Tuesday, July 20, 2010

Challenging Paradigms - Part 1

Burning questions of the day: How best to approach issues where culture, nature and science clash to create disparity and disease? Can health care and mental health professionals be both public health minded AND individualized? Can we utilize research and best practices to support parents and children to live healthfully while also preserving individual choice? When does personal need, culture or tradition trump science and public health concerns? What happens when something challenges us to examine our current paradigms? Can we adjust those paradigms to care for individuals as well as groups at large?

This past week I hosted a conference on the science behind the benefits of skin-to-skin care from birth through the first few months of life for all babies with this conference having a special emphasis on the need for skin-to-skin contact for the smallest, most premature infants. One of our main speakers, Nils Bergman (http://www.kangaroomothercare.com/) speaks to current knowledge in neuroscience, animal studies and his own randomized control trial of 1200 - 2000 gram infants who were randomized into a control group (standard small baby care = separation) and an experimental group (no separation) with the medical care provided being exactly the same. His outcomes found that the incubator destabilized infants while 100% of the infants without separation were stable within 6 hours. His overall conclusion - Incubators cause harm. He then goes into a mini history lesson about how incubators came into fashion and how the paradigm emerged that incubators were better than the mother's own body. He is actively challenging that assumption with his work and also challenges institutions to rethink how and why they do things the way they do.
Interestingly the physicians barely blinked when presented with this provocative message. Honestly I just don't think a message like that can fully sink in when one's paradigm is still firmly in the "incubators save babies" camp.
From an allopathic perspective, I sort of "get it". If you are trained to see concerns, worries and problems as something to be "fixed", then you might have a tendency to look to your bag of tricks from technology and/or pharmacology and not move beyond that much. Health care professionals tend to assume "normal" takes care of its self and, unfortunately, "health" is the big misnomer in health care. There are exceptions of course but those tend to fall into the gone-overboard category such as lack of access to VBAC in order to reduce risk of uterine rupture, militant recommendations for "safe" sleep to prevent SIDS, and others that typically become one-size-fits-all solutions in a misguided, impossible attempt to reduce/control all risks.

I wish more researchers and scientists would challenge us to look at our assumptions. Randomized controlled trials might be the gold standard but who checks on whether the paradigm that underlies the research question is still valid? In my opinion, most studies pertaining to maternal/child care ask the wrong questions or worse, ask questions that can never be validated under the flawed paradigm. If we are to make radical changes in HEALTH outcomes for infants, then we have to be able to look beyond the barriers of our current paradigms (that's fine for third world societies that don't HAVE incubators...well, OUR families would NEVER want to stay with their baby in the hospital for that long, breastfeed on demand, etc...) and start to challenge all of our assumptions. Of course most don't have the kahunas to take on that task. Paradigms and assumptions come wrapped in emotional ribbons.

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