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.

the sequence of exothermic chemical reactions between a fuel and an oxidant accompanied by the production of heat and conversion of chemical species

So this is what we’ve been doing for entertainment recently:

My parents have a freestanding fire pit they bought last summer and never used, and so Elana, a sort of Ambassador Eagle Brownie Girl at heart, has been putting it to good use. For several nights running we’ve rustled up wood from the various scrap piles around the yard and gleefully set it ablaze. This has turned out to be quite good for family unity — having something to do, a low-key central activity around which to organize conversation, has led to more thoughtful and less awkward intergenerational talk. I don’t know why, but staring into the fire, you can ruminate on religion and culture and growing up in a way that is less likely in a torchiere-lit living room.

It has occurred to me, sitting there in the flickering dark, that fire-building is one of those important pieces of shit-hits-the-fan, End-of-Days lore that ought to be passed down from parent to child. Let’s be honest — I’m not good for much after the apocalypse. I haven’t been storing food, for example. I can shoot a rifle, but I don’t in fact own a rifle, and man, I suuuuuuuuck with an atl-atl.

But one thing I think I’m actually okay at is tending a fire. Elana, who is really good with fires, likes to tease me about not having done enough camping when I was young, but the basics are pretty simple, and in case this blog turns out to be the only thing to survive the coming catastrophe, I write the following for my son.

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Some people will tell you about the “fire triangle.” This is very confusing, because you’re going to think it’s something practical, like, “arrange your sticks in a triangle,” when in fact what people mean is, “you need three things to make fire.” Those three things are heat, fuel, and oxygen. Heat and fuel are obvious; oxygen a little less so. Most of the actual technique in building and maintaining a fire has to do with getting oxygen into the process. More on that in a minute.

Part 1: Make It Hot

Starting a fire is not hard with modern tools. I highly recommend matches or a lighter. If you are actually reading this after the apocalypse, you may have to make do with less. Many metals are pyrophoric, meaning that very fine shavings of them will ignite spontaneously in contact with air. Traditionally a piece of flint was used to nick tiny pieces off of iron or steel; the tiny pieces would ignite as they sailed through the air, and a hot spark would land where you were trying to make a fire. This fellow, who sells specially formulated “firesteel,” demonstrates the process in a wood-clad hallway:

This video, on the other hand, assumes that you have access to soda and chocolate bars and yet for some reason still need to cook over an open fire. I suppose it’s possible. It also assumes you have fairly strong direct sunlight, an assumption that may not hold in certain post-apocalyptic scenarios:

Anyway, if you were smart enough to raid a convenience store for the Royal Crown and the Toblerone, I hope you also picked up matches.

Part Two: Little To Big

Once you’ve lit the match, you’ve got to set something on fire. What should you start with? People throw around a lot of terms for “stuff you set on fire” — they’ll tell you to start with “tinder,” then “kindling,” etc. — but the general principle is little to big. This is related to the oxygen thing — again, more on that later, but basically you want tiny pieces of flammable stuff surrounded by a lot of air. So pine straw burns better, to start with, than pine logs, and crumpled up shreds of newspaper burn faster and easier than a neatly folded sheaf. (Newspaper is something you won’t have in the future, post-apocalyptic or not, but you can’t burn your iBrain, so I don’t really know how to relate to you anyway, but… where the fuck was I?)

So, little to big: start with small bits of dry, flammable material, either crumpled or well-shredded so lots of air can get in. That stuff will burn crazy fast, but that’s okay, because it’s not the main fuel for your fire. You’re just using it to catch the spark of your match/lighter/firesteel/Coke can and transfer that spark to slightly larger fuel: small sticks are good. Then you progress to larger sticks, branches, and finally logs. Little to big.

Part 3: Everything Goes Up

I mentioned earlier that pine straw would burn better than a pine log, because oxygen has an easier time getting into a mound of straw than into a solid piece of wood. Solid wood, of course, only burns on its exterior surface, and so if you want to burn anything bigger than a dried leaf you’re going to have to get the maximum amount of oxygen possible onto that surface. Again, there’s a simple principle to remember here: everything goes up.

