Lift Up Your Hearts!

Despite my efforts, my backblog appears to be growing faster than I can deal with it.  Here's a quick look at several interesting health-related issues that have come my way recently.  (Where "recently" is defined as "sometime within the last year or two"; that's how old some of my backblog is.)

Acknowledging Preindustrial Patterns of Sleep May Revolutionize Approach to Sleep Dysfunction  Do you worry when you awaken in the middle of the night and can't get back to sleep?  Your body may be rebelling against unnatural sleep patterns imposed by artificial lighting and our frantic schedules.

In the course of gathering information for his book, At Day's Close: Night in Times Past, which is about night in preindustrial times, A. Roger Ekirch, professor of history at Virginia Polytechnic Institute in Roanoke, uncovered the fact that in preindustrial times before artificial illumination was widely used, persons typically slept in 2 shifts. They called the shifts "first sleep" and "second sleep." In those times, sleep was more closely associated with sunset and sunrise than it is now. Within an hour or so after sunset, persons retired to bed, slept for about 4 hours and then woke up. They remained awake for a few hours and then returned to sleep at about 2 am for another 4 hours or so.

Written records from before the first century onward indicate that the period between first and second sleep afforded persons a chance for quiet contemplation, but persons also rose from bed during this interval and did household chores or visited with family and friends. Although diaries, court documents, and literature of the time indicate that this sleep pattern was widely acknowledged, this bit of history had been lost until the debut of Ekirch's work. The pattern of sleep he describes as the norm in days past is no longer the norm in developed countries where artificial light extends the day.  Anthropologists, however, have observed a similar pattern of segmented sleep among some contemporary African tribes, such as the Tiv of central Nigeria, who even refer to their customary sleep patterns as first sleep and second sleep, just as the early Europeans did.

In-Body Stem Cell Therapy Has Enormous Potential for Bone Injuries If you're as sensitive as I am to the violence committed in the name of stem cell research, rest easy:  this amazing breakthrough from the University of Rochester Medical Center uses the body's own stem cells, in vivo.

At the heart of the research is the drug teriparatide . . . which was approved by the FDA in 2002 for the treatment of osteoporosis. Astute observations led a team of clinicians and researchers to uncover how this drug can also boost our bodies’ bone stem cell production to the point that adults’ bones appear to have the ability to heal at a rate typically seen when they were young kids.

“I had patients with severe osteoporosis, in tremendous pain from multiple fractures throughout their spine and pelvis, who I would put on teriparatide. . . . When they would come back for their follow-up visits three months later, it was amazing to see not just the significant healing in their fractures, but to realize they were pain-free—a new and welcome experience for many of these patients.” 

Circumcision Is Found to Curb Two S.T.D.’s This New York Times article left me both confused and concerned.  First, even if subsequent research verifies the protective effects of circumcision, the question still remains, why?  What would drive men to choose major, irreversible surgery on a most sensitive and important body part over simple hygiene and sexual fidelity?  If we needed further evidence that our sexual drive is broken and gangrenous, this would be it.  I am not one of those who would ban circumcision, not even for infants who have no say in the matter.  For those without religious or other strong convictions, however, administration of the procedure under the mere assumption that one's newborn son will inevitably engage in illegitimate sex seems bizarre.  (I wouldn't subject a daughter to the HPV vaccine, either.)  Newborn circumcision is a lucrative practice, however, so I wouldn't be surprised to find doctors using this study as an excuse to encourage it.

Women must toughen up for birth—expert  A British midwife is mocked for saying that normal childbirth without anesthesia is better for mom and baby.  The article does allude to hospital practices, such as leaving the laboring mother alone, that increase pain and subsequent desire for anesthesia.  "He urged women to use yoga, hypnosis and massage to overcome pain."

Or they could swear.

Curses can foil pain, scientist discovers  According to an English study, swearing lessens pain, though only if it's an unusual response to the stimulus and not a habitual part of one's vocabulary.  This may bode ill for our profanity-saturated culture.

Though both sexes experienced a reduction in perceived pain while swearing, females did so to a greater extent. Similarly, swearing increased the heart rate of both sexes, but more so for females. . . . [T]hat result may have stemmed from differences in the way swearing figures in men's and women's vocabularies.

"I suggested for prisoners who commonly swear, the words kind of lose their shock value, whereas a nun who never uses those words may be more emotionally aroused by cursing."

President Obama has declared the swine flu outbreak to be a national emergency.  I'm not sure that's all that bad of a measure, given that it lifts some governmental rules for hospitals that probably weren't a good idea in the first place.  But as Susan McWilliams points out in this Front Porch Republic post, our media-hyped fears seem 'way out of line.  It's hard not to quote her entire post.

What Thucydides helps us to see [in his description of a plague in Athens during the Pelopponesian War], as George Kateb has written, is “the ways in which fear of death through contagion disorganizes all human relations”:

It is the peculiar power of contagious disease to isolate people from each other; normal communal ties give way before the desire of every man to avoid contact which could bring on the disease and with it, death. The wish to remain free of sickness overrides all duty and all affection.

The plague resulted in what Kateb calls “a kind of negative state of nature: instead of the war of all against all, there was the avoidance of all by all.” What is ultimately most horrifying about the plague is how it exposes the fragility of civilization.  You might not be able to build Rome in a day, but you can destroy Athens in a few weeks.

[F]ears of the swine flu have curbed many of life’s rituals in the United States. Employers are forcing employees to stop sharing candy. Colleges are forcing students—heaven forfend!—to stop playing beer pong. People are cancelling holiday parties, or serving hand sanitizer instead of punch.

Religious institutions have seemed especially willing to change generations-old rituals on the chance that they might spread contagion. Churches are instructing congregants not to shake hands at the sign of peace, emptying the holy water fonts, and putting away hymnals. Many churches have stopped offering a shared sacrament, thereby taking a lot of the communing out of communion.

