Dr. Amy Tuteur calls out the homebirth movement for denialism

I’ve been lurking at the Skeptical OB for a while and enjoying Amy Tuteur’s very effective criticism of some of the extremes of the homebirth movement. I had noticed that among some advocates of homebirth that were proposing risky behavior for pregnant mom’s that conflict with the literature that it appears to be a movement rife with denialists who promote the valorization of ignorance in Dr. Tuteur’s words. Mostly their problems seem to be with accepting there is a real, measureable increase in risk with homebirth, and rejecting the very real health benefits that medical physicans offer in preventing fetal and maternal mortality. She summarizes the argument for homebirth-advocacy-as-denialism here and my heart was warmed that she used our 5 criteria for identifying denialist argumentation.
I’ll also point out she has some really compelling posts I’ve read in the last few weeks that are worth a look for anyone who is considering homebirth using a CPM rather than an OB/Gyn. See:
Humbled by Birth
Latest in homebirth deaths plus a near miss
Homebirth midwife requirements “tightened” to include high school diploma
Yes it is your fault that your baby died at homebirth
even more homebirth deaths– in particular I was jumping up and down angry when I read about people describing their childrens deaths from group B strep! What the hell! This is imminently preventable, treatable, and such an example of an obvious preventable death I nearly fell out of my chair.
Dr. Tuteur does an excellent job of providing compelling data, experience, and examples of why this movement is bad for mothers and bad for babies. Denialism can kill. There are very real advantages to appropriate prenatal screening and testing offered by OB’s, and very real problems that can occur even with “low risk” births that may result in the death of an infant or the mother. People can argue about homebirth and rejecting medicine as a choice, but you can’t argue that this is risky behavior that is resulting in preventable deaths. The idea that a high-school dropout with a CPM certification (requiring passing a test and attending a handful of births) can offer the same level of experience and safety as an OB/GYN that has training in hundreds of deliveries, is a medical doctor, can perform prenatal risk assessment and screening, and has the ability to surgically rescue in an emergency is ludicrous. In my very limited OB experience as a medical student I’ve seen “low risk” go to “potential disaster” and the life of the baby and possibly the mother be saved by interventions as simple as fetal heart monitoring and ready access to an operating suite. These stories of people being in labor for 48 hours and delivering dead infants are very distressing because we can avoid this! It’s like choosing non-sterile surgery over anti-septic surgery because bacteria are natural. Why ignore decades of research, experience and the obvious improvement in perinatal and maternal mortality that obstetrics has provided over the last century?

Holy cow, yet another conspiracy theory!

This has been a year of some wonderfully crazy new conspiracies. Birtherism is actually looking pretty banal next to the “Obama is gay-married to a Pakistani” conspiracy, the “Obama is a Jihadist sleeper agent conspiracy, the Aurora conspiracies, job numbers conspiracies, polling conspiracy theories from America’s least-accurate pollster Dick Morris, and, my former favorite, the Obama is buying bullets for the Social Security Administration to kill all Americans conspiracy theory.
Now the American Spectator is publishing a new crackpot conspiracy theory that I think rivals my former favorite. It’s “the media has a secret backchannel where they discuss their plans to get Obama re-elected conspiracy”. And who is the proof this conspiracy theory is at work? Candy Crowley!

Shortly after Obamacare was passed and signed by the President, Michael Tanner of the Cato Institute noted a sudden plethora of articles that had begun to appear in a wide variety of MSM outlets about the probable ill-effects of “reform.” This prompted him to ask, “Where were these reporters before the passage of the health care bill?” The answer to this question is now pretty obvious. They were colluding, via JournoList and other such forums that we don’t know about, to make sure that no one screwed up and told the truth before that morass of taxes and regulations became the law of the land. To the nation’s cost, their self-censorship succeeded.
Today, we face a similar but much more dangerous situation. The “reporters” of the establishment news media are engaged in a concerted campaign of misinformation to get Barack Obama re-elected. This has been evident for some time, but the breathtaking mendacity of this effort was writ large by Candy Crowley during last Tuesday’s presidential debate. Everyone has by now seen the video clip: the President made the preposterous claim that he had identified the attack on our Benghazi consulate as an act of terrorism as early as September 12. Then, when Romney called him on this egregious whopper, Crowley repeated the lie.