Look, fire is hot, right? And the hot gases that make up the visible flames are compelled upward by the comparatively cool and dense air around them. Or maybe it’s that fire, the substance of hell itself, reaches upward toward heaven in longing. I’m not really sure. But the point is that fire tends to go upward — if you hold a burning stick out in front of you, the flames point upward from the top surface of the stick.

So flame moves upward, generally, which means it needs to be replenished from below, and that’s where your oxygen needs to be. You need to get as much oxygen as possible coming up from below the actual flames themselves. This means that anything larger than the initial “tinder” — the shredded/crumpled stuff — needs to be carefully arranged so as to allow air to come in from the bottom. There are probably a number of good ways to do this, but the ones you want to learn are the “teepee” and the “log cabin,” because they will remind you of Indians and Abraham Lincoln, respectively, which will be good when you’re sitting around your post-apocalyptic fire telling your children legends about the great and terrible “America” which once was. You don’t want to leave out the aboriginal peoples — they’ve suffered enough without you slighting them — and of course talking about Abraham Lincoln gives you an opportunity to use the phrase “stovepipe hat,” which would otherwise fall out of use entirely.

Here, then, are the two configurations of sticks you are advised to use. The “teepee” configuration, in which the sticks form a cone and converge to lean against each other at the top, requires a little bit of balance but allows for terrific airflow and lets fire creep upward, as is its natural wont.

The “log cabin,” by contrast, doesn’t require a balancing act — you just lay two sticks on the ground, then lay two sticks across them, then lay two sticks in the original direction again, and so on, as high as you like. You can accommodate more sticks this way, creating a nice blaze all at once. Also, you don’t have to worry about random bits of flaming stick escaping your fire pit as they burn and crumble, which is a concern with the teepee. On the other hand, you do have to worry about looking like a guy who spends way too much time arranging sticks.

Whichever method you choose, the sticks will burn for a while and then collapse into the bottom of your fire pit. You’ll feel an inevitable sense of loss and dismay when this happens, but try to be philosophical about it — the dying sticks are transmuted into living, glowing coals.

Part 4: Bed Of Coals

This is the last thing you need to know, really: after wood burns with a flame, it goes into a second stage of burning as a hot coal. This stage is actually more awesome than the flame stage, not only because of the creeping orange glow, but also because when you’ve got a bed of hot coals going in the bottom of your fire pit, you can essentially keep a fire going indefinitely just by adding more fuel. You may have to arrange this fuel artfully so that, for example, air can still come in from the bottom. But you shouldn’t have to light the fire again — your bed of coals lights each new piece of fuel as it’s added.

And that’s it, really. Enjoy your fire, and if it’s cold where you live, be sure to keep in mind Jack London’s grim warning about survival in the wild:

[A]ll this—the mysterious, far-reaching hair-line trail, the absence of sun from the sky, the tremendous cold, and the strangeness and weirdness of it all—made no impression on the man. It was not because he was long used to it. He was a newcomer in the land, a chechaquo, and this was his first winter. The trouble with him was that he was without imagination. He was quick and alert in the things of life, but only in the things, and not in the significances. Fifty degrees below zero meant eighty-odd degrees of frost. Such fact impressed him as being cold and uncomfortable, and that was all. It did not lead him to meditate upon his frailty as a creature of temperature, and upon man’s frailty in general, able only to live within certain narrow limits of heat and cold; and from there on it did not lead him to the conjectural field of immortality and man’s place in the universe. Fifty degrees below zero stood for a bite of frost that hurt and that must be guarded against by the use of mittens, ear-flaps, warm moccasins, and thick socks. Fifty degrees below zero was to him just precisely fifty degrees below zero. That there should be anything more to it than that was a thought that never entered his head.

Also, if there are zombies, aim for the head.

Love,

Your dad.

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!”)

the robots… are coming

USA Today led with this story about rising military health care costs on Thursday. Reading just the headline, you might think, “Oh great. Another bloated, inefficient government health care program.” And indeed the statistics cited are alarming:

Total U.S. spending on health care has climbed from nearly $1.5 trillion in 2001 to an estimated $2.7 trillion next year, an 84% increase.

