A radical notion of child rearing

Following in the footsteps of Dr. Spock, a Yale alumnus updates the classic guide for parents.

By Cathy Shufro

According to Robert D. Needlman, M.D. ’85, Dr. Spock’s Baby and Child Care—which has found a place on the bookshelves of 50 million parents across three generations—is “subversive.”

Benjamin M. Spock, M.D., MED ’29, initiated a revolution, said Needlman, with the first words of his 25-cent book, published in 1946. “Trust yourself,” Spock told parents. “You know more than you think you do.”

“Those famous lines were subversive to the doctor as expert,” says Needlman, who revised and expanded the book for its eighth edition, the first revision since Spock died in 1998 at age 94. In Spock’s day, pediatricians dictated rigid schedules for sleeping and feeding and warned parents to resist the temptation to pick up fussy children for fear of spoiling them. Spock, in contrast, encouraged parents to discover what their children needed as individuals and to foster relationships of mutual affection and respect. This model of parenting is now so unexceptional that contemporary Americans may not appreciate how much of it originated with Spock. “We understand that it’s no longer optimal, or even appropriate, to dictate to people what to do,” said Needlman.

An associate professor at Case Western Reserve University in Cleveland, Needlman incorporated his own insights in the new 992-page edition. He discusses gay and lesbian parents, how to stimulate a love of reading, how children respond to disaster and how young adults react when they leave home for college.

Needlman felt no qualms when he disagreed with Spock’s recommendations. “I changed them—it was easy,” he said with a laugh. For instance, he eliminated the suggestion that a woman with postpartum blues cheer herself up by buying a new outfit. Instead, he suggests exercise, renewed contact with friends, talking to one’s partner—and seeking medical help if the change of mood is severe.

The book combines the practical with the abstract, he said. “Some of it is very nuts-and-bolts: How do you change a diaper? A lot is philosophical: How do you raise children to be responsible citizens?” Needlman preserves Spock’s exact words in short passages labeled “Classic Spock,” such as Spock’s views on TV: “There seems to be very little similarity between the world the electronic babysitter is selling to our children and the world we would like to see.”

Raised in Chicago in a household with the 1958 edition of Spock’s book on the shelf, Needlman coincidentally followed Spock’s career path. Both majored in English at Yale College. Both attended medical school at Yale, although Spock transferred to Columbia. After training in pediatrics at Boston University, Needlman took a job at Case Western in the same clinic where Spock had worked.

Needlman has found his own experience of the parent-child relationship endlessly interesting. He has a 16-year-old daughter, Grace, with his wife, Carol F. Farver, M.D. ’85, a surgical pathologist he met on their first day at Yale medical school. As a father and a doctor, he has observed that children can be both predictable and surprising. “A wonderful mystery of parenting is that there are some qualities that show a lot of continuity. You can look at a child at two and then at 15 and say, ‘I recognize that.’ But there are a lot of things that you can’t recognize: the same kid who was unhinged at five can be amazing, interested, interesting and capable of handling things beautifully at 15.” Six months after its publication by Pocket Books in June 2004, the Spock-Needlman edition of Dr. Spock’s Baby and Child Care had sold nearly 100,000 copies. Not bad for a subversive little book that’s been around since 1946.

Bookshelf is a column in Yale Medicine focusing on matters related to books and authors at the School of Medicine. Send ideas to Cathy Shufro at cathy.shufro@yale.edu.

The Synaptic Organization of the Brain book cover

Dietary Supplements and Multiple Sclerosis book cover

Diagnostic Atlas of Renal Pathology book cover

Book notes

Sighting Anton Pavlovich
by Elizabeth Loewald, M.D., FW ’77 (Hermitage Publishers) The author considers Chekhov’s life as a doctor and writer, describing how his chronic tuberculosis, interests and talents affected his character, life choices and literary work.

Preventive Cardiology: A Practical Approach, 2nd ed.
edited by Nathan D. Wong, M.P.H. ’85, Ph.D. ’87, Henry R. Black, M.D., FW ’74, HS ’75, and Julius M. Gardin, M.D. (McGraw-Hill Professional) This updated source provides clinically relevant information about the prevention of coronary heart disease, including risk factors and screening guidelines.

