Thursday, March 27, 2008

New Stuff

I've found a new site to put on my blogroll which is really interesting. Mainstream Parenting Resources debunks all the craziest "natural parenting" quackery, and it's very well written. Check it out.

Tuesday, March 25, 2008

Circumcision and Medical Ethics

Ah, the circumcision debate.

I've been reading a lot about it lately, which probably isn't good for me, but oh well. I've analyzed both sides of the issue, I watched Penn and Teller's Bullshit on it, I read the medical literature. My conclusion is physically, it's not necessary-- but it doesn't harm them, either.

Circumcision has been consistently proven to not decrease fertility (clearly, Eritrea has a 95% rate of circumcision and they have a population growth rate of 2.5% with 33.97 births per 1000 population), it has been proven to have no effect or a positive effect on sex enjoyment and ability to have sex repeatedly, with all studies stating it had no effect on sex drive, two studies saying it improved and two studies saying it decreased erectile function, with three more claiming no difference, most studies claiming it prevented premature ejaculation, of seven studies, only one claimed it decreased penile sensation, and absolutely no studies claiming it decreased overall satisfaction.

In other words, no impact on sex. At all. No impact on fertility. Complications are very rare (comes from practice all these years) and they can be performed under local anesthesia to prevent pain (and should be, after all, we numb ears before piercing). There's some evidence that they reduce the risk of STDs, including AIDS, but there haven't been enough studies for me to comfortably say that is the case, and anyway, condoms do a much better job. The truth is, medically, there's not really any reason to bother circumcising, and it's just a body modification which we perform for aesthetic and cultural reasons. At the same time, though, it's not actually doing any long-term damage. I think the closest real comparison we have is the idea of piercing ears. Pierced ears are incredibly common, they show up in many cultures, and piercing usually happens when the person is still a child or a teen (ie not a legal adult). They are socially acceptable, and yet, they are body modification-- it is punching holes in a child's body and forcing the skin to grow back around a metal object to produce a permanent hole. They also hurt like all hell if you don't get numbed first.

So the question-- medically, neonate circumcisions (usually, barring complications) aren't needed; thus, are they ethical? Well, pierced ears aren't considered unethical. I don't think I'd want to pierce a baby's ears myself, but I wouldn't stop someone who did so to their kid, and it's quite common. And since there is no long-term pain or disability, there's nothing unethical about doing it as an initiation into a religion or something. People do all kinds of weird shit to their kids in the name of religion, and body modification is a common religious practice, so as long as the kid's life isn't really impacted, I see no objection to that. Provided, naturally, that the religious official performing the circumcision is trained, licensed, and willing to use anesthetic.

But what about people who simply think the circumcised penis looks better? Is it ethical for a doctor to circumcise a boy?

Honestly? I don't think so. I don't really like the idea of doctors doing it. However, at the same time, I think we should have people who are licensed and trained to perform circumcisions for anyone who wants it for their son or themselves. The trouble with doctors doing it is it becomes about "healing" the kid somehow. I say take medicine out of the equation, except in the sense that a person performing a circumcision should have training and licensing, same as someone who does tattoos or piercings, and more so because a mistake could be problematic. Or perhaps list it as a form of plastic surgery or something. I think it should be made quite clear to parents that it is an aesthetic/religious, not medical, choice for them to make.

But ethically, I see no problem with them making that choice. It's not like FGM, where a woman can no longer enjoy sex because her sexual organs have been cut out. The foreskin is a small and relatively insignificant part of the genitalia. Losing it does not cause lasting pain, it does not decrease sexual abilities, nothing. In other words, yes, it is a body modification, yes, it is unnecessary, no, doctors should never suggest it or encourage it for medical reasons (unless there actually IS a medical reason, like phimosis), though they should answer any questions as free from personal bias as possible. At the same time, I think that it is still firmly the choice of the parents and there is nothing unethical about allowing parents to choose to do so to their son. If it bothers him that much, he can have it restored as an adult, same as the girl whose ears are pierced can let them grow back together.

And me personally? I don't really care. I don't practice a religion that cares about foreskins, and while I find circumcision more aesthetically pleasing myself, my opinion on the appearance of my son's penis is irrelevant, what matters is what his future girlfriends/spouse thinks of it. What I find more attractive shouldn't really apply to my son's genitals. So I'll probably defer to my husband on the subject.

Saturday, March 8, 2008

Paternity Testing

Tennessee has proposed a new bill that would require mandatory paternity tests for all newborns.

OKay, on the one hand, there are a ridiculous number of children out there who are being raised by men who are unaware that their wife/girlfriend cheated on them and did not have their child, which often would indicate a desire for a divorce; also, many men are made to pay child support for children that they are not related to, nor ever made any effort to serve as a father.

