Purpose of Labour Pains

In my post on Back Pain, in response to Scott Adam's complaint that back-pain was evil, I asserted that pain has a perfectly valid function, and it is painkillers that are evil.

Pain has a perfectly valid function - it is the body's way of communicating something important to the mind. If you ignore a small child, it will misbehave louder until it gets your attention. And pain works the same way. If you completely ignore your back until it seizes up, then you shouldn't be surprised if it seizes up from time to time. That's how systems work.

In my view, it is painkillers that are evil - or rather the casual use of painkillers - because they interfere with the natural communication between the mind and the body, and the natural balance of work, rest and play.

However, although this is the general function of pain, it sometimes doesn't seem to work properly. For example, in some chronic situations such as cancer, the body sends excessive pain signals to which the only possible response appears to be some kind of signal blocking mechanism such as drugs or TENS. Alternative therapies in this category might include acupuncture and hypnosis.

Childbirth is another situation where pain-killing drugs and TENS machines are commonly used. Why should mothers suffer labour pains?

Childbirth is a natural and, if all goes well, perfectly healthy procedure; many people therefore think it is inappropriate to treat childbirth as a medical condition. And there is a common ideology of "natural" childbirth: many women adopt birth plans that aim to avoid excessive medical intervention, not just out of bravado or authenticity, but also for fear of unnecessary side-effects.

But it is one thing to oppose or refuse excessive medical intervention; quite another to assert that labour pain has a positive function, as does Dr Denis Walsh.

"Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby." [Observer, 12 July 2009]

Dr Denis Walsh is an associate professor of midwifery at the University of Nottingham; he is described by the Observer as "one of the UK's leading midwives". The basis for his claim is apparently set out in an article Dr Walsh has written for the Royal College of Midwives journal Evidence-Based Midwifery. (See note below)

Evidence-based midwifery, huh? I wonder what kind of evidence can Dr Walsh produce for the purpose of labour pains? Is this perhaps the kind of hypothesis that can only be evaluated by evolutionary biologists? Labour pains have doubtless co-evolved with maternal care, many other species lacking both, but can we really conclude that labour pains are an adaptation that help to promote maternal care? I think it is more plausible to say that labour pains are a side-effect of a much more important adaptation, namely large brains.

In any case, evolutionary biology offers one possible meaning of the word "purpose" - some functional trait that has evolved or co-evolved for a reason. If that's not what Dr Walsh means, what else could he possibly mean?

---

Note 1: Dr Walsh has an article in the current issue of Evidence-Based Midwifery (Volume 7, Issue 2, June 2009), but this seems to be about something else and I couldn't find the word "purpose"; he had an article on the Role of the Midwife in a previous issue, but this is for subscribers only. However, I did find an interesting editorial in the current issue by one Professor Marlene Sinclair, Practice: a battlefield where the natural versus the technological, citing Elul, Habermas and Ihde.)

Note 2: I didn't know whether evolutionary biologists had ever studied labour pains as a separate phenomenon, so I tried Google and found an abstract of an article by Wulf Schiefenhövel called Perception, Expression, and Social Function of Pain: A Human Ethological View (Science in Context, 1995). I have sent an email to Professor Schiefenhövel asking for his opinion on Dr Walsh's claim.

Note 3: When I previously blogged on pain, I got a lot of comments from people trying to sell dodgy pain relief. Any such comments will be quickly deleted, so please don't bother. I am only interested in retaining comments that discuss the points in this blog.

Anti-Psychotic Drugs

Doctors are continuing to prescribe anti-psychotic drugs (such as olanzapine and risperidone) to control the behaviour of elderly and confused patients, especially in hospitals and care homes, despite strong guidelines indicating that they are inappropriate for this purpose and carry dangerous side-effects.

• BBC News: Doctors 'ignoring drugs warning'
• BBC File on 4: 'What did they give my mother?'

A typical pretext for prescribing these drugs is that the patient is agitated or upset - assertiveness framed as aggression. In other words, if an old person complains about the quality of care, the easiest way to fix the problem is to slip some olanzapine into the cocoa. If there is any psychosis here, it is in the system and not in the individual.

Drugs may be justified if they provide some therapeutic benefit for the patient, but not if their purpose is merely to compensate for the inadequate care offered to old people. The BBC has found cases where the patient's life appears to have been significantly degraded or shortened by these drugs, simply to make things easier for the carers. The use of these drugs for this purpose is deeply unethical.

