Association, prediction and soothsaying

If you are reading this, then it is likely that the world did not end in December 2012 and that we made it to 2013 relatively unscathed. I cannot say this for certain, of course, because I am not a soothsayer. I suppose it is possible that a cataclysm did occur as the Mayan calendar passed from one b’ak’tun into another but that, in contrast to every disaster film made since 1950, the focus of any survivors was not on gathering food, but on reading my upcoming articles. If this happened, then please feel free to help yourself to my chocolate stash which is hidden in my top drawer. But I think all of these things are unlikely, and one of the reasons I feel confident that my editorial will one day reach its intended readership is that, when it comes to our ability to take something that appears factual (such as an element of an ancient calendar, or a finding in a research study) and calculate what it actually means, signifies or predicts, we humans don’t exactly have a fabulous track record.

Here’s an example. I recently spotted an interesting paper in the November issue of Human Reproduction. Faccinetti et al (2012) report on their retrospective study which involved 700 women in Northern Italy. They set out to look at the frequency of use of herbal products during pregnancy and the question of whether they adversely affect pregnancy outcome and found – as do most such studies – that a good proportion of women use these, sometimes on a daily basis. The topical application of almond oil appears to be a popular remedy for stretch marks, with 56.6% of women saying they used this, but Faccinetti et al (2012) found a possible association between the daily massaging of almond oil into the skin and preterm birth, ‘even after controlling for confounding factors such as smoking habit and multiple pregnancies’ (3165).

While they acknowledge that this finding should be interpreted with caution due to the retrospective nature of their study, Faccinetti et al (2012) speculate about possible mechanisms by which the topical application of almond oil might bring labour on early. Yet while each of their theories seems plausible, they rely on leaps of deduction that some may not consider justifiable. Firstly, they suggest that spreading oil on the abdomen may mechanically stimulate the myometrium and thus stimulate contractions, which seems fair enough as a theory. However, they then attempt to support this theory by noting that users of almond oil were more likely to receive tocolytic drugs. Surely the very fact that – whether coincidentally or because of some causal relationship – women who used this substance experienced a higher likelihood of preterm birth means it is almost inevitable that they are also going to have received more tocolytic drugs?

Faccinetti et al’s (2012) next theory considers that ‘one or more components of almond oil might penetrate the tissue and produce some uterotonic effects’ (3165). In support of this, they add that, ‘In fact, almond oil has been successfully used as a solvent to carry herbal cocktails for the treatment of dysmenorrhoea in Korean high-school girls (Hur et al, 2012), suggesting that this compound can effectively target the myometrium’ (Faccinetti et al 2012: 3165).

But if it is being used as a solvent then by implication it is a solvent for something that is considered to have greater therapeutic properties? Indeed, my understanding is that almond oil is used to carry other essential oils in massage blends because it is relatively inert, and that some of these other oils are deemed to have a much greater effect than sweet almond oil. This is not to say that almond oil has no therapeutic properties or that our current view of it is correct but Faccinetti et al (2012) do not even mention whether women used almond oil alone, whether it was used in combination with other essential oils, or whether this question was even asked.

It is the conclusion to this study that raises the issue that I would most like to offer for discussion, however:

‘…the use of herbal products during pregnancy is common and popular despite being poorly studied.  This frequent use is particularly worrisome because many of these compounds are taken without an expert physician’s advice and are often not supported by adequate information… The association between the daily topical use of almond oil and PTB raised a hypothesis that requires further confirmation.  It is important to emphasize that more data are needed to clarify the causality of this relationship.’ (Faccinetti et al 2012: 3166).

So the authors do acknowledge that this finding is by no means confirmed, and is purely a hypothesis. Hypotheses are very important in the development of knowledge, and it is possible that this one might turn out to be a landmark finding which changes our knowledge.  Some hypotheses, however, have a tendency to wriggle off the pages of journals and into discussion in practice (and, of course, newspapers) and become ‘facts’ that are shared with women before they are adequately tested, and I realise that I may be playing a part in the propagation of an unproven link by giving the study more airtime. Or, if this study turns out the be the first step in discovering that stretch mark oil is a major factor in preterm birth, then I may have helped get the word out at an early stage. We just don’t know whether this finding means anything real or not, because we’re not soothsayers, and we can’t predict the future, and yet we still have to decide what to do with it.

We also have to decide whether, like Faccinetti et al (2012) we take the position that women need to take ‘expert’ advice on everything and should not even use stretch mark oil without professional say so. Or whether we are willing to engage with the complexity, reflect on the issues and encourage women to tap into their own knowledge, relying on experience and intuition as well as seeking the experience of someone who has midwifery or medical expertise and cared for many women and/or the evidence that is available in a particular area.

Our inability to know for certain what will happen next week, month, millennium or b’ak’tun isn’t (at least in my opinion) a bad thing, but the fact that humans have to live with uncertainty on a daily basis means that it is imperative that we engage with the questions that arise from our never-ending search for information.

 

 

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A version of this article was first published as Wickham S (2013). Association, Prediction and Soothsaying. EM 4(1): 50-51.

Facchinetti F; Pedrielli G; Benoni G; et al (2012).  Herbal supplements in pregnancy: unexpected results from a multicentre study. Human Reproduction 27(11): 3161-3167.