Radiology Illustrated: Gynecologic Imaging
by Seung Hyup Kim, M.D., Bruce L. McClennan, M.D., professor and chair of diagnostic radiology, and Eric K. Outwater, M.D. (W.B. Saunders) Over 3,000 images and brief descriptions of clinical disorders and diseases followed by case studies demonstrate the spectrum of benign and malignant gynecologic disorders and the optimal modality for imaging each condition.

Guide to Publishing a Scientific Paper
by Ann M. Körner, Ph.D. ’74 (Bioscript Press) This book explains how to produce, submit and revise a scientific paper for publication and offers advice about applying for funding.

Pathology & Genetics: Tumours of the Breast and Female Genital Organs
edited by Fattaneh A. Tavassoli, M.D., professor of pathology, and Peter Devilee, Ph.D. (Oxford University Press) This guide describes the pathology and genetics of each lesion, along with its epidemiology, etiology, clinical features, prognosis and predictive factors.

50 Signs of Mental Illness: A User-Friendly Alphabetical Guide to Psychiatric Symptoms and What You Should Know About Them
by James W. Hicks, M.D. ’91, HS ’95 (Yale University Press) From anger to sexual preoccupations, from cravings to obsessions, this volume describes the clues that may signal mental illness. Starting each topic with a vignette to illustrate a symptom, the author considers whether it arises from illness or constitutes a normal response to stress. The book outlines available treatments and coping strategies for each symptom.

Parent Management Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents
by Alan E. Kazdin, Ph.D., director of the Child Study Center and the John M. Musser Professor of Psychology (Oxford University Press) This manual covers the background, principles and theory of parent management training and discusses techniques for treating children and adolescents who display oppositional, aggressive and antisocial behavior.

Sharing the Land of Canaan: Human Rights and the Israeli-Palestinian Struggle
by Mazin B. Qumsiyeh, Ph.D., associate professor of genetics (Pluto Press) Qumsiyeh documents the core issues in the conflict between Israelis and Palestinians and articulates a road map for peace based on human rights and a shared future rather than apartheid.

American Dreaming and Other Stories
by Doris M. Iarovici, M.D. ’92 (Novello Festival Press) The author explores the American ideal of success based on self-reliance and draws upon her own immigrant childhood to create stories of people in transition. She tells of their trials, resilience, empathy and hope.

The Breast Cancer Book: What You Need to Know to Make Informed Decisions
by Ruth H. Grobstein, M.D., Ph.D. ’57, FW ’63 (Yale University Press) This guide provides the tools women and men facing breast cancer need to make informed decisions.

I’m Your Father, Boy: A Family Memoir of Barbados
by Ezra E.H. Griffith, M.D., professor of psychiatry and African American Studies (Hats Off Books) The author talks of father-son relationships, the cultural changes involved in moving to New York City in 1956 and the impact of modernization and globalization on his memories of his father.

A Field Guide to North Atlantic Wildlife: Mammals, Seabirds, Fish, and Other Sea Life
by Noble S. Proctor and Patrick J. Lynch, director of the MedMedia Group at the School of Medicine (Yale University Press) With range maps and text on pages directly opposite full-color illustrations, this guidebook provides concise information that facilitates quick identification of more than 200 species of wild-life on or near the Atlantic coast.

The Synaptic Organization of the Brain, 5th ed.
edited by Gordon M. Shepherd, M.D., Ph.D., professor of neurobiology and neuroscience (Oxford University Press) This book covers new advances in the study of the neural basis of brain function resulting from the mouse and human genome projects, biochemical analyses and laser microscopy of dendrites. Each chapter highlights the principles common to all regions and the adaptations unique to each.

Carotenoids in Health and Disease
edited by Norman I. Krinsky, Ph.D., Susan T. Mayne, Ph.D., professor of epidemiology, and Helmut Sies, Ph.D. (Marcel Dekker) Carotenoids such as beta carotene and lycopene are a focus of research on the relationship between plant nutrients and human health. This reference reviews studies on the latest biochemical research and reports findings regarding the use of carotenoids in preventing cancers and sunburn, as well as eye, heart, vascular and photosensitivity diseases.

Medical Physiology: A Cellular and Molecular Approach
by Walter F. Boron, M.D., Ph.D., professor of cellular and molecular physiology, and Emile L. Boulpaep, M.D., professor of cellular and molecular physiology (W.B. Saunders) This textbook links molecular and cellular biology to the study of human physiology and disease and includes new material on hemostasis and fibrinolysis.

