On the face of it, it sounds like an idea that everyone can love, patients, doctors and insurers. I’m talking about “evidence based medicine,” the idea that treatment decisions should be determined solely by the scientific evidence. In practice, though, evidence based medicine can harm or even kill patients. That’s because the evidence may be conflicting and various third parties like drug companies and insurers may have undue influence in determining what qualifies as the “evidence” in evidence based medicine.

The recent findings about diabetes and tight control serve as a stark reminder of the drawbacks of evidence based medicine. Good control of blood sugar levels in adult onset diabetics improves long-term health outcomes. Therefore, it seemed reasonable to assume that tight control (very strict control of blood sugar levels) would provide even better outcomes. When drawing up the guidelines for management of adult onset diabetes, the National Committee for Quality Assurance deemed tight control to be the evidence based treatment guideline.

A recent large-scale study of tight control showed that, contrary to assumptions, tight control actually increased the death rate for adult onset diabetics. In fact, the results were so dramatic that the study was ended early to prevent harm to any other patients. This unexpected finding prompted a deeper look at how the standard had been promulgated and the story is not pretty.

First, it quickly became apparent that the guideline for tight control was approved over the protests of many diabetes experts. They had cautioned that the evidence for tight control was lacking and that the difficulties of maintaining tight control often led to unexpected side effects, poorer compliance, and poorer outcomes.

Second, there was a third party that would benefit from a guideline for tighter control, whether that guideline helped or harmed patients. That party was the pharmaceutical companies that sold insulin, the cornerstone of blood sugar control. Tighter control automatically means using more insulin than less rigorous control. A guideline insisting on tight control would immediately and dramatically benefit drug companies.

Third, the National Committee for Quality Assurance, a supposedly impartial organization that sets the standards used by insurers to determine whether a treatment qualifies for payment, had received money from the drug industry. Indeed, last year the NCQA received approximately $3 million from drug companies, fully 10% of its revenue.

This story is a cautionary tale about the dangers of evidence based medicine. In theory, evidence based medicine is the ideal. In practice, the evidence is often unclear, or leads to the need for personalized recommendations in place of a universal standard. Since the evidence is often unclear, third parties like drug companies and insurers may have motives for promoting one view of the evidence over another and can exert undue influence over supposedly impartial organizations that set the evidence based standards.

This does not mean that we shouldn’t use evidence in determining care. It just means that we need to be sensitive to the fact that the evidence for specific treatment recommendations in specific cases is often lacking or conflicting. Sometimes there really is no evidence based standard and we shouldn’t try to create one simply to fill the gap.

Moreover, acknowledging that the evidence is lacking or conflicting minimizes the chance that the standard will be influenced by third parties. When a treatment standard is set, there are often third party winners and losers like device manufacturers and drug companies. A specific standard may represents millions of dollars in profit or loss, and it is only to be expected that the winners and losers will try to influence the choice of standard.

Finally, the entities that promulgated evidence based standards must be thoroughly insulated from the influence of third parties. Those organizations must be prohibited from taking money from companies who stand to benefit or lose based on the standards.

Evidence should always guide treatment decisions, but evidence based medicine often doesn’t reflect the evidence accurately, leading to injury or even death of patients.

Natural vision advocates are planning rallies at DMV (Department of Motor Vehicle) offices around the country today. They are protesting what they believe to be the coercive tactics of the DMV in mandating vision correction for drivers with less than perfect vision. Simply put, anyone applying for a license must submit to a vision test, and anyone who has been diagnosed with nearsightedness must wear glasses or contacts while driving. Members of the group Vision Junkies United think that is wrong.

According to their spokesperson Mr. Jayden Kayden Hayden:

Human eyes are designed by nature to see perfectly. Are we really supposed to believe that 25% if the population needs vision correction? That’s simply laughable. We wouldn’t be here if nearsightedness were so common. We would have died out long ago.

Ms. I. C. Yu, the president of Vision Junkies United, explains the ten point manifesto prepared by her organization:

Eyeglasses and contacts are unnatural. Nature never intended human beings to have vision correction.

Relying on natural vision instead of giving in to glasses is empowering. Anyone can drive safely wearing glasses. It is a true achievement to drive safely without them.

The requirement for a vision test is absurd. All you have to do to drive it to see; it is hardly necessary to test every single person for vision impairment.

We need to trust vision. It’s time for us to reject the notion that human eyes are broken and need to be “fixed” by artificial means.

