Saturday, November 01, 2008

Liar, liar, pants on fire

(nb. I am not the Devil's Kitchen)

Drinking heavily while pregnant is, of course, a very bad idea. Foetal Alcohol Syndrome is a serious condition and it has long been accepted that alcohol abuse while pregnant can lead to birth defects and behavioural problems.

Having the odd drink while pregnant, on the other hand, poses no risk to either mother or child. It's good for the ticker, relieves stress and there is not a shred of evidence that light drinking can lead to any of the problems associated with Foetal Alcohol Syndrome. Consequently, pregnant women have always been advised to limit themselves to no more than one or two drinks, once or twice a week.

Or rather they were until May last year, when the Department of Health announced that there was no safe amount of alcohol that could be drunk during pregnancy and that the government was now advising expectant mothers to drink no alcohol whatsoever.
"Our advice is simple: avoid alcohol if pregnant or trying to conceive."
Since then, warning labels have been slapped on millions of bottles of booze with an unambiguous message that any consumption of alcohol by a pregnant woman was verboten. Unacceptable. Dangerous.

What led to this change of policy? Bugger all, as everyone involved admitted:
The Department of Health said the revision was not based on new scientific evidence but was needed to help ensure that women did not underestimate the risks to their baby.
Ten months later, NICE followed the government's lead, even though it, too, believed that occasional light drinking posed no hazard.
As the Beeb reported:
It brings NICE in line with government advice and replaces previous guidance saying small daily amounts were fine.
However, NICE concedes there is no evidence to support the change.
Only the Royal College of Obstetricians and Gynaecologists held firm and maintained their position that small amounts of alcohol during pregnancy were harmless, basing their opinion on the quaint idea that medical advice should be based on fact rather than scare-mongering.

Yesterday, however, some evidence finally appeared. An epidemiological study found that the children of those who abstained from alcohol performed rather worse than those whose mother had had the occasional drink.
The study, published in the International Journal of Epidemiology, found boys born to light drinkers were 40% less likely to have conduct problems and 30% less likely to be hyperactive than those whose mothers had abstained.
They also scored more highly on vocabulary tests and on identifying colours, shapes, letters and numbers.

This study pissed on the government's bonfire somewhat, and led to headlines such as:
Blessing of a weekly tipple in pregnancy

Light drinking in pregnancy may be good for baby boys, says study

Light Drinking During Pregnancy May Benefit Baby

Light drinking in pregnancy may be good for baby boys, says study


Light drinking when pregnant may lead to calm babies, says study


Let's be clear. This study, though large, is not conclusive and the idea that taking alcohol during pregnancy reduces the risk of behavioural and learning disorders remains a hypothesis. Be that as it may, it does seem to refute the 'no safe level of alcohol' theory. And since the UK government's zero tolerance advice was based on no evidence in the first place, will the doctors now be changing their advice?

Apparently not.
Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, said: "We are concerned that the findings from the UCL study may lull women into a false sense of security and give them the green light that there is no problem with drinking during pregnancy. This is not the case."

These are weasel words. No one disputes the risks from heavy drinking during pregnancy but that is not the issue here. The question is whether moderate, occasional alcohol consumption poses a risk and this study clearly shows that it does not.
"The BMA believes the simplest and safest advice is for women not to drink alcohol during pregnancy."

That's because the BMA considers pregnant women to be a set of cretins who will go on a bender if it veers, even for a minute, away from the 'demon drink' rhetoric. Total abstinance may be the "simplest" advice, but is it the safest? According to this study, the safest advice is to have an occasional drink. Apparently the BMA is prepared to disregard the evidence, and resent its very publication, because it fucks up their simple but completely unsubstantiated zero tolerance policy.

But why should I give a damn? I'm not a woman and I'm never going to be pregnant. There might be a libertarian argument here but I'm not going to lose any sleep over it and I don't expect people to take to the streets to defend a woman's right to relax with a glass of vino while in the family way.

But I do expect medical advice to be based on facts. The lesson here is, once again, that the medical establishment can no longer be trusted to give advice without exaggerating or fabricating risks to scare the proles into submission. That is not advice. That is propaganda.

At the heart of the total abstinance policy is a contemptuous attitude towards pregnant women; that they cannot handle shades of grey; that unless something is defined as 'good' or 'evil', the plebs will not understand it. Beneath the talk about 'sending out the right message' is the fact that doctors are being told to lie to their patients about a risk that just does not exist.

