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Is The Cerebral Palsy Research Rigged?
Posted by: William Cirignani
August 21, 2007

(This is a re-print from another topic in this blog -- Medical Research)

I ask whether political (or cultural) considerations influence scientific research at the scientist level; that is, is the person or group doing the research slanting their data or conclusions to fit a particular personal bias or agenda. Even more specifically I want to ask: In the area of medicine are there scientists whose bias is influencing the direction of their research? In the area of cerebral palsy (www.cirignani.com/PracticeAreas/Cerebral-Palsy.asp) the answer seems to be yes.

Cerebral palsy is a term used to describe brain damage in babies found at birth or shortly thereafter. About one third of cerebral palsy is preventable and is caused by not enough oxygen getting to the baby during the labor or delivery process. Yet, there is a group of doctors promoting the view that asphyxia (lack of oxygen) during the labor and delivery process rarely causes cerebral palsy. This group is called: The American College of Obstetricians and Gynecologists, or ACOG.

ACOG's history is marked by tireless and consistent efforts to promote through the medical literature and specifically for use in medical malpractice cases their position that cerebral palsy rarely arises by preventable causes, thereby excusing even the most negligent care of their members. They try to prevent cerebral palsy malpractice lawsuits by creating a very rigid set of criteria for birth injury due to asphyxia and claim that only cases meeting every one of the criteria are truly birth-related cerebral palsy cases. In fact, even if a child meets every one of these criteria, except one, they'll claim the injury wasn't due to birth asphyxia.

These hurdles are tall ones and given ACOG's political motivation the question is whether their science is true or whether the conclusion is driven by their bias of eliminating liability for their members and the companies that insure them. This is not an academic question. False and biased conclusions not only impact babies already born with cerebral palsy (whose families are trying to recover damages to help care for these children) but perhaps more tragically it impacts the quality of medicine going forward - preventable injuries will not be prevented. So, is the ACOG literature reliable?

First, you may be surprised to learn that obstetricians are notthe doctors involved in resuscitating or intubating asphyxiated newborns, nor are they the ones who test, diagnose or treat babies born with brain injuries or the complications of brain injuries. Instead, it is the pediatric neurologists, pediatric neuro-radiologists, neonatalogists and others like them whose research, data and methods focus on the timing and causes of brain damage in newborns.

Second, this research, and there is a lot of it from all around the world, (email us for citations: info@medsuit.com) directly contradicts the obstetricians' claims that cerebral palsy is rare and that in the vast majority of such cases the damage occurs before labor and delivery. One study (author: Francis Cowan), for example, looked at 351 cases of newborns with signs of brain injury within 72 hours of birth to see if there was a link between the injury and events during the labor and delivery process and found a link in almost 90% of the cases! Other studies had similar findings.

Third, another group of studies looked at whether the asphyxia that occurred during the intrapartum period (during labor and delivery) was observable and preventable. For example, in one study (author: Hakan Noren) the author looked at 29 babies born with evidence of asphyxic brain injuries and discovered that in 22 of those cases, there were abnormal fetal heart rate patterns long associated with hypoxic insult (lack of oxygen getting to baby) meaning that the oxygen deprivation was discoverable. Even more troublesome, though, was the study's finding that in many of the 22 cases appropriate medical intervention was either delayed or not given at all despite the abnormal patterns.

Here are the points: First, ACOG's "scientific" position that cerebral palsy is rare and rarely caused by preventable conditions is self-serving and untrustworthy. It is bad science generated by bias; second, every mom and dad should expect their obstetrician to know the realliterature (not the propaganda) and to be ready to intervene should evidence of oxygen deprivation show up during labor and delivery. It is the least they can do.

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Hospitals Discourage C-Sections
Posted by: Stan Heller
April 19, 2007

Nearly three in 10 U.S. mothers are giving birth by Caesarean section and more seem to be choosing a surgical birth even when there's no clear medical need.  No one knows exactly how many C-sections are purely elective. Some estimates suggest there could be tens of thousands annually, and critics say many of those women were pressured into surgery or didn't know the risks.  There are good reasons to avoid C-sections, if possible. First, they increase, though very slightly, the risk to the mother. Second, they leave a uterine scar, which can cause problems in future pregnancies. But third, they cost more money than vaginal deliveries.  

Sometimes, however, a c-section is the only way to ensure your baby is delivered safely. I’m sure you believe that your obstetrician wouldn’t let the cost differential sway her from doing what’s best for you and you are probably right. What you aren’t being told, however, is that your obstetrician’s hospital and managed care organizations care very much about the cost and they are leaning on your obstetrician not to do C-sections.

How? They keep track and calculate a C-section rate for every obstetrician. If she’s at 30%, when the “guideline” is 25%, she may get a call from her section chief. And she may get calls from the various managed care entities she contracts with. They threaten to label her an “over-utilizer.” They need say nothing more.  It’s understood that these are “friendly” warnings before the powers that be start playing hardball. Times have truly changed when one of the things doctors fear most is to labeled an “over-utilizer.”

There can hardly be a more vulnerable position for a woman to be in. She’s in labor and in pain.  There are indications of trouble. She has no idea (unless she herself is an obstetrician)  what the various “things” mean nor what should be done. She has to trust her obstetrician to properly balance the risks between waiting and intervening -a quintessential exercise of judgment, to be sure, but the woman has a right for that judgment to exercised solely for the benefit of herself and her fetus, not for the obstetrician’s statistics.

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