The North American Mission Board of the Southern Baptist Convention, which is the nation’s largest Protestant group, has raised the possibility of cancelling all mass gatherings: weekly services, weekday events at church, weddings, and funerals.

Keep in mind a few things here: 1) although swine flu is not pretty, most people recover from it within a week, without needing any medical care; 2) Americans who do get sick with the swine flu may be treated with antiviral medication; 3) there is a vaccine available to protect against this flu; and 3) according to epidemiologists, there isn’t even that much of a swine flu resurgence in American cities this year to begin with.

When even our religious institutions—the places that in theory are devoted to the primacy of spiritual health (and the attendant conviction that the health of the spirit might be more important than the health of the body)—are willing to dismantle themselves at the idea of what is for the most part a transient and nonfatal illness, I think we should be getting more than a little nervous about the spiritual health of the country.

The greatest horror of the Athenian plague, as Thucydides says, is not the number of the dead but the degradation of the terms of life for the living.

That understanding—which sees death as something that you must risk in the name of a good life—has in the past been central to American thought and practice, evidenced by homestead wives and warriors alike.

In all this fear about exposure to the H1N1 virus, our willingness to abandon core rituals and community life might be the most frightening thing out there.

As a child, I always had trouble cleaning my room.  What should have been a 10-minute exercise turned into an all-day project, because of course the most important part of cleaning my room was reorganizing the bookshelves, and a book, once in my hand, demanded to be read.

Tonight, trying to get my office in order, and with no time to spare for distractions, I came upon the paperwork I received along with my seasonal flu shot.

Plus ça change:  Twenty minutes later, I finally tossed the papers in the trash, and will be back to work as soon as I've posted this—meaning what should have taken half a second to deal with will have eaten up about 40 minutes.  I was inspired to try to find out where the vaccine had been manufactured, hoping it was in some country whose quality control I thought I could trust, i.e. not China.  The information is surprisingly hard to discover.  Although the papers were covered with remarkably fine print, I could see no point of origin.  "Manufactured by..." does not necessarily indicate where.  Once I found out the names of the company and  of the vaccine, however, I could do an Internet search.

Not that that helped, except negatively:  there was at least no evidence that the manufacturing facilities were in China.  I must also say that the name of the company itself was reassuring:  Novartis.  For no good reason, I must admit—but anything from Basel must be reliable, right?

Until recently, Cairo had a refuse-collection system unlike any you'll find in the United States, but it worked—and might even be commended for its efficiency and environmental responsibility.  Cairo's households enjoyed free or inexpensive garbage collection, right from the door, by the zabaleen ("garbage people"), an impoverished community of Egyptian Christians living in an area of Cairo known as "Garbage City."   The collectors and their families then sorted the trash, reusing, repairing, and recycling what they could, and feeding the organic waste to their livestock, primarily pigs.

Sanitation workers do not generally enjoy high status anywhere, and the zabaleen are despised not only for their jobs, but also for their poverty, their religion, and their willingness to keep pigs as livestock.  However, as even American cities discover during a protracted sanitation strike, we do not do well to devalue other human beings, least of all those responsible for keeping us from suffocating in trash. 

In a misguided effort to stave off a swine flu epidemic, Egypt ordered that all the pigs be killed, even though the disease is not, in fact, spread by pigs.  By the law of unintended consequences, Cairo's citizens are now more vulnerable to disease than before.  The zabaleen no longer collect the trash, and the government's effort to replace them with multinational corporations has largely failed.  The poorest of the poor have lost their only livelihood as well as their source of food, and Cairo's streets overflow with filth.

I don't write this to belittle Egypt or the Egyptian government, but as a warning.  Our country has a problem:  Our healthcare system, once arguably the best in the world, is falling apart.  (We can disagree over the causes, or even the definition, of "falling apart," but that's not the point here.)  There's no shortage of wrangling over what the intended consequences of a federally-imposed health plan might be, but whatever shakes out of that debate, I fervently hope that we will consider the possible unintended consequences before killing off the pigs.

(Sources used for this post included The New York Times and Wikipedia.)

My Swiss family doesn't let me forget that "universal health care" does not necessarily mean a system like that in the United Kingdom.  For this I am grateful, because of the horror stories that keep emerging from that system, such as the cases of Charlotte Wyatt, Leslie Burke, Linda O'Boyle, Jayden Capewell, and too many others to write about.  It's worth looking at alternatives, and T. R. Reid's The Healing of America does just that.

I haven't read the book; my opinion is based on the New York Times review. There's much I don't agree with in the review, and I'm sure in the book also, but I like the gimmick:  Reid had shoulder problems that were interfering with his golf game, and he decided to present the case to 10 different doctors around the world.  The results?

• When Mr. Reid presents his shoulder to his own orthopedist in Colorado, the doctor is quick to recommend a shoulder replacement. It will cost his insurer tens of thousands of dollars (assuming it agrees to pay), with unknown co-payments for him. Risks include all those of major surgery; benefits include a restored golf swing.
• In France, a general practitioner sends him to an orthopedist (out-of-pocket consultation fee: $10) who recommends physical therapy, suggests an easily available second opinion if Mr. Reid really wants that surgery, and notes that the cost of the operation will be entirely covered by insurance (waiting time about a month).
• In Germany, the operation is his for the asking the following week, for an out-of-pocket cost of about $30.
• In London, a cheerful general practitioner tells Mr. Reid to learn to live with his shoulder. No joint replacement is done in Britain without disability far more serious than his to justify the expense and the risks, and if his golf game is that important, he can go private and foot the bill himself.
• In Japan, the foremost orthopedist in the country (waiting time for an appointment, less than a day) offers a range of possible treatments, from steroid injections to surgery, all covered by insurance. (“Think about it, and call me.”)
• In an Ayurvedic hospital in India, a regimen of meditation, rice, lentils and massage paid for entirely out of pocket, $42.85 per night, led to “obvious improvement in my frozen joint,” Mr. Reid writes, adding, “To this day, I don’t know why it happened.”

