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Monday, April 15, 2013

Q&A with Jennifer Margulis - Business of Baby


You may have seen my review of The Business of Baby yesterday. If not, go back and read it when you're done with this.


Buy the Business of Baby here.
Just a brief intro, because I blabbered on yesterday about how much respect I have for Jennifer and her work. The Business of Baby: What Doctors Don't Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line publishes today (!). I'm so excited to have Jennifer here, answering a few of my questions about her book. 

Frisco Kids: Your section on ultrasound and a possible connection to autism was the first I heard on that topic. Also it's the first I heard that ultrasound may not be a benign test (and I write for radiologists as a regular gig!). Is ultrasound something that pregnant moms should protest or worry about?
Jennifer Margulis: We are lulled into thinking the scanning helps us have a healthy pregnancy. It does not.

The largest study to date -- of over 15,000 pregnant women -- showed that multiple ultrasound scans did not improve fetal outcomes. Most women don't realize that the American College of Obstetrics and Gynecologists does not explicitly recommend ultrasound scans (link added by Frisco Kids). They've become the "standard of care," which means that almost every doctor does them, often at every appointment, even though there is often no medical indication to do so. If you tell your doctor you don't want one, he or she might be astonished. Medical practices make more money at every appointment where they perform a scan. But, honestly, unless you are going to have an abortion,
there is no reason to get an ultrasound in the absence of some other medical indication. 

Yes, women should be worried. The neuroscience is complicated but we are finding out from studies done at Yale University and from research out of the University of Louisville in Kentucky that exposure to ultrasound waves alters the path of migrating brain cells in developing embryos. We don't know definitely that they are dangerous but any doctor who says that ultrasounds are safe and nothing to worry about is sorely misinformed. Pregnant women need to realize that when they are told "there is no evidence of harm" that does not mean something is safe, it just means it has not been thoroughly studied. The FDA unequivocally warns against prolonged ultrasound exposure. Pregnant women should consider simply opting out of ultrasound. If done, it should be done in as short amount a time as possible. Pregnant women should not go to the mall for entertainment ultrasounds or have a technician come to the house for an ultrasound party (these are becoming increasingly popular). 

If a doctor says he wants to induce pregnancy or perform a C-section because of something troubling from an ultrasound scan, you need to get a second opinion, tell the doctor you prefer to go into labor when your body and the baby are ready, rehydrate and rest (if the issue appears to be low amniotic fluid, which is what doctors often think they see, whether this is a true problem or not), or simply say, "No, thanks."

ACOG guidelines state that "the lowest possible ultrasound setting should be used to get the necessary diagnostic information" and that the examination should be as brief as possible, but, unfortunately, most ultrasound technicians do not follow this standard of practice. They often ask parents if they want to extra photographs or to look longer. They think they are being nice, because parents like to see the unborn baby.

The bottom line with ultrasound: until the results of a double-blind seven-year study on primates that is being conducted now are published, we should be as careful with ultrasound exposure as we are with exposure to X-rays.

Frisco Kids: In the book you talk about why some prenatal testing can actually cause harm - by giving some false positives and causing the parents unnecessary concern and even cause the mother to give off stress hormones that can injure the baby. Also because some parents might choose to abort based on false findings. How should a parent decide what tests to do, and how to interpret the findings if they do them?

Here's Jennifer Marguilis! Photo by Byron Devore
JM: How much testing to do is a very personal decision. I recommend that before a couple even tries to conceive, they talk through how they would feel about raising a special needs child, how they feel about abortion, and how much prenatal testing they want done. The bias in most places in America is to do test after test after test. For some women this is reassuring. For others it is deeply disturbing. The false positives create weeks, if not months of stress. If the testing makes you anxious, it may be better to skip the testing. 

In Iceland an autopsy is performed on every aborted fetus. That should be the standard practice in America as well. If we are aborting healthy fetuses due to faulty testing, we need to know about it. Complete transparency is what will make medicine safer.

It is important to be proactive about your health! Instead of worrying about developing gestational diabetes and doing the horrible test for it, a woman who wants to conceive should eliminate all processed sugar from her diet, introduce high quality protein, eat whole foods, including lots of green leafy vegetables, and begin regular exercise. A childbirth educator I know reminds her clients, "You are what you ate three months ago." These kinds of lifestyle changes, more than any medical testing, are what will help American women have the best possible pregnancy outcomes.


Frisco Kids: It's really hard in this era because so much information is thrown at us and we have access to so much online. When it comes to caring for our kids (and our fetus during pregnancy), how do we know who to believe, and how do we find the time to do our research without it becoming all-encompassing? It's hard enough to get through work and home life. 

JM: Good question. It can be overwhelming. It is overwhelming.

Most of us just want to follow our doctor's advice and do whatever they suggest. That works in some countries, where doctors' salaries are not tied to medical intervention, where there aren't strong incentives for doctors to do more than necessary, and where doctors are not openly being used as middlemen by corporations to peddle products (like prescription drugs and infant formula) on their patients. 

But, sadly, it hasn't been working very well in America. 

You don't want to find out the hard way and keep blindly following a broken medical system until something disastrous goes wrong for you or your baby (at which point the doctors will tell you they have "no idea why" your child has, say, a debilitating autoimmune disorder, autism, or narcolepsy). If you want to read 24 heartbreaking examples of this, get the brand new book, The Thinking Moms' Revolution.