Wowzers. It’s hard to continue to debate with a conspiracy theory that is dependent on questioning such an easily verifiable fact. For the record, the transcript from Obama’s speech on the 12 reads:

No acts of terror will ever shake the resolve of this great nation, alter that character, or eclipse the light of the values that we stand for. Today we mourn four more Americans who represent the very best of the United States of America. We will not waver in our commitment to see that justice is done for this terrible act. And make no mistake, justice will be done.

or you can watch the video:

To believe that Obama was talking about some other act of terror other than Benghazi is highly disingenuous as the very next sentence refers to “four more Americans” that died as a result of this “terrible act”. But I suppose it’s possible, if you are reading at a fifth grade level or something, you could think he was still referring to 9/11. That might make sense, and Romney then might have a valid claim about “14 days” until the relatively meaningless distinction is made, except the very next day Obama says it’s an act of terror again.

Let me say at the outset that obviously our hearts are heavy this week — we had a tough day a couple of days ago, for four Americans were killed in an attack on our diplomatic post in Libya. Yesterday I had a chance to go over to the State Department to talk to friends and colleagues of those who were killed. And these were Americans who, like so many others, both in uniform and civilians, who serve in difficult and dangerous places all around the world to advance the interests and the values that we hold dear as Americans.
And a lot of times their work goes unheralded, doesn’t get a lot of attention, but it is vitally important. We enjoy our security and our liberty because of the sacrifices that they make. And they do an outstanding job every single day without a lot of fanfare. (Applause.)
So what I want all of you to know is that we are going to bring those who killed our fellow Americans to justice. (Applause.) I want people around the world to hear me: To all those who would do us harm, no act of terror will go unpunished. It will not dim the light of the values that we proudly present to the rest of the world. No act of violence shakes the resolve of the United States of America.

Talking about these deaths he again describes it as an act of terror, unless of course, you think he just threw that in there as a red herring. He just randomly inserts “act of terror” into speeches about healthcare I’m sure. But why this is my favorite new conspiracy theory is because there actually are people who think a defunct online Google forum is evidence of left wing journalists’ attempts to rule the world.
For those that are interested, the reference to “journolist” is this now defunct chat group of which many prominent left-leaning journalists shared often impolitic statements about people in the news. Ezra Klein even tried to bring in Tucker Carlson just to allay the crank conspiracy fears about journalists *gasp* socializing online. We even used to have one here at scienceblogs where we would, yes, even coordinate posts, but mostly it was a forum for invective, like most online forums. Snore. Anyway, for the conspiratorial mind the existence of such a group combined with a few cherry-picked offensive statements is proof enough for an illuminati-style conspiracy of the MSM to rule the world. At worst, it seemed to include what I thought were appropriate reactions to the Jeremiah Wright story, which could be summed up by, “this is crap, we shouldn’t even cover it, it makes us all stupider.” The most obvious question raised by such a non-parsimonious conspiracy theory is do you really think that if journalists were engaged in a conspiracy to control the MSM, would the gateway to this super-secret and all powerful Google group be a mouse-click by Ezra Klein? And would Ezra Klein, being the mastermind of this great conspiracy, be exercising good judgment by inviting Tucker Carlson to join and telling him all about it?
I have something for people who think this is proof of a conspiracy:

The tinfoil hat!

Scientific American addresses denialism in politics – says it jeopardizes democracy

Scientific American evaluates the candidates on their answers to Sciencedebate 2012 and evaluates ideology-based denialism as a whole:

Today’s denial of inconvenient science comes from partisans on both ends of the political spectrum. Science denialism among Democrats tends to be motivated by unsupported suspicions of hidden dangers to health and the environment. Common examples include the belief that cell phones cause brain cancer (high school physics shows why this is impossible) or that vaccines cause autism (science has shown no link whatsoever). Republican science denialism tends to be motivated by antiregulatory fervor and fundamentalist concerns over control of the reproductive cycle. Examples are the conviction that global warming is a hoax (billions of measurements show it is a fact) or that we should “teach the controversy” to schoolchildren over whether life on the planet was shaped by evolution over millions of years or an intelligent designer over thousands of years (scientists agree evolution is real). Of these two forms of science denialism, the Republican version is more dangerous because the party has taken to attacking the validity of science itself as a basis for public policy when science disagrees with its ideology.

