“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?

One of the things that has been recommended to me many times are homeopathic teething tablets or drops such as Hyland’s.  People swear  it is the ONLY thing that worked for their kid.  They say that they are “all natural” and “completely safe” so there is no harm in trying them! Well, I’ve done some research on homeopathy and yes, homeopathic remedies are completely safe, but it is doubtful that they actually work.

Homeopathic products often get lumped in with natural or herbal products. This confusion is completely understandable. Homeopathic products are marketed that way and are sold next to herbal products and vitamins on store shelves, but homeopathy is a distinct and specific form of alternative medicine.

What is Homeopathy?

Homeopathy was developed in the late 1700s or early 1800s by Samuel Hahnemann and is based on two main principals:

The law of similars or “like cures like”

The law of infinitesimals or minimal dose

The law of similars states that a disease can be cured by administering a substance that causes similar symptoms in a healthy person.

The National Center for Complementary and Alternative Medicine (NCCAM) explains it like this:

The principle of similars (or “like cures like”) states that a disease can be cured by a substance that produces similar symptoms in healthy people. This idea, which can be traced back to Hippocrates, was further developed by Hahnemann after he repeatedly ingested cinchona bark, a popular treatment for malaria, and found that he developed the symptoms of the disease. Hahnemann theorized that if a substance could cause disease symptoms in a healthy person, small amounts could cure a sick person who had similar symptoms.

Abchomeopathy.com uses this example:

For example, if the symptoms of your cold are similar to poisoning by mercury, then mercury would be your homeopathic remedy.

By that logic, if I’m having trouble sleeping I should drink a very small dose of caffeine. I’m just sayin’.

In Hahnemann’s defense, he developed his principal at a time when the predominate medical theory was to “balance the body’s humors” by treating a disease with its opposite which included letting out the offensive matter causing the illness by bloodletting, purging or enemas. His law of similars was at least partly a reaction to these horrifying and harmful practices. The thing is that when people got more information about how the body and the world work, bloodletting was abandoned in favor of a more effective and provable system.  But homeopathy continues to use the law of similars even though there is no conclusive evidence that it is effective or even plausible.

The law of infinitesimals states that the smaller the dose of the medication, the more effective it will be.

Again NCCAM explains it like this:

The principle of dilutions (or “law of minimum dose”) states that the lower the dose of the medication, the greater its effectiveness. In homeopathy, substances are diluted in a stepwise fashion and shaken vigorously between each dilution. This process, referred to as “potentization,” is believed to transmit some form of information or energy from the original substance to the final diluted remedy. Most homeopathic remedies are so dilute that no molecules of the healing substance remain; however, in homeopathy, it is believed that the substance has left its imprint or “essence,” which stimulates the body to heal itself (this theory is called the “memory of water”).

ABC Homeopathy explains it like this:

Minimal Dose
The remedy is taken in an extremely dilute form; normally one part of the remedy to around 1,000,000,000,000 parts of water.

That’s a trillion! That’s a whole lot. That is so much that the likelihood of there even being one molecule of the substance left in the remedy in your bottle is next to zero.

The “law of minimal dose” contradicts the laws of chemistry, physics (yes, even quantum physics) and, in my opinion, common sense. By this logic, the less alcohol you drink, the more drunk you should feel. (This isn’t an actual claim made by homeopaths, but I’m using it to illustrate the point.)

As NCCAM states above, homeopaths believe that the healing substance leaves its imprint or essence in the water and that the water has a memory of the substance. As of now there is no plausible explanation of how this can happen.  Even if water does have a memory, how does the water know to keep the memory of that particular substance and not all the other stuff (urine, fish spawn, etc.) that has been in it before?  Let’s say that homeopaths have a way to purify or flush the memory of the water, how does the water know not to remember the essence of the container that they shake it up in?

Even the NCCAM acknowledges that homeopathy is inconsistent with established laws of science:

Homeopathy is a controversial area of CAM because a number of its key concepts are not consistent with established laws of science (particularly chemistry and physics). Critics think it is implausible that a remedy containing a miniscule amount of an active ingredient (sometimes not a single molecule of the original compound) can have any biological effect—beneficial or otherwise.

I agree that if a remedy is truly homeopathic then it is safe and will have no harmful side effects. The problem is that it will have no positive effect either. Or at least no effect beyond that of a placebo.