Yet I believe that DNA is not important, it's intent. Once a man decides to raise a kid, he should raise that kid, regardless of the kid's actual DNA...

I don't think it should be mandatory. No way. That's a terrible invasion of privacy and automatically assumes fault on the part of the woman, plus it can give men information they don't want to have. I think it should be offered to all fathers (when the mother is not in the room) for free. They refuse it? Fine. They can never contest the paternity of the child again, because they've made that decision at that point that they don't care about DNA (and I applaud them). Even if at a later point the child is determined to be genetically unrelated, doesn't matter, they made that choice.

If they accept the test, and they are confirmed to be the father, great. If not? Well, if they immediately deny responsibility for the child, then they don't have to take it, as long as they never take on the role of father. BUt if they stay with the mother, start to raise the kid, whatever, then the paternity test will become irrelevant.

Also, once a paternity test is completed, all the DNA and records should be destroyed except for a note on the child's birth certificate. LAst thing we want is that shit on record.

Fathers should be offered one chance to know for sure, for free, with or without the mother's consent, if the child is theirs before they bond with the kid or make financial obligations towards them. One chance. That's it. And in exchange, women should get to subpoena men they believe to be the father for a confidential, free paternity test with the DNA information destroyed immediately afterwards. So women won't be left to fend for themselves, as long as they can reel off a list of all the men they slept with about 9 months earlier. Of course, you would have to require that the entire process would be completely confidential unless the man really is the father.

So in summary:

At birth, the man who thinks he is the father is offered a free paternity test. He refuses, he's the father by default, even if later he learns otherwise. He made the decision to be the father.
He accepts and it's positive, he's the father, and can never contest that.
He accepts and it's negative, he's not the father, and he can immediately sever all ties with the kid and the mom and not be held responsible. OR, he can decide to raise the kid anyway, despite that information, and will be considered the legal father even if he's not biologically related-- a relationship he then can't contest.

At any point, a mother can subpoena a guy she suspects of being a father for a paternity test. The entire process is kept discreet and if the man is not the father, he can go on his merry way and not worry about it. If he is, she can request child support from him and insist he take responsibility.

All DNA samples and anything that could be used against a person later is destroyed, as it would otherwise be self-incrimination and illegal to use it at a later point for a purpose other than it was provided for. That would be very important and have to be specifically mentioned in the law in such a way that the entire law would have to be scrapped and rewritten to get past it.

And for Pete's sake, don't make it mandatory (unless someone is attempting to skip out on the paternity checks). Make it free an readily available, sure. But not mandatory. The law should not be intruding into people's lives in that manner.

Thursday, March 6, 2008

Too much of medicine is stuck in the 1950s

I have a question/idea.

I'm hoping to go into medicine. So I read a lot of people's opinions of doctors, and their mistakes, etc. You know, figure out what I should keep in mind. One thing I notice is that a lot of people complain that doctors just have a few medications that they prescribe for everything, and that medication interactions are common, especially if you're taking a lot of different meds. It's understandable; there's like a thousand plus medications on the market and doctors aren't perfect.

The thing about this, though, is, I can't help thinking it would be really easy to fix. All the doctors I've seen have a laptop they carry in to their session with me, so they can check my old medical records against my new info, update their records, etc, without having to carry in folders (they print out a hard copy later, I presume, they have files too). Anyway, they have a laptop right in front of them. Couldn't somebody come up with a program for doctors that enables them to enter a medication name and it immediately comes up with what the meds can treat, what they are normally prescribed for, their various approval ratings (government, etc), their prices, any recent recalls or class-action suits, any side-effects, and any interactions with other drugs? And couldn't that same program be modified so that a doctor could enter the diagnosis, say, "chronic joint pain," and would be immediately provided with a list of medications commonly prescribed to treat chronic joint pain? You could maybe even do a cross-referencing program so that doctors could list current medications and the ones with interactions would be eliminated from the list, for people with lots of medication (obviously unnecessary for someone who's taking only a few pills, but if you get an elderly woman with 25 medications she's on...).

Doctors could prescribe generics when people don't have sufficient insurance to cover the name-brand ones, because they would have access to the generic brand names. Of course, insured people would still get name-brands, because they've proven that the placebo effect means name-brands can work better. They could double-check prescriptions very quickly and could learn if a medication someone was on could be causing symptoms. Better care, less problems to fix down the road, insurance companies win. Better care, patients win. Slight reduction in malpractice lawsuits, happier patients, and more memory space to devote to diagnosing techniques, doctors win. Even pharmaceutical companies would benefit because they could get their lesser-known drugs out and prescribed to patients who are always getting their competitor's medication. Okay, that might be a stretch.

