[calibraxis]

Science vs. hysterical racism, yet again. There's a reason it's "crack baby", and not "cocaine baby". Helps imprison the right sort of person. (http://en.wikipedia.org/wiki/Fair_Sentencing_Act)

There's a much more dangerous drug than cocaine, for babies. (http://en.wikipedia.org/wiki/Prenatal_cocaine_exposure) It's alcohol, a legal drug. (https://en.wikipedia.org/wiki/Fetal_alcohol_syndrome)

[rayiner]

Alcohol isn't really that dangerous for babies either. The prevalence of fetal alcohol syndrome is less than 5% for babies of women who drink more than 14 drinks per week during pregnancy: http://www.motherisk.org/prof/updatesDetail.jsp?content_id=2.... There's very little evidence that low levels of alcohol consumption during pregnancy are bad for babies: http://www.time.com/time/nation/article/0,8599,2023984,00.ht.... Indeed, the available data shows the opposite: babies whose mothers drink lightly during pregnancy have better balance and higher IQs: http://www.cbsnews.com/8301-204_162-57589867/moderate-drinki.... This is largely due to maternal predisposition; higher-IQ women are more likely to drink during pregnancy.

It turns out that the placental barrier is pretty awesome.

[DanBC]

Go careful when recommending that pregnant women should drink, especially if you're quoting general media.

(http://www.nhs.uk/news/2012/06june/Pages/daily-drinking-preg...)

> “Pregnant women can binge drink safely,” according to a report in today’s Metro. Expectant mothers should be able to “down up to 12 alcoholic beverages a week knowing it will have no ill effect on their offspring before the age of five”, the paper continued. Reports in several other papers were in agreement, with the Daily Mail claiming that a drink a day would not harm the baby’s development and the Daily Express reporting that 12 drinks a week is safe in pregnancy. So should pregnant women heave a sigh of relief and down a large glass of Chardonnay? Unfortunately, no.

(http://www.nhs.uk/news/2013/06June/Pages/Misguided-claims-al...)

> “A glass of wine every day in pregnancy could be good for your baby,” is the entirely incorrect headline in The Daily Telegraph today. Other newspapers reported that drinking while pregnant does ‘no harm’, these claims are also misleading.

(http://www.nhs.uk/news/2012/11November/Pages/Just-one-glass-...)

> has not been made clear in many of the reports, the researchers were also looking at foetal and maternal variations in genes thought to affect the metabolism of alcohol (how long it takes for the body to break down alcohol). Researchers then looked at whether these variations had an impact on the children’s IQ at age eight.

This is UK media, so "one drink" is "one unit", and that means 125 ml of drink of 8% Alcohol by volume. One bottle of wine (750 ml) at 8% has 6 units. Chardonnay is usually about 12.5% ABV, so a bottle has about 9.5 units. One unit of a 12.5ABV chardonnay is going to be 80 ml of wine. This is important because no one ever pours themselves 80 ml of wine.

[smsm42]

>>> This is important because no one ever pours themselves 80 ml of wine.

Well, this is not completely correct - in wine tastings, for example, the recommended pouring usually is about 2 oz which is under 80 ml. Of course, tasting just once is another question that gets us back to the square one...

[DanBC]

You make an excellent point.

A wine tasting portion is a sip, that you slurp up and then spit out. No-one (I imagine) thinks of that portion as a real serving size!

[smsm42]

I never spit out when tasting wine, that seems pointless to me :) Then again, I'm not a professional or even in any manner advanced taster, I just do it for fun.

[7s]

Why would you do that, I never even heard of this before.

[enraged_camel]

>>Go careful when recommending that pregnant women should drink, especially if you're quoting general media.

I think there's quite a big difference between saying we have no evidence that alcohol consumption during pregnancy is unsafe, and recommending that pregnant women should drink.

[cleaver]

My understanding of the reason for total abstinence is while there may be a shoulder in the graph (eg. more than 5 drinks a week) beyond which FAS begins to take effect, nobody knows where that point is. It's not exactly the sort of thing you want to run a controlled test for.

It would be great if we could tell expecting mothers: "have two drinks a week, you'll be fine." We don't know, so "don't drink at all" is a reasonable statement.

[rayiner]

The studies have not proven that there is a level of alcohol consumption below which there are no negative effects, but they fail to demonstrate long-term negative effects from low levels of alcohol consumption.

Now, absence of proof is not proof of absence, but in what other contexts do we tell people: the studies don't show harmful effects at low levels, but you shouldn't do it anyway because the studies haven't proven there aren't harmful effects at low levels? That's not how we generally do things. We only say "no" when we have actual evidence that some activity is harmful.

The reason we do it is not because science demonstrates there is a danger. We do it because we as a society love to control women, their behavior and their bodies, and pregnancy offers a great opportunity to exert that control.

[yummyfajitas]

We only say "no" when we have actual evidence that some activity is harmful....We do it because we as a society love to control women, their behavior and their bodies, and pregnancy offers a great opportunity to exert that control.

This latter theory is a bit silly.

In fact, we say "no" to all sorts of things regardless of evidence that the activity is harmful. Examples include modafinil, steroids and various other brain and body enhancers. More commonplace examples include salt, fat, carbs, second hand smoke, marijuana, gluten and foods not present in the cave man era.

[rayiner]

I'm not familiar with the side effects of steroids, etc, but nobody tells pregnant women that they shouldn't eat any salt, any fat, any carbs, etc. Nobody freaked out at a restaurant when my wife ordered a nice ribeye or a piece of chocolate cake.

[yummyfajitas]

You miss the point. Without evidence, "they" tell everyone (pregnant or not, male or female) to avoid all sorts of things for imagined or minor harms.

And if you decided to light up and expose others to harmless secondhand smoke, "they" certainly would freak out.

