Monday, December 25, 2017

ATI Wisdom Booklet: STD's, Cervical Cancer and Infant Vitamin K levels

These Wisdom Booklets are full of shoddy facts - but thankfully, most of them will not kill people.  People can and do live fulfilling lives in spite of knowing nothing about evolution or the Second Law of Thermodynamics. 

Unfortunately, the same Wisdom Booklet that contains the Evils of Evolution also has a medical section that makes some outlandish, mistaken and potentially lethal claims about sexually transmitted diseases, cervical cancers and infant production of Vitamin K after birth. 

The section covers random Old Testament Laws that pertain cleanliness and purity and attempts to prove that there's a valid medical reason for each of them.  The writer manages to stretch the list into seven items by covering the idea that blood can transmit diseases in three separate items,  implying that cud-chewing ruminants have less parasites and diseases than other animals in two separate items, applying bio-amplification in food chains to the animals that are forbidden in the Bible, and stating that eating fat leads directly to heart disease. 

Unfortunately, most of those are simply wrong.
  • Blood can transmit diseases - but it's a poor vector compared to oral-fecal and airborne routes.  
  • Pigs that free-range and have access to carrion are at much higher risk of parasitic diseases than grass-eating ruminants - but that's because the pig is an omnivorous trash can.  Kept reasonably contained and fed pig food, table scraps, waste milk, forage crops etc., and you get a parasite free piggy.
  • The Bible forbids some animals that do bio-amplification like mussels - but left in cows.  In the US, the most dangerous food for bio-amplification for generations was milk or meat after cows ate milk snake-root.  (Oops.)
  • The fat = heart disease theory was in vogue when the Wisdom Booklet was written - but it's not particularly accurate.   Heart disease has many causes and many interlocking parts.
Eight and nine, though, are just plain dangerous.
Let me give a quick rundown of the real history of the discovery of the connection between human papillomavirus (HPV) and cervical cancer.  First, doctors studying cervical cancer had noticed a strange phenomenon.  Women who had never had sex had extremely low rates of cervical cancer - way lower than rates of women who had had sexual intercourse.  One example - although not the only - were groups of monastic nuns who volunteered their bodies to science.  Their rates of cervical cancer were non-existent.   

On the other hand, the rate of sexual partners to rate of cervical cancer wasn't directly correlated - no matter what the ATI booklet wants to imply - for reasons that are pretty obvious once the HPV connection was made.  Some women have a single sexual partner who gave them HPV.  Other women have multiple partners but never contracted HPV.  Some women who have HPV develop cervical cancer while others do not. 

The discovery of HPV and cervical cancer was found after this booklet was published - but women had a perfectly good screening method for cervical cancer known as a Pap smear.  In fact, women still receive Pap smears after testing negative for HPV every 3-5 years to catch non-HPV cervical cancers early enough for non-invasive treatment.  Nowadays, we have the HPV vaccine for teens which greatly reduces their risk of cervical, penile, oral and neck cancer which is a great advancement.

Women can be allergic to their husband's semen.  That's  a real phenomenon - but women KNOW when it happens.  Vaginal skin develops the same reaction that all skin does after an allergic reaction - red, itchy, burning irritated skin.  It's pretty rare - and has no relation to cervical cancer.

Nothing like a creepy clip-art to bring home the point.


Um...kind of. 

Look, I'm old enough to realize that just because one spouse is monogamous doesn't mean that their spouse is.  Good behavior doesn't protect innocent people from other people's bad behavior.  

Condoms work quite well to prevent STDs as well.

HIV is transmitted through sexual activity - but it can also be transmitted by intravenous drug use, accidental needle sticks or from blood transfusions prior to modern donor screening.


In fairness to the inhabitants of Canaan, their main sin was worshiping other gods.   I think that the last sentence is supporting the anti-circumcision argument that an intact foreskin has more sensitivity - but the sentence unclear.    The most current AAP recommendation on infant circumcision is that parents should make decisions based on their cultural, religious and social beliefs.  