But in the end, if the only people who suffer are pharmaceutical companies and only in the fact that they couldn't get doctors who were quite as devoted to them due to knowing of the top of their heads that they didn't have a lot of recalls or anything, I say that's a win. I have no idea why this hasn't been created and put into widespread use yet. It's not like we don't have the ability, there are online sites that basically do the same thing, but doctors are still relying on memory (at least mine are).

If any computer programmer wants to design this and sell it for millions, feel free to steal my idea, no royalties required. I'd be benefiting as much as anyone.

Now, anyone want to tell me why this wouldn't work, or wouldn't be popular, or how my doctors are actually idiots and there already is something like this out there?

Home Schooling and the Law

So California is requiring that all homeschooling parents have teaching credentials.

I'm not sure how I feel about this. On the one hand, there are a lot of crazy whackjobs who homeschool their children so the kids don't have to learn about evolution or condoms. On the other, public schools can really suck, and homeschooled kids whose parents were actually trying to help the kid are going to get penalized.

Clearly there should be regulations for homeschooling. You can't just let people homeschool kids any way they want, because kids aren't able to make their own informed decisions and therefore should not be at the mercy of their parents' every whim. But teaching credentials? Nah. What I think they should have is the following:

1. If a parent wants to homeschool, they should have to register with the state, or their kid should be considered to be playing hooky. That's pretty standard.

2. The parent can't have a history of physical or emotional abuse of the child, or any other kids. Also think that's pretty standard.

3. The parent should have a high school diploma, or a GED. I know, seems like a no brainer, but apparently a very small percentage of home school parents in the US never finished high school. That's probably a good sign that they aren't qualified to teach their kids.

4. Once a year, the kid should be tested against the standards for kids in his or her year. They do better or equal to other kids their age, they can continue homeschooling. I think this is also common. These tests should also include more than just reading and writing-- if it's required learning at school, and it's not gym/art/music etc, it should be required at home. So cover English, math, and history, but also science, health (even sex ed), and basic computer studies, which are neccessary to survive in the modern world.

5. When the kid reaches middle school material (ie stuff they could theoretically have forgotten since they were in school, as opposed to your basic reading and writing and times tables), the parents should have to get a special Parent Teaching Certification. I'm not talking about holding them to the levels of normal teachers. I'm talking about giving them a test that covers the material they want to teach to the kid. They pass the test, they can teach that material. If they don't, community college classes or back to school. That way you won't get people who are unqualified teaching their kids, but it's also not like they have to know Calculus and have a master's degree to teach middle-school algebra.

6. If the kid is mentally disabled (beyond a learning disability or ADHD, I mean really disabled), the parent should have some kind of degree in working with people with disabilities. Those kids need pretty specialized education, and allowing them to be homeschooled, especially since there's no real way to measure their progress like with most kids, is asking for the system to be abused. Similarly, if the kid is blind, the parent should be able to read and create (write?) Braille and if the kid is deaf, the parent should be fluent in sign language. Now, of course, sometimes you get people who are just too disabled to ever really learn anything. If that truly is the case, like they'll never pass a toddler's mental level, then I understand not making them go into a SPED program that basically will babysit them all day. That would have to be decided on a case-by-case basis. But someone with, say, Down's Syndrome can benefit a great deal from a teacher who actually understands how to work with them, rather than an unqualified parent.

And that would be it. Check on the kid once a year (every six months if you want to be paranoid) to make sure something's sticking, make sure their parent is actually remotely qualified to teach the stuff and not some hick who plans to plop their kid in front of the TV all day, and keep track of who's getting homeschooled. That's all you really need. Do it right, and your homeschool kids won't be able to get a worse education than the public school ones, and it'll probably be better. And hey, to address the social aspect, let homeschool kids join sports teams and clubs at the local high school if they want and offer lots of community programs.

But making parents have the same credentials as teachers seems a bit silly. An education course (usually part of the requirement) makes sense if you need to learn how to effectively teach many different children the same thing all at once and maximize learning. For a parent who teaches one or two kids at once, and always the same kids, it's easy to learn what teaching style the kid needs. What's more, effective teaching strategies for 25 kids are going to be very ineffective for 2 kids. This just serves to make it very challenging for parents to homeschool without addressing the real problems with homeschooling, ie, that it can be abused without anyone knowing, and that no one was enforcing the old rules.

Also, maybe, just maybe, California should try to fix the problems in the public school system before wasting time trying to micromanage home schoolers, who on average are more successful than public-school graduates?

Just saying.