Why India Has Stopped Giving HPV Vaccines

In April, the government of India called a halt to trials of the Hu man Papilloma Virus (HPV) vac cine.  This came about because of a civil society-led investigation which highlighted serious ethical violations in at least one trial.


In India, civil society groups have long been voicing their concerns regarding the safety and efficacy of the two HPV vaccines, along with the aggressive promo tion of the vaccines and the need to inves tigate reported deaths and adverse events post vaccination.

According to Economic and Political Weekly, the investigation that led to the ban highlights how:

"... the promotional practices of drug companies, pressure from powerful international organizations, and the co-option of, and uncritical endorsement by India's medical associations are influencing the country's public health priorities."

In the US, only about one third of eligible young U.S. women complete a full course of the vaccine against the human papillomavirus. The older the woman, the less likely she is to have gotten even one of the three doses.

A study looked at almost 10,000 women between the ages of 9 and 26 eligible for HPV vaccination. Of these, only 39.1 percent received a single dose, 30.1 percent received two doses, and 30.8 percent completed the three dose regimen.

According to Yahoo News:

"Women between the ages of 18 to 26 were least likely to get even a single dose, which ... was probably due to the influence of parents on younger women, since parental consent is required for getting the vaccine under age 18."

Sources:
Economic and Political Weekly November 29, 2010
E! Science News November 9, 2010
Yahoo News November 9, 2010


Dr. Mercola's Comments:


This is all good news, considering the fact that the HPV vaccine may be one of the most dangerous and unnecessary vaccines on the market.

Millions of women in the U.S. were scared by Merck's powerful ad campaign into becoming "one less" victim to cervical cancer by getting vaccinated with Gardasil. But instead of saving women from cancer, the vaccine has turned an increasing number of formerly healthy girls into "one more" victim of vaccine abuse.

The reported death toll for the HPV vaccine now stands at 89, and the first male death has also been reported. A young boy died just eight days after being vaccinated with Gardasil.

As of November 3, 2010, there were also 20,575 adverse reactions, the Age of Autism reports, and 352 reports of abnormal pap smears post vaccination. Keep in mind however, that it has been estimated that only 1 to 10 percent of all vaccine adverse events are ever reported, which means there could actually be millions of vaccine injuries related to Gardasil, and perhaps thousands of deaths.

Shockingly, the vaccine is now also related to infant deaths.

Breastfed Infants Die after Mothers get HPV Vaccine

Yes, according to a November 1, 2010 PRLog press release:

"Information has been received from a physician for the pregnancy registry for GARDASIL, concerning a female who on September 1, 2010 was vaccinated with the first dose of GARDASIL intramuscularly while breastfeeding. Her baby was 40 days old. It was reported that the mother's and baby's health were good (well controlled).

On September 2, 2010, in the morning, the baby's condition was still good, but in the afternoon the condition suddenly dropped. The family immediately took the baby to hospital but it did not help since the baby died shortly after that. The cause of death was not reported…"

Two additional VAERS reports of infants dying in a similar fashion have been filed in the last 16 months.

"Where is government accountability and responsibility in allowing this uncontrolled medical experiment on adolescents and women of child-bearing age?" the press release states.

"How many lives will be destroyed before they realize the travesty that is unfolding as they stand by and say and do nothing – other than "monitor" the situation?"

Those are the same questions I ask myself each time I write on this topic…

Unethical Clinical Research Performed in India, Civil Society Group Claims

In March of this year, a team of women's rights activists visited one of the vaccination sites in the Khammam district of India. According to Economic & Political Weekly:

"A look at the findings of this visit… sug gests that these projects – which were in fact research – violated existing ethical guidelines on clinical research, as well as child rights.

These violations include – but are not limited to – testing on vulnerable and marginalized groups (particularly pediatric populations), who are not likely to benefit from the results of the research, and without taking their proper informed consent or assent."

This seems to be more the rule than the exception when it comes to many pharmaceutical companies' drug studies overseas. India in particular has seen an upsurge of clinical pharmaceutical studies, and the questionable practices employed are becoming increasingly apparent.

According to an article published last June, "proposed new laws to prevent pharmaceutical companies from conducting clinical studies of medicines involving humans without obtaining permission from accredited ethical committees may soon come into force in India."

The article goes on to say that:

"Deaths during clinical trials are increasing in India in the recent years even as the country emerges to be one of the most sought-after destinations of human studies of experimental medicines.

According to the figures collated with available information collected, as many as 308 persons died in the year 2009 till the month of August, reports said."

The Indian government suspended Merck's Gardasil study in April, when they discovered that four of the young participants had died, and more than 120 girls suffered severe adverse reactions, including:

stomach disorders
epilepsy
headaches
early menarche
HPV Vaccine Doesn't Even Work as Advertised

The marketers of Merck's HPV vaccine Gardasil would like you to believe that getting your daughter vaccinated can save her from HPV related illnesses like cervical cancer and genital warts, but where is the good evidence to show that is true?

There are more than 100 viral strains of HPV. Of these, about 30-40 are sexually transmitted and 15 strains are associated with cervical cancer. Several HPV strains are also associated with skin infections that cause genital warts or common warts on your hands and feet.

But Gardasil contains only four of these HPV strains, so if you contract one of the 96+ types that aren't included, you're out of luck. And, if you've already been exposed to one of the four types of virus in the vaccine, it doesn't work against those either.

Therefore, even if you accept the risks and get vaccinated, your chances of getting some form of HPV are still very high.

But even then there's actually very little cause for alarm because, as the Centers for Disease Control and Prevention states, "In 90 percent of cases, your body's immune system clears the HPV infection naturally within two years."

This is true whether the infection is the type that can cause warts or cancer.

Personally, I don't see how the mediocre-at-best benefits of Gardasil could possibly outweigh its risks.

How Does HPV Vaccine Cause Injury and Death?

All vaccines, like all pharmaceutical products, have risks and can cause reactions that can lead to permanent health problems or even death. HPV vaccine is no different. Ever since the vaccine was fast tracked by the FDA and licensed in 2006, there have been many reports of Gardasil-related injuries and deaths.

The symptoms and causes of death after Gardasil vaccination include:

blood clots
acute respiratory failure
cardiac arrest
"sudden death" due to "unknown causes" shortly after receiving the vaccine
According to the National Cancer Institute, an estimated 4,210 women will die from cervical cancer in the U.S. this year. Many of these mostly older women will have had high risk factors for developing a chronic HPV infection that leads to cervical cancer, such as lack of regular pap screening tests that could have promptly identified pre-cancer signs and led to life saving treatment. In fact, other high risk factors for chronic HPV infection that is associated with development of cervical cancer also include smoking; co-infection with HIV and chlamydia; and long term oral contraceptive use.

Cervical cancer CAN be prevented without vaccination and yet it looks like we may have already lost 89 healthy children and young women to HPV vaccination in the effort to spare them from the possibility of developing cervical cancer later in life.

Surely I'm not the only one who sees that as morally reprehensible!

Can Gardasil Increase Your Chances of Cervical Cancer ?

Yes, according to information Merck presented to the FDA prior to approval, if you have already been exposed to HPV 16 or 18 before getting a Gadasil shot, then Gardasil may increase your risk of developing precancerous lesions and cancer by nearly 45 percent!

None of this is advertised by Merck or public health officials, and the FDA has not recommended screening for HPV prior to vaccination. The FDA did not even demand that a warning be included in the package insert.

This is yet another potential hazard that no one is talking about, let alone making parents fully aware of before vaccinating their daughters (and sons).

