The Problem with Sids Statistics: Truthiness

A sleep deprived mother wakes to the sound of a soft cry at 5:15 AM.  This will be the 8th time in three hours that the mother will get up and re position her baby's binky.  She just can't do this anymore.  She walks in to the baby's room and notices that the child is suffering from some gas-related discomfort.  Desperate, the Mother moves the baby onto her tummy.  The baby moves into a little ball position and gets rid of some gas, and then falls fast asleep for two hours.  Two...precious....hours.

Well according to many doctors and websites, stomach sleepers are twice as likely to die from Sudden Infant Death Syndrome ("SIDS").

Unfortunately, this is a classic example of statistical bologna.  Look, I'm not suggesting that you shouldn't take precautions, or that it's a good idea to go against the American Academy of Pediatrics recommendation that "back is best."  I am saying that the way the statistics are presented is bull crap.

If you look at the data, the "double risk" conclusion is based on the change in SIDS deaths after the "back to sleep" campaign in 1992-1994.  SIDS rates dropped from approximately 14 deaths per 10,000 babies in 1992  down to just under 7 deaths per 10,000 babies now.   Yeah, that's a 50% reduction all right!  And that reduction is enough evidence for the CDC, AAP, and NHI to say that you should NEVER let your child sleep on her stomach, not even for a nap, unless she has a significant digestive disorder and your doctor tells you to try stomach sleeping.

A few things:

1: While the reduction in SIDS did accelerate after "back to sleep," the SIDS rate was already coming down. The overall infant mortality rate was also coming down quickly before the back to sleep campaign.

2:  The SIDS rate continued to decrease long after the "back to sleep" campaign was commonly known among health care practitioners and new moms.

3: A massive campaign against SIDS would have increased SIDS awareness, and other preventative measures were surely taken.

4: Doctors and researchers admit they can only show a strong correlation, not a causal connection, between stomach sleeping and SIDS.

5: Not all 50% reductions are equal.   If the rate changed from 22%  to 11%, that would be an incredibly significant 50% reduction.  In this case, the change was from 0.14% to 0.07% where at least half of the reduction occurred more than 4 years after the campaign.

6:  SIDS is the third leading cause of infant death after congenital defects and low birth weight.  Also, low birth weight increases the likelihood of a SIDS death, but I'm not sure which cause gets blamed.

Apparently more kids die of SIDS in the winter, even though colder room temperatures might prevent temperatures.  Heaters working too well?
Black children are far more likely than white children to die of sids, and boys are more likely than girls.
A pacifier might also reduce the risk of SIDS.
SIDS rates are higher when babies sleep in the parental bed, but lower when babies sleep in a separate bed in a different room.
One theory suggests that SIDS is caused by deep sleep and brains that fail to wake babies up when oxygen levels dip too low.

When you read the SIDS sources, common words include "might" "may" and "possibly."   I read an article by one doctor who said, "if we knew what caused SIDS, we wouldn't call it SIDS."   Finally, some researchers think that a large part of the SIDS rate reduction was due to reclassification of suffocation deaths which used to be considered SIDS.

Again, it's better safe than sorry, but SIDS is so terrifying that we are particularly sensitive to the risks.

We aren't as sensitive in other areas.  For example, my wife could conceivably never take our children out of the house.  The risk of dying in a car accident is infinitely larger if you ride in cars than if you don't.
My wife could refuse to take my toddler to church or allow her to go to nursery with her little friends in order to prevent my toddler from catching something and infecting our infant.
My wife could decide to not allow anyone without a whooping cough vaccine to enter our home.

I sincerely doubt a Doctor would recommend that a mother do any of those things.  Is that simply because SIDS is far more likely to result in death?  Probably, but I think the manipulation of the statistics happens because SIDS is terrifying.  It's so terrifying to me, that even if there were bull crap statistics that suggested I should wake up my baby every 30 minutes (which would almost certainly  limit SIDS risk) I would consider it... until I fell into a sleep deprivation coma.

Thoughts?

Public Enemy #1: Procrastination

(Disclaimer, this post was written during "free time," when I probably should have been exercising or sleeping)

I think the real disease attacking the work ethic of young adults and children today isn't specifically video games, movies, social networking, texting, or other time wasters--these are just the symptoms--the problem is procrastination.  Why do young people procrastinate so much?  Yeah, I'm going to blame schools.

I typically think of procrastination as putting something off for tomorrow.  Failure to act immediately, driven by the existence of extra time.   The dictionary defines "procrastinate" as a verb meaning to defer action or put off till another time.  I think it's more than that.

As a Mormon missionary in Taiwan, I always worked with a partner, or "companion" as we called them.  Each week, my companion and I had a designated time set aside to plan for the rest of the week, and we were instructed to make goals for the week, for each day, and for each hour of the day.  We were also instructed to plan out every 15 minute block of time with separate strategies on how to meet those goals.  This included planning for travel time, eating, bathroom breaks, and everything else you could think of.

I discovered quicky that I was either poor at planning or implementation, because my companions and I were constantly modifying our plans (or ignoring them) in favor of doing something else.  Often, once we failed to adhere to our planning for an hour or two, the whole day's plan would go out the window.

