Monday, August 2, 2010

Tuesday, June 8, 2010

America's Complicated Relationship with Breastfeeding

The health benefits of breastfeeding are already well established and continuing research finds new benefits every year. Breastfed infants have fewer infections, fewer illnesses, fewer allergies, better cognitive development and improved long-term health well into childhood and maybe even adulthood. If breast milk could always be administered with the same ease that formula is administered, it would be absurd to give babies anything else. However, for many reasons, breast milk is not always as easy to give as formula.

In the U.S., women are damned if they do and damned if they don't when it comes to breastfeeding. We, Americans, are acutely uncomfortable with breasts, irrationally incapable of divorcing our concept of our bodies from sexuality, even in the most clearly nonsexual contexts. The Victorian mindset of the U.S. is a real inconvenience for women who are trying to breastfeed their infants. Women bold enough to feed their infants in public are subject to constant stares and occasional glares. Most women retreat to bathrooms to feed their infants or pump milk. On the other hand, women who simply choose to forgo the hassle of breastfeeding, opting to feed their infants with formula, are subject to scorn from those who view such a choice as willful child neglect.

Despite all of its benefits for babies, there are many reasons women might choose, or be forced, not to breastfeed. Aside from the embarrassment of public breastfeeding, there are also myriad medical complications that may occur with breastfeeding. Most are "minor" and can be overcome with a little extra counseling or effort. But at the same time, the assumption that all breastfeeding complications can be overcome may be an unreasonable expectation for moms. I've followed the struggles of a few friends who set out with the wonderful goal of exclusively breastfeeding their infants. But, in each case, a combination of latching problems, breast infections, and/or intensely painful nipple conditions caused each of them inordinate stress and, worst of all, guilt and feelings of inadequacy as they faced the impossibility of achieving their goal. The postnatal period can be an acutely stressful period for women. For many women, the expected blissful glow of motherhood is obscured by the stress of having their lives turned upside, being deprived of sleep, money and relationship woes and even postpartum depression. Most women return to work not long after giving birth, and breastfeeding becomes further complicated by the challenge of finding time and a place to pump milk. At some point, we must allow for the negative effects of the additional stress of breastfeeding to be sufficient justification for formula feeding.

Ultimately, I think the best thing we can do for moms and their babies is to make sure that women are able to breastfeed, or not, for the right reasons. One way we can help is to get over our discomfort with public breastfeeding. Easier said than done. But women who are proud and bold can help by continuing to do what they probably do anyway--breastfeed in public. The more we are exposed to public breastfeeding, the less caught off guard we'll be the next time we see it. Employers can help by working with their employees to provide time, and reasonable accommodations, for pumping breast milk. What doesn't help? Bullying women into breastfeeding by comparing formula feeding to child neglect. Formula fed babies may not have some of the advantages of breastfed babies but they do, overwhelmingly, do just fine. What I would recommend to new moms is to breastfeed if you can, for as long as you can, even if it's only for the first couple of weeks. Those first couple of weeks of breastfeeding can provide valuable immunity to your baby in a period when it's not yet safe to immunize. Take advantage of lactation consultants and support groups if breastfeeding proves challenging, but don't let anyone bully you into feeling guilty if it doesn't work out.

The painting, borrowed from, is "Lenore" as painted by Samantha Weber (

Thursday, May 27, 2010


A man's opinion on the subject of circumcision more often than not reflects the state of his own foreskin. The majority of men in this country are circumcised as infants and, therefore, have no memory of what it was like to have an intact member. They don't remember the pain of being circumcised and they are, more often than not, content with the appearance and function of their penis (and if they're not content, it usually has nothing to do with their lack of foreskin). On the other hand, most men who reach adulthood with intact foreskins are equally content with the appearance and function of their penis.

A woman's opinion of circumcision is more variable. European women, who are unaccustomed to circumcised penises, think that they are pretty funny-looking, and will generally prefer an uncircumcised man. American women, who are accustomed to circumcision, may think that foreskins are a bit strange. Fortunately for men from both camps, any woman worth having is smart enough to judge a man on qualities other than the presence or lack of a quarter ounce of skin (in truth, I have no idea how much an adult foreskin weighs, but you get the idea).

