Archive for June 24th, 2010
Jezebel is skeptical of the Daily Mail’s latest hyping of the supposed link between abortion and breast cancer. I keep wanting to ask: why in the heck do Jezebel contributors keep reading the Daily Mail as if it has something relevant to offer aside from unintentional comedy perpetrated by disturbed, miseducated people?
But anyway, we keep hearing from the pro-quantity bunch about how abortion increases the risk of breast cancer, and Anna also helpfully links to the American Cancer Society’s (that’d be folks concerned with cancer, not abortion rights) information page on the topic. The National Cancer Institute’s findings, briefly summarized, are:
You have to feel like you’re being watched. You have to feel that other people are paying. You have to feel like you’re part of a cool experiment.
That’s the psychology that’s supposed to make a pay-what-you-want restaurant profitable, and Cowen is, as an economist, skeptical of its application to the food industry. I have another perspective on why this is a bad idea: I was a waitress at one time.
(Not that I have any business criticizing Britain’s treatment of pregnant women, as I live in the U.S., but still. Don’t emulate our example, Britain!)
UK health agency National Institute for Health and Clinical Excellence (NICE) recommends that pregnant women be tested for CO on their breath at prenatal appointments:
The National Institute for Health and Clinical Excellence (Nice) said that every expectant mother should be encouraged to have a carbon monoxide test to see whether they smoke so they can get the appropriate advice for quitting.
Because simply asking a woman if she smokes is too respectful of her dignity, it would seem.
The education and research manager at the Royal College of Midwives, however, is not convinced.
“Strategies for smoking cessation should apply to all women regardless of being pregnant,” said MacDonald. “There is no doubt that most women are aware of the effects of smoking. The challenge is to reduce the numbers doing it. There appears to an emphasis on pregnant women, which is appropriate given the evidence. However, the key issue here for Nice is their emphasis on the CO2 monitor.”
Let’s see here: a major arm of the national health bureaucracy (not that there’s anything wrong with having such a thing) says all pregnant women should be treated like liars, while the midwives—you know, the people who actually deal with expectant and new mothers?—say this is not helpful. The folks who work in offices are concerned with rule enforcement. The folks who work in clinics are concerned with harm reduction.
All this is not to say there isn’t some logic behind the use of CO2 monitors. Pregnant women are just as human as the rest of us, and people do lie sometimes. Since we all know that maternal smoking is harmful to the fetus in , it is not unreasonable to suspect that some women will tell their prenatal care providers they don’t smoke when in fact they do. If some pregnant women believed they were posing no undue risk to their offspring by smoking, they would have no reason to lie about it. If NICE were only concerned about giving expectant mothers advice about smoking cessation, they would let the midwives and obstetricians simply ask their patients if they smoke. The CO2 detectors are not about giving patients the best information possible. The breathalyzer tests are about catching patients in a lie. It isn’t because expectant mothers want to hurt their children that they might lie about smoking, but because they don’t like being lectured and shamed by their healthcare providers. The result of NICE’s recommendation, if it’s implemented, will be that some pregnant women who smoke, or live with smokers, will wait much longer than they should to visit the midwife, or possibly not go at all.
Thus, some women will forego prenatal care when in fact they need it more than others. They will not only go without advice on smoking cessation, they will go without any advice on taking care of themselves while pregnant, and lack any monitoring of health and fetal development issues which may or may not be related to their tobacco use. This is what happens when healthcare involves treating patients like criminals: some patients simply avoid the doctor, with varying results.