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The Business of Baby and the Monkey Business of Margulis

A correspondent asked for my opinion of a new book by journalist Jennifer Margulis that is apparently getting a lot of attention in some circles: The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line. I got a copy from the library and read it. It was a painful experience. One of the customer reviews on the Amazon website accurately sums up my own reaction:

There is a great need for an incisive look at all sides of modern maternity care in the United States, because — let’s face it — we all know it’s not perfect. This, however, is not that book.

The author is a strong advocate of home birth, water birth, midwives, “embracing the pain to make you stronger,” “parents know better than doctors,” natural = good, and very early potty training. She thinks bathing a newborn is harmful. She questions the need for well baby checkups: she thinks they are mainly a gimmick to sell vaccines. She questions the (science-based) practice of giving newborns vitamin K and prophylactic eye drops. She is against the use of chemicals in general. She reports that Johnson’s Baby Wash contains “a host of unpronounceable chemicals, some of which are known toxins…and carcinogens.” She doesn’t seem to have grasped the basic principle of toxicology that the poison is in the dose. She is against formula, which she says is killing babies, and against disposable diapers because they contain chemicals and petroleum and because they can cause your child to become infertile. Her only evidence for “infertility” is one study showing that disposable diapers raise scrotal temperatures. Indeed, plastic underpants are probably warm.

She chooses anecdotes and words intended to bias the reader. For instance, a description of a C-section says electrocautery produced an “odor of burning meat” so awful that it caused two nurses to “step away and turn their heads in disgust,” and when the obstetrician exteriorizes the uterus to facilitate repairing the incision, she characterizes it as leaving the patient’s guts inside out on the operating table.

Prenatal ultrasounds

Margulis says we do way too many ultrasounds. She’s right about that. A New England Journal of Medicine study found that routine prenatal ultrasound screening in low-risk women does not improve perinatal outcomes. There are legitimate reasons for doing ultrasounds in high-risk pregnancies or when a specific problem is suspected, but not as a routine for every pregnant woman.

In an article I wrote a couple of years ago, I reviewed the arguments for and against ultrasounds. There is no actual evidence of harm, but since adverse effects might not be immediately obvious and since there is no way to entirely rule out any possibility of harm, the precautionary principle argues for restraint. Non-medical use is particularly objectionable, especially for long-exposure keepsake videos done just “for fun” and for sex-prediction ultrasounds done with the intention of aborting female fetuses.

She recommends that ultrasounds be done as infrequently as possible and as quickly as possible. So do most doctors. The American Academy of Radiology and the American Congress of Obstetricians and Gynecologists jointly published guidelines in 2007:

Fetal ultrasound should be performed only when there is a valid medical reason, and the lowest possible ultrasonic exposure settings should be used to gain the necessary diagnostic information.

Margulis strongly implies that ultrasounds cause autism, but she doesn’t have any actual supporting evidence. She herself reminds us that correlation is not causation. Yet the “evidence” she gives us against ultrasounds is a mishmash of correlations, hypotheticals, emotion-laced anecdotes, and speculations:

  • She gives a lot of credence to speculations based on rat studies and the untested hypotheses of a handful of researchers.
  • She says “High-risk women who receive multiple ultrasounds are at higher risk of having autistic children.” High-risk women are already at higher risk of having autistic children, whether they have ultrasounds or not. High-risk women will naturally get more ultrasounds for legitimate reasons because they are at high risk.
  • She claims that countries where ultrasounds are commonly done have higher rates of autism. Countries where ultrasounds are more available are countries where diagnosis of autism is also more available, so the reported rates might be higher even if the actual rates were the same.
  • “People who do not use ultrasound, like the Amish, are at lower risk for autism.” This is doubly wrong.  Amish women don’t reject ultrasounds and the idea that the Amish don’t get autism has been shown to be a myth.
  • Someone who observed a long-exposure sonogram procedure thought the baby looked like it was in pain because it “flipped transverse and buried its face in the placenta and covered its ears with its hands.” But newborns are not capable of covering their ears with their hands in response to anything. They have poor control of their arms and don’t know what ears are or where they are located.
  • A patient was “bullied” by a doctor when she said she didn’t want ultrasounds. Admittedly his bedside manner was insensitive, but it sounds like he was only trying to persuade her to get a test that he thought was medically necessary and that was in her and her baby’s best interests.
  • She points out that x-rays were done on pregnant women before the link between cancer and x-ray exposure was recognized. True, but irrelevant.
  • She suggests that doctors’ decisions to order ultrasounds are often profit-motivated, but offers no supporting evidence. Do doctors who are on a fixed salary order fewer ultrasounds? Do doctors who bought their own machines order more tests to re-coup the purchase cost? Maybe, but I couldn’t find any studies.
  • She omits any mention of the evidence against the ultrasound/autism hypothesis. She cherry-picked only the studies that supported her opinion. I easily found this study showing there was no correlation between ultrasounds and autism. And this one. And this one.

Circumcision

There are many valid arguments against infant circumcision, but Margulis’ chapter on circumcision is a biased diatribe, full of distortions, exaggerations, and inflammatory verbiage. She describes some of the published studies about medical risks and benefits, but she refuses to accept them, preferring to rely on anecdotal evidence. She tells horror stories of botched circumcisions. She thinks there is a high incidence of unreported complications and deaths. She says hospitals encourage circumcisions because they make a profit from selling the foreskins.

She thinks babies suffer terribly during and after the procedure. When a doctor reported that his newborn son went right to sleep after the procedure, she refused to believe the baby could be comfortable: she argued that falling into a deep sleep is a coping mechanism babies use to deal with extreme pain. And then on the same page she tells us that newborns react to pain by screaming. You can’t have it both ways. As a family physician caring for newborns, I have personally observed hundreds of newborns in pain; every one of them cried, and not a single one went into a deep sleep. I have heard hundreds of babies cry vigorously, but it wouldn’t have occurred to me to describe their vocalizations as “screaming.”

Vaccines

The chapter on vaccines is by far the worst. She admits that vaccines save lives, but then she recites all the tired old anti-vaccine myths that have been repeatedly debunked. She defies the scientific consensus by insisting that “we know vaccines cause autism in some children.” She misinterprets the meaning of the Hannah Poling case and misrepresents the story of the removal of thimerosal from US vaccines. She believes Barbara Loe Fisher of the anti-vaccine NVIC and she misquotes what vaccine expert Paul Offit says about infants’ ability to handle multiple antigens. She claims that the US vaccine schedule is a result of profit motives and collusion between Big Pharma and the government. She says the chickenpox vaccine is more dangerous than the disease (clearly false, since the death rate from chickenpox dropped 97% after the introduction of the vaccine and no deaths have been reported from the vaccine). She claims that even the doctors who most vocally support the CDC’s current vaccine schedule are choosing an alternative route for their own children, delaying the schedule or refusing individual or all vaccines. She doesn’t offer a single reference to support that claim, and I don’t believe it for a minute.

It goes on and on, and gets worse. She digs herself deeper and deeper into the anti-vaccine party line, with no attempt at balance or acknowledgement that there are facts and arguments on the other side. It’s really pathetic.

A Condemnation of doctors

She mentions a lot of things doctors have done in the past that were later found to be harmful, such as x-rays, Twilight Sleep, and routine episiotomy. She describes episiotomy — an incision to enlarge the vaginal opening during labor — as “sexual assault”!  And she says it has unnecessarily harmed millions of women, in “many” cases making lovemaking unbearably painful or even impossible. That can’t be true. I might be persuaded to believe “rare cases” but not “many” cases. Just think about how many women have gotten pregnant again through lovemaking after having an episiotomy. The number of children per woman peaked in the US during the years when episiotomy was routine.

Margulis sees past errors as a reason not to trust doctors. I see them as illustrating the value of the scientific process as it constantly asks better questions, accepts new evidence, and changes practices accordingly.

Things that need fixing

Common practices tend to lag behind published evidence. We should make sure obstetric practice is following the best available evidence:

  • Delayed cord clamping.
  • No routine episiotomy.
  • Allowing ambulation during labor.
  • Choice of positions during labor and delivery.
  • Having a birth attendant remain with the patient throughout labor and delivery.
  • Reducing the rate of C-sections.
  • No exorbitant overcharging on bills (hospitals have been known to charge the patient $41.85 for 8 Tylenol pills that only cost them 8 cents each; that’s abusive.)
  • Less use of continuous fetal monitoring.
  • Accommodating personal preferences during the birth process whenever possible.
  • Allowing women to eat during labor.
  • Not only strongly encouraging breast-feeding, but actively providing practical support to help women breast-feed successfully.
  • Allowing newborns to stay with Mom instead of in the nursery.
  • Not handing out free samples of formula (because it tends to undermine breast feeding).
  • Not doing routine ultrasounds on low-risk patients.
  • Recruiting nurse practitioners to do well-baby exams and provide practical advice to parents, thus freeing up pediatricians to spend more time on the more specialized tasks they were trained to do.

It really boils down to two things: following the evidence, and improving personal interactions with patients.

Legitimate problems, poor solutions

That which is broken in the medical system is fixable, but opting out of it doesn’t fix anything. She tells about a mother who worried about exposing her baby to sick children in the pediatrician’s waiting room and thought it didn’t make sense to follow the advice of a doctor who only saw her child for 10 minutes. Her solution? She switched from a pediatrician to a chiropractor trained in nutrition and homeopathy! If that isn’t the epitome of idiocy, I don’t know what is.

Conclusion

This is a dreadful book. It is inaccurate, biased, and inflammatory. It could do a lot of harm.

It is a polemical screed that promotes unscientific beliefs while masquerading as science journalism. As Amy Tuteur, the Skeptical OB wrote in her review, this book has nothing to do with science, and nothing to do with journalism.

Too bad. The baby business in the US is far from perfect. A responsible journalist could have produced a science-based analysis of its deficiencies, with useful suggestions for improvement. Instead, Margulis chose to produce a deplorable travesty.

Posted in: Book & movie reviews, Obstetrics & gynecology, Vaccines

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197 thoughts on “The Business of Baby and the Monkey Business of Margulis

  1. Carl says:

    Margulis has a PhD in English, which makes her as qualified to write about medicine as someone with a PhD in any other language, which makes her as qualified to write about medicine as someone without a PhD at all. She ought to actually learn things before cranking out those books, of which she has apparently written “too many, too soon”.

    1. You? A “white supremacist”? LOL For what it’s worth, I hate when people like Merola and Burzynski appropriate actual issues to somehow prove they’re right because someone in scientific medicine has had an ethical lapse at some point. For instance, there’s this:

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447108/

      The government copped to the sterilizations in 1976, but these days, you’re more likely to find out about IHS sterilizations on conspiracy sites, including our favorite sea mammal. But if only nuts are telling the story, the story is likely the work of nuts. That’s a major reason I hate alties.

  2. Stephen H says:

    Wait, autism causes ultrasound? Or was it the other way around? It certainly sounds like the author doesn’t have a clue, and doesn’t really care – as long as people buy the book.

  3. araikwao says:

    Delayed cord clamping isn’t beneficial in term babies, and leads to increased rates of jaundice and requirement for phototherapy (although it is useful for premature babies) – Cochrane. And there is some evidence that early formula supplementation may increase breastfeeding rates. But otherwise, resounding yes.

    1. Harriet Hall says:

      This Cochrane review showed that delayed cord clamping was beneficial in term babies: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004074.pub3/abstract
      Early supplementation with formula is only indicated for preterm babies or babies who are losing too much weight before milk production is well established, and it must be used judiciously so as not to decrease rates of successful breastfeeding.

      1. Rokujolady says:

        Why is it always so important to not decrease rates of breastfeeding? Why is breastfeeding so important? The long term benefits in the first world are so minor as to be nil. If you want to do it, great. Make every effort. If you don’t want to do it, even if the idea just doesn’t appeal to you, you shouldn’t have to undergo a full psychoanalysis as to WHY before you can get a bottle for your baby.
        …Which brings us to how insulting it is to assume that a woman who wants to breastfeed is going to change her fickle ladymind because free samples are available at the hospital.
        A whole generation was raised on formula and is currently living to be old enough to bankrupt social safety nets for everyone else, so I’m really not seeing how this choice is such an important public health matter in the developed world.
        And oh god I really hope this thread doesn’t turn into another endless discussion on male circumcision.

        1. WilliamLawrenceUtridge says:

          Hear-hear (or is it “here-here”?).

          Naw, if you’re going to thread-jack with anything it’ll probably be breast vs. bottle.

          Breast isn’t best if it means resentment, guilt and anger. Pretending breastfeeding is a panacea when at best it’s only going to temporarily reduce certain types of infections during the first years of life irritates me as a skeptic. Beyond the doses of absorbable antibodies, it’s just food. Jebus it pisses me off to hear hospitals pretend formula is poison.

        2. araikwao says:

          Ha ha, I decided to not even go there (re breastfeeding)!! Not touching the circumcision – it seems to be a very US thing (excluding religious reasons, etc)

      2. araikwao says:

        Beneficial in what sense? My understanding is that the only significant difference still present at three months or more was increased iron stores, but the authors state that there was high heterogeneity and a difference in definitions of anaemia between studies. As the paper states, this could be important in developing countries where anaemia is more of an issue, but is it clinically significant in developed countries?
        Is there a clinically important effect of having higher Hb (the other significant difference)for a few days while all the extra RBCs get haemolysed?
        I have no doubt that your haematology knowledge is far superior to mine, and I am happy to be corrected here; my understanding was that while there are the effects on the test results you would expect from extra RBCs, and the effects you’d expect from the extra haemolysis required, that there is otherwise nothing clinically significant to gain from delayed cord clamping in term neonates.,

        1. Harriet Hall says:

          According to the study I cited, there was less iron deficiency at 3-6 months. In my opinion preventing iron deficiency is clinically significant although the risks are small. It is usually asymptomatic and is treatable, but can result in long-lasting detrimental effects on neurodevelopment.

        2. angorarabbit says:

          This is my area of research. The new review does recommend delayed clamping to improve term infant iron endowment, with the minor caveat that jaundice phototherapy be available for the small # of cases that might emerge. What you need to do is read the full introduction as to why we want to promote delayed clamping. This is because 22% of US women between 18-45yrs (child-bearing) are iron deficient (NHANES). When mom is deficient, she lacks sufficent iron stores for fetal transfer. And because breast is a poor source, we need strategies to replete the 22% of newborns at risk. On top of this, certain common gestational conditions (diabetes, preeclampsia, IUGR, alcohol use) further reduce maternal-fetal iron transfer. The reality is that gestational and infant iron deficiency is still a huge problem in western countries.

          Also, hematological indicators are slow monitors of iron status. They don’t reflect iron stores b/c iron is prioritized to blood over tissues like heart and brain. Better indicators are serum ferritin or transferrin saturation, though the former changes with inflammation. Hepcidin has the same problem. Clinically we’re moving to zinc protoporphyrin/Fe ratios, which capture iron availability closer to real-time. You could say, why not take Fe supplements, but we do recommend them, and many women who took them in pregnancy will tell you why they’re miserable (constipation, diarrhea).

          Finally, if the infant is born iron-deficient, our treatment options are limited. We can do a transfusion, but again there’s a jaundice risk. We can’t sample blood for hematology (esp with premies) because they need that iron. Liver may not be fully functional to handle the iron infusion. We can look at urinary hepcidin, but that takes time. So the simplest, cheapest, and safest solution is to delay cord clamping. Which, of course, is what folks used to do before modern medicine, so isn’t this actually what the naturalistic folks would favor?

          Sorry for the long reply. I was so delighted with the review but just wish the recommendation had been even stronger. The cost of Fe deficiency to children is huge, and the damage is not fully reversible. Go into PubMed and read the work by Betsy Lozoff, John Beard, and Michael Georgieff, among others, to learn more.

          1. WilliamLawrenceUtridge says:

            Whenever you get technical I have a nerdgasm.

            That’s supposed to be a compliment…so keep it up!

          2. araikwao says:

            Thanks @angorarabbit, that’s amazing!! I’d initially seen a blog post about this, and it, and a number of doctors in the comments section were quite dismissive of what is essentially a single positive finding. I had a quick look over the review (guiltily,as I should have been doing some other research) myself, but definitely appreciate the clinical context.

          3. Thor says:

            I, too, get a mental ‘rise’ reading your technical comments. Gives me sort of a warm, safe feeling. Thanks for sharing this with us, and for the obvious immense amount of time, work, energy you put into the field.

  4. WilliamLawrenceUtridge says:

    Not to mention the idea that the pendulum appears to have swung on breastfeeding. Several decades back it was seen as primitive and backwards, and bottle-feeding was encouraged. Now it’s seen as a panacea, a borderline-miracle, something to be encouraged even if the parents don’t want to do it, and that it’s almost a crime to not breastfeed your child. Meanwhile, the long-term benefits of breastfeeding appear to be almost nill.

    While breastfeeding does offer many benefits, I dislike the trend I see in sanctimommy circles that you can only be a good mother by breastfeeding, and that bottlefeeding means you don’t love your child. I look forward to bottlefeeding my child, because I will be able to both help my wife and nurture my baby in a very direct way. While there is something to be said for supporting breastfeeding, I am extremely irked by what appears to be a move towards condemning bottle feeding. I plan on losing it with the first nurse, midwife, doula or doctor who tries to guilt my wife into breastfeeding. I see no issue with both handing out formula and supporting breastfeeding, and I wish it were approached that way.

    Sorry, it’s a button issue. End rant and tangent.

    1. Beamup says:

      Even when there’s a specific medical contraindication to breastfeeding (e.g. necessary medications which are known to make it into breast milk and are harmful to the baby), some people STILL demonize parents who bottle-feed (I was originally going to say they demonize formula, but they go beyond that). Completely despicable. New parents shouldn’t be told that they’re vile and evil because they want their daughter to still have a mommy down the road.

      1. Harriet Hall says:

        Some women who know the benefits of breastfeeding still choose to bottle feed for various personal and practical reasons, even when there are no medical contraindications. No one should be criticized for bottle-feeding: it is a viable option that produces healthy babies. It isn’t the best, but it’s close enough for practical purposes.

        1. Jon says:

          I don’t even get the criticism. If nothing else, we know some women have to bottle feed. (My friend’s mother had hormonal issues that made her incapable of breastfeeding. I don’t know the details.) But among lactivists, if you bottle feed for any reason, you’re a horrible monster and should never consider parenting.

          1. Nashira says:

            Yeah, never be a woman and mention valid concerns about your personal ability to breastfeed. Mine are medication-related, which meant that before I stopped going to places they were at, “helpful” lactivists would demand to know my drug regimen while assuring me that almost nobody has to worry about their meds. I have, as I said, valid concerns. Functional mommy who feeds formula > breastfeeding one who hurts too much to get out of bed.

            They never explicitly stated I shouldn’t have kids for it, but even someone as socially dense as I am could tell that they thought it. I mean, I have gotten a few explicit “don’t have kids”, but that’s mostly because apparently disabled women shouldn’t ever have kids, no matter what their circumstances are. Eugenics makes me want to smash.

          2. WilliamLawrenceUtridge says:

            Functional mommy who feeds formula > breastfeeding one who hurts too much to get out of bed.

            Again, here-here (hear-hear?). I fully endorse breastfeeding if you can, if you enjoy it, and if your baby keeps gaining weight. But if you resent it, if it causes you stress, how can the short-term benefits possibly be worth the guilt, shame and frustration you will feel trying to force it? How can it possibly do anything but make you resent your baby? Past the antibodies, it’s just calories and building blocks. Humans are omnivores, we can thrive on nearly anything.

    2. brewandferment says:

      WLU: what if your wife should find she doesn’t want to formula feed? (I don’t know her so of course this is purely speculation) I was surprised beyond my wildest dreams as to how much I hated the idea of someone else doing the only other thing that I alone could do for my child besides carrying and birthing. I still remember how much I resented that my husband, who was the stay at home parent for our kids, got to be the one feeding them while I was stuck being hooked up to a stupid machine at work. Once I got home, and on weekends, it was really hard to let anyone else hold the kid and for sure no one else was feeding them when I was within range! It eased some by the time they got to solid food, but still, I was in no hurry to give up breastfeeding. And up until first kid was born, I was still a bit ambivalent and even still am not especially fond of other people’s kids (family and close friends excepted). My outlook was so changed after I became a mom, it still amazes me, because I expected to be anxious to run screaming back to work at the soonest opportunity.

      1. WilliamLawrenceUtridge says:

        what if your wife should find she doesn’t want to formula feed? (I don’t know her so of course this is purely speculation)

        My wife and I have discussed it extensively. I would prefer the child be partially breastfed, if comfortable and possible, for at least a couple months, for the transitory benefits it does afford (reduced ear infections, firmer and better-smelling stool, some passive immunity). The push for formula feeding is from her end, and I support it because above everything else, the most important thing is to love your child. Food is not love, it’s just food. My wife is my superior in conscientiousness and common sense, and her conclusion is that, in the abstract, the net gains of breastfeeding may not be worth the effort. As in abortions, so in breastfeeding – it’s her body and her decision. I will support her either way. We have both examined the benefits of breastfeeding and compared them to the benefits of not breastfeeding, and come to a consensus that it is very, very far from the most important part of a baby’s life.

        I almost look forward to a sanctimommy, nurse or doula attempting to bring it up with her shortly after birth. So rarely do I feel completely entitled to absolutely lose it and yell at someone. It would only happen once. I’ve been given permission to express my support for her at length and volume as I consider appropriate.

        Of course, this is in the abstract. The reality may be very different. She may try it and love it, in which case I will do everything I can to support her.

        I was surprised beyond my wildest dreams as to how much I hated the idea of someone else doing the only other thing that I alone could do for my child besides carrying and birthing. I still remember how much I resented that my husband, who was the stay at home parent for our kids, got to be the one feeding them while I was stuck being hooked up to a stupid machine at work. Once I got home, and on weekends, it was really hard to let anyone else hold the kid and for sure no one else was feeding them when I was within range! It eased some by the time they got to solid food, but still, I was in no hurry to give up breastfeeding. And up until first kid was born, I was still a bit ambivalent and even still am not especially fond of other people’s kids (family and close friends excepted). My outlook was so changed after I became a mom, it still amazes me, because I expected to be anxious to run screaming back to work at the soonest opportunity.

        Evolution is astonishing, it’s amazing how it will kick your ass into completely unexpected directions. Perhaps she’ll change her mind, in which case I will give her my full support.

        In addition to conscientiousness and common sense, she is also my superior in arbiting fairness. If I ask, I’m quite sure she’ll let me feed the baby once in a while at least.

        1. brewandferment says:

          yeah, he got to feed them plenty…and sometimes brought them to me at work so he could get a break from babydom during my lunch break. Remember too, though, that there are also benefits for mom, too–there was a big BMJ study about a decade ago (something like 20K women) comparing developed and developing countries and the beneficial effects on women’s risk for breast cancer were most closely tied to the number of kids (more was better) and the number of months breastfeeding (again, more was better.) So, not just about food for baby. There are other good things for mom’s long term health benefit, but I haven’t followed them in awhile, and it’s more than just weight loss. Not trying to pressure of course, I just didn’t want those considerations to be overlooked as it sometimes is when baby and parenting is the only focus.

          1. WilliamLawrenceUtridge says:

            My vague recollection is that the breast cancer-breastfeeding link is actually not that strong, but I can’t provide any sources. It was one of the issues we (she, really) looked into and I believe the recent results were that it wasn’t protective (or not strongly so).

          2. WilliamLawrenceUtridge says:

            A bit of digging on pubmed this morning and just now indicates that it is indeed appears to be a risk factor, but not a huge one:

            http://www.ncbi.nlm.nih.gov/pubmed/22405187

            I found more this morning but for some reason pubmed isn’t pulling up the meta analysis I saw then.

            But this is rather besides the point in my mind – most people who breastfeed, and in particularly the sanctimommies who think bottle feeding is a crime, don’t give a shit about my wife’s risk of breast cancer. They may use it as a final, triumphal stick when they fail to convince her that it’s impossible to love your baby without breastfeeding, but what they’re really concerned with is (in my opinion) justifying and imposing their choices on others.

