Tuesday, December 12, 2006

Epidurals bad for breast-feeding

Women who give birth with the aid of pain-relieving epidurals find it harder to breast-feed than those who give birth naturally, a study has found. The research suggests that some of the drugs used in epidurals make their way into babies' bloodstreams, subtly affecting their brains and development for weeks afterwards - including making them less willing to breast-feed. If confirmed, such research could force a rethink over the use of the drugs.

Up to a third of British women giving birth are routinely given epidurals in which a catheter is inserted into the spine to allow the infusion of pain-killing drugs. These deaden the nerves that relay sensations of pain from the lower body and legs.

In a commentary on the research, published today, one expert suggests the impact of epidurals on breast-feeding should be officially classed as an "adverse drug reaction". Writing in International Breastfeeding Journal, Sue Jordan, senior lecturer in applied therapeutics at Swansea University, says women given the infusions should be offered extra support to stop their infants being "disadvantaged by this hidden, but far-reaching, adverse drug reaction".

Such a link could help explain why many British women fail to breast-feed, with 55% giving up within six weeks of birth. More than a third of women give up within a week, saying their babies simply refuse to breast-feed.

In the research, published in the same journal, Siranda Torvaldsen, from Sydney University, and colleagues from other institutions in Australia, studied 1,280 women who had given birth, of whom 416 had an epidural. The researchers found 93% of the women breast-fed their baby in the first week but those who received epidurals generally had more difficulty in the days immediately after birth.

By the time six months had passed, the women who had been given epidurals were twice as likely to have stopped breast-feeding, even after allowing for factors such as maternal age and education. The authors suggest the most likely cause of the problem was fentanyl, an opioid drug widely used as a component of epidurals. Such drugs pass quickly into the bloodstream and easily cross the placenta to reach the unborn baby.

Many women have a good experience with epidurals because the drugs allow them to relax. However, researchers have long known that there are also potential adverse side effects such as lowered blood pressure, a slowing of the birth process and a greater risk of having to pull the baby out with forceps. There has, however, been less research into the impact of such drugs on babies, although it is known that, because of their immature livers, the drugs can linger in the body.

Other researchers support Torvaldsen's findings. A study at Toronto University, Canada, of 177 women found they were less likely to be breast-feeding after six weeks if they had been given an epidural with fentanyl.


This report seems to have caused some uproar. Even though it was cautiously worded, the editorial by Ms Jordan ("Infant feeding and analgesia in labour: the evidence is accumulating") in International Breastfeeding Journal 2006; 1: 25 has now been taken down. See the cached table of contents here. It must have hit pretty close to the mark to get censored. Truth is the most usual victim of censorship. The abstract of the Torvaldsen study ("Intrapartum epidural analgesia and breastfeeding: a prospective cohort study") is however still available here. I reproduce the abstract of the censored editorial below:

The interesting and important paper by Torvaldsen and colleagues provides further circumstantial evidence of a positive association between intrapartum analgesia and feeding infant formula. Not all research supports this association. Before failure to breastfeed can be adjudged an adverse effect of intrapartum analgesia, the research evidence needs to be considered in detail. Examination of the existing evidence against the Bradford-Hill criteria indicates that the evidence is not yet conclusive. However, the difficulties of obtaining funding and undertaking large trials to explore putative adverse drug reactions in pregnant women may mean that we shall never have conclusive evidence of harm. Therefore, reports of large cohort studies with regression models, as in the paper published today, assume a greater importance than in other areas of investigation. Meanwhile, women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour.


Being true to their hidden agenda -- helping Leftist elitists to feel better about themselves

In the midst of a really big news week for all Americans, including the release and reaction to the Baker-Hamilton Iraq Study Group Report, came one of the weirder bits of news involving PBS. On Dec. 6, it was announced that the Public Broadcasting Service and Green Mountain Coffee Roasters had formed a partnership to launch a new organic coffee blend known as PBS Blend. The press release says the new blend will be offered in "whole bean, 10-oz. packages and single-serve K-Cups for use in Keurig Single-Cup brewers," also owned by Green Mountain.

The press release itself seems to present a masterpiece of politically, environmentally and socially correct blended images of this new marriage, in keeping with discriminating TV watchers and coffee drinkers. "Sweetly balanced and smooth," it states, "with full flavor and a rich finish, PBS Blend is grown in the lush, tropical rain forests surrounding the El Triunfo Biosphere in Mexico. PBS Blend carries the Fair Trade Certified label, which guarantees farmers a fair price for their coffee harvest and enables them to reinvest in their communities. In addition, PBS Blend is environmentally-friendly. A certified organic coffee, its beans were grown using agricultural practices that preserve biodiversity and vital habitats for migratory birds and other wildlife.

"`We are pleased to be working with Green Mountain Coffee Roasters, which shares PBS's commitment to social responsibility and community education,' said Andrea Downing, Vice President, Home Entertainment and Partnerships. `This partnership allows PBS a new way to engage and inform consumers around a quality product, provides them with another way to support public television through their every day lifestyle choices and purchases, and ensures that our member stations can continue to deliver a valuable public service in their communities.'

"Robert Stiller, President of Green Mountain Coffee Roasters, said, `This collaboration with PBS reinforces our belief that when like-minded organizations join together, they can be an agent for positive change. We admire PBS and its member stations' focus on public service and education, as well as its long-standing reputation as a trusted community resource. This delicious coffee provides us with new avenues for supporting our global community and advancing public education about Fair Trade.'"....