Cervical Cancer Virtually 100 Percent Avoidable

Cervical cancer is well documented to be caused by an infection acquired through sexual contact. So it is virtually 100% behaviorally avoidable. According to a New England Journal of Medicine study, the use of condoms reduces the incidence of HPV by 70 percent, offering FAR better protection than Gardasil.

According to the CDC, HPV is the most common sexually transmitted disease in America. The majority of people, who are sexually active, have had contact with HPV viruses. More than 6 million women contract HPV infection annually, yet, as I already mentioned, more than 90 percent of these women will naturally clear the virus from their body without any residual health effects. And if girls and women get regular pap screening tests, which identify pre-cancerous lesions early, they can greatly reduce their chances of eventually being one of the estimated 4,200 American women to die from cervical cancer.

Why?

Because if you are healthy, your immune system is usually strong enough to clear up this kind of infection on its own, and does so in more than 90 percent of all cases.

Rather than subjecting your daughter or son to this unnecessary and potentially dangerous vaccine, you may want to nip the problem in the bud before it starts.

Here's how:

Recognize that cervical cancer (or any cancer) is not caused by a "vaccine deficiency."
Talk to your kids about HPV. This infection is sexually transmitted, so it is 100 percent preventable through lifestyle choices.
Keep your immune system strong. A healthy immune system is better able to handle a heavier emotional and physical stress load. I've written many times on how to supercharge your immune system as an alternative to vaccinations, but I can't stress it enough: Proper diet, exercise, good hygiene, staying well rested, and hand-washing are excellent ways to begin the road to a long, healthy life, no matter what your age.

I also advocate getting plenty of the most natural health-booster of all, something that's free from Mother Nature – sunshine. Or, when you can't be out in the sun, supplements of Vitamin D, and particularly Vitamin D3, can keep your immune levels up.

A Tour of McDonald's Horrifying Mechanized Meat Factories

"Just A Dream" by Nelly - Sam Tsui & Christina Grimmie

Study: fluoridated water causes brain damage in children

(NaturalNews) A new study pre-published in the journal Environmental Health Perspectives confirms that fluoridated water causes brain damage in children. The most recent among 23 others pertaining to fluoride and lowered IQ levels, the new study so strongly proves that fluoride is a dangerous, brain-destroying toxin that experts say it could be the one that finally ends water fluoridation.

"This is the 24th study that has found this association," explained Paul Connett, Ph.D., director of the Fluoride Action Network (FAN). "[B]ut this study is stronger than the rest because the authors have controlled for key confounding variables and in addition to correlating lowered IQ with levels of fluoride in the water, the authors found a correlation between lowered IQ and fluoride levels in children's blood."

For the study, researchers evaluated 512 children ages 8-13 in two Chinese villages, one village with higher than average fluoride levels and the other with lower than average fluoride levels. After accounting for external variables like lead exposure, iodine deficiency and other conditions that might affect brain health, the team still found that the number of higher intelligence children in the low fluoride community was 350 percent higher than the number in the high fluoride community.

"In this study we found a significant dose-response relation between fluoride level in serum and children's IQ," wrote the study authors.

Though there have been numerous studies over the years the identify fluoride as a neurotoxin, most mainstream medical professionals in the U.S. have ignored them and continue to support water fluoridation. But the evidence continues to mount, and sooner or later the medical community will have to come to grips with the truth about fluoride.

"This should be the study that finally ends water fluoridation," explained Tara Blank, Ph.D., Science and Health Officer at FAN. "Millions of American children are being exposed unnecessarily to this neurotoxin on a daily basis. Who in their right minds would risk lowering their child's intelligence in order to reduce a small amount of tooth decay, for which the evidence is very weak."

To learn more about the dangers of fluoride, visit:
www.fluorideaction.org

Sources for this story include:

http://www.prnewswire.com/news-rele...

Visit To An Animal Rendering Plant

The following is a description of a "rendering" plant. WARNING: very graphic
You may not be familiar with the idea of rendering plants. The dead animal and discarded flesh disposal industry. Yet rendering represents a multi-billion dollar business, and these facilities operate 24 hours a day just about everywhere in America, and they've been in operation for years.

Here is an article entitled “The Dark Side of Recycling” from the Fall, 1990, Earth Island Journal to learn about rendering plants:

“The rendering plant floor is piled high with ’raw product’: thousands of dead dogs and cats; heads and hooves from cattle, sheep, pigs and horses; whole skunks; rats and raccoons --all waiting to be processed. In the 90 degree heat, the piles of dead animals seem to have a life of their own as millions of maggots swarm over the carcasses.

“Two bandana-masked men begin operating Bobcat mini-dozers, loading the ‘raw’ into a 10-foot-deep stainless steel pit. They are undocumented workers from Mexico, doing a dirty job. A giant auger grinder at the bottom of the pit begins to turn. Popping bones and squeezing flesh are sounds from a nightmare you will never forget.

“Rendering is the process of cooking raw animal material to remove the moisture and fat. The rendering plant works like a giant kitchen. The cooker, or ‘chef,’ blends the raw product in order to maintain a certain ratio between the carcasses of pets, livestock, poultry waste and supermarket rejects.

“Once the mass is cut into small pieces, it is transported to another auger for fine shredding. It is then cooked at 280 degrees for one hour. The continuous batch cooking process goes on non-stop 24 hours a day, seven days a week as meat is melted away from bones in the hot 'soup.’ During this cooking process, the soup produces a fat of yellow grease or tallow that rises to the top and is skimmed off. The cooked meat and bone are sent to a hammer mill press, which squeezes out the remaining moisture and pulverizes the product into a gritty powder. Shaker screens sift out excess hair and large bone chips. Once the batch is finished, all that is left is yellow grease, meal and bone meal.

“As the American Journal of Veterinary Research explains, this recycled meat and bone meal is used as ‘a source of protein and other nutrients in the diets of poultry and swine and in pet foods, with lesser amounts used in the feed of cattle and sheep. Animal fat is also used in animal feeds as an energy source.’ Every day, hundreds of rendering plants across the United States truck millions of tons of this ‘food enhancer’ to poultry ranches, cattle feed-lots, dairy and hog farms, fish feed plants and pet food manufacturers where it is mixed with other ingredients to feed the billions of animals that meat eating humans, in turn, will eat.

“Rendering plants have different specialties. The labeling designation of a particular ‘run’ of product is defined by the predominance of a specific animal. Some product label names are: meat meal, meat by-products, poultry meal, poultry by-products, fish meal, fish oil, yellow grease, tallow, beef fat and chicken fat.

“Rendering plants perform one of the most valuable functions on Earth: they recycle used animals. Without rendering, our cities would run the risk of becoming filled with diseased and rotting carcasses. Fatal viruses and bacteria would spread uncontrolled through the population.

“Death is the number one commodity in a business where the demand for feed ingredients far exceeds the supply of raw product. But this elaborate system of food production through waste management has evolved into a recycling nightmare. Rendering plants are unavoidably processing toxic waste.

“The dead animals (the ‘raw’) are accompanied by a whole menu of unwanted ingredients. Pesticides enter the rendering process via poisoned livestock, and fish oil laced with bootleg DDT and other organophosphates that have accumulated in the bodies of West Coast mackerel and tuna.

“Because animals are frequently shoved into the pit with flea collars still attached organophosphate-containing insecticides get into the mix as well. The insecticide Dursban arrives in the form of cattle insecticide patches. Pharmaceuticals leak from antibiotics in livestock, and euthanasia drugs given to pets are also included. Heavy metals accumulate from a variety of sources: pet ID tags, surgical pins and needles.