            Perhaps I’m biased because I like to read the Skeptical OB’s site, where this sort of thing is highlighted – but either way, it’s my wife’s choice and neither she nor I take kindly to people attempting to scare or shame others into behaviours that ultimately don’t make that much difference.

          3. brewandferment says:

            Actually this is for WLU, below, but the reply thread stops at this level–you have a point about people trying to justify their own choices and force them on you, although I think you are going a bit far afield to say “most” who breastfeed. Anyone who says you can’t bond with your kid without breastfeeding is clearly full of crap and there are no shortages of counter examples to prove it (adoption esp. of older children as just one.) It’s not, however, unreasonable to say that the physiological processes of breastfeeding can lead to incredible experiences–I can’t think of the type of logical error that incorrectly says if one thing is true, then the opposite must be false. As in, if I say that tent camping is a great way to truly experience the outdoors, that does not mean (nor should it be implied) that someone who prefers a motorhome or is physically incapable of pitching and sleeping in a tent is somehow having an inferior outdoors experience. And some might not even care if they ever experience the outdoors.

            To make objective statements of facts about assorted issues is not abusive, although the way in which those statements are made and in some circumstances, can be. (isn’t that just a paraphrase of Orac?? ;-> )

          4. WilliamLawrenceUtridge says:

            The fallacy is false dilemma :)

          5. brewandferment says:

            WLU–I think I described it wrong. It says that if something is a certain way, the reverse is not necessarily true. In the camping example (less controversial ;-> ) if I say “people who tent camp really like the outdoors” it is NOT true that people who do not tent camp do not like the outdoors. Is that still a false dilemma?? it doesn’t seem like there’s a dilemma at all but an assumption that is not based on anything in the statement. Or, in physical terms: a diode, a one-way street. The logic only gets you to one point but it doesn’t bring you back the opposite direction because nothing has been stated about people who do not tent camp and therefore you cannot conclude anything about motorhome or hotel guests.

        2. anthro49 says:

          I exclusively breastfed for 6 – 10 months (varied with child and circumstances)–no bottles, no supplements, no one else feeding; but I did let him change as many diapers as possible. :-)

          One thing about breastfeeding is that it’s CHEAP. Formula is WOW expensive. I had babies in the “olden days” when you couldn’t wait for years and years while you got financially comfortable, so that was a factor, though mostly I just found it easy and natural, although I realize that many do not.

          1. WilliamLawrenceUtridge says:

            There is an argument that breastfeeding is only cheap if you don’t factor in the cost of the time spent dong it. Obviously that’s a gross simplification, some people value the close, quiet time they get with their child more than a lot of other activities.

            Being able to afford formula, I consider myself lucky that the cost of it does not have to impact my decision (or my wife’s decision) to bottle feed.

  5. Samantha says:

    I think the fact that this book has gotten so much attention is a sad reminder of the dire need for critical thinking in our country, especially in the parenting world. It started with the “Business of Being Born” and seems to go on, and on, and on….

    Have you read “Bottled Up” by Suzanne Barston? The book focuses solely on breastfeeding and bottle feeding, but I think she does a far better job doing what you mentioned here… she isn’t a scientist, but admits this in the introduction, and uses expert interviews and a critical reading of the existing literature to critique maternal and pediatric care in the U.S (by way of the infant feeding debate). What I liked about this book over Margulis’s is that she is careful – almost to the point of being overly apologetic, which is my main criticism of her work – to acknowledge her personal bias and thus makes a very human, and cutting, argument. Really good stuff- would love to hear your thoughts on this one, too, Harriet.

  6. Jon says:

    This is an interesting argument. I was born at home, not because of “nature” or anything like that, but because I was born in the wake of IHS (Indian Health Services) sterilization scandals. Compared to that, homebirthers actually offend me. “Not natural” is first-world problems compared to that kind of thing.

    I still got all my immunizations, though. (Actually, one oddball aspect of the antivaccine scare is now Indians get vaccines at higher rates than whites.) I honestly feel we should do with antivaccine parents what Fidel Castro wanted to do with people with HIV: Put them all on an island. Their own “natural” island, where natural diphtheria, natural measles, and natural Hib all are free to prey on people, naturally. It lets them continue to live “naturally” while not endangering the rest of us.

    I was breastfed, but in a more pragmatic manner. (My mother did use bottles if we were in public.) And no, there was no “more natural”, “bonding”, whatever else. Nor was there the now-cliché trend of “lactivists” to attack any mother who has some sort of hormonal problem that prevents breastfeeding. I mean, the two things I can think of against formula are that one the one hand, it’s heavily supplemented (so your money is going to the same companies that), and on the other, in a Third World country, you need to boil the water first, but historically companies like Nestle didn’t tell the mothers that. (Obviously this was negligence, rather than malevolence. Never underestimate human stupidity.)

    On circumcision, I find it funny because circumcision advocates engage in every alternative medicine cliché you can name, and borrow a few other dodgy methodologies from other forms of woo, such as starting and stopping when you feel like it (common in studies of ESP). I would take the AIDS claims with a grain of salt; fortunately, even if what Auvert et alia say is correct, their results still pale in comparison to the condom. (And you’re more able to get a typical man to use a condom.) The claims about penile cancer refer to a disease which occurs in about 1 in 100000 men, mostly the elderly. In addition to the aforementioned condoms, we have a vaccine for HPV, therefore circumcision to prevent HPV is, by default, antivaccine. Finally, phimosis shouldn’t be diagnosed in small children, and it can be dealt with when the problem happens. (I’m focusing on the AAP position here.)

    The risks of circumcision are very minor, though. Which makes it analogous to acupuncture and a lot of other woo. And above all, why infants? There is no biologically plausible reason an infant should survive any surgical procedure better than a twelve-year-old. I could speculate; a number of circumcision advocates in popular media (Halperin, Morris, Auvert) regularly refer the readers or viewers to Circlist, a site I’m not going to link to because it’s pure porn. I myself was first referred to Circlist on a now-defunct skeptic forum on Delphi by one Vernon Quaintance, who got v& last year.

    All of which adds up to, you guessed it, stopped clock.

    1. Sarah says:

      Unfortunately, Nestlé didn’t just forget to tell mothers in developing countries that hey need to boil water for formula – it’s a whole lot more complicated than that, and you’re talking about mothers who may not have access to fuel to boil water. There are also things like cryptosporidium, which mean even boiled water in developing countries may not be safe. UNICEF estimates 1.5 million children die in developing countries each year because of not being adequately breastfed – and Nestlé are still carrying on with their unethical marketing practices, http://babymilkaction.org/nestlefree

      1. brewandferment says:

        Not to forget the financial impact upon impoverished families and ecosystems where improving mom’s caloric and food quality/reliability is far cheaper (I think by at least an order of magnitude, but haven’t followed this issue closely in awhile) than the staggering cost of formula.

        1. WilliamLawrenceUtridge says:

          In cases where the mother is the primary (or even just substantial) source of money for the family, then her being able to return to work can be important. This goes back to my earlier point about the opportunity cost of time spent breastfeeding. Of course, it’s immensely complicated, and varies by location. A “poor” person in North America is generally still far, far better off in material, nutritional and often temporal terms than a poor person in (say) India, China, Angola, Liberia, Guyana, etc. And the cost of formula relative to the cost of other foods is another huge variable.

      2. Yeah, it gets…complicated. Sadly, it’s not the first time a business has put profits before people. Nor is it even the millionth. The scandal broke before I was born, so I don’t know all the details.

        In this case, I would assume it’s like when, well, when the usual woo peddlers claim to be helping Third World countries. Remember the homeopaths trying to make their own version of MSF? What would that be? Médecins sans Médicament? And I’m convinced Rath was just trying to get PR in the West so people could say “Look how much he cares about dying Africans.” Tch, people make me want to puke sometimes.

    2. Would your mother be available to comment on her experiences? I’m sure it would be really interesting to hear what she has to say.

      1. She’s on the other side of the country, and doesn’t have even one internet, so no.

    3. Thor says:

      I think you meant to say anti-circumcision advocates. I’m categorically against circumcision and don’t subscribe to woo or any sort of CAM.
      The risks are, indeed, minimal. The issue is sensation and function.

      1. (Just registered a WordPress account for here. It’s a throwaway, but it’s a way to keep me from being misrepresented. Years ago, some New Age shaman I’d been debunking hired some hackers and…yeah. Would’ve been worse, had I not been doing the whole thing from a Yahoo! account.)

        I actually meant circumcision is like CAM in many ways.

        Magical “ancient tradition” crap. An article in Men’s Health from several years ago (yeah, I know, wretched hive of SCAM and villainy, but they have good workout routines) claimed circumcision was practiced traditionally in “Asia, Africa, Australia, and the Americas”. Which, first, is extremely broad strokes. And secondly, it wasn’t practiced in the Americas; seriously, Jose de Acosta ripped that theory a new one back in the 16th century. Thirdly, none of which suggests it can prevent a disease that didn’t exist until less than a century ago (specifically, AIDS), especially since it’s been done for thousands of years in a much greater portion of Africa, where AIDS is a serious problem.

        “Best out of three, no five! Seven! 255! 9001!” Suffice it to say, Bertran Auvert is guilty of this one. Starting and stopping his studies wrt: circumcision and AIDS when he gets the results he wants. Even ignoring regression toward the mean, there were the 22 weeks of sexual abstinence (in a study that was supposed to go for 18 months) in the circumcised cohort.

        “One study? Make it three!” Auvert again. Yes, he did this. Took one study in three different countries (Uganda, Kenya, and South Africa) and split it in three.

        “Spoiler alert!” Yes, Auvert did this one too.

        “Oh, this is a systematic review? Because it looks more like a mutual admiration society.” Some blog I read claiming to debunk the men’s rights movement (but was secretly about how super-awesomesauce circumcision was since that was all she discussed) did one of these. The author has, since, made her blog invite-only, so I can’t find it. The article in question was completely uncritical of seven studies (three by Auvert) that took a pro-circumcision stance, and had no other trials on it.

        “Well, now that I have my data, I can form my hypothesis, which the data I currently have will prove, so there’s no need for further investigation.” I’ve seen this one in Time magazine of all places, by Alice Park.

        “That premier medical journal, Oprah!” I can’t remember who said this. I think it was Daniel Halperin, but don’t quote me on that. Dr Oz also likes circumcision, as does Lisa Masterson. So the talk show circuit apparently loves it.

        The usual gang of fallacies. In Tinderbox (wherein our hero, though only an anthropologist, basically discovers everything about AIDS), Halperin and Timberg claim that those of us who don’t think the reason Africa has such a high seroprevalence rate is because of foreskins instead opt for racist explanations. (Funny, I would say it’s because some government types drank Rath’s Kool-Aid, so condoms and antiretrovirals were unavailable.) I myself have listened to a lecture by Stephen Lewis, also not a physician (but a political appointee; Lewis brought the NDP into the civil rights movement back in the day), in which Lewis (who is supposed to be talking about anthropogenic global warming and malaria) claims that at one time, the mainstream position was that AIDS was “an autoimmune reaction to other men’s semen”. No, Mr Lewis. It wasn’t. Call it the Nobel disease. And that the only preventive measure we have is circumcision. Someone never told him about condoms.

        1. Thor says:

          Excellent comments, thanks. Understood, my misinterpretation. I agree with the point re: “ancient tradition”. But, by the same token, one could say the anti-circ view is like CAM in ascribing to the naturalistic fallacy. Guess it can go both ways.

          On a side note, aldos, there are dramatic differences in how the procedure is performed; the more millimeters cut, the greater the damage (just the overhang or radical, ie. pulling shaft skin forward, then cutting). As much of the frenulum should be preserved as possible because of its nerve density. Men know how sensitive this part is.

          Finally, a rhetorical question: Which man among us would want less sensation there than the most possible; what parent would want their son to have less sexual fulfillment than more? Non-rhetorical answer: If it is just a vestigial, useless flap of skin, the issue is moot.

  7. Young CC Prof says:

    Thank you for this lovely review which I showed to my mother, so hopefully she will stop emailing me all the stuff from the natural-birth extremists. (I’m also in favor of natural birth. With competent help, and emergency help less than a minute away, of course.)

    1. WilliamLawrenceUtridge says:

      Have you heard of the delightful Amy Tuteur and her website of most amusing abbreviation, the Skeptical OB? It combines my two favourite things – science and snark.

  8. Thor says:

    Thanks for the insightful review. Regarding circumcision, though, it must be stated that the two main harms are the permanent removal of the vital covering (protection) of the glans, which is moist tissue similar to the inner lip—an exposed glans becomes desensitized, almost calloused like skin due to constant friction and exposure (the glans in all mammals should remain covered throughout life)—and the hundreds of nerves embedded therein, which have sexual sensation as their sole purpose. Circumcised men have no frame of reference for comparison, thus the declaration “my sexual feeling is just fine, thank-you”, is so predictably common. Ejaculation is the same for both, but everything up to that point must logically be inferior in the circumcised group. The British and American Medical Associations long ago stated that there is no medical reason for routine infant circumcision.

    Keep in mind that circumcision is a direct remnant of religious dictate. God, himself, mandated to Abraham in Genesis 17 that every baby must be circumcised or be ostracized. Leviticus 12:3 restates this. Maimonides, the renowned Jewish scholar of the 12th century, stated in the most succinct language possible in his The Guide of the Perplexed, Part III, Chapters 33, 49, that the reason for circumcision is to diminish sexual sensation and function. I dare and challenge anyone to read this. Interestingly, this is one custom that we share with the Muslim world. Most Europeans simply can’t believe that we Americans still do this to newborns.
    Having a cavalier attitude regarding this issue doesn’t serve the rights of babies, and thus the right of boys and men to have full sexual function and experience. These little humans were not asked if it was alright to cut off a part of their vital anatomy to decrease physiological function.

    As Hitch so eloquently made clear in his debate with Rabbi Kushner, this is simply a barbaric, immoral practice that must end.

    1. Andrey Pavlov says:

      Well said. I am in the same page as you and Hitch. Not my chosen battle, though I commend those who take it up. It is a tough one to broach.

      1. Thor says:

        Thanks, Andrey. Years ago I was going to be active, but it is just too damn depressing. I’m certainly not silent when it comes up, but wage no formal battles. My inner battle is coming to terms with the harm done.

        1. Andrey Pavlov says:

          I am in agreement that it is purely a socially constructed, religiously based, practice with nearly no genuine medical use. Hence my own distaste for the procedure. I too am not activist about it, primarily for practical reasons (both my own time and the push back I would get from it in my field).

          That said, I am also not silent about it and when I was on my OB rotation, I refused to do any circs and when asked why I refused I stated unequivocally why. If it comes up, depending on the circumstance, I voice my opposition. But my goal is to do it professionally and in a manner that doesn’t come across as boorish.

          There are a few cases where circumcision actually is medically indicated, but that is certainly very uncommon. In all other cases it comes down to a personal preference which I believe cannot be countenanced by the fact that it is imposing a life-long alteration on an individual without capacity to consent. Things like ear piercings are marginally questionable but at least they are not necessarily permanent and very rarely disfiguring. But can you imagine if we had a drove of parents tattooing infants? Or doing those body modifications where they split the tongue or cut the ears to make them look like elf’s ears? I am perfectly fine with an adult doing such things, but I think most people would agree that if two parents with split tongues and elf ears wanted to have the same procedure done to their child there would be an uproar. Yet if daddy is circumcised it is perfectly reasonable to say that it is OK to circ the kid so he can “look like daddy.”

          1. Thor says:

            Thanks for commenting again, Andrey. As we see from this thread, “broaching” the subject isn’t easy—many tend to be flippant, unconcerned, or uneducated about the issue. You hit the nail on the head—it is, indeed, an informed consent/child’s rights issue, although the anatomical/physiological one should not be ignored. Of course, there are medically valid reasons for it, but none for routine infant circumcision. Your views as an MD carry a bit more weight than a layman’s. Your input is appreciated, especially since I don’t think you were really planning on this discussion. I’m happy to let it rest, though, as per Rokujolady’s plea.

            1. Andrey Pavlov says:

              My pleasure.

              And indeed, the “meh” responses tend to be the majority. I can understand the “meh” since most people don’t frame it from a human rights and informed consent perspective as well as the fact that, objectively, it is a reasonably well tolerated procedure. That doesn’t make it right and doesn’t justify it, IMHO, but in the scale of evils that does make it a little easier to “meh” about.

              Ultimately I would like to see the practice die out entirely and I think we are moving in that direction. At the moment we still suffer from the “tolerance of religious and personal views” aspect of things where someone claiming religious motivation is automatically exempt from criticism and can do whatever they like, with those casting aspersions branded as the intolerant and boorish ones by definition, regardless of the tack taken.

              However, most medical authorities have unequivocally stated it is an unnecessary procedure with no definitive medical benefit in routine use and in Germany they tried to outlaw it (the backlash was from the Jewish community who called it, I kid you not, “the worst offense to the Jewish people since the Holocaust”). It is, once again IMHO, only a matter of time before rational secularized thinking casts aside that last bastion of “religious tolerance” and renders circs a procedure requiring medical justification rather than merely a “personal choice.”

          2. Thor says:

            Once again, Andrey, very well spoken. As the renowned SBM commentator, WLU, so eloquently stated, “hear-hear”!

            (I hope this gets placed under your comment referencing the situation in Germany, as the ‘reply’ link is missing, for some reason.)

            I grew up in Germany and have been back three times in the last three years. Despite their love of homeopathy and other forms of medical quackery, they were ‘enlightened’ on this issue. If I’m not mistaken, it was outlawed only to be reversed due to religious pressure. Because of their history, they are uber-sensitive to such accusations. Do you see the irony of most mainstream ‘skeptics’ being allied with outdated, harmful religious practices?

            PS. This comment is solely directed to you, Andrey, and not to the group at large.
            Wouldn’t want to ‘offend’ anyone.

            1. Andrey Pavlov says:

              I believe you are correct about the German situation. It is understandable that they may be a tad overly sensitive to accusations of anti-Semitism.

              I do see the irony, but I also realize that nobody – myself included – can be perfectly skeptical in all things at all times. Some things are very, very hard to overcome. Sam Harris has an excellent discussion of this using recreational fires (i.e. relaxing by your fireplace). If you haven’t already read The Fireplace Delusion. I, myself, still enjoy a fire up at our cabin in the mountains despite cognitively realizing I shouldn’t engage in the activity from a skeptical perspective.

              We must all pick our battles, eschewing some for various reasons.

        2. anthro49 says:

          My (uncircumcised) sons would agree with all you have said, as do I; but none of us get preachy about it. Same with breastfeeding. People have their own takes as you can see from the lengthy posts here from LWU on breastfeeding.

          1. Andrey Pavlov says:

            I agree that there is no need to get “preachy” but merely from a pragmatic standpoint. One point where WLU and I agree is that the level of harm and amount of risk is low enough that it needn’t be boorishly demonstrated about.

          2. WilliamLawrenceUtridge says:

            And despite this fact, how many electrons have died today alone in our “discussions”? I think we both just like to argue :)

    2. WilliamLawrenceUtridge says:

      I’m with C0nc0rdance on this one – the risks and benefits of circumcision are both minor, and ultimately it’s not worth the heat or light it gets.

      1. Andrey Pavlov says:

        It is not about the risk in the case, WLU. It is about the premise of informed consent and permanent bodily alterations. I responded to Thor and will copy-pasta part of it here:

        There are a few cases where circumcision actually is medically indicated, but that is certainly very uncommon. In all other cases it comes down to a personal preference which I believe cannot be countenanced by the fact that it is imposing a life-long alteration on an individual without capacity to consent. Things like ear piercings are marginally questionable but at least they are not necessarily permanent and very rarely disfiguring. But can you imagine if we had a drove of parents tattooing infants? Or doing those body modifications where they split the tongue or cut the ears to make them look like elf’s ears? I am perfectly fine with an adult doing such things, but I think most people would agree that if two parents with split tongues and elf ears wanted to have the same procedure done to their child there would be an uproar. Yet if daddy is circumcised it is perfectly reasonable to say that it is OK to circ the kid so he can “look like daddy.”

        1. WilliamLawrenceUtridge says:

          It is not about the risk in the case, WLU. It is about the premise of informed consent and permanent bodily alterations.

          Meh, we do a multitude of things to children that lack their informed consent, of necessity. Some are permanent bodily alterations. It’s a minor flap of skin of little biological importance. The argument of “informed consent” strikes me as a weak one, a straw grasped at for lack of a better one. It strikes me as an example of Parkinson’s law of triviality; witness the time, effort and electoral interest wasted in Germany over the issue. I don’t think anybody can make the case that this was the best use of the government’s time – either in terms of enacting the law, or repealing it.

          There are a few cases where circumcision actually is medically indicated, but that is certainly very uncommon.

          I think we can both agree that this is uncontroversial, and can be put aside.

          In all other cases it comes down to a personal preference which I believe cannot be countenanced by the fact that it is imposing a life-long alteration on an individual without capacity to consent. Things like ear piercings are marginally questionable but at least they are not necessarily permanent and very rarely disfiguring. But can you imagine if we had a drove of parents tattooing infants? Or doing those body modifications where they split the tongue or cut the ears to make them look like elf’s ears? I am perfectly fine with an adult doing such things, but I think most people would agree that if two parents with split tongues and elf ears wanted to have the same procedure done to their child there would be an uproar. Yet if daddy is circumcised it is perfectly reasonable to say that it is OK to circ the kid so he can “look like daddy.”

          If parents tattooed (or tongue-split, or ear-pointed) infants as part of a cultural practice that permitted them entry into an exclusive or recognized part of society, without which they would lack participation in a key part of ingroup belonging, I would again have little problem with it. However, unlike tattooing, tongue-splitting or ear-pointing, a circumcision is a change to a body part that is rarely seen, that can be concealed, that is concealed most of the time. It’s also socially acceptable (where I live), thus offering no systematic stigmatiziation from society.

          All that being said, kudos to you for refusing to perform circumcisions, I respect you taking a stand. I don’t think I can be convinced to either side of this argument, simply because I don’t think there is anything meaningful in terms of objective benefit. And in fact, to put my keyboard where my mouth is (my money where my hands are?) I’ll try not to respond further to this.

          To summate – there are weak arguments for and against circiumcision. Rarely is there a strong argument either way, and in sitations where there is a strong argument, it’s a non-issue. I don’t think the force and resources of the state should ever become involved in these questions.

          1. Andrey Pavlov says:

            I certainly appreciate your point about triviality and indeed concur that this is part of the reason why I am not activist about it myself.

            However, I disagree that framing it from a consent and rights issue is incorrect. For example, female circumcision. What is the material difference between forcibly removing a clitoris vs a prepuce? By your own arguments I can see none. Yet I think we are generally more ready to condemn the female version and in fact call it “female genital mutilation.” Why is male circumcision not called “male genital mutilation”?

            Your further argument of:

            If parents tattooed (or tongue-split, or ear-pointed) infants as part of a cultural practice that permitted them entry into an exclusive or recognized part of society, without which they would lack participation in a key part of ingroup belonging, I would again have little problem with it.

            falls flat IMHO. Using extremes as examples is, I believe, useful in this case. What if the ingroup required amputation of a limb? The key here is not the inclusiveness of the group but the fact that the child cannot choose to be part of the group and, should he or she choose to opt out of the group cannot change what has been permanently altered. If an adult wishes to convert to Judiasm and get a circumcision I have no problem with that at all. But forcing a permanent choice on a child is something I think most reasonable people would consider wrong. It becomes obviously so in my extreme examples but nothing except the degree of trauma and the obviousness of the procedure are changed in regards to circumcision.

            So I agree that in the grand scheme of things it is much more trivial than other practices and issues, but that doesn’t change the premise that it is still wrong, merely how much effort to change it (and how quickly I’d demand it) is reasonable to expend.

