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» Ship of Fools   » Community discussion   » Purgatory   » Church, drinking cultures, and the exclusion of teetotalers (Page 5)

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Source: (consider it) Thread: Church, drinking cultures, and the exclusion of teetotalers
Ricardus
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quote:
Originally posted by mdijon:
absolutely no evidence that moderate alcohol use during breastfeeding is harmful at all.

Fwiw (not much), my wife was advised that although alcohol does indeed pass into the milk, the dilution is at the level of a shot of vodka poured into a swimming pool.

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Then the dog ran before, and coming as if he had brought the news, shewed his joy by his fawning and wagging his tail. -- Tobit 11:9 (Douai-Rheims)

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mdijon
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Downing vodka shots in the swimming pool sounds like the right way to facilitate breastfeeding to me.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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chris stiles
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quote:
Originally posted by cliffdweller:

Well, but the studies that have been done find these same symptoms among children removed from the home and adopted by non drug-addicted parents. I don't think you can dismiss the substantial evidence of fetal alcohol syndrome as a Real Thing.

I'm not dismissing it as a Real Thing, I'm pretty sure it is. I was just contesting the idea that it was necessarily the only thing to blame in the particular scenario described given the particular set of circumstances that were laid out.
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lilBuddha
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quote:
Originally posted by Moo:
quote:
Originally posted by lilBuddha
Alcohol is a poison. In moderate amounts it does not seem to be excessively detrimental to adults. This does not automatically translate to children.

Why risk it?

Because without very small amounts of alcohol, some women can not manage to breastfeed.

Moo

If you read the link I supplied above, it is the barley not the alcohol. Indeed, according to one of the links I posted, the alcohol has an opposite effect.

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So goodnight moon, I want the sun
If it's not here soon, I might be done
No it won't be too soon 'til I say goodnight moon

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Moo

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quote:
Originally posted by lilBuddha:
If you read the link I supplied above, it is the barley not the alcohol. Indeed, according to one of the links I posted, the alcohol has an opposite effect.

Leorning Cniht reports that his wife got the same effect from a small glass of wine.

Moo

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lilBuddha
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quote:
Originally posted by Moo:
quote:
Originally posted by lilBuddha:
If you read the link I supplied above, it is the barley not the alcohol. Indeed, according to one of the links I posted, the alcohol has an opposite effect.

Leorning Cniht reports that his wife got the same effect from a small glass of wine.

Moo

That statement, in itself, means nothing. Some people report beneficial effects from all sorts of things that are a placebo at best.

--------------------
So goodnight moon, I want the sun
If it's not here soon, I might be done
No it won't be too soon 'til I say goodnight moon

- A. N. Parsley, D. Mcvinni

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mdijon
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To be even-handed I don't think that link quotes much scientific data either.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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lilBuddha
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I'll have to go back through the pages I found, but right now this is too wearying.
This reminds me of the crazy rationales that popped up during a Ship exchange on smoking. Anything to justify.
Sugar is not healthy in large amounts, but it is not a poison. Neither is salt. Neither is fat. Anything can be dangerous in too large an amount, even water.
They are not the equivalent of alcohol.
Perhaps I'll revisit the searching I've done. At this moment, I grow too tired.

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So goodnight moon, I want the sun
If it's not here soon, I might be done
No it won't be too soon 'til I say goodnight moon

- A. N. Parsley, D. Mcvinni

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mdijon
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Here is stuff on alcohol and mortality in adults showing the "J-shaped" effect with moderate alcohol intake appearing to be beneficial; study one and two.

I would say at that point it makes no sense to describe alcohol as a poison.

Here is a paper on alcohol use in pregnancy suggesting that the overall evidence is not supportive of a risk of low-moderate drinking on pregnancy outcomes, but acknowledging weaknesses in the evidence.

And here is a review on evidence on alcohol in breastfeeding concluding things like;

"Alcohol intake inhibits the milk ejection reflex, causing a temporary decrease in milk yield.... even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol.... "

and

"Minute behavioural changes in infants exposed to alcohol-containing milk have been reported, but the literature is contradictory. Any long-term consequences for the children of alcohol-abusing mothers are yet unknown, but occasional drinking while breastfeeding has not been convincingly shown to adversely affect nursing infants. In conclusion, special recommendations aimed at lactating women are not warranted. Instead, lactating women should simply follow standard recommendations on alcohol consumption."