“Even plastic winds up going into the pit. Unsold supermarket meats, chicken and fish arrive in Styrofoam trays and shrink wrap. No one has time for the tedious chore of unwrapping thousands of rejected meat packs. More plastic is added to the pits with the arrival of cattle ID tags, plastic insecticide patches and the green plastic bags containing pets from veterinarians.

“Skyrocketing labor costs are one of the economic factors forcing the corporate flesh peddlers to cheat. It is far too costly for plant personnel to cut off flea collars or unwrap spoiled T-bone steaks. Every week, millions of packages of plastic wrapped meat go through the rendering process and become one of the unwanted ingredients in animal feed.

“The most environmentally conscious state in the nation is California, where spot checks and testing of animal feed ingredients happen at the wobbly rate of once every two-and-a-half months. The supervising state agency is the Department of Agriculture's Feed and Fertilizer Division of Compliance. Its main objective is to test for truth in labeling: does the percentage of protein, phosphorous and calcium match the rendering plant's claims; do the percentages meet state requirements? However, testing for pesticides and other toxins in animal feeds is incomplete.

“In California, eight field inspectors regulate a rendering industry that feeds the animals that the state's 30 million people eat. When it comes to rendering plants, however, state and federal agencies have maintained a hands off policy, allowing the industry to become largely self regulating. An article in the February 1990 issue of Render, the industry's national magazine, suggests that the self regulation of certain contamination problems is not working.

“One policing program that is already off to a shaky start is the Salmonella Education/Reduction Program, formed under the auspices of the National Renders Association. The magazine states that ‘...unless US and Canadian renders get their heads out of the ground and demonstrate that they are serious about reducing the incidence of salmonella contamination in their animal protein meals, they are going to be faced with new and overly stringent government regulations.’

“So far, the voluntary self testing program is not working. According to the magazine, ‘...only about 20 per cent of the total number of companies producing or blending animal protein meal have signed up for the program...’ Far fewer have done the actual testing.

“The American Journal of Veterinary Research conducted an investigation into the persistence of sodium Phenobarbital in the carcasses of euphonized animals at a typical rendering plant in 1985 and found ‘... virtually no degradation of the drug occurred during this conventional rendering process...’ and that ‘...the potential of other chemical contaminants (e.g., heavy metals, pesticides and environmental toxicants, which may cause massive herd mortalities) to degrade during conventional rendering needs further evaluation.’

“Renderers are the silent partners in our food chain. But worried insiders are beginning to talk, and one word that continues to come up in conversation is ‘pesticides.’ The possibility of petrochemicals poisoning our food has become a reality. Government agencies and the industry itself are allowing toxins to be inadvertently recycled from the streets and supermarket shelves into the food chain. As we break into a new decade of increasingly complex pollution problems, we must rethink our place in the environment. No longer hunters, we are becoming the victims of our technologically altered food chain.

“The possibility of petrochemicals poisoning our food has become a reality.”

That article is one of the most disgusting things we have ever read.

Meat consumption leaves an acidic residue and a diet of acid forming foods requires the body to balance its pH by withdrawing calcium from the bones and teeth. So even if we consume enough calcium, a high protein, meat based diet will cause calcium to be leached from our bodies.

As children we were taught to eat from the "Four Food Groups". This was merely a marketing concoction by the joint efforts of the Meat and Dairy Associations (which are VERY BIG business) to sell their products.

According to John Stauber and Sheldon Rampton’s article, “The US ‘Mad Cow’ Cover-Up.” Stauber and Sheldon write, “For seven years, the U.S. Department of Agriculture (USDA), the Food and Drug Administration (FDA), and the multi-billion dollar animal livestock industry have cooperated in a PR cover-up of huge health risks to U.S. animals and people.

“For ten years preceding the outbreak of Mad Cow Disease in Britain, the USDA had scientific evidence that a version of the disease existed in U.S. cattle. Yet government and industry have failed, even at this late date, to ban the practice of ‘cow cannibalism.’

“The practice, prohibited in Britain for years, continues throughout the U.S. It is, in fact, more widespread in the U.S. than in any other country. And, as USDA researcher Dr. Mark Robinson points out, ‘the rendering processes employed in the UK and the US are virtually the same.’ The USDA confirms that, for decades, scrapie-infected sheep have passed through U.S. rendering plants.’

“After a decade of official denials, the British government finally admitted that Mad Cow Disease -- responsible for the deaths of more than 160,000 British cattle -- appeared to have migrated into humans who ate contaminated beef and are now dying of Creutzfeldt-Jakob Disease (CJD).

“The British government's acknowledgment that infected beef was the likely cause of death for ten unusually young CJD victims came as grim vindication to Dr. Richard Lacey, a leading British microbiologist whose increasingly desperate warnings that the BSE threat was ‘more serious than AIDS’ have been officially dismissed for the past six years.

“Dr. Lacey predicts that the government's failure to act sooner, combined with the disease's long latency period, could produce 5,000-500,000 human deaths per year in Britain sometime after the year 2000.

“Internal documents and PR plans obtained by PR Watch, via a Freedom of Information Act (FOIA) investigation, show that the U.S. government has sought to protect the economic interests of the powerful meat and animal feed industries, while denying the existence of risks to animals and human.

“In a 1991 internal PR document, the USDA advised officials to use the technical name for the disease. ‘The term “Mad Cow Disease” has been detrimental,’ the document explained. ‘We should emphasize the need to use the term “bovine spongiform encephalopathy” or “BSE.”’

“Mad Cow Disease apparently became an epidemic in England as a result of ‘rendering plants’ -- factories that melt carcasses and waste meat products into protein used in animal feeds, cosmetics, nutritional supplements, medicines, and other products. As little as one teaspoon of feed derived from infected cattle can transmit the disease to another cow.

“In the U.S., plants process billions of pounds of protein from dead cows, sheep, pigs, chickens and other animals into animal feed each year.

“In 1990, the USDA and FDA convened a committee dominated by the cattle, dairy, sheep, and rendering industries. They launched a ‘voluntary ban’ on feeding rendered cows to cows. This was simply a PR maneuver. A similar voluntary ban failed miserably in Britain. The feeding of ruminant protein to cows continues at a rate of millions of pounds per day.

“U.S. government and industry representatives still insist that Mad Cow Disease does not exist in the U.S. Unfortunately, this party line is based on wishful thinking, rather than scientific proof.

“A major U.S. outbreak seems plausible, even likely, unless the U.S. government acts swiftly to outlaw the practice of feeding rendered by-product protein to cows.

“Has a meat borne form of Creutzfeldt-Jakob Disease already spread into the U.S. human population? Despite denials from the federal government, a number of statistically alarming clusters of CJD already have been reported in the U.S.

“In the past, victims of CJD have been misdiagnosed with Alzheimer’s -- a disease afflicting some four million Americans. The beginnings of a CJD epidemic could, therefore, already be hidden within the country's huge population of dementia patients.”

As usual, though, in this country, the bottom line boils down to money and not the public good. In another USDA internal document from 1991, entitled “BSE Rendering Policy,” we read: “There is speculation... that a spongiform encephalopathy agent is present in the U.S. cattle population.” The report concluded that “prohibit[ing] the feeding of sheep and cattle origin protein products to all ruminants... minimizes the risk of BSE. The disadvantage is that the cost to the livestock and rendering industries would be substantial.”