            And (because I know you can take it) I am going to call you out about being selective in your skepticism. You have stated that acupuncture is a bad practice because the premise on which it is administered is false and there is (albeit minor) risk for no benefit. You reserve that adults properly informed that it is a placebo with said minor risks and no benefit can still choose whatever they wish.

            Yet, here we have a procedure with once again no benefit and significantly more risk than acupuncture, performed on a false premise (whether religious or false medical claims), or at best performed purely for choice and aesthetic. Only in the latter case is there room for rebuttal (since the premise is not false) but I would ask you – would you be alright with treating children with acupuncture under similar context?

            However, unlike tattooing, tongue-splitting or ear-pointing, a circumcision is a change to a body part that is rarely seen, that can be concealed, that is concealed most of the time. It’s also soci ally acceptable (where I live), thus offering no systematic stigmatiziation from society

            Which brings me to this point – what if a particular group liked the tongue-splitting and ear-pointing? Or what if we decided circumcision was to be stigmatized? I think in these cases the whims of a cultural idea about a permanent medical procedure with risks, no benefits, and decided for an individual who cannot consent should fall under the purview of the state to protect the child in question.

            Once again, the issue here is only degree of harm and conceal-ability. We would expect the state to step in a prevent a commune of cultists from amputating the toes of children born to the adherents. Yet we somehow feel that amputating the foreskin of a penis is OK because enough people are OK with it and it just isn’t “that big of a deal.”

            That, to me, is the antithesis of being skeptical.

          2. theLaplaceDemon says:

            I just want to chime in to this (very interesting, very appreciated!) discussion to make a small point: I don’t think the fact that circumcision is done on a part of the body “rarely seen” is at all relevant. Just because it is rarely seen doesn’t mean that it can’t cause an individual serious anxiety or distress, particularly if it was stigmatized.

          3. WilliamLawrenceUtridge says:

            True, but it can’t cause social ostracism without them being naked – a rare scenario.

          4. theLaplaceDemon says:

            (hopefully threading correctly…@WLU)

            Unless a previous sex partner/someone who didn’t keep their eyes to themselves in the urinal/whathaveyou decided to leak it to a social group.

            I’m thinking specifically of the anguish a few individuals I’ve known with non-normative genitalia went through – the stress over choosing sex partners, etc., because they perceived their gentiles as embarrassing or shameful. And if you add on top of that our hypothetical culture where circumcision is stigmatized, it’s easy to see how it could be socially damaging if it becomes known that an individual has this particular trait.

            Imagine a high school – an already pretty socially vicious place, often with strict hierarchies and complex social rules and both physical and psychological bullying. In our hypothetical culture, not only does this kid have to be careful not to let anyone see him that he is circumcised unless he absolutely trusts they won’t tell, he also has to avoid doing anything that will lead to the people questioning whether or not he’s circumcised. If nudity is socially accepted at all (say, a bunch of kids skinny dipping in the lake together, or people being comfortable naked in the locker room) this kid has to find excuses to stay clothed, because just one instance is enough for his secret to get out.

            I don’t think this is an implausible scenario*, based on the social norms of highschools. Bullying around real or perceived “flaws” is not uncommon, and in many social groups a certain degree of nudity, in the right circumstance, is acceptable as well.

            * I do think it’s somewhat implausible that circumcision is stigmatized, though not impossible. I am referring to the rest of the scenario with this statement.

          5. WilliamLawrenceUtridge says:

            Unless a previous sex partner/someone who didn’t keep their eyes to themselves in the urinal/whathaveyou decided to leak it to a social group.

            First off, you can avoid this by avoiding sexual partners or using a toilet rather than urinal. Second, this would take place in a society where circumcision is a social detriment, which is a world we don’t live in (in North America anyway). There is no social ostracism here, for general society. Of course, there was in the past (witness the big deal about JFK being president since everyone thought he would cave to the pope – circumcision being a proxy for Catholicism). This is sort of the core of my argument with Andrey, I’m dealing with this world, not an imaginary one that must be constructed in order to illustrate the underlying principles. The hypothetical scenarios are interesting – they’re just not reality.

            I’m thinking specifically of the anguish a few individuals I’ve known with non-normative genitalia went through

            I don’t think you can compare circumcision to non-normative genitalia.

            Imagine a high school – an already pretty socially vicious place, often with strict hierarchies and complex social rules and both physical and psychological bullying. In our hypothetical culture, not only does this kid have to be careful not to let anyone see him that he is circumcised unless he absolutely trusts they won’t tell, he also has to avoid doing anything that will lead to the people questioning whether or not he’s circumcised. If nudity is socially accepted at all (say, a bunch of kids skinny dipping in the lake together, or people being comfortable naked in the locker room) this kid has to find excuses to stay clothed, because just one instance is enough for his secret to get out.Obese or early developing females would, and do have to deal with these issues – but again, that’s not circumcision in North America.

            I don’t think this is an implausible scenario*, based on the social norms of highschools. Bullying around real or perceived “flaws” is not uncommon, and in many social groups a certain degree of nudity, in the right circumstance, is acceptable as well.

            Bullying isn’t about actual flaws – those are the excuses and emotional levers used by bullies to torment their victims.

          6. theLaplaceDemon says:

            @WLU –

            I more or less take your point about wanting to discuss *this* world rather than a hypothetical, but I think the hypothetical is useful for demonstrating a principle. And trends can change.

            I will say though, that this:

            “First off, you can avoid this by avoiding sexual partners or using a toilet rather than urinal”

            is absolutely ridiculous. At that point you’d be asking people to make potentially major sacrifices to avoid ostracizisation (and no, I’m not talking about the toilet).

            As for the bullying example: I was demonstrating a way in which ostracizisation could come despite circumcision being rather hidden. It seems like you are arguing that it makes a big difference whether it’s in your pants and not on your forehead. This baffles me. Same with non-normative genitalia – my point is simply that “out of sight” doesn’t mean “resistant ostracizisation.”

          7. WilliamLawrenceUtridge says:

            Hypotheticals are absolutely valuable in illustrating principles, but then you have to move away from them in order to reach reality. And in our current social context, limited in time and place, circumcision bears very little stigma. So while yes, my toilet/urinal examples are indeed absurd, they would be valid options in a social context where circumcision is stigmatized to the point that you would deliberately want to hide it. Nobody has to make the kinds of sacrifices I claim, because nobody lives in the hypothetical world where circumcision is this stigmatized.

    3. I just hold that it’s like acupuncture: If a treatment has no benefit, and even the slightest risk, don’t do it.

  9. Andrey Pavlov says:

    “She says hospitals encourage circumcisions because they make a profit from selling the foreskins.”

    That’s where I lost it.

    1. Thor says:

      She’s creating misinformation, of course, but the idea is there. Only one UK company called Intecytex has used them. Their product is called Vavelta; it’s potential use is dermatological. They were in a Phase ll clinical trial a couple years ago trying out the concoction for a genetic skin disorder, RDEB. They’re using live fibroblasts in suspension, which is injected. Don’t know the results but, regardless, they had major plans to use it for aesthetic purposes as well.

      And let’s call a spade a spade—there is a nice chunk of change to be made in the circumcision business, probably all said and done close to two billion a year, although the doctor doesn’t even make $200 per. More is made on the extra quarter day of hospital. But, there are no bad guys: no evil Big Hospital, no Big Bad Medical Establishment. It is simply what our culture, religion, law, medicine allows. Parents want their sons to be like dad, like 80% American men were (although the rate is perhaps only 50% now).

      To me, this is just a logical issue, self explained by the very act itself.

      1. Possum says:

        My advice for undecided parents was that if they didn’t circ, it was a possible source for unburned skin for use as a graft in the event that the boy suffered a terrible burn and needed a donor site.

        1. It’s amusing and tragic that doctors still denigrate the sensory function of the foreskin. Your advice to parents reveals a great deal of denial on your part. There is far more normal skin with normal innervation available on the body for use in grafts, yet you concentrate on this one spot that just happens to map into the ecstatic sexual circuits of the brain. Why? Societally speaking, what is so offensive about strong parental bonding? And why do you assume that a normal baby would prefer to live in sexual/ecstatic poverty?

          1. WilliamLawrenceUtridge says:

            Has anyone here advocated for circumcision? Certainly I haven’t, and I can’t recall seeing anyone – though several have argued against it.

            Societally speaking, what is so offensive about strong parental bonding? And why do you assume that a normal baby would prefer to live in sexual/ecstatic poverty?

            The offensive thing is the belief that yours is the only way by which parents can bond with their children, and that there is something wrong with parents that don’t adopt your narrow, rigid definition of proper child-rearing. There’s nothing wrong with breastfeeding, there’s nothing wrong with bottle feeding, and neither will guarantee healthy, happy children anymore than it would guarantee monstrous, defective children. You can pretend it will, but that doesn’t make it true.

            Further, despite mandating circumcision for religious reasons, neither Christianity, Islam or Judaism have died out due to the inability of circumcised males to orgasm. And since cut cock tastes better, there’s even an argument that it can lead to greater sexual satisfaction. But the most important sexual organ is the brain, not the genitals, and even male-to-female transsexuals can have orgasms thanks to neural plasticity.

            Look, circumcision just isn’t worth getting bent out of shape about, and it’s certainly not worth being dogmatic about. There are benefits and rare detrimental effects to both cutting, and not cutting, the foreskin. You can’t pretend that it is anything close to a mastectomy, severing a limb or some sort of major trauma. It’s frankly rather minor, and only in vanishingly rare circumstances does it lead to any serious consequences. Don’t you have something better to advocate for, like campaign finance reform?

          2. It’s true no one has advocated MGM here, rather you very gingerly tiptoe around the issue by pretending that it doesn’t matter whether a so-called care giver amputates the primary erogenous zone from a non-consenting infant for no good reason. I can see why you’d rather blame the parents, but the history is clear, parents have only been acting on medical advice as they’ve very faithfully done for decades. And as a result of their misplaced trust, male genital mutilation has become a cultural norm in this country based on a long series of patently ridiculous medical claims about everything from masturbatory insanity to HIV.

            Let’s just take a wild leap here and hypothesize for a minute that sexual satisfaction is positively correlated with marital stability. I know that’s not scientific but it turns out emotions aren’t very scientific either. Do you suppose we’d have the highest divorce rate in the industrialized world if we really had evidence based medicine?

            Isn’t it long past time to admit that circumcision is the most reprehensible kind of child abuse and put a stop to it? Seriously, can anyone actually say that this quackery has no meaningful consequences?

      2. They use fibroblasts in skin creams for ladies, such as Oprah. They also using fibroblasts in the new 3D printers that make ears, noses, etc for transplantation. Human tissue marketing is big business. The foreskin of a newborn is rather pristine.

  10. angorarabbit says:

    I have a longer post on this topic and cord clamping, but cannot post it because carriage returns hide the “post comment” button. Help!

    1. Chris says:

      I also never comment on circumcision threads. My hubby was not born American, so he is not. So are sons are not. It was not that big a deal. It is really weird how come obsess over it. My opinion is: meh.

      Oh, and what you do to get the “post comment” button is to hit the “tab” button. Works like a charm. Or according to some, use the Chrome browser.

  11. I would like to leave a comment in regards to the epidemiologic studies that were stated, in reference to not detecting autism after ultrasound scans.

    I have come across these papers before. After contemplation, I do not believe that the conclusions are unquestionably valid. True, “The dose makes the poison” – and each of these papers attempts to correlate of the number of ultrasound scans with negative health effects. However, the number of scans is not dose. If ultrasound is to induce autism, it would likely be due to overexposure of a specific sensitive organ. I am unlikely to develop autism from ultrasound on my elbow.

    On that note, consider this side effect and how it may relate. Ultrasound has the propensity to stimulate growth of most all tissues relying on glucose metabolism – plants, microbes, and human tissue have all been noted to grow at accelerated rates following exposure to ultrasound. Some studies indicate that a large majority of autistic individuals have excessive growth in the prefrontal cortex. So, when a sonographer is getting a nice, flush, face picture – that ultrasound is first passing through the prefrontal cortex on its way through the brain. This is one such side effect of ultrasound exposure that needs to be investigated further.

    In another study, a regiment of ultrasound exposed to rat gonads dramatically altered the testosterone levels of these rats in an age dependent manner. This emphasizes another point that I would like to make regarding epidemiology based on scan number. Should prenatal testosterone levels be linked to autism in any way, it cannot be guaranteed that in any arbitrary number of scans that the testes were directly shone upon in the first place, and/or at the right time of development with sufficient intensity, duration, etc. **continued in reply post**

    1. Further complicating, one could have 5 scans for 5 minutes each at a very low power, conservatively, and another practitioner may give a single higher power scan for an hour. On paper, the latter doctor will only show as ‘1 scan’ – but in reality, his exposure could be much more.

      > In Antenatal Ultrasound and Risk of Autism Spectrum Disorders, no record of dose is given save for the number of scans.
      > In Associated With the Autism Phenotype?, there is also no record of dose given save for the number of scans. Further, while this study did select specific times during pregnancy to administer scans, there may be delicate windows of vulnerability outside of those selected times. Since only one time was selected for either group, I find the conclusion that “there is no clear association between frequency and timing of scans” to be misleading.
      > Ultrasound and autism: association, link, or coincidence? – it appears to be a review article, and thus suffers from the methodological flaws I had previously mentioned.

      Thank you for your time, and I hope that good things come out of this discussion.

      1. One last comment — I was re-reading through the argument and noted the Amish-autism-thing, ..I would like to note that the preliminary study was not complete, hence preliminary, but also their rate of 1/271 is dramatically less than the 1/80~ of surrounding areas. It is also true that while they do not outright ban ultrasound, it is not promoted in their society for vanity or excess. They are very moderate with exposures, and I have read that more experienced mothers opt out of them in their society. I am enthusiastic to hear more developments from Amish autism studies in the future – their cultural bubble is very interesting.

        1. anthro49 says:

          I spend a fair amount of time in an area with a robust old order Amish community. I observe them and talk with them when possible. I talk to people who live next door to them and know them well.

          They may (may) have a lower than average autism rate (which could be explained in numerous ways, including lack of diagnosis), but I can tell you that they have problems. Their genetic pool is limited even though they move people around to avoid obvious inbreeding. In my area, they all look like siblings–cousins at best. There is a lot of angst amongst the women who mostly don’t want to bear umpteen children starting at age 18 or so. They try everything they hear about (mostly woo, so no help) as they cannot tell their husbands they don’t want any more babies.

          It is a mistake to apply “noble savage” thinking to the Amish as much as any other isolated or ancestral population. I love to visit their community (it’s quiet!) and buy their wares, and observe their ways, but I don’t assume they live magical lives.

          1. Calli Arcale says:

            I don’t think fetalsonosafety was suggesting a noble savage thing, just that because of their relatively isolated society and gene pool, they offer interesting opportunities for research. Which is true, and noted by a great many researchers.

          2. Haha, ok. I didn’t mean to come across like I was talking about a museum exhibit or anything. The only Amish I’ve ever met had a candle shop, and I did not know them long enough to learn much about them personally.

            My comments were based off of readings. For example, http://www.cwru.edu/artsci/anth/Campanella%20et%20al%201993.pdf discusses some ultrasound opinions among Amish.

      2. Harriet Hall says:

        Thank you for stressing the importance of ultrasound dose. I certainly agree. My article mentioned using the lowest possible settings, but limiting the exposure time is also important. That’s why those vanity scans at the mall and Tom Cruise’s home unit are bad ideas.

        1. It is not just duration but other factors as well. Ultrasound interacts with only the things it penetrates, and so -where- the ultrasound passes through is important.

  12. Xerxes Croes says:

    She was tha anti-vaccine wacko in the Frontline documentary Vaccine War. The arrogance of ignorance is undoubtedly strong with this one.

  13. anthro49 says:

    testing–I am having trouble posting–again. Why do I have to create a blog? I have a WP user name and password already, but it won’t work. I’m lost–again.

  14. anthro49 says:

    Okay, it works*.

    I had three babies at home after a horrible hospital experience that embodied all the bullet points Harriet listed–and more. I had excellent prenatal care–including untra sound and amnio for the last, due to age, my doctor knew what I was up to, I understood the small (but real) risk and accepted it. I had a midwife (lay, but not woo-wacky) for two and just the spouse for one (he studied with a nurse midwife). I have very quick and easy labors and faced a real possibility of not making it to a hospital to begin with, so it worked for me.

    They were all boys and there are no circumcisions–all are happy with that. The three home births were successfully breastfed. No big deal, just easier in my book. In the olden days when my daughter (the first) was bottle fed (thanks to the hospital–and I’m talking way beyond just pushing the formula) you had to sterilize everything in a big kettle, rather like canning!

    I have no time for this silly woman and her idiotic book, but I defend my choice of birthing venue as well. I never preached or pushed it on anyone and all six of my grandchildren were born in hospitals or birthing centers (usually just rooms in hospitals) and yes, a lot has changed, but I’d still prefer my own home–for ME, given my own history.

    *Formerly posted as goodnightirene

    1. brewandferment says:

      And that is similar to the reasons for which I also chose homebirth. My eldest was a hospital birth and it wasn’t all that bad, in fact was fairly positive, but when the other two–now 12 and 9–came along, the only hospital available to active duty women was a military hospital, and at the time of the 12 year old’s birth, nurse-midwives were not permitted to attend active duty mothers (contractual matters, not health driven). Said military hospital was not only a teaching hospital, but it also was still pretty behind the times in the matter of fixing the list of things that need to be fixed (in fact, it was somewhat less forward thinking than the admittedly boutiquey hospital where eldest, now 19, was born.)

      It wasn’t a fetish about natural childbirth, it was simply because I soundly disagreed with several items, particularly the continuous fetal monitoring, discouragement from ambulation so as to support the monitory, and nutrition deprivation–and though my OB agreed with my perspective, she could not guarantee being on hand to attend my birth. Having had such a great homebirth experience with the 12 year old, who was born at 24 inches and a few ounces short of 11 lbs (I am quite tall so not as scary as it sounds), at my own home, with not one but 3 attendants plus husband all paying attention to mine and the baby’s needs–and only a first degree tear to show for such a large baby–naturally I was happy to do it at home again with the last kid. I was aware, as above, of risks, but having already delivered with a minimum of trouble in the case of the eldest, and knowing that the midwife came certified in the use of resuscitation and with oxygen, pitocin and methergine for postpartum bleeding, etc, I decided to do it that way. Plus, hospital acquired infections were starting to come on the radar by then and they scare me silly, much more so than some of the risks of homebirth. Perhaps not a rational fear, but then again when I heard an acquaintance recently tell me about her baby being diagnosed last fall with pertussis at the age of 3 WEEKS (all the family members who’d had contact with the baby had titre proof of pertussis boosters)–maybe not so irrational.

      As to risk, I have 2 anecdotes of people in my circle of acquaintances and friends for hospital complications–one was a young woman who was obese, to be true, but she developed a pulmonary embolism a day or two after discharge and died. The other was a mother of four who developed an infection at her c-section site with the fifth kid and it became septic. Not only did that put her at real risk of death but it cost her a desired breastfeeding with her baby by the time she was cleared from the sepsis meds–she was homeschooling her kids due to her husband’s duty station changes (for continuity for them rather than ideological) and her next youngest was a toddler. And they were going to be moving before the baby was 3 months old. So regaining a nursing relationship would have been near impossible and though I am a strong advocate of breastfeeding, I myself would have been inclined to discourage her from trying to regain it.

      1. Chris says:

        Then there are stories like mine: I was glad we were still in the hospital when my newborn had his first seizures. They just started as little shivers, and then they got stronger. He was transported by a special infant ambulance to the children’s hospital where they got his seizures under control in the Infant Intensive Care Unit.

        He did not get to come home until he was a week old, and then it was lots of neurology appointments, and later many speech therapists, and then special ed.

        So I had no problem having the other two in the hospital. Though the last one was almost at home, because I gave birth ten minutes after arriving and the hospital is only twenty minutes away.

        Also, I did not have to clean up. Something I have been doing for over twenty years now. The oldest falls between the cracks by being too capable to qualify for the Dept. of Developmental Disabilities, and not being able to get a job, or adequately keep his bathroom clean. He is kind of like a fourteen old boy in a twenty-something body.

        1. anthro49 says:

          All my home birthed babies went to the pediatrician (or family practice) doc within hours–this always shocked people in the elevator–for a check up. All three boys were jaundiced to some degree, but nobody needed treatment (it was mild and declared to be some kind of blood group incompatibility that I’ve never been clear on). Otherwise, all was well. I brought the placenta along to make sure the doc agreed with our view that it was all there and nothing had been retained (in the case of the one where Dad was the midwife).

  15. Sean Duggan says:

    I think the worst part of it all is that Monty Python’s satire on modern hospital practice during a birth is pretty true to life now.

  16. angorarabbit says:

    Thanks, Chris. Let’s try this again.

    What people seldom discuss in the breast/formula discussion is that we don’t have a good grasp on neonate / infant micronutrient requirements. This is partly what underlies “breast is best.” Because we can’t ethically do the nutrient trial, we make the reasonable assumption that breast milk nutrient content evolved to meet needs up to 3-6 months. So formula nutrient content, in part, is based on breast milk comparisons.

    Alas, the analogy is imperfect because it doesn’t account for micronutrients like iron, where much of the infant’s endowment is transferred during the last trimester. Breast milk is actually pretty low in iron and won’t meet reqts alone. (Hence the delayed cord clamping recommendation.) For EFAs like DHA, we’ll probably never know the requirement because what formula mfcr is willing to pull it out for the experiment?

  17. judy neldam says:

    I would like to see a better relationship between traditional wisdom and modern medicine. Science has brought us great medical advancements, but an outsider looking at the general health of the citizens of the U.S. might be left scratching their head when observing the vast number of overweight and obese Americans living on a steady diet of highly processed foods and pharmaceuticals (thanks to science). I gave birth to four children (in hospitals), including a set of full-term twins without drugs and that was by my choice. I breast fed my first two exclusively, and supplemented the twins because I could not keep up with four kids while nursing two full-time. I support midwives and doulas and wanted to have a home birth the last time around because I had no maternity coverage, but the law in my state prevents midwives from delivering twins. So, I had a 24-hour in and out hospital stay which turned out to be the most expensive 24 hours of my life (and it was 24 years ago!). I have three boys and one girl and all the boys were circumcised because it was routine at that time, but now I am not sure I would have made the same decision today. However, I am grateful to be able to make most of my own health choices and I think as a society we need to realize that modern medicine is a blessing but that we can still learn a lot from traditional healing methods and they should not be mutually exclusive.

    1. WilliamLawrenceUtridge says:

      I would like to see a better relationship between traditional wisdom and modern medicine.

      I predict massive strawmen in the upcoming sentences…

      Science has brought us great medical advancements, but an outsider looking at the general health of the citizens of the U.S. might be left scratching their head when observing the vast number of overweight and obese Americans living on a steady diet of highly processed foods and pharmaceuticals (thanks to science).

      …and I win.

      Do you honestly think there is anyone in the United States who thinks a BMI of 40+ is healthy? Fat Americans are an example of the citizens of the US systematically ignoring what science has to say about diet, nutrition and health. Would you prefer nanny-state interventions like what happened in New York City, nonsensical bans of large-volume drinks? Should we have nutrition police, who prevent fat people from buying ice cream? Should ice cream be banned completely?

      In some cases, the medication keeps the patient alive long enough to enact lifestyle changes that make the medications unnecessary. In other cases, they keep the patient alive and the patient continues to have a lifestyle that is unhealthy. Should fat people be refused medication and left to die? Should smokers? Should fat people be fed a steady diet of amphetamines to force them to lose weight? Can you honestly tell me that you think there are doctors who see a five-foot-one woman who weighs 250 pounds and says to her, “keep it up champ”? Or a man so obese he can’t get out of bed being told “no worries, we can control that with insulin”?

      I gave birth to four children (in hospitals), including a set of full-term twins without drugs and that was by my choice.

      Are you proud of having to endure unnecessary pain? Why?

      I breast fed my first two exclusively, and supplemented the twins because I could not keep up with four kids while nursing two full-time.