Health and the Income Inequality Hypothesis: A Doctrine in Search of Data
by Nick Eberstadt and Sally L. Satel, M.D., HS ’88, lecturer in psychiatry (AEI Press) While a number of recent studies suggest that inequality in income—not poverty per se—is bad for people’s health, the rich included, this volume offers another view of this hypothesis. By controlling relevant variables, the authors suggest that income distribution is less a determinant of population health than the inequality hypothesis would suggest.

Dietary Supplements and Multiple Sclerosis: A Health Professional’s Guide
by Allen C. Bowling, M.D. ’88, Ph.D. ’88, and Thomas M. Stewart, J.D., PA-C, M.S. (Demos Medical Publishing) Health professionals knowledgeable about complementary and alternative medicine can guide MS patients away from possibly harmful therapies and toward low-risk, possibly effective therapies. The supplements selected for inclusion are those with specific relevance to MS that are popular among the general public or known to have serious adverse effects.

Listening to Fear: Helping Kids Cope, from Nightmares to the Nightly News
by Steven Marans, M.S.W., Ph.D., the Harris Associate Professor of Child Psychoanalysis in the Child Study Center (Owl Books) This text seeks to equip readers with hands-on tools: specific words and actions to elicit information and ease distress. The book is organized by age group, from infancy to adolescence.

Diagnostic Atlas of Renal Pathology
by Agnes B. Fogo, M.D., and Michael Kashgarian, M.D. ’58, HS ’63, professor of pathology and molecular, cellular and developmental biology (W.B. Saunders) This new atlas covers all major inflammatory, infectious, pre-neoplastic and neoplastic diseases of the kidney. More than 600 illustrations help readers to recognize the pathologic features and clinical manifestations of both common and rare renal disorders and to formulate confident and accurate diagnoses.

The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, P.O. Box 7612, New Haven, CT 06519-0612, or via e-mail to cheryl.violante@yale.edu.

In circulation

As the library enters cyberspace, patrons still arrive to read, write, research—and listen to music

Arthur E. Broadus, M.D., Ph.D., Ensign Professor of Medicine, hesitates to advertise his not-so-private sanctuary: Yale’s Medical Historical Library. He is hoping the crowds won’t catch on.

“I escape over here for about an hour a day when I can, because it’s peaceful and lovely and I can think and read, and sometimes write—and mostly get away from the din,” said Broadus, section chief in endocrinology.

Down the hall and past the rotunda, in the Information Room of the Harvey Cushing/John Hay Whitney Medical Library, medical student Tejaswini More is studying from Robbins Pathologic Basis of Disease while listening to Haydn through earphones. The library computers have a really good music program, says More, and she gets more done here than in her room.

Just a few years ago, ophthalmology resident Amir Ahmadi, M.D., would have been a more typical library visitor: he has come to look up an article. But now Ahmadi is the exception, because patterns of library use have changed radically. Where annual electronic visits number in the millions, those who walk in the door just top 500,000, a ratio of 18 remote users for every person who walks in. And yet, said Director R. Kenny Marone, M.L.S., “Come in here in the afternoon, and you can’t find a seat.”

Medical students come to use the conference rooms for study groups, to seek guidance from a reference librarian or to borrow a laptop. Residents and students bring their personal digital assistants to a workstation in the Information Room, where they install applications such as InfoPOEMs, eMedicine and Griffith’s 5-Minute Clinical Consult, which provide information about drugs and diagnoses. Students isolate themselves in carrels. Researchers read journals in the sun-drenched Morse Periodical Room. Downstairs, students click away in the Computer Resource Laboratory (CRL), night and day. “We used to have people leave at quarter of twelve, and they were unhappy,” says Marone. “So we decided to make the CRL a 24-hour facility.”

The library is also open to the general public. “They have access: It’s Yale’s way of giving back to the greater New Haven community,” said Marone. Sometimes patients or parents drop in to look up information after a visit to the doctor or hospital.

When library service assistant George Moore began working at the library in 1978, “the furniture was dark, very heavy, very male, and there were heavy drapes on the windows. It was really a very forbidding place. Now we have carpeting, comfortable furniture, plants and better lighting. It’s warm, it’s alive. It’s a very pleasant place to be—a livable space.”

