Blessed epidurals: Or, Biting the hand that delivers us?

Just wanted to update anyone curious on my posting frequency that I am doing some writing for other sites at the moment, but that I will be hoping to return to some of these longer ones.

I am going to work on the anti-artificial post--it is too long, I know. But I actually think that these are important ideas to counter the ubiquitous flipside. Everywhere I look there is someone arguing the opposite of what I am saying, of course without addressing any of the essential arguments.

As to the actual benefit to society angle, anyone curious about the origin of my interest in this topic should be aware of its origins within my ethical system, which believes that whether through human advances or the gift of God we can expect relief from our struggles and pains through modern medicine. Modern medicine is better than its naturopathic competition in my opinion because it uses dispationate science rather than the psychologically powerful pull of placebo and anecdotal evidence that have had customers swearing by every snake oil salesman through town for thousands of years. With medicine, rather than word of mouth and superstition, there is the chance of one generation's knowledge to improve apon another's.

I think that the subject of epidurals is an interesting example of what I am talking about. Individual women who choose to have one or not come to those individual decisions in a very emotionally-invested way, so I am not knocking any one personal decision past or future. And as I have come to learn, surprisingly, most of us come to think what we did in life was the right thing no matter what it resulted in, so that would pretty much not be possible anyway.

But there are other elements in this discussion with motives that I am less thrilled by, however, than just women trying to do the best thing by themselves and their babies (many of them scared by the various propaganda). Having no better name to call them than the 'detractor factor,' this element detracts from anything in the formal medical community but particularly they have success here where they can claim (bravely) that it was better when women birthed their babies on their own. They portray modern obstetrics as some Victorian Patiarical imposition on a better alternative--not the result of the long-time attempt of the whole human race to eliminate suffering of women and the death of unborn children during birth.

It is certainly right to question the actual consequences of encouraging women back from these hard-fought advances, but any reasons offered ought to be good ones, and not just some vague ideology such as the suspicion of anything 'not natural,' like un-natural pain-free childbirth. In my view, though, it sure as heck beats REAL natural child birth a hundred years ago when a half of children and a third of women died afterward. I would sure love it if the obstetrical community, rather than defending itself for the amazing feat of the amount human agony that they have already ended, could be encouraged to do more of the same.

This kind of attack on their usefulness or even safety is making epidurals being tossed out like the baby in the bathwater in Europe, where in managing their health care systems they seem to be forgetting one of the things that they were meant to achieve--elimination of human suffering. This thinking can prevent useful advances in medicine. The doctors that we sent to solve the problem finally return and say hey lookie here, we have reversed the curse of Eve for you with a modern-day miracle! And that miracle is no worse than a flu shot which can look as scary and risky if it is sold as such.

Sometimes I wonder about who gains when women loose--I picture a marketing meeting in some HMO board room where they think up the idea that rather than being forced to cover this wonderful procedure (because it is obviously so wonderful), the better option would be to convince women it would be better if they just writhe in agony for free. Those who welcome national health care can expect this to come to the US. No pain relief for you!

I am all for natural childbirth, or for doing whatever my ancestors did if anyone tells me what it is they did and how it will help me in some way that I don't know. I have a suspicion if they discover that their ancestors lived of of killing one elk and eating it all winter they aren't going to be so excited, but who knows, the writing in agony thing has gone over. But just because the practice was older, has been around a long time, or somehow more 'natural', doesn't make it better, and those that argue these types of alternatives to medical advances should not be allowed to stop at that justification. Most of the actual evidence of archaeological remains of past civilizations, especially Egypt which actually ate very much like the USDA pyramid, the mummies show that they suffered from the same degenerative diseases that we do, along with the chronic ones that we are now getting under control from intervention in 'nature.'

Life of our ancestors was hard and short. So nothing is convincing me that it needs returning to, there, but I will think on it.

The case against nature

PREFACE--WHY WOULD I MAKE SUCH A CASE?