9% of pregnant women drink above the old guidelines and there is doubtless a hard core of stupid bitches who binge their way through pregnancy. These are the people the doctors want to reach and they are prepared to mislead and stigmatise the other 91% to do so. But common sense dictates that if these women were ignoring the old guidelines, they will ignore the new ones. And so the campaign won't work because only the health conscious will pay any attention.

They are only guidelines, of course, and women can take them or leave them. But be under no illusion, if it was practical and enforceable, the doctors would be pushing for the government to make it illegal for pregnant women to touch a drop of alcohol. I'd take even money on a law being passed in the next five years to make it a crime to sell alcohol to a pregnant woman (as it is in parts of America).

For the time being, they will have to settle for a programme of denormalisation - to make drinking any quantity of alcohol socially unacceptable. However well intentioned, the outcome will be that women who are doing nothing wrong feel anxious, ashamed and guilty. They will be glared at, lectured to and abused. In Louisiana a few years ago, a man shot a pregnant woman dead because he saw her smoking a cigarette. It's a strange way to express your concern about health but that's how these things end.

Like I say, I'm not a woman so this won't affect me. But these quacks make it up as they go along. That's all I'm saying.

31 comments:

Mark Wadsworth said...

IT's all bollocks, as you rightly point out, but think about this bit:

The study ... found boys born to light drinkers were 40% less likely to have conduct problems and 30% less likely to be hyperactive than those whose mothers had abstained. They also scored more highly on vocabulary tests and on identifying colours, shapes, letters and numbers.

Now, might this be because women who are so uptight as to not drink a drop during pregnancy probably believe in a ton of other crap as well and are hence not the best parents anyway?

These findings tie in nicely with all the statistics that say that Muslims do relatively badly at school and that there are effectively no Muslim Nobel Prize winners or patents taken out in Muslim countries.

Little Black Sambo said...

And wasn't there evidence a while ago that light drinking improved a person's driving?

John B said...

The study also found, oddly, that girls whose mothers were heavy drinkers had the fewest problems of all groups (obviously this is probably due to coincidence and the very low n of heavy drinkers in the survey, but interesting nonetheless).

I guess the point is that their view of 'heavy drinking' is most of our view of 'normal drinking' - whereas actual foetal alcohol syndrome happens when women are sinking half a bottle of spirits every day...

James Higham said...

What brand do you smoke, S?

Miss Snuffleupagus said...

Yes, but Filthy, it would be interesting to hear the stats on what has happened since... Has the 9% remained the same? Or what has happened in those states in American where pregnant women are shamed into not drinking at all.

the doctor said...

This is the first time that I have dis agreed on this forum , but I must . For my sins I am a researcher in the field of FASD and I know that there is an enormous amount of research out there showing that there is NO safe amount of alcohol consumption during pregnancy . The problem is that much of it has been done outside of the U.K. and so gets overlooked by lazy researchers and others , who are incapable of conduction a proper literature search .
You fellows should not be complacent , drink has a nasty effect on your sperm giving rise to two headed , stunted and tail-less sperm and a low sperm count . If trying for a baby men should watch their own alcohol consumption .

julymorning said...

Where in America is it a crime to sell alcohol to a pregnant woman? Just out of curiosity.

Philip Thomas said...

Excellent post. Yet another example of puritanism supplanting the evidence. keep it up and hopefully someone will listen.

The Filthy Smoker said...

Miss Snuffleupagus said...

Yes, but Filthy, it would be interesting to hear the stats on what has happened since... Has the 9% remained the same? Or what has happened in those states in American where pregnant women are shamed into not drinking at all.


Your guess is as good as mine but let's say, for the sake of argument, that the rate has fallen. Does that justify making shit up? Does it justify inciting hatred? Rates of HIV are a lot lower in Mecca than in San Francisco. Does that make violent homophobia a valid public health policy?

Doctor - welcome. Can you point me in the direction of the "enormous amount of research out there showing that there is NO safe amount of alcohol consumption during pregnancy" because no fucker from the Dept of Health, the British government, Royal College of Obstetricians and Gynaecologists or the Royal College of Midwives can find it.

James - Marlie red-tops. Why?

July - North Carolina certainly and, I think, California too.

julymorning said...

North Carolina does no such thing - you defame my home-away-from-home. Besides, that would surely violate the state's anti-discrimination laws. See for yourself here.

The Filthy Smoker said...

"In North Carolina, it's against the law for anyone to serve or sell alcohol to a pregnant woman. Ignorance of a woman's pregnancy is not an excuse."

http://www.epinions.com/content_4457406596

mister_choos said...

"And wasn't there evidence a while ago that light drinking improved a person's driving?"