      How do you feel about hospitals essentially forbidding women from accessing formula unless they make a stink about it? Or nurses shaming women who don’t want to breastfeed?

      I support midwives and doulas

      Oh god why? A certified nurse midwife, sure, that’s OK I guess, as a substitute for a doctor in low-risk cases. But the other tiers of midwives who lack training, or worse a doula – whose role seems completely redundant to me in most cases, certainly I will do my best to fill it with my own wife – seem worse than useless, actively dangerous. Like SCAMs, they frequently come bundled with nonsense and erroneous beliefs about sickness and health.

      and wanted to have a home birth the last time around because I had no maternity coverage, but the law in my state prevents midwives from delivering twins. So, I had a 24-hour in and out hospital stay which turned out to be the most expensive 24 hours of my life (and it was 24 years ago!).

      Sounds like you didn’t need a midwife, sounds like you needed a federally-funded health care system. Picking a health care option because it is cheaper, rather than because it is safer, is sub-optimal in my mind. I’m glad I live in a country where I don’t have to put my wife and baby’s life a risk because of the cost of health care. I really, really feel sorry for everyone in the US who does.

      I think as a society we need to realize that modern medicine is a blessing but that we can still learn a lot from traditional healing methods and they should not be mutually exclusive.

      Bullshit. What can we learn from traditional healing methods? In fact, any traditional healing methods that actually work, that are shown to work in clinical trials, are adopted. But the fact of the matter is, there just aren’t many. “Traditional healing methods” are naught but a code phrase for “unproven claims that I’ll still make you pay for”.

      “Tradition” often isn’t wise, and is downright ignorant when it comes to medicine and biology. “Tradition” was great at killing mothers and babies for thousands of years, and I just don’t understand why people fetishize it.

      If “traditional wisdom” actually conveys benefits, then it should be possible to demonstrate this – which should happen before widescale adoption.

      1. Nashira says:

        You’re dead-on when it comes to sanctimommies and the pain. It is almost like a machismo thing, but for women. “You labored for sixteen hours with no epidural? Well, I did it for three days before having my footling breech angelbaby.”

        It’s yet another thing I find offensive about their brand of misogynistic disablist woo. (Said woo embraces all forms of discrimination and prejudice, really.) And frankly confusing, after a decade of having ever-present trigeminal neuropathy. Pain sucks. Really bad. Enduring unnecessary pain does not make one better or stronger than people who utilize pain meds, epidurals, etc. Bragging about essentially being a tourist to a place where I and many of my loved ones live is really. really. really offensive.

        But I guess pain is natural, right?

        1. Sean Duggan says:

          Frankly, I think that’s the question that’s sometimes raised, is the pain natural? Are we treating the pain the mother has or the pain we expect her to have? Is the treatment of the pain causing further issues? I obviously have not given birth myself, but the impression I get from anecdotes of hospital stays is that the assumption is that you want to be doped up to your eyeballs, and it’s often done in advance of any pain. Given there are people who apparently have painless births, that seems odd to me. I know the technology and the outlook has improved. The one time my mother got an epidural (the hospital insisted), she barely remembers anything for that day, including holding my older brother for the first time. Subsequent times, they adjusting the medicine to fit the actual pain and discomfort rather than applying a blanket prescription. To me, the latter seems like it would be desirable and, in some cases, people aren’t going to need it or want it.

          1. Calli Arcale says:

            It varies. It really varies. Hospital birth is treated in these types of conversations as if it were some sort of discrete entity, but really it’s not. Every birth is different, and every hospital has its own policies and even within that hospital practices may vary depending on the attending physician. Pain relief is often offered proactively, but this isn’t because they just assume the woman wants it; it’s because it works better if you start it before the pain is out of control. (There also the factor that some pain relief simply cannot be given after various points in the labor. Epidurals cannot be given if you’re on the home stretch, which unfortunately is also typically the most painful part.) That’s not peculiar to childbirth, either; it’s true of postsurgical recovery too. They want you to be comfortable, because discomfort can itself cause things to go worse. Pain relief has enabled people to become active much more quickly after surgery, which has in turn improved surgical recovery, and you need to understand that hospital people don’t just do babies — they do the other things too, and so that gives them a broader perspective on pain. Over in the orthopedic wing, people are begging for morphine; it’s got to seem downright weird to come over to the maternity wing and meet patients who think accepting pain meds is some sort of weakness. So that’s the perspective a lot of them are coming from. It’s not that they want to dope you up or don’t respect you; it’s that they want you to be happy. Some hospitals are more flexible about it than others.

          2. Harriet Hall says:

            Straw man. Standard practice is NOT to dope patients in advance of pain, it is to (1) gladly allow women who express a preference for “natural” childbirth to labor with no meds (2) give meds only when pain is significant and only if the patient asks for relief, (3) try to balance the mother’s needs with the baby’s needs, limiting meds that might leave the baby groggy. The days of “twilight sleep” are long gone. I’m puzzled by your mother’s experience: epidurals have no effect on memory, and I’ve never heard of a hospital “insisting” on an epidural. Informed consent is required. It would be unethical to bully a patient into accepting an epidural. I wrote about this subject at http://www.sciencebasedmedicine.org/childbirth-without-pain-are-epidurals-the-answer/

            1. Sean Duggan says:

              Thank you for your response, Dr. Hall. Given my brother is 36, it has been a long time, enough time for both her memories and mine to fade or get distorted, but the way I remember her telling it to me involved the doctor insisting that she needed the epidural before he’d go on, and she says she barely remembered the day other than feeling like she was trying to balance on a beach ball in the ocean and a vague memory of Brian being handed to her and her wondering why someone was handing her a baby. It could be that the memory has become exaggerated over time and retelling. It could be that the hospital gave her something else or she had a bad interaction with the drug they used. *wry grin* Could be any number of things, with 36 years of distance.

              I just reread your article. I agree with you that the best policy is to provide for pain relief and then let people choose. Birth is not a one-size-fits-all situation. To take a small data sample, out or the six children my mother had, she had four complication-free deliveries where she gave birth within an hour or so, one which took a few hours, and then my youngest brother, where there were complications involving scarring. The latter two were the fifth and sixth children, so I think some of it was that my mother was getting older and dealing with the stress of the prior deliveries. I’ve known people who claimed there was no pain at all. There are people for whom it is agonizing. If the policy is intended to be to always ask first, either I misremember the narratives, the people themselves misremember, or they had bad luck in their choice of hospital / practitioner. My susicious is that it might be a mix thereof, possibly involving a misinterpretation of queries of “Are you sure you don’t want something stronger?” being mistaken for insistence.

          3. Chris says:

            I never had an epidural. There seems to be a window of opportunity depending on how dilated the woman is. Either I was not dilated enough, and the next time they checked I was too dilated.

            I only got very little for pain, just to “take the edge off” for the first two. Especially since the first one got stuck, and and to be guided out (it should have been a caesarian). The last one was too quick.

            I have fun with the sanctimommies who declare the developmental issues with my oldest is because of the epidural. I remind them I never had one, and then ask if they were nice. :-)

        2. brewandferment says:

          It’s not that I “like” pain. But my experiences with pain management have caused me to say that I don’t like sedation. I had 3 orthopedic surgeries (two fracture repairs and one pin removal after healing because the military wouldn’t take me with it in) and greatly disliked the whole coming to. Also, during the femur fracture repair, I began to regain consciousness, not to any great pain, but the sensations were pretty distressing, to say the least. I have been drunk and no longer enjoy the end of party wooziness and coming down. Buzz, sure, but full out blotto? just no fun anymore. And of course labor pain is nowhere the same as acute injury pain or chronic pain. Post-surgical pain management for my femur repair was not what it is in more recent times (it was 33 years ago) and my parents may not have been willing to fill a prescription for narcotics for a 17 year old. They’re both dead now, so I can’t ask and it never occurred to me before. I sometimes joked after my youngest was born that I would have happily traded 3 more unmedicated births for the post-surgery pain.

          I dislike sedation so much that I chose to attempt my first screening colonoscopy without sedation, with the caveat that I would have the IV in place should I need it for procedural completion/safety or my own comfort. I simply didn’t need it, on either condition, and it was lovely to bounce out on my own steam immediately after completion of the procedure without spending the day in a post-sedation haze. Would the sedative available have bothered me? dunno. Don’t care. I didn’t need it and didn’t have to deal with the post-sedation effects that I detest. There were one or two moments when some breathing did the trick, and the rest was fine. And it was intriguing to watch the process on the monitor, too.

          As to childbirth, I did try sedation “to take the edge off”; it was Demerol and the effect on me was to do little for the pain, nothing for the real source of my discomfort and distress: severe caffeine withdrawal. A shot of espresso would very likely have solved the problem, but all fluids by mouth were prohibited and my husband was not willing to disobey the hospital rules. And the worst? I also felt both drunk AND hungover on top of all that. So not fair. If I did get drunk, I accepted a hangover as the price to pay the day after the party–but not to be able to enjoy a drunk without a hangover at the same time? Bah!

          Epidurals were not for me. I have an irrational fear of needles into my spinal cord and nothing will change that. If it was for a medically necessary procedure, perhaps, but you’d have a hard time convincing me that full on anesthesia is not as good a plan. See my stated feelings about sedation etc above–so epidurals are even worse FOR ME. Not to mention I don’t do well stuck in bed and despise catheterization. Again, I emphasize that in cases where such things are medically necessary, that’s one thing. But if other ways are available to manage pain to keep it within my own personal limits and not interfere with health, then I chose those. Do others have a different perspective? Sure! Again, it’s not about being some sort of martyr or showoff–it’s just that for me due to a number of physical factors (I’m really tall, and a restless person in labor etc, don’t do well lying there feeling nothing and just letting things happen, and more) labor pain was way less objectionable than the alternatives. And I don’t push it on other moms–I just tell them that all the absurd tales about how miserable labor is may not be true for them and not to anticipate more than might be the case. In truth, the afterpains for my youngest child were far more ferocious than actually birthing said youngest and I was definitely sucking down the pain meds not a minute after the next dose was available. They were probably so bad due to the injections of pitocin and methergine my midwife gave me as a result of greater postpartum blood loss than she wanted; at my 6 week checkup the military OB I saw as a backup to the midwife just shrugged and said the blood loss was pretty trivial for someone as tall as me.

          1. Harriet Hall says:

            Epidurals have improved. Patients are allowed to ambulate with the “walking epidural” technique, and urinary catheterization can be avoided.
            I had an epidural for my first. For the second, no one was available who knew how to administer and epidural, so I had one IV dose of an analgesic (which relieved the pain without making me feel sedated) followed by a paracervical/pudendal block. I got excellent pain relief in both cases. The needle doesn’t go into the spinal cord, but into the fluid-filled space outside the spinal cord. I was quite comfortable with the idea, since I had done lots of spinal taps on patients and understood the anatomy.

          2. Chris says:

            Pain is different for everyone. When doing a procedure on me one doctor thought I had a high threshold of pain, but seriously I could not feel it. It is not that I can stand pain, it is just that many of my nerves do not fire up until a certain point is met.

            Many people were amazed that I had a very difficult six hour labor with only one dose of stadol, but I was too busy dealing with getting a child out whose head was just too big (it really should have been a caesarian, I was ripped from stem to stern and ended up with an infection).

            It is not necessarily a good thing, it can be bad. I get cuts and bruises where I have no clue how they happened. It can be very annoying, especially since I stabbed myself somehow while repairing the marching band drum major uniform, and only noticed when I saw red dots on the white wool.

            I am also the type of person that can give anesthesiologists nightmares because it is hard to dose, because I do feel pain at a certain level and the drugs do not work like they do in normal people. At the dentist the hygienist thinks I should be in pain for some part, but when I got a crown the Novocain wore off too early. Then when I do feel pain, I am the most miserable person to be around.

            Oh, for second child I was given Demerol too, it made me sick to my stomach. It turns out each and every narcotic I have been given from percodan for my wisdom teeth as a teenager to something I got when I broke my ankle all make me upchuck. Which is not fun when you are on crutches, or in labor. Usually I just get by with ibuprofen, though for my colonoscopy I was given medication to counteract the nausea.

            So I don’t take pain stories as gospel. I figure it depends on how a person’s nerve system is wired. And I know I am weird.

      2. William, please be more respectful. Your bitter cynicism is not a productive way to get others to listen. At the core of your argument, you seem to believe that better education is necessary for mothers to make informed choices. I would much rather support that than your incendiary comments about others decisions and beliefs. Further, by antagonizing people who did not come here for an argument in the first place, you actually do damage to the legitimacy of the very beliefs you support. Legitimacy is stronger than facts, when it comes to these things.

        When you recognize this, only then will you stop beating your head against an elephant long enough for it to move out of your way.

        1. WilliamLawrenceUtridge says:

          William, please be more respectful.

          No.

          Your bitter cynicism is not a productive way to get others to listen.

          I have trouble pretending there is anything to respect in someone who uses the words “traditional wisdom” without scare quotes. Plus, generally you are fighting an uphill battle to convince someone who thinks such a ridiculous, fetishizing concept of anything that might involve actual facts. My comments are aimed at pointing out the logical flaws and factual errors for any lurkers out there, or fence-sitters.

          If someone is pretending the current obesty epidemic in the United States is brought about by doctors prescribing cheeseburgers three times a day, they are probably to deluded, or have drunk too much of the SCAM kool-aid to ever respond to anything remotely rational. This annoys me, so I mock. Feel free to try to respectfully engage with judy and try to convince her that our traditional ancestors were ignorant people who lived short, fear-filled lives of limited horizons. Having done so many, many times, with many, many people, I think the attempt is futile – so I aim for people who aren’t convinced.

          At the core of your argument, you seem to believe that better education is necessary for mothers to make informed choices.

          Not really, if someone thinks midwives and doulas are the best option for birth, I consider them already lost. Particularly doulas. Have you seen what a doula is supposed to do? How is that not the role of the partner? If the mother doesn’t have a partner, then they may need assistance – but not a duola. Particularly when they come pre-packaged with nonsense and antimedical rhetoric. I have naught but contempt for doulas, I would much rather engage the specialists (and family and friends) to get the real care that is needed, not someone who half-asses it all ’round.

          I would much rather support that than your incendiary comments about others decisions and beliefs.

          I believe in judging where I think it appropriate. I wouldn’t judge a decision to circumcise a male. I wouldn’t judge a decision between two types of painkillers. I wouldn’t judge a decision to avoid finding the sex of the child. I will judge someone who decides to increase the risk of childbirth for both parent and child on the basis of naturalistic fallacy. While I disagree with brewandferment’s decision to homebirth, at least the decision was made on a reasonable risk-basis (even if I disagree with it, in case I was unclear before). It wasn’t made on the basis of “traditional wisdom” (ha!), it was made on the basis of a poorly-run hospital, and a concern over hospital-acquiered infection. Those are two rational risks dueling head-to-head. Judy’s comment has nothing in common.

          Further, by antagonizing people who did not come here for an argument in the first place, you actually do damage to the legitimacy of the very beliefs you support. Legitimacy is stronger than facts, when it comes to these things.

          Yep, because humans tend to be irrational. For instance, the believe that “traditional”, which is to say “old”, is somehow a good thing.

          When you recognize this, only then will you stop beating your head against an elephant long enough for it to move out of your way.

          Never will I support a person’s right to avoid being criticized for doing something stupid. Never. I’ve had arguments about not vaccinating, I’ve had arguments about home birth, I realize that people make stupid, irrational decisions on the basis of inadequate education and sometimes outright misinformation. And I’ve pointed this out. I would rather try to block the elephant than merely let it pass by and trample someone unnecessarily. You can feel free to respect others’ beliefs, but I hope you never see a tragedy as a result. I’ve read the work on the bystander effect, groupthink and similar cognitive failings of individuals and groups. Being aware of them, I make the conscious decision, on a daily basis, to criticize, dissent and point out errors.

          I’ll never stand by and watch someone present a turd for polishing.

          1. Let me rephrase. You don’t have to respect their beliefs, but you should respect the people. You are giving your anger to the wrong target and it’s not productive. Insulting people just makes them not want to listen to your side of the story.

            You’ll never stop an elephant like that. You’ll just give it power. If you’ve truly read about group cognition theories, do you believe that the women in this thread are going to support you, or the people who you are insulting?

            The only reason I’m emphasizing this point is because it’s something I deal with on a daily basis. I’m an ultrasound researcher, and I have the taxing responsibility to wake people up and enlighten them to risks involved with fetal sonography since pretty much nobody involved with the medical practice talks about it.

            After reading the body of literature surrounding it, and my lab experiences, I am convinced that excessive prenatal ultrasound can cause developmental problems. There’s very few people in the world who know that, or even want to know that.

            In my situation, I have to recognize that — you know, at the end of the day all I know is what I’ve seen with my own two eyes. I can’t expect other people to have had my experiences and to have learned what I have. They havn’t seen the evidence, and that’s why they make their choices.

            The best thing I can do is tell them what I’ve learned, and to back up my arguments with credible sources. Thus, empowering them with informed consent. That ends my involvement in their decision making.

            So far I have a petition running at https://www.change.org/petitions/health-risks-of-prenatal-ultrasound-the-urgent-need-for-more-research-and-regulation that has over 700 signatures. Not a single one of them would have signed if I opened up and called them stupid and falling for a scam in medicine.

            I appreciate that you are a livid skeptic and have a lot of energy for the subject in what you truly believe. But, you do need more finesse with your persuasion tactics. That’s all I’m saying.

          2. WilliamLawrenceUtridge says:

            Let me rephrase. You don’t have to respect their beliefs, but you should respect the people.

            No I don’t. Respect is earned. If someone is doing or saying something stupid – I believe it is my right, and duty, to speak up – particularly if it puts someone’s life at risk. There is a considerable body of literature in cognitive and social psychology that indicates people are quite prone to ignoring problems, idiocy or error in an effort to be polite or simply as a way to avoid getting involved (vis. Kitty Genovese as the most well-known example). I consciously attempt to buck this trend and challenge assumptions. I actively try to educate myself, if possible on both sides of an issue, and challenge my own assumptions. I have thought about and through the issues of things like “ancient wisdom” and “traditional knowledge”, and they are nonsense – pretend explanations that often cover racist assumptions that I find personally offensive and ignore the reality that we are all of the same species. They are ideas that do not deserve to be treated with respect, and people who use them as arguments should be confronted with the errors of their thinking. And, as Judy indicated in her comment, come bundled with other nonsense that is little more than SCAM PR. I challenge PR when it comes from Pfizer, and from homeopaths, and from their convinced customers.

            You are giving your anger to the wrong target and it’s not productive. Insulting people just makes them not want to listen to your side of the story.

            You are projecting anger onto my comments. I am frequently annoyed at stupid and arrogant people, and their comments, but it’s pretty rare that I get angry.

            Also, as I said before, my comments are often aimed at lurkers and fence sitters, not the person making the idiot claim. Often they are beyond help. The human brain is preprogrammed to resolve conflicts of “I am smart/I am wrong” by discounting the latter. See Mistakes were made (but not by me). So generally, I don’t bother.

            You’ll never stop an elephant like that. You’ll just give it power. If you’ve truly read about group cognition theories, do you believe that the women in this thread are going to support you, or the people who you are insulting?

            Again, your comment assumes I am aiming to convince the person posting on this thread. As I stated in my first reply, generally I am not trying. Someone shows up spouting nonsense about traditional wisdom has already drunk the kool-aid. I can’t force them to read up on why traditional wisdom is anything but. I can point to the flaws in their arguments, and you’ll note I do address the substance of their points as well as the unrecognized assumptions and fallacies that underscore them.

            The only reason I’m emphasizing this point is because it’s something I deal with on a daily basis. I’m an ultrasound researcher, and I have the taxing responsibility to wake people up and enlighten them to risks involved with fetal sonography since pretty much nobody involved with the medical practice talks about it.

            I’ve avoided commenting on the substance of your comments so far, and I think I will continue to do so – I lack the technical knowledge or willingness to engage substantively. However, I do trust the medical community, and I believe the clear lack of evidence of harm to children, the presence of merely theoretical risks, and the clear benefits to ultrasounds in terms of congenital and correctable abnormalities, suggest the risk:benefit ratio is fairly clear. Please don’t devote time to convincing me, please focus on your research. I hope you’re actually an ultrasound researcher, with a PhD or MD, and not someone who merely calls themselves that because you’ve convinced yourself that there are unrecognized harms because of Google University.

            After reading the body of literature surrounding it, and my lab experiences, I am convinced that excessive prenatal ultrasound can cause developmental problems. There’s very few people in the world who know that, or even want to know that.

            If you are on the genuine track of a real effect, then you will find a protocol to allow the signal to rise from the noise. The lack of current signal indicates that if there is such a risk, it’s probably not very large. More research, and in particular high-quality research, will generate the relevant data. Your own experience, f not buttressed by an appropriate methodology, stands a very great risk of being wrong.

            That being said, my children will have only the 2-3 ultrasounds required for a conventional birth.

            In my situation, I have to recognize that — you know, at the end of the day all I know is what I’ve seen with my own two eyes. I can’t expect other people to have had my experiences and to have learned what I have. They havn’t seen the evidence, and that’s why they make their choices.

            Again, personal experience can deceive. You need data to convince anyone but yourself, and in particular to result in a scientific consensus. The fact that you are using petitions rather than publications (i.e. your own, backed by primary research results) is a rather large red flag for me and rather undercuts your credibility. Press release “science” and similar “direct to public” appeals are generally signs of weak data and alarmism rather than a solid case.

            I appreciate that you are a livid skeptic and have a lot of energy for the subject in what you truly believe. But, you do need more finesse with your persuasion tactics. That’s all I’m saying.

            Again, I’m not livid though I do get annoyed. And again, I am not trying to convince Judy or her ilk – you can’t rationally convince someone out of a position that wasn’t rational to begin with.

            Now, if we’re dispensing advice – I would suggest that you not bother trying to convince scientists, researchers and doctors with petitions and stick to the data. Peer-review committees for funding do respond to solid research rationals, and often include fudge-factors for population-wide threats. If you have submitted a research funding application and your response to the criticisms was anything but “I didn’t think of that, I should improve for my next iteration” you probably won’t succeed. Ruthless criticism of hypotheses are an absolute necessity.

            If you haven’t applied for NIH or similar funding, that’s another red flag.

    2. Chris says:

      ” traditional healing methods”

      One traditional bit of “wisdom” was to use teething powders with mercury:
      Mercury nephrosis in young children, with special reference to teething powders containing mercury.

      And in case you don’t think some have abandoned that “traditional wisdom”:
      Pink ladies: mercury poisoning in twin girls

  18. WilliamLawrenceUtridge says:

    Ugh, nothing could induce me to support a home birth. The very thought is terrifying, and thinking about it for too long makes me nauseous with fear.

    1. Chris says:

      Plus there is the clean up. Who gets to do that?

      If you are the dad, it will be you. Have fun with that.

      1. WilliamLawrenceUtridge says:

        Ugh, not enough bleach in the world…

      2. brewandferment says:

        No, both times it was the midwife’s apprentice that cleaned it all up. I think my husband took the trash bags out to the trash can, but that was the extent of his cleanup. Certainly I am not attempting to change minds, only to point out that for me the negatives of the hospital regimen were significant enough for a homebirth. If I had lived in the country down a long dirt road I most likely would not have made the same choice. That said, the last kid was fully born not more than 8 minutes after my water broke, so if I’d been driving in one of California’s epic traffic jams, it could have been on the side of the freeway!

        1. Chris says:

          I was actually channeling a Betty MacDonald book. I can’t remember if it was The Egg and I or the one she wrote about leaving that husband Anyone Can Do Anything. For her the then week in a hospital was bliss because she did not have to go deal with the chickens in the morning, get food on the table several times of the day and on and on.

          Despite what you may have seen in the old movie, she had married young and to someone she grew to hate. As I remember he swept her away to the chicken farm in the boonies without consulting her. Some parts of the books did not age well, like the treatment of the native peoples on the Olympic Peninsula, but she did write about the Kettles more favorably than what was depicted in the movie.

