Why is home birth in America so dangerous when compared to other comparable countries?

Refers to article: http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?ref=opinion

 

Firm conclusions aren't possible from the New York Times article referred in the question since it examines a minuscule piece of the pie. However, analyzing in conjunction with other relevant data such as excess medicalization propensity of US births, total US maternal mortality and overall medical error rates suggests US home births are unlikely to get a fair chance because they simply aren't integrated with OB/GYN practices and hospitals, making it practically impossible to optimally co-ordinate care, if and when an in-labor transfer is necessary from home/birthing center to hospital. However, doing so would not only greatly reduce short- and long-term costs and rates of medically unnecessary C-sections but also improve both short- and long-term outcomes for maternal and fetal health.

Unfortunately this is easier said than done since, perhaps more than in other countries, US medicine in general and US births in particular exist at the uneasy intersection of medicine, politics and law. Unfortunately, this toxic mix pollutes every aspect of the birth process, from greater propensity for unnecessary medicalization (off-label use of Misoprostol for cervical ripening and excessive C-section rates being examples) to questionable data, all predictable responses of a system driven more by need for institutional control and liability avoidance rather than scientific allegiance to evidence-based medicine.

US Births Increasingly Medicalized, Having Among The Highest Rates Of C-Sections

The late American perinatologist and perinatal epidemiologist Marsden Wagner, divided current human birth processes into 3 broad categories (1).

• Highly medicalized, 'high tech', doctor-centric, midwife-marginalized. Examples found in Belgium, urban Brazil, Czech Republic, France, Ireland, Russia, USA.
• Humanized, more autonomous, strongly midwife-centric with much lower intervention rates. Examples found in the Netherlands, New Zealand and Scandinavia.
• Mixture of both approaches. Examples found in Australia, Britain, Canada, Germany, Japan.

Problem with the first option that dominates in the US is that over the course of the 20th century and beyond, it helped inculcate an institutional and cultural memory of medicalized birth at the expense of humanized birth. To quote from the 1985 report Wagner helped publish as the Director of the WHO's Women's and Children's Health (1) (emphasis mine),

'By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman’s state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what “non-medicalized” birth is. The entire modern obstetric and neonatological literature is essentially based on observations of “medicalized” birth.'

For example, according to the US National Center for Health Statistics, 1 in 3 babies is delivered by C-section in the US (2). US C-section rates are much higher compared to other OECD countries (see figures below from 2, 3, 4, 5). This even though the WHO has recommended for more than 30 years that C-sections shouldn't be >10 to 15% of total births (5, 6).

US C-sections rates are one of the clearest pieces of evidence for excess medicalization of US births. C-section risks aren't limited to mothers' immediate higher risks of post-surgical complications either. As we learn more about the importance of immediate post-birth microbial colonization, epidemiology is steadily building a hefty database of children's long-term adverse outcomes of C-sections, namely life-long increased risks of allergies and autoimmunities (7, 8).

Since home births are a minuscule proportion of total births, accounting for a mere 1.47% of total births as recently as 2014 (see table below from 9), obviously US C-sections can't simply be attributed to home birth complications that necessitate in-labor transfers to hospitals for emergency C-sections. Rather, they're a logical expansion of excessive medicalization of US births in general.

No Firm Conclusions Possible When Available Data Are Suspect

Inextricably linked to the larger issue of births and maternal health in general, not just home births but also maternal mortality rates in the US buck global trends. A 2014 assessment of global maternal mortality rates shockingly revealed that the US is the only developed country where the maternal mortality rate seems to be increasing even as it's decreasing across the globe (10). According to this study, US maternal mortality rate per 100000 live births were 12.4 in 1990, 17.6 in 2003 and 18.5 in 2013, meaning they increased 2.7% from 1990 to 2003, increased 0.5% from 2003 to 2013, and increased 1.7% from 1990 to 2013 (see figures below from 11). Since home births are a minuscule proportion of total US births, this implies maternal mortality rate is increasing in US hospital births.

Increasing US maternal mortality fits into the larger issue of medical errors. A 2016 study extrapolated data to suggest medical errors have now become the 3rd leading cause of deaths in the US (12). While statistical over-reach is a major weakness of this study, it's long been an open secret that frank admission of error is practically impossible in medical culture (13). Since deaths incurred during or through hospital births (complications following C-sections for example) fall under the medical error rubric, data related to births, be they home or hospital, especially data on adverse outcomes, can only be taken with a generous pinch of salt.

Doubts about accuracy of maternal death data become an even more pressing issue given that there are no US federal requirements to report maternal deaths and US authorities themselves concede they may be twice as high as reported (14). According to Amnesty International (15) (emphasis mine),

'reporting of pregnancy -related deaths as a distinct category is mandatory in only six states – Florida, Illinois, Massachusetts, New York, Pennsylvania and Washington. Despite voluntary efforts in some other states, systematic undercounting of pregnancy -related deaths persists'

Bottomline, data on US deaths due to either home or hospital births are far from reliable.

Amy Tuteur, Author Of This New York Times Article, Has A Patently Clear Conflict Of Interest

As author of the blog, The Skeptical OB, Amy Tuteur, the author of this New York Times piece, has a patently clear conflict of interest regarding home births. She herself revealed this bias in her incorrect criticism (16) of a large, thorough 2013 British Medical Journal study comparing maternal mortality between home and hospital births in the Netherlands (17). After misunderstanding this Netherlands data and incorrectly critiquing it, a volte-face to say the least when she writes in this New York Times piece 'there are places in the world where home birth is relatively safe, like the Netherlands, where it is popular at 16 percent of births' (18). So, per this author, are home births in the Netherlands safe or not? When an author's opinion varies based on the context, better not to take such opinions at face value.

Birth Is A Normal Physiologic Process. Medicalizing It Changes It From A Sanctuary To Surveillance, Often To Mother And Child's Detriment

As we understand better the short- and long-term harms of birth medicalization, we see its costs are paid not just by mothers and children but by all of society, economic, physiological and psychological costs from avoidable chronic health conditions.