From NCCAM:

Most analyses of the research on homeopathy have concluded that there is little evidence to support homeopathy as an effective treatment for any specific condition, and that many of the studies have been flawed. However, there are some individual observational studies, randomized placebo-controlled trials, and laboratory research that report positive effects or unique physical and chemical properties of homeopathic remedies.

From Wikipedia:

Health organizations such as the UK’s National Health Service,[121] the American Medical Association,[11] and the FASEB[103] have issued statements of their conclusion that there is no convincing scientific evidence to support the use of homeopathic treatments in medicine.

From Pub Med:

CONCLUSIONS: The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.

Teething

Whenever Duncan seems to be in a lot of pain from teething I give him some infant Tylenol or Motrin and that seems to help, but if you are looking to avoid these medications there are plenty of other things you can try.

Remedies seem to fall into two broad categories: 1) cold things to chew on and 2) various textures to chew on.

In the first category there are any number of teething rings that you can put in the freezer.  I’ve also heard of people freezing bagels, carrots and pieces of fruit for the little ones to chew on. I know it sounds a little gross, but my son likes to chew on an ice cube wrapped in a clean washcloth.

In the second category, my son loves the Wee Play Hand and Foot Teether. You can also try plush toys or wooden teething rings.

Teething is no fun and all we can do is try and help our babies be more comfortable as they go through it. If you still have some of those homeopathic teething drops in your medicine cabinet, I recommend freezing them into an ice cube, wrapping a washcloth around it and letting your kid chew on it. That is the best use of a homeopathic remedy.

If you would like to learn more about homeopathy, here are some good articles and videos:

http://video.google.ca/videoplay?docid=2785985155605802136&q=James+Randi#

http://www.acsh.org/healthissues/newsID.632/healthissue_detail.asp

http://www.skepdic.com/homeo.html#why

Some of the myths discussed include sitting too close to the television, eating carrots, and contact lenses. My favorite nugget of information:

“If a child is sitting too close to the TV or computer screen, it is probably because he needs glasses to see well. Sitting very close to the screen will not cause them to need glasses,” said Dr. Borchert.

To make your child’s computer station more comfortable, make sure the screen is at eye level. Reduce screen glare by using a desk lamp with a dimmer so there isn’t a big contrast between the brightness of the screen and the room. Make sure your child can’t see her own reflection on the screen.

I’ve been hearing a lot about Baltic Amber Teething Necklaces, and here’s a little photo of one from this site, which is just one place you can buy them.  The idea is that the succinic acid in the amber is released by the warmth of the baby’s skin and is a natural analgesic.

I couldn’t find any studies about this at all and I think I’ll stick to Infant Tylenol.  The obvious drawbacks of a baby wearing a necklace seem to have been noticed on this particular site, which states in a disclaimer:

Although we have never had any any incidents that have resulted in harm to infants, there is always a chance they will break the necklace apart and perhaps swallow one of the beads.

Um, duh.

If anyone does have any reliable information about how this necklace might actually work, I’m curious to read it. But since many of the sites selling these things also claim that the necklace will align my baby’s energy, I just have to be extremely skeptical about this one.

To sum up the following pages, the vaccine is similar to the seasonal flu vaccine and yes, multi-dose vials do contain thimerosal.  There is a single dose vial available which does not contain thimerosal.  Thimerosal is a preservative that has been removed from most vaccines because of concerns about a link to autism, but no such link was ever proven.  Because the flu vaccine has to be manufactured quickly in large batches, it requires some kind of preservative in multi-dose vials so it doesn’t become contaminated with bacteria and fungi.  (Yech.)  Links:

General Questions and Answers on the H1N1 Vaccine from CDC

General Questions and Answers on Thimerosal from the CDC

And now let’s get to straightening out some of the lies.

Harriet Hall on Science Based Medicine does a great takedown of the fear mongering surrounding the H1N1 vaccine.

A favorite quote:

Claim: People should be allowed to “self-shield.” For self-shielding you go home lock the doors and stay there. Then you can try to further protect yourself with nano-silver, homeopathic remedies, cold packs, vitamins, flavonoids, zinc, astaxanthin, magnesium, and other stuff.

Fact: A self-imposed quarantine is better than nothing, but I question whether it would be effective in practice. The suggested (untested) remedies might conceivably keep people entertained so they are more willing to stay home.

Hee hee.

“More on flu woo” on Science Based Medicine explains some other misguided thinking about the flu.

And finally, an “Influenza Primer” on Science Based Medicine explains why this flu is different from normal seasonal flu.