Meanwhile, there is a much better and cheaper remedy for agitation among demented patients: drinking more water.

• BBC News: How care home keeps elderly healthy

Unfortunately, drinking water has a well-known side-effect, possibly resulting in more work for the care home staff, so we may see some resistance to this remedy among the less caring care homes. (Some schools also discourage water-drinking, to prevent the pupils needing to go during lessons.) When you are checking out a home for an elderly relative (or a school for a younger one), small details like the provision of water can provide good clues about the real purpose of the institution.

DNA and Crime 2

In a police state, anything that makes the police more effective is a Good Thing.

We are being bombarded with various measures (actual and proposed) that apparently make the police more effective. Longer detention-without-trial for terrorist suspects. CCTV evidence. And a national DNA database.

Proponents of these measures never fail to slip positive messages into the news media.

On the one hand, here's a terrible crime that was fortuitously solved many years later, *thanks to* the brilliant intervention of DNA scientists. On the other hand, here are some terrible crimes that may never be cleared up, *because* the relevant DNA wasn't recorded.

On the one hand, here is a wicked terrorist whom we were forced to release after a mere 28 days, although we *knew* he was plotting something terrible. On the other hand, here is another wicked terrorist, whom we were able to prosecute *because* the evidence just happened to emerge after a mere 45 days of investigation.

Opponents of these measures sometimes argue that they are ineffective or inaccurate. It is implausible to believe that evidence will suddenly appear after 28 days that was not available before. They say they will only agree to this measure if it can be shown that it sometimes works.

Other opponents argue that they are disproportionate. They do not deny that they may possibly work in a few cases, but claim that the benefits are grossly outweighed by the illiberal side-effects.

The problem with both of these lines of argument is that they are vulnerable to constructed refutation. Detection can be attributed to DNA for crimes that might possibly have been solved by other means. Suspected terrorists can be detained for the maximum permitted period, not just because the investigators are under less pressure to find evidence more quickly, but also because the investigators need to demonstrate that the currently permitted maximum is barely enough. Under certain conditions, the statistics could start to look very favourable, enough to overcome the "disproportionate" argument.

And the supporters of these measures have a further argument up their sleeve - the hypothetical deterrent effect. Imagine how many more crimes might have been perpetrated: would-be criminals who saw the cameras, or remembered the DNA held hostage in the police database, and decided to stay home and watch Big Brother instead. Imagine how many more people might have attempted to smuggle dangerous chemicals or stiletto heels onto aeroplanes, if it had not been for the constant vigilance of dedicated security screeners.

My point is this. Opponents of some specific measure may declare that the measure is unacceptable or counter-productive in a civilized society, may declare that the measure could only be accepted if such-and-such facts could be produced. And they may believe that this opposition is fairly solid, because these facts are extremely unlikely.

But what if the advocates of these measures are able to influence the facts? ...

Of course, I am not saying we are in a police state today. I am not even saying that specific measures would turn our country into a police state. All I am saying is that it is possible to see how repeated application of certain lines of argument could result in a police state.

Update

Here's some evidence to support my conjecture:

• "Up against the buffers": Fact and fiction about the existing 28 day pre-charge detention limit (Liberty, 10 June 2008)
• BBC News 10 June 2008 quoting Liberty Director Shami Chakrabarti

Political Party Donors

Donations to the UK Labour Party are in the news again [Party funding row 'a sorry tale' - BBC News, December 4th 2007]. There are two related questions here, which Stafford Beer's POSIWID principle may help us answer.

1. Why does anyone give money to a political party?
2. Why does anyone care about the manner of the donation?

Doubtless some political donations are made in the hope of getting something in return. The UK still has a so-called honours system, where selected people can be given various awards, including peerages and knighthoods. People may also hope to be appointed to various statutory bodies and quangos, where they can exercise some influence and status. Sometimes the motive is more straightforward - perhaps a business wishes to lobby for a favourable decision. (Lots of political donations come from property developers, for some reason.) 

From a moral point of view, all of these practices would count as corrupt. Some people find it hard to believe that anyone gives large sums of money to a political campaign without having some agenda of this kind. And public servants (including politicians, judges and policemen) are vulnerable to accusations of corruption if they accept these donations - and get found out. 

