Pregnancy book births a movie

The recently released movie What To Expect When You're Expecting has plenty of stars (Cameron Diaz, Jennifer Lopez, Chace Crawford, Elizabeth Banks) and a storyline chockablock with pregnancy and, eventually, birth.

Critics hated it but viewers gave it a somewhat warmer reception.

What to expect movie 2

Elizabeth Banks and Brooklyn Decker in What To Expect: The Movie

The mere fact a movie called What to Expect...  got made reflects the strength of the brand of the 28-year-old self-help book that inspired it, What to Expect When You're Expecting.

And it is an awesome brand. WTE is in its fourth edition, with more than 15 million books in print.

The author of What to Expect When You're Expecting, Heidi Murkoff, wrote the first edition of the book with her late mother, Arlene Eisenberg, and her sister Sandee Hathaway, who is no longer involved with the series. Sharon Mazel co-authored the fourth edition.

The WTE franchise also includes books on babies and toddlers, plus a baby-sitter's handbook.

The WTE website now has a page about the movie, including the stars' thoughts about the book. It has all come full circle, which gets to be a little dizzying, if you ask me.

Pitti Palace, incubator of the scientific method

By 1657, the plague was largely spent and the Catholic Church was becoming a little choosier about its battles, especially given the spread of the Protestant Reformation.

In Italy, the Renaissance was winding down. Science had become so intrinsic to intellectual life that Leopoldo De' Medici, who was both a prince and, later, a Catholic cardinal, opened his private chambers in the Pitti Palace in Florence to a new scientific academy, the  Accademia del Cimento. ("Cimento" means "trial.")

Lion from the Pitti Palace
Lion from the Pitti Palace

Leopoldo and his brother, Grand Duke Ferdinando II of Tuscany, founded, and funded, the academy, which would meet for just 10 years. Its influence would last much longer.

Ferdinando had supported Galileo's experiments and had tried unsuccessfully to nudge the Church toward accepting them in the spirit of exploration. In the 1640s, he opened the Boboli Garden, the grounds of the Pitti Palace, his official residence, to experiments with thermometers, poultry incubators and other instruments.

Galileo's spirit hovered over the academy. Its motto was "provando e riprovando" — "testing and re-testing." Founding members included Galileo's students, like Vincenzo Viviani, who with fellow academy member Giovanni Alfonso Borelli, worked on experiments to pin down the speed of sound waves.

Another member was the physician Francesco Redi, who performed what is considered the first scientific experiment.

Distractions to the patrons, and quarrels among the members, doomed the academy. Its last act was the publication of a compilation of members' work, Examples of Natural Experiments, which in its Latin translation influenced the European scientific community profoundly, becoming essentially the science textbook for at least 100 years.

Image courtesy of Wikimedia Commons

A first look at the small world

In 1665, the Englishman Robert Hooke published an amazing book called Micrographia that contained some of the first peeks at a world that was too small to see with the naked eye.

Micrographia, published when Hooke was 30, was the first publication of the Royal Society of London, and the first scientific best-seller. The diarist Samuel Pepys called it "the most ingenious book that I ever read in my life."

Hooke made the illustrations himself, based on what he had seen through a microscope he had built. Looking at a slice of cork, he saw divisions that reminded him of monks' cells in a monastery, and that is what he called them, "cells."

Cork drawing by Robert Hooke

Robert Hooke's drawing of cork cells

Hooke was born on the Isle of Wight, home-schooled and then apprenticed as an artist. He went on to Oxford at a time of unprecedented scientific activity, and he impressed his teachers with his ability to design and execute experiments: He built the vacuum pumps for Robert Boyle, who would demonstrate that gases all act in more or less the same way.

Hooke himself described how springs work in a treatise that gave rise to "Hooke's law" of elasticity. He was also an architect, and worked to help rebuild London after the Great Fire of 1666.

Hooke would probably be more famous than he is had he not quarreled with Isaac Newton over some of their overlapping discoveries. When the scientific community took sides in the dispute, Hooke was shunted aside.

His writings on fossils showed amazing rigor and originality. In the face of a scientific community that considered fossils a "sport of nature," Hook argued correctly that they were the remains of extinct organisms.

Image from Wikimedia Commons

Early stirrings of the germ theory

The germ theory of disease, which holds that certain diseases are caused by living organisms, occurred to people thousands of years ago, but  it was proved only in the 19th century.

In the western tradition, the Roman scholar Marcus Terentius Varro first laid out the germ theory in his book, On Agriculture, a practical guide published in about 36 B.C. In it, Varro advises the farmer against building near swamps because “certain minute animals, invisible to the eye, breed there and, borne by the air, reach inside the body by way of the mouth and nose and cause diseases that are difficult to get rid of.”

Varro was a prodigious scholar and well known public figure, and his works were highly influential. However, at least some of his contemporaries, apparently including the writer/philosopher/statesman Marcus Tullius Cicero, considered his germ theory a crackpot idea.

It is worth noting that the Atharva Veda, the first Indian book that addresses medical topics, includes a fairly detailed germ theory. The book identifies a number of living organisms that were deemed responsible for causing various diseases, and prescribes cures to kill the organisms. The Atharva Veda was written down about 200 B.C., but its ideas may date as far back as 1,000 B.C.

Booties on the ground

In his excellent review of Annie Murphy Paul's new book, Origins: How the Nine Months Before Birth Shape the Rest of Our Lives in the New York Times Book Review on Sunday, physician/author Dr. Jerome Groopman wrote:

Of necessity, research on fetal development involves observing pregnant women in their daily lives; no one would purposefully have one group eat in a possibly risky way or be exposed to a potentially dangerous substance, and compare outcomes with an unperturbed control group. We have, at best, only correlations between a mother’s lifestyle and her child’s future health, not clear causation.

And, in "The Case Against Breast-Feeding," Hanna Rosin's 2009 article in The Atlantic, she wrote, "An ideal study would randomly divide a group of mothers, tell one half to breast-feed and the other not to, and then measure the outcomes. But researchers cannot ethically tell mothers what to feed their babies."

Really? Why not? Both Groopman and Rosin are writing about how vulnerable observational studies are to being tainted by hidden variables. Controlled trials are a better system for testing what works and what doesn't.

But if I am reading their statements correctly, Groopman and Rosin are saying that we cannot even think about practicing actual, rigorous science if babies and fetuses are involved.

Building up a body of "evidence-based medicine" around a segment of the population that is exempted from clinical trials — depending entirely on observational research, that is — seems unwise to me. We don't need to wonder what a worst-case scenario involving babies would look like;  we have the 50-year-old thalidomide catastrophe as a demonstration. Thousands of children around the world were born with deformed limbs after their mothers took the drug.

Subjecting drugs and behaviors that can affect unborn children to standard scientific trials that include pregnant women might save the population from potentially massive damage from those behaviors, and from the drugs once they are put on the market. This is especially true now that we suspect the experience in the womb has a huge influence on the course of an individual's life — the subject of Paul's book, Origins.

Now I understand why the medical ethicist Ruth Macklin, writing in The Lancet last winter, called for the inclusion of pregnant women in drug trials, and retaining women who get pregnant in such trials. Conventional wisdom seems to have rendered the concept so unthinkable that a call for change is necessary.

What do you think about including pregnant women in clinical trials? I would love to read your comments.