Saturday, August 24, 2013


I was listening to a TED Talk today on NPR that caught my attention.  The particular segment was focused on Margaret Heffernan's talk on how conflict is good for change.  It made me think of my years in health care as both a registered nurse and more recently a nurse midwife, and the seemingly constant conflict of paradigms within maternity care.  My personal experience within that conflict was not pleasant, and I am still deeply affected by it.  But on a whole, the talk was a bit uplifting. 

Much of the talk focused on an example that occurred in health care.  During the 1950s, a research physician in England interested in epidemiology named Dr. Alice Stewart wanted to look at the cause(s) of childhood cancer.  Her approach was thorough, and in some ways revolutionary.  She asked the children's mothers.  Other researchers questioned her methods (like, "Why ask them? What do they know?").  But she did find a direct correlation: prenatal x-rays could statistically be linked to childhood cancers (leukemia specifically, I think).

Another interesting approach she took was hiring a statistician to make sure her research numbers were correct; that her findings and their interpretation was correct.  The man she hired was at some point quoted in saying it was his job to find Dr. Stewart wrong.  What I find especially interesting is that Dr. Stewart used someone not directly related to her field of research.  Very much not "peer review".  And with these particular data he couldn't find her wrong.

So Dr. Stewart went on to publish her findings in well respected medical journals about prenatal x-ray exposure and its dangers.  Her work seemed to be an obvious call to stop the routine practice of obstetrical x-rays due to the potential dangers to the fetus.

And what happened?  Her research was so conflicting with current thought that her work was scoffed.  Her methods were criticized.  And obstetrical x-rays were continued.  In fact, my mom had an obstetrical x-ray when she was pregnant with me.  That was in 1976!   My mom said that she questioned it's use, mostly because the reason she was given for needing the procedure was to make sure her hips were big enough for childbirth, and she argued that her hips were plenty big.  But she did it anyway, because the doctor said it was needed and pushed right back.

Obstetrical x-rays were abandoned soon after in the 1970s as Dr. Stewart continued her work on her original findings and finally got the "establishment" to listen.  But it took a lot of conflict.

What I drew a line to in  my own head is that much of what is routinely done in obstetrics today does have some research that conflicts with current practice.  I'm hoping in this age of evidenced based medicine/practice is that the conflicts won't need to be as long as the x-ray example.  One such thing that is studied quite a bit today is possible causes of autism, with a recent study that made the headlines that use of oxytocin during labor either for reasons of augmentation or induction of labor increases the chances of the child being diagnosed autistic.

With the rampant use of oxytocin in modern obstetrics, do you think that it will be easy to get use of drug down to much lower proportions?  I sure hope so, but I'm thinking this may be one of those cases that will take a lot of conflict.  And this is just one example.

1 comment:

  1. I wish I had been able to listen in on this! I'm constantly baffled as to why it takes so long to address serious evidence based medicine/practice and why there isn't more support from the general public to raise awareness! With an estimated 1 out of 54 boys and 1 in 252 girls diagnosed with autism in the United States alone, you'd THINK there'd be far more conflict/support all around from your example given above. From a general, non-obstetric standpoint, we need to stand our ground and fight back with our questions, beliefs, and thoughts. Your mother is a classic example of so many other women out there who pose concerns, questions, or beliefs who quickly back down to the "expert" opinion. Aside from the conflict in the medical world, which is only one aspect in all this, we, as a general public, can fight back for answers, support funding, etc.

    I'd also like to make mention how difficult it was for me to stay on topic here lol!!!!


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