As a share of overall defense spending, health care costs have risen from 6% to 9% and will keep growing, said Navy Lt. Cmdr. Kathleen Kesler, a Pentagon spokeswoman.

But look closer. What’s causing this rise in health care costs? Is it that we pay doctors too much? Is it overuse of medical resources by patients who are shielded from the expense? Is it the passage of Obamacare?

In this case, no. The costs are driven by two things:

The rapid rise has been driven by a surge in mental health and physical problems for troops who have deployed to war multiple times and by a flood of career military retirees fleeing less-generous civilian health programs….

Specifically,

Behavioral-health counseling sessions for troops and family members rose 65% since 2004. The Pentagon paid for 7.3 million visits last year — treatment of 140,000 patients each week, according to TRICARE numbers….. Many new patients are children suffering anxiety or depression because of a parent away at war. Children had 42% more counseling sessions last year than in 2005, TRICARE numbers show.

and also

In addition to mental issues, multiple combat tours have created more strains on joints, backs and legs, Pentagon statistics show. Medical visits for such problems rose from 2.8 million in 2005 to 3.7 million in 2009.

We might draw a cautionary lesson from this, I think: in the future, we should count all costs, not merely upfront costs, when considering going to war for less-than-urgent reasons. And not just the direct costs either — by allowing two hugely expensive wars to become our national priority for seven years, we lost opportunities — opportunities to deal with health care sooner, not to mention nipping the financial crisis in the bud. Taking both of those latter steps would have meant fewer retirees — not to mention semi-employed hobos like me — buying into Tricare instead of a crapped-out private plan.

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Is there any good news? Well, sort of. The USA Today article was accompanied by a photo of Tammy Duckworth, a former helicopter pilot who lost her legs in Iraq and is now an Assistant Secretary for Public and Intergovernmental Affairs at the V.A.

Ms. Duckworth meeting with SGT Derick Hurt.

As you can see, Ms. Duckworth and SGT Hurt both have excellent prosthetics. It’s an old and tired cliche that wars improve our medical capabilities, but it’s true. Body armor has reduced combat deaths in Iraq,even from IED blasts, and so much of the medical expertise developed in the Iraq war is dedicated to the extremities — replacing arms and legs and even the complicated mechanics of hands and faces.

Here’s a “TED talk” by Dean Kamen, inventor of the Segway, about being asked by the DOD to develop robotic arms for wounded vets. (If you want to skip to the demonstration of the arm, it starts about 45 seconds from the end.)

America hasn’t always done its best by its vets, but one good thing about our ambivalence over these recent wars is that it has often translated into a serious solicitousness for the well-being of the common soldier; we are keenly aware of our prior history with war vets, and we are, this time, attempting to do right by those we send out into the world to do violence on our behalf.

I often argue on this blog that we ought to do right by everyone else who serves America, too: that we would be better served by providing good medical care to farmers and teachers and cops and entrepreneurs and baristas, as well. But our sentimental sense of duty toward our soldiers is a good start. So here’s to a future of truly amazing prosthetics, the development of which was paid for out of our tax dollars for the sake of a few, and which will incidentally come to benefit us all.

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And now some music as we ponder our semi-robotized future:

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.

I’ve just got to get these last few ibexes in….

Today I was channel-surfing in order to find something suitable for Henry to watch, and I saw something on the “American Life Network” called Ancient Secrets of the Bible: Noah’s Ark — Fact or Fable?. It was being billed as a documentary, so I sort of assumed it would come down on the side of “fable,” but that’s because I still tend to think of documentaries as stodgy, fact-laden things. Whereas even full-fledged evangelicals reviewing Ancient Secrets of the Bible on Amazon warn that

[I]f one is looking for unbiased viewpoints and for an actual academic bible study, the series title is very misleading…. Even my friends who are ministers saw the series more as entertaining propaganda than revealing any actual historical or scientific secrets….