I agree. We’ve debated on this site the prevalence of denialism on the left vs. the right, but I think it’s a distraction from the central point which I think is being argued most effectively by Jonathan Haidt. That is, humans are not rational beings and most uses of reason are to rationalize positions that we arrived at by intuitive means. That means all ideology is going to strain your relationship with science. Humans tend to hold positions based on shortcuts, or heuristics, that lead them to what feels right, then they use reason to dig in to those positions. It is extremely difficult, and uncommon, for people to change their minds based on reason and evidence. So, any time you have political ideology as the source of people’s positions, you will encounter anti-science when those ideologies conflict with the science. Just like right-wingers have a big problem with climate change and evolution, left-wingers have a big problem with a kind of food religion, GMO and toxin paranoia, and other health and environmental denialism. I think the author here, Shawn Otto, has it exactly right.
His argument to tie the problem into encroaching authoritarianism might be more of a stretch:

By falsely equating knowledge with opinion, postmodernists and antiscience conservatives alike collapse our thinking back to a pre-Enlightenment era, leaving no common basis for public policy. Public discourse is reduced to endless warring opinions, none seen as more valid than another. Policy is determined by the loudest voices, reducing us to a world in which might makes right—the classic definition of authoritarianism.

I don’t know if authoritarianism is the destiny of a population that rejects science. Surely we are at greater risk of manipulation by those that control the message most effectively. More likely, we would be easily manipulated into supporting an oligarchy or plutocracy of those at the top of society who can manage media and politicians through money and influence, or at worst we might get a kakistocracy if the likes of the tea party come to power. Otto is right, however, when empiricism and facts are no longer important, the likelihood that the unqualified, the unprincipled, and the ignorant coming to power will increase.

Ken Ham Meets Everything is Terrible

Every once in a while Everything is Terrible has a fun denialism-overlap as they show some ad for a terrible piece of quackery, or in this case a great cut of Ken Ham speaking nonsense to a group of very unfortunate children. This is child abuse. Not the creationism bit, but the embarrassingly-shoddy job he does presenting his evidence which seems to consist of poorly-drawn cartoons of men standing next to dinosaurs and an overhead projector.

Mitt Romney is the wrong choice for healthcare

It seems every day brings a new, glaring falsehood about medical care from Romney, who has bizarrely decided to run against his own healthcare plan in order to appease right wing voters. Now he’s claiming Americans don’t die from lack of healthcare coverage. His reasoning? The unfunded mandate and healthcare-of-last resort stopgap that is EMTALA. For those of you who don’t know the function of the Emergency Medical Treatment and Active Labor Act, it’s law passed in the Reagan era to stop hospitals from dumping patients who were acutely ill and needed emergency care. It prevents hospitals from refusing or delaying treatment of an emergency condition if the patient is uninsured or their ability to pay is unknown. It only obligates hospitals to provide enough care to stabilize the patient, and then the patient is discharged or transferred to another center if a higher level of care is needed. Despite the mandate that such patients be cared for, the federal government did not prescribe a method of reimbursement for such patients, making it an unfunded mandate, and as a result, some 55% of emergency room care goes uncompensated. EMTALA also doesn’t protect you from hospitals attempts to recoup their losses, and those that can pay often receive a surprisingly large bill that can easily bankrupt those living on the edge of solvency. But besides being a cruel and stupid thing to say for someone who proposes to lead our country, it’s also wildly false. Not only does the Institute of Medicine estimate these deaths at about 20,000 a year, but we also see it in admissions that aren’t due to prolonged illness or chronic medical conditions, for example we see a 40% higher trauma mortality among uninsured patients even after accounting for age, race, sex, and severity or mechanism of injury. If you are injured in a car accident, you are 40% more likely to die just by virtue of being uninsured, because the fact is, many hospitals will treat you differently if you can’t pay for your care.
As someone who has done almost all of my medical training at medical centers that are the highest level of care in the region, I’ve seen many of these patients and transfers. Often at such centers you hear griping that a patient’s condition had been exaggerated to suggest that the patient was sicker than they actually were, in order to initiate the transfer of a patient that would be costly to treat, but perfectly within their means to care for. Sometimes you hear complaints the referring hospitals could have done a better job stabilizing a patient before transferring them, it’s impossible to know the motivations of the referrers in any given instance, and I generally believe that the physicians are acting in their patient’s best interests, but we can’t ignore the fact that EMTALA creates a conflict of interest between physician and patient interests by creating a financial incentive for transfer. I suspect such patterns are the reason why you find such a huge disparity in medicare reimbursements and imaging and procedure costs between hospitals. In order to recover the costs of their “mission” expenditures, hospitals that care for more uninsured have to charge medicare and insurers more to reflect their “cost of doing business”, whereas smaller private hospitals that manage to deflect more of these patients can offer elective services cheaper.
In the end, it’s all one big stupid cost-shifting game that ignores the central problem. No matter what, we end up paying for people’s medical care! There is no avoiding it. You can either pay for it prospectively, thoughtfully, and humanely by giving people care in primary care offices, or you can wait for them to get really sick, not to mention really expensive to care for, and pay for it then. But there’s no avoiding the bill. The type of care advocated by Romney here is also just plain stupid. For example, what is the point of stabilizing a patient with COPD and asthma as they come in the hospital in crisis every month, rather than just paying for their medications as an outpatient? ICU admissions, intubation, medications, doctors fees and nursing are all far more expensive (not to mention hard on the patient) than a couple of inhalers a month. Or how about the uninsured patient with a mental illness that requires constant stabilization with inpatient admissions because no one will pay for their anti-psychotic medications? You see it happen like clockwork, a patient is discharged “plugged in” with a month of medications, plans for follow up etc., and then as they can’t pay for medications after that time is up they start missing appointments, losing their job or their housing arrangement, then they’re back in the ER in crisis. Or think about the risk involved in all those transfers, which the current system encourages referring hospitals to engage in even if the patient might not benefit, because it allows them to unload a patient that will just create uncompensated costs for the hospital?
This is leadership on healthcare? I don’t think so.

