“Here, let me kiss it and make it better.”

— moms from time immemorial

In a recent post on wellness and woo, a commenter pointed me to one of the most interesting articles I’ve ever read about medicine: Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. The most interesting part of the article (for me) was the idea that — rather than dismissing the placebo response as gullibility and a nuisance to research — it’s an effect that scientists can research, to benefit patients.

One finding was that the health-care practitioner’s empathy can give the placebo response a huge boost:

Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition. Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.

That immediately reminded me of this cartoon discussion of Homeopathy. Despite being just a cartoon, it’s correct that people derive benefit merely from talking to a practitioner about their symptoms.

There’s one big obstacle to using the placebo response in a clinical setting: by definition, the patient has to believe that s/he is getting a real treatment in order for it to work. If the practitioner is intentionally lying, that raises real ethical questions. And if the practitioner is not lying (and believes the bogus treatment is real), that’s even more dangerous. The intentional liar (like the mom who kisses the boo-boo), knows to get a real doctor if the condition is serious. As outlined in the cartoon above, a Homeopath will often continue to recommend only placebos, even in cases (eg. cancer, vaccines) where that advice is totally inappropriate.

Even aside from the danger, there’s the ethical question of selling goods and services through deception and fraud. Here’s a personal example of what I mean:

A couple of years ago, one of my kids came down with pink-eye (conjunctivitis). So I went to a local pharmacy (here in Zürich) and asked the pharmacist to recommend a treatment. I bought the one she recommended. When I brought it home to my husband, he pointed out something I hadn’t noticed — the product was marked “Homéopathie” — and he told me that means it’s just a placebo.

Now, I consider myself to be a relatively well-informed and well-educated person. But a couple years ago (when I bought this product), I had no idea what “Homeopathy” was. As soon as my husband told me it was a placebo, my immediate reaction was that that can’t be. A professional pharmacist isn’t going to recommend me a placebo when I ask for a medicine for my sick child, right? Homeopathy sounds so homey — I figured it must just be another word for “home remedies.” You know, like herbal tea, which might potentially have a physical effect (even if it’s not the same as medicine).

Nope. Homeopathy is not “home remedies.” I later learned that Homeopathy is water. It is placebo pills whose active ingredient is water. (For details, see this earlier post on Homeopathic teething remedies.)

Once I found this out, it pissed me off that the pharmacist would take advantage of my ignorance like that. I know that I’m not an expert on medicines, which is why I went to a professional — and I expected ethical, professional advice. I won’t call it fraud because I’m not 100% certain she didn’t say the word “Homeopathy” at some point when she was pulling this choice off the shelf for me. But since I had no idea what Homeopathy was, the word would have gone right past me without my notice. She certainly didn’t make it clear that she was suggesting an “alternative” or “complementary” medicine. If pharmacists’ professional organizations don’t have guidelines about this sort of unethical behavior, they should.

So the question remains: Is it possible to use the placebo response ethically and responsibly? It’s quite effective and useful in a lot of cases — it seems a shame not to use it. Based on the findings in the above-linked article, I think the following would work:

Create a class of medical practitioners who have enough medical training to dispense basic advice and (important!) who know how to identify symptoms that are serious enough to require referral to a doctor. This practitioner would listen carefully to the patient’s symptoms and offer appropriate suggestions. For example: “Take an aspirin, and if the fever doesn’t go down in a few hours, call a doctor,” or “If you get plenty of rest, your condition should go away in a week or so — come see me again in a few days, and we’ll see how it’s progressing.”

Logically, this should yield the benefits of the placebo effect without the disadvantages. It wouldn’t give any money to “big pharma” — or to the big business of Homeopathy — but it might help some patients. Thoughts?

Episode 5 Raising Happy Kids:

This Week in Parenting Science
* Wait a second – ARE pregnant women more forgetful?
* Girls are just as good at math as boys
* Gender inequity in raising children

Roundtable discussion – How to raise happy kids?

Interview: Christine Carter, Ph.D. from UC Berkeley’s Greater Good “Half-Full” Blog and author of Raising Happiness: 10 Simple Steps for More Joyful Kids and Happier Parents. Dr. Carter discusses how to raise happy children.