There was research done in the 60s that showed accident rates fell to a low point at 50mg BAC, and rose above the 0mg level at around 80mg. That is why our level was set as it was. The research has never been discredited or superceded. Which is why calls for a 0 limit are just talking out of theirarse with no knowledge of the facts (otherwise known as politician speak).

Oswald Bastable said...

Make it socially taboo for one one group and when that is firmly entrenched,it's sooo much easier to make it taboo for other groups- until everyone is evil for imbibing.

Hell- it's classic divide & conquer!

Philip Thomas said...

Filthy Smoker, just noticed. Love the Mr A pic. Steve Ditko rules.

The Filthy Smoker said...

Philip Thomas said...

Filthy Smoker, just noticed. Love the Mr A pic. Steve Ditko rules.


God bless you, sir. You're the first one to spot the reference. And you have a fine blog yourself (I bookmarked it 2 weeks ago, as it happens). I hope your political career won't be too handicapped by your own sane opinions.

Dick Puddlecote said...

Doctor said: "If trying for a baby men should watch their own alcohol consumption"

Bollocks! Your post should read "If NOT trying for a baby men should watch their own alcohol consumption". I was careful to avoid conception with my other half until a Guinness-sodden weekend in Dublin in 2000 cocked all that up.

He is now 7 years old, bright as a button, makes his teacher scared at how good at maths he is & can give me a verbal kicking at times ... the bastard!

He must have been the product of one of those two-headed ones. ;-)

As for your "enormous amount of research", is that the same as "the debate is over" or "the evidence is overwhelming"? Never any real linkable proof though, is there?

Devil's Kitchen said...

The only time that I have conceived, I was a raging, stinking alcoholic.

Whoah! What do you know -- doctors talk shit 99% of the time: who would have thunk it?

Dear Doctors,

Shut your fucking faces.

Love,

DK

Devil's Kitchen said...

P.S. Just in case you thought that I was joking, will you doctors shut the fuck up, you know-nothing, piece-of-shit, authoritarian (did I say "know-nothing") bastards.

Shut. The. Fuck. Up. Especially GPs: you know less than anyone else.

So, once more: Shut. The. Fuck. Up.

I loathe doctors only slightly less than politicians: doctors are more corrupt but are, luckily for them, mildly more useful.

DK

hsld said...

I find it ironic that the medical profession are on the one hand worried about the effects of alcohol and smoking on foetuses ( foeti ? ) but on the other are perfectly happy to rip them out of the womb and kill them with an abortion.

DK - you won't truly hate doctors until the NHS has made repeated attempts on your life and failed.
Botched operations, lousy care, disgustingly filthy conditions, doctors who can't speak English and a temporary morphine addiction induced by a malfunctioning automatic drip.
All wrapped up with a holier than though attitude that my injuries were self inflicted because I chose to ride a motorbike.
There is a cliche about patients falling in love with their nurses. I would like to hunt the people who 'cared' for me down and extract their teeth with a pair of pliers.
In the end I got better by doing the exact opposite of what they told me to and the only way I'll ever go back to an NHS hospital is if I'm darted by a tranquiliser gun.

Leg-iron said...

Speaking as a likely product of one of those no-tailed ones...

My mother never smoked. Not one. She had me. She wasn't a pisshead either and has never taken any illegal substances. I was not swapped at birth, despite her efforts. I am the product of a non-smoking, occasionally pissed, never doped and married just in time mother.

My father's brother smokes like a factory with a deadline. So does his wife. Their three sons are fucking huge and fitter than a butcher's dog on steroids. Every one is self-employed in the building trade and all are in the 40% bracket.

Okay, it's smoking, not drinking, but it just goes to show one little detail.

We are not one homogeneous organism. We do not all react in exactly the same way to any 'health scare'.

People will not, never have, never will fit the 'expert' mould.

If the 'experts' ever move beyond their assertion that 'human' consists of one group, we might get somewhere.

I doubt it'll happen in my lifetime. Although nobody else need worry - at my rate of alcohol and tobacco consumption I technically died three years before I was born.

Anonymous said...

The problem here is not FAS, although admittedly it is very easy to attack pregnant women who are already feeling guilty (how dare they have the temerity to breed?) and vulnerable.

The real problem is the vast number of non-jobbers who make their living from haranguing and lecturing the rest of us. Money should be directed into rebuilding our industrial sector to give these career busybodies something real to do. Send the whole tedious pack of them down the pits, with only a pick and shovel.

Problem solved

Devil's Kitchen said...

hsld,

"DK - you won't truly hate doctors until the NHS has made repeated attempts on your life and failed."