People should rely on their intuition about vision. If they believe that it is safer to drive without glasses, then they should drive without glasses.

Vision affirmations lead to better outcomes. Drivers should continually remind themselves, “I can see the car in front of me” and that will naturally improve their ability to see.

The decision to wear glasses is a choice. The DMV has no right to interfere with individuals’ right to make their own choice about whether they will wear glasses or contacts while driving, or even whether they will submit to the vision test when renewing their license.

Vision junkies are far more educated on the topic of vision than others. Most people behave like sheep when told that they need glasses for vision correction. They just go out and buy them, without ever questioning whether they are truly necessary.

There’s no scientific evidence that driving with glasses is safer than driving without. No one has even bothered to study it. Those in authority simply assumed that correcting nearsightedness is safer.

No one should underestimate the influence of “Big Glasses.” The vision industry is a multi-billion dollar industry. No one profits by declaring that you have perfect vision. Eyeglass manufacturers, contact lens manufacturers, optometrists and opticians only profit if you need vision correct. Is it any wonder that so many people are told they need glasses?

According to Ms. Yu, the American people need to “take back vision” from those who have tried to intimidate us into believing that our eyes are broken. We should stop giving in to the perceived need to actually see the road and return to our natural roots. We must learn to see the way nature intended, without glasses and without contacts, and we will surely feel empowered as a result.

It’s not enough for Christian Fundamentalists to keep their own compatriots ignorant of science; now they want you to be ignorant, too. And they are bringing their traditional technique, mob rule, to a movie theater near you.

The producers of a widely acclaimed British film about Charles Darwin’s life have revealed that they cannot find an American distributor for the film because it is “too controversial.” Not the substance of the film Creation; that’s true and that, of course, is the problem. The movie reveals that Charles Darwin could not reconcile his scientific discoveries with the Bible, and like millions of people since, was forced to conclude that the religion he was taught is directly contradicted by scientific discoveries.

In many ways this movie represents a more critical challenge than the scientific facts of evolution. Religious fundamentalists fear evolution, but for a very specific reason. If evolution is true than the Bible is not, and Fundamentalists will not, cannot, acknowledge that.

If this conflict sounds familiar, that’s because it is. As I wrote in When it comes to science, religion is always wrong:

The “debate” over evolution is almost an exact recapitulation of the “debate” over Galileo’s demonstration that the sun is at the center of the solar system, not the earth. The Bible had located the earth as the center of the entire universe, to literally represent the role of man as the center of God’s concern. When it became apparent that the earth wasn’t even the central planet in our little solar system, religious authorities felt compelled to prevent anyone from learning the truth.

If it became widely known that the Bible was wrong about something as straightforward as the location of the earth within the universe, then it might be wrong about anything. Church leaders reacted as conservatives often do; they attempted to suppress knowledge…

What is particularly frightening for Fundamentalists about this movie is that it focuses specifically irreconcilable aspects of science and the Bible. Darwin was not irreligious. He was a religious man who could not reconcile the tenets of his faith with the scientific discoveries he had made.

What’s especially frightening for the rest of us about the Fundamentalist reaction is that it is no longer enough for them to make sure that their compatriots, and especially their children, never hear the scientific truth. They are exerting their political power to make sure the rest of us don’t hear the truth.

Fundamentalists could easily avoid the film, and they could ensure that their children do not see the film. They don’t want anyone to see the film and they plan to exert political and economic leverage to punish anyone who makes it possible for others to see the film.

Don’t get me wrong. They are well within their political rights to speak out against anything they want to speak out against. Nonetheless, it is chilling when any group tries to exert political power to suppress the truth.

As I have written before, over the last two millennia, religion has opposed science on many different occasions. And every time religion has opposed science, regardless of the topic, religion has been spectacularly wrong, every single time. Evolution is no different. Religion has never vanquished science and it isn’t about to start now.

Religious efforts to suppress scientific facts are harmful to society. Those efforts make our children ignorant and prevent progress. They make us the laughingstock of the world. Most countries are trying to solve contemporary problems. Americans are still fighting about issues that were definitively settled 200 years ago.

Hopefully, Americans who care about the truth will step forward and bring the movie to this country. It is up to us to resist the public promotion of ignorance.

Officials of the American grocery industry have announced that they are preparing a two pronged attack against soup kitchens for the poor. They plan an advertising campaign to alert the public of the dangers of soup kitchens, and a lobbying effort in Congress.

