[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.

[foobarbazqux]

My guess is that if we controlled for environmental and purchasing stress, more crack use alone would lead to more stress, possibly in a dramatic way depending on the levels.

[clavalle]

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

[foobarbazqux]

Yes, a related hypothesis is that more crack results in more health problems for a baby. If both are true, then by excluding pre-term babies you are excluding the ones with the most serious health problems.

[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?

[clavalle]

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

I suppose technically, yes. But it also comes from my father working as a neonatologist and my own experience working with severely disabled children, many of whom were crack babies or suffering from fetal alcohol syndrome, throughout my 20s.

> which after some time appears to have negligible effect

This is the problem. This study does not show that cocaine has a negligible effect. It shows that cocaine has a less than poverty effect for children that make it to term. Big, big difference.

>Where are the statistics?

Enjoy. Cocaine causes increased rates of premature birth (between 3 and 4 times the normal incidence). Premature birth, by itself, leads to severe developmental problems. Here are a few recent studies and surveys. [1], [2], [3], [4]

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

You could look at women in poverty who give birth without cocaine in their system and compare statistics that way. It has been done. Prematurity is at about a percentage point higher for that group than the population at large compared to around 320% for those that test positive for cocaine.

[1] http://fn.bmj.com/content/94/5/339.short

[2]https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&c...

[3] http://www.issues4life.org/pdfs/20110100ajog.pdf

[4] http://www.ncbi.nlm.nih.gov/pubmed/21257143

[fnordfnordfnord]

> This study does not show that cocaine has a negligible effect. It shows that cocaine has a less than poverty effect for children that make it to term. Big, big difference.

You're right, I overstated my claim. The effect is negligible with respect to the effects of poverty.

> Cocaine causes increased rates of premature birth

The studies you've linked do not support your statement. The studies say that cocaine use is associated with, not that cocaine is the cause.

re: [1] I never disputed that PT infants have developmental problems.

re: [2] "Studies revealed that in most domains, the neurobiological effects of PCE play a subtle role, with effects no greater than other known teratogens or environmental factors. Associations between PCE and negative developmental outcomes were typically attenuated when models included conditions that commonly co-occur with PCE (eg. tobacco or alcohol exposure, malnutrition, poor quality of care)." and "Preconception and prenatal cocaine use is commonly associated with poor pregnancy outcomes with psychosocial, behavioral, and risk factors, such as poverty, poor nutrition, stress, depression, physical abuse, lake[sic] of social support, and sexually transmitted infection. Illicit drug use during pregnancy is a major risk factor for maternal morbidity and neonatal complications."

re: [3] "Cocaine use during pregnancy was associated with significantly higher odds of preterm birth"

re: [4] "Prenatal cocaine exposure is significantly associated with preterm birth, low birthweight, and small for gestational age infants."

[specialist]

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

I don't know how cavalle could be more clear:

s/he's not judging the study design, but rather the popular report of the study results.

[fnordfnordfnord]

Is the newspaper report non-factual? It even mentions the researcher's caveat not to use cocaine during pregnancy.

"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."

[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?