I don't know what happened in the other four countries, but this sample is sufficient warrant for questioning "best practices," wherever we are.  Maybe second opinions ought to be obtained in a second country.

It would not be too strong to say that I loathe politics.  I vote, and have done so since I was first able to at age 19, but mostly without enthusiasm; choosing the least objectionable candidate is gritty, unsatisfactory work.  Other than that, I try to ignore politics.  Unfortunately, politics does not return the favor, so I occasionally give in to the prodding of my conscience and attempt to articulate a political opinion in a blog post, or write a letter to an elected official, or attend a political meeting.

The last is rare indeed, but that's what I did the other night.  Our state representative held a health care "town hall meeting."  On my list of preferred activities it was somewhat below scrubbing the bathroom floor with a toothbrush, but I put on my Sunday-go-to-meeting clothes and ventured out into the rain anyway.  Not without a bit of grumbling under my breath, but this was one of the few candidates in memory who actually impressed me in his campaign—or maybe credit goes to the campaign worker who rang my doorbell; those of you who know me know that it takes someone really special to impress me after starting out on such a wrong foot! Anyway, I decided to go because I can't very well complain about what they're doing to health care if I don't express my opinion, and because I think our representative is a good guy and what a shame it would be if he held a meeting to get people's opinions and no one showed up.  I thought I'd at least go and say hi and maybe get to know him better.

Now that was a pretty funny idea!  Shows how little I know about politics.  I began to suspect I might have been wrong when I saw all the cars in the parking lot.  I managed to find a parking space, and later a seat, thanks to the fact that Google Maps is unaware of an important street closing on the way to the hall, so many people arrived late.

Anyway, the room was packed—I'm guessing 300-350 people—with policemen stationed around to prevent...what?  Riots?  We Central Floridians are pretty civilized folk, I guess.  There was some speaking out of turn—though one man who did later apologized—and clearly feelings were running strong, but at least up to the time I left, it was pretty calm.

Yes, I left early.  I had decided soon after seeing the crowd that I would listen, not speak, and many of those who spoke expressed my concerns for me.  So after about an hour I decided I'd had enough.  I'm the kind who leaves ball games in the middle of the ninth and exits EPCOT before the fireworks—anything to avoid the madding crowd of cars all trying to leave the parking lot simultaneously.  The headache induced by the strobe effect of the ceiling fans that hung below the lights was all the excuse I needed.  Fortunately, the Mozart clarinet concerto on the radio on the way home brought relief; Advil and hydration at home completed the cure.

It was worth the effort, even if our representative has no idea I was there.  Here are a few observations:

• Feelings, as said, were strong.  What's happening with health care is an important issue to a whole lot of people who have far better things to do than go out in the rain to a political meeting.  (Scrubbing the bathroom floor, for instance.)
• Our representative, along with others, is sponsoring a bill that would (if it makes it through the many necessary steps) enshrine in the Florida Constitution an individual's freedom of choice when it comes to health care and insurance.  My first reaction was that the idea was pretty silly, because if the federal government imposes dislocations in the health care market that drive out private competition, our state constitution isn't going to make any difference.  Upon reconsideration, however, I think it's a worthwhile effort.  Governmental and corporate subsidization of public education, for instance, has indeed placed a burden on private and home education, but that's all the more reason the right to the alternatives needs to be clearly established.  What's more, if successful, this and similar efforts under way in other states will make a clear point, one which the national government will do well not to ignore.
• The crowd was far from uniform, but a great majority were very worried that we are about to dismantle the best health care system in the world.  As one person put it, sure, there are some changes needed, but if 85 percent of the population is content with the health care they have now, is it necessary to take such drastic action to please the remaining 15?  At the risk of ending up with much more than 15 percent unhappy?
• Dissenters generally spoke well, and made some good points, though sadly they were by and large irrelevant.  It sounds good—and we no doubt need the reminder—to plead that we need to be compassionate and care for the poor and needy, but it begs the question as to what policies will best accomplish that goal.   It reminds me of a "status message" that made its way around Facebook recently:  "No one should die because they cannot afford health care, and no one should go broke because they get sick."  True, but you might as well say, "no one should die, and no one should go broke."  The issue is not a simple, "Should we help people?" but the much more difficult, "What is the best way?"
• Which brings up another point from the meeting:  health care rationing.  Everyone speaks of this as a bad thing, and I agree, but what most people are unwilling to acknowledge is its inevitability.  Thirty years ago a physician friend of ours shocked people with this idea, and I haven't forgotten his logic:  as medical care becomes more and more technological, complex, and expensive, it will become impossible to give the highest level of care to everyone.  He was a Catholic and as pro-life as you could want, but even he spoke of triage, of the necessity of addressing the issue of the best allocation of healthcare resources.  Whether the allocation is done economically (some will die because they are too poor to afford care), or through availability (some will die because they must wait too long or travel too far for care, or because innovations have been discouraged), by policy (the old and disabled will die because care is diverted from them to those younger and more fit), or by some other means, there is no getting around it: people will die.  So far, my own opinion is that the economic allocation is actually the fairest of these, because it holds out more hope for individuals:  financial obstacles, difficult as they may be, are easier to overcome than unavailable care or bureaucratic rules.
• On the lighter side, the crowd at this meeting was not only civil, but educated.  We began with the Star Spangled Banner, sung by the representative's young daughter, who turned out to have a very nice voice.  But you couldn't hear her for long, because most of the audience joined in the singing—and knew the words.  Best of all, the daughter must be an alto, because the song was pitched so that no one screeched on the rocket's red glare.  It's a pity we didn't sing my favorite verse,* but then no one would have known all the words, not even me.
• One final note.  No one should hold a public meeting without giving the audience members a quick lesson in microphone use:  hold the mike close to your mouth if you aren't a trained singer, a regular church lector, or a trial attorney.  Clearly this crowd had not been to enough karaoke bars....

