Saturday, December 31, 2016

Of Experts and IQ

Reading Andrew Hacker's books about the follies of American educational theory and practice reminded me of an episode at one the annual Endocrine Society meetings some years ago.

The annual Endocrine Society meeting brings together four thousand endocrinologists from all over the world and it's where you have a chance to ask the "experts," the authors of the articles you've read in the "New England Journal of Medicine" or the "Journal of Endocrinology and Metabolism" all those questions you've been storing up all year.

Every week I see newly pregnant women in my practice who have just learned they are hypothyroid, and these women have gone on line and read their babies will suffer a big hit to their IQ scores unless the mothers are treated yesterday. They arrive at my office, understandably, in a panic. Their incubating babies have been deprived of thyroid hormone from week 8 to 12 of their gestation and now they will never be smart enough to get into Harvard.

The source of this bad news about baby's IQ was a study done in Milan, Italy some years ago where mothers with low blood levels of thyroid hormone were divided into two groups, and one was treated with thyroid hormone to bring their levels to normal and the other was not.  The babies were tested at three years of age and those whose mothers were not treated with supplemental thyroid hormone scored three to four  IQ points lower than those whose mother got the extra thyroid hormone.

We discussed this study in our weekly endocrine conference and I was alone in voicing substantial doubts about the study, but, of course, like my colleagues, I figured, what the hell? Why not treat women with thyroid hormone?  The only real question was how often they needed their blood tests monitored and what to tell them about the harm done before they were treated.
Many of these women had experienced some delay before they were tested or treated and some were ready to sue their obstetricians for the blow dealt to their babies's brains and academic futures.

This simply made no sense to me for a variety of reasons:
1.  The developing fetal brain, it is well known, does not need thyroid hormone at various stages in development, which is the reason you can check babies at birth for the babies' blood level of thyroid hormone and you have a several weeks to treat them with thyroid hormone. This is the reason every American baby gets tested at birth for hypothyroidism (a test called TSH) and public health nurses track down those who are low and treat them. Since this practice was instituted the incidence of cretinism (the mental retardation caused by infantile hypothyroidism) in the United States has fallen to nearly zero, being seen only in babies born in places where mothers deliver off the grid. 
2. It's been long taught that thyroid hormone does not cross the placental barrier from mother to child, so why would treating the mother help?  Since this study, people have been back pedaling on this teaching and it has made me wonder how we knew this "fact" in the first place, and I have not yet discovered the answer. Another "truth" that "experts" taught, which may not be true.
3. The kids' IQ's were tested at age three. How do you test a 3 year old for IQ? And if you could reliably test for something called intelligence, at age three, what would you find at age 18 in these same kids?  This was the question I asked the panel at the meeting. I pointed out the neurosurgeons have been telling us for decades about how plastic the brains of kids are compared to adults, which permits all sorts of brain surgery, from which kids seem to recover and become perfectly functional. So why should we believe these kids whose mother did not get thyroid would not, at age 17,  get into Harvard because thyroid hormone therapy was delayed a few weeks when they were in utero?

4. During the discussion at the Society meeting someone mentioned that women in Italy do not get tested for thyroid until the 2nd trimester, sometime around week 14-16, so even the treated group got treated a lot later in pregnancy than American women, who are typically tested around week 8.  The organs are all "formed" by week 12, but this is one of those things which make you think that there might be more to an organ than its structure as seen by an ultrasound--there might be more going on in a brain or a liver in terms of "formation" and maturation. Lungs, of course, have long been known to look like lungs far before they can function outside the womb as lungs. 

The members of the panel on stage started squirming. One or two suppressed smiles, others could not, but some were clearly angry. No clear answer was forthcoming other than the usual, "We need more studies."

In the hallway, afterward a woman who introduced herself as a professor of pediatrics caught my arm and informed me that actually three year olds can be test for IQ and these IQ tests are very "durable" and predictive of adult IQ's, and a 3 to 4 point difference is "very significant."

I thanked her for her input and told her I did not believe a word she said. 

I'm a long way from being a pediatrician, but I've had two kids and I had the opportunity of observing them daily and closely and watching my wife, a nurse, put each one through their little Piaget tests at every age and I can tell you, I had no clue whether these kids would be academically talented, intelligent enough to tie their own shoes or even find their way from their rooms to the kitchen.  

For the longest time, our dog seemed several steps ahead of our kids. (He was a very bright dog, admittedly.)
an early fondness for blades

And one of these kids, was charming but I would not have bet on his getting out of middle school on time.  Doing his math homework with him, helping him write his essays, I thought, well, maybe he can work with his hands when he grows up, but he may not want to go to college.

Of course, I missed a few key clues about him. For one thing, when he was in 6th grade, he wrote an "epic" poem, based on a mix of fantasy books he loved, and the "Iliad" and his teacher put it in the literary magazine.  For another, while he seemed incapable of staying in his chair for more than thirty seconds, when he got home from wrestling team practice, beaten to a pulp and exhausted, he would read a 1,500 page fantasy novel with two dozen plot lines and as many characters and he would not budge until he finished. 

I was right about one thing: He did wind up making his living with his hands, as a surgeon. 
Working with his hands

His middle school teachers, his counselors, all the experts told us not to expect much from him, and looked at us as typical pushy parents who wanted their kid to go to Harvard when he really belonged in the construction trades.
His patients are human, but he makes an exception for gorillas

Expert opinion, right there. 

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