Category Archives: Politics

Breaking news: School kids would rather eat junk!

Well, that didn’t take long…

Fox News reports on an epidemic of “starving” schoolchildren in the wake of recent changes in federal school lunch programs that made the meals a bit healthier.

Shockingly, Fox reporters discovered that part of the problem is that, well, kids would rather eat pizza and chocolate milk than more fruits and veggies, less meat and cheese, and plain old low-fat milk. (Which was true in 1971 at Bishop McNamara High School in Kankakee, Illinois, too–I know this for a fact.*)

Why is this even an issue? Fox’s concern makes a bit more sense when you consider who was behind the school lunch changes: none other than Michelle Obama, whose husband happens to not be Fox News’s choice for president.

Normally I’d pontificate a bit about this, but nobody says it better than Jon Stewart:

*Me, suavely ignoring broccoli, 1971.

“Why is this news?!” he rhetorically asked. “If [Michelle Obama] said we needed clean air, half the country would demand gills, because, freedom!” Stewart said.

Watch Stewart’s take on the “issue” here.

(And yes, it is a bit ironic that Stewart’s video is preceded by an ad for Jack-in-the-Box…)

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Filed under Nutrition, Politics

Michelle Obama and “Let’s Move!”

As anyone who watched her speech at the Democratic convention knows, Michelle Obama is an impressive woman. She’s quite sincere in her concern for children, too, as evidenced by her “Let’s Move!” initiative–an admirable, sensible approach to fighting childhood obesity. (If you haven’t visited the “Let’s Move!” website, here’s the link. It’s worth a look.)

“Let’s Move!” isn’t just a public relations stunt. Michelle Obama has had considerable success in changing the national conversation on childhood obesity, such as putting mega-food producers on notice. I’d like to see her be more aggressive on fast food industry shenanigans (marketing to kids and such), but for now she’s no doubt held in check a bit by her First Lady gig. It’s definitely a vast improvement over the efforts of past administrations, though.

It will be interesting to see what her future holds. I’m betting she gets the girls off to college (after a second White House term), then enters the political fray herself, with Barack tending the garden back home… Should be interesting, and good for children.

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Photo by Statsministerens kontor

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Filed under Nutrition, Obesity, Politics

Poor kids likely to eat more sugar. Why?

Here’s a follow-up to my last post:

The deck really is stacked against poor kids in terms of risks for obesity. Not only are they less likely to be breastfed, which can help prevent obesity, but they’re significantly more likely to have high-sugar, high calorie diets.

Lots of sugar, not much fruit…                      (Photo by Dominic)

Why? Because sugar is cheap and convenient, and poor kids tend to live in neighborhoods where convenience stores–with their snack-and-proccessed-food-heavy offerings–dominate the local market scene. The politics of of American farming has a lot to do with our unhealthy way of eating, too.

The good news is the increase in local efforts to bring fresh fruits and vegetables to the neighborhoods where they’re most needed. Here in Santa Rosa, CA, we have the Megan Furth Harvest Pantry, a mobile, miniature produce market that distributes healthy foods, as well as nutrition education, to needy families with kids five years old and younger.

Megan Furth Harvest Pantry

You can find other examples all across the nation, like this one in St. Paul, and this one in New York. Still, until the big-box grocers venture back into the poorer neighborhoods they abandoned long ago, far too many children will have sugar-heavy, unhealthy diets.

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Filed under Breastfeeding, Nutrition, Obesity, Politics

Breastfeeding (Part 3) and Obesity: A state-by-state review

Okay… I’m about to break my single-post personal record for number crunching and hotlinks. Please bear with me!

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(Photo by sebribeiro)

Obesity is a complicated health issue. A bewildering array of factors— everything from the culture we live in, to the foods we eat, genetics, politics, and the exercise we get (or, usually, don’t)–come into play in determining whether today’s average-sized newborn will become tomorrow’s obese adult.

Breastfeeding helps prevent obesity, as demonstrated here and here and many other places. The association between low breastfeeding rates and child obesity doesn’t get any stronger than this:

The eight states with the highest rates of teen obesity (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Ohio, Oklahoma, and West Virginia) are also America’s eight lowest in exclusive breastfeeding at 6 months of age.