A highly medicalized, overweeningly C-section-favoring approach to birth prevails in the US. It represents a financial medico-legal culture highly resistant to the notion of home births. Primed to regard midwifery as a potentially harmful interloper, such a culture easily gives it short shrift, depriving it the integration and co-ordination necessary to thrive and succeed. This reveals a schism in the US birth process, a schism between need for sanctuary during birth to ensure physiological processes prevail and need for surveillance to ensure technology provides state-of-the-art safe care (19).

Examining and importing best practices and structures from countries like Netherlands, adept at straddling the divide between home births and best of medical care, is an obvious approach. However, such measures require humility and an open mind. Is US medico-legal culture up to that challenge? That's the crucial question.

Bibliography

1. Wagner, Marsden. "Fish can't see water: the need to humanize birth." International Journal of Gynecology & Obstetrics 75 (2001): S25-S37. http://www.midwiferyservices.org...

2. Menacker, Fay, and Brady E. Hamilton. Recent trends in cesarean delivery in the United States. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2010. http://www.gapha.org/wp-content/...

3. Health at a Glance 2011. OECD Indicators.

4. Brazil Isn't The Only Country With A Startlingly High C-Section Rate

5. World Health Organization. "WHO statement on caesarean section rates." (2015). http://apps.who.int/iris/bitstre...

6. Moore, Ben. "Appropriate technology for birth." The Lancet 326.8458 (1985): 787).

7. Tirumalai Kamala's answer to Is giving birth in water bad for the development of the child's immune system?

8. Tirumalai Kamala's answer to Do you think there is sufficient evidence for the "hygiene hypothesis"?

9. Grunebaum, Amos, and Frank A. Chervenak. "Out-of-hospital births in the United States 2009–2014." Journal of perinatal medicine (2016). http://www.degruyter.com/dg/view...

10. Kassebaum, Nicholas J., et al. "Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013." The Lancet 384.9947 (2014): 980-1004. http://www.ncbi.nlm.nih.gov/pmc/...

11. The US Is The Only Developed Nation With A Rising Maternal Mortality Rate. Anna Almendrala, The Huffington Post, May 19, 2014. This Is The Deadliest Industrialized Country For Pregnant Moms

12. Makary, Martin A., and Michael Daniel. "Medical error—the third leading cause of death in the US." BMJ 353 (2016): i2139. http://www.bmj.com/content/bmj/3...

13. Medical errors in America kill more people than AIDS or drug overdoses. Here's why. Vox, Sarah Cliff, April 22, 2015.

14. Berg, Cynthia, et al. "Strategies to reduce pregnancy-related deaths: from identification and review to action." (2001)., Centers for Disease Control and Prevention, 2001. http://stacks.cdc.gov/view/cdc/6...

15. Delivery, Deadly. "The Maternal Health Care Crisis in the USA." London: Amnesty International (2010). http://www.amnestyusa.org/sites/...

16. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

17. de Jonge, Ank, et al. "Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study." BMJ 346 (2013): f3263. http://www.bmj.com/content/bmj/3...

18. Why Is American Home Birth So Dangerous? The New York Times, Amy Tuteur, April 30, 2016.

19. Stenglin, Maree, and Maralyn Foureur. "Designing out the Fear Cascade to increase the likelihood of normal birth." Midwifery 29.8 (2013): 819-825.

https://www.quora.com/Why-is-home-birth-in-America-so-dangerous-when-compared-to-other-comparable-countries/answer/Tirumalai-Kamala

What do scientists think about Sci-Hub?

 Refers to articles: http://www.sciencemag.org/news/2016/04/whos-downloading-pirated-papers-everyone, http://www.sciencemag.org/news/2016/04/alexandra-elbakyan-founded-sci-hub-thwart-journal-paywalls

Presumably most respondents who took Science magazine's recent survey were scientists (1). Results suggest they whole-heartedly endorse Sci-Hub (see figures below from 1).

• 88% say it isn't wrong to download pirated papers.
• For >50%, it's the only way to access scientific papers.
• >60% think Sci-Hub will disrupt traditional scientific publishing.

Sci-Hub and Alexandra Elbakyan have accomplished two important breakthroughs

• Provided pirated access to paywalled scientific journals and in doing so, revealed the previously unimagined extent to which scientists the world over lacked access to scientific papers, often to even their own published work.
• Brought Scientific Publishing to mainstream awareness. While the odium and coercion inherent to its structure are well-known to scientists themselves or should be at the very least, Sci-Hub and Elbakyan have helped cast a more prominent spotlight on it so it's under broader scrutiny, helping fuel its long overdue Napster moment.

What Sci-Hub and Elbakyan have done and why can only be fully appreciated by understanding what Scientific Publishing's odium and coercion consist of, and why in hindsight it seems inevitable something like Sci-Hub would come up sooner or later.

Scientific Publishing In A Nutshell

• Most basic science research is taxpayer-funded.
• Scientific credibility and career advancement, especially in academia, depend on peer-reviewed scientific publication of such research.
• Enter Scientific Publishing.
• Dominated by for-profit publishing houses like Elsevier, Springer-Nature, Wiley to name a few, whose platforms publish among the most prestigious scientific journals in the various scientific specialities.
• Publishing in such journals is considered necessary for scientists to accrue credibility and advancement.
• In a throwback to post-Renaissance Independent scientist, scientists, as editorial board members and even just peers, perform peer-review of each other's manuscripts pro-bono (free), meaning free of cost to Scientific Publishers.
• Burden of Scientific Publishers is mainly limited to page layouts, editing and publishing, now mainly online.
• Since the internet exploded in the mid-1990s, most Scientific Publishers have migrated online and their costs have dramatically reduced since electronic publishing costs a fraction of print.
• Scientific Publishers manage to cut administrative costs even more to the bone by out-sourcing editing processes to back offices in developing countries.
• Scientific Publishers typically own the copyright to papers scientists publish on their journals. Why? Answer's lost to the mists of time.
• For-profit Scientific Journals are typically Paywalled: Scientific Publishers charge an arm and a leg for accessing just one paper on their web-sites. Such paywalls can range from US $6 to >$50 for just one paper, even for papers published decades earlier, and even for scientists who've published in those same journals and/or have peer-reviewed pro bono on their behalf.
• Annual subscriptions to the thousands of journals published by these Scientific Publishers is an onerous financial burden even for the best-endowed universities in the world like Harvard (2).