[pyre]

  | We do it because we as a society love to
  | control women

This is a ridiculous claim. If anything erring on the side of caution and telling pregnant women not to drink alcohol falls under the "Think of the Children" banner. It's an effort to prevent babies from being born with issues, rather than some need to tell women to 'get back in the kitchen.'

[rayiner]

So my wife was a summer associate at a law firm while she was pregnant. The difference between having a drink with dinner and not drinking at all was the difference between being a regular summer associate, interviewing for a job, and "the pregnant one."

In our society, where drinking is an important social rite, not drinking makes you "the other" and we're tremendously eager to force women into that position based on little to no evidence that it actually has any impact on children at low levels. Even the justifications that are possible ("doctors say not to do it at all because women might drink too much") treat women like children instead of adults who are capable of evaluating truthful information from their doctors and reaching reasoned conclusions about their behavior.

[pdonis]

In our society, where drinking is an important social rite, not drinking makes you "the other"

IMO, the appropriate response to that is to fix our society's attitudes about drinking as a social rite, not to use it as an excuse for women to risk harm to their children.

That said, if the woman's job is what's going to support the child, that does add an element to the risk-benefit calculation.

[pyre]

  > Even the justifications that are possible
  > treat women like children

There are plenty of cases where social convention and/or the law treat adults like children. This, to me, seems like something that only happens to be aimed at women because they are the only ones that get pregnant. This doesn't seem like a social convention that is targeted explicitly at women because people believe that women have no self-control, and would do keg-stands while pregnant if we didn't hold them to task.

[saraid216]

Heh.

You don't think "Think of the Children" is part of the "Women need to be controlled" category? This is also where we get the notion that there is a magical mystical maternal mojo.

Women are resources, not players.

[pyre]

  > You don't think "Think of the Children" is
  > part of the "Women need to be controlled"
  > category?

Here are a few "Think of the Children" scenarios:

- Preventing child pornography

- Preventing child abuse

- Preventing children from hearing 'bad words'

- Stopping children from gaining access to violent video games

I fail to see how any of these is about 'controlling women.' I don't see how being generally concerned with the well-being of children (even if it's misguided) has anything to do with controlling women[1].

  > This is also where we get the notion that there is a
  > magical mystical maternal mojo.

How do we get this from "Think of the Children" + "Women Need to be Controlled?"

[1] I realize that some people's solutions to Think of the Children problems might involve 'controlling women,' but I fail to see how the entire "Think of the Children" category is a sub-category of "Women Need to be Controlled."

[sopooneo]

It could also be a matter of public health advocates being savvy about how their messages are received. If we say it's probably safe to drink d drinks per week, then some percentage p of the population will assume it's okay to drink x*d drinks per week and may harm their babies.

Also, simple rules are easy to state and simple to follow. The words "never" and "always" are very clear and leave no room for misinterpretation.

However, if any of my speculation is correct, and public health messages are tuned to account for their real world affect, than perhaps there is a risk that they will loose credibility.

[mhb]

Saying "never" without a reasonable basis is a great way to lose credibility.

[mpyne]

Sure, but "it would require a Ph.D. $3000 to estimate the amount you can safely drink over the course of a pregnancy, so the only accurate amount I can recommend that we know won't cause issues is 0" might actually be a reasonable basis.

[rdtsc]

> but in what other contexts do we tell people: the studies don't show harmful effects at low levels, but you shouldn't do it anyway because the studies haven't proven there aren't harmful effects at low levels?

Erm...in health and safety related contexts. At least in countries that care about those things. When it comes to someone's life isn't that hard to assume that if something is considered it could even be dangerous or not enough is known to advise staying away from it, rather than way and find out until experiments have shown otherwise.

Seems like a no brainier to me. To put it another way, if you are a parent, do you want your child or wife to participate in a study where she told to go ahead and drink 15 glasses of wine while pregnant so 20 year from then they can publish a paper on it.

To put it yet another way, each person has only one life and if they are told it is ok to consume a substance because there is not evidence it is harmful but then oops it turns out it is, they don't get a do over. It is not like buying a car someone saying, wash it with this new acid substance and it rusts and has to be replaced. You can replace a car, you can't replace your body.

Moreover. It is considered unlikely that alcohol will help in the pregnancy case. It seems at best it won't have any effect and at worst it will have a detrimental effect. Again, seems like a pretty good reason for the advice to stay away from it for 9 months.

> We do it because we as a society love to control women, their behavior and their bodies, and pregnancy offers a great opportunity to exert that control.

See now I don't know if you are serious or sarcastic. That is a pretty ridiculous argument. Sure go ahead and tell your wife, friends and family to drink so they can liberate themselves from the shackles of the Western Anglo-Saxon While Male Dominated Society

[mpyne]

> but in what other contexts do we tell people: the studies don't show harmful effects at low levels, but you shouldn't do it anyway because the studies haven't proven there aren't harmful effects at low levels.

A specific 'health and safety' context where this exact issue comes up is actually with ionizing radiation (such as from nuclear reactors).

Humans (like most animals) actually have a remarkable ability to overcome low levels of radiation damage, by means such as genetic repair, programmed apotosis (essentially ASSERT()s in your own genetic code), and even roving patrols by your immune system that catch pre-cancerous cells.

The problem is that it is difficult to determine whether there is a real low-dose threshold, below which people do not suffer appreciable increase in health risk from radiation. Also, whether that threshold depends on the person, depends on prior exposure, depends on type of dose received, a combination of the above, etc.

The evidence leans heavily to there being a threshold much higher than the levels of radiation we'd ever encounter in day-to-day life (and possibly even there being a beneficial effect to low levels of radiation).

But our radiation health physicists (and UN health organizations) have tended to take a very conservative view and simply recommend that people minimize radiation exposure, at least until there is enough evidence to make very clear what a safe threshold level is.