A spokesman for the grocery industry, I. M. Greedy, declares:

“Americans are compassionate people and on the face of it, a soup kitchen is a compassionate attempt to help the poor. Dig a little deeper, though, and you’ll find that the soup kitchen option is both unfair competition and will hurt all Americans.”

The grocery industry is concerned, first and foremost, that the soup kitchen option represents unfair competition. As Greedy explains:

“We have to make a profit, but soup kitchens do not. Therefore they can charge less for their soup.

Let’s be honest here. When poor people are given a choice between buying their soup in the grocery store or heading to the soup kitchen, they’ll pick the soup kitchen every time. The only way we could make the grocery store more attractive is to lower the price of soup and that is unfair.”

Greedy emphasizes that they are not the only ones who will be harmed. Though the government insists that the soup kitchen option will be just one among many options for obtaining soup (citing the continuing availability of soup in grocery stores, restaurants and food courts, the industry is convinced it is only a matter of time before everyone is forced to get their soup in soup kitchens.

According to Greedy:

“Sure, they say that you will still be able to choose where to get your soup. That’s what they want you to believe. The reality is that it is only a matter of time before the government bans soup in grocery stores, restaurants and other places, forcing everyone who wants soup to get it from a soup kitchen.”

The grocery industry believes that the worst thing about the soup kitchen option, from the point of view of the general public, is that it takes away choice. Rather than selecting any soup from the grocery store shelves, consumers who select the soup kitchen option will be restricted to eating only the soup available that day.

Greedy says:

“Americans are not going to tolerate any situation in which they are deprived of choice. You go to a soup kitchen, and can you choose your favorite soup, the one that you have loved for years? No, you cannot. At the soup kitchen you are forced to accept whatever they are offering. Suppose it’s chicken soup and you don’t like chicken soup? Too bad.”

The grocery industry also plans an extensive lobbying effort on Capitol Hill. They have already contributed millions to the re-election campaigns of several Senators and Congressmen. One of those Congressmen has introduced legislation to ban soup kitchens.

Greedy explains:

“We in the grocery industry are gratified that several Senators and Congressmen already understand what it is at stake here. That’s not enough, though. We want to meet with even more Senators and Congressmen to impress upon them the unfairness of the soup plan option. American is a great nation because it won’t countenance socialism. And what are soup kitchens but a socialist attempt to benefit the poor at the expense of the rich? Real Americans refuse to accept schemes that redistribute money from those, like grocers, who work for a living, to the undeserving poor.”

Mr. Greedy is optimistic about the eventual outcome.

“Once Americans understand what is at stake here: government forcing people to get their soup through soup kitchens; government restricting people’s choice of soup; government stifling honest American competition; they will reject the soup kitchen option.”

Mr. Greedy is modest:

“I don’t think that Americans will ever realize that the grocery industry, through a successful advertising and lobbying effort, will have protected them from the harms that would occur if the soup kitchen option were allowed. That’s okay. We in the grocery industry are content to let people believe that they thought of opposing the soup kitchen option instead of being incited to do so by a relentless barrage of fear mongering.”

Mr. Greedy smiles:

“We don’t need the public to thank us. Banning the soup kitchen option will be thanks enough.”

Narcissistic injury is a term from psychoanalysis. A narcissist in psychoanalytic theory is different from our colloquial use of the word. Rather than being a person who is obsessed with herself, a narcissist is a person who suffers a deep sense of inferiority and masks it by projecting an air of grandiosity and excessive self regard. A narcissistic injury occurs when reality threatens the narcissist’s carefully constructed facade of perfection.

In reading the work of homebirth and natural childbirth advocates, I am repeatedly struck by the assumption that a not having an uncomplicated vaginal birth is viewed as an imperfection. Hence the use of words like “failed” and “broken”, the insistence on comparing birth to competitive sports, and the use of goofy birth “affirmations” that are all variants of “I can do it.”

I suspect that some homebirth and natural childbirth advocates experience a C-section as a narcissistic injury. A narcissistic injury is not simply an imperfection. It is an imperfection that threatens the narcissist’s protections against feelings of inferiority.

