July 24, 2011
Open letter to be posted on nobabies.net

Jacqueline H. Wolf, PhD
Department of Social Medicine
Ohio University College of Osteopathic Medicine
302 Grosvenor Hall
Athens, OH 45701
740 597 2777

Dear Dr. Wolf:
I noticed that you had taken an interest in the number of C sections being done.  Both the number at 34% of births and the rate of increase of about 1% per year do not make sense in terms of ordinary medical explanations. 

But I have been expecting something like this, although it may be coincidence.  It is often remarked that male development is in decline: falling sperm counts, penis size average going from six to five inches, increasing hypospadias, and if homosexuality is not increasing, tolerance of it certainly is – more people understand even if they do not share.  I do not have references at hand on any of this, so consider it hearsay.  

At the same time, fertility is pathologically low.  Throughout the developed world, fertility has been below replacement levels for about thirty years, and that is from professional UN estimates.  I have heard the “choice” argument so loud and long my ears ring, but who in the world ever chose hypospadias? 

Well if it is happening to men, then it is reasonable to wonder whether it could be happening to women.  So my nose was all awiggle when some time last year it came out that the maternal death rate was rising.  When I looked into it, I found that 1) the numbers were small, 2) it was happening to the poorest and most vulnerable segments of the population and 3) that it was going right along with the increase in C sections.

I asked knowledgeable people at a genetics conference in Vancouver whether that meant pelvis sizes were getting smaller.  Maybe comparing pelvimetry’s would give a clue.  I was met with the tolerant look an old fossil like me receives from the kind and was told pelvimetry had gone out with the unhafted stone axe. 

I’m a practicing board certified diagnostic radiologist and I confess that I have not seen a pelvimetry in many years even though a lot of those years were passed in a facility with an OB wing.  Sometimes one part of the brain just does not illuminate another.

Still, the number of C section deliveries is going up and no other cause for the change comes to mind.  Beat up on the clinicians all you like about unnecessary surgery, but there really has not been an increase in the pressure to do them that I know about. 

Maybe it’s obesity.  That has been increasing right along with infertility.  So I don’t know.  There is only the evidence of the circumstances.  Failing male development is sometimes attributed to estrogens in the food.  (Sorry, no reference; it just gets hurled into my teeth sometimes.)  But that should not affect females the same way.  It can’t be that excess estrogen causes early bone maturity and growth arrest making the pelvis smaller because otherwise we live in the age of the giantess. 

I once heard that female pubic hair was in decline, but that is probably because more shave.  Somewhere there has to be an archive, like abdomen films taken for other purposes, which would tell if there really was a physiologic change at the root.  The rate of change more or less correlates with a rising number of people in their late teens and early twenties who have never had intimate relations with anybody.  So the circumstantial evidence correlates as well as one could expect. 

That brings us to the delicate matter of root cause.  If you are going to think me mad, ignore this, but throughout history and pre history the pattern among people has generally been to marry cousins.  Kinship and Marriage by Robin Fox is the classic, still the most widely read anthropology text, and his recent The Tribal Imagination: Civilization and the Savage Mind is up to his usual high standard, among other things reiterating the observation.  Now we have entered an age when we are defined by citizenship not kinship, as he would say, and we no longer marry cousins. 

The problem there is that if you don’t marry cousins your fertility collapses.  This has been proven in more than a thousand studies of animals and in at least two studies in humans.

R. Sibly et al., Science 309 607 (2005). 
A. Helgason et al., Science 319 813 (2008).
R. Labouriau, A. Amorim Genetics 178 601 (2008).
R. Labouriau, A. Amorim Science 322 1634 (2008).

It looks like a crisis to me.  But that gets us beyond your interests.  Can you think of any way to confirm or deny on the basis of evidence that females just aren’t as female as they used to be?


M. Linton Herbert MD 

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