          Not to go into more detail, my firstborn and I may not have survived the birth without a hospital. Since there were issues, some that could occur again, it is deemed safer to be in a hospital.

          Then there are issues I have with other people puttering around my house. I hired someone to help with older boy when I had the second baby. I seem to have OCD issues with the dishwasher and how things are arranged in my kitchen. I have loosened up a bit, but not then.

          1. WilliamLawrenceUtridge says:

            It’s not OCD to make sure things are put away right. Sometimes you have to do it yourself to make sure it’s done properly.

            Or it may be actual, diagnosed OCD :)

            I realize there are risks to just walking into a hospital (which these days are perceived as high), and there are risks to giving birth, period (which, for some reason are perceived as low). For me the act of giving birth seems both painful and dangerous, for all that it is natural. The chances of something going wrong (breech, hemorrhage, whatever) may be low, but if it happens, particularly if it’s not just something mechanical, the risk of simply bleeding out (or your baby losing blood supply) looms far too large in my mind.

            No, nothing could convince me that homebirth is anything but an invited disaster. The risks may be low, but the consequences are unimaginable. Literally, I actively avoid trying to imagine them.

  19. Sarah says:

    Thank you for the review. The book sounds excellent! I’ll be purchasing it today and sharing it with everyone that I can.

  20. WilliamLawrenceUtridge says:

    Thank you for the review. The book sounds excellent! I’ll be purchasing it today and sharing it with everyone that I can.

    In that case, it appears you are simply stupid.

    1. carmelcath says:

      name calling…nice

      1. WilliamLawrenceUtridge says:

        Normally I would call “spammer” since the comment is so obviously at odds with the content of the article. However, there are no links in either the body, or the name, or the avatar. Either the person did not understand the article (which, given the clarity of Dr. Hall’s writing, makes them stupid) or did understand the article and still thinks there is something to Margulis’ points (again, stupid), or decided to read the book because Dr. Hall panned it (which again, makes them stupid). A fourth option is they are an attention whore or troll who didn’t read the article at all, in which case we are both stupid (me for feeding the troll).

        Do you have another interpretation, given the article content and the comment? Some people are stupid, so perhaps my comment is merely accurate.

        1. Sean Duggan says:

          :) My first impulse was “spam” too, but my second one was someone unfamiliar with the mechanic of replying to a particular posting and responding to one of the two other book suggestions in the comments with a response that seems to be to the main article.

      2. Xerxes Croes says:

        But so true!!

  21. WilliamLawrenceUtridge says:

    Hell and damn, I enjoy arguing too much.

    However, I disagree that framing it from a consent and rights issue is incorrect. For example, female circumcision. What is the material difference between forcibly removing a clitoris vs a prepuce?

    There is an enormous difference. While removing the foreskin may impair sexual sensation to a degree, it is to a degree. Severing the clitoris removes all chance of clitoral orgasm, which is the primary means by which a woman can have an orgasm. The apt comparison would be cutting off the entire head of the penis, which is not circumcision. There is a substantial and material difference between circumcision and clitorectomy, they are totally incomparable.

    In fact, to stir the pot, one can even argue that there is a sexual advantage to being circumcised. To quote Dan Savage, cut cock tastes better.

    I should have taken Dr. Gorski’s advice and stay classy.

    Why is male circumcision not called “male genital mutilation”?

    Marketing? Strictly speaking it is conceptually similar, in practical terms it is worlds apart. If you were giving the choice to adults, you would frame it in terms of this:

    Men – how do you feel about having a small flap of skin removed from the end of your penis? You may notice a small reduction in sensation but will still be able to have penile orgasms.

    Women – how do you feel about having your entire clitoris removed? You will only be able to have orgasms through stimulation of the g-spot. If it exists.

    To put my money where my mouth is (see my earlier comments about calling people out), I can only see this, and your points below, as straw men. When you have to compare circumcision to far more invasive, far more damaging, far more crippling actions, that only underscores to me the case that can’t be made for circumcision being damaging.

    Using extremes as examples is, I believe, useful in this case. What if the ingroup required amputation of a limb?

    Yep, I would be against that – but we’re not talking about amputating a limb. I am firmly, solidly, positively against female genital mutilation (and limb amputation). I am not against circumcision in the same way. If you want to discuss female genital mutilation (or limb amputation) we can discuss that – but it’s a separate conversation from circumcision.

    Further, the social impact of being circumcised or not is, at least where I live, minimal. Nobody I am aware of is ostracized because of their foreskin. The social (and biological) consequences for this act, in this context, are almost certainly zero. Is there any group that you are aware of that excludes you if you are circumcised? If not, your point about a circumcised child being ostracized is moot in the real world. If you wanted to discuss hypothetical scenarios, that’s another conversation.

    If an adult wishes to convert to Judiasm and get a circumcision I have no problem with that at all.

    Completely agreed. It would in fact, be better in my mind if all religions that required circumcision did so with adults rather than children (though the consequences in terms of numbers of male adherents would almost certainly be catastrophic, but as an atheist I see that as a nonproblem).

    But forcing a permanent choice on a child is something I think most reasonable people would consider wrong. It becomes obviously so in my extreme examples but nothing except the degree of trauma and the obviousness of the procedure are changed in regards to circumcision.

    That’s true – but only in your extreme, and thus noncomparable examples.

    So I agree that in the grand scheme of things it is much more trivial than other practices and issues, but that doesn’t change the premise that it is still wrong, merely how much effort to change it (and how quickly I’d demand it) is reasonable to expend.

    It’s wrong like tailgating, jaywalking, speeding and complimenting someone’s ugly shoes are wrong – in the low likelihood of something bad happening, it is catastrophic. But for all intents and purposes, it is essentially trivial.

    And (because I know you can take it) I am going to call you out about being selective in your skepticism.

    Bring it! And right back at ya! :)

    You have stated that acupuncture is a bad practice because the premise on which it is administered is false and there is (albeit minor) risk for no benefit. You reserve that adults properly informed that it is a placebo with said minor risks and no benefit can still choose whatever they wish.

    True, sort-of. I’ve actually said, repeatedly, that though I personally believe acupuncture is essentially all placebo, that it might work and be a valid option for some people for pain relief and nausea. I’ve given conditions for how I think it should be administered. I’ve even argued with Dr. Novella against restricting acupuncture, given my conditions, and have written up a little speech I would give to patients about receiving acupuncture, were I their doctor. I like to think my positions on both acupuncture and circumcision are “nuanced”, and where I’m a bit Pete Moran-ian is in my willingness to tolerate both as defensible practice within certain conditions (though my long-term view is that both should, and probably will if current trends continue, become extinct or extreme rarities).

    Yet, here we have a procedure with once again no benefit and significantly more risk than acupuncture,

    Saying “no benefit” is false. There are small biological benefits to circumcision, and in some cases there are noteworthy social benefits. But overall the benefits are in my opinion minor (and the religious ones, stupid).

    performed on a false premise (whether religious or false medical claims), or at best performed purely for choice and aesthetic.

    Not true. The religious benefits (which are really social benefits, since God doesn’t exist but religions and social ostracism do) are not false. You can not be a good Jew, Muslim or certain denominations of Christian without being circumcised. Whether that’s worth it really depends. Aesthetic benefits depend – for the person without a foreskin, it’s pure judgement call. But (citing again Dan Savage), “9 out of 10 cocksuckers prefer cut cock.”
    I do not envy the mod who has to sigh and approve this comment.

    Only in the latter case is there room for rebuttal (since the premise is not false) but I would ask you – would you be alright with treating children with acupuncture under similar context?

    Is acupuncture ever done for social or religious benefits? Your premise only holds if we limit our discussion to pure biological benefits. And even there, the comparison is not true – there are objective, non-placebo benefits to circumcision. They’re just not that serious, and easily overcome by the use of a (flavoured?) condom.
    If there were some religion that required acupuncture of their practitioners in order to belong, I would think it was stupid (like all religious practices are stupid) but I would not object to it. The risks are extremely low but the social benefits in our imaginary religion are high.

    Which brings me to this point – what if a particular group liked the tongue-splitting and ear-pointing? Or what if we decided circumcision was to be stigmatized? I think in these cases the whims of a cultural idea about a permanent medical procedure with risks, no benefits, and decided for an individual who cannot consent should fall under the purview of the state to protect the child in question.

    But you’re still using a fallacy here in that circumcision is not the same thing as tongue-splitting or ear-pointing.

    Yet we somehow feel that amputating the foreskin of a penis is OK because enough people are OK with it and it just isn’t “that big of a deal.”

    Yup, and here’s where we part ways. There is no stigma for or against circumcised people in our current 21st century North American context, regards overall society. In balance, the objective risks and benefits edge ever so slightly towards circumcision being a tiny bit risky, but the social preferences in this case easily overcome that risk.

    That, to me, is the antithesis of being skeptical.

    I think we both agree that arbitrary modifications of the body are not a good thing. I think we both agree that modifications that are not socially acceptable are bad. I think we both agree that modifications that significantly impair some aspect of human functioning without significant comparable (ideally objective) benefit should not be done.

    I think we disagree whether circumcision meets all three of these criteria.

    If it makes you feel any better, if I had a son, I would not have him circumcised. I still think your refusal to perform a circumcision is laudable. I think your “challenge role” to the decision to circumcise is laudable. I disagree with your insistence that the state should prevent circumcision. If I were to discuss circumcision with any parent contemplating it, I would bring up your points. I would probably even argue against circumcision until the child is older (though I would also emphasize to the parent that they should tell their child “cut cock tastes better” and 9/10 cocksuckers prefer it). I would want the parent to think about it (and unless they have a religious motivation for circumcision, my inkling is most parents would probably wait for their child to decide). But I wouldn’t be enthusiastic in the same way I am discussing how stupid homeopathy or acupuncture are, I wouldn’t judge if they decided to go ahead anyway (I would hope my “Dan Savage” argument was the most compelling point :)) and I’d end with a Crislip shrug (like a Gallic shrug, but funnier) and a resounding “meh”.

    But hey, when else would I get to quote some of Dan Savage’s most memorable words in a comment?

    1. Andrey Pavlov says:

      LOL. You response did indeed make me laugh. Thankfully I essentially impossible to offend, else your Dan Savage comment may have derailed the conversation.

      However, I think you have not duly afforded me the principle of charity which I was to a small degree banking on in my initial comment since I knew it was not written to my typical exacting standards.

      I will try and refocus on just the narrow salient points.

      There is an enormous difference. While removing the foreskin may impair sexual sensation to a degree, it is to a degree. Severing the clitoris removes all chance of clitoral orgasm, which is the primary means by which a woman can have an orgasm

      This is my point exactly – it is the same, but a matter of degree. In other words, if I just smack my wife it is OK but if I punch her unconscious now it is wrong.

      Permanently removing a part of the body and altering the appearance of it along with diminishing sensation is the issue here. Whether you personally feel it is trivial or not is irrelevant. Your only justification is that it is trivial enough that you feel popular opinion is enough to make the decision. Yet that does not address the heart of the issue at hand – the permanent alteration and diminished function of an organ in a non-consenting individual with no better justification than one’s feelings.

      Once again, I agree that the triviality and risks are such that I won’t be at anti-circumcision rallies (whilst I have been at pro-gay-marriage rallies, for example) but the principle still stands.

      If you want to discuss female genital mutilation (or limb amputation) we can discuss that – but it’s a separate conversation from circumcision.

      As you yourself opened the comment – it is the same thing, just a matter of degree. To expand my “smack your wife” vs “punch her unconscious” analogy, would you be OK with the idea that when my wife is “out of line” I can slap her across the face since the “damage” there is very minor, leaving only a red hand print for a few minutes? What if the culture I was in generally accepted such behavior? What if I would not be considered “a man” by my peers and social group if they found out that I didn’t smack my wife occasionally? (Which, is quite analogous to circumcision because a group of Jews wouldn’t immediately know if I was circumcised without specific further investigation in a similar way, though obviously one is easier to lie about). Would you support my “right” to be part of my in group by smacking my wife whilst condemning me if I beat her unconscious?

      It’s wrong like tailgating, jaywalking, speeding and complimenting someone’s ugly shoes are wrong – in the low likelihood of something bad happening, it is catastrophic. But for all intents and purposes, it is essentially trivial.

      Except that you are determining that triviality for someone else who does not have any ability to make that determination for himself. Which is why an adult can choose whatever he wants. But I would be willing to bet that if you proposed circumcision to an adult – someone who can actually make a decision – most would kindly decline the offer. Which I think also speaks to the issue – we do so many circs because the person receiving it has no choice. Wait until 18 and see how many circs are actually done before deciding the triviality of it. If you have evidence that droves of non-circumcised adult men are getting circ’d in order to fit in to some group and/or because the procedure is “so trivial” to them, then I will admit my argument is false.

      Saying “no benefit” is false. There are small biological benefits to circumcision, and in some cases there are noteworthy social benefits.

      Fair enough. The benefits are on par with that of acupuncture. Nearly non-existent and ephemeral (placebo effects can vanish, just as sociocultural whims can change).

      Aesthetic benefits depend – for the person without a foreskin, it’s pure judgement call. But (citing again Dan Savage), “9 out of 10 cocksuckers prefer cut cock

      No doubt, but that is a decision to be made… not one to make for someone else. Which is the entire premise of my argument against circs. Do you not think that if an 18 year old male has sufficient evidence that we will receive much more fellatio if he were circumcised that he wouldn’t be beating down the door and borrowing money for the procedure? If 9 out of 10 really do prefer it cut, believe me, adult males will be getting cut left and right. However, what we find is that just as good a solution is keeping the area nice and clean and we tend to see more adults opting for a more rigorous hygiene regimen rather than getting cut.

      And even there, the comparison is not true – there are objective, non-placebo benefits to circumcision.

      The only two objective non-placebo benefits to circumcision I have ever come across in my research of the topic (and I did research it extensively in order to feel confident in my refusal to do the procedure myself) are that of decreased incidence of penile cancer and decreased transmissibility of HIV via specific CD8+ Langherhan’s cells in the foreskin. The former is a jokingly trivial objective benefit in that the incidence of penile cancer is already incredibly small and the absolute risk reduction from circs is even more laughably small. You have a much better argument for prophylactic bilateral mastectomies in every female than you do for circs for this benefit. The latter is also a very small benefit which can only be argued even remotely successfully in certain sub-Saharan countries where the incidence of HIV is extremely high and there is no easy access to condoms. In the US the point becomes utterly moot. Furthermore whilst the mechanism by which pain and nausea are relieved in acupuncture is placebo the effect is objectively real, at least in a minority of cases which IMHO puts it entirely on par with acupuncture in terms of a medical procedure and the decision to do it or not.

      The risks are extremely low but the social benefits in our imaginary religion are high.

      And this is the crux – we don’t decide the rightness and wrongness of something by popular vote. The social benefits of denying homosexuals the right to marry is actually still pretty high. That doesn’t make it right for you to make the decision for someone else. Another analogy just popped into my head – you would agree that in many large Christian groups being homosexual has a significant negative impact on social acceptance and benefits. Would you be OK with a child who tells his parents he is gay being sent to deconversion camps? Clearly that would be a huge social benefit for in group belonging. The child has no say in the matter and the parents decide. The only difference is that there is a more significant likelihood of psychological trauma but, once again, we are just talking about degree of damage here and the point is whether any damage is occurring or not.

      In balance, the objective risks and benefits edge ever so slightly towards circumcision being a tiny bit risky, but the social preferences in this case easily overcome that risk.

      I’ll stress it again – the point is that you (in the royal sense) are making that decision of risk for someone else. And that is the fundamental problem.

      I think we both agree that arbitrary modifications of the body are not a good thing. I think we both agree that modifications that are not socially acceptable are bad.

      I actually do not agree with that. Any body modifications done by an adult with informed consent is perfectly fine. If they are socially unacceptable then there will be selective pressure against those modifications and we will see less of them. But there is no inherent “badness” about a body modification. Modifying the body of a child, however, would be bad since the child cannot consent. Imagine if a severely mentally handicapped 20 year old had a parent who decided to become Jewish and thus demanded a circ for the 20 year old? Would you be OK with that?

      I think we both agree that modifications that significantly impair some aspect of human functioning without significant comparable (ideally objective) benefit should not be done

      Here I agree. However, I disagree in that the benefit is not comparable to the impairment in the case of circs. There are many other ways to achieve the exact same goals that are not permanent, do not impair function at all, and carry no risk.

      But I wouldn’t be enthusiastic in the same way I am discussing how stupid homeopathy or acupuncture are, I wouldn’t judge if they decided to go ahead anyway

      Here is where we agree in practice but not in principle. Especially because I feel that the eventual eradication of magical thinking (incl. religion) will address the issue more thoroughly and in a better manner than direct injunction against circs.

      1. Thor says:

        Quite interesting to see you two go ‘head to head’; evolved thinking processes are always impressive to witness. Looks like my original comment pulled you and WLU into a rigorous debate. I could never keep up with you guys (unlike you, I’m too ‘thin-skinned’, and since circumcision has directly affected me negatively, there is a visceral component to my utterings which can get in the way), so have opted not to comment further here on this. It is apparent, though, that what seemed at first to be a categorical trivialization, almost denial on WLU’s part is, in fact, more nuanced. I was hoping it might be. I’ve always enjoyed his articulate comments and opinions, so that is encouraging (…..” if I had a son, I would not have him circumcised” stands out).
        Thanks, wholeheartedly, for stating the key points and sorry I wasn’t more supportive in expressing ‘our’ position.

        1. Andrey Pavlov says:

          No need to apologize and thank you for the kind words. I also engaged WLU knowingly – I knew he would be able to articulate and go back and forth much better than most. I still believe he is fundamentally wrong about the premise involved, even though we are pragmatically in agreement. Such is the fun of skeptical conversation though :-D

          I am heading off for a mini vacation this weekend, but WLU and I have agreed to take our discourse further come Monday.

          Sorry about your own negative impact from circumcision. Strangely enough I have actually had a negative impact in the same region and am *not* circumcised (phimosis). When I went to see a physician about it, the response was a flippant “circumcision.” It was at that moment that WLU argument about the triviality of it went right out the window. Since then I have managed much less drastic treatment with good outcomes. I’m glad I didn’t take the “trivial” solution offered by the physician.

          1. Thor says:

            I thought that was the case, and it sure is entertaining (and informative). Have a fruitful respite; brewandferment and I will eagerly await the continuation of the sparring. Gives both of you some time to process, and perhaps formulate more argument.

            PS. I’m glad you waited. As you know, full retraction can, in some cases, take years.
            The forceable retraction on Day 1 or Day 8 has the potential for harm, as the foreskin is adhered to the glans. My son couldn’t fully retract until 17! Now he’s 26, and is grateful that we didn’t excise his anatomy for a quick, easy fix.

      2. brewandferment says:

        It’s my understanding that some female “circumcisions” do not remove the clitoris but just the clitoral hood which seems to be a much better analogy to male circumcision. Yet I can’t see that being considered to be of minor import. What’s your take on that comparison, WLU and Andrey?

        1. Andrey Pavlov says:

          I was referring to the form in which the clitoris itself is removed. I am unfamiliar with removal of the clitoral hood, but my stance would be the same. My premise is that any permanent alteration, particularly with loss of function (no matter how small), for no good medical reason is unethical to force upon an individual unable to provide informed consent.

          1. Sean Duggan says:

            FWIW, I can’t look it up here, since I’m at work, but I saw references to the “removal of the clitoral hood” version in an online article discussing a 1970s Playgirl magazine article which espoused the procedure as a form of cosmetic surgery, although I don’t remember if it was strictly cosmetic, for looks, or with the suggestion that it also made the clitoris more accessible.

            On a side note, arguments regarding advantages regarding oral sex may be a bit fallacious (insert obvious homophone pun), at least if you’re arguing a historical benefit. That particular practice is relatively recent for reasons of that daily bathing didn’t used to be a thing. “Natural musk” only takes you so far when your partner hasn’t washed or wiped for months.

            On a side note, since we’re discussing different levels of female circumcision, it’s worth noting that that male circumcision has meant different things over the years and across different cultures. Victorian circumcision removed a lot more of skin, making it actively painful to have an erection. Some of the aborigine tribes in Australia perform a version which requires slicing the penis from top to bottom, forcing the man to adopt a sitting version of urination much like a woman.

      3. WilliamLawrenceUtridge says:

        This is my point exactly – it is the same, but a matter of degree. In other words, if I just smack my wife it is OK but if I punch her unconscious now it is wrong.

        This doesn’t apply since domestic abuse is not socially acceptable anywhere (or at least not in the polite culture I live in). Circumcision is not equivalent in my mind

        Permanently removing a part of the body and altering the appearance of it along with diminishing sensation is the issue here.

        Yes, that is the principle, but one can’t compare one body part to all body parts and one can’t compare circumcision, with a history lasting several millenia and currently affecting billions of people, to a mere whim. While the principles are indeed there, as I said to Laplacedemon, eventually you must move from the principles to reality. I’m not endorsing wholesale circumcision – only in cases of medical necessity, and as an option when desired for social reasons. Ultmately, I still consider the decision to be trivial (if done properly, and in the absence of accidental harm – the fact that circumcisions can go wrong is definitely reason enough in my mind to not circumcise my own son, should I have one).

        To expand my “smack your wife” vs “punch her unconscious” analogy, would you be OK with the idea that when my wife is “out of line” I can slap her across the face since the “damage” there is very minor, leaving only a red hand print for a few minutes? [snip] Would you support my “right” to be part of my in group by smacking my wife whilst condemning me if I beat her unconscious?

        This is where analogies can break down and must be carefully examined or selected. In your mind, a slap is like circumcision and a closed fist is like female genital mutilation. I don’t see these comparisons as apt. If we’re shoehorning it into the metaphor, it’s more like criticizing your spouse in an accurate way, possibly in a situation that is less than ideal (like in public). Far more ambiguous, in fact it’s basically on a different scale (and as I said above, in the culture I live in there is no acceptable situation for smacking your spouse). I see the point you are making, I just disagree with your assessment of it.

        Wait until 18 and see how many circs are actually done before deciding the triviality of it. If you have evidence that droves of non-circumcised adult men are getting circ’d in order to fit in to some group and/or because the procedure is “so trivial” to them, then I will admit my argument is false.

        Again, I think it would be better if circumcision were something undertaken in adulthood, but it’s not.

  22. brewandferment says:

    why am i in moderation for everything all of a sudden; I’m not the first making this complaint.

    1. WilliamLawrenceUtridge says:

      You’re not alone, several others have complained about it and the site admins are trying to do something about it. It’s oddly spotty, it doesn’t seem to affect me at all beyond the usual potty-mouth-and-links limits. There appears to be a limited list of the accounts that get modded regularly.

  23. Joe says:

    It’s sad to see such well-intentioned people like Margulis go one crusades like this about the absolute wrong things. I agree with the vast majority of this article, the book is aimed at real problems but suggests weak solutions. Vaccines, as usual, are at the center of this fight. I admit to sympathy with Margulis in this area. I know that they don’t cause autism and are really quite safe, but I’ve never been convinced that vaccines really do what their manufacturers claim they do. Anyone up on the scientific proofs for vaccine effectiveness?

    1. WilliamLawrenceUtridge says:

      Yes, several of the editors here. If you want an example of a vaccine doing exactly what their manufacturers claim, you could note that smallpox no longer exists. Polio is now so rare that when it shows up in Israel, it is news. In decades past, polio was so common the only news you got about it was “polio season is here, so keep your kids out of swimming pools”. There’s a ton of proof in the scientific literature, even for influenza where people somehow think that the basic principles of vaccination don’t hold.

      I understand skepticism for the claims of Big Pharma for new drugs, but for an old technology like vaccination, I don’t understand it. Quite obviously inoculation, as a principle, works. Diseases that used to be huge killers are now controlled, or extinct. Once Big Pharma is in the manufacturing stage, I would suggest that generally the concerns of effectiveness are somewhat moot. Vaccines do a very good job of preventing illness, I don’t understand the skepticism.