Chocolate Unwrapped:  The Surprising Health Benefits of America's Favorite Passion, by Rowan Jacobsen (Invisible Cities Press, Montpelier, Vermont, 2003)

Like chocolate, this delicious book goes down easily, and the facts about chocolate's health benefits are not hard to swallow.  At a mere 126 pages from introduction through references, it's a quick and easy read—I read most of it on the way to and from church today—and yet manages to cover the history and production of chocolate, a good deal of detail on why chocolate—which begins as a fruit, after all—should be considered a health food, environmental and labor issues in the production of chocolate, unusual chocolate recipes, and list of great chocolate sources.  It is necessary to ignore a few insults to Columbus, the Puritans, and anyone who likes milk chocolate, but on the whole these are minor annoyances.

Did you know that there are three types of cacao plant?  The criollo beans of Mesoamerica have the best flavor; but the forastero beans of South America (transplanted to Africa) have taken over 90% of the market, because their trees are hardier and more productive.  Trinitario, a hybrid of the two, was developed in Trinidad and though it supposedly carries the best characteristics of each, it runs a far-distant second.  It is a familiar story, this choice of quantity over quality:  think instant coffee, Velveeta cheese, cheap wine, Wonder Bread, and red-rock tomatoes.  But as more and more people join the taste revolution, choosing to enjoy whole grains, local vegetables, and espresso, so also are the more flavorful varieties of cacao becoming popular.  And as with wine and cheese, where chocolate comes from—the soil, the climate, the environment—makes a difference in the flavor.

It's not too surprising that the darker the chocolate, the more beneficial components it retains. The author recommends 70% cacao, as beyond that the melt-in-your-mouth effect is lost.  I figure I'm close enough with my Ghirardelli 60% cacao chocolate chips.  :)

And what are those beneficial components?  Legion.  Anti-oxidants galore—it blows away the competition, including blueberries, red wine, and green tea.  "[O]ne good-quality dark chocolate bar can have more polyphenols than two whole days' worth of fruits and vegetables."  You know how some doctors prescribe daily 81-milligram doses of aspirin for its clot-prevention effects?  Turns out a couple of squares of dark chocolate have the same effect.  Hmmm...I know what my choice would be.

Chocolate also contains a whole slew of low-dose, mood-altering chemicals, including anadamide, which is nearly identical to the THC found in marijuana.  Seems those marijuana brownies of our college days did more than just disguise the illegal drug.  (And no, I didn't partake, didn't even have the opportunity.  But I can't follow President Clinton in saying I didn't inhale, because second-hand smoke of more than one kind was unavoidable back then.)  There's a reason eating chocolate makes us feel better.

The section on environmental and labor issues is balanced, pointing out that the issues are complicated.  In attempting to combat child labor on cacao plantations in Côte d'Ivoire, for example, one must take care not to do more harm than good.

For these cacao laborers, a poor-paying job is still better than none.  And preteens working in agriculture alongside their parents has been part of African culture for centuries, if not longer.  Of the one million cacao farms in West Africa, the vast majority are tiny (less than five acres) family affairs. The child labor abuses reported were confined to the few large plantations, but boycotting cacao from Ivory Coast would affect the family farms even more severely than the plantations.

Jacobson supports the Fair Trade program, which has grown beyond coffee to include cacao, and has two sets of standards, one for small farmers and another for plantations and factories.  He also recommends buying organic chocolate, which is grown in a more environmentally-sustainable fashion—and also is more likely to contain the better-tasting criollo beans.

There's one more delightful side effect of Chocolate Unwrapped:  last night I read a section of it out loud after dinner, and Porter immediately brought me a bowl of Publix Chocolate Trinity ice cream and a glass of red wine.  :)

I'm thinking of moving to Canada, and it has nothing to do with avoiding the draft, nor with frustrations over our current political direction, nor because of the recent heat wave in which our near-100-degree daytime temperatures "cooled down" all the way to 85 in the middle of the night—and not even because Canada ranks close to Switzerland and New Zealand at the top of my list of the world's most beautiful places.  No, what makes being Canadian particularly attractive at the moment is this study of the relationship between body mass index and death of more than 10,000 Canadian adults.

Researchers found that while underweight and extremely obese people die earlier than people of a normal weight, people who are slightly overweight actually live longer than those of a normal weight.

[U]nderweight people were 70 percent more likely than people of normal weight to die, and extremely obese people were 36 percent more likely to die.  But overweight individuals were 17 percent less likely to die. The relative risk for obese people was nearly the same as for people of normal weight.

[T]his was the first large Canadian study to show that people who are overweight may actually live longer than those of normal weight.

But wait...there's good news...I may not have to move after all:

An earlier study, conducted in the United States and published in 2005 in the Journal of the American Medical Association, showed similar results.

Gotta love medical studies. You can find one that proves whatever you want.  Now to get my hands on a copy of Chocolate Unwrapped:  The Surprising Heath Benefits of America's Favorite Passion.

A friend alerted me to an article on midwives from the May 20, 2009 Orlando Sentinel.  It's about a recently-developed program of the Orange County Health Department that provides hospital-based midwife services for low-income women in the Orlando area, and told me some things I didn't know about midwives and Florida law.

Knowing from experience that links to Sentinel articles break after a while, I'll provide a few relevant excerpts below.

The program came about after health officials took notice of the positive birth outcomes of women who were working with local lay midwives. Florida is one of only four states in the country where women with little medical training can be state certified as midwives....Legal practice of [lay] midwifery in Florida—one of 25 states that regulate midwifery—is done by Certified Professional Midwives, who must complete training and meet clinical requirements.

"We were seeing low cesarean rates and very low percentage of low birth weight babies," said Dr. Kevin Sherin, Orange County Health Department director. "It was sort of a natural to bring together their successful practice and our resources."