I could repeat the exercise for smoking, but I promise you we wouldn't get the same output. The fact that people might use similar arguments for smoking doesn't mean that the arguments are faulty. Simply that they are misplaced for smoking and better placed for alcohol.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Ricardus
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The other reason for being cautious about giving advice on drinking while nursing is that parents already get far too much advice already.

Much of it is contradictory and falls on a spectrum of:
1.) Stuff that is supported by actual evidence, e.g. babies should sleep on their backs
2.) "Some studies have suggested"
3.) Plausible "it stands to reason" ideas developed by someone with a supply of envelopes to write on the back of.
4.) "My family has always done it this way"
5.) Utterly made-up bullshit

My guess is that a lot of parents aren't good at putting advice into categories, but are capable of recognising contradictory advice, and therefore conclude that experts don't know what they're talking about.

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Then the dog ran before, and coming as if he had brought the news, shewed his joy by his fawning and wagging his tail. -- Tobit 11:9 (Douai-Rheims)

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mdijon
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quote:
Originally posted by Ricardus:
...and therefore conclude that experts don't know what they're talking about.

That's my worry as well. There's only so much bandwidth for absorbing health advice, and I don't want smoking to end up in the same list as alcohol, prawns, peanuts and soft cheese.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Twilight

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quote:
Originally posted by Ricardus:
The other reason for being cautious about giving advice on drinking while nursing is that parents already get far too much advice already.

Much of it is contradictory and falls on a spectrum of:
1.) Stuff that is supported by actual evidence, e.g. babies should sleep on their backs
2.) "Some studies have suggested"
3.) Plausible "it stands to reason" ideas developed by someone with a supply of envelopes to write on the back of.
4.) "My family has always done it this way"
5.) Utterly made-up bullshit

My guess is that a lot of parents aren't good at putting advice into categories, but are capable of recognising contradictory advice, and therefore conclude that experts don't know what they're talking about.

6.) things your mother-in-law tells your husband, such as my MIL telling him, "The baby cries too much because her milk is bad."

My baby and I barely slept for the first six months. It would go like this; baby wakes up screaming, I change him, feed him until he goes to sleep in my arms, carefully lay him on his back in his crib, still asleep, then turn him over on his stomach because in 1968 all the doctors and official Baby Books said that if he slept on his back and spit up, he would strangle to death. So I would turn him on his stomach and he would wake-up and scream. Repeat process.

I've had a lot of experience listening to experts who didn't know what they were talking about.

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mdijon
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That sleeping on the front advice is exactly the sort of reason why recommendations should be made only based on evidence. It is very damaging to public confidence (and here to Twilight-confidence) to be advised to do something that turns out to be harmful.

Likewise imagine how all the parents feel who assiduously prevented their toddlers getting their hands on peanut butter for fear of allergies, only to hear later that they were increasing the risk of a peanut allergy.

The recommendations to sleep babies on their front or avoid peanuts were made on a precautionary basis. The experts would have said "Just in case". "There are reasons to believe even though the evidence isn't clear." "Babies are precious, we shouldn't take any risks".

So now we don't believe in experts anymore. The irony is that many of us are still using the same language to justify advising avoidance of all alcohol. "Just in case."

It seems like this precautionary fallacy is a human failing, not just an expert one.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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cliffdweller
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quote:
Originally posted by mdijon:
That sleeping on the front advice is exactly the sort of reason why recommendations should be made only based on evidence. It is very damaging to public confidence (and here to Twilight-confidence) to be advised to do something that turns out to be harmful.

I too, was caught in the middle of the front- to- back sleeping switcheroo. But I think you are failing to appreciate (both here and re alcohol) the way research is done/reported. And the illustration from front/back sleeping to alcohol use is entirely relevant.

At the time experts were recommending front sleeping there was good reason to do so. We were concerned about SIDs and looking for explanations. Since babies are known to be prone to spitting up, it was a reasonable thesis that choking on their own vomit was causing SIDs. It wasn't just made up, there was sound scientific reasoning behind it and even a small bit of data to support it (babies who did, in fact, die from choking on their own vomit). And, when lives are involved, it would be irresponsible not to avail parents of the best thinking/advice/research available at the time.

But the experts didn't rest there either. They continued to study the problem of SIDs and the effect of "front sleeping" recommendations. They discovered they were wrong. They instituted a comprehensive, science-based "back to sleep" program.