In Michael Greger’s groundbreaking article, “The Public Health Implications of Mad Cow Disease,” we learn: “With scientists like Marsh saying, ‘The exact same thing could happen over here as happened in Britain,’ and with beef consumption already at a thirty-year low, the USDA is justifiably worried. There was even a complaint filed with the FDA concerning a woman with CJD who had been taking a dietary supplement containing bovine tissue. Like England, we have been feeding dead cows to living cows for decades. In fact, here in the U.S. a minimum of 14% of the remains of rendered cattle is fed to other cows (another 50% goes on the pig and chicken menu). In 1989 alone, almost 800 million pounds of processed animal were fed to beef and dairy cattle. Partly because of this, the USDA has conceded that ‘the potential risk of amplification of the BSE agent is much greater in the United States’ than in Britain.

“... Four million Americans are affected by Alzheimer's; it is the fourth leading cause of death among the elderly in the U.S. Epidemiological evidence suggests that people eating meat more than four times a week for a prolonged period have a three times higher chance of suffering a dementia than long-time vegetarians. A preliminary 1989 study at the University of Pennsylvania showed that over 5% of patients diagnosed with Alzheimer's were actually dying from a human spongiform encephalopathy. That means that as many as 200,000 people in the United States may already be dying from mad cow disease each year.”

The cattle that so many folks eat every day not only fatten on the flesh of their fellows, but they also feed on the manure of other species. Feast your eyes on this information from the U.S. News and World Report: “Chicken manure in particular, which costs from $15 to $45 a ton in comparison with up to $125 a ton for alfalfa, is increasingly used as feed by cattle farmers despite possible health risks to consumers... more and more farmers are turning to chicken manure as a cheaper alternative to grains and hay.”

The same story quotes farmer Lamar Carter, who feeds to his 800 head of cattle a witches’ brew of soybean bran and chicken manure: “My cows are as fat as butter balls. If I didn't have chicken litter, I’d have to sell half my herd. Other feed's too expensive.”

Farmer Carter doesn't mention this, but reporters Satchell and Hedges do: “Chicken manure often contains campylobacter and salmonella bacteria, which can cause disease in humans, as well as intestinal parasites, veterinary drug residues, and toxic heavy metals such as arsenic, lead, cadmium, and mercury. These bacteria and toxins are passed on to the cattle and can be cycled to humans who eat beef contaminated by feces during slaughter.”

If they're not being fed on rendered by-products or chicken manure, according to the Satchell and Hedges article, “Animal feed manufacturers and farmers also have begun using or trying out dehydrated food garbage, fats emptied from restaurant fryers and grease traps, cement kiln dust, even newsprint and cardboard that are derived from plant cellulose. Researchers in addition have experimented with cattle and hog manure, and human sewage sludge. New feed additives are being introduced so fast, says Daniel McChesney, head of animal feed safety for the U.S. Food and Drug Administration, that the government cannot keep pace with new regulations to cover them.”

Cattle and hog manure and human sewage sludge as possible foods for the animals eaten by human beings.

Words fail me.

AboutKidsHealth: Pain: Long-Term Effects

Long-Term Effects


Researchers have provided information that can improve the ways in which pain is assessed and treated. At the same time, they have described the previously unknown and negative long-term effects of pain. As a result, pain issues are taken much more seriously today than in the past. The provision of optimal pain relief is now an independent goal of treatment. For example, good pain control in children following surgery allows the child to walk earlier, do deep breathing, and get better sleep, all of which generally promote faster healing.

Acute pain causes a release of "fight or flight" stress hormones. These stress hormones cause a breakdown of body tissues, as well as an increase in heart rate and blood pressure. The end result is a strain on the immune system which can complicate the effects of injury and slow down recovery. For the very young infant, the effects of stress may be associated with significant illness and may affect survival.

Consequences of pain for babies and children
There has been an enduring belief that pain does not have long-term consequences. It is also falsely believed that babies and young children cannot remember painful events. These beliefs have resulted in the notion that pain in a young child is not important in their immediate or future development. However, researchers are accumulating information that indicates that these claims are false.

Some research now suggests that there are long-term consequences of pain in infants. This is especially the case for babies who spend a long time in hospital early in life and undergo many painful procedures without the benefit of any pain relief medication. However, researchers are also showing that the young child’s brain is very adaptable, or "plastic", in the way it deals with painful events. As a consequence, the brain is often able to find ways to compensate for these early pain events. Other research shows that babies who suffer a lot of pain from procedures early on without effective pain relief may go on to develop further pain as they grow older. They may also respond differently to pain during future pain events.

Furthermore, there is some evidence that children whose pain was managed adequately in the hospital are less likely to need to return to the hospital for another visit. They also use other health care services less frequently.

There is a lot more that we need to learn about how pain specifically affects children in the early years of their lives and what repercussions pain has as they develop into older children, teenagers, and adults. At the same time, researchers continue to show that when pain is not appropriately relieved, it has many negative consequences that may be long-lasting.

Other negative effects of long-term pain
Early painful experiences and high doses of morphine frequently leave a permanent imprint on the developing nervous system. Untreated acute pain contributes to an increase in the excitability of the central nervous system. This prolongs pain and creates a biological memory of pain.

Most children do not become used to repeated painful procedures over time. In fact, their anxiety can increase and they may respond with much more negative behaviour when faced with a repeated painful event. If procedural pain, such as getting a needle, is not well managed during the first instance of a procedure, children can develop increased anxiety about the next time they face this or similar procedures. Such increased anxiety leads to greater pain intensity, which may make the management of pain relief medications more challenging.

In summary, the inadequate treatment of pain in babies and children produces not only physiological pain problems, but also psychological, behavioural, and social challenges.

Babies Don't Feel Pain: A Century of Denial in Medicine

A CENTURY OF DENIAL IN MEDICINE...


by David B. Chamberlain, Ph.D.


If the text on this page runs over the border, please adjust the "View"
to a lower percentage (usually 90% or 75% works best).
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Thanks to Dr. Chamberlain for allowing us to share this paper with you!
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Abstract
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During the 20th Century, when medicine rose to dominate childbirth in developed countries, it brought with it a denial of infant pain based on ancient prejudices and 'scientific' dogmas that can no longer be supported. The painful collision of babies with doctors continues today in neonatology, infant surgery without anesthetic, aggressive obstetrics and genital modification of newborn males. This presentation, given in San Francisco on May 2, 1991 includes an historical review of empirical findings on infant pain, some the reasons for physicians' indifference, and speculations about the negative consequences of violence to infants.
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Introduction
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Babies have had a difficult time getting us to accept them as real people with real feelings having real experiences. Deep prejudices have shadowed them for centuries: babies were sub-human, prehuman, or as Luis de Granada, a 16th century authority put it, "a lower animal in human form."
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In the Age of Science, babies have not necessarily fared better. It may shock you to consider how many ways they have fared worse. In the last hundred years, scientific authorities robbed babies of their cries by calling them "random sound;" robbed them of their smiles by calling them "muscle spasms" or "gas;" robbed them of their memories by calling them "fantasies" and robbed them of their pain by calling it a "reflex."
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In this paper, I reflect on the painful impact of medicine on infants over the last century. This is not an easy story to tell. It has been a century of discovery and denial, of promise and disillusionment, and the story still has a very uncertain ending.
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In the 20th Century, infants have had a head-on collision with physicians, typically male physicians. Before this time, they always found themselves in the hands of women: mothers, grandmothers, aunts, and midwives. In the collision, infant senses, emotions, and cognitions were generally ignored. Over the years, doctors paid increasing attention to the pain of mothers but not to the pain of infants. Actually birth become more painful for infants. We must try to understand why.