I am an unorthodox thinker, for good or ill, having the frequent experience that the questions I ask don't seem quite 'normal' to their recipients. One thing that I have asked people about over the years is why they very often express an opinion that 'natural ingredients' are always vastly superior to any 'substitutes.' One such ingredient that attracts negative attention is sweetener. This is a common substitute because sweetness serves a function that doesn't need to be performed by something natural, or at all. You couldn't, for example, have artificial food, because most of us need at least some amount of digestible nutrition. But sweetening can be achieved by something that isn't even really itself a caloric food product--in fact that is the idea.

This topic has been an interest of mine before, because sugar itself obviously has bad health consequences, at least in large quantities. I used to diet before mysteriously loosing my appetite, and I had best results avoiding sugar/starch. It was frustrating how rare good alternatives to sugar are, and even more so because I suspect this rarity is related to just this vilification. No food company would be super eager to manufacture a product that will be scrutinized in every direction for any hint of the danger people feel very strongly must be there, thus there have only been a few main choices, even though a good tasting and versatile one would be a holy grail for dieters and a gang buster seller.

Seeking specifics on reasons for automatic mistrust of something meant to instead be a healthier alternative, I queried a local BB about why some of them had stated this mistrust when the subject came up. Answers were along the lines of 'I figure I might as well avoid artificial ingredients' or 'call me trendy, but that's where I come down.' Not really answers--at most restatements of the original position, with occasional justification that no reason at all is necessary in the case of something so obvious.

'MAKING CASES' VS. 'JUST BECAUSE'

Opinions are everywhere, but it doesn't always follow that their owners have thought them through. I am sure I don't always, but I do value giving some thought before I introduce a habit impacting my life like my diet would, or doing anything that has a consequence for me or anyone else. When I don't get the chance, I prefer to say I have no strong opinion on a topic like say gun control, rather than take one anyway, which in my opinion is a problem. It seems common to come down on one side or another rather than just abstain.

I try to learn about what goes into others' thinking. I might ask about things said in the process of making small talk, online or spoken, even though it isn't a big deal, just curiosity. But sometimes my attempt to just be social, even supportive by showing interest in someone's views, is interpreted as 'pinning them down.' I am not sure why, maybe how much actual homework goes into an opinion always makes people nervous, it does me. Maybe the answers seem plain obvious: everyone knows that is just the way to think, etc. (Slade gets this all the time, too, who even more than I do, commonly leaves people nonplussed).

Bumper-sticker-ready statements, substituting near-universal thinking for individual opinions, are ripe territory. ("Of course it must be good to have natural ingredients--every box of anything touts them!") When something is understood to be good it can practically travel through the air all the way to the status of a passionate mission statement. The whole 'natural is best' reflex I am quite sure otherwise intelligent people buy into because it seems rather harmless at worst, and it could be.

But any 'everyone is doing it' reasoning is surprising in this commercial environment, where some companies can suggest 'apply directly to the forehead' even without bothering to mention WHY ANYONE WOULD EVER WANT TO DO SUCH A THING! Seriously, this particular product launch is so choice; it is unbelievable but obviously in some marketing meeting someone discussed their belief that they never even had to mention pain or make a claim that this product is an actual remedy in any way, but they are probably right and someone is marching out to buy it anyway.


'CULTURAL MYTH'--THE HARM OF 'JUST BECAUSE'

It never IS, BTW, the intellect of someone that I question in any case that I make for something being less than a super idea. There are many reasons why intelligent people can end up wrong. Plato was not a stupid person but it has taken 2500 years to fight back some of the attractive but destructively unhelpful concepts he introduced, such as dualism. Cultural myths, found in all ideologies and levels of education, don't have anything to do with capacity, they result when that capacity is surrendered voluntarily. Rather than analyze an idea a belief held by the larger culture is deliberately substituted. While there are many reasons this is done (efficiency or the pleasure of positive association), in fact it seems to result sometimes from deliberate anti-intellectualism, where someone chooses to for whatever reason reject possibly improving on their views. (This demonstrates that I am distinguishing a choice, rather than claiming some better ability, which I do not.) And this choice can be inconsequential in some cases, but the potential for danger in resisting rigorous analyisis in areas of diet and health seems large to me.