Again, there's a weird mix of truth and lies mixed together. 

Yes, uncircumcised men have to clean under the foreskin.  The foreskin doesn't retract immediately in young boys so that's not an large problem before the kid is old enough to learn how to clean his penis.   On the other hand, some circumcised boys have a foreskin remnant that needs to be cleaned under until the penis grows enough that it is permanently retracted.  Either way, we are not taking about a major difference in personal hygiene.

Uncircumcised men do have slightly higher rates of STDs including HIV - but the difference can be eliminated by the use of condoms in non-monogamous relationships.  Uncircumcised men have higher rates of cancer of the penis - but that's a super-rare cancer.

Oh - this next one might kill a kid pointlessly.




Human infants are born with very low Vitamin K levels.  Vitamin K doesn't cross the placenta well.  The bacteria that produce Vitamin K in the digestive tract don't produce large amounts of Vitamin K until solid foods are introduced at between 4-6 months.   

The real danger of low Vitamin K levels in infants isn't due to visible surface cuts.  First, the body has an entirely different clotting cascade that happens when skin is cut.  Second, parents are surprisingly good at connecting "My baby is covered in blood" with the response of "Get medical help immediately!".   No, the real danger is bleeding into the brain or intestines.  That can lead to a very, very ill baby before parents realize the problem.

There's a mindlessly easy solution: newborns are given a large injected dose of Vitamin K after birth - assuming their parents do not withhold consent due to mistaken beliefs in the power of cuddling.
Argh.  The mix of truth and lies gets under my skin. 

True: Vitamin K is fat-soluble; that's why doctors can give newborns a shot of Vitamin K that lasts for 6 months.  Fat-soluble vitamins do need fat to be absorbed by the body. 

Lies: Human breast-milk has very low levels of Vitamin K regardless of the fat content.  Assuming your child is a healthy, term baby, no one is going to interfere with breastfeeding let alone insist on antiseptic contact.  (Heck, even with my micro-preemie son, we were encouraged to clean under our nails, wash to the elbow for 30 seconds and use hand sanitizer at his bedside.  It's more than need for a term baby - but hardly over the top.)
No one's against circumcision on the 8th day after a son is born - but get the Vitamin K shot first.

Merry Christmas!

6 comments:

  1. How can a couple deal with semen allergies?

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    1. Most simply use condoms during sex. Conceiving can be a bit trickier - but with things like ovulation prediction kits the couple can narrow down the window over which they need to have sex. Artificial reproductive techniques like intrauterine insemination work well, too.

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    2. Oh gosh, thank goodness it's pretty rare.

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  2. I'm curious: who do they recommend to perform the circumcision? A trained doctor in a hospital? Or, as per biblical law, a mohel? I had my kids in NYC and even there, no mohel would circumcise a non-Jewish infant.

    It was done by my fabulous, well-trained OB-GYN. Plus, one son bled slightly at circumcision (done on the fourth day) and did not die. (He's a healthy 25 year old today...)

    TL:DR. These people are totally inconsistent even within their own belief system.

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    1. They don't have a specific recommendation - but I would hope they would use a pediatrician or someone who has the required training to deal with the rare emergencies. My son was circumcised by the neonatalogist who was on "minor elective surgical duty" that day. I remember that because when I showed up at the NICU the day before my son's nurse starts the day with "Don't let me forget to check with you about circumcision" and I replied "He's going home!?!?!?" They put off circumcision until the last possible moment in the NICU to minimize the chances of an hospital acquired infection - and sure enough, he came home about 5 days later.

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    2. I remember the excitement we felt when my extremely premature niec finally came home from the NICU. I am so glad your boy is home with you....

      I've been thinking about your comment on the mix of truth and lies. I wonder if they do this on purpose. It makes it harder to refute their assertions because you have to disentangle the facts from the fiction. I sometimes find it much harder to explain to students which bits of historical fiction are accurate and which are completely made up for the storyline....

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