As a (political) response to earlier incidents of sleaze in the UK, we now have laws that govern donations to political parties. It seems that some recent donations to the Labour party have broken these laws, while other donations have evaded these restrictions by being framed as "loans" rather than "gifts". 

There is now an extraordinary public dispute going on between Labour Party officials and someone called David Abrahams, who donated large amounts of money anonymously (and therefore illegally) to the Labour Party. Like most people perhaps, I had never heard of Mr Abrahams until his attempts to maintain his anonymity back-fired. And like many other people, I started to wonder what his real motives were. 

In the past, giving anonymously was an accepted way of ensuring that the recipient was not put under obligation. But under the new regulations, anonymity is now always suspect and often illegal. So things change. 

By donating a few hundred thousand pounds to the Labour Party in a dodgy manner, Mr Abrahams may have delivered a greater benefit to the Conservative Party. Indeed, some Labour Party officials may be treating Mr Abrahams as if they believed this was the effect he intended all along. Abrahams himself has written an aggrieved article in the Independent on Sunday ("I accuse", Sunday December 2nd, 2007), putting the blame for this embarrassment on Labour Party fund-raisers. 

Fund-raising is not an easy job, and it is perhaps understandable that some people with this responsibility steer close to the limits of what is ethical or legal, and are willing to be flexible in order to accommodate the whims of donors. After all, you probably wouldn't be doing the job if you didn't believe in the goals of the party, and the party obviously needs money to achieve these goals. And if you believe absolutely in the moral integrity of the Party Leaders, then surely there is no harm in allowing donors to pay large amounts of money for the privilege of meeting them, since the Party Leaders will never allow their principles to be compromised by vulgar financial influence. So it is easy to see how party functionaries might persuade themselves that the end justifies the means, and that there is no moral risk in bending the rules or exploiting any loopholes. 

The rules may be supposed to protect the nation from corruption, but it's not easy to see whether they actually work. As a citizen with limited access to information, I don't really benefit much from knowing the donors' names or nationalities - what I really want to know is whether there is any link between party donation and, say, planning approval. Advocates of the current arrangements speak of the benefits of "transparency" - but transparency isn't worth much unless you can see the whole end-to-end system, from donation to influence. And links can't be proved from single cases, but require detailed data and statistical analysis. 

Transparency alone (at least in its current form) cannot control corruption. Is it relevant here that the current arrangements were designed by politicians who had a strong stake in the continued possibility of political donation? 

Because they have little power, at least in the mundane world, churches and charities have always been free to accept donations from the most vile people, and devote these donations to worthy causes. (Yet even this freedom is nowadays put under question, and charities are sometimes put under pressure to return donations from highly unpopular sources, lest they are themselves tainted by the same unpopularity.) But political parties can never be given this freedom. 

There are several nested layers of analysis here, which Stafford Beer's POSIWID principle can help us with.

• What is the purpose/effect of a single donation, and the manner in which it was given?

• What is the (collective) purpose /effect of the totality of donations, and the manner in which they were given?

• What is the purpose of the regulations governing political donation, and what are the (presumably unintended) side-effects of these regulations?

• How do the systems of political donation and funding fit into the larger political system?

In general, there are major problems with looking for engineering solutions to social and political problems. Stafford Beer ran into some of these problems himself, in Chile and elsewhere. But regulation is itself a form of engineering; thus once we are on a regulatory path it makes sense to turn to the systems engineering tradition to discover why a particular regulation doesn't produce the required outcome, and how to design better regulations. 

Hence POSIWID.

Childhood Diseases

Should children be protected against minor diseases? Or are childhood diseases a normal (and perhaps even necessary) part of growing up? 

Some doctors are now recommending routine vaccination against chicken pox (varicella) - there is a suggestion that it might be combined with the (already controversial) MMR vaccine to produce MMRV [BBC News November 8th 2007]. 

Chicken pox killed six children in the UK and Irish Republic last year, and there were 112 cases involving severe complications. So there is certainly a risk. But is this risk high enough to warrant action? Each mass vaccination campaign has

• financial costs - could the same resources deployed elsewhere have delivered greater medical benefits to a greater number of people?

