science gone wrong, pt 1: are vaccines really causing higher infant mortality rates?

This study, purporting to show that greater numbers of vaccines in the first year of life are associated with greater risk of infant mortality, came across my radar recently. I thought I’d take a moment to look at it in part of a series of posts on the emotionally fraught relationship between science and our everyday lives. This post is the one that has the most to do with parenting; the ones that follow will be more about a health scare I had recently and some of the changes it’s wrought on our life.

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Neil Miller and Gary Goldman claim to have found a correlation, on a population scale, between the number of vaccines children receive in the first year of life in a given country and that country’s infant mortality rate. (Full text of the paper in PDF here.) Their work is riddled with conceptual and procedural problems, and of course whenever someone asserts a correlation without establishing a concrete causal mechanism, we should be skeptical. (Using the phrase “synergistic toxicity” over and over again does not count as establishing a causal mechanism.) But since this kind of “research” frequently gets turned into news items that get circulated among worried parents trying to make good decisions for their kids, I thought I’d delve into it a little bit, leaning gently on a couple of excellent analyses from David Gorski at Science-Based Medicine and Catherina at Just The Vax.

A summary of the problems addressed by Catherina and Dr. Gorski:

1. The paper is inconsistent in its definition of a “dose.” Catherina lays it out neatly:

[T]he way Miller and Goldman are counting vaccines is completely arbitrary and riddled with mistakes.

Arbitrary: they count number of vaccines in US bins (DTaP is one, hib is separate) and non-specific designations (some “polio” is still given as OPV in Singapore), rather than antigens. If they did that, Japan, still giving the live bacterial vaccine BCG, would immediately go to the top of the list. That wouldn’t fit the agenda, of course. But if you go by “shot” rather than by antigen, why are DTaP, IPV, hepB and hib counted as 4 shots for example in Austria, when they are given as Infanrix hexa, in one syringe?

Mistakes: The German childhood vaccination schedule recommends DTaP, hib, IPV AND hepB, as well as PCV at 2, 3 and 4 months, putting them squarely into the 21 – 23 bin. The fourth round of shots is recommended at 11 to 14 months, and MenC, MMR and Varicella are recommended with a lower age limit of 11 months, too, which means that a number of German kids will fall into the highest bin, at least as long as you count the Miller/Goldman way.

(If you’re bored and want to check their work, here are the vaccine schedules from Europe that Miller and Goldman claim to have relied on. They cite UNICEF’s website as their source for non-European countries, although, since they don’t provide a URL for a specific page on the site, I’ve been unable to find that data.)

The definition of a “dose” is critically important here. If you want to entertain the hypothesis that vaccines are in some way “toxic” because of, for example, preservatives or other foreign material, then the number of antigens matters less than the number of shots or vials. On the other hand, if you want to say that the antigens are the toxic substance, then as Catherina points out you have to account for different levels of antigens in different types of vaccines for the same diseases. Miller and Goldman’s vague and confusing approach does little to tease out or account for these differences.

2. Countries don’t all count dead infants the same way. Dr. Gorski quotes Bernardine Healy, former director of the NIH:

[I]t’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don’t reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Miller and Goldman claim to have accounted for these differences and quote a CDC paper which says that “[I]t appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking.” Of course, this statement in itself is quite vague, giving no idea what percentage of the difference in rankings the reporting problem plays. But it also begs the question, “What is the primary explanation?” The same CDC paper gives a perfectly reasonable answer, to which we shall return later.

In the meantime, this paper commissioned by the Congressional Budget Office on the subject of America’s seemingly awful infant mortality stats provides more detail on the difficulties of accurately comparing IMRs:

In countries where physicians are more aggressive about attempting to resuscitate very premature newborns — of which the United States is probably the leading example — extremely small neonates are more likely to be classified as live births than in countries with less aggressive resuscitation policies. Thus, for example, if little attempt is made to resuscitate newborns weighing less than 500 grams (1 pound, 2 ounces), these births may be classified as fetal deaths and not be included in either the live birth or the infant mortality statistics. By contrast, when attempts are made to resuscitate the tiniest newborns, they are more likely to be classified as live births, although most will subsequently die and then be included in the infant mortality statistics.

(We’ll get back to this idea of aggressive treatment in the final section.)

3. Miller and Goldman selected data from a single year, 2009. But why? Surely an analysis over multiple years, or multiple decades, would be more useful. We could be more certain that the IMRs in 2009 weren’t some sort of statistical fluke. And we could watch IMRs move (or not) according to changes in vaccination schedules. As Catherina points out,

For example, in the early 1980ies, Germany’s infant mortality was about 5 times as high (10000 infants died per year) than it is today (2000 died in 2009 with approximately the same birth rate), however (in Miller’s and Goldman’s twisted logic), the vaccination schedule contained far fewer vaccines in the first year (essentially just DT and polio, since the whole cell pertussis was not given between 1974 and 1991, the aP not yet introduced, the MMR given in year 2, no hib, nor hepB, nor PCV given either), while Germany was already very much a “developed country”.

4. Miller and Goldman do not consider the whole world. It’s tempting to say that they’re on stronger ground here — that you want to compare wealthy, industrialized countries to other wealthy, industrialized countries. But they don’t seem to be particularly interested even in other industrialized and/or wealthy countries whose IMRs fall below that of the U.S. — say, countries in Eastern Europe, or the wealthy Arab states — to see whether their correlation holds up further down the list. Gorski:

[S]ince the focal point of the analysis seems to be the U.S., which, according to Miller and Goldman, requires more vaccine doses than any other nation, then it would make sense to look at the 33 nations with worse IMRs than the U.S.

Be that as it may, I looked at the data myself and played around with it. One thing I noticed immediately is that the authors removed four nations, Andorra, Liechenstein, Monaco, and San Marino, the justification being that because they are all so small, each nation only recorded less than five infant deaths. Coincidentally, or not, when all the data are used, the r²=.426, whereas when those four nations are excluded, r² increases to 0.494, meaning that the goodness of fit improved.

In other words, even among the countries above the U.S., Miller and Goldman cherry pick the data, dropping small countries that don’t make the data fit the way they want it to. (4 countries out of 33 is an 8th of the data being excluded, in case you were counting.)

Are these decisions reasonable? Would including Russia or Andorra have made the data clearer, or muddied the waters? I’m not sure, but in light of other methodological decisions, this is questionable at best.

5. What’s with the grouping? Why sort the countries into groups based on the number of vaccines, and then plot the average IMR of each group, instead of just plotting all the data points separately? Gorski again:

[F]or some reason the authors, not content with an weak and not particularly convincing linear relationship in the raw data, decided to do a little creative data manipulation and divide the nations into five groups based on number of vaccine doses, take the means of each of these groups, and then regraph the data. Not surprisingly, the data look a lot cleaner, which was no doubt why this was done, as it was a completely extraneous analysis. As a rule of thumb, this sort of analysis will almost always produce a much nicer-looking linear graph, as opposed to the “star chart” in Figure 1. Usually, this sort of data massaging is done when a raw scatterplot doesn’t produce the desired relationship.

Indeed. Of particular note is Group 2, countries with a vaccination schedule of 15-17 “doses” in the first year. Group 2 only includes 5 countries, and one of those countries is Singapore, which has the best IMR in the world (2.31) and calls for its infants to receive 17 vaccines doses in their first year, according to Miller and Goldman’s counting. Because Group 2 is so small, Singapore is clearly dragging down the average IMR of the whole group — from 4.30 to 3.90. Take out Singapore, which is clearly an enormous outlier, and Group 2 has about the same IMR as Group 3, which makes the linear relationship a lot less neat. Also, 4.30 is very similar to Denmark’s 4.34, and Denmark only requires 12 vaccines in the first year. And speaking of Singapore, if this linear correlation based on vaccination schedules is so strong, why does Singapore have such a drastically low IMR with 17 vaccine doses in the first year, when Italy and San Marino have drastically high IMRs (5.51 and 5.53, respectively) with only a single dose more (18) per year? Naturally, there will be outliers in any linear regression, but it seems that when you get done smoothing out the outliers here by dropping data points and sorting the data into bins, you’ve essentially hidden half the statistical reality.

6. They fall prey to the “ecological fallacy.” Gorski once more:

The ecological fallacy can occur when an epidemiological analysis is carried out on group level data rather than individual-level data. In other words, the group is the unit of analysis. Clearly, comparing vaccination schedules to nation-level infant mortality rates is the very definition of an ecological analysis.

In other words, measuring correlations between variables on the population level tells you nothing about the correlation on an individual level, and indeed is likely to vastly overstate the likelihood of such a correlation. For example, let us suppose that Italians have fewer heart attacks than do Englishmen, and yet eat pasta at a much greater rate. Can we conclude that pasta is preventive against heart attacks? No, because, among other things, you haven’t demonstrated that the pasta-eating individuals in the Italian population are the ones getting fewer heart attacks. Perhaps there’s a smaller subset of Italians who eat hardly any pasta at all, yet get plenty of vigorous exercise, and therefore drag down the national average incidence of heart disease.