[sk5t]

> Erm...in health and safety related contexts.

Exactly. The rule is not "put on your seatbelt except when you don't plan to exceed 10mph and there are no obvious nearby hazards, or if the windows are open and you're near a body of water," the rule is "always wear a seat belt."

If American society would tolerate it, surely we'd have anti-drunk driving laws that allowed no higher BAC than naturally occurs due to metabolism.

[cwp]

Perhaps... but as a society, we also love to freak out about danger to children. The younger the child and the less-well-defined the risk, the better. FAS presses all the right buttons.

[pdonis]

in what other contexts do we tell people: the studies don't show harmful effects at low levels, but you shouldn't do it anyway because the studies haven't proven there aren't harmful effects at low levels?

In contexts where the effects aren't suffered by the person making the choice, but by someone else that's at their mercy--in this case, the child. Making decisions about one's own risk is very different from making decisions about someone else's; the latter involves a much greater responsibility to avoid possible harm.

[pdonis]

Alcohol isn't really that dangerous for babies either.

So you're basically saying that it's OK to roll the dice with a child, since after all it's only a 20-sided die? That a mother's temporary gratification is more important than a 5% chance of your child suffering damage?

[gd1]

He said it was 5% for mothers that have 14 drinks per week or more. It will be much less (if not zero) for someone who has 2-3 drinks a week, which is his point.

[saalweachter]

I'm not informed on this topic but I'd like to point out that "14 drinks per week" is "two glasses of wine per day", which sounds like a lot less. You're not getting smashed or even buzzed on a couple of glasses of wine with dinner.

[rayiner]

10+% of women self-report as binge drinking during the first trimester, and the FAS rate is only about 0.05-0.2%: http://fasdcenter.samhsa.gov/documents/WYNK_Numbers.pdf.

[tptacek]

What does fetal alcohol syndrome have to do with intoxication?

[pbhjpbhj]

From the UK drinkaware campaign website (government campaign), http://www.drinkaware.co.uk/check-the-facts/health-effects-o...:

>"The government advises that people should not regularly drink more than the daily unit guidelines of [...] and 2-3 units of alcohol for women (equivalent to a 13% ABV 175 ml glass of wine). ‘Regularly’ means drinking every day or most days of the week."

[175ml is about ¾ cup (USA) and the units above are about equivalent to a single pint of 4% beer]

FWIW If I have 2 glasses of wine I'll be "buzzed" because I don't drink every day. Take a month off from drinking, try two normal glasses (ie not pub measures) and you'll notice.

[DanBC]

Your phrasing is frustratingly confrontational.

For example:

So you're saying that it's OK to roll the dice with a child, since after all it's only a 20-sided die? That forcing a mother to restrict all alcohol, and thus suffer stress (which we know to be harmful to the child) is more important than an unknown chance of the child suffering damage from alcohol?

[pdonis]

Your phrasing is frustratingly confrontational.

So was the phrasing of the post I responded to. He didn't even raise the question of whether the mother's drinking might have benefits (such as the one you cite) which might outweigh the risk the alcohol poses to the child. He just said, "oh, it's not really all that dangerous". That, IMO, is not a justifiable mindset for a parent.

If there is no compensating benefit, then IMO a parent should not incur any avoidable risk to a child. There must always be a reason for incurring the risk, and it must be a stronger reason than "well, I like drinking". If the mother's stress level would really be increased that much by not drinking, then that could be a valid reason. (Though I would tend to be skeptical of such a claim; is abstaining from alcohol, for a person who is not an alcoholic, really that hard, hard enough to outweigh the risk to the child's health?)

[DanBC]

> If there is no compensating benefit, then IMO a parent should not incur any avoidable risk to a child.

Wait, what? Are you actually serious? Not joking? I'm sorry to ask but I have a problem understanding people and I can never tell when people are pulling my leg or not. I almost never spot satire. So, if you're engaging in some devastatingly witty attack on something or other then I'm afraid it's gone right over my head.

> There must always be a reason for incurring the risk, and it must be a stronger reason than "well, I like drinking". If the mother's stress level would really be increased that much by not drinking, then that could be a valid reason.

We don't know if a pregnant woman drinking a couple of units a week is doing any harm to her child. Thus, the advice is to avoid all alcohol. But this has some disadvantages. It makes people ignore much clearer health advice. (This thread has someone suggesting that the drinking advice is similar to the smoking advice, as an example.) It also causes a great deal of stress to women. Some women may drink their regular amounts and then be very distressed when they discover that they are pregnant and have been drinking during the pregnancy. For most women the stress they experience is more harmful than the alcohol.

> (Though I would tend to be skeptical of such a claim; is abstaining from alcohol, for a person who is not an alcoholic, really that hard, hard enough to outweigh the risk to the child's health?)

Wow. That sentence bundles up so many misunderstandings of pregnancy and societal pressures and all kinds of stuff. It's too hard to respond to.

> There must always be a reason for incurring the risk

I'm quoting this part again because it's the core of your message, and it's very very wrong.

You assume that we know what the risks are, and that we can communicate those risks to pregnant women, and that they have power to control the risks they're exposed to.

Women undergo a bunch of prenatal checks. To get to those checks they have to use some form of transport. Are the risks of travel outweighed by the benefits of the prenatal checks?

What about different types of scans? There's no point in the 3d / 4d scans, and there's a possible risk of harm, so should the scans be banned? Or should we tell women not to get them? And who should we be criticising, the firms making money by pushing a possibly harmful but pointless scan to vulnerable women, or the women who get these scans?

(http://www.nhs.uk/news/2010/02February/Pages/Warning-over-so...)

[pdonis]

Are you actually serious? Not joking?

No, I'm not joking. Evidently I have a very different take on this subject than you do.