Also:

Of the eight states with the lowest rates of teen obesity (CO, MT, ID, UT, MA, VT, SD, WI), five are in the Top 10 in terms of exclusive breastfeeding at 6 months.

The obesity-breastfeeding association pans out across all age ranges, too:

The 10 states with the leanest overall populations average 21.2% exclusive breastfeeding at 6 months. The 10 most overweight/obese states average 11.5%.

Of course, it’s hard to successfully breastfeed if the support isn’t there:

Now, as I said, there’s more to obesity than whether or not a baby is breastfed. The more obese states tend to have significantly higher rates of poverty than the “leaner” states do, to cite one obvious example. And an association between two variables doesn’t prove one is the cause of the other.

Still… what more evidence do you need to support breastfeeding for all mothers in all situations? In an ever more obese nation, why not give kids the healthiest start we can?

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*(US average is 3.24 IBCLC’s per 1,000 births; the bottom 8 states average 2.49; the 5 states with the highest breastfeeding rates [CO, OR, UT, NH and VT] average 22.8).

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Filed under Breastfeeding, Obesity, Politics

“Optimal Care in Childbirth,” by Henci Goer and Amy Romano: A review

I’m a pediatrician. My interest in childbirth, from the time I finished my obstetrics rotation in medical school until I began writing my book, Birth Day, in the mid-2000s, was focused on what I needed to know in the course of preparing for the arrival of a sick newborn. What’s the gestational age? Any maternal illnesses? How’s the fetal heart tracing? Then I’d set out my tools and watch and wait until my new patient emerged from his mother.

I confess I did not give much thought to what was being done to the mother in the course of her giving birth, whether it was an induction, an episiotomy, or as happened more and more frequently over the years, a cesarean. Babies were my business; I was only peripherally aware of any obstetrical controversies smoldering behind the scenes.

My research for Birth Day was a crash course in the science and politics—especially the politics—of childbirth. I was introduced to the deep divide between what I’ve come to think of as the right and left wings of American maternity care.

At the extremes I saw a clash of incompatible cultures: the “all technology, all the time” (right-wing) camp–which viewed childbirth as a potentially lethal affair and managed laboring women accordingly–versus the solo, unassisted (lefty) birthers whose only desire was to be ignored by doctors and their interventions as nature took its wise, benign course. From many of the the emails I received from Birth Day readers, there really didn’t seem to be much in between.

The research literature of childbirth is the battlefield on which these “baby wars” have long been fought, a landscape littered with studies–some excellent, some awful–that support just about any conclusion an observer might want to make. Take a hot-wire topic like cesarean section. Depending on the biases and prejudices of the author, the same operation can be an unqualified boon to mankind or the devil’s own handiwork. Separating the research wheat from the chaff, the solid evidence from the cherry-picked, can be a daunting task.

So where can a maternity care provider turn for reasonable and reasoned advice? In their new book, Optimal Care in Childbirth: The Case for a Physiologic Approach (Classic Day Publishing), Henci Goer and Amy Romano seek to be that go-to resource—and they succeed.

Professional life has not been easy for Goer and Romano. In the introductory chapters of Optimal Care they describe the conflict between the birth-as-pathology-oriented medical management (MM) model of care so prevalent in the U.S. (the obstetric right wing, in my mental construct), and the low-intervention physiologic care (PC) model that emphasizes birth as a normal event and a major life milestone marking

Henci Goer

the transition to parenthood. Despite the authors’ declaration that “every group that has ever set out to design a healthy maternity care system has articulated the principles and practices” of the PC model, change in the American way of birth has been slow and incremental.

“The [PC model] wheel has been reinvented repeatedly, yet somehow we cannot get it rolling. The obvious question then becomes, Why not?”

Goer and Romano then line up the suspects, usual and not, for the maddeningly unmovable status quo. There’s money, of course—the perverse economic incentives that support hospital maternity wards and the expensive technologies that come with them—and the inertia of entrenched habits and practices. Too, there is the belief held by many women, often reinforced by their maternity care providers, that their bodies are not competent for the task of giving birth.

