I guess I don't really have anything to add to that, except that it continues to surprise me how many parents I know embrace the Santa thing. In part I think it has to do with happy childhood memories; if you believed in Santa and didn't feel traumatized by the disillusionment, you're more likely to want your kids to have the same experience -- or to want to revisit the belief yourself.
There are lots of good reasons not to lie to your kids, especially about something so trivial. I mean, really, the default should always be honesty unless there's a particularly good reason to lie. And this is what gets me about the Santa thing: no one ever gives a good reason for doing it. "Magic," they say, as if the very absurdity of the story justifies it. The thing is, it's only magical to grown-ups, because we're the ones who live in a world where Santa cannot exist. It's not particularly magical to children, because so many explanations are beyond their comprehension, and so much of their understanding is about taking our word for stuff. Is it so much more magical to think that a fat dude in a red suit delivers presents down the chimney than that a burly dude in a brown uniform brings them from grandparents in Wisconsin to your front door in Schenectady? To us, sure, but to a little kid? So is it really about making more magic in their lives, or is it about reliving the magic of our own childhoods?
As a kid who grew up knowing presents came from mom and dad, I can assure you that there's no lack of magic on Christmas morning for kids like me. You can even indulge in some of the Santa stuff -- I certainly got presents "from Santa" and left out cookies, knowing full well that Mom and I were playing pretend (Dad not so much a participant in the Santa thing), and enjoying it no less, and maybe more, for the knowledge. At the age when most kids are learning The Truth about Santa, I could throw myself wholeheartedly into the fantasy because it was never a matter of True or Not True; it had always been a myth.
I should probably leave well enough alone, but I went to bed last night still thinking about the anti-circ petition and what I'd said about it, unable to let it go, and convinced I'd become bogged down in nitpicking the text instead of making the bigger points that were really under my skin. (Ew, how did I end up with lice metaphors?)
So, allow me to beat this dead horse.
I don't think opposition to routine circumcision is wrong -- generally I find it reasonable and justified, and though I chose to circumcise my son, I consider myself an opponent of routine circumcision. But this petition obliterates any respect I might ever have had for the sense of anyone involved with it because it A) seeks to shut down debate rather than encourage it, and B) shows no respect whatsoever for science or expertise.
If you have taken a position based on a reasonable interpretation of factual evidence, you should never be afraid to hear new evidence that tests your position. If you're correct, new evidence will bear you out. If you're incorrect, why would you want to maintain your position? Similarly, you shouldn't be afraid to argue the point, especially with an expert in the field. Opposition to routine circumcision isn't an irrational position and has considerable foundation in medical science, so of all the responses available to a potential challenge, why on earth choose the one that boils down to SHUT UP SHUT UP SHUT UP LALALALALA WE CAN'T HEAR YOU?
I can't fathom what motive the authors and supporters of the petition ascribe to the CDC for doing something so unethical and counter to its mission as ignoring -- not insufficiently weighing, but ignoring -- the risks of a procedure it is considering recommending. The CDC is not some crazy bunch of penis-mutilating yahoos. It is a body of public health experts. Being human, of course, they are fallible and certainly have biases of their own. It is foolish to take their word as gospel, but it is equally foolish not to accord them the respect their expertise deserves. If we could all conduct research and draw appropriate conclusions, we wouldn't need scientists, but the fact is that we're all a little busy doing other things, and many of us plumb ain't smart enough, and few of us have the talent or training, honed over a lifetime, to conduct or interpret the kind of medical research that the CDC is reviewing before making its recommendations. Skepticism is fine -- it's admirable even -- but when it crosses the line into anti-intellectualism, into opposition to science itself, it deserves a smackdown.
Though I chose to circumcise my son, I do not support routine circumcision. But if the CDC is considering recommending it, I'm certainly interested to hear why. What research, what interpretation of the research, could support such a radical position? I look forward to the opportunity to re-evaluate my own position in light of new evidence or new argument. I look forward to hearing the opposition's response -- if it's rational, if it's based, as the CDC's certainly will be, on evidence and informed interpretation.