Anyway, this one was about the story of the Great Flood, and it had a number of, erm, scientists talking at length about how the Ark would have been super seaworthy, and how you wouldn’t really have needed every animal on earth to fit in the Ark — whales, for example, could just have kept swimming!

I find stuff like this irritating, because it seems to me that people spend HUGE amounts of time trying to prove that a book like Genesis is some sort of true and factual history of the Earth — which efforts are, of course, really aimed at proving that Genesis is the literal word of God, even though the Bible itself makes no such claim.

And so, in a quest to prove that the Bible is exactly the sort of document that it isn’t, the video parades by a series of people in coats, some of them claiming to be scientists, to testify to the seaworthiness of the Ark, or to explain that “two of every living thing” doesn’t mean as many as it sounds like, because, for example, all breeds of dog have a common ancestor.

These arguments always tend to be specious or irrelevant, though this guy, for example, goes to pretty extraordinary lengths to ignore the text in order to make the text sensible. Claiming that by “clean animals” God only means the ten kosher mammals mentioned in Deuteronomy 14:4-5 is reasonable, but to then claim that by “every unclean animal” God is referring specifically and only to the unclean animals mentioned here and here — to include rabbits, rock hydraxes, and pigs, but not hippos or kangaroos — takes a certain amount of narrow legalism, and it certainly flies in the face of the obvious meaning of Genesis 7:17-21:

I am going to bring floodwaters on the earth to destroy all life under the heavens, every creature that has the breath of life in it…. You are to bring into the ark two of all living creatures, male and female, to keep them alive with you. Two of every kind of bird, of every kind of animal and of every kind of creature that moves along the ground will come to you to be kept alive. You are to take every kind of food that is to be eaten and store it away as food for you and for them.

I have highlighted the Lord’s multiple uses of “every” and “all” because I’m an asshole and I’m making a point in a snarky way. But, seriously, here is that guy’s argument:

The broad words of Genesis 6:19: “And of every living thing of all flesh, you shall bring two of every kind into the ark” and a similar phrase in Genesis 7:15 are clearly inconsistent with the sacrifices of Genesis 8:20 and the seven pairs mentioned in Genesis 7:2-3. Since the phrase “two of every kind” is an overgeneralization, the preceding phrase “every living thing” can also be treated as an overgeneralization and be interpreted narrowly to mean every living thing of importance that Noah owned or had custody of. If Noah was asked years later how many animals he took on the barge, Noah may have replied, “Every one; I took them all.” In such a remark, the words “every” and “all” would mean only that he did not leave any of his animals behind, not that he took every species on the planet….

Noah’s clean animals included cattle, sheep and goats. His unclean animals included raven, swine and eagles. They were his inventory, his stock in trade. But most of the world’s animals were not included. Exotic zoo animals such as elephants, giraffes, hippos, lions, apes and kangaroos are not mentioned in Genesis or Deuteronomy and were not included in Noah’s inventory. Since it would be impossible for Noah to attract millions of animals from all over the planet, he did not do so. The animals came to the ark because local herdsmen brought them to the ark.

This argument is nonsense from the get-go. Noah kept eagles as part of his stock-in-trade? Well, that explains why he needed the rock hydraxes, I guess: eagle food. And the last line flatly contradicts the Lord’s assertion that every kind of animal “will come to you to be kept alive,” as well as providing some tragicomic scenes just before the flood:

HERDSMAN: Hey Noah, that’s one big boat.

NOAH: Yup. The Lord God’s gonna destroy the world by unleashing the floodwaters.

HERDSMAN: You don’t say. And you’re gonna float it out in that thing?

NOAH: Yes, that’s right.

HERDSMAN: Oh. Can I come?

NOAH: ‘Fraid not. You’re sinful and God is grieved that he made you.

HERDSMAN: Oh. Well, would you take my camels with you? They’re good animals, and I’d hate to see anything happen to them.

NOAH: No — I’ve already got two camels. Do you have any hoopoes? God seems to think they’ll come in handy.

