Review of “The Business of Baby” by Jennifer Margulis

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It is not surprising that Margulis’ book strikes a nerve. It is a nerve that needs to be struck. As she clearly and coherently makes her case for the enormous influence that profit has in our medical decision making and health outcomes, Margulis challenges us to examine things we take for granted as inevitable – the overmedicalization of childbirth, the obstacles US women face in breastfeeding, the disconnect between our health resources – like safety and nutrition education – and what actually can get delivered in the course of a traditional doctor-patient visit. I winced a bit at some of her depictions of very authoritarian or uncaring doctors; they do exist, but in my experience the typical doctor is kinder and gentler. Yet I cannot ignore the underlying truth that doctors, just like everyone else, need to constantly assess the influences on our decision making and the assumptions we were trained with and live with. There are places where I take issue with Margulis. I find the current medical research on vaccines highly compelling but underemphasized in this chapter of her book. I am strongly convinced of the safety and efficacy of immunizations and a strong proponent. Yet even here she offers some important challenges, like about giving hepatitis vaccines to newborns. Its a fair question. The cold and uncomfortable truth is that we will never be able to feel fully confident in our health care system until we can come out from under the thumb of third party payers, pharmaceutical companies and all the other special interests that profit from the status quo. We need to be able to practice medicine that is based purely on the best interest of the patient. Margulis challenges us to take a hard look at our medical decision-making process as well as the doctor-patient relationship.  Mainstream pediatrician that I am, I think its a worthwhile place to go. If it makes us uncomfortable, maybe that’s not such a bad thing.

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