I definitely look forward to any chance to improve public health. If it turns out that the research demonstrates that routine circumcision actually does provide a significant protection against deadly STDs, against cancer, wouldn't that be good news?
*I'm so sorry. I'm 12, and I can't write two whole blog posts about penises without a single bad pun.
Circumcision is not a big issue for me, though of course I'm aware that it's one of those parenting third rails, like breastfeeding and vaccination. I did a lot of reading about it before Ben was born, and the most I could muster was a mild bias against, based on a general principle of avoiding all non-crucial surgery. At the time, there was some not-extraordinarily-significant research supporting circumcision as plausibly prophylactic against certain STDs, and the combination of that, Andy's more-than-mild-but-not-very-strong bias for, and the extreme discomfort and embarrassment of a family friend who had to be circumcised for medical reasons in his 70s added up to a Yes. There's also in there somewhere, in a way I can't possibly justify, a weird little family-cultural / atheist-but-CYA adherence to the covenant. Or comfort in the tradition. Or notion of tribal belonging. Or something.
Anyway, like I said, it's not something I can work up a lot of strong feelings for or against, and it's one of those things, like whether you use a baby carrier or stroller, that I have a hard time understanding why some people are excited enough about to advocate publicly rather than simply decide for themselves. But I do feel strongly about this petition, strongly enough to have broken my own very sensible rule about not picking fights on Facebook.
Here's some of what Mothering says:
Based on flawed studies that ignore the risks and ethical concerns of infant circumcision, the CDC may recommend this unnecessary surgery for our baby boys. We know that safe sexual practices and abstinence – not circumcision – prevent sexually transmitted diseases. And we know that there is NO link between infant circumcision and better health.
We will be delivering our petitions to CDC headquarters in April with the hopes of convincing them to make the right decision.
Mothering doesn't specify which studies it considers flawed and what those flaws might be. Unlike the CDC, it doesn't cite references. The CDC's fact sheet on male circumcision contains a useful paragraph, helpfully titled "Risks Associated with Male Circumcision," which includes no fewer than eight cites to studies that explicitly did not ignore the risks of the procedure. Mothering doesn't state its ethical objections, but I'm guessing they have something to do with the fact that an infant can't consent. And that's not something to dismiss out of hand, but we make decisions for our children every day, and that kind of ethical hairsplitting simply can't weigh heavily against substantive evidence (should there prove to be any) that performing the procedure would be a significant benefit to public health.
Motheringknows some stuff. Again, they don't cite references for how they know circumcision doesn't prevent transmission of STDs or how they know "there is NO link between infant circumcision and better health." And this kind of arrogant ignorance professing knowledge just honks me off. Take the claim that there's NO link between infant circumcision and "better" (as if that's even a meaningful or specific term) health: the American Medical Association says in this report, "there is little doubt that the uncircumcised infant is at higher risk for urinary tract infection." Smaller risk of UTIs = "better health"! But that's hardly the point, is it? The question isn't whether circumcision has any health benefits whatsoever (the most cursory review of current research makes it clear that it does); the question is whether the benefits are significant, whether they outweigh the risks and justify the costs. The ability to make that kind of essential distinction is only one of the reasons we trust the CDC before Mothering magazine to advise us about public health issues.
Mothering claims to want to convince the CDC to make the right decision. But to convince someone of something, you need to present an argument -- ideally with some evidence to back it up. A petition is not an argument. It's political pressure. It's a more or less polite way of ganging up. And I think we should all think very carefully about whether applying political pressure to the CDC is something we'd want to put our names to, or something we seriously think a group like the CDC should allow itself to be persuaded by.