It's important to be a savvy consumer, both with your doctor and with where you go online. Many internet sites are trying to dupe parents. Formula companies advertise "feeding hotlines" on parenting sites for bleary-eyed moms who are searching the internet at 3:00 a.m. These companies have one motive: to undermine your ability to breastfeed and get you to buy their brand. Diaper companies give potty training advice! They too, have one motive: to keep your child in diapers as long as possible so they can sell more diapers to boost their bottom line.

My best advice is to stay off the internet as much as possible and get your advice from experienced moms whose children are thriving and well adjusted. You can also empower yourself as a parent by reading the right books, like Ina May's Guide to Childbirth, Gabrielle Palmer's The Politics of BreastfeedingDr. Robert Sears' The Vaccine Book, and Christine Gross-Loh's Parenting Without Borders

Make sure your advice is always coming from a credible source. For example, if you need help with breastfeeding, contact the La Leche League (1-800-LA-LECHE), a non-profit that offers a breastfeeding hotline and volunteers around the country.

Frisco Kids: Given medical insurance (the difficulty of finding a doctor in your plan, let alone one who will offer the type of care you want) and the business of doctors' offices (who are so busy that not only are we waiting for 45 minutes, but the doctor doesn't have much time to talk), how  can we be assured that the doctor has our child's interests at heart, versus just pushing the line of standard  treatment because that's the way the office practice flows best? I ask this partly because you are a proponent for selective vaccination and vaccinating on a different schedule, something that seemed a little silly to me until I really read through your vaccination chapter and realized it made a lot of sense. My sister broke up her daughter's vaccinations into a different schedule so she wasn't getting multiple vaccines at a time, and the doctor's office made it very difficult for her, because she was asking them to do something out of the routine.

JM: I didn't know I was a proponent of selective vaccination, Debbie! But I do advise parents to make their own decisions on a vaccine by vaccine basis about how and when to vaccinate based on their family's medical history, past experience, and risk factors. Because we lived in Niger, West Africa, my children are vaccinated against some diseases most Americans have never heard of. Those vaccines would not be right for other American families. Conversely, the misguidedness of the birth dose of the hepatitis B shot (hepatitis is a sexually transmitted disease) is something I write about extensively in my book. If you are hepatitis B negative, with a monogamous partner, and not an intravenous drug user, your baby has no medical reason to have that shot.

The vaccine schedule is constantly changing. The CDC recommends new vaccines and takes problematic vaccines off the schedule until they can develop a safer vaccine. A swine flu vaccine used in children in Sweden was found to dramatically increase the risk of narcolepsy, a debilitating chronic disorder that causes drowsiness. The American media tends to vilify parents like your sister who are cautious about vaccines. But the truth is that we give different medications to different children all the time, and what is right for one child may not be right for another. I am baffled by the vehemence of one-size-fits-all vaccine proponents and I think alienating or ridiculing parents for making the best choices for their children (one writer called me an "asshole" in a public on-line forum) is not the way to get them to comply with the CDC's current and highly problematic vaccine schedule.

Some doctors feel very threatened when parents ask them to do something out of the routine. I wouldn't want someone defensive and rigid to be safeguarding my children's health. When something goes wrong with our children we -- the parents -- pay the price. Not the doctors. If you feel like your time at the doctor is a tug of war, stop going to that doctor.

An excellent book about children's health is Dr. Robert S. Mendelsohn's How to Raise a Healthy Child In Spite of Your Doctor. Another excellent, newer book by a pediatrician is Dr. Susan Markel's What Your Pediatrician Doesn't Know Can Hurt Your Child.

Dr. Sears maintains a list of vaccine-friendly doctors that is helpful for parents looking for an open-minded pediatrician. 

Frisco Kids: What do you see as the biggest take-away messages for anyone reading The Business of Baby

JM: I think the book has two main take-aways: 

#1: Don't be duped into thinking that large corporations want what's best for you or your baby. They don't. They want what's best for their profit margins. 

A case in point from the book: Johnson & Johnson knowingly puts a chemical in their baby soap that off-gasses formaldehyde. They changed their formula for the European market but keep selling it as-is in the United States.

Another case in point that did not make it into the book: Beech-Nut knowingly marketed a product to parents that contained beet sugar, cane sugar syrup, corn syrup and other ingredients, with little if any apple juice in it as "100 percent apple juice" made specifically for babies. The evidence against them was so unequivocal that they ended up pleading guilty to fraud in courtThe fake apple juice cost about 20 percent less to make than real apple juice. When high level executives knew regulators were on to them, they shipped 23,000 cases of the "juice" to the Dominican Republic to sell to babies there.

#2. Babies teach us as much as we teach them. As they grow we gain confidence in our ability to parent and, especially, to know when something is wrong. 'Read your baby, not the books,' is how one Kenyan grandma put it to her granddaughter who was living in England and overwhelmed by all the advice she was receiving. Though our tendency is to defer to doctors and others in the medical establishment, it is we parents, and our babies, who actually know best.

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A big thank you to Jennifer for talking with me about her book. If you liked this, please share it with others, and be sure to check out her blog or Facebook page, where also she discusses parenting issues on a deeper level. And read the book!

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