Episode 4 Secular Summer Camp:

This Week in Parenting Science
* Vaccine Court Rules Against Thimerosal-Vaccine Link to Autism
* Giving Flu Shots just to kids Protects Entire Community
* Warning for Soft Slings

Discussion of Camp Inquiry

Interview: Amanda Metskas – Camp Quest; Raising Free-Thinkers. Amanda Metskas and our own Laurie Tarr discuss Camp Quest and Camp Inquiry.

Episode 3 What is Skepticism?:

This Week in Parenting Science
* Effectiveness of 1-2-3 Magic
* Infants Do Not Appear to Learn Words from Educational DVDs
* 27% of Children’s Daily Calories Come From Snacks

Round Table Discussion: What is Skepticism?

Interview: Daniel Loxton of Junior Skeptic. Daniel joins us for a discussion about skepticism.

Episode 2 Pop Culture Science:

This Week in Parenting Science
* Marshmallow Temptations Debunked
* Jenny McCarthy Does Not Recant
* The Added Importance of Reading to English Speaking Kids
* Scientist Parents Have Scientist Children

Interview: John Flansburgh of They Might Be Giants

FAQ: Dr. David Elkind – Maximize Toddler’s Learning Potential

Episode 1 What is Secular Humanism?:

Dale McGowan of the Foundation Beyond Belief helps us kick off our new podcast.

FAQ: Dr. Harriet Hall – Is it too late to get a flu shot?

(P.S. If you have questions for the FAQ – please send them to podcastbeyondbelief at gmail dot com. We’ll pick our favorites to send to the experts for their answers.)

(The picture is of my son’s leg after getting his vaccinations)

Andrew Wakefield kicked off the anti vaccination movement with his paper published in 1998 that claimed to show a link between Autism and vaccines. His  findings  have been proven false over and over again. It was also found that he most likely faked his data.

Last week  the UK’s General Medical Council found that Andrew Wakefield acted “dishonestly and irresponsibly” when doing his research. And now The Lancet (who published the paper) has issued a full retraction.

This is very good news and I hope that this will help put parents concerns about vaccinating their children to rest.

In other news, Bill Gates has committed $10 Billion (yes Billion!)  to develop and deliver vaccines to children in the developing world. “We must make this the decade of vaccines,” said Bill Gates. “Vaccines already save and improve millions of lives in developing countries. Innovation will make it possible to save more children than ever before.”

I get a daily email from the American Council on Science and Health called “Health Facts and Fears”. In that news letter Dr Gilbert Ross is quoted as saying of Bill Gates, “We must give credit to him for taking a very effective, targeted, lifesaving approach to charitable giving as opposed to activists, who prefer to wage irrational attacks on substances that have no nexus with human health.”

I’m a Mac girl but this makes me want to buy a PC!

How Safe is the HPV Vaccine

So they explained the controversy, and they had some good takeaways for parents, but all in all, Dateline failed to spend enough time pounding home the multiple studies that have shown no link between vaccines and autism.  Sure, they mentioned the conflicting studies in passing a couple of times, but then they spent an entire segment on an 11-year-old getting a controversial treatment at Dr. Wakefield’s Thoughtful House.  If they truly wanted to have their show be science based, they would have spent a segment on those other studies.

Head on over there and read Rob’s entire review.

Skepdad compiled a fantastic list of blogs, book recommendations, and other links:

These are sites I read, books I reference, documents I consult, or information I find otherwise useful and interesting. I’ve put it here specifically to be a central hub of information (hopefully useful for others) for all things skeptical, science, parenting, educational, or otherwise tangential to that.

Check it out.  You will be reading for days and days.

“As a follow up, this story was online today (February 12) :

http://www.cnn.com/2009/HEALTH/02/12/autism.vaccines/index.html

A special vaccine court ruled that, in the case of three children, there was not enough evidence to support the claim that the MMR vaccine had caused autism. But there will be more court decisions to come. From the article:

“Since 2001, thousands of parents of autistic children have filed petitions seeking compensation from the Vaccine Injury Compensation Program at Health and Human Services.