We don't know if a pregnant woman drinking a couple of units a week is doing any harm to her child. Thus, the advice is to avoid all alcohol.

Yes; we don't know if it will cause harm, and it's avoidable--at least, that's the assumption underlying the advice.

It makes people ignore much clearer health advice. (This thread has someone suggesting that the drinking advice is similar to the smoking advice, as an example.)

So you're saying that, if we tell a person that drinking might harm her child, and smoking might harm her child, she'll ignore the smoking advice because she doesn't agree with the drinking advice; but if we don't tell her that the drinking might be harmful, she'll be more likely to listen when we tell her that the smoking is harmful? (I haven't seen the subthread you're referring to, so I'm not sure exactly what the argument is.)

I see several problems with this argument. First, many (I would say most) people can drink in moderation without becoming addicted, and can stop drinking, if given a good reason, without suffering significant harm. That's not true of smoking; I'm not aware of any significant number of people who can smoke in moderation without becoming addicted, or who can stop, if they choose, without suffering significant harm in the short term. If a person is a regular smoker, quitting smoking is going to put them under severe stress. Obviously that changes the risk-benefit calculation, but the fact that such a calculation might apply to an addict doesn't mean it applies to a non-addict.

Second, given the overwhelming evidence about the health risks of smoking, a person who has chosen to smoke has already decided to ignore a lot of potential risk. I don't think such a person will be easily convinced to change that behavior if they become pregnant (and, as I said above, it will be very hard and stressful for them to change it even if they try to).

Third, you're basically saying we should hide facts from people because we don't think they will make wise use of the information. I'll comment on that further below.

It also causes a great deal of stress to women. Some women may drink their regular amounts and then be very distressed when they discover that they are pregnant and have been drinking during the pregnancy. For most women the stress they experience is more harmful than the alcohol.

I'm not sure I understand this argument. As you're presenting the situation, it doesn't seem like the choice is between drinking and less stress, vs. not drinking and more stress. The drinking is the cause of the stress: the woman is worried that she might be harming her child. The rational response to that is for her to stop drinking, not to try to convince herself that the drinking doesn't really incur any risk to her child so she won't stress about it.

As for discovering you're pregnant and worrying about the fact that you've been drinking, if you're that worried about the risk of drinking to your child, why wouldn't you stop drinking if you are engaging in activities that might get you pregnant, just to be safe?

You assume that we know what the risks are, and that we can communicate those risks to pregnant women, and that they have power to control the risks they're exposed to.

We do know that alcohol poses some risk to a developing fetus. That's all I was assuming.

I don't understand the problem with communicating the risk; there are plenty of links in this thread to sources that give information about it, so the information that alcohol poses some risk to a developing fetus is out there.

As for women having the power to control the risks they're exposed to, sure, nobody can control all the risks they're exposed to, but that's why I specified "avoidable" risks in the post you responded to. Consumption of alcohol strikes me as a risk that is quite controllable and avoidable.

Women undergo a bunch of prenatal checks. To get to those checks they have to use some form of transport. Are the risks of travel outweighed by the benefits of the prenatal checks?

It depends on the relative risk vs. benefit. See further comments below.

There's no point in the 3d / 4d scans, and there's a possible risk of harm, so should the scans be banned? Or should we tell women not to get them?

No, and no. We should make sure that accurate information about the risks and benefits is available, and let women make their own decisions.

And who should we be criticising, the firms making money by pushing a possibly harmful but pointless scan to vulnerable women, or the women who get these scans?

If the scans really are pointless but carry a risk of harm, then the firm deserves criticism. If the women decide to get a scan that they know is pointless (or that the best evidence available to them says is pointless) but carries a risk of harm, then they deserve criticism.

It seems to me that we have a fundamentally different view of how this process is supposed to work. You seem to be assuming that there is some central authority that needs to decide what information to release and to whom. I see this as a bunch of individual actors, each of whom has a responsibility to provide accurate information and to make reasonable decisions based on the information they have.

[raverbashing]

You're presenting facts, the "total abstinence" people don't like that.

I find it funny how the "total abstinence" people come up with such amount of unproven facts, like "any consumption of alcohol" will cause harm. You'll be hard pressed to find a mother that hasn't consumed any alcohol whatsoever during pregnancy in Europe.

This looks like it works as well as the "total abstinence" for sex works.

[dalke]

Can you really speak with such authority about all of Europe?

In Sweden, where I live, alcohol and pregnancy are not suppose to mix. For example, translating from http://www.vardguiden.se/Tema/Gravid/Livsstilsfragor/Alkohol... : "Since no one knows where the border lies, the recommendations in Sweden and many other countries are to not drink alcohol at all during pregnancy."

Or translating from http://www.lakartidningen.se/07engine.php?articleId=12235: "It's been known for a long time that alcohol consumption during pregnancy can damage the fetus, and most women also stop drinking alcohol when they discover that they are pregnant."

I'm lead to believe that the other Nordic countries are similar.

[raverbashing]

You're right, that's the recommendation

But about this I'm not so sure: "most women also stop drinking alcohol when they discover that they are pregnant."

[dalke]

Just like I and others are "not so sure" about your original statement.

Again I ask, how well can you claim to speak for the entirety of Europe? My observation is that Nordic women abstain from drinking during pregnancy at least as often as women who are native born to the US.

What would you accept as evidence that your original statement is incorrect? Perhaps the journal article "Alcohol consumption among pregnant women in a Swedish sample and its effects on the newborn outcomes", which finds: "Before pregnancy, 89% of the women regularly consumed alcohol and 49% reported occasional or frequent binge drinking. Nicotine was used by 15% before and by 5% during pregnancy. During pregnancy, 12% continued using alcohol and 5% also admitted binge drinking." ?