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These people seem, at first glance, to have a more scientific approach — at any rate, they have a lot more numbers on their website. Also, they take the novel, if completely unwarranted, approach of claiming that “kind” doesn’t mean species — it means genus or even family:

The word species and the biblical word “kind” are often used interchangeably. This is incorrect since they are not synonymous. The biblical word “kind” denotes an organism that reproduces others like itself…. The word kind is probably closer to the modern taxonomic unit of genus, and in some cases the larger taxonomic unit, family.

The Canidae (canine) family includes about 14 genera of dog like animals. These include the coyote, dog, wolf, jackal, etc. The ark did not have to contain the hundreds of species of canines that make up this group. In reality, these were all represented by a few “kind.” These “kind” would then produce all the animals that make up the Canidae family.

Gosh. I thought evolution took too long as it was. Who knew it was actually so speedy?

Anyway, after excluding fish — because, you know, fish live in water, don’t they? — these folks also decide to leave plenty of other animals off the Ark, too:

Noah would not have to be concerned with the aquatic mammals such as the dolphins, whales, porpoises, sea lions, and walrus. There are also many aquatic reptiles that could survive outside of the ark. These would include many types of snakes, alligators, crocodiles, and sea turtles. There are almost a million species of arthropods that would survive the flood. Animals such as the following: shrimps, crabs, lobsters, and many other crustaceans. All of the insects could survive outside the ark. Mote than 35,000 species of worms and nematodes would also survive the flood.

All right, first of all — insects drown. There’s actually a mosquito trap that depends on it.

Second of all, these guys are still failing to account for the Lord’s emphatic instruction to take two of “every kind of creature that moves along the ground.” (Emphasis mine, not the Lord’s.) That means, I’m sorry, every snake, lizard, beetle, ant, scorpion, hedgehog, and so on.

But let’s assume for a second that they find a way to wriggle out of those problems. There’s still the basic fact that their idea of how things “survive” is that of A CHILD. Noah stays on the Ark for a year, and the waters cover the Earth completely for at least 150 days. No land creature on earth can hold its breath for that long, but even if it could, let’s say, float, how could it live for five months to a year when its entire ecosystem has been destroyed? What would it have eaten? How would it have plausibly reproduced? The life cycle of the painted lady butterfly is 21 days, and during that time it relies intensively on specific types of plants as part of the process.

Oh, dear — plants. Why did God forget about the plants? 150 days of complete immersion in water would be enough to turn the earth’s surface into a complete desert. And although I’m sure someone will argue that Noah could have brought enough seeds to repopulate the earth with plants (even though, you know, he had no access to several of the continents, and even though this is supposed to have have happened just a few thousand years ago), this again shows an extremely childish understanding of how individual organisms relate to their ecosystem. A plant does not exist in isolation, nor can you just stick it in some dirt and hope for the best. Destroy the environment completely, and you destroy the ability of each individual creature to feed itself, reproduce, and go through its life cycle.

Then there are the fishes, whales, and other waterbound creatures that the authors of Genesis, and our ersatz scholars, don’t even bother with. Genesis tells us that the mountaintops were covered (7:20) to a depth of 20 feet, which means that the waters must have covered Everest. Assuming that the seas prior to the flood were at about the same height they are today, this means that there must have been enough water to cover the surface of the earth (510.07200 million km²) to roughly the height of Everest (over 8km), or about 4,513,117,056 km³. That’s about 3 times the volume of the earth’s oceans now. So suddenly all the earth’s water creatures are living in a space 4 times the size of the space they were living in previously — meaning predators and prey, herbivores and their food, are now much farther apart. The ocean, formerly teeming with life, is now fairly empty, and many if not most creatures would starve.

Coastal water ecosystems, meanwhile, which rely extensively on photosynthesizing and photosensitive organisms, would of course be obliterated. And while we’re pondering this — does it rain salt water or fresh? If it rains fresh water, most of the sea creatures would die, but if it rains salt water, most of the freshwater fish are goners.