If you just read or even skim these articles, you should be reassured that the benefits of the H1N1 vaccine outweigh the risks.  And you can make an educated decision about who in your household should get the vaccine.  We’re definitely getting our 15-month-old son vaccinated, and I will probably get vaccinated myself.  I am not among the groups listed as high priority, but I work in a public school, and I’d like to minimize the chance that I will get swine flu.

If I were pregnant or trying to get pregnant, I would not hesitate to vaccinate myself against H1N1. So far, the 2009 H1N1 virus has affected pregnant women more severely than the general population.

So that’s the real information.  Next post, I’ll muse about some of the misinformation I’m hearing in my neck of the woods.

duncan @ five minutes

By Dean Cameron

This past August 1, 2009 at 10:45am, my son, Duncan Huxley Cameron was born.

Not only is he quite a bit bigger now than he is in that photo, his ability to melt me with a look, has increased.

We are raising him as rationally as possible. Obviously, he’ll make his own decisions about how to interact with his world, but we’ll tell the truth as we see it and let it go. There’s plenty of woo out there for him to encounter and deal with on his own, so we don’t need to burden him with more at home. It’s going to be intersting as, even before he was born, people I consider rational were saying really weird and irrational things.

It makes sense, I suppose. There’s so much about having a child that is completely out of ones control that, like the rest of life, we tend to look for patterns to apply to random things. Here in the west, where we have an abundance of food and nutrition, once you’re out of the first trimester of pregnancy, if you’re not behaving like an idiot, your kid is probably going to come out just fine.

But… because that stuff is out of our control, people start making up rules to follow. Sure, some of ‘em might make sense and actually keep you healthy, but, again… as long as you’re not being an idiot, that kid is going to come out and, most likely, come out fine.

Childbirth as an Extreme Sport
Extreme Sports came about because of great medicine and the boredom of practice. Back in “ye oldene tymes” no one, except for inventors, had the time or inclination to go hang gliding because a) broken bones meant death or worse, suffering and disfigurement for the rest of one’s life and 2) life already had enough fucking terror, what with everyone dying because of disease and war.

Here in the future, if you survive a hang gliding crash and break your legs and crack your spine, the worst part is your drunken friends driving you to the hospital in the back of the 4-Runner. After that, it’s 6 weeks off of work, Fentanyl Patches and 150,000 hits on YouTube. As far as skill goes, it’s a matter of being able to buy the gear. The wealthier you are, the more three day weekends you can spend hang-gliding and the better gear you can buy. You can’t buy the skill that comes spending 4 hours a day doing boring tennis drills for your entire youth.

So, like extreme sports, unless there is a rare complication, the sheer terror of having a child is gone. Western Infant mortality rates are extremely low and mothers dying in childbirth is almost non-existent so, to shake things up, we make it exciting by having a kid at home or with people beating drums or standing up in the shower or in a hot tub with your family there or in a dumpster behind chuck e. cheese. If something goes wrong, you’re a quick ambulance drive away from the hospital and all is well.

(A side note… We had our son at Cedars Sinai here in L.A. Our hippie friends told us that it’s a bad place to have a child because they have such a high record of emergency births. We aksed (yes, aksed) the doctor about it and she said the emergencies were mainly home deliveries gone haywire and since Cedars has the best Natal Intensive Care Unit, the botched home births are rushed to Cedars.)

“Pitocin is Evil!!!”
Because we wanted to feel like we were “doing something”, the bride and I went to a Lamaze class. I made it through the three hours without having an episode. I’m not sure why; perhaps it’s the extreme sports thing, but we encountered quite a bit of anti-science bias associated with having a baby. The point of the Lamaze method is to have the baby “naturally”. Since we’re living in the future and having the baby at a hospital “natural” really just means “without an epidural”. This is fine, if that’s how you roll, but there was no reason for it. The instructor hinted, quite strongly, that it’s better for the baby if it’s “natural”, but wouldn’t come out and say as much (because it’s not true). She made the claim that medical students today aren’t shown “natural” child births. When I questioned her about this; pressing her for a source for her claim, she said she learned the med student facts from “articles”. The larger subtext was that women who chose to receive epidurals were less woman than those who went without because they weren’t completely experiencing the delivery. Not only that, it is, somehow, better for the child if it’s “natural”.

Yep, after a full term of pregnancy what’s really going to have an affect on junior is that final few hours.