—Cathy Shufro



Sachs		McKibben



Oddsdóttir		Miles

On campus

The poor need help from the rich

You don’t get much health care for $4 per person. That’s what India spends on public health each year, far too little to confront its growing aids crisis, said economist Jeffrey D. Sachs, Ph.D., author of The End of Poverty: Economic Possibilities for Our Time and director of the Earth Institute at Columbia University.

India must increase health spending 10-fold, and to do so, Sachs argued at a February conference, “Health Crisis in South Asia,” it needs help from the developed world. As its economy grows, India will be able to finance its own health system within a decade, but until then it requires assistance. That proposal is among the recommendations of the U.N.’s Millennium Project, directed by Sachs, a plan to meet the Millennium Development Goals, including halving the world’s extreme poverty by 2015.

Sachs points out that in 2002, 22 donor countries including the United States promised to give 0.7 percent of their gross national product annually as development assistance to poor countries. The United States’ rate is now only 0.15 percent.

“In many cases governments are ready to take action but need the donor countries to give the help they promised,” said Sachs.

—Cathy Shufro

Humans change their world, with no end in sight

Over the last 20 years writer Bill McKibben has looked at the ways humans have altered the world around them, and he has come away worried. “Without quite realizing it,” he said at a talk in February sponsored by the Yale Divinity School and Yale’s Interdisciplinary Bioethics Project, “we had grown so large that there was nothing except tectonic and volcanic forces that remained outside our deep influence. … Humans have always interfered with the world around them, but their alterations have always had an edge. We live in a world where, all of a sudden, that is not true. There is no longer any edge to our effects on the world around us.”

With the advent of genetic engineering, the influence of humans has turned inward and, McKibben said, it is important to draw a moral line. “I would say we draw it at germ line manipulation of human embryos, what a layman would call the creation of designer babies,” said McKibben, author of The End of Nature and Long Distance and scholar-in-residence at Middle-bury College. “It is a line that is very real and very palpable, yet allows room for human therapy.”

—John Curtis

Iceland’s national health service provides for all

In Iceland, universal access to health care is enshrined in law. As a result the country has no private health insurance and the island’s 290,000 residents rely on a national health service—state-run hospitals and primary health care centers—at minimal charge. If they see specialists in private practice, about 75 percent of the fees are reimbursed by the government.

Margrét Oddsdóttir, M.D., HS ’92, professor and chief of surgery at Landspitali University Hospital in Reykjavik, described the Icelandic health system in March at the 50th annual Samuel Clark Harvey Lecture sponsored by the Department of Surgery. Most surgical procedures, she said, can be done in Iceland, but patients travel abroad for heart operations in infants, solid organ transplantation (other than living-related renal transplantation) and allogenic bone marrow transplantation. The national health system has a waiting list for surgery, but if waiting time exceeds six months, patients may travel abroad for treatment at government expense. Today, the only waiting list longer than six months is for cataract eye surgery.

Such a health system—which accounts for 10 percent of the country’s gross domestic product—is possible in a small, homogeneous population, Oddsdóttir said, adding, “I don’t know if it’s possible in a large, heterogeneous population like the United States.”

—J.C.

Silence among doctors in the face of torture

Even as FBI agents and intelligence officers were warning their superiors that interrogations of detainees in Iraq and Afghanistan and at Guantanamo Bay in Cuba had gone terribly wrong, military doctors and nurses remained silent. “I have reviewed 14,000 pages of documents and can find only two instances of health care professionals trying to stop this abuse,” said Steven H. Miles, M.D., director of the Center for Bioethics at the University of Minnesota, in a talk at medical grand rounds in March.

Those whose duty it was to see to the well-being of prisoners, he said, often failed: They provided inadequate health care. They supplied confidential medical data to interrogators and oversaw coercive interrogations. They filed false reports to cover up torture. And they failed to report abuses.

“I think we can look at the failure in two ways,” Miles said. “There was a policy environment going down the chain of command authorizing the abuse. And there was a failure of accountability going up.”

—J.C.


			Originally published in Yale Medicine, Summer 2005. Copyright © 2005 Yale University School of Medicine. All rights reserved.