For example, many people need vision correction, but the overwhelming majority are able to accept that their eyes are not perfect without viewing it as a fundamental deficiency. Similarly, many women have C-sections and view the surgery as nothing more than one of many acceptable ways to have a baby. In contrast, a small proportion of women have such a fragile sense of self, and have constructed such elaborate defenses to protect against these feelings, that a C-section is experienced as a “failure,” a sign of being “broken,” and an insupportable assault on a very fragile sense of self-regard.

Experiencing C-section as a narcissistic injury can explain many confusing aspects of homebirth and natural childbirth advocacy, particularly among advocates who have already had a C-section. The refusal to see a doctor (with some women even refusing to see a midwife) can be explained as the inevitable result of regarding even the possibility of pregnancy complications as personal criticism, combined with the inability to tolerate criticism of any kind.

It can also explain the seemingly inexplicable reactions to the death of a baby at homebirth. Reacting to a baby’s death by being “proud” of oneself for having a vaginal birth is extremely bizarre. However, it makes sense if the mother’s overriding preoccupation is to preserve her narcissistic mask of perfection and keep feelings of inferiority at bay.

The real problem, then, for women who view C-section as “failure” is not the C-section, but the outlook of the women themselves. C-section is experienced as a narcissistic injury, not because it really is an injury, but because women with carefully constructed defenses that keep feelings of inferiority at bay feel those defenses threatened by the lack of perfection.

I don’t expect homebirth and natural childbirth advocates to acknowledge this. Narcissists are notorious for their lack of introspection and their insistence on blaming everything on everyone else. They could never acknowledge that the source of their distress comes from within; they are compelled to externalize it to others who are supposedly criticizing them or disrespecting them.

This piece originally appeared on Homebirth Debate in November 2008.

Homebirth and natural childbirth advocates are incensed that anyone might think a healthy baby is compensation for a less than ideal birth “experience.”

The piece by Kathy at Woman to Woman Childbirth Education, At least you have a healthy baby, is typical of the genre bemoaning C-sections and other life saving methods of modern obstetrics.

Many women, on telling stories of how they felt abused or traumatized during birth — or some other negative feeling, like having failed as a woman after having a C-section, or something — have their feelings dismissed with, “at least you have a healthy baby…” [I]t only makes her feel worse, because then she has the added guilt of not being able to “just be happy” that her baby is healthy. Certainly she is happy that her baby is healthy… but can she not also be sad that it came at the cost of severe bodily trauma?

I especially like the picture of the “mutilated” apple. That apple was torn apart and left ruined just to get at the seeds.

Certainly, not every woman who had a C-section is going to feel this way … otherwise there would be at least 31.7% of women last year who were as traumatized in body and spirit as this apple was brutalized …

So, the next time you hear someone process her negative birth experience, and you’re tempted to say, “At least you have a healthy baby,” remember the picture of the mutilated apple, bite your tongue, and if you can’t think of anything else, just say, “I’m so sorry.”

Is a healthy baby merely a “silver lining” after a C-section? Let’s do a little thought experiment and consider the converse. Imagine a courtroom during a malpractice trial, a trail that alleges that an obstetrician did not perform a C-section in time to save a baby’s life. The mother is on the stand and being questioned by the doctor’s lawyer:

Yes, Mrs. Smith, your baby is dead, but at least you had a great birth experience. You didn’t have surgery; you didn’t have an epidural; the baby was born vaginally and put immediately on your chest for bonding. Sure the baby was dead, but consider the experience.

And look at the picture of this mutilated and brutalized apple. Is this what you would have preferred? Dr. Jones has saved you from a psychic wound that would never have healed. You ought to be grateful.

People would be horrified by the lawyer’s complete lack of perspective. The health of the baby and the quality of the “experience” are not remotely comparable, and it is absurd, and even cruel, to suggest they are.

Similarly, the idea that a healthy baby is merely a “silver lining” after C-section is indicative of the complete loss of perspective on the part of homebirth and natural childbirth advocates. The picture of the “brutalized” apple is particularly telling. The implication is that physical perfection is critical, and a surgical incision leaves a woman mutilated and incapable of healing.

There is another, deeper implication that is both unexamined and unjustified. The implication of the picture is that the removal of the seeds could have and should have occurred without changing the apple. The reality in nature is far worse that the “brutalization” of the apple. In nature, the apple must desiccate and die in order for the seeds to live.

The reality of childbirth in nature is far more brutal than a C-section. In nature, the mother often dies while the baby lives. Or the baby must die in order for the mother to expel it and live. Thousands of women and millions of babies around the world die each year for lack of C-sections.