Similarly, if you want to find out if a heavier vaccine schedule in the first year correlates with higher infant mortality — or, to be even more specific, whether it correlates with higher rates of SIDS, since Miller and Goldman argue that SIDS and unexplained deaths caused by vaccine “toxicity” are probably the real culprit here — you should do a study following outcomes for individual kids who receive different schedules of vaccines. Trying to track a phenomenon, if there is one, by comparing different whole populations is both inefficient and brutally error-prone.

To their credit, Miller and Goldman attempt to address this problem in a section titled “Ecological Bias.” To their discredit, their explanation is simply awful:

Although most of the nations in this study had 90%–99% of their infants fully vaccinated, without additional data we do not know whether it is the vaccinated or unvaccinated infants who are dying in infancy at higher rates. However, respiratory disturbances have been documented in close proximity to infant vaccinations, and lethal changes in the brainstem of a recently vaccinated baby have been observed. Since some infants may be more susceptible to SIDS shortly after being vaccinated, and babies vaccinated against diarrhea died from pneumonia at a statistically higher rate than non-vaccinated babies, there is plausible biologic and causal evidence that the observed correlation between IMRs and the number of vaccine doses routinely given to infants should not be dismissed as ecological bias.

[emphasis mine]

So after admitting that they have in no way correlated these higher rates of infant mortality with actual vaccination on the individual level, Miller and Goldman attempt to razzle-dazzle the reader with a lot of scary-sounding stuff. But, for example, the “lethal changes in the brainstem” occurred in a single child after a vaccination — to infer anything from that would be a classic case of “post hoc, ergo propter hoc” reasoning. I’m sure you can find a single case of a child who died of bullet wounds after being vaccinated, too.

And the babies who died of pneumonia at a statistically significantly higher rate after receiving the rotavirus vaccine? That was in a single study out of eight studies conducted on the safety of Rotarix, the vaccine in question. When you compile all eight studies, the relative risk of pneumonia between Rotarix and placebo is exactly 1, according to this exhaustive FDA briefing (PPT — skip to slide 59).

I’m not going to bother batting at the other examples, but you see where this is going. And the problem of the ecological fallacy is probably the most damning, because even if all the other problems in this paper were fixed, this alone would be enough to keep it from making any sense as science.

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Finally, I’d like to discuss that CDC report I promised to come back to, and pile on a criticism of my own that neither Catherina nor Dr. Gorski really dealt with. Namely, we know the risk factors that bring the U.S.’s IMR up. Alice Park discusses them in a 2009 article for Time:

Starting in 2008, the March of Dimes began tracking three of the major contributors to the high preterm birth rate — lack of insurance among women of childbearing age, rates of cigarette smoking and the rate of babies born preterm, but at the tail end of pregnancy, between 34 and 36 weeks….

By far the biggest contributor to the high premature birth rate is the rate of so-called late-preterm births. About 70% of babies born too early in the U.S. are born between 34 and 37 weeks. There are many reasons for these early deliveries, making it particularly difficult to target one or even a few factors and address them head-on. The increase in multiples — twins, triplets or more — is one contributor. The rise in assisted reproductive technologies, such as in vitro fertilization, is another; these techniques are associated with both an increased risk of multiples as well as a higher risk of premature delivery, even of singletons….

This is relatively undisputed, as far as I can tell from reading through literature on America’s woeful infant mortality rate. What do Miller and Goodman make of this? From the paper:

Preterm birth rates in the United States have steadily increased since the early 1980s…. Preterm
babies are more likely than full-term babies to die within the first year of life. About 12.4% of US births are preterm…. Preventing preterm births is essential to lower infant mortality rates. However, it is important to note that some nations such as Ireland and Greece, which have very low preterm birth rates (5.5% and 6%, respectively) compared to the United States, require their infants to receive a relatively high number of vaccine doses (23) and have correspondingly high IMRs. Therefore, reducing preterm birth rates is only part of the solution to reduce IMRs.

There are several squirrelly points packed into this paragraph. First, note the phrase “within the first year of life,” which, while part of a technically correct definition of infant mortality, leads us to the question: why are we counting all deaths in the first year in this study anyway? Surely the correct measure of whether vaccines influence mortality would exclude all deaths prior to the first vaccine — i.e., all deaths that occur at or immediately after birth.

Second, the cherry-picking of Ireland and Greece as countries with low preterm birth rates and high IMRs, and then imputing those figures to vaccination rates is obviously putting the cart before the horse. If you’re trying to draw correlations of this kind, why not include a table of preterm birth rates and use them to factor out that difference in IMRs before trying to measure a difference attributable to vaccine schedules? I mean, if you have those preterm birth rates handy, which Miller and Goldman seem to, although they don’t provide a footnote for the Ireland and Greece numbers.

Anyway, here’s an interesting graphic from that CDC paper Miller and Goldman cited to show that reporting differences did not account for the bulk of the difference in IMRs. It shows what the US infant mortality rate would look like if we had Sweden’s level of preterm births:

What does this tell us? It tells us that, exactly as the CDC, the CBO, and the March of Dimes have concluded, much of the difference in IMR between the U.S. and other countries can be attributed to pre-term birth rates. And what does that tell us about this supposed correlation between vaccination and IMR?

It tells us that having an aggressively interventionist medical culture in the U.S. leads, somewhat paradoxically, to higher IMR. Remember that many of those preterm births are the result of fertility treatments. And U.S. physicians are more aggressive about attempting to resuscitate very small babies, even though most will die anyway; this leads to a much higher count of live births followed by death than in countries that treat those unbreathing preemies as still births. And aggressive monitoring of fetal health, and a greater willingness to either induce early labor or perform caesareans, may also play a role.

And then there’s this interesting paper from the New England Journal of Medicine that finds that, paradoxically, the rapidly increasing numbers of new neonatal ICUs in the U.S. may be responsible for at least some of the rise in infant morbidity and mortality:

In regions with a greater supply of beds and neonatologists, infants with less serious illness might be more likely to be admitted to a neonatal intensive care unit and might be subjected to more intensive diagnostic and therapeutic measures, with the attendant risks of errors and iatrogenic complications, as well as impaired family–infant bonding.

In short, if there is a correlation between vaccination schedules and IMR — a fact not proven here — there may be a simple explanation (e.g., a more aggressive approach to medicine overall) that does not require invoking unproven and unexplained “toxicity” in vaccines.

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Where does all this leave us, in terms of what I was talking about at the beginning, the relationship between science and our everyday lives? Well, it counsels skepticism, certainly, when “news” of a disturbing “scientific” discovery shows up on parenting forums or in our inboxes. And of course it challenges each of us to become more scientifically literate in our reading — which is why I occasionally undertake these close examinations of scientific subjects related to parenting.

But this process is exhausting. To really delve into this paper, to take it apart and understand it to my own satisfaction, has taken two days and 3500 words. I can’t possibly do this with each piece of scientific information (or misinformation) that comes my way. For the most part, I’m forced to shrug and rely on professionals at the CDC, the FDA, and the doctor’s office to steer me the right way. But what happens when the professionals start to seem untrustworthy or themselves misinformed? What do you do when your need for expert knowledge is undermined by an almost paranoid sense that the experts are not on your side? And how do you avoid going too far in the other direction and falling victim to things like vaccine denialism?

I’ll try to talk more about that in the next couple of entries in this series.

smackdown

I don’t know how you come down on the incarceration question… whether it’s for rehabilitation or revenge…. But I was beginning to think revenge is the only argument makes any sense.

— H.I. McDonough, Raising Arizona

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When Elana and I were courting — when we still thought having a baby was a long way off — we had a lot of discussions about raising kids. These discussions were sometimes very abstract, and sometimes they involved very aspirational notions, such as, “Wouldn’t it be nice to raise our kids on a farm?” (We do not own a farm.)

Elana was not just fantasizing, however, when she said she would never spank her kids. She was very serious on this point. “I’m not telling other people what to do, but no child of mine will ever be spanked.”

I was more on the fence. On the one hand, I had been spanked, quite a bit. I was spanked on the behind with open hands and flyswatters and once, when I was an amazingly mouthy pre-teen, my dad even smacked me across the face. I don’t believe corporal punishment did harm, in and of itself, to my relationship with my parents or to my self-esteem or my ability not to murder people. Lots of my friends were spanked, and none of us has grown up to so much as get in bar fights, let alone become violent criminals.

It was just part of the culture of parenting in Georgia in the 1970s, and we all generally looked back on our spanking episodes with amusement. The angry parent brandishing flyswatter or belt or kitchen spoon seemed to us, in nostalgic hindsight, a little cartoonish — inexplicably but hilariously violent, to be avoided if possible, but not abusive.

On the other hand, I couldn’t think of a single time corporal punishment had changed my behavior for the better. On the contrary, during a ten-year epic battle with both parents and teachers over whether I would do homework and participate in class, the desire to avoid spanking never encouraged me to do my homework or become a better student, in part because blowing off homework felt good now, while a spanking might or might not feel bad later.

