Friday, June 13, 2008

Homebirth and the classic signs of quackery

Rory Coker, professor of physics and University of Texas Austin, has written a very informative article for the website Quackwatch. The article, Distinguishing Science from Pseudoscience, was not written with homebirth in mind, but accurately captures the essence of homebirth advocacy. Let's take a look at the criteria for pseudoscience and how homebirth advocacy meets virtually every criterion.

1. "Pseudoscience displays an indifference to facts.

Instead of bothering to consult reference works or investigating directly, its advocates simply spout bogus "facts" where needed. These fictions are often central to the pseudoscientist's argument and conclusions. Moreover, pseudoscientists rarely revise. The first edition of a pseudoscience book is almost always the last, even though the book remains in print for decades or even centuries..."

Homebirth advocates, both professional and amateur, routinely make up "facts" to suit themselves. For example, homebirth advocates routinely claim that the US does poorly on measures of obstetric care (false), that Cytotec was used "experimentally" for labor induction (false) or that homebirth is "as safe as life gets" (only if life is filled with easily preventable infant deaths).

Cory points out that pseudoscientists rarely revise their books even though new scientific studies are constantly published. Williams Obstetrics has been through 3 editions (20th, 21st and 22nd) since Henci Goer published "The Thinking Woman's Guide to a Better Birth" which represents itself as an analysis of the scientific evidence, yet she has not revised it.

2. "Pseudoscience begins with a hypothesis ... and then looks only for items which appear to support it.

Conflicting evidence is ignored... [T]he aim of pseudoscience is to rationalize strongly held beliefs, rather than to investigate or to test alternative possibilities. Pseudoscience specializes in jumping to "congenial conclusions," grinding ideological axes, appealing to preconceived ideas and to widespread misunderstandings."

Homebirth advocacy doesn't merely appeal to widespread misunderstandings, it actively seeks to create widespread misunderstanding. Hence the deliberate efforts to conflate homebirth midwives with nurse midwives or European midwives, the deliberate efforts to substitute infant mortality (a measure of pediatric care) for perinatal mortality (the best measure of obstetric care), and the faux shock over the use of "off-label" medication.

3. "Pseudoscience relies heavily on subjective validation.

Joe Blow puts jello on his head and his headache goes away. To pseudoscience, this means jello cures headaches... This phenomenon, called subjective validation, is one of the foundations of popular support for pseudoscience..."

Can you say "birth story"?

4. "Pseudoscience always avoids putting its claims to a meaningful test.

Pseudoscientists never carry out careful, methodical experiments themselves ... Pseudoscientists also never follow up. If one pseudoscientist claims to have done an experiment ... no other pseudoscientist ever tries to duplicate it or to check him,.. Further, where a pseudoscientist claims to have done an experiment with a remarkable result, he himself never repeats it to check his results and procedures..."

A corollary to this is also often found in homebirth advocacy, the claim that the authors "hasn't had time" to publish the results.

Professional homebirth advocates are also very careful never to appear in any venue where they could be questioned by scientific peers, yet they speak extensively at gatherings of laypeople.

5. "Pseudoscience often contradicts itself, even in its own terms.

Such logical contradictions are simply ignored or rationalized away..."

Childbirth is painless. Childbirth is very painful, but the pain can be managed with the right attitude. Not only is childbirth not painful, it is actually pleasurable. Homebirth advocates can't make up their minds which one of these claims is preferable.

6. "Pseudoscience deliberately creates mystery where none exists, by omitting crucial information and important details.

Anything can be made "mysterious" by omitting what is known about it or presenting completely imaginary details..."

Vaccine rejectionism relies very heavily on misrepresenting what vaccine rejectionists don't know as "unknown". Homebirth advocates prefer to claim that there is no scientific evidence for obstetrics practices when copious evidence exists and is easily accessible to anyone who bothers to look.

7. "Pseudoscience does not progress.

... within a given topic, no progress is made... New theories are seldom proposed, and old concepts are rarely modified or discarded in light of new "discoveries," since pseudoscience rarely makes new "discoveries." ... No natural phenomena or processes previously unknown to science have ever been discovered by pseudoscientists..."

Homebirth advocacy never changes. It always amounts to nothing more than rejection of conventional practice.

8. "Pseudoscience appeals to false authority, to emotion, sentiment, or distrust of established fact.

A high-school dropout is accepted as an expert on archaeology ... A psychoanalyst is accepted as an expert on all of human history, not to mention physics, astronomy, and mythology, even though his claims are inconsistent with everything known in all four fields..."

Henci Goer and Ina May Gaskin have no training in their supposed areas of "expertise". Marsden Wagner is a pediatrician and Michel Odent is a general surgeon, yet they are touted as experts on birth even though obstetricians disagree with them.

9. "Pseudoscience appeals to the truth-criteria of scientific methodology while simultaneously denying their validity.

Thus, a procedurally invalid experiment which seems to show that astrology works is advanced as "proof" that astrology is correct, while thousands of procedurally sound experiments that show it does not work are ignored..."

The homebirth version is to loudly and shrilly proclaim that recent evidence has shown that episiotomy does not prevent obstetric lacerations, while simultaneously ignoring established research that shows that vaginal breech increases neonatal death, postdates is associated with an increased risk of stillbirth or VBAC has a significant risk of catastrophic uterine rupture.

10. "Pseudoscientists often appeal to the ancient human habit of magical thinking.

Magic, sorcery, witchcraft—these are based on spurious similarity, false analogy, false cause-and-effect connections, etc. That is, inexplicable influences and connections between things are assumed from the beginning—not found by investigation."

For example, birth "affirmations" can purportedly influence whether a baby will be breech or will fit.

11. "Pseudoscience relies heavily on anachronistic thinking.

The older the idea, the more attractive it is to pseudoscience—it's the wisdom of the ancients!—especially if the idea is transparently wrong and has long been discarded by science..."

Homebirth advocates love to claim that homebirth is safe because it is ancient or that herbs are effective because primitive people used them, when homebirth was never safe and herbs are less effective (or ineffective) compared to medication.

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