What Happened to Ethics in Pediatric Medicine?
Is Pediatric Medicine Failing Children?
Posted September 16, 2012
A six-week old baby screams for attention, every cell crying out for comfort. Comfort never arrives. This is sleep training. The baby screams so much for so long, that she vomits from the effort, finally giving up in exhaustion. The parents were adivsed to sleep train the baby this way. And now the premiere journal of pediatric medicine has declared that sleep training has no adverse effects on the baby. Have they lost their minds?
If we care deeply about child well-being, it may be time to question the ethics and advice of the leaders in pediatric medicine.
One of the primary ethical principles in medicine is “do no harm.” Two recent occurrences suggest that this principle is no longer valued by the majority of leaders in the field of pediatric medicine.
First, a study recently published in Pediatrics, the academy's journal, suggests that using “cry it out” sleep training with infants does not harm them. The authors actually say “Behavioral sleep techniques have no marked long-lasting effects (positive or negative).” They actual draw this very strong non-scientific conclusion even though they did not look at all possible effects AND they did not examine what the control group families were doing AND even though there are decades of studies on mammals showing the long term harm that distressing young offspring can have on mammalian brains. The great ignorance and disdain for babies shown here is alarming.By allowing this irresponsible and unethical conclusion the editors are encouraging parents to do great harm to their children and our fellow citizens..
See letters of protest submitted to the editors of Pediatrics regarding the article.
After my post on the “Dangers of Crying it out” a mother emailed me about being advised by a baby sleep clinic to let her 6-week-old baby cry herself to sleep as described above. This is an excellent technique for destroying not only general trust in the world but intelligence, self-confidence, mental and physical health.
Even when sleep training is used and the baby stops crying for help, it does not mean the baby is not stressed (though the parent feels great not hearing the baby cry). Cortisol levels in the baby are still high, doing their damage to young neurons (Middlemiss, Granger, Goldberg, & Nathans, 2012)
The second piece of evidence calling into question the ethics of leaders in pediatric medicine is a statement that was published in August, again in the academy's journal, Pediatrics. This was the American Academy of Pediatrics' statement on circumcision that 'leaves it to parents to decide' whether to circumcise their infant, instead of condemning it like medical bodies around the world. The statement says:
“Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.”
Even the “benefits” that the policy points out for circumcised ADULT males are controversial. And how many cases of INFANT penile cancer are there? As my colleagues and I have pointed out in a series of posts (start here), there is next to no benefit infant circumcision and much harm that lasts a lifetime.
No other medical body in the world is endorsing circumcision and in fact, Germany outlawed it recently.
The people putting out these policies and papers seem to still be operating in the mindset that babies don’t feel pain, that they are born with a set of genes that have predetermined their wellbeing and personality. These are myths. Everything that happens to a baby in the first years of life is being recorded the body and brain, shaping who they become. Thresholds for all systems are being established in the early days, co-constructed by caregivers. Trauma lasts a lifetime.
These decisions represent what I call detached imagination and what Bandura (1999) calls moral disengagement. Empathy is disengaged and rationalizations are used for a self-interested conclusion (which can be sticking to the status quo or to your own experience). Much evil in the world is conducted from this mindset.
If pediatricians and parents are not going to protect babies and young children, who will?
Bandura, A. (1999). Moral disengagement in the perpetration of inhumanities. Personality and Social Psychology Review, 3, 193–209.
Middlemiss, W., Granger, D.A. Goldberg, W.A., Nathans, L. (2012). Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Human Development, 88 (4), 227-232.