For those of you following the trial of Judy Wilson, Judy is a Certified Professional Midwife.  According to this state-by-state chart from the Midwives' Alliance of North America, the statement that Florida is one of only four states to license lay midwives is incomplete; many other states have licensing procedures in a different form.

But instead of lay midwives, the county hired five certified nurse midwives to work with women at the Lila Mitchell Health Center in west Orlando, where about half the patients are uninsured and the other half are on Medicaid. The clinic also serves a largely black and Hispanic clientele....Certified nurse midwives, like doctors, can use some medical intervention including electronic fetal monitoring, labor-inducing drugs, pain medications and episiotomies.

I'm all in favor of Certified Nurse Midwives—especially the one that delivered Faith —though it should be clear from all the medical interventions listed that they're operating from a different model of care from the midwife in Amish country who delivered Jonathan and Noah.  "Electronic fetal monitoring, labor-inducing drugs, pain medications and episiotomies" are, in my experience, what people who employ the services of midwives are seeking to escape.  This route is not for everyone, however, and Orange County's hospital-based choice appeals to many of the women they hope to reach.

Like a lot of women, Tiana Marrero thought having a midwife meant giving birth at home.  "I was kind of scared," said the west Orlando resident. "Once they broke it down for me, I learned it was a good program that gave you a lot of good information about having a healthy baby.....They give you personalized service. They make you feel comfortable."

"In Hispanic countries, women know all about midwifery. When we tell them about it, they say, ‘Oh, yeah, partera," said Alyn McGee, a certified nurse midwife, referring to the Spanish word for midwife. McGee said women from the Caribbean islands are also well-versed in the practice. Other women, like Marerro, get on board once stereotypes about midwives are debunked.

"There's a lot of education that goes on," said Stacey Gruka, a certified nurse midwife. "When they find out a midwife isn't someone wearing hoop skirts and lighting candles, they feel better about participating." 

I don't remember any hoop skirts, nor can I imagine a midwife wearing one—it would get in the way, horribly.  I don't remember candles, either, but they may have been an option.   I wonder how wide-spread that stereotype is.

It seems to me that hospital-based midwifery is providing the care that obstetricians gave in the 70s and 80s, back when our children were being born.  The practice of obstetrics has changed radically since then, as I wrote in Options in Childbirth.  All women should have legal access to home birth, free-standing birth centers, and midwives for whom medical intervention is a last resort rather than a first response, but Orange County's program is a good middle ground.

So far, the program, under way since last October, has had a cesarean rate of less than 10 percent and low percentage of low birth weight babies. The average cesarean rate is 30 percent for pregnant women who don't have pre-existing conditions such as high blood pressure or HIV infection.

Daniel Hauser, a 13-year-old boy with cancer, is being forced to receive treatment that both he and his parents have refused.

"It is imperative that Daniel receive the attention of an oncologist as soon as possible," wrote Brown County District Judge John R. Rodenberg in an order to "apprehend and detain....His best interests require it."

I often find myself in the minority when I argue for parental rights.  Doctors, teachers, social workers, and "concerned citizens" fret over the idea that parents should be allowed to make decisions that they believe are not in the bests interests of their children.  In one sense it's hard to blame them, as these are often people who are in a position to see better than most the consequences of physical, emotional, and educational neglect and abuse.

However, I insist that, other than in exceptional and egregious cases of insanity or malicious, criminal intent on the part of the parents, we cannot afford to entrust the care of children to anyone else, least of all a bureaucracy.  There's a quote from Rabindranath Tagore that I like:  He alone may chastise who loves.  I would also say, "He alone may decide who loves."  No one else, ultimately, can be trusted.  The judge in this case may be right, he may even be wise, but in no way can we pretend he loves Daniel.

Do I think parents make stupid mistakes?  Yes, yes, yes!  I've made enough myself.   This is where the community comes in, providing education, encouragement, and role models—but never, unless in cases of proven criminality, legal coercion.

Medical ethicists say parents generally have a legal right to make decisions for their children, but there is a limit.  "You have a right, but not an open-ended right," Arthur Caplan, director of the center for bioethics at the University of Pennsylvania, said last week. "You can't compromise the life of your child."

Sounds noble, but consider what it could lead do.  Forced Caesarean sections if a doctor thinks childbirth might be risky?   Forced sterilizations of "unfit parents"?  Court-ordered immunization of children using controversial vaccines?  Jehovah's Witnesses are already being court-ordered to compromise their children's souls through blood transfusions.  (For the record, I don't agree that blood transfusions are a spiritual danger, though they may be a physical one.  But choose your own belief—what if a court ordered you to do something you knew would harm your child?)  It means very little to me that the overwhelming majority of medical opinion be against the parents; at one point in time, the overwhelming majority of medical opinion was in favor of bloodletting as a treatment, and many patients died because of it.

If the rights and responsibilities for children are not to rest securely with the parents, where shall they lie?  Whom do you trust more than yourself to make decisions for your family?  I trust (and rely on) many sources for advice, example, and support, but none—least of all a bureaucracy—for the final decision.  Parents can and will be wrong, but they are still the best hope for children.  The argument is often made that "if one child is saved" through bureaucratic intervention, that is sufficient justification.  What this logic misses is how many children are irreparably damaged by such intervention.  First, do no harm.

More random tidbits found while sweeping the corners of the Internet.

Professor John Stackhouse gives a cheer, a half a cheer, and a hiss to Charles Darwin in honor of his birthday:

[W]e can all cheer Darwin's work in bringing microevolution—the phenomenon of small-scale changes happening within species as they adapt to their environment—into focus. Even "creation science" proponents grant the reality of evolution on this scale.