Experiments with Infant Pain
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Against a back of general (scientific) ignorance of infant behavior, experiments were undertaken as early as 1917 at Johns Hopkins University to observe newborn tears, smiles, reactions to having blood drawn, infections lanced, and to a series of pin-pricks on the wrist during sleep. [1] In these experiments (the first of many), infants reacted defensively. When blood was taken from the big toe, the opposite foot would go up at once with a pushing motion against the other ankle. Lancing produced exaggerated crying, and pin-pricks during sleep roused half the babies to move the hand and forearm. Rough cleaning of the back and head to remove vernix provoked vigorous battling movements of the hands, frantic efforts to crawl away, and angry crying. Psychologist Mary Blanton concluded:
The reflex and instinctive equipment of the child at birth is more complex and advanced than has hitherto been thought. [2].
This line of investigation continued in a series of experiments [3,4,5] at Northwestern University and Chicago's Lying-In Hospital in which newborns were stuck with needles on the cheeks, thighs, and calves. Virtually all infants reacted during the first hours and first day after birth, but the trend, the researchers noted, was toward more reaction to less stimulation from day one through day twelve. As a physiologic finding, this suggested that, at birth, newborns were not very sensitive, but became so gradually. However, they failed to tell us (and apparently overlooked the possible consequences) that all the mothers had received anesthetic drugs during labor and delivery! For the missing information, we are indebted to psychologist Daphne Maurer. [6]
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The Shermans discovered infants would cry in reaction to hunger, to being dropped two to three feet (and caught), to having their heads restrained with firm pressure, or to someone pressing on their chins for 30 seconds. [7,8] Babies tried to escape and made defensive movements of the arms and legs, including striking at the object to push it away. Today, we would see these behaviors as "self-management," an example of "kinesthetic intelligence," but in those days, experts were arguing about whether the head or tail end of a human baby was more sensitive [9]
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Subsequent studies to learn how well infants could feel were directed at the big toe, [10] calf, [11] head, trunk, upper and lower extremities. Especially influential was an ambitious study at Myrtle McGraw [12] at Columbia University and The Babies' Hospital, New York, using pin pricks to reveal the progressive maturation of nerves. Seventy-five infants were stimulated with a blunt sterile safety pin at intervals from birth to four years, and their responses duly recorded (half were recorded on motion picture film). Ten pricks in each area ensured that reactions were sufficiently "intense." (We are not told if the mothers had received anesthetics.)
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McGraw reported that some infants a few hours or days old showed no response to pin prick. The usual response, she said, "consists of diffuse bodily movements accompanied by crying, and possibly a local reflex." In spite of the fact that these babies did react, did cry, and did try to withdraw their limbs, Dr. McGraw concluded there was only limited sensitivity to pain and labeled the first week to ten days a period of "hypesthesia" (abnormally weak sense of pain, heat, cold, or touch.) Her reference to "a local reflex" reflected the common medical view that reactions were mechanical and had not mental or emotional importance. In the discussion section of her paper, she reveals the belief behind the interpretations:
Even when there is sensitivity is it reasonable to assume that neural mediation does not extend above the level of the thalamus. [13]
To physicians, McGraw's work seemed thoroughly scientific and justified the continuation of painful encounters between physicians and newborns. In retrospect, the conclusion that infants were somehow not yet sensitive to pain was a prejudiced interpretation, which fit comfortably into the traditional view expressed in medical journals reaching back into the 19th Century. [14,15] In recent research, newborns and older babies pinched on the arm reacted instantly to the pain: [16] No suggestion of "hypesthesia." There were more pin-prick experiments. In 1974, in ignorance of the experiments already performed Rich tested 124 full-term babies to determine the "normal response" to a succession of pin pricks around the knee. They concluded that: "The normal response is movement of the upper and lower limbs usually accompanied by grimace and/or cry." [17]
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All infants demonstrated the "complete" response after six or fewer pin pricks. [18]
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A different method for studying infant pain was to run water of different temperatures through cylinders attached to the baby's abdomen, leg, or forehead while filming their reactions as the water was made hotter or colder. This line of research began in Europe in 1873 and was taken up in America by Pratt, Nelson & Sun at Ohio State University [19] and by Crudden at the University of Michigan Hospital in 1937. [20] Babies reacted violently, especially to cold water. Crudden found that any deviation from normal body temperature produced immediate respiratory and circulation changes in all subjects: No sign of "hypesthesia" here either.
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Do Babies Really Feel Pain?
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Do babies feel pain? I certainly think they do, but, to find out, we should not have stuck them with pins. There are other objective indications of pain.
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1. Crying. It seems perfectly obvious now, but for a long time, experts were informing the public that infants cries were only "random" sounds, not genuine communications. It took a quarter century of cry research to prove otherwise. [21] Cries are not only meaningful signals, but often compelling ones. They increase in intensity with degrees of pain. Spectrographic studies that reduce sound to an elaborate visual portrait show just how varied and complex cry language is. [22] Acoustic studies show that changes in pitch, temporal patterning, and harmonic structure also reflect the degree of pain and urgency. For example, in a thorough study of cries during circumcision, acoustic features precisely reflected the degree of invasiveness of the surgery. [23]
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Parents present at circumcision (a rarity) have recalled how their babies cried. One father, present in the delivery room told me of his great surprise when the obstetrician proceeded to circumcise this boy at delivery. Having been quiet through the entire birth, the boy proceeded to protest loudly about the circumcision! A Jewish father, reflecting on this boy's circumcision on the eighth day, said it was the saddest occurrence of his babyhood: the boy cried more that afternoon, he said, than anytime in his whole first year.
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2. Facial expressions. Second, the pain that babies feel is clearly expressed on their faces. [24] Brows bulge, crease, and furrow. Eyes squeeze shut: bulging of the fatty pads about the eyes is pronounced. There is a nasolabial furrow that runs down and outwards from the corners of the lip. Lips purse, the mouth opens wide, the tongue is taut, and the chin quivers. This look on a human face of any age communicates pain. Why do we doubt that it means the same on the face of a baby?
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3. Body movement. Body language in its larger motor dimensions is also a language that babies share with older humans. In response to pain, babies jerk, pull back, try to escape, swing their arms, use their hands to push away, and frantically scrape one leg against the other to dislodge an offending stimulus in that area. They strike out with their upper extremities and kick with the lower. Fitzgerald and Millard [25] made close observations of babies receiving routine heel lancing, a deep wound made in the heel to obtain blood samples. Using calibrated hairs, they gently stroked the corresponding areas in the injured and non-injured heel. Even premature infants showed the same well-defined hypersensitivity to tissue injury that is found in adults.
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4. Vital signs. Fourth, we can see how baby pain is revealed by changed in vital signs and blood chemistry. Pain causes increased respiration. Babies hold their breath and release it in piercing cries. Researchers have observed infant heart rates increase 50 beats per minute and peak above 180 beats per minute. [26,27,28] In a study to compare behavioral states of the newborn to those of the fetus, Pillai and James [29] discovered that the heart rate during newborn crying was unlike anything seen in prenatal life. This racing heartbeat was unstable, often reaching peaks in excess of 200 bpm, in spite of the fact that baseline heart rates after birth are generally 20-25 bpm lower than they are in utero. These extremely elevated heart rates signal a serious and urgent disturbance.