It would be one thing if the petition advocated further specific study, if it made specific criticisms of the evidence, if it provided, in other words, an evidence-based argument to which it could then legitimately claim the CDC wasn't giving enough credence. But that's not what the petition advocates. Here's the text of the introduction:
No medical society in the world recommends male circumcision – yet newborn male circumcision is the most common surgical procedure in the U.S. This painful and risky procedure deprives more than a million boys each year of healthy, functional tissue – without their consent – while increasing medical costs by an average of $678 per baby.
The Centers for Disease Control (CDC) is developing public health recommendations for the U.S. on male circumcision that could ignore the serious risks of this non-therapeutic surgery. As the foremost expert on public health in our country, the CDC has a responsibility to share the truth about infant circumcision.
We need just a few more signatures to help us reach our 25,000 goal before the end of March. Sign our petition to the CDC below and demand a truthful statement on the risks and harms of newborn male circumcision.
So, if the CDC's recommendations don't ignore the risks of the procedure and do present a truthful assessment of said risks, but conclude that the benefits outweigh the risks, Intact America will support the recommendations?
Here's the text of the petition itself:
As the foremost expert on public health in our country, the Centers for Disease Control (CDC) has a responsibility to share the truth about public health issues that can affect millions of Americans.
Newborn male circumcision is the most common surgical procedure in the U.S. - yet this painful and unnecessary surgery carries serious risks, including hemorrhage, infection, surgical mishap, and death.
The role of circumcision in preventing sexually transmitted diseases (STDs) and other health claims has been investigated by public health researchers and remains highly debatable. Only safe sexual practices, such as the use of condoms and abstinence, can prevent STDs, including HIV/AIDS. Circumcision cannot be responsibly recommended as a way of preventing disease.
If the CDC chooses to promote newborn male circumcision, it is supporting a procedure called "non-therapeutic" by the American Medical Association - in favor of inconclusive and highly debatable research.
I ask that the CDC not recommend circumcision as a means of preventing HIV/AIDS and formally recognize the risks and harms of the procedure and the right of every child to bodily integrity.
Though Intact America makes no wild claims about what they know about circumcision, they throw the word "debatable" around as if it means "worthless." But they fail to mention what standard of proof they would find conclusive, and indeed fail to cite a single reference, most notably for their claims of the associated risks. They demand that the CDC admit the truth, implying of course that the CDC has failed to do so or is likely to fail to do so, but there is no evidence presented that suggests any kind of obfuscation or dishonesty.
What I can't understand is, if they accept that the CDC is the foremost expert on public health in the US, that the CDC has a duty to present the truth to the American people, and that there is debatable evidence about whether routine circumcision is beneficial to the public health, why on earth they can't just get the hell out of the way and let the CDC examine the evidence and make its conclusions?
The evidence is debatable, so for pity's sake, let's debate it! Let's hear it, all of it, including what the CDC -- the acknowledged experts -- think we should do. Let's open our minds to the possibility that while there might not have been significant evidence to support recommending routine circumcision five years ago, or last year, perhaps there is now. And if there isn't this year, perhaps there will be five years from now. Let's keep asking the questions whose answers might save or improve lives, and let's listen to the people who can speak about those questions with informed intelligence before we start arguing with them. Let's not dig so deep into the trenches we make of our personal decisions that we can't occasionally climb out and take a look at what a new day's sun might have revealed.
Generally I'm all about agreeing to disagree when it comes to someone else's parenting choices. After all, what you choose to do to your kid usually begins and ends inside your house, and while I might have an opinion, it doesn't directly affect me and mine. But that's not the case with vaccination, and that's part of why there's such a bitter debate about it. Anti-vax people feel oppressed by regulations and pressured, sometimes bullied and terrified, by doctors. Pro-vax people feel betrayed by members of their communities whose refusal to vaccinate reduces the herd immunity and puts everybody -- even the vaccinated -- at risk.
