November | 2011 | Motherworldly

22 Nov

Book Review: Testing Treatments

Testing Treatments by Imogen Evans, Hazel Thornton, Iain Chalmers & Paul Glasziou asks the crucial question, how can we ensure that medical research effectively meets the needs of patients? It is a crucial question because all over the world, resources are wasted on poor quality research, research that only meets the needs of drug companies, and on unproven, disproven, or unnecessary treatment.

The authors state that medical research is ‘everybody’s business’ (p.114) and suggest that if patients, doctors and researchers worked as a team, the testing of treatments could be more effective, precise and useful. The BMJ famously bans the phrase ‘more research is needed,’ and Evans et al, who comment ‘do less… but focus the research on the needs of patients’ (p114) clearly agree.

A useful complement to Ben Goldacre’s Bad Science and Simon Singh’s Trick or Treatment, Testing Treatments clearly lays out the principles of robust research, defining what makes a fair test, and explaining the importance of setting a study within the context of existing research. In itself, these principles do not sound particularly challenging, but the authors go on to show how the waters are muddied by vested interests, patient pester power, paternalistic clinicians, and inexcusable poor practice.

Finally, they set out a strong blueprint for a better future, asking for patients to be treated as equal partners, both as individuals requiring treatment, and as groups participating in research.

The manifesto is laudable, but for this to work, people need to read this book and get on board; and not just other academics. There is an obvious effort to make the style of the book accessible to the wider public, and indeed it is, as I read it in two days despite the company of a bored five year old. I found the slight dumbing-down of some of the terminology (words like ‘menstrual’ and ‘cardiac’ explained in parentheses) slightly patronising; and the over-simplified diagrams lacked much meaning. Boxed quotations are scattered over almost every pages, which breaks up the flow of the text without adding very much in terms of content. However the chapters are very clearly laid out and richly illustrated with anecdotes and examples. It was impressive that the entire chapter on statistics managed to avoid using the word ‘statistics.’

I would definitely recommend this book to my colleagues and to some of my more sciencey friends, but this is why I feel that it will mainly preach to the converted. Those paternalistic GPs who are certain of their infallibility, those focus groups desperate to prolong precious life, those politicians in the pockets of big pharma: they should be forced to read it!

I took away from Testing Treatments, a much enhanced understanding of the arguments against routine screening, and an appreciation of the need for greater regulation and better-informed consent for treatment outside the context of clinical trials. I enjoyed reading what could potentially have been a heavy-going book, but was in fact, as Ben Goldacre says in the foreword, ‘interesting and clever.’ (p.xii)

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To order Testing Treatments with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

18 Nov

Book Review: Saggy Boobs & Other Breastfeeding Myths, by Val Finigan

Saggy Boobs & Other Breastfeeding Myths is a fabulous little book! It may be a light read, but it is certainly not light on evidence-based information.

Dispelling breastfeeding myths is one of my main aims in antenatal classes, and the myths appear to be limitless: babies get the runs when you eat curry, champagne gives them hiccups, you end up with boobs like spaniels’ ears, and of course you’re at the beck and call of a miniature tyrant who never learns to sleep, if you breastfeed.

I love the clear, factual answers, especially the response to ‘modern formula milks are as good as breastmilk,’ (p.20) which I might memorise:

Even though modern milks are considerably better than old-fashioned milks they do not replicate breastmilk. They contain no antibodies to fight infections, no living cells, no enzymes and no hormones. They contain higher levels of aluminium, manganese, cadmium, lead and iron than breastmilk. They have significantly higher levels of protein than breastmilk, and the proteins and fats are fundamentally different from those found in breastmilk.
The constituents of formula do not change feed-to-feed, day-to-day like breastmilk and are not species specific. All we can say about formula milk is that it is successful at making babies grow well.

Each page includes the most amazing embroidered illustrations by Lou Gardiner, and the whole book is so unique, accessible and appealing that I think it should be standard issue for expectant mothers. The author and publishers may be interested to know that there is one at every Baby Cafe Local in Hertfordshire.

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To order Saggy Boobs & Other Breastfeeding Myths with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

10 Nov

Book Review AND Giveaway: How Mothers Love (and how relationships are born) – Naomi Stadlen

I am a huge fan of Naomi Stadlen’s first book, What Mothers Do: Especially When it Looks Like Nothing, which I first read when my son was around six months old, and then again five years later when I had just completed my doula training. So I have been looking forward to getting my hands on her second book, How Mothers Love; and as soon as I did, I set about creating some space (ignoring the rest of my family!) so that I could read it.

This is a wise and compassionate book, with a pondering gentle tone and a very Plain English style. In its quest to describe and explain how mothers and babies relate to each other, and to examine the implications of this for the development of relationships in later life, the book provides another wealth of anecdotal colour that would sit alongside a more sciencey tome such as Sue Gerhardt’s Why Love Matters: How Affection Shapes a Baby’s Brain.

I read this book holding a pencil with which to annotate moments of epiphany and insightful remarks I would like to quote later. I have underlined something on nearly every page, as I repeatedly recognise something from my own experience or from talking with other mothers, including the idea of mothers as fellow travellers, the dread of disapproval, the feeling that motherhood is undervalued and misunderstood in wider society.

