Child Safety

Child?  Safe?  Now there is an oxymoron!

Personally, I consider children to be inherently unsafe devices   They are rife with design flaws (no OFF button, for instance) and have a control mechanism liable to intermittent faults that cause expensive damage to their surroundings.  They are overpriced and have very high maintenance charges.  They are hardly “hands-off” units, requiring a higher level of owner attention than ever mentioned in the sales brochure.

Considered purely as a product, it is hard to see how they it got off the ground at all.

But no wonder the products are so unreliable!  Look at how they are made!  They are the result of a production cycle that is a quality control nightmare, with fantastic defect rates at each stage:  fertilization, gestation and delivery.

Now brace yourself, because I have done a bit of homework and am armed with numbers (avec moi, le deluge):

It has been estimated that as many as 50% of all pregnancies (i.e. fertilized eggs) miscarry before implantation in the womb. In the period after implantation but before the pregnancy is clinically detectable, another 30% of those left will miscarry.  After the point where the pregnancy is detectable another 25% will miscarry.

Of those who do not miscarry, something like 11%  will result in low birth weight babies.  Of those, the majority will be born prematurely (i.e. 37 weeks or less gestation).  Many of those will have some level of physical or neurological impairment.  About 1% of births are classed as very low birth weight babies (i.e. less than 1500 grams).  The vast majority of them will suffer from some level of impairment, from mild to catastrophic.

Of all live births, 4% will have some level of birth defect.  These range from the mild and correctable, such as harelips and webbed fingers, all the way up through compromised circulatory and nervous systems to those that will inevitably cause death in a few days at most.

All of which, I would suggest, indicates just how precarious the whole manufacturing process for this product is.  On the other hand, it also shows that the quality control department is not only alive and well, it is also rather ruthless.

For most scientists agree that the entire first two stages of loss, the 50% and the 30%, are the body’s way of culling ova with defects so severe that they could never come to term.  The large majority of the final 25% also represent the body’s rejection of embryos that are too flawed to gestate.

Over the last few decades we have learned a lot about prenatal care.  We now know a good deal about what factors such as poor nutrition, substance abuse, etc. can damage developing fetuses.  We have also learned a lot about saving neonates from harm. Logically, one would expect the statistics about healthy versus handicapped babies to have improved over that period.

Oddly, it has not.  In fact, in certain categories such a cerebral palsy, the numbers have actually gotten worse.  That is, the number of babies with cerebral palsy (and some other neurological conditions) has actually increased.

How can this be?

The answer, sadly, is that medical science has become so advanced that it has actually made the situation worse.

Very low weight babies used to have a very grim prognosis.  Most of them died, usually from respiratory failure of their under-developed lungs.  Of those few that survived, most suffered from one or more conditions of blindness, deafness, mental retardation, cerebral palsy, underdeveloped limbs, etc.

Nowadays, with all of our medical advances, we can keep a great number of those babies from dying.  Unfortunately, a great number of them still suffer from one or more conditions of blindness, deafness, mental retardation, cerebral palsy, etc.

We can now keep them from dying, but we cannot make them well.

The same is true of birth defects.  Take the example of spina bifida.  In this condition, the most common of the seriously handicapping birth defects, the most obvious symptom is that some or all of the spine is never covered and the spinal cord is left exposed during the gestation of the fetus.  As the uterine fluid is very hostile to the developing neural tissue, the spinal cord is damaged.  The result is (once again) cerebral palsy, retardation, distorted or incomplete growth, etc.:  A whole grab bag of horrors.

Spina bifida cases used to be fairly rapidly fatal.  However, over the last few years there have been a considerable effort to repair the spinal defect and save lives.  At first, they simply tried surgically closing the spine at birth, with mixed results.  Then they tried intrauterine surgery, pushing the procedure back earlier and earlier.  Today, the surgery can be performed before 24 weeks.

Again, this increased the survival rate, but had an ambiguous impact on the defects those survivors carried.  The defects have been reduced in frequency and severity, but virtually all of the babies still exhibit some level of defects, from mild to severe.

But now we have a lot more of those babies.

The cost?

Human cost cannot be measured in dollars, but it has been estimated that the average spina bifida case costs $294,000.  If the child is lucky enough to have cerebral palsy, that number jumps to $503,000.  This places one heck of a burden on society, not to mention what it does to the parents and the rest of the families.

There are many such examples.  I’ll just cite one more, one of the most recent.

It involves a form of in vitro fertilization called Intra-Cytoplasmic Sperm Injection (ICSI).  In this process, a single sperm is selected and injected directly into the ovum, producing instant fertilization.

Sounds good, huh?  Researchers brag that even low sperm count males now have a shot at becoming fathers.

There have been, however, unforeseen consequences.

The first barrier that normally must be overcome to make a baby is the sperms’ race to impregnate the ovum.  Oddly, although hundreds of busy little sperm make it to the egg and wriggle their hardest to get through the ovum wall,  only one normally makes it.  Scientists believe this is actually the first active selection step.  The ovum wall itself rejects any sperm with noticeable (to the wall, anyway) defects.

In ICSI, that first selection process is subverted.  The result is that the latest figures suggest that ICSI  averages twice as many birth defects as the normal population.

In my humble opinion, there is a common problem in all of this.  In this area, as in so many others, we have replaced ethics with technocracy.  Simply because we can do some new procedure, we think it logically follows that we should — as often as possible.

I beg to differ.

It seems to me that if medicine is to be truly guided by the Hippocratic Oath’s “Above all, do no harm,” then we must take a hard look at our results.  If a procedure cannot produce, with a fair expectation of success, a full, unburdened human being, perhaps it should not be undertaken for anything but research purposes (so that we can develop the techniques that will eventually give us a human baby with a reasonable chance of normalcy).

Any physician who commits some act of medical error (such as not monitoring the fetal oxygen level) and accidentally produces a brain damaged child will certainly be sued for malpractice and may lose his license.  But what is the real difference between that and artificially “saving” a brain-damaged infant who would normally die?  Each will now require constant care, be an immense burden upon its family, cost an immense amount of money, face years of painful medical treatments and will probably not live a normal life span.

I think they both look suspiciously like cases of malpractice.

As parents, we worry about the safety of our children.  We worry that baby sitters or au pairs might shake our babies.  When we send them off to school we worry whether their teachers are competent or whether some lunatic may shoot up their school yard.  How odd, then that we give so little thought to and place so few restrictions on the ethically challenged technocrats to whom we entrust our babies before they are born.

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