I should say up front that I am squarely, adamantly in the camp of the vaccinators. But I'm not without sympathy for the members of the other camp. I'm by nature a skeptic, and the healthcare industry deserves major skepticism. I am also, like many anti-vax-ers, a buyer of organic foods and eschewer of nasty chemicals. I treat colds with herb tea and bed rest. I clean with vinegar or baking soda. I don't love the idea of injecting my toddler with a passel of chemicals I can't spell -- it goes against a lot of my better instincts as a parent.
But here's the thing: there's a lot of good science on the side of vaccination, and opposing it is one flawed if not downright dirty study, a lot of anedote, and a lot of straight-up ignorance.
Most of the recent fear of vaccination comes from a study led by Andrew Wakefield and published in the British medical journal The Lancet in 1998. It purported to show a link between the MMR (measles mumps rubella) vaccine and autism. The study followed only 12 children -- a head-scratchingly small sample size -- and made only modest claims of correlation in 8 of those children. But even though 10 of the 13 co-authors of the Lancet article formally withdrew their findings, even though the study has been thoroughly discredited, and most importantly, even though considerable subsequent research has been unable to find a link between the MMR vaccine and autism spectrum disorder (ASD), people are still freaked out about vaccination.
Part of the reason is that there's a lot of anecdotal evidence of correlation between vaccines and the onset of autism. What happens is a kid gets a shot, and the next day, or maybe an hour later, or maybe a week later, he begins showing the first symptoms of ASD. Now, it's completely understandable that the adults in this child's life draw a line between the jab and the symptom, but it's not necessarily scientifically significant. Correlation is not causation. Just because two things happen in temporal proximity doesn't mean that one is the result of the other. Kids get vaccinated at almost every preventive-care visit (every three months) for the first two years, and most autism is diagnosed during that same period. When you think about how many millions of kids are getting shots, it makes sense that hundreds of them -- not a significant percentage, but a big number -- happen to develop ASD symptoms within 48 hours of a vaccination.
And again, it's not like this perceived correlation hasn't been extensively studied. The American Academy of Pediatrics (AAP) recently published a review paper (pdf) summarizing 29 studies that failed to find a link between the MMR shot and ASD and another 10 that failed to find a link between thimerosal (a preservative containing ethyl mercury) and ASD. "Failed to find" might sound like incompetence on the part of the researchers, so it's important to understand that it's usually impossible to prove a negative, so proving a negative is not the scientific standard. You will often hear from anti-vax activists that the MMR vaccine has never been proven not to cause autism, and that is strictly true, but neither has Tylenol. Neither have M&Ms. You can't prove something is safe, but on the other hand, harmful things are generally pretty easy to prove unsafe, especially when they're being given routinely to millions of people every year.
And you know what? Even if the evidence supported a link between the MMR vaccine and autism, I still might lean towards vaccinating. Autism can be heartbreaking, and I've already blogged about being afraid of it, but it doesn't kill 3 out of 1000 people who have it like measles does. It doesn't cause deafness, cataracts, and mental disability in 8 out of 10 infants of mothers who have it in early pregnancy like rubella does. Take a look at this pamphlet (pdf), from the AAP (based on Centers for Disease Control [CDC] publications) comparing the scientifically demonstrable risks of vaccines to the diseases they prevent. Choosing not to vaccinate isn't choosing to avoid risks: it's choosing to take different risks, and across the board, greater risks of mostly much more dire outcomes.