This is not to say spanking had no effect: I did still want to avoid the spanking, if possible, and so I became a rather inveterate liar. I don’t know if I was a good liar — you’d have to ask my parents about that — but I lied prolifically, because, after all, the only real proof my parents had of my misdeeds came at report card time. (This was back when teachers and parents weren’t in such constant contact.) This was my childhood logic: lie all quarter long, sleep in class, accumulate months of homework-free days, and then deal with the spankings at the end of the term. It was a horrible, guilty, harried existence… but I did get out of a lot of math homework.

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I know a lot of people claim that spanking did them no end of good. The story usually goes something like this: “When I got out of line, my dad would wallop me good. He did it to teach me a lesson, because he loved me. And I learned to be a good person and work hard and respect my elders because of it.” Now, I don’t deny any part of that except the “because of it.” I’m sure your dad loved you and wanted to teach you how to be a moral and responsible person, and I’m sure that you did, in fact, learn to be a good person from this dynamic with your dad. I’m just not sure the spanking magically transmitted the morality into your bloodstream via your asscheeks.

My guess is that the fact that your dad was attentive to your moral progress and strove to correct you when you were wrong was the determining factor, not the spanking itself. The spanking was a kind of placebo ritual, which your dad, following generations of good dads before him, performed for your benefit, carefully explaining its purpose. He could have performed other rituals, of course — he could have told you to say ten Our Fathers, for example, in order to cleanse your sin away and discipline your soul. But spanking is a good ritual for kids because it’s physical and easily understood, and because kids would like to believe that the memory of the pain will remind them not to transgress again in the future.

This turns out not to be true, of course, because children have notoriously poor impulse control even when they’re under threat. But the child wants it to be true, and the dad believes it, and so they perform the ritual together. The child is reassured that his father cares about his behavior, and he strives to be worthy of his dad’s approval. That, I suspect, is why spanking “works,” to the degree that it does, sometimes, for some people.

But if the child doesn’t care? If he would like your approval but not as much as he’d like to skip homework/tease his sister/paint the dog blue? Or worse yet, if he sees the thing you’re asking him to do as having no value, as an arbitrary demand on your part? Well, then you’re nowhere, I think.

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Science bears me out, by the way, on corporal punishment encouraging kids to lie, and lie big. Po Bronson and Ashley Merryman, in their eyebrow-raising book on scientific studies of parenting, Nurtureshock, write about Victoria Talwar, a child psychologist who studies lying. (The relevant chapter can be found here; scroll down past the text of the NPR story to find it.) Talwar does variations on an experiment in which children are given an opportunity to illicitly peek at the answer during a guessing game. Her interest is not just in which kids peek, but which kids lie about having done so.

Increasing the threat of punishment for lying only makes children hyperaware of the potential personal cost. It distracts the child from learning how his lies impact others. In studies, scholars find that kids who live in threat of consistent punishment don’t lie less. Instead, they become better liars, at an earlier age — learning to get caught less often.

Talwar did a version of the peeking game in western Africa, with children who attend a traditional colonial school. In this school, Talwar described, “The teachers would slap the children’s heads, hit them with switches, pinch them, for anything — forgetting a pencil, getting homework wrong. Sometimes, a good child would be made to enforce the bad kid.” While the North American kids usually peek within five seconds, “Children in this school took longer to peek — 35 seconds, even 58 seconds. But just as many peeked. Then they lied and continued to lie. They go for broke because of the severe consequences of getting caught.”

Even three-year-olds pretended they didn’t know what the toy was, though they’d just peeked. They understood that naming the toy was to drop a clue, and the temptation of being right didn’t outweigh the risk of being caught. They were able to completely control their verbal leakage — an ability that still eluded six-year-old [American children].

In other words, corporal punishment, which is painful, gives a child a strong incentive not to get caught, and the more intense the punishment, the higher the stakes and the greater the lie. (In my own experience, I found this to be true even when the crime in question was lying itself.)

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So I’ve seen little evidence that spanking curbs bad behavior (except inasmuch as it’s perceived as a sign of love and attention), and I’m pretty sure it gives kids a good, concrete reason to lie.

But for myself — I won’t presume to speak for other parents — there’s a more powerful reason not to hit my kids. I think it makes me a worse person.

In 1996, right after I graduated from college, I spent a few months in Florida watching my sister’s kids while she finished her degree and studied for the MCAT. As an uncle and the only adult looking after three children under 6, I was granted guest spanking rights. And occasionally… I exercised them. Here are my observations:

• I spanked when I was pissed off. It was not that I spanked as part of a coldly rational system of discipline; I spanked when the kids were out of control and I wanted to re-assert my authority.
• Once I had opened the spanking can, I found that I went to it sooner and sooner.
• This, of course, meant that the kids got inured to it. Having been spanked, they knew it was unpleasant… but also that they could endure it. I would have had to hit them MUCH harder to get their attention — to the point of bruising, probably, which I think we can all agree crosses some kind of line.
• Spanking and yelling didn’t end misbehavior, but their mom’s attention and affection at the end of the day generally did.

Corporal punishment felt, to me, like bullying. And it was very attractive for precisely that reason — because bullying annoying people is very satisfying. But it didn’t feel like a good way to get respect from the kids; in general, the spanking came about because I had already lost their respect and obedience.

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Which leads me to my final thought on corporal punishment: it doesn’t teach either the parent or the child anything about how to live in the world. At no other time in life — in no other relationship — is a beating an acceptable way to solve a problem.

If you work in an office, you can’t turn your subordinate over your knee. If your friend takes up smoking, you can’t smack his hand with a ruler. I’ve seen many, many parents and other caretakers take a child by the arm and say, “You wait ’till we get home. You’re gonna get an ass-whupping!” But what would you think of a man who said that to his wife?

I was on the subway once and the woman across from me smacked her tiny son repeatedly for crying. I didn’t do anything about it, because in our society there’s a sacred line drawn around parenting decisions. I felt I lacked moral authority, and that if I tried to stop her other people in the car might turn against me and defend her.

But consider the case of Rep. Bob Etheridge, who slapped around two college students who tried to ambush-interview him:

Commentators from the left (Glenn Greenwald) and the right (Michelle Malkin’s guest blogger) have noted that Etheridge is clearly guilty of assault here.

But what if the cameraman, or the young man he dragged around by the arm, had been his 7-year-old son? Why should we consider it assault when a grown man hits another grown man but good discipline when a grown man hits a defenseless small child? It doesn’t matter that the child “deserves” it or “might learn from it.” Lots of people deserve an ass-whupping; that doesn’t make it the right thing to do. Or as Chris Rock once put it: “You know what they say: ‘There’s no reason to ever hit a woman.’ Shit. There’s a reason to hit everybody — just don’t do it. There’s a reason to kick an old man down a flight of stairs — just don’t do it.”

To hit my son, I think, would be to allow myself a particularly satisfying way of ending an argument — one that I’m not allowed in any other sphere of life — for no better reason than that I’m bigger and the law permits it. I think that kind of indulgence softens your character and leads to moral weakness, as surely as sugary drinks soften your teeth and lead to cavities. It makes you a person less able to deal with the real world, and it teaches your kid that you are periodically a failure of an authority figure whose only recourse is to violence.

That’s not the relationship I want to have with my son. When he looks back on our life together, I know he’ll see a huge number of failings, places where I could have done better. But I hope he won’t see me as an ineffectual buffoon who felt he had to use force to get someone a sixth his size to stop throwing french fries in the McDonald’s.

perhaps it goes into an alternate universe for a while before coming out the other side

I received this email from Outstation Elana at 00:13 this morning:

poopwatch – day 14

Infant continues to grumble at higher than normal rate. GPM – grumbles per minute – has reached hitherto unknown levels, as high as eight ear-piercing shrieks per minute.

Infant’s belly remains soft, with no apparent tenderness. Pear juice has done nothing. Nothing. Terribly disappointing. Had been avoiding this last, drastic step, but am prepared to present infant with shamanistic offering of cloth diapers in the morning. Constant motorboating leading to increased mental confusion, fuzziness. Must find a way out before it is too late.

Note to self: do not leave house with infant until situation is resolved. A repeat of Poopocalypse ’10 is likely.

SEND HELP, DEAR GOD, SEND HELP

The message ends there. We do not know what has happened to the scientific team since.

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Breastfed babies don’t always poop that much. Here’s an interesting Ask Moxie post in which she informally surveys her readers about their babies’ poop schedules. The range is astonishing: some babies poop 4-6 times a day (no, God, no!), while others have occasionally taken 3-4 weeks to poop. H. isn’t in that range quite yet, but he has already hit his pediatrician’s record for longest spell without a poop. Man. I hope the dam breaks soon.

seating arrangements

So we bought H. a baby seat, because, you know, the state troopers told us we couldn’t strap him to the hood of my truck anymore. Car seats are kind of a bummer — they’re marketed as the difference between life and death for your baby, but ONLY if they’re installed correctly. There’s a common meme that floats around the internet that “[X]% of child safety seats are installed incorrectly!” — where X is some alarmingly high number, usually between 75 and 90.