Compare this to the statement in "FOCUS ON: Biomarkers Of Fetal Alcohol Exposure And Fetal Alcohol Effects", which says that "roughly one of every eight women in the United States continues to drink during her pregnancy". 16% is higher than 12%, though I don't know the error bars to tell if that's significant.

If you don't like self-reported tests, then perhaps "Measurement of direct ethanol metabolites suggests higher rate of alcohol use among pregnant women than found with the AUDIT—a pilot study in a population-based sample of Swedish women" is useful. It concludes "Twenty-six women (25.2%) were identified as possible alcohol consumers by the combined use of AUDIT and direct ethanol metabolites."? (Note though that hair cosmetics and other things can cause false positives in a direct metabolites test.)

I interpret this to mean that 75% of Swedish women certainly do not drink alcohol while pregnant.

In other words, it's very easy in Sweden to find women who don't drink while pregnant.

Then for Germany, in "Smoking, alcohol and caffeine consumption of mothers before, during and after pregnancy--results of the study 'breast-feeding habits in Bavaria" the researchers report "25.3% of the mothers reported any alcohol consumption during pregnancy, 69.0% of pregnant women were drinking caffeine-containing beverages. The consumption rates were reduced clearly during pregnancy."

And for France, in "Is pregnancy the time to change alcohol consumption habits in France?" reports that "A total of 52.2% of women indicated that they had consumed alcohol at least once during their pregnancy".

Why did you make such a large, encompassing statement about all of Europe, when (1) there is such a variable rate, depending on the country, and (2) it looks like better than even odds that a 'European' woman does not drink once she knows she's pregnant.

[polymatter]

I agree with your broad argument, but it isn't clear to me if you are referencing actual studies. If you are, please at least state how you are finding them and/or the journals in which they are published so that others can do so too.

[bjourne]

You're just wrong. Of the Swedish mothers I know, they all stopped drinking when they became aware of their pregnancy. Any mother who didn't would be seen as a skank and probably would even be denied wine if she ordered it at restaurants. The general sentiment is that drinking/smoking/drugging pregnant women are trash.

[Flimm]

This is exactly the kind of comment I wish I could downvote:

"You're presenting facts, {position X} people don't like that."

"I find it funny how {position X} people come up with such amount of unproven facts, such as {exaggerated position X straw man}. You'll be hard pressed to find {an anecdote that supposedly confirms position X}."

"This looks like it works as well as {position Y}."

[brazzy]

>You'll be hard pressed to find a mother that hasn't consumed any alcohol whatsoever during pregnancy in Europe.

You are very, very wrong about this.

[raverbashing]

Yes, I said it wrong.

What I should have said is this: It's trivial to find a woman that has consumed alcohol during pregnancy

Especially in the cases of older woman (whose sons and daughters are adults now)

[pbhjpbhj]

>You'll be hard pressed to find a mother that hasn't consumed any alcohol whatsoever during pregnancy in Europe. //

Amongst most groups I know of, working class and lower-middle, a female refusing an alcolholic drink [at a party] is a sign that you think you're pregnant.

Total abstinence for the entire pregnancy? Wouldn't expect a huge proportion but as a comparison to normal intake it's going to look a lot more like marked abstemiousness than anything else. I think my wife probably had 1 or 2 glasses across each of her pregnancies.

>This looks like it works as well as the "total abstinence" for sex works. //

What are you trying to say here. That abstinence from sexual interaction doesn't prevent conception or transmission of STIs. Or maybe that abstinence from alcohol in pregnancy doesn't stop fetal alcohol syndrome. ?

[mistermann]

Same with smoking. If someone sees a pregnant woman smoking, they lose their mind. I don't know the stats, but I know a lot of people walking around today were born to smoking mothers. Prior to 1980 or so, whenever the media campaign began, massive numbers of people smoked, including pregnant women who didn't know any better.

[DanBC]

tobacco use and alcohol use are very different. We don't know if there's a safe level of alcohol, and we do know that it varies between different women.

We do know that any level of tobacco use is harmful to the mother and harmful to the child.

Please don't conflate the two.

> Prior to 1980 or so, whenever the media campaign began, massive numbers of people smoked, including pregnant women who didn't know any better.

You're ignoring all the people who were harmed by those smoking parents.

[mistermann]

> We do know that any level of tobacco use is harmful to the mother and harmful to the child.

Every child born to a smoking mother is "harmed"? Depends on the definition of "harmed" I suppose.

[cleaver]

You could replace "in Europe" with "40 years ago", perhaps. Maybe not "hard pressed", but alcohol consumption certainly was pretty common.

[epsylon]

> This is largely due to maternal predisposition; higher-IQ women are more likely to drink during pregnancy.

There is quite a huge deal of controversy around the heritability of IQ.

If anything, the story in this article shows that IQ is much more influenced by the environment than genetics.

[Spooky23]

My dad worked in an environment heavily impacted by the crack epidemic. It was real, and the hysteria was based on the horrific situations that that existed.

Smugly determining that "crack baby" was some racist code word cooked up to imprison black people is missing the point. Crack lowered the price point of cocaine dramatically, and was devastating to inner city communities.

You should note who the study didn't look at -- premature babies or the rates of premature delivery of crack abusers vs the average.

[rpedroso]

As the article notes:

Hurt's study enrolled only full-term babies so the possible effects of prematurity did not skew the results.

Nonetheless the head of the study does note that crack cocaine can induce premature labor, among other issues:

Hurt, who is also a professor of pediatrics at the University of Pennsylvania, is always quick to point out that cocaine can have devastating effects on pregnancy. The drug can cause a problematic rise in a pregnant woman's blood pressure, trigger premature labor, and may be linked to a dangerous condition in which the placenta tears away from the uterine wall. Babies born prematurely, no matter the cause, are at risk for a host of medical and developmental problems. On top of that, a parent's drug use can create a chaotic home life for a child.