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Serum cortisol is a measure of stress. In painful conditions, adrenals may release cortisol three to four times the baseline. [30, 31,32,33] In one study, cortisol levels clearly differentiated between three different surgical techniques of circumcision. [34]
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Under painful conditions, tissue and blood oxygen levels drop. [35]
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5. Neurobehavioral assessments. Further consequences of infant pain can be seen in neurobehavioral assessments. Babies who have been subjected to pain may have difficulty quieting themselves. Following circumcision, the normal progression of sleep cycles is reversed with immediate and prolonged escape into Non-REM sleep. [36] After circumcision, babies withdraw, change their social interactions with their mothers, and modify their motor behavior. [37]
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Als, Lester, and Tonic [38] developed an Assessment of Preterm Infants' Behavior, which includes a list of infant behaviors indicating stress and defense. Behaviors indicating pain include seizuring, tremoring, spitting up, trunk arching, finger splaying, fisting, squirming, inconsolability, and restlessness.
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6. Memory. Finally, we know that newborns feel pain because they sometimes remember and speak of painful experiences as soon as they acquire sufficient language. [39] At age two, my granddaughter, talking about her birth, asked her parents, "Why did they poke me with a thing?" Her mother asked, "What thing?" "Like a pencil," she said, "they hurted me." She was probably referring to heel lancing, done routinely in American hospitals at birth. Various studies have shown that lancing is always painful. [40,41,41] Other such spontaneous memories of birth pain have surfaced, as I have shown by the collection of stories in chapter seven of my book, Babies Remember Birth. [43]
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Adults also remember, although reports are rare. Three men have told me they have always remembered their circumcision in infancy. Another man, Keith, of Dallas, Texas, remembers that he was born with an open abdomen. He says he has always remembered that surgery and the emotions he felt at the time.
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We may not like to think babies feel pain, but they do.
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Birth Has Become More Painful For Babies
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Ironically, in the hands of 20th century physicians, birth itself has become more painful for babies. Generally, doctors have not been concerned about babies' pain. They have been more concerned about fetal distress (heart rate fluctuations signaling distress) than about neonatal distress.
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1. The pain of hospital birth. In the last half century, hospital birth has become the standard birth for the majority of Americans. From a baby's point of view, it is a new type of childbirth characterized by a series of painful routines surely not designed with sentient babies in mind. Sources of pain include: scalp wounds for electronic monitoring and blood samples during labor, forceps extraction (made more frequent now by epidural anesthetics), extreme spatial disorientations, being held upside down by the heels, frigid scales and utensils in a room 20 degrees lower than the womb, bright lights, noise, heel lancing, vitamin injections, astringent eye medications, irritating wiping and washing, sudden separation from their mothers, and banishment to a nursery of crying babies, all of it distinctly painful and upsetting and a flagrant violation of the baby's senses. Obstetricians defend all these practices, calling them necessary and "the best of care."
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2. Pain in the womb. Even prior to birth, conditions exist which can provoke crying. When air is available to the fetal larynx, it is possible to hear a cry. "Squalling in the womb" (known as vagitus uterinus) is a dramatic signal of fetal pain, rare but well documented over many years. [44,45,46] Virtually all modern cases of fetal crying are subsequent to obstetrical manipulation: tests, versions, deliberate rupture of the amniotic sac, and attachment of scalp electrodes or taking scalp blood while the baby is still in the birth canal. The fact that 20% of these squalling babies die is testimony to the meaning and the urgency of their cries. [47]
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3. Pain of Neonatal Intensive Care. Premature and dangerously ill newborns face pain and peril trying to complete gestation in a neonatal intensive care unit. [43,49,50,51] For a comprehensive review of the many stresses babies face in this man-made womb, see Gottfried and Gaiter, 1985. [52]
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Pain is a way of life as babies are tied or immobilized while breathing tubes, suction tubes, and feeding tubes are pushed down their throats. [53] Tubes, needles, and wires are constantly stuck into them; their delicate skin is easily burned with alcohol prior to venipuncture or accidentally pulled off when adhesive monitor pads are removed. [54,55] The need for gentle and maternal interactions with the babies is only partly met. [56,57,58] Psychological strategies and principles of care, urgently needed in this intense, technological environment, are slowly making an appearance. [59,60,61]
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NICU graduates are not necessarily healthy. Mortality and morbidity are high. They suffer emotionally, [62] cognitively, [63] and in their neuromotor development. [64] Life in a neonatal intensive care unit is a mixed blessing, [65] and presents agonizing problems of public policy and medical ethics. [66]
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4. Pain of Surgery Without Anesthesia. Hospitalized newborns, from preemies to babies up to 18 months of age, have been routinely operated upon without benefit of pain-killing anesthesia. This has been the practice for decades but was unknown to the general public until 1985 when some parents discovered that their seriously ill premature babies had suffered major surgery without benefit of anesthesia. [67,68,69,70,71,72] Up to this time, babies were typically given a form of curare to paralyze their muscles for surgery, making it impossible for them to lift a finger or make a sound of protest!
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Jill Lawson reported that her premature baby, Jeffrey, had holes cut in both sides of his neck, another in his right chest, an incision from his breastbone around to his backbone, his ribs pried apart, and an extra artery near his heart tied off. Another hole was cut in his left side for a chest tube, all of this while he was awake but paralyzed! The anesthesiologist who presided said, "It has never been shown that premature babies have pain." [73]
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Mrs. Lawson was describing the most common surgery done on premature babies, thoracotomy for litigation of the patent ductus arteriosus, which experts taught could be "safely accomplished with oxygen and pancuronium as the sole agents. [74]" After the parents told their story with the help of nation-wide television, radio, and print media, the ethics of these practices was seriously discussed for the first time. [75,76,77,78,79] Resisting change, some doctors continued to argue that "following major operations, most babies sleep," and that "all we need to do is feed them..." [80]
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Surveys taken of policies and practices of infant surgery in the United Kingdom and the United States revealed ambivalence about whether infants really needed anesthesia or would be endangered by it. [81,82] Although some hospitals reported twenty years of successful use of anesthesia with infants, [83] surveys of common practice revealed infrequent use of anesthesia, under-utilization of anesthesia, and the lack of policies on the subject. [84,85]
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Key medical objections to infant anesthesia -that it was (a) unnecessary and (b) dangerous -were resolved by the brilliant research of Kanwal Anand and colleagues at Oxford from 1985 to 1987. Making precise measurements of infant reactions to surgery, they proved that the babies experienced pain, needed and tolerated anesthesia well, and had probably been dying of metabolic and endocrine shock following unanesthetized operations. [86,87,88]
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When these findings arrived in the midst of the parent rebellion, official bodies of physicians began to acknowledge the need for change and promised to five neonates the same consideration in surgery as they gave to other patients, [89] ending 140 years of discrimination. This was a milestone, but not a guarantee. We have no way to predict just how many doctors and hospitals actually follow these policies. Historically, announcement of new policy by a guild has not always affected the practice of individual members. [90]