On one side of this debate is pretty much the entire medical, medical research, and public health community. On the other are a few physicians who are not scientists and a whole lot of passionate amateurs. The evidence on the pro-vaccine side is manifold, and it is backed up by established procedures of peer review and standards of scientific proof. The evidence on the anti-vaccine side is anecdotal and backed by nothing. The internet and cable news tend to present these two sides as more or less balanced: the internet because you can certainly find as many anti-vax sites as pro-, and the vast majority of the information, if presented with a bare minimum of layout competence, looks equally trustworthy on its face; cable news because it tends to bestow a level of expertise just by virtue of putting someone in front of the camera and slapping the title of "expert" on him whether he deserves it or not. Take a look at this clip from a Fox News segment on the H1N1 vaccine:
Dr. Holtorf, billed by the Fox anchor as an expert on infectious disease, claims no expertise on his own website in anything relating to vaccination or epidemiology. He is not a scientist or an expert on public health; he is a physician specializing in hormone replacement. He claims expertise in chronic infectious disease, like lupus, which is a far cry from expertise in epidemiology. In the clip, he says that thimerosal is "highly implicated" in causing ASD though the medical literature doesn't suggest any implication at all. He says it (presumably a single dose of the vaccine, though it's unclear) has 25,000 times the amount of mercury that would be considered toxic in food or water, which is simply not true: there are 25 micrograms of mercury in an H1N1 shot and 28 in a typical tuna sandwich. He says he's seen this vaccine "devastate" patients with chronic fatigue and fibromyalgia and implies that it would be similarly dangerous to pregnant women, but he doesn't specify the symptoms his patients suffered or how he determined causation or whether their reactions were life-threatening, as H1N1 certainly is to pregnant women. But if you saw this clip and were predisposed to distrust the federal government and the medical and scientific establishment, this jackass would have confirmed all your fears with the imprimatur of an established news source. And even had Fox followed this guest with an actual expert to refute the bogus claims, it would have looked like two experts who came to different conclusions, as if there's debatable evidence on both sides.
Anti-vax activists like to frame the debate in terms of personal choice: it's up to you to choose what's right for you child. And that's true. But I think you have a much higher standard of proof to meet when you choose not to vaccinate because you're not just choosing for yourself; you're choosing for your whole community. Some people, because of weakened or suppressed immune systems or certain allergies, cannot be immunized. And vaccines are not 100% effective. Those who can't be vaccinated and those who have been but happen not to be fully protected depend on herd immunity, the notion that, depending on a disease's virulence, once a certain percentage of the population has been inoculated, the lack of hosts acts as a kind of firebreak. If you don't vaccinate, you're putting kindling into the firebreak.
And this is why I have a lot of sympathy for the physicians who "pressure" their patients into getting vaccinated. Not only is it demonstrably in the patient's own best interest, it's in the best interest of all the doctor's other patients, too. Yes, it's unpleasant to have your convictions challenged, but do you really want a doctor who won't passionately advocate for what she thinks is best for your health and the health of your community, a doctor who won't challenge what she sees as your misconceptions or ignorance? Would you really prefer a doctor who doesn't read -- or worse, doesn't believe or can't understand -- the results of scientifically rigorous medical research? And if you're so sure that vaccines are the wrong choice that you're willing to bet your kid's health and the health of everybody in your community on it, you should be able to go toe-to-toe with the biggest bully in town to defend your conviction. Right?
First of all, it's a wretched title. She's not actually making a case against breastfeeding so much as she's knocking a few holes in the case for breastfeeding, and in fact she concludes the piece by telling us that she herself continues to breastfeed, and even cherishes her time doing so. I've heard that Rosin had a different title in mind, and the editors switched to this more sensational one. Phooey on that.
I haven't read the relevant medical literature, but I have no reason to disbelieve Rosin's representation, which is basically that the evidence behind our culture's current mania for breastfeeding is thin because it's difficult to control for all the other healthy choices breastfeeding mothers tend to make, and the socio-economic group to which they all belong. In other words, if you want the benefits that advocates of breastfeeding claim are the results of the boob, your best bet is to be educated and upper-middle class.
I agree with Rosin that the pressure put on mothers to breastfeed is well out of proportion to the established benefits. Formula is not dangerous, and it's outrageous that it is presented by breastfeeding advocates as tantamount to smoking while pregnant. However, I don't think that the benefits of the boob are to be dismissed simply because they are difficult to prove. And even if the balance only slightly favors nursing, that's a solid argument for giving it the old college try.