That's the way science works-- both times. It was good science when they were advocating front sleeping and good science when they were advocating back sleeping. It was responsible science to give parents the best advice possible based on the available data at that particular point in time, even though research is always going forward and that may change things. Because babies won't wait until all the research is in and we've got the final word on every issue. If that undermines public confidence in expert opinion that's because we're doing a crap job of teaching people about the scientific method and how it works.

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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mdijon
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quote:
Originally posted by cliffdweller:
But I think you are failing to appreciate (both here and re alcohol) the way research is done/reported.

I have to say that I do quite a lot of medical research for a living, so whatever the issue with my explanation is that isn't it.

quote:
Originally posted by cliffdweller:
At the time experts were recommending front sleeping there was good reason to do so. We were concerned about SIDs and looking for explanations. Since babies are known to be prone to spitting up, it was a reasonable thesis that choking on their own vomit was causing SIDs. It wasn't just made up, there was sound scientific reasoning behind it and even a small bit of data to support it (babies who did, in fact, die from choking on their own vomit).

That's very tangential data. It would have been just as possible to come to the opposite conclusion from similarly weak data - for instance that babies would be more likely to have their nose pushed into the bedding and stop breathing. And one could find blocked secretions in the noses that might be related to cot death.

But biology is that it isn't like process engineering on a machine. The complex systems of human beings respond counter-intuitively. Tightly controlling the high blood sugar levels that are associated with diabetes doesn't always improve outcome. An antibody response to a virus sometimes makes the disease worse instead of clearing it.

quote:
Originally posted by cliffdweller:
They continued to study the problem of SIDs and the effect of "front sleeping" recommendations. They discovered they were wrong. They instituted a comprehensive, science-based "back to sleep" program.

Ironically if everyone had followed advice it wouldn't have been possible to do the study. The benefits of back to sleep were only possible to determine by making empiric observations on what actually happened when parents did either thing. That could have been done at any time, it didn't need the prior recommendation to come out first.

So my message is that recommendations should generally be made based on actual observations, not based on theoretical considerations. And certainly these days policy makers are much more likely to insist on randomised trials or, where that isn't possible, observations of outcomes in the real world rather than biological reasoning.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Leorning Cniht
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quote:
Originally posted by cliffdweller:
And, when lives are involved, it would be irresponsible not to avail parents of the best thinking/advice/research available at the time.

But there's a considerable difference between "I don't have much good data, but based on what I do know, this would be my advice" and "the evidence is clear - don't do this."

And "expert" advice almost never distinguishes between the two. Which is an issue, because those cultural issues tend to weigh in to the first category in a big way.

There's a third category, too. The new UK limits on weekly alcohol consumption are set at the level that will cause less than a 1% increased risk of cancer in an average person. This is a small number. If we were to take it seriously, we would be going through every activity that people do, and telling them how much of it increases their cancer risk by 1%. (We do, in some cases. That's why the advice for eating processed meats is "don't". In terms of cancer risk, moderate bacon consumption is worse than moderate beer consumption.)

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Brenda Clough
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The 'what is best practice at the time' is the killer. The best thing to do for your baby alters often. I remember putting my children to sleep on their tummies; the trend now is on the back. And the whole peanut allergy issue is fearful.

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mdijon
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But it isn't just a trend. That's the danger of giving "what is best practice at the time" advice. If we don't really know we shouldn't say anything until we do. There will still sometimes be flips, but the point is that if we wait until we are 95% certain before saying something we will change the advice less often than if we say stuff when the evidence is 50:50.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Jane R
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When I had my daughter they'd just decided that babies shouldn't be weaned until they were six months old, if it was possible to keep them on milk-only until then. So the imperfectly updated leaflet I got gave the impression that you should start weaning your baby on fruit and vegetable purees, then progress to meat, eggs etc. at six months - but because you weren't supposed to start feeding them solids until they were six months old it sounded like you had a window of a single day to introduce your baby to a range of different foods, one at a time...

I don't know how typical I was, but I ignored the (then-current) advice and started giving her pureed fruit and vegetables (and baby rice) as soon as Madam decided that milk was Not Good Enough - around the age of four and a half months, IIRC. And they seem to have gone back to the 'fruit and veg after four months, meat/fish/eggs etc after 6' advice.

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Pyx_e

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I find it hard to express my disappointment at the direction this thread has taken. While it is important to keep abreast of current medical thinking is it not time to get this thread back on track before I call for the Nurse.

Pyx_e

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It is better to be Kind than right.

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mdijon
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I think I know what you want. I think nurse does too.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

Posts: 12175 | From: UK | Registered: Sep 2004  |  IP: Logged



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