There have been quite a few studies evaluating the health risks and benefits of circumcision. If you ask the rabid anti-circumcision activists, they will cite the studies that found higher rates of erectile dysfunction in circumcised men, lower sensitivity of the glans of the penis in circumcised men and significantly reduced satisfaction with masturbation. They will also tell you the horror stories about circumcisions gone wrong, where more than the foreskin was removed or where post-surgical infections had disastrous, even deadly consequences. On the other hand, if you visit, a decidedly pro-circumcision website, you will find citations from studies showing that circumcision reduces rates of erectile dysfunction and increases sexual satisfaction. Interestingly, pro-circumcision advocates will either argue that circumcision increases the sensitivity of the glans of the penis, which sounds good, or they will argue that it decreases the sensitivity, which is also good... because it allows men to last longer during sex. Considering that men may experience either the problem of too much sensitivity or too little, its not clear to me that either change can be considered of universal benefit. The results of all of these studies add up to very few if any statistically significant results, and about as many anti-circumcision results as pro.

The most compelling argument for circumcision, since there is no consistent evidence of harm or benefit in terms of sexual function, comes from the studies relating to rates of disease in circumcised versus uncircumcised men. Advocates of circumcision will tell you that uncircumcised men have ten times the risk of penile cancer as compared to circumcised men. And the risk of penile cancer is related to other diseases that occur in greater frequency in uncircumcised men, including HPV, HIV and phimosis. However, the risk of penile cancer in American men is only 1 in 100,000. Therefore, we would have to do tens of thousands of circumcisions to prevent one case of penile cancer. And as rare as complications of circumcision are, for every ten thousand circumcisions we do, at least a few will result in serious complications. In essence, by performing neonatal circumcisions, we are trading the extremely slim possibility of disease in the older adult male for a similar possibility of serious iatrogenic complications beginning in infancy. Virtually all of the diseases that circumcision is purported to be protective against can be traced to poor hygiene. The most significant studies in defense of circumcision were performed in Africa, where access to clean water, condoms and changes in dangerous sexual practices, would have a more profound positive effect than would circumcising the entire population. In the Unites States, the incidence of these diseases is quite low and the means to prevent them, without circumcision, are readily available. Studies performed regarding circumcision in third world countries, therefore bear little relevance to the risks facing men in the U.S.

The American Academy of Pediatrics has a very comprehensive policy statement regarding circumcision, which they revise frequently to reflect the most recent research regarding the possible health benefits of circumcision. However, they, like virtually every other respected medical society, ultimately conclude that the potential benefits of neonatal circumcision are insufficient to make a recommendation.

I would hazard a guess that most parents are not making the decision of whether to circumcise their sons based on their careful appraisal of its potential health benefits. Rather, they are making the decision based on one factor: Dad. If Dad is circumcised, then circumcision is the obvious, normal choice. Circumcised Dad will, no doubt, worry that his son will be the subject of locker room bullying if his penis does not conform to American standards. Circumcised Dad will assume the worst about the consequences of going uncircumcised and will latch onto the studies which indicate the vast dangers of possessing a foreskin. Ultimately, Circumcised Dad will be compelled to take the path of least resistance, which for him is to obey tradition and not question the decision that his own parents made for him. Uncircumcised Dad, of course, has no such concerns. He knows that, even if he did get curious looks in the locker room growing up, the rates of circumcision are steadily dropping so that nearly half the other boys in the locker room in the future will also be in possession of a foreskin. Uncircumcised Dad pays careful attention to the studies and statements that fail to support neonatal circumcision and wouldn't think of letting his son be altered.

As far as I am concerned, circumcision is an elective cosmetic procedure being routinely performed on individuals who are incapable of giving consent. Although they can not communicate the extent, and do not remember years later, circumcision causes infants stress and at least some degree of pain. And although the complications are infrequent, it is by no means clear that the benefits outweigh the risks. Therefore, I would not, as a doctor, recommend neonatal circumcision to my patients, I would not perform neonatal circumcisions, and my sons, if I have any, will not be circumcised. That said, I understand that many people have and will continue to choose circumcision with the best of intentions. I only hope that parents who have yet to make those decisions will do so with an open mind and as true an understanding of the facts as is possible.

Monday, May 24, 2010

Single Motherhood: Dan Quayle vs. Murphy Brown 18 Years Later

This past week marked what would have been the 18th birthday of Avery Brown, the son born to fictional single mother, Murphy Brown, on the sitcom of the same name. Days after the episode featuring the birth aired, then Vice President Dan Quayle mentioned the show in a speech he gave in response to L.A. riots, regarding the "poverty of values" in America. "It doesn't help matters," Quayle said, "when primetime TV has Murphy Brown, a character who supposedly epitomizes today's intelligent, highly paid professional woman, mocking the importance of fathers, by bearing a child alone, and calling it just another 'lifestyle choice'."