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In the end, I prefer the first guy’s theory, in which God is more interested in saving Noah’s property than in preserving genetic diversity. It contradicts the text, but it doesn’t contradict basic biology. Of course, there’s a simple solution to all of these logistical issues with the flood story — God just uses magic to recreate life anew at the other end. That almost has to be the solution, because there’s an olive tree growing somewhere even before Noah gets out of the Ark.

But as soon as God starts using magic powers, we’re immediately struck by the ridiculousness of the whole story. If God regretted how men turned out (somewhat undermining any claims to omniscience or wisdom), why didn’t He just wink all the evil men out of existence? Why does He go out of His way to “destroy all life under the heavens, every creature that has the breath of life in it”? On the other hand, if the entire creation is unsatisfactory, why bother repopulating it with “two of every creature”?

And finally, and most damningly, why is God unaware that His plan isn’t going to work?? God makes a covenant with Noah, supposedly the most righteous of men — and then not four verses later sin returns to the world in a particularly embarrassing and squalid fashion: Noah gets passing-out drunk, Ham checks out his father’s “nakedness,” and when Noah wakes up he petulantly curses Ham’s lineage. These are the people You chose to save? Why not just start over entirely?

None of it makes sense if the God of Genesis is the all-knowing, all-seeing, all-wise, and yet completely benevolent God we like to think of today. On the other hand, the story of the flood makes some sense if the God of at least that particular story is an older, more mythological god, a god who makes mistakes, who can’t see or even imagine the future, who is carried away by human passions like grief, regret, and anger. And the aftermath makes sense, too, as a crude and obvious Just-So Story cooked up to make it okay to enslave Canaanites. In other words, this story makes perfect sense as an ancient myth welded with some clumsy tribal propaganda. It makes not a lick of sense as a story about any sort of loving, or even moderately humane, uber-Deity.

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All of which is only by way of saying that I hope my son doesn’t waste his life trying to defend a collection of obviously man-made myths as the literal transcription of the words of an anthropomorphic (and apparently very confused) God. So we’re not going to watch Ancient Secrets of the Bible in our house. I know how impressionable young people can be — I was terrorized out of my gourd by Orson Welles in The Man Who Saw Tomorow when I was about ten. Welles, hosting a supposedly nonfiction investigation into the predictions of Nostradamus, made what sounded to me like very convincing arguments that the French astrologer had predicted just about everything in history, and that his latter predictions strongly suggested a coming apocalypse precipitated by a Middle Eastern madman. My mom and my sister laughed it off when I came upstairs, white as a sheet, convinced we were all going to die in the very near future. But I kept it in the back of my mind for years, waiting for the inevitable, and even today it’s hard for me to be sure that this guy isn’t going to destroy us all:

(That is Ahmedinejad, isn’t it?)

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Anyway, I’ve been trying to figure out what I might tell my son about God, or, in keeping with the context of this post, what I might let him watch on TV to form an accurate opinion of how the world works and what kind of being or force might be running it. My own agnosticism and inability to stay firmly within the religion in which I was brought up stems at least in part from the horrific displays of cruelty and suffering you can see in, oh, Disney and the BBC’s earth. Or, as my wife memorably put it, “All this natural magnificence makes me want to die.”

I can accept human suffering within a religious framework. I can accept that as generally moral creatures we’re here to be a balm and a comfort to one another, and without suffering there wouldn’t be much basis for morality or balming or comforting. I get that. But that doesn’t really explain the overwhelming viciousness and selfishness that the entire world both exhibits and suffers from. Most sentient creatures are born to eat or be eaten by other creatures, and not in a nice way, and there’s no getting around that. Everything gets sick, everything suffers, everything dies (and rarely in bed).

Fervent literal-Genesis Christians will tell you it’s because of the Fall without stopping to work out the implications of what they’re saying. God made tiny baby birds to be eaten by snakes and cows to become hosts for insect larvae and great noble-browed bears to lie down and die of starvation and exhaustion in the Arctic circle because some human woman ate some fruit she wasn’t supposed to before she even had the knowledge of the difference between good and evil. I’d rather have an indifferent God than a God who behaves like that.

