Orac insists that those pregnancies should not be included on their stats.
Truly low-risk homebirth might be of academic interest to him. To the majority of us, it isn’t as interesting as the reality of the situation.
I agree that Jamie should have reached out to Dr. Tuteur for clarification before writing her post. It would have avoided this whole nonsense, just as Dr. Tuteur being clearer in her original post would have avoided the back-and-forth of insulting comments from both sides.
From my reading of the original posts, Jamie was looking at the statistics and the comparisons that were made, solely on the merits of the paper and original post, rather than within the larger context of MANA’s baggage and past actions. As far as that larger context, yes, Jamie did not appear to do her due diligence to more fully understand why Dr. Tuteur took very hard line with this study.
However, the primary criticisms (namely, Dr. Tuteur’s lack of clarity in how she came to the numbers she had) were valid. For a lay reader coming to that post without knowing the background and all of the other knowledge Dr. Tuteur has but failed to state, it was sloppy work and opens her claims up to spurious attacks. Yes, Dr. Tuteur clarified after questions were raised, but still hasn’t gone back to edit the article to make it clearer to readers what she did and why she did it.
A lot of the comments aimed at Jamie in her original post were from SOB regulars who know more of the background that was not stated in Dr. Tuteur’s original post. They attacked Jamie in large part because Jamie did not include in her commentary what wasn’t even written.
Frankly, the whole thing has gotten out of hand and ridiculous (e.g., this post spends most of its verbiage on getting in a dig at Dr. Gorski and only brings it to the meat of the current disagreement at the very end). Everyone needs to take a step back, breathe and drop it. Get back to the important work: fighting anti-scientific nonsense.
Yes, fuck all that. In the end, Dr Amy’s analysis was exactly right, Jaime’s analysis was wrong, and HB is dangerous.
Let’s agree to that and fight against the things that cause harm.
I was willing to take your points until that condescending little dig at the end.
I am still stuck on the part where you don’t realize that Jamie’s post IS PART OF THE UNSCIENTIFIC NONSENSE. She was working without context, true, but her conclusion that the risk of homebirth is “negligible” is flat out wrong, and dangerous, and she is letting it stand even though she has plenty of information now to know better.
As I mentioned in another comment, I’ve reached out to her and suggested she add an addendum to her original post clarifying what the misunderstanding was.
As for “that condescending dig”, I assume (and please correct me if I’m wrong) that you’re referring to my comment about this all getting ridiculous, including this post from Dr. Tuteur? I stand by that comment. This post is ridiculous and really, looked at from an outside perspective, reads as a petty dig that adds nothing to the conversation about science communication. There have been similar comments from people on all sides, and, quite frankly, it’s stupid and distracts from the more important work that needs to be done.
Ah, I assumed that by “everyone” you were including the people with whom you are engaging in the comments right now.
Nope, everyone. I try to say what I mean. If I meant the people in this comment thread, then I would have said “everyone here” or “Dr. Tuteur’s supporters” or something like that.
Todd, the moment Jamie decided to do a commentary on a post, any post, she lost her right to be a lay reader. She hails herself as guru statistician or whatever, so she cannot be held to the same standards lay readers are held. She chose to write her post, meaning that she took the responsibility to check what she was writing about. That’s what I do every day in my work. I bet that’s what you do every day in yours, too.
But it wasn’t written on their site and I couldn’t be bothered to click on the links that were provided! No, not gonna fly with my boss.
Todd, let’s be honest here. Would it fly with yours?
Amazed, if you submitted a paper that included a quote, and simply said, “It’s found in this section of this shelf at the library,” would that be okay? That is basically what Dr. Tuteur did. She should have said, “The quote is from this book” (i.e., link right to the source document).
And I think I mentioned in another comment that I agree that Jamie did not do her due diligence and should have clicked around more to find it.
The problem I have had with this whole dispute is that it takes away from the real problems with woo that has seeped its way into the mainstream regarding childbirth, pregnancy and infant care.
Dr. Amy: I noticed it too while you were at SBM, I felt you were treated unfairly and honestly I don’t find much of a different between Gorski’s SBM post vs. Orac’s RI posts.
It’s really unfortunate because Gorski has done some great work on exposing the anti-vax crowd. Unfortunately he has an ego the size of the Hindenberg and that got in his way then and it is getting in his way now.
It reminds me of the old joke about why they couldn’t have a surgeons’ meeting at the hospital … there was no room big enough to hold all the egos.
I discovered the skeptical movement due to his posts on Jenny McCarthy (I was so angry at how her views were being spouted everywhere). In fact I found your home birth debate blog in the comments of a poat there. I was so grateful, so much of the ncb movement seemed off to me though at that point I viewed ncb as “Superior”.
Kind of like your massive ego, eh?
Oh no! Now we have to write both of them off!! Well, I suppose it will cut down on my time reading blogs.
Duelling egos? Sounds like fun.
Dude, the woman who writes this blog CARES an awful lot! And she has been the target of anger and vitriol and a lawsuit, for her bothering.