In other words, established, for-profit Scientific Publishers are middlemen making money hand over fist for work product that's largely taxpayer-funded, then deemed worthy of publication free of cost by scientific peers, who then have to pay through their noses to access their own published work, which by the way they don't even own the copyright to. For people considered really smart by the rest of society, how could scientists have allowed themselves to be bamboozled to such an extent? A question for the ages, that.

The explosion of the internet brought the fruits of scientists' labor that much closer to their brethren the world over but in this case, the Digital divide's exacerbated by the outrageously priced paywalls. Science is a rather unique enterprise in that it's essentially cooperative and collaborative, and advances by Standing on the shoulders of giants, as the saying goes. In practical terms, this means accessing and reading hundreds to thousands of peer-reviewed scientific papers relevant to one's own field of study, both in helping formulate one's own scientific work as well as citing these other studies to help rationalize one's results and help justify one's interpretation. If Harvard finds it hard to subscribe to all scientific journals its students need, no way a Kazakhstan scientist like Elbakyan could access and download all the papers necessary for their research. Thus, sheer frustration with an untenable status quo likely drove the creation of Elbakyan's mirror site, Sci-Hub.

Open-access Scientific Journals: Their Advantages And Pitfalls

Since the 2000s, Open access journals have appeared as an economically less onerous alternative to the robber baron for-profit Scientific Publishers. However, open access journals have at least three obstacles they haven't yet managed to successfully overcome.

• One, path to successful grants and promotions is greased by prestigious peer-reviewed publications. This is still largely the purview of for-profit journals who accrued such prestige over decades, some, even centuries. Big names and big name wannabees in various scientific sub-fields prop up this status quo by continuing to publish their 'best' work in these journals rather than gravitating to their newer, less notable, open-access counterparts. Though big names like Fields Medal winning mathematician Timothy Gowers (3), and Nobel Prize-winner Randy Schekman (4) have openly proclaimed their rejection of these so-called 'luxury' journals, the trickle hasn't yet become a flood, and rank and file scientists continue to offer their 'best' work to long-established, for-profit, paywalled prestige journals.
• Two, current open-access largely subsidizes free access through prohibitive front-end costs to authors who publish in them. In the post-Great Recession world, when even government-funded labs are forced to cut costs to the bone, paying on average ~US $2000 to get a paper published in PLOS or BioMed Central is an onerous financial burden. Plos and BioMedCentral are examples of open access publishers who've managed to accrue prestige sufficient to be competitive against their older for-profit counterparts.
• Three, sensing opportunity, open-access has become a lure attracting a host of rapacious publishers looking to make a killing. They offer junior scientists the opportunity to both publish and peer-review on their journals, and use this imprimatur to attract their peers but ultimately their editorial processes are far less stringent to the established norms. Papers published in these ever-mushrooming journals muddy the scientific waters, making it more difficult for the rank and file traditional speciality science journals to distinguish themselves from their newer, predatory counterparts. This problem has assumed such epidemic proportions that Jeffrey Beall, librarian at Auraria Library, University of Colorado, Denver, Colorado, annually publishes his list of predatory, open-access publishers (5) to help scientists sift gold from dross in Scientific Publishing.

Science publishing, especially in biomedical research, is thus passing through one of its most momentous transitions. Heavyweights in the public health arena like the Bill & Melinda Gates Foundation have instituted guidelines mandating publications ensuing from their grants be published in open-access journals starting in January 2017 (6). The Gates Foundation will pay the author fees charged by such open-access journals. The onus is now on governments, other science funders, universities and research institutes to develop approaches that ensure taxpayer-funded research becomes open-access for all from the moment they're published, regardless of the journal it's published in. After all, as things stand, imprimatur of peer-review remains the gold standard for grants and career advancement in science, at least in biomedical research. At this moment, it’s unclear how experiments like bioRxiv, pre-publication repository of raw biology data, will influence scientists’ careers.

Bibliography

1. In survey, most give thumbs-up to pirated papers. Science, John Travis, May 6, 2016.

2. Harvard University says it can't afford journal publishers' prices. The Guardian, Ian Sample, April 24, 2012.

3. Elsevier — my part in its downfall. Tim Gowers, Jan 21, 2012.

4. How journals like Nature, Cell and Science are damaging science | Randy Schekman, The Guardian, December 9, 2013.

5. Beall’s List of Predatory Publishers 2016.

6. Gates Foundation to require immediate free access for journal articles. Science, Jocelyn Kaiser, November 21, 2014.

https://www.quora.com/What-do-scientists-think-about-Sci-Hub/answer/Tirumalai-Kamala

Why do people believe that bottled water is better than tap water?

People may or may not have started out believing bottled water is better than tap water. However for >20 years now in the US, they've certainly been marketed to that way and consumption patterns suggest it worked.

In 1975, Americans hardly drank bottled water, just one gallon of bottled water per person per year on average. By 2005, it had grown to ~26 gallons per person per year (1). By 2012, touching 30 gallons per person per year (see figure below from 2), it had become the veritable 'superstar of the beverage industry' (3).

The US sociologist, Andrew Szasz offers an intriguing explanation for the explosion in bottled water consumption in recent decades. Calling it the phenomenon of 'inverted quarantine', modeled after quarantine, he characterizes it as a distinct consumer response to widespread threats, both perceived and real. In classic quarantine, the collective community and environment are deemed healthy and some discrete sources within it present a spreadable danger. The community then protects itself by isolating that source, i.e., the diseased individual(s). This reduces the chance that others will get exposed and spread the infection. What happens when the threat is perceived to be everywhere? When the surrounding environment itself is perceived to be toxic, dangerous? According to Szasz, in the US, many healthy individuals responded by isolating themselves from their disease-inducing environment. Healthy and relatively affluent. Hence 'inverted quarantine', a walling-off response to threats perceived everywhere, gated communities perhaps the purest expression yet of such impulses.