The Selling of Circumcision
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Circumcision has been a scandal for centuries, but like the scandal of neonatal surgery without anesthesia, it is a particular scandal of the 20th Century. Nowhere on earth has the sheer number of suffering infants been greater than in the United States where generations of newborn boys have been routinely circumcised without anesthesia. Over the last three decades, the rate has fallen from over 90% (an incredibly large social experiment) to around 60%, affecting over one million baby boys per year.
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Apparently, this sexual rite originated some 4,000 years ago as a tribal and religious symbol in Semitic cultures. However, psychohistorian Lloyd DeMause [91] sees circumcision as only one of numerous acts of genital mutilation and violence perpetrated on infants and children in virtually every culture since the earliest times. Because it involves sexual mutilation in the family circle, he classifies it as incest and identifies it as an adult perversion.
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Others believe that circumcision is a violation of the United Nations Convention on the Rights of the Child, Articles 19 and 37, which call for protection from physical injury and abuse, torture and cruel treatment, and from harmful traditional practices. [24] The treaty went into effect in September 1990.
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Ironically, it was modern obstetricians who gave the practice new status, sanctifying it as a "medical" procedure. Thus legitimized, circumcision became all but universal in many Western countries, a trend that has taken a long time to reverse. In Australia, where doctors have taken an official stand against it, the rate has fallen below 25%. In England, medical warnings [92] helped to bring the percentage down to single digits.
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A century ago, the physician Remondino made an evangelistic appeal for circumcision, calling the prepuce "a maligned influence causing all manner of ills, unfitting a man for marriage or business and likely to land him in jail or a lunatic asylum." [93]
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According to him, "...circumcision is like a substantial and well-secured life annuity; every year of life draw the benefit...Parents cannot make a better investment for their little boys, as it assures them better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctors bills..." [94]
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Alleged dangers of the intact foreskin, listed by Clifford in 1893, [95] included penile irritation, phimosis, interference with urination, nocturnal incontinence, hernia or prolapse of the rectum (from a tight foreskin!), syphilis, cancer, hysteria, epilepsy, chorea, erotic stimulation, and masturbation.
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In modern times, dire warnings are still clothed in medical language: the dangers of the foreskin now include contracting sexually transmitted diseases, urinary tract infection, and penile cancer. Not one of these conditions is caused by the foreskin or cured by circumcision. Male urinary tract infection is very rare and can be treated medically. The incidence of penile cancer is also rare, even in Japan and Denmark where most men have not been circumcised. Actually, each year more deaths are caused by the complications of circumcision than from cancer of the penis. [96] Another "medical" argument for circumcision is that it lowers the rate of cervical cancer in future sexual partners. the fact that nuns have a higher rate of cervical cancer than wives and other sexually active women makes circumcision irrelevant.
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In a comprehensive appraisal, a government epidemiologist [97] finds that circumcision lies outside the province of modern surgery, selects patients illogically, neglects the requirement of informed consent, wastes public health funds, disregards pain, has dubious objective, and is too radically done by inappropriate operators.
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Actually, no purported medical benefits can possibly justify the routine mutilation of baby boys. For other voices of reason on the subject, see Winberg et al., 1989; [98] Snyder, 1989; [99] Altschul, 1989; [100] Romberg, 1985 [101] and 1989; [102] Ritter, 1992. [103]
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A new trend in research and journal publication is encouraging. Recent articles report the precise measurement of stress during circumcision and compare various forms of anesthesia for relief of pain. [104. 105,106,107] One can see a growing sympathy for the infants, full acceptance of their pain, serious doubt about performing circumcisions, and strong recommendations for pain relief. [108,109,110]
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New in the literature is any consideration of sexual and psychological losses from having been deprived of a sensitive and functional portion of the penis, having been betrayed by mother and father, and the impact of torture shortly after delivery from the womb. [111,112]
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In exploring the extent of physician influence on parental choice for circumcision one survey showed that when the doctor was opposed, the circumcision rate fell to 20%, but when he was in favor, the rate was 100%. [113] By contrast, when four pediatricians in Baltimore gave medical information about the "risks and benefits" of circumcision to half the young mothers in an inner city clinic and none to the other half, they were surprised to find that virtually all the mothers in both halves ended up choosing circumcision. They concluded that deep cultural and traditional issues were working against a change in attitude in their group. [114]
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Surveys examining parental motives for requesting circumcision have revealed similar cultural pressures: they care about appearances, yield to pressure from relatives, misunderstand the medical "benefits," and hold a variety of false notions that circumcision is mandated by the hospital, by public health law, or is required for admission into the Armed Forces. [115,116] Parents do not usually know their infants will suffer.
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If this form of sexual violence to newborns is to end anytime soon, success will probably require one or more of the following: (1) massive consumer education leading to public revolt against a painful ritual with no benefit; (2) application of national and international child abuse statutes to forbid sexual alteration of newborns and any form of infant torture; (3) a requirement that both parents be present to observe and circumcision performed on their babies; or (4) a rebellion of obstetricians themselves, actively opposing circumcision and refusing to perform the operation. Any one of these would go a long way toward ending a century of scandal for both parents and doctors.










