Monday, November 19, 2007


Popular summary followed by journal abstract below. The conclusions below meet conventional expectations but they conflict with other findings (e.g. here) showing that kindergarten INCREASES aggressive behaviour in children. There are however lots of problems with the study. The effect found was very weak; Reports by the mother again seem to be relied on; The aggregation of care at kindergarten with care by relatives is stupid etc. There would surely be large differences between care given by relatives and care given by teachers. So why did the researchers aggregate them? No mystery. There would have been NO visible effect if they had been treated separately

Children of mothers with a low education level may be less likely to have behavioural problems if they receive regular care from other adults during pre-school years. In the Archives of General Psychiatry this week, a new study has found that non-maternal care -- including centre-based childcare and family arrangements -- can reduce physical aggression problems in these children.

Researchers followed 1691 children from age five months to five years. Mothers were interviewed at regular intervals about their children's behaviour, including frequency of hitting, kicking, biting and bullying. Overall, 17.5 per cent of mothers had not finished high school. Among their children, those who started regular childcare before the age of nine months were 80 per cent less likely to have high levels of aggression compared to those who did not receive such care.


The Role of Maternal Education and Nonmaternal Care Services in the Prevention of Children's Physical Aggression Problems

By Sylvana M. Cote et al.

Context: Physical violence is an important health problem, and low maternal education is a significant risk for the development of chronic physical aggression (PA). We hypothesized that nonmaternal care (NMC) services could prevent the development of childhood PA problems, depending on the age at which the services are initiated.

Method: Children who followed a trajectory of atypically frequent PA between 17 and 60 months of age among a population sample of 1691 Canadian families were identified. Maternal education and NMC were considered in predicting group membership while controlling for confounding family characteristics.

Results: Children of mothers with low education levels (ie, no high school diploma) were less likely to receive NMC. Those who did receive such care had significantly lower risk of a high PA trajectory. Results from logistic regressions indicated that NMC reduced the risk of high PA, especially when initiated before age 9 months (odds ratio, 0.20; 95% confidence interval, 0.05-0.90). Children of mothers who graduated from high school were less at risk of PA problems, and NMC had no additional protective effect.

Conclusions: Nonmaternal care services to children of mothers with low levels of education could substantially reduce their risk of chronic PA, especially if provided soon after birth. Because children most likely to benefit from NMC services are less likely to receive them, special measures encouraging the use of NMC services among high-risk families are needed.

Arch Gen Psychiatry. 2007;64(11):1305-1312.

Apparently everyone in our society is vulnerable and millions are harming the health of others. Really?

Forget about the hypothetical risks of a human bird flu epidemic or terror attacks on cinemas. The scariest thing I saw this week was the demand from the Nuffield Council on Bioethics for more “coercive” public health policies to protect “vulnerable people”. The influential Nuffield experts propose the sort of measures once considered the preserve of “health fascists”: even higher taxes on alcohol, shorter licensing hours, a ban on smoking in your home, denying or delaying health treatment for unrepentant smokers and drinkers, compulsory food labelling, even anti-obesity architecture. Their report confirms that public health policy now means not just providing clean air or water, but policing personal behaviour.

Worse, they justify this as the “liberal” approach - a word that, like the “public” in public health, now seems to mean its opposite. The Nuffield report rejects the old “nanny state” label and champions a “stewardship model”. The job of the steward State should be to “reduce the risks of ill-health that people might impose on each other”, and “pay special attention to the health of children and other vulnerable people”.

Unless you really are a health fascist - and bioethicists are no Nazis - there are limits to what you can make people do “for their own good”. Thus the report concedes that the State should “not attempt to coerce adults to lead healthy lives”. But the trick is that, by adopting the stewardship model, it can coerce us not to lead lives that are deemed risky to the health of others.

The illiberal liberals even wheel on J.S.Mill to support coercion. The summary claims that Mill's “classic harm principle” (I thought his classic principle was liberty, but still), backs state intervention “where an individual's actions affect others”. It is hard to think of any non-hermit who does not “affect others”. In fact, what Mill said in On Liberty - quoted in the full report - was that to justify compulsion, an individual's conduct “must be calculated to produce evil to someone else”. It seems that the definition of calculated evil is now to smoke in your living room, feed your family burgers or drink more than a couple of glasses of wine.

And who are the vulnerable people that the steward State must protect? More to the point, who aren't they? Those labelled “vulnerable groups” now include children, women, the elderly, ethnic minorities, disabled people — in short, most people. So, we supposedly live in a society where almost everybody is vulnerable, and millions are harming the health of others. No matter that we are actually living longer and healthier lives than ever before.

As a man of the libertarian Left who believes that autonomy and freedom from coercion are the basis of a healthy society, I recall how that passage in Mill's On Liberty ends: “Over himself, over his own body and mind, the individual is sovereign.” Bioethicist, steward thyself.



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 and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology:
"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correla-tion coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic condi-tions and lynchings in Raper's data. Raper had the misfortune of stopping his anal-ysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic condi-tions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."
So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.


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