[M]ost of us will cheer Darwin's work in helping us understand macroevolution, a comprehensive theory of how all species have arisen in the complex history of life on Earth....To be sure, Darwin's theory is not complete in its details. Confirmed Darwinists argue over how life emerged from non-life, how single-celled organisms could have evolved into multi-celled organisms, how various complex organs of this or that organism (most notably the eye) originated and so on. Darwinists also dispute whether the man's own allegiance to "gradualism" was misplaced (as his advocate T. H. Huxley warned him it was). Some wonder whether another understanding of evolution's timetable (such as the idea of rapid evolution in outlying populations—Stephen Jay Gould and Niles Eldredge's theory of "punctuated equilibria") would be better.

Where we theists get off, however, is at the third level of Darwinism, the level of "myth." It's one thing to believe in microevolution and macroevolution. Both of those levels, to be clear, are zones of scientific investigation and disputation. But at the third level—where Darwinism becomes "The Theory of Everything"—we leave the realm of science entirely. Darwinism now functions as a religion, as an all-encompassing worldview and as a "myth" in the anthropological sense—the governing story of a people. It is no longer a scientific theory....Darwinism as myth...makes no room for God or the supernatural. The physical cosmos is all there is—everything important can be explained in terms of physical phenomena. And human behaviour, in particular, is simply a result of the evolutionary imperative to reproduce oneself as prolifically as possible....The world is reduced to a grim arena of competitive reproduction. No more science pursued "to think God's thoughts after him," as the great astronomer Johannes Kepler put it. No more "art for art's sake." No more altruism or heroism or honour.

[H]ere's a cheer for Darwin celebrating the glorious adaptability of species. Here's another for the great sketch of the world as an ever-changing kaleidoscope of variation, improvisation and wonder....But only a sad shake of the head instead for Darwin's dark world, shrunken down to mere sex and violence. There's nothing we can celebrate there.

One of my favorite of Stackhouse's articles appeared in the February 2009 issue of Christianity Today:  Memo to Worship Bands:  Five Sound Reasons to Lower the Volume.  I've become inured to, if not happy about, the necessity of carrying earplugs with me at all times.  I never know when my hearing will be assaulted, though I can pretty much guarantee it at theme parks, movie theaters, skating rinks, and—sadly—church.  I fail to see why volume levels above the threshold of pain are attractive.  "Feeling the music" should be an emotional sensation, not a physical one:  with the exception of some very low bass tones, if the music registers on any part of my body less delicate than my eardrums, it's too loud.

But I'm just an old curmudgeon, so I'm delighted to have a bone fide, rocking, electric guitar-playing lover of loud music, who has no doubt already damaged his hearing, stand up and shout—not rudely, but in order to be heard—"TURN IT DOWN!"

I am not 110 years old, friends. I grew up in the 1970s with fuzz boxes, stacks of Marshall amplifiers, and heavy metal bands loud enough to take on Boeing 747s and win. I have played in worship bands for more than 30 years, and like lots of juice running through my Roland keyboard or Fender bass or Godin guitar. Furthermore, I'm a middle-aged man and my hearing is supposed to be fading. But even I find almost every worship band in every church I visit to be too loud—not just a little bit loud, but uncomfortably, even painfully, loud.  So here are five reasons for everyone to turn it down a notch—or maybe three or four.

1. I know it's breaking the performer's code to say so...but cranking up the volume is just a cheap trick to add energy to a room....Do not compensate for mediocrity by amping it up to MEDIOCRITY.
2. [W]hen your intonation is not very good—and let's face it, most singers and instrumentalists are not anywhere close to being in perfect tune—turning it up only makes it hurt worse.
3. [T]he speakers in most church PA systems cannot take that much energy through their small, old magnets and cones, especially from piano, bass, and kick drum. So we are being pounded with high-powered fluffing and sputtering—which do not induce praise.
4. [C]onsider that you might be marginalizing older people, most of whom probably do not like Guns N' Roses volumes at church. And if you suspect older congregants may be secretly delighted behind their tight smiles, ask them. I dare you.
5. [L]et me drop some church history and theology on you. By the time church music matured...in the 16th century, it had become too demanding and ornate for ordinary singers. So Christians went to church to listen to a priest and a choir.  The Protestant Reformation yanked musical worship away from the professionals and put it back in the pews....The problem today, to be sure, is rarely elaborate music. We could use a little more artistry, in fact, than we usually get with the simplistic and repetitive musical figures of many contemporary worship songs.  No, the contrast with the Reformation is the modern-day insistence that a few people at the front be the center of attention. We do it by making six band members louder than a room full of people. But a church service isn't a concert at which an audience sings along with the real performers. Musicians—every one of them, including the singers—are accompanists to the congregation's praise. They should be mixed loudly enough only to do their job of leading and supporting the congregation.

[C]hurch musicians, if you want to perform a fine song that requires advanced musicianship, by all means do it. We will listen and pray and enjoy it to the glory of God.  But when you are leading us in singing, then lead us in singing. And turn it down so we are not listening to you—or, even worse, merely enduring you. I know that is not what you want to happen. But I am telling you that's what is happening.

I would expand the message to include all church musicians, not just worship bands.  We attend the most "traditional" of our church's four services, which has a choir, not a worship band, and sings primarily hymns.  But the "organ" is actually an electronic keyboard, and a recent change is philosophy has jacked the sound up to the point where I must wear my earplugs almost every time we sing.  It's not easy to sing with earplugs, and I have some concern about blend and pitch...but console myself with the thought that no one can hear me over the organ anyway.  But when the "old, deaf" people in your service complain that the music is too loud, maybe it's time to rethink.

Let me add one more reason to Stackhouse's list:

6.  The church, of all places, should be "safe," especially for children.  In all too many church services, however, babies and children who have no choice nor chance of escape are assailed by sound volumes that threaten to damage their hearing.  If we do not fear the wrath of God for injuring his little ones, let's at least fear the potential for crippling lawsuits.

Dr. Mark Gendreau offers some very reasonable advice, mostly about travel, for those who wish to avoid swine flu or any other airborne illness.  A combination of individual, corporate and governmental action could make a great difference.