That's why I have private health insurance: I don't intend to give the NHS the chance...

DK

the a&e charge nurse said...

I am amazed that such a trivial story has provoked this kind of outrage.

It wasn't that long ago that pregnancy and childbirth were fraught with danger [reflected in the horrendous obstetric mortality rates in the Victorian era, for example].

Since then doctors and midwives have dedicated time and energy to identify/minimise risk - their endevour has made birth a much safer event than it ever was before.

Like morphine, alcohol/ethanol is a drug that will quite happily cross the placental barrier - in small doses this is probably insignificant although some groups seem to lack enzymes for metabolising alcohol [I have no idea if these biological differences increase teratogenicity].
http://madminerva.blog-city.com/asian_alcohol_intolerance.htm

Maybe it's OK for a foetus to be mildly pissed, I'm not going to pronounce on it - I'll leave that for others to decide.

the a&e charge nurse said...

Devil - try presenting to a private provider after a motorbike crash.

I would be amazed if any of them admitted you directly [no matter how good your policy is].

Mitch said...

Drs eh study a very narrow discipline for 7 years and think they are god.Masters of the narrow is what they are experts in exclusion.
Nearly as bad as MPs who study shit for never then tell everyone how to live.

Devil's Kitchen said...

"Devil - try presenting to a private provider after a motorbike crash.

I would be amazed if any of them admitted you directly [no matter how good your policy is]."


Good point, A&E.

An ambulance will not deliver to a private provider, alas. My provider would, however, then transfer me -- in a private ambulance -- to a private hospital (assuming that I was stable enough).

DK

Henry Crun said...

"...avoid alcohol if pregnant or trying to conceive."

Bloody hell! Have you seen some of the women on our streets with their offspring?

It strikes me that alcohol was a neccessity in order for them to conceive. And lots of it.

the a&e charge nurse said...

Quite, Devil - but not only that, if you become very sick [yes, it does happen in the private sector, I'm afraid] they would probably ship you out again to an NHS ITU facility.

Stable patients with a single, well delineated problem undoubtably benefit from having a consultant [who often does most of his/her work in the NHS] hovering at the end of the bed each morning.
Another benefit, of course, is that you are free of the riff-raff the NHS is mandated to deal with, although a fair % of middle class punters can be equally objectionable, especially those that regard nursing staff as akin to some sort of house boy.

But factor in multiple pathologies [requiring renal, surgical, plastic opinions after poly-trauma, say] then the private hospital may not seem like such a great place to be, the transfer of such patients to the NHS is the usual outcome.

It goes without saying that if you develop complications after a procedure then the privates will not hesitate to send you to the NHS.
I have seen several cases of young women with deep infections, poor comsetic outcomes, etc who have ended up in A&E after bodged breast augmentation to cite just one problematic area.

Miss Snuffleupagus said...

Filthy
No, it wouldn't. But it might justify a campaign to get pregnant women to stop drinking altogether. You may in fact have an argument -but it would be even stronger if you had those stats.

DK
Why the anger against doctors? What have they done? Aren't they just working men like the rest of us? Anger against the NHS, I understand. But doctors?

Devil's Kitchen said...

Snuffy,

"Why the anger against doctors? What have they done? Aren't they just working men like the rest of us? Anger against the NHS, I understand. But doctors?"

I have no problem with doctors who shut the fuck up and get on with their very valuable job.

Doctors who try to get the gvernment to legislate on how we should live our lives, however, are just as bad as these scummy MPs.

One could argue that its often doctors groups like the BMA or the Edinburgh College of Surgeons who advocate this kind of crap...

However, any doctor who pays his BMA fees is effectively endorsing the leaders of said organisation so they all get it in the neck.

I mean, you had some medical bloggers ranting about how the BMA had sided with the government in the Remedy UK court case (over the MTAS, MMC scandal) who were, nevertheless, still paying their dues to the BMA.

Unlike the rest of us with politicians, doctors can choose not to pay their dues to what is, in effect, simply a very powerful union. That won't shut the fuck up.

DK

Miss Snuffleupagus said...

DK
Those of us who work for the state are necessarily implicated in this corruption, but we don't want to be. I'm guessing that most doctors rail against the NHS, as I do against state schooling.

I was a member of the NUT for years, in spite of hating them and everything they stood for. But that was because I had little choice. I had to be part of a union, just as doctors have to be part of a union and so you do it, in spite of your beliefs.

And some of us don't know any better. We do as we are told. And that isn't good, but that doesn't make us as scummy as MPs who are deliberately lying and corrupt.