The New York Times doesn't know how to write a headline

I don’t understand how they could write the headline,”On Health Care, Two Visions With Their Own Set of Facts” in regards to the debate between Obama and Romney last week. The appropriate headline should have been “On Health Care, Two Visions With Romney Telling Falsehoods”.
It’s another example of the NYT’s false-parity reporting. Every single instance described in the article describes Romney lying about Obama’s law, lying about his own proposals, and lying about other facts.
For instance:

Mr. Romney made a similar claim in an appearance last month on NBC’s “Meet the Press.” At the time, he said, “I’m not getting rid of all of health care reform. Of course, there are a number of things that I like in health care reform that I’m going to put in place. One is to make sure that those with pre-existing conditions can get coverage.”
But Mr. Romney’s aides later clarified that he would only explicitly guarantee insurance for people with pre-existing conditions if they have maintained coverage with no significant lapses. That could exclude millions of Americans with conditions like cancer, heart disease and asthma.

He’s for covering pre-existing conditions, except for the single instance in which it matters! When you are unhealthy and lack coverage! This is such an egregious example of mendacity, and it’s not like he didn’t provide a dozen such instances the night of the debate. The article headline suggests that there were falsehoods told by Obama, or at least that he has another view similarly divorced from reality, but the article doesn’t provide such examples. Obama’s worst crime seems to be from trying fill in the blanks in Romney and Ryan’s proposals, making reasonable assumptions about how such proposals and plans would work and be paid for. Take for example factcheck.org’s summary of claims in the debate, again trying to create parity. Take the first claim:

Obama accused Romney of proposing a $5 trillion tax cut. Not true. Romney proposes to offset his rate cuts and promises he won’t add to the deficit.

Yes, but Romney is still proposing a 5 trillion dollar cut if he really intends to drop rates as far as he says. How he’s going to pay for that is hazy and vague. He “proposes” to offset his rate cuts and “promises” he won’t add to the deficit, but there is no loophole you could close to cover that amount of revenue, nor possible way to offer these cuts without adding to the deficit.
Obama’s other great errors? An incorrect stating of a true fact (healthcare spending has slowed), a rounding error (5 million new jobs rather than 4.6), etc. Then factcheck commits it’s own classic disgusting parity routine with this one:

Obama again said he’d raise taxes on upper-income persons only to the “rates that we had when Bill Clinton was president.” Actually, many high-income persons would pay more than they did then, because of new taxes in Obama’s health care law.

