The sins of the father and mother

‘These children should not be suffering from these problems and they should not be here at this hospital. People are starting to say maybe this is a generation where children will be dying before their parents.’ Dr Steve Ryan’s soundbite, advertising Tuesday’s edition of the BBC current affairs programme Panorama, was trailed so heavily that it was hard for British TV viewers to avoid it.

The message of the programme was clear: people in Britain – and especially working-class families in Liverpool – are causing pain and suffering to their children, and may even be signing their death warrants. In truth, it is this endless diet of bullshit programmes about our children’s health that is really bad news.

‘Alcohol abuse, childhood obesity, rotting teeth and hearing problems linked to parental smoking. Doctors say that these conditions are caused by the way children live.’ So intoned Panorama reporter Richard Bilton, opening his report about Alder Hey in Liverpool, Europe’s largest children’s hospital. The focus of the show was the way in which the dumb decisions of parents are causing health problems for their children.

It featured Kaitlyn, just five years old, whose love of sugary tomato ketchup – her mum Sharon says she likes ‘half a mug a day’ – means her teeth are rotting. She needed to have eight of them removed, an operation so traumatic for a young child that she required a general anaesthetic. Sharon was very upset and vowed to cut out the sweet stuff, including ketchup and fizzy drinks. But when Bilton went to visit the family a few weeks after the operation, he found that changing their diets had been struggle. Kaitlyn, a typical fussy eater, is not keen on vegetables that haven’t been drowned in ketchup.

Another child featured in the programme, Leon, was grossly overweight for a five-year-old. At 140 pounds, his weight is more typical of a 17-year-old than a boy of five. Leon’s mother (also called Sharon) has to take a wheelchair when she is walking with her son because he is sure to run out of puff before they get back home. Leon’s consultant, Mohammed Didi, told Panorama that he wants to make sure that Leon is not eating too much and is getting plenty of exercise. Leon’s mum insisted that she only feeds him healthy food and is encouraging him to exercise more.

Didi had a chat with the family in order to, as Bilton put it, ‘find out where the problem really lies’. No prizes for guessing who was put in the frame. After a discussion in which Sharon told the doctor that Leon is now getting more exercise and she is trying to make sure that he eats well, she thanked the doctor and left. The next line in the programme came across like bitching behind her back. ‘Parents often assure [Dr Didi] they’re doing their bit’, said Bilton, ‘but the big question as far as Dr Didi is concerned is what really goes on in the home’. Bilton later interrogated Sharon about Leon’s diet and exercise. She replied: ‘How much more activity have I gotta increase on a five-year-old? At the end of the day, he’s five, he’s not eighteen and can go running six miles or go to the gym and all that. I’ll push Leon’s physical activity till I know Leon’s breathing is getting affected and then I’ll stop.’

But who cares what Leon’s mum thinks? Bilton had already decided that the problem must be at home. Did Sharon not realise that the portions of food she gave to Leon were too big? Never mind that it was, generally, all the ‘right’ kind of stuff. As far as Panorama was concerned, the parents were idiots and the doctors must be right.

But how exactly does a five-year-old get to be so fat? For most children, that kind of weight gain would be simply impossible. Unless his mother is secretly feeding him in the same manner as geese are force-fed to produce foie gras, there must be something else going on. Just because Dr Didi cannot seem to work out the source of the problem does not mean that Leon’s mother is – as the programme implied – lying or deluded.

Still, perhaps Leon and Sharon should be grateful. In other cases of this kind, children have actually been taken away from parents. In 2004, the American commentator Paul Campos described the terrible case of Anamarie Regino, a three-year-old from New Mexico who was taken away from her family because of her obesity. Doctors couldn’t explain her size so assumed the family must be to blame. Eventually, Anamarie was returned to the family, but only on very strict conditions. Now, Anamarie is 12 years old, and guess what? She’s still very big, weighing over 300 pounds. Either her family have been stuffing her for years or there is something else going on, possibly something genetic. Perhaps it is time obesity researchers and doctors developed a little more imagination.