    2. Chris says:

      Joe: ” Anyone up on the scientific proofs for vaccine effectiveness?”

      There is an online book that will have all the information you could desire:
      http://www.cdc.gov/vaccines/pubs/pinkbook/index.html

      Each disease has its own chapter, with data on history and effects on vaccination. Click on the measles chapter and read the section on the “Secular Trends”, and check out the graph of incidence. What happens to the line after the measles vaccine was introduced? You should also check out the numbers in Appendix G.

      Then there is Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States, which has the impact for the vaccines. Though I think the CDC Pink Book has the data in an easier to read format.

      And I know this comment will go into moderation, so I will go for the third URL. One thing that many vaccine detractors claim is that a severe disease like measles was just a “mild childhood disease.” This cannot be further from the truth. I search for measles in PubMed and then went to the last page for some historical papers. This is one that I found that is a very good read:
      A STATISTICAL STUDY OF MEASLES (1914)

      Those statistics include a mortality between 1 and 6% for measles, and causing an average of 1% of all deaths in a survey of 22 countries from 1906 to 1910. It is quite sobering.

  24. WilliamLawrenceUtridge says:

    Arthur Allens’s Vaccine, which was well received and extremely readable, is an excellent starting point. I quite enjoyed Paul Offit’s Vaccinated, which discusses a single researcher’s heroic efforts to create vaccines for a multitude of deadly diseases. A great book to get you scared of influenza is John Barry’s The Great Influenza. Jonathan Tucker’s Scourge and Jeffrey Kludger’s Splendid Solution are both good at doing the same thing – getting a glimpse of what it took to eliminate a disease, and how horrible it was, at a time when people lacked the luxury we have now of watching our children grow up, and grow up without significant scarring or paralysis. Read them, or any other book on a specific deadly illness that now has a vaccine, as an antidote to claims that we are over-vaccinating our kids.

    As always, the best evidence for the effectiveness of vaccines is the fact that you essentially don’t have to worry about the diseases they prevent against any more.

  25. Jennifer says:

    Thanks for this op-ed, Ms. Hall. I appreciate you bringing your views to us. Based on your extremely slanted opinion piece (and some of the hilarious comments), I have just ordered Ms. Margulis’s book.

    I’ll just pick on one comment: “As always, the best evidence for the effectiveness of vaccines is the fact that you essentially don’t have to worry about the diseases they prevent against any more,” is especially good and leaves me wondering where is the paradise in which you live? I’ve lost count of the number of times “responsible journalists” have used the terms “outbreak”, “epidemic” and “pandemic” just this past year to whip up hysteria with predictions of huge numbers of dead and dying from the diseases vaccines are supposed to prevent but which still happen anyway even though we have the highest rates of vaccination EVER. And when it turns out the few who get sick are vaccinated, then the same “journalists” shout out that everybody and their dog needs to get vaccinated again!! No body seems to give a hoot that the vaccine clearly failed.

    C’mon people, do you really want a future where you, your children and your grandchildren are all required to get every vaccine they come up with? And they are coming up with lots:

    http://www.slideshare.net/PhRMA/vaccines-in-development-2012

    Once you give up your right to say NO, you give up your autonomy. Be very careful what you wish for.

    Cheers!

    1. Chris says:

      “Thanks for this op-ed, Ms. Hall.”

      You might want to read this: http://www.sciencebasedmedicine.org/editorial-staff/harriet-hall-md-assistant-editor/

      Dr. Hall is also a retired Air Force colonel.

      Now explain where it is mandated that a child get every vaccine? One place that requires vaccines are public schools, and they only require vaccines for certain infectious diseases (depending on state). I doubt any on that list would be required (some look like therapeutic vaccines to help treat certain conditions like peanut allergies). But in all but two states one can get an exemption. And no state requires a child go to public school. There are plenty of private school that don’t care, plus there is homeschooling.

      Other places where vaccines would be required would be in the military and in certain medical professions. You must be eighteen to join the military, and most medical professionals are older than that. So they are not children.

    2. WilliamLawrenceUtridge says:

      Thanks for this op-ed, Ms. Hall. I appreciate you bringing your views to us. Based on your extremely slanted opinion piece (and some of the hilarious comments), I have just ordered Ms. Margulis’s book.

      Well, look forward to wasting further money, as well as time, and putting yourself and any children you might have at unnecessary risk. I would explain why, but I doubt you would understand.

      I’ll just pick on one comment: “As always, the best evidence for the effectiveness of vaccines is the fact that you essentially don’t have to worry about the diseases they prevent against any more,” is especially good and leaves me wondering where is the paradise in which you live? I’ve lost count of the number of times “responsible journalists” have used the terms “outbreak”, “epidemic” and “pandemic” just this past year to whip up hysteria with predictions of huge numbers of dead and dying from the diseases vaccines are supposed to prevent but which still happen anyway even though we have the highest rates of vaccination EVER.

      For one thing, we’re not at the “highest rates of vaccination ever”. We’re flirting with rates low enough to break herd immunity. For another thing, journalists almost always get it wrong. They were wrong about the MMR vaccine being related to autism. They were wrong to give Jenny McCarthy any attention. They were wrong to listen to Andrew Wakefield. If people had listened to doctors, hell, if they had listened to Penn & Teller, who based their show on actual science, they would have done better. Journalists are credulous to charasmatic people who convey confidence – no matter how wrong they are. The fact of the matter is, there are right and wrong answers.

      Also note technical epidemiological terms – outbreak is the appearance of a disease above base rates. Epidemic is an outbreak of significant proportions. Pandemic is an epidemic that spreads between humans to multiple countries – so while you may translate these terms into “everybody is dying”, the reality is they may be used technically correctly for diseases that are rarely deadly. Or, they may be used for diseases that are normally well-controlled like measles or polio. So perhaps you might try listening to health authorities rather than journalists.

      Another point – often the diseases kill in terms we consider rare, on the order of 0.01% or less. In a population of 1,000,000, that means 100 deaths – which doesn’t seem like a lot, unless it’s your child that dies. The salient fact here is that it represents 100 people dying when they didn’t have to. Those 100 people absolutely didn’t need to die, and only did so because they, or the poeple around them, were not vaccinated.

      Another point – diseases often are accompanied by few deaths, but a lot of other effects. Smallpox left tremendous scarring on the face – cosmetic but avoidable. Polio, on the other hand, kept people from walking. Vaccination kept small children from growing up, growing old and dying in an iron lung, staring at the same ceiling for decades. It’s not always about preventing death. Hell, for that matter, an effective influenza vaccination will prevent you from experiencing a few days of misery – fever, chills and horribly aching joints.

      As a final point here – vaccines do work. The people who get infected are normally the unvaccinated, though sometimes a vaccine will not take and in other cases the patient can not get vaccinated (think pediatric cancer patients for instance, who have compromised immunity, or HIV-infected children). These people rely on herd immunity, mass vaccination, for protection.

      And when it turns out the few who get sick are vaccinated, then the same “journalists” shout out that everybody and their dog needs to get vaccinated again!! No body seems to give a hoot that the vaccine clearly failed.

      Yup, journalists get it wrong. I’d also like to see an example of a news story where it is mostly the vaccinated who get sick – usually what you’ll see is larger absolute numbers of the unvaccinated, simply because most people get their kids vaccinated, but far higher relative numbers in the unvaccinated. If 30 of each group gets sick, but there are 1,000,000 vaccinated kids and only 100 unvaccinated kids, that’s rather telling regards the efficacy of vaccines.

      C’mon people, do you really want a future where you, your children and your grandchildren are all required to get every vaccine they come up with? And they are coming up with lots:

      Oh yes, dearly would I love there to be vaccines for all major diseases out there. I don’t really like being sick, and I don’t really like the thought of having to watch my child suffer, sweat, shake and vomit unnecessarily. Getting sick sucks. And did you notice that most of those vaccines are for allergies? It would be great to not have to deal with itchy eyes, drippy nose and sneezing all summer, or to be able to own a cat, or to be able to eat peanut butter in schools again. Peanut butter is delicious, and it would mean I won’t have to worry about my kids’ playmates going into anaphylactic shock because of a snack. Not to mention, if those allergy vaccines are effective they wouldn’t be mandatory – but I’d be sure my kid got all of them so they wouldn’t develop allergies. You’d have to be an idiot not to.

      Once you give up your right to say NO, you give up your autonomy. Be very careful what you wish for.

      Well that’s just dumb. You have the right to say no, that’s part of the problem. It’s way too easy to get vaccine exemptions for stupid reasons like religion or being too stupid to realize vaccines don’t cause autism.

      1. Jennifer says:

        Thank you for being so polite and not at all condescending or rude to someone you do not know. Your mother, I’m sure, would be ever so proud of you.

        Here is an example of a news story where “it is mostly the vaccinated who get sick”, at least according to the CDC. Paragraph 7
        http://www.huffingtonpost.com/2012/07/19/whooping-cough-pertussis-cdc-case_n_1687096.html

        According to this, paragraph 3, adolescent vaccination coverage increased from 2006-2011.
        http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6134a3.htm

        Here is a news story from Australia about soaring whooping cough rates in West Australia. Paragraph 8 : “The highest rates of whooping cough, also known as pertussis, are occurring in primary school aged children.”
        http://www.watoday.com.au/wa-news/whooping-cough-cases-soar-across-wa-20120416-1x3co.html#ixzz2aEnfxVbm

        According to this, paragraph 3: “In Australia the take-up rate of the pertussis vaccine is very high, with around 95 per cent of children receiving the full three doses of vaccine by age two (at two, four and six months).”
        http://www.abc.net.au/health/thepulse/stories/2012/08/14/3567495.htm#.UfOCvBZ9k5Q

        This corresponds to the information here:
        http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Healthy-communities/$file/HC_ImmRates_2011-12_FINAL_130409.pdf
        which finds that, across Australia, 84-95 % of 5 year olds were fully immunised in 2011-2012.

        This from the US:
        http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6133a2.htm
        is the MMWR for Vaccination Coverage Among Children in Kindergarten – US, 2011-12 School Year
        Under: What is already known on this topic?, it states that “Outbreaks of some VPD’s can occur despite generally high levels of vaccination coverage.”

        Looks like we are at “the highest rates of vaccination ever.”
        Cheers!

        1. Chris says:

          “Thank you for being so polite and not at all condescending or rude to someone you do not know. Your mother, I’m sure, would be ever so proud of you.”

          You were disrespectful to Dr. Hall’s medical credentials. You have nothing to complain about in regards to tone.

          The Huffington Post is not a a medical citation. Do show how it how most of those who got measles in Wales were unvaccinated. Plus show the relative levels of pertussis infection in vaccinated versus unvaccinated groups. Vaccination is not perfect, and sometimes in getting the actual disease is no guarantee of immunity. I got mumps twice as a kid, and my kids got chicken pox, so they are candidates for getting shingles (especially the youngest since she was a baby). It is disingenuous to think the vaccine would work better at providing immunity than the bacterial disease when immunity after a pertussis infection can wear off in four years, which is why herd immunity and Tdap boosters are important:
          Pediatr Infect Dis J. 2005 May;24(5 Suppl):S58-61.
          Duration of immunity against pertussis after natural infection or vaccination.

          Here are some more actual studies:
          Pediatrics. 2009 Jun;123(6):1446-51.
          Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.

          Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
          Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.

          Now if those are unclear to you, I have some herd immunity arithmetic to show you how it seems that those with pertussis vaccination seem to get more disease, it is simply because there are more of them:

          Take 1000 people (ignoring the infants under 2 months who cannot be vaccinated, or babies under a year who can only be partially vaccinated), if 5% refuse vaccines then the numbers are:

          950 vaccinated persons (assuming full schedule)
          50 unvaccinated persons

          The pertussis vaccine is actually only 80% effective at worse, so the numbers are:

          760 protected persons
          190 vaccinated but vulnerable persons
          50 unvaccinated persons

          There is an outbreak and it gets spread to 20% of the population, then:

          760 protected persons without pertussis

          38 vaccinated persons get pertussis
          152 vaccinated person who may still get pertussis

          10 unvaccinated persons get pertussis
          40 unvaccinated persons who may still get pertussis.

          This is how more vaccinated persons get the disease than unvaccinated. Even if the infection rate was at 100%, there would still be more of the vaccinated getting the diseases because there are more of them!

          Also, you might want to read you last cite where you said:

          is the MMWR for Vaccination Coverage Among Children in Kindergarten – US, 2011-12 School Year
          Under: What is already known on this topic?, it states that “Outbreaks of some VPD’s can occur despite generally high levels of vaccination coverage.”

          Take note of the word “some”. And the first sentence which said: “In 2011, CDC reported 17 outbreaks of measles and 222 measles cases, most of which were imported cases in unvaccinated persons.” Uh, huh.

          Also look at the table, where several states have DTaP vaccination rates at less than 90%, like Arkansas, Colorado, Idaho, Kansas, Wisconsin. Indiana has had some measles outbreaks and it is only at 93.3% coverage for MMR, it should be 95% because measles is so infectious. Often the Indiana measles infectious were spread through like minded groups who did not vaccinate like in an extended family in 2011 and a in 2005: Measles Outbreak Associated with a Church Congregation: A Study of Immunization Attitudes of Congregation Members.

          You see, one thing that is very important is when groups of those who refuse to vaccinate are collected together. Like in certain schools, churches and in the case of the Netherlands: entire communities.

        2. WilliamLawrenceUtridge says:

          Here is an example of a news story where “it is mostly the vaccinated who get sick”, at least according to the CDC.

          First of all, as Chris pointed out – the Huffington Post is not a scholarly source.

          Second, as Chris also pointed out, they do not specify if this is in absolute numbers, or relative. Since there are orders of magnitude more vaccinated than unvaccinated children, and we know the vaccine isn’t 100% effective, this can translate into larger absolute numbers even if the relative numbers are different. In other words, in a world of 10,100 children, if 10,000 are vaccinated and the vaccine is 99% effective, then 100 children get whooping cough. Say 10% of the unvaccinated children get sick – that’s 10 children. In absolute numbers, there are 10 times as many vaccinated children with whooping cough, but in relative numbers, it’s reversed.

          Third, it is already well known that the acellular pertussis vaccine is less than optimal for a lot of reasons. Immunity wanes quickly, it requires multiple booster shots, it’s not very effective in adults, and it often simply doesn’t “take” (see, for instance, here). The whole-cell pertussis vaccine was much better, but concerns over its safety caused a switch (see here and here).

          Fourth, antigens do drift and bacteria do evolve. Vaccines actually exert evolutionary pressure on diseases, both viral and bacterial, so it’s possible a new variant is responsible. Overall, pertussis is a trickier disease than many others, which partially explains why you get so many news stories about it compared to, say, chicken pox (see here).

          It would be most excellent if the vaccine were 100% effective and immunity never waned, but it would also be nice if I were taller and everyone had enough to eat – but we live in the world we have, not the world we want. Feel free to advocate for more funding dollars towards a superior pertussis vaccine, or simply a switch back to the whole-cell version. That would address most of your points.

          You could also take a course, or degree, in epidemiology, to really understand the complications involved. Perhaps then you wouldn’t get your information from the Huffington Post. Reporters aren’t doctors, and science is complicated – generally too complicated to fit into a single-column news article.

          There is one simple fact we can all be happy about though – we eliminated smallpox with vaccines. We’re close to another one, we’ve almost eliminated polio. With vaccines. You should read a book about polio, which will often go into the horrors of the summer season, because of polio. Aren’t you glad you don’t have to worry about it anymore? And do you know why milkmaids were often reknowned for the clarity of their skin? They got cowpox from milking infected udders, which scarred their hands but meant smallpox couldn’t ravage their faces. Smallpox was so ubiquitous that everyone had facial scars from it, sufficient to start a literary trope.

          That’s a lot less condescending, it’s basically all facts. Do you find it more convincing?

          1. Jennifer says:

            Chris, where did I disparage Ms. Hall’s credentials? I commented on her opinion piece. I understand Ms. Hall has loads of letters hanging off her name; so does Orac (well some anyway) and with that I rest my case.

            Mr Utridge, you wrote: “I’d also like to see an example of a news story where it is mostly the vaccinated who get sick.” Use different words if you don’t want a news story.

            Likewise, if you want evidence that we are 100% vaccinated and not 84-95% vaccinated, just say so.

            The largest outbreak of smallpox in England’s recorded history was the epidemic of 1871-72, when 40,000+ died. According to Sir John Simon, CMO to the Privy Counsel, 97.5% of the population between 2 and 50 had been vaccinated or had already had smallpox. Vaccination for smallpox in England and Wales began in 1798 and was made compulsory in 1853.

            Graphs to help you are here: http://healthsentinel.com/joomla/index.php?option=com_content&view=article&id=2656:england-smallpoxvaccine&catid=58:england-smallpoxvaccine&Itemid=55

            In closing, I must say that you two have a great tag team thing going and Ms. Hall must be ecstatic that she has the two of you as backup. A formidable duo and positively the must-have accessory for every paid-by-pharma gig going. I do hope, for all your hard work, you both get your fair cut.

            Cheers!

            1. Harriet Hall says:

              Do you really think I am paid by big pharma? Why?
              If they’re supposed to be paying me, the checks must have gone astray.:-)
              For the record, I am not paid by anyone for writing.

          2. WilliamLawrenceUtridge says:

            Chris, where did I disparage Ms. Hall’s credentials? I commented on her opinion piece. I understand Ms. Hall has loads of letters hanging off her name; so does Orac (well some anyway) and with that I rest my case.

            Sure, but those letters imply meeting a standard of learning and practice that you obviously haven’t. Resting your case implies that you have one, and you don’t really seem to – a bit of tone trolling, a bit of time spent implying that degrees aren’t that important, a whole bunch of easily-refuted and vague arguments, and a whole mess of condecension despite your apparent dislike of it.

            Use different words if you don’t want a news story.

            So…you didn’t understand my point, or you can’t reply in a meaningful way? You might want to look into getting a couple more letters after your name, perhaps BSc Epidem. for instance, so you could understand the issues involved instead of pretending your spoon-fed, pharmanoia-fueled, grossly simplified charicatures of medicine and disease are adding anything to the discussion. Let me guess, you got most of these arguments from a single website, or perhaps a circle-jerk of them, and never explored the issues beyond what you were presented with? You didn’t know the difference between cellular and acellular pertussis vaccines? You thought vaccines were 100% effective (and booster shots were presumably just for fun and profit)? You’ve never heard of pubmed?

            It’s the rare news story that ever get the facts, balance and tone correct, because such an approach is rarely interesting enough to up their circulation. Big Pharma wants to make a profit, and so do newspapers, and in both cases honesty suffers.

            Likewise, if you want evidence that we are 100% vaccinated and not 84-95% vaccinated, just say so.

            I’m not sure what hair you are splitting here. I know there are no nations that are 100% vaccinated for any disease, and further that even if we were, it would still not be 100% effective for a variety of complicated reasons, some of which I understand and others I don’t. Higher vaccine rates are better – less suffering, less money lost to the economy and far fewer deaths.

            The largest outbreak of smallpox in England’s recorded history was the epidemic of 1871-72, when 40,000+ died. According to Sir John Simon, CMO to the Privy Counsel, 97.5% of the population between 2 and 50 had been vaccinated or had already had smallpox. Vaccination for smallpox in England and Wales began in 1798 and was made compulsory in 1853.

            Graphs to help you are here: http://healthsentinel.com/joomla/index.php?option=com_content&view=article&id=2656:england-smallpoxvaccine&catid=58:england-smallpoxvaccine&Itemid=55

            I’m not sure what your point is here – that vaccination in the past was imperfect? Or that even in a vaccinated population, you can still expect death rates on the order of 0.1% (40,000 deaths/27.8 million in England in the UK in 1870 = 0.1%, a death rate far lower than the 30% that is usually expected, or 50% in young children). The form of vaccination used previously, which used cowpox or blister-to-blister transmission was dramatically different compared to current vaccines in general or the smallpox-specific vaccine we stopped using in the early 80s because smallpox was extinct. Perhaps if they had used a ring-vaccination program like that used to make smallpox go extinct, they might have had an even lower rate, though they didn’t have the logistical capabilities that we have now that was so necessary to ensure the success of the smallpox extinction effort. I’m frankly not going to bother digging any further here given the distance in time, geography and reality between now and then, I’ll just reiterate – the smallpox vaccine is no longer given to anybody, because smallpox is extinct bar two samples found in labs in Maryland and Russia. I think that’s a good thing, but perhaps you think this is a better look for children.

            In closing, I must say that you two have a great tag team thing going and Ms. Hall must be ecstatic that she has the two of you as backup. A formidable duo and positively the must-have accessory for every paid-by-pharma gig going. I do hope, for all your hard work, you both get your fair cut.

            Ah, so here you are essentially admitting you can’t make an evidence-based or logical point, so you’re going to just assume our opposition to your largely ignorant, incorrect and content-free points is based on bribes rather than an honest belief in science. Do you end a lot of the arguments you use with “you’re a poopy-head” or something similar?

            Look, I know why you are doing this – you read a bunch of superficially-convincing nonsense on some natural health or health freedom website, and you didn’t know enough to realize how inaccurate and misleading it was. You probably pimped the links to your friends and family members. You bitched and moaned about how greedy Big Pharma is (read Bad Pharma by Ben Goldacre, it’s worse than you realize) and you thought that was the same thing as natural cures being effective (this is a false dilemma – medicine being effective or ineffective has no impact on the effectiveness of vinegar and nonsense). And now you’ve tried to argue with some people who can point out that you’re wrong. You’re defensive. You think you’re smart and educated, and that means you must be smart and educated about everything, even something as incredibly complicated as medicine. So you mouthed off a bit and tried to throw out a couple personal attacks to salve your ego. That’s fine, I’m used to it. Now could you go away and read a bit? Spend some time in the 616 section of your local library. Maybe read Mistakes were made (but not by me) and see how hard it can be to change your mind or admit you are wrong.

      2. Jennifer says:

        PS. Vaccination coverage in the UK is also “high”.

        http://www.hpa.org.uk/hpr/archives/2013/hpr2613_cover.pdf

        Hmmm…where else can you look?

        1. Chris says:

          “Chris, where did I disparage Ms. Hall’s credentials?”

          By calling her “Ms” instead of “Dr. Hall”, which you still seem to be doing. What part of disregarding of her medical credentials did you not understand?

          Since it is quite clear that the major authors on this blog are medical doctors, it has been noted that many who disagree with them will disrespectfully call them either “Mr.” or “Ms.” in the case of Col. Hall, If you are unclear about who they are, just click on the name under the title of the article.

          Also, you should be informed that the “healthsentianal” website is not a scientific, and cannot be trusted. And as far as high vaccine rates in the UK, As I tried to explain it depends on the group. There was a large number of persons of a certain age in Wales who were not vaccinated with the MMR starting in 1998. Though I am sure you read that as well as you did when I explained “Dr. Hall is also a retired Air Force colonel.”, you must have thought the “D” was an “M”, or something like that.

          Now, do you have an actual point? You are making a claim that vaccination rates are high, but don’t understand that outbreaks happen in undervaccinated populations. You have listed some rather odd news articles that make claims that have nothing to do with epidemiology. The papers I listed are mostly available for free from http://www.pubmed.gov, and should explain that pockets of outbreaks happen when clusters of similar anti-vaccine sentiment cluster together. It is not a coincidence that schools that have that close for pertussis outbreaks are in private schools like East Bay Waldorf and Blue Mountain.

          If you read those stories, plus the links I put up about the Indiana outbreaks, you will realize that your statement “And when it turns out the few who get sick are vaccinated,” was in error. So you might want to really work on learning a bit about epidemiology.

          By the way, smallpox is no longer with us. A couple of good books on the subject are Pox: An American History by Michael Willrich, and House on Fire by William Foege, MD.

          And some other interesting readings that deal with epidemiology include Spillover by David Quammen, The American Plague by Molly Crosby, and Inside the Outbreaks by Mark Pendergrast.

          1. Jennifer says:

            Her byline is Harriet Hall; her comment name is Harriet Hall. Perhaps Harriet Hall should speak up if she is offended by the title “Ms”.