Conservatives who supported Quayle's statement will cite statistics about the less favorable outcomes for children from single-parent homes. Such children are more likely to live in poverty, to become teen parents, to run away from home, to suffer from depression, more likely to end up in prison, etc., etc., etc. However, what the individuals quoting these statistics routinely fail to do is distinguish between correlation and causation. I have no doubt that these correlations are sound. But, I would question whether the fact of having a single parent is the primary cause, independent of other factors, of these children's problems.

In the same breath that he criticized Murphy Brown, Dan Quayle described her as an, "intelligent, highly paid professional woman." Such a woman, in my mind, is precisely the person most likely to succeed at single parenting. So what, precisely, was her crime? Quayle says that she "chooses" to raise a child without a father. But Murphy Brown, like many real women, only chooses to raise her child without a father when the father has expressed his disinterest in being a parent. And what precisely would Quayle have had Murphy Brown do if he'd been writing the script? Presumably, 42-year old Murphy Brown would have been abstinent and therefore never gotten pregnant. Because, of course, Quayle can't have meant to imply that she should have aborted the baby rather than subjecting it to the trauma of growing up without a father. Quayle's speech, given in response to the L.A. riots, could not have included a less relevant example. The delinquents rioting in L.A. didn't come from wealthy homes which merely lacked father figures. They came, more likely, from poor homes, in poor neighborhoods, many born to uneducated, teenage mothers and, yes, on top of all that, they may have grown up without the benefit of a father.

To be fair, I do agree with Quayle that, all other things being equal, children are better off with two parents. However, all other things are rarely equal. And I think that Murphy Brown, despite not having a father for her child, was more than unusually prepared to provide a safe, stable and comfortable home for a child. At 42, and unmarried, her accidental pregnancy represented her first, and probably last, chance at motherhood. If we all let an inability to provide the absolute ideal situation to our children prevent us from having them, we'd none of us have any children at all. I have always known that I want to have children some day. I hope that I have a husband to be a father to those children but I won't let the lack of one stop me.

Dan Quayle and others were and are bemoaning the loss of traditional family values in America. They long for the days when all families were cookie-cutter units of a father, a mother and two perfect little well-adjusted children. The only problem is that, while this happy traditional family may have existed for some, it was a facade for many others. How many homosexual men married women and had children because they believed that was their only option and what kind of life was that for their wives? And for their children when the truth eventually came out? How many women put up with physically abusive husbands because divorce and single motherhood were unacceptable alternatives? How many talented, intelligent women were stay-at-home mothers despite longing to pursue careers and how many women never had children, despite longing for them, simply because they were never fortunate enough to marry? I think a family with a mother, a father and their well-adjusted, biological children, is a perfectly wonderful thing, and more or less represents the family that I came from. But to relentlessly pursue such a family as the only acceptable incarnation of family is foolish. Dan Quayle's attack on Murphy Brown was a blind attack that unnecessarily demonizes a subset of our population that are neither inherently good, nor inherently bad. Being a single parent is not just another "lifestyle choice". It's often not a choice at all.

Thursday, May 21, 2009

US swine flu deaths hit double-digits

Double-digits could mean anything from 10 to 99. In this case, it means... 10. One more than 9.

For some perspective, here are the estimated number of deaths from some other causes, in the US, in the one month since the swine flu hit:
  • Motor vehicle accidents: 3,500
  • Firearms: 2,400
  • Homicide: 1,600
  • Drowning: 316
  • Suicide: 300
  • Regular Flu: 3,000

Do I really need to say more?

Monday, May 18, 2009

On boycotting Wal-Mart after CEO signs a petition

Recently, one of my friends posted a link suggesting that people boycott Wal-Mart after its CEO signed a petition which would ban unmarried couples from adopting. The proposal would disproportionately affect gay couples and is therefore considered to be anti-gay legislation. Many other facebook users posted their support for the ban but I, and one other, voiced some hesitation to jump on the Wal-Mart-bashing bandwagon.