And claiming these are matters of preference, perhaps that it comes down to what we feel like doing, say to even purposefully attempt a placebo effect, is also a bit dangerous. If something can have a good effect it can just as easily have a bad one. This might seem obvious stating it out of context, but there are clearly those who would have us believe that if something is 'natural' it can't harm us . But that ultimately implies that something natural can't do anything physical to us at all, revealing that some proponents and users of say alternative medicine really do believe we are talking about inert substances. But anything that we think does something physiological, or that could, is medicine, however you slice it--little distinction about levels of naturalness can really be made. And if a substance does anything to us, it could just as easily be what ails as what cures, unless the rationale behind it is good. Good reasoning is therefore what I am advocating, not a particular substance or abstinence.

To be clear, I have little opinion one way or the other about food additives other than preferring nothing like say rat poison in my food, because current state of knowledge on what constitutes 'harm' is unfortunately little more helpful than to avoid the obvious. One of my ongoing goals is to avoid questionably-generated or biased opinions, and getting rid of the ones I am sure that I have. The process of submission of my current opinions for evaluation and critique by others, to benefit from perspectives I haven't thought of, is one way to achieve that goal.

OK, FINALLY, THE CASE AGAINST NATURE

My husband all the time at work asks his colleagues (most of them developing the typical pot-bellied engineer physique) why they don't drink diet soda. They say, 'I am not going to put those chemicals in my body!' Somehow in this simplistic response, very intelligent men are able to ignore that that drinking 200+ calories of concentrated sugar in one small serving is not only ingesting a chemical, that particular chemical regularly in those quantities produces in the body the surge of a habit-forming drug--insulin--which has many harmful secondary and tertiary effects on health. Most likely that drug has medicated an extra 30 lbs onto their bodies at least. And unlike the harms of insulin surges, harms of the chemicals that could substitute for concentrated natural sugars are unspecified.

Large numbers of people prefer to ignore the known health hazards of ingesting the artificially sweet--and I make the distinction of artificial sweetener and artificially sweet because very few foods in nature (if any) have such concentrated forms of sugar as soda. Thus any soda, however it is sweetened, is a somewhat 'unnatural' thing. Instead what causes more general alarm are non-specific substances not known to harm anyone in any way, particularly not in any known ways like the ones that their sugary drinks are now.

What is strangest to me is how it is that the term 'natural', even though it provocatively undefined, bears the association of benign health consequences. Here I am, thinking in my typically contrary way, that it is obvious to me that in a large number of cases, natural substances are the ones known to have the greatest capacity of known or unknown harms.

The reason for that is that they are made specifically to have effects on living things, whereas substances foreign to biological systems are often capable of passing through us without even communicating with any of our tissues.

So if I were going to want my toothpaste to taste like mint (something rather unnecessary as opposed to something like nutrients, much the way sweetness itself is), why would I want to insist that the mint taste come from plant chemicals rather than something manufactured for that purpose alone? Anything found in a plant is by design going to have an affect living things--wouldn't I be better off with something not meant to do anything to me at all rather than risk an unwanted interaction which is more likely to exist in the case of the plant chemical?

This argument may be obvious to me, but I don't really have the standard of relying on something's seeming obvious in cases where I profess strong opinions (or reject them, which is more typical of me personally, because I prefer not to have strong opinions whenever it can be avoided). So to evaluate either the the 'natural is best' presumption or its opposite, in addition to the fact that by association it is very often that most examples of actual known harmful substances are natural or semi-natural, I will want an actual argument one way or the other to nail things down.

ARGUMENT AGAINST FEAR OF THE MANMADE SUBSTANCE

And the main argument I see against the likelihood that it is a formerly-unevaluated 'unnatural' chemical which might pose the greater health risk to me than a natural one, is that If a substance is capable of harming me, it must have a mechanism for doing so, or it cannot do so. By definition the natural substances are the ones that most often have mechanisms of doing ANYTHING to a biological system.

Mechanisms for something being harmful to the body include the following:

1. Things can mimic or suppress natural processes of the body.

Like artificial hormones, these can do things that the body recognizes and allows in predictable ways. An enzyme has to be a certain shape or it won't fit, like a key in a lock. Neurotransmitters and minerals have certain channels that they travel, and other foreign substances can't use them. This is why most potent substances, like arsenic, cyanide, heroin are usually things already found in nature, made to be like them or as in natural sugar, are a highly concentrated form of them. The fact that most of the most potent substances we can think of come from living things means that potency often amounts to making use of substances that serve known functions in some or other biological system.