Novella points out that “the standard of evidence for the compensation program has been significantly lowered recently. To make it easier to compensate families, they only have to provide a plausible theory of injury – not evidence that the theory is correct.”

So, even with these lowered standards for compensation the judges found that  they could not award compensation because the evedence is so strong that, there is NO link between the MMR vaccine and thimerasol and the children’s illnesses.

Special Master Hastings wrote,” The petitioners in this case have advanced a causation theory that has several parts, including contentions  that thimerosal-containing vaccines can cause immune dysfunction, that the MMR vaccine can cause autism, and  that the MMR vaccine can cause chronic gastrointestinal dysfunction. However, as to each of those issues, I concluded that the evidence was overwhelmingly contrary to the petitioners’ contentions. The expert witnesses presented by the respondent were far better qualified, far more experienced, and far more persuasive than the petitioners’ experts, concerning most of the key points. The numerous medical studies concerning these issues, performed by medical scientists worldwide, have come down strongly against the petitioners’ contentions.”

That is pretty clear and direct language and difficult to argue with, although we can be sure the anti-vaccination people will try.

Happily, there is a system set up where families who were actually harmed by vaccines can be quickly and easily compensated, it’s good that that the lower standards of evidence needed for compensation didn’t effect the fact that the overwhelming evidence is that there is no causal link between vaccines and Autism.

All this changed when I had a baby.

It started when I was four months pregnant. I was not even thinking about baby products yet when I got the email from a friend, who had heard from a friend, that it was discovered plastic bottles had some kind of poison in them. My friend kindly attached a link to a “natural baby” website, where all good mothers shopped, with a link to the check-out line for a pair of all natural, organic, non-poisonous Dr. Brown’s glass baby bottles — for the price of $29.95. I did the quick calculations: I’d need at least 10 bottles to be safe, with washing and everything, so at $30 a pair that would be… $150. More than her bouncy seat and swing added together. That didn’t seem like a good idea. Besides, I was pretty sure the whole breastfeeding thing would work out. And that whatever this poison was, they’d probably change their minds about it in a few months.

So I did a little research on the poison involved: Bisphenol A, or BPA, is an organic compound often used in the synthesis of polymers and polymer additives. The problem with BPA is that it gets into your system and acts as a hormone, interrupting your normal systems. While the EPA hasn’t decided exactly how toxic the substance is to adults, or even if the EPA maximum daily dose is “safe” for humans, researchers from the U.S. Department for Helath and Human Services and Yale agree that those most at risk are fetuses, infants, and children. Basically, if you’re very small, even the lowest daily dose will be too much.

And the things this chemical can do to you! Breast cancer, obesity, diabetes, prostate gland enlargement – at a dose of 30 micrograms per day, you can even reverse the normal sex differences in your brain structure and behavior. That’s at HALF the maximum daily dose as recommended by EPA!

I didn’t even get to the end of the side effects list before I started to freak out. There was no time to stop and think. I frantically clicked on the site my friend recommended, but by the time I got there, the store was in back order. “BPA is a deeply toxic material,” the site read. “But we look forward to filling the orders of all concerned mothers and their natural babies just as soon as we can!” This was no time to be using chipper exclamation points, I thought. This is my baby’s sexual identity we’re talking about here.

I wasn’t the only one freaked out by the prospect of feeding BPA to my baby. One site after the next offered their condolences to mothers who were just now trying to order glass bottles. The one exception was Babies ‘R Us. They said they got new shipments of glass bottles every week, so all I had to do was put my name on the email list. As soon as an order came in, they’d send me a message, and I’d go to the store. That seemed simple enough. Until I got the first notice — along with a message that the bottles were already sold out again. This seemed like a mistake. But then it happened again. And again. Finally I decided to go the store, thinking things would be simpler in person.

“I’m looking for Dr. Brown’s glass bottles. Can you help me?” I smiled at the employee. Those hips said she’d had a few babies. I knew she’d understand.