A live baby is not the “silver lining” of a C-section. It is the entire purpose of pregnancy and childbirth.

They say blondes have more fun, but they’re wrong. According to recent scientific research, wealthy women do, or, more accurately, partners of wealthy men.

Researchers Pollet and Nettle of the Centre for Behavior and Evolution at Newcastle University have reached that conclusion after surveying more than 1500 women. Their study, Partner wealth predicts self-reported orgasm frequency in a sample of Chinese women, was published in the Journal Evolution and Human Behavior. As the authors explain:

The frequency of orgasm has been found to be an important component of sexual satisfaction, which in turn is a predictor of relationship satisfaction, for Chinese women. In American women, age and religiosity are negative predictors of orgasm frequency, and the frequency of masturbatory orgasms but not orgasms with a partner increases with increasing education…

The authors found:

In a large representative sample of the Chinese population, we found evidence that women’s self-reported orgasm frequency increases with the income of their partner. The effect of partner income is not an artifact of female age, educational attainment, happiness, health, relationship duration, regional differences, and differences between partners in educational attainment and wealth.

The following graph makes that clear.

It is difficult to tell if the authors complicated regression models actually show a correlation, and, as we know, a correlation does not mean causation. Nonetheless, the results are more than a fun fact. The study is meant to contribute to an ongoing investigation of the evolutionary purpose of female orgasm.

Evolutionists have taken opposing positions on the function of female orgasm. On one hand, it has been seen as a functionless by-product of the ejaculatory response in males. An alternative view is that women’s capacity for orgasm is an adaptation that serves to discriminate between males on the basis of their quality, leading to either enhanced conception probability or selective emotional bonding with high-quality sires…

The findings of this study appear to confirm the adaptive origins of female orgasm. In other words, better lovers make better fathers.

This paper is hardly definitive, but it is a good faith attempt to investigate the origins of female orgasm. Rather than being a neurologic relic of male orgasm, female orgasm may serve an important evolutionary function.

It may also explain a preference for wealthy men that extends across all cultures. Wealthy men may be perceived as not only better able to provide for children, but more pleasurable as partners for conceiving children.

Hard on the heels of the Katie Roiphe contretemps, the feminist world is being roiled by another conflict. Two prominent feminists are arguing over the meaning of the Islamic practice of veiling women. As Tracy Clark-Flory of Salon explains:

[Naomi Wolf] recounts … the time she spent with women in “typical Muslim households.” She observes, “It is not that Islam suppresses sexuality, but that it embodies a strongly developed sense of its appropriate channelling — toward marriage, the bonds that sustain family life, and the attachment that secures a home.” …

Then, Wolf turns to the inevitable comparison with Western styles of dress. Many of the Muslim women she spoke with said that revealing get-ups cause men to stare at and objectify them. Wearing a headscarf or chador, however, leads people to “relate to me as an individual, not an object,” they told her…

Feminist Phyllis Chesler vehemently disagrees:

Chesler is horrified by Wolf’s argument and doesn’t pull any punches in a blog response titled “The Burqa: Ultimate Feminist Choice?” …

She goes on to contend that “most Muslim girls and women are not given a choice about wearing the chador, burqa, abaya, niqab, jilbab, or hijab (headscarf), and those who resist are beaten, threatened with death, arrested, caned or lashed, jailed, or honor murdered by their own families” and asks whether Wolf is so “thoroughly unfamiliar with the news coming out of Afghanistan, Pakistan, Iran, Saudi Arabia, and Sudan on these very subjects.” …

I’m with Chesler on this one. Wolf’s argument is touching in its naivite, absurd in its reasoning, and vile in its implications, implications that Wolf fails to understand. The burqua is just the Islamic iteration of the solution to a very serious problem. Other iterations include female genital mutilation and chastity belts. The serious problem? Cuckolding, of course.

In animals where fathers have a substantial role in raising young (that includes humans), the possibility always exists that the father will exert himself on behalf of offspring that are not his own. That is an evolutionary dead end, and many animal behaviors have evolved to prevent cuckolding. Human beings have taken it further by creating cultural methods of prohibiting cuckolding.

Men want to be absolutely certain that the children borne to their wives are their children, and they will go to extraordinary lengths to do so. Hence the emphasis in all cultures on virginity for women and absolute sexual fidelity among married women with no analogue for men in either case. The punishment for deviation is fierce, ranging from shunning, to stoning, to death. Since men are typically stronger, they have been able to enforce their will on this point.