Contrasting it with past social movements which brought about change through collective action, Szasz characterizes choices to buy bottled water, and 'organic', 'natural', 'non-toxic' food, household and personal hygiene products as ultimate expressions of individualism. 'Assembling a personal commodity bubble for one's body' (3), an attempt to shop one's way out of trouble instead of banding together collectively to change the status quo. In the case of bottled water, it started with a long-perceived suspicion of tap water. Long before the tragic Flint water crisis, US residents reported their tap water mistrust in survey after survey (3, Chapter 3, reference 5).

'The 1999 National Consumer Water Quality Survey found that “about three -quarters [of American adults] have some concern regarding the quality of their household water supply” and “almost half are concerned about possible health-related contaminants.” Two years later, a follow -up survey found those numbers had grown bigger still. Eight -six percent agreed they had “concerns about their water,” and “51 percent worried about possible health contaminants.'

In other words, widespread perception of toxic industrial and agricultural chemicals polluting tap water. Once the beverage industry understood this was driving consumer interest in bottled water, it set about explicitly marketing it as a safer alternative to assuage precisely these concerns. While bottled spring water brands pitched the pristine purity of their bottled water (see some examples below from 3, chapter 3)...

Odwalla

'ANCIENT FRESHNESS™—The Odwalla water you are now meeting fell on the land as rain, snow, and glacial melt 16,000 years ago. When it began its circular journey deep into the earth, ecosystems were in balance, the air was clear, the landscape wild and primeval. It carried this prehistoric purity underground, where it has remained totally isolated from environmental changes. —This water is as pure as the day it fell to Earth 16,000 years ago.78'

Fiji Water

'water that has never been touched by pollution or dirtied by pollution because it was created hundreds of years before the industrial revolution and it’s been locked under the earth in an aquifer in Fiji . . . at the very edge of a primitive rainforest, 1,500 miles away from the nearest continent. . . . Far from pollution. Far from acid rain. Far from industrial waste. . . . when it comes to drinking water, “remote” happens to be very, very good.79'

...Brands sourcing their water from the public water system focused on the 'hypertechnological efforts' (3) to render the hitherto toxic pure (see some examples below from 3, chapter 3).

Big Sur Water Company

'goes through a carbon filter . . . then [it is] put through a vapor compression™ processor . . . then through a 1 micron . . . paper filter . . . [finally,] As the water then goes toward the filler, superoxygen in the form of ozone (O3) is injected into the water to assure our water will remain in a pure state after it is bottled.81'

Ionic

'The process used to purify and produce Aqua CoolR Pure Bottled Water involves the use of The Ionics ToolboxSM of technologies [that ToolboxSM has in it: Electrodialysis Reversal, Reverse Osmosis, Ultrafiltration, Adsorption] to obtain the complete removal of all dissolved and undissolved materials from the source water. The resulting highly pure water is then remineralized with a specific “menu” of minerals selected for taste and fortification.82'

Once such relentless, focused marketing succeeded and how (see an eyebrow-raising example below from Wikipedia), a virtuous positively reinforcing cycle came into existence. And it's a hard one to knock off. After all, the perceived threat is the subtle one of long-term consequences of ingesting low doses of 'toxic' pollutants present in tap water. Once beverage company marketers succeeded in convincing consumers of the superior safety of their product, it required less effort in expanding its appeal by pitching it to the health-conscious as a lifestyle choice. And thus, bottled water sales increase year on year.

Irony of choosing bottled water over tap water is it implicitly imbues beverage companies with saintly trustworthiness that may be just as unwarranted.

Bibliography

1. Beverage Marketing Corporation of New York, “News Release: Bottled Water Continues Tradition of Strong Growth in 2005,” April 2006, Consulting, Advisory Services, Trend Data and Market Reports for the Global Beverage Industry

2. Bottled Water Sales: The Shocking Reality. Peter Gleick, April 25, 2013.

3. Shopping Our Way to Safety: How We Changed from Protecting the Environment to Protecting Ourselves: Andrew Szasz: 9780816635092: Amazon.com: Books. Andrew Szasz, University of Minnesota Press, 2009.

https://www.quora.com/Why-do-people-believe-that-bottled-water-is-better-than-tap-water/answer/Tirumalai-Kamala

Are there any animals that actually enjoy being hugged by humans?

Question could be examined from at least three angles.

• How do animals react to a human's hug as in are there any physiological similarities between animal and human response to hugs?
• Do animals offer hugs to each other in their native habitats in social contexts plausibly similar to those among humans?
• Do animals offer hugs to humans?

Currently there seem to be scientific studies about the first two but not the last question.

How do animals react to a human's hug? Examples from Indirect Dog Studies.

What's a hug but a gesture of affection, consolation and/or support? If pet dogs expected such affectionate gestures from their human parents/owners as a matter of course, a logical extension would be that such expectations entail possessiveness expressed as jealousy when the dogs see those same gestures extended to others in their environment. So do pet dogs express jealousy in such situations?

I. A 2012 Plos One study on 36 dogs studied in their homes suggested they became jealous when they observed a rival for their affection (1). The study videotaped the dogs' reactions when their human parents/owners ignored them to instead pay attention to a stuffed animal, a jack-o-lantern pail or a pop-up book they read aloud. The stuffed animal consisted of a realistic-looking dog that barked, wagged its tail and whined. The authors chose not to include real rival dogs because such situations would be more difficult to control and would have yielded results much more difficult to interpret. The dogs in the study included a variety of breeds ranging from a Boston terrier, Yorkshire terriers, chihuahuas, mutts and a pug.

The study found a clear hierarchy of perceived affection deprivation

• 78% would push or touch the human parent/owner when they petted or sweet-talked the fake dog.
• 42% became upset when the human parent/owner gave attention to the jack-o-lantern pail.
• 22% became upset when the human parent/owner gave attention to the book.

Only a preliminary study so results can't be taken as conclusive and there are caveats as well. Study was small, only 36 dogs. The researchers didn't record the dogs' initial reactions to these new objects so we don't know if the dogs' reactions were to the objects per se or to human parents'/owners' interactions with them. However, the study does suggest that jealousy may not be solely a human construct nor based on sexual rivalry alone. Rather it may stem from 'the need to secure resources in all kinds of valued social relationships, be they sexual, parental, sibling, or just friendly' (2).

