Issues for consideration by A+

Pteryxx asked me to elaborate upon http://freethoughtblogs.com/blaghag/2012/08/atheism-its-time-to-walk-the-walk/#comment-98203">my comment
 on the subject of issues that might be relevant to the budding A+ (positive atheism/etc) movement.
Note: because it's the middle of the night and because I'm lazy, I'm posting this as is.  I may come back and paste in some links or I may wait to see if anyone asks. I invite any of my regular readers (that sounds like there are more than 10 of you) to offer some links.

I would like to offer an additional plus–when willful ignorance and psuedoscience and wishful thinking get packaged as healthcare specifically for suspect groups. It’s wrapped up in all the others listed above, but it so frequently gets dropped to the bottom of the heap. The traditional skeptical community gives up after antivax and homeopathy and chiro. And far too many in even the would-be A+ community toss out opposition to those when it comes to the oppressed. And yes, I’m specifically talking about essentialist garbage passed off as women’s reproductive care and childrearing, and the constant misrepresentation of evolution as resulting in ANYTHING optimal. But the phenomenon is not restricted to women’s health. It also includes ignoring the real effects of chronic stress (from the above listed social problems) on health and behavior that get passed off as personal failure, the persistent -isms that are found in health systems which compound the health problems faced by oppressed groups, AND the antiscience escapism that is the consistent response to these problems.

This sums up a number of issues, some of which I'm personally still very new to and most of them are best represented in a series of ponderings.  First I'll touch on the chronic stress idea.  There is a growing body of work on allostatic load, which includes physical and mental (I'll poke at this as well) health effects to oppressed classes and also the Adverse Childhood Experiences research.  It's really interesting stuff that I'm not in the slightest qualified to wax about.  It has a few potential applications though.  1) Changing the view of patient culpability (for want of a better word and also to call out puritan-inspired health blaming); 2) Fundamentally changing the nature of the health frameworks to reflect to respect the overlap of mental and medical health (Descartes must die once and for all) and  the universality of trauma and the complexities it brings to all professional relationships; 3) Transforming treatment to include addressing underlying social issues; 4) Making social abuses a public health issue.  Tied to this is a discussion of antisocial behaviors (not to be confused with any titled disorder) as possible symptoms of hardship rather than social and economic hardship resulting from the behaviors of primarily flawed individuals. (Look, ma! More puritanism!)
[The commentary regarding mental health is not to state the value of any given treatment modality, as, quite frankly, until we have established clear mechanisms and discrete pathologies instead of symptom groupings, we're doing little more than guessing.]

The second topic is that of the pseudoscience in reproductive health being sold to women as "empowerment" and feminism.  It is neither. This is everything from supplements and altmed for fertility control and even abortion care to increasingly dangerous stunt birthing to refusal of not just vaccines but basic screening for chronic and deadly disease in infants and refusal of all but emergency care for children.  The birth issue is the one I am so stunned to see swallowed by many in the would-be A+ group. Women are being convinced to seek out undereducated, inexperienced hobbyists who at best are banned but ignored as they practice on and at worst legitimized through a licensing process that still fails to provide even a fraction of the kind of oversight required of the rest of healthcare (and even your nail lady). But if only it were that simple. Sadly, the propaganda that feeds this is seeping into hospital-based care under the guise of cost-cutting and patient choice (both plausibly worthy goals).  The results are increasing difficulty accessing timely intervention to prevent serious complications, denial of pain relief (see the trauma topic above), and risk-taking in the pursuit of nonintervention for the sake of nonintervention.

This is different from providers respecting the informed refusal of care.  And though there are a few cavalier individuals who are worthy of being identified for their reckless disregard for their patients' wellbeing, more and more these are becoming mainstream hospital policy. There have been some wonderful changes in women's care in recent years, like the almost complete elimination of routine episiotomy. But the popularity of some changes with a vocal minority is disguising the danger they carry. For example, there is a growing push for bans on "elective" induction before 39 weeks. This may reduce what is being called late prematurity and some NICU stays. But it comes with a rise in term stillbirth and is also restricting the judicious application of preventive care for those showing clear but early signs of serious complications. Here the misunderstanding is that elective means "mom is sick of being pregnant" (or worse, Dr. Bill has a golf game) which is not demonstrated to be the case. All of this is carried by a movement with a long history of fomenting adversarial relationships between patients and providers while creating unrealistic expectations that turn into bitter disappointments and unnecessary heartbreak... to say nothing of the preventable deaths of mothers and their wanted children.

And then there's the hypermilitantism on the feeding and rearing of children which fervently denies the reality of anything that can't be cured by block feeding and gripe water and don't even get me started on safe sleep and unregulated trade in human fluids (frighteningly popular with antivaxers and even HIV/AIDS deniers... I wish I were being hyperbolic). This is wrapped up in willful misrepresentations of human physiology and the nature of evolution, moralizing on correct (and constant!) mothering, and religious and spiritual proclamations about what a given act or role is supposed to mean/be/etc. There have been a few wonderful people in this sphere discussing this (Isis and Elyse come to mind, and there's been some limited discussion over on SBM after the whole Dr. Amy dustup), but on the whole it really doesn't get covered. The coverage of reproductive health is usually restricted to birth control, abortion, and circumcision. Now, this part has become a novel because I have been engaged with this topic for a while, but I certainly don't expect A+ to become yet another place to be overwhelmed with all the blahblah floating around about preggos and babies and all that. Far from it. But I do think there is insufficient skepticism being applied to this area which has become an echo chamber of reactionary antiscience.

A third issue is the alternative treatments so frequently offered with impunity to those who are already disadvantaged. There is a lot of discussion of chiropractic, etc but is there any mention of how it is packaged as an affordable alternative to real medicine (even when this isn't the case)? Is there any discussion of how the above mentioned substandard providers are being sold to state and federal lawmakers as the cure for rising costs in maternity care despite clear evidence of short-term harm and reason to suspect increases in long-term costs as well? Of the push for altmed to deal with difficult patients and whether this represents an active failure to treat? On that note, we are just beginning to see some legitimate attention being paid to issues that have previously been handwaved as somatization like female sexual dysfunction. Unsurprisingly, rather than being recognized as long delayed response to real complaints, there's a cynical backlash over creating a problem in need of a pill. This in particular falls back to classic expectations for women's desires relating to sex.

So then the final issue is the wholesale opting-out of real medicine by people who are throwing up their hands due to something meaningful like mistreatment by medical professionals or as a result of lies and fearmongering by the predictable sort of charlatans taking on new and exciting fields. This is often described as skepticism but it fails to rise to the standard of evidence and is built on emotive argument. This is a whole issue unto itself, but I've run out of steam for the night.