Nevertheless, this partnership is indeed something new and moves the Public Broadcasting Service further down the road toward commercial linkages on the margins of its still largely commercial-free main mission of delivering high quality programming free of interruption and free of the influences that network and cable television impose. In August and September, ombudsman's columns dealt with a still small but steadily growing number of complaints from viewers upset at what they see as a steady growth of "commercials" and "advertisements" on various PBS outlets that they see as undermining the network's special mission. Much of this was focused on the new PBS KIDS Sprout digital channel offered by Comcast, which is the biggest partner in that enterprise, and which contains real commercials. I still get a small but steady stream of mail from viewers who don't like that idea....

Nevertheless, this new arrow in PBS's growing quiver of commercial marketing-on-the-margins projects strikes me somehow as more sad than innovative. I'm no businessman and this all may be none of my business as ombudsman, either. But it is hard to see this generating enough revenue to really matter and meanwhile it may make it look, to still more people, as though PBS is sort of desperate to find money anywhere it can. The purist view, which I can afford to take and PBS perhaps can't, is that the piling up of these commercial linkages might slowly add-up to a weakening of this vital network's standing with enough viewers that will really matter....



Comment by Jeff Jacoby on trans fats and smoking

Big Brother has been busy. New York City's board of health voted last week to ban the use of trans fats in restaurants, a step that will force many of the Big Apple's 26,000 eating establishments to radically alter the way they prepare food. The prohibition is being called a model for other cities, such as Chicago, where similar bans have been proposed.

Is it a good idea to avoid food made with trans fats? That depends on what you consider good. Trans fats are said to raise the risk of heart disease by increasing levels of LDL ("bad") cholesterol. They also contribute to the appealing taste of many baked and fried foods, and provide an economical alternative to saturated fats. As with most things in life, trans fats carry both risks and benefits. Do the possible long-term health concerns outweigh the short-term pleasures? That's a question of values -- one that scientists and regulators aren't competent to answer.

Different people have different priorities. They make different choices about the fats in their diet, just as they make different choices about whether to drive a Toyota, drink their coffee black, or get a tattoo. In a free society, men and women decide such things for themselves. In New York, men and women are now a little less free. And since a loss of liberty anywhere is a threat to liberty everywhere, the rest of us are now a little less free as well.

But the slow erosion of freedom doesn't trouble the lifestyle bullies. They are quite sure that they have the right to dictate people's eating (and other) habits. "It's basically a slow form of poison," sniffs David Katz of the Yale Prevention Research Center. "I applaud New York City, and frankly, I think there should be a nationwide ban."

Yes, why go through the trouble of making your own decision about trans fats or anything else when officious bureaucrats are willing to make it for you? Liberty can be *so* messy. Who wouldn't rather have Big Brother prohibit something outright -- smoking in bars, say, or cycling without a helmet, or using marijuana, or gambling, or working a job for less than some "minimum" wage -- than be allowed the freedom to choose for oneself?

"A nationwide ban," says Katz wishfully. It's an old temptation. New York's interdiction on trans fats was adopted on December 5 -- 73 years to the day from the repeal of Prohibition, the mother of all "nationwide bans."

But Big Brother doesn't always appear as a hectoring nanny. Sometimes he comes disguised instead as a victim of the bullies. Consider the plight of Scott Rodrigues, a Cape Cod man who lost his job with the Scotts lawn-care corporation when a drug test showed that he had violated a company rule against smoking at any time -- on or off the job. Scotts no longer hires tobacco users, since they drive up the cost of medical insurance, and Rodrigues, a former pack-a-day smoker, knew about the policy and was trying to kick his habit. He was down to about six cigarettes daily when he was fired. Now he claims that Scotts violated his privacy and civil rights, and is suing his ex-employer in Superior Court. "How employees want to lead their private lives is their own business," his lawyer told The Boston Globe. "Next they're going to say, 'you don't get enough exercise'. . . . I don't think anybody ought to be smoking cigarettes, but as long as it's legal, it's none of the employer's business as long as it doesn't impact the workplace."

It's hard not to feel a measure of sympathy for Rodrigues . Many activities endanger health and can drive up the cost of health insurance, from drag-racing to overeating to promiscuous sex. Yet none of *those* appear to be grounds for termination at Scotts. It seems capricious to treat only smokers so harshly.

But capricious or not, Scotts is entitled to condition its employment on any criteria it wishes. (With the significant exception of the "protected categories" -- race, religion, etc. -- itemized in civil rights statutes.) Rodrigues has not been cheated. No one forced him to take a job with an antismoking employer. Scotts is a private firm, and if it chooses not to employ smokers -- or skiers, or Socialists, or "Seinfeld" fans -- that choice should be legally unassailable. Rodrigues is free to vent his disappointment, of course. He can criticize Scotts publicly, even organize a boycott. (He can also go to work for one of Scotts' competitors.) But forcing the company to defend itself against a groundless lawsuit goes too far. That is an abuse of governmental power -- an assault on the liberty of employers to operate freely in the market. It is a different kind of bullying than the ban on trans fats, but it's an act of bullying nonetheless.

The price of liberty, Thomas Jefferson warned, is eternal vigilance. But too few of us have been vigilant. And the bullies keep gaining ground.


Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter? It is just about pure fat. Surely it should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). For a summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and no lasting harm from them has ever been shown.


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