            Thank you for clarifying that you don’t get paid for writing, Ms. Hall. It would certainly be a screwy world if people were paid for their opinions, especially by drug companies. Then again, it would be a screwy world if drug companies had no liability for any injury or death caused by their vaccines.

            Cheers!

            1. Harriet Hall says:

              You may not have intended any offense by calling me Ms., but it rubs me the wrong way because so often my detractors have called me that instead of Dr. with the intent of insulting me. It is a convention to call MDs “Dr.” as a sign of respect, and it makes me wonder why you chose not to follow the convention, especially after it was called to your attention.

        2. Chris says:

          “A formidable duo and positively the must-have accessory for every paid-by-pharma gig going.”

          I always find this amusing because of what happens when there are outbreaks of vaccine preventable diseases. What happens is that kids often end up in the hospital. I think it would be interesting if someone could actually answer how treating the one out of ten to twenty who get measles in the hospital is so much cheaper than providing each child two MMR doses. Then there is the parental anxiety, and loss of time at work. Remember the measles outbreak in Wales put almost 10% in the hospital. You might also want to read how the 1990 measles epidemic cost the state of California: Pediatric hospital admissions for measles. Lessons from the 1990 epidemic.

          Or why it is so much nicer to just let babies get pertussis and deal with them in the hospital, instead making sure kids and adults are caught up with their DTaP and Tdap boosters.

          Since I had a kid who was a frequent flier in Children’s Hospital for various things, including seizures from a now vaccine preventable disease, I am very familiar with the both the financial and emotional cost. As an example of cost: a two mile trip by ambulance to the hospital was over $700. That could pay for lots of vaccines. The total time in the emergency room, and being hospitalized went into five figures.

          In light of actual studies that show preventing diseases actually save money:

          Arch Pediatr Adolesc Med. 2005;159:1136-1144.
          Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001

          J Infect Dis. 2004 May 1;189 Suppl 1:S131-45.
          An economic analysis of the current universal 2-dose measles-mumps-rubella vaccination program in the United States.

          That last little quip was not only disrespectful, but also economically foolish and very silly.

  26. weing says:

    “I’ve lost count of the number of times “responsible journalists” have used the terms “outbreak”, “epidemic” and “pandemic” just this past year to whip up hysteria with predictions of huge numbers of dead and dying from the diseases vaccines are supposed to prevent but which still happen anyway even though we have the highest rates of vaccination EVER.”

    You mean diseases like smallpox? polio? measles? pertussis? Have you looked at the actual cases? Who gave you the idea that vaccines are 100% effective?

  27. Chris says:

    Jennifer:

    Then again, it would be a screwy world if drug companies had no liability for any injury or death caused by their vaccines.

    There is a program in the USA to pay for vaccine injuries. So in over twenty years only 3320 have been compensated, even though the bar is set very low. There is even a table outlining where there is automatic compensation within a certain timeline for some symptoms. And for that time period billions of doses of vaccines have been given, so that is a very tiny number (like one in several million doses).

    Now who pays when a child gets injured by an actual disease? The statistics show that the vaccine preventable diseases are much more dangerous than the vaccines. Measles causes encephalopathy, deafness, pneumonia, and even a long slow death from SSPE. Pertussis can cause permanent lung damage. And on a on.

    If you have any actual scientific evidence that any vaccine on the American pediatric schedule causes more injury than the disease, then post the PubMed indexed study by a qualified reputable researcher that outlines the relative risks.

    You can add that to the studies evidence that preventing a disease with a vaccine is actually more costly than treating those who actually get the disease. Again, the documentation that says vaccinating for measles costs more than hospitalizing 5% to 10% who get measles should be verifiable documentation from someone who is qualified. Much like the several papers I have provided.

    1. another harriet h not hall says:

      coincidental similar names but I am another Harriet H and I am also repeatedly accused of being a pharmaceutical shill. I had measles encephalitis at 4 months old, wild virus obviously but this was 1965 before widespread vaccination. Given the contrived controversy of mmr I now consider it my sacred duty to go head to head with the antivaxxers and match anecdote to anecdote. Of course I have to science to back me up as well. The financial costs of post encephalitis as an adult are not too high. $6000-7000 for prescriptions per year. 1-2 neurologist appointments per year, 10 gp appointments(I don’t have costs for these I’m a canuk) eeg every 2 years if normal more frequent if not. had an mri last year because I have weird brain waves from my temporal lobe- not epileptic. I have also had several CAT scans. I can not work so there is the cost of income replacement. I have spent more than $50/month on bandages during blister season. 1 emergency visits per year for stitches. I drop things and can’t always get out of the way of the knife. $3000-4000 year for dental care. The AEDs I had as a child are notoriously bad for your teeth. All in all it is in the 10s of 1000s dollars per year for fairly uncomplicated post encephalitis. When I was a child it was a lot more expensive. The initial hospitalization was about 2 weeks. My family was going to a xmas concert when I started seizing so they rushed me to the hospital. The admission form says “Measles?” Please notice all antivaxxers that when their child deteriorated right in front of their eyes My Parents rushed Me to the Hospital. I am not sure what was done not much you can do for encephalitis. My parents weren’t sure if I was going to live or die. They were told that even if I lived i would be so severely mentally retarded that they should put me in a home. Severe mental retardation is a complication of measles. I lived through that and I don’t have mental retardation. I do have numerous other complications. But for the next 6 years I would have severe febrile convulsions I would be in status epilepticus regularly requiring ambulance and emergency visits and hospitalizations. I have seen studies linking severe febrile seizures with prior brain injury or disease. It is possible that the severe febrile seizures were the result of a cause other than the encephalitis but it is the most probable cause especially given that my first seizure was at 4 months and non-febrile. (I am the youngest of 6 children I had experienced parents who wouldn’t have taken a feverish infant to a xmas concert) The cost of all those hospitalizations would have been quite high. I also saw neurologists every couple of months. My parents would have had to take time off work. It terrified my family. They never knew at what moment I was going to die. The costs are now well into the $millions and hopefully I have a few more decades to ring up the bills. So please explain how a vaccine is more profitable to the pharmaceuticals than the disease. Especially given that the risk of encephalitis is 1 per 1000 for wild virus vs 1 per 1million for the attenuated vaccine. I consider myself on the mild side of severe complications from measles.

      I love this site and thank you Dr Harriet Hall and Orac for your wonderful posts. I have learned so much here and taken many references which I have posted on the encephalitis forums to be called an industry shill. They now seem to be a hotbed of antivax nonsense and other woo. It also aggravates my para sympathetic nervous system disorder. Since they won’t listen to reason. I must match them anecdote to anecdote.

  28. Jennifer says:

    Dr. Hall, sorry to have rubbed you the wrong way. I would have thought a retired airforce colonel (is that correct) would have a thicker skin (especially when pontificating on this topic) and especially when you don’t appear to call yourself anything but your name, without titles. At least on this page. My apologises for calling you something that you find offensive.

    Cheers!

    1. Harriet Hall says:

      I didn’t complain. You asked. Apology accepted.
      Perhaps you would also like to apologize for falsely accusing me of being a paid shill for Big Pharma.

    2. Chris says:

      You know when you have finished digging yourself in a hole, it is usually best to put the shovel down.

  29. J Power says:

    I hope Dr. Hall isn’t offended by that hole digging remark.

    Dr. Hall, if you say you are not a paid pharma shill, then that is good enough for me. It certainly would be an awful way to earn a living. Making up stuff to scare, intimidate and ridicule those with different opinions all for financial gain just seems so mercenary. So it is really fantastic that everybody on this page just scares, intimidates and ridicules for fun! Seriously now, I heartily apologise for not using one of your proper titles and for insulting your prose by calling you a pharma shill. That is most certainly not a title anyone should aspire to, especially someone of your stature.

    It has been a hoot interacting with you and the guys but I’m off on a journey that may keep me away from technology for quite some time so I bid you adieu!

    Cheers!

    1. Chris says:

      The hole remark was for Jennifer. I am sorry if the threading did not make it clear.

      And, really, you should put that shovel away.

    2. Chris says:

      “So it is really fantastic that everybody on this page just scares, intimidates and ridicules for fun!”

      Interesting that you are running away without answering any of our questions. Do you find having to justify your comments to be a form of of intimidation and ridicule?

      You made the comment that “And when it turns out the few who get sick are vaccinated”, which was explained to be in error. I even posted a set of papers and some herd immunity math to explain it to you. And yet you call that scary, intimidating and ridicule.

      You invoked the very boring and tired Pharma Shill, and when asked questions you resorted to more passive aggressive insults. What would have been more interesting would if you had actually explained how preventing diseases with vaccines was more costly than treating many who get the diseases in the hospital with evidence, like the economic studies I provided.

      Instead of a shovel to keep digging that hole you were in, perhaps you should have actually tried using some actual evidence. While debate can be fun, you didn’t even try to engage in honest discussion. Instead you proved that anti-science detractors have a behavior that is very easy to spot.

    3. Harriet Hall says:

      Now you can apologize for accusing me of intimidating and ridiculing for fun.
      I don’t know that I have ever intimidated anyone, and it is sometimes fun to point out the ridiculous, but the reason I write is not to have fun. It is to do a public service, to counter misinformation, pseudoscience, poor science and other things that mislead the public and can potentially hurt people. Also to educate people about critical thinking as it applies to medicine. There are lots of ways to have fun that would require a lot less effort than writing these articles.

  30. circumcision, chemical induction, pit to distress, routine epidural, needless suctioning, needless and risky vaccination, needless eyedrops that prevent visual imprinting, inviting everyone up to and including their 3rd cousins to witness the spectacle, circumcision, circumcision, oh did i mention circumcision? What were doctors practicing before the advent of evidence based medicine? And where is the evidence base for any of the above?
    For normal pregnancy, birth at home unless you want to be taken for a very expensive and traumatizing ride.

  31. More to the point: where is the evidence base for traumatizing newborn babies at a time when they imprint everything?

    1. mouse says:

      Personally, I like to take my medical advice from people who don’t confuse humans with ducks.

    2. mousethatroared says:

      For those who are interested, there is a blog that discussed the myth of child development, by Jean Mercer. Mercer focus a lot on adoption issues and debunking the theories behind Attachment Therapy, which is an pseudoscientific reinterpolation of attachment theory (seemingly similar to Richard Winkel’s comments) which has gone terribly in some cases.

      Mercer discusses how a baby is not like a duck, developmental, here.
      http://childmyths.blogspot.com/2012/06/who-can-pick-up-baby-or-if-it-doesnt.html

  32. WilliamLawrenceUtridge says:

    More to the point: where is the evidence base for traumatizing newborn babies at a time when they imprint everything?

    Where is the evidence that babies can even remember what occurs in the first month of life, let alone the first hours? My understanding is that they lack the biological machinery to consolidate long-term memories for several months. Plus, why would the first hours immediately following birth overshadow the treatment the baby gets in the subsequent decades of life, or the genetics they are born with? The belief that one’s future, or the whole of the future, is set in stone and unchangeable based on a single act or the first experience of a person is closer to the magical thinking of a prescientific mind than the rational observation that people can change in the face of ongoing life events.

    Hospital birth isn’t expensive if you have a national health care service, if you live in the United States I suggest you advocate for one. As a country it will be much better for everybody.

    Home birth just seems like such a terrible idea. Sure, in most cases the mother can deliver without anything serious going wrong. But if something serious does go wrong, you pretty much get to watch her, and probably your baby, bleed out before your very eyes. That seems less than appealing to me.

    1. Oh my god people, this is dark ages medicine. Science discovered centuries ago that absence of evidence is not evidence of absence, but in this case absence of evidence is just laziness. The evidence has been out there for years. Try these links:

      Obstetric care and proneness of offspring to suicide as adults: case-control study
      BMJ 1998;317:1346
      http://www.bmj.com/cgi/content/full/317/7169/1346
      “Results: For multiple birth trauma the estimated relative risks of offspring subsequently committing suicide by violent means were 4.9 (95% confidence interval 1.8 to 13) for men and 1.04 (0.2 to 4.6) for women. In mothers who received multiple opiate treatment during delivery, the estimated relative risk of offspring subsequently committing suicide was equal for both sexes (0.26, 0.09 to 0.69).”

      Perinatal origin of adult self-destructive behavior
      Acta psychiatrica Scandinavia, Volume 76, Number 42, Pages 364-371, October 1987.
      http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.1987.tb05620.x/abstract
      “ABSTRACT: The study was undertaken to test whether obstetric procedures are of importance for eventual adult behavior of the newborn, as ecological data from the United States seem to indicate. Birth record data were gathered for 412 forensic victims comprising suicides, alcoholics and drug addicts born in Stockholm after 1940, and who died there in 1978–1984. The births of the victims were unevenly distributed among six hospitals. Comparison with 2,901 controls, and mutual comparison of categories, showed that suicides involving asphyxiation were closely associated with asphyxia at birth, suicides by violent mechanical means were associated with mechanical birth trauma and drug addiction was associated with opiate and/or barbiturate administration to mothers during labor. Irrespective of the mechanism transferring the birth trauma to adulthood—which might be analogous to imprinting—the results show that obstetric procedures should be carefully evaluated and possibly modified to prevent eventual self-destructive behavior.”

      Neonatal Circumcision Reconsidered
      TRANSACTIONAL ANALYSIS JOURNAL, Volume 29, Number 3, Pages 215-221, July 1999.
      http://www.cirp.org/library/psych/rhinehart1/
      Abstract: This article describes the present status of neonatal circumcision in the United States and presents clinical findings regarding the long-term somatic, emotional, and psychological consequences of this procedure in adult men. These consequences are seen as typical of complex posttraumatic stress disorder. They emerged during psychotherapy focused on the resolution of prenatal, perinatal, and developmental trauma and shock experiences. Their relationship to phenomena such as trauma, shock, somatic decisions, discounting, and scripting is described.

      Birth Complications Combined With Early Maternal Rejection at Age 1 Year Predispose to Violent Crime at Age 18 Years
      Results: A significant interaction (P<.0001) between birth complications and early maternal rejection indicated that those who suffered both birth complications and early child rejection were most likely to become violent offenders in adulthood. While only 4.5% of the subjects had both risk factors, this small group accounted for 18% of all violent crimes. The effect was specific to violence and was not observed for nonviolent criminal offending.

      Re: the last article, My guess that this is a serious underestimate because the two determining factors (birth trauma and maternal rejection) are judged by conventional medical criteria, not by the baby’s perception. But in any case, how would the infant perceive standard obstetrical care in this country?

      First of all, depending on the specific OB, it can be obstructive to the process (birthing on the back, epidurals blocking contractions), violent (forecep delivery, chemical induction), painful (internal fetal heart monitor) suffocating (prolonged movement through the vagina followed by immediate cord clamping before the baby starts breathing), traumatic (c-section), torturous (circumcision) and ending in maternal rejection (the removal to “isolettes” and lack of touch and carrying that would normally occur with breast feeding is in itself a surefire way to increase adult violence, see http://www.violence.de ). Of course any mammal would perceive lack of breast feeding as maternal rejection. Think about it.

      Consider the fact that it’s the fetus that initiates labor through the release of hormones. The fetus is an active participant in its own birth, pushing with its feet and writhing through the birth canal. A normal, self-made birth would be any baby’s proud accomplishment, its first lesson in self-empowerment. How would it perceive an induced delivery? Since it didn’t initiate it and doesn’t want it, it would perceive it as a miscarriage, another form of maternal rejection.

      Medical "science" in this country cries out for some humility. The natural approach, supporting a process which has been successful for thousands of years is always best. Don't fool with things that you don't know anything about.

      1. That last article was from Archives of General Psychiatry
        Issue: Volume 51(12), December 1994, pp 984-988
        http://archpsyc.jamanetwork.com/article.aspx?articleid=496876

      2. Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?
        Biol Neonate 2000;77:69–82
        http://www.karger.com/Article/FullText/14197
        “Administration of multiple doses of opiates, barbiturates and nitrous oxide to mothers during delivery were found to increase the occurrence of subsequent opiate (RR 4.7, 95% CI 1.8-12.0, p = 0.002) or amphetamine (RR 5.6, 95% CI 1.6-16.9, p = 0.005) addiction in the offspring as compared to when no drug was given. Obstetric factors had greater influence on future drug addiction than socioeconomic factors. Neonatal hypoxia was not a significant risk factor in any of these studies, suggesting that such long-term effects were not associated with extensive brain damage. Conversely, maternal smoking during pregnancy showed a dose-response relationship with persistent criminal behavior in male offspring, after controlling for demographic, parental, and perinatal risk factors.”

      3. “Pit to Distress” is the apparently common obstetrical practice
        of deliberately overdosing a birthing mother with the induction
        drug pitocin in order to create a medical emergency “necessitating”
        a cesarean.
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920649/
        Again, zero consideration is paid to the baby’s subjective experience
        of essentially suffering a miscarriage. Normal labor is initiated
        by the fetus, not the mother. Most likely this would be imprinted
        by the baby as total maternal rejection.

      4. Contrary to popular belief, most american physicians who practice circumcision still don’t administer anesthetic of any kind, except for whatever residual obstetrical sedatives which might still be circulating in the baby’s blood.
        http://pediatrics.aappublications.org/content/101/6/e5.full.pdf

        And just as an aside, do you suppose amputating the primary erogenous zone of the male (which is the “frenar band” contained in the foreskin) might have something to do with the USA’s divorce rate?
        The Prepuce
        BJU International
        Volume 83, Issue S1, pages 34–44, January 1999
        http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.1999.0830s1034.x/full

      5. Also contrary to popular belief, certain american vaccines STILL contain mercury as a preservative (including bulk packaged flu vaccine, which is given every year) despite the availability of alternatives.
        http://www.vaccinesafety.edu/thi-table.htm

      6. WilliamLawrenceUtridge says:

        A normal, self-made birth would be any baby’s proud accomplishment, its first lesson in self-empowerment. How would it perceive an induced delivery? Since it didn’t initiate it and doesn’t want it, it would perceive it as a miscarriage, another form of maternal rejection.

        That is hilarious!!!! The baby can’t focus its eyes, can’t control its sphincter, can’t control its breathing, can’t crawl, can’t identify its own mother, can’t respond to objects – but it feels pride? Are you trolling?

        Medical “science” in this country cries out for some humility. The natural approach, supporting a process which has been successful for thousands of years is always best. Don’t fool with things that you don’t know anything about.

        Oh my, you owe me a new irony meter. So, “science” needs some humility, despite reducing death rates of mother and child by orders of magnitude. Meanwhile, natural child birth, which killed those mothers and children, is “successful”? Meanwhile, your post consists of cherry-picked scientific articles of uniformly low quality. So what do we learn? Science is awful and arrogant and stupid, except for when it supports your point. That seems a little…hypocritical. Oh, and “thousands of years”? The history of humans can be stretched out to millions of years depending on where you put the interspecies split. Birthing live young relates to mammals, which date back over 150 million years.

        Also, breast milk is just food. Its benefits are transitory, and you’re an asshole if you claim that parents can’t love their children if they bottlefeed their babies.

        But at least we agree circumcision is stupid.

        If you think the baby’s experience is important, you must support cesarean sections since there is much less “birth trauma” involved. Compared to being squeezed out a tube considerably smaller than your body, being removed through incision must be a cinch and lead to happier babies. I bet they high-five other babies in the nursery for being “smart” enough to choose the path to delivery that caused them the least pain.

        Also contrary to popular belief, certain american vaccines STILL contain mercury as a preservative (including bulk packaged flu vaccine, which is given every year) despite the availability of alternatives.

        Who cares? Thimerosal is an easily-excreted form of mercury that has never been proven to cause harm in the doses given as part of the vaccine schedule, even when more vaccines contained it and the total dose was much higher. What are you going to concern-troll about next, dihydrogen monoxide? It’s found in 100% of all vaccines.

        Your literature is borderline-amusingly bad. So maternal rejection causes bad outcomes in adulthood? Astonishing! Now, is the maternal rejection the cause, or the “birth trauma”? I’m not sure what your article about exposure to multiple painful stimuli has to do with “birth trauma”, but I wouldn’t be surprised if years of exposure to painful stimuli has adverse outcomes. The “pit to distress” comment in your article by a La Leche activist is sourced to a blog. This is not science, but it certainly is cherry-picking of low-quality data. Pseudoscience is the practice of attempting to co-opt the social capital of science without adhering to any of its methodologies or underpinnings. Congratulations, you win at pseudoscience.

        1. Andrey Pavlov says:

          Bazinga!

        2. Bobby Hannum says:

          I honestly feel the need to copy some of this down for use in need.

  33. Is this going to devolve into dissecting the time difference between the rise of apes and the rise of humans? When did narrow pelvises evolve? I don’t know, maybe you can enlighten us. My guess is it was more recent than a million years ago. Does it matter?
    Re: breast milk
    Smarty Gene: Breast-fed kids show DNA-aided IQ boost
    http://sciencenews.org/articles/20071110/fob1.asp
    “Breast-feeding boosts children’s IQs by 6 to 7 points over the IQs
    of kids who weren’t breast-fed, but only if the breast-fed youngsters
    have inherited a gene variant associated with enhanced chemical
    processing of mothers’ milk, reports a team led by psychologist
    Avshalom Caspi of King’s College London.
    In DNA isolated from blood samples, the researchers probed the gene
    fatty acid desaturase 2, or FADS2. This gene assists in breaking
    down fatty acids present in human milk. FADS2 comes in two forms,
    one of which enables the body to process fatty acids more efficiently
    than the other does.
    Only breast-fed children who carried one or two copies of the more
    efficient gene displayed an IQ advantage.
    In the two groups of children, 90 percent of youngsters possessed
    the critical FADS2 gene variant. Roughly half of all participants
    were breast-fed regularly during infancy, according to reports
    collected from the mothers when their children were 1 to 3 years
    old. The formula-fed infants typically received no fatty acids in
    their diets.”
    How about a different headline:
    “Medical research demonstrates IQ cost of hubris and recklessness in pediatric practice”. Or “90% of formula fed children would have higher IQ’s if their parents had
    ignored a century of conventional medical wisdom”. The admission that “formula-fed infants typically received no fatty acids in their diets” is an indictment of american quack pediatric medicine if there ever was one.

    As far as breastmilk being just food:
    Breast milk contains stem cells
    http://www.sciencealert.com.au/news/20081102-16879.html
    “The Perth scientist who made the world-first discovery that human
    breast milk contains stem cells is confident that within five years
    scientists will be harvesting them to research treatment for
    conditions as far-reaching as spinal injuries, diabetes and Parkinson’s
    disease.
    But what Dr Mark Cregan is excited about right now is the promise
    that his discovery could be the start of many more exciting revelations
    about the potency of breast milk.
    He believes that it not only meets all the nutritional needs of a
    growing infant but contains key markers that guide his or her
    development into adulthood.
    “We already know how breast milk provides for the baby’s nutritional
    needs, but we are only just beginning to understand that it probably
    performs many other functions,” says Dr Cregan, a molecular biologist
    at The University of Western Australia.
    He says that, in essence, a new mother’s mammary glands take over
    from the placenta to provide the development guidance to ensure a
    baby’s genetic destiny is fulfilled….”
    What a radical idea, that breast milk is an extension of the epigenetic input provided by the placenta. NOT.
    What’s radical is pathologizing and trying to control a process which 90+% percent of cases produces a superior result if left alone. But in those cases where difficulties arise, a doctor SHOULD be available to provide interventions which are COMMENSURATE with patient needs. That’s not the situation today, in which doctors aren’t even taught how to do breech births any more. They just go straight for the knife.
    As far as cesareans being less traumatic, there are hormonal processes which are short circuited by cesarean section and this shows up in higher rates of PTS in cesarean’d mothers, with unknown effects on babies. Do you need me to find some links on this or do you care?
    Again, some humility is called for. Sometimes doctors are needed, sometimes not.
    Honestly, you don’t have to put on this air of superiority. Maybe you could learn something if you admit you don’t know everything.