[H]and hygiene is...the single most significant thing you can do to protect yourself and your family when you are traveling or out in public.  Study after study shows marked reductions in transmission in public spaces when hand hygiene is practiced, and a recent study found nearly undetectable influenza particle levels after hands contaminated with influenza were washed with either soap and water or an over-the-counter gel containing at least 50 percent alcohol.  Sanitize your hands before eating, drinking and after retrieving something from the overhead bin or returning from the restroom, and you have just cut your chances of getting infected by at least 40 percent. One of my disappointments with the airline industry is its lack of providing alcohol-based hand sanitizers to passengers. Such a service would go a long way in eliminating infection spread within aircraft.

Unlike antibacterial soaps, plain handwashing and alcohol-based hand cleaners have not been shown to promote the development of resistant strains of microbes.  I've always been in favor of handwashing (with plain soap), but it was the advice of a physician friend during the SARS crisis that led to the habit of carrying a pocket-sized bottle of hand sanitizer—particularly useful in restaurants and grocery stores, before the Eucharist at church, after changing diapers in public place, and before consuming airplane food.

Most commercial aircraft in service recirculate 50 percent of the air delivered to the passenger cabin....The recirculated air usually passes through high-efficiency particulate (HEPA) filters before delivery into the cabin.  HEPA filtering of recirculated cabin air to minimize exposure to infectious particles is established within scientific literature, practiced daily in health care facilities and is strongly endorsed by the medical community and cabin health experts.  However...the Federal Aviation Administration, its British counterpart, the Civil Aviation Authority, and Europe's Joint Aviation Authorities do not require the use of these filters on commercial airlines.  Efforts to improve international regulations regarding the certification, inspection and maintenance of aircraft environmental control systems are needed. To minimize the risk of disease spread by aircraft, regulations requiring HEPA filters for any aircraft that uses recirculated air should be seriously considered....In the meantime, you can improve the ventilation at your seat by turning on the overhead air vent to low and positioning the airflow to be slightly in front of your face. This may create enough air turbulence to push a viral particle from landing on your face and mucous membranes.

I haven't tried this portable air filter device, but frequent air travellers might want to consider it.  (Hat tip to Heather.)

Use a surgical mask when you are traveling to areas that have reported cases of swine flu and bring an additional one to give to anyone near you who forgot one or appears to be sick and is coughing or sneezing....A recent analysis of public health interventions used during the SARS epidemic suggests that the use of masks by the public was 68 percent effective in decreasing rates of infection, with simple face masks, and 91 percent effective for more sophisticated N95 face masks.

Okay, so it's very uncool to wear a face mask when ill, but it needn't be so.  "Sick masks" are common in Japan, even amongst the coolest high school students, who see them for what they are:  an invitation to sympathy, especially from teachers and pretty girls.

The only way to eliminate any risk of cross-infection in the aircraft cabin—or the rapid worldwide spread of an infectious agent—is to prevent would-be passengers who are either substantially exposed to or carrying transmissible infections from flying....This needs to come from education and promoting individual responsibility, since the systematic screening of passengers for contagious diseases is impractical. Although thermal scanners used in airports may detect travelers with symptoms, they are not effective since people exposed to an infectious disease could travel without any signs or symptoms and yet still be infectious.

May I suggest a change in the way airplane ticket refunds are handled?  When a family is about to embark on a long-planned vacation, and one of the children begins to sniffle or develops a low-grade fever, it's unlikely that any policy change will make them decide to stay home, as brief, inconsequential illnesses happen frequently to children.  However, many people with health issues are deterred from rescheduling their flights because of the financial consequences of cancelling a flight.  If the airlines had a standing policy of rebooking, at no additional charge, all the members of the sick person's party, I suspect we'd see a substantial increase in the number of people who were civic-minded enough to stay home when ill.  In a health emergency, during which flight cancellations could be expected to have a substantial impact on the airlines' financial situation, it would be appropriate for the federal government to bear some of the burden, much in the same way our local government lifts the tolls on major roads during a hurricane evacuation.

Be prudent, fear not, have fun, and stay safe, my friends.

(This is a follow-up to previous posts:   Options In Childbirth: A Personal Odyssey; The Trial; The Trial, Part II; and The Trial, Part III.)

I am not a lawyer, and I have no idea what Judy or her lawyer really think, but that doesn't stop me from pondering what happened in Judy's trial.  It has been an interesting look into our criminal justice system.  We know, personally, good policemen and excellent prosecutors who work hard for truth, fairness, and speedy justice, so any negative comments are not a blanket indictment, but food for thought.