I think the OP's point is that some (political) groups attribute minority group failure to advance socioeconomically to drug use, whereas this study suggests that poverty has a very relevant effect on child development (and thus prospects of long-term economic success).

That's not to say that there is no truth to the "crack baby" myth, but that like the "welfare queen" myth, it is part of a strategy to delegitimize welfare programs or socioeconomic criticisms by blaming the low-income groups for their lack of success.

[tome]

Why is crack cheaper? Google and Wikipedia are quite unhelpful on this question.

[geoffw8]

I can't speak with any real authority, but I would suggest its down to the fact crack is cocaine mixed with further agents, allowing there to be a higher yield from the same amount of cocaine.

You'd have to also consider whether smoking the drug is more intense than sniffing, which would possibly compensate for the fact theres less cocaine.

Not a source per se, but some interesting info here on consumption methods: http://learn.genetics.utah.edu/content/addiction/drugs/deliv...

[shmageggy]

This paper [1] backs up your hypothesis. "First, crack can be smoked, which is an extremely effective means of delivering the drug psychopharmacologically. Second, because crack is composed primarily of air and baking soda, it is possible to sell in small units containing fractions of a gram of pure cocaine, opening up the market to consumers wishing to spend $10 at a time. Third, because the drug is extremely addictive and the high that comes from taking the drug is so short-lived, crack quickly generated a large following of users wishing to purchase at high rates of frequency."

This DEA History Book [2], however, suggests the reasons might be partially economic. "Soon there was a huge glut of cocaine powder in these islands which caused the price to drop by as much as 80 percent."

[1] http://scholar.harvard.edu/files/fryer/files/fhlm_crack_coca... [2] http://archive.is/1wF5

[acjohnson55]

For some anecdotal answers: http://answers.yahoo.com/question/index?qid=20090531181900AA...

[JulianMorrison]

Who're you going to believe, a randomized controlled trial or your own lying eyes?

Hint: if you believe your own eyes, your sample size is one, confirmation bias and the availability heuristic are dancing the cha-cha all over your results, and you fail at science.

[clavalle]

Having worked with a slew of severely developmentally delayed crack babies and alcohol syndrome kids, I am going to have to go with my own eyes.

This study did not include pre-term crack babies. That is a selection method that is going to skew heavily towards 'light' crack users.

Crack or cocaine is very, very bad for development. It can create a child that literally cannot do anything for themselves and some that live in excruciating pain every single day of their lives (that is the very dark side of having such advanced neo-natal care).

Fetal alcohol syndrome is just as bad if not worse.

It is irresponsible to suggest otherwise. The fact that astute HN readers are looking at this and saying "See, it is overblown!" is very scary. That means the broader population reading this article is likely to do the same thing.

The writer of this article owes it to society to be very clear about the limitations and biases of this study.

[fnordfnordfnord]

>This study did not include pre-term crack babies.

It is entirely reasonable to select only full-term babies for the study. Including pre-term babies makes analysis more complicated.

>That is a selection method that is going to skew heavily towards 'light' crack users.

Do you have some basis for that conclusion? It sounds reasonable (if beside the point), but are we working off of the folklore or facts?

>Crack or cocaine is very, very bad for development.

Did you read the article? They concluded after a long and careful study that poverty had a much bigger effect than cocaine use.

>It can create a child that literally cannot do anything for themselves and some that live in excruciating pain every single day of their lives (that is the very dark side of having such advanced neo-natal care).

Did you know that the NY Times and others recently recanted much of their sensationalist reporting of the "Crack Epidemic" http://retroreport.org/crack-babies-a-tale-from-the-drug-war...

http://www.nytimes.com/2013/05/20/booming/revisiting-the-cra...

>Fetal alcohol syndrome is just as bad if not worse.

FAS probably is worse. If my recollection is correct, one needs to do a lot of binge drinking during the first trimester.

>It is irresponsible to suggest otherwise.

You mean it is irresponsible to disagree with you? No, skepticism and critical analysis are never irresponsible. It is irresponsible to falsely assign a cause to some phenomena or event, and set about treating that cause without ever checking to see if what you're doing is actually helping.

>The fact that astute HN readers are looking at this and saying "See, it is overblown!" is very scary.

No, it isn't. It means that people are reading and thinking instead of reacting to headlines and summaries.

>That means the broader population reading this article is likely to do the same thing.

What's your basis for that assumption?

>The writer of this article owes it to society to be very clear about the limitations and biases of this study.

The study was narrow in scope in order to obtain a clear and concise conclusion.

Note before you jump to a conclusion about the HN general consensus on in-utero cocaine exposure, is that nobody here has come out in support of it. Rather, at least my take on it (judging by a casual perusal of this paper) is that efforts to reduce infant mortality and morbidity, and developmental defects in early childhood by combating drug-use were misguided; and going forward those efforts should be focused on learning about and mitigating whatever the effects of impoverishment are.

[foobarbazqux]

Crack can trigger premature labor, as noted in the study. The hypothesis here is that more crack increases the risk of premature labor. It's a hypothesis that might be worth investigating, and I would be surprised if there was no effect observed. As to the extent obviously I cannot say.

[fnordfnordfnord]

> It's a hypothesis that might be worth investigating,

I don't disagree with that and I wouldn't be surprised to learn that such a study already exists.

>I would be surprised if there was no effect observed.

There are a lot of things that can cause premature labor. My personal opinion is that it is just as likely to be some stress otherwise related to their environment, or even stress related to the process of obtaining illegal drugs.

[clavalle]

But premature crack-babies have health problems beyond being merely premature.

[clavalle]

>>This study did not include pre-term crack babies. >It is entirely reasonable to select only full-term babies for the study.