    1. WilliamLawrenceUtridge says:

      I’m going to explain why my link is better than yours. I don’t really expect you to understand my point, or agree with it, because you’ve rather clearly made up your mind and don’t appear to care about science unless it supports your pre-existing position.

      1) My link is to a systematic review. Your links are to press releases of individual studies. A systematic review is superior to a press release because it is a scientific article that is aimed to evaluate the topic in a meaningful, evidenc-based manner. A press release is meant to raise the profile of the organization or researcher with little regard to accuracy or context.

      2) A systematic review is superior to a set of press releases, or any set of studies, because it synthesizes them. It systematically gathers the studies that can be located, and evaluates the quality of their research. This has two benefts – it minimizes the impact of bias and noise of individual studies, and it prevents cherry-picking, which is to say selecting and linking to only studies that support your point, while ignoring the rest.

      3) This comes from an essentially pro-breastfeeding organization; the WHO strongly supports breastfeeding. Despite this fact, the very best that it can manage is some rather weak evidence and questionable null hypotheses. Now let’s talk about the findings.

      Most can simply be discarded – the long-term benefits identified, in aggregate, rarely move beyond the centrepoint of a graph used to show the direction and size of effect. The results for CVD and blood pressure and really all but the IQ findings are essentially zero. They may appear to be slightly canted towards an actual benefit, but in addition to encompassing the “null effect” point, we can reasonably expect a file-drawer effect, also known as publication bias – findings that show little or no benefit are much less likely to get published. Even if these effects are real, they are so small they are rather obviously washed-out by the kinds of interventions that doctors routinely recommend – diet, exercise, adequate sleep and no smoking. If you want to ensure the health of your child, you inculcate healthy eating and exercise habits, you don’t breastfeed then proclaim your job done.

      Now for IQ. For one thing, IQ is a rather liable construct, and it’s unclear just how meaningful it is. It’s hard to measure, and it’s unclear exactly what you are measuring. Factors like persistence, support, and good work-study habits are again far more meaningful to success than the perhaps 3-point difference that shows up when you take the studies together (and again, one must watch for publication bias, particularly for the sexy concept of intelligence). Not to mention, the ability to test IQ has a rather broad spread of something like three points anyway – which makes bragging about IQ differences of three points rather stupid since you might be bragging about a statistical curve shift, or a difference that can vanish upon retesting. And of course, let’s not pretend that IQ tests are anything but bragging rights. I’m sure they make you feel good about your child’s alleged “intelligence”, but as creationism, 9/11 truthers, birthers and Penn Jilette show us – high intelligence in no way guarantees they will be “smart”. Throwing up “breastfeeding shifts gene markers” takes it further down the road of reified absurdity, since we are far from the point of being able to link a “shift in gene markers” to anything meaningful.

      And let’s not forget the biggest confound in all of this – time. Parents who can exclusively breastfeed for 6 months will have tremendous advantages over those who can’t. They will have more free time, a higher-paying job or skill set that is in such demand that they can set a schedule or are supported in their breastfeeding, the mother might not have to work at all, they are probably extremely dedicated, they’re probably better off financially, they probably have a supportive partner, and a host of other confounds. So which is it? The breastfeeding, or the mom who gets a year of parental leave rather than two weeks? We don’t know.

      As far as breast feeding containing stem cells, who cares? Is that meaningful for the baby? Meat contains muscle cells, do they make your baby stronger? Carrots contain plant cells, do they make your baby a treant? Or are the cells digested by the gut, or passed through it intact? Breastmilk contains lots of things, but mere presence does not imply benefit.

      a doctor SHOULD be available to provide interventions which are COMMENSURATE with patient needs.

      You’re saying nothing of note here. You can claim “all hospitals support birth rape”, but a handful of shitty anecdotes is not evidence, any more than me plopping down a series of links about homebirth deaths proves that all doulas are murderers. You can pretend that C-sections and vacuum births are done purely for the benefit of doctors or mere convenience, but that doesn’t mean you are right. Giving birth is both natural and dangerous, just like snakes, cancer, gravity and forest fires. Nature doesn’t care if you live or die, and death in childbirth is merely one way in which natural selection removes the poorly-adapted; hospitals are a way of giving natural selection the finger, which I heartily support.

      doctors aren’t even taught how to do breech births any more.

      Ha, you know this because you’re a doctor? Or maybe it’s because you’ve been told this repeatedly, fed the kool-aid in a steady drip, don’t understand confirmation bias, and don’t know how to use pubmed. Or, you’re a liar liar, pants on fire. There is ongoing research to reduce cesarean deliveries and study both its benefits and dangers. Breech births are dangerous for mother and child, pretending they are not doesn’t magically make delivery safer.

      Do you need me to find some links on this or do you care?

      No, I don’t care. Please don’t bother.

      Honestly, you don’t have to put on this air of superiority. Maybe you could learn something if you admit you don’t know everything.

      So says the man so certain of his press releases. The thing is, I admit I don’t know everything, which is why I rely on pubmed to find review articles that summarize the literature. I don’t start with an opinion then move from there with whatever shoddy press releases have been fed to me by advocates.

  34. I don’t have time to argue against experimenting on healthy nonconsenting babies. Suffice to say that if any adult was given a choice between some of these treatments (such as partial penile amputation) and being left alone, the choice would be obvious. It shouldn’t be necessary to speak english with a midwestern accent to have one’s rights respected.

    1. Harriet Hall says:

      If a boy or man required circumcision later in life for medical reasons (requiring hospitalization, general anesthesia, more pain, complications, etc.), or if he developed cancer of the foreskin, and were given a choice between his present suffering and rolling back the time machine and having had circumcision as an infant, the choice would be obvious.

      1. a says:

        I have to disagree with this line of reasoning Dr. Hall. By the same token would a woman with breast cancer wish she’d had a prophylactic mastectomy as a child? After all, the incidence of breast cancer is vastly higher than actual medical needs for adult circumcision.

        Whilst the rest of what Richard Winkel is blathering on about is not particularly worth my time addressing, I do agree with him on that one narrow point about circumcision.

        1. Harriet Hall says:

          I don’t think prophylactic mastectomy is a fair comparison to circumcision.
          But his comparison of partial penile amputation to non-amputation is ludicrous.

          1. Andrey Pavlov says:

            Any sort of prophylactic removal of any body part seems to me to be the same in principle. The removal of a body part for any non-medical, non-science based reason should require the informed consent of this individual having the part removed. And of course that means children can’t consent, certainly not neonates.

            I find the ongoing argument of degree in the case of circumcision to be short sighted and not fully thought out. Saying “it is not on par with mastectomy” is purely an argument of degree – a woman doesn’t need her breasts any more than a man needs his foreskin. The only difference is that a lack of breasts is (generally, but not always) more noticeable and our society and culture place more value on breasts than foreskins. But the underlying principle is the same – the unnecessary removal of a body part in an non-consenting individual.

            1. Harriet Hall says:

              We will have to agree to disagree on this. There is some evidence of medical benefits of circumcision, enough evidence to convince the AAP. Reasonable people can agree or disagree with the AAP depending on how they interpret the evidence, how they value the risks and benefits, and how they feel about the ethics of doing an elective procedure on a child too young to give informed consent. There is no medical reason to remove a rudimentary extra digit attached only by a small stalk, but I have done that. I also allowed my daughters to get their ears pierced when I judged they were responsible enough to take care of them, but not old enough to give legal informed consent. And you could argue that orthodontia is typically for cosmetic rather than medical benefit; and most of us condone that. It’s fine to stick by strict principles, but sometimes there are gray areas where it is not unreasonable to relax those principles.

              1. Andrey Pavlov says:

                I think we can both agree that a professional body being convinced of something isn’t sacrosanct (a la urology and the PSA). I disagree with their assessment since their rationale is rather flimsy:

                According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life

                .

                I’ve done my own research into the reduced risks of HIV transmission and while this is supported by the basic sciences (the specific Langerhans cells more likely to take up HIV are more concentrated in the foreskin) and there is some data to indicate that there is some noise in the signal of this actually leading to decreased rates of transmission, that effect size it pretty small. And completely obviated by the use of condoms which, even if you are circumcised, should be used anyways. So circs don’t offer much protection at all and no additional protection over what one should be doing anyways. Same goes for the rest of the STI’s listed.

                Plus they double dip. The risk for cervical cancer in partners and the risk of HPV are linked. And once again completely obviated by both condoms and, more importantly, HPV vaccine.

                Penile cancer is, IMHO, a ridiculous reason to endorse circs. It is so rare that by that rationale we should be doing prophylactic mastectomies. Or if that example is too different in degree, prophylactic appendectomy – the likelihood of appendicitis is rather high and the need for the appendix rather low.

                Lower UTI is once again a very small effect – unless there is an abnormality in the foreskin (e.g. phimosis) or penis (e.g. hypospadias) (and then that would be a medical indication for circ) then the rate of UTI in males is already exceedingly low. I haven’t seen any good data on this specific topic in healthy normal male infants, so I can’t comment with as much certainty here, so it may stand as a very minor point in favor of circ. Though I can’t help but liken it to prophylactic toe amputations in diabetics since they have a significantly higher risk of foot infections (I know that is not a perfect analogy and certainly rather extreme).

                But moving on, I also disagree that we can’t have a reasonable and reasoned stance on things in a gray area. And I do agree this falls into an area not quite so clear cut.

                Firstly, as I have argued here many times before, intent plays a large role in such cases. When do we cease to call a food a food? When it is concentrated into a pill and taken for health reasons. Or, I have argued, when someone eats excessive quantities of it for specific medicinal reasons. In this case, the intent of circumcision is certainly 100% rooted in religious mythology and to this day largely driven by it.

                You make the excellent contrast with orthodontia and ear piercing. In the case of orthodontia, we find that it arose as a popular thing to do as an overall benefit. We haven’t arbitrarily decided to make teeth straight and white or some other random assortment – the benefits of good oral hygiene were demonstrated and the culture as a whole adopted it. This is in contrast to circa which were purely religious with no purpose other than that and has only won popular acceptance because of the popularity of religious thought. The justifications a la the AAP are post hoc rationalizations (since I view them to be rather flimsy as I stated above). In other words, if we had never done circa as a people before and this data emerged, would we even remotely think to “give parents the choice” of whether to do circs? I think not.

                But it gets even more interesting than that. Especially in the case of ear piercing. Australia has a legal concept of Gillick competence which states that children are assessed on their ability to consent based on their maturity, rather than solely their age. Certain things they cannot consent to. And they cannot refuse life-saving treatment (at least, not without the courts being involved). However, it is recognized that the ability for informed consent is not binary with 0 ability before age 18 and 100% ability the day after. So your daughter was, from the perspective of Australian medical ethics (and other developed nations, something I agree with) able to consent to a minor procedure such as ear piercing. Same would go with orthodontia.

                Now, I would actually agree that in the case of purely cosmetic orthodontia that some modicum of consent should be encouraged but it needs less in particular since the treatment is temporary and the effects potentially reversible (unlike circumcision). I also think that young adults can consent for circ – however that treads on tricky ground. Someone the age of 13 would, in general, be mature enough to consent for such a thing. The problem is that I think in most practical cases this would be a religious decision with significant coercion that it would not be reasonably considered informed consent.

                Your supernumerary digit example is also rather different – removing a part of the body that is not medically indicated but also not normally present is, once again IMHO, rather different than removing a part this is indeed normal to develop and have.

                So, overall, I see no reason to justify a permanent alteration such as a circ on a non-consenting individual any more than I would be able to agree with an argument that certain parents should be allowed to tattoo their religious or political affiliation on their infant’s buttocks.

                Now, all of that said, I think you and I do agree on one thing – the absolute level or harm by this particular practice. Which is why I am not an anti-circ crusader, nor do I angrily condemn parents or physicians you engage in the practice (although I do recognize that if the compensation for doing a circ weren’t so high relative to the time and effort put into it, I think more physicians would be less willing to do them and advocate for them). I am happy with a slow cultural shift away from the practice.

                Where we seem to disagree is the relative harm which I think is not outweighed by the flimsy at best benefits of a circumcision and tainted by the initial and most often true reason for performing them – mythology.

              2. Andrey Pavlov says:

                Oh yes, and I entirely forgot to include that Richard Winkel is actually correct in that a fairly sizable portion of the popularization of circs in America specifically was based on the notion that it would help prevent masturbation. So not only mythology as the basis for the procedure, but actual intent to engender a modicum of sexual dysfunction for the sake of perceived propriety. I simply cannot see any sort of rationale to justify allowing circs to be done on non-consenting infants.

                As I said though, the absolute harm – particularly in the context of our society – is small enough that I’m not tirading around about it and shaming physicians who do it. But I certainly did refuse to do any and gave my reasons when I was on my OB rotation.

    2. windriven says:

      Partial penile amputation??? Get a grip.

    3. WilliamLawrenceUtridge says:

      It’s not going to devolve into a discussion of individual studies, I’ll just drop this systematic analysis of breastfeeding:

      http://apps.who.int/iris/bitstream/10665/79198/1/9789241505307_eng.pdf

      Main finding – most of the claims are weak, the confounds are many, and in my opinion, what matters more than what you feed your child for the first six months is if you love and nurture them for the first two decades. Breastmilk is food, not a miracle.

      1. Bobby Hannum says:

        And boom goes the dynamite.

        I’m glad you posted that link – I’ve been looking for it for the past 10 minutes (unsuccessfully). Page 68 is where you want to go.

  35. You people are really showing your colors here. On the basis of this narrow snapshot of studies of a very narrow list of maladies (which remarkably excludes allergies and vulnerability to infection) you would deprive babies of their mother’s body. That alone is enough to shock the conscience. And to argue that babies don’t imprint their earliest experiences is simply delusional and easily refuted. Luckily the credibility of american obstetrics is collapsing around your ears, and the legal profession is starting to take notice of the opportunities presented, especially by a century of involuntary circumcision, which after all was originally openly marketed as a way to damage male sexuality. Concealing that foundation of quackery and malevolence with a succession of bogus rationalizations up to and including HIV prevention doesn’t work any more. People are catching on. When young parents catch on and start demanding their rights, babies will be protected, and that’s all that really matters. But don’t worry, when you’re no longer so indispensable to the world, you can always fall back on your mutual admiration society.

  36. WilliamLawrenceUtridge says:

    You people are really showing your colors here. On the basis of this narrow snapshot of studies of a very narrow list of maladies (which remarkably excludes allergies and vulnerability to infection) you would deprive babies of their mother’s body.

    Because a mother can’t touch her baby without breastfeeding.? No, it’s not about “depriving a baby of their mother’s body”, it’s about selecting a type of food. I plan on holding and feeding my child quite a lot thanks, despite lacking breasts or the ability to feed with them. Somehow I think my baby will be OK, and my wife will be better-slept because she’s not having to get up night after night as the sole food provider. We plan on taking turns.

    Also, the benefits of breastfeeding for allergy development are unremarkable and equivocal. Note the words “potential” in all of those studies. Yes, breastfeeding does provide a small degree of short-term protection against some illnesses. I don’t argue that breastmilk is a good source of nutrition and does offer some benefits – but they are grossly oversold and the shame experienced by mothers who choose to bottle-feed, or even just supplement breastmilk, is unwarranted. I would suggest skipping the intro and going straight to the results on page 19, and note that the benefits regards infection are largely based on a single large study carried out in 2000, which showed “…a significant reduction in risk of one or more episodes of gastrointestinal infection. No other significant reduction in infectious morbidity has been demonstrated, and the combined data from Finland, Australia, and Belarus do not suggest a protective effect against short- or longterm atopic outcomes.” In other words – breastfeeding might get you one less bout of diarrhea per year. Which is definitely a benefit, but it’s certainly not a panacea. You know what’s better? Vaccination. Permanent protection, for 99% of all children, for most of their lives, against all major deadly diseases, if the recommended vaccination schedule is followed.

    And to argue that babies don’t imprint their earliest experiences is simply delusional and easily refuted.

    Really? Because if it’s so easy, I don’t really see much scientific consensus. In fact, the scientific consensus seems to be that childhood amnesia is a thing.

    Luckily the credibility of american obstetrics is collapsing around your ears, and the legal profession is starting to take notice of the opportunities presented,

    Oh, great, because adding lawyers to the debate always brings clarity and objectivity to the results. Nobody has ever been motivated by the money that can result from lawsuits, irrespective the truth.

    especially by a century of involuntary circumcision, which after all was originally openly marketed as a way to damage male sexuality.

    Well hot damn, it’s a good thing I think circumcision is stupid and unnecessary.

  37. WilliamLawrenceUtridge says:

    It’s true no one has advocated MGM here

    Yeah, so why are you harping and bitching at us like we’re a gaggle of mohels trying to safeguard our livelihoods? You’re tilting at windmills and knocking down straw men here.

    rather you very gingerly tiptoe around the issue by pretending that it doesn’t matter whether a so-called care giver amputates the primary erogenous zone from a non-consenting infant for no good reason.

    Actually, you’re the one pretending circumcision renders males anorgasmic. It quite obviously doesn’t, and if it occurs in childhood, they will never realize there is a different way to experience orgasms.

    Incidentally, you do advocate for the mandatory instruction of young boys on anal prostate stimulation? Because we wouldn’t want to deprive them of every single means of orgasm, would we?

    I can see why you’d rather blame the parents, but the history is clear, parents have only been acting on medical advice as they’ve very faithfully done for decades.

    Geez, every time you open your mouth (pound on your keyboard?) more bullshit falls out. CIrciumcision is primarily a religious decision, and at times a cultural preference. The science is clear – there are few benefits and few risks, and scientifically nobody is justified in advocating for, or prohibiting, circumcision. You seem to think “doctors failing to adhere to your dogmatism” is the same thing as “circumcising everyone”. In fact, Andrey Pavlov, a medical student who comments here regularly and has in fact commented on this article, has refused to perform circumcisions on moral grounds. So much for doctors providing scissor-happy medical advice to all parents that cut cock is better.

    And as a result of their misplaced trust, male genital mutilation has become a cultural norm in this country based on a long series of patently ridiculous medical claims about everything from masturbatory insanity to HIV.

    Sure. Because the main reason why a primarily-Christian country circumcised most of its sons for generations is purely cultural. Nothing to do with religion at all. Also, can you provide me with any example. ANY. EXAMPLE. Of a peer-reviewed journal that advocates for mandatory circumcision? Or is it an absurd tempest in a teapot with each side claiming science supports them (without actually reflecting the full scientific research).

    Let’s just take a wild leap here and hypothesize for a minute that sexual satisfaction is positively correlated with marital stability.

    That certainly is a wild leap. Any evidence for that? And if sexual satisfaction is correlated with marital stability, how is that related to circumcision? Do men magically grow back their foreskins when they cheat on their wives in your world?

    I know that’s not scientific but it turns out emotions aren’t very scientific either. Do you suppose we’d have the highest divorce rate in the industrialized world if we really had evidence based medicine?

    You could actually study this – a controlled trial of matched children, ideally randomly selected into cut- versus uncut-cock. I doubt any ethics board would approve it, but I doubt even more that it would find anything. In fact, there is even data to suggest you are wrong – looking at the rates over the past decades, circumcision has been falling since the 70s, meanwhile divorce rates have been climbing. One could even argue that circumcision is protective against divorce (I would say that is pretty inarguable actually, since divorce is strongly discouraged and circumcision encouraged in the most common religions found in the US).

    Marriage is far, far more than merely sexual activity, and if yours is based solely on orgasms, I feel a bit sorry for you (and a bit of envy, since you must get a lot of them). Divorce is far, far more than orgasms. In fact, the main reasons couples split up are unrelated to sexual satisfaction (and money doubtless has far greater an influence than circumcision). Dearly would I love to see how you are going to twist the reasons and correlations into links with the foreskin. Divorce is complicated, there’s trust, social sanctions, religious affiliation, expectations, parenting, self-esteem, abuse, alcoholism, money, children, but I don’t think I’ve ever seen “circumcision” given as a reason for divorce.

    Isn’t it long past time to admit that circumcision is the most reprehensible kind of child abuse and put a stop to it? Seriously, can anyone actually say that this quackery has no meaningful consequences?

    Again, straw man. No doctor says circumcision should be mandatory. It’s hardly child abuse. The kids can’t even remember it if it occurs within a few days of birth. It’s primarily justified through cultural rather than medical reasons, and done properly has very few risks. And nobody here is claiming that circumcision should be mandatory – just that it doesn’t merit the kind of histrionics you have been piling up in its name.
    So are we done here?

  38. Chris says:

    Richard Winkel:

    Also contrary to popular belief, certain american vaccines STILL contain mercury as a preservative…

    This is an article about children, not adults. Please tell us which vaccine on the American pediatric schedule is only available with thimerosal. Do not mention influenza because half of the eight formulations allowed for children are thimerosal free.

    And, personally, I believe my adulthood was more affected by the death of my mother when I was eleven years old, with being plunged into a very confused step-family six months later by my father because my mother’s relatives were going to take us away…. than by the birthing practices of the late 1950s.

    Mr. Winkel, how often have you actually given birth? I have done it three times. If my first was done at home instead of a hospital, my dear hubby would be visiting two graves instead of having to pay three college tuition bills next month. Considering the paragraph previous to this one, be careful with those glib remarks. It is a rather sensitive subject for me at the present.

    (I have just come back from almost a week visiting relatives, including my elderly father. I helped clear out years of accumulated mail, that includes right wing nutbattery newsletters, with several uber-silly “natural cures” from quacks like this guy, I even had the newsletter with the goofy graph with me, but it disappeared from my backpack. We also were clearing out several decades of photos, many to be scanned and shared among the siblings. The one thing my father did not want to leave the house for scanning were the two “grief albums” he created from photos of my mother.)

    1. Chris says:

      I should add that if one decides to visit the part of Arizona that has Tombstone and the old mining town of Bisbee, that you also visit Ft Huachuca.

      Their history museum with information on Buffalo Soldiers will let you know that the cavalry that came to the rescue in movies were too pale, and to make sure to see the military intelligence museum (it is not open every day). A very important must see is further up the hill from the museums: the cemetery. Be sure to check out the headstones near the gate, especially the several that just say “Infant.”

      And unlike Tombstone, it will not cost you anything. All you have to do is show your identification at the main gate. A driver’s license is adequate.

  39. Chris says:

    I have been gone for a week, and yet everyone of my comments still go into moderation? AAArgh!

  40. windriven says:

    You aren’t alone. Mine too. And some responses still get unlinked from the antecedent comment. I’ve stopped bitching and just accept it as the new reality. But I do hope others will keep up the good fight.

  41. mousethatroared says:

    You know how the doctors here are always saying “Everything in Moderations…” We just didn’t know til now, that they meant the comments. ;)

    I just feel sorry for the person who has to go through all this stuff and pass it through moderation. I hope it’s automated in some way.

    1. Bobby Hannum says:

      Ideally it is, but for some reason it’s wonky with some accounts.

  42. mousethatroared says:

    WLU – ” It’s hardly child abuse. The kids can’t even remember it if it occurs within a few days of birth. It’s primarily justified through cultural rather than medical reasons, and done properly has very few risks. And nobody here is claiming that circumcision should be mandatory – just that it doesn’t merit the kind of histrionics you have been piling up in its name.”

    I’m in complete agreement with you on your points. A little point, just because I’m being a stickler…children can experience PTSD due to traumatic events at earlier ages than we typically think childhood memory kicks in*. Of course those events are of the type that the general population would consider traumatic, witnessing the abuse of a caregiver, a life threatening event, natural disasters.

    These traumas don’t include the kind of typical brief medical procedures that we are talking about, circumcision, eye ointment, vaccination, being born. ;) As an adoptive parent and member of an adoption community, I can attest to the face that kids are resilient and often do very well in spite of the sometimes unavoidable traumas that life throws at them. It’s just good to be aware of the possibility of PTSD in a young child, if help is needed.

    … and Ricard Winkel is obviously living in an alternate reality. It’s great, on the internet we can even talk to folks from other mulitverses. ;)

  43. mousethatroared says:

    ignore that *

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