Smug comments are always the short little rude ones, never ready to speak to the actual issue, only a nasty little comment hoping to silence those who possess the bravery you so obviously lack!
I and others owe Dr. Tuteur a great debt of gratitude!
Such a huge ego that every time a spelling, math, or other error is mentioned in the comments here, she responds quickly and with gratitude, then fixes it. No, she’s not humble, and she doesn’t back down. She takes pride in her accomplishments and is confident in her knowledge. So what? That’s hardly the same thing as having a big ego.
Okay, that explains a very out of character post from Orac.
I know everyone writes a dud, even the best writers have off days, but Orac isn’t in the habit of white knighting for anyone, so why he did it this time baffled me.
I agree, and am disappointed. There was no reason for him to get involved. He has no dog in the home birth fight- other than his friendship with Jamie. He blogs about alt med and vaccines almost exclusively.
Looks like Dr. Gorski might need some of this: http://youngsgifts.com/images/at_home/emergency/704-443064.jpg
I am confused. Why would Gorski bring you on and then push you out?
Oh, where do we start? Strong woman, big following. How’s that for a beginning?
Right, but if he was going to be threatened by those things, why not just leave her be?
I don’t think he anticipated it. After all, at the time I was a minor blogger with a site that got far less traffic than it does today.
I’m not sure that he even recognized the reason for his animosity. He may really think it is only about the moderation policy, but the fact is that SBM does moderate comments, they just wouldn’t let ME moderate comments on my posts.
Other SBM writers, on the other hand, were supportive.
He may not have meant to drive her out, but (consciously or not) to intimidate her, to get her to defer to him. I wouldn’t be surprised if Orac, who is obviously not merely joking when he writes about his “omniscience”, expected her to act a bit star-struck when she became SBM’s newest recruit.
I feel really disappointed in Dr. Gorski right now. I love his blog, and it is indeed a well-known fact that he double dips regularly for his posts on SBM. That he is connected with someone who did such a poor statistical analysis on the MANA data is disheartening.
Dr. Gorski, if you read this, please think very seriously about why you chose to write what you did. I am growing increasingly frustrated by the way that supposed “women’s issues” are treated by the larger skeptic community. You are incredibly passionate about vaccines, and the people that read this blog are just as passionate about getting rid of incompetent providers who parade their ignorance under the banner of feminism and choice. I get the feeling that you just want to write off your friend’s hatchet job as a manufacturoversy. It’s not. She screwed up, had plenty of opportunity to correct her errors, and instead doubled down on her sloppiness.
Same here. Actually, I just can’t fathom how anyone can write with a straight face that Jamie just wanted to know whether she was wrong. She wrote that she couldn’t be bothered to press on Dr Amy’s links, for Pete’s sake! Did Orac miss that?
Pity that he embarrassed himself this way.
I don’t understand either. In fact in one of the comments he is quoting Dr Amy (the ‘you are wrong about the maths, wrong about the…) and complains of her tone. Really?
That’s what I thought. Friendship or not, I cannot imagine defending such sloppiness out in the open, for everyone to see my embarrassment. Let alone the fact that the whole “let’s defend my poor friend Jamie” thing inadvertedly turned into “let’s show the world what a sloppy work my friend Jamie did, just in case the world forgot”. To me, being a friend in this situation means telling Jamie privately that she was wrong and advise her to lay low for a while, since each mentioning of the whole thing is bound to make her look less than stellar.
It’s a kind of apology – someone will when being told that they made a mistake look at the arguments and say ok I was wrong, and someone else will write a bunch of follow up blogs and even invite a few friends over to speak on their behalf. I completely understand where the level of bias comes from, it is even highlighted in the “who I am friends with” statement but all that set aside I am more than glad to see another public opinion agreeing on the fact that MANA numbers are bad and show significantly increased risks of homebirth vs. hospital birth.
I never bought his claim that you left over the moderation policy, since I see you only minimally moderating here. Ergo, I’d long suspected that the real story went something like this. You’ve always declined to get into it with him, which I’ve admired, but this salvo can’t go unanswered.
On the ‘kerfluffle’ question, I couldn’t agree more. Whether babies are given good care or not is NOT a women’s issue. It’s a public health and human rights issue. Shame on you, Dr. Gorski.
Wow but zero disclosure of this history on his article. That is a pretty glaring omission!
He was so quick to admit that he was friends with Jamie but failed to mention that he was antagonistic to Dr. Amy.
I thought that came through, actually. He hinted there was a backstory with conflict.
I caught that, too. But I felt he contradicted himself quite quickly in the comments. His post made it sound like “water under the bridge, no big deal, no hard feelings” but in the comments, not so much. But perhaps I’m just reading into it wrong. If he doesn’t like her, or holds a grudge, he can say it! I wouldn’t necessarily stop following someone b/c of their feelings over someone else. But, I don’t know… This one seems to be veering away from reason. Again, I could be wrong.
And Dr. Gorski, did you not JUST blog about the need for skeptics to disclose any and all conflicts of interest? You told us you were friends with Beyerstein, but your omission about the real story behind you and Dr. Amy is the exact same that you claim to abhor in others.