II. In a first of its kind study, animal cognition scientists at Eotvos Lorand University in Budapest trained dogs to lie still in an https://en.wikipedia.org/wiki/Ma... machine, and compared human (n=22) and canine (n=11) brain activity in response to different human and dog sounds such as voices, barks, and meaningful grunts and sighs that both species articulate (3). They found that happy sounds lit up the auditory cortex in both humans and dogs. According to Attila Andics, the neuroscientist and lead author of the study, dogs seems to be neurologically hardwired to pick up on their human companions' subtle mood shifts (4). This suggests they may welcome and appreciate hugs from their human parents/owners.

III. In another dog MRI study, Emory University also trained dogs (n=37) to lie still in an MRI machine and measured their neural responses to smells of familiar and unknown people using Functional magnetic resonance imaging (5). They found dog owners' smell triggered their brains' caudate nucleus, the brain's 'reward center'. This is extremely pertinent since dogs use their noses to navigate through the world. Study of how their brains process smell stimuli could improve our understanding of their social world, what's important, what's not, and how this process is similar or not to that in humans. In this case, smells of their human parents/owners seemed to be looped into their brains' reward circuits. Again, this suggests they'd likely enjoy being hugged by their human parents/owners. A follow-up fMRI study on 13 dogs found somewhat similar results in response to touch (6).

Caveats with these MRI studies is dogs were trained to sit motionless in the MRI machines using food rewards, i.e., essentially bribed to submit to such examinations (see photos below from 3). That definitely muddies the waters since it diminishes the dogs' autonomy in the experimental process (7).

Do animals offer hugs to each other in their native habitats? Example From A Chimpanzee Study.

If animals within a particular species are seen hugging each other, presumably they wouldn't mind hugs from humans either or at least from humans they're familiar with and perceive to be non-threatening. The former has indeed been documented in chimpanzees. In one of the largest studies of its kind and led by the acclaimed primatologist Frans de Waal, research showed two outdoor-housed groups of chimpanzees consistently and spontaneously consoled individuals with whom they were socially close, consolation defined as interaction 'in which an uninvolved bystander initiates friendly contact with a recent victim of aggression' (see photo below from 8).

Bibliography

1. Harris, Christine R., and Caroline Prouvost. "Jealousy in dogs." PloS one 9.7 (2014): e94597. http://journals.plos.org/plosone...

2. Dogs Get Jealous, Too. National Geographic, Jennifer S. Holland, July 23, 2014.

3. Andics, Attila, et al. "Voice-sensitive regions in the dog and human brain are revealed by comparative fMRI." Current Biology 24.5 (2014): 574-578. http://ac.els-cdn.com/S096098221...

4. Brain Scans Reveal What Dogs Really Think of Us. Science.Mic, Theresa Fisher, November 20, 2014.

5. Berns, Gregory S., Andrew M. Brooks, and Mark Spivak. "Scent of the familiar: An fMRI study of canine brain responses to familiar and unfamiliar human and dog odors." Behavioural processes 110 (2015): 37-46. Scent of the familiar: An fMRI study of canine brain responses to familiar and unfamiliar human and dog odors

6. Cook, Peter F., Mark Spivak, and Gregory S. Berns. "One pair of hands is not like another: caudate BOLD response in dogs depends on signal source and canine temperament." PeerJ 2 (2014): e596. https://peerj.com/articles/596.pdf

7. Dogs Are Not People. Boston Review, Colin Dayan, January 23, 2014.

8. Romero, Teresa, Miguel A. Castellanos, and Frans BM de Waal. "Consolation as possible expression of sympathetic concern among chimpanzees." Proceedings of the National Academy of Sciences 107.27 (2010): 12110-12115. http://www.pnas.org/content/107/...

https://www.quora.com/Are-there-any-animals-that-actually-enjoy-being-hugged-by-humans/answer/Tirumalai-Kamala

How widely accepted is the link between meat consumption and climate change?

 Logic dictates that if the link between meat consumption and climate change were widely accepted, industrial meat production would decrease, governments would push policies towards achieving such a goal, and per capita meat consumption rates would decline. But simple, straightforward logic isn't the only attribute to guide our actions, is it? Instead, notwithstanding the link between global meat production and climate change, the data show that meat production and consumption are on the rise globally as industrialization globalizes, industrial agriculture replaces traditional small-scale farming and hundreds of millions of humans are pulled out of poverty. Why does affluence tend to go hand in hand with meat consumption? Meat eating's a status symbol for the newly affluent the world over. A look at some of the obscene, shocking numbers suffices to convince we're far from global peak industrial meat production and consumption (see figures below from 1, 2, 3, 4).

Industrial meat production's much more inefficient in energy conversion and much more unsustainable in terms of deforestation and desertification, i.e., much more costly for Mother Earth.

• For e.g., massive forest cover's already been depleted in Brazil to make way for croplands needed to sustain food animal feed crops (soybean, corn).
• Land taken over for monoculture crop production for animal feed tends to become degraded faster.
• Industrial food animal production (IFAP) also requires massive freshwater use, this when increasing millions of humans the world over lack access to potable (safe drinking) water.
• Animal poop and pee from IFAPs heavily pollute nearby lands and waterways, working their way through the ecosystem.
• Also working their way through the ecosystem are the massive doses of antibiotics these hapless masses of animals are fed to accelerate their weight gain so they're ready for market that much sooner.
• Not to mention the sheer immeasurable pain and suffering of billions of food animals housed in soul-destroying inhumane conditions.

Rounding off such a perfectly dreadful litany of intractable problems associated with IFAP is its unmistakable contribution to global greenhouse gas (GHG) emissions.

So why, in the face of all the most compelling data advising otherwise, are meat production and consumption increasing globally?