Why Such Indifference to Infant Pain?
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A look at the literature on infant pain is both discouraging and hopeful. An analysis of the ten most commonly used textbooks in pediatrics [117] revealed that pain was a topic virtually ignored. In 15,000 pages of text, they could find only three and a half pages devoted to pain. Noted French obstetrician Frederick Leboyer's bestseller, Birth Without Violence, [118] stands practically alone in its concern for the pain babies feel at birth. In my own collection of journal articles dealing with infant pain, I can count only twenty during sixty years from 1920 to 1980. However, in the 1980s alone, I have collected 44 studies, reflecting a great surge of interest.
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We must wonder why there has been such widespread denial of neonatal pain in medicine.
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1. Because they were men? Historically, men have been the surgeons and the circumcisers of little babies. Until recently, few physicians were women: even these were trained by male doctors and were obligated to accept masculine doctrines and protocols. In society at large, men have been notoriously violent, comprising at least 90% of all persons arrested for homicide.
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Would women perform operations without anesthesia? Nurse anesthetists assist. Jeffrey Lawson's anesthesiologist was a woman. Would mothers circumcise their own sons? It seem unlikely, yet mothers have been willing to let others do so. Further, in many countries of the African continent, mothers participate regularly in female genital mutilation of their daughters. This includes excision of the clitoris (sometimes also the labia) and infibulation, the sewing up of the vaginal opening. [119] Mothers describe these brutal surgeries as necessary and harmless (much as physicians have described male circumcision).
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Their motivations, like those behind male circumcision, are erroneous: they fear the clitoris would get longer and longer until it was like a penis, they claim that these female parts are ugly; they maintain a woman's external genitalia endanger babies and husbands, and contaminate mother's milk. Sewing up the vaginal opening is used as a seal of virginity, which is a cultural prerequisite for marriage. The World Health Organization is determined to eliminate female genital mutilation, and women's groups have mounted educational campaigns. [120]
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Jill Lawson, one of the leaders of the parents' campaign of the mid 1980s to shield infants from surgical pain, questions why doctors did not react as individuals. In the New England Journal of Medicine, she writes:
I cannot help but wonder how such a situation came to develop...If I had been told by a physician, no matter how senior, that infants don't feel pain, I would never have believe it. What constitutes the difference between my reaction and that of the thousands of physicians who did believe it? [121]
2. Were they trying to be scientific? Another possible reason for such flagrant indifference was that these men and women were trying to be objective rather than subjective; being objective was considered ideal, but this had unfortunate consequences in the blocking out of unpleasant realities, the blunting and denial of feelings.
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Ironically, while cultivating objectivity, these doctors were still unable to accept objective findings when they were made. Why was it so hard for them? Why should doctors have to go to a library to find out if babies feel pain? Why did they not believe what they saw with their own eyes and hear with their own ears? Being already sure that the infant brain was inadequate, they simply dismissed evidence for pain.
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Perhaps they were not trying to be scientific so much as they were trying conform.
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3. Tradition. Traditional beliefs in the guild of surgeons have indeed had a powerful influence.
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One very old belief was that pain is good, necessary, part of healing, a sign of life, and perhaps even sacred. For example, 26 years after the first application of ether vapors in surgery, a prominent New York gynecologist rhapsodized: "The baptism of pain and privation has regenerated the individual's whole nature...by the chastening, made but a little lower than the angels." [122]
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In that light, it may not be so surprising that, after the anesthetic properties of ether were demonstrated in 1846, surgeons developed an elaborate calculus to decide who "needed it." As many as a third of amputations were still done without anesthetic! The process of selection was deeply prejudicial. You can guess who got anesthetic and who did not. Among those who did not were blacks, redskins and the Chinese, immigrant Germans and Irish, many soldiers and sailors, the "hardened" urban poor, and "tough" country women. Those who did get anesthetic were the well-off, the well-educated, and the "artistic" urban woman. When it came to infants, surgeons were never sure.
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The majority view was penned back in 1848 by Henry Bigelow, writing in one of the first publications of the new American Medical Association. He wrote that babies had "neither the anticipation nor remembrance of suffering, however severe," making anesthesia unnecessary for them. Like most of his colleagues then and since, Bigelow believed the ability to experience pain was related to intelligence, memory, and rationality. Like the lower animals, the very young lacked the mental capacity to suffer.
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A view with strong similarities - that babies do not feel pain as we do - was recently asserted again by a developmental psychologist. [123] This is reminiscent of an earlier view that Jews or blacks do not feel or do not suffer "as we do." The campaign for infant rights is not over yet.
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A fundamental dogma keeping doctors from recognizing infant pain sprang directly for their study of anatomy: the newborn brain was incomplete and unprepared for learning, memory, and meaning. The early brain was thought to be primitive; only the late brain (cerebral cortex) was capable of complex activity, and this part of the brain was not complete by birth. These myths hurt infants badly.
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4. Professionals missed the baby as person. Finally, it was the reluctance of both medical and psychological professionals to see the perinatal infant as a self with mind that encouraged continued indifference toward pain. [124,125] If babies were not people, their suffering was not meaningful and could be dismissed. If babies could not think, the mortification of the body could proceed. Reluctance to consider the reality of the newborn mind/person apart from the brain is a glaring example of materialism -a person was his or her brain matter. All that mattered was brain matter.
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This reigning philosophy not only led to violations of dignity and needless suffering, but to mistaken clinical judgments. When assessing the impact of surgery without anesthesia, for example, physicians saw babies fall asleep after surgery and assumed they were all right. If a pale baby regained color, or if blood pressure returned to normal 24 hours after surgery, the surgery and the baby must be okay, as if the experience of pain could go away like a rash.
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The Chairperson of the Task Force on Circumcision of the American Academy of Pediatrics said of circumcision that "responses are short-lived, lasting only minutes to hours, and there is no evidence of long-term sequelae." [126] Missing from this view is any understanding of the psychological sequellae of torture. More than a decade before, psychologists had pointed out that the effects of circumcision are so profound that researchers had mistakenly attribute certain behaviors to gender when they were probably due to circumcision. [127]
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When babies received anesthesia indirectly via mothers at birth, obstetricians judged the effect of it by superficial observations of how the baby looked, showing no appreciation for invisible phenomena associated with emotions and psyche. It was only after decades of refinement in psychological testing and observation of neonates that the effects could be properly calculated. [128,129,130]
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Obstetricians and pediatricians were likewise naive about the suffering of infants (and mothers) as a result of being routinely separated after delivery, [131,132,133] These psychological realities have been further illuminated by psychological trauma, writes:
In infants who are separated from their mothers, changes have been observed in hypothalamic serontonin, adrenal gland catecholamine synthesizing enzymes, plasma cortisol, heart rate, body temperature, and sleep. These changes are not transient or mild, and their persistence suggests that long-term neurobiological alterations underlie the psychological effects of early separation. [134]
According to van der Kolk, disruptions of attachments during infancy can lead to mental illness featuring, typically, a biophasic protest/despair response correlated with erratic activity of neurotransmitters. This damage may result in panic attacks and cyclical depressions; To van der Kolk, the essence of psychological trauma is the loss of faith in the order and continuity of life and loss of a safe place from which to deal with frightening emotions. The result is a feeling of helplessness.
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Others have pointed to circumcision as a breech of trust. [135,136] But this concept only has meaning if you consider the baby as a person.
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Conclusions and Recommendations
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1. Pain is a universal language that can be understood by its vocal sounds, facial expressions, body movements, respiration, color, and even its crashing metabolism. Babies speak this language as well as anyone. We should listen seriously and react appropriately.
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2. Pain is as real and upsetting to babies as it is to the rest of us. The myth that their pain is not like our pain is ancient, insidious, and harmful. We should reject it.
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3. Pain makes a deep impression; babies are probably more impressionable than older children and adults. Protecting them from the impact of pain would prevent personal suffering at the beginning of life and the need for psychotherapeutic repairs later.
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4. The earlier an infant is subjected to pain, the greater the potential for harm. Early pains include being born prematurely into a man-made "womb," being born full-term in a man-made delivery room, being subject to any surgery (major or minor), and being circumcised. We must alert the medical community to the psychological hazards of early pain and call for the removal of all man-made pain surrounding birth.
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5. Physicians have made birth routinely painful for newborns, believing that they would not feel, not care, not remember, and not learn from painful experiences. In effect, they denied pain, and they failed to recognize babies as persons.
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6. Obstetrics was constructed on a false psychology, born in the 19th Century and generally indifferent to the mind of the newborn. The question is: Can obstetricians construct anew approach to infants on the foundations of a new psychology of babies who feel, think, learn and remember?
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About the Author
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David B. Chamberlain, Ph.D., is a psychologist (Boston University, 1958), author, and long-time leader of the Association of Pre-and Perinatal Psychology and Health ( serving as co-founder, former president, former newsletter editor and current website editor). His special contributions include original research on the reliability of birth memory (1980), a dozen scholarly papers on the capabilities of unborn and newborn babies, and the popular book for parents, "Babies Remember Birth" (republished in 1998 in a 10th anniversary edition as "The Mind of Your Newborn Baby," ISBN 1-55643-264-X, $14.95, North Atlantic Books). He was the 1999 recipient of APPPAH's prestigous Thomas Verny Award and a broad sampling of his work was compiled in a special edition of the APPPAH Journal in the fall of 1999. For his other papers and books, send email inquiries to him at .
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References
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1. Blanton, M.G., "The Behavior of the human Infant in the First 30 Days of Life," Psychological Review, vol. 24, no. 6 (1917): pp.456-483.
2. Ibid.
3. Sherman, M. & I. Sherman. "Sensori-motor Responses in Infants. Journal of Comparative Psychology vol. 5 (1925): pp.53-68.
4. Sherman, M. "The Differentiation of Emotional Responses in Infants. I. Judgments of Emotional Responses from Motion Picture Views and From Actual Observations," Journal of Comparative Psychology, vol. 7, no. 4 (1927): pp. 265-284.
5. Sherman, M., I. Sherman, C. Flory. "Infant Behavior," Comparative Psychology Monographs, vol. 12, no. 4 (1936): pp. 1-107.
6. Maurer, D. & C. Maurer. The World of the Newborn. New York; Basic Books. 1988.
7. Sherman, M. "The Differentiation of Emotional Responses in Infants. I. Judgments of Emotional Responses from Potion Picture Views and from Actual Observations." Journal of Comparative Psychology, vol. 7, no. 4 (1927): pp. 265-284.
8. Sherman, M., I. Sherman, C. Flory. "Infant Behavior," Comparative Psychology Monographs, vol. 12, no. 4 (1936): pp. 1-107.
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