The science of parenting and its discontents

In an uncommonly thoughtful and thought-provoking essay for Spiked, Nancy McDermott reflects on the challenges of parenting in an age that claims to be ruled by science but has considerable difficulty deciding what is, in fact, scientific.

It’s not simply that parents are spending time deliberating things like whether their baby’s first food should be rice cereal or pears or avocado – once simple decisions that are now apparently terribly complicated. It’s the way we are deliberating. The whole language we use has undergone a transformation. We investigate. We research. We weigh the evidence.

Eavesdrop on a conversation between parents about something like breastfeeding and you might be forgiven for thinking you’d stumbled upon an impromptu gathering of nutritionists, epidemiologists and child psychologists. The highly technical language we use to discuss ordinary aspects of childrearing belies a collective lack of confidence. We no longer feel comfortable justifying our beliefs about bringing up our children on the basis of ‘common sense’ or experience. Instead we now rely on science.

Except we don’t actually rely on science in the way a scientist relies on science to test a hypothesis; rather, parenting, McDermott suggests, has become infected with a scientizing impulse that might be better seen as an an anxiety disorder. Where once common sense or the shared wisdom of a community guided parents in raising children, and for good or ill they just got on with it,  the scientizing impulse requires that everything be interrogated and justified with a certainty that actual science often can’t supply. Even when there is certainty – or as close to certainty as rationality allows – McDermott shows that the scientizing impulse will dress up nonsense to resound with unearned authority.  As anti-vaccination activist Jenny McCarthy put it to Larry King: “Parents’ anecdotal information is science-based information.”

As every scientist and statistician knows, the plural of anecdote isn’t data.

School bus evacuated over peanut

If ever we needed confirmation that we have entered a strange, unpleasant era of hyper-irrationality, it comes in the form of peanut allergies. That at least is the inescapable conclusion from reading “This allergy is just nuts,” by Nicholas A. Christakis, professor of medical sociology, Harvard Medical School, in the latest issue of the British Medical Journal.

The article was written in response to the increasingly nutty behavior by schools and parents over the threat from peanuts, which included the evacuation of a school bus full of 10-year olds after a single peanut was spotted on the floor, and the decision by the municipal school where Dr. Christakis’ children attend to mandate collecting wrapped candy gifts, some of which contained sealed tins of nuts, from the loading dock rather than the classroom to prevent endangering the children.

Add to this the general banning of nuts and foods associated with nuts in schools and we have, according to Dr. Christakis, a case of “epidemic hysteria.” The numbers, of course, tell a different story,  he says:

“About 3.3 million Americans are allergic to nuts, and even more – 6.9 million – are allergic to seafood. However, all told, serious allergic reactions to foods cause just 2,000 hospitalisations a year (out of more than 30 million hospitalisations nationwide). And only 150 people (children and adults) die each year from all food allergies combined.”

That’s roughly in the ballpark of the number of people who die from lightning strikes (about 100) each year. Maybe we should build a really big umbrella or stay indoors for the entire spring and summer…

Addiction pablum at the New Yorker

Maia Szalavitz

Last week, an extraordinary example of the sorry state of addiction coverage and treatment in the United States appeared in the New Yorker.

The story focused on “luxury rehab” as practiced in California’s Wonderland program; unfortunately, the magazine seemed to take the program’s outdated views on addiction as representing the consensus among addiction experts about the appropriate medical treatment for this disorder.

What’s sad and bizarre is that what would pass for alternative treatment in any other area of medicine — telling people to turn their lives over to God, meet, confess and pray, as 12-step programs suggest — is seen as top-notch care in 21^st century America for drug problems.

While it’s true that 90 percent of addiction programs still push this approach, decades of research have shown that portraying the 12-step model of Alcoholics Anonymous as the only way to recover from addiction is not only inaccurate, but harmful. Twelve-step programs have not been found superior to other techniques, and implying that they are can do harm by making those for whom they fail feel hopeless and avoid help.

Nonetheless, there in the New Yorker is Wonderland’s executive director, saying that most addicts will relapse “until they finally surrender to the reality of doing it through AA.” In fact—unmentioned by the magazine — studies find that many, perhaps most, addicts and alcoholics recover without AA or any formal treatment program. Though there’s no doubt that 12-step programs are useful for some, they shouldn’t be seen as the only way.

The article did note that the “attack therapy” widely practiced in addiction treatment in the 1980’s and 90’s — and still common in care for teens — has “fallen out of favor.” But it didn’t mention that this is because research found it to be both ineffective and sometimes harmful.

Further, the line taken by many of the “experts” quoted in the article — that addicts “need frustration,” that “the more you cater to an addict’s demands, the more you support their disease,” and that they need to “Get with the program or get out”— is also unsupported.

The reporter clearly buys their approach, talking about how “granting so much agency” to addicts by allowing them to have their way in treatment might be problematic. But in what other conditions do doctors get to choose whether to “grant patients agency”?

If you went for cancer care and were told that you “need frustration,” and you must obey what the doctor tells you without question or “get out,” you would probably find such high-handedness unacceptable. It would certainly be seen as poor bedside manner. For addicts, however, such paternalism is not even questioned — even though, again, the research finds that empathetic and supportive care is more effective.

The New Yorker didn’t pull its punches on Wonderland — it noted the low success rate of residential rehabs and clearly highlighted the absurdity of some of its practices. But it could have done a much greater service by talking to academic addiction experts about why even the rich and famous don’t get evidence-based care for addiction.