The Amber Room

I like amber. It’s beautiful, has a nice not-quite-rock but not-quite-gem quality to it. It’s warm. It has dinosaur DNA.

Today I was interviewed prospectively by a mother who was looking for a new pediatrician. I always encourage parents to bring their kids with them. Kids generally like me right away, which is an advantage in my line of work. I'm not as good with adults, so having the kid there is often what sells me to the parent. She brought her 18-month-old daughter. While trying to carry on a conversation with the mother, trying to sound well-informed, I was playing peekaboo with the kid who was laughing pretty much the whole time we spoke.

I noticed that the child was wearing a short necklace of amber beads. Showing off my multicultural insight, I asked if they were Swiss or German. Mom smiled and told me they were from Germany, and the parents moved here with a job from a multinational technology firm. Mother said authoritatively that it was "to help with the teething."

She told me she was looking for a new pediatrician because every time she went to her current pediatrician, she saw a different doctor. That wasn't possible in a one-person practice like mine, of course. She liked that. I explained my belief in the benefit of a relationship between doctor and patient, even if that were a baby. I know all my patients, I will see them any time, they can call me any time. She liked that, too. She had been recommended to me.

This lovely little girl had not been vaccinated. Her mother explained that she believed that since the child was home with her all the time, she wasn't exposed to diseases and didn't need vaccination during her infancy while her immune system was still developing. She said that there was no point in putting her child at risk by vaccinating her. This mother told me that they like to travel and expect to go to central Africa in about a year. They have family in India and will visit there soon.

I have known about the amber necklace tradition since the first child of my dear Swiss friends from grad school. Has this ever been studied for teething? Does it work? How, exactly would it work? If amber is beneficial, will it work for other types of pain? What about toothaches or cavities? I didn't know any of the answers to these questions. What about the form of the amber--what if you crushed it into a powder and ate it or rubbed it onto the gums, would it work even better? Are small beads better than big beads for teething? And what about beads in general--are they safe for 16-month-olds? How about necklaces in general?

The things we do for our children are decisions. Maybe we don't have to stop and research everything, but I wonder about how all of us make medical decisions for our children.

Most parents and nurses believe that teething causes many different symptoms, including fever, pain, and drooling. Why do they think this? Does teething really cause these symptoms?

Now I am more confused than ever. There's this teething thing that's definitely real: kids go from no teeth to having teeth. That's an observable event. The first decision (1) is to decide if it's a problem. Most parents think so, but when objectively studied, a lot of the symptoms we observe look like they are caused by other things. But let's say the parent decides that teething does cause a problem. The next decision (2) is to decide if it needs to be treated. What will happen if we don't treat teething--what is the danger to the child? The parent must decide that the problem needs treatment, rather than, say, support and observation, in order to get to a decision (3) about what kind of treatment is appropriate. Pain-killing teething gel will definitely make the kid's gums numb, but it doesn't last long. Treatment decisions can be tough. What is the likely benefit of an amber necklace (4)? An amber necklace seems benign enough, but a necklace on a toddler has risks. So there's a decision (5) about risks. What if the risk is rare? That adds a decision considering how serious that rare risk might be. You might not be too concerned about the child swallowing a bead. What about choking on one? Somehow you have to decide if your measurement of benefit (4) outweighed your measurement of risk (5). That is a decision (6) too.

I wondered how she had decided about vaccinations. I didn't ask her why she had refused them. I asked her about the pieces of the final decision. How did she decide the amount of risk? How did she evaluate the benefit? What did she believe? What did she know?

Belief beats knowledge every time. How much do we have to know before it changes our beliefs?

Epilogue: After about 2 hours of friendly chat and keeping that sweet little girl amused, I was sure that this mom wasn't going to choose me as her child's doctor. I was surprised that she did, and together we made a plan to bring the child up to date on her vaccinations.


The guy in the picture on the left is Thomas Bayes, whose ideas about making decisions remain interesting to me. The picture at the top is of the Amber Room, looted from the Catherine Palace in St. Petersburg by the Germans at the end of World War II, and lost since then.

Buckle Up for Safety

Have you ever thought about bike helmets? No, seriously. What do they do? Do they work? Are they effective? Yes, I’m going somewhere with this.

First, the facts. Bike helmets reduce serious head injuries in people who have bike accidents. Obviously, they don’t eliminate the possibility of a serious head injury, they just reduce the likelihood of having one. Yet people wearing helmets can die in bike accidents. If you think about it, imagining reasons this could happen isn’t very difficult. The energy of a car or truck hitting a person on a bicycle is likely to overwhelm the protective power of a helmet. When I lived in Utah, I remember a case of somebody unintentionally mountain-biking off a cliff. But most bike accidents occur because the front wheel catches a rock or a curb, or gets caught in a street drain. It’s in these most common accidents that the helmet makes the most difference, potentially changing the outcome of these common accidents from uncomfortable scrapes to seriously life-altering.

So good parents will insist on their children wearing bike helmets. Better parents will make sure they fit right. Insane parents will make the kid wear the helmet to bed.

So it confuses me when I see a parent and child bicycling together (I love seeing that! Good exercise and fun with the kid!) and the child is wearing a helmet but the parent is not.

Nobody wants or anticipates an accident. That’s why they’re called accidents. Being a good, experienced, adult bicyclist does not protect you from a head injury. Wearing a helmet does. So picture the following scenarios. The child goes over the handlebars--parent stops, assesses the situation, uses the cellphone or flags down some help as needed. The parent goes over the handlebars--who is looking after the child? Can the child summon help if needed? Will the child’s judgment about what to do have suboptimal implications for the injured parent? And then how well off will the child be?

A perspective empathic to the child leads to a conclusion that the child needs a helmet, but so does the parent. So when you go bicycling with your child, please wear a helmet--for the kid’s sake.

There are, of course, other examples of this kind of decision about the safety of the child. We put our children in car seats, though they are obviously restrictive and children often don’t like them. I’ll ask the same questions as I did for bike helmets. Did you research this yourself? Do they actually work? What, specifically , do they prevent? If your child complains about sitting in one, do you give in and let them climb from back seat to front or play in the back of the station wagon like I did over 40 years ago? Why don’t you? What made you believe? After all, you know that seat belts won’t always protect you, and that plenty of people are injured and killed in auto accidents who are wearing seatbelts. Even people who never met somebody who was in a horrible car crash wear seatbelts. At some point, they believed that they are safer. I remember seeing ads on TV about buckling up for safety. My sister and I had to pester our parents about wearing seatbelts--which didn’t retract and weren’t convenient back in the stone age. It took a lot of annoying before they regularly did it just to shut us up. I wonder why they were so resistant to doing this, and I’m sad to say I have missed my chance to ask them.

I don’t think reasonable people need absolute perfection to take advantage of these potentially life-saving technologies. Most of us know that putting on that bike helmet doesn’t eliminate our risk, it just cuts it down a lot. We should act on that to help protect our children. I don’t think that most readers who got this far will think my logic particularly controversial. When it comes to sitting in the car seat or wearing a bicycle helmet, the empathic parent does not negotiate with their child. It’s helmet on or no bicycling allowed.

When I read the tragic story about the unvaccinated baby in Minnesota who died of HIB disease--pretty much preventable with vaccine since 1988--I wondered what the parents had thought beforehand. Did they do their own research or did they take somebody’s word for it? Whose word? Who did they trust to guide them about the potential protection of their child from this deadly disease? What were their information sources to make this important decision? How authoritative is a web page? Did they research the vaccine? Did they research the disease it prevents (it’s a bad one)? Did they always put the baby in a car seat?

How to fit a bike helmet video.