• medical side-effects - possible negative reactions to the vaccination itself in some children, reduced protection against related diseases such as shingles

• social costs - fear of side-effects (whether founded or unfounded) reducing the take-up of all vaccines, not just this one

But I have a more general concern. If this proposal makes sense, then it would make sense for every other infectious disease that kills a small number of people every year. Medical researchers think they understand the effect of a single vaccine on the human immune system, or even a compound vaccine such as MMR. But how would it be if a child never got ill, because every possible disease was preempted by vaccination? Would the immune system develop normally, or would it be weak from lack of exercise? Would new diseases emerge to fill the gap? Will medical research tell us the answers to these questions before it is too late? 

Childhood disease involves some suffering, and a tiny risk of complications and even death, and most parents accept that. If I wanted to protect my children totally from any suffering or risk, then they wouldn't learn to cross the road or ride a bicycle or climb trees; they wouldn't be allowed to use the kettle or the toaster, or bathe in more than 3cm of water; and they certainly wouldn't have any contact with the opposite sex until they were at least 25 years old. This is of course ridiculous - I would be condemning them to a life-without-life. 

While my heart goes out to those parents who have lost their children to childhood disease, I don't think the answer is to eliminate childhood disease altogether. It is a normal part of growing up: it develops the immune system, and equally importantly it develops confidence in the immune system. A child can feel poorly one week, with spots all over her face, and then be back at school the following week: this experience engenders a deep belief in your ability to recover, a belief that however bad you feel right now, you should feel better tomorrow. 

What doesn't kill you makes you stronger.

Update

The Chief Executive of RoSPA (Royal Society for the Prevention of Accidents) made a similar point in his 2007 Annual Report.

"Rather than adopt the extremist protectionism of ‘cotton wool kids’ our argument is that a skinned knee or a twisted ankle in a challenging and exciting play environment is not just acceptable, it is a positive necessity in order to educate our children and to prepare them for a complex, dangerous world, in which healthy, robust activity is more a national need than ever before."

Of course this is not an argument dismissing safety precautions altogether, and my blogpost should not be read as an argument against all vaccinations - merely an argument against the extreme idea that we need to vaccinate against every possible condition.

See also

Gever Tulley: 5 dangerous things you should let your kids do (Ted Talks, March 2007)

Government for the People

Why are our elected representatives such prats?

There has been lots of high moral commentary about the latest action by British MPs, who voted to exempt themselves from the Freedom of Information Act. Not for their benefit, you understand, but to preserve the privacy of their constituents.

We could have a technical discussion about the degree of protection constituents already had - either from the Data Protection Act or from other provisions of the Freedom of Information Act. I had a minor disagreement with Robin Wilton recently on the adequacy of the DPA. [See his post Exploding Venus Probe.] For my part, I don't believe the DPA is strong enough. But if our legislators have now (belatedly) realised this, the proper thing for them to do would be to make the DPA stronger, rather than tinker with some other legislation in an apparently self-interested way.

In a later post, Robin despairs of our elected representatives. "I don't know what's more depressing; the idea that our MPs haven't read their own legislation, or the idea that they think we can't."

This problem is not a new one. Our beloved legislators produce too much bad law all the time - and not just when there is any apparent self-interest. In general, legislation is hopelessly complicated, self-contradictory, and riddled with accidental loop-holes and unintended side-effects. (I've seen a lot of badly designed software systems, and I recognize many of the same characteristics.)

What is the effect of this bad legislation? More work for lawyers, and more wriggle-room for the powerful. In many cases, it is not the MPs themselves who are affected by the low level of legislative competence, but those behind the scenes pulling the strings.

But I wanted to go beyond the technical legal discussion. Some people have complained that blatant self-interest serves to distance the elected representatives from the people they purport to represent. I don't agree with that argument. We may observe that the rogue with his hand in the till often has much more popular support than the cold fish who wouldn't dream of bending the rules.

It's an interesting question - should not the elected representatives have the same collection of strengths and weaknesses as the population as a whole - including their moral weaknesses? Surely the biggest turnoff for the electorate is to be presented with a supposedly superior governing class? In the past, the supposed superiority has been through attending the right schools and universities (the magic combination of Eton and Oxford has a good chance of producing yet another Prime Minister, if Gordon Brown doesn't watch out) - or perhaps the right trade union credentials. In the future, perhaps, the superiority will be through squeaky clean morals, a completely respectable CV, and a total lack of testosterone.