Interestingly, Goer and Romano also cite the rise of “evidence-based decision-making” in medicine (or, as the late Canadian obstetrician Phil Hall described it, “decision-based evidence making”) as a self-reinforcer of conventional obstetric care. When an evidence-gathering framework designed to evaluate the treatment of  illness is instead applied to a normal physiologic process, the result is an increasingly narrow definition of “normal” and a much broader one of “pathology.”  Of such thinking, the authors conclude, comes the likes of early labor induction, routine episiotomies, and skyrocketing cesarean rates—and the incredibly difficult task of trying to change an obstetric culture so committed to the MM model that the benefits of all births being cesareans is actually considered a legitimate topic of discussion.

“By now you may be thinking that the situation is hopeless; resistance is futile.”

Well, yes, that thought does cross a reader’s mind. The research deck does seem to be stacked in favor of medical management. So, given decades of crying in the childbirth wilderness, what keeps Goer and Romano going? Why haven’t they surrendered to the inexorable march of techno-birthing? How have they not gone completely nuts?

“It is not [hopeless],” Goer and Romano insist, “but those wanting to reform maternity care need a solid foundation in what the obstetric evidence does, does not, or only seems to support, as well as an

Amy Romano

understanding of the impediments to change…”

In other words, you have to fight “science” with science, and that is what Goer and Romano do so well in this fine book.

Optimal Care is a hefty volume–nearly 600 pages—and not every reader will want to plow through it from start to finish. There’s really no need to, though—the book’s structure invites focused reading. Each of its eight sections is divided into chapters that hone in on specific aspects of a more general topic. A reader interested in the subject of episiotomies, say, need read only the twenty pages of Chapter 15 to learn why episiotomies are rarely necessary, and why, despite that evidence, they are still commonly performed. Meanwhile, those who wish to read about a more complicated topic like cesarean section will find an in-depth discussion of the science and politics of that surgery spread over the three chapters of Section II, “The Cesarean Epidemic.”

I found two features of Optimal Care in Childbirth particularly helpful for busy clinicians. At the end of each chapter are concise, bulleted “Strategies for Optimal Care” designed to promote physiologic birth in a variety of settings.  Following that are “Mini-Reviews”—summaries of topic-related research which include, notably, the authors’ reasons for including and excluding certain studies. Goer and Romano are refreshingly upfront about their PC model biases—literally from page one—an honest and rare thing to see in the highly polarized world of modern maternity care.

Optimal Care in Childbirth is a welcome addition to the ever-expanding library of maternity care books. By using science in the service of physiologic birth, Henci Goer and Amy Romano offer a welcome push-back to the all too common view of uncomplicated childbirth as a disaster just waiting to happen.

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Filed under Book review, Cesareans, Maternal-child health, Natural childbirth, Politics

Why ‘Obamacare’ is important for American children

Good news for kids.

“You cannot educate an unhealthy child, and you cannot keep an uneducated child healthy.” Jocelyn Elders M.D., former U.S. Surgeon General

I was one of millions of happy people following Thursday’s Supreme Court ruling that upheld the Affordable Care Act. The ACA greatly expands access to care, benefits, and coverage for millions of children, and if there’s any hope for the future of this country it has to start with healthy children.

It’s difficult for people with health insurance to truly understand what it’s like for those who don’t have it. Or for those who had it and then lost it in the recent economic downturn. And it’s easy to overlook the toll this can take on a child’s chances of success in life.

Here’s one example from my practice:

I took care of a family I’ll call the Swensons for several years. Greg and Connie have three kids, ages 6, 7,and 10. Greg is a welder and his wife Connie was a receptionist at the construction firm where Greg worked. Both lost their jobs about a year ago, and with it went their health insurance. They moved to a neighboring state to live with family and search for work in a more construction-friendly region.

Stephen, their ten year-old, is a very bright boy who suffers from asthma. When they had health insurance and jobs, Greg and Connie were able to keep Stephen healthy, but not without inhalers, allergy medications, and clinic visits.