We were told “don’t let them give her any drugs!!!” a couple of times. One of the drugs that the bride was given was Pitocin, a drug that induces labor.

Back in the “good old days” one of the many ways a woman could die in childbirth was bleeding to death after being ripped open by a too large baby.

Duncan was full term and ready to come out, but the bride’s body wasn’t ready to let him go. Instead of waiting another two weeks and getting a Caesarian, or worse, a drip of Pitocin induced labor and we were on our way. (Before you say “body knows best”, aks yourself if cancer is the body knowing best?)

When you google Pitocin, the very first result is an anti-science web page, childbirth.org. It’s so sad. It looks official, but it’s just some anti-science people picking and choosing their facts and scaring people.

We were told that Pitocin keeps the mother from producing milk. Once the bride had the epidural she was able to calm down, as she didn’t realize how freaked out she was. It was only a matter of minutes after the Pitocin kicked in until she began pushing. Duncan was born within the hour. The bride was breast-feeding almost immediately. So much for the horror stories.

(I know, personal experience is one of the worst ways to come to an understanding of how the world works. I’m just saying that our experience with Pitocin and the epidoodle was aces! )

The bride is a genius. She made the point that people now use bleeding edge science to get pregnant; in vitro pregnancies are so common now, and that is, rightfully, considered a beautiful and excellent thing. BUT, using science for the delivery cheapens the experience. If someone is of the mind that “nature knows best” then why take the shortcut around nature and go in vitro? Hmm?!?!

Genius, I tell you. Genius.

Infants as Unemployment Insurance
Since the turn of the century (I love saying that!) I was fortunate enough to have a nice career doing voice overs for radio and television. I began the century writing front end code at an online games web site. I also helped a friend develop a web service, Tightcircle.com, which he later patented and sold to an “unnamed company in Mountain View, California”. My main income was voice overs and I would, occasionally supplement it by doing web work.

About two years ago, the voice overs began slowing down. Thanks to strikes and technology, fewer people were needed to do voice overs. Finally, the work seems to have dried up almost completely. I had been averaging a couple of gigs a month. At this point, I haven’t had a VO gig since early 2008.

Once we discovered the bride was with child, I began looking for web work in earnest. Thanks to technology, I found myself a bit behind the curve as far as front-end coding goes. I’ve been on all the tech job boards for years so I started scouring those and other resources and by January of this year started sending out at least 2 resumes a day and doing tutorials online on the stuff I’d missed.

Our plan had been that by the time the bride finished her latest editing gig, I would either have some foot back in showbiz or a web coding gig. Unfortunately, that wasn’t happening and it began getting hairy.

I kept hearing “babies bring luck” and it only pissed me off more. What is the method? How does it work? Gravity? Hmm. The week before Duncan was born, I received two job offers. Some poor soul on MyFaceSpaceBook wrote “babies bring luck!!!” and I kinda/sort jumped down her throat. See… by saying that not only are you simply being an idiot, unaware of confirmation bias, you are discounting the work I did to get those jobs. If a baby is born every minute, wouldn’t there be more “luck” in the world? I can’t even begin to start deconstructing this…. The week before he was born, I had to put a new radiator in my car. Lucky? As Linus Van Pelt often said: Aaargh!

Pisces Virgo Rising is a very good siiiiignnnnnn
Racism is just lazy. Instead of investigating cultural differences, racism just lays down blanket statements about large groups of people. The only criteria is how they were born. Not who they are. People are different through their cultures, but it’s more about geography than biology. But, even then, I realllly hate it. It makes me so sad when I hear someone describe themselves based on their race. “I’m Italian, I can’t help being jealous!” Well, you were raised to think that. It has nothing to do with you being Italian, except everyone you know who is Italian has told you that you can’t help but be jealous. There are lots of Italians who aren’t. I bet there are Italians at swingers clubs.

The worst manifestation of racism is astrology. Because of the date and time of your birth, you are endowed with personality traits that are inescapable.

I think this is so maddening to me because I’m a Taurus.

duncan y bride @ one minute

But seriously… This country was created so we can be free. We are free to try to do whatever we want and be whoever we want. We are free to choose our own identity and make our own lives and yet people voluntarily yoke themselves with zodiac signs, shrug and say “I can’t help that I’m clumsy, I’m a gemini”.

