Seatbelts not only save lives --- they prevent tragedies

photo credit: AlamosaCountyPublicHealth via photopin cc

Everyone in the New York area has by now heard the tragic story of a young pregnant couple killed on their way to the hospital when their car was hit from the side by a hit-and-run driver (now identified as someone with an arrest record including recently driving under the influence of alcohol, but it's still unknown who was at fault.) The baby was delivered but sadly died because he was only 6 months gestation.  As tragic as this story is, the real tragedy is that the woman and possibly her husband and child might be alive today if they had been wearing seatbelts.

The couple was being driven in a 2008 Toyota Camry, a very safe car, but the woman was thrown from the car, meaning that she could not have been wearing a seatbelt.  The IIHS ratings for this car for a side impact give this car this highest rating for both passengers and drivers, and the driver walked away relatively unharmed.  Seatbelts reduce by half the risk of mortality from motor vehicle accidents, and certainly prevent passengers from being thrown from vehicles.

This couple was not alone in not wearing seatbelts in the backseat of a taxi, which is all-too-common behavior, although illegal in New York State.  Police are even allowed to stop cars for seatbelt non-use, but only drivers and front seat passengers can be ticketed.

A paper published last year in the journal Injury Prevention notes that the press often labels events as "freak accidents."  People mourn accidents, but journalists afraid of being seen as blaming the victims fail to communicate that many accidents could be prevented.   

Few accidents are truly freak accidents.  Many injuries, deaths, and tragedies can be prevented through sensible precautions, including wearing seatbelts.  There is no excuse not to wear a seatbelt, ever, even riding in a taxi.  New York State should expand its seatbelt laws to allow ticketing passengers.  If all passengers consistently wore seatbelts, we would have many fewer such tragedies. 

Lead in chicken broth?

After the lead and crime article in Mother Jones last month, I've been more aware of lead in the environment.  Perhaps that is why a paper finding lead in organic chicken stock in the journal Medical Hypotheses alarms me, at least slightly and hypothetically.  The researchers found concentrations of 9.5 mcg/L and 7 mcg/L, still below the EPA's "action level" of 15 mcg/L for drinking water, but the EPA in the same publication says that no concentration of lead is acceptable:  i.e., the goal level concentration is zero. 

As is the nature for a hypothesis-generating publication, the study used only one batch of chicken stock of each type:  one with bones, one with skin and cartilage, and one with meat.  Perhaps they picked a bad chicken, or perhaps it is only chicken from the UK.  It's impossible to know without more tests.  People always ask us statisticians what would have happened if the sample size would have been larger, and it's important to remember that we're statisticians, not fortune-tellers:  we can't know what results would have been without having the actual results.  It's strange and frustrating that with 3 authors on the paper, they couldn't be bothered to get a few more chickens to test.  At least they did a control of plain water boiled for the same period of time, which found near-zero concentrations, under 1 mcg/L.  (Chicken meat broth by contrast was just over 2 mcg/L.)

The authors neglected to mention that the technique of saving bones for stock from every piece of meat you eat is almost universally recommended by cookbook authors including Melissa Clark and Nigella Lawson, to ensure that you always have stock available when it's called for.  Cookbooks say that there is no substitute for stock, and if you don't have stock around, use water rather than canned.  It's disappointing that there might be dangers from what is considered a best practice for cooking, not to mention one that I've just started following myself!  The lentil soup made from homemade beef stock was amazing, and one guest told us that he'd never tasted anything like it. 

I will still use the chicken stock in my freezer, but I'd be reluctant to continue this habit if pregnant or if I had children, given how dangerous lead is during critical formative periods. I do wish that the authors had gotten their act together to get at least an n=10 from geographically dispersed chickens.  How hard would that have been, seriously? 

Beating a dead fish: more reasons to correct for multiple comparisons

Last night, the Ignobel prizes rewarded research using an fMRI on a dead salmon as an extreme case of a null effect.  fMRI machines identify over a hundred thousand of voxels (the tiny pieces they divide the brain into), and by chance some voxels show activity even where there isn't activity simply because of the sheer number of opportunities for a false positive: similar to how a broken clock is right twice a day, and if you looked at the clock 100,000 times, you would see several times when it said the correct time.  The researchers had a dead salmon complete a standard task that would be used on live human subjects and showed that --- without correcting for multiple comparisons --- the salmon appeared to be thinking.  With correction for multiple comparisons, the scientists saw no effects.  This research was published in the Journal of Serendipitous and Unexpected Results.

DNC: Planned Parenthood promotes fertility

We all know that Planned Parenthood is in favor of parenthood at the right time. Giving women a place to address every type of reproductive health needs leaves them in better health, so that they are able to have children when it's their time. I found the story of Elizabeth Ann "Libby" Bruce, whose endometriosis was discovered at Planned Parenthood particularly moving, especially her delivery. Planned Parenthood didn't save her life, but it did make new life possible. There's nothing more pro-life than that. It doesn't hurt that her baby was born just 9 weeks ago, on our country's birthday. In Ohio.