But who can the British people relate to better - John Prescott or Hilary Benn? Yes our MPs may be prats, but there are worse alternatives.

[Update July 2008] This was written before Prescott published his autobiography, revealing that he suffered from an eating disorder. [Prescott tells of bulimia battle BBC News April 2008]
I'm not sure whether that makes any difference to my argument, although clearly he was not willing to reveal this until his political career was over. However, there are larger questions about politicians and mental health. [MPs reveal mental health problems BBC News July 2008]

Escalation

Yet another tense situation in the Middle East, where the actions of both sides seems to result in escalation rather than resolution.

BBC News: Israel PM warns of 'escalation' (July 5), Israelis to escalate Gaza raids (July 11), Hezbollah capture marks new escalation (July 12), Israel blockades Lebanese waters (July 13).

Recent commentary (via Technorati): Bush Faces Major Choice Amid Escalation (Jim Lobe, IPS News), Worse and Worse (Yoav, NewZionist).

POSIWID tells us that escalation may sometimes be a deliberate outcome of some tactic, not merely an unfortunate side-effect. For example, escalation is sometimes used as a tactic to convince people that you are serious about something. (Rodger makes this point in Framing Iraq: A Lesson from the Vietnam Experience on the Duck of Minerva blog.) Tactical escalation is also used to build support for your position, although it also tends to build support for your opponent as well [source: Conflict Research Consortium, University of Colerado]. Louis Kreisberg (Beyond Intractability) advocates non-violent modes of Constructive Escalation.

Escalation is also an act of reframing - a way of refusing to treat some incident in isolation, but as part of a long-running chronic situation. "This has been going on for generations ... we cannot continue tolerating this kind of thing ... weakness now would encourage further incidents in future ... and so on." In other words, it is an act that is intended to be interpreted by the other side - a message calling for a response. (Both fight and flight are symmetric responses to violence, because they take the violence on its own terms. Non-violent resistance to a violent situation is an asymmetric response, in so far as it reframes the initial violence.)

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iPod

Why did the US government fund research in microdrive storage, electrochemistry and signal compression? President Bush reveals the answer:

"They did so for one reason: It turned out that those were the key ingredients for the development of the iPod."

[source White House via PRnewswire, GMSV and Barry Briggs]
[see also BrewTown Politico and Engadget]

Over the years, the US Government has invested significant amounts of money into hi-tech research and development, much of it for aerospace and military purposes. Billions of dollars are poured into the space programme, but at least we get useful civilian spin-offs such as non-stick saucepans. (Wikipedia says this is an urban legend, but who can trust Wikipedia these days?) Billions of dollars are spent on DARPA, but at least we get the iPod.

This is a classic POSIWID argument. In recognition of this, I believe President Bush deserves be elected as an honorary member of the POSIWID institute for his dedicated commitment to the cause of POSIWID.

However, there are a few minor difficulties with the details of the President's argument. Although some of the iPod technology comes from Xerox Parc, some of it comes from Hitachi and Toshiba and the Fraunhofer Institute. And can the US Government take the credit for the research that enabled the iPod without also taking the credit for the research that enabled Internet porn and phishing?

It is of course possible for unprincipled thinkers to use POSIWID selectively or misleadingly, drawing attention to a minor (but popular) side-effect in order to distract attention from the major purpose. Such abuse of POSIWID would of course lead to immediate expulsion from the POSIWID institute, even for someone as prestigious as the US president.

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Educational Ideals

Aidan expresses some good educational aspirations, which are not well achieved by the prevailing educational system. 

This raises the question - is there a system anywhere that achieves anything remotely similar to these aspirations? It is possible that we might find a system whose official purpose was something entirely different. 

In the past, educators (both in schools and in management training) have discovered that some aspects of personality and character can be developed in activities outside the classroom - perhaps the sports field or some outward bound adventure. The education system has then tried to incorporate some of these activities in the curriculum. 

But what happens to these activities when they are given a new context, and an explicit educational purpose? Do they remain as effective at the development of character? 

At the same time, activities that were central to my own experience of university life (such as political debate) have nowadays been pushed aside as non-essential, a waste of time and a distraction to study. However, activities such as these undoubtedly helped many people to develop some critical intellectual and communication skills, skills from which many of today's students would benefit. 

 

Related posts: Richard, Purpose of Education (December 2003), Aidan, Educational Ideals (December 2003)