 “Right here.” She gestured to the Playtex bottle feeding system without looking.

 “No,” I shook my head. Playtex is for tampons. “I need the Dr. Brown’s bottles.”

 “Here,” she annunciated, pointing to the empty spot.

Just as she got done saying this, I noticed a group of women gathering. They watched the store back door nervously as they strapped their babies down to their car seats. Slowly, a circle started to form around the door.

“What are they doing?” I asked.

The door flew open.

“Shipment!”

The women moved in quickly. As fast as the employees could unload the glass bottles, they disappeared from the shelves. Eight months pregnant, I lurched forward. Hands and arms bounced off my belly as I barreled through to snatch two packages. BAM! I scored four bottles. It was all I could get.

I spent a good two hours gloating over my victory that night. I even called my friend to tell her.

“That’s great,” she said. “Though, of course you know not to refrigerate your milk in glass containers, right?”

Um, what?

“Oh, sure. I know that,” I said. “Everybody knows you shouldn’t do that because of the—the—”

“White blood cells.”

“Right.”

I could feel another Google search coming on.

Glass baby bottles are better than plastic in a few ways: the material is non-porous, so fat and other nutrients don’t stick to the sides of the bottle. This is good. However, glass bottles are breakable and have a tendency to chip. I don’t even want to think about getting a glass shard in my breast milk. More to the point, What to Expect: The First Year reports that glass should be used only when you plan to feed your breast milk immediately to the baby, because white blood cells from the breast milk attach to glass when that breast milk is refrigerated. Apparently, the cells start to detach after 24 hours, so if you refrigerate your milk for longer than that, or if you choose to freeze your milk in glass containers, you should be okay.

It was the “should” in that sentence that bothered me. Transferred immune function was one of the main reasons to breastfeed, so I wanted to be extra careful with my white blood cells. How would I know if they’d decided to detach by the time I was feeding my baby? How would I know if my baby was getting the full nutrition possible? And the bigger question: How could I ever be sure that the products I was using were truly safe and healthy for my baby?

I turned off the computer and realized I was back to zero bottles. I was completely undone. Sixty bucks on crap I was never going to use. I sank into the couch.

My husband looked up from the horde of plastic sacks that littered the floor, each with unopened boxes I’d brought home from Babies ‘R Us. “But this says the Medela plastic baby bottles have never had BPA in them.”

“Really?” I leaned forward.

He pointed to the large-print propaganda on the side of the Medela Pump-In-Style breast pump. No glass. No BPA. And it came with four bottles included. It wasn’t perfect, but it would have to be enough to start.

Since the baby bottle incident, I’ve realized that even skeptical people like me can get drawn in to the culture of fear. My baby is just that important to me. And sometimes, as with the case of BPA, that fear seems justified. But I try to be rational, and do my research, and resist the urge to freak out.  I try.

One of my students raised her hand and said, “But I have a cousin who believes it does. She’s home-schooling her kids just so they won’t have to get the vaccine. She’s never going to believe this.” And my student is right. The human mind doesn’t latch on to statistics the same way it does to a vivid anecdote about a child who was ‘fine’ one month, and then diagnosed with autism the next, just after receiving the vaccine. We overweight vivid risks (the pain of an autism diagnosis; the chance our baby will never grow up to say “I love you, Mom”) and we minimize the more diffuse risk of a non-immunized population. We coast on the confidence that if all the other kids get the vaccine, the risk to our own child will be low, not noticing that more and more parents are avoiding the vaccine.

I think the fundamental problem arises from what psychologists call an “illusory correlation”, the mistaken impression that two things go together that often arises when vivid, distinctive events are paired. One of the hallmarks of autism is delay of speech, which cannot be noticed in kids before 12-18 months of age because kids are just not expected to speak earlier than that. The MMR vaccine is typically administered between the ages of 12-15 months. So if a parent receives a diagnosis of autism for her child, she will naturally cast about for an explanation. It’s hard to accept that some things just happen, so we look for a way to explain it, to make the universe a little less random. What was it that happened just before the diagnosis? The child received the vaccine. It’s easy to believe that’s the cause, and hard to reject that idea for the explanation that you just got really unlucky. It’s perhaps even harder to recall all the people who got the vaccine and did not develop autism, which is one of the things you’d need to do to consider the probability of this link. But who could summon the emotional detachment necessary to sift through case after case of your friends’ and neighbors’ children who will not face the challenges your own child will? It would not be easy, or even possible, for most of us.