The important issue here isn't access to health care, but access to the right health care. We have all known how scary and frustrating it is to feel sick without answers, even where insurance and health care access are assured. It's scary to think that Ms. Bruce might have never found a doctor to treat her condition, and thus found herself unable to have children.

I don't know whether Planned Parenthood is always better than women's other options, but it is important that Planned Parenthood is always an option. Planned Parenthood has saved the fertility of so many other women, but in ways that are sadly less politically palatable. We've come so far that we can have a woman say "endometriosis" in front of a full political convention, but we'll have come even farther when we can speak openly about chlamydia and other sexual health issues.

The Democrats are obviously way ahead on speaking candidly about women's health. Any guesses on how many decades before anyone will ever say the word "endometriosis" at the Republican convention?

Media coverage of "Cash, cars, and condoms" paper in Journal of Adolescent Health

Our newest paper on women getting money from their sexual partners was just published in the Journal of Adolescent Health, and covered by
ABC News, the
Health Behavior News Service (by Laura Kennedy), the
Empowerher blog (by Susan Cody), and in Latvian (?).

Birth control and the sexual revolution

Birth control, something practiced by nearly 100% of women, was once uncontroversial. Now, almost inexplicably, opposition to birth control has exploded.

Once upon a time, there were pro-choice Republicans. Now, not only has this breed become extinct, but it's no longer enough to oppose abortion. Birth control is now considered suspect.

It seems baffling to see such a reversal so suddenly. Social conservatives accept the standard narrative about the sexual revolution --- oral contraception allowed premarital sex, which caused the sexual revolution --- and they oppose it. Next step will be to reduce condom access, not just in schools, but also in stores, such as requiring them to be behind the counter and perhaps having age limits.

Telling kids to act as though the sexual revolution had not occurred, and teaching them that contraception is dangerous and ineffective --- abstinence only sex education --- didn't reverse the sexual revolution. The Congressionally mandated evaluation found that abstinence-only sex education did not decrease premarital sex. That failure was particularly embarrassing because some comprehensive sex education programs that teach about birth control decrease premarital sex.

Social conservatives' assumption may be that if birth control caused the sexual revolution, reducing birth control access might reverse the sexual revolution.

Unfortunately, they're wrong. Even before the advent of birth control, attitudes began to favor sex within loving non-marital relationships in the late 1940s and 1950s, as documented by sociologist Ira Reiss in his 1967 book, The Social Context of Premarital Sexual Permissiveness. (The entire book is available online for free at that link, and I highly recommend it.)

Even if there had been no oral contraceptive, there would have still been a sexual revolution. After all, in a society where sex within loving relationships is accepted, certainly people will find a way. For instance, withdrawal is only slightly less effective than condoms. The modern IUD is safe and effective. Diaphragms are safe and effective, if they are used without spermicide which could increase STI risk. And these methods may even be superior to hormonal contraception.

Elsewhere in this blog, I have spoken about shortcomings of oral contraception, according to my Second Wave feminist bias towards non-systemic, barrier methods of contraception. And I've spoken about problems with hookups, or as Reiss would say, permissiveness without affection.

Even if the conventional narrative were true, and birth control somehow caused the sexual revolution, it is not necessarily possible to reverse course and return to no premarital sex. How far will social conservatives go in attempting to reverse gains from the feminist movement?

Heterosexual-only sex education: next generation abstinence-only?

Rolling Stone tells of a rash of suicides among lesbian/gay/bisexual/questioning teens in a conservative town in Minnesota. They mention a next generation sex education program in public schools sponsored by evangelical organizations that questions same sex attraction. This heterosexual-only sex education program appears to be just another guise of abstinence-only sex education, and it seems to follow from the same motivation.

Both programs come from an assumption that both same sex attraction and premarital sex are brand new phenomena, and that it's possible to go back to the way things used to be. (Of course, plenty of evidence indicates that they're not new, and even if they were new, it's neither possible nor desirable to go back to a time when women's suffrage was unthinkable. None of the strong women evangelical leaders would agree to reverse feminist gains.)

Both programs attempt security via obscurity, and treat education as dangerous. Teaching a subject (contraception or same-sex attraction) is thought to encourage and legitimize the subject, and to advance an imagined liberal agenda.

Instead, the programs just delegitimize normal behavior and endanger teenagers. Abstinence-only sex education increased unsafe sex probably because it taught that pregnancy and STDs were unavoidable, so there was no point to avoiding them. Alternatively, it made teens so worried about the spiritual effects of sex that they never worried about the physical effects. That's dangerous and bad for public health, but probably no one would die from it. Hetero-only sex education is more insidious because it further marginalizes a population that is already marginalized, at high risk for educational and health disadvantages, and at high risk of suicide.

Right now these hetero-only sex education programs are coming into public schools using private funds. That's how abstinence-only sex education started in the early/mid 1990s. The next stage would be to slip funding for these programs into another bill, as abstinence-only began in 1996 with the welfare reform bill. I hope it doesn't get that far.