When Greg and Connie lost their incomes and insurance, though, medications and regular doctor visits quickly ate up what money the Swensons had saved. Stephen got sicker. He wound up in  emergency rooms three times, and then was hospitalized for a few days when his asthma got out of control. He missed about three weeks of school due to his illness, and he was fatigued for a few weeks after that.  It took him the rest of the school year to catch up to his new classmates on the work he’d missed when he was sick.

None of that had to happen. In most other industrialized countries Greg and Connie could have simply taken Stephen to a pediatrician or family doctor in their new home town and stayed on top of his asthma care. Money would still have been tight, but they wouldn’t have had to go deep into debt to keep Stephen healthy and doing well in school.

The American Academy of Pediatrics has a nice summary the ACA’s benefits for children  (see the fact sheets for more details). Take a look–it’ll give you some hope for the future. How anyone can equate that to the second coming of 9/11 is beyond my powers of comprehension.

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Filed under Asthma, Politics

Jailing addicted new moms: A slippery slope?

Two troubling articles about pregnant women, addiction, and the law came out this week.

1) The first, in the most recent New York Times Magazine, describes how Alabama is increasingly handing out long jail sentences to drug-addicted new mothers. The charge? “Chemical endangerment of a child,” a Class A felony in Alabama that carries a mandatory 10-year sentence.

Emma Ketteringham, the director of legal advocacy at the National Advocates for Pregnant Women (NAPW), is particularly rankled by the use of the “chemical endangerment” statute to prosecute addicted women. The law was originally drawn up to protect children from the dangers of parental meth labs and the like; it was never intended to be used against pregnant women struggling with the disease of addiction. From the Times article:

[Ketteringham] argues that applying Alabama’s chemical-endangerment law to pregnant women “violates constitutional guarantees of liberty, privacy, equality, due process and freedom from cruel and unusual punishment.” In effect, she says, under Alabama’s chemical-endangerment law, pregnant women have become “a special class of people that should be treated differently from every other citizen.” And, she says, the law violates pregnant women’s constitutional rights to equal protection under the law.

It also makes it much less likely that an addicted woman will seek help during her pregnancy, thus putting her child in even greater danger–a point which seems to have been lost on the state’s legislators.

The push to prosecute drug-addicted pregnant women is actually part of the larger effort to pass “fetal personhood” laws (which have been introduced as initiatives and measures in 22 states to date), which declare that a fully constitutional-rights-endowed person is created the moment sperm meets egg.  A major problem with this view, according to Lynn Paltrow, executive director of NAPW, is that:

“… there is no way to treat fertilized eggs, embryos and fetuses as separate constitutional persons without subtracting pregnant women from the community of constitutional persons.”

In other words, from the moment of conception a woman’s rights would be superseded by those of her fertilized egg.

2) Okay, so getting jailed on a PWA (pregnant-while-addicted) charge may seem like a distant concern for most Americans–the vast majority of pregnant women in the U.S. are not drug-addicted, after all.

But hold on a moment. As the second article (from the Washington Post) points out, the number of pregnant women addicted to prescription painkillers has tripled in the last decade, including many women who are being treated for very legitimate pain issues–not the “typical” drug addict so often reviled in the media.

The Alabama law makes no distinction between “medical” addiction to painkillers (prescribed after a car accident, say), and “recreational” addiction to heroin or crack, and in a way, they’ve got a point. From a baby’s standpoint it doesn’t matter why mom’s addicted, so why not prosecute them all? There hasn’t been a legal stampede to throw the book at moms on Vicodin as yet, but it shouldn’t take a politically ambitious Alabama attorney too long to figure that one out.

Spending a decade in jail for the “crime” of having a baby while addicted to a doctor-prescribed treatment may seem like a stretch today, but today’s stretch is often tomorrow’s norm. As Rush Limbaugh-esque politicians steadily chip away at women’s reproductive rights, it doesn’t sound so far-fetched to me.

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Filed under Maternal-child health, Newborns, Politics