This last point led me to wonder if non-parents could even begin to understand this book, or grasp why it is so important. Stadlen describes herself, beautifully, as being ‘steeped’ in the conversation of mothers, and her frame of reference is highly accessible to me, being similarly steeped. But when trying to convey some of these concepts to non-parents (or even to parents for whom motherhood is not an important subject), I feel like I am speaking a different language. This is why Stadlen has to make up wonderful words to describe something like making ‘heartroom’ for our babies; and why she frequently laments that our language simply has no words for so many of the deeply significant but less tangible things that mothers do.

I had never previously considered the impact of Freud’s work on parenting (perhaps I should give my psychology degree back!) but it was interesting to add him to the pile of ‘experts’ undermining mothers’ instincts across the years. Equally, while I am well aware of the dichotomy in fashionable parenting styles, I had never thought of it in terms of Spartan versus Athenian, a description which really elucidates the fundamental differences between the two philosophies, and the resulting conflict in how mothers think and the ways in which they relate to each other.

For me the book throws up the stark contrast with one group of mothers (and fathers) who do not feature quite so strongly; that is, the expectant ones (and I quite understand why this is). In antenatal sessions, parents-to-be refer to ‘the baby’ as ‘it,’ and their expectations are often that a Spartan approach to parenting will work very well for them. The dawning of realisation that their baby is a person deserving of respect and warmth must be a huge epiphany for many first time parents, and I find it frustrating to have confidence that this almost always happens, but not to be able to convince them of that in the antenatal period.

How Mothers Love enlarges on the themes of What Mothers Do, and introduces new ones, going on to look at how the supply of love expands (like breastmilk, as one of the women in my own antenatal group once said), to meet the needs of the next child, and the next; and how being a mother changes one’s relationships with the other members of the family.

Towards the end there are suggestions about how mothers could co-operate to have their work recognised and valued more widely; but I feel that short-term financial interests will always work against this optimistic manifesto. As a Breastfeeding Counsellor, the work I do is a drop in the ocean. A book like this can make waves where I cannot. Reading this helped to reaffirm my approach to my paid work; but more importantly, to my unpaid work as a mother.

***

Naomi Stadlen’s publisher, Piatkus, has very kindly offered two copies of How Mothers Love as a giveaway to two readers of the Double Helping Doulas blog. I have never had a giveaway before, and I’m torn between holding an actual competition, or offering the books to the first two commenters. I have no idea if anyone even reads this thing, so to increase the number of comments, just let me know you’re there and you’re interested, and I’ll pick names out of a hat on Tuesday 15th November.

03 Nov

Book Review: Complementary Feeding: Nutrition, Culture and Politics, by Gabrielle Palmer

Palmer’s ‘The Politics of Breastfeeding’ was a hugely influential book for me as a breastfeeding counsellor, opening up a far wider picture of the subject than I had ever seen before. ‘Complementary Feeding’ has done the same thing with the subject of introducing solid food and feeding infants and young children on food other than milk.

The title itself raises the huge issue of what we call this process, which many people refer to as ‘weaning.’ As Palmer explains, this is in fact the term for cutting down on milk, which may well be a consequence of introducing solid food, but is not, in fact, the same thing. This confusion of the terms leads to parents and healthcare professionals having a drive to reduce a baby’s milk intake long before he or she is developmentally ready to do so.

I particularly enjoyed the book because it reinforced my own approach to talking about the introduction of solids, with the focus being on education and exploration rather than on filling the child up with non-nutritious cereal-based or pureed foods to the exclusion of milk. She even pinched my throwaway remark that food is a great, cheap educational toy that comes in lots of lovely colours and textures, and can be played with at the table while the rest of the family gets on with their meal!

The book starts with an overview of the inequalities in global food entitlement, a subject I had not considered before, but which became highly topical this morning when research comparing the average English diet with diets in Scotland, Wales and Northern Ireland, suggested that if they all stopped eating deep fried Mars Bars, they would, amazingly, live longer. Of course, the research does not say this at all, but identifies food entitlement inequalities in less affluent populations in the UK, but that does not make such a good headline.

It goes on to look in greater detail at the evolution of the human diet, and cultural variations, as well as innate factors such as the drive for nutrient-dense food (hence the preference for salty, sweet and fatty foods), and the inbuilt appetite control mechanism that allows baby-led complementary feeding to become the natural progression from baby-led breastfeeding. I learned some interesting facts about human consumption of animal milk (most humans do not produce the necessary enzyme to digest milk, beyond infancy, but northern Europeans have evolved to do so), and was interested, but (I admit) slightly revolted by the discussion of feeding insects and molluscs to small children. My cultural prejudices are pretty well embedded!

Finally, Palmer suggests some processes for change, including an examination of the language used around feeding children; and compares the effects of wartime rationing with a frankly disempowering US initiative to provide poorer families with food but not with information about nutrition or food preparation.

For me, one of the most important conclusions of the book is that malnutrition exists in affluent cultures as well as in the developing world, because parents are driven to cut back on milk and give commercial or home-made processed foods to their children, often before the children are ready to move on to a solid diet. Also, that spinach is not particularly good for children; as Palmer writes, how wise they are to refuse it!

This book was a free copy kindly sent by Pinter & Martin publishers, and can be obtained from them here.