Now, if that turns out to be true, I think we can safely say that the problem lies not with installers but with the manufacturers. If 90% of seat belts were worn “incorrectly,” I don’t think we’d be satisfied with manufacturers sending us to police stations to get properly belted in.

But where does that statistic come from? Top Google results for “car seats installed incorrectly” cite the National Highway Traffic Safety Administration, but none of them link to it. (They also cite wildly different numbers.) It’s true that the NHTSA throws around the figure “3 out of 4” in at least a couple of places. But nowhere does that agency bother to cite a specific study or explain how it arrived at that number.

A few state law enforcement agencies have provided real statistics about car seat installation shortcomings: Pennsylvania inspected 619 vehicles in September of 2008 and found that 80% of those were installed incorrectly; Nebraska, inspecting 7,900 vehicles over the course of a year, found an almost unbelievable 89% failure rate.

But are these numbers representative? Both states relied on a self-selecting pool of parents who went out of their way to have their car seats inspected. It’s hard to say whether that group overrepresents people who know they’ve put the car seat in wrong, or whether it actually skews toward people who are super-conscientious about safety. I’m also not sure I believe that a state trooper who took a four-day course in car seat installation really has some magic technique that my wife and I were unable to divine in the many seat-strapping sessions we’ve taken part in since having a baby and acquiring a passenger car.

The standard for “correct installation” given in nearly every car seat manual in America is that the seat should no more than an inch in either direction “along the belt path” — i.e., from side to side. But because the seat is basically cinched down by a semi-circle of slippery nylon seatbelt, that standard is rank bullshit. I issue the following challenge to all car seat proponents everywhere: I can, with my arms of average strength, easily rock any car seat on the market, installed by whatever expert you choose, more than an inch along the belt path. And if I can do it, so can a Buick in a side-impact crash.

Which is not to say child safety seats are useless. There’s plenty of evidence that, for infants and young toddlers in particular, they’re quite effective at reducing injury and mortality in car accidents. But the “correct installation” phantom is representative of the way we think about child safety — we tend to want to make it into a measure of personal dedication, so that a parent who buys an expensive car seat and takes it to the technician to have it installed can feel like a “good” parent. But as this cranky mom points out, a system that lets people feel like they’ve won Safe Parent Of The Year is not necessarily a system that makes sense in terms of child safety:

It seems that auto manufacturer Volvo has partnered with carseat manufacturer Britax-Romer to create a custom-made carseat model that fits and works perfectly only in Volvo vehicles. The intention was to create a carseat that would be supremely safe when used in Volvo vehicles. The National Highway Traffic Safety Administration will not allow that carseat to be sold in the U.S. because the “NHTSA has mandated that child seats cannot be vehicle-specific”…”every child seat must fit in every car”….

[W]hat could be the NHTSA’s motive for denying the new product to be sold in the U.S.? Are they being irrationally bureaucratic? Are they trying to protect the consumer by not letting the market become flooded with vehicle-specific seats? Is inspection and regulation of so many seats too much of a logistical nightmare for all truly concerned with child safety? And wouldn’t the whole bloody mess just evaporate if all cars had the option to come pre-built with integrated safety seats?

Amen, sister.

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Nonetheless, the debate over car seat safety occasionally produces interesting tangential results. Steven Levitt, the University of Chicago economist and co-author of the much-debated Freakonomics books, caused a stir in 2008 by claiming in the New York Times Magazine that for children over the age of two, seat belts are as effective as after-market car seats in reducing mortality and serious injuries. That’s a bold claim, and Transportation Secretary Ray LaHood attacked Levitt’s work as an attempt to be “provocative,” which it probably was. But he also claimed that Levitt’s work was based on a single set of data, the U.S. Department of Transportation’s Fatal Accident Reporting System, and that he used an overly broad timeframe in his study, reaching back as far as 1975, when there were no child car seats. (LaHood, not a scientist, derives these criticisms from a paper in the Archives of Pediatric and Adolescent Medicine which attempts to refute Levitt’s claims.)

It’s true that in Levitt’s early work on the subject he did rely exclusively on the FARS, and he acknowledges the limitations of his data set. (Levitt in fact goes further than his critics, noting that:

[I]n order for a crash to be included in the FARS data set, there must be at least one fatality. For those crashes in which a child is the only fatality, if that child would have survived the crash had he or she been differently restrained, the crash would have been absent from FARS. Similarly, for crashes in which no one dies, but a child would have died had he or she been using a different restraint, the sample composition depends upon the child’s restraint use. As demonstrated by Levitt and Porter (2001), this sample selection is likely to cause the benefits of effective safety devices to be systematically understated in the analysis presented above.

(You have to admire the cheek of a guy who cites his own studies when determining whether he has any blind spots in his data selection.)

But between 2005, when the first study was published, and 2009, when LaHood was complaining, Levitt had undertaken an additional study with Joseph Doyle, mining data from three additional databases: the General Estimates Survey, the New Jersey Department of Transportation’s figures, and the Wisconsin Crash Outcome Data Evaluation System (CODES). The newer study also restricted itself to more recent, car-seat-utilizing years. And the new study confirmed the results of the earlier study: seat belts are approximately as safe as after-market car seats for children over 2.

Levitt responded to LaHood’s criticism with all the social grace you might expect from a University of Chicago economics professor: he accused the Secretary of Transportation of not really caring about safety. Fair enough, since LaHood had said as much about Levitt, but what I found interesting were the comments on Levitt’s various blog posts on child seat safety. Some people, of course, reacted emotionally to the issue: this fellow celebrated the joy his son felt when his father illegally turned his seat forward on a lonely back road, while this anonymous commenter tastelessly brought Levitt’s dead child into the discussion. But other commenters, it seemed, were really inspired by the emotional intensity of discussing child safety to broaden their knowledge of science and to try to read and understand outside their comfort zone.

I find it heartening, in a weird way, that many non-scientists have waded into this discussion and tried to apply critical thinking to a technical issue in which they are not experts. For example, there’s this thoughtful comment arguing that we can’t test the effectiveness of car seats or seat belts under laboratory conditions (i.e., properly installed) — we have to test them as they’re actually used. And even this guy, who’s such a huge douchebag he brings up his law school class ranking (and misspells “Summa Cum Laude”) when someone wounds his pride, is at base defending his right as a layman to wrangle with science, to try to understand it and become better informed about its methodologies.

I find this invigorating. I’ve been a parent for just over six months, and already I’ve run into a lot of areas, like co-sleeping, where public health authorities make sweeping proclamations based on really sketchy and inadequate science. And I don’t necessarily blame them — science is often cautious and unsure, while pamphlets and billboards need to be bold, certain, and unwavering. But I do dream of a world that encourages a little more skepticism and curiosity and “What’s your source for that?”

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(Elana has an idea that everyone should take a kind of personality test that would enable you to encode your own degree of scientific curiosity vs. your level of trust in authority. So if you’re a big fat jerk, like me, you could go to the doctor or the supermarket or wherever and say, “I’m a 2-F,” and they’d say, “Oh, all right. Here are the studies supporting this conclusion.” Or if you didn’t care and just wanted someone to tell you what to do, you could say, “I’m a 7-A,” and they’d say, “Here’s your pamphlet. It’s in bullet points!”)

two breads

Some brief notes on food.

We went to the pediatrician about a month ago to get H. some shots and because we like how warm they keep the exam room. In the course of the visit, our doctor recommended that we go ahead and start our son on solid foods. We were surprised — he’s so little! — but I asked the doctor what kind of food we should start with. “Rice cereal,” he said, as though rice cereal were the kind of thing people keep around the house.

We wondered if this was really the right time, or if Dr. S. was just giving us the standard timetable without taking into account H.’s extreme preemieness. (I mean, yes, he is already in the 50th percentile in height and weight, thanks to our spectacular parenting, but even so….) Still, we agreed that some time soon Henry would probably become interested in food, and that would probably be the right time to start feeding him solids. (There are, of course, also some technical recommendations for when to start: “when he can sit on his own, turn his head from side to side on his own, turn his head from side to side showing he has had enough to eat, and accept food from a spoon without the tongue pushing the food out of his mouth.”)

We soon found out, though, that it’s harder than you might think to tell when a baby is ready to eat. What does it mean to be interested in food? Here are the things he does so far:

• Stares at other people’s food.
• Watches you eat.
• Puts anything he can get in his hands into his mouth.

But on the occasions that I have attempted to put bits of mashed-up food in his mouth, the reaction has generally been confusion. Not that he’s upset, exactly — he just doesn’t understand why I did that, or what he’s supposed to do with the mush. (Though this last time it was a bit of mushed-up potato from the inside of a french fry, and while he wasn’t interested in the potato, he did suck the salt off my finger. Yes, that might have been my child’s first food — french fry salt. Leave your “worst father in history” comments below.)