Because where I really disagree with Rosin is her notion that breastfeeding is a significant hardship, that it's keeping women down the way housekeeping did in the 50s. "Modesty, independence, career, sanity" are what one stands to lose, she says, by breastfeeding, and that's utter hogwash. Sure, I have the luxury of not working, but I know far too many women who pump on the job without bitching about it to believe that it's that big a deal. And modesty? Come on -- it takes a little practice, but anyone can learn to nurse in public without flashing a nipple, and past the first couple months, you almost never have to nurse in public if it bothers you, anyway. If you stand to lose your sanity because of breastfeeding, by all means, do please stop, but I can't imagine that this is seriously a problem for any but the tiniest and therefore most entirely irrelevant minority. And if independence is that big an issue, don't introduce into your life a tiny creature who is wholly dependent on you -- how you choose to feed it is the least of your worries.
Rosin makes a stab at arguing from the perspective of the working class, but it's not very convincing. Her argument that breastfeeding can only be considered "free" if you don't count the mother's time ignores the time spent sterilizing, mixing, and warming bottles -- which is only "free" if you're paying someone else to do it, which is not generally an option open to blue-collar moms. And, yes, pumping on the job is a lot harder "if you are, say, a waitress or bus driver." But you know what? Everything is harder if you're a waitress or a bus driver, so it's not exactly a winning argument against the boob -- though of course I'm more sympathetic to a mother who gives up pumping because it's genuinely a pain in the ass than one who just can't be bothered to give it a try.
Her only argument against breastfeeding that really resonates with me at all is her claim that it makes for an imbalance in marriage. I remember fondly the very early days of Ben's life, when I felt strongly that Andy and I were a team, were in it 100% together; and I remember the feeling of being at sea when he went back to work, when it became clear that the only way to get the baby back to sleep at night was to nurse him, when suddenly I felt like the parent and he felt like the occasional assistant, when my parenting felt required and his felt optional. That sucked. But some of that would have happened even if we'd been bottle-feeding. With one of us working and the other staying home, there was bound to be an imbalance. And now that we're night-weaning, and nursing doesn't have that kind of powerful sleep magic any longer, the little imbalance that remains doesn't feel at all unfair, and has everything to do with my spending 16 waking hours a day with Ben compared to Andy's eight.
Rosin goes on to posit that this initial inequality leads to others: "[The mother] alone fed the child, so she naturally knows better how to comfort the child, so she is the better judge to pick a school for the child and the better nurse when the child is sick and so on." Talk about hogwash. This kind of gatekeeping is a conscious choice on the parts of both parents, and if you wish to avoid it, you damned well avoid it, and it has fuck-all to do with breastfeeding.
She closes the article by bringing up a suggestion of one of the medical researchers whose studies she's read that perhaps it is not something in the breastmilk, but the physical closeness between mother and child which is responsible for whatever positive outcomes are associated with nursing. And she's right to say that if this is the case, it should be more widely publicized.
I, like many mothers in my generation, have mixed feelings about the debate. I feel for women who try to breastfeed and can't, and are made to feel just awful for their "failure." At the same time, there's still enough cultural squickiness to the idea of putting a baby to suck that without some measure of peer pressure, I think fewer women would make the effort, and I do believe it's an effort worth making. I feel strongly, right or wrong, that I'd have been missing out on a profoundly rewarding part of Ben's infancy if I hadn't nursed him -- and I feel just as strongly that if I'd been unable to, he'd have been just as healthy and every bit as smart on formula.
A quick further thought: I want to make it clear that I'm very much in favor of everybody giving breastfeeding a real go, but I am also vehemently against giving anybody for whom it doesn't work a hard time. I argued against Rosin's characterization of breastfeeding as costing "modesty, independence, career, sanity," and I stand by what I said as a generalization (as Rosin's characterization was), but I'm well aware that individuals do sometimes feel these precise costs -- and others -- and I absolutely support mothers who value their own health and happiness enough to put them squarely on the scale.