Yeah, but his statement is true! He was talking about rates, not overall tax burden. Why does this get counted as counterfactual? Or this:

Obama again touted his “$4 trillion” deficit reduction plan, which includes $1 trillion from winding down wars that are coming to an end in any event.

Why doesn’t ending wars count? This is an Obama accomplishment, isn’t it? And it’s the source of a huge component of a the deficit! I’m all for ending stupid wars in the wrong countries. That’s a conservative ideal if you ask me.
If you look at Romney’s exaggerations (I would call them lies), they are much more severe. They include doubling the amount of jobless, repeating the 50% lie about jobless college grads, exaggerating bankruptcies in an energy investment program (less than 10% went bankrupt like Solyndra, not “half” as Romney claimed), he repeated the “death panels” trope, he repeated the often debunked “716 billion cut” from medicare lie, he claimed Obama doubled the deficit (it barely changed at all from Bush), and he doubled the amount of income loss during Obama’s term.
I don’t understand how these sets of inaccuracies are comparable. Obama, at worst, seems to have used the wrong word “premiums”, during his most inaccurate statement, committed a rounding error, and is being punished for applying arithmetic to Romney’s vague proposals. Whereas Romney doubles every statistic, fabricates others, and misrepresents fundamental facts about the state of the country and laws that are passed and on the books, all the while never providing details as to how he’s going to do anything he proposes.
Both the NYT and factcheck are engaging in false parity here. I find it very upsetting when a presidential candidate addresses a national audience with such falsehoods, and they should be addressed appropriately as such by the media. Until then these races will always be between people who will say whatever is necessary to get elected and those who are trying to make an honest effort (if we’re lucky – eventually we won’t even have that). I could never vote for a global-warming denying (or in this case minimizing), pro-choice before he was pro-life, quackery-promoting etch-a-sketch candidate like Romney. I hope for a day when we actually have an alternative vision provided by a candidate, a true conservative, with a small government vision, but one that’s based on details, facts, and personal responsibility. I don’t want tax cuts for the sake of tax cuts, I want a government that will pay it’s bills, and Romney’s tax plan is insane. Most importantly I want a candidate that believes in facts. Don’t tell me pre-existing coverage will exist in your program then have your minions the next day clarify pre-existing conditions won’t be covered. Own up to it! Say, “I’m a conservative, in my vision of America, you’re on your own.” Be honest about it for once, and consistent, and maybe the message would be more appealing. If your vision of limited government also meant no more unnecessary transvaginal ultrasound laws, no more anti-gay bigotry, no more interfering in the doctor-patient relationship, etc., people might be able to get behind it.

Monckton goes birther – demonstrates crank magnetism

Via Ed I see that Christopher Monckton is expanding his crankery from denying global warming, claiming to be and MP despite cease and desist letters from parliament asking him to stop, curing HIV, the flu, MS and the common cold to now engaging in Birtherism. It’s pathetic when you’ve been pre-debunked by snopes, but there’s no stopping a crank like Monckton.
This reminds me of all the fuss last month over Lewandowsky’s study that basically demonstrated crank magnetism, that is, the tendency of those who believe in one kind of conspiratorial nonsense to believe all sorts of other conspiratorial nonsense if it fits with their ideological worldview. One of the major criticisms of his results was the idea that it was scammed by people trying to make global warming denialists look bad, because there were too many respondents who believed in all the conspiracies. Lewandowsky responded that even removing the “true nutters” did not affect his analysis, but I disagree with the move, and as he notes in the post, Christopher Monckton is an example of why such responses are likely real. This guy is convinced he’s an expert on global warming (and that it doesn’t exist), that he’s cured HIV, that he’s a member of Parliament (despite a cease-and-desist letter from Parliament), and now that Obama is Kenyan. Why anyone should have been surprised by Lewandowsky’s results is beyond me.

Conspiracy-targeted Campaigning from Romney

Slate has an interesting article about Romney campaign mailings that appear to contain buzzwords for chronic Lyme disease advocates in Virginia. Romney’s plan for Lyme disease includes these two points:

Ensure that government agencies have an open line of communication and work with patients, researchers, doctors, and businesses in an objective, comprehensive manner.
Encourage increased options for the treatment of Lyme Disease and provide local physicians with protection from lawsuits to ensure they can treat the disease with the aggressive antibiotics that are required.