Tuesday’s Panorama sunk even lower in its discussion of two boys with a condition called ‘glue ear’, which can cause serious hearing problems. In both cases, the medical professional – ear, nose and throat consultant Alison Flynn – asked if there was ‘any smoking in the household’ before lecturing each of the fathers about the dangers of smoking. One father assured her that he only smoked outside. Incredibly, Flynn told him that this was irrelevant, since the smoke would linger on his breath and his clothes for hours afterwards. The right thing to do would be to give up smoking altogether or, at the very least, go nowhere near his child for two hours after smoking a cigarette.

But this idea that ‘third-hand smoking’ impacts on people’s health is rubbish, plain and simple (see Advocacy research: what a filthy habit). While it is plausible that sitting in a room full of smoke for hours on end, day after day, might exacerbate glue ear, I would like to have heard Flynn explain by what mechanism the whiff of smoke on a parent’s breath or clothes can cause an ear condition.

Panorama implied that glue ear is unquestionably caused by smoking. But as a paper published in the journal Thorax in 1998 suggests, smoking might increase the risk of glue ear but ‘it is not possible to quantify that risk’. The paper gives a rough estimate of the risk, however, suggesting that in a group of studies on the topic, ‘risk of glue ear increased by 38 per cent if either parent smoked’, but the paper also notes that associations between middle-ear disease and smoking were ‘generally quite weak’.

What does that mean? Well, for one thing, if smoking increases the risk of a disease, that also means that there are cases of that disease that are not caused by smoking. Let’s assume, for the purposes of illustration, that the Thorax article’s estimate was spot on. If there were 100 cases of glue ear in households with no smoking, then, all other things being equal, there would be 138 cases in households with smokers. The additional 38 cases would be caused by smoking. So, in households with smokers, 38 out of 138 cases – about 28 per cent of cases – would be caused by smoking. Therefore, even in households with smokers, most cases of glue ear are not caused by smoking.

As it happens, a 38 per cent increase is actually quite small in epidemiological terms. There could be other factors explaining the onset of glue ear. For example, smoking is more common among poorer people. So is bad housing. Perhaps the bad housing causes the glue ear. In any event, it is certainly not the case, as Flynn implied, that smokers are definitely responsible if their children develop glue ear. In fact, the chances are that smoking is not to blame. But such trifles didn’t stop Flynn from dishing out a lecture – or in healthcare Newspeak, an ‘intervention’ – to the families concerned.

It was quite obvious that the two fathers concerned thought it was nonsense, too. One father decided to give up smoking, but only because he wanted to live as long as possible and see his son grow up. The other father, who – shock, horror – smoked inside, wasn’t convinced that he was responsible for his son’s glue ear and carried on smoking. So Panorama presenter Bilton took it upon himself to draw out the tragedy of his son’s hearing loss, with the less-than-subtle implication that his father was responsible for it.

Children, said Bilton, have to deal with the allegedly terrible consequences of their parents’ choices. Yet the idea that adult choices should be made the slaves of children’s welfare – even if the claims made about that welfare are based on dubious science – is ridiculous. And this message is not restricted to one episode of Panorama. Recent anti-smoking campaigns have focused on the idea that children will grow up to be smokers by copying their parents. Other TV shows, like Honey, We’re Killing the Kids, explicitly bash parents for ‘ruining’ their children.

Ironically, berating parents in this way could actually make things worse. Firstly, because this focus on how parental choices are causing obesity or ill-health through smoking is actually a distraction from well-established health messages like ‘sweets cause tooth decay’. When being a parent means negotiating your way through a constant shitstorm of health lectures, how are you supposed to tell which ones have some basis in fact?

And secondly, making unbelievable statements – like third-hand smoking causes glue ear – leads to a state of constant disbelief about anything a doctor tells you. The result of these endless health campaigns and interventions is an increasingly dishonest relationship between doctor and patient. Who hasn’t felt tempted to tell the doctor what he or she wants to hear just so you can get out of the surgery without another lecture?

What we really need is a medical profession that doesn’t spend so much time promoting the ‘right’ health messages to parents that it forgets to treat the patient. And a journalistic profession that is prepared to ask the one question that matters – ‘Is it true?’ – without fear or favour.

Rob Lyons is deputy editor of spiked.