Wednesday, July 25, 2012

Infant Colic - A Whole New World of Manipulating the Vulnerable

Maybe the title oversells itself, maybe not. I'm writing this as a parent with no medical background.

As I mentioned in my last post, last Christmas I became a parent for the first time. Like probably every other parent since the dawn of time, my wife and I became over-joyed, sleep-deprived, ecstatic, irritable, jibberish-talking, mono-dimensional, indecisive, happy-as-its-possible-to-be, braindead and amazed all at the same time.

Probably also like every other first time parent, it felt like it wasn't just the first time for us, but for the whole of mankind. It turns out, I now know, that the total sum of 25,000 years or so of human knowledge on early day parenting is pretty much "Do what you think is right".

I had never realised how effective sleep-deprivation is at reducing the average human to a jibbering jelly-wobble of indecision in just a few nights - it is used as a torture method for extremely good reasons, as a prisoner can be reduced to basic functionality very quickly, and as result the practice is banned under the European Convention on Human Rights. Very soon, dealing with the three basic childcare functions (eating, sleeping and nappy-filling) becomes more difficult than that dream you have when you are on Mastermind answering questions about 12th Century Russia, and you realise you're only wearing your pants. Stories from the hilarious near-misses to the other horrific extreme are plentiful and at least in part caused by an otherwise well-intentioned but sleep-deprived parent.

On top of the zombified brains of the parents, it turns out that the innate language of the newborn is loud crying - it appears to operate on a many-to-one relationship with no assistance given in establishing what issue is caused the howling. The amount of crying varies a lot from one to another, but the scale goes from "A LOT" to "INCESSANT". Throw in sleep deprivation and you have the following:

1. Potential for marital discord, postpartum depression, Shaken Baby Syndrome, suffocation,  frequent visits to doctors and an increase in maternal smoking amongst other outcomes.
2. A huge and continual group of people, whose reasoning ability has been crippled, and who would do almost literally anything to alleviate the pressure they are under.

You can hear the marketeers of magic potions rubbing their hands.

Everyone knows what colic is and how it's dealt with. Except it turns out they don't, instead relying on perceived wisdom passed down the generation or osmosed from friends and adverts. My experience (from friends) is that having a baby screaming for what feels like an eternity for no reason on a fairly regular basis for those first few months is common and is just babies doing their newborn thing. This, in my experience, is difficult to deal with has two extremely painful psychological outcomes:

1. To have this beautiful bundle of happiness that relies on you for everything screaming without reason is surely indicative of BAD PARENTING and the noise hell is YOUR FAULT.
2. A responsible parent would DO SOMETHING ABOUT IT. (The something is irrelevant, as long as it is being done.)

It's no wonder that there is a huge market for colic relief products - what self-respecting marketeer could miss out on the opportunity to medicalise a natural part of life and sell some placebos to such a vulnerable, inexhaustable strata of exhausted consumers who are actively looking for an elixir?

It's even better for snakeoil salespeople that colic is undefinable - the strict definition is "a condition of a healthy baby in which it shows periods of intense, unexplained fussing/crying lasting more than 3 hours a day, more than 3 days a week for more than 3 weeks" but in reality it is a term given to any fussy/crying baby that seems to be crying more than the person would expect a baby to cry for. It resolves both the pyschological situations above - my baby has colic, and so I am not a bad parent and it is not my fault. More than that I CAN DO SOMETHING ABOUT IT!

Colic is historically assumed to caused by trapped gas somewhere in the innards - the babies tend to be stretching, bending, farting and burping whilst in the midst of a big yell, so it seems to make sense, but the truth is more likely to be a complex variety of causes and indeed it's poorly understood. This is only a minor inconvenience to the marketeers - people reckon it's gas, so they sell a product that treats the issue parents think their babies have.

It's worth noting that it was chiropractors claiming to treat colic that led Simon Singh to write in the Guardian in April 2008
The British Chiropractic Association claims that their members can help treat children with colic, [...], even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments
The quote lead to the BCA suing Simon Singh for libel, which resulted in the "Quacklash" (my own assistance is here), and lead to the BCA dropping the suit.

The Breastfeeding Network UK has provided an overview document here called "Assessing the Evidence - treatments for Colic" (2002) which covers most of the major products around - given the fact that colic is now considered to be a multi-cause issue, I'd be surprised if there was much new to discuss in the decade since it was written. Let me know if this is isn't the case. 

Unsurprisingly, the major products treat (either directly or indirectly) the problem of trapped gas -

- Simethicone (sold in UK under the brandname of INFACOL(R)) is the leading selling product and has been shown to be no better than distilled water. Of course, such a minor truth wouldn't stop them from claiming that the "Trusted help for infant colic is right here".

- lactase enzymes (brand name COLIEF(R)) that are supposed to assist with transient lactase deficiency have also shown to be ineffective, or at the very least have a small number of poor quality trials that sort of show a dubious effect in some cases.

As you can see from the pic, COLIEF(R) claims to Reduce the Hours of Crying. Any sleep-deprived, vulnerable parent with a colicky baby seeing this will read no further than the marketing strapline and head for the tills. Obviously, it doesn't make mention of the fact that the studies (which involved very small numbers of babies) only looked at those cases which were believed to have been caused by lactase deficiency and that previous larger studies had found no correlation between lactase deficiency and colic. Talk about cherry-picking...

Mrs Dr*T picked up a similar COLIEF(R) leaflet in her GP's surgery - the marketeers making sure they had access to as many de-sleepified automatons as possible.

More positively, the UK adverts watchdog has today ruled that both the website and the leaflet were misleading and the claims could not be substantiated. The company who markets COLIEF(R) in the UK, Crosscare Ltd, despite being in Ireland and technically outside ASA's remit, were told that they had to have adequate substantiation before they could make efficacy claims in future and the ad must not be used again.

In my view, putting misleading literature with dubious claims in a doctor's surgery to cash in on vulnerable parents is not very classy. In fact, it's pretty shitty.

Most of our friends have tried and used these dodgy products sometimes with anecdotal success - given the cause of colic is unknown, it's path of presentation is also unknown, as is it's longevity. It's easy to see how a confusion of causality with coincidence could occur - colic only tends to last 12 weeks in the majority of cases, it'll take a few of those to get you to breaking point and a few more trying various treatments. Throw in a handful of regression to the mean and you can see how you get the mix up. We tried the one of the products ourselves on the advice of the health visitor. I was apprehensive and did some research only to find the evidence found wanting. In truth, the psychological impact of "doing something" was extremely persuasive, and it was a battle of rationality over gut-feeling to convince ourselves that the treatment was pointless, and we were just psychologically manipulating ourselves.

(The health visitor went on to recommend cranial osteopathy (which deserves a blogpost of its own) - when I said that the NHS website says there is no evidence for it, she claimed that was because "the NHS don't provide it and they only want people to use their services". Indeed.)

We're through the worst of those crazy, fun, exhilerating, desperate days and the brain is currently doing an excellent job of rewriting history and making me think that it wasn't as bad as we initially remembered, which I guess is a good thing.

One thing it won't stop me doing though, is getting angry and vociferous about companies who are prepared to see weak, vulnerable, sleep-deprived parents as an acceptable demographic for their bullshit potions.