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Related: Jamie Oliver’s Food Revolution is an interesting show. British TV Chef Oliver goes into American schools and tries to convince West Virginia lunch ladies to cook healthy meals, which is fascinating, because he finds it challenging to make meals that are nutritious yet also meet the program’s budget and the government’s “nutrition” guidelines. These guidelines are often obtusely enforced. In one episode Oliver is chastised for not providing “two breads” at a meal, even though he provides a pasta dish, which is nutritionally at least equivalent to white bread. He goes over to a competing meal line staffed by professional lunch ladies.

“Where are your breads?” he asks.

“The pizza,” one of the lunch ladies answers. “It counts as two breads.”

Oliver’s chief nemesis, though, ends up being, not one of the lunch ladies, but the administrator in charge of determining whether Oliver’s meals are “reimbursable” according to government standards:

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Oliver’s struggle to provide children with real food can’t have been more futile than our attempts to get real food in a suburban Maryland office park. So far we have discovered a really wonderful Afghan curry place and a locally reputable joint for Maryland crab cakes, a dish whose popularity eludes me. (A lot of crab is lumped together. Then some heat happens. Then they charge you $14.) And other than that, it’s a vast wasteland of chain restaurants.

You can read our previous takes on chain restaurants here and here, but I’ll admit it — I’m not above them, when they’re done right. Subway makes a reliable $5 sandwich, to include vegetables; Ruby Tuesday makes an adequate, if not thrilling, hamburger; there’s even a Chik-Fil-A here, which makes my little Southern heart sing.

But here is what we have learned since we’ve been here: never go to a non-chain restaurant that models itself on chain restaurants. We went to the “Olive Grove” restaurant around the corner, and we thought we knew what we were getting: an Olive Grove ripoff featuring Sysco processed chicken lumps over fettucine. Man, if only. Instead we got dishes that came with all the health and self-image hazards of processed foodstuffs, yet still somehow lacked the reliable saltiness and transfat satisfaction of your typical extruded nutrition. The marinara with sausage was noticeably worse than if you had made it yourself from a jar of Ragu and some Jimmy Dean hot sausage links. The chicken piccata tasted like margarine and death.

But the place was packed to the brim — the decor resembles a convention hall, and families crammed in around banquet tables like they were at a favored cousin’s wedding. There are clearly a lot of people in Maryland who hate food and want to see revenge worked upon it.

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Finally, here is an interesting article about how orange juice is made. Squeezing is involved… but so are “flavor packs.” Kind of appalling; kind of… what you’d expect, really. Just be aware that the phrase “100% juice” is a careful semantic positioning.

if you’re not experimenting on your child, you’re doing something wrong

So I haven’t written anything in a couple of weeks, and I had some exciting ideas worked up about food and also war crimes, but I’m putting those on hold in favor of science.

Our son has a fair number of toys at this point. A number of generous people have contributed new and old playthings for his amusement. Many are met with indifference; a few, like the grabby-ball with the rattle trapped inside and the wand-rattle with the spinning mirror, are favorites. But almost all of them are made of plastic, and being the sort of people who worry at night about pthalates and BPA and the Chinese plot to bring down America by making us a nation of hermaprhodites, we thought it would be nice if he had some wooden toys. So we headed on down to the local IKEA, because obviously nothing in IKEA is made in China, and we bought our son this baby gym:

Brightly colored! Dangly things!

(We also got him a sheepskin to lie on, because apparently he doesn’t enjoy lying on the industrial carpet in our hotel room that much. Go figure. Also because a sheepskin basically triples your baby’s powers of cuteness.)

So we got home and put him on his back on the sheepskin (which he loved right away) and assembled the gym and put it over him… and we saw something we’d never seen before. He whipped his arms out to the side as though he was falling; he seemed unable to focus his eyes. Then he started waving his arms, grabbing the wooden feet of the gym as if to steady himself, and began to cry in fear. It wasn’t the sharp cry of pain or the annoyed complaining of being hungry or tired. Instead there was a long, steady ramp-up that led to full-throated screaming.

We took him out of the gym.

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Now lots of times kids don’t like stuff. That’s fine. But we are nerds, and also we had just spent TWENTY-FIVE WHOLE DOLLARS on that gym. So we were determined to get to the bottom of the problem.

Here is a diagram from overhead of how we had set the gym up originally:

As you can see, the gym is perpendicular to the baby.

We tried taking the toys off the gym and dangling them over him one by one:

Don't laugh at my drawings! I was working with a touchpad.

That went well, so we strung the toys on a tape measure over him. This also did not freak him out. So it didn’t seem to be the toys dangling overhead.

We tried repositioning the gym in various ways. First we rotated it 90 degrees, so it was parallel with his midline:

This could also be a picture of a construction accident.

He was fine with that — slightly nervous at the re-appearance of the gym, but not panicky.

Elana lay down on her back and put the gym over her face. “The underside is very dark compared to the ceiling overhead,” she noted. “Maybe he’s having a depth perception problem?”

We put the gym over him again and watched him carefully. Now starting to become familiar with it, he didn’t freak out right away, but reached out for the toys. But he reached past them, or off to the side, as though he could see them but couldn’t work out quite where they were. And his eyes got that unfocused look again. Then he panicked and started to cry.

Normal parents, at this point, would probably conclude that that was enough for one day.

We did not do that.

We put the gym over him with a cloth spread out just above it so he couldn’t see the ceiling. He didn’t love it, but he didn’t strenuously object this time.

We tried turning it upside-down and holding it by its feet, so that the bar was above his face but the legs weren’t in his peripheral vision. Fine. We held a folded-up towel over him at the height of the gym. Also fine.

Hmmm. Mysterious.

Eventually we gave the experimenting a rest and let him use the gym for something else — standing practice. (Also biting practice.)

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The best theory we had was that perhaps something about the contrast between the dark underside of the gym and the bright white ceiling was producing an optical illusion that interfered with his vision. The following morning, Elana put him down with the gym next to the window, where the brilliant early light lit up gym, baby, sheepskin and room in a very even and pleasing way. And hey, presto! he suddenly liked his gym. He played with it for quite a while.

So that seemed like a validation of our theory. But I think maybe there’s a more interesting facet to this, because now he’ll play with his gym at any time, under any lighting conditions. Here is a video taken at night, to prove it:

So here is what I think. I think the gym gave him a new vision problem that he hadn’t faced before — it presented objects in multiple planes of depth in his field of vision; the nearest objects were also swinging in unpredictable patterns. I think he literally could not focus the first few times he lay under it, and it may even have made him feel like he was falling.

But as we experimented with different positions and put the gym over him again and again in different ways, I think perhaps his brain began to figure out how to process that information. And then in the morning, when he was fully rested and all the planes in his field of vision were equally well-lit, something in his visual cortex went CLICK!, and it was fine and he had mastered the problem. Simply by repeating the experience for him over and over with slight modifications, I think, we may have helped him work out how to understand it.

Anyway, that’s my theory, but if you have another 5-month-old that I can repeat this experiment on, please contact me.

Thousand dollar shots

I wrote this two weeks ago. You know what’s weird about having a baby? How your life becomes really fragmented. You get to do things in ten-minute increments, constantly on high alert in case somebody starts complaining loudly. So the measurements are out of date – we took H. for another doctor’s appointment more recently, and he was eight pounds, nine ounces. He probably weighs FORTY-TWO POUNDS by now or something. You should see his jowls. Sometimes I like to kind of tuck his chin into his chest, because I’m a jerk and it makes him look exactly like Winston Churchill.

Key quote: A man does what he must - in spite of personal consequences, in spite of obstacles and dangers and pressures - and that is the basis of all human morality.

Key quote: UNGH GAH! UNGH GAH! UNGH GAH!

But anyway. Here’s a somewhat-out-of-date tale of some stuff relating to our kid, Captain Jowly Gruntles of the RAF:

Henry is seven pounds, 11 ounces today. And he’s 20 inches long. And his head circumference is – I forget, but it’s some number that gets his head ON THE HEAD GROWTH CURVE. In fact, he’s now on the curve for everything: in the bottom 1% for weight and length for baby boys who are 1.6 months old, but in the 4th percentile for head circumference. So if he were in a room with 99 other babies, he could beat up three of them USING ONLY HIS HEAD.

We were at the pediatrician’s office yesterday morning. In addition to getting a set of measurements, we got our kid a shot of antibodies that will theoretically help him fight off Respiratory Syncytial Virus (RSV).

We had a hard time deciding to do this, deciding to agree with his doctor’s recommendation that he get these shots once a month for the duration of cold and flu season. And not because we’re Opposed To Vaccines. (For some stupid reason it is very important to me that everyone understand that I LOVE SCIENCE and do not believe that the MMR vaccine causes ASTHMAUTISM… parenthood is kind of a trip in terms of how it smashes your face into a whole bunch of your less-ignorable character flaws.) And not even because watching your seven pound, 11 ounce baby get a shot is kind of a horrifying experience. Although I freely admit that I am morally weak and it is a horrifying experience.