Premature babies account for between 1/5 and 1/4 of all births to crack using mothers. If you decide to ignore those in your study because you want to study something specific then you should make it very, very clear. And anyone reporting on it should make it clear as well. It is like studying coal miners, but only the ones that work in the preparation plant on the surface.

>>Crack or cocaine is very, very bad for development. >Did you read the article? They concluded after a long and careful study that poverty had a much bigger effect than cocaine use.

Yes. For this particularly culled population.

>Did you know that the NY Times and others recently recanted much of their sensationalist reporting of the "Crack Epidemic"

I don't know how that is relevant. I am basing my position on personal experience working with these kids.

>No, it isn't. It means that people are reading and thinking instead of reacting to headlines and summaries.

Frankly, just the opposite. Many, many people in this thread, including yourself, are reacting to this particular headline and summary.

>>That means the broader population reading this article is likely to do the same thing. >What's your basis for that assumption?

Induction. It may be unfounded, but if relatively smart people make a bad leap of logic it is not unreasonable to imagine that less intelligent people will make the same mistake.

>efforts to reduce infant mortality and morbidity, and developmental defects in early childhood by combating drug-use were misguided; and going forward those efforts should be focused on learning about and mitigating whatever the effects of impoverishment are.

>efforts to reduce infant mortality and morbidity, and developmental defects in early childhood by combating drug-use were misguided;

No, they weren't. Cocaine use does lead to disabled children, statistically speaking. Many of whom are premature. This was a study has no information on the amount of cocaine used throughout pregnancy, only that the mothers and children tested positive at the time of full-term birth.

All we can conclude from this study is that poverty is worse for kids than cocaine exposure near the time of full-term birth. It has no information for the 1/4 to 1/5 of the kids that are born to people that test positive for cocaine that are born prematurely and tend to have much more severe health and developmental problems. Not to mention the ones that don't make it to birth at all.

[fnordfnordfnord]

>If you decide to ignore those in your study because you want to study something specific then you should make it very, very clear.

There are a lot of things researchers want. They write grant proposals to study things which they can, at the beginning of the study demonstrate the possibility of obtaining a useful unambiguous conclusion. I don't get the impression that the researchers misrepresented their study. Is that what you're alleging?

>>Did you know that the NY Times and others recently recanted much of their sensationalist reporting of the "Crack Epidemic" >I don't know how that is relevant. I am basing my position on personal experience working with these kids.

Does your personal experience involve having read news articles like the one we're discussing, or watching television news covering the subject?

>>efforts to reduce infant mortality and morbidity, and developmental defects in early childhood by combating drug-use were misguided; >No, they weren't. Cocaine use does lead to disabled children,

If you have finite resources n to spend fixing problem p and you have been using solution x which after some time appears to have negligible effect, would you continue x, or consider looking for another solution?

>No, they weren't. Cocaine use does lead to disabled children, statistically speaking.

Where are the statistics? The news article is reporting a study that does not, or only barely supports that conclusion, suggesting that the Cocaine use may be merely incidental, and not causal.

>Many of whom are premature.

From the article:

  >Babies born prematurely, no matter the cause, are at risk for a host of medical and developmental problems.

>This was a study has no information on the amount of cocaine used throughout pregnancy,

Is it even possible to conduct such a study? It would likely require clinicians to closely supervise pregnant women while the women were using illegal drugs.

>All we can conclude from this study is that poverty is worse for kids than cocaine exposure near the time of full-term birth. It has no information for the 1/4 to 1/5 of the kids that are born to people that test positive for cocaine that are born prematurely and tend to have much more severe health and developmental problems. Not to mention the ones that don't make it to birth at all.

What is your hypothesis for how the effects of poverty would be negated for the cohort/time period you're interested in?

[smsm42]

Heavy crack users would have, I presume, a wide array of other problems, from bad nutrition to bad living conditions to physical abuse to child neglect. So singling out one chemical and attributing a problem of a life in complete disarray to it seems wrong, especially if statistics suggest otherwise. Unless you are looking for an easy political fix - we'd just eliminate crack and all problems would go away! But then it turns out chemical is not a problem, the life that makes using the chemical an attractive option is.

[JulianMorrison]

fnordfnordfnord is right. I'll add: the article strongly implies that you were working with babies born into poverty, misdiagnosed and stigmatised as crack/alcohol babies.

You saw the outcome; you failed to adequately question the etiology. Those babies now have a mental label in your memory, "crack babies", which you use to reason from. But the label itself is incorrect.

[clavalle]

A million times, no.

Fetal Alcohol Syndrome has some very recognizable symptoms that have nothing to do with being born into poverty. A very specific skull shape for the worst cases, for one.

Crack babies not included in this study, the ones that are premature (20 something percent of crack user births fall into this category compared to 3-4% of births in general), also have very characteristic physical problems.

It is not poverty or malnutrition or stress that comes from poverty causing these very specific families of disorders. The crack kids are not coming from poor rural areas. They are coming from the inner city from crack using mothers.

[marshray]

> Having worked with a slew of severely developmentally delayed crack babies and alcohol syndrome kids, I am going to have to go with my own eyes.

How many healthy kids born to crack-using mothers and severely messed up kids born to non-crack-using mothers did you work with to make a basis for comparison?

[kevinskii]

You fail at reading comprehension. The OP isn't trying to dispute the study with anecdotal evidence. He's simply suggesting that even though premature birth wasn't a consideration in this particular study, it nonetheless is an important factor when considering the broader effects of crack cocaine use. You can agree or disagree, but you may want to be a bit less smug when you do.

[JabavuAdams]

Wrong, but funny.

[lisper]

> Helps imprison the right sort of person.

While I agree with the general sentiment, it is worth noting that the original law that created the sentencing disparities between crack and powder cocaine, the anti-druge abuse act of 1986, was supported by the congressional black caucus [1] because crack was such a serious problem in the black community at the time. So it was not a case of white people conspiring to put black people in prison, it was black people trying to impose prohibition on themselves, which of course backfired badly as prohibition always does.