Still, the evidence against this claim is strong. For instance, for many years the proposed mechanism was Thimerosal, a form of mercury, used as a preservative in the vaccine. So, just in case, the compound was removed from vaccines.  Since 2001, vaccines for children younger than 6 years of age have contained no Thimerosal.  If this compound was causing autism, you’d have to expect the number of diagnoses to drop, but that hasn’t happened. The rates of diagnosis have actually increased since 2001. Another way to look at it is this: when you compare large numbers of children who have been vaccinated to large numbers who haven’t, you don’t see a difference in the incidence of autism, and if the vaccine really was the problem, you should.  That’s why scientists come out and say with confidence, “There is no evidence of a causal link,” which in science-speak is extremely strongly worded. But to the average person, perhaps “there is no evidence” is heard as “well, you just didn’t find it yet.” And that gives a very vivid fear room to play.

Science has served the public well when it comes to autism. Fifty years ago, the mental health community believed that autism was caused by “refrigerator mothers”, women who could not show enough affection to their children. If there is a crueler thing than to blame and illness on a parent for not loving enough, I have a hard time imagining what it is. Since that time, we’ve learned a great deal about the spectrum of autistic disorders, and about specific risk factors and treatment possibilities. It’s unfortunate, I think, that the myth about the MMR vaccine continues to get so much attention when there is real scientific work going on that has the potential to be so beneficial to the children diagnosed with autism and to their families.

I’m not pregnant yet and my husband and I have been trying for a while, which is pretty fun, but we recently went to a doctor to help things along a bit. (That’s a subject for another post.) When I mentioned to a friend of mine that that we are going to need a little help from the doctor, my friend looked concerned and said, “I prefer Eastern medicine to Western Medicine in general. Western medicine waits until you’re sick to do anything, but Eastern medicine is about overall health and preventive care.” He then went on to say that Western doctors want you sick because that’s how they make their money.

I immediately pictured my doctor standing outside the exam room with dollar signs in her eyes chanting to herself, “Let her be sick!  Oh, please let her be sick.” and greedily rubbing her hands while I sat on the other side of the door freezing my toes off in that inadequate cotton smock. This image is particularly funny if you’ve ever met my doctor, a lovely, smart, compassionate, funny woman who reminds me of Dr. Bailey on Grey’s Anatomy, but I digress…

My friend’s comments didn’t sit right with me and got me thinking. I’m pretty sure that just about all Western doctors would advise you to eat a balanced diet, exercise, stay rested and if you smoke, to stop. This is free preventative medicine.

Doctors do not get any kick backs from the grocery store when you buy fruit and vegetables, from the sweat suit company when you go for a jog, or from the mattress manufacturer when you get to bed at a reasonable hour.

A purveyor of eastern medicine may or may not give you the same advice, but they will also have you take herbs or receive acupuncture, which they provide at a price.

Hm.

Western doctor: ” You’re healthy, that’s great. Continue to do what you’re doing (eating right, exercising and getting enough rest) and don’t come back (or pay me) until you’re sick. “

Eastern Practitioner: ” You’re healthy…for now, but you need my help to keep you that way. You need to visit me regularly. Oh, and you need these things that I just so happen to be able to sell you.”

I get the appeal of Eastern Medicine. Regular “treatments” and taking herbs make you feel like you are doing something actively healthy, which might be more satisfying then having your doctor tell you to go away and come back when you’re sick. There is something so obvious and mundane about eating well, exercising and getting enough rest.  Those things just aren’t sexy. But in this case the obvious and mundane is also cheap and effective.

Personally, the fact that my doctor doles out free, if somewhat predictable advice, makes me trust my doctor more.