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November 2006
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The State of Birth in Afghanistan

Along with Siera Leone, Afghanistan is the most dangerous place in the world to have a baby, according to The Independent. According to writer Kim Sengupta, a shocking one in six of the women between the ages of 15 and 49 who is pregnant will die in childbirth.

Most deaths could be avoided if skilled midwifery care was available. Many of the deaths are due to infections or haemorrhages. There is also the dangerous practice, widespread throughout the country, of administering oxytocin, a hormone that accelerates labour. If given in too high a dose, this can lead to uterine rupture and cause the foetus to die.

Where else is the dangerous practice of aministering oxytocin widespread? In theUnited States, where pitocin the synthetic form of oxytocin, is given routinely.

Damage Award Highlights Pitocin Danger

The family of a seven-year-old boy in the UK won substantial damages for medical malpractice, in a lawsuit that illustrates the dangers of induced labor.

Seven year old Mohammed Usama Ahmed requires constant care, and will never be able to work. He has severe behavioural and educational difficulties, and is unable to talk.

His family sued the hospital where he was born, saying doctors failed to adequately monitor the fetus during labor. His mother was given Syntocinon, a synthetic form of oxytocin, to induce labor. This article takes for granted how dangerous this practice is to the baby.

The baby’s heartbeat and the uterine contractions need to be monitored whilst the mother receives the Syntocinon, as excessive contractions can cause the foetal heart rate to increase. In Mohammed’s case, too much of the drug was given to his mother causing an abnormal foetal heart rate and coupling of contractions. The combination resulted in hypoxia to the foetal brain.

Despite the acknowledged dangers, this kind of medical intervention is on the rise in the United States. For more, see "Medical Meddling in Birth."

Possum Oxytocin Could Hold Key to Prostate Problems

  Brush-tailed possum 
  Originally uploaded by pierre pouliquin.

A form of oxytocin in the brush-tailed possum could provide a cure for enlarged prostrate glands in humans.

According to this rather vague article, the prostate gland of the brush-tailed possum is similar to the human. The possum's prostate grows and shrinks seasonally. In human males, on the other hand, the prostrate tends to enlarge with age. Sometimes it becomes cancerous; other times, it squeezes the urethra.

Evidently, studies have already indicated a role for oxytocin in  regulating prostate growth. The 2004 study led by Jo Fink that the Sydney Morning Herald reported on identified the areas in the possum that produced and responded to mesotocin, the possum form of oxytocin.

According to the study,

    Prostatic mesotocin concentrations were highest
    immediately before the increases in prostate weight associated
    with the autumn and spring breeding periods. At this time, mesotocin
    receptors were also present in the prostatic capsule in
    addition to those present in the glandular tissue. Mesotocin concentrations
    proceeded to decrease in association with the regression
    of prostate size toward the end of the breeding periods.
    No significant differences were present in serum testosterone or
    dihydrotestosterone throughout the year.

Because mesotocin levels rose before the breeding seasons and fell afterwards, with a concomitant increase and reduction in prostate size, it seems likely that mesotocin plays a role in regulating this growth -- and that oxytocin plays a similar role in the human man.

Therefore, these possums could be used to study treatments for humans.

His and Hers Oxytocin

One common misconception about oxytocin is that it's a female hormone.

That's  understandable, because for a long time, scientists only knew about oxytocin's role in labor and breastfeeding.

We now know that oxytocin is released in a variety of social situations, including during sex and orgasm. The working theory is that release of oxytocin at climax connects the pleasure of sex with the particular sex partner.

This study is the clincher. A team of scientists measured the plasma levels of oxytocin in 13 women and 9 men while they masturbated to orgasm.

Plasma [oxytocin] levels increased during sexual arousal in both women and men and were significantly higher during orgasm/ejaculation than during prior baseline testing.

Why It's Better to Give Than to Receive

We don’t need to learn the pleasure of receiving; the brain's reward system evolved eons ago to drive us to eat, drink and copulate. But the joy of giving is a learned response, and it ties reward into the brain's trust and love circuitry.

 An FMRI study by Jordan Grafman, chief of the Cognitive Neuroscience Section of the National Institute of Neurological Disorders and Stroke, showed two interesting things. First, it was more rewarding to give than to receive; second, when people gave, the part of the brain that produces the oxytocin response got involved.

Grafman's team had volunteers play a computer game in which they would sometimes receive an imaginary monetary reward and other times have the opportunity to donate it to a variety of charities. Under the scanner, when people received money, the parts of the brain that release dopamine lit up. Dopamine is the brain's own opiate, the neurochemical that makes sex, food and drugs so rewarding.

 When volunteers donated money, those reward centers were even more activated. At the same time, the oxytocin-producing system went to work, something that didn’t happen when the test subjects received money.