• For one, IFAP's rise accompanies our increasing dissociation with the source of our food (2). It's not just food animal raising that's industrialized. So has their slaughter. The Brazilian company JBS is the world leader in animal slaughter. Its worldwide facilities can slaughter 85000 cattle, 70000 pigs and 12 million birds...every day. Following close on its heels is the US firm Tyson which can slaughter 170000 cattle, 350000 pigs and 42 million chickens...every week (2). And it isn't by accident that industrialized country IFAPs and abattoirs (slaughterhouses) are located far from cities in rural backwoods nor that they employ low-wage workers working in terrible conditions, i.e., captive labor market. Most industrial country consumers and increasingly, urban consumers in industrializing countries buy prettily packaged pre-cut slabs of meat in urban supermarkets, The Stepford Wives world far removed from the slaughterhouses with their rivers of blood, squeals, bulging eyes and sheer soul-chilling terror.
• For another, why change current habits when there's no immediate penalty for the status quo and no incentive for change? After all, governments haven't shown much inclination to curb meat consumption nor taken a stance against IFAPs and CAFOs (Concentrated Animal Feeding Operation) nor have citizenry successfully prevailed upon them to do so.
• Lastly, scientifically exploring the link between diet and climate change is of fairly recent vintage. It started in the late 1990s with Goodland saying 'diet matters' in the conversation about climate change (5). Since then many researchers have used life analysis and input-output models to estimate energy consumptions and GHG emissions of different foodstuffs (6, 7). Global meat production and climate change were first definitively linked in 2006 in a groundbreaking, massive (400 pages) study by Henning Steinfeld et al at the UN's Food and Agriculture Organization (FAO). This was the first study that clearly showed 'the livestock sector emerges as one of the top two or three most significant contributors to the most serious environmental problems' (8). They estimated global meat production contributes to 15 to 24% of total annual GHG emissions (5 to 7 X 109 tonnes per year).  Studies since show that meat and dairy production in particular are associated with disproportionately high GHG emissions (9, 10).

Since agriculture and related industrial activity are a massive part of the global economy, and directly and indirectly employ at least 1/7th of the global human population, there's been immediate and sustained pushback against the argument linking IFAP to GHG emission (see reference 8's wikipedia page for sources and their rationale). However, the conflict of interest inherent in the stance of such stakeholders renders their arguments weak and unconvincing.

Meantime, as the figures above show, meat production in places like China and Brazil has only increased even more steeply in the last few years. This means global meat production's contribution to GHG is only increasing, not decreasing and it will continue to do so unless and until governments intervene with specific policy changes. They could stop or curtail massive subsidies to agriculture for example so that we each pay the real price for our food. Pigs are likely to fly sooner. Yet if nothing changes, inevitable major environmental cataclysms from anthropogenic global warming (AGW) will likely hijack the agenda willy-nilly or IFAP-sourced pandemics will help wipe out a substantial chunk of global human population (11). Our pathetic history of collective problem solving shows these latter possibilities are far more likely than timely and wise government intervention, and when such eventualities inevitably come to pass, those humans unlucky enough to survive such apocalyptic catastrophes will perforce need to change their obscenely profligate abuse of Earth and domesticated animals. In fact, such survivors would likely no longer be able to dictate terms and the Earth will be all the more better off for it.

Bibliography

1. Growing greenhouse gas emissions due to meat production. UN Environment Programme (UNEP), 2012. http://www.unep.org/pdf/unep-gea...

2. Meat Atlas: Facts and Figures about the animals we eat. Heinrich Boll Stiftung, 2014. https://www.bund.net/fileadmin/b....

3. FAOSTAT

4. Thornton, Philip K. "Livestock production: recent trends, future prospects.” Philosophical Transactions of the Royal Society of London B: Biological Sciences 365.1554 (2010): 2853-2867. http://rstb.royalsocietypublishi...

5. Goodland, Robert. "Environmental sustainability in agriculture: diet matters." Ecological Economics 23.3 (1997): 189-200. http://www.is.cnpm.embrapa.br/bi...

6. Coley, David A., Emma Goodliffe, and Jennie Macdiarmid. "The embodied energy of food: the role of diet." Energy policy 26.6 (1998): 455-460.

7. Phetteplace, Hope W., Donald E. Johnson, and Andrew F. Seidl. "Greenhouse gas emissions from simulated beef and dairy livestock systems in the United States." Nutrient cycling in agroecosystems 60.1-3 (2001): 99-102. https://www.researchgate.net/pro...

8. Steinfeld, H., Gerber, P., Wassenaar, T., Castel, V., Rosales, M. and de Haan, C. (2006). Livestock’s long shadow: Environmental issues and options. Food and Agriculture Organization of the United Nations (FAO), Rome, Italy. Livestock's Long Shadow

9. Eshel, Gidon, and Pamela A. Martin. "Diet, energy, and global warming." Earth interactions 10.9 (2006): 1-17. http://www.environmentalcalculat...

10. Stehfest, Elke, et al. "Climate benefits of changing diet." Climatic change 95.1-2 (2009): 83-102. http://dels.nationalacademies.or...

11. Leibler, Jessica H., et al. "Industrial food animal production and global health risks: exploring the ecosystems and economics of avian influenza." Ecohealth 6.1 (2009): 58-70. http://are.berkeley.edu/~dwrh/CE...

https://www.quora.com/How-widely-accepted-is-the-link-between-meat-consumption-and-climate-change/answer/Tirumalai-Kamala

How can clinical trial enrollment be increased?

In this technocracy dominated era, there's no dearth of technological approaches to improve clinical trial (CT) participation. Ranging from alert systems linked to electronic health records (1) to online registries (2, 3, 4), the usual technology-based suspects have made their appearance on the scene to no avail. For e.g., available free to anyone online, ResearchMatch allows any US resident to register as a potential CT participant (volunteer). Hosted at Vanderbilt University and funded by the NIH, this registry launched in December 2008. Yet >7 years on, its name recognition is limited and <100000 volunteers have signed up (2).

Obviously, core of the problem requires a human, not technological, touch. Meantime, the general population gains the bulk of its knowledge about CTs from entertainment fare online or on TV and from news (5, 6, 7, 8). Obviously such sources are more likely to fuel and sustain misconceptions rather than anything remotely close to the truth about CTs. Essentially, the current CT ecosystem woefully under-utilizes two of its foundational pillars,

1) Referring physicians and other healthcare providers who lead patients to CTs (9, 10).