Obviously, you are absolutely free to do this in this free country. You’re totally free to hamstring yourself or create excuses based on your deep misunderstanding of the gravitational effects of the planets. Please don’t do it to my son. Please don’t tell him how he is before he can walk. Please don’t make up your mind how he is before he can walk. Let him find out who he is and how he is. It’s going to take a long time and, this is important: it will change. Duncan may start out shy and become an extrovert, but let’s not keep him one way by telling him it’s preordained. It may be. But it’s not because of the moon and jupiter. As William Shakespeare wrote: “I should have been that I am, had the maidenliest star in the firmament twinkled on my bastardizing.” (Edmund has a great deconstruction of astrology in King Lear.)

There are so many real mysteries and phenomenon, both explained and unexplained, associated with infants. When does he begin recognizing us? Is he thinking abstractly? How does language happen? The nature/nurture question. All of those things. They are fascinating, vexing and beautiful. Why throw crap in there like ass-trology, babies bringing luck and anti-science? I loved him before he was born. Isn’t that enough?

One viewer went online to ask McCarthy what she would do if she could do it all over again. “If I had another child,” McCarthy answered, “I would not vaccinate.” A mother wrote in to say that she had decided not to give her child the MMR vaccine because of fears of autism. McCarthy was delighted. “I’m so proud you followed your mommy instinct,” she wrote. A year later, McCarthy was back on the show for an episode about “Warrior Moms,” which gave her another opportunity to expand on her claims about vaccines and autism. Oprah must have liked what she heard. McCarthy became a semiregular guest on the show, and in May, Oprah announced that her production company had signed McCarthy for a talk show of her own.

The article discusses Oprah’s fascination with The Secret, and this little story cracked me up:

This is a great example of a post-hoc ergo propter hoc fallacy. Obviously, women who are past their due date are going to give birth any day. So they eat The Salad, go into labor, and attribute the onset of labor to The Salad.

One day, in a prenatal yoga class, a couple came by to show off their new baby. “By the way,” said the husband, “The Salad doesn’t work!” He detailed his and his wife’s efforts to induce labor. I was thinking that he had possibly learned that the whole myth of The Salad was a post-hoc fallacy, until he said, “What finally worked was Thai food! We ate it, and she went into labor that night!”

So there you have it. Whatever you eat the day you give birth gets the credit for bringing your child into the world. It couldn’t possibly be that you were nine months pregnant, after all!

As it happened, my son was not only late but seemed to have no intention of making an appearance. The days after my due date crept slowly by. My husband and I would wake up every day, both off from work, with no idea of how to occupy ourselves. Invariably, we would somehow end up at Target or Babies R Us, buying more stuff for the child we hoped would come soon. The eleven days of waiting were beneficial for the economy of baby goods, thanks to us.

I thought for sure my doctor would want to induce labor, but I did not dilate or efface or in any other way progress. He proclaimed me “not even close to induceable.” And as we waited for anything at all to happen, my son grew inside me to record levels. Even now, he is quite literally “off the charts,” and he was a very big baby when he was born. Had I ever started labor, I would have argued to try to do things the old fashioned way, but I didn’t have a leg to stand on. I simply never began to labor at all, and a final late ultrasound revealed that our baby was like a ship in a bottle inside me.

My doctor scheduled a c-section.

I was disappointed with this outcome, and as a lark to cheer me up, my husband and I went to Caioti Café and ordered The Salad. We grabbed the journals, and I wrote something to the effect that The Salad would definitely work for me, since I knew for sure I was giving birth the next day! If I actually went into labor, I joked, I would chuck out my beliefs in science.

The waitress saw us laughing and said, “No, you’ve got to believe it! You have to have faith.” If it worked, we told her, we might. But we knew it wouldn’t work, and she was too busy with other tables for us to explain that no one should believe in The Salad.

My water broke the next afternoon, six hours before my scheduled c-section.

Okay, no, I didn’t give up my skeptic outlook and become a salad follower. I just thought the whole thing was kind of funny. But my success with the salad inspired a friend of mine, who was six weeks behind me in her pregnancy. She ate The Salad several times after her 39th week, hoping to bring on an early birth. Nothing happened at all, except that she had a delicious and healthy lunch. She finally was induced into labor about a week after her due date.

Los Angeles is a huge place, and I like that there’s a quaint local custom like this nearby. It makes life a little more fun. It gives pregnant women something to talk about. It alarms me just a little that The Salad is part of a larger issue I have with the world—that people believe silly things. But at least it tastes good.