Giving also activated parts of the prefrontal cortex, the "executive brain," the part that, in humans, makes decisions that may override our basic instincts. According to Grafman, this shows that taking pleasure in giving is a learned response. (just as the release of oxytocin in response to intimacy with others is learned after birth). From the article in Science Central,

 Grafman points out that while kids get excited about receiving gifts, their parents prefer the Santa Claus role. "I think if you have young children you can see that they're much more excited when they're receiving something and they don't like giving something up to somebody else. So clearly, donating is a much more learned behavior than simply taking or receiving from others ... in some sense, you have to experience donation, you have to be persuaded to donate in the beginning. But once you do donate you'll come back and give more because you'll realize what a pleasurable sensation it was to donate."

A Damaged Generation

As I learn more and more about how the nurturing a baby gets in its first year of life  influences the develoment of the brain and the oxytocin response, I wonder whether modern childrearing practices -- bottle feeding, multitasking, daycare -- may create entire generations with an impaired ability to bond.

An intriguing but vague press release from the Universitat Autonoma de Barcelona adds some evidence that this might be true.

The UAB department of Clinical and Health Psychology is doing a study of children aged three to six in Catalonia, the region of Spain that saw great oppression under the fascist dictator Franco in the 1930s. The researchers hope that by early detection of emotional and behavioral disorders, they can heal these children and change the course of their lives while they are still relatively malleable.

According to the press release,

The results show a high percentage of children in this age group with some kind of psychopathological symptom.

The research consists of multiple field studies that are looking at the differences between children living in urban areas and those living in the country, the appearance of physical symptoms, and whether parents and teachers can detect evidence of developing depression or other disorders.

This is the first such study undertaken in Catalonia, and the press release says that the geographical location is an important aspect of the study; therefore data from studies  in other countries may not apply.

Still unanswered questions: What percentage of kids show psychopathological symptoms? Do the researchers think there's something about the Catalonian history, culture or values that contributes to this?

All About Hug the Monkey

Thanks to Dr. Aleksandr Kavokin for interviewing me on his blog, RDoctor. Alek asked me some interesting questions that made it easy for me to distill my interests and motivations for writing this blog and my forthcoming book (due out in the second half of 2007).

You can read the interview here.

While you're at, look around. There's a wealth of information on symptoms, treatments and diagnostic techniques for ailments common and obscure.

Loving Pets Is Like Loving Kids

Pets provide a real alternative to children, according to this article by Diane Crabtree in Halifax Today. She writes that many people turn to animals for love, either because they're not ready to have children or because they don't plan to have kids at all.

Crabtree reported on a survey of people in the UK that found 600,000 women own pets specifically as a child substitute. (That number seems awfully high to me, but I'm sure it's a big trend.)

Petting, cuddling or interacting with a furry pet releases the same happy neurochemicals that canoodling with another person does. For a report on a study that measured the release of oxytocin in humans and dogs as they interacted, see "My Dog Really Loves Me."

According to the article,

But prefering pets doesn't mean your life need be a child-free zone forever. Doorbar says the myth that "you either like pets or you like children" is usually misguided.

"It's kind of like love is rationed and if you give love to an animal then you haven't got any left for people - and that's just a load of old rubbish really," [psychologist Patricia Doorbar] says. "You find that people who love animals tend to love children, tend to care about other people. It kind of spreads - it's a habit."

So is being a good pet owner a good indication of future parenting skills? "Yes, it probably is. They're still very much the same," Doorbar agrees.

When a Kid Is a Lemon

In some countries, there may be whole generations in which the majority of people suffer from the inability to bond. Orphanages are full of traumatized kids who have never learned to love, kids who are so angry and afraid that they're unable to survive in a family.

Many of these kids, suffering from reactive attachment disorder, or RAD, could be healed, but only at great cost and with an extreme commitment of time and resources from their adoptive parents. Neurofeedback can help develop and change brain structures, while cognitive therapy, psychotherapy and unremitting attention and love can train the brain to respond to physical and emotional intimacy with soothing, healing oxytocin instead of the neurochemicals of fear and anger. Some day, I think, exogenous oxytocin will be administered as part of the therapy for RAD.

But these  therapies aren't accepted as treatments for RAD, nor is there money available from social services.

Instead, too many kids will suffer the fate of a 12-year-old boy adopted from the Ukraine. According to a story by Mary Divine of the St. Paul Pioneer Press,

The troubled boy was adopted when he was 7 and brought to Minnesota from the other side of the world.

Four years later, his parents were saying they had given up trying to deal with the disturbing, sometimes violent, behavior his mother described: He broke his little sister's ankles. He killed animals. He ran away.

They tried and failed to have another family adopt him. Then they returned with him to Ukraine, where he was born. They left him at a psychiatric hospital. They said they would be back. And they never returned.

The boy was returned to Minnesota, where social workers are trying to figure out how to help him.

In general, parents who adopt do so "with their best hopes for their family and what can happen, and it's devastating when things don't turn out as they had imagined," said Tamara Kincaid, a social-services supervisor for the county. "Either the child has needs that the parents just don't have the capacity to meet, or the parents just aren't able to follow through with it."

But, she said: "We don't have lemon laws on kids. There isn't a return policy."

What should happen to these damaged kids? Should we continue to warehouse them in institutions, drugging them into a stupor so they don't harm each other or themselves? Should we ship them off to war when they're old enough?

What will happen when this little boy is put out on the street at 18?