And I’m not alone. Jesus says, in Luke 11,

Which of you fathers, if your son asks for a fish, will give him a snake instead? Or if he asks for an egg, will give him a scorpion? If you then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give the Holy Spirit to those who ask him!

In other words, we can’t hold God to a lower standard than we hold ourselves. If we, who are evil, wouldn’t think of condemning thousands or millions of men and other creatures to die for the act of a single person, how can we believe in a God who would do the same? Or, to approach another theological briar patch the same way, if we sinners, who are low, angry, and vengeful, wouldn’t punish someone infinitely for a finite lifetime of transgression, how can we believe that the loving and just Creator would do the same?

My wife is not bothered by many of the traditional theological bugaboos. Recognizing the fragmentary, mosaic nature of the Bible, she believes in the good words of Jesus and ignores most of the rest and is a contented Christian. I’m in a somewhat different boat. The Baha’i Writings are harder to take piecemeal (at least, according to Baha’is), and anyway, as I said above, the natural world inclines me to disbelieve in a personal God who manipulates things on a day-to-day basis for anyone’s benefit.

But at the same time, I miss the sense of having a personal, conversational relationship with the universe. And I would feel dreadful and ashamed if I inhibited any budding sense of the divine or the ideal within my children. (Or anybody else, really.)

So. You see. I start out this post smug and playful and end up humbled and serious.

Here is what I say, then, to my son: do the best you can. Put your faith in reason and science and our shared experience and do not seclude yourself in burrows of illogic and bigotry masquerading as faith in something higher, and do the best you can. If there is a God worth meeting, He won’t fault you for it.

developmental milestone #47

Ah, Jesus. It’s happened already. I didn’t want to believe it. I mean, here’s a kid who can’t even reach for things yet, or sit up by himself, or belch without assistance. Here’s a guy who’s still sometimes afraid of his own farts, is what I’m saying.

But he watches TV.

I don’t mean he’s programming the TiVo for Top Gear. But starting about three weeks ago I noticed him staring at the sizzling, flickering rectangle whenever it came into his field of vision. At first I thought he was just noticing it the way he notices any intense light source. But after a few days it became clear that he loved the TV for something more than its brightness. If you turn him away from the TV, he cranes his head around trying to find it again — something he doesn’t do with lamps or windows. And unlike other sources of light, TV actually seems to calm him down when he’s upset.

Sorry, let me just quote that last part again and add some typesetting for emphasis:

[U]nlike other sources of light, TV actually seems to calm him down when he’s upset.

This is freaking me out.

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For the record, the AAP recommends, in a short, stern, and citationless statement, that you not let children under 2 watch television. Science Daily gives more details here, noting specifically that the idea of “Baby Einstein”-type videos helping your kid learn seems not to be borne out by science.

Watching TV programmes or DVDs aimed at infants can actually delay language development, according to a number of studies. For example, a 2008 Thai study published in Acta Paediatrica found that if children under 12 months watched TV for more than two hours a day they were six times more likely to have delayed language skills. Another study found that children who watched baby DVDs between seven and 16 months knew fewer words than children who did not.

The problem, researchers point out, is that time in front of the TV oftens substitutes for time spent interacting with parents and siblings. And as anyone who’s ever tried to learn a foreign language knows, four hours of Telemundo is not the same as four hours of active conversation with a native speaker.

On the other hand, as these parents will tell you, sometimes it’s nice to let the little wriggler zone out in a narcotic stupor for a few seconds. Sometimes you don’t want to be somebody’s physical trainer, language coach, and best friend all at once. Sometimes you just want the little pasha to hang out for an hour and not require much of you.

We do not plunk Henry down in front of the TV by himself. Even if we wanted to, he HATES being by himself. But here’s the thing: I like TV. I like it a lot. I like to watch it. It’s bright and colorful and makes pleasing noises. I’m watching it right now. And I have already learned to walk and talk.

I have adopted various placement strategies to keep him from looking at the TV while I watch it, but I can see already that that’s not going to be a long term solution. Man… this is bumming me out. I wonder what it’s like to live without TV.

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.