My plans weren't usually derailed by external forces like, say, getting hit by a car (happened twice).  In most cases my companion and I either lost focus (33% of the time) or we made deliberate changes.  I never considered it at the time, but I subconsciously valued planning in the moment over planning for the long term even though I truly believed that goal oriented, long-term planning was more effective.  That's procrastination.  You make a goal, you determine how to achieve that goal, and you do something else.

This wasn't disruptive during my mission, because the drop in efficiency was not substantial.  Rather than knocking on doors to spread a message, we would talk to people coming out of the subway station.  The change could have been due to anything from laziness to a strategy shift based on new information, but it was still procrastination.  Fortunately, I didn't have distractions to fill the gaps

However, in academic and professional areas, procrastination can be incredibly harmful, even debilitating.  I can't tell you how many bank tellers I worked with who would spend time cleaning out their printers with canned air in lieu of handling mundane paperwork.  I've been tempted hundreds of times to clean up my desk and work area in the name of efficiency when I still have a long to-do list staring me in the face. In those times when I've given in, I even broke out the furniture polish and canned air.

There's no way I would claim that the task of polishing my desk is more important than urgent work for a client.  There's also no way that polishing my desk during a busy time will help me reach the goals I have set for myself.  Nevertheless, when a person believes there is time available in the future for a task, then it becomes harder to balance what tasks are more important.

In other words, if I was planning for an entire week, I would separate tasks into categories: (Covey Matrix)

1: Urgent & Important  (Goal-related activities with pending deadlines)
2: Non-Urgent & Important  (Goal-related activities with no deadlines, like planning or education)
3: Urgent & Unimportant and  (Deadlines for things that are not goal-related)
4: non-urgent & non important.  (Waste)

From a birds-eye view, I would never plan time for a #4 activity at the expense of the others.  However, If it's 8 AM and I think I have 8 hours of time and five hours of work to do in category #1, I suddenly I lose the ability to realize that spending my first two hours on waste will generally come at the expense of planning and education when those inevitable emergencies and delays pop up.

Consider this from New Yorker book review:

"Most of the contributors to the new book agree that this peculiar irrationality stems from our relationship to time—in particular, from a tendency that economists call “hyperbolic discounting.” A two-stage experiment provides a classic illustration: In the first stage, people are offered the choice between a hundred dollars today or a hundred and ten dollars tomorrow; in the second stage, they choose between a hundred dollars a month from now or a hundred and ten dollars a month and a day from now. In substance, the two choices are identical: wait an extra day, get an extra ten bucks. Yet, in the first stage many people choose to take the smaller sum immediately, whereas in the second they prefer to wait one more day and get the extra ten bucks. In other words, hyperbolic discounters are able to make the rational choice when they’re thinking about the future, but, as the present gets closer, short-term considerations overwhelm their long-term goals"


But why do people lack the ability to prioritize in the moment?  Why do so many people allow themselves to be distracted when there is important work to be done?
Is it because we are hit from a very young age with information, media, and recreational overload? Maybe that's part of it.  But the real culprit is:  School.  Yes, School.

Now I know what those three people who read my blog regularly are saying: "John, why do you blame teachers for everything."  First, I don't.  Second, Teachers and schools are directly involved in the development of work ethic.  I don't have time to develop statistical evidence, so I'm obviously working off assumptions here, but is it that big of a leap that schools play a major role?

Consider a normal school day.  You get to school with all of your friends and distractions everywhere, and then you are corralled into a classroom.  You are designed to be loud and active, but you have to suppress your very nature and wait for recess and lunchtime.  You sit around and "learn" so that you can do work which is due at a later date to prepare for tests at a later date. (Information that will be mostly forgotten)  Most or all of your potential rewards are based on future performance.  Furthermore, most students believe that they can always make up for a poor performance or two.

Basically, students are engineered to believe that they can always make up for today's performance with a good performance tomorrow.  In many classes, they can struggle for weeks without any long term consequences.

I'm not advocating for harsh punishment at a young age, but it seems to me like this trend continues throughout public education and even into college.  In law school, you can essentially sleep through the first half of the semester and still get great grades come finals time.

Consider athletics.  You slack off in practice, you're benched for the game.  You miss practice, you're benched for the game.  You come to the game unprepared, you lose...publicly, and you might not get another chance next game.   Why do you think so many schools try to enforce academic standards with athletic penalties?   It's instant feedback, instant punishment, instant reward, which are MIA in our schools.  Students are graduating with bad habits, and some employers have given in.

You have adult men with responsibilities who will put off studying, work, sleep, or even sex to play video games.  You have countless employees who will read articles, peruse Facebook, and write blog posts (oops) when they should be working.  While threats of termination of the personal or professional relationship may motivate a person to temporarily change, I believe this bad behavior is not a result of a lack of love or duty.  It's due to a condition developed at a young age.   Your time in school as a child taught you over and over and over that now means little, and later means a lot.

We can combat this problem through immediate rewards and punishments.  Students who demonstrate preparedness in class should be free from homework assignments.  At a certain age, Students should have the opportunity to advance through classes faster if they can test out.  Students should be ranked every week and the top half should be published in order.  Each and every week is a new opportunity to shine in front of your teachers, parents, and peers.  Benefits and punishments should be specifically outlined and enforced, and benefits for short term diligence should be larger.

These are just a few examples.  I know they have problems, and I'm sure there would be countless excuses if any of these initiatives were implemented on a broad scale.

Even though the solution may be hard, the first step is admitting there is a problem... but not until you reorganize your book collection or clean out your DVR.