But because this shot is insanely expensive (and because the experience of being convinced to get it made me feel really bad about a lot of things relating to the American health care system, ahem.)

How expensive, you ask?

Well, of course nobody in the US can actually just say “This is how much Shot X costs”, because it depends on if you’re a sucker who’s paying cash, or if you have an insurance company (partially) footing the bill, and if so which insurance company – the cost of everything DEPENDS. So I couldn’t nail down exactly how much this shot costs. But it’s expensive, somewhere between $1000 and $3300 (the highest number for a cash-paying patient I saw On The Internet) per shot. And your baby gets one shot a month. For up to six months. So you can see how this could add up to quite a lot of money.

Henry’s pediatrician – who is so cool Seth and I wish we could hang out with him on a social basis… you know, maybe go see a movie or something – said of this drug that he recommended it for premature babies, but that it was crazy expensive and that most insurance companies refused to pay for it. And if ours, as he expected they would, refused to pay for it, he wouldn’t advise us to pay cash for it or anything. It wasn’t a disaster if we couldn’t get it, it was just some extra protection for a developing immune system during cold season.

So it was pretty clear that Dr. S- didn’t expect our insurance company to approve the drug. And Seth and I felt fine about that. Even before we got in the car and talked it over, I knew we felt fine about it. Guess how I knew! It was because when Dr. S- first said “This drug costs about a thousand dollars per shot”, Seth and I looked at each other and shared The Gaze Of Cheap/Bad Parents, where both of us were clearly going “HAHAHAHAHAHA” in our heads.

But then Dr. S-‘s biller started calling us. “I’m still working on getting that approval!” she’d say. And we’d go “…oh.” because we had expected our sensible military insurance company to immediately shut this nonsense down, possibly by sending our kid a letter reading “TOUGHEN UP, BUTTERCUP”.

In the meantime, we started Googling this drug and this disease (I know! You should never do this. Who among us hasn’t decided that he or she has a terminal case of TOE CANCER after some late-night Googling?), and discovered the following:

• Different medical groups have different ways of deciding if this drug is appropriate, but generally, it’s recommended for premature babies during cold and flu season, but only if the babies have one or more added risk factors in addition to being premature. Such as “lungs are not so great” and “lives with a bunch of other babies who bring home illnesses a lot”.
• RSV is not that big of a deal for the vast majority of people, something akin to a cold. But it can be bad for little babies and end up giving them permanent lung issues. Like wheeziness.
• The drug doesn’t actually keep your baby from getting RSV. It just tends to make the course of the illness less awful.
• Bearing in mind our layperson’s ability to read study extracts, it seemed to be the case that this drug did not actually reduce mortality – reduce the number of babies dying from this virus – it just reduced the number of hospitalizations.
• The drug is super-expensive. HAD I MENTIONED THAT?
• Most parents of babies, premature or otherwise at elevated risk for this disease, were desperate to get their hands on this drug. They lobbied their doctors, they lobbied their insurance companies, they lobbied their state legislators to make it available, they paid outrageous co-pays gladly, they went into debt to pay for the whole course of shots themselves. Cash. Because their insurance companies said no dice. But apparently, the drug company was sometimes willing to help desperate parents arrange financing. How nice of them.

After some debate, we pretty much decided that this drug wasn’t for us. Henry was premature, but he’s really healthy (yes, I knock wood, typing this) and he doesn’t have any lung issues. And it’s not like he hangs out with a bunch of other babies at baby nightclubs snorting lines of baby coke and compromising the integrity of his airways. It was hard to see how you could justify the cost in his case. We were pretty sure that our insurance company was going to deny the request, which was PERFECT, because then we wouldn’t have to seem like bad, unfeeling parents and actually reject the drug ourselves.

AND THEN THE PEDIACTRICIAN’S BILLER CALLED AND SAID WE HAD BEEN APPROVED, dangit.

And then, when we didn’t immediately schedule the appointment to get the shot, the company that makes the drug started calling us. Was I Henry’s mother? Was I aware that this wonderful drug had been approved for his use? DID I WANT TO SCHEDULE THE APPOINTMENT IMMEDIATELY? I DID, RIGHT?

It was a hard sell in the vein of talking to a car salesman. It was really bizarre.

Also the company sent us a “starter kit” in the mail. Which was a sales flyer talking about how terrible it would be to HAVE YOUR BABY DIE BECAUSE YOU DIDN’T GIVE IT THIS MIRACLE DRUG.

Finally, cementing my “this is so totally creepy” feeling, the car/drug salesman, when attempting to lock me into a six-shot course for the rest of the winter, told me: “And your co-pay is zero dollars! So it’s free!”

Now, okay, getting really outraged in a moral-high-horse way over that probably means I need to take a meditation class.

But even so, it’s kind of weird. There not being a co-pay doesn’t mean that it’s free. It’s just free to me, the end user. But you know who pays for it? Everyone else in the risk pool. That’s how insurance works. And in the case of our insurance, although we pay into a pot for it, it’s also underwritten by you, THE AMERICAN TAXPAYER. So no. It’s not “free”.

And also, just to get this out of the way, it makes me have COMMUNIST EMOTIONS to think about how this super-expensive drug is available to only some babies, basically at the whim of their parents’ insurer, and it’s available at vastly differing prices, and some parents can get it and some parents can’t, and some parents go into debt for it and some parents don’t have to because it’s “free”.

All of that strikes me as basically not okay.

But. In the end, we got him the shots. Seth got on the phone with Dr. S, who proved his awesomeness by understanding our ambivalence and saying “Would it be better to use this money to get 800 kids a polio vaccine? I don’t know. Maybe.”

Also, Seth pointed out that at this point H. has cost our sensible military insurance company quite a bit of money, so they probably would rather pay for ridiculous shots now than risk a hospital stay later.

Also, Seth’s sensible doctor sister said we should probably do it.

So we did, but I still don’t know if that was the best choice or not: Making medical decisions for someone else is much harder than I would have guessed. And I feel much less qualified to do it than my know-it-all personality might lead you to believe. I keep wanting the answers to be starkly black and white, and I guess they never are, they’re always going to be vague and best-guess-y and sometimes they will involve someone sticking a needle in your baby’s thigh when he’s not paying attention, leading to a serious case of the UNGH GAHs.

but what will we tell the children?

I hope you had a good Christmas; ours was lovely. My family doesn’t normally do Christmas — we were always the sort of culture snobs who thought that Christmas should be a Christian holiday and everyone else should butt out. And since we weren’t Christians, we did.

But my wife is Episcopalian, and there is a grandchild, so my parents got very into the spirit of the thing with a ham dinner and stocking stuffers and a really lovely candle display on the hearth. Later in the evening, after my dad had gone to work — his holiday tradition, an act of infidel charity performed so that some believing soul might spend the night at home with family — we watched It’s A Wonderful Life, that great secular paean to duty and misery and not getting what you want, and we got to talking about what makes Christmas such a great folk holiday.

Why is it that Christmas, a theologically somewhat minor festival, is nonetheless easily explained to even the smallest children of even the most far-flung cultures, while Easter, whose antecedent is supposed to be the crowning climax of the Christian story, comes across as abstract, highly mythological, overly constrained by the rhythms of liturgy, and devoid of human feeling? Sure, these people might disagree:

But it strikes me that what they’re doing has more in common with this:

or even this:

than this:

We knocked around the theory of the winter solstice as a universal calendar pivot, of course, but I’m not sure I buy that. Certainly a winter holiday would have appealed to the ancient Germanic and Celtic tribes who were among Christianity’s most eager converts, but I suspect the return of the summer sun meant less to the Copts, for example, and nothing at all, really, to a kid in Miami on whom the symbolism of the evergreen fir or spruce so carefully recreated in plastic and aluminum in his living room is probably lost. When you’ve got palms and sunshine and twelve-hour days all year round, who gives a damn about the solstice, the equinox, or any of the rest of it?

No, I think Linus hits the nail on the head: Christmas is about being afraid and lowly and then realizing that a savior is born. Christmas is about how the birth of a child renews the world. Kids love the Christmas story because it’s about Someone Who is loved for His potential, rather than anything He does in the story, and adults love it because it’s about adoring Someone Who, in some unspecified, future-tense sort of way, will redeem your life and make it all worthwhile. Christmas is about the deal between children and parents.

The problem Easter has is that it’s hard to live up to Christmas’s giant, vague promises. When you get down to specifics, everything is less satisfying. There’s no shame in this, really. Many science fiction writers have perished under the weight of an unsustainable premise: the Matrix series is at its best in the first movie, when it’s hinting at a truer, realer world beyond our own and a savior to shake us from our slumber. Then we find out that the real world is kind of lame and the savior is less than inspiring (and also just part of the program). The first film actually cleverly acknowledges this kind of disappointment (“I know what you’re thinking…. ‘Why, oh why, didn’t I take the blue pill??'”) before wrapping everything up with some ass-kicking and bullet-dodging. But for some reason the story goes on for two more movies, with spider-worm-robots and rain-fighting-sunglasses-guys and blah-blah-sacrifices-himself-blah-blah-blah….