[1] http://en.wikipedia.org/wiki/Race_and_the_War_on_Drugs

[smoyer]

My wife was a early-childhood development specialist at our local Easter Seals and the kids with Fetal Alcohol Syndrome were very sad. It's totally preventable, and the lack of understanding of consequences is devastating.

[klawed]

>It's totally preventable, and the lack of understanding of consequences is devastating. While the behavior that causes FAS is easy to stop for most women, for some segment of the population (those who are addicted to alcohol) it is seemingly impossible to eliminate or moderate alcohol consumption for even 1 week, let alone 9 months. The success of preventing FAS should correlate directly to advances in treating alcohol addiction.

[bittired]

Agreed. Don't drink too much when pregnant. But, a short glass of wine once a week or so isn't excessive.

[JshWright]

A glass of wine a _day_ wouldn't be excessive.

[colomon]

In 1970, a glass of wine a day was what the doctor suggested my mother should drink during her pregnancy.

[pbhjpbhj]

A glass of wine a day, normal home glass rather than a pub glass, may be more than the UK recommended allowance for a female.

[Alex3917]

Caffeine is actually much more dangerous for babies than either crack or alcohol. After caffeine the second highest drug-related risk factor may actually be not smoking weed; that is, mothers who don't smoke enough weed during pregnancy may have a much higher rate of infant mortality:

http://pediatrics.aappublications.org/content/100/1/79

[Killah911]

> mothers who don't smoke enough weed

I don't see any part where the talk about the "amount" of drugs consumed?

There were rougly 1600+ babies who were used as control and ~338 who tested positive for "weed". Some of the things that aren't broken down is the distribution for infant mortality. Perhaps there were outliers in the control group such as premature babies, which, if taken into account might explain some of the differences in mortality rates.

Very funny though, with actual data to back up some part of your claim, made me think... :)

[Alex3917]

> I don't see any part where the talk about the "amount" of drugs consumed?

What I meant is that if cannabis does confer some sort of protective benefit, then by definition the benefits would have to come from use that was above some minimum level, and perhaps also below some maximum level.

[thundara]

FTA

> Mortality rates between the drug-positive group or specifically, the cocaine-positive, morphine-positive, or cannabinoid-positive groups were not significantly different from the drug-negative groups (P < .3)

A number of 8.9 to 15.7 deaths per 1k live births doesn't necessarily imply a protective factor, especially when considering all the variable factors and a much smaller sample size compared to the drug negative group.

Also, caffeine isn't mentioned once on there, sure you don't mean cocaine?

[flexie]

Of the 110 "crack babies" followed for 25 years, only 12 finished college or were on track to finish college, while 2 were shot dead. So it's only 6 times more likely for inner city kids to graduate from college than to get shot to death?

[thejsjunky]

Keep in mind this is Philadelphia, which although it's improving has historically had a pretty high level of gun violence and homicide. It's usually not the worst city in this regard (New Orleans or Detroit has had that distinction lately) but it's generally the worst among the large cities; for comparison in 2010 Philly had several times more homicides per 100,000 people than NYC (19.6 vs 6.4), and beat out Chicago (15.2) by a few points.

Probably more importantly these are not just "inner city kids". Nearly all of them are African American which means they are less likely to enroll in/graduate college overall; and they are all the children of parents who were addicted to crack at some point (and probably continued to struggle with it). That puts them at even more of a disadvantage.

[KMag]

If you're poor, and especially if you're poor and have the "wrong" skin color, people don't expect you to get a college degree, so people don't push you to succeed. It was always an unspoken assumption that I would graduate from college, and people around me set up my life that way.

Yes, the homicide rate is high, but I find the low college graduation rate more disturbing.

On a side note: shot, stabbed, or strangled doesn't make much difference to the homicide victim or their loved ones. Hopefully you'd have the same reaction if two of them were stabbed to death.

[randomdata]

> I find the low college graduation rate more disturbing.

I was thinking it is rather high, all things considered. The statistical norm would expect only about 25 people to graduate out of that group. It would be interesting to compare against people in similar situations, but without the crack influence. I expect that the attainment rate will be similar.

[newnewnew]

Is your hypothesis that people with an IQ of 79 could largely obtain meaningful college degrees if only given the proper encouragement?

[flexie]

Any kind of murder is terrible. 2/110 is an extremely high murder rate. I realise the sample is not representative, but still...

[notdrunkatall]

>people don't expect you to get a college degree, so people don't push you to succeed.

Is 'people' a euphemism for 'parents?'

[randomdata]

I'm not the previous poster, and my experience is the exact opposite, but I don't think so. My parents gave me the least amount of pressure to go to college of anyone. Teachers, peers, and other people of the community were much more adamant about it. I even remember a few people lecturing my parents, not even me directly, over the importance of me going to college.

Not all communities, especially those on the poorer side, are like that at all. Education is even demonized in some locations. Parents are just a small part of the social attitudes towards such ventures.

[JabavuAdams]

I doubt it. Friends are very influential. I'm not sure about this, but I assume everyone in my high-school class went on to some kind of post-secondary education within the next few years. I would have felt very strange to not go to university. Everyone's doing it, y'know?

[newnewnew]

The children had an average IQ of 79. Most people with that IQ are going to struggle mightily to attend college, let alone graduate.

[pessimizer]

More like science as hysterical racism. The "crack baby" mark was created by a bunch of terrible studies in the 80s, and seized on as convenient by a lot of terrible people. This is simply the last of a large number of studies that have found no relationship, all of which occurred well after the time when the term was useful to those terrible people.

This is science correcting itself after power has ceased to care what position science takes on the existence of the crack baby.