Cultural constraints are not nearly enough, and men have taken steps physical steps to ensure female sexual continence. These physical steps include chastity belts, precluding sexual intercourse, and female genital mutilation, making intercourse painful and destroying the possibility of female orgasm. Physical efforts to ensure female sexual continence extend to hiding women so that they cannot be the objects of male desire. They may be literally hidden, as in harems, or figuratively hidden behind garments meant to rob them of any sexual allure.

In the most fundamental sense, the burqa is an instrument for controlling female sexuality. In this, it is no different from a chastity belt or a clitoridectomy. It exists for one and only purpose: to ensure that men are not cuckolded.

Wolf’s naivite on this point is stunning. The burqa, chador, etc. have nothing to do with preventing objectification of women. They exist precisely because women are viewed only as objects, objects owned by men. The burqa, the chasity belt and clitoridectomy are all ways in which men keep their property off limits to other men, nothing more.

Yes, in countries like the US or those of Western Europe, women can adopt the burqa as their own choice, just as they are free to don chastity belts if they choose. That, however, does not change the purpose of the burqa, nor does it change the fact that most women who wear it, like the women who wore chastity belts, and the women who endure clitoridectomy, are forced to do so.

The burqa is an instrument of sexual control. Women may don it willingly, and they have every right to do so. However, no one should be so foolish as to pretend it is a sign of liberation.

Yes, you read that right. Doctors often wonder if they can trust their patients.

Most patients want a trusting relationship with their doctor and they assume that the only issue is whether the doctor is trustworthy. However, a lot of the problems in the contemporary doctor-patient relationship stem from the fact that doctors cannot be sure they should believe their patients. Patients insist that they are educated, that they want to manage their care and that they want treatment plan A. Yet when treatment plan A does not work out, they are unhappy with the doctor. He or she should have explained it better or been more aggressive or refused to go along with their plan.

Don’t believe me? Here’s an excerpt article by a professional journalist detailing her years of infertility treatment, Not giving up hope for a biological baby:

My first doctor in Santa Monica, Calif., was thoughtful and attentive, with an Ed Harris sort of look and a kindly, if somewhat passive, approach. The fertility practice he was part of had wonderful nurses, a sleek, minimalist aesthetic and a reputation for a celebrity clientele.

My second doctor was in Arizona, a blowhard with pictures of his success stories (i.e., babies) insensitively plastered on the walls of his tacky Southwest-décor office. (Please don’t make infertile women look at photos of other people’s kids, I wanted to scream.) After keeping me waiting for 45 minutes, his first words on hearing my history with the L.A. doc were that I should have done a single round of IVF instead of the seven inseminations — I would have been more likely to get pregnant, he said. Very helpful, I thought, since I can’t actually turn back time. I disliked him immediately.

But who do I think was the better doctor for me? Probably Dr. Arizona. The truth is, in retrospect, I should have had a doctor who was much more aggressive. Though I had no history of any sort of physical problem, I believe I should have started drugs much sooner, and my L.A. doctor should have tried to make a case for IVF rather than simply swallow my (admittedly defiant) declarative that I would not do anything high-tech…

I said I’d never do IVF. Never. That was when I was 37, when it wasn’t so much that I had hope as that I had no doubt that this would work. It wasn’t even a question in my mind…

So the patient ignored the advice of her doctor and told him that she would not follow his recommendation ever, under any circumstances. Instead she asked for, and received, the treatment that she wanted.

She was wrong. Now she knows that, but her doctor knew that at the time. In retrospect, does she blame herself? No, her doctor should have been “much more aggressive” and he should have argued with her rather than “swallow” her clear, unambiguous refusal to accept his treatment plan. At no point does it occur to Ms. Parch that this is her fault and that she bears sole responsibility for what happened.

These situations happen quite often. Patients make demands or refuse treatments because they believe that they are “educated” about their options and they are in the best position to decide what is most likely to work. Now just imagine the same situation playing out with a baby’s life at stake. The doctor recommends a C-section or an induction and the patient refuses. Should the doctor just accept that refusal? What happens when the baby is harmed or dies? Typically what happens is that the patient blames the doctor in exactly the same way that this journalist blames her doctor. She refuses to accept responsibility for the results of the decision that she made.

Patients complain that doctors do not respect their decisions, but how can you respect a decision if the patient refuses to take responsibility for it?