Where was I? Oh yes — Christmas.

Christmas represents our covenant with our children. At Christmas the child is magical and divine for no reason other than his existence, and parents come in two flavors: meek (Mary, Joseph) and omnipotent (the Other Guy). And everyone else exists to adore and to give gifts.

Since H. was born he’s been showered with both gifts and third-party adoration, so that part’s well in hand. But man… we have had a hard, hard time treating this kid like the divine gift that everyone around us believes him to be. It’s as if the Wise Men and the shepherds were all prostrating themselves before the Lord, while Mary and Joseph huddled in the corner saying things like, “We’ve GOT to move out of this manger and get an apartment of our own!” and “Why don’t we find his prophesying as cute as everyone else does??”

We’re probably not as badly off as the anonymous Metafilter poster who timidly admitted to the whole online world that she didn’t think she loved her six-week old. But the nearly-unanimous outpouring of support and “me too!” anecdotes her post received makes me think this is a fairly common phenomenon. For some reason, nature has chosen to make babies both amazingly dull and amazingly annoying in their first few months. Dr. Harvey Karp, author of The Happiest Baby On The Block, calls this the “fourth trimester,” which is accurate up to a point — your baby is still only about as interactive as a fetus (hint: he will not be joining you for racquetball), but he’s no longer self-contained and easy to keep clean.

And of course all that is true if you planned to have a baby. We didn’t — which makes us, okay, a little like Mary and Joseph. But I’ve always liked the Mary of the Qur’an, who expressed what I think are fairly realistic new-parent feelings:

And the pains of childbirth drove her to the trunk of a palm-tree: She cried (in her anguish): “Ah! would that I had died before this! would that I had been a thing forgotten and out of sight!” (Sura 19, verse 23)

Sure, God tells her to reach up and shake the palm tree, which comforts her with a shower of fresh dates. So I’m not saying these things don’t work themselves out, or that you don’t at least get some snacks out of it. But it’s worth noting that Islam considers Jesus to be merely a man — albeit a Holy Messenger — and not in any way a part of the person of God. Maybe it’s okay, in Muslim societies, to feel like a baby is less of a personal savior and source of meaning in your life and more of a terrifying spiritual commission imposed upon you by forces greater than yourself.

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The reasons I love my son at this point are slightly embarrassing, having little to do with his character or deeds and a great deal to do with:

• his bear-like gruntling
• his fat little neck, in the folds of which he seems to make some sort of artisanal cheese curd
• his dramatic gesturing, which makes him seem a lot like a silent film star
• his usual response to tenderness and cooing, which is to fart disdainfully
• his generally contented and mellow nature
• the sweet, soft hoots he makes when he’s sleeping at your chest

Also, literally as I write this, he seems to have given his mom his first genuinely social smile. That little bit of coin will go a long way in the parent-child economy, I think.

Yes, he’s an amazingly sweet baby, and I can only imagine him growing into a wonderful, curious boy. I have no doubt that in 18 or 20 years I’ll love this young man like my own life. But there’s no arguing that he will have, in a fairly substantial way, replaced my life, obliterated it and plowed it under and reseeded it. All of which is fine, and ultimately we made that choice and I’m proud that we did. There’s something badass about abandoning your comfortable life as a beach bum to do something hard and socially worthwhile. But….

The other night Elana and I were talking, and we hit on the subject of how to tell Henry the story of how we got married and how he came to be. Every family develops an origin story over time, and to be honest I’m concerned about what ours says to our kid. Because there are only two ways that this plays out. One is that we never get over our RUINED LIVES and we burden our son with guilt about it so that he never feels entirely secure or loved or wanted. I don’t think that will happen, for several reasons.

First, there was no guarantee we were going to become successful writers/rail-riding hobos/alligator wrestlers anyway, so you can’t blame a kid or anybody else for that. Second, I’m pretty sure we would have gotten married anyway — I’ve been at least a tiny bit in love with Elana since the first time I read her writing, which was actually a week or two before we met. She’s sitting next to me now, just reading something on the internet and feeding Henry, but her hair’s still up in this adorable folded-over ponytail thing from our day out and we just had a fairly hilarious disaster-bath with the baby and I want to marry her all over again. So. Not everything that happened here was unplanned, let alone unwelcome.

But the other narrative is wrong, too — the one where he grows up thinking that if he gets some girl pregnant before they’re married or have jobs or health insurance, it’s no big deal and everything will work out fine.

BECAUSE THAT IS THE EXACT OPPOSITE OF THE TAKEAWAY FROM THIS EXPERIENCE.

I want my son to be terrified of sex, terrified of birth control failures and terrified of the possibility of unwanted pregnancy. I want him to wear six condoms at a time and use spermicidal jelly as a body wash, or maybe go to the seminary for a few years in his youth. Or prison. Or something. Anything but having a baby when he’s not ready. And I say this not because I don’t love him, but because in some weird, uncertain way I do, and I don’t want things to go hard for him.

Elana and I worry about what will happen if Henry someday grows up and reads this blog. Who knows how extensive and searchable the archives will be in the GOOGLE BRAIN-NET of 2030?? Should we talk about our doubts? Our fears, our concerns, our ambivalence? Should we admit that we are not good parents? I don’t know. I don’t want to hurt his feelings or make him feel unwelcome — especially if he stumbles across this when he’s, say, nine years old — but I really want to drill down the right lessons here.

So, Henry-Of-The-Future, here’s the deal: you’re not responsible for, nor can you control, your parents’ feelings about the way you came into the world. Therefore, I encourage you not to worry about that stuff. Are we ambivalent at the moment? Yes. But think about it this way — our love for you is a lot like your intestine: when you first come into the world, it’s immature and fragile and even a little painful. But by the time you’re old enough to read this, it will be completely sealed and fully functional. So now, having gotten that out of the way, please, take your dad’s advice —

• DO NOT HAVE SEX UNLESS YOU ARE READY TO HAVE A BABY.
• YOU ARE NOT READY TO HAVE A BABY. HOWEVER OLD YOU THINK YOU NEED TO BE TO HAVE A BABY, ADD SEVEN YEARS.
• SINCE NONE OF THE ABOVE WILL REGISTER IN YOUR LUST-ADDLED YOUNG ADULT BRAIN, JUST KNOW THIS: I WILL BUY YOU CONDOMS. I WILL BUY YOUR GIRLFRIEND THE PILL. I WILL GET YOU A VASECTOMY OR HELP YOU MEET SOME GAYS SO THEY CAN CONVERT YOU. BUT IF YOU GET SOMEONE PREGNANT BEFORE YOU’RE READY, I, YOUR DAD, WILL KICK YOU IN THE BALLS.

Your mom and I love you very much. Now turn off the brain-net and go play in the yard-bubble.

more about fighting commies, less about health insurance!

well i thought about the army
dad said, son you’re fucking high
and i thought, yeah there’s a first for everything
so i took my old man’s advice
three sad semesters
it was only fifteen grand spent in bed
i thought about the army
i dropped out and joined a band instead

— Ben Folds, “Army”

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My career options are limited. It’s not that I couldn’t get a job of some kind, if jobs were all that were wanted. According to the New York Times, even during this depression, white college-educated guys like me have seen basically no change in our employability, which is pretty much golden to begin with. (This is not, however, a good time to be a black man over 50 without a high school degree. If there ever is such a time.)

But as people rightly wondered about their returning soldiers at the end of World War I, “How Ya Gonna Keep ‘Em Down On The Farm (After They’ve Seen Paree)?” Or, to put in modern terms, can you really work at Wal-Mart after hunting terrorists in Baghdad?

This is the question posed by the most interesting Iraq war film so far, The Hurt Locker, about a talented EOD tech whose work is destroying his psyche but who can’t seem to tear himself away from it. Being a bomb tech is, of course, only the most extreme version of wartime military life in general — grinding and relentless and psychically wearing, but also, for the right kind of person, intellectually demanding and morally satisfying.

I detailed my own annoyance with a lot of things about military life here and here. But the truth is that the Army was the first organization to offer me a straightforward path to a professional career, the first to really channel my intellect to a useful purpose, the first to pay me an adult’s wages, and the first to provide me with work that I didn’t feel could be done by a talented orangutan. (Your mileage may vary.) And I know reasonable people can disagree about this, but I also found I was totally at peace with finding and catching insurgents in Iraq. How I would feel in a different war, especially if I were called on to fight conscripts, I can’t say.

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When I came off active duty, I had some money saved up, and I was single, so I didn’t really care about making a decent wage. I thought I might head to Hollywood and try my hand at writing for TV. Sure, it was a long shot, but if I could get in, it seemed like potentially intellectually satisfying work, work I would be good at, and work that in a small number of cases is financially remunerative. Not that I cared about that.