• I can't help wondering if Heather and Jon were treated differently because they lived in the city, rather than in a wealthy suburb, where the police might be more likely to find themselves facing a lawsuit for interrogating a cold, naked, hungry, and exhausted woman immediately after a traumatic birth and in the midst of unimaginable grief.
• I learned that if you are accused of a crime the police can take away your computer, no matter how essential it is for your for your daily life and business, and no matter how much personal and irreplaceable data is on it.  Memo to self:  buy an "emergency" computer, make frequent backups of all data, and figure out a search-warrant-proof hiding place.  I'm not planning to get in trouble with the police—but who does?
• The proceedings were dragged out for seven years, prolonging the agony for Heather and Jon, leaving Judy and her family in limbo, and incurring great financial costs to both Judy and Allegheny County.  Why not, since there was little incentive for the powers that be to move it along?  The prosecution got what it wanted in the interim—Judy prohibited from doing her work—so why should they rush to judgement, and risk losing their case, as they did?  Delay increases lawyers' fees, and even ordinary civil servants go to work and go home and get paid, independent of whether any one particular trial takes seven years or seven days.  The only person with any incentive for speedy justice was Judy herself.  And in the cases where the defendent knows himself guilty, even his desire would probably be to delay the verdict.  No wonder our court system is overwhelmed.
• I learned something of how frustrating it is for those who know better to see false evidence enshrined as truth.  In this case, the medical examiner, who exhibited an obvious prejudice against all midwives, testified—and his word was taken as authoritative—that the injuries he found on Isaac were due to Judy's efforts to assist the birth, despite the verifiable fact that all injuries except for one (a small mark on the back of Isaac's head) corresponded exactly to the locations of the various injections, sensors, and other bodily indignities that were part of the attempt to save Isaac during his two-day stay in the hospital.  I wish this testimony had been properly contradicted during the trial, but it was apparently not part of the defense attorney's strategy, so it was left to become "truth" forever. (See Jon's comments after this Daley Ponderings post.)
• Knowing that the judge was also a medical doctor, I wondered at the decision of Judy's attorney to go with a non-jury trial.  There is a strong and often acrimonious division between physicians and midwives, especially traditional midwives who work independent of a doctor's control, but even nurse-midwives feel the sting.  My guess is that he knew the integrity of the judge, whereas juries can be swayed by emotional appeals.  The judge clearly wanted to throw the book at Judy, and, had he had the authority, at Heather.  (What he thinks about Jon he apparently kept to himself, but I doubt it's complimentary.)  However, in an exercise of that increasingly rare commodity, judicial restraint, he ruled according to the law, contenting himself with a tongue-lashing from the bench and imposition of the maximum allowed penalty ($100 fine) for the most minor charge of practicing midwifery without a certificate, a grey area in Pennsylvania's law.  (See the ruling in midwife Diane Goslin's case.)
• While I had been hoping for an enthusiastic endorsement of the rights of Pennsylvanians to be attended in childbirth by the assistants of their choice, and of the value of traditional midwives in retaining critical knowledge that is rapidly being lost in an overly-litigious and highly medicalized society, I consider this case a solid victory for midwives, because a judge with an intense desire to convict Judy ruled that Pennsylvania's law would not allow him to do so.

Tribune-Review article, with Heather interviewed

Post-Gazette article, with Jon interviewed

KDKA report, with misinformation including number of subsequent children

Let's not do it again.  Back in 1976, panic over swine flu led to a mass-vaccination program in which nearly a quarter of the U.S. population received immunizations at a cost of $137 million—followed by millions more the government paid out in damages to victims of vaccine-related Guillain-Barre syndrome.  Working in a medical facility at the time, I stood in line and received my free shot and thought no more about it.  However, the whole affair is now considered a debacle, a textbook case of governmental over-response to fears of a pandemic, fears that turned out to be unfounded.  Let's not do it again.

Panic and misinformation are spreading online, aided and abetted by the mainstream news media, which I know from local hurricane reports are adept at the art of crying wolf, deliberately creating fear because fear keeps people glued to the news reports, no matter how little real information is imparted.

Should the government be aware, alert, and prepared to act if this becomes a true emergency?  Certainly.  But let the ordinary citizen take reasonable precautions of the kind we should always be taking (handwashing, keeping sick people home), and avoid spreading panic, which is itself a dangerous disease.

(Standard legal disclaimer:  I am an Ordinary Citizen, not a doctor.  If your doctor tells you to panic, don't let me stop you.)

Here's a perfect funding opportunity for the Bill and Melinda Gates Foundatation, or anyone else who is interested in both technology and education:  Sponsor grants—available to both universities and private video game companies—for the production of really good educational games.

Although video game technology has made tremendous progress in recent years, educational software is for the most part stuck in the past.  Entertainment is where the commercial money is, but with proper funding there's no reason why the best and brightest of our video game designers couldn't revolutionize gaming as a learning tool.

The first thing we'd need to ditch is the idea that entertainment and education are separable, that the one is given as a reward for making one's way through the other.  We want neither 90% entertainment and 10% education, nor the other way around, but 100% education and 100% entertainment.

Consider the possibilities in language learning, for example.  A virtual world that is a total immersion experience, in which one's character must survive by interacting with the native speakers.  Speech recognition technology is good enough that this could be both an oral and a written experience.  One could be learning culture, geography, and more in addition to language by having the virtual world be a real country.

Imagine starting the game and finding yourself in Paris.  You could explore the city, learn to use the metro, convert your dollars to euro, explore the Louvre, enjoy crêpes at a café...all the while picking up French vocabulary and grammar in the most natural way.  I WANT THIS GAME!  Don't tell me it's impossible; I know it can be done.  And I know it can be so much fun the next generation of Americans could actually grow up culturally and linguistically literate—how cool is that?

If our friend's four-year-old son can bowl a 198 in Wii Bowling, the possibilities are mind-blowing.  Yes, I know—Wii Bowling is not real bowling, and Virtual Paris would not be real Paris.  There are some true dangers that our computer models might lead us astry if we don't remember always that they are only models.  But this is too powerful a tool not to be used for good ans well as entertainment.

Tangentially related, here's an article for those like me, who think that video games and computers must be bad for the eyes.  They probably are, under the wrong circumstance, but a University of Rochester study showed they can also be used to improve vision.

People who used a video-game training program saw improvements in their contrast sensitivity, or the ability to notice subtle differences in shades of gray....The training could be beneficial to people who have amblyopia—commonly known as lazy eye—and those who have trouble seeing while driving at night.

Researchers studied two groups that played video games for 50 hours during a nine-week course. One group played action games such as "Call of Duty 2" and "Unreal Tournament 2004." Another group played non-action games such as "Sims 2," which doesn't require precise, visually guided aiming actions. People who played the action games showed enhanced contrast sensitivity compared with those in the non-action game group, with improvements ranging from 43 percent to 58 percent, according to the study.

"When people play action games, they're changing the brain's pathway responsible for visual processing. These games push the human visual system to the limits and the brain adapts to it, and we've seen the positive effect remains even two years after the training was over."

Researchers suggested that the video game training's effect could last for years and could be a useful complement to other eye-correction techniques such as eyeglasses, contact lenses, or surgery. The study, which was funded by the National Eye Institute and the Office of Naval Research, noted that not all action games have such a benefit to the visually impaired.