2) Current and previous CT participants, i.e., potential Patient Advocates.

Even more inexplicably, pertinent questions relating to the CT process remain unanswered

• What's the difference between healthcare providers who either do or don't participate in CTs, and between those who either do or don't refer patients to CTs?
• What are the recruiting strategies used by successful CTs (11, 12, 13)?
• Why don't organizers of successful CTs routinely record and report their recruiting strategies? Clearly trial funders should mandate their doing so.
• What level of engagement remains with CT participants after a trial's over? Do trial organizers and their staff stay in touch with them? While volunteers are enrolled in a trial, which can be for several months to even years, do trial organizers develop a rapport with at least their most enthusiastic participants, and teach and encourage them to advocate and recruit newer volunteers on their behalf within their families and communities (14, 15)? Given the current state of affairs, clearly not and yet wouldn't doing so set up a virtuous positively reinforcing cycle leading to cumulatively increasing CT participants? Instead, why is the system set up to recruit and forget once the trial's over? Isn't this an egregious example of re-inventing the wheel every time?

~70 years since the 1st double-blind, placebo-controlled randomized CT and with >210,000 ongoing registered CTs across the US and 193 other countries (see figure below from 16), it's scarcely believable but sadly true that such basic issues aren't well-studied nor their lessons freely available for others' benefit (17, 18).

Upon reflection, it's only to be expected that an inherently top-down and paternalistic enterprise like human biomedical research would under-utilize Patient Advocates. After all so insular is it that its very basics such as research ethics and regulatory oversight have been developed without seeking and incorporating the input of research volunteers (19), who are more frequently described condescendingly as subjects. Even peer-reviewed literature about woefully lacking CT participation rates is dominated by the voices of biomedical research aficionados. Where are the voices of CT participants? Why don't medical and scientific journals report their perspective, about their experiences and suggestions in their own words? Imbalance couldn't get starker than this (20). When was the last time the US FDA or the NIH convened meetings or town halls specifically inviting volunteer input into the CT process? Never. The current CT world is strikingly insular (21, 22).

'Findings concur with previous research suggesting that CT investigators rarely communicate about clinical research outside of specific, study-based recruitment messages, which are often only provided to current patients already familiar with the medical institution...Findings from the current study, however, show that CT teams rarely promote CT research outside of the medical setting or reach out to community organizations to serve as an important conduit between the medical institution ß and hard-to-reach populations...Although investigators rely heavily on local physicians to recruit patients into their studies, there may be limited communication between the investigators and local physicians [37] and between these local doctors and their patients [28].'

(8).

The funders and fund recipients, i.e., clinical researchers and their support staff working largely in academic medical centers, currently control the process. They hold endless rounds of meetings and write exhaustive white papers and reports filled with earnest recommendations. These current CT stakeholders haven't yet thought to expand their fold and bring into it the ones whose voices perhaps matter the most in CT participation and logistics, patients and volunteers who've participated in CTs, i.e., Patient Advocates. We all know new drugs and therapies can't get approved unless robustly tested on large pools of volunteers, and yet those same volunteers, the very heart of human biomedical research, have no say in how the process could be structured so their ranks stay filled, not depleted.

What Factors Deter CT Participation And How They Could Be Mitigated

Obvious ones are fears about unapproved medications and procedures, i.e., that one could be used as a 'guinea pig', as well as fears of side-effects, and that one could get a placebo instead of Rx due to randomization. Given such fears are likely pervasive among the population at large (23, 24, 25, 26), who could be more persuasive in convincing others to participate in CTs than those who've done so themselves? If previous trial participants aren't doing so, maybe there's something inherently discouraging about the process that urgently needs to be overhauled? While the medical and scientific aspects of CTs are rightfully the purview of clinical researchers and scientists, and should remain so, these patient-centric aspects are areas where Patient Advocates could help reshape the process to encourage others.

Studies also suggest local community-based sources of CT information are seen as more trustworthy. These include local doctors, TV and community health centers (7). As well, informal family and community networks, i.e., family and friends, and local church and faith-based organizations (26).

Cancer Clinical Trial (CT) Participation Rates Are High In Children Regardless of Race/Ethnicity But Very Low Among Adults. What Accounts For Such A Difference?

Poorly envisaged top-down policies often lack mechanisms to enforce their recommendations. In US biomedical research, one of the most prominent examples is the 1993 NIH Revitalization Act that mandates inclusion of racial and ethnic minorities in federally funded biomedical research (27). 23 years on, African Americans and Hispanics represent 12% and 16%, respectively, of the US population and yet constitute only 5% and 1% of CT participants (28) while whites are over-represented (29). Why is this so? Among US CT volunteers, blacks are supposed to mistrust medical research, and language and culture are supposed to be barriers to Hispanic participation while implicit bias among clinical researchers is supposed to disfavor minority participation in CTs. However, a crucial piece of data unerringly rebuts these oft-repeated myths because there's more than adequate participation among children regardless of race/ethnicity compared to dismal rates among adults.

In the US, only 3 to 5% of ~10 million adults with cancer participate in CTs (30). However, CT enrollment among <15 years old is anything but dismal. In the US, 60% of cancer patients aged <15 years are enrolled in CTs (31). That's not all. Proportion of minority pediatric cancer patients enrolled in cancer CTs (~10% blacks, ~12% Hispanic) ~matches their proportion in the population (32). This means neither do pediatric minorities systematically lack access to health research nor face systemic bias against CT enrollment. How to explain this huge difference between children and adult CT enrollment rates? What's different about the pediatric CT recruitment process? Undoubtedly, applying what works in recruiting children to CTs would hugely improve adult enrollment rates.

Crux Of The Problem: Huge Gap Between Eligible And Actual Adult Clinical Trial (CT) Participants

Real gap in adult CT enrollment is ~10X. For e.g., in the US, ~20% of cancer patients are typically eligible to participate (33, 34) but only 3 to 5% of them do so (30). This huge gap between eligible and actual participants is the critical problem needing to be solved. Weakest link in the chain? Extremely poor inclusion of referring physicians and Patient Advocates into the CT recruitment process, i.e., we're back to square one, the need to expand the fold of current CT stakeholders to include patients and volunteers, and their physicians, and seek their input in improving CT participation and logistics. One approach could be to have CT participants access trial-related procedures and services closer to their home rather than exclusively at academic CT sites, which are often far from their homes.