Well, obviously, having a baby means the end of screwing around. Not just in terms of screenwriting, mind you. I have now effectively priced myself out of becoming a blacksmith, learning to drive Formula One, or starting a kung fu school — that is, I no longer have the luxury of poorly- or unpaid apprenticeships. The entire film industry is right out, but so are lots of other fields I might be just as interested in — journalism, cabinet-making, businessmanery, organic farming, competition barbecue, advertising, card-sharping, dog whispering, barbering, DJing for a hip-hop crew, zookeeping…. Anything that’s worth doing, apparently, is worth several years of living with roommates and eating rice for dinner.

No, I’ve served my apprenticeships already — a somewhat abortive one in film and photography, and one in government service. The weird thing about the one in film is that I was sort of on the cusp of making grown-up money (albeit doing something kind of boring like coordinating), but when I left it for seven years to go be a soldier, I essentially reset the clock to zero. I’d have to start all over again at the bottom as a production assistant and work two or three or four years just to get a dull job I don’t really want with (at best) a moderately middle-class income.

So that leaves the military or other government work. Certain kinds of government work, including the military, the police, and the fire department, are great precisely because they pay you enough to live on during the apprenticeship phase. I’m too old to become a cop in most districts — though, curiously, not in L.A. Of course, L.A. just dropped its starting salary for cops by about $15,000 as part of a negotiation between the union and a strapped city government. But still — a guy with a college degree and some military experience can make about $50,000 to start with. That’s not bad.

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I’m probably not going to become a cop. I thought about it — took the exam, even — but Elana squirrelled out of me that the primary reason I wanted to do it was to take her back to L.A., at which she balked. She took me firmly aside and explained that if I had dragged her away from all that was holy and decent — or at least, all that was sunny and governed by Schwarzenegger — in order to have a baby, and if, therefore, God only knew when and if and how her writing career might recover (living in L.A. or not), then at least one of us was damned well going to move forward with a professional career doing something he likes.

Which is the other reason I can’t start a kung fu school.

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Here’s something nobody talks about much when it comes to joining the Army: for some of us, it’s a form of suicide. That word is usually fraught with negative associations, like depression and aggression and Morrissey songs. But that’s not how I mean it. I mean that it’s a way of rejecting the bonds that hold us here to earth, of embracing danger, of questioning the notion that death is the worst thing that can happen to a person. In a society conspicuously lacking in vision quests, enlisting is the one definitive ritual for sticking a thumb in death’s eye.

Of course, after you enlist you spend the rest of your time building up your ability to stay alive. You learn how to shoot and how to use a gas mask and how to survive an ambush. You get in shape so you can run faster and you get stronger so you can carry more body armor. You do pushups so that you can push the enemy away from you before running away quickly and hoping that he shoots you in the body armor and not the ass.

Still, when you are deployed, you are starkly confronted with your own mortality, and you find ways to deal with it. I dealt with it by buying a burial ring and by engaging in superstitious rituals to create my own luck. I learned to smoke a pipe and I wrote a song about how comforting it is to think of dying of cancer rather than by enemy fire. I made myself ready for death, and death didn’t come.

Which is great. It’s a cool way to live, and if you die… well, you can’t say you didn’t see it coming.

On the other hand, it’s apparently nerve-wracking as hell for the people you leave behind. My parents, for example, were initially encouraging about my joining the military, but that was before Iraq started, and their enthusiasm waned considerably as it became increasingly clear that, four years after the initial invasion, my unit was going to be deployed. They dealt with it in different ways — my mother worried a lot and demanded to know what kind of snacks I wanted her to send in care packages, while my dad periodically got gloomy and argued with me over whether having a military was a good idea. It was a bummer. Recently, they ambushed me in the kitchen of their house as I was coming in the door, demanding to know whether I was planning to re-enlist. I tried to talk them down off the ceiling, but to be honest, I haven’t ruled it out.

Your parents’ claim on your emotional loyalties loosens somewhat over the years, but unfortunately in my case it’s replaced by the claims of my wife and baby son. Now that I’ve successfully reproduced, I feel I’ve basically fulfilled my filial obligation not to go around leaping into the abyss, but the same act of parentage has now bestowed on me additional duties. Hard as it might have been to detach myself from this world and live only in the moment (or the “mission,” as we call it in the Army) when I was only a son, it was still possible. But now that I’m a husband and a father, I find it nearly impossible.

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I knew a girl in college who once told me that when she was young she often felt she was floating above or outside of herself. She had a theory that when we were young our souls still weren’t used to being in bodies, and that as you got older, you were gradually more tied to your body, until eventually you didn’t float away anymore.

I think I know what she meant, now.

So here’s to the end of childhood! I don’t know what I’m doing yet, but it’s not going to be this:

Oh my God, motherhood DOES mean mental freeze.

Henry came home from the hospital about a week and a half ago. He is doing really well and has no health issues, and we’ve mostly figured out breastfeeding (as I may have mentioned, the nurses at this hospital were basically FASCISTS about nursing… which is ultimately great and admirable but tough to deal with when it’s 3am and you’re in the ICU and a lady walks in and flips on the lights and trills “TIME FOR YOU TO PUMP, DEAR!”) and he’s gaining weight and crossed five pounds when we saw his pediatrician last week.

That’s all the good stuff. The tough stuff:

OH MY GOD YOU GUYS. I didn’t know having a baby was so hard. I thought I knew it was kind of hard, but- HA HA HA, I had no idea. You people who are parents are heroes. LITERAL HEROES.

YOU ALL DESERVE PURPLE HEARTS OR SOME SHIT LIKE THAT.

It is so rough, you guys. Babies, even ones that are pretty good sleepers like mine (knock wood), wake up every two hours during the night. Except it also takes about a half-hour to feed and change them and settle them again and then you need a little time to actually fall asleep again… so really you get about 70-80 minutes of sleep between feedings.

This is crazy hard.

Have you ever seen that episode of Battlestar Galactica called “33”, and it’s about how the fleet has to hyperjump every 33 minutes because that’s when the Cylons find them?

IT’S LIKE THAT.

ONLY CROSSED WITH A CIA BLACK SITE PRISON WHERE THEY TORTURE YOU TO EXTRACT INFORMATION YOU DON’T EVEN HAVE

YOU’RE JUST THIS UNFORTUNATE LUCKLESS UIGHER WHO KNOWS NOTHING ABOUT ANYTHING

AND IS TOTALLY CONFUSED AND CRYING ALL THE TIME

I was reading something in this baby book I have about post partum depression, and it made me really annoyed. Because, would you say that in general one might define “depression” as “feelings of sadness that aren’t directly tied to external circumstances”? Like, a person could have a really great life but also be extremely depressed, right?

Well, post partum depression is A BULLSHIT PHRASE. Because if a new mother is freaking out and losing it, it’s for good reasons like:

*hormones going crazy
*sleep deprivation levels set to: “GITMO”
*life as you know it carpet-bombed into oblivion, never to return

etc etc etc

So come on man, “post partum depression” is just kind of dismissive and patronizing, you should call it something like “You Have Good Cause To Feel That Way Syndrome”… this is just my opinion, but I’m pretty sure I’m right.

Henry is fine. He is napping beside me in his Snuggle Nest right now. His dad is off to do Army Things in the morning, so we banished him to the couch. Now I am torn between sleeping myself and the knowledge that Henry – who may be going through a growth spurt – will want to eat again in about 45 minutes. Is it worth the 45 minutes of sleep to suffer through the staring-into-the-abyss horror of having to wake up so soon? Or am I better off staying awake until he wants to eat and then falling asleep afterward?

I USED TO BE AN INTERESTING PERSON. I HAD A PSEUDO-CAREER. I WAS GONNA BE A CONTENDER. Now I lie awake and stare at the ceiling and plot imaginary charts where the X axis is “time to next feeding” and the Y axis is “level of despair experienced when you have to wake up for said feeding”.

(This is pretty bleak stuff.)

So, the Snuggle Nest. Let me tell you my big lame lesson about all of this pregnancy and parenthood stuff: I am trying really hard to be less judgmental. Not because I think that being less judgmental makes me more moral or whatever, but because I have come to the understanding that

I KNOW NOTHING.

NOTHING.

When I was pregnant, I happened upon the Snuggle Nest at some point. And I laaaaaaughed and pointed and laughed some more. What a ridiculous product! What kind of sucker would buy this? Why not just stick the kid in bed with you? Why have the little baby-in-a-box setup?

Now, of course, I think that the Snuggle Nest is the greatest thing ever, responsible for me getting those 70-to-80-minute stretches of sleep. Which doesn’t sound that great but is up from 40-50-minute stretches when Henry was in his sleeper thing.

I had other awesomely ironic examples of this kind of thing, of how something I used to make fun of was now the only thing keeping me from the edge, but you know what? I can’t remember them. This is a big factor in my life right now, being unable to remember things. Like about 40% of my conversations start with me saying “So I probably already told you this – did I already tell you this?” because I’m trying to hedge my bets, and you know, I probably DID already tell them this, it’s very FOG OF WAR in my brain these days.

Here is a picture of Henry in his Snuggle Nest – or, as I like to call it, ELANA’S HUBRIS BOX. He is so comfortable and snuggly! I am jealous.

so comfortabuhls.