Note the “aggressive antibiotics” line. This refers to a bogus medical practice of prescribing long courses of antibiotics, often in IV form, for “chronic Lyme” syndrome. While people can have chronic complications of actual Lyme disease, another, crankier disease entity has been promoted by irresponsible doctors who treat a syndrome similar to fibromyalgia, or chronic fatigue, or maybe even depression, with long-term IV antibiotics. These treatments are administered at their own clinics, usually without insurance paying for it (insurance companies can smell this BS and won’t cover it), at great expense because IV antibiotics cost a lot more to administer, and often without evidence of Lyme infection by tests or history.
This has been a season of bizarre political conspiracy mongering with everything from birtherism from Mitt Romney, Sheriff Joe’s craziness, magic Kenyan Telegrams, Aurora conspiracies, job numbers conspiracies, polling conspiracy theories from America’s least-accurate pollster Dick Morris, and my favorite Obama is buying bullets for the Social Security Administration to kill all Americans conspiracy theory. Now, rather than coming up with Obama conspiracies it looks like they’re trying to solicit vocal conspiracy theorists who think the pharma/CDC/infectious disease society illuminati are trying to suppress a bogus diagnosis their doctor has successfully treated by emptying out their wallets.
It’s very sad, really. People with a legitimate medical disorder, likely along a similar spectrum with fibromyalgia and chronic fatigue that have a disordered sense of pain perception, are being exploited by quack physicians who directly profit from a dangerous course of powerful antibiotics. Antibiotics are not benign drugs, and should not be used carelessly, as they too often are. And the non-evidence based used of megadoses of these drugs, often without any actual evidence of infection should result in a campaign to revoke these physicians’ licenses, not to solicit their votes by hinting at support of quack medical theories and protection of irresponsible physicians from liability. Is this a new all time low for a political campaign?

AEI writes an honest article about ObamaCare

This article from the Sunday Times by AEI fellow J.D. Kleinke is exceptional for two reasons. For one, it’s an excellent explanation for why conservatives should agree with Obamacare. Second, despite coming from the American Enterprise Institute, an organization that regularly contributes global warming and other conspiratorial nonsense to the WSJ editorial page, it appears to contain nothing but factual information. It’s a good reminder of why liberals have been weak in their defense of the law – it’s really just Federal Romney/Bob Dole care, but also provides a very striking critique of the justifications of conservatives opposing it. Including my favorite argument for why the supposedly free-market system we enjoy now is bogus:

Chief among these obstacles are market limitations imposed by the problematic nature of health insurance, which requires that younger, healthier people subsidize older, sicker ones. Because such participation is often expensive and always voluntary, millions have simply opted out, a risky bet emboldened by the 24/7 presence of the heavily subsidized emergency room down the street. The health care law forcibly repatriates these gamblers, along with those who cannot afford to participate in a market that ultimately cross-subsidizes their medical misfortunes anyway, when they get sick and show up in that E.R. And it outlaws discrimination against those who want to participate but cannot because of their medical histories. Put aside the considerable legislative detritus of the act, and its aim is clear: to rationalize a dysfunctional health insurance marketplace.

This is spot on. The analysis of the possible true motivations for the bile and invective levied at what is essentially a conservative piece of legislation are also stunning coming from a conservative:

Clear away all the demagogy and scare tactics, and Obamacare is, at its core, Romneycare across state lines. But today’s Republicans dare not own anything built on principles of economic conservatism, if it also protects one of the four horsemen of the social conservatives’ apocalypse: coverage for the full spectrum of women’s reproductive health, from birth control to abortion.
Social conservatives’ hostility to the health care act is a natural corollary to their broader agenda of controlling women’s bodies. These are not the objections of traditional “conservatives,” but of agitators for prying, invasive government — the very things they project, erroneously, onto the workings of the president’s plan. Decrying the legislation for interfering in the doctor-patient relationship, while seeking to pass grossly intrusive laws involving the OB-GYN-patient relationship, is one of the more bizarre disconnects in American politics.

This is a rare, clear-eyed, honest, and insightful piece of writing from AEI. Have they turned a corner?