I absolutely disagree with the legislation in question. I think any loving individuals, or couples, that want to adopt and can demonstrate the means, should be allowed to, be they gay, straight, married or unmarried. However, I am decidedly uncomfortable with a company being boycotted on the basis of the CEO exercising his rights as a citizen to participate privately in politics.

What people have argued is that a CEO is the public face of a company and that, therefore, his actions reflect on the company as a whole. I understand and agree with this, within limits. I think that any statements or actions made in a public sphere, that a CEO can reasonably expect to be recorded and reported upon, may be used as a reflection on that company. A petition is a matter of public record, but is not necessarily a public act. Mike Duke did not advertise his signing of this petition, did not issue statements on the subject. He merely signed a petition which reflected his views as a voter. Someone recognized his name on the petition, checked the address to make sure that it was the same Mike Duke, and publicized the fact, and the media ran with it. Furthermore, I don't see how a CEO's views on adoption law are at all relevant to a company like Wal-Mart, a retail store. One person argued that it indicated how Wal-Mart as a company would treat gays. But I think this is an unfair leap. Good businessman will often ignore their own prejudices in the interest of good business.

My concern is that by using the private political behavior of a CEO against his business, we would seem to be extorting him out of his right to be politically active. Duke is not a politician and this legislation has nothing to do with his business. If you want to boycott Wal-Mart because they import too much from China, because you think their employee benefits stink or because they refuse to carry certain cds and dvds on the basis of their content, I have no problem with that. If Mike Duke gets drunk, runs over a number of school children with his Lexus and Wal-Mart fails to immediately remove him from his position and condemn his behavior, then boycott them by all means. But boycotting the company because Duke quietly signed a petition which represents a not particularly radical political view unrelated to anything Wal-Mart has anything to do with... that I can not understand.

Friday, March 27, 2009

On Unemployment Benefits

A local radio talk show was discussing the proposal of a few states that individuals collecting unemployment benefits be randomly drug-tested. It was clear that the host, who often comes down on the side of legalizing drugs, particularly marijuana, thought that this was unjust. He also stated that "Libertarians" were up in arms over the proposed legislation and I found myself wondering if that were true. After all, I'm a libertarian (little "l" libertarian) and I found myself thinking it a reasonable idea.

I am for the legalization of marijuana, at the very least, and think the legalization (or decriminalization) of other drugs would probably be a good idea as well. I have also always questioned the wisdom of employers doing random drug-screenings of employees. After all, if you have a good worker, why should what they are doing at home in their free time matter?

However, despite that, in the case of individuals receiving unemployment benefits from the government, I think the random drug-testing might well be warranted. These benefits are funded by tax-payers and paid out to the unemployed as a sort of life-support while they seek a new job. Therefore, I have two problems with these individuals using drugs. First, given the high likelihood of a new employer requiring a drug screen, use of these drugs significantly reduces the chances of being hired. Second, tax-payers should not have to fund someone's recreational drug use. Ceasing drug use while you are unemployed is a good-faith demonstration of earnestly seeking work. After all, the money is being paid out on the basis of need, not entitlement. You are entitled to the money you earn from working and can therefore spend it how you like. Government assistance should be spent to the effect for which it is offered.

*** Addendum *** Some have pointed out that we pay into the unemployment insurance pool when we are working and that benefits are somehow based on the sum/duration of these payments. Therefore, receiving unemployment benefits is hardly the charity I make it out to be and that there should, therefore, be no conditions on how they are spent. Excellent point.

However, the fact that "we all pay taxes" isn't always sufficient argument that we are all equally entitled to the services they fund.These benefits are paid out to individuals that find themselves unemployed "through no fault of their own". The fault of your unemployment doesn't end when you are laid off. The spirit of the insurance is still for you to make an effort to find employment. You are not necessarily "entitled" to all 26 weeks of unemployment that may be available. That's kind of like saying your health insurance should cover your boob job and face lift because you haven't been sick enough to use up your deductible. Just because you've paid into the system for your unemployment benefits doesn't entitle you to collect money for the full duration while sitting at home smoking crack instead of lookingfor a job.

Someone else worried that the expense of drug testing would only be an additional tax burden. But, random testing of 10 or 20% of individuals shouldn't be prohibitively expensive. Even though the hope would be to dissuade people from using the drugs, it wouldn't take many people losing their benefits to cover the cost of the testing.

It is, of course, hard for me to argue the logistics of a system that I largely disagree with in the first place. I would rather we not beforced to pay the government for this insurance in the first place.