(An aside would be that I am no big fan of synthetic hormones. But the fact that they are synthetic is not exactly what makes them harmful, it is that hormones are so complicated and we don't understand them well enough to be creating versions of them to treat various conditions. Most typically (and this is true even for naturally occurring hormone substitutes such as the one in soy) if we use a substitute of something that our body needs in subtly diverse and complicated ways, there will be unintended consequences, at least for the time being. Some day we may nail it all down and then I say let's go for it.)

With this in mind, theoretical predictions can be made about what effect things might have, particularly on pregnancy. The possibility that DES, a synthetic female hormone that caused problems in developing girls 30-40 years ago, might influence a developing reproductive system is something that careful scientists would probably be able to guess. Paning artificiality probably has much to do with fear the unknown, but there are actual things we can predict theoretically and rule out, and others that we can notice are harmful after only a small amount of good science is applied.

2. Things can be toxic.

Toxicity is a level to which a substance needs to attain in the body to cause a harmful environmental situation for organs and bodily processes. This can happen all at once, such as in poison, or it can happen over time, but it can only happen over time if it is actually stored in the body over that time because it must eventually reach some level at which the harmful condition is potentiated. Something can't harm us over time if it isn't stored, or at least its effect would not be considered toxicity in that case. Buildup in the body's tissues can be measured and detected and usually is. One of the things they test for in FDA approval is I think just this, whether it or its metabolites store in the body, usually in several predicted places like the liver or fat, which tend to do this.

As in #1, no fear of the unknown required, because toxicity is readily determinable.

3. [Few] Things can communicate molecularly.

Viruses are one of the very unique things that can mess directly with molecular structure, primarily functioning to rearrange strands of genetic molecules--but no one would be surprised by the idea that a virus would cause harm or sickness in living things, so again knowns tend to be the bad guys rather than unknowns.

There are very few other ways that substances can directly affect living things at the level of specific particles, but radioactive elements are some that can cause damage to cells that weren't necessarily designed to recognize them. But this feature makes them some of the most dangerous in the world. The fact that these things can aggressively mess with the structure of other molecules is something that accounts for this uniqueness and danger, and other things don't do it.

Developing babies can be particularly vulnerable to both viruses and radioactivity because most of the time in adults a certain number of abnormal cells can be repaired and no harm is done in the mean time. But if a virus infects the mother at the right time, or radiation affects the right cell at the right time, even during a short period of time it can put development off course. And most things that affect developing babies also do so predictably, as do things through these other mechanisms. Something like Tylenol or even heroin for that matter won't do anything to a foetus that it wouldn't do to an adult. Things that affect rate do, because development has a strict time schedule. That is why cigarettes and alcohol are some of the worst things, being respectively stimulants and sedatives. (Heroin does affect the rate of respiration, but since newborn babies don't breathe, they aren't vulnerable to this property).


4. Things can cause physical obstruction, blockage or erosion.

Bacteria deposit plaque (which are really like another aggressive organism like the shark that could eat us I suppose), they wear away our teeth, and acid wears away our stomach and esophagus. The milk that might be fine in someone with my particular makeup (I am the Dairy Queen), in others it can disrupt digestion by failing to break down. Other ill effects of milk are usually attributed to its artificial hormone or antibiotic content, which would be considered #1 and also very predictable, and also because of the way these substances mimic natural substances and not the degree to which they are artificial.

5. Secondary effects: irritations, infections.

Smoking and asbestos are often thought to be somehow directly carcinogenic, based on a flawed and outdated model of cancer. The assumption for the first 50 years or so that lung cancer was understood as a cellular phenomenon was that chemicals within cigarette smoke must have some kind of direct carcinogenic affect on the lung tissue. In actuality smoke (and it is likely that most kinds of smoke blown through the lungs with such intensity and frequency) causes an environment of irritation in the respiratory system. But as there is in most of the cancers that are better understood, there is a secondary mechanism based on an actual way that they have of affecting us that is directly observable. They simply irritate lung cells faster than we can repair them, and eventually a malignant cell is allowed to survive and multiply.