Clinical Trial (CT) Location Matters Hugely To CT Participants

Travel distance to and lack of transportation to and from the trial site are major barriers in CT participation (35, 36, 37). Even in the US, arguably the wealthiest country in the world and unquestionable global CT leader, many if not most CT volunteers need to drive >1 hour each way to reach a CT site (see figure below from 38).

Bibliography

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3. Denicoff, Andrea M., et al. "The National Cancer Institute–American Society of Clinical Oncology Cancer Trial Accrual Symposium: Summary and Recommendations." Journal of Oncology Practice 9.6 (2013): 267-276. Summary and Recommendations

4. Tan, Meng H., Matthew Thomas, and Mark P. MacEachern. "Using registries to recruit subjects for clinical trials." Contemporary clinical trials 41 (2015): 31-38.

5. Kelch, Robert P. "Maintaining the public trust in clinical research." The New England journal of medicine 346.4 (2002): 285.

6. Len-Rios, Maria E., and Qi Qiu. "Negative articles predict clinical trial reluctance." Newspaper Research Journal 28.1 (2007): 24.

7. Tanner, Andrea, et al. "Communicating Effectively About Clinical Trials With African American Communities A Comparison of African American and White Information Sources and Needs." Health Promotion Practice (2015): 1524839915621545.

8. Tanner, Andrea, et al. "Promoting clinical research to medically underserved communities: Current practices and perceptions about clinical trial recruiting strategies." Contemporary clinical trials 41 (2015): 39-44.

9. Baer, Allison R., et al. "Engaging referring physicians in the clinical trial process." Journal of Oncology Practice 8.1 (2012): e8-e10. Engaging Referring Physicians in the Clinical Trial Process

10. Robinson, M. Koa, JoAnn U. Tsark, and Kathryn L. Braun. "Increasing primary care physician support for and promotion of cancer clinical trials." Hawai'i Journal of Medicine & Public Health 73.3 (2014): 84. http://www.hjmph.org/HJMPH_Mar14...

11. Lai, Gabriel Y., et al. "Effectiveness of strategies to recruit underrepresented populations into cancer clinical trials." Clinical Trials 3.2 (2006): 133-141. Effectiveness of strategies to recruit underrepresented populations into cancer clinical trials

12. Friedman, Daniela B., et al. "How are we communicating about clinical trials?: an assessment of the content and readability of recruitment resources." Contemporary clinical trials 38.2 (2014): 275-283.

13. Friedman, Daniela B., et al. "A qualitative study of recruitment barriers, motivators, and community-based strategies for increasing clinical trials participation among rural and urban populations." American Journal of Health Promotion 29.5 (2015): 332-338. https://www.researchgate.net/pro...

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15. Tanner, Andrea, et al. "Barriers to medical research participation as perceived by clinical trial investigators: communicating with rural and African American communities." Journal of health communication 20.1 (2015): 88-96.

16. Trends, Charts, and Maps

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18. Sriphanlop, Pathu, et al. "New York state health care provider participation in clinical trials: a brief report." (2016). http://www.vipoa.org/journals/pd...

19. Dresser, Rebecca. "What Subjects Teach: The Everyday Ethics of Human Research." Wake Forest Law Review 50 (2015): 301. What Subjects Teach: The Everyday Ethics of Human Research

20. Holzer, Jessica K., Lauren Ellis, and Maria W. Merritt. "Why We Need Community Engagement in Medical Research." Journal of Investigative Medicine 62.6 (2014): 851-855.

21. Comis, R. L., et al. "Baseline study of patient accrual onto publicly sponsored US Cancer Clinical Trials: an analysis conducted for the global access project of the National Patient Advocate Foundation." Philadelphia, PA, Coalition of Cancer Cooperative Groups (2006): 1-52.

22. Friedman, Daniela B., et al. "What do people really know and think about clinical trials? A comparison of rural and urban communities in the South." Journal of community health 38.4 (2013): 642-651.

23. Meropol, Neal J., et al. "Barriers to clinical trial participation as perceived by oncologists and patients." Journal of the National Comprehensive Cancer Network 5.8 (2007): 753-762. Barriers to Clinical Trial Participation as Perceived by Oncologists and Patients

24. Weckstein, Douglas J., et al. "Assessment of perceived cost to the patient and other barriers to clinical trial participation." Journal of Oncology Practice 7.5 (2011): 330-333. http://nnecos.org/Resources/Docu...

25. Fleisher, Linda, et al. "Application of best practice approaches for designing decision support tools: the preparatory education about clinical trials (PRE-ACT) study." Patient education and counseling 96.1 (2014): 63-71. http://www.ncbi.nlm.nih.gov/pmc/...

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27. Chen, Moon S., et al. "Twenty years post‐NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual." Cancer 120.S7 (2014): 1091-1096. Twenty years post-NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual - Chen - 2014 - Cancer - Wiley Online Library

28. Clinical Trials Shed Light on Minority Health. FDA, April 2013. http://www.fda.gov/downloads/For...

29. ThinkProgress, Tara Culp-Ressler, April 4, 2014. There Are Too Many White People In Clinical Trials, And It’s A Bigger Problem Than You Think

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31. Fern, Lorna A., and Jeremy S. Whelan. "Recruitment of adolescents and young adults to cancer clinical trials—international comparisons, barriers, and implications." Seminars in oncology. Vol. 37. No. 2. WB Saunders, 2010.

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33. Sateren, Warren B., et al. "How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials." Journal of Clinical Oncology 20.8 (2002): 2109-2117.

34. Brawley, Otis W. "The study of accrual to clinical trials: Can we learn from studying who enters our studies?." Journal of Clinical Oncology 22.11 (2004): 2039-2040. Can We Learn From Studying Who Enters Our Studies?

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https://www.quora.com/How-can-clinical-trial-enrollment-be-increased/answer/Tirumalai-Kamala