I am sure there are other ways that substances can be harmful than those I just listed, but essentially when there is a possibly harmful substance, to know for sure scientists usually first want to know one major thing:

What would be the mechanism for that thing harming us?

Because something can't just be harmful in general or 'bother' the body in some vague way. The famous study in 1977 that after years of biased attempts to prove a harmful effect, finally established some kind of link between saccharin and some type of health concern (the study was since discredited and removed from labels in 2000), is not applicable to humans because rats have a mechanism that makes saccharine harmful to their bladders. It causes a precipitate in their urine, and this precipitate, not the saccharine itself, is what may possibly lead to more cancers. In humans, the fact that there would not be such a mechanism, means also that there is no such risk.

Cancer as I said about lung cancer and smoking is usually caused by a more predictable way of something harms the body and not some sort of vague direct effect of a chemical on the tissues or cells. This actually eliminates the mechanism that most people use to argue unknown effects of certain chemicals, that they might just 'somehow' result in a malignancy in their bodies. Studies attempting to prove cancer from pesticides were motivated by this assumption, and few of them have any affect on us at all, and the ones that do do so not because they are artificial chemicals but because they are natural chemicals that do something in particular like have an effect on an insect's reproductive system that might also affect humans in a similar way.

And I think the fact that most of the ill effects of substances that people actually have mentioned as being demonstrably harmful, like DES or milk, are only harmful in very in predictable ways proves the point that it really isn't very likely that some synthetic chemical pointedly designed to not be recognized by the body will have some unknown or unpredicted harm. No one in my entire query of why they believed artificial to be worse than any natural equivalent brought up a single established harmful substance that has none of the above known mechanisms for interacting with the body, and most of them are the most harmful because they are the most natural, like estrogen or milk. If it can't do any of the above things, it probably won't do too much. It just hasn't happened, as long as people have been watching for it to happen.

CASE FOR AVOIDING NATURAL HARMS

Essentially this leads me back to my more obvious reaction, that the more natural and central to how the body works something it is, the larger affect it can have, even such an unpredicted effect. That is why I have been so frustrated that artificial sweeteners are maligned more than sugar itself. Sweeteners that are not processed as energy are specifically designed to not cause the harm that sugar causes because our body doesn't recognize them, and thus they also have no mechanism for harming us.

And a substance's harm, even unknown, will be limited by its ability to impact major systems of the body. Salt, long thought to cause health problems, only affects the body's fluid retention and can't do much else. Radioactive iodine can kill off the thyroid, but it can't do anything else, even in large quantities. But things the body itself secretes like estrogen and insulin do hundreds of things, half of which we don't understand, and this means there could be many, and some unknown, consequences to introduce artificially. And this potential effect is proportional to its omnipresence in living things, not its foreignness or artificiality.

SCIENCE--THE TOOL-KIT OF CASE-MAKING, IS OUR FRIEND

The good news for me is that there is also not enough reason for the pessimism that science won't be able to figure out what will hurt us so that we are safer just with our own random irrational fear. In all of the cases of harm I mentioned, most historically harmful things have been, based on this principle, able to be eliminated early either in theoretical science or initial empirical data about how they affect living things. Thalidomide was demonstrably and highly tetratogenic in animals and never should have been used in pregnant women. DES was a reproductive hormone and its effect on the developing reproductive system was not a stretch. Radioactivity has a highly unusual capability of changing cells on a molecular level and more caution should have been taken before it was initially overused in medicine. The fact that these things did eventually cause harm was because good science was for whatever reason not applied, not that it wasn't available. With the scrutiny, even character assassination, that things like artificial sweeteners have received, it really does become highly unlikely that there are looming unknowns, given that these known mechanisms for their harming us have been eliminated.

The result? There probably are, to quote a recent talk by Jane Goodall at TED, probably about fifty chemicals in our bodies that weren't there fifty years ago. Sounds like a wild and crazy coincidence of the number fifty, but I have no problem with that estimate. Unless those substances have a way to harm us, though, they can't. As my sister Donna